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Home My WebLink About12-18-06 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 JOHNSON WAYNE W 129 WilLIAM STREET PORTLAND, ME 04103 nnnn fold ESTATE INFORMATION: SSN: 043-12-3452 FILE NUMBER: 2105-0377 DECEDENT NAME: SANDERS WINIFRED E DA TE OF PAYMENT: 12/18/2006 POSTMARK DATE: 12/18/2006 COUNTY: CUMBERLAND DATE OF DEATH: 01/25/2005 NO. CD 007576 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $38,498.70 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $38,498.70 GLENDA FARNER STRASBAUGH REGISTER OF WillS ,. \ ~FrV-1500 EX + !i-OO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT W I- ~ :$U) ()<<~ wa.() J: 00 " <<..... ..., a. III a. c( FILE NUMBER 2 1 -0 5 0 3 7 7 ""CciUNTYCOOE ----VEAR- - - NUMsER- - I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY SOCIAL SECURITY NUMBER o 4 3 - 1 2 - 3 4 5 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (date of death prior to 12-13-82) D 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Ste hen J. Ho Es uire 19 South Hanover Street, Suite 101 FIRM NAME (If Applicable) z o i= :3 ::;) I- a: <C o w 0::: z o i= ~ ::;) n.. :i o o >< ~ Sanders Winifred E. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 01/25/2005 04/15/1908 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [R] 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy o!Trust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W C Z o a. U) w << << o () TELEPHONE NUMBER 717245-2698 Carlisle 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)(1.2) X _(15) 792,226.15 X .045 (16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 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 < < OFFICIAL USE ONLY PA 17013 687,863.98 :J C;o :.0 "TI :r::p c:;. III 2;.~1~ 198,575.67 CjO --::C2-n ;>C_ - :"'0 --I :B 47,857.63 46,355.87 f'-..) = = c:;r'\ c:;J fT1 n co ::r:-- :Jt ~ N -l 886,439.65 94,213.50 792,226.15 792,226.15 35,650.18 35,650.18 , 1 REV-1503 t.=~ + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Sanders Winifred E. FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0377 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 176,116.03 Edward Jones 2. Vanguard Group - Wellington Fund 148,436.31 3. Prime Money Market 85,320.41 4. American Funds 229,860.67 5. American Funds 16,897.34 6. Van Kampen Investments - Value at DOD 29,907.47 7. Van Kampen sold July 2006 at $29,106.27 -801.20 8. Van Kampen Dividends - 2005 726.74 9. Van Kampen Dividends - 2006 587.79 10. Van Kampen Dividends - 2002-2003 - Dividend Checks 641.14 11. Vangard Group - Wellington Funds Dividends 2005 171.28 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 687863.98 ,'REV-1508EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sanders. Winifred E. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 05 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. 0377 VALUE AT DATE OF DEATH 111,963.52 1,937.23 610.24 154.01 18,698.84 646.40 1,644.12 909.00 40,641.36 272.42 15,219.59 23.41 16.51 4,941.00 898.02 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. DESCRIPTION Adams County National Bank & Farmers National Bank of Newville Checking Account No.: 222755 BFAA Dividends - Acct. No: 222755 - 2005 Interest - Acct. No.: 222755 - 2005 Interest - Acct. No.: 222755 - 2006 Account closed April 2006 - transferred to Estate Acct. State of Connecticut Payroll - 2005 VGI Prime Money Market - 2005 ING Life Insurance - 2005 MMBB Gift Peoples Bank - TO Banknorth, N.A. Checking Account No.: 24-0646250 Dividends - Account No: 24-0646250 - 2005 Account closed April 2005 - transferred to Estate Acct. Peoples Bank - TO Banknorth, N.A. Checking Account No: 02-1984647 Interest - Account No: 02-1984647 - 2005 Interest - Account No: 02-1984647 - 2006 Personal Property Presbyterian Homes - Refund TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 198 575.67 :REV-1511'EiX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sanders. Winifred E. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 05 0377 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Neill Funeral Home 370.00 2. Steve Clements - burial 100.00 3. Reverend Charles Erb - service 200.00 4. Conroy-Tully Crawford - Urn 445.00 5. WWS - Flowers 62.42 6. Smith Memorial - Stone 189.00 7. Green Lawn Cemetery - care 400.00 8. Chowder House - Restaurant 220.32 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Wayne W. Johnson 30,000.00 Social Security Number(s}/EIN Number of Personal Representative(s} 004-32-4782 Street Address 129 William Street City Portland State ME Zip 04103 Year(s} Commission Paid: 2. Attorney Fees Stephen J. Hogg, Esquire 13,296.59 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 680.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Advertising Cumberland Law Journal 75.00 Carlisle Sentinel 122.51 8. Filing Inheritance Tax Return 30.00 9. Filing Accounting 165.00 10. Representative's expenses for travel 1,461.79 11. Short Certificates 40.00 TOTAL (Also enter on line 9, Recapitulation) $ 47,857.63 (If more space is needed, insert additional sheets of the same size) } , . 'REV-1512 'EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sanders. Winifred E. FILE NUMBER 21 05 0377 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, Postage Humanity Gift Registery VALUE AT DATE OF DEATH 4.42 2. Graham Medical Clinic 3. Andorra Radiology Associates 4. Continuing Care 5. Asera Care Hospice 6. Carlisle Regional Medical Center 7. Graham Medical Clinic 8. Moffitt Heart & Vascular Group 9. Omega Medical Labs 10. Swaim Health Center 11. Personal Property Appraisal Fee 12. United States Treasury 13. PA Department of Revenue 14. Howard Accounting 15. Earle W. Noyes & Sons 110.00 64.00 9.27 409.00 133.28 60.00 10.00 97.70 30.56 125.00 12,935.97 467.00 690.00 4,815.20 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 46 355.87 ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent Sanders, Winifred E. Decedent's Name Page 1 21 05 0377 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Internal Revenue Service 119.01 17. Check Printing Fee - Acct. No.: 1328451 8.00 18. PA Fiduciary 1,197.00 19. Norwalk Public School - Medical Insurance 1,897.42 20. Teachers Retirement Board - State of CT. Pension 14,024.13 21. ING Life Insurance 1,664.12 22. AARP - 2005 75.00 23. Bank Account Maintenance Fees - Acct. No. 1984647 - 2005 135.00 24. Bank Account Maintenance Fees - Acct. No. 1984647 - 2006 150.00 25. Expenses due to Helen Norby Estate (sister)- Cumberland County PA - Acet. No. 1984647 7,124.79 SUBTOTAL SCHEDULE I 26,394.47 GRAND TOTAL SCHEDULE I $ 46,355.87 ""."" '\;"- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ~;::mrlp.r!'; Winifrp.rl F. 21 05 ()~77 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Wayne Woodbury Johnson Nephew 38% 129 William Street Portland, ME 04103 2. David Leslie Johnson Nephew 10% 1815 Kingsland Avenue Orlando, FL 32808 3. Phyllis E. Johnson (Phyllis Johnson Mortimer) Niece 38% 19 Kineo Street Portland, ME 04103 4. Jacquie Kaye Albert (Jacqueline Dufresne) Grandchild of late cousin 2% 113 Gosher Road Edith Weber Williamsburg, MA 01096-9754 5. Vivienne Kaye West Grandchild of late cousin 2% 4 Claremont Avenue Edith Weber Maplewood, NJ 07040 6. Luana Weber Bogue Grandchild of late cousin 1% 8906 McGregor Drive Edith Weber Chevy Chase, MD 20815 7. Sharalyn Weber McMahon Grandchild of late cousin 2% 1696 Maple Street Edith Weber Waltham, VT 05491-9439 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 $ (If more space is needed, insert additional sheets of the same size) , . "" '. ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent Sanders, Winifred E. Decedent's Name Page 2 21 05 0377 File Number Schedule J - Beneficiaries - 1 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) 8. William Weber Grandchild of late cousin 1% 6 Garden Street Edith Weber Albany, NY 12209 9. Delanne Stage man Grandchild of late cousin 1% 1715 Wendell Avenue Edward Sanders Schenectady, NY 12308 10. Janet Johnson Thompson Daughter of Nephew 2% 5 Bonnie Hill Road Wayne Johnson Gorham, ME 04038 11. Jennifer Johnson Shugars Daughter of Nephew 1% 11 Willowood Lane Wayne Johnson Ccarborough, Maine 04074 12. Judy Johnson Walter Daugher of Nephew 1% 5903 Spring Blossom Street Wayne Johnson Bakersfield, CA 93313 13. Marcia Richardson Severance Grandchild of late cousin 1% 44 Bow Lake Road, Box 561 Roxie Richardson Northwood, NH 03261 T INVENTORY Estate of Winifred E. Sanders No.21 05 0377 also known as , Deceased Date of Death 1/25/2005 Social Security No. 043-12-3452 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IflNe verify that the statements made in this inventory are true and correct. IflNe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: () ~O "u;g !i~P ,~~~ :00 -\C) ','j , --'11'- , .J-J :LJ --l J-:..... r--.,) c:::) = ~ o f"11 n -:-'f ~-'Tl "li C) c: ) c:::) ;- >; J..J ;i ~,~~ :..uO ',,)0 'n --Tl _~___ t, ,": c'S -.. fT'1 Name of Attorney: Stephen J. Hogg, Esquire 1.0. No.: 36812 Address: 19 S. Hanover Street, Ste. 101 Carlisle Telephone: 7172452698 Wayne W. Johnson co Dated 12/8/2006 ):IIa :x \.0 N -.J PA 17013 Description Value Edward Jones 176,116.03 Vanguard Group - Wellington Fund 148,436.31 Prime Money Market 85,320.41 American Funds 229,860.67 American Funds 16,897.34 Van Kampen Investments - Value at DOD 29,907.47 Total (Attach Additional Sheets if necessary) 886,439.65 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. RW-4 .. Continuation of Inventory Winifred E. Sanders 21 05 0377 Page 1 Description of Inventory Description Van Kampen sold July 2006 at $29,106.27 Value -801 .20 Van Kampen Dividends - 2005 726.74 Van Kampen Dividends - 2006 587.79 Van Kampen Dividends - 2002-2003 - Dividend Checks 641.14 Vanguard Group - Wellington Funds Dividends - 2005 171.28 Adams County National Bank & Farmers National Bank of Newville Checking Account No.: 222755 111,963.52 BFAA Dividends - Acct. No: 222755 - 2005 1,937.23 Interest Earned - Acct. No.: 222755 - 2005 610.24 Interest Earned - Acct. No.: 222755 - 2006 Account closed April 2006 - transferred to Estate Acct. 154.01 State of Connecticut Payroll - 2005 18,698.84 VGI Prime Money Market - 2005 646.40 ING Life Insurance - 2005 1,644.12 MMBB Gift 909.00 Peoples Bank - TD Banknorth, NA Checking Account No.: 24-0646250 40,641.36 Subtotal $ 178,530.47 , . Continuation of Inventory Winifred E. Sanders 21 05 0377 Page 2 Description of Inventory Description Dividends - Account No.: 24-0646250 - 2005 Account closed April 2005 - transferred to Estate Acct. Value 272.42 Peoples Bank - TD Banknorth, N.A. Checking Account No.: 02-1984647 15,219.59 Interest Earned - Account No.: 02-1984647 - 2005 23.41 Interest Earned - Account No.: 02-1984647 - 2006 16.51 Personal Property 4,941.00 Presbyterian Homes - Refund 898.02 Subtotal $ 21,370.95 886,439.65 Grand Total $