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Home My WebLink About03-1023 PETITION FOR PROBATE and GRANT OF LETTERS Estate of CL I i ~ n E-rl..f t4,,~ V No. r;:J 1- CJ.3 - I()~ also known as I To: Register of Wills for the , Deceased. County of G\i',."J}~""J~ in the Social Security No. 17~-''''''- .;? ) I.J, 0 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: . y our peti~ioner(s), who is/are 18 years of age or ~der 6n the execut ~(V) t..S G OJ~amed In the last will of the above decedent, dated SIP, NY' fA. J ~ . ,5) , 19_ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C \i ,." -'\t,ot, L."C}-t" {) County, Pennsylvania, with h f..c.... last' family or prin~al residence at MI-I-?" ct:.. C""~ C N,J R Sf j ~. rto'?1 t' c;;;o /01., 1..'- LJ;.~ /).:Jv ~Kf'j .;>',Rff'j C..or~ 1-lILt Pr-t I)() (list street, number and muncipality) Decendent, then If b years of age, died ~.J J ~1;)..J- ~ .2~" J, at ~lv/...'f .sPf~ II r4J sP I '7~ l 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: Decendent at death owned property with estimated values as follows: 7, linO. o-:j (If domiciled in Pa.) All personal property $ ,- (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: !\l f/:\ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c. La.; administration d.b.n.c.La.) theron. hd'~~ J G A LC:r D/f. j OS~\J.. J.. S \') vjJd- 13~ }.-ffi t./'tN. ..;:)A I V L C':$'O v .. 3~ ~.~.5 ..PA I )3tCf O<+. :;0 .. <::: t>I) CiS OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ss COUNTY OF ___ J 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 'Lhe knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will wIland truly administer the estate according to law. affirmed and en //7?V ~. :::! l:l ..... s::: ~ ~ No. c:J/-L1S- /0t:03 Estate of U/ Z/96f!L7.N ~..e/-=: V , Deceased / DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~..c~heoC-/ /.,;;v ~~, in consideration of the petition on the reverse side hereof, satisfactory proof having been resented before me, IT IS DECREED that the instrument(s) date I described therein be admitted to probate and filed f record as the last will of ~ ::? A8.c:rh' ;f:;,,~ ;/,.~ , and Letters /;r: 5TA /n#!:.A/~-e t.,/ ./ C:f5ffJ .QrJ are hereby granted to J ~t:.~ /Jy-?2#I~a4 /k'L~ ~~~ FEES Probate, Letters, Etc. ......... $ ~,c>o Short Certificates( ).......... $ C'\.~~ ATTORNEY (Sup. Ct. I.D. No.) i'~~~ t:,.06 nunclatlon ................ $ ~ $ //).00 ADDRESS TOTAL _ ~ no FiI~b~~. .L~l' .0)cQ~.... PHONE .-- DWn c k'i7 ,c.. , 4-Q ---.---..-">'...'" Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/15/2005 OSMAN J GREGORY 2 SOUTH BEN HOGAN DRIVE ETTERS, PA 17319 RE: Estate of EARLEY ELIZABETH File Number: 2003-01023 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: 7/22/2005 Your prompt attention to this matter will be appreciated. Thank You. A:~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge 0. oR H] ()'5,RO'5 R.FV l)/H(} This 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 Srate Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 a~ /?c <1';;;~/7?'- Local Registrar p 9269007 JUL 2 8 2003 No. Date ) 143 Rev, 2/87 COMMONWEALTH OF PENNSYlVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH STATE fILE NUMBER NAME OF DECEDENT (Fir.t. Middle. La.t) SEX SOCIAL SECURITY NUMBER 'L'WB 1. ELizabe.th EaJr.le.y 2. Fe.mai.e. 3. 172 _ 01 - 2760 AGE (last Birthday) AC F 0 ATH h nl - . in. tion HOSPIT[0-' DOAD 0 96 Yr.. Inpatient R..ideACllD ~fy)O 5. aa. COUNTY OF DEATH RACE - American Indian, Black. White. et , 0 CumbVl.R.a.nd (Specify) WhLte. ab. 10. DECEDENTS USUAL OCCUPATION MARITAL STATUS - Maniad. SURVIVING SPOUSE (C:~of~~u~~r Never Married, Widowed. (It wife, gtve maid.n name) Divorced (Specify) . lla. ClVl.i.eai. Wo/[kVl. llbL i. 6 e. IMUltanee. 14.Ne.VVI. Mivr/[i.e.d DECEDENTS MAILING ADDRESS (SIreaI, CilylTown, Stale. Zip Coda) DECEDENTS 17., State PA Did 17<:. 0 Yes. decedent lived in Iwp. . ACTUAl 1700 MaJr.ke.t StJr.e.e.t RESIDENCE decedent (See instructions Cumbeltland live in a 17d.18I ~~h~e~e:~~i~: of Camp Hi.U 16Camp Hi.li, PA 17011 on olher side) 17b. County township? city/boro. FATHER'S NAME (Fir&I, Middle, Last) MOTHER'S NAME (Firsl. Middle. Maiden Surname) . HVl.bVl.t la. lame.J.> W. EaJr.le.y la. CathVl...tne. E. INFORMANTS NAME (TypalPrint) INFO~~TS 'thLl~ ADDRfflS (Slreel. 'iJ~IT""n. SlalYltiode) PA 17319 201. Mit. GIt e. g OJ.>man 20b. Ou ('.n ogan ..tVe., V1.J.>, METHOD OF DISPOSITION PLACE OF DISPOSITION. Name of Cemetery, Crematory lOCATION. CityfTown, State, Zip Code 0 Burial 0 Cremation ~emoval from State 0 orOlherPlace CJc.e.mation Soc.i.e.tJj 06 Donation 0 . 218, Other (Specily) 21c. PA CIte.matoJc. 21d. HaJr.Iti.J.>bwr. , PA 17109 SIGNATURE FUNERAL SERVICE NAME AND ADDRESS OF FACILITY Clte.mati.on SoeIe.tif 06 PA . 221. Comp/ele i1ems 23.0-<: only when certilying physician Is not available at time of death to certify cause of death. Items 24-26 must be completed by person who pronounces death, 27. PART I: Enter th. cU....... Injun.. or complklllion. whIch cau..d the ..th. U.. only on. ,.u.. on .ach line. IMMEDIATE CAUSE (Final C'i, ,.,.. ~ C.-.. ~ -, ,... 7.L.., I.u/~., disease or condition :.. resulting to death)--+ a. . DUE TO (OR AS A CONSEQUENCE OF) .&-~ Ih,..-,;'" Sequentially list condilions r A ... J,."., r<-f._h._ .1..-. >-- if any. leading to immediate DUE TO (OR AS A CONSEQUENCE OF): iJ _ .)~,~... ,,"':.... . cau.e. Enter UNDERLYING c. h. L~"''''_I- f!.>(...-.{ CAUSE (Disease or injury DUE TO (OR AS A CONSEQUENCE OF)' . thai initialed events resulhng 00 dealh ) LAST d. . WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERFORMED? AVAILABLE PRIOR TO (Mon&h, Day, Year) COMPLETION OF CAUSE Natural ~ Homicide D OF DEATH? D D Ye. D No D Accident Pending Investigation Ye. D No 181 Ye.D No~ D D 30a. 30b. M. 30<:. 30d. Suicide Could not be determined PLACE OF INJURY - At home. farm, street, (actory. offICe LOCATION (Street, CityfTown, Stale) building, elc, (Specif~) 2". 28b. 29. 30.. 3Of. CERTIFIER (Check only one) o TITLE OF C~ .~~~:~~ta.,r~~"'~~~.ll;,'lr.~~:\h ~~~~~.r..":: ,': g,e:~a~:~(:i'~::der .r.'x~~a.:'. h:~g,~~~~~.~. d.eal~ ~~ .~~.m.~et~d I~~.~~).................. D 31 b __?- I ~...,~ . LICENSE NUMBER DATE SIGNED (Month, Day. Year) .p~O~~~:;I~IGm~~~;;':;::'~C:o~,~~~::;'~ ~~:~::.".~~r:~;:;'~,d:~~hd~".d'~:::~~~ut~e~i~):~~ ~:~~or.. .,alod......... ..... ....... ~ 31c. 07-1 ~ ~ /.-. 31d. _2;-G~ NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH . .~~~:'<;~~~~~~~~~~~~:'or Invo.lIUollon. In my opinion, doath OCcurrod ., tho lime, doto. and placo. ond duo to the cau.e.(.) and (11e~2~~;::; ~~ '-_ (; a/)#' p v....J ........P . 310mennor.. .~ted"''''''''''''''''''''''''''~'''''''''''''''''''''''''''':''''''''''r''''''''''''''......................................................................... D 32. Jbl .:>;. /.. ,).J....- /.1-.._,. ~ (1'..,/ 111r.v REGIS~ SIGNATU~~r~ ~ Aol'I/ 1/1 DATE FILED (Month. Day. Year) '..4Vf(.' /..) .~ ~.z4.-' .t-,p;:;c' <:1:..._ 33 .,' "'.... ........._ / .. c::2/-CJ3- /O::L3 -- , . -- ~.-- -' ! I ../ " LAST WILL AND TESTAMENT OF ELIZABETH EARLEy I, ELIZABETH EARLEY, a single woman, of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all wills and codicils previously made by me heretofore. I - I direct my Executor hereinafter named to pay from my Estate all of my just and lawful debts as well as the expenses of my last illness, funeral and internment. II. I devise and bequeath all the rest, residue and remainder of my estate as follows: A. One half of said residue shall be paid to my nephew, J. Gregory Osman. B. One-half of said residue shall be divided among my nephews, Michael B. Osman, Jeffrey S. Osman, J. Dixon Earley and J. Scott Jenkins III. I appoint my nephew, J. Gregory Osman, Executor of SAIDIS, his, my Last Will and Testament. In the event that he is unable SHUFF & MASLAND o serve or ceases to serve as such then I appoint my nephew, ATIORNEYSoAToLAW J. 2109 Market Street Camp HilI, PA ixon Earley. Neither of my personal representatives shall be equired to post bond in this or any juriSdiction. E ~- - IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the ! ~ 'f'.~ day of ~ ,1999. ~ / ,I. t/ . ~~ ..~fJ/ ce-Cl..:/ .;d '-< .' . ." (.- ('~j '>-- -(SEAL) ELiZABETH EARLEY Signed, sealed, published and declared by Elizabeth Earley therein named, on this and one (1) other sheet of paper as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in tile presence of each other, have hereunto subscribed our names as attesting witnesses. ~ 0 Name ~ ~p ~i~) I r; 'J:n I , \~ . " . ,.;:; ~L(JI . ~~ f/fA/L'.d:uuit I I Q , Name I Addr S SAIDIS, SHUFF & MASLAND ATIURNEYSoAToLAW 2109 Market Street Camp Hili, PA - . . - - COMMONWEALTH OF PENNSYLVANIA } COUNTY OF CUMBERLAND } WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will 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 their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constrain or undue influence. ?L~ ~.. rf""C-~ lb'L ~ci/ .J:~,~ ~ / Testatrix p~ L Witness ~7. 1 OA Witness ." Subscribed, sworn to and acknowledged before me by the testatrix, and subscribed and sworn tp gefore me by both witnesses, this iL,{h day of ~uk())D:.;::: , 1999. I Er--~::--~ I ...... .........~ flG-l:1- l.._._._. otary Public Notarial Sa Jo Smith, Nota SAID IS Camp Hill Bora, CulT.' , My Commission Explr SHUFF & MASLAND AITORNEYSoAToLAW 2109 Market Street Camp Hill, PA I I ~ Z t'-t'- $ -a -< l"'ll"'l t'- t'- ~ ~ 0 o I ~ Illzl%lo ~- a PLI -< 0 II) 0 ...:l - u t'- P::: ~~iB- t'- ,c:( '" 0 0 ell lI'l 0 PLI 8~~t;.a o ~ ~ <<;> ~~1..atl ._ 0 0 ell l"'l t'- ::z:: !:::. u t:l.. ~ I l"'l E-t o~~.~ ~ t'- '~ ~ Z '" t'- ,......, PLI t'- j$~~a ,......, ..... !Xl t'- t'- ~J ,c:( ..... '-' ~rJ')=- c ~ ~ III ~ '0 :::f H ~ tl... ..::.d .- ...:l r1I.( t;; == PLI ~ ::g =- ~ 0'\ El ~ 0 ell -< r::;u III COMMONWEALTH OF PENNSYLVANIA REV-1 162 EX(1 1-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003400 OSMAN JAMES G 2 SOUTH BEN HOGAN DRIVE ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER __hhn fold ---------- -------- 101 I $109.62 ESTATE INFORMATION: SSN: 172-01-2760 I FILE NUMBER: 2103-1023 I DECEDENT NAME: EARLEY ELIZABETH I DATE OF PAYMENT: 12/31/2003 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/22/2003 I I TOTAL AMOUNT PAID: $109.62 .. - REMARKS: JAMES GOSMAN CHECK# 1364 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS , /1-/f~- ? G \! REV~" ~ EX (6~OO) REV-1500 OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 ~-1- ~3- J)L J1 J-3 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER ..... Z I 0 W THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W REGISTER OF WILLS 0 W SOCIAL SECURITY NUMBER C - w ~ Original Return o 2. Supplemental Return o 3. Remainder Return (date of death prior to 12-13-82) I- ~~Ul o 4. Limited Estate o 4a. Future Interest Compromise (date of death after 12-12-82) o 5. Federal Estate Tax Return Required UO::~ wll.U J:OO o 6. Decedent Died Testate (Attach copy of Will) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes uO::..J II.m - II. o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) < I- Z w NAME JAM COMPLETE MAILING ADDRESS c S ~ z S'O v7J.f BeN rto~+d M\v~ 0 Ol.. II. FIRM NAME (If Applicable) Ul W 0:: ~rr-~5. PfOt 17';/'1 0:: 0 u (1) '- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) - 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) - 4. Mortgages & Notes Receivable (Schedule D) (4) - 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ L.( 7 7 ' t..( 'i! \... Z (Schedule E) -~~ 0 - 6. Jointly Owned Property (Schedule F) (6) ~ o Separate Billing Requested ..J (7) - :J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property !:: (Schedule G or L) D. (8) ? t"f 7 7 ' '-ff-' <( 8. Total Gross Assets (total Lines 1-7) 0 ~ , W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) Oy J ' ~\) 0::: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) - 11. Total Deductions (total Lines 9 & 10) (11) Sr o l.J1, ~O 12. Net Value of Estate (Line 8 minus Line 11) (12) J.., '-I ~ ~, 7t 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) ..- made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) J., L/3S", 'if SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 - ~ rate, or transfers under Sec. 9116 (a)(1.2) x.O _ (15) ;)., 'f 3 ~, 7~ x .0 l.fL (16) I V '1 . tq).. ~ 16. Amount of Line 14 taxable at lineal rate :J - D. 17. Amount of Line 14 taxable at sibling rate x .12 (17) ::E 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) 0 ~ 19. Tax Due (19) J 0'1. ("l. 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS . I CITY STATE f' F't- ZIP 1)<)/) Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) IO'1,~2... 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C ) (2) '- 3. I nterest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) JD?""z... A. Enter the interest on the tax due. (5A) - B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) /{)<[,\ol- OF AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 EW" 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 GY' 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 W' 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which cg/ contains a beneficiary designation? ........................................................................................................................ 0 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 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 pre parer has any knowledge. DATE ) ADDRESS .J.. .s 0 vi <;Jtfr D t. ('-oJ. rh? (, ~ ~,vl ~'I~ , fr+ I 73/ <f SIGNATURE OF PREPARER OTHER T AN REPRESENTATIVE DATE ADDRESS For dates of death on or after July . [72 P.S. 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 surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 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) [72 P.S. 99116(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. 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. . _.~".~"., '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT . ESTATE OF FILE NUMBER 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. fI',1~\J FA<-T v~ &eS ~ m~De~ 'i7X \J'::;,~ C4 v11P "tN '/ ~ 'If <-j 77, ,-/y (sp~ ..-4 '171'Krl-~ a ) TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0 AdO~ 1::13WO.lSn~ II '0 f!' III. [i;} 8_ I 8 eEl -- ~t ...,CD* ...., -.- eD .Ii_ ~~:~ " (Y') u ~~:~ .5 (X) .. '.*1 E N.......* ., -** ...... ~ 0; * >00 CJ>'C - ~ -e - ~~ *-~ )~ (X) ..*~ >0'-' -* CO ~li >- * ~g ~-I N W IX .. eo <t* 0> - !;;: l./J_ .,< .. lil ~z 0 .. : >0"; %* :;! .0'" --*:1.= ;:: 'Co .J.J*O ... .,'" .:D*~O .:, ::>'" "'''' <:: .. ~ ... ,!!!Cll ""-1- =:~ .0.1* . u..: I :J * 15 .. l./J: - ~l -_s:s: ~_4,l\1l ~ -_:> :>e U ~ :: ~ ~1 . tLJ '" - J: ~ "'- U . 0; .so ..J J c( ~ - u. l; ..-- ~ 0 ~ CI;.. Wo: Iw 15. ! CI;.. )-1-0 ! 0 <coO: 'i c..1-0 1 ! . 5 . ....... i ~ >- 'l _"h'.':,,,-: c: ! os '."".;-.1,,' C. i;' E e . 0 w ] u I' ~ cr; ~ f=. ::) c ~ i ~ z ~ ~o !:2 li CJ> _ l!!~ o 0 1-(\1 w II 'C~ N . c:~ cd os . ~~~ o Q. :I: . ~j!: ~ci c( .r ==~~ w ::E c:u. ~ os::> ~ :OlD 0 g I) ~ b z __________________ ~J "'... : : REV-1511 EX+ (12-99) _ " . SCHEDULE H , COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER &L/7-. 1(') tfl'f f A(<..J,A. _ Y dl - D.3 - 01 0 '2.3 Debts of decedent-must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ($~t 47'1 ~J~D ) -4 9 010 . ~O 1. ( s' ~f 1+7{4c.H-~ () ) J I I 3..). ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 1\1 f A Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees l\ll It 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees ~/f\' 5. Accountant's Fees "'1.A- 6. Tax Return Preparer's Fees NIPr- 7. TOTAL (Also enter on line 9, Recapitulation) $~ 04 I, \""TI (If more space is needed, insert additional sheets of the same size) -, ./ CEMETERY AGREEMENT I f ROLLING GREEN CEMETERY ~ (Street AdLlress) 1811 Carlisle Road, C:amp Hill. Penn.c;ylvania 17011 . (717) 761-40.55 . (Milling Addres.o;l P.O. Box 126. C;lmp Hill. Pennsylvania 1701 J ,.,.tlTAR MAUSOLEUM CORPORATION. :In Indiana Ctll'flOrali",", lining "",,..in<<s as Rnllin~ Green CrrTk'lcry lhcrealkr "Sf;UI'RU) and IE.. ". _ / 'Pl_ 1"'" Mnlel~) u...,I, ... .,11 aftICat ... s..rq/ _.,IM. Cet1,rlC8lel 7~ residence i,; al Ihe ~~.. shown belo"," (her,,'afler "PURCHASER"). do herdlY .gr("C .s foUow!i: ~ WITNESSETH THAT. ror and in considerafion of lhe !T.utu..1 ..-o...enant.. herein oonlaintd. lhe PURCHASER af!:'CCS III bur alld lhe SELLER "~rl'l'" III "<'II rhl' ?' ~"'hand'sc andlo, SC<V"'.S h.",...II... .nume<a!ed .nd desc,,1onJ andio, ''''' ....105". d,h" or "'mal.. ,he. 'P""" he,.,...Il... '"""'''''00 .nd d,,,,.,,,,,,,, on 'he <:cmClery known.... ROllan, Green Cemetery, upon the Icrm'i and l'tlndUtonS and for the amounl' as:oo..1 forth In Ihls Agreement TIUll A,reemcnt: IS SUhjtl"IIO '":ccptim..:e by SELLER. and when aC'cepled, shall be binding upon the SUCc.:es.sors. assi2ft.~, ~neficiarie:o;, helr_~ and legal rcprescnlatlves o( the roanlC'5 hereto I ~ 1. DESCRIPTION OF BURIAL RIGHTS. The Burial Ri{(hb n1vert.'lI by lllls ^~rttmenl ;llC s.....wn by the lllap uf su\:h tEar\Jen/bUlJ...linJZ tin file in Ihe nffil"C~ III SELLER. and are more p.nlcularly d~nbed heklw _ 1lw punhaw prY. or Burial R~b don noI incluM Inl~tmmt/EnlombmC'nt/lnurn..nl .'ttS loprnilll( .nd '~";"ll ...Is). Openi"ll end .....ng must be purchosed soporo'.ly. j / - Grave S~: _ .~:_JnIt'nnr _hlm..,r _Deluxe_Fanlll}' _SIIl):1c - Lewn Crypt: _Double lkr'lh -Side by Side: -5inglc - ~ --.Jntertl.r _E1l1enor _SIIl@:le _Comp.niun Isle...... 2nd C...... ~ 2nd Choltt Garden ~ BUIlding ~.....()tI-"'f'd1 Section "- '-... Scclion ~iY'" Lol .............. No.ls) y,\ SpaccfS) ..... Level If"'l 7 2. DESCRIPTION OF MERCHANDISE .Muimum easkC'1 dimensions are: length 90-. width .11-, heil!hl 2f,-. 3. ITEMIZATION OF CHARGES [ ] Check here i( merchandi~ being purchased (or use al another ('emelery. (Al Burial Rights (a!i dc~rihed in P;lta_ I ;IOOVl') ~ 3(1'15. V< Cemelery'.. name (B) Let.. PrttonslrUClinn Di...l.:ounl L==::=:J ~ 5l:C' cr- A. VAULTlSI: III. Oescripcion (C) I.e....... Cenifieale Dist.'ounl I 112. Description (D) Second Right o( Imernlenl ~ H. URN(S): # I, Description 'JI:. (E) Vaull(s) ~ #1. Descripcion (Fl Casket #1 I C. MEMORlAUMONUMENT: (G) Casket 12 I Memorial No. , (H) Urn(s) I ,;)0!. l.JU 1<1 Design \, . Emblem'" (I) Mlu50leum L.etterin8~ $ ~::Z"'-.O(> G"ni'e SiZ.~ X X- ! 0) Memorial 0 Monument 0 ' $ (K) In..tallalion Charge .and Early Clre F~ (or Memorial/Monument $ Bronze Size X To~elher Forever: e5_ No_ (Ll Orh(or $ Mllllumenl Descrip(ion (Sec attached Monument Order Form) (M)Salcs Tax $ ,; (N) Care o( Tur( AroUnd MemonallMonument ~ D. CASKET(S): (O)~Enlornbme~ S "'Ie:- #1 De!iCrtption , "- Model No\ Fees (or Weekdays (Circle One) Model Name \ No. Purchased I 112 Description "- Model No. " (P) Processing Fee ~ 35.00 Model Name " "- (Q) TOTAL CASII PRICE (A 'hro P) I ...3 YoG: 00 INSCRIPTION ITEMIZATION OF THE AMOUNT FINANCED (I) Total Cash Price $ ..3 'I ('L. . C'(' (2) A. Cash Down Payment L S 3.<,;~! r (r H.T".deln, I~p~ ~ ~$ '?~" (,n Old Al!reerlf'nt No, -A _, 8~I3-G ~'=:L. I C Total Down Paymenl (2A+2B) S ~~'//"l f'r (J) Unpaid Balance o( Cash Pnce (I - 2e) S _ _ (4, Credil Li(e In~uranee I -----r ($1 TOlal Unpaid Balance (3+4) 1- c: - '. , % S S S S YOUR PAYMENT SCHEDULE WILL BE: Nom of Payments Amount of Plyments First PI~t Due Dlle Thereaher, Plyments Are Due \ $,",- I Monlhly on lhc ~ ~ r! Quarterly '\ $ INSURANCE: Credillife insurance is not required lo~obI: credit and will no! he provided unless you sign and agree 10 ptlY the additional COSI Credit Lit. o Individual Pr~ium Cost o Joint & O.te of Birth ... -~- "-... ,.. ~--- Late Char!!c: If a )a)lIlcm is laIc. you will he ehar~ed $5.0015% of Ihe payment. " Prerx1ymem: If you pav off early, you will fKIt have to pa:-, a penalt)' and may he enlilled lu a refund of rarlllf lhe finant.c .....hart-:c See lerms and conditions elf Ihili AI!reC'ment (II( any addiliunal in(orm;uinn ahoul non.paymtnl, default. and rC4111red repaymenl in lull hclufl.' Ihe M:hedllkd .lalc, and rc menl refund~ and nallies. NOTICE TO TIlE PURCHASER (I) DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACE. (2) YOU ARE ENTITLED TO A COMPLETELY FILLED-IN COpy OF. THIS AGREEMENT. (3) UNDER THE LAW. YOU HAVE THE RIGHT TO PAY OFF IN ADVANCE THE FULL AMOUNT DUE AND UNDER CERTAIN CONDITIONS TO OBTAIN A PARTIAL REFUND OF THE FINANCE CHARGE. PURCHASER'S RIGHT TO CANCEL (APPLIES ONLY IF SALE SOLICITED IN PURCHASER'S HOME) YOU MAY CANCEL THIS AGREEMENT BY PROVIDING A WRIITEN NOTICE TO THE SEHER. OR BY SENDING A TELEGRAM. OR BY MAIL. THIS NOTICE MUST INDICATE THAT YOU DO NOT WANT THE GOODS OR SERVICES ANII MU~T BE DEU- VEREI> OR POSTMARKED BEFORE MIDNIGHT OF THE THIRD BUSINESS DAY AFTER YOU SIGN THIS A/;REEMENT. THE NOTICE MUST BE MAILED TO ROLLING GREEN CEMETERY AT P.O. BOX 126, CAMP HILL, PENNSYLVANIA 17011. IF YOU CANn:L THIS AGREEMENT, THE SELLER MA Y NOT KEEP ALL OR PART OF ANY CASH DOWN PAYMENT. FOR AN EXPLA- NATION OF THIS RIGHT, SEE NOTICE OF CANCELLATION FORM WHICH YOU WILL RECEIVE AWNG WITH A COPY Of' THIS AGREEMENT. / PURCHASER'S ACKNOWLEDGEMENT BY SIGNING BEWW, PURCHASER REPRESENTS AND ACKNOWLEDGES THAT PURCHASER HAS READ AND UNDER~TANDS THE TERMS OF TIllS AGREEMENT, THAT ALL RELEVANT BLANK SPACES HAVE BEEN COMPLETED, AND THAT PURCHASER HAS RECEIVED A COpy OF THIS AGREEMENT AND PRIOR TO DISCUSSING PRICES. SERVICES OR MERCHANDISE, A COPY OF THE APPLICABLE PRICE LIST AS REQUIRED BY THE FEDERAL TRADE COMMISSION, FUNERAL PRACTICES TRADE REGULATION RULE. SEE REVERSE SIDE FOR ADDITIONAL TERMS ~ND CONDIT~Nl .19~ IN WITNESS WHEREOF, SELLER RCHASER have executed Ihis Agreemenl this .30' 1... day of ~ ...,.b. r AIL JNsrALLM~ ~~ENl,; --: I. PURCHASER ~ --::2'-&....1;<'- "'<'. ...(,~ Soc_ Stt_ No. ;4. If 81'NIA.I. RIGHTS C":RTltlCATE Tn HE IN NAM~S) OTIIER THAN Phone No., 737- 7D3 7 ZIp PURCIIA.SERfSl. THEN PROVlOf: NAMt:(S) HERE: I. Employer: 'Kd;"~<L Phone - \~rlTnK'nt ~0 -__CLtU____.____. Flllrln\'l"r ~--'-'-_ _~.____ _ PII'lnr__ - . Nationwide 1-800-722-8200 7-24-2003 230808 AB-5 Mr. Greg Osman 2 South Ben Hogan Drive Etters, PA 17319 ! Elizabeth Earley - Deceased X Direct Cremation $995.00 Special 48 Hour Or Weekend Cremation Service Nationwide Guarantee Program Worldwide Travel Protection Program Private Family Viewing/Witnessing Crematiqn Cremation Container Medical Documents/Courier Fee Cardboard Container Urn Burial Vault Arrange For Burial X Personal Delivery of Cremated Remains $85.00 Arrange/Deliver Remains To A National Cemetery Scattering Charge Packaging And Forwarding Cremated Remains Express Mail X Certified Copies 6 @ $2.00 $12.00 Register Book Memorial Folders Thank You Cards # Memorial Service Package Flowers Newspapers X Harrisburg Patriot $18.50 X County Coroner Cremation Approval Fee (Cumb) $25.00 DNA Preservation Other Other TOTAL $1,135.50 7-30-2003 PAID $1,135.50 BALANCE DUE $0.00 Fax (717) 541-9943 REV-:S13 EX+ (9-00. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER t..L r p( , - ~ RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ 1. J ~VY\ ~ So C7 OSYM-N I\J 'dJ M ~, w .3, (08":3. 8'b f J.. IYl \ (..J; A-~ L B O>~ I' 'f ).1 'O\> ~ 3 j :::b , X ON b\AL.. L. 'Y 1\ 7^'. D\) ~ -1 VY=f\~ Y O.swvtl~ ''\ <=j')..I. '00 ~ oS Jl ~{ SU'T/ ....( EN \.( (PQ. ~ I' 7^I,\)O 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, 'PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP 101-05) r.,f DATE 02-16-2004 :): ESTATE OF EARLEY ELIZABETH DATE OF DEATH 07-22-2003 P 3 :29 FILE NUMBER 21 03-1023 .04 FEB 13 COUNTY CUMBERLAND JAMES GOSMAN ACN 101 2 S BEN HOGAN DR I Allount Rellitted I ETTERS P A \i131<9 .. h' ",,' i'~'t) FA CAlm..A..m-~ti '''' '-#',"., 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 =is4-j-Ex-AFP--foY=03Y-No'TicE--oF-YNHEifiTAifcE-'TAx-jfPPRjfisEifENT~--Ai:rowANcE-OR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EARLEY ELIZABETH FILE NO. 21 03-1023 ACN 101 DATE 02-16-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE 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) .00 credit to your account. 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 7.477.48 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 7.477.48 APPROVED DEDUCTIONS AND EXEMPTIONS: 5.041.50 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 5.041 liD 12. Net Value of Tax Return (12) 2.435.98 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 2.435.98 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of 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) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 2.435.98 X 15 = 365.39 19. Principal Tax Due (19)= 365.39 TAX CREDITS: ~...~ ""''''''.lor. {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-31-2003 CD003400 .00 109.62 PAYMENT MUST BE MADE BY 04-22-2004*. TOTAL TAX CREDIT 109.62 BALANCE OF TAX DUE 255.77 INTEREST AND PEN. .00 TOTAL DUE 255.77 . IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- 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 Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z 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 MILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). 08JECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 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, 198Z 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, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z003 are: Interest Daily Interest DailY Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z Z07- .000548 1987 97- .000Z47 1999 77- .00019Z 1983 167- .000438 1988-1991 117- .000301 ZOOO 87- .000Z19 1984 117- .000301 199Z 97- .000Z47 ZOOl 97- .000Z47 1985 137- .000356 1993-1994 77- .00019Z ZOOZ 67- .000164 1986 107- .000Z74 1995-1998 97- .000Z47 Z003 57- .000137 --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. REV-1470 EX (6-88) , -~ INHERITANCE TAX ~ EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER EARLEY,ELlZABETH 2103-1023 REVIEWED BY ACN Kathryn Harbilas 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J Changed tax rate from 4,5 percent to 15 percent since nephews are a collateral beneficiary. ROW Page 1 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: 'f..LI ~ 1dr~kf ~L-E--Y Date of Death: 7/.1..~I~c~..J , I Will No. ~/-v3"'/1JG3 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address .J AM t.,s DJ'M+tv ).. SOI.,i71 '3l:~ I-/o~ m :;~tv2 J) 3/9 G E~s ('I} . ''1'(-,..( A....L 19 -:~ <; wv')-'" 2 J... 2 J~*~LL.. )te,vl M\..J ~~V/ LL [, 172l'L / .J J ( /('DA' /LUt.I 'f ~ 1)/ Of.-bhlC ,) '~ RV'L (.-4 ~ 4ft L J 70 ff ,J r:^F R. . S t),r 1",*" )jLf 0 1,.1 .J 5l~;-; -J ~ Nk:'oJ-S iL (p Ot/"~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except .N /"1 Date: ri(~h"4J.~ ~ ~fiature Name -.J f-l ,,"1 f S (.... n '7, YY1-1 'I. Address 2.. ~) -:: .,) '17-1 -'i>~ fo....l l-(v (.-1,\ I ~.>v.:? Il/~ lnlnquU\~ f: ';- ; SI) s. .'1./9 171/) - , ~)~:;~~ Telephone <J I )) 'j .,)~-;'" ~~ (0: Zd 17Z HlfW VO. Capacity: / Personal Representative .; !)(~8 :)88 _Counsel for personal representative 0' y ,In ,I e: :: -I I .I,> '1 r- "nO ~IO ITlNt.. ..IZ ... ~~ rn ." IGl -l J> '" ....1-4 II -lVl3: .. ~~ .:: -I ITl ITl ... ::IO=VI .... "'1-4 1% VlITl ... ""c 'IH N ~~ ZCU .. 11(1) I ,I CI ""c lr- xc II' Q~ CVI CI Zr- ..H ... tlZ CU3: -l 'I m J>J> ~ ZZ x . m ~I ~ 1Il 11 ,I ::10 I I "tl ;1' > II I-' . I n~" 'I ::la =t" g :n m ::1. (r -I c;- ~ > ~T, "11 0"11 H ;:x::. "11:11I n Z ;g ~ 0 CI-4 3 r- mlll t:lI3 0 I cmz mo c:zo :E Ul nm-l -aZ m -lZI-4 >:E ::la l-4-ln ::lam -0 0" m -I> Z -a -.. 1Il~0 3r- 0 1...'.'1' r-"II m-l ::la ~r- Z% -I -.. ZOI-4 -I \Q C:EZ H ~:a: 0 0 3 >n"l1t:l1mt:ll ~zm 0"11 lZ > nOH>(I)> lIln:lll "11 lIlml-4 -a :;ll;; ze:r--I-I-I m -l '''11 m zmm>m 1Il0~ ::lam :0 (")(")::10 -I -I lIl:lllZ mz ::la n <zorn :z n <z J>CITl % e:"I1 mcm m(l) '< ::I03:CU ZI-4 z< ....=1-1 m 3 0 -llll-l 0 n IlIIt:lI"I1 ~~ e:r- e: I-IITlVl :;ll;; mm or-x m< ::la VI::IO-l ::la> "IIr- > ........1Tl 0 1TlJ>::IO -a -I -l:E Z ::la > % ~~ H m .. z < U\~ XZ > n ~C > n "tl "T1 I-'(")NCITlCl m 0 J>(") IlII Ul~ ClCI-'.....J>N ::la C:E r- 1-'3: I ::10 I t:lI 1-1 m r+ =ClN....1-' (I) 1-'(").... -1 ITlClolNITlO\ .....C.... > = ,., I I < I ClCVI z .J II ....I-'N N 1 I-' ::10 t:lI ... J>ClCl Cl CIoI-l r+ ZNCl Cl ::la r+ lD ~CIoICIoI .C\ X m CI. C 3 C H VI -I ITl -a > ITl < .... 3 1-1 m N z J> -I = -I ITl -l 0 X .. ...c;: ~ COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) ,- OE~<ii\TMENT OF REVENUE t BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG. PA 17128-0601 PENNSYLVANIA RBCEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003761 OSMAN J GREGORY 2 SOUTH BEN HOGAN DRIVE ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER ________ fold ---------- --~----- 101 I $255.77 F{ ;" ESTATE INFORMATION: SSN: 172-01-2760 \ FILE NUMBER: 2103-1023 I .. DECEDENT NAME: EARLEY ELIZABETH \ , . DATE OF PAYMENT: 04/05/2004 \ POSTMARK DATE: 04/03/2004 \ COUNTY: CUMBERLAND \ DATE OF DEATH: 07/22/2003 \ \ TOTAL AMOUNT PAID: $255.77 L:. ',,,.".- iREMARKS: i CHECK# 1542 INITIALS: JA _.. SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH i _ REGISTER OF WILLS i :_. REGISTER OF WILLS R .-~-~' . ~ .,.... , \. :. ,.: . .' ..... ~ ~ C) ~ - ,--\~ ~ 5 J ~ :t - / 0 h ~ ~ J ~ ~ -- - :!'J ~ .~ ........ 1;: ~ - !~ I = ..- "'" - .. 0.. ~ ...01 UI ~. <to . "'1 I I.~ it' ~ ~ ill~ (::1 ~ .' ~ ro .~ JJ ..... ,tr. 3 """:;.' t'l . ,.,) ::::: .- i~ 1 ~~ ~ ~ 0\ - C") ~~ :E~ , r/l", Ot) ~ffi ~c3 ~1a o~ g2~ oll.l 0:1 r/l N JRD/June 30, 1992/17858 MA Y 0 6 2004 V In Re: Estate ofBEVERL Y J BARTCH ORPHANS' COURT DIVISION Late of UPPER ALLEN TOWNSHIP COURT OF COMMON PLEAS OF CUMBERLAND COUNTY Estate No.: 21-03-1073 PENNSYLVANIA NO. 21-2003-1073 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: CHARLES E BARTCH Counsel for Personal Representative: Date of Grant of Original Letters: 12-30-2003 Date of Delinquency Notice: 04-09-2004 The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk ofthe Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on APRIL 9, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6{ e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 05-06-2004 ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File ~ J-?tJtJ'/ ]>.3d /1//11, A hearing is scheduled for at in Courtroom No.3. Ifthe Certification of Notice is filed prior to the hearing date, the hearing will automatically b I COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 INHERITANCE TAX HARRISBURG, PA 171Z8-0601 STATEMENT OF ACCOUNT REV-1U7 EX AFP 101-05) .- , DATE 05-17-2004 ESTATE OF EARLEY ELIZABETH DATE OF DEATH 07-22-2003 FILE NUMBER 21 03-1023 '04 i'!fIY 211 "~t(8tY CUMBERLAND JAMES GOSMAN ACN 101 2 S BEN HOGAN DR I Anount Renitted I ETTERS PA 17319 . '-..< (~\ r"-j 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. subnit the upper portion of this forn with your tax paynent. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =i61fj-Ex-AFP-(fff.:oiY------...-iNHERiYANcE-TAx-sTAfEM'E-NT-1fF-Ac-couiif--.-i.---------------- ----- ESTATE OF EARLEY ELIZABETH FILE NO. 21 03-1023 ACN 101 DATE 05-17-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-16-2004 PR I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 365.39 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-31-2003 CD003400 .00 109.62 04-03-2004 CD003761 .00 255.77 TOTAL TAX CREDIT 365.39 BALANCE OF TAX DUE ,00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PAYMENT: Detach the tDP pDrtiDn Df this NDtice and sub.it with YDur payment made payable tD the na.e and address printed Dn the reverse side. -- If RESIDENT DECEDENT make check Dr .Dney Drder payable tD: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check Dr .Dney Drder payable tD: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the Z3 Revenue District Offices Dr frDm the Department's Z4-hDur answering service fDr fDrms Drdering: 1-800-36Z-Z050; services fDr taxpayers with special hearing and I Dr speaking needs: 1-800-447-30Z0 (TT Dnly). REPLY TO: QuestiDns regarding errDrs cDntained Dn this nDtice shDuld be addressed tD: PA Depart.ent Df Revenue, Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17IZ8-0601, phDne (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df the tax paid is allDwed. PENALTY: The 15% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (I) day frDm the date Df death, tD the date Df payment. Taxes which became delinquent befDre January I, 198Z bear interest at the rate Df six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which beca.e delinquent Dn and after January I, 198Z will bear interest at a rate which will vary frD. calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 198Z thrDugh Z004 are: Interest Daily Interest Daily Interest Daily Year Rate FactDr Year Rate FactDr Year Rate FactDr - - - - - - - - - 198Z ZO% .000548 1988-1991 11% .000301 ZOOI 9% .000Z47 1983 16% .000438 199Z 9% .000Z47 ZOOZ 6% .000164 1984 11% .000301 1993-1994 n .00019Z Z003 5% .000137 1985 13% .000356 1995-1998 9% .000Z47 Z004 4% .000110 1986 10% .000Z74 1999 n .00019Z 1987 9% .000Z47 ZOOO 8% .000Z19 --Interest is calculated as fDIIDws: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cD.putatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated. ~ - "-\~ \i - "\oS'L COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-I547 EX AFP 1Dl-03l DATE 10-25-2004 ESTATE OF CURNES EDWARD I DATE OF DEATH 11-26-2003 FILE NUMBER 21 03-1055 '04 rfT ',-,~' .') fOUNTY CUMBERLAND JENNIFER B HIPP ESQ Uul L~ "~'.)-ACN 101 I W MAIN 5T I .._, __.H.. I SHIREMANSTOWN PA 170~}_?i:. ,..\-.,j,-_.,- 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=i54-j-E3f-AFP-foY=oiT-Nii'~ficE--OF-YNHEifi;:ANCE-TAjrA-PPRA-isEifENT~--ALi-oWAi,rCE-(fR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CURNES EDWARD I FILE NO. 21 03-1055 ACN 101 DATE 10-25-2004 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) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 4.500.00 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 4,500.00 APPROVED DEDUCTIONS AND EXEMPT~ONS: ,00 9. Funeral Expenses/Adm. CoStS/M1SC. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 00 12. Net Value of Tax Return (12) 4,500 . 00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 4,500.00 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 4,500.00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= .00 TAX CREDITS: , "DAi-"i" 'NUM"B~iR INTEREST /PEN P~+;D (_) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 ,. INTEREST AND PEN. .00 .p 'Y\.... TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- 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 Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (n 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 KILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050, services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 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, 198Z 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, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ zor- ~ Im-1991 ~ ~ mil -r- .~ 1983 167- .000438 199Z 97- .000Z47 ZOOZ 67- .000164 1984 117- .000301 1993-1994 77. .00019Z Z003 57- .000137 1985 137- .000356 1995-1998 97- .000Z47 Z004 47- .000110 1986 107- .000Z74 1999 77. .00019Z 1987 107- .000Z74 ZOOO 77. .00019Z --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 I