HomeMy WebLinkAbout12-05-06
REV-1500 EX. (6-00)
.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 -06 0 8 3
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Burleson Bett J.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
1 62- 2 2 - 0 556
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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09/07/2006 12/05/1927
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death atter 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
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
Gerald J. Shekletski Es . 414 Bridge S1.
FIRM NAME (If Applicable)
Stone La Faver & Shekletski
TELEPHONE NUMBER
717 774-7435
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New Cumberland
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
co
4. Mortgages & Notes Receivable (Schedule D)
(6)
200,387.72
(8)
390,906.66
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(7)
12,891.25
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
0.00 X _(15) 0.00
378,015.41 X .045 (16) 17,010.69
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 17,010.69
(11)
(12)
(13)
12,891.25
378,015.41
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
(14)
378,015.41
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
Decedent's omplete ress:
STREET ADDRESS
3755 Sullivan S1.
CITY 1 STATE I ZIP
Mechanicsburg PA 17050
C Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
17,010.69
850.53
Total Credits (A + 8 + C)
(2)
850.53
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
16,160.16
16,160.16
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; ........................................................................... 0 llil
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 llil
c. retain a reversionary interest; or ...................................................................................................... 0 llil
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 llil
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 llil
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 llil
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... llil 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 aI/Information of which preparer has any knowledge.
SIGNATURE PERSON RESPONSIBL FOR I NG{lETURN
rA
Darlene M. Noggle
3725 Sullivan S1. Mechanicsbur PA
New Cumberland PA 17070
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S.99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The 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. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
pp\wllls\BURLESON,BETTY
LAST WILL AND TESTAMENT
OF
BETTY J. BURLESON
I, BETTY J. BURLESON, of East Pennsboro Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I:
I direct that my Executor hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease from the residue of my estate.
ITEM II:
I devise and bequeath my one-half interest in premises
known as 3755 Sullivan Street, East Pennsboro Township, Cumberland
County, Pennsylvania, in equal shares to my children, WILLIAM H.
CRANDY, DARLENE M. NOGGLE, PATRICIA K. GIVEN, RONALD L. CRANDY, and
DIANE M. HAULSEE, or to their issue, per stirpes.
ITEM III: I devise and bequeath all the rest, residue, and
remainder of my estate, of every nature and wherever situate, in equal
shares to my children, WILLIAM H. CRANDY, DARLENE M. NOGGLE, PATRICIA
K. GIVEN, RONALD L. CRANDY, and DIANA M. HAULSEE, or to their issue,
per stirpes.
ITEM IV: For purposes of equitable distribution, the principal
balanc:e due dL Ll1e L.iHle uf my death under the loan of money which 1.
have made to my daughter, DIANA M. HAULSEE, shall be added to the
Page :. of 5
residue of my estate to be divided under Item III above and the
principal balance due at the time of my death of such loan shall be
charged against her share. It is my intention to forgive all interest
due at the time of my death on such loan to my daughter, DIANA M.
HAULSEE. In addition to the principal balance due under the above
stated loan, the principal balance due at the time of my death under
the loan of $5,000.00 which I have made to my daughter, DIANA M.
HAULSEE, shall also be added to the residue of my estate and the
principal balance due at the time of my death of such loan shall be
charged against her share. It is my intention to forgive all interest
due at the time of my death on such loan to my daughter, DIANA M.
HAULSEE.
ITEM V: I appoint my daughters, PATRICIA K. GIVEN and DARLENE M.
NOGGLE, or the survivor of them, Co-Executrices of this my last will.
ITEM VI: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her
duties in any jurisdiction.
IN WITNESS WHEREOF, I, BETTY J. BURLESON, have hereunto set my
hand and seal this
-
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/
day of
/' /.'
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, 2005.
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BiTTY J. BURLESON
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Paq'e 2 of 5
SIGNED, SEALED, PUBLISHED and DECLARED by BETTY J. BURLESON, the
Testatrix above named, as and for her Last Will and Testament, and In
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed
..&~~/
Wltnes
~,""y ~.,~
Witness
our names as witnesses.
1/(1 &/?:{/ J7j ~.-t:-f:~r~~ #I
Address / &7u
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Address
Page 3 of 5
i
II
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, BETTY J. BURLESON, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
8--<--11#- :;; ~:3(.Ul-~1/'
/' BetTY J. BURLESON
Sworn to or affirmed to and
COMMONWEAlTH OF PENNSYLVANIA
NOTARIAL SEAL
DANIEl M. HARTMAN, Notary Public
New Cumberland Bora., Cumberland Co.
My Commission Expires Jan. 21, 2009
me by BETTY J.
BURLESON, the Testatrix, this
, 2005.
,J'1..--./
Page 4 of 5
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, k~~-t' J ~~~/0'>
and
C\,.,--",- ~ .\'k,~\)
,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she 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 witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
-~~~
~~..~~.
Witness ~
Sworn t:.- o~ affirmed ~~ ~nd aCkno~ged befo::-me by
k-c:< I~/ \/. i~/C cE/1/f /" and ~ ~\.~". \. ~~\.:-\\\
witnesses, this ~ day Of~~ )._ ,2005.'
COMMONWEAlTH OF PENNSYLVANIA J .. .}?
I NOTARIAL SEAL. ; ~
IEL M. HARTMAN, Notary Public 1
~:: Cumberland Bora., Cumberland Co.
My CommisSion Expires Jan. 21,2009
Notary Public
\ Fage 5 of 5
REV-1502 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Burleson. Betty J. 21 06 0831
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real DrODertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Undivided one-half interest in that certain piece or parcel of land with improvements
thereon situate in Hampden Township, Cumberland County, Pennsylvania known as
3755 Sullivan St., Mechanicsburg, PA 17050...BEING the same premises conveyed
to Robert L. Burleson and Betty J. Crandy (later by marriage to Robert L. Burleson in
1985 known as Betty J. Burleson), by Lewis F. Dunaway and Shirley J. Dunaway,
his wife, by deed dated October 11,1985, recorded October 17, 1985, in the Office of the
Recorder of Deeds of Cumberland County, Pennsylvania, in Deed Book N- 31,
Page 897. Cumberland County real estate tax parcel number 09-16-1056-004.
$166,680 tax assessed value x 1.14 common level ratio = $190,015,20 x 1/2 =
$95,007.60.
VALUE AT DATE
OF DEATH
95,007.60
NOTE: By terms of their deed dated October 11, 1985, the decedent, Betty J. Burleson
(formerly Betty J. Crandy prior to their marriage) and her husband, Robert J. Burleson
left a life interest upon the death of one of them to the survivor.
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
95 007.60
Detailed Results for Parcel 09-16-1056-004. in the 2004 Tax Assessment Database
PistrictNo 9
Parcel ID 09-16-1056-004.
MapSuffix
HouseNo 3755
Direction
Street SULLIV AN STREET
Ownerl BURLESON, ROBERT L
C/O & BETTY J CRANDY
Prop Type R
PropDesc
Liv Area 2296
CurLandVal 42400
CurIrnp V al 124280
CurTotVal 166680
CurPretval
Acreage 1.48
CIGrnStat
TaxEx 1
SaleArnt 80000
SaleMo 10
SaleDa 17
SaleCe 19
Sale Y r 85
DeedBkPage 0031 N -00897
YearBIt 1978
HF _File_Date 2/28/2005
HF _Approval_Status A
$166,680 tax assessed value x 1.14 common level ratio
$190,015.20 x 1/2
$95,007.60
201CT.11 Warranty Deed Short Form Act 1909. Double Sheet
Henry Hall, In( , IndIana, PA \
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MADE THE / / tJ day of {! #~J
of our Lord one thousand nine hundred and eighty-five (1985)
in the year
BETWEEN
LEWIS F. DUNAWAY and SHIRLEY J. DUNAWAY, his wife,
of East Pennsboro Township, Cumberland County, Pennsylvania,
GrantolS .
and
ROBERT L. BURLESON, single person, and BETTY J. CRANDY, single
person, to hold each an undiveded one-half interest as Tenants
in Common,
WITNESSETH, that in consideration of
Grantee
Eighty Thousand and no/lOO ($80,000.00)
irt hand paid, the receipt whereof is hereby acknowledged, the said grantor S do
to the said grantee S .
Dollars.
hereby grant and convey
ALL THAT CERTAIN piece or parcel of land situate in Hampden Township, Cumberland
County, Pennsylvania, more particularly bounded and described in accordance with
the survey of Michael C. D'Angelo, R.S., dated May 5, 1975, as follows, to wit:
BEGINNING at the point of intersection of the southern line of Sullivan Street
and the line of adjoiner between Lots 6 and 7 on the hereinafter mentioned Plan of
Lots; thence south 5 degrees 39 minutes 20 seconds east by said line of adjoiner
a distance of 238.40 feet to a stake; thence south 3 degrees 42 minutes 10 seconds
west along the western line of lands now or formerly of Will iam E. Moyer- a distance
of 208.7 feet to a stake; thence north 77 degrees 45 minutes 30 seconds west along
the northern line of lands now or formerly of Eligio Acri a distance of 202.15
feet to a pin; thence north 08 degrees 38 minutes 18 seconds east along the line
of adjoiner between Lots 5 and 6 on said plan a distance of 422.58 feet to a point
on the southern line of Sullivan Street; thence continuing along said southern line
measured in an easterly direction on a curve to the left having a radius of 2025 feet
an arc distance of 96.97 feet to a point on same; thence along said southern line
of Sullivan Street south 84 degrees 6 minutes 20 seconds east a distance of 28.02
feet to a stake, the point and place of BEGINNING.
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BEING Lot No. 6 on the Plan of Lots laid out by Ovidio and Edith Acri and known
as Mountain View East, said plan being recorded in the Office for the Recorder of
Deeds in and for Cumberland County in Plan Book 17, page 80.
HAVING thereon erected a bi-1evel dwelling known and numbered as 1007 Sullivan
Street.
BEING THE SAME premises which Frederick R. Marlin, Jr. and Susan K. Marlin, his wife,
by deed dated May 9, 1975 and recorded in the Office of the Recorder of Deed in and
for Cumberland County, Pennsylvania, in Deed Book B-26, page 32, granted and conveyed
unto Lewis F. Dunaway and Shirley J. Dunaway, his wife, Grantors herein.
Each tenant in common shall have a life interest for the term of his or her life
upon the death of the other tenant herein in said premises free and clear from
any rental obligations from the heirs of the decesaed tenant.
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School Did. Cumbo Co., P.
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Oumb. Co., Pa.
. ,'''' Real est4l'te Transfer Tax
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And the said grantors
will warrant
hereby covenant and agree that
generally
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they
the property hereby conveyed.
IN WITNESS WHEREOF, said grantor S have hereunto set their
and year first above written.
hand s and seals the day
&igntll. &raltll anll Itltutrtll
. in tlyt .....J; 1-
---~-Y-~.--I/:7 ^~-
State of Pennsyl vania
County Of~(' .l7Liu.-ltl!L^-~L /
On th', the /;p
a Notan Public,
the undersigned officer, personally appeared
ss.
day of
October
,1985 ,before me,
Lewis F. Dunaway and Shirley J~Dunaway
,\,.. II' 1"1,
:I :. '.: '.' ., '
~nown to me (or satisfactorily proven) to be the person S whose name s r.~re .!u~bicribe1,.t.f,. th/ W~~It. ~n
mstrument, and aclmowle~ged that they executed. same fk e purpO#fS }!J.~rem t:o,;tf1.~neJ;.;
IN WITNESS WHEREOF, I hereunto set my hand and {ficlal seal. U~ f :' i;.' . _":.
J '- \ ~<,). g p ~ 0,
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REDER I K. tJa~"p.lI~~/>I', .,,~'~~
My commission xpires Marc l e 'QJ:Office~..--'
camp Hill Cumberland County, PIi.' .
State of
ss.
County of
On this, the
day of
, 19
, Before me,
the undersigned officer, personally appeared
known to me (or satisfactorily proven) to be the person whose name subscribed to the
within instrument, and acknowledged that executed same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Title of Officer.
{1 ~ Lob1-A
do hereby certify that the precise residence and complete post office address
/00.1 Vt///;,Ihr/ Ufr,ccl, e /-?nr/--J; /~
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19 ].b
of the within named grantee is
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Attorney for_-,i.{;fiJ.. /l f { .U
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COMMONWEALTH OF PENNSYLVANIA
County of __ ~_u_~\}J,,\-..\.~~__
ss.
\~-I ~._ day of _____j~j~,"-
A. D. 192:i, in the Recorder's office of the said County, in Deed Book \0
RECORDED on this_
Vol. 3.L- _, Page__'j_~ 7 _. .._.....
Given under my hand and the seal of the said office. the date abore written,
.- _._~~~~ . R,,('()rdPr,
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Burleson Bettv J.
FILE NUMBER
21 06
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0831
ITEM
NUMBER
1.
DESCRIPTION
2004 Dodge Sedan, Title Number 60132365702BU, VIN 1 B3ES56C54D583924.
22,246 miles. Sold November 6, 2006 - Sale Price $9,000.00
VALUE AT DATE
OF DEATH
9,000.00
2.
PNC Bank checking account #5140115187
(For informational purposes, INV account 20002197 referenced in the letter dated
October 19, 2006, was closed by the decedent as of November 15, 2004).
PNC Investments Account Number 8196-1654
6,989.49
3.
78,822.15
4.
United Health Care premium refund
25.03
5.
ServiceMaster lawn care refund
22.30
6.
HighMark Health Insurance premium refund
378.62
7.
Conseco Insurance (prescription coverage) premium refund
139.65
8.
Nationwide auto insurance premium refund
134.10
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
95511.34
CERTIFICATE OF TITLE FOR A VEHICLE
142
lBJESS6C5lf0583~2lf I 200lf DODGE 60132365102 8U
VEHICLE IDENTIFICATION NUMBER YEAR MAKF OF VEHICLE TITlE NUM9EA
0 I I ~~~~!~Sl ~!~?e~bl 0
BODy TYPE DUP SEAT CAP PRIOR TITLE ST. TE 000M STATUS
3/22/014 5/31./05 I I
DA TE PA TITLED DA 1 E OF ISSUE UNLADEN WEIGHT GVWR ClCWR TITLE BRANDS
BETTY J
3155 SULLIVAN
MECHANICS8URG
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BURLESON \../,1; .
STREE'r
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ODOMETER ST_TlJS
o '" 4CTUA.L MILEAGE
1 ' 'AILEA.GE EXCEEDS tHE MI':.C,.,....NfC,ll
LfMrrs
NOT THE ACTUAL MllEA.GE
- NOT THE A.CTUA.L MllEAGF.OO()METE~
T AMPEPING VERIFIED
... OEMPT FROM OOOMf.rEA UJ~lOSLJAE"
SECOND LIEN FAVOR OF
rilLE BRANDS
A ANTlOU€ VEHiClE
C", C'lASSte VEHiClE
o ,. COU,ECTIBlE vEHICLE
F "OUT OF COVNTAy
G ... QRltilNALl,. V' UFGD. I=on "4ON-u ~
DISTRIBUTION
4GRlClllTLRAll/EHfClf
L "LOGGING VEHICLE
P <>' IS-WAS" potJCr VfHICLE:.
R ~ AECONS TRUCTEO
S ,STREET ROO
T .. RECOVERED THEFT 'IE:.HICLE
V .. VEHICl.E CONTAINS REISSUED VIN
'N '"' FLOOD VEHtCl E
X '" !SM'AS .. T.o!
DATE
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If . second lfenhoider IS listed upon satisfaction of the r'fbl lien. the IIrst
16enhoIder must forward thie Tms 10 the Bureau 01 Motor V81'1IcJe'.....nf1 the
appropriate Ionn and fee
BY
AUTHOFlIZED FlEPRESENT A nVE
SECOND LIEN RELEASED
DATE
By
AUTHORIZED REPRESENTATIVE
8ETTY J BURLESON
3755 SULLrVAN STREET
MECHANICS8URG PA 1.7050
ALLEN 0 BIEHLER
.'^
, ""
If a co-purchaser other than your spouse IS listed and you want !tie ""e to
be holed as 'Joint Tenants WIth Right of SUlYivorShip' (On death of one
owner, title goes 10 SUlYiYlng own....) CHECK HERE G Otherwise. Ihe tnle
will be issued as "Tenants in Common' (On death of one owner. Interest of
deceased Owner goes to hlslher heirs or estate).
~1Cr.;"nJRJ.: ,)f i'E.PSC~l "i.WII',I.;"-ECl;N'-:, O"....f-,
1ST UE~ C....TE'
... IF NO lIE'j CHECK 0
1 5T UEN~OLDER
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I STREET
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1 cln'
srATE
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) f'jOTE FiN REQl;iAEO
FiNANCIAL
INSTiTUTION NO
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o PNCBAN<
October 19, 2006
Gerald J. Shekletski
414 Bridge Street
P.O. Box E
New Cumberland, P A 17070
RE: Estate of Betty J. Burleson, deceased
SSN: 162-22-0556
DOD: 9/712006
Dear Mr. Shekletski:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account#5140115187
Established 05/01/1971
BETIY J BURLESON
DOD balance: $6,988.83 + $.66 accrued interest
The decedent maintained htvcstment Accounts (INV #20002197) and (INV #81961654).
For further infonnation, you may contact the Brokerage Department at 1-800-762-6111.
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do Dot process any rmandaI
transactions or provide statements. If you need assistance with any of these items,
please call ]-S88-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
&1oclU.Dlt ~
Rachelle Wells
1-800-762-1775
P7-PFSC-04-F
SOO flrn Ave.
Pitlsburih PA 15219
Member FDIC
TOTAL P.01
. , 'I' "l I 'V_ _ f .J. (-O::'ll. -'H::J::>1
Sep. 27 2006 11:40AM Pi
0. PNC1NVESTMENTS
M....b'" ~SD ;,.d ~'P(
September 27,2006
Stone LaFaver & ShekJetski, Attorneys at Law
414 Bridge Street - Post Office Box E
New Cumberland, P A 17070
Altn: Gerald 1 Shekletski
RE: Estate of Betty J Burleson Date..of-Death Valuation _ Date of De lh: 09/07/2006
Social Security Number: 162-22-0556
The date of death valuation for securities held by Betty Jane Burlcso ill her PNC
Investment Account Number 8196-1654 is as fonows:
1933.748 shares BLCKRCK MANAGED INC PORT PMISX @ $
3900.900 shares HLACKROCK FOS MONEY MKT PNPXX @
415.923 shares FEDERATED EOTY KAUFMNN A KAUAX@
34.384 shareR FED EOTY KAUFMN SML CP A FKASX@
25.589 shares FIDELTY VII VAL STRAT T F ASPX @
35.562 shares FRNKLNtrMPLTN FRGN 8M A FlNEX @
S8<<106B shares OWfH FUND AMER INC CL F GFAFX@
480.751 shares INVESTMENT CO AMER CL F AICFX @
62.615 shares ROWE PRICE MID CAP AnV TAMVX@
969.710 shares TEMPLETN FOREIGN FO CL A TEMFX@
.93 per share
.00 per share
.66 per share
22. 71 per share
30.39 per share
21.95 per share
31.44 per share
33.26 per share
24.95 per share
13.65 per share
The information contained herein has been obtained from sources we bdieve to be
reliable but do not guarantee it to be accurate, correct, complete or timely, and ~hal1 not
be responsible for the results obtained from it's use.
Please do not hesitate to contact me if I can provide you with furthcI in1ormation.
Sincerely,
C1<- ;;~
Chuck Liltle, CFP
Vice President
Senior Financial Consultant
CLldp
A mrmhrr of The PNC Finandal Servi~ Group
7. E,,~t Main Srrl'l'l \1erhanicsburg Pennsvl\lani~ 17055
www.pnrinvl'stments.rom
'mporbiftt '"ftltor Inform.lIOft: !\c.Tur;ril'\ ..net h"'.lke...~t' sr'Viu~~ ..."' prn\l.tlC'd by I'NL In'Yc~tl'l< Ilt~ L~ C,
n'~"htl NM;n ;,n(l ~rrc ^"nujllt~ and othtr jn~ulantl- I'rr)~l/.-r~ ,orr offr'rd IlV PNC 1r1~lJmntt SCf\lir <", I, c.
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REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Burleson. Bettv J.
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
FILE NUMBER
21 06
0831
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME Of' THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE Of' TRANSFER ATTACH A copy OF THE DEED FOR REAl ESTATE VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. American United Life - Fixed Annuity 200,387.72 100. 200,387.72
Account #20 522 01600
Transferees: William Crandy - $ 44,085.00 (Son)
Ronald Crandy - $ 44,085.00 (Son)
Patricia Given - $ 44,085.00 (Daughter)
Darlene Noggle - $ 44,085.00 (Daughter)
Diane Haulsee - $ 24,047.00 (Daughter)
TOTAL (Also enter on line 7 Recapitulation) $ 200 387.72
(If more space is needed, insert additional sheets of the same size)
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PAX,
(717) 939-4344 .. 8
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OFFICE ADDRESS: .I
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1420 Farmhouse L1ne ~ co
Middletown, PA 17057 ..
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MAlUNO ADDRESS: .i i
P.O. Box 205 ell l::
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Highsplre, M 17034 <
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REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
Burleson. Betty J.
Debts of decedent must be reported on Schedule I.
21
06
0831
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. John C. Sullivan Funeral Home 3,601.00
51 N. Enola Drive
Enola, PA 17025
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personai Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Gerald J. Shekletski, Esq. 7,500.00
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 Letters Testamentary 360.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Legal Advertising - The Patriot-News 143.70
8. Legal Advertising - The Cumberland Law Journal 75.00
9. Death Certificates 54.00
10. HighMark Health Care Insurance 410.55
11, Advertising Cost - Sale of Automobile 27.00
12. Verizon 5.00
13. Funeral Luncheon 385.00
14. Reserve for Closing Expenses 300.00
15. Filing Fees - Inheritance Tax Return ($15.00) and Inventory ($15.00) 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 12,891.25
(If more space is needed, insert additional sheets of the same size)
,R"'''''~'. ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
R",th, .1 21 06 nAq1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Patricia K. Given Lineal 44,085.00
2717 Keystone Dr. SChed, G + 1/5 residue
Harrisburg, PA 17112
2. Darlene M. Noggle Lineal 44,085.00
3725 Sullivan St. Sched. G + 1/5 residue
Mechanicsburg, PA 17050
3. William H. Crandy Lineal 44,085.00
602 B Street, Box 252 Sched. G + 1/5 residue
Summerdale, PA 17093
4. Ronald L. Crandy Lineal 44,085.00
134 Willow Lake Drive Sched G + 1/5 residue
Carlisle, PA 17105
5. Diane M. Haulsee Lineal 24,047.00
1175 Teeter Road Sched G + 1/5 residue
Littlestown, PA 17340
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
FILE NUMBER
(If more space is needed, insert additional sheets of the same size)