Loading...
HomeMy WebLinkAbout03-0923 CUMBERLAND Register of Wills of County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Elizabeth Dunlap Thorpe No.~/-O~_ 9^'2,~ also known as , Deceased Social Security No. 324-46-9314 Petitioner(s) who is/are 18 years of a&e or older, apply(ies) for: (COMPLETE "A" OR "B" BEL W) Gd A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut~ iXnamed in the last Will of the decedent, dated March 1 0, 1 983 and codicil(s) dated See Renunciation of Joy S. Chambers, formerly Joy S. Mason ( State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: 0 B. Grant of Letters of Administration (d.b.n.c.la.; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES;) Attach additional sheets if necessary Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 1512 Kathr n Street New Cumberland PA 17070 (Boro of New (list street, number, and municipality) U d) Decedent, then 71 years of age, died Julv 24 ,20~,at Allegheny Hospital Decedent at death owned property with estimated values as follows: Pi ttsbfr!tcg~n)PA (If domiciled in PA) All personal property $ 500.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of Real Estate in Pennsylvania $ situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence ~~ Rebecca Ruth LaRosa 95 Burning Brush Circle Etters PA 17319 snacelWillsPetGrantLV2001 Oath of Personal Representative Commonwealth of Pennsylvania County of York 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 or Petitioner(s) and that, as personal representative(s) of the Decedent, Petition(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~~~~ before me this day of 20 - For the Register No. ~/-I"JB- 9a3 Estate of Elizabeth Dunlap Thorpe Deceased Social Security No.: 3 2 4 - 4-6 - 9 3 1 4- Date of Death: Julv 24, 2003 AND NOW, ,20 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary 0 Of Administration are hereby granted to Rebecca Ruth LaRosa d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate in the above estate and that the instrument(s) dated March 10, 1983 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters . . . . . . . . . . . . $ "- Short Certificate(s) . . .$ j~ Renunciation. . . . . . . $ Attorney: Affidavits ( )....... $ I.D. No: Extra Pages ( ).....$ Address: Codicil . . . . . . . . . . . . $ Etters PA 17319 Telephone: 71 7 938-3396 ...'~ -" JCP Fee. . . . . . . . . . .$ . .: ~ . Inventory. . . . . . . . . . .$ Automation Fee. . . . . $ Other. . . . . . . . . . . . . .$ TOTAL. . . . . . . . $ .. snacelWillsPetGrantLV2001 - Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240-6345 Date: 6/15/2005 SECHRIST JOEL 0 568 OLD YORK ROAD ETTERS, PA 17319 RE: Estate of THORPE ELIZABETH DUNLAP File Number: 2003-00923 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. 1, for decedents dying on or after Jul y 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: 7/24/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File oCR Personal Representative(s) Judge WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEAll H OF PENNSYLVANIA DEPA iTME"NT OF ~:EALTH VITAL RECORDS L.OCAL REGll;TRAR'S CERTIFICATION OF DEATH ~'(~(\~ip~ I..' ~ ' , It - ".,~ / '~i--" ,l~l/ .~. ~\ 'g ~;t1~'?% ~~. . ...,:;2:, % ~:,I':~ . i~i CERT. NO. T 5445487 I~~;, """"'" >"':/ 7-~1-()3 ~. /./~I\I Date of Issue of This Certification - Af,f' '~ I' ~'-,,"-. 1M Dlf \\\ ~ """' ..........;r.... //,1 "'//"'11'/#11/11' Name of Decedent f L\ a b ei--"'- D nD l< p-o Fi'~1 Middle Last Sex ---F_ Social Security No. 3J.J1-=--.!i t,- q3 I ~ Date of Death 7-JLf-o-" - Date of Birth 3-1'!?'30 Birthplace _ C~J\A~ ~, 9rA~ Place of Death Penns Ivania Race vJ~IT.JU Occupation s" c,,\{l \ ~ so 1\../ Armed Forces? (Yes or No) J\VOR('-~1 Decedent's t~eR~l' ~. Wow CtYh ~ \tlwb ~~ Marital Status Mailing Address 15"1 :f Number Sir t Crlv or Town Slate Informant ~\~ f'~~~ Q \20){}-- Funeral Director Lr..., ~ \.0 ~ L Co N\ R.Q ) Name and Address of ~rvQ\P~ R(){V\ --Q C.hJ)l\~ C\(\ w -r tJ.. Funeral Establishment ~ (' Ci/l.;tR.QA I I I nterval Between Part I: Immediate Cause I Onset and Death I -rORtJ2. ~ \k --rR.UAJ{::-- I ~ \ urv-t f\ROJlfi. A.J I (a) I I I (b) I I I I (c)_. I I I (d). I Part 1/: Other Significant Conditions I I I Manner of Death De~be how injury occurred: eO Ih\IO^--- Natural [J Homicide 0 5')Q~)~JJ - dV1~\(',\"f> Accident r$- Pending Investigation 0 Suicide 0 Could not be Determined 0 Name and Title of Certfier i:..o ~}AJ ..P't~ Sur hQ~./ (M.D., D.O.~ ~i\ ,be I'G h VI> , Address 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.CfyJ -------- &G~~ 11' )-...6 ,J H:-e",,: b~$ ;eq"t,q 3 J1 flee ~/-O~ - 9~-tttl '1',..' --'-. .\. II 1 [.4' \ . f "I .. ".. QUAKER STATE: 7178888618 10/14/08 111 18arn P. 002 c:2/-08- 9526' RENUNCIATION INRE: Estate of ELIZABETH DUNLAP THORPE, deceased To the Register of Wills of Cumberland County, Pennsylvania The undersigned JOY S. CHAMBERS, fannedy known as JOY S. MASON, Co- Executor of the Estate of the above decedent, hereby renounces the right to administer the estate and respectfully asks that Letters Testamentary be issued to REBECCA RUTH LA ROSA. WITNESS my hand this \l\ day of oct-- ,2003. >:-,}!~ S C/1vv-~J~-P Joy ~am~rs ~~~ 201 North Fairfax Street, Suite 12 Alexandria V A 22314 Sworn to and Subscribed before me this /,/rh. day of 0 L..t <9 h e,r , 2003. , ~o-~~ Notary My Commission Expires Oc~j,~ r .1$ ;ooLJ LAST WILL AND TESTAMENT OF ELIZABETH DUNLAP THORPE I, ELIZABETH DUNLAP THORPE, of l200 South Washington Street, Apartment 723-E, Alexandria, Virginia make this my will. I revoke any other wills or amendments to wills made by me. ARTICLE I. Distribution of My Estate. I give all of my estate to my only child and daughter, MRS. REBECCA RUTH LA ROSA, if she survives me. If MRS. REBECCA RUTH LA ROSA does not survive me, I give all of my estate to her descendants, per stirpes, who survive me. ARTICLE II. Payment of Debts and Other Charges. I direct my Co-executors to pay my debts and my funeral and burial expenses, including the cost of a monument or marker over my grave. The estate, inheritance and similar taxes assessable on my death, including taxes on assets not passing under this will also shall be paid as a cost of administering my estate and my Co-executors shall not request any beneficiary to pay any part of such tax. ARTICLE III. Co-executors A. I name MRS. REBECCA RUTH LA ROSA and MRS. JOY S. MASON to be my Co-executors. I request that no security be required of any Executor. B. In addition to the powers granted by law, I grant my Co-executors the powers set forth~n ~64.l-57 of the Code of Virginia, and I incorporate that Code Section in my will by reference. All successor Executors or Co- executors shall have the powers, immunities and discretion . which I have granted to my named Co-executors. , - 2 - IN TESTIMONY WHEREOF, I have set my hand and seal to this my last will and testament, consisting of three "(3) typewritten pages on which I have placed my signature this lOth day of March, 1983. ~.~~ ~~ ~~.tY ~~ ( SEAL) EL ZABETH DUNLAP THORPE The foregoing instrument, consisting of four (4) typewritten pages, including this attestation clause, was on this lOth day of March, 1983, subscribed by ELIZABETH DUNLAP THORPE, the Testatrix named herein, and by her signed, sealed, published and declared to be her LAST WILL AND TESTAMENT in the presence of us, and each of us, who thereupon, at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses thereto. of In N F'~ ~) OtA. of .jf1.,2. ~~ fJL ~ L of Jl)M'd.ll/fldISoi) ~tJf.vQ.. STATE OF VIRGINIA I ' CITY OF ALEXANDRIA Before me the undersigned authority, on this day personally appeared ELIZABETH DUNLAP THORPE, ~ S~ , 7~ tv~and~~ , known to me to be the Testatrix and the Witnesses, respectively, whose names are signed to the attached or foregoing instrument, and, all of these presons being first duly sworn, ELIZABETH DUNLAP THORPE, the Testatrix, declared to me and to the Witnesses in my presence, that said instrument is her LAST WILL AND TESTAMENT and that she had willingly signed or directed another to sign the same for her and executed it 'I . , 3 in the presence of said Witnesses as her free and voluntary act for the purposes therein expressed; that said Witnesses stat before me that the foregoing will was executed and acknowledged by the Testatrix as her LAST WILL AND TESTAMENT in the presence said witnesses, who in her presence, and at her request, and in the presence of each other, did subscribe their names thereto as attesting Witnesses on the day of the date of said Will, and that the Testatrix , at the time of the execution of said Will, was over the age of eighteen (l8) years and of sound and disposing mind and memory. ~ I..~~_I~~ Te tatrlx Wit~S.~ ~~.~ ltness . 5r::t~flL~ I?~ '""W'l tn s SUBSCRIBED, SWORN AND ACKNOWLEDGED before me by ELIZABETH DUNLAP THORPE, the Testatrix, SUBSCRIBED AND SWORN to before me by ~ ~ ,..,.. 4u-- /,..J ~ and ~ ' the Witnesses, this lOth day of March, 1983. My Commission expires: 5d:?#tt / I; ~- . . I ~ P-i p:; 0 H ::r: ~ E-t .::t: Z H H E-t P-i 0 Z H Z .::t: Ul E-t H ~ H ~ .::t: H :3: Q ~ Z ~ .::t: i:l.i ::> ::>t 0 E-t E-t 0 Q . ~ Ul Ul Ul Z H .::t: ~ ::r: p:; H E-t E-t ::>t 0 p:; ~ 0 E-t (1:l I-J E-t 0 .::t: .::t: t-j H H ~ , I I , ~ -. .. . 1- ! CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Elizabeth Dunlap Thorpe Date of Death: July 24, 2003 Will No. 2003-00923 Administration No. To the Register: I certify that notice of beneficial interest 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 November 10,2003. Name Address Rebecca Ruth LaRosa 95 Burning Brush Circle, Etters P A 17319 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No Exceptions --- Date: rfrjo:s ) Capacity: _ Personal Representative X Counsel for Personal Representative I ',-- _. Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters PA 17319 April 14, 2004 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle P A 17013 aC :.:; r:< g ::1 -., C ,'. ::P -0 ?:J To Whom It May Concern: --- Ul -0 Enclosed are the original and one copy of the Pennsylvania Inheritance TaX.iRetum in regard to the above estate. Also enclosed is a check made payable to Register of "Wlill, Agent in the amount of $40.90 for the inheritance tax and a check made payable to Regist~fWills in the amount of$15.00 for the filing fee. .-,>, JOS:lm PC: Rebecca LaRosa V. REV'1500 EX (6-00) Rev-1500 USE ONl'y COMMONWEALTH OF PENNSYLVANIA ..................-........-............................................-.-........ . DEPARTMENT OF REVENUE FILE NUMBER DEPT. 280601 INHERITANCE TAX RETURN . HARRISBURG, PA 17128-0601 - RESIDENT DECEDENT County Code Year Number DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- z Tbqrpe, Eliza~~~hP, w Cl DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH W () 03-18-1930 REGISTER OF WILLS w Cl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER .s 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12- ~.~ (/J 4. Limited Estate 4a. Future Interest Comprise (date of death after 12-12-82) 5. Federal Estate Tax Return Required 0'--" III 0.0 .ce.Q x 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Atlach a copy of Trust) 8. Total Number of Safe Deposit Boxes () li lD <( 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) 9. Litigation Proceeds Received = NAME COMPLETE MAILING ADDRESS <U Rebecca R. LaRosa -= = C> FIRM NAME =- en ~ C> TELEPHONE NUMBER c....:> 1. Real Estate (Schedule A) (1) $0.001 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) $0.001 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 i z 4. Mortgages & Notes Receivable (Schedule D) (4) --$0.00 i 0 d :!J I- 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) . . $-250.00 ti} J::>, .-, <( '. .: .J ...J 6. Jointly Owned Property (Schedule F) (6) $8,596.30 :::-;, ::> D Separate Billing Requested ;-d I- a.. --' <( 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) $0.00 'n ............................................................... U (Schedule G or L) i W a:: 8. Total Gross Assets (total Lines 1-7) (8) $8,846.30 ;1 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $6,772.00 ,.::_,,- 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $1,165.31 11. Total Deductions (total Lines 9 & 10) (11 ) $793731 12. Net Value of Estate (Line 8 minus Line 11) (12) $908.99 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $908.99 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax Z rate, or transfers under Sec. 9116 (aX1.2) x (15) $0.00 0 j: 16. Amount of line 14 taxable at lineal rate x (16) $40.90 ~~ 17. Amount of line 14 taxable at sibling rate x .12 (17) $0.00 I-:J Q. ~ 18. Amount of line 14 taxable at collateral rate x .15 (18) $000 0 () 19. Tax Due (19) $40.90 20,1>1 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT v' Decedent's Complete Address: ST~EET ADDRESS . crT'1 STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) $40.90 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) $000 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) (3) $0.00 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $40.90 Make Check Payable to: REGISTER OF AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ~ ~ b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary 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 on year of death without receiving adequate consideration? ~ EE] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her/i 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? 1< < I 1.>......i~..............1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. DATE L~ r/Zt!/O// .~.('... t t...Jj~...~/ ft. DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a) (1.2)]. The 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 an individual who has at least one parent in common with the decedent, whether by blood or adoption. ,,=====. "'==== ''=-~, . LAST WILL AND TESTAMENT OF ELIZABETH DUNLAP THORPE I. ELIZABETH DUNLAP THORPE, of 1200 South Washington Street, Apartment 723-E, Alexandria, Virginia make this my will. I revoke any other wills or amendments to wills made by me. ARTICLE I. Distribution of My Estate. I give all of my estate to my only child and daughter, MRS. REBECCA RUTH LA ROSA, if she survives me. If MRS. REBECCA RUTH LA ROSA does not survive me, I give all of my estate to her descendants, per stirpes, who survive me. ARTICLE II. Payment of Debts and Other Charges. I direct my Co-executors to pay my debts and my funeral and burial expenses, including the cost of a monument or marker over my grave. The estate, inheritance and similar taxes assessable on my death, including taxes on assets not passing under this will also shall be paid as a cost of administering my estate and my Co-executors shall not request any beneficiary to pay any part of such tax. ARTICLE III. Co-executors A. I name MRS. REBECCA RUTH LA ROSA and MRS. JOY S. MASON to be my Co-executors. I request that no security be required of any Executor. B. In addition to the powers granted by law, I grant my Co-executors the powers set forthJn 564.1-57 of the Code of Virginia, and I incorporate that Code Section in my will by reference. All successor Executors or Co- executors shall have the powers, immunities and discretion which I have granted to my named Co-executors. I IN TESTIMONY WHEREOF, I have set my hand and seal to this my last will and testament, consisting of three (3 ) typewritten pages on which I have placed my signature this 10th day of March, 1983. . ~ C~r i~.(,-V,t;r '""~ (SEAL) EL ZABETH DUNLAP THORPE The foregoing instrument, consisting of four (4 ) typewritten pages, including this attestation clause, was on this 10th day of March, 1983, subscribed by ELIZABETH DUNLAP THORPE, the Testatrix named herein, and by her signed, sealed, published and declared to be her LAST WILL AND TESTAMENT in the presence of us, and each of us, who thereupon, at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses thereto. of III N F~ ~) O~ of 3'i1.;1.. ~i) P/ d.t# tieL.- of J/)M/'I. i1/0d,s"f) J~~.,tSkixl jO-. STATE OF VIRGINIA CITY OF ALEXANDRIA Before me the undersigned authority, on this day personally appeared ELIZABETH DUNLAP THORPE, ifrL s ~ , /~ t.....J~ and~~ , known to me to be the Testatrix and the Witnesses, respectively, whose names are signed to the attached or foregoing instrument, and, all of these pre sons being first duly sworn, ELIZABETH DUNLAP THORPE., the Testatrix, declared to me and to the Witnesses in my presence, that said instruJ'1ent is her L}I.ST WILL AND TESTAMENT and that she had willingly signed or directed another to sign the same for her and executed it -~ -- ........ ~ ~........ v..........LUllLdry act for the purposes therein expressed; that said "Ji tnesses stat before me that the foregoing Will was executed and acknowledged by the Testatrix as her LAST WILL AND TESTAMENT in the presence said witnesses, who in her presence, and at her request, and in the presence of each other, did subscribe their names thereto as attesting Witnesses on the day of the date of said ,.viII, and that the Testatrix , at the time of the execution of said Will, was over the age of eighteen (18) years and of sound and disposing mind and memory. ~~,4~1Z>~~ Te tatrlx Wit~S,~ ~ff );,.~ " ~1?o'F^~ Wltn s . SUBSCRIBED, SWORN AND ACKNOWLEDGED before me by ELIZABETH DUNLAP THORPE, the Testatrix, SUBSCRIBED AND SWORN to before me by 'kt-~ ,-r-J-..0~ and ~ ' the Witnesses, this 10th day of March, 1983. . \ /./} ,k~~~/ // My Commission expires: .~/:b ;"~? ... .. .. /. / REV-150B EX + ~1-97X1) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 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 disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Furniture $250.00 TOTAL (Also enter on line 5, Recapitulation) $250.00 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (1-97X1) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTL V-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Rebecca R. LaRosa 95 Buming Brush Circle. Etters PA 17319 daughter B. John M. LaRosa 95 Burning Brush Circle. Etters PA 17319 son-in-law C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A.&B. 12/31/85 Savings Account PSECU $23,150.79 33.3% $7,716.93 2. A.&B. 12/31/85 Checking Account PSECU $2,638.12 33.3% $879.37 TOTAL (Also enter on line 6, Recapitulation) $8,596.30 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + ()-97X1) COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FUNERAL EXPENSES & RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Long Contres Funeral Home $6,700.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees $57.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - file return $15.00 TOTAL (Also enter on line 9, Recapitulation) $6,772.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (1-97X1) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Discover Card $78.00 2. American Water $32.53 3. Verizon $40.68 4. Storage World $750.10 5. PPL $264.00 TOTAL (Also enter on line 10, Recapitulation) $1,165.31 (If more space is needed, insert additional sheets of the same size) REV-1513 E~ + (9-00)) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Rebecca LaRosa daughter entire estate 95 Burning Brush Circle Etters PA 17319 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters PA 17319 TO: Department of Revenue From: Joel O. Sechrist, Esquire RE: Estate of Elizabeth D. Thorpe No. 21-03-0923 There is a claim pending regarding the death of Mrs. Thorpe in a vehicle accident. At this time it is not known what amount of recovery will be realized. At such time a Supplemental Return will be filed. The Executrix respectfully requests that any penalties or interest on this recovery be waived. PSEC~ the financial link TM October 28, 2003 Account # 0324469314 JOEL 0 SECRIST 568 OLD YORK. RD ETTERS, PA 17319 Dear MR SECRIST: The following is the status of ELIZABETH D THORPE's account with PSECU as of the date of death. Joint Owner's Name JOHN M LAROSA, REBECCA R LAROSA - ADDED 11.26.1996 AS JOINT TENANT W /ROS Date Established 12.31.1985 Date of Death 07.24.2003 Date of Birth 03.18.1930 Share(s) Balance Accrued Dividend Regular Shares (S 1) $23,139.85 $10.94 Checking Shares (S4) 2,637.66 0.46 The dividend earned from January 1,2003 through the date of death was $134.25. The decedent had no loans with us. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, ( Meacie Fa fax Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990. (717) 234-8484. (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO) . (800) 472-1967 (TOO) Web Address: www.psecu.com Savings federally insured up to $100.000 by the National Credit Union Administration. COMMONWEALTH OF PENNSYLVANIA *' OEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 BUREAU OF INDIVIDUAL TAXES AND DEPT. 280601 TAXPAYER RESPONSE ACN 03138130 HARRISBURG, PA 17128-0601 DATE 10-24-2003 REY-1543 EX AFP (09-00) TYPE OF ACCOUNT EST. OF ELIZABETH D THORPE o SAVINGS S.S. NO. 324-46-9314 [Xl CHECKING DATE OF DEATH 07-24-2003 o TRUST COUNTY CUMBERLAND o CERTIF . REMIT PAYMENT AND FORMS TO: JOHN M LAROSA REGISTER OF WILLS 95 BURNING BRUSH CIR CUMBERLAND CO COURT HOUSE ETTERS PA 17319 CARLISLE, PA 17013 PSECU 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 joint 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) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0324469314 Date 11-26-1996 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 2,638.12 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax 439.70 NOTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Potential Tax Due 19.79 Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE [!]1:jljili~~,~B~lij!!~~jili~!!!~!!jiji~:!~~I!jjj!E!~jil!jOO!ilil.jili!TI~i!~j!I~!iiijl.ijjll~~~~~~II:!:i!!~~ili!'mIjij~I!~ijijj!'~!~~jj::li' A. [] 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 [ ONE Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY 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 ~ and/or PART ~ below. If you indicate a different tax rate, please state your . . _n ...... ........ _ . _... PART i!iiilijiii!!!!j!!!!!!!j!!!!!j~ij~~il!li!I~~~~~~,~ili!i~~~ililil~j~liii~ijijll!iill~ij: @J relationship to decedent: :::::::::::::::::::::mm::~~:::::~Ei~~R:IMENI:::::JjI!f.:::::RE~EiNtJE:::::::m::::::::::: .............................................................-...................................................................-...........-...............-.........". ...................................................................._..............................................................._.........................m....._._ TAX RETURN COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ......................................................................................................................................................................... - ::::~~:b::::::::,mm:mmmmmm:mm:mmmmmm,:m:;m:;::m:m::mmmmmmmmm:mm:mmm,mm:m:m,m::; ;:;:;;;:;;;:;;;;;:;,;i;i;:;:;:;;;;;;;;;;;;:;;:;i;:;;;;;;;;;;;;:;;:::::::;!;!:J!i:i!i;:ii;i;i!:;;;;;i;;!;;;;;:;;;;;;;;;:;:;:;;;:;;;;;;;:;;;;;;;:;::;;;:;;;::;;;;;;;;;;;;;; LINE 1. Date Established 1 '''''''''''''''''''ll''''''''''''''''''''''''''''''''''''''''''''''''''"'''''''''"''''''"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' m 1;1; i; ~jim Hgi . ;;1 ;i~ ;~;~: ~:;: ~;: :~: :;;:: ;;;;;i::: ~ ::; ;;;::;:~ Ii; ~ ;~:::i::: ~ ;~: ~:::: ;:: ::::;::::: ::':::;; :::::::; ::::;; ::~:::::' ::" ::'::;;;;;;;:;;:;;:: ":::::' .......-.............-.....................................................................-............................................................................. ........................................-.............-.-.............................................................-.-...............................-.......-........ .........................................................-...............................................................................-.-...........-................. 2. Account Balance 2 ..........................................................-.....-........................................................................................................ mmmmm~m~;~n;~gj~g1;gi;i;1i1;1;!~1;~;g1~g!m~;~;gggggmggg~gm:1img;1;i;i;1;j!m~!i!;!;j;gi;1;!;~~!!~~1!j~1;i;~~1!~~1;1;g1;1;1;~; :::;,:,:,;,;,;,;,;,;:;:;,;:;:;:::;:;:;:;::::::,::;:::;:;:;:;:;,;:::::::;:;:;:::;:::;:::;:::;:;:::;:::;:;,;:;:;:::::;:;:;:::::;:::::;:::::::::::::::;:::::::::::::::::;::: 3. Percent Taxable .....-...-.............................-.............................................-.............................-.........-.........................................-. 3 X i1~1~~~mmj~m~~1~1j1m~~~~m~~~~~1~~~m~~1~imm~!!Hm1~1i11m~i;~~!~!~~i~i~i~mm1j~!imm~1m1m!~1~1~i~m~i~1j1m1j11i1HIH1H!~m: ......................................................................................................................................................................... .........................h..............................._._............................................................................................................ .......................................................-...-...........................................................................-.......................-......... 4. Amount Subject to Tax 4 11~j~1~1~[~1j1~~j1j~!j~1~jjHHI;11i;1~iH~~m1mlji1~11mm;~~m~1mi~mH1!~mmml~i;m1i11;!~H1;1;1;~~1;111~H!~11~~1~1~!~1~1~1~m~Hm!~H~i~~~~~ .....................................................................................................................................................-................... ................................................................................_.......................................................h............................... 5. Debts and Deductions ...............-......................................................................................................................................................... 5 - """""""""'~""""""""""""""""""'''''''''''''''''''''''''''''''''''''''''''''''""""""""'"'''''''''''''''''''''''''''''''''''''''''' jjmmmmmi~' . .:~1;1~;;:;;;;;::;;;;;;;;;;;;:;;;;;;;;;:::;:;;:1;;::;;~;;:;;;:;;~;;;;;;;;:;:;;::;::;;;;:~;;;:::;;;;:;;;;;:;;;;;;::;;;I~:;:;:;:;;~;;I;:;:;:;:;:;:::: ........._................................._.................................mh....................................................................................... ..................................................................................................................................................-.......-.............. .................................................-....................................................................................................................... 6. Amount Taxable 6 jlj1!1!1~1~1!m~j!i!fj~HmiEHm~11!lH~H!~~~1~1~1~1!!m~j1~~~1~~~1~1~mmnH~1i~1~1~1~mm!~j!j!1;~~m1HH~~lm1;1~~m!~1~~~~~1~1~1!1~~~1~1~1~1~1~1~ .....-................................................................................................................................................................... 7. Tax Rate 7 X mjii!!li!ijmijjijjj~j!i1~1~l~i~!~f~jj~~j1~1~1i1~jj~~!j!jlj1!jl!1!!~1~1mli11[j1jHjl1j~jjjjjHij1~1~1jl1!i[~1!1!f~1~H1~1~11~~~!1!1~j!~!1!~j1![!1!1jlm~H~~' ......................._......................................._..........................................................................................._.......m... ......................................................................................................................................................-.................. ...............................................................................................................................h..m..................._............... 8. Tax Due 8 ~jjjiljj!j~1j1~1ml!;~~m1~1~1~1jmE~1~H1~m~mmmml~1~1~j~m~1~1~1~1~!j1~1m!H~H~m1;~~m~~1j1Hm!mmmm;ljm;!j1jm1!;li!;j~lj!mm~ ......................................................................................................................................................................... ..................................................................................................-...................................................-.-................ .................................................................................-...................................-................................................... PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO 21 BUREAU OF INDIVIDUAL TAXES ANI)' DEPT. 280601 TAXPAYER RESPONSE ACN 03138129 HARRISBURG, PA 17128-0601 DATE 10-24-2003 REV-154! EX AFP (09-00) TYPE OF ACCOUNT EST. OF ELIZABETH D THORPE D SAVINGS S.S. NO. 324-46-9314 [X] CHECKING DATE OF DEATH 07-24-2003 D TRUST COUNTY CUMBERLAND D CERTIF. REMIT PAYMENT AND FORMS TO: REBECCA R LAROSA REGISTER OF WILLS 95 BURNING BRUSH CIR CUMBERLAND CO COURT HOUSE ETTERS PA 17319 CARLISLE, PA 17013 PSECU 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 joint 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) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0324469314 Date 11-26-1996 To insure proper credit to your account, two Established (2) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 2,638.12 payable to: "Register of Wills, Agent". Percent Taxable X 16 .667 NOTE: If tax payments are made within three Amount Subject to Tax 439.70 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 19.79 nine (9) months after the date of death. PART TAXPAYER RESPONSE [!]ljliljl~~i~~~Eijii~~ii~~~~.Eil:i!!,~~~i:lji!~.!lil,1~~liiil~!iiiil~I~~j~!~iii'!.iii:i~~~~~I1~!iijie~~'ii~~iiii~I~~.iiiiE!~~~I:lili~ A. [] 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. ONE BLOCK B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY 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 ~ and/or PART ~ below. If - d" t d" f f t t tIt t ,,,,g,,:,:,:,:,,,:,:,,,:,,,,,,:,,,::,:,:,::',,,,,,,,,,,,,',,,,,,,,,,,'''''''''''''''''''''''''''''''''''''''''''-i\l''-'''':'''''''':':'''''Iill-:::':::-""",,,,,,:,,,,,,,, PART you 1n 1ca e a 1 eren ax ra e, P ease S a e your -...-...-.-..............-..-..............-O'Jfi-.Jfi-.:!:- 'C:!:-.'A-:t'-'-'-USe:-.-.-.-a. :t'~"-"'."'_."-'-"-~'~-F.'.. ........................................,.... ." .....". ......... . ....... ... .........-...-....... -. .... ...........................--................ .............. ........... ....... .... ....................-. .... ............................................ ........ .. -...... ...... '......................- ...... 1?1 1 t - h - t d d t """"""""""""""""""""""'...,..'''..'''....,...,.....-.,-.,....""".-.,,-.,-...-""'-.-.,.-,.......,-.""""" '"'''' '" , . ,. -.'''''. ~ re a 10ns 1p 0 ece en : ijililiiiliiilii!iijij!lii!I!~~i!I!IIJm~~I.I~l.Wlw.liliiiJ.ll~1il!Ii.l.W~l.Wfj~!iliiii!!ijlil!iii!l, ...................-...............-...-......-.................................................................-..............-...-.....-...-..-........-..-..........-. TAX RETURN - COM PUT AT I ON OF TAX ON JO I NT /TRUST ACCOUNTS iiiiPADiiiii!i!i:::!!!::::::,:!!!!!!:::!!!::!!!::!!!!!!mmj::m::!!!:::i::m!!!:m:::::!!!::::::::mm::::::::::::::::::::::!!!!!!::,::::::m:::jj" .........._......-.........................-.....-.......................-...-.........-.-.............................-................................................. -..............--...............-.-.-...-.........................-...-.......-.......-...-.................................................-...-........................ '"''''''''''''''''1"'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''""""""""""""""""""""""""""""""'''''' LINE 1. Date Established 1 :mm:~mmjj:' :j!j,:;:;:;;;;:;,;;;;;;;"g::g:;;;;;:;;;;:;;,,,,;;:::;;;;;;;:;;,,,,:;;g,,:;;:;;;;;;;;:';;;;;;"''':;;,,:,,;;,,;;,,:;;:;;:'':':;,,;;;;,,;;;;:ii ..._......._....._..........................__..................._...m..............._..._....._..._..............._........................__..._..................... ........................................................................-.......................................-........................................................ ...........-.................-.-......................................................................................................................................... 2. Account Balance 2 ::::::::::ii:::::::2::immm:",:,;:,:mmm,;:"mmm:m,m:,;:mmmmm:,j,;:m,,,,,,,m,,,,m,,,m,,,,,,mmmmmmmi':;:"':':": .........................................-............................................................................................................................... ............................................-................................".............,.....-.........................-.........."".....-....,......,..,..,...... ....................,.................,........-.....-....,.............,................,.,.............-...................-...................-......................, 3 P t T bl 3 X """"""'"'''';;z;''''''''''''''''''''''''''''''''''''''''''''''''''''"'''''''''''''''''''''''''''''''""""""""""""""""""""""""""""'" 4: A:::~~ su:;:ct e to Tax 4 !":,i.::.,ii.ill:ili'ii;ii;;~i:iiiiiiiiiiiiii;iii;;:iiii::;i;:ii;iii!iii,i:~iii:iij;:!ii'ii'i'iiii;iiii:i:iii,i;:,iiiiiiiiiiiiiii;:i,:;i'ii'ii,;ii!ii:i',i:;',iiii ...-.........-...................................................-................"..............................................................,...-.................. ....................................................."...........-..................,..............................-......................................"............ ....,..................'......................................................................,......'.............-..............................,..........-........,.. 5 D bt d D d t - 5 """""""""'iE""""'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 6: A:ou~t a; axa:l~c 10ns 6 - iiiiiii1i:il:ii,;iil':,i:i:iii,i.;,;;lii;iiiiiiiiiii';ii,!:iiiiiii!iii,iiii;i!iiiii,i:iii!!!!;;!iiii;ii;;!,i;:i!;iii,i;';;i':!,i,i,iiiii!:.i;,!i;:;:ii,iiiii::iii,ii; ...................................................................................................-.-................................................................... -.............-...-.-...........'.,........_..............'.......................................-...................................................................... .......................-...........................................................................-.-...-............................................................... 7. Tax Rate 7 X :i:::H1i:::iiii::ilH1::mm""m"mmm"Hm"immmmmm'imi:m:i'i;:"m"mm,m",m"m;:m,m;:;:imim;:i,mm:;:mmm,: .......................................................................-....................................,........-...........-.....-................................. ............................-......................................................".................................................................................... """""'''''''''S.,-''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''"'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ................... .......................-...-...........................................................-......................................................... 8. Tax Due 8 mHm~H~~~m~j . :mF;;:;:;;;:;;;;;::!,,;!;!i:;:;:;I::;;;:i:~:::;:;:;:;:;;;;~!i:~;;p:~:;!;;;:~:;:;;;:;:;!;;;;;:;:;:;I;I;:;I;:;:;:;:;:;:;:;:~:~;;:;:;;;:;;;:~;;;; ..........,........-.....-........................................................................................................................,...-.............,.. ...............................................................................-...............................................................................,....... ..................-..................................................................-.............-,....................................................-............. PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEAL TH OF PENNSYLVANIA '*' DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO 21 BUREAU DF INDIVIDUAL TAXES AND. DEPT. 280601 TAXPAYER RESPONSE ACN 03138128 HARRr5BURG, PA 17128-0601 DATE I I 10-24-2003 REV-1543 EX AFP (09-00> TYPE OF ACCOUNT EST. OF ELIZABETH D THORPE 00 SAVINGS S.S. NO. 324-46-9314 DCHECKING DATE OF DEATH 07-24-2003 D TRUST COUNTY CUMBERLAND D CERTIF. REMIT PAYMENT AND FORMS TO: JOHN M LAROSA REGISTER OF WILLS 95 BURNING BRUSH CIR CUMBERLAND CO COURT HOUSE ETTERS PA 17319 CARLISLE, PA 17013 PSECU 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 joint 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) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0324469314 Date 11-26-1996 To insure proper credit to your account, two Established (2) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 23, 150 . 79 payable to: "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax 3,858.54 (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 173.63 nine (9) months after the date of death. ~~ TAXPAYER RESPONSE lIll!ii:i:~~i~~~~~iiiii~liii:~~~~I~~.!i'i!iOO~~i'ili~~~!i~lmi!:i~~i!!!iD1!iii!B100~iOO~~iii,il.ilili!m~~~~.!i!I!!~mim.iili~!100~.iii!I1~OO~~iiiiii~ A. [] 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. ONE BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONL 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 ~ and/or PART ~ below. If - d' t d - ff t t t 1 t t """"""''''''''''''''''''''''''','',,''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''m-'''''' ."",,,,,,,,,',,,,,,, PART you 1n 1ca e a 1 eren ax ra e, P ease S a e your ""''''''''''''''''''''''''''''''''''''''''Ofj-'fj'-l- 'Cl- 'A' 'E!-"""IJ- se-.""tJ.-. Nllj"rt. """"'-"''''''''A'' 'A" '1111"--' .................-........................... .......... ......... . ...... 'n ........................ ... ......m.................................... .. ..... ...... . .......... ........ .... .......... ........... ... t ""'''''''''''''''''''''''''''''''''''''''' - ,,' ",- -. -, - - - -"",. .. - ""'.. -, -, """"" """"". - """ ~ relationship to deceden : i!i!i~!i!i!i!i~!i!iii!iii!i~i!i!j!I~~I~~I~~~i!i!i~l!i!i!~~~~~~~ii!!iimm!imm T AX RETURN - COM PUT AT I ON OF TAX ON JO I NT /TRUST ACCOUNTS :i:iiAniii:im:mH::H,:::::::H:mm:i:::::i:::H:'::::::::::::H::::::::::::mm~m:HHH:H:::::::::::::::::::::::mH::::::::H::::::::,:::::: LINE 1 D t E t blish d 1 ':::::m:::,:::m:~::mH:H:"mmHm:H:::,:::::::::::~m::::m~m:,,:::::,::::m:::::::::::,:::::,::,:H:,:m::,,:':::,:m:::,m,:,:n:::mmm_, - 2: A:c:un: :alanc: 2 i!!iillilllll.!!i:!~::i::i:iii:i:ii;iii!i,i:iiiii:iiii:iiiiiiiiiiiii~iiiiiiiiiii:i:i,iiiiiiiiiii~:i;~,:.iiiiii:i,iii:i',i:ii,ii::iiiii,i'ii:,:i,ji:iii,i:::i!::::: ...............-._.................................................-.......................................-......................................................... 3 P t T b 1 3 X mmmm"mni3mnmm,m,mmH,mm:m::,mmmmH:m,mHm",Hmn:Hmm:mm:"mmm'H""H""Hmmmmmn",:n,',; 4: A:::~~ su:;:ct e t~ Tax 4 ~lil,'i'ilil!I!:~~"",:,::",!,:,:"j:""",/,~!,:'/~'::~'j'!::/"j/J,,:,,;/!~':'i,!~,,"~:"!:!:1,:,:"",:'!/,",/',/"':'i,',::,:""""/,,,,!,,/,///!! :: ~::~~t a;:x::~~ct 10ns : - i!:i,i"ij!:!'!il':lii:iiii!:!i!i::iiiiiiii!!!iii!i!i!ili!i!ii!!iii!iii!iiiii!ii';i!i!i',iiiiii!i!iii!i!i:iiiii:i;i':,'.:!,:i!i!i,i!i!i!i:iiii:!iii.ii,':!i!!ii!.,!.i :::;::::::::::~;::::::,,:;:;:;:;:;::::::::,,:::::::::;:::::::::;:;';:;:;::::0::::::::::;:::;:;:::;:;:;:;:::;:;:::;:;:::;:::::;:;,;:;,;::::,;:;:::::;,,::::,::;,::;:::;:;, .....-..................................................,................................'...........................................................-................... ~: ~:: ~::e ~ X :1:',:"I""'i'I:,II,!':;:"',!11'1.'11'1:1,!""I'!:",ill':::!"'!I!,"I!"!,!,!",,,,',',:::!I!!!!'1,1'111i,!""!!"",:,:::,i;I:,lil:I'!:,'",,,!,1',1""",,1 PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO 21 BUREAU OF INDIVIDUAL TAXES ANI). DEPT. 280601 TAXPAYER RESPONSE ACN 03138127 HARRI~BURG, PA 17128-0601 DATE 10-24-2003 REV-1543 EX AFP (09-00) I I TYPE OF ACCOUNT EST. OF ElIZABETH D THORPE [i] SAVINGS S. S. NO. 324-46-9314 0 CHECKING DATE OF DEATH 07-24-2003 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REBECCA R LAROSA REGISTER OF WILLS 95 BURNING BRUSH CIR CUMBERLAND CO COURT HOUSE ETTERS PA 17319 CARLISLE, PA 17013 PSECU 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 joint 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) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0324469314 Date 11-26-1996 To insure proper credit to your account, two Established (2) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 23,150.79 payable to: "Register of Wills, Agent". Percent Taxable X 16 .667 NOTE: If tax payments are made within three Amount Subject to Tax 3,858.54 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 173.63 nine (9) months after the date of death. M~ TAXPAYER RESPONSE [!]liii!ii~li~~.~li!li~~,ii!i~~~~~Wliiiiil~~!!i!i!~!~~1iiii!~~!II!~lii!!~.~~!~I!!i!!!.i!i'i!~~~!M!i!ii~~~~,!!!i.,!!i!~~~~ili!!!!!~~~!!!!!il A. [] 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 [ E ] Wills and an official assessment will be issued by the PA Department of Revenue. Br~CK B. D The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONL V 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 ~ and/or PART ~ below. p~r ~:l~~~o~~~~~a:~ ~e=~::~;~nt tax rate, please state your ;,~~",;,';I;'I,i'i;i';i",iil!i,!lllilllli~~ii~~I~i~1;il~I',1 TAX RETURN - COMPUT AT I ON OF TAX ON JO INT /TRUST ACCOUNTS Ji!ipADlli!i!ilijHiiiijiHiiiiHjj,ijjiiiiHHii,jijiiHiHmiHi"i:iiiiiiiimiii:iHijjijij:ji::j:::i:j:iji:j,jij:,:iii:i:imHjiHi:i:imj:::imim .......................................-.......-...-...........-...........................................-_....-...........-.................-......................... ................................-.............-.......................-...................................................................................-...-.......... ....-........................-.....-.-.....-.-...-.......................-.........................-_..........................-.............-.-......................... LINE I D i: E i: . -.. . - ""'''''''''''''''1;'';;''''''''''''''''''''''''''';'''''''''''''''''''''''''';;'""",,,,,,,,,,,,,,,,,,",,,,,,,,,,,,,,,,,,,,,,,,,;;,,,,;;,,,,;;,,;;"',";;,,,,,,, 2: A:c:un: ::~:~::a ~ iiiilli.ii.l~liiii~iliiiiiiiiiiiii;iiiiiiiiiiiii;ii,i',i;i;~iiili;i,iiiii,iiiiiiii;ii,iiii'iiii;iiiiiiiiiiiliiiiijiiiii;'ii!iiiii:iii'ijiiiiij;,iiiiijiii:iii'i.iii ..........._.............-...............-......................-........................-.....-.....-...............-.......-.........-.-................_..........-... ....-...............-...-...........-.-.-...............................................-.-.-.-...........-...............-............................................. ...........................-.....-.....-.-.............................................-.-.............................................-.....-...........-............... 3. Percent Taxable 3 X :i:::l:i:::!:i:l:l:~:i:im,m,f,m"i"miii,""",,,;,""mmm"""immmim"""iEm",Emmimm""'iimimim",iim;imm,mi;;; .....-............................_........._....-......................................................................................-..........................-..... ............................................................................-.........................-.................................................................. 4. Amount Subject to Tax 4 ,!j:!!!!!!:!!!!!!!!li!!!mm"mmmmi""im"i:"iimmfjiim"""iimi"iimm""mmm"m"""m":mm"imim"iim:mmii,,mi ...............................-...............................................................................-.............-........................................ ....... ..........................................................................................-.................-........................................... 5. Debts and Deductions 5 - !!!!!!!!!:!!!!!!!!!s.!!!!"ii,iiiii:iiiiimimimim""mm"m:""mmmmim"""im"li"mmiijii:i,:"m"m:mmm,m:mmm"mmi 6 . Amount Taxable 6 !!m!!imm!!l!l~mi!!!:i!!!jil:!:!:!!!!!:!!!:!!:!!!!!!!i!!!!!!!!m!!!:!!!:!:!:!!:!::i:!:!!:::!!!::i!!!!!!!!!!::::!!!!:!m!!!!!!!!!!!:j!:::i!!!!!!:!!!!!!!i!!!i .....................................................-.............-..................................................................................................... ......................................................................................................................................................................... 7. Tax Rate 7 X !!!:!:!!:!::!!:!!!!1:!!!!"mmmi"mi:mmm"mi,mimmimm,i"mi;""im:::"m"immm"i:im:miimmiiim""iii:iiiiii',mi',mi ,;,;,;:;,;,;:;,;,;:;:;:;,;:;:;:;:;:;:;:;,;:;,;:;:;:::;:::::::;:::;:;:;:;:::;:::;:;:;:;:;::,;:::::;:::::::;::::,::::;:;:;:;,::::::::::::::::::::::;:::::::::::::;:;:;:::;: 8. Tax Due 8 ::::!!!m!!!!!!!:!IiI!!!:iiiiiii"ii"iiiiiiii""iiiii:"mmiii:"i"""m,miiimiiiii,miiimiim"""":::":",,:::iiiiii"imiiiiimmi::i,,,,mi ................................................................................................................._....................................................... ...................................................................................................................................._.................................... .................................................................................................................................-.-................................... PART DEBTS AND DEDUCTIONS CLAIMED @] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003824 LAROSA REBECCA RUTH 95 BURNING BRUSH CIRCLE ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER ____u__ fold ---------- -------- 101 I $40.90 ESTATE INFORMATION: SSN: 324-46-9314 I FILE NUMBER: 2103-0923 I DECEDENT NAME: THORPE ELIZABETH DUNLAP I DA TE OF PAYMENT: 04/15/2004 I POSTMARK DATE: 04/14/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/24/2003 I I TOT AL AMOUNT PAID: $40.90 ,.._/ REMARKS: ~'_'M. '-' ..' CHECK# 2837 _.,...,,~ INITIALS: JA 'SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH =,.,'-." REGISTER OF WILLS REGISTER OF WILLS 0' . COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 171Z8-0601 APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESS"ENT OF TAX REY-1547 EX AFP 101-031 , ; DATE 05-31-2004 ESTATE OF THORPE ELIZABETH D DATE OF DEATH 07-24-2003 FILE NUMBER 21 03-0923 REBECCA R LAROSA'OJ I'IAY 28 P'"' :36 COUNTY CUMBERLAND ACN 101 C/O JOEL 0 SECHRIST I Allount Rellitted I 568 OLD YORK RD\.. ETTERS C\PA..17319 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 ~ REV=is4-j-Eif-AFP-(fff':oiY-NoYlcE--oF-YNHEifITANci-YAx-A-PPRAISEMENT~--Ai.l-owANci-c'-R-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF THORPE ELIZABETH D FILE NO. 21 03-0923 ACN 101 DATE 05-31-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .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 subllit the upper portion 4. "ortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your S. Cash/Bank Deposits/"isc. Personal Property (Schedule E) (S) 250.00 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) 8,596.30 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 8,846.30 APPROVED DEDUCTIONS AND EXEMPTIONS: 6,772.00 9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H) (9) 10. Debts/"ortgage Liabilities/Liens (Schedule I) (10) 1.165.31 11. Total Deductions (11) 7.937 31 12. Net Value of Tax Return (12) 908.99 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 908.99 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: lS. Allount of Line 14 at Spousal rate (1S) .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 908.99 X 045 = 40.90 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 40.90 TAX CREDITS: ~ .. .~.. l+J A"OUNT PAID DATE NU"BER INTEREST/PEN PAID (-) 04-14-2004 CD003824 .00 40.90 TOTAL TAX CREDIT 40.90 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 !Ii 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 "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) , , RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B [collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B [collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Zl40 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. [7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND [CR): 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-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 [TT only). OBJECTIONS: 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. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" [REV-1501) for an explanation of administrativelY correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent [5X) discount of the tax paid is allowed. PENALTY: The 15X 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: 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 [6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ~ ~ nn-1991 ~ :D1mDI" mn ~ .~ 1983 16X .000438 199Z 9X .000Z47 ZOOZ 6X .000164 1984 llX .000301 1993-1994 n .00019Z Z003 5X .000137 1985 13X .000356 1995-1998 9X .000Z47 Z004 4X .000110 1986 lOX .000Z74 1999 n .00019Z 1987 lOX .000Z74 ZOOO n .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [15) 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. -----,',"~" -~._~ . REV-1470 EX (6-88) '* INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Elizabeth 0 Thorpe 2103-0923 REVIEWED BY ACN Sandra J Eslinger 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES E The value of this item has been suspended from the appraisement of the return until the final value can be determined. A supplemental return must be filed when the value of the suspended item is determined. ROW Page 1 r - JOt';', ~~';.;:..:hlis1. Esquue AIl-I'''::1 at Law 568 t" lid York Road Etters. P A 17319 ~~' , ~ .. ~'; ~. (' ., - . ~ r- c~/~ tJ3-d- 93 '. \\ \ 'c.'f Q. \.~ : \,), ').'........0-., ..' "., \. C -,....,.....:.'.,-;-r.~. '.".'.- \J Register of Wills ....- Curnbedand County Courthouse r-~ 1 Courthouse Square '~'~ Carlisle P A 17013 ..-"" P (I) ~ .~(.) .- Marjorie A. Wevodau Glenda Farner Strasbaugh First Deputy Register of Wills and Kirk S. Sohonage, Esq Clerk of Orphans' Court Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 I INVOICE I Bill To: InvoiceNo: 268 Invoice Date: 3/23/2005 JAMES D. CARMELLA Estate of: E'LIZABE1HDUNLAP 1HORPE 724 GIURo-IST Estate No: 21-03-0923 JA INDIANA, PA 15701 Qty Fee Description Fee Total 1 PHOTOCOPIES 7.00 $7.00 Total: $7.00 Checks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. . REV-1500E{I6-(0) Rev-1500 ffl'iC,':'l.'JSC:() ;~ COMMONWEALTH OF PENNSYLVANIA ...................................................u ............................. DEPARTMENT OF REVENUE FILE NUMBER DEPT_ 280601 INHERITANCE TAX RETURN HARRISBURG. PA 17128-0601 21 - 03 0923 RESIDENT DECEDENT County Code Year Number DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER f- :z Thorpe, Elizabeth D. 324-46-9134 w 0 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH W () 07.24-2003 03-18-1930 REGISTER OF WILLS w 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER . 1. Original Return x 2. Supplemental Return 3. Remainder Return (date of death prior 10 12. x.~ r/J 4. Limited Estate 4a. Future Interest Comprise (dale of death aller 12-12-82) 5. Federal Estate Tax Return Required oc~ . ~o .c 2.2 x 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes U ~rn ~ '" 9. Litigation Proceeds Received 10. Spollsal Poverty Credil(dateofdeath between 12.~1-91 and 1.1-95) 011. Election to tax under Sec. 9113(A) THIS SECTION MUST BE COMPLETED. ALLCORRESPONDENC-EANOCONFfOENTIALTAX INFORMATION SHOULD BE DIRECTED to: <= NAME COMPLETE MAILING ADDRESS = c/o Joel O. Sechrist Esquire ~ Rebecca R. LaRosa = '" FIRM NAME (If Applicable) 568 Old York Road = ~ ~ EttersPA17319 '" TELEPHONE NUMBER ~ 717938-3396 1. Real Estate (Schedule A) (1) $0.00: 2. Stocks and Bonds (Schedule B) (2) $0.00: 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00: Z 4, Mortgages & Notes Receivable (Schedule D) (4) $0.00: 0 !;( 5. Cash, Bank Deposits & Misc, Personal Property (Schedule E) (5) $12,638.02 ' -I 6. Jointly Owned Property (Schedule F) (6) $0.00' ::> D Separate Billing Requested C ~ t- ....................................... ................1 0.. 7. InterNivos Transfers & Misc. Non-Probate Property (7) $0.00 <t: 0 (Schedule G or l) LU 0:: 8. Total Gross Assets (total Lines 1-7) (6) $12,638.02 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $15.00 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $0.00 11. Total Deductions (total Lines 9 & 10) (11) $1fiOO 12. Net Value of Estate (Line 8 minus Line 11) (12) $12,623.02 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $() 00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $12,623.02 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax Z rate, or transfers under Sec. 9116 (a)(1.2) x (15) $0.00 0 - ;: 16. Amount of line 14 taxable at lineal rate $12,623.02 x .045 (16) $568.04 X'" - (~ 17. Amount ofiine 14 taxable at sibling rate x .12 (17) $0.00 ~:o ~ ~ 18, Amount of line 14 taxable at collateral rate x .15 (18) $000 0 U 19. Tax Due (19) $568.04 200 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > ....llESORl: 'r~AJ\lSVVERALLO,OESTlQNSON.REVERSESIPE.I\Nl! REGIlECKMA'rH<.<.. 'Decedent's Complete Address: STREET ADDRESS 95 Burning Brush Circle CITY I~TATE .I~IP Etters PA 17319 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) $568.04 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) $0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenally (D + E) (3) $0.00 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $568.04 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) $568.04 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ~ ; b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary 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 on year of death without receiving adequate consideration? B E8 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her '.' .',. .',.. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? E:::J CZJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct. and complete. Dedaration of preparer other than the personal representative is based on alllhe information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN DATE OJ~ ('i~rjp € -thLJ If 173/ Dr For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .5. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even jf the surviving spouse is the only beneficiary. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or young Jarent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116{a) (1.2)). b,-^--,,- So ' ~\) The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is (Pd :1.2)[72 P.S. ~9116(a) (1)]. lf5.<S0 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P l\ .\),b mder Section 9102, as an individual who has at least one parent in common with the decedent whether by bloo 3~ .CD ~'~\\."51 "I-i: 3% -- -. '~ LAST WILL AND TESTAMENT OF ELIZABETH DUNLAP THORPE I, ELIZABETH DUNLAP THORPE, of 1200 South washington Street, Apartment 723-E, Alexandria, Virginia make this my will. I revoke any other wills or amendments to wills made by me. r ARTICLE I. Distribution of My Estate. I give all of my estate to my only child and daughter, MRS. REBECCA RUTH LA ROSA, if she survives me. If MRS. REBECCA RUTH LA ROSA does not survive me, I give all of my estate to her descendants, per stirpes, who survive me. ARTICLE II. Payment of Debts and Other Charges. I direct my Co-executors to pay my debts and my funeral and burial expenses, including the cost of a monument or marker over my grave. The estate, inheritance and similar taxes assessable on my death, including taxes on assets not passing under this will also shall be paid as a cost of administering my estate and my Co-executors shall not request any beneficiary to pay any part of such tax. ARTICLE III. Co-executors A. I name MRS. REBECCA RUTH LA ROSA and MRS. JOY S. MASON to be my Co-executors. I request that no security be required of any Executor. B. In addition to the powers granted by law, I grant my Co-executors the powers set forthj:n ~64 .1-57 of I the Code of Virginia, and I incorporate that Code Section in my will by reference. All successor Executors or Co- executors shall have the powers, immunities and discretion which I have granted to my named Co-executors. IN TESTIMONY WHEREOF, I have set my hand and seal to this my last will and testament, consisting of three (3 ) typewritten pages on which I have placen my signature this 10th day of March, 1983. i . ~ C'.I~ ../"Z....(;'Y ,,~ (SEAL) EL ZABETH DUNLAP THORPE The foregoing inst~ument, consisting of four (4 ) typewritten page s , including this attestation clause, was on this 10th day of March, 1983, subscribed by ELIZABETH DUNLAP THORPE, the Testatrix named herein, and by her signed, sealed, published and declared to be her LAST WILL AND TESTAMENT in the presence of us, and each of 1.1S, who thereupon, at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attestinq witnesses thereto. of In N F~ {;Ay/ D'^- of 3'11~ ~o PI d..6t iL.. of ,JtJ3o /I. iJ/.(J r}, ~ -J) (h, ~J" If<; x , c.Jo.. . STATE OF VIRGINIA I ' CITY OF ALEXANDRIA Before me the undersigned authority, on this day personally appeared ELIZABETH DUNLAP THORPE, ~ S~ 7~ {,v~ and ~ ~ known to me to be the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, and, all of these pre sons being first duly sworn, ELIZABETH DUNLAP THORPE, the Testatrix, declared to me and to the wi blesses in my presence, that said instrument is her LAST WILL AND TESTAMENT and that she had willingly signed or directed another to sign the same for her and executen it ____ _..~ yV.l-UlIc-dry act for the purposes therein expressed; that said witnesses stat before me that the foregoing Will waS executed and acknowledged by the Testatrix as her LAST WILL AND TESTAMENT in the presence said witnesses, who in her presence, and at her request, and in the presence of each other, did subscribe their names thereto as attesting Witnesses on the day of the date of said Will, and that the Testatrix. at the time of the execution of said Will, was over the age of eighteen (18) years and of sound and disposing mind and memory. C~ h~:&~~ Te tatrlX Wit~S.~ ~7h.~4~ ltness '~MW A{?or ltn s SUBSCRIBED, SWORN AND ACKNOWLEDGED before me by ELIZABETH DUNLAP THORPE, the Testatrix, SUBSCRIBED AND SWORN to before me by ~.S~ ,7'-~W~ and ~ ~ I the Witnesses, this 10th day of March, 1983. My Commission expires: 58 ::~~ REV.1508EX+{1-S7)(1) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 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 disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Proceeds from survival action from Erie Insurance Group. Survival action proceeds from another $12,638.02 insurer have not yet been received. We request that interest be waived. TOTAL (Also enter on line 5, Recapitulation) $12,638.02 (If more space is needed, insert additional sheets of the same size) REV.1511 EX + (1-97X1) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) . Social Security Number(s) I EIN Number of Personal Representative(s) Street Address ... City State Zip :. - Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - . Relationship of Claimant to Decedent . 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - file retum $15.00 TOTAL (Also enter on line 9, Recapitulation) $15.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00)) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Rebecca laRosa daughter entire estate 95 Burning Brush Circle Etters PA 17319 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) . -- IN THE COURT OF COMMON PLEAS OF YORK COUNTY, PENNSYLVANIA ORPHANS COURT DMSION In re: administration of the Estate of NO. to 1--DS -I S0 ELIZABETH D. THORPE ORDER OF COURT AND NOW, this n-rrl day of !vI (\ ,c h ,2005, upon presentation and consideration of the Petition, it is hereby Ordered and Decreed as follows: Ii 1. Rebecca R. LaRosa may execute the necessary release in exchange for the settlement ...... = II amount of$118,883.90, which shall be distributed as follows: (-- = 0 c '-'"' ~:::o 0 3' -<C:~ 55 D::I:rT1 --)>(") 0-- <::Z:fTI A. Wrongful Death - $95,107.12 (80% of settlement) ;:0 :r.~' - Ai -l UHf> - on 0"< vrrl :P :z:ofTI 1. $63,290.15 to RebeccaR. LaRosa. J>:;r: co -4 ::0 rr1 .. -i :0, +: 2. $31,702.37 (80% oftotal counsel fees) to Katherman,Brig~ Greenberg, LLP as counsel fees; and 3. $114.60 (80% oftotal costs) to Katherman, Briggs & Greenberg, LLP as reimbursement for advanced costs. B. Survival Action - $23,776.78 (20% of settlement) I 1. $15,822.55 to Rebecca R. LaRosa as Executrix of the Estate of Elizabeth I D. Thorpe, on behalf of the survival action; I 2. $7,925.59 (20% of total counsel fees) to Katherman, Briggs & Greenberg, 'I LLP as counsel fees; and I , 3. $28.64 (20% of total costs) to Katherman, Briggs & Greenberg, LLP as , reimbursement for advanced costs. BY THE COURT f':fLhc: C' ::r:;'(';C:1 f';"!t::'c::;:' C:.J:i: n.\" Oh~ ~ Ul J. , Estate of Elizabeth D. Thorpe v. Erie Insurance Group CLOSING STATEMENT TOTAL AMOUNT OF SETTLEMENT: $95,000.00 .- DISBURSEMENTS: Attorney's ree of one-third of settlement: $31,666.67 COSTS: Recordex 33.82 Citizens' Ambulance Service 15.00 Smart Document 41.42 Pennsylvania State Police 8.00 Orphans' Court 45.00 TOTAL COSTS: $143.24 / . $31,809.91 TOTAL DISBURSEMENTS: CHECKS PAYABLE: Katherman, Briggs & Greenberg <. 15,976.58 Sechrist Law Office 15,833.33 Rebecca R. LaRosa 50,552.07 ~ Rebecca R. LaRosa as Executrix ofthe Estate of Elizabeth D. Thorpe 12.638.02 <- TOTAL CHECKS: $95,000.00 By: ~~ Brian P. Strong The above-captioned matter has been settled to my complete satisfaction and all disbursements made with complete approval. I acknowledge that I have advised my attorney of all subrogated claims, or protected interests and outstanding medica 1 bills of which I am aware and I acknowledge and understand that any claims that are not paid as set forth above or any future claims regarding these are my responsibility and not the responsibility of my attorney or his law firm. I further agree to indenmify and hold my attorney harmless from any and all claims which may be made by any of my creditors or medical providers against my attorney arising out of my personal injury claims. "2-1<) ~L ,2005. Approved this _ day of ~~ /.). d...~ Rebecca R. LaRosa, individually and as Executrix of the Estate of Elizabeth D. Thorpe Marjorie A. Wevodau Glenda Farner Strasbaugh First Deputy Register of Wills and Clerk of Orphans' Court Kirk S. Sohonage, Esq Solicitor -- Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 I INVOICE I Bill To: InvoiceNo: 396 Invoice Date: 6/18/2005 JOEL 0 SErnRIST, ESQ Estate of: EUZABE1HD.1HORPE 568 OID YORK ROAD Estate No: 21-03-0923 JA ETIERS, PA 17319 Qty Fee Description Fee Total 1 Additional Probate 32.00 $32.00 Total: -PO .j #- ,;zQ70 $32.00 ~CO~ _.n,. \,;:> Q.ecks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. STATUS REPORT UNDER RULE 6.12 Name of Decedent: J ~ 0 ~ l f t I i.z I) b ~'f~ !pu., Jt9 fJ I Jv I Date ofDeath: L-t J4 ?ff)o3 ~\\~ ) wntNo.: '2 0 0 3 - CD 0 r z. J ~rl--:".l'{u.. ~ 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 0 No jS. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: e.... R y-e/jl-- 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes - NoD 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 D No D c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to Ibis report. D ' Date: Wor 0uh~; J'i ((L Name Lf) G ff!{LJ )/4- C-P) J7:! old Yef,le }~. .. -..., -"'- I 1.1 Address .~ C") ~llp:njN~:5 I' - :5 3 ~ t "') , , , Capacity: n Personal Representative ~Counsel for personal representative \J' Marjorie A. Wevodau Glenda Farner Strasbaugh First Deputy Register of Wills and Clerk of Orphans' Court Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland . One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 I INVOICE I Bill To: InvoiceNo: 396 Invoice Date: 6/18/2005 JOEL 0 SEUllUST, ESQ Estate of: EUZABETIID. TIIORPE 568 OLD YORK ROAD Estate No: 21-03-0923 JA ETTERS, PA 17319 Qty Fee Description Fee Total 1 Additional Probate 32.00 $32.00 Total: $32.00 O1ecks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters PA 17319 717 938-3396 Facsimile 717 938-9613 C-'" June 3, 2005 '::'::0 ?;;:o '- ;-""J c:: ~:.~(~ - , r~- rTl I Register of Wills ;-:-: 0'1 Cumberland County Courthouse I Courthouse Square -- - Carlisle PA 17013 .. vi co RE: Estate of Elizabeth D. Thorpe No. 21-03-0923 To Whom It May Concern: Enclosed are two copies ofthe Supplemental Inheritance Tax Return in regard to the above estate, together with a check in the amount of $568.04 representing inheritance tax and a check in the amount of$15.00 representing the filing fee. Thank you very much for your assistance in this matter. JOS:Im Enclosures COMMONWEALTH OF PENNSYLVANIA REV-1 162 EX(1 1-96) OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 171, 28-0601 PENNSYLVANIA RECEIVEO FROM: INHERIT ANCE AND EST ATE TAX OFFICIAL RECEIPT NO. CD 005396 SECHRIST JOEL 0 568 OLD YORK ROAD ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER _nn___ fold _~__n_n_ nn__n 101 I $568.04 ESTATE INFORMATION: SSN: 324.46-9314 I FILE NUMBER: 2103-0923 I OECEDENT NAME: THORPE ELIZABETH DUNLAP I DATE OF PAYMENT: 06/06/2005 I POSTMARK DATE: 06/03/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/24/2003 I I TOTAL AMOUNT PAID: $568.04 REMARKS: CHECK# 3399 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ..... ....\ - 0 +" .:..1 + (~l ~. C"\ ...., ..... 0 ~. C~~) C-:-:J I,JJ ~ "', ~ \"(): L,: ~ ~ lO'.. S""--: J ~ '"' ~ .h, I r- ""' ~ ::0 CT ...... J) ,," - \s' '/:)0 ~ c. .r-:"-n l:"- P. ,,< 0 "t/')'.ij ~ .::......; - Cj :D - C5 ~ '- ..., ~ ~~ ~ , 6\ - - ,"'-l 'v ~ :t. l\) <:) ....... C; 'w ('b ii BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128~0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* REBECCA R LAROSA CIO JOEL 0 SECHRIST 568 OLD YORK RD ETTERS PA 17319 NI3f1~I'IH~(:E/1'p APPRAlsE!;lEi>lir)Au:OWAtoleE MnlSALLOWANCE OF DEDUCTlQNS'ANb !(SSE~~MENT OF TAX ; ...... -. . "!YATE ESTATE OF rynnr, "cO I 3 PI~i ~!li160F DEATH L0U0 .... ,-, \ . FILE NO. COUNTY ACN "iT R!:V-1547 EX 1~1 PC 0i CD'! ,,: ,..-,1_1.-, ,;\ \....,. r\):':'I" , (' "--,, ',-" 09-05-2005 THORPE 07-24-2003 21 03-0923 Cumberland 501 Appeal Date: 11-04-2005 (See (fJverse side under Objections) ELIZABETH o 01 \.- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE 0:::> RETAIN LOWER PORTION FOR YOUR RECORDS <:0 . -REV:1547EX-(06-OSYPC- - - - -- - - - --- - Notic-e -riF-INiieRfi A-NcE-tA)(AP-PR-AiSEMENt;-AiIOWANCE- OR- - - - -- - - - - - - - - - - - - - -- - - --- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF THORPE ELl2ABETH 0 FILE NO. 21 03-0923 ACN 501 DATE 09-05-2005 TAX RETURN WAS: ( 121 ) ACCEPTED AS FILED ( 0 ) CHANGED RESI:RVATION CONCERNING FUTURE INTEREST - SEE RI:VERSE APPRAISED VALUE OF RI:TURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits! Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVI:D DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. CostslMisc. Expenses (Schedule H) (9) 15.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions (11) 15.00 12. Net Value ofTax Return (12) 12623.02 13. Char~ableJGovernmenlal Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00 14. Net Value of Estate Subject to Tax (14) 12.623.02 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures that include the total of ALL returns assessed to date. (1) (2) (3) (4) (5) (6) (7) 0.00 0.00 0.00 0.00 12,638.02 0.00 0.00 (8) NOTE: To Insure proper credit to your account, submit the upper portion of this form with your tax payment. 12,638.02 ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of line 14 taxable at Lineal/Class A rate 17. Amount of Line 14laxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) 0.00 X.OO 0.00 (16) 12,623.02 X .045 568.04 (17) 0.00 X.12 0.00 (18) 0.00 X.15 0.00 (19) 568.04 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID I-I 06-03-2005 CD005396 0.00 568.04 TOTAL TAX CREDIT 568.04 BALANCE OF TAX DUE 0.00 INTERI:ST 0.00 TOTAL DUI: 0.00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . v-1/o RE'J 500 EX (6-00) Rev-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 0923 COMPLETE MAILING ADDRESS County Code Year Number I- Z W Cl w () w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Thorpe, Elizabeth D. DATE OF DEATH (MM-DD-YEAR) 07-24-2003 SOCIAL SECURITY NUMBER 32446-9134 THIS RETURN MUST BE FILED IN DUPLICATE WITH REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (date 01 death prior to 12- 5. Federal Estate Tax Return Required Litigation Proceeds Received 7. Decedent Maintained a Living Trust (Attach a copy ot Trust) 8. Total Number of Safe Deposit Boxes 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) $0.00 ~ $0.00 ~ $0.001 $o.ooi $3, 184.52 ~ $o.ooi ! , $0.00 i .....0"..................................... ~w:'!...........o.....o................... 0_ ~....................o. OFFICIAL USE ONLY ,-,", C_:j r", ., (8) $3,184.52 DATE OF BIRTH (MM-DD-YEAR) 03-18-1930 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) III ~:-ffi(/) o~~ III a. 0 .ce.Q U a.1D a. <( 1. Original Return x 2. Supplemental Return $15.00 $0.00 (11) (12) (13) $1500 $3,169.52 $000 4. Lirnited Estate 4a. Future Interest Comprise (date of death after 12-12-82) (14) $3,169.52 x 6. Decedent Died Testate (Attach copy of Will) = CD -= = a CL. en ~ C5 c...:> NAME Rebecca R. LaRosa FIRM NAME (If Applicable) (15) (16) (17) (18) (19) $0.00 $142.63 $0.00 $000 $142.63 TELEPHONE NUMBER 717938-3396 1. Real Estate (Schedule A) (1) (2) (3) (4) (5) (6) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o I- <( ....J ::> I- a. <( () w 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) z o j: ~~ f-:l Il. ~ o U SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x 16. Amount of line 14 taxable at lineal rate $3,169.52 x _045 17. Amount of line 14 taxable at sibling rate x .12 18. Amount of line 14 taxable at collateral rate 19. Tax Due x .15 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT pt. Decedent's Complete Address: STREET ADDRESS 95 Burning BrushCircl~ CITY Etters STATE PA ZIP 17319 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) $142.63 Total Credits (A + B + C) (2) $000 3. InteresUPenalty if applicable D. Interest E. Penalty 4. TotallnteresUPenalty (D + E) (3) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $0.00 5. $142.63 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) $142.63 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: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary interest; or d. receive the promise for life of either payments, benefits or care? If death occurred after December 12, 1982, did decedent transfer property within on year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? Yes No 2. ~ B ~ E8 3. 4. 1)(. ., IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. I I Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct, and complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. SIGNA~RE JF PERSON RESPONSIBLE FOR FILING RETURN /~ /2, ole( ~ ADDRESS DATE 2- DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '==== '=- .~ LAST WILL AND TESTAMENT OF ELIZABETH DUNLAP THORPE I, ELIZABETH DUNLAP THORPE, of 1200 South Washington Street, Apartment 723-E, Alexandria, Virginia make this my will. I revoke any other wills or amendments to wills made by me. ARTICLE I. Distribution of My Estate. I give all of my estate to my only child and daughter, MRS. REBECCA RUTH LA ROSA, if she survives me. If MRS. REBECCA RUTH LA ROSA does not survive me, I give all of my estate to her descendants, per stirpes, who survive me. ARTICLE II. Payment of Debts and Other Charges. I direct my Co-executors to pay my debts and my funeral and burial expenses, including the cost of a monument or marker over my grave. The estate, inheritance and similar taxes assessable on my death, including taxes on assets not passing under this will also shall be paid as a cost of administering my estate and my Co-executors shall not request any beneficiary to pay any part of such tax. ARTICLE III. Co-executors A. I name MRS. REBECCA RUTH LA ROSA and MRS. JOY S. MASON to be my Co-executors. I request that no security be required of any Executor. B. In addition to the powers granted by law, I grant my Co-executors the powers set forth~n S64.1-57 of the Code of Virginia, and I incorporate that Code Section in my will by reference. All successor Executors or Co- executors shall have the powers, immunities and discretion which I have granted to my named Co-executors. IN TESTIMONY WHEREOF, I have set my hand and seal to this my last will and testament, consisting of three (3) typewritten pages on which I have placed my signature this 10th day of March, 1983. , ~ C.JIr .I..(.v If' -J~ EL ZABETH DUNLAP THORPE (SEAL) The foregoing instrument, consisting of four (4) typewritten pages, including this attestation clause, was on this 10th day of March, 1983, subscribed by ELIZABETH DUNLAP THORPE, the Testatrix named herein, and by her signed, sealed, published and declared to be her LAST WILL AND TESTAMENT in the presence of us, and each of us, who thereupon, at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses thereto. of IL, N F~ ~) 00.... of 3'i1.;l. ~O PL ~ L of ,jlljuf. ~(J ch50 i) I ak PU'6{.; ii, i}O-- . STATE OF VIRGINIA CITY OF ALEXANDRIA Before me the undersigned authority, on this day personally appeared ELIZABETH DUNLAP THORPE, ~ S~ /~ 0~and~~ known to me to be the Testatrix and the Witnesses, respectively, whose names are signed to the attached or foregoing instrument, and, all of these pre sons being first duly sworn, ELIZABETH DUNLAP THORPE, the Testatrix, declared to me and to the Witnesses in my presence, that said instrument is her LAST WILL AND TESTAMENT and that she had willingly signed or directed another to sign the same for her and executed it ___.....- .................. vlJ..LUllLdry act for the purposes therein expressed; that said Witnesses stat before me that the foregoing Will was executed and acknowledged by the Testatrix as her LAST WILL AND TESTAMENT in the presence said witnesses, who in her presence, and at her request, and in the presence of each other, did subscribe their names thereto as attesting Witnesses on the day of the date of said Will, and that the Testatrix, at the time of the execution of said will, was over the age of eighteen (18) years and of sound and disposing mind and memory. ~~~ Te tatrix Wit~S.~ ~7h.~ ltness ~fdr ltn s SUBSCRIBED, SWORN AND ACKNOWLEDGED before me by ELIZABETH DUNLAP THORPE, the Testatrix, SUBSCRIBED AND SWORN to before me by ~,S~ ~~ ' the March, 1983. , 7'~f,J~ Witnesses, this lOth day of My Commission expires: .~5~b ,///~.c: / and REV-1508 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thorpe, Elizabeth D_ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-03-0923 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 disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Proceeds from survival action from Penn National Insurance. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $3,184.52 $3,184.52 REV-1511 EX+ (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thorpe, Elizabeth D. Debts of decedent must be reported on Schedule I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-03-0923 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - file return $15.00 .. TOTAL (Also enter on line 9, Recapitulation) $15.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + ~9-00)) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BENEFICIARIES ESTATE OF Thorpe, Elizabeth D. FILE NUMBER 21-03-0923 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(sl OF ESTATE 1. Rebecca LaRosa 95 Burning Brush Circle Etters PA 17319 daughter entire estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- 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) $0.00 FEB. -14' 06(TVE) 08:55 KATHERMAN BRIGGS & GREENBERG P. 004/005 . j' '\.-.' '-./ '--" REBECCA R, LaROSA, Administrator for the ESTATE OF ELIZAaETH D. THORPB, IN THE COURT OF COMMON PI.BAS OF INDIANA COUNTY, PENNSYLVANIA CIVIL ACTION LAW NO. ~005-11084 Plaintiffs, va. ~~~) ~ l~ \~ n ill ~ ~ Uti JUll ~ 2005 ~ CATHERINE ZIMMERMAN, Executrix for the ESTATE OF PHILIP ZIMMERMAN. Bv- -= Defendant. ORDla 01' COURT AND NOW this / SrJ::. day of J7 , 21)05, upon the Petition to Interplead of Catherine Zimmerman, Executrix for the Estate of Philip Zimmerman, the same is h!r.by granted and David carl Lee, the Administrator of the Estate of Oavid C. Lee; John L. Speer, III, the Administrator of the Estate of Rose Ann Lee; vicki Kanyan. individually, $nd as the parent and natural guardian of Courtney Jean Peles: .1ames zimmerman, individually and as parent and natural guardian of Jamie zimmerman; and Erie Insurance are added to the recorc. as party-plaintiffs, and enjoined from commencing or further prosecuting any action in any Court against Catherine ZimmE!rman, axecutrix for the Estate of Philip zimmerman and/or the Eatat.~ , ~l!~i:jj::i:'i:!:i\:: Exhibit for Schedule E FEB, -14' 06lTCE) C8:56 I -' ~ I I KATHERMAN BRIGGS & GREENBERG p, 005/005 "-../ .......-'. ! of Philip Zimmerman, to enforce, in whole or in part, any c:lnim against the petitioner set forth in said Petition, except as a party to the above-captioned action. Claimants, David Carl Lee, the Administrator of t~ Estate of David C. Lee; John L. speer, III, the Adminiatrat~~ of the Estate of Rose Ann Lee; vicld Kanyan, individualljr, and illl the parent and natural guardian of Courtney Jean Peles; Jame~ zimmerman, individually and a.s pa.rent and natural guardian oE Jamie Zimmerman; and Erie Insurance are hereby directed to file their Complaints within twenty (20) days after service of the petition for Interpleader and this Order. J. " 'i:' ::<CS.;;~ '7J/. ',: I I I/"'fl'l)''':' , I : "', , ...,., ..; '..., r_,;"} .'b I., 'r;: [3 I il1l' ~OOl ('-J ::." ',~, ~ .~ f: I " . '/00,. 1''';, ',. "~'I'"~ "," ':;~:; \~"I . :'~ :\I!!fli~' :;,II~~ ;, ' '~;I' . "dJ~I!o' '.. 1'1', .ll,.",. ' FEB. -14' 06 (TUE) 08:55 KATHERMAN BRIGGS & GREENBERG p, 002/005 . . Closfng Statement CaSel Type: AUT Estate of Elizabeth D. Thorpe Rec;ov8ry~ SETTLEMENT Penn Nalionallnsurence 1& 23,683.90 $ 23,883.90 ATTORNEY FEES. LIENS AND OTHER pAYMEft.jTS: Katherman, Briggs & Greenberg $ 3,980.65 Sechrist Law Office $ 3,980.65 Total Due Others: $ 7.961.30 Total Deductions Total Amount Due to Rebecca R. LaRosa Total Amount Due to Rebecca R. laRosa, E)(6cutrhc of the Estate of Elizabeth D. Thorpe i.Z..g61.30 !Ii 12J38.08 $ 3,184.62 The above.captionad matter has been settled to my/our complete satisfaction and all disbursements made with complete approval. IIWe agree that a minimum of ten business days (or such other time as indicated on my/our disbursement draft) will be allowed for clearance of the settlement draft. I/We acknowledge that IIwe have advised my/our attorney of all subrogation claims, or protected interests and outstanding medical bills of which I am/we are aware and I/we acknowledge and understand that a ny claims that are not paid as set forth above or any future claims regarding these are my/our responsibility and not the responsibility of my/our attorney or his/her law firm. I/we further agree to indemnify and hold my/our attorney harmless from any and all claims which may be made by any of my creditors, medical providers. health insurer, or health plans against my/our attorney arising out of my/our personal injury or wrongful death claims. CLIENT: ~TTORN Y: ~?1~~~ Rebecca R. LaRosa, il1dividuallv and as . n9 Executrix of the Estate of EJizabath D. lhorpa (J .!).q or; ated l/zrIo , Dated Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters P A 17319 717 938-3396 Facsimile 717 938-9613 February 14,2006 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle P A 17013 RE: Estate of Elizabeth D. Thorpe File No. 21-03-0923 To Whom It May Concern: Enclosed are two copies of the Supplemental Pennsylvania Inheritance Tax return in regard to the above estate together with a check in the amount of$15.00 for the filing fee and a check in the amount $142.63 representing Pennsylvania Inheritance Tax. Thank you very much for your assistance in this matter. JOS:lm Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SECHRIST JOEL 0 568 OLD YORK ROAD ETTERS, PA 17319 _____n_ fold ESTATE INFORMATION: SSN: 324-46-9314 2103-0923 THORPE ELIZABETH DUNLAP 02/15/2006 02/14/2006 CUMBERLAND 07/24/2003 FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: REMARKS: JOEL SECHRIST, ESQ CHECK# 1934 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: RSK RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 006328 AMOUNT $142.63 $142.63 GLENDA FARNER STRASBAUGH REGISTER OF WILLS 05-01-2006 THORPE 07-24-2003 21 03-0923 CUMBERLAND 502 APPEAL DATE: 06-30-2006 ( See reverse side under Objections) Amount Remitted I I 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 +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ELIZABETH D FILE NO. 21 03-0923 ACN 502 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PD BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '~i- r c:-:-r.c-NOTICE OF INHERITANCE TAX " - APPR'AlSEkEtn ~ ALLOWANCE OR DISALLOWANCE OF DEDOCTIONS AND ASSESSMENT OF TAX .. -...., '...:" :~~: 3l, DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN :j. :.1 t !: i:"'.T , REBECCA R LAROSA v C/O JOEL 0 SECHRIST 568 OLD YORK RD ETTERS PA 17319 ESTATE OF THORPE REV-1547 EX AFP (06-05) ELIZABETH D TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 05-01-2006 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 3,184.52 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdD. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 15.00 .00 (11) (12) (13) (14) NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 3,184.52 15 00 3,169.52 .00 3,169.52 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total D~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX C ITS: .00 X 00 = 3~169.52 X 045 = .00 X 12 = .00x 15 = (19)= DATE 02-14-2006 NUMBER CD006328 + INTEREST/PEN PAID (-) .00 AMOUNT PAID 142.63 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 142.63 .00 .00 142.63 142.63 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE l}fl A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Elizabeth D. Thorpe Date of Death: July 24, 2003 Will No. 21-03-0923 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. State whether administration of the estate lS complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the aGuinistration will be comDlete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x 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 x No Date: o d. Copies of rec~ipts, releases, joinders and approvals of formal or informcl oC'C':".2nt:5 lT13Y be filec: w5th "th,,:, Cerk of the Orphans' Court and may be at_tached to th~1 report. C"\ ~ ~Il .. -~ ~/ - l ----~-. Sig:~ture ./ \ // Joel O. Sechrist, Name (Please type 568 Old York Road Etters PA 17319 Address f/ I 7 /2-- () 0 b ! I Esquire or print) ( 717) 938-3396 Tel. No_ Capacity: Personal Representative x Counsel for personal representative /-C ~I (. !\\.'W (Y.AH: rmf IAM3)