HomeMy WebLinkAbout12-07-06 (2)
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
...lL .-.QL 0196 ___
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
180-26-5904
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Eisenhauer Helen
DAlE OF DEATH (MM-DD-YEAR) DAlE OF BIRTH (MM-DD-YEAR)
2/28/2006 11/24/1934
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
B
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[X] 1. Original Retum
D 4. Limited Estate
[XJ 6. Decedent Died Testate (Attach copy of WII)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (dale of death after 12.12.82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copyofTrust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (dlte of dellh betwOln 12-31-91 Ind 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
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THIS. .$6Cl"~MQ$T.B~'..'POMJ:lt.~'t'eP...At.l..d(JR~6$P(JNQ.ENC6AN~eON~liEN't'iAtT~'fN-F(JRM~'t'IO'N..$HOUl..p...BEal~tC't'60~i:
NAME COMPLETE MAILING ADDRESS
Richard c. Snelbaker 44 West Main Street
FIRM NAME (If Applicable)
Snelbaker & Brenneman, P.C. Mechanicsbug, PA 17055
lELEPHONE NUMBER
717-697-8528
(1 )
1. Real Estate (Schedule A)
139,000.00
74,197.57
0.00
0.00
83,463.51
0.00
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
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6. J~ Owned Property (Schedule F)
LJ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
(6)
117,008.07
8. Total Gross Assets (total Lines 1-7)
(8)
34,338.81
1,030.51
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Sdledule I) (10)
11. Total Deductions (total Lines 9 & 10)
(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)
OFFICIAL USE ONLY
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413,669..15
35,369.32
378,299.83
0.00
378,299.83
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 0.00 x.o L. (15)
z rate, or transfers under See. 9116 (a)(1.2)
0
~ 16. Amount of Line 14 taxable at lineal rate 378,299.83 X.O 45 (16)
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D.. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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0 0.00
U 18. Amount of Line 14 taxable at collateral rate x.15 (18)
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c( 19. Tax Due
I- ( 19)
0.00
17,023.49
0.00
0.00
17,023.49
20. [K]
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>> BE~q~I;'TQ~~~~I;R At..Lcal.JE$JIC:)~$QNReYER$e.$I[)EAN[)RECHeCf(MATH < <
3W4645 1.000
Decedent's Complete Address:
STREET ADDRESS St t Mechanicsburg Borough
43 W. Keller ree ,_~~_ .
Cumberland County
em I STA1E I ZIP
Mechanicsburq PA ~7055-
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
10.000.00
500.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
0.00
0.00
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
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)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Pa able to: REGISTER. OF WILLS, AGENT
(58)
6.523.49
Yes
D
D
D
D
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 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 haw examined this retum, Including accompanying schedules and statements, and to the best of my knowledge and belief, 11 is true, corre and mplete.
Declaration of preparer ather than the personal representallwls based an all information of which preparer has any knowledge.
I E R RESP III RElURN
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "XU IN THE APPROPRIATE BLOCKS
1. Old 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
17,023.49
10.500.00
0.00
0.00
6.523.49
0.00
No
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Richard C. Snelbaker, Equire
Co-Executor
DATEf /
16 /(J~
44 W. Main Street, Mechanicsburg, PA 17055
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.~ 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. ~ 9116 (a) (1.1) (ii)]
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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 r:l 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(8)(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.
