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Home My WebLink About02-0069PETITION FOR PROBATE & GRANT OF LETTERS Estate of HAZEL O. BELTZHOOVER also known as Social' Security No. 209-38-2884 , deceased. No. 21-02- ~:~ ~ To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioner, who is 18 years of age or older and the Executor named in the Last Will of the above decedent dated October 27 ,199...Z7, and codicils dated none . The Executor named none died. Renunciations for none attached hereto. -~' Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 231 West Ridge Street, Carlisle Borough Decedent, the'n'"~3 years of age, died January 15 ,2002, at Forest Park Health Cente~,_Carlisle, PA 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 Decedent at d~att'~owne'~l property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: none $435,000.00 $ WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of lett~.r~testamentary thereon· Signature(s) and Resid~(~(s): o oV v nVue Joliet, IL 60435 815-726-7915 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA · COUNTY 6F CUMBERLAND · SS The Petitioner above.named swears or affirms that the statements in the foregoing petition are true and correct to the best of the k00.wledge and belief of Petitioner and that as p.er. seqal repre~'t"~ive of the above decedent, petitioner will well ~nd/truly administer the estate according to la(~. ~;~.. January ,2002. ' G. Edward Beltzhoover Register /'7- Il No. 21-02- 69 Estate of HAZEL O. BELTZHOOVER , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, January 22, , 2002, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 27; 1997 described therein be admitted to probate and filed of record as the Last Will of Hazel O. Beltzhoover and Letters Testamentary are hereby granted to '" '- ' G. Edward Beltzhoover FEES Probate, Letters, Etc ........ $ 340.00 Short Certificates(-5- ) .... $. 15.00 Renunciation(s) ... '-. ....... $ JCP ............. . ....... $ 5.00 Other Will Pages (-3-) .... $ 9.00 .. TOTAL: .... $ 369.00 Filed .3..4N.U..A_~..Y..2.2.,..2.qQ2. .......... - ¢ ~st~r o.f. Will~ -.. "J~am~s/D. H u,~es, ~sq uire (58864) OR~fiY (Sup. Ct. I.D. ~o.) West ~omfret St., Carlisle, ~A ~70~3 ADDRESS 717-249-2353 PHONE d) 105.805 REV 9/86 this Certific 21-02'69 LAST WILL AND TESTAMENT I, HAZEL O. BELTZHOOVER; of the Borough of Carlisle Cumberland 'County,. Pennsylvania, being of sound mind, disposing memory and full !.egal age, d° hereby make, publish and declare this to be my Last Will and Testament, hereby ~ revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case 'may be, to pay all of my' debts, funeral and administrative expenses as soon 'as convenient after my decease. Furthermore, I direct that all state, inheritance, sUccession and other death taxes imposed or paYable by reason of my death and interest and penalties' thereon with resPect to all prOPerty composing of my gross estate for death tax purposes, whether or not such prOperty passes Under this Will,~ shall be paid by the Executor or Executrix of my estate. TWO. My Executor or 'Executrix may, at his or her discretionl compromise claims, borrow money, retain property for such length of time as he or she may deem proPer; lease and sell property for such prices, on such terms, at 'public Or private sales, as he or she may deem proper; and invest estate property, and income Without restriction to legal investments. unless otherwise provided hereunder. I authorize and emPower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or beqUeathed'. herein, at public pr private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. MY Executor or'Executrix is 'authorized and empowered to engage in any business in which I may be engaged at my death,'for such Period of time aft'er my death as seems expedient to said Executor or Executrix. THREE. I giVe, devise and bequeath any and all ·personal effects ·that I haVe~ specifically set forth on that certain written list Setting forth the' name of Such perSonal Property. ' 'item and the designated beneficiary, which list is incorporated herein by this reference. The aforementioned list of specific bequests shall be kept with the' conformed copy of this, my Last Will and Testament, however, if for whatever reason no ~uch list exists or can be found Wiihin a reasonable time after my decease, then' in that. event; fall °fmy personal effects and Personal. '. property shall be and become a part of my residuary estate and distributed in accordance. therewith. FOUR. I give, devise and bequeath therest, 'residue and remainder of my estate, in equal shares, to my children, DELORIS MORROW, G. EDWARD BELTZHOOVER, KAY L. KAYLOR, JANICE M. WARICHER, RICHARD L. BELTZHOOVER,: CAROL A," SCHWARTZ and BONNIE R. KUHNS, share and share alike, per stirpes, which provides .that the child or children of any deceased child shall take the share their parent would. have taken if FIVE. I nominate and appoint my son, G. EDWARD BELTZHOOVER, to be the ' Executor of this my Last Will and Testament. If my Son has Predeceased me,. failed t° qUalify or 'is not able or does not serve for whatever reason,-I, then appoint 'my daughter, JANICE' M. ' WARICHER, to be the Executrix of my estate. In the event that she has Predeceased me, failed. to qualify or is not able or does not serve for whatever reason, then in her place I appoint mY daughter, BONNIE R. KUHNS, to be the ExecUtrix of my estate, whereby' bOth' substitute .'~ ' "'" '.. Executrices shall have the same powers as the original Executor hereunder. It is my intent in '..' .".'.." . appointing my personal representative as stated above' that such individual iserve in such a EIGHT. or principal held otherwise reach any such interest. capacity without any consideration or fee being taken by such individual in an effort to fairly and equally distribute my assets between my heirs. SIX. No person(s) shall benefit hereunder unless 'such .beneficiary shall survive.. me by sixty (60) days. · SEVEN. No ExecUtor or Executrix acting hereunder shall be required to' post bOnd . or enter security in this or any other jurisdiction. No beneficiary may assign or 'anticipate his or her interest in any income .- creditors may attach or or distributable hereunder; and no beneficiary's I haVe hereunto IN WITNESS WHEREOF, October, 1997. set' my hand and seal this ~q '/'day of Signed, sealed, published and declared by the aboveznamed person as and fOr a Last Will" and Testament, in our presence, who at said person's request, in said PersOn's presence and in the' presence of each other have hereunto set Our names as Subscribing witnesses. L3 A CKNO WLEDGMENT AND AFFIDAVIT ' WE, HAZEL O. BELTZHOOVER, SHARON L. ScHWALM · and: CHERYL. L, CLELAND, the testatrix and witnesses resPectively? whose names are: signed to thc .foregoing 'instrument, being fa'st duly swom,'do hereby declare to thc' undersigned. authority that. thc testatrix signed and executed thc instrument as her Last Will and' Testament that she had .signed willingly, and that. she executed it as her free and Voluntary act for the purpose herein expressed,' and that each of the witnesses, in the presence and hearing of'the testatrix~ signed thc Will as a 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.. AZEL O. BEI~ZHOOVER SHARON L. SCHWALM C~ERYL L. CLELAND' COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : : SS : Subscribed, sworn to and acknowledged before me by HAZEL O. BELTZHOOVER, the testatrix, and sUbscribed, and sworn to before me by SHARON ~L. SCHWALM and' 'CHERYL L. CLELAND, witnesses, this ~ day of October, 1997.. Notarial Soal [ ' ' - ' ! dacquellne L Drawbaugh. Notary Public - ,, ! Carlisle Bom, Cumberland. County J My Commission Expires Aug.. 14. 1999 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: - HAZEL O. BELTZHOOVER JANUARY 15, 2002 21-02-0069 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 21, 2002 . Name Address G. Edward Beltzhoover Richard L. Beltzhoover Kay B. Kaylor Carole Schwartz 818 Glenwood Avenue, Joliet, IL 60435 3659 Bramley Way, Carmel, IN 46033 19407 North 86th Drive, Peoria, AZ 85382 20 Olde Mill Run, Medford, NJ 08055 Janice B. Waricher Deloris B. Morrow Bonnie B. Kuhns 20 Tunbridge Lance, Carlisle, PA 17013 1833 Spring Road, Carlisle, PA 17013 812 Flintlock Ridge Road, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled /~,gllqe James D. Hughes, Esquire Address 60 West Pomfret Street Date: 02/21/02 Capacity: Carlisle, PA 17013 Telephone (717) 249-2353 Personal Representative X Counsel for Personal Representative 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 001069 HUGHES JAMES D 60 WEST POMFRET STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 209-38-2884 FILE NUMBER: 2102-0069 DECEDENT NAME: BELTZHOOVER HAZEL O DATE OF PAYMENT: 04/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/15/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $17,967.26 TOTAL AMOUNT PAID: $17,967.26 REMARKS: JIM HUGHES ESQUIRE SEAL CHECK# 18449 INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS EV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. ?80601 HARRISBURG, PA 17128-0601 E C E D E N T CA-P HP~ EP," CR~ KO~ C O R R E S R E C A P I T U L A T I O N C O M 1 0 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Beltzhoover Hazel 0. OFFICIAL USE ONLY /7-J,5 - II FILE NUMBER 21-02-0069 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 209-38-2884 DATE OF DEATH (MM- OD-YEAR) I DATE OF BIRTH (MM-DO-YEAR) THIS RETURN MUST BE FILED IN DUPMCATE V~ITH THE 01/15/2002 I 01/04/1909 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 1. Original Return ~ 247! Supplemental Return 4. Limited Estate . Future Interest Compromise (date of death after 12-12-82) 6. Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) [~9. Litigation Proceeds Received [--~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1 - 1-9~) (date of death 3. Remainder Return prior to 12-13-82) 5. Federal EstateTax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME James D. Hu~hes Esq. FI R M NAM E (If Applicable) IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER 717/249- 2353 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds(Schedule B) (2) 3. Closely Held Corporation, Partnership or ~' (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D)' (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6.~ JOintly Owned Property (Schedule F) (6) ~]:, Separate Billing Requested 7."lnte~-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 Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) COMPLETE MAILING ADDRESS 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 170.?1,3C~ No~'& '244,014'.44 .' Noh'e None 198,2.93..70- None None' (a) 18,220.30 3,801.22 (11) (12) OFFICIAL(U-SE:ON LY 442,308.14 22,021.52 420,286.62 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 420,286.62 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1.5. ~A. mount of Line 14 taxable at the spousal tax ' jate, 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 420,286.62 x .0 0 (15) 0.00 X .o 45 (16) 18 ~ 912.90 X .12 (17) 0.00 x .15 (18). 0.00 19. Tax Due (19) 18,912.90 iii .................. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 231 West Ridge Street CITY Carlisle STATE ?A ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount 0.00 945.65 (1) Total Credits ( A + B + C ) (2) 18,912.90 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB) 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. retaintheuseorincomeofthepropertytransferred; · ........................ ~ ~ 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? ........... '... i .... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................ ' ........ r-] ~] · 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r-~ ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ [~ ~-~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 945.65 0.00 0.00 17,967.26 0.00 17,967.26 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PER. SONRESPONSIB~-FORFIL~RETURN G. Edward Beltzhoover DATE ., D ,. (/,) . I J 818 Glenwood Ave - ]% ii¥ . ' 7£- - ............................. SIGNATURE OF~~THER~HAN RE~NTAT~E IRWIN Mc~IGHT & ~GHES DATE. 60 West Pomfret Street ' -- .... ...................... ~i~.g ~u~ i~ ~% [z~ P.S. 9~ (~)(~.~) ~r date~f death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [7~1 ~ (a) (1.1) (ii)]. The statute does not exempt.a transfer to a surviving spouse from tax, and the statuto~ requirements for dmclosure of assets and filing a tax return are still applicable even if the'surviving spouse is the on~ beneficial. 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. 9~ ~6(a)(~)]. 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. Copyright (c) ~000 form software only The Lackner Group, Inc. Form REV-I~00. EX (Rev. 6-00) REV-1503 EX + (I-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Hazel O. Beltzhoover SS# 209-38-2884 01/15/2002 21-02-0069 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 3,257 shares M&T Bank Corporation - traded on the NYSE, 74.92 244,014.44 C omRlon TOTAL (Also enter on Jine 2, Recapitulation) 244,014.44 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) REV-1508 EX * (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF FILE NUMBER Hazel O. Beltzhoover SS# 209-38-2884 01/15/2002 21-02-0069 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 4 6 7 8 9 10 11 12 Citizens Bank - account #01249497 M&T Bank - checking account #402796 Members First Federal Credit Union - regular #202751-00 Members First Federal Credit Union - investments #202751-05 Members First Federal Credit Union - certificate of deposit #202751-40 Waypoint Bank - certificate #1766240259 Waypoint Bank - certificate #8000039735 - Waypoint Bank - certificate #8000044207 Waypoint Bank - certificate #8000045381 BC/BS, premium refund Hooke & Surer, security deposit refund Miscellaneous personal property/household goods savings account savings account TOTAL (Also enter on line 5, Recapitulation) 39,145.55 8,064.41 25.00 33,264.18 25,056.00 18,036.80 30,068.35 15,033.31 28,067.77 224.90 307.43 1,000.00 198,293.70 (If more space is needed, insert additional sheets of the same size) copyr ght (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV- 151 t EX + (1-97) SCHEDULE H. FUNERAL EXPENSES 8, ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hazel O. Beltzhoover SS# 209-38-2884 01/15/2002 21-02-0069 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Ao 2 2 3 4 FUNERAL EXPENSES: After funeral reception Carlisle Memorial Service 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: Zip Attorney's Fees IRWIN McKNIGHT & HUGHES Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal - Marston's Tax Service - Register of Wills The Sentinel, Legal Copyright (c) 1996 form software only CPSystems, Inc. State Zip estate notice publication income tax preparation filing fee estate notice publication 167.47 490.00 16,970.00 369.00 75.00 30.00 25.00 93.83 TOTAL (Also enter on Fine 9, Recapitulation) i $ 18,220.30 (If more space is needed, insert additional sheets of the same size) Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) sCHEDuLE j COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCETAXRETURNREsiDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Hazel O. Beltzhoover SS# 209-38-2884 01/15/2002 21-02-0069 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT U.S. Treasury - cleared 01/17/2002 1 2 3 4 5 6 7 Check #2989 written 01/12/02, Comcast Cable Continuing Care RX Forest Park Health Center PA Department of Revenue, 2001 Penn Power & Light Co. Sprint Telephone income tax due 375.00 12.73 508.94 2,560.21 150.00 178.55 15.79 TOTAL (Also enter on line 10, Recapitulation) 3,801.22 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, lac. Form REV- 1512 EX (Rev. 1-97) REV* 1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA iNHERITANCE 'FAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hazel O. Beltzhoover SS# 209-38-2884 01/15/2002 21-02-0069 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE '3 4 II. TAXABLE DISTRIBUTIONS [includeoutright spousal distributions, and transfers under Sec. 9116(a)(1.2)] G. Edward Beltzhoover 818 Glenwood Avenue 3oliet, IL 60435 Richard L. Beltzhoover 3659 Brumley Way Carmel, IN 46033 Kay B. Kaylor 19407 North 86th Drive Peoria, AZ 85382 Bonnie B. Kuhns 812 Flintlock Ridge Road Mechanicsburg, PA 17055 Deloris B. Morrow 1833 Spring Road Carlisle, PA 17013 Son Son Daughter Daughter Daughter 1/7 remainder 1/7 remainder 1/7 remainder 1/7 remainder 1/7 remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 1.5 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Estate of: Hazel O. Beltzhoover Soc Sec #: 209-38-2884 Date of Death: 01/15/2002 Continuation of Schedule J, Part I (Taxable Bequests) Item Name and Address of Beneficiary Relationship Amount or Share of Estate 6 Carole Schwartz Daughter 20 Olde Mill Run Medford, NJ 08055 7 Janice B. Waricher Daughter 20 Tunbridge Lane Carlisle, PA 17013 1/7 remainder 1/7 remainder LAST WILL AND TESTAMENT I, HAZEL O. BELTZHOOVER; of the Borough of Cat'lisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make,'- publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix,' as the 'case. may be, tO pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or Payable by reason of my death and interest and penalties' thereon with respect to all property composing of my gross- estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate. TWO. My Executor or Executrix may, at his or her discretion,, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income Without restriction to legal investments unless otherwise provided.hereunder. I authorize and empower my Executor or ExeCutrix to sell · any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in tee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which ! may be engaged at my death,"for'sUch Period of · time after my death as seems expedient to said Executor or Executrix. THREE. I give, devise and bequeath any and all personal effects that I have specifically set forth on that certain Written list Setting forth the name of'Such personal prOperty item and the designated beneficiary, which list is incorporated herein by this reference. The aforementioned list of specific bequests shall be kept with the conformed copy of this, my Last Will and Testament, however, if for Whatever reason no Such list exists or can be found Within a reasonable time after my decease, then in that event, all of my personal. effects and personal.. property shall be and become a part of my 'residuary estate and distributed in accordance therewith. FOUR. I give, devise and bequeath the rest,' residue and remainder of my estate, in equal shares, to my children, DELORIS MORROW,' G. EDWARD BELTZHOOVER, KAY L.' KAYLOR, JANICE M. WARICHER, RICHARD L. BELTZHOOVER," CAROL A.." SCHWARTZ and BONNIE R. KUHNS, share and share alike, per stirpes, which provides that the child or children of any deceased child shall take the share their parent would have taken if living. FIVE. I nominate and appoint my son, G. EDWARD BELTZHOOVER, to be the Executor of this my Last Will and Testament. If my son has predeceased me, failed to qualify or is not able or does not serve for whatever reason,' I 'then appoint my daughter, JANICE M. WARICHER, to be'the Executrix of my estate. In the event that she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, then in her place I appoint my daughter, BONNIE R. KUHNS, to be the Executrix of my estate, whereby bOth substitute Executrices shall have the same powers as the original Executor hereunder. It is my intent in appointing my personal representative as stated above that such individual serve in such a capacity without any consideration or fee being taken by such individual in an effort to fairly and equally distribute my assets between my heirs. SIX. me by sixty (60) days. SEVEN. No person(s) shall benefit hereunder unless such beneficiary shall survive No Executor or Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. EIGHT. No beneficiary may assign or anticipate his Or her interest in any income .. or principal held or distributable hereunder; and no beneficiary's creditors may attach or otherwise reach any such interest. IN WITNESS October, 1997. WHEREOF, I have hereunt° set my hand and seal this .~ ? day of Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set Our names as subscribing witnesses. A CKNO WLEDGMENTAND AFFIDAVIT WE, HAZEL O. BELTZHOOVER, SHARON L. SCHWALM and CHERYL L. CLELAND, the testatrix and witnesses respectively, whose names are' signed to the fbregoing 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 Testament that she had ·signed willingly, and that she executed it as her free and voluntary act for the purpose herein· expressed, and that each of the witnesses, in the presence and hearing of'the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that· time, eighteen years of age or older, of sound nfind 'and under no constraint or undue influence.· . .. · fJHAZEff6. BECZHOOVER SHARON L. SCHWALM' C~rERYL L. CLELAND' ' COMMONWEALTH OF PENNSYLVANIA' COUNTY OF CUMBERLAND '-. SS : Subscribed, sworn to and acknowledged before me by HAZEL O. BELTZHOOVER, the testatrix, and subscribed and swom to before me by SHARON L. SCHWALM and' '" ".i i'': CHERYL L. CLELAND, witnesses, this ,5:~'~ day °fOctober,'1997..' : . - . .' .. .. ' ["- .[ t~/y'~'hblic "' ' Notarial .~al [ Je, cqueline L. Drawbaugh, Notary Public I Carlisle Boro, Cumberland County. ! . . ~,y Commission Expi~'esAug. 14, 1999 1 ' '' Menm-~; Pmr~'ymmAsa~datm of Nam~ .' .' Manufacturers and Traders Trust Company One M&T Plaza, Buffalo, NY 14240 (7!6) 842-4200 Finance Division January 24, 2002 JAN 2 8 2002 IRWIN, MCKNIGHT & HUGH[S James D. HugheS ' Irwin McKnight & Hughes West Pomfret Professional Building 60 West Pomfi'et Street Carlisle, pA 17013 Re: Estate of Hazel O. Beltzhoover .Dear k/Ir. Hughes: 'I would like to confirm the shareholder account containing 3,257 shares of M&T Bank Corporation common stock is registered solelY in the name of Hazel O. Beltzhoover. If you have any additional questions, please feel free to call me (716) 842-593'1. Please note our mailing is: M&T Bank Corporation 1 M&T Plaza Floor 12-Investor Relations Buffalo, NY 14240 Sincerely Arme Frandina Financial Analyst Investor Relations CITIZENS BANK P.O. Box 7899 Philadelphia, PA 19101-7899 January 31, 2002 Law Offices IRWIN, McKNIGHT & HUGHES Attention: James D. Hughes 60 W. Pomfret Street Carlisle, PA 17013 Estate Of Hazel O Beltzhoover Date of'Death: 01/15/2002 SSN 209-38-2884 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-53%5591. For all other inquiries, please call (215) 553-1585. Sincerely, Emel~~gulto Deposit Support Services 199-5355 Page 1 of 2 CITIZENS BANK Account Number Account Title Thursday, January 31, 2002 01249497 Hazel O Beltzhoover Date Opened: Principal Bal as of DOD $39,000.00 1 1/30/2001 Int from Last Posting to DOD $145.55 Account Type: TD Account Bal YTD Int to as of DOD DOD $39,145.55 $44.36 Page 2 of 2 Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 February 14, 2002 James D. Hughes Irwin, McKnight & Hughes West Pomfret Professional Building 60 W. Pomfret Street Carlisle, PA 17013-3222 .. RE: Estate of Hazel O. Beltzhoover SSlN 209-38-2884 FEB t 6 ,...uuc Dear Mr. Hughes, Enclosed is the information requested in your letter of January 18, 2002 regarding the accounts held with Members 1st by Hazel Beltzhoover. Please provide instructions for closing these accounts. Please do not hesitate to contact me at 795-5131 should you have any questions or require additional information. V ~uly yours Denise A. Andbrs'----" Insurance Products Supervisor Enclosure Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Certificate Purchased Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 202751-00 03/09/2001 $25.00 $.oo $25.00 None 202751-05 09/04/2001 $33,236.39 $27.79 $33,264.18 None 202751-40 1YR 03/09/2001 $25,000.00 $56.00 $25,056.00 None ~BERS 1 ST..~EpE~CRJEDiT b~dON Denise A. Anders Insurance Products Supervisor February 14, 2002 Estate of: HAZEL O. BELTZHOOVER Date of Death: 01/15/2002 Social Security Number: 209-38-2884 y# wag LOOK FOR US. WE'LL GET YOU THERE. 01/22/2002 IRWIN MCKNIGHT & HUGHES 60 WEST POMFRET ST CARLISLE PA 17013 The information which you requested on the account(s) of HAZEL BELTZHOOVER DECEASED (Social Security Number 209-38-2884) is/are as follows: Account Number 1766240259 Class of Account' CERTIFICATE Date Opened 08/17/93 Principal Balance 18000.00 AccrUed Interest 36.80 Balance at Date of 18036.80 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership ' Was Established Account Number Class of Account Date Opened Principal Balance AccrUed Interest Balance at 'Date of Death Account Ownership . Name of Joint Owner, if any Date Ownership Was Established 8000039735 8000044207 8000045381 . CERTIFICATE CERTIFICATE CERTJFICATE 12/24/97 07/07/98 09/25/98 30000.00 15000.00 28000.00 68.35 33.31 67.77 30068.35 15033.31 28067.77 SOLE SOLE. SOLE Additional Information Requested PLEASE COMPLETE w-g Sincerely, KATHYd'YZ) UNCd SENIOR SERVICES REP. RO. Box 171 I, HARRISBURG, PGNNSYLVANIA 17105-1711 Toll I=rG~ I-R66-WAYPOINT (I-866-9E~9-7646) "wWW.wagpointbank.com January 31, 2002 RE: Estate Search The Estate of: Date of Death (D.O.D.) To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: HAZEL O BELTZHOOVER 1/15/2002 Account Account Number Account Title Type Opening Branch CHK 402796 OPENED 9/67 HAZEL O BELTZHOOVER 4319 D.O.D. Accrued' Interest Balances (Includes Accr. Int.) $8,064.41 $.00 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description .. :-~..;~ - NO Safe Deposit Box titled in the Decedent's name existed at our office. If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION BY: Authorized Signature DATE: Manufacturers and Traders Trust Company · 1100 Wehde Drive, RO. Box 767, Buffalo, NY 14240-0767 Inventory Of the real.and personal estate of 'HAZEL O. BELTgHOOVER deceased 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 3,257 Shares M&T Bank Corporation - Traded on the NYSE - Common ...... Citizens Bank - Account #01249497 ' M&T Bank - Checking'Adcount #402796 .................... Members 1st Federal Credit Union - Regular Savings Account #202751-00. . Members 1st Fede~'a)_'?Credit Union - Investments Savings Account #202751-05. Members 1st Federal Credit Union - Certificate of Deposit #202751-40 . . Waypoint Bank- Certificate #1766240259 ................ ,.. Waypoint Bank- Certificate #8000039735. . . . . . . ;~ .............. . . . . Bank Certificate ,a~Fo~n~ - #8000044207 ....... ; ,~,.~ ,,. Waypoint Bank -,.~ Certificate #8000045381. BC/BS Premium Refund ' . ......... Hooke & Suter - Security Deposit Refund. . ' ............ ' .... Miscellaneous Personal.Property/Household Goods .............. 'TOTAL .... · ......... , .... 244,014 44 39,145 55 .~,064 41 25 '00 33,.264 18 25,056 00 18,036 80 "'~0,068 35 ~5,033 31 067 77 9o 307 43 1,000 00 442,308 14 COMMONWEALTH OF PENNSYLVANIA"' COUNTY OF CUMBERLAND G. Edward Beltzhoover b~ingi dul~ ~ ' ,' of the-Estate of Hazel O. Beltzhoover ~ate of the Borough of Carlisle , Cumberla.d Cou.~y, Pa.. deceased and that the wlfhin is an inventor~ made by G. Edward Bettzhoover .... , the said Executor of the entire estate of sa~d decedent, consisting of all the personal property and real estate, except real estate outside the Comn~onweaLf. h of Pennsylvania, and tha't the figures'opposlte ~ech' item of the Inventory represent it's felt value · sworn - -' "accordln~ tb law, deposes and ~ays'-tha"t~' '~ ~'is t~he~ExecU't'o~' :"-~ ''" "':':-"' :' C..Edward Bel~tZ-Ho-o~[Kxecu~r 818 Glenwood Avenue. Joliet, IL 60435 Address 2002 as of the date of decedent's death. Sworn. _.'r~; .'' and. subscribed, before me,' · this/~ /~/~'~a¥ o~cil, ~2002 ! l,V - I I v I Jacquclinc L Dmwbau~, No~ ~blic I Date of Death 2. 3. 4. Day Month Year INSTRUCTIONS ,. An inventory mu~st °be° filed within three months after appointment of personal 'representative. A supplement inventory must be filed within thirty days of dlscov~.ry of addition~l assets. Additional sheets may be attached as to personalty or realty See Article IV,, Fiduciaries Act of 1949. , I--- --I Z . ~ < 0 Z o o ~ "~ Z ,,, < BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX D'rvIsI'ON DEPT. :~80601 HARRZSBURG, PA 17128-0601 JANES D HUGHES ESQ IRWIN ETAL 60 W PONFRET ST CARLISLE .CUT ALONG THIS LINE ~ CONHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX Recoi'cied ,.'2:i,.,.;t of '02 JUN 1D A8:07 DATE ESTATEOF DATE OF DEATH FILE NUMBER COUNTY ACN I 06-0q-2002 BELTZHOOVER 01-15-2002 21 02-0069 CUMBERLAND 101 Aaount Remitted I REV-l;47 EX AFP ('01-02) HAZEL 0 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-0:~) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF RELTZHOOVER HAZEL 0 FILE NO. 21 02-0069 ACN 101 DATE 06-0q-2002 TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 0RIGINAL RETURN 1. Real Estate (SchaduZe 'A) (1) 2. Stocks and Bonds {Schedule B) (2} $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/MAsc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (~0) 11. Total Deductions Not Value of Tax Return 2qqzOlq.~ .00 198~295.70 , .00 .00 NOTE: To insure proper credit to your account, ;subaA* the upper port/on .00 of this form with your tax payment.. .O0 (8) 18,220.30 15. lq. NOTE: ~2,$08.1~ S~801.22 (11) 22.02].52 (12) ~20,286.62 Charitable/Govarnaental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Net Value of Estate Sub~act to Tax (1~} q20,286.62 Tf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that include the total of ALL returns assessed to date. (1.;), .00 X O0 = .00 (16) R20,286.62 X 0~5= 18,912.90 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 18,912.90 ASSESSMENT OF TAX: 15. Aaount of Line 1~ et Spousal rata 16. Aaount of LAne 1~ taxable at Lineal/Class A rate 17. Aaount of LAne 1~ at Sibling rata 18. Amount of Line 1~ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS:' PAYMENT I RECEZPT DATE NUMBER 0~-15-2002 CD001069 ZF PAID AFTER DATE /NDZCATED~ SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. AMOUNT PAID DISCOUNT (+) INTEREST/PEN PAID (-) 9q5.65 17,967.26 TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 18,912.91 .01CR .00 .01CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADHIH- ISTRAT[VE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates o~ decedents dying on or before December 1Z, 198Z -- if any future interest in tha estate iS transferred* in possessionor enjoyment to Class B (collatoral).baneficiaries of the decedent after the expiration of any estate for life or for years, the Commoneealth hereby axpressly reserves the right to appraise and assess transfer Inheritance Taxes at fha lawful Ciasa B (collateral) rate on any such future intarest. To fulfill the raquiramants of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of 1000. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with y~ur payment to tha Registar of Nills printed on the reverse side. --Hake chock or money order payable to: REGISTER OF HILLS, AGENT A ra~und of a tax credit, mhich mas not requested on tha Tax Return, may bo requested by completing an "Application for Rafund of Pennsylvania Inharitance and Estate Tax" (REV-1515). Applications ara availabla at tha Office of the Register of ~i118, any of the Z$ Revenue District Offices, or by calling tha special Z4-hour ansaering service ~or forms ordering: 1-800-$61-Z0505 services 'for taxpayers with spacial haaring and ~ or speaking needs: 1-800-447-$010 (TT only). Any party il intarast net satisfied mith tho appraisement, alloaanca, or disallowance of daductions, or assassment of tax (including discount, or interest)' as shown an this Notice must object mithin sixty (60) day~ of race]pt of this Hotica by: --aritten pretest to the PA Department of Revenue, Board of Appeals, Dept. Z81OZ1, Harrisburg, PA 17128-lOZ1, OR --election tb have tha 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 mritin9 to: PA Departmant of Ravenua, Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit~ Dept. 280601, Harrisburg~ PA 17118-0601 'Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REVx1501) for an explanation of administrativaly correctable errors. If any tax due i~ paid aithin three (5') calendar months after tha dacedant's death, a riva percent (51) discount of .the tax paid is allowed. . The 15Z tax amnesty non-participation penalty is computed an tha total of the tax and intarast assessed, and not paid before January 18, 1996, tho first day after the and of tha tax amnasty period. This non-participation panalty is 'appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning mlth first day of delinquency, or nine (9) months and one (I) day from tha date of death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of six (67.) percent per annum calculatad at a daily rate of .000164. All taxes ahich became dalinquent an and altar January 1, 1982 will bear interest at a rate mhich mill vary from calendar year to calendar year eith that rate announced by the PA Dapartmant of Revenue. Tho applicable interest rates for 1982 through 2002 are= Daily Interest Factor Year Interest Rate Daily Interest Factor .000548 1991 97. .000247 .0004~8 1995-1994 77. .000192 · .000S01 1995-1998 91 .000147 .000~56 1999 71 .000192 .000274 ZOO0 81 .000219 .O00~Ol 2002 6X .00016~ X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR Y~ar Interest Rate 1982 ZOZ 198~ 161 1984 111 1985 ISZ 1986 IOZ 1987 97. 1988-1991 111 .--Interest is calculetad as follows: INTEREST = BALANCE OF TAX UNPAID --Any*Notice issued after tha tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond fha date of the assessment. If payment is made after the interest computation date sheen on the Notica, additional interest must be calculated. STATUS REPORT uNDER.RuLE 6.12 Name of Decedent: Date of Death: No. 21-02-0069 HAZEL O. BELTZHOOVER January 15, 2002 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: X Yes __ 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. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: Date: c. Did the personal representative state an account informally to the parties in interest? X Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the CI~(~ Orphan's Court and may be attached to this repo~.~~7~ .... ~ [ IR~, Mc~IGHT & ~GHES ~' '~ 7.. ~ ~mes ~ Hughes, Esquire ~ .~ _: ~ Name (please ~pe or print) 60 WeSt Pomfret Street Address Carlisle, PA 17013 City, State, Zip (717) 249-2353 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: REAGER & ADLER PC 2331 MARKET STREET CAMP HILL, PA 17011 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002355 fold ESTATE INFORMATION: SSN: 175-18-7213 FILE NUMBER: 21 03-0069 DECEDENT NAME: KELLY JENNIE A DATE OF PAYMENT: 03/28/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 01/12/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $ 16,000.00 I TOTAL AMOUNT PAID: $1 6,000.00 REMARKS' JACQUELINE M CONRAD C/O REAGER & ADLER PC SEAL CHECK//112 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS