The URL can be used to link to this page

Home My WebLink About03-0889 PETITION FOR PROBATE and GRANT OF LETTERS Estate of MILDRED L. ST. JOHN No. ~/- 03- ~~9 also known as To: Register of Wills for the Deceased. County of Cumberland in the Social Security No. 196-14-3141 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rix named in the last will of the abov?decedent, dated March 15 ,~9 2000 "I1,;Vt and codicil(s) ~ N A UJIIIt~ IV.. .~ tf~e;/ ~~/ ~ ~<JO/ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 375 Claremont Driv~. Minnl~R~x ~nwn~hip. (list street, number and muncipality) Decendent, then 79 years of age, died July 30 ,:Jt~ 2002 , at 375 Claremont Drive, Middlesex Township. Cumberland County, P~nnRylvrlnia. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: none Decendent at death owned property with estimated values as follows: 10,000.00 (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.I.a.; administration d.b.n.c.t.a.) theron. ~ on 1;" u 0:: <l.> ~3 <l.> .... O::<l.> C 21 Woodland Court ",,0 1::'';::: Mansfield, TX 76063 c-;j'':: 3~ <l.>'- ::;0 ~ 0:: OJ) (/) STATE OF TBA\;TH OF PERSONAL REPRESENTATIVE CZ0~'Il~l{mxJI~~ I COUNTY OF TARRANT J SS 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 petitioner(s) and that as p sonal repre e - tative(s) of the above decedent petitioner(s) will well and administ~the estate a ordin to "' ~ -. - ...... ~ ~ -. ~~- ~- ~ . - i.~.~.:-l~L~-_ \\- \I~-lo No. QI-03- 8RCJ Estate of MILDRED L. ST. JOHN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW O~ ~8 xxi} 2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 15, 2000 described therein be admitted to probate and filed ofrecord as the last will of Mildred L. St. John ; and Letters Testamentary are hereby granted to Gloria Jean Gurkoff ~n"J'1rtrn 1&1: ~ 9~ Register of Wills {/ FEES Probate, Letters, Etc. ......... $ 40. 00 Marlin R. McCaleb #06353 Short Certificates( ).......... $ q.OO ATTORNEY (Sup. Ct. I.D. No.) 219 East Main Street Norll.....~n-~I;.;!--\.'-r~.... $1Q..oO Mechanicsburg, PA 17055 ~p $ 10, 00 ADDRESS Filed ..O~~~~~, .-?9~~'.'.~.. (717) 691-7770 m~Gcl. tb PHONE -,- Q~ IO-J'3""-.,;LOu3 . . ~ .- REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS ~ I - 03 - ~8'q EMILY A. JOERG , xlllliiri: (exad19 a subscribing witness to the will presented herewith, (cadi) being duly qualified according to law, depose(s) and say(s) that I was present and saw Mildred L. St. John , the testat r ix , sign the same and that I signed as a witness at the request of testat r ix in h er presence and ~~)lama}Q(~~) (in the presence of the other subscribing witness( es)). {5~yt1. ~~/ Sworn to or affirmed and subscribed before me this :27 )Gfl day of ~JN A. foerglj &~kt~2003 219 East Main s~rj~e ME>,...h",ni,...",hl1r'], PA 1 70" " (Address) -liBg~tf/w NofariaI Seal (Name) Marlin R. MoCaIeb, Notary Public Mechanicsburg 80m, Cumberland County (Address) My Cormlission Expires Dec. 14,2006 Member, Pennsylvania Association Of Notaries REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS f-o": ...- - , (each), a subscriber hereto, (each) being du ualified according familiar with tli , codicil testat_ of (one of the will prese and codicil that ieves the signature 0 e will is in the han testat_ believes e signature of the will pre ted herewith and tha codicil l;lelieves the signature on the is in the handwriting 0 to the best of know e and belief. Sworn to or affirme d subscribed befor me this day of 19_ Register (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS ~\ - o~ - c;l~q MARLIN R. McCALEB , ~m (ea.oh} a subscribing witness to the will presented herewith, (~R) being duly qualified according to law, depose(s) and say(s) that I was present and saw Mildred L. St. John , the testat r ix , sign the same and that I signed as a witness at the request of testat rix in h er presence and eAnlwc~JOf~~~~) (in the presence of the other subscribing witness(es)). ~~~~ Sworn to or affirmed and subscribed before m this ~4-rY\ day of Marli~mine~ccaleb ~ 2003 219 East Main Street Mechanlcsburg, FA 170~~ .'\. (Address) ..,--- . . (Name) (Address) R~ISTER OF WILLS OF COUNTY 6ATH OF NON-SUBSC~ WITNESS ~ .~ '-..,,' , (each), a subscriber hereto, (each) being au ualified according to law, de se(s) and say(s) that familiar with te.~ignature of , codicil will presented h ewith and '-.........~, "" ......~odicil ... that .............. eves the signature 6n..the will is in the handwriting of testat_ believes the signature oftlie-...wi,ll prese~erewith andthat' ......... \ codicil "- "", ~ the will is in the handwn . dge and belief. ........... Sworn to or affirme~ subscribed before me this '" day of (Name) , ')- (Address) Register (Name) (Address) H105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ".""''(1H'O.F'P!:----__ a ~",? ~,-" ,.t~~~.. !t,',f;;.", ).,'.'-""/ /<- (;~'?-'> !tit; ,'/!i;J::"- \~'~ . .', u~~ .. '" I~_ ....~.. ~...,:.\ Local Registrar ,_ - t::E{ '..... ~i U ~ 3~. '<j11;~ :,' ii;;~ \~~~. /;.~:l AUG 0 1 2002- P 8463276 ,,-~~---,,~~\.\ "'-----LMENl \\\J",,"\ No. """##,,,,/11 Date ,.143 R.v. 211I7 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STATE FI4...E NUMBER NAME OF DECEOENT (Fvll. MOote. La) SEX SOCIAL SeCURITY NUMBE.R 1. M 't.O Il-t:.!) -,', .JC't\....J 2. Fanale .. 196 - 14 - 3141 30 2002 AGE (laII Birlhday) UNDER 1 YEAR UNDER 1 OA) BIATHPl.ACE (City and PlACE OF OERH (Ct'leek oNy QI"II! __ ->ee It'lSlJlICltOofI 0.. arhef ~) MonItle . 0.,. HourII. MInut8I SlaJ. or fore.gn CounuYJ HOSPITAl.: 79 Yra. i i ChamberSbur~~ lnPllI~ 0 ERlOlApaa;on' 0 OOA 0 ="" 0 ~. ~ k . COUNTY OF OEAJ'H FACtlfTY NAME (I' not W\SIitubon. QfV8 SCree! ~ number, Cunberland ...Middlese,x 'I'wp. .... ClarffilOnt Nursing & Rehab. Ctr. White DECEDENT'S USUAL OCCUlWlON KIND 0#' BUSINESs/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION l<ARfTAL STAJUS _ _ SUIMVING SPOuSE ~Iondol....k_""'..._ U.S.ARMEDFOACES' _M_-. ,......___ oI_Ing"""'__,ofiredj Yes 0 ...lCI: ~CSPoc>II1 11 Saleswanan 11b. Dept. Store ... Widowed DECEDENT.SMAIlINGAOORESSlSU....CIy/bon.SIaIo,l"<>Codol ~~~NT'S "..SlaI. D;d 17.x:J Yoo.__in 1Wp. . 375 Claranont Drive RESIDENCE ___ ..' (See ansarucc.ona Min. ~lisle, PA 17013 on..........) '1b. Cunberland _1 ..d.o ::.:.......""::.. ...___ MliE:ft.s NAMe (First Meddte. Lastl UOTHER"S NAME (FlIsl. ModdIe. MoiIIden Surname) ... David Z..k II. INFORMANT'SNAMElT_mtl INF~T~~~....Cily/"R>wn.Slo...ZipCodol Gloria Gurkoff _.., . ME1ltOO OF DISPOSITION PlACE OF DISPO$ITK)N. HarM of C.met.ry, Ct.malOlY L 8unoo6i C._I.... 0 Removal.... Stal. 0 Of 0Ih0f ..... ou...~ ..c?t. John's Cffiletery 2.d. Canp Hill, PA 17011 NAME AND ADDRESS Of fACIlITY Myers-Hamer PH, 1903 Mkt St, CH, PA 17011 .... LICENse HUM8ER :la. I Appro"lmal. MIlT I: Clther I9\iftcanI CDndIIionI conttibudng 10 death. bur : inlernJ....... no<< rnuIlng in... ~ ca&M gMn" PAAT I. lonMI and de.1h I .. 5icN\U:: D"''^'lt.....'\A A.L.lI-lL\"'It:.n.'') "Ii'\C l DUE m (OR AS A CONSEOUENCE OF): I . b ! DUEm(OAASACONSEOUENCEOFlo , I C I DUE m (OR AS A CONSEOUENCE OF): I d , WERE AUlOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIMe OF INJURY INJURY IJ \YORK? DESCRIBE HON INJURY OCCURRED. A\otIUlA8lE PRIOR 10 IMonlh. Oa.v. Year) COMPLETION 0#' CAUSE '-' Of'DEArH' N_a1 U Hamic... 0 ..... 0 No 0 Aec:idllnI 0 Pending tnlt'eslM;alion 0 No~ ..... 0 No El'''' Suic.,. 0 Coufdnocbedelermined 0 PLACEOFINJURV.A.lhom..larm,SlIe...,aaGfy.orfic. M. Oc. buiIdInv. .tc. ISpec,M 21b. OIl. 30.. a:"'IIfIE.A (Ct-ec:k oniyon.l -CERTIFYING PHYSICIAN fF'hySlCtan Cftblyonc) cause oJ dNlh wher' anoII>.. phvSlC>an has Pfonounced de_an ana CompIeled lIem 231 To... beet o. my knowledge. d..lhoec:urred due 10 Ih. caua.(a) and manner...I.tlld. ... ........,...... ....... .............,.......... ... 0 31b. lICENSe NUM8ER '~c;.~vAk~~~:~~~:.~:'::'~~~~:,:::,::;,:~:",~~::':=:.:'~~~=(~~:'oIm~::",.....,........................ [3..c. A,.) L ,{)" ~i/. "d. '/ IU NAME AND AODRESS OF PERSON WHO COMPlETED CAUSE Of OeATH (lIem 27) Type Of Prinl '''EDlCA~ EXAMINER/CORONER . . . of... c", /_1 J ' . ~,I ) ~~':.:~::~t:::.:.~':'.l~~t.'~~..n~o~ ~~~.~t.I~.~'~~: ~~ m.v. ~pln.'~~: ~~~~ ~~~:~~~ ~~ ~~~ ~'~~'.~~'~: ~~~.~'~~~: ~nd.~~~ ~~ ~~~ ~~~~~~~).~n~ 0 ~,', '> ) L ~C,l )'1'1 - L :- J'), / -J J . _ 31.. 32. I::>Q c{,OJ J-k/f: I;,y L.......v__, " /t,.,..-') REGaSTR .S. SIGNATURE AND NUY8ER . I J,/ J DATE FllEO(Monlh Gay '!'eall ~ "-" eiL.e!1 /;/1 ~ ~':I'~ " ~ ~...(-.!..,:t:~Y~"1:fi- " 'U-4-a~ I. c:? 0 0 L.. - .~-- L _.-" -.- .~ LAST WILL AND TESTAMENT I, MILDRED L. ST. JOHN, of the Borough of Carlisle, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and - Testament, hereby revoking and making void all former Wills and Codicils by me at j any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be ~ paid by my Executrix, hereinafter named, as soon as conveniently may be done ~ after my decease. SECOND. I give and bequeath my automobiles and personal effects and such household goods, furniture and furnishings as may be my individual property and not the property of my husband, or owned jointly by me with him, and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my daughter, GLORIA JEAN GURKOFF, if she survives me. THIRD. If my husband, VV:LLlAM \/1/. ST. JOHN, survives me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, unto my daughter, GLORIA JEAN GURKOFF, IN TRUST NEVERTHELESS, to hold, LAW OFFICES manage, invest and reinvest the same and the income therefrom and to use and MARLIN R. McCALEB apply as much of the principal and income therefrom as my Trustee, in the exercise of her sole and absolute discretion, may deem appropriate for the comfortable support, care and maintenance of my husband, WILLIAM W. ST. JOHN, for and during the term of his natural life; and upon the death of my husband, this Trust shall terminate and my Trustee shall pay over and distribute the remaining balance of principal and income, if any, thereof unto my daughter, ~ GLORIA JEAN GURKOFF, absolutely and in fee simple; provided, however, that if ~ my daughter is not then living, then the same shall be paid over and distributed ~ unto her then-living issue per stirpes, said issue to take the ancestor's share by '-' representation and not per capita. My Trustee shall hold all income and principal from any Trust herein free from all claims, attachments, judgments, executions and liens of every kind and nature by creditors of any beneficiary and no beneficiary shall have any power to anticipate, assign, alienate, pledge, charge or encumber the income or principal of any Trust herein. FOURTH. If my husband, WILLIAM W. ST. JOHN, shall not survive me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, unto my daughter, GLORIA JEAN GURKOFF, absolutely and in fee simple. FIFTH. In addition to any other powers conferred by law, my Trustee herein is hereby expressly authorized and empowered at all times, in her sole and LAW OFFICES MARLIN R. McCALEB -2- absolute discretion: A. To purchase, invest in or otherwise acquire and to retain, whether originally a part of the Trust estate or subsequently acquired, any and all stocks, bonds, notes or other securities, or any variety of real or personal property, including stocks or interest in investment trusts and common trust funds maintained by any bank, or interest-bearing accounts in or certificates issued by any bank, as she may deem advisable without being limited by any statute or rule of law prescribing or relating to legal investments by trustees; and to hold or retain cash or readily marketable securities of little or no yield for such periods as she may deem advisable. The investments r" need not be diversified and may be made or retained with a view to a possible increase in value. S. To sell at public or private sale, pledge, mortgage, lease, transfer, exchange, convert or otherwise dispose of, or grant options with respect to, any and all property at any time forming a part of the Trust estate, in such manner, at such time or times, for such purposes, for such prices and upon such terms, credits and conditions as she may deem advisable, including the right to lease such property for periods of time which may ex1end beyond the termination of this Trust. C. To allocate receipts and expenses to principal or income, or partly to each, as she may from time to time deem proper in her sole and absolute LAW OFFICES MARLIN R. McCALEB -3- discretion. D. To employ accountants, agents, attorneys, investment counselor brokers to perform services for and at the expense of the Trust hereunder for which such services are performed and to carry or register investments in the name of the nominee of such agent or broker. The expenses and charges for such services shall be charged against principal or income or partly against each, as my Trustee may determine. My Trustee is expressly relieved from any liability or responsibility whatsoever for any act or failure to act by, or for following the advice of, such accountants, agents, attorneys, investment counselor brokers so long as my Trustee exercises due care in their selection. LASTLY. I nominate, constitute and appoint my daughter, GLORIA JEAN GURKOFF, Executrix of this, my Last Will and Testament, to serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, MILDRED L. ST. JOHN, have hereunto set my hand and seal to this, my Last Will and Testament which consists of five (5) typewritten pages to each of which I have affixed my signature this 1/]-cI day of ~J&.e..ti- , A.D., Two Thousand (2000). 7J~~;( J-I~SEAL) The preceding instrument, consisting of this and four (4) other typewritten LAW OFFICES MARLIN R. McCALEB -4- . page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MILDRED L. ST. JOHN, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at this request, in her presence, and in the presence of each other, have ~ subscribed our names as witnesses hereto. ~~ ~ ~ 04a #7J u \\ LAW OFFICES MARLIN R. f'VlcCALEB -5- ~. .- . . -: -- , . on on 0 !:: Z ~ ~ ~ l:I:l ~ ~ 8 ~ 0 !"'j ....I p:: ....I 8 ~~s..~ . ~ III ~ Z ~ ::: p:: z z tI) ~ ~~~<~ o ~::>:. ~ \+-+ . LP ~ ~.. ~ ~ ~ H ~ ~ ~ H T Q (Q . ~ ~ ~ ~ Q r.:I III _ p:j I<. ~ Q := H Q ~ H ::>: ~ . . . . . l ,; r7 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mildred L. St. John Date of Death: July 30, 2002 will No. 21-03-0889 To the Register: I certify that notice of beneficial interest and estate administration required by Rule 5.6(a) of the Orphans' Court Rules was personally served on the following beneficiary of the above-captioned estate on October 31, 2003. Name Address Gloria Jean Gurkoff 21 Woodland Court Mansfield, TX 76063 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: October 31, 2003 ~~ Marlin R. McCaleb Attorney I.D. No. 06353 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 (717) 691-7770 FAX: (717) 691-7772 Counsel for Personal Representative ," , i . - LAW OFFICES MARLIN R. McCALEB - COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 03-0889 BUREAU OF INDIVIDUAL TAXES AND DEPT. 280601 TAXPAYER RESPONSE ACN 04101744 HARRISBURG, PA 17128-0601 DATE 01-23-2004 REY-1545 EX AFP 109-001 TYPE OF ACCOUNT of o SAVINGS oi Wills EST. OF MILDRED L STJOHN S.S. NO. 196-14-3141 [Xl CHECKING DATE OF DEATH 07-30-2002 o TRUST FEB 17 P 2 :07 COUNTY CUMBERLAND o CERTIF . '04 REMIT PAYMENT AND FORMS TO: GLORIA GURKOFF REGISTER OF WILLS 21 WOODLAND CT 76 ou:;n<..- C" , C~ C>ourt CUMBERLAND CO COURT HOUSE MANSFIELD TX CO'l PA CARLISLE, PA 17013 C\!lnbenan{j PNC BANK has provided the Department with the information listed below which has been used in calculating tha potantial tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a COpy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW JE JE JE SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5003606553 Date 05-15-2001 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 4,010.66 payment to the Register of Wills. Make check payable to: ."Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax 668.46 NOTE: If tax payments are made within three (3) months of the decedent.s date of death, Tax Rate X .045 you may deduct a 5~ discount of the tax due. Potential Tax Due 30.08 Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE []111!1!!I1~~.lllil~tli!i_lii!II~~~!I!li"liiiii~liiii.ilii.~I~I~!i!iil~li!i!_BlJ!iii..iiii.iiii.~liiil.~lllii!I above information and tax due is correct. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK ] a discount or avoid interest, or you may check box "A" and return this notice to the Register of [ ONE Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent.s representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on Line 5 of Tax Computation) $ I declare that the facts I and dge and belief. HOME d-~l{~Ot{ DATE GENERAL INFORMATION l. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritence tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assesSllent (Form REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after lZ/IZ/8Z: Accounts which the decedent put in joint nalles within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established lIore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 OIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.77. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 507. (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%11 12% 15% MThe tax rate lmposed on the net value of transfers from a deceased Chlld 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 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legallY are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Depart.ent of Revenue. el...DE~tfR!tMEN!t"Qf:t,.RE~ENlJ.fjt.,DIS!tRIC::J1..,Q~JffiIC.E.....O~'iC.It:iL,..JfflEiiJUJ.~EiIIJ.'iQ~.,.""".......,.."", ,.."".......,..,..,.,,'i.'...,..,...., r Commtmwealth of Pennsylvania Department of Revenue 00') Bureau of Individual Taxes DROP SHIPMENT w<fl ...-<l: Dept 280601 AUTHORIZA nON 2E.S o::..J 0<"> VJf- Harrisburg PAl 7128-0601 IlAllEO AT READING PI\ wU) a:CJ: ~ Rec.c~rGb\..-, , .,..4> ~JI .... ~ '. 'D4MJ~LlJmj~2 M.8mER c21-i) 3 - ~~l REGISTER OF WILLS '. letitirm:ER~~iO COURTHOUSE ~e~flfu SQ CARLISLE PA 17013 LAL._.l5t'1S i 7(:; i ::;: 1111111111 nlllllllflnlllllllllllllllllull n 11111 r ---" --_._~---- , '* DEX55 (9-93) COMMONWEALTH OF PENNSYLVANIA ;(j-o 3 -gg'l BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE Dear Register aI WilIS~ Enclosed you will find: eck(s) Ddocuments(s) which were received by the Department of Revenue in error, These may be processe according to normal procedures, . REMINDER: The POST MARK DATE on envelope attached to any checks enclosed must appear on your Official Receipt. Thank you. Sincerely, John Murphy, Chief Inheritance Tax Division (717) 787-6201 r . c9J r ~..... . -' Eo148 EX (NI) ~.. " ~ -1-;: , c;lo~~ ~~~ ' j "~ .- rl-.\ ~\JLf\~C) , , _. c;t- " JUe. ---~" / - J.I\ 'f\ f\.J ~ ~ t€l~ ) tl. ~boC93 Zip Code AttenUon: TIC 340 PA DEPARTMENT OF REVENUE ;l.)-D 3-g~5 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 Imlll.III...II..I.II..I.II....II..II......II.1 I COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEKENT~ ALLONANCE OR DISALLONANCE OF DEDUCTION , AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP 101-D5l Recore, DATE 03-08-2004 ReC:Si ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 COUNTY CUMBERLAND '04 MAR -5 P 3 :43 SSN/DC 196-14-3141 WILLIAM W STJOHN ACN 04101743 21 WOODLAND CT I Allount Rellitted I MANSFIELD TX 76U~rk. . l C\lInber,(".;:,Cl MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....... iifv=is4-i-E3f-AFP--coi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-08-2004 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 COUNTY CUMBERLAND FILE NO. 21 03-0889 S.S/D.C. NO. 196-14-3141 ACN 04101743 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003606553 TYPE OF ACCOUNT: ( ) SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-15-2001 Account Balance 4,010.66 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 668.46 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 668.46 REGISTER OF WILLS AT THE Tax Rate X ,00 ABOVE ADDRESS. MAKE CHECK Tax Due .00 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 ,00 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, · ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. vl; IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA *' ~ BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISE"ENTt ALLOHANCE OR DISALLOHANCE OF DEDUCTION . AND ASSESS"ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP 101-05) Rec;-' DATE 03-15-2004 Re ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 .04 MAR 12 P 1 '45 COUNTY CUMBERLAND . SSN/DC 196-14-3141 GLORIA GURKOFF ACN 04101744 21 WOODLAND CT TX 7~t~bt, ic ~ \ Allount Rellitted \ MANSFIELD MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... Rifv;i5~8-E)f-AFFi-(Oi-;03)------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-15-2004 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 COUNTY CUMBERLAND FILE NO. 21 03-0889 S.S/D.C. NO, 196-14-3141 ACN 04101744 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003606553 TYPE OF ACCOUNT: ( ) SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-15-2001 Account Balance 4.010.66 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.166 YOUR ACCOUNT. SUBMIT THE Amount Subject to Tax 668.46 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 668.46 REGISTER OF WILLS AT THE Tax Rate X .45 ABOVE ADDRESS. MAKE CHECK Tax Due 30.08 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 03-23-2004 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 30.08 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.28 TOTAL DUE 31. 36 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. \Jl IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate TaK Act, Act 23 of 2000. (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 taK credit, which was not requested on the taK return, may be requested by completing an "Application for Refund of PennsYlvania Inheritance and Estate TaK" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taKpayerS with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of taK (including discount or interest) as shown on this Notice may object within siKty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual TaKes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance TaK Return for a Resident Decedent" (REV-1501) for an eKplanation of administratively correctable errors. DISCOUNT: If any taK due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the taK paid is allowed. PENALTY: The 15% taK amnesty non-participation penalty is computed on the total of the taK and interest assessed, and not paid before January 18, 1996, the first day after the end of the taK amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the taK 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. TaKes which became delinquent before January 1, 1982 bear interest at the rate of siK (6%) percent per annum calculated at a daily rate of .000164. All taKes which became delinquent on or 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 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor i98Z -m- -:Diiii548 rn8-1991 "'li% :oOo3iil 2OOi. ~ . 'ffiZ47 1983 16% .000438 1992 9% .000247 2002 6% .000219 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 NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the taK 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. COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ~~:~iS~~~~OlpA l7lZ8-0601 INHERITANCE TAX , STATEMENT OF ACCOUNT REY-IU7 EX AFP 101-03> Re(,(j DATE 03-15-2004 Rt>, ., ESTATE OF ST JOHN MILDRED L DATE OF DEATH 07-30-2002 ., FILE NUMBER 21 03-0889 04 tlAR 26 All :49 COUNTY CUMBERLAND GLORIA GURKOFF ACN 04101744 21 WOODLAND CT.C'" ".,.., . I A t R . tt d I " ~I' 1I0un ell 1 e MANSFIELD Cl~n~, ~~063 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'EV=i6'ifj-E3f-AFP-coY=03Y------...--iNifERITANc'E--TAx-si'jrfEMEN"T-1fF-Accouiff--.-..---------------- ----- ESTATE OF STJOHN MILDRED L FILE NO.21 03-0889 ACN 04101744 DATE 03-15-2004 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: 03-15-2004 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 30 . 08 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-12-2004 CD003564 .00 30.08 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-13-2004 TOTAL TAX CREDIT 30.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. 1.15 iii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1.15 SIDE 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 DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: 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 to: REGISTER OF WILLS, AGENT, __ If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. 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. 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, 198Z 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, 198Z 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 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor - - - - - - - 198Z ZO% .000548 1988-1991 11% .000301 ZOOl 9% .000Z47 1983 16% .000438 199Z 9% .000Z47 ZOOZ 6% .000164 1984 11% .000301 1993-1994 n .00019Z Z003 5% .000137 1985 13% .000356 1995-1998 9% .000Z47 Z004 4% .000110 1986 10% .000Z74 1999 n .00019Z 1987 9% .000Z47 ZOOO 8% .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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. COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ......" ~ DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS REV-1604 EX AFP 101-051 Raul' DATE 03-23-2004 P"v ~ "."..' ,,-' ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 .04 APR -5 P3 :04 COUNTY CUMBERLAND SSN/DC 196-14-3141 WILLIAM W STJOHN ACN 04101743 21 WOODLAND CT Ge; I Allount Rellitted I MANSFIELD 1] 1111t06 3 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-03) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS -- DATE 03-23-2004 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 COUNTY CUMBERLAND FILE NO. 21 03-0889 S.S/D,C. NO. 196-14-3141 ACN 04101743 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003606553 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECK! NG ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-15-2001 Account Balance .00 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable X 0,166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate X ,00 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due ,00 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 00 IE 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.) . ,- PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address 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, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. 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. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (I) day from the date of death to the date of payment. Taxes which became delinquent before January I, 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 I, 1982 will bear interest at a rate which will vary from calendar year to calendar y~ar with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 n .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 n .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) 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. ! / / 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 [ECEDENT'S NAME FILE NUMBER St John, Mildred L 21 03-0889 REVIEWED BY ACN Steven James 04101743 .. ITEM SCHEDULE NO. EXPLANATION OF CHANGES The above referenced CAN has been adjusted to $0 as the survivor listed on the assessment in actuality predeceased Mrs, St. John, The full amount of the account should be listed on the probate return when it is filed, ,..... ~ ROW Paqe 1 ...I .. .... c 0 III CI .... iii )\ W .... II Ill:: Z Do CI III X ...I :E II 1-1 >- .... :E cC I. a. W :l 0 .... eI) )\ H :) .J:. :E 0 .... " III :c ... ~ NCI'\CI III Ill:: ~ , 0 ClCOZ .... ....1'/) Cl ClCOet~ .... Ill:: .... iii ... CI I. N NCl...l~ iii Z eI):)Cl 0 I Z I I IlI::..... III cC ...10..... 'I- In:cClI'/)W.... lII: ...IU.... en m ""01'/) Cl lIlICl III 1-1 ... CI I .., I ~.... 3:0 .J:. 1:1I:: I'/)I-.........:)~ IQ Uet .... 0 Clel)ClNUCl cC U. 11. 'I- U >- OCl 0 III cC ::E: cC Z .. Ill:: H IlI::etw C Z ... .... a. W...l...l 0 cC cCl:II:: 1-IlI::V'l '.. 1:1I:: Z 11I11I lIli: .... =>> >11I X:;' I&.ClIQ U V'lWI-I I. 0 ...=>> 0 ~ III 1-1 lIlI ...I 0 >- >-Z etO I&.=>> ::E: (!)~IlI:: Do mill ...0 1II0Z>- U W:)et I. Ill:: Z> 0 .... .... IlI::UU III 0 ZIII lI.Iet IIIcC 11I11I Z III Do I&. III Ill:: Do ...............=>>Z lIli: :l a. OLL cCmcCHOU cC Z I&. Zo ClIIIClI&.UcC ~ III 0 1&.0 .J:. 0 et .... H .... ...... .... ::E:Z .... 1:1I:: HZ ... 0 ....11I iii ...~ ~II.I .Q a. CC.... 11.I% :l 11I1:1I:: :E:II.I en Ill:: :acC Z... .. III Za. Het .... 3: 011I c 0 :ECI ... :l ... 0 :E UJ u Z 0 u U II H I. cC :l .... I'/) 0 III '" )\ 1:1I:: Cl 0 '" .... ..... .... , u. )( ... " U. I- III 0 I. ~ U CIl Ill:: I. w :)1- III x (!)U Do III 0 C I. Z I- CI Do H ..Iz ... Z ... c:o etCl III Co "" I. ~... c:o ...I ...I :l m QIIl I ClW 1-1'" <<I en H >~ N etOI-l C ::E: ... 1-I0u. ... I-ICl ... .... Qx ... IlI::3:V'l 0 Zc c 0 Z ?- m I-I~ c.. ...I....et Z ... (!)N~ .. L&. LLJ CI .. W 0 Q U"" to I- ... zc:oa: ~ c <<I::> Q cC ~N'" Z C... III L&.I a: ...... .... lII: lIJ ~ a: ~:I: c.. a: =>> CD ~~;! U ~ ." .. < 3: '" Z ... I I ." co I I , II ... ... .... ... ::J III ... ... .... n z Xl II ::J' a. CO '" g: z Ul 0 I ... ::J II Xl CO '" '" g: .... Ul Z 0 ... ... II ." CO '" CO , ." Z '" II 0 ... n c , '" II .... CO CO , ... '" '" III 0 n z II ::J '" ... CO III 0 '" . ... ... Z III a. ... "" II .... II II ::J' ... .. n III "" ::J' II .. Z n 0 n "" :! ::J' .. 0 n n , II "" . .. 0 0 ::J , ::J a. .. . '" III 0 " ::J 0 r:r II , . '" a. ... II .... 0 , , E a. ." ... .. III g: , '" .. ." r:r '" .. ... 0 '" .. " .. , r:r .... ... 0 ." II .. .. '" .... ;lII . 0 1ft III .. ::J In .... n .... 0 CIl . :z -4 .. a. :z 1ft II 0 ;lII Z ." 0 .. :E '" 1ft .." .. > r:r r- :E ... -4 .... II :c r- .... r- 0 0 CIl .... .." .. ::J' > II "II 1ft In ::J Z 1ft .. Z Z . CIl -4 III < III r- ::J C a. > III Z a. .... a. > , II III III COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) OEPARTMENT OF REVENUE BUREAU OF INOIVIOUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003771 MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER _nn___ fold ---------- -------- 04101744 I $1.15 f:; C ( ESTATE INFORMATION: SSN: 196-14-3141 I FILE NUMBER: 2103-0889 I DECEDENT NAME: ST JOHN MILDRED L I - 04/06/2004 DATE OF PAYMENT: I POSTMARK DATE: 04/05/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/30/2002 I I TOTAL AMOUNT PAID: $1.15 ".-..'.'. REMARKS: ,...,..".- , ".- .- CHECK# 2568 INITIALS: JA ,.. SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WilLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISIDN DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-16D7 EX AFP 101-DSI ". DATE 05-17-2004 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 '04 hkY 24 . '2 ~NTY CUMBERLAND GLORIA GURKOFF \ t..) . '. ACN 04101744 21 WOODLAND CT I Allount Rellitted I MANSFIELD TX 76063 C... Cnne MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'ifj-EX-AFP-(Cff.:oiY------...-iNHERiYANC'E--fAX-ST'AfEMENf-o"F-A"ccouiif--.-..--------------------- ESTATE OF STJOHN MILDRED L FILE NO.21 03-0889 ACN 04101744 DATE 05-17-2004 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: 03-15-2004 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 30.08 PAYMENTS (lAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-12-2004 CD003564 .00 30.08 04-05-2004 CD003771 1.15- 1.15 TOTAL TAX CREDIT 30.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 !Ii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE 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 DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your pay.ent made payable to the na.e and address printed on the reverse side. -- If RESIDENT DECEDENT make check or .oney order payable to: REGISTER OF WILLS, AGENT. -- If NDN-RESIDENT DECEDENT make check or .oney order payable to: COMMONWEALTH OF PENNSYLVANIA, REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, .ay be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-13l3). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Dffices or from the Department's Z4-hour answering service for for.s ordering: l-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: l-800-447-30Z0 (TT only). REPLY TD: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060l, Harrisburg, PA l7lZ8-060l, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (570) discount of the tax paid is allowed. PENALTY: The 1570 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 a.nesty period. 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 beca.e delinquent before January 1, 198Z bear interest at the rate of six (670) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z 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 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor - - - - - - - 198Z ZOX .000548 1988-1991 1170 .000301 ZOOl 970 .000Z47 1983 1670 .000438 199Z 970 .000Z47 ZOOZ 670 .000164 1984 1170 .000301 1993-1994 n .00019Z Z003 570 .000137 1985 1370 .000356 1995-1998 970 .000Z47 Z004 470 .000110 1986 lOX .000Z74 1999 n .00019Z 1987 970 .000Z47 ZOOO 870 .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER 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. jI1JU r ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: MILDRED L. ST. JOHN Date of Death: July 30, 2002 Will No.: 2003-00889 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 0 No 1KI 2, If the answer is No, state when the personal representative reasonably believes that the administration will be complete: October 1, 2004 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 - NoD b, The separate Orphans' Court No, Cifany) for the personal representative's account is: - c, Did the personal representative state an account informally to the parties in interest? Yes 0 No' 0 c, Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court Date: 7/08/04 and maybe attached to this ~~~ Signature Marlin R. McCaleb, Esq. Name 219 East Main Street I Mechanicsburg, PA 17055 D 1'0,,- Address' ~..._~ WI (717) 691-7770 I .I Telephone No. -:J 'J '~.~- Capacity: 0 Personal Representative c.::;, 00- Gl Counsel for personal representative ~". ....,...- Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Mildred L. St, John No. 21-03-0889 also known as Date of Death 07/30/2002 , Deceased Social Security No. 196-14-3141 Gloria Jean Gurkoff, 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 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. l!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. Personal Representative Name of Signature: / I / ~ Attorney: Marlin R. McCaleb Esq. G orla I.D. No.: 06353 Signature: Address: 219 East Main Street Address: 21 Woodland Court Mechanicsburg, PA 17055 Mansfield, TX 76063 Telephone: 717/691-7700 Telephone: 817/572 - 4822 Dated: ~ JJ-- 00 -O,-#: Description Value "'" '8 c:;:) c:::> :::0 ~~ or- fg[Ij 0 m~o rrt (-:JC) ::D .- ("") 65 ::1::1 ;-m - _. -I \:.-::1 )> :n ... 1'""1"'1: ("f'1 zcn:A ~-::I~] ;':"-:J (See continuation page(s) attached) DO -0 C:0 08-" ".;'j -'"h 0 3: E~~~ = :::0 - ::u-i .. (./J (::> )> +" -J -" (Attach additional sheets if necessary) Total: 8,805.20 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. P,epared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Formt#RW-7 (1992) < OFFICIAL USE ONLY REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA 21-03-0889 DEPARTMENT OF REVENUE RESIDENT DECEDENT DEPT. 280601 COUNTY CODE YEAR NUMBER HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 St. John Mildred L. 196-14-3141 E C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE E 0 REGISTER OF WILLS E SOCIAL SECURITY NUMBER N T 2. Supplemental Return 3' date of death . Remainder Return prior to 12-13-82) CAP B 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required ~ ~ ~ a x 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes C R ~ ~ (Attach copy of W1I1) (Attach copy of Trust) - K 0 E S 0 9. litigation Proceeds Received 0 10. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A} (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) ,;': :i;'..'::':'::III:.:~':'::':']..JIIJ_.:::'i_JI.Uli:I""Jili!!:;;! P COMPLETE MAILING ADDRESS C 0 0 Marlin R. McCaleb Es . 219 East Main Street R N FIRM NAME (If Applicable) R 0 P. O. Box 230 E E Law Offices-Marlin R. McCaleb Mechanicsburg, PA 17055 S N T TELEPHONE NUMBER 691- 00 1. Real Estate (Schedule A) (1) None 2 OFFICI.. SE ONLY :0 2. Stocks and Bonds (Schedule B) (2) None ~ ....-::0 En :s: 0 rrlg 3. Closely Held Corporation, Partnership or (3) None CJ? -0 rr1 C"') rq~(") n .;- eg Sole-Proprietorship :;g.- ., ~' ~ C. f"n - tTl rn 4. Mortgages & Notes Receivable (Schedule D) (4) 3,454.21 ,." -:lJ .(;:'"' . ",. '--I Zen ^ -'. ,-- R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5,350.99 C) (") C"> c:-) E (Schedule E) 88~ ~ ~:~4 C A 6. Jointly Owned Property (Schedule F) (6) 2,005.33 ~:n _ r" rn -1 ..-:-- P 0 =31 en 0 I Separate Billing Requested .i>> .r:- -n T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None -.: U L (Schedule G or L) A T 8. Total Gross Assets (total Lines 1-7) (8) 10,810.53 I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 8,396.98 0 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 36,423.61 11. Total Deductions (total Lines 9 & 10) (11) 44.820.59 12. Net Value of Estate (Line 8 minus Line 11) (12) (34,010.06) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (34,010.06) C 0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M P T U A T X .0 0 (15) 0.00 X A T (34,010.06) X .0 45 (16) 0.00 I - 0 X .12 (17) 0.00 N X .15 (18) 0,00 (19) 0.00 Copyright (c) 2000 form software only The Lackne, Group,lnc. Form REV-1500 EX (Rev. 6-00) . ~ ~ . . LAST WILL AND TESTAMENT I, MILDRED L. ST. JOHN, of the Borough of Carlisle, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and ("\ Testament, hereby revoking and making void all former Wills and Codicils by me at \\ ' ~. "\ any time heretofore made. \ J FIRST. I order and direct that all my just debts and funeral expenses be .~ '0 " paid by my Executrix, hereinafter named, as soon as conveniently may be done ..~ \ ~ r(' after my decease. SECOND. I give and bequeath my automobiles and personal effects and such household goods, furniture and furnishings as may be my individual property and not the property of my husband, or owned jointly by me with him, and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my daughter, GLORIA JEAN GURKOFF, if she survives me. THIRD. If my husband,VVlLLlAM \IV. ST. JOHN, survives me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my . estate, real, personal and mixed, whatsoever and wheresoever situate, unto my daughter, GLORIA JEAN GURKOFF, IN TRUST NEVERTHELESS, to hold, LAW OFFICES manage, invest and reinvest the same and the income therefrom and to use and ,RUN R. McCALEB apply as much of the principal and income therefrom as my Trustee, in the exercise of her sole and absolute discretion, may deem appropriate for the .--" comfortable support, care and maintenance of my husband, WILLIAM W. ST. JOHN, for and during the term of his natural life; and upon the death of my '-- ", ) ~ husband, this Trust shall terminate and my Trustee shall pay over and distribute \ the remaining balance of principal and income, if any, thereof unto my daughter, ~ GLORIA JEAN GURKOFF, absolutely and in fee simple; provided, however, that if .~ my daughter is not then living, then the same shall be paid over and distributed 'J unto her then-living issue per stirpes, said issue to take the ancestor's share by ~ <,. "-' ~ representation and not per capita. '"'. My Trustee shall hold all income and principal from any Trust herein ~ free from all claims, attachments, judgments, executions and liens of every kind and nature by creditors of any beneficiary and no beneficiary shall have any power to anticipate, assign, alienate, pledge, charge or encumber the income or principal of any Trust herein. FOURTH. If my husband, WILLIAM W. S1. JOHN, shall not survive me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, unto my daughter, GLORIA JEAN GURKOFF, absolutely and in fee simple. FIFTH. In addition to any other powers conferred by law, my Trustee herein is hereby expressly authorized and empowered at all times, in her sole and L.A.W OFFICES MARLIN R. McCALEB -2- absolute discretion: A. To purchase, invest in or otherwise acquire and to retain, whether originally a part of the Trust estate or subsequently acquired, any and all stocks, bonds, notes or other securities, or any variety of real or personal . property, including stocks or interest in investment trusts and common trust funds maintained by any bank, or interest-bearing accounts in or certificates issued by any bank, as she may deem advisable without being limited by any statute or rule of law prescribing or relating to legal investments by ~ l, trustees; and to hold or retain cash or readily marketable securities of little ~ \\ .\) or no yield for such periods as she may deem advisable. The investments r''' need not be diversified and may be made or retained with a view to a possible increase in value. B. To sell at public or private sale, pledge, mortgage, lease, transfer, exchange, convert or otherwise dispose of, or grant options with respect to, any and all property at any time forming a part of the Trust estate, in such manner, at such time or times, for such purposes, for such prices and upon such terms, credits and conditions as she may deem advisable, including the right to lease such property for periods of time which may extend beyond the termination of this Trust. C. To allocate receipts and expenses to principal or income, or partly to each, as she may from time to time deem proper in her sole and absolute LAW OFFICES MARLIN R. McCALEB -3- discretion. D. To employ accountants, agents, attorneys, investment counselor brokers to perform services for and at the expense of the Trust hereunder for which such services are performed and to carry or register investments in the name of the nominee of such agent or broker. The expenses and charges for such services shall be charged against principal or income or partly against each, as my Trustee may determine. My Trustee is expressly relieved from any liability or responsibility whatsoever for any act or failure to act by, or for following the advice of, such accountants, agents, attorneys, investment counselor brokers so long as my Trustee exercises due care in their selection. LASTL Y. I nominate, constitute and appoint my daughter, GLORIA JEAN GURKOFF, Executrix of this, my Last Will and Testament, to serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, MILDRED L. ST. JOHN, have hereunto set my hand and seal to this, my Last Will and Testament which consists of five (5) typewritten pages to each of which I have affixed my signature this -0' I 'T day of "7-71....,"[> Jo.-<<::-.((.____ , A.D., Two Thousand (2000). 7J'1~~~ ,/. J~:"0/.-LJ.SEAL) I / / The preceding instrument, consisting of this and four (4) other typewritten LAW OFFICES MARLIN R. McCALEB -4- . .. page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MILDRED L. ST. JOHN, the Testatrix \ i therein named, as and for her Last Will and Testament, in the presence of us, who, at this request, in her presence, and in the presence of each other, have "- subscribed our names as witnesses hereto. ~ / ~~/) ~ ," s ...", .4,,' ..'" /. 'Y ,,' /H~~.. %4tf[~~ ,J 1/ ~ G;~y-a ?}-C''-€/cq U U 0 \'. \" LAW OFFICES MARLIN R. McCALEB -5- REV-1507 EX +(1-97) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred L. St. John SS1f 196-14-3141 07/30/2002 21-03-0889 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Laurel Kuehn, - claim for restitution for money stolen from 3,454.21 Decedent by Laurel Kuehn, documented by Order of Court dated 10/01/2002 in Commonwealth v. Laurel Kuehn, No. 02-0488 Criminal (Cumberland County). - TOTAL (Also enter on line 4, Recapitulation) $ 3,454.21 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1507 EX (Rev. 1-97) . ,3- fY) -- O:J.. COMMONWEALTH : IN THE COURT OF COMMON PLEAS OF : CUMBER~~ COUNTY, PENNSYLVANIA : v. : 02-0488 CRIMINAL TERM : : CHARGE: (1) FORGERY : (4 ) THEFT BY UNLAWFUL : TAKING OR DISPOSITION LAUREL KUEHN . : OTN: H264295-3 : AFFIANT: DET. SGT. WILLIAM GOODHART IN RE: SENTENCING ORDER OF COURT AND NOW, this 1st day of October, 2002, the Defendant, Laurel Kuehn, having appeared for sentence with court-appointed counsel, Dirk Berry, Esquire, and the Court being in receipt of a sentencing report, the sentence of the Court at Count 1, Forgery, is that the Defendant pay the costs of prosecution, make restitution to Gloria Gurkoff, power of attorney for Mildred St. John, in the amount of $3,454,21, and that she undergo imprisonment in the Cumberland County Prison for not less than 8 days nor more than 12 months, It appearing to the Court that she has already served her minimum sentence, she is paroled immediately on the condition that she comply with all recommendations of her parole officer. The sentence of the Court on Count 4, Theft by Unlawful Taking, is that the Defendant be placed in the Intermediate Punishment Program for 30 months, consecutive to the sentence imposed at Count 1, and subject to the following Restorative Sanctions: 1. That she pay the costs of prosecution. 2, That she make restitution and pay all court costs imposed at Count 1. 3. That she maintain full-time employment as soon as child care can be arranged, but beginning not less than 45 ~ 'If- '\: . days from today's date. 4. That she pay not less than $100.00 per month toward the costs and restitution. 5. That she comply with all rules and regulations of the Stewart House in which she resides. 6. That she not use any drugs or alcohol whatsoever. 7. That she be and remain on good behavior. 8 . That she comply with all other directions of her parole officer. Jonathan R, Birbeck, Esquire Chief Deputy District Attorney Dirk Berry, Esquire Court-appointed Counsel Probation Sheriff Copies delivered on /ll- if - O't\ . CCP Victim - Witness srs \fd AJr,~rn:J Cli-;\! J8Hn8 ! ". ! '_:! r, -.., I [- .;.,. (.. i :.," ~~] REV - 1508 EX + (1 -97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred L. St. John SSfI 196-14-3141 07/30/2002 21-03-0889 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Claremont Nursing & Rehabilitation Center, - Patient Account 5,350.99 114079, TOTAL (Also enter on line 5, Recapitulation) $ 5,350.99 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems,lnc. Fo,m REV-1508 EX (Rev. 1-97) . REV-1509 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred L. St. John SS1I 196-14-3141 07/30/2002 21-03-0889 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. Gloria Gurkoff 21 Woodland Court Daughter Mansfield, TX 76063 B. c. - JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of flnanclallnstltutlon and bank DATE OF DEATH DECD'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for JoIntly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 05/15/01 PNC Bank, - Checking 4,010.66 50.00% 2,005.33 Account 1150-0360-6553, opened 05/15/2001 in names of William W, St. John (Decedent's husband), Decedent and Gloria Gurkoff (Decedent's daughter). William W. St. John died 09/18/2001. Principal balance as of D.G.D.: $4,010.66. - - TOTAL (Also enter on line 6, Recapitulation) $ 2,005.33 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1509 EX (Rev. 1-97) . o PNCBAN< November 4, 2003 Marlin McCaleb scp Attorney at Law 219 E Main St. Mechanicsburg, P A 17055 RE: Estate of Mildred L StJohn (Deceased) SSN: 196-14-3141 DOD: 07-30-2002 Dear Mr. McCaleb: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account#5003606553 Established 05-15-2001 WILLIAM W ST JOHN MILDRED L ST JOHN GLORIA GURKOFF DOD balance: $4,010.66 Non interest bearing account Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any fmancial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~ ~:J. Erica L Schlegel PNC Decedent Reporting Firstside Center 500 First Ave, 4th Fl CIF Pittsburgh PA 15219-3128 1-800-762-1775 Member FDIC . REV-1511 EX +(1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred L. St. John SSfF 196-14-3141 07/30/2002 21-03-0889 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Brachendorf Memorials, - gravemarker. 605.00 2 McCray Press, - copies of obituary. 12.25 3 Myers-Harner Funeral Home, Inc. , - funeral service. 6,158.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 500.00 Name of Personal Representative(s) Gloria Jean Gurkoff Social Security Number(s) I EIN Number of Personal Representative(s) 87-6264341 Street Address 21 Woodland Court City Mansfield State TX Zip 76063 Year(s) Commission Paid: 2. Attorney's Fees Law Offices-Marlin R. McCaleb 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 71.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal, - advertising Letters. 75.00 2 Register of Wills, - filing Inventory and Appraisement. 20.00 3 Reserve - for final administration expenses. 100.00 4 The Patriot-News, - advertising Letters. 105.73 TOTAL (Also enter on line 9, Recapitulation) $ 8,396.98 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) , . REV-1512 EX + (1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred L. St. John SSfft 196-14-3141 07/30/2002 21-03-0889 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Allan J. Mira, MD, - account payable, medical. 20.07 2 Carlisle Regional Medical Center, - account payable, medical. 23.04 3 Central Penn Medical Group, - account payable, medical. 29.19 4 Commonwealth of Pennsylvania, - Department of Public Welfare, 36,219.84 reimbursement for medical assistance paid ($10,629.70 for medical assistance paid within six months of 0.0.0. and $25,590.14 for medical assistance paid more than six months before 0.0.0.). 5 Cumberland-Goodwill Fire & Rescue EMS, - account payable, 29.94 medical. 6 Heritage Women's Health, - account payable, medical. 14.33 7 Mobile X-Ray Imaging, - account payable, medical. 26.90 8 Quantum Imaging, - account payable, medical, 9.99 9 Tristan Associates, - account payable, medical. 13.11 10 Yellow Breeches EMS, - account payable, ambulance. 37.20 TOTAL (Also enter on line 10, Recapitulation) $ 36,423.61 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) . . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 January 14, 2004 MARLIN R MCCALEB ESQ 219 E MAIN ST MECHANICSBURG PA 17055 Re: MILDRED ST. JOHN CIS #: 830154246 SSN: 196-14-3141 Date of Death: 7/30/2002 Dear Attorney McCaleb: Please be advised that the Department of Public Welfare maintains a claim in the amount of $36,219.84 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $10,629.70, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392 (3) . The balance of the claim, namely $25,590.14., is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~qf.~ Janet L. Brown Claims Investigation Agent 717-772--6612 717-705-8150 FAX Enclosure INVENTORY Estate of: Mildred L. St. John Date of Death: 07/30/2002 County: Cumberland CASH: ----- Claremont Nursing & 5,350.99 Rehabilitation Center, - Patient Account #4079. -------------- 5,350.99 MORTGAGE/NOTE RECEIVABLE: -- ------------- ---------- Laurel Kuehn, - claim for 3,454.21 restitution for money stolen from Decedent by Laurel Kuehn, documented by Order of Court dated 10/01/2002 in Commonwealth v. Laurel Kuehn, No. 02-0488 Criminal (Cumberland County). -------------- 3,454.21 ---------------- TOTAL RECEIPTS OF PRINCIPAL............... 8,805.20 ================ -1- COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE '"---;~.n,.'\'-.'_".-'. BUREAU OF INDIVIDUAt:'r~ES--' NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION:' APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG PA 17128-0601 REY-15~7 EX AFP 112-D~) ('"f. r; DATE 02-21-2005 t~: ,J ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 COUNTY CUMBERLAND MARLIN RMCCALEBESQ ACN 101 M R MCCALEB LAW OFCS I Allount Rellitted I PO BOX 230 MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ..... REV:UW-EX--AFP--nr:6J')--NoT-fcE-o'F-iliHERYflNci-""-Ax-APPRAYslM€Ni'~--ALlowl~cE-oR-----_._----- - --. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STJOHN MILDRED L FILE NO. 21 03-0889 ACN 101 DATE 02-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1, Real Estate (Schedule A) U) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) ,00 credit to your account, 3, Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4, Mortgages/Notes Receivable (Schedule D) (4) 3.454.21 of this forll with your 5. CashlBank Deposits/Mise, Personal Property (Schedule E) (5) 5.350,99 tax paYllent. 6, Jointly Owned Property (Schedule F) (6) 2.005.33 7, Transfers (Schedule G) (7) .00 8. Total Assets (8) 10,810.53 APPROVED DEDUCTIONS AND EXEMPTIONS: 8..396.98 9, Funeral ExPenses/Adll, Costs/Mise, Expenses (Schedule H) (9) 10, Debts/Mortgage Liabilities/Liens (Schedule I) UO) 36.423.61 11, Total Deductions Ul) 44,820 59 12. Net Value of Tax Return (2) 34,010,06- 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) (3) ,00 14, Net Value of Estate Subject to Tax (4) 34,010.06- NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: ,00 X 00 15. Allount of Line 14 at Spousal rate US) = ,00 16, Allount of Line 14 taxable at Lineal/Class A rate (16) ,00 X 045 = .00 17. Allount of Line 14 at Sibling rate (7) ,00 X 12 = .00 18, Allount of Line 14 taxable at Collateral/Class B rate (8) ,00 X 15 = .00 19. Principal Tax Due (9)= .00 T X C DIT : + AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-12-2004 CD003564 .00 30,08 02-14-2005 REFUND ,00 30,08- TOTAL TAX CREDIT ,00 BALANCE OF TAX DUE ,00 ~ INTEREST AND PEN. .00 TOTAL DUE .00 IE IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED, FOR CALCULATION OF ADDITIONAL INTEREST, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF ~",I,V)fDU:+(! .~x~;(I INHERITANCE TAX INHERITANCE TAl{:~VJSION, PO BOll Z80601 ........... RECORD ADJUSTMENT HARRISBURG PA 171Z8~0601 JOINTLY HELD OR TRUST ASSETS REY-1604 EX AFP 112-041 DATE 02-17-2005 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 COUNTY CUMBERLAND r..! :~ GURKOFF SSN/DC 196-14-3141 GLORlA ACN 04101744 21 WOODLAND CT I Allount Rellitted I MANSFIELD TX 76063 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-03) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS -- DATE 02-17-2005 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 COUNTY CUMBERLAND FILE NO, 21 03-0889 S,S/D.C, NO, 196-14-3141 ACN 04101744 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003606553 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-15-2001 Account Balance ,00 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable X 0,166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate X ,45 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due .00 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-05-2004 CD003771 .00 1.15 TOTAL TAX CREDIT 1.15 BALANCE OF TAX DUE 1.15CR INTEREST AND PEN. ,00 TOTAL DUE 1 1 "~R ;II IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, ( IF TOTAL DUE IS LESS THAN $1. ND 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,) n'-"- 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 DECEDENTS NAME FILE NUMBER Mildred Stjohn 2103-0889 REVIEWED BY ACN Emerson Luciano 04101744 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 COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT PO BOX Z80601 HARRISBURG PA 171Z8-0601 REV-1U7 EX AFP <12-041 DATE 02-22-2005 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 COUNTY CUMBERLAND GLORIA GURKOFF ACN 04101744 21 WOODLAND CT I Allount Rellitted I MAN~IELD TX 76063 ""'1"""") , / ." MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: Tp~insu~BiRroper credit to your account, subllit the upper portion of this forll with your tax paYllent. '. '. ".. ce:,... CUT ALONG:)THIS LiNt: ..... RETAIN LOWER PORTION FOR YOUR RECORDS .... ~W:I'&'fJ".lrA'fJ..fn~.cfJ".......";..'"fAmMfl'A'N~r""lY.~nYt!Am.'Zn~.lt1!'60Fif......................... ... ESTATE OF STJOHN MILDRED L FILE NO.21 03-0889 ACN 04101744 DATE 02-22-2005 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE, SHOWN BELOW IS A SUNMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-16-2005 PRINCIPAL TAX DUE:. ...IIIIUIIIOO"IIIII"_________IIHHIOIOIIIOOI_ , .00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-05-2004 CD003771 .00 1.15 TOTAL TAX CREDIT 1.15 ~ BALANCE OF TAX DUE 1.15CR INTEREST AND PEN. ,00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1.15CR If SIDE FOR CALCULATION OF ADDITIONAL INTEREST, ( IF TOTAL DUE IS LESS THAN $1, NO PA~ENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT PO BOX Z80601 HARRISBURG PA 171Z8-0601 IEV-li07 EX AFP <12-041 DATE 02-22-2005 ESTATE OF STJOHN MILDRED L DATE OF DEATH 07-30-2002 FILE NUMBER 21 03-0889 COUNTY CUMBERLAND MAR~N R MCCALEB ESQ ACN 101 M R~CCALEB.t:AW OFCS I A.ount R_i Heel I PO "ibx 23ft:" ME<;ffANIt;~'~~G PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE ~. .f';::;. CARLISLE, PA 17013 ','-,::: ! -..,-, NOTE: 'id insure p~oper credit to your account, sub.it the upper portion of this for. with your tax pay.ent, CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS ... ~w:r&f).,.!r.~'~..rllr:d'!'.......i;..'TARlMI"''Nar''lY.~'AytAm.'bV.lt1:60Fff....................... ... ESTATE OF STJOHN MILDRED L FILE NO.21 03-0889 ACN 101 DATE 02-22-2005 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: 02-21-2005 PRINCIPAL TAX DUE:, _.....11..111I11I111."'.... 11l~1II..._1111111111...11...__ . .00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-12-2004 CD003564 .00 30,08 02-14-2005 REFUND .00 30,08- TOTAL TAX CREDIT .00 BALANCE OF TAX DUE ,00 ~ INTEREST AND PEN. ,00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE ,00 . SIDE 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), _u ..... ft" ,,"': A IlI'I'UND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) . , . , , COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-0889 ~ r... ~"---'- ESTATE OF MILDRED L. ST. JOHN, DECEASED r ,-.".. ==================================*==== -,." ACCOUNT OF Gloria Jean Gurkoff, Executrix ... C.i\ ======================================================~========================= Date of Death: July 30, 2002 Date of Executor's Appointment: October 28, 2003 Date of First Advertisement of Letters: November 28, 2003 Accounting for the Period: July 30., 2002 to June 2, 2005 ======================================================~========================= Purpose of Account: Gloria Jean Gurkoff, Executrix, offers this account to acquaint interested parties with the transactions that have occurred during this administration. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Marlin R. McCaleb Esq. Attorney Identification No. 06353 Law Offices-Marlin R. McCaleb 219 East Main Street Mechanicsburg, PA 17055 717/691-7700 GROSS ESTATE 8,835.28 (Principal Receipts + Income Receipts) -------- -------- . , I . SUMMARY OF ACCOUNT Estate of Mildred L. St. John, Deceased For Period of 07/30/2002 through 06/02/2005 Fiduciary Current Acquisition Page Value Value ------ ------- ----------- Proposed Distributions 0.00 0.00 to Beneficiaries ======~======== --------------- --------------- PRINCIPAL Receipts: Per Inventory Filed This Account 1 8,835.28 Net Gain (or Loss) on Sales 0.00 or Other Disposition --------------- 8,835.28 Less Disbursements: Debts of Decedent 0.00 Funeral Expenses 0.00 Administration Expenses 2 406.61 Federal and State Taxes 0.00 Fees and Commissions 0.00 Family Exemption 0.00 406.61 --------------- --------------- Balance before Distributions 8,428.67 Distributions to Beneficiaries 0.00 --------------- Principal Balance on Hand 3 8,428.67 For Information: Investments Made Changes in Investment Holdings 4 INCOME Receipts: This Account 0.00 Net Gain (or Loss) on Sales 0.00 or Other Disposition --------------- 0.00 Less Disbursements 0.00 --------------- Balance Before Distribution 0.00 Distributions to Beneficiaries 0.00 --------------- Income Balance on Hand 0.00 Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND 8,428.67 --------------- --------------- . . . SCHEDULE A RECEIPTS OF PRINCIPAL Fiduciary Acquisition Value ----------- CASH: - - - - 07/30/02 Claremont Nursing & 5,350.99 Rehabilitation Center, - Patient Account #4079. ----;.---------- 5,350.99 PERSONAL PROPERTY: ----------------- 03/01/05 PA Depsrtment of Revenue, - 30.08 refund of inheritance tax overpayment. ----....--------- 30.08 MORTGAGE/NOTE RECEIVABLE: - - - - - - - - - - - - -- - -- - ---- -- 07/30/02 Laurel Kuehn, - claim for 3,454.21 restitution for money stolen from Decedent by Laurel Kuehn, documented by Order of Court dated 10/01/2002 in Commonwealth v. Laurel Kuehn, No. 02-0488 Criminal (Cumberland County). ----010--------- 3,454.21 -------------- TOTAL RECEIPTS OF PRINCIPAL...... ...... ... 8,835.28 -------------- -------------- -1- , : , SCHEDULE C DISBURSEMENTS OF PRINCIPAL SCHEDULE C-3 ADMINISTRATION EXPENSES - -- --- ---- - - - ---- - - - - -- 10/28/03 Register of Wills, - probate 71. 00 Will. 11/19/03 Cumberland Law Journal, - 75.00 advertising Letters. 01/14/04 The Patriot-News, - 105.73 advertising Letters. 11/23/04 Register of Wills, - filing 20.00 Inventory and Appraisement. 05/31/05 Register of Wills, - filing 130.00 Account and Statement. 06/02/05 Postmaster, - certified mail 4.88 postage, Notice of Filing Account. --4-___________ TOTAL ADMINISTRATION EXPENSES....... ........ ........ 406.61 -------------- TOTAL DISBURSEMENTS OF PRINCIPAL........ .... ........ 406.61 -------------- -------------- -2- , I . PRINCIPAL BALANCE ON HAND Current Value Fiduciary Acquisition If Units Description or as Noted Value PNC Checking 7,609.37 6,273.49 Laurel Kuehn, Restitution Order 819.30 3,454.21 - - - - - -,- - - - - - - - - --------------- 8,428.67 9,727.70 =====~======== =============== -3- I \ . SCHEDULE F CHANGES IN INVESTMENT HOLDINGS - PRINCIPAL Cost - - - - Laurel Kuehn, ------------- 07/30/02 received 3,454.21 11/14/03 - restitution for money st~len (922.50) from Decedent. 03/11/04 - restitution for money st~len (192.50) from Decedent. 04/14/04 - restitution for money st~len (125.00) from Decedent. 05/13/04 - restitution for money st~len (250.00) from Decedent. 06/30/04 - restitution for money stolen (125.00) from Decedent. 08/20/04 - restitution for money st~len (175.00) from Decedent. 09/21/04 - restitution for money st~len (125.00) from Decedent. 10/13/04 - restitution for money stolen (75.00) from Decedent. 11/15/04 - restitution for money stolen (100.00) from Decedent. 12/22/04 - restitution for money st~len (175.00) from Decedent. 01/19/05 - restitution for money st~len (100.00) from Decedent. 02/17/05 - restitution for money st~len (75.00) from Decedent. 02/17/05 - restitution for money stolen (25.00) from Decedent. 03/15/05 - restitution for money stolen (75.00) from Decedent. 04/15/05 - restitution for money st~len (94.91) from Decedent. -------------- 819.30 -------------- -------------- -4- . . : AFFIDAVIT Gloria Jean Gurkoff hereby certifies and says: that I am the Executrix under the Last Will and Testament of Mildred L. St. John, Deceased; that I am the Accountant herein; that I have fully and faithfully discharged the duties of my office; that the foregoing accounting is true, correct and complete; that the attached list or schedule (*) contains the ~ames, addresses and amounts due unpaid creditors having given notice of 1heir claims; that the attached list or schedule (**) contains the names an addresses of all persons interested in the distribution of the said Estate; t~at there are no unpaid claimants or persons interested in the distribution ~f the Estate who have given notice to the Executrix and who are not listed,herein; and that the facts set forth in the foregoing Account are true an~ correct to the best of my knowledge, information and belief. I understand that false statement are made subject to the penalties of 18 Pa.C.S. , Section 4904, to uIllsworn fal ification to authorities. Date: June 3-, 2005 ) Qxec..v-..~'X * UNPAID CREDITORS Name/Address of Amount of Creditor Claim 1. Gloria Jean Gurkoff $ 500.00 21 Woodland Court Mansfield, TX 76063 2. Marlin R. McCaleb, Esquire 750>.00 210 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 3. Department of Public Welfare 10,629.70 Bureau of Financial Operations Division of Third Party Liability Estate Recovery Program P.O. Box 8486 Harrisburg, PA 17105-8486 4. Department of Public Welfare 25,59C).14 Bureau of Financial Operations Division of Third Party Liability Estate Recovery Program P.O. Box 8486 Harrisburg, PA 17105-8486 ** PERSONS INTERESTED IN ESTATE: Gloria Jean Gurkoff 21 Woodland Court Mansfield, TX 76063 -5- . . STATEMENT OF PROPOSED DISTRIBUTION BY GLORIA JEAN GURKOFF, EXECUTRIX UNDER THE LAST WILL AND TESTAMENT OF MILDRED L. ST. JOHN, tATE OF MIDDLESEX TOWNSHIP, CUMBER AND COUNTY, PENNSYLVANIA, DECEASED GLORIA JEAN GURKOFF, Executrix under the iLast Will and Testament of Mildred L. St. John, Deceased, proposes to dis~ribute the balance of said Estate in her hands, to wit: $8,428.67, in aCdordance with Section 3392 of the Probate, Estates and Fiduciaries Code of Pdnnsylvania, as follows: The Costs of Administration (Section 3392 (1) ) : TO: l. Gloria Jean Gurkoff, Executrix Commission: 500.00 2. Marlin R. McCaleb, Esquire Attorney's Fee: 750.00 1,250.00 The Family Exemption (Section 3392 (2) ) : No eligible claimant None The Costs of Decedent's Funeral and Burial and Medical and Hospital Services Furnished Within Six Months of Death (Section 3392 (3) ) : TO: Department of Public Welfare Bureau of Financial Operations Division of Third Party Claims Estate Recovery Program (original claim: $10,629.70) Cash: 6,,359.37 Laurel Kuehn Restitution Order: 819.30 7,178.67 The Cost of a Gravemarker (Section 3392 (4) ) : No eligible claimant None Rents for Six Months Prior to Death (Section 33~2 (5) ) : No eligible claimant None All Other Claims (Section 3392 (6) ) : TO: Department of Public Welfare Bureau of Financial Operations Division of Third Party Claims -6- . . . . . . . . . Estate Recovery Program (original claim: $25,590.14) None TOTAL TO BE DIST~IBUTED: $8,428.67 AFFIDAVIT GLORIA JEAN GURKOFF, hereby certifies an~ says: that she is the Executrix under the Last Will and Testament ofiMildred L. St. John, Deceased; and that the facts set forth in the ~oregoing Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. I understand that false statements he are made subject to the penalties of 18 Pa.C.S., Section 4904, reI to unsworn fal ification to authorities. Date: June S--, 2005 ~~ -7- Ii-< F1; ~ o H r<t: ~ (f.l?;i H P-< "-' ~ ~ ~ H ~ ~ 0 r<t: :> H ~ m z ..".. c- fil H 0 (f.l ~ p ~ ~ H >< 0 fil Z >< 0 ~~ <( P-<(f.l fil(f.l~8 U ~ wt- Z Z P:<r<t:OZ U ~ u~ <( ZZ ZO"I Ofil8P r<t: Ul~:Sa: ::'i Qfil OCO HU 0 w ~ "-tJjgi;; ~P-< HCO Hfil:><:Ur<t: H 'd oJ ffiZNZ _ (f.lO ::;:Ofil H r<t: LL . <.9-XZ O~HI (f.lOZ Z LL~a:<(OW U >< :> (V) Ii-< ~ fil Z r<t: H 0 'S'\ w 2 OJ "-. 8 H 0 0 Z H.... ..... Ii-< S 00- OJ f- ci <.9 '-Z...... ~...... <( WUl a: ...... ...... I mOHH --' ~ >L<(cL::J o P M fil 0 0 P:< >< 0 .~ z W OJ o 8 N 8 IJ H fil (f.l Z ......"'i' ~ Ol Ul 8 U P:< r<t:::;: III Z r<t: ..".. LL N 'd P:< P 8, z.::Z ~ z pO O. (f.l81i-<Pfil E~ ~ <( o Z U 0 fil (f.l 0 U p-< (JJ ~~ is U r<t: Z P:< . W H (f.l H 2 r~ P:< Z fil.. Ii-< 0- m fil r<t: 8 fil 8 III m ~ P:< ::;: p-< 8 ZP p:<(f.l Z HU Ofil H . c: -0 I '5 ~ 0 !i2J ~,- - I ~8~€g i~ c€- o "0- 2 1 ~ -l 0 ~ ~ E .~ i~lfll I ;~~. ~5!~~~~1 ~. I~B)lS~Z; 1 ." ~~~~!i~c5 ~ ,111~1 I,~ ~~-i~~~~ i Ii ~I~jl ~ iiljii~\511 '~..~. il.8"5~i ~~ ,,~\ 1115t1 t ii ! t iJli~~ ' i~i\! lllO ~ tl51.~I.~i.i~;.~~ tl~ ~h.~l~ fl~gi..2;.if ~ i..l H~h~ =(})~~~ ~!j< _ii ~~ 0 ~~._~ . . . , , . . Estate of ST JOHN MILDRED L Late of MIDDLESEX TOWNSHIP ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-03-00889 Date: 6/16/2005 NO.: 21-03-00889 MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG PA 17055 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: GURKOFF GLORIA JEAN Personal Representative Counsel: MCCALEB MARLIN R Date of Decedent's Death: 7/30/2002 Date of Delinquency Notice: 7/30/2005 The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans' 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 their counsel, have filed with the Register of Wills or Clerk of Orphans' Court, his/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk of Orphans' Court on 8/16/2005 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 their counsel. cc: File Personal Representative Counsel ~~~ ,-" Glenda Farner Strasbaugh Clerk of Orhans' Court A hearing is scheduled for October 07, 2005 at 9:30 PM in Courtroom No. 03. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. oR -- '- ~-. "=-- "---"". ~, H!UtHij ~ ,--".9.'311 i I Q'"i I i ~, f-If!8:lli&ill.,f _~, WQills t I .::?,Jlll I ~ I ~ l;il1liUt ~~J Is) fie st ",.,' l I fii~lllf ~'II I~! I I I: ~ :2. i - o~ foJi i5'S~~~~ii ~ g t i 3 ~ \3 ~ ~ ~~'i 3'5~ i ~ ~i ~~~a:g ~.g . ~,~ Utili! ~\ ~ il qiia ~_! ~ i! , ~~c;:Tfl~~ ;:;:1>> (\)I-$=-n ~~~ ingtO ig-<i~Ses. ::losa,::lOg.a,=; (\) iii' :T1O =" to CD 8' -' ~ <" (D 01 :!! jij,3 ~~o - ~Q)"O ...c ::l '< ::l (\) _ -' ~ cO - ~os So g ::l H t!J 0 (J Z (J) :::0 c::: >-3 '1:l :s: :::0 ~ =r:: tl:l t!J >-3 ~ t!J .. t!J Z :::0 t'Ij (J) t-< ~ H Z :J:' ;;: ~ :::0 '1:l (J 0 (J) t!J 0 (J Z m en t!J c::: t'Ij >-3 (J) . 0 0 n ~;J Z :s; . >-3 c::: I ~ P Z tl:l :s; :J:' :::0 (J z No :J:' I (J) t!J H l:..4 >-3 N>-3 0 n N " ~ Z >< :::0 0 0 t!J I-' c::: ~ JJ (f) ill P 0 t-< t-< 0 =r:: I 0 Z OJ m Z ~ r ;; ~' t-< Z 0 OH >-3 C~p" ~ t'Ij Z t!J ~ t'Ij w<: >< ~ 0 "j 8J ~ H Z 0 (J) I H ~ :"OJ;;:g,; 0 Z H t!J 0 :s: O(J) mOPGl " :J:' :t' (J >:: t!J H ooH '1:l ~ ~ Z ~ :1J t-< 0 (J t-< 000 t!J ~ n c::: >-3 t!J 0 \DZ Z (f) W (f) ~ m -< 0 -l ""U (f) :J:' Z 0 :r:- :::0 Z <: :ot: (J >-3 :.s (J) t!J (J) P ~ n ~~ (J >< Z t!J 0 >< Z -< m ~ 0 ~ (J) 0 t-< ~ c::: =r:: ~ t-< <: ::::: ~ Z H :r:- ~ >-3 '1:l t-< Z 0 ~ ~~ H (j1 ~ (j1 >-3 ~ t!J ~:f~ 00_ -8 c , Q.a.! 1 i!;'C ~ :lo. ~ ~.l \ :::~ -Q. -- ::r. - ::r -g ~ ~...;: .oc: ."0 - -00 ;:;:, '0. -.:g 'Cg.~li ;!.: CD . Q. ^ .I~ -- L t\~. _ L.c-:- t.___ t_.~: (~~J 1.'__\ '...-- . ,- A.-_ C Date: ..=r ,--', ~- C:) (~~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: MILDRED L. ST. JOHN Date of Death: July 30, 2002 Estate No.: 2003-00889 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes~ No 0 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 rg[ No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Clerk of he Orphans' Court and may be attached to this report. 09/02/05 ~ Signature Marlin R. McCaleb, Esq. Name 219 East Main Street Mechanicsburg, PA 17055 Address (71 7) 691-7770 Telephone No. c__ Capacity: 0 Personal Representative J}(l Counsel for personal representative ~ v'.J ~] c--J- (- (. )