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Home My WebLink About04-0108PETITION FOR PROBATE and GRANT OF LETTERS Estate of' ~ffcx~ ~ ~. }~c~ No. also known as To: · Deceased. Social Security No. I "? ~ - ! ~ - ~ ~ q ~ Register of Wills for the County of C~\c~xd. Commonwealth of Pennsylvania in the The petition of the undersigned respectfully represents that: Your petitioner(s), wh~tre 18 years of age or older an the execut in the last will of the above decedent, dated N\o-~ ~,w~t c' % ' and codiCil(s) dated ~.l[ ~ named .,19 qc] (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~xc"-v~3~.a~d last family or principal residence at Iooo Lo. %o,~.__~LxCou~t~, Pennsylvania, with (list street, number and muncipality) Decendent~then B X yearLof age, died ~ &c} Except as follows, decedent d~d 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: 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 theron. (testamentary; aafninistration c.t.a.; administration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALJ?H OF PENNSYLVANIA · COUNTY OF Qx~ h~ ~-~.,~ d_ . ~ ss Thc petitioner(s) above-named swear(s) or affirm(s) that thc statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as person~ represen- tative(s) of the above decedent petitioner(s) will well an~/trUly admini~?r thc estate according to law. Sworn to or affixed and subscribed 'r ~/{C~'~.~ ~ before me this ~x ~ day of / Estate Of ~a:~nlo,I ~ ¥~ IFps , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW F~- ¥71~, ~ ~-~)~, / [ ~/' ~1~--~, in consideration of the petition on the reverse side hereof, satisfacto~ proof having been presented before me, IT IS DEC~ED that the inst~ment(s) dated ~x)~ (~-~ ~' ]~ ~ ~ described therein be admitted to probate and filed of record as the last will of I ~d Letters ~w~t ~ ~e hereby granted to ~~ ~ ~ ~ [ ~ ~ ~ FEES Probate, Letters, Etc .......... $ ~ "~v Short Certificates( ) $ clation ................ $ /~, (~ $ TOTAL . Filed . .~F-X~Z/x'..W~..~ .,~-~..,..~7.~. ~. ..... A'~ORNEY (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 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. No. Date H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS .R,,T CERTIFICATE OF DEATH ~ STATE FILE NUMBER 'NENT I NAME OF DECEDENT (First. Middle. Last) I SEX I SOCIAL SECURITY NUMBER l DATE OF DEATH (Mo~[h. Day, Year) ~ I s J Da~ J Houm J ~mes I ( , y, ) J Stale ~F~e~n~nt~) IHOSPIT~: e-see in IOTHER ~ COUN~ OF D~TH I Cl~. B~O. ~ OF D~TH I "*C'L'~ NAME (If "Ct ,nsfitul~,. g~e ,1 ..... d n,~r} IWAS DECEDENT OF HIS;~IC ~,. School Teacher DECEDENT'S MA~LING ADDRESS (Street, CityfTowfl, Stile, Zip Code) I DECEDENT'S · ACTUAL Pa Did 17c. [] Yes. decedent lived in Sarah Todd Memorial Home iRESiDENCE 17a. State decedenl twp. (See ir~tmctio~s live in a s- 1000 West South St. ~ --'~ 17d. r~ within actual #mit$ o~ · --ale.l= ' Carlisle .^ =.'.":'TH -'2-': h^,~= [.r*t, ~ PA.17Ol.~,~: t a~-------- I .... ' ,Th. Co~.~ Cumberland ..... hip, No..cede., ,ired I MOTHER'S NAME {First. Midd}e. Maiden Surname) ,,. Charles L. Myers ',. Hazel Irene Nat~_le ~NFORMAhn's NAME ITyP~Pfint) I INFORMANt'S MAILING AODRESS (Street, City/Town, Slele, ~p Co~e) 20~ Sharon E. Myers hob. 222 South Pitt St., Carlisle, PA 17013 Mm. OD* D,SPOS,~O~ m ~ I DA~ O~ D~S~S,T,O, I P~_CE O_~ D.SPOS~T,ON- N.. o, C..t.~. Cr.%a,~ I LOC^T,ON- C,ty/T... Slele Z~ Cod. D~atidn [] Bur~ L-J Cremation L~Removal f.~ State I I I (~o.~. D.y. Yea0 I ~r uther ~iace I ' ,,= /"T o~er(Sp.c~,l I-][2~b. Jan. 27, 2004 ]2,¢Yorktow~e Crernn~ion S,rv. I-d. v~r~. pa 17ztn~t s'~N~[.~ ~UNE~EnL S~.?'OE\'CE~SE~ O~ PERSON ADT~"~AS3UC" IucE"sE NuMSER I NAME AND ADORESS OF ~^O,UTY Hoff.~. =.&~ .... { 1 ~ ,~~l;~'~ J22b. (")1 ~1~/I I' 22c 2~n ...................... ~u~0~deam. ~ ~' ~ \ \l ~ J · _ I(~°"m. Day, Year) , -4 ..... I'" ~ %."~-~t~ " In~ lC~\ %%~'%,~' J,~ WAS AN AUTOPSY J W~RE AUTOPSY FINDINGS ] MANNER OF DEATH DATE OF INJURY TIME OF N JURY INJURY AT WORK? DESCRIBE HOW N JURY -- I?-P'--~-°"°"cAUSEI"'' [] .o.~e [] ' ' ' I IAccident [] Pendillg, ...... gatkm D I I I Y., [] .° [] I ~- [] ~o ~a I ~. [] ~o [] Is.~. [] c.,.ot,, ...... . []13_?.:__ 13°~. M. I'0~' 130d. __ I I I "~ o~,~Y - At h~., le.~, .trot. ~m,y, o~* I LOCATION (Street, City/Town State) ~%~ ........... ~."~.. -- ~ ii;: .............. I~,. PART Ih Other ~gnificant co~dilJ0~a contri~JUilg to death, b~t not resulting in the underlyklg Cauls given in PART I. 'P.R_O~l~ _O~1~ NC. IN.G AN.D CE.R'flFYI .NG PHYSICIAN (Physician both p~o~ounci~g death and ce:relying to cause of death) LICE~i~ NUMSER DATE SIGNED (Iv.J~onth. Day, year) ...... myxnowledOe, lleethoocurredatth®tlme, date, andpl .... ndduetoth ...... (a)and ......... tared ...................... [] 31c. ~ O[~¢~I~ 31d. *MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE O~ DEATH ~i O~1 the blllB Of exlmlnltteel Brt~/O~ Inveltigatteel In my open ~1, death Occurred it the time date Jfld place and due to the causes · llld (Item 27) Type or Pdnt :,~m. ..... t.,., ............................................................................................... '.......' .............. : ....................................... [] 22. '~$3 ..... '' '~' '01 DATE FILED (MO~th. Day.;eBr~..~ , WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 LAST WILL AND TESTAMENT I, STANLEY E. MYERS, of the Borough of Carlisle, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. ! order and direct that all my just debts and funeral expenses be paid by my personal representative or representatives, hereinafter named, as soon as conveniently may be done after my decease. I further authorize my personal representative to expend funds from my Estate in such amounts as my personal representative shall consider appropriate, for the disposition and memorial of my remains. SECOND. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my wife, SARA G. MYERS, if she survives me. THIRD. For the purposes of this my Last Will and Testament, a person shall not be deemed to have survived me unless he or she shall have survived me by more than ninety (90) days. FOURTH. If my wife, SARA G. MYERS, should fail to survive me, I give, devise and bequeath the said residue of my Estate unto such of my issue who shall survive me, in equal shares by representation and not per capita. In the event that any person who WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 is entitled to a share of my Estate shall be a minor at the date of distribution of my Estate, I order and direct that his or her share may be distributed to the Guardian of the minor or deposited in the name of the minor in a savings account fully insured under the Federal Deposit Insurance Corporation, its successors or assigns, until the minor attains the age of eighteen (18) years. FIFTH. I order and direct that any estate, inheritance or similar tax due as a result of my death with respect to any property passing as a result of my death, shall be paid from the residue of my Estate before its division into shares and prior to distribution as an expense of administration and that no part of the taxes should be prorated or apportioned among the persons or beneficiaries receiving the taxable property. It is my express intention that all inheritance taxes imposed as a result of my death be paid from the residue of my Estate whether or not the property passes under my Last Will and Testament. My personal representative shall have full power and authority to pay, compromise or settle any such taxes at anytime whether with respect to present or future interests. SIXTH. Any and all decisions, determinations or actions made or taken by a personal representative or Trustee hereunder, if made in good faith, shall be final and conclusive on all persons who are or may become interested in my Estate. No fiduciary acting under this my Last Will and Testament shall be liable for any error in judgment or for any depreciation or reduction in value of any Estate or Trust assets at anytime, in the absence of willful default. -2- WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 LASTLY. I nominate, constitute and appoint my wife, SARA G. MYERS, to be the Executrix of this my Last Will and Testament, but if, for any reason, she should fail to qualify as such Executrix or decline or cease so to serve, I nominate, constitute and appoint my children, SHARON E. MYERS, STEPHEN G. MYERS and SUSAN E. GROSENICK, as successive altemate personal representatives hereof, all to serve without bond. The order of designation of my altemate personal representatives is only for the purpose of convenience and should not be regarded as any form of partiality. IN WITNESS WHEREOF, I, STANLEY E. MYERS, have hereunto set my hand and seal to this my Last Will and Testament which consists of five (5) typewritten pages to each of which I have affixed my signature, this 3rd day of November , A.D. One Thousand Nine Hundred Ninety-Nine (1999). st s ? fl' ' SEAL) The preceding instrument, consisting of this and four (4) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by STANLEY E. MYERS, the Testator therein named, as -3- WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: I, STANLEY E. MYERS, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by STANLEY E. MYERS, this 3rd day of November ., 1999. Stanley E. Myers Notary Pub~i~ Notarial Seal Connie J. fritt, Notary Public Cariisle?umberland County My Commisoion Expires Oct. ,5, 2000j -4- WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 Affidavit COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: We, Wayne F. Shade and Christopher C. Houston ,the witnesses whose names are signed hereto, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness; and that, to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Wayne F. Shade and Christopher C. Houston 3rd day of November , 1999. , witnesses, this Notary Pt~161ic Seal >tary Public and_Counly ,s oct. 5, 2000 -5- STANLEY E. MYERS WAYNE F. SHADE A'VrORN~Y AT L~w 53 Wzsx PO~tFRET STRUT CARLISLE, ~a~SYLVAN~ 17013 CG~,,MONWEALTH OF PENNSYLVANIA DEi ARTMENT OF REVENUE BUI'~EAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003703 MYERS SHARON E 222 S PITT STREET CARLISLE, PA 17013 ........ foid ESTATE INFORMATION: SSN: 179-12-5343 FILE NUMBER: 2104-01 08 DECEDENT NAME: MYERS STANLEY E DATE OF PAYMENT: 03/22/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $10,660.93 REMARKS: CHECK//107 SEAL TOTAL AMOUNT PAID: $10,660.93 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~a~ COMMONWEALTH OF ~ PENNSYLVANIA ~~~ DERN~TMENT OF REVENUE ' F'~,'"~~'~ DEPT, 280601 *,~r~~ HARRISBURG, PA 17128-0601 W U,I C.) LU REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'$ N/~IE (L,~T, FIRST, AND MIDDLE INITIAL) Myers, Stanley, E DATE OF DEATH (MM-DD-YF..,~) I DATE OF BIRTH {MM-BD-YEAR) 01/24/2004 1 02/02/1920 (IF APPLICABLE) SURVIV~IG SPOUSE'S NAME (LAST, FIRST, AND MDDLE INITIAL) E~2. Supplemental Relum 4a, Futura Interest Compromise 7. Decedent Maintained a Uving Trust [-"~ 10. Spousal Poverty Credit (~ ~ ~ ~, 12.3~.91 ..d ~-~) ~ 1. Ordinal Ream ~'-'] 4. Limited Estate [~6. Decedenl Died Testate {At~ co~w d wa) r'-'] g, UligaUen Proceeds Received NAME Sharon Myers FIRM NAME (~) TELEPHONE NU~u~-K (717) 241-0919 1. Real Estate ($chedulaA) 2. Stocks and Bonds (Schedule B) 3. Closely Held Coq3oralion, Partnership or Sole-Proprietorship 4. Mortgages 8, Ne*es Reseivable (Schedule D) 5. Cash, Be~k Deposita & Miscellaneous Pemonal Property (Sc~uta E) LJ Separate Biang Requested 7. Inter. Vivos Transfers & Miscel~neous Non-Probata Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. 10. 11. 12. 13. (1) (2) (3) (4) (5) (6) (7) Funeral Expenses & Adminislmlive Cosls (Schedule H) (9) Debts of Decedent, Mortgage LiabiliUea, & Liens (StiPule I) (10) Total Beductiofl$ (total Lines 9 & 10) Net Value of Estate (Une 8 minus Line 11) Chadlable and Governmental Bequests/Sec 9113 Trusts for which an election 1o lax has not been made (Schedule J) Net Value Subject to Tax (Une 12 minus Une 13) 14, i_o_&__ -oq COUNTY CODE YEAR SOCIAL SECURITY NUMBER 179-12-5343 hUla]ER THIS RETURN MUST BE FILED IN DURMCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D3. Remainder Return (date ~deah p~m 12-13-82) Q S. Federal Estate Tax Retum Required I 8. Tolal Number of Safe Deposit Boxes 1"--'~ 11. Etaction to tax under Sec. 9113(A) (~d~ sc~ o) COMPLETE MAILING ADDRESS 222 South Pitt Street Carlisle, Pa 17013 0.00 163,67 >0~ .Z':.; 49,161!68 29,736.~3 (8) 242,567.98 5,460.24 198.27 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount d Line 14 taxable at the spousal tax rate, or Iransfers under Sec. 9116 (a)(1.2) 16. Nnounl of Line 14 taxable al lineal rate 17. Amount of Line 14 taxable at sibling rale 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (11) 6,668.$1 (12) 236,909.47 (13), , 0.00 (14) 236,909.47 x .0__ (15) 236,909.47 x .o 45 (16) 10,660.93 x .12 (17) x .15 (18) (19) 10,660.93 Decedent's Complete Address: % Sharon Myers 222 South Pitt Street crrYcarlisle Tax Payments and Credits: 1. Tax Due (Page I Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount J STATEpA 3. Interest/Panalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page t Line 20 to request a refund 5. IfLinel +Uns3isgreaterthanUne2, enterlhedilfmence. This is the TAX DUE. 0) A. Enter the interest on the tax due. Total Credits (A + B + C ) (2) (3) (4) (5) (5A) I~P17013 10,660.93 0.00 0.00 10,660.93 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 10,660.93 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 incoma of the property tmnsferr~, ....................................... · ................................................... [] I-El b. mta~ the right to designate wh~ shall use the property transferred or ils income; ............................................ [] [] c. retain a mverstanay interest; or ......................................................................................................................... [] [] d. receive the promise for life of eithor paymants, bene¢~ or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ~thout ~ adequate consUera~on? ............................................................................................................. [] [] 3. Did decedent o~n an 'in trust for' or payable upoo death bank account or security at his or her denth? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or oiler non-probate property which contains a beneF~a'y designation? ........................................................................................................................ [] [] IF THE ANSWER 1'0 ANY OF THE ABOVE OUESTIOHS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNATURE OF PERSOJ~I~RESPONSIBLE FOR FLING RETURN 222 S. Pitt St., Carlisle, PA 17013-3814 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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% F2 P.S. §9116 (a) (1.1) For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a sundving spouse from tax, and the stelutory requirements for disdosure 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 adoplJve parent, or a stepparent of the child is 0% [72 P.S. §9115(a)(1.2)]. The tax rate imposed on the net value of b'ansfers to or for Ihe 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 RS. §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. COMMONV1EAL'rH OF PENNSYLVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE A REAL ESTATE FILE NUMBER All real ~;~-y o~-.. _~ sc..'-_--.~ or as a ~,-,~t in c~-__:L...-.u~ be ;~ted at fair mm~,[ value. Fair ~,~ut value is Gei',~e~ as the prfce at which property would be exchanged betweem a w~ling buyer and a wilting seller, neither being compelled to buy or sell belh havfng reasonable knowledge of Ihe relevant faclm Real property which is joialfy-o~med with right of on Schedule F. i~EM NUMBER DESCRIPTION TOTAL (Also enter on line 1, Recapitulation (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ 0.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE B STOCKS & BONDS FILE NU~iE~.R All pm~ ~ntly-o~m~ wilh ~ht ~ iuwbomh~ must ~ dbclosed ~ ~hedub F. ITEM NUMBER DESCRIPTION 1. Securities America, Inc Account #RCT-023132 186.250 shrs Evergreen Grth & Inc Fd C1 C 2. Securities America, Inc Account #RCT-023132 920.242 shrs John Hanocock Regional Bank Fd C1 A 3. Securities America, Inc Account #RCT-023132 3129.107 shrs Oppenheimer STP, AT Income Fd C1 A 4. Thrivent Financial Account #1752214098 2846.18 shrs AAL Capiral Growth Fd C1 A 5. Thrivent Finamcial Account #2550414146 3187.252 shrs AAL High Yield Bond Fd C1 A 1 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 4,112.40 38,843.41 13.392.57 85,584.63 21,737.06 $ 163,670.07 REV-1504 EX+ 11-97~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (including all suppodi.g ;.;u,.,a{ion) must be attached for each closely-held corporation/partnership interest of the decedent, other than a ITEM NUMBER NUMBER sole-proprietorship. See Insb'uctions for the supporting information to be submitted for sole-propile{oi_..h; ,s. DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 1. Name of Cmpora~m None State of Incoq3omikm Address Dale of Incorpor~on City State ~ 2ip Cede Total Number of Shareholders 2. Federai Employer I.D. Number Business Reporting Year 3. Type of Business Rdduct/Service TYPE TOTAL NUMBER OF NUMBER oF SHARES VALUE OF THE STOCK Voting I Non-YoUng SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Com~-i $ a all rights and restrictions pedaining to each class of stock. 5. Was the decedent employed bythe Corporation? [] Yes [] No If yes, Position Annual Salary $ Time Devol~d to Business 6. Was the Corporation indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No ff yes, Cash Surrender Value $ Net proceeds payable $ 8. Old the decedent sell or transfer stock of this cempany within one yesr ixior to death or within two years if the date of death was lxior to 12.31.827 [] Yes [] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for add~onal transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedenfs death? [] Yes [] No If yes, provide a copy of the agreement. Was the decedenfs stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. Was the corporation dissolved or liquidated alter the decedenrs death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. Did the corporation have an interest in other corporations or padnerships? [] Yes [] No If yes, report the necessa7 information on a separate sheet, including a Schedule C-1 or C-2 for each interest. !]_ ~ ..... ~, ,, .... A. Detailed calculatlo~s used in the valuation of the decedont's stock .... 10. 11. 12. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. Mst of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. Mst lhose declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. COMMONWEALTH OF PENNSYLVANIA INHEI~I'.~H~ TAX RETUF~ ESTATE OF Stanley E. ~yers SCHEDULE C-2 PARTNERSHIP' Name of Parmership Address 2. Federal Employer I.D. Number 3. Type of Business 4. Decedantwasa [] General None Stale Zip Code Date Business Commenced Business Repmting Year [] Limited pather. If decedent was a limited patina', provide initial investment $ F'F_ACENT OF ;-~.~CENT OF BALANCE OF -- PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. 8. C. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indabtedrmes $ 8. Was them life insurance payable to the partnership upon the death of the decedent? [] Yes If yes, Cash Surrender Value $ Net proceeds payable $ 9. Did the decedent sell or transfer an interest in this par'mership within on'e year prior to death or within two yearn if the date of deeth was.prior to 12.31.827 [] Yes [] No Ifyes, r-] Transfer [] Sale Percentagelrandarre~sold Transferee or Purchaser Consideration $ Date Altach a separate sheet for add'dJonal bansfem and/or sales. 10. Wes them a writtan partnership agreement in effect at the time of the decedent, sdeath? r'-] Yes [] No If yes, provide a copy of the agreement. 10, Wes the decedenrs partnership interest sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 11. Wes the pa~ership dissolved or liquidated after the decedant's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12 Was the decedent retated to any of the partners? [] Yes [] No Ifyes, expiain 13. Did the partnership have an interest in other cor~s or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule O-1 or 0-2 for each interest A. Detailed calculations used in the valuation of the decedont's partnership interesL Et. Complete copies of financial statements or Federal Patna'ship Income Tax ~ums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete eddress/es and estimated fair market value/s, If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedenrs partnership interest. REV-1507 EX+ {I-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE D MORTGAGES & NOTES RECEIVABLE RLE NUMBER I rEM NUMBER All ~,:,~iTy ;o;,,;;y-o~ed ~;~ ~;,;,;. of suwivorship must be ,e_~_n=_ed on Sch,~,,b F. DESCRIPTION TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ O. O0 FILE NUMBER ITEM NUMBER Inciude the proceeds of litigation and the date the proceeds were received by the estate. All property jelatly-evmed walt ~ o1' sundvorship must be diselo~ed on _=~h_.._-du!s F. DESCRIPTION Orrstown Bank - Carlisle, Pa Accfft415731 - Checking Securities America Advisors, Inc Account # RCT 023132 18676.50 shrs Money Market Fund Hoffman Roth Funeral Home. Carlisle Pa - Prepaid Funeral TOTAL (Also enter on line 5, Recapitulation) $ (If ~uie space is needed, instal additional sheets of the same size) VALUE AT DATE OF DEATH 27850.18 18676. 50 2635.00 49,161.68 REV-1509 EX * (1.97) ~ COMMONWEALTH OF PENNS%VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers S. CHEDULE F JOINTLY OWNED PROPERTY FILE NUMBER If an a~ was made Joint within one year of the de~_~ ent~ date of death, it mat be repotted on Schedule $. SURVIVING JOINT TENANT[8) NAME ADDRESS RELATIONSHIP TO DECEDEN'r JOINTLY-OWNED PROPERTY: L.I::I I1=~ DATE OES~a~m iC~i OF PRO~eK i if %OF DATE OF DEATH ITEM F0R JOINT MADE Indude name of ~nandal Inslfl~ and bank acmunt number m. similar k~mtifying number, A~ 0ATE OF OEATH DECD'S VN. UE OF NUMBER TENANT JOINT deed for jointly-held real e~tale. VALUE OF ASSET INT~ n;dEDENT'~ INTERES I TOTAL(Also ent~ on line 6, Recapitulation) $; 0. O0 d, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be c~,~e;.ed and filed if the answer t~ any of queslions I through 4 on Ihe reverse side of Ihe REV-1500 COVER S ITEM DESCRIPTION OF PROf't:R1Y NUMBER INCLUDETHENAMEO~IHEIR/~N~'EREF.,'n. IEIRRELATIOf~ShlPTOi3ECEi3ERrAND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE mE ~A~E O~ m~S~T~ A~AC~ A COPY a= ~e ~=a~ ma p.E~. ESTATE. VALUE OFASSET INTEREST gF ~_ _~,-_.~-) VALUE I. Wacovia Securities, Account fK)44-R7678 - IRA 12025.60 12025.~ 2027.925 shrs Dryden High YId Fd CI B 2 Wacovia Securities, Account #044-R7678 - IRA 2136.97 2136.9 2136.97 shrs Money Market 3 Thdvent Financial Account ~L3505639 - Fixed Annuity 15573.66 15573.6 TOTAL (Also enter on line 7 RecapitulatJon) $ 29,736.23 ) ~7 (If more ~ is needed, insert additional sheets of Ihe same size) REV-1511 EX+.(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER 2. 3. 4. 5 6. B, 5. 6. 7. Debts of decedent must be reported on Sche~,_,!e ]. DESCRIPTION FUNERAL EXPENSES: AMOUNT Hoffman-Roth Funeral Home Organist - William Hemminger Lunch - St. Paul's Lutheran Church Bethany Guild Funeral Honorariums - Rustic Tavern Family Travel - Susan Grosenick & .Family; Evan Kepner Flowers - George's Flowers ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pemonal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State .. Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State Zip TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, inser~ additional sheets of the same size) 2,802.04 80.00 250.00 150.00 1,791.20 106.00 281.00 $ 5,460.24 .REV-1512 EX - (1-9~') ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN .. RESIDENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE ! DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Personal Tax - Per Capita PharMerica - Medicine Belvedere Medical Center - Physician TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of [he same size) AMOUNT 9.90 128.51 59.86 $ 198.27 CO~IdONWEN.TH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Stanley E. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTNiBUTIONS (include ou~gh{ SCHEDULE J Myers FILE NUMBER NUMBER H. Stephen G. Myers 1449 Robinson Place Yardley, PA 19067 Susan E. Grosenick 2612 N. Laurie St. Appleton, WI 54914 Sharon E. Myers 222 S. Pitt St. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Do Not LI~ Tp?:-'_--:-~$) Son Daughter Daughter AMOUNT OR: SHARE OF E8 lATE 1/3 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER Sh~-r-I NON-TAXABLE Dh~i~iBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART i~- ENTER TOTAL NON-TAXAEP_E DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0. O0 (If more space is needed, insert additional*sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF Stanley E. Myers SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check _~_x 4 on Rev-1500 Cover She=t) FILE NUM~.k Th~ ~hedule is to ~ used ~' all sing~ li~, ~int or. su~ive li~ esta~ and ~ ~r~in ~lculal~s. For da~s of d~th prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actua~al Values, Alpha Volume for dates of dealh on or alter 5 -1-89. Indicate the type of instrument which created the future interest below and attach a copy to the lax retum. ~--) Will I--i Intervivos Deed of Trust [] Other NAME(S) OF NEAREST AGE AT [ElaM* OF ~S LI~ ESTATE LIFE ~E~T(S) DATE ~ 81R~ ' DATE OF D~TH PAYAB~ ~ L~ m ~ Te~ of Yearn ~or~r~Y~ ~ U~m ~ T~ ~Yeam ~ Li~ or ~ Term ~ Yearn pay $ 2. Actuarial factor Per appropriate table Interestteblerate- 1--13 1/2%. 1--16% [] 10% I--I Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) $ NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Ufe or [] Term of Years anm ~/ payable 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Bi-weekly (26) [] Quarterly (4) [] Semi-annually (2) [] Annually (1) 3. Amount of payout per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate Adjustment Factor (see instructions) [] Monthly (12) !-I ( ) Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Une 6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (if more space is needed, i~serl additional sheets of the same size) nEV-,~ EX+ (~,4J I INHERITANCE TAX I .~ SCHEDULE "L" co NIX REMAINDER PREPAYMENT OR INVASION J . OF TRUST PRINCIPAL FILE NUMBER I. Estate of Myers, Stanley E. (Last Name) (first Nome) (Middle Inilkd} This schedule is appropriate onlY for estates of decedents dying on or before December 12, 1982. -'"'--- This schedule is to be used for oil remainder returns when an election to prepay has been filed under the provisiafls of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust pr~al. II. Remainder Prepayment: A. Election to prepay filed with the Register of Wills on (attach copy of election) B. Name(s) of Life Tenant(s) Date of Birth or Annuitant(s) {Date) Age on date of election Term of years income or annuity is payable III. C. Assets: Complete Schedule L-! 1. Real Estate $ 2. Stocks and Bonds $ 3. Closely Held Stock/Partnership $ 4. Mortgages and Notes $ 5. Cash/Misc. Personal Property $ 6. Total from Schedule L-1 D. Credits: Complete Schedule L-2 I. Unpaid Liabilities $ 2. Unpaid Bequests $ 3. Value of Unincludable Assets $ 4. Total from Schedule L-2 Eo F. G. Taxable Remainder value (Line E x Line F) (Also enter on Line 7, Recapitulation) Invasion of Corpus: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth or Annuitant(s) Total value of trust assets (Line C-6 minus Line D-4J Remainder factor (see Table I or Table II in Instruction Booklet) Age on date corpus consumed Term of years income or annuity is payable C. Corpus consumed D. Remainder factor (see Table I or Table II in Instruction Booklet) E. Taxable value of corpus consumed (Line C x Line D) (Also enter on Line 7, Recapitulation) ' ~ INHERITANCE TAX SCHEDULE L-1 CO/~IMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN / REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT _L -ASSETS- FILE NUMBER I. Estate of Myers, Stanley E. ~ (Last Name) (First Name) (Mid~ II. Item No. Description Value A. Real Estate (please describe) Total value of real estate $ ~ (include on Section II, Line C-1 on Schedule ~ B. Stocks and Bonds (please list) -~ Total value of stocks and bonds $ (indude on Section II, Line C-2 on Schedule L~ ~ C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ = (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) ~ ~ Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property' (please list) Total value of Cash/Misc. Pers. Property $ (include on Section II, Line C-5 on Schedule LJ III.. TOTAL (Also enter on Section II, Line C-6 on Schedule L) S 0.00 (If m,~r,~ ~ .... : .... -~_-~ _- . ..... space ~s nee~ d, attach additional 8¥2 x 11 sheets.) REV-164~, EX+ i3,.84J ,~ INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA II"~HERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION .m~mT D~CEDmT -- -CREDITS- FILE NUMBER I. Estate of ~ye~s, 5~a~le~ ~. ~ (Lad Name} (Fird Name} (~ddle In~ia~ II. Item No. ~scrlptien A~t A. Unpaid Liabilities Claimed against Original Estate, and payable fram assets reposed on Schedule L-I (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid B~ues~s payable from assets reported on Schedule L-1 (please list) Total unpaid bequests S - (include on Se~ion II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid b~u~ts lis~ under ~ "B" above) that are not included for tax purposes or that do not form a pa~ of the t~st. Computation as follows: Total unincludable assets $ ~ (include on Sedion II, Line D-3 on Schedule L~ III. TOTAL (Also enter on Section .11, Line D-4 on Schedule L) $ 0.00 more space ~s needed, attach additional 8¥2 x 11 sheets.) COMUONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI~NT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Ch~k Box 4a on Rev-1500 Cover ~.SYATE OF Stanley E. Myers This ~ule is appropr.:a:_a only for a~i~iea of ~aca~n~ d)In~ ar,~ December 12, t982. FILE NUMBER This schedule is tO be used for all future Interests 'where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with ce~inty. Ino~cate below the ~ of inslrument which created the future interest and attach a copy to the tax retum. [] Will [] Trust [] Other I. Beneficiaries 2. 3. 4. NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO - NEAREST BIRTHDAY II. For d__ac~J_ ents dying on or after July 1, 1994, if a Surviving spouse exert;seal or in[ends tO exerdse a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such wi~drawal right. [] Unlimited fight of wffhdrawal [] Um!t~ right of withdrawal IlLExp;-~a.'_;._-.n of Compromise Offer. IV. Summary of Compromise Offer: 1. Amount of Future Interest 2. Value of Line 1 exempt from tax as amount passing tO charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One J-']6%, [-'13%, [] 0% (also include as part of total shown on Une 15 of Cover Sheet) 4. Value of Line 1 Taxable at 6% Rate (also include as part of total shown on Line 16 of Cover Sheet) $ 5. Value ofUne 1 Taxable at 15% Rate (also include as part of total shown on Line 17 of Cover Sheet) 6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line1) (If ~u space is needed, insert additional sheets of the same size) $ 0.00 REV-16dg EX (1-92~ COM/V'~ONWEALTH OF PENNSYLANIA II~HERtTANCE TAX DIVISION ESTATE OF SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DECEDENTS DYING AFTER 12J31/91 Stanley E. Myers FILE NUMBER This schedule must be completed and filed if'you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) .................................................................... 2. Insurance Proceeds on Life of Decedent ..................................................... f ...................... 3. Retirement Benefits ......................... '...i ................................ ? ........................................... 4. Joint Assets with Spouse ................................................................................................. 5. PA Lottery Winnings ...................................................................................................... 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. ~ 6. SUBTOTAL (Lines 6a, b, c, d) ......................................................................................... 7. Total Gross Assets (Add lines 1 thru 6) ........................... i ................................................. 8. Total Actual Liabilities .................................................................................................... 9. Net Value of Estate (Subtract line 8 from line 7) ............................................................... If lime 9 is greater than $200,000.- STOP. The estate is not eligible to claim the credit. If not, cant/hue to Part Ii. nt 3b lc. 2c. 3c. d. Tax Exempt Income ..... ld. 2d. 3d e. Other Income not listed above ........... le. '2e. 3e. f. Total ............ ' .............. lt. 2f. 4. Averaae Joint Exemption Im'nrnA Add Joint Exemption Income from above: (lf) + (20 + (30 = (+ 3) Average Joinf Exemption Income ..................................................................................... __ If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Port III. Insert amount of taxable transfers to spouse or $100,000, whichever is less .......................... 2. Multiply by credit percentage (see instructions) .................................................................. 3. This is the amount of the Resident Spousal Poverty Credit. nclude this figure in the calculation of total cred ts on ine 18 of the cover sheet ............................................. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .................................................................................................. $. Multiply line 3 by line 4 and enter the tara here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. 0.00 I SCHEDULE O '/ ELECTION UNDER SEC. 9113(A Stanley E. Myers FI~ NUMBER ~mpl~e ~is sch~ub un~s ~ ~ ~ ~n~ ~e el~ ~ ~ ~ ~d~ ~n 9~13(A) of ~e bh~ & Es~ T~ ~ ~ If the elec~on applies to more than one trust or similar arrangement, a separate form must be filed for each ~ust. If a lrustThis eleCdon a lies to the Trus! marital residual A, B, s, Unified Credit, etc.. or similar arangemant meets the requirements of Seclion 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferors personal representalive may specifically Identify the trust (all or a fraclfonal po~on or percentage) to be included in the eleclion to have such Irust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar prepmty is included as a taxable transfer on Schedule O, the personal mpresenta§ve shall be ' · · the amount conmdered to have made the election only as to a fracbon of the trust or similar arrangement. The numerator of this fraction is equal to of the trust or similar aTangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the lrust or similar arra~ PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DE$CR~'ION VALUE Part B Total (If more space is needed, insert additional sheets of the same size VN.UE $ 0,.00 Part A Total PART B: Enter the descd_ption and value of all interests included in Part A for which the Section ~ election to tax is bein. g_~.ade~ DESCRIPTION March ,I, 2004 Jennifer L. Buehler Financial Advisor |ennifer. buehler~wachoviasec~com Shelly A. Weibley Registered Account Administrator shelly, weibleyC~wachovtasec.com Sharon E. Myers 222 South Pitt Street Carlisle, PA 17013 Please be advised that as of.lanuary 24, 2004, Stanley E. Myers maintained an account at Wachovla SeoJdUes: Titled: Stanley E. Myers IRA Accxxmt #: 044-R76783-J5 Opened: Sept. 11, 2002 Value a/o Value a/o 0uantitv ~ 1/P~/04 1/~/0- 2027.925 Oryden HighYId Fda B $12,025.60 $12,005.32 Symbol: PRHYX 2136.97 Money Market Funds $2,136.97 If you need help with anything else, please don't hesitate to call. $2136.97 Register~ Account Administrator THI~ INFORMATION CONTAINED HEREIN HAS BEEN OBTAINED FROM SOURCES BELIEVED RELIABLE BUT NOT NECESSARILY COMPLETE AND CANNOT BE GUARANTEED. THIS REPORT IS klOT THE OFFICIAL RECORD OF YOUR ACCOUNT. YOUR /VACHOVlA SECURITIES CLIENT STATEMENT IS THE OFFICIAL :{ECORD OF YOUR ACCOUNT. Thrivent Financial for Lutherans,. March 5, 2004 Sharon E Myers 222 S Pitt St Carlisle, PA 17013-3814 Richard M. Clapp, ChFC [UTC~ FI, Financial Consultant ' ' 401 E. Louther St., Suite 221 Carlisle, PA 17013-2647 Office: 717-245-9515 Toll-free: 800-662.8704 Fax: 717-243-4152 Home: 717-258-4440 richard.clappOthrivent, corn Member- M/Ilion Do#or Round Table Member. NAIFA Dear Sharon: Sharon, per your request, the following data is representative of the three funds at the time of death. Contract #3505639 fixed annuity value was $15,573.66; Contract #1752214098 shares of 2,846.18, price of $30.07, value of $85,584.63; Contract #2550414146 sharos of 3187.252, price of $6.82, value of $21737.06. If you need any further information, please call. Also as the estate is being settled with you and your siblings, I would like to offer my financial services in planning your use of the settlement. Please advise if I could assist you in that process. Sincerely Richard (Dick) M Clapp, ChFC, LUTCF, FIC Financial Consultant 401 E Louther Street Suite 221 Carlisle, PA 17013-2647 Richard. Clapp~}Thrivent. Com ASHELL Main Offices: Appleton, Wisconsin, and Minneapolis, Minnesoto * www. thrivent, corn Registered representative for securities offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 554tS-1665, 800-847-4836, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member NASD. Member SIPC. ~aron Myers - RE: Account values as of 1124104 To: Date: Subject:. "Jay Wegner" <.lWegner@saionline.com> 'Sharon Myers" <Smyers@pahousegop.com> 3/4/2004 3:11 PM RE: Account values as of 1/24/04 EGIAX $ 22.08 x 186.250 shares = $ 4,112.40 FRBAX $ 42.21 x 920.242 shares = $ 38,843.41 OPSIX $ 4.28 x 3129.107 shares = $13,392.57 Money Market $18,676.50 Total value $ 75,024.88 Should you need any further assistance please feel free to send me an e-mail or call me at the number listed below. Sincerely, ]ay D. Wegner Investment Advisor Representative 800-747-6111 Ex'c 2282 Securities America Inc., a Registered Broker/Dealer, Member NASD/SIPC. Advisory services offered through Securities America Advisors, Inc., an SEC Registered Investment Advisory Firm. file://C :LDocuments%20and%20SettingsLsmyers~Local%20Settings\Temp\GW } 00001 .HTM 3/4/2004 (A) OUR SERVICE: BASIC SERVICES OF FUNERAL DIRECTOR & STAFF ..... $ al · .hl.nerll With vleMng, you may have to pay for embalming, You d~ not hive t~ IMy Itzr embllmlng y~u did not approve If you ~eleM arrangemanta auah aa a dlreet ~remetlon or Immediate burial. If we ~har~ed for amlmlm. lng. we Will explain why below. i REASON FOR EMBALMING: OTHER PaEP*RAT~3N OF THE BODY ................. $ USE OF FACILITIES, 8'rAFF & EQUIPMENT: Funmgl Ceremony ( C. oM,d.d .. F~.,M )~,m ) .............. $_ Visitation / Viewing ( C:o.dumd I r..n.ml mm. ) .............. $ Memorial Service ( c(,.d,~.d M FUMM i.(.m ) ............... USE OF STAFF AND EQUIPMENT: Funeral Ceremony ( ~ ,d .,1caw f, mlty } ............. $ Vis#arian / Viewing ( CaM.md -, ~.Mw f.d~) ............. Memorial 8e~e ( C..,*,,M..,atwhdiy ) .............. $ TRANSFER OF REMAINS TO FUNERAL HOME (MfI~ Tmnmorted) ..... AUTOMOTIVE EQUIPMENT: ........................ $ Ca.et Coach (Heame) ............................. $ Rower Car ..... Family Car (Eight Passenger Llmoultne) ............... $ Lead / Clergy / Errand Car ........................... MISCELLANEOUS MERCHANDISE: Ackno~edgm.m Card. ............................. $ Vlsitom Register .................................. $ Memodal Foldem .................................. $ ..~ $ CASKET. ............ $ au', e. BU, RIAL CONTAINER (Aa Selected) ~ R~,~taule (other than casket) ~ Weadng Apparel FORWARDING OF REMAIN~ TO ANOTHER FUNERAL HOME ............ ' ........... RECEIVING OF REIvt~IN8 FROM ANOTHER FUNERAL HOME ....................... $-7 PA. $ $ DIRECT CREMATION (AS ~elanted)............................................ $~ IMMEDIATE BURIAL (As Belanted) $ Tot~(A) $~ (C) OTHER ITEMS: Total (B) $ / ~'~-~ Total (C) $ LESS: PreneedAdJummant/AIIowanee [] INS [] 'iR Payment / Date ( ) Other (Specify) I Date .-9-~'.//5' '~'"'*~/ ~'-'~'~' Age l · of person arranging sewices. Total (A) & (e) $ Total (A) (e) & (C $( ) $( ) $(- ) BALANCE $ )~ CEMETERY, CREMATORY OR OTHER REQUIREMENTS COMPELLING THE PURCHASE OF ANY ITEMS LISTED .~fa'~lo"ed Pu"MN~.) ~'eby mtuttoth, fo.?~ (~) ~V. d~ daf.o* detested. (~) I/Wewere W l Cllke~ Pries ( ) ( ) autlm~b~e embllmto oftheeb '-'-.- ~ enwer Nlection of lendees end merclmnm~l~ I ,-, ~ ,-m upon me esgmnlng of a dbeUllion of TERMS: Net due 30 days. A charge of 1B% per annum for unanticipated late payment will be charged on any amount unpaid after due data. Pumha~er(e) agrees to pay reaeonable attorney's fees, court costa and other costs of collection if incurred in the collection of this daM. I, Or We, ~urchaser lmm lot one or mom copy of this contract is ~reet Address 5.8, No. City State Zip Code Signature of Pumhaser(s) ~reei A~,~a City and State Zip Code Signature of PunY~aser(s) ~tf~lt A~.,,~i,,,~ City and State We agree m provide Ihe ~mvlM & memhandlse incllcated above. Zip Code February 23, 2004 Sharon E. Myers 222 South Pitt St. Carlisle, PA 17013- The Funeral Service for Stanley E. Myers Hoffman-Roth Funeral Home, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 14204-19 We sincerely appreciate the confidence you have placed in us and will omt~ to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. ' THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MI~R~HANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: CREMATION PACKAGE # 4. FACILITY, STAFF, EQUIPMEI~T ................. ' Graveside Service. FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: Veteran Urn Vault. Acknowledg~nnent C~d~ ..................... $650.00 Memorial Folders ..................... $20.00 $25.00 THE COST O1~ OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED ............... $2535.00 Cash Advances Newspaper Obituary Notice_Patriot News. Certified Copies of Death Certificates. $247.04 ................. $20.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $267.04 $1650.00 $190.00 $1840.00 Total Total Cost History 01/30/2004 Homesteaders Insurance Company 02/23/2004 Cumberland County VA ............... 02/23/2004 Discount Received .................. TOTAL A~OUNT DUE This statement is net and payable in full within 30 days of receipt. $2802.04 $-2620.20 $-100.00 $-14.80 RECEIPT FOR PAYMENT umberland_Coun~y - Register Of Wills anover and Hiqh Street Carlisle, PA ~7013 Receipt Date Receipt Time Receipt No. 2/04/2004 08:50:55 1035473 FPfERS STANLEY E File Number '.,.Remarks 2004-00108 SHARON E MYERS AC Transaction Description PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE Check# 958 Total Received ......... Distribution Of Receipt Pa~nnent Amount 235.00 12.00 24.00 10.00 Payee Name CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D 281.00 281.00 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2004-00108 PA No. 21-04-0108 ESTATE OF MYERS STANLEY E (Lu/~'£', ~'I~'I','M±~) Late of CARLISLE BOROUGH uuMBE~k~_ND CuuN'l'z, Deceased Social Security No. 179-12-5343 WHEREAS, on the 4th day of February ~ted November 3rd 1999 2004 an instrument ~s admitted to probate as the last will of MYERS STANLEY E (l-d~'l', ~'£~'1', MI~) ~te of CARLISLE BOROUGH , CUMBERLAND County, who died on the ~4th day of January 2004 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify lat I have this day granted Letters TESTAMENTARY MYERS SHARON E ~ my Office the has duly qualified as Executor(rix) has agreed to administer the estate according to law, all of which fully ~pears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, ~RLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal 4th day of February 2004. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) WAYlqE F. SHADE Altomey at Law 53 West Pomfr~ Street Carlisle, Pcrmsylvania 17013 LAST WILL AND TESTAMENT I, STANLEY E. MYERS, of the Borough of Carlisle, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my personal representative or representatives, hereinafter named, as soon as conveniently may be done after my decease. I further authorize my personal representative to expend funds from my Estate in such amounts as my personal representative shall consider appropriate, for the disposition and memorial of my remains. SECOND. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my wife, SARA G. MYERS, if she survives me. THIRD. For the purposes of this my Last Will and Testament, a person shall not be deemed to have survived me unless he or she shall have survived me by more than ninety (90) days. FOURTH. If my wife, SARA G. MYERS, should fail to survive me, I give, devise and bequeath the said residue of my Estate unto such of my issue who shall survive me, in equal shares by representation and not per capita. In the event that any person who WAYNE F. ~HADE Attorney at Law 53 We$~ Pomftet Street Carlisle, Pennsylvania 17013 is entitled to a share of my Estate shall be a minor at the date of distribution of my Estate, I order and direct that his or her share may be distributed to the Guardian of the minor or deposited in the name of the minor in a savings account fully insured under the Federal Deposit Insurance Corporation, its successors or assigns, until the minor attains the age of eighteen (! 8) years. FIFTH. I order and direct that any estate, inheritance or similar tax due as a result of my death with respect to any property passing as a result of my death, shall be paid from the residue of my Estate before its division into shares and prior to distribution as an expense of administration and that no part of the taxes should be prorated or apportioned among the persons or beneficiaries receiving the taxable property. It is my express intention that all inheritance taxes imposed as a result of my death be paid from the residue of my Estate whether or not the property passes under my Last Will and Testament. My personal representative shall have full power and authority to pay, compromise or settle any such taxes at anytime whether with respect to present or future interests. SIXTH. Any and all decisions, determinations or actions made or taken by a personal representative or Trustee hereunder, if made in good faith, shall be final and conclusive on all persons who are or may become interested in my Estate. No fiduciary acting under this my Last Will and Testament shall be liable for any error in judgment or' for any depreciation or reduction in value of any Estate or Trust assets at anytime, in the absence of willful default. LASTLY. I nominate, constitute and appoint my wife, SARA G. MYERS, to t ihe Executrix of this my Last Will and Testament, but if, for any reason, she should fai qualify as such Executrix or decline or cease so to serve, I nominate, constitute and appoint my children, SHARON E. MYERS, STEPHEN G. MYERS and SUSAN E. GROSENICK, as successive alternate personal rePresentatives hereof, all to serve without bond. The order of designation of my alternate personal representatives is onl) for the purpose of convenience and should not be regarded as any form of partiality. IN WITNESS WHEREOF, I, STANLEY E. MYERS, have hereunto set my ban4 and seal to this my Last Will and Testament which consists of five (5) typewritten page: to each of which I have affixed my signature, this 3rd _ day of November · , A.D. One Thousand Nine Hundred Ninety-Nine (1999). st s The preceding instrument, consisting of this and four (4) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by STANLEY E. MYERS, the Testator therein named, as W^Y~E F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, P~nn.nylvania 17013 -3- Last Will and Testament, in the presence of us, who, at his request, in his presence, in the presence of each other, have subscribed our names as wimesses hereto. Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) I, STANLEY E. MYERS, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge thai signed and executed the instrument as my Last Will and Testament and that I signed willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affuxned and acknowledged before me by STANLEY E. MYER~ 3rd day of blovember j 1999. Stanley E. Myers WAYNE F. SHAD~ Attom~ at Law 53 Wcst PomfrCt St~c~t Carlisle, Pcnnsylvania 17013 Notary Pub~ Notarial Seal Connie J. Tdtt, Notary Public Carlisle, Cumberland County My Commission Expires Oct. 5, 2000 Affidavit COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: We, Wayne F. Shade and Christopher C. Houston ,the witnesses whose names are signed hereto, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instmmer as his Last Will and Testament; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness iJ the hearing and sight of the Testator signed the Will as a witness; and that, to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Wayne F. Shade and Christopher C. Houston __~ day of November , 1999. , witnesses, this iXlotary P .~lic ;and Courtly 's Oct $, WAYm~ F. SHADE Attorney ~t Lnw 53 W~st Pomfret Cnrlkqle, Pennsylvania 17013 -5- Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Stanley E. Myers DateofDeath: January 24, 2004 Will No. 2104-0108 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 March 22, 2004 : Name Address Stephen G. Myers 1449 Robinson Place, Yardley, PA 19067 Susan E. Grosenick 2612 N. Laurie St., Appleton, WI 54914 Sharon E. Myers 222 S. Pitt St., Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A Date: Signature Name Address Sharon E. Myers 222 S. Pitt St. Carlisle, PA 17013 Teleph°ne (xx) (717) 241-0919 Capacity: XX Personal Representative/ Executrix Counsel for personal representative BUREAU OF ZNDZVZDUAL TAXES ZNHERZTANCE TAX DZVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 SHARON HYERS 222 S PZTT ST CARLISLE PA 17015 CONNONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTZONS AND ASSESSNENT OF TAX RE¥-15¢7 EX AFP C01-05) DATE 05-05-2004 ESTATE OF HYERS STANLEY E DATE OF DEATH 01-24-2004 FILE NUHBER 21 04-0108 COUNTY CUHBERLAND ACH 101 Amoun~ Rem/~ed HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLZSLE, PA 1701:5 CUT ALONG TH]:S LINE ~- RETAZN LONER PORTZON FOR YOUR RECORDS -~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF HYERS STAHLEY E FZLE NO. 21 04-0108 ACN 101 DATE 05-05-2004 TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1} 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Per~nership Zn~aras~ (Schedule C) ($) ~. Nor~gages/No~as Receivable (Schedule D) (~) 5. Cash/Bank Depos/~s/Nisc. Personal Propar~y (Schedule E) (5) 6. Jo/n~ly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule O) (7) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Cos~s/Nisc. Expenses (Schedule H} (9) 10. Deb~s/Hor~gaga Liabili~ias/Liens (Schedule Z) (10) 11. To,al Deductions 12. Na~ Value of Tax Ra~urn 00 1651670.07 O0 O0 49~161.68 O0 29~756.25 5,460 198.27 (11) (12} 13. NOTE: ASSESSNENT OF TAX: 15. Amoun~ of L/ne 1~ a~ Spousal rate 16. Amount: of L/ne lq ~:axable a~ L~naal/Class A ra~e 17. Amoun~ of L/ne lq e~ S/bl/ng ra~a 18. Amoun~ of Lin~ lq ~axable a~ Colla~eraZ/CZass B rate 19. Principa~ Tax Du~ TAX CREDZTS: PAYflENT RECEZPT ~ DZSCOUNT DATE NUHBER ZNTEREST/PEN PAID (-) 05-22-200~ CDO0~70~ 5~.05 Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Ne~ Value of Es~a~e Subjec~ ~o Tax (1~) Zf an assessment was issued prsviously, lines 14, 15 and/er 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. (15) .00 X (16) 236,909.q7 x (17) .. X (ts) ~0 x AHOUNT PAZD ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. NOTE: To /nsura proper cred/~ ~o your account, subm/~ ~he upper por~/on of ~h~s form ~/th your ~ax payment. 10,660.95 242,567.98 5.6~8.51 256,909.47 .00 256,909.47 18 and 19 will ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.) 555.05CR .00 555.05CR 11,195.98 TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE O0 = .00 045 = 10,660.9:5 1~ '~' O0 15~ = ~?:: ": .00 (:]~t&) = 1:0,660.9:5 · ~,, ,', RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTZONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collatmral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S. Section 9lqO). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Make check or money order payable to: REGISTER OF HXLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax"' [REV-IS13}. Applications are available at the Office of the Register of Rills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-aOO-qq7-3OZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, Harrisburg, PA 17128-10Z1, 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 Review Unit, Dept. ZB060i, Harrisburg, PA 171Z8-0601 Phone (717) 787-6503. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is alloeed. The 15Z tax amnesty non-participation penalty is computed on the to"al 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 I, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .OOO16q. AIl 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 2004 are: Interest Daily Tnterest DaiXy [nterest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lO7. .0005~8 1988-1991 XXZ .000301 ~ 97. .OOOZq? 1983 167. .000q58 199Z 9Z .0002~? ZOOZ 62 .00016~, 1984 117. .000301 1993-1994 77. .00019Z ZOO3 57. .000137 1985 132 .000356 1995-1998 92 .000247 ZOO~, ~Z .000110 1986 IOZ .O00Z7~, 1999 7Z .O0019Z 1987 ZOZ .O0027~ ZOO0 72 .00019Z --Znterest is calculatmd as follows: /NTEREST = BALANCE OF TAX UNPATD X NUtlBER OF DAYS DELZNI~UENT X DAZL¥ I'NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen lIS) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. BUREAU OF ZND/V/DUAL TAXES INHERITANCE TAX DIVISION DEPT. ZBn601 HARRISBURG, PA 1712:6-0601 COHNONNEALTH OF PENNSYLVAN/A DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-I;07 EX &FP (01-05) SHARON HYERS ZZ2 S PITT ST CARLISLE PA 17015 DATE 06-Zl-ZO0q ESTATE OF HYERS DATE OF DEATH 01-Zr*-200~ F'rLE NUHBER 21 0~,-0108 COUNTY CUHBERLAND ACN 101 I Amount: Rem/*l:*l:ed STANLEY E HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF NILLS CUH]IERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credi~ ~o your accoun~:~ submi~ ~he upper por~:ion of ~hls form wi~h your ~:ax payment. CUT ALONG THIS LINE ~-- RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) .## 'rNHER'rTANCE TAX STATEHENT OF ACCOUNT .~. ESTATE OF HYERS STANLEY E F/LE NO. 21 0c~-0108 ACN 101 DATE 06-Z1-200~ THTS STATENENT 'rs PROV/DED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN 'rN THE NANED ESTATE. SHO#N BELON TS A SUNHARY OF THE pR'rNC.rPAL TAX DUE, APPL'rCAT'rON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, 'rF APPL'rCABLE, A PROJECTED 'rNTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-05-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 10,660.9:5 PAYHENT RECEIPT DISCOUNT (+) DATE NUHSER INTEREST/PEN PAID (-) 0:5-2Z-ZO0~ 06-OZ-ZOOR CD00:5705 REFUND 533.05 .00 IF PAID AFTER TN.rS DATE, SEE REVERSE S.rDE FOR CALCULAT.rON OF ADD.rTIONAL 'rNTEREST. ( IF TOTAL DUE 'rS LESS THAN $1, NO PAYNENT 'rS REQU'rRED. 'rF TOTAL DUE 'rS REFLECTED AS A 'CRED'rT" (CR), AHOUNT PAID 10,660.95 53:5.05- TOTAL TAX CREDIT 10,660.9:5 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR 'rNSTRUCT'rONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Zf RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RES/DENT DECEOENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CA]: A refund of a tax credit, ehich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices or free the Department's ZG-hour answering service far fores ordering: [-800-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: [-BOg-Gq7-$OZO [TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 18060[, Harrisburg, PA 17118-060[, phone (7[7) 787-650S. DZSCDUNT: If any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The lSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, [996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to tho date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of six (61) percent par annum calculated at a daily rate of .000166. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate #hich will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2006 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1981 201 .O00Sq8 1988-1991 llZ .000301 Z001 1983 161 .000638 1992 91 .000167 ZOOZ 1986 111 .000301 1993-1996 71 .O00Zez 20D3 198S 131 .0003S6 1995-1998 91 .000267 2006 1986 IOZ .000176 1999 7Z .OO019Z 1987 91 .000167 2000 81 .000119 Interest Daily Rate Factor 91 .000267 61 .00016q 51 .000137 61 .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent aill reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. Tf payment is made after the interest computation date shoHn on the Notice, additional interest must be calculated. Cumberland County - Register Of wills One C?urthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/16/2005 MYERS SHARON E 222 S PITT STREET CARLISLE, PA 17013 RE: Estate of MYERS STANLEY E File Number: 2004-00108 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS I COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/24/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~ ~~^" i gA'z .. AI # .11 . ~ v~A;tu!:",,__/ j,,"VU"'~~ GLENDA FAJli~ER STRASBAUvH REGISTER OF WILLS ~ cc: File Counsel Judge ~ ~ r.::-r'~'...).. f~f ~ v\ J,:,,~ ""''1 ~~ ~J ~ ~ _ ----= _."_ ___~. ~,A~~r.T~ilii _ _e r.1_____:1_ __.....i'i ___....3 .0_...............,..!!-_ ~.~Sc~.!1~ltt:;.!r tV! 'ij~ lLl!.lL~ OJ!. ~1Ui.llldl.lU)U:::l.L-.!I."Jl.!J..\UL \J.....AU)!L:lJj,lJ.ll....,'V STATUS REPORT TJl\iTIER RlTLE 6.12 Name of Decedent: MYERS, STANLEY E. Date of Death: 24th day of January 2004 Estate No.: 21-04-0108 . Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes Iik No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N / A 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a fmal accou...-ri.t with the Court? . Yes fiI No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: 21-04-0108 c. Did the personal representative state an account infonnally to the parties in interest? Yes 0 No ~ Formally c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~~' ~ft(lVL ~, ~~ Signature Date: 01/19/2006 Sharon E. Myers Name 222 S. Pitt St., Carlisle, PA 17013 Address 717-241-0919 Telephone No. ~"~~---~.I......, VV 1 n . ~ va..1..li:lvlLY. ~ PerSG:LlaJ. .r'....epresenI2..~i.\Te o C~:ol.lD.sel fOT personal representative \\1/ WHEREAS, on the 4th dated November 3rd 1999 was admitted to probate as the last will of MYERS STANLEY E (LA::i'l' , X"l1<.::i'l' , IVllLJLJLt.;) late of CARLISLE BOROUGH Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2004-00108 PA No. 21-04-0108 ESTATE OF MYERS STANLEY E (LA::i'l' , X'l1<.::i'l', 1"11LJLJLt.;) Late of CARLISLE BOROUGH L:UlVIHt.;1<.LAl\ILJ LUU.N'l'Y, Deceased Social Security No. 179-12-5343 day of February 2004 an instrument CUMBERLAND County, who died on the 24th day of January 2004 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for the County of CUMBERLAND in the ,Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to MYERS SHARON E who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 4th day of February 2004. I J"Jt~ /~:'/Z'~E"/ 44{4f~':Y i" (' ,/" eg l s er 0 II s - -- /'?C,/t:../ fiG' k~L...J'~/ * *NOTE* * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)