Loading...
HomeMy WebLinkAbout04-0160PETITION FOR PROBATE & GRANT OF LETTERS Estate of Donald R. Seibert also known as N/A , deceased. Social Security No. 579-26-3066 No. 21-04- /~) Register of Wills for the County of Cumberland Comrnonwea/th of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who is 18 years of age or older and the Executor named in the Last Will of the above decedent dated 9/1/1987 , and codicils dated N/A . The Executor named Henrietta B. Seibert died 11/15/1998 · Renunciations for ..N/A attached hereto. Charles Leonard Seibert successor Executor as named in said Will. ~ Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 35 Wilson Street, Carlisle, PA 17013 Decedent, then 81 years of age, died December 9 , 2003 , at 9:59 PM Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A Decedent at death owned prope~y with estimated values as follows: (If domiciled in PA) .... All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: $~2,000.00 $. $., $ WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. Signature~ and Residenqe(s) of Petition~er(s): Charles L. Seibed 240 Harvest Drive, Carlisle, PA 17013 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 18th day of ..February, 2004. No. 21-04-/~ Estate of Donald R. Seibert , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, /~r-~z"d. /9 , 2004, in consideration of the Petition on the reverse side hereof, satisfactory proof having been'presented before me, IT IS DECREED that the instrument(s) dated _September. 1, 1987 ,described therein be admitted to probate and filed of record as the Last Will of Donald R. Seibert and Letters testamentary are hereby granted to Charles Leonard Seibert FEES 11..5;. ~ Probate, Letters, Etc ........ $ ~ Short Certificates(3 ) .... $. 9.00 Renunciation(s) ........... $ 0.00 JCP .................... $. 10.00 Other .... $ 9.00 TOTAL: .... $-z~LzS;l~. .-... Filed..~.-. ! .~ .--.O..'¢. ........ ~..~L~.-.c~  H~,,~S, & FISHMAN, P.C. / (~~ ughes, Esquir~ "- ! g5 Ale)c(nder Spring Rd, Ste 3, Carlisle, PA 17013  ,,,,.,,,/' ADDRESS 717-249-6333 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l~ocal 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 P 9898716 No. Cumberland COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECOROS CERTIFICATE OF DEATH ~rlxsle ~m. ,.~rl~sle ~onal ~1 ~ter ~'~.~"~-~- ~,. ~ite KIND O¢ 8LI$1NE SS/INDUSTRY WAS OECE D~NT EVER IN OECEDENT'S E OUCATION (G,*.~ ka'~l Ot .,~'~ oone ~%e er,~er I ........ I U S. ARMEO FOflCES? ,,~ Profes~r/~ch I . D~c~n~n ~] ]~1,,. I,,. I - ~c~'s u~ A~ ~. c~. ~. z~ c~, ~CE~NT'S ' Pa 35 Wil~n Strut ,~ ,,. ~rlisle, PA 17013 ~'~ ~' I,,. ~le . Sei~ ~i~im - Rec~ ~. Charles C. Se~m ~ 240 Ha~s~ D~im, ~11sle, ~A 17013 ,~ ~ O,,,. 12/12/2003 b~rl~d Valley ~. Grdsk,,./ ~rlisle, PA 17013 F~/~~ (/ ~~ [,,,. FD 012633 L ~inq Brothers ~eral H~, ~rlisle, PA 17013  n ~, I~. M. I~, I~, °Ml~ DIC&L EXA MINER/CORON£FI ( le¢~ ;~7) TYPe °+' PNnl ~.f; F 2~ .... · ....................................... 0 ,,. /,4 t .rF~:,'~ r, ,la,q- LAST WILL AND TESTAMENT OF DONALD R. SEIBERT I, DONALD R. SEIBERT, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make and declare this to be my Last Will and Testament, and I do hereby revoke and make null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administration expenses, and inheritance and estate taxes incurred on account of my death shall be paid by my personal representative out of my residuary estate as soon after my death as practicable. I authorize my personal representative to cause title to or ownership of the cemetery lot now owned by me at Cumberland Valley Memorial Gardens to be vested in such person as my personal representative shall designate. ITEM II. I give, devise and bequeath all of the residue of my estate of every nature and wherever situate to my wife, HENRIETTA B. SEIBERT, if she survives me by thirty (30) days. Should HENRIETTA B. SEIBERT not be living on the thirty-first day after my death, I give, devise and bequeath all of my estate of every nature and wherever situate to be divided equally among my children, per stirpes. Should any of my three children fail to survive HENRIETTA B. SEIBERT by thirty days, I give, devise and bequeath that child's per stirpes share of my estate to his/her children per stirpes. ITEM III. I appoint HENRIETTA B. SEIBERT as Executrix of this my Last Will and Testament. In the event of the refusal or inability of said Appointee to serve or continue to serve as my Executrix, I nominate and appoint CHARLES LEONARD SEIBERT as my Successor Executor. ITEM IV. I direct that my Executrix and Successor Executor shall not be required to give bond or post any other security for the faithful performance of their duties in any jurisdiction. ITEM V. My Executrix and Successor Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: (a) To retain any or all of the assets of my estate, real or personal, in their sole discretion. (b) To sell at public or private sale, to exchange or lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms as they deem proper. (c) To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. ITEM VI. If at any time any minor child shall be entitled to receive any assets hereunder, FARMERS TRUST 2 COMPANY, of Carlisle, Pennsylvania, shall act as Guardian of the assets payable to such child. Said Guardian may receive and administer all assets authorized by law and shall have full authority to use such assets, both principal and income, in any manner said Guardian shall deem advisable for the best interests of such child, including college, university, post-graduate or other education, without securing court order. Said Guardian shall have all the rights and privileges as to the Guardianship(s) and the assets thereof as are herein granted to my Executrix and Successor Executor as to my Estate and the assets therein. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) type-written pages, this /,j/ day of~?~~_C_ 1987. ~! DONALD R. SEIBERT We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof the said Testator, DONALD R. SEIBERT, was of sound and disposing mind and memory. JMS006/E COMMONWEALTH OF PENNSYLVANIA : COUNTY OF~P~N- : ss.: We, the Testator, DONALD R. SEIBERT, and PA~ ~.~6~/~T and ~.~. ~~c~T , the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~DONALD R. SEIBE~T Witness~_~, . Subscribed, sworn to and acknowledged before me by the Testator, DONALD R. SEIBERT, and subscribed and sworn to before me by ay~A ~. ~F~9~and ~.J'. ~z~/7- , witnesses, this /$~' of ~~~ , 1987. ! Notary Public (SEAL) My Commission Expires: LEE S. S,'. ?C~iTO, ?,!atar¥ Publi~ I-larrLq_~ur~, D~upi~in Count~, Pa. N~y Commission ~pires July 30, 199~t 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 003649 HUGHES JAMES D 60 WEST POMFRET STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN'. 579-26-3066 FILE NUMBER: 2104-01 60 DECEDENT NAME: SEIBERT DONALD R DATE OF PAYMENT: 03/08/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,500.00 iREMARKS: SEAL ' JAMES HUGHES, ESQ CHECK# 3022 TOTAL AMOUNT PAID: ~ 1,500.00 INITIALS' AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: DONALD R. SEIBERT DECEMBER 9, 2003 21-04-0160 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February l9, 2004 . Name Donald A. Seibert Charles L. Seibert Address 621 North 26th Street, Allentown, PA 18104 240 Harvest Drive, Carlisle, PA 17013 Rebecca A. Thumma 250 Candlelite Drive, Carlisle, PA 17013 Notice has now been given to all persons enti~pt __ Date: 04/01/04 e James D. Hughes, Esquire Address 95 Alexander Spring Road, Suite 3 none . Carlisle. PA 17013 Telephone (717) 249-2353 Capacity: __ Personal Representative __ Counsel for Personal Representative REVo1500 E~ (6-00) ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFJC~N. USE ONLY FILE NUMBER -- 21-04-0160 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z~ Seibert Donald R 579-26-3066 U.I DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE UJ 12/9/2003 I 1/31/1922 REGISTER OF WILLS III (IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ i L.X_J 1. Odginal Return I I 2. Supplemental Return ,,-<~ I r---~ (j ~' I I I 4. Limited Estate r-~ 4a. Future Interest Compromise (date of death after 12-12-82) UJ ~'~ ~OO F~q , ~ ~ L~J 6. Decedent Died Testate (Attach copy of Will) r~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~ Q.~ z uJ C~ z 0 O --'-]9. Litigation Proceeds Received Z NAME James D. Hughes, Esquire ~-"-'~ 3. Remainder Return (date of death pdor to 12-13-82) ~---'"] 5. Federal Estate Tax Return Required 0~ 8. Total Number of Safe Deposit Boxes ~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [~ I 1. Election to tax under Sec. 9113(A) (Attach Sch O) FIRM NAME (If Applicable) SALZMANN HUGHES & FISHMAN PC COMPLETE MAILING ADDRESS 95 Alexander Spring Road, Carlisle, PA 17013 ~LEPHONE NUMBER 717-249-6333 0 0 0 0 64,799 0 129,900 (8) 6,087 392 (11) (12) (13) (14) 1. Real Estate (Schedule A) 2. (1) Stocks and Bonds (Schedule B) (2) 3. Closely Held Cerporation, Partnership or Sole-Prepdetorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. J~ Owned Property (Schedule F) (6) !.__J Separate Billing Requested 7.Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (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 to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES Suite 3 OFFICIO. U~E ONLY r 194,699 6,479 188,220 0 188,220 1 5. Amount of Line 1 4 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 1 6. Amount of Line 14 taxable at lineal rate 1 7. Amount of Line 14 taxable at sibling rate 18. Amount of Line 1 4 taxable at collateral rate 19. Tax Due 20. 0 x.0 0 (15) 188,220 x.0 45 (16) 0 x .12 (17) 0 x .15 (18) (19) 0 8,470 0 0 8,470 3W4645 1.000 Decedent's Complete Address: S3REET ADDRESS 35 Wilson Street Cl~ Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1~500 79 Interest/Penalty if applicable D. Interest E. Penalty ISTATE (1) tZIP 17013- 8,470 0 0 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 1~579 0 0 6,891 0 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the taxdue. (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 6 ~ 891 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... r-~ [] b. retain the right to designate who shall use the property transferred or its income; ......... ~] [] c. retain a reversionary interest; or ................................ [--"] E~ d. receive the promise for life of either payments, benefits or care? ................. r~ r-~ 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 security at his or her death? ~ [] 4. Did decedent own an Individual Retirement Account, annuity, Dr other non-probate property which contains a beneficiary designation? ................................ ~ [] 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, I declare that I have examine~ this ratum, including accompanying s~edulas and statements, and to the best of my knowtsdge and belief, it is tree, ~.,rr~[ and complete. Declaration of preparer other than the personal representative is based en all information of which preparer has any knovdedge. DATE 240 Drive Carlisle, PA NTATIVE Spring Road, Suite 3 Carlisle, PA 17013 17013 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% '.S. § 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exem pt 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 im posed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. §9116(a)(1 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPER'fY ESTATE OF FILE NUMBER Donald R. Seibert 21-04-0160 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 1991 Buick, sedan M&T Bank, checking account #435910 Miscellaneous personal property (sold) TIAA-CREF receivable from predeceased spouse, Henrietta B. Seibert 6,195 45,743 1,333 11,528 64,79q TOTAL (Also enter on line 5, Recapitulation) $ 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMON~VEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Donald R. Seibert 21-04-0160 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCtLI~ TI'E N~MEOF TF~TRANS,=EREE. THEIR RELATiONS~-Ip TO DECEDEhFF AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBEF TI-E DATE O~= TRANSFER. ATTACH A COPY OF T~-~ DEED FO R REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. 35 Wilson Street, Carlisle Borough, C,,mherland County - RETAINED LIFE ESTATE 129,900 100.000 0 129,900 TOTAL (Also enter on line 7, Recapitulation) $ 12 9,900 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 ,EX + (12-99) , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Donald R. Seibert FILE NUMBER 21-04-0160 Debts of decedent must be reported on Schedule I. ri'EM NUMBER DESCRIPTION A. 1. Bo 5. 6. 7. 2 FUNERAL EXPENSES: Ewing Brothers Funeral Home First Lutheran Church ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Brickers Auction, commission C,,mBerland Law Journal TOTAL (Also enter on line 9, Recapitulation) AMOUNT 13 123 5,300 143 433 75 $ 6,087 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald R. Seibert 21-04-0160 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Andorra Radiology Central Penn Medical Group United Church of Christ Homes nursing TOTAL (Also enter on line 10, Recapitulation) $ VALUE AT DATE OF DEATH 194 28 170 39? 3W46AH 1.000 (If more space is needed, insert additional sheets of the same size) REV-151 ;~ EX+ (9-00)' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Donald R. Seibert NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I 2 TAXABLEDISTRIBUTIONS[includeoutrights~usaldistributions, andt~ns~rs underSec. 9116(a)(l.2)] Charles L. Seibert 240 Harvest Drive Carlisle, PA 17013 Donald A. Seibert 621 North 26th Street Allentown, PA 18104 Rebecca A. Th,,mma 250 Candelite Drive Carlisle, PA 17013 FILE NUMBER 21-04-0160 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Son Son Daughter one-third one-third one-third ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUG H 18, 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 II - ENTER TOTAL NON-TAXARLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 3W46AI 1.000 (if more space is needed, i~$e~[ additional sheets of the same size) LAST WILL AND TESTAMENT OF DONALD R. SEIBERT I, DONALD R. SEIBERT, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make and declare this to be my Last Will and Testament, and I do hereby revoke and make null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administration expenses, and inheritance and estate taxes incurred on account of my death shall be paid by my personal representative out of my residuary estate as soon after my death as practicable. I authorize my personal representative to cause title to or ownership of the cemetery lot now owned by me at Cumberland Valley Memorial Gardens to be vested in such person as my personal representative shall designate. ITEM II. I give, devise and bequeath all of the residue of my estate of every nature and wherever situate to my wife, HENRIETTA B. SEIBERT, if she survives me by thirty (30) days. Should HENRIETTA B. SEIBERT not be living on the thirty-first day after my death, I give, devise and bequeath all of my estate of every nature and wherever situate to be divided equally among my children, per stirpes. Should any of my three children fail to survive HENRIETTA B. SEIBERT by thirty days, I give, devise and bequeath that child's per stirpes share of my estate to his/her children per stirpes. ITEM III. I appoint HENRIETTA B. SEIBERT as Executrix of this my Last Will and Testament. In the event of the refusal or inability of said Appointee to serve or continue to serve as my Executrix, I nominate and appoint CHARLES LEONARD SEIBERT as my Successor Executor. ITEM IV. I direct that my Executrix and Successor Executor shall not be required to give bond or post any other security for the faithful performance of their duties in any jurisdiction. ITEM V. My Executrix and Successor Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: (a) To retain any or all of the assets of my estate, real or personal, in their sole discretion. (b) To sell at public or private sale, to exchange or lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms as they deem proper. (c) To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. ITEM VI. If at any time any minor child shall be entitled to receive any assets hereunder, FARMERS TRUST COMPANY, of Carlisle, Pennsylvania, shall act as Guardian of the assets payable to such child. Said Guardian may receive and administer all assets authorized by law and shall have full authority to use such assets, both principal and income, in any manner said Guardian shall deem advisable for the best interests of such child, including college, university, post-graduate or other education, without securing court order. Said Guardian shall have all the rights and privileges as to the Guardianship(s) and the assets thereof as are herein granted to my Executrix and Successor Executor as to my Estate and the assets therein. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) type-written pages, this ; .'~ / day of 1987. DONALD R. SEIBERT We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof the said Testator, DONALD R. SEIBERT, was of sound and disposing mind and memory. residing at , ::, _ . / residing at '~ "' ~ JMS006/E COMMONWEALTH OF PENNSYLVANIA : COUNTY OF ~hASk~HT-N- : ss.: We, the Testator, DONALD R. SEIBERT, and and ~).~7'. ~~ , the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound, mind and under no constraint or undue influence. Witness: Subscribed, sworn to and acknowledged before me by the Testator, DONALD R. SEIBERT, and subscribed and sworn to before me by ~ ~. ~~w~and ~).~-.~~ , witnesses, this /~.? day of ~_~_~./~,~ _, 1987. ! Notary Public (SEAL) My Commission Expires: , ~'- % -, .~ :.~ i::'! C, ~'~'"" ~.u','~!i~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Salzmann, Hughes & Fishman, P. C. Attorneys At Law 95 Alexander Spring Road, Suite 3 Carlisle, PA 17013 Phone (888) 5024349 Fax (302) 934-2955 March 4, 2004 Re; Estate of Donald R. Seibert Social SecuriW: 5 79-26-3066 Date of Death: December 9, 2003 Dear Mr. Hughes: Per your inquiry dated February 10, 2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o]) Opening Date Balance on Date of Death Accrued Interest Total Checking Account 435910 Donald R Seibert Henrietta B Seibert Charles L Seibert, POA 09/01/67 $45,742.98 $ 0.00 $45,742.98 Please be advised there was no safe deposit box found for the above decedent. For further account information, closures and/or reimbursement of funds please call the High Street Carlisle Office # 717-240-4536. Sincerely, Records Management BRICKERS AUCTION Complete Auction Service Auction - Wednesday Evenings 766-5785 Chuck Bricker, Auctioneer TOTAL SALE COMM. ,~,"~ ~ --, .. -- CLEAR. he IINSURANCE May12,2004 CHARLES LEONARD SE[BERT ADMINISTRATOR FOR THE ESTATE OF DONALD R SEIBERT, DECEASED 240 HARVEST DR CARLISLE PA 17013 RE,' Deceased: Claim Number: Group Policy No.: Policyholder: Henrietta B. Seibert B03018 131981 Dickinson College Dear Mr. Seibert: We have recently completed our review of this claim. We are pleased to provide the enclosed benefits: BASIC LIFE: $ 11,527.50 You inquired in your letter to us dated May 10, 2004, as to whether or not your father, Donald Seibert, was eligible for life insurance from TIAA-CREF. There is not coverage under this policy as it was terminated in 1986, and your father was not covered under a Waiver of Premium claim as your mother had been covered. The Benefits Office at Dickinson College may be able to provide you with eligibility information for your father under their current group life insurance carrier. We believe you will find the enclosed in order and hope this claim has been handled to your satisfaction. Please let us know if you have any questions, or if we can provide any further service. Sincerely, Alicia Perkins Lehrle Life Benefits Analyst The Standard (800) 348-3226 ext. 8605 Standard Insurance Company 900 SW Fifth Avenue Portland OR 97204-1935 503.321.7000 Tel · Oi . 5nbenture day of ~P-- ~ ~ bq the year of our Lord one d~ouaa~d nine hundred and ..' (l 9 8 ? I ~1~11~1~I~1~ DONALD R, $~-ZBERT and HENRIETTA n. S~IB~RT,' his wife',., of the Borough of Carlisle, Cumberland County, Penn~ylvan£a (hereinaftercalledtheOrant0rd, oftheonepart, and CHARLES L. $~IBERT, of Carlisle, Pennsylvania, ~ONA~D ALAN B~IB~RT, of Allentowa, Pennsylvania, and R£BECCA A. THUMMA, of Carlisle, ' Pennsylvania, a~ equal tenants in common thereinalter called the Orsntee~ I, o! the other part. ' ' for and One and 00/~00 ~.00} ................. 4awful money of ~e United S~tee of Amain, ~to them well and ~uly paid by the said Grantee at or ~[ore the ~aling and delive~ beryl ~e r~eipt wher~ ia hereby ae~owledged, have ~ant~, bargain~ ~d mid, released and eonflm~, and by these presents ~o 8runt, b~rgaM and ~11, releaae and ~nr~m ~to the ~id Gr~te~ ~heir here and a~eigne, ALL THAT CERTAIN tract of 'land with the 'improvements thereon erected 0ituate in the Third W~rd of the Borough of Carlisle, Cumberland County, Pennsylvania, more particulagly bounded ~n~ deocribed ~$ follows~ . BEGINNING at a point'on the Eastern building line of Wilson Street, said point being a~ the northern lin~' of lo~ of ground now or formerly of Irvin E. Minn/c~ and Betty J. Ninnich, his wife, and s~id point al~o being at the northern line of Lot on the hereinafter.mentioned plan of lots; thence North along the line of said WilsOn Street a distance of 55 feet to a Point 15 feet'North of the Southern line of lot %229; thence in a straight line EaSt 120 feet to a 16 foot alley running North'aad SOuth; thence along the line of said alley a distance of 55 feet to the Northern line of the lot now or formerly of the Minnich'e aforesaid; thence West along the Mlnn~ch line 120 feet to ~he Pla~e of BEGINNING. BEING Lot No. 230 and the. Southern 15 feet of Lot No. 229 on'the Plan of Lot~ of Mooreland L~nd Company aa the same are recorded in the Office of the Recorder of Deeds in and for Cumberland County~ in Plan Book 1, Page 61. Subject to the restrictions as recorded with said plan. BE~G the same tract of Land vh$ch Bartolomeo D'Agos~no and Ka~h~yn M. D'.Agoetino, hie w£Ee, by the$~ deed ~S?, and reco=~ed Sn t~e O~ce o~ ~e Beco=~er Cumbe~$and County, ~enn~ySvan$~, £n Dee~ Boo~ "X", Vo$~e ~?, ~OCO~d. ' UNDER AND SUSuTECT~ aLsO, nevertheLees',~o a' certain reservation and use in the aEorement,£oned p~emtses, which the aa'id Grantors do herebZ reserve ~o and for ~he benefi~ of Donild Seiber~, one of ~he Grantors herein~ in ~he nat=rs ~ee~rv~tion o~ the righ~ for ~nald'a. Seibert to uee, en~oy, and o~cupy and to live in the dvelZing houee on the premieea~ vhich uae 8ha~l cease, end ~erm~nate ~ he eha~l vacate the pre~sea a cofit, inuoue .~eriod of one (~) year or die~ and after such an even: and ~ermination sha~l oceur~ thio reaervatiofl eha~l longer be o~ e~ect oF HL:D - i UNIFORM SETTLEMENT STATEMENT OMB :kpproval No. 2502-0265 A. US. DEPAR'TMENT OF ROUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. 6. File Number: TYPE OF LOAN -'- I. FHA 3. X Con','. Unins. 4. VA 2. FmHA 5. Conv. Ins. 7. Loan Number: 61745297 8. Mortgage Insurance Case Number C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items rnarked "(p.o.c.)" ,.,,ere paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = Taxpayer's Identification Number D. NAME AND ADDRESS OF BORROWER: Georgia L. Burton 541 W. Penn Stree~ Carlisle, PA 17013 G. PROPERTY LOCATION: 35 Wilson SEreet Carlisle, PA 17013 E. NAME, ADDRESS AND T~ OFSELLER: Charles L. Seibert, Donald A. Seibert, Rebecca A. Thumma Carlisle, PA 17013 F. N~ME ~NDADDRESSOFLENDER: CountryWide Home Loan 4830 Carlisle Pike Mechanicsburg, PA 17055 H. SETTLEMENT AGENT NAME. ADDRESS AND TIN Jacqueline M. Verney, Esquire 44 South Hanover Street, Carlisle,, PA 17013 PLACE OFSETTLEMENT II. SETTLEMENT DATE B-H Agency 163 N Hanover StreetI 04/14/2004 Carlisle, PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS ,AMOUNT DUE TO SELLER: I 01. Contract sales price 129,900.00 401. Contract sales price 129r 900.00 IO2 Personal property 402. Personal property IO3 Settlement charges to borrower (Line 141)0} 3,4 13.91 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid bv seller in advance 106. CitT/town taxes 406. City/town taxes 107. County taxes 407. County taxes 108. Assessments 408. Assessments IO9. 409. 110. School Tax 04/14/04-06/30/04 244.07 410. School Tax 04/14/04-06/30/04 244.07 Ill. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BOR ROWER 13 3,5 5 7.9 8 420. GROSS AMOUNT DUE TO SELLER 13 0, 14 4.07 200. AMOI.!NTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS/N AMOU~xrT DUE TO SELLER: 201. Deposit or earnest money 1,000.00 50!. Excess&posit 202. Principal amount of new loan(s) 103,920.00 502. Settlement charges to seller (Line 1400} 11,284.02 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subiect to 204. 504 Payoff of first mortgage loan 205. 505. Payoffofsecond mortga,,e loan 206. 506. 207. 507. 208. 508. 209. 509. Adiustments for items unpaid by seller Adjustments for items unpaid by seller 210 Cia'/town taxes 510. City/town taxes 211. County taxes 01/01/2004-04/14/2004 153.84 511. County taxes 01/01/2004-04/14/2004 153.84 212. Assessments 512. Assessments .213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519 220. TOTAL PAID BY/FOR BORROWER 1 0 5, 0 7 3.8 4 520. TOTAL REDUCTION AMOUNT DUE SELLER 1 1, 4 3 7. $ 6 300. CASH AT SETTLEMENT FROM/TO BORROXVER 600. CASH AT SETTLEMENT FROM/TO SELLER 602. Less reduction in amount due seller (Line 520) 301. Gross amount due from borrower (Line t201 I 133,557.98 601. Gross amount due to seller (Line 420) 130,144.07 302. Less amount paid by/for borrower eLine 220'1 [ 1 0 5 t 0 7 3.8 4 1 1 t 4 3 7.8 6 303. CASH FRON BORROWER 28,484.14 603. CASH TO SELLER 118,706.21 SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty, or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, 1 certify that the number shown on this statement is my correct taxpayer identification re, tuber. (Seller's Signature) Charles L. Seibert, Donald A. (SellefsSignature) Seibert, Rebecca A. Thumma ~ BAS Y SOFT, [nc. 2001 Previous editions are obsolete Page I form H UD-I 0/86) ref Handbook 4305.2 L. SETTLEMENT CHARGES [700. TOTAL SALESIBROKER's COMM1SSION based on price $ 129, 900.00 @ 6.000% P.~JDFKOM PAIDFROM Division of Commission (line 700) as fi~llows: BORROWER'S SELLER'S 701 53,922.00 to Coldwell Banker HSG FUNDSAT FUNDSAT 702.$ 3t872.00 to B-H Aqencv SETTLEMENT SETTLEMENT 703. Commission paid at Settlement 7 I 704. Coldwell Banker HSG transaction fee 195.00 800. ITEMS PAYABLE IN' CONNECTION WITH LOAN 801 Loan Origination Fee S . 802 Loan Discount S 803. Appraisal Fee to Cenr. ral Penn AD~raisals-S275 (POC-$300.00} -25.00 804. Credit report to CYS (POC S35.001 805. Lender's Inspection Fee 806 Flood Check to Landsafe Flood 25.00 807. Tax Service Fee to Countrywide tax service 90.00 808 Document_ PreD to Ccuntrvwide 400.00 got). 811. 812. 813. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. [nterest from 04/14/2004-04/30/2004 @ $17.440 per day 296.48 902. Mortgage Insurance Premium for 903. Hazard insurance Premium for 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance 3 month(sl @ $31.17 Der month 93.51 1002 Mortgage insurance 1003. City Property Taxes 1004. CountvPropertvTaxes 4 mont:h(s) @ $44.56 per month 178.24 1005. Annual assessments 1006. school tax 12 month(s) @ S97.68 ~er month 1,172.16 1007. 1008. Aggregate Acc@until@_ Adjustment -2 71.7 5 ! 100. TITLE CHARGES I I01. Settlement or closing fee to Jacqueline M. Verney, Esquire , 172.16 327.84 1102. Abstract or title search to Karen Coon 1 12.00 1103. Title Examination to 1104. Title insurance binder to 1105. Document preparation to 1106. NotaryfeestoValerie Gsell !0.00 1107. Attorney's fees to James Huqhes ( (includes line numbers: ~: /:¢ 108. Title lnsurance to Penn A~tornevs Title Co. 350.00 (includes line numbers: end 100~ 300, 8.1 CPL 109. Lender's coverage S 12 9 9 0 0.0 0 110. Owner's coverage $ 12 9 9 0 0.0 0, IlIl. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $ 4 0.0 0 Mortgage $ 64.5 0 Release $ 104 . 5 0 1202. Citylcntytax/stamps: Deeds lt299.00 Mortgao, e $ lt299.00 1203. State tax/stamps: Deed $ 1,2 9 9.0 0 Mortgage $ 1 t 2 9 9.0 0 1204. 1205. i$00. ADDITIONAL SETTLE,MENT CHARGES 1301. Survey to 1302. Pest inspection to ( POC} 1303. Carlisle Boro water 21.02 1304. AHS Warranty 475.00 1305. Darlene Mover tax collector 534.77 1306. JN Verney, Esquire overniqht mail and wire fee 45.00 '/..0?LT_O..T?L... ~S.E. TTLEMENT CHARG/:S (e',ter on 'i"es m~, Sectio" J and 50Z, Section K} 3,413.91 11,204.02 CERTIFJ~,~,YION: I have.zffrefully reviewer: HUD-I Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement oral receipts and disbuD'~jg~fs made o~ account or ~me in ~his transaction.- I fu~her ceai~ that l received a copy of~UD- 1~ SeRlement Statement Seller ~ Charl~ L/ Seibergyc9 C¢~.~[,&~i~ower ~ '%;~oia L. Burton The HuD-I SeRlement Statement which I have prepared is a true and accurate account of the hnds disbumed or to be disbursed b~th~'~nder~igned ~ pan of the settlement of '' ' n~e N. ve~ 04 2004 S~eme~gent gacqueli y, Esquire Date W~O: It is a crime to knowingly make false state~nts to the United States on this or any other similar fo~. Penalties upon conviction can includ~ a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. EASY SOFT, Inc. 2001 Previous editions are obsolete Page 2 l%rm HUD-I (3186) ref Handbook 4305.2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Charles L. Seibert being duly _swo:L~ according fo law, deposes and says that he is the Executor of +he Estate of Donald R. S~3hert [ate of Ca~l~_s~.e_.~B°r°~gh .... , Cumberland County, Pa., deceased and that the within is an inventory made by h:Lm , the said ]~eoutor of the enHre estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sw~ '~ and subscribed before me, Ja~queline L D~ugh, Nomu Public ~dis~ B~t Cum~nd ~n~ My ~m~i~ ~g. 14, 2~7 Date of Death~m~r'penns~aa~a~ ~~~les ~,. ExeCutor - Admini'stretor Seibert 240 Harvest Drive Carlisle, PA 17013 Address 2003 Day Month INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed wlfh~n thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949., ~ 0 z< ~" Z 0 c3 ~ u3 Z Inventory of the real and personal estate of DONkLD R. SEIBERT deceased M&T Bank, checking account 1991 Buick autc~obile Miscellaneous personal pro~c~_rty TIAA-CREF, receivable frcm predeceased spouse TOTAL: $45,743. 6,195 1,333 11,528 $64,799~ O0 O0 O0 O0 O0 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 004114 HUGHES JAMES D 95 ALEXANDER SPRING RD SUITE 3 CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 579-26-3066 FILE NUMBER: 2104-0160 DECEDENT NAME: SEIBERT DONALD R DATE OF PAYMENT: 07/02/2004 POSTMARK DATE: 07/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,891.00 TOTAL AMOUNT PAID: $6,891.00 REMARKS: SALZMANN HUGHES & FISHMAN SEAL CHECK# 03076 INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: DONALD R. SEIBERT Date of Death: December 9, 2003 No. 21-04-0160 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: X Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No Date: d. Copies of receipts, releases, joinders and a/pprovals of formal or informal accounts may be filed with the Clefl( oj/Orphan's Court and may be attachedto this r~7,~oyh~,,~~ 10/01/2004 / /~' ~ ~']~,.._.~ .. \ SALZ1VJ/ANN, HUGHES & FISHMAN PC :- ~, Jam/D. Hughes, Esquire ~..~ Na~(please type or print) ~95 Alexander Spring Road, Suite 3 Address Carlisle, PA 17013 ' City, State, Zip ~ ~::~: (717) 249-6333 - -, ,< Telephone Number Capacity: X Personal Representative Counsel for Personal Representative BUREAU OF TNDTVTDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. Z&060! HARRTSBURG, PA 17128-060! JANES D HUGHES ESQ SALZHANN ETAL 95 ALEXANDER SPG RD 5 CARLISLE PA 17015 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-1547 EX AFP (01-0S) DATE 08-50-2004 ESTATE OF SEIB~RT DATE OF DEATH FILE NUMBER COUNTY C~BERLAN~ ACN Amo~ DONALD :L ~'~_ HAKE CHECK PAYA~LtE ?AND ITENZT PAypENT TO: REGISTER OF ~i:ELS ~ .... CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SEIBERT DONALD R FZLE NO. 21 04-0160 ACN 101 DATE 08-50-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE ZNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks end Bonds (Schedule B) (2) $. Closely Held S~cock/Per~cnarship Tn~eres~ (Schedule C) ($) q. Hot,gages/No,es Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa'cs APPROVED DEDUCTTONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Dab~s/Hor~gage Liabilities/Liens (Schedule I) (10) 11. To,al Deduc~ ions 12. Na~ Value of Tax Ra~urn 64~799.00 .00 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 subei~ ~he upper portion .00 of ~his form wi~h your tax payment. 129~900.00 (8) 6,087.00 592.00 13. Ii. NOTE: 194,699.00 (11) ~ .~79. Off (l~) 188,220.00 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq) zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 188,220. O0 18 and 19 will TOTAL TAX CREDIT [ 8,469.95 BALANCE OF TAX DUEl .05 INTEREST AND PEN. .00 TOTAL DUE .05 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ~S RE~U~RED. ZF TOTAL DUE ~S REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE~/D~... A REFUND. SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTZDNS.) ~ ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 1,500.00 6,891.00 ASSESSNENT OF TAX: 15. kmoun'l: of Line 1~ a~ Spousal ra~e 16. Amoun~ of Line 1~ ~axabla e~ Lineal/Class A ra~e 17. Amoun~ of Line lq a~ Sibling ra~e 18. Aeoun~ of Line 1~ ~axabla a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYNENT RECEx~' I DISCOUNT (+) DATE NUHBER TNTEREST/PEN PATD (-) 05-08-2004 CD00~649 78.95 07-02-2004 CD004114 ~ . O0 ANOUNT PAZD (is) .00 x O0 = .00 (16) 188,220.00 x 045= 8,470.00 (17) .00 x 1Z = .00 (~8) .00 x 15 = .00 (19)= 8,470.00 RESERVATION: Estates of decedents dying on or before December 1Z) 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Comaonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: D/SCOUNT: PENALTY: INTEREST: To ~ulfi11 the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed 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 are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for fores ordering: 1-800-362-2050; services for taxpayers ~ith special hearing and / or speaking needs: 1-BOO-qq7-3OZO (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sho~n on this Notice must object eithin sixty (60) days of receipt of this Notice by: --erittan protest to the PA Department of Revenue, Board of Appeals, Dept. Z81621, Harrisburg, PA 171ZS-lOZ1, 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 ~riting to: PA Departd~ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17128-0601 Phone (717) 787-650S. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. [f any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allo.ed. The 1SI 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 eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z mill bear interest at a rate ehich mill vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 1988-1991 llX .OOO$O1 ~ 9Z .O002q? 1983 16Z .000q38 1992 9Z .0002q7 ZOOZ 6Z .00016q 198~ XXZ .O003Ol 1993-199~ 7Z .OOOlgZ 2003 5Z .000137 1985 13X .000356 1995-199B 9Z .O00Z~7 ZOOq ~Z .000110 1986 lOX .O0027~ 1999 72 .O00lgZ 1987 IOZ .O0027~ ZOO0 7Z .O0019Z --Interest 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 mill reflect an interest calculation to fifteen (1S) 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.