3W46461.000
REV-1502 EX + (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Helen B. Eisenhauer
21 06 0196
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 property which Is Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIP1l0N
VALUE AT DATE
OF DEATH
43 West Keller Street, Borough
of Mechanicsburg, Cumberland
County, PA, sale value
(settlement sheet attached)
139,000.00
3W4695 1.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
139,000.00
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A.. B. TYPE OF LOAN:
"'''' 1.DFHA 2.0FmHA 3. OOCONV. UNINS. 4. OVA 5. DCONV. INS.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6. FILE NUMBER: . 17. LOAN NUMBER:
SETTLEMENT STATEMENT 06-486 3000989586
8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER:
7.250%\F\948 JSG
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POCr were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3198 (FREEMAN.LANCE.PFDJ06.486I17)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Lance D. Freeman and Estate of Helen Eisenhauer Aegis Wholesale Corporation
Sharon Freeman PO Box 7739
43 W. Keller Street Springfield, OH 45501-7739
Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE:
43 W. Keller Street Midstate Abstract Company
Mechanicsburg, PA 17055 August 11, 2006
Dauphin County, Pennsylvania PLACE OF SETTLEMENT
2331 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 139,000.00 401. Contract Sales Price 139,000.00
102. Personal ProDertv 402. Personal Prooertv
103. Settlement Charaes to Borrower (Line 1400) 6,408.88 403.
104. . 404.
105. 405.
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. CitvlTown Taxes to 406. CitvlTown Taxes to
107. CountvTaxes 07/24/06 to 01/01/07 176.78 407. County Taxes 07/24/06 to 01/01/07 176.78
108. School Taxes 07/24/06 to 07/01/07 1,045.75 408. School Taxes 07/24/06 to 07/01/0' 1.045.75
109. Transer Credit Sewer & Refuse 103.90 409. Transer Credit Sewer & Refuse 103.90
110. Sewer & Refuse Proration 07/24/06 to 10/01/06 77.93 410. Sewer & Refuse Proration 07/24/06 to 10/01/06: 77.93
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 146,813.24 420. GROSS AMOUNT DUE TO SELLER 140.404.36
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: SOO. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 7 500.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New Loan(s} 139000.00 502. Settlement Charaes to Seller (Line 1400) 8,494.61
203. Existina loan(s) taken subiect to 503. Existing loan(s} taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Payoff of second Mortaaae
206. 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. 509.
Adjustments For Items UnDaid By Seller Adiustments For Items Unpaid By Seller
210. CitvlTown Taxes to 510. CitvlTown Taxes to
211. County Taxes to 511. County Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 146,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 8,494.61
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 146813.24 601. Gross Amount Due To Seller (Line 420) 140.404.36
302. Less Amount Paid BvlFor Borrower (Line 220) ( 146,500.00) 602. Less Reductions Due Seller (Line 520) ( 8,494.61
303. CASH ( X FROM) ( TO) BORROWER 313.24 603. CASH ( X TO) ( FROM) SELLER 131,909.75
OMS NO 2502 0265 ......
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Seller
.__...._~-..,
BY:
Page 2
. . ...... L. SETTLEMENT CHARGES
J. TOTAL COMMISSION Based on Price $ 139,000.00 liil 5.0000 % 6 950.00 PAID FROM PAID FROM
Division of Commission (line 700J as Follows: BORROWER'S SELLER'S
701. $ 6,950.00 to Ensminger Auctioneer FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 6,950.00
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Admin. Fee to Aeois Wholesale Corooration 483.50
807. Processing Fee to HOMETOWN MORTGAGE RESOURCES 250.00
808. Yield Spread Premium -Aegis to HOMETOWN MORTGAGE RESOURCES POC:L3301.25
809. Application Fee to HOMETOWN MORTGAGE RESOURCES 400.00
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 08/11/06 to 09/01/06 @ $ 27.609600/day ( 21 days %) 579.80
902. Mortaaae Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months ~ $ 37.75 per month 113.25
1002. Mortgage Insurance months ~ $ per month
1003. Citv/Town Taxes months ~ $ per month
1004. County Taxes 7.000 months ~ $ 33.40 per month 233.80
1005. School Taxes 3.000 months @ $ 91.15 per month 273.45
1006. months ~ $ per month
1007. months I $ oer month
1008. Aoareaate Adiustment months $ per month -133.67
1100. TITLE CHARGES
1101. Settlement or Closina Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Electronic Document Preo. to Midstate Abstract Comoany 50.00
1106. Closina Service Letter to Midstate Abstract Comoany 35.00
1107. Attorney's Fees to
(includes above item numbers: )
1108. Title Insurance to MIDSTATE ABSTRACT 1 053.75
(includes above item numbers.11 02 1103 & 1104 J
1109. Lender's Coverage $ 139,000,00
1110. Owner's Coverage $ 139,000.00 1,053.75
1111. Endorsements 100, 300, 8.1 to Midstate Abstract Company 150.00
1112. Notary Fee to Midstate Abstract Company. 10.00
1113. Notary Fee to Midstate Abstract Company 5.00
1114. Ovemight Fees & Handling to Midstate Abstract Company 15.00
1115.
1116.
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 43.50; Mortgage $ 71.50; Releases $ 115.00
1202. City/County Tax/Stamps: Deed 1,390.00' Mortgage 1,390.00
1203. State Tax/Stamps: Deed 1 390.00; Mortaaoe 1 390.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev to
1302. Pest Insoection to
1303. 2006 Countv/Townshio taxes to Barrv L. Heckard Treasurer 440.85
1304. 200612007 School taxes to Barrv L. Heckard Treasurer 1,093.76
1305. Tax Certification to Barry L. Heckard, Treasurer 5.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) ..--? 6,408.88 8,494.61
By..""'....' ol'" _'" _ _ -"ol._ _ol.... ,,,,,.. ....... - / ~
Midst~stract Company
Settle nt Agent
Certified to be a true copy.
( 06-486/ 06-486/17)
REV.1503 EX +'(6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Helen B. Eisenhauer
21 06 0196
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NlMBER
DESCRlPllON
VALUE AT DATE
OF DEATH
1,133.22
1. The Hershey Company
22 shares of common stock valued
at $51.51 per share
2 UGI Corporation
15 shares of common stock valued
at $22.40 per share
336.00
3 United States Savings Bonds
126 E & EE Bonds, 2 I Bonds and 7
HH Bonds (total of 135 bonds, see
attached listing)
72,728.35
3W46961.oo0
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
74,197.57
VdhH: As UI
Savin,gs Bond .Calculator
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Savin
02/2006
Bond Info
Series
EE Bonds
Results
# Bonds
128
Serial Number
K14966342EE
K15587594EE
K14966696EE
K15587845EE
K15587996EE
K15588256EE
K15588171EE
K15588426EE
K15588539EE
K15588748EE
K15589052EE
K15589276EE
K15589412EE
K 17002082EE
K17002155EE
K17002337EE
K17002397EE
K17002706EE
K17002611EE
K17002913EE
K28545459EE
K28545332EE
K28545693EE
K28545839EE
K28571158EE
K28571237EE
K28571512EE
K28571401EE
K28571702EE
K28571791EE
K28571960EE
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Denomination
Serial Number
Issue Date
$ 75
Total Price
$11,612.50
Total Interest
$32,115.85
Total Value
$43,728.35
YTD Interest
$254.45
Issue Interest Next Final
Issue Date Series Denom Price Interest Value Rate Accrual Maturity Note
03/1981 EE $75 $37.50 $147.60 $185.10 4.00% 03/2006 03/2011 llllr-j
04/1981 EE 75 37.50 147.60 185.10 4.00% 04/2006 04/2011 ..
~ -,', .
04/1981 EE 75 37.50 147.60 185.10 4.000/0 04/2006 04/2011 llil
. '~ '
05/1981 EE 75 37.50 139.71 177.21 4.00% OS/2006 OS/2011 I.'ll
05/1981 EE 75 37.50 139.71 177.21 4.00% OS/2006 OS/2011 IIIl
06/1981 EE 75 37.50 139.71 1 77.21 4.00% 06/2006 06/2011 R1
~ ': ~ .;
06/1981 EE 75 37.50 139.71 1 77.21 4.00% 06/2006 06/2011 III
~ ,. ;
07/1981 EE 75 37.50 139.71 177.21 4.00% 07/2006 07/2011 ..
07/1981 EE 75 37.50 139.71 177.21 4.00% 07/2006 07/2011 fII~
08/1981 EE 75 37.50 139.71 177.21 4.00% 08/2006 08/2011 f{.lIt
..:.v.. .... ,~~
08/1981 EE 75 37.50 139.71 177.21 4.00% 08/2006 08/2011 tiltl
09/1981 EE 75 37.50 136.23 173.73 4.00% 03/2006 09/2011 1M
09/1981 EE 75 37.50 136.23 173.73 4.00% 03/2006 09/2011 III
... .d
10/1981 EE 75 37.50 136.23 173.73 4.00% 04/2006 10/2011 _I
10/1981 EE 75 37.50 136.23 173.73 4.00% 04/2006 10/2011 IBIIIl
11/1981 EE 75 37.50 136.23 173.73 4J}0% OS/2006 11/2011 III
. .
11/1981 EE 75 37.50 136.23 173.73 4.00% OS/2006 11/2011 fill
~ :i ~-
12/1981 EE 75 37.50 136.23 173.73 4.00% 06/2006 12/2011 [IIjJ
12/1981 EE 75 37.50 136.23 173.73 4.00% 06/2006 12/2011 fIIIJ
". " ~".",::
01/1982 EE 75 37.50 136.23 173.73 4.00% 07/2006 01/2012 [Ijj
01/1982 EE 75 37.50 136.23 1 73 .73 4.00% 07/2006 01/2012 !':..11
01/1982 EE 75 37.50 136.23 173.73 4.00% 07/2006 01/2012 [jj;j~
02/1982 EE 75 37.50 136.23 173.73 4.00% 08/2006 02/2012 (BJ
~ " ~
02/1982 EE 75 37.50 136.23 173.73 4.00% 08/2006 02/2012 fill
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03/1982 EE 75 37.50 132.84 170.34 4.00% 03/2006 03/2012 [jjjj
03/1982 EE 75 37.50 132.84 170.34 4.00% 03/2006 03/2012 [I"";.~
i ,I"
04/1982 EE 75 37.50 132.84 170.34 4.00% 04/2006 04/2012 [1111
04/1982 EE 75 37.50 132.84 170.34 4.00% 04/2006 04/2012 ..
05/1982 EE 75 37.50 132.84 170.34 4.00% OS/2006 OS/2012 [III
I
05/1982 EE 75 37.50 132.84 170.34 4.00% OS/2006 OS/2012 fill
06/1982 EE 75 37.50 132.84 170.34 4.00% 06/2006 06/2012 1-
http://wwws. publicdebt. treas.gov /BC/SBCPrice
3/16/2006
Savings Bond Calculator Page 2 of 4
K32968671EE 06/1982 EE 75 37.50 132.84 170.34 4.00% 06/2006 06/2012 III
K32968859EE 07/1982 EE 75 37.50 132.84 170.34 4.00% 07/2006 07/2012 11111
K32969016EE 07/1982 EE 75 37.50 132.84 170.34 4.000/0 07/2006 07/2012 ['II'
K32969207EE 07/1982 EE 75 37.50 132.84 170.34 4.00% 07/2006 07/2012 .tttl
K32969448EE 08/1982 EE 75 37.50 132.84 170.34 4.00% 08/2006 08/2012 'lIIll
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K32969315EE 08/1982 EE 75 37.50 132.84 170.34 4.00% 08/2006 08/2012 [1111
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K33504678EE 09/1982 EE 75 37.50 129.48 166.98 4.00% 03/2006 09/2012 fIB
. ..,......,
K32969557EE 09/1982 EE 75 37.50 129.48 166.98 4.00% 03/2006 09/2012 I il:flli I
K33504979EE 10/1982 EE 75 37.50 129.48 166.98 4.00% 04/2006 10/2012 !p:ell
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K33504807EE 10/1982 EE 75 37.50 129.48 166.98 4.00% 04/2006 10/2012 !if.
K15588861EE 08/1981 EE 75 37.50 139.71 177.21 4.00% 08/2006 08/2011 .f~
K5552978EE 04/1980 EE 75 37.50 170.52 208.02 4.00% 04/2006 04/2010 'lI;illil
K5552849EE 04/1980 EE 75 37.50 170.52 208.02 4.00% 04/2006 04/2010 [PB
K5925593EE 05/1980 EE 75 37.50 172.62 210.12 4.00% OS/2006 OS/2010 [11"
"'Ill
K5925751EE 05/1980 EE 75 37.50 172.62 210.12 4.00% OS/2006 OS/2010 [lr".'~
ililJii
K5927033EE 06/1980 EE 75 37.50 172.62 210.12 4.00% 06/2006 06/2010 Ill]
K5927198EE 06/1980 EE 75 37.50 172.62 210.12 4.00% 06/2006 06/2010 Rl
K13236137EE 07/1980 EE 75 37.50 172.62 210.12 4.00% 07/2006 07/2010 ..1
K13236295EE 07/1980 EE 75 37.50 172.62 210.12 4.00% 07/2006 07/2010 [1111
'W,o'm,.;m;'
K13236614EE 08/1980 EE 75 37.50 172.62 210.12 4.00% 08/2006 08/2010 Ir:'II'!
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REV-15OB EX + (6-98)
COMMONWEAL lH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT" DECEDENT"
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Helen B. Eisenhauer
FILE NUMBER
21 06 0196
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntty-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
1992 Plymouth Acclaim
Kelly Blue Book value
850.00
2
Household Goods
sold at public auction by
Ensminger Auction
7,375.50
3
Internal Revenue Service
refund due on 2005 personal income
tax return
258.00
4
Jewelry
appraised value (see attched
appraisal)
1,400.00
5
Member's First Federal Credit
Union
Savings account # 81481-00
4,452.83
6
Members First Federal Credit Union
Checking account #81481-11
11,797.87
7
Members First Federal Credit Union
Money Management Account #
81481-05
38.54
8
Members First Federal Credit Union
Certificate of Deposit #81481-47
11,176.11
9
Members First Federal Credit Union
Certificate of Deposit #81481-49
4,039.97
10
Members First Federal Credit Union
Certificate of Deposit # 81481-50
30,337.24
11
Members First Federal Credit Union
Certificate of Deposit # 81481-51
5,106.19
12
Pennsylvania State Bank
Certificate of Deposit #
9150004885
5,141.68
13
Sovereign Bank
Checking account #1681717735
1,166.23
Total from continuation schedules
323.35
3W46AO 1.000
TOTAL (Also enter on line 5. Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
83,463.51
Estate of: Helen B. Eisenhauer
180-26-5904
Schedule E (Page 2)
Item
No.
Description
Value at Date
of Death
14
Sovereign Bank
savings account # 1684009002
323.35
Total (Carry forward to main schedule)
323.35
M~UMM~S
I weaT ettyJ tOICE;.
().. 34 WEST MAIN STREET
MECHANICSBURG, PA 17055
APPRAISAL
Phone: 717-766-9422
APPRAISAL
Appraisal for.
Estate of Helen Eisenhauer
03/07/2006
1. Lady's diamond pendant consists of 16 round bnlllant cut diamonds ot appro>omately .3 pOints each and set
in a ma~quise shaped pendant on a 14 karat yellow gold chain.
Estate value: $100.00
2. Lady's 10 karat yellow gold mounting with three emerald-cut blue stones. The ring has one 1-point diamond
on each side.
Estate value: $50.00
3. Lady's 10 karat yet/ow gold necklace with three synthetic red heart-shaped stones.
Estate value: $25.00
4. Lady's five-stone lady's diamond ring. The ring consists of five round-brilliant cut stones of approximately .18
points each, for a total of approximately .90 points. The rings is a 14 karat yellow gold mounting, set in prongs.
Estate value: $500.00
5. Lady's 10 karat yellow gold bracelet. The bracelet has 85 baguette-shaped diamonds channel set. Total
weight of the diamonds is approximately 1 carat.
