The URL can be used to link to this page

Home My WebLink About02-0037COMMONWEALTH 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. REV-1162 EX(11-96) CD OOO745 WEIGLE JERRY A 126 E KING STI:IEET SHIPPENSBI PA 17257 ........ fold ESTATE INFORMATI()N: SSN: 207-32-3232 FILE NUMBER: DECEDENT NAME: 21-2002- 0037 OSTHEIM EMMA MAY DATE OF PAYMENT: POSTMARK DATE: COUNTY: 01/14/2002 01/11/2002 CUMBERLAND DATE OF DEATH: 10/21/2001 ACN ' ASSESSMENT CONTROL NUMBER AMOUNT 101 $180.00 TOTAL AMOUNT PAID: 80.00 REMARKS: :IY A WEIGLE ESQUIRE SEAL CHECK# 3181 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00' OFFICIAL USE ONLY COMMON~ EALTH OF PENNSYLVANIA REV-1500 SEPT. 280601 INHERITANCE TAX RETURN F~LE.UM.E. HARRI SBURG, PA 17128-0601 RESIDENT DECEDENT 21 2002. 0037 COUNTY CODE YEAR NUMBER DECEDENl?S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Ostheim Emma May 207-32-3232 DECE- DATE OF D LATH (MM-Db-YEAR) I DATE OF BIRTH (MM-Db-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 10/21/0 [I 10/16/1909 WITH THE REGISTER OF WILLS (IF APPLIC~%BLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return' CHECK ~ 1. Origimal Return 2. Supplemental Return I~ (date of death prior to 12-13-82) APPRO- 4. Limit.~d Estate - 48. Future Interest Compromise (date of death after 12-12-82) 5. Federal .Estate Tax Return Required PRIATE ~ 6. Dece, lent Died Testate - 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes _ (Attich copy of Will) (Attach a copy of Trust) BLOCKS 9. Utig.'tion Proceeds Received - 10. Spousal Poverty Credit (date of death between [--] 11. EIection to tax under Sec. 9113(A) _ 12-31-91 and 1-1-95)I I (Attach Sch O) NAME COMPLETE MAILING ADDRESS COR- 'Jerry A Weigle, Esquire 126 East KinG Street RE- FIRM NAME (If Applicable) Shippensbu_~, PA 17257 SPON DENT Weigle ;,: Associates, P.C. C~ C~ TELEPHON -- NUMBER ~ ~i!~ d .-~ ~ (717) 5:~2-7388 Cr ~' ~ -c~ OFFICIAE 8SE ONLY 1. Real Est ~.te (Schedule A) (1) NO~E~ ~ ~-; ~, 2. Stocks and Bonds (Schedule B) (2) N~ne ~ ~" ~"~ 3. Closely H ,Id Corpor,~tion, Partnership or Sole-Proprietorship (3) None ~, ;f;- 4. Mortgag .~s & Notes Receivable (Schedule D) (4) N~e ?~.._~ ~'t~ 5. Cash, B~ ~nk Deposits & Miscellaneous Personal ~ ~, ~.., ~3 C~ Property (Schedule E) (5) 7,324~'~2'~ C~ 6. Jointly C wned Property (Schedule F) I-IS~ ~parate Billing Requested (6) None RECA- PITULA- 7. Inter-Viv ~s Transfers & Miscellaneous TION Non-Pro bate Property (SchedUle G or L) (7) None 8. Total Gr )ss Assets (tot~ Lines 1-7) (8) 7,324.29 9. Funeral .~penses & Administrative.Costs (Sohsdule H)(9) 2,771.60 10. Debts of [ ecedent, Mortgage Liabilities, & Liens (Schedule I) (10) 36.43 11. Total De ~uctlons (total Unes 9 & 10) (11) 2,808.03 12. Net Valu ., of Estate (Line 8 minus Line 11) (12) 4,516.26 13. Charitabl ~ and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) None has not ~ een made (Schedule J) 14. Net Valu ; Subject to Tax (Line 12 minus Line 13) (14) 4,516.26 SEE INSTRUC'rlONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of _ine 14 taxable at the spousal tax rate, or tral ,sfers un der Sec. 9116 (a)(1.2) X .0 (1 5) 16. Amountof _ine14 taxable at lineal rate 4,516.26 x.O ~=5 (16) 203.23 TAX COMPU- 17. Amount of _ine 14 taxable at sibling rate 0. 00 X .12 (17) 0.00 TATION 18. Amountof .ine14 taxable at collateral rate 0.00 x.15 (18) 0.00 19. Tax Due (19) 203.23 0 PA15001 NTF 2 755 Copyright 2000 Greatland/Nelco LP- Forms Software Only Estate of: Em naMay.Ostheim · ~Y OF ALLOCATiONS TO BENEFICIARIES Taxable at lineal rate Jean Jones Lori A. Barnes David W. Barnes Richard Jones 495.00 1,340.42 1,340.42 1,340.42 4,516.26 21-2002-0037 1 PA REV-1500 EX ((~-00) Decedent's Co~mplete Address: Page 2 STREET ADDRESS Green Ridqe CITY Newville Tax Payments ~ 1. Tax Due (Page 2. Credits/Paymer A. Spousal Po B. Prior Paym~ C. Discount 3. Interest/Penalty D. Interest E. Penalty 4. If Line, 2 is great 5. If Line 1 + Line: A. Enter the intE B. Enter the tots Villaqe STATE ZIP 17241 ~nd Credits: I Line 19) ts verb/Credit ~ nts applicable 180.00 9.47 (1) Total Credits (A + B + C) (2) 203.23 189.47 0.00 13.76 0.00 13.76 Total Interest/Penalty (D + E) (3) than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) is greater than Line 2, enter the difference. This is the TAX DUE. (5) 'est on the tax due. (5A) of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE AN ;WER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did dec~ dent make a transfer and: Yes No a. reta in the use or income of the property transferred; ....................................... b. reta in the right to designate who shall use the property transferred or its income; ................. c. reta n a reversionary interest; or ................................................... : .... d. rec( ve the prom se for fe of ether payments, benefits or caret ..................... 2. If death ~ccurred after December 12, 1982, did decedent transfer property within one year of death without leceiving adequate consideration? ................................................... 3. Did dec~ ~dent own an "in trust for" or payable upon death bank account or security at 'his or her death? ... 4. Did decE dent 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 COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. kUnnde.r p.enalties of .pe. rj ~.ry, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my owleoge and belier, !s tru.e, c. orrect and complete. Declaration of preparer other than the personal representative is based on information of which preparer has an~ Know~eoge. SIG,~;~RE OF PERS )N RESPQ~ISIBLE FOR FILING RETURN See Sdhedule ,~Lttached ' 126 East King Street Shipper~burg, PA 17257 For dates of death on oraft~ July 1~1994andbeforeJanuary~~1995,thetaxrateimposedonthenetvalueoftransferstoorfortheuseofthesurvivingspouseis3"/" [72 P.S. § 9116 (a) (1.1)(i)]. For dates of death on or aft~ The statute does not exembl th e surviving spouse is th e o For dates of death on or afte The tax rate imposed on the orastepparent of the child i; The tax rate imposed on the The tax rate imposed on th~ who has at least one parent i January 1, 1995, th e tax rate is imposed on the net value of transfers to or for th e use of th e surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)]. a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and ~iling.a tax retu~:n are still applicable even if lly beneficiary. r July 1, 2000: ~et value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of · natural parent, an adoptive parent, ;0% [72 P.S. §9116(a)(1.2)]. let value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S. § 9116(1.2) [72 P.S. 69116(a)(1)]. et 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 common with the decedent, whether by blood or adoption. 756 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of: The follow-in Larry E. Wea 421 McCulloc Shippensbu~ Emma May Ostheim 3person(s) ver h Road PA 17257 are i signing the 21-2002-0037 return as representative(s) of the estate':' REV-1508 EX + (1-.c7) SCHEDULE E COMMONWEA_TH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITA ICE TAX RETURN RESIDE NT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Emma May Ost.neim 21-2002-0037 Include proceeds of ]iff aation & date proceeds were received by the estate. All prop. Jointly-owned with right of survivorship must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH 1 Orrstown Bank Checking Account ~000607339 1,332.03 2 Orrstown Bank Irrevocable Burial Fund Certificate of Deposit 2,160.30 #3004869( Interest on above item accrued as of decedent's death 1.30 3 Yellow C<)ld Diamond Ring - appraised value 495.00 4 Presbytezian Homes - 11/23/01 refund 3,335.66 · / TOTAL (A~so enter o, ~ine 5. Recapitu~a~on) $ 7,324.29 7 CPA81 NTF 10908 Copyright Forms Software On 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) REV-1511EX + (1-9") SCHEDULE H COMMONWEA.TH OF PENNSYLVANIA FUNERAL EXPENSES & I NHERIT,~ NCE TAX RETURN ADMINISTRATIVE COSTS RESIDJ "NT DECEDENT ESTATE OF FILE NUMBER Emma May Ost.~eim 21-2002-0037 Debts of decede nt must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EX[ ENSES: 1 Fogelsan(. [er-Bricker Funeral Home 2,161.60 B. ADMINISTRATI'/E COSTS: 1. Personal Re )resentative's Commissions 0.00 Name of P.~rsonal Representative(s) Social Sec Jdty Number(s)/EIN No. of Personal Representative(s) Street Add 'ess City State Zip Year(s) Cot emission Paid: 2. AttorneyFee.~ Name: Weigle & Associates, P.C. 500.00 3. Family Exem~ tion: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Addr ,ss City State Zip Relationship of Claimant to Decedent 4. Probate Fees 0.00 5. Accountant's ees 0.00 6. Tax Return Pn )arer's Fees 0.00 7 Zales Jewel.ers - appraisal of ring 15.00 8 Register o: Wills, Oznt~rland County - filing PA Inheritance Tax 15.00 Return 9 Register oJ Wills, Clmt~rland County - filing Family Settlement 75.00 Agreement 10 Linda K. Klein - notary fee 5.00 TOTAL (Also enter on line 9. Recapitulation) $ 2,771.60 7 CPA11 NTF lO911 Copyright Forms Software Onl' , 1997 Nelco, Inc. (if more space is needed, insert additional sheets of the same size) REV-1512 EX + (1-;~7) SCHEDULE I COMMONWEAL I'H OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITAt ICE TAX RETURN RESIDE IT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Emma May Ost:heim 21-2002-0037 Include unreimbur 3ed medical expenses. ITEM NO. DESCRIPTION AMOUNT 1 Graham ~'_=dical Clinic - final statement 6.43 2 Mooney's Tax Service - final income tax preparation 30.00 TOTAL (Aisc enter on line 10, Recapitulation) $ 36.43 ' 7 CPA12 NTF 10912 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software On , 1997 Nel¢o, inc. REV-1513 EX + (1-~c7) SCHEDULE J COMMONWEA .TH OF PENNSYLVANIA INHERITA ~CE TAX RETURN BEN EFICIARIES RESIDI-'NT DECEDENT ESTATE OF FILE NUMBER Emma May Ost.~eim 21~2002~0037 RELATIONSHIP TO DECEDENT AMOUNT OR No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) SHARE OF ESTATE I. TAXABLE DIS' rRIBUTIONS (include outright spousal distributions) 1 Jean Jo~ ~s Daughter 495.00 690 SW 3..:th Street Palm Cit],, FL 34990 2 Lori A. ttarnes Granddaughter 1,340.42 555 Oak ~nor Drive Ukian, C3 95482 3 David W. Barnes Grandson 1,340.42 122 Calvert Court Ukiah, CA 95482 4 Richard J Dnes Grandson 1,340.42 690 SW 345h Street Palm City FL 34990, ENTER DOLI~ kR AMIS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE tlSTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE A qD GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART ,~ -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ O. O0 7 CPA13 NTF 10913 Copyright Forms Software Only11997 Nelco~ Inc. (If more space is needed, insert additional sheets of the same size) · TO: FROI I FOLL( (1) (2)] (3) .- PO Box 250 · je~'r~ A,'".W~ U ' '" igle, Esq ire Weigle~ Pe[kins &Associates .. 126 ,East King ,Street '- ShippensbUrg, PA 17257 oRRsTOWN BANK' P.'O. BO~( 2'50 -, _ SHIPPENSBURG PA 1.7257-0250 '.' ESTATE OF Emma May Osthelm .DECEASED ,WING ACCOUNTS WITH ORRSTOWN BANK: DATE OF DEATH: October 21,2001' iT/S HEREBY CERTIFIED THAT THE'ABOVE NAMEDDECEDENT HAD; oN.THE ABO~E DATE, THE.: CHECKING ACCOUNTS ^c buNT NO. T TLE OF ACCOUNT DATE'OPENED 000607339" Emma May Ostheim '09-02-83 DATE OF DEATH,. ., PRINCIP'LE~'& ACCRUED INTEREST, $1.332.03 n/a- " ' DATE OF DEATH DATE OPENED. 'PRINCIPLE &'.ACCRUED INTEREST SAVINGSACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT - cERTIFICATES.OF DEPOSIT ACCOUNT NO. TITLE-OF ACCOUNT 10048696 Emma May'Ostheim Irrevocable Burial Fuhd DATE OPENED DATE· OF DEATH- - PRINCIPLE: & ·ACCRUED INTEREST _ $ 2,160.30 $1.30 ' ' 08~1~7-93 1]-01-01 By:: WendY BullOck Shippensburg, PA 17257 · (717) 532-6114 · (7:i7) 532-4i43 Fax · wvvw. orrstoWn.'com 'T'H F.,, DIAMONDIg'I"ORE"' THE.FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER I1' 0 THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK--HOLD AT AN ANGLE TO VIEW '~(~'~ LAST WILLANDTESTAMENT I, EMMA MAY OSTHEIM, of 2715 Esther Circle, 'Chambersburg, Franklin County, being of sound mind,.memory and disposition, do hereby make, publish and declare .s my Last Will and Testament, hereby revoking and making void all wills by me at any time FIRST. I Order and direct the payment of all my just debts and funeral expenses as n as may be convenient after my decease. SECOND. I give, and bequeath all of my shares of stock in Ameritech, ATT & T and South to my daughter JEAN O. JONES of palm City, Florida. In the event that JEAN O. should predecease me or is not living on the thirtieth (30) day following my death, I then and bequeath said shares of stock to my grandson RICHARD JONES, of .Palm City, Florida stripes distribution basis. THIRD. I give and bequeath my original set of white gold wedding rings to'my ANNE BARNES. FOURTH. I give and bequeath my yellow gold diamond ring made from grandmother im's earrings to my daughter JEAN JONES. to my FIFTH. I give and bequeath mY two wedding rings banded together on a gold chain KATHERINE WEAVER. (5) Ameri, SIXTH.' I give and bequeath my Amish collection consisting of tWo (2) dolls and five 'the Johnstown framed poster of the Incline Plane, and the book A Day in theLife of my daughter ANNE BARNES. I give and bequeath my needlepoint entitled "Flowers and Lace" to K. PETERMAN. of Biglerville, Pennsylvania. In the event that DOROTHY should predecease me or is not living on the thirtieth (30th) day following my then give and bequeath my needlepoint entitled "Flowers and Lace" to her daughter PETERMAN DUNLOP. M/~RI~ WEIGLE AND PERKINS -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 to I give and bequeath the full sum of two thousand ($2,000.00) dollars granddaughter, LORI A. BARNES, of Ukiah, California, absolutely. son NINTH. I give and bequeath the full sum of two thousand ($2,000.00) dollars to DAVID W. BARNES, of Ukiah, California absolutely. TENTH. I. give and bequeath the full sum of two thousand ($2,000.00) dollars to my JONES, of Palm City, Florida, absolutely. estate ELEVENTH. I give, deviSe and bequeath all the rest, residue and remainder of my personal ~ahd'mi3~ed, whatsoever and wheresoever situate, as follows: Ao FIVE PERCENT (5%) of the rest and residue' of my estate to' cHRIST EVANGELICAL LUTHERAN CHURCH of Westmont, Johnstown, Pennsylvania; I direct that the remaining NINETY~FIVE PERCENT (95%) of the rest and residue of my estate be divided in equal shares as follows: ONE SHARE to my daughter, ANNE BARNES, on a per stripes distribution basis; ONE SHARE to my daughter, JEAN JONES, on a per stripes distribution basis; and , ~ ONE sHARE to my daughter, KATHERINE WEAVER, on a per stripes distribution basis. In the event that the said KATHERINE WEAVER should predecease me without leaving issue surviving, I direct that the share she would have received shall be divided as follows: ao 'A two-thirds (2/3) portion of said share shall be distributed to my son- in-law, LARRY E. WEAVER; A one-third' (1/3) portion of said share shall be divided equally between my other daughters, ANNE BARNES and·JEAN JONES, on a per stripes distribution basis. because ofn or not passh taxes, shall b out of the re~ I hereby direct that all federal, state and other death taxes paYable y death, with respect to the property forming my gross estate for tax purposes, whether g under this Will, inclUding any interest or penalty imposed.in Connection with such e, considered a part of the expense of adminigtration of my estate and that such be paid ~t and residue of my estate. MARK, WEIG2E AND PERKINS -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 THIRTEENTH. I nominate, constitute and appoint my son-in-law, LARRY E. W~AVER, to be the Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint ORRSTOWN BANK, of Shippensburg Pert ~sylvania, to be the Executor of this my Last Will and Testament. ( bone seal tc identif -FOURTEENTH. I direct that my personal representatives shall not be required to give for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I EMMA MAY OSTHE!M, ha~ye-hereunto set my hand and this my Last Will and Testament, written on three pages, the' first two pages signed for cation only, this,~z='' day Of dT;~/~ ,1995. .. ,.,, .. -.-.a .... (SEAL) , WEIGLE AND PERKINS -- ATTORNEYS AT LAW -- 126 EAsT KING STREET -- SHIPPENSBURG, PA" 17257-1397 ...... This instrument was by the Testatrix, EMMA MAY OSTHEIM, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disp, ing mind and memory, have hereunto subscribed our names as witnesses. COIVI~ iONWEALTH OF PENNSYLVANIA · : SS. COUN~ 'Y OF CUMBERLAND · EMMA MAY OSTHEIM, the Testatrix whose name is signed to the foregoing instrument, having 1~ :en duly qualified according to law, do hereby acknowledge that I signed and executed the instrume~ as my Last Will; that I signed it willingly; and that I.signed it as my free and voluntary act for thc purposes therein expressed. o' before b, EMMA me IVi~Y OSTHEIM, the Testatrix, this c~9~qc~ ay of . ~~, : ', 1995. · ?- blota~al Seal [ ' ' Rhonda R. Wc>~orct, Notary Public ~ . I- Shipl~ensburg Boro, Cumbor~and O, oun~ ~' My Oommission Expires Jan. 20 1997 sign it as and s Testa~ constr ~MMONWEALTH OF PENNSYLVANIA · UNTY OF CUMBERLAND · SS. vitnesses whose names are signed to the foregoing instrument, being duly qUalified according s, do depose and say that we were present and saw EMMA MAY OSTHEIM, Testatrix, md execute the instrument as her'Last Will; that she signed Willingly and that she executed ~er free and voluntary act for the purposes therein expressed; that each of us in the hearing ght of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the rix was at the time eighteen (18) or more years ofage and of sound mind and under no tint or undue influence. Sworn ~~to and subscribed before ~ ~ by~ ~ )rd~"- ~ Mm~s ~ 'da~f No~h~ Seal' Rhonda R. Wo~, N°~ Public Shi~ Bo~, Cum~fla~ Coun~ My Commi~i0~' ~i[~ ~.,2~, 1997 . MARK, WEIGLE AND PERKINS -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- 5HIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PI ~JNSYLVANIA DEPARTMENT OF REVEN~ JE BUREAU OF INDIVIDUAL DEPT. 280601 HARRISBURG, PA RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001061 WEIGLE J A 126 E KING S G, PA 17257 ........ fold ESTATE INFORMATI~ )N: SSN: FILE NUMBER: 2102-0037 207-32-3232 DECEDENT NAME: DATE OF PAYMENT: oSTHEIM EMMA MAY O4/12/2002 POSTMARK DATE: COUNTY: DATE OF DEATH: 00/00/0000 CUMBERLAND 10/21/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 J $13.76 I' I I I I I TOTAL AMOUNT PAID: $13.76 REMARKS: A WEIGLE ESQUIRE CHECK# 32. [5 INITIALS: JA SEAL RECEIVED BY: MARY C. LEWIS .: REGISTER OF WILLS .; REGISTER OF WILLS BUREAU OF ZNDIV TNHERITANCE TAX DTV DEPT. 280601 HARRISBURG, PA 1712 JERRY :DUAL [SION ~-0601 TAXES WEIGLE ESQ COHNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE ,NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX '02 31 p1:51 CUT ALONG THIS REV-1547 EX AFl ESTATE OF OST~ RESERVATION CON' APPRAISED VALUE 1. Real Es~atd 2. Stocks end $. Closely He: DATE 05-27-2002 ESTATE OF OSTHEIN DATE OF DEATH 10-21-2001 FILE NUNBER 21 02-0037 COUNTY CUHBERLAND ACN 101 Amount Remitted REV-154? EX AFP (01-02) ENNA N LINE HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 RETAIN ~OWER PORTION FOR YOUR RECORDS ~ (01-02) NOTICE OF XNHERITANCE TAX APPRAXSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ElM EMMA HFXLE NO. 21 02-0037 ACN 101 DATE 05-27-2002 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED :ERNXNG FUTURE INTEREST - SEE REVERSE OF RETURN BASED ON: ORIGINAL-RETURN (Schedule A) (1) Bonds (Schedule B) (2) Stock/Partnership Interest (Schedule C) ($) .00 .00 .00 .00 NOTE: To 1nsure proper credit to your account, submit the upper port/on ~. Hortgages/N~tes Receivable (Schedule D) $. Cash/Bank Dposits/Hisc. Personal Property (Schedule E) 6. Jolntly O~n;.d Property (Schedule F) 7. Transfers (~.chedule G) 8. Total Assets APPROVED DEDUCTII 9. Funeral Expm 10. Debts/Nortga! 11. Total Ded; 12. Net Value 15. 1~. (q) (5) (6) :(7) 7~32q.29 .00 .00 ,NS.AND EXEHPTIONS: ~ses/Adm. Costs/NAsc. Expenses (Schedule H) (9) le Liabilities/Liens (Schedule I) (10) c~ions of Tax Return CharitablE~Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value )f Estate SubSec~ ~o Tax (8) 2,771.60 36.~3 (11) (12) (15) ' (lq) NOTE: If an ass~ssment was issued previously, lines 1~, 15 and/er 16, 17, reflect f~.gures that include the total of ALL returns assessed to date. 1~ a~ Spousal rate 1~ taxable at Lineal/Class A rate 1~ at S1bllng rate 1~ taxable a~ Collateral/Class B rate DISCOUNT (+) INTEREST/PEN PAID (-) 9 .~,7 .00 ASSESSNENT OF TAX: 15. Amount of Lind 16. Amount of L/ne 17. Amoun~ of L/ne 18. Amount of L/ne 19. Principal Tax u~ TAX CREDITS: PAYH~NT DATE 0~-12-2002 061 (is) .00 x 00 = (16) q,516.26 x 0~5= (17) .00 x 12 = (18) .00 X 15 = (19)= AHOUNT PAID 180.00 13.76 of this form wJ~h your tax payment. 7,32~.29 ~,516.26 .00 q,516.26 18 and 19 will .00 203.23 .00 .00 203.23 TOTAL TAX CREDIT 203.23 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ' A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE'OF NOTICE: PAYNENT: REFUND (CR}': OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST:' Estates of decedents dying an* or before December 11, 1982 -- [f any future interest [n the estate [s transferred.i . *in possess[oh or enjoyment'to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, .the Commonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the la~ful Class B (collateral) rate an any such future interest. To fulfill the requirements of Sect[on 21~0 of the Inheritance and Estate Tax Act, Act 25 of'ZOO0. (72 P.S. Section 91qO). Detach the top port[on of this Not[ce and submit mith your payment to the Register of Hills printed on the reverse side. ' --Hake check or money order payable to: REG/STER OF H/LLS, AGENT A refund of a tax credit, which ~as not requested on the Tax Return, may be requested by completing an ~Appl[cation for Refund of Pennsylvania Inheritance and Estate Tax" (REV-151:5). Applications are available at .the Off[ce of .the Register of N[lls, any of the 2:5 Revenue District Offices, or by calling.the spec[a[ Z~-hour answering service f~r forms ordering: 1-800-561-2050; services for taxpayers with special hea~Jng and / or ~peaking needs: 1-&00-~7-:5010 (TT only). Any party in interest not satisfied ~ith the appraisement, a11bwance, or disallowance Of deductions, er assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, Harrisburg, PA 17118-1011, 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 on this assessment should be addressed [n writing to: PA Departaent of Revenue, Bureau of Individual Taxes~ ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. 'If any tax due [s paid within three (:5) calendar months after the decedent's de~th, a five percent (51) discount of the tax paid is allowed. The 151 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 [s appealable [n the same manner and in the the same tiaa per[od as you would appeal the tax and interest that has been assessed as indicated on this not[ce. Interest [s charged beginning ~ith 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, 1981 bear interest at the rate of slx (6X) percent per annum, calculated at a dally rate of .00016~. A11 taxes mb[ch became delinquent on and after January 1, 1981 w[11 bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Departaen~ of Revenue. Theappl[cable interest rates for 1981 ~hrough 2001 are: Year Interest Rate Da[Zy Interest Factor Year Interest Rate Da[ly Interest Factor 198Z 207. .0005~,8 1983 167. ~ '- ~ ' .000~,38 198~ llZ .000:501 1985 1:5Z .000~56 1986 IOZ . OOOZ70, 1987 97. . OOOZ~7 1988-1991 111 .000:501 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD 199Z 92 ~* .O00Z~7 199:5=199fi 72 ~00019Z ' 1995-1998 92 .OOOZ~7 ~ 1999 ' 7Z .000192 ZOOO 82 .OOOZ19 2001 9Z .OOOZ~7 2002 67. .00016q X NUNBER OF DAYS DELZNQUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent .ill 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. REGISTER OF WILLS, CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 Nar~e of Decedent: Da~e of Death: wi]Il No. Cou the repz comp. acco% the p~ accou approv Cerk o Date: Emma May OstheiTM 10-21-2001 21-02-0037 Admin. No. Pursuant to Rule 6..12 of the Supreme Court Orphans' it Rules, I report the following with respect to completion of administration of the above-captioned estate: State whether administration of the estate is complete: Yes X -No 2. If the answer is No, state when the personal ~sentative reasonably believes that the administration will be Lete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final nt with the Court? Yes No X b.~ The separate Orphans' Court No. (if any) for ~rsonal representative's account is: c. Did the personal representative state an t informally to' the parties in interest? Yes x No d. Copies of receipts, releases, joinders and ~ls of formal or informal accounts may be .filed with the the Orphans' Court and may be attached to this report. nat%are Jerry A. Weigle, Esquire' Name (Please type or print) WEIGLE. & AS SOC IATES, _ P. C. 12-6- East King Street Address Shippensburg, PA (717) 532-7388 Tel. No. 17257 Capacity: Personal Representative (MAH:rm~ AIM3) X Counsel for personal representative Ostt Will to pr Cuml duty ESTATE OF EMMA MAY OSTHEIM File No. 21-02-0037 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT made this ~ ~t&-~ ~ day of ~ ,2002, BETWEEN: JEAN JONES, LORI A. BARNES, DAVID W. BARNES, and JONES, being the legatees under the Last Will and Testament of Emma May eim, late of West Pennsboro Township, Cumberland County, Pennsylvania. WHEREAS, Emma May Ostheim died October 21, 2001, testate, and under her left her estate to the parties herein; and WHEREAS, there were no probate assets in the estate so that it was unnecessary :sent the .Last Will and Testament of Emma May Ostheim for formal probate in ~erland County, PA; and WHEREAS, all assets of the late Emma May Ostheim have been liquidated or and all her debts paid in full, the said parties ,f the filing of a First and Final Account hereto desire to waive the with Propose~l Schedule of for purposes of confirmation by the Court of Common Pleas of Cumberland Orphan's Court Division, AND further desire that a Family Settlement Agree be executed, which Family Settlement will be duly recorded among the deed recor&, in and for Cumberland County. THEREFORE, WITNESSETH, that the parties hereto, in consideration of the pre above stated, and of the Accounting and Proposed Schedule of Distribution WEIGLE ASSOCIATES, P.C.-- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 att~ached hereto and made a part hereof, and the receipt of their distributive shares as the ein shown, do mutually bind themselves to the said Distribution and Accounting as set ~orth and further mutually release each other from all claims and demands whatsoever arising out of settlement of the Estate of Emma May Ostheim. The parties hereto do further agree that should any liability come due to the estate - of tire said decedent after the signing of this agreement, we and each of us do hereby covonant and agree with each other that we will contribute pro rata our share of the estate to s isfy ~tny'and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate after the signing, sealing and delivery of this ~mily settlement agreement and final release. IN WITNESS WHEREOF, the parties have' hereunto set their hands and seals the day ~d year first above written. WIT) 'ESS': Jean Jones / (~~~'~fs,--/ (SEAL) By Richard Jon~AS~wer ~ Attorney '~'~ ~~'~-'~ (SEAL) z~yid ~1~_ .'-- (SE~L) WEIGLE I~ ASSOCIATES,RC. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 ST CO me, and pers~ exec X. TE OF FLORIDA ONTY OF On this the ."5'3~' :-2-- day °~I: .:...___.. 2002, before the undersigned officer, personally appeared RICHARD JONES, in his own right hs Attorney-in-Fact for Jean Jones, known to me (or satisfactorily proven) to be the )n whose name is subscribed to the within instrument, and acknowledged that he ~ted the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal LORRIE L BECKHAM MY COMMISSION if CC 914146 EXPIRES: February 28, 2004 Bonded Tnm Nota~/Public Unde~dtem TSEAL) before OF CALIFORNIA · · SS OF · this, the ~2~ day of t~ , 2002, the undersigned officer, perSonally appeared LORI A. BARNES, known to me (or ;atisfactorily proven) to be the person whose name is subscribed to the within instrum{ containe WEIGLE nt, and acknowledged that she executed the same for the purposes therein WITNESS WHEREOF, I h~and and official seal. .co~.#~0~ ~ ~RY PUBLIC~ALIFORN a 0 EN~INO COUN~ 0 & ~SSOCIATES, RC, -- ATTORNEYS AT LAW -- 126 ~St KING STREET -- SHIPPENSBURG, PA 17257-1397 ST ATE OF CALIFORNIA CO bef me inst~ cont~ ined. · SS JNTY OF · On this, the '2-~ day of '(~/~ , 2002, re me, the undersigned officer, personally appeared DAVID W. BARNES, known to or satisfactorily proven) to be the person whose name is subscribed to the within anent, and acknowledged that he executed the same for the purposes therein IN WITNESS WHEREOF, I hereunto set my hand and official seal. COMM. # 't 249094 ii'f~15~N OTARY PUBLIC-CALIFORNIA MENDOCINO (~OUN?Y COMM. ~P. J~, ~0, ~0~ (~~' ~ ~~' X._.)(SEAL) WEIGLE ASSOCIATES, P.C.-- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 II ~ FIRST AND FINAL ACCOUNT FOR ESTATE OF EMMA MAY OSTHEIM, DECEASED Date of Death: October 21,2001 Acco unting for the Period: October 21,2001, to t June 5, 2002 Purp se of Account: The Estate of Emma May Ostheim offers this account to acquaint ~ntere~sted part~es w~th the transactions that have occurred during the administration. The ac~count also indicates the proposed distribution of the estate. I". / ' tthtth tb f~il ' 'd R t ~s ~m. portan a e accoun e care u y examine . equesrs for additional ~nformat~on or questions or objections can be d~scussed w~th: Jerry A. Weigle, Esquire Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 717-532-7388 WEIGLE & P.C. -- ATTORNEYS AT LAW -- 126 EAST KINg STP.EET -- SHIPPENSBURG. PA 17257-1397 SUMMARY OF ACCOUNT Estate of EmmaMay Ostheim For Period 10/21/01 Through 6/5/02 Proposed Principal Receipts Net Gain (or Loss) on Sales or Other £ispositions Other Receipts Less Dis ~burS~ts: Adminis~rationExpenses.(Prin) Fees an~ Connissions (Prin) Funeral ~Ebq:::~_nses' (Prin) Other Expenses (Prin Balance l~ore D±stribu~i~ns DistributiOns to Beneficiaries Principal Balance on Hand istribution to Beneficiaries Page 5 1 2 2 2 2 Income Receipts Less Disbursements Balance before Distributions Distribution~ to Beneficiaries $ 303.76 500.00 -2,'161.60 36.43 Fiduciary Acquisition Value ,$3j827.50 $7,324.29 0.00 0.00 $7,324.29 3,001.79 $4,322.50 495.00 $3,827.50 $ 0.00 0.00 $ 0.00 0.00 $ 0.00 $3,827.50 Assets Listed in Inventory '(Vil~d '~ ~ d~'E~ ~-f' d~t~i) RECEIPTS OF PRIN~P~ Estate of EmmaMay Ostheim As of 6/5/02 Page 1 Fiduciary Acquisition Value Checkin¢ Accounts Orrstoa~ Bank Checking Account #000607339 Savi~gs Accounts Orrsto~Bank Irrevocable Burial Fund CertifiCate of Deposit #30048696 $1.30 Accrued Interest Misc. Pe~ 'Yellow Refunds Presbyte ~onal Property Old Diamond Rin9 - appraised value _~ian Hon~s - 11/23/01 refund $ 1,332.03 2,161.60 495.00 3,335.66 $ 7,324.29 DISBLIRSSbS1N~fS OF PR_q~CIPAL Estate of EmmaMay Ostheim For Period 10/21/01 Through 6/5/02 Page 2 Administrati°nExpenses (Pr/m) Jmes ~ewelers - appraisal o~ .ring 01/14/02 Register of Wills, Cumberland County - PA I[~eritance Tax payment at discount 04/02/02 R~gister of Wills, Cumberland County - filing ~ Inheritance Tax Return 04/02/02 Register of Wills, Cumberland County - PA IraheritanceTaxbalance due 06/05/02.Re~ister of Wills, Cumberland County - filing Farkily Settlement Agreement 06/05/02 L K. Klein - notary fee ' / Fees and Commissions (Prin) 04/02/02 Wei~le &Associates, P.C. - attorney fee Funeral ~Js (PrS_n) 10/26/01 Foge~sanger-Bricker Funeral Home Other~Sbq0enses (Prin) 11/06/01 Gratum' Medical Clinic - final statement 04/02/02 Moone z's Tax Service - preparation of final income tax returns TOTAL DISB~S OF PR/NCIPAL $ 1 .oo 180.00 15.00, 13.76 75.00 5.00 $ 6.43 30.00 $ 303 '. 76 500.00 2,!6!.60 36.43 $ 3.,001.79 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Emma May Ostheim For Period 10/21/01 Through 6/5/02 Page 3 To: Jean Jones Yello~Gold Diamond Pd_ng 01/10/02 Yellow Gold Diamond Ring' TOTAL DISTRIBUTIONS OF PRINCIPAL TOBkNEFICIARIES $ 495.00 $ 495.00 Accounts Checkinc Weigle & Associates, P.C. Account PRINCIPA~ BALANcE ON'HAND PRINCIPAL BALANcEONHAND Estate of Emma May Ostheim As of 6/5/02 Clients Checking Current Value $ 3,827.50 $ 3,827.50 Page 4 Carrying Value $ 3,827.50 $ 3,827.50 PROPOSED DISTRIBUTIONS TO BENEFICIARIES Estate of E mm aM ay Ostheim For Period l0/21/01 Through 6/5/02 Page 5 To: Lori A. Barnes Cash 06/05/ Total D2 The beneficiary will receive a 33.3334% interest in the estate's residue, representing a portion of the following assets: Cash $ 1,275.83 $ 1,275.83 To: David W/. o6/os/ Total Barnes The beneficiary will receive a 33.3333% interest in the estate's residue, representing a portion of the ~ following assets: Cash 1,275.83 $ 1,275.83 To: Richard Jones 06/05/02 ~he beneficiary will receive a 33.. 3333% interest in the ' ~state's residue, representing'a portion of the following assets: ~ash 1,275.84 Total TOTAL PROPOSEE DISTR/BUTIONS TO BENEFICIARIES $ 1,275.84 $ 3~827.50