The URL can be used to link to this page

Home My WebLink About04-0249 · Deceased· Social Security No. } 8 ~ o ~ q 7.. ~ 7 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut,r~ in the last wilt of the above decedent, dated 2. ?_ hEr-~w ~ ~. ~ /9 8 ~ and codicil(s) dated PETITION FOR PROBATE and GRANT OF LETTERS Estate of'$l~t4~C ~, *dlC_F}o/$o~ No. C'~l-0t4-c~t4q also known as To: - Register of Wills for the County of C._ t./o3/~ fR.[. ~ ~..¢ in the Commonwealth of Pennsylvania named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was death in C ~ m ~ F_~L~0,O z~ County, Pennsylvania, with domiciled at 1~ ! $ last family or pri~c~:~al residence at I (list street, number and muncipality) Decendent, then ~ years of age, died Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (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: ~,~ooo o o0 WHEREFORE, petitioner(s) respectfully request(s) the probate of the::lla~t will'nd co~c~s) presented herewith and the grant of letters P~,'V/,,~ rt~ 7'/o,.L (2, 77, ~9, ~t:~:' ,.::_.~ ~ theron. (testamenta~administration c.t~i; ~dministll~on iq £, ,0~ z2a .~ ~, i4z /70u7 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 Thc petitioner(s) above-named swear(s) or affirm(s) that thc statements in the foregoing petition arc truc and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer thc estate according to law. Sworn to or affir~a.~d+_jand subscribedf befor~e~rne this I d~ iX_ day of xo. l-O'4- Estate Of ~~ ? ~/~ic~o/~c~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS the .reverse side hereof, satisfacto~ proof having been presented before me, IT IS DECREED that the instrument(s) dated I ~-. - c~- [c~ ~ described therein be admitted to probate and filed of record as the last will of and Letters ('Q~.ck~c~~ ca .~' a'~') are hereby granted to [.k~0.~,~_aLo~ ~ f'~r'Y~ /o~ ,:~00~ ~,~ , in consideration of the petitionon FEES Probate, Letters, Etc .......... Short Certificates( ) .......... TOTAL Filed ...~.. :-. 1~. :-..o..q. .................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ~.~. - ' I ~ ~. 1 ............... ~ "' ,,.. ~- PA ' "' 314 Fore ~rlisle, PA 17013 ~ ~m, - ................ Nichol~n :"u Palm LAST WILL AND TESTAMENT I, SAMUEL G. NICHOLSON, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. 2. If my spouse shall survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my wife, NORINE M. NICHOLSON, absolutely. 3. In the event my said wife shall predecease or fail to survive me by more than thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, in the following manner: 4/5 thereof, I give unto my daughter, WANDA M. PALM, absolutely. The remaining 1/5 thereof, I give unto my grandson, WILLIAM BRADLEY PALM and I hereby appoint the said WANDA M. PALM as guardian of the estate of my said 1 LAW OFFICES--MARTSON, DEARDORFF, WILLIAMS & OTTO grandson. I further direct that said guardian may use the principal of said sum for secondary education of my grandson. I hereby appoint the said WANDA M. PALM as Executrix under the provisions of this fourth paragraph of my Last Will and Testament. 5. I nominate, constitute and appoint NORINE M. NICHOLSON as Executrix of my estate. 6. I direct that my Executrix shall not be required to file a bond to secure the faithful performance of her duties in any jurisdiction. 7. I authorize and empower my Executrix, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make 2 LAW OFFICES--MARTSON, DEARDORFF, WILLIAMS & OTTO distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; and to execute and deliver such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~ day of /~~.(~ , 198 ~. Samuel G. Nicholson SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named testator, as and for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed our names as witnesses thereto, in the presence of the said testator and of each other. 3 LAW OFFICES -- MARTSON, DEARDORFF, WILLIAMS & OTTO COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, SAMUEL G. NICHOLSON, testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and volunta~ act for the purposes therein expressed. Sworn or affirmed to and acknowledged befo~'e me by SAMUEL G. NICHOLSON, the testator, this ~n~day 198 ~. Notary Public COMMONWEALTH OF PENNSYLVANIA ) : SS. . ~ E. w~. No~y COUNTY OF CUMBERLAND ) ~m.~ E~..~j~.., Oumb~la~ My ~ss~ Ex~re~ ~. 23, 1~1 the witnesses whose names are signed to the attached or foregoing instr~ent, being duly qualified according to law, do depose and say that we were present and saw S~UEL G. NICHOLSON, the testator, sign and execute the instr~ent as his Last Will; that the testator signed willingly and that the testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testator, signed the Will as witnesses; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~Addre~s A~dress /O ~% Sworn or affixed to and subscribed before me this Nota~ Public / LA~ OFFICES- ~TSON, DE~DO~~ OTTO Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) WilINo. ZOOt-I- O0 ~-Cl 9 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule $.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on i ?.- ~/9~¢ It Z-o o 7 : Name Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Telephone ('ttT) c~ g ~- Capacity: . Personal Representative / 7vc 7 ~.Counsel for personal representative F:\User Folder\Firm Docs\Estates~3501- I ceaificafion.wpd Name of Decedent: Date of Death: Will No. To the Register: CERTWICATION OF NOTICE UNDER RULE 5.6(a) SAMUEL G. NICHOLSON March 6, 2004 2004-00249 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 April~./), 2004. .Nalile William Bradley Palm Wanda M. Palm Address 300 West King Street, Shippensburg, Pennsylvania 17257 19 East Countryside Drive, Boiling Springs, Pennsylvania 17007 Notice has not been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: April f'q , 2004 H~T, P.C. Michael J. Hanft, ~ Attorney I.D. No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 Telephone (717) 249-5373 Capacity: Counsel forpersonal representative 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 NO. REV-1162 EX(11-96) CD 004003 PALM WANDA M 19 EAST COUNTRYSIDE DRIVE BOILING SPRINGS, PA 17007 ........ fold ESTATE INFORMATION: SSN: 189-09-4287 FILE NUMBER: 2104-0249 DECEDENT NAME: NICHOLSON SAMUEL G DATE OF PAYMENT: 06/03/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $21,000.00 REMARKS: HANFT & KNIGHT TOTAL AMOUNT PAID: $21,000.00 SEAL CHECK# 1467 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS HANFT & KNIGHT, P.C. ATTORNEYS & COUNSEI_I_ORS AT LAW December 3, 2004 W1 [.l lAM A. ADDAMS MICHAEI~ J. HANFF GREGORY H. KNIGIIT JAMES I. NE[S()N SEAN M. SIt[JITZ Register of Wills 1 Courthouse Square Carlisle, Pennsylvania 17013 Estate of Samuel G. Nicholson Estate No. 21-04-00249 My File No. 3501.1 Dear Register of Wills: Enclosed for filing please find an original and two copies of the Inheritance Tax Return in the above-referenced estate. Please return a time-stamped copy to my office in the enclosed self- addressed, stamped envelope. I have also enclosed a check in the amount of$15.00 representing the filing fee for the return and a check in the amount of $4,370.42 representing the inheritance tax that is due. I have also enclosed an original Disclaimer of Interest and two copies. Please return those time-stamped copies to my office also. Enclosed is a check in the amount of $3.00 representing the filing fee for the Disclaimer. Should you have any questions or wish to discuss this matter further, please do not hesitate to contact me. SMS/dmh Very truly yours, HANFT & KNIGHT, P._C.L///~,~,_.___- Enclosures F:'~User FoldeBFi~Tn Docs\Estatesk3501 - I rcg wills I wpd WHEN EXPERTISE AN[3 INTEGRITY MA'I'I ER. m 19 BROOKWOOI) AVENUE SUITE 106 CARLISLE, PA ]7013-9142 717.249.5373 FAX 717.249.0457 VV\A/~,~,/.IIANFTIAYVFIRM.COM 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 NO. REV-1162 EX(11-96) CD 004697 PALM WANDA M 19 EAST COUNTRYSIDE DRIVE BOLLING SPRINGS, PA 17007 ........ fold ESTATE INFORMATION: SSN: 189-09-4287 FILE NUMBER: 2104-0249 DECEDENT NAME: NICHOLSON SAMUEL G DATE OF PAYMENT: 12/06/2004 POSTMARK DATE: 1 2/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,370.42 TOTAL AMOUNT PAID: $4,370.42 REMARKS: WANDA M PALM SEAL CHECK# 1032 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT {-FILE NUMBER 21 COUNTY CODE 04 00249 YEAR NUMBER O0 DECEDENT'S NAME <LAST, FIRST, AND MIDDLE INITIAL) Nicholson, Samuel G. DATE OF DEATH (MM-OD-YEAR> DATE OF BIRTH (MM-OD-YEAR) 03/06/2004 09/27/1910 SOCIAL SECURITY NUMBER 189-09-4287 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [] 1 Original Return [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Tn. Jst) [] 9 Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ] 3. Remainder Return (date o[ death pdor to 12-13-82) [] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: qAME Sean M. Shultz, Esquire :IRM NAME (If applicable) Hanft & Knight, P.C. COMPLETE MAILING ADDRESS 11 Roadway Drive, Suite B TELEPHONE NUMBER Carlisle, PA 17013 717/249-5373 :"--~ 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 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) 119,820.00 226,305.12 None None 257,759.85 5,002.06 None 15,562.99 2,966.74 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) - C'":? 1 (8) 608,887.03 18,529.73 590,357.30 2,000.00 588,357.30 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 17.Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .1 5 19. Tax Due 20. 588,357.30 (15) (16) 26,476.08 (17) (18) (19) 26,476.08 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH Cor)¥right 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) De'c,edent's Complete Address: ISTREET ADDRESS 1314 Forge Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) 21,000.00 1,105.26 26,476.08 Total Credits (A + B + C) (2) 22,105.26 0.00 4,370.82 4,370.82 Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 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) 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; .................................... FI [~ c. retain a reversionary interest; or .................................................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Wand,a M. Palm ~]~~.x~I~, /~e~,-~ 19 East Countryside Drive Boiling Springs, PA 17007 SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE Sea~, ~,~re ~ ~.__~_- o.._.._ ~~ ll Roadway Drive, Suite B Carlisle, PA 17013 ! ~; 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nicholson, Samuel G. SCHEDULE A REAL ESTATE FILE NUMBER 21-04-00249 All real property owned solely or as a tenant in comm, on must,be r.e, j3orted, at fai.r.,mar, ket value. Fair mar, ket value is defined as the price at which property would be exchanged between a willing buyer an(] a wimng seller, neimer Deing compelled to Duy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION Real Estate and house situate at 1314 Forge Road, Carlisle, South Middleton Township, Cumberland County, Pennsylvania TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE OF DEATH 119,820.00 119,820.00 COMMONWEALTH OF PENNSYLVANtA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE OF ITEM DESCRIPTION UNIT VALUE NUMBER DEATH 1 Series E $1000Savings Bond m202832164e dated 12/1976 4,902.80 2 Series E $1000 Savings Bond m202832163e dated 12/1976 4,902.80 3 Series E $1000 Savings Bond m202832162e dated 12/1976 4,902.80 4 Series E $1000 Savings Bond m104801604e dated 12/1975 4,979.60 5 Series EE $5,000 Savings Bond v3907452ee dated 12/1992 4,792.00 · ~' ~ 6 Series EE $5,000 Savings Bond v5348843ee dated 12/1997 3,294.00 7 Series EE $5,000 Savings Bond v3911298ee dated 12/1992 4,792.00 8 Series EE $10,000 Savings Bond xS035454ee dated 12/1996 6,664.00 9 Series EE $1,000 Savings Bond m55519335ee dated 12/1992 958.40 , 10 Series EE $1,000 Savings Bond m55519336ee dated 12/1992 958.40 11 Series EE $1,000 Savings Bond m55803200ee dated 12/1992 958.40 12 Series EE $5,000 Savings Bond v40258465ee dated 1/1993 4,792.00 13 Series E $1,000 Savings Bond m100860948e dated 01/1993 5,182.40 14 Series E $1,000 Savings Bond m100860947e dated 01/1973 5,182.40 15 Series E $1,000 Savings Bond m100860945e dated 1/1973 5,182.40 16 Series E $1,000 Savings Bond m1008690944e dated 1/1973 5,182.40 17 Series E $I,000 Savings Bond m101710332e dated 1/1974 5,139.20 18 Series E $1,000 Savings Bond m101710331e dated 1/1974 5,139.20 19 Series E $1,000 Savings Bond m101710330e dated 1/1974 5,139.20 20 Series E $1,000 Savings Bond m101710329e dated 1/1974 5,139.20 Total of Continuation Schedule(s) 138,121.52 TOTAL (Also enter on line 2, Recapitulation) 226,305.12 COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS continued ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE O NUMBER DESCRIPTION UNIT VALUE DEATH 21 Series E $1,000 Savings Bond m104801603e dated 12/1975 4,979.60 22 Series E $1,000 Savings Bond m104801602e dated 12/1975 4,979.60 23 Series E $1,000 Savings Bond m101710334e dated 1/1974 5,139.20 24 Series E $1,000 Savings Bond m101710333e dated 1/1974 5,139.20 25 Series E $1,000 Savings Bond m202832168 dated 12/1976 4,902.80 :~ ' 26 Series E $1,000 Savings Bond m202832167e dated 12/1976 4,902.80 27 Series E $1,000 Savings Bond m202832166e dated 12/1976 4,902.80 28 Series E $1,000 Savings Bond m202832165e dated 12/1976 4,902.80 29 Series E $1,000 Savings Bond m204513303e dated 12/1977 4,~8>.20' - ' 30 Series E $1,000 Savings Bond m202832171e dated 12/1976 4,902.80 31 Series E $1,000 Savings Bond m202832170e dated 12/1976 4,902.80 32 Series E $1,000 Savings Bond m202832169e dated 12/1976 4,902.80 33 Series E $1,000 Savings Bond m204513307e dated 12/1977 4,385.20 34 Series E $1,000 Savings Bond m204513306 dated 12/1977 4,385.20 35 Series E $1,000 Savings Bond m204513305e dated 12/1977 4,385.20 36 Series E $1,000 Savings Bond m204513304e dated 12/1977 4,385.20 37 Series E $1,000 Savings Bond m204513308e dated 12/1977 4,385.20 38 Series E $1,000 Savings Bond m204513309e dated 12/1977 4,385.20 39 Series E $1,000 Savings Bond m204513310e dated 12/1977 4,385.20 I 40 ! Series E $1,000 Savings Bond m100860943e dated 1/1973 5,182.40 I Page 2 of Schedule B COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RET~IRN RESIDENT DECEDENT ESTATE OF Nicholson, Samuel G. SCHEDULE B STOCKS & BONDS continued FILE NUMBER 21 - 04 - 00249 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM I DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 41 Series E $1,000 Savings Bond m100860942e dated 1/1973 5,182.40 42 Series E $1,000 Savings Bond m100860941e dated 1/1973 5,182.40 43 Series EE $1,000 Savings Bond m55803199ee dated 12/1992 958.40 44 Series E $500 Savings Bond d204338852e dated 12/1977 2,192.60 45 Series E $500 Savings Bond d203257752e dated 12/1976 2,451.40 46 Series E $500 Savings Bond d102883904e dated 2/1974 2,569.60 47 Series E $500 Savings Bond d102883903 dated 2/1974 2,569.60 48 Series E $500 Savings Bond d102883902e dated 2/1974 2,569.60 49 Series E $500 Savings Bond d102093713e dated 1/1974 2,569.60 50 Series E $200 Savings Bond r45311739e dated 1/1973 1,036.48 51 Series E $100 Savings Bond c1008870081e dated 1/1973 518.24 52 Series HH $5,000 Savings Bond V1696496HH dated December 2002 5,000.00 53 Series HH $5,000 Savings Bond V1696497HH dated December 2002 5,000.00 54 Series HH $5,000 Savings Bond V1696495HH dated December 2002 5,000.00 55 Series HH $500 Savings Bond D6166080HH dated December 2002 500.00 Page 3 of Schedule B COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 Include the j3roceeds 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. DESCRIPTION ITEM NUMBER 1 2 3 4 5 '- 6 7 8 9 10 11 12 13 14 15 16 17 lg 19 20 Members 1st Federal Credit Union Savings Account No. 117997-00 Members 1st Federal Credit Union Certificate of Deposit No. 117997-62 Wachovia Bank Certificate of Deposit No. 247412061676888 Wachovia Bank Certificate of Deposit No. 247412061676897 Wachovia Bank Certificate of Deposit No. 247412802005703 Wachovia Bank Checking Accmmt No. 1010058870462 Waypoint Bank Certificate of Deposit No. 1700004770 Waypoint Bank Certificate of Deposit No. 1755313039 Waypoint Bank Certificate of Deposit No. 7100019156 Waypoint Bank Certificate of Deposit No. 8000003983 Waypoint Bank Certificate of Deposit No. 8000029074 Citizens Bank Checking Account No. 6200842993 Citizens Bank Checking Account No. 6100634183 Prudential Financial Life Insurance Refund from Sprint Refund from Comcast Cablevision Refund from The Patriot News Refund from PA Department of Revenue Personal Property (see attached appraisal) 1988 Chevolet Caprice Sedan TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 4,460.04 10,004.05 12,000.00 I0,000.00 10,000.00 12,601.92 10,005.38 55,036.84 14,007.70 15,007.08 15,006.88 81,771.51 20.00 4,992.99 18.86 42.40 24.20 85.00 1,870.00 805.00 257,759.85 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 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 Wanda M. Palm daughter 19 East Countryside Drive Boiling Springs, PA 17007 JOINTLY OWNED PROPERTY: LETTER DESCRIPTION OF PROPERTY % OF DATE OF DEATH DATE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF · ITEM ~FOR JO NT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST NUMBER TENANT JOINT estate. : . 1 A 02/03/2003 Viembers 1st Federal Credit Union Certificate of 10,004.1111 50% 5,002.06 Deposit 117997-61 IOIAL IAIso entor on line 6, Recapitulation) 5,002.06 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATNE COSTS ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: Hoffman-Roth Funeral Home Carlisle Memorial Service, Inc. - headstone engraving ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address State Zip City Year(s) Commission paid Attorney's Fees to Hanft & Knight, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees to Register of Wills State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs The Sentinel - advertising letters Cumberland Law Journal - advertising letters 7,495.00 294.00 1,000.00 77.00 149.99 75.00 Total of Continuation Schedule(s) 6,472.00 TOTAL (Also enter on line 9, Recapitulation) 15,562.99 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral Expenses & klministrafive Costs continued ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 04 - 00249 R. McKee Construction & Masonry - repairs to decedent's home Cumberland Valley Tree Service - re moval of tree stumps (estimate) Electric Service upgrade for decedent's home (estimate) Robert Wickard - repairs to decedent's home (estimate) 1,500.00 65.00 1,200.00 3,707.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Nicholson, Samuel G. 21 - 04 - 00249 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 2 3 4 5 6 7 8 PPL Utilities Sprint Comcast Cablevision Spring Green Lawn Care South Middleton To~vnship Municipal Authority Agway Energy Products Judy Campbell, Tax Collector J. Rodney Fickel Insurance Agency 429.05 24.22 50.58 132.10 301.00 18.30 1,668.49 343.00 TOTAL (Also enter on Line 10, Recapitulation) 2,966.74 REV-151~ EX+ (9-00)t .f~ ' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA B E N E Fl C I ARI ES ~N,~E~'rANC~ TAX ~'ru~N ESTATE OF FILE NUMBER .T: ,_ ,~mDo~son, Samuel (3. 2 ! - 04 - 00249 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE ][. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Wanda M. Palm daughter 100% estate 19 East Countryside Drive Boiling Springs, PA 17007 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 First Lutheran Church 2,000.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 2,000.00 LAST WILL AND TESTAMENT I, SAMUEL G. NICHOLSON, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and d~s~osing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes shall be.paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. If my spouse shall survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my wife, NORINE M. NICHOLSON, absolutely. 3. In the event my said wife shall predecease or fail to survive me by more than thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, in the following manner: 4/5 thereof, I give unto my daughter, WANDA M. PALM, absolutely. The remaining.i/5 thereof, I give unto my grandson, WILLIAM BRADLEY PALM and I hereby appoint the said WANDA M. PALM as guardian of the estate of my said 1 LAY/ OFFICES- ~IARTSON, DEARDORFF, WlLLIA.%[S & OTTO grandson. I further direct that said guardian may use the principal of said sum for secondary education of my grandson. I hereby appoint the said WANDA M. PALM as Executri~ ~nder th~ provisions of this fourth paragraph of my Last Will and Testament. 5 I nominate, constitute and appoint NORINE M. NICHOLSON as Executrix of my estate. 6. I direct that my Executrix shall not be required to file a bond 'to secure the faithful performance of her duties in any jurisdiction. 7. I authorize and empower my Executrix, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; and to execute and deliver such instruments as may be necessary to carry out any of these.powers. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~ day of /~c~~ , 198 ~. Samuel G. Nicholson SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named testator, as and for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed our names as witnesses thereto, in the presence of the said testator and of each other. 3 LAW' OFFICES- ~,I.-%RT$05. DEAIRDORFF, '~'iLLIA.%IS & COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY'OF CUMBERLAND ) I, SAMUEL G. NICHOLSON, testator, whose name is signed to the attached or foregoing instrument, having been duly qua. Lified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expresse~. ,, (/~i~F?:' ~,' . , ~ Sworn or affirmed to and acknowledged before r~:e by IEL G. NICHOLSON, the testator, this ~i~d day 198 ~'. - ..... Notary Public .':~ COMMONWEALTH OF PENNSYLVANIA ) : S S · ~m~,~ E. Y;~w. NoL~y Pubic COUNTY OF C~BE~D ) the witnesses whose names are signed to the attach or foregoing instr~eht, being duly qualified according to law, do depose and say that we were present and saw S~EL G. NICHOLSON, the. testator, sign and execute the instr~ent as his Last Will; that the testator signed willingly and that the testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testator, signed the Will as witnesses; and that to the best of our knowledge the testator was at that time 18 or more years of sound mind and under no constraint or undue of age, influence. -"AddreSs /c ~'-, I-/.~..L ~--,- - S - "' ~' - 'k~dres /0 ~Z-~,'o~ , Sworn or affixed to and subscribed before me this of/.~~.~, , 19 8 ~. i ' ". , '': ~ . ' . ~o~a~ PubZfc , ~ : '. ~ ~ No~ ~ '... .! LAW OFFICES -- MARTSO~. DEABDOR~~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of SAMUEL G. NICHOLSON : Estate No. 2004-00249 : DISCLAIMER OF INTEREST PURSUANT TO 20 PA. CONS. STAT. §6201 William Bradley Palm, Beneficiary under the Will dated December 22, 1988, of Sa~nuel G. Nicholson, Deceased, hereby states as follows: 1. Decedent, Samuel G. Nicholson died on March 6, 2004, leaving a will dated December 22, 1988, ~vhich was admitted to probate by the Register of Wills of Cumberland County, Pennsylvania. Letters of Administration C.T.A. thereon were granted to Wanda M. Palm on March 12, 2004. 2. William Bradley Palm is entitled under Item 3 of Decedent's Will to 1/5 of Decedent's estate. 3. As beneficiary under the Will of Samuel G. Nicholson, William Bradley Palm, the undersigned, hereby disclaims his interest under Item 3 of the Will of Samuel G. Nicholson. 4. By the terms of Item 3, the legacy now passes to Wanda M. Palm. 5. William Bradley Palm, Beneficiary under the Will of Samuel G. Nicholson, Deceased, intends to deliver this disclaimer to the Administrator under the Will of Samuel G. Nicholson, and, if necessary, to file it with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, pursuant to 20 Pa. Cons. Stat. {}6201. IN WITNESS WHEREOF, the undersigned has signed this document this /,5"/" day of Wiiliam Bradley Palm, Bene~m"'iar~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of SAMUEL G. NICHOLSON · Estate No. 2004-00249 DISCLAIMER OF INTEREST PURSUANT TO 20 PA. CONS. STAT· §6201 William Bradley Palm, Beneficiary under the Will dated December 22, 1988, of Samuel G. Nicholson, Deceased, hereby states as follows: 1. Decedent, Samuel G. Nicholson died on March 6, 2004, leaving a will dated December 22, 1988, which was admitted to probate by the Register of Wills of~ _C.umberland County, Pennsylvania. Letters of Administration C.T.A. thereon were granted to Wariila M. Palm on March 12, 2004. 2. William Bradley Palm is entitled under Item 3 of Decedent's Wit:l to 1/5 of Decedent's estate. 3. As beneficiary under the Will of Samuel G. Nicholson, William Bradley Palm, the undersigned, hereby disclaims his interest under Item 3 of the Will of Samuel G. Nicholson. 4. By the terms of Item 3, the legacy now passes to Wanda M. Palm. 5. William Bradley Pahn, Beneficiary under the Will of Samuel G. Nicholson, Deceased, intends to deliver this disclaimer to the Administrator under the Will of Samuel G. Nicholson, and, if necessary, to file it with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, pursuant to 20 Pa. Cons. Stat. §6201. IN WITNESS WHEREOF, the undersigned has signed this document this //5"/' day of /N~i~ ~ ~,{', 2004· WiiliamBradley Palm, Bene iary COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVIDUAL tAXEs;~r"\=c INHERITA :E TAX DIVISION PO BOX 2tJ601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX \ ~PPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1541 EX AFP 112-041 ! 8 ... 12: 02 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-21-2005 NICHOLSON 03-06-2004 21 04-0249 CUMBERLAND 101 SAMUEL G SEAN M SHUL,JTZ"ESQ HANFT & KNIGHT 11 ROADWAY DR STE B CARLISLE PA 17013 Allount Rellitted 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 :r!W-EX'-,u.,r-CD1-:6J"-NoY'I-cE-oF-l'N'liER-illilcE-TA'x-l-PPR1-fsE'iErU'~--ALtowANCE-oR-----_._----- - --. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NICHOLSON SAMUEL G FILE NO. 21 04-0249 ACN 101 DATE 02-21-2005 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) 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 (1) (2) (3) (4) (5) (6) (7) 119,820.00 226,305.12 .00 .00 257,759.85 5,002.06 .00 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tex paYllent. (8) 608,887.03 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 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 (9) (10) 9,090.99 2.966.74 (1lJ (12) (13) (14) 12.057 73 596,829.30 .00 596,829.30 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: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due D T . NOTE: .00 X 596,829.30 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 26,857.32 .00 .00 26,857.32 DATE 06-03-2004 12-03-2004 NUtlBER CD004003 CD004697 + INTEREST/PEN PAID (-) 1,105.26 .00 AMOUNT PAID 21,000.00 4,370.42 ~ INTEREST IS CHARGED THROUGH 03-08-2005 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 26,475.68 381.64 4.55 386.19 . 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.) REV-1470 EX (6-88) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Nicholson, Samuel G. REVIEWED BY ACN 2104-0249 101 Daniel Heck ITEM SCHEDULE NO. EXPLANATION OF CHANGES H B-7 Estimated expenses are not allowable deductions. (3,4,5,6) The value of the charitable bequest has been disallowed. The decedent's Will did not contain a specific bequest to the charity. ROW Page 1 RE'f-1500 EX + (1..00) w .... ll:<tu) Oii:ll: w"-g Zli!..J o ,,-Ill "- <t OFFIC\!-\L USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00249 NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Nicholson, Samuel G. .... z w o w o w o DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 189-09-4287 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 1. Original Retum 2. Supplemental Retum 03/06/2004 09/27/1910 11 Roadway Drive, Suite B Carlisle, P A 17013 (1 ) None OFFICIAL USE ONLY (2) None (3) None (4) None (5) None (6) None (7) None (8) (9) 51,198.86 (10) (11 ) 51,198.86 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) (12) -51,198.86 4. Limited Estate :iJffi ~ !i IRM NAME (If applicable) 8 ~ Knight & Associates, P.c. ELEPHONE NUMBER 717/249-5373 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o ~ ::l .... ii: <t o w ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (13) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) -51,198.86 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20. 181 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) Copyright 2000 form software only The Lackner Group, Inc. 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z -51,198.86 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ~ .... ::l "- 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) .... 19. Tax Due (19) -2,303.95 -2,303.95 Form REV-1500 EX (Rev. 6..(0) Decedent's Complete Address: STREET ADDRESS 1314 Forge Road CITY Carlisle lSTATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) -2,303.95 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penally Total Interest/Penalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund S. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (S) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line S + SA. This is the BALANCE DUE. (58) 0.00 2,303.95 0.00 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 reversionary interest; or.................................................................................................................. d. receive the promise for life of either payments, benefits or care?............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......................................,.,...................................................................... ....... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..............................,....................................................................................... Yes No ~ I D ~ D ~ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Wand M. Palm 19 East Countryside Drive Boiling Springs, P A 17007 DATE ~ {sf()5 ADDRESS DATE ADDRESS 11 Roadway Drive... Suite B Carlisle, P A 170 b ~. 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. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax r [72 P .S. 99116 (a) (1.1) (ii)]. The statute does not exen of assets and filing a tax return are still applicable even to or for the use of the surviving spouse is 0% ax, and the statutory requirements for disclosure :iary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers frolT parent, an adoptive parent, or a stepparent of the child Ie or younger at death to or for the use of a natural The tax rate imposed on the net value of transfers to 0 1.2) [72 P.S. 99116 (a) (1)1. f\~pc\ :r The tax rate imposed on the net value of transfers to ( 12% [72 P.S. 99116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent In comlllUII ...... u._ _____ _ "whether by blood or adoption. lficiaries is 4.5%, except as noted in 72 P.S. 99116 . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nicholson, Samuel G. I FILE NUMBER 21 - 04 - 00249 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's 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. Other Administrative Costs 1 Decedent's 2004 Federal Income Tax 40,706.00 2 Estate 2004 Federal Income Tax 1,443.00 Total of Continuation Schedule(s) 9,049.86 TOTAL (Also enter on line 9, Recapitulation) 51,198.86 Schedule H Funeral Expenses & PdninistJative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nicholson, Samuel G. I FILE NUMBER 21 - 04 - 00249 3 R. McKee Construction & Masonry - Repairs to Decedent's home 1,500.00 4 Cumberland Valley Tree Service - removal of tree stumps 65.00 5 Quigley Mechanical Service, Inc. - electric service upgrade of Defendant's home 374.86 6 R.L. Adams & Sons & A.L. Karper, Inc. - repairs to outside of Defendant's home 3,520.00 7 Carlisle Kitchen Center, Inc. - Repairs to Decedent's home 3,590.00 Page 2 of Schedule H 11-28-2005 NICHOLSON 03-06-2004 21 04-0249 CUMBERLAND 101 APPEAL DATE: 01-27-2006 ( 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 ~~!_~~9~9_!~!~_~!~~------~___~~!!!~_~9~~~_~9~!!9~_~9~_Y9~~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX SAMUEL G FILE NO. 21 04-0249 ACN 101 BUREAU OF INDIVIDu4r=!T~~~~D INHERITANCE TAX DIVISIdI/- .. ..- PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 0~ NOTICE OF INHERITANCE TAX '_T APPRAISEI1ENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSI1ENT OF TAX 28. _0 .) r~". ";. ns ; \ '..,:. ",," DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ( (-- SEAN M SHULTZ ESQ KNIGHT S ASSOCS 11 ROADWAY DR STE B CARLISLE PA 17013 ESTATE OF NICHOLSON TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) ~. 110rtgages/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/l1isc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/l1isc. Expenses (Schedule H) 10. Debts/l1ortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) l~. Net Value of Estate Subject to Tax (9) llO) 40,706.00 .00 lll) ll2) ll3) ll~) REV-1547 EX AFP (06-05) SAMUEL G DATE 11-28-2005 SEE ATTACHED NOTICE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. .00 40.706 00 40,706.00- .00 556,123.30 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: 15. Amount of Line l~ at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line l~ at Sibling rate (17) 18. Amount of Line l~ taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 556,123.30 X 045 = 25,025.55 .00 X 12 = .00 .00 X 15 = .00 ll9)= 25,025.55 ""'-".I.r l+J AI10UNT PAID DATE NUI1BER INTEREST/PEN PAID (-) 06-03-2004 ~ CD004003 1,105.26 21,000.00 12-03-2004 CD004697 .00 4,370.42 TOTAL TAX CREDIT 26,475.68 BALANCE OF TAX DUE 1,450.13CR INTEREST AND PEN. .00 TOTAL DUE l,450.13CR · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED. ^~ IF TOTAL DUE IS REFlECTED AS A "CREDIT" (CR), YOU I1AY BE DUE ~iJ' A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.) REV-1470 EX (6-88). INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME Nicholson, Samuel G. FILE NUMBER Daniel Heck ACN 2104-0249 101 REVIEWED BY ITEM SCHEDULE NO. H B-7(2) EXPLANATION OF CHANGES Reduced to zero. Fiduciary income taxes are not allowable deductions for Pennsylvania inheritance tax purposes. H B-7 (3 to 7) Repairs to the real estate are only allowable when the real estate has been sold and reported at the selling value for inheritance tax purposes. ROW Page 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of SAMUEL G. NICHOLSON Estate No. 2004-00249 PRAECIPE FOR WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Please withdraw my appearance on behalf of the Executor of the Estate of Samuel G. Nicholson. KNIGHT & ASSOCIATES, P.C. Date: 1/4 } oi., Sean M. Shultz, qUIre Attorney LD. No. 90946 11 Roadway Drive, Suite B Carlisle, Pennsylvania 17013 (717) 249-5373 Counsel for personal representative F:\User Fo!der\Finn Docs\E<.;tates\3501-1praecipe.wpd -~,,;, "," ( ~ r , '._'_1 1"',) 4 . BUREAU OF INDIVIDUAL 'iA1(e:s ',' INHERITANCE TAX DIVISION ' ' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) 1 r I '. I '~ D ! : - .J " , , '...; 1 i \.) :J r:.~=:_r",: SEAN M SHUJlTiZ"ESQ \.. ..~ KNIGHT 8 ASSOCS 11 ROADWAY DR STE B CARLISLE PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-27-2005 NICHOLSON 03-06-2004 21 04-0249 CUMBERLAND 101 SAMUEL G Amount Remitted 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~. THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. ESTATE OF NICHOLSON SAMUEL G FILE NO.21 04-0249 ACN 101 DATE 12-27-2005 DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-28-2005 PRINCIPAL TAX DUE: 25,025.55 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-03-2004 CD004003 1,105.26 21,000.00 12-03-2004 CD004697 .00 4,370.42 12-06-2005 "'- REFUND .00 1,450.13- TOTAL TAX CREDIT 25,025.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE 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. ) pJ( IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of SAMUEL G. NICHOLSON Estate No. 2004-00249 PRAECIPE FOR WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Please withdraw my appearance on behalf of the Executor of the Estate of Samuel G. Nicholson. KNIGHT & ASSOCIATES, P.C. Date: 1/4} oLp F:\User Folder\Finn Docs\E'ltates\3501-1 praecipe.wpd Sean M. Shultz, qUIre Attorney LD. No. 90946 11 Roadway Drive, Suite B Carlisle, Pennsylvania 17013 (717) 249-5373 Counsel for personal representative ( "" . " l_'_' 0" f'-2 A ~ . b- //> /,/ /' <!!" In Re: Estate of NICHOLSON SAMUEL G ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00249 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: PALM WANDA M Counsel for Personal Representative: Date of Decedent's Death: 3/6/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 4/3/2006 ~~.~ .. Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File