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HomeMy WebLinkAbout03-0894Register of Wills of c~s~^~) County, Pennsylvania PETITION FOR GRANT OF LETrERS also known as Par;~ioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased s=i.i secu~.o, i q/-- i g-'~X ~ '7 (COMPLETE 'A' or 'B' BELOW:) ['~ A. Probate.and qrant of Lel~ers Testamentary and the Decedent, dated ~ /1'7/~) ( i a. C~i{S)dated.. a,e.r that Petitioner(s)is/are the execut~_.l .~ named in the last Will of State relevant cJrcu~Y~ances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B, Grant of Letters of Administration (c. La.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: [ Name I , I. Relationship (COMPLb~i= IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in or principal residence at , O.cedent, then --~ y*arso, a~.,d~ / ' Residence County, Pennsylvania with his/her last family (list street, number, and municipality) (Location) Decedem at death owned proper'o/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: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Sic. mature TTped or printed name and residence Prepared by the Pennsylvarfla Bar Association Copyright (c) 1996 form software only CPSystems, Inc. / ~,~-/.~_~ Form RW-1 Commonwealth of Pennsylvania County of Oath of Personal Representative The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me thi~day of Soc S. ur yNo: ICl~-I - Z t-/DateofOeath: AND NOW, "f~ I S Deceased , ~,00_.~ , inconsideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters J'~ Testamentary J---J Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to :L~ ~/) vt 14 1~/'iT UT~'p~'I A ~ in the above estate and that the instrument(s) dated ~)-'//"7 /0 / described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES ........... Short Certificate(s) ..... $ .,, ~/'L~'~'~---'~---~ Renunciation ........ Affidavits ( ) .... $ Extra Pages ( ) .... $ ~, ~_.~ ' - ' / -Register of Will~- Attorney: Thomas E. Flower,, Esquire I.D. No: 83993 Address: SAIDIS, SHLTF,F, FLOWER & LINDSAY Codicil ........... $ JCP Fee .......... $ ~/~. ~ <~ 2109 Market Street~ Camp Hill, PA 17011 Telephone: 717/737-3405 Inventory .......... Other ........... $ TOTAL ......... $ ~.~ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (~ee~) Ex.' 9/R6 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illogal to duplicato this ¢op¥ by photostat or photograph. Fee for this certificate, $2.00 P 9749628 No. /Local Registrar OCT 1 6 2003 Date mo$.t4~ ne,,. 2/a7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS ~., CERTIFICATE OF DEATH [,. ~oris B. .. ~rlisle ~rlisle R~ional Mediul Center ~_~-~.~.. ~' . . ' ' ' ' "' ~ ....~ I,,. I,,. '~'~ I '"'~'*' I,,. ~a~ -" I,,. 1 West Pe~ ~ ~rlisle ,,. J. ~ Br~ ........ ~'--' '~'s ~ ¢,--~,;4 I". Bl~che ~ttge~ch ~ 18 ~o~ill Court, Carlisle, Pa 17013 ~ ~ I ~C. 17, 2~3 [ ~esLminnLer CeaSe · , ~ ~~,~L i~~ ...... ~,~'~?~,J~.~,,, [~. 219 N- Hanover St., ~rlisle, Pa 17013 ~-~,~ ,. %~ :~ _ I ~ I~PL~ ~ ~ I ~ ll~ ~. ~.. I I'~' ~ ~' I~e~ ~ ~u~ ~o. ~ I~"~ I"-- ~ ~ Ol I I I I LAST WILL AND TESTAMENT OF DORIS B. PRATT I, DORIS B. PRATT, of 738 Sherwood Drive, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I am currently married to HAYDEN PRATT. We are separated, and I have filed a divorce action against him. I do not wish to leave any portion of my estate to him. I believe that he has, in essence, abandoned me and that our differences are irreconcilable. THIRD: I leave to my grandson, JUSTIN HALTEMAN, my book on Lewis the Robber and any other books on local history that he is interested in. FOURTH: I leave all the rest, residue and remainder of my estate to my two children, SUE ANN HALTEMAN and J. FRED QUIGLEY, in equal shares. FIFTH: If my daughter, SUE ANN HALTEMAN, fails to survive me by thirty days, I give her share of my estate to her three children, KIMBERLY, JOSEPH and JUSTIN HALTEMAN, in equal shares. SIXTH: If my son, J. FRED QUIGLEY, fails to survive me before thirty days, I give his share of my estate to my daughter, SUE ANN HALTEMAN, or should she also fail to survive me, I give said share of my estate to her aforesaid three children, in equai shares. LASTLY: I nominate, constitute and appoint my daughter, SUE ANN HALTEMAN, to be the Executrix of this my Last Will and Testament. In the event that my said daughter, SUE ANN HALTEMAN, shall be unable to serve as Executrix for any reason, I appoint my son, J. FRED QUIGLEY, as Executor. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /'~_'¢7 ¢'~,~ day of ,,/~¢'~ ,2001. Doris B. Pratt SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS, I, DORIS B. PRATT, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by DORIS B. PRATT, the Testatrix, this I "-~ 4:...~ day of -~d ,t<:~.,~..~L_ ,2001. Doris B. Pratt, Testatrix N~ PL~blib ~ J. kl~ NOTARY PIJBLJC COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS We, James D. Flower, Jr. and Sharon Simpson , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. and 2001. Sworn or affirmed to and subscribed to before me by James D. Flower, Sharon Simpson this ~'"7'~ day of _~~L,A~ ~ JR. W~tness ~ ~ 4 DORIS B. PRATT SAIDIS, SHUFF, FLOWER & LiNDSAY 26 WEST HIGH STREET CARLILSE, Pa 17013 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Doris B. Pratt Date of Death: October 14, 2003 Will No. 21-03-0894 Admin. No. 2003-00894 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 / [ '"" ~ '~ ,2003. Name Address J. Fred Quigley Sue Ann Halteman Justin Halteman 18 Thornhill Court, Carlisle, PA 17013 738 Sherwood Drive, Carlisle, PA 17013 738 Sherwood Drive, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: Capacity: Thomas E. Flower, Esquire SAIDIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-- Pratt, Doris B. Z 191-18-3247 ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LLI 10/14/2003 07/03/1924 REGISTER OF WILLS U,J (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER a. Il. I.-- Z o n,' 0 r~ ILl r~-i 1. Odginal Return r--i 4. Limited Estate ~-16. Decedent Died Testate (Attach copy of Will) r~9. Litigation Proceeds Received ~12. Supplemental Return E~] 4a. Future Interest Compromise (date of death after 12-12-82) --'1 7. Decedent Maintained a Living Trust (Attach copy of Trust) ---I10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) E~]3, Remainder Return (date of death prior to 12-13-82) E~]5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes E]11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Thomas E. Flower FIRM NAME (IfApplicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 737-3405 COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 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. Cash1 Bank Deposits & Miscellaneous Personal Property (5) 99,883. (Schedule E) 6. Jointly Owned Property (Schedule F) (6) U Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses &Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (8) 12,653.03 1,406.79 (11) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 99,883.16 14,059.82 85,823.34 85,823.34 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 16. Amount of Line 14 taxable at lineal rate 85,823.34 x .0 45 (16) 17~ Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20. [] 3,862.05 3,862.05 Decedent's Complete Address: STREET ADDRESS One West Penn ClTYCarlisle I STATEpA ] z~P17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Povedy Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 3,862.05 0.00 0.00 3,862.05 0.00 3,862.05 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 consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, 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 and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSON RESPO.NSIB_LE F.,OR FILING RETURN ADDRESS Sue Ann Halteman, 738 Sherwood Drive, Carlisle, PA 17013 SI~R~ DATE 2-, ADDRESS Saidis, Shuff, Flower & Lindsay, 2109 Market St., Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (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 RS. §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 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris 8. Pratt SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-03-0894 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION M&T Bank checking account Cf 950551201, principal - $9,773.39 accrued interest - $0.29 M&T Bank checking account Cf 951050775, principal - $87,832.78 accrued interest - $50.55 M&T Bank savings account # 15004207009554, principal - $1,713.65 accrued interest - $0.42 personal effects (see attached inventory) refund, Comcast T.V. Cable TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE Of DEATH $ 9,773.68 87,883.33 1,714.07 500.00 12.08 99,883.16 REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Doris B. Pratt 21-03-0894 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. 5. 6. 7. FUNERAL EXPENSES: Hoffman-Roth Funeral Home- professional services ......................................... $ 2,890.00 casket and burial container ................................. 3,665.00 memorial folders .................................................. 25.00 memorial flowers ................................................. 132.50 hairdresser .......................................................... 30.00 death certificates ................................................. 16.00 Westminster Cemetery - grave opening and interment .................................. $ 945.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (if decedenrs address is not the same as claimant's, attach explanation) Claimant __ Zip Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal, estate advertisement Sentinel, estate advertisement __ Zip $ 7,703.50 4,500.00 269.00 75.00 105.53 TOTAL (Also enter on line 9, Recapitulation) $ 12,653.03 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris B. Pratt SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-03-0894 ITEM NUMBER 2 3 4 5 6 7 8 9 Include unreimbursed medical expenses. DESCRIPTION Central Penn Medical Group West Shore EMS, ambulance service Cumberland-Goodwill Fire & Rescue, ambulance service Carlisle Regional Medical Center Belvedere Medical Corp. Lancaster HM^ Physician Management Sprint, phone bill Spring Road Family Practice PPL, Electric Utility TOTAL (Also enter on line 10, Recapitulation) $ VALUE AT DATE OF DEATH 43.89 69.89 28.38 840.00 278.45 22.31 6.98 107.61 9.28 1,406.79 (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 Doris B. Pratt 21-03-0894 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I Ii TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] J. Fred Quigley 18 Thornhill Court Carlisle, PA 17013 Sue Ann Halteman 738 Sherwood Drive Carlisle, PA 17013 son daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 1/2 1/2 (If more space is needed, insed additional sheets of the same size) LAST WILL AND TESTAMENT OF DORIS B. PRATT I, DORIS lB. PI~ATr, of 738 Sherwood Drive, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my l.ast Will and l es[ament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession 'l axes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: t am currently married to HAYDEN PRATT. We are separated, and I have filed a divorce action against him. I do not wish to leave any portion of my estate to him. I believe that he has, in essence, abandoned me and that our differences are irreconcilable. THIRD: I leave to my grandson, JUSTIN HALTEMAN, my book on Lewis the Robber and any other books on local history that he is in[erested in. FOURTH: I leave all the rest, residue and remainder of my estate to my two children, SUE ANN HALTEMAN and J. FRED QUIGLEY, in equal shares. FIFTH: If my daught~;r, SUE ANN HALTEMAN, fails to survive me by thirty days. I give her share, of my estate to her throe children, KIMBERLY, JOSEPH and JUSTIN HALTEMAN, in equal shares. SIXTH: If my son, J. FRED QUIGLEY, fails to survive me before thirty days, I give his share of my estate to my daughter, SUE ANN HALTEMAN, or should she also fail to survive me, I give said share of' my estate to her aforesaid three children, in equal shares. LASTLY: t nominate, constitute and appoint my daughter, SUE ANN HALTENIAN, to be the Executrix of this my Last Will and Testament. in the event that my said daughter, SUE ANN HALTEMAN, shall be unable to serve as Executrix for any reason, i appoint my son, J. FRED QUIGLEY, as Executor. No Fxecutor or Executrix shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, J have hereunto set my hand and seal this .... Z/_?~ dayof ..~ _~/~"~ , 2001. Doris B. Pratt SIGNED, SEALED, PUBLISHED and DECLARED iQ the presence of: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. I, DORIS B. PP-,.ATT, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that t signed and executed the instrument as my Last Will; that 1 signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged_ before me, by the Testatrix, this _ l ~74~r'~ day of ~._tL DORIS B. PRATT, ,2001. Doris B. Pratt, -f estatrix -- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND $$ We, James D. F_~owor, ~.r', and '°'har~)n Simpson , the witness~--~h--~e' h-ames are sig~d to the-attach~'d or 'foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary ac/for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Festatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. and 2004. Sworn or affirmed to and subscribed to before me by Jame:s D. F.lower, OR. Sharon Simpson __ this .. _j_._~'~'-' __ day of ---'~~ 'i, ~itne~s ~' ~ 4 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Saidis, Shuff, Flower & Lindsay Attorney At Law 2109 Market Street Camp Hill, PA 17011 DEC Phone (302) 934-2909 F ax (302) 934-2955 November 26, 2003 0i 2003 ge~ Estate of Doris B Pratt Social Security: 191-18-3247 Date o[Death: October 14, 2003 Dear Sir or Madam: Per your inquiry dated November 4, 2003, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued b?terest Total Checkh?g Accom~t 950551201 Doris B Pt'alt 12/09/00 $9,773.39 $ .29 ..... ~2"~i'3:~ ........................................................................................ Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Chec'king Accozmt 951050775 Doris B Pralt 01/02/03 $87,832. 78 $ 50.55 ""$g'~'g~i'~ ................................................................................... Type of Account Account Number Ownership (Names Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names Opening Date Balance on Date of Death Accrued Interest Total SavhTgs Account 15004207009554 Fo~wmrly #80000002147679 Doris B Pratt 04/18/02 $1,713.65 $ .42 .... ~7;?'D~ ....................................................................................... Home Equity Line 102746820002 Doris B Pratt Hcoden T Pratt 06/10/98 $0.00 $0. O0 For further account information, closures aud/or reimbursement of fuods please call the Carlise West Office at //717-240-6717. Please be advised, there was no sali~ deposit box found for the above decedent. S)h'~erely, / k Records Management Doris B. Pratt Inventory of Personal Possessions Love seat Chair with ottoman Desk with chair Bookcase TV stand Portable TV Kitchen table with two chairs Small hutch Bed with mattress & box spring Chest of drawers Vanity with chair Night stand Cedar chest Clothing Costume jewelry Dishes and Cookware Microwave Oven Books Several lamps Most of the above items were donated to other residences of the One West Penn Apartments for elderly, or to the Goodwill store. 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 003581 FLOWER THOMAS E 2109 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 191-18-3247 FILE NUMBER: 2103-0894 DECEDENT NAME: PRATT DORIS B DATE OF PAYMENT: 02/1 9/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/14/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,862.05 REMARKS' TOTAL AMOUNT PAID: $3,862.05 SEAL CHECK# 1006 INITIALS: dA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS .PNCBAI K Central PA 60-12~3/313 PAYTOTHE ']~.. ' ~ DATE ~ ~ I ~- ~/ Io2 ESTATE OF ESTATE OF DORIS B. PRATT cup .~U., p^ ~?o~ FOR_ .~1 - ~ ~ ..- ~ ,~'.,)' ~ EXECUTOR/ ADMINISTRATOR PERSONAL REPRESENTATIVE TRUSTEE "'OOl, OOg,' ~:0:~I,~,I,i~7:18~: 5DO:tBTOq87,' 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 003804 FLOWER THOMAS E 2109 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 191-18~3247 FILE NUMBER: 21 03-0894 DECEDENT NAME: PRATT DORIS B DATE OF PAYMENT: 04/13/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/1 4/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 91,234.41 TOTAL AMOUNT PAID: 91,234.41 REMARKS: ....... SEAL CHECK# 1010 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS t~ COMMONWEALTH OF ~ PENNSYLVANIA · ,~~~;~ DEPARTMENT OF REVENUE · -~r~. _~r ~1~¢~i~ ~ DEPT. 280601 ~HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ 03 0894 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-- PRATT, DORIS B. Z 191-03-0894 I-t DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-DM-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU 10/14/2003 07/03/1924 (.3 REGISTER OF WILLS LM (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z UJ Z o o [--"~ 1. Odginal Return ~--J 4. Limited Estate [---~ 6. Decedent Died Testate (Attach copy of W~ll) ~'-~ 9. Litigation Proceeds Received ['~J 2. Supplemental Return J-~ 4a. Future Interest Compromise (date of death after 12-12-82) ~--~7. Decedent Maintained a Living Trust (Altach copy of Trust) []10. Spousal Poverty Credit (date of death belween 12-31-91 and 1~1-95) E~3. Remainder Return (date of death pdor to 12~13-82) E~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes E~11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Thomas E. Flower, Esquire FiRM NAME (IfApplicaLde) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 737-3405 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Prepdetorship {3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E] Separate Billing Requested COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 27,431.40 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) (11) (12) (13) 27,431.40 27,431.40 (14) 27,431.40 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .0__ (15) 27,431.40 x .0 45 (16) 1,234.41 x .12 (17) x .15 (18) ,, (19) 1 r234.41 Decedent's Complete Address: STREET ADDRESS One West Penn ClTYcarlisle I STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,234.41 0.00 0.00 1,234.41 0.00 1,234.41 Total Credits (A + B + C ) (2) 3. Interest/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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5) (5A) (5B) 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 consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, 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 and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S.G,ATU PERSt ESPO,S.B. DATE ADDRESS Sue Ann Halteman, 738 ShenNood Drive, Carlisle, PA 17013 DATE ADDRESS 04/09/04 Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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. §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 RS. {}9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF PRATT, DORIS B. FILE NUMBER 21-03-0894 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. A'n'ACHACOPYOFTHEDEEDFORREALESTATE. VALUE OFASSET INTEREST IIFAPPLICABLEI VALUE 1. IRA- BALTIMORE LIFE RETIREMENT ANNUITY 26,723.36 100 27,431.4 plus 708.04 BENEFICIARIES: accrued interest SUE ANN HALTEMAN, DAUGHTER - 50% 738 Sherwood Dr. Carlisle, PA 17013 J. FRED QUIGLEY, SON - 50% 18 Thornhill Court Carlisle, PA 17013 TOTAL (Also enter on line 7 Recapitulation) $ 27,431.4 (If more space is needed, insert additional sheets of the same size) The Baltimore Life COMPANIES AGENCY CUMBERLAND VALLEY AGENCY DORIS B PRATT ONE WEST PENN CARLISLE PA 17013 01-04-2004 BALTIMORE LIFE FEDERAL TAX ID 52-0236900 TAX ID NO. - 191-18-3247 POLICY NO. 01052032129 TYPE IRA SHOWN BELOW IS THE FINANCIAL ACTIVITY OF YOUR BALTIMORE LIFE RETIREMENT ANNUITY FOR 2003 BALANCE AS OF 05-14-2003 + 2003 CONTRIBUTIONS + ROLLOVERS (BOX 2) DISTRIBUTIONS + EARNINGS * = BALANCE AS OF 01-01-2004 (BOX 4) SURRENDER VALUE AS OF 01-01-2004 00 00 26,723 36 00 708 04 27,431 40 25,236 89 2003 CONTRIBUTIONS FOR TAX YEAR 2002 .00 2003 CONTRIBUTIONS FOR TAX YEAR 2003 (BOX 1) .00 2004 CONTRIBUTIONS FOR TAX YEAR 2003 (BOX 1) .00 REQUIRED MINIMUM DISTRIBUTION FOR TAX YEAR 2004 1,558.60 EARNINGS EQUAL INTEREST CREDITED MINUS THE COST OF DISABLITY RIDER, IF APPLICABLE, AND ANY APPLICABLE FEES. THIS STATEMENT IS A SUBSTITUTE FORM 5498. THIS INFORMATION WILL BE FURNISHED TO THE INTERNAL REVENUE SERVICE. The Baltimore Life Insurance Company 10075 Red Run Boulevard · Owings Mills · Maryland 21117-4871 Tel: (410) 581-6600 · www. baltlife.com BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX nTVTS/ON DEPT. 280601 HARRTSBURG, PA 17128-0601 THOMAS E FLOWER SAIDIS ETAL 2109 MARKET ST CAMP HILL COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ,,PA 170! 1 DATE Oq-lZ-ZOOq ESTATE OF PRATT DATE OF DEATH 10-1q-2003 FILE NUMBER 21 03-089q COUNTY CUMBERLAND ACN 101 I Amoun~ Remi~ed REV-1547 EX AFP (51-n5) DORIS B HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PRATT DORIS B FILE NO. 21 03-089~ ACN 101 DATE 0~-12-200~ TAX RETURN HAS: (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) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 99~883.16 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this fora with your tax payment. .00 (8) 12,653.03 13. lq. NOTE: 99,883.16 1~q06.79 (11) 1~.05g.82 (la) 85,823.$t Charitable/Governmental Bequests; Non-elected 911-~ Trusts (Schedule J) (13) Net Value of Estate Subject ~o Tax (Iq) If an assessment was lssued previeusly, 11nes 14, 15 and/er 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of Line lq taxable at Lineal/CZass A rate 17. Amount of Line lq at Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT I RECEIPT BATE NUMBER 02-19-200q CD003581 .00 85,823.3fi 18 and 19 w111 3,862.05 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 3,862.05 .00 .00 .00 IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .O0 DISCOUNT INTEREST/PEN PAID (-) AMOUNT PAZD (15) .00 X 00 = .00 (la) 85,823.3q x Oq5= 3,862.05 (17) . O0 x 12 = . O0 (lB) .00 x 15 : .00 (19)= 3,862.05 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PEN3LTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for life er for years, the Comaonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 2~ of ZOO0. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Hake check or money order payable to: REGISTER OF N/ELS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the Z~ Revenue District Offices, or by calling the special Iq-hour anseering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-3020 (TT only). Any party in interest not satisfied aith 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 pretest to the PA Department of Revenue, Beard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxesj ATTN: Post Assessment Review Unit, Dept. 280601j Harrisburg, PA 17128-0601 Phone (717) 767-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid eithin three (3) calendar months after the decedant"s death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one [1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable tntarest rates for 1982 through ZOO4 are: Interest Daily Interest Dally Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20X .0005q8 ~'~-1991 1XX .000501 ~ 9Z .O00Zq7 1983 16Z .000q38 1992 9Z .000247 2002 62 .Og016q 1984 llZ .000301 1993-1994 7Z .000192 2003 52 .000137 1985 13X .000356 1995-1998 9X .000247 ZOOq qZ .000110 1986 IOZ .OOOZTq 1999 7Z .000192 1987 lOX .O00Z7q ZOO0 7Z .OOOlgZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DA/L¥ 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. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: Doris B. Pratt Date of Death: October 14, 2003 Will No.: 21-03-0894 Admin. No. 2003-00894 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X; No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: No X ao Did the personal representative file a final account with the Court? Yes_; account is: b. The separate Orphans' Court No. (if any) for the personal representative's Co in interest? Yes X; No Did the personal representative state an account informally to the parties 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: gig~"tth-e Name: Thomas E. Flower, Esquire I.D. No. 83993 SAIDIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: __ Personal Representative X Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. 280601 HARRTSBURG, PA 171Z8-060! COMMONWEALTH OF PgNNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-154? EX AFP C§1-D3) THOMAS E FLOWER SAIDIS ETAL 2109 MARKET ST CAMP HILL PA 17011 DATE 07-15-2004 ESTATE OF PRATT DATE OF DEATH 10-14-2003 FZLE NUMBER Z1 03-0894 COUNTY CUMBERLAND ACN 101 Amoun~ Remitted DORIS B HAKE 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 4 REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PRATT DORIS B FILE NO. 21 03-0894 ACN 101 DATE 07-13-2004 TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1 $ 6 7 8. SUPPLEMENTAL RETURN Reel Estate (Schedule A) Stocks and Bonds (Schedule B) (2) Closely Held Stock/Partnership Interest (Schedule C) (3) Hot,gages/Notes Receivable (Schedule D) (~) Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) Joint.~y Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Total Assets NO. 01 .00 .00 .00 .00 .00 .00 27/431 NOTE: To insure proper credit to your account, submit tho upper portion of this form with your ~ax payment. Z7,431 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Hot,gage Liabilities/Liens (Schedule I) 11. 12. 13. 1~. NOTE .00 (9) (10) .00 Total Deductions (11) Net VeXue of Tax Return (12) CharitabXa/GovernmantaX Bequests; Non-eXacted 9113 Trusts (Schedule J) (13) Not Value of Estate Subject to Tax (li) .O0 27,431 .00 113,Z54.74 Xf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 Hill reflect flgures that lnclude the total of ALL returns assessed to date. AMOUNT PAid) < 3,86~o5 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 5,096.46 .00 .00 .00 ASSESSMENT OF TAX: 15. Amount of Line 1~ et Spouse1 rote 16. Amount of Line 1~ taxable at Lineal/Class A rate 17. Amount of Line 1~ at Sibling rote 18. Amount of Line lfi taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYHENT RECEXPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID 02-19-2004 CD003581 .00 04-13-2004 CD003804 .00 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1~ NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT- (CR)z YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 19BE -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the mxpiFation of any estate for lifo 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 DF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADNZN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section glqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Nills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-BOO-~47-30ZO (TT only). 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 eithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171Z8-1021, 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. 260601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-lEO1) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the data of payment. Taxes ehich became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. 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 1982 through ZO0~ arm: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lOX .OOOSqB T'~-1991 llZ .000301 ~ 9Z .0002&7 1983 162 .000438 1992 92 .O00Z~7 ZOOZ 62 .000164 198~ 111 .000301 1993-1994 72 .O0019Z ZOO3 5Z .000137 1985 l~Z .000356 1995-1998 92 .000247 ZOO4 42 .O00llO 1986 IOZ .ogoz7q 1999 7Z .00019Z 1987 10Z ,O00Z7~ ZOO0 7Z ,O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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 ba calculated.