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Home My WebLink About03-0501Estate of also known as , Deceased R. Bradford Adams Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Janice E. Adams No. Social Security No. 194-36-4688 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut the Decedent, dated and codicil(s) dated None named in the last Will of State relevant circumstances, 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.ta.; d.b.n.c.ta; 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: I Name Relationship (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland Residence John Glenn Blvd., Webster NY County, Pennsylvania with his/her last family or principal residence at 5 Center Drive, Lower Decedent, then 55 years of age, died 05/03/2003 Allen Township (liststreet, number, and municipality) at Lower Allen Township, Decedent 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 PA (Location) 40,000.00 100,000.00 situated as follows: 5 Center Drive, Camp Hill, PA 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: I Si~lnature Typed or printed name and residence ~. R. Bradford Adams . 802 John Glenn Blvd., Webster, NY 14580 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~'~ ~'~ R. Bradford Adams before me thi~l:~,~ day of NO. Estate of Janice E. Adams Social Security No: 194-36-4688 AND NOW, Date of Death: 05/03/2003 Deceased , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary [] Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to R. Bradford Adams in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent, FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( ) .... $ Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Attorney: Michael L. Bangs I.D. No: 41263 Address: 302 South 18th Street Camp Hill, Pa 17011 Telephone: 717/730- 7310 Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1(1991) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local Registrar Date , 144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) , kasl) STATE FILE NUMBER Janice E Adams ~U.eER ~ [---UNO~RleAY ............ eI"THP ~ ...... "194--36--4688 J4. May 3, 2003 55 Cumberland ~merk u~ ~lll, Pa 170 o.m.~o.~ R~s S. ~ Winifr~,~.*~,~.~ R. ~adfo~ ~ ~u~ial~ Cremal~ Re~omSlme~ c~rllly cause of dealh. 802 John Glenn Blvd Webster New York 14580 East Harrisburg Harrisburg, Pa 19( demon who pronounces death. Ap r x. May 4, 2'003 ,~,~o~ ~ ~,m)---~ a. Pendin= Investigation Natural [] Homicide m ~ ~) I~ ~.~ ~ ,m~ ..................................................... Ho~ Coroner May 6, 2003 Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050 IN RE ESTATE OF Janice E. Adams THE STATE OF Pennsylvania COUNTY OF Cumberland BOND AND OATH Bond #104108412 IN THE COURT OF COUNTY, FA NO. KNOW ALL MEN BY THESE PRESENTS That we R. B.,r_,a. dford Adams as Principal, and the Travelers C~sualty and m~ , as Surety are held and firmly bound unto Cumberland County Court rOrul~re~ Cumberland County, PA , and~h~X their successors in office, in the sum of $. 607000,00 , conditioned that the above bound Principal, who has been appointed by the Judge of said Court as. executor shall well and truly perform the duties required of him b under such appointment. ....... y law .... Surety Company of America Witness our signature this 2nd day of June 2003 R, Bradford Adams Clerk's Stamp Principal ~ave2ers Casualty ard Surety Company of ~ Mary Afine Brennan Attomey-in-Fact APPROVED, this day of It is further ordered that all other bonds in force in this cause at this time are hereby cancelled on the approval of this bond, and the Sureties on said bonds are hereby relieved of all further liability for the future acts of the Principal. Judge, Court County, OATH , do solemnly swear that will faithfully discharge the duties of Subscribed~and sworn to bei%l£~i.~he this of the estate of ~:t-ntJe_. ~-. /'~.o-,~..5 according to law Signature 9ta,.~ Public, ii~;nd fo~ ~ (~ County Or: f [ Nfl? [0. TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY Hartford, Connecticut 06183-9062 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, corporations duly orgardzcd under the laws of the State of Connecticut, and having their principal offices in thc City of Hartford, County of Hartford, State of Connecticut, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make, constitute and appoint: James C. Byerly, Mary Anne Brennan, Richard C. Atkinson, James F. Cuff, Jr, Allen T. Miller, Jr., of Lemoyne, Pennsylvania, their true and lawful Attorncy(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within thc United States, the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto and to bind the Companies, thereby as fully and to thc same extent as if the same were signed by the duly authorized officers of thc Companies, and all thc acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now in full force and effect: VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, uny Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the compuny and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her. VOTED: That the Chairman, the President, any Vice Chairman, uny Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of tiffs Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary. VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact und Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile (mechanical or printed) under and by authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, which Resolution is now in full force and effect: VOTED: That the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid und binding upon the Company und any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. ¥~:- ~ ] : ~ .... ~ ~ , , , ~ £ [ Nfl[' (11-00 Standard) uosueqo~'~ ?Jo~ ~ " o!lqnd/ue~ON 900E 'OC eunp seJldxe uo!ss!uuuuoo ~ ~,uaplseJd ao?^ Joluas uosdmoql '~ e§Joa~) XlqVd~0D .~J, TgflSVD A_k~dl~I0~) .~.J~R~flS (INV ~J~Tv'flSVD VDIlt~t]SV ~I0 .MqVdI~03 X~'SLiI$ (Igr¢ .~£Tv'flSVD $~I~t~IRAV'SJ~ ([MOd~LMVI-I .qO AANflOO pzoj~-mH ' $ S { AflOLI,OHNNOD ~IO HAV£$ 'g00Z I.ud¥ jo f~'p q~0I s.~ pox~a~ olo~oq oq ol SlgaS olg~o&oo :qoq~ pu~ luap!sa.~d aa!A .~o!ua$ =.mql tq poug!s oq m luoum.nsu! s.~ posng~ 0A~LI ANVdI~OD AJ~TqflSVD /qOJ~DNII~SWI pug ANVd~IOD AJ~IflS ~Ilq~ AJ~VflSVD SIiR~I~AVHJ~ 'VDI/tRIAIV ~I0 AlqVd~IOD A~IflS fllqV .~J~qVI1SVD SH~t~I~IAV'd,L '~IORH~HA~ SS~INJ~IAk NI CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JANICE E. ADAMS Date of Death: Will No.: To the Register: May 3, 2003 Admin. No: 2003-00501 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 June 23, 2003: NAME ADDRESS R. Bradford Adams 802 John Glenn Blvd., Webster, NY 14580 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Date: Signature: ~~/7'~ ?~/~~ Michael L. Bangs, Attome~at-Law 302 South 18th Street Camp Hill, PA 1701 (717) 730-7310 Counsel for Personal Representative 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 O03511 BANGS MICHAEL L .302 S. 18TH STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 194-36-4688 FILE NUMBER: 2103-0501 DECEDENT NAME: ADAMS JANICE E DATE OF PAYMENT: 02/02/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $33,969.87 REMARKS: TOTAL AMOUNT PAID: MICHAEL L BANGS, ESQ $33,969.87 SEAL CHECK//01 O0 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT D / DECEDENT'S NAME (LAST, FIRST, ANi MIDDLE INITIAL) E Adams Janice E. C DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO-YEAR) E D 05/03/2003 01/26/1948 E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N T / 1. original Return ~ Z478.. Supplemental Return C A P B 4. Limited Estate Future Interest Compromise (date of death after 12-12-82) HpRL · E P I O 6, Decedent Died Testate · Decedent Maintained a Living Trust C R A C (Attach copy of Will) (Attach copy of Trust) TK KO E S 9. Litigation Proceeds Received ~-~ 10. Spousal Poverty Credit Co" R E C A P I T U L A T I O N O M T I O N OFFICIAL USE ONLY FILE NUMBER COUNTYCODE YEAR SOCIAL SECURITY NUMBER 194-36-4688 NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (date of death 3. Remainder Return priorto 1Z-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes NAME Michael L. Ban~s FIRM NAME (If Applicable) J-~ 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1 - 1-95) (Attach Sch O) COMPLETE MAILING ADDREss TELEPHONE NUMBER 717/730- 7310 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E~ 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. 302 South 18th Street Camp Hill, PA 17011 None None None None 291,837.04 None OFFICIAL USE ONLY None (8) 291,837.04 8,210.27 544.48 (11) 8,754.75 (12) 283,082.29 (13) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 14. 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 (14) 283,082.29 x .0 0 (15) 0.00 0.00 x .0 45 (16) 0.00 283,082.29 x .12 (17) 33,969.87 0.00 X .15 (18) 0.00 (1~) 33,969.87 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 5 Center Drivw CIYY 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 STATE ZIP PA 17011 (1) 33,969.87 Total Credits ( A + B + C ) (2) 0.00 0,00 0.00 33,969.87 0.00 33,969.87 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. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 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 fe of either payments benefts 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? .............................................. [---] j~] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benef c ary 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 acco..panying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Ro Bradford Adams DATE :'-, 802 John Glenn Blv. S~GNATUREOFPREPAR~ROTHERTHANREI~ESENTATiVE Michael L. Bangs DATE V~C/~ .~/, ~,~ / 302 South 18th Street [(~( ............ >, ' .... ;- .......................... For dates of death on or ~J~r July 1, 1994 and before ~JanUa~ 1, 1995, the tax rate' imposed or; the' net vaiue'of tra~;fers ~o ~; ~0r't~e'use0f tl~;' ' ' surwv~ng 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 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. Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 I~X (Rev. 6-00) REV- 1508 EX + (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Janice E. Adams SSf/ 194-36-4688 05/03/2003 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 DESCRIPTION Commerce Bank - Savings Account TV Guide Refund Highmark Blue Shield Refund Nationwide Mutual Insurance Refund 1999 Chevrolet Malibu Sedan Proceeds from Estate of Winifred D. Adams Accounting and letter of explanation) (see attached TOTAL (Also enter on line 5, Recapitulation) FILE NUMBER VALUE AT DATE Of DEATH 10,698.35 54.83 895.37 40.50 3,500.00 276,647.99 291,837.04 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) The decedent, Janice E. Adams, died on May 3, 2003, less than thirty (30) days after her mother, Winifred D. Adams (see file No. 21-03-0360 and First and Final Account attached). The Administrator of the Estate of Winifred D. Adams has approved the First and Final Account such that final distribution is available to be made to the Estate of Janice E. Adams per the Account which is attached to this return. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION FILE NO. 21-03-0360 ESTATE of WINIFRED D. ADAMS, Deceased Late of Lower Allen Township, Cumberland County, Pennsylvania Date of Death: Date of Grant of Letters of Administration to R. Bradford Adams, Administrator Date of First Advertisement of Letters: Date of Accounting April 9, 2003 May 23, 2003 August 22, 2003 April 9, 2003 to January 26, 2004 PURPOSE OF ACCOUNTING: R. Bradford Adams; Administrator, offers this Account to acquaint interested parties with the transactions that have o'ccurred during this administration. It is important that the Account be carefully reviewed. Requests for additional information or questions can be discussed with: Michael L. Bangs, Esquire Bangs Law Office Attorney Identification Number 41263 302 South 18th Street, Camp Hill, PA 17011 (717) 730-7310 GROSS ESTATE: $307,071.11 ASSETS DESCRIPTION U.S. Treasury--- PA State Bank (interest) PA State B~k (interest) Patriot News (refund) Allfirst Checking Account Allfirst Savings Account Commerce BanJ~ Accounts LIQUIDATION DATF AMOUNT 6/13/031 2(~0.6~) 6/13/~ ~6.82 6/13/03~ ~4~99 TOTAL ASSETS: EXPENSES OF ESTATE DESCRIPTION Register o_f Wills_ (_probate fee-advanced by attorney,) Register of Wills (appointment of Brad Adams-advanced by attorney) L.G Connor Real Estate Appraisers (Lower Allen Propert~Lad~anced) L~gg & Lugg (Lock Haven Real E~t~te research-advanced by attorney) Postmaster Cumberland Law Journal (estate advertising-advanced by attorney) ~'he Seniinel (estate advertising-advanced by attorney) Community Banks Certificate of Deposit Community Banks Certificate of Dep~)~it -'- PA State Bank Account Waypoint Bank Account PA State Bank (interest) Miscellaneous Cash AT&T Refund Highmark Blue Shield (refund of unused premium) Cumberland Valley Land Clearing (refund) Beverly Enterprises (refund) Verizon (refund) Proceeds from auction of personal pro-p~rty Proceeds from sale of Lower Allen Townsh p real estate Interest on M&T Estate Checking Account to 12/31/03 6/13/03 6/20/03 6/20/03 6/27/0~ 6/27/03 6/27/03 6/27/03 20.55 4,605.34 ~0,397.58 7,538.35 20 247.10 50,681.24 30,003.66 6/27/03 44,070.74 7/1/03 56.82 7/1/03 3,100.00 8/1/03 28.50 8/11/03. 167.16 8~28/0~+ ..... 77,40 8/28/03 525.00 .9/16/03_ 13.94 9/16/03 970.25 10/2/03 124,148.30 107.37 307,071.11 4/24/03 5/23/03 6/5/03 6/9/03 8/11/03 8/13/03 10/10/03 AMOUN' 266.00 40.00 275.00 50.00 13.65 75.00 102 01 I Postmaster 9/18/03 13.65 Register of Wills (filing fee for inheritance tax return-advanced by atty) Recorder of Deeds (fiiir~-g~ee for Lock Haven Deed) Register.of Wills(filing fee for Receipts and Releases) susque_hanna O_il company PA Water C_om_pany Myers-Harner Funeral Home, Inc. Gingrich Memorials conner-Rich Associates CitiCards Beverly Healthcare Cumberland Valley Land Tran-sf~e~-(dumpster rental) R. Bradford Adams (reimbursement of costs paid) M & T Bank (check order fee) Merry Maids R. Bradford Adams (reimbursement of costs paid) Verizon (phone bill) PA Water Company PP&L El_ectric Company J.R. Yinger (lawn maintenance) Renninger Appraisals (Lock Haven PA property) Travelers Indemnity (1 month home owners insurance coverage) Stevens & Monica Vogelsong (repairs to house-reimbursement) C. Fritz & Sons (furnace repairs) PA Water Company PP&L Electric Company PP&L Electric Company (final bill) PA Water _C0_mpany (fina! bill) Register of Wills (inheritance tax due) _Michael L. Bangs, Esquire (at~to_r_ney fees) 11/14/03 25.00 42.00 7.OO 114.56 83.79 2,075.00 745.0( 100.0( 51.58 6/20/03 525.00 7/2/O3 34O00 7/10/03 762.46 6/18/03 15.47 8/1/0~* ' 556.~ 811103[ 26~.'~2 8/8/03 24;~2 8/28/03 17.79 8/28/03 20.83 6~20~03 6/20/03 6/20/03 ~/20/03 6/20/03. 6/20/03 9/3/03_ 15_0.00 9/16/03 185.00 9/16/03 72.91 10/2/03 2,000.00 10/2/03 98.00 10/6/03 16.19 10/6/03 20.04 10/16/03 14.7(~ 10/22/03 17.84 8,000.00 TOTAL EXPENSES 30,423.1; PROPOSEI~ DISTRIBUTION - ASSETS AVAILABLE FOR DISTRIBUTION LESS EXPENSES __ __ 307,071.11 FUNDS AVAILABLE FOR DISTRIBUTION __ 276,647.99 R. BRADFORD ADAMS Real Estate located 802 John Glenn Blvd. ~n Lock Haven, PA Webster, NY 14580 Estate of Janice Adams 276,647.99 AFFIDAVIT R. BRADFORD ADAMS, Administrator, of the Estate of Winifred D. Adams, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of his office; that the foregoing Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to the best of his knowledge, there are no claims now outstanding against the estate; that all taxes presently due from the estate have been paid; and that more than four months have elapsed since the first complete advertisement of the granting of letters in this estate. R. BRADFORD ADAMS, Administrator SUBSCRIBED AND SWORN_ rp BY R. BRADFORD ADAMS. ~ISTRATOR ~,~EFORE ME THIS ~,~o~'~q~DXy OF ~ ~,,~ z.t.~,4.,~ - ,2004. otary Public ' Commerce Commerce Bank/Harrisburg N.A. 100 Senate Avenue Camp Hill, PA 17011 888-937-0004 J E ADAMS 5 CENTER DR CAMP HILL PA 17011 STATEMENT DATE J 05/31/03 0010303916 I ACCOUNT NO. CYCLE-052 *** SAVINGS *** PASSBOOK BEGINNING RATE 0.50000 ACCOUNT NUMBER 0010303916 PREVIOUS STATEMENT BALANCE AS OF 04/30/03 ........................ 10,698.35 PLUS 0 DEPOSITS AND OTHER CREDITS ................... .00 LESS 0 WITHDRAWALS AND OTHER DEBITS .00 CURRENT STATEMENT BALANCE AS OF 05/31/03 ................ 10,698.35 NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 *** SAVINGS ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 05/06 RATE CHANGE TO 0.40000 DEBITS CREDITS .00 *** BALANCE BY DATE *** 04/30 10,698.35 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE 23-2324730 10.50 *** INTEREST EARNED THIS STATEMENT PERIOD *** DAYS IN PERIOD ......................... 31 INTEREST EARNED ........................ 3.78 ANNUAL PERCENTAGE YIELD EARNED (APY) .... 0.42% NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC 01~26/2004 11:43 ?176913418 SPANKEY'S AUTO SALES PAGE 01 "A CUT ABOVE THE REST" AUTOiSALE$, INC. 701 E.Locust Street, Mechanicsburg · Rt. 11&15, Surhmerdale. 532 W. 4th Street, Lewistown 1702 Harrisburg Pike, Carlisle · 200 N. Walnut Street, Mechanicsburg REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice E. Adams SS~/ 194-36-4688 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 05/03/2003 FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1 Myers-Harner Funeral Home 2 1 2 3 4 Gingrich Memorials - Headstone Engraving ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Michael L. Bangs Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal The Sentinel Byerly Filing State~ Zip Incorporated - Probate Bond fee fee for Probate Bond TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 2,710.00 745.00 4,000.00 275.00 75.00 95.27 300.00 10.00 $ 8,210.27 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice E. Adams SS# SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 194-36-4688 05/03/2003 FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Verizon 2 3 4 Jack Yinger Jack Yinger Jack Yinger TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. AMOUNT 24.48 150.00 135.00 235.00 $ 544.48 Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice E. Adams SS~/ 194-36-4688 SCHEDULE J BENEFICIARIES 05/03/2003 NUMBER I. I1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116~(1.Z)] R. Bradford Adams 802 John Glenn Blvd. Webster, NY 14580 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Brother FILE NUMBER AMOUNT OR SHARE OF ESTATE Entire Estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 (If more space is needed, insert additional sheets of the same size) 0.00 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Janice E. Adams also known as , Deceased No. 21-03-0501 Date of Death 05/03/2003 Social Security No. 194- 36-4688 R. Bradford Adams, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Michael L. Ban~;s I.D. No.: 41263 Address: 302 South 18th Street Telephone: Camp Hill, PA 17011 717/730- 7310 Personal Representative Signature: /~( ~.. ~..~. ~ ..~-~..~,,~._.' R. Br adf or o~V'.~Adams Signature: Address: 802 John Glenn Blv. Webster, NY 14580 Telephone: Dated: (See continuation page(s) (Attach additional sheets if necessary) Description attached) Value Total: 291,83'7.04 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form i~RW-7 (1992) Estate of: Date of Death: County: Janice E. Adams 05/03/2003 Cumberland INVENTORY CASH: Commerce Bank - Savings Account TV Guide Refund Highmark Blue Shield Refund Nationwide Mutual Insurance Refund 10,698.35 54.83 895.37 40.50 PERSONAL PROPERTY: Proceeds from Mother's Estate 1999 Chevrolet Malibu Sedan 276,647.99 3,500.00 TOTAL RECEIPTS OF PRINCIPAL ............... 11,689.05 280,147.99 291,837.04 -1- 429 SOUTH 18TM STREET CAMP HILL, PA 17011 E-mail: mikebangs~,vcrizon net MICHAEL L. BANGS, Attorney-at-Law PHONE: 717-730-7310 FAX: 717-730-7374 WILLIAM E. MILLER, JR. WENDY S. CHESBRO, Paralegal April 7, 2004 Of Counsel Glenda Famer Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of ~lanice E. Adams File No. 21-03-0501 Dear Ms. Strasbaugh: Enclosed for filing please find a Receipt and Release together with a check in the amount of $7.00 to pay the filing fee. I am also enclosing a Status Report Form indicating that the estate administration is now concluded. Please mark your records accordingly. Thank you very much. eVery truly yours, ~ic'hael L. Bangs wsc Enclosures cc: Mr. R. Bradford Adams IN RE: ESTATE OF JANICE E. ADAMS, Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-03-0501 RECEIPT AND RELEASE I, R. BRADFORD ADAMS, the undersigned, being a beneficiary under the Estate of Janice E. Adams, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums of money to which I am entitled as a beneficiary of the Estate of Janice E. Adams; 4. To the extent of said distribution, release R. Bradford Adams, Administrator, of the Estate of Janice E. Adams, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said R. Bradford Adams, Administrator, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him ~ and the Estate all expenses and costs incurred in connection with any such claim; anat.. -: 6. Declare that this instrument shall be legally binding upon me, my personal~ representatives, and assigns. '"~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ rC~ ,2004. day of ~. ~ ~/~~~(SEAL) R. BRADFIf~RD ADAMS STATE OF NEW YORK ) COUNTY OF~) ( SS: On this, the ..~0%ay of ~ ,2004, before me, the undersigned officer, personally appeared R. BRADFORD ADAMS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that (s)he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hav~reunto~t m,,y?hand ~ official sW Notary Public Ccnmlia~loa Expire~ 0ok 21, Name of Decedent: Social Security No.: REGISTER OF WILLS OF CUMBERLAND COUNTY REPORT OF STATUS OF ADMINISTRATION (For Resident Decedents Dying after July 1, 1984) ESTATE NO. 21 - 03-0501 JANICE E. ADAMS 194-36-4688 Date of Death: May 3, 2003 Name of Personal Representative: R. Bradford Adams 802 John Glenn Blvd. Webster, NY 14580 Capacity Executor (check one) Administrator X Administrator c.t.a. Administrator d.b.n. Is the administration of the estate complete? Yes X No If "Yes", how was the administration ended? (check one) By court accounting By account stated to parties in interest Did the parties release the personal representative? Yes Other (explain) X Total amount paid to date to creditors and for funeral and $42,303.64 administrative expenses Total value of distributions to date to beneficiaries $246,088.57 If administration is not complete, estimated value of assets $ still in administration NOTE: This status report is due no later than the due date for filing of the Pennsylvania inheritance tax return or, if no inheritance tax return is required, nine (9) months after the date of death; if the administration of the estate has not been concluded, a summary report shall be filed annually thereafter until the administration is complete. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. Date: BUREAU OF /NDIVZDUAL TAXES XNHERTTANCE TAX DXVTS/ON DEPT. 280601 HARR/SBURg, PA 17118-06n! MICHAEL L BANGS $02 S 18TH ST CAMP HILL COMMONWEALTH OF PENNSYLVAN/A DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR D/SALLONANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN ~PA 17011 03-15-200q ADAMS 05-05-2005 21 05-0501 CUMBERLAND 101 Aeoun~ Raai~ad RE¥-15¢7 EX AFP (nl-OS) JAN]CE E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 4 REV-1547 EX AFP (01-03) NOTTCE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF ADAMS JAN/CE E FZLE NO. 21 05-0501 ACN 101 DATE 05-15-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I Real Es~a~a (Schedule A) S~ocks end Bonds (Schedule B) $ Closely Held S~ock/Par~nership In~eras~ (Schedule C) Mor~gagas/No~as Receivable (Schedule D) 5 Cash/Bank Daposi~s/Hisc. Personal Propar~y (Schedule E) 6 Jointly Owned Propar~y (Schedule F) 7 Transfers (Schedule G) 8 To,al Assa~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) 10. Deb~s/Nor~gaga Liabilities/Liens (Schedule 1) 11. To,al Deductions 12. Na~ Value of Tax Ra~urn (1) .00 (2) .00 ($) .00 (¢) .00 (5) 291/857.0~ (6) .00 (7) .00 (9) (8) 8,210.27 (10) 5~.~8 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper por~/on of ~his form wi~h your ~ax payment. 291,837.0q OZ-OZ-200~ RECEZPT NUMBER CD003511 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/T/ONAL INTEREST. DISCOUNT (+) INTEREST/PEN PAID (=) .00 AMOUNT PAID 33,969.87 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE TAX CREDITS: FAYII~NT DATE Charitable/Governmental Baques*s; Non-elected 911:5 Trusts (Schedule J) (13) Na~: Value of Es4:a~:a Subject: ~:o Tax (1¢) 183,081. ?9 Zf an assess, ant ,as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ,ill .00 .00 .0O 35,969.87 .00 33,969.87 33,969.87 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT TS REI~UZRED. ~/ ZF TOTAL DUE TS REFLECTED AS A "CREDIT' (CR), YOU NAY BE DUE/~ A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS.) ~ 13. NOTE: reflect figures that include the tote! of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aaoun* of Line 1¢ a~ Spousal ra~e (15) .00 X O0 = 16. Amoun~ of Line 1¢ ~axabla e~ Lineal/Class A ra~a (16) .00 X 0~5 = 17. Aaoun~ of Line 1¢ a* SAbling re~e (17) 283,082.29 X 12 = 18. Amoun{ of Line 1¢ {axabZa a~ Collateral/Class B ra{a (18) .00 X 15 = 19. Principal Tax Due (19)= (11) 8.756.7; (1R) Z83,08g. Z9 RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1982 -- if any future interest in the estate is transferred in possassion or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for lira or for years, the Coemonaaalth hereby expressly reserves tho right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. To ~ulfill the requiramants of Section ZlqO of the Inharitance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Hake check or money order payabla to: REGISTER OF NILES, AGENT A refund of a tax credit, ahich Nas not requested on tho Tax Return, may be requested by compXeting an "Application for Refund of PannsyXvania Xnharitanca and Estate Tax" (REV-1315). Applications are available at the Office of the Rag[star of Rills, any of the 23 Revenue District Offices, or by calling the special Z~-hour ansaerlng servJca for forms ordering: 1-800-361-2050; services for taxpayers with special haaring and / or spaaking needs: 1-800-q~7-$010 (TT only). Any party in interest not satisfied with the appraisement, aZlomanca, ar disaZlowanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice oust object within sixty (60) days of raceJpt of this Notice by: --written protest to the PA Department of Revenue, Saard af Appeals, Dept. 281021, Harrisburg, PA 1717_8-1021, DR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to tha Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171ZB-0601 Phone (717) 787-650S. Sam page S of the booklet "[nstructions for Inheritance Tax Return for a Rasident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadant's death, a five percent (5Z) discount of the tax paid is allowed. Tha 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 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 nina (9) months and one (13 day from the date of death, to [ha date of payment. Taxes which became deltnquant bafora January I, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .OO016q. A11 taxes which became dalinquant on and after January 1, 1981 will bear interest at a rate ahich 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 200q ara: In[aras[ Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lox .0005~8 ~J~'8-1991 11Z .OOO3Ol ~ 9Z .OOOZq7 1983 16Z .000q38 1992 92 .0002~7 ZOOZ 62 .00016~ 198q llZ .OOO~O1 1995-199~ 72 .000192 2003 52 .000137 1985 131 .000356 1995-1998 9Z .OOOZq7 200q ~Z .000110 1986 101 .O00Z7q 1999 71 .000192 1987 IOZ .O00Z7q ZOO0 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fiftaen (15) days beyond [ha date of the assessment. If payment is made after the interast computation date shown on [ha No[ica, additional in[aras[ must ba calculated.