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Home My WebLink About04-0070 r ---- . !'agc I of 2 Register of Wills ....... ~Ufv1~. _ County, Pennsylvania Petition for Probate and Grant of Letters .. 66/67 RW Estate of Grace R. Orwan No.: l~j/ - LJ~.. 7~ I Also known as Deceased 195-07-0362 Social Security No.: DaicofDealh; 1-8-2004 Pctitioner(s), wbo is/are 18 years of age Of older, respectfully represents and apply(ies) for: COMPLETE' A' OR' B' and if necessary, Part' C' BELOW ~A. Probate and Grant of Letters ~Testamentary Oof Administration 0 C.t.a 0 d.b.n.c.t.a. (complete Part 'C also) and aver Ihat Petitioner(s) is/are entitfed to the aforementioned Letters Testamentary 9-16-2003 Clnd codicil(s) dated under Ihe Last Will orth", above named Decedent dated Stalc relevlnt cireul11S11ncC!l. c.g. lIrnUllCialion, death or execulor, etC, Except as follows, DG:cedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents otTcred for probate; was not the victim of a killing :lnd was never adjudicated incapacitated: no exceotions o B. Grant of Letters of Administration (d.!),n.; pcndcnrc lite: durante ob~cnli~ ; duronle minorilale) Pctitionl.lr(s) after .1 proper search has/havl.l ascertained that Decedent lell no Will .1nu was ~urvived by the following spouse (if any) and heirs:l.'1 set forth below in part 'C'. o C. Decedent's heirs and next of kin Name " ~; Relationshin' Residence :' , ':; ':':;',:, ;d" ,:",:--:', ",'7" COMPLE'rE THE FOLLOWJNG IN ALL CASES Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family Or principal residence at Mess;i.ah V'il1age, Mechanicsburg PA 91 (ti~1 slTl:ct, nUITI~r and f~lr&~lity) Mechanicsburg PA Decedent. then years of age, died January, ,M (IOCl\tion) $ $ $ $ 942 Mountain ~. A 1701 Grace Bell 550 Second St. High~ (13 Y- . - Rc:gi!l~r Q( Wills P~gl: 2 of 2 (l(('vI/?k/2U'WD. County, ~ennsYlvania . Oath of Personal Representative Commo~11h OfPcnnaylYallia. - .. The Petitioner(s) above-named swear(s) or afrtmJ(s) that the statcment in the foregoing Petition are we and correct to the "" of". know,..... ood b.liot of Po''''oooo(.) and ...~ .. P.....w .............0(.) of tho De=Ion~ Poti.ooer(.) wal well and truly administer thc estate acCOrding to law. Signa~s) c' ~ 1JJ~;~~~~[1, n '<11 d .tlell - No.:/ R. --, Estate of Grace Orwan Social SeCUrity No.: 195-07-0362 Also ~nown as Deceased Date of Death: 1~,q-2004 DECREE OF PROBATE AND GRANT OF LETTERS AND NO:2;*H ... ;;r' ::J ~/.;. "'os,_,... of", Pet,... 0' ... r<YoB. ';do h.reof, "'Mcto", proof havj n present before me, IT IS DECREED that LCltcrsc:JTestamentaryOOf Administration (tl.l->.11."....1. : Illlnt!cnlc :lh"cnl;~ : r111r:1nIC tIlmoritalc eta.dbn) are hereby granted to Winifred Ren,a rd and Grace Bell in the above estate of Grace R. Q.rl.(tl;t jr) also lmown as =- and that the instrument(s) dated _ 9-1b-L003 - described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. BOND SURETY IN THE SUM OF $ - FEES Probate, Letters............. S J g CJCJ R,gi'"'OfW;;~ ~J...u Short Certitieates(s),,[ 1$ ~ ~ /7':) Deputy or Prq(:;te Clerk .::; R.enunciation(s),..... .r 1$ Aftidavit(s).. ....... ....r ]$ Attorney Reg. Compo Fee............. $ Signature ; NONE - JCp Fee............. ..... "" $ / t":J 02. Name RRC Fee..................... $ Address Other. .. . ( )(",4P?- ] s_ 9 1')6 Other.. .. r J$_ = - - TOTAL.......... ..,... ......$ l~L?O Telephone - - Receipt #...... ............... $ Supreme Court l.n. No. : - JPCtition_ oach-08021 nlU).l'IU) t<.l:,V ~/M6 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 ~~~ F Lo~i"m ~ p 10046764 /-1~/ No. r Date H'05.:4JRew 2117 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS , CERTIFICATE OF DEATH PAlHT . 'NENl '5 KINK -O:t IURTHPUCE :C.,." MlG . EAIOuIoM...,. C . .... ,.... - .... WI\S CASE ""FEAREO TO MEDICAl. E.....INERIc:OAONEll? 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Ie IhiI cauMC_. and fNftNt'........... ....... -~ll On 1M........ ..,aminatlon andIor ilweallgadon. in my opinion. d..th occwrect e. the tim.. dele. and place. and due 10 the c........) end 0 J'L-..ItaIecI...... ....... ..... ........ .......... .... ....,.. ................................... ........ AlGlSTAAR'S SIONAJ'UAE AND NUMBER !;>C2I~I~1 )C. / ,r ~~- . , 1 '. : ~ . . . WILL OF GRACE R. OR WAN I, GRACE R. ORW AN, currently of Upper Allen Township, Cumberland County, Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose again to redeem me and give me etemallife, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as ifsaid taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath as follows: A. Twenty- five percent (25%) unto my sister, Winifred Renard, or her issue per stirpes. B. Twenty-five percent (25%) unto my niece, Grace Bell, or her issue per stirpes. C. Fifty percent (50%) to be divided equally among the following charities to be used as they determine best: (1) Child Evangelism Fellowship of Dauphin County, Inc., P.O. Box 6129, Harrisburg, Pennsylvania. QQ6 ~/ca.~.e K:'7 /J;uf/CZ/t/ ". "'I /f:p -1- 0.. ~ . . .' . . : .' (2) The Christian Broadcasting National, Inc., 977 Centerville Turnpike, Virginia Beach, Virginia. (3) Northeast Animal Shelter, 204 Highland A venue, P.O. Box 4516, Salem, Massachusetts. (4) Physicians Committee for Responsible Medicine, P.O. Box 96736, Washington, D.C.. (5) International Fellowship of Christian & Jews, Chicago, Illinois. (6) Chosen People Ministries, New York, New York. (7) Radio Bible Class, Grand Rapids, Michigan. (8) Transworld Radio, Cary, North Carolina. (9) Mission Aviation Fellowship, Redlands, California. (10) Brookfield Bible Church, Harris burg, Pennsylvania. (11) Coral Ridge Ministries, Fort Lauderdale, Florida. If any of the above-mentioned charities is not in existence at the time of my death, said share shall be divided proportionately among the other charities mentioned in this Sub-Paragraph. IV. I appoint my sister, Winifred Renard, and my niece, Grace Bell, Executrixes, or the survivor of them as sole Executrix, of this my Will. V. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. ~ -2- . -JJJ1fi...~ R,~ J .. , " . ," IN WITNESS WHEREOF, I, GRACE R. ORWAN, herewith set my hand to this ",Iy Last Will, typewritten .on two (2) sheets o;taper including the attestation clause and SIgnatures of WItnesses, thIS 1:'pt4 day of ..S.o .. , 2003. 2/rctil I~/ ,.e6UtL~EAL) ...- GRACE R. ORW AN Signed by GRACE R. ORW AN, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this It;, 'f1,. day of .J' ~ pt- ,2003. ~ /) /~~i! /cp~ residing at .. -'7~: ~ r t:. (j~,- q?~ residing at '~'/?7 ~A---x-~ /#9- / -2- , - , . '. . J . . COMMONWEAL TH OF PENNSYLVANIA COUNTYOF L~BANON WE, GRACE R. ORWAN,GF;.".4( 1:> .7. 6~"'..vss:~~nd Qlnfll1/1 A "oA.R~~ the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. LA ;? r yJ./-t..o../fj- I tf21-u~" GRACE R. ORWAN $;~ /)/~ C;'/ /' . . '-' WITNESS // (~t1.,;O~ WITNESS Subscribed, Sworn o~ affinned and acknowledged before me % gRACE R. OR W A~, the testatrIx, C ~ ,(,1,-t..J;J ...J. /J/f IN J or./2 and (1 Y h HIt /1 j/.}- 'H~ ~ ~ wItnesses, thIS '7tL1 day of [)C/o(~.N~ ,2003. -'A)~~~~AL) NOTARIAL SEAL WENDYl. CRAWFORD, Notary Public Palm1sra Boro., Lebanon coun~ Comm sslon expires Sept. 10, 2 -3- Z 0:: <( 0 ::E 0 co cr: ...J I' W IJ.. 0 ::E 0 !:: Cl :z ::E Z <( :z c::c. - 0 - <( I- 3: N u (1') Z ~ :z e:::: ~~WN~ (1') -lW a -l :E U Ul (1')...J (0 t-t <( u... ii: cr: r:- >< >- I cO 3: I- a e:::: ~ W W 0 Ul (1') VI W Z W to Z co I... I-w ~ (9 0:: 0 Z ~ VII- u <( <( <( I- W I' <( ...J Ul' a.. - -J e:::: :s: a..'I' <..!) Z <( ~ . ~ 0:: cr: ~ >- W I- ~ (J) Ul ...J <( Z <( a.. (2 W m (0 " . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION IN RE: ESTATE OF GRACE R. ORWAN, DECEASED NO. 21-04-0070 CERTIFICATION OF NOTICE UNDER RULE 5.6(Al Name of decedent: Grace R. Orwan Date of death: January 8, 2004 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on February 24, 2004. Name Address See attached Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: -t:e-. J.. 3 oZ () 0 f- Signature: ---TLl ~... 0..0 '-I( ~~ I Winifred Renard, Co-Executrix 942 S. Mountain Road Dillsburg PA 17019 p(.: Phone: 717/432-3339 ;;;;;: 'D g :o~ ::'1 :;: ('t) a (':') ~ ,"', , t' -'''''j ~=) , 3: = :;0 I N -0 --- N -.J 0 - Benficiaries of the Estate of Grace Orwan Winifred Renard 942 S. Mountain Road Dillsburg, PA 17019 Grace Bell 550 Second Street Harrisburg, P A 17034 Child Evangelism Fellowship of Dauphin County, Inc. P.O. Box 6129 Highspire, P A 17112-0129 The Christian Broadcasting National, Inc. 977 Centerville Pike Virginia Beach, V A 23463-7701 Northeast Animal Shelter 204 Highland Avenue P.O. Box 4516 Salem, MA 01970-0901 Physicians Committee for Responsible Medicine P.O. Box 96736 Washington, DC 20090-6736 International Fellowship of Christians & Jews 3098 W. Washington Street Suite 800 Chicago, IL 60606 Chosen People Ministries International Headquarters 241 East 51 st Street New York, NY 10022 Radio Bible Class Box 2222 Grand Rapids, MI 49555-0001 Transworld Radio Box 8700 Cary, NC 27512 vA- Mission Aviation Fellowship Box 3202 Redlands, CA 92373-0998 Brookfield Bible Church 3601 Brookfield Road Harrisburg, P A 17109 Coral Ridge Ministries P.O. Box 40 Ft. Lauderdale, FL 33302 >-.. Cohick & Associates RBC\'. F:e. '04 APR -8 P2 :09 LS', CU1nct:' ! April 7, 2004 Glenda Farner Strasbaugh Register of Wills Cumberland County High & Hanover Streets Carlisle, PA 17013 RE: Estate of Grace R. Orwan Date of death: Janu~ 8, 2004 County file nod004-000~ Dear Ms Farner Strasbaugh: Enclosed is a check in the amount of $11,000.00, to be applied to the transfer inheritance tax for this estate. Please send the receipt to the undersigned. . Thank you for your assistance. Sincerely, r;,)~.,/, k~ Winifred Renard, Co-Executor 942 S Mountain Road Dillsburg, PA 17019-9701 V Bookkeeping, Accounting and Tax Services 390 Alexander Spring Road, Carlisle, PA 17013 Phone (717) 249-5321 Fax (717) 249-5830 INI:l:l n ~g 0 i!: ~ ::r ~ Ii _. ~'l:I t") 8-= ~ ..~ ~ CIl> "eI" ~'i > lJQ::r ~ ~c ~ [~ 0 . .. t") ~::r _. Q.~ a: '"i __ "'.. t'D .n~ ~ ~~ '" " ~~ :i e. .. :::i :: IN ,..1. OIO;;oG)= ...1 ID cO' C CD CD :... "', :::l. :::T 3 '9. ::J =- ~ '... !-J. en' Qo 0" !e. a. =- (..1 - CDCDID= ..... _CD I :::l. .., ." = \ (..1 "UIDIDOID= ~ . , )> ::J ::J _ .., = f.... Oa.~$:- IiI -to ".;. ...... < 0 -. .., =- .......~Oencn== ~ OcnC -= ...... :::J ..,_ W -- ID =- aI .., '< en CD 0" - m. ID -. en c (Q -- :::T _. - -. :r'~ ~ D_ - 'j :-- '0 1 \.--,! Q - f..) ;1) OJ I I I f-., ,. -~-.... '..i "*- ~ - 0:::: ;:: tr_J a... I (-'~ _. .' <:::c: ~t:~~ - ..; (,;) om ~ r---".< _ C) (1)0: P 'I' .., / ", ~ t"7 ." _.," a: ;~... ~( .I .., . J COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYL VANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO, CD 003789 RENARD WINIFRED 942 MOUNTAIN DRIVE DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER _nn___ fold ---------- -------- 101 I $11,000.00 .:'::r'i ESTATE INFORMATION: SSN: 195-07-0362 I FILE NUMBER: 2104-0070 I DECEDENT NAME: ORWAN GRACE R I DATE OF PAYMENT: 04/08/2004 I POSTMARK DATE: 04/07/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/08/2004 I I TOTAL AMOUNT PAID: $11,000.00 (, CHECK# 8 L INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS ! ~,.; REGISTER OF WILLS , I; COMMONWEALTH OF PENNSYLVANIA REV-1162 EXll 1-96) DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 PENNSYL V AN IA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CO 004497 RENARD WINIFRED 942 MOUNTAIN DRIVE DlllSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- lold _nn_nn ____un 101 I $9,163.04 EST A TE INFORMATION: SSN: 195-07-0362 I FILE NUMBER: 2104-0070 I DECEDENT NAME: ORWAN GRACE R I DATE OF PAYMENT: 10/15/2004 I POSTMARK DATE: 10/15/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/08/2004 I I TOTAL AMOUNT PAID: $9,163.04 REMARKS: WINIFRED RENARD CHECK#106 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS 0 w Vl L5 :;:: 0 ~ U Vl r--.. w c 0 0 :;: 0 0 ..... ..... ~ 0 0 Z 0 , ~ Cl! <l: Cl! c "" Z ...... ~ ...... Cl! 0 ru ru , W ...... ....J <l: Vl ..... > W 0 N ~ Z "'" Cl! 0 Z 1-1 w => U ~ t9 INVENTORY REAL AND PERSONAL ESTATE OF Grace R. Orwan, Deceased Late of Upper Allen Township, Cumberland County, PA Date of death: January 8, 2004 Social Security Number 195-07-0362 1. Securities per list attached $ 306,393.62 2. Alliance Bernstein Money Market Fund 13,624.81 3. PNC Bank - checking account #50-7009-9424 2,105.96 4. PNC Bank - savings account #50-3008-7648 