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04-0244
Register of Wills Cumberland County, pennsylvania PETITION FOR GRANT OF LETTERS Estate of Nelson L. Viedng, Jr. No...~/--43 4//' _~-'~'~/ also known as. , Deceased Social Security No. 161-32-5768 Kimberly Ann Shumaker, {COMPLETE "A" OR "B" BELOW:) mm A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix named in the Last Will of the Decedent, dated October 15~ 1999 and codicil(s} dated n/a Except as follows, Decedent did not marry, was not divorced, and did not have s child born or adopted after execution of the documents offered for probate; was not the victim of a killing end was never adjudicated incompetent: B. Grant of Letters of Administration Petitioner[s) after a prooer search has/have ascertained that Decedent left no Will and was survived by the following spouse [if any) and heirs: Name Relationship Residence/ ] (COMPLETE IN ALL CASES:) Attach additional heats if neeessery. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 74 McAIlister Church Road, Carlisle~ West Pennsboro Twsp., Cumberland County, PA 17013 Decedent, then 64 years of age, died' January 19 ,2004. at 74 McAIlister Church Road, Carlislei W. Pennsbo~l~v~sp., Cumberland County, PA Decedent at death owned property with estimated values as follows: {If domiciled in PA) All personal property .......................... :... S 16,000.00 (If not domiciled in PA) Personal property in Pennsylvania ...................... $ (If not domiciled in PA) Personal property in County .......................... $ Value of real estate in Pennsylvania ............................................... $ 85,000.00 Total .......................................................... $ '101 ,DUU.UU Real Estate situated as follows: 88 McAIlister Church Road, Carlisle, W. Pennsboro TWSD.. Cumberland County_, PA Wherefore, Petitioner(s) respectfully-.request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letter~ in the appropriate form to the undersigned: I Signature ^ Typed or printed name and residence I I~~/t~/ (~~ Kimberly Ann Shumaker '"' ~ 101 Eddin~lton Avenue Harrisburg, PA 17111 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and ~°rrect to the best ofthe knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this ~-~'-'~/ day of ° ~.o~,~/.~.Tz~_~.,~,c~,/_~,~.,~zz.¢,~,/~.~ I~mberly A~nt~ll'tJmaker DECREE OF REGISTER Estate of Nelson L. Viering, Jr. Deceased No. also known as Social Security No: 161-32-5768 Date of Death: January 19~ 2004 AND NOW, ~J,,~,~.~,f' /, // , 20 04 , in consideration of the Petition on the reverse side he~eon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~1 Testamentary 1'-I of Administration are hereby granted to Kimberly Ann Shumaker in the above estate and that the instrument(s), if any, dated October 15, 1999 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES etters ........................... Short Certificate(s)..6. ....... $ /~,~'-~ (/ ~' ,oo~.to, o~w.~ - Renunciation .................. Affidavit ( ) ................. $ Extra Pages ( ) ............ $ Codicil .... ' ...................... $ jCp Fee ........................ $ /~-~' ~ Attorney: Mark E. Halbruner, Esquire ln~'ent0ry & Tax Forms... $ I.D. No: .66737 Other.i .................... $ Address: Gates, Haibruner & Hatch, P.C. 1013 Mumma Road, Suite 100, LemOyne, PA 17043 TOTAL ......... ' - $~~'~ Telephone: 717-731-9600 DATE FILED: REGISTER OF WILLS OF CUMBERLAND COUNTY Oath of Witness to Will Executed by Mark Wayne F. Shade, Esquire, a subscribing witness to the Will presented herewith, being duly qualified according to law, deposes and says that testator was unable to sign his name thereto; testator made his mark thereon; testator and deponent were present when testator made his mark; and testator was present when the undersigned signed the Will as wimess. ~ Name eq i? 53 West Pomfret Street "'~ ~"~ " ~ Carlisle, PA 17013 ~ ::~ Address Sworn ~ or af~rned andlii subsC~d before me ~ Mir ch ~ c5 ,2004. Notary Pu~lic Notarial Seal Connie J. Tritt, Notary Public Carlisle, Cumberland County I My Commission Expires Oct. 5, 2004 For the Reg/ster REGISTER OF WILLS OF CUMBERLAND COUNTY Oath of Wimess to Will Executed by Mark Nona I. Sheriff, a subscribing wimess to the Will presented herewith, being duly qualified according to law, deposes and says that testator was unable to sign his name thereto; testator made his mark thereon; testator and deponent were present when testator made his mark; and testator was present when the undersigned signed the Will as wimess. Swom to or affirmed and subscribed before me this q~b~ dayof fi}. t:U-e/3 ,2004. Notfiry Public NOTARIAL SEAL MyCommission Expires: ~[cc r~ ta a r~ ~ q t flOOr] ~U..I~. M_.GARNER, NoIayPt~ic uams~e t:~oro,, Cumberland My Commission Expires Januar~ For the Reg/ster ;'. 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. Local Registrar JAN 2 0 200 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH . _ _ C~N~ OF D~TH r C~ ..... I.~ . I · ~Sa. I C~rland m W Pen~s~ I ( a*~, g~e sheet and num~) mw~ OECEDENT ~ HISPANIC ORigIN? I RACE- Am~n I~ian, 8lack. ~ite et, . ~e~n ~. Werzn~, ,,. ~1 lena ~rrick NAME (Ty~nt) Kll ~rly Sh~er NFORM~TS M~LI~ AD.ESS (St~ ClN"~ ~...~_~ ..... ~ ~=.,~o~o,,,o~,,,o, I,==o~=~,,,,o..._~c ..: ...... ~[z,, Jan. 22, 2~4 I,,~p~r Fra~ford Brick ~~5~~'/~~ I,,,. 014819~ /,~. o~ ~ = Ho~nTRo~h ~eral H~ ~~ ~ DATE FILED (M.~Ty' LAST WILL AND TESTAMENT I, NELSON L. VIERING, JR., of the Township of West Pennsboro, 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 children, KIMBERLY ANN SHUMAKER and NELSON L. VIERING, III, in equal shares. If either of them should fail to survive me, I give, devise and bequeath the entire said residue of my Estate unto the one of them who shall survive me. If both of them 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, per capita and not by representation. WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 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. 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. FIFTH. 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 daughter, KIMBERLY ANN WAYNE F. SHADE ^,or~ey at ~aw SHUMAKER, to be the Executrix of this my Last Will and Testament, but if, for any 53 West Pomfret Street Carlisle, Pennsylvania 17013 -2- reason, she should fail to qualify as such Executrix or decline or cease so to serve, I nominate, constitute and appoint my son, NELSON L. VIERING, III, to be the Executor hereof, each to serve without bond. IN WITNESS WHEREOF, I, NELSON L. VIERING, JR., being physically unable to sign my name, do hereby make my mark in the presence of the undersigned witnesses, this 15th day of October , A.D. One Thousand Nine Hundred Ninety-Nine (1999). NELSON L. VIERING, JR. By: ~3~ (SEAL) Mark The preceding instrument, consisting of this and four (4) other typewritten pages, was on the date thereof signed, sealed, published and declared by NELSON L. VIERING, JR., the Testator therein named, as 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. WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -3- Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) I, NELSON L. VIERING, JR., 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 NELSON L. VIERING, JR., this 15~:h day of October ,1999. NELSON L. VIERING, JR. Mark Notary Pubt~c Notarial Seal Connie J. Tritt, Notary Public Affidavit Carlisle, Cumberland County My Commission Expires Oct. 5, 2000 COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) We, Wayne F. Shade and Nona I. Sheriff ,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. WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -4- Swom to or affirmed and subscribed to before me by Wayne F. Shade and Nona I. Sheriff ,witnesses, this 15th day of October ., 1999. Notarial Seal Connie J. Tritt, Notar~ public Carlisle, Cumberland County My Commission Expires Oct, 5, 2000 WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -5- 05: [i~~ 9?;'. S3.-.i ~. CERTIFICATION OF NOTICE UNDER RULE 5.6(&) Name of Decedent: Nelson L. V£ering, Jr. Date of Death: January 19, 2004 File No.: 21-2004-244 To the Register: I certify that notice of 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 ~, 2004. Name Address Kimberly A. Shumaker 101 Eddington Avenue Harrisburg, PA 17111 Nelson L. Viering, III 349 Braddock Drive Etters, PA 17319 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Mark E. Halbruner, Esquire Counsel for Personal Representative GATES, HALBRUNER &~{ATCH, P.C. 1013 Mumma Road, S~'~ 1~ ~ Lemoyne, PA 17043~r~ ~ zulu. (717) 731-9600 r: '::~" ~.. Dated: March 2.~__ , 2004 . ~ .~ COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003848 SHUMAKER KIMBERLY ANN 101 EDDINGTON AVENUE HARRISBURG, PA 17111 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $2,500.00 ESTATE INFORMATION: SSN: 161-32-5768 FILE NUMBER: 21 04-0244 DECEDENT NAME: VIERING NELSON L JR DATE OF PAYMENT: 04/20/2004 POSTMARK DATE: 04/19/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 01/19/2004 ' TOTAL AMOUNT PAID: $2,500.00 REMARKS: CHECK# 1004 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS IN RE: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF : ORPHANS' COURT DIVISION NELSON L. VIERING, JR., : Deceased. : DOCKET NO. 21-2004-244 DISCLAIMER )~? of ('~ THIS DISCLAIMER is executed on this ,. day. _4-"J'a-'<"~ ,2004, by the undersigned, THERESA A. TUDOR, formerly known as T A A. VIERING (herein referred to as "the Disclaimant"), now of 4906 Golfview Drive, Chattanooga, Tennessee 37411. RECITALS WHEREAS, Nelson L. Viering, Jr. also known as Nelson Leroy Viering (herein referred to as "the Decedent") died on January 19, 2004, while a resident of Cumberla~l~ount~Pennsylvania; WHEREAS, on March 11, 2004, the Cumberland County Register of Wills admitted the Decedent's will to probate and issued letters testamentary to Kimberly A. Shumakc~as executrix of the Decedent's estate; WHEREAS, the Decedent was previously married to the Disclaimant; WHEREAS, title to the real property located at 88 McAllister Church Road, West Pennsboro Township, Cumberland County, Pennsylvania, and also known as Route 5, Box 165, Carlisle, Cumberland County, Pennsylvania (hereinat~er ''the Real Property"), is vested in the Decedent and the Disclaimant, as husband and wife, by virtue of a deed dated October 24, 1977, and recorded on October 26, 1977, in the Office of the Recorder of Deeds of Cumberland County, Pennsylvania, in Deed Book M27, Page 285 (a copy of which is attached hereto as Exhibit "A"); WHEREAS, the Decedent and the Disclaimant were divorced, and on April 6, 1984, the Decedent and the Disclaimant executed a Divorce Settlement Agreement (a copy of which is 444 attached hereto as Exhibit "B") which was filed with the Circuit Court of Hamilton County, Tennessee, Division I, at No. D-51913; WHEREAS, in Paragraph 4 of the Divorce Settlement Agreement, the Disclaimant agreed to execute a quitclaim deed or other instrument necessary to transfer her interest in the Real Property to the Decedent; WI-IEREAS, the Disclaimant has never executed a deed or other instrument transferring her interest in the Real Property to the Decedent; and WHEREAS, the Disclaimant now desires to fully disclaim her interests as surviving joint tenant of the Real Property. NOW TI-IEREFORE, based upon the foregoing recitals and intending to be legally bound hereby, the Disclaimant declares as follows: 1. The recitals above stated are incorporated herein by reference. 2. Pursuant to 20 Pa.C.S. §6201 etseq, and the Divorce Settlement Agreement identified above, the Disclaimant fully and irrevocably disclaims and releases any and all interest in and to the Real Property to which the Disclaimant may now or hereafter be entitled as the surviving joint tenant of the Real Property. 4. The Disclaimant hereby transfers, assigns, and quitclaims the Real Property to the Decedent's estate, and further agrees to sign and execute any documents, instruments or deeds, necessary to complete or confirm the transfer of the Real Property to the Decedent's estate. 5. In accordance with 20 Pa.C.S. §6204(a), the Disclaimant hereby provides notice of this Disclaimer to Kimberly A. Shumaker, Executrix of the Decedent's estate. In doing so, the Disclaimant desires and hereby instructs that the aforenamed Executrix shall file this Disclaimer with 709 445 the Cumberland County Orphans' Court Clerk, the Cumberland County Recorder of Deeds, and any other governmental office or agency as may be necessary from time to time to enforce and effectuate this Disclaimer. 6. By acceptance of this Disclaimer, Kimberly A. Shumaker, as Executrix of the Decedent's estate, hereby acknowledges the notice of this Disclaimer and agrees to file the same with the Cumberland County Orphans' Court Clerk, the Cumberland County Recorder of Deeds, and any other governmental office or agency as may be necessary from time to time to enforce and effectuate this Disclaimer. IN WITNESS WHEREOF, and intending to be legally bound hereby, the Disclaimant has hereunto set her hand and seal the day and year first written above. WITNE~ THERESA A. TUDOR, formerly known as WITNESS (Y "T~H~RESk A. VlERfNG STATE OF ~ · : SS: COUNTY OF ~-~ · On this, the {~ day of ~_/_~( , 2004, before me, a Notary Public, the undersigned officer, personally appeared THERESA A. TUDOR, formerly known as THERESA A. VIERING, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official se~. /~ MY GOMMISSION EXPIRE8 MARCH 18, 2008 EXHIBIT "A" 709 ?~CE 44'7 MADE THE 24th da//o! October in tl~ gear o/our Lord on~ t)wusand ,in~ hu~red seven~-seven (1977). BETWEEN NELSON L. V~RING, JR. and ~ERE~ A. VIERING, humid and wife, of West Pennsboro Township, (R. D. ~5, Box 165, Carlisle), Cumberland Count, Pennsylv~i% parties of ~e ftr~ part, G~rantors , NELSON L. VIERING, JR. and THERESA A. VIERING, husband and wife, of West Pennsboro Township, (R. D. #5, Box 165, Carlisle), Cumberland County, Pennsylvania, parties of the second part, Grantee S; WITNBSSETH, that in ~,~W~mt~n o! One and 00/100 .......... ($1.00) ............... - .............. Dollars, in hand paid, the receipt whereof is h~reby acknowledged, the said grantor Sdo hereby grant and convey to the said grantee s, their heirs and assigns, as tenants by the entireties, ALL that certain tract of land situate in the Township of West Pennsboro, County of Cumberland and State of Pennsylvania, bounded and described as follows: BEGINNING at a point in the center of a Township Road known as T-482, at lands now or formerly of Clair Byers; thence along the center of said road, South 14 degrees 40 minutes East, One Hundred Fifty-three (153) feet to lands now or formerly of Atha B. Blain; thence along said lands, South 80 degrees' West, Two Hundred (200) feet, more or less, to a stake at lands now or formerly of Atha B. Blain; thence still along said lands, North 13 1/2 degrees West, One Hundred Fifty-four (154) feet to a stake at lands now or formerly of Clair Byers; thence along said last mentioned lands, North 80 1/4 degrees East, One Hundred Ninety-seven (197) feet to the center line of a public road known as T-482, the Place of BEGINNING. CONTAINING 0.69 acreS, more or less and having thereon erected a one story frame dwelling house. BEING the same premises which Nelson L. Viering, Jr. and Patricia A. . Viering, husband and wife, by deed dated December 15, 1972 and recorded in the Office or the Recorder of Deeds in and for Cumberland County at Carlisle,. Pennsylvania in Deed Book "A", Volume 25, Page 156, granted and conveyed to Nelson L. Viering, Jr., one of the Grantors herein. THIS conveyance is from husband and wife to husband and wife and therefore : is exempt from Commonwealth of Pennsylvania, West Pennsboro Township and Big Spring School District realty transfer taxes. ' AND the said grantors hereby covenant and agree tha~ they will warrant generally the property hereby conveyed. IN WITNESS WHEREOF, said grantors ha ve hereunto set their hand s and seal s the day and year first above written. ~ ~, ~.,,.. ,! .... t Nelsor~-L. Viering.~Jr~'r ............ ~ ........ .............. I do hereby certify that *.he precise residence and complete post office address of the within named Grantees is R. D. #5, Box 165, Carlisle, Pennsylvania 17013. Attorney for the Gr~ee State of PENNSYLVANIA 'l County of CUMBERLAND ~ ss. On this, the 24th day o~ October ,1977 , be[ore me, the undersigned officer, personally appeared Nelson L. Viering, Jr. and Theresa A. Viering, husband and wife, known to me (or satisfactorily proven) to be the persons whose name s are subscribed to the within instrument, and acknowledged that the y executed the same io~ the purposes therein ] contained. ' i IN WITNESS WHEREOF, I hereunto set my hand and official seal ~ NOtary Public ~rl;sle Cumberland Coun~ .' 'J ."~ ( ~ ". . EXHIBIT "B" tills to be recorded cCand County P A Recorder of Deeds 709 m;E 450 ~-~f~_~l :Sherwin LJiIlia~s' 50~. FAX NO. :7175972417. Ma~. 84 2004'07:23AM P2 "'~- ,' .~'h_.~-1~'"~4 ..lf~:47 HRM CO, c!rRCUIT COU~T ! 4~'21a~ s?o'~ P.O3 ~or t~e purp0s~ partie~ eoncep~g a~ ~.d all marital pro~e~y ~d~,~.r .uppor~ r1~ts, the property owned or be~t~ed rl~J~nab~y eo~ded to · ', Fl*' ' de~or/~ tn ~tl ~eem~nt, eXClUsive o~ tho=~' g~pe~,~ i~s o~ p~raonal a~ tenant~ tn .om~on. ~pon 2be discovery cf any ~h property ~ 'e:i. them par~. he ~ ~he ~hjll pr~ptly nott~ ' o~ ~ ~rty ~out the kn~led~e par~ nagll~ntly ~ wi~lf~ly r~l~ to disel~e to tb~~' ,~o~s=em~tn~ party. 2. P~a~nt to T.~A. 3eetio~ zu~tts to ~* J~sdiot~on ~egardi~ tbla dlv~- ~ t~ righ~ to ~ re~8~e~ed ~ a~ ~t~l~, but I ohoose{.~o~, t~ do uo. ' YOUNG · OOUNIC~Da~ ;' ' 70 1 .151. FROM :S~rwin William$'50~O* FAX NO. :717397241~ May. 04 ~004: 07:~i~AM P3 f'iZ~O-r~J-4~ .l~,q~ IIHff/ tU, (flk~dU~ f CBURT I 423~2¢;J9 ~;70! P. 04 ~oint~ ~ne8 b~ ~e ~tioe located ~ ~cu~&'."::-~', Box 16~, U~ber~nd County, ?e~yiYa~, and con,tatUng of a"~o~e m~d appro~maL~iy oo~ ~cre Zot t~ directed =ut o~ the Pialn~l~ and ';v.~sted ~ully t~ the m~d &o o~td re~ property to ~he ~e~ndent. 9effc~nt ~grees t~ h~d th~ 5. All pm~so~al property belongln~ to the~tl~ ha~ ~m~ dlv~d~d ~nd ~hl p~rttem agree that a~l ~lg~t, title ;nd l~,~re~t 1~ =nd to ,, .~[. C' 2h~eoF. ..'.. ,'. , , ,L '*~" r. o, Box ~ . . ~ :'." '"< ,~, s~A~ O~ ~~, '"3~~''-'' ratE,ed t~e able lua~nt e~ hep f~mo mot ~nd dee~ .~eoti~e the , ,,,,, ~oRr& vou~ , .. ~.!'~'..,, 1500 EX (6 ~0) OFFICtN. USE ONLY COMMONVVEALTH OF REV-1500 DEPARTMENT OF REVENUE D PT. 28O Ol INHERITANCE TAX RETURN F LENU ER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 04 00244 ~=(.4=DI=N~S NAME (LAST, FIRST. AND MIDDLE INITIAL) SOCIAL SECURI3Y NUMBER V~e~4 rig, Jr. Nelson ~. 161-32-5768 DATE OF DEATH (MM-DB-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RE~JF&I MUST BE RLED IN [~JPUCATE wrIH THE 1/19/2004 6/2/1939 REGISTER OF WILLS F APPL~3LE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURr~' NUMBER ~ 1. Original Ratum ~ 2. Supplemental Return [] 3. Remainder Return (date of death pr~r to 12-13-82) ~~ [] 4. Limited Estate ~[~ 4a. Future Interest Compromise (date of death ofter 12-12-82) r'~ 5. Feqoral Estate Tax Ratum Required ~ L~J 6. Deced~lt Died Testate (Attach copy of Will) I I 7. Decedent Maintained a Living Trust (Attach copy of Trust) -- 8. Total NU mba' of Safe Deport Boxes I I 9. Litigation Proceeds Received ~ 10. Spousal Povedy Credit {aa~e o~ de~,h ~aween ~-3~-$ an~ ~.~*m) ~ 11. Election to tax under Sec. 9113(A) {~tach s~ o) THIS SECTION MUST BE CONPLETEO. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION DI'IOULD BE DIRECTED TO: NAME CO~PLE'IE MAILING ADDRESS Mar][ E. Halhrunar, EscAt~re 1013 Mumma ~oa{[, Su4te 100 FIRM ~AME (1t Apgl~ab~) ~tas, Malbrlznter & Hatch, P.C. Lemo~ne, PA 17043 3ELEPHONE NUMBER 717-731-9600 1. Reel Eatate (Schequle A) (1) $52,962.45 2. Stocks and Bonds (Schequle B) (2) $0,00 3, Closely Held Coq3oralion, Peltnemhip or Sols-Proprietorship (3) ~ 0.0 0 4. Mortgages & Note~ Recek. able (Bohequle D) (4) ~0o00 (Schedule E) (5) i 6. J~ o~ed Prop~ (Sc~ale F) (81 $0 · 00 made (Schedule J) (13) 14. Net Value $,,hJe¢t to Tax (Line 12 minus Line 13) (14) $51~, 945.15 ~ INSTRUC~ONS ON REVERBE SIDE FOR APPLICABLE RATES 15. AmountofLine14taxablealthespousaltax ~0.00 x.O 0 ~0.00 rate, or transfe~ under Sec. 9116 (aX1.2) (15) $51,945.15 45 $2,337.53 16. Amount of Line 14 taxable at Ileeal rate x .0 (1 6) t/O.OO $o.00 17. Amount of Line 14 texable at siblleg rate x.12 (17) $o.00 $0.00 18. Amount of Line 14 taxable at collateral rote x.15 (18) $2,337.53 19. Tax Due (19) >> BE SURE TO ANSWER ALL QUES1]ONS ON REVERSE SIDE AND RECHECK MATH ~< Decedent'$ Complete Address: 88 Mc~Al't,:Lmt;o,r Chu~'c~h Ro&d ¢~zl~nd 1. Tax Due (Page 1 Line 19) (1) $2,337.53 2. Cmdits/Payme~ A. Spousal Pove~ Credit $0.00 B. P~r Pa~e~s ~2,500 C. Dis~u~ ~131.58 Total Cmd~s (A + B + C) (2) ~3,631.58 3. IntemsVPenalty if applicab;e D. Interest ~0.00 E. Pena~ ~0.00 Total InteresFPenal~ (D + E) (3) ~0.00 4. If Line 2 is greater than Line I + Line 3, enter the difference. ~is is the OVERPAYME~. C~k box on Page I LI~ 20 to r~st a r~u~ (4) ;29~. 05 5. If Line I + Line 3 is greater than Line 2, enter the difference. ~is is the T~ DUE. (5) ~0.00 A. Enter the interest on the t~ due. (5A) $0.00 B. Enter the total of Line 5 + 5A. ~is is the BAL~CE DUE. (5B) ~0.00 ~ke ~ ~ ~ AG~ PLEASE ~SWER THE FOLLOWING QUES~ONS BY P~ING ~ "X' IN ~E ~PROPRIATE BL~KS a. r~ain the use or income ~ the ~y tr~sferr~; ....................... c. r~ain a r~rsiona~ inter,t; ~ ................................ d. r~eive the promise for lite ~ either ~ts, ~its or without receiving ad~uate c~si~rat[~? ............................ 3. Did d~edent own an "in trust for" or payable u~n death ~nk accent or s~u~ at his ~ her ~th? contains a beneficia~ ~ignati~? ................................ 1013 ~,~- ~a~, Su~e 100 L~e, PA 17043 [7~ P.s. ~ 99~6 (a) (1 .~) (i)]. ,,,v-,= SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ~ DECEDENT ESTATE OF FILE NUMBER Nelson L. viering, Jr. 00244 NUMBER OF DEATH 1. 88 McA11ister Church Road ~52,962.45 Two-story, single-fam/ly level McA11ister Church Road, Township, Cumberla~Ad County, Pennsylvania. Valuation is net Settlement Statement. TOTAL (Also enter on line 1, Recapitulation) $ $52,9 62,45 3w4695 ~.o~) (If more space is needed, insert additional sheets of the same size) REV-150~ EX SCHEDULE E CONIMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Nelson L. Vis=4ng, ~r. 00244 Include the proceeds of litigation and the date the proceeds were received by the estate. NUMBER DESCRIPTION OF DEATH i Ac'lmns County Nat~.onal Bank $7,334.11 Checking Acct. No. 2103737 2 Cash $3,218.87 3 M&T B~nk $6,692.10 C~eck~ng Acct. No. 962716 TOTAL (Also enter on line 5, Re,-~,pit ~,t~!on) $ $17,2 4 5.0 8 3Wd6AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1551 EX + (12-g~) , SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX REI~JRN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Nelson L. Viering, Jr. 00244 Debts of decedent must be reported on Schedule I. iTEM NUMBER DESCRIPTION AMOUNT A. FUNEP, N- EXPENSES: 1. Hoffm~-Roth Funeral Home, funeral goods & services $6,940.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions $4,000.00 Name of Personal Representative(s) Ki~a]oerl~r A. Shl,tata.~:er Social Security Number(s) / EIN Number of Personal Reprasontative(s) Street Address 101 E~:Lngton Avenue City Harrisburg State PA Zip 17111 Yeer{s) Commission Paid: 2004, 2. Attorney Fees $4. 000.00 3. Family Exemption: (If decddent's address is not the same as claimant's, attach e~olanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent 4. Probate Fees $300 o 00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Cumberland County Recorder of Deeds fee for ~otocopy of deed and recording disclaimer $28.50 Tote1 fro~ con~inua~on pages $2,607.92 TOTAL (Also enter on line 9, Recapitulation} l $ $17,877.00 3W48AG 1.000 (If more space is needed, insert additional sheets of the same size) Schedule H part 2 (Page 2) Estate of: Nelson L. Item No. Description Amount 2 ~,~erla~d Law Journal ~Lblicetion fee $75.00 3 Deborah W. Piper, Tm Collector 2004 re&l estate taxes (co~bined school ~ c~ty =~ bills) $1,189.12 ~stage ~d f~ tran~ssion fee $16.05 5 Patriot-News D~lica~on fee $236.17 6 PP~L electric utility se~ice $132.56 7 Register of Wills filing ~ee for ~isclaA~r $9.00 8 Sb,,~er J~i~or~al Se~ice la~ ~inten~ce for ~r~l 2004 - Septet 2004 $618.00 9 U.S. Pos~ Office ~s~age $3.04 10 York Waste Disuse1, Inc. trash r~val $328.98 Tote1 (Carr~ forward to main schedule) $2,607.92 SCHEDULE I COM~EAL~I OF PENNSYLVANIA DEBTS OF DECEDENT, RESIDENTDECEDENT MORTGAGE LIABILITIES, & LIENS E~TATE OF FILE NUMBER Nelion r.. Viaring, Jr. 00244 Include unreimbur~ed medical expenses. N~MBER DESCRIPTION VALUE AT DATE OF DEATH 1. ~,m~erZ and-Goodwi I z Fire emergency medical transport $34.24 2 Fuel Oil Service fuel oil delivery ordered prior to ~ate of ~eath and paid after ~ate of death $279.43 3 PP&L electric utility service $71.71 TOTAL(Also enter on line 10, Rec~?,,l~tion) $ $385.3R 3W46AH 1.000 (If more space is needed, insert additional sheets of the same size) SCHEDULE J BENEFICIARIES ~ATE OF FILE NUMBER RE~ONSHIP TO DECED~ A~UNT OR SHARE ~MBER ~E ~D ~DRESS OF P~N(S) RECEIVI~ P~PER~ Do Not List Tr,,=*~-) ~ E~A~ I TAXABLE DISTRIBUTIONS [include ~tright s~usal distHbuti~s, and tr~sfers under S~. 9116 (a) (1.2)] 101 Eddington Avenue Harris~rg, PA 17111 Daugh=er $25,972. S8 2 Neil L. V~er~ng, III 349 Braddock Dr~ve Etters, PA 17319 Son $25,972.57 ~ DOLLAR AMOUNTS FOR DISI'~IBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON R EV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBU'flONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART #- EN'I~R TOTAL NON-T~ DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~0 · 0 0 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) WARNING: It is iNegal to duplicate this copy by photostat or photograph. COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH C~rland W. Penns~ro ~ 74 McCalister Church R~d ~.,~ ~.b. O1 ~d[ngton Ave., Harrlsbu~, PA 17111 Hof f~n-Roth ~eral LAST WILL ANDTESTAMENT OF NELSON L. VIERING, JR. LAST WILL AND TESTAMENT I, NELSON L. VIEPdNG, JR., of the Township of West Pennsboro, County of Cumberland, Commonwealth of Pennsylvania, being o£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 fonner 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, hereinalter 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 children, KIMBERLY ANN SHUMAKER and NELSON L. VIERING, III, in equal shares. If either of them should fail to survive me, I give, devise and bequeath the entire said residue of my Estate unto the one of them who shall survive me. If both of them 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, per capita and not by representation. ~/AYNE F. SHADE 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. 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 $r 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. FIFTH. Any and all decisions, determinations or actions made or taken by a ~ersonal 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 °fwillful default. LASTLY. I nominate, constitute and appoint my daughter, KIMBERLY ANN ~VAYNE F. SHADE ^~omey~t L~,~ SHUMAKER, to be the Executrix of this my Last Will and Testament, but if, for any ;3 West Porn fret Street Carlisle, Pennsylvania 17013 I reason, she should fail to qualify as such Executrix or decline or cease so to serve, I nominate, constitute and appoint my son, NELSON L. VIERING, III, to be the Executor hereof, each to serve without bond. 1N WITNESS WHEREOF, I, NELSON L. VIERING, JR., being physically unable to sign my name, do hereby make my mark in the presence of the undersigned witnesses, this 15~:h day of Oct:ober , A.D. One Thousand Nine Hundred Ninety-Nine (1999). NELSON L. VIERING, JR. By: .9~ (SEAL) Mark The preceding instrument, consisting of this and four (4) other typewritten pages, ,as on the date thereof signed, sealed, published and declared by NELSON L. VIERING, JR., the Testator therein named, as 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. ~VAYNE F. SHADE Attorney at Law 3 West Porn fret Street ~arlisl~, Pennsylvania 17013 Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) I, NELSON L. VIERING, JR., 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 NELSON L. VIERING, JR., this 15th day'of October ., 1999. NELSON L. VIERING, JR. Notary Pubflc [ .....Notarial Seal J Connie J. Tritt, Notap/Public Affidavit I Carlisle, Cumberland County I My Commission Expires Oct. 5, 2000 COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) We, W'ayne F. Shade and Nona I. Sheriff , 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. WAYNE F. SHADE Attorney at Law Carlisle, Pennsylvania Sworn to or affirmed and subscribed to before me by Wayne F. Shade and Nona I. Sheriff ,witnesses, this 15th day of October , 1999. Notary Pubic Notarial Seal i [ Connie J. Tritt, Notary Public Carlisle, Cumberland County My Commission Expires Oct. 5, 2000 WAYNE F. SHADE add~ea~ o~ ~e ~ n~ed G~teeo ~ ~, D, ~5, B~ 165, C~lislc, __ ~ $~ o! P ~gN~f LVANIA Cmm~ o[ CUIVIBERLAND ~ Oa ~. ~ 24th ~ of Octnber , ~977 , ~efo~a ~ t~ o~, ~o~ ~=eg Nelson L, Vler~g, Jr, ~d ~eresa A~ "%0; ...... HUD - I UNIFORM SETTLEMENT STATEMENT OMB A~groval No. 2502-bzu A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPF~ OF LOAN 6. File Number: 7. Loan Number: 1. FHA 2. FmHA 3. Cony. Unins. 4~ VA 5. Conw [ns. 8. Mortgage Insurance C~se Number C. NOTE: This form is fumisbed to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = Taxpayer's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: Scott S. Hench KimberlyAnnShumakerExecutrix None 251 Sheaffer Road 88 McCalister Church Road Carlisle, , Pa 17013 Carlisle, Pa 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 88 McCalister Church Road Jacqueline M. Verney, Esquire Carlisle,, Pa 17013 44 South Hanover Street, Carlisle, PA 17013 PLACE OF SETTLEMENT L SETTLEMENT DATE 44 South Hanover Street 11/17/2004 ~ Carlisle Pa. 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400._~ GROSS AMOUNT DUE TO SELLER: 101. Contract salc~ 401. Contract sal~ 102. Personal roe -- 103. Setflementchar. gestoberrow~ 402 Personal ro 403. 104. 404. 105. 405. Adiustments for items ai3~~ seller in advance ~tments for its~el~er in advance -- ~own taxes ~n taxes 107~2oun taxes 11 17 2004-12 31 2004 24.00 407. Coun ~xesll 17 2004-12 31 2004 108. Assessments -- __ 2 4.0 0 109. 4~08. Assessments 409. Il0. School Tax 11 17 04-06 30 05 607.45 III-- __ 410~chool Tax 11 17 04-06 30 05 607.45 120. GROSS AMOUNT DUE FROM BORROWER 5 8 51 6.9~ 420 GROSS AMOUNT DUE TO SELLER 5 7 13 1.4 5 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500~ P.~DUCTIONS IN AMOUNT DUE TO SELLER: -- 201. De sitoreamestmonev 2_~000.0--~'-- 501. Excessde osit -- 202. Principal amount of new Ioa~ 502. Settlement char es to seller Line 1400 4 1 6 9.0 0 203. Exisfin~ect to 503. Existin~ect to 204. ~offirst mort a.g.%ge IRan -- 205. ~econd mort agile loan 206, 506. 207. 507. 208. -- 209. 508. -- ~_~stments for items ~r 509. ~ taxes ~wn taxes items ~ller ~axes -- -- 51 I. Couniy taxes 212. Assessments 213. 51__2. Assessments 513. 214. 514. 216. 515. 217. 516. 219. 518, 220. TOTAL PAID BY/FOR BORROWER ~ 520. TOTAL REDUCTION AMOUNT DUE SELLER 4 16 9.0 0 300. CASIt AT SETTLEMENT FROM/TO BORROWER 600, CASH AT SETTLEMENT FROM/TO SELLER 303. CASH FRON BORROWER 603. CASH TO SELLER SELLER'S STATEMENT The information contained in Blocks E, G, H, and 1 and on line 401 (or, if line 401 is asterisked, line 403 and 404) is impormtu tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported, You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civ0 or criminal penalties imposed by law. Under penalties of perjury, I certi~ that the number shown on this statement is my correct taxpayer identification number. (Seller's Signature) KiI~ber lyAnnShumakerExecut rix (Seller's Signature) © EASY SOFT, Inc. 2001 Previous editions are obsolete Page I form HUD-I (3/86) refHandbook 4305.2 L. SETTLEMENT CHARGES ~ 700. TOTAL SALES/BROKER's COMMISSION based on price $ § 6, 5 0 0.0 0 @ 6.0 0 0 % PAID FROM PAID FROM Division of Commission (line 700) as follows: BORROWER'S SELLER'S 701. $ 1, ~20.00 to Ebener & Associates FUNDS AT FUNDS AT 702.$ 1,670.00 to C-21 Piscioneri Realtv, Inc. SETTLEMENT SETTLEMENT 703. Commission paid at Settlement 3, 3 90.00 704. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801 Loan Origination Fee 802. Loan Discount 803. Appraisal Fee to 804 Credit report to 805. Lender's Inspection Fee 806 807. 808. 809. 810. 812. 813 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 902. Mortgage Insurance Premium for 903. Hazard insurance Premium for 904. 905. 1000. RESERVES HEPOSITED WITH LENDER I00I. Hazard insurance 1002. Mortgage insurance 1003. City Property Taxes 1004. County Property Taxes 1005. Annual assessments 1006. 1007. 1008. Aggregate Accounting Adiustmeta 1100. TITLE CHARGES ll0LSet0¢mcntorclosingfeeto Jacquoline M. Verne¥,Esq. 500.00 1102. Abstract or title search to Karen Coon 128.00 1103. Title Examination to I 104. Title insurance binder to 1105. Document preparation to 1106. Nota~' fees to Cash 4.00 4 . 00 1107. Aitorney'sfeestoGates, Halbruner & Hatch {POC) (includes line numbers: 1108. Title Insurance to (includes line numbers: 1109. Lender's coverage $ I 110. Owner's coverage $ 0.0 0 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $ 3 8.5 0 Mortgage $ Release $ 3 8.5 0 1202. City/cnty tax/stamps: Deeds 565.00 Mortgages 565.00 1203. State tax/stamps: Deed $ 565.00 Mortgage $ 565.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey o 1302. Pest inspection to 1303. D&D Septic total $360.00 150.00 210.00 1304. 1305. 1306. 1400. TOTAL ~1~ 1 1LEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 1, 3 8 5.5 0~ ~ 4, 1 6 9.0 0 y UD-I Settlement Statement and to the best of my knowledge and belief, all receipts and disbursements made on my account or by ~e in this transaction. I further certify that I received a copy of the HUD-1 Se~emen SeII~i~ " Nimbler 1 yAnnShuma ke r E>~o cut r ix Borrower .-' Sco~ Seller Borrower Thc HUD-1 Sei~lement Statement which I have prepared is a true and accurate account of thc funds disbursed or to be disbursed by the undersigned as part of the settlement of this transaction. WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. © EASY SOFT, Inc. 2001 Previous editions are obsolete Page 2 form HUD-1 (3/86) ref Handbook 4305.2 PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY NATIONAL BANK June 22, 2004 Kimberly Shumaker 101 Eddington Ave. Harrisburg, PA 17111 Re: Nelson Viering Jr. Dear Ms. Shumaker: The following information is being provided as per your request: Acct. Type Account Account Accrued Ownership Date No. Principal on Interest to Account D.O.D. D.O.D. Opened Checking 2103737 $7,334.11 $.81 Individual 12-23-02 Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)338-2171. Sincerely, Lois Kime Deposit Services ~ ADAMS COUNTY NATIONAL BANK & FARMERS NATIONAL BANK OF NEWVILLE CHECKING STATEMENT Statement Date: 02/12/04 Account #: 2103737 Enclosures: 0 801 Page NELSON L VIERING JR 88 MCALISTER CHURCH ROAD CARLISLE PA 17013 Banking that fits your schedule... 24 hours a day, 7 days a week, 365 days a year! Internet Banking at wwv.acnb.com. check account balances and transactions, transfer funds, and pay bills. Stop by one of our offices for a personal demonstration! ESTEEM CHECKING Account# 2103737 Account Summary Beginning Balance Activity Ending Balance Previous Statement Balance 01/11/04 $7,334.11 + Deposits and Other Credits 1 3,218.87 - Checks Paid or Other Debits ;00- - Service Charges .00- + Interest Paid 4.13 Ending Balance $10,557,11 Days in Statement Period 32 Account Detail Date Activ/ty Description Deposits/C~edits Checks/Debits Balance BEGINNING BALANCE 7,334.11 01-20 CUSTOMER DEPOSIT 3,218.87 I0, S 52.98 02-12 INTEREST PAYMENT 4.13 10, 557.11 02-12 ENDING BALANCE 10,557.11 Interest Summary from 01111/04to 02/12/04 Days in Period 32 Interest Earned $4.13 Annual Percentage Yield Earned .50% Interest Paid This Year $6.94 Interest VV'd:hheld This Year $. 00 END OF STATEMENT PO. Box 3129, Gettysburg, PA 17325 · 888/334-ACNB (2262) 00 2 04319M M 021 NELSON L VIERING JR JACQUELYN MEALS POA 88 MC~/LLISTER CHURCH RD CARLISLE PA 17013-9379 HIGR STREET-CARLISLE ACCOUNT SUMMARY NO. ~OU~ NO. AMOUNT NO. I AMOUNT 6,692.10 0 0.00 2 279.43 1I 3.00 0.00 6,409.67 ACCOUNT ACTIVITY 1015 01-22-04 41.02 1016 01-22-04 238.41 DO YODR TAXES ONLINE WIT~ TURBOTAX(R) FOR THE WEB(SM), BROUGRT TO YOU BY M&TI IT'S EASY AND YOU C~ GET YOUR REFUND FASTER. TBERE IS NO RISK BECAUSE YOU CAM TRY IT BEFORE YOU BUY IT! VIEIT W~;W.MA~DTBAMK.COM/TURBOTAXg. AT M&T, HE'RB COMMITTED TO UNDERSTANDING WRAT'S IMPORTANT TO YOU. ONE OF THE WAYS WE DO TRIS IS THROUGR MAIL, TELEPHONE OR INTEHNET SURVEYS REUAR/DING YOUR SATISFACTION. YOUR INPUT IS CRITICAL AND WE'D APPRECIATE YOUR FEEDBACK. IF YOU EVER QUESTION TRE LEGITIMACY OF AM M&T SURVEY PLEASE CALL US AT 1-800-724-2440. PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS Hoffman-Roth Funeral Home, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-451 l February 6, 2004 Kimberly Shumaker 101 Eddington Ave. Harrisburg, PA 17111- The Funeral Service for Nelson L. Viering Jr. 14201-16 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Pleas, 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 MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package .................. $3590.00 FUNERAL HOME SERVICE CHARGES ............ $3590.00 SELECTED MERCHANDISE: Sterling 18 ga Steel Casket ..................... $1825.00 Cave Proof, Concrete Box lnt Recepc .................. $750.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED ............... $6165.00 Cash Advances Opening Grave. $500.00 Newspaper Obituary Notice- PaYor News ................ $I 1.58 Clergy Offering ........................ $75.00 Certified Copies of Death Certificates .................. $30.00 Flowers ........................... $159.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ $775.58 Total Total Cost .......................... $6940.58 TOTAL AMOUNT DUE .................. $6940.58 This statement is net and payable In full within 30 days of receipt. Please return this portion with your Remittance $, Amount Enclosed Service ID # 14201-16 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 MAY 7, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Mark E. Halbrurmer, ESQUIRE Nelson L. Viering, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: APRIL 23, 30, MAY 7, 2004 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 Total Amount Due $ 0.00 Payment received APRIL 21, 2004 by Becky H. Morgenthal/Executive Director Ii ~ £1ectriCutilities Page 1 : ~: '¥~.*~h~o~at..N~!79140_74004 :']l I Electric Summary Page ~Jc~ ~an~ ~ of~p 17, 2~ $ ~arges: For: ~bI~PL ELEC~IC U2ILI ~ Charg~ $10.20 N~N LVI~ING JR ~ ~C~r~ CHURC~ KD To~ Ch~es $10. A~ount ~an~ ~u~ns a~t is bill? Plea~ coa~ac~ a~ by Oct ~ ~ %%~ at 1-~-5775 or ~omr Se~i~ 827 Hangman Rd. Allentown, PA 181~-9~92 m.pplweb.~m Electric ~wa- Avenge Per Day Meter Re,a~g 15 ISep 17 Aclual 4554 [ Aug 18 ~our elec~ic ~ 130 ~vs KWH Billed over the las113 12 Avenge - Sep 2~ mont~. 9 ~mpemlure 71F 71F ~y~ of KWH Per ~y 11 1 Meter Read.ga: 6 Yearly U~ To~l Average Use Mon~ly A~I I 3 Oct 2(~2 - Sep 2~3 3974 331 ~6mat~ ~ 0 Ocl 2~3 - Sop ~ 3451 288 C~tomcr ~ SONDJ FMAMJ JAS Moaths 2~4 Other important information on back "~ Electric Summary Page Service Balance as orApr 19, 2004 $ 0.00 CharRes: For: Totar'PPl. EI.ECTRIC [YllLYIIES Charges $ 29.86 NELSON L VIERING JR 88 MCALLISTER CHURCH RD Total Charg~ $ 29.86 CARLISLE PA 17013 tQhUcztions about is bill? Please contact us by May 10 ~'1'"::> ~ ..0'rof at 1-800-342-~775 or 484-634-4900 or write to: ~ustomer Service 827 Hausman ~d. Allentown, PA 18t04-9392 www.pplweb.com Electric Kwu- Average Per Day Mete,' Reading Information This graph shows 15 [ Apr 19 Actual 3525 I Mar 18 ~ctual 3249 your electric use 12 132 Days KWH Billed 276 over the last 13 months. Average - Apr 2003 2004 9 T, emperamre 48F 47~ _Types of KWH Per Day 11 Meter Readings: 6 Yearly IJse: Tolul Average Actual I 3 Use Mootblv May 2002 - Apr 2003 4108 34.a5 Estimated ~ 0 May 2003 - Apr 2004 3960 330 Customer F--] AMJ J ASONI).I FMA 2003 Mouths 2004 Other important information on back ~/~, r~c..o~, er ~ po.'rt, i6ii of PPL El~-cli:iiT'{J~Tt'i'//~sfr~,~ile-d'7~,.5~i~ 'Ibc -ross receipts ~aa~n,o/.Wh[ch is collecled for the Commonwealth of P~nnsyl~hnla, is equa/to ~.q ?o ut Ihe ITC. For your conveuience, you can now pay, your J)ill using your Visa, MasterCard Discover, orATM Card. Jail BdlMat~4x it ~-~.ti'7', B.i.llMatrlx will charge your credfl and A~IM card a aery ce fee for makiag th~s paymenl. ~[~w,you can ,ret.ely? and pa× your PI>.L Electric Utilities' bill onl ne .necKour wed site rot more uformatlon slid lo sign up -- www.pplWeb. Coln No charge Convemenl Secure SAVE MONEY ' PPL Electric ~,, - 79140-74004 Electric Summary Page Service Balance as of Mar 18, 2004 $ 0.00 CharRes: · For: TotaFPPL ELECTRIC UTILYIIES Charges $ 27.47 NELSON L VIERING IR 88 MCALLISTER CHURCH RD Total Charges $ 27.47 CARLISLE PA 17013 Account Btdance $ 27~ is bill? Please coutact us by Apr 8 ~ at 1-800--~42-5775 or 484-6344900 or write to,' Castomer Service 827 Hausman Rd. Allentown, PA 18104-9392 m.pplweb.com Electric ~:w.- Average Per Day Meter Readin~ Information Thisillonths.MeterUse gmph Readings: shows 18~1 9 6 [Meter #59033878 15 I Mar 18 Actual 3249 IFeb 18 .A?mal 3004 your eleclric use 129 Days KWH Billed over the last 13 12 Average - Mar 2003 2004 ,'I~e. mpemture 34F 401~ Types of KWH Pe~ Day 13 Yearly Use: Total Average Use Monthly Actual I 3 Apr 2002 - Mar 2003 4070 339 Estimated ~ 0 Apr 2003 - Mar 2004 4013 334 Cuslomer [~ MAMJ JASONI) J FM 2003 Months 2004 Other important infi)rmation on back -'~ 'PL Irlectd¢ . Utillt~ , Electric S,mmary Page Se ice ~ce ~ of Jul 19, 2~ $ 0.~ Ch~ges: For: Tot~PL ELEC~IC U3]LI3]ES ~ges $ ~ L71 N~N L VI~ING JR ~ ~ ~V~C. gO To~ Ch~ $ ~ 1.71 ~5~ PA ~7~3 A~ount Balan~ ~u~s a~ut is bill? Ple~ con.ct us by Aug at 1~.5775 or ~4~ Cu~o~r Servl~ 827 ~usman ~lcmown, PA 181~9392 ~,pplweb.com Elect c ~w.- *verge Per Day Meter Read~g ~formafion Use ~e~r ~5~3878 ~ g~ph shows l Jun 17 Aclual 4116 your elecffie u~ 12 132 ~vs ~er the l~t 13 monks. 9 Average - Jul 2~ 2~4 ~y~ of Terapemmre 75F 72F K~I Per Day 1 ~ 9 Me~r Read.s: 6 Yearly Use: To~ Avenge Actual I 3 U~ Mon~]y Aug 2~2 - Jul 2~3 4022 335 ~timat~ ~ 0 Aug 2~3 - Jul 2~ 3964 3~ C~tomer JASONDJ F~MJ J Months 2~ ....... ~. ...................... Other important information on back ,; ~;d ~ ,' Page 1 I Elm:trig p'pV 79140_74004 Electric Summary Page Se ice ~an~ ~ of Jun 17, 2~4 $ 0.~ Char~es: For: ~bta~PL ELE~IC UTILITIES ~arges $ 33.32 ~ MC~LI~I:~ CHURCH RD To~ Cha~ $ 33.32 Account Bal~ce is bill? Plea~ ~ O conlact us by Jul 8 at 1~-342-5775 or or w~ to: Customer Service 827 ~ausman Rd. ~llentown, PA ~81~-9392 ~.ppl~b.~m Electric ~.- ~ve~ge ~ ~ay ~cter Reading Information 15 [Jun 17 Actual 4116 ~is graph ~hows [ May 18 ~etual your elecffic use ~30 Days KWlt Billed 316 over the las113 12 Average - Jun 2~ 2~4 months. 9 ~mpemtu~ 63F 69F ~y~ of KWH Per ~ay 10 11 Meter Readings: 6 Yea~y U~: ~'Total AveraRe Actual I 3 U~ ~on~]y Jul 2~2 - Juu 2(g~3 4~2 341 ~timaled ~ 0 Jul 2~3 - Jun 2~ 3964 330 Customer ~ J J ASOND ~ FMAMJ Mouths Other important intbrmation on back ~ ne'-n'an,~s~gon'~narge mcnmc~ aw~mang~me ~rmmmar,n'x0nm~c~' [~z c) ~,~u~ the applicable ~r~ ~ip~ t~ which to~ether amounl to $3.v5. ~e ITC s aver usaae c~ar~e av~r~d by the Public Ulility Commi~ion which PPU' ElecinZ Utilities do'llec~ m~gent for PPL Electric Ulilities Transition ~nd Company LLC and which I~at ~mpany u~s to se~i~ debt incu~ed to re~er a portion of PPL Electric Utilihes~ strand~ ~ts. ~e greys ~ivm t~, which is collected for the Commonwealth of Pennsyl~mia, is equaIto 4.4% of the ITC. For vour convellien~, voe can now pavyour bill usiug your Visa, M~terCa~ Dis~er br A~ C~d. Call BffiMa~x at 1-8~-672:2{13. BIHMa~x w charge your credit and A~ crud a se~i~ t~e tbr m~mg this payment. PPL Electric icctric Summary Page ~ B~ance ~q of May 18, 2~ $ Char~es: For: ~Bt~PL ELE(T~IC U~LYII~ Charges $ 29.78 ~ ~c~l.l~ c~vac, ~o To~ Cha~ $ 29.78 A~ount Balan~ ~ueffi~s about is bill.'? Please at 1~42-5775 or or w~te Cus~mer Se~i~ 827 Hausman Allentown, PA 181~-9392 ~.pplweb.~m Use ~8 ~ ~ter ~59~a3878TXmpe~mre ,no,38~]9 15 I May 18 Actual ~is graph shows [ Apr 19 Actual 3525 your el~ic u~ 12 ] 29 Days K~ Bill~ I over the las113 Avenge - May 2~ .004 months. 9 58F 63F ~y~ of KWH Per ~ay 10 Meter Read~gs: 6 Yearly Use: To~l Avenge Actual I 3 U~ Mon~]y Juu ~2 - May 2(~3 4~8 341 ~tima~ ~ 0 Jun 2~3 - May 20(M 3957 330 Customer ~ MJ J ASONDJ FMAM 2003 Moutbs 2004 Othcr important information on back receipts tax, wmcn Is COll~teo Ior the L.ommouwealih o[ relmsylvaula, equa[to 4.4% of the ITC. For your convenieuce you cau uow ~aV your bill usino your Visa M~terC~d I)~ver, or A~ C~. ~all BIIIMa~x al 1 BillMa~x wil charge your credit and A~ card a ~ice fee l~r making thia payment. Now you eau recede and pa~ your PPL Electric Utilities' bill online. ChecKout web sile [~r more iul~rmatiou and to sign up -- ~.pplweb. com ~o charge Couvenleul Secure SA~ MONEY INVOICE YORK NASTE DZSPOSAL; ZNC. PO BOX 140! . YORK; PA 17405 08/02/04 j 535722 30 27962 I I (717) 845-1557 KZH SHURAKER FOR PERIOD: 88 HCCALLZSTER CHURCH RD PAGE NO. I JULY 2004 CARLISLE PA 17013 MO~l( OR~ER~ ~ f;$2749 7/27/04 20 YD PULL r, REHOVAI. 13S.00 7/27/04 FUEL SURCHAROE 7.43 7/27/04 D'rsPO~AL - TON CONST/DEItO 2.:'3 ,SO.O00 Z$3.80 ACCOUNT STATUS PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS Cumberland-Goodwill% WAYPOINTpO BOX 11511BANKFire Rescu ~..~ I-IARRISRURG~ P~ e 74 n~ PATIENT NAME: [~ELSO[q ViERING PATIENT NUMBER: ~4~ NMOt CALL NUMBER: CG~00~ 71 SUP~ '~ R' iNSURANCE: MEDICARE B tB1J~7~A DATE OF CALL: Dt/t0/2OQ4 TIME OF CALL: CALLER: CARLISLE HOSPITAL CG0~0171 FROM: C4RLIS~ REGIONAL MEDIC.AL CTR TO: 74 MCA~S~R CHURCH RD NELSON VlEBN6 74 ~ALLISTER CHURCH RD REASON(S) Re~ir~o~, Digress ~RLISLE, PA ~70i3 FOR Gene~lized Weakness TRANSPORT DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT BLS NON EMERGENCY A0428 1.0 350.00 350.130 MILEAGE CHARGE A0425 8.~ 7.QO 42.QQ O'K¥'G EN A0422 i .0 50.00 50.00 ~o~1 Charg~ 442.~ DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUN"[ Medioare A~gnrrent Adju~,~c~nt I]:3/~]/2~]Cq 270.79 Medic~re Pa~ B PaymerE ! 8539232: 03/10~'20¢.~ i 36 97 Total Credits 407_76 PLEASE PAY THIS AMOUNT =;_ ./ ~ ~ ~: ~ / · Page 1 ppi "' ':--..._ PPL Electric -t-- I 79140-74004 Utilities ' 1 Electric Summary Page Service Balance as of Jan 20, 2004 $ 41.02 For: Total~PPL ELEC~IRIC UTILITIES Charges $ 41.01 ss MCALLI~TER ¢HURCtl RD Total Charges $ 82.03 Account Balance $ 82.03 ~uestioas about contact us by Feb 10 · at 1-800-34~-~77~ or or Write to'. Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 vcww.pplweb.cem Electric Kw.- Average Per Day Meier Reading haformation I Jan 20 Actual 2724 I Dec 18 Actual 2312 This graph shows 133 Days ~ '412 your electric use 12 over the last 13 months. Average - Jau 2003 2004 9 -- .T,e?nperalure 28F 32F T~,pes of KWH Per Day 13 12 Miter Readings: Yearly Use: Total Average Use Monthly Aclual I Feb 2002 - Jan 2003 3984 332 Estimated ~ Feb 2003 - Jan 2004 4225 352 Customer ~ J FMAMJ JASONDJ 2003 Months 2004 Other important infornmtion on back addfl~on, al×mt $3.60 of th~s bill pays the PA Grogs l~e~e~pts ~lhe Trals on Charge includes an lutangible Transitiou Chare. e ([_FC) and the applicab e *,ross ~ece pts tax which together amount to $.4.72. l'h~clTC is a p~r usage charge app. roved by the Public Utility Comm~gsion wh~ 'h PPL Electric Utilities collects as agent for PPL Electric Utilities ~r.aan~t~}1 Bond Company LLC and which teat company uses to service aeot m to recover a pqrtion of PP~,Electric Ut t es' stra ~ded costs. The gross recel ts tax which is collected for the Commonwealth of Pennsylvania, is equa~to 4.4b,& of the ITC. - For your convenience, you can now oavyour bill using your Visa, MasterCard Discover orATM Card. [?all BillMatr/x at 1-800:672-24.13. BillMatrix wil charge your credit and A'IM card a service fee lot mak ng this payment. "- PO Box 280601 HARRISBURG, PA 17128-0601 Telephone October 26, 2004 '04 ' ~'''~ '~': :'! 7 ~,u, -1 i ~: (717) 787-3930 FAX (717) 772-0412 Mark E Halbruner ~'~ - Attorney at Law 1013 Mumma Road Suite 100 Lemoyne Pa 17043 Re: Estate of Nelson L Viering Jr File Number 2104-0244 Dear Sir or Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 04-19-2005. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely~..i~.-.---''~'-'~) , ..,, .' _ ,,' ,:-". ."!. ,~. Claudia Maffei, Supe~i~o~ Document Processing Unit Inheritance Tax Division Register of Wills Dauphin County, Pennsylvania INVENTORY Estate of Nelson L. Vierinq, Jr. No. 21-04-00244 also known as Date of Death January 19, 2004 , Deceased Social Security No, 161-32-5768 Kimberly A. Shumaker, the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvanla except that which appears in a memorandum at the end of this inventory. I/~Ve verify that the statements made in this ~nventor¥ are true and correct. I/V~e understand that raise statements herein are made subject to the penaltlee of 18 Pa, C,S. Section 4904 relating to unsworn falsification to authorities. Name of Pers~al Representative:~ Attorney: Mark E. Halbruner, Esquire --~/ ~.~.-~z~_~_~_ ~"~("2(.~, I.D, No.: 66737 Address: Gates, Halbruner & Hatch, P.C. Dated_ //,/~/~¥ 1013 Mumma Road, Sui~._e 100, _L. emoyne, PA 17043 Telephone: (717) 731-9600 Description Value Real estate located at 88 McAllister Church Road, Carlisle, West Pennsboro Township, Cumberland County, Pennsylvania $52,962.45 Adams County National Bank - Checking Acct. No. 2103737 7,334.11 Cash ¢-) 3,21~7 ~ M&T Bank - Checking Acct. No. 962716 ~2~3 6,69~10 ~.-n t--> Total: $70,207.53 (Attach Additional Sheets if necessary) RW-8 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Nelson L. Viering, Jr. Date of Death: January 11, 2004 Will No.: 21-2004-244 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: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: April 2005 3. If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? N/A B. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A C. Did the personal representative state an account informally to the parties in interest? N/A D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Mark E. Halbruner, Esquire PA I.D. # 66737 GATES, H~BR~ER & HATCH, P.C. 1013 Mu~a Road, Suite 100 Lemo~e, PA 17043 (717) 731-9600 Capacity: Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX ZBD6Dl HARRISBURG PA 171ZB-D6Dl NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARK E HAL BRUNER ESQ GATES ETAL 1013 MUMMA RD STE 100 LE~~VNE PA 17043 ':0 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-01-2005 VIERING JR 01-19-2004 21 04-0244 CUMBERLAND 101 '* REY-1541 EX AFP 112-04) NELSON L Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG'"' 'THIS L:INE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... REV:fJ'li".Ir.A~fL~61-:6!'..NoT.icE.oF.l'N'HER.ifA'rcE.TAi.A.PPRA.fiEirEN'~..A[lowANcE.OR.............. ... '.......... ;;::: c:;;~i;: DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF:qVIERING(-~R NELSON L FILE NO. 21 04-0244 ACN 101 ("'''..,j: TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (S) (6) (7) 52.962.45 .00 .00 .00 17.245.08 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 17 ,877.00 385.38 UlJ (2) (3) (4) DATE 03-01-2005 NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. 70,207.53 18.262 38 51,945.15 .00 51,945.15 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate 16. AlIOunt of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rata 19. Principal Tax Due TAX C ITS: US) .00 X 00 = .00 (6) 51,945.15 X 045 = 2,337.53 (7) .00 X 12 = .00 (8) .00 X 15 = .00 (9)= 2,337.53 AMOUNT PAID 2,500.00 DATE 04-19-2004 NUMBER CDo03848 + INTEREST/PEN PAID (-) 116.88 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 2,616.88 279.35CR .00 279.35CR IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. Name of Decedent: Date of Death: Will No.: STATUS REPORT UNDER RULE 6.12 Nelson L. Viering, Jr. January 11, 2004 21-2004-244 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 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: nla 3. If the answer to No.1 is yes, state the following: c"-) Dat~;~ March 31 , 2005 A. Did the personal representative file a final account with the court? No B. The separate Orphans' Court No. (if any) for the personal representative's account is: nla C. Did the personal representative state an account informally to the parties in interest? Yes D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. ~LQ;.~ Mark E. Halbruner, Esquire P A J.D. # 66737 GATES, HALBRUNER & HATCH, P.C. 1013 Mumma Road, Suite 100 Lemoyne, P A 17043 (717) 731-9600 Capacity: Counsel for Personal Representative J i:':~n,A'n::\c'-' BUREAU OF INDIVIDUALCtAliES; t, INHERITANCE TAX DIVISION PO lOX 28D601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE J:NHERJ:TANCE TAX STATEMENT OF ACCOUNT '* REV-I'G7 EX AFP (03-05) !i: 53 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 VIERING JR 01-19-2004 21 04-0244 CUMBERLAND 101 _t _UtMl NELSON L I ORFJ, I MARK E HALBRUMER GATES ETAL 1013 MUMMA RD STE 100 LEMOYNE PA 17043 (" l.:;- ne", "T i.jf):_:;-i ESQ' , I: PAYMENT TO: MAKE CHECK PAYABLE AND REMIT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, .~it the upper portion of this fo~ with your tax p~ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF VIERING JR NELSON L FILE NO.21 04-0244 ACN 101 DATE ,4-04-2005 THIS STATEIIENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH IN THE NAMED ESTATE. S" BELOII IS A ~ OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYIIENTS, THE CURRENT BALANCE, AND, IF APP~ICABLE, A PROJECTED INTEREST FISURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-01-2005 PRINCIPAL TAX DUE: 2,337.53 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-19-2004 CD003848 116.88 2,500.00 "l'i3-15-2005 REFUND .00 279.35- , , , TOTAL TAX CREDIT 21,337.53 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE I .00 . IF PAID AFTER THIS DATE, SEE REVERSE , SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN tl, III PAYIIENT IS REllUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )