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03-0594
PETITION FOR PROBATE and GRANT OF LETTERS Estate of Narlin R. Cornman No. ,~] '-f) j~--~"~ ~ also known as To: ~ Deceased. Social Security No. 200-21! Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor in the last will of the above decedent, dated May 10, and codicil(s) dated November 17, 1997 in the named' ,19 93 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with lis last family or nrincipal resicl, ence at ~ York Circle, Mechanicsbure Silver Spring Township) Cumberland County, P~nnsylvania. - (list street, number and muncipality) Decendent, then . 72 years ofag~, di,ed July 18~ ,:~t~ 2003, at Holy Spirit Hospital, ~as~ Pennsboro Township Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ l~O, 000. O0 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 1.70.. 000.00 situated as follows: House arid Lot of Ground. at 3 York Circle~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Tes tame nt (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron,r// ,G~eg A. Cornman 28~4 East Berlin Road York: PA 17~! Oh' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF Cumberland ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are tt ra¥ievea(l~ o?~rheeCtatb~vtehedeb~i~nft tpheet~t~lo°%lr~s?ew~l~ldwebl~lifnff~ Peru;it~~eastt aatSePfjcSo°rnE~/;tP~elSfwn~ ~f~mteOth~ af~[[nl~d and subsjarib~ ~ ~'~~. ,%7) c/ Donna M.Otto;/st-D~u%y '- /~--~/! Regt~t~r-~,y ~ NO. 21-2003-594 Estate of MARLIN R. CORNMAN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 24th, Jl~ 2003_ 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 May 10, 1993 described therein be admitted tO probate and filed of record as the last will of Marlin R. Cornman ; and Letters are hereby granted to Testamentary Greg A. Cornman FEES Probate, Letters, Etc .......... $ 305.00 Short Certificates(6) .......... $. 18.00 B~a~i~c~x. Codicil ...... $ 10.50 x-Pages (5) $ 15.00 JCP TOTAL __ $ ~'-~ Filed Ju,l,y.. 2.4.t.h., g.0.0.3 .................. Donna M. Otto, 1st Deputy J. Robert Stauffer ATTORNEY (Sup. Ct. I.D. No.) Market Square Bldg. Mechanicsburg, PA 170~5 ADDRESS 717-766-9673 PHONE Mailed letters to Attorney on 7/24/03 his is to certif? that the information here given is correctly copied from an original certificate of death duJy filed with me as I,ocal R<gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent dling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee fi)r this certificate, $2.00 P 9331502 No. Loc~i ~Registrar d -7 /' 'Dat~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH , Marlin R. Cornman , Male ~ -- -- , - - - 200 24 0294 · old~ If, , 72 ,,,[ { I k10/24/1930L~mI .... [] ..~.,..o ~E~ I~-~m ,~. :] ,,,. ~,~ ~[uJ Im ~l~cs 1,~ '--- .. 1~"'~' ("-~- I 3 York Circle l~,u~ ,,..~. Pe~sylv~ia ,,.~ ~.~ Sil~r Spring ,t ~cs~, PA 17050 ~) ,m.~ ~1~ ~? ,M.S ~. Patricia L. ~ffney .... ~ 921 ~ Argue Tal~dge Ohio 8~ c .... ~ ~.--~.,.~ I~-~.~, .~ ....... ~ .... ~ I ~h,m¢~ ~_ I,,,. July 22, 20_03 ~,~cs~q ~te~ [ .... Mechanicsbur . PA m. t ~../t/~ h,.'~-014889 [, ................ ~ ~' ~~ ...... --t'~ .............. ~.*.,ObSV' ~V~S ]~.ER~ ....... ~ ........ ' ............................. ~ ........ - ....................... .............-----,'' .... I-.. - l---I-T-'---' .... ~ / I~,~ El ..~,. L]I i~ 0 ~0 [ ~ ................................ ~,~. //%- _ . - ,/ --~,. _ ............................................................. u ,, ~- ~4 /~:/'~ 21-2003-594 CODICIL I, MARLIN R. CORYDON, of the Township of Silver Spring, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this the First Codicil to my Last Will and Testament dated May 10, 1993. In the event that my son, GREG A. CORN~N, should predecease me, or should he be unable to serve as Executor of my Last Will and Testament for any reason, then in such event, I nominate, constitute and appoint my two (2) daughters, PATRICIA L. GAFFNEY and MELINDA K. WOOD, Co-Executrices of this my Last Will and Testament, in his place and stead, and in all instances, I direct that my said personal representatives be excused from posting bond or other security for the faithful performance of their duties in any jurisdiction. I hereby ratify and confirm my Last Will and Testament, dated May 10, 1993, in all other respects and to all intents and purposes, not inconsistent herewith. -1- IN WITNESS WHEREOF, I have hereunto set my hand and seal this ....~/ day of November, A. D., 1997. (SEAL) Signed, sealed, published and declared by the above named, MARLIN R. COR~N, as and for the First Codicil to his Last Will and Testament, in the presence of us, who have subscribed our. names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. -2- COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, MARLIN R. COR}~I~AN , the testat or whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as a Codicil to my Last Will and Testament dated May 10~ 1997 ; that I signed it willing- ly; and that I signed it as my free and voluntary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before me~ I'!ARLIN R. CORNMAN , the testat , this/ day of /~~ , A. D. 1997. No't ary ~ubli e COMMONWEALTH OF PENNSYVLANIA ) : SS. COUNTY OF CUMBERLAND ) We, the undersigned, SUSAN A. McCOY and J. ROBERT STAUFFER , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator , I'fARLIN R. COR~q't~N , signed and exe- cute the instrument as a Codicil to h~s/~ Last Will and Testament; that the said testat or , MARLIN R. CORN[tAN , executed it as his~.X free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testator , signed the Codicil as witnesses; and that, to the best of our knowledge, the testatOr was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribe3~o before me 'this /~//~ day of November , 1997. -3- :~R~I:~ R. CORI%iAN CODICIL j. ROBERT STAUFFER ATTOP, NI~Y AT LAW Maamz~ S~}u~m~ BUVY.D~NO MECHANICSBURG, PA. 17055 LAST WILL AND TESTAMENT OF M~RLiN R. CORNMAN I, ~IARLIN R. CORI~N, of the Township of Silver Spring, County of Cumberland and State o£ Pennsylvania, being of sou_nd and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. e I give, devise and bequeath all the rest, residue and remainder of ray estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my wife, ALTHEA R. CORNMAN, absolutely and unconditionally. In the event that ray wife, ALTHEA R. CORNMAN, should predecease me, or should she die within thirty (30) days from the date of my death, then in either such event, I give and bequeath my entire estate, of whatsoever nature and wheresoever the same may be situate, to my three (3) children, to wit, PATRICIA L. GAFFNEY, MRT,INDA K. WOOD and GREG A. CORI~t~N, share and share alike, per stirpes. -1- LASTLY, I nominate, constitute and appoint my wife, ALTHEA R. CORNMAN, Executrix of this my Last Will and Testament, and in the event that r~y said wife should predecease me, or should she be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, GREG A. CORNMAN, Executor of this my Last Will and Testament, in her place and stead, and in either instance, I direct that my said personal representative be excused from posting bond or other security for the faithful performance of their duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /~· day of May, i. D., 1993. Marii~ R. Cornman -2- Signed, sealed, published and declared by the above named, MARLIN R. CORNMAN, as and for his Last Will and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. -3- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS, I, MARLIN R. COR~rMAN , the testato~ whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrumenu as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before me by IfARLIN R. CORIYMAN , the testat O1~ , this /~ ~ day of May , A. D. , 1993. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ? / : SS. ' ) We, the undersigned, [[. ROBERT STAUFFER and ~i~IRII~ Y,o Y,~'VEI~t-IAG~.N , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testatO~ , P~LIN R. O0~N , sign and exe- cute the instrument as his.~ Lz~s~ WJl. 1 and Testament; that the said testato~ ~ ~L~ R~__ O0~__ , executed ~t as his~ free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testato~ , signed the Will as witnesses; and that to the best of our knowledge, the testatO~ was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and s~,~ibed to me this /'~7' . day of ~'- ~ ~~ - -'~ LAST WILL AND TESTAMENT OF lv[ARLIN R. COR~AN J. ROBERT STAUFFER ATTOP. T~Y AT LAW M~.x~T S~u~uu~ Bumnmo MEGHANIGSBURG, PA. 17055 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) MARLIN R. CORNMAN Date of Death: July 18, 2003 Will No. 2003-00594 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address GREG A. CORNMAN - 2834 East Berlin Road, York, PA PATRIC IA L. GAFFNEY - 921 Ashmun Ave. s Tallmadge, July 29, 2003 : 174o4 ohio 44278 I~ELINDA K. WOOD - 12905 Tarragon Courts Oak Hills Virginia 20171 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N o ne Date: July 29, 2003 Name J. Robert Stauffer Address Market Square Bldg. Mecharricsburg, PA 17055 Telephone (717-766-9673 Capacity: Personal Representative X Counsel for personal represeutative COMMONWEALTH OF PENNSYLVANIA DE~'ARTMENT 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 003759 STAUFFER J ROBERT MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 200-24-0294 FILE NUMBER: 2103-0594 DECEDENT NAME: CORNMAN MARLIN R DATE OF PAYMENT: 04/05/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,111.64 R!EMARKS: SEAL GREG CORNMAN CHECK# 1058 TOTAL AMOUNT PAID: $15,111.64 INITIALS' VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER o COUNTY CODE YEAR NUMBER uJ I- Z lU C~ Z O u.I n~ n,, O DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CORNMAN, Marlin R. DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-DO-YEAR) July 18, 2003 J October 24, (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 20o - 24 -o294 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1930 REGISTER OF WILLS SOCIAL SECURITY NUMBER ~-]1. Original Return --]4. Limited Estate ~]6. Decedent Died Testate (A~ch copy of Will) El9. Litigation Proceeds Received [-]2. Supplemental Return E~4a. Future Interest Compromise (date of death after 12-12-82) El7. Decedent Maintained a Living Trust (A~ch copy of Trust) ~]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) NAME J. Robert Stauffer, Atty. FIRM NAME (IfApplicable) TELEPHONE NUMBER 717-766-9673 --]3. Remainder Return (date ofdeath prior Io 12.13-82) -'-]5. Federal Estate Tax Return Required ~. 8. Total Number of Safe Deposit Boxes [--]11. Election to tax under Sec. 9113(A) (Aftach Sch O) COMPLETE MAILING ADDRESS Market Square Bldg. I West Main St. Mechanicsburg, PA 17055 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) F-'I Separata 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 Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 140,000.00 58.329.53 o.o0 OoOO 3:1,74o.64 O.00 z4z,23o.oo (8) OFFICIAL USE ONLY , .'iD 371,300.17 35,374.69 O. 00':::' (11) 35,374.69 (12) 335,925.48 0.00 (13) (14) 335,925.48 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax O O "" rate, or transfers under Sec. 9116 (a)(1.2) __ x .0 (15) U. 16. Amount of Line 14 taxable at lineal rate 335,925 x .0 45 (16) 15,111.64 17. Amount of Line 14 taxable at sibling rate __~O x.12 (17) O,OO 18. Amount of Line 14 taxable at cellateral rate __.___.~O x .15 (18) O. OO 19, Tax Due,~ (19) 15,111.64 20. i-~ ' ' ' ' 'Sl ,' ' t 2 3 4 5 7 12 :3 i$ 19 20 23 27 28 29 31 32 34 35 36 37 38 39 40 4t 42 44 46 47 49 52 63 64 $8 69 ~' ~ STANI)ARD AGREEMENT FOR TIlE SALE OF REAL ESTATE ,s nrta r¢co,mm,d2-d and approved for. but not leSlrictcd to use by. the mrmbcls of thc Pin ~ va,ia Associalhm of RE^ .TORS® (PARt. A/S-2K SI~,]A.,ER'S BI~SINESS~I,ATIONSIIII, WITll PA LICENSEi) BROKER - ............ B OR ....... ~ ~ ~ -_~ FAX~ ROKER IS ·FILE AGENT FOR SELLER/b~Ign~t~ Agent(s) for ,Seller, ff upFli~able:. Broker Is NOT lite Agent for Seller and is ~nn: ~ AGENT FOR BUYER ~ T~NSACTION LICENSEE iBT~YE~'S Ii USINE,,~,,~,,~,,~,,~,,~,~S REI~,ATLO. NSII~,.?ITi I PA LICENSED BROKE OR S IIH, AGLN, FOR BDYER. Des,.mued Agent(g)far Buyer, if ul,p~:~ ~ ' .... Ilrnker ,s NO I lira A~¢nl for Bn~¢r and ,s tiaa ~ A(,ENI FOR SELLER ~ SUbteEN I FOR ~I.LER ~ TRANS~CTION LICENSEE When Ihe sfime Itrnker Is Agent for Seller and Agenl for Bayer, Brnker Is. I)nnl Agenl. All nr Brnker'n licensees are also Dual Agen~ UNL~ ' the~ a~ separate Designnfed Ageuts for Buyer and Seller. If the same Licensee Is designated for Seller and Bnyer, the Llce~ee ~ a Dual Agent. SELLERIS): (~-~ &.~z~.~ , Is betw~n 2. PROPERTY (i-O") Sd(er he,by n,r~ to ~ll~q~on,ey to Buyer. who h, rehy ALl. I'IIAT CERTAIN lot or piece of g~und wl~ bulldogs and Improvemen~ Ihe~on e~cled, 3. (A) Purchase Price ~ which will be paid to Seller by Buyer as follows: I. Cash or check at signing Ibis Ag~efnent: 2. Cash or check within . days of the execution of this Ag~ , $ 3. ' - Cash, cashier's or cc~ifiod check at time of settlement: Dc s ' (Bt ~. its paid oft account of pu~hase price to ~ held by Broker for ~ere: (D) Selllemeallo~on ~~ ~ ~0~ (E) Conveyance from Seller will ~ by fee simp~eed of ~cial wananty unless otherwise slated here: (F) Payment of transfer taxes will be divided equally between Bayer afid Seller unless otherwise stated here 31 (G) Al time of settlement, the following will be adjusted pro-rata on a daily basis between Buyer and Seller, reimbursing where applicable: taxes 32 (see Informfllion Regard ng Tax Proration)' rents; interest on mortgage assumptions; condominium fees and homeowner association fees, if 33 tiny: water and/or sewer fees. if any, Iogelber will) any other Item)hie municipal service. The charges are to be pro-rated for the period(s) 3,1 covered: Seller will pay up to and including the date of settlement; Buyer will pay for all days following settlement, unless otherwise stated as 3~ 4. FIXTURES & PERSONAL PROPERTY (1-00) ,v 38 lA) INCLUDED in this sale and purchase price are all existing items permanently installed in the Properly, free of liens, including plumbing; 3~ heating; lighting fixtures (including chandeliers and ceiling fans); water treatment systems; pool and spa equipment; garage door openers 40 and transntitters: television antennas', shrubbery, plantings and unpolted trees; any remaining heating and cooking fuels stored on the 41 Property at thc time of settlement; wall to wall carpeting; window covering hardware, shades and blind~/buiJt- n air conditioners; ~built-Jn 42 applia_.~.?nd th.c.r~n~e/ .... .unles~ otherwise stated. A~so included: /~'~-4~Cq~'~'t~'~'~-~'l '~t .' ~ \~-~- -/--~ - ',..~ ~ (Bt LEASED ilelns (not owned by Seller): lC) EXCLUDED fixtures and items: 5. DATES/'ITME IS OFTHE ESSENCE (1-02) 47 48 '- 49 (At The said date for settlement and all other dates and times referred lo for thc performance of any of the obligations of this Agreement are So agreed to be of the essence of this Agreement and are binding. SI (Bt For the purposes of Ihis Agreement, number of days will be counted from the date of execution, by excluding the day this Ag~ement was s2 executed and ificludiflg the last day of thc time period. 53 (Ct The date of settlement is not extended by any other provision of this Agreement and may only be extended by mutual written agreement of 54 the parties. (D) Certain time periods ar/~-printed in this Agreemenl~as a convenience to the Buyer and Seller. Any p!e-printed time periods ate ne oliable SS and may be,;~/yking, out the pre-printed text and inserting a different time period acceptable Io all phrties, g $~ [l~ REALTORSe COPYRIGHT PENNSYLVANIA A~OCiATION O~' RE<OR~ ~0] IF TAXES ARE IN ESCRO,W, FORWAHD TO MORTGAGE CO. $1.00 FEE FOR'ADDITIONAL RECEIPTS PAYABLE TO: DESC: DEBRA BASEHORE WIEST 269 WOODS DRIVE MECHANICSBURG, PA 17050-2635 MAP NO: 38-22-0144-081 3 YORK CIRCLE ACRES .780 BRANDYWINE VILLAGE LAND Residential Building RESIDENTIAL TAX PAYER CORNMAN, MARLIN R & WIFE 3 YORK CIRCLE MECHANICSBURG PA 17050 TAXPAYER COPY Bill No: 8 Control No: 038- 004105 2004 Statement of Real Estate Taxes Bill Date: 3/01/; Assessed Land I Improvement Mineral Total Values 27,260I 112,940 0 140,200 COUNTY OF CUMBERLAND Discount Face Pen Rates .00214900 .00214900i 2 % COUNTY R/E 58.58 242.71 295.26 301.29 33 Rates .00020300 .00020300 2 % COUNTY LIB 5.53 22.93 27.89 28.46 3 TOWNSHIP OF SILVER SPRING Rates .00065600I .00065600 2 % MUNIC. R/E 17.$8l 74.09 90.13 91.97 10' TAX AMOUNT DUE > $41a.28 $421.72 $463. If Paid On or After 3/01/2004 5/01/2004 7/01/ If Paid On or Before 4/30/2004 6/30/2004 IF NOT PAID BY 12/15/2004 THIS BILL WILL BE RETURNED TO TAX CLAIM BUREAU FOR COLLECTION AND FILING OF A LIEN AGAINST YOUR PROPERTY. OFFICE HOURS: MON & WED 9-5 *CLOSED HOLIDAYS* OPEN 4/22, 4/29 5-7PM & 4/30 9-5 APPTS AVAILABLE,CLSD 4/12 & 5/24 PHONE: (717)697-1294 Return Bill with Payment. For a Receipt, Enclose Self Addressed Stamped Envelope. tx+ (lzes) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER 21-03-0594 CORneliAN 20O3-OO594 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH ALL THAT CERTAIN parcel of land, together with the improvements thereon erected, situate in the Town- ship of Silver Spring, County of Cumberland and state of Pennsylvania, bounded and described as follows: BEGINNING at a point in the center line of the Old Hogestown Road, at the southeast corner of lan8 now or formerly of Charles W. Stoner and wife; thence along the center line of said Old Hogestown Road, South 02 degrees 45 minutes East 217 feet to a point in the center line of said Road where it intersects with the center line of another public township road; thence along the center line of said last mentioned public township road, South 75 degrees 40 minutes West, 123 feet to a point in the eastern right-of-way line of the new Hogestown Road (L. R. 416); thence along said eastern right-of-way line o~ the new Hogestown Road (L. R. 416), North 27 degree~ 45 minutes West, 2~4.8 feet to a stake in the line of land now or formerly oF Charles W. Stoner and wife, aforementioned; thence along the line of said land now or formerly of Charles W. Stoner and wife, North 77 degrees l0 minutes East, ~1~.05 feet to a point in the center line of She old Hogestown Road, aforementioned, at the point and place of BEGINNING. CONTAI~NG 0.83 acres. HAVING thereon erected a single family brick dwell- ing presently known and numbered as ~ York Circle, Mechanicsburg, PA. BEING the same premises which William H. Hellinger and Anna. L. Hollinger, his wife, by their Deed dated July 14, 1961 and recorded in the Cumberland County Recorder's Office in Deed Book "G", Volume 2~ Page 295, granted and conveyed unto Marlin R. Cornm~ and Althea R. Cornman, his wife. The said Althea R. Cornman died on the ~2~day of ~ ~ ~¢~q , i~?y ~ Whereupon sole title in said Premises vested in Marlin R. Cornman by right of survivorship, whose estate is reported herein. Assessed for year 2004 at $140,200.00. Under contract of sale to Wesley L. Cook and Teresa R. Wills, for $140,000.00. Property was to be settled for on February 27, 2004, but did not transpire due to fact that pipes burst and there was considerable damage to plumbing and flooring. See copy of tax bill and contract of sale. TOTAL (Also enter on line 1, Recapitulation) n 140,000.00 140,000.00 (If more space is needed, insert additional sheets of same size.) COMMONWEALTH OF PENNSYLVANIA INNERITANCE TAX RETURN RESIDENT DECEDENt SCHEDULE B STOCKS & BONDS ESTATE OF ,~"U1RI, IN R. C0t'lhU.'L'iN PAGE ~ 1 FILE NUMBER 21_O3_O594 2o0.3-00594 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIP] ION 1. Series EE Il. S. Savings Bonds registered in the names of Marlin R. Cornman or Althea R. Cornman. Althea R. Cornman predecease8 Marlin R. Cornman, having died R94~06~0~EE issued 01-1993. R9386~OZ6E'g issue~ 02-1993. C417~63907EE issued 0~-1993. C417~63909EE issued 0~-1993. C~1.17~63910EE issued 0~'1993. C~1.17~63911EE issued 0~-1993. C433230981EE issued 08-1993. C433230980EE issued 08-1993. C433230979EE issued 08-1993. " C]$33230978EE issued 08-1993. C433679899EE issued 09-1993. C433679898EE issued 09-1993. C433679900EE issued 09-1993. C434088927EE issued 10-1993. C434088926EE issued 10-1993. C4347~3169EE issued 11-1993. C434753168EE issued 11-1993. R74348367EE issued 08-1991. H74349276E~ issued 09-1991. R74~06183EE issued 10-1991. R74~0740~EE issued 11-1991. R74~07982EE issued 12-1991. R74723691EE issued 01-i992. R7472;$232EE issued 02-1992. R7472~037EE issued 03-1992. { -;1 t 7l 7260 ~f,E 04-1992 ~ 4. issued R74726731EE issued 05-1992~ R75087803EE issued 06-1992. RT~089317EE issued 07-1992. RT~090319EE issued 08-1992. RT~091287EE issued 09-1992. Ry~l13986EE issued 10-1992. RT~ll~0~IEE issued 11-1992. RT~l16099EE issued 12-1992. Rl10648742EE issued 03-1994. RllO648741EE issued 03-1994. C4474~4647EE issued 12-1993. C~7454646~ issued 12-1993. CM~7454645~ issued 12-1993. 2. 337 shares of common stock of E. I. DuPont Nemours & Company at $42.14 per share. 3. 1~0 shares of co~on stock of Weis Markets, Inc., at $32.28 per share. 2 TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 186.08 18o 80.28 80.28 80.28 79.08 79.O8 79.08 ~79.08 79. O8 79.O8 79. O8 79.O8 79. O8 197.36 197.36 197.36 197.36 197.36 197.36 191.68 191.68 191.68 191.68 191.68 191.68 186.08 186.08 186.08 186.08 186. O8 154.48 15~.40 7~8.40 7~ .40 78.4© 14,201.18 (If more space is needed, insert additional sheets of lhe same size) COMMOHWFAI III ()F PEIII,IgYLVAHIA INIIERIIAHCE IAX RFIURN RESIDENI Dt2CEDEN 1 SCHEDULE B STOCKS & BONDS ESTAI'E OF MARLIN R. CORYDON PAGE FILE NUMBER 21_03.0594 ~oo3-oo59N All properly joi~llly-ow, led with rlgh! of smvlvo[shlp re.st I~e disclosed o. Sched.le F. II'EM NUMBER DESCRIP I loll 3,015.217 shares of Blackrock FDS Government Income Port CL B stock at $11.28 per share. TOTAL (Also enter on II.e 2, Recapilulallon) VALUE AT DATE OF DEATtl 33,921.19 $ 58,329.53 · ~ ',,.' RECEIVED BY' ) CONS GNOR'S NAME '~ ~ `-% '~- ~ ~ ,t Jp~ONE CONSIGNMENT CONTRACT AND SETTLEM~'NT ZIP CODE SHEET # OF TOTAL SHEETS I (consignor) hereby commission you to sell the items listed above & on the altached sheets to the highest bidder by public auction. I certify that I am the owner of the above listed items and have good title and lhe right to sell them. I certify that the items listed are free from all incumbrances I agree to accept all responsibility for providing good title and for del very of title to the purchaser. II is agreed that the consignee is not responsible for the loss of any item due to fire, theft, damage, etc. I understand that a % commission will be deducted from the gross sales of my items. "No Bid" items will be disposed of at the discret on of the Auctioneer/Auction House. Payment will be made to the consignor within days from date of sale. · Date Consignor Signature Date Auctioneer/Auction Staff Signature $ TOTAL EXPENSES NET PAYABLE TO CONSIGNOR CONSIGNOR'S SETTLEMENT COPY ADDRESS PHONE / I"U I tt~-~~- RECEIVED BY: LiDATE ,,; CONSIGNOR'S NAME ZIP CODE SHEET # OF TOTAL SHEETS EXPENSES: I (consignor) hereby commission you to sell the items listed above & on the attached sheets to