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Home My WebLink About04-0370 PETITION FOR PROBATE and GRANT OF LETTERS u.:, ~/-a~-~?~ Estate of . 7 () B t.~ T --r;'Yh ,?'L II...) No. also known as To: Register of Wills for the Deceased. County of c.. ^^ p. r;.R. LA.vb in the Social Security No. 17~ - C 7 -<< (~"+1 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 iI" x. '-' {let named in the last will of the above decedent, dated ,W~, )q91 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) County, Pennsylvania, with hiS bft I vC:- . I C'-v.'J ~ . (list street, number and muncipality) Decendent, then _ 8 ~ years of age, died '-I / I ,.$ Zeo 'f, at m c:-s So ul H J L '-'-..to .=- 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: /J/+ Decendent at death owned property with estimated values as follows: t ~ I ceo (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: nc WHEREFOR~, petitioner(s) respectfully request(s). the probate of the last ~~.and c&icil(s) presented herewIth and the grant of letters -; <2 I.. -t- t.<... M. '" I\tf ..... II Y f5,' . .c:,. .;p' (testamentary; administration c.I.a.; admiJ;listration d.b.n.c.t.a.) '." ~oo. ~ . ::0 ~ S\"DP ~ -.. '" ~ \0 '" (kJu..rJ clkp..{~ u c '" .::r..:.';1 :-2~ "'~ ./ "..... ():) "'... c.:'" ~~~:~~~. nD=- N I,,; C -00 c';::; lJI ~''::: 3~ "''- :;0 0; c 00 (;j OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF j The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best 01 the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well a truly administer he estate according to law. Swom to 0' affumed and snbsccibed 4 ^ ~ VJ before me this 197/-/ day of ~. ;:s ~ ~ l::l - ;:: / ~~ Y~P/n(/z1~~4. ~ ~. ~ Regl ter ~ ffi.-/ A ~ r No. r:2/-t1-</.. ~o Estate of , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW a~~/9 ~~ in consideration of the petition on the reverse side hereof, satisfactory proof having n presented before me, IT IS DECREED that the instrument(s) date I described therein be admitte . probate and filed. f recor - e/oL/ ~ , and Letters '/. '4 are hereby granted to a//.c~N fLtZd~~~/V//~-J~LJ~ ~/b . Register of WiUs)2tL-<./ /J-e.-/ ~ FEES Probate, Letters, Etc. ......... $ \. ~co Short Certificates( ).......... $ /CQ.L;C> ATTORNEY (Sup. Ct. I.D. No.) fji"'dtE? <0/d')'" e u;3atlon ................ ~ /O,0C/ ADDRESS ~ TOTAL _ $ q.s,OO Filed .. ~./~....iUJ.q.~......... PHONE ",,,,,,,,,-:n,, '?,-,'\' ','/"r, This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~~~ ~ . ~ ~ Local Registrar r', C:/l hr~I')'1 C~ APR 1 2 2004 , ) ...L '.<~~ ,.) \..} ...i. \,..,' , No. Date Or: :lJ == (or g ::;:S:: ro '"' 0- . i...." "~ C' ;:::, -0 :::0 I:',"~ --" \0 ::....-=> co N U1 Hl05_143Aev 2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH TYPE/PAINT IN STATE FILE NUMBER PERMANENT NAME Of DECEDENT If.(Sf, Middle, las) sex SOCiAl SECURITY NUMBER BLACk INK ,. ROBERT W. TIMBLIN .. ma 1 e ,. 176 - 09 2004 \0 AGE (lasl BlrthOayl UNDER' YEAR BlRTHPI..ACE (Coty;And PlACE OF DEATH ICt>ec)l onIyQl\e__ -;ee'nSlJUCloOll$on_Olt'eI '!lOe1 Mono,," ! D.,. Stale 01 FCl&q"lCOUnllYJ HOSPITAL: 86 v... Rossiter, PA ,_....0 =",0 r. Ie. COUNTY OF DERH FACIUT'Y NAME (It noIIOSl'I\Aton. gtlle slIest and f1l.IJTItMlfl RACE - Am.ncan 1ndiIIn, BIKtI.. White, ek 1_' 2..( Cumberland white .... '0. SUAVlvlNG SPQIJSI; (If.... QMt ma.den fWl'Iel . .... 'rb. Cumber 1 and l;d.O ~-='::-:::oI - FMHEA'SNAME jFlI'lt M.lldlll, I dill MOTtiER'S HAME lFolIl MddkI. Ma.u.o SulInlllTlOI ,.. Samuel Timblin ... Cl ara Gri ffith IHFOAMAHT'S NAME (T rpiWPml1 INFORMANT'S MAllIt<<l AOORESS ISlt.... QfyITown. SI.M.ltp coo.. Co 11 een Sherman .....2139 Coventr Court Mechanicsbur PA 17055 METHOD OF DISPOSITION PlACE OF DISPOSITION. Name of Cemlllery. Cremalofy LOCRK)H. QtyITown. Stale, ZipCode 8uriIlt OCJ Cren\llion D RemowaIIrom Stala 0 .. ""* """" fil Other (Specify. ril 5 2004 .... Greenwood Memori a 1 Park on LICENSE NUMBER NAME AHD ADDRESS OF FACILITY " FD-013594-L ...ROSS G. WALKER FH.,L TD. .. 0( :; lICENSE NUMBER 0( , :~Of t25 ~.IAtEA;M;NC'~~~o04 Il,,~~----- :SCASE RmllRW "':it' "'M'N'IVcOR<>>oEn1 ...KJ Ii, -M'" ,,'-- C;II., illa.~-.'-;.~ 1I'l11l1...... 1.1..1'1. ...;.... whkh .,.'....1111. .....111 Uu 1-.4 .nl.. III. rt"'''lll .",.."". "11.11.., ".nll." 11I1."'III..IIIIY .."..... ..hill.. uI,......lldu.. I "t~u.lm.la f'A"'.; I.,., iW\tllffll;alll Will....... ..........;.....'" ~-.....ll bwt tiel IHIt';' u"e ellu.. un ...11..... I 111I1"'" IMt_n "Ulr..."""II'''" .......,..,.,.....UlVanlnfWn I ---J 11I......ld......1 ~ , ~D . ~~ : ~ DUE lC(OA AS ACONSEOUENCE Of): 0 ! : 0 \--= DUE lO(OA AS A CONSEOUENCE Of): I I 0 OUElOIORASACON5[OUENC~~~~--.- - ~~------"-~-T WERE AIJ10PSY FlNOtNGS MANNER Of' DEATH DATE OF INJURY TIME OF INJURY INJURV /IiI WORK1 DESCRIBE HOW INJURY OCCURRED. ~ A\IlULA8lE PRIOR TO lMonlh. D~. 'NNw) ~ COMPLETION QJF CAUSE ........ !Xl 0 OF DERH1 HomiCida _0 ...0 Acctdllnt 0 Pending an-s.tQlilkN'l 0 ~ _0 ...0 0 0 ... - Could I'tOI be delermtned lOCA:r1OH $__ CtlylTown. SCala, - .... >0. CERTIFIER lelled< only one) "CEllTWYING PHYSICIAN (PhySIC..... Cet~ cause 01 death when anolher phyStCoan hllS p1'Ol'OJ.inced de~ ana canpleled Item 231 To...... of...y Ilnowladg.a, dea... ocelolR'M'" to.. cauM'(s) and maroner.. stated. . . . . .. .......... .... ~ ffi .PAOMOUNCING AND CERTifYING ,,"VSICIAH IPhVSC.an bom Ollonouocrng dealh olOd ceflltyoOr,110 Cduse of dealtll fil Ta lhe t..1 of my kno_ledgfl.cs.aU.occurracllallhe "'"-, data. ~ pfaoca. and due to.... cau-c,a) and ...anner as "atad.. :rl a .MEDICAL EXAMINER/CORONER ~ On !he b..i. 0' ..amlnation andlCN' InvesUg"lion. in my opinion, death occurred at the lime. da.e,.JInd pl.JIce, and due 10 the cause(s).nd PO- 11D4~ ~ -.-nMr..st.tect............. ............. _...... ................ ... ......,. .'. .~_,_.._..... ..... ._._....._'_,......_.._~_ :)1.. 0( REGISTRAR'S SIGNATURE AND NUMBER DATE FK.EO (MOnlh_ Day, Yea" Z ,. /-\PR 0 5 2004 LAST WILL AND TESTAMENT OF ROBERT TIMBLIN I, ROBERT TIMBLIN, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will. I revoke all other Wills and Codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executrix from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executrix has to claim reimbursement for any such taxes which become payabre~as the result ~woperty over which I have the power ; '!~ ';) of appointment. ~Z: 8 'd 6 l t.Jdlf tJO. II d i "'-}Fltj Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my Will or with my valuable papers and found within 30 days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and ifthere is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath as follows: (a) Twenty-five percent (25%) to my son, PAUL W. TIMBLIN, ofLemgo, Germany, if he survives my death by thirty (30) days. If he does not survive my death, then to his spouse, SANDRA TIMBLIN, ofLemgo, German, if she survives my death by thirty (30) days. If she does not so survive my death then to the issue of PAUL W. TIMBLIN, per stirpes. (b) Twenty-five percent (25%) to my daughter, JANICE E. COPLIN, of Shiremanstown, Pennsylvania, if she survives my death by thirty (30) days. If she does not so survive my death, then to her issue, per stirpes. (c) Twenty-five percent (25%) to my daughter, COLLEEN SHERMAN, of Mechanicsburg, Pennsylvania, if she survives my death by thirty (30) days. If she does not so survive my death, then to her issue, per stirpes. (d) Twenty-five percent (25%) in equal shares to JONATHAN L. FULLMER, JOSHUA W. FULLMER and JULIE A. FULLMER, all of Roanoke, Virginia. I give, devise and - 2 - bequeath the share of any deceased, named grandchild to his or her issue who survive me, per stirpes, or if he or she has no issue, the share is to be added equally to the shares of my surviving, named grandchildren. However, if a beneficiary does not survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, per stirpes, the share the beneficiary would have received had he or she survived me by thirty (30) days. Article V If a beneficiary under this Will has not attained the age of twenty-eight (28) years, the share ofthe beneficiary shall be placed in a separate trust, for the benefit ofthat beneficiary according to the terms in Article VI. Article VI In the event that a Trust is created by or as a result of any part of this Will, the terms and conditions ofthe Trust shall be as follows: A. To expend and apply so much ofthe net income and so much ofthe principal ofthe Trust as the Trustee shall consider advisable for the support, health, care and education of the child until the child attains the age of twenty-two (22) years. B. Upon attaining the age of twenty-two (22), one-third (113) ofthe child's share shall be distributed outright to the child. - 3 - . C. Upon attaining the age of twenty- five (25), one-half (1f2) of the child's remaining share shall be distributed outright to the child. D. Upon attaining the age of twenty-eight (28), the remaining principal and accumulated income of the child's share shall be distributed outright to the child. E. No beneficiary or remainderman of this Trust shall have any right to alienate, encumber, or hypothecate his or her interest in the principal or income ofthe Trust in any manner, nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or other processes of law. Article VII In order to carry out the purposes of the Trust established by this Will, the Trustee, in addition to all other powers granted by this Will or by law, shall have the following powers over the Trust estate, subject to any limitations specified elsewhere in this Will: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, - 4- . (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; to pay from my estate reasonable compensation for all their services, (i) to conduct along with or with others, any business in which I am engaged in or have an interest in at the time of my death, and G) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. Article VIII I hereby appoint CAREY L. FULLMER of Roanoke, Virginia, as Trustee of any Trust( s) created in this Will. In the event of the renunciation, death, or inability to act, for any reason whatsoever of CAREY L. FULLMER, I nominate, constitute and appoint my daughter, COLLEEN SHERMAN, successor Trustee of any Trust(s) created in this Will. Article IX I nominate, constitute, and appoint my daughter, COLLEEN SHERMAN, Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my daughter, JANICE E. COPLIN, - 5 - successor Executrix of my Last Will and Testament. I direct that my Executrix or successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed ifliving. My Executrix or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article X In addition to the powers conferred by law, I authorize my Executrix or successor Executrix, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, - 6 - - (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule offees in effect while their services are performed. IN WITNESS WHEREOF, I, ROBERT TIMBLIN, hereby set my hand to this my Last Will and Testament, on f}~ /q , 1999, at Harrisburg, Pennsylvania. ~~~ ROBERT TIMBLIN In our presence, the above-named ROBERT TIMBLIN signed this and declared this to be his Last Will and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name Address ~o..uJal( ~ GlJSS.('T~ct- ~2ADlo, ~4-/;~} (j). .,8" (' ~Q/JUVJU 'i?f1,C; JiIJ !htJYYYuj. C:l:f ~~) PIl /7/0/ - 7 - . . ~ I, ROBERT TIMBLIN, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by ROB T TIMBLIN, the Testator, \ , 1999. -/2~ ROBERT TIMBLIN Notarial Seal Jan ~. Brown, Notary Public Lower Paxton Twp., Dauphin County My Commission Expires Mar. 20, 2000 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~~ ~o..d-oJ( ~ Witness and j{(,I'~'() w: 8u~ ~,irb:n} fA} ;1L('~ witnesses, onJ~ \q ,1999. 4i~bliC~~ ltness Notarial Seal Jan L. Brown. Notary Public Lower Paxton Twp., Dauphin County My Commission Expires Mar. 20, 2000 - 8 - Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 07/01/2004 SHERMAN COLLEEN 2139 COVENTRY COURT MECHANICSBURG, PA 17055 RE: Estate of TIMBLIN ROBERT W File Number: 2004-00370 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 ( a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 07/29/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ ~ LENDA FARNER STRASBAUG~ Clerk of the Orphans I Cour cc: File Counsel Judge CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Raha--\- lA.'fl.,/ I"~ ~l'YIn\i(\ , Date of Death: "'-II \\Oq Will No. ::::ZOO L{ -o(J3 76 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the ~h~ourt Rules was served on or mailed to the following beneficiaries of the above-captioned estate on .s ~ 0 : ~ Address Raw \inLb\in f \ f,e.r mOxlf\Sblfd I~ r .J;i~l Ledo, 0exmory -::$!.()I' ( e. Cop\ln ..5\ W. ~1(jeS-\ .s h 1 rt:rYUr1.",.h~,w" . ?A no\ I (lNl'j Dll II nH.r I~H IC~()(y1z,tl\n P-d (' r. .- \i,'\ \e PA \70\3 , ~)()I1JIni1 ruJlrMr ,~"("l,, \1\( \ loW P6il1-t LQ(l(. Wo. rn::,on 11'1 3T~'-t\ -:::s- oshUCC, f:' LL II ryLQ. r U08 ~-\<< ()cL( +<d- R00S16Ke I V A dLlo 1'1 Notice has now been given to ail persons entitled thereto under Rule 5.6(a) except Date: 1115/nlf Ch{I,J4"j ~~ / (:' u1 \rY11.r Signature --::r L.l\\ e:... (' i'>\\een \lel t4 Ic'lnXjtnwn P-d Name .s Vle.Y mO-f\ ilid\~e, pJ\ ~n6\?~ Address ~1"Cj O[)"~v\'rr'j (It o '" .. ?a: ~ 0\ }~ s;~ c::c \,j m ec..hQI'\( (..'-,$1.u5, fA Il()S"," ,:;;: 0 N U T.} .... ~ c (j'::~ Q} .~ Telephone (111) e.~ 2ii lL.l~-\oln~ 00) ~ um ~ iDe:: Capacity: V-- Personal Representative e:: 0 _Counsel for personal representative :> REV.1500EX Ift.OOj REV-1500 OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER ~ DEPT 280601 2L-Q (1010_ HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~ W Z L./ W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) C THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W 0 -0\-200'-\ 0\- 0 /8 REGISTER OF WILLS U W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - I w ~ 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13.82) '- ::.:::!:rJ} D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12.82) D 5. Federal Estate Tax Return Required u"'''' w"-u ,,00 D 6. Decedent Died Testate (Altach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copyofTrust) 8. Total Number of Safe Deposit Boxes uO:-' "-ID - "- D 9. Litigation Proceeds Received D 10, Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95) D 11. Election to lax under Sec. 9113(A) (Attach Sch 0) " '- z 3t+€ w NAME C COMPLETE MAILING ADDQS 0 z LL - U eoLLEa0 ltaMll0 0 "- FIRM NAME (If Applicable) ., eO\J6IJr1U( CT w .;t\3Q 0: 0: 0 m E(.t-t/tAJIC ~ B 4elo fJ/l-, no:s;~ u 7t.1.-lo 3 1. Real Estate (Schedule A) (1) I OFFICIAL USE ONLY I i 2. Stocks and Bonds (Schedule B) (2) I i .'~ Y' I 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) -' d ~ 4. Mortgages & Notes Receivable (Schedule D) (4) "..~ I , IOo.jt.,~ I i 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) .5(, i I , Z (Schedule E) I 0 6. Jointly Owned Property (Schedule F) (6) --.J ~ D Separate Billing Requested (7) i '-- I ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property I ,. .----1 '-~~'--'-- ~ (Schedule G or L) ex ii: IOYlo:l..51,. cs: 8. Total Gross Assets (total Lines 1-7) (B) U 9. Funeral Expenses & Administrative Costs (Schedule H) (9) W It: (10) <j 5 Co 5. If 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) '-ISI.S. I 'f 12. Net Value of Estate (Line 8 minus Line 11) (12) .S'R'l r.. ~.2 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14, Net Value Subject to Tax (Une 12 minus Line 13) (14) !f8Gj 1,., ~~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Une 14 taxable at the spousal tax 0 !;( rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) S8q~. g;;. X.o 4.5 (16) .:t105..3L I-' 16. Amount of Line 14 taxable at lineal rate ~ Il. 17. Amount of line 14 taxable at sibling rate x .12 (17) ::E 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) U ~ 19. Tax Due (19) ;;tt.S.3t,.. 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT "".,,, "" ,'.n . SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER (( 0 ME. ~-r W. --r-;- '" <3 ~ 110 ';/'1 0'-1 -(l>37D Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disctosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Q.1f ~ \ '" G, A-c..c.OU.N, - LoQ../>J ellSlWli:: t=C-u.. # t'..3q~-t:>1 31~1. 8<- a.. ~A" \""'~ Ac:...c..O-......Ni- Qoa.I\.J~"::>TOfoJE ~c..u.. -tt ("3~~-() I 7 33'1."7'1 TOTAL (Also enter on line 5. Recapitulation) $ It) ./1.;) . 51.. (If more space is needed, insert edditional sheets of the same size) ,,,.,,,m,,,,,,. SCHEDULE I DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE ~ FILE NUMBER oJ. --r; 1>\ C LI/J ~\ C)'-/ - 0370 Ol-'>GlT Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. ()'\ ;;os, 1~H- if I LWfI- """ _ IY) 1\ It WI- 4%j~ U;.I,AJb CosH L/~ 1q.I.'f. .;(. Cu.1'\'Ba.Li\:tJD Q l2.e", 1~""1L OF u..J\l....-L~ 9300 1=' ""IS'" S .... III ,..es. 3. V.>;;P- \ '- % - h""l\;~ Vl.,o",€ ']'C-l- 30.(.1. 4. t.4J 12.;;: \ I'tt" ~€!> mCl>IUTL E><.pa;~E.s. /q:(4f TOTAL (Also enter on line 10. Recapitulation) $ L/5~S.7'-i (If more space IS needed, ,"sert additional sheets of the same SiZe) COMMONWEALTH OF PENNSYLVANIA AEV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 1712B.0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004704 SHERMAN COLLEEN 2139 COVENTRY COURT MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER --------Iold ---------- -------- 101 I $265.36 EST A TE INFORMATION: SSN; 176-09-8649 I FILE NUMBER: 2104-0370 I DECEDENT NAME: TIMBLIN ROBERT W I DATE OF PAYMENT: 12/07/2004 I POSTMARK DATE: 12/07/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 04/01/2004 I I TOTAL AMOUNT PAID: $265.36 REMARKS: CHECK#1033 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 04-0370 BUREAU OF INDIVIDUAL TAXES AND IlEPT. 280601 ACN 04125032 HARRISBURG~ PA 17126-0601 TAXPAYER RESPONSE DATE 06-25-2004 IEY-lSUEXAFP t09-DU TYPE OF ACCOUNT EST. OF ROBERT W TIMBLIN IX] SAVINGS S.S. NO. 176-09-8649 D CHECKING DATE OF DEATH 04-01-2004 D TRUST '04 -7 ~~ltg CUMBERLAND D CERTIF. REHIT PAYHENT AND FDRHS TD: COLLEEN SHERMAN REGISTER OF WILLS 2139 COVENTRY CT "- CUMBERLAND CD COURT HOUSE MECHANICS BURG PA 17 055 CUi'! CARLISLE, PA 17013 CORNERSTDNE FCU has provided the Oepartment with the info~ation listed below which has been used in calculating the potential tax due. Their records indicate that at the daath of tha above dacedent~ YOU were a joint owner/bensficiary of this account. If you hel this Infor.ation is incorrsct~ please obtain written correction frOIll the financial institution~ attach a copy to this for. and return it to the above address. This account is taxabls in accordance with ths Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 767-6327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6398-01 Dat. 02-19-1998 To insure proper credit to your account~ two Established (2) copies of this notice .ust accoBpany your Account Balance 14,669.47 pay.ent to the Register of Wills. Meke check payable to: "Register of Wills~ Agent". Percent Taxable X 50.000 Amount Subject to Tax 7,334.74 NOTE: If tax paYllents ars Bade within three (3) months of the decedent"s date of death~ Tax Rate X .045 you .ay dsduct a 5% discount of ths tax due. Potential Tax Due 330.06 Any inheritance tax due will becoBe delinquent nine (9) Bonths after the data of death. PART TAXPAYER RESPONSE [!]lililil~~~_I!I!B1!i!i"'i~II~~~!lii!_~liiii~Ilili.ii!i.~I~~~ilili~.ii!ii.!!~ilil_ii!i~~iiiil!~~iiil.~111 A. D The above information and tax dUB is correct. I. You Bay choose to reBit pay.ent to the Rsgistsr of Wills with two copies of this notics to obtain CHECK ] a discount or avoid interest, or you may check box "A" and rsturn this notics to the Register of [ ONE Wills and an official assess.snt will be issuad by the PA DepartBsnt of Revenue. BLOCK B. 1iZJ Ths above asset has bsen or will be rsportBd and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent"s rspresentative. C. D The above infor.ation is incorrsct and/or debts and deductions wers paid by you. You Bust cOlllplete PART ~ and/or PART ~ below. PART If you indicate a different tax rate~ please state your ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dot. Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. ABOunt Subject to Tax ~ S. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due e PART DEBTS AND DEDUCTIONS CLAIMED [!J DATE PAID PAYEE DESCR I PH ON AMOUNT PAID I I I TOTAL (Enter on Line 5 of Tax Co~ut.tlon) , of perjury, I declare that the facts I have reported abov. .re tru., correct and c BY knowledge and belief. HOME ( 117 ) 7:L. -~D0 WORK ( 711 12.~'7 /0 <f ) '7 t..- DI..3 TELEPHONE N MBER DA E' GENERAL INFORMATION l. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicab18 interest bned an inforntion sub.ftted by the financial institution. 2. Inheritance tax beco.as delinquent nina eanths afte... the decedent's date of death. 3. A joint account is taxable BVe" though the dBcadent"s name was added as 8 .atter of convenlance. 4. Accounts (inCluding thasa held batw..n husband and wife) which the decedent put in joint ne.es within one yaar prior to death are fully taxable as transfers. 5. Accounts established jointlY between husband and wife .ore than one year prior to dasth are not taxabla. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE l. BLOCK A _ If the infor.ation and computation in the notice are correct and deductions are not being clai.ed~ place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the_ with your check for the amount of tax to the Register of wills of the county indicated. The PA Depart..nt of Revenue will issue an official assessment (Far. REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B _ If the asset specified an this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the envelope provided. 3. BLOCK C _ If the notice info~ation is incorrect and/or deductions are being claimed~ check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check far the amount of tax paYable to the Register of wills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originallY was established or titled in the manner existing at date of death. NOTE: Far a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However~ there is an exclusion not to exceed $3~000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first na_e in the address portion of this notice~ the $3~000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balanca of the account inCluding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is dete~ined as follows: .. The percent taxable for joint assets established more than one year prior to the decedent"s death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF . 10' - PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Examplll : A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 . 10. = 16.TI. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent"s death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT . 10' - PERCENT TAXABLE OWNERS DR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established wi thin one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 . 10' = soX (TAXABLE FOR EACH SURVIVOR) .. The allount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. .. The amount taxable (line 6) is datermined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 1. Enter the appropriate tax rata (line 7) as determined below. Date of Death Spouse Lineal Sibling Collat.....l 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to p...esent OX 4.5%- 12X 15X tiThe tax rate mposed on the net value of transfers from a deceased Ch11d b1enty-one years of age or younger at death to or for the use of a natural parent~ an adoptive par8nt~ or a stepparent of the child is OX. The lineal class of heirs Includes grandparents~ parents~ children~ and lIneal descendents. "Children" includes natural children whether or not they have been adopted by othars~ adopted childran and step children. "Lineal descandents" includes all children of the natural parants and their descendents~ whether or not they have been adopted by others~ adoptad descendents and their dascendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co.mon with the decedent~ whether by blood or adoption. The "Collateral" class of heirs includes all othar beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductIons are determined as follows: .. You legally ara responsIble for paymant~ or the estate subject to adminIstratIon by a personal representative is insufficIent to pay the deductible Uen. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai..d lIIust be itemized fully in Part 3. If additional space is naeded~ usa plain paper 8 I/l" xli". Proof of payment .ay be requested by the PA Department of Rsvenue. - CDMMONWEALTH DF PENNSVLVANIA *' DEPARTHENT OF REVENUE INFORMATION NOTICE FILE NO. 21 04-0370 BUREAU OF INDIVIDUAL TAKES AND DEPT. Z80601 TAXPAYER RESPONSE ACN 04131881 HARRISBURG, PA 17128-0601 DATE 09-01-2004 REV-15U EX UP CD9.DD> TYPE OF ACCOUNT EST. OF ROBERT W TIMBLIN o SAVINGS 5.5. NO. 176-09-8649 IX] CHECKING DATE OF DEATH 04-01-2004 o TRUST '04 [Ee -7 !iPOII~Y CUMBERLAND o CERTIF. REHIT PAYHENT AND FORMS TO: COLLEEN SHERMAN REGISTER OF WILLS 2139 COVENTRY CT , CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055 Ct:li CARLISLE, PA 17013 CORNERSTONE FCU has provided the Depart.ent with the infor.ation listed below which has been used in calculating the potential tex due. Their records indicate thet at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction fro. the financial institution, attach a copy to this form and return it to the ebove address. This account is taxeble in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Questions may be answerqd by calling (7171 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6398-07 Date 02-19-1998 To insure proper credit to your account, two Established (21 copies of this notice must accompany your Account Balance 6,255.63 pay.ent to the Register of Wills. Hake check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax 3,127.82 NOTE: If tax peyments are made within three (31 months of the decadent's dete of deeth, Tax Rate X .045 you mey deduct a 5X discount of the tax due. Potentiel Tex Due 140.75 Any inheritance tex due will become delinquent nine (9) months after the date of deeth. PART TAXPAYER RESPONSE [!]1~i!~lJ~lli~i!i!.~!""Ji~'~IIil!!!!!"'~!!!i!~~iiil.!!!!~I~~!~~Iil!!!i!~gji!!!\I.~.II!!!i!"_!i!i.!!!~~I!!!l-~~Imi!l _...._-.-.,.-.""~.,.,~.,.,.,,~,,',',.,.,',.,.,.,.,.,.,.,.,.,.~,.,.~,...........,...,..............-.......-...,.-.-.,.-.-.,.,.,.'.""',""'.""'.',','.""'.',',',',',',.,',',.,',.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,',.,.,...,.....,.,.,...,......................................-.-.,...-.-.-.,.-.-.-.,.,.,.,.,.-.,.,.,",'."'."',',',',',.,',.,',.,.,.,.,.,.,.~,.,.,.,.,.,,.,.,.,.....,...,.................... ,. ...,......-.......-.......-..............,.. .. '"'J"'."" .,..,..,.,.......,.,...,.,................................-.....-.............................:<1"'.....1'.....,...,..,..,. ..,...,...,......,...,.,...,...................................................... .....,...........,......,.,...,.,. A. D The ebove infor.aUon and tax due is correct. 1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtain CHECK ] a discount or avoid interest, or you mey check box "An and return this notice to the Register of [ ONE Wills end an official assess.ent will be issued by the PA Depart.ent of Revenue. BLOCK B. ~ The above asset hes been or will be reported and tax paid with the Pennsylvania Inheritance T!lx return ONLY to be filed by the decedent's representative. C. D The above information is incorrect and/or debts and deductions ware paid by you. You .ust co~let8 PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your [!] reletionship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dete Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. A.ount Subject to Tax 4 S. Debts end Deductions 5 - 6. Amount Texable 6 7. Tax Rat. 7 X iiliillilil!il~I!I!~I!!~ii:iiliii:i:i:!:!~li:i:i:i::I:li:il::ilii:li:i:i:ili:i:i::I::i::li:i:::i:::~ii!::~:~:~!:i:!:!:~:~iI:!i!:~!:i:!~:!:!;j!~:!:!i 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on Line S of Tax Computation) $ perjury, I declare that the facts I have reported above are true, correct and my knowledge and belief. HOME (tn) 7G;;t", - /I) In ~ WORK (in ) 7~Ie-jo"'3 12JT Jo'f TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicabla interest based on inforllation submitted by tha financial institution. 2. Inheritance tax b.C~BS delinquent nina months after the decedent"s date of death. 3. A joint account is taxable even though the decedent's naBa was added 85 a .attar of convenience. 4. Accounts (including those held betwBen husband and wife) which the decedent put in joint nBlles within one year prior to death are fully taxable as transfers. 5. Accounts establishsd jointlY between husband and wife lIore than onB year prior to death are not taxable. 6. Accounts held by a decedent Rin trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and COMPutation in the notice are correct and deductions are not being claiMed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and sub.it them with your check fo~ the aMount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, HarriSburg, PA 17128-0601 in the envelope provided. .. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (ForM REV-1548 EX) upon receipt of the return fro. the Register of wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originallY was established or titled in the .anner existing at date of death. NOTE: Far a decedent dying after 12/12182: Accounts which the decedent put in joint naMes within one (1) year of death ere taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first nBae in the address portion of this notice, the $3,000 exclusion already has been deducted frOM the account balance as reported by the financial institution. Z. Enter the total balance of the account inclUding interest accrued to the date of death. .. The percent of the account that is taxable for each survivor is deterMined as folloWS: A. The percent taxable for joint assets established More than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 1DO . PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS EXBllple: A joint asset registered in the na.e of the decedent and two ather persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) - .167 X 1DO . 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxabla far assets created within one year of the decedent.s death or accounts awned by the decedent but held in trust for another indlvidual(s) (trust beneficil!lrlesh 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 1DO . PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES ExaMple: Joint account registered in the nl!lMe of the decedent and two ather persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) - .50 X 1DO . SOX (TAXABLE FOR EACH SURVIVOR) .. The B80unt subject to tax (line 4) is detereinad by eUltiplying the account balance (line 2) by the parcent taxabla (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deterllinad by SUbtracting the debts and deductions (line 5) fro. the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterMined below. D.t. of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3" 6" 15" 15" 01/01/95 to 06/30/00 0" 6" 15" 15" 07/01/00 to present 0" 4.5,,- 12" 15" _The tax rate 111posed an the net value of transfers from a deceased child twenty-one years of age or younger at deBth to or far the use of a natural parent, an adaptive parent, or a stepparent of the child is OX. The linesl class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes naturl!ll children whether or not they have been adopted by others, adopted children I!lnd step children. "Linel!ll descendants" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adapted descendents and their descendl!lnts I!lnd step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You i.gally I!lre responsible far payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible ite~s. B. You actually paid the debts aftar death of the decedent and can furnish proof of payment. C. Debts being claimed eust be iteMized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 1In. Proof of paYMent .ay be requested by the PA Department of Revenue. ~~. ~~~. N~~~' ;'~~~t~~~ "~~~~~MA~I=~Po~I~~s~I~I~~~m~E~~N~A~~':::~N~iiilii~ijl~~~~ii!ii~~ii:ii~;ij~~i~i!l~iiiii:i:. :':"i;i;i;" iil:':,:::,' Pollf 'DE~ARfl!liNi Ofi: RE~Il!;NliIE . D~SfR.:r:Cf. OFli1~CE liI~ CALlll "THE lIli1~itjU 'OF.:u. uu :":.:..':-;: .,,,u...: . mil".; ~lI~~!!~~QAL' .rr.A~~S..])AX~lIl~~R. IN!lItltR~" ~=1]) (l~A HARRl=I~=~i ~~L'I~i~~4~15~;=i~'j~:i~~~T~~~':'" i~@~ijiij~~~~~~~~~jiiji~i~~~iiiii~~~~i~~~ijiii~~~~i~~~iiiii:;,:.",.~i@~~,i,.;,.;~~~~jiiii.:.,...:.i".'.';'i:'ii~ijij:ji~ml""'.ii"."i~ii.,ii;,;.:,ml;';;iiiiii,j,.miij,:ii..:!!..:!im,;""i:;,."j..,jiffijjmij;ni::j;im:m, COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF INDIVIDU~'i.:r1t~ME$~T NOTICE OF INHERITANCE TAX ! '_';'''' ,_/ "..' '~r _'~ _. INHERITANCE TAX DIVISION.., ,. / APPRAISEMENT. ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG PA 17128-0601 IEY-1541 EX AFP 112-04) 18 ' I. I "'- DATE 03-21-2005 II' ~I;:) ESTATE OF TIMBLIN ROBERT W DATE OF DEATH 04-01-2004 e'cn.., FILE NUMBER 21 04-0370 Lct~:; t\ oory !~l-'.rt'\ COUNTY CUMBERLAND . j Ii' 'll}\r~ ~) COLLEEN()JJ,~1-\N.' ACN 101 2139 COVENTRY CT I Allount Rellitted I MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE.V :rA'1."f.I;c..AFp..rOr:O~".NaT.icE.'i:i'F.iNHErtI.fAN.CE.TAiC-A.PPRA.fsEi"EN'~..A[l'i:i'WANCE.OR................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF TIMBLIN ROBERT W FILE NO. 21 04-0370 ACN 101 DATE 03-21-2005 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) U) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account. 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 10.462.56 tax pay_nt. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 10.462.56 APPROVED DEDUCTIONS AND EXEMPTIONS: .00 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) UO) 4,565.74 u. Total Deductions Ul) 4.565 74 12. Net Value of Tax Return (2) 5.896.82 13. Charitable/Governaental Bequestsj Non-elected 9113 Trusts (Schedule J) (3) .00 14. Net Value of Estate Subject to Tax (4) 5.896.82 NOTE: If an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (5) .00 X 00 = .00 16. AlIOUnt of Line 14 taxable at Lineal/Class A rate (6) 5.896.82 X 045 = 265.36 17. Allount of Line 14 at Sibling rate (7) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (8) .00 X 15 = .00 19. Principal Tax Due (9)= 265.36 TAX CR I S: + AMOUNT PAID DATE NUltBER INTEREST/PEN PAID (-) 12-07-2004 CDo04704 .00 265.36 TOTAL TAX CREDIT 265.36 \ BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT"' (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . . ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: R()h>xt lDfuJ(1L Gmb\;(\ 41 tl ot-t \ Date of Death: Will No.: ,-1noi.{.- 00310 Admin. No.: '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. Stat~ administration of the estate is complete: Yes No 0 2. lithe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a Did jPersonal representative file a final account with the Court? Yes No 0 . b. The separate Orphans' Court No. (if any) for the personal representative's account is: - c. Did the perso~esentative state an account informally to the parties in interest? Yes No 0 - c. Copies of receipts, releases, joinders and approval oHonna! or infonna! accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Date: 1b./05- afllLo--<) g)UY>?1/1... / 19nature ./ (J.1J I / t" Ot l <;/; e/ /YJa-n Name {~I-''3 q (to IIt.ttlr-fr-z. ~ Amt.clv..f0 10 b (l '-3f! 70 ss 7 { 7- 71LJ (/7 - J D &- o? Telephone No. Capacit~onal Representative o Counsel for personal representative , erA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF tNDI VIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 0101 1 1 COPLIN JANICE T 51 WEST VINE STREET SHIREMANSTOWN, PA 17011 fold ESTATE INFORMATION: ssN: i 7s-os-seas FILE NUMBER: 2104-0370 DECEDENT NAME: TIMBLIN ROBERT W DATE OF PAYMENT: 08/08/2008 POSTMARK DATE: 08/08/2008 COUNTY: CUMBERLAND DATE OF DEATH: 04/01 /2004 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 08133635 ~ $41.94 1 TOTAL AMOUNT PAID: 541 .94 CHECK# 3660 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 04-0370 BUREAU OF INDIVIDUAL TAXES DEPT. zeo6ol A ACN 08133635 HARRISBURG, PA n1zB-o661 _ '.;TAX P AY E R R E S P O N S E DATE 07-24-2008 REY-1543 EX AFP'(09-90) ' TYPE OF ACCOUNT r~€ ~ ~~~ -~'~ ~'~i ~~5~~ OF ROBERT W TIMBLIN ® savlNGs $.$. N0. 176-09-8649 ^ CHECKING ~; DATE OF DEATH 04-01-2004 ^ TRUST ~'" CERTIF. ~-,,-__ :COUNTY CUMBERLAND ^ ~`i I' ` '~~, REMIT PAYMENT AND FORMS T0: JANICE COPLIN 51 W VINE ST SHIREMANSTOWN PA 17011-6345 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 A-K VALLEY FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-6327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5608000 Date 03-03-1989 To .insure proper credit to your account, two Established (2) copies of this notice must accompany Your 8 6 3.9 8 payment to the Register of Wills. Make check Account Balance 1 , payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject t0 Tax 931.99 (3) months of the decedent's date of death, TaX Rate X . 045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 41 • 94 nine C9I months after the date of death. PART TAXPAYER RESPONSE ':_:.: ~~.:, ::. ~:.:: :~: ~ ~ ;~:~: :~ : ~::::..E..DE:'!`::IH:;ANA:~D~~F:I.I#1L:.°E'1.1~...A~~:~~~N:EN:fiz~A~E~..#lN..7`N.~rr.... ~1;~'E`I:~:E€ ...AIIrU~IE...,.°f Il.....RE~~?'D~1~1:: ~i ~~.~::: R..._.~~ .................................................................................................................................................:........::......:::... ::::...: ...: .::.....: . :.......:.:......................................:........:....... The above information and tax due is correct. / 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If ou indicate a different tax rate, please state your Y ;:;~:~ z':i i':ii ? :`:. ` ~ iii: . . . . . . . . ;i:'iiif€si'tii?i?i'.~€i€iEi'i'iiiiiisiii~i~i~ii~~i'~~'?i'~Q~..._ ::.....:......... ~... . . . . . . . . . . : : : : : : :: : : : : : : : Z e e dent : o sh to d C relata n sp . . . . . . . . . : :::::: :::::::::. . . . . . : . :: ~:::: ...: ..._ . .-:.:. . .::::. .: :. .: . . . E€ :ii:€~.'-.:~:i ~:i:~'::t,~:::~::~t :::::: :::::::::::::~: ~::::::~::::~a:::;:;::::~~::::,::.....:...,...:,.,.,.,.,.,.,.,.,. .:N'~~~0 :~ i~iF~sl~Ii~is~~i~i AX - T TRUST ACCOUNTS 0 ON JOIN 1 0 F TAX C MPUTATI N RETURN 0 '~~'_~_~€~iii~s~ ~='_~~_~ii~€~~ €€i~'€i=€~=~~~€ii€=€=€~€ €i fi*~4 N LI E l . b 's ed 1 t e s t a l a h Da E :::~:: ~iisi~=~ ~ ''' ~ ~`i~ ii!? [`~i i~ 1~ i~~ € ~i6ii~ ~ E€siis€ij~s';r;;=~i€'=~ ~?~~ €i 2. o t a ante 2 Acc un B 1 3. 3 X c t a ab e P e r e n T x l s'a'<?''`is??~~'~€1~ ' '•':''i~~''~~ %E_ _€~ti~`~s': ~' 4. u b ' e c t T ax 4 Amo nt Su ~ t o i'~kii`;~ '~j _~~ E'5':':~ ~~i ['''':i's' ~~ i~ _~'~':;~ ':~ i':= 5. a ed ct'o s 5 Debts nd D u i n - ~~i= ~~~'':~ ~~=?: ~':'':~ ~i~ ': ~':': ~i ~~ ~~ ~ ~~=€_'~ ?': ~ iii ~'i~ ~'=i~ _ ~ii~ iii 6 A ou t axable 6 7 7 X T ate ' 8 T ue 8 ax D j'~s_s~=~ssit '~s`~€s'?~s~~~ ~_ ''`€!€€€~€~~€~=€'r_€€€€is~ps's PART DEBTS AND DEDUCTIONS CLAIMED TOTAL CEnter on Line 5 of Tax Computations 8 Under penalties of perjury, I declare that the facts I have repo~r~t7ed above are true, cor e~ct/and co e e to the best of my knowledge and belief. HOME C / ~ ~F- C - ~ ?. ' WORK C J ~ /, TAX YER SIG ATURE TELEPHONE NUMBER D TE `~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~^) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate Cline 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present ~Thn +av ~+o - ..a 0% 4.5%~ 12% 15% ~-~- --- ~- - - ~--~- -•• _ ••_~ ~_~ nnrers rrom a peceasep cniln twenty-one years of age or younger at death to or for the use of a natural Darent, an adoptive parent, or a stepparent of the child is 0%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. Vou legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. 1 ~~ ° ;~ t _ r ~ !~ ~, ,~.. P,~a -: . ~Y~i i ,~' `~ '~. `h rim Y` l: ~"" i S.~ Sr. ~a~ ; ;~+ W W W~ 1 0 ,~ D .~ ~' _y~ O ~ ~ r \ ~^4 a ~ W? W t'S ~ u" Z ~ ` V ~ ~ N Qaa~ON ~ ~ W m ~ = Q ~ ~ a~?n .= ~~ ~~ ~~ ~~ ~~ X :W e w 0 m a 0 0 z 0 =Z m ~ n C i N O to m ~ ~ 2 m O (n ~ m Z Wm r O o e st t m ....- .~ 'i1 D~ C Z ~ $ ~ ~ o c Z ~ BUREAU DF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 JANICE COPLIN 51 W VINE ST COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTPCf= DF INHERITANCE TAX APPRgZSEMENT, ALLOWgNCE OR DISALLOWANCE OF ;DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP cos-o5) ~~~~;~ ~;} ~• _~-; r~,- rTE 10-06-2008 `- '~' ~""I " I~`' ,~. STATE OF TIMBLIN ROBERT W DATE OF DEATH 04-01-2004 ~!r:- FILE NUMBER 21 04-0370 r,,.- ,~„ COUNTY CUMBERLAND -•'' -' ",.,.SSN/DC 176-09-8649 r., ~ . , -- ACN 08133635 S~HIREMANSTOWN PA 17011-6345 APPEAL DATE: 12-05-2008 (See reverse side under Objections) Amount Remitted ~ ~~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~"> RETAIN LOWER PORTION FOR YOUR RECORDS <'~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-06-2008 ESTATE OF TIMBLIN ROBERT W DATE OF DEATH 04-01-2004 COUNTY CUMBERLAND FILE N0. 21 04-0370 S.S/D.C. N0. 176-09-8649 ACN 08133635 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: A-K VALLEY FCU ACCOUNT N0. 5608000 TYPE OF ACCOUNT: 4C )SAVINGS ( ) CHECKING C )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 03-03-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CF',EDITS 1,863.98 X 0.500 931.99 .00 931.99 X .45 41.94 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2008 CDO10111 .00 41.94 BALANCE: OF UNPAID INTEREST/PENALTY AS OF 08-09-2008 TOTAL TAX CREDIT 41.94 BALANCE OF TAX DUE .00 INTEREST AND PEN. 10.16 TOTAL DUE 10.16 ~ IF P/SID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF_TOTAL_DUE-IS-REFLECTED_AS A-^CREDIT" C-CR), YOU MAY BE DUE A REFUND.