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Home My WebLink About04-0265 · ~ PETITION FOR PROBATE and GRANT OF LETTERS Estateof flELVA K. WATSON No also known as To Regtster of Wills for the , Deceased County of CUMBERLAND tn the SoctalSecumtyNo 174-05-1989 Commonwealth of Pennsylvama The petmon of the understgned respectfully represents that Your petitioner(s), who ~s/are 18 years of age or older an the execut or named m the last will of the above decedent, dated OCTOBER 7~ 2003 and codmfl(s) dated NONE Decedent was domtcded at death m CUMBERLAND County, Pennsylvania, w~th h er last family or pnnctpal residence at CHURCH OF GOD HOME; 80t N. HANOVER STREET1 CARLISLEI NORTH MIDDLETON TOWNSHIP~ PENNSYLVANIA 17013 (hst street, number and mumcxpahty) Decedent, then 0S years of age, d~ed 314104 at Carhsle ReRIonal Medical Center, CarhsleI Carlisle Borou,qhI Pennsylvania Except as follows, decedent d~d not marry, was not d~vorced and d~d not have a chdd bom or adopted after executton of the will offered for probate, was not the wct~m of a kflhng and was never ajudmated mcompetent Decedent at death owned property w~th estimated values as follows (If dormcfled tn Pa ) All personal property $ 70~000.00 (If not dommfled m Pa ) Personal property ~n Pennsylvama $ (If not dommfled tn Pa ) Personal property ~n County $ Value of real estate ~n Pennsylvama $ sttuated as follows WHEREFORE, pettt~oner(s) respectfully request(s) the probate of the last wdl and codtcd(s) presented herewtth and the grant of letters TESTAMEHTARY thereon (testamenhary, adm~mstrat~on c t a, adm~mstrat~on d b n c t a ) )~CK~A 0~ 808 WALNUT LANE ~C' CARLISLE WPA 013 ~ J CE ~m ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF CUMBERLAND The petite?ncr(s) above-named swear(s) or affirm(s) that the statements tn the foregmng petttton are true and correct to the best of the knowledge and behef ofpetttmner(s) and that as personal represen- tattve(s) ofxthe ab_ore d_ecedent p?tttoner(s) will well and truly adm~ntster the estate according to law Swum to oI!.affirm..e.d~tgld subscribed ~---"'~ fi, J/to-- ~ before me this I '~ c,~ d~y of f -r- / ~ ter 0 Estate of BELVA K. WATSON ~ Deceased DECREE OF PROBATE AND GRANT OF LETTERS ANDNOW ~7~LIP-~ I~, ~ ,,nconslderat,onofthepet,t,onon the reverse s~de hereof, satisfactory proof having been presented before me, IT IS DECREED that the ~nstrument(s) dated t orr/os described there~n be admitted to probate and filed of record as the last w~ll of BELVA R. WATSON and Letters TESTAMENTARY are hereby granted to JACK NACE FEES Probate, Letters, Etc $ ] I~..~ , oc) MURREL R. WALTERS III ~4849 Short Certtficates( ) $ ~ ^TTORNEy (Sup Ct 1D No ) tt~*a~s~tat~n ~cza~ $ ~[o -cu~ 54 EAST MAIN STREET $ ~,0 ~ MECHANICSBURG PA 17055 To?~ $ p4~, aD ^~ss Flled~.~ ~ I ~ - ~) t_~ 717-69'/-4650 oq I05 805 REV 9/86 This is to certify that the information here given Is correctly copied from an original certificate of death duly filed with me as Local Registrar The original certificate will be forwarded to the State V~tal Records Office for permanent fflmg WARNING It is illegal to duplicate th~s copy by photostat or photograph. Local Registrar P 10159549 t AL8 200 , No Dale LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, BELVA K. WATSON, a resident of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not marned, my beloved husband, HAROLD W WATSON, having predeceased me, and that I have four (4) ~randchlldren, CAROL ANN SHEETS, BELVA KOHLMAN, TERRY HOLLINGER and CHESTER HOLLINGER, JR. II I dtrect that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I d~rect that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be prod from my residuary estate as a part of the expense of the administration of my estate. IV I give and bequeath FIVE HUNDRED DOLLARS ($500.00) to my great- granddaughter, ROBIN ANN KOHLMAN, per stlrpes V I give, devise and bequeath all the rest, remdue and remmnder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appmntment;,.to my grandchildren, CAROL ANN SHEETS, BELVA KOHLMAN, TERRY HOLLINGER and CHESTER HOLLINGER, JR in equal shares, per stlrpes. VI I nominate, constitute and appmnt JACK NACE, as Executor of th~s LAST WILL, to serve without bond. If JACK NACE is unable or unvalling to act in that capacity, then I nominate, constitute and appoint my grandson, TERRY HOLLINGER, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, BELVA K. WATSON, have set my hand to this LAST WILL this -~ ~ day of OC~°~- , 2003. BELVA K. WATSON Signed, sealed, pubhshed and declared by the above-named BELVA K. WATSON, as and for her Last Will and Testament, in the presence of us, who, at her request and ~n her presence, and in the presence of each other, have hereunto subscribed our names as witnesses ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND : I, BELVA K. WATSON, Testatrix, whose name m signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I mgned and executed the instrument as my LAST WILL, that I mgned it as my free and voluntary act for the purposes therein expressed. BELVA K. WATSON Sworn or affirmed to and acknowledged before me by BELVA WATSON, Testatrix, this 7~- day of 0~--~ ~ ,2003. Notary Public / My COMMISSION EXPIRES JUNE 11,2006 J AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : We, , the witnesses-- who~'e names are mgned to the attached or foregoin'g instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix mgn and execute the ~nstrument as her LAST WILL, that BELVA WATSON signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the heanng and sight of the Testatrix mgned the W~ll as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. Sworn or affh'med to and acknowledged before me this "~ day of ~)(_.Z-~,~ gfd~ ,2003. Notary Pubhc NOTARIAL SEAL DEBORAH L RYAN, NOTARY PUBLIC Cl~ OF M£CHANICSBURG, CUMBERLAND COUNTYJ MY COMMISSION EXPIRES JUNE 11,2006 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: BELVA K. WATSON Date of Death: March 4, 2004 Will No. 2004-00265 Admin. No. 21-04-01265 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 22, 2004 Name Address Carol Ann Sheets 16 Camp Ground Road, Dillsburg, PA 17019 Belva Kohlman 611 Brush Run Road, Bethel Park, PA 15102 Dr. Chester B. Hollinger, Jr. 302 Fox Chapel Road, Apt. 408, Pittsburgh, PA 15238 Terry L. Hollinger 425 Black Walnut Drive, Mountain Top, PA 18707 Robin Ann Kohlman 611 Brush Run Road, Bethel Park, PA 15102 / Notice has now been given to all persons entitled thereto ,under Rt~ 5.6(a)/xcept: NONE Date: March 22, 2004 r-- .~ Murrel R. Walters, III, Esquire ..... .tO. ~:~. 54 East Main Street ~ ii. Mechanicsburg, PA 17055 ~ (717) 697-4650 cz~ :.,.~'~i: Capacity: __ Personal Representative a~ ~z: ~ ~'~, = X Counsel for personal representative ~ :Dca COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003980 NACE JACK 808 WALNUT LANE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $3,200.00 ESTATE INFORMATION: SSN: 174-05-1989 FILE NUMBER: 2104-0265 DECEDENT NAME: WATSON BELVA K DATE OF PAYMENT: 05/26/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/04/2004 TOTAL AMOUNT PAID: $3,200.00 REMARKS: CHECK//507 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTBO, REV'1500 PENNSYLVANIA DEP*RT ENTOFREVEN B INHERITANCE TAX RETURN , NUMBER DEPT 280601 HARR,SBU* , PA 7128-060t RESIDENT DECEDENT 2 Z WATSON, BELVAK. I 7 4 - 0 $ - I 9 8 9 UJ REGISTER OF WILLS (,~ 03/04/2004 04/'19/t 907 ~ [] 1 Original Return [] 2 Supplementa[ Return [] 3 Remainder Return (dateofdeCpnorto~2. rs 82) ~ [] 4 Limited Estate [] 4a. FuturelnterestCompromise(d,teofde~haf~er~2rs82/ [] 5. Federal Estate Tax Retum Required L~J 6. Decedent Died Testate (Attao, copy of wi,) bi 7 Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ~' [] 9 Litigation Proceeds Received [] 10. SpousaIPovert~Credit(d~eofde~t~be~eea123191aad1~gsl [] 11.ElectiontotaxunderSec. 9113(A)(Ati~hS¢~ol ~_ THI~ SECTION MUST BE COMPLETEDL ALL CORRESPONDENCE AND CONFIDENTIAL TA~ INFoI~dlATiON SHO~; IRE DtRECTEE ~O! uJz NAME C~MPLETE MAILING ABDRESS z MURREL R. WALTERS III ~- FIRM NAME (If Applicable) ~ 54 E&$T MAIN o TELEPHONE NUMBER 1. Real Estate (Schedule A) (ti 2. Stocks and Bonds (Schedule B) (2) 3 Closely Held Corporation. Partnership or Sole-Proprietarship (3) 4 Mortgages & Notes Receivable (Schedule D) (4) 5 Cash. Bank Deposits & Miscellaneous Personal Property (5) 79,79t.27 (Schedule E) Z 0 6. Jointly Owned Prope~ (Schedule F) (6) [] Separate Billing Requested 22 7 inter-Vivos Transfers & Miscellaneous Non-Probate Prope~ (7) ~ (Schedule G or L) ,,~ 8. Total Gross Assets (total Lines 1-7) (8) 79,79'1.27 ILl 9 Funeral Expenses & Administrative Costs (Schedute H) (9) 5,119.50 10. Debts of Decedent. Modgage Liabilities, & Liens (Schedule I) (10) 8'10,29 11. Total Deductions (total Lines 9 & 1 O) (11) $~929.79 12 Net Value of Estate (Li~e 8 minus Line 11) (12) 73,86'1.48 13. Charitab!e and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Scdedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) 73,86'1.48 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES '~ rate. or transfers under Sec 9116 (a)(1 2) X __ (15) ~h- 16 Amount of Line 14 taxable at lineal rata X (16) 73,861.48 3,323.77 I~. t7 Amount of Line 14 taxable at sibling rate X 12 (17) O 18 Amount of Line 14 taxable at collataral rate X 15 (18) X 19 Tax Due (19) 3,323.77 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<: Decedent's Complete Address: STREET ADDRESS 801 NORTH HANOVER STREET DITY ISTATE IZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 3,323.77 2. Credits/Payments A. Spousal Poverty Credit B Prior Payments 3~200.00 C Discount 160.00 Total Credits ( A + B + C ) (2) 3,360.00 3 Interest/Penalty if applicable D interest E Penalty Total InteresC'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) 36.23 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ~ (5) A Enter the interesl on the tax due. (5A) B. Enter the total of Line 5 + 5A This is the BALANCE OUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 Did decedent make a transfer and: Yes No a re~ain 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 without receiving adequate consideration? ............................................................................................... [] [] 3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4 Did decedent own an Individual Retirement Account, annuity, or other non probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST OOMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. dnaef penalties of perjun¢ I deciare that i have examined this relum, including accom[:anymg s¢'eduJes and statements, and to the Pest of my knowledge and belief it is lrue correct and complete DeclaraPon of prep~r !hah [he aersonai represen[ative is based on all information of which preparer has any knowledge ADDRESS dACI~ HACE ~. SIGNATURE OF PRF~ir;~ OT,~E~;~/~'E?RESENTATIVE DATE ADDRESS MURREL I~. WALTERS III ESQ 54 EAST MAIN STREET, MECHANICSSURG 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 [72 PS §9116 (a)(1 1) For dates of death on or after January 1,1995, the tax tale ~mposed 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 surv~wng spouse from lax, and the statutory requwements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is :he 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 chiid is 0% [72 PS §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 45%, except as noted n 72 P S. §9116(1 2) (72 P S. §9116(a1(1)] The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiinos is 12% [72 P S. §9116(a)(1,3)1. 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. REV-1508 EX + (6-98) ~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER WATSON BELVA K. 21 04 Q2;t~5 Inctude the proceeds of liti§ation and the date the proceeds were received by the estate. All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PENNSYLVANIA STATE BANK 20,052.5~ CD 2 PENNSYLVANIA STATE BANK 50,277.54 SAVINGS 3 CITIZENS BANK 8,249.73 CHECKING 4 CHURCH OF GOD HOME 66t.29 PERSONAL ACCOUNT 5 ;ASH 164.00 6 IOFFMAN ROTH FUNERAL HOME 386.16 REFUND OF EXCESS FROM PREPAID FUNERAL TOTAL (Also enter on line 5. Recapitulat[or $ 79,791.27 (If more space is needed, insert additional streets of the same size) REV-1511 EX + (12 99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER WATSON, BELVA K. 21 04 0265 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN ROTH FUNERAL HOME MONUMENT LETTERING 65.00 B ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative (s) JACK NACE 2,000.00 Social Secudty Number(s)/EtN Number of Personal Representative(s) StreetAddress 808 WALNUT LANE City CARLISLE State PA Zip '1'7013 Year(s) Commission Paid: 2005 2. AttomeyFees MURREL R. WALTERS III ESQ 2,000.00 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 RECISTER OF WILLS 181,00 CUMBERLAND COUNTY 5 Accountant's Fees 6 Tax Return PrepareCs Fees JACK NACE C.P.A. 880.00 7. PENNSYLVANIA STATE BANK CHECKS 13.50 TOTAL (Also enter on line 9. Recapitulation) $ 5,1 '19.50 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) ,~ SCHEDULE I COMMONW~L~H OF PENNSYLV^N,^DEBTS OF DECEDENT, RES'DEN~ DECEDEN~ MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER WATSON, BELVA K. 21 04 0265 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 CAPITAL TAX COLLECTION BUREAU 9.90 PERSONAL TAX 2 CHURCH OF GOD HOME 657.00 RESIDENTIAL CARE 3 BROCKIE PHARMATECH 143.39 MEDICAL TOTAL (Also enter on line 10, Recapitulation) $ 810.29 (If more space is needed, insert additional sheets of the same size) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES ESTATE OF FILE NUMBER WATSOi'I. BELVA K. 21 04 0265 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE [. TAXABLE DISTRIBUTIONS [include outright spousal distdbutJons, and transfers under Sec, 9116 (a) (1.2)} G~REAT 1. ROBIN ANN KOHLMAN GRANDDAUGHTER $500 611 BRUSH RUN ROAD BETHEL PARK, PA 15102 2 CAROL ANN SHEETS GRANDDAUGHTER ONE QUARTER OF 16 CAMP GROUND ROAD RESIDUE DILLSBURG~ PA 17019 3 BELVA KOHLMAN GRANDDAUGHTER ONE QUARTER OF 611 BRUSH RUN ROAD RESIDUE BETHEL PARK, PA 15102 4 DR. CHESTER B. HOLLINGER iRANDSON ONE QUARTER OF 302 FO~/CHAPEI. ROAD, APT. 408 RESIDUE PITTSBURGH, 15238 5 TERRY L. HOLLINGER iRANDSON ONE QUARTER OF 425 BLACK WALNUT DRIVE RESIDUE MOUNTAIN TOP~ PA 18707 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET [][. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DiSTRIBUTiONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MAOE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET i $ (If more space is needed, insert additional sheets of the same s~ze) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDU~~=fAX~,' INHERITANCE TAX DIVISION,'''' PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX AFP 112-041 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-21-2005 WATSON 03-04-2004 21 04-0265 CUMBERLAND 101 BelVA K MURREl I} WALTERS 'Itt IfS,Q 54 E MAIN ST MECHANICSBURG PA 17055 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =!!l;7-Ex--AFP--rn-:(J!'r-NOY-ici-oF-i'N'tlE'RYfANC'E-TAi-A-PPRAYsEii€NT~--ALtowANcE-o'ir-----_._----- - --. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WATSON BelVA K FILE NO. 21 04-0265 ACN 101 DATE 02-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. HortgageslNotes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. .Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 79.791. 27 .00 .00 (8) NOTE: To insure proper credit to your account, subRit the upper portion of this for.. with your tax pay..ent. 79,791.27 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governll8ntal Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax (9) 1l0) 5,119.50 810.29 (11) (12) (13) (14) 5.929 79 73,861.48 .00 73,861.48 (Schedule J) NOTE: I~ an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total ~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. AlIOunt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 73,861.48 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 3,323.77 .00 .00 3,323.77 ~ TAX CR,"-DITS: .. Uk'" ...........r' I+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-26-2004 CD003980 166.19 3,200.00 02-14-2005 REFUND .00 42.42- TOTAL TAX CREDIT 3,323.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BUREAU OF INDIVlDUALi,fA)(ES, INHERITANCE TAX DIVISIOIf,,' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-16D7 EX AFl' {lZ-D41 '" ~'.., ,....., " C 'i ~ ~^ , .;, i. ~' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-28-2005 WATSON 03-04-2004 21 04-0265 CUMBERLAND 101 BElVA K MURREl Ih~At"fERS 54 E MAiN ST MECHANICSBURG lIt E'S't Allount Relli Hed PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IW :rgTJ.,.!r.'('~..(l5r:6J'.......i..."ARW!mer"Ar.~'1"t'tAm.bY'.1tc60FN...iii.................. ... ESTATE OF WATSON BElVA K FILE NO.21 04-0265 ACN 101 DATE 02-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-14-2005 PRINCIPAL TAX DUE:. 3.323.77 PAVMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-26-2004 CD003980 166.19 3.200.00 02-14-2005 REFUND .00 42.42- TOTAL TAX CREDIT 3.323.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 it SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. VNI MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: BELVAK.WATSON March 4, 2004 Estate No.: 2004-00265 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes_X_ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete (date) 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No_X_ B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. in interest: Did the personal representative state an account informally to the parties Yes_X_ No D. Copies of receipts, releases, joinders and approvals of formal 0 informal accounts may be filed with the Clerk of the Orphans' Cour nd may be attached to this report. ~ , </y Date::~ . co t.2 j-- MURRE R. W ALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 Capacity: Personal Representative ~_ Counsel for Personal Representative y1