Estate value: $300.00
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,.", ~-l ~ ~Uc)t'AJ 4 8lJ . e~ fcJeVi.t (~ I.f ~~ 0 <,;)
This appraisal constitutes our carefully studied opinion of
[J the retaD replacement cost through our fadities
In the distress sales nature value
of the artlcle(s) described above insofar as the mounting(s)
hove permitted observation. We assume no nobility with
respect to any action that may be taken on the basis of this
appraisal.
w~ fV\~
Appraiser
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen B. Eisenhauer
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 06 0196
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 N:l..Ll:E TH: NOME OF TH: TRANSFEREE, TH:IR RELATIONSHIP TO DECEDENT IWJ DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER TH: DAlE OF 1RANSFER AlTl'CHACOPf OF TI-E DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPUCABLE\ VALUE
1. Jackson National Life Insurance
Company 38,345.69 100.0000 0.00 38,345.69
annuity # 0040343120
2 Jackson National Life Insurance
Company 74,248.55 100.0000 0.00 74,248.55
annuity #1001280178
3 Met-Life 886.11 100.0000 0.00 886.11
total control account
#4049789257
4 Thrivent Financial for
Lutherans 3,527.72 100.0000 0.00 3,527.72
annuity #03896943
TOTAL (Also enter on line 7, Recapitulation) $ 117.008.07
(If more space Is needed, insert additional sheets of the same size)
3W46AF 1.000
REV-1511 EX ~ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INl-ERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen B. Eisenhauer
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 06 0196
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ronan Funeral Home
funeral services 11,263.60
B. ADMINISTRATIVE COSTS:
1. 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 Snelbaker & Brenneman, P.C. 9,500.00
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 314.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1 Cumberland Law Journal
advertising Executors' notice 75.00
Total from continuation schedules 13,186.21
TOTAL (Also enter on line 9, Recapitulation) $ 34.338.81
3W46AG 1.000
(If more space is needed, insert additional sheets of the same size)
Estate of: Helen B. Eisenhauer
5
6
7
8
9
10
180-26-5904
Schedule H Part 7 (Page 2)
2 Ensminger Auction
commission on sale of household
goods
2,735.21
3
H&R Block
preparation of 2005 Individual
Income Tax Returns
350.00
4
Mumma's Jewelry Store
jewelry appraisal
100.00
Patriot News
advertising Executors' notice
151.39
Register of Wills
short certificates
40.00
Register of Wills
filing fee for Inheritance tax
return
15.00
RSR Appraisers & Analysts
real estate appraisal
300.00
Settlement charges on sale of 43
West Keller Street, Mechanicsburg
as follows:
a. Ensminger Auctioneer,
commission $6,950.00
b. Notary fees $5.00
c. 2006 County/Township taxes
$440.85
d. 2006/2007 School taxes
$1,093.76
e. Tax certification $5.00
8,494.61
Reserve
for filing fees, accounting fees
and other costs associated with
the administration of Decedent's
estate
1,000.00
Total (Carry forward to main schedule)
13,186.21
REV-1512 EX+ (12-03)
COMMONVVEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen B. Eisenhauer
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0196
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NLIJIBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Borough of Mechanicsburg
sewer/refuse service
93.22
2 Cingular
cell phone service
27.13
3 Comcast Cable
cable TV service
120.56
4 Community Life Team EMS
ambulance service
80.00
5 Griswold Special Care
medical services
114.00
6 Members First Federal Credit Union
Visa Credit card #
4287590000814810
21. 95
7 PPL Electric
electric service
117.70
8 UGI
gas service
318.00
9 United Water Pennsylvania
water service
52.05
10 Verizon
phone service
85.90
3W46AH 2.000
tOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,030.51
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen B. Eisenhauer
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Lynn R. Eisenhauer
191 Pinetown Road
Leola, PA 17540
1
50% of Residue: 189,149.92
2 Cindy Lou E. Poorman
2087 South Olathe Street
Aurora, CO 80013
50% of Residue: 189,149.92
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Daughter
FILE NUMBER
21 06 0196
AMOUNT OR SHARE
OF ESTATE
189,149.92
189,149.92
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
\I 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" - 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
"
LAW OFFICES
SNELBAKER Be
JRENNEMAN. P.C.
-
LAST WILL AND TESTAMENT
I, HELEN B. EISENHAUER, of the Borough of Mechanicsburg, County of Cumberland,
and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and Testament, hereby
revoking and making void all former wills and codicils by me at anytime heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be paid by my
Executors, hereinafter named, as soon as conveniently may be done after my decease.
SECOND. I give and bequeath all of my jewelry, wedding portrait and personal effects
unto my daughter, namely, CINDY LOU E. POORMAN, absolutely.
THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate,
real, personal and mixed, whatsoever and wheresoever situated, unto my two (2) children,
namely, CINDY LOU E. POORMAN and LYNN R. EISENHAUER, share and share alike,
absolutely and in fee simple.
If either of my children should predecease me and leave issue to survive me, I
order and direct that the foregoing share of my residuary estate attributable to/such deceased
child shall be distributed to such child's issue per stirpes by representation and not per capita.
If either of said children should predecease me without leaving issue to survive
me, I order and direct that the foregoing share of my residuary estate attributable to such
deceased child shall lapse and the subject matter distributed unto my surviving child.
LASTL Y. I nominate, constitute and appoint my two (2) children, namely, CINDY LOU
E. POORMAN and LYNN R. EISENHAUER, to be the Executors of this, my Last Will and
Testament, to serve without bond or other security as a condition of qualification hereunder. If
either of my said children should fail to qualify or cease to serve hereunder, I order and direct
that the one so qualifying or remaining shall serve as my sole personal representative.
IN WITNESS WHEREOF, I HELEN B. EISENHAUER, have hereunto set my hand and
seal to this my Last Will and Testament, which consists of two (2) typewritten pages to each of
which I have affixed my signature this /d~. day of November, A.D., Two Thousand Five.
~ 7!!}. ~A '?~1' ~~bl.b
Helen B. Eisenhauer
(SEAL)
The preceding instrument, consisting of this and one (1) other typewritten page, each
identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and
declared by Helen B. Eisenhauer, the Testatrix therein named, as and for her Last Will and
Testament, in the presence of us, who, at her request, in her presence and in the. presence of each
other, have subscribed our names as witnesses h~~
. ~,,!,-f~J
~8'~
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND
)
We, HELEN B. EISENHAUER; RICHARD C. SNELBAKER and JANE 1. COONEY,
the Testatrix and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the uhdersign~d authority that
the Testatrix signed and executed the instrument as her Last Will and T estamenti. and that she had
signed willingly, and that she executed it as her free and voluntary act for the purPoses therein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the
Will as a witness and that to the best of his or her knowledge, the Testatrix was ~t that time
eighteen years of age or older, of sound mind and under no constraint or undue ib.fluence.
~ J.~.J _ ~ ~~~At:~
Testatrix
~-L'~
1 ess
~,. i .~
W ess
Subscribed, sworn to and acknowledged before me by HELEN B. EISENHAUER, the
Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J.
COONEY, the witnesses, this IOret day of November, 2005.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Susan L Matrazl. Notary PubIc
Medlanicsburg Boro. CUmberland County
My COllllllisslon Expires Nov. 24, 2CYJt
Member. Pennsytvania Association Of Notaries
.~ - ~7!J~
Notary Public .
-2-
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
SNELBAKER RICHARD C
44 W MAIN ST
MECHANICSBURG, PA 17055
nn_h. fold
ESTATE INFORMATION: SSN: 180-26-5904
FILE NUMBER: 2106-0196
DECEDENT NAME: EISENHAUER HELEN B
DA TE OF PAYMENT: 12/07/2006
POSTMARK DATE: 12/07/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 02/28/2006
NO. CD 007530
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
101 I $6,523.49
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$6,523.49
REMARKS:
CHECK#166
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS