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Home My WebLink About03-0616PETITION FOR PROBATE and GRANT OF LETTERS Estate of JACQIIELINE C.. gTTNE No. also known as To: Register of Wills for the Deceased. County of Cumberland in the Social Security No. 202-16-/+41'1 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor named in the last will of the above decedent, dated March 13, ,1~9 and codicil(s) dated nolle (slate relevant circumslances, e.g. renuncialion, death of execulor, elc,) Decenctent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 7 West Shore Drive_, Cnrnp lq-~'I'l (lisl slrecJ, number and muncipality) Decendent, then '7 ~ years of age, died , July / Oy'H , y~2003 Except as follows, decedent d~c~ ~'ot marry, was not divorced and did not have a child born or adopted after execution of the wilt offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendenl at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 7 West Shore Drive, Camp Hill $ 120,000.00 $ $ 160,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary theron. (lestamentary; adrninistralion c.l.a.; administration d.b.n.c.l.a.) Rrra, c~a, SY Mellon Bank, N.A. Box 1010 wnrw~.qburg, PA 17108 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -) COUNTY OF CUMBERLAND ? ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s)will well and truly admi_nist¢r the estate according to law. Sworn to or affirmed an~ subscribed ,- ~_ ' before mgd:his _ c:~ ~ day of ' I~ ' ' I "1 I NO. 21-03-616 Estate of Jacqueline C. Stine , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JULY 30 ~:2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 03-13-1999 described therein be admitted to probate and filed of record as the last will of JACQUELINE C. STINE ; and Letters TESTAMENTARY are hereby granted to MELLON BANK. N.A. Register o~ Wills FEES Probate, Letters, Etc .......... $ 270.00 Short Certificates(10) .......... $ 30.00 ]R~ EXTR~ P. AGES..1 $ 3.00 JCP $ 10.00 TOTAL __ $ 313.99 Filed . J. ULY..30,. 2003 .................. Terrence J. Kerwin, Esquire #29922 ATTORNEY (Sup. Ct. I.D. No.) 27 North Front Street Harrisburg, APORESS PA 17101 (717) 238~4765 PHONE M~ILED LETTERS TO ATTORNEY JULY 30, 2003 21-03-616 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS TERRENCE J. KERWIN (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that HE WAS present and saw JACQUELINE C. STINE the testa~r , sign the same and that lqv. signed as a witness at the request of testat or in her presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before ~~ ~ me this ~9 t~ day of ~ h~, . ~ .O.O, ~ff'~d'~t~i (Address) g/ ) &/7/t~ / Register (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS CINDY L. SEMIC (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that SHE IS familiar with the signature of .IACQIIEI,TNV. C..qTTNE , testat or of (one of the subscribing witnesses to) the will presented herewith and codicil that SHE believes the signature on the will is in the handwriting of JACQUELINE C. STINE to the best of HER knowledge and belief. Sworn to or affirmed a d subscribed before me this~ o~,~~ dayof Register (Name) (Address) his is to certify that the information here given is correctly copied fi:om an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9268195 No. · Local Registrar U [)ate COMMONWEALTN OF PENNSYLVANIA o DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Jac¢ ueltne C. Stine AGE(La~IBt.'I~Oay} t U~R I u~.i~ o~.t. , ~e,c,~ I~-~ze p-202 -- 16 -- 4411 , * ' 76 v. I : I ~ ~y 18, 192~ aazelton, PA ,~, : I ~.~_ _~'__ /,. Cumberland Lower Allen ~- , ............ J*~ ~_"'.~. ~ ~ ~ ~u , I ~ ~ BU~S~IN~STRy ~ ~CE~NT EVER IN ~c~. e I. ~dio lo~Te chnlc lan ~,,~. Healthcare C 7 West Shore Drive Camp Hill, PA 17011 FATHER'S NAME (FIIsl. M~h;]hl. kasl) John Re ze Moil' M. McGarvey Lower Allen July 14, 2003 DUE *TO (Off AS A CONS[OUElaCE (~: On the bll~! ol examination and/or investigation, n my opinion, death OCcurred at he mi d mamlm' al Staled ............................................. . ale, andplace, and due to lhe cause(a) and MOTHER'S NAME iF#M. M ,~le. Ma~en Suename) J,,. Elizabeth Agatha Boyle ~. 7 West Shore Drive~ Camp Hill, PA 17011 J,,=.Resurrection Cemetery ~,,tW. Hanover ~p., PA 17112 [,,~. FD 013 340 L . · · ~ox 4]1. New Cumberland, PA 17070-0431 LEENSENU~g=n J~~~l~ Parthemore FH& CS, Inc. I P,~ ~,~ 0 ~ 0 ~ c~. I~* ~. . ~. 21-03-616 GregoRY M. KERWiN TERRENCE J. KERWlN JOSEPH D. KERV~iN HOllY MCCLURE KERWIN ATTORNEYS AT LAW 21-03-616 LAST WILL AND TESTAMENT OF JA CQUELINE C. STINE I, JACQUELINE C. STLNE, of 7 West Shore Drive, Camp Hill, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. FIRST: I direct my hereinafter named Executor to pay all my legally enforceable debts, funeral expenses, administration expenses, and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. SECOND: I give and bequeath my jewelry, Waterford crystal and Lladro figurines to my sister, MARY BETH SHROPP. I further direct that MARY BETH SHROPP, in her absolute discretion, may distribute some of these items to MAUREEN MCGARVEY and JANE WILES. THIRD: I give, devise and bequeath all the rest, residue and remainder of my estate to my brothers and sisters in equal shares as follows: 1. One-fifth (1/5) of my estate shall pass to JOHN MOYE, currently of New Castle, Delaware. 2. One-fifth (1/5) of my estate shall pass to RICHARD MOYE, currently of Manassas, Virginia. Page 1 of 2 Pages (SEAL) 3. One-fifth (1/5) of my estate shall pass to MARY BETH SHROPP, currently of Harrisburg, Pennsylvania. 4. One-fifth (1/5) of my estate shall pass to JANE SHURIG, currently of West Lafayette, Indiana. 5. One-fifth (1/5) of my estate shall pass to MAUREEN MCGARVEY, currently of San Jose, California. In the evem one or more of my brothers or sisters should predecease me or fail to survive me, I direct that their share of my estate shall pass to their issue per stirpes. FOURTH: I nominate, constitute and appoint MELLON BANK, N.A., as Executor of this, my Last Will and Testament, authorizing and empowering it to sell and convey any and all real estate of which I may die seized and possessed. I further direct that my Executor or personal representative shall not be required to post bond to act in said capacity. IN WITNESS WHEREOF, I, JACQUELINE C. STINE, have hereunto set my hand and seal, to this my Last Will and Testamem, this /~ day of March, 1999. SIGNED, SEALED, PUBLISHED and DECLARED by the above- named Testatrix, JACQUELINE C. STINE, as and for her Last Will and Testament, in the presence of us, who at her request and in the presence of each other, have hereunto set our names as witnesses: , / JACQUELINE C. STINE (SEAL) JACQUELINE C STINE KERWIN AND KERWIN ATTORNEYS AT LAW 27 NORTH FRONT STREET HAt~RISBUR(3, PA 171OI (717) 238-4765 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: No. JACQUELINE C. STINE July 10, 2003 2003-00616 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Com't Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 22, 2003. Name: Address: Mary Beth Shropp 2526 Boas Street Harrisburg, PA 17103 Maureen McGarvey 7 West Shore Drive Camp Hill, PA 17011 John Moye 136 Edge Avenue New Castle, DE 19720 Richard Moye 9816 Greenview Lane Manassas, VA 22109 Jane Shurig 211 East Lutz Avenue Lafayette, IN 47906 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: September 17, 2003 Signature: ~~~aD ~ Name: Address: Telephone: Capacity: X Terrence J. Kerwin, Esquire 4245 Route 209 Elizabethville, PA 17023 (717) 362-3215 Personal Representative Counsel for Personal Representative D:/lak\estateXstine. 5 -6 _D Mellon October 10, 2003 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlise PA 17013-3387 RE: Estate of Jacqueline C Stine DOD 7-10-03 File No. 21-03-0616 Ladies and Gentlemen: Enclosed please find our check in the amount of $45,600.00, which represents payment on account of the Pennsylvania Inheritance tax within three months of the decedent's death in order to obtain the 5% discount. Please send us your official receipt. Sincerely, Robert G Chase Estate Tax Officer (215)553-1047 cc: Wanda S Jones, Trust Officer Room 193-0205 Private Wealth Management · 1735 Market Street o P.O. Box 7899 · Philadelphia. PA 19101-7899 A Mellon Financial Company? Room 193,-0205 1735 Market Street P.O. Box 7899 Philadelphia, PA 19101-7899 7003 1010 0001 7882 7065 fl000 17013 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O31 1 5 MELLON BANK, N.A. BOX 1010 HARRISBURG, PA 17108 ........ fold ESTATE INFORMATION: SSN: 202-16-4411 FILE NUMBER: 2103-0616 DECEDENT NAME: STINE JACQUELINE C DATE OF PAYMENT: 1 O/14/2003 POSTMARK DATE: 10/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/1 0/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $45,600.00 TOTAL AMOUNT PAID: $45,600.00 REMARKS: MELLON BANK NO CHECK NUMBER SEAL INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS AFFIDAVIT OF EXECUTOR COMMONWEALTH OF PENNSYLVANIA ) ) SS COUNTY OF PHILADELPHIA Personally before me, the undersigned authority, a Notary Public in and for said County and State, appeared Wanda S. Jones, Estate Officer, who being duly sworn according to law, deposes and says that MELLON BANK, N.A., is the Executor of the Estate of Jacqueline C. Stine, deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal Estate of Jacqueline C. Stine, deceased, except real estate outside the Commonwealth of Pennsylvania, that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn and subscribed before me This /~7%ay of ~~ , 2004 Notary Public Notarial Seal Maureen A. Reynok:ls Notas/Pub c Philadelphia, Philadelphia County My Commission Expires Mar. 29, 2004 ~'~ber, Pennsylvania As~ciation of Notaries WAND× S. JONES ~ ESTATE OFFICER OF MELLON BANK, N.A~,, EXECUTOR FOR THE'ESTAT~0F '~ JACQUELINE C. STINE, ~3 '!'~ DECEASED ~o ESTATE OF JACQUELINE C. STINE Estate Inventory Valued as of Date of Death No. of Shares 4,032 Cash & Cash Equivalents AARP AUTO & HOMEOWNERS' INSURANCE PROGRAM, REFUND RE CANCELLED AUTO COVERAGE, POLICY # PH500645 CITIZENS' INVESTMENT SERS. CORP., PRINC CASH BALANCE HELD IN MM ACCOUNT # 658329751 HARTFORD INSURANDE POLICY NO. 55PH500645 REFUND M&T BANK CHECKING ACCOUNT NO. 82042047 PROCEEDS Interest at Date of Death M&T BANK SAVINGS ACCOUNT # 87005313618172 Interest at Date of Death PALADIN AUCTION COMPANY - PROCEEDS RE SALE OF PERSONALTY LOCATED AT 7 WEST SHORE DR., CAMP HILL, PA 17011 THE HARTFORD INS CO. HOMEOWNER'S INS POLICY NO. 80306224 PREMIUM REFUND VERIZON PAYMENT REFUND Total Cash & Cash Equivalents Stocks ALLIED IRISH BKS PLC SPONSORED ADR REPSTG ORD Total Stocks 408.00 15,140.61 319.00 24,602.64 0.33 22,578.21 0.92 1,071.95 683.00 13.91 115,012.80 64,818.57 115,012.80 Tangible Personal Property AUTO 31,000.00 Page 1 ESTATE OF JACQUELINE C. STINE Estate Inventory Valued as of Date of Death Tangible Personal Property JEWELRY PERSONALTY Total Tangible Personal Property 10,453.00 7,396.00 $ 48,849.00 No. of Shares 1,751.948 6,759.907 Real Property 7 WEST SHORE DRIVE CAMP HILL, PA 17011 Total Real Property Mutual Funds DREYFUS PA INTERMEDIATE MUN BOND DREYFUS PREMIER MUN BOND FUND Total Mutual Funds Total Inventory 170,000.00 24,352.08 109,037.30 170,000.00 133,389.38 $ 532,069.75 Page 2 Mellon Estate Settlement Room 193-0205 (215) 553-2394- Office 1-800-813-1530- Toll Free (215) 553-2631 - Fax Trust Officer jones.ws @ mellon.com March 25, 2004 Estate of Jacqueline C. Stine, Dec'd. #108439ML000 ' Register of Wills of Cumberland County Cumberland County Courthouse 1 Courthouse Square Carlisle, Pa. 17013-3387 Dear Madam/Sir: Please file the enclosed "Amended" inventory for the above referenced estate. I have enclosed a second copy to be stamped "FILED" and returned to me in the envelope provided. Also, please stamp the enclosed copy of this letter and return it to me along with the copy of the inventory. Thank you. ~ a S. Jones' Estate Officer Cc: Terrence J. Kerwin, Esquire Private Wealth Management Room 193~0205 · 1735 Market Street · P.O. Box 7899 · Philadelphia, PA 19101-7899 A Mellon Financial Company. sM 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 0O3810 KERWIN TERRENCE J ESQ E. MAIN STREET RR01 BOX 566 ELIZABETHVILLE, PA 17023-9765 ........ fold ESTATE INFORMATION: SSN: 202-16-4411 FILE NUMBER: 2103-061 6 DECEDENT NAME: STINE JACQUELINE C DATE OF PAYMENT: 04/1 3/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/10/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,781.00 REMARKS: TOTAL AMOUNT PAID: $15,781.00 SEAL CHECK//10613124 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS AMENDED INVENTORY AFFIDAVIT OF EXECUTOR '04 ILAR29 P3:54 COMMONWEALTH OF PENNSYLVANIA ) ,--,,, Personally before me, the undersigned authority, a Notary Public in and for said County and State, appeared Wanda S. Jones, Estate Officer, who being duly sworn according to law, deposes and says that MELLON BANK, N.A., is the Executor of the Estate of Jacqueline C. Stine, deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal Estate of Jacqueline C. Stine, deceased, except real estate outside the Commonwealth of Pennsylvania, that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn and subscribed before me This ~day of ~~ , 2004 Notary J'-'~--"--'- Notarial Seal ~ Maureen A. Reynolds, No-ta Public ~ PhiladeJphia, Philadelphia ~ounty JJY Commission Expires Mar. 29, 2004 ~ember, PennsWvania Associatior~ oi Notanc-.s WANDA S. JONES ESTATE OFFICER OF MELLON BANK, N.A., EXECUTOR FOR THE ESTATE OF JACQUELINE C. STINE, DECEASED ESTATE OF JACQUELINE C. STINE Estate Inventory Valued as of Date of Death No. of Shares 4,032 Cash & Cash Equivalents AARP AUTO & HOMEOWNERS' INSURANCE PROGRAM, REFUND RE CANCELLED AUTO COVERAGE, POLICY # PH500645 CITIZENS' INVESTMENT SERS. CORP., PRINC CASH BALANCE HELD IN MM ACCOUNT # 658329751 HARTFORD INSURANDE POLICY NO. 55PH500645 REFUND M&T BANK CHECKING ACCOUNT NO. 82042047 PROCEEDS Interest at Date of Death M&T BANK SAVINGS ACCOUNT # 87005313618172 Interest at Date of Death PALADIN AUCTION COMPANY - PROCEEDS RE SALE OF PERSONALTY LOCATED AT 7 WEST SHORE DR., CAMP HILL, PA 17011 THE HARTFORD INS CO. HOMEOWNER'S INS POLICY NO. 80306224 PREMIUM REFUND VERIZON PAYMENT REFUND Total Cash & Cash Equivalents Stocks ALLIED IRISH BKS PLC SPONSORED ADR REPSTG ORD Total Stocks Tangible Personal Property AUTO 408.00 15,140.61 319.00 24,602.64 0.33 22,578.21 0.92 1,071.95 683.00 13.91 115,012.80 31,000.00 64,818.57 115,012.80 Page 1 ESTATE OF JACQUELINE C. STINE Estate Inventory Valued as of Date of Death Tangible Personal Property JEWELRY PERSONALTY Total Tangible Personal Property Real Property 7 WEST SHORE DRIVE CAMP HILL, PA 17011 Total Real Property $ 10,453.00 $ 7,396.00 $ 170,000.00 $ 48,849.00 $ 170,000.00 No. of Shs Mutual Funds 1,751.948 DREYFUS PA INTERMEDIATE MUN BOND FUND 6,759.907 DREYFUS PREMIER MUN BOND FUND 2,621.189 MERRILL LYNCH BAL CAP FUND $ 24,352.08 $ 109,037.30 $ 64,035.64 133,389.38 64,035.64 TOTALINVENTORY $ 596,105.39 Page 2 REV-1500 EX (8-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-O601 REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -- 20__0 ~__ COUNTY CODE YEAR 0616 NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~tine Jacqueline C 202-16-4411 Z LU DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE RLED IN DUPLICATE WITH THE '" 7/10/2003 I ' ' 5/18/1927 REGISTER OF WILLS LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I.U -~ oo Z Z 0 X SOCIAL SECURITY NUMBER ~ 1. Original Return r'--~ 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) ~--~ 9. Litigation Proceeds Received -~2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-8 ~'-} 4a. Future Interest Compromise (date of death after 12-12-821 ~ 5. Federal Estate Tax Return Required ~-'] 7. Decedent Maintained a Living Trust (Attach copy of Trust) ]- 8. Total Number of Safe Deposit Boxes r--'~ 10. Spousal Poverty credit id,re of death between 12-31-91 a~d 1-1-95) [~ 1 1. Election to tax under Sec. 9 1 13(A)(Aaach S~ mIS:SECTION MuSTBEi COMP~Di:~iicORRESP0~iDENCE~D :iC0NFiOE~ TAXilNFORMATION SH ::: NAME Robert G Chase FIRM NAME (If Applicable) ~ellon Bank N.A. TELEPHONE NUMBER 215-553-1047 COMPL~EMAILINGADDRESS P.O. BOX 7899 RN 193-0205 Philadelphia PA 19101 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) ~-] ,~perata Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (7) (Schedule G or L) 178,500.00 c~. 312,437.83 0.00 0.00 113 , 719 . 31 '~i: 0.00 10,506.63 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) 81,510.59 2,144.88 1 1. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 1 1) 13, Charitable and Governmental Bequests/Sec 9 1 13 Trusts for which an election to tax has not been made (Schedule J) (lZ) (13) OFFICIAL USE ONLY 615,163.77 83,655.47 531,508.30 0.00 531,508.30 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1 5. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9 1 1 6 la)( 1,2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20, 0.00 x.o0.00(15) 0.00 0.00 x.o45 (16) 0.00 531,508.30 x.12 (17) 63,781.00 0.00 x.15 (18) 0.00 (le) 63,781.00 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH: < < {~ HASPXXNUMBER Decedent's Complete Address: 'S¥~EEi ADDRESS 7 West Shore Drive Cumberland County CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 45,600.00 2,400.00 0.00 0.00 Interest/Penalty if applicable D. Interest E. Penalty t STATE ZIP PA 17011- Total Credits (A + B + C) (2) (1) 63,781.00 Total Interest/Penalty (D + E) (3) 48,000.00 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) 15~781.00 A. Enter the interest on the tax due. (SA). 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 15 f 781.00 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; ....................... [~ ~ b. retain the right to designate who shall use the property transferred or its income; ......... [~ ~ c. retain a reversionary interest; or ................................ ~ [--~ d. receive the promise for life of either payments, benefits or care? ................. [~ [--~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration7 ............................ [~ ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death7 r-~ [~ 4. Did decedent own an Individual Retirement Account, annuity, or 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 examined this return, including accompanying schedules and statements, and to the best of my knowledge end belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. A~oDN~ATURE OF PERSON RESPONSIBL~FOR FIL~G RETURN ,,,) FRANCIS A. BOYLE, V.P SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3°6 [72 P.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°,6 [ 72 P.S. § 9116 (a) ( 1.1 ) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax 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 OO6 [ 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. § 9110(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. § 911 §(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. HASPXXNUMBER REV- fSO2EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchange beWveen a willing buyer and a willing seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is jointly-owned wit right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Property known as 7 West Shore Drive, Camp Hill, PA; sold at Copy of Settlement Sheet attached TOTAL (Also enter on line 1, Recapitulation) $ 178,500.00 HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) 178,500.00 REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2 4,032 Shares Allied Irish Banks PLC 1,751.948 Shares Dreyfus PA Intermediate Municipal Bond Fund; NYSE 6,759.907 Shares Dreyfus Premier Municipal Bond Fund PA - Class B; NYSE 2,621.189 Shares ML Balanced Capital I; NYSE Fund Class TOTAL (Also enter on line 2, Recapitulation) $ 312,4 3 7.8 3 HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) 115,012.80 24,352.08 109,037.30 64,035.65 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 Include the )roceeds 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 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 3 4 10 11 Automobile, 2003 Lexus ES300; appraisal attached Checking Account No. 82042047 with M&T Bank Interest accrued to 7/10/2003 Jewelry; appraisal attached Personal Property; appraisal attached Personal Property; sold at Premium refund from AARP Auto and Homeowner's Insurance Program Premium refunds from Hartford Insurance Company Refund from Verizon Refund of County/City real estate taxes due to sale of property listed on Schedule A Savings Account No. 15004208556281 with M&T Bank Interest accrued to 7/10/2003 Money Market Fund held in Account No. 57307316 with Citizens Bank 31,000.00 24,602.64 0.33 10,453.00 7,396.00 1,071.95 408.00 1,002.00 13.91 51.74 22,578.21 0.92 15,140.61 $ 113,719.31 TOTAL (Also enter on line 5, Recapitulation) HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) REV-I~510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Jacc~el£ne C St±ne 21 2003 0616 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 % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DATE OF DEATH DECD'S EXCLUSION DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE TAXABLE VALUE NUMBER DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~F APPLICABLEI 1. IRA Account No. 57659950 with Citizens Bank; now payable to Maureen McGarvey (sister) and Richard Moye (brother) 10,506.63 100.000 0.00 10,506.63 TOTAL (Also enter on line 7, Recapitulation) $ 10,506.63 (If more space is needed, insert additional sheets of same size.) HASPXXNUMBER REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERALEXPENSES: Parthemore Funeral Home statement Catholic Cemeteries opening DESCRIPTION - grave Total from continuation pages ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Mellon Rank N.A. 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 Prepareds Fees Cumberland Law Journal estate notice The Patriot News notice estate Eby Real Estate Appraisals - appraisal fee Total from continuation pages AMOUNT 7,966.90 675.00 1,690.69 32,390.00 21,590.00 436.00 75.00 205.69 300.00 16,181.31 TOTAL (Also enter on line 9, Recapitulation) $ 81,510 . 5 9 HASPXXNUMBER (If more space is needed, insert additional sheets of same size) Schedule H part 1 (Page 2) Estate of: Jacqueline C Stine Item No. Description Amount Maureen McGarvey - reimbursement of funeral expenses 1,690.69 Total (Carry forward to main schedule) 1,690.69 Estate of: Jacqueline C Stine Item No. Description Schedule H part 2 (Page 2) Amount 4 AT&T - telephone service 5 Bonnie K Miller - tax certification fee 6 City/County Tax Stamps due to sale of real estate 7 Comcast - cable service 8 Greg Fuller - maintenance 9 J C Ehrlich Company - maintenance 10 Jack Guzzi maintenance 11 Lawns Unlimited - maintenance 12 Lower Allen Township - water & sewer service 13 Marsh USA Inc - property insurance 14 Mary Beth Schropp jewelry appraisal fee 15 Mellon Bank - fee re settlement of real estate 16 Molly Hardy - maintenance 17 Paladin Auction Company - commissions & costs of selling personal property 18 PAWC - water service 19 PP&L - electric service 20 Real Estate Agent's Commission due to sale of real estate 21 Tim's Carpet & Upholstery Cleaning - maintenance 22 Verizon - telephone service Total (Carry forward to main schedule) 68.16 4.00 1,785.00 95.07 50.00 103.50 25.00 1,060.00 41.20 178.74 300.00 1,785.00 545.39 317.99 87.46 275.59 8,925.00 68.90 115.31 15,831.31 Schedule H part 2 (Page 3) Estate of: Jacqueline C Stine Item No. Description 23 Ziegler Auction Company - personal property appraisal 24 Miscellaneous Estate Costs Amount 250.00 100.00 Total (Carry forward to main schedule) 350.00 REV-I'512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 7 8 9 10 11 12 13 United States Treasury - 2003 federal individual income tax PA Department of Revenue - 2003 state individual income tax AT&T - statement Bankcard Services - statement Comcast statement J C Ehrlich Company - statement PAWC - statement PP&L - statement Shipley Energy - heating oil Shipley Energy - repairs Verizon - statement Bonnie K Miller, Tax Collector - per capita tax Bonnie K Miller, Tax Collector - school real estate tax TOTAL (Also enter on line 100 Recapitulation) $ 2,144.88 444.00 295.00 40.85 213.49 39.64 69.00 43.83 154.28 119.61 156.00 73.55 9.80 485.83 HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) REV-,1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Jacqueline C Stine 21 2003 0616 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtransfers underSec. 9116(a)(1.2)] Maureen M. McGarvey 7 West Shore Drive Camp Hill, PA 17011 John C. Moye Sr 136 Edge Avenue New Castle, DE 19720 Richard A. Moye 9816 Greenview Lane Manassas, VA 22109 Mary Beth Schropp 2526 Boas Street Harrisburg, PA 17103 Total from continuation pages Eister Brother ~rother ~ister 109,453.62 104,200.35 109,453.62 104,200.35 104,200.36 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ HASPXXNUMBER (If more space is needed, insert additional sheets of the same size) Schedule J part 1 (Page 2) Estate of: Jacqueline C Stine Item No. Description Relation Amount 5 Jane A. Shurig 211 E Lutz Avenue Lafayette, IN 47906 Sister 104,200.36 Total (Carry forward to main schedule) 0.00 SETTLEMEN r s rAl EMEN r Affiliated Settlemeot Services Group, LLP 3912 Market Slree/ Camp Hill, PA 17011 (717) 975-7839 FINAL 0 rYPl:~ OF lOAN 1. [ [ t'llA 21 FMIIA :] :Xldt)IIV Ullit,i5 .1. ~ I VA .5. t I COflV I1l.'; 6 ESl'l~'l)W FII F NIIMliER: ! I.OAN NtIMHFR: 00002591)-0() I I~.ll )ti 3()31 1SI(J5 D. NAME OF BORROWER: -' David A. Enri6b and Do,ma M: EnriCo ADDRESS OF BORROWER: 423 Herman Ave. Lemoyne, Pa. 17043 El -i'AME OF §[Li~i ..... Million Bank N.A.' .... ADDRESS OF SELLER: F. HAME OF LENDER: ADDRESS OF LENDER: G: PROPERTY L-OCATION: --' - Sunset Mor~cja-~e--C~lSan-};, LP -'- 1408 West Baltimore Pike Franklin Center, Pa. 19091-001 '- ' 7 W~st Sh(Sfi}-Di'ii2~ Camp Hill, PA 17011 Cumberland County 13-24-0807-101 13-24-0807-101 ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/Town Taxes 212. Assessments 213. 214. 215. 216. 217. 218. 2t9. 220. TOTAL PAID BY/FOR BORROWER I~ a~: re~d'A'~_ ~. _~ .~. ~-"~-' 301. Gross amount due from Borrower ( line 120) ......... '~.01 ~'.Cou~l(y~a~es li/')1103 t,, i~J3{10::~ ' - 2901 ~ 408. Assessmenls 794.78 -4-~. gchoolTaxe 11/21/03 to 06/30/04 7~.78 411. 412. 413. 414. 415. 420. GROSS AMOUNT DUE TO SELLER: 179,378.67 501. Ex,ss deposit (see inslmclions} 60~00.~ ~. ~ei~emeni ~ai0~i i~ ~ii~ {i~'i ~j ................ ~0.7~0.~ 505. Payoff of second mortgage loan -~06. - ~o9.' ................ ADJUSTMENTS FOR I~i~ ~;iF~I3 ~Y ~iL~k~ ........... 516· 186,724,O5601. Gloss amount due to Seller (line 420) 179,378.67 603. CASII ( [ ~FROM ) { [~ TO ) SEt I ER 168.665 67 1~1,000 O0 303 CASII(,~JFROM) (Ii TO)BORROWER: 25,72405 ~0_-~. City/Town Taxes to 12/31/03 10__7:County Taxes 11121103 to 12/31/03 108. Assessmenls 109. SchooITaxe 11121/03 to 06/30/04 110. Sewer/Refus 11/21/03 to 12/31/03 111. 112. 113. 114. 115. 120. GROSS AMOUNT DUE FROM BORROWER: 180,724.05 201. Deposit or earnest money 202. Principal amount o! new loan(s) 20:J: ~:xl~-I,~(~d~ect to 204. 208. -- 209. P~CE OF SE~LEMENT: Affiliated Settlement Settees Group, 3912 Market Streel, Camp Hill. PA 17011 t. SE~LEMENT DATE: 11/21/2003 PRORATION DATE: ......... D~R~L:ME~f 5~: .... ~ ~/~/~03 ~- SUM~RY OF BORROWER'~SACTION ....... ~'R: ....... ~UMMAA? OF ~ELLER'S rRAHsAcfioh ......... 101. Con,ac, Sales Pr,~ !7.8'_~00~0 I~L59nlract ~"~ ~'?t ................. l ...... ~'t~0-'p0- 102. Personal Properly [ 40Z Pets~al Properly 103. Setllemenl charges lo Borrower (line 1400) ' 7.31ff38 ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID it~' SELLER IN ADVAHCE: 11121103 ....... 22:73 '~6. Cil~0-~-Taxes 11121103 I, 12i~i/03 .... 22.~ _S[]-rlEMENT CHA~ES _ ~ ES_C_~OW F!_L,E ~'ilIMBER: _00.09259_0-0.~0! MDB BASFD ON PRICES 178,500.00 ~ 5.000%= $8,925 00 [ PAiD FROM PAID FROM DIVISION OF COMMISSION {LINE 700) AS FOLLOWS: I 80~{ROVVER'S SELLFR'S ~i.~ ..... ~-~i~0 i~-- Re-r~x R~liy Prai~ai~al~ _ __ : .... - .. { FUNDS A r FUNDS AT , I SETtLEMENt SE'FILEMEN r 702;$' 4,462.50 to M.C. W~I[~i R~It~ ............ , 703. Commission paid at seltlement 801. Loan OriginaOon Fee % Io Sunset Mortgage C~pany, LP 1,600.00 802. Loan Dis~onl Fee .................... ~. " 803. Appraisal Fee Io Pedormance Appraisal 275 00 804. Credil Repod ._ 805. Lenders Inspecti~ Fee ' ....................... 806. Modgage Insuran~ Ap¢i~lion Fee 807. A~umpdon Fee ............. ~ -- - ~ ......... 808. Administration Fee lo Sunsel Mo,gage Company, L~ ...... 809. Pro~ssing Fee ~ i~ Sunset ~5~y, LP ................ 250 00 810. 811. 901;Interest From ~1~1/03 Io 902. Mortgage Insurance Premium for Month(s) Io 903. Hazard Insurance Premium for Years(s) lo 1001. Hazard Insurance 4 months I~J $ 34.50 per month 1002: Mortgage Insurance months 1003. City Property Taxes 11 months i 0d,i. County Property Taxes 11- months 1005. ~nnual Assessments months 1006. School Taxes 5 months ~ $ 1007, months @ $ 54.67 ]er month 12.29 )er month 22.06 )er month )er month 108.90 )er month tar month ........ ~"- .......... "='~'_.' ":=2 ',i ......... 13800 .... _--'L' '2242_'66 - 1008. Aggregate Acct. Adj. months (i~ $ )er month ...... %527;16 ] ............. 1101. SelUement or dosing fee 1102. Abstract or tlUe search 1103. TiOe examination 1104. Title insurance binder Document preparation 1106. Notary lees to Settlemenl O~ficer 1107. Attorney's Fees 1108. 1109. Lenders coverage $ 160,000.00 (includes above items numbers: Title Insurance tO ~ffili~l~le~ (includes above ilems numbers: 1110. Owner's coverage 1111. End. 8.1, 100 & 300 i i ~:- v~'~'~-~ig-~iFl~llvery Fees 1113. ]ns~ C--~i~g Letter $ 178,500.00 lo Aff~liated SetUement Servi~'GT&-up,~EEP lo 'Affili:~ t-6'd- S~tU ~-n~'~ f S ~-P;i~ ~'G r-ou p, L L P - lo Gu~ra-'~'~e-'TiU~n--d T~t C~'~pany ............ 2500 ........... i'.253.75 150.00 1201. Recording Fees: Deed $ 38.50 Mortgage $ 64.50 Release $ 120Z CltylCounly lax/stamps Deed $ 1,785.00 Mortgage 1203. Slate lax/stamps Deed $ 1204. Assignment of Mortgage lo Recorder ol Deeds 1205. 1,785.00 Mortgage $ 1301. Survey 1302. Pest Inspection i303. ~C-~-r~ficatlon Fee 1304. HomeANondPest Insp.&Radon ~305. to B~iller 1o Bie--c~fllery, Inc. - --- 30.00 .......... ' 3,&bo -~ ................. .:C-_' .~_ 103.00 1,785.00 _ --'~-.'--~.,_77s ~ ........... 27.00 4.00 405:'00 1306, 1307. "See attached for breakdown '~ ~ ~. ~r OTAL--SETT EEJglE N T '~R-A-R ~, E 5'-{ E B ~m'~'~103,~io-~-J~- ~'-d: h'~-5-02~-S ~-Etio n K ) 7,345.38 10,7 t 0.00 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of al receipts and dist~ursements made on my account or by me in this transaction. I lurther certify thai 1 have received a copy ~f the HUD-1 Settlement Statement. (.,/Lc'L Lit ~ (-- ' // ',~/- 2,:'u :5 Donna M. Endco Borrowers Sellers The 1IUD-1 Se~efnenl Statement wflJch I have prepared is a true and accurale account of this transaction. I ha,.u caused or will cause the funds to be disbursed in accordance with th~. statement. · ~ . '3 (~,~..r~*'"-' Settlement Agent Affiliated'Setlle(~ Services Group, LLP ~'~)- ) ! -¢~ _ Date WARNING: It is · crime to knowingly make false statements ID the United Slates on this or any similar form. Penalties upon conviction can include a fine and Int,oitsonmenL For details see: Titb 18 U.S. Code Section 1001 and Section 1010. Diamond Mounting A Specialty CG BUSER & SON 875 Market Street, Second Floor Lemoyne, PA 17043 (717) 972-1230 Prompt Attention To Mail Orders September 2, 2003 Page 1 Appraisal For: Estate ofJacqueline Stine C/O Mary Schropp Lady's 14K yellow gold 7.75mm wide omega necklace with figure 8 catch. The necklace ,weighs approximately loz 9dwt 21gr. Total fair market value, approximately $~600. Lady's 14K white gold 17 jewel Hamilton watch on black chord band. The Case contains 2 brilliant cut diamonds and 26 single cut diamonds. The diamonds weigh approximately 2-Spt brilliant cut, 6-3pt single cut, 2-2.5 single cut, 16-1pt, and 2-1/2pt. All the diamonds are of VS to VVS clarity and I-H color. Total fair market value, approximately $350. Lady's 14K white and yellow gold twisted rope ankle chain measuring approximately 9 inches long and weighing approximately 3dwt 19gr. Total fair market value, approximately $70. Lady's 14K yellow and white gold twisted rope bracelet measuring approximately 8 inches long and weighing approximately 3dwt 7gr. Total fair market value, approximately $62. Lady'.s 14K yellow gold 24-inch twisted rope chain that weighs approximately 7dwt ltgr. Total fair market value, approximately $150. Lady's 14K yellow gold hollow 30-inch rope chain that weighs approximately 4dwt 20gr. Total fair market value, approximately $96. ManufacturingJewclers & Diamond Sctters Estate ofJacqueline Stine Page 2 Lady's 14K yellow gold 18-inch Gucci chain with 14K yellow gold 3-leaf clover pendent. The chain and pendent weigh approximately 3dwt 21gr. Total fair market value, approximately $75. Lady's 7.5-inch long 14K yellow gold diamond tennis bracelet containing 35 brilliant cut diamonds. The diamonds weigh approximately 13 to 15pts each with a total weight of approximately 5cts. The diamonds are of I1 to I3 clarity and I-H color. The bracelet weighs approximately 9dwt lgr. Total fair market value, approximately $1,700. Lady's fancy 8-inch 14K yellow gold bracelet that weighs approximately 4dwt 3gr. Total fair market value, approximately $80. Lady's 14K yellow gold oval shaped pendent containing 1 large brilliant cut diamond~nd 2 smaller brilliant cut diamonds. The larger diamond weighs approximately 28pts is of I2 clarity and I-H color. The smaller diamonds weigh approximately 15pts each and are of I2 clarity and I-H color. The pendent weighs approximately 3dwt 13gr. Total fair market value, approximately $340. Lady's 14K white gold ring containing one emerald cut emerald and two brilliant cut diamonds. The emerald measures approximately 6.6mm x 4.6mm, is chipped and of medium green color. The diamonds weigh approximately 3pts each and are of I1 to 12 clarity and I-H color. The ring weighs approximately 1 dwt 18gr. Total fair market value, approximately $300. Lady's 14K white gold ting containing 5 brilliant cut diamonds. The diamonds weigh approximately 19pts each. Two of the diamonds are of]I! clarity, two ~ 9f~3 ~_'~ and one is chipped. All the diamonds are of I-J color With t,l~e excePtion of the di~ll~l'i~i" is chipped, which is of J-K color. The ring weighs approximately 2dwt 12gr. Total fair market value, approximately $350. Lady's 14K white gold six prong ring containing one brilliant cut diamond that weighs approximately l ct and is of VVS clarity and G-H color. The ring weighs approximately 2dwt. Total fair market value, approximately $5,500. Estate ofJacqueline Stine Page 3 Lady's 14k white gold diamond cluster ring containing one large brilliant cut diamond and 24 smaller brilliant cut diamonds. The larger bril~ant cut diamond weighs approximately 33pts and is of I1 clarity and I-H color. The smaller brilliant cut diamonds weigh approximately 2.5 to 3pts each, are of SI to VS clarity and I-H color except one that is badly chipped. Total weight of all diamonds approximately lct. Total weight of ting approximately 5dwt 1 lgr. Total fair market'valu~, approximately $780. Ckarl:s G Buser G.G., I.S.A. Fair Market Value: The price in the market place in which the item would change hands between willing buyer and willing seller, neither under any compulsion to buy or sell and each having reasonable knowledge of the relevant facts (i.e.: the price in the marketplace in which the item is most commonly sold to the public). Also taken into consideration was a reasonable and realistic time frame for willing buyers and willing sellers to reach an "arms-length" agreement within the market. T JAY E. ZIEGLER, CAI, AARE AUCTIONEER 1550 SAND HILL RD. HUMMELSTOWN, PA 17036 VOICE: 717.533.4267 FAX: 717.533.2114 WEB SITE: zieglerauction.com E-MAIL: info@zielglerauction, corn APPRAISAL AUGUST 19, 2003 TO WHOM IT MAY CONCERN: THIS IS TO CERTIFY THAT WE ARE ENGAGED IN THE ANTIQUES, HOUSEHOLD FURNITURE AND HOUSEHOLD GOODS BUSINESS. WE CERTIFY THAT WE CAREFULLY EXAMINED THE FOLLOWING LISTED AND DESCRIBED ARTICLES, WHICH ARE THE PROPERTY OF - ESTATE OF JACQUELINE ST/NE 7' WEST SHORE DRIVE CAMP HILL, PA C/O WANDA S. JONES MELLON BANK 7'35 MA RKET $ T., SUITE 205 PHILADELPHIA, PA fgf03 WE ESTIMATE THE APPRAISED VALUE AS LISTED FOR ESTATE OR OTHER PURPOSE AT THE PRESENT CURRENT MARKET VALUE. IN MAKING THIS APPRAISAL, WE DO NOT AGREE TO PURCHASE OR REPLACE THE ARTICLES. SINCERELY, jX~ ~.~GLER,/, CAi~~ ZIEGLER AUCTION COMPANY, LTD. 1 ESTATE OF JACQUELINE STINE APPRAISAL LIVING ROOM Wall Shelf Unit, Contents, Kissing Statue, Cut Glass Pieces Wedgwood Box ,~ $ 55.00 Gold Framed Round Bullseye Mirror wi Eagle $ 85.00 Brass Umbrella Stand $ 10.00 Set of 3 Nesting End Tables $ 40.00 Urn Shaped Lamp, 3 Carved Wood Figurines, Marble Dish $ 15.00 Gold Flowered Loveseat & Matching Sofa $ 100.00 Magazine Rack $ 25.00 Corner Curio Cabinet $ 80.00 (10) Lladro Figurines $ 300.00 (3) Hummel Figurines (2-damaged) $ 70.00 Mahogany Duncan Phyffe Style End Table $ 50.00 (2) Capadamonte Flowers, Golden Crown Flower, Byer Choice Sea Captain $ 75.00 (3) Signed Belgium Framed Prints "Linck' $ 40.00 Wall Candle Sconce, Mirrors & Shelf, Brass Shamrock, Wedgwood Plaque $ 25.00 Royal Doult~n "The Clockmaker' $ 100.00 Norman Rockwell Figurine "T~,e Marriage License' $ 20.00 4-Drawer Chest/Server wi Inlay (Goldsmith) $ 80.00 (2) Light Blue Arm Chairs (show use) $ 20.00 Round Coffee Table wi Leather Top $ 35.00 Glass Table FloOr Lamp $ 20.00 (4) Norman Rockwell Collector Plates, (2) Foo Dog Figurines, Brass Candle Holder, Cricket, Figurines $ 35.00 Elgin Open Case Pocket Watch $ 80.00 Oriental Satsuma Vase $ 60.00 Heritage Grandfather Clock wi Walnut Case $ 120.00 3-Tier Mahogany Shelf $ 40.00 Contents - Miscellaneous Figurines, Wood Carvings, Oriental Jar & Figurines, Framed Religious Picture $ 20.00 Sony TV, VCR & Stand $ 120.00 TV Trays & Stand, (2) Signed Prints "Winter Thaw" & "Winter Day' $ 30.00 ZIEGLER AUCTION COMPANY, LTD. 2 ESTATE OF JACQUELINE STINE APPRAISAL DINING ROOM Crystal Chandelier French Provincial Dining Set- China Cabinet, Table, 6 Chairs, Server Bristol 5-piece Silverplate Tea Set Oval Mirror wi Gold & Green Frame Server Contents, Serving Bowls, Fostoria Dishes 8 Tall, 8 Sherbets Waterford Jam Jar, Creamer, Small Bowl, Bell, 4 Shakers Silverplate Trays, Bowls, Sterling Candle Holders Service for 12 Theodore Haviland Limoges (many pieces are damaged) Miscellaneous Glass Dishes, Glass Salts, Decorated Bowl, Large Cut Glass Bowl Sterling International Service for 8 wi extra Sterling Spoons (pine spray pattern) (6) Royal Austria Salts Glass Punch Bowl, Ladle, 8 Cups Small High Chair Closet Contents - Stemware, Cow Creamer, Glasses & Serving Pieces Waterford Bowl & Candle Holders 600.00 350.00 100.00 40.00 25.00 400.00 $ 120.00 $ 70.00 $ 5o.oo $ 5o.oo $ 300.00 20.00 60.00 35.00 25.00 85.00 PORCH AREA Wrought Iron Table & 4 Chairs Wrought Iron Settee, 2 Chairs, 2 End Tables $ 100.00 $13o.oo KITCHEN Franciscanware- Dishes, 16 Plates, Pots & Pans, Appliances $ 120.00 HALLWAY Chalk Dog Door Stop Oreck Vacuum Cleaner 10.00 30.00 BEDROOM #1 Poster Bed, Dresser wi Mirror, Chest of Drawers, Rocker Electrified Blue Glass Oil Lamp Flat Iron, Candle Holder, Frame, Miscellaneous Trinket Boxes 350.00 75.00 $ 15.00 ZIEGLER AUCTION COMPANY, LTD. 3 ESTATE OF JACQUELINE STINE APPRAISAL BEDROOM #2 Sheraton 1-Drawer Stand wi Tiger Maple Drawer White Lounge Chair ,. Pine Poster Rope Bed Cherry Dresser wi Mirror $ 175.00 60.00 225.00 $ 150.00 Ornate Silverplate Hand Mirror $ 15.00 BEDROOM #3 ~ Set - Modern Poster Bed, Dresser wi Mirror, Nightstand, Lingerie Chest $ 300.00 Decorated Plank Bottom Chair $ 20.00 BASEMENT ~ther-top Coffee Table ~ 15.00 (4) Pine Spindle-back Chairs 40.00 Maple Corner Desk $ 20.00 Oak Child's Rocker $ 20.00 Figural Statues, Mugs $ 10.00 Decorated Plank Bottom Chair $ 20.00 Card Table & Chairs $ 10.00 Small 4-Drawer Pine Chest of Drawers $ 35.00 (2) Tan Platform RockerslRecliners $ 80.00 Blue Sofa wi Recliner Ends $ 100.00 Glass Top Golf Green Coffee Table $ 75.00 (4) TV Trays & Stand $ 8.00 2-Drawer Sheraton Lamp Tables $ 170.00 (2) Wicker (back & side) Arm Chairs 6' Bar & (2) Bar Stools End Table & (2) Lamp Tables (11) Framed Pictures, Golf Clock Black Horse Chalk Figurine 20.00 35.00 20.00 30.00 20.00 HALL Garden Tools Walnut Wash Stand Maytag Refrigerator $ $ $ 8.00 110.00 20.00 ZIEGLER AUCTION COMPANY, LTD. 4 ESTATE OF JACQUELINE STINE APPRAISAL BEDROOM #4 Large Cedar Blanket Chest $ 80.00 Knee-hole Desk $ 35.00 Grain Painted Shelf Unit $ 45.00 Mattress & Box Spring wi Frame $ 30.00 Windsor Style Chair $ 20.00 Safe, Lamp, Tennis Racket, Globe, Books $ 25.00 Cuckoo Clock $ 30.00 LAUNDRY ROOM ~r & Dryer $ eo.oo Step Ladder, 4-Drawer File Cabinet, Step Stool, Metal Cabinets $ 15.00 Miscellaneous Pots & Pans, Vases $ 10.00 Walnut Organ Stool $ 40.00 Hair Dryer & Chair $ 10.00 WORK ROOM ~e $ 15.00 Garden Stools $ 5.00 Hand Tools & Cabinets, Binoculars, Fans, Lamps $ 35.00 Wooden Tool Box $ 70.00 GARAGE ~inum Ladder $ 15.00 Step Ladder, Garden Hose, Step Stool $ 15.00 Golf Clubs $ 50.00 Garden Tools $ 20.00 Concrete Porch Bench $ 30.00 TOTAL APPRAISAL $~, 39--~-~. O0 2003 Lexus ES300 4-door Sedan, 4,695 miles - $31,000 YIN #~JTHBF3OG830092564, gray ZIEGLER AUCTION COMPANY, LTD. 5 LAST WILL AND TE:; tMENT OF JA CQUELINE C. STINE I, JACQIYELINE C. STINE, of 7 West Shore Drive, Camp Hill, Pennsylvania, being ' of sound mind, memory and understanding, do make ~:nd publish this, my Last Will and Tesramer~, hereby revoking and making void all formc~ ~,v'ills by me at any time heretofore made. FIR~: I direa my hereim/ter named Executor to pay all my legally enforceable debts, funeral expenses, administration expenses, and i~l,, kance, estate, succession or excise taxes, which I owe or may become due on account of ny, ,', .:ath, as soon as may be eonvenier~ after my decease. · ~: [give and bequeath my jewelry, Waterford crystal and Lladro figurines to my,sister, MARY BETH SHROPP. I further direct that MARY BETH SHROPP, in her 'absolute discretion, may distribute some of these items to MAUREEN MCGARVEY and THIRD: I give, devise and bequeath all the rest, residue and remainder of my estate, to my brothers and sisters in equal shares as follows: 1. One-fifth (1/5) of my estate shall pass to JOHN MOYE, curremly of New castle, ~Delaware. 2. One.fifth (1H) of my estate shall pas~. to RICHARD MOYE, currently of Manassas, Virginia. Pase, of 2 Pages ,~'"/'~'~-~*'":/;j -//*~(, (SEAL) ,' J.~4~QUEI,INE C. STINE 3. One-fifth (1/5) of my estate shall pass to MARY RETIi SItROPP, currently of Harrisburg, Pennsylvania. 4. One-f'fflh (1/5) of my estate shall pass 1o i..UNE SHURIG, currently of West Lafayette, Indiana. 5. One-f'dlh (1/5) of my estate shall pass to MAUREEN MCGARVEY, currently of San Jose, California. In the event one or more of my brothers or sisters should predecease me or fail to survive me, I direct that their share of my estate shall pass to their issue per stirpes. FORTH: I nominate, constitute and appoint MELLON BANK, N.A., as Executor of this, my Last Will and Tes~ment, authorizing and empowering it to sell and convey any and all real estate of which I may die seized and possessed. I further direct that my Executor or personal representative shall not be required to post I~ond to act i~'said capacity. IN WITNESS WHEREOF, I, JACQUELINE C. STINE, have hereunto set my hand and seal, to this my Last Will and Testament, this ~ day of March, 1999. SIONED, SEALED, PUBLISHED and DECLARED by the above- named Testatrix, JACQUELINE C. STINE, as and for her Last Will and Testament, in the presence of us, who at her request and in the presence of each other, have hereunto set our names as witnesses: j/ J.~UQUELINE C. '$TIN~ (SEAL) Mellon April 8, 2004 '04 APR 13 Alt:50 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013-3387 RE: Estate of Jacqueline C Stine DOD 7-10-03 File No. 21-03-0616 Ladies and Gentlemen: As Executor of the above named Estate, we file herewith 2 copies of the Pennsylvania Inheritance Tax Remm (Form Rev-1500). Also, please find enclosed are checks in the amounts of $15,781.00 and $15.00 for the balance of inheritance tax due and your filing fee respectively. Please send us your official receipts. Sincerely, Robert G Chase Estate Tax Officer (215)553-1047 cc: Terrence J Kerwin, Esquire Wanda S Jones, Trust Officer Room 193-0205 · Private Wealth Management 1735 Market Street · P.O. Box 7899 · Philadelphia, PA 19101-7899 A Mellon Financial Company.s,u 170J3 000~632-0~ FIRST CLASS MAIL CB-1059.113 (Rev. 4~3) PD 4~03 ITY COURTHOUSE IUARE 'L7013-3387 BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX D/VTSZON DEPT. Z80601 HARR/SBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15q7 EX AFP ROBERT G CHASE HELLON BANK NA PO BOX 7899 PHZLA ~:., ';: DATE 05-Zq-ZOOq ESTATE OF STINE DATE OF DEATH 07-10-2005 FILE NUHBER 21 05-0616 ACN IO! I Amount Remitted PA 1910-! JACQUELIN C HAKE CHECK PAYABLE AND REMIT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THXS LXNE ~ RETAXN LOWER PORTXON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTXCE OF XNHERXTANCE TAX APPRAXSEHENT, ALLOWANCE OR DXSALLO#ANCE OF DEDUCTXONS AND ASSESSHENT OF TAX ESTATE OF ST/NE JACQUELTN C FXLE NO. 21 03-0616 ACN 101 DATE 05-Zq-ZOOq TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNTNG FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnersh/p Interest (Schedule C) (3) q. Mortgages/Notes Race/vabla (Schedule D) 5. Cash/Bank Deposits~Misc. Personal Property (Schedule E) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/N/so. Expenses (Schedule H) (9) 10. Dabts/Nortgaga L/ab/1/tias/Lians (Schedule I) (10) 11. Total Deduct/ons 12. Net Value of Tax Return 178~500.00 312~q37.85 .00 .00 115~719.31 .00 NOTE: To /nsure proper cred/t to your account, sube/t the upper portion of th/s fore w/th your tax payment. 10z506.63 (a) 615,163.77 81,510.59 13. NOTE: Z,lqq.88 (11) 83.655.~7 (12) 531,508.30 Char~table~Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) Nat Value of Estate SubSect to Tax (lq) 531,508.30 Zf an assessment was issued prevlousZy, Zines 14, 15 and/or 16, 17, 18 and 19 w111 AMOUNT PAID q5,600.00 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of L/ne lfi at Spousal rate (15) . O0 X O0 = 16. Amount of L/ne lfi taxable a~ Lineal/Class A rate (16) . O0 X Oq5 = 17. Amount of L/ns lq at Slbllng rata (17) 531,508.30 x 12 = 18. Amount of L/ne lq taxable at Collateral/Class B rate (18) . O0 X 15 = 19. Princ/pal Tax Due (19}= TAX CREDITS: PAYMENT RECE/PT OTSCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 10-10-2003 CD003115 Z,qO0.O0 INTEREST IS CHARGED THROUGH 06-08-ZOOq AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM .00 .00 .0O 63,781.00 .00 63,781.00 q8,000.O0 15,781.00 lOZ.qZ 15,883.~2 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 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 SZDE OF THIS FORM FOR /NSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE= PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is trmnsferred 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 S (collateral) rata an any such futura interest. To fulfill the requirements of Section 2140 af the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit mith your payment to the Register of #ills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, ~hich Has not requested an the Tax Return, say ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special Z4-hour ansearing service for forms ordering: 1-800-58Z-ZOSO; services for taxpayers eith special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disalloaanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object ~ithin sixty (60) days of receipt of this Notice by: --~rittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZBZOZI, Harrisburg, PA 17128-10Z1, 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 mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid eithin three (3) calendar months after the dacedant's death, a five percent (SI) discount of the tax paid is allowed. 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 appeaIabla in the same manner and in the the same tiaa period as you ~ouId appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (i) day from the data of death, to the data of payment. Taxes which became delinquent before January l, 198Z bear interest at the rata of six (6Z) percent par annum calculated at a daily rate of .000164. Ali taxes ahich became delinquent on and after January 1, 198Z will bear interest at a rata ahich 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 ZOO4 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rata Factor ~ lOX .00054B ~r8-1991 ill .000501 1985 16Z .000438 199Z 9Z .000247 1984 IlZ .000501 1993-1994 ?Z .OOO19Z 1985 15Z .000356 1995-1998 9Z .000Z47 1986 lOZ .000274 1999 7Z .O00IgZ 1987 IOZ .000Z74 ZOO0 7X .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Daily Year Rate Factor ~ 9X .000247 ZOOZ 6Z .000164 ZOO5 5Z .000157 2004 4X .000110 X NUIIBER OF DAYS DELZNI~UENT X DALLY INTEREST FACTOR --Any Notice issued after tho 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 sheen on the Notice, additional interest must ba calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-1607 EX AFP (01-03) ROBERT G CHASE MELLON BANK NA PO BOX 7899 PHILA PA ~:i DATE 05-24-Z004 ESTATE OF STINE JACQUELIN C DATE OF DEATH 07-10-2005 FILE NUHBER 21 05-0616 '04 JU;'~ -7 71 ?;5 COUNTY CUMBERLAND ACN 101 Aeoun'l: Reei *l:*~ed HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To Ansure proper credit: ~:o your account, subei~: ~:he upper portion of ~his fore w/~h your ~ax payeen~. CUT ALONG THIS LINE ~* RETAIN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ##~ 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF STINE JACQUELIN C FILE NO. 21 05-0616 ACN 101 DATE 05-24-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM IN THE NAHED ESTATE. SHO~/N BELON IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPL/CATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED /NTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 65,781.00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-10-2005 04-15-2004 CD005115 CD005810 2,400.00 .00 45,600.00 15,781.00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-14-2004 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 65,781.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. 5.21 TOTAL DUE 5.21 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PAYNENT: Detach the top portion of this Notice and submit aith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- If NON-RES/DENT DECEDENT sake check or eoney order payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Ni]ls, any of the 23 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-361-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-3010 (TT only). REPLY TO: guastions regarding errors contained on this notice should ba addressed to: PA Departeant of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (51) discount of the tax paid is allowed. PENALTY: The 151 tax amnesty non-participation penalty is computed on the tote1 of the tax and interest assessed, and not paid before January ZB, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on end after January 1, 1981 mill 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 2004 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 lOX .000548 1988-1991 11Z .000301 ZOOl 1983 16Z .000438 1991 91 .000147 2002 1984 111 .000301 1993-1994 71 .000192 ZOOS 1985 131 .000356 1995-1998 9Z .000147 Z004 1986 lOZ .000274 1999 72 .OOOlgZ 1987 91 .000247 2000 81 .000219 Interest Daily Rate Factor 9X .000147 61 .000164 SZ .000137 41 .000110 --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 will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. GREGORY M. KERWIN TERRENCE J KE~W~N JOSEPH D. KERWIN hOLLY MCCLURE KERWIN ATTORNEYS AT LAW ESTATE OF JACQUELINE C. ST1NE, -2 [~'~ :39Deceased : 1N THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA : ORPHANS' COURT DIVISION : ESTATE NO. 2003-00616 RECEIPT. RELEASE AND INDEMNIFICATION KNOW ALL MEN BY THESE PRESENTS, that THE ESTATE OF JOHN MOYE, deceased, late of 136 Edge Avenue, New Castle, Delaware, does hereby acknowledge that John Moye received from Mellon Bank, N.A., c/o Wanda S. Jones, Trust Officer, P.O. Box 7899, Philadelphia, Pennsylvania 19101-7899, Executor of the Estate of Jacqueline C. Stine, late of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, an advanced distribution of Fifty Thousand Dollars ($50,000.00), and property distributed in-kind. Upon the signing of this Receipt and Release, the Estate will receive the additional sum of Forty Thousand Six Hundred Eighty-Nine Dollars and Eighty-Five Cents ($40,689.85), in accordance with the attached Schedule of Distribution in full settlement of any claim or claims that the Estate may have by, under and because of the Will of the late Jacqueline C Stine. THE ESTATE OF JOHN MOYE, acknowledges that the entitlement to the above sum is dependent upon there being no farther sums determined to be due and owing by the Estate, including but not limited to, inheritance tax, income taxes, and debts of the decedent; and in the event such additional amounts are due by the Estate, the undersigned agrees to refund to the Executor a proportionate share of such expenses, not to exceed the amount the undersigned received from the Estate. AND, THEREFORE, THE ESTATE OF JOHN MOYE, intending to be legally bound hereby, does, upon receipt of the sums set forth above, by these presents, release, quit- claim and discharge Mellon Bank, N.A., as Executor of the Estate ofJacqueline C. $tine, deceased, and, its successors and assigns, of and from all actions, claims and demands whatsoever, related to the administration of any Trust administered for the late Jacqueline C. Stine and the administration of the Estate of Jacqueline C. Stine. GREGORY M. KERWIN TERRENCE J KErWIN JOSEPh D KERWIN HOLLY MCCLURe KERWIN ATTORNEYS AT LAW THE ESTATE OF JOItN MOYE, acknowledges that John Moye received quarterly account statements from Mellon Bank, N.A., Executor, and acknowledges the Estate has been duly advised of its right to have Mellon Bank, N.A., Executor, file with the Orphans' Court Division of the Court of Common Pleas of Cumberland County an Accounting of the services it has rendered, and does hereby specifically waive the right to have such an Accounting prepared and presented to the Court. IN WITNESS WHE.~i~__OF, I hav~ hereuntq set my hand and seal on behalf of the Estate of John Moye, this ~ ttay of ~-~ U'72004. WITNESS: STATE OF '~e l~t../.,OO-- ir'-~ COUNTY OF ~/'LO~ ~.t S3b/c · ' -- '~ ~-'l.~' , . t~,~Z,~, tmders]gnedofficer, personallyappeared~r?rle~et.~zlor~ ~, ',tor me i~stl~te'of John Moye, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and of~)al seal. ~ :~ JULY ~.:t.- ~_ My Commission Expires: GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D KERWIN HOLLY MCCLURE KERWfN ATTORNEYS AT LAW ESTATE OF JACQUELINE C. STINE, -2 : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA : ORPHANS' COURT DIVISION : ESTATE NO. 2003-00616 RECEIPT. RELEASE AND INDEMNIFICATION KNOW ALL MEN BY THESE PRESENTS, that I, MARY BETH SCHROPP, of 2526 Boas Street, Harrisburg, Pennsylvania, do hereby acknowledge that I received from Mellon Bank, N.A., c/o Wanda S. Jones, Trust Officer, P.O. Box 7899, Philadelphia, Pennsylvania 19101-7899, Executor of the Estate ofJacqueline C. Stine, late of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, an advanced distribution of Fifty Thousand Dollars ($50,000.00), and property distributed M-kind. Upon the signing of this Receipt and Release, I will receive the additional sum of Forty Thousand Three Hundred Eighty-One Dollars and Eighty- Five Cents ($40,381.85), in accordance with the attached Schedule of Distribution in full settlement of any claim or claims that I may have by, under and because of the Will of the late Jacqueline C. Stine. I, MARY BETH SCHROPP, do acknowledge that my entitlement to the above sum is dependent upon there being no further sums determined to be due and owing by the Estate, including but not limited to, inheritance tax, income taxes, and debts of the decedent; and in the event such additional amounts are due by the Estate, the undersigned agrees to refund to the Executor a proportionate share of such expenses, not to exceed the amount the undersigned received from the Estate. AND, THEREFORE, I, MARY BETH SCHROPP, intending to be legally bound hereby, do, upon receipt of the sums set forth above, by these presents, release, quit-claim and discharge Mellon Bank, N.A., as Executor of the Estate of Jacqueline C. Stine, deceased, and, its successors and assigns, of and from all actions, claims and demands whatsoever, related to the administration of any Trust administered for the late Jacqueline C. Stine and the administration of the Estate of Jacqueline C. Stine. GREGORY M KERWIN TERRENCE J. KERWrN JosePH D KERWIN HOLLY MCCLURE KERWIN ATTORNEYS AT LAW I, MARY BETH SCHROPP, acknowledge that I have received quarterly accoum statemems from Mellon Bank, N.A., Executor, and I acknowledge I have been duly advised of my right to have Mellon Bank, N.A., Executor, file with the Orphans' Court Division of the Court of Common Pleas of Cumberland County an Accouming of the services it has rendered, and I do hereby specifically waive my right to have such an Accounting prepared and presented to the Court. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this?3;)__~day of ~'-~u'.\ ~ , 2004. WITNESS: -Mw J~l~'-H ~CHROPP ~/[ COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : On this, the'9~~& day of~kX~ , 2004, before me a Notary Public, the undersigned officer, personally appeared ~IARY BETH SCHROPP, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have~y hand and official seal. NotaXry Public My Commission Expires:~'O¥3 x')- ~')' D:~LAK~ESTATE~RELEAS E2,JCS ~2,553 52 Rich.ard 9~026 54 inn* 50,000 O0 J~ohn Mo)s 173~870.7~ 59.49 MmT Beth Sch[opp 5949 Jane GREGORY M. KERWIN TERRENCE J. K£RWIN JOSEPH D, KERWIN ESTATE OF JACQUELINE C. STINE, '0~ SEF~e~a~ :39 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION : ESTATE NO. 2003-00616 RECEIPT. RELEASE AND INDEMNIFICATION KNOW ALL MEN BY THESE PRESENTS, that I, RICHARD MOYE, of 9816 Greenview Lane, Manassas, Virginia, do hereby acknowledge that I received from Mellon Bank, N.A., c/o Wanda S. Jones, Trust Officer, P.O. Box 7899, Philadelphia, Pennsylvania 19101-7899, Executor of the Estate of Jacqueline C. Stine, late of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, an advanced distribution of Fifty Thousand Dollars ($50, 000. 00), and property distributed in-kind. Upon the signing of this Receipt and Release, I will receive the additional sum of Twelve Thousand Four Hundred Fifty Six Dollars and Eighty-Four Cents ($12,456.84), in accordance with the attached Schedule of Distribution in full settlement of any claim or claims that I may have by, under and because of the Will of the late Jacqueline C. Stine. I, RICHARD MOYE, do acknowledge that my entitlement to the above sum is dependent upon there being no further sums determined to be due and owing by the Estate, including but not limited to, inheritance tax, income taxes, and debts of the decedent; and in the event such additional amounts are due by the Estate, the undersigned agrees to refund to the Executor a proportionate share of such expenses, not to exceed the amount the undersigned received from the Estate. AND, THEREFORE, I, RICHARD MOYE, intending to be legally bound hereby, do, upon receipt of the sums set forth above, by these presents, release, quit-claim and discharge Mellon Bank, N.A., as Executor of the Estate of Jaequeline C. Stine, deceased, and, its successors and assigns, of and from all actions, claims and demands whatsoever, related to the administration of any Trust administered for the late Jacqueline C. Stine and the administration of the Estate of Jacqueline C. Stine. GREGORY M. KERWiN TERRENCE J KERW~N JosePH D. KERWIN I, RICHARD MOYE, acknowledge that I have received quarterly account statements from Mellon Bank, N.A., Executor, and I acknowledge I have been duly advised of my right to have Mellon Bank, N.A., Executor, file with the Orphans' Court Division of the Court of Common Pleas of Cumberland County an Accounting of the services it has rendered, and I do hereby specifically waive my right to have such an Accounting prepared and presented to the Court. ~zIN WITNESS WHEREOF, I have hereunto set my hand and seal, this ,-~ day of ,2004. WITNESS: STATE OF VIRGINIA COUNTY On this, the ..~ day of ~ ,2004, before me a Notary Public, the undersigned officer, personallyappea~d RICHARD MOYE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. I{otary Public My Commission Expires: D:/lak/estate/release.jcs ¢0,000,00 .",dzr7 Ba~h Sch~'o?p _73~713 7S ESTATE OF JACOUELINE C..STINE, : 1N THE COURT OF COMMON PLEAS 'O~ece~d-2 g. ll '.39 : CUMBERLAND COUNTY, PA : ORPHANS' COURT DIVISION ~.~,, ,, : ESTATE NO. 2003-00616 RECEIPT, RELEASE AND INDEMNIFICATION KNOW ALL MEN BY THESE PRESENTS, that I, MAUREEN HARDY, of c/o Richard Moye, 9816 Greenview Lane, Manassas, Virginia, do hereby acknowledge that I received from Mellon Bank, N.A., c/o Wanda S. Jones, Trust Officer, P.O. Box 7899, Philadelphia, Pennsylvania 19101-7899, Executor of the Estate ofJacqueline C. Stine, late of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, an advanced distribution of Fifty Thousand Dollars ($$0,000.00), and property distributed in-kind. Upon the signing of this Receipt and Release, I will receive the additional sum of Thirty-Nine Thousand Two Hundred Nine Dollars and Eighty-Five Cents ($39,209.85), in accordance with the attached Schedule of Distribution in full settlement of any claim or claims that I may have by, under and because of the Will of the late Jacqueline C. Stine. I, MAUREEN HARDY, do acknowledge that my entitlement to the above sum is dependent upon there being no further sums determined to be due and owing by the Estate, including but not limited to, inheritance tax, income taxes, and debts of the decedent; and in the event such additional amounts are due by the Estate, the undersigned agrees to mfnnd to the Executor a proportionate share of such expenses, not to exceed the amount the undersigned received from the Estate. AND, THEREFORE, I, MAUREEN HARDY, intending to be legally bound hereby, do, upon receipt of the sums set forth above, by these presents, release, quit-claim and discharge Mellon Bank, N.A., as Executor of the Estate ofJacqueline C. Stine, deceased, and, its successors and assigns, of and from all actions, claims and demands whatsoever, related to the administration of any Trust administered for the late Jacqueline C. Stine and the administration of the Estate of Jacqueline C. Stine. I, MAUREEN HARDY, acknowledge that I have received quarterly account statemems from Mellon Bank, N.A., Executor, and I acknowledge I have been duly advised of my right to have Mellon Bank, N.A., Executor, file with the Orphans' Court Division of the Court of Common Pleas of Cumberland County an Accouming of the services it has rendered, and I do hereby specifically waive my right to have such an Accounting prepared and presented to the Court. WITNESS WHEREOF, I have hereunto set my hand and seal, this~day of x.~,, ~' ,2004. MJ. UREEN HARDY (SEAL) O __ COUNTY undersigned officer, personally appea~d MAUREEN HARDY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public x My Commission Expires: D:~AK~STATE~RELEASE3.JCS OTARIAL SEAL CAROL L TROXELL, Notary Public New Cumberland 8crc Cumberland Co, Corem sstcn Expire8 Dec~ 27, 2005 90,'JJ8 54 N!~y Beth Sc5zo?? 90,786 5~ John Mole 50,000 O0 Juhn Mays _73~70 7~ GREGORY M KERW[N TERRENCE J KERWJN JosePH D. KERWIN hOLlY McCiuRe KERWIN ATTORNEYS AT LAW ESTATE OF J~AC~U .E~t~2C. ,~t.~Jl, ~eceasea : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION ESTATE NO. 2003-00616 RECEIPT, RELEASE AND INDEMNIFICATION KNOW ALL MEN BY THESE PRESENTS, that I, JANE SHURIG, of 211 E. Lutz Avenue, Lafayette, Indiana, do hereby acknowledge that I received from Mellon Bank, N.A., c/o Wanda S. Jones, Trust Officer, P.O. Box 7899, Philadelphia, Pennsylvania 19101-7899, Executor of the Estate of Jacqueline C. Stine, late of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, an advanced distribution of Fifty Thousand Dollars ($50,000.00), and property distributed in-kind. Upon the signing of this Receipt and Release, I will receive the additional sum of Forty Thousand Nine Hundred Twenty-Nine Dollars and Eighty-Five Cents ($40,929.85), in accordance with the attached Schedule of Distribution in full settlement of any claim or claims that I may have by, under and because of the Will of the late Jacqueline C. Stine. I, JANE SHURIG, do acknowledge that my entitlement to the above sum is dependent upon there being no further sums determined to be due and owing by the Estate, including but not limited to, inheritance tax, income taxes, and debts of the decedent; and in the event such additional amounts are due by the Estate, the undersigned agrees to refund to the Executor a proportionate share of such expenses, not to exceed the amount the undersigned received from the Estate. AND, THEREFORE, I, JANE SHURIG, intending to be legally bound hereby, do, upon receipt of the sums set forth above, by these presents, release, quit-claim and discharge Mellon Bank, N.A., as Executor of the Estate of Jacqueline C. Stine, deceased, and, its successors and assigns, of and from all actions, claims and demands whatsoever, related to the admixfistration of any Trust administered for the late Jacqueline C. Stine and the administration of the Estate of Jacqueline C. Stine. ' :. GrEGOry M KERW~N TERrENCE J. KERW~N JOSEPH D KERWIN HOLLY MCCLURe K£RWIN ATTORNEYS AT LAW I, JANE SI-IURIG, acknowledge that I have received quarterly account statements from Mellon Bank, N.A., Executor, and I acknowledge I have been duly advised of my right to have Mellon Bank, N.A., Executor, file with the Orphans' Court Division of the Court of Common Pleas of Cumberland County an Accounting of the services it has rendered, and I do hereby specifically waive my right to have such an Accounting prepared and presented to the Court. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this30 day of ,2004. W~.~ESS: ~ · (SEAL) STATE OF INDIANA COUNTY OF k-ONxx, N-r,/- On this, the ~ day of ~",.~x~ , 2004, before me a Notary Public, the undersigned officer, personally appeared JANE S/tURIG, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. N~)tary{)i)ublic - My Commission Expires: D:~.AK~STATENRELEASES.JCS 50,000.00 Mas) Sc~h 5O,OOO flO John 59.49 M~T Beth 5chropp 59.49 Jane qnur,£ Name of Decedent: Date of Death: Estate No.: STATUS REPORT UNDER RULE 6.12 JACQUELINE C. STINE July 10, 2003 2003-00616 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: ao No X Did the personal representative file a final account with the Court? Yes account is: bo The separate Orphans' Court No. ( if any) for the personal representatives' interest? Yes X Did the personal representative state an account informally to the parties in No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: September 1, 2004 07: [iV 2-d3S g ure~// TERRENCE J. KERWIN, ESQUIRE 4245 ROUTE 209 ELIZABETHVILLE, PA 17023 (717) 362-3215 D:\CLW\ESTATE\STINE.612 Capacity: X __ Personal Representative __ Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVI*SInN DEPT. Z80601 HARR/SBURG., PA 17128-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP COl-OS) ROBERT G CHASE MELLON BANK NA PO BOX 7899 PHILA PA 19101 DATE 06-07-Z004 ESTATE OF STINE DATE OF DEATH 07-10-Z005 FILE NUHBER 21 05-0616 COUNTY CUHBERLAND ACN 101 Amoun*~ Remi ~'l:ed JACQUELIN C HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/~: ~o your account, submit: ~he upper por~/on o'f this for. wi~:h your ~:ax payment:. CUT ALONG THIS LINE ~* RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) N## INHERITANCE TAX STATEHENT OF ACCOUNT ESTATE OF STINE JACQUELTN C FILE NO. 21 05-0616 ACN 101 DATE 06-07-2004 THIS STATEMENT TS PROVI'DED TO ADV"SE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAHED ESTATE. SHO#N BELON 'rs A SUMMARY OF THE PRTNCZPAL TAX DUE, APPLTCAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, .rF APPL.rCABLE, A PROJECTED /NTEREST F.rGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 05-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 65,781.00 PAYMENT DATE 10-10-2005 04-08-2004 RECEIPT NUMBER CD005115 DISCOUNT (+) INTEREST/PEN PAID (-) CD005810 2,400.00 .00 AMOUNT PAID 45,6'00~.00 15,781.00 IF PA.rD AFTER THIS DATE, SEE REVERSE S'rDE FOR CALCULAT'rON OF ADD'rTZONAL 'rNTEREST. ( 'rF TOTAL DUE 'rS LESS THAN $1, NO PAYHENT 'rS REQU'rRED. IF TOTAL DUE IS REFLECTED AS A "CRED'rT" (CR), TOTAL TAX CREDIT C 65,781.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORH FOR TNSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CR]: A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "AppLication for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1513). Applications are available at the Office of the Register of NiZIs, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: l-BO0-56Z-Z050; services for taxpayers with spec[aZ hearing and / or speaking needs: I-B00-447-50Z0 (TT onIy). REPLY TO: gums[ions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 28060Z, Harrisburg, PA I7IZB-060I, phone (717) 787-6505. DISCOUNT: If any tax due is paid et[bin three (23 calendar months after the decedent's death, a five percent (52) discount of the tax paid is aZloaed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of death, to the date of payment. Taxes which became delinquent before January [, Z98Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. A11 taxes ahich became delinquent on and after January 1, IeBZ eilZ bear interest at a rate which will very from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor Iga~ Z02 .OOOS4B' XgB'~8-I99! IX2 .00030~ ZO0-'~ 92 .000Z47 1983 162 .000438 199Z 92 .O00Z~7 gOOZ 62 .000164 198q llg .O0030Z 1993-1994 7X .0D0192 2005 52 .000137 1985 152 .000556 1992-1998 92 .000247 2004 42 .000110 1986 102 .000Z74 1999 72 .O0019Z 1987 92 .000247 ZOO0 82 .000219 --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill 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.