The URL can be used to link to this page

Home My WebLink About04-0284Register of Wills of Cumber!and County, Pennsylvania Estate of PETITION FOR GRANT OF LETTERS DOROTHY K. BAlE Deceased Social Security No 186-30-6453 Petmoner{s), who is/are 18 years of age or older apply0es) for (COMPLETE "A" OR "B' BELOW ) A Probate and Grant of Letters and aver that Pebboner ~s the executrix named ~n the Last Wdl of the Decedent, dated Au~st ]3, 1992 and codm~l(s) dated State relevant c~rcumstances, e g renunciation, death of Executor, etc Except as follows, Decedent d~d not mare/, was not d~vorced, and d~d not have a chdd born or adopted after execution of the documents offered for probate, was not to wct~m of a kdhng and was never adjudicated incompetent B Grant of Letters of Adm~mstrat~on (d b n c t a pendente hte, durante absent,a, durante mlnorltate) Petd~oner(s) after a proper search has/have ascertmned that Decedent left no Will and was survived by the following spouse 0f any) and heirs Name Relabonsh~p Residence COMPLETE IN ALL CASES ) Attach add~honal sheets ~f necessary Decedent was domiciled at death in Cumberland 153 Creek Road, Lower Allen Township (List street, number and mun~clpahty) Decedent, then 85 .years of age, d~ed March 6, 2004 County, Pennsylvania, w~th h~s last<~[an~dy or principal residence at at 153 Creek Road, Camp Hdl, PA Decedent at death owned property w~th estimated values as follows (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property m County Value of real estate in Pennsylvania $ 66,500 00 $ $ 100,000 00 Total $ 166,500.00 Real Estate s~tuated as follows 153 Creek Road, Lower Allen Township, Cumberland County, Wherefore, Petitioners respectfully request the probate of the Fast W~II presented w~th th~s Petition and the grant of letters ~n the appropriate form to the undersigned Typed or pnnted name and residence ROBERT O. BAlE 129 OLD MILL DRIVE, CAMP HILL, PA 17011 Oath of Personal Representabve COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The Pebboner(s) above-named swear(s) and affirm(s) that the statement(in the f~go~n~P~bbon are true and correct to the best of the knowledge and behef of Petitioner(s) and that,~s.pers~l repEe~ntat~ve(s) of the Decedent, Pet~bo~er(s) will well and truly administer the estate according to~l~w Sworn to and affirme~-and~u~scnbed - ~ROBERT O. BA1~ Estate of DOROTHY K BAIR , Deceased Social Secunty No 186-30-6453 Date of Death 03/06/2004 AND NOW, ./~./E.¢. ~' ,2004, in cons~derabon of the Pebt~on on the reverse s~de hereon, sabsfactory proof hawng been presented before me, IT IS DECREED that Letters Testamentary d b n c t a, pendente lite, durente absentla durante mlnontate are hereby granted to ROBERT O BAIR ~n the above estate and that the ~nstrument(s) dated Auqust 13, 1992 descnbed ~n the Pebbon be admitted to probate and filed of record as the last Wdl of the Decedent FEES Letters Short Certificate(s) Renunciation Aff~dav~t ( ) Extra Pages Codicil JCP Fee Inventory . Other TOTAL Attorney R~chard W Stewart I D No 18039 Address Johnson, DuffleI Stewart & We~dner, 301 Market Street1 P O Box 109, Lemoyne, PA 17043- Telephone 717-761-4540 hts ~s to certdy that the ,nformaUon here given ~s correctly cop~ed from an or, g~nal cerUhcate of death duly filed with me as Local Registrar The original certfficate will be forwarded to the State V~tal Records Office for permanent f, hng WARNING: It ~s Illegal to duphcate th~s copy by photostat or photograph. Local Registrar P 10135863 092004 No Date H105143 Rev 2ia? Dorothy K. Balr Cumberland ,~ome maker New Cumber~a COMMONWEALIH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Lower Allen 153 Creek Rd. KiND OF BUSINESS I INDUSTRY WAS DECEDENT OF HISPANIC ORIGIN? RACE Ame~can Ind~a~l ~,CTUAL 153 Creek Rd Camp Hill,Pc .~E$IDENCE ,, Mervln ~omberger =, Ro~er~ O. Bair ,, ~aro~yn Beaver I~u ~:~-~ ~r. ~amp ~1, Pa. ~. Olivet Cemetery ~,~w Cumberland, Pa. METHOD OF DISPOSiTiON .[] !.S.Inc. 324 Hummel OR PERSON ACTING AS SUCH LICENSE NUMBER WAS CASE REFERRED TO A MEDICAL EXAMINER ,~ORONER9 NUMBER INJURYATWORK?ye,• NoD 3""DESCRIBEHOWINJURYOCCURRED RWS/August 10, 1992/18804 ill t tuteut of DOROTHY K. BAIR I, Dorothy K Balr, of the Township of Lower Allen, Cumberland C.~nty, Commonw_~aljh of Pennsylvania, declare this to be my Last Will and revoke any Will previously mad6 by n~ P. ~' ITEM I. ! grant my son, Robert O Bait, the option to purchase my.~real e~te kn~v~ and numbered as 15~ Creek Road, Lower Allen Township, Cumberland County, Pennsylvama,~ its fair market value as of the date of my death The fair market value shall be obtained by an appraisal performed by a real estate appraiser selected jointly by my sons, Ronald R Bait and Robert O Bait In the event that my sons cannot agree upon an appraiser, each shall select an appraiser who ~s a member of the Appraisal Institute If the two appraisers so selected cannot arrive at a value, the two appraisers shall select a third appraiser who shall be a member of the Appra,sal Institute and that appraiser's oplmon shall be final In the event the appraisers are unable to agree on a third appraiser, the third appraiser shall be selected by a Judge in the Court of Common Pleas of Cumberland County, Pennsylvania Such option must be exercised wttfun rune (9) months of the date of my death ITEM II. I devise and bequeath all of my estate of every nature and wherever situate to such of my children, Ronald R Bait and Robert O Bmr as survive me Should either of my said sons predecease me. I devise and bequeath the share of such chdd to his issue, per stlrpe~, hvlng on the 31st day followlng my death, and should e~ther of my sa,d sons leave no such issue to survive me, I devise and bequeath the share of such child to my other child or to his issue, per stlrpes, who survive me ITEM III. I appoint CCNB BANK, N A, of Camp H~II, Pennsylvania, guard,an of any property which passes, either under th,s W~ll or otherwise, to a m~nor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not apply to property distributable to a minor for whom I have otherwise made special provision and 9rovided further that th~s appointment of a guardian shall not supersede the right of any fiduciary ~n its RWS/August 10, 1992/18804 discretion to distribute a share where possible to the minor or to another for the minor's benefit Such guardian shall have the power to use principal as well as income from time to time for the minor's support or educatmn (including college education, both graduate and undergraduate) without regard for his or her ~arent's ability to provide for such support and education, and to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor ITEM IV. I direct that all taxes that may be assessed as a consequence of death, of whatever nature and by whatever jurisdiction Imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate ITEM V. I appoint my son, Robert O Balr, Executor oI this my last will Should my son, Robert O Balr, fall to qualify or cease to act as Executor, I appoint my son Ronald R Balr, Executor of this, my last Will ITEM VI. I direct that my Executor or guardian shall not be required to give bond for the faithful ~erformance of their duties in any jurisdiction lay of IN WITNESS WHEREOF, I, Dorothy K Balr, have hereunto set my hand and seal this ~3~>~ , 1992 Dorothy K SIGNED, SEALED, PUBLISHED AND DECLARED, by Dorothy K Bait, the Testatrix above named, as and for her Last Will and Testament and in the presence of us, who, at her request, m her >resence and in the presence of each other, have subscribed our names as witnesses Witn~57~ ~~ o~'~,-- Address RWS/August 10, 1992/18804 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : I, Dorothy K Balr, Testatrix, whose name ~s signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the ~nstmment as my Last Will and Testament, that I signed it wdhngly, and that I signed it as my free and voluntary act for the purposes therein expressed Dorothy K ~}~lr ' - of ~.~,-~ ~ 1992 NOTARIAL SEAL 'BONNIE k. STARR, NOTARY PUBLIC LEMOYNE BORO CUMBERLAND COUNTY MY COMMISSION EXPIRES ~UNE 3, 1993 Sworn to or affirmed and acknowledged before me, by Dorothy K Ba,r, the Testatrix, th~s I day Notary Public My commission expires (SE^D AI~'FIDAVIT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : We, g,O,~,~, /,0 .~le~oo~and 71/~,v,~J~/~ ~rf.~/, the w,tnesses whose names are signed to the foregoing instrument, being duly quahfied according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregmng instrument as her Last Will and Testament, that she signed wflhngly and that she executed It as her free and voluntary act for the purposes therein expressed, that each of us ~n the heanng and sight of the Testatrix signed the Wdl as witnesses, and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, ot sound m~nd and under no constraint or undue influence RWS/August 10, 1992/18804 Sworn to or affirmed and subscr,bed to before me waness~, ~s ~ay of~ 1992 BONNIE L, STAIR, ~TARY PUBLIC Not~y ~bh~~ LE~YNE BORO CUMBERLAND COUNTY MY COMMISSION EXPIRES JUNE 3, t993 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DOROTHY K. BAIR Date of Death: MARCH 6, 2004 Will No.: 21-04-00284 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 24, 2004. Name Address Robert O. Bair, Executor 129 Old Mill Dr., Camp Hill, PA 17011 Ronald R. Bair - Deceased - 2/03/1998 (Single -left no issue.) Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: March ¢~ ,2004 Name Richard W. Stewart, Attorney Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 '~UBJECT: Estate of Dorothy K. Bair No. 21-04-00284 DOD: March 6, 2004 FROM 3OHNSON, DUFFle'' STEWART & WE[DNER Attorneys at Law Lemoyne, PA 17043 (7!7) 761-4540 Fa~-f717~ 761-3015 , ~ Enclosed is a check in the amount of $6,000.00 as a payment on account of Inheritance for the above-captioned Estate being made within the 90 days to allow for the 5% discount. -~IGNED: Cindy Hubler, Estate Le_g..~ Assistant 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. REV-1162 EX(11-96) CD 003977 STEWART RICHARD W 3RD & MARKET STREETS P. O. BOX 109 LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 186-30-6453 FILE NUMBER: 2104-0284 DECEDENT NAME: BAIR DOROTHY K DATE OF PAYMENT: 05/26/2004 POSTMARK DATE: 05/25/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,000.00 REMARKS: CHECK# 1002 SEAL TOTAL AMOUNT PAID' $6,000.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS LAW OFFICES JOHNSON, DUFFLE, STEWART tB WEIDNER 301 MARKET STREET P. O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 REGISTER OF WILLS OFFICE CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE, PA 17013-3387 TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 SUBJECT: Estate of Dorothy K. Bair No. 21-04-00284 FROM 3OHNSON, DUFF]:E, STEWART & WEZDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 Fax: (717) 761-3015 DATE: June 4, 2004 Enclosed for filing in the above-captioned Estate are the following:-~ 1. Original Inventory. 2. Original and copy of Inheritance Tax Return. 3. Check in the amount of $28.00, filing charges. 4. Check in the amount of $1,384.62, Inheritance Tax. Envelope to return the filing receipt to this office. Thank you. SIGNED: ~ Cindy .~bler, Estate Legal Assistant 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. REV-1162 EX(11-96) CD 004018 ........ fold STEWART RICHARD W 3RD & MARKET STREETS P. O. BOX 109 LEMOYNE, PA 17043 ESTATE INFORMATION: SSN: 186-30-6453 FILE NUMBER: 2104-0284 DECEDENT NAME: BAIR DOROTHY K DATE OF PAYMENT: 06/07/2004 POSTMARK DATE: 06/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 J 91,384.62 REMARKS: TOTAL AMOUNT PAID: 91,384.62 SEAL CHECK# 1 OO3 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV - 1500 EX + (6.00) .~ c(~MMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 04 00284 Y~R INHERITANCE TAX RETURN I FILE NUMBER 21 RESIDENT DECEDENT ] COUNTYCODE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) BAIR, DOROTHY K. z~ i DATE OF-DEATN (MM-DD:YEAR) ~ : DATE OF BIRTH (MM-DD-YEAR) LU ~ 03/06/2004 : 03/03/1919 "" i(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) -,-o~o NUMBER ISOCIAL SECURITY NUMBER 186-30-6453 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1. original Retu;n [] 21 SupCementai Retur~ ~] ~. Remainder Return (date of death prior to 12-13-82) [] 4. Limited Estate [] 4a, Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) - ICOMPLETE MAILING ADDRESS i RICHARD W. STEWART FIRM NAME (If applicable) i JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market St. TELEPHONENUMBER 7 ! 7/76 !-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Lemoyne, PA 17043-0109 (1) 108,685.50 [~r:ClCiAt. us~ (2) 855.07 Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Fune~'al Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (4) None (5) 71,489.52 (6) None (7) None (9) 9,707.80 (10) 202.09 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) I (8) 181,030.09 (11) 9,909.89 (12) (13) 171,120.20 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) (14) ] 7 !, ! 2 0.2 0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ~. 171,120.20 x .045 (16) 7,700.41 16. Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) ?,700.41 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-'I500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 153 Creek Road CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE I z~P PA 1701 1 6,000.00 315.79 (1) Total Credits (A + B + C) (2) 7,700.41 6,315.79 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) _. 1,384.62 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) ] ~384.62 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; ................................ c. retain a reversionary interest; or. ........................................................................................................... d. receive the promise for life of either payments, benefits or care? ........................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ....... [] [] 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?. ............................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS SIGNA'[flJR~,OF PERSON RE'~JPON~'~..~-~OR FILING RETURN ADDRESS 129 Old Mill Drive Camp Hill, PA 17011 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS ' DATE RICHARD W~STEWART 3ut tvtar~ret :St. - / For dates ofdeath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) {i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 {a) (1.1) (ii)]. The statutedoes not exempta transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §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 BAIR, DOROTHY K. SCHEDULE A REAL ESTATE iFILE NUMBER 21-04-00284 TOTAL (Also enter on Line 1, Recapitulation) ]08,685.50 ITEM NUMBER 1 DESCRIPTION ' ' i~ Creek Road, Lower Alen ToTM Real Estate - No. 1 ship, Cumberland County, PA. Deed Book V, Volume 25, Page 534 Assessed Value - $103,510.00 x 1.05 (CLR) = $108,685.50 (Copy of 2004 tax statement attached) VALUE AT DATE OF DEATH 108,685.50 All real property owned solely or as a tenant in common must be rel3orted at fair market valu~air market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. iF TAXES ARE ESCROWED, FORWARD THiS BiLL TO yOUR M ORT ~G'E COMPANY BONNIE K. MILLER, TREASURER 93 HUMMEL AVENUE ~MP HILL, PA 17011-5938 OESC: MAP NO: t3.24-0805-080A · CREEK ROAD 153 _- ~'m DEED 0025V/00534 ACRE~ .... LAND Commercial - General coMMERCiAL CA"P HILL PA ,7011 Bill No: TAXPAYER cOPY ate Taxes Bill ....... t of Real Estate ~aA~o Total Contro~ No: u]o %~ OF LOWER ~ . .n15000C ~S2.16 /uvv,- ..... 0150000 J .u~ . .0 144.5. /~ % Rates ~ ~ ~ TAX AMOUNT DUE ~> CLAIM BUR~&U YOUR p~oPERT~- 135 10% 23.32 lO % io% $4§0.49 $49.5.54 6/30/200 ~~ ETuRNED T~- mO DAX ?ILING OF A LIEN AGAINST OFFICE HouRS: _ & THURS 9AM-4PM OR BY ON TUES 0 9AM-4PM M ,. 4/3 us APPT, 4_/2.9. ,9, ,A = R,.'~ L OW E R - A_L,L.,.E~.; ~P,A ' OLSD HLD¥5/~¢-~'~ Return Bill with Payment. For a Receipt, Enclose Sell Addressed Stamped Envelope· COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF BAIR, DOROTHY K. FILE NUMBER 21 - 04 - 00284 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ! 25 Shares - MetLife Common @ $34.2028 per share UNIT VALUE VALUE AT DATE OF DEATH 855.07 TOTAL (Also enter on line 2, Recapitulation) 855.07 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF BAIR, DOROTHY K. :FILE NUMBER 21 - 04 - 00284 Include the proceeds of litigation and the date the proceeds were received by the estate~ll property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 HOusehold Goods- date of death value 1978 Ford Thunderbird - needs work - poor condition - extensive mst. Date of death value Waypoint Bank - Checking Account No. 1000010156 Date of death balance Waypoint Bank - Checking Account No. 1005004451 Date of death balance Waypoint Bank - Certificate of Deposit No. 1066273233 Date of death balance, plus accrued interest. Waypoint Bank - Certificate of Deposit No. 7100021268 Date of death balance, plus accrued interest. Waypoint Bank - Certificate of Deposit No. 9600016010 Date of death balance, plus accrued interest. TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 1,250.00 1,500.00 822.89 7,182.95 40,583.13 11,061.59 9,088.96 71,489.52 COMMOr~WEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN ; RESIDENT DECEDENT j ESTATE OF BAIR, DOROTHY K. Debts of decedent must be reported on Schedule I. iTEM NUMBER DESCRIPTION A. FuNE~L EXpENSEs: 1 Musselman Funeral Home SCHE[XJLE H FUNERAL EXPENSES & ADMIN~~ COSTS FILE NUMBER 21 - 04 - 00284 AMOUNT 5,818.00 2 Mt. Olivet Cemetery Association - interment 700.00 3 Romberger Memorials - marker lettering 127.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Johnson, Duffle, Stewart & Weidner Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Street Add ress City State Relationship of Claimant to Decedent Probate Fees Register of Wills - Cumberland County Zip 2,250.00 263.00 Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal - advertising letters The Patriot-News - advertising letters Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 75.00 109.30 365.50 9,707.80 COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Fureral Expenses & Administrative Cosls ~nu~ ESTATE OF BAIR, DOROTHY K. Register of Wills - file Inventory & Inheritance Tax Remm Recorder of Deeds - recording charges - conveyance to Robert O. Bait Hunter Agency - Homeowner's Insurance Reserve for close-out costs ~FILE NUMBER ~ 21 04 - 00284 28.00 38.50 224.00 75.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BAIR, DOROTHY K. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 04 - 00284 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Verizon - decedent's account - telephone charges PA American Water Co. - decedent's account - water charges PP&L - decedent's account - electricity charges Lower Allen Township - decedent's account- sewer/refuse TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 41.51 29.84 57.39 73.35 202.09 REV-1513 EX+ (9-00) ~ SCHEDULE J eom MONWEA.TH OF PENNS¥.¥^.,A B E N E F lC IA RI E S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BAIR, DOROTHY K. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Robert O. Bait 129 Old Mill Drive Camp Hill, PA 17011 *Ronald R. Bair, Son of the decedent - predeceased her - Ronald R. Bair died on February 3, 1998 - he was never married and left no issue. FILE NUMBER 21 - 04 - 00284 RELATIONSHIP TO AMOUNT OR SHARE DECEDENT OF ESTATE Dx) Not L[st~mstee(s) Son Real Estate/ Residue II. / !Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee~t i NON-TAXABLE DISTRIBUTIONS: iA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT ~BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Register of Wills of Cumberland County, Pennsylvania Estate of BAIR, DOROTHY K. also known as INVENTORY , Deceased No. 21 - 04- 00284 Date of Death 3/6/2004 Social Security No. 186-30-6453 Robert O. Bair, Executor The 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 located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: I.D. No.: Personal Represe~ sTEWART RICHARD W. Rob~r~ O. Bair, Ex c~uto~- 18039 Signature: Signature: Address: Telephone: 301 Market St. Lemoyne, PA 17043-0109 717/761-4540 Personal Property Address: 129 Old Mill Drive Camp Hill, PA 17011 Telephone: (717) 761-1597 Dated: ~, 25 Shares - MetLife Common ~ $34.2028 per share Household Goods - date of death value 1978 Ford Thunderbird - needs work - poor condition - extensive mst. Date of death value Waypoint Bank - Checking Account No. 1000010156 Date of death balance -¢-"' 855.07 1,250.00 I 1,500.00 822.89 Waypoint Bank - Checking Account No. 1005004451 Date of death balance 7,182.95 Waypoint Bank - Certificate of Deposit No. 1066273233 Date of death balance, plus accrued interest. 40,583.13 Waypoint Bank - Certificate of Deposit No. 7100021268 Date of death balance, plus accrued interest. 11,061.59 (Attach additional sheets if necessary) Total Personal Property and Real Estate $181,030.09 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of BAIR, DOROTHY K. also known as continued , Deceased Waypoint Bank - Certificate of Deposit No. 9600016010 Date of death balance, plus accrued interest. No. 21 - 04- 00284 Date of Death 3/6/2004 Social Security No. 186-30-6453 9,088.96 Total Personal Property $72,344.59 2 Register of Wills of Cumberland County, Pennsylvania Estate of BAIR, DOROTHY K. also known as INVENTORY continued , Deceased No. 21 - 04- 00284 Date of Death 3/6/2004 Social Security No. 186-30-6453 Real Estate Real Estate - No. 153 Creek Road, Lower Allen Township, Cumberland County, PA. Deed Book V, Volume 25, Page 534 Assessed Value - $103,510.00 x 1.05 (CLR) = $108,685.50 (Copy of 2004 tax statement attached) 108,685.50 Total Real Estate $108,685.50 3 JOHNSON, DUFFLE, STEWART ~ WEIDNER ATTORNEYS AT LAW 301 MARKET STREET P. O. BOX 109 First Class Mail REGISTER OF WILLS OFFICE · ~'- · CUMEERLAND COUNTY COUPTHOUSE , ~. - ' 1 COURTHOUSE SQUARE ~5 CARI,ISLE PA 17013-3387 FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF GEORGE V BOLTON (Deceased) To the Clerk of Orphans court Division: CLAIM No. 21-L4-280 of 2004 Index and make proper entry in your official records of the claim ~f. OMN~M WORLDWIDE, INC. for BANK ONE (Claimant), account # 42668499790677a~4, in the & amount of $5,318.59 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 4 PLAINVIEW RD, CAMP HILL, PA 17011-7928, died on March 16, 2004. Written notice of this claim was given to THOMAS SCHRENK, 4 PLAINVIEW RD, CAMPHILL, PA 17011-7928 (Personalrepresentative, ifany, or counsel). August 12 , 2004 OMNIUM WORLDWIDE, INC~/ 7171 MERCY RD, SUITE 400 PO BOX 6~18 OMAHA, NE 6~106 800-999-3778 (Claimant's Address) RECOSP 10:21:06 8/12/2004 CLIENT: BANK ONE STANDARD STATUS: ACTIVE STATUS L~NG~GE: ENGLSH ~ESP: PRMRS? CLI RE~: 4266849979067734 REASONS: 42-CLAIM FILED ~DDRESS TYPE: PRMHOM STREET: 4 PLIINVIEW ~ CITY: CAMP HILL STATE: PA S~: 161340299 ZIP CCOE: ~ 7928 COUNTRY: US ~LCODE: MAIL ACOCONT: 97592936 P~T: Fore... PHONE II~FOI~TIC~ ] PH~ TYPE: ~ CODE: P~F~: EXTENSI~: -- ~ CCOE: -- ~ CCOE: L EwTSl L ms l L A~m~TSl ImA~'~TSl L ACOO~T s~mmcsJ BALANCE: PAIg~NTS: 5318.59000 ADJUSTED BALANCE: 0.00000 0.00000 PRINCIPAL PA~TS: 0.00000 RTNBEC RETURN TO RECOVERY S42 CLAIM FILED CLM REPRES-FILE CLAIM WITH PROBATE:PROBATE CLAIM FORM FOLLC# UP ACTMTY: REVIEW FOLRT~ UP DATE: 8/13/2004 FOLLO# UP LIST~G BAL~: 5318.59000 LOCAL LIST~G BAL: 0.00000 102749 08/I2/2004 10:2i:06 102749 08/12/2004 10:21:03 102749 08/12/2004 10:21:0I Fore... L ~'~ m~BmsJ F2=CO~TIHUE SEARCH F3=EXIT F4=PI%O~T F-6=ADD C(~NTACT F7=PREVIOUS C(INTACT FS=t~"~ COt~TACT F9=HISTORY F24=MORE ~YS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: ANNE SCHAEFFER KEEFER MOORE AUGUST 27, 2002 Will No.: 0875-2002 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report that following with respect to completion of the administration of the above-captioned estate: complete: 1. State whether administration of the estate is Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No 1 is Yes state following: ' , the Date: Sept. 10, 2004 a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court the personal representative's account is: c. Did the personal representative --state an account informally to the parties in interest? Yes X '~No d. Copies of receipts, releases, joi~ders..and approvals of formal or informal accounts may be ,:fi ledo~with the Clerk of the Orphans' Court and may.,,be attached to/t%his report. gnature ~ Anna Marie Sossong Name (Please type or print) Skarlatos & Zonarich LLP 17 S. Second St., 6th Floor Harrisburg, PA 17101 Address (717)233-1000 Tel. No. Capacity: Counsel for Personal Representative PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY K. BAIR Date of Death: March 67 2004 Will No.: 21-04-00284 Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: . If the answer to No. 1 is yes, state the following: Date: 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 informally to the parties in interest? Yes No X ~ C... .~.~ Executor was also the sole beneficiary. Copies of receipts, releases, joinders and approvals of ~rmal ~r informal accounts may be filed with the Clerk 0~f the Or ~l~ns' Court and may be attached to this report. :~ .-~ ' Signature Richard W. Stewart, Attorney Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemoyne, PA 17043-0109 Address (717) 761-4540 Telephone No. Capacity: Personal Representative X Counsel for Personal Representative BUREAU OF ZNDTVTDUAL TAXES 'rNHERITANCE TAX D'rvzs'roN DEPT. 280601 HARR]'SBURG, PA 17128-0601 RICHARD N STEWART JOHNSON ETAL $01HARKET ST LENOYNE PA 170~$ CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF [NHER/TANCE TAX A P P R A I S EIl~r,,~ Oi~.I~/AR~ ? .~ I~);~ALLONANCE OF DEDUC~!IS.*'AH, D ~$~UEHT OF TAX DATE 08-02-200~ _ESTATE OF BAIR 'OZ~ ,JUL '~AT~]O~]DEATH 05-06-200~ FILE NUNDER 21 0q-028~ ~,~." ~.~ COUNTY CUMBERLAND ~,,~.!t}: ~;~ :!: ACN . 101 Amoun~ Rel~l~ed REV-151i? EX &FP (01-0S) DOROTHY K MAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF NILLS CUN]}ERLAND CO COURT HOUSE CARLTSLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTTCE OF ]:NHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF BAIR DOROTHY K F]:LE NO. 21 04-0284 ACN 101 DATE 08-02-200~ TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANBED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es*a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~narship In~ares~ (Schedule C) (3) ~. Not'gages/No,es Receivable (Schedule D) S. Cash/Bank Deposi~s/Nisc. Personal Proper*y (Schedule E) ($) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al AssaYs APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expansas/Adm. Costs/Hist. Expanses (Schedule H) (9) 10. Debts/Hot,gage Liabili~ies/Liens (Schedule Z) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn 108;685.50 855.07 .00 .00 71~489.52 .00 .0o (8) 9,707.80 NOTE: To insure proper credi~ ~o your account, submi* ~he upper pore/on of *his form ~i*h your ~ax payment. 13. 1~. NOTE: ASSESSNENT OF TAX: 16. Aaoun~ of L/ne lq a~ Spousal ra~:e (15) 16. A~oun~ of L/ne 1~ ~axable a~ L~neal/Class A ra~e (16) 17. Aeoun~ of L/ne lfi e* Sibl/ng ra~e (17) 18. Aaoun~ of L/ne lq ~axable a* Collateral/Class B ra~e (18) 19. Principal Tax Due TAX CREDITS: 181,030.09 . O0 x O0 = . O0 171,120.20 X 045= 7,700.~.1 · O0 x 12 = . O0 · O0 x 15 = . O0 (lC)= 7,700.41 PAYHENT DATE 05-25-2004 06-04-2004 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RECEIPT NUMBER CD005977 CD004018 DZSCOUNT (+) INTEREST/PEN PAID (-) ANOUNT PAID 315.79 6,000.00 I 69.25 1,$84.6Z TOTAL TAX CREDIT I 7,769.64 BALANCE OF TAX DUEI 69.25CRI INTEREST AND PEN. I .00 TOTAL DUE I 69'25CR ( ZF TOTAL DUE ZS LESS THAN $1, N~ PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE ~'/ A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) Charitable/Governmental Bequests; Non-elec*ed 911:3 Trusts (Schedule J) (13) .00 Ne~ Value of Es*a*e Sub.iec~: '1:o Tax (1fi) 171,120.20 Zf an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that include the total of ALL returns assessed to date. 202.09 (11) 9.909.89 (12) 171,120.20 RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, tho Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfut Class S (collateral) rate on any such futura interest. PURPOSE OF NOTICE: PAYHENT: REFUHD (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, ahich 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 ara available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z4-hour ansaaring service for forms ordering: 1-800-562-Z050; services for taxpayers with special hearing and / ar speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, alloaance, or disallowance of deductions, or 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. Z81021, Harrisburg, PA 171ZS-IOZ1, 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 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. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SZ) discount of the tax paid is allowed. The 1SZ 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 tho end of tho tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal tho tax and interest that has been assessed as indicated on this notice. Interest 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 (6Z) percent per annum calculated at a daily rate of .000164. A11 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. Tho applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily lnterast Dally Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 1988-1991 11Z .000501 2001 9Z .000Z47 1983 162 .000458 199Z 9Z .OOOZ47 ZOOZ 6Z .000164 1984 llZ .000301 1992-1994 72 .000192 2002 5Z .000157 1985 122 .000556 1995-1998 9Z .000Z47 2004 4Z .000110 1986 102 .00027~ 1999 72 .000192 1987 lOX .000Z74 2000 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAXD X NUI~BER OF DAYS DELINQUENT X DAI'LY 'rNTEREST 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 TNDZV'rDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRTSBURG, PA 171ZS-O6D1 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 'rNHERZTANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (D2-D3) RICHARD W STEWART JOHNSON ETAL 501HARKET ST LEMOYNE PA 17045 DATE 08-25-2004 ESTATE OF BAIR DATE OF DEATH 0:5-06-2004 FILE NUMBER Z1 04-0Z84 COUNTY CUMBERLAND ACN 101 Amoun'lc Remi'l:'~ed DOROTHY K HAKE CHECK PAYADLE AND REHIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credit: ~:o your account, subei~c ~he upper por~:ion of ~chis form wASh your ~ax paymen~c. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDg': ~. ~-~ ESTATE OF BAIR DOROTHY K FILE NO. 2! 04-0284 ACN ;:101 ~ DATE 08-2:5-2004 TH/S STATEHENT IS PROV/DED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAMED--ESTATE. SHO#N BELO# ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, A'Nb, ZF APPLICABLE, A PROJECTED /NTEREST F/GURE. ,.... ,~ :: , DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-26-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 7,700 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) :515.79 05-25-2004 06-04-Z004 08-09-2004 CD00:5977 CD004018 REFUND 69.2:5 .00 6,000.00 1,:584.62 69.2:5- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT/ON OF ADDITIONAL INTEREST. [ KF TOTAL DUE KS LESS THAN NO PAYMENT KS REQUKRED. KF TOTAL DUE KS REFLECTED AS A 'CRED/T' TOTAL TAX CREDIT 7,700.41 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. }