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HomeMy WebLinkAbout03-0497 PETITION FOR PROBATE and GRANT OF LETTERS No. To: Register of Wills for the ,, Deceased. County of Cumber'land Social Security No. .~.~2~) -~-~z/' ~~d~.~2a-/' ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or. older,an the execut~i¥ in the last wilt of the above decedent, dated '.~/~ ,~/~/ ' and codicil(s) dated in the named ,19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Dfcendent was domiciled at death in (_~LfrT~c~.A~/_:~,~)/L/~ .~ C99nty, Pennsylvania, with hr.-3 ct ~/las_~t f, am~il~¥ o~r pfigc~sjdence a~ /~, ~ ~, ( ~/~ffZ/ (list street, number and muncipality) Decendent, then /e ~ years of age, died ~*~ ~ ,'~--~ 4 at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $~_..~d~ · (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 Te$t amen t ary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF Cumberland ~ SS The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and th94 as personal represen- tative(s) of the above decedent petitioner(s) will wel~mttx, l&uly adminis~r thg"~tate according to law. bS~f~ mte° th~ affirm%% and subscribed c ~~ ~/~~~ ~ ~, ~ day of I / - - ~' Donna M Otto,Z~t DCpu~, 4 · ' RegiSte;- ~~ ~ NO. 21-2003-497 Estate Of CLYDE RAY. SHANK, SR. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 03 / 27 / 2001 described therein be admitted to probate and filed of record as the last will of CLYDE RAY. SHANK, SR. and Letters TESTAMENTARY are hereby granted to PHYLLIS W. GIVLER 18th, 2003 IO~xx× , in consideration of the petition on FEES Probate, Letters, Etc .......... $ 18.0 0 Short Certificates(1 ) .......... $ 3.0 0 t~m~~x-.~.-.p.o.ge.s.( 0.1 $ -0- JCP $ 10 - no TOTAL ~ $ 31.00 Filed . .Ju.ne. · 18th.; Z00'3 ............. CALL ATTORNEY ON 6/18/03 Register of Wills ~~) DONNA M-OTTO,lst DEPUTY Richard P. Mislitsky ATTORNEY (Sup. Ct. I.D. No.) 1 West High Street, Suite 208 ADDRESS Carlisle, PA 17013 PHONE (717) 241-6363 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to the law, depose(s) and say(s) that codicil will presented herewith, (each) being duly qualified according to present and saw the testat , sign the same and that signed as a witness at the request of testat~ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19__ Register (Name) (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) ~ ' being duly qualified according to law~ depose(s) and say(s) that '-~, ~_/ ~ze.. familiar with the signature of__~1_,:' ~'~-~,~_.., ~h ~), testat~,~., of (one of the subscribing witnesses to) the will presented herewith and codicil that 1 ~J believe}~the signature on the will is in the handwriting of · I to the best of ~ {',~ a knowlec~ and belief. Sworn to or affirmed and subscribed before me this I~TM day of (Name) (Address) LAST WILL AND TESTAMENT OF CLYDE RAY SHANK, SR. This Document is intended to express my intentions and to act as my Last Will and Testament. My family has chosen to ignore me for a long time. I have had few contacts with them. As a result, I do not wish to have my family benefit in any way from my death. To the extent that any family member may have an interest in whatever property I may own at the time of my death, I give to that person $1.00 so they can participate in the distribution of my property without the possibility of claiming anymore than I intend to give them. In the event that I become terminally ill, I do not want my family to be notified. do not want my illness or death publicized. I have very few possessions. Whatever possessions I may have I give to my beloved companion, Phyllis. She has provided comfort and companionship to me when it was most needed and when no one else (esp. my family) was there for me. Phyllis and I have had many conversations regarding who would be the best person to have the few things I own. I ask Phyllis to distribute whatever property I may have according to our prior conversations. I trust her to do so. I fear that I have more debts than I have possessions. I do not wish Phyllis to have any responsibility for payment or repayment of my debts. I do not wish Phyllis to have any obligations whatsoever other than what I have mentioned in this document. If Phyllis were to become responsible for any of my debts, obligations or expenses, because I do not want Phyllis to be responsible, Phyllis may have the choice of accepting the benefits and responsibilities under this document, or rejecting them as she may see fit. I ask Phyllis to administer all of the assets and responsibilities up my death. She will, in all respects, be my personal representative without the need of establishing bond. I have read this document and it is an accurate reflection of my intentions DA'I'E / CLY[~E li~,AY SHANK, sR.- DATE WI'~NESS DATE WITNESS ,/ COMMONWEALTH OF PENNSYLVANIA NO TICE OF CI_ IM COURT OF COMMON PLEAS OF CUMBERLAND ,COUNTY ORPHANS' COURT DIVISION In Re: The Estate of: CLYDE R SHANK SR Deceased Court: File No: 21-03-497 TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(7) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.$.A. §3532(b)(2). MBNA AMERICA 1) 2) 3) Claimant's name: Claimant's address: P.O. BOX 15137 WI LMINGTON, DE 19850--5137 8777679383 Creditor listed below is the owner and holder of a claim in the amount of $. 8287.18 4) 5) The facts upon which this claim is based' This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. Decedent's address: 1326 FORGE RD CARLISLE, PA 17013 6) Date of Death' 06/08/03 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, ! do solemnly declare and affirm under th~., penalties of perjury that they !nformation and representations made herein are:true and~orrect to the best of my knowledge, information and belief. Dated: Z,~ Kyle Frenzel/Lucille RobeAs/~sica Le~s - Aut~rized Representative For ~BNA Ameri~ Wri~en notice of claim was given to Personal Representative and/or his/her counsel as stated below: PHYLLIS W GIVLER Name 1326 FORGE RD Address CARLISLE, PA 17013 Date notice IN RE ESTATE OF:CLYDE R SHANK SR AFFIDAVIT OF ACCOUNT The undersigned, being first duly swom deposes and states the follows: Your Affiant is authorized by the Claimant as its Authorized Representative- In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. o The Decedent purchased merchandise in the amount of $ 8287.18 evidenced by account number 5490997174038565 The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not MBNA America. Ogle of its A~orized Representatives: Kyle Frenzel __ Lucille Roberts Jessica Lerbs ~ MBNA America P. O. Box 15137 Wilmington, DE 19850-5137 Subscribed and sworn before me This ,~, ~/~day o f .~_~_..~'~'Y7~2 003. 14BNA America P.O. Box 15137 Wilmington, DE 877-767-g383 19850-5137 08/27/03 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 Re: In the Estate of CLYDE R SHANK SR Probate Case No. Social Security No: Last known residence: Our Client: Account Number: Amount of Debt: 21-03~497 220342248 1326 FORGE RD CARLISLE, PA 17013 MBNA AMERICA 5490997174038565 8287.18 Dear Sir or Madam Enclosed please find a Creditor's claim to be filed in the record W~th the above-ret~renced ]zstate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or concerns, please call our firm toll free at 1-877-767-9383. Cordially, MBNA America Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. 3313 8/21t2003 990201 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: C Ray Shank, Sr. Date of Death: 06-08-03 Will No. 2! -2003- a. 97 Admin. No. 21 -2003-497 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 1 0-1 3-03 : Name Address Phyllis W. Givler 1326 Forge Road, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Richard P. Mislitsky, Esquire Address 1 West High Street, Suite 208 Carlisle, PA 17013 Telephone( ) (717) 241 -6363 Capacity: __ Personal Representative X Counsel for personal representative JRD/June 30, 1992/17858 In Re: Estate of C RAY SHANK, SR. Late of SOUTH MIDDLETON TOWNSHIP Estate No.: 21-21-03-497 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2003-497 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: PHYLLIS W GIVLER Counsel for Personal Representative: RICHARD P MISLITSKY, ESQ. Date of Grant of Original Letters: 06-19-2003 Date of Delinquency Notice: 09-29-2003 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on SEPTEMBER 29, 2003, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a heating to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 10-15-2003 Distribution: Personal Representative ~ Register c~f Wills Counsel for Personal Representative Estate File A heating is scheduled for ~~2Oj 4~. o~4at .~-~'d,~P/, In Courtroom No. 3. If the Certification of Notice is filed prior to-~h~ l~earing date, the heating will automatically be cancelled. Georg~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 9E3EDENT'S '~A~,IE LAS"' :'!RST AND MIDDLE ~NiTIAL;~ 34TE CF 2EATN M,'..!-DC-VEAR} uA,-__ ~F ~!RTH ~MM-DD-YEAR} SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS iF ~,P:~LiCASLE., SUR'/F/iNG SP©LSE S NAi',,I~ d..AST. F!RST. AND MIDDLE !NIT'AL~  , !Or,ginalReturn 4. L~m~ted Estate 9 LJtigatlcn 2roceeds Rece,ved i 2..Supplemental Return 4a. Future Interest Compromise ,date cf aealh a~er 12-12-82; '-~ ? Deceden~ Maintained a L:ving Trust A~cr :~cy :f ~s~: '~ 10. Spousal Poverty Credit date ~f 2eatf' serween ~2-3'-9' .~rd '-~-95. THIS SECTION MUST BE COM~EIO~ ALIE:~~DENOE~ FiRM NAME ;'.f A~.,cao:el TELEPHONE NUMBER SOCIAL SECURITY NUMBER ! . 3. Remainder date 3f ~ea[h ::nor :o I ~ 5. Federal Estate Tax Return Required 8 Total Number of Safe Deposit Boxes J I ~! Ejection to tax under Sec 9!13tA) COMPLETE MAILING ADDRESS · 17013 1 Real Estate (Schedule A) (1) ~ O ""'" 2. Stocks and Bonds (Schedule B) (2) -- ~ "'"" 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~ O '-'" 4. Mortgages & Notes Receivable (Schedule D) (4) 5 Cash, Bank Deposits & Miscellaneous Personal Property (5) / ~Schedute E) Jointly Owned Property (Schedule F/ (6) ~ OI '"" ~/ Separate Bit ng Requested 7 inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8 Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10 Debts of Decedent, Me,gage Liabilities. & Liens (Schedule I) *~. Total Deductions {tolal Lines 9 & 10) ~2. Net Value of Estate {bne $ minus Line 13 ChantaOte and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) ,12) (13) (14) - -._25"&/'7. b 7 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line ~4 ~axable at the spousal tax rate, or transfers under Sec. 9116 Ia)(1.2) (15) 16. Amount of Line 14 taxable at lineal rate x 0_ ¢6) Amount of Line 14 taxable at snbling rate x !2 (t7) 18. Amount of Line 14 taxable at collateral rate x 15 (18) X 19 Tax Due (19) ~ (~ '-'"" De'cedent's Complete Address: CITY. Tax Payments and Credits: ~. Tax Due (Page I Line !9) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount /¥ l I'~ ,I STATE p,,~.. InterestJPenalty if applicable Interest Penalty !f Line 2 is greater than Line 1 .- Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. !f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 '* 5A. This is the BALANCE DUE. Total Credits ( A + 8 + C I (2) Total Interest/Penalty ( D + E ) '"-'O-" (5. (5A) (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the right to designate who shall use the property transferred or its income; ............................................ ~ I c. retain a reversionary interest; or .......... . ...................... d. receive the promise for life of either payments, benefits or care? ............................. 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. .i~ I 3. Did decedent own an "in trust for" or payab e upon death bank account or security at his or her death? .............. !~j I 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? --; I IF THE ANSWER TO ANY OF THE ABO_VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under .~enaities of gerlup/. I declare :hat ! have exammed this return, including accom;any~ng schedules and statements, and to the best of my knowledge and belief t s true. ;orrect and complete .3eclara,.ion of 2reparer other :hap the persopaI fepresentative s based on ail ;nformation of which prefarer has any knowledge SIGNATURE OF PEJ~O"~J~PONSIBLE F~ FILIJ~FRETURN DATE .AC, CRESS / " For dates of death on or after July !. !994 and before January !, !995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. §9116 (a) (1.1) (i)] For dates of death on or after Januan/ I. !995, the tax rate imposed on the net value of transfers to or for the use of ',he surv~wng spouse is 0% [72 P.S. §9116 (a) (!.!'1; The statute does not exempt a transfer to a survivmg spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable eve" the surviving spouse is the only beneficiaq/. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parer': or a stepparent of the child is 0% [72 PS. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as ar' individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502EX * L1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHEDULE A REAL ESTATE All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION --- 0 "' VALUE AT DATE OF DEATH TOTAL (Also enter on line 1, Recapitulation) $ '"' ~/ (If more space is needed, insert additional sheets of the same size) COMMONWE. ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF All property jointly.owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 2, Recapitulation) $ '"-' (If more space is needed, insert additional sheets of the same size) REV-I$04 EX+ 13-q2) COMMONWEALTH OF PENNSYLVANIA · INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD STOCK, PARTNERSHIP AND PROPRIETORSHIP Please Print or Type ESTATE OF ITEM NUMBER FILE NUMBER DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) $ VALUE AT DATE OF DEATH (If more space is needed, insert additional sheets of same size.) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT City to ~ 2. F~eral Employer i.D. Numar 3. Ty~ of Business SCHEDULE C.1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER Zip Code Product]Service State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK YoUng / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all dghts and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? tf yes, Position 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ 10. t!. E. F. G. 12. [] Yes [] No Annual Salary $ [] Yes [] No Was there life insurance payable to the corporation upon the death of the decedent? If yes, Cash Surrender Value $ Owner of the policy [] Yes Net proceeds payable $ Time Devoted,~7 [] No Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was pdor to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. Was there a wdtten shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. Was the corporation dissolved or liquidated after the decedent's 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 partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. Detailed calculations used in the valuation of the decedent's stock. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. 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. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. List of officers, their salaries, bonuses and any other benefits received from the corporation. Statement of dividends paid each year. List those declared and unpaid. Any other information relating to the valuation of the decedent's,stock. CO~MONV~cALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I. Name of Partnership Address City 2. Federal Employer I.D. Number 3, Type of Business 4. Decedent was a [] General SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT FILE NUMBER State Date Business Commenced Business Reporting Year ~ Hmited partner. If decedent was a limited parmer, provide initial investment $ PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. Transferee or Purchaser Attach a separate sheet for a(:ldi~onal transfers andJor sales. !0. Was there a wntten partnership agreement in effect at the time of the decedent's death? if yes, provide a copy of the agreement. ~,0. Was the decedent's ~artnership interest sold? [] Yes if yes, provide a copy of the agreement of sale, etc. 1 I. Was the partnership dissolved or licuidated after the decedent's death? [] Yes !2 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the m31icy 9. Did the decedent sell or transfer an interest in this partnership within one year pdor to death or within two years if the date of death was pdor to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Percentage transfen'ed/sold Consideration $ Date [] ,No [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. Was the decedent related to any of ;he partners? [] Yes [] No If yes, explain Did the partnership have an interest ~n other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest [] No / [] NO A. Detailed calculations used in the valuation of the decedent's 13artnership interest, B. Complete copies of financial statements or Federal Partnership Income Tax ratums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate apprasals have been secured, attacr~ cop~es. D. Any other information relating to :he valuation of the decedem's ~artnershi[~ ~nterest. REV-1507 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 4, Recapitulation) $ '"'"'" O ~ (If more space is neede¢, insert additional sheets of the same size) REV-1508 EX. d-97) ~ 'NHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY fnclude the p~eds of li~gation and ~e date ~e pro~s were r~iv~ by Be ~te, All pro~ ~in~-o~ ~ the d~ht of su~o~hi ITEM NUMBER 1. SCHEDULE E CASH, BANK DEPOSITS, & MISC. TOTAL. (Also enter on line 5, Recapitulation) must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH /55'. (If more space is needed, insert additional sheets of the same size) CORNERSTONE F'ederal Credit Union P.O. BOX 1181 CARLISLE, PA 17013 717-24.~-1661 M01-004206 STATEMENT OF ACCOUNT NOTICE SEE ENCLOSED FORM FOR IMPORTANT INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS. NOTICE SEE ENCLOSED FORM FOR IMPORTANT INFORMATION IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS IDENTIFIED WITH LETTERS "EFT" 002079 CLYDE RAY SHANK I/ MEMBER :i' 1326 FORGE ROAD [::NUMi~ER 82~ CARLISLE PA 17013 ~:: 0A'rl~; ::'I 0,6/01/2003 :~: 06/30/2003 OWNERSHIP OF SHAFIE, DEPOSIT AND CERTIFIDATE ACCOUNTS SHOWN ON THIS STATEMENT IS NOT TRANSFERAblE EXCEPT ON THE BOOKS OF THE CREDIT UNION. Transaction Date Transaction Description T,o,s;,,~0n [ Pr ncipa[. Payments{ FINANCE · '~' ~"~ I New Loafs I Amount [ and Cred ts I CHARGE SHARE 01..REGULARSHARE ACCOUNT 06-01 PREVIOUS BALANCE 06-30 TRANSFER IN 15.62 CLOSE 08 TRANSFER BALANCE TO 01 06-30 TRANSFER IN 1236.47 BALANCE FROM 07 TO CLOSE 06-30 TRANSFER OUT -300.00 06-30 WITHDRAWAL -952 . 51 A DIVIDEND OF .08 WILL BE POSTED TO THIS ACCOUNT ON JUL O1 06-30 NEW BALANCE YEAR-TO-DATE DIVIDENDS THIS ACCOUNT .21 SHARE 07..SHARE DRAFT ACCOUNT 06-01 PREVIOUS BALANCE 2026.60 05-30e POS DEBIT/PURCHASE -32.17 EFT 1994.43 SAYLOR' S NEWVILLE PA 06-02 WITHDRAWAL -289.78 1704.65 GMAC-GMAC PAYMT 06-01e TRANSFER OUT -215.87 1488.78 06-04 TRANSFER OUT -803.15 685.63 06-05e POS DEBIT/PURCHASE -293.40 EFT 392.23 SOU GIANT FOOD CARLISL271120PA 06~06 DRAFT # 1314 0011033946 -73.50 06-06 DRAFT # 1315 0Gl1103857 -123.00 06-09e ATM WITHDRAWAL -60.00 EFT ~' ~ -~,~T--TE . , --06-25 D~OSI US TREASURY 303-SOC SEC 1.74 · 1236,47 06-30 DIVIDEND ANNUAL PERCENTAGE YIELD EARNED VROM 04/01/~003 - 06/30/2003 ON AN AVERAGE DAILY BALANCE OF $ 740,81 WAS .95%' 06-30 CLOSE ACCOUNT -1236.47 .00 CLOSE 07 & TRANSFER TO 01 - PER ADMINISTRATOR OF THE ESTATE 06~30 NEW BALANCE .00 YEAR-TO-DATE DIVIDENDS THIS ACCOUNT 4,75 DRAFT~ AMOUNT DRAFT~ AMOUNT DRAFT~ AMOUNT DRAFT~ AMOUNT' 1314 73.50 1315 123.00 06-30 D~V~D~D .0~ ~ ~~0~ ~D ~ ~OM 0~/0~/~003 ~ 06~30/~003 06-30 ~0~ ~OU~ -~-6~ .00 06-30 ~W ~~ . O0 · **~ ANNUAL P~CENTAGE RATE **** 11.75% PERIODIC RATE OF .0321917% 06-0t PREVIOUS BALANCE 5585.24 06-01e TRANSFER IN 215.87 160.13 55.74 5425,11 06-30 NEW BALANCE 5425.11 YEAR-TO-DATE FINANCE CHARGES THIS LOAN 350.41 · ** CONTINUED ON NEXT PAGE 25.42 4i.04 1277.51 977.51 25.00 25.00 318.73 195.73 135.73 R~'V-1509 EX * (Io97) .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT If an ass~ ~s ~de ~int ~in one year of~e d~en~s d~ of d~, ff must ~ ~ff~ on ~h~uM G. FILE NUMBER SCHEDULE F JOINTLY-OWNED PROPERTY SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JOINTLY-OWNED PROPERTY: LI:: i ) bN DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institutJo~ and bank account number or similar identJf,/ing number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES' (Also enter on line 6, Recapitulation) $ TOTAL (if more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY This schedule must be completed and filed if the answer to any of ques~ons 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM iNCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE OEED ~OR ~ ESTATE. NUMBER VALUE OF ASSET INTEREST i~F,V'~C~,~LE} TOTAL (Also enter on line 7, Recapitulation) $ ..--'"-- ~ "'""O -'-" (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule [. ITEM NUMBER 5. 6. 7. DESCRIPTION AMOUNT FUNERAL EXPENSES: ADmINISTrATIVE OOSTS: Persond ~epresentative's Oommission~ Name of Personal Representative(s) Social Securi~ Number(s)/EIN Number of Personal Representative(s~ Street Address ~ Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the. same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) $o --0'" I2. ZF (If more space is needed, insert additional sheets of the same size) CCM,¥C,VNEALTH OF PENNSYL'IAFi;~' 'iHERtTANCE TAX RETURh RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT ! 7 FEDe"~A L bo /t ~l ~s-r'o~J r TOTAL (Also enter on line lO, Recapitulation) $ /z more space ~s needled, insert additicnal sheets of the same size) COMMONWEALTH OF PENNSYLVANIA · INHERITANCE ]'AX RETURN RESIDENT OECEDENT ESTATE OF NUMBER [I. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outdght spousal distributions) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ FILE NUMBER RELATIONSHIP TO DECEDENT DO Not List Trustee(s) 15 THROUGH 17, AS APPROPRIATE AMOUNT OR SHARE OF ESTATE ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il' . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-l§14 EX * (1-97) j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) ~ FILE NUMBER This schedule is to be used for all single life, joint orsuccessive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the DepaCu'nent of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [] Will [] Intervivos Deed of Trust [] Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE /k [] Life or [--] Term of Years __  [] Life or [] Term of Years [] Life or [] Term of Years ~ [] Life or [] Term of Years 1. Value of fund from which ifa estate is oavable $ 2. Actuarial factor per appropriate table Interest table rate- r-] 31/2% [] 6% 3. value of life estate (Line 1 multiplied by Line 2) [] 10% [] Variable Rate % NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) f DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years ¢ [] Life or [] Term of Years ' [] Life or [] Term of Years 1. Value of fund from which y is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Uonthly (12) [] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other( ) 3. Amount of payout per pedod $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% [] 6% [] 10% [] Vadable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity- If using 3 1/2%, 6%, 10%, or if vadable rate and pedod payout is at end of pedod, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and pedod payout is at beginning of pedod, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 $ V $ 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 retum. 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, insert additional sheets of the same size) REV-1644 E.)(+ (3-84) CO~AMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT III. INHERITANCE TAX II. Estate of SCHEDULE "L" REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL JFILE NUMBER This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. 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 Assets: Complete Schedule L-1 1. Real Estate $ 2. Stocks and Bonds S 3. Closely Held Stock/Partnership S 4. Mortgages and Notes S 5. Cash/Misc. Personal Property S 6. Total from Schedule L-1 Credits: Complete Schedule L-2 1. Unpaid Liabilities S ~ 2. Unpaid Bequests S 3. Value of Uninclu_dable Assets S 4. Total from Schedule L-2 Total value of trust assets (Line C-6 minus Line D-4) Remainder factor (see Table I or Table II in Instruction Booklet) 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) 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) (Last Name) (First Name) (Middle Initial) REV-1645 EX+ (7-85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-1 REMAINDER PREPAYMENT ELECTION -ASSETS- (Last Name) (First Name) II. Item No. Description i A. Real Estate (please describe) FILE NUMBER (Middle Initial) Value III. Total value of real estate (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds (include 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) fO-- / Total value of Mortgages and Notes / S (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 L) TOTAL (Also enter on Section II, Line C-6 on Schedule L) S "'-- (~ ~ (If more space is needed, attach additional 8V2 x 11 sheets.) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) This schedule is appropriate only for estates of decedents dying after December 12, 1982. 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 certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. [] Will [] Trust [] Other I1. III. IV. Beneficiaries NAME OF BENEFICIARY 1. 2. 3. 4. 5. DATE OF BIRTH AGETO NEAREST BIRTHDAY For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise 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 withdrawal right. [] Unlimited right of withdrawal [] Limited right of withdrawal Explanation of Compromise Offer: 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 [--]6%, [-']3%, [] 0% (also include as part of total shown on Line 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 of Line 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 more space is needed, insert additional sheets of the same size) REV.]~48 EX (1,92) COMMONWEALTH OF PENNSYLANIA IN~HERITANCE TAX DIVISION ESTATE OF SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91) 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 .............................. '";-~'"-'t-" ........................... 3. Retirement Benefits ................................................................................................. .~)...//~ j3. 4. Joint Assets with Spouse ................................................................................................. 4. 5. PA Lottery Winnings ......................................................................................................iS. t 6a. Other NontaxabJeAssets: List (Attach schedule if necessary).. 6d. ! 6. SUBTOTAL (Lines 6a, b, c, d) .................................................................../ .................... / 7. Total Gross Assets (Add lines l thru 6) ......................................... ..~j../...~ ............... IV~I! Total Actual Liabilities 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part Ih 7__:__ 8. 9. Income: TAX YEAR: 19 a. Spouse ...................... Ila.l b. Decedent ................... lb.j - c. Joint .......................... d. Tax Exempt Income ..... e. Other ncome not · I I hsted above ........... :le. ~ I f. Total .......................... i lt. j J2c. TAX YEAR: 19 TAX YEAR: 19 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: 4b. (lf) + (2f) + (3f) - (+ 3) Average Joint 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 Part III. I. 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. Include this figure I /~J / / /// in the calculation of total credits on line 18 of the cover sheet ............................................. 13.j //I/! 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ..................................................................................................!4.1 / 5. Multiply line 3 by line 4 and enter the total 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. 5.] REV-1649 EX ·/1-9~3 ,~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 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 transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrancjement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. 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. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE Part B Total $ (,--/ (If more space is needed, insert additional sheets of the same size) BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF XNHER/TANCE TAX APPRAXSENENT, ALLO#ANCE OR D/SALLONANCE OF DEDUCT/OHS AND ASSESSNENT OF TAX REV-15¢? El( AFP (gl-SS) RICH HISLITSKY ESQ PO BOX 1290 CARLISLE '04 Jb~J -7 PA 17~$ DATE 06-08-2004 ESTATE OF SHANK SR DATE OF DEATH 06-08-Z005 FILE NUHBER 21 05-0497 ~7~COUNTY CUHBERLAND ACN 101 I Amount Remitted CLYDE R HAKE CHECK PAYABLE AND REHZT PAYHENT TO= REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LXNE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHER/TANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTTONS AND ASSESSHENT OF TAX ESTATE OF SHANK SR CLYDE R FILE NO. 21 05-0497 ACH 101 DATE 06-08-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE ~NTEREST ' SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks end Bonds (Schedule B) (2) 3. Closely Held Stock~Partnership Interest (Schedule C) (3) 4. Nortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/N~sc. Personal Property (Schedule E) &. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Dabts/Hortgege Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 155.73 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper port/on .00 of th~s form ~$th your tax payment. .00 .00 2,868.28 (8) 13. 14. NOTE: ASSESSNENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rata 17. Amount of Line 14 at Sibllng rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Prlnclpal Tax Due TAX CREDXTS: PAYHENT RECETp1 DTSCOUNT DATE NUNBER ]:NTEREST/PEN PA:]:D (-) 22,885.12 (11) (12) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Net Value of Estate Sub~ect to Tax (14) Zf an assessment ~as issued previously, 11nas 14, 15 and/or 16, 17, reflect f/gures that include the total of ALL returns assessed to date. (15), .00 x O0 = (16) .00 x 045= (17) .00 x 12 = (18) .00 x 15 = (19)= ZF PA/D AFTER DATE ZNDICATED~ SEE REVERSE FOR CALCULAT/ON OF ADDXTZONAL INTEREST. ANOUNT PAID 135.73 ~5.753.~0 25,617.67- .00 25,617.67- 18 and 19 w111 .00 .00 .00 .00 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( ZF TOTAL DUE XS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST= Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfut Class B (collaterat) rate on any such future interest. To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGXSTER OF NXLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Hills, any of the 2S Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-BOO-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (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. ZDIOZ1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual attars discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (SI) percent par annum calculated at a daily rate of .000164. A11 taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor ~ 20Z .000548 ~'~'8 - 1991 llZ .000301 1983 16Z ,000438 199Z 9Z .000247 1984 117- .000301 1993-1994 7Z .000192 1985 13Z .000356 1995-1998 9Z .000247 1986 lOZ .000Z74 1999 7Z .00019Z 1987 lOX .000Z74 ZOOO 77. .000192 --Interest is calculated es follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~ 9Z .000247 ZOOZ 62 .000164 2003 52 .000137 2004 42 .O001lO X NUHBER OF DAYS DBLXN~IUENT X DALLY /NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/03/2005 MISLITSKY RICHARD P 1 W. HIGH ST P.O. BOX 1290 CARLISLE, PA 17013 RE: Estate of SHANK C RAY SR File Number: 2003-00497 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' 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: 6/08/2005 Your prompt attention to this matter will be appreciated. Thank You. :~:z~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge o rjA ST A TUS REPORT UNDER RULE 6.12 Name of Decedent: Clyde R. Shank, Sr. Date of Death: 06-08-2004 Will No. Admin. No. 21 03-0497 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 No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: August 31, 2005 3. Ifthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No - d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk 0 t e Orphans' Court and may be attached to this report. P Date: Richard P. Mislitsky Name (Please type or print) 1 W. High St.. Suite 208. Carlisle. P A 17013 Address '. .r"J (717) 241-6363 Tel. No. Capacity: Personal Representative ~ Counsel for personal representative ;~ \..-' ..: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: Clyde Ray Shank, Sr. Date of Death: June 8, 2003 Will No. 2003-00497 Admin. No. 21-03-0497 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 -X; No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: No X a. Did the personal representative file a final account with the Court? Yes_; account is: b. The separate Orphans' Court No. (if any) for the personal representative's c. Did the personal representative state an account informally to the parties in interest? Yes X; No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: "l l!J 0:) (,.J ~..:;- Signature Richard P. Mislitsky, Esquire Attorney ID # 28123 One West High Street, Suite 208 Carlisle, P A 17013 (717) 241-6363 (""~ r- -~ .~ l ~) c..:..., C..:..:J ("-J Capacity: _ Personal Representative ~ Counsel for Personal Representative t?