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HomeMy WebLinkAbout04-0027PETITION FOR PROBATE and GRANT OF LETTERS Estate of ELIZABE,~I~I W. HOPKINS No. also known as To: Deceased. Social Security No./~-~.~- .q~-~O' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of ag~ or ql~ler/all the.~y,.egg.tr i x in the last wilt of the above decedent, dated -apr ]._L lO, ZUUZ and codicil(s) dated Register of Wills for the County of Cumberland Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, With h er last family or principal residence at 3 2 5 we ~ 1 oy r~ r ~ ye: _a_?t. 3 3 2 9 Bethany V~llag~; Moc'han~c~b,_!rg, PA 17055 (list street, number and muncipality) Decendent, then 75 _ years of age, died December 14 , 2003., at Bethany Village, Mechanicsburg, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offe'red 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: $ 621,000.00 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.) theron. ~"7-1~&~Goldman 893 Emily Dr. Mechnn~n~hl~rg, 'PA 1 7055 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF J ' The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best 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 af~rmed and subscribed ~- K~.~td,~,/~--_~ f~,/./A~.Af~//~z/~~ /be, fore me this /~7-,z/ day of | ~" - ~' ~-~,,~_? ~ R~gister L ~ Estate Of No. ELIZABETH W HOPKINS · , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~_, ~ [ o ~2. described therein be admitted to probate and filed of record as the last will of and Letters IF-~ ~ ~menT~u are hereby granted to ~__-rr, i J(?-,oL~rr~ ~ r~ ~x~.~:~, in consideration of the petitionon FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... $. ~en~n~c auon ................ $ TOTAL , $ ~.~.~/o File~..~....~- ........... 218 F~ne S%. Fo uox ooo Harrisburg, PA 17101 717-232-18'~l:)l~ss 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. Fee for this certificate, $2.00 P 9811840 No. L al Registrar ~C 1 6 2003 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF OECEDENT (F*r si. MiOOle. kas~) STATE FILE NUM6ER SEX SOCIAL SECURITY NUMBER DATE OF DEATH t Mc, t'atl. Day. ~N~ OF ~H I C~. ~, ~P OF OEATH FACIL~ NAME (11 ~1 ,n~,~. g,~ ~r~ a~ ~, ~S ~C~0E~ ~ HIS~AN~ ORm N? I~E- ~ I~. ,,, Sales Supervisor ,,,. Retail Sales ,, ~.D ~ f~'~/~ ~ . ,~. 3 ,~. widowed 325 Wesley Drive Mechanicsburg, PA 17055 FATHER'S NAME (Fbi. M~e. La~ :.. Francis Howell Wallace INF~MANT'$N~E~y~pr~ 2~. Elizabeth Ann Goldman METH~ ~ ~S~O~ON [ D~vo~ce~ (Spece/) I ACTUAL :?..Sial. Pennsylvania md '=*~ Y--.~.--~,~ Lower Allen ,~. co.~ Cumberland ,,~.~ '' ,,. Elizabeth Regina Grabner ~. 893 Emily Drive, Mechanicsburg, PA 17055 ~1-,. December 17, 2003'~------]=,. ~t. Olivet Cemetery ~rv~ew/ ~-. PA 17070 ~S~H IL~ENSENUU~R NAME~OAOORE~FACIU~ Parthemore FH & CS Inc. ,,u. FD 013 340 L a~. P,O. Box 431, New Cumberland P~ 17070-0431  TiME OF INJURY INJURY AT WORK? ~SCFUBE NOV,/INJURY PERFORMED? AVAJ LADLE PRIOR ~ ~U~D /I~' ~ .... ~ ..... ~ ....~1 I I'" ~ .o~ ~. ~ No ~ y.. ~ ~ ~1~ ~ ~.~,.~,~ ~ 1~' I~- u. I~. I~. .... .,.,,o..,..,o.,...,..,. ....... ..,,..,.....,......, ..... ..u.,o,. ...... LAST WILL AND TESTAMENT OF ELLZABETH W. HOPKINS I, ELIZABETH W. HOPKINS, declare this to be my Last Will and Testament and hereby revoke all prior wills and codicils made by me. FIRST: My Executrix shall pay from the residue of my estate all my debts, funeral and administration expenses and all estate, inheritance, succession and transfer taxes imposed by the United States or any state, territory or possession which shall become payable by reason of my death. It shall not be necessary to file any claims therefor, nor to have them allowed by any court. SECOND: I give all tangible personal property which I own and insurance thereon, to my surviving children, to be divided among them as they may select in as nearly equal shares as is practical. If there is any disagreement as to distribution, I direct my Executrix to make such distribution. The decision of my Executrix shall be final and binding. I direct my Executrix to sell, or otherwise dispose of in her discretion, any such property not selected and to add the net proceeds from their sale to the residue of my estate. LAST WILL AND TESTAMENT OF ELIZABETH W. HOPKINS THIRD: I give and bequeath my American Funds Group Account #61252069 to my daughter, ELIZABETH ANN GOLDMAN, her heirs and assigns forever. FOURTH: I give and bequeath the sum of One Hundred Thousand ($100,000) Dollars to my daughter, CAROLYN $. GAROMONE, to hold IN TRUST, to pay expenses associated with the maintenance and upkeep of the real estate located at l~17 Lake Avenue, Au Gres, Michigan, title to which, upon my death, will vest in my surviving children. To this end, my daughter, CAROLYN S. GAROMON~, shall invest this trust fund and with the income and/or principal of this fund pay all reasonable expenses associated with the property, such expenses to include, but not be limited to, casualty insurance premiums, real estate taxes, and maintenance involved with the everyday wear and tear of the property. This trust shall be terminated, in whole or in part, at any time after the five-year anniversary of my death, upon a majority vote of the surviving property owners. It is my desire that the property owners continue this "common fund" for as long as the principal of the trust exists. Allthough it is 2 LAST WILL AND TESTAMENT OF ELIZABETH W. HOPKINS my strongest desire that the Michigan property remain vested mn lineal descendants of Henry J.P. Graebner, should my children ever sell the Michigan property to a third party, this trust shall terminate. Upon termination of this trust for whatever reason, the principal of the trust and any accumulated income shall be distributed to my then-living children in equal shares. FIFTH: I give and devise my interest in the real estate located at 1117 Lake Avenue, Au Gres, Michigan, to my surviving children, in equal shares, as joint tenants with right of survivorship. SIXTH: I give and devise the residue of my estate, real, personal and mixed, of whatever kind and nature, and wherever situate at the time of my death, including any property over which I now have or hereafter acquire a power of appointment, to my surviving children, per stirpes. SEVENTH: I nominate, constitute and appoint my daughter, ELIZABETH ANN GOLDMAN, Executrix of this my Last Will and Testament, to serve without bond or security, and to make LAST WILL AND TESTAMENT OF ELIZABETH W. HOPKINS distribution of my estate in cash or in kind, or partly in cash and partly in kind, and in such manner as she may determine. I authorize, empower and direct her to sell and convey, by good and sufficient deed, in fee simple estate, any and all of my real estate, at public or private sale, for such price or prices, upon such terms and conditions, as in her judgment is best for my estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds or other instruments necessary therefor, as effectively as I could do if I were personally present. In the event such person does not survive me, or refuses to act as Executrix, or does not complete the duties of Executrix, then I nominate, constitute and appoint my attorney, JOHN D. KILLIAN, as the alternate Executor, to serve without bond or security. My alternate Executor shall have all of the powers, privileges, duties and immunities granted to my Executrix as provided herein. LAST WILL AND TESTAMENT OF ELIZABETH W. HOPKINS IN WITNESS WHEREOF, I, ELIZABETH W. HOPKINS, the Testatrix, have to this my Last Will and Testament, set my hand and seal this 19th day of April, 2002. ~..~BETH W[-HOPK~'NS (SEAL) Signed, sealed, published and declared by the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and of each other. The preceding document consists of this and four (4) other consecutively numbered typewritten pages. residing at ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS.: COUNTY OF DAUPHIN : The Testatrix and the witnesses whose names are subscribed to the foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge and declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will in the presence of the witnesses, that she signed willingly or willingly directed another to sign for her, that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses, and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix Witness /~ ~ Sworn to, subscribed and acknowledged before me by the above named Testatrix and witnesses this ]9th day of April, 2002. · Notary Publi~ - '~ (SEAL) Notarial Seal Rhonda L. Lang, Notary Public Harrisburg, Dauphin County My Commission Expires Aug. 9, 2004 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: KILLIAN JOHN D 218 PINE STREET HARRISBURG, PA 17101 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003668 ........ fold ESTATE INFORMATION: SSN: 198-36-7030 FILE NUMBER: 2104-0027 DECEDENT NAME: HOPKINS ELIZABETH W DATE OF PAYMENT: 03/12/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 12/14/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $25,500.00 iREMARKS: .... SEAL CHECK//7241 09953 TOTAL AMOUNT PAID: $25,500.00 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS THOMAS W. SCOTT JANE GOWEN PENNY TERRENCE J. McGOWAN J. PAUL HELVY MICHAEL J. O'CONNOR HEATHER M. FAUST STEVEN K. BAINBRIDGE THE LAW FIRM OF KILLIAN & GEPHART, LLP 218 PINE STREET P. O. BOX 886 HARRISBURG, PENNSYLVANIA 17108-0886 TELEPHONE (717) 232-1851 FAX NO. (717) 238-0592 www. killiangephart.com Of Counsel: JOHN D. K1LLIAN SMITH B. GEPHART March 12, 2004 Register of Wills of Cumberland County Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Estate of ELIZABETH W. HOPKINS Date of Death: December 14, 2003 Will No.: 00027-2004 Dear Sir or Madam: Attached is a check in the amount of Twenty-five thousand Five hundred ($25,500.00) dollars as payment for Inheritance Tax in the above listed estate. Enclosure Very truly yours, Corinne Eggers W~ous~ Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) December 14, 2003 Will No. 00027-200zl Admin. No. 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 02/20/04 : Name Ad&ess Betty Goldman- 893 Emily Drive, Mechanicsburg, PA 17055 Carolyn Suzanne Garramone 34 Hollingshead Drive, Aurora, Ontario, CANADA L4G5K3 John Wallace Hopkins BWX Technologies, Inc., 2016 Mt. Athos Rd., Lynchburg, VA 24504-5447 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 04/20/04 Signature ~~ Name 3ohh D. Killi~n, Esquire Killian & Gephart Address 218 Pine Street Harrisburg, PA 17108 Telephone (717 232-1851 Capacity: ~ Personal Representative X Counsel for personal representative September 22, 2004 The Law Firm of Killian & Gephart LLP 218 Pine Street PO BOX 886 Harrisburg, PA 17108-0886 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 Telephone (717) 787-3930 FAX (717) 772-0412 Dear Sir/Madam: Re: Estate of El~:~eth V~. Hopki~s File Numbe~:2104-00r~7 : , This is in response to your request for an extension of time to file the Idher tanq~Tax Return for the above estate. ~ In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 03~22~05. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, ~auo~a Ma~e~, ~up~r Document Processib~ Inheritance Tax Division REV-1500 EX (6-00) J OFFICIAL USE ONLY ~~, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 - O~ ~D~l- COUNTY CODE YEAR NUWBER SOCIAL SECURITY NUMBER 198-36-7030 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I- Z W C w o w c DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Hopkins Elizabeth DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12/14/2003 5/21/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER w W l- x: ~U) o a:x: wo..o :J:~ Oo..m 0.. <C 00 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a LMng Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of death between 12-31-91aOO 1-1-95) D 11. Election to tax under Sec. 9113(A)(AttachSchO) THIS SECTION .MUSTBE COMPLETED. A1.L CORRESPONDENCE AND CONFlDENTtAL tAX INFORMAtION SHOI.ILDBE DIRECTED TO: !Z NAME COMPLETE MAILING ADDRESS w ~ John D. Killian, Esquire 218 Pine Street ~ FIRM NAME (If Applicable) IIJ ~ Killian & Gephart Harrisburg, PA 17101 0:: o TELEPHONE NUMBER (.) 717-232-1851 .. ....1 1. Real Estate (Schedule A) o 359,552 o o 258,605 o '>... ~ ,t 2. Stocks and Bonds (Schedule B) (1) (2) 'OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) z o i= ~ ::) l- ii: <C o w ~ 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Sched ule G or L) o 618,157 8. Total Gross Assets (total Lines 1-7) (8) 26,322 3 , 121 (11 ) (12) (13) (14) 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) 29,443 588,714 o 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) 588,714 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable atthe spousal tax z rate, or transfers under Sec. 9116 (aX1.2) o ~ 16. Amount of Line 14 taxable at lineal rate I- ;:) ~ 17. Amount of Line 14 taxable at sibling rate o o 18. Amount of Line 14 taxable at collateral rate x ~ 19. Tax Due 20. [!] o 588,714 o o x.O ~ (15) x.O ~ (16) o 26,492 o x.12 (17) x .15 (18) o 26,492 (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Complete Address: S1REET ADDRESS 325 Wesley Dr Cwnberland CI1Y I STA1E I ZIP Mechanicsburg PA 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 26,492 o 25,500 1,359 Total Credits (A + 8 + C) (2) 26,859 3. Interest/Penalty if applicable D. Interest E. Penalty o o Total Interest/Penalty (0 + E) (3) 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 367 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 A. Enter the interest on the tax due. (5A) 0 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 0 Make Check Pa able to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D []I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPlETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and befief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN alia kLL tJ ~#/J71t4U ADDRE~ 893 Emil Drive, echanicsburg, PA SIGNATURE OF PREPA ER TH AN E E 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 No OJ OJ OJ []] ~ ~ DATE /"'- ~ .?<'-,;2L{-OS 17055 ADDRESS Killian & Gep art 218 Pine St. J gb'fE (O~ Harrisburg, PA 17101 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 ofthe surviving spouse is 3% [72 P.S. 99916 (a) (1.1) (i)l. 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. 99116 (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 ofthe child is 0% [72 P.S. 99116(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. 9 9116(1.2) [72 P.S. 9 9116(a)(1)]. The tax rate imposed on the net value of transfers to or fur the use of the decedent's siblings is 12% (72 P.S. 9 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. 3W4646 1.000 REV.ASS EX + (1.921 '* SAFE DEp.OSIT BOX INVENTORY COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS a. (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) . NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED a. (;JJ0t~/l (STATE) (ZIP CODE) 17"J~ .J'- WAS A WILL IN THE BOX? DYES ~ b. Name and address of personal representative, if named in the will (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) c. Name and address of anorney, if any (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 'J-J.. C ...;.IJ,I c-.~ 0/- ea;As (I). ~r~, ) ~#efS ).\f.. Idkr (roM. US //~/~rtr.AS &lr~V'v .tor (.:/"t#f7tt) 7/). lef~1 (Jr}f1L~!-o1' Pf~Mt:'r/Q'1 c.44/"t RG. 1~:,Al C0"+,+~'+>/e t-<:>r FINlllJ H~f{ lIvo}/pce ).. 7, o-{5Lt,l?~ pa(JerS {orf,,;f{(j H Wb.//6 (c r:~~;: . . ~~(l.d--I~?lr ~ ~ o.f- ~ II Wd /(uc~ REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Elizabeth Hopkins All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRlPllON 1.2,000 Units ACM Income Fund Inc. 2 146.745 Shares American Funds #04 3 105.165 Shares ADlerican Funds #06 4 351. 874 Shares ADlerican funds #07 5 244.305 Shares ADlerican Funds #16 6 216.774 Shares ADlerican Funds #33 7 182.886 Shares American funds #35 8 300 Shares Annaly Mortgage Management 9 1,000 Units Blackrock Core Bd. Tr. 10 500 Units Blackrock Income Opportunity Trust Inc. VALUE AT DATE OF DEATH 16,940 4,132 1,754 8,329 7,163 6,263 4,764 5,319. 13,600 5,545 11 1,000 Shares Cholestech Corp 7,130 12 1,300 Shares Cholestech Corp/IRA 9,269 13 1,800 Shares Citigroup Inc. 85,590 14 200 Shares Citigroup Inc./IRA 9,510 Total from continuation pages 174,244 3W4696 1.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 359,552 Schedule B (Page 2) Bstate of: Elizabeth Hopkins Item No. Description Value at Date of Death 15 500 Shares Corts for Bellsouth 13,100 16 500 Shares Corts for Corning 12,700 17 500 Shares Dominion Cng. Cap. Tr. 13,535 18 1,028.647 Units Evergreen Managed Income Fd 18,979 19 400 Shares Hartford Capital III 10,688 20 200 Shares JP Morgan Chase/IRA 7,018 21 1,000 Par Managed Municipal Portfolio 11,280 22 400 Shares Proxymed Inc./lRA 6,804 23 500 Shares Public Storage Inc. SIR R 13,350 24 500 Shares Public Storage Inc. SIR S 13,295 25 300 Shares St. Paul Capital Tr. 7,992 26 1,527 Units Tri Continental Corp 24,279 27 800 Shares Verizon South PFD. 21,224 Total (Carry forward to main schedule) 174,244 )1AR 2 2 2DD; @ American Funds. American Funds Service Company Post Office Box 2280 Norfolk, Virginia 23501-2280 americanfunds.com JOHN D KILLIAN ESQ THE LAW FIRM OF KILLIAN & GEPHART 218 PINE ST PO BOX 886 HARRISBURG P A 17108-0000 March 17, 2004 Re: The Investment Company of America - A The Income Fund of America - A New Perspective Fund - A EuroPacific Growth Fund - A Capital World Growth and Income Fund - A SMALLCAP World Fund - A ELIZABETH W HOPKINS Dear Mr. Gephart: We recently received an inquiry regarding the balance of account #6125-2069-04/06/07/16/33/35. Because the date requested, December 14,2003, was a Sunday, we are quoting the balance as of December 12,2003, the preceding business day. The net asset value (NA V) was the same on that day. The table below reflects the share balance, per share NA V, and total value of the following account: Date Account Number Share Balance NA V Per Share Total Value 12/12/03 6125-2069-04 146.745 $28.16 $4,132.34 12/12/03 6125-2069-06 105.165 16.68 1,754.15 12/12/03 6125-2069-07 351.874 23.67 8,328.86 12/12/03 6125-2069-16 244.305 29.32 7,163.02 12/12/03 6125-2069-33 216.774 28.89 6,262.60 12/12/03 6125-2069-35 182.886 26.05 4,764.18 Mutual fund share prices vary with the fluctuations of financial market share prices. The prices of the funds are found in the financial pages of most metropolitan newspapers under American Funds in the Mutual Funds listings. If you have any questions, please call us at 1-800-421-0180. You can reach one of our service representatives between 8 a.m. and 8 p.m. Eastern time, Monday throu&h Friday. Cordially, American Funds Service Company The Capital Group Companies American Funds Capital Research and Management Capital International Capital Guardian Capital Bank and Trust SMITH BARNEY... cltlgroupJ Elizabeth Hopkins Account 724-21394-13-503 *Value on 12/12/03 Security Cash and Money Market Funds ACM Income Fund Inc. Annaly Mortgage Management Blackrock Income Opportunity Trust Blackrock Core Bd. Tr. Cholestech Corp. Citigroup Inc. Corts for Bellsouth 7.00% Corts for Coming 8.00% Dominion Cng. Cap. Tr. 7.80% Evergreen Managed Income F d. Hartford Capital III 7.45% Managed Municipal Portfolio Public Storage Inc. Dep. Shs. 7.875% Public Storage Inc. Dep. Shs. 8.00% St. Paul Capital Tr. 7 .6% Tri Continental Corp. Verizon South Pfd. 7.00% Total Account Value Quantity 17,152.64 2,000 300 500 1,000 1,000 1,800 500 500 500 1,028.647 400 1,000 500 500 300 1,527 800 Price 1.00 8.47 17.73 11.09 13.60 7.13 47.55 26.20 25.40 27.07 18.45 26.72 11.28 26.59 26.70 26.64 15.90 26.53 Value $17,152.64 $16,940.00 $5,319.00 $5,545.00 $13,600.00 $7,130.00 $85,590.00 $13,100.00 $12,700.00 $13,535.00 $18,978.54 $10,688.00 $11,280.00 $13,295.00 $13,350.00 $7,992.00 $24,279.30 $21.224.00 $311,698.48 'The il!formatiol/ herein has been obtained.from sources we believe to be reliable. but do not guarantee its accuracy or completeness. Citigroup Global Markets Inc. 11 North 3rd Street, 2nd Floor Harrisburg, PA 17101 Tel 717 7801700 Fax 717 233 2090 Toll-free 800 2371700 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF B1izabeth Hopkins FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All properlY Jolntlv-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATl-f 1 Bethany village Retirement Center Bntrance Pee 217,400 Return of apartment rent reserve. 2 General B1ectric Capital Assurance Company 277 Premium Refund from Long-Time Care Insurance 3 M&T Bank Checking 19,040 4 M&T Bank Savings 2,060 5 Peerless Insurance Co 279 Refund of Auto Insurance Premium 6 Smith Barney Citibank Bank Deposit Program 17,153 7 Smith Barney IRA Bank Deposit Program 2,396 3W46AD 1.000 TOTAL (Also enter on line 5 Recaoitulation\ 9; (If more space is needed. Insert additional sheets of the same size) 258,605 Estate of Elizabeth W. Hopkins Payout from Bethany Village Retirement Center ITo be release when monthly fee for Dee 2003 is paid. $217,400.00 $2,412.001 Ck will be sent to Elizabeth A. Goldman 1/30104 " FEB 1 3 2004 m1 M&EfBmllt IVIemor~li1L(itlln, To: 'ElltlD1Y B"ker Eu: II 7L7.237H6853 From: Nwl..:y Clagett Records tvhn:lgemcnt 888.,502-43"l(i Date: Febmary 10. 2004 Sl.lbject; I)a(.(.' of death v;tlues for the Est<'-tc of Elizabeth tv lh)phins As of 1:2/14/03 Per YOW' ingu,rv dated Jamnry- 30, 20C\4~ p,k..a;;;c be ;l&.r;~:ed that lt the time or d'_';tth" \,lw Above narl1eddcccdent had on dcpsit with 1:11;.$ b,lSlk dle following: L TWic if A cc(){.-tnl (X,,%{-i:',g A ,:u'i'ml A (,(ot1J1l Nym/:l;7' 440/21S08 Oanr:rship (Narnf.'S oj) Eliz,1.bcrh ):Vflo/lb'<~s "'I' I r ' (' , , Dr) A L ,zzr;,x;L;J 1.1 .J{)itlf?k:t.'1, r', ,1j ~:nifig Dale OS/2 S/64 fJalma: 0>;1 Dale // D}:d) ~"'J9,04C;27 ACCrtKri ji'llL'7r'?st J" c.oo Total tJ?;LMC~ 2/ I . d 9Cl2't..t:820Cl ~'.; I] !~' :,J E: : f3 U t. D LJ I q.;}::l '1 L.. Typc~/Accurll S,"nxn(~:) ~...I{~~n~fn! A C())l"nt .Num.lx'r () f 500420;;'5.5 566} Oij,'7(~.hlp I~""mn('s 0/) E!i~:al~:!h \~/ [,:~IPI{~I"?:; rli:;.a!.t'rh A G'l)lli"~'in) .1\).'1 q~Cj1m~ ntlle C8/10/79 Bd~?la: OJ! D.~irc 0/ Dmli} n,(5).67 AtClu!d fnl/,!lI:"s.! y Aj," U. j L~ '7' , ,Okll $2,059./'/3 3. T.Y.If).~' 0/ A (<:''Ol'Itil S~1)i:' DI/"'05ir Box B..c;': i'/uiTd cr/L(XJi/l0"1 D')OC}15./{-!/gh{tl',;t~' r~o'/.:: O""r.\c"'sJJip (/'kn/cs of) rli:J.iIJ)['lh If," rlr;p/ml" Op.-nmg Dille OS/13/0.! If I (~:ln be of fun!wr :issistano:-, rk:l~(: do not lwsit~ltc to c;tll me ;l'~ x8S-502-4Yi9. Th;mk you nnd h:lVe:1 great (byl ::71"t;?t1la~"~ 1,tmcy C:b.gcn Records M,\n.lgem,,~nt (888) 502-43.VI 2-d Sf: 1 C i;tf:6c:OE: 1 SLJ <~~J::::.f:\C 1"0 U1 q'~::1 SMITH BARNEY.... cltlgroupJ Elizabeth Hopkins Account 724-60497-17-503 *Va1ue on 12/12/2003 Security Cash and Money Market Funds Cho1estech Corp. Citigroup Inc. JP Morgan Chase Proxymed Inc. Total Account Value Quantitv 2,396.20 1,300 200 200 400 Price 1.00 7.13 47.55 35.09 17.01 OThe information herein has been obtainedfrom sources we believe to be reliable, but do not guarantee its accuracy or completeness. Value $2,396.20 $9,269.00 $9,510.00 $7,018.00 $6,804.00 $34,997.20 Citigroup Global Markets lnc. II North 3rd Street, 2nd Floor Harrisburg, PA 17101 Tel 717 7801700 Fax 7172332090 Toll-free 800 2371700 REV-1511 EX +(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT" DECEDENT ESTATE OF Elizabeth Hopkins SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAl EXPENSES: 1. Parthemore Funeral Home 8,850 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 9,264 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 641 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Area Xndependent Underwriters 376 2 Arenac County Probate Court 307 Total from continuation pages 6,883 TOTAL (Also enter on line 9, Recapitulation) $ 26,322 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Elizabeth Hopkins Item No. Description 3 Arenac County Register of Deeds Schedule H part 2 (Page 2) Amount 35 313 107 2 112 75 1,254 19 23 4,254 350 157 183 Total (Carry forward to main schedule) 4 Arenac County Treasurer 5 Arenac Independent 6 Carolyn Garamone 7 Consumers Energy 8 Cumberland Law Journal 9 Marion J. Dittenbir 10 Huron Community Bank AuGres MI 11 Killian & Gephart 12 Marcella Prueter, Treasurer 13 Point Lookout Improvement 14 Sentinel 15 Sims Township Water Dept. 6,883 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REnJRN RESIDENT DECEDENT ESTATE OF Blizabeth Hopkins SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Alert Physioians at Bethany Village VALUE AT DATE OF DEATH 308 2 Bethany Skilled Nursery 3 Capital Blue Cross 4 Consumers Energy 5 M&T Bank Cheoking 6 Gino Martin 7 Penn Credit Corp. 2,412 122 20 10 220 29 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,121 BUREAU OF INDIVIDUAL f:IJillf$:,nCi' nCC:r:~ nC INHERITANCE TAX DIVISION' ,,_,,'J' l__:J v l'lj,- '. PO BOX Z8D6Dl,....'~ r'! HARRISBURG PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05) r" fT',' ,-"..,-~,--; \ OF~ ., JOHN D K~~[ANESQ KILLIAN & GEPHART 218 PINE ST HBG I~T ';1' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-18-2005 HOPKINS 12-14-2003 21 04-0027 CUMBERLAND 101 ELIZABETH W ZG05ld.JG '2 Pl~ i: 04 A.aunt R...l tted PA 17101 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paynent. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS - --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF HOPKINS ELIZABETH W FILE NO.21 04-0027 ACN 101 DATE 07-18-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE MANED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-06-2005 PRINCIPAL TAX DUE: 26,492.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-12-2004 ~ CD003668 1,324.60 25,500.00 06-28-2005 REFUND .00 332.60- TOTAL TAX CREDIT 26,492.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION DF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORH FOR INSTRUCTIONS. J r\i-. ~J. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/01/2005 KILLIAN JOHN D 218 PINE STREET HARRISBURG, PA 17101 RE: Estate of HOPKINS ELIZABETH W File Number: 2004-00027 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/14/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~1j,~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent ELIZABETH W. HOPKINS Date of Death December 14. 2003 will No. 00027-2004 Admin. No . Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: April. 2006 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: NA c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: November 4. 2005 ohn D. Killian. Esquire Name (Please type or print) (\J ('<-.J Killian & Gephart 218 Pine Street Harrisburg. PA 17101 Address .. - t"-.... (717) 232-1851 Tel. No. Capacity: Personal Representative X Counsel for Personal Representative ~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent ELIZABETH W. HOPKINS Date of Death December 14. 2003 Will No. 00027-2004 Admin. No. Pursuant to Rule 6.12 ofthe 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 ofthe estate is complete: Yes]LNo_. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes NoX-. b. The separate Orphans' Court No. (if any) for the personal representative's account is: NA c. Did the personal representative state an account informally to the parties in interest? YeslNo_ 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~e attached to this n;~port. . \ Date: July 27.2006 .m;~ John D. Killian. Esquire Name (Please type or print) ~'() Killian & Gephart 218 Pine Street Harrisburg. PAl 71 0 1 Address t-= ) (717) 232-1851 Tel. No. Capacity: _ Personal Representative -.-X.- Counsel for Personal Representativt~ J THOMAS W. SCOTT JANE GOWEN PENNY ITRRENCE .I. MCGOWAN MICHAEl.!. O'CONNOR LlNDA.l. OLSEN ROBERT.l. DANIELS THE LAW FIRM OF KILLIAN & GEPHART, LLP 218 PINE STREET P. O. BOX 886 HARRISBURG, PENNSYLVANIA 17108-0886 HEATHER M. FAUST (2000-2005) TELEPHONE (717) 232-1851 FAX NO. (717) 238-0592 www.killiangephart.com OrCounsel: JOHN D. KILLIAN SMITH B. GEPHART August 2, 2006 Cumberland County Courthouse Attn. Register of Wills 1 Courthouse Square Carlisle, P A 17013 Dear Sir or Madam; Enclosed for filing is a final status report for the Elizabeth W.. Hopkins Estate. Very truly yours, a~f~~ Corinne Eggers Woodhouse Paralegal Enclosure (:'r", 15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue County Gode Year File Number Bureau of Individual Taxes ` ~ INHERITANCE TAX RETURN Dept, 280601 ~ ' Q /.~ Q © `~ "~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth a3~ ~6 /y8:~ 07 r 3~,oog i~i3~ qi9 Decedent's Last Name Suffix Decedent's First Name MI ~f ®P K i ~;~s ~1 ~C 5 C ~ T z ~413~ ~Tf~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~~ r~ r~ ~ r~ ~. v r r ~ ~~ ~ ~ ~ ~ ~ ~ ~~~z Firm Name (If Applicable) First line of address ~' ~ ~ ~~ a RC''N Second line of address City or Post Office t)vN ~s r ot~N' Correspondent's a-mail address: ~. State ZIP Code REGISTER bE.>(~.LS USE i~Y ';t:7 ~ s ~ i C~ -~=~ r .rr~ N - `~ l.: i l '. N J ~' ~ ,~{ ~ tV -t , _,v~ G.J DATE FILED C(} Under penalties of perjury, I declare that I have examined this retuk~including accompanying schedules and statements, and to the best of my knowiedge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA7U{~E OF, PERSON RESP~N LE F 11~19t ETURN ~ QATE ~ .k ~ ~ AD6R~~ / J~~I.~~~! d~-l-~~------Y~1i.cscs.~~~l/1~~J/'~ + ~ ~~~~(~ SIGNATURE OF PREPARER OTHER THAN REPRtSENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 J _J 15056042047 REV-1500 EX Decedent's Social S~^ecuriJty NLUfmb~eir' Decedent's Name: ~ ~ ~ ~ ~~ ` 1 J RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested ... .... 6. ' 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 8. Total Gross Assets (total Lines 1-7) ................................ .... 8. / ~/ / ~ I 1~ ! ~ ! J 9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. ~~ ,~ ~ J ,~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 11. Total Deductions (total Lines 9 & 10) ............................... .... 11. ~ ~ ,~~• ~1'~ 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12 • 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .... 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. // 7 ~ tQ ~A ~/ . ,{ / TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 ~ 16 / -~ , 9 ~' 17. Amount of Line 14 taxable at sibling rate X .12 . 17. . 18. Amount of Line 14 taxable at collateral rate X .15 •- 1g. ; 19. TAX DUE ...................................................... ...19. ` ,~ ` Q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505604204? 15056042047 REV-1500 EX Page 3 File Number Decedent's Complete Address: Utl.tU I J NHMt l ~~Z~ b~J th /~~ C~o~ktn s STREET ADDRESS ~ Lf- ~~~.~ l1c~1 Lc~n ~ CITY ~ STATE ~ ZIP t~ ©~1 ~~~-0 v1 ~' Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) ~~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 7~ , yQ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :................................................................................... ...... ^ [/~ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ [~ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d 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? ........................................................................................................ ...... ^ rye emu{ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ LJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~,/ contains a beneficiary tlesignation? .................................................................................................................. ...... ^ LLZI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 KATHRYN L OTTO 84 CHURCH LN JONESTOWN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE r',.' , ~,,? i !~l0'I2CE OF INHERITANCE TAX "'~Li.JiJ~r~i~ ~fF~D'EDti~TIONSLANDAASSESSMENTAOFOTA)(CE 2Q49 J4lN 12 PM 12~ 38 Q• I~~~~CJ~~t,~.NUn: PA 17038 REV-1547 EX AFP (01-09) DATE 06-08-2009 ESTATE OF HOPKINS ELIZABETH W DATE OF DEATH 12-14-2003 FILE NUMBER 21 04-0027 COUNTY CUMBERLAND ACN 501 APPEAL DATE: 08-07-2009 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALON_6 THIS LINE ---- ~--- R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~ _ _______ REV-1547 EX AFP (01-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOPKINS ELIZABETH W FILE N0. 21 04-0027 ACN 501 nerc D~-nR-~nno TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED RtJtKYAI1UIV LUNI:EKNiNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: (1) .00 NOTE: To insure proper (2) .00 credit to your account, (3) .00 submit the upper portion of this form with your (4) .00 tax payment. c5) 1.932.75 c6) .00 cn .00 ~$) 1, 932.75 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) ~9) 24 5.54 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions C11) 74~.~4 12. Net Value of Tax Return I12) 1 , 687.21 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax C14) 1,687.21 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 1,687.21 X 045 _ 75.90 17. Amount of Line 14 at Sibling rate (17) .00 X 12 _ .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 _ .00 19. Principal Tax Due 75 90 TAX C_RFnTTC. Ily)= . PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 09-19-2008 CD010296 .00 75.90 ~u~wL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 75.90 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF_TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE