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HomeMy WebLinkAbout03-1067PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as VIOLET O. CASSNER Deceased Social Security No. 201-16-4269 No. To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners are 18 years of age or older and the Executors named in the last will of the above decedent, dated August 1, 1997, and codicil(s) dated none. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 257 Three Square Hollow Road, Newburg, Hopewell Township. Decedent, then 83 years of age, died December 22, 2003, at Carlisle Regional Medical Center, Carlisle, Pennsylvania 17013. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with 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 in County Value of real estate in Pennsylvania situated as follows: Hopewell Township, Cumberland County $ unestimated $ $ unestimated WHEREFORE, petitioner respectfully requests the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary. C~ R. Cassner, Jr. 8'~5' Prospect Drive Shippensburg, PA 17257 (717) 532-3703 Newburg, PA 17240 (717) 423-6243 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) fore me this ~' d yo, .... Registo¥ adm/~er Ruby E. The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above decedent, petitioner(s) will well and truly the estate according to law. Sworn to or affirmed and subscribed Cassner, Jr. / Estate of Violet O. Cassner, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND Now,C-~)ec~zm~r ~c~, ~3 , in consideration ofthe petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated August 1, 1997 described therein be admitted to probate and filed of record as the last will of Violet O. Cassner and Letters Testamentary are hereby granted to Cyril R. Cassner, Jr. and Ruby L. Lineaweaver. Will Book # Page l{egister of Wills FEES Pd:9/z~at~¢',~Letters' Etc. $ / / ~.. o~ ~'h-~ficates( ) $ ~ $ ~e~atiOn / --- TOTAL $/~/0. O o Carl C. Risch, Esquire (75901) ATTORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 Filed F:\FILES\DATAFILE\EST AT ES\9103-2 petition Itr his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Lodal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. Fee for this certificate, $2.00 WARNING: It is illegal to duplicate this copy by photostat or photograph. ~cal Registrar No. Date TYPE/PRINT PERMANENT COMMONWEALTH OF: PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Violet O. Cassner 2. Female 3. 201- 16 --4269 4. December 22, 2003 | Cumberland Co. , ~ ~ ~ N.,,~ C~ [ : ,05/25/1920 7 Newbur~ PA [~-n,~ E,~U~,,.~ ~ [~ ~ ~ ,~y)~ I ' " [ ,- ~, I-- I I 1~. Carlisle ]~.Carlisle Reqional Medical Center 1,~'~"'~ [,0. White I I ~ ~ I ~ ~ D~) I.... I,,. I,,. 8 t I,,. Wldowed I-. t'* 83 v,* ; ~ Cumberland ,,~ District Justice Three Square Hollow Road ~N~ 257 ~mDENC~ Newburg, PA 17240 m~w~ 'm-~ r~'HER'S NAME (Fi~m, Mk~le. Last) Clarence Franklin Pennsylvania D~ ,~¢.~] ~,., ~.c.d~, ,v.. ~ Hopewell m C~berland ~? ,Td.O ~ ...... ~. Charlotte Flea~le ~. 33 Lovers Lane, Newburq, PA 17240 ~'~ / Washington County, la1=, Smithsburq Crematory b*.. Smithsburq, MD 21783 Jnc.~Ol~-~i~ F.H.~ ~ ~ 3~ ~i~, PA 1725~ ,..~ 5131~ 7- ~~ ~a I-. , / / DATE OF INJURY ITIME OF INJURY 0 I LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, VIOLET O. CASSNER, of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes, administration costs, etc., shall be paid from my residuary estate and shall not be charged or apportioned to any other legatee, donee, beneficiary or joining tenant as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I direct my Executors herein after named to retain the services of a surveyor and to subdivide my land into two lots with the Northern most lot beginning at the property line and extending along the public road to the driveway and extending to the rear lot line being the lot upon which the mobile home of Sherry R. Lineaweaver is located and I do give and devised the lot so subdivided to Sherry R. Lineaweaver upon her payment to the Estate of the cost of survey, subdivision and other governmental fees. THIRD: I give to each of my grandchildren and great- grandchildren alive at the time of my death, the sum of One Thousand ($1,000.00) Dollars. FOURTH: The rest and residue of my estate, I give, devise and bequeath, whatsoever and wheresoever situate, to my children, Cyril R. Cassner, Jr. and Ruby L. Lineaweaver, in equal shares, share and share alike, per stirpes. FIFTH: I nominate and appoint my children, Cyril R. Cassner, Jr., and Ruby L. Lineaweaver, as the Executors of this my Last Will and Testament. If they should fail to serve or be unable to serve, then in either of those said events, I nominate and appoint, Sherry R. Lineaweaver, as Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I, VIOLET O. CASSNER, to this my Last Will and Testament, set my hand and official seal, this ~ day of ~, 1997. ~ ~. Violet O. Cassner Sworn to and subscribed, declared and published by Violet O. Cassner, as her Last Will and Testament, and so done in the presence of we the witnesses, who sign at her request, and in her presence, and in the presence of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : I, Violet O. Cassner, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. ~~/~ ~c~.~z/6~/ V"lolet O. Cassner Sworn to and acknowledged, before me, by Violet O. Cassne~, the . thi~ /5~ day of Ui~_&~Testatrix', ~997. Notary Public ' COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : DAWN MARIE SHOOR NOTARY PUBLIC Shipl3ensburg. Cumberland County, PA IMy Commission Expires February 5. 2000 WE, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by, H. Anthony Adams and Sharon Coleman Adams, the witnesses, this ~ da~ of t~l/~%~, N~t~ry Public 1997. DAWN MARIE SHOOR NOTARY PUBLIC Shippensburg, Cumberlend County, PA IMy Commission Expires February 5. 2000 VIOLET O. CASSNER H. ANTHONY ADAMS ATTORNEY at LAW 128 East KING StREEt, SUITE A ShIPPENSBURG, PA 17257 (717) 532-3~70 F:\FILES\DATAFILE\ESTATES\9103-2. notice.cert CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Violet O.Cassner Date of Death: December 22, 2004 File No. 21-03-1067 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about February 12, 2004. Mr. Cyril R. Cassner, Jr. 875 Prospect Drive Shippensburg, PA 17257 Ms. Heidi Cassner 623 Parkview Drive Phoenixville, PA 19460-4233 Mrs. Ruby L. Lineaweaver 33 Lovers Lane Newburg, PA 17240 Johnny Lineaweaver PCS 37 Box 4058 APO, AE 09459 Mr. Chad Cassner, individually, and as Guardian of Hannah Cassner 502 N. Monocacy Creek Rd. Douglassville, PA 19518-8737 Mrs. Sherri Porter, individually, and as Guardian of Cassie Lineaweaver and Hunter Porter, 265 Three Square Hollow Road Newburg, PA 17240 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: Februal~ 12, 2004 Signature ...... m ~ m~ Name Carl C. Risch, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative HBNA America P.O, Box ~5X37 Wilmington, DE ~.g850--53.37 877-767-9383 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 02/20/04 Re: In the Estate of Probate Case No. Social Security No: Last known residence: Our Client: Account Number: Amount of Debt: Dear Sir or Madam VIOLET O CASSNER 21-03-1067 201164269 MBNAAMERICA 4264298468337764 9291.61 Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll flee at 1-877-767-9383. Cordially, MBNA America Enclosures A check for $5.00 for the filing fee. cc: Attomey for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that propose. This letter is from a debt collector. 4073 2/18/2004 1074727 COMMONWEALTH OF PENNSYLVANZA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DJ:VI:SI:ON NO lICE OF CI.~IA'I In Re: The Estate of: Court File No: 21-03-1067 VIOLET O CASSNER Deceased TO: THE CLERK OF THE ORPHANS' COURT DZVZSZON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). MBNA AMERICA l) 2) 3) 4) Claimant's name: Claimant's address: s) 6) 7) P.O. BOX 15137 WILMINGTON, DE 19850-5137 877-767-9383 Creditor listed below is the owner and holder of a claim in the amount of $. 9291.61 The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. Decedent's address: Date of Death: 12/22/03 That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by. On behalf of the claimant, ! do solemnly declare and affirm under the penalties of perjury that they Information and representations made herein are true and correct to the best of my knowledge, information and belie~. Dated: ~,~ /~), ~ ~ /~ ~/ Kyle Frenzel/Lucille Roberts/de2s~a Lerbs - Author)~ed Representative For MBNA America Written notice of claim was given to Persona~'Representat/'ve and/or his/her counsel as stated below: RUBY L LINEAWEAVER Name 33 LOVERS LN Address NEWBURG, PA 17240 City/State./Zip ! . Date notlce rr(ailed IN RE ESTATE OF:VIOLET O CASSNER AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: Your Affiant is authorized by the Claimant as its Authorized Representative- In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. The Decedent purchased merchandise in the amount of $ 9291.61 evidenced by account number 4264298468337764 4. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not MBNA America. o/ V ts Representatives: Kyle Frenzel Lucille Roberts Jessica Lerbs J MBNA America P. O. Box 15137 Wilmington, DE 19850-5137 Subscribed and sworn before me This ~:~ ~day of_ ~'~ ,2004. PROBATE FINDER/DECEASED CREDIT MANAGEMENT, LLC REFERENCE NO. DES~RIpTI0N : ; ; iNV~lCEDATE 4264298468337764 CHECK DATE 2/24/04 4452 REGISTER OF WILLS ESTATE DEPARTMENT PO BOX 15409 WILMINGTON, DE 19885-5409 ADDRESS SERVICE REQUESTED % . J' '~ .I0425}9[ U.S. h,,llh,,lll,',,,,,li,,li,,,li;,,li,,,l,l,,ll',l,l,,l,!,,ht,,i IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF VIOLET CASSNER ) ) Register' s # Deceas~ed) CLAIM To the Clerk of the Orphans' Court Division : Index and make proper entry in your official records of the claim of CITI USA NA in the amount of 2,482.02 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) ~2) . The said decedent, whose last known residence was at POB 36 NEWBURG PA 17240 Written notice of this claim was given to RUBY LINEAWEAVER 33 LOVERS LN NEWBURG PA 17240 on February 25, 2004 (Claimant) ~ SHAWN HARMER,manager of Citicorp Credit Services, Inc. USA under limited power of attorney for CITI USA NA 7930 NW 110TM ST KANSAS CITY, MO 64153 (Claimant's Address) Account #(s) 7738211684194 RADIOSHACK POC $2482.02 ARIB ( ) ORGANIZATION BHV SCR/DATE STMT BALANCE AMOUNT SALES TOTAL AMT DUE AMOUNT PAST DUE AMOUNT PAYMENTS AMOUNT RETURNS 685 007 CCS/FATHOM SYSTE BEHAVIOR HISTORY INQUIRY ACCOUNT NBR PAGE 01 02/19/20 09:27:26 02/03/2004 2,482 02 0 00 122 00 61 00 0 00 0 00 BHV SCR/DATE 610 11/03/2003 STMT BALANCE 2,528.47 AMOUNT SALES 0.00 TOTAL AMT DUE 61.00 AMOUNT PAST DUE 0.00 AMOUNT PAYMENTS 75.00 AMOUNT RETURNS 0.00 0000007738211684194 NAME CASSNER, VIOLET 644 %~ 605 61.00 0.00 75.00 0.00 12/03/2003 2,504.72 0.00 61.00 0.00 75.00 0.00 635 10/03/2003 637 2,312.67 0.00 57.00 0.00 25.00 0.00 09/03/2003 2,291 71 0 00 0 00 0 00 75 00 0 00 PFi=ARAN PF2=ARMN PF3=ARQN PF4=ARAE PF5=ARME PF6=ARIB IN THE COURT OF COMMON PLEAS,CUMBERLAND COUNTY ESTATE OF PENNSYLVANIA ORPHANS' COURT DIVISION VIOLET CASSNER ) Register's ~ 21-03-1067 Deceased) CLAIM To the Clerk of the Orphans' Court Division : Index and make proper entry in your official records of the claim of CITIBANK USA NA in'the amount of 2,429.72 against the estate of the above-named decedent. This claim is filed under SectiOn 3532 (b) (2) PEF Code; 20 Pa. C.S. ss. 3532 (b) (2) The said decedent, whose last known residence was at PO BOX 36 NEWBURRY, PA 17240 Written notice of this Claim was given to RUBY L LINEAWEABER 33 LOVERS LN NEWBURY, PA 17240 on March 8, 2004 ~C~'~mant) SHAWN HARMER,manager of Citicorp Credit Services, Inc. USA under limited power of attorney for CITIBANK .USA NA 7930NW 110TM ST KANSAS CITY, MO 64153 (Claimant's Address) Account .#(s) 6035365010871633 TJ~ ~ ~ha~ S~ment The Radioshack Statement ** NO MORE DETAILS ON FILE **CRCD 840 RL 0001 OF 0001 CASSNER, VIOLET**PO BOX 36**NEWBURG*PA*17240-0036*603536501~0871633*0 1203 1228 30 61.00 4500 01 1126 l128#P919400AABLGXP81H PAYMENT 02 00000015151126366078660 03 1203 1203#P919400AHBLGXP81V BILLED 'FINANCE CHARGES' 04 16850120021203000107170 05 1203 1203$P919400AHBLGXP823 BILLED 'FINANCE CHARGES' 06 10000055551203000107180 11:12:36 03/04/04 2472 7 0 75.00- 40.02 11.23 2528.47 75.00 .00 .00 .00 51.25 07630 ADB MDSE ADB CASH CUR SALE 27.85 51.25 .00 2504.72 Citicorp Credit Services, Inc. USA Citicorp Credit Services, Inc. USA A Subsidiary of Citicorp Kansas City Regional Center 7920 N. W. 110* St Kansas City MO 64153 CUMBERLAND CO CRTHOUSE 1 COURTHOUSE SQ ROOM 102 CARLISLE, PA 17013-3387 RE: The Estate of VIOLET CASSNER File.Number: 21-03-1067 Dear Sir/Madam, / Mar~h 9, 2004 Please fin~'enclosed our claim against' the above mentioned estate. return a FILED stamped copy in the enclosed envelope. Thank you for your attention to this matter. Please Sincerely, SHAWN HARMER Manager, of Citicorp Credit Services, Inc. USA under limited power of attorney for Citibank USA NA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 1067 _ ~HARRISBUR__G,_pA 17128-_O6~_1 ...... COUNTY CODE YEAR --DE(~E~ENT~ N~A-~(LAS'ri' FIRST,~-N6~IDD-L-I~ INITIAL) .... ~0CiAL ~FCURiTY NUMBER NUMBER : CASSNER, VIOLET O 201 - 16-4269 DATE OF DEATH (MM-DD-YEAR) i--DATE OfBTRTH iMM-DD-'-~'~:~AR) Ti-ilS RETuR~ MUST BE FILED I. DUPLICATE WITH THE 12/22/2003 05/25/1920 lilF APPLICABLE) SURvIViNG sPOosE'S NAME ( LAS~i F~RsT~ND MIDDLE INiTi,~L~ '- i ..REGI_STER OF WILLS [] 1. OdginalReturn [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) SOCIAL SECURITY NUMBER [] 3. Remainder Retu~h iS~i~o-f deathChor i8 i2:1~-82) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 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__:9_1_ and 1_-_1:95~ ~!~ SEC~!~" MUST BE COMPLETED A~ CORRESPONDENCE AND CONFIDEN~L TAX iNFORMATi0N ~ULD BE DiRECTeD TO; NAME .... I c0M'PLETE MAILING ADDRES'~ . ,- Carl C. Risch, Esquire i :IRM NAME (If applicable) Martson Deardorff Williams & Otto Ten East High Street ~ELEPHONE NUMBER ' Carlisle, PA 17013 717/243-3341 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 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. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (1) 44,.000.~& (2) . ~o~ (3) None (4) None (5) 23,291.12 (6) 354.10 (7) Nor}~ (9) 8,449.75 (lO) 18,470.82 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) (8) 67,645.22 (11) (12) (13) (14) 26,920.57 40,724.65 40,724.65 (15) 16. Amount of Line 14 taxable at lineal rate 40,724:65 x .045 (16) 1,832.6 ] 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .1 5 (18) 19. Tax Due (19) 20. [] 1,832.61 z Form REV-1500 EX (Rev. 6-00) >~ B~ ~URE TO ANSWER ~L Q-~U-~ION$ ON RE~RSE SIDE AND RECHECK Copyright 2000 form software only The Lackner Group, Inc. Decedent's Complete Address: ';TREET ADDRESS 257 Three Square Hollow Road ICITY Newbur-- 7STATE _.f "ZIP ,2_ I g PA 17240 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is theOVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE Make Check Payable to: REGISTER OF WILLS, AGENT (1) 1,832.61 0.00 (3) 0.00 (4) (5) 1,832.61 (SA) (5B) 1,832.61 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 cons derat on9 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 des gnat on9 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 perjurg, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and' belief, it is irue, 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 Cassner, Jr, [ESPONSIBLE FOR FILING RETURN Carl THAN REPRESENTATIVE ADDRESS DATE 875 Prospect Drive Shippens'burg, PA 17257 /.:/t_/~ ~_ 49/?Z ADDRESS DATE 33 Lovers Lane Newburg, PA 17240 A~/-,;t~ 0O- t9 V ADDRESS DATE Ten East High Street Carlisle, PA 17013 L~_ ~c..f~. ~1..~ 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. {}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 SCHEDULE A REAL ESTATE ESTATE OF CASSNER, VIOLET O FILE NUMBER ................... 21 - 03- 1067 All real property 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 properti/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. ITEM NUMBER DESCRIPTION VALUE AT DATE OF ...... DEATH 1 Residence situate at 257 Three Square Hollow Road, Newburg,Hopeweli Township, Cumberl~nd ~ounty, - 44,000.00 PA, known as parcel No. 11-08-0601, being described in Deed dated January 3, 1967, and recorded in Cumberland County, PA, Deed Book "U", Volume 22, Page 494, and being conveyed to Cyril R. Cassner, Sr. and Violet O. Cassner. Cyril R. Cassner, Sr. died 9/30/1996. (Value is actual sale price. See attached settlement statement.) TOTAL (Also enter on Line 1, Recapitulation) 44,000.00 ,.. ~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMO.WEALTH OF.E.NSYLVAN.A PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CASSNER, VIOLET O FILE NUMBER 21-03-1067 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of suntivorshJp must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Y- Orrstown Bank, checking account # 505803 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Orrstown Bank, savings account # 15651 Orrstown Bank, Christmas Club account # 983846 Cash, on hand State Employees' Retirement System, retirement benefits State Employees' Retirement System, annuity benefit, beneficiary estate Adams Electric Cooperative, patronage Allstate, refund of vehicle insurance Highmark Blue Shield, benefit Lancaster Farming, refund Nationwide Mutual Insurance Co., refund Nationwide Mutual Fire Insurance Co., refund of homeowners insurance United Health Care, benefit Tax proration Dan Hershey Auctioneering Services, sale proceeds TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 2,565.02 1,132.47 250.38 6,421.00 662.00 2,544.32 51.59 8.85 56.90 62.49 5.30 263.00 270.00 225.55 8,772.25 23,291.12 SCHEDULE F " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA2( RETURN JOINTLY-OWN ED PROPERTY RESIDENT DECEDENT ESTATE OF CASSNER, VIOLET O FILE NUMBER 21 - 03- 1067 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Cassie Joy Cassner 365 Three Square Hollow Road Great- Newburg, PA 17240 granddaughter JOINTLY OWNED PROPERTY: ~ ~ DESCRiPTiO~O~PROPERTY , ITEM i FOR: LETTERjoiNT~ MADEDATE ]lncl.ud.e. ne.me .o.,f financial institution and bank account number DATE OF DEATH ~ ~°~°~O.-.F,~ DATE OF DEATH NUMBER TENANT: JOINT lestate.l°r similar ioend~ying number. Attach deed for jointly-held real VALUE OF ASSET iNDTEE~I~,~T. DEOEDENT'sVALUE OFiNTEREST 1 A o7/o5/199or Orrstown Bank savings account #18010 708.19: 50%i 354.10 TOTAL (Also enter on line 6, Recapitulation) 354.10 INHERITANCE TAX RETURN RESIDENT DECEDENT CASSNER, VIOLET O ~FILE NUMBER 21 - 03- 1067 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I Fogelsanger-Bricker Funeral Home, Inc., Shippensburg, PA 2,716.00 2 Cyril R. Cassner, Jr., reimbursement of funeral expenses 280.86 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 Martson Deardorff Williams & Otto (estimated) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip 4,125.00 140.00 Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Certified mailing, Department of Public Welfare Register of Wills, short certificate 4.42 3.00 Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 1,180.47 8,449.75 · ,~ ~H : ~ cou~ONWE^Cr, O~ ~ENNmV^N~^ Fune~ Expenses & ,N.ER,T^NCE T~X RETU.. Admi~ Co~Is conlinued RESIDENT DECEDENT ESTATE OF CASSNER, VIOLET O FILE NUMBER 21-03-1067 3 Register of Wills, filing fee, Inheritance Tax return 15.00 4 5 6 7 8 9 10 11 12 Cumberland Law Journal, advertising Letters Testamentary The Sentinel, advertising Letters Testamentary Copies from Lien Search Cumberland County Recorder of Deeds, Estate Deed, recording fee Adams Electric Cooperative, electric service pending sale of real estate Timmons Oil, Inc. kerosene pending disposition of real estate County of Cumberland, 1% Realty Transfer Tax 2004 Cumberland County real estate taxes Reserved for filing fees and miscellaneous expenses 75.00 97.55 0.50 40.50 151.44 163.00 220.00 117.48 300.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CASSNER, VIOLET 0 Include unreimbursed medical expenses. FILE NUMBER 21-03-1067 iTEM / .... NUMBER DESCRIPTION 1 Orrstown Bank, checking a-ccount #505803,outstanding check fees on date of death 2 Orrstown Bank, line of credit, 202444L, balance due on date of death 3 Adams Electric Cooperative, Inc. account payable 4 CPO2 Billing Center, account payable 5 Lowes credit card # 822-2139-045446-6, balance due 6 Wachovia credit card # 4264-2094-7933-8854, balance due 7 Wal-Mart credit card # 6032-2071-0078-9437, balance due 8 Radio Shack credit card # 0007-7382-1168-4194, balance due TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 281.59 756.48 198.39 52.95 1,705.64 9,291.62 3,754.43 2,429.72 18,470.82 REV-1513~ EX+. (9-00), ~ i SCHEDULE J · , ' COMMONWEALTH OF PENNSYLVANIA I ,N.ER,TANCE T~ RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF CASSNER, VIOLET 0 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY - - - DQNot List Trustee(s) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Mr. Chad Cassner Grandson 502 North Monacacy Creek Road ~ Douglassville, PA 19518-8737 FILE NUMBER 21-03-1067 RELATIONSHIP TO AMOUNT OR SHARE DECEDENT OF ESTATE 1,000.00 Ms. Hannah Cassner 502 North Monacacy Creek Road Douglassville, PA 19518-8737 Ms. Heidi Cassner 623 Parkville Drive Phoenixville, PA 19460-4233 Mr. Johnny Lineaweaver PCS 37 Box 4058 APO, AE 09459 Great 1,000.00 Granddaughter Granddaughter 1,000.00 Grandson 1,000.00 II. See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECT ON 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 ~ ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CASSNER, VIOLET O SCHEDULE J BENEFICIARIES continued FILE NUMBER 21 - 03 - 1067 AMOUNT ORSHARE OF ESTATE i RELAflONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY : DECEDENT - . Do Not List Trustee(s) · m~,¥~= r~,e'r~ ......... ~ [include outright spousal distributions, '~nd transfers Under ~ 1o ~ .... ~ ~.~.r~.~H~.~ Sec. 9116(a)(1.2)] 5 Ms. Cassie Lineaweaver Great 265 Three Square Hollow Road Granddaughter Newburg, PA 17240 1,000.00 Mr. Hunter Porter 265 Three Square Hollow Road Newburg, PA 17240 Great Grandson 1,000.00 Mrs. Sheri Porter 265 Three Square Hollow Road Newburg, PA 17240 Mr. Cyril R. Cassner, Jr. 875 Prospect Drive Shippensburg, PA 17257 Mrs. Ruby Lineaweaver 33 Lovers Lane Newburg, PA 17240 Granddaughter Son Daughter 1,000.00 One-half of estate residue One-half of estate residue Page 2 of Schedule J OMB NO. 2502-0265 A. . , B. TYPE OF LOAN: -U.S~D~PARTMENT OF HOUSING & URBAN DEVELOPMENT 1.j~FHA 2.r'-]FmHA 3.[~]CONV. UNINS. 4. F"~VA 5. r-]coN~/. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: 11125-1 .LINEAWEAVER I SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (11125-1.LINEAWEAVER. PFD/11125-1.LINEAWEAVEPJ14) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Sherry R. Porter and Estate of Violet O. Cassner Orrstown Bank Troy W. Porter c/o Ten East High Street P.O. Box 250 265 Three Square Hollow Road Carlisle, PA 17013 Shippensburg, PA 17257 Newburg, PA 17240 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SE'I-rLEMENTDATE: 265 Three Square Hollow Road Martson Deardorff Williams & Otto Newburg, PA 17240 March 29, 2004 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 10 East High Street Carlisle, PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER; 101. Contract Sales Price 44,000.00 401. Contract Sales Price 44,000.00 102. Personal Property 402. Personal Property 103. Settlement Char~ies to Borrower (Line 1400) 2,049.25 403. 104. 404. 105. 405. Adjustments For Items Paid Bv Seller in advance Adiustments For Items Paid Bv Seller in advance 106. County/Twp. Taxes 03/30/04 to 01/01/05 88.91 406. County/Twp. Taxes 03/30/04 to 01/01/05 88.91 107. School Taxes 03/30/04 to 07/01/04 136.64 407. School Taxes 03/30/04 to 07/01/04 136.64 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 46,274.80 420. GROSS AMOUNT DUE TO SELLER 44,225.55 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s) 35,000.00 502. Settlement Charges to Seller (Line 1400) 377.98 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortcjacje 206. 506. 207. 507. 208. 508. 209. 509. Ad/ustments For Items Unpaid By Seller Ad/ustments For Items Unpaid By Seller i210. County/Twp. Taxes to 510. County/Twp. Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 216. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 35,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 377.98 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 46,274.80 601. Gross Amount Due To Seller (Line 420) 44,225.55 302. Less Amount Paid By/For Borrower (Line 220) ( 35,000.00) 602. Less Reductions Due Seller (Line 520) 377.98 303. CASH ( X FROM) ( TO) BORROWER 11,274.80 603. CASH ( X TO) ( FROM) SELLER 43,847.57 gned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower Seller Estate of Violet O. Cassner Sherry R. Porter BY: Troy W. Porter HUD-1 (3-86) RESPA, HB4305.2 Pa,~e; L. SEttLEMENT CHARGES 700.~TOTA, L ~OMMISSION Based on Price $ ~ % D~vision of Commission (line 700) as Foflows: 701. '$' to 702. $ to 703. Commission Paid at Settlement 704. to PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SE'I-rLEMENT 800. ITEMS PAYABLE IN ~:ONNECTION WITH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to Orrstown Bank 804. Document/Prep. Fee to Orrstown Bank 250.00 200.00 805. Flood Ced. Fee to Orrstown Bank 30.00 806. Application Fee to Orrstown Bank 200.00 807. Assumption Fee to 808. Underwriting Fee to Orrstown Bank 200.00 8O9. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 03/29/04 to 04/01/04 @ $ /day ( 3 days %) 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 1002. Mortga~]e Insurance 1003. County/Twp. Taxes 1004. School Taxes 1005. Assessments 1006. 1007. 1008. 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 102. Abstract or Title Search to 103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Notary Fees to months (~ $ per month months (~ $ per month months (~ $ per month months (~ $ per month months @ $ per month months ~) $ per month months @ $ per month months ~ $ per month 1107. Attorney's Fees to Martson Deardorff Williams & Otto POC (includes above item numbers: 1108. Title Insurance to Lawyers Title Insurance Company 672.75 (includes above item numbers: 1109. Lender's Coverage $ 35,000.00 1110. Owner's Coverage $ 69,000.00 1111. Endorsements100/300/900 to Lawye~ Titlelnsurance Company 150.00 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 43.50; Mortgage $ 44.50; Releases $ 1202. City/County Tax/Stamps: Deed 1203. State Tax/Stamps: Revenue Stamps 1204. Estate Deed 220.00; Mortgage 220.00; Mortgage to Cumberland CounW Recorderof Deeds 1205. Deed to Cumberland County Recorder of Deeds 88.00r 220.00 40.50 1300. ADDITIONAL S~- i [LEMENT CHARGES 1301. Survey to 1302. Pestlnspection to 1303. 2004 County/Township Taxes to Har~ E. Killian 117.48 1304. 1305. 1400. TOTAL S~IILEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 377.98 By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement. 2,049.251 Certified to be a true copy. Martson Deardorff Williams & Otto Settlement Agent ( 11125-1 LINEAWEAVER / 11125-1.LINEAWEAVER / 14 ) Borrower: Seller: Lender: Settlement Agent: Place of Settlement: Settlement Date: Property Location: DISBURSEMENTS SUMMARY / BALANCE SHEET Sherry R. Porter and Troy W. Porter Estate of Violet O. Cassner Orrstown Bank Martson Deardorff Williams & Otto (717)243-3341 10 East High Street Carlisle, PA 17013 March 29, 2004 265 Three Square Hollow Road Newburg, PA 17240 Cumberland County, Pennsylvania INCOMING FUNDS Orrstown Bank Sherry R. Porter and Troy W. Porter Loan Funding Amount Total Incoming Funds 35,000.00 11,274.80 46,274.80 DISBURSEMENTS Cumberland County Recorder of Deeds Cumberland County Recorder of Deeds Cumberland County Recorder of Deeds Harry E. Killian Estate of Violet O. Cassner 6817 Orrstown Bank Appraisal Fee Document/Prep. Fee Flood Cert. Fee Application Fee Underwriting Fee Martson Deardorff Williams & Otto Title Insurance Endorsements 100/300/900 Lawyers Title Insurance Company Title Insurance Endorsements 100/300/900 Cumberland County Recorder of Deeds Recording Fees State Tax/Stamps Number of checks - 9 City/County Tax/Stamps Estate Deed Deed 2004 County/Township Taxes Closing Proceeds Loan Closing 250.00 200.00 30.00 200.00 200.00 Settlement Agents Fees 583.05 90.00 Title Charges 89.70 60.00 Government Charges 88.00 220.00 Total Disbursements 220.00 40.50 38.50 117.48 43,847.57 880.00 673.05 149.70 308.00 46,274.80 (11125-1 .LINEAWEAVER.PFD/11125-1 .LINEAWEAVER/14) TO: MDW&O Attorneys at Law Ten East High Street Carlisle, PA 17013 FROM: ORRSTOWN BANK P.O. BOX 25O SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Violet O Cassner DECEASED DATE OF DEATH: 'December 22, 2003 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT 505803 Violet O Cassner DATE OPENED 12/1/81 DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 2,564.91 .11 ACCOUNT NO. SAVINGS ACCOUNT TITLE OF ACCOUNT 15651 Violet O Cassner 18010 Cassie Joy Cassner Cyril R Cassner Sr Violet O Cassner 983846 Violet O Cassner Christmas Club DATE OPENED 7/22/82 7/5/90 1/22/96 DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 1,131.57 .90 707.63 .56 250.00 .38 (3) CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED DATE OF DEATH PRINCIPLE & ACCRUEDINTEREST Date: 1/5/04 By: Timothea Customer Service Operator P.O. BOX 250 ,, 1 SHIPPENSBURG, PA 17257 TEL. (717) 532-6114 ORRBTOWN BANK; Z/~9/04 OL~T 0 CASSNER a~t due Messages Credit Original balance: Current balance: Control: From Posted Effective Due 7175303553; FEB-9-04 5:I4PM~ PAGE 4/4 Loan Inquiry Loan number: Line 5,000.00 Payment amount: 760.99 Next due date: To Date Src T/C Affects Amount ].0/29/03 10/29/03 10/20/03 10/30/03 ]0/30/03 ].]./].0/03 11/10/03 11/20/03 ]l/12/03 11/10/03 11/20/03 11/17/03 1!/17/03 11/20/03 12/11/03 12/11/03 ~1~91~ 1/U~/:~ 1/~t0~ 1/0~104 1/i~I04 1/t2/0~ 1./1.2/04 2/04/04 2/04/04 1119/04 010 C Q 119.68 085 D P 800.00 470 D P 1.99 889 C N .00 010 C Q 25.00 470 D P 4.49 -G_._.889 C N 010 C O 25.00 470 D P 4.51 889 C N .00 889 N .00 804 D LA 2.50 ]=View 16:23:58 202444 L lofl 2'5'. 00 1/19/04 6=Pr].n t T=TS Balance .00 800.00 801.99 801.99 776.99 781.48 _781.48 7 56. 42~) 760.99 760.99 760.99 760.99 Bottom F4=Redisplay Ftl=Sort F5=Rate/Status chg F7=Scan forward F13=Allocation Hist F14=Esc Only F8=Scan backward F16=Dsp serial no. Address City Home Phone Account Number: Payment Due Date: Minimum Payment: Payoff Amount If Payment Received By Due Date: Indicate Amount Enclosed: 822 2159 Oq5q46 6 03-19-0q 115.70 1705,64 I ] Make your check payable to Lowe's/MCCBC, State Zip Work Phone C21 S300 DOOS 0010618 001-001 VIOLET CASSNER C/O MDW&O ATTN:VICTORIA 10 E HIGH ST CARLISLE PA 17013-3015 h,,llh,,lll,,,,,,lh,lh,,Ihlh,,,,,Ihhh,,,lllh,,h,l,I 0004800000750001000115700017056407900213900000454466002 PO BOX 105980 DEPT,79 ATLANTA GA 30353-5980 h,lhlh,,,,Ih,hl,,,Ih,l,l,hl,,I,,I,Ih,,h,hlh,,,Ih,I Detach and mail this portion with your check to the address above. 822 2139 045446 6 02-25-04 05-19-04 YOUR ACCOUNT HAS 3 PAYMENTS DUE. REMZT THE FULL AMOUNT DUE NOW. YOUR CHARGE PRZVZLEGES ARE SUSPENDED. 32 REG = REGULAR PURCHASE PLAN REG 1705.6~, .00 .00 .00 .00 1705.64 115.70 TOTAL 1705.64 .00 .00 .00 .00 1705.64 115.70 -Plan The finance charge ~is ah Tothat parto ~baa~ A~ ~ ~ is ~ermi~ by ~ ~ . -,~,,~an ro~paa~s applYi~ a Periodic penoaic ~ o~ razor ~- RES .O0000Z DAZLY .00~ ENTIRE BALANCE ' PAYMENT DUE BY 5 P.M. ON THE DUE DATE. Purcha~.~ rRt.rnc ~nd ....... ,~ ~* ; .................... payments just prior to billing date may not appear until next month's statement. Unle: nromotions call lot special e ms, additiona finance charges can be avoided if we receive the new belance by 5 p.m on the due date. It you send us a check or other item as payment let all or any podion of this billing statement, and that check o'-r item is returned to us as unpaid for insuff~ent or uncollected fu~s, you agree that we may obtain payment for the check or ilem by initiating an ACH {electronic) debit to your account in the ameunl of the check or item Your check or item will not be returoed to you by us or your bank. INQUIRIES: Send inquiries (not payment) and your account number to: PO BOX 103080 ROSWELL, GA 30076 NOTICE: See reverse side for important Billing Rights and other information. CUSTOMER SERVICE: For account information call toll free: (8oo)s6s-ozsq. n Telephoning about billing errors will not preserve your rights under federal law. To preserve your rights, please write to the Billing Rights Summary Address on reverse side. PAYMENTS: ~nd ~ymen~ ~: PO BOX 105980 DEPT.79 ATLANTA GA 30353-5980 aiBN f4~NA America P,O. Box 15137 Wilmington, DE 877-767-9383 19850-5137 02/20/04 CARL C RISCH 10 E HIGH ST CARLISLE, PA 17013 Re: In the Estate of VIOLET O CASSNER Probate Case No. Social Security No: Last known residence: Our Client: Account Number: Amount of Debt: Dear CARL C RISCH 21-03-1067 2O1164269 MBNAAMERICA 4264298468337764 9291.61 Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate. The original was mailed to CUMBERLAND COUNTY COURTHOUSE If you have any questions or if this is a duplicate claim, please call our firm toll free at 1-877-767-9383. Cordially, MBNA America Enclosures CC: Court Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. 4073 2/18,r2004 1074727 Please indicate Address Change bit checking the box above and completing the form on the reverse side. VIOLET R CASSNER C/O RUBY LINEAWEAVER ESTATE OF DECEDENT NEWBURG PA 17240 h.llh,,h,l.hh,llh,,,Ih J 00142100010000 73936 WALMART P.O. BOX 530927 ATLANTA, GA 30353-0927 h,lhlh,,,,Ih,hh,,Ihlh,,I,h,,,I,Ih,,h,hlh.ll,h,I 001421000375443023 6032207100789437 23 Make check payable in U.S. Dollars to Walmart/blCCBG, using blue or black ink. Please allow 5-7 days for mail delivarv. Detach and mai! yoL~r coupon with ~o~!r payment to the above address. I I Date I Perio~ I I Previous Balance + New Purchas~ + Cash Advanc~ - Paymen~ +/- Credits, Insu~nce ~ +1- ~NANCE ~ = New I J I I Fees & Adjustments (,;~) I CHARGE (~t~ i o.oo I o.oo i ,o.oo I o.oo I / Your promotionaI purchase(s) listed below were purchased under the special tenT= shown, which are in effect until the Expiration Date listed. NO INTEREST promotions are not assessed linance charges during the promotional period. DEFERRED INTEREST promotions accrue finance charges, which can be avoided if you pay at least your ndnimum payment due, if any, each month and the entire Current Balance for each Deferred Interest promotional purchase by the Expiration Date. If you do not, any Accrued FTnance Charges from the purchase date will be added to your new balance. For all promotional purchases, regular credit terms will apply to any remaining balance after the Expiration Date of each promotion. 12/07/2003 ~639.59 No Interest With Pay Promotibn ~0.00 ~639.59 J 03/31/2004 Billing Date FEBRUARY 5, 2004 Days in Billing Period= 31 Purchases and Cash Advances NO INTEREST WITH PA Y PROMOTION ANNUAL PERCENTAGE RATE Periodic Rate .02737% .00000% PERCENTAGE Assessed to [ CHARGE ~ Method RATE This Rate Finance Charge ~ ~ ~.~/~ En~e $o.0oI ~o.oo j ~D O. Om~ I Entire $0.00 ! $0.00 I ~O 9.990% ! Total Periodic FINANCE CHARGE ~49.90- MAIL PAYMENTS TO: WALMART P.O. BOX 530927 ATLANTA, GA 30353-0927 PAYMENT DUE BY 5:00 PM ON THE DUE DATE. Pumhases, returns, and payments made prior to billing date may not appear untilnext month's statement. To avoid additional finance charges, payment of the Total New Balance must be received by 5:00 PM~ on the p~Tlent due date. Notice: See reverse side for important information. ~ /~ . ~ 5604 O00Z iOD I 7 5 0~0205 IXPage I of 2 911Z 7100 NEYO FOR CUSTOMER SERVICE: For customer service or to report your card lost or stolen, call: 1-877-969-1130 INQUIRIES: Send inquiries (not payments) including your account number to: P.O. BOX 103042 ROSWELL, GA 30076-9042 739.36 The Radio Shack Statement q%he Radioshack Statement ** NO MORE DETAILS ON FILE **CRCD 840 RL 0001 OF 0001 CASSNER, VIOLET**PO BOX 36**NEWBURG*PA*17240-0036*6035365010871633*0 1203 1228 30 61.00 4500 01 1126 lt28#P919400AABLGXP81H PAYMENT 02 00000015151126366078660 03 1203 1203#P919400AHBLGXPS1V BILLED 'FINANCE CHARGES' 04 16850120021203000107170 05 1203 1203#P919400AHBLGXP823 BILLED 'FINANCE CHARGES' 06 10000055551203000107180 11:12:36 03/04/04 2472 7 0 75.00- 40.02 11.23 2528.47 75.00 .00 .00 .00 51.25 07630 ADB MDSE ADB CASH CUR SALE 27.85 51.25 .00 2504.72 .00 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 EXI11-96) CD 003870 ........ ford RISCH CARL C 10 EAST HIGH STREET CARLISLE, PA 17013 !STATE INFORMATION: SSN: 201-16-4269 :ILE NUMBER: 2103- 1067 iECEDENT NAME: CASSNER VIOLET O ~- DATE OF PAYMENT: 04-/28/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,832.61 REMARKS: TOTAL AMOUNT PAID: $1,832.61 ..... SEAL CHECK# 510 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS IN RE: ESTATE OF VIOLET O. ASSNER, DECEASED : IN THE COURT OF COMMON PI,EAS OF : CUMBERi,AND COUNTY, PEN'NSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-03-1067 FIRST AND FINAL ACCOUNT OF CYRIL R. CASSNER, JR. and RUBY L. LINEAWEAVER, EXECUTORS OF THE ESTATE OF VIOLET O. CASSNER, LATE OF HOPEWELL TOWNSHIP, NEWBURG, CUMBERLAND COUNTY, PENNSYLVANIA Date of Death: Letters Testamentary Granted: l,etters Advertised: Sentinel - Cumberland Law Journal - Account Stated to December 22, 2003 December 29, 2003 January 3, 10, & 17, 2004 January 16, 23 & 30, 2004 July 20, 2004 [The account also indicates the proposed distribution of the estate.] SUMMARY_ PRINCIPAl, Receipts Conversions to Cash Less Disbursements Balance Bcfbre Distributions Distributions to Beneficiaries Principal Balance Remaining $ 72,420.67 9.00 72,420.67 -29,020.11 43,400.56 :18,274.80 $ 25,125.76 INCOME Receipts Less Disbursements Balance Belbre Distributions Distributions to Beneficiaries Income Balance Remaining COMBINED BALANCE REMAINING 0.28 0.oo 0.28 0.28 $ 25 126.04 ASSETS COMPRISING ESTATE Estate checking account, cash Partial distribution to Ruby L, Lineaweaver TOTAL PRINCIPAL RECEIPTS Real Estate situate at 257 Three Square Hollow Road, Newburg, Cumberland County, PA [$69,000 less $25,000 distribution to Sherry Porter per Item 2 of said Will] Orrstown Bank, checking account #505803 Orrstown Bank, savings account #15651 Orrstown Bank, Christmas Club account #983846 Cash State Employecs' Retirement System, death benefit State Employees' Retirement System, retirement benefit Dan Hershey Auctioneering Services, proceeds from sale of household goods Gerber Life Insurance policy # 00007997 Monumental I.ife Insurance policy #MM 1930621 Monumental Life Insurance policy #W70629474 Monumental Life Insurance policy #I017374627 Monumental Life Insurance policy #W95620301 Monumental Life Insurance policy #1012248477 Adams Electric Co-op, patronage American Legion Auxiliary, death benefit Allstate Insurance, refund of vehicle insurance Highmark Blue Shield, benefit Lancaster Far~ning, refund Nationwide Mutual Insurance, refund $ 25,126.04 11,274.80 $ 36,400.84 $ 44,000.00 2,565.02 1,132.47 250.38 6.421.00 2,544.32 882.77 8,772.25 1,012.00 1,016.85 1,000.00 504.93 1,000.00 100.00 51.59 150.00 8.85 56.90 62.49 5.30 -2- US Treasury, refund, 2003 personal income tax Nationwide Mutual Fire Insurance, refund of homeowners insurance AARP. United Health Care, benefit Tax Proration TOTAL PRINCIPAL DISBURSEMENTS va~ous 01/07/04 01/07/04 02/03/04 02/03/04 02/03/04 02/11/04 02/19/04 02/26/04 03/29/04 03/29/04 03/29/04 04/01/04 04/01/04 04/01/04 04/01/04 04/13/04 04/27/04 04/27/04 Orrstown Bank checking account #505803, outstanding checks on date of death Fogel-Sanger Bricker Funeral Home Cyril R. Cassner, Jr., funeral expenses Adams Electric Co-op, electric service State Employees' Retirement, refund of benefits Cyril R. Cassner, Jr., funeral expenses Orrstown Bank, balance due on line of credit Timmons Oil, Inc. Adams Electric Co-op, electric service Cumberland County Recorder of Deeds, recording fee County of Cumberland, 1% realty transfer tax 2004 Cumberland County real estate taxes Lowe's, credit card balance Walmm~., credit card balance MBNA, Wachovia credit card balance Citicorp Credit Card Services, balance due to Radio Shack Adams Electric Co-op, electric service, final bill CPO2 Billing Center, account payable Register of Wills, Agent, Inheritance Tax 125.00 263.00 270.00 225.55 $ 72,420.67 $ 281.59 2,616.00 250.48 198.39 220.86 30.38 767.91 163.00 I00.34 40.50 220.00 117.48 1,705.64 3,754.43 9,291.61 2,429.72 51.10 52.95 1,832.61 04/30/04 05/11/04 reserved Reserved reserved TOTAL Ruby L. Lineaweavcr, reimbursement of Monumental Life Insurance proceeds Cyril R. Cassner, Jr., reimbursement for dumpster service Martson Deardorff Williams & Otto, attorneys' fees, Martson Deardorff Williams & Otto, disbursements Probate Fee, Register of Wills $ 140.00 Copies, Recorder of Deeds .50 Filing Fee, Register of Wills 15.00 Certified mailing, Dept. of Public Welfare 4.42 The Sentinel, Letters of Testamentary 97.55 Cumberland Law Journal, Letters of Testamentary 75.00 Short Certificate, Register of Wills 3.00 Martson Deardorff William & Otto, miscellaneous filing fees and expenses PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES Specific Bequests: Chad Cassner, per Item 3 of said Will Hannah Cassner, per Item 3 of said Will Heidi Cassner, per Item 3 of said Will Johnny Lineaweaver, per Item 3 of said Will Cassie I,ineaweaver, per Item 3 of said Will Hunter Porter, per Item 3 of said Will Sherry Porter, per Item 3 of said Will Residue: Ruby L. Lineaweaver, advance on share of residue lbr purchase of real estate TOTAL INCOME RECEIPTS Orrstown checking account #505803, interest through closing 1,016.85 142.80 3,000.00 335.47 400.00 29,020.1I 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 11,274.80 18,274.80 0.10 -4- Orrstown savings account #15651, interest through closing Orrstown Bank Christmas Club account #983846, interest through closing TOTAL INCOME DISBURSEMENTS 0.15 0.03 0.28 None $ 0.00 TOTAL $ 0.00 INCOME DISTRIBUTIONS TO BENEFICIARIES None $ 0.00 TOTAL $ 0.00 Cyj~I~R. Cassner, Jr., Executor( ,'~. ].. L./ :z' · Ruby L/Lineaweaver, Executor COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) Cyril R. Cassner, Jr. and Ruby L. Lineaweaver, being duly sworn according to law, deposes and says: That they re the Executors of the Estate of Violet O. Cassner, deceased; that they have fully and faithfully discharged the duties oftheir office; that the furegoing First and Final Account is true and correct and fully discloses ail significant transactions occun-ing during the accounting period; that all known claims against the estate have been paid in fhll; that to their knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the estate have been paid; and that the Grant of Letters Testamentary and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. Sw, rn and subscribed to before me this day:of '4/"t/ . , 579~ Public NOTARIAL SaL I I ~ORIA C. 0~0, NOTA~ meUC I I CARLISLE BORO., CUMBERLAND COUNt] L M~ CO~ISSION ~PIRES ~ -5- SCHEDULE OF PROPOSED DISTRIBUTION Cyril R. Cassner, Jr. and Ruby L. Lineaweaver, Executors of the Last Will and Testament of Violet O. Cassner, deceased, proposes to distribute the balance in their hands, to wit: $ 36,400.84, in accordance with the said Last Will and Testament as heretofore filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, as follows: TO: Cyril R. Cassner, Jr., one-half of estate residuc per Item 4 of said Will: Cash: TO: Ruby L. Lineaweaver, one-half of estate residue per Item 4 of said Will: Prior distribution: $ 11,274.80 Cash: 6,925.62 $ 18,200.42 $ 18,200.42 TOTAL BALANCE FOR DISTRIBUTION $ 36,400.84 STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION The above distribution is proposed in accordance with the Last Will and Testament of Violet O. Cassner. Sworn and subsgribed to before me this day of /~-//~/'/ , c~ (' Notary Public NOTARIAL SEAL VICTORIA L. OTTO, NOTARY PUBLIC CARLISLE BORO. CUMBERLAND COUNTY MY COMM SS ON EXPIRES DEC. 2, 2006 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, VIOLET O. CASSNER, of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes, administration costs, etc., shall be paid from my residuary estate and shall not be charged or apportioned to any other legatee, donee, beneficiary or joining tenant as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I direct my Executors herein after named to retain the services of a surveyor and to subdivide my land into two lots with the Northern most lot beginning at the property line and extending along the public road to the driveway and extending to the rear lot line being the lot upon which the mobile home of Sherry R. Lineaweaver is located and I do give and devised the lot so subdivided to Sherry R. Lineaweaver upon her payment to the Estate of the cost of survey, subdivision and other governmental fees. THIRD: I give to each of my grandchildren and great- grandchildren alive at the time of my death, the sum of One Thousand ($1,000.00) Dollars. FOURTH: The rest and residue of my estate, I give, devise and bequeath, whatsoever and wheresoever situate, to my children, Cyril R. Cassner, Jr. and Ruby L. Lineaweaver, in equal shares, share and share alike, per stirpes. FIFTH: I nominate and appoint my children, Cyril R. Cassner, Jr., and Ruby L. Lineaweaver, as the Executors of this my Last Will and Testament. If they should fail to serve or be unable to serve, then in either of those said events, I nominate and appoint, Sherry R. Lineaweaver, as Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I, VIOLET O. CASSNER, to this my Last set my hand and official seal, this /~7 1997. Will and Testament, Violet O. Cassner Sworn to and subscribed, declared and published by Violet O. Cassner, as her Last Will and Testament, and so done in the presence of we the witnesses, who sign at her request, and in her presence, and in the presence of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : I, Violet O. Cassner, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act. for the purpose therein expressed. Sworn to and acknowledged, before me, by Violet O. Cassner, the Testatrix, thi~ /~- day of ~i'~J~ ~ , 1997. Notary Public COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : DAWN MARIE SHOOR NOTARY PUBLIC Shippensburg, Cumberland County, PA My Commission ExDires February 5, 2000 WE, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ...... £ Sworn to and subscribed before me by, H. Anthony Adams and Sharon Coleman Adams, of ~./!i~/~ / , 1997. the witnesses, this /:~_~.i day Notary Public NOTAROAL SEAL 1 DAWN MARl[ SHOOR NOTARY PUeLIC~ Shippensbur~3 Cumberland Cou~W, PA/ Mv Commission Expires FebruarV 5, 2~0 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVAND ORPHANS' COURT DIVISION NO. 21-03-1067 IN RE: VIOLET O. CASSNER DECEASED FIRST AND FINAL ACCOUNT AND SCHEDULE OF PROPOSED DISTRIBUTIOi~ OE CYRIL R, CASSNER, JR. AND RUBY L. LINEAWEAVER, EXECUTORS MDW( O hereby certl~ that written notice Of the filing of ti'tis Statemont of Pro~ ~, and of ~ dale, tlrrm and phaeo w~m Iflo ~ ~1 be I:~~3 t~ Co~ f~ ~~~~ h~ nni~~m~, t hereby certify that written ~ of th~ filing of ti'ds Account, arid of the date, time and place when the same will be ~ to the Ooutt for confirmatiOn and of ~ ~ d8¥ to fl~ written obiectione to said Account, has been given to known to the ac~x}unta~ to have or cleim en inte~ost in the estate as cmdtto~, bone~ciao/. heir or next of kin. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-1067 IN RE: VIOLET O. CASSNER DECEASED FIRST AND FINAL ACCOUNT AND SCHEDULE OF PROPOSED DISTRIBUTIOB OF CYRIL R. CASSNER, JR. AND RUBY L. LINEAWEAVER, EXECUTORS MDW&O TiN [:.?~5,q [ IIGII STREET Ti:I.~WHONI (717) 243 3341 t hereby certl~ that wfltte~ noUce of the filing et ~s Stateroom of Proposed D~'lbu~. m',d of the ~e, time end piece when the same will be ~ to the Court fo~ confirmation m~d of Ihe le~ dav tollle written obviations to ~ 81alee~ of ~ Dis~rlbuUon, has been ~ to e~efy u~d clak, nant and to eveqt other pemon Imoam to ~e accoumant to I hereby certify that written notice of the filing of this Account, ar~ of the date, ttme and PlaCe when the sam wffi be p~e~=,,-&~.d to the Court for confirmation and el the le~ day to fire written evee/unpaid ctaima~ end to every othe~ person known to the ascountant to have or cle~n an int~est in the estate as creditor, bene~iary. heir or next of kin. al~mt21V a.d distribution decreed in accordance wltl~ pro~oeed ~c~- BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRTSBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRA/SEMENT, ALLONANCE OR DISALLONANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX CARL C RISCH ESQ HARTSON ETAL 10 E HIGH ST CARLISLE PA 17015 DATE 06-1q-ZOOq ESTATE OF CASSNER DATE OF DEATH 1Z-ZZ-ZO03 FILE NUHBER 21 03-1067 COUNTY CUHIIERLAND ACN 101 I Amount Ramittad VIOLET 0 HAKE CHECK PAYABLE AND REHTT PAYHENT TO: REGTSTER OF NTLLS CUHI~ERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~-~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF CASSNER VIOLET 0 FILE NO. 21 03-1067 ACN 101 DATE 06-1q-200~ TAX RETURN ~/AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION 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) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assa*s qR/O00.O0 O0 O0 O0 23/291.12 35~ 10 O0 (8) NOTE: To insure proper credi~ to your account, submit the upper portion of this form wi~h your tax payment. 67,6~5.22 APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) 10. Dabts/Hortgaga Liabilities/Liens (Schedule 1) 11. 12. 15. 14. NOTE: ASSESSHENT OF TAX: 15. Amount of L~ne 14 a~ Spouse1 ra~a 16. Amoun~ of Line 14 taxable at Lineal/Class A rata 17. Aaount of Line 14 at Sibling rate 18. Aaount of Line 14 taxable a~ Colla*eral/Class B rata 8,qq9.75 (9) (10) 18,q70.8:;' Total Deduct ions (11) Na~ Value of Tax Ra~urn (12) Charitabla/Govarnaan~al Bequests; Non-elected 911:3 Trusts (Schedule J) (1:3) Nat Value of Estate Subjac~ to Tax (14) :Zf an assessment Has issued prev/ously, 1/nes 14, 15 and/or 16, 17, reflect figures that /nclude the total of ALL returns assessed to date. 19. Principal Tax Due TAX CRED:ZTS: PAYMENT RECETpT DATE NUMBER 0q'-28-200q DISCOUNT (+) ':'*'/NTEREST/PEN!~ PAID . (-) O0 (15) .00 X O0 = (Z6) qO,72q.65 X Oq5= (17) . O0 x 12 = (~8) .00 x 15 = (19)= AMOUNT PAID ~0,7Z~.65 .00 ~0,7Z~.65 18 and 19 ~ill .00 1,832.61 .00 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. .00 1,832.61 1,832.61 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,832.61 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DU~/~ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December IZ) Z98Z -- 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 Coaaonmealth hereby expressly reserves the right to appraise and assess transfer ]nheritance Taxes at the laaful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To RJlfiI1 the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TZ P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, Nhich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Zq-hour answering service for fores ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-50Z0 (TT only). Any party in interest not satisfied with the appraisement, alloNance, ar disallowance of deductions, or assessment of tax (including discount or interest) as sho~n on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Beard of Appeals, Dept. ZelOZ1, Harrisburg, PA 171ze-IOZi, 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 Revie~ 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 aithin three (3) calendar months after the dacedent's death, a five percent (5Z) discount of the tax paid is allo~ed. The 15X 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 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, 19AZ bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which ail1 vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 200q ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .0005~8 1988-1991 11Z .000301 ~ 9Z .OOOZ~7 1963 16Z .000~38 1992 9Z .0002q7 2002 6Z .00016q 19B~ Ill .000501 1995-199~ 7Z .O0019Z 2003 SZ .000157 1985 15Z .000556 1995-1998 9~ .O00Z~7 200~ qZ .ODOIID 1986 lOZ .00027q 1999 72 .00019Z 1987 ZOZ .O00Z7q ZOO0 7Z .O0019Z --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to ;ifteen (15) days beyond the date o; the assessment. I~ payment is made after the interest computation date shoNn on the Notice, additional interest must be calculated. REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: VIOLET O. CASSNER Date of Death: December 22, 2003 File No.' 21-03-1067 Social Security No.: 201 - 16-4269 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: 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: 3. If the answer to No. ! is Yes, state the following: Did the personal representative file a final account with the Court? Yes X No bo 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 x No Date: d. Copies of receipts, releases,/~oinders and approvals of formal or informal accounts maybefiledwiththeClerklfth~~5~andmaybeattachedtothisreport. December 21, 2004 Signature: k~k,/~ \ <.22t~ Name: Carl C. Risch, Esquire Address: MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Counsel for personal representative F:WILES\DATAFILE\ESTATES\9103 2.srcp Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/15/2005 RISCH CARL C 10 EAST HIGH STREET CARLISLE, PA 17013 RE: Estate of CASSNER VIOLET 0 File Number: 2003-01067 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 12/22/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ I , -...-' GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge