The URL can be used to link to this page

Home My WebLink About03-0315PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as Donald E. Barrick Social Security No. 201-18-9478 The petition of the undersigned respectfully represents that: To No, 21-03- BI 5 Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Your petitioner(s), who is/are 18 years of age or older and the exe¢ in the last will of the above decedent, dated May 24, 1976 and codicil(s) dated N/A cutrix named (state relevenat circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland his last family or principal residence at 750 Pine Road, Borough of Carlisle, Carlisle, Pennsylvania (list street, number and municipality) County, Pennsylvania, with Decedent, then 86 years of age, died Forest Park Health Center,700 Walnut Bottom Road, Borough of Carlisle, Carlisle, Pennsylvania 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: No Exceptions March 28, 2003 Decedent 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: unestimated WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) thereon. Mary E. Barrick 750 Pine Road Carlisle PA 17013 OATH OF PERSONAL REPRSENTATIVE COMMONWEATLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true 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 the estate according to law. Sworn to or affirmed and subscribed before me this q'J:tl day of April, 2003 {J-t // --- I Re~ster Estate of Donald E. Barrick , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~)~/O~_~r~, ~03 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated_ May 24, 1976 described therein be admitted to probate and filed of record as the last will of Donald E. Barrick and Letters Testamentary are hereby granted to Mary E. Barrick FEES Probate, Letters, Etc. Short Certificates~ ) .3Cf~ Total ~Register of ' ' Wi,ls ~' () Robert M. Frey 06274 ATTORNEY (Sup. Ct. I.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly fiied with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 /.,~ ~/ Local Registrar P 919 0 7 2 3 ~,,~'~;,':' APR 1 2003 No. ~ Date INK COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '- Donald E. Barrick I" a~e 13. 201 -- 18 -- 9478 4. March 28, 2003 · I i I : J- 1916 ] Newville, PA N~,: I~ R.~ ~F~ e. I ' I ; I,. /7. I~,. ~rland Carlisle Poresb Par]; ftealth Center ,~ v..[],,,~.~e~,.. (~ ..._ M,~ ~,~R~,.,,,. wn~.ce DECE DENT'S USUAL OCCUPATION ! KINO OF I Caretaker ,,s. Envir. Re~ourse 750 Pine Road Carlisle PA 17013 m ,,. Harvey A. Barrick IDATE OF DISPOSITION - [],,~.April 1, 2003 ,e. Mabel Bowers ~. 750 Pine Road, Carlisle PA 17013 ,~t. Holly Springs Cem. ,.~. Holly Springs, PA LICE N~E NUMBER 22b. ~]~]~.--~. INAMEANOAD~E~OFK%C~J~ Hoffman Roth Funeral i - MANNER OF OEATH the testat \. ,x~.s~gn the same and that ~ % ~ me this _ \ _ da~of \ 'X 7~ ~""W.~. ~ (Name) Register (Name) (Address) REGISTER' OF WILLS OF COMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Robert M. Frey and Laresa Ann Snyder (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Donald E. Barrick testat...or of (one of the subscribing witnesses to) the will presented herewith and believes the signature on the will is in the handwriting of that they Donald E. Barrick to the best of our knowledge and belief. Sworn to or affirmed and subscribed before me this .. ~ ~Vh day of Aoril. 2003 l~Xxxx Robert M. Frey (Name) fi~South Hn3vnv Street. Carlisle ~'~ . . PA 17013 (Name) 203 Cold Springs Road, Carlisle PA 17013 (Address) l_. A S T W 11. t, .-\ N 1 ~ T F: ,q T A h I E N '7I' () F D('~NAI,1) }q. I~ARRICK I, DOX.:\[.I) E. I]ARRI('K, ,'fi' l.)i('kins;otu T()wnship, (KinR"s (;al), IL. D. //5, t]ox 340), Cumberland (',.,unt>, Pennsylvania, bein~ of sound and disposin~ mind, ~-nemory, and ~n¢terst;,ndin~, do hereby make, publish, and declare this as and fnr my last Will and Testament, hereby revoking and makin~ void any nnd all Wills l)v the ~t any time h-retofore made. 1. I direct my hereinafter !mm~d Exec,,trix t(, pay all ,)f my just debts and fune~ral expenses as semn ;fitter my death as may be found convenient to do so. 2. and mixed, All the rest, residue, and rprnainder of my estate, real, personal, and wheresoever th,.:~ sa~'~e may be situate, ', ;,ire, devise, and bequeath to m,y wife, Mary E. t]arrick, her heirs and assigns, to the exelusio~ of rny children born and u.nborn, provided my said wif't, qhall survive me by a period of ninety (90) days. 3. Should my said wife, Mary E. Barriek, predecease me or fail to survive me bs; the aforesaid perio~.] of ninety (90) day.q, then in such event all the rest, resid~e, and remainder of my estate real, pe~t'sonal, and mixed and wheresoever the same may be situate, I give, devise and bequeath as follows: a) one-half (1/2) to my daughter, Mary Ann Weidner, but should she predecease me then to her is~u- per :-;,Ir[' ' ~es. b) the other (me-hal? (1 .~2~ in equal shape, s to my grandchildren, the shape of any de-ceased ~ranc]ehild to pass t~ his or her issue per stirpes and if there be n¢~ issue then said share shall lapse and be added to the remain- ing shares. At the present time I have th¢~ followin~ two (2) grandchildren: Lisa Ann Weidner and Laresa Ann W-idner. tion from my estate-, ]n ,-.t~etn ~-,v,-~:' I ~,>mi~,ate, constitut~t, [~nd appoint Farmers Tr~t~t ('cm~p:.my and its ~(',',~s~{~rs, 1 West }ti~h Street, Carlisle, P~nnsvlvan/a, :~s Guard/an direct it to receive and invest t}~-. s:~t:~- and pay the income ar'[sin~ th~refrom person (~btaJnin~ 21 y,~:~rs ~;' affe irt, p:y to h~m (~r hot ~}-~ then remainin~ principal to~ether with any 4. I hereby nominate, constitute, and app~fint my wi~e, Mary E. Barrick, as Lx~{,utrix o[ this my l:~sl Will and 'Fe~tament but should she predecease m~ or fail to qua]if5', tln{~ I nominate, constitute, and appoint my daughter, Mary Ann Weidner, as Executrix, but shr~uld ~he predecease me then I nominate, constitute, and appoint my ~randdaughters, Lisa A~ Weidnez and l.aresa Ann Weidner, or either of them as Co-t']xecutrices, and I ~upther direct that mine of them shall be re, q~l/r{.d to l~{)st rmv bound to secure the faithf,1 performance of hot duties in the C{~mmonwealth of Pennsylvania or in afl5r other jurisdiction. IN WITNESS WI-rEFIEOF, my last Will and T~stament, May, I 976. I have here,~ntc~ so~ my hand and seal to this consistin~ cfi two i~a~es, this -2~/~ day of Donald E. Rnrrict,: Si~ned, sealed, published, arm dee]ar,--d by I)()N\I,D E. BARIiICK, the Testator above named, as and [or his last: \rill :~nd T,~tament, in our presence, who, in his presence, at ~,5.~ request, anti in th~-. presence of each other, have hereunto subscribed ot~r names [ts att,-sti~tf4 witnesses. From : RODNEY WE I I)NER PHONE No. : 717 486 5593 Apt. t7 2003 12:SBPM I'agc I of I PO! Mar~ Ann We!drier From: To: ~ent: Subject: <Snvd3~aol.com> <r.m.welaner~lp~.net> VVedne~day, April 'H~, 2003 6:O6 PM r)nn.ld Banick 4/17/2003 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Donald E. Barrick Date of Death: March 28, 2003 Will No. Admin. No. 21-03-0315 To the Register: I certify that notice of (beneficial Interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: May 19, 2003 Name Address Mary E. Barrick Mary Ann Weidner Laresa Ann Weidner Lisa Ann Weidner 750 Pine Road, Carlisle, Pennsylvania 17013 4050 Carlisle Road, Gardners, Pennsylvania 17324 203 Cold Springs Road, Carlisle, Pennsylvania 17013 5 Ballpark Road, Gardners, Pennsylvania 17324 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: May 19, 2003 i~.'. :~'~'~r .~ ~ .'.:i'Name: . , .: o,, Address: ,. ~. cc ~ ~ ~ Capacity: Signature Robert M. Frey 5 South Hanover Street Carlisle, Pennsylvania 17013 Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA D~PARTMENT 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 003563 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 201-18-9478 FILE NUMBER: 2103-031 5 DECEDENT NAME: BARRICK DONALD E DATE OF PAYMENT: 02/17/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 03/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,262.00 REMARKS' TOTAL AMOUNT PAID: $2,262.00 SEAL CHECK//178 INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PSNNSYLVANIA ~EPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 KI::V-I OU INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21-03-00315 ;OUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~- Donald E Barrick z 201-18-9478 LU DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR) r'~ TI.IS RETURN MU~T BE FILED IN DUPUCATE WITH THE I.U ,,,~ 3/28/2003 9/14/1916 REGISTER OF WILLS ¢3 IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-. Z UJ Z o iii o Z I~1. Odginal Return L._J 2. Supplemental Return Z 0 X I-- J'---'] 3. Remainder Return (date of death pi'tot to 12-13-82) [~4. Limited Estate F-~6, Decedent Died Testate (Attach copy of Will) E~9. LitigafJon Proceeds Received NAME Robert M. Frey FIRM NAME (ff Applicable) Frey & Tiley TELEPHONE NUMBER (717)243-5838 J'--'J4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required r--'j 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes J----Il0. spousal Povn~ Credit (date of death between 12-31-91 and I-1-95} ~11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS South Hanover Street Carlisle, Pennsylvania 17013 1. Real Estate (Schedule A) (1) NONE 2. Stocks and Bonds (Schedule B) (2) NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE 4. Mortgages & Notes Receivable (Schedule D) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 100,30~ 6. Jointly Owned Property (Schedule F) J"'~Separate Billing Requested (6) 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property (Schedule G or L) (7) 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) 110) 11. TOTAL DEDUCTIONS (total Lines 9 & 10) 394,64~ 49,979 (8) 544,933 1,019 1,060 (11) 2,079 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) (12) 542,854 (13) 0 (14) 542,854 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 .0 (15) 0 16. Amount of Line 14 taxable at lineal rate 49,979 x .0 45 (16) 2,249 17. Amount of Line 14 taxable at sibling rate x .12 ( 1 7) 0 18. Amount of Line 14 taxable at collateral rate x . 15 (18) 0 19. Tax Due (19) 2,249 .......................... ' ................ '"'"'" ............................. "'""'"'"':< ......... : .......... :':':'~:' '~' '~':'.'":'. ............. :'"" '.'.'.'.'::::: ........... : ........ .'.::-..::.- - ..::..'.~::~::. :~:~:x::::::. :-!:~:~:~:~:~:! :~:~:~:~: i:;:;:;9;:;:i:i:!:i:i:i:i:i:i:!:;:~:~:~:i :!:!:;9i:i~:!~;;~i! Decedent's Complete Address: STREF.T/-,DDRF, SS e Road ISTATE ZIP PA 1701 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 2,249 3. Interest/Penalty if applicable D. Interest 13 E. Penalty Total Interest/Penalty ( D + E ) (3) 13 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 2,262 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2,262 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; ....................... r'~ r~ b. retain the right to designate who shall use the property transferred or its income; ........... J-~ [~ c. retain a reversionary interest; or .............................. E~ r~ d. receive the promise for life of either payments, benefits or care? .................. E~] r~J 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ............................ E~ [] 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? ............................... ~] E~] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE ff AS PART OF THE RETURN. Under penalties of perjury, I declara that I have examined this return including accompany ng schedules and statements, and to the best of my knowledge and belief, it is true and complete. Declaration of prep~er othj,' than the pemonal represent~ive is based on all informat on of which preparer has an}/knowled~le. SIGNATURE OF PERSON R.ESP(~/SISLE FOR FILING RE"DORN J /3 _ DATE ! ADDRESS 750 Pine Road, Carlisle, Pennsylvania 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 5 South Hanover Street, Carlisle, Pennsylvania 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. Section 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. Section 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 ara 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 yearn 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. Section 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decadent's lineal benoficianes is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Section 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decadent's siblings is 12% [72 P.S. Section 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. REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-03-0315 Include the proceeds of litigation and the date the proceeds were received by the estate. ALL PROPERTY JOINTLY-OWNED WiTH THE RIGHT OF SUR~VORSHIP MUST BE DISCLOSED ON SCHEDULE F. ITEM NUMBER DESCRIPTION Members 1 st, C/D #128516-42 VALUE AT DATE OF DEATH 100,308 TOTAL (Also enter on line 5, (If more space is needed, insert additional sheets of the same size) 100,308 Members/ FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT' Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created CERTIFICATE OF DEPOSIT' Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 128516 -00 09/02/1992 $44/97 $.oo $44.97 Mary E. Bardck 09/02/1992 128516 .-..42 08/13/1999 $100,000.00 $308.47 $100,308.47 None 30 MO M~BE, RS lS,~,~/~ CREDIT UNION Denise A. Ander'~''~ ~ Insurance Supervisor May 13, 2003 Estate of: DONALD E. BARRICK Date of Death: 03~28~2003 Social Security Number: 201-18-9478 217 ' ' REV-1509 EX+ (6-98) COMMONWEAL'iH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER Donald E Barrick 21-03-00315 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 A. Mary E. Barrick ADDRESS 750 Pine Road Carlisle, Pennsylvania 17013 RELATIONSHIP TO DECEDENT Spouse JOINTLY-OWNED PROPERTY: L~-~ YER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR $1MI!.~R DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD RE~/. ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 9.02.92 Members 1st, Savings Acct #128516-00 45 50.00% 23 2. A. 12.29.97 F&M Trust, C/D #016-2954376 20,013 50.00% 10,007 3. A. 10.4.99 M&T Bank, C/D #31003910445864 50,011' 50.00% 25,006 4. A. '10.29.99 M&T Bank, CID #31003910513835 100,061 50.00% 50,031 5. A. 9.1.67 M&T Bank, Checking Acct #401862 1,338 50.00% 669 6. A. 1.6.83 M&T Bank, Savings Acct #15004200598752 40,293 50.00% 20,147 7. A. 2.7.89 Waypoint Bank, C/D#1730136965 20,022 50.00% 10,011 8. A. 12.20.00 Waypoint Bank, C/D #7100006041 100,340 50.00% 50,170 9. A. 8.10.00 Waypoint Bank, Checking Acct #20088052 27,467 50.00% 13,734 10. A. 3.20.95 Waypoint Bank, C/D#8000013217 50,016 50.00% 25,008 11. A. 8.10.00 Waypoint Bank, C/D #4~000059772 50,075 50.00% 25,038 12. A. M&T Bank, (Formerly Allfirst Bank) Certificate of Deposit 20,000 50.00% 10,000 13. A. Real Estate, 750 Pine Road, Dickinson Twp.,Cumberland Cty, 78,940 50.00% 39,470 14. A. 1.16.01 Orrstown Bank, C/D #5060066126 50,055 50.00% 25,028 15. A. Western-Southern Life, Annuity Contract #W0020128331 121,552 50.00% 60,776 16. A. Western-Southern Live, Annuity Contract #W0020570415 58,555 50.00% 29,278 17. A. 1980 Mercury Automobile 500 50.00% 250 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 6, Recapitulation) $ 394,646 (If more space ~s needed, insert additional sheets of the same size) DEC 23 2003 IO:01RM CALL CENTER 717 530 2624 p.l TO: Frey & Tiley Attorneys al Law 5 South Hanove~ Street Carlisle, PA 17013 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Donald E Barrick DECEASED DATE OF DEATH: March 28, 2003 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) .~HECKING ACCOUNTS DATE OF DEATH ACCOUNT NO. TITLE OF AccOUNT ~ ~ & ACCRUED INTERF_-_~T SAVINGS ACCOUNT C~. TITLE OF ACCOUNT DATE OF DEATH PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT ~,~_.b~. TITLE OF ACCOUNT 5060066126 Donald E Barrlck Mary E Barrick 1/16/01 DATE OF DEATH ~ & ACCRUED INTEREST 50,019.32 35.49 Date: 12/23/03 By: Timothea Customer Service Operator P.O. BOX 250 · SHIPPENSBURG, PA 17257 * TEL. (717) 532-6114 wag LOOK FOR Ut:;. WE?LL GET YOU THERE). 9/15/2003 FREY & TILEY 5 S HANOVER ST CARLISLE PA 17013 The information which you requested on the account(s) of DONALD BARRICK (Social Security Number 201-18-9478) is/are as follows: Account Number 1730136965 20088052 7100006041 8000013217 8000059772 Class of Account CERTIFICATE CHECKING CERTIFICATE CERTIFICATE CERTIFICATE Date Opened 020789 081000 122200 032095 081000 Principal Balance 20000.00 27464.35 100000.00 50000.00 50000.00 Accrued Interest 22.04 2.55 340.27 15.72 75.00 Balance at Date of 20022.04 27466.90 100340.27 50015.72 50075.00 Death Account Ownership JTO JTO JTO JTO JTO Name of Joint MARY MARY MARY MARY E MARY E Owner, if any BARRICK BARRICK BARRICK BARRICK BARRICK Date Ownership 020789 081000 122200 032095 081000 Was E~tablished Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested ERIN V~ATT S SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG, PENNSYLVANIA 1710~;-1711 Toll Fr~ 1-866-WAYPOINT (I-B66-929-7646) · IN YORK ARg_A 717/BIS-4S00 · www, wagpointbank.corn September 15, 2003 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, PA 17013 499 Mitchell Street, Millsboro, DE 19966 Estate of Donald E. Barrlck Date of Death: April 7, 2003 Social Security Number: 201-18-9478 Dear Mr. Frey: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Certificate of Deposit Account Number. ................. i .... 31003910445864 Ownership (Names oj) ..............Donald E. Barrick, Mary E. Barrick Opening Date ........................... 10/04/99 Balance on Date of Death. .........$50,000.00 Accrued Interest $ 10.77 Total. ...................................... $50,010.77 Account Type. .......................... Certificate of Deposit Account Number. ...................... 31003910513835 Ownership (Names oj') .............. Donald E. Barrick, Mary E. Barrick Opening Date ........................... 10/29/99 Balance on Date of Deatlt .........$100,000.00 Accrued Interest $ 60.92 Total ...................................... $100,060.92 · page 2 September 15, 2003 o Account Type ........................... Checking Account Account Number. ...................... 401862 Ownership (Names qf) .............. Donald E. Barrick, Mary E. Barrick Opening Date ........................... 09/01/67 Balance on Date of Death. ......... $1,338.06 Accrued Interest $ 0.00 Total. ...................................... $1,338.06 Account Type ........................... Savings Account Account Number. ...................... 15004200598752 Ownership (Names oj') .............. Donald E. Barrick, Mary E. Barrick Opening Date ........................... 01/06/83 Balance on Date of Deatlt ......... $40,288.80 Accrued Interest $ 4.10 Total ...................................... $40,292.90 Sincerely, Charlene Warrington, Associate I (302) 934-2722 JAN-14-ZO04 ll:OOAM FRO~-U & T BANK +7172404515 Western-Soulhern Life· P.003/003 November lg, 2003 M & T SECURITIES C/O SHAWNEE SMITH 1 WEST HIGH b'l' CARLISLE PA 17013 Subject: Annuity Contract Numl~0~2057041S-Donald Bardck Dear Shavmee Smith: Please express out sympathy for the death of Donald Bartick ~ his family. hope the following informalion is helpful. May E. Barrick is the Joint Owner end she has the following options: Lump sum death benefit · The death benefil may be paid out as an annuity or an annuity over a period not Io~gef than the life expectancy of the beneficiary, with payments beginning lan/December 31 of the year following the year of the death of the OwnerlAnnuif~lnt. · The contract value may be paid by December 31 of the fifth year following the year of the death of the Owner/Annuitant- , The contract may be continued in the surviving spouse's name as Annuitant/Owner. The value as of March 28, 2003 was approximately $58,555.48. Please have Mary Banick complete the enclosed annuity service request form where indicated. Please return the form with a ce~tfied copy of Donald Baniclc's death When we receive this information, we will give our prompt attention to this claim. If you have questions, please contact the sales representative or our Annuity Operations Department et 1-800.926-1702. A representative will be happy to assist you. Sincerely. Jennifer Sturdivant Annuity Administrator Annuity Operations Department Annuity Operalions Group - P.O. Box 2918 · Cincinnati. OH ,, 45201-2918 JAN-I4-ZO04 II:OOAM FROMM & T BANK WeslerrrSoulhern Ufa' November 19, 2003 M & T SECURITII;$ C/O SHAWNEE SMITH I WEST HIGH ST CARLISLE PA 17013 Subject: Annuity Contract Numi~0128331-DoAelcl Barrick Dear Shawnee Smith: Please express our sympathy for th~ death of Oonalcl Bamck to his family. I hope the following information is helpful. Mary E. Bartick is the Joint Owner and she has the following optk~ns: · Lump sum death benefit · The cleath benefit may be paid out as an annuity or an annuity over a period not longer than the life expectancy o1' the beneficiary, With payments beginning by December 31 of the yearfoltowing the yaa~ of the death of the Owner/Annuitant. The contract value may be paid by December 31 of the fifth year following the year of the ¢leath of the Owner/Annuitant. The contract may be continued in the surviving spouse's name as Annuitant/Owner. The value as of March 28, 2003 was api~oximately $121,551.~4. Please have Mary Barrick complete the enclosed annuity service request form where indicated, Please tatum the farm with a r,e~fied copy of Donald Barrick's death cal~if~.~ tO US. When we receive this infermallon, we wilt give our prompt atter~ion to this claim. If you have questions, please contact the sales representative or our Annuity Operations Oepartment at 1-800-926-1702. A re~'eeenfative will be happy to assist you. Sincerely, Jennifer Sturdivant Annu~y Administrator Annuity Operations Department Annuily Opmalbns Group · P,O. Box 2918 · Cim~iflnati. OH · 45201-~g18 ACCOUNT INFORMATION RE: DONALD E. BARRICK DATE OF DEATH 4-7-2003 CHECKING SAFE DEPOSIT SAVINGS X CERTIFICATE OF DEPOSIT __.SHARES OF STOCK DATE OPENED ACCOUNT NUMBER 016-2954376 ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST $13.42 TOTAL ACCOUNT BALANCE NAME(S) ON ACCOUNT REGISTRATION OF ACCOUNT 12-29-1997 DATE CLOSED STILL OPEN $20,000.00 $20,013.42 DONALD E. BARRICK & MARY E. BARRICK JOINT WITH SURVIVORSHIP ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS CERTIFICATE OF DEPOSIT __SHARE~ OF STOCK DATE OPENED DATE CLOSED ACCOUNT NUMBER ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST TOTAL ACCOUNT BALANCE NAME(S) ON ACCOUNT REGISTRATION OF ACCOUNT Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created CERTIFICATE OF DEPOSIT: Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 128516 -00 09/02/1992 $44/97 $.oo $44.97 Mary E. Barrick 09/02/1992 128516 -42 08/13/1999 $100,000.00 $3O8.47 $1 OO,3O8.47 None 30 MO Denise~ Insurance Supervisor May 13, 2003 Estate of: DONALD E. BARRICK Date of Death: 03~28~2003 Social Security Number: 201-18-9478 217 REV-1510 E.~+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER Donald E Barrick This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-150( COVER SHEET is ~es. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER mANSPE,. ATTACH A COPY OF THE DEED FOR RE.N. ESTATE. VALUE OF ASSET INTEREST (,F,,~uc~) VALUE 1. AIG Annuity Insurance Company, Contract/Policy #RJ243150 49,979 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 Recapitulation) $ 49,979 (If more space ~s needed, insert additional sheets of the same size) AIG Annuity INSURANCE COMPANY July 1, 2003 Robert Frey, Esquire 5 South Hanover Street Carlisle, PA 17013 AIG Annuity Insurance Company Donald E. Barrick, Deceased Contract/Policy #FJ243150 Dear Mr. Frey: The Internal Revenue Service requires reporting of all death benefits for federal estate tax purposes. Form 712 is prepared for regular life insurance contracts only. Since this contract was an annuity, the Form 712 is not applicable. Listed below is the death benefit information for the above-referenced annuity contact. Type of Annuity Contract: Date of Issue: Contract Owner's Name(s): Original Investment: Cost Basis Cash Value as of Date of Death on 5/01/03: Total Payment for Death Benefit on 5/27/03: Proceeds made payable to: Non-Qualified Tax Deferred Annuity (Single Premium) 12/23/2002 Donald Barrick $50,000.00 $50,000.00 $49,979.37 $50,393.66 Laresa Snyder If you have any questions or require further assistance, please contact our Customer Care Representatives, available Monday through Friday, 8:00 AM to 6:00 PM Central Time, at (800) 424-4990 ext. 3111. We appreciate this opportunity to serve you. Sincerely, Camilla Craine, Annuity Claims Clerk AIG Annuity Insurance Company Annuity Administration P.O. Box 871 · Amarillo, TX 79105-0871 · 800.424.4990 217 REV-1511 EX~+ (12-99) = COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Donald E Barrick 21-03-0315 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT 5. 6. 7. 8. C, OSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Zip Attorney Fees Family Exemp§on: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees Trust, Research Fee for Date of Death Value of Certificate of Deposit Register of Wills, Filing Fee for PA Inheritance Tax Return 75O 254 5 10 TOTAL (Also enter on line 9, (If more space is needed, insert additional sheets of the same size) $ 1,019 REV-15'~2 EX+ (6-98) AT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Donald E Barrick SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-03-0315 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Carlisle Digestive Disease Associates Carlisle Regional MEdical Center Continuing Care RX VALUE AT DATE OF DEATH 100 840 120 TOTAL (Also enter on line 10, Reca (If more space is needed, insert additional sheets of the same size) 1,060 217 ~ '~ REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donal( E Barrick 21-03-0315 NUMBER II. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Mary E. Barrick 750 Pine Road Carlisle PA 17013 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse AMOUNT OR SHARE OF ESTATE 100% of residue of estab ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18~ AS APPROPRIATE~ ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - 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) LAST WI[.L. AND TESTAMENT OF D¢~NAI,D E. BARRICK I, DONAE. D E. BARRICK, nf I)ickinson Town.~hip, (King's Gap, R. D. ~5, Box 340), Cumber]and (-'oun .fy, Penn~-lvania, being o~ sound and disposing mind, memory, and ,n(lersianding, do hereby make. publish, and declare this as and fro' my]asr Will and Testament, hereby revoking and making void any and ;~1] Wills by me at any time h~retofore made. 1. I direct my her~-in~ter named Executrix to pay ~] of my just debts ~d fund, raj ~xpenses as sonn after my death as may he found convenient to do so.. 2. All the r~st. residue, and r~mainder of my estate, real, personal. and mixed, and wheresoever the ~:am+· may h~ situate, ' ~{ive. de~se, and bequeath to my wife, Mary E. l~arrick, her heirs and assigns, to the exclusio~ o~ my children bnrn ~d u~bnrn, provided my said wife, ~hal] survive me by a ~eriod of ninety (90) d~ys. 3. Shnuld my said wife. Mary E. Barrick, predecease me or fail sur~'i~'e ~e by the ~or~'said pe~'iod o[' ninety (90) days, th~n in such event all the r~st, resid.~e, and remainder ~ff n;y estate, real, personal, and mixed and wheresn~ver th~ same may be ~itunte, I giv,% devis~ and h~queath as a) nne-half (1/2)to my daughter. Mnr¥ Ann W~,idner, but ~hr~uld sh~ predecease me then to bet is~m. p,.'r :;tir'pes. b) the oth~-,r ~,ne-ha]r il 12) ~n ~,.lual :~h~.,,,.s h~ my grandchildren, the shara or any deceased grandchihl ~.~ pass to his ,w h,:~' is~u~ per and ir ther~ I'.: nc~ issue then said ~har, shah l~ps~ r, nd b,-, ndd,d to. tl~ remainJ lng shares. At the presen~time I have the roll,)winging,-, ,2) grandchild~'~.n: Lisa Ann Weidner and LaresaAnn W~idner. B. SIl,~uld any person ]p.~ than 21 y,~ars or ;.,lip b,., entitled tn distribu- tion from nly ~stat.,-, in ~uch evl-.nt [ n,m~inat~, c,'mstitut~, and appoint Farmers Trust Campany and its st-'c,:.sso~-s, 1 West l{i~h Street, Carlisle, Pe~svlvania, as Guardian or th~ Estate of each such i)~rson and authol-ize andJ direct it to receive and invest l.h,~ ~nm(~ and j)~ty the incom~ a~'isin~ therefrom to~ether with so mu~:h ~,f tl~e princil.{al th(~reof as in its opinion i~ nPci~ssary (,l'j d~sirab]e to he exp(-.nde~l for the pre,per maintenance; support, and education of such person, tothe person having custody or suel~ p~rson, mhd upon such person bbtainin~ 21 years o1' age lo pay to him nr her the then romaining principal to~eth~r with any undist~-ilmt,-.d incnme. 4. I I~ereby nominate, constitute, 'and aPp,,int my wi~e, Mary E. Barrick. as Ex~cut~-ix (~f this my last Will and Testament but should she ~redeceane m,~ or fail to qu~iry, then I nominate, constitute, and appoint my daughter, Marl' Ann Weld,er, a~ Executrix, but sh,,uld she predecease me then [ nominate, cnns'titute, and appoint my granddaughters, l~isa.~nn Weidne~ and La~esa ;~nn Weidner, ,~r oil. her of them as Ca-Executrices, and I further direct that nan~ of thrum shall be r,~,quired to post n. ny b,,nd to secure the faithful performance o6 her duties in th~ ("omnmnwealth of Pennsylvania or in any other jtu-isdiction. IN WITNESS WHER. EOP', ] Imv,. b~?reuntn set my hand ~d se~ to this my last Will and T~stament, crmsistinE nc two pn~,..~, this ~-~day or May, la~6. (SEA Donnld E. ~la~-rick ~J~n~d, .~ealecl, pul)lis}~ed, itlld declar',~d by I)( )N.~I,D E. ltAIili[CK, the Testator' ab(,ve llamed, as and for bi~ last Will :,nd 'F~sl:~m~,nt, i~l ~resence, who, in his presence, at l:is 1-,-~queat, aa, I ill t[]~. presence, ,,r ~ach other, h'av, I,-.t'euntn subscribed rmr names as att,.-~t'in~ witn~,ss~s. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZB0601 HARRISBURG, PA 171Z8-060! COHNONt/EALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-154? EX AFP C01-05) ~ ..... ~' DATE O~-1Z-Z004 ~ ~ ESTATE OF BARRICK DATE OF DEATH 05-28-2003 FILE NUHBER 21 03-0315 '04 APR ]4 ~? :/i~ COUNTY CUHBERLAND ROBERT H FREY ACN 101 FREY & TILEY 5 S HANOVER ST LJti I Amoun~ Remi~ad I CARLISLE PA ~O~);~ ~ DONALD E HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF UILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOt/ER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRATSEHENT, ALLOt/ANCE OR DZSALLOt/ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BARRTCK DONALD E FILE NO. 21 03-0315 ACN 101 DATE 0~-12-200~ TAX RETURN WAS: (X) ACCEPTED AS FTLED ( } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S*ock/Par~nership In~eres~ (Schedule C) ($) ~. Nor~gegas/No~es Receivable (Schedule D) 5. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) (5) 6. Jointly O~ned Proper*y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To*el Asse~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H) (9) 10. Debts/Hot,gage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re*urn 00 oo O0 oo 100t308.00 $94~6~6.00 49z979.00 (8) 1,019.00 1~060.00 (11) (12) 15. 1~. NOTE: ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra*e 16. Amoun~ of Line lfi ~axabla a~ Lineal/Class A ra~e 17. A.oun~ of Line lq a~ Sibling re~e 18. Aaoun~ of Line 1~ ~axable a* Collateral/Class B ra*e 19. Principal Tax Due TAX CREDITS: PAYNENT RECEZPI' DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) 02-17-2004 CD003563 12.80- Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Ne~ Value of Estate Subjec~ ~o Tax (1fi) Zf an assess.ant Nas issued previously, 11nes 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. NOTE: To insure proper cradi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ax payment. 544,933.00 2.079.00 54Z,85~.00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .o0 542,854.00 18 and 19 will (1.6) 492,875. O0 X O0 = . O0 (16) R9,979.00 x 0~5 = 2,249.00 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 2,2~9. O0 AHOUNT PAID 2,262.00 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE Z,Z49.ZO .2OCR .00 .2OCR ( TF TOTAL DUE IS LESS THAN $1, NO PAYNENT 1~S RE;iUZRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR TNSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (ccllatarat) rata on any such future interest. To fulfill the requirements of Section 2160 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9160). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Mills, any of the 23 Revenue District Offices, or by calling the special 26-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers mith special hearing and / or speaking needs; 1-B00-667-3020 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object mithin sixty (60) days of receipt of this Notice by: --arittenprotest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual 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. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interas':* assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .000166. Al1 taxes which became delinquent on and after January l, 1982 will bear interest at a rate which ail1 vary from calendar year to calendar year with that rate announced by the PA Dapartaent of Revenue. The applicable interest rates for 1982 through 2006 are: Interest Daily Interest Daily Year Rata Factor Year Rata Factor 1'~ 20Z .000568 1988-1991 Ill .O0030X 1983 161 .0006,.38 1991 91 .000267 1986 117. .000301 1993-1996 77. .000192 1985 132 .000356 1995-1998 92 .000267 1986 107. .000276 1999 7Z .000191 1987 IOZ .000276 ZOO0 7Z .000192 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPA/D Interest Daily Year Rate Factor ~ 9Z .000267 ZOOZ 62 .000166 2003 SZ .000137 2006 6Z .000110 X NUMBER 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. Name of Decedent: Date of Death: Will No. STATUS REPORT UNDER RULE 6.12 DONALD E. BARRICK March 28, 2003 Admin. No. 21-03-0315 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (X) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Date: 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 (). (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 ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. June7~2004 Carlisle, Pa 17013 Address Signature Robert M. Frey Name (Please type or print) 5 South Hanover Street (717) 243-5838 Telephone No. Capacity: ( ) Personal Representative ( X ) Counsel for personal representative Name of Decedent: Date of Death: Will No. ¢/~ To the Register: OQ } - 0 q -- ~'~ J ~-~ Admin. No. 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 : Naroe Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. Date: Zt: td ZZ d3S Capacity: __ Signature Name ~D~ ~ L,,,~,~ k~ ~ Address Telephone( ) Personal Representative Counsel for personal representative BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVZS1rOH DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 ROBERT N FREY FREY & TILEY 5 S HANOVER ST CARLISLE PA 17015 COHNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF DETERHZNATZON AND ASSESSNENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN Amoun'l: Rem/~ed 07-26-2004 BARRICK 05-28-2005 Z1 0:5-0515 CUHBERLAND 201 REV-~83 EX iFP C01~03) DONALD E HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To /nsure proper credi~ ~:o your account, submi~ ~he upper por~:ion of ~:his form frith your ~ax paymen*. CUT ALONG THIS LTNE I1~ RETATN LONER PORTION FOR YOUR FILES ~ REV-483 EX AFP [01-03) #~ NOTTCE OF DETERN]:NATZON AND ASSESSNENT OF PENNSYLVAN]:A ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~ ESTATE OF BARRICK DONALD E FTLE NO.Z1 0:5-0:515 ACN 201 DATE 07-26-2004 ESTATE TAX DETERHTNATZON 1. Credit For S~cate Death Taxes as Veri~=ied .00 2. Pennsylvan/a Inheri'cance Tax Assessed (Excluding D/scount and/or In'ceres~c) Inher/tance Tax Assessed by O~cher Stances .00 or Terr/tor/es o~= the Un/ted States (Exclud/ng D/scount and/or Interest) Total Inher/~cance Tax Assessed 2z249.00 Pennsylvania Estate Tax Due .00 CREDITS: 5. TAX Zz249.00 PAYNENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) ANOUNT PAID ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT .00 BALANCE OF TAX DUEI .00 INTEREST AND PEN. I .00 TOTAL DUE J .00 (IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED ZF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) PURPOSE OF NDTICE: PAYMENT: To fulfill the requirements of Section 21qO (b) of the Inheritance and Estate Tax Act, Act Z2 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF #ILLS, AGENT. REFUND (CR): A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1312). Applications ere available at the Office of the Register of ~i118, any of the Z3 Revenue District OFfices or from the Department's Iff-hour answering service for forms ordering: 1-800-26Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-20Z0 (TT only). OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Oepartment of Revenue, Board of Appeals, Dept. ZSlOZl, Harrisburg, PA 171ZS-10Zl, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenuo~ Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. See page S of the booklet "'Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. OR PENALTY: INTEREST: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and 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. For dates of death on or after 10-2-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the axpiratlon of eighteen (18) months from the date of death. 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 or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Yea: Rate Factor Yaa.~_r Rate Factor Yea._._r Rate Factor 1982 20Z .OOOSq8 1988-1991 llZ .000301 ZOO1 9Z .000247 1982 X6Z .000q28 1992 9Z .000Z47 ZOOZ 6Z .000164 1984 llZ .000301 1993-1994 7Z .OOOlgZ ZOO3 5Z .000127 1985 12Z .000~56 1995-1998 92 .000247 2004 42 .000110 1986 lOX .000274 1999 7Z .O0019Z 1986 lOX .000Z74 ZOO0 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (la) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bm calculated. BUREAU OF INDIVIDUAL TAXES ZNHERXTANCE TAX DTVZSZON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 ROBERT N FREY FREY & TILEY 5 S HANOVER ST CARLISLE PA 17015 CONNONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-0Z-Z00q BARRICK 05-28-2005 21 05-0515 CUMBERLAND 20Z Amoun't RE¥-TS~ EX AFP (01-OZ) DONALD E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To ;-nsure proper credi~ ~o your eccoun~¢, submi~ ~he upper portion of ~chis form wi~h your ~ex payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV-736 EX AFP (01-02) ~ NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~ ESTATE OF BARRICK DONALD E FILE NO.Z1 05-0515 ACN 202 DATE 08-02-200q ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verif/ed .00 Z. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 2,2~9.00 .00 Inheritance Tax Assessed by Other States or Territories of the Un/ted States (Exclud&ng Discount and/or Interest) q. Total Inheritance Tax Assessed 2z2~9.00 5. Pennsylvan&a Estate Tax Due .00 .00 .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return 7. Additional Pennsylvania Estate Tax Due TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) ~IF PA~D AFTER THZS DATE~ SEE REVERSE SIDE FOR CALCULAT/ON OF ADDITIONAL INTEREST. AMOUNT TOTAL TAX CREDZT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 (TF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS RE{~UTRED TF TOTAL DUE TS REFLECTED AS A "CREDTT" {CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS.) PURPOSE OF NOTZCE: PAYNENT: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (7Z P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NXLLS, AGENT. REFUND (CA): OBJECTXONS: ADHXN- ZSTRATZVE CORRECTZONS: PENALTY: INTEREST: A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z~-hour answering service for forms ordering: 1-800-36Z-2050; services for taxpayers aith special hearing and/or speaking needs: 1-800-~7-30Z0 (TT only). Any party in interest not satisfied with the assessment of tax as shown on this notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSlOZl, Harrisburg, PA 171Z&-lOZ1, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court OR Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue, Bureau of [ndividual Taxes, ATTN: Post Assessment Review Unit~ Dept. 280601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. Sea page S of the booklet "instructions for Xnheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. The 15Z tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you ~ould appeal the tax and interest that has been assessed as indicated on this notice. Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase in Federal Estate Tax is received. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6g) percent par annum calculated at a daily rate of .00016¢. All taxes which became delinquent on or after January 1, 1982 ail1 bear interest at a rate ahich ail1 vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq ara: interest Daily Xnterest Daily Xnterest Daily Yea~ Rate ~actor Yea~ Rate Factor Yea~ Rate Factor 1982 20Z .0005~8 1988-1991 11Z .000301 2001 9Z .0002~7 1963 16Z .O00~3B 1992 92 .O00Zfi7 ZOO2 6Z .00016~ 198~ 11Z .000S01 1993-199q 7Z .00019Z ZO0~ 5Z .000137 1985 13X .000356 1995-199B 9Z .O00Zq7 ZOOq qZ .000110 1986 lOX .O00Z7q 1999 7Z .00019Z 1987 9Z .O00Zq7 ZOO0 8Z .000219 --Xnterast is calculated as follows: /NTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELTNQUENT X DALLY TNTEREST 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.