The URL can be used to link to this page

Home My WebLink About12-01-06 REV-1500 EX (6-00) OFFICiAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX. RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNTY CODE ~L 0372 ___ YEAR NUMBER W I- :s::~cn ua:::s:: wll.U %00 ull::..J ll.lXl ll. <( ~ Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Flint Ardella DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 3/21/2006 10/4/1909 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER v SOCIAL SECURITY NUMBER 206-38-9993 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE [i] 1. Original Return D 4. Limited Estate [i] 6. Decedent Died Testate (Attach CCPY 01 Will) D 9. Litigation Proceeds Received D 2. Suppiemental Return D 3. Remainder Return (date 01 death prior to 12-13-82) D 4a. Future Interest Compromise (date 01 death after 12-12-82) D 5. Federal Estate Tax Return Required [i] 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of death between 12-31-91 and H-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z w o z o a. m w a: a: o u Stanle A. Smith, Es ire FIRM NAME (If Applicable) Rhoads & Sinon LLP TELEPHONE NUMBER 717-233-5731 PO Box 1146 Harrisburg PA 17108-1146 1. Real Estate (Schedule A) 0.00 0.00 0.00 0.00 3,990.00 0.00 ~ (1) OFFICIAL USE ONLY -) '- , , 2. Stocks and Bonds (Schedule B) (2) ('j -") 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) . ' . "! <') C} 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) z o j:: :5 ::> ~ ii: <( u w 0:: 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) : ) : ,"..... C.J , , \ 1,168,260.48 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (8) 26,719.83 12,746.12 1,172,250.48 8. Total Gross Assets (total Lines 1-7) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 39,465.95 1,132,784.53 0.00 (11 ) 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) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) 1,132,784.53 (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amou nt of Line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (a)(1.2) o ~ 16. Amount of Line 14 taxable at lineal rate I- :) ~ 17. Amount of Line 14 taxable at sibling rate o u 18. Amount of Line 14 taxable at collateral rate X ~ 19. Tax Due 20. D 0.00 x .0 ~(15) x .0 ~(16) x .12 (17) x.15 (18) (19) 0.00 50,975.30 0.00 1,132,784.53 0.00 0.00 0.00 50,975.30 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W46451.000 Estate of Executors Name Address Tax ID Name Address Tax ID 206-38-9993 (Page 1.) Frederick L. Morefield 35960 Birch Hollow Road purcellville, VA 201.32-2766 204-28-0693 John A. Morefield, Jr 1. Woodstock Court Mechanicsburg, PA 1.7050-8230 204-28-0691 ATTACHMENT TO FORM REV-1500 Estate 0 f: Date of Death: 88#: Ardella V. Flint March 21, 2006 206-38-9993 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. ATTACHMENT TO FORM REV-1500 Estate of: Date of Death: SS#: Ardella V. Flint March 21, 2006 206-38-9993 Under penalties of peIjury, 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. 628425.1 Decedent's Complete Address: SlREET ADDRESS 100 Mt. Allen Drive Cumberland CITY I STATE I ZIP Mechanicsburq PA 17050- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 50,975.30 0.00 40,000.00 2,000.00 Total Credits (A + B + C) (2) 42,000.00 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,975.30 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Pa able to: REGISTER OFWlLLS, AGENT 8,975.30 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. [X] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes IX] D D D D oa oa Ul D og No 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 RE1URN DATE ADDRESS C/O Rhoads & Sinon LLP PO Box 1146 SIGNATURE OF PREPARER O"THE "THAN REPRESENTATIVE & Sinon LLP Harrisburg PA ADDRESS PO Box 1146 Harrisburg PA 17108-1146 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S.9 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (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 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. 