The URL can be used to link to this page

Home My WebLink About02-0875 ~ - Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS ~1-o~-gt7.5 Estate of also known as ANNE SCHAEFFER KEEFER MOORE No. , Deceased Social Security No. 183 -12 -1302 Herbert C. Moore Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW) o A. Probate and Grant of Letters Testamentary and aver that Petitioner{s) is/are the execut the Decedent. dated and codicil(s) dated named in the last Will of State relevant circumstances, e,g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate: was not the victim of a killing and was never adjudicated incompetent: [K] B. Grant of Letters of Administration (c.ta.; d.b.n.c.ta; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationshio Residence I Herbert C. Moore Son 1510 N. Union St. , Middletown, PA Richard W. Moore Son 8110 Ventner Ave. , Margate, NJ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with his/her last family or principal residence at 15 Amherst Dr lve, Lower Allen Township, Camp HIll, PA 17011 (list street, number, and municipality) Oecedentthen ~years of age, died 08/27/2002 at Harr i sburg Hosp i tal, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property Of not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania $ $ $ $ 104,000.00 196 ,000.00 300,000.00 situated as follows: 'IOl'AL 15 Amherst Dr., Camp Hill and a lot on Felker Rd., Middletown Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of ro riate form to the undersi ned: T ed or rinted name and residence Herbert C. Moore 1510 North Union Street, Middletown, PA 17057 /7- 9/-.y Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) - Oath of Personal Representative './ Commonwealth of Pennsylvania County of Cumber land The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner ) and that, as personal representative(s) of the Decedent, Petitioner(s) wi!! well and truly administer the e ac di to law. Sworn to or affirmed and subscribed before me this~tb.y of September 2002 !t..UMu'J' W.V/h-:- /.a:t~,.(.IhJ For the Register - )d~~ Donna M.Otto,lst Deputy r/ No. 3 21-2002-875 Estate of ANNE SCHAEFFER KEEFER MOORE Deceased Social Security No, 183 -12 -1302 Date of Death, 08/27/2002 September 30th AND NOW, 2002 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters D Testamentary [!] Of Administration (c.t.a.: d.b.n.c.t.a.; pendente lite; :durante abs,.e.ntia; durante minoritateJ are hereby granted to Herbert C. Moore in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. $ 270.00 Short Certificate(s). .6. $ 18.00 Renunciation. $ 5.00 Affidavits ( $ Extra Pages ( 0 ) $ -0- Codicil. $ JCP Fee. $ 5.00 Inventory $ Other $ [J~m.if~~~1~'lU/~i}f Donna M. Otto, 1st Deputy Harrisburg, PA 17101 Telephone, 717/233 -1000 TOTAL. ...... $ 298.00 Mailed Letters to Attorney on 9/30/02 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, inc. puplicate sent 10/11/2002 Form RW-1 (1991) 21-2002-875 Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of ANNE SCHAEFFER ~.lli l'lXlRE No. 183-12-1302 also known as , Deceased The undersigned, Son of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Herbert C. Moore WITNESS my hand this 27th day of September, 2002 (2f: )~~ (Signa r~) Richard W. Moore 8110 Ventner Ave., Margate, NJ (Address) (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this d pA day of ~~akJ;, d1tl4;Z, I >2!{~~~. Notarial Seal Sbaron K, Shaffer, N""!'l Public City of Harrisburg, Dauphin County ~ Commilllon Expires Sept 6, 2004 nf8 AIsodatIon of Nottuies My Commission Expires' (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) ..' -;: .;;, =---..........: ;$~\r~~;~. ! . \,.. -' - , :. .;;~:; i' - / , :-!. 3 executed outside the Office of Register of Wills ties are required to be notarized. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems.lnc. --- . ' . .)-;'.- --... ,.," .,. ~ Y:~'" ...~~... Form#RW-4 (1991) lc WARNING: IT IS IllEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. :,"" "'Ci,lIVlJN'~f:, '- oc :~t,f\JJ\S" 1,"'.)1 rY,PA,:~ln.'IEr-.IT -J- ) ,F A. -Of, 'fi': 1\1 F',; ..crrr:~: 1.'J':,'U, iEGIL::,fi"M: '; CEHnFic,,'IION :IF DE,~'rH CERT NO T 5 2 6 q .5 2 4 ,. '::,~ "i'f"r.~~:,::, :i~~:~r5,~~f~; ,\.( ~\~~ "// " :8, , , l'.t l~-\ .\~,~::,,~ ,;'/ ;~ "~, ::,,~VG,:, ~>>2W2 Na~e or Decedent ANNE_SCHAEFFER. _.KEEFER.- MOORE__ '1,;,,1. Sex F <=.Ill<J.J'?__ SDClal Secunty No JI'L3u,,-12 - 13.02 Date nt Dedi: AllgUSt 27 L2.0Q2 Date of Blrth.[)J~QeJ!L!::l"'L1J. .r.l_920Birthplace__ ..J1idc;'UeJ:OWl1.Lf'enl1 s.yl.Vil.ni.i'L. Placo of :JeatiJI<lorXisbllf;9"_Ih:>S.2i talL___ pauphil1,' FI i'it"x;LEl QU r sr..L_. Race White Cccupatlorf) <=.creta.r.u_S ta tEl_Gove1:I1Ill_eJl),m,ed Forces) Decedic;nts _ __ Mailing Acrdress (Yes 01' ~~'! No Marlial Status WoLdo_Wgq 15_ hl1lheJ;st.lJx:i,y"," CaI1)P HiJl.L PA t", ',I".'" POll Informant He-d:>,grt C. I-lQQr", Funera! Director .B:r:el1cl.<J.1l_MgG1o.l1<=. Name and P.ijdn-?ss ut reLlne,al EstalJ:,sI1!1lE"li, C:QQ.L",-R"'QS"J: F. H,'.1_:W8 N.._lLniQI1_S..t.., Mid..dLetQWD_Lf>l\ :L7057 l':Jarl I: !rnrneolate CaiJE;r lmerval B~::1"Neen Onset ariri Death i,,3j .C"rdiop\lJ,IllOl1ary a,r 1:e s t IL) Sepsj.s Ie Pan :1' fcll _ DU1'_:;, Siqnif!Cdilt Ccndijions ManrF--;r- or [}:::;1~~1 Describe how injul,\/ 0CCH"led: Natuml xxx r',ofl1'(;ide J1,cc!d~mt i:l"./8stlqat,oi" SUicidp Cullie! nOI t)8 DetelT~llfJ(~d Name EFFl rij!~ of Cenh? David P-awlush-,.- MrD. Uv'l.D ,) \ n((;!i'-' ;"'1 r::.' Address .--1-0-00 N- .-F-ront- St. r . u-Worm-leySbUI;<}r -FA fil!S is ro cf:r!lfy j~;aT lile InformatIon here given is cQrrectly copied :-1';';(1;1 {:'r'~:';';-li ('c:' ;1' of df?dth du!v fih:~d \ilJlth me ciS Lor::(li Registrar. The orI9in;'11 certificate '/Vii! h to' ','v;')r(j Stale Vlt,,! fiecoldc, Of lice ior permE/llont fllln(::Z~7.~~4/}:./.. 22-226 AugUS.t:2~f2Q02 lW.Spr~St._,",-Mid<ll.etQ.w~, PA 17057 ," (. / ,- CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: ANNE SCHAEFFER KEEFER MOORE Date of Death: AUGUST 27, 2002 Will No. 2002 - 00875 To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned Estate on October 15, 2002: Name Address Herbert C. Moore 1510 North Union Street Middletown, PA 17057 Richard W. Moore 8110 Ventner Avenue Margate, NJ 08402 Notice has been given to all persons entitled thereto under Rule 5.6 (a) . Dated: Oct. 15, 2002 Signature ~~ Shelly J. Kunkel, Esquire Skarlatos & Zonarich LLP Name: Address: 204 State Street Harrisburg, PA 17101 Telephone: (717)233-1000 C~pacity: Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX{11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KUNKEL SHEllY J 204 STATE STREET HARRISBURG, PA 17101 uuun told ESTATE INFORMATION: SSN: 183-12-1302 FILE NUMBER: 2102-0875 DECEDENT NAME: MOORE ANNE SCHAEFFER KEE DATE OF PAYMENT: 11/21/2002 POSTMARK DATE: 11/20/2002 COUNTY: CUMBERLAND DATE OF DEATH: 08/27/2002 NO. CD 001872 ACN ASSESSMENT CONTROL NUMBER AMOUNT F 101 I $14,000.00 I I R I I I I I I TOTAL AMOUNT PAID: $14,000.00 REMARKS: CHECK# 20207 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WillS MARY C. lEWIS REGISTER OF WillS ~~ r 111~a ,; ,p'~. i'"- ii! ~} (\1 f'i1 w \':J d ~ ....-"'-.- "~ '~lIM\O-{.I . w..-, f( .,\ "'''' .... N"lOO~ ."in.., , .. --,.,.... \,''', ~ 0 .J - .J " - ~ < ~ U >- z ~ < W < < w > -' " -' ~ >- >- > < <Jl " ~ " W Z > >- z \ w ~ w ~ "" z ~ " <Jl ~ ~ ~ <5 \J 0 " N 0 \ ~ m ~ " " " '\l < I "" QJ CJ) :::J o .r: 1:: :::J o OQJ ~ro(V") C:::J~ CJ) :::J 0-0 -0(/)1'- =-=u ~ S""O~<( .... C :::J c... o CIl 0 lo.. ""C..c _ QJQJ1::QJ .......~:JCI) .!!! EO = OJ '- QJ :::J 0 CIl a:::o~o .. o .. (I' i'> I'! ... i'> .. o r- .. ,,/1-9/-"/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REJUREAU OF IND,IVIDUAL TAXES R: DEPARTMENT 280601 HARRISBURG,PA 17128-0601 'OJ nAY 23 I\1D:27 Telephone May 19, 2003 Law Offices of Skarlatos & Zona rich 204 State St. Harrisburg, Pa.171 01 C;;:"I. CuntJ, (717) 787-3930 FAX (717) 772-0412 , r' Re: Estate of Anne Schaffer aka Keefer, Moore File Number 2102-0875 Dear Ms Kunkel: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before November 27,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. / , _ Sincerely, / // ~, - ,; ,,' \......--^-~~---- ~- ....,..,--_...~_..- Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division -- ESTATE OF ANNE SCHAEFFER KEEFER MOORE, beceaseJ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE NO. 21 - 02 - 0875 RECEIPT. RELEASE AND INDEMNIFICATION AGREEMENT For Full Distribution This Receipt, Release and Indemnification Agreement (hereinafter referred to as "Agreement") is given this 10 "f>..- day of O~ ,2003, by HERBERT C. MOORE, of 1510 North Union Street, Middletown, Pennsylvania, 17057, (hereinafter referred to as "Beneficiary"). WITNESSETH: WHEREAS, Anne Schaeffer Keefer Moore, (hereinafter referred to as "Decedent"), late of Lower Allen Township, Cumberland County, Pennsylvania, died intestate on August 27,2002. WHEREAS, Letters of Administration on the Estate of the said Decedent were duly issued on September 30, 2002, by the Register of Wills of Cumberland County, Pennsylvania, unto Herbert C. Moore, who was appointed as Administrator of the Estate (hereinafter referred to as "Administrator"); WHEREAS, the Administrator has paid all the debts, taxes and expenses of the Estate known to him as detailed in the Pennsylvania Inheritance Tax Return and Tax Assessment Notice, and he has no knowledge of any unpaid claim which may be asserted against the Estate, nor does he have any reason to believe that there are any such claims; WHEREAS, the Beneficiary is beneficially interested in the above referenced estate; and WHEREAS, it is the desire of the Beneficiary that distribution be made without the formality of an accounting, and the Administrator is willing to make such distribution upon the receipt of a proper release and indemnification, which it is the purpose of this Agreement to provide. NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Waiver of Accounting. The Beneficiary hereby waives the necessity for an accounting and directs the Administrator to dispense with a formal audit of the same. 2. Receipt. The Beneficiary requests the Administrator to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery to the undersigned of the property shown as distributable, acknowledges receipt of such property: 51! Skarlatos & Zonarich LLP OPEN FILESlEslates\MOORA0201 . Anne SK. MoorelRelease _ Full Distribution _ Herber! Moore doc Page I of3 - Distribution to Vartan National Bank on Behalf of Herbert C. Moore Payoff of Loan #6161641 $41,083.36 Cash $20,528.64 Total $61,612.00 The Beneficiary does further acknowledge that the aforesaid distribution, in addition to any partial distribution made prior to the date of this Agreement, represents the Beneficiary's entire interest in the above-referenced estate. 3. Release. Upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit-claim and forever discharge from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, (a) the Administrator for or by reason of the Administrator's administration of the above-referenced Estate, or any other act, matter, cause or thing whatsoever; and (b) Skarlatos & Zonarich LLP, its employees, successors and assigns, for or by reason of their representation of the Administrator, or any other act, matter, cause or thing whatsoever. 4. Indemnification. In exchange for the Administrator's willingness to make the distribution hereunder without first securing the benefit of a formal court audit, the Beneficiary agrees to indemnity Administrator and Skarlatos & Zonarich LLP, its employees, successors and assigns, and hold them harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's then pro rata share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which (i) the Administrator may be subjected by reason of the Administrator's administration of the above referenced Estate, as well as the settlement thereof by means of an informal distribution; and (ii) Skarlatos & Zonarich LLP, its employees, successors and assigns may be subjected by reason of their representation of the Administrator. The Beneficiary further agrees to: a. Refund or return, promptly upon the Administrator's written demand, any funds or assets distributed by the Administrator to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. b. Modity and displace any otherwise applicable period limiting the time within which the Administrator's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Administrator need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Administrator shall have obtained actual knowledge of such error or negligence. 5. Miscellaneous a. The provisions of this Agreement shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Agreement shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. 5:\1 Skarlatos & Zonarich LLP OPEN FILES\Estates\MOORA0201 _ Anne S.K. Moore\Release _ Full Distribution Herbert Moore doc Page 2 of3 ---- b. This Agreement shall bind the Beneficiary, the Beneficiary's heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. c. The Beneficiary hereby acknowledges that this Agreement may be filed at any time, at the discretion of the Administrator with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Agreement on the date first above inscribed. ~ ~- WITNESS' \ ORE Social Security Number: 171-38-1332 * * * * * * * * * * * * COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this, the /iJ~ day of f)~ ,2003, before me, the undersigned authority, personally appeared HERBERT C. MOORE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that the Beneficiary executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. ff2!:;~J My Commission Ex I Notarial Seal Sharon K. Shaffer, Notary Public City of Harrisburg, Dauphin County My Commission Expires Sept. 6. 2004 Mernbei, ylvanl8AasocI8~onotNofaries 5\1 Skarlatos & Zonarich LLP OPEN FILES\Estates\MOORA020J _ Anne SK Moore\Release _ Full Distribution Herbert Moore doc Page 3 DO ......... ~ ESTATE OF ANNE SCHAEFFER KEEFER MOORE, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE NO. 21 - 02 - 0875 RECEIPT, RELEASE AND INDEMNIFICA nON AGREEMENT For Full Distribution This Receipt, Release and Indemnification Agreement (hereinafter referred to as "Agreement") is given this ~ day of ~<'EfJ. , 2003, by RlCHARD W. MOORE, of 8110 Ventner Avenue, Margate, New Jersey, (hereinafter referred to as "Beneficiary"). WITNESSETH: WHEREAS, Anne Schaeffer Keefer Moore, (hereinafter referred to as "Decedent"), late of Lower Allen Township, Cumberland County, Pennsylvania, died intestate on August 27, 2002. WHEREAS, Letters of Administration on the Estate of the said Decedent were duly issued on September 30,2002, by the Register of Wills of Cumberland County, Pennsylvania, unto Herbert C. Moore, who was appointed as Administrator of the Estate (hereinafter referred to as "Administrator"); WHEREAS, the Administrator has paid all the debts, taxes and expenses of the Estate known to him as detailed in the Pennsylvania Inheritance Tax Return and Tax Assessment Notice, and he has no knowledge of any unpaid claim which may be asserted against the Estate, nor does he have any reason to believe that there are any such claims; WHEREAS, the Beneficiary is beneficially interested in the above referenced estate; and WHEREAS, it is the desire of the Beneficiary that distribution be made without the formality of an accounting, and the Administrator is willing to make such distribution upon the receipt of a proper release and indemnification, which it is the purpose of this Agreement to provide. NOW. THEREFORE, intending to be legaliy bound hereby, the Beneticiary represents, warrants, covenants and agrees as follows: I. Waiver of Accounting. The Beneficiary hereby waives the necessity for an accounting and directs the Administrator to dispense with a formal audit ofthe same. 2. Receipt. The Beneficiary requests the Administrator to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery to the undersigned of the property shown as distributable, acknowledges receipt of such property: Cash - $78,823.00 The Beneficiary does further acknowledge that the aforesaid distribution, in addition to any partial distribution made prior to the date of this Agreement, represents the Beneficiary's entire interest in the S II Skarlalos & Zonarich LLP OPE:-.I FII_ES\Estates\MOORA0201 _ Anne SK. M00le\Release _ Full Distribution _ Richard r-loore doc Page I of3 ............ . above-referenced estate. 3. Release. Upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit-claim and forever discharge from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, (a) the Administrator for or by reason of the Administrator's administration of the above-referenced Estate, or any other act, matter, cause or thing whatsoever; and (b) Skarlatos & Zonarich LLP, its employees, successors and assigns, for or by reason of their representation of the Administrator, or any other act, matter, cause or thing whatsoever. 4. Indemnification. In exchange for the Administrator's willingness to make the distribution hereunder without first securing the benefit of a formal court audit, the Beneficiary agrees to indemnity Administrator and Skarlatos & Zonarich LLP, its employees, successors and assigns, and hold them harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's then pro rata share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which (i) the Administrator may be subjected by reason of the Administrator's administration of the above reterenced Estate, as well as the settlement thereof by means of an informal distribution; and (ii) Skarlatos & Zonarich LLP, its employees, successors and assigns may be subjected by reason of their representation of the Administrator. The Beneficiary further agrees to: a. Refund or return, promptly upon the Administrator's written demand, any funds or assets distributed by the Administrator to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. b. Modity and displace any otherwise applicable period limiting the time within which the Administrator's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Administrator need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Administrator shall have obtained actual knowledge of such error or negligence. 5. Miscellaneous a. The provisions of this Agreement shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Agreement shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. b. This Agreement shall bind the Beneficiary, the Beneficiary's heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. c. The Beneficiary hereby acknowledges that this Agreement may be filed at any time, at the discretion of the Administrator with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Agreement on the date first above inscribed. 5:\1 Skarlatos & Zonarich LLP OPEN FILES\Eslates\MOORA0201 . Anne S.K Moore\Release _ Full Distribution _ Richard Moore.doc Page 2 of3 .. . . ~ci!ht/k.Fi?rzler Social Security Number: /70- 3 2.- 2- cy g Lj * * * * * * * * * * * * COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN . ' ..-, t~\ ~'_ ~ I~ ~ . On thiS, the I, day of 'JePi6J11 r;t::12-- , 2003, before me, the undersigned authority, personally appeared RICHARD W. MOORE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that the Beneficiary executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. My Commission Expires: ., 5:\1 Skarlatos & Zonarich LLP OPEN FILESlEslales\MOORA0201 - Anne S.K. Moore\Release. Full Distributioll _ Richard Moore doc Page 3 of3 ---- " //- P/- Y ..v BUREAU OF INOIVIOUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR OISALLOHANCE OF OEDUCTION~, AND ASSESSHENT OF TAX ON JOINTLr HELD OR TRUST ASSETS REV.lS48EXAFPIDl_O!l RICHARD 23 KELLY CARLISLE W MOORE DR DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 10-27-2003 MOORE 08-27-2002 21 02-0875 CUMBERLAND 183-12-1302 02149805 Allount Remitted ANNE S PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: RESISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-v=is4-i-Ex--AFP--fol-:03i----------------------------------------------------________________________________ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF MOORE ANNE S DATE OF DEATH 08-27-2002 COUNTY CUMBERLAND FILE NO. 21 02-0875 TAX RETURN WAS: S.S/D.C. NO. 183-12-1302 (X) ACCEPTED AS FILED () CHANSED JOINT OR TRUST ASSET INFORMATION ACN 02149805 FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0183121302-50 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINSS ( ) CHECKINS ( ) TRUST (Xl TIME CERTIFICATE 01-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 54,525.62 0.166 9,087.79 .00 9,087.79 .45 408.95 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE RESISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "RESISTER OF WILLS, ASENT." X TAX CREDITS: PAYMENT RECEl PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARSED THROUSH 11-04-2003 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 408.95 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 9.02 TOTAL DUE 417.97 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . [ IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I ~.. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of MOORE, ANNE SCHAEFFER KEEFER ---------- __ __ ___n_________________ , Deceased No. 21 - 02 - 00875 Date of Death 8/27/2002 Social Security No. 183-12-1302 also known as Herbert C. Moore - - --- -- -- The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Sheliy J. Kunkel Personal RepreseiJta, :~ Signature: ~.. e . oore Signature: LD. No.: 64485 Signature: Address: 204 State Street Harrisburg, PA 17101 Address: 1510 North Union Street Middletown, PA 17057 Telephone: 717/233-1000 Telephone: 717-944-7544 Dated: _llJ..~~aJ Personal Property Citizens Bank Checking Account No. 6100725782 (per verification attached hereto as Schedule E) 5,083.52 Citizens Bank Checking Account No. 6100725782 (accrued interest to DOD per verification letter attached hereto as Schedule E) 0.78 M & T Bank Savings Account No. 15004200900006 (per verification attached hereto as Schedule E) 2,403.04 M & T Bank Savings Account No. 15004200900006 (accrued interest to DOD per verification attached hereto as Schedule E) 0.36 M & T Bank Certificate of Deposit No. 31003910413564 (per verification attached hereto as Schedule E) 5,627.80 M & T Bank Certificate of Deposit No. 31003910413564 (accrued interest to DOD per verification attached hereto as Schedule E) 342.08 (Attach additional sheets if necessary) Total Personal Property and Real Estate $200,602.04 ; Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of MOORE, ANNE SCHAEFFER KEEFER No. 21 - 02 - 00875 Date of Death 8/27/2002 Social Security No. 183-12-1302 also known as , Deceased 1,134.95 M & T Bank Certificate of Deposit No. 31003910506525 (per verification attached hereto as Schedule E) M & T Bank Certificate of Deposit No. 31003910506525 (accrued interest to DOD per verification attached hereto as Schedule E) M & T Bank Certificate of Deposit No. 31003910076049 (per verification attached hereto as Schedule E) M & T Bank Certificate of Deposit No. 31003910076049 (accrued interest to DOD per verification attached hereto as Schedule E) M & T Bank Certificate of Deposit No. 31003910076065 (per verification attached hereto as Schedule E) M & T Bank Certificate of Deposit No. 31003910076065 (accrued interest to DOD per verification attached hereto as Schedule E) 1987 Cadillac Sedan 1968 Volkswagen Sedan Personal and household property Patriot News - subscription refund 21.31 6,266.43 257.85 10,421.77 428.85 3,000.00 100.00 500.00 13.30 Total Personal Property $35,602.04 2 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of MOORE, ANNE SCHAEFFER KEEFER ----.-- ---- J" . also known as No. 21 - 02 - 00875 , Deceased Date of Death 8/27/2002 Social Security No. 183-12-1302 Real Estate 15 Amherst Drive, Camp Hill (settlement proceeds per Settlement Statement attached hereto as Schedule A) 165,000.00 Total Real Estate $165,000.00 3 '\ (l.',~ \~EV.1600H'('.oo) w ~ ~<~ U~~ w~g :r::~.J U~~ ~ < *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER 21 02 yEAR SOCIAL SECURITY NUMBER 00875 !\lUMBER - ---0 --2. Sup-pleme~taJ Retur~ o 4a. Future Interest Compromise (date of death after 12-12-82) 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach of Will) copyofTNSt) o 9 litigation Proceeds Received 0 10. Spousal poverty Credit (dale of dealh between 0 11.Election to lax under Sec. 9113(A) (Attach Sch OJ ~H.sseCtIQNMU$rescqMi>LeTEB.ALkCORRE~;d~~~~~~~lI"ibtfriiW.t~NfQ~tio'"SH()lILDB~!lI~~CTEO TO: AME I COMPLETE MAILING ADDRESS Shelly J. Kunkel , COMMONWEALTH OF PENNSYLVANIA DEPAR"TMENl OF REVENUE j DEPT. 260601 __ ~RRISa~G,PA t71~a~060_1____ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) MOORE, ANNE SCHAEFFER KEEFER ~ z W Q W U W Q DATE OFO-EA TH -{MM-DD~YEART------ DATE OF BIRTH {MM-DD-YEAR} 0812712002 ____ _~J2III1I920__ (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL) ---~ o o Original Return 4. Limited Estate ~ z W Q ~ fiRM NAME (If applicable) ! Skarlatos & Zonarich LLP rElEPHONE NUM8ER---- 717/233-1000 1. Real Estate (Schedule A) 2. Slacks and Bonds (Schedule B) z Q ~ " ~ ~ < u w ~ 3, Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. InterNivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule J) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 183-12-1302 --r THIS RETURN MUST BE FILED IN DUPLICATE WITH THE \ -'~EGISTER OF WILLS SOCIAl SECURITY NUMBER I -0 o 3.- Remainder Return (dale of death priorlo 12-13.82) 5. Federal Estate Tax Return Required 8 Total Number of Safe Deposit Boxes 204 State Street Harrisburg, P A 1710 1 (1) 165,000.00 -.. --..-.-.--- (2) None (3) None (4) None (5) 35,602.04 (6) 54,683.25 (7) 86,362.19 (8) 341.647.48 (9) 28,477.04 (10) 5,388.31 (11) 33,865.35 (12) 307,782.13 (13) 13. Charitable and Governmental Bequests/See 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) (14) 307,782.13 SEE INSTRUCtiONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or Iransfers under Sec. 9116(a)(1.2) z o ~ ~ " ~ ~ 8 ~ 16,Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x ,00 (15) 307,782.13 x ,045 (16) 13.850.20 x .12 (17) x ,15 (18) (19) 13,850.20 120 ~- CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT _ >>,BE SURnO AN$1NER AU. QlI~Tt~bI$ ON !(I!~E l!!b.EANO ~<lIIE~K MATH<< ' Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 15 Amherst Drive --~- CITY FTE PA --iZIP 170]] Camp Hill Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 13,850.20 14,000.00 ---- ----- 692.5 ] Total Credits (A . B. C) (2) 14,692.51 3. InteresUPenalty if applicable D. Interest E. Penally TolallnleresUPenally (D' E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enler the tolal of Line 5 . SA. This is the BALANCE DUE. (5B) Make Check Payable foe REGISTER OF WILLS, AGENT 0.00 842.31 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.. ~ I b. retain the right to designate who shall use the property transferred or its income;... c. retain a reversionary interest; or. d. receive the promise for life of either payments, benefits or care?.. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without 0 receiving adequate consideration?........ ............... o 181 3. Did decedent own an uin trust for" or payable upon death bank account or security at his or her death?. . 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation?...... 181 181 o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of p&~ury, I dedare that I hava examined this retum, Including accompanying schedules and statements, and to the best of my knowledge and balief. it is true. correct and complete Declaration of prepa . ~~_her t l~e e~rsonal_rep.resentatll,le__I~_ based on alllnforma.tlC?~of which_prEl~rer ha!.anr_knowl~d~~-______ _ _______ _ _ SIG URE 0 S N RESPONSIBLE FOR FILING RETURN ADDRESS DATE Hef rt re , \.; / 1510 North Union Streel _ Middletown, PA 17Q57 ADDRESS II. J'I-'63 DATE -6F--PREP-ARE-R OTHER T-HAN REPRESENTAT~ nkel ADDRESS DATE .~ 204 State Street Harrisburg, PA 17101 Ij-J,q. a?J For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 <a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)l. The statute does not exemot a transfer to a sUNiving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% {72 P .S. 99116 (a) (1.2)}. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2)\72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. ~9116 (a) (1.3)]. A sibling (s defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . SCHEDULE A REAL ESTATE I __1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT , FILE NUMBER 21 - 02 - 00875 ESTATE OF MOORE, ANNE SCHAEFFER KEEFER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilnng seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 165,000.00 15 Amherst Drive, Camp Hill (settlement proceeds per Settlement Stalement attached herelo as Schedule A) TOTAL (Also enler on Line 1, Recapitulation) 165,000.00 ESTATE OF *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX. RETURN RESIDENT DECEDENT j -- I FILE NUII/I-SER . ___.... 21 -(j2 - 00875 MOORE, ANNE SCHAEFFER KEEFER 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 NUMBER ___n 1 DESCRiPTION VALUE AT DATE OF DEATH 5,083.52 ---- ----- --- ---. ---.- Citizens Bank Checking Account No. 6100725782 (per verification attached hereto as Schedule E) 2 Citizens Bank Checking Account No. 6100725782 (accrued interest to DOD per verification letter attached hereto as Schedule E) 0.78 3 M & T Bank Savings Account No. 15004200900006 (per verification attached hereto as Schedule E) 2,403.04 4 M & T Bank Savings Account No. 15004200900006 (accrued interest to DOD per verification attached hereto as Schedule E) 0.36 5 M & T Bank Certificate of Deposit No. 31003910413564 (per verification attached hereto as Scheduie E) 5,627.80 6 M & T Bank Certificate of Deposit No. 31003910413564 (accrued interest to DOD per verification attached hereto as Schedule E) 342.08 7 M & T Bank Certificate of Deposit No. 31003910506525 (per verification attached hereto as Schedule E) 1,134.95 8 M & T Bank Certificate of Deposit No. 31003910506525 (accrued interest to DOD per verification attached hereto as Schedule E) 21.31 9 M & T Bank Certificate of Deposit No. 31003910076049 (per verification attached hereto as Schedule E) 6,266.43 10 M & T Bank Certificate of Deposit No. 31003910076049 (accrued interest to DOD per verification attached hereto as Schedule E) 257.85 II M & T Bank Certificate of Deposit No. 31003910076065 (per verification attached hereto as Schedule E) 10,421.77 12 M & T Bank Certificate of Deposit No. 31003910076065 (accrued interest to DOD per verification attached hereto as Schedule E) 428.85 13 1987 Cadillac Sedan 3,000.00 14 1968 Volkswagen Sedan 100.00 15 Personal and household property 500.00 16 Patriot News - subscription refund 13.30 TOTAL (Also enter on Line 5, Recapitulation) 35,602.04 *' SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER I I 21-02-00875 MOORE, ANNE SCHAEFFER KEEFER If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Richard W. Moore 8110 Ventner Avenue Margare, NJ 1510 North Union Street Middletown, PA Son B Herbert C. Moore Son JOINTLY OWNED PROPERTY: ITEM T F~~1Jgl~~L' . ..~~~~ . Include name o~~~~~~T~~t~u~:nPa~~~~~:;cc~~nt nU~ber~1 DATE~F ~~:T-:-I D~CO&S DA0~~GED~TH NUMBER tl TENANT. JOINT ~~t~~'lar Identifying number. Attach deed for JOintly-held real VALUE OF ASSET IINTEREST DECEDENT'S INTEREST --1 - -A,B--01/15/2002PSECU~RegularShar~AccountNo~0183121~ -----157.41 100% 157.41 I I (per verification attached hereto as Schedule F) , 2 A, B 01/15/2002 PSECU - Regular Share Account No. 0183121302 0.22' 100% 0.22 (accrued interest to DOD per verification attached hereto as Schedule F) 3 , A, B ' 01/15/2002 PSECU - 60 Month Certificate Account No. 0183121302 (per verification attached hereto as . Schedule E) 54,336.351 100%; 54,336.35 4 A,B 0111512002 PSECU-60 Month Certificate No. 0183121302 (accrued interest to DOD per verification attached hereto as Schedule F) 189.27: I 100%' 189.27 ..L._ _1 _...L_ TOTAL (Also enter on line 6, Recapitulation) 54,683.25 . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY _ __ This schedule must be completed and filed if the answer to any otguestlons 1 through 4 on page 2 is yes. , - DESCRIPTION OF PROPERTY A OF o---r- % OF -I --- - ITEM II IncJudelhe name of the transferee IhBlr relallOnshlp 10 decedent and Ihe date of transfer. I~ TE 0 EATH DECO'S I EXCLUSION TAXABLE VALUE NUM8ER~_ ___ _AI"""ropy Oflh"":'" ,,,' ,,"" ___ +LUE_: ASSET \ INT~E_ST ,(IFAPPUCABLEI M & T Bank IRA No_ 35004200214259 (transferred on 25,958:nf 25,958_73 DOD to decedent's sons, Herbert C Moore and Richard W_ . Moore) I M & T Bank IRA No. 35004200307418 (transferred on DOD to decedent's sons, Herbert C. Moore and Richard W. Moore) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ----...-------" ESTATE OF MOORE, ANNE SCHAEFFER KEEFER 2 3 Western Southern Life - Annuity Contract No. W0020126936 (transferred on DOD to Bonnie L. Moore, Sheri Ann Moore-Ritz, Christie L. Moore, Cay1a A. Ritz, I Marianne Moore, Richard H. Moore and David C. Moore I (per verification attached hereto as Schedule G) ~ I FILE NUMBER 21 - 02 - 00875 I 23'907.301 23,907.30 36,496.161 36,496.16 __~_~ ____L. 86,362.19 TOTAL (Also enter on line 7, Recapitulation) *' SCHEDlII..E H FUNERAL EXPENSES & ADMINI51RA1lVE COSTS I 1 I FiLE NUMBER 21 - 02 - 00875 COlltMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX ReTURN RESIDENT DECEDENT ESTATE OF MOORE, ANNE SCHAEFFER KEEFER Debts of decedent must be reported on Schedule I. --- ------ - ITEM h NUMBER .... -.... -..-.- --- ..---- - ---- ---- A. FUNERAL EXPENSES: I ,Coble Reber Funeral Home DESCRIPTION AMOUNT 2 Hughes Flowers 3 James Gingrich Memorials - Headstone inscription I I B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Skarlatos & Zonarich 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees Register of Wills State Zip 5. Accountant's Fees Preparation of Fiduciary Income Tax Return 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland County Reporter - Advertise Lellers of Administration 2 The Sentinel - Advertise Letters of Administration Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 4,441.89 50.88 80.00 5,250.00 298.00 550.00 75.00 90.59 17,640.68 28,477.04 . Schedule H FunemlExpenses& Adminislrative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOORE, ANNE SCHAEFFER KEEFER 3 Settlement Charges from sale of 15 Amherst Drive, Camp Hill (per Settlement Statement attached hereto as Schedule A) 4 Register of Wills - Additional Short Certificates 5 Federal Express - Overnight car title to Richard Moore 6 File Receipt, Release & Indemnification Agreements 7 Pennsylvania Department of Transportation - Vehicle transfer I __I I FILE NUMBER _ 2 I - 02 - 00875 17,564.93 9.00 11.75 19.00 36.00 Page 2 of Schedule H ESTATE OF *' I DEBTS OF DECEDENT, MORTGAGE _Lu .~IABILlTIES, & LIENS SCHEDULE I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MOORE, ANNE SCHAEFFER KEEFER I FILE NUMBER ___1 21 - 02 - 00875 Include unreimbursed medical expenses. ITEM NUMBER -- ---- I 2 3 4 5 6 7 10 II 12 DESCRIPTION AMOUNT ____ ____, ___ __ _____n _____________ 413.56 SERS - Return of benefit 8/8/02 - 09/20/02 Chase Go Id Visa - Balance 195.26 Bonnie Miller, Tax Collector - 2002 Real Estate taxes, 15 Amherst Drive, Camp Hill 1,633.17 Bank Card Services - Balance 33.58 PPL - IS Amherst Drive, Camp Hill 481.97 Comcast Cable - IS Amherst Drive, Camp Hill 27.08 Pennsylvania American Water - IS Amherst Drive, Camp Hill 194.67 8 Lower Allen Township - Trash/Sewer - IS Amherst Drive, Camp Hill 316.32 9 UGI - IS Amherst Drive, Camp Hill 387.94 Traveler's Insurance - Automobile !Insurance 704.00 Bonnie Miller, Tax Collector - Real Estate Taxes, 15 Amherst Drive, Camp Hill 532.76 Travelers Insurance - Homeowner's Insurance, IS Amherst Drive, Camp Hill 468.00 TOTAL (Also enter on Line 10, Recapitulation) 5,388.31 REV-1513 EX+ (9.00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOORE, ANNE SCHAEFFER KEEFER FILE NUMBER 21 - 02 - 00875 NUMBER I - ---1- TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Herbert C. Moore 11510 North Union Street Middletown, P A 17057 ut RELATIONSHIP TO DECEDENT no Nnl I I_I Tnl_IA.I.~ AMOUNT OR SHARE OF ESTATE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. Son One-half Estate Residue 2 Richard W. Moore 8110 Ventner Avenue Margate, NJ 08402 Son One-half Estate Residue II. Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet: I ,NON-TAXABLE DISTRIBUTIONS: IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ESTATE OF ANNE SCHAEFFER KEEFER MOORE FILE NO. 21 - 02 - 00875 INHERITANCE TAX RETURN - SCHEDULE A 'A. R TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT I.QFHA 2-:-nFmHA 3.lxlcONV. UNINS. 4.nVA 5-:-nCONV. INS. SETTLEMENT STATEMENT 6. ~~.f ~~~BER 17. LOANN1.JMaER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[pOC]" were paid outside the closing; they are shown here for informational purposes and are not included in the fota/s. 1.0 3I\J8 (MOORE RlCHARD.PFDIFAT 3-102/18) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: RICHARD MOORE ESTATE OF ANNA MOORE Vartan National Bank 15 AMHERST DRIVE 3601 Varian Way CAMP HILL, PA 17011 Harrisburg, PA 17110 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1802264 I. SETTLEMENT DATE: 15 AMHERST DRIVE CHESAPEAKE ABSTRACT COMPANY CAMP HILL, PA 17011 August IS, 2003 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 204 STATE STREET HARRISBURG, PA 17101 . UMMARY OF SE~ACTIO J. S Y B ER'S NSAC N 101. ContractSalesPrice 165,000.00 401. Contract S~les Price 165,000.00 102. Personal Prooertv 402. Personal Prooertv 103. Settlemenl Charoe. to Borrower lLine 1400 4,310.93 403. 104. 404. 105. 405. n r , In n m 1 v n 106. Citvrrown Taxes to 406. Citvrrown Taxes to 107. County Taxes to 407. Coon Taxes to 108. School to 408. School to 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 169,310.93 420. GROSS AMOUNT DUE TO SELLER 165,000.00 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Denosit or earnest monev 500.00 501. Excess Deposit (See Instruction.\ 202. Princioal Amount of New Loants) 152,100.00 502. Settlement Charces to Seller (Une 1400 354.00 203. Exstino loanls\ taken sublect to 503. Existinc Joan{s taken subiect to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortcaae 206. 506. Deoosit retained bv seller 500.00 207. 507. 208. 508. 209. Intestate Interest 16,710.93 509. Intestate Interest 16,710.93 us ns r tems n al e er u ens or Items Un Bl e er 210. Citvrrown Taxes to 510. C'itVITown Taxes to 211. CountvTaxes to 511. CouiiiV Taxes to 212. School to 512. SChool to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. - 220. TOTAL PAID BY/FOR BORROWER 169,310.93 520. TOTAL REDUCTION AMOUNT DUE SELLER 17,564.93 300. CASH AT SETTLEMENT FROMfTO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower ILine 120) 169,310.93 601. Gross Amounl Due To Seller lLine 420\ 165,000.00 302. Less Amount Paid By/For r bi(le4<!O) ( 169,310.93 602. Less Reductions Due Seller (Line 520) ( 17,564.93 303. CASH ( FR MJ{ TO I 8~RROWEW 0.00 603. CASH ( X TO)( FROM) SELLER 147,435.07 The undersigned ere\\:Ckn ':ltJ7L- completed copy of pages 1&2 of this statement & a AChm~cJ..M1'i6rein. Borrowe 1A'... Y/ . _ Seller . ~D MOORE TATE OF ANNA MOORE , Palle2 "1> L SETTLEMENT CHARGES FAL COMMISSION Based on Price . Iiil "^ PAID FROM PAID FROM ~vision of Commission fline 700) as Follows: BORROWER'S SELLER'S Ai to FUNDS AT FUNDS AT A:$ to SETTLEMENT SETTLEMENT ./03. Commission Paid at Settlement I 704. to 8 . TEM LEIN ON WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to Vartan National Bank 300.00 POC -200.00 804. Credit Report to Vartan National Bank 50.00 POC 805. Lender's Inspection Fee to 806. Document Preo to Vartan National Bank 300.00 807. Flood Certification to 808. 809, 810. 811. D BY LENDFR Tn BE PAID 901. Interest From 08115/03 to 09/01/03 @ $ 27.460000/day ( 16 days %) 439.40 902. Mortaage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVE" nEPnSITED WITH LENDER 1001. Hazard Insurance 10.000 months $ 36.42 per month , 364.20 1002. Mortnane Insurance 2.000 months $ 98.67 per month 197.74 1003. CitvfTown Taxes months $ per month 1004. CountvTaxes 8.000 months $ 44.40 per month 355.20 1005. Schooi 3.000 months @ $ 120.43 per month 361.29 1006. months $ per month 1007. months $ oer month 1008. annrenate adjustment months $ per month -476.86 1100. TITLE CHARGES 1101. Settlement or Ctosinc Fee to 1102. DR Lien Search to 1103. Closinn Protection Letter to First American Title Insurance Comoany 35.00 1104. Pren of Anreement of Sate to Skartatos & Zonarich LLP 250.00 1105. Document Prenaration-deed to Skarlatos & Zonarich LLP 100.00 1106. Nolaru Fees to CHESAPEAKE ABSTRACT COMPANY 12.00 1107. Federal Express to CHESAPEAKE ABSTRACT COMPANY 45.00 includes above item numbers: J 1108. Title Insurance to CheasanAake Abstract Comnanv 1183.75 (includes above item numbers: ) 1109. Lender's Coverage $ 152,100.00 1110. Owner's Coverage $ 165,000.00 1,183.75 1111. Endorsements 100,300,8.1 to CHESAPEAKE ABSTRACT COMPANY 150.00 1112. 1113. 12M" NMEN DIN D ES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 60.50; Releases $ 99.00 1202. Citv/CountVTax/Slamos: Deed . Mortaaae 1203. Slate Tax/Slamns: Revenue Stamps ; Mortcace 1204. 1205. pnn AnOIT E E 1301. Survev to 1302. Pest InsnAction to 1303. 2003 school lax to Bonnie K. Miller 1,445.21 1304. Tax certification to Bonnie K. Miller 4.00 1305. 1400. TOTAL SETTLEMENT CHARGES IEnter on Lines 103, Section J and 502, Section KI /" 4,310.93 354.00 By signing page 1 of this slatement, the signatories acknowledge receipt of a comPlez:qf :ag1~th~s ~ole~~__ Certified to be a true copy. SfIESAPEAKE ABSTRAC I t-~G Settlement Agent (FAT3-102/FAT3-102/19) ESTATE OF ANNE SCHAEFFER KEEFER MOORE FILE NO. 21 -02 - 00875 INHERITANCE TAX RETURN - SCHEDULE E ~ ~ r./) ~ ~ ~ () ~ m M&rBank Manufacturers and Traders Trust Company, 1100 Wehrle Drive, P.O. Box 767, Buffalo, NY 14240-0767 ---// October 24, 2002 RE: Estate Search The Estate of: Date of Death (D.O.D.) ANNE S MOORE 8/27/2002 To Whom It May Concern: Identified below is the account information requested. I. M&T Bank accounts in which the decedent's name appears: Account Type SAY CD CD CD IRA IRA CD Account Number Account Title Opening BnIJ1ch D.O.D. Accrued Interest Balances (Includes Accr. Int.) $2403.40 $.36 15004200900006 ANNE S MOORE 4330 OPENED 4/91 31003910413564 ANNE S MOORE 4330 OPENED 9/99 31003910506525 ANNE S MOORE 4330 OPENED 10/99 31003910076049 ANNE S MOORE 4330 OPENED 12/97 35004200214259 ANNE S MOORE 4330 OPENED 4/99 35004200307418 ANNE S MOORE 4330 OPENED 4/99 31003910076065 ANNE S MOORE 4330 OPENED 12/97 $5969.88 $342.08 $1156.26 $21.31 $6524.28 $257.85 $25,958.73 $864.67 $23,907.30 $124.22 $10,850.62 $428.85 2. Loans, Mortgages, or other obligations titled in the decedent's name Amount Owed Account Description Account Number 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: <fJ~~ ~~ Authonzed Signature DATE: (O~J'-f ~OL-- EST ATE OF ANNE SCHAEFFER KEEFER MOORE FILE NO. 21 - 02 - 00875 INHERITANCE TAX RETURN - SCHEDULE F PSECIt; the finaneia/link TM October 18, 2002 Account # 0183121302 SHELLY J KUNKEL 204 STATE ST HARRISBURG, PA 17101 Dear MS KUNKEL: The following is the status of ANNE S MOORE's account with PSECU as of the date of death. Joint Owner's Name Date Established Date of Death Date of Birth , RICHARD W MOORE, HUBERT C MOORE, JOINT TENANTS WIROS 01.15.2002 08.27.2002 12.11.1920 Share( s) Regular Shares (S 1) MoneyHandler Shares (S4) 60 Month Certificate-l (S50) Balance $ 157.41 0.00 54,336.35 Accrued Dividend $ 0.22 0.00 189.27 The dividend earned from January I, 2002 through the date of death was $1,709.93. The decedent had no loans with us and no automatic deposits. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, ~. -[ Meacie FairY Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990. (717) 234-8484. (BOO) 237-7328 Mailing Address: P.O< Box 67013, Harrisburg, PA 17106~7013 . (717) 777-2100 (TOD) . (800) 472-1967 (TOO) Web Address: www.psecu.com Savings federally insun!d up to $100,000 by the National Credit Union Administration. EST ATE OF ANNE SCHAEFFER KEEFER MOORE FILE NO. 21- 02 - 00875 INHERITANCE TAX RETURN - SCHEDULE G . Western-Southern Llfe~ 08/13/2003 SHELLY J KUNKEL SKARLOTOS & ZONARICH lLP ATTORNEYS AT LAW 204 STATE STREET HARRISBURG PA 17101 Dear Ms Kunkel Subject: Annuity Contract W0020126936 for Anne S Moore This is in reference to your faxed information dated August 12, 2003 conceming the previous information requested in your letter dated April 25, 2003. I hope the following contract information is helpful to you. . Annuitant and Owner: ANNE MOORE . Date Annuity Opened: 10-05-1999 . Quarterly interest checks starting 6-30-2000 ceased 12-17-02. Note: There was a quarterly interest check in the amount of $471.23 mailed to client 10-03-02 that was not retumed to Westem-Southem Ufe. . Date of death value $35,753.24 . Amount of interest accrued and paid since date of death $742.92 If you have any questions conceming this information, please contact the Annuity Operations Department at 1-800-926-1702. Sincerely, /'~ A-r~ Pamela A Fultz Annuity Administrator Annuity Operations Department F011 Annuity Operations Group' P.O. Box 2918' Cincinnati, OH. 45201-2918 COHHONHEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTHENT OF REVENUE [NHERZTANCE TAX D[VZSZON DEPT. Z8060! HARRZSBURG, PA 171Z8-0601 NOT/CE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX REV-I~7 EX AFP CD1-05) DATE 01-27-200~ ESTATE OF HOORE ANNE S DATE OF DEATH 08-27-2002 FZLE NUNBER 21 02-0875 '' COUNTY CUHBERLAND SHELLY J KUNKEL SKARLATOS & ZONARICH ACN 101 ZO~ STATE ST Aaoun~ Remli~ed HBG PA 17101 HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTZCE OF INHERZTANCE TAX APPRAZSENENT, ALLOW~-~[-~-~ ................. DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF HOORE ANNE S FZLE NO. 21 02-0875 ACH 101 DATE 01-27-ZOOq TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 165/000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, $. Closely Held Stock/Partnership Knterest (Schedule C) ($) .010 submit the upper portion 4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 55/60Z.Oq tax payment. 6. Jointly Owned Property (Schedule F) (6). 7. Transfers (Schedule G) (7) 86/562.19 8. Total Assets (8) 5~1,6~7.~8 APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 28,~77.0~ 10. Debts/Hortgege Liabilities/Liens (Schedule K) (10)_ 11. Total Deductions (11) 33.8&5.3~ 12. Net Value of Tax Return (12) 507,782.15 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 14. Net Value of Estate SubSact to Tax (lq) 507,782.15 NOTE: Zf an assessment was issued previously, lines la, 15 and/or 16, 17, 18 and 19 will reflect figures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X O0 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 507,782.15 X Oq5 = 15,850.20 17. Amount of L/ne 14 at Sibling rate (17) .00 X 12 = .00 18. Aeount of Line 14 taxable at Collateral/Class B rate (18) .00 X 1~ = .00 19. Principal Tax Due TAX CREDZTS: (~9)~ 13,850.20 PAYMENT / RECEZP[ DZ$COUNT DATE NUNBER ZNTEREST/PEN PAKD (-) ANOUNT PAZD 11-20-2002 CD001872 692.51 1~,000.0~ TOTAL TAX CREDIT BALANCE OF TAX DUEI 8~Z.SlCR ZNJ=~EST AND PEN. I .00 TOTAL DUE / 8~Z.31CR n ZF PAZD AFTER DATE KNDKCATED~ SEE REVERSE ( ZF TOTAL DUE KS LESS THAN $1~ NO PAYffENT KS RE~UZRED FOR CALCULATZON OF ADDKTKONAL [NTEREST. KF TOTAL DUE KS REFLECTED AS A 'CREDZT' (CR)~ YOU A REFUND. SEE REVERSE SKDE OF THKS FORH FOR ZNSTRUCTZONS.) CONNON~/EALTH OF PENNSYLVAN'rA BUREAU OF TND'rVTDUAL TAXES DEPARTNENT OF REVENUE ][NHERTTANCE TAX DI*VTSTON DEPT. 280601 ZNHERZTANCE TAX HARRISBURG, PA 17128-0601 STATEHENT OF ACCOUNT REV-i~07 EX AFP (01-03) R~"~. ~ ' ~ .~ATE 05- 01-2004 ~:~:~ ~ ~ ESTATE OF NOORE ANNE S DATE OF DEATH 08-27-Z002 F'rLE NUNBER 21 02-0875 '04 APR -5 P 3 : QUNTY CUNilERLAND SHELLY J KUNKEL ACN 101 SKARLATOS I~ ZONARTCH I Amoun'l: Remi'l:'l:ed 204 STATE ST PA 17101~t~1'1'1~ .. i:. HAKE CHECK PAYABLE AND REN/T PAYNENT TO: REGISTER OF NILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper crmdi~ ~o your account, submi~ ~hm upper por~Jon of *his form wi~h your ~ax payment. CUT ALONG THZS LZNE ~'* RETAZN LO~ER PORTZON FOR YOUR RECORDS REV-1607 EX AFP [01-03) ### ZNHERZTANCE TAX STATENENT OF ACCOUNT ESTATE OF HOORE ANNE S F*rLE NO. 21 02-0875 ACN 101 DATE 05-01-2004 TH/S STATEHENT *rs PROVIDED TO ADV*rSE OF THE CURRENT STATUS OF THE STATED ACN *rN THE NAHED ESTATE. SHONN BELO# *rS A SUNHARY OF THE pR'rNC*rPAL TAX DUE, APPL*rCAT*rON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, *rF APPL*rCABLE, A PROJECTED TNTEREST F*rGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTNENT: 01-20-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 15,850.20 PAYNENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 11-20-2002 CD001872 692.51 14,000.00 02-11-2004 REFUND .00 842.$1- TOTAL TAX CREDIT 13,850.20 BALANCE OF TAX DUE .00 TNTEREST AND PEN. . O0 'rF PATD AFTER TH*rS DATE, SEE REVERSE TOTAL DUE . O0 S*rDE FOR CALCULAT*rON OF ADD*rT*rONAL *rNTEREST. ZF TOTAL DUE *rS LESS THAN $1, NO PAYHENT *rS REGU*rRED. *rF TOTAL DUE *rS REFLECTED AS A "CRED]:T" YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF TNTS FORN FOR *rNSTRUCTTONS. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 KUNKEL SHELLY J 204 STATE STREET HARRISBURG, PA 17101 RE: Estate of MOORE ANNE SCHAEFFER KEEFER File Number: 2002-00875 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/27/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 MOORE HERBERT C 1510 NORTH UNION STREET MIDDLETOWN, PA 17057 RE: Estate of MOORE ANNE SCHAEFFER KEEFER File Number: 2002-00875 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/27/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge JRD/June 30, 1992/17858 SEP U 'i 2004 In Re: Estate of Anne Schaeffer Keefer Moore · ORPHANS' COURT DIVISION Late of Lower Allen Township · COURT OF COMMON PLEAS OF · CUMBERLAND COUNTY Estate No.: 2002-0875 · PENNSYLVANIA NO. 21-2002-0875 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Herbert C. Moore Counsel for Personal Representative: Shelly J. Kunkel, Esquire Date of Decedent's Death: 08/27/2002 Date of Delinquency Notice: 09/10/04 The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on April 30, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the dehnquent personal representative. Date: 09/10/04 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for at in Cou~room No. 3. If the Status Repo~ is filed prior to the he~ng date, the hemng will automatically be c~celled. STATUS REPORT UNDER RULE 6.12 Name of Decedent: ANNE SCHAEFFER KEEFER MOORE Date of Death: AUGUST 27, 2002 Will No.: 0875-2002 Admin. No.: ()~ J615 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report that 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 . representative be complete: If the answer is No, state when the personal reasonably believes that the administration will 3. following: If the answer to No. 1 is Yes, state the a. Did the personal representative file a final account with the Court? Yes No ~~ ...I'. b. The separate Orphans' Court Nd: (i~ any) for the personal representative's account is: fT; ,~ -state U1No an c. Did the personal representative account informally to the parties in interest? Yes X :_9 d. Copies of receipts, releases, j oi'i1l:Iers and approvals of formal or informal accounts may be filed~ith the Clerk of the Orphans' Court and maybe attached to is report. Date: Sept. 10, 2004 Signature Anna Marie Sossong Name (Please type or print) Skarlatos & Zonarich LLP 17 S. Second St., 6th Floor Harrisburg, PA 17101 ~ Address - (717)233-1000 Tel. No. Capacity: Counsel for Personal Representative ~ -^'.\-:-'. /' ~i C'.l b " o o ..J o..u.. :L:t.~ -~~ :r. _ t- <..)'--~ -w ~w~ z" _ ot)C!> ~o~ \() (() ~ ~ r-- 0 <..) ~ ' \-:w" VO '5 ({) c:( . \.. ~:r.:r. ! ~~ \~, ({) 0 {::J (() \ ';: a> (/) 6 € 5 <..)~(") z;-~~ C 0"0 (/) ::l ,,.., t- _ 0 'J" ~ ~<..)?hc:( ~~::lo.. OcoO _ -.sa> ~\.-I.-lii ~lS6'-c . c;, E <..) co ~8~<..) REV - 1&00 EX ; (1.00) *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 02 COJ,ltflYc:;ODE'y'EAR SOCIAL SECURITY NUMBER 00875 .NIJMJlER I 181 1. Original Return -- ~~'2. Supplemental Return 0 3. Remainder Return (date of death p~* to 12-13-82) I o 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 0 5. Federal Estate Tax Return Reqluired 12-12-82) I o 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach B. Total Number of Safe Deposit $oxes of Will) copy of Trust) ~ 120 :.:;;'::~;:::@.AL~~~;~~";;;;;:'N~~.:::~;~;;;;;911E)""oc"'mo: AME JCOMPLETE MAILING ADDRESS I i Anna Mari~ ~~ssong I i FIRM NAME (If applicable) : I Skarlatos & Zonarich LLP 17 South Second Street, 6th Floor I Harrisburg, P A 17101 : COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ... z w o w o w o I' DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ~MOORE,AN~~SCI-IAEFFER K~EF~~ '.'m _ I DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 08/27/2002 12/11/1920 t0FAPPLlCABLE) SURVIVING SPOUSE'S NAME (LAST,FiRSTAN[) MIDDLE INITIAL) I 183-12-1302 w ... lI::!lIl oO:lI: wlLO :cog olf:m IL <( .... lIlz Ww 0:0 O:z 00 Oil. ~ELEPHONE NUMBER THIS RETURN MUST BE FILED IN DupLICATE WITH THE REGISTER OF W}I..L~ SOCIAL SECURITY NUMBER 130,000.00 , 717/233-1000 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o i= ~ ::> ... iL <( o W 0: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (1 ) (2) (3) (4) (5) (6) (7) . -J-:oc-:"~.4---, I . I : 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) None None None I I I j " I I .) i I ! ...--1. None None None (8) 130,000.00 (9) 38,614.74 (11 ) 38,614.74 (12) 91,385.26 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) (13) (14) 91,385.26 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20. D 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 91,385.26 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x i= ~ ::> IL 17.Amount of Line 14 taxable at sibling rate x .12 (17) :l! 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 4,112.34 4,112.34 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. --r." >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 ~X (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 15 Amherst Drive CITY Camp Hill STATE PA I ZIP 170 II Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 4,112.34 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 902.21 Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 902.21 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.................................................................................. D ~ b. retain the right to designate who shall use the property transferred or its income;.............................. ..... D ~ c. retain a reversionary interest; or.................................................................................................................. D ~ d. receive the promise for life of either payments, benefits or care?.................................................. D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................... D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................... ................................................ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF RETURN. .- Under penalties of pe~ury. 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 prep."re! olherth""~h.....p"rs""~"~pre~e,,taliv.~JsJ>-"..e(jo_nall infiJl'l11lllio_~~~J"eparer has any knowledge. SIGNA OF P SO ES NSIBLE FOR FILING RETURN ADDRESS Her er e Declarallon of DATE 1510 North Union Street Middletown, P A 17057 ADDRESS DATE 17 South Second Street, 6th Floor Harrisburg, P A 17101 ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use pf the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. ! __, I \_)0 c.?:,c> S- (.. \) he use of the surviving spouse is 0% e statutory requirements for disclosure For dates of death on or after January 1, 1995, the tax rate impos [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a tram of assets and filing a tax return are still applicable even if the sur K~\ ~PD r'\ --l "\ 01-. (; . () 1) For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceas parent, an adoptive parent, or a stepparent of the child is 0% [72 The tax rate imposed on the net value of transfers to or for the u: 1.2) [72 P.S. ~9116 (a) (1)]. -~c.;- - (,.X) ~er at death to or for the use of a natural ~ tAtA.,.n' ,4.5%, except as noted in 72 P.S. ~9116 The tax rate imposed on the net value of transfers to or for the u '.S. ~9116 (a) (1.3)]. A sibling is ~efined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ESTATE OF *' SCHEDULE A REAL ESTATE All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is de~ned 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. Real property which is jointly-owned with right of survivorship must be disqlosed on schedule F. i i VA~UE AT DATE OF i DEATH -j I 130,000.00 ITEM NUMBER 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MOORE, ANNE SCHAEFFER KEEFER FILE NUMBER 21-02-00875 DESCRIPTION Felker Road - Parcel #34-011-184 (Sale Value) TOTAL (Also enter on Line 1, Recapitulation) 130,000.00 ESTATE OF '. SCH3)lJL.EH FUNERAL EXPENSES & ADMINIS1RAT1VE COSTS FILE NUMBER 21-02-00875 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MOORE, ANNE SCHAEFFER KEEFER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. FUNERAL EXPENSES: 2 3 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions DESCRIPTION AMOUNT. Social Security Number(s) I EIN Number of Personal Representative(s): City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 State Zip Street Address City Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zip Other Administrative Costs Robert Sherrick, Surveyor (Expense required for lot subdivision in order to sell property) 2 Londonderry Township - Subdivision cost (Expense required for lot subdivision in order to sell property) Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) II 10,366.40 70.00 28,178.34 38,614.74 '. Schedule H Funeral Expenses & Administrative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . FILE NUMBER 21 - 02 - 00875 ESTATE OF MOORE ANNE SCHAEFFER KEEFER , 3 Dauphin County Planning Commission - Subdivision (Expense required for lot subdivision in order to sell property) 4 Marvin Stoner, SEO - Perk and probe tests (Expense required for lot subdivision in order to sell property) 5 H. C. Moore Contracting - Excavation, land clearing (Expense required for lot subdivision in order to sell property) 6 Settlement charges 7 Register of Wills - Cumbo Co. - Filing fee for Supplemental Return II 148.00 325.00 9,840.00 17,850.34 15.00 Page 2 of Schedule H 1/ REV.151i EX. (9-00) '. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY FILE NUMBER 21 - 02 - 00875 I AMOUNT OR SHARE Or ESTATE MOORE, ANNE SCHAEFFER KEEFER I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Herbert C. Moore 1510 North Union Street i Middletown, P A 17057 ! RELATIONSHIP TO DECEDENT llo_NoILlsUrustu(s) I Son : ' lOne-half Estate Residue 2 Richard W. Moore I 8110 V entner Avenue ! Margate, NJ 08402 I Son I One-haIr Estate Residue j I I :, I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet! I II. ! NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS SKARIA.1I.U) & WNARIffi UP ATTORNEYS AT l.AW SKARLATOS 8: ZONARICH BUILDING 17 SOUTH SECOND STREET, 6..... FLOOR HARRISBURG, PENNSYLVANIA 17101-2039 (717) 233-1000 TELEFAX (7 t 7) 2.33~6740 WWW.SKARLATOSZONARle....COM WRITER'S EMAIL: sharon@skal1atoszonarich.com September 15, 2005 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Anne S.K. Moore Gentlemen: Enclosed please find check in the amount of $5,014.55 in payment of the Inheritance Tax for the above Estate along with check in the amount of$15.00 to cover filing fee. The tax return as well as the inventory is enclosed for filing. Please time-stamp the copies and return to this office in the enclosed prepaid envelope. ince~ - .~l Enclosure ) -,,'. A MEMBER OF LAWPACT™ - AN INTERNATIONAL ASSOCIATION OF (NDEPENDENT BUSINESS !-AW FIRMS co"- '\IWI;.A.LTH OF PENNSYLVANIA DEF'ARTMENi Clf REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-..Q601 REV-1162 EX{11-961 RECEIVED FROM; PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005806 KUNKEL SHELLY J 204 STATE STREET HARRISBURG, PA 17101 ACN ASSESSMENT CONTROL NUMBER AMOUNT ______u fold 101 I $5,014.55 ESTATE INFORMATION: SSN: 183-12-1302 I FILE NUMBER: 2102-0875 I DECEDENT NAME: MOORE ANNE SCHAEFFER KEE 1=[ R I DATE OF PAYMENT: 09/16/2005 I POSTMARK DATE: 09/15/2005 I COUNTY; CUMBERLAND I DATE OF DEATH: 08/27/2002 I I TOTAL AMOUNT PAID: $5,014.55 REMARKS: CHECK# 4182 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 10-31-2005 MOORE 08-27-2002 21 02-0875 CUMBERLAND 101 APPEAL DATE: 12-30-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~Y!_~~9~~_!~!~-~!~~------~---~~!~!~_~9~~~_~9~!!9~_E9~_Y9Y~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ANNE S FILE NO. 21 02-0875 ACN 101 BUREAU OF INDIV~tfr~~!!SrrT'r'-~- INHERITANCE TAX DIVISIOK;' ,',j' \.'1 : "/ ,,' PO BOX 280601 HARRISBURG PA 17128-0601' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ~..., ~;- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN " ~ r~. t'\ ~ ..: ,,,~:J ANNA SOSSONG 17 S 2ND ST 6TH FL HBG PA 17101 ESTATE OF MOORE REV-1547 EX AFP (06-05) ANNE S TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 10-31-2005 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) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 130,000.00 .00 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) 38,614.74 .00 (11) ll2) ll3) ll4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 130,000.00 38.614 74 91,385.26 .00 399,167.39 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS. .00 X 00 = .00 399,167.39 X 045 = 17 ,962.55 .00 X 12 = .00 .00 X 15 = .00 ll9)= 17,962.54 . . ". .n.". Kt.l,;t..L1" I II l + J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2002 " CDOOI872 736.84 14,000.00 02-11-2004 .... REFUND .00 842.31- 09-15-2005 - CD005806 400.01- 5,014.55 TOTAL TAX CREDIT 18,509.07 BALANCE OF TAX DUE 546.53CR INTEREST AND PEN. .00 TOTAL DUE 546.53CR · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU~J' A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ I~UREA~OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS REV-1604 EX AFP (03-05) RIOKARD W MOORE 811~ VENTNOR AVENUE MAROATE NJ 08402 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 05-09-2006 MOORE 08-27-2002 21 02-0875 CUMBERLAND 183-12-1302 02149805 Amount Remitted ANNE S J .-'-, MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 "--"j CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS -- DATE 05-09-2006 ESTATE OF MOORE ANNE S DATE OF DEATH 08-27-2002 COUNTY CUMBERLAND FILE NO. 21 02- 0875 ADJUSTMENT BASED ON: S.S/D.C. NO. 183-12-1302 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 02149805 FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0183121302-50 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 01-22-1997 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.166 .00 .00 .00 .45 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE on . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) J.1J REV-1470 EX (6-88) . '* INHERITANCE TAX ~ EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER ANNE MOORE 2102-0875 REVIEWED BY ACN PHYLLIS HOCH 02149805 SCHEDULE ITEM EXPLANATION OF CHANGES NO. The above referenced ACN has been reduced to zero, as this account was reported on the probate return. PaQe 1