The URL can be used to link to this page

Home My WebLink About01-18-07 REV-15oo EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNlY CODE FILE NUMBER 21 OFFICIAL USE ONLY 20~ .-J>35!L __ YEAR NUMBER SOCIAL SECURITY NUMBER 107-03-1405 THIS REl1JRN MUST BE FILED IN DUPLICATE WITH THE I- Z W C w frl c DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) Bovier, Lloyd S DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 04/16/2003 12/03/1910 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ::.:::~(/) oa:::.::: wl1.0 :%:00 o a:.J l1.lD l1. c( [Z] 1. Original Retum D 4. Limited Estate 00 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date ot death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy otTrust) - 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (dale 01 dealh between 12.31-91 ard 1.1-95) D 11. Election to tax under See. 9113(A) (Allach 5ch 0) ... Z w C Z o a.. III II! II:: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Elyse E. Rogers FIRM NAME (If Applicable) Keefer Wood Allen & Rahal, LLP TELEPHONE NUMBER 635 North 12th Street, suite 400 Lemoyne, PA 17043 717-612-5801 1. Real Estate (Schedule A) (1) (2) 0.00 881,866.04 0.00 0.00 103,056.61 10,522.46 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) z o i= :3 ::) l- ii: <( () w 0::: 6. Jointly Owned property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 151,324.79 8. Total Gross Assets (total Lines 1-7) (8) 21,679.96 5,962.47 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 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) 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 Z rate, or transfers under See. 9116 (a)(1.2) o ~ 1 6. Amou nt of Line 14 taxable at lineal rate I- ::J ~ 17. Amount of Line 14 taxable at sibling rate o o 18. Amount of Line 14 taxable at collateral rate X ~ 19.TaxDue 20.0 0.00 x.OO_ (15) 1,119,127.47 0.00 0.00 x .045-- (16) x .12 (17) x .15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o OFFICIAL USE @ --- -..J (- :.t,'b -":111" ...-:1_ en -0 ....... N W 0"' .) 1,146,769.90 27,642.43 1,119,127.47 0.00 1,119,127.47 0.00 50,360.74 0.00 0.00 50,360.74 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W4645 1.000 Ob . Decedent's Complete Address: S1REET ADDRESS 2100 Bent Creek Boulevard CliY Mechanicsbur STA1E PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 50,360.74 0.00 47,000.00 2,473.68 Total Credits (A + B + C) (2) 49,473.68 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 887.06 (5A) 0.00 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTEROFIMLLS,AGENT (5B) 887.06 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D b. retain the right to designate who shall use the property transferred or its income; . D c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [z] 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 all information of which preparer has any knowledge. [Xl [Xl [Xl [Xl [X] [X] DATE - ~l ~ C7 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. 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. S 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 retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .s. 9 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 9 9116(a)( 1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. 9 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. !W4646 1.000 EXHIBIT B REV.1503 EX + (1-97) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2006-0359 Bovier, Lloyd S All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER ceSCRIPTlON VALUE AT DATE OF OEA TH 182,211.14 1.4,516.969 shares Dow Chemical Co. (New England Securities account) 2 132 shares International Business Machines Corp. (New England Securities account) 10,825.32 3 218.914 shares National Fuel Gas Co. NJ (New England Securities account) 6,940.12 4 1,576.463 shares RPM International (New England Securities account) 30,228.67 5 5,414.478 shares Delaware Large Cap Val Fd Cl A (New England Securities account) 100,276.13 6 1,183.898 shares Delaware Ltd Term Govt Fd Class A (New England Securities account) 9,660.61 7 3,919.028 shares Franklin Penn Tax Free Inc Fd Cl A (New England Securities account) 40,365.99 8 1,575.388 shares pioneer Equity Inc Fd Cl A (New England Securities account) 47,277.39 9 6,243.226 shares Rochester Fd Municipals Cl A (New England Securities account) 113,876.44 10 16,789.432 shares Wm Balanced Portfolio Fd Cl A (New England Securities account) 234,548.37 11 2,987.775 shares Washington Mutual Investors Fd (New England Securities account) 95,429.53 12 255.8869 shares Dow Chemical Co. H,226.33 2W4696 3.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 881,866.04 . Estate Valuation Date 0: Death 0 16 006 Valuation Da: 0 16 C06 Processing Da C' 0 16 006 Shares or Par Securi t\; Desc:ription Hlgh/As): . Esta:e of: Es:a:e of ~loyd S. Bcvie~ ~ccount: Ne~ England Secu~~ties Bro}:erao Acct. Report ~,'pe: Date 0 Deat~ Number of Se':".lri':. es: 1: File ID: Bovier, Lloyd S. -- Estb:e Lo....,;/Bid 39.65000 H/L 39.68000 H/L Div: 0.375 Ex: 03/29/2006 Rec: 03/31/2006 Pay: 04/28/2006 132 INTERNATIONAL BUSINESS MACHS (459200101) COM NYSE 04/13/2006 82.60000 04/17/2006 82.92000 Mean and/or Di7 and :0: Sec~ri:v Adjustrner::s Ac:ruo::'s ValUE: 81.12000 H/L 81.40000 H/L 31.33000 H/L 31. 59000 H/L 18.89000 H/L 18.91000 H/L 5) Div: 0.16 Ex: 04/11/2006 Rec: 04/13/2006 Pay: 04/28/2006 5414.478 DELAWARE GROUP EQUITY FDS II (245907100) LRG CAP VAL A NASDAQ 04/13/2006 39.964250 180,517.=8 1 ) 4516.969 DOW :HE~ CO (260543103) COM NYSE 04/13/2006 04/17/2006 40.07700 40.45000 18.52000 Bid 8.16000 Bid 10.30000 Bid 30.01000 Bid 18.24000 Bid 13.97000 Bid 31. 94000 Bid 1,693.86 82.010000 10,825.32 2) 3) 218.914 NATIONAL FUEL GAS CO N J (6361801011 COt~ NYSE 04/13/2006 04/17/2006 31.75000 32.14000 31.702500 6,940.12 4 ) 1576.463 RPM INTL INC (7496851031 COM NYSE 04/13/2006 04/17/2006 19.06000 19.20000 19.015000 29,976.44 6) 1183.898 DELAWARE GROUP TREAS RESVS (245912308) LTD TRM GV NAS m,Q 04/13/2006 252.23 18.520000 100,276.13 7 } 3919.028 f~~NKLIN TP~ FREE TR (3547238011 Pl'. TIF INCM A NASDl',Q 04/1312006 8.160000 9,660.61 81 1575.388 PIONEER EQUITY INCOME FD (72366VI08) CL A NASDAQ 04/13/2006 10.300000 40,365.99 9 ) 6243.226 ROCHESTER FD MUNS INC (771362100) COI~ NASDAQ 04/1312006 30.010000 47,277.39 10 ) 16789.432 WM STRATEGIC ASSET MGMT PORTfL (928967504) B.~LANCED POR A NASDAQ 04/13/2006 18.240000 113,876.44 11) 2987.775 WASHINGTON MUT INVS fD INC (939330106) COM NASDAQ 04/13/2006 13.970000 234,548.37 Page 1 31.940000 95,429.53 This report was produced with EstateVal, a product of Estate Valuations & Pricing s,'stems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsYS.com. (Revision 7.0.2) . . Date of Deatt 0 6 006 Val1.;'otion Oat " 6 006 P:-oc:essing Da c' 0 6 006 Acco~nt: Es:ate of: Esta:e of Lloyd~. B~v r tJe~ England Secur~ties Bro~:erag~ A: Repor: ~:::pe: DatE of De h !'Jumbe:: of Secu::.~ieo: l~ Fi~e :D: Bo~..ie=, :"'lo~..-::i S. -- Es:a~e Totel V'clue: Tota~ Accn;al: Total: S87l,639.7~ $869, 69j. 62 S::',946.09 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, ,Inc~ I~,YOU have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revlslon !.O.~I . . Esta~e .v7aluation )c~e . Dea::!;: 0 16 I 006 Valua :o~ Date: 0 16/ 006 p.....,....",...Q sing Da:e: 0 08/ 006 Estate of: ES'tc.tE 0: Lloyd S. B8'\.-ier Ac:coun t.: Do\"\' :herr~ical Di yidenc Re i:1-v~es tmen ~ccot.: Report Type: D~t'2 0 Dea:r: N"Jmbe:- c: Sec~ri .le.s: 1 rilE: ID: Bo'\~ie:1 :"loyd S. -- Es:ate Shares Securi t': DescriptiofJ High/;~st: L::Yvi/Sid Mean and./or Div anc In~ Adjustme~t5 AC2~~als .sec~ri:: \' or Pa::: \~alue :55.8869 DOW CHEM co (260543103) COH tJ~SE 04/:3/2006 04/:7/2006 40.0~700 40.45000 39.65000 filL 39.68000 H/L 39.964250 10, 2~E.33 Div: 0.375 Ex: 03/:29/2006 Rec: 03/31/2006 P"'''' 04/28/2006 95.96 Total Value: Total J:I.ccrual: Total: $10,322.29 $10,226.33 $95.96 Page 1 This report was produced with EstateVal, a product of Estate valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.2) EXHIBIT E COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY . REV-1508 EX + (1-97) ESTATE OF Bovier, Lloyd S FILE NUMBER 21-2006-0359 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Short Term Income Cl B Money Market Account (New England Securities account) VALUE AT DATE OF DEATH 25,513.88 2 MetLife Bank Premier Money Market (New England Securities account) 40,296.50 3 The Bridges - - refund 1,495.90 4 Bisys Retirement Account 35,750.33 2W46AD 2.000 TOTAL (Also enter on line 5, Recaoitulationl $ (If more space is needed, insert additional sheets of1he same size) 103,056.61 700 17th.' Suite 300 Denver, C 0202 REF NeE NUMBER CHECK NUMBER 0000506923 OL~~~ ~~ ~C DATE 08/09/2006 PLAN ACCOUNT NUMBER 07C22497 PAID TO: PAID FOR: ESTATE OF LLOYD BOVIER 55 10TH CT HERMOSA BEACH, CA 90254 000 EST A TE OF LLOYD BOVIER 55 10TH CT HERMOSA BEACH, CA 90254 PLAN NAME: LLOYD S BOVIER DESCRIPTION: Disbursement TAX DESCRIPTION: (4)Death Distribution Gross Fed Tax State Tax Loan Default 35,750.33 7,150.07 715.01 0.00 ~~:~: Net Check Amount $27,885 .25 ;~tt~i~~~~~~~~~~j~~j~~~~~~l~lit~~j~:~:~~i~i;~~~j~~~~j~~~;1j~~~~j1jjji~;ij~jjj~~j~itji~~jiij~~1~t~jj~j1jjjjjj;~jjijiijjjjjjjiij~jjjjjjjjjjjjjjjjj1;j~j1jjijjjj~jjjjjjjjjjjjj~ijjjtjj1ijiij~jjj~j;jitiijjjjijjjjjjjjjijjjjjjjjijjjjtjjijjjjjj;jjjjjjj;ijjjiijji@jjjtj~ijjjj~jjjj~jjijijjjjjjjtjijjjjjjiijjjjjjijjjjjjjtjjjjjijjjj~ijtjjiif1 By signing, cashing, and/or depositing this Disbursement check I agree to all of the terms of this distribution. If you have questions about your payment, please call your employer or plan administrator. Because the legal and tax rules for a distribution differ for each person, please consult an attorney or tax advisor. Tax forms will be mailed in January of the year following the distribution. .. FOLD ON PERFORATION AND DETACH AT THE DOTTED LINE .. -------------------------------------------------- PrMTl JwlATRlXl P)oIEMATJ HP1 "'" . I. . .. .: I . . .. .... ',' . ~:f..0....e.n....0..:.'.-:::~~:~~~~3PQ ,:::.". '. .. "'~ 89-53 !Il'2'r ...... .......:::;;;.... ," '.:;::.,':::..... '. '. ~, ~ . :'.' .' .,' ..;.' ..-;:;',....;: :~:;-' '::.:: . '~:;.::;:. ,", ," ,,- ~~~~1[~~usand eimr~uff~"~tf!1~:=ll:/l00 180 DAYS ",,::;:;:::;;.:::;.", . ~~I~~7~~1r.:t ~.".. .:C,'.. ...'../0!JJ~. "'/./'... . ..:--..... . .." -," ....... ....... .... ........... .... - .... .... '. - . ,," .." ".......... "'......' ..'.'.,"'....:,.....,........ ....' K ...,>ii , - -, -' . , . . . . - . . " :-.':' -.: .:.':- .... .",'., -., ,':': .'.:-:' ..:- ,".'. .... .-. .... ... .,' ",' ","' '-'", --.. ....'... . .. " .... ".-.."-" ....' ".-.' ", ',". . .- ..... ',' '. .' ,.... '-'-"- . - . - ','-',,-, .. -.. ,". .... ,",' ,",,' .. A~ih~riZed~i~~~ture ."'./ ...... :~/: " - :'.': .:.::;.;::: II- 0 0 0 0 50 b 9 2 :111- I: ~ 0 2 0 B 9 5 :1 ~ I: 2 7 0 0 0 0 0 0 ~ 711- .: 1:::all:1 [oll~'" .1111" I h'll::I ~I.: "'\.""'.:1 ::I::l.::IolI .l'l ::&'.'1'''.::1 :1""":1 ~c I] ~II.: l::a =f" oj:_: (.1. ...... .,~..mol.:a .0.'11 ::1.'.'&'.'1: 1::1 ~I": 1::11l:~ (Nell.: l::a::l ~ Illo]:~::I ""::I ~. EXIBIT F . . REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bovier, Lloyd S SCHEDULE F JOINTL V-OWNED PROPERTY FILE NUMBER 21-2006-0359 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOI NT TENANT(S) NAME A. Petko, Catherine B ADDRESS RELATIONSHIP TO DECEDENT Daughter 458 Woodcrest Drive Mechanicsburg, PA 17050 B. c. JOINTL Y-OWNEO PROPERTY: LE1""TER DATE DESCRIPTlON OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-heid real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A 08/09/2002 Orrstown Bank Checking 21,044.92 50.00 10,522.46 Account #111000440 inc1uding $1. 32 interest accrued to date of death TOTAL (Also enter on line 6, Recaoitulation) $ 10,522.46 2W46AE 2.000 (If more space is needed, insert additional sheets of same size) . . O/tA4~ ~ May 9,2006 TO: law Offices of Keefer Wood Allen & Rahal, llP 415 Fallowfield RD, Suite 301 Camp Hill, PA 17011-4906 FROM: Todd L. Miller Cust. Service Specialist P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Lloyd S. Bovier DATE OF DEATH: April 16, 2006 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOllOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED 111000440 Lloyd S. Bovier 08/09/02 Catharine B. Petko PRINCIPAL & ACCRUED INTEREST ~.91 $1.32 ~J uJ).'5'1 EXHIBIT G COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bovier, Lloyd S . . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY REV-1S10 EX + (1-97) FILE NUMBER 21-2006-0359 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 %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBEF DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIF APPLICABLE) 1. Hartford Life Annuity - 151,324.79 J.oo.oo 0.00 J.5J.,324.79 contract no. 47636 TOTAL (Also enter on line 7, Recapitulation) $ 151,324.79 2W46AF 2.000 (If more space is needed, insert additional sheets of same size.) . -~ May 8, 2006 Keefer Wood Allen & Rahal Attn: Elyse E Rogers 415 Fallowfie1d Rd Suite #301 Camp Hill, PAl 70 11-4906 . X Hartford Life Reference: Annuity Contract Number - 47636 Decedent - Lloyd S. Bovier Dear Ms. Rogers: For your convenience, we are providing you with the following information: Contract Number: Owner: Decedent: Owner's Social Security Number: Date of Death: Value as of Date of Death: Tax Cost Basis: 47636 Lloyd S. Bovier Lloyd S. Bovier 107-03-1405 Apri116, 2006 $ 151,324.79 $ 45,000.00 Hartford Life employees do not provide tax or legal advice. We strongly recommend that you speak with a qualified tax advisor. If you have any questions, please contact one of our Annuity Service Specialists by calling 1-800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m., Friday 9:15 a.m. to 6 p.m., Eastern time. We will be happy to assist you. Sincerely, Dina McCann Assistant Director Contract Management Investment Products Services Hartford Life Insurance Company DMlkmc Hartford Life Insurance Companies 200 Hopmeadow Street Simsbur)', CT 06089 Toll Free 1 800 862 6668 Individual Annuity Operations Mailing Address: P.O. Box 5085 Hartford, CT 06102-5085 EXHIBIT H REV-1511 EX + (1-97) . . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bovier, Lloyd S FILE NUMBER 21-2006-0359 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. 8 9 10 11 2W46AG 2.000 DESCRIPTION 1. FUNERAL EXPENSES: E. Canton OM Church - post funeral reception 2 Malpezzi Funeral Home - funeral expense 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip 2. Year(s) Commission Paid: Attorney Fees Name: Keefer Wood Allen & Rahal, LLP 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Sovereign Bank - checkbook fee Cumberland Law Journal - legal advertising The Sentinal - legal advertising Register of Wills of Cumberland County - additional probate fee Reserve for additional out of pocket expenses TOTAL (AlSO enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of same size) $ AMOUNT 100.00 10,401.20 0.00 10,000.00 0.00 652.00 0.00 0.00 21. 99 75.00 129 .77 50.00 250.00 21,679.96 EXHIBIT I REV-1512 EX + (1-97) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bovier, Lloyd S SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2006-0359 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 3,546.00 1. U.S. Treasury -- balance due on 2005 income tax 2 PA Dept. of Revenue - balance due on 2005 income tax 453.00 3 U.S. Treasury - quarterly estimated tax payment for 2006 1,000.00 4 Greenawalt & Co., P.C. - tax preparation fees for 2005 275.00 5 Alert Pharmacy - balance due 68.13 6 West Shore EMS - services on 4/15/06 not covered by Medicare 620.34 2W46AH 2.000 TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,962.47 EXHIBIT J REV-1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bov~er Llovd S NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Bovier, Irene S 55 10th Court Her.mosa Beach, CA 90254 1. 2 Bovier, Frederick L 14528 Cutstone Way Silver Spring, MD 20905 3 Petko, Catherine B 458 Woodcrest Drive Mechanicsburg, PA 17050 . FILE NUMBER 21-2006-0359 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Daughter AMOUNT OR SHARE OF ESTATE 470,418.19 319,093.41 329,615.87 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. 2W46A11.000 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) $ 0.00 . . LAST WILL AND TESTAMENT OF LLOYD S. BOVIER I, LLOYD S. BOVIER, presently residing at 13 Spruce Acres, in the Village of Penn Yan, County of Yates, State of New YorK, D~ing of sound ano disposing mind and memory, DO HEREBY MAKE, PUBLISH AND DECLARE this as and for my Last will and Testament, hereby revoking any and all former Wills and Codicils thereto by me heretofore made. FIRST: I direct that all of my just debts and funeral expenses be paid as soon after my death as may be convenient and proper. SECOND: I give and bequeath to share and share alike to my children who survive me, all of my articles of domestic and personal use and any automobile which I may own at the time of my death. THIRD: All of the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wherever situate, which I may own or have the right to dispose of at the time of my death (hereinafter referred to as "my residuary estate"), I give, devise and bequeath in equal shares to my children who survive me. In the event any child or mine should prt:=deceasE: t;';e, I gi -v'e, devis2 and bequeath the share he or she sho~ld have received to his or her issue, natural-born and adopted in equal shares per stirpes. In the event there should be any child of mine who has predeceased me without issue surviving, I give, devise and bequeath the share he or she should have received if living to my remaining issue in equal shares per stirpes. ~Ajj . . FOURTH: Whenever the terms "issue" and "children" are referred to herein, they are intended to apply to adopted as well as natural-born children. FIFTH: If any party to a judicial proceeding involving my estate or a trust created hereunder has the same interest as another party who is a person under a disability, it shall not be necessary to serve a citation in such proceeding upon the person under a disability, it being my intention to provide for the virtu~l representation under Section 315(5) of the New York Surrogate's Court Procedure Act or any successor statute thereto. SIXTH: The masculine gender shall be deemed to include the feminine, the singular shall be deemed to include the plural, and vice versa, where appropriate. In addition, anyone Executor and/or Trustee acting hereunder shall have the right to act alone in performing ministerial duties or powers in connection with the administration of my estate and any trust hereby created, including, but not limited to, signing checks, notes, acceptances and other instruments and orders for the payment of money and endorsing stock certificates and bonds. SEVENTH: I hereby direct that all transfer, succession, inheritance and estate taxes and any interest and/or penalties thereon assessed against in:/" taxable csti:.te shall be charged against .and paid out of m~l residuary estate. EIGHTH: In addition to and not in limitation of the powers and discretions conferred upon my Executrix and her successor or successors by law or herein elsewhere conferred upon them, I give and grant to my Executrix the following powers and authority which may be exercised by her 2 i/PJ . . at any time and from time to time as she shall, in her absolute discretion, deem advisable. 1. To sell, mortgage, lease, conveyor transfer any or all of my property, real, personal or mixed, at public or private sale, without obtaining the approval of any court, judge or surrogate therefor. 2. To lease any such property upon such terms and conditions as she deems advisable irrespective of whether the term of such lease shall exceed an}T lease period permitted by law aD.d to renew or modif:{ any such lease, to make repairs, replacements and improvements, structural or otherwise, of any such property and to charge the expenses thereof to principal or income as she may deem proper. 3. To divide the principal of my estate, when she is required to do so, without converting same into money, but in her discretion, by apportioning the property held, whether income-producing or not, to such different parts or shares in such manner as she shall deem fairly and equitably to bring about the required division. 4. To exercise all power and authority conferred in this Last Will and Testament with respect to all accumulations of income under this Last Will and Testament and with respect to all property held under any power in trust crea~ed by this Will. 5. To invest and reinvest all of the funds and property coming into her hands in such securities and real estate as she may deem proper and suitable, without restriction to the class of investment which executors and trustees are, or may hereafter be permitted by law to make; to retain, sell, lease, mortgage, exchange or otherwise dispose of any and all 3 I It' P , /l/ .( /\ ~ \. . . . securities or property in my estate, and for such periods of time as she may deem proper. 6. To employ counsel and other agents in the discharge of her duties and to determine and pay them reasonable compensation. 7. To enforce or extend the time of payment of any bonds, mortgages or other obligations or liens, to enter upon such contracts or agreements, and to make such compromises or settlements of debts, claims or controversies as she shall de~m ~dvisable. 8. To vote securities by proxy, consent to mergers, consolidations and reorganizations, exercise options, make exchanges or deposits of securities, hold investments in the name of nominee and otherwise to do any act or exercise any power with reference to any property held by my Executrix that may be legally done or exercised by any person owning similar property in his own right. To exercise any outstanding stock options which I may hold at the time of my death, and with respect to any such options, my Executrix shall be endowed with all the rights incident to absolute ownership, and is authorized to borrow upon such terms as she may deem appropriate such sum or sums of money as she may deem necessary or desirable to facilitate the exercise of such stock options and to extend or apply any money or property of mine or of my estate for such purpose. 9. I hereby authorize my Executrix to retain and/or to invest in property that is unproductive or underproductive of income, or to retain or to invest in property expressly without regard to whether it is productive of income, any provision of law and, specifically, New York State EPTL Section 11-2.1(k) or any successor statute thereto, notwithstanding. 4 ) 4JAJ . . Further, my Executrix is hereby directed that, upon sale of such unproductive or underproductive property, no portion of the sale proceeds hereof are to be added to or classified as income. 10. a. Every election, determination or other exercise by my Executrix of any discretion granted to her expressly or by implication in this Will or by law, whether made upon a question actually raised or implied in the acts or proceedings of my Executrix, shall, so far as permitted by law, be conclusive and binding upon all persons. b. No person dealing with my Executrix shall be required to see to the application of any property paid or delivered to her, or to inquire into the expediency or propriety of any transaction or the authority of my Executrix to enter into or consummate the same upon such terms as my Executrix may deem advisable. NINTH: I hereby nominate, constitute and appoint my daughter, IRENE S. BOVIER, presently residing at 55 10th Court, Hermosa Beach, California 90254, as Executrix of this, my Last will and Testament, to serve without bond. In the event that, for any reason whatsoever, my said daughter, IRENE S. BOVIER, shall fail to qualify or cease to act as such Executrix, I nominate, constitute and appoint my daughter, CATHARINE B. PETKO, presently residing at 458 Woodcrest Drive, Mechanicsburg, Pennsyl,rania 17055 and my son, FREDERICK L. BOVIER, 14528 Cutstone Way, Silver Springs, Maryland, as Successor Executors hereunder in her place and stead, to serve without bond. I further direct that no bond or other security shall be required of my said Executrix or her Successor in connection with the advance payment of any commissions to her for acting as such Executrix hereunder. 5 iJQJ \; . . IN WITNESS WHEREOF, I have hereunto set my hand and seal and do publish and declare these presents as and for my Last will and Testament, in the presence of the witnesses attesting the same at my request to this, my / 1 Last Will and Testament, this ~ day of i JC(~l2f~.c..: , 1999. ;{~~~~4Pp/ . ;{ (L.S. ) The above instrument, consisting of SlY.: (6~ t:'r':pewri..tten pages, including the page on which we, the undersigned, have subscribed our names as witnesses, was on the date hereof subscribed, sealed, published and declared by the Testator, LLOYD S. BOVIER, as and for his Last Will and Testament, in the presence of us and each of us, who, at his request, in his presence and in and the presence of each other, we believing him to be of sound and disposing mind memory have hereunto subscribed our names as witnesses thereto, the ~ o~ I 1999. day ~ ;JJf~~ W\ residing at ~~(7 residing at (lc-vn I?O, rJ..l 6 . . STATE OF NEW YORK COUNTY OF MONROE SS: On this 6th day of January, 2000, personally appeared before me, a Notary Public in and for the County of Monroe, State of New York, Douglas J. Lustig and William J. Shramek, who being severally and duly sworn on their respective oaths, depose and say: That they witnessed the execution of the attached Will of Lloyd S. Bovier, the within Testator, on the 21st day of December, 1999; That said instrument was executed at Penn Yan, New York, under the supervision of Douglas J. Lustig, Esq. an attorney at law with offices at Saperston & Day, P.C., Suite 800 First Federal Plaza, 28 East Main Street, Rochester, New York 14614; That deponents make this Affidavit at the request of the Testator; That said Testator, in their presence, subscribed his name to said Will at the end thereof and at the time of making such subscription declared the instrument so subscribed by him to be his Will; That each and all of the deponents, at the request of said Testator and in his sight and presence and in the sight and presence of each other, thereupon witnessed the executed of said Will by the said Testator by subscribing their names as witnesses thereto; That said Testator at the time of the execution of said Will was upwards of 18 years of age and in the opinion of each and all of the deponents was of sound mind, memory, and understanding and not under any restraint or in any respect incompetent to make a Will; That said Testator could read, write and converse in the English language and was not suffering from any defect of sight, hearing or speech, or from any physical or mental impairment which would affect his capacity to make a valid Will; and That the Testator signed only one copy of the said Will on said occasion. Severally subscribed and sworn to before me this ~tt day of J nuary, 2000. Severally subscribed and to before me this ~~day January, 2000. JOYCE R. SPANGAi'':i3Li,,,; Notary Public, Slate of New Yo;k Qualified in Monroe County Commission Expires /ol.3e,jc( Library: rochdocs Doc #: 5534 vI CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY. .JR. .JOHN H. ENOS m GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE .JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONG YEAR .JOHN A. FEICHTEL DONALD M. LEWIS m STEPHANIE KLEINFELTER ERIC R. AUGUSTINE TODD F. TRUNTZ CAROL L. VERISH KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 635 NORTH 12TH STREET. 4TH FLOOR LEMOYNE, PA 17043 PHONE 717-612-5800 FAX 717-612-5805 EIN No. 23-0716135 www.keeferwood.com January 17, 2007 Register of Wills of Cumberland County Attention: Jackie Courthouse High and Hanover Streets Carlisle, PA 17013 Re: Estate of Lloyd S. Bovier File #2006-0359 Dear Sir/Madam: ESTABLISHED IN 1878 OF COUNSEL: HEATH L. ALLEN N. DAVID RAHAL SAMUEL C. HARRY HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG. PA 17101 PHONE 717-255-8000 717-612-5801 erogers@keeferwood.com Enclosed is a check in the amount of $30 representing the filing fee for the Pennsylvania Inheritance Tax Return and Inventory for the above-referenced estate. cJr Enclosure Sincerel yours, -LP2 y~- ) Elyse E Rogers 0- l"-..) <=> <:::::> -.J c- ::;:,.. 2 co u :::: ., C) N w U'l Vlllo. d lP' D - pvro 1->. k c- c1 ~ t>U<. - ---.- 3~"lSOd sn l!'l 0) ..- (0 o N l!'l ..- :r: ';t ..- o C') I'- ;g 8 I'- ~ E I'- !: ..- LL ;:: '0 o ~ '; :;: 01 Q') C"") o ~ ~31S.V'H 'c tJ") C'? N ~It .JO ~o .J ...I <Cu. I <c :r e') a: I- "t "to ~ .-:" w,... z w <( W It 0.. .JI- .J(J)ui <(:rZ 01->- O C\I 0 ,...~ o :r w ~ ~...1 I!O Wz U. WLO We') ~<O - ......... 0_ co % '4L.~:.:. -. r- = = C"-..l II C) ~ o U "0 1a ] .0 tI) g ~ U ~ '- r:/) o I-; ("f') ,$ Q) ~ (5 ~ ~ ~ ~ ~:~~~~p..~ E .g] 1a ~ .~ ~ t..!:i'~ Ol)E;::lOl)~ Q) ..... 0..... ~ ~<U::c:U - - - - - - - - - - - - - - if ~.~: ~. LLJ ~:;:~ . -J:'T" (.,)."- n, o C ~ o f> r> .,. f) ~ o f" ...