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03-0618
Estate of PALMER A. NACE also known as , Dgceased. I SoctalSecurttyNo. ~7q-l?-/'~7.F~ fit: .~f/of'W The petttton of the undersigned respectfully represents that Your petmoner(s), who is/are 18 years of age or older~j~ the execut rSces In the last will of the above decedent, dated July 21 and codlctl(s) dated None PETITION FOR PROBATE and GRANT OF LETTERS To Register of Walls for the County of Cumberland m the Commonwealth of Pennsylvania named 19_8/__ (state relevant circumstances, e g renunciation, death of executor, etc ) Decendent was domiciled at death in Cumberland County, Pennsylvama, with his last family or pnnmpat remdence at 9~7 w,~ee R~*~pe~, ~tr~o~-. Borough of (hst street, number and munc~pahty) Decendent, then 80 years of age, d~ed July 25. 2003 J~9 at Harrisburg Hospital. Harrisburg. PA. Except as follows, decedent did not marry, was not divorced and d~d not have a chdd born or adopted after execuUon of the will offered for probate, was not the wct~m of a kdhng and was never adjudicated ~ncompetent None Decendent at death owned property w~th esumated values as follows (If domiciled ]n Pa ) All personal property $ (If not domiciled ]n Pa.) Personal property Ln Pennsylvania $ (If not domiciled in Pa ) Personal property ]n County $ Value of real estate ~n Pennsylvania $ situated as follows 207 West Simpson Street, Borough of Mechanicsburg~ Cumberland County. PennsylYnn~ ~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the la'st ~dl and codicil(s) presented herewith and the grant of letters toatmmont-mry (testamentary, admm~stranon c t a, admmlstranon d b n c t a ) theron Virginia Beach. VA 23454 ~cki J. S~ea'r~r - 76 Kensxngton Drive OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND . The pemtoner(s) above-named swear(s) or affirm(s) that the statements zn the foregoing pettUon are true and correct to the best of the knowledge and behef of petmoner(s) and that as persomd represen- tatwe(s) of the above decedent petmoner(s) wall web and truly adrmmster the estate according to law SworntoorafErmed nd ubsc.bed before me th~s 29th day of ~ ~ Vxcki J~ S~earq[. ~ ~ / ~ ~ Estate Of NO. 21-2003-61~ PALMER A. ~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 30th ~.~ 200~ 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 July 21, 198] described therein be admitted to probate and filed of record as the last will of Palmer A. Nace ; and Letters To~_~mentary are herebygranted to Vicki 3. Shearer and AnEal~ M. White Kelly FEES Probate, Letters, Etc .......... $ 80.00 Short Certificates(4 ) ... '. ...... $12.00 ~,a~l~i~. ~-.Pages. [ 0.). $ -0- JCP $10.00 Filed .J.u.l.y...3.0.t.h. ,..~99.~. .................. Mailed Letters to Attorney Snelbaker on 7/30/2003. Resister of Wills Donn/a M?Otto, 1st dep~ SNELBAKER, BRENNENAN & SPARE, P. C. By Ri cha r,~q~R f~P~.~.ri. D. ~o9)6355 44 West Main Street Mechanicsburg~ PA 17055-0318 ADDRESS (717) 697-8528 PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscrlbmg law, depose(s) and say(s) that the testat ,stgn the same request of testat,__ ~n h__ other subscnbtng wttness(es)) codmd :he will presented herewith, (each) Sworn to or affirmed and subscmbed before me thru day of 19__ 0n the quahfied according to present and saw mgned as a w~tness at the of each other) (m the presence of the (Name) (Address) / (Address) 21-2003-618 REGISTER OF WILLS OF CUI'~ERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Vicki J. Shearer and AnEela M. Kelly (each) a subscmber hereto, (each) being duly quahfied according to law, deposes) and say(s) that they are each famdtar w~th the mgnature of Palmer A. Nace ~fl~xx testator of (~g~]~n~-,~'~t~k the wdl presented herewtth and that onch of thom beheves the signature on the wtll ts in the handwmUng of to the best of Sworn to or affirmed and subscmbed before D me th~s 30th day of .~__ ,~Julv ~ 19x2003 Donna M. Ot~o'ist De~t~--, ~almer A. Naae knowledge and behef U Vic(~ Shearer 76 Kensington Dr., Camp Hill, PA 17011 -' O Angela ~a~ll~ 1028 Commodore Dr.~ Viris~na Beach, VA 23454 (Address) I05 805 REV 918fi t Th~s is to certify that the information here g~ven is correctly copied from an original cernficate of death duly filed with me as Local RegiStrar The ong~nal cernficate will be forwarded to the State Vital Records Office for permanent fi'hng WARNING: It ~s illegal to duplicate this copy by photostat or photograph. Fee for th~s cemficate, $2 00 P 9331576 No Local Reg,strar ff / 21-2003-618 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH PalmerA Nace , Male , 179 --, .1~2-- 4571 207 West S~mpson Street Mechanlcsburg, Pennsylvama 170 Mabel Amey ,.~o..*., s ~.. ,~m ~.~ 54 West Locust~StreetS~'Mechamcsburg,~C~ Pa 17055 Conohte Crematory ~,. Schaefferstown, Pa 17088 Wilham Nace Mdz~ R Valentine Jul 26. 2003 FD-014318-L Myers Funeral Home Inc 37 East Main Street Mechanmsbulg Pa 1705! his is t6 certify that th~s is a true copy of the record which is on file in the Pennsylvania Division of V~tal Records in accordance with Act 66, P L 304, approved by the General Assembly, June 29, 1953 WARNING: It is illegal to duphcate this copy by photostat or photograph. 2883629 No d ~)fi,'c/:/oh ~- Charles Hardester State Registrar 25 8'43 ~'t-uuerlaad Co, ~e CO~CT~D [T~ ( S ): 3 bCaOsM M ONW ~LTN OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS PER FD DATE:8-29-03 CERTIFICATEOFDEATH 068666 PamerA Nace , Male , 179-- 12-- 4577 ,~ ~s Z'~-- Harrisburg Hamsburg Hospital ~ ~.~.,~..- White Federa Governmenl ,~E]x.~] ~,,,~as.~=.=~ ] ,,~¢.~. _¢~,~ . Supply Foreman 207 West S~mpson Street r.i~t,~c~ Mechamcsburg, Pennsylvania 170~'~ Cumberland Mechan~csburg Wilham Nace ,, Mabel Amey ~.~ 54 West Locust Street Mechamcsburg, Pa 17055 I~KE.U~Ka FD-014318-L Myers Funeral Home Inc 37 East Mmn Street Mechanlcsburg Pal70.= LAST WILL AND TESTAMENT OF PALMER A. NACE ~, PALMER A. NA6E, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvani. a, beiDg of sound and disposing mind,, memory and understanding,' do make publish and declare this to be my Last Will and Testament, hereby revoking and .making .void all.' forme~ Wills by. me at any time "heretof6~e made. ' I direct th~ payment of all my'~u~t debts ~and funeral expenses as soon as conveniently ma~. be after my decease., Ali the rest, resid%e ~nd ~maind~r of ~y Estate, real,~'personal and mixed, ~hatsoever ~nd wheresoever situate, I give, devis~ and bequeat~ to my four daughters, Vicki J. Shearer, Eileen C. Durham, Mitzi R. Mentzer; 'and Angola M. Whi~e,.in equal s~args. , '~J. ~ ~ LASTLY,~ I.nom~nate;~const~tute and appoint my ~d~ugh~9~s,~Vlc~J..! ~he~rgr, and Anggla M. White, to be the Executrices of this, my Last Will and Testament.. They shall .not be requ2red-.~o file bond or. other security in the office ~of the:Register o~ ~ill~'f6f~(h~,pu~pose of~.adminis~efing m~ IN WITNESS W~IEREOF, I have hereunto set my"hand and seal this. 21st day of July,.A; D. 1981. Signed, sealed, published and declared by the ,~bq~e-n~aod P~M~R A,. ~NACE, as and for his Las.t Will and Testament, in~th~"~res~nc~ of us~ who, at his request and in his presence, and in the'presence of each othe.r, have hereufito subscribed ,our names as witnesses. CERTI]glCATION OF NOTICE UNDER RULE 5 6(a) ,Name of Decedent Date of Death. No 2003-00618 PALMER A NACE, Deceased July 25, 2003 PA No 2103-0618 ro the Regmter I cerhfy that notice of beneficial interest reqmred by Rule 5 6(a) of the Orphans' Court Rules was served on or totaled to the following beneficmnes o£the above-captioned estate on or about August 1, 2003 Angela M White Kelly Vmk~ J Shearer Efieen C Vasco M~tz~ R Valentine Address 1028 Commodore Drive V~rg~ma Beach, VA 23454 76 Kensington Drive Camp Hffi, PA 17011 29 Essex Road Camp Hill, PA 17011 54 West Locust Street Mechanmsburg, PA 17055 Notme has now been g~ven to all persons entitled thereto under Rule 5 6(a) except NONE Date August 1, 2003 44 West Main Street Mechanmsburg, PA 17055-0318 (717) 697-8528 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 OO3163 SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 179-12-4571 FILE NUMBER: 2103-061 8 DECEDENT NAME: NACE PALMER A DATE OF PAYMENT: 10/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~4,000.00 TOTAL AMOUNT PAID' $4,000.00 REMARKS: VICKI J SHEARER&ANGELAM KELLY C/O RICHARD C SNELBAKER SEAL CHECK# 115 INITIALS: SK RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVAN IA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 OFFICIAL USE ONLY -- 2003 0618 z LU z 0 z NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER CEO~::nENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ Nace, Palmer A z 179-12-4577 ILl DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DO-YEAR ~ TI-IS RETURN MUST BE FILED IN DUPLICATE WITH THE LU 07/25/2003 10/25/1922 o REGISTER OF WILLS U.J (IFAPPLIDABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) t'h SOCIAL SECURITY NUMBER I.u L.z~J 1. Original Return L~ 2. Supplemental Return I I 3. Remainder Return (date or death pdorto 12-13-82) Lr~ 4. Limited Estate ~ 4a Future Interest Comprom,se (date of death after 12-12-82) [----'] 5. Federal Estate Tax Retum Required -r~- 6' Decedent Died Testate (Attach c°py°fWlll) [----] 7. Decedent Maintained a Living Trust (Attach copy of Trust) 0 8. Total Number of Safe Deposit Boxes ~ 9. Litigation Proceeds Received r'~ 10. Spousal Poverty Credit (date or death between 12-31-91 and 1-1-95) ~ 1 1. Election to tax under Sec. 9113(A)(Attac~ sch o) NA ME COMPLETE MAILING ADDRESS Richard C. Snelbaker FIRM NAME (If Applicable) 44 West Main Street Snelbaker, Brenneman & Spare, P.C. Mechanicsburg, PA 17055 TELEPHONE NUMBER 717-697-8528 OFF~C2,AL USE ONLY -1:3 137,827.88 16,858.59 2,865.79 19,724.38 118,103.50 0.00 118,103.50 1 Real Estate (Schedule A) (1) 60,000.00 2. Stocks and Bonds (Schedule B) (2) 0 . 1~0~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0. 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 77,827.88 6. Jointly Owned Property (Schedule F) ~'-~ Separate Billing Requested (6) 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens{Schedule I) (10) 11, Total Deductions (total Lines 9 & 10) (11 ) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an eleotion to tax has not been made (Schedule J) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE IN~TRLi~TiC~S ON REVERSE SIDE FOR APPLICABLE RATES 0.00 x.O0. (15) 118,103.50 x.045 (16) 0.00 x .12 (17) 0,00 (18) (19) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .15 0.00 5,314.66 0.00 0.00 5,314.66 20. 2W4645 1000 Decedent's Complete Address: ~ ADDRESS 207 West Simpson Street Boro of Mechanicsburg t Cumberland County CITY Mechanicsburg I STATE IZ,P PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 5,314.66 A. Spousal Poverty Credit 0.00 B. Prior Payments 4,000.00 C. Discount 200.00 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) 4 ~200.00 D. Interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,114.66 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B). 1 ~ 114.66 ...................................................................................... ~ ~.h. eck 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; ........................ r~ E~] b. retain the right to designate who shall use the property transferred or its income;. : ....... ['---] c. retain a reversionary interest; or ................................ ~-~ d. receive the promise for life of either payments, benefits or care? ................. ~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES YO~I ~J~T'C~&I~L~T'E'S~'"~'~;,,'-'~'-:,~.: .'-' -' --' - -'- , n=~u~.= ~ ~r~u ~-~LI= I! P.~i PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return, including accompanying schedules and statements, and to ~e best of my knowledge and belief, it is l~ue. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIC-~ATURE O.F PERSON RESPONSIBLE FOR FILING RETURN 1028 Com~___odore Drive ~ I61KensEngton Drive Vi~inia Beach, VA 23454 S~GNA~~ATIVE A~RESS~z4 W~s~t-Main Street P.O. Box 318 Mechanicsburg, PA 17055 Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. § 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S § 9116 (a) (1~ 1 ) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 im posed 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 PS. §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. 2w4646 1.000 Estate of: Palmer A Nace Vicki J Shearer 76 Kensington Drive Camp Hill, PA 17011 Executrice Angela M. White-Kelly 1028 Commodore Drive Virginia Beach, VA 23454 179-12-4577 REV-1502EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REALESTATE Nace, Palmer A FILE NUMBER 21-2003-0618 real propeiTy owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wi ng seller neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is jointly-owned wilh right o~ survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRI~ION Property located in Blossburg PA, Tioga (settlement sheet attached) County, sale value Property known and numbered as 207 West Simpson Street, Borough of Mechanicsburg, Cumberland County, Mechanicsburg, PA, sale value (settlement sheet attached) TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH 20,000.00 40,000.00 $ 60,000.00 2W4695 2.000 (If more space is needed, insert additional sheets of the same size) ^. Settlement Statement u.s. Department of Housing and Urban Development B. Type of Loan OMB No. 2502-0265 REV. HUD-1 (3/86) 1. I-IFHA 2. I-IFmHA 3. FIConv. Unins. [ 6. File Number 7. Loan Number I 8. Mortgage Insurance Case Number 4. I-]VA 5. FlConv ns I 2004-26 Ibis form ,s furnished to give you a slatement ol actual seltlemenl costs. Amounts paid to aha b) le settlement agenl are shown. TitleExpress Settlement System C. Note: terns marked "(p.o.c.)" were paid outside the c os ng; they are shown here for information purposes and are nol included in the totals. WARNING: It is a crime to knowingly make false slatements Io he Untied States on this or any cther sim ar form. Penal les upon Printed 01130/2004 al 11:15 BPM conviction can include a fine and imprisonment. For details see: Tille 18 U. S. Code Section 1001 and Section 1010. D. NAME OF BORROWER: ADDRESS: E. NAME OF SELLER: ADDRESS: F. NAME OF LENDER: ADDRESS: NEVIN L. STUCK 708 S. Old Trail, Selin~sgrove, PA 17870 ESTATE OF NACE PALMER 76 Kensington Drive, Camp Hill, PA 17011 G. PROPERTYADDRESS: H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: Blossburg, PA 16912 Blossburg Borough, Tioga County Owlett & Lewis, P.C., TIN - 25-1464314 P.O. Box 878, One Charles Street, Wellsboro, PA 16901 I. SETTLEMENT DATE: 0113112004 J. SUMMARY OF BORROWER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. 101. Contract sales pdce 102. Personal Property 103. Settlement char.qes to borrower (line 1400) 104. 105. 20,000.00 554.00 Adiustments for items paid by seller in advance School Taxes 01131104 to 06130104 111. 402. Personal Property K. SUMMARY OF SELLER'S TRANSACTION: GROSS AMOUNT DUE TO SELLER 401. Contract sales price I 20,000.0u 403. 404. 405. Adjustments for items paid by seller School Taxes 011311041o06130104 n advance 108. 123.90 408. 123.90 109. 409. 110. 410. 411. 20,677.90 112. '120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 201. Deposit or eamest money 202, Principal amount of new loans 1,000.00 203. Ex sting loan(s) taken subject to 204. 205. 206. 506. 207. 507, 208. 209. Adjustments for items unpaid by seller City/town taxes 011011041o01131104 210. 211. County taxes 011011041o01131104 213. 214. 412. 420. GROSS AMOUNT DUE TO SELLER 20,123.90 500. REDUCTIONS IN AMOUNT DUE TO SELLER 12.85 9.81 215. 216. 217, 501. Excess Deposit (see instructions) 502. Settlement charges to seller {line 1400) 503. Existin.q loan(s) taken subject to 504. Payoff of First Mortgage Loan 505. 508. 509. 1,400.0~ Adjustments for items unpaid by seller 510. City/town taxes 011011041o01131104 12.8~ 511. County taxes 011011041o01131104 9.81 513. 514., 515. 516, 517. 218. 518. 219, 519. TOTAL REBUCTIONAMOUNT BUE SELLER 1,422.6~ 220. TOTAL PAID BY/FOR BORROWER 1,022.66 520. 300. CASH AT SETTLEMENT FROM OR TO BORROWER 301. Gross amount due from borrower (line 120) J 20,677.90 302. Less amounts paid by/for borrower (line 220) I '1,022.66 303. CASH FROM BORROWER '19,655.24 603. CASH TO SELLER SUBSTITUTE FORM 1099 SELLER STATEMENT: The infonmation contained herein is important tax information and is being furnished to the Inlernal Revenue Service. If you are required to file a return, a neg gence penalty or other sanction will be imposed on you if this item is required to be reported and the IRSdetermines that it has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: If this real estate ,,vas your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040). You are required by law to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide your correct taxpayer ident ficat on number, you may be subject to civil or criminal penalties imposed by law. Under penalties of pequry, I certify that the number shown on this statement is my correct taxpayer dent f cation number. TIN: I SELLER(S) SIGNATURE(S): I 600. CASH AT SETTLEMENT TO OR FROM SELLER 601, Gross amount due to seller (line 420) 602, Less reduction amount due seller (line 520) 20,123.9u '1,422.6~0 18,701.24 SELLER(S) NEW MAILING ADDRESS: KS. DEPAi~TMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT REV. HUD-1 (3/86) L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION based on price $20~000.00 @ 6.000 = 1~200.00 Division of co~mission (line 700) as follows: 1~200.00 to Koch Homestead Realty to Commission paid at Settlement File Number: 2004-26 PAGE 2 TitleExpmss Settlement System Printed 01130/2004 at 11:15 BPM PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 1,200,00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori.qination Fee % 802. Loan Discount % Fee 804. Credit Re 805. Lender's Inspection Fee 806. Mort.qa.~e Application Fee Assumption Fee 807. 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to ~$ /day 902. Mort.q~e Insurance Premium for to 903. Hazard Insurance Premium for to 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. ~ $ 1002. Mort.q~e Insurance mo. ~, $ , Tax mo. ~, $ 1004. County Property Tax mo. ~ $ 1005. School Taxes mo. ~ $ /mo /mo 13.03/mo 9.95/mo ' 24.80/mo ~stment 1100. TITLE CHARGES 75.00 I 1101. Settleme~or clash§ fee to Owlett & Lewis~ P.C. 1102. Abstract or title seamh 1103. Title examinatbn 1104. Title insurance binder 1105. Document Preparation 1106. Notary Fees 1107. Attomey's fees (includes above items No: 1108. Title Insurance includes above ileitis No: 1109. Lender's Coverafle $ to Owlett & Lewis, P.C. 1110, Owner's Coverafle $ 20~000.00 - 1111. 1112. 1113. 250.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordinfl Fees Deed $29.00 ; Mort,qafle $ Deed $200.00 1203. State Tax/stamps Deed $200.00 I1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey ; Release $ ; Mort~lafle $ ; Modqa.qe $ 29.00 200.00 200.0u 1302. Pestlnspection 1303. 1304. 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103. Section J and 502, Sedion K) 554.00 1~400.00 I have carefully reviewed the HUD-1 Settlement Statement and to Ihe best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursemenfsmade°nmyaccaunti~ythatlhavereceivedac°py°ttheHuo'lSettlamanfSfatement'''~'~ '..-..~-"'"'--"~ ~. --'- ~l~,- ~/~o ~~ NFVIN L.~I U{SK The HUD-I Seltlement Statement wh~h I have prepared is a flue and accurate account of this transaction. I have caused or will cause funds to be disbursed inaccordancewiththil~statement. !~,~,~,~ ,.-/ ~'~'~ ~ Settlement ~ent{ - - Date · WARN NG; It is a mime fo knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment For details see: Tit e 18 U S. Code Section 1001 and Section 1010. A. · ~ OMB NO. 2502-0265 ?.~,TYPE OF CAN: U.S. DEP~I;MENT OF HOUSING & URBAN DEVELOPI~IENT I 8. FILE NUMBER: I 7. LOAN NUMbct~: 2.F--IFmHA 3. ~CO~. UNIHS. 4.~VA ~. ~COHV. SE~LEMENT STATEMENT I 2oo3~ooo99. 8. ~u~ I ~G~ INS CASE NUM.~: I D. N~E AND ~DRE~S OF SORROWER: E. ~E ~D ADDRE~ OF S~LLE~ Elleen O. Vaeco 2O7 West Simpson Street Meohanlc-,burg, PA 17055 SSN: 199..34-8443 PROPERTY LOCATION: 207 West Simpson Street Mechanlceburg. PA 17055 Cumberland County, Pennsylvania Eaters of Pelmar A. NaM, end Co-Executrices, Vlokl J. Shearer and Angola M. Whim H. ~E I~L~MENT ~GENT: Chelsea ~m~lement P~CE OF ~Ei i LEMENT 3800 Market ~tr~et Camp Hill, PA 1.7011 J. SUMMARY OF BORROWER'S T~NSACTION Chase Manhattan Mortgage Corporation 556 Qulnc~ Orchard Road, Suite 650 Galthersburg, MD 20878 I. SE ,'I~rLEMENT DATE: November 7, 2003 200. AMOUNTE PAID BY OR IN El;HALF OF SORROWEfll ;301. Deppslt er earneet money 202, Principal Amount pf N~w Loan(s) 203. Exlatlno loan[a) taken subleGt to 204. 205. 206..__.:..._. .207.. 208. EsOt P 209 A~Euatmanta ~=or Items Unpaid By Seller _210, Lo0~l T~xee to exeB· to 214. _215. 217. 100. ~O~S ~MOUNT DUI; FROM BORROWS/ER: 101. Contract ~eles 102 Perso a o e lo3~~t Char ee te Borrowe~lne 1400 108. P~ ff o ~ A ua~enta ~r ~eme ~1~ B ~efler In advance . 108. Lo~lTaxea tl/07103 to 01/01104 [ 32.34 108 SchoolTaxee 11/07103 to 07~1104 465.3~ 1~0, 'f20. G~O$$ AMOU~T DUE PROM BORROWER ~ 43,g28.25 30.000.00 219. K. SUMMARY OF ~ 400 ~ OSSAMOU T · 401. ContraCt Salsa Prlo~ 409. L 420. GROSS AMOUNT DUE TO SELLER 600. REDUCTION8 IN AMOUNT DUE TO 8El ~ eR: 601. Ex-_---_-_~_~ Del~oelt (See Instructions) 502. Sett;~ent Charueato Seller (Line 1400) 503. Exlstlna Joan(e) t~ken auble~t to o~o I-'J Ti' OT eaoo d orr a e 5ce., 608. Estate PrG~_= to Mrs. V~_-co ~F°rlMmsUneldtB° Seller 511. County Taxes to ~~ to 516, 519. 220. TOTAL PAID BY/~OR ~ - .... 620. TOTAL ~uUCTION 43 92 .2 · Arn 13 T II r Line420 602. Le~ ReduoUone Due Seller (Line 520) 303. CASH ( X FROMJ ( 'FO) BORROWER .... 3,925.2~I ac3. CASH( X TO ) ( FROM J $1=I I ER The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any' attachment~ referred to herein. Borrower ~Elleen C. Vasco Seller c-tats of Palmer A. Nace, 10,033.17 29,864.47 Co-Exec=utrJ=ee, ~/lekl J. Shearer ~gela M. White POO,/7~OO'd [ I [# RCI:TA ,qOO~/go./[ ! · ulo.~ 4 L. SETTLEMENT CHAROE8 ~"~': 700. TOTAL COMMI~'~ION I~aeed on Price DIv~omn?ls on lin 7' II S.'''~'~ 701. $ to 704. to ~LE IN CONNECTION WITH LOAN 801 Loan Orl Inetlon~ee % t~~tlon 602. Loan Discount % to Chase Manhattan Mo a e Co oration 003. A ~ ?~_. A rllaml Fee 004, Tax Related 6arvlee Fee 605. ~ u~. ~m~ ~Pmmlum to (o I mt American Tax Service to Ch~ oration 808. In[Ual Flood Dartlmlnatlon 809. Flood Ced.--Llfa of Loa~ -- ~: c}C~alra Mannhnaffa n U P~ ~ ~l~attan Mo a ~etlon to Central P~ POC~ 6g.oc 8t0. Pre cee si ng Fe"--"-----~ 811. 900, ITEMB REQUIRED BY LENDER TO BE PAIl;) IN ADVANCE 901. InteremtFrom 11/07103 to 12./01/03 ~ $ 4.730000/de 24da · % 902. Mort a e Ins-~'r'~-nce r~mlum-"~'7"~r m n h 903, Hazard Insurance Premium for 1.0 ars IoALLSTATE; Insurance Co. 904. 900. 100O. F~SERVES DI~OglTED V~ITH LENDER 11.00 ?.b'U 3o0__~_ 1.H ~ n r n 1002. crt a m ce ~Texee 1005, $choolTexes 1008. 1. n I . r m nh 6.00~ 53.35 per month loo8. rs · sad ua men 1100. TITLE CHARGI;~, 11 1, Tran I Fee 1102, Service Rendered Fee 11 1104, Title I suranoe Binder tlon 110B. Nots Fees 1107, Attorna s Fees Inc/ud~m numbers: , __l~n_~l_ _? a ova Item number,a: 1110. OwneP~ 1111. A A Endor',ements ~attar 1118. to Chelsea Settlement Services h se 8e le · tServlces to to Chel,~ea Seltlamenl Services n Serv cee to S _.. ~ervlcee to Chelsea Settlement Service= ;attlemenl ..°~e rvlc~B 35,00 1200. ~OVE~NMENT RECORDING AND TI=lANai=ER CHARGES 1~2~01.. ~R.e. ~._n:lln, 1202. Ci~s..--Deed 38.50. Mort 8 e 70.80; ~_at_e _,T~am ~ae 400.00: Mo a e 1205. t 300. ADDITIONAl. 8ETTLEMENT CHARGR8 1303, Final Sewer/Wats Biff to 1_~04. 1305..~ee eddlt'l dlab. exhibit t to · 400. TOTAL 8BTTLEMENT CHARGES Enter~'n Linde Releases $' Certified to be a true copy. Chelsea Settlement Services Settlement Agent T T T.~I ( 200:810009~ / 200310000013e ) ON'?l PCIFI ,-'..'OCl '"T ! _' Ills ~l _! Borrower: Seller: Lender: Settlement Agent: Place of Settlement: Settlement Date: Property Location: PAYEE/DESCRIPTION Eileen C. Vasco Estate of Palmer A. Nace, and Co-Executrices, Vi~ki J. Shearer and Angels M. White Chase Manhattan Mortgage Corporation Cl'ielsea Settlement Services (717)731-g700 3800 Market Street Camp Hill, PA 17011 November 7, 2003 207 West Simpson Street Mechanlcsburg, PA 17055 Cumberland County, PennSylvania N T ; E ELLER Barry L. Heckard County Taxes Due Barry L. Heckard School Taxes Due 20230567-160 214.61 20230567-160 718.56 Total Additional Disbumement~ shown on Line 1306 $ = 0.00 $ 933.17 (2003100099.PFD/2003100099/38) REV-1508 F__,X + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONA~~ Nace, Palmer A FILE NUMBE~ 21-2003-0618 Include the proceeds of litigation and the date the proceeds W~re received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Household Goods, sold via public auction by Bricker.s auction, OFDEATH gross sale proceeds 1,674.75 2 Gulf, refund due on credit card 7.70 3People's Benefit Services, Inc., refund on prescription service 11.54 4 5 6 7 8 9 10 11 12 13 14 15 16 21 Firearms, sale proceeds 1995 Chevrolet, blue book value 1983 Yamaha Scooter, sale value 1979 Trailer, sale value 1973 Pontiac, sale value 1929 Whippet Sedan, sale value 1989 Ford Truck, sale value 1997 Yamaha ATV, sale value First Citizens National Bank, savings account #02-111136-20 Citizens Bank, Certificate of Deposit # 6240853327 Citizens Bank, Certificate of Deposit #6140738105 Citizens Bank, checking account # 6204178540 Citizens Bank, checking account #6100703878 2,100.00 2,100.00 700.00 50.00 2,100.00 8,500.00 800.00 925.00 498.00 10,165.79 6,169.26 31,825.84 10,200.00 2W46AD 2.000 TOTAL(Also enter on line (If more space is needed, insert additional sheets of the same size) 77,827.88 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Nace, Palmer A SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE~ FILE NUMBER~ 21-2003-0618 Debts NUMBER A. 1. 5. 6. 7. on Schedule I. DESCRIPTION FUNERAL EXPENSES: Myers Funeral Home, Inc., funeral services ADMINISTRATIVE COSTS: Personal Representative's Commissions ( sp lit equal ly ) Name of Personal Representative(s) .Angela M White-Kelly/Vicki J. Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 1028 Commodore Drive / 76 Kerzsir~c[ton Dr. Shear City _~irginia Beach / Camp Hill State VA/PA Zip 23454/17011 Year(s) Commission Paid: Attorney Fees Name: Snelbaker, Brenneman & Spare Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address city Relationship of Claimant to Decedent Probate Fees State Zip Accountant's Fees ~xReturnPre~rer'sFees ~ettlement charges associated with Blossburg, Tioga County property: a) Realtors Commission $1,200.00 b) Transfer taxes $ 200.00 William M. Davis, appraisal property fee for Mechanicsburg Steve Mansfield, garage rent from Oct 2003 - March 2004 AMOUNT 1,080.58 :r 6,800.00 4,500.00 0.00 102.00 0.00 0.00 1,400.00 250.00 240.00 Dn pages .... TOTAL (Also enter on line 9, Recapitulation $ 16,858.59 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) Estate of: Nace, Palmer A Schedule H, Part B -- Administrative Costs Item No. ~ Description 10 11 12 13 14 15 16 Village Locksmith, change locks on Mechanicsburg property Mary Hating, hauling/removal of trash Ritter's Hardware, gun appraisals Barry Heckard, per capita and school per capita taxes Catherine Asalone, Tax Collector, real estate taxes on Blossburg property William H. Smith, appraisal fee for 1929 Whippet & 1973 pontiac Brickers Auction, commission on sale of household goods Page 2 21-2003-0618 Amount 63.60 50.00 53.00 22.00 327.29 100.00 554.75 17 Register of Wills, filing fee for Inheritance Tax Return 15.00 18 Cumberland Law Journal, advertising Executrices notice 75.00 19 20 21 22 The Patriot-News, advertising Executrices notice Myers Funeral Home, death certificates Register of Wills, short certificates Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent.s estate 141.37 60.00 24.00 1,000.00 TOTAL. (Carry forward to main schedule) ...... 2,486.01 · REV-1512, EX + (1-97) COMMONVVEALTH OF PENNSYLVANIA ESTATE OF Nace, Palmer A SCHEDULE I · DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2003-0618 Incl~ ~ed medical e__~enses. ITEM NUMBER DESCRIPTION 1. PPL Gas Utilities, gas serice for Blossburg property 2 PPL, electric service for Mechanicsburg property 3 Penelec, electric servcie Blossburg property 4 United Water, water service for Mechanicsburg property 5 AT&T, long distance phone service for Mechanicsburg property 6 CTCO, phone service for Blossburg property 7 Verizon, local phone service for Mechanicsburg property 8 Comcast Cable, cable TV service 9 Peoples Benefit Service, Inc., prescription service 10 Heritage Cardiology Assoc., medical services 11 Pennsylvania Neuro Assoc LTD, medical services 12 West Shore EMS, ambulance services 13 Associated Cardiologists, medical services 14 Pinnacle Health, medical services 15 Siegelbaum, Gunder & Lacey Gastroenterology, medical services 16 Quantum Imaging & Therapeutic, medical services 17 Pinnacle Health Hospital, medical services 18 Choice Visa, credit card payment 19 ExxonMobil/MCCBG, credit card payment ~ 20 Sunoco, credit card payment 21 Steve Mansfield, garage rent for August & September 2003 22 Pinnacle Health Emergency, medical services AMOUNT 64.75 75.77 27.48 17.82 43.50 47.24 58.23 11.22 7.95 3.40 26.67 226.50 445.14 5.90 58.11 12.31 840.00 716.91 22.51 27.76 80.00 46.62 TOTAL (Also enter on line 10, R.__.___ecapitulation 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) 2,865.79 REV-,~51,3 EX* COMMONWEALTH OF PENNSYLVANIA INHER'TANCEE T~J~ RETURN RESIDENT DECEDEN~ .... ESTATE O~ A SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and trar underSec. 9116(a)(1.2)] TA~ite-Kelly, JLngela H 1028 Commodore Drive Virginia Beach, VA 23454 Shearer, Vicki J 76 Kensington Drive Cam~ Hill, PA 17011 Vasco, Eileen C 29 Essex Road Camp Hill, PA 17011 Valentine, Mitzi R 54 West Locust Street Mechanicsburg, PA 17055 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughterr Daughter Daughter AMOUNT OR SHARE OFESTATE 29,525.88 29,525.88 29,525.87 29,525.87 II. 2W46AI 1.000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.0 0 LAST WILL AND TESTAMENT OF PALMER A. NACE I, PALMER A. NACE, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making.void all former Wills by me at any time'heretofore made. I direct the payment of all my just debts and funeral expenses as soon as conveniently-may be after my decease. All the rest, residue and remainder of my'Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my four daughters, Vicki J. Shearer, Eileen C. Durham, Mitzi R. Mentzer, and Angela M. White, in equal shares. ~ ~ LASTLY, I nominate', cgnstitute and appoint my d&~h~e~s,~.f'Vibki~ J' Shearer! and ~Angela M. White, to be the Executrices of this, my Last Will and Testament. They shall ~ot.be~required to file bond or other security in the office of thelRegister of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 21st day of July, A. D. 1981. (SEAL) Signed, sealed, published and declared by the above-named PALMER A. NACE, as and for his Last Will and Testament, in the~preSence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. 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) 0O3851 SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 179-12-4577 FILE NUMBER: 2103-061 8 DECEDENT NAME: NACE PALMER A DATE OF PAYMENT: 04/21/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 07/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,114.66 TOTAL AMOUNT PAID: $1,114.66 REMARKS: ANGELA M KELLY AND VICKI J SHEARER SEAL CHECK//145 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Palmer A. Nace Date of Death: 7/25/2003 Will No.: 21-03-0618 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 ID No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Approximately '8 months 3. If the answer to No. 1 is Yes, state the following: Did the personal representative fiie a final account with the Court? Yes _ No ['-] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 4/2]/04 Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed wi~the Clerk oft,he O~hans' Court and may be attached to this r~~~ Richard C. Snelbaker ~amneibaker srenneman & Spare, 44 West Main Street Mechanicsburg, PA 17055 Address P.Co Capacity: (717) 697-8528 Telephone No. [~ Personal Representative t-X-] Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG.. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RICHARD C SNELBAKER '~ SNELBAKR BRENNEMN ETAL qq W MAIN ST MECHANICSBURG PA jui,~ -7 DATE 06-08-200q ESTATE OF NACE DATE OF DEATH 07-25-2003 FILE NUMBER 21 03-0618 · ~OUNTY CUMBERLAND · DACN 101 Amount Remitted REV-1;q7 EX AFP (01-05) PALMER A MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHER]:TANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MACE PALMER A FILE NO. 21 03-0618 ACN 101 DATE 06-08-200~ TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RE$~-AVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Hortgagas/Notas Receivable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS= 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Dmductions 12. Nat Value of Tax Return 60/000.00 .00 .00 .0O 77/827.88 .00 .00 (8) 16,858.59 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 15. Zq. NOTE: ASSESSMENT OF TAX: 16. Amount of Line lq at Spousal rate 16. Amount of Linm lq taxablm at Lineal/Class A rate 17. Amount of Line lq et Sibling rata 16. Amount of Line lq taxable at Collateral~Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECezP[ DATE NUMBER 137,827.88 CD003851 IF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TIONAL /NTEREST. Oq-Zl-ZOOq lO-Z3-ZO03 CD003163 (15) .00 x O0 = .00 (16) 118,103.50 x Oq5 = 5,31~.66 (17) .00 X 12 = .00 (18) .00 x 15 = .00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE DISCOUNT INTEREST/PEN PAID (-) 210.53 .00 (19)-- 5,31q.66 AMOUNT PAID q,000.O0 1,11~.66 5,325.19 10.53CR .00 10.53CR Charitable/govmrnmmntal Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Net Value of Estate Subject to Tax (lq) 118,103.50 ;f an assessment ~as ~ssued prev$ously, ZSnes 14, 15 and/or 16, 17, 18 and 19 ~1! reflect fAgures that ~nclude the total of ALL returns assessed to date. 2,865.79 (11) ]9.72q.3~ (la) 118,103.50 RESERVATION: Estates of decedents dying on ar before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Comaonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. (7Z P.S. PURPOSE OF NOT[CE: To fulfill the requirements of Section ZI~O of the inheritance and Estate Tax Act, Act 25 of ZOO0. Section 91~0). PAYHENT: Detach the top portion of this Notice and submit eith yaur payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may bm 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 Hills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour ansaaring service For forms ordering: I-BOO-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-&OO-~47-50ZO (TT only). OBJECTIONS: Any party in interest nat satisfied aith the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including disccunt 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. ZeIOZ1, Harrisburg, PA 17128-lOZI, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- Revenue, ISTRAT[VE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Bureau of Individual Taxes, ATTN: Post Assessment Reviaa Unit, Dept. ZB060I, 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. DISCOUNT: if any tax due is paid within three (5) calendar months after the dacedant's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The leg 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 would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes ahich became delinquent before January l, lgBZ bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .O00lBq. All taxes which became delinquent on and after January 1, 198Z 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 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor ['~ ZOX ~OOOSqB' 1988-1991 llX ~0003Ol ~ 9X .O00Zq7 · 1983 16X .000q$8 199Z 9X .O00Z~7 ZOOZ 6Z .O0016q 198~ llZ .00030! 1993-199q 7Z .000192 ZOOS 52 .000137 1985 13Z .0003S6 199S-1998 9Z .O00Zq7 ZOOq qZ .000110 1986 lOX .000Z74 1999 7Z .O0019g 1987 lOX .O00Z7q ZOO0 7Z .O0019Z --Interest ls calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) 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. SPARE RECEIPT RIND RELEASE WHEREAS, Palmer A. Nace, late of Borough of Hechanicsburg, County of Cumberland and Ce~enwealth of Pennsylvania, died en July 25, 2003, having first made his Last Will and Testament in writing probated befere the Register of Wills ef said Cumberland County on July 30, 2003, and Letters Testamentary were issued on the same date te Vicki J. Shearer and Angela H. White Kelly, the Executrices named in the Last Will and Testament ef said Decedent; and WHEREAS, said Executrices have entered upon and completed their administration of said Decedent's Estate as set forth in their First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the persons named in the Statement of Proposed Distributien alse attached hereto, both of said documents being incorporated herein by reference thereto; and NOW KNOW ALL MEN BY THESE PRESENTS, that we, Vicki J, Shearer, Angela M. White Kelly, Eileen C. Vasco and Mitzi R. Valentine, being the principal legatees and distributees named in the Will of said Decedent and the persons entitled to share in the residuary distribution of the Estate ef said Decedent, do hereby declare and say that we, and each of us, have examined the SHEL BAKER E3RENNEMAN SPARE attached Account and Statement of Proposed Distribution, and find the same to be true and cerrect, and in strict accerdance with the terms and provisiens of said Will, and we de hereby acknowledge that we, and each of us, this day have, had and received of and from Vicki J. Shearer and Angela H. White Kelly, Executrices of the Estate of Palmer A. Nace, the cash, personalty and/or real estate set opposite ©ur names in the above Statement ef Propesed Distribution, in full satisfactien, pa!m~ent and discharge of all such sum or sums of money, legacies and bequests, share or shares, purports and dividends which were due, ©wing and payable and belonging to us, and each of us, by any means whatsoever, for or on account of our full share, part or dividend of the Estate of Palmer A. Nace Deceased. NOW, THEREFORE, we, and each of us, the said Vicki J, Shearer, Angeia H. White Kelly, Eileen C. Vasco and Hitzi R. ValeRtine, do by these presents, remise, release, quit-claim and ferever discharge the said Vicki J. Shearer and Angela H. White Helly, their heirs, executors and ads~inistrators, of and from our said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whats©ever, from the beginning of the world t© the day and date ©f these presents. AND, desiring te avoid the delay and expense of the settlement of said Estate by filing the foregeing Account of said LAWOFFICES SNELBAKER SPARE ads~inistration in the Office of the Register of Wills of said Cun~erland County and by having the balance in the hands of the Executrices, as shown by said Account, distributed by the Court of Come, on Pleas of Cumberland County - Orphans~ Court Division, we, and each of us, do hereby agree that the foregoing Account and Statement concerning the matter of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported upon by said Court, in a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that we, and each of us, the said Vicki J, Shearer, Angela M. White Kelly, Eileen C. Vasco and Mitzi R. Valentine, do hereby agree that if any debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that we, and each of us, will return to the said Executrices such amounts thereof as may be necessary to pay such debts or demands. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of 2004. WITNESSED BY: ,. ~'.¢~ / /2~.· ~ {SEAL) Vitki J: Shearer {~/,.~A ~,/~ ~,L~& 2'{~[&~i, (SEAL) Angels M. White Kell~ Eileen C. Vasco Hitzff R. Valentine LAW OFFICES SNELBAKER BRENNEMAN ~ SPARE COMHONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND) On this the day of 2004, before me, a Notary Public in and for said State and County, the undersigned efficer, personally appeared Vicki J. Shearer, Angela M. White Kelly, Eileen C. Vasco and Mitzi R. Valentine, knewn to me (er satisfactorily proven) te be the persens whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I ~ ~/~;~"~:/ ' Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Susan L. Matrazi, Notap/Public Mechanicsburg Boro, Cumberland CoulAy My Commission Expires Nov. 24, 20~7 LAW OFFICES SNELBAKER BRENNEMAN & SPARE ESTATE NO. 21-03-0618 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY VICKI J. SHEARER AND ANGELA M WHITE KELLY, EXECUTRICES OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF PALMER A. NACE, DECEASED, LATE OF MECHANICSBURG BOROUGH CUMBERLAND COUNTY, PENNSYLVANIA ¢icki J. Shearer and Angela M. White Kelly, Executrices as aforesaid and Accountants herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: July 25, 2003 July 30, 2003 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal Patriot News August 15, 22, 29, 2003 August 12, 19, 26, 2003 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. Household goods, sold via public auction by Bricker's Auction 2. Gulf, refund due on credit card 3. People's Benefit Services, Inc., refund due on prescnption service 4. 21 Firearms, sale proceeds 5, 1995 Chevrolet, blue book value 6. 1983 Yamaha Scooter, sale value 7. 1979 Trailer, sale value 8. 1973 Pontiac, sale value 9, 1929 Whippet Sedan, sale value 10. 1989 Ford Truck, sale value 11. 1997 Yamaha ATV, sale value 12. First Citizens National Bank, savings account #02-111136-20 13. Citizens Bank, Certificate of Deposit #6240853327 14. Citizens Bank, Certificate of Deposit #6140738105 15. Citizens Bank, checking account #6204178540 16. Citizens Bank, checking account #6100703878 17, Erie Insurance Group, refund on policy # Q0032600199 18. Erie Insurance Group, refund on policy # Q542800375H 19. U.S. Treasury, refund on 2003 Final Individual Income taxes 20. Commonwealth of Pennsylvania, refund on Inheritance tax TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY - PRINCIPAL ACCOUNT CREDITS The Accountants claim credit for the payment of the following items from Decedent's Personalty Account: 1. Myers Funeral Home, Inc,, funerar services 2. AT&T, phone service Mechanisburg property ; 3. CTCO, phone serwce for Blossburg property 4. Vebzon, phone serwce for Mechanicsburg property 5. People's Benefit Service, Inc., prescription service Page 1 1,674.75 7.70 11.54 2,100,00 2,100.00 700,00 50,00 2,10000 8,500.00 800.00 925.00 498.00 10,165.79 6,169.26 31,825.84 10,200.00 245,00 192.00 731,00 10.53 $ 79,006.41 S 1,080.58 43.50 47,24 58.23 7.95 6. Heritage Cardiology Assoc,, medical services 7. Pennsylvania Neuro Assoc LTD, medical services 8. West Shore EMS, ambulance service 9. Associated Cardiologists, medical services 10. PinnacleHealth, medical services 11. Seigelbaum, Gunder & Lacey Gastroenterology, medical services 12. Quantum Imaging & Therapeutic, medical services 13. Choice Visa, credit card payment 14. ExxonMobil/MCCBG, credit card payment 5. Pinnacle Health Hospitals, medical serwces 16. Sunoco, credit card payment 17. Comcast Cable, cable TV service 18. Steve Mansfield, garage rent for automobile storage 19. Register of Wills, Agent, estimated Inheritance Tax payment 20. Ritter's Hardware, gun appraisals 21. Barry Heckard, per capita and school per capita taxes 22. William H. Smith, appraisal fee for Whippet & 1973 pontiac 23. Mary Haring, trash hauling/removal 24. Register of Wills, filing fee for Inheritance tax return 25, Register of Wills, Agent, Inheritance tax 26. Bricker's Auction, commrssion on sale of household goods 27. Citizens Bank, check #824 written by Decedent prior to death to Eileen Vasco 28. Pinnacle Health Emergency, medical services 29. Sneibaker, Brenneman & Spare, P.C., attorney fees 30. Snelbaker, Brenneman & Spare, P.C., costs advanced: a, Register of Wills, probate fee b. Cumberland County Law Journal, advertising Executrices notice c. Patriot-News, advertising Executrices notice d. Register of Wills, short certificates e. Vital Records, death certificates 31. Vicki J. Shearer, Executrice commission 32. Angela M. White Kelly, Executrice commission 33. Gift of 1995 Chevrolet automobile (Item # 5 on Inventory) in kind to Angela M. White Kelly by unanimous agreement of all other parties entitled to the final distribution of this Estate, namely Vicki J. Shearer, Eileen C. Vasco and Mitzi R, Valentine 34. Reserve for filing fees, accounting fees and other costs associated with the administration of the Decedent's Estate TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: PERSONALTY - INCOME ACCOUNT DEBITS The Accountants charge themselves with the receipt of the following income from the investment of Personalty Principal: 1. Citizens Bank, interest on estate checking account 2. First Citizens National Bank, savings account # 02-11136 20, interest 3. Citizens Bank, checking account # 6204178540, interest 4. Citizens Bank, checking account # 6100703878, interest 5. Citizens Bank, Certificate of Deposits, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: Page 2 102.00 75.00 141,37 24,00 60.00 340 2667 226.50 445,14 5.90 58.11 12.31 716~91 22.51 840.00 27.76 11.22 320.00 4,000.00 53,00 22,00 100 00 5000 15.00 1,114,66 554.75 100,00 46.62 4,500.00 402.37 3,400.00 3,400.00 2,100.O0 1 ,O00.00 $ 24,812.33 265,89 0.90 64.98 14,06 669.39 $ 1,015.22 LAW OFFICES SNELBAKER ~ SPARE PERSONALTY - INCOME ACCOUNT CREDITS The Accountants claim credit for the payment of the following items from the Personalty Principal Account: 1. Greenawalt & Company, P.C., preparation of Final Individual Income taxes TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of Decedent's Real Estate as follows: 1. Property located in Blossburg, PA, Tioga County, sale value 2. Property known and numbered as 207 West Simpson Street, Borough of Mechanicsburg, Cumberland County, PA, sale value 3. Adjustment at settlement for Blossburg property for school taxes 4. Adjustment at settlement for Mechanicsburg property for school, county and local taxes TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountants claim credit for the payment of the following ,terns from Real Estate Principal Account: 1. Settlement charges on Blossburg property as follows: a, Koch Homestead Realty, commission b. Transfer taxes c, City and County taxes 2. Settlement charges on Mechanicsburg property for County and School taxes 3. Erie Insurance Group, homeowners and auto policy premium 4. PPL Gas Utilities, gas service for BIossburg property 5. PPL Electric, electric service for Mechanicsburg property 6. Penelec, electric service for Blossburg property 7. United Water Pennsylvania, water service for Mechanicsburg property 8. WilHam M. Davis, real estate appraisal for Mechanisburg property 9. Catherine Asalone, Tax Collector, real estate taxes on Blossburg property 10, Village Locksmith, change locks on Mechanisburg property 11. Borough of Mechanicsburg, sewer/refuse for Mechanicsburg property TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: REAL ESTATE INCOME ACCOUNT DEBITS The Accountants charge themselves with the receipt of the income from the investment of Rea~ Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: REAL ESTATE * INCOME ACCOUNT CREDITS The Accountants claim credit for the payment of the following ~tems from the Real Estate Income Account: TOTAL, REAL ESTATE. INCOME ACCOUNT, CREDITS: Page 3 1,200.00 200.00 22,66 $ 250.00 $ 250.00 $ 20,000.00 40,000.00 123.90 497.64 $ 60,62154 $ 1,422.66 933,17 616.00 205.84 174.99 81,79 59.36 250.00 327.29 63.60 98.02 $ 4,232.72 $ NONE $ NONE $ NONE $ NONE LAW OFFfCE$ SNELBAKER B~ENNEMAN ~ SPARE PERSONALTY: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION; RECAPITULATION Page 4 79,006.41 24,812.33 250.00 60,621.54 4,232.72 NONE NONE $ 54,194,08 765.22 56,388.82 NONE 54,959,30 56,38882 $ 111,348.12 LAW ©FFfCE$ SNELBAKBR BRENNEMAN STATEMENT OF PROPOSED DISTRIBUTION Vicki J. Shearer and Angela M. White Kelly, Executrices and Accountants herein, proposes to distribute the balance of the Estate of PaJmer A. Nace, Deceased, to wit: $ 111,348.12 in accordance with the Last Will and Testament of said Decedent as follows: Angela M. White Kelly 1/4 of residue as per Item 2 of Will Vicki J. Shearer 1/4 of residue as per Item 2 of Will Eileen C. Vasco 1/4 of residue as per Item 2 of Will Advance Distribution made November 10, 2003 1983 Yamaha Scooter, in kind Mitzi R. Valentine 1/4 of residue as per Item 2 of Will Advance Distribution made November 25, 2003 TOTAL FOR DISTRIBUTION: Page 5 $ 27,837.03 27,837.03 17,137.03 10,000.00 700.00 15,837.03 12,000,00 $ 111,348,12 tAWOFFfCES SNELBAKER BRENNBMAN SPARE COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Vicki J. Shearer and An§ela M. White Kelly, being duly sworn according to law deposes and says: that they are the Fxecutdces of the Estate and under the Last Will and Testament of Palmer A. Nace, Deceased, and the Accountants herein; that there are no unpaid creditors or claimants of said ~state; that there are no persons interested in the distribution of said Estate other than as stated in the foregoin9 Statement of Proposed Distribution; and that the facts set forth in the foreqoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of their knowledge, information and belief Sworn to and subscribed before me this ,,~L~ t~/Ctay o f ~,~ z~- ~,~_ 2004 Notary Pu~h~ t)'~ ' COMMONWEALTH OF PENNSYLVANIA Notanal Seal Susan L. Matrazi, Notaw Public Medaanicsburg Boro, Cumberland County My Commi~sicn Expires Nov. 24, 2007 Member Pennsylvania AAsociatioq Of Notades Paqe 6 ¢ Vicki J. Shearer Executrice and Accountant Angela M. White Kelly Executrice and Accountant Inventory of the real and personal estate of PALMER A. NACE, Deceased PERSONALTY: 1. Household goods sold at public auction by Bricker's Auction 2. Gulf, refund due on credit card 3. People's Benefit Services, Inc., refund on prescription service 4. 21 firearms, sale value 5. 1995 Chevrolet, blue book value 6. 1983 Yamaha Scooter, sale value 7. 1979 Trailer, sale value 8. 1973 Pontiac, sale value 9. 1929 Whippet Sedan, sale value 10. 1989 Ford Truck, sale value 11. 1997 Yamaha ATV, sale value 12. First Citizens National Bank, savings account # 02-111136-20 13. Citizens Bank, Certificate of Deposit # 6240853327 14. Citizens Bank, Certificate of Deposit # 6140738105 15. Citizens Bank, checking account # 6204178540 16. Citizens Bank, checking account # 6100703878 TOTAL PERSONALTY: REAL ESTATE: 1. House and rot known as numbered as 207 West Simpson Street, Borough of Mechanicsburg, Cumberland County, Mechanicsburg, PA 17055 2. Property located in Blossburg PA, Tioga County TOTAL PERSONALTY AND REAL ESTATE: Page 1 1,674.75 7.70 11.54 2,100.00 2,100.00 700.00 50.00 2,100.00 8,500.00 800.00 925.00 498.00 10,165.79 6,169.26 31,825.84 1 O, 200.00 77,827.88 40,000.00 20,000.00 137,827.88 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND I Vicki J. Shearer and Angela M. White Kelly being duly sworn according to law, deposes and says that they are the Executr~ices~__ of the Estate of Palmer A. Nace late of Mechanisburg Borough , Cumberland County, Pa., deceased and fha'[' the wifhln is an inventory made by Vicki J__. She~er nnd Angola M.~te K~] l~fhe sa;d ExPcurr~c~s o{ +he ant;re estate of sa;d ~ece~enf, consisi;ng o{ al~ +he persona~ property end real estate, except real estate oufslde fha Commonwealth of Pennsy[vania, an~ fhef fha figures opposi+e each item of fha ~nvenfory represent it's fair value as o~ fha ~afe o~ dece~-nfs death. and subscribed before me, COMMONWEAL1H OF: PENNSYLVANIA Not~dal Seal [ Susan L. Matrazl, Notaq/Public I Meohanicsburg Bor(~, ~Cumbedand County Date of DL~+~/lyC°mmissi°nE~N°v'24,2007 Member. Pennsylvania ~,~ciation Of Notaries Executor - Admln~strator ~/ Vicki J. Shearer Ang~a M. White Kelly 76 Kensington Dr. 10~8PCommodore Drive Cgn~ ilill, PA 17011 Virginia~each, VA~454 Addres~ July 2003 Month Year INSTRUCTIONS I. An inventory must be filed within three months a{fer appolnfment of personal representative. 2. A supplement inventory must be flied within thirty days of discovery of additional assets. 3. Additional sheets may be attached as +o personalty or realty 4. See Article IV, Fiduciaries Act of 1949. 0 0 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISDURG, PA 171Z8-0601 COMMONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TNHERZTANGE TAX STATEMENT OF AGGOUNT REV-160? EX AFP (0~-03) RICHARD C SNELBAKER SNELBAKR BRENNEMN ETAL qq N MAIN ST MECHANICSBURG PA 17055 DATE 09-07-200q ESTATE OF NACE DATE OF DEATH 07-25-2005 FILE NUMBER 21 05-0618 COUNTY CUMBERLAND ACN 101 Amount Ree'i ~ed PALMER A HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~:o your account:`' subei~ ~:he upper por~:ion of ~his form wi~h your ~:ax payeen~c. CUT ALONG THZS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS '~ ESTATE OF NACE PALMER A FILE ND. g1 05-0618 ACM 101 DATE 09-07-200q THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHO#N BELO# IS A SUMMARY OF THE PRINCIPAL TAX DUE`' APPLICATION OF ALL PAYMENTS., THE CURRENT BALANCE`' AND`' ZF APPLICABLE:, A PROdECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-01-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 5,$1~.66 PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) CD005165 10-25-2003 Oq-21-200q 08-23-200q CD003851 REFUND ZF PAID AFTER THIS DATE`' SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1`' NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR)`' 210.53 .00 .00 4,ooo. o o 1,11~::66 1~. 53- TOTAL TAX CREDIT 5,314.66 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. ) Name of Decedent: Date of Death: STATUS REPORT UNDER RULE 6.12 Palmer A. Nace 7/25/2003 Will No.: 21-03-0618 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: Date: l. State whether administration of the estate is complete: 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 the following: mo Did the personal representative file a final account with the Court? Yes _ No ~] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [] No [--] ~3 Co 10/29./04 Copies of receipts, releases, joinde?r&and approval of formal o,r informal accounts may be filed~tl3}the Clerk o.~.f the Orphans Court and may be attached to Si~aatur~ Richard C. Snelbaker Snelbaker~ Brenneman & Spare, P,¢ Name 44 West Main Street - Mechanicsburg, PA 17055 Address Capacity: (717) 697-8528 Telephone No. Personal Representative Counsel for personal representative