The URL can be used to link to this page

Home My WebLink About04-0030 PETITION FOR PROBATE and Estate of_ FRANCES A. WERTZ also ktlowlt as Deceased. GRANT OF LETTERS No. To: P, egister of Wills for tile County of. CUMBERLAND Social Security No. 162-22-6804' Coimnonwealth of Pennsylvania Tile petition of tile undersigned respectfully represents that: Your petitiouer(s), who is/are 18 years of age or Older an the execut or itl the last will of the above decedent, dated July 9 and codicil(s) dated _. N/A ' in the named ,~1990 (stale rclcvanl circmnslanccs, c.g. rcmmciation, death of executor, etc.) Deceudcnt was domiciled at death in Cumberland Couuty, Pennsylvania, with hat last family or principal residence at 820 Lisburn Road, Apartment 511, Camp Ilill, PA (Lower Allen Twp.) (Iisi slrccl, number and muncipality) Dccendent, then 76 years of age, died January 5 I~2004 at_ Holy Spirit Hosp_j_tal - , , Exccpt as follows, dcccdc,~t did not marry, was not divorced and did not have a child born or adopted after execution of'the will offered for probate; ~vas noi tile victim of a killing and was never adjudicated incompetent: Dcccndcnt at death owned property xvith estimated values as follows: (If domiciled itl Pa.) All pcrsoual property (Il' not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pcm~sylvania situated as follows: $ !00,000.00 $ SNnna WHEREFORE, petitioner{~) respectfully request(s) tile probate of the last will presented herewith and the grant of letters T___estamentary t []lel'Ou. tlcstamcnlary; administralion c.t.a.; administration d.b.n.c.t.a.) eg±nald H. ~ertz .~ ~5 Cold Sorines Road D%llsburg~ PA- 17019 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF SUlVLB E~RL/~ND The petitioncr(s~ above-named awear(s) or a£firm(s) that the statements in the foregoing petition are truc and correct to thc best of thc knowledge and belief of petitioner(s) and that as personal represen- tativc(s) of lhc above decedent petitioner(s) will well and truly administer the estate according to law. · S~rn lo or affirmed and subscriho,~ lC .... --' (be[~l~C... IBC Ibis ~ day of / Estate of FRANCES A. WERTZ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~/~'~'~'-'-e~" ~_"-~o. }e~K 2004,, in consideration of the petition on the reverse si~ereof, satisfactory proof having been presented before me, IT iS DECREED that the instrument(s) dated 7-9-90 described therein be admitted to probate and filed of record as the last will of FRANCES A. WERTZ and Letters Testamentary are hereby granted to REGINALD H.~ WERTZ FEES Probate, Letters, Etc .......... ShorLCertificates( ) .......... $ Kenunc~atmn ................ $ ~-~ $ z'~.~o TOTAL ~/, Filed ~./.~--~...q~...~.~. William A. Yecum 06263 ATTORNEY (Sup. Ct. I.D. No.) 3001 Market Street, Camp Hill, PA 17011 ADDRESS 717-761-5041 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9 8 1 3 18 4 JAN 0 O 2004 No. Local Registrar (j' Date H105.143 Rev. 2/87 NAME OF DECEDENT (Flint. Middle, La~t) ~. Frances A. Wertz AGE (Last I~dhdey) 76 COUNTY OF DEATH ~.Cumber land DECEDENT'S USUAL OCCUPATION CITY, BORe. TWPOF DEATH ~.ast Pennsboro KIND OF BUSINESS I INDUSTRY PA State De LI~ 820 Lisburn Rca, ~amp Hill, PA 17011 FA: R'S (F ~'~ ,. ~r~n~ ~'. ~ght, Sr. ~.Reg Wertz 21a. ~ {S~) cert~ cause ~ death. resulting in dea~) "--'+ a. leading to imme~ine f ) LAST cl. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ] SEX I SOCIAL SECURITY NUMBER ] DATE~QF DEATH (Mo~th, Day, Year) . I ],.Female ,,. 162_22 _6804 DATE OF BIRTH ] BIRTHPLACE (Ctly ~ , o (bl0win, Day, year) ! Slate ~' Fo~ign Coughs} IPLACE OF DEATH (Check 0111¥ erie - ~ klstnlcflo~'m on otfler Mdal ,pr25,192 ]~. arrisburg, P ~ ~.. [-1 ~[] ~ ,,,~, I-1 ,,_-,__~.,) E] FACILITY NA~E (1! mX kmffiu~n. ~ve s~e~ and num~e~ . [RACE- Ame~can In, an. ~ack. VV~te. el DECEDENT'S EDOCATION UARITAL STATUS - Macring. I SURVIVING SPOUSE U.S. ARMED FORCES? Never Manled 1Mdowed. ] (If~h. ~v. ~l~ nam,) Yes r'l No~] ~ ,-.,., wi~r-,,) DECEDENT'S 1Ta. State ACTUAL PA ~ 17C. [] Yes, decedent~hm(lin Lower Allen ~p RESIDENCE (m e~he~ ~de) ITU. 23a. MOTHER'S NAME.{FI. rst, ~e.~da~ Su4~ame) ~..Mary we~stl~ng INF A RESS~S~. ~ n. S , ~p [2~~ ~rlngs ~a~', ~lsburg,PA 17019 ~TE OF ~S~TION [ ~CE ~ ~S~SITION- Na~ ~ ~ ~, Cr~ . ]LOCATION - ~n State ~p C~ I=~ ' I ' ' 1-3 2004 I~addletown Cometery ~ ~ewborrytown, P~ ACTI~ AS ~H LICE U [ ~E ~D A~SS ~ FACI~. . ~[one~urray~n408 3rd S~ ~ew Cumberlan~ LICENSE NUMBER [DATE SIGNED (Month. Day, Year) 23b. [ 23c. WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONER? Yes [] PART I1: O~her significant c~lili~sNoc~,~l:~li~~ to death, but ~ result mg in the undedyiog cause give~ in PART L AUTOPSy J ~RE AUTOPSY FINDINGS [ MANNER OF DEATH J DATE OF INJURY [ TIME OF INJURY N JURY AT I~I=RFuRMED? [ AVN~ PRIOR TO [ -- [ ~, ~y, Yi~) [ I ~MPLETION OF CAUSE I N.~ ~ ~ ~l I I I OF D~TH? I ~ I I ~ ~ I (~Y~) .. SIG~TURE ~D TIT O IER 'ME~AL ~NE~O~NER [ ~ME ~O A~E~ ~ ~R~ ~ ~M~ED ~USE ~ ~TH ( ~ 27) Ty~ LAST WILL AND TESTAMENT OF FRANCES A. WERTZ I, FRANCES A. WERTZ, of the Township of Lower Allen, County of Cumber- land, and State of Pennsylvania, being of sound mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other Wills by me at any time hereto- fore made. I. I direct that my Executor, hereinafter named, shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. Ail the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my son, REGINALD HARVEY WERTZ, per stirpes. III. I hereby nominate, constitute and appoint my son, REGINALD HARVEY WERTZ, as Executor of this, my Last Will and Testament. If my said son should predecease me, not qualify or not accept the position of Executor, then I hereby nominate, constitute and appoint CCNB BANK N.A. as Executor. IN WITNESS WHEREOF, I, FRANCES A. WERTZ, the Testatrix, have unto this my Last Will and Testament, set my hand and seal this ~ day of 3~ /~ / 1990. (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by FRANCES A. WERTZ, the above named Testatrix, as and for her Last Will and Testament in the presence of us who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and of each other. AC~O~EDGMENT AND AFFIDAVIT STATE OF PENNSYLVANIA ) ) ss. COUNTY OF CUMBERLAND ) We, FRANCES A. WERTZ, ~THLEEN E. LOYD and ~?~p// ~ ~P.~p.~ the Testatrix and the witnesses, respectively, whose names are signed to the fore- going instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix Wi ~ e s s ,' ? Wit~ess (SEAL) (SEAL) (SEAL) Page Two of Three Pages Subscribed, sworn to and acknowledged before me by FRANCES A. WERTZ, the Testatrix· and subscribed and sworn to before me by KATHLEEN E. LOYD and · witnesses, this ~ day of ~ ~ 1990. Notary Publi~ i NOTARIAL SEAL "-I WILLIAM A. YOCUM, NOTARY PUBLIC CAMP HILL BO~O CUMBERLAND CO. ~.-MY COMMISSION, i ~XPIRES JUNE 27, 1992992 Page Three of Three Pages CERTIFICATIOH OF NOTICE UNDER RULE Name 0'~ Decedent: Frmnces A.' Wert~ Date of Death:_ 1-5-04 Will No. '2004-0b030 Achuin. No. To the Register: '"I certify that notice of beneficial interest required by Rule 5.6(a) of tile Orphans' Court :l{ules was served on 'or mailed to · tile following bene£iciaries of tll~ above-captioned estate on : _Name ' Address Reginald H~ Wettz 25 Cold Springs Road, Dillsburg, PA 17019 Notice has now been givea to all perso~s e~titled thereto under Rule 5,6(a) except None Sig{uiture ..... I'lai,e ~illiam A, Yocum Add~ess 3001 Market Street Camp Hill, Pk · Telephone(717) ~61-5'041 CaNacity~ 17011 X Personal Representative Cou,'lse ~ for'personal repres e n ta t'iv~ Mark A. Mateya Attorney at Law Post Office Box 127 Boiling Springs, Pa 17007-0127 Phone 717-241-6500 Fax 717-241-3099 April 16, 2004 The Honorable George E Hoffer Cumberland County President Judge Cumberland County Courthouse Courthouse Square Carlisle PA 17013 Re: Estate of Frances A. Wertz No. 2104-0030 Dear Judge Hoffer, I am writing regarding the Estate of Frances A. Wertz. Attorney William Yocum was originally handling the administration of this Estate on behalf of the Executor, Reginald H. Wertz. Mr. Yocum recently passed away. Sadly, Mr. Wertz approached my office with a view to having me settle his Estate in place of Mr. Yocum. It is for that reason that I am contacting your office today. Prior to leaming of Mr. Yocum's passing, I telephoned Cumberland County Bar Association and the Pennsylvania Disciplinary Board. I spoke with the Pennsylvania Disciplinary Board's Mr. Jay Frese who told me he was aware that there was some action being taken on this case but that to the best of his knowledge, a conservator had not been appointed. A quick review of the date of death of Frances Wertz and the size of the Estate led me to the conclusion that the ninety (90) day grace period wherein an Estate may take advantage of five (5%) percent discount was about to expire. I met with Mr. Wertz on Friday, April 2, 2004, and was able to file the appropriate estimated taxes for the Estate, saving the Estate between $400.00 and $500.00. www.mateyafamilylaw.com The Honorable George E. Hoffer April 16, 2OO4 Page Two I am writing this letter to apprise this Honorable Court as well as the Disciplinary Board of my actions. I acted quickly in order to protect the client's and Estate's financial interests. I have included with this correspondence a copy of the retainer letter which I had Mr. Wertz sign. This is an unusual case and I attempted to craft a retainer letter which protected Mr. Wertz's rights as well as Mr. Yocum's interests. I have no interest in trying to take fees due to Mr. Yocum. I am taking every step possible to preserve the client's rights and protect Mr. Yocum's financial interest in this case. I will happily pay Mr. Yocum's Estate a quantum meruit for the work performed in this case. I will await your further instruction before continuing in my representation of Mr. Wertz in this case. I felt it necessary to act quickly in light of the circumstances. I do not, however, wish to "step on the Court's toes" if the Court is about to appoint a conservator over Mr. Yocum's cases. If you have any questions or need more information, please contact me. I may be reached at (717) 241- 6500 or by e-mail at mmateya(~verizonmail.com. I look forward to heating from you. Sincerely, Mark A. Mateya, Esq. MAM/aa CC' Becky Morgenthal Cumberland County Bar Association 32 S Bedford Street Carlisle PA 17013 Jennifer L Carr PA Disciplinary Counsel 2 Lemoyne Drive 2nd F1 Lemoyne PA 17043 Reginald H Wertz 25 Cold Springs Road Dillsburg PA 17019 www.mateyafamilylaw.com Sent By: ~ark A Matey Esq; 717 241 3099; Apr-22-04 11:2@AM Mark A. Mateya Attom.e0r at I.aw P,O, BOX 127 BOILING .~PR 1N¢.i.%.', PA 17(gl? Phone: 717/241-6500 Fax: 717/241.3099 Page 2/2 FILE COPY Reggie Wertz April 2, 2004 RE: New Client Dcm' Mr. Wertz, This letter is intended to explain the basis for my representation of you, the chargesithat T will make for r~pms~nth,g you in tl~c matter mentioned below. I met with yn,, on Friday. April 2, 2004. and you have requested t.ne to represent .you .~nccrning the estate administration of your late mother. You will be charged the rate of legal fee-, ,a.q net forth in yoa, r retainer agrccmnent with Attorney Yocum tbr work performed mgm-ding this matter. Attorney Yocut.n will be remunerated on a quantum merult basis, subject to third party verification. If any court ofcomnpeten t jurisdiction deems this agreement to have been entered Into tn ei'ror for any reason, the agreement is null and void as of such pronouncement. lnaddition lo Fees, my statements will reflect charges for disbumtan~nt~, including travel (whore applicablc), postage, court costs and filing fees which we may incur in thc course of this engagement.]Additionally, as we discussed in our consultation, I will ask you for referrals, if you axe satisfied with the service I provide to you. I will t.naXe every crrorrto keep you informed on the progrvsu of yum cmo. I expect yea to kccp ourrcnt with your billings and to give me your thllest cooperation so that I might represent you effectively, iBy workh[g in a relationship of mutual trust and confidence, we can maximize our pertbrmance and develOP the best chance for achieving the results for which you have retained us. Attached you w~ II also lind my Policy Concerning Allot'ney-Client Relation~lHIJ. I te£~rcncc that document herein as part of this retainer lctter. Attested to m~l agrcc, d npon by: Reggifi-'(4e~tz - ~/aa www,.matcyafaml)vlnw.oom Sent By: MaPk A Matey Esq; 717 241 3099; Apr- 22- 04 Law Office of Mark A. Mateya ~'OST OmCE SOX ]2? BOLLING SPRINGS, PA 17007 Phone: 717/'241-6bOU Pox: / I//241-3099 11:2gAM: TOTAI. PAGES: TO: FROM: RE: DATE: HARD COPY TO FOLLOW: Two (2) including Cover page The Honorable George E. Heifer Mark A. Mateya, Esq. Estate of Frances Wertz April 2~-, ~004 Yos No FAX NUMBER; 240-6~62 Page 1 Attached hereto please find the Retainer I~tter referenced in my recent correspondence t~ you. my apologies for this inadvertent omission. Please accept If you have any questions, please feel free to oomaot me. I may bo re~hcd at (717) 241q6500 or by e-mall at m mat _e?ra~,verizoztmail .yom. Mark A. Mateya. Esq. mmateyaO-~vexizonmai l.eom MAM/aa F. nclo.,ure THIS MESSAGE IS II~NDED ONLY FOR TH-E URF. OF THE I~-~UAL OR E~ ~ ~',~ IT IS ADIIR~:~gD, ANI} MAY ~N'I'~ ~~'I'ION '!'~'1' ~ P~V~, CONF~E~L AND E~ }'ROM DISClOSIng I~ER APPLICABI,E I,AW. ~ ~ US AT T~ A~ AD~ ~A ~ U,S, ~AL ~, ~ ~LPAY ~ ~'A~. 3~NK YOu. ~ ~ YOU ~VE ~Y PROB~ ~IV~G ~ ~SAGE OR ~ NOT ~CEI~ ALL OF ~ PAGe, ~$~ C~L THE ABO~ ~. ~ DEPT. 280607 RECEIVED FROM: ,:; WERTZ REGINAI D H ,RVEY :,_: 25 COLD SPINGS ROi~D :,-, DILLSBURG, PA 17019 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT AKA ACN ASSESSMENT CONTROL NUMBER REV-1 162 EX(11-96) NO. CD 003760 AMOUNT ESTATE iNFORMATION: SSN: 162-22-6804 210~- 0030 FILE NUMBER: ?ECEDENT NAME: -DATE OF PAYMENT: /WE~TZ FRANCES A 04/~05/2004 ~OSTMARK DATE: / 00/1~0/00001 COUNTY: ICU~BERLAND ~ATE OF DEATH: 01/~15/2004 IR',EMARKS: R. WALT2 CHECK# 113 ESQ TOTAL AMOUNT PAID: INITIALS: VZ RECEIVED BY: REGISTER OF WILLS 101 $3,450.00 $3,450.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Mark A. Mateya Attorney at Law Post Office Box 127 Boiling Springs, Pa 17007-0127 Phone 717-241-6500 Fax 717-241-3099 April 6, 2004 Glenda Farner Strasbaugh Cumberland County Register of Wills One Courthouse Square Carlisle PA 17013 Re: Estate of Frances A. Wertz No. 04-0030 Dear Ms. Strasbaugh, Enclosed herewith please find an original and one copy of a Praecipe for Entry of Appearance in the above-referenced matter. Please accept the original for filing and return the remaining time-stamped copy to me in the enclosed self-addressed stamped envelope. Thank you for your fine service in this regard. If you are in need of additional information or have any questions, please call. I may be reached at (717) 241-6500 or by e-mail at mmateya(~verizonmail.com. Sincerely, Mark A. Mateya, Esq. MAM/aa Enclosure cc: Reginald H Wertz Executor ESTATE OF FRANCES A. WERTZ · IN THE ORPHANS' COURT OF · CUMBERLAND COUNTY, PENNSYLVANIA · NO. 04-0030 PRAECIPE FOR ENTRY OF APPEARANCE Please enter my appearance on behalf of the ESTATE OF FRANCES A. WERTZ, Decedent in the above-referenced matter. Respectfully submitted, Attorney I.D. No. 78931 P.O. Box 127 Boiling Springs, PA 17007 (717) 241-6500 (717) 241-3099 Fax ¢.C) 0 CERTIFICATE OF SERVICE I, Mark A. Mateya, Esquire, hereby certify that I have served a copy of the PRAECIPE TO ENTER APPEARANCE on the following person(s) by depositing a true and correct copy of the same in the United States Mail, first class, postage prepaid, at Harrisburg, Dauphin County, Pennsylvania addressed to: Reginald H Wertz Executor 25 Cold Springs Road Dillsburg PA 17019 William A Yocum Esquire 3001 Market Street Camp Hill PA 17001 MSA.~h~at~~y~uire P.O. Box 127 Boiling Springs, PA 17007 (717) 241-6500 DATED: REV-~[500 ~X + (6-0( W LM COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAl. WERTZ, FRANCES A. DATE OF DEATH (MM-DD-Year) 01/05/2004 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT IDATE OF BIRTH (MM-DD-Year) 04/25/1927 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 0 0 3 0 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 6 2-2 2-6 8 0 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1, Odginal Retum J'--J 4. Limited Estate J'~'J 6, Decedent Died Testate (Att~h cOpy of Will) J~9. Liligation Proceeds Received E] 2. Supplemental Return r'-j 4a. Future Interest Compromise (date of death after 12-12-82) J---J 7. Decedent Maintained a Living Trust (Attach copy of Trust) J---J 10, Spousal Poverty Credit (d~ of de~ between 12-31-91 and 1-1-9fl r"-~ 3. RemainderRetum {dateofdeathpdorto12~13-82) [~]5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes --]11. Election to tax under Sec. 9113(A) (Attach Sch O) : iNFORMATiON SHOUED BE DiRECtED TO: I.- Z MJ Z O LU ,,v' O Z MARK a. MATEYA, ESQUIRE FIRM NAME (If Applicable) TELEPHONE NUMBER (717) 241-6500 COMPLETE MAILING ADDRESS P.O. BOX 127 BOILING SPRINGS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) j-"J Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Beductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) PA 17007 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) OFFICIAL USE ONLY 32,~4.69 26,920.29 12,198.00 563.25 (11) (12) (13) 99,526.19 12~761.25 (14) 86,764.94 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 86,764.94 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 20. 0.00 X ~ (15) 86~764.94 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) ~ > >BE SU UES~ON REVE ND RECHECK MATH < < 0.00 3~904.42 0.00 0.00 3,904.42 Decedent's Complete Address: · :[" STREET ADDRESS 820 LISBURN ROAD CITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty JSTATE PA ziP 17011 (1) 3,45O.O0 181.57 3,904.42 Total Credits ( A + B + C ) (2) 3~631.57 Total Interest/Penalty ( D + E ) (3) 0.00 0.00 272.85 272.85 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .............................................................................................. [] [] 3. Did decedent own an 'in trust for' or payable upon death bank account or secudty 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 I$ YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this retum, including accompanying schedules and statements, and to the Pest of my knowledge and Pelief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOE FILING RETURN ADDRESS 25 6gOLD SPRINGSROADO DILLSBURG DATE PA 17O19 SIGNATURE OF pREPAI~ER eTHER ,THAN R P~SENTA TIVE ADDRESS O~BOX~ 12-~ '~/~ ~' HARRISBURG ,,/.~ATE ! PA 17007 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 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 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. LAST WILL AND TESTAMENT OF FRANCES A. WERTZ I, FRANCES A. WERTZ, of the Township of Lower Allen, County of Cumber- land, and State of Pennsylvania, being of sound mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other Wills by me at any time hereto- fore made. I. I direct that my Executor, hereinafter named, shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. Ail the rest, residue and remainder of my estate, whether~real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my son, REGINALD HARVEY WERTZ, per stirpes. III. I hereby nominate, consti~ute and appoint my son, REGINALD HARVEY WERTZ, as Executor of this, my Last Will and Testament. If my said son should predecease me, not qualify or not accept the position of Executor, then I hereby nominate, constitute and appoint CCNB BANK N.A. as Executor. IN WITNESS WHEREOF, I, FRANCES A. WERTZ, the Testatrix, have unto this my Last Will and Testament, set my hand and seal this ~'Z~ day of ~~ 1990. SIGHED, SEALED, PUBLISR~D"~nd DECLARED by FRANCES A. ~ERTZ, the above named Testatrix, as and for h~r L~t Will and Testament in the presence of us who have hereunto subscrib~d:.our~.~witnesses at her request, in the presence of the said Testatrix and of, sash o~ker. A~~~AND AFFIDAVIT STATE OF PENNSYLVANIA ) ) ss, the Testatrix and the witnesses, reopectively, whose names are signed to the fore- going instrument, being first duly ~rn, do hereby declare to the undersigned authority that the Testatrix signea and executed the instrument as her Last Will and that she signed willingly, ~d that she executed it as her free and voluntary act for the purposes therein expresssd, and that each of the witnesses, in the presence and hearing of the Testa~rix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Page T~o of Three Pages SubScrib~d, s~o~"t~ and acknowledged before me by FRANCES A. WERTZ, the Tes~a~rix, and subscribed and s~orn co btfor~ me b~ ~HLEEN E. LOYD and 1990. Page Three of Three Pages REV-I,~08 EX' + (6-98) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER WERTZ. FRANCES A, 21 Include the proceeds of litigation and the date the proceeds were received by the estate. All pmper~ jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION 1. 04 0030 6 HOUSEHOLD/PERSONAL EFFECTS APPRAISED VALUE APPRAISAL ATTACHED 1986 CHEVY CAVALIER AUTOMOBILE 2003 HYUNDAI ELANTRA AUTOMOBILE WAYPOINT BANK CHECKING ACCOUNT ACCOUNT #700004544 WAYPOINT BANK CERTIFICATE OF DEPOSIT ACCOUNT #10-66-169462 AARP/HARTFORD - REFUND FOR CANCELLATION OF AUTOMOBILE INSURANCE AARP/HARTFORD - REFUND FOR CANCELLATION OF RENTERS INSURANCE MALLARD RUN APARTMENTS - REFUND OF SECURITY DEPOSIT US TREASURY - 2003 FEDERAL INCOME TAX REFUND TOTAL (Also enter on line 5, Recapitulation) VALUEAT DATE OF DEATH 905.00 950.00 10,500.00 3,095.54 16,009.85 151.00 16.00 349.30 598.00 32,574.6u (If more space is needed, insert additional sheets of the same size) ..... l.-qo -' Frank Potteiger Auctioneer · Complete Auctteneonng Serwce · Your tocatton or rome · Or I'll DUi' your entire lot · Sales Eveo' Tuesclay 5:00p. m. at 2_29 Petersbur~a F~oad CARLISLE, PA 17013 · (717) 243-1388 - REV-I,509 EX' + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY WERTZ. FRANCES A, FILE NUMBER 21 04 0030 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 A. REGINALD H. WERTZ REGINALD H. WERTZ C REGINALD H. WERTZ 25 COLD SPRINGS ROAD DILLSBURG, PA 17019 25 COLD SPRINGS ROAD DILLSBURG, PA 17019 25 COLD SPRINGS ROAD DILLSBURG, PA 17019 ADDRESS RELATIONSHIP TO DECEDENT SON SON SON JOINTLY-OWNED PROPERTY: LE ~ IER DATE DESCRIPTION OF PROP~-M~I Y % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTERE$ 1. A. 3/19/98 PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 174.64 50. 87.32 SAVINGS ACCOUNT 2. B. 3/19/98 PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 383.27 50. 191.64 CHECKING ACCOUNT 3. C. 3/19/98 PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 50,021.53 50. 25,010.77 CERTIFICATE OF DEPOSIT 4. D. POINT BREEZE CREDIT UNION 3,261.12 50. 1,630.56 SAVINGS ACCOUNT TOTAL (Also enter on line 6, Recapitulation) $ nf ....... ~ .... ,~,~ , .......................... 26,920.29 , insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent WERTZ, FRANCES A. Decedent's Name Page 1 21 04 0030 File Number Schedule F-1 - Jointly Owned Property SURVIVING JOINT TENANT(S) NAME D. REGINALD H. WERTZ ADDRESS 25 COLD SPRINGS ROAD DILLSBURG, PA 17019 RELATIONSHIP TO DECEDENT SON REV-1510 E)~'+ (e-98)" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WERTZ. FRANCES A. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 04 0030 This schedule must be completed and tiled if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is/es. DESCRIPTION OF PROPERTY ITEM ~,O. UDE THE NAME OF THE TR.V~SFEREE, THEIR RELATIONSHip TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TUE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~FAPPUC~E) VALUE 1. WAYPOINT BANK 40,031.21 100. 40,031.21 IRA ACCOUNT #1086524967 TOTAL (Also enter on line 7 Recapitulation) $ 40,031.21 pace is needed, insert additional sheets of the same size) REV-1511 E~('+ (12-99)" COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE H FUNEEAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER WERTZ, FRANCES A, ITEM NUMBER 8. 9. 10. 11. 21 04 0030 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: STONE & MURRAY FUNERAL HOME JAMES R. GINGERICH MEMORIALS - INSCRIPTION ON MEMORIAL MARKER ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City. State Year(s) Commission Paid: AttomeyFees MARK A. MATEYA, ESQUIRE Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent State Zip Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS CARLISLE, PA Accountant's Fees Tax Return Preparer's Fees WAGGONER FRUTIGER & DAUB 2003 INCOME TAX RETURN PREPARATION PATRIOT NEWS - ADVERTISEMENT OF ESTATE CUMBERLAND LAW JOURNAL - ADVERTISEMENT OF ESTATE FRANK POTTEIGER - APPRAISAL FEE FOR PERSONAL/HOUSHOLD ITEMS AUTO LOCATOR - ADVERTISEMENT FOR SALE OF AUTOMOBILE WAGGONER FRUTIGER & DAUB - INVESTMENT CONSULTATION TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 6,293.00 100.00 4,945.00 261.00 170.00 97.00 75.00 45.00 32.00 180.00 12,198.00 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER WERTZ, FRANCES A. Include unreimbursed medical expenses. DESCRIPTION PATRIOT NEWS - PERSONAL NEWSPAPER SUBSCRIPTION 21 04 0030 ITEM NUMBER 1. PPL - ELECTRIC BILL - FINAL BILL COMCAST - CABLE TV BILL - FINAL BILL NORTH AMERICA COLLECTION AGENCY COLLECTION FOR PRIOR COMCAST ACCOUNT VERIZON - TELEPHONE SERVICE - FINAL BILL AT& T UNIVERSAL CARD - CREDIT CARD BOCOVS' CREDIT CARD BONNIE K. MILLER 2004 PERSONAL TAXES MALLARD RUN ASSISTED LIVING RENT FEE TOTAL (Also enter on line 10, Recapitulation) $ VALUE AT DATE OF DEATH 4.80 43.35 1.97 18.47 28.29 144.38 65.19 9.80 247.00 (If more space is needed, insert additional sheets of the same size) 563.2b REV-1~13 EX ~- (~q.hm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER WERTZ. FRANCES A, NUMBER II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal dls~ibutions, and transfers under Sec. 9116 (a)(1.2)] REGINALD H. WERTZ 25 COLD SPRINGS ROAD DILLSBURG, PA 17019 ;~1 04 0030 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal 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 NONE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ]] - 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) 86,763.94 INVENTORY Estate of FRANCES A. WERTZ also known as FRANCES A. WERTZ , Deceased REGINALD H. WERTZ, EXECUTOR No. 21 04 0030 Date of Death 1/5/2004 Social Security No. 162-22-6804 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of ! I.D. No.: 78931 Address: PO BOX 127 Dated BOILING SPRINGS PA 17007 Telephone: (717) 241-6500 Description HOUSEHOLD/PERSONAL EFFECTS APPRAISED VALUE 1986 CHEVY CAVALIER AUTOMOBILE 2003 HYUNDAI ELANTRA AUTOMOBILE WAYPOINT BANK CHECKING ACCOUNT #700004544 WAYPOINT BANK CERTIFICATE OF DEPOSIT ACCOUNT #10-66-169462 AARP/HARTFORD REFUND FOR CANCELLATION OF AUTOMOBILE INSURANCE (Attach Additional Sheets if necessary) Total Value 905.00 ::!'. ;~50.00 10,500 00 3,095.54 16,009.85 151.00 99,526.19 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory FRANCES A. WERTZ Description of Inventory Page 1 21 04 0030 Description AARP/HARTFORD REFUND FOR CANCELLATION OF RENTERS INSURANCE MALLARD RUN APARTMENTS REFUND OF SECURITY DEPOSIT PENNSYLVANIA STATE EMPLOYEES CREDIT UNION SAVINGS ACCOUNT - JOINTLY OWNED 174.64 TOTAL PENNSYLVNAIA STATE EMPLOYEES CREDIT UNION CHECKING ACCOUNT - JOINTLY OWNED 383.27 TOTAL PENNSYLVANIA STATE EMPLOYEES CREDIT UNION CERTIFICATE OF DEPOSIT - JOINTLY OWNED 50021.53 TOTAL POINT BREEZE CREDIT UNION SAVINGS ACCOUNT - JOINTLY OWNED 3261.12 TOTAL WAYPOINT BANK IRA ACCOUNT #1086524967 US TREASURY 2003 FEDERAL INCOME TAX REFUND Subtotal $ Grand Total $ 16.00 349.30 87.32 598.00 67,914.80 99,526.19 40,031.21 Value 1,630.56 25,010.77 191.64 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 004321 WERTZ REGINALD HARVEY 25 COLD SPINGS ROAD DILLSBURG, PA 17019 AKA ........ fold ESTATE INFORMATION: SSN: 162-22-6804 FILE NUMBER: 21 04-0030 DECEDENT NAME: WERTZ FRANCES A DATE OF PAYMENT: 08/30/2004 POSTMARK DATE: 08/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/05/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $272.85 TOTAL AMOUNT PAID: 8272.85 REMARKS: WERTZ REGINALD H SEAL CHECK//117 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX nTV/SZON DEPT. 180601 HARRISBURG, PA 17118-06D1 COHHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1;47 EX &FP (01-05) HARK A HATEYA ESQ PO BOX 127 BOILING sPaS ~A 17007 DATE 11-01-Z00q ESTATE OF WERTZ DATE OF DEATH 01-05-200q FILE NUNBER 21 Oq-O0$O COUNTY CUHBERLAND ACN 101 Amount Ralli'l:tad FRANCES A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGTSTER OF HTLLS CUHBERLAND CO COURT HOUSE CARLTSLE, PA 17015 CUT ALONG THZS LINE ~ RETAIN LOHER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HERTZ FRANCES A FILE NO. 21 0~-0050 ACN 101 DATE 11-01-200~ TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON 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) $. Closely Held Stock/Partnership In{arest [Schedule C) ($) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Join{ly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expansas/Adm. Costs/Nisc. Expenses (Schedule H) (9). 10. Debts/Nortgaga Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return $2z57q.69 26~920.29 qOz031.21 (8) 12,198.00 563.25 O0 NOTE: To insure proper O0 credi~ ~o your account, O0 submit the upper portion O0 of this form with your ~ax payment. 13. 14. NOTE: 99,526.19 (11) 12.781.25 (12) 86,76~' 9r* Charitable/Governaen~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Not Value of Estate Subject to Tax (14) Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line 14 at Spousal ra~e 16. Amount of Line 1~ ~axable at Lineal/Class A rate 17. Aaount of Line 14 a~ Sibling rate 18. Amount of Line 14 taxabla at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYflENT RECEIPT' DISCOUNT DATE NUNBER INTEREST/PEN PAID (-) 0~-05-200~ ~ CD003760 181.58 08-30-200~ ~' CD00~321 .00 .00 86,76~.9~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 will (15) .00 x O0 = .00 (16) 86,76R.9~ x 0~5= 3,90R.~2 (17) . O0 x 12 = .00 (lB) .00 x 15 = .00 (19)= 3,90R.~2 ANOUNT PAID 3,q50.00 272.85 TOTAL TAX CREDZT I 3'90R'c~3 BALANCE OF TAX DUEl .01CR ZNTEREST AND PEN. .00 TOTAL DUE .01CR ( IF TOTAL DUE ZS LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORfl FOR INSTRUCTIONS. RESERVATION: Estates of decedents dying on er before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafui Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR)= OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act g$ of 2000. (TZ P.S. Section 9140). Detach the tap portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Nills, any of the 03 Revenue District Offices, or by calling the special gq-hour answering service for forms ordering: 1-800-360-g050; services for taxpayers with special hearing and / or speaking needs: 1-B00-447-3000 iTT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZelOZl~ Harrisburg, PA 17128-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 080601, Harrisburg, PA 17ii&-0601 Phone (717) 787-6SOS. See page 5 of the book[et "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January l&, 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 free the date of death, to the date of payment. Taxes which became delinquent before January 1, 19SI bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19De through g004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ gOZ .000548 ~'~-1991 11Z .000301 ~ 9Z .000247 1983 16Z .00043& 1992 9Z .000047 gOOg 6Z .000164 1984 III .000301 1993-1994 72 .O0019Z 2003 5Z .000137 1985 132 .0003S6 1995-1998 92 .OOOZ47 2004 4Z .OOOlXO 1986 IOZ .000Z74 1999 7Z .00019Z 1987 log .000Z74 ZOO0 7Z .00019Z --Xntarest is calculated as follows: INTEREST = 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 fifteen (15) days beyond the date of tho assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Mark A. Mateya Attorney at Law Post Office Box 127 Boiling Springs, Pa 17007-0127 Phone 717-241-6500 Fax 717-241-3099 December 8, 2005 Glenda Farner Strasbaugh Cumberland County Register of Wills One Courthouse Square Carlisle PA 17013 Re: Estate of Frances A. \Vertz No. 04-0030 Dear Ms. Strasbaugh, Enclosed herewith please find an original and one copy of a Status Report Under Rule 6.12 in the above-referenced matter. Please accept the original for filing and return the remaining time-stamped copy to me in the enclosed self-addressed stamped envelope. Thank you for your fine service in this regard. If you are in need of additional information or have any questions, please call. I may be reached at (717) 241-6500 or bye-mail atmmateya@verizonmai1.com. Sincerely, ~A,~ Mark A. Mateya, Esq. MAM/aa Enclosure cc: Reginald H Wertz Executor 25 Cold Springs Road Dillsburg P A 17019 y- , ... " STATUS REPORT UNDER RULE 6.12 Name of Decedent: FRANCES A. WERTZ Date of Death: 1/5/2004 Will No. Admin. No. 21-04-0030 Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether administration of the estate is complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete : 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans I Court No. (if any) for the personal representative I s account is : c . Did the personal representative state an account informally to the parties in interest ? Yes X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans I Court and may be attached to this report. Date: 12/8/2005 ~el\ J~ MARK A. MATEYA. ESQUIRE Name (Please type or print) P.O. BOX 127 BOILING SPRINGS PA 17007 Address ( 717 ) 241- 6500 Tel. No . _.:1- W Capacity : Personal Representative '1 X Counsel for personal representative ".~: Vb .. ,. RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that I, Reginald H. Wertz, heir of the Estate of Frances A. Wertz, deceased, do hereby acknowledge that I have this day had and received from Reginald H. Wertz, Executor of the Estate of Frances A. Wertz, deceased, the sum of TWELVE THOUSAND ONE HUNDRED FORTY-TWO DOLLARS AND THIRTY-SIX CENTS (12,142.36), in full satisfaction and payment due me as said heir. And therefore I, the said Reginald H. Wertz, do by these presents remise, release, quit- claim and forever discharge the said Reginald H. Wertz, Executor of the Estate of Frances A. Wertz, deceased, and Mark A. Mateya, Esquire, Attorney for the Estate of Frances A. Wertz, their successors and assigns, of and from their actions as Executor and Attorney of the Estate of Frances A. Wertz, deceased, of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatever, limited however to the receipt of this full and final payment. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 'Z q day of FJ~ , 2004. WITNESS: ~t.~~ <lYfVj'JIJ l/. ~ Reginal[H. Wertz ,a. \. SCHEDULE OF DISTRIBUTION Reginald H. Wertz $12,142.56 Upon review of the foregoing Informal First and Final Account of the Estate of Frances A. Wertz, I have no objections and hereby approve said Account. WITNESS: ~Q,~ ~ILG~ Reginald . Wertz' DATE: i I (:z.ct{ 01..( ,-' '" " STATUS REPORT UNDER RULE 6.12 Name of Decedent: FRANCES A. WERTZ Date of Death: 1/5/2004 Will No. Admin. No. 21-04-0030 Pursuant to Rule 6. 12 of the Supreme Court Orphans I Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether administration of the estate IS complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans I 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 X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 12/8/2005 ~ 1\ .l~ Signature MARK A. MATEYA. ESQUIRE Name (Please type or print) P.O. BOX 127 BOILING SPRINGS PA 17007 Address ( 717 ) 241-6500 Tel. No . ....:t L) Capacity : Personal Representative X Counsel for personal representative . J i....j Vb .. ,. RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that I, Reginald H. Wertz, heir ofthe Estate of Frances A. Wertz, deceased, do hereby acknowledge that I have this day had and received from Reginald H. Wertz, Executor of the Estate of Frances A. Wertz, deceased, the sum of TWELVE THOUSAND ONE HUNDRED FORTY-TWO DOLLARS AND THIRTY-SIX CENTS (12,142.36) , in full satisfaction and payment due me as said heir. And therefore I, the said Reginald H. Wertz, do by these presents remise, release, quit- claim and forever discharge the said Reginald H. Wertz, Executor of the Estate of Frances A. Wertz, deceased, and Mark A. Mateya, Esquire, Attorney for the Estate of Frances A. Wertz, their successors and assigns, of and from their actions as Executor and Attorney of the Estate of Frances A. Wertz, deceased, of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatever, limited however to the receipt of this full and final payment. IN WITNESS WHEREOF, I have hereunto set my hand and seal this -z q day of FJ~ , 2004. WITNESS: ~0.l~ '1&~ JJ ~ Reginald-H. Wertz ... " SCHEDULE OF DISTRIBUTION Reginald H. Wertz $12,142.56 Upon review of the foregoing Informal First and Final Account of the Estate of Frances A. Wertz, I have no objections and hereby approve said Account. WITNESS: 1~ ~QJ ~1L0___ Reginald . Wertz' DATE: i d:;,Cf.( of..( Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 phone: (717) 240-6345 Date: 12/06/2005 MATEYA MARK A PO BOX 127 BOILING SPRINGS, PA 17007 RE: Estate of WERTZ FRANCES A File Number: 2004-00030 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: 1/05/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, A-v~ " , ,;.-:' ...C.....1 l . . v'-:/"'" ",,,,/,,,"', '..... . . ~...- '''-' ...... - . GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge V~