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HomeMy WebLinkAbout12-21-06 :EV-1500 EX (6-00) OFFOAI.. 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 .-9L 0323 ___ YEAR NUMBER DECEDEN'T'S NAM: (LAST, FIRST, AND MIDDLE INITIAL) ~ stoner Revere ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~ 4/2/2006 1/6/1918 W OF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C M SOCIAL SECURrTY NUMBER 181-01-7938 THIS RETURH MUST BE FILED 1M DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SEClRlTY NUMBER [i] 1. Original Retum D 4. Limited Estate 00 6. Decedent Died Testate (Attach copy of VWI) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Ren1ainder Retum (date of death prior to 12-13-82) o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (A~tachCOPY of Trual) L 8. Total Number of Safe Deposit Boxes o 10. Spousal Poverty Credit (dal~ of death b~twe.n 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A)(AllachSchO) W I- ~$n O<<~ WD-O :J:~ Oo.m D- c( THIS SECTION MUST BE. COMPLETED. ALL CORRESPONDI;NCEAND.CONFIPENTIAl TAX INFORMATIONSHOUlP BEPIRECTEDTO: NAME COMPLETE MAILING ADDRESS I- Z W o Z o 0- r/) w 0: 0: o o Richard C. Snelbaker FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. TELEPHOI'E N\.NBER 717-697-8528 44 West Main Street Mechanicsburg, PA 17055 z o i= :3 ~ t- o:: c( u w a:: 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sdledule E) (5) 6. Jointly O'Mled Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 145,000.00 114,955.45 0.00 0.00 198,465.83 0.00 ~USEO~ 0-0 rr1 ';-1 - 0 c-> :'2$h=t N -.r.2:o 'e'(;);>'::: :J C) 0 :p. -;011 ::c .--,c:: :-' :D 'E :-0 --I ):::- .s;:- 1. Real Estate (Schedule A) . (1) 2. Stocks and Bonds (Schedule B) (2) ;J. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 269,808.36 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (8) 35,843.00 347.34 728,229.64 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (13) 36,190.34 692,039.30 0.00 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 -Mlich an eIectioo to tax has not been made (Schedule J) (12) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 692,039.30 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount 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 )( ~ 19. Tax Due 20. ~ 0.00 0.00 0.00 692,039.30 x .0 9--(15) X.O 45 (16) x .12 (17) x .15 (18) (19) 0.00 0.00 0.00 103,805.90 103,805.90 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>BESURETO ANSWER ALLQUESTIONSONREVERSE.$IDE AND RECHECK MATH << 3W4645 1.000 Decedent's Complete Address: STREET ADDRESS 1006 Orrs Bird e Road Cumberland Count CITY Mechanicsbur STAiE PA ZIP 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) 103,805.90' 0.00 80,000.00 4,000.00 Total Credits (A + B + C) (2) 84,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnterestlPenalty (0 + 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) 19,805.90 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. (5B) 19,805.90 AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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] D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare thai I have examined this return, induding accompanying schedules and statements. and to !he best of my knOWledge and belief. it is true. correct and complete. =~~~~fj:.J~71i-4~' Elizabeth n Cam ell Christi, Executrix 3825 Mt. Shadows Circle, Fayetteville, PA 17222 SlGNATl.RE REPRESENfATlVE DAlE 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 No og og og ua []I []] AOORESS Richard C. Snelbaker, Esquire I , J 0," 44 West Main Street, Mechanicsburq, 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. 9 9916 (a) (1.1) (ill. 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'9 9116 (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 ewn if the surviving spouse is the only benefidary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P.S. ~ 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(l)]. 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. f. 3W46461.0oo COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ~EV-1502 EX + (&98) ESTATE OF FILE NUMBER Revere M. Stoner 21 06 0323 All real property owned solely or as a tenant in common must be reported at fair market value. Fair. arket 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: h halAng reasonable knOllllledge of the relevant facts. Real property which Is joinUy-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Property located at 1005 Orrs Bridge Road, Hampden Township, Cumberland County, Mechanicsburg, Pennsylvania, sale value (see attached settlement sheet) 145,000.00 3W4695 1.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 145,000.00 N 2 ~ OMS O. 2502-0 65 .,-... - B. TYPE OF LOAN: A. , . 1.0FHA 2.DFmHA 3. [gJCONV. UNINS. 4. OVA 5.0CONV. INS. U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 06-542 0004837906 8. MORTGAGE INS CASE fJMBER: OLD MORtGAGE INS CASE NUMBER: 7.875/F/946.22 · ". MMO 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 ''{POC]'' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3196 (KNOUSE.ElIZABETH10050RRS.PFOJ06-5421141 D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Elizabeth P. Knouse Elizabeth Ann Campbell Christi NATIONAL Cln' BANK 1112 Wansford Road Executrix of the Estate of 3232 NEWMARK DRIVE Mechanicsburg, PA 17055 Revere N. Stoner MIAMISBURG, OH 45342 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 68-0510988 I. SElTLEMENT DATE: 1005 Orrs Bridge Road Community Land Transfer, LLC Mechanicsburg, PA 17050 August 30, 2006 Cumberland 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 145,000.00 401. Contract Sales Price 145,000.00 102. Personal Property 402. Personal Prooertv . 103. Settlement Charoes to Borrower (Line 140m 4,635.01 403. 104. 404. 105. 405. Adjustments For Items Paid Bv Seller in advance Adiustments For Items Paid Bv Seller in advance 106. Cityffown Taxes to 406. Citvffown Taxes to 107. County Taxes 08/30/06 to 01/01/07 119.99 407. County Taxes 08/30/06 to 01/01107 119.99 108. School Taxes 08/30/06 to 07/01/07 1,102.68 408. School Taxes 08130/06 to 07/01/07 1.102.68 109. Sewer 08/30/06 to 10/01/06 . 29.31 409. Sewer 08/30/06 to 10/01/06 29.31 110. 410. 111. 4'11. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 150,886.99 420. GROSS AMOUNT DUE TO SELLER 146,251.98 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 10.000.00 501. Excess DepositlSee Instructions) 202. Principal Amount of New Loarie!;) 130 500.00 502. Settlement Charaes to Seller (Line 1400) 2748.21 203. Existina loan(s) taken subject to 503. Existing loan(s) taken subiect to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortaaiie 206. 506. Deposit retained bv seller 10,000.00 207. 507. 208. SOB. 209. 509. Adiustments For Items Unpaid Bv Seller Adjustments For. Items Unpaid By Seller 210. Cityffown Taxes to 510. Citvrrown Taxes to 211. CountvTaxes to 511. County Taxes to 212. School Taxes to 512. SchoolTaxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 140,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 12,748.21 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Borrower (Line 12m 150 886.99 601. Gross Amount Due To Seller (Une 420) 146,~51.98 302. Less Amount Paid BylFor Borrower (Line 220) ( 140,500.00) 602. Less Reductions Due Seller (Line 520) ( 12,748.21 303. CASH ( X FROM) ( TO) BORROWER 10,386.99 603. CASH ( X TO) ( FROM) SELLER 133,503.77 . The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Bo~r ~-f. ~ EI' "eth . Knouse ~llgll ~ L. SETTLEMfFNT CHARGES 700. tOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM Division of Commission (fine 700) as Folfows: BORROWER'S SELLER'S 701.$ to FUNDS AT FUNDS AT 702. $ to SETTlEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to ! , ! BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to . Apex Appraisals, Inc. 300.00 804. Credit Report to 805. Lender's Inspection Fee to ~ 806. MortgaQe Ins. APD. Fee to '. 807. Assumption Fee to 808. Tax Service Fee to LandAmerlca 77.00 809. Broker Processing Fee to Fairway Mortgage Funding, Inc. 250.00 810. Flood Cert. Fee to LSI 5.00 811. Administration Fee to NATIONAL CllY BANK 490.00 812. Mortgage Broker Fee to Fairway Mortgage Funding, Inc. POC:2446.00 NCB 813. Wire Fee to NATIONAL CllY BANK 25.00 814. 815. 816. 817. 818. 819. 820. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 08/30/06 to 09/01/06 @ $ 28.160000/day ( 2 days %) 56.32 902. Mortgage Insurance Premium for months to Erie Ins. 903. Hazard Insurance Premium for 1.0 years to Erie Ins. POC $390.00b 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 2.000 months @ $ 32.50 per month 65.00 1002. MortQaQe Insurance months @ $ per month 1003. CilvlTown Taxes months @ $ per month 1004. CountvTaxes 7.000 months @ $ 29.43 per month 206.02 1005. School Taxes 3.000 months @ $ 109.97 per month 329.91 1006. months ~ ~ $ per month 1007. months fl . $ Der month '1008. AQQreQate Adiustment months d $ oer month -85.23 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Prep. to Community Land Transfer, LLC 50.00 1106. Closin~ Service Letter to Community Land Transfer, LLC 35.00 1107. Attorney's Fees to (includes above item numbers: J 1108. Title Insurance to COMMUNITY LAND TRANSFER 1083.75 (includes above item numbers.11 02, 1103 & 1104 . J 1109. Lender's Coverage $ 130,500.00 1110. Owner's Coverage $ 145,000.00 1,083.75 1111. Endorsements 100, 300, 8.1 to Community Land Transfer, LLC 150.00 . , 1112. Nolary Fee to Community Land Transfer 10.00 1113. Notary Fee Community Land Transfer 1114. Overnight Fees & Handling to Community Land Transfer, LLC 15.00 1115. September Trash to Hampden Township Authority 13.24 1116. Tax Cert. to Marie Huber, Treas. 5.00 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 70.50; Releases $ 109.00 1202.City/Coun~Ta~Stamps:Deed 1,450.00' Mortgage 1 450.00 1203. State Ta~Stamps: beed 1 450.00; Mort~age 1,450.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to . 1302. Pest Inspection to 1303. 2006/07 School Taxes to Marie Huber, Treas. 1 293.21 1304. 1305. 1400.;TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) ~ 4,635.01 2,748.21 By signing page 1 of this Slatement, lIle slgnalDrie.s acknowledge receipl of a cornpleled copy.otpage 2 oflllls two page stalemenl /L-r - Communit~d Transfer, LLC - Certified to be a true copy. Settlement Agent (06-542/06-542/19 ) :EV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 8 STOCKS & BONDS ESTATE OF 'FILE NUMBER ~E~Jlere M. Stoner 21 06 0323 All property jointly-owned witt! right of survivorship must be disclosed on Schedule F. -- ITEM r tU1BE~_ --1.Duquesne Light Holdings, Inc. 150 shares of common stock valued at $16.69 per share DESCRIPTION VALUE AT DATE OF DEATH 2,503.50 2 Exelon Corp 200 shares of common stock valued at $53.29 per share 10,658.00 3 ExxonMobil 320 shares of common stock valued at $61.21 per share 19,587.20 4 Finova Group, Inc. 128 shares of common stock valued at $.07 per share 8.96 5 Hershey Company 1,200 shares of common stock valued at $52.33 per share 62,796.00 6 Moneygram International, Inc. 254 shares of common stock valued at $30.65 per share 7,785.10 7 Rite Aid Corporation 2,388 shares of co~on stock valued at $3.97 per share 9,480.36 8 Viad Corp 63 shares of common stock valued at $33.91 per share 2,136.33 IW46961.ooo TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 114,955.45 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Revere M. Stoner FilE NUMBER 21 06 0323 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 lESCRIPTlON VALUE AT DATE OF DEATH 1 2004 Honda Accord LX Kelly Blue Book value 15,300.00 2 Highmark Insurance refund unused premium on health insurance policy 186.95 3 Household goods sold at public auction by Bricker's Auction 4,139.25 4 M&T Bank checking account, #38344459 73,687.21 5 Merrill Lynch investment account, #872-17305 105,144.32 6 Patriot-News refund unused portion of newspaper subscription 8.10 3W46AD 1.000 TOTAL (Also enter on line 5, Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 198,465.83 {EV-1510 EX + (6-98) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~STATE OF Revere M. stoner SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 06 0323 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. "UM [ DESCRIPTION OF PROPERlY ITE M .. . N::U.r:.E ne NOME OF TI-E TRANSfEREE, HEIR RElATIONSHIP TO DECEDENT Al>V DAlE OF DEATH % OF DECO'S EXCLUSION TAXABLE BE Tl-EDATEOF1RAIGER.ATTACHACOPV OF TtE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLEI VALUE 1. ING 261,024.96 100.0000 0.00 261,024.96 annui.ty, account #90126286 2 Wachovia 8,783.40 100.0000 0.00 8,783.40 IRA accounts, #257410279171940 & 257410279172037 '. TOTAL (Also enter on line 7, Recapitulation) $ 269 808.36 (If more space is needed, insert additional sheets eX the same size) W46AF 1.000 R EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYlVANIA IN-JERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Revere M. Stoner ITEM NUMBER A. 1_ B. 1. 2. FUNERAl EXPENSES: Gingrich Memorials grave marker SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 06 0323 Debts of decedent must be reported on Schedule I. DESCRIPTION Total from continuation schedules ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address Social Security Number(s) I EIN Number of Personal Representative(s) City Year(s) Commission Paid: State lip Si1elbaker & Brennanan I P.. C.. Claimant Street Address City Relationship of Claimant to Decedent Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 AT&T phone service Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4. 3W46AG 1.000 State lip 2 Bricker's Auction commission on sale of household goods Total from continuation schedules TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 775.00 9,701.00 15,710.00 468.00 24.43 2,550.00 6,614.57 35,843.00 Estate of: Revere M. stoner 181-01-7938 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Malpezzi Funeral Home, Inc..~ funeral services 9,701. 00 Total (Carry forward to ma~n schedule) 9,'701.00 Estate of: Revere M. Stoner 3 4 5 6 7 181-01-7938 Schedule H Part 7 (Page 2) Cumberland Law Journal advert~s~ng Executrix Notice 75.00 Elizabeth P. Knouse trash removal fee for property on Orrs Br~dge Road 200.00 Hampden Township sewer/trash service 248.00 Marie Huber, Tax Collector real estate taxes and personal taxes 355.92 Orrstown Bank stop payment fee 28.00 8 PPL Electric electric service 9 10 11 12 13 14 15 16 63.64 Patriot News advertising Executrix Notice 123.18 Penn National Insurance auto insurance premium 165.00 RSR Appraisers & Analysts real estate appra~sal fee 300.00 Register of Wills f~l~ng fee for Inheritance Tax Return 15.00 Register of Wills short certificates 16.00 Settlement charges associated with the sale of property as follows: a. Tax certification $5.00 b. Transfer taxes $1,450.00 c. 2006/07 School Taxes $1,293.21 2,748.21 Tyrone E. Kre~tzer lawn care serv~ces 560.00 Verizon phone service 32.62 17 Wachovia process~ng fee for estate valuation 25.00 Total (Carry forward to main schedule) 4,955.57 Estate of: Revere M. Stoner 181-01-7938 Schedule H Part 7 (Page 3) 18 Wonders LTD tent rented for day of auction 159.00 19 Reserve for filing fees, accounting costs and other fees associated with the administration of Decedent's estate 1,500.00 Total (Carry forward to main schedule) 1,659.00 {EV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX REiURN RESIDENT DECEDENT ESTATE OF R~vere M. Stoner SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABiliTIES, & LIENS FILE NUMBER 21 06 0323 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. - J ITEM NLt.4BER . -. ~. 1. . a::SCRIPTION VALUE AT DATE OF DEATH AT&T phone service 14.55 2 Comcas t cable TV service 28.66 3 Eichelbergers, Inc. heating oil 184.69 4 Family Physician Associates, Inc. medical services 45.37 5 PPL Electric electric service 35.56 6 Verizon phone service 38.51 iN46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 347.34 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX RE11JRN RESIDENT DECEDENT ESTATE OF Revere M. Stoner NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) Elizabeth Ann Campbell Christi 3825 Mt. Shadows Circle Fayetteville, PA 17222 100% of Residue: 692,039.30 RElATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21 06 0323 AMOUNT OR SHARE OF ESTATE Niece 692,039.30 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 N46AI 1.000 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS QN LINE 13 OF REV-1500 COVER SHEET (If more space IS needed. Insert additional sheets of the same SIZe) $ 0.00 -=....-- ~ J LAW OFFICES "'-RTSON AND SNELBAKER LAST WILL AND TESTAMENT I, REVERE M. STONER, of the Township of Hampden, County of Cwnber- land 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 any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as conyen- iently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal. and mixed, whatsoever and where- soever situated, unto my wife, ELIZABETH M. STONER, absolutely and in fee simple, if she survives me. THIRD. If my wife, ELIZABETH M. STONER, does not survive me, then and in that event, I give, devise and bequeath all the rest, residue and I remaind~r of my Estate, real, personal and mixed, whatsoever and where- soever situated, unto my niece, namely, ELIZABETH ANN CAMPBELL, abso- lutely and in fee simple. LASTLY. I nominate, constitute and appoint my wife, ELIZABETH M. STONER, to be the Executrix of this my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my niece, namely, ELIZABETH ANN CAMPBELL, to be the Executrix hereof, each to serve without bond. IN WITNESS WHEREOF, I, REVERE M. STONER, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages tD each of which I have affixed my signature this 17th day of June, A. D., One Thousand Nine Hundred Seventy-six (1976) . ~ k )~-1 (S EAL) The preceding instrument, consisting of this and one (i) other typewri tten page, each identified by the signat:tiJ?:e of the Testator, was on the date thereof signed, sealed, published and declared by REVERE M. STONER, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of / // as witnesses thereto. ./ ,. / ,.t subscribed our names LAW OFFICES tTSON AND SNELBAKER