the highest bidder by public auction. I certify that I am the owner of the above lisled items and have good title and the right to sell them, I certify that the items listed are free from all incumbrances, I agree to accept al/responsibility for providing good title and for delivery of title to the purchaser. It is agreed that the consignee is not responsible for the loss of any item due to fire, theft, damage, etc. I understand that a % commission will be deducted from the gross sales of my items. "No Bid" items will be disposed of at the discrelion of the Auctioneer/Auction House. Payment will be made to the consignor within days from date of sale, Date Consignor Signature Date Auctioneer/Auction Staff Signature __ % COMMISSION SES CHECK NO' [~ ,t~NET PAYABLE TO CONSIGNOR CONSIGNOR'S SETTLEMENT COPY AUG-l~-~00~ ~:~? PNCBq~K ~1~ ?68 ~58 P.01 PNCBA K August 14, 2003 J Robert Stauft~ 1 W Main St Mechanicsburg, Pa 17055 Scp RE: Estate of Marlin R Comman (Deceased) SSN: 200-24-0294 DOD: 07/18/2003 Dear Mr Stauffer: In response to your roquest for Date of Death balances for the customer noted above, our records show the following: Checking Account Account#5070078009 Established 01/01/1979 MARLIN R CORNMAN DOD balance: $6,576.00 + $0.10 accrued interest Interest earned 01-01-03 thru 07-18-03 $3.65 YTD Savings Account Account#5030000784 Established 01/01/1979 MARLIN CORNMAN DOD balance: $7,878.34 + $0.30 accrued interest Interest earned 01-01-03 thru 07-18-03 $70.93 YTD The decedent maintained investment g21151635 & 2115637. For more information contact tho brokerage department at 1400-762-6111. Page 1 of 2 WED 08:31PH ID: PAGE:I st MEMBERS 1" FEDERAL CRI~DIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Accouut Number/Suffix Date Account Established Principal Balance at Date of Death Accrued hlterest to Date of Death Total Principal and Accrued Interest Name of Joint Owner IRA CERTIFICATE OF DEPOSIT: Account Nmnber/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary IRA CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary Estate of: MARLIN R. CORNMAN Date of Death: July 18, 2003 Social Security Number: 200-24-0294 56409-00 12/14/1979 $195.35 $.11 $195.46 None 56409-11 04/17/1987 $2,363.28 $.00 $2,363.28 None 56409 -15 5 yr 11/14/2000 $14,280.08. $46.42 $14,326.50 Patricia L. Gaffney, Melinda K. Wood Greg A. Comman 56409 -17 5 yr 02/06/2002 $13,868.69 $28.49 $13,897.18 Patricia L. Gaffney, Melinda K. Wood Greg A. Cornman 56409 -16 5 yr 6/13/2001 $45,310.49 $105.10 $45,415.59 Patricia L. Gaffney. Melinda K. Wood Greg A. Comman 56409 -18 5 yr 01/04/2003 $7,449.39 $14.47 $7,463.86 Patricia L. Gaffney. Melinda K. Wood Greg A. Comman · Denise A. Wolfe,'Insuranlf8 Supervisor August 26, 2003 5000 Louise Drive · RO. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org I. 5 e 6. 7. 8. 9. 10. I~1 !:~.1~11'11~ )Il Members 1st Federal Credit Union, Account No. 56409-00 Regular Savings. Members 1st Federal Credit Union, Account No. 56409-11 Checking Account. PNC Bank, N. A., Checking Account No. 5070078009. PNC Bank, N. A., Savings Account No. 5030000784. Proceeds from sale of 1998 Chevrolet TruCk. Net proceeds from Public Sale of Household Furnishings AT&T Consumer Lease Services, refund. Verizon, refun~. Safeco Insurance. Companies, refund. Verizon, refund. ": 1 ~)I^L (~1..o e.le~ u. II.e §, Rec~l,llul.$11o.) VAI.IJE Al DAIE OF DEAII! $ 195.46 2,363.28 6,576.10 7,878.64 10,250. OO 4,268· 36 9.00 39.93 149.70 10.17 31,740.64 10/7/03 2;21 PAGE q/q RightF&x Glenbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE October 7, 2003 PNC Bank Attn: Chuck Little Via Facsimile (717) 691-4051 Re: Contract Number: Marlin Ray Comman GA0686159 Dear Mr. Little: We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to th~' referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract). The contract referenced was an mmuity contract, which is not reportable on IRS form 712. The following information is provided regarding the value of the annuity and other data as of the date specified: Date of Death: 07/18/2003 Annuity Value as of Date of Death: $ 20,043.28 Cost Basis: $ 20,000.00 Named Beneficiary: Greg Comman The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact us at 1-877-499-6418. Sincerely, Isela Balderas Life and Annuity Claims Overnight Address: 544 Lakeview Parkway, Vernon Hills, IL 60061 Toll Free Fax: 1-866-635-4523 10/7/03 2:21 PAGE 214 RightFax Glenbroolc Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Mtmber o£Allaate Fi ncial Group October 7, 2003 PNC Bank Attn: Chuck Little Via Facsimile (717) 691-40-51 Re: Contract Number: Marlin Ray Cornman GA0584848 Dear Mr. Little: We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to the referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or with its proceeds as of certain date (usually the o ' wner s date of death or date of transfer of the contract). The contract referenced was an annuity contract, which is not reportable on IRS form 712. The following information is provided regarding the value of the annuity and other data as of the date specified: Date of Death: 07/18/2003 Annuity Value as of Date of Death: $ 20,040.79 Cost Basis: $ 20,000.00 Named Beneficiary: Melinda K. Wood The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact us at 1-877-499-6418. Sincerely, Isela Balderas Life and Annuity Claims Overnight/Mdress: 544 Lakeview Parkway, Vernon I~lls, IL 60061 Toll Free Faxz 1-866-635-4523 10/7/03 2:21 PAGE 3/4 RightF&x Glenbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE October 7, 2003 PNC Bank Attn: Chuck Little Via Facsimile (717) 691-4051 Re: Contract Number: Marlin Ray Comman GA0688708 Dear Mr. Little: We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to the referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contrac0. The contract referenced was an annuity contract, which is not reportable on IRS form 712. The following information is provided regarding the value of the annuity and other data as of the date specified: Date of Death: 07/18/2003 Annuity Value as of Date of Death: $ 20,043.28 Cost Basis: $ 20,000.00 Named Beneficiary: Patricia L. Gaffrey The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact us at 1-877-499-6418. Sincerely, Isela Balderas Life and Annuity Claims Overnight Address.. 544 Lakeview Parkway, Vernon Hills, IL 60061 Toll Free Fax: 1-866 635-4523 st MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner IRA CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary IRA CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary Estate of: MARLIN R. CORNMAN Date of Death: July 18, 2003 Social Security Number: 200-24-0294 56409 -00 12/14/1979 $195.35 $.11 $195.46 None 56409-11 04/17/1987 $2,363.28 $.00 $2,363.28 None 56409 -15 5 yr 11/14/2000 $14,280.08 $46.42 $14,326.50 Patricia L. Gaffney, Melinda K. Wood Greg A. Cornman 56409 -16 5 yr 6/13/2001 $45,310.49 $105.10 $45,415.59 Patricia L. Gaffney. Melinda K. Wood Greg A. Comman 56409 -17 5 yr 56409 -18 5 yr 02/06/2002 01/04/2003 $13,868.69 $7,449.39 $28.49 $14.47 $13,897.18 $7,463.86 Patricia L. Gaffney, Patricia L. Gaffney. Melinda K. Wood Melinda K. Wood Greg A. Conunan Greg A. Cornman ~Sw~~m~an L S~up eD~vli~?I ON August 26, 2003 5000 Louise Drive · PO. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717)697-1161 ° www. memberslst.org REV-ISIO EX* (1-9~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARLIN R. CORm N SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-03-05~9~4 2003-00594 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM ,,C~.UOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECFDENT.~NO THE DATE OF TR.~NSF~R~ DATE OF DEATH DECD'S EXCLUSION TAXABLE VALL NUMBER ~,rr^CH A COPY OF THE {)EEO FOR REAL ESTATE. VALUE OF ASSET INTEREST 1. Members let Federal Credit Union, 5'~'~ear IRA Certificate of Deposit No. 56409-15, naming Patricia L.~ Gaffney, Melinda K. Wood and Greg A. Cornman as beneficiaries. Establish.- ~.- ed 11/14/2000. 14,326.50 '100% None $' 14,326 2. Members 1st Federal Credit Union, .. 5 year IRA Certificate of Deposit No. 56409-16, naming Patricia L. - Gaffney, Melinda K. Wood and Greg A Cornman as beneficiaries. Establish. ed 6/13/2001.. · 45,415.59 100% None 45,415 3. Members 1st Federal Credit Union, .~ ,'.. 5 "year 'irma .Certificate of'.DepOsit No. 56409-17, naming Patricia L. Gaffney, Melinda K. Wood and Greg A. Cornman as beneficiaries. Establish. ed 2/6/2002. 13,897.18 100%~ None 13,897 4. Members 1st Federal Credit Union, 5 year IRA Certificate of Deposit No. 56409-18, naming Patricia L. Gaffney, Melinda K. Wood and Grog A. Cornman as beneficiaries. Establish ed 1/4/2003. 7,463.86 100% None 7,463 5. Glennbrook Life and Annuity Company~ annuity contract no. GA0.584848 naming Melinda K, Wood ~as bene- ficiary. Date of Death vaiue.~...~. 20,040.79 100% None ~0,*040 6. Glennbrook Life and Annuity-Company, annuity contract no. GA0688708 .~ naming Patricia L. Gaff ney as '~Dene- ficiary. Date ef Death Value.~. .... 20,043.28 100% None 20,043 7. Glen.nbrook Life and Annuity Company, annumtY COntract n°~ GA0686159 naming Greg Cornman as beneficiary. Date of Death value..... ............ 20,04~28 100% None 20,043 TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) R~-'V-IS11F~* (1-9T~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARLIN R. CORNMAN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER 5o 10. I1. 12. 16. 17. DESCRIPTION FUNERAL EXPENSES: MalpezZi Funeral Home, 8 Market Plaza Way, Mechanicsburg, PA, funeral expenses. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Gre ~; A. C or nman Social Secudty Number(s) I EIN Number of Personal Representative(s) SlmetAddress283;, East Berlin Road city York State Year(s) Commission Paid: 2004 AttomeyFees J. Robert Stauffer, Esq., attorney fee. Family Exemption: (If decedent's address is not ~he same as daiment's, attach explanation) Claimant N/A PA Zip 17404 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills of Cumberland aounty, Pennsylvania. Letters Testamentary; Accountant's Fees Tax Return Preparer's Fees Internists of Central Pennsylvania, balance due. Verizon, July 2003 telephone. Ike Shelly, Lawn Care. PPL Electric Utilities, August 2003 electric. Quantum Imaging, balance dme. Verizon, August 2003 telephone. Cumberland Law Journal, Estate Notice. The Sentinel, Estate Notice. PharMertca, medications. Comcast, Cable Television. Ike Shelly, lawn care. Register of Wills, ten (10) Short Certificates. TOTAL (Also enler on line 9, Recapitulation) AMOUNT 10,655.90 ,,¢ 9,000.00 7,500.00 358.50 3.96 23.36 ,~OO;OO 81.9~, 4~;oo 75.00 78'17 39,52 15o.oo 30.00 $Carried Forward (If more space is needed, insert additional sheets of the same size) PAGE- I RE¥-ISI1 EX+ (?-esi ~ ,i.;-.: 'i ,~ COMMONWEALTH OF PENNSYLVANIA ~,~ INHERITANCE TAX RETURN RESIDENT DECEDENt ESTATE OF SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES :.?/..'::' ~ .... .' MARLIN R. CORNMAN . NUMBER DESCRIPTION 19 · ~2. ~?. 28. 30. 31. 32. 33, 36. ~?. 38. 39. ~0. 41. 48. ~3. 56. 57. United Water Pennsylvania, August 2003 water. Central'Pennsylvania Imaging Center, ~I. 'Messiah Village, balance due for care. 'PPL Electric Utilities, September 2003 electric. Internists of Central Pennsylvania, balance ~ue. Unltsd Water Pennsylvania, September.2003 water. Safe 'Co, automobile insurance. Safe Co, Homeowners Insurance. Patti Gaffney, reimbursement for hose used in basement. Terry Lindsey, cleaning house. BOyd Diller, bin refuse and trash. Ike Sholly, lawn care. John Conroy, M. D., balance due. Verizon, telephone for September 2003. Comcast, final bill for Cable Television. Quantum Imaging, balance due. PPL Electric Utilities, October 2003.electric. Pinnacle Health, balance due. Silver Spring Township Authority, sewer and refuse for 4th quarter. Verizon, October 2003 telephone. Ike Sholly, lawn care. PPL Electric Utilities, November'2003 electric. Safe Co., Homeowners insurance. AT&T Consumer Lease,~telephone lease. PPL Electric Utilities, December'2003 electric. United Water Pennsylvania, December 2003 water. PPL Electric Utilities, January 2004 ~lectric. United Water Pennsylvau~a, January ~004 water. Silver Spring Township Authority, 1st quarter 2004 sewer and refuse. CIA, Home Security contract. Shipley Humble, heating fuel. Zimmerman Plumbing & HeatingInc., plumbing repairs. Shipley Humbler, heating fuel. PPL Electric Utilities, electric through 3/19/04. United Water Pennsylvania, Water through 3.19.04. Shipley Humble, heating fuel. Foremost Insurance Group, Home Insttrance. Register of Wills, filing:Inventory and Pennsylvania Inheritance Tax Return.. Register of Wills, filing Account... Plekzie Print or Type FILE NUMBER ' ' ~- 21-03-0594 soo~-oo~ $ 24.04 4o.'18 1,124. O0 72.83 :g.87 30.79 130.85 159..oo 252.68' 200.00 340.00 100 00, 3o~9 20.2' 51.7 7.:;:~: 'lO0. O0:~ ": %00 ~00- 00::. E,lO0. O0 ':':::' :~6. o~ ' ~o5.~5 ~.oo q. oo $ ~5 374.69 Total. ............ ., PAGE REV-IS13 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF .MARLIN R. SCHEDULE J BENEFICIARIES 21-03-0594 CORNMAN 2003-00594 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal distributions) FILE NUMBER e ]I. PATRICIA L. GAFFNE~Y 921 Ashmun Avenue Tallmadge, Ohio MELINDA~.~r WOOD 12905 Tarragon Court Oak Hill, Virginia 20171 GREG A. CORNMAN 283[~ East Berl~.n Road York, PA 17l.~04 D aught e r Daught er Son A one-third interest in Estate. A one-third interest in Estate. A one-thrd interest in Estate. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART I! - 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) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: .......... G~eg A, Corpman being duly SWO~ ..... according fo law, deposes and says fhaf he is the Executor of fha Estate of [~[arlin R. Corrigan late of _~_~%~_r Spring To~hip -, Cumberland County, Pa., deceased and that the within is an inventory made by . G~eg A. ~o~ ....... , the said of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde the Commonwealth of Pennsylvania, and that the figures opposlfe each item of the Inventory represent it's fair value as of the date of decedenf's death. gWO~D and subscribed before me, 2834 East Berlin Road York, PA 17404 Date of Death 18 July 2003 Day Month Year INSTRUCTIONS I. An inventory must be filed w;fhln three months after appolnfmenf of personal represenfaflve. 2. A supplement inventory must be filed wifhln fhlrfy days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Arflcle IV, Fiduciaries Act of 1949. BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVTSTON DEPT. Z80601 HARRISBURG, PA.~71ZB-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX J ROBERT STAUFFER ATTY MARKET SQUARE BLDG I N MAIN ST MECHANICSBURG PA '04 ~'iti'f 24 DATE 05-Zq-ZOOq ESTATE OF CORNMAN DATE OF DEATH 07-18-2005 FILE NUMBER 21 05-059q :!;;~COUNTY CUMBERLAND ACM 101 REV-15~7 EX AFP [01-OS) MARLIN R Amount Roe/ttod MAKE CHECK PAYABLE AND REM'rT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~:-V'£[-~'7--~=~('-~ (01-03) NOTICE OF INHERITANCE TAX APPRA:ZSENENT, ALLONANCE OR ESTATE OF CORNMAN DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARLIN R FILE NO. 21 05-059q ACM 101 DATE 05-Zq-ZOOq TAX RETURN NAS: ( ) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE (X) CHANGED SEE ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1)_ 2. Stocks and Bonds (Schedule B) (2)... $. Closely Held Stock/Partnership Interest (Schedule C) ($) fi. Mortgages/Notes Race/robie (Schedule D) (q) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($). 51/7qO. 6q 6. Jointly Owned Property (Schedule F) (6) O0 7. Transfers (Schedule G) ' 8. Tote1 Assets (7) lql/250. O0 (B) APPROVED DEDUCT:iONS AND EXEMPTIONS: 9. Funeral Expenses/Ado. Costs/MAsc. Expenses (Schedule H) (9) 55,57q.69 10. Debts/Hortgego Liabilit/es/LAons (Schedule I) (10) · O0 11. Total Deduct/ons ' 12. Net Value of Tax Return (11) lqO/O00.O0 58/329.53 .00 NOTE: To insure proper credit ~o your account, submit the upper port/on of this fore with your tax Payment. 571,500.17 35.37~. ~9_ 335,925.q8 D!$COUNT (+J INTEREST/PEN PAID (-) AMOUNT PAID .00 15,111.6q TOTAL TAX CREDIT--/--- 15,111.6q BALANCE OF TAX DUEI 5.01 INTEREST AND PEN./ .03 TOTAL DUE / 5. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. INTEREST IS CHARGED THROUGH 06-08-200q AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT DATE Oq-OS-ZOOq .00 15,116.65 .00 .00 15,116.65 RECETPT NUMBER CD005759 15. Aeount of Line lq at Spousal rate (15). .00 X O0 = 16. Amount of L/ne lq taxable at Lineal/Class A rate (16) 555,925.00 X Oq5 = 17. Amount of L/no lq et S/bling rate (17). .00 X 12 = 18. Amount of Line lq taxable at Collateral/Class B rate (18) .00 X 15 = (19); (12) 15. Char/table/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (15) . O0 lq. Net Value of Estate Sub,oct to Tax (l~) 555,925. q8 NOTE: Z~ an assessment was lssued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: -- RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after fha expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. Estate Tax Act, Act Z5 of ZOO0. (TZ P.S. PURPOSE OF NOTICE: To ~Jlfill the requirements of Section Il40 of the Inheritance and Section 91~0). pAYHENT: Detach fha top portion of this Notice and submit with your payment to the Register of Hills printed on fha reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which Nas not reqUested on tha Tax Return, may be requested by completing an -Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ars available at the Office of the Register of Hills, any of tha Z5 Revenue District Offices, or bY calling the special z~-hour ensnaring service for forms ordering: 1-800-56Z-ZOBO~ services for taxpayers with special hearing and / or speaking needs: i-BOO-~7-5OZO (TT only). oBJECTIONS: Any party in interest not satisfied with fha appraisement, allowance, or disallowanca 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. ZBIOZ1, Harrisburg, PA 171ZB-IOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADHIH- in writing to: PA Department of Revenue, ISTRATIVE CORRECTIONS: Factual errors discoverad on this assessment should be addressed Bureau of Individual Taxes, ATTN: post AsseSsment Review Unit, Dept. IS0601, Harrisburg, PA 171Z8-0601 f the booklet -InstructiOns for Inheritance Tax Return for a Residant phone (717) 787-6505. Sea page.5 ~,=__ ~f administratively correctable errors. Decedent" (REV-1501) for an axp~ana~u.. ~ DISCOUNT: If any tax due is paid within three (3) calendar months after the dscadant's death, a five percent (SI) discount of fha tax paid is allowed. PEHALTY: The 15Z tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not paid before January 18, 1996, fha first day after the end of the tax amnesty period. This non-participation panaltY is appealable in the same manner and in the the same time period es you would appeal the tax and intarast that has been assessed as indicated on this notice. and one 1, 19aZ bear interest at the rate of INTEREST: Interest is charged beginning with first day of delinquency~ or nine (9) months death, to the date of payment. Taxes which becaaa delinquent before January which became delinquent on and after six (BI) percent par annum calculated et a daily rate of .000164. All taxesNith that rate January 1~ 198Z will bear interest at a rate which will vary from calendar year to calendar yearara: Interest Daily announced by the PA Department of RevenUe. The applicable interest rates for IgBZ through 2004 Interest Daily Factor Interest Daily Factor Year Rate Year Rate Factor Year Rate ~s5 l~x .ooo45s l~z ~x .oooz~7 zooz ~x .oool~ 198~ llX .000302 1995-199~ ?X .O0019Z 2003 SX .000~57 1985 lSZ .000556 1995-1998 9Z .O00Z~7 ZO0~ ~Z .O001lO 19s6 lox .0ooz74 t9~9 7x .ooot9z 1987 lO~ .O00ZT~ 2000 7~ --Interest is calculated as follOWS: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --ANY Notice issued after tha tax becomes delinquant will reflect an interest calculation to fifteen (15) days beyond tho date of the assessment. If payment is made after the intarest computation date shown on fha Notica, additional interest ,ust be calculated- REV-1470 EX (6-88) COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDEN'FS NAME REVIEWED BY INHERITANCE TAX EXPLANATION OF CHANGES Marlin R Cornman Deborah Washington SCHEDUI EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ROW Pag~ 1 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 004014 STAUFFER J ROBERT MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 ......... fold ESTATE INFORMATION: SSN: 200-24-0294 FILE NUMBER: 2103-0594 DECEDENT NAME: CORNMAN MARLIN R DATE OF PAYMENT: 06/07/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5.04 REMARKS: TOTAL AMOUNT PAID: $5.04 SEAL CHECK# 1 O73 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OE INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004165 STAUFFER J ROBERT MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 ESTATE INFORMATION: SSN: 200-24-0294 FILE NUMBER: 2103-0594 DECEDENT NAME: CORNMAN MARLIN R DATE OF PAYMENT: 07/1 6/2004 POSTMARK DATE: 07/1 6/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,912.23 TOTAL AMOUNT PAID: $3,912.23 REMARKS: SEAL CHECK#1081 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~.~.~ ~ COMMONWEALTH OF PENNSYLVANIA ,a~2.-~'~ DEPARTMENT OF REVENUE ~'~"t~.~,~'~ DEPT. 280601 ~HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2I --O_?L 0 CO~TY~E -YEAR DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER COR~h~%~I~, Harlin R. 200- 2;$ - 029~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-Y~R) THIS RETURN MUST BE FILED IN DUPLICATE WITH THI ~ O July 18~ ~.0 ~ October 2[~ ~9~0 REOISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 8OCIAL SECURI~ NUMBER ?~/A - - ~ I [~ l'OdginalRetern [~4. Limited Estate ~i~ [~ 6, Decedent Died Testata (^itach c~y of Will) < [] 9. Litigation Proceeds Received [~]2. Supplemental Retera [~4a. Future Interest Compromise (date el death after 12.12-1~2) [~7 Decedent Mainlained a Living Trust IA,ach copy of Tr~st) ] 10. Spousal Povedy Credi~ (dateofdea~hbetwe~ 12-31.91 a.d 1-1-S5) ]5, Federal Estate Tax Relurn Required __ 8. Total Number of Safe Deposit Boxes E~I 1, Eleclion to tax under Sec. 9113(A) (A~ch Sch O) NAME J Robert o ' Atty. · ot auf ~ er, FIRM NAME~f~A~t TELEPHONE NUMBER (_ ~ 717-7 :~ '~- 9673 COMPLETE MAILING ADDRESS Market Square Bldgo 1 !,~est Main St. Mechanicsburg, PA 17055 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Propdetership {3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) [~ Seperata Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Properly (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) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election [o tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) O. _00 0700 0.00 0. O0 69,316.32 O. O0 O,00 OFFICIAL USE ONLY (8) (11) (12) (13) (14) 0.00 0.00 69,316.~2 0.00 0.00 69,316.32 BEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amounl of Line 14 taxable al the spousal lax rate, or transfers under Sec. 9116 (a)(l.2) 16. Amount of Line 14 taxable al lineal rate 17. Amount of Line 14 taxable al sibling rate 18. Amounl of Line 14 taxable at collateral rate 19. Tax Due 0.00 x.O 69,316.32 x.og5 0.00 x.12 0.00 x.15 (15) (16} 0.00 3,119.23 0.00 0.00 (17) (18) (19) 3,119.23 SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER -U R. Co!'~i~L?~]? 2003_00~94 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All teal estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. VALUE AT DATE OF DEATH ITEM NUMBER DESCRIPTION 1. · ct g ~o lan e TOTAL (Also enter on line 1, Recapitulation) more space is needed, insert additional sheets of same size.) All property Johtlly-owned with Ilgllt o! survivorship musl he dfsclosed on Bchedule F, HEM NUMBER tlESCRIP r lop 1. VALUE Al' DAlE OF DEATII " ch ng TOTAL (Also enler on tine 2, Recapilulalion) $ ];Io cha~.~g,9 Prudential Financial Annual Statement Account Statement to December 31, 2003 MARLIN R. CORNMAN 3 YORK CIR MECHANICSBURG PA 17055-2752 Owner: MARIAN R. CORNMAN Annuitant: MARLIN R. COI~MAN Contract Number: 96082138 Contract Date: 01/22/1996 Type of Contract: Variable Investment Plan Market: IRA This statmnent shows time values of your Variable Investment Plan Ammity as of December 31, 2003, and the changes in values since January 01, 2003. Please retain this statemeat for ynur records. Although great care has been taken in preparing this statement, we reserve lite right lo antend the stalmnenl as needed. Thank yon for choosing Pmdentlal. [Account Smnmary as of 12/31/2003 Prndential Conservative Balanced 6,338.78654 4.4915811 $ 28,471.17 l'nldcnlial l)ivcrslficd llond 5,039.24656 4.291290 21,624.87 Prudential lqexlble Managed 4,227.57977 5.040600 21,309.54 !::~t~ ~ ::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::: :i :::::::::::::::::::::::::: :::::::: ::: ::::::::: :: :: :::::::::::::::: :'::::~:~i:'~';~' ~ ~ ~ ~ ~ ~:t: ~:~:: IContract Activity Sutnmary 01/01/2003 - 12/31/2003 01/01/2003 Beginning Balance $66,560.00 12131/2003 Total Purchase Payments Additional Amonnt Premium Tax Charge Total Withdrawals Total Withdrawal Charges Coulrac! Maintenance Charge Investment Results Intesest Credited Ending Balance 0.00 0.00 0.00 -4,800.00 0.00 0.00 9,645.58 0.00 $71,405.58 890160, W date of the Iransaelion. Information regm~ling agent's commissions (rem.aeration) is available upon written request. atiai Financial Annual Statement Account Statement toDecember $1,2003 Cnntract Namber: 96082138 VARIABLE INVESTMENT OPTION ACTIVITY DETAIL [Prudential Cnnservative Balanced 01/01/2003 01/01/2003 Beglnaing Balance $26,025.03 6,800.07220 3.827170 $26,02~.03 01/15/2003 01/15/2003 Automated Withdrawal -157.24 6,759.93559 3.917620 26,482.86 02/18./2003 02/18/2003 Autmnated Withdrawal - 155.05 6,718.72771 3.762630 25,280.09 03/17/2003 03/17/2003 Aatomated Withdrawal -155.14 6,677.92630 3.802320 25,391.61 04/15/2003 04/15/20113 Automated Withdrawal -155.75 6,637.77575 3.879150 25,748.93 05/1512003 05/15/2003 Automated Withdrawal -156.67 6,599.20181 4.061550 26,802.99 06/16/2003 06/16/2003 Automated Withdrawal -157.73 6,562.11313 4.252780 27,907.22 07/15/2003 07/15/2003 Automated Withdrawal -157.71 6,524.46363 4.188900 27,3_3_0.33 08/15/2003 08/15/2003 Automated Withdrawal -158.27 6,486.12331 4.128030 26,774.91 09/15/2003 09/15/2003 Aatoulated Withdrawal -158.27 6,448.63003 4.221290 27,221.54 10/15/2003 10/15/2003 Aatomated Withdrawal - 158.83 6,411.68251 4.298800 27,562.54 11/17/2003 11/17/2003 Automalcd Withdrawal -158.18 6,375.03377 4~316110 27,515.35 12/15/2003 12/15/2003 Aatou]ated Withdrawal -158.69 6,338.78654 4.377990 27,751.14 12/31/2003 12/31/2003 Eliding Balance 6,338.78654 4.491580 $28,471.17 [Prudential Diversified Bond 01/01/2003 01/01/2003 i;eglnnlag Balance $21,842.24 5,405.95867 4.040400 $21,842.24 01/15/2003 01/15/2003 Automated Withdrawal -128.97 5,374.05230 4.042140 21,722.67 02/18/2003 02/18/2003 Aatomated Withdrawal -133.74 5,341.29224 4.082410 21,805.34 03/17/2003 03/17/2003 Automated Withdrawal -133.5l 5,308.85580 4.116050 21,851.52 04/15/2003 04/15/2003 Automated Withdrawal -131.87 5,276.93637 4.131340 21,800.82 05/15/2003 05/15/2003 Automated Withdrawal -129.79 5,246.27150 4.232530 22,205.00 06/16/2003 06/16/2003 Automated Withdrawal -126.77 5,216.78633 4.299450 22,429.31 07/15/2003 07/15/2003 Aatomated Withdrawal -125.99 5,186.85499 4.209300 21,833.03 08/15/2003 08/15/2003 Aatomated Withdrawal - 125.29 5,156.37422 4.110460 21,195.0:1 09/15/2003 09/15/211113 Aatomated Witi~d~awal -124.99 5,126.56636 4.193190 21,496.67 10/15/2003 10/15/2003 Automated Withdrawal - 123.30 5,097.19635 4.198160 21,398.85 11/17/2003 11/17/2003 Aatomated Withdrawal -124.29 5,068.06133 4.266000 21,620.35 12/15/2003 12/15/2003 Aatonmted Withdrawal -123.25 5,1139.24656 4.277320 21,554.47 12/31/2003 12/31/2003 Ending Balance 5,039.246~6 4.291290 $21,624.87 IeL~RLI14 R. CORI~i~AN IRA Variable Investment Plan, Contract No. 96082138. Mar].~]m R. Corn.man, Annuitant. Prudential ConservatT. ve Balances Fund. Prudential Diversified Bond Fund. Prudential Flexible Managed Fund. OF DE^Ill $ ;~7,33o. 33 21, ~33.03 2o, ~J2.96 ll)l^l I^I:. mitre milllin. [. IT:m.',Idl.lnllm,) 69 · '~16 · '~2 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER ~]._03_0~94 aoo3-oo59k Joint tenant(s): Bo NAME ADDRESS RELATIONSHIP TO DECEDENT Jointly-owned property: LETTER ITEM FOR DATE NUMBEE JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST 1. ITo change TOTAL (Also enter on line 6, Recapitulation) $ No change (If more space is needed insert additional sheets of same size) ~...l~.~,,~. SCHEDULE H ~ ~ .~. ~.~? FUNERAL EXPENSES, COMMONWE^UH O~ ~S~V~,~ ADMINISTRATIVE COSTS AND ~,~c~ ~x ~u~ MISCELLANEOUS EXPENSES RESIDENT DECEDENT Please Print or Type ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: ~O 1. B. Admlnlstralive Costs: ~. Personal Representative Commissions Social Securily Number of Personal Representative: Year Commissions paid 2. Attorney Fees 3. Famiiy Exemplion Claimant Relationship Address of Claimant at decedent's death ,Street Address City .Stale ~ Zip Code 4. Probate Fees C. Miscellaneous Expenses~ 1. 2. 3. 5. 6. 7. 8. TOTAL (Also enter on Jine 9, Recapitulation) $ }~O (If more space is needed, Insert additional sheets of same size.) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER II. 1. SCHEDULEJ BENEFICIARIES FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TA~ABLE DISTRIBUTIONS (include ouflighl $~usal dislribulions} RELATIONSHIP TO DECEDENT Do Not List Trustee(s) no chat~ge AMOUNTORSHARE OFESTATE No change ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il · ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ ~'o ch atqge (If more space is needed, Insert addillonal, sheets of the same size) BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DZVZSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-1697 EX AFP J ROBERT STAUFFER ATTY MARKET SQUARE BLDG I W MAIN ST MECHANICSBURG PA 17055 DATE 07-12-2004 ESTATE OF CORNHAN DATE OF DEATH 07-18-2005 FILE NUHBER Z1 05-0594 COUNTY CUHBERLAND ACN 101 Amoun'l: Remi~:~md NARLXN R HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~c ~he upper por~/on of ~his form wi~h your ~ax payment. CUT ALONG THZS LINE ~"~ RETATN LONER PORTZON FOR YOUR RECORDS '~ REV-1607 EX AFP [01-03) #~# ZNHERXTANCE TAX STATEHENT OF ACCOUNT ~.- ESTATE OF CORNMAN MARLXN R FILE NO. 21 05-0594 ACN 101 DATE 07-12-2004 THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELOW 'rs A SUMMARY OF THE PRINC'rPAL TAX DUE, APPL'rCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPL/CABLE, A PROJECTED TNTEREST F'rOURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 15,116.65 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-05-2004 06-07-Z004 CD005759 CD004014 .00 .05- TOTAL TAX CREDIT 'rF PA'rD AFTER TH'rS DATE, SEE REVERSE SIDE FOR CALCULAT'rON OF ADDIT'rONAL 'rNTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 'rS REQU'rRED. XF TOTAL DUE 'rS REFLECTED AS A 'CRED'rT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR 'rNSTRUCTXONS. 15,116.65 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 J ROBERT STAUFFER ATTY MARKET SQUARE BLDG I g MAIN ST HECHANICSBURG PA 17055 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT DF TAX REV-l;4? EX AFP DATE 09-06-2004 ESTATE OF CORNMAN MARLIN DATE OF DEATH 07-18-2005 FZLE NU.BER 21,. 0S94 COUNTY Affioun~ HAKE CHECK PAYABLE 'AND REHZT PAYMENT TO: REGISTER OF WILLS ~ ::': CUHBERLAND CO:!?DURT HI)USE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-154? EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CORNMAN MARLIN R FILE NO. 21 05-0594 ACN 101 DATE 09-06-2004 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) :5. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Nortgages/Notes ReceivabZe (Schedule D) (~) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTTONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return NO. O1 O0 69~$16.$2 O0 NOTE: To insure proper O0 credi~ to your account, O0 submit the upper portion 00 of this form with your tax payment. O0 (8) .00 .00 1:5. 1~. NOTE: 69,516.52 (11) . O0 (la) 69,:516 .$2 Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (lq) zf an assessment ,as lssued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. DISCOUNT INTEREST/PEN PAID (-) (1.;) .00 X O0 = (16) 405,241.$2 x 045= (17) .00 x 12 = (18) .00 x 15 = (19)= ANOUNT PAID 15,111.64 5.04 $,912.25 ASSESSHENT OF TAX: 15. Amount of Line lfi et Spousal rate 16. Amount of Line 1~ taxable et Lineal/Class A rata 17. Aeount of L/ne lq at Sibling rate 18. Amount of Line 1~ taxable et Collataral/C1ass B rate 19. Pr/nc/pal Tax Due TAX CREDITS: PAYHENT RECEIPT DATE NUHBER 04-05-2004 CD005759 06-07-2004 CD004014 07-16-2004 CD004165 .00 405,241.80 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 .00 50.56- TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 18 and 19 will 18,998.35 762.47CR .00 762.47CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .00 18,255.88 .00 .00 18,255.88 RESERVATION= Estates of decedants dying an or before December lZ, 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 Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Zawful CIass S (coZtateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S. Section 9140). Detach the top portion of this Notice and submit ~ith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pannsy[vania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Rag[star of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for farms ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-~47-50Z0 (TT only). Any party in interest not satisfied ~ith 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 race[pt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZI~ Harrisburg, PA 171Z8-10Z1, 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. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-15Ol) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is alZoaed. The 15Z tax amnesty non-participation penalty is computed on tha total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or ninm (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (62) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z ~il1 bear interast at a rate which mill vary from calendar year to calendar year mlth that rata announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20X .000548 ~'8-1991 ~ .00050! ~'~ 9X .000Z47 1985 16Z .000438 199Z 9Z .000Z47 ZOOZ 6X .000164 1984 llZ .000301 1993-1994 72 .00019Z 2003 5Z .000157 1985 15Z .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOZ .000Z74 1999 7Z .O0019Z 1987 XOZ .000274 ZOO0 72 .000192 --Interest is caIculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI~UENT X DALLY INTEREST FACTOR --Any Not[ce issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond tho date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I&07 EX AFP (01-05) J ROBERT STAUFFER ATTY MARKET SQUARE BLD$ I W MAIN ST MECHANICSBUR$ PA 17055 DATE 10-18-Z00q ESTATE OF CORNMAN MARLIN DATE OF DEATH 07-18-2005 FZLE NUMBER 21 CU~,t~ER LAN~t-~ COUNTY ACN 10 Amoun~ Rem J.'l:'~ I HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT'~HOUSE CARLTSLE, PA 17015 R NOTE: To Lnsure proper crmdi~ ~o your account, subm/~ ~he upper por~Lon of thLs fore wi~h your ~ax payment. CUT ALONG TH'rS LINE ~ RETA'rN LONER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) sa# ZNHER'rTANCE TAX STATEMENT OF ACCOUNT aa~ ESTATE OF CORNMAN MARLIN R FILE NO. 21 05-059q ACN 101 DATE 10-18-200q THIS STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELO# IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE:, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-06-200q PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 18,255.88 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID .00 Oq-OS-ZOOq 06=07=ZOOq 07-16-200q 10-01-200q CD005759 COOOqOlq COOOq165 REFUND .00 30.56- .00 15,111.6q 5.0q 3,91Z.Z3 762.q7- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" TOTAL TAX CREDIT 18,235.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach tho top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- if RESIDENT DECEDENT make check or money order payable to: REGISTER OF #TLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTN OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania inheritance and Estate Tax" (REV-L313). AppZications are available at the Office of the Register of Hills) any of the 23 Revenue District Offices or from the Department's Iq-hour anseering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: [-800-qqT-3OZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Dureau of individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060[, Harrisburg, PA [7[Z8-060[, phone (7[7) 787-6S05. DISCOUNT: 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. PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January I8, 1996, the first day after the end o~ the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one ([) day from the date of death, to the date of payment. Taxes ahich became delinquent before January [, [982 bear interest at the rate of six (SX) percent per annum caLcuLated at a daily rate of .O00[Sq. Ali taxes ahich became delinquent on and after January 1, [982 aill bear interest at a rate which aill vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200fi are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year~ Rate Factor [98Z ZOX .0005q8 1988-1991 llZ .O003Ol ZOO1 9Z .000Z~7 1983 16Z .000q38 199Z 9Z .O00Zq7 ZOOZ 6Z .00016~ 198q llZ .000301 1993-199q 7Z .O0019Z 2003 5Z .000137 1985 13Z .000356 1995-[998 92 .O00Zq7 ZOOq q2 .000110 1986 IOZ .O00ZT~ 1999 7Z .O0019Z [987 9Z .O00Z~7 ZOO0 aZ .O00Z19 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUtIBBR OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent alii reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: 'MARLIN R. CORNNAN Date of Death: July 18. 2001 Will No. 200~-00~9u Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the perspnal representative reasonably believes that the administra~ion will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: , c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be,ttached to this report. D.te' Ap"il 20, 2005 C:,l;/et"f/7)~ C'J,)S i gna ture / / t \" / J. ;1obert Stauffer Name (Please type or print) }\Tarlt.=et ~~quare Bldg. 11' ., P^ l'70r-c:' ,ecnarncsourg.,t i )',J Address (717) 76()-C)673 Tel. No. Capacity: Personal Representative (MAH: rmf/ AM3) x Counsel for personal representati~e .~ I