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HomeMy WebLinkAbout03-0935PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~ [/[~-g--~ t~ ,~/st IX ~, 1~ V fJ'L~ x,~ No. Deceased. Social Security No. I q. ~ - I f3 -'~ ~-I ~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut~,~ in the last will of the above decedent, dated ~ ~t ~. I~ ~- 7 and codicil(s) dated dx/o ~ t~ ,-3,1-o3 -c73..5 Register of Wills for the County of C2-O~ O~_,t~-'~-vOin the Commonwealth of Pennsylvania named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~_._o ~ f~art., t~r~ ~ f) County, Pennsylvania, with h F~f~, last family or principal residence at _'~ -g .14 i F_,-I~L.~/O ./>~.W~: ~ (list street, number and muncipality) De.ce, ndent, then ~ } years of age, died .J ,,~-,t,t,,.~-,.-4 ~ , AC--~ 0 "g Except as follows, decedent did hot 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully__request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters"U~'s inistration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF ~lancl f 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 ,~ .-fyq:v~,, ,.~..~Z'~ ~ before rn~ this lOSn day of [ ...... ~ ~' ~nna M. Otto, lst- ~puty ~-f--/r~ Register~,, ~ ~ /7-/76-/o /--7 No. 21-2003-935 Estate 0f EVELYN MARY HUBLEY a/k/a , Deceased EVELYN M. HUBLEY DECREE OF PROBATE AND GRANT OF LETTERS November 12th AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June P7~-h: 9001 described therein be admitted to probate and filed of record as the last will of Evelyn Mary Hubley, a/k/a Evel_vn M. Hubley and Letters Test0mentary_ are hereby granted to W5 ] bur R.W. Hubley 2003, in consideration of the petition on FEES Probate, Letters, Etc .......... $, 40.00 Short Certificates(2) .......... $. 6.00 ~ .x-Pa§es.-64).. $12.00 JCP Fee $- 10.00 TOTAL __ $~ 68.00 Filed No~ember..12th.,.2003 .............. Mailed Letters to Executor on 11/12/2003. ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death dui;' filed with nic' as l~ocal Registrar. The origimd certificate will be fbrwarded to the State \/ital Records Office for permanent WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, 52.00 P 8647178 ~43 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,,. Cumberland O~C~'S USUAL ~U~ .... Ass~. offZce Supv. ,,~. Off~c~ ,~. ,~. ~o.,~) 12 ' ~" ,,M~ed ,, W~b~ Hubgey 33 Hlghland Drlve J~c~u~ ,..~,. PA ~ ~,..~.~ Lowea Atle. n PA 17011 ..... o., ,~.c~., Cumberland ~ ,,,.~ ~.~ B~clnda Llph~t Wllb~ R. W. Hubley, i~ 33 Hrgh~and DAlve, Camp Hlgl, PA 17011 [ ..... c~emaz~on ~oc<e~ o~I ~1,,~.1 I - q- o 5 I,,..PA Crematory I~,,. H~risb~, PA 17109 I t~u~uuu~. .~UE~D~C,u~ Caem~Zon Society of PA '.'/z IMMEDIATE CAUSE (F,nal lIN JURY ATWORK? IDESCRmE ~INJURYOCCURRED. I}ec. 3e0. DATE FILED(Month Day, Yea,I 21-2003-935 EVELYN MARY HUBLEY I, Evelyn Mary Hubley, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable marker at my grave, and to expend sums from my estate for this purpose. SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse, Wilbur R. W. Hubley, providing that he survives me by sixty (60) days. THIRD Should my spouse, Wilbur R. W. Hubley, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate in equal shares to my son, Marc W. W. Hubley, who survives me by sixty (60) days, per stirpes. If my son, Marc W. W. Hubley, predeceases me or fails to survive me by sixty days then I give and bequeath all the rest, residue and remainder of my Estate of whatever nature and wheresoever situated as follows: 1. 50% of my Estate to my nieces, ,Jo Ann Shepp Burns, of York. Pennsylvania, Lou Ann Shepp Dillman, of York, Pennsylvania, per capita. 2. 50% of my Estate to my husband's nephews, Dennis L. Myers, of York, Pennsylvania, Gene F. Myers, of Cordorus, Pennsylvania, per capita. The interest of Marc W. W. Hubley shall not be subject to further anticipation, voluntary or involuntary alienation, assignment, pledge or obligation nor subiect to fees set by the Commonwealth related to his incarceration. FOURTH I nominate, constitute and appoint my spouse, Wilbur R. W. Hubley, of Camp Hill, Cumberland County, Pennsylvania, Executor of this my Last Will and Testament. In the event Wilbur R. W. Hubley is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint Jo Ann Shepp Burns, of York, Pennsylvania and, Lou Ann Shepp Dillman, of York, Pennsylvania, as Co-Executors to serve instead, ir, the event that either Co-Executor, ,Jo Ann Shepp Burns, and Lou Ann Shepp Dillman, is unable or unwilling to serve or shall cease to serve for any reason whatsoever then I nominate, constitute and appoint my son, Marc W. W. Hubley, to serve in place of that Co-Executor and to serve as co- Executor and as personal representative to this my Last Will and Testament. I direct that my personal representatives shall not be required to give or post bond for the faithful performance of his/her duties in this or any other jurisdiction. FIFTH I hereby declare it to be my expressed desire that my personal representative employ Turo Law Offices of Cumberland County, Pennsylvania, for legal advise and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this 27th day of June, 2001. Witness Evelyn Ma~y HUbley ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS I, Evelyn Mary Hubley, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to the law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that ! signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed and acknowledged before me by Evelyn Mary Hubley, the Testatrix, this 27th day of June, 2001. Notary ~ubiic ~--~ Notarial Seal Robert J. Muldedg, Notary Public Carlisle Boro, CumberlandCounly My Commission Expires Nov. 13, 2004 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS We, James M. Robinson and Renee M. Steinour, the witnesses whose names are attached to the foregoing document, being duly qualified according to the law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subsCribed before me by James M. Robinson and Renee M. Steinour this 27th day of June, 2001. Notarial Seal Robert j. Mulder g, Notary Public Carlisle Boro, CumbedandCounty My Commission E×pims Nov. 13 2o04J EVELYN MARY HUBLEY JRD/June 30, 1992/17858 1 7 21104 In Re: Estate of EVELYN MARY HUBLEY Late of LOWER ALLEN TOWNSHIP Estate No.' 21-03-935 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2003-935 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: WILBUR R W HUBLEY Counsel for Personal Representative: Date of Grant of Original Letters: 11-12-2004 Date of Delinquency Notice: 02-22-2004 The undersigned, Glenda Farner-Strasbaugh, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on FEBRUARY 22, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 03-15-2004 Distribution: ! ~lenda Famer Strasb-augl~, Register of 13~s Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ~ c//, cff~ ff at ~'?L,4'~',~./q,In Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. George. ~er~P.~ ~] ,q~v%soo Ex, i" Z LU .ILl z Z Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-15OO INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Huble¥, Evelyn M. DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DO-Year) 01/02/2003 I 09/23/1 921 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Hubley, Wilbur R.W. [-]2 Supplemental Return [-~1. Original Return '--']4. Limited Estate r~6. Decedent Died Testate (A~tach copy ol Will) '-"]9. Litigation Proceeds Received OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 9 3 5 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 9 3- 1 8-6 2 1 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS L J3. Remainder Return (dateofdeathpriorto 12q3-82) "--]5, Federal Estate Tax Return Required __ 8. Total Number of Sate Deposit Boxes r-~ 11. Election to tax under Sec. 9i 13(A) (^ltach Sch O) '-'] 4a, Future Interest Compromise [date oldea(h alter 12-12-82) E~]7. Decedent Maintained a Living Trust (Attach copy CTrust) [] 10. Spousal Povedy Credit (dae ol death ~etween 12-31-91 and 1.1.95) THis SECTION MUST BE C~E~ i ~Di ALL. CORRESpO~DBNe~ A~D ~bN~i~iA~T~ R. Mark Thomas, Esq. I 101 S. Market St. FIRM NAME (if Applicable) I I TELEPHONE NUMBER 717-796-2100 ] Mechanicsbur9 PA 17055 1. Real Estate (Schedule A) (I) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) -'] Separate Billing Requested 7. Inter-Vivos Trans[ers & 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, Modgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (~otal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts [or which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 68.50 117;582.51 . ,~.O0 OFi=K~iAL U~' ONLY (8) 124,180.76 1,717,00 (11) 1,717,00 (~2) 122,463.76 (13) (14) 122,46'3.76 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount ot Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 (a)(1.2) 16. Amount ot Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 122,409.82 x 0 (~5) 53.94 x .045 (16) 2.43 x .12 (17) X .15 (18) (19) 2.43 >> BE SURE TO ANSWER ALL QUESTIONS ON REVE~MATH : ~ Decedcnt's Complete Address: STREET ADDRESS 33 Highland Dr. CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Inlerest/Penally if applicable D. Interest E. Penally 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due, JSTATE PA (1) Total Credits ( A + B + C (2) Jz~P 17011 2.43 (3) (4) (5) (5A) Total Interest/Penalty ( D + E B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AppROpRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for 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 cons derat on? 3. Did decedent own an "in trusl for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Reliremenl 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 pena lies of perjury, I declare Ihat I have examined this relum, including accompanying schedules and slalements, and Io the best of my knowledge and belief, it is true, correct and complete, 2.43 2.43 Declaration of preparer olher than Ihe personal representative is based on all informalion of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 33 Highland Dr. Camp Hill Mechanicsburg PA 17011 PA 17055 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% I72 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 exemp! 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 lax 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 leasl one parent in common with the decedent, whether by blood o.r adoption. , REV, ~503 EX * I,~-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Hubley. Evelyn M. All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM 'NUMBER DESCRIPTION 1. Four (4) shares of Tyco International Ltd. Common stock See attached certificate) 21 03 VALUE AT DATE TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insed additional sheets of the same size) 935 OF DEATH 68.50 68.50 COMMONWEALTH OF PENNSYLVANIA {NHERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Hubley. Evelyn M. Include the ITEM NUMBER 1. 21 O3 935 ~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Savings Acct. #40558-00 VALUE AT DATE DESCRIPTION OF DEATH Members 1st FCU, 5000 Louise Dr., Mechanicsburg, PA 17055 6,529.75 TOTAL (Also enter on line 5, Recapitulation $ (If more space s needed, inserl additional sheets of the same size) 6,529.7b COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY Hubley. Evelyn M. If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21 03 935 RELATIONSHIP TO DECEDENT SURVIVING JOIN]' TENANT(S) NAME A. Wilbur R.W. Hubley B Marc W. Hubley 33 Highland Dr. Camp Hill, PA 17011 c/o 33 Highland Rd. Camp Hill, PA 17011 ADDRESS Husband Son 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. Allach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointfy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. One (1) Series E US.Savings Bond 120.60 50. 60.3C $25 denomination 2. A. ,Twenty-three (23) Series EE U.S. Savings Bonds 2,629.76 50. 1,314.88 $50 denomination 3. A. Thirty-nine (39) Series E U.S. Savings Bonds 8,033.44 50. 4,016.72 $50 denomination 4. A. Real property situate at 110,000.00 50. 55,000.00 33 Highland Dr., Camp Hill, PA 17011 5. A. 10/1998 Certificate of Deposit #247412046192897 14,004.88 50. 7,002.44 Wachovia Bank N.A. !PO Box 40028, Roanoke, VA 24022~7313 6. A. 10/1998 Checking Acct. #1000015159262 4,788.55 50. 2,394.28 Wachovia Bank N.A. PO Box 40028, Roanoke, VA 24022-7313 7. 'B. One (1) Series EE U.S. Savings Bond 107.88 50. 53.94 $100 denomination 8. A 07/2002 Certificate of Deposit #31800230194 23,536.66 50. 11,768.33 PNC Bank 500 1st Ave., Pittsburgh, PA 15219 9. A 07/2002 Certificate of Deposit #31000229254 23,536.66 50. 11,768.33 PNC Bank 500 1st Ave., Pittsburgh, PA 15219 10. A 03/1973 Checking Acct. #5140030781 10,532.96 50. 5,266.48 PNC Bank 500 1st Ave., Pittsburgh, PA 15219 TOTAL (Also enter on line 6, Recapitulation) $ 117,582.51 sheets of the same size) Hubley, Evelyn M. Continuation of REV-1500 Inheritance Tax Return Resident Decedent Schedule F-2 - Jointly-Owned Property Pa,qe 1 21 03 935 LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial inslilufion and bank accounl number or similar identifying number. Altach DAlE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joinlly-held real eslate. VALUE OF ASSET INTEREST DECEDENTS INTERES 11. A 03/2001 Savings Acct.//5003505277 10,370.79 50. 5,185.4(: PNC Bank 500 1st Ave., Pittsburgh, PA 15219 12. .A 11/1988 Savings Acct.//500115609 202.47 50. 101.24 Waypoint Bank PO Box 1711, Harrisburg, PA 17105 13. A 11/1993 Certificate of Deposit//554244757 19,129.35 50. 9,564.68 Waypoint Bank PO Box 1711, Harrisburg, PA 17105 14. A 03/2002 Certificate of Deposit 8,170.97 50. 4,085.49 Waypoint Bank PO Box 1711, Harrisburg, PA 17105 SUBTOTAL SCHEDULE F.2 18,936.81 GRAND TOTAL SCHEDULE F-2 $ 117,582.51 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G ; INTER-VIVOS TRANSFERS 8, MISC. NON-PROBATE PROPERTY FILE NUMBER Hubley. Evelyn rvl, 21 03 935 This schedure must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM ,UCLUDE [RE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND file DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER A [TACH A COPY OF THE DEED FOR REAL ESIAfE 1. Allstate IRA VALUE OF ASSET INTEREST 11,547.46 100. 11,547.46 0.0( TOTAL (Also enter on line 7, Recapitulation) $ 0.00 Iditional sheets of the same size) ~ REVo1511EX · (1'97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H ' FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Hubley. Evelyn M. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 5. 6, 7. 21 O3 DESCRIPTION FUNERAL EXPENSES: Cremation Society of Pennsylvania ADMINISTRATIVE COSTS: Personal Representalive's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representalive(s) Street Address City State Year(s) Commission Paid: Attorney Fees R. Mark Thomas, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address Cily Relationship of Claimant to Decedent Stale . Zip Probate Fees Petition for Grant of Letters $40.00; Short Certificates $12.00; Inheritance Tax Return Filing Fee $15.00 Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) $ 935 AMOUNT 1,200.00 450.00 67.00 1,717.00 (Ifmorespaceisneeded, insedadditionalsheetsofthesamesize) ¢1E~-~513 EX'+ (9~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Hubley. NUMBER il. E;velyn M. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousa distributions, and transfers under Wilbur R.W. Hubley 33 Highland Dr. Camp Hill, PA 17011 Sec. 9116 (a)(1.2)] FILE NUMBER 21 O3 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Husband 935 AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: -- A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il' ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insed additional sheets of the same size) COMMON STOCK PAR VALUE $.20 0705 ~0298782~I6358991IIShU3LEY E 06Pa6~ IN NE:W YORK, NEW YORK SEE REVERSE FOR CERTAIN DEFINmONS CUSIP 902124 10 6 TYCO INTERNATIONAL LTD. 73,9~. (4/92) FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK Of 11/22/99 COUNTERSIGNED AND REGISTERED: CHAsEMELLON SHAREHOLDER SERVICES, L.L.C. TRANSFER AGENT BY AND REGISTRAR AUTHORIZED SIGNATURE PLEASED TO HANDLE THE TRANSACTION FOR YOU. CHAIRMAN, PRESIDENT AND FFICER Tyco - inveslor Relatiofts - Quotes - l'rice lx~oktip Page i of l i Semch Home > Investor Relations > Quotes > Price Lookup Price Lookup Select a date to determine the split-adjusted cost bas~s per share on that date. Data is available from July 28, 1980 to the present. January 02, 2003 High $17.40 Low $16.85 Open $17.30 Close $17.25 Volume il 7,979,300 l °o'31 [January i~ 02 Home I Careers I Contact Us I Site Map I Temps or Use © 2004 Tyco International, Ltd. All Rights Reserved DOWNLOAD DOCUMI Read "Fast Facts: A Guk · Tyco Today" ~ Download ~.56kb Major Tyco acquisitions date ~] DoWnload 40kb p s£ MEMBERS 1" FEDERAL GREDIT UNION 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 Name of Joint Owner 40558 -00 08/24/1984 $6,529.48 $.27 $6,529.75 None _~Zj.C,~c,BERS 1s~' EEDERAL CREDIT UNION Denise A. Wolfe ,/~ Insurance Superviso¢ December 4, 2003 Estate of: EVELYN M. HUBLEY Date of Death: 0110212003 Social Security Number: 193-18-6213 5(1(1() I.ouisc I)rivc · P.(.). Box 40 · Mccha~ficsbt,rg I'c,~]sylva~]ia 17(155 · (717) 697-1161 ' www. mcn,berslst.org Savings Bond Calculator Page 1 of 3 Savinc Series De[ioul il[:lliol[ Serial Nuu[ be[' # Bouds Tolal I'rice Total h[te['est 63 $2,056.25 $8,727.55 ]SSIle Serial Number Issue Dale Se['ies Deuom Price L63788853EE 10/1981 EIE $50 :$;25.00 L63788744EE 09/1981 EE 50 25.00 440611EE 08/1981 EE' 5(} 25.00 L60440495EE 07/! 981 EE 50 25.00 L43754312EE 06/1981 EE 50 25.00 L43754194EE 05/1981 EE 50 25.00 L42847015EE 04/1981 EE 5{) 25.00 L40104213 04/1981 I:;E 50 25.00 L40104137EE 03/1981 EE 50 25.00 L37298833 02/1981 EE 50 25.00 L37298646EE 12/1980 EE 50 25.00 L35124059EE 11/1980 EE 50 25.00 L33192331EL: 10/1980 EF, 50 25.00 L33192250EE 09/I 980 EE 50 25.00 LI4018520EE 08/1980 EE 50 25.00 L14018427EE 07/1980 EE 50 25.00 L4994548EE 06/1980 I-ZE 50 25.00 L4921589EE 05/1980 EE 50 .25.00 L4921486EE 05/1980 EE 50 '25.00 L4615851EIS 04/1980 EE 50 25.00 L2735132EE 03/I 980 EE 50 25.00 L2735074EE 02/I 980 EE 50 25.00 L37298751EE 01/1981 El,; 50 25.00 L2176915905E 12/1979 E' 50 37.50 L2177738542E 11/1979 E 50 37.50 L2172199567E 10/1979 E ' 50 37.50 L2172199374E 08/1979 L:' 50 37.50 L2169110627E 07/1979 E.- 50 37.50 Issue Dale Tolal Value YTD hr $10,783.80 $38.1 luterest Next Final h[lerest Vahle Rale Accrual Maim'iii $77.86 $102.86 4.00% 04/2003 10/2011 77.86 102.86 4.00% . 03/2003 09/2011 77.86 102.86 4.00% 02/2003 08/201] 79.90 104.90 4.00% 07/2003 07/2011 79.90 104.90 4.00% 06/2003 06/2011 79.90 104.90 4.00% 05/2003 05/201 l 84.58 i09.58 4.00% 04/2003 04/2011 84.58 109.58 4.00% 04/2003 04/2011 84.58 109.58 4.00% 03/2003 03/2011 84.58 109.58 4.00% 02/2003 02/2011 86.78 111.78 4.00% 06/2003 12/201( 86.78 111.78 4.00% 05/2003 11/201( 96.94 121.94 4.00% 04/2003 10/201( 96.94 121.94 4.00% 03/2003 09/20'1( 96.94 121.94 4.00% 02/2003 08/201( 99.38 124.38 4.00% 07/2003 07/201( 99.38 124.38 4.00% -06/2003 06/201( 99.38 124.38 4.00% 05/2003 05/201( 99.38 124.38 4.00% 05/2003 05/201( 98.16 123.16 4.00% 04/2003 04/201( 98.16 123.16 4.00% 03/2003 03/201( ' 98.16 123.16 4.00% 02/2003 02/201( 86.78 111.78 '4.00% 07/2003 01/2011 130.18 167.68 4.00% 06/2003 12/200t. 130.18 167.68 4.00% 05/2003 11/200(. 128.60 166.10 4.00% 04/2003 I0/200t. 128.60 166.10 4.00% 02/2003 08/200t. 131.92 169.42 4.00% 07/2003 07/200t. hllp://wwxvs.lmlq icdel)l.treas.tz(~v/l/C/S i/C i,[.ice ,~/-m/-~,,,, Savings Bond Calculator L2161646793E L2155082597E L2146835164E L2146809997E L2141079302E L2129478460E L2125224727E L2120899081E L2120897920E L2117300265E L2117300018E 2106216430E L2106216135E L2105844519E L2098396815E L2094541606E L2087979516E L20853144413E L2078462830E L2073585334E L2068002156E L2062051606E L2057826616E L2057446610E L2050113865E L2046837591E L2029205493E L2039761990E L2039022897E L2032755675E L2029202360E L2023147868E L2017gI6227E L2015279760E Q6005516755E 06/1979 04/1979 03/1979 01/1979 12/1978 11/1978 09/1978 08/1978 06/1978 05/1978 04/1978 02/1978 01/1978 12/1977 10/1977 09/1977 07/1977 06/1977 05/1977 03/1977 02/1977 12/1976 11/1976 10/1976 08/1976 07/1976 07/1976 06/1976 04/1976 03/1976 01/1976 12/1975 11/1975 09/1975 06/1975 Viewing Bonds 1-63 E E' E E' E E E E E E E E E E E E E E E E E E E E E E E E, E E 5O 37.5O 5O 37.5O 50.37.50 5O 37.50 50 37.50 50 37.50 50 37.50 50 37.50 5O 37.50 50 37.50 5O 37.50 50 37.50 50 37.50 5O 37.5{/ 50 37.50 50 37.50 50 37.50 50 37.50 50 37.50 50 37.50 5(} 37.50 50 37.50 50 37.5O 50 37.50 50 37.50 50 37.50 50 37.50 50 -37.50 50 37.50 50 37.50 50 37.50 50 37.50 50 37.50 50 37.50 25 18.75 Page 2 o1'3 131.92 169.42 4.00% 06/2003 06/200t. 129.92 167.42 4.00% 04/2003 04/200(- 129.92 167.42 4.00% 03/2003 03/200(- 133.26 170.76 4.00% 07/2003 01/200(. 133.24 170.74 4.00% 06/2003 12/200~ 132.78 170.28 4.00% 05/2003 ll/200~ 131.18 168.68 4.00% 03/2003 09/200,~ 131.18 168.68 4.00% 02/2003 08/200~ 134.52 172.02 4.00% 06/2003 06/200~ 134.08 171.58 4.00% 05/2003 05/200~ 143.54 181.04 4.01%' 04/2003 04/200~ 167.10 204.60 6.00% 02/2003 02/200[ 173.24 210.74 4.00% 07/2003 01/200[ 173.24 210.74 4.00% 06/2003 12/2005 191.66 229.16 4.00% 04/2003 10/200; 191.66 229.16 4,00% 03/2003 09/200; 196.24 233.74 4.00% 07/2003 07/200; 196.28 233.78 4.00% 06/2003 06/200; 195.80 233.30 4.00% 05/2003 05/200; 193.50 231.00 4.00% 03/2003 03/200'; 193.50 231.00 4.00% 02/2003 02/200; 198.12 235.62 4.00% 06/2003 12/200~ 197.46 234.96 4.00% 05/2003 11/200{5 195.20 232.70 4.00% 04/2003 10/200( 195.20 232.70 4.00% 02/2003 08/200~ 199.84 237.34 4.00% 07/2003 07/200~ 199.84 237.34 4.00% 07/2003 07/200( 199.90 237.40 4.00% 06/2003 06/200~ 197.14 234.64 4.00% 04/2003 04/20015 10.7.14 234.64 4.00% 03/2003 03/200( . 201.82 239.32 4.00% 07/2003 01/200( 201.80 239.30 ~4.00% 06/2003 12/2005 201.28 238.78 4.00% 05/2003 11/2005 198.96 236.46 4.00% 03/2003 09/2005 101.85 120.60 4.00% 06/2003 06/200: hltl~://wwws.l~ul>licdebt.treas_pov/llC/S/.t 'l,,.i:.(. .: ;.,,,, ...... WACHOVIA Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 774351 December 19, 2003 R MARK THOMAS ATTORNEY AT LAW 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055-3851 SUBJECT: Verification / Confirmation of Account and Balance Infom~atiol~ provided for: Customer: EVELYN M ItUBLEY (SSN# 193-18-6213) Date of Death: January 2, 2003 Account Type ~ERTIFICATE OF DEPOSIT Deposit Account hfformation Account Date of Death Average Date Maturity Interest Accrued Number Balance Balance* Opened Date Rate lnterest 247412046192897 $14,004.88 4/13/1998 $25.81 LEGAL TITLE: WILBUR R W HUBLEY EVELYN M ttUBLEY CLOSING BALANCE: $14306.83 OUR RECORDS INDICATE ACCT ttAS BEEN JOINT SINCE 10-17-98 YTD Date Interest Paid Closed $0.00 8/14/2003 CItECKING 1000015159262 LEGAL TITLE: WILBUR R W HUBLEY EVELYN M ItUBLEY $4,788.55 OUR RECORDS INDICATE ACCT tlAS BEEN JOINTSINCE 10-17-98 1/2/1950 N/A * Due to system limitations, we can only provide a twelve month average balance ou depository accouuts. . WA(~OVIA No Safe Deposit Box found for custo~ner. Reference ID: 774351 * Date of death balance does not include accrued interest. * Il'date o[death occurrs on a weekend or a holiday, date o£death balance does not include made during that ti~'od. Servicenter Associate Phone: (540)563-7323 abs; tb any transactions that were 0006 ~ 4 Savings Bond C~lculator Page Iofl Savinc Series Dehorn inn lion -~E Bonds~ I $i'i0o # Bonds Total I'rice I $50.00 Serial Number Issue Dale Series Oeuvre C266712334EE 10/1990 EE $100 Serial Number Tolal Inleresl $57.88 Issue I'rice lulerest $50.00 $57.88 Issue Date 'l'olal Value YTD In' $107.88 $2. I Interest Next Fiual Value Rate Accrual Maturlt3 $107.88 4.00% 10/2004 10/202( Note Description NI Not Issued NE Not Eligible tbr Paylnent !>5 Includes 3-month interest penalty MI:; Matured (Exchangeable lbr III I) MN Matured (Not Exchangeable 1bt 1111) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator C C C C J Ut,.]- 1.5-2UM4 2.5: 55 h'NL. bHNt< ,:],1,2 ','6~, .5458 P.OI. PNCBAlXK June 14, 2004 Mark Thomas Attorney at Law I01 S Market St. Mechanicsburg, PA 17055 sop Estate of Evelyn M Hubley (Deceased) SSN: 193-18-6213 DOD: 01-02-2003 Dear Mr. Thomas: . In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Accomlt #31800230194 WILBUR R IqUBLEY EVELYN 54[ ttUBLEY DOD balance: $23,536.66 + $13.93 accrued interest Established 07-18-2002 Account #31000229254 WILBUR It HUBLEY EVELYN M IIUBLEY DOD balmme: $23,536.66 + $13.93 accrued interest Established 07-18-2002 ~;~' Checking Account Account #5140030781 WILBUR R IIUBLEY EVELYN 5,I tlUBLEY DOD balance: $10,532.96 + $2.77 accrued intexest Established 03-01-1973 Savings Account Account #5003505277 WILBUR R ItUBLEY EVELYN M HUBLEY DOD balance: $10,370.79 + $3.82 accrued interest Establj, shed 03-02-2001 Page 1 of 2 Please note that lids office mdy provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings ac¢ount~)i We do not process any financial transaclious or provide statements. If you need assislance with any of these items, please cal! 1-8§8-PNC-FIANK (i-888-762-2265) or stop 12), your local PNC Bank brauch office. $inc,erely, Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F :500 First Ave. Pittsburgh PA 15219 Member FDIC Page 2 of 2 TOTAL P.g2 LOOK FOR US. WI~'LL (51~T YOU TH6R6~. 5/25/2004 R. MAICK THOMAS 101 S MARKET ST MECHANCISBURG PA 17055-3851 The information which you requested on the account(s) of EVELYN M HUBLEY (Social Security Number 193-18-6213) is/are as follows: Account Number 500115609 554244757 7100026149 Class of Account SAVINGS CERTIFICATE CERTIFICATE Date Opened 113088 110593 . 031202 Principal Balance 202.47 19088.02 8170.39 Accrued Interest 0.00 41.33 .58 Balance at Date of 202.47 19129.35 8170.97 Death Account Ownership JTO Name of Joint WILBUR Owner, if any HUBLEY Date Ownership 113088 Was Established JTO JTO WILBUR WILBUR HUBLEY HUBLEY 110593 031202 Accom~t Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additioual Information Requested E~14 E-WATTS SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG. P.6NNSYLVANIA 17105-1711 Toll FrE~ I-1~66-WAYPOINT (I-866;-Cl;~9-7646) · IN YeRK AFtrA 717/~Jlg-Zl~;(3r) . w~n.,,~,=,,..,~.~.=.~ .... Glenbrook Life and,4nnuity Company P.O. Box 94212 Palatine, IL 60094-42!2 GLENBROOK LIFE A Member of Allstate Financial Group June 15, 2004 R. Mark Thomas Attorney at Law 101 South Market Street Mechanicsburg, PA 17055-3851 Re: Contract Number: Wilbur R.W. tIubley GA207343 Dear Mr. Thomas: We have been requested to complete Internal Revenue Service (1RS) Form 712 with regard to the referenced contract. The purpose of Form 712 is to provide an estate or donor with tile value of a life insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract). The contract referenced was an am~uity contract, which is not reportable on IRS form 712. The following information is provided regarding the value of tile mmuity and other data as of the date specified: Date of Death: 01/02/2003 Am~uity Value* as of Date of Death: $11,547.46 Cost Basis: $ 0.00 Nmned Beneficim-y: Evelyn Hubley *The actual amount paid ~nay differ due to Market Value Adjustments and/or any applicable Sun'ender Charges. If you have any questions, or need further assistance, please contact us at 1-877-499-6418. Sincerely, Jennifer Long ~)~ Life and A~muity Claims · OvernightAddress: 544 Lakeview Parkway, Ven~on Hills, IL 60061 Toll Free Fax: 1-866-635-4523 EVEL'~N MARY HUBLEY I, Evelyn Mary Hubley, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageOus to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable marker at my grave, and to expend sums from my estate for this purpose. SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse, Wilbur R. W. Hubley, providing that he survives me by sixty (60) days. THIRD Should my spouse, Wilbur R. W. Hubley, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate in equal shares to my son, Marc W. W. Hubley, who Survives me by sixty (60) days, per stirpes. If my son, Marc W. W. HUbley, predeceases me or fails to survive me by sixty days then I give and bequeath all the rest, residue and remainder of my Estate of whatever nature and wheresoever situated as follows: 1. 50% of my Estate to my nieces, Jo Ann Shepp Burns, of York, Pennsylvania, LOu Ann Shepp Dillrnan, of York, Pennsylvania, per capita. 2. 50% of my Estate to my husband's nephews, Dennis L. Myers, of York, Pennsylvania, Gene F. Myers, of Cordorus, Pennsylvania, per capita. The interest of Marc W. W. Flubley shall not be subject to further anticipation, voluntary or involuntary alienation, assignment, pledge or obligation nor subject to fees set by the Commonwealth related to his incarceration. FOURTH I nominate, constitute and appoint my spouse, Wilbur R. W. Hubley, of Camp Hill, Cumberland County, Pennsylvania, Executor of this my Last Will and Testament. In the event Wilbur R. W. Hubley is deceased, unable or unwilling to se~e or shall' cease to serve for any reason whatsoever, then I nominate, constitute and appoint Jo Ann Shepp Burns, of York, Pennsylvania and, Lou Ann Shepp Dillman, of York, Pennsylvania, as Co-Executors to serve instead. In the event that either COExecutor, Jo Ann Shepp Burns, and Lou Ann Shepp Dillman, is unable or unwilling to serve or' shall cease to serve for any reason whatsoever then I nominate, constitute and appoint my son, Marc W. W. Hubley, to serve in place of that Co-Executor and to serve as co- Executor and as personal representative to this my Last Will and Testament. I direct that my personal representatives shall not be required to give 'or post bond for the faithful performance of his/her duties in this or any other jurisdiction. FIFTH I hereby declare it to be my expressed desire that my personal representative employ Turo Law Offices of Cumberland County, Pennsylvania, for legal advise and assistance regarding this my Last Will and Testament, .they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and tile execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this 27th day of June, 2001. Witness Evelyn MaCy' Hubley ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS I, Evelyn Mary Hubley, the_ Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to the 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 voluntary act for the purposes therein expressed. Sworn or affirmed and acknowledged before me by Evelyn Mary Hubley, the Testatrix, this 27th day of June, 2001. / / ,? ./i ~:'-,.~'~ . ~ :.//..:;:,~..,_.~,,x..~.~:.~ ~ .: ,~ .... Notary Notarial Seal Rober! J. Mulderig, Notary Public Carlisle Boro, CumberlandCounty My Commission Expires Nov. 13, 2004 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS We, James M. Robinson and Renee M. Steinour, the witnesses whose names are attached to the foregoing document, being duly qualified according to the law, do depose and say that we. were present and saw Testatrix sign and execute the instrument as her Last Wili and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed before me by James M. Robinson and Renee M. Steinour this 27th day of June, 2001. _---,~.--~,f' ~ , .,.,:' ,? Notary PU?/I(c ' L-':_ .) Notarial Seal Robed O. Mulderig, Notary Public Carlisle Bore, Cumber and Courtly y Corem ssion Expires Nov 13 2004 33 High±ana Ur±ye Camp Hill, Pa. iTUli u±~naa ffarner btrasOaugh, Register ~;Wills One Court House bouare ~ N~ Carlisle, Wa. RS: Gert±fica ~it-Kstaoe oi' E~elyn ~ ~ ~t~- ~e~ shortly after I received ~ IN~'[ENGb 'l'~ FO~ in %he ~il from your office I began %o complete the I:~s. Howe~er, I ~ia not un~erstand the Instructions regar~ing one item on I~s. A%ou~ that time a ~n arrive~ for a visit who ~d al one %~e sLate~ %hat he was a ~ara-~gai- I asKe~ him if he un~lerstood %hat question and he ~:,tated that he Kno',~ a man who coula answer that question. He 5oo~ me to an Attorney in MechanicsDurg. ~.e Attorney asked me some questions ~.n~ then conwinced me 5hal it ~,ul~ se '~o ~ oeneI'it %o have nlm taK~ care of the ~tter for me. I~s relucant because I alreaay ha~ snort certicicates a~ h~d been in contact wi~ most of ~he agencies, inclu~ing the com~ny thnt handled the IRA for ~ ~ecease~ spouse. However, I agee~ to lev him complete the settlement oi' the b;state. I suppiie~ k~ with the ~teriaJ he asKe~ for, ]nclufling items ~hat I dim not beieive was reiatem to my wife's bstate. WeeKs or months went Dy and ± dim not hear I'rom nlm and i placeo calls rD his to learn oi' his progress, none oi' the calls were returned. I am plauged by many other nrobiems and responsibilities, therefore~ did not persue %he mat%er with additio] ca±Is to his office. No¥~ I HAVE ~ C~2t'l'lfflmD ]~T'I'~R SCheDULING A HEARING FOR JflN~'~';2QQ~' I do not recall the actual date that I was in the attorney's office but :~now it has Oee~ some time ago. He has ~l± the informztion he requested and I have not palm him any money to date or has he requestea any. I do intend to write to hi::~ vhi~ week aru will enclose a copy o~' your letter. A,L age S~ with other prob±em~ anu resFonslbl±lties ! find that ± mo not accomplish much each aa~. ! ,-~r. sincerely sorry that this matter has cause your oI'I'ice additiona] woFK. Sincerely, Wi/our ~. W. Huoley .~.~ Higalan~ Drive Ca~ip Hi~L, Pa. 17011 I~013+3323 02 I,,,lll,,,lll,,,,,,Ih,ih,,Ih,,ll,,,I,h,ihl,h,hh,hh,i R. MARK THOMAS - Attorney at La~v - 101 S. Market Street O~echanicsbur~, PA 17055 (717) 796-2100 Fax (717) 796-3600 I am sincerely sorry I'or :~, ."~'-~, .'A ,, ~ :,i' tile extra work I a'ausea your ell'ice. ~.~]~ile ! di~ everything for years ?flor to Evelyn's aecease, I finm ~t ~]_rflcuit to fin~ the time to t~ke care oi' ~y resrons~bi[/ties-the ~ay just see~ to ei~:ao?~sr, an~ i promise ~s]e]f that tomorrow miming I w~ll start ........ ! Jost th~ notes .[ ~ae ~ur~nK our conversation, i borne that I ccmpiecea all th~ items [,hr~[-, you tolG me ~,, eh,er on the form. If the r'orm is nor, completeQ ~roperly or additional imform~tJon is necaea please let me know. Jr.' it ks cecessaey .[ ~,ill come Lo Carlisle . J_ ]~o[.e that ,you can ream my typing. ! cad no Longer fine even a unvers~t ri6~on bo re-w'[md for t~ is old ~yf~wrmter. I ~am ~ buy some tyme of cosputor riDoon a couple ye,:rs ago and rewinm it, anm it was not as wide a~ a stamaara rib~oa, i su~:po~:e 2[ shou/~ .]earn t,o use ~ ,: ,npu~,or. I 5hank you rot your patience with th~, cia man.. Wilbur i~. W. Hubley %7] JRD/June 30, 1992/17858 In Re: Estate of EVELYN MARY HUBLEY Late of LOWER ALLEN TOWNSHIP Estate No.' 21-03-935 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2003-935 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: WILBUR R W HUBLEY :~ ' Counsel for Personal Representative: Date of' Grant of Original Letters: 11-12-2004 Date of Delinquency Notice: 02-22-2004 The undersigned, Glenda Famer-Strasbaugh, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on FEBRUARY 22, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 03-15-2004 Distribution: f Glenda Famer Strasbaugl~, Register of V~s Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ,~(~_~ c4, .~ ,/ at ~L~','~./~J_n Courtroom No. 3. If the Cegification of Notice is fil~0 prior to the hearing date, the he~ng will automatically be cancelled. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: WillNo. 7.1 -- o J~ ~)3~W Admin. No. To the Register: I certify that notice of (beneficial interest) _estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on : Name Address ! /' Oa. Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 24 -/7- O ~ ES: -;'_I 0~ 8dV 170. Telephone? 1'7) '7 '~ "'7 ~ ~ C "~ Capacity: Personal Representative ~.Counsel for personal representative ~,;ilbur ~oW. Hubley 33 Highlan~ Drive Camp Hill, Pa. 17Oli Attention: Jackie Register of Wi31s and Clerk of ~Jh~;'Orphans Cour~ One Courthouse Square Carlisle, Pa. 17013-3387 i,,,lll,,,lti,,,,,,ii,,ll,,,ii,,,li,,,I,i,,il, hi,,i,i,,i,I Name of Decedent: Date of Death: Will No. To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) / I Admin. No. I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of ~e Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on _ ,////~,R/~:~,.~ : Name Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. Date: Signature Name Capacity: ~ Personal Representative _~Counsel for personal representative IT! ITt r'-t Certified Fee Ci I--1 Return Reciept Fee (Endorsement Required) r"q Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Postmark Here Postage $ · · AttaCh this card to the back o~ the mailplece, HUBLEY WILBUR R W 33 HIGHLAND DRIVE CAMP HILL PA 17011 D. Is clelivery address different from Item 17 If YES, enter delivery address below:. [] Registered [] Return Receipt for Memhandlse [] InmJred Mall r"] C.O.D. · pas~cted D~e~ (~_xtm Fee) OYes 2. W~N~m~b~? , 7003 1010 0001 1203 8137 .......... ~ ..... _~[~.~ 'i'[ ~---?==,,~,:~..~,~,.,.,- ~ ~ J~.[~ ..... 38t~; ~~ '" "~ ~u~ ~p~ ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMEN] OF REVENUE DEPT 280601 HARRISBURG. PA 17/28-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2 1 0 3 9 3 5 t.- Z Huble¥,Evelyn M. 1 9 3 - 1 8 - 6 2 1 3 LLJ ~ REGISTER OF WILLS 0 01/02/2003 09/23/1921 goo Hubley, Wilbur R.W Z Z 0 O X 1 6 8- 1 4 - 1 0 5 4 ] 10dginal Reborn [] 4 Limited Estate [] 6 Decedent Died I estate (Atlach copy [] 9 Litigalion Proceeds Received E~5 Federal Estate Tax Return Required __ 8 Total Number of Sate Deposit Bo×es ] 11 Election to tax under Sec 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS R, Mark Thomas, Esq 101 S, Market St. TELEPHONE NUMBER 717-7962100 Mechanicsburg PA 17055 Real Estate (Sched(de A/ (1) SIocks and Bonds (Schedule B) (2) Closely Held Corporalion. Padnership or Sole Proprietorship {3) Modgages & Notes Receivable (Schedule D) (4) Cash. Bank Deposils & Miscellaneous Pemonal Property (5) (Schedule E) ,Jointly Owned Property (Schedule F) (6) ] Separate Billi~g Requested Inter-Vivos Transfers & Miscellaneous Non Probate Properly (?} (Schedule G or [ ) Total Gross Assets 0otal Lines 1 ~) FuI/eral Expenses & AdminislratJve Costs (Schedule H) (9) Debts of Becedenl Mortgage Liabilities & Liens {Schedule Ii (10} Total Deductions (tolal Lines 9 & 10) Net Value of Estate (Line 8 mirlus Line 11) 13 Charitable and Governmenlal Beguests/Sec 9113 T rusts for which an election to tax bas r}o[ been rhode (Schedule J) 68.50 OFFICIAL USE ONLY 0.OO :' 6,529.75 117,582.51 124,180.76 1,717.00 (~1) 1,717.00 122,463.76 (12) (13) 14 Net Value Subject to Tax (Li~,e 12 minus Line 13) (~4) 122,463.76 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES ! 5 Amount of Line 14 taxable a{ the spousal tax rate or transfers under Sec 9116 (a)(1 2) 16 Arnount of Line 14 taxable at lineal role 17 Amount of Line 14 taxable at sibling fate 2O 122,40982 X 0 ¢5) 53.94 X .045 (16) X 12 (17) x 15 (~8) (19) 2.43 2.43 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE ~IDE ANn RFC. FI~=~K MATH .- . Decedent's Complete Address: SIREET ABOUESS 33 Highland DL e.~ Carnp Hill J S~^IE PA Iz!p 17011 Tax Payments and Credits: 1 1'ax Due (Page 1 Line 19) 2 Credits/Payments A Spousal Povedy Credil B Prio~ Payments C Discount (f) Total Credils ( A ,' B+C) (2) Intemsl/Penal~y if applicable D Inte~esl E Penally Total Interest/Peualty ( D + E ) (3) If Line 2 is grealer than Line 1 , Liue 3, enter tile difference This is tile OVERPAYMENt, Check box on Page 1 Line 20 lo request a refund (4) If Li,e 1 + Line 3 is greater thaa Line 2, euler tile dilfemnce lhis is tile TAX DUE. (5) A Enter Ihe interest on the tax due (gA) B Emer the Iotal of Line 5 + 5A This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and Yes No e retain the use or mconle of the property transCerred; [] [] b retaia tile right to designate who shall use the property transiened or its income; .................................. [] [] c retain a ieverslonary interest; or [] [] d receive Ihe promise for life of eilher paymenls, benefits or care? [] [] If death occurred afte~ December 12, 1982, did decedent Iransfer properly wilhin one year of death withoul receiving adeguate consideration? [] [] Did decedent own an "ie trust Ior" o~ payable upon deaB bauk account or security al bis or her dea[tl7 ............. [] [] Did decedenl own an b/dividual Reliremenl Ac count aunuity, or other nou probale property which conlains 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. PER,SON RESPOHSIBLE FOR FILING RETURII DATE f ADDRESS 33 Highland Dr. , Camp Hill PA 17011 ADDRESS 101 S. Market St. Mechanicsburg PA 17055 2.43 2.43 2.43 For dates ot death on o ater lulyl 1994andbeoeJa ay 995 the tax rate imposed on [he r~el value of hansfers to or for the use of the survivirqg spouse is 3% [72 PS §9116 (a)(1 1)(i)] For dates of death on or after Ja,ua~ y 1 1995, the tax rote imposed ou the net value of I~ a~sfers to er for the use of the surviving spouse is 0% [72 PS §9116 (ar (1 1/(i )] ~he stalule d_oes not exerr~ a trausler to a surviving spouse flora tax, aad the slatutory requiremen[s for disclosure el assets and filing a tax return are still applicable even il the surviving spoose is Ihe only beneficiary For da(es of death on or si[er July 1,2000: The tax rale imposed on the net value of transfers from a deceased child twen[y one years of age or younger a[ death to or for the use of a natural parent an adop ire pa ent nra stepparent of the child is 0% [72 PS §9116(a)(1 2)] ' The tax tale ir']posed on the net value bf Iransfers to or for the use of tile decedent's lineal beneficiaries is 45%. except as noted in 72 P.S §9116( 1 2) [72 PS §9116(a)(1 )] [he tax rate imposed on the net value of transfers to or for tile use of the decedent's siblings is 12% [72 PS §9116(a)(1 3)] A sibling is defiaed, uader Section 9102, as an SCHEDULE B STOCKS & BONDS ESTATE OF Hubley. Evel? M All property jointly-owned with right ol survivorship must be disclosed oil Schedule F FILE NUMBER 21 O3 935 ITEM VALUE AT DA1 E NUMBER DESCRIPTION OF DEATH 1 Four (4) shares of Tyco International Ltd, Common stock 68.50 See attached certificate) TOTAL (Also emer on line 2, Recapitulation) $ 68.50 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Hubley. Evelyn M, k~c!ude the proceeds ol liligation FILE NUMBER 21 03 and the date tke proceeds v,e~e rece~'~ed by lke estate All property joint¥owned with the right of survivorsh 935 must be disclosed on Schedule F. ITEM RUMBER DESCRIPTIOri Savings Acct #40558 00 Members 1stFCU, 5000 Louise Dr , Mechanicsburg, PA 17055 TOTAL (Also enter on rine 5, Recap[lulation) VALUE AT D41E OF DEATH 6,529.75 6,5297!, SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER _Hubley. Evelyn M 21 935 If an asset was made joint within one year of tile decedent's date of death, it illust be reported on Schedule G. ^ Wilbur R.W. Hubley 33 Highlarrd Dr. Husband Camp Hill, PA 17011 Marc W. Hubley c ;/o 33 Highland Rd. Camp Hill, PA 17011 Son JOINTLY OWNED PROPERTY: i A One (1) Series E U.S.Savings Bond 120.60 50. ;25 denomination 2. A. Twenty-three (23) Series EE U.S. Savings Bonds 2,629.76 50. 1,314.8t $50 denomination 3. A. Thirty-nine (39) Series E US. Savings Bonds 8,033.44 50 4,016.7; $50 denomination 4. A. Real property situate at 110,000.00 50. 55,000.0( 33 Highland Dr., Camp Hill, PA 1701 ~ 5. A. 10/1998 Certificate of Deposit #247412046192897 14,004.88 50. 7,002.4, Wachovia Bank NA. PO Box 40028, Roanoke, VA 24022 7313 6 A 10/1998 Checking Acct. #1000015159262 4,788.55 80. 2,394.2E Wachovia Bank N.A PO Box 40028. Roanoke, VA 24022-7313 7. B. One (1) Series EE U.S. Savings Bond 107.88 50. 53.9z $100 denomination 8. A 07/2002 Certificate of Deposit//3 ~ 800230194 23,536.66 50. 11,768.3,?: PNC Bank 500 lst Ave., Pittsburgh, PA 15219 9. A 07/2002 Certificate of Deposit fl31000229254 23,536.66 50. 11,768.33 PNC Bank 5001st Ave., Pittsburgh, PA 15219 10. A 03/1973 Checking Acct. #5140030781 10,532.96 50. 5,266.48 PNC Bank 500 1st Ave., Pittsburgh, PA 15219 TOTAL (Also enler on lir~e 6. Recapitulation) $ 117,582.51 (If too o space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Hub[ey, Evelyn M. 21 03 935 Paqe 1 Schedule F-2 - Jointly-Owned Property 11. A 03/200t Savirrgs Acct. #5003505277 10,370.79 50. 5,185.41 PNC Bank 500 lstAve.,Pittsbu~gh, PA 15219 12 A 1/1988 Savings Acct. fl500115609 202.47 50. 101.2, Waypoint Bank PO Box 1711,Harlisburg, PA 17105 13. A 111/1993 Certificate of Deposit fl554244757 19,129.35 50 9,564.61 Waypoint Bank PO Box 1711, Harrisburg, PA 17105 14 A 03/2002 Celtificate of Deposit 8,170.97 50. 4,085.4! Waypoint Bank PO Box 1711, Harrisburg, PA 17105 SUBTOTAL SCHEDULE F-2 18,936.81 GRAND TOTAL SCHEDULE F-2 $ 117,582.51 SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Hublev. Evelvl M 21 03 935 This schedule II/ust be completed and filed if the answer (o any of ques!ions 1 tnrotJgh 4 on tile reverse side or Ihe REV-1500 COVER SFrEET is yes DESCRIPf'ION OF PROPERTY % OF 1 Allstate IRA 11,547.46 100. 11,547.46 0.0( TOTAL (Also enler on line 7, Recapitulation) $ O.OO SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVECOSTS ESTATE OF Hubley. Evelyn M, Debts of decedent must be reported on Schedule I. FILE NUMBER 21 03 935 ITEM NUMBER A 1 B 1 4 DESCRIPTION FUNERAL EXPENSES Cremation Society of Pennsylvania ADMINISTRATIVE COSTS: Personal Represenlalive s Comrr~issions Social Secudty Numbel(s) / EIN Number of Personal Representative(s) Sheet Address Oily State AttomeyFees F~. Mark Thoeras, Esq. Zip Street Address Oily Stale . Zip Probate Fees Petition for Grant of Letters $40.00; Short Certificates $12.00: Inheritance Tax Return Filing Fee $1500 Tax Re[urn Preparer's Fees AMOUNT 1,200.00 450.00 67.00 TOTAL (Also enter on line 9, Recapitula[ion) I $ 1,717.00 (If more space seeded, insert additional sheets of the same size) COMMONWEAL] H OF PENNSYLVANIA INHERITANCE TAX RE TURN RESIDENT DECEDENT ESTATE OF Hubl~/. E velyI~ M, _ NUMBER TAXABLE DISTRIBUTIONS [include outdght spousal distributions and kansfers under Sec 9116 (a) il 2)l Wilbur RW. Hubley 33 Highland Dr. Camp Hill, PA I70~1 SCHEDULE J BENEFICIARIES FILE NUMBER --21__ 03 RELACrONSHIP TO DECEDENT __ Do Not List Trustee(s} Husband ,935__ AMOUNT OR SHARE -- OF E~STATE 100% 1 iNTER DOLLAR AMOUNTS FOR DISTRIBU I IONS SHOWN ABOVE ON LINES 15 THROUGH NON TAXABLE DIS~ RIBUTIONS: A SPOUSAL DISTRFBUTIONS UNDER SECT/ON 9~ 13 FOR WHICH AR ELECTION TO TAX IS Nor BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBU f IONS TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 18, AS APPROPRIATE, ON REV-1500 COVER SHEET (If more space is needed insed additional sheds of the sarrle size) COMMON STOCK 0?05 402987821163g~99!i15HUSEEy E O6P~ CUSZP ~02124 10 6 TYCO INTERNATIONAL LTD 1!/22/99 FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF ~ .........,,~.,,.,,,~e,-,.~,/~,~.,.e~.,~rp.~,,.. ., _ PLzA~=D TO HANDLE THE TRANSACTION FOR YOU // SECRETARY Tycu - hlvc,~/or Rclafiulls - ()uotc~ - I'licc I uUkUl~ I'agc I Price Lookup serect a dale t(J detel mh]e tlie si)fit adjusted cost basis per shale on Lhat dale Data is available flom)uly 28, J980 to file plesel/t. Janualy 02, 2003 liigh low $~685 Open $17.30 Close $i7.25 Volullle 17,979,300 Read 'FasLlacts: A GuK '[~l Dowllload 156kb Download 40kt/ I! st MEMBERS 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 Name of Joint Owner 40558 -00 08/24/1984 $6,529.48 $27 $6,529.75 No~e ,/~_._b~/(~BERS 1s~ EEDERAL CREDIT UNION Denise A. Wolie ~ Insurance Supervisor December 8, 2003 Estate of: EVELYNM, HUBLEY Date of Death: 01/02/2003 Social Security Number: 193-18-6213 5(U)l) I OLliSL' IhiVC · [~(). ll(~x 'lO ' Nit'ti) s ~ !', I'ctul:;vJ~m]ia 17{J55 · (717~ f,(I7 I I(~l · w~w,~,.,,,h,,,<[,, Savings Bt)nd Calculalor I'ag¢ I o1'3 jOI/2003 i hUpdaiei $~vinc Series I)enoniinali(m fl Bonds '1 oral Ih'ice 63 $2,056.25 Serial Number Issue [)tile Sclies I)eliOln I,(,37888531{1,i 10/1981 I:.;I $~o I,f13788744El( ()9/1981 Iii 50 4406111.;I.; (,)8/1981 13F. 50 1,60,14(,)495 EI.: (!7/1981 I!li 1.43754312EE (16/1981 El.; 50 1.4375419,11iI.; 05/198/ Iii'; 1~428471)151iI'~ 04/19gl I1] 1,40104213 04/1081 I(1( 51) L41}I {)4137F, li 03/1981 lie 1~37298833 02/1981 El( 5I/ L37298646l{1~; 12/1980 I.,1( 1,351240591!E I 1/198g 1i1¢ 50 L331923311 I! 10/1980 I~1; 1~331922501~K 09/1980 1'1( 50 I,1401852()151i (}8/1980 I:1! 50 IA40184271~;1! 07/1980 P;13 50 1,49945481,;E 06/198(,) Iil~ 50 1,49215891,iF, 05/I 980 I}li 50 L49214861,,1¢ 05/I980 El 5(/ L4615851FJ( 04/1980 }{I¢ 5{~ L27351321.;1. 03/1980 Ill! 50 1~273507,11:J( (}2/1980 lie 50 1,3729875 I El{ 01/1981 Il! 50 1,217(i9159051.; 12/1979 li 50 1.21777385 121. 11/1979 I'i 50 1.21721YY5671.; I(}/I 97Y I. 50 1,21721993741.; 08/I t)7g Ii 5(I 1,21691106271! I)7/1979 1~ 5(t 'l olal hilel esl Iolal V:ilue 't"l'l) |n $8,727.55 $ I (I,783.8tt $38.l Issue IIIlel'es! Nex( F'iual PI it'e Illlel esl Value Il:fie Accrual hla tul'il~ $25.00 377.86 $102.86 ,1.00% 04/2003 10/2011 25.t)1t 77,86 102.86 4.()0% t)3/2003 09/201 I 25.0(} 77.86 102.86 4.o0% o2/20()3 25.1~o 79.~0 IO4.9(i 4.0(~% 07/2{)03 (/7/2Oll 25.o(} 7rLYO IO.l.91~ 4.()0"~, o6/2(~o3 o6/201] 25.oo 79.90 1()4.9o 4.00"4, (~5/2o(}3 05/2ol I 25.{~o 84.58 ~o9.5g 5.00% I)4/2(/(13 1}4/201 I 25.()u 84.58 109.58 4.00% {)4/2o03 o4/2Oll 25/)0 84.58 1{)9.58 4.(~0% 03/2(}o3 25/)0 84.58 1o9.58 4.0{)74 02/20o3 02/2011 25.00 86.78 111.78 d.o(}% 06/2003 12/201{ 25.1~() 86.78 I11.78 4.0()% 05/2003 11/2o1( 25.oo %.94 ]21.94 4.0o% 04/20~3 10/2o1( 25/)0 Y6.¥.I 121.94 4.00% 03/20()3 09/2(~1( 25.00 YoJ)4 121.94 4.(~{)V, 02/2003 08/201 25.0o Y9.¢8 ~2~.38 4.00% 07/2o0~ 07/20]( 25.00 99.38 124.38 4.0(/% 06/2(/03 06/201 25/)0 99.38 12,1.38 4.007~, 05/20(/3 05/201( 25.00 99.38 124.38 4.00% 05/2()03 05/201~ 25.00 98.16 123.16 4.00% 04/2003 04/2o 25.00 98.16 123.16 4.00% 03/2003 03/201( 25.00 98.16 123.16 4.00% o2/2003 02/201( 25.(t~} 86.78 II 1.78 4.00% 07/2003 0[/2011 37.50 IBO. lg 167.68 4.0(}'3~, 06/2~)03 12/201~t 37.50 130.18 167.68 4.0(;% 05/2003 I l/2t)O~ 37.50 128.60 166.[0 4.{}{)'h, (~4/20(13 10/200[ 37.5O 128.60 166.1() ,L(I(;% 02/2003 37.50 131.92 169.42 4.00S$, (17/2003 07/2(}0~ L2161646793[i (/6/1979 12 155082597I,i 04/1979 1,2146835164E (13/1979 I2 1468(199971! 01/1979 [ 214111793021~ 12/1978 L2129478,160l, I l/[978 [ 21252247271! (19/[978 1,2120899081 Ii (18/I 978 1,212{}8979201,2 06/1978 1,21173002651i 05/1978 1,21173{}00181! 04/1978 210621643{}1i 02/1978 1,21062161351! 01/1978 L21058445191,, 12/I977 120983968151( 10/1977 L2094541606E 09/I 977 1,2087979516[.: 07/1977 1208531,1,14 [ 31( (/6/[ 977 12078462830E 05/1977 12073585334E 03/1977 I2068002 [ 561! (12/1977 L20620516061.i 12/1976 1,20578266161( 11/1976 1,20574466101i 10/1976 1,2{}5{}1138651( 08/1976 L2()4683759I[~ 07/1976 1,2(}292054931~ 07/1976 L2039761990E 06/1976 [,2039022897I! 04/1976 L2032755675]'i 03/] 976 120292023601'~ 01/1976 L2t123147968E 12/1975 L2017816227I~ 11/1975 1,201527976(}E 09/I975 Q60(t55167551.2 {16/1975 50 37.50 5O 37.50 50 37.5O 50 37.50 5{) 37.5o 5{} 37.5O 50 U.50 5{} 37.5o 50 Y?.50 50 37.50 50 37.5O 5O 37.50 50 37.5O 5O 37.5{I 50 37.51) 5{I 3 ?.50 5O 37.50 50 37.5O 50 37.5O 5(I 37.5(} 5O 37.5O 50 37.50 50 Y7.50 5O 37.5O 50 37.50 50 37.5O 50 37.5O 5O 37,50 50 37.5{) 50 37.5O 5O 37.5O 50 37.5{) 50 37.50 50 37.50 25 18.75 3 I.!12 129.92 129.92 133.26 133.24 132.78 1t1.18 131.18 · 134.52 131.08 143.54 167.10 173.24 173.24 191.66 191.66 196,24 196.28 195.80 193.50 193.50 198.12 197.,16 195.20 195.20 199.84 199.84 199.90 197.11 ]97.14 2{11.82 20 [.80 201.28 ] 98.96 ]01.85 169.42 167.42 I (37.,12 170.76 [70.74 168.(38 168.68 172.02 17t.58 181.01 2(},I .60 210.74 210.74 229.16 229.16 233.74 233.78 233.30 231.00 231.00 235.62 234.96 232,70 232.70 237.YI 237.34 237.40 234.64 23'1.64 239,32 239.30 238.78 236.46 120.6O 4.00% 4.00% 4.00% 4.0{}% 4.00% 4.00% 4.00 % 4.00% 4.0 I% 6.00% 4. 007,6 4.00% 4,00% 4.00?4, 4.00% 4.00% 4.00% 4.O0% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% ,l. 00~3 b 4.00% 4.00% 06/2003 06/200~ 04/2003 04/200~ 03/20(}3 03/200t. 07/2003 01/200[ 06/2003 12/200~ 05/2003 I 1/200~ 03/2(Io3 o9/200~ 02/2O03 08/200~ (}6/2{){}3 05/2003 05/2{}{}} 04/2003 04/2(}0~' 02/2003 02/200~ {)7/2{)03 0]/200[ 06/2(}03 12/20(1~ {14/2(}{}3 10/200; {}3/2003 09/2{}{}~ 07/2(}{}3 {17/2{}{}~ 06/2{}03 06/20(}~ O5/2003 05/2002 03/20{}3 03/2{}0; 02/2003 (}2/200; 06/2{}{}3 12/20(1( (}5/20{}3 I I/2(}0( 04/2003 10/2(}{}( 02/2{}03 08/200( {}7/2003 07/2{10( {}7/2(}03 07/200( 06/2003 06/200( 04/2003 04/200( 03/2003 03/200( 07/2003 01/200( 06/2003 12/200,~ 05/2(/(}3 I 1/200.~ 03/2(103 09/2(}0~ 06/2{}03 06/200f ~CItOVIA Wachovia Bank N,A. Balance Confim~ation Scrviccs P O Box 40028 Roanoke, VA 24022-7313 RelEtcnce ID: 774351 l)ecember 19, 2003 R MARK TIIOMAS ATTORNEY AT LAW 101 SOUTII MARIrU~;'I' STREET iMECIIANICSIIURG, PA 17055-3851 SUBJECT: Vcli(icalion / (~iollfhlllatioll of Account a~ld Balancc lnfimualion provided fro: Cuslomer: EVI!;ILYhr ~111UIII.EY (SSNT~ 193-18-6!13) Dale of Death: January 2, 2003 'lype Numbe~ CERIIFICAI E O[: DEPOSI F 247412046192897 LEGAE TI1EE: WILBUR R W [IUBI EY EVELYN hi IItJBLEY CLOSING BALANCE: $1430683 $14,00488 4/I 3/I 998 Acmued Y I D Date Intclest [t~telcst Paid Closed $25 81 $0 00 8/I 4/2003 ()UR RECO[U)S INDICA I'E ACCI' IIAS BEEN J()INI SINCE CI IECKING 1000015159262 $,1,788 55 EEGAE'IIILE: WILBUR R W IIUBLEY EVELYN M HUBLEY ()UR RECORDS [NI)[CAllf ACCI tlAS BEEN JOINI SINCI 10 17-98 WAr2 IIOVIA * Date of dealb balance clues not include accl ucd inlelesl. * lF date ofdcatb occults on a weekend ol a ltt)lid~;,, dale o{ c i bala.ce docs m~l include any hansactions Ihal wine ,made during that t/me ~od. Teresa Abbott ~ Se~ vicenter Associale Phone: (540)563-7323 al)s; tb 'Update Snvinc Series iai ~ tllllllel- fl Ih.ids 'I olal Ihice Tohll [[lieresl I o(al Value I $51).00 557.88 $ 107,8§ Serial Nunibcr Issue I)nle C2667123.~-11c1,, 10/1990 Dehorn I'rice $100 $~0.00 Inlel'e$( Nex( Inleiesl Value Rale Acclu:ll $57.88 $197.g8 4.00% 10/200q 'FID In $2.1 Final Malulil) 10/202( Nole I)escriplimn NI Not Issued NE Not F. ligibl¢/bi I~aylnenl P5 Includes ~ IllOlllh intcicsl ])Cl/~]l)' MI! Mahllcd (l;xchal~gealfle Ibr l Ill) MN Matured (Nol [']xcJlangeltl)Je hnlII I) Please rate this service. (Please p/i/It and/or save Ibis page before sub/oitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator C (- (' C PNCBAN< June 1,1, 2004 R Mark 'ihomas Attorney at Law i01 S Market St Mecha~ficsbmg, PA 17055 sop Estate of Evely'n M ltubley (Deceasedl SSN: 193-18-6213 DOD: 01-02 2003 Dear Mt. Thomas: hi response to/,'our request lbr Date of De. ath balances lbr tile customer noted above, our records show lhe tbllowing: Certificale of Deposit Account #3 [80023015)4 WILBUR R HUBI EY EVELYN b/HUBLEY DOD balance: $23,536.66 + $13.93 accrued interest Account #31000229254 WILBUR R IfUBI,EY EVEI,YN M tlUBI.EY DOD balmme; $23,536.66 I $[3.93 accrued interest Established Ol 18 2002 Checking Account Established 07-18-2002 Account #5140030781 WILBUR R IIUBLEY EVELYN M IIUBLEY DOD balance: $10,532.96 + $2.77 accrued inIe~est l*2stablished 03-01-1973 Savings Accouut Acctmnt #5003505277 WILBUR R ][fUBLEY EVELYN bi Itl.rBIACf DOD balam:e: $10,370.'79 + $382 accrued imezest Estabi~shed 03-02-2001 Page l of 2 Please aote that t}fis office only pro',' des date of death balances for deposit accvunts ( RAs, CDs, Checking mid Savinss accounts). We do not process any financl,q transacl:iorl!g or provide statemenls. If you need assistmme with troy of lhese items, please call 1 -888 PNC BANK (1-888-7~2~2265} or stop by your local PNC Bank branch office. S i~cu:rely, E~ica L Schlegel I 800 762-1775 PT-PFSC-04-F 500 First Ave Pills burgh PA 15219 b. lcrnbe~ FDIC Page 2 rl£ 2 LOOK FOR US. WE'LL GET YOU IHERE. 5/25/2004 R. MARK TI lOMAS 101 S MARKET ST MECttANCISBURG IDA 17055-3 851 The information which you requested on the account(s) of EVEI~YN M I ILIBI~F.Y (Social Security Number 193-18-62 / 3) is/are as tbllows: Account Nlllllber Class o£Account Date Opened P~iacipal Balance Accltied lnlerest Balance at Date oF Death Account Ownership Name of Joint Owner, i£any Date Ownership Was Established Account Number Class of' Account Date Opeaed Principal Balance Accrued late~est Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 500115609 554244757 7100026149 SAVINGS CEP* I IFICATE CERTIFICATE 113088 110593 031202 202.47 19088.02 8170.39 0.00 41.33 .58 202.47 19129.35 8170.97 J'lO JTO J I O WILBUR WILBUR WII.BUR 1 IUBLEY I IUBLEY flu BI 113088 110593 031202 Additioaal Information Requested ~illgere,ly~N ~ SENIOR SERVICES RI~P. Box 1711, tlARmSBURG, P(:NNSYLVANIA 1710[;-1711 Glenbrool~ L~fe and Annuity Cottti~at~y 1'.0. Box 94212 Palatine, IL 6{)094-4212 GLLNI3ROOK LiI E A Member ofA[htate Finam'ial Group June 15, 2004 R. Mark '1 boreas Attorney at Law 101 South Mmket Street Mechanicsbm-g, PA 17055~3851 Re: Wilbur R.W. llubley Contract Number: GA207343 Dear Mr. Thomas: We have been requested to complete Internal Revenue Service (IRS) Form 712 wit fl ~egm d to the re~erellced COlltracl. The propose of Form 712 is to provide an estate or donor with the value of a lil~ insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract). The contract referenced was an ammity contract, which is not reportable on IRS lbrm 712. The following information is provided mgm'ding the wflue of the ammity and other data as of the date speci fled: Date of Deafl~: 01/02/2003 Ammity Value* as of Dale of Dealh: $ I 1,547.46 Cost Basis: $ 0.00 Named Beneficiary: Evelyn llublcy *Tfle actual amount paid may difl~r due to Mmket Value Adjuslmcnts ami/or any applicable Smrender Charges. If you have any questions, or need fresher assislance, please contact us at 1-877 499-6418. S iucerely, Jennifer Long ~ Life attd Am~uity Claims · Overnight Address: 544 Lakevielv Parlm'rt),, l'c, rnon llills', IL 60061 Toll Free Fax: 1-866-635-4.523 EVELYN MARY HUBLEY I, Evelyn Mary Hubley, o1: Camp Hill, Cumberland County, Pennsylvauia, being of sound and disposing Inind, memoly and understanding, do make, publish and declare this to be my Lasl, Will and Testament, hereby revoking aud making void all previous Wills and Codicils heretorole made by me. FIRST I order and direct my personal represenl,ative hereina[ler named to pay all of my just debl,s, l'uneral expenses and expenses involved or connected with the admirfistration of lay estate as soon after my death as is reasonably possible, However, my personal representative need not accelerate and pay those unmal,ured obligations whict~, in his, her or its opinion, it might be proper and more advantageous to ~etain or renew and pay as they become due and payable. If l do nol, own a burial plot or a grave marker al. the time of my death, I authorize my personal ~epresen~ative, in his, her o~ i~s sole discrel,ion, to purchase a burial plol, and to erect a suitable marker at my grave, and to expend sums from my esl,a[e roi I. his purpose, SECOND I give, devise and beclueath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse, Wilbur R. W. Hubley, providing that he survives me by sixty (60) days. THIRD $t~ould my spouse, Wilbur R. W. Hubley, predecease me or die on or before the sixtieth (60m) day following my death, then I give, devise and bequeath my el~ti~e estate together with all insurance proceeds theieon of whatever nature and wheresoever situate in equal shares to my son, Marc W. W. Hubley, who survives me by sixty (60) days, per stirpes. If my son, Marc W. W. Hubley, p~edeceases me or fails to survive me by sixty days then I give and bequeath all tile lest, ~esidue and remainder of my Estate of whatever nature and wheresoever situated as follows: 1. 50% of my Estate to Iny nieces, Jo Ami Shel)p Burns, of York, Pennsylvania, Lou Ann Shepp Dillman, of York, Pennsylvania, per capita. 2. 50% of my Estate to my husband's nephews, Dennis L. Myers, of York, Penl]sylvania, Gene F. Myers, of Coldorus, Pennsylvania, per capita. The interest of Marc W. W, Hubley shall i~ot be subject to rulther anticipation, voluntary or involuntary alienatioe, assignment, pledge or obligation nor subject to fees set by the Commonwealth related to bis incarceration. FOURTH I eominate, constitute and appoint my spouse, Wilbur R. W. Itubley, of Camp I lill, Cumberland County, Pennsylvania, Executor o1' this my Last Will and Testament. In the event Wilbur R. W. Hubley is deceased, unable or unwilling to ser¥e or shall cease to serve for any reasorl whatsoever, then I nominate, constitute and appoint Jo Ann Shepp Burns, of Yodq Pennsylvania and, Lou Ami Shepp Dillman, of York, Pennsylvania, as Co-Executols to serve instead. In tire event that eitberCo-Executor, Jo Arm Sbepp Burns, arid Lou Ann Shepp Dillman, is unable or unwilling to serve or shall cease to serve for any reason whatsoever tlien I nominate, constitute and appoint my son, Marc W. W. Hubley, to serve in place of that Co-Executor and to serve as co- Executor and as personal representative to this my Last Will and Festament. I direct that my personal representatives shall not be required to give or post bond for the faithful performance of his/ber duties in this or any other jurisdiction. FIFTI-t I hereby declare it to be my expressed desire that my personal repmese~rtative employ Turo Law Offices of Cumberland Counly, Pennsylvania, for legal advise and assistance regarding this my Last Will and Testament, they having corrsiderable knowledge of my affairs, views and wishes respecling any matters that may a~ise at lhe probate of this instrument, the adminis(ration of my eslate, and tire execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunlo sel rny hand to this my Last Will and Teslamenf this 27th day of June, 2001. Evelyn MaCy Hubley Witness ACKNOWLEDGMENr COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS I, Evelyn Mary Hubley, tile Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to the law, do hereby acknowledge that I signed arrd executed tire instrument as my Last Will and lestamenL that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Evelyn Mary Hubley u Sworn or affirmed and acknowledged before me lay Evelyn Mary Hubley, the Testatrix, this 27~h day of June, 2001. C~rhsle Bom Cumberla rJ Cou~ ly AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'SS We, James M. Robinson ard Renee M. Steinour, the witnesses whose names are attached to the foregoing document, being duly qualified according to the law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the Ilearing and sight of tile lestatdx signed the Last Will and Testament as witnesses and that to the best of our knowledge tile Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ,/ / Sworn or affirmed and subscribed before me by James M. Robinson and Renee M. Steinour this 27th day of June, 2001. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004193 R MARK THOMAS ESQ 101 S. MARKET STREET MECHANICSBURG, PA 17055 ESTATE INFORMATION: SSN: 19318-6213 FILE NUMBER: 2103 0935 DECEDENT NAME: HUBLEY EVELYN MARY DATE OF PAYMENT: 07/23/2004 POSTMARK DATE: 07/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/02/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2.43 TOTAL AMOUNT PAID: $2.43 REMARKS: R MARK THOMAS ESQ SEAL CHECK#5443 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS R. MARK THOMAS Attorney at Law 101 South Market Street Mechanicsburg, Pennsylvania 17055-3851 Telefax: (717) 796-3600 Telephone: (717) 796-2100 October 5, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 RE: Estate of Evelyn M. Hubley No. 2003-00935 Dear Register of Wills: Enclosed please find the Status Report for the above referenced estate denoting that administration of the estate is complete. Very truly yours, R. Mark Thomas RMT/ac STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND Name of Decedent: Date of Death: File 1'4o. EVELYN MARY HUBLE¥' 1/2/2003 2003-00935 , PENNSYLVANIA Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES X NO Date: 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to No. 1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES b. The separate Orphan's Court No. (if any) for the personal representative's account is: 10/4/2004 Did the personal representative state an account informally to the parties in in(erest? YES X NO Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature R. MARK THOMAS Name (Please type or print) 101 S. MARKET ST. Address MECHANICSBURG PA 17055 717-796-2100 Tel. No. Capacity: Personal Representative X Counsel for personal representative ~- ~.'g~ BUREAU OF TNDTVTDUAL INHERITA~ TAX~ DIVISION DEPT. ?~ HARRISBL ,~A 17118-0601 TAXES R HARK THOr:.~$ ESQ. := 101-:S'HARKL:~ ST :~ HECHANICS]}URG -P~,' 17055 COHNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE 09-27-200~ ESTATE OF HUBLEY DATE OF DEATH 01-02-200~ FILE NUMBER 21 05-0955 COUNTY CUHBERLAND ACN 101 Amoun't RamA~ed REV-15~? EX AFP EVELYN H HAKE CHECK PAYABLE AND RENTT PAYNENT TO: REGISTER OF WILLS CUH~ERLAND CO COURT HOUSE CARLTSLE, PA 1701:5 CUT ALONG THIS LINE ~ RETAIN LONER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLO#ANCE OR DZSALLOgANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HU~LEY EVELYN H FILE NO. 21 0:5-09:55 ACN 101 DATE 09-27-200~ TAX RETURN WAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE RESERVATTON CONCERN]NO FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es*a~a (Schedule A) (1) 2. S~ocks end Bonds (Schedule B) (2) $. Closely Held S~ock/Par~narshAp /n~eras~ (Schedule C) ($) ~. Hor~gagas/No~as RacaAvabla (Schedule D) (~) $. Cash/Bank Daposi*s/NAsc. Personal Propar~y (Schedule E) (5) 6. )DAnkly O~nad Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse*s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Cos*s/Misc. Expanses (Schedule H) (9) 10. Dab,s/Mortgage LAabAIA~Aes/LAens (Schedule 1) (10) 11. To,al Deductions 12. Na~ Value of Tax Re~urn 15. 1~. CharA~able/Governman~al Bequests; Non-elected 9113 Trusts (Schedule J) Ne~ Value of Es~a~a Sub~ac~ ~o Tax .00 68.50 .00 .00 6~529.75 117~582.51 11~5~7 .~6 1,717.00 .O0 NOTE: To insure proper credA~ ~o your account, subeA~ ~he upper pore/on of ~hAs fora wASh your ~ax payment. NOTE: 1:55,728.21 (11) ] .717. oo (12) 15~, 011.22 (13) . O0 (1~) 1:5~, 011.22 Zf an assessment was issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 will reflect ~/gures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Aeoun~ of LAne lq a'l: Spousal ra~:a 16. Aeoun~ of L/ne 1~ ~axabla a~ Lineal/Class A ra~a 17. Aeoun* of LAne 1~ a* SAblAng ra~a 18. Aeoun* of LAne lr* ~axabla a* Colla~caral/C1ass B ra*e 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER /NTEREST/PEN pAID (-) 07-2:5-200~ CD00~195 .00 (15) 133,957.28 x O0 = .00 (16) 5:5.9~ x 0c~5 = 2.~3 (17) . O0 x 12 = . O0 (18) .00 x 15 = . O0 (].9)= 2.~:5 AMOUNT PAID ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 2.~3 TOTAL TAX CREBZT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 2.~3 .00 .08 .08 ( ZF TOTAL DUE [S LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR /NSTRUCTZONS.) RESERVATION: PURPOSE OF NOTZCE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DZSCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 1Z, 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life ar for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (co118tera1) rata on any such future interest. To fulfill the requirements of Section gl~O of the Inheritance and Estate Tax Act, Act Z$ of 2000. (7Z P.S. Section 91q0). 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: REGXSTER OF NZLLS, AGENT A refund of a tax credit, which ams not requested on the Tax Return, say 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 Hills, any of the 25 Revenue District Offices, or by calling the special Iq-hour ansaering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-q~7-5OZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice oust object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81OZ1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans" Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. Sam page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-iS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decadent's death, a five percent (5X) discount of the tax paid is allowed. The iSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of deathj to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year ~ ZOZ .00056,8 ~)'~'8 - 1991 1XZ .O003Ol ~'~ 1985 16Z .000~$8 199Z 9Z . O00Z~7 2002 198q 117. .000301 1993-199q 77. . O0019Z ZOOS 1985 13Z .000556 1995-1998 9Z .000Z~7 ZOOq 1986 lOX .O00Z7q 1999 7Z .000192 1987 107. . O00Z7q ZOO0 77. .00019Z --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELTNQUENT X DAZLY TNTEREST FACTOR Interest Daily Rate Factor 9Z .O00Zq7 6Z .00016~ 5Z .000137 qZ .000110 --Any Notice issued after the tax becomes delinquent aill reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. ~EV-1470 EX  INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANG ES BUREAU OF INDIVIDUAL TAXES DEPT. 28O601 HARRISBURGi PA 17128-0601 DECEDENTS NAME FILE NUMBER Hubley, Evelyn M. 2103-0935 ACN REVIEVVED BY Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G I IRA's are fully taxable with no exclusion. ROW Page 1