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HomeMy WebLinkAbout03-0697 PETITIOI 2 FOR PROBATE and GRANT OF LETTERS Estate of Jane ,.--~'-Allen No. also known as Jane ~ Allen To: Register Of Wills for the Deceased. County ofCumberland in the Social Security No. 19 2 - 3 4- 7 41 ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who ~/are 18 years of age or older an the execu~ _ named in the last will of the above decedent, dated September 8 ,19 8 2 and codicil(s) dated none John W. Allen p~edeceased Jane ~-llen (state relevant circumstances, e.g. renunciation, death of executor, etc.} Deeendent was domiciled at death in OumBerl~n~ County, Pennsylvania, with her last family or principal residence at 62 ~ Wilson Street, Borough of Carlislee Cumberland County, Pennsylvania (list street, number and muncipality) Decendent, then 82 years of age, died July 30, 2003 ~x at Harrisburg Hospital, Harrisburq. Dauphin Conne. y: ~onn~y!vanl.a Except as follows, decedent did not marry, was not divorced and did not have a child horn or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: 250 000 00 (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 $ 100,000.00 situated as follows: 62 Wilson Street, Carlisle, Cumberland County, P~nnsylvania WHEREFORE, petitioner(s) respectfully .requ.est(s) th.e probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~=._o 1138 Redwood Drive ~'= Carlisle, PA 17013 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -~ COUNTY OF Cumberland ; ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,- ~;~L.~-0..~Lff~~O~..o--~ co /'~l~lefore me this . 22nd day of { __ ~' o~' (.,..J Auqu~ ')., ,,, ,~ /] t~_ 2003 ~ M ~ Donna M.Ot%0,1~-Deputy' - f-- ~]~drgiS~er [~[ ],~d,, ~/TjT. ~ "-/- $0. 21-2003-697 ..~ , jane M. Allen, a/k/a Estate of Jane P. Allen , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August 25th 1~x 200,3in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 8, 198 2 described therein be admitted to probate and filed of record as the last will of Jane M. Allen, a/k/a Jane P. Allen ; and Letters Testamentary _ Barbara Jane Allen are hereby granted to. FEES 4 4 8 5 3 Probate, Letters, Etc .......... $ 305.00 Short Certificates(l ) ... ~ ...... $ 12.00 ATTORNEY (Sup. Ct. I.D. No.) Renunciation ..(.1.) ........... $ 5.00 17 West South Street x-Pages (0) -0- $ Carlisle ADDRESS PA 17013 JCP 5.00 TOTAL__ $332.00 (717) 249-6873 Filed ...A.u. 99..s.t...2.5..th. ,. 2..0Q~ ............. Call Attorney when the letters are finished PHONE on August 25th,2003. RENUNCIATION 21-2003-697 To the Register of Wills of ~/)~ ,O7,~e',~/7/',~ County, Pennsylvania. The undersigned '~' '~ 4/V~ /~//~','~/ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters (Signature) (Signature) (Address) (Signature) (Address) TER OF WILLS OF Cumberland/~COUNTY H OF SUBSCRI/~/W~TNESS Henry Stuart~nd__ 'Karen~,~ Faircloth cOC~e' (each) a subscr_bingi witness to the d herewith, (each) being duly qualified according to law de oses and sa s that we , depose(s) and say(s) that we/were ~-..._ present and saw Jane M. Allen a/k/a/ffane V. Alle~ the testatrix , sign the s~e and that we ~_ signed as a witness at the request of testatr ix i~/er presence and (in the presence ~he presence of the other subscribing/~ss(es)). Sworn to or af~med and subscribed before me this _/ day of (Name) / (Address) Register (Name) (Address) 21-2003-697 REGISTER OF WILLS OF CL~nberland COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~e ~e familiar with the signature of J~e ~. Allen, a/k/a J~e P. ~len ' testat r~ of ~~ to) the presented herewith and ~dicil that ~Y believes the signature on thais in the h~dwriting of J~ M. Allen,a/k/a J~e P. Allen~ ~ // to the best of our knoWledge and belief./~. //~ /~ this 22nd day of am . " ~ ~/'~~~"-~ ~ (Bddress) _ _1 ~nna M.'~o,lst ~puty/- ~:st'-~f_~ ~~ ~ ~ . (Name) (Address) 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 illegal to duplicate this copy by photostat or photograph. Local Registrar 9449571 No. ~ Date '~05.=*o ~, z,87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS '~ CERTIFICATE OF DEATH Jane P. Allen Fe~le 192 -- 34 -- 7410 82 : : J~e ~ - ~~'" '~ , 1921 Bl~fteld ~ ,~,.,~ ~. ~ ~ ~u~in Ha~isbu~ Harr~sbu~ Hospital ,~. ~ite Nurse H~ m ~ ~ ~ ~,~ t,~. ~ 62 Wilson St. ,~..~. PA ~ ,~..Q~,~_ ~rlisle PA 17013 ~'~ ~ Pilch Rees Allen PA 17013 ~ ~ -~ A~ust 2, 2~3 Mem. ~rdens Carlisle PA 17013 ~_~. ~rlisle PA 17013 21-2003-697 HENRY L. $'I'UART ~-3 I. HANOVI;III LAST ~glLL AND TESTAb~ENT :~.,,:~.~~.~-,~},," I, JANE ~i. ALLEN, of Carlisle, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my last will and testament, hereby revoking and making void all fornter wills by me at any time heretofore ~ade. FIRST. I direct all my just debts and funeral expenses be fully paid and satisfied out off my estate bi/ my personal representa- tive hereinafter named as soon as conveniently may be after my deceas SECOND. ~ give, devise and bequeath all of my estate, real_ and personal, to my husband, John ~. Allen, absolutely. THIRD. In the event that my said husband predeceases me, %hen I give, devise and bequeath alt of my estate, rea~ and personal, to my children in equal shares, or their issue. LASTLY, I nominate, constitute and appoint my said husband, John ~'{. Allen, Executor, if living, otherwise my two daughters, Barbara Ja ~llen and Judith Ann Allen, Executrices, of [his my last will and merit and ~ direct that any of [hem be permitted to serve and act in capacity without g'iving bond. IN ~ITNE$S WHEREOF, I have hereunto set my hand and seal this day of . ~ ~,~..~.~ ~., A.D., 1982. :::' L,'t'''( ( s Signed, sealed, published and declared by the above named Testatrix, Jane M. Alien, as and for her last will and testament in th~ presence of us, who, at her request and in her presence and in th~ presence of each other, have hereunto subscribed our names as witnesses thereto. J~/ , ,..;~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: Jane M. Allen aJk/a Jane P. Allen DATE OF DEATH: July 30, 2003 TO THE REGISTER: ~. o ~>- Iool-3 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: NAME ADDRESS Barbara Jane Allen 1138 Redwood Drive, Carlisle, Pennsylvania 17013 Judith Allen 998 Forty Foot Road, Hatfield, Pennsylvania 19440 Susan Squibb 377 Mooredale Road, Carlisle, Pennsylvania 17013 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except: NONE DATE: September 2, 2003 ~~~ David A. Baric, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Counsel for Personal Representative COHMONWEALTH OF PENNSYLVANIA BUREAU OF ZNDZVTDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTIC~ OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DXSALLORANCE OF DEDUCTIONS, AND ASSESSI~ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ttEV-XSqe EX AFP ~O~-OS~ R~._ -. DATE~ 08-02-2004 i";<:~' :<:: ESTatE OF ALLEN JANE P r~e~:~!~? :: DA~E OF DEATH 07-:$0-2005 FILE NUMBER 21 0:$-0697 COUNTY CUMBER LAND SUSAN G SQUIBB '0~ JUL 30 0:$140184 62 WILSON ST Amount; Rem~.'t'ted CARLISLE PA 1701:$ (~!g~r ~ ~ MAKE CMECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:$ CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-15&8 EX AFP (01-03) NOT/CE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-2004 ESTATE OF ALLEN JANE P DATE OF DEATH 07-:$0-200:$ COUNTY CUMBERLAND FILE NO. 21 0:$-0697 S.S/D.C. NO. 192-:$4-7410 ACN 0:$140184 TAX RETURN WAS: iX) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 5060068020 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-20-2001 Accoun~ Balance .00 NOTE: TO INSURE PROPER CREDIT TO Percen~ Taxable ~ 0.500 YOUR ACCOUNT, SUBMIT THE Amoun~c Subjec~ to Tax .00 UPPER PORTION OF THIS NOTICE Deb*s and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amoun~ .00 REGISTER OF WILLS AT THE Tax Ra~e )~ .15 ABOVE ADDRESS. MAKE CHECK Tax Due .00 OR MONEY ORDER PAYABLE TO: **REGISTER OF WILLS, AGENT.** TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PATD DATE NUNBER INTEREST/PEN PAID (-) 04-15-2004 CDO 0:$8:$8 .00 165.22 TOTAL TAX CREDITI 165.22 ¢ BALANCE OF TAX DUE 165.22CR INTEREST AND PEN. .00 TOTAL DUE 165.22CR IF PAID AFTER TH/S DATE, SEE REVERSE FOR CALCULATION OF ADD/TXONAL INTEREST. ~ ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCT/OHS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 11~0 of the Inheritance and Estate Tax Act, Act 15 of ZOO0. ¢71 P.S. Section 91~0), PAYMENT: Detach the top portion of this Notice and submit eith your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NILLS, AGENT. REFUND (CA): A refund of e tax credit, Nhich ams not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ere available et the Office of the Register of #ills, any of the 25 Revenue District Offices or by calling the special 2~-hour answering service for forms ordering: 1-800-$62-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-q~7-5020 (TT Dilly). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days af receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81071, Harrisburg, PA 17118-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department o~: Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. 280601, Harrisburg, PA 17118-0601 Phone (717} 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (5Z3 discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you mould appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day fram the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January 1, 1961 will bear interest at a rate ahich aill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1961 through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .0005q8 196-"-8-1991 11Z .000501 2009 97. .O00Zq7 1985 167. .000q58 1992 97. . OOOZq7 ZOOZ 67. .000119 198~ 117. .000501 1993-199fi 77. .00019Z 2005 57. .000137 1985 157. .000556 1995-1998 91 . OOOZq7 200~ ~7. .000110 1986 107. . OOO 17~ 1999 77. .000191 1967 97. .OOOZ~7 ZOO0 87. .000119 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on tho Notice, additional interest must be calculated. COHNONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DI¥ISZON DEPT. 280601 HARRISBURG, PA 1712B-0601 NOTICE OF INHERITANCE TAX APPRAXSENENT, ALLO#ANCE OR DISALLO#ANCB OF DEDUCTIONS** AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS *EV-XS4e EX AFl* ¢01-0S) ,.,DATE 08-02-2004 R~(':o~;~ :,i~ :', ~c)~' '~i:STATE OF ALLEN JANE P ~'?~iE~'. DATE OF DEATH 07-50-2005 FILE NUHBER 21 05-0697 COUNTY CUHBERLAND 62 WILSON ST Amoun~ Retaliated CARLISLE PA 170 I~,~,~K' :~.~ HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-2004 ESTATE OF ALLEN JANE P DATE OF DEATH 07-50-2005 COUNTY CUHBERLAND FILE NO. 21 05-0697 S.S/D.C. NO. 192-54-7410 ACN 05140186 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORNATION FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 5060070521 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 10-05-2002 Accoun~ Balance .00 NOTE: TO INSURE PROPER CREDIT TO PePcent Taxable X 1.000 YOUR ACCOUNT, SUBHIT THE Amoun~ Sub~ec~ ~o Tax .00 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYHENT TO THE Taxable Amount .00 REGISTER OF WILLS AT THE Tax Ra~ce )~ .15 ABOVE ADDRESS. HAKE CHECK Tax Due .00 OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYNENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER :NTEREST/PEN PAZD (-) 04-15-2004 CD005857 .00 570.90 TOTAL TAX CREDIT 570.90 BALANCE OF TAX DUEI 570.90CR INTEREST AND PEN. .00 TOTAL DUE 570.90CR ZF PAID AFTER THIS DATE~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. PURPOSE OF NOTICE: To fulfil1 the requirements of Section Z[40 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 91~0). PAYMENT: 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 NILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Nills, any of the ZS Revenue District Offices or by calling the special [4-hour answering service for forms ordering: 1-800-562-ZOS0; services for taxpayers with special hearing and or speaking needs: 1-800-447-S020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 1712B-1021, OR --e[ecting to have the matter determined at the audit of the account of the persona[ representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 28060[, Harrisburg, PA 17[28-0601 Phone (717) 787-6505. See page 5 of the book[at "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-J501} for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appeaZab[e in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of deZinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 appIicab[e interest rates for 1982 through ZOO°, are: Interest I)aily Interest I)ai[y Interest Dai[y Year Rate Factor Year Rate Factor Year Rate Factor 198~ 20Z .0005,q.8 198"-'~- 1991 llZ .000501 200~ 97. .000247 XaB'~ 162 .000438 1992 aY. , O002~7 2002 67. .000219 1984 IIZ .000301 1993-1996 72 .O00laZ ZOOS 52 .000137 1985 X3Z .000556 1995-1998 92 .0002~7 2004 4Z .000110 1986 102 .000274 1999 7Z .000192 1987 9Z .000247 ZOO0 82 .000219 --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NU~IBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003186 BARIC DAVID A ESQ 17 WEST SOUTH ST CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $21,000.00 ESTATE INFORMATION: SSN: 192-34-7410 FILE NUMBER: 21 03-0697 DECEDENT NAME: ALLEN JANE M DATE OF PAYMENT: 10/30/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 TOTAL AMOUNT PAID: $21,000.00 REMARKS: BARBARA J ALLEN-TAX PAYMT SAME DAY 10/30/03-DAVID A BARIC ESQ CHECK# 101 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS OFFICIAL USE ONLY REV:tS00 EX+ 6-00 REV--1500 COMMO.WEA,T. OFPE..SYLVA.,A INHERITANCE TAX RETURN roLE.UMBER DEPARTMENT OF REVENUE DEPT. 260 0 RESIDENT DECEDENT 02- 0697 HARRISBURG, PA 171Z8-0601 COUNTYCODE YEAR NUMBER D DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER E Straub Dorothy E. 207-09-0209 C DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-DO-YEAR) E THIS RETURN MUST BE FILED IN DUPLICATE WITH THE D 07/08/2002 07/03/1918 REGISTER OF WILLS NE (IF APPLICABLE) SURV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER T ~ ~4; H (date of death 1. Original Return 2. Supplemental Return 3. Remainder Return prior to 1;>- 13-8;>) C A P B 4. Limited Estate Future Interest Compromise (date of death after 1:>- 1;>-8;>) 5. Federal Estate Tax Return Required HpRL · E P I O 6. Decedent Died Testate Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes C R A C (Attach copy of Will) (Attach copy of Trust) KoTK ES ~ 9. Litigafion Proceeds Received I~110. Spousal Poverty Credit F'~ 11. Election to tax under Sec. 9113(A) (date of death between 1;>-:31-91 and 1 - 1-95) (Attach Sch O) C g NAME COMPLETE MAILINGADDRESS O George A. Vau~hn III RR DN FIRMNAME(IfApplicable) 3904 Trindle Road E ~1 Camp Hill, PA 17011 S T TELEPHONE NUMBER 717/975- 9102 1. Real Estate (Schedule A) (1) 82 , 000.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 30,432.89 3. Closely Held Corporation, Partnership or (3) None Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) Nolte R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ].52 605.87 E ~ , C (Schedule E) A 6. Jointly Owned Property (Schedule F) (6) 4,499.04 P I Separate Billing Requested T U 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None L (Schedule G or L) A T 8. Total Gross Assets (total Lines 1-7) (8) 269,537.80 I O 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14, ].83.80 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 576.16 11. Total Deductions (total Lines 9 & 10) (11) 14,759.96 12. Net Value of Estate (Line 8 minus Line 11) (12) 254,777.84 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 254,777.84 C O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M T UP 15. Amount of Line 14 taxable at the spousal tax A X I rate, or transfers under Sec. 9116(aX1.2) X .0 0 (15) 0.00 T 16. Amount of Line 14 taxable at lineal rate 254,777.84 X .0 45 (16) 11,465.00 I 17. Amount of Line 14 taxable at sibling rate (17) 0.00 O X .12 N 18. Amount of Line 14 taxable at collateral rate X .15 (18). 0.00 19. Tax Due (19) 11,465.00 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev, 6-00) Decedent's Complete Address: STREET ADDRESS 722 Alexander Sprin~ Road CITY I STATE ZIP Carlisle I PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) l1,465.00 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 9,900.00 C. Discount 521.05 Total Credits ( A + B + C ) (2) 10,421.05 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( O + E ) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,043.95 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) '1 , 043.95 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? .............................................. r-~ ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge 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. .~~._RE OF PERSON RESPONSIBLE FOR FILING RETURN Dennis R. St:raub DATE ~ ~~ 722 Alexander Slqrin~. Road .-/- /7 -- Pk- - -i Ydi§ .......................... SIC~/~UREO~F~,PR~IL;~RF~'HERTHANREPRESENTATIVE George A Vaughn III DATE__ . ~~_~-~ 3904 Tri~tdle Road ~/,~/~,_~ 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 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) z000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1502 EX + (1-97) SCHEDULE A CO.,O.WEA,TH O~ PENNS~LVA.~A REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy E. Straub SS~/ 207-09-0209 07/08/2002 21-02-0697 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledc~e of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Residential real estate located at 441 Middletown Road, 82,000.00 I~ummelstown, PA 17036; value established by arm's length sale on November 22, 2002 (copy of Settlement Statement attached) TOTAL (Also enter on line 1, Recapitulation) $ 82,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1502 EX (Rev. 1-97) REV-1503 EX + (1-97) SCHEDULE B COMMONWEALTH OF PENNSYLVANIASTOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy E. Straub SS~/ 207-09-0209 07/08/2002 21-02-0697 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 14 $25.00 US Savings Bonds - Series E; all issued in 1,596.18 1977 See attached Exhibit "E" 2 21 US Savings Bonds Series E - See attached Exhibit 5,014.33 tt Ftt 3 26 $25.00 US Savings Bonds - Series E; all issued in 3,240.53 1973 - See attached Exhibit "A" 4 26 $25.00 US Savings Bonds - Series E; all issued in 3,095.92 1974 - See attached Exhibit "B" 5 26 $25.00 US Savings Bonds Series E; all issued in 3,046.23 1975 - See attached Exhibit "C" 6 26 $25.00 US Savings Bonds Series E; all issued in 2,999.10 1976 - See attached Exhibit "D" 7 26 $25 US Savings Bonds - Series E; all issued in 1972 3,279.05 - See attached Exhibit "I" 8 7 US Savings Bonds Series E - See attached Exhibit 578.43 t~ Gtt 9 9 US Savings Bonds Series EE; See attached Exhibit 7,583.12 "H" See attached Exhibit "H" TOTAL (Also enter on line 2, Recapitulation) 30,432.89 (If more space IS needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) Inventory Report Active Inventory Print Date: 01/01/2003 Bonds: File Pricin~ Date: 07/200? Issue Next Interest Final Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 E $25 Q5072032105E 01/1973 $18.75 $107,43 $126.18 4.00% 6.61% 11/2002 01/2003 2 E 25 Q5071986744E 01/1973 18.75 107.43 126.18 4.00% 6.61% 11/2002 01/2003 3 E 25 Q5078471868E 02/1973 18.75 107.75 126,50 4.00°~ 6.62% 12/2002 02/2003 4 E 25 Q5072716855E 02/1973 18,75 107.75 126.50 4,00% 6.62% 12/2002 02/2003 5 E 25 Q5085867761E 03/1973 18,75 107.75 126.50 4.00% 6.62% 01/2003 03/2003 6 E 25 Q5086692109E 03/1973 18,75 107.75 126.50 4.00% 6.62% 01/2003 03/2003 7 E 25 Q5091660831E 04/1973 18.75 105.27 124,02 4.00% 6.66% 08/2002 04/2003 8 E 25 Q5091786953E 04/1973 18.75 105,27 124,02 4.00% 6.66% 08/2002 04/2003 9 E 25 Q5092592811E 05/1973 18.75 105.27 124.02 4.00% 6.66% 09/2002 05/2003 10 E 25 Q5093277807E 05/1973 18.75 105.27 124.02 4.00% 6.66% 09/2002 05/2003 11 E 25 ! QS099679623E 06/1973 18.75 105.57 124.32 4.00% 6.67% 10/2002 06/2003 12 E 25 Q5100004732E 06/1973 18.75 105.57 124.32 4.00% 6.67% 10/2002 06/2003 13 E 25 Q5100430913E 06/1973 18.75 105.57 124.32 4.00% 6.67% 10/2002 06/2003 14 E 25 Q5107059294E 07/1973 18.75= 106,77 125,52 4.00% 6.70% 11/2002 07/2003 15 E 25 Q5107291467E 07/1973 18.75 106,77 125.52 4.00% 6.70% 11/2002 07/2003 16 E 25 Q5114954370E 08/1973 18.75 107.04' 125.79~ 4.00% 6.71% 12/2002 08/2003 17 E 25 Q5107674786E 08/1973 18.75 107.04 125.79 4.00% 6.71% 12/2002 08/2003 18 E 25 Q5121312223E 09/1973 18.75 107.06 125.81 4.00% 6.71% 01/2003 09/2003 19 E 25 Q5122107327E 09/1973 18.75 107.06 125.81 4.00% 6.71% 01/2003 09/2003 20 E 25 Q5127705307E 10/1973 18,75 104.60 123.35 4.00% 6.76% 08/2002 10/2003 21 E 25 Q5128409919E 10/1973 18.75 104.60 123.35 4.00% 6.76% 08/2002 10/2003 22 E 25 Q5128446617E 11/1973 18.75 104,60 123,35 4.00% 6.76% 09/2002 11/2003 23 E 25 Q5134921763E 11/1973 18.75 104.60 123.35 4.00% 6.76% 09/2002 11/2003 24 E 25 Q5135100989E 11/1973 18.75 104.60 123.35 4.00% 6.76% 09/2002 11/2003 25 E 25 Q5142431201E 12/1973 18.75 102.32 121.07 4.00% 6.65% 12/2002 12/2003 26 E 25 Q5142377840E 12/1973 18.75 102.32 121.07 4.00% 6.65% 12/2002 12/2003 Inventor~ Totals: · Cl ~ bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Sedes I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled I Page 1 of 1 InVen'- tory Report Active Inventory Bonds: Print Date: 01/01/2003 Issue File Pricir Date: 0712002 Final Maturity Serial Number Date Price Interest Value Date Date QS142431935E 01/1974 $18~ $1 $121 01/2003 01/2004 Q5148130473E 01/1974 18.7~- 102.32 121.07 01/2003 01/2004 Q5155980218E 02/1974 18.75 99.,~ 118.7( 08/2002 02/2004 Q5155980455E 02/1974 18.75 99.95 118.70 08/2002 02/2004 Q5163459430E 03/1974 18.75- 99 118.70 09/2002 03/2004 Q5163476929E 03/1974 18.~" 99.95 118.70 09/2002 03/2004 Q5170438771E 04/1974 18.7~- 99.95 118.7 10/2002 04/2004 Q5170933687E 04/1974 18 .~-~' 99.95 118.70 10/2002 04/2004 Q5178280508E 05/1974 18.-~' 101 .~ 119.83 11/2002 05/2004 Q5178909294E 05/1974 18.75 101 119.83 11/2002 05/2004 Q5178949734E 05/1974 18.75 101.08 119.83 11/2002 05/2004 Q5185913216E 06/1974 18.75 101.37 120.12 12/2002 06/2004 Q5193103325E 06/1974 18.~' 101 120.12 12/2002 06/2004 Q5193152198E 07/1974 18.75 101. 120.12 01/2003 07/2004 Q5193152434E 07/1974 18.75 101. 120., 01/2003 07/2004 - Q5193171063E 08/1974 18.75 99.0' 117.76 08/2002 08/2004 ~ Q5193420939E 08/1974 18.75- 99.0' 117.76 08/2002 08/2004 Q5204210432E 09/1974 18.75 99.01 117.76 09/2002 09/2004 ~ Q5209741409E 09/1974 18.75 99.01 11 09/2002 09/2004 ~m Q5209741692E 10/1974 18.75 99.01 117.76 10/2002 10/2004 ~ Q5213615060E 10/1974 18.7,~ 99.01 117.76 10/2002 10/2004 Q5216840757E 11/1974 18.75 100.' 118.89 11/2002 11/2004 Q5223188777E 11/1974 18.75 100.14 118.89 11/2002 11/2004 Q5223891390E 11/1974 18.75 100.14 11 11/2002 11/2004 Q5223891640E 12/1974 18.~- 100.4, 119.19 12/2002 12/2004 Q5236033589E 12/1974 18.7.__~~ 100.4~ 119.19 12/2002 12/2004 Inventory Totals: ~-Bonds I l, 26 ~ $487.50 1 Interest I Value ~ $2,608.421 $3,095.97~ · Cl - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · PS - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is $ years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education Untitled 2 ° () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Page 1 of 1 Active Inventory Print Date: 01/01/2003 Bonds: File Issue Next Interest Final Maturity i No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note I E $25 Q5236217914E 01/1975 $18.75 $t00.41 $119.16 4.00% 6.84% 01/2003 01/2005 2 E 25 Q5236226252E 01/1975 18.75 100.4' 119.16 4.00% 6.84% 01/2003 01/2005 3 E 25 Q5242944436E 02/1975 18.75 98.08 116.83 4.00% 6.89% 08/2002 02/2005 4 E 25 ~ Q5244060759E 02/1975 18.75 98.08 116.83 4.00% 6.89% 08/2002 02/2005 5 E 25 Q5253319259E 03/1975 18.75 98.08 116.83 4.00% 6.89% 09/2002 03/2005 6 E 25 Q5253764184E 03/1975 18.75 98.08 116.83 4.00% 6.89% 09/2002 03/2005 7 E 25 Q5252244126E 04/1975 18.75 98.08 116.83 4.00% 6.89% 10/2002 04/2005 8 E 25 Q5254146456E 04/1975 18.75 98.08 116.83 4.00% 6.89% 10/2002 04/2005 9 E 25 Q6005160562E 05/1975 18.75 99.20 117.95 4.00% 6.93% 11/2002 05/2005 10 E 25 Q6005160764E 05/1975 18.75 99.20 117.95 4.00% 6.93% 11/2002 05/2005 11 E 25 Q6005506038E 05/1975 18.75 99.20 117.95 4.00% 6.93% 11/2002 05/2005 12 E 25 Q6013729868E 06/1975 18.75 99.48 118.23 4.00% 6.94% 12/2002 06/2005 13 E 25 Q6022273403E 06/1975 18.75 99.48 118.23 4.00% 6.94% 12/2002 06/2005 14 E 25 Q6022273643E 07/1975 18.75 99.48 118.23 4.00% 6.94% 01/2003 07/2005 15 E 25 Q6022684954E 07/1975 18.75 99.48 118.23 4.00% 6.94% 01/2003 07/2005 16 E 25 Q6028489622E 08/1975 18.75 97.17 115.92 4.00% 6.99% 08/2002 08/2005 17 E 25 Q6029383183E 08/1975 18.75 97.17 115.92 4.00% 6.99% 08/2002 08/2005 18 E 25 Q6033146953E 09/1975 18.75 97.17 115.92 4.00% 6.99% 09/2002 09/2005 19 E 25 Q60331'47146E 09/1975 18.75 97.17 115.92 4.00% 6.99% 09/2002 09/2005 20 E 25 Q6034464733E 10/1975 18.75 97.17 115.92 4.00% 6.99% 10/2002 10/2005 21 E 25 Q6038496969E 10/1975 18.75 97.17 115.92 4.00% 6.99% 10/2002 10/2005 22 E 25 Q6039078606E 10/1975 18.75 97.17 115.92 4.00% 6.99% 10/2002 10/2005' 23 E 25 Q6031949250E 11/1975 18.75 98.30 117.05 4.00% 7.03% 11/2002 11/2005 24 E 25 Q6037023456E 11/1975 i8.75 98.30 117.05 4.00% 7.03% 11/2002 11/2005 25 E 25 Q6043955257E 12/1975 18.75 98.56 117.31 4.00% 7.04% 12/2002 12/2005 26 E 25 Q6044238732E 12/1975 18.75 98.56 117.31 4.00% 7.04% 12/2002 12/2005 InventoR Totals: 26 J $487.50 $2,558.73 $3,046.23 · CI - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · PS - bond is a Sedes I or EE, was issued in or after May 1997 and includes a 3-month-intersst Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 3 Page 1 of 1 Inventory Report Active Inventory Print Date: 01/01/2003 Bonds: Fil~ Pricin~ Date: Issue Next Interest Final Maturity No. Series Denorr Serial Number Date Price Interest Value Rate Yield Date Date Note 1 E $25 Q6044478781E 01/1976 $18.75 $98.57 $117.32 4.00% 7.04% 01/2003 01/2006 2 E 25 Q6065581188E 01/1976 18.75 98.57 117.32 4.00% 7.04% 01/2003 01/2006 3 E 25 Q6070715233E 02/1976 18.75 96.27 115.02 4.00% 7.10% 08/2002 02/2006 4 E 25 Q6070750228E 02/1976 18.75 96.27 115.02 4.00% 7.10% 08/2002 02/2006 5 E 25 Q6071592247E 03/1975 18.75 98.08 116.83 4.00% 6.89% 09/2002 03/2005 6 E 25 Q6071602751E 03/1976 18.75 96.27 115.02 4.00% 7.10% 09/2002 03/2006 7 E 25= Q60793746926E 04/1976 18.75 96.27 115102 4.00% 7.10% 10/2002 04/2006 8 E 25 Q6079378820E 04/1976 18.75 96.27 i15.02 4.00% 7.10°~ 10/2002 04/2006 9 E 25 Q6086099887E 04/1976 18.75 96.27 115.02 4.00% 7.'10% 10/2002 04/2006 10 E 25 , Q6086243251E 05/1976 18.75 97.36 116.11 4.00% 7.14% 11/2002 05/2006 11 E 25 Q6087214220E 05/1976 18.75 97.36 116.11 4.00% 7.14% 11/2002 05/2006 12 E 25 Q6087344666E 06/1976 18.75 97.62 116.37 4.00% 7.15% 12/2002 06/2006 13 E 25 Q6094755123E 06/1976 18.75 97.62i 116.37 4.00% 7.15% 12/2002 06/2006 14 E 25 Q6095349126E 07/1976 18.75 97,60 116.35 4.00% 7.15% 01/2003 07/2006 15 E 25 Q6094787734E 07/1976 18.75 97.60 116.35 4.00% 7.15% 01/2003 07/2006 16 E 25 Q6101244262E 08/1976 18.75 95.32 114.07~ 4.00% 7.21% 08/2002 08/2006 17 E ' 25 Q6101880097E 08/1976 18.75 95.32 114.07 4.00% 7.21% 08/2002 08/2006 18 E 25 Q6109511839E 09/1976 18.75 95.32 114.07 4.00% 7.21% 09/2002 09/2006 19 E 25 Q6109547284E 09/1976 18.75 95.32 114.07 4.00% 7.21% 09/2002 09/2006 20 E 25 Q6109676891E 10/1976 18.75 95.32 114.07 4.00% 7.21% 10/2002 10/2006 21 E 25~ Q6115750857E 10/1976 18.75 95.32 114.07 4.00% 7.21% 10/2002 10/2006 22 E 25 Q6115941464E 10/1976 18.75 95.32 114.07 4.00% 7.21% 10/2002 10/2006 23 E 25 Q6129350770E 11/1976 18.75 96.43 115.18 4.00% 7.25% 11/2002 11/2006 24 E 25 'Q6123404129E 11/1976 18.75 96.43 115.18 4.00% 7.25% 11/2002 11/2006 25 E 25 Q6129988238E 12/1976 18.75 96.75 115.50 4.00% 7.26% 12/2002 12/2006 26 E 25 Q6138851273E 12/1976 18.75 96.75 115.50 4.00% 7.26% 12/2002 12/2006 Inventory Totals: B~dS/ I Price $487.50 1 Interest Value $2,511.60 1 $2,999.101 * Cl - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE. was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 4 Page 1 of 1 Active Inventory Print Date: 01/01/2003 Bonds: File Pricinu Date: 07/200,. Issue Next interest Final Maturity N1o. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note E '$25 Q6139015266E 01/1977 $~8.75 $96.75 $115.50 4.00% 7.26% 01/2003 01/2007 2 E 25 Q6146783698E' 01/1977 18.75 96.75 115.50 4.00% 7.26% 01/2003 01/2007' 3 E 25 Q6146960738E 02/1977 18.75 94.49 113.24 4.00% 7.32% 08/2002 02/2007 4 E 25 Q6146984346E 02/1977 18.75 94.49 113.24 4.00% 7.32% 08/2002 02/2007 5 E 25 Q6153511397E 03/1977 18.75i 94.49 113.24 4.00% 7.32% 09/2002 03/2007 6 E 25 Q6157931461E 03/1977 18.75 94.49 113.24 4.00% 7.32% 09/2002 03/2007 7 E 25 Q6165319387E 04/1977 18.75 94.49 113.24 4.00% 7.32% 10/2002 04/2007 8 E 25 Q6165372369E 04/1977 18.75 94.49 113.24 4.00% 7.32% 10/2002 04/2007 9 E 25 Q6166302830E 04/1977 18.75 94.49 113.24 4.00% 7.32% 10/2002 04/2007 10 E 25 Q6178377310E 05/1977 18.75 95.61 114.36 4.00% 7.36% 11/2002 05/2007 11 E 25 Q6178377309E 05/1977 18.75 95.61 114.36 4.00% 7.36% 11/2002 05/2007 12 E 25~ Q6187313481E 06/1977 18.75 95.85 114.60 4.00% 7.37% 12/2002 06/2007 i3 E 25 Q6187'313480E 06/1977 18.75 95.85 114.60 4.00% 7.37% 12/2002 06/2007 14 E 25 Q6186392667E 07/1977 ... !8.75 95.83 114.58 4.00% 7.37% 01/2003 07/2007 Inventor Totals: = 14 $262.50 $1,333.68 $1,596.18 · Cl - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is $ years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 5 Page 1 of 1 Active Inventory Print Date: 01/01/2003 Bonds: File Pdcing Date: 07/2002 ISsue Next Interest ' Finil Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 E $50 L2119111068E 07/1978 $37.50 $131.18 $168.68 4.00% 6.36% 01/2003 'O7/2008 2 E 50 L2123189538E 08/1978 37.50 127.86 165.36 4.00% 6.41% 08/2002 08/2008 3 E 50 L2128169457E 11/1978 37.50 129.44 166.94 4.00% 6.46% 11/2002 11/2008 4 E 50 L2123205063E 09/1978 37.50 127.86 165.36 4.00% 6.41% 09/2002 09/2008 5 E 50 L2152621330E 03/1979 37.50 126.64 164.14 4.00% 6.52% 09/2002 03/2009 6 E 50 1,2157617095E 05/1979 37.50 128.22 165.72 4.00% 6.57% 11/2002 05/2009 7 E 50 L2157647308E 07/1979 37.50 128.60 166.10 4.00% 6.58% 01/2003 07/2009 8 E 50 ! L2176738154E 08/1979 37.50 125.36 162.86 4.00% 6.63% 08/2002 08/2009 9 E 50 1.2176738150E 08/1979 37.50 125.36 162.86 4.00% 6.63% 08/2002 08/2009 10 E 50 L2176754156E 10/1979 37.50 125.36 162.86 4.00% 6.63% 10/2002 10/2009 11 E 50! L2176754206E 11/1979 37.50 126.88 '164.38 4.00% 6.68% 11/2002 11/2009 12 E 50 i L2183293229E 12/1979 37150 126.88 164.38 4.00% 6.68% 12/2002 12/2009 13 E 501 L2093982745E 10/1977 37.50 184.98 222.48 6.00% 7.40% 10/2002 10/2007 14 E 50 L786469527E 07/1970 37.50 241.22 278.72 6.80% 07/2000 MN 15 E ~ 75i K101354679E 01/1973 56.25 322.29 378.54 4.00% 6.61% 11/2002 01/2003 16 E ," 75 K201475019E 02/1978 56.25 241.71 297.96 6.00% 7.07% 08/2002 02/2008 17 E /' 75 K211045860E 07/1978 56.25 196.77 253.02 4.00% 6.36% 01/2003 07/2008 18 E 75; K213560734E 02/1979 56.25 189.96 246.21 4.00% 6.52% 08/2002 02/2009 19 E ,~ 100 C2049111988E 11/1977 75.00 333.08 408.08 6.00% 7.04% 11/2002 11/2007 20 E ,,~ 100 C2048608673E 10/1977 75.00 369.96 444.96 6.00% 7.40% 10/2002 10/2007 21 E / 100 C1014254030E 01/1973 75.00 429.72 504.72 4.00% 6.61% 11/2002 01/2003 Inventory Totals:  Price $975.001 Interest $4,039.331 Value $5,014.33 · Cl - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (ifs < 8 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 7 Page 1 of 1 Inventory Report Active Inventory Print Date: 01/01/2003 Bonds: File I IIg FIl~,,dll~ IJ~ll,~, Issue Next Interest Final Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 E ' ' $25 Q62gg234097E 12/1978 $18.75 $64.94 $83.69 4.00% 6.47% 12/2002 12/2008 2 E 25 Q6299234277E 01/1979 18.75 64.96 83.71 4.00% 6.47% 01/2003 01/2009 ..... 3 E 25 Q6315391892E 04/1979 18.75 63.32 82.07 4,00% 6.52% 10/2002 0412009 4 E 25 Q6322435929E 06/1979 18.75 64.30 83.05 4.00% 6.58% 12/2002 06/2009 5 E 25 Q6342037552E 06/1979 18.75 64.30 83.05 4.00% 6.58% 12/2002 06/2009 6 E 25 Q6342410385E 09/1979 18.75 62,68 81,43 4.00% 6.63% 09/2002 09/2009 7 E 25 Q6342410386E 09/1979 18.75 62,68 81.43 4.00% 6.63% 09/2002 09/2009 Inventory Totals: $131,251 $447.18 1 $578.43 · Cl - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (ifs < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date pdor to the cashed or exchanged date Untitled 6 Page 1 of I Active Inventory Print Date: 01/01/2003 Bonds: File Pricing Date: 07/2002 Issue Next Interest Final Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 EE $100 C6040643EE 08/1980 $50.00 $189'.12 $239.12 4.00% 7.41% 08/2002 08/2010 2 EE 100 C13076224EE 10/1980 50.00 189.12 239.12 4.00% 7.41% 10/2002 10/2010 3 EE 100 C13076225EE 10/1980 50.00 189.12 239.12 4.00% 7.41% 10/2002 10/2010 4 EE 200 R2440025EE 05/1980 100.00 387.76 487.761 4.00% 7.33% 11/2002 05/20'10 5 EE 200 R2440027EE 06/1980 100.00 387.76 487.76 4.00% 7.33% 12/2002 06/2010 6 EE 200 R73596368EE 01t1992 100.00 86.08 186.08 6.00% 6.00% 01/2003 01/2022 * 7 EE 1,000 1M45835814EE 10/1992 500.00 376.80 876.80 6.00% 6.00% 10/2002 10/2022 ~ 8 EE 200 R85951023EE 10/1992 100.00 75.36 175.36 6.00% 6.00% i 0/2002 10/2022 * 9 EE 5,000 V2285366EE 01/1992 2,500.00 2,152.00 4,652.00 6.00% 6.00% 01/2003 01/2022 · Inventory Totals: Bonds~ Price Value $3,550.001 Interest 9 ~ $4,033.12 $7,583.12 · CI - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 8 Page 1 of 1 Inventory Report Active Inventory Print Date: 10/13/2003 Bonds: File Pricing Date: 07/2002 I - Issue ~ Next Interest 1:i~1 Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 E $25 02619532432E 01/1972 $18.75 $107.13 $125.88 6.45% 01/2002 ME 2 E 25 Q2626109094E 01/1972 18.75 107.13 125.88 6.45% 01/2002 ME 3 E 25 02632073854E 02/1972 18.75 107.42 126.17 6.46% 02/2002 ME 4 E 25 QSOOOO22039E 02/1972 18.75 107.42 126 17 6.46% 0212002 ME 5 E 25 05000022226E 03/1972 18.75 107.44 126.19 I 6.46% 03/2002 ME 6 E 25' Q5006904736E 03/1972 18.75 107.44 126,19 ~ '6.46% 03/2002 ME 7 E 25,Q5007788739E '04/1972 18.75 107.44 126.19 I 6.46% 04/2002 ME 8 E 25 Q5007788928E 04/1972 18.75 107.44 126.19 ! 6.46%i 04/2002 ME 9 E 25 Q5008250120E 05/1972 18.75 107.44 126.19 ~ 6,46% 05/2002 ME 10 E 25 Q5015820801E 05/1972 18.75 107.4z 126.19 I 6.46% 05/2002 ME 11 E 25 Q5015928383E 06/1972 18.75 107.79 126.54 t 6.47% 06/2002 ME 12 E 25 Q5015932576E i 06/1972 18.75 107.79 126.54~ 6.47% 06/2002 ME 13 E 25 Q5024152535Et 06/1972 18.75 107.79 126.54' 6.47% 06/2002 ME 14 E 25 Q5024191025E 07/1972 18.75 109.02 127.77 6,50% 07/2002 07/2002 ME 15 E 25 Q5024525867E 07/1972 18.75 109.02 127.77 ~ 6.50% 07/2002 07/2002 ME 16 E 25 Q5032106268E 08/1972 18.75 108.46 127.21 4.00% 6.52% 08/2002 08~2002 17 E 25 Q5032725352E 08/1972 18.75 108.46 127.21 4.00% 6.52% 08/2002 08~2002 18 E 25 Q5039525207E 09/1972 18.75 108.46 127.21 4.00% 6.52% 09/2002 09/2002 I 19 I E 25 Q5039896762E 09/1972 18.75 108.46 127.21 4.00%! 6.52% 09/2002 09/2002 20 E 25 Q5045826219E 10/1972 18.75 105,96 124.71 4.00% 6.56% 08/2002 10/2002 21 E 251Q5052408861E 10/1972 18.75 105.96 124.71 4.00% 6.56% 08/2002 10/2002 22 E 25 Q5052766733E 11/1972 18.75 105.96 124.71 4.00% 6.56% 09/2002 11/2002 23 E 25 Q5053179713E 11/1972 18.75 105.96 124.71 4.00% 6.56% 09/2002 11/2002 24 E 25 Q5059098226E 12/1972 18.75 106.24 124.99 4.00% 6.57% 10/2002 12/2002 25 i E 25 Q5065643630E 12/1972 18.75 106.24~ 124.99 4.00% 6.57% 10/2002 12/2002 26 E 25Q5056125787E 12/1972 18.75i 106.24 124.99 4.00% 6.57% 10/2002 i 12/2002 Inventory Totals: Bonds I Price Interest Value 26 $487.50 $2,791.55 $3,279.05 · CI - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date C:\SavingsBonds\straubl .sbw Page 1 of 1 REV- 1508 EX + (1-97) SCHEDULE E COMMONWEALT. O~PE,,S~LVA,~A CASH, BANK DEPOSITS, & MISC. INHERITANCE TM RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Dorothy E. Straub SS# 207-09-0209 07/08/2002 21-02-0697 Include the ~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned web the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Allfirst Bank; Money Market Account #009449393 Principal 103,824.99 balance as of date of death 2 Allfirst Bank; Money Market Account #009449393 Interest accrued 72.27 to date of death 3 Allfirst Bank; Passbook Savings Account #87004956705778 - 1,143.01 Principal balance as of date of death 4 Allfirst Bank; Passbook Savings Account #87004956705778 - 0.87 Interest accrued to date of death 5 Allfirst Bank; Certificate of Deposit #87008000744317 Interest 321.22 accrued to date of death Accrued income on item 5 to date of death 6,842.12 Accrued income on item to date of death 29,669.15 6 Allftrst Bank; Certificate of Deposit #8700800074561 - Interest 122.58 accrued to date of death 7 Allfirst Bank; Certificate of Deposit #87008000746328 - Interest 237.93 accrued to date of death Accrued income on item 7 to date of death 6,113.43 8 Allfirst Bank; Certificate of Deposit #87008001154904 - Principal 3,528.97 balance as of date of death 9 Allfirst Bank; Certificate of Deposit #87008001154904 - Interest 123.25 accrued to date of death 10 Refund of prepaid school real estate tax (2002-03) 506.08 11 Appliances sold as part of real estate closing 100.00 TOTAL (Also enter on line 5, Recapitulation) 152,605.87 (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) REV- 1509 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy E. Straub SS~/ 207-09-0209 07/08/2002 21-02-0697 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G, SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Dennis R. Straub 722 Alexander Spring Road Son Carlisle, PA 17013 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar Identifying number, DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attachdeedforjolntly-heldrealestate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 A 02/28/69 kllfirst Bank; Checking 8,998.08 50.007o 4,499.04 Account f/0000881342 - Balance as of date of death TOTAL (Also enter on line 6, Recapitulation) $ 4,499.04 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev, 1-97) REV-1511 EX+ (I-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy F.. Straub SS~/ 207-09-0209 07/08/2002 21-02-0697 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Trefz and Bowen Funeral Home, Inc. - Funeral services 8,312.55 B. ADMINISTRATIVE COSTS: 1. 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: 2. Attorney's Fees George A. Vaughn III 3,525.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 301.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Dennis R. Straub - Reimbursement for miscellaneous expenses 93.57 incurred by executor 2 Derry Township Municipal Authority - Sewer service to decedent's 24.00 house 3 Derry Township Municipal Authority - Sewer service to decedent's 24.00 house 4 Derry Township Municipal Authority - Sewer service to decedent's 24.00 house , Total of Continuation Schedule(s) 1,879.68 TOTAL (Also enter on line 9, Recapitulation) $ 14,183.80 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Dorothy E. Straub Soc Sec #: 207-09-0209 Date of Death: 07/08/2002 Continuation of Schedule H-B2 (Attorney's Fees) Item Description Amount 1 George A. Vaughn, III - Interim attorney's fee 435.00 2 George A. Vaughn, III - Interim attorney's fee 360.00 3 George A. Vaughn, III - Interim attorney's fee 480.00 4 George A. Vaughn, III - Final attorney's fee 2,250.00 3,525.00 Estate of: Dorothy E. Straub Soc Sec #: 207-09-0209 Date of Death: 07/08/2002 Continuation of Schedule H-B4 (Probate Fees) Item Description Amount 1 Register of Wills Probate filing fee 301.00 301.00 Estate of: Dorothy E. Straub Soc Sec #: 207-09-0209 Date of Death: 07/08/2002 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount 5 Derry Township Municipal Authority - Final sewer service to 54.38 decedent's house (paid at closing) 6 Hummelstown Oil Company - Heating oil for decedent's house 34.54 7 Philip J. Fratti, Tax Collector - 2003-04 school real estate 822.84 taxes 8 PPL - Electric service to decedent's house 39.85 9 PPL - Electric service to decedent's house 34.64 10 PPL - Electric service to decedent's house 40.34 11 PPL - Electric service to decedent's house 33.09 12 Recorder of Deeds - Transfer tax paid on sale of real estate 820.00 1,879.68 REV-151Z EX + (1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Dorothy F.. Straub SS~; 207-09-0209 07/08/2002 21-02-0697 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Allfirst Bank; Checking Account ~/0000881342 Checks written 504.01 prior to date of death but cleared after date of death 2 Brockie Pharmatech - Prescription service supplied to decedent 72.15 TOTAL (Also enter on line 10, Recapitulation) $ 576.16 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy E. Straub SS~/ 207-09-0209 07/08/2002 21-02-0697 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(aX1,Z)] 1 Dennis R. Straub Son One-half 722 Alexander Spring Road Carlisle, PA 17013 2 Gregory L. Straub Son One-half 228 South Cyrus Street Cleona, PA 17042 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. 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 $ 0 o 00 (If more space is needed, insert additional sheets of the same size) Copyright (c) ZOOO form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) HUD - 1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LOAN 6. File Number: 7. Loan Number: 1. FHA 2. FmHA 3. X Cony. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance Case Number C. NOTE: This form is furni_~ed to give you a ~a!__~raem of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = Taxpayer's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: John T., Ann M., and Dennis R. Straub, Executor of Waypoint Bank Jason S. Haldeman Dorothy E. Straub 101 S George Street 117 Bradley Road ' Annville, PA 17003 York, PA 17401 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 441 Middletown Road Brinser, Wagner & Zimmerman Hummelstown, PA 17036 6 EAST MAIN STREET,, PALMYRA, PA 17078 PLACE OF SETTLEMENT I I. SETTLEMENT DATE 24-050-013 Brinser, Wagner & ZimmermanI 11/22/2002 6 East Main Street Palm ra PA J. SUMMARY OF BORROWER'S TRA~NSACTION IC SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Conha~ sales price 82,000.00 401. Coahact sales price 82,000.00 102. Pers~M ~ 100. O0 402. Persona~ 100. O0 103. Settlement charges to borrower ~ 3,95 1.1 2 403. 104. 404. 105. 405. ._____~'ustments for items aid~seller in advance Adjustments for items paid by seller in advance ~taxes 11 2__~_~_~002-12/31/2002 t 8.78 40'---~. CiWAowntaxes 11/22/2002-1~ 8.78 107. Countvt~xes 11 22 2002-12 31 2002 38.69 407. Coun tax~ 11 2--~--2002-12 31 2002 38.69 108. Assessments 408. Assessments 109. 409. 111.110' School Tax 11/2_._~2/02-06/30/03~____ 506.08 410. School Tax 11 22 02-06/30 03 506.08 ~ 411. 112. ~~ ~~ 412. ~ 120. GROSS AMOUNT DUE FROM BORROWER 8 6 604.67 ~ ~ ~ 420. GROSS AMOUNT DUE TO SELLER 82 653.55 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: ~r eamesl money 2_~000.00 501. Exce~ d__e~it 202. Principalamountofnewloan(s) 65 600.00 ~02. Settlement char estoseller Linel400 2 000.00 203. Existing'eot to ~ 503. Existing'eat to .874.38 204. 205. ~offirst mert~a~e loan 206. ~second mort~oan 506. 207. 507. 208. 508. 209. 509. .~_.__Ad_jAd'ustments for items ~ seller __~_.[ustments for items un aidala~ller ~ taxes ~ taxes 211. County taxes 511. County taxes -- 212. Assessments 512. Assessments 213. _-- 513. 214. ~ 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 6 7 6 00. 0 0 520. TOTAL REDUCTION AMOUNT DUE SELLE~R 2 8 7 4.3 8 300. CASH AT SETTLEMENT FROM/TO BORROWER ~' 600. CASH AT SETTLEMENT FROM/TO SELLER _ '~ 301. Gross amount due from berro~ ~. 6 7 ~ ~ ~'~--a~nount due to seli.er~ 302. Less amo~for borrower~~ ~ ~ due Seller ~ 303. CASH FROM BORROWER ~ U04.67 603. CASH~-~ ~ SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (er, if~ne 401 is a~iske~ line 403 and 404) is important tax infonTmtion and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this ~ is required ~°° nbed ~q~°o~v~ddea~de ~:~Ren~S fn~t~?w~a~juhr~2L ~b~a~ _r_.q~___r~. f ¥.of ~e requ,r.ed to proxade ?e S.ett. lement.A..g., ent w..~ your co .~.ect .taxpayer identification number. Ifyou perju ~. I c~tifv that the numl~e'~' ,~'~,,~ ,~,~o~,.~o~,r~_~y_~.r. ~_ _aent~ .cauon nu .m~t~er;.~you~ .may Ge ,su0jeet to ¢~vd or enm~l ~t~es ~ by law. U~er ~es of ' I~llL 1~ lily i.;OIT~Ct u~xpayer I~nlHICatloil number. (Sellers Signature) Dennis R. Straub, Executor of (Seller's Signature) Dorothy E. Straub L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER's COMMISSION based on rice $ 8 2 0 0 0.0 0 @ ~ PAID FROM ] PAID FROM Division of Commission (line 700) a.s follows: 701. $ [ BORROWER'S ] SELLERn3 702. $ ~ FUNDS AT [ FUNDS AT 703. Commission paid at Se~ttlcment 704. S00. ITEMS i gO 1. Loan ~mation Fee $ 802. Loan Discount FeetoEb Ay_~p_p_~aisal Services 1 312.00 804. Credit report to -- 805. Lender's Inspection Fee Fee 807. Document Pre aration 100.00 NOg. Tax Service Fee 290.00 n Fee POC_Q~470 91.00 Fee gll. Flood Certification 16.00 gl2. ~ 813. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interestfromll 22 2002-12 01 2002 10.930 er da I 98.37 ~ Insurance Premium for 903. Hazard insurance Prenfium for 1 ear s to POC 390 904. 905· 1001. Hazard insurance 1002. Mortgage insurance Taxes 1004. Coun?W_.~/~ Taxes 1005. Annual assessments 1006. 1007. __ 1100. TITLE CHARGES 1101. Settlement or closin feeto Brinser Wa ner& Zimmerman l 102. Abstract or title search to 12 5.0 0 103. Title Examination to I 104. Title insurance binder to ' 1105. Document preparation to Cash 1107. Attome. y's fees to 10.0_.__.~.0 1108. Title Insurance to ~includes line numbers: 75 0.75 11o9. l d 's 0.00 1110. Owner's cover · Sag~_.~.~._Q 00.00 llll. Endorsements 100 300 and 8.1 1112. Closin__cL_Protectio__D__n Letter 150.00 1113. 35.00__ 1201 · Recor .~.g_fees: Deeds 41.50 ~ 77.50 .Releases Deed $ 820.00 Mon ag~$ 1203. State tax/stam_.arqps:.__: Deed $ 820. O0 Mo~_.~g_~$ 1204. 820. O0 1205. 1301. Surve.v to 1302. Pest: ~0_~_~ 20.00 54.3~8 ~Th~vE,~M--z.~EN.~T.gFL4.._RGES enter on lines 103 $ee~onJan,$O, SecflonK 874.38 · z nave caremny renewed the HUD-I Settlement Statement and to the ~ of my knowledge and belief, it is a ~ ~ receipts and &~b~-'~'e~ts made_0n my acce .)~J~,4?y me in this t~ansact.~m. I further certify that I re~eiv6d a copy of the HUD- 1 Settlement Statement. B°n'P~wer '~ .-7 John T. ~. / ., Doroth~t'E. Straub ' Jas The HUD-1 Settlement Statement wh~q h-ye .... a is a true ~-~ ............ on S. Haldeman wS~Nem~.A~.e~..,t . . B~i.~?r 1? W~gner & Zimmerman Da~ WILL OF _ DOROTHY E. STRAUB I, DOROTHY E. STRAUB, of Derry Township, Dauphin County, Pennsylvania, declare this to be my last Will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this Will or otherwise, shall be paid from my residuary estate as soon as practicable after my death as a part of the expense of the administration of my estate. ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, to those of my issue, per stirpes and not per capita, who survive my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate, to those of my issue, per stirpes and not per capita, who survive my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my sons, DENNIS R. STRAUB and GREGORY L. STRAUB, co-executors of this my last Will. Should either of my sons predecease me or otherwise fail to qualify or cease to serve as co-executor of this my last Will, my surviving son shall serve as executor. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this Will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this Z/f/' day of ,2000. ' DORO n The preceding instrument, consisting of this and one other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by DOROTHY E. STRAUB, the testatrix therein named, as and for her last Will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. DIANE B. JE~NVKINS E A. VA]~'GHN, ffI -2- COMMONWEALTH OF PENNSYLVANIA ) (SS.: COUNTY OF CUMBERLAND ) I, DOROTHY E. STRAUB, being the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the foregoing instrument as my Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. STRAUB Sworn or affirmed to and acknowledged b~fore me by the testatrix named above this ~/~'~ay of ,2000. - · ,~ ., Franoe, T. Vaughn, Notary Public My Oommi~sion Expires Sept. 15, 2008 Notary Public COMMONWEALTH OF PENNSYLVANIA ) (SS.: COUNTY OF CUMBERLAND ) WE, DIANE B. JENKINS and GEORGE A. VAUGHN, llI, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that she signed it willingly; 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 the time eighteen or more years or age, of sound mind, and under no constraint or undue influence. 7 ~ GEORGE A.~7~V/AUGHN, m Sworn or affirmed to and acknowledged before me this ~7~y of ~C(,.~St~%.~_.~ , 2000. OTARIAL SEAL J Hmnpden Twp., Cumberland County I Notary Public / My Oommi.iofl Expires S,ept. 16, 2003 i George Harrison 101 E. 15th Avenue Conshohocken, PA 9428-2328 BUS: 610-668-2900 ext 283 RES: 610-828-3748 March 30, 2004 Register of Wills Cumberland Co Court House Carlisle, PA 17013 Attention: Enclosed two information notices sent to Judith A Allen for Estate of Jane M Allen, 192-34-7410 To whom it may concern: As long time income tax preparer of the party named above and on the attached, I am returning to you the two signed forms indicating that the certificates of deposit for these will be incorporated as assets of Jane A Allen when her inheritance tax return is filed by the attorney handling her estate. Also note that you incorrectly have Judith A Allen, who is one of the surviving daughters of the deceased, as being liable for 15% inheritance tax on these notices, whereas she is only subjey to a 4.5% inheritance tax. The error really will have no effect, since these assets will be reported and taxed accordingly on the inheritance tax return of Jane M Allen, which will be soon filed. Very truly yours, rison George Public Accountant Attachments - 2 cc: Judith Allen "~ r COHHbNWEALTH ~F PENNSYLVANIA DEPARTMENT OF'~EVENUE ZNFORNATZON NOTICE FILE NO. 21 03-0697 BUREAU ~F I~]IVIDUAL TAXES OEPT. ZB060 AND HARRI,;BURG, aA 17126-0601 TAXPAYER RESPONSE ACN 051q0181 DATE 10-50-2003 REV-~5 EX AFP TYPE OF ACCOUNT R,c~.~T. OF JANE.~fALLEN OSAVZNGS S:S~ NO. ~92-3q-7qlO [] CHECK/Ha DATE OF DEATH 07-30-2003 [] TRUST 'o~OU~'Y -2 !~,~ERLAND [] CERTZF. REMIT PAYMENT AND FORMS TO: ~ dUDITH A ALLEN REGISTER OF WILLS 62 WILSON ST ~:~:i~ CUMBERLAND co COURT HOUSE CARLISLE PA 17013 CUlT CArLiSLE, PA 17015 ORRSTO#N BANK has provided the Department mlth the information listed belo~ mhich has bean used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you ~ere a ~oint o~nar/benaficiary of this account. Zf you feel this information is incorrect~ please obtain ~rittan correction from the financial institution, attach a copy to this ~ora and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax La~s of the Commonaealth of Pennsylvania. gusstions may be ansemred by calling (717) 787-8527. COMPLETE PART I BELOW X l~ x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5060070322 Date 10-03-Z002 To insure proper credit to your account, t.o Established cz) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 5,2q2.17 payable to: "Register of Wills, Agent". Percent Taxable X 10 0.0 0 NOTE: If tax payments are made eithin three Amount SubSact to Tax 5,2q2.17 (s) months of the decsdent's date of death, Tax Rate X .15 you amy deduct a SZ discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 786.33 nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~-~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid intsrast~ or you amy check box "A" end return this notice to the Register of ~ ONE ~ ~ Wills and an official assessment ~ill be issued by the PA Department of Revenue. BLOCK B. Tho above asset has been or mill be reported and tax paid ~ith the Pennsylvania Inheritance Tax return ONLY --to be filed by the decedent's representative. C. [] The above information is~incorrect and/or debts and deductions ~ere paid by you. You oust complete PART z~j and/or PART [] belo~. PART Tf you indicate a different tax rate~ please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOZNT/TRUST ACCOUNTS LZNE I. Dar& Ect~,~.hlie'h,~,d l 2. Account Balance 2. $. Percent Taxable $ }{ q. Amount SubSect to Tax q 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART DE]ITS AND DEDUCTZONS CLAZMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, Z declare that the facts T have reported above ara true, correct end complete to the best of my k.owledge end belief. HONE (~/,~') -'~'""~/--°--,r./- c~ _~4 /~? ~ (~, ~ WORK ( ) ~/2LI 0~ ~xrAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FA/LURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT .ith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's data of death. 5. A joint account is taxable even though the decedant's name was added as a matter af convenience, q. Accounts (including those held between husband and aife) ahich the decedent put in joint names within one year prior to death ars fully taxable as transfers. 5. Accounts established jointly between husband and ,ifa more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - [f the information and computation in the notice ara correct and deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for tho amount of tax ta the Register af Wills of the county indicated. The PA. Department of Revenue ail1 issue an officiaL assessment (Form REV-15qB EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the decedant's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt ZOO601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - Zf the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according ta the instructions below. Sign tee copies and submit them with your check for the amount of tax payable to the Register of WiLls of the county indicated. The PA Department of Revenue ail1 issue an official assessment (Form REV-ISq8 EX) upon receipt of the return from the Register of #ills. TAX RETURN - PART Z - TAX CONPUTATION LINE 1. Enter the date the account originally ams established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/82: Accounts ahich tho decedent put in joint names within one (1) year of death ars taxable fully as transfers. Haaever, there is an exclusion not to exceed $5,000 per transferee regardless af the value af the account er the number of accounts held. Xf a doubXe asterisk (ex) appears before your first name in the address portion of this notice, the $5,000 axcXusion aIready has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as fallows: A. The percent taxable far joint assets established more than one year prior to the decadent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other parsons. 1 DIVIDED BY $ (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created aithin one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUNDER OF SURVIVING JOINT X 100 PERCENT TAXABLE BONERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established aithin one year of death by the decedent. I DIVXDED BY Z (SURVIVORS) = .SO X 100 = SOZ (TAXABLE FOR EACH SURVIVOR) ~. The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (1ina 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (1ina ~). 7. Enter the appropriate tax rata (1ina 7) as determined below. Da~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~o 1Z/$1/gq SX 6X 15X 01/01/95 ~o 06/50/00 OX 6X 15X 07/01/00 ~o presen~ OX q.BXa 12Z mTha tax rate imposed on the net value of transfers from a decr---" -~11" * .... *Y .... years m& ~m. nr younger at death to or far the usa of a nature! parent, an adoptive parent, or a stepparant of the child is OZ. The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahether er not they have been adopted by others, adopted children and step chiLdren. "Lineal descendents" includes alL children of the natural parents and their descendents, ehethar or net they have bean adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes al1 other beneficiaries. CLAINED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAZHED Alloaabla debts and deductions are determined as folloas: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, uss plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. Mr. Geo Harrison 101 E 15th Ave Conshoho~en, PA 19428-2328 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE PA !7013 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX{11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003818 BARIC DAVID A ESQ 19 WEST SOUTH ST CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $292.07 ESTATE INFORMATION: SSN.' 192-34-7410 FILE NUMBER: 21 03-0697 DECEDENT NAME: ALLEN JANE M DATE OF PAYMENT: 04/1 4/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 TOTAL AMOUNT PAID: $292.07 REMARKS: BARBARA J ALLEN CHECK# 107 .... INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH .... REGISTER OF WILLS REGISTER OF WILLS ~k COMMONWEALTH OF REV- 1 500 ~ PENNSYLVANIA ~2'~~m~ DEPARTMENT OF REVENUE DEPT. 28060 INHERITANCE TAX RETURN 21 _0 3 0 O69 7 HARRIS,URG. PAm26-060 RESIDENT DECEDENT cOUNT COO DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Alle~, ,.]'a~e Irt. 192 _ 34 _ 7410 Z ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU July 30, 2003 J'u~e 18, 1921 REGISTER OF WILLS LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ,,, [] 1. Original Return [] 2. Supplemental Return ~-] 3. Remainder Return (ease of death prior to 12-13-82) '~ ~ [] 4. Limited Estate [] 4a. Future Interest Compromise (date erdealh after ~2-12-e2) [] 5. Federal Estate Tax Return Required ~i~ [~ 6. Decedent Died Testate (^ttach ce~y el wi,I) [3 7. Decedent Maintained a Living Trust (^ttac, copy ofrrust) 'l 8~ Total Number of Sa,e Deposit Boxes < [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death bet .... 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A)(Attach Sch O) Z ,..,"'NAME David A. Baric, Esqu:i. re COMPLETE MAILING ADDRESS Z O~ FIRM NAME (IfApplica~Ie) 17 West So.a-kb.. Sbree~c ~,,, O'Brzen, Baric 8, Scherer Carlisle, ~nsT~aran±.~,~ 17013 o TELEPHONE NUMBER o (717) 249-6873 F ~:3 OFFICIAL USE ©NLY 1. Real Estate (Schedule A) (1) 140,000 · O0 2. Stocks and Bonds (Schedule B) (2) 3 4 5,7 9 6 · 3 7 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) r,,3 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 26,452.33 (Schedule E) 23,377 · 95 ~ 6. Jointly Owned Property (Schedule F) (6) ~ E~ Separate Billing Requested -I 18,021.39 ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ~ (Schedule G or L) o. 553 648 04 ,~ 8. Total Gross Assets (total Lines 1-7) (8) ' ' (g 57 15~ 59 LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ' ° 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 57,157.59 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) Z~96,490 · 45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 4 9 6,4 9 0 · 4 5 14. 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 x .0_ (15) ~,. rate, or transfers under Sec. 9116 (a)(1.2) 496,490.45 22,342. O?  16. Amount of Line 14 taxable at lineal rate x .0 ~ 5 (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) 22,342.07 Decedent's Complete Address: STREETADDRESS 62 Wilson Street cl~ Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 22,342.07 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 21, O 00.00 C. Discount i, O 50.00 Total Credits ( A + B + C ) (2) 22, O 50. 00 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) 292.07 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 + SA. 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 shal! 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. .SIGNATURE OF PERSON RESPONSIBLE-FOR FILING RETURN DATE Z~,// "~ 0]~1.~/~ , ADDRESS U % 1138 ~Redwood/~ive, Carlisle, Pennsylvania 17013 ~ RE 0 F I:~'~t EJ;f~'~l F_J~'~ R E P R ES E NTATIV E . DATE// ~,/~"~,-~ ['.~_.~_, David A. Baric, Esquire ADDRESS 17 West South Street, Carlisle, Pennsylvania 17013 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) 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 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 paren 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 a~ individual who has at least one parent in common with the decedent, whether by blood or adoption. '~.~so2 EX+ U2-S5) j COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jane M. Allen 21-03-00697 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 62 Wilson Street $140,000.00 Carlisle, Pennsylvania 17013 (appraisal of S.W. Barrett Real Estate & Appraisal Services attached) TOTAL (Also enter on line 1, Recapitulation) $ 140 , 000 . O0 (If more space is needed, insert additional sheets of same size.) ~.,~,.(,.9~ ,~~ SCHEDULE B CO,~MO,W~,LT. OF PE,,S¥, V^,,^ STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF Jane M. Allen FILENUMBER 21-03-00697 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Prudential Securities Account $345,796.37 (see statement attached) TOTAL (Also enter on line2, Recapitulation) $ 345,796.37 (If more space is needed, insert additional sheets of the same size) Amount Security .... Price Value 1 Agere Systems Inc. Class "A" 2.82 / 2.69 2.755 $ 2.76 45 Agere Systems Inc Class "B" 2.69 / 2.54 2.615 1 I7.68 14 Avaya Inc. 9.35 / 9.10 9.225 129.15 880 BellSouth Corporation 25.69 / 25.04 25.365 22,321.20 312 ChevronTexaco Corporation 72.30 / 71.52 71.91 22,435.92 104 Delphi Corporation 8.40 / 8.25 8.325 865.80 40 Electronic Date Systems Corp 22.30 / 22.06 22.18 887.20 150 General Motors Corporation 37.20 / 36.77 36.985 5,547.75 30 General Motors Corp Class "H" New 13.88 / 13.67 13.775 413.25 172 Lucent Technologies Inc. 1.79/1.75 1,77 304.44 1,840 Pepsico Incorporated 47.37 / 46.00 46.685 85,900.40 2,000 Pfizer Incorporated 33.39 / 32.70 33.045 66,090.00 1,166 PNC Financial Services Corp 49.69 / 49.26 49.475 57,68735 400 PPL Corporation 40.61 / 40.00 40.305 16,122.00 278 Union Pacific Corporation 60.30/59.97 60.135 16,717.53 176 Verizon Communications 35.90 / 35.23 35.565 6,259.44 500 Wyeth 46.40 / 45.50 45.95 22,975.00 21017 Command Money Fund Class "A" 1.00 21,017.00 Accrued Interest 2.00 ***TOTAL*** $345,796.37 ~E~-~O~ E×*(~-~ -~ SCHEDULE E I COMMONWEALTHOF PENNSYLVANIA I CASH, BANK DEPOSITS, & MISC. ' N '~s~ ~^~T~ ~T~E%~T~UTR N J PERSONAL PROPER~ ESTATE OF FILE NUMBER ~ane ~. ~Zen 2~-03-00697 Include ~e proceeds of litigation and the date the proceeds were received by ~e estate. All prope~ jointly.owned with right of su~ivorshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF D~TH ~ · Pe=sona~y $4,085.00 (app=a~sa~ o~ Robe=~ R. Ro~e 2. ~e~e~=y ~3,975.00 3. C~ec~ng ~ccounL $3,027.~2 O~sCo~n Ban~ ~ccounL No. 403695 O~s~o~n Ban~ Accoun~ No. 706000047 5. 200~ Buick Cen~u=y $~0,855.00 ~m~ed 4-~oo= sedan TOTAL (Also enter on line 5, Recapitulation) $ 2 6, z[.5 ;2.3 3 (If more space is needed, insert additional sheets of the same size) 824 NORTH COLLEGE STREET CARLISLE, PENNSYLVANIA 17013-1304 (717) 249-3531 C. THOMAS PARKER CONSTANCE F. PARKER October 30, 2003 Estate appraisal for: Jane Allen 62 Wilson Street Carlisle, PA 17013 1. Ladies 14kt yellow gold ring with white gold "illusion" head set with approximately 1/3 carat diamond. Estate Value: $325.00 2. Ladies 14kt yellow gold ring with approximately 1 ¼ carat solitaire diamond with six white gold prongs. Estate Value: $3,000.00 3. Ladies 14kt yellow gold ring with three approximately 1/3 carat old mine cut diamonds set in six prong heads in a row. Center diamond has many chips. Estate Value: $200.00 4. Ladies 14kt yellow gold bracelet. Center has an approximate. 15 carat diamond. Blue and white enamel accents and oxidized links. Estate Value: $200.00 5. ' Ladies 14kt yellow gold brooch/pendant with a white cameo on black onyx. Estate Value: $200.00 6. Ladies yellow gold filled pin with 65 garnets arranged in a cluster. Similarly styled garnet earrings with French screw backs. Estate Value: $50.00 Constance F. Parker 1. 2. 3. 5. Robert R. Rowe 3490 Ritner Highway Newville, PA 17241 (717) 776-6769 Estate of Jane Pilch Allen 62 Wilson Street Carlisle, PA 17013 INVOICE Appraisal: Personal property of Jane Pilch Allen TOTA~ AMOUNT DUE $ 65.00 Please make check payable to Robert R. Rowe. Thank !"~/°~ '~~' ~~ ANTIQUES ON THE RITNER Robert R. Rowe 3490 Ritner Highway Newville, PA 17241 (717) 776-6769 APPRAISAL for Barbara Allen, the household contents of Jane Pilch Allen, 62 Wilson, Carlisle, PA 17013 This is to certify that I, Robert R. Rowe, am a qualified appraiser. I have 40 years of buying, selling and appraising experience in the area of antiques and household items. I am also a bonded and licensed auctioneer (PA LIC # AU2276L). I further certify that the purpose of this appraisal is to provide current auction value for the following items and that this appraisal in no way represents an offer or solicitation to purchase said items. I have viewed the following items and in my opinion the current fair auction value of these items is set forth. Tea Cart $ 65.00 Sh&, Oak 200.00 Dining Room Set, Mahogany Table, 6 Chairs, China, Sideboard, Server 1,200.00 Stand, Walnut, 2 Drawer 175.00 Pressed Glass (3 pieces) Cake Dish 20.00 Compote 30.00 Lady with Child 20.00 Dish, Noritake 5.00 China, set, Lenox, Rose(Approx. 75 pieces) 225.00 Chairs, Plank, Painted 35.00 Stand, Night 100.00 Rocker, Cane, Child 35.00 Chest, Sewing 50.00 Frames, Walnut (2) w/man & mirror 90.00 Stoneware, 4 pieces 40.00 Rocker, Twig 100.00 Chairs, Cane (4) 75.00 Pitcher, Blue Top 75.00 Crock, Gray 25.00 Tin Collection 40.00 Dresser, Walnut, Mid Size 150.00 Chest, Blanket, Pine 110.00 Page2 Rocker, Cane $ 40.00 Wash Stand, Soft Wood 150.00 Coverlet, Blue 50.00 Chair, Arm, Plum 65.00 Flatware Set, Sterling, 98 Pieces 500.00 Sterling, Odd Pieces (15) 75.00 Water Pitcher. Sterling 75.00 Tea Pot, Sugar, Creamer, Tray, Sterling 125.00 Coffee Pot, Sterling 85.00 Dish, Footed, Sterling 55.00 TOTAL $4,085.00 Appraiser July 18, 2003 SCHEDULE F CO, , NV LTH PE' I SYLVAN,A JOINTLY-OWNED PROPERTY INHERITANCE T~ RETURN RESIDENT DECEDENT ESTATEOF ~ane M. ~[[e~ FILENUMBER 21-03-00697 If an asset ~s made joint ~hin one year of the decede~t's date of dea~, ~ must ~ reposed on Schedule G. SURVIVING JOINT TENANT(S~ I~ME ADD. SS RE~TIONSHIP TO DECEDENT A. Barbara ~. Alle~ ii38 Redwood D~ve daughte~ Ca~i~sle, Pe~sylva~a I7013 Judith Allen 998 Forty Foot Road daughter Hatfield, Pennsylvania 19440 ¢. Susan Squibb 337 Mooredale Road daughter Carlisle, Pennsylvania 17103 JOiNTLY-OWNED FROFERTY: LETTER D~TE DESCRIPTION OF PR~ERTY % OF DATE OF D~TH ITEM FOR JOINT MADE Include na~ of financial ins~tu~ and bank account numar ~ $imil~ iden~ing numar, A~h DATE OF D~TH DECD'S V~UE OF NUMBER TENANT JOINT ~ for ~nfly-held real ~t~e. V~UE ~ ~SET I~EREST DECEDENT'S INTERES' 1. A. 10/02 Orrstown Bank 8,242.17 50 4,121.08 Joint Time Certificate Account No. 5060070323 2. A. 09/01 Orrstown Bank 7,343.14 50 3,671.57 Joint Time Certificate Account No. 5060068018 3. B. 10/02 Orrstown Bank 8,242.17 50 4,121.08 Joint Time Certificate Account No. 5060070322 4. B. 09/01 Orrstown Bank 7,343.14 50 3,671.57 Joint Time Certificate Account No. 5060068021 5. C. 10/02 Orrstown Bank 8,242.17 50 4,i21.08 Joint Time Certificate Account No. 5060070321 6. C. 09/01 Orrstown Bank 7,343.14 50 3,671.57 Joint Time Certificate Account No. 5060068020 TOTAL (Also enter on line 6, Re~apitula~;on) $ 2 3,3 7 7.9 5 (If more spa~ is needed, ' ~ ~, ~ - ~ ms~. ~ ad~.,,ona, shee~ o. the same size) EX ~ (1-97) SCHEDULE O INTER-VIVOS TI~NSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATEOF Jane M. Allen FILENUMBER 21-O3-OO697 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 ~s (es. DESCRIPTION OF PROPERTY % OF ITEM i.C~.UOE THE NN~E OF THE TRN~ISFEREE, THEIR RELATIONSHIP TO DECEDENT N4D THE DATE OF TRANSFER~ DATE OF DEATH DECD'S EXCLUSION TAXABLE VAL[ ATTACH A COPY OF THE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST 1, IRA Certificate of Deposit 18,021.39 100 Orrstown Bank Account No. 5060068745 18,021.39 TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) SCHEDULE H CO..O.W~.H~O~ ~...SnW. a FUNERAL EXPENSES & ,.HE...~c~ T*X .~U.. ADMINISTRATIVE COSTS ESTATEOF Jane M. Allen FILENUMBER 21-03-00697 -- D~ of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home 7,027.40 2. Westminister Cemetary 1,130.00 B. ADMINISTRATIVE COSTS: 1. Personal Representaave's Commissions Barbara J. Allen 19,493.14 Name of Personal Repr'-,~entative (s) Social Security Number(s) I EIN Number of Personal Representative{s) 1138 Redwood Drive Sb'eet Address Carlisle PA 17013 C~y Stata r~ 2004 Year(s) Commission Paid: 2. A~0meyFees O'Brien, Baric & Scherer 19,493.14 3. Family ExemplJon: (If decedent's address is not the same as claimant's, attach explanalJon) Claimant None Street Address c~y stata r~ Relationship of Claimant to Decedent 4. PmbetaF~ R_egister Of Wills-Cumberland County 332.00 5. Accountant's Fees 6. Tax Return Preparers Fees 7. Cumberland Law Journal 75.00 8. The Sentinel ~43.15 9. Real Estate Taxes 1,293.90 10. UGI 8.54 11. Borough Of Carlisle 23.76 12. PPL 63.52 13. Masland Associates 3.16 14. Sprint 77.54 15. Social Security Administration 940.00 16. Georges Flowers 74.20 17. Comcast Cable 00.84 56,008.53 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets d the same size) Estate Of Jane M. Allen File No. 21-03-00697 Continuation of Schedule H-Funeral Expenses & Administrative Costs 18. Erie Insurance-homeowners $ 393.00 19. Robert Rowe-appraisal $ 65.00 20. Borough Of Carlisle $ 15.08 21. UGI $ 8.54 22. Sprint $ 31.75 23. PPL $ 60.16 24. T Mobile $ 45.77 25. Parker Jewelers-appraisal $ 37.10 26. Steven Barrett-appraisal $ 275.00 27. Sprint $ 31.72 28. PPL $ 28.85 29. UGI $ 8.53 30. Sprint $ 33.95 31. UGI $ 8.53 32. Borough Of Carlisle $ 15.08 33. PPL $ 27.14 34. Barbara J. Allen $ 11.17 35. Title transfer fees for car $ 54.00 36. Dorothy Pilch $ 50.00 SUBTOTAL $1,200.00 37. Pete Belcher-lawn mowing $ 50.00 38. PPL $ 36.57 39. UG! $ 8.42 40. Borough Of Carlisle $ 15.08 41. The Hartford $ 320.18 42. Sprint $ 33.95 43. Barbara J. Allen-postage $ 5.16 44. Safety Deposit Box Fee $ 20.00 45. Dauphin Oil $ 319.14 46. Sprint $ 35.57 47. PPL $ 42.09 48. UGI $ 8.65 49. Borough Of Carlisle $ 15.08 50. Dauphin Oil $ 124.50 51. Borough of Carlisle $ 15.08 52. Wachovia Securities $ 3,579.34 commissions on sale of stock account SUBTOTAL: $ 4,628.81 53. Erie Insurance $ 35.00 54. UGI $ 8.43 55. Sprint $ 33.57 56. Light repair at house $ 56.00 57. PP&L $ 33.18 58. Tuckey-plumbing repairs $ 946.16 59. First Presbyterian Church-flowers $ 37.15 SUBTOTAL: $1,149.49 TOTAL: $6,978.30 SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES I IN.E. TANCE RETU.N I .ES,DENT OECEDENT ESTATE OF Jane H. Allen FILENUMBER 21-03-00697 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE [. TAXABLE DISTRIBUTIONS (include outdght spousal distributions) 1. Barbara J. Allen daughter 1/3 of rest, 1138 Redwood Drive residue and Carlisle, Pennsylvania 17013 remainder 2. Judith Allen daughter 1/3 of rest, 998 Forty Foot Road residue and Hatfield, Pennsylvania 19440 remainder 3. Susan Squibb daughter 1/3 of rest, 337 Mooredale Road residue and Carlisle, Pennsylvania 17013 remainder ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART [[ - 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) · FEB 05 2004 lO:34AM ORRSTOWN BANK 7172400804 p.2 ~~,~*- SAFE DEPOSIT BOX ,----,---~ INVENTORY ~um. ~A ,7,~ ~ea~e P~lnf ar Type ~ C~Jh~ CODE ~ ~ flUtER ~ ~CU~TY OR D~TH ~R~RUTI NUbiA -,' ~11~ . ~n~ . //~ ~~ ~. ~//~ ~ ~z ~ND ADaR~S OF ~I~IAL ~t~ ~ THE SA~ D~O$~ ~X ~ L~ .... ,,, t~,~/~ ~ ~ ~ /~ / ~n~ ///. ~t,,~.. I I I ~ ~M! AND ~ OF ~OYB TAKING ~1 ~W&S~WILLIN~SG~ ~~ ~ a. ~fw~h b. ~am~ md a~s ~ ~n~l r~ntMlve, ~ N~ h ~.~ (STREET ~DR~$$J Io~YI IS~AT~ ~P C~E) {STRE~ ADDRESS) ~1~ ~TAI~ ~'FEB 05 2004 lO:34RM ORRSTOWM BRI'tK ?172~00804 p.3 SAFE DEPOSIT BOX INVENTORY " INSTRUCTIONS (1) ~.d~: Report total ooly. " C2) Steals: II~t in detail every conmmn or preferred certiflcaln, warrant or olher rlghls found in box. Stocke are la be clesignatKI by name of company, certiflcme number, date of cnrtfflcate, name in which stock is regist.md, · ' and number of zhares and class af stock. (3) Obligations of U. S. Govammeet:. Number of items, date o~ issue, h~ce vohse, nam.s in which registered and type of owne~hip, i.e., joinliy held, payable on death, etc. (4) ~.m~d~: Designate b:y nome, amoum, serial number, or Other dmignalion. IBearer ~onds) C5} Bank and Savings amd L~an P,,~___l,~mk~: Slam name of depositor, number of book, last date appearing ;n book, name of bank and branch, and balance. (6) Jewels, Ca~ns, Stamps, Mamu~,ipts, ere: list and describe as fully as possible. (7) Deedsr M~rtgages, Cu,enl Insurance Pollcie~ or olher evidenc~ of indebled~e~s: Lis1 and describe as fully as possible. (8) All other a~tent~. NO. ITEM DISCRIFIION ,,, CiifiiY LMD~q FEN~L?Y O~ ~E~U~?TH~T THE ~JOYE RECO~D ~$ ~r~q$ON RECB~NG CO~Y OF x ] !" sheet (si t~ ~ece~sc~r' , or use dulolicafes of'this page of form. 76 /I, JANE M. ALLEN, of Carlisle, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my last will and testament, hereby revoking and making void all former wills by me at any time heretofore made. FIRST. I direct all my just debts and funeral expenses be fully paid and satisfied out of my estate by my personal representa- tive hereinafter named as soon as conveniently may be after my decease. SECOND. I give, devise and bequeath all of my estate, real and personal, to my husband, John W. Allen, absolutely. THIRD. In the event that my said husband predeceases me, then I give, devise and bequeath all of my estate, real and personal, to my children in equal shares, or their issue. LASTLY, I nominate, constitute and appoint my said husband, John W. Allen, Executor, if living, otherwise my two daughters, Barbara Jane Allen and Judith Ann Allen, Executrices, of this my last will and testa- ment and I direct that any of them be permitted to serve and act in this capacity without giving bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~n~/~43 , A.D., 1982. Signed, sealed, published and declared by the above named Testatrix, Jane M. Allen, as and for her last will and testament in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto.' CONHONNEALTH OF PENNSYLVANIA ~ DEPARTMENT OF REVENUE ZNFORMATZON NOT[CE FILE NO. 21 05-0697 BUREAU OF TNDTVTDUAL TAXES DEPT. em0601 AND HARRTSBURG, PA 171Z8-0601 TAXPAYER RESPONSE ACN 051q018q DATE 10-50-2005 RE¥-~diS EX &FP F~e¢ o? TYPE OF ACCOUNT R6 RST. OE JANE M ALLEN [] SAVINGS S.S. NO. 19Z-Sq-7q]0 [] CHECKTNG DATE OF DEATH 07-50-Z005 [] TRUST '~ ';,"i;: ~0U~ :t 8 CUMBERLAND [] CERTTF. REMTT PAYMENT AND FORMS TO: SUSAN G SQUIBB k~c..r;:__ REGISTER OF WILLS 6~ NILSON ST ~ ~ CUMBERLAND CO COURT HOUSE CARLISLE PA 17015 [,Lmb ~-~=~ CARLISLE, PA 17015 ORRSTONN BANK has provided the Department elth the information listed below which has been used in calculating the potential tax due. Their records indicate that at tho death of the above decedent, you mere a joint oaner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction frae the financial institution, attach a copy to this farm and return it to the above address. This account is taxable in accordance with the inheritance Tax Laos of the CoamcnNaalth of PannsyZvania. guastions may ba ansaared by calling (717) 767-85ZT. COMPLETE PART 1 DELON # x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 50600680Z0 Data 09-20-200! To insure proper credit to your account, Established (z) copies of this notice must accompany your payment to the Register of Hills. Make check Account Balance 7,5q5 .lq payable to: "'Register of gills, Agent". Percent Taxable X 50.000 NOTE: Zf tax payments ara made ~ithin three Amount Subject to Tax 5,671.57 cs) months of the decadent's datm of death, Tax Rate X .15 you may deduct a Sg discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 550.7~ nine (9) months after the date of death. PART TAXPAYER RESPONSE A. N The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with tho copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE ~ Hills and an official assessment ~111 be issued by the PA Department of Revenue. BLOCK J B. [] Tho above asset has been or Nil1 be reported and tax paid aith the Pennsylvania Inheritance Tax return ONLY to be filed by the dmcadent's representative. C. r~The above information is incorrect and/or debts and deductions paid by you. You must complete PART-- W and/or PART PART If you indicate a different tax rate, please state your ~-~ rmletionsh~p to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LZNE 1. Data Established I [) ~ -- c~,~ -- ~ ~[ 2. Account Balance 2 ~. ~ Y ~R $. Percent Taxable $ X ~-£~ . q. Amount Subject to Tax q 3, ~7 5. Debts and Deductions $ 6. Amount Taxable 6 ;~: ~ 7/. ~-7 7. Tax Rata 7 ~ ~ 8. Tax Due 8 //~ ~-.~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tmx Computation) $ Under peneZties of perjury, T declare that the facts ! have reported above ere trum~ correct mnd complete to the best o]~ my knowledge and belAef. HOME ( ?/7 ) ~ ~/5 ' r~~-~-c~- ~ ~XPAYER S[GN~URE ~ TELEPHONE NUMBER 'OATE COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003838 BARIC DAVID A ESQ 19 WEST SOUTH ST CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 03140184 $ 165.22 ESTATE INFORMATION: SSN: 192-34-7410 'FILE NUMBER: 2103-0697 DECEDENT NAME: ALLEN JANE M DATE OF PAYMENT: 04/1 6/2004 POSTMARK DATE: 04/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 -'' TOTAL AMOUNT PAID: $165.22 REMARKS: RECEIVED OF SUSAN G SUIBB CHECK# 4562 " INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CbHHONNEALTH OF PENNSYLVANTA ~ DEPARTHENT OF REVENUE ZNFORHATZON NOTICE F]:LE NO. 21 05-0697 BUREAU OF INDTV]:DUAL TAXES AND ACN 051q0186 DEPT. Z80601 TAXPAYER RESPONSE HARRTSBURG, PA 171Z8-0601 DATE 10-30-2005 REV-15'~S EX AFP COg-O0) TYPE OF ACCOUNT [!~C~i EST. OF JANE M ALLEN $.$. NO. 192-Sq-7qlO [] CHECKTNG DATF. OF O~.ATH 07-50-2005 [] TRUST 'Od AF COUNTY :! ~ CUMBERLAND [] CERTTF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS ~ SUSAN G SQUIBB CUMBERLAND CO COURT HOUSE 62 WILSON ST ('"~ CARLISLE· PA 17013 CARLISLE PA 17015 ORRSTO#N BANK has provided the Department wlth the information lis[ad below uhich has been used in calculating the potent[at tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by cml[inN [717) 787-8SZ7. COMPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Ac[Dun* No. 506007032! Data 10-03-2002 To insure proper credit to your account, (Z) copies of this notice must accompany your Es*ablished payment to the Register of Ni[ls. Hake check Accoun~ Balance 5 · ~q~ ' [7 '~ payable to: "Register of gills, Agent". Percen~ Taxable X 100. O0 NOTE: [f tax payments are made within three Aeoun~ Subjec~ ~o Tax 5,2q2.17 cs) months of the decedant's date of death, Tax Ra~e X 15 you may deduct a SZ discount of the tax due. · Any inheritance tax due will become delinquent poSen*la1 Tax Due 786.53 nine (9) months after the date of death. A. ~The above information and tax due is correct. 1. You may choose to remit payment to the Register of gills with two copies of this notice to obtain a discount or avoid interest, or you may check box Wills end an official assessment ail1 be issued by the PA Department of Revenue. CHECK ~  ONE BLOCK B. ~Tha above asset has been er wit1 be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be fi[ed by the dacedent's representative. C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~below. PART Zf you [nd[ca~e a differen~ ~ax ~e~e· pZease s~a~e your ~-~ rela~/onsh~p ~o decaden~: ~'~-~'-~' TAX RETURN -COMPUTATION OF TAX ON JO;NT/TRUST ACCOUNTS LINE 1. DG~e Es~abl/shed 1 2. Accoun~ BaZance 2 ~, ~ ~ ~ /~ 3. Percen~ Taxable 3 q. Amoun~ Sub~ec~ ~o Tax ~ ~l~ ' /-Z 5. Deb~s and Deduc~/ons 5 7. Tax Ra~- 7 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED ~ ~<~_ ~[~c~,~ ~ AMOUNT PAID DATE PAID PAYEE DESCRIPTION TOTAL (Enter on L1~ .6 of ~u~:e~ion) $ ~ Under penal~:ies of perjury, Z declare ~ha4: ~he fac~:s Z have reported above ara ~rue, corrac~ and co~:-~-'o th. p.s' of my knowl,dg-.nd b. li.f. HOME (7~) ~---~5-~ ~~~ TAXPAYER SZGNATURE / TELEPHONE NUMBER NOTICE OF DECEDENT ACCOUNT STATUS DEPT. 2~0~01 HARRISBURG, PA 1~ 2~01 ~1~ 7~7~27 DECEDE~ ~ S~URI~ NUMBER OF DECEDE~: ~ DA~ ~ D~ ~) (Day) ~ear) ~ORE~ ~ ~DE~: C~ . CI~ STATE ~P IN~R~ON TE~PH~E NUMBER or ACCOU' ~ Joint Sa~ngs ~ Joint Ch,lng D 'In Trust ,o, _ ._lnt,m. ~.~ate INFORMA~ON XCCOU~ B~CE (Include interest to date of death) O~GI~ DA~ A~U~ W~ .ST~U~D ~ . IsUR"VO~ENEF~IARY ~ OF AC~U~ T~E AS ff ~P~RS ON SlGNA~RE CARD OR CE~FICA~ OF DE~ C~D P~OE CHECK IN BLUR B~OW IF AC~ WAS ESTABLISHED BY~R O~UN~ ~M ~O~ ~ ~T W~ R~Oi~i ~HED 'IN IF AVN~B~ ~E N~ES OF ~E SAME ~1~ O~ERS ~D E~R ~E DA~ ORIGI~Y E~HEO. ~' · ~ ~lover ~unt - Date Oflgi~ ~1~."~ ~E{~ , , (~) ~:~) OFFICIAL USE ~',~ ~~~ ONLY JOl~ ~RE~ U PERCE~ T~BLE B~EflCIA~ C~ .... s~at~% ~PmOE RE~SHIP TO DECEDE~ SU~ ~ SECUR~ NUMEER ~E (U.) (~) (Mi~ ~ OFFICI~ USE ONLY JOl~ A~REss PERCE~ T~BLE SU~IVO~ BENER~A~ c~ STATE ~p ~DE INFOR~ON T~ RATE RE~ONSHe TO DECEDE.T SU~VOR'S S~ SE~R~ NU~ER ~- ~E (~st) (~m (U~ ~) OFFIC~ USE ONLY dOl~ ~SS ~' PER~ T~BLE SUeR BENE~IA~ C~ STA~ ZIP ~E INFORMA~N " T~ RA~ ~ONSHIP TO DECEDE~ SU~OR'S ~L SECUR~ NUMBER ~ ~) (~t) ~ i~ OFFICI~ USE ONLY JOl~ : A~RE~ PERCE~ T~BLE SU~O~ BEggaRY C~ STA~ ZIP ~E INFORMA~ON T~ R~TIONSHIP TO DECEDENT SU~IVOR'S ~ SECURI~ NUMBER REV-1162 EXI11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ~NDIV~DUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: iNHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO, CD 003837 · BARIC DAVID A ESQ 19 WEST SOUTH ST CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER 03140186 $ 370.90 ESTATE INFORMATION: SSN: 192-34-7410 ---------- :ILE NUMBER: 2103-0697 DECEDENT NAME: ALLEN JANE M ---------- DATE OF PAYMENT: 04/1 6/2004 POSTMARK DATE: 04/15/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ,: ..... TOTAL AMOUNT PAID: $370.90 'REMARKS: RECEIVED OF SUSAN G SQUIBB CHECK//4561 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH SEAL i" REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE ~ XNHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV~lS&7 ~ ~p (01-05) DATE 06-21-2004 ESTATE OF ALLEN JANE p DATE OF DEATH 07-$0-2003 FILE NUMBER 21 05-0697 DAVID A BARIC ESQ COUNTY CUMBERLAND OBRIEN ETAL ACN 101 17 W SOUTH ST I Amount Remiltted CARLISLE PA 1701:5 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND 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, ALLOWA~-C-~-~-R- ................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ALLEN JANE P FILE NO. 21 03-0697 ACN 101 DATE 06-21-200d TAX RETURN NAS: ( ) ACCEPTED AS FILED ( X} CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A) C1} 140~000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) C2}, 345t796.37 credit to your account, S. Closely Held Stock/Partnership Interest CSchedule C) CS} .0~ submit the upper portion 4. Mortgages/Notes Receivable CSchedule D} C4} .00 of this form w/th your 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E} C5} 26r452.3~ tax Payment. &. Jointly Owned Property CSchedule F} C6} 7. Transfers CSchedule G) (73 18r021.39 8. Total Assets c8) 553,648.04 APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Adm. Costs/N/sc. Expenses CSchedule H} (9} 10. Debts/Mortgage Liabilit~es/L~ens (Schedule I} C10} .OQ 11. Total Deductions Cll) 12. Net Value of Tax Return c[2) 497,492.61 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J} C15} .00 14. Net Value of Estate Subject to Tax C14) 497,492.61 NOTE: If an assessment ~as issued previously, lines 14, 15 and/.Or 16, 17, 18 and 19 ~i11 reflect figures that include the iota! of ALL returns assessed t~ date. ASSESSMENT OF TAX: ' 15. Amount of L/ne 14 at Spousal rate C15} .00 X O~ = .00 16. Amount of Line 14 taxable at Lineal/Class A rate C7.6) 497,492.61 x 0~5= 22,387.17 17. Amount of Line 14 at Sibling rate Cl7) .00 X 1~-2 = .00 18. Amount of L/ne 14 taxable at Collateral/Class B rate C18} .00 X [5 = .00 19. Pr/nc/pal Tax Due TAX CREDITS: ¢[9~ 22,387.17 PAYMENT } RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-} AMOUNT PAID 10-~0-2003 CD003186 1,105.26 21,000. O0 04-14-2004 CD003818 . O0 292.07 TOTAL TAX CREDIT I! 22,397.33 BALANCE OF TAX DUEl IO.16CR INTEREST AND PEN. I .00 TOTAL DUE J IO.16CR ~ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or efl§oymeflt to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE= To fulfill the requirements of Section 2140 of the inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9140). PAYHENT= Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: ~F_~IS~"~ OF MILLS, AGENT REFUND OCR)= 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-ISIS). Applications are available at the Office of the Register of Wills, any of the 25 Revenue District Offices, or bv calling the special 24-hour answering service for forms ordering= 1-800-562-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-447-$020 (TT only). OBJECTIONS= Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sho~n on this Notice must object within sixty (60) days of receipt of this Notice bY= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 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. ADH[N- [STRAT[VE CORRECT[OHS= Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. D[SCOUNT= If any tax due is paid within three (S) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allo~ed. PENALTY= The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before JanuarY 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST= Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before JanuarY 1, 1982 bear interest at the rate of six CA%) percent per annum calculated at a daily rate of .000164. 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 interest rates for 1982 through 2004 are= Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20~ .000548 1988-1991 11~ .000501' ~ 9~ .000247 1985 16% .000458 1992 9% .000247 2002 6% .000164 1984 11% .000501 1995-1994 7% .000192 2005 5% .000137 1985 13% .000556 1995-1998 9~ .000247 2004 4% .000110 1986 10% .000274 1999 7~ .000192 1987 10~ .000274 2000 7% .000192 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELINQUENT X DALLY INTEREST FACTOR *-Any Notice issued after the tax becomes delinquent will reflect an /nterest calculation to fifteen C15) days beyond the date of the assessment. Xf payment Zs made after the interest computation date sho~n on the Notice, additional interest must be calculated. REV-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG~ PA 17128-0601 DECEDENTS NAME FILE NUMBER Jane M. Allen 2103-0697 REVIEVVED BY ACN ANITA MCCULLY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H 56 & Repairs are not allowable deductions unless the real estate has been sold. 58 ROW Page 1 BUREAU OF INDIVIDUAL TAXES INHER/TAHCE TAX DIYZS/ON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHON#EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-I~D7 EX AFP (DI-OS) SUSAN G SQUIBB 62 NILSON ST CARLISLE PA 17015 DATE 09-07-Z00~ ESTATE OF ALLEN DATE OF DEATH 07-$0-2005 FILE NUHDER 21 05-0697 COUNTY CUHBER LAND ACN 051~0186 I Amoun~ Remi~ed JANE P HAKE CHECK PAYADLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMIiERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper crmdi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~cax payment. CUT ALONG THIS L/NE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP ¢01-03) ESTATE OF ALLEN x~ INHERITANCE TAX STATEHENT OF ACCOUNT JANE P FILE HO. Z1 03-0697 ACH 051R0186 DATE 09-07-ZOOq THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHONN BELO# IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 08-02-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT ~D DATE NUHBER INTEREST/PEN PAID (-) O~-15-ZOOq 08-16-200q CD003857 REFUND .00 ,00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ~0~ 90 $7o. 9o- TOTAL TAX CREDIT .00 DALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-160? EX AFP (01-05) SUSAN G SQUIBB 62 WILSON ST CARLISLE PA 17015 DATE 09-07-2004 ESTATE OF ALLEN DATE OF DEATH 07-$0-2005 FILE NUMBER 21 05-0697 COUNTY CUMBERLAND ACM 05140184 I Aeoun~ Reei~ed JANE P MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account:, submi~ ~he upper por~:ion of ~:his fore wi~:h your ~:ax payment. CUT ALONG TH'rS L'rNE ~ RETAIN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ESTATE OF ALLEN .-~ INHERITANCE TAX STATEHENT OF ACCOUNT JANE P FILE N0.21 05-0697 ACN 05140184 DATE 09-07-2004 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHO#N BELO# ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-02-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): .O0 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-15-2004 08-16-2004 CD005858 REFUND .00 .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), 16~i22- TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR ZNSTRUCTTONS. ) STATUS .~, POR~_UI~.ER RIFLE &l ?, N~oofD~d~nt: Jane M. Allen a/k/a Jane P. Allen Dat~ olD,th: July 30, 2003 Will No.: 21 - 03 - 0697 Adm~n. No.: ~s~t to ~ul~ 6.12 of thc S~r~e Co~ ~h~s' Com~ R~es, I r~o~ ~e foHo~g ~ reject to ~mplefion of~ a~s~aflon of~ ~ov~c~oned I. S~te whe~ ~m~s~afion of~e estats is complete: 2. If~e ~ i~ No, s~e wh~ ~e p~so~l r~resenmfive ~zt ~e a~s~afion ~ be complet:: ~ Did ~.e p~son~ r~r:sm~ve file a ~ accost ~ ~e Co~? Y~ _ No ~ b. ~e s~am ~h~' Co~ No, (~uy) for ~e p'e~o~ r~r:s~tafive's accost is: c. Did the personal representative state an account informally to the parti~ iuintercst? Yes [X-3 No [~. c. Copies ofreceipU, release~, joinder~ and approval of formal =,~ ~y ~e ~tm~i to ~,~ rep° ' . q / ~ David A. Baric, Esquire 19 West South Street .... Address Carlisle, PA 17013 (717) 249-6873 :- ._. Tcl~hone No, Capacity: [--~ ?~rson2..i R.~prcsentztive ~ Couns~I for personal rcprcsentativa