9 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. 9 9116(1.2) [72 P.S. 9 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. 9 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 REV-1508 EX. (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ardella V. Flint FILE NUMBER 21 06 0372 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Tangible personal property *valued by co-executors 3,990.00 3W46AD 1.000 TOTAL (Also enter on line 5 Recaoitulation\ $ (If more space is needed, insert addttionai sheets of the same size) 3,990.00 REV-1S10 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ardella V. Flint FILE NUMBER 21 06 0372 ITEM NUMBER 1. This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTlON OF PROPERTY II'O..LOE TI-E NAME OF 1'i-E TRANSFEREE, THEIR RELA. Tl0NSHIP TO DECEDENT AND TrE DATE OF TRANSFER ATT~A COPY OF THE DEED FOR REAL ESTATE TAXABLE VALUE Gift to Susan Morefield, great-grandaughter of decedent 2/10/2006 2 Gift to Noora Emilia Morefield, great-grandaughter of decedent 2/10/2006 3 Gift to Laura Louise Morefield, great-grandaughter of decedent 2/10/2006 4 Gift to Anne Morefield, spouse of grandson of decedent 2/10/2006 5 Gift to Anne Huston Morefield, great-grandaughter of decedent 2/10/2006 6 Gift to Colin D. Morefield, great-grandson of decedent 2/10/2006 7 Gift to Evan D. Morefield, great-grandson of decedent 2/10/2006 8 Gift to Sydney E. Holter, great-grandaughter of decedent 2/10/2006 9 Gift to Chloe Holter, great-grandaughter of decedent 2/10/2006 10 Gift to Rhys Schoepke, great-grandson of decedent 2/10/2006 11 Gift to Justin Schoepke, great-grandson of decedent 2/10/2006 DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 Total from continuation sched les . . . . . . . . . TOTAL (Also enter on line 7, Recapitulation) $ 3W46AF 1.000 (If more space is needed, insert additional sheets of the same size) EXCLUSION IF AFPUCABLE' 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 1,069,260.48 1,168,260.48 Estate of: Ardella V. Flint Schedule G (Page 2) Item No. Description 12 Gift to Julie Morefield Holter, grandaughter of decedent 2/10/2006 13 Gift to Hans P. Morefield, grandson of decedent 2/10/2006 14 Gift to James F. Morefield, grandson of decedent 2/10/2006 15 Gift to Elizabeth Morefield Schoepke, grandaughter of decedent 2/10/2006 16 Gift to John D. Morefield, grandson of decedent 2/10/2006 17 Gift to Raimo Morefield, grandson of decedent 12/8/2005 18 Ardella V. Morefield-Flint Revocable Trust Under Agreement, dated June 10, 2002 *valuation of trust assets attached Interest accrued to 3/21/2006 19 Gift to Anne Huston Morefield, great-grandaughter of decedent 12/8/2005 20 Gift to Chloe Holter, great-grandaughter of decedent 12/8/2005 21 Gift to Colin D. Morefield, great-grandson of decedent 12/8/2005 22 Gift to Elizabeth Morefield Schoepke, grandaughter of decedent 12/8/2005 Total (Carry forward to main schedule) DOD Value of Asset % Interest 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 12,000.00 100.0000 11,000.00 100.0000 891,592.05 100.0000 4,668.43 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 Exclusion 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 0.00 3,000.00 3,000.00 3,000.00 3,000.00 206-38-9993 Taxable Value 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 8,000.00 891,592.05 4,668.43 8,000.00 8,000.00 8,000.00 8,000.00 981,260.48 Estate of: Ardella V. Flint Schedule G (Page 3) Item No. Description 23 Gift to Evan D. Morefield, great-grandson of decedent 12/8/2005 24 Gift to Hans P. Morefield, grandson of decedent 12/8/2005 25 Gift to James F. Morefield, grandson of decedent 12/8/2005 26 Gift to John D. Morefield, grandson of decedent 12/8/2005 27 Gift to Julie Morefield Holter, grandaughter of decedent 12/8/2005 28 Gift to Justin Schoepke, great-grandson of decedent 12/8/2005 29 Gift to Laura Louise Morefield, great-grandaughter of decedent 12/8/2005 30 Gift to Noora Emilia Morefield, great-grandaughter of decedent 12/8/2005 31 Gift to Rhys Schoepke, great-grandson of decedent 12/8/2005 32 Gift to Susan Morefield, great-grandaughter of decedent 12/8/2005 33 Gift to Sydney E. Holter, great-grandaughter of decedent 12/8/2005 Total (Carry forward to main schedule) DaD Value of Asset % Interest 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 11,000.00 100.0000 Exclusion 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 206-38-9993 Taxable Value 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 88,000.00 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ardella V. Flint FILE NUMBER 2106 0372 ITEM NUMBER A. 1. B. 1. 3W46AG 1.000 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Carlisle Memorial Service Inc Total from continuation schedules . ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 RESERVES: Cumberland County Register of wills Reserves for additional probate expenses 2 Cumberland County Register of wills Filing fees for disclaimer Total from continuation schedules . AMOUNT 1,153.00 4,846.65 19,500.00 664.00 50.00 25.00 481.18 $ 26,719.83 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) Estate of: Ardella V. Flint 206-38-9993 Schedule H Part ~ (Page 2) Item No. Description Amount 2 Trinity Lutheran Church Luncheon and flowers 722.46 3 Hoffman-Roth Funeral Home, Inc Funeral expenses 2,592.72 4 Rolling Green Cemetery Funeral expense 920.00 5 John A. Morefield Reimbursement for funeral/memorial service expenses as follows: Programs - $9.81; Napkins - $37.83; Postage - $49.53; Flowers - $79.50; Pastor's honorarium - $250.00; Organist's honorarium - $185.00 611. 47 Total (Carry forward to main schedule) 4,846.65 Estate of: Ardella V. Flint 206-38-9993 Schedule H Part 7 (Page 2) 3 Patriot News Legal advertising 175.26 4 Cumberland Law Journal Legal advertising 75.00 5 John A. Morefield Reimbursement for misc expenses as follows: Postage for taxes - $7.92; Photo processing for inventory - $3.00 10.92 6 Dauphin County Register of wills Oath of personal representative 20.00 7 RESERVES: Rhoads & Sinon LLP Out of pocket expenses to include: Copies - $51.30; Postage - $31.68; Mileage - $31.00; Fax - $2.00; Courier - $10.00; Reserves for filing fees and expenses - $75.22 200.00 Total (Carry forward to main schedule) 481.18 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX REnJRN RESIDENT DECEDENT ESTATE OF Ardella V. Flint SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 2J. 06 0372 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PauJ. D Dalbey, DPM Medical expense 40.57 2 Messiah Village Final nursing home biJ.l J.O,984.78 3 Charles E Groff & Sons, Inc Storage expenses 64.00 4 Alert Pharmacy Services, Inc Pharmacy charges 243.85 5 Verizon Telephone expense 20.2J. 6 Hershey Trust Trustees fees 439.91 7 PA Department of Revenue First quarter 2006 PA estimated tax payment 480.00 8 John A. Morefield Reimbursement for caregiver telephone expenses 9.80 9 PA Department of Revenue 2005 PA personal income tax 463.00 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) J.2,746.J.2 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ardella V. Flint FILE NUMBER 21 06 0372 NUMBER I NAME AND ADDRESS OF PERSON(S) RECENlNG PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Ardella V. Flint Trust u/Will f/h/o Betty Louise Morefield RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 *Frederick L Morefield, son of the decedent, has disclaimed his interest in this Trust. A copy of the disclaimer is attached to the return. 50% of Residue: 430,392.27 Trust 430,392.27 2 Raimo Morefield Gift to Raimo Morefield, grandson of decedent Inventory Value: 8,000.00 Grandson 8,000.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 3W46AI 1.000 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 Estate of: Ardella V. Flint 206-38-9993 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Anne Morefield Gift to Anne Morefield, spouse of grandson of decedent Inventory Value: 9,000.00 Granddaughter 9,000.00 4 Ardella V. Flint Trust u/Will f/b/o John A. Morefield, Jr. 50% of Residue: 430,392.27 Trust 430,392.27 5 Chloe Holter Gift to Chloe Holter, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Chloe Holter, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 6 Sydney E. Holter Gift to Sydney E. Holter, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Sydney E. Holter, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 7 Julie Morefield Holter Gift to Julie Morefield Holter, grandaughter of decedent Inventory Value: 8,000.00 Gift to Julie Morefield Holter, grandaughter of decedent Inventory Value: 9,000.00 Granddaughter 17,000.00 Estate of: Ardella V. Flint 206-38-9993 Schedule J Part 1 (Page 3) Item No. Description Relation Amount 8 Elizabeth Morefield Schoepke Gift to Elizabeth Morefield Schoepke, grandaughter of decedent Inventory Value: 8,000.00 Gift to Elizabeth Morefield Schoepke, grandaughter of decedent Inventory Value: 9,000.00 Granddaughter 17,000.00 9 Colin D. Morefield Gift to Colin D. Morefield, great-grandson of decedent Inventory Value: 8,000.00 Gift to Colin D. Morefield, great-grandson of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 10 Evan D. Morefield Gift to Evan D. Morefield, great-grandson of decedent Inventory Value: 8,000.00 Gift to Evan D. Morefield, great-grandson of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 11 Hans P. Morefield Gift to Hans P. Morefield, grandson of decedent Inventory Value: 8,000.00 Gift to Hans P. Morefield, grandson of decedent Inventory Value: 9,000.00 Grandson 17,000.00 Estate of: Ardella V. Flint 206-38-9993 Schedule J Part 1 (Page 4) Item No. Description Relation Amount 12 James F. Morefield Gift to James F. Morefield, grandson of decedent Inventory Value: 8,000.00 Gift to James F. Morefield, grandson of decedent Inventory Value: 9,000.00 Grandson 17,000.00 13 John D. Morefield Gift to John D. Morefield, grandson of decedent Inventory Value: 8,000.00 Gift to John D. Morefield, grandson of decedent Inventory Value: 9,000.00 Grandson 17,000.00 14 Laura L. Morefield Gift to Laura Louise Morefield, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Laura Louise Morefield, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 15 Noora E. Morefield Gift to Noora Emilia Morefield, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Noora Emilia Morefield, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 Estate of: Ardella V. Flint 206-38-9993 Schedule J Part 1 (Page 5) Item No. Description Relation Amount 16 Susan Morefield Gift to Susan Morefield, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Susan Morefield, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 17 Justin Schoepke Gift to Justin Schoepke, great-grandson of decedent Inventory Value: 8,000.00 Gift to Justin Schoepke, great-grandson of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 18 Rhys Schoepke Gift to Rhys Schoepke, great-grandson of decedent Inventory Value: 8,000.00 Gift to Rhys Schoepke, great-grandson of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 19 Anne Huston Morefield Gift to Anne Huston Morefield, great-grandaughter of decedent Inventory Value: 8,000.00 Gift to Anne Huston Morefield, great-grandaughter of decedent Inventory Value: 9,000.00 Great Grandchild 17,000.00 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 SMITH STANLEY ALLEN ROADS & SINON LLP 1 S MARKET SO PO BOX 1146 HARRISBURG, PA 17108-1146 nn____ fold ESTATE INFORMATION: SSN: 206-38-9993 FILE NUMBER: 2106-0372 DECEDENT NAME: FLINT ARDELLA V DATE OF PAYMENT: 12/01/2006 POSTMARK DATE: 12/01/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 03/21/2006 NO. CD 007495 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8,975.30 I I I I I I I I TOTAL AMOUNT PAID: $8,975.30 REMARKS: HERSHEY TRUST COMPANY CHECK# 86058 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS RHOADS & SINON LLP Shawn D. Funk ph (717) 231-6671 Ix (717) 232-1459 sfunk@rhoads-sinon.com FILE NO 30011 December 1, 2006 Re: Estate of Ardella V. Flint File No.: 21-06-0372 Ms. Glenda Farner-Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013-3387 VIA HAND DELIVERY Dear Ms. Farner-Strasbaugh: Enclosed are the following in connection with the above-captioned Estate: 1. Pennsylvania Inheritance Tax Return, in duplicate showing tax due of $8,975.30. Please note that the copy with exhibits is Revenue's copy. 2. A check in the amount of$8,975.30. 3. Two (2) original Inventory documents. Please date stamp one and return it to us in the enclosed envelope. 4. A check in the amount of$30.00 to cover the filing fee for the return and Inventory. 5. A copy of this letter, with the first page of Return and Inventory attached, which we ask that you date stamp and return it to us in the enclosed envelope. Very truly yours, RHOADS & SINON LLP /1 ..} By: . / ( Shawlr<~. Paralegal c;:; r-;.~ C) 1 :-,\ Enclosures ~.- "--I- - ~:-) .' c...) co 631626.1 Rhoads & Sinon LLP . Attorneys at Law. Twelfth Floor. One South Market Square. P.O. Box 1146 Harrisburg, PA 17108.1146 . ph (717) 233.5731 . fx (717) 232.1459 . www.rhoads.sinon.com INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } SS File Number 2006-00372 Personal Representative(s) of the Estate of Ardella V. Flint deceased, depose( s) and say( s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate 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 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 verify that the statements made in this Inven- } tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. ~ 4904 relating to unsworn falsification to authorities. r;. L..-I-~ ( j i{/~I.i/()~ I I Attorney -- (Name) Stanley A Smith (Supreme Court J.D. No.) 33782 (Address) c/o Rhoads & Sinon LLP PO Box 1146 HarrisburgPA 17108-1146 (Telephone) 717-233-5731 DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO. March 21, 2006 Messiah Village, 100 Mt. Allen Drive, Mechanicsburg P A 17055 206-38-9993 FIGURES MUST BE TOTALED Please see attached. 900,250.32 '.,~, " r -) C) ..,.......;.. (:; r ,_': C~. '-' (Attach additional sheets as needed) TOTAL: 900,250.32 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Po. c.s. 9' 3301(b)) Form RW-09 rev. 10.13.06 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEAL TH OF PENNSYLVANIA COUNTY OF CUMBERLAND } SS File Number 2006-00372 Personal Representative(s) of the Estate of Ardella V. Flint deceased, depose( s) and say( s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate 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 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 verify that the statements made in this Inven- }--_:::::::o~:z~~~~ tory are true and correct. I understand that false state- " .,/ / ..... ments herein are made subject to the penaltie.~f.' . -- 18 Pa.C.S. ~ 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Stanley A Smith (Supreme Court J.D. No.) 33782 (Address) c/o Rhoads & Sinon LLP PO Box 1146 Harrisburg P A 17108-1146 (Telephone) 717-233-5731 DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO. March 21, 2006 Messiah Village, 100 Mt. Allen Drive, Mechanicsburg P A 17055 I FIGURES MUST BE TOTALED I 206-38-9993 Please see attached. 900,250.32 (Attach additional sheets as needed) TOTAL: 900,250.32 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S f 330/(b)) Form RW-09 rev. /0./3.06 Estate of Ardella V. Flint Estate Inventory Valued as of Date of Death Cash & Cash Equivalents TEMPORARY INVESTMENT FUND $ 86,005.57 Interest at Date of Death 236.20 Total Cash & Cash Equivalents $ 86,241.77 Par Value Bonds, Debentures & T-Bills 10,000 ABINGTON PASCH DIST SCH BDS 3.5% MAT:3/1512011 $ 9,928.70 Interest at Date of Death 5.83 20,000 ALLENTOWN P A WTR REV GTD 3% MAT: 10/112007 19,873.60 Interest at Date of Death 283.33 25,000 BEAVER CNTY P A 3% MA T:9/112009 24,558.50 Interest at Date of Death 41.67 10,000 BERWICK P A AREA SCH DIST GO SCH BDS 3.8% MAT:3/1512012 10,056.60 Interest at Date of Death 6.33 25,000 BLAIRSVILLE-SAL TSBURG SCH DIST GO REF BD 3.25% MAT:11/1512009 24,466.50 Interest at Date of Death 262.50 20,000 BRISTOL BORO PASCH DIST GO BDS 3.05% MAT:3/112010 19,505.80 Interest at Date of Death 33.89 25,000 CHESTER CNTY PA 3.25% MAT:9/1/2009 24,454.50 Interest at Date of Death 45.14 25,000 CHESTER CNTY P A GO BDS 3.1 % MAT: 8/1512009 24,595.75 Interest at Date of Death 77.50 25,000 DERRY TWP PA MUN AUTH SWR REV GTD SWR REF 3.4% MAT: 12/15/2013 Page 1 (1) Estate Inventory (Continued) Par Value Bonds, Debentures & T-Bills 24,510.75 Interest at Date of Death 226.67 25,000 FAIRFIELD P A AREA SCH DIST GO REF BD 3% MAT:6/112011 24,192.50 Interest at Date of Death 229.17 25,000 FRANKLIN CNTY P A G.O. BDS 3% MAT: 511 512009 24,535.75 Interest at Date of Death 262.50 15,000 GATEWAY PA SCH DIST ALLEGHANY GO BDS 3.7% MAT:I01l512011 14,910.30 Interest at Date of Death 240.50 15,000 LANCASTER CNTY P A GO BDS 3.8% MAT:5/112013 14,898.15 Interest at Date of Death 221.67 15,000 LANCASTER P A HIGHER ED AUTH CO REV REF BDS 3.5% MAT:41l512011 14,868.45 Interest at Date of Death 227.50 25,000 LAUREL HIGHLANDS PASCH DIST REF GO BD 3.4% MAT:2/1/2011 24,815.25 Interest at Date of Death 118.06 25,000 LEHIGH CNTY P A INDL DEV AUTH P REV BDS 3.125% MAT: 11/112008 24,677.25 Interest at Date of Death 303.82 25,000 MIFFLIN CNTY PASCH DIST GO BDS 3% MAT:9/1/2010 24,340.00 Interest at Date of Death 41.67 25,000 MOUNT LEBANON PASCH DIST GO REF BD 3.375% MAT:l1/1512013 24,265.00 Interest at Date of Death 295.31 15,000 NORTHAMPTON P A ARE SCH DIST GO REF BD 3.65% MAT:9/1/2012 14,939.70 Page 2 (2) Estate Inventory (Continued) Par Value Bonds, Debentures & T-Bills Interest at Date of Death 30.42 10,000 PLEASANT VY PASCH DIST GO BDS 3.1 % MAT:3/1512010 9,774.60 Interest at Date of Death 5.17 25,000 SHADE-CENTRAL P A CITY SCH DIST REF BDS 3.2% MAT:8/1512012 24,285.25 Interest at Date of Death 80.00 50,000 STATE PUB SCH BLDG AUTH P A COL REV BDS 3.35% MAT:7/1512011 49,118.00 Interest at Date of Death 307.08 25,000 UPPER MORELAND TWP P A GO BDS 3.2% MAT:11/1512013 24,074.75 Interest at Date of Death 280.00 15,000 WILSON PASCH DIST GO BDS 4% MAT:5/1512013 15,204.30 Interest at Date of Death 210.00 25,000 WINDBER P A AREA SCH DIST 3% MAT: 9/1/2008 24,704.50 Interest at Date of Death 41.67 25,000 WISSAHICKON PASCH DIST MONTGO GO BDS 4% MAT:11/1512010 25,058.50 Interest at Date of Death 350.00 Total Bonds, Debentures & T -Bills $ 564,840.35 Tangible Personal Property Tangible personal property *va1ued by co-executors $ 3,990.00 Total Tangible Personal Property 3,990.00 No. of Units Mutual Funds 494 COMMON TRUST FUNDS - GROWTH EQUITY $ 38,044.65 Page 3 (3) Estate Inventory (Continued) No. of Units Mutual Funds 382 COMMON TRUST FUNDS - V ALUE EQUITY $ 155,622.20 394 SPDR TR UNIT SER 1 51,306.68 Dividend at Date of Death 204.67 Total Mutual Funds $ 245,178.20 Total Inventory $ 900,250.32 Page 4 (4)