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HomeMy WebLinkAbout02-0033PETITION FOR PROBATE and GRANT OF LETTERS Estate of ROBERT B. FAILOR No. 21-02-33 also known as To: Register of Wills for the Deceased. County of CUMBERLAND in the Social Security No. 2 0 5 - 09-~ 9J 4 6 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: ' alternate Your petitioner(s), who is/are 18years of age or older an theixecut fir · named in the last wilt of the above decedent, dated 'October 8, ,19. 9 3 and codicil(s) dated Dorothy B. Failor, the '~t~ointed Executrix, died February 3, 1999. (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, With h ~ _~ last family or principal residence at 4 5~West Avenue ." Shiremans tow~B~ -./~6Nr ~ (list street, number and muncipality) Decendent, then 80 years of age, died December 23, , L.2001 , at ~cll~ ~Momc~r~.~,~] Hospital Except as follow, s,. d~e~cefl, e. nt,djd not marry, was not d~vorced and did not have a child born or adopted after execution 01~ the wili-0f{ered for probate; was not the victim of a killing and was never adjudicated incompetent: ' ' . "" "~ ' Decendent at.death owfied ' ~- prppe~gy with estimated values as follows: {If domic{led in Pa.) ': '-Ail personal property ' $ 800,000.00 (If not domiciled in Pa.).~ ; .~P_~rsonal property in Pennsylvania $ (If not domiciled-in Pa.) :'? .'_Personal property in County . ' $ Value of real estate in Peffn~ylgania $ 130, 0 0 0.0 0 situated as follows:" '. 45 Wes'~ Avenue. Borough of Shiremanstown, Cumberland County, PA WHEREFORE, petitioner(s) respectfully request(s) the probate of the' last will and codicil(s) pre~ented herewith and the grant of letters Testamentary theron. (testamentary; administration e.t.a.; administration d.b.n.c.t.a.) 'Wil.lia~ Z immerman 210 Belaire Drive Shiremanstown, PA 17011 Sworn .to'"or afflrmed' ';and :subscrlbed'"¢ .... ~. (2~xm-~,.., '~f'r..Z& ~ '-j$~ · before me this 10tW ." ". day of [~ Gleo~ae Willia~Zim~erman ~ J~UARY , _ ~ ' ".~ 2002 J . - OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA '1 COUNTY O]~,,,,,~C,.U. MBERLAND y SS · ".-~ £~ ~/,',,,,, . · The pem,oner~s)~above-n~med swear(~) or affirm(s) that the statements in the foregoing petition are true and correct~ to the bestof'the knowledge and belief of petitioner(s) and that as personal represen- tative(s) p*f'ih'e/abov¢~ ' ' .... ' · d.e..cedeat petitioner(s) will well and truly administer the estate according to law. No. ,21-02-33' Estate of ROBERT B. FAILOR., Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW _ JANUARY 14, 2002 .-'c:--' .', in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 8, 1993 described therein be admitted to probate a~nd filed of record as the last will of Robert B. Failor and Letters Testamentary ai'e hereby granted to Geor_c[e Wi'l l~am Zimmerman Filed FEES., Probate, Letters, EtC .......... $ 515.00 Short Certificates( ) .......... $ 12.00 - a es 21.00 ~e~u~mtion ................ $ :J.G~ $ 5.00 .. TOTAL . $ ;:.'553~00 · . J~KY.. ~,..2. Q .o.2 ........ ;.... '. Horace A.. :J'oh'nson ( 06340 ) Johnson, Duf,f~e,. Stewart & Weidner A~ORNEY'(S~JCt. I.D. No.) 301 Market St., P. O. Box' Lemoyne., PA 1'7043-0109 ADDRESS i(715) 761-4540 PHONE 109 ' '{105.805 REV 9/86 "" ::"'~""::: :'%"""~'"':'>: :'~: the-,nf6rmat~on,~here ,g~ven ~s correctly cop~ed' f~om an'ong~n~'cerufi~te of death duly/filed ~i{h me as:', ~n~' ceruficatm~dl 8e fo~efl to' the~Statt%t~ Records O~ce':for. ~erma~'ent '- , > ~:5 ~NING:. i~ graph.,,.. kedA~ AN AUTOPSY 099999-00005/August 16, 1993/HAJ/LAB/28575 ROBERT B. FAILOR '" I, ROBERT B. FAILOR, of the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania, declare this to be my Last Will and Testament, hereby revOking all other Wills heretofore made by me. ITEM I My automobiles, household 'and personal effects and other tangible personalty of like nature are owned jointly be me and my wife, DOROTHY B. FAILOR. However, to resolve any question that may arise concerning said property, I bequeath my automobiles, household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing .insurance thereon to my wife, DOROTHY B. FAILOR, if she survives me by thirty (30) days. Should my wife, DOROTHY B. F~AILOR, not be living on the thirty-first (31) day after my death, I bequeath such tangible personalty (except as noted below in this Item I) together with any existing insurance thereon to GEORGE WILLIAM ZIMMERMAN and BARBARA M. ZIMMERMAN except, however, my.white marbletop table presently in the living room of my residence Igive to LISA MILOS GAJEWSKI and all toys, cat collection, dolls and coaches I give to children of Wendy Branderhorse to wit: Ruth, Martha and Leah, to be divided among them by my executrix as she deems best. Any such article allotted to a minor may, as my executrix thinks advisable, either be delivered to the minor or any person to hold for the minor. ITEM 1I If my wife, DOROTHY B. FAILOR, survives me (and I direct that for purposes for of this Item II she shall be deemed to have survived me unless it appears unmistakably that she predeceased me). and if the Federal Estate Tax due because of my death will be reduced by making this gift for her benefit, I devise 'and bequeath to my wife, DOROTHY B. FAILOR, the least amount (based upon values as finally determined for federal estate tax purposes) as shall be needed for the federal estate tax marital deduction to 099999-00005/August 16, 1993/HAJ/LAB/28575 reduce the federal estate tax to the lowest possible figure after full use of all other deductions and credits allowable in Calculating the federal estate tax. Accordingly, I direct that: A. If the marital deduction or any similar benefit is allowable with respect to any property, including property held by entireties, which my wife has received prior to my death or at my death will receive otherwise then pursuant to this Item II, the value of such property shall be taken into consideration in calculating the size of the gift under this Item II. B. No property ineligible for the marital dedUction or any' similar benefit shall be distributed to this gift for my wife, DOROTHY B. FAILOR, pursuant to this Item II. C. Either cash or investments or both may be allocated to the gift under this Item II. D. Any property allocated under this Item II in kind shall be valued at the value at which it is finally included in my gross estate for federal estate tax purposes, provided that the aggregate market value thereof on the date of allocation (plus the value as finally determined for federal estate tax purposes of all other property qualifying for the marital deduction) it at least equal to the dollar value of the marital deduction as finally determined for federal estate tax purposes. E. If any provision of my Will shall result in the depriving my estate of the marital deduction for federal estate tax purposes, such provision is hereby revoked :and my Will shall be read'as if any portion thereof inconsistent with allowance of the marital deduction'for federal estate tax-purposes is null and void. ITEM III I devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate to the Trustee hereinafter named, IN TRUST, for the following uses and purposes: -2- 099999-00005/August 16, 1993/HAJ/LAB/25575 A. To pay the net income therefrom to my wife, DOROTHY B. FAILOR, for and during her lifetime in such periodic installments as the Trustee shall find convenient, but at least as often as quarter- annually. B. As much of the principal of this Trust as Trustee in its sole discretion may from time to time think advisable for the support of my wife or during illness or emergency shall be either paid to her or else applied directly for her benefit by the Trustee after taking into account her other readily available assets and sources of income and support. C. Trustee may apply the net income of this Trust for the support of my wife, DOROTHY B. FAILOR, should she by reason of age, illness or any other cause in the opinion of the Trustee be incapable of disbursing it. D! On the death of my wife, DOROTHY B. FAILOR, the then remaining principal and any undistributed income shall be distributed as follows: Twenty percent (20%) thereof as follows: Twenty percent (20%) to Andrea Jane Royce Twenty percent (20%) Helen Ann F DeBenneditto The balance as shall be divided equally among the following: (i) one equal share to Christine and Harry Habecker or the survivor thereof (ii) one equal share (iii) one equal share (iv) one equal share (v) one equal share (vi) one equal share (vii) one equal share (viii) one equal share (ix) one equal share to Todd W. Zimmerman to Chris M. Zimmerman to Kathy Turner Irlbacher to Mindy Milos to Lisa Milos Gajewski to Florence Miller to Richard Shatzer to James R. McGee; Jr. -3- 099999-00005/August 16, 1993/HAJ/LAB/28575 (x) (xi) (xii) (xiii) (xiv) (xv) one equal share to Michael McGee one equal share to Patrick McGee one equal share to Nancy Lengkeek one equal share to Gail W. Merrill one equal share to Wendy Branderhorse one equal share to Douglas Watson d. Should any of the gifts provided for in Item III paragraph D, subparagraphs a, b and c (i) through and in.eluding (xiv) lapse, the share which he, she or they would have taken but for said lapse shall go to GEORGE WILLIAM ZIMMERMAN and BARBARA M. ZIMMERMAN and their then living issue, per stirpes. 2. Eighty percent (80%) thereof to George William Zimmerman and Barbara M. Zimmerman, and their then living issue, per stirpes. ITEM IV If my wife, DOROTHY B. FAILOR, does not survive me, I devise and bequeath the rest, residue and remainder of my estate as set forth in Item III paragraph D of this my Will. ITEM V All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid from my residuary estate under Item III without apportionment or right of reimbursement. All such taxes on present or future interest shall be paid at such time or times as my Executor or my Trustee may think proper, regardless of whether such taxes are then due. 099999-00005/August 16, 1993/HAJ/LAB/28575 ITEM VI The interest of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM VII My executrix, executor and trustee and their successors shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all Property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To retain any or all of the assets of my estate, real or personal, including any shares of stock or other securities I may own of the corporate fiduciary or its successor, or of a holding company controlling the corporate fiduciary or its successor, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principal of diversification or risk. B. To invest in all forms of property (including stock or other securities of the corporate fiduciary or its successor, or of a holding company controlling the corporate fiduciary or its successor, and common trust funds and mortgage investment funds whether maintained by my corporate fiduciary or its successor or others), without restriction to investments authorized for Pennsylvania fiduciaries, as they deem prgper, without regard to any principal of diversification or risk. C. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. -5- 099999-00005/August 16, 1993/HAJ/LAB/28575 E. To join with my wife, DOROTHY B. FAILOR, or her personal representative in filing a joint income tax return without requiring her or her estate to indemnify my estate against liability for the tax attributable to her income and to consent to any gifts made by my wife during my lifetime being treated as having been made one-half by me for purposes of the federal gift tax law. F. To choose the optional valuation date for federal estate tax purposes, without regard to whether the size of the marital deduction gift in Item II hereof will be increased or decreased thereby and without requiring reimbursement. G. To exercise any law-given option to treat administrative expenses either as income or as estate tax deductions, without regard to whether the expenses were paid from principal or income, without regard to whether the size of the marital deduction gift in Item Il hereof will be increased thereby and without requiring reimbursement. ITEM VIII I appoint GEORGE WILLIAM ZIMMERMAN Trustee of any Trust created by this my Last Will. Should he fail to qualify or cease to act as Trustee, I appoint PNC BANK, NATIONAL ASSOCIATION, as Trustee. ITEM IX I appoint my wife, DOROTHY B. FAILOR, Executrix or this my Last Will. Should my wife, DOROTHY B. FAILOR, fail to qualify or cease to act as Executrix, I appoint GEORGE WILLIAM ZIMMERMAN Executor of this my Last Will. Should both DOROTHY B. FAILOR and GEORGE WILLIAM ZIMMERMAN fail to qualify or cease to act as Executrix or Executor respectively, I appoint BARBARA Z. ZIMMERMAN Executrix of this my Last Will. Should all the foregoing fail to qualify or cease to act as Executrix or Executor, I appoint CHRISTINE HABECKER, Executrix of this my Last Will. -6- 099999-00005/August 16, 1993/HA J/LAB/28575 IN WITNESS WHEREOF, I have hereunto set my hand and seal this t9~'-~ day of °t - '- Robert B. Failor Signed, sealed, published and declared by the above-named Testator, 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 each other have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS ~ We, Robert B. Failor, the Testator and ~ .~.~ and ~. ~'1 ~ ~ ~ ~t~x . the witnesses, respectively, whose names are signed to the attachedX~'or foregoing instrument, being first duly sworn, do hereby declare to'the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Robert B. Failor -7- 099999-00005/August 16, 1993/HAJ/LAB/28575 Witness Subscribed, sworn to and acknowledged before me by Robert B. Failor, the Testator, and subscribed and sworn to before me by¥,,~..~ c~, .~ and c~. q.~'xr.~~ ,~.. , witnesses, this <~-N'- day of ~ , 1993. Notary Putfl,ic~ NOTARIAL SEAL l DIANNE LENIG, NOTARY PUBLIC I LE~YNE BORO: CUMBERLAND CO. J 'MY COMMISSION EXPIRES DEC, 21, 1993~ -8- r <o.>-, z ~ - Z _"ri .q COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) O0O962 ZIMMERMAN GEORGE WILLIAM 210 BELAIRE DRIVE SHIREMANSTOWN, PA 17011 --; ..... fold ESTATE INFORMATION: SSN: 205-09-9346 FILE NUMBER: 2102-0033 DECEDENT NAME: FAILOR ROBERT B DATE OF PAYMENT: 03/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 1 2/23/2001 ACN ASSESSMENT CONTROL NUMBER AMouNT 101 $175,000.00 TOTAL AMOUNT PAID: $175,000.00 REMARKS: GEROGEWILLIAM ZIMMERMAN SEAL CHECK#1012 INITIALS' JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will Noi:' .-' To the Recster: ROBERT B; FAILOR DECEMBER 23, 2001 2002-00033 Admin. No.:! I certify that notice of beneficial interest required by Rule 5.6(a) of the Orpha'ns' Court Rules was served on or mailed to the following beneficiaries of the above-~aptioned lestate on April 3, 2002. Name Address JAMES R. McGEE, III 10406 N.W. 7th Street Plantation, Florida 33324 PATRICK J. McGEE 3784 Sedgefield Drive Conover, North Carolina 28613-8960 MICHAEL T. McGEE 14211 N.W. 18 Manor Pembroke Pines, Florida 33028 ~ I ANDREA J. FAILOR ROYCE 17 Union Turnpike Branchville, New Jersey 07826-4217 HELEN A. FAILOR DiBENEDETTO 15 Carol Court Sebastian, Florida 32958 KATHARINE L. TURNER IRLBACHER 2278 Reis Run Road Pittsburgh, PA 15237 RICHARD FRANKLIN SHATZER 369 Bethel Church Road New Cumberland, PA 170~'0 MELINDA M. MILOS DALE 4865 Gallagher Road Rochester, M 48306-1508 , LISA G. MILOS GAJEWSKI 50 Lindsay Lane Carlisle, PA 17013 FLORENCE L. MILLER 47 Riley Drive Hampton, Virginia 23666-1337 REVEREND DOUGLAS A. WATSON 104 Sarah's Lane Horsham, PA 19044 GAlL D. WATSON MERRILL 5 Alton Court Drummond Hill Newark, Delaware 19711-7614 WENDY L. WATSON BRANDERHORST 312 Eastmont Avenue Holland, MI 49424 [O:~d ~Z-~d'~ ZO. RegiSter of Wills of CUMBERLAND INVENTORY County, ,PennsylVania Estate of ROBERT B. FAILOR No. 21-02-00033 Also known as Date of Death: 12/23/2001 Social Security No. 205-09-9346 Deceased I, GEORGE WILLIAM ZIMMERMAN 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 place opposite each item of said Inventory represent 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. INVe verify that the statements made in this Inventory are true and correct. INVe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. HORACE A. JOHNSON Name of Attorney: I.D. No.: 06340 Address: Johnson Duffle, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemoyne, PA 17043 Telephone: (717) 761-4540 Personal Representative: -(](~)I~(~E WiLLIAr~I~I~IEI~MAN, EXECUTOR Address: 201 Belaire Drive . Shiremanstown, PA 17011 Telephone: 717/761-1894 Dated: ~~t,) -/4 Description 1. 1938 Chevrolet Master Deluxe, 2 Door Sedan Appraised value 2. 1989 Lincoln Sedan - date of death value 3. White Marbletop Table - appraised value 4. Coins-appraised value 5. Household Goods - appraised value 6. Doll Collection - appraised value 7. Toys, Cat Collection, Coaches- Appraised value 8. Jewelry-appraised value 9. Cumberland County-final pension payments 10. Major Medical reimbursements - October 11. Major Medical reimbursements - November 12. Major Medical reimbursements - EJecember 13. Penn Treaty Insurance -long term care 14. Metropolitan Life- Policy No. 760-675-944M - Beneficiary: Decedent's Estate 15. 2,501.403 Shares - Federated Kaufmann Fund @ $4.39 per share 16. 883.466 Shares - Mutual Beacon Fund - Class Z (Franklin Templeton Investment) @ $12.63 per share Value lq,500.00 2,400.00 1100.00 2,,161.00 2,320.00 120.00 ' 80.00 800.00 996.97 10,947.14 8,819.37 7,452.78 3,900.00 5,395.59 10,981.16 11~,158.18 COMMONWEALTH OF PENNSYLVANIA DEPART, MENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA · INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001 605 JOHNSON HORACE A 3RD & MARKET STREETS P. O. BOX 109 LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 205-09-9346 FILE NUMBER: 2102- 0033 DECEDENT NAME: FAILOR ROBERT B DATE OF PAYMENT: 09/1 1/2002 POSTMARK DATE: 09/1 0/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/23/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $18,839.27 I I I[ ., I TOTAL AMOUNT PAID: $18,839.27 REMARKS: GEORGE WILLIAM ZIMMERMAN C/O HORACE A JOHNSON ESQUIRE SEAL CHECK# 1029 INITIALS' CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS 'REGISTER OF WILLS ',~ .' ~, ,,. cOmMONWEALTH OF ~ ~5~" PENNSYLVANIA .~"~.__~,~ DEPARTMENT OF REVENUE ,tir~.4~~.~ ~ DEPT, 280601 J~ HARRISBURG, PA 17128-0601 "REV-1500 INHERITANCE TAX RETURN F..E.UMBE. ..... 21 -0 2 0 00 3 RESIDENT DECEDENT t- DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) FAILOR, ROBERT B. DATE OF DEATH (MM-DD-YEAR) December 23, 2001 DATE OF BIRTH (MM-DD-YEAR) August 14, 1921 (IF APPLICABLE) SURVNING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 205- 09 - 9346 THIS RETURN, MUST BE FILED IN DUPLICATE WiTH THE REGISTER OF WILLS SOCIALSECURITYNUMBER [~-J 1. Original Return r'~4. Umited Estate l'~6. Decedent Died Testate (^Uach capy o[ Will) r'-'l 9. Litigation prOCeeds Received --]2. Supplemental Return [~4a, Futura Interest Compromise (da!e of death after 12-!2-82) [~7. Decedent Maintained a Living Trust (A~chcopy of T~t) -'-']10. Spousal Poverty Credit (dam of ~ath ~n ~2-3~-~ and 1-~-95) r.~3. Remainder R~tum (date of doeth p~ te ~243-.~ 5. Feideral Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (A~ sob 0) NAME Horace A. Johnson, Esq. FIRM NAME TELEPHONE NUMBER (717) 761-4540 COMPLETE MAILING ADDRESS 301 Na~ket St. ; P. O. Box 109 ~. Lemoyne, PA 1704~0109 X (1) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Join'dy Owned Prope~ (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non,Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Admiqistrat~ve Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Uabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 128,000.00 :~ 767,194.30 ~-, 82,697.80. :~ ici i 502,695.10 ; 77,727.57 27,484.01 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) (11) (12) (13) cQFFICIAL='UsE ONLY 1,480,587.20 105,211.58 1,375,375.62 1 -0- i (14) 1,375,375.62 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ 16. Amount of Line 14 taxable at lineal rate x .0 108,551.56 x .12 17. Amount of Line 14 taxable at sibling rate 1,266,824.06 x .15 18. Amount of Line 14 taxable at collateral rate 19. Tax Due -O- (15) (16) -0- (17) (18) (19) 13,026.19 190,023.61 203,049.80 Decedent's Complete Address: STRE, ET ADDRESS , , 45 South West Avenue CITY Shiremans town ISTATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount. Interest/Penalty if applicable D. Interest E. Penalty 203,.049.80 184,210.53 --0-- 18,839.27 175,000.00 9,210.53 Total Credits (A + B + C ) (2) Total Interest/Penalty ( D + E )(3) If Uno'2 is greater.than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT, Ch'ack box on Page I Line 20 to request a refund (4) If Line 1 +Une 3 is greater than Uno 2, enter the difference. This is the TAX DUE, (5) A. Enter the interest on the tax due, (5A) ~ B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. iSB) ' I -0- ' 18,839.27 . 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, retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............... '. ............................ [] [] ~. retain a reversionary interest; or ................................................................. ?...'...;.....; ............................... i .......... [] [] ' d, receive the promise for life of either payments, benefits or care? ............................... ; ........................... i .......... [] . I~l. 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 bust for" or payable upon death bank account or security at his or her death?...i .......... [] [] 4. Did decedent own'an Indivfdual Retirement Account, annuity, or other non-probata properly which ' . contains a beneficiary designation? ...................................................... ~ ...................................................... i .......... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THERETURN. Under penalties of perjury, I declare ~at I have examined this rettrm, including accompanying schedules and statements, and to the best oi' my knowledge and belie, f, it is true, correct and complete. Oeclara~on of preparer other than the personal representative Is based on all infom~alJon of which preparer has any knowledge. '~ SIGNATURE OF PERSON RESPONS, IBLE FOR FILING RETURN .[. DATE ADDRESS GeOrge Willi~ Zi~mermah, Executor : ~0~Belaire Dr., Shiremanstown, PA 17011 SIGNATURE OFA~E~ OTY~R THAN REPRESENTATIVE, ' DATE ADDRESS V~/ace ~. Johnson, Esq. I · ~71 Market St., P. O. Box 109, Lemoyne, PA 17043-0109 ~ For dates of death on or after July 1, 1994 and before January'l, 1995, the tax rate imposed on the net value of transfers to or for t~e use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (iii. · . ·. · ' ' 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 surviying spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemet a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets a~nd filing a tax return are still applicable even if the surviving spouse is the °nly beneficiary. , For dates of death on or after July 1, 2000: t 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)]. in 72 P.S. 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 {}9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FAILOR, ROBERT B. SCHEDULE A REAL ESTATE FILE NUMBER 21-02-00033 A real property owaed so e y or as a tenant In common must be reported at fair market value. Fair market ya[ue is defined as ~e price at which pfopeA¥ would be exchanged betwee~ a willing buyer and a w[~ing seller, neither being compelled to buy or sell, both bavlng reasonable k~owledge of the relevant facts. Real prcpe~ which is Jointly-owned with rlght of ITEM NUWBER 1. on Schedule F. VALUE ATDATE DESCRIPTION Real Estate - No. 45 South West Avenue, Lower Allen Township, Cumberland County, Pennsylvania. (Deed Book A, Volume 32, .Page 894) Sale Price (Copy of Settlement Statement attached). OF DEATH TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) 128,000.00 $ 128,000.00 n. Settlement Statement u.s. Department of Housing . ~ and Urban Development · OMB Approval No. 2502-0265 B. Type of Loan 1. [] FHA 2. [] FmHA 3. [] Conv. Un/ns. 0. Fi~Numbe~ 7. Lo~nNumber 8. MongagetnsumnceCs~,Number 4. [] VA 5. [] Cony. Ins.. 33331478 C. Note: This form is furnished to give you a statement of actual settlement costa. Amounts paid to and by the settlement agent are shown, items marked "(p.o.c.)" were paid outside closing; Ihey are shown here for informational purposes and not included in the totals. D. Name and Addms~ of Sorrower E. Name and Address of SoRer F. Name end Address of Lander CHARLES L. MILLER, JR. GEORGEExECUToRWILLIAMoF THEZIMMERMANEsTATE OF COMMERCE BANK/HARRISBURG N.A. 6200 VALLEYBROOKDRIVE ROBERT B. FAILER 100 SENATE AVENUE MECHANICSBURG PA 17050 CAMP HILL ' PA 17011 45 SOUTH WEST AVENUE IMURREL R, WALTERS, III, ESQUIRE 54 EAsT MAIN STREET MECHANICSBURG PA 17055 516102 SHIREMANSTOWN PA 17011 I Lot: elect: 1516102 J. Summary of Borrower's TransactiOn K. Summary of Seller's Transaction Gross Amount Due To Seller 100. Gross Amount Due From Borrower 400. 101. Contract sales price ~ t28~000,O0 401. 102. Personal property 402. 103. SetUement char~es to borrower (line 1400) 5;34S.48 403. 104. 404. 105. 405. Adjustments for Items paid by seller In advance 106. City/town taxes to 107. County taxes 516102 to t2/31102 302,56 108. Assessrcants to 109. SCHOOL TAX 516102 to 6130102 $206.07 110. to 111. SEWER 516/02 to 6130102 14.51 112. to 113. REFUSE 516102 to 6/30102 26.29 114. to 115. to 120. Gross Amount Due From Borrower Conlmct sales ;)dca Personal property Ad,iustments for items paid by seller In advance 406. CIb/l{awn taxes {a 407. Count), laxes 5~6~02 to 12/31102 408. Assessments to 128,000.00 302.56 409. SCHOOL TAX 516102 to 6130102 206.O7 410. tn 411. SEWER 5/6102 ts 6~30~02 . 14.5'i 412. to 413. REFUSE 516/02 to 6~30~02 26.29 414. to 415. to 133,897.9t 420. Grees Amount Due To Seller 128,549.43 200. Amounts paid By Or In Behalf O! Borrower 500. 201. Deposit or earnest money ' t0~000.00 501. 202. Princlpalamountofnawloan(s) 100~000,00 502. 203. Ex[sUng loan(s) taken subject Io 503. 204. 504. 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for Items unpaid by seller 210. Cib/Aown taxes to 211. County taxes to 212. Assessments to Reductions In Amount Due To Seller Excess deposll (see instrucUons) 10~000.00 SetUement charges to seller (line 1400) 0.00 Existing loan(s) taken subject to Payoff of flint modgage loan Payoff of second mortgage loan Adjustments for Items unpaid by seller 510. City/town {axes to 511. Counly taxes {a 512. Assessments to 213. lo 513. to 214. to 514. to 215. to 515. to 216. to 516. to 217· to 218. to 219. to 517. to 518. to 519. to 220. Total Paid By/For Borrower t 10,000.00 520. Total Reduction Amount Due Seller 10,000.00; 300. Cash At Settlement From/To Borrower 600. Cash At Settlement To/From Seller 301. Gross Amount due from borrower (line 120) t33t897,9t 601. Gross amount due to sel~er (fine 420) 128,549.4: 302. Less amount paid byli'or borrower (line 220) '110,DO0.OC 602. Less reducUons in amt.-due softer (line 520) 10sO00.Ol 303. Cash [] From [] ToBorrower 23,897.91 603. Cash [] To [] Prom Seller 1t8,549.4: The undemigned hereby ac,knowledge the moslpt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. I HAVE CAREFULLY REVIEVVED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE SORROwERRECEIVED A COPY OF THE HUD-I SE'i-FLEMENT STATEMENT· SELLEF~[~'/~ :~'~.~r.~,~ ~u_____. J ~-~--~ ~7~v~.,~/'~>~ BORROWER SELLER '/~v ~ ~/- - ~ TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SEiTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION. WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. Previous Edition Is Obsolete HUD-1 (3-86) RESPA, HB 4305.2 I.. Settlement Chargas 128,000.00 ~ · 7...O0..__~.~otaJ Sa'~es/i~roker's CemmlFslon based on price $ · , Divlsl.on,of Comfnlsslon (line 700) as follows: 701. $ to 0'001 Borrower's Funds At Settlement 702` $ to 703. Commission paid at Seti[emerd 704. Paid From Seller's Funds At SeBlement 800. Items Payable In Connection With Loan 801. Loan Odl]inaflon Fee 1.OO 802. Loan Discount % 803. Appraisal Fee to 804. Cradit Report to 805. Lender's Inspection Fee 808. Mortga~]e Insurance Application Fee to 807. Assumption Fee % COMMERCEBANK 808. DOCUMENT PREP FEE COMMERCE BANK 809. 810. Bll. FLOOD CERT. FEE COMMERCE BANK 812. 813. lwO00.O0 150.00 15.00 906. Items Requlred By Lender To Be Pald ln Advanoa X Exclude last day in calcs - line g01 901. Interest from 5~6~02 to 06101102 ~$18.84 I da), 902. Mort;age Insurance Premium for months to 903. Hazard Insurance Premium for years Io 904. years to 805. 489.73 1000. Reserves Deposited With Lender 1001. Hazard Insurance months~$ )er month 1002. Mortgage insurance months~$ 1003. City property 1axes months(~$ 1004. County property texas months~$ 1005. Annual assessments months~l$ months~$ 1007. months~$ 1008. Afl~lragata Accounflnfl Adjustment ~er month rer month mr month ~er month mr month month 1100. Tiffs Charges 1101. Set8ement or dosing fee to 1102. Abslract or title search to 1103. Title examination to 1104. Title insurance binder to 1105. Des~ment prepsrstlon to 1106. Notary fees to CASH 1107. Attorney's fees to EDMUND G. MYERS ESQ. (SELLER) P.O.C. (Includes above items numbem: 1108. Title insurance to MURREL R. WALTERS; III, ESQ. (Includes above Itsms numbers: t101-1t04, t108 1109. LondeFa coverage $ t00,000.00 1110. Owner's coverage $ 128;000.OO 1111. 1112, 1113. 8.00 1~048,75 1200. Government Recording and Transfer Charges 1201. Recordtn0 fees: Deed $ 25.50 ; Mort~aga $ 1202` Cily/couniy tax/stamps: Deed $ 1,280.00 ; Mortgage 1203. State tax/stamps: Deed $ t~280.00 ; Mortgage 1204. 1205. 31.50 ; Releases $ 57.00 I 1p280.001 t,280.00 1300. Additional Settlement Charges 1301. Survey to 1302. Pest inspection to 1303. 1305. 1306. :1307. FEDERAL EXPRESS MORTGAGE PACKAGE RETURN 1308, 1400. Tolal Settlement Charges (enter on lines 103, Section J and 502, Section K) 20.00 51348~,8 0.00' I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVES A COPY OF.THE HUD-1 SE~rLE, I~iENT STA.~I~NT. ~,, SO.ROWER SELLER 7HARLES L. M,~'i~ER, JR. ~'- / GE'ROE WI LLIAI~.IMMERMAN BORROWER / ~ /,' .,f SELLER /~/~////;//,~ //////// /////I // EXECUTOR OF THE ESTATEOF TO THE BEST OF MY'Pi~',~VL'~D~I]V~'HE I'JUD-1 SE3-I'LEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WH,C. WERE,EC ,, D,SBURSED BY UNDERS,GNEO AS A OF THE SE EMENT OFTH,ST SAC;O.. MURREL R. WALTERS, III, ESQUIRE WARNING: iT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. COMMOI'~NEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FAILOR, ROBERT B. FILE NUM, BER 21-02-00033 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. e 2,501.403 Shares - Federated Kaufmann Fund @ $4.39 per share 883.466 Shares - Mutual Beacon Fund - Class Z ( Franklin Templeton Investment ) @ $12.63 per share 305.156 Shares - Oakmark Fund (110) @ $35.27 per share 302~ Shares - AmerUS Group Co. @ $35.91 per share PNC Brokerage Corp. - Investment Account No. 30499906 Various investments - date of death value TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) ' VALUE AT DATE OF DEATH 10,981.16 11,158.18 10,762.85 10,844.82 723,447.29 767,194.30 $ EX* (1.97) ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF ] FILE NUMBER FAILO, R, ROBERT B. 21-02. -00033 Include the proceeds of I~gatJon and the date.the proceeds were received by the estate. All property jointly-owned with the right of s*urvivorship must be disclosed on Schedule F. ITEM : VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 10. 11. 12. 13. 14. 15; 16. 17. 18. 19. 20. Mellon Bank - Checking Account No. 1620106-2668~ Date of death balance, plus accrued interest Major Medical reimburs~nent .- October Major Medical reimbursement - November Major Medical reimbursement - December Penn Treaty Insurance - long term care Equiserve - uncashed Kmart dividend check dated 3/13/95 (replaced) Har!eysville Insurance - premium refund - antique car DiScover Card - refund Internal Revenue Service - refund - decedent' s 2001 F, orm 1040 PA Department of Revenue - refund - decedent's 2001 PA 40 One iBeacon Insurance - homeowner's insurance refund Whi~e Marbletop Table - appraised value .' Co~s- appraised value D°l Collection, etc. - appraised value 1938 Chevrolet Master Deluxe, 2'P.Door[ Sedan Appraised value 1989 Lincoln Sedan - date of death value Household Goods - appraised value Adj~tments - real estate settlement - taxes, t~ash paid prior to settlement Jewelry - appraised value sewer & ToyS, Cat Collection, Coaches - appraised value TOTAL (Also enter on line 5, Recapitulation) ' 26,141.98 10,947.14 8,81'9.37 7,452.78 3,900.00 259.20 86.00 1.90 5,951.00 61.00 47.00 100.00 '2,161.00 120.00 10,500.00 2,400.00 2,320.00 549.43 800.00 80.00 $ 82,697.80 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PEN.NSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC, NON-PROBATE PROPERTY ESTATE OF I FILE NUMBER FAILOR, ~ROBERT B. 21-62-00033. This schedule must be co Jrnpieted and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVE,R SHEET ~s es. DESCRIPTION OF PROPERTY % OF ITEM iNCLUDE'rilE NN,,4E OFI'HETRAN~ll~EIR R.rfi..~TIOi'ISHIP?O DECEgB'IT~D~E D^~ OF'm~,~'~ DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ^'rrAc~ ^ co~ oF ~,~ DEED FO, ~ ~ST^T~. NUMBER VALUE OF ASSET INTEREST (1F A~PUCAB-E) -- 1. PNC Brokerage Corp. IRA Account No. 33393863 Beneficiary: Decedent, s Estate Date of death balance i 2,916.94 2. PNC Brokerage Corp. - Trust Account No. 89936006 Trust established under the Will of ,. Dorothy B. Failor, wife of Robert B. Failor - BOD: 2/3/1999 - for the Benefit of Robert B. Failor Date of death balance 499,778.16 TOTAL {^Is0 enter on line 7, R~apitulation) $ 502,695.10 (If more space is needed, insert, additional sheets of the same size) OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FAiLOR, ROBERT B. FILENUMBER 21.-02-00033 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION 8. 9. 10. 11. 12. 13. 14. 15, FUNERAL EXPENSES: Musselma~ [~.tneral Home ~,DMINISTRATIVE COSTS: Personal Representative's Commissions George Willi~n ZinTnerman Name of Personal Representative (s) Social Securit'/Number(s) / EIN Number of Personal Representative(s) ~,7c.)- 30- 3071 ~Street Address 201 Belaire Drive 17011 Zip i Shir6~nans town PA  3ity . State Year(s) commission Paid: 2002/2003 A~nmey .F~ - Johnson, Duffle, Stewart & Weidner Family Exemption: (If decedent's address is not He same as claimant's, attach explanation) Claimant Street Address c~ty sta~e __ Relationship of Claimant to Decedent Probate Fees - Register of Wills - Cumberland County Zip Accountant's Fees Tax Return Preparer's Fees Cumbe~rland Law Journal - legal advertisement t . The Patriot-News - legal advertisement Regislter 'of Wills - Short Certificates L. G.t Connor - Real Estate appraisal Auto !Appraisal Group, Inc. - appraisal of 1938 Chevrolet Chuck~ Bricker - household goods/specific bequests - appraisal David L. Rei~nan, Lawn Service - spring tan barking Bonn~'e K. Miller, Tax Collector - County/Township real l estate taxes - 45 S. West Ave. Cordier Appraisal Se~ice Sub-total frcxn additional sheet TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 747.00 33,500.00 38,.500.00 553.00 75.00 102.67 36.00 275.00 250.00 ' 60.00-' 330.00 462.07- 75.00. 2,761.83 $ 77,727.57 Estate ~f: SCHEDULE H - CONTINUED FAILOR, ROBERT B. 21-02-00033 16. Lower Allen Township - Sewer/Trash 17. PA Water Company - water service 18. PP&L - electric service 19. BBEC, Inc. - electrical repairs 20. John Wolfe - garage rent (antique car) 21. Blue Jay Service - lawn mowing 22. Chuck Bricker - Auction charges - sale of real estate '45 South West Avenue, 23. Register of Wills - file Inventory & Inheritance Tax Return 23. Park Financial Service - preparation of decedent's 2~01 income tax returns 24. Reserve for close-out costs 141.75' 78.30 371.78' 107.00 90.00 25.00 !,500.00 28.00 245.00' 175.00 Sub-total $ 2~761.83 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETU?,N RESIDENT DECEOENT ', SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FAILOR, ROBERT B. :ILENUMBER 21-02-00033 Include unreimbursed medical exPenses, ITEM NUMBER DESCRIPTION 1. e e e Penn Treaty Network Amer. Refund - overpayment in Dec~mber 2001 State Eh~ployees' Retir~nent System - return of a portion of decedent ' s December retirement check Pinnacle Health Hospitals - charges for nursing care provided the decedent - October 2001 Pinnacle Health Hospitals - charges for nursing care provided the decedent - November & December 200I> TOTAL (Also enter on line 10, Recapitulalion) (I,~ more space is needed, insert additional sheets of the same size) AMOUNT 130.00 134.72 10,947.14 16,272.15 $ 27,484.01 fl~HERIT^NC~: T^× RI::T.U~N R~S~D~T D~C~D~NT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER e e II. FAILOR, ROBERT B. NAME AN, D ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outdght spousal distributions) George Willi~n Zimnerman and Barbara M. i Zinmerman 201 Belaire Drive shiremanstown, PA 17011-6502 Andrea Jane Royce 17 Union Turnpike Branchville, NJ 07826-4217 Helen Ann F. DiBenedetto 15 Carl Court Sebastian FL 32958 (Please~ see attached for additional beneficiaries ) ~ FILE NUMBER 21-02-00033 RELATIONSHIP TO DEC,EDENT AMOUNT OR SHARE Do Not Ltst Trustee(s) OF ESTATE Friends Niece Niece Automobiles; Household & personal effects; other tangible personalty; 80% residue. 20% of 20%~of the residue. 20% of 20% of the residue. ENTER DOLl.EAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES I5 THROUGH 17, AS APl ROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: ~A A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING M' DE B. CHARITABLE. ~,ND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART '1-1'. 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) SCHEDULE J BENEFICIARIES - CONTINUED Estate Of: FAILOR, ROBERT B. Christinb and Harry Habecker 7131 Sdmerset Street Swatara, PA 17111 Todd W. Zimmerman 18 Mercier Way Gorham, ME 04038 Chris M. Zimmerman 2605 Forest Lake Court Wake Forest, NC 27587 Kathy Turner Irlbacher 2278 Reis Run Road Pittsburgh, PA 15237 Melinda~ (Mindy) Milos Dale 4865 G~llagher Road Rochest,~r, MI 48306-1508 Lisa Milos Gajewski 50 Lindsay Lane Carlisle,: PA 17013 Florenc6 L. Miller 47 Riley Drive Hampton, VA 23666-1337 Richard ~F. Shatzer 369 Bethel Church Road New Cumberland, PA 17070 James R!. McGee, (Jr.) III 10406 N. W. 7th Street Plantatio~n, FL 33324 Michael T. McGee 14211 N' W. 18 Manor Pembroke Pines, FL 33028 Friends Fhend Friend Friend Friend Friend Friend Friend Friend Friend 21-02200033 1/15th ruder Item III D-I~. 1/i 5th ruder Item III D-lc 1/15th ander Item III D-lc 1/15th ander Item III D-lc. 1/15th hnder Item III D-lie. 1/15th i~nder Item III D - 1 ~.; white marblettop table 1/15th !nder Item III D-lc~' 1/15th !nder Item III D-lc. 1/15th lunder Item III D-lc. 1/15th.llnder Item III D- lc: SCHEDULE F - BENEFICIARIES - CONTINUED. (FAIL~R, ROBERT B. ESTATE - 21-02-00033) Patrick J. McGee 3784 Se.'dgefield Drive Conovei, NC 28613-8960 Nancy Watson Lengkeek C/O Kevin Lengkeek 81 Chambord Drive Frenchtown Woods Newark~ DE 19702 Gail Wa]tson Merrill 5 Alton Court Drummond Hill Newarki DE 19711-7614 Wendy ~L. Watson Branderhorst 312 Eastmont Avenue HollandI MI 49424 Ruth, Martha & Leah Branderhorst · I Children of Wendy L. Branderhorst 312 Eastmont Avenue Holland; MI 49424 Douglas A Watson 104 Sara~h'~ Lane Horsharfl, PA 19044 Friend Friend Friend Friend Friends Friend 1/15th ~under Item III D- 1 ~c. / 1/15th !nder Item III D-lc. 1/15th ~nder Item III D~lc. 1/15th ~nder Item III D-lc. Toys, !at collection dolls and coaches 1/15th !nder Item III D-lc. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYTSTOH DEPT. Z80601 HARRISBURG, PA 17128-0601 HORACE A,JOHNSON ESQ JOHNSON ETAL PO BOX 109 LEHOYNE NOTE: To insure CUT ALONG THIS LINE COHNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERNZNATION AND ASSESSNENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ~. Rei:,i:-:L.:'.;' ,./".",~:,!~ ESTATE OF DATE OF DEATH .-FILE NUHBER '02 flgT 18 P2.4~OUNTY ACN PA 170 10-22-2002 FAIL0R 12-25~2001 21 0~00~$ CUHBERLAND 201 Amount Remitted] [, REV-glBS EX AFP (01-02) ROBERT B HAKE CHECK PAYABLE AND RENIT PAYHENT TO: REGISTER OF WIL,LS CUHBERLAND CO C,0URT HOUSE CARLISLE, PA 17015 proper credit ~:o your eccoun~ submit: ~he upper portion of this Iform wi~h your ~ax payment. ~" RETAIN LONER PORTION FOR YOUR FILES REV-~83 EX AFP i(Ol-OE) ~ NOTICE OF DETERHINATZON AND ASSESSHENTI OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~ ESTATE OF FAILOR ROBERT B FILE N0.21 02-00~$ ACN 201 DATE 10-22-2002 ESTATE TAX DETERHZNATZON 1. .Credit For State Death Taxes as Verified Z.' ennsylvania Inheritance TaX Assessed (Excluding Discount and/or Interest) $. Inheritance Tax Assessed by Other States .00 or Territories of the United States (Excluding Discount and/or Interest) / 4. Total inheritance Tax'Assessed Pen 1 5. nsy vanza Estate Tax Due TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID ~ZF PAID AFTER THIS DATE~ SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. 197zO95.SZ 26~857.00 TOTAL TAX CREDTT [ BALANCE OF TAX DUEI .00 INTEREST AND PEN. [ .00 TOTAL DUE ~ I .00 (IF TOTAL DUE ZS LESS THAN ~1, NO PAYHENT ZS REgUZRED ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 197zO95.SZ .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: To fulfill the requirements of Section Zl¢O (b) of the Inheritance and Estate Tax Act, Act 2S of ZOO0. (71 P.S. Section 91q0). . , Detach the' top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. .' -- Make check or money order payable to: REGISTER OF NXLLS, AGENT. A refund of a tax credit may be requestedby completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of'the Register of Nills, any of the Z$ Revenue District Offices or from the Department's Z4-hour ansaering service for forms ordering: 1-800-361-Z050; services for taxpayers ~ith special hearing and / or speaking needs: 1-800-447-3020 (TT mn~y). Any party in interest not satisfied ~ith tho assessment of tax as shomn on this notice may object ~ithin sixty (60) days of receipt of this Notice by: --uritten protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 17128-10Z1, --mIecting to have the matter determined at audit of the pers~nal representative, OR --appeal to the Orphans' Court. OR Factual errors discovered on this assessment should be addressed in ~riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. 180601~ Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. The 151 tax amnesty nan-participation penalty is computed on the total of the tax.~nd interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This no~-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. For dates of death on or after 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death.' For dates of death prior to 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (18) months from the date of death. Taxes mhich became delinquent before January 1, 19BI bear interest at the*~ate of six (6X) percent per annum calculated at a daily, rate of .000164.' All taxes mhich became delinquent on er after January 1, 1981 ~ill bear interest at a rate Nhich mill vary from calendar year tm calendar year .Jth that rate announced by the PA Department of Revenue. The appZicabla interest rates for 1981 through ZOOZ are: Year Interest Rate Daily Interest Factor 1981 20Z .D00548 1985 161 .000438 198q llZ .D00301 1985 13X .000356 1986 IOZ .000174 1987 9Z .000247 1988-1991 11Z .000501 --Interest is calculated as follows: Year Interest Rate 199Z 92 1995-1994 7Z 1995-1996 9Z 1999 71 ZOOO 8Z 2001 9Z ZOOZ 6Z Daily Xnterest Factor .000247 .000191 .000247 .000191 .000119 .000147 .00016~ ZNTEREST = BALANCE OF TAX UNPAXD X NUHBER OF DAYS DELZNI~UENT X DALLY XNTEREST FACTOR 7-Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shoNn on the Notice, additional interest must be calculated. ' 0 ~c:,z ::Z: ... ~m ~ c~ 3>, xo m 3> & ,-., c: c. ~, '~r- (,/). m rtl ~ ~ ~o z~ 0 ~N~ m ~N~N COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NE). REV-1162 EX(11-96) CD 001763 JOHNSON HOI~ACE A 3RD & MARKEIT STREETS P. O. BOX 1091 LEMOYNE, PAI, 17043 ........ fold ESTATE INFORMATIQN: SSN: 205-09-9346 FILE NUMBER: 2102-0033 DECEDENT NAME: FAILOR ROBERT B DATE OF PAYMENT: 10/23/2002 POSTMARK DATE: 1 0/22/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/23/2001 REMARKS: TOTAL AMOUNT PAID: SEAL CHECK# 1 ©34 INITIALS' AC RECEIVED BY: REGISTER OF WILLS ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,280.05 I I I $3,280.05 MARY C. LEWIS REGISTER OF WILLS BUREAU OR' TNI)IV~JDUAL ZNHERZTANCE TAX DTVT$1'ON DEPT. Z80601 HARRI*$BURG, PA '171Z8-0601 TAXES 1 ~IEALTH OF PENNSYLVANZA ~DEP~RTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCTZONS AND ASSESSHENT OF TAX HORACE A JOHNSON ESQ JOHNSON ETAL PO BOX 109 ' ..... ' .... LEHOYNE PA 170~3 r~,~,,~.m DATE OF DEATH FZLE NUNBER '02 I]BT 25 P 2 C_-~{JNT¥ ACN REV-lSd? EX AFP (01-Oe) 10-22-2002 FAILER ROBERT 12-23-2001 21 01-0033 CUHBERLAND Amoun~ Remi~ad I HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF ~I~LS CUHBERLAND CO COURT HOUSE CARLISLE, PA ~7013 RETAZN LOgER PORTZON FOR YOUR RECORDS ~ CUT ALONG THZS LZNE ~ REV-15~7 EX AFl (01-02) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLO~ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF FAIL. gR ROBERT B FZLE NO. 21 02-0033 ACN 101 DATE 10-22-2002 TAX RETURN HAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE 118~000 O0 767~19~ 30 Ioo Ioo 82~69~ 80 Ioo APPRAZSED VALUE, OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) 2. S~ocks and Bonds (Schedule B) 3. Closely He~ld S~:ock/Par~narship ]:n~eres~ (Schedule C) q. Nor~gages~No~as Receivable (Schedule D) $. Cash/Bank IDaposi~cs/Hisc. Personal Proper~y (Schedule E) (5) 6. Jointly Okned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Cos:ks/Hisc. Expenses (Schedule H) (9) D ~ 10. abts/Hor~gaga Liabilities/Liens (Schedule 1) (lO) 11. To,al Deductions (1) (2) ($) 502~695.10 (8) 77,72~ .57 27; R8~. 01 (11) NOTE: To insure proper credi~ ~o your account, SUbmi~ ~he upper portion of ~h~s for. ~h your ~ax payment. 1,~80,587.20 lll5.2ll .51t 12. 15. lq. NOTE: Net Val~ue of Tax Ra~urn (12) 1,375,375.62 Charitable/Governmental Bequests; Non-elected 9115 Trus~:s (Schedule J) (13) . O0 Na~ Va]~ue of Es~:a~:a Subject: ~o Tax (1~) 1,375,375.62 Zf an assessment ~as issued previously, 1/nas 1~, 15 and/er 16, 17, 18 and 19 reflect, figures that include' the total of ALL returns assessed to date. L/ne lq L/ne lq ~axabla a~ Lineal/Class A ra~a ,.(16) 'Line 1~ a~ Sibling ra~e (17) Line lq taxable a~ Collateral/Class B ra~e Tax DUB RECEIPT NUHBER CDO00962 CD001605 DISCOUNT 1+) ZNTEREST/PEN PAZD (-) 9,Z10.53 .00 ASSESSHENT OF TAX: 15. Amoun~ of 16. Amoun~ of 17. Amoun~ of 18. Amoun~ of 19. Principal TAX CREDITS: PAYHENT I DATE 03-15-2002 09-10-2002 INTEREST IS CHARGED THROUGH I -06-2002 AT THE RATES A~PLICABLE AS OUTLINED ON THE REVERSE SIDE OE THIS FORH .OQ x oo : .oo .oo x o~5= .oo .00 x 12 = .00 (18) 1,375,375.62 x 15 : 206,306.35 (xg)= 206,306.$5 175,000.00 , 18,839.27 TOTAL TAX CREDiZT BALANCE OF TAX ~UE I ZNTEREST AND P~N. TOTAL DUE 203,0~9.80 3,256.55 23.50 3,280.05 I I ZF PAZD AFTER DATE ZNDZCATED~ SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REgUZRED. FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ZF TOTAL DUE ZS REFLECTED AS A?'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S~DE OF THZS FORN FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying On or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiratianof any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance Taxes at the lawful Class B (collateral) rate on any such ~uture interest. To ~ulfill the requirements of Ssctio~ ZlqO of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91q0}." Detach the top portion of this Notice and submit with~our payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLSj AGENT A refund of a tax credit, which was not'requested on the Tax Return, may be requested by completing an ':Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515}. Applications are available at the Office: of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-4qT-30ZO (TT only}. Any party in interest not satisfied mith'the appraisement, aliowance, or disallowance of ded~ctions~ or assessment of tax (including discount or interest) as shown on this Notice must abject within .sixty (60) days of receipt of ' this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. Z80601, Harrisburg, PA 17128-0601 Phone ¢717} 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decadent" [REV-IS01} for an explanation of administratively correctable errors. If any tax due is paid within three (5) ~alendar months after the decedent's death, a five percent (52)discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty .is computed on the total of the tax and interest assessed, and not paid before January 18, 1996~ the first day after the.end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you wauld appeal the tax and interest that has been assessed as indicated on this notice. lnterest is charged beginning with first day of delinquency~ or nine (9) months and one [1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at 'the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became.delinquent on and after' January 1, 1982 mill bear interest at a rate mhich will vary from calendar year to calendar year mit~. that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate DaiIy Interest Factor Year Interest Rate Daily Interest Factor 1982 ZDZ .000548 i992 9Z 1985 162 .. .000458. · 1993-1994 77. 1984 112 .000501 1995-1998 92 1985 152 .000556 1999 72 1986 IOZ .000:~74 ZOO0 82 1987 9X . O00Zq7 2001 92 1988-1991 117. .000~01 ZOOZ 62 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT .000247 - .000192 .000247 .000192 .000219 .000247 .000164 X DATL¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15} days beyond the date.of the assessment. Ifpayaent is made after the interest computation date shown on the Notice, additional interest must be'calculated. ~EV-1470 EX (8-88) , INHERITANCE TAX EXPLANATION COMMONWEALTH OF P~ ENNSYLVANIA DEPARTMENT OF;REVENUE OF CHANGES BUREAU OF INDIVID, UAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 ~,O FILE NUMBER DECEDENTS NAME R BERT B FAILOR 2102-0033 ACN REVIEWED BY J~hn Kealy 101 I SCHEDULE'! NO. EXPLANATION OF CHANGES / J C nged tax rate from 12% to 15% because a niece is a collateral heir. ROW Page 1 /~- 33 -~ COMMONWEALTH OF PENNSYLVANIA ~, BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE 7AX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-1607 E% AFV CB1-BR) HORACE A JOHNSON ESQ JOHNSON ETAL PO BOX 109 LEMOYNE PA 17043 DATE 12-03-2002 ESTATE OF FAILOR ROBERT B DATE OF DEATH 12-23-2001 FILE NUMBER 21 02-0033 COUNTY CUMBERLAND ACN 101 ~- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-02) *~* INHERITANCE TAX STATEMENT OF ACCOUNT ~~* ESTATE OF FAILOR ROBERT B FILE N0. 21 02-0033 ACN 101 DATE 12-03-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATIDN OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-22-2002 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 206,306.35 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 03-15-2002 CD000962 9,210.53 175,000.00 09-10-2002 CD001605 .00 18,839.27 10-22-2002 CD001763 15.49- 3,280.05 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. [ IF TOTAL DUE IS LESS THAN Sl, 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. 206,314.36 8.O1CR .00 8.O1CR PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed an the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check ar money ardor payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Applicatian for Refund of Pennsylvania Inheritance and Estate Tax^ CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and ! or speaking needs: 1-800-447-3020 [TT only). REPLY T0: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280b01, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY; The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate oS six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7'l. .000192 1986 1D% .000274 2000 8% .000219 1987 9% ,000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDU. AL TAXES TNHERTTANCE TAX DZV/SZON DEPT. 280601 17128 010!'6 HARRISBURG., PA - HORACE ~ JOHNSON ESQ JOHNSON ETAL PO BOX 109 LEHOYNE COHHONNEALTH OF pENNSYLVANTA DEPARTNENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT .... --, DATE ......... ~ '':' ESTATE OF DATE OF DEATH FILE NUHBER '03 FEB 10 f 8:22COUNTY ACN REV-I~07 EX AFP (01-03) 01-06-Z005 FAILOR ROBERT 12-25-2001 21 02-0055 CUHBERLAND 101 Amoun~ Romi~od I HAKE CHECK PAYABLE lAND REHZT PAYNENT TO: REGISTER OF NI~LS CUHBERLAND CO ~OURT HOUSE CARLISLE, PA 1701:5 NOTE: To insur, el proper credit: ~:o your accoun*, submit: ~:he upper por~:Lon of '~hLs form wi~h your *ex payment. CUT ALONG THIS I LZNE ~ RETAIN LOt~ER PORTION FOR YOUR RECORDS -~ (01-03) REV-1607 EX AFPI ~ INHERITANCE TAX STATEHENT OF ACCOUN~ / ESTATE OF FAZLQR ROBERT B FILE NO. 21 02-00:3:3 ACN 10! DATE 01-06-200:3 THIS STATEHENT IS pROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELON IS A SUHNARY OF THE PRINCIPAL TAX DUE~, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED ZNTERE:~T FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 10-15-2002 PR[NC[PAL TAX DUE: .......................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PA[] 03-15-2002 09-10-2002 '10 22-2002 12-2:3-2002 CDO00962 CD001605 CD001765 REFUND IF PAID AFTER TH/S DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. [F TOTAL DUE IS REFLECTED AS A "CREDIT" 9,210.5:3 .00 15.49- .00 175,000.00 18,8:39.27 TOTAL TAX CREDIT 206,306:35 ' BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE ~ REFUND. SEE REVERSE STDE OF THIS FORH FOR INSTRUCTIONS. 206,:306.:35 PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGXSTER OF #XLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, mhich was not requested on the Tax Return, may bo requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of.the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z~-hour answering service for forms ~rdering: 1-800-362-2050; services for taxpayer? mith special hearing and / or speaking needs: 1-800-qq7-3020 (TT only). REPLY TO: DISCOUNT: PENALTY: INTEREST: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, mPA 17128-0601, phone (717) 787-6505. If any tax due is paid within three [3) calendar months after the decedent's death, a five percent CSX) discount of the tax paid is aZZowed. The 1SI tax amnesty non-participation penalty'is computed on tho total Of the tax and interest, assmsssd~ and not paid before January 18, 1996, the first day after the end of the tax amnesty periodL Interest is charged beginning with first da~ of delinquency, or nine (93 months and one (1) day.from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of' six (62) percent per annum calculated at a daily rate of .OOOX6q. At1 taxes which became delinquent on and after January l, 198Z will bear interest at a rate ahich will vary from calendar year to calendar year with that.rate announced by.the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily ; Interest Daily Interest Year Rate Factor Yea~ Rate Factor Year Rate 1982 20Z .0005~8 1987 9Z .O00Zq7 1999- 7Z 1983 .ZBZ .O00q3B 1988-1991 XXZ .000301 2000 8Z X98~ 'IZZ .O0030X 1992 9Z .0002~7 2001 9Z 1985 132' .0003S6 1993-1996 7Z .O00lgg ZOOZ 62 .!986 __IOZ .00027~ 1995-1998 9Z .0002q7 Z003 52 Daily F~ctor .000192 .000219 .O00Zq7 .00016q .0D0137 --Xnterest is calculated as follows: TNTERBST = BALANCE OF TAX UNPATD X NUI~BER OF DAYS DELTNI~UENT X DA/LY XNTBREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the as'sessment. ' If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STiATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILIE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name f Decedent: ROBERT B. FAILOR Date of. Death: December 23, 2001 Will Noi: 21-02-00033 Admin No.: ,Pursuant to Rule 6.12 of the Supreme Court Orphans' Court RLiles, I report the followinlg with respect to completion of the administration of the above-captioned estate: ;1. State whether administration of the estate is complete: i Yes X No 2. If the answer is No, state when the personal representative reas°r~ably believes that the administration will be complete: . ,3. If the answer to No. 1 is yes, state the following: Date: Co Did the personal representative file a final account with the Court? Yes No X The separate Orphans' Court No. (if any) for the personal representative's account is:. Did the personal representative state an'account ~f0rmally'to the parties in interest? Yes X No Copies of receipts, releases; joinders and approvals of formal or informal accounts may be filed with the Clerk of th~ Orphans' Court and may be attached to this report. Signature Edmund G. Myers Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Bo~ 109 Lemoyne, PA 17043-0109 Address Capacity: (717) 761-4540 Telephone No. Personal Representative X Counsel for Personal Representabve BUREAU OF ZNDZV/DUAL TAXES INHERITANCE TAX DIVISION DEPT, HARRISBURG, PA 17128-0601 HORACE A JOHNSON PO BOX 109 LEMOYNE JOHNSON ESQ !TAL COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER PA 17~t~beri'and Co., PA 12-29 -ZOOS RE¥-755 EX RFP (01-0Z) Re~,~ .... of Wills ESTATE OF FAZLOR DATE OF DEATH 12-2~-Z001 FZLE NUHBER 21 02-0055 FEB 25 A8:29 COUNTY CUMBERLAND ACN ~0~ Amoun~ Remi~ed ROBERT HAKE CHECK PAYABLE AND REHZT PAYHENT TO.' REGISTER OF WILILS CUMBERLAND CO COURT HOUSE CARLISLE, PA 117015 ' portion of ~his for. wi~:h NOTE: To insur proper credA~ ~o your account, sub. A~ *he upper your ~ax pay,en~. CUT ALONG THIS .ZNE ~ RETAIN LONER PORTION FOR YOUR FILES ~ REV-736 EX AFP (01-OE) ~ NOTZCE OF DETERMZNATZON AND ASSESSHENTI OF PENNSYLVANZA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~ ESTATE OF FAILOR ROBERT B FILE NO.*Z1 02-0055 ACN IZOZ' DATE 1Z-Zg-ZO03 ESTATE TAX DETERHZNATTON 1. Credit For State Death Taxes as Ver/fied 2o (Excluding Pennsylvan/a Inheritance Tax Assessed Discount and/or Interest) $. Inheritanc~ or Territm (Excluding q. Total Inhel Tax Assessed by Other States /es of the Un/ted States Discount and/o~ Interest) itance Tax Assessed 5. Pennsylvanla Estate Tax Due 6. Amount of ~ennsylvania Estate Tax Previously Assessed Based On Federal Estate Tax Return 7. Additional TAX CREDITS: Pennsylvania Estate Tax Due 197,095.82 .00 PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID 26,857.00 . 197~095.82 .00 .00 .00 TOTAL TAX CREDiZT I BALANCE OF TAX ~UE I · ZNTEREST AND P~N. TOTAL DUE I ~ZF PAID AFTER T~IS DATE, SEE REVERSE S/DE (IF TOTAL DUE 1S LESS THAN ~1, NO PAYHEHT 1S REQUIRED FOR CALCULATZON~OF ADD/T/ONAL /NTEREST. ZF TOTAL DUE 1S REFLECTED AS A 'CRED/T~' (CR), YOU HAY BE ' DUE A REFUND. SEE REVERSE SIDE OF TH/SI FORH FOR /NSTRUCTZONS.) ~ I .00 .00 .00 .0O J PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: To fulfill the requirements of'Section 21~0 of the Inheritance and Estate Tax Act, Act 23'of ZOO0. (TZ P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed an the reverse side. -- Hake chock or money order payable to: REGISTER OF #XLLS, AGENT. A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices er from the Department's Z~-hour ensnaring servlce for forms ordering: 1-eDO-~DZ-ZO50; services for taxpayers with special hearing end/or speaking needs: 1-BOO-~7-$0ZO (TT only). Any party in interest not satisfied aith the assessment of tax as shomn on this.notice may object aithih sixty (60) days of receipt of this Notice by: --Nritten protest to the PA Department of Revenue, Board of Appeals~ Dept. Z81021, Harrisburg, PA'171Ze-lOZ1, --electing to have the matter determined at audit of the personal representative, OR ' --appeal to the Orphans' Court .Factual errors discovered on this a~sesseent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratlvely correctable errors. The 15Z tax amnesty nan-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-partic~pation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest 'that has been assessed as indicated on this notice. ' ' Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase in Federal Estate Tax is received. Taxes mhich became delinquent before January 1, 19BZ bear interest at the rate of six (DZ) percent per annqm calculated at a daily'rate of .00016~. All taxes ahich became delinquent on or after January 1, 198Z will bear interest at a rate which-ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 198Z ZOZ .0005~8 199Z 9Z .O00Z~7 1983 162 .000~38 1993-199q 7Z .O0019Z 198~ llZ .000~01 1995-1998 9Z .O00Z~7 1985 I~Z .000356 1999 7Z .OOO19Z 1986 IOZ .O00ZT~ ZOO0 8Z .O00Z19 1987 9Z .0002~7 -ZOO1- 9Z - * .OOOZ~7 - 1988-1991 Z1Z .000301 ZOOZ 6Z .00016~ --Xnterest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after.the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date.of the assessment. Zf payment ismade after the interest computatiDn date shown enthe Notice, additional interest must ba calculated. '! '* OR