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Home My WebLink About02-1010MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of MIRIAM L. WENGER also known as ,Deceased Social Security No.159-50-1465 WILLIAM N. WENGER Petitioner(s), who is/are 18 years of age or older, apply)ies) for (COMPLETE "A" OR "B" BELOW:) n A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut OR named in the Last Will of the 4~.1 Decedent, dated 9~24~02 and codicil(s) dated 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 incapacitated: (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at MESSIAH VILLAGE 100 M I". ALLEN DRIVE, UPPER ALLEN TWP., MECHANICSBURG, PA 17055 (list street, number and municipality) Decedent, then 81 years of age, died NOVEMBER,'[ , 2002 , at MESSIAH VILLAGE, MECHANICSBURG, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ /O D, O a ~ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ ~ 0 De O 0 v Rcal Fc4a4aa cifua}arl as fnllnwc• NONE __ Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence t/ ;'.,//i,~//A~;ti,~ /(/ /',/J(~G/~_ WILLIAM N. WENGER V ~ 1334 GEORGETOWN CIRCLE, CARLISLE, PA 17013 B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente life, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Oath of Personal Representative Commonwealth of Pennsylvania COlJnty Of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer a state acc rding to la _ . Sworn to and affirmed and subscribed WILL---'~ j M before me this 12TH day of NOVEMBER 2002 - .~ • ~-- ~. ,~ r DECREE OF REGISTER Estate of MIRIAM L WENGER Deceased No. 21-02-1Ot 0 also known as Social Security No: 159-50-1465 Date of Death: NOVEMBER 5 , 2002 AND NOW, NOVEMBER 12, 2QQ2._ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ~ of Administration ((c.t.a., d.b.n.c.t.; pendente life; durante absentia; durante minoriate) are hereby granted to WILLI in the above estate and that the instrument(s), if any, dated SEPTEMBER 24th 2002 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES aj •. L 200.00 ~ , Letters ................................... . $ egister of Wills rtificates(s) rt C Sh $ 15.00 ............. e o .. ti n i R $ ........................ o enunc a .. s ( 3 ) P t E $ 9.00 age .......•••••~ ra x ~~ Signature R T $ ...................................... . . . JCP F $ 10.00 Attorney: GERALD J. BRINSER ee .............................. ... $ I.D. No: 09655 Inventory .............................. .. $ Address: 6 E. MAIN STREET P.O. BOX 323 Other ................................... ... PALMYRA PA 17078 TOTAL ..................... ........$ 234.00 Telephone: (717)838-6348 DATE FILED: NOVEMBER 12 2002 MAILED TO ATTORNEY NOVEMBER 13, 2002 This is to ce(etf~' tint ?he i.t~~>rntation here given is correctly copied ~rost~ an original certificate of.i:°at~t dui' fi{«. E~:tn -ne .~s Local Rti:+„(,rrr.r. The ori~;t(~aa cerr)ficate w!ll be. forwarded to the _~rarc~ Vital Records Office for pErti ~t1t°t;r ti,i,(~:. WARNING: It is illegal to duplicate this copy by photostat or photograph. I e:: sere- thti certih::u:, $'.00 _____P __8703683 _ ,~ /,, H105.143 Rev. 2/87 " RINT VENT xt i! ~O.a.~a Q • ~_Lia.C~ls local :~gistrar--- N 0 ~~ __ 7 20a rat COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH c ~~~~~~ ~ ~ ~ 1eIDf SEX SOCIAL SECURITY NUMBER DATE OF DEATH IMOnm. Oay Yen) ,. Miriam L. Wenger ,Female ,. 159 - 50 -- 1465 .. ~j,. ~ ^ AGEILam Birmtley) UNDERtVEAR UNDERI DAY DATE OF BIRTH BIRTHPIACE(Ca d~~ antl PUCE OF y DEATH(Cheok only one ~-see inmuc4ons an aver sitle) Months r Dsys Hour MInnN (Monet, 09Y. Y~arl Slate a Fore'gn Country) t HOSPITAL: OTHER: 82 Vra. , March 3 Gormley In ^ Nlminq atient ^ ER/O ^ p DDA utpstieM Dtror S' 1920 7. Canada Homf ~ Reaiosnn ^ rsE.cav) ^ COUNTY OF DEATH CITY, BORO, TWP OF DEATH FACILITY NAME (If rtd inmaUtgn. grva mren ntl nunumber WAS DECEDENTOF HISPANIC ORIGINS RACE•Amenunlntlifn Buck Whn ~` , , e. NC. • ~ Cumberland Upper Allen TWp. /[ No ® vsa ^ Ilya, spacNyCubin, ~~) ~/y~Yl (/-(.L'CQ s b P ; a an. k wno Rion. rec. White W. OECEDENT'$US A O U L CCUPATgN KINDOF BUSINESS/INDUSTRY WA$DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS-Marrfeo ,0 (Give kxMd work ooro mom U.S. ARMED FORCES? a ord h nest ratl SURYIVINO SPOl19E e l NevU Mnneo,WMOwstl, of workkq Us: oo not ufe rdastl.l ENmeMery/SaCOnEary M wNa. 9rve ma~Cen nrrol . ,, Missionary Teacher (a,~ , °o«° ° Church "' ^ "° ® °h"cs°~Pa""' ,• ,,,. ( . s ,_ , t, DECED ' 4 14 ENT S MAIUNO ADDRESS (SOfn, CMRovm, Stale. Zry Cotle) DECEDENT'S ' 13. t7a.stan_ PA Dltl rear®ns,n.c.amli.seb 980 Mt. Allen Drive TT nar A11on rR _ ~ m RESIDENCE Oacsosm lwp. 'N. gyn. Mechanicsburg, PA 17055 ~na~aina ,e ,7b. Cou township? No. oeeeoem Nreo Cumberland na ^ wenin t lll . ac w mn.d ckYAtoro FATHER'S NAME (Fkm. Mitltlb, Last) MOTHER'S NAME (Fam, Mitltly, Meitlen Surname) Or1a Lambert Heise ,.. ,N Catherine Lehman . INFORMANT'S NAME (,ypUPnM) INFORMANT'S MAILING ADDRESS (SYreel Cl /town, Sara, ZipCWs) ~: William N. Wenger 1334 Georgetown ~ircle Carli l P y z~ s e A 17013 METHOD OF DISPOSITION DATE OF DISPOSITION PLAOE OF DISPOSITION•N1med Cemetery,Crematory LOCATION-Cpy/TOwn, State, Zip Coos ^ (MOnM, Dey Year) U Oth BurW ® Cnmaron ^ Rsmo n I P S ' , v ron tets U Mo =tf. D°nf'""^ O1"°~~" ^ = E November 8, 2002 Cumberland Valley Mem. Gar Carlisle PA 17013 2to. =tar ' SK3NAT UNERAL R E ICE E P SOMA AS SUCH LICENSE NUMBER NAMEANDADDRESSOFFACILITY Hoffm -R th an o Funeral Home res. 014351-L ::e. 219 N. Hanover St. Carlisle PA 17013 Cortt • reams 2,fe oMl"•sten M To tro Eon d my kmwNtlNa oeath oaumN et Me rim G , s, ta ono pkce masse. phyficifn is red lvfafENntlmadeNMto (Signature antl Ttlb) LICENSE NUMBER DATE SIGNED ' artly auw d ewlh. (,~,~. DeY. ~) _,.. rear =x. N1ms 2425 must Ee corrl0letW E1' TIME OF DERH GATE PRONOUNCED DEAD (MOnM,Day,Year) WAS CASE REFERREDTO MEDICAL EXAMINEN/CORONER? p«fon wro porourlwf aafm. a : a O Y1s ^ =7. PART 1: EmU tM eiwafef, injurief or oompiutbro wnicn caueso tM eNM. Da not sMSr tM moos of eying, ouch v ur laC or rsnpiratory arrem, shock or roan failure. I Approaimats PART N: qnU NInM ConeNlons CoMrlpnlltg ro r,NM Lip only OM GYN dl eaoh FM. l ~n ErA , in1eM1 Ee1wNn IMMEDIATE CAUSE (Final ~ oron aro eenh 1101 ~~ Nt ~ ~ uu•• 9Mn N PART I. tlieeese or Mntlilion + I rswddrp n OeaYt)-- a. ~ DUE TO (OR AS A CONSEQUENCE OF): S•aefM4M,n conahnro E. 1 .. 8Ury•IffOingroknmemeM DUEro( A$ACON U N EOF): uusf. EMU UNOERLYINO I - CAUSE (Dieeaea ariryury c. ~ ' otU sMiatatl aveMS DUE lb (l]R AS A CONSEQUENCE OF): rasutNq h tleeMl LAST e I WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OFINJVRV TIME OFINJURY INJURY AT WORK? DESCRIBE HON INJURY OCCURRED. PERFORMED? Aw1LABLE PRIOR TO (Monet DaY Near) , • COMPLETION OFCAUSE OF DEAfNT Natwal {~ Homkid ^ AcdosM ^ Perolrlg Imrostigatbn ^ We ^ No ^ YM ^ No ~ N» ^ No ^ 3ukMe ^ COWe red W enermineo ^ pa 30E M. LACE OF IN JU R Y • M rom. 6rm nr1n ladory offwe LOCATIO R .. ., . y , , , , N (Bran, City?own, Sete) ,a. ,a. CERTIFIER (Cnxk onN Oro) SIGNATURE AND TI ,LE OF CERTIFIER 'CEIYTIfYN10 PNY$IgAN (FltYmcian cernyinq rsuae d eeaM wron andnn pnyeicien new pronouncetl tlsaM ono eampbtatl Item 23) To1,le ESll of mykrot•IMOf, NaM OeeumW ewbIM NYM(f)and ma~,Mr Nflnem ..................................................... ^ „b. . •PRONOUNCNq AND CEATIPYIND -NYSICIAN (Pnyaicint OoM wonouroirp tlesM ono cerlayirp Ia cause d tleaM) LICEN NUMj~~E/Rp ~'~I DRE 81ON /(ManM. " TO tM WU W my knowNegf, Matlt ocowrW n t1M tNro, eab, lno m~4/[./ J (J t~ ~~ ~ t / /qty Veer p4cf,lnoowletMcaufga)•nom.nrorNUftee.........~ ................. =to• „e I / , NAME AND ADWiESS OF PERSON WHO COMPLETED CAUSE OF DEATH • 'MEDICAL E%AMINER/CORDNER (Item 27)Typew PAM Michael D. M1Chea18 Dn n,f bNlf of Naminl,len Ind/a Inrenlgltlon, In my opinion, anh oeeured n IM time deb Ind plfee ^ne auf b m , , , e uuN(.)1na 208 Lowther St . mer111M N H^IW .................................................... • .................................. ^ =7e~ __. Lemo a PA 17043 REGISTRAR'S 3tONATURE AND N F DATE FILED (MOnM. Day, Year) ,,. A• e~a..c~ ~ t I \ N. ~V s 1 NVI).2 WILL 21-02-1010 OF MIRIAM L. WENGER I, MIRIAM L. WENGER, currently ofUpperAllen Township, Cumberland County, Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that each beneficiary of my estate under the terms of this my Will or as beneficiary by way of beneficiary designation on assets passing outside of this my Will shall be solely responsible for the payment of any death taxes assessed on the portion passing unto him or her. III. I intend to keep with this my Will a separate memorandum concerning disposition of certain items of tangible personal property. I bequeath the items on said memorandum to the persons designated. IV. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, shall be divided into two (2) equal shares. One (1) share shall be divided into eight (8) equal shares which I devise and bequeath as follows: one (1) share equally unto Matthew and Heather Hinderland, or the survivor of them; one (1) share each unto the following individuals: Blenda Wenger, Brad Wenger, Elizabeth Philbrick, Jane Hatfield Erickson, James Hatfield, John W. Hatfield; and one (1) share to be divided equally between Angela and Jason Wenger, or the survivor ofthem. Provided, however, the share of Blenda Wenger shall be held in trust by my hereinafter-named Trustee pursuant to the terms and conditions set forth in Paragraph V below. The remaining share, or fifty percent (50%) of my estate, shall be divided into four (4) equal shares, which I devise and bequeath as follows: -1- .~c.~,~.L,u...-,.~~ ~G~~-mac or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries hereunder for the liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. VII. Any amounts which are payable to a beneficiary under this Will may, at the discretion of my fiduciaries hereunder, be paid to the guardian of the person and/or property of such beneficiary, to the person who has custody of such beneficiary, or directly to such beneficiary, or may be applied for the use or benefit of such beneficiary. The receipt of such guardian, custodian, or beneficiary or evidence of the application of such amounts, shall be a full and complete discharge of my fiduciaries hereunder to the extent of such payment or application. This paragraph shall be applicable to payments of income as well as principal. VIII. I appoint William N. Wenger Executor of this my Will. In the event that he fails to qualify or ceases to act as Executor, I appoint John G. Hatfield Executor in his place. IX. I appoint Brad Wenger as Trustee of any trusts created by this my Will. In the event that he fails to qualify or ceases to act as Trustee, I appoint Elizabeth Philbrick as Trustee in his place. X. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, MIRIAM L. WENGER, herewith set my hand to this my Last Will, typewritten on three (3) sheets of paper including the attestation clause and signatures of witnesses, this ~ Y ~ day of ~',,~~~,~ , 2002. ~-~-~~-~-- ~~ (SEAL) MIRIAM L. WENGER Signed by MIRIAM L. WENGER, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this ~?~/is, day of .T~~~~.~ LP .~ , 2002. G ~'-~-~ residing at V t~2.r~~ ~ ~2~JCVrr~l-~ residing at ~2C.~~~'~~~,r~~ ~/~- -3- MARY C. LE`NIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MIRIAM__L._WENGER Date of Death: 11/6/02. Estate No. -_- -_ SSN: 159-50-1465 File No. 2002-01.010 Date Letters Granted: 1.1/12/02 Will or Administration No. To the Register: 1 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 12/10/02 ___ Name Address MATTHEW HINDERLAND 20920 N. 67TH DRIVE ~t _ ___ _ - --- GLEN_ DALE AZ 85308 HEATHER HINDERLAND 20920 N. 67TH DRIVE -- -- _ - GLENDALE __ - _- AZ 85308 -- BLENDA WENGER 1334 GEORGETOWN CIRCLE __ -__- - C_A-RLISLE __ PA _ _ -- 17013 - BRAD WENGER 1221 GEORGETOWN CIRCLE - _-CARLISLE ___-- __-. _. PA - --- 17013 --- ELIZABETH PHILBRICK 5138 NICKLAUS DRIVE, N.W. - - - _-__ _--_-_ROCHESTER __ MN - --. 55901 JANE HATFIELD ERICKSON 342 FOREST AVENUE __RIVER FOREST - __ _ IL 60305 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 12/9/02 Capacity: Personal Representative X Counsel for Personal Representative Signature GERALD J._.BRINSER, ESQUIRE.. Name (Please type or print) 6 E.-MAIN STREET .- -_ - -- - _ -- Address P.O. -BOX 323 __ PALMYRA-_ PA 17078 Telephone No. X717)838-6348__. -_ Continuation of Certification of Notice Under Rule 5.6(a) MIRIAM L. WENGER Page 1 11/6/02 Names and addresses Name JAMES HATFIELD Address 536 DAVENTRY ROAD JOHN W. HATFIELD BERWYN PA 19312 URBAN VET. CARE, 2930 N. LINCOLN AVE. ANGELA (WENGER) NEHRBASS CHICAGO 12656 MEADE STREET - IL -60657 -_ _- JASON WENGER BROOMFIELD _ _ _ 910 E. 130TH DRIVE _ CO - 80.02.0 - - - --- - - HAROLD M. HEISE THORNTON ----- --- -----_-- ------ 12184 NINTH LINE A-212 -- - - - - - CO 80241 - -- - LEWIS B. HEISE ---------- ---STOUFFVILLE, _ ONTARIO L4A 3N6 _ 208-465 RUPERT AVENUE __-- _ - - -- -- -- - - - -- - -- - - -_ - __- -_ ANNA G. REESOR _ STOUFFVILLE, _ _ ON_TA_ RIO L4A 1 T4 _ _ 12184 NINTH LINE A-112 __ _ __ - - - - -- ---- LOIS P. WINGER - - _ - ------ ----STOUFFVILLE, ----ONTARIO L4A 3N6 1382 NIPISSING ROAD, S. R.R. -------------- #1 -_ -- -- --- -- ERMA J. S1DER -- - -- - - ---MAGNETAWAN,-- ONTARIO POA 1 PO 1301 NIAGARA PARKWAY -- _ ---_- -- - - --_ -------- CARLISLE BRETHREN IN CHRIST CHURCH ----F_ORTERIE,_---ONTARIO L2A 5M4 ---- 1155 WALNUT BOTTOM ROAD -__----- MESSIAH COLLEGE - -- CARLISLE RICHARD J. MORRISON, COLL. COUNSELOR PA 170.13 MESSIAH VILLAGE ---- - - _ GRANTHAM _ DR. EMERSON LESHER, 100 MT. ALLEN DRIVE _PA_ ___ 170_2.9 - - _ - - MECHANICSBURG - PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 002783 BRINSER GERALD J 6 E MAIN STREET,2ND FLOOR P O BOX 323 PALMYRA, PA 17078 ACN ASSESSMENT AMOUNT CONTROL NUMBER told ESTATE INFORMATION: ssrv: 15s-5o-1465 FILE NUMBER: 2102-1010 DECEDENT NAME: WENGER MIRIAM L DATE OF PAYMENT: 07/09/2003 POSTMARK DATE: 07/08/2003 couNTY: CUMBERLAND DATE OF DEATH: 1 1 /06/2002 REMARKS: SEAL CHECK# 17 101 ~ 58,321.38 TOTAL AMOUNT PAID: INITIALS: AC RECEIVED BY: DONNA M. OTTO 58,321.38 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~ ~~ ~ WE, MIRIAM L. WENGER, GERALD J. BRINSER and ~a le.n ~ J ~ E~~-~ ~h, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. MIRIAM L. WENGER ' `./L ~ in WITNESS WITNESS ~ Subscribed, sworn or affirmed and acknowledged before me by MIRIAM L. WENGER, the testatrix, GERALD J. BRINSER and (/~~..~i~ J < ~~~ ,witnesses, this ~"y'day of -~e~~'rn~2l~, 2002. EAL) otary Public ~.e u~ .._ ._ ,~..~..~._~,_ ..._..n_.._ . _. _ ..._ .._,. NOTARIAL SEhI. WENDY L. CFW~Rt), Notary Pub4ic P~myra Boo., t.eb~non County My Commission Expires Sept~snt~er 10, 20Q5 -4- COMMONWEALTH OF PENNSYLVANIA IREAU OF INDNIDUAL TAXES DEPARTMENT OF REVENUE .~eRITANCE TAX DIVISION SEPT. 280601 NOTICE OF INHERITANCE TAX ,i„RRISBURG, PA ~7~2a-oso~ APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REW1647 Ex (12-97) PC DATE 03-22-2004 ESTATE OF WENGER MIRIAM L DATE OF DEATH 11-06-2002 FILE NO. 21 02-1010 COUNTY Cumberland GERALD J BRINSER ESQ '~f f~,i-; -' ~ `' .~ :~ti ~l ACN 101 BRISNER ETAL PO BOX 323 Amount Remitted PALMYRA PA 17078 ~..: r•~ , MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE '~ RETAIN LOWER PORTION FOR YOUR RECORDS G - -- ---- - -- ------- ----------------- - ----------------------------------------------------------------------------------------------------- REV-1547 EX (08-97) PC NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WENGER MIRIAM L FILE NO. 21 02-1010 ACN 101. DATE 03-22-2004 TAX RETURN WAS: (~) ACCEPTED AS FILED (®) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST -SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/ Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: (1) 0.00 NOTE: To insure proper (2) 0.00 credit to your account, (3) 0.00 submit the upper portion (4) 0.00 of this form with your (5) 245,692.31 tax payment. (6) 0.00 (7) 89,977.01 (8) 335,669.32 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 30,358.94 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions (11) 30,358.94 12. Net Value of Tax Retum (12) 305,310.38 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 150,126.22 14. Net Value of Estate Subject to Tax (14) 155,184.16 NOTE: If an assessment was issued previously, lines 14, 15 and/or 18, 17 and 18 will reflect figures that Include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (- ~~ ~a onn~ rnnro7as 0.00 (15) 0.00 X .00 0.00 (16) 120,168.29 X .045 5,407.57 (17) 30,042.07 X .12 3,605.05 (18) 0.00 X .15 0.00 (19) 9,012.62 AMOUNT PAID TOTAL TAX CREDIT 8,321.38 BALANCE OF TAX DUE 691.24 INTEREST 21.29 TOTAL DUE ~ 712.53 + IP PAID AFTER DATE INDICATED, S8E REVSRSE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQIIIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DU8 IS REFLECTED AS A CREDIT (CR), YOU MAY SE DU8 A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRIICTIONS.) RF 1988) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER WENGER MIRIAM 2102-1010 REVIEWED BY ACN 101 CHARLES WRIGHT ITEM EXPLANATION OF CHANGES SCHEDULE NO. H B-12 Costs to deliver property reduced to $500.00 as a more reasonable charge. Personal property valued at $500.00. ~ Adjusted to show specific bequest of annuities at $60, 000.00 plus'/4 of 50% of the residue. Lineal Adjusted to show 50% of the residue at 4.5%. Sibling Adjusted to show'/4 of 50% of the residue at 12%. Row Page 1 T'" m ~ N W c O t yA c tl A ` L r ~ ~ ~ W ~ Q o 'r d .. c~o° = ~ V F W ~, M ~ ~ ~o e a NWoo~ NO~`' c ~ ~=o'~ a3~ . ° e-NV~o md ~ m Q W a -- ' = y' ~'d~ o ~ ~~ Q Q W ~~~ O; a >W ~p O E U ~: Zj W~ W 1-FQIW~W~ U O; a~ Qp~y ~Q~J ~~7 aWOWV Q ~~ {L 0 ~ V y "4~ ~~,J ~ ~' Z Z o ', o x 3 ~ 2 ~ a~~ V QO _ ~ ~ a ~Z~ ° ~ ` ' o z ~ ~ ~- J 3; O (.1 ~ W p LL ` ~' Z; ~~ ~~ Q W; ~;~ ~ Q' ~' W ~ ;~ W y a~ ? ~ J F O m° ~~ ~ ~ m~ a , 0o N ~WN°' W; ~ ~ M ~ Z. J a _z°° Q20~' ; y; ~Qo~ WHO ~ ~; WAN" ~~ ~mo.a z, ~W a m?o= Q~ ~: U. REV-1162 EX111-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE gU~=AU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: WENGER WILLIAM N 1334 GEORGETOWN CIRCLE CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 159-50-1465 2102-1010 WENGER MIRIAM L 04/13/2004 00/00/0000 CUMBERLAND 11/06/2002 TOTAL AMOUNT PAID: REMARKS: CHECK# T-2 SEAL INITIALS: JA RECEIVED BY: NO. CD 003815 AMOUNT $712.53 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ./ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT O F ACCOUNT REV-1607 ER ~FP (01-037 DATE 05-24-2004 ESTATE OF WENGER MIRIAM L DATE OF DEATH 11-06-2002 FILE NUMBER 21 02-1010 _ ,_ _ . - ~' COUNTY CUMBERLAND GERALD J BRINSER ESQ ACN 101 BRINSER ETAL Amount Remitted PO BOX 323 PALMYRA PA 17078 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ___~______________________ --------------------------------- ----------------------------- REV-1607 EX AFP (01-03) *** INHERITANCE TAX STATEMENT OF ACCOUN *~* ESTATE OF WENGER MIRIAM L FILE N0. 21 02-1010 ACN 101 DATE 05-24-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-26-2004 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) 07-08-2003 04-13-2004 CD002783 CD003815 .00 21.29- ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. 9,012.62 AMOUNT PAID 8,321.38 712.53 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), .,,..~ ..... cc m(~ a RFFIINn_ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 9,012.62 .00 .54 .54 REV-1S00Ex+(e,OO) /7-/m--.3 '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 / REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE QNL Y FilE NUMBER /0 I 0 2 1 -0 2 2 e 8 2 ""'COUNTYCOOE ---vE~ - NUMBER- I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) MIRIAM L WENGER DATE OF DEATH (MM-OQ.-Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DQ.-Year) 159-50-1465 THIS RETURN MUST BE FILED IN OUPLICATE WITH THE REGISTER OF WILLS 11/0612002 03/03/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER W I- ::.:::$(1) u"'''' w..u ",00 U"''''' .... .. '" [Xl 1. Original Return o 4. LImited Estate lXl 6. Decedent Died Testate (AttachCOPYofWillj o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death alter 12-12-82) o 7. Decedent Maintained a Living Trust(~~OO?yofTI\l'b\) o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) o 3. Remainder Return (date of death pJior 10 12-13-82) o 5. Federal Estate Tax Return Required Q.- B. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z W o z o .. '" w '" '" o u THIS SECTION MUST BE COMPLETED, ALLCORRESPONDENl>E AND cPNFIDENTIAL TAXINPORMATlON SHOULD BE OIREOTED TO: NAME COMPLETE MAILING ADDRESS GERALD J. BRINSER ESQUIRE 6 E. MAIN STREET FIRM NAME (If Applicable) BRINSER WAGNER & ZIMMERMAN P.O. BOX 323 TELEPHONE NUMBER 717838-6348 PALMYRA PA 17078 z o ~ ..J ::J l- ii: 0( u W It: z o i= ~ ::J 0.. ~ o u S 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (ScI1edule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabililies, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value 01 Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) Of'FICIAlj;lSE ONLY d <.".J (1) (2) (3) (4) (5) ~r '~.J \. _ r' r' ?i l,}' L c:: , 1 \0 245,692.31 ~ f<,I CO 89,977.01 , (8) 335,669.32 32,753.94 4,973.80 (11) (12) (13) 37,727.74 297,941,58 159,251,86 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTiONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 138,689.72 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 tax.able at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 110,951.79 0.00 27,737.93 0.00 x .04.5 (15) 4,992.83 X OL(16) X .12 (17) 3,328.55 X .15 (18) (19) 8,321.38 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER All QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < d C dd Dece ent's omplete A ress: STREET ADDRESS MESSIAH VILLAGE 100 MT. ALLEN DRIVE CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 8,321.38 Total Credits (A + 8 + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty T otallnteresUPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) Make Check Payable to: REGISTER OF WILL$, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves No a. retain the use or income of the property transferred; ........................................................... ............ 0 00 b. retain the right to designate who shall use the property transferred or its income; .................................. .... 0 00 c. retain a reversionary interest; or .......... ...................... . ............... .................. ......... D 00 d. receive the promise for life of either payments, benefits or care? ........ .................... ................... .......... 0 00 2. If death occurred aher December 12, 1982, did decedent transfer property within one year of death without receiving adecuate consideration? .......................... ........................................ ...................... 0 00 3. Did decedent own an "in truslfor' or payable upon death bank account or security at his or her death? . . ............. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..... ..................... .............................. ................ ................ 00 0 8,321.38 8,321.38 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Uflder penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statemeflts, and to the besl of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS PA 17013 DATE ADDRESS -c; 12.<.- , .0. BOX 323 PA 17078 For dates of death on or aher 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. ~9118 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fiiing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9118(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. :'~EX.{'~~ *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF MIRIAM L WENGER FILE NUMBER 21 02 2002-01010 Include the proceeds of litigation and the date the proceeds were received by the eslate. A" property jolnlfy-owned with the right of sUlVlvol1hlp must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 4,498.00 PNC BANK - CHECKING ACCOUNT 2. KEYSTONE FINANCIAL - VARIOUS ACCOUNTS (SEE ATTACHED) 209,378.00 3. MISCELLANEOUS PERSONALTY IN ROOM AT MESSIAH VILLAGE 500.00 4. REFUND ON COTTAGE AT MESSIAH VILLAGE 28,029.00 5. MMA - INSURANCE REFUND 163.17 6. P P & L - REFUND 62.87 7. CNA - UNUSED PREMIUM 2,866.27 8. INSURANCE REFUND 195.00 TOTAL (Also enteron line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 245692.31 ~/0&/2002 18:0& 71 77378721 MMA KEVSTCJ.E FINANel PAGE 01 Net Worth Statement bMMd R--J M.,It.. Not Nsd o-r R"",n V... ~ w_ Cash and Checking Cbod<iDc PNC Miriam 0.00% S4,498 SO S4,498 Savlnss, CD"', T-Bl1Is A1liOl1ClC Moaey MoJItct Miriam 1.00% 21,312 0 21,312 TAP Miriam 3.00"~ 8,523 0 8,523 Tar Free Bond Funds BorbCnlyPA 11/15/12 Mirilllll 5.75% S,OOS 0 5,005 Deuphin Cnty P. 6/1/10 Miriam 5.30% 5,267 0 5.267 WNC HousiDa Tax VI MiriJan 9.00% 10,000 0 10,000 Bondsllncome Funds MMAPnIxis~_B MiriJan 5.39% 11,139 0 11,139 . S/ockslGrowth Funds V8llllUlllll WiIIdoor.D Miriam 10.55% 25,510 0 25.510 MMA Praxis Intunational B Miriam (3.08%) 23,339 0 23,339 ;l,Dq3'l6,06 P...........F""" Miriom 9.69% 15,750 0 lS,75O V8llllUlllll Sp Port Health Care Miri.... 19.04% 15,898 0 15,898 V8IIllUIIIII Capital OppcrIUnity Miriam n.46% 14.911 0 )4,911 Pan\aaIIIO _ fd.-Equity_ Miriam 11.29% 8,724 0 8.724 Real Eslale CNL Hospitality REIT Miriam 7.75% 10,000 0 10,000 CNL ReliRmelIl REIT Miriam 7.00% 12.000 0 12.000 Limiled Partnership A TEL Cepit.,) Eq,uipmenl vm Miriam 9,04% 22,000 0 22,000 Annuities Ml!niab CoJJese Oift Annuity Miriam 7.00% 50.000 0 50,000 """'" llI!IIe Gift AImUity Miriam 6.00% 15.000 0 15,000 ~llI!IIeGift~l)' Miriam 6.00% 10,000 0 .10,000 MFSJ,optla OolcIYoIa/.Retum Miriam 7,78"" 4,427 0 MZ1 q~ ~q.c/) .MP.tP...~~.esI""Tt Miriam 6.37% 3,108 0 3,108 M...iah ViIlOli:Uift AnnuitY Miriam 8.70". 10,000 0 10,000 Mi'S.lleptta O!>k\ GIoboI QroWlh Miriam 007%) 6,404 0 6.404 Residmce Velue OfRClideacc Miriam 0.00% 27,500 0 27,500 Persqnal Properly POI'lIOIIAI Elfools Miriam 0,000/. 500 0 500 r_ 5348,815 SO $340,815 Ii PIOEquhle8, Inc. November 5, 2002 Miriam Wenger PfrlHtlt~ by: TImothy G Long, MBA / (\~ \\). ~/B6/2BB2 18:B6 71 77378721 ~ KEVSTot-E FINANeI PAGE B1 Net Worth Statement A6_ RtIU .f M.,"" N.. AsI<I o-r R"""" v_ LWiIity w_ Cash IBId Checking Cbo<:IciDg PNC Miriam 0.00% S4,498 SO S4,498 Savings, CD's, T-BII/s Alii"""" M_ Modtcl Miriam 1.00% 21,312 0 21,312 TAP Miriam 3.00"~ 8,523 0 8,523 Tar Free Bond Funds BeIb cnty PA lJIlS/12 Miri.... S.7S% s,oos 0 5,005 Deupbin Cnt}' Pa 6/1110 Miriam 5.30% 5,267 0 5.267 WNC Housina Tax VI Miriam 9.00% 10,000 0 10,000 Bcmdsllncome Funds MMA Praxis IDtam<diate _ B Miriam 5.39% 11,139 0 11,139 SlockslGrowth Funds V~ Windoor-B Miriam 10.55% 2S,SI0 0 2S,S10 MMA Praxi. JntrrnationaI B Miriam (3.08%) 23.339 0 23,339 a.Ci1;;'16.oo P.......... Fund Miriam 9.69% 15,7SO 0 15,750 V~ Sp Port Hco1th Care Miriam 19.04% 15,898 0 15,898 V~ Capital Opportunity Miriam 13.40% 14,911 0 14,911 P.....- _Fcl-EquitY- Miriam 11.29% 8,724 0 8,724 Real Estate CNL Hospitality REIT Miriam 7.75% 10,000 0 10,000 CNL RelircmelIl REIT Miriam 7.lJOt'. 12,000 0 12,000 Limited Partnership A lliL Cepit.! Equipment vm Miriun 9.04"- 22,000 0 22,000 Annuitie. MesIiab CoUO(le Gift Annuity Miriam 7.00% SO,OOO 0 SO,OOO ."....l!qa1. Gift ADDuity Miriam 6.00% 15,000 0 15,000 JlICOl> llnBIe Gift Annuity Miriam 6.00% 10,000 0 10,000 MEB",. 0DId 1:oIalRctum Miriam 7.78". 4,427 0 url. q~ ~q.cx) 'MI'lt""llI!!JO~.~veato!s T. Miriam 6.37% 3,108 0 3,108 M...iah VillaPGift AnnuitY. Miriam 8.70% 10,000 0 .10,000 MFSll<pUa 0DId Globol qroWlh Miriam (2 070/0) 6,404 0 6,404 Re:s;denu Value OfRe.ideace Miriam 0.00% 27.soo 0 27,500 Personal Property P.....w Elfecls Miriam O.lJOt'. 500 0 SOO T_ $J4t,1I15 SO S34t,1I15 iii ProEqullle8, Inc. November 5, 2002 Miriam Wenger PfNBI1lf/d by: TImothy G Long, MBA / ~ "'.''''''''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF MIRIAM L. WENGER FILE NUMBER 21 02 2002-01010 This schedule must be completed and filed jf 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 INCLlJOETKEi'lAMEOFTHETRANSFEREE,Tf-IEIRRELATIONSHIPTODECEDENTANDTHEDATEOfTAANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATIACf-IACOPYOFTHEDEEDFORREA1-ESTATE VALUE OF ASSET INTEREST (IF APPLlCABLEI 1. MESSIAH COLLEGE GIFT ANNUITY 50,000.00 100. 50,000.00 2. JACOB ENGLE (NOW KNOWN AS BRETHREN IN CHRIST 8,976.16 100. 8,976.16 FOUNDATION) GIFT ANNUITY 3. JACOB ENGLE (NOW KNOWN AS BRETHREN IN CHRIST 7,061.85 100. 7,061.85 FOUNDATION) GIFT ANNUITY 4. MFS REGATTA GOLD TOTAL RETURN ANNUITY 4,427.00 100. 4,427.00 5. MFS REGATTA GOLD MASS INVESTORS TX ANNUITY 3,108.00 100. 3,108.00 6. MESSIAH VILLAGE GIFT ANNUITY 10,000.00 100. 10,000.00 7. MFS REGATTA GOLD GLOBAL GROWTH ANNUITY 6,404.00 100. 6,404.00 TOTAL (Also enter on line 7, Recapitulation) $ 89 977.01 (If more space is needed, insert additional sheets of the same size) "Y.""".""';* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MIRIAM L WENGER FILE NUMBER 21 02 2002-01010 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. HOFFMAN ROTH FUNERAL HOME 7,322.50 2. C.v. MEMORIAL GARDENS 900.00 3. FUNERAL MEAL 393.75 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) WILLIAM N. WENGER 10,370.00 Sod.1 Secunty Numbe~s) I EIN Number of PelSOn.1 Representative!s) Street Address 1334 GEORGETOWN CIRCLE City CARLISLE State PA Zip 17013 Yea~s) Commission Paid: 2003 2. AtlomeyFees BRINSER, WAGNER & ZIMMERMAN 10,370.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 234.00 5. Accountanfs Fees 6. Tax Return Prepare(s Fees 7. REGISTER OF WILLS - ADDITIONAL COST OF LETTERS 70.00 8. REGISTER OF WILLS - INHERITANCE TAX RETURN FILING FEE 15.00 9. REGISTER OF WILLS - INVENTORY FILING FEE 10.00 10. CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING 75.00 11. THE SENTINEL - LEGAL ADVERTISING 98.69 12. COSTS OF DELIVERY OF PERSONALTY TO GRANDCHILDREN 2,895.00 TOTAL (Also enter on line 9, Recapitulation) $ 32 753.94 (If mOTe space is needed, insert additional sheets of the same size) ~1"2ex,"~~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MIRIAM L WENGER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 02 2002-01010 Includ. un..lmbul1led m.dlcal expen.... ITEM NUMBER DESCRIPTION AMOUNT 1. ALERT PHARMACY SERVICES 25.57 2. PHARMERICA 47.47 3. VERIZON - PHONE 9.76 4. MESSIAH VILLAGE - LONG TERM FINAL 4,891.00 5. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 973.80 RE~."m"I'.il. COMMONWEALTH OF PENNSYLVANIA INHERITANCE lAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER I. 1. 2. 3. 4. 5. 6. 7. . FilE NUMBER 71 02 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 7007-01010 AMOUNT OR SHARE OF ESTATE 1/2 of 1/8 of 50% of Residue HEATHER HINDERLAND 20920 N. 67TH DRIVE, GLENDALE, AZ 85308 GREAT-GRANDDAUGHTE 1/2 of 1/8 of 50% of Residue 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS CARLISLE BRETHREN IN CHRIST CHURCH (1/4 OF 50% RESIDUE) 1155 WALNUT BOTTOM ROAD, CARLISLE, PA 17013 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) MATTHEW HINDERLAND 20920 N. 67TH DRIVE, GLENDALE, AZ 85308 GREAT-GRANDSON 1/8 of 50% of Residue 1/8 of 50% of Residue 1/8 of 50% of Residue 1/8 of 50% of Residue 1/8 of 50% of Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE BLENDA WENGER (C/O SPECIAL NEEDS TRUST) 1334 GEORGETOWN CIRCLE, CARLISLE, PA 17013 GRANDDAUGHTER BRAD WENGER 1221 GEORGETOWN CIRCLE, CALlSLE, PA 17013 GRANDSON ELIZABETH PHILBRICK 5138 NICKLAUS DR, NW., ROCHESTER, MN 55901 JANE HATFIELD ERICKSON 342 FOREST AVENUE, RIVER FOREST, IL 60305 GRANDDAUGHTER GRANDDAUGHTER JAMES HATFIELD 536 DAVENTRY ROAD, BERWYN" PA 19312 GRANDSON 2. MESSIAH VILLAGE (GIFT ANNUITY - $10,000.00) 100 MT. ALLEN DRIVE, MECHANICSBURG, PA 17055 AND 1/4 OF 50% OF RESI- DUE - $27,737.95) (GIFT ANNUITY - $50,000.00) (1/4 of 50% RESIDUE - $27,737.95) 3. MESSIAH COLLEGE GRANTHAM, PA 17027 TOTAL OF PART II - 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) 27,737.95 37,737.95 77,737.95 159251.86 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MIRIAM L. WENGER 21 02 2002-01010 PaQe 1 Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONIS) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions) 8. JOHN W. HATFIELD GRANDSON 1/8 of 50% of Residue URBAN VET. CARE, 2930 N. LINCOLN AVE., CHICAGO, IL 9. ANGELA NEHRBASS GREAT -GRANDDAUGHTE 112 of 1/8 of 50% 12656 MEADE STREET, BROOMFIELD, CO 80020 of Residue 10. JASON WENGER GREAT-GRANDSON 1/2 of 1/8 of 50% 910 E. 130TH DRIVE, THORNTON, CO 80241 of Residue 11. HAROLD M. HEISE BROTHER 1/5 of 1/4 of 50% 12184 NINTH LINE A-212, STOUFFVILLE, ONT. L4A 3N of Residue 12. LEWIS B. HEISE BROTHER 1/5 of 1/4 of 50% 208-465 RUPERT AVENUE, STOUFFVILLE, ONT. L4A 1T4 of Residue 13. ANNA G. REESOR SISTER 1/5 of 114 of 50% 12184 NINTH LINE A-112, STOUFFVILLE, ONT. L4A 3N6 of Residue 14. LOIS P. WINGER SISTER 1/5 of 1/4 of 50% 1382 NIPISSING ROAD, S R.R. #1, MAGNETAWAN, aNT. 1 of Residue 15. ERMA J. SIDER SISTER 1/5 of 1/4 of 50% 1301 NIAGARA PARKWAY, FORT ERIE, aNT. L2A 5M4 of Residue Continuation of REV-1500 Inheritance Tax Return Resident Decedent MIRIAM L WENGER 21 02 2002-01010 PaQe 2 Schedule J - Beneficiaries - 2B B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 4. BRETHREN IN CHRIST FOUNDATION (formerly Jacob Engle Foundation) P.O. BOX 290 GRANTHAM, PA 17027-0290 (2 GIFT ANNUITIES) 16,038.01 SUBTOTAL SCHEDULE J.2B 16,038.01 WILL 21-02-1010 ill: MIRIAM L. WENGER I, MIRIAM L. WENGER, currently of Upper Allen Township, Cumberland County, Pennsylvania, realizing tl1e uncertainty oftl1is life, but witl1 confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon tl1e cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct tl1at all my just debts and funeral expenses be paid from tl1e assets of my estate as soon as practicable after my demise. II. I direct that each beneficiary of my estate under tl1e terms of this my Will or as beneficiary by way of beneficiary designation on assets passing outside oftl1is my Will shall be solely responsible fortl1e payment of any death taxes assessed on the portion passing unto him or her. III. I intend to keep witl1 tl1is my Will a separate memorandum concerning disposition of certain items of tangible personal property. I bequeatl1 tl1e items on said memorandum to tl1e persons designated. IV. All tl1e rest, residue and remainder of my estate, of whatever nature and wherever situate, shall be divided into two (2) equal shares. One (l) share shall be divided into eight (8) equal shares which I devise and bequeatl1 as follows: one (1) share equally unto Mattl1ew and Heather Hinderland, or tl1e survivor of them; one (l) share each unto tl1e following individuals: Blenda Wenger, Brad Wenger, Elizabetl1 Philbrick, Jane Hatfield Erickson, James Hatfield, John W. Hatfield; and one (1) share to be divided equally between Angela and Jason Wenger, or tl1e survivor oftl1em. Provided, however, tl1e share of Blenda Wenger shall be held in trust by my hereinafter-named Trustee pursuant to tl1e terms and conditions set forth in Paragraph V below. The remaining share, or fifty percent (50%) of my estate, shall be divided into four (4) equal shares, which I devise and bequeath as follows: ~ -1- ?rt~ ;;( V.R-n;-R-r- /---^~ A. One (1) share to be divided equally among my brothers and sisters who survive me. Currently, they are Harold M. Heise, Lewis B. Heise, Anna G. Reesor, Lois P. Winger and Erma J. Sider. B. One (1) share unto the Carlisle Brethren in Christ Church, Carlisle, Pennsylvania, to be used as it determines best. C. One (1) share unto Messiah College, Grantham, Pennsylvania, to be made a part of the John W. and Elizabeth B. Niesley Scholarship Fund, which provides scholarships for those members of the Carlisle Brethren in Christ Church who attend Messiah College. D. One (1) share unto Messiah Village, Mechanicsburg, Pennsylvania, to be made a part of its Endowment Fund. V. In the event that any assets of my estate pass into a trust fund for the benefit of Blenda Wenger as set forth above, said assets shall be held pursuant to the following specific terms and conditions: A. It is my intention that this trust fund be used solely to supplement any other means of support available to Blenda, and not to replace any other funds or other programs. In the event that said fund would cause other sources of funds to terminate, this fund shall immediately terminate and be distributed as though she had predeceased me as set forth in Sub-Paragraph C below. B. My Trustee shall use said fund, both income and/or principal, for the benefit of Blenda as he sees necessary and proper for her maintenance, after consideration of all other means of support available unto her. C. Upon Blenda's death, or in the event that she predeceases me, any remaining funds shall be divided into four (4) equal shares and distributed as follows: one (1) share each unto Elizabeth Philbrick, Brad Wenger and Barbara Hinderland, and the remaining share to be divided equally between Angela and Jason Wenger. VI. No interest of any beneficiary of my estate, either in income or principal, shall be subject to anticipation or to pledge, assignment, sale or transfer in any manner, nor shall any ben2ciaiy have power in any manner to charge or encumber his interest, either in income ~~ -2- ?JL~~~ ~ h~1P~ " , or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries hereunder for the liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. VII. Any amounts which are payable to a beneficiary under this Will may, at the discretion of my fiduciaries hereunder, be paid to the guardian of the person and/or property of such beneficiary, to the person who has custody of such beneficiary, or directly to such beneficiary, or may be applied for the use or benefit of such beneficiary. The receipt of such guardian, custodian, or beneficiary or evidence of the application of such amounts, shall be a full and complete discharge of my fiduciaries hereunder to the extent of such payment or application. This paragraph shall be applicable to payments of income as well as principal. VIII. I appoint William N. Wenger Executor of this my Will. In the event that he fails to qualifY or ceases to act as Executor, I appoint John G. Hatfield Executor in his place. IX. I appoint Brad Wenger as Trustee of any trusts created by this my Will. In the event that he fails to qualifY or ceases to act as Trustee, I appoint Elizabeth Philbrick as Trustee in his place. X. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, MIRIAM L. WENGER, herewith set my hand to this my Last Will, typewritten on three (3) sheets of paper including the attestation clause and signatures of witnesses, this ;?yfl day of SS2;I,t.-b-- ,2002. ~J;J~(SEAL) MIRIAM L. WENGER Signed by MIRIAM L. WENGER, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this .:?r7fl day of..r..p1~~ j,~, 2002. y~(~~. " VcJh~6-~ J, ~ -3- residing at ~ ~ ;{l residing at MecJw.IA.)cnburf} P;t " .' COMMONWEALTH OF PENNSYL VANIA COUNTY OF L~I3f'\1'J eN WE, MIRIAM L. WENGER, GERALD J. BRINSER and ValelJe...J. Bugo~h, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affinned, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 'h~~ ~uJ~ MIRIAM L. WENGER ~~(~ 1/~J,~ WITNESS Subscribed, sworn or affinned and acknowledged before me by MIRIAM L. WENGER, the testatrix, GERALD J. BRINSER and i/o..!e.I1L J. 13~1, ,witnesses, this ~day of ~ 2002, 1). )~ 'd. .~EAL) otary Public NOT ARJAL SEAL WENDY L CRAI"lfOflll. NaIIry Public Palmyra Boro.,l.ebMon County My Commission Expires ber 10, 2005 -4- COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE DEPT. 28O601 N~RRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX R~J(? '~- DATE 03-22-2004 · ;:7 ~:: :~ ESTATE OF WENGER MIRIAM L DATE OF DEATH 11-06-2002 FILE NO. 21 02-1010 COUNTY Cumberland GERALD J BRINSER ESQ '04 AFi~ -5 P '~ :04 ACH 101 BRISNER ETAL PO BOX 323 PALMYRA PA 17078 i.j:: Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE ~> RETAIN LOWER PORTION FOR YOUR RECORDS ¢: REV.1547 EX (06-97) PC N OTICl~'b'~ '~i ~'~ i~iYA~ E~- ~r~j(- ;~ F~ h'Ai~'~ ~i~=~i ~-] 'A-Q~iS~.'~ ~=- iSh' ................................ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WENGER MIRIAM L FILE NO. 21 02-1010 ACN 101 DATE 03-22-2004 TAX RET~~=~A~CCE~T.E_D_A..S_F/L_E_D [] CHANGED SEE ATTACHED NOTICE RESE~'~ATION CONCE--~'~T~'~ FUTURE INTEREST-SEE REVERSE APPRAISED VALUE OF RETURN BASED O~: ORI~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) 0.00 NOTE: To Insure proper (2) 0.00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 0.00 submit the upper port]on 4. Mortgages/Notes Receivable (Schedule D) (4) 0.00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 245,692.31 tax payment. 6. Jointly Owned Property (Schedule F) ' 7. Transfers (Schedule G) (6) 0.00 8. Total Assets (7) . 89,977.01 APPROVED DEDUCTIONS AND EXEMPTIONS: (8) 335,669.32 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 30,358.94 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions 12. Net Value of Tax Return (11) 30,358.94 (12) _ 305,310.38 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 150,126.22 14. Net Value of Estate Subject to Tax (14)" 155,184.16 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will reflect figures that Include the total of AL......~L returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 0.00 X .00 0.00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 120,168.29 X .045 5~407.57 17. Amount of Line 14 taxable at Sibling rate (17) 30,042.07 X .12 3,605.05 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 0.00 X .15 19. Principal Tax Due 0.00 TAX CREDITS: (19) 9,012.62 PAY--M----NT RECEIPT I DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID {-! AMOUNT PAID 07-08-2003 C D002783 0.00 8,321.38 TOTAL TAX CREDIT 8,321.38 BALANCE OF TAX DUE 691.24 INTEREST 21.29 TOTAL DUE 712.53 · ZF PAJ:D AFTER DATE INDICATED, SEE REVERSE (IF TOTA~ DUE IS L~.._q~ ~ $:1, NO PA~-m,Yf,,'~ IS R~QU:I:R~. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) tCOMMONV~EALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003815 WENGER WILLIAM N 1334 GEORGETOWN CIRCLE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $712.53 ESTATE INFORMATION: SSN: 159-50-1465 FILE NUMBER: 2102- 101 0 DECEDENT NAME: WENGER MIRIAM L DATE OF PAYMENT: 04/13/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 11/06/2002 TOTAL AMOUNT PAID: $712.53 REMARKS: ~ CHECK#T-2 -. INITIALS: JA ' SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS re December 12 1982 - if any future nterest in the estate is transferred in possession or enjoyment to Class B RESERVATION: Estates of decedents dying on ~re~lf~nt after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to (collateral) beneficiaries of the appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 21 of 1995. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. 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-1313). Applications are available at the Office of the Register of Wills or any of the 23 Revenue District Offices, or by calling the special 24-hour answering service numbers for forms ordering: In Pennsylvania 1-800-362-2050, outside Pennsylvania and within local Harrisburg area (717) 787-8094, TDD~ (717) 772-2252 (Hearing Impaired Only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: -written pretest to the PA Department of Revenue Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR -election to have the matter determined at audit of the account of the personal representative OR -appeal to the Orphans' Court. ADMINISTRATIVE CORRECTIONS: 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 17128-0601 Phone (717) 787-6505. See page 3 of the booklet"Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18,1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are: Interest Daily Interest Daily Interest Daily Year Rate . Factor Year Rate Factor Year Rate Factor .. 1982 20% .000548 1988-1991' 11% .000301 2001 9% .000247 1983 16% .000438 1992 9% .000247 2002 6% .000164 1984 11% .000301 1993-1994 7% .000192 2003 5% .000137 1985 13% .000356 1995-1998 9% .000247 2004 4% .000110 1986 10% .000274 1999 7% .000192 1987 9% .000247 2000 8% .000219 -Interest is calculated as follows: INTEREST -- BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR -Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ~EV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 FILE NUMBER DECEDENTS NAME WENGER MIRIAM 2102-1010 ^CN REWEWED BY CHARLES WRIGHT t 01 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Costs to deliver property reduced to $500.00 as a more reasonable charge. Personal H B-12 property valued at $$00.00. J Adjusted to show specific bequest of annuities at $60, 000.00 plus ¥4 of 50% of the residue. Lineal Adjusted to show 50% of the residue at 4.5%. Sibling Adjusted to show 1/4 of 50% of the residue at 12%. ROW Page 1 COHMONNEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTMENT OF REVENUE ZNHERZTANCE TAX DZVZSZON DEPT. Z80601 ZNHERZTANGE TAX HARRZSBURG, PA 171Z8-0601 STATENENT OF ACCOUNT REV-lgD7 EX AFP (01-03) : ~ DATE 05-2~-2004 ESTATE OF NENGER HIRZAM L DATE OF DEATH 11-06-2002 FZLE NUNBER Z! 02-10~0 '04 au;'¢ -7 ¢OU.NT,~ CUHBERLAND GERALD J BRINSER ESQ ACN 101 BRINSER ETAL Amoun* Remi*~ed PO BOX $25 ~-~ PALHYRA PA 17078 [~t MAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGZSTER OF WZLLS CUMBERLAND CO COURT HOUSE CARLZSLE, PA 17015 NOTE: To insure proper credi~ ~o your account, subm~ ~he upper por~ion of ~hSs form wi~h your ~ax payment. CUT ALONG THZS LZNE ~-- RETAIN LONER PORTZON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF NENGER HTRIAM L FZLE NO. 21 02-1010 ACN 101 DATE 05-24-2004 THZS STATENENT ZS PROVZDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHONN BELOW ZS A SUNNARY OF THE PRZNCZPAL TAX DUE, APPLZCATTON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE, A PROJECTED ZNTEREST FZ{~URE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-26-200~ PRZNCZPAL TAX DUE: ........................................................................................................................................................................................................................... 9,012.62 PAYHENTS (TAX CREDZTS): PAYHENT RECEZPT DZSCOUNT (+) AMOUNT PAZD DATE NUNBER ZNTEREST/PEN PAZD (-) 07-08-2005 CD002785 .00 8,$21.$8 04-15-2004 CD003815 21.29- 712.55 TOTAL TAX CREDZT 9,012.62 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .54 'rF PAZD AFTER TNZS DATE, SEE REVERSE TOTAL DUE .54 STDE FOR CALCULATTON OF ADDZTZONAL TNTEREST. ZF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS REQUZRED. ZF TOTAL DUE 'rs REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTZONS. ) PAYNENT: Detach the 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 tm: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND ICR): 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" IRE¥-1313}. Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Depart~ent's Z~-hour answering service for forms ordering: 1-800-$6Z-ZOSg; services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-3020 iTT only}. REPLY TO: Questions regarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 260601, Harrisburg, PA 17128-0601, phone I717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (Si) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine I9} months and Dna II} 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 (GZ) percent per annum calculated at a daily rate of .O0016q. Al1 taxes which became delinquent on and after January l, 1982 will bear interest at a rate which will vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through gOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 207. .OOOS~8 1988-1991 117. .goos01 200Z 97. .000Z~7 1985 16Z . O 00q38 1992 9Z . O00Zq7 ZOOZ 6Z .00016q 19&q 11Z .000501 1995-199q 7Z .00019Z Z003 57. .000137 1985 13Z .000356 1995-1998 9Z . OOOZ~7 ZO0~ 4Z .000110 1986 IOZ .000Z74 1999 7Z .000192 1987 9Z .O00Zq.7 ZOO0 8Z .O00219 --Interest is calculated as folXows: XNTEREST= BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNQUENT X DAZLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bo calculated. ~umoer±ana ~ounty - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/24/2004 BRINSER GERALD J 6 E MAIN STREET,2ND FLOOR P 0 BOX 323 PALMYRA, PA 17078 RE: Estate of WENGER MIRIAM L File Number: 2002-01010 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: 11/06/2004 Your prompt attention to this matter will be appreciated. Thank You. GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: MIRIAM L. WENGER Date of Death: 11/6/2002 Will No. 2002-01010 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 )~ '~ No~ -~, 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court ? Yes No * 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 Clerk of the Orphans' Court and may be attached to this report. Signature GERALD d. BRINSER Name (Please type or print ) 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Address (717) 838-6348 ~ '::.~!~ ~i ~) Tel. No. Capacity: ~ Personal Representative ~;cJ L- }~ PO. )~ Counsel for personal representative ~umperlana county - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/24/2004 BRINSER GERALD J 6 E MAIN STREET,2ND FLOOR P O BOX 323 PALMYRA, PA 17078 RE: Estate of WENGER MIRIAM L File Number: 2002-01010 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: 11/06/2004 Your prompt attention to this matter will be appreciated. Thank You. S' cerel GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of MIRIAM L. WENGER also known as ~o~o No. 21 02 -~66z- Date of Death 11 /06/2002 Deceased Social Security No. 159-50-1465 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 in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: GERALD J. BRINSER ESQUIRE I.D. No.: 09655 Address: 6 E. MAIN STREET PALMYRA PA 17078 Telephone: (717)838-6348 Personal Representative: C~%,~~ WILLIAM N. WENGER Dated JULY 1, 2003 Description Cash, Bank Deposits, & Misc. Personal Property PNC BANK -CHECKING ACCOUNT KEYSTONE FINANCIAL -VARIOUS ACCOUNTS (SEE ATTACHED) MISCELLANEOUS PERSONALTY IN ROOM AT MESSIAH VILLAGE REFUND ON COTTAGE AT MESSIAH VILLAGE MMA -INSURANCE REFUND Total (Attach Additional Sheets if necessary) 4,498.00 209,378.00 500.00 28, 029.00 163.17 245,692.31 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Value RW-4 STATUS REPORT UNDER RULE 6.12 Name of Decedent : MIRIAM L. WENGER Date of Death : 11 /6/2002 Will No .2_002-01010 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 State whether administration of the estate is complete Yes _~~ No ~~ '~%~y%C~~i 2 . If the answer is No , state when the personal representative reasonably believes that the administration will be complete 3 . If the answer to No . 1 is Yes , state the following: a . Did the personal representative file a final account with the Court ? Yes No ~_ 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 ~S_ No _ d . Copies of receipts , releases , joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report . Date : 10/6/2004 ~ ~"~ Signature GERALD J. BRINSER Name (Please type or print ) 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Address ( 717) 838- 6348 .~: ~'?~~; Tel . No . .-~ Capacity : Personal Representative „-., ; ~ ,~~ 170. '`~ -~~ ~ ~~ ~ ~ ~ _~ Counsel for personal representative