The URL can be used to link to this page

Home My WebLink About03-0181PETITION Estate of Jimm~e Ann Atwood Ano Koyai Atwood also known as FOR PROBATE and GRANT OF LETTERS No. To: Deceased. Social Security No. 255-48-8940 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix in the last wilt of the above decedent, dated Feb_--,_,a_--y 21; 20011 and codicil(s) dated in the named ,19 (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with k er last family or principal residence at 3560 Ritner l~.ghway, Newille, Penn To~--nship (list street, number and muncipality) Decendent, then 65 years of age, died February 18, 2003 19 at C, arlisle Rel~-ional Medical Center, Carl.isle, Pennsylvania ' ' Except as follows, decedent did not marry, was not d. ivorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (ll not domiciled in Pa.) Personal property in COunty $ Value of real estate in Pennsylvania $ situated as follows: 25,000.00 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters [heron. request(s) the probate of the last will and codicil(s) testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Johnna Ann £ohl formerly Johnna Ann Franklin 3560 Ritner Highway Newville, PA 17241 OATH OF PERSONAL REPRESEN,TATIVE COMMONWEALTtl OF PENNSYLVANIA ] COUNTY OF Cumberland j~ ~s The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the be~t of the. knowledge and belief~of,,p'etitioner(s) and that as personal represen- ,ative(s) o f the above decedent petitioner(s) will well ~d~~e~~~w. Sworn to ?r arr~_ and subscribed ~ ~l~)~2~a~ ~; b~o:'c me this __ ~'1TM ...... day of [ ~na Ann Kohl' fomerly ~' No. ~1-0~- llal Estate of J~mmie Ann Atwood a/k/a Ann Royal Atwood ~ Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~'~z)c3x~ xac~ ~,c~, ~C~O~ ~ , in consideration of the petition on the reverse side hereof, satisfac y proof having been presented before me, IT IS DECREED that the instrument(s) dated Feb~ua~ 21, 2001 described therein be admitted to probate and filed of record as the last will of J~e ~nn Atwood a/k/a ~n Royal At~ood ; and Letters Testta~eutary are hereby granted to Johnna Ann Kohl. formerl.y Johnna Ann Franklin FEES Probate, Letters, Etc .......... Short Certificates( ) .......... TOTAL Filed .. ~..-. ~.~'.-..0..,.~ .................... Register of Wills I ~J ~ 0 ~.~ ATTORNEY (Sup. Ct. I.D. No.) William A. Duncan, Esquire ID ~ 22080 1 I~:i-~e _~_ow, C~_r!i_-!e. PA !_70!3 ADDRESS 717--249--7780 PHONE LAST WILL & TESTAMENT OF $1MMIE ANN ATWOOD, of 3560 Ritner Highway~ Ne~ille~ Pe~ To~s~p~ Cumberl~d County, Pe~sylv~a, being of sound ~d disposing ~nd, memo~ ~d underst~ding, do hereby m~e, publish and &dare t~s as and for my Last Will ~d Test~ent, hereby revo~ng ~y ~d all other wills and codidls heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within the Royal family burial plot side by side my mother, located in Mt. Comfort Cemetery, Alexandria, Virginia, accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give and bequeath the sum of Five Hundred ($500.00) Dollars unto each of the following grandchildren; Steven Kleimola; Robert Kleimola; Lisa Kleimola; Samantha Kleimola and Joseph Kleimola, to be held in trust in accord with Paragraph Ninth below. FIFTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death as follows; 70 % unto my daughter, Johnna Ann Franklin, per stirpes; 25 % unto my daughter, Shawn Marie Kleimola, per stirpes; 5 % unto my daughter, Nancy Gayle Liberatory, per stirpes. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate owned by me at the time of my death as follows; 70 % unto my daughter, Johnna Ann Franklin, per stirpes; 25 % unto my daughter, Shawn Marie Kleimola, per stirpes; 5 % unto my daughter, Nancy Gayle Liberatory, per stirpes. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my daughter, Johnna Ann Franklin, as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. If any of my grandchildren, beneficiaries of this, my Last Will and Testament, shall be under the age of twenty-one (21) at the time of my death, then any portion of my estate in which they share shall be held in trust for them with Shawn Marie Kleimola as Trustee. The trusteeship shall end when the child attains the age of twenty-one (21) years. As Trustee, Shawn Marie Kleimola shall provide for the care, maintenance and education of said children and shall from time to time use either principal or income from the inheritance to provide for these needs. TENTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set m~y.,h~tnd and seal to this, my Last Will and Testament, consisting of two typewritten pages thi~/'Sffay of February, 2001. Signed, sealed, published and declared by the above named Testatrix Jimmie Ann Atwood as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEAL TH OF PENNS YL VANI,4 : :SS. COUNTY OF CUMBERLAND : I, Jimmie Ann Atwood, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, b~y~t.~ Jimmie Ann Atwood this>9/""day of February, 2001. 'Pf~blic ~~rfy ~ ~,ynthia Darr .... J , ,'~o[ary Public /S°uth Middle~'ut~ Twp.. County of Cu buy Corem ~:~, :~ :.~.~ mberland/ COMMONWEAL TH OF PENNSYLVANIA ; · ,~.~z,,,:? ?Ca Au0. 14, 2004 ~ : SS. COUNTY OF CUMBERLAND : We, ~)} tit ~ ~. I'~txrX09 t~ and ~ct~ ~. /T}t31~.I~B~V~- the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Jimmie Ann Atwood sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testatrix signed the will as wimesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~.~,j~ ~ . ,-. ~~.~,,...~/~ Sworn or affirmed to and subscribed b.efo_.re me by kJ/I/I//"/~ //. /~ ~//~(o/~ and ~4_c,'4~ ~, ~/3tu_m ~ e (ac , witnesses, this~.~,/'~y 9f Fe, b~ 2001. N~ry pubh~ i NOTARIAL SEAL Cynthia L, Dart, Notary Public South Middleton Twp,. County of Cumberland My Commisaion E~,~r;iro$ Aug. 14, 2004 CERTIFICATION OF NOTICE UNDER RULE 5.6(A) NAME OF DECEDENT: Jimm~e Ann Atwood a/k/a Ann Royal Atwood DATE OF DEATH: February 18, 2003 WILL NO. 21-03-00181 ADMIN. NO. TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.5(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March Il, 2003 : NAME ADDRESS Johnna Ann Kohl 3560 Ritner Hi_~hway. N,wvill,: PA Nancy GaYle Liberator 2848 Cedarest Road, Fairfax, VA 22031 Steven Kleimola 704 North Logan Avenue, Fleming, CO 80728 Robert Kle{mola 704 North Lo,an Av~n~; ]~]~m{n~; Cfi Lisa Kleimola 704 North Logan Avenue, Fleming, CO 80728 Sa F~eimnla 704 North ].n~an Av~nmm~; ]~l.min. CN Joe ~eimola 704 North Lo~an Avenue, Fle~ng, CO 80728 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except Name William A. Duncan, Esquire Address 1 Irvine Row Carlisle, PA 17013 Telephone 717-249-7780 Capacity:__ Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002474 DUNCAN WILLIAM A ESQUIRE 1 IRVINE ROW CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 255~48-8940 FILE NUMBER: 2103-01 81 DECEDENT NAME: ATWOOD JIMMIE ANN DATE OF PAYMENT: 04/21/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,500.00 REMARKS: TOTAL AMOUNT PAID: WILLIAM A DUNCAN ESQUIRE $1,500.00 SEAL CHECK# 92 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O03162 DUNCAN WILLIAM A 1 IRVINE ROW CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 25§-48-8940 FILE NUMBER: 2103-01 81 DECEDENT NAME: ATWOOD JIMMIE ANN DATE OF PAYMENT: 10/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/1 8/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $88.88 TOTAL AMOUNT PAID: $88.88 REMARKS' JOHANN KOHL C/O WILLIAM A DUNCAN ESQUIRE SEAL CHECK# 1005 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS mmm 0 mmm 0 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 FIARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Atwood, Jimmie Ann a.k.a Atwood, Ann Royal DATE OF DEATH (MM-DD-Year) [ BATE OF BIRTH (MM-DD-Year) 02/18/2003 1 09/13/1937 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FILE NUMBER 2 1 -0 3 0 0 1 8 1 SOQAL SECURITY NUMBER 2 5 5-4 8-8 9 4 0 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r~l. Original Return r~4. Limited Estate [~6. Decedent Died Testate (AUa~ cow of W~ [~9. Litigation Proceeds Received '"]2. Supplemental Return [~4a. Future Interest Compromise (~e ~f aaa ate r~ 71 Decedent Maintained a Living Trust (mtach c,~w of True) r-'] 10. Spousal Poverty Credit (~e of d~th ~ 12-31-~1 and 1-1-~5) E~3. Remainder Return (dateofdeathpn~rto 12-13-82) r-J5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (~,~ Sch O) THIS SECTION MUST BE COMPt. ETED, ALL CORRESPONDENCE AND CONFIDE'r~RAJ. TAX INFORMATION SHOULD BE DIRECTED TO: :NAME I COMPLETE MAILING ADDRESS !William A.Duncan '11 Irvine Row FIRM NAME (If Appicable) Duncan, Hartman & Douglas I Carlisle, Pa 17013 TELEPHONE NUMBER I 717-249-7780 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election lo tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 9,042.99 35,042.14 OFFICIAL USE ONLY (8) 6,825.21 284.73 (11) (12) (13) (14) 44,085.13 7,109.94 36,975.19 36,975.19 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate X ~ (15) 36,975.19 X .045 (16) X .12 (17) x .15 (le) (19) 19. Tax Due 1,663.88 1,663.88 Decedent's Complete Address: STREET ADDRESS · 1 Irvine Row cn-Y Carlisle ISTATE PA I ziP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,5oo.oo 75.00 Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE BUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 1,663.88 1,575.00 88.88 88.88 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................................................................... [] [] b. retain the dght to designate who shall use the property translated or its income; ...................................... [] [] c. retain a reversionary interest;.or .................................................................................................. [] [] d. receive the promise for life of either payments, benefits or care? .......................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death2 ............... [] [] 4. Did decedent own an Individual Retiremant Account, annuity, or other non-probate property which contains a beneficiary designaUon~ .................................................................................................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ur~ ~ of pe~u~, I ~ that I have examined tbs tatum, incbd~g .accom. panyi.ng.` .s~les an,d state~menknot~l~d to the best of my knowbdge and beief, it is true, core,ct and complete. Decleration of preparer other than the personal repmsentathe is based on am inTormaaon ot ~'m~ p~ nas any ge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AD ' ' ' SIG~-A"rlIJRE (~F PREPA~rER OTF1E-R THAN REPI~E~SENTATIVE DATE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the suwiving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rote imposed on the net value of ~'ansfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rote imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rote imposed on the net value of bansfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate ~osed on the net value of transfers to or for the use of the decedents siblinos is 12% [72 PS. 69116(a)H .3)]. A siblino is defined, under Section 9102 as an REV- 1503 EX + (1-9"/) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Atwood, Jimmie Ann a.k.a Atwood. Ann Roval All property Jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 03 ITEM NUMBER DESCRIPTION 280 Shares of Barnes Group Inc at 21.1933 per sham (see attached) 113 Shares of Home Depot Inc. Stock at 27.51 per share (see attached) TOTAL (Also enter on line 2, Recapitulation)' 00181 VALUE AT DATE OF DEATH 5,934.36 3,108.63 9,042.99 I~'V-I~ EX + (1-i1'/) SCHEDULE E · co..o.w~T, oF PE..s~_v^.~ CASH. BANK DEPOSITS. & MISC. ,..E.rr^.cETAx.~r... PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER AtW0o(;I, Jimmie Ann a.k.a Atwood. Ann Royal 21 03 00181 Include the proceeds of litigation and the date the proceeds were received by the estale. All property jointly-owned with the right of survivomhip must be dls~ on Schedule F. ESTATE OF ITEM NUMBER 1. VALUE AT DATE DESCRIPTION OF DEATH 1st Union checking Account # 1000750513464 373.91 Glendale Management Refund USAA Insurance Refund AARP Refund Physician Mutual Refund AIG Annuity # FI230799 AIG Annuity # FC200291 Life Investors Insurance Physicians Mutual Insurance Refund 148.86 5.39 111.50 80.55 20,807.72 12,931.71 20.00 562.50 TOTAL (Also enter on line 5, Recapitulation) $ 35,042.14 ~'~/-1511EX* (1-97) · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Atwood, Jimmie Ann a.k.a AbNood. Ann Roval FILE NUMBER 21 03 00181 Debts of decedent must be reported on Schedule I. ITEM NUMBER 8. 9. 10. 11. 12. DESCRIPTION FUNERAL EXPENSES: Georges Flowers Reverand Jim Early ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / KIN Number of Personal Representative{s) Street Address City State Year(s) Commission Paid: Attorney Fees Duncan, Hartman & Douglas Family Exemption: (If decedent's address is not the same as claimant's, altach explanation) Claimant Johnna Kohl Zip Street Address 3560 Ritner Highway city Newville Relationship of Claimant to Decedent daughter Probate Fees Register of Wills Accountant's Fees Tax Return Preparers Fees 1st Union Check Order M&T Securities Inc. The Sentinel(Legal Ad) Chambersburg Hospital Washington Post Shippensburg Animal Hospital Pa. Department of Revenue s~ pa Zip 17241 TOTAL (Also enter on line 9, Recapitulation) ANIOUNT 221.54 125.00 2,204.26 3,500.00 177.00 24.00 50.94 95.27 8.54 196.66 215.00 7.00 6r825.21 ~¥t512EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REI'URN RESIDENT DECEBENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Atw00d, Jimmie Ann a.k.a Atwood. Ann Royal Include unreimbursed medical expenses. FILE NUMBER 21 03 ITEM NUMBER 1. DESCRIPTION Capital One Visa #4121-7415-7264-0428 TOTAL (Also enter on line 10, Recapitulation) 00181 AMOUNT 284.73 284.73 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Atwood. Jimmie Ann a.k.a Atwood. Ann Roval NUMBER SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Johna Ann Kohl 3560 Ritner Highway Newville Pa. 17241 Shaun Marie Kleimola 704 N. Logan Ave. Fleming, CO. 80728 Nancy Gayle Liberator 2848 Cedarest Road Fair[ax, VA 22031 Steven Kleimola 704 N. Logan Ave Fleming CO. 80728 Robert Kleimola 704 N. Logan Ave Fleming CO 80728 Lisa Kleimola 704 Logan Ave. Fleming CO 80728 Sam Kleimola 704 N. Logan Ave. Fleming CO 80728 FILE NUMBER 21 03 00181 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE daughter daughter daughter grandson grandson grandaughter grandaughter 70 % remainder 25% remainder 5% remainder 500.00 500.00 500.00 500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART [! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEE1 $ (If mnm m3,~.~ i~ n~c~d in~:~rf ;~ldifinn~l ;=h~:~f~ nf fh~ ;:~m~ ;~i7~1 Continuation of REV-1500 Inheritance Tax Retum Resident Decedent Atwood, Ji~mie Ann a.k.a Atwood, Ann Royal 21 03 Page 1 Schedule J - Beneficiaries 00181 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(s) OF ESTATE ! TAXABLE DISTRIBUTIONS (include outright spousal distribu~ns) 8. Joe Kleimola grandson 500.00 704 N. Logan Ave. Fleming CO 80728 LAST WILL & TESTAMENT OF JIMMIE ANN ATWOOD, of 3560 Ritner Highway, Newville, Penn Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon aRer my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within the Royal family burial plot side by side my mother, located in Mt. Comfort Cemetery, Alexandria, Virginia, accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give and bequeath the sum of Five Hundred ($500.00) Dollars unto each of the following grandchildren; Steven Kleimola; Robert Kleimola; Lisa Kleimola; Samantha Kleimola and Joseph Kleimola, to be held in trust in accord with Paragraph Ninth below. FIFTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death as follows; 70 % unto my daughter, Johnna Ann Franklin, per stirpes; 25 % unto my daughter, Shawn Marie Kleimola, per stirpes; 5 % unto my daughter, Nancy Gayle Liberatory, per stirpes. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate owned by me at the time of my death as follows; 70 % unto my daughter, Johnna Ann Franklin, per stirpes; 25 % unto my daughter, Shawn Marie Kleimola, per stirpes; 5 % unto my daughter, Nancy Gayle Liberatory, per stirpes. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my daughter, Johnna Ann Franklin, as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. If any of my grandchildren, beneficiaries of this, my Last Will and Testament, shall be under the age of twenty-one (21) at the time of my death, then any portion of my estate in which they share shall be held in trust for them with Shawn Marie Kleimola as Trustee. The trusteeship shall end when the child attains the age of twenty-one (21) years. As Trustee, Shawn Marie Kleimola shall provide for the care, maintenance and education of said children and shall from time to time use either principal or income fi.om the inheritance to provide for these needs. TENTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set m~y.~ha~nd and seal to this, my Last Will and Testament, consisting of two typewritten pages thi~/~ay of February, 2001. '~,~2qN A~TWOOD Signed, sealed, published and declared by the above named Testatrix Jimmie Ann Atwood as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA : :S$. COUNTY OF CUMBERLAND : I, Jimmie Ann Atwood, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. gWo6i) Sworn or affirmed to and acknowledged before me, b¥~ Jimmie Ann Atwood thi~,9/~day of February, 2001. / Cynthia £. Dart-, Notary Public ISOuth Middleto~ Twp., Court of CO--ONe. TH OFPENNS~V~ . '~ ....... ~.,?~ Au~. ~4 200 · : SS. COUNTY OF CU~E~D : We, IL), II l ~ g .'""~bt~ rO t} ~d ~¢~[ ~. [')~)¢[lli0q~F~. the Mtnesses whose nines ~e si~ed to the attached or foregoing instrument, being duly qu~ified according to law, do depose ~d say that we were present ~d saw Jime ~ A~ood sign and execute the instrument as her Last Will; that she si~ed willingly and that she executed as her flee and voluma~ act for the purposes therein expressed; that each of us in the he~ng ~d sight of the Testatrix signed the will as Mtnesses; ~d that to the best of our ~oMedge, the Testatrix was at that time eighteen (18) or more ye~s of age, of sound ~nd and under no constr~nt or undue i~uence. Sworn or affirmed to and subscribed before me by [{)lll/~z~ /~ ~ ~/l~(:r~,/c" and idc--'~ %~./~ku-;qn t~t e (~4', witnesses, t~~y 9f Fe~ 2001. Cynthia L Darr;Notary Public South Middleton Twp., C~unty of Cumberland A..,n, REV-485 EX+ (9-00) CO~vlMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS ~m c°uNTy CODE2 ' ~j~m FILE NUMBER03-00181 ~m SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER255-48-8940 Atwood, Ji~e Ann , 2003 .~ ADDRESS OF DECEDENT (STREET) 3560 Ritner R~gh~ay, Ne-,-~i_lle, PA 17241 (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) ~illiam A. Dtmcan (STREETNAME) (CITY) (STATE) (ZIPCODE) 11rvine Row Carlisle, PA 17013 ~NAME, ADDRESSANDRELATIONSHIP(IFAN~TODECEDEN~OFPERSON(S)PRESENTATTHEBOXOPENING a. (NA.M.~FT.)..7, /~ / ,. .~ (R. ELATIONSHIP) "'(STREET NA ~. ~ b. (NAME) (RELATIONSHIP) (ZIP CODE) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) m~ NAME AND ADDRESS OF FINANCIAL INSTITUTION WNERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) 1st Union (STREET NAME) ~:11 NAME OF PERSON MAKING LAST ENTRY ~{E QFrqON~CT TO RENT BOX~ NUMBER~F BOX NAME 7N~ (AD~22~ PERSON(S~ING ACC~S/TO BOX C(Cl?) (ZIP CODE) j DATE AND TIME OF LAST ENTRY FwLE UND~ WHICH BOX IS REQUESTED a. (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) b. (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) ~1 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY :. - :./ rlm[Jm WAS A WILL IN THE SOX? [] YES [~J~O If yes, ,. Bate of will: b. Name and address of personal representative, if named in the will _ (c~TY) (ST/~. E) Name and address ~ afforney, if any (NAME) ..- (STREET NAME) ."~' ~ .~ _. (ZIP CODE) (STATE) . .~-_~.. (ZIP CODE) ', ........ SAFE DEPOSIT BOX INVENTORY Page__.of INSTRUCTIONSi '" (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other' designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and descdbe as fully as possible. (7') Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. , ¢' ITEM DESCRIPTION I CERTIFY UNDER PENALTY~-P_E~URY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE ?O THE~i]LL'~T.,~F MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNATURE ' /t I ~ SIGNATURE P~RIN[..Jb. IAIVlE~'~-"' - - ?;?:/ ~'"""~"'"--,,~"/ ~" ~-~'' ~ PRINT NAME AND CHECK APPROPRIATE BOX BELOW: "~RiNT TITLE [] Executor(trix) [] Administralor(Idx) National Financial Services LLC VOUCHER NO. 310526294 O4/3O HOME DEPOT INC UNSOLICITED ORDER ,.~ ~l~Lt I~lllVr I SLD 3,057.69 04/30 CREDIT BALANCE ~ 20.38 DETACH THIS PORTION BEFORE CASHING CHECK ' :.~' ...... ' "~' '" '" "~ 'i ...... " ...... ~ ",/.~p :~..,..:~ ¢ ? ,..,.".~,..~.. ? '.,. ,¢ :: .' /......,, ,:;. ~ :¥ .:.'.-,.. ;, '.. :~ ;~ .: ........... ~ .; ... , ~ , Y ~ re o u~ e t / a IEXACTLY');~ ;t :'~ I $3,078.o7.- 0000593 Not Valid AAer 90 Days TO JOHNNA ANN KOHL EX THE E/O JIMMIE ANN ATWOOD ORDER I I RVIN E ROW National Financial Se~ices LLC OF CARLISLE PA 17013 Mellon Investor Services ,4 ,~fHh~tl Fill~Ul~'M C~.~ll~.?~ P.O. Box 3338 South Hackensack, NJ 07606-1938 3405 01 0001399 0001652 Page 1 of 2 Shareholder Of: BARNES GROUP INC DIVIDEND REINVESTMENT PLAN Statement Print Date: 05/0712003 Account Key ................... A_'T~/_ _~O_ .D_: -_- J_IMMA_O _F0~0 .................. 0001399 01 I~B 0. 309 **AUTO T4 0 3405 17013-301901 C01 B_M_AIL - JOHNNA ANN KOHL EX EST JIMMIE ANN ATWOOD 1 IRVlNE ROW CARLISLE PA 17013-3019 FOR QUESTIONS CONCERNING YOUR ACCOUNT, PLEASE CALL 1-800-801-9519. Year-To-Date Account Summary Save this Statement for Tax Purposes · Invested ($) !_ ...... L_._/ TradJng F"S paid BY ($) $ Se~ice FeeS paid By ($) I Sale Of Plan Shares ($) J ce~t:d~:ares : ~ha~ld : shares He d By 1680 500 5934 36 Current Activi~ Information -~.~o~-~ ......... ~-;6..~,~.~ .............. ~' =-~;vq.~.~=-~ ~.~.~,~- .... ~---'~ o.~. ............. - ..... - ........... ..... ~' ~ ~sCription Ra' ~ Or W~drawn :: :: Investment,S) ....... :-J~='~ ' i~ PARD~F~i~ ~5~RD b-~?~ 1680 500 _: .... _.L_ Year-To-Date Transaction Detail Date Transaction Cash Description Investment ($) BALANCE FORWARD 104107120031 BOOK TO BOOK 05~05~2003 [_~ .... 3__L SHARES SOLD Net Distribution ($) s ~)~ F~ee$ ($~)[ Invested ($) 16 80 5 00 L__S-°°l =~1 Pri~e~;; .... -~ h; r-e-s- ~-c q~u i-- ~e~d-- - ' -[ Shares Held ] Share ($) Or Withdrawn ~ By Plan ..... --] -%o00 2~OOlOfl ~6o o~o~l :~ ~ -:~ o~o~ o oooo BARNES GROUP INC CUSIP; 107-002-06780610 ACCOUNT KEY: ATWOOD---JIMMAOF00 JOHNNA ANN KOHL EX EST JIMMIE ANN ATVVOOD I IRVINE ROW CARLISLE PA 17013-3019 Partial Withdrawal (Continue Plan Participation) Issue a certificate for this r number of shares: L Sell this number of shares: Full Withdrawal (Terminate Plan Participation) __-] Issue a certificate for all full shares and a check for fractional shares. [-~] Sell all plan shares, Additional Cash Investments Write the amount enclosed: [- ........... I Make check payable to: .............. J MELLON BANK, N.A. Deposit of Certificates Deposit the enclosed number of shares: 7575 10700206780610ATWOOD---JIMMAOF00IR00122 PAYABLE AT: CHASE MANHATTAN BANK, SYRACUSE OR TO THE ORDER OF THE CHASE MANHATTAN BANK, NEW YORK I,,,111,,,111,,,,,,11,,11,,,11,11,,,,,,111,1,,11,,,,,,11,1,,11 JOHNNA ANN KOHL EX EST JIMMIE ANN ATWOOD 1 IRVINE ROW CARLISLE PA 17013-3019 CHECK NO. 00773464 AUTHORIZED SIGNATURE ,'OO??3hr::,h,' ~.'O i]i, 3, OCi3,?cil-' r=Oi, SclOOO~,' AIG Annuity Insurance Company A Member of American International Group, Inc. AIG ANNUITY INSURANCE COMPANY P.O. Box 871 Amarillo, TX 79105-0871 QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 03/31/2003 1-800-424-4990 >18108 0602079 001 008129 ANN R ATWOOD 3560 RITNER HWYT NEWVILLE, PA 17241 · Contract Number · Policy Date · Annuitant · Policy Type · Agent FJ230799 09/24/2001 Ann R Atwood Non-Qualified Wachovia Insurance Agency Inc Important Messages Beginning this quarter the format of your statement has changed. This change places your monthly and yearly information in side by side columns that makes it easier to compare quarterly and yearly information. All of the information that was on your previous statement is reflected on your new statement. Account Information Current Quarter 01/01/2003 - 03/31/2003 Year- To - Date 01/01/2003 - 03/31/2003 Beginning Value 20,619.69 20,619.69 Withdrawals (20,807.72) (20,807.72) Interest 188.03 188.03 Accumulated Value 0o00 0.00 Deposits And Withdrawals Processed During This Quarter Date Amount 03/31/2003 (20,807.72) Member of American International Group, Inc. 18108 0602079 018109 018109 00001/00001 8129-AIC AIG Annuity Insurance Company A Member of American International Group, Inc. AIG ANNUITY INSURANCE COMPANY P.O. Box 871 Amarillo, TX 79105-0871 mm mm mm .mmm QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 03/31/2003 1-800-424-4990 >14885 0602028 001 008129 ANN R ATWOOD 3560 RITNER HWY NEWVlLLE, PA 17241-9120 · Contract Number · Policy Date · Annuitant · Policy Type · Agent FC200291 08/13/1998 Ann R Atwood Non-Qualified Wachovia Insurance Agency Inc Important Messages Beginning this quarter the format of your statement has changed. This change places your monthly and yearly information in side by side columns that makes it easier to compare quarterly and yearly information. All of the information that was on your previous statement is reflected on your new statement. Account Information Current Quarter 01/01/2003- 03/31/2003 Year - To - Date 01/01/2003 - 03/31/2003 Beginning Value 12,792.11 12,792.11 Withdrawals (12,931.71) (12,931.71) Interest 139.60 139.60 Accumulated Value 0.00 0.00 Deposits And Withdrawals Processed During This Quarter Date Amount 03/31/2003 (12,931.71) Member of American International Group, Inc. 14885 0602028014886 014886 00001/00001 8129~AIC BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DIV;STON DEPT. 180601 HARRTSBURG, PA 17118-0601 WILLIAH A DUNCAN DUNCAN ETAL I IRVINE ROW CARLISLE PA 17015 CONNONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF 1NHERZTANCE TAX APPRAISENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FZLE NUHBER COUNTY ACN REV-164? EX AFP C01-05) 12-15-2005 ATWOOD JINHIE A 02-18-2005 21 05-0181 CUHBERLAND 101 Amount Ramittad I HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~'~ RETAZN LOWER PORTTON FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTZCE OF TNHERTTANCE TAX APPRATSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF ATWOOD JTHHTE AFTLE NO. 21 05-0181 ACN 101 DATE 12-15-2005 TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATTON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRA/SED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Raal Estata (Schadula A) (1) 2. Stocks and Bonds (Schadula B) (2) 5. Closely Held Stock/Partnership lntarast (Schadula C) (3) ~. Nortgagas/Notas Racaivabla (Schadula D) (~) $. Cash/Bank Daposits/Hisc. Personal Propmrty (Schedule E) 6. Jointly Offned Property (Schedule F) {6) 7. Transfers (Schedule O) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expansas/Adm. Costs/Hisc. Expanses (Schedule H) (9) 10. Debts/Hortgaga Liabilities~Liens (Schedule I) (10) 11. Total Deductions 12. Ne~ Value of Tax Re~urn 9/042.99 .00 55/042.14 .00 .00 NOTE: To insure proper cradi~ to your account, submit the upper portion .00 of ~his fora with your ~ax payment. .0O (B) 6,825.21 284.75 44,085.15 (11) 7.1o9.9~ (12) 56,975.19 13. 14. NOTE: Charitable/Governmental Bequests; Non-alactad 911:5 Trusts (Schedule J) (13) Nat Value of Estate Subject to Tax (14) :]:f an assess.ent was issued previously, lines 14, 15 and/or 16, 17, reflect f/gures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 1S. Amount of Line lq a* Spousal rata (15). 16. Amount of Line 14 taxable at Lineal~Class A rate (16) 17. Amount of Line 14 at Sibling rata (17) 18. Amount of Line 14 taxable a~ Collateral/Class B rata (18) )al Tax Due RECElrl NUHBER 19. Princi TAX CREDITS PAYNENT DATE DZSCOUNT 1+) INTEREST/PEN PAZD (-) 78.95 .00 CDOOZ~74 CD005162 04-21-2005 10-25-2005 . O0 x O0 = 56,975.19 x 0~5= · 00 x 12 = . O0 x 15 = (19)= ANOUNT PAZD 1,500.00 88.88 TOTAL TAX CREDZT I BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE .00 56,975.19 ZF PAZD AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST. 18 and 19 will .00 1,663.88 .00 .00 1,665.88 1,667.85 5.95CR .00 3.95CR ( 1F TOTAL DUE 1S LESS THAN $1, NO PAYNENT IS RE~UZRED. 1F TOTAL DUE 1S REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TH[S FORN FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate Js transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for Life or for years, the Coemonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such future interest. PURPOSE OF NOT[CE: PAYHENT: REFUND (CR): OBJECTZONS: ADHZN- ZSTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements oF Section ZIqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 91¢0). Detach the tap portion of thls Notice and submit with your payment to the Register of Hills prlnted on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the 13 Revenue District Offices, or by calling the specie1 2~-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-~7-3010 (TT only). Any party in interest not satisfied with the appraisement, alloeance, or disallomance of deductions, or assessment of tax (including discount ar interest) as shown on this Notice suet object mithin slxty (60) days of receipt of this Notice by: --eritten protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17128-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated et a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 are: [ntarest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 Z0Z .0005~8 1987 91 .0002~7 1999 7Z .000192 1983 161 .000~38 1988-1991 111 .000301 ZOO0 81 .000119 1984 111 .000301 1992 91 .0001~7 2001 91 .0002~7 1985 13Z .000356 1993-1994 72 .000192 ZOOZ 61 .00016~ 1986 102 .00027~ 1995-1998 92 .0001~7 Z003 5Z .000137 --Tntarest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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 shomn on the Notice, additional interest must bm calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX nIVISION DEPT. 280601 HARRISBURG.. PA 17128-0601 COHNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT R£V-I~O? EX AFP C01-03) WILLIAH A DUNCAN DUNCAN ETAL I IRVINE ROW CARLISLE ~ ~ DATE O1-ZO-2OOq i:~!~?~;:~ 0'! ~JiiiS ESTATE OF ATNOOD DATE OF DEATH 02-18-2005 FILE NUNDER Z! 05-0181 '04 FEB 13 P3:28 COUNTY CUHBERLAND ACN 101 PA 1C~eriar:d Co., PA Amoun'l: Rem ~.'l:'l:ed JIHHIE A HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF HILLS CUH]iERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper por~:~.on of ~his form frith your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORT'rON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ##- 'rNHER'rTANCE TAX STATEHENT OF ACCOUNT ESTATE OF ATNOOD JZHHIE A FZLE NO. 21 05-0181 ACN 101 DATE 01-20-200q THIS STATEMENT TS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACH TN THE NAMED ESTATE. SHO#N BELON TS A SUMMARY OF THE pRINCIpAL TAX DUE, APpLTCAT/ON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE, A PROJECTED TNTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTNENT: 12-08-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 1,665.88 PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 0~-21-2005 10-25-2005 Ol-05-ZOOR CD002~7~ CDOO$16Z REFUND 78.95 .00 .00 1,500.00 88.88 3.95- ZF PAID AFTER TH/S DATE, SEE REVERSE S/DE FOR CALCULAT/ON OF ADD/TZONAL /NTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S REQU/RED. ZF TOTAL DUE 1S REFLECTED AS A "CRED/T' (CR), TOTAL TAX CREDIT 1,665.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTTONS. ) PAYMENT: Detach the top portion of this Noticm and submit with your payment made payable to the name and address printed on thm reverse side. -- IF RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RES/DENT DECEDENT make check or money order payable to: COHMONNEALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available mt the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Depar~ent's Z~-hour answering service for forms ordering: 1-800-362-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-qqT-3OZO (TT only). REPLY TO: guestions 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 (52) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and 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, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates For 1982 through 2003 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate Daily Factor 1982 ZOZ .0005~8 1987 9X .0002q7 1999 7Z .000192 1983 162 .000q38 1988-1991 llZ .OOO30l 2000 82 .000219 198& IIi .000301 1992 9X .0002q7 ZOO1 92 .0002q7 1985 132 .000556 1993-1994 72 .000192 ZOOZ 62 .000164 1986 lOZ .00027~ 1995-1998 92 .000247 2003 52 .000137 --Xntarast is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER 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. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jimm~e Ann Atwood Date of Death: March 18, 2003 Will No. 21-03-0181 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: Signature William A. Duncan, Esquire Name (Please type or print) 1 Irvine Row, Carlisle, PA 17013 Address ( 717) 249-7780 Tel. No. Capacity: __Personal Representative (MAH:rmf/AM3) x __Counsel for personal representative