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04-0154
PETITION FOR PROBATE & GRANT OF LETTERS Estate of Christine A. Derrick also known as Social Security No. 186-34-2391 , deceased. No. 21-04- ].~' ~, To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Executrices named in the Last Will of the above decedent dated December 18, 1990 , and codicils dated none . The Executor named Luther O. Derrick died May 29, 1996 Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 6 Wiltshire West, South Middleton Township, Carlisle Decedent, then 61 years of age, died January 14, ,2004, at her residence Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: 6 Wiltshire West, Carlisle, South Middleton Township, Cumberland County $133,000.00 $. $105,000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. ~~en,~, s.~~s): Genevie R. Hurley, incorrectly ~' referred to as Genevieve R. Hurley 216 Burnt House Road Carlisle, PA 17013 717-243-2542 Arlene M. Treaster 335 Wesley Drive #109 Mechanicsburq, PA 17055 717-766-0401 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 representative of the above decedent, petitioner(s) will well and truly administer the estate ,~ccording to law. Sworn to or affirmed and subscribed ,n.JA//-~ ~~-~J~-~> ~"~: ~ ~._~efore me this I ~-t.~ day of Genevie R. Hurley, incorrectly referred to a,~ . ~.~ · ~, 2004. ~ Genevieve R. Hurley ~.L.~,J~,~_.~.~W Arlene U. Treaster No. 21-04-~q Estate of CHRISTINE A. DERRICK , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, February I ~ ,2004, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated December 18, 1990 described therein be admitted to probate and filed of record as the Last Will of Christine A. Derrick ; and Letters Testamentary are hereby granted to Genevie M. Hurley, incorrectly referred to as Genevieve R. Hurley and Arlene M. Treaster. FEES Probate, Letters, Etc ........ $ 270.00 Short Certificates(-4,- ) .... $12.00 Renunciation(s) ........... $.~ JCP .................... $10.00 Other Will paqes (-3-) .... $ 9.00 _4 TOTAL: .... $ 301.00 Filed..~...t~,:~cv,,~. ] .~.,.,~c~c2.~. .... IRWIN & McKNIGHT ATTORN ~?~p. Ct. I.D. No.) 60 West Pomfret St., Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9990467 No. Local Registrar JAN 16 2004 Date H106.144 Rev. ,F. JI~INT IN ~ ~29-186 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) STATE FILE NUMBER (F~rsl, M~, I.a~) SEX ISOClAL SECURITY NUMBER Christine A. ,.Female ],. 186 - 34 - 2391 61 1942 ~rlisle, PA ~"~. ~,"~' ~ ~ ~,"~"~ Q ~ ~)~ ~,,~2~c~7 ~---""' ...... Cumberland South Middleton 6 Wiltshire West Ir'""~.... 1- 12 =) <"~+ ,~e~r ~rri~ ~nt~l (~' ~w. c~. ~. z~ ~) PA 6 Wilts~re We~ ~"ES'~E~,~, ,~. ,?..~ ~,,~ South Middle~n ~rlisle, PA 17013 ~) ,~.~.~ ~rl~d ~,? ,,,.~ Lu~ O. ~rrick ,,. Clara E. Si~ ~.~e R. nur~ m 2~6 ~thou~ ~d; ~rlisle, PA 17013 .,~ 1/17/2004 I_.~rl~d Valley ~ Gr~. ~rllsle. PA ~~~~ ~- ~ ~ lu,~ 012633 L I~..~inq B~thers ~eral H~t Inc , ~rlisle,PA -ed-~ ~.~.~ ~3~;~;:~ I~ ~ ~ ~k,--~, ~th ~u~., ,~ ,i~, ~,e ~ ~ ..,~. ICENSE NUMBER ..... ~ ' ~~~'~ I''"'~" ~-rx. I°~'"°~"~"~°~"~'~',~' ~ Cardiomyopathy ~)-- a. Pulmonary Hypertension ~ml~l~n, ln~a~,~h~u~athtlm, datl, lfldpla~,a~duetothec~l)l~ ~375 Basehore Road, LAST WILL AND TESTAHENT OF CHIIIS~II~ A. ~F.1IIIICK I, CMP, ISTINE A. DERRICK, of the Township of South Middleton, County of Cumberland and State of Pennsylvania, being of sound and dis- posing mind, memory and understanding, do make, publish and declare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. I give and bequeath twenty-five (25%) per cent. of my estate to my father, LDTMER O. DERRICK, if he survives me, and in the event that my said father should predecease me, then in such event, I give and bequeath said twenty-five (25%) per cent. interest in my estate to my two (2) sisters, to wit, ARLENE M. TREASTER and GENEVIEVE R. HURLEY, share and share alike, per stirpes. I give and bequeath twenty-five (25%) per cent. of my estate to my sister, ARLENE M. TREASTER. I give and bequeath twenty-five (25%) per cent. of my estate to my sister, GENEVIEVE R. HURLEY. I give and bequeath twenty-five (25%) per cent. of my estate to my three (3) nephews, to wit, KEVIN L. HURLEY, CHAD B. HURLEY, and HARLAN J. SPROUL, share and share alike, and in the event that any of my said three (3) nephews should predecease me, I give and bequeath his share in my estate to the survivors of said three (3) nephews, share and share alike. LASTLY, I nominate, constitute and appoint my father, LUTheR O. DERRICK, and my two (2) sisters, the aforesaid ARLENE M. TREASTER and GENEVIEVE R. HtIRLEY, Co-Executors of this, my Last Will and Testa- ment, and direct that they be excused from posting bond or other security for the faithful performance of their duties. this IN WITNESS W~,EOF, I have hereunto set my hand and seal day of December, A. D. 1990. ~ - -'Christine A. Derric~k (SEAL) Signed, sealed, published and declared by the above-named CMI~ISTINE A. DEI~RICK, 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 wit- messes. COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, C~RISTINE A. DERRICK , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the ~purposes therein contained. Sworn and affirmed to and acknowledged before me_~ CMRISTINE A. DERRICK , the testatrix , this day of December , A. D.1990. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) SS. We, the undersigned, J. ROBI~IIT STAIIl~ and JOHN M. EAKIN , the witnesses whose names are sigged to the attached or foregoing instrument, being duly qualified acco?ding to law, depose and say that we were present and saw the testat rix , CHRISTINE A. DERRICK , sign and exe- cute the instrument as ~d~/her Last Will and Testament; that the said testatrix, C~RISTINEA. DERRICK , executed it as h~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 (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. me, rth..s~and /~su~ cribedda tOofbefore~/. ~.. ~[/, C-F~,¢~-~. December , ~990. ~ LAST WILL AND TESTAMENT OF CHRISTINE A. DERRICK J. ROBERT STAIJFFER ATTOI~I~y AT LAW h/hm~r SQuast~ Bun~nmc MECHANICSBL/RG, PA. 17055 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: CHRISTINE A. DERRICK JANUARY 14, 2004 21-04-0154 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 24, 2004 . Name Address Arlene M. Treaster Genevie R. Hurley Kevin L. Hurley Chad B. Hurley 335 Wesley Drive #109, Mechanicsburg, PA 17055 216 Burnt House Road, Carlisle, PA 17013 1092 Myerstown Road, Gardners, PA 17324 196 Branch Circle, East Berlin, PA 17316 Harlan J. Sproul 206 Pennsylvania Drive, Mohnton, PA 195480 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none . Date: 02/24/04 Signature IRWI~McKNIGHT Capacity: Name Roger B. Irwin, Esquire Address 60 West Pomfret Street Carlisle, PA 17013 Telephone (717) 249-2353 X __ Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003819 IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 186-34-2391 FILE NUMBER: 2104-01 54 DECEDENT NAME: DERRICK CHRISTINE A DATE OF PAYMENT: 04/14/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 14/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $30,000.00 REMARKS: IRWIN ET AL CHECK# 021091 SEAL TOTAL AMOUNT PAID' $30,000.00 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-tEOOE×.IS*00 REV--1500 CBMMBNWEALTBOFPE..SYLVA.,A INHERITANCE TAX RETURN DEPARTMENT OF REVENUE OEFT. 2S0$0 RESIDENT DECEDENT HARRISBURG. PA 17328-0601 DECEBENT'S NAME(LAST F[RST AND MJDDLEINiTIAL) Derrick Christine A. DATE OF DEATH (MM- DB-YEAR) I DATE OF BIRTH (MM - DD-YEAR) 01/14/2004 06/20/1942 (IF APPLICABLE)SURV~V NG SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) OFFICIALUSEONLY FILE NUMBER 21-04-0154 COUNTYCODE YEAR NUMBER SOCIAL SECURiTy NUMBER 186-34-2391 E O E N T upRLC A P a 4. Limited Estate . Future Interest Compromise/date of death after 12-12-82) ~ p ~ O 6. Decedent Died Testate Decedent Maintained a Living Trust cRAC -- ~( O T _K (Attach copy of Will) (Attach copy of Trust/ i~:;3 [] 9. LJt[gatlon Proceeds Received ~'~0. SpousalPovertyCredlt /date of death between 12-31-91 and 1- t-95) NAME B. Irwin Esq. FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER R E C A P I T U L A T I O N THIS REFURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER date of death 3. Remainder Return prior o 12-13-82 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Election to tax u,der Sec. 9113(A) (Attach ScL O) C O M T ! O N COMPLETE MNLING ADDRESS 60 West ?omfret Street West ?omfret Professional Bldg. Carlisle, PA 17013 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3, Closely Held Corporation, Partnership or Sole-Proprietorship 4, Mortgages & Notes Receivable (Schedule D) $, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines § & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. (1) 104,000~ (ID (3) (4) ffone (s) 132, 32,659~ 27,172.49 2,656.75 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY (8) 269,414.01 (11) 29,829.24 (12) 239,584.77 (13) (14) 239,584.77 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 0 16. Amount of Line 14 taxable at lineal rate 0.00 X .0 45 17. Amount of Line 14 taxable at sibling rate 178 ~ 749.8]_ X .12 18. Amount of Line 14 taxable at collateral rate 59,583.27. X .15 19. Tax Due (15) O. O0 (16) 0.00 (17) 21,449.98 (18) 8,937.49 (19) 30,387.47 Copyright (c) 2000 form software only The Lackner Group. Inc. Form REV- 1500 EX (Rev. 6- 00) Decedent's Complete Address: STREET ADDRESS 6 Wiltshire Drive CITY STATE J ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Pover~7 Credit 0.00 B. Prior Payments 30,000.00 C. Discount 1,519.37 Total Credits ( A + 8 + C ) (2) 3. InteresUPenaity if applicable D. Interest E. Penalty Total Interest/Penalty ( D + 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) 1,131.90 5. If Line I + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due, (SA) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ['~ ~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate 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 Q AND FILE IT AS PART OF THE RETURN. 30,387.47 31,519.37 Under penalties of periury, I declare that J have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is trae, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATUREOFPERSONRESPONSIBLEFORFILINGRETURN Genevie RD [-~urley DATE SiGNATUREOFPREPAREROTHERTHANREPRES~NTATiVE IRWIN & McKNIGHT DATE -/'~/f-~ ~'t --/~. 60 West Pomfret Street sFu°[vid~tne;~ ~ou~/~:~ul~~':~ ~ l(~l~:i?]~fore Janua~ 1 1995. he tax rate mposedi:~:on the net value of transfers to or for the use of the For dates o~ death on or after Janua~ 1, 1995, the tax rate imposed o~ 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 statuto~ require~nts for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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 ~x 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 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) ~0~ form software only The Lackner Group, I~. Form REV-150O EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of Christine A. Derrick SS# 186-34-2391 01/14/2004 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature Name Address Line 1 Address Line 2 City, State, Zip Date Arlene M. Treaster 335 Wesley Dirve Mechanicsburg, PA 17055 REV- 1502 EX · {1-97) SCHEDULE A COMMONWEALTH or PENNSYLVA.~^ REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Christine A. Derrick SS~/ 186-34-2391 01/14/2004 21-04-0154 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 knowledge 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 6 Wiltshire West, Mayapple Village, Carlisle - sold 104,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 104,000.00 (if more space is needed, insert additional sheets of the same size) Copyright (c} 1996 form software only CPSystems, [nc. Form REV-1502 EX (Rev.; -97) REV-1503 EX + (t -97) / SCHEDULE B r COMMONWEALTHOFRENNSYLVANI^ STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Christine A. Derrick SS~/ 186-34-2391 01/14/2004 21-04-0154 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 $100 [J.S. Savimgs Bond, Series EE issued 04/1995 75.04 TOTAL (Also enter on line 2, Recapitulation) 75.04 (If more space ~s needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1503 EX (Rev. 1 97) REV- re08 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER Christine A. Derrick SSf/ 186-34-2391 01/14/2004 21-04-0154 Include the proceeds of litigation and the date the proceeds were rece ved by the estate, All pl'operty jointly-ow.ed with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 DESCRIPTION Cornerstone Federal Credit Union Cornerstone Federal Credit Union Cornerstone Federal Credit Union Cornerstone Federal Credit Union Cornerstone Federal Credit Union Cornerstone Federal Credit Union M&T Bank - certificate of deposit M&T Bank - checking account savings certificate certificate certificate certificate certificate Members First Federal Credit Union - regular savings Members First Federal Credit Union - certificate Members First Federal Credit Union - certificate 1997 Chevrolet - sold Miscellaneous personal property VALUE AT DATE Of DEATH 15,922.46 15,081.84 13,200.95 13,200.95 20,032.22 10,013.04 16,839.49 11,821.40 3,714.13 3,505.37 5,088..57 3,500.00 759.00 TOTAL (Also enter on line 5, Recapitulation) $ 132,679.42 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Ir, c. Form REV- 1508 EX (Rev 1-97) .Ev-~5~o Ex,(~-97) I SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Christine A. Derrick SS~/ 186-34-2391 01/14/2004 21-04-0154 This schedule must be completed and filed i/the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAMEOFTHETRANSFEREE THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AN D TH E DATE O~ TRANSFER. NUMBEF~ ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST {IF APPMCABLE) 1 Fidelity Investments - 32,659.55 32,659.55 Retirement Savings TOTAL (Also enter on line 7, Recapitulation) $ 32,659.55 (If more space ~s needed, insert additional sheets of the same s~ze) Copyrlg ht (c) 1996 form software only CPSystems, Inc. Form REV- 1510 EX (Rev, 1-97) REV-tS' EX ~/t-97/ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Christine A. Derrick SS~/ 186-34-2391 01/14/2004 Debts of decedent must be reported on Schedule I. FILE NUMBER 21-04-0154 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Ewing Brothers Funeral Home 2 3 7, 1 2 3 4 5 6 Mt. Holly Springs United Methodist Church Rev. Bradley C. Knepp ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees IRWIN & McKNIGHT & CHARLES E. SHIELDS, III Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Better View - repair broken window locks Castles Lumber - handle screen door Cornerstone Federal Credit Union - Federal Express Cornerstone Federal Credit Union - The Shoppers Guide Cumberland Law Journal - estate notice publication Judy A. Campbell - Township Tax Total of Continuation Schedule(s) 7,677.50 75.00 75.00 11,800.00 301.00 480.00 36.00 4.45 56.00 21.60 75.00 233.60 6,337.34 TOTAL (Also enter on line 9, Recapitulation) $ 27,172.49 (If more space is needed, insert additional sheets of the same size) CopyNg ht (c) 1996 form software only CPSystems, inc. Form REV- 1511 EX (Rev. 1 -97) Estate of: Christine A. Derrick Soc Sec #: 186-34-2391 Date of Death: 01/14/2004 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description 7 KMART - Sign 8 Lowe's - 18X24 Sign with Frame 9 Mayapple Village Condo Association Fee 10 Mileage - J. Hurley 11 Phone Calls - J. Hurley 12 Postage - J. Hurley 13 Real Estate - Realty Transfer Tax 14 Real Estate - Seller Assist 15 Register of Wills -Short Certificate 16 Register of Wills - filing fee 17 Roy D. Gottshall Auctioneer - appraisal fee 18 Russell Wagner - carpet 19 South Middleton Township Fire Dept. 20 Steven W. Barrett Real Estate - appraisal fee 21 The Sentinel - Legal - estate notice publication 22 The Sentinel - Advertising 23 Yellow Breeches EMS, Inc. - Emergency 10.00 18.79 30.00 377°65 33.70 4.81 1,040.00 4,000.00 3.00 25.00 40.00 100.00 75.00 275.00 122.63 106.76 75.00 6,337.34 REV-15 IZ EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Christine A. Derrick SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSf/ 186-34-2391 01/14/2004 FILE NUMBER 21-04-0154 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 Bill Sheaffer Auto Repairs Meadowrtdge - condo fee Members First Federal Credit Union - VISA balance Met-Ed PA Department of Revenue - 2003 income tax due South Middleton Township - Water Sprint Telephone UCI TOTAL (Also enter on line 10, Recapitulation) 1,370.60 544.50 18.00 80.07 113.00 193.60 96.07 240.91 2,656.75 (if more space is needed, insert additional sheets of the same size) Copyright {c) 1996 form software ordy CPSystems, inc. Form REV-1512 EX (Rev, 1-97) SCHEDULE J COMMONWEALTH OF PEN NSYLVANIA BENEFICIAR lES ESTATE OF Christine A. Derrick SS~ 186-34-2391 01/14/2004 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1 Chad B. Hurley 196 Branch Circle East Berlin, PA 17316 2 Genevie R. Hurley 216 Burnt House Road Carlisle, PA 17013 3 Kevin L. Hurley 1092 Myerstown Road Gardners, PA 17324 4 Harlan J. Sproul 206 Pennsylvan Drive Mohnton, PA 19540 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Nephew Sister Nephew Nephew FILE NUMBER 21-04-0154 AMOUNT ORSHARE OF ESTATE 8 1/3z remainder 37 1/2% remainder 8 1/3× remainder 8 1/3z remainder 5 Arlene M. Treaster Sister 37 1/2% 335 Wesley Drive ~/109 remainder Mechanicsburg, PA 17055 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 $ O. O0 {If more space is needed, insert additional sheets of the same size) Copyright (c) ZO00 form software only The Lackner Group, ~nc. Form REV- 1513 EX (Rev. 9-00) LAST WILL AND TESTAMFRqT OF g~I~ISTINE A. DERRICK I, CHRISTINE A. DERRICK, of the Township of South Middleton, County of Cumberland and State of Pennsylvania, being of sound and dis- posing mind, memory and understanding, do make, publish and declare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. I give and bequeath twenty-five (25%) per cent. of my estate to my father, LUTHER O. DERRICK, if he survives me, and in the event that my said father should predecease me, then in such event, I give and bequeath said twenty-five (25%) per cent. interest in my estate to my two (2) sisters, to wit, AP~LENE M. TREASTER and GEI~EVIEVE R. RURLEY, share and share alike, per stirpes. 3o I give and bequeath twenty-five (25%) per cent. to my sister, AP, LENE M. TREASTER. of my estate I give and bequeath twenty-five (25%) per cent. of my estate to my sister, GENEVI~ R. HURLEY. I give and bequeath twenty-five (25%) per cent. of my estate to my three (3) nephews, to wit, KEVIN L. HURLEY, CMAD B. HURLEY, and MARLAN J. SPROLrL, share and share alike, and in the event that any of my said three (3) nephews should predecease me, I give and bequeath his share in my estate to the survivors of said three (3) nephews, share and share alike. LASTLY, I nominate, constitute and appoint my father, LUTHk~R O. DERRICK, and my two (2) sisters, the aforesaid ARLENE M. TI~TER and GENEVIEVE R. RIIRLEY, Co-Executors of this, my Last Will and Testa- ment, and direct that they be excused from posting bond or other security for the faithful performance of their duties. this IN WITNESS W~]LzREOF, I have hereunto set my hand and seal day of December, A. D. 1990. (SEAL) Signed, sealed, published and declared by the above-named C~{RISTINE A. DERRICK, 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 wit- nesses. COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLA~ND ) I, C~ISTINE A. DERRICK , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before msb~ C]~RISTINE A. DERRICK , the testatrix , this day of December , A. D.1990. COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, the undersigned, .f. ROBERT STAIIFFF~R and JOHN M. EAKIN , the witnesses whose names are sighed to the attached or foregoing instrument, being duly qualified accoYding to law, depose and say that we were present and saw the testat rix , CHRISTINE A. DERRICK , sign and exe- cute the instrument as ~d~/her Last Will and Testament; that the said testatrix, CHRISTINE A. D]~LRICK , executed it as ~/her free and voluntary act for ~he purposes therein expressed; that each of us, in the hearing and sigh~ of the testatrix , signed the Will as witnesses; and tha~ to the best of our knowledge, the testatrix was, at ~he time, eighteen (18) or more years of a~e, of sound mind, and under no cons~raint, duress or undue influence. me ~i~ /'7' day of ~ i - December , 1990. ~ CORNERSTONE Federal Credit Union P.O. Box I 181,5 East Gate Drive, Carlisle, PA 17013 Telephone (717) 249-1661 FAX (717) 249-8208 Member founded -- Service based www. cornerstonefcu.org January 27, 2004 Roger Irwin Irwin and Mcknight 60 West Pomfret Street Carlisle, PA 17013 RE: Christine A. Derrick S.S.# 186-34-2391 Dear Sir: Per your request I am providing the following account information on the above referenced member. The account was opened 11/11/1996 as a single owner account. See attached for detailed account information. If you require any further information, please contact our office. Sincerely, Member Service 2004 IRWIN & McKNtGHT MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $100,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION Christine A. Derrick - Account Number 5660 Record Account Interest No. Type Rate 01 Regular Savings 1.00% 10 Certificate 4.10% 11 Certificate 3.25% 12 Certificate 3.25% 13 Certificate 4.20% 14 Certificate 3.40% B~ance Interest Dae of 1/1/04 thml/14/04 Death Balance $15916.36 $6.10 $15922.46 $15058.16 $23.68 $15081.84 $13184.51 $16.44 $13200.95 $13184.51 $16.44 $13200.95 $20000.00 $32.22 $20032.22 $10000.00 $13.04 $10013.04 Total Date of Death Balance: $87451.46 Bonds: --- TSSUe · ~-- l E~$100~c5__16652041 EE / 04/1995 Inventop ' Totals: Bonds Price $50.00 Inventory Report Active Inventory Print Date: 02/17/2004 File Pricing Date: 01/2004 Interest t I [ext Interes~_nal Maturi~ I Value Rate i Yield / Date / Date /Not~ $25.04 $75.04 2.50% 4.83%/ 04-/~] _04_/2025 ~2~ Price Interest - Value $50.00 ~25.04 $75.04t · ti- bond was Cashed :n · EX. bond was EXchanged for an HH bond · ME - bond is Natured and Exchangeable for an HH bond · ~ - bond is z atured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (irs < 6 months old) · NI - bond has Not yet been :ssued · 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:\My Documents\Christine A. Derrick Estate.sbw Page 1 of 1 50439154202 DE MAKE OF V£itICLE MODEL YEAR PURCHASE Chevrolet 1997 PRICE $3500.00 161JFI2TgV139745 ~ D~rrtck. Chris_tine A. (decased) Shughart, Allen W. TAXABLE AMOUNT CO-PURCHASER MIDDLE INfTIALDATE ACQUIRED/ PURCHASED STREET 6 James Circle CITY STATE air C'ODE )ensbur PA 17257 I $3500.00 I Title Fee BUREAU (PROOE OF tN- ~ TRANSFER & REPLACEMENT OF PLATE ISSUED BY BUREAU [ PLATE NO ~ REASON FDR REPLACEMENT I RELATIONSHIP TO APPLICANT IREQ REG GROSS COMB ?~©TE: fl a cc-pJ:chase~ other than your spouse is listed and you want the til!e to be listed as "Joint Tenants With I ' ~ ' -- ~ U ~V~ r S '~' {On death of one owner titie goes to surviving owne,- ) ClflECK HERE ~ Otherwise the tille iMESSENGER NUMBER: CERTIFICATE OF TITLE FOR A VEHICLE 972040845001818-001 161,JFI2T9V7139745 97 CHEVROL£T 50439154202 DE CP 0 NI 8/18/97 0132021 g 1/21/97 8/18/q7 CHRISTINE A DERRICK 6 HILTSHIRE ~EST CARLISLE PA 17013 CHRISTIN~ a DERRICK 6 HILTSHIRE W~ST CARLISLE PA 17013 4~ BRADLEY L MALt L;EN REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/04 to Date of Death Name of Joint Owner CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/04 to Date of Death Name of Joint Owner st MEMBERS 1st FEDERAL CREDIT UNION 165714 -00 02/06/1997 $3,712.81 $1.32 $3,714.13 $1.32 None IRWIN & McKN[GHT 165714 -40 165714 -41 02/06/1997 06/28/1997 $3,500.00 $5,079.90 $5.37 $8.67 $3,505.37 $5,088.57 $5.37 $8.67 None None MI~MI~ERS 1sT F./~ERAL CREDIT UNION D~nise A. Wolfe ~// Insurance Supervisor February 2, 2004 Estate of; CHRISTINE A. DERRICK Date of Death: 01/14/2004 Social Security Number: 186-34-2391 50(10 [ouise Drive · [~O. Box 41) · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · xvw-,v, memberslst.org M&T Bank 499 Mitchell Road, Millsbom, DE 19966 Mail Code DE-MB-12 Irwin & McKnight Attorneys At Law 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Christine A Derrick Social Securi~: 186-34-2391 Date of'Death: .lam2arv 14. 2004 Phone (888) 502-4349 F ax (302) 934-2955 Februa~ 6, 2004 Dear Sir or Madam: Per your inquiry dated January 26, 2004, please be advised that at the time of death, the above-named decedent had on Certificate of Deposit 31003910848985 Christine A Det?'ic/¢ 05/20/00 $16,542.77 $ 2.96 Checking Account 2679022877 Chr~rtine A Derrick 06/13/96 $ll, 82)0.19 $ 1.2I deposit with this bank the following: 1. Type of Accotmt Account Number Ownership (Names qJ) Opening Date Balance on Date of Death Accrued lnterest Total 2. Type of Acco~mt Account Number Ownership (Names' oj') Opening Date Balance on Date of Death Acct~ed lnterest Total For further account information, closures and/or reimburscmcnl of I'unds please cml Ibc Boiling Springs Office at #717-211-779{}. Please be advised, there was no safe deposit box lbund l~r Ihe abme decedent. Sincerely, Records Management A. Sefflement Statement B. Type of Loan 1. [] FHA 2. [] FmHA 3 [] Cony. Unins File Number Loan Number Mo~lgage Jnsurance Case Number 4. [] VA 5. [] Cony, Ins. ~135-983/Shiffer C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked p.o.c" were paid outs de of closing; they are shown hero for reformational purposes and are not InClUded in the totMs. D. NAME AND ADDRESS OF BORROWE R:Kara L., Shfffer . 240 E Stmet,,Apt: f Carllsle/PA~170i3 , E. NAME AND ADDRESS OF SELLER: F=~ of Christine A. Derrick 6 WStshlre West, Carlisle, PA f7013 F. RAME AND ADDRESS OF LENDER: WaypolntBank I. SE~-EMENT DATE: 06/25/2004 J~ORROWER'S TRANSACTION 100. GROSS AMOUNT DUE FROM SORROWER: lO5. 17 West South Street, Carlisle, PA; 170f3 RESCrSSION DATE: K. SUMMARY OF SELLER'S TRANSACTION 4~0. GROSS AMOUNT DUE TO SELLER: ADJUSTMENTS FOR ITEMS PAID BY SELLER iN ADVANCE: ~ ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCS: 112. 120. GROSS AMOUNT DUE FROM SORROWER: 200. AMOUNTS PAID SY OR IN BEHALF OF SORROWER: ADJUSTMENTS FOR ITEMS UNPAID BY ~ 213. 214. 215. 216. 217. 218. 219 220. TOTAL PAID BY/FOR BORROWER: 300. CASH AT SETTLEMSNT FROM/TO SORROWER: 301 Gross amount due from borrower (lide 120) 302. Less amount paid by/for borrower (tine 220) 303. CASH (~FBOM) (~]TO) 411. 412. 420. GROSS AMOUNT DUE TO SELLER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: $122.24 $21.07 $500.00 $4,000.00 ADJUSTMENTS FOR ITEMS UNPAID SY SELLER: $12Assessmen~ to 513. 514, 517. $I08,500.00 520. TOTAL REDUCTIONS IN AMOUNT DUE TO SELLER: ~00. CASS AT SETTLEMENT TO/FROM SELLER 601. Gross amount due to sMtsr (line 420) 602. Less reductions in ami due seller (line 520) $53.43 603. CASH ( ElFROM) (~TO) SELLEi HUD-'I (3-86) - RESPA, HB 4305.2 $5,664.60 $104,143.31 $5,664.60 $98,478.71 PAGE SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION DIVISION OF COMMISSION (L~NE 70(}) AS FOLLOWS: PAID FROM PAID FROM BORROWER'S SELLER*S FUNDS FUNDS AT AT SETTLEMENT SETTLEMENT $290.0 $12.00 $Z,040.00 O TOTAL SETTLEMENT CHARGES COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Genevie R. Hurley and Arlene M. Treaster being duly sworn according to law, deposes and says that they are Co-Executors of the Estate of Christine A. Derrick late of So~uthMiddletQn Township ., Cumberland County, Pa., deceased and that fha w~fhln is an inventory made by Genevie R. Hurley & Arlene M. Treaster , the said Co-Executors of the entire estate of said decedent, consisting of all the personal property and real esfete, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent ~t's fair value es of the date of decedent's death. Sworn and subscribed before me, this 27th day of July, 2004. / camm m~ cmmmm ~_.~ I Date of Death 14 Genevie R. Hurley, Executor 216 Burnt House Road Carlisle, PA 17013 Addre,, 01 2004 2. 3. 4. Day Month Year INSTRUCTIONS An inventory must be filed within three months after appointment of personal represenfaflve. A supplement inventory must be filed within thirty days of discovery of addltlonel assets. Additional sheets may be attached as to personalty or realty See Article IV, Fiduciaries Act of 1949. z Z ~ ~ < 0 Z 0 r, Inventory of the real and personal estate of CHRISTINE A. DERRICK deceased 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 6 Wiltshire West, Mayapple Village, Carlisle, PA - Sold. $100 U.S. Savings Bond, Series EE, issued 04/1995. Cornerstone Federal Credit Union - Savings . Cornerstone Federal Credit Union - Certificate Cornerstone Federal Credit Union - Certificate Cornerstone Federal Credit Union - Certificate Cornerstone Federal Credit Union - Certificate Cornerstone Federal Credit Union - Certificate M&T Bank - Certificate of Deposit ..... M&T Bank - Checking Account ...... Members 1st Federal Credit Union - Regular Savings Members 1st Federal Credit Union - Certificate . Members 1st Federal Credit Union - Certificate . 1997 Chevrolet - Sold ......... Miscellaneous Personal Property ...... 104,000 00 75 04 15,922 46 15,081 84 13,200 95 13,200 95 20,032 22 ~0,013 04 ~6,839 49 ';"~1,821 40 3~714 13 3~505 37 5,088 57 3,500 00 759 00 236,754 46 STATUS REPORT UNDER RULE 6.12 Name of Decedent: CHRISTINE A. DERRICK Date of Death: JANUARY 14, 2004 No. 21-04-0154 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: X Yes __ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No Date: 10/19/2004 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. :'~nawturlNe &~M~~H~~ ~''''~' Roger B. Irwin, Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle, PA 17013 ' :i V,.] City, State, Zip (717) 249-2353 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative BUR.EAU OF ~NDTVTDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. 280601 HARR/SBURG, PA 17128-0601 COHNONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF /NHERZTANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1547 EX AFP (01-0S} ROGER B IRWK'N ESQ IRWIN.& HCK~IGHT 60 W POHFR£~_~ST CARLISLE P~L17013 DATE 09-27-2004 ESTATE OF DERRICK DATE OF DEATH 01-14-2004 FZLE NUHBER 21 04-0154 COUNTY CUHBER LAND ACN 101 I Amoun~ Rami*~ad CHRISTINE A HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF DERRICK CHRISTINE AFZLE NO. 21 04-0154 ACN 101 DATE 09-27-2004 TAX RETURN HAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 1 2 $ 6 ORIGINAL RETURN Real Es~a~e (Schedule A) (1) S~ocks and Bonds (Schedule B) (2) Closely Held S~ock/Par~narship In~eres~ (Schedule C) ($) Hor~gages/No~es Receivable (Schedule D) (4) Cash/Bank Daposi~s/Hisc. Personal Propar~y (Schedule E) (5) Jointly O~nad Proper~y (Schedule F) (6) (7) 7. Transfers (Schedule G) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H) 10. Dab~s/Hor~gega Liabilities/Liens (Schedule I) 11. Total Deductions 12. Na~ Value of Tax Re~urn (9) lOqzO00.O0 75 04 O0 O0 132;679.q2 O0 32;659.55 (8) 27,172.49 (10) 2,656.75 (11) (12) 15. 14. NOTE: NOTE: To insure proper cradi~ ~o your account, submi~ th. upper portion of ~his fora Nigh your ~ax payment. 269,414.01 259,584.77 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Es~a~e Sub5ec~ ~o Tax (14) Zf an assess, ent ~as lssued previously, 11nee 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. (1;) .00 x O0 = (16) .00 x 045= (17) 179,688.57 x 12 = (18) 59,896.Z0 x 15 = (19)= ASSESSNENT OF TAX: 16. Amoun~ of Line 14 a~ Spousal ra~e 16. Amoun~ of Line 14 ~axable a~ Lineal/Class A ra~e 17. Amoun~ of Line 14 a~ Sibling ra~e 18. Amoun~ of Line 14 ~axable a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDZTS: PAYHENT RECE/PT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 04-14-2004 CD003819 1,527.35 ANOUNT PAID IF PA[D AFTER DATE ZNDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL ZNTEREST. 30,000.00 .00 239,584.77 18 and 19 wil1 .00 .00 21,562.63 8,984.43 30,547.06 TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 31,527.35 980.29CR .00 980.29CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED. ¢,~/' IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTIONS.) RESERVATION= PURPOSE OF NOTICE= PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z) 19BI -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To ~ulfill the requirements of Section Zi~O of the Inheritance and Estate Tax Act, Act 22 of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit) which ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of NilIs, any of the ZS Revenue District Offices) or by calling the special Z~-hour answering service for forms ordering: 1-BOO-SBZ-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-q47-SOZO (TT only). Any party in interest not satisfied with the appraisement, allowance) or disallomance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --mritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171za-lozl~ OR --election to have the matter determined at audit of the account of the personal representative) OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes, ATTN= Post Assessment Reviee Unit) Dept. ZB0601) Harrisburg, PA 17128-0601 Phone (7[7) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150I) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18) 1996) the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency) or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1) 1982 mill bear interest at a rate mhich mill vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO~ are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .0005~8 ~'~-1991 11Z .O00SO1 ~ 9Z .O00Z~7 1985 16X .000~S8 199Z 9Z .000247 ZOOZ 6Z .00016~ 198~ llZ .OOOSO1 199S-199~ 7Z .00019Z ZOOS 52 .000137 1985 13Z .000S56 1995-1998 92 .O00Z~7 ZO0~ ~Z .000110 1986 lOZ .O0027~ 1999 72 .000192 1987 lOZ .OOOZ7~ ZOO0 72 .O0019Z --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELIN{~UENT 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 ba calculated. REV-1470 EX (~-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME FILE NUMBER Derrick, Christine A. 2104-0154 REVIEWED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ROW Page 1 BUREAU OF I'NDTVZDUAL TAXES ZNHER]'TANCE TAX D*rVTSTOH DEPT. 280601 HARRTSBURG., PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (01-05) ROGER B IRWIN ESQ IRWIN & MCKNIGHT 60 W POMFRET ST CARLISLE PA 17015 DATE 11-01-2004 ESTATE OF DERRICK CHRISTINE A DATE OF DEATH 01-14-2004 PILE NUMBER 21 04-0154 COUNTY CUMBERLAND ACN 101-;-~,; MAKE CHECK PAYABLE AND REM*~T PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ..... NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wallet your ~ax payment. CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF DERRICK CHRISTINE A FILE NO. Z1 04-0154 ACN 101 DATE 11-01-2004 TN'rS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN 'tN THE NAHED ESTATE. SHONN BELON TS A SUMMARY OF THE PR/NC/PAL TAX DUE,, APpLTCAT'rON OF ALL PAYHENTS, THE CURRENT BALANCE,, AND,, 'rF APpLTCABLE, A PROJECTED TNTEREST F'rGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-20-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 30,547.06 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 1,527.$5 04-14-2004 10-15-2004 CD003819 REFUND .O0 30,000.00 980.29- ZF PAID AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULATION OF ADDZTZONAL INTEREST. IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" TOTAL TAX CREDIT 30,547.06 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF TH'rS FORM FOR TNSTRUCT/ONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- TF RESTDENT DECEDENT make check or money order payable to: REGTSTER OF NILLS, AGENT. -- Tf NON-RESTDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Tnhmritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the g3 Revenue District Offices or from the Department's gq-hour ansmering service for forms ordering: 1-BOO-36Z-ZO50; services for taxpayers Nith special hearing and / or speaking needs: l-BOO-qq7-3OZO (TT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Tndividual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA lTlg&-0601, phone (7173 787-6~05, DTSCOUNT: Tf any tax due is paid Nithin three (3) calendar months after the decedent's death, a five percent (BZ) discount of the tax paid is alloaed. PENALTY: The 15Z tax amnesty nan-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996~ the first day after tho and oF the tax amnesty period. TNTEREST: Tntarast is charged beginning ~ith 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 l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes ahich became delinquent on and after January T, 198Z mill bear interest at a rate which ~ill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Tntarest Daily Tnterest Daily Year Rate Factor Year Rate Factor --Year Rate Factor 198Z gO[ .OO05q& 1988-1991 llZ .000301 goo1 9Z .O00Zq7 1983 Z6Z .000q38 199Z 9Z .O00Zq7 ZOOZ 6Z .O0016q 198q llZ .000301 I993-199q 7Z .O0019Z ZOO3 SZ .000137 1985 13Z .000356 1995-X99B 92 .O00gq7 gO0~ q2 .O00110 1986 lOX .O00Z7q 1999 72 .O0019Z 1987 9Z .0002q7 ZOO0 82 .O00Z19 --Tnterest is calculated as follo~s: TNTERBST = BALANCE OF TAX UNPATD X NUMBER OF DAYS DELIN~IUENT X DA/L¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on tho Notice, additional interest must be caIculatad.