5,665.64 Total $ 327.790.03 Estate of Grace R. Orwan File No. 21-04-00070 Security Listing Item Shares Security Per Share Total 1 5,181.347 American High Income Trust CI A 12.500 64,766.84 2 1,066.000 Blackrock Insurance Mun Income Trust 14.195 15,13187 3 950.000 Commercial Net Lease Realty Inc. 17.705 16,81975 4 6,151.142 Eaton Vance High Income Fund CI C 6.970 42,873.46 5 3,699789 Eaton Vance Income Fund of Boston CI C 11.390 42,140.60 6 1.646 Federated Total Return Bond Fund CI B 10.870 17.89 7 450.000 Hospitality PPTYS Trust 40740 18,333.00 8 8,103.728 Mainstay High Yield Corp Bond Fund CI A 6.350 51,45867 9 585.000 Mid-America Apartment Cmntys Inc 33.685 19,705.73 10 460.000 Realty Income Corp 39700 18,26200 11 470.000 Sovran Self Storage 35.923 16,883.81 Total 306,39362 COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : WINIFRED RENARD and GRACE BELL, being duly sworn according to law, depose and say that they are the Co-Executors of the Estate of GRACE R. ORWAN, deceased; that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of GRACE R. ORWAN, deceased, except real estate outside the Commonwealth of Pennsylvania and that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn to and subscribed before me this ISl-lt day of October, 2004. / "M ~ '{J~Lfu,C 'I(~{ ( , (/uti. <- Notary Publ c WINIFRED RENARD ~_~~.-~-!.'1:I':l"" ..-~ NOTAR!Al.SEAL ,. ~ OOH''''~'' n"-"TI"'" ~'J,..f~"" ~ ~~ deft. r.:ff~ s. - Ii.,,'=~ l't~~;'l . _ ''';',::7 }j -f J. l' C"""i'"'I~J' Sou.\h .<l'~dl:t~' wn "1."--::.-."",, ,. l" Mv~~~;~~i:t2~:",'~~qU GRACE BELL REV.1500EX(6.00) REV 1500 OFFICIAL USE ONLY COMMONWEALTH OF - PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 RESIDENT DECEDENT J.. / 0 'L- 0 0 0 7 0 HARRISBURG, PA 17128-0601 COUNTYCOOE ITAR - NUMBER-- DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z Orwan Grace R. 195-07-0362 ~ OATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLlCATE~TH THE ~ 01-08-2004 08-29-1912 REGISTER OF WILLS W (IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCAL SECURITY NUMBER Cl nja LlJ [X] 1 Original Return D 2. Supplemental Return 0 3 Remainder Relurn (date of deatn prior to 12.13-82i e- ::.::: ~ ~ 0 4 limitedEstale 0 4a. Future InlerestCompromis€{deteofdealhafter 12-12-82) 0 5 Federal Eslale Tax Relurn Required fIln.u G ~ g [X] 6 Decedent Died Testate (Attacl1 copy ofVViIl) D 7. Decedent Maintained a Living Trust (Attach copy of Trusl) _ 8 Total Number of Safe Deposit Boxes ,,-m ~ D 9. Litigation Proceeds Received D 10 Spousal Poverty Credilldale of death between 12-31.91 a~d 1-1-95) 0 11. Election to tax under Sec. 9113(A) {Attach Sch OJ e- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: m NAME COMPLETE MAILING ADDRESS ~ Jeffrev S. Cohick 390 Alexander Spring Road B; FIRM NAME IlfAppl,,,blel Carlisle PA 17013 w C( C( TELEPHONE NUMBER 8 717/249-5321 I Real Estate (ScI1edule A) (I) OFFICIAL USE ONLY 2 Stocks and Bonds (Schedule B) (2) 306,393.f>2 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Receivable (Schedule 0) (4) 5 Cash, Bank Deposits & Miscellaneous Personal Property (5) 21,396.41 z (ScI1eduleE) --. o 6 JOInUy Owned Property (ScI1edule F) (6) !;;: D Separate Billing Requested -I ::> 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) !::: (ScheduleGorl) ~ 8 TotaIGrossAssets(totallinesl-7) (8) 327,790.03 ~ 9 Funeral Expenses & Administrative Costs (ScI1edule H) (9) 17,635.41 ~ 10 Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 2,865.85 It Total Deductions(totaILlnes9& 10) (11)_ __ _ _~0,501.26 ----.-- --'.- 12. Net Value of Estate (line 8 minus line II) (12) 307,288.77 13. Charitable and Governmental BequestsfSec9113 Trusts for which an election to tax has nol been (13)_ __ __ __ 153,641.38 made (Schedule J) -- --- -- - - 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) 153,644.39 SEE INSTRUCTIONS FOR APPLICABLE RATES Z o 15 Amount of Line 14 taxable al the spousal lax i= rate, or transfers under Sec. 9116(a}(1.2) X .0_ (15) <I: I- 16 Amount of Line 14 laxable al lineal rate X 0_ (16) ::> ~ 17. Amount of line 14 taxableatslbllng rate 76,822.20 X .12 (17) 9,218.66 8 18 AmounlofLlnel4taxableatcollateralrale 76,822.19 X .15 (18) _~____.~_ 11,523.31 ~ 19 TaxDue (19) 20.741.99 I- 20 D I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < STFPA42021F,1 Decedent's Complete Address: STREET ADDRESS 100 Mt. Allen Drive CITY Mechanicsbura I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 20,741.99 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 11 000.00 C Discount 578.95 Total Credits (A + B + C) (2) 11,578.95 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund (4) 0.00 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE. (5) 9,163.04 A Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 9,163.04 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 3. retain the use or income of the property transferred; D IX] b retain the right to designate who shall use the property transferred or its income; , D IX] c. retain a reversionary interest; or . D IX] d. receive the promise for life of either payments, benefits or care? D IX] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . D IX] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? . D IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . D IX] IF THE ANSWER TO AN'( OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON R spa IBLE FOR FILING RETURN DATE /c -/~-[J,/ 'tJ, . ~WL.'.e. i!L ADDRESS 942 S. ountain Rd. and 550 Second St. Hi hs SI UREa ESS 390 Alexander Sprinq Rd. Carlisle PA 17013 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 sUNi~ng spouse is 3% 172 PS 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNiving spouse is 0% [72 PS. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% 172 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) 172 P.S. 99116(a)(1 I]. The tax rate imposed on the net value of transfers 10 or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. STFPA42Q21F.2 REV-1503 EX + (1-97) (I) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. See list attached 306,393.62 TOTAL (Also enter on line 2, Recapitulation) $ 306.393.62 (If more space is needed, insert additional sheets of the same size) STFPA42021FA Estate of Grace R. Orwan File No. 21-04-00070 Security Listing Item Shares Security Per Share Total 1 5,181.347 American High Income Trust CI A 12.500 64,76684 2 1,066.000 Blackrock Insurance Mun Income Trust 14.195 15,131.87 3 950.000 Commercial Net Lease Realty Inc. 17.705 16,819.75 4 6,151.142 Eaton Vance High Income Fund CI C 6.970 42,873.46 5 3,699.789 Eaton Vance Income Fund of Boston CI C 11.390 42,14060 6 1.646 Federated Total Return Bond Fund CI B 10.870 17.89 7 450.000 Hospitality PPTYS Trust 40.740 18,33300 8 8,103.728 Mainstay High Yield Corp Bond Fund CI A 6.350 51,45867 9 585.000 Mid-America Apartment Cmntys Inc 33.685 19,705.73 10 460.000 Realty Income Corp 39.700 18,262.00 11 470.000 Sovran Self Storage 35.923 16,88381 Total 306,393.62 REV-15GB EX + (1-97) (I) SCHEDULE E COMMON1NEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 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. Alliance Bernstein Money Market Fund 13,624.81 2. PNC Bank - checking account #50-7009-9424 2,105.96 3. PNC Bank - savings account #50-3008-7648 5,665.64 TOTAL (Also enter on line 5, Recapitulation) $ 21396.41 (If more space IS needed, Insert additional sheets of the same size) STF PA42021F9 REV-1511 EX + (1-97) (I) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES 1. Neill Funeral Home 899.90 2. Brackendorf Memorials, Inc. 195.00 B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representalive(s) see attached Social Security Number(s)! EIN Number of Personal Representative(s) Street Address Ci~ State Zip Year(s) Commission Paid: 2004 9,000.00 2 Attorney Fees 3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address CI~ State Zip Relationship of Claimant to Decedent 4. Probate Fees 52.00 5. Accountant's Fees 4,500.00 6 Tax Return Preparer's Fees 335.00 7. Register of Wills - additional short certificates 30.00 8. Estate bank charges 15.99 9. Commission to sell securities 2,302.52 10. Register of Wills - filing fee for inventory 305.00 TOTAL (Also enter on line 9, Recapitulation) $ 17635.41 (If more space is needed, insert additional sheets of the same size) STFPA42021F.12 Estate of Grace R. Owan File No. 21-04-00070 Attachment to Schedule H - Personal Representative Listing 1. Winifred Renard $ 4,500 942 S. Mountain Rd. Dillsburg PA 17019-9701 SS# 184-12-2580 2. Grace Bell $ 4,500 550 Second St. Highspire, PA 17034 SS# REV-1512 EX + (1-97) (I) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PA Dept. of Revenue - 2003 personal income tax 174.00 2. Verizon - telephone service 8.48 3. Metro Medical Service - medical care 92.50 4. Universal Card - credit card balance 22.59 5. Messiah Village - nursing home charges 2,568.28 TOTAL (Also enter on line 10, Recapitulation) $ 2 865.85 (If more space is needed, insert additional sheets of the same size) STFPA42021F.13 REV-1513 EX + (g.OO) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan Grace R. 21-04-00070 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE i. TAXABLE DISTRIBUTIONS [include outright spousal dislributlons, and transfers under See, 9116 la) (1.2)] 1. Winifred Renard Sister 25% residue 2. Grace Bell Niece 25% residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ti. NON-TAXABLE DISTRIBUTIONS' A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. nja B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. see attached TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 153 644.38 (If more space IS needed, Insert additional sheets of the same size) STFP^42021F14 Estate of Grace R. Orwan File No. 21-04-00070 Attachment to Schedule J - Charitable Bequests 1. Child Evangelism Fellowship of Dauphin County $ 13,967.68 P.O. Box 6129 Harrisburq. PA 17112-0129 2. The Christian Broadcasting National, Inc. $ 13,967.67 977 Centerville Turnpike Virqinia Beach,VA 23463-7701 3. Northeast Animal Shelter $ 13,967.67 204 Highland Avenue P.O. Box 4506 Salem MA 01970-9849 4. Physicians Committee for Responsible Medicine $ 13,967.67 P.O. Box 96736 Washinqton, DC 20090-6736 5. International Fellowship of Christians & Jews $ 13,967.67 30 N. LaSalle St. Suite 2600 Chicaqo IL 60602 6. Chosen People Ministries $ 13,967.67 International Headquarters 241 East 51st Street New York NY 10022 7. Radio Bible Class $ 13,967.67 Box 2222 Grand Rapids MI49555-0001 8. Transworld Radio $ 13,967.67 Box 8700 Carv, NC 27512 9. Mission Aviation Fellowship $ 13,967.67 Box 3202 Redlands, CA 92373-0998 10. Brookfield Bible Church $ 13,967.67 3601 Brookfield Road Harrisburq, PA 17109 11. Coral Ridge Ministries $ 13,967.67 P.O. Box 40 Ft. Lauderdale FL 33302 Total $ 153,644.38 LAW OFFICES BRINSER, WAGNER & ZIMMERMAN - - 6 EAST MAIN STR[:>€-T~~-5E-GOND FLOOR p.-O. BOX 323 '---~ PALMYRA. PENNSYLVANIA 17078 Ci 1 7) 838-6348 WILL OF GRACE R. ORWAN I. GRACE R. ORW AN, currently of Upper Allen Township, Cumberland County, Pennsylvania. realizing the uncertainty of this life. but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose again to redeem me and give me etemallife, do hereby make, publish and declare Ihis to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable~state whether or not passing under this Will shall be ti'ee and clear thereof. III. All the rest, residue and remainder of my estate, of whatever nature and whtTever situate, including property over which [ hold a power of appointment I devise and bequeath as follows: A. Twenty-five percent (25%) unto my sister, Winifred Renard, or her issue per stirpes. B. Twenty-five percent (25%) unto my niece, Grace Bell, or her issue per stirpes. C. Fifty percent (50%) to be divided equally among the following charities to be used as they detennine best: (1) Child Evangelism Fellowship of Dauphin County, Inc.. P.O. Box 6] 29. Harrisburg, Pennsylvania. .!h /r/", ) ..:! If /' -I- .- -- (2) The Christian Broadcasting NationaL Inc., 977 Centerville Turnpike, Virginia Beach, Virginia. (3) Northeast Animal Shelter, 204 Highland A venue, P.O. Box 4516, Salem, Massachusetts. (4) Physicians Committee for Responsible Medicine, P.O. Box 96736, Washington, D.C.. (5) International Fellowship of Christian & Jews, Chicago, Illinois. (6) Chosen People Ministries, New York. New York. (7) Radio Bible Class, Grand Rapids, Michigan. (8) Transworld Radio, Cary, North Carolina. (9) Mission Aviation Fellowship, Redlands, California. (10) Brookfield Bible Church, Harrisburg, Pennsylvania. (11 ) Coral Ridge Ministries, Fort Lauderdale, Florida. I f any of the above-mentioned charities is not in existence at the time of my death, said share shall be divided proportionately among the other charities mentioned in this Sub-Paragraph. IV. I appoint my sister, Winifred Renard, and my niece, Grace BelL Executrixes, or the survivor of them as sole Executrix, of this my WilL V. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. " -, GL_ -2- -~ IN WITNESS WHEREOF. L GRACE R. ORWAN, herewith sct my hand to this my Last Will, typcwritten on two (2) sheets of paper including the attestation c1ausc and signatures of witnesses, this' day of ,2003. , (SEAL) GRACE R. ORWAN Signed by GRACE R. OR WAN, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this /. 'i, dayof ~ ,2003. " residing at .t. . _residing at / -2- --.--.,.,-.-- I COMMONWEAL HI OF PENNSYLVANIA COUNTY OF , ; WE, GRACE R. ORWAN, and the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witn~sses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to th~ best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. - GRACE R. ORWAN WITNESS I , / / WITNESS Subscribed, sworn or affirmed and acknowledged before me by GRACE R. ORW AN, the testatrix. ~ ' and -, '. witnesses. this '17/, day of . ,2003. . , J ;1. ,1'.1 ';: ,. y. (~EAL) . ~ Notary Public NOTAR:AL ~E:'''L WENDYL. CRAWFORD, ilotanl Public Palmyra Bora., Lebanon County Commission Expires Sept 10, 2005 -3- COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION PO BOX 280601 APPRAISEHENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSHENT OF TAX REY-1547 EX AFP (D9-D41 DATE 12-13-2004 ESTATE OF ORWAN GRACE R DATE OF DEATH 01-08-2004 ..~. 7 FILE NUMBER 21 04-0070 T/\ 1(\ COUNTY CUMBERLAND JEFFREY S COHICK ACN 101 390 ALEXANDER SPG RD I Allount Rellitted I CARLISLE PA..17013 f'\ \ ,\' 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=i5'4-j-Eif-AFP-rOY=03Y-Noi"-icE--OF-YNHER-ifAifcE-YAX-A-PPR"jrisEi"-iNT~--ALrOWAifCE-(rR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ORWAN GRACE R FILE NO. 21 04-0070 ACN 101 DATE 12-13-2004 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) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 306.393.62 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 21.396.41 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 327,790.03 APPROVED DEDUCTIONS AND EXEMPTIONS: 17,635.41 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 2,865.85 11. Total Deductions (11) 20.501 26 12. Net Value of Tax Return (12) 307,288.77 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 153,644.38 14. Net Value of Estate Subject to Tax (14) 153,644.39 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .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 (17) 76,822.20 X 12 = 9,218.66 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 76,822.19 X 15 = ll, 523.33 19. Principal Tax Due (19)= 20,741. 99 TAX CREDITS: ",..~... (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-07-2004 CD003789 578.95 1l,000.00 10-15-2004 CD004497 .00 9,163.04 BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-16-2004 TOTAL TAX CREDIT 20,741. 99 BALANCE OF TAX DUE .00 INTEREST AND PEN. 7.06 TOTAL DUE 7.06 lIE IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~'<- RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 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 HILLS, 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 online at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 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. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount of the tax paid is allowed. PENALTY: The 157- 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: 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 (67-) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor I9iiZ ~ ~ Im-1991 ~ :D"OD!OT mil ~ .~ 1983 167- .000438 1992 97- .000247 2002 67- .000164 1984 117- .000301 1993-1994 n .000192 2003 57- .000137 1985 137- .000356 1995-1998 97- .000247 2004 47- .000110 1986 107- .000274 1999 n .000192 1987 107- .000274 2000 n .000192 --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. I "" g .. , 0 ~ ... : UJ l- . U Z . ..: ... i! Dil:: .E ~ (!) > . ..: II. LU ... lI> ... :> :E .. ...,. ...,. Q Q ... %' = =r-..Z D: 1-",' = QQC:C D::..... N N=...I ~ (1),:)0 ~Z~~~ C.....O"" .....<Q== ...IU,.., en 131:E..... III~ A (\,I"'..........===- .... 0 D:: LU .....OONU..... ~ LLU~ 0 ..: !i!x > .. Q U... tot -c<:t: cC Z.. Z :1:1- I- a. CC:<cw D:: C 9.... < iIllII: W....I...I a:: >11I x....O III... ::.:: I-D::V) _ ....:Ii c< ILAIQ U Cl'JLIJ...... o~ >z ,... U) I- 0 z: 1&1 ...... = ...I en III ....z 11.::) :r (!)::Ect: > z> LUQW 11I02> w::::)ct z... !i! ...ilS ... ~... U "" U U ~O ilia:: i::! 'CI) IIIZ III a. t-t&:> .... .... :Ii Z<r.:.::.c: II. II. ac: . I < tn.C tot OI-QD.: C Z 11.0 W --1 A 1d"::Q II. Ui::l!I:: E 0 o :z: :::oC I- i!i :a:: lLOU ...... :rZ 0... 0 1-11I ..... 0C:~ D: ....E Q ~ -,~ 0 ee.... cr....: 0 o.:f.f);:, a. 11I0: r.J,1 N WZ."; :ace tJ') (...) rl~C::; f5 i!illi ~i <2:i 4l '--'eLl'}; 3: ZQ l' UJ 0 a:-s. 0 :E ,. 0:: -"" 05 ... o :FiL = u Z U ILQ c:::;:) .. c-.l ... .. i! '" ... .... ~ c r-. .... ~..: , ... '" ""... III U lI> w .... x :r "" ~ c W 1&1 ~ UQ Z """z c Z .... :I e ;g V) c:c .... Q en I >< W !::; :s > LLI ....I II) .... JooI .-j LLI ...I V) tot Q.I:l ~ CIl: <...... % Z x LL ...I .... ....~....: LLCl.Q:: CI L&J 0'1 < Q II.I.U",.. ..., 1\1') U z o~:&! 0 :) ;:! Nil -' : ;~~ c ac:!!!IIlCl: it ~~, S u /:> 1 , , , . , . " r , . ~ .. ~ c 2' I" S' .. IS ,0 .. " 1:3 \~ .. , 0 i~ . " 0 .. , ! 0 ;: , , . D- o \ , ... , { , . \ ~~ \ \ . \ I ~ j .:- ""'~ ( '1 ~, . / , i/ ~. Ll 1-= ,Iii I ,~ I I '2) ~ [ c m ~ II! [ ;!I !il [ [ [ f I I I I I I I I I I , COMMONWEALTH OF PENNSYLVANIA REV-'162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004754 COHICK JEFFREY S 390 ALEXANDER SPG RD CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER nnnn fold n_n~~n_ n_un_ 101 I $7.06 ESTATE INFORMATION: SSN: 195-07-0362 I FILE NUMBER: 2104-0070 I DECEDENT NAME: ORWAN GRACE R I DATE OF PAYMENT: 12/20/2004 I POSTMARK DATE: 12/18/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/08/2004 I I TOTAL AMOUNT PAID: $7.06 REMARKS: CHECK#10009 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INDIV1DUALTAXES INHERITANCE TAX INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT PO BOX 280601 HARRISBURG PA 17128-0601 REV-IU1 EX 'FP [ll~a4J ; . ',- ,-.! DATE 01-31-2005 <LJ- ESTATE OF ORWAN GRACE R DATE OF DEATH 01-08-2004 FILE NUMBER 21 04-0070 COUNTY CUMBERLAND JEFFREY S COHICK ACN 101 390 ALEXANDER SPG RD I Allount Rellitted I CARLISLE PA 17013 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, submit the upper portion of this for.. with your tax pay.ent. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ...... 1~:r&~,r.~5r.x~~..ral~.~~'........;..:rA~!~~!:"fA5r.~~~~.b~.A~1!~DJrr...;;.....................' ESTATE OF ORWAN GRACE R FILE NO.21 04-0070 ACN 101 DATE 01-31-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED 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: 12-13-2004 PRINCIPAL TAX DUE:, .....,.,........,.,.,.,.,.,..,.,.,.,.".,.,.'.'..0".'.....,."."".".".. 20,741. 99 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-07-2004 CD003789 578.95 11,000.00 10-15-2004 CD004497 .00 9,163.04 12-18-2004 CD004754 7.06- 7.06 TOTAL TAX eREDIT 20,741. 99 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. I IF TDTAL DUE IS LESS THAN $1, ~ NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYL VANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005495 RENARD WINIFRED 942 MOUNTAIN DRIVE DlllSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER __u___ told ______nn n______ 101 I $4,588.43 ESTATE INFORMATION: SSN, , 95-07-0362 I FILE NUMBER: 2104-0070 I DECEDENT NAME: ORWAN GRACE R I DATE OF PAYMENT: 06/28/2005 I POSTMARK DATE: 06/28/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/08/2004 I I TOTAL AMOUNT PAID: $4,588.43 REMARKS: CHECK# 112 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS - SUPPLEMENTAL INVENTORY REAL AND PERSONAL ESTATE OF Grace R. Orwan, Deceased late of Upper Allen Township, Cumberland County, PA Date of death: January 8, 2004 Social Security Number 195-07-0362 1. 2000 shs. Inland Retail Real Estate Investment Trust @9.25 $ 18,500.00 Dividend dated 1-7-04 140.99 2. 2000 shs. Wells Reai Estate Investment Trust @1O.00 20,000.00 3. 1500 shs. CNL Retirement Properties Real Estate Investment Trust @9.50 14,250.00 4. 1500 shs. CNL Hospitality Real Estate Investment Trust @9.50 14.250.00 Total $ 67.140,99 Gl ~ c n m 1-4 2: m ?" ZVl !=' ~ 0 m <-5 N :t> ~ :>J Ul m'E. ...... liT , 10 ~ zm 0 :J fD fD -13 ... , d 0 z 0 O~ 0 ..." ..." 0 ::;: 0 ;QaT 0 :J m -<- '-l Ul n 0 =r. ~ VI m 0 -- Estate of Grace R. Orwan Statement of Account RECEIPTS Balance in PNC savings account #50-3008-7648 $5,665.64 Balance in PNC checking account #50-7009-9424 2,105.96 Redemption Real Estate Investment Trust units (date of death value was $67,000.00) 66,900.00 Redemption securities held by National Planning Corporation including dividends, interest and balance in Alliance Bernstein Money Market Fund (date of death value was $320,018.43) 332.147.95 Total Receipts $40681955 DISBURSEMENTS Verizon - telephone services 8.48 Metro Medical Services - prescriptions 92.50 Universal Card - credit card balance 22.59 Messiah Village - rent and charges 2,568.28 Probate fees 52.00 Neill Funeral Home - funeral expense 899.90 Pinnacle Health Hospital - medical expenses 103.00 Brackendorf Memorials, Inc. - headstone expense 195.00 Bank fees for estate account 15.99 PA Dept. of Revenue - 2003 personal income tax 174.00 Jeffrey S. Cohick & Associates - accounting fees for income tax preparation for personal and fiduciary tax returns and inheritance tax return 6,335.00 PA Dept. of Revenue - 2004 fiduciary income tax 222.00 Register of Wills - short certificates 64.00 Register of Wills - inventory filing fee 287.00 Winifred R. Renard - reimbursed for miscellaneous expenses 196.98 Register of Wills, Agent for the Commonwealth of PA inheritance tax payment (includes discount earned of $578.95) 24,751.47 Winifred R. Renard - Co-Executrix fee 4,500.00 Grace Bell - Co-Executrix fee 4.500.00 Total Disbursements $44988 19 Page 1 of 2 Estate of Grace R. Orwan Statement of Account SUMMARY AND SCHEDULE OF DISTRIBUTION Receipts $406,819.55 Disbursements 44.988.19 Balance $361 831 36 The balance (all cash) to be distributed as follows: Reserve held by Co-Executors pending all tax clearances $9,831.36 TO: Winifred R. Renard - 25% balance 88,000.00 Grace Bell - 25% balance 88,000.00 Child Evangelism Fellowship of Dauphin County - 1/11 of 50% balance 16,000.00 The Christian Broadcasting National, Inc. - 1/11 of 50% balance 16,000.00 Northeast Animal Shelter - 1/11 of 50% balance 16,000.00 Physicians Committee for Responsible Medicine - 1/11 of 50% balance 16,000.00 International Fellowship of Christians & Jews - 1/11 of 50% balance 16,000.00 Chosen People Ministries - 1/11 of 50% balance 16,000.00 Radio Bible Class - 1/11 of 50% balance 16,000.00 Transworld Radio - 1/11 of 50% balance 16,000.00 Mission Aviation Fellowship - 1/11 of 50% balance 16,000.00 Brookfield Bible Church - 1/11 of 50% balance 16,000.00 Coral Ridge Ministries - 1/11 of 50% balance 16.000.00 Total Distribution $361 831 36 Page 2 of 2 COMMONWEALTH OF PENNSYLVANIA : . 55 . COUNTY OF CUMBERLAND . . WINIFRED RENARD, being duly sworn according to law, deposes and says that she is a Co-Executrix of the Estate of GRACE R. ORWAN, deceased; that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of GRACE R. ORWAN, deceased, except real estate outside the Commonwealth of Pennsylvania and that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn to and sUbscrib~e me tli1is ;) '6+1' day of , 2005. S 0\/'- 'uLn;tf;J c/!..~ WINIFR RENARD r---'~""'~"-'~~'"'''''' .cc..,,'. ",i ., .:.: M~m,\~T~,f :~;-,,:;:;X:'~<}::i.,:;:,~.'~:>>',?;:',,~~:: ;>.\ ~ M" "....""",. ,. '........'......"..iJ \:....~~<~\l.~}.:,;;;,~,.-.,"". ~..i'c: "":--- ..... .~.,..,..,:::" ~ MY Cm~~~....';'n Fl!'."\,~' ~';;~:',7. ~,,). l~,::~,.t ' .~~~:~';~~~'~..~~..;,ll:; REV-iSOOEX(6-00) REV-1500 OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 RESIDENT DECEDENT Cl-L - QI.f- _OOllL HARRISBURG, PA 17128-0601 COiJllTYCODE YEM ~BER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z ORWAN GRACE R. 195-07-0362 w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 0 W 01-08-2004 08-29-1912 REGISTER OF WILLS 0 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 N/A w o 1, Original Return !Xl 2. Supplemental Return o 3. Remainder Return (date of death prior to 12-13-82) f-- ::::c:$cn o 4. limited Estate o 4a. Future Interest Compromise (dale of l1&alh after 12-12-62) o 5. Federal Estate Tax Return Required u"'''' w"-u o 6. DecedentDiedTestate(AttachcopyOfWl~) o 7. Decedent Maintained a living Trust (Attach copy of TrU5t) rOO _ 8. Total Number of Safe Deposit Boxes u"'~ "-,,, "- o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (dale of dealhbetween 12-31-91 andl.1.9S) o 11. Election to tax under Sec. 9113(A) (AtlachScl1 0) <{ f-- TH.lS SECTION MUSTBI': COMPLETIID. ALL CORRESPONDENCE AND CONFIDENTiAl TAX INFORMATiON SHOULD BE DIRECTED TO: z NAME COMPLETE MAILING ADDRESS w 0 JEFFREY S. COHICK EA 390 ALEXANDER SPRING ROAD z 0 "- FIRM NAME (If Applicable) CARLISLE PA 17013 "' w '" '" TELEPHONE NUMBER 0 717/249-5321 u ,. Real Eslale (Schedule A) (I) 0.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 67,140.99 - 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 4. Mortgages & Noles Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 0.00 Z (Schedule E) 0 6. Joinlly Owned Property (Schedule F) (6) 0.00 ~ o Separate Billing Requested ....I 7. Inter-Vivos Transfers & Miscellaneous Noo-Probate Property (7) 0.00 ::::l I- (Schedule G or L) ii: 8. Total Gross Assets (Iotallines 1 - 7) (8) 67,140.99 <l: 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,500.00 w a:: 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 0.00 11. Total Deductions (total Lines 9 & 10) (11) 1,500.00 12. Net Value of Estate (line B minus Line 11) (12) 65,640.99 13. Charitable and Governmental Bequests/See 9113 Trusts for which an erection to tax has not beeo (13) 32,820.49 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) (14) 32,820.50 SEE INSTRUCTIONS FOR APPLICABLE RATES Z 0 15. Amount of line 14 taxable at the spousal tax l- rate, or transfers under Sec. 9116 (a)(1.2) X.O_ (15) 0.00 ;:! 16. Amount of line 14 taxable at lineal rate XO_ (16) 0.00 ::::l c.. 17. Amount of line 14 taxable at sibling rate 16,410.25 X12 (17) 1,969.23 :!!: 0 18. Amount of Line 14 taxable at collateral rate 16,410.25 X .15 (18) 2,461.54 0 >< 1 g, Tax Due (19) 4.430.77 ;:! 20. 0 I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < STFPA42021F.1 Decedent's Complete Address: STREET ADDRESS 100 MT. ALLEN DRIVE CITY MECHANICSBURG I STATE PA I liP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 4.430.77 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest 157.66 E. Penalty TotallnteresVPenalty (0 + E) (3) 157.66 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,588.43 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,588.43 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOVvlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves No a. retain the use or income of the property transferred; ........................ 0 IXI b. retain the right to designate who shall use the property transfelTed or its income; . 0 IXI c. retain a reversionary interest; or ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 IXI d. receive the promise for life of either payments, benefits or care? ................... .........0 IXI 2. If death OCCUlTed after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 IXI 3. Did decedent own an "in trust fa;' or payable upon death bank account or security at his or her death? 0 IXI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... 0 IXI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, r dedwe thai f have examined this return, including accompanying schedules and statements, and 10 the besl of my knowledge and belief, it is true, correct and complete. Declaratioo of preparer other than the personal representative is based on all information of whidl preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN I'~/o~~ ADD~J/;" t.~ .if 11,~/> d- 942 S. MOUNTAIN RD. DILLSBU G 9-9701 SIGNATURE 0 ARER EP S , ADDRESS 390 ALEXAND R SPRING ROAD CARLISLE PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imc,osed on the net value of transfers to or forthe use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J. The statute does not exemot a transfer to a surviving spouse om tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers rrom a deceased child twenty-one years of age or younger at death to or for the use of a natural parenl, an adoptive parent, or a stepparent of the child is 0% {72 P.S. 99116(a)(1.2)). The tax rate imposed on the net value oftransters to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% {72 P.S. 99116(a)(1.3)1. A siblin9 is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. STFPA42021F.2 REV-1503 EX + (1-97) (I) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2000 shs. Inland Retail Real Estate Investment Trust @9.25 18,500.00 dividend dated 1-7-04 140.99 2. 2000 shs. Wells Real Estate Investment Trust @10.00 20,000.00 3. 1500 shs. CNL Retirement Properties Real Estate Investment Trust @9.50 14,250.00 4. 1500 shs. CNL Hospitality Real Estate Investment Trust @9.50 14,250.00 TOTAL (Also enter on line 2, Recapitulation) $ 67 140.99 (If more space is needed, insert additional sheets of the same size) STFPA42021F.4 REV-1511 EX + (1-97)(1) SCHEDULE H COMMONVv'EAlTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Represeota~ve's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreelAddress City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 1,500.00 6. Tax Return Preparer's Fees 7. TOTAL (Also enler on line 9, Recapitulation) $ 1 500.00 (If more space is needed, insert additIOnal sheets of the same size) STFPA42021F.12 REV-1513 EX... (9..00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Orwan, Grace R. 21-04-00070 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfern under Sec. 9116 (a) (1.2)) 1. Winifred Renard Sister 25% residue 2. Grace Bell Niece 25% residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. See attached 32,820.49 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 32 820.49 (If more space IS needed, Insert additional sheets of Ihe same Size) $TFPA42021F.14 Estate of Grace R. Orwan File No. 21-04-00070 Attachment to Schedule J - Charitable Bequests 1. Child Evangelism Fellowship of Dauphin County $ 2,983.69 P.O. Box 6129 Harrisburg, PA 17112-0129 2. The Christian Broadcasting National, Inc. $ 2,983.68 977 Centerville Turnpike Virginia Beach VA 23463-7701 3. Northeast Animal Shelter $ 2,983.68 204 Highland Avenue P.O. Box 4506 Salem, MA 01970-9849 4. Physicians Committee for Responsible Medicine $ 2,983.68 P.O. Box 96736 Washington, DC 20090-6736 5. International Fellowship of Christians & Jews $ 2,983.68 30 N. LaSalle St. Suite 2600 Chicago IL 60602 6. Chosen People Ministries $ 2,983.68 International Headquarters 241 East 51st Street New York NY 10022 7. Radio Bible Class $ 2,983.68 Box 2222 Grand Rapids MI 49555-0001 8. Transworld Radio $ 2,983.68 Box 8700 Cary, NC 27512 9. Mission Aviation Fellowship $ 2,983.68 Box 3202 Redlands, CA 92373-0998 10. Brookfield Bible Church $ 2,983.68 3601 Brookfield Road Harrisburg. PA 17109 11. Coral Ridge Ministries $ 2,983.68 P.O. Box 40 Ft. Lauderdale FL 33302 Total $ 32,820.49 09-05-2005 ORWAN 01-08-2004 21 04-0070 CUMBERLAND 101 APPEAL DATE: 11-04-2005 ( See reverse .ide "nder Objection.) Amount Rem:l.ttedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LONER PORTION FOR YOUR RECORDS - REy:is4'-EX"AFP-io3:0Sj-NOTicE-OF-iNHERiTANCE-TAX-APPRAisEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX GRACE R FILE NO. 21 04-0070 ACN 101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~ NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUA~~Dl:D OFFiCE Ci.....RAISEHENT, ALLOIIANCE OR DISALLOWANCE INlERITAHCE TAX DIVISION . .... .._ .. ~ Of DEDUCTIONS AND ASSESSHENT OF TAX PO BOX 280601.--.' ,,' ;.)' - '" ' HARRISBURG PA 17128-0601 1,,"_ ' ZO~5 SEP -2 PHI?:! 0 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN (" rD'/ n~ ".;L~.I ,;\ '.....'1- O~". JEFFREY !l'i(i:OHICK 390 ALEXANDER SPG RD CARLISLE PA 17013 ESTATE OF ORWAN *' REV~1547 EX AFP (D6-05) GRACE R TAX RETURN WAS: (X I ACCEPTED AS FILED ( I CHANGED DATE 09-05-2005 NO. 01 I~ an assesS8ent was :l.ssued prev:l.ously, l:l.nes 14, 15 and/or 16, 17, 18 and reflect ~:l.9ures that :l.nclude the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: 16. ~t of Line 14 at Spousal rat. (15) 16. AMOUnt of Line 14 taxable at Lineal/Class A rat. (16) 17. Aaount of Line 14 et Sibling rate (171 18. A~nt of Line 14 taxable at Collateral/Class Brat. (18) 19. Principel Tax Due S' RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL 1. Real Est.t. (Schedule A) 2. Stocks and Bonds (Schedule BI 3. Closely Held Stock/Partnership Interest (Schedule CJ 4. Hort~ages/Notes Receivable (Schedule DJ 5. C.sh/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Sch.dule Q) 8. Total Assets RETURN (11 (21 (31 \41 (51 (6) (71 .00 67.140.99 .00 .00 .00 .00 .00 \81 APPROVED DEDUCTIONS AND EXEMPTIONS: 1,500.00 .00 (111 \121 \131 \141 (91 \101 9. Funeral ExPenses/~. Costs/"isc. Expenses (Schedule H) 10. Debts/Hortgaga Liabilities/Liens (Schedule Il 11. Totel Deductions 12. Net Value 0" Tax Retum 13. Charltable/Gove~ental 8equestsi Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax (Schedule ..J) NOTE: .00 X .00 X 93,232.45 X 93,232.44 X 00 = 045 = 12 = 15 = AHOUNT "AID 11,000.00 9,163.04 7.06 4,588.43 DATE 04-07-2004 10-15-2004 12-18-2004 06-28-2005 NUHIlER CD003789 CD004497 CD004754 CD005495 INTEREST/"EN ..AID (-I 578.95 .00 .00 156.47- ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account~ subIo1t the upper portion 0" this form with your tax pay.ent. 67,140.99 1.GnO nn 65,640.99 32,820.49 186,464.89 19 w:l.ll \191= .00 .00 11,187.89 13,984.87 25,172.76 25,181. 01 8.25eR .00 8.25CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYIlENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREDI~' (CRI, YOU ~Y BE DUE A REFUND. SEE REVERSI;: ~Tn': Itl:' TUTe- ............... ...-- -.------- IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DMSION ESTATE OF GRACE R ORWAN NO. 21-04-00070 DECEASED STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of death: Grace R Orwan January 8. 2004 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No _x_ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: April 1. 2006 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a formal 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 No x d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and attached hereto. Date: ~ ))u ~ ,;l sf, 2.aOS- -,.:.... T.Al~..tl~4- 4.~~ Signature: C.J I~~ Name: Address: Winifred R Renard 942 S Mountain Road Dillsburg. PA 17019 en C'-,J ,." -. - - Telephone: Capacity: 717/249-5321 Personal Representative I ~J , ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/06/2005 BELL GRACE 550 SECOND STREET HIGHSPIRE, PA 17034 RE: Estate of ORWAN GRACE R File Number: 2004-00070 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/08/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, fA /y,~~ _.f'>,.~,,"~.:'! ,: . '~".rl/:"'P'i"' / ." .._,.:i ',' " ,_~!. !~_,.. '" .' ~".~..... ~-",' . ...,..,..~ ,.' .._~ -- , GLENDA FARNER STR~SBAUGH REGISTER OF WILLS cc: File Counsel Judge ~~ Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/06/2005 RENARD WINIFRED 942 MOUNTAIN DRIVE DILLSBURG, PA 17019 RE: Estate of ORWAN GRACE R File Number: 2004-00070 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/08/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, A v~ . I ?~};.,-';I;,; f I . ~..z.. \v'.,""'C.".'-' .' .. GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge V~ IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF GRACE R ORWAN NO. 21-04-00070 DECEASED 1/8/04 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of death: Grace R Orwan January 8. 2004 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes _x_ No 2. If the answer is No, state when the 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 formal 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 -L No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and attached hereto. Da~: ~. .!irJ. ~(J? ,: , w.~~~.~P~ Signature: . .-.- I Name: Address: Winifred R Renard 942 S Mountain Road Dillsbur9. PA 17019 ,-.,--- Telephone: Capacity: 717/249-5321 Personal Representative ~t