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HomeMy WebLinkAbout04-0101Register of Wills of ,k. County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of also known as , Deceased NO. Social Security No. 153-'18-6546 Petitioner~ who is/~,g 18 years of age or older, apply(les) for: (COMPLETE "A" OR "B" BELOW:) [~ A. Probate and Grant of Letters Testamentary and aver that Petitionert'~q is~l~ the executer decedent, dated October 6, 1998 and codicil(s) dated ___named in the last Will of the ( State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [~ B. Grant of Letters of Administration Petitioner(s) after a proper search has/have (if any) and heirs: Name (d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) ascertained that Decedent left no Will and was survived by the following spouse Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary Decedent was domiciled at death in Cider I and County, Pennsylvania, with3i::~qer last family or principal residence at 2413 Massachusetts Avenue, Camp Hill, PA 17011 (Lower Allen Twp.) (list street, number, and municipality) Decedent, then 81 years of age, died January 19 .2004 Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property $ 150,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of Real Estate in Pennsylvania $ 100,000.00 situated as follows: single-family residence at 2413 Massachusetts Avenue, ~ Hill, __, at C(xm'a~ity General Hospital (Location) PA 17011 Wherefore, Petitioner(~) respectfully request(s) the probate of the last Will~i~resented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence .~~~ Signature .,~ ,// 311 West Ridge Road Dillsburg, PA 17019 snaceNVillsPetGrantLtJ2001 Oath of Personal Representative Commonwealth of Pennsylvania County of The Petitioner¢~) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief or Petitioner(x) and that, as personal representative(x) of the Decedent, Petition. will well and truly administer~ccording to la~v. /) Sworn to or affirmed and subscribed before me this second day of ~J~/~/~/~ebruar¥ 20 04 . For the Register Estate of ~ ~]. S(~]R~E]VI Deceased Social Security No.: 183 18 6546 Date of Death: January 19, AND NOW, February 2 ,20 04 of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ~ Of Administration are hereby granted to 1:~1~3~ E. S(~-]RI]VI 2004 , in consideration db.nc.t.a.; pendente lite; durante absentia; durante minoritate in the above estate and that the instrument(~ dated October 6, 1998 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ............ $ Short Certificate(s) .4 .$ Renunciation ....... $ Affidavits ( ) ....... $ Extra Pages ( ) ..... $ Codicil ............ $ JCP Fee ........... $ Inventory ........... $ Automation Fee ..... $ Other .............. $. TOTAL ........ $ I.D. No: 15893 Address: Post Office Box 310 Dillsburg, PA 17019-0310 Telephone: 717-432-9733 snaceNVillsPetGrant Lt/2001 - - - ~ - - - ~ - - - ~"r :':' ""', ~ ' :~~ ~ ~\J /1 1 ~) ~~ ~'1 ~ N'\ ..... ~ \' - l ? , \"" C " ~f~, _.. CJ -\ ''{"_ X.....1 r; ~' (i,.} :-. ,', (.'<;, ~:b ,) Cf) z., .';. '. ~d ' ~.~ g '" ;;. cr: < ~:d hJ ;. .-<~ . ~ (J:' .~~ ~L~' //,:q~ >.' -/ -"~:", :;::,-, r~~ . ,. ~ ,)" ,.....j ,.', -J ,.... , r :~' 7 ,:"~ ..h"ju ., 1 ,1.J: - - ~ -:::: :; - =; - .~:I ir' (':' .,.ot .t. i') .to" .~, ~~ r.' .,..1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISIDN PD BDX 2B0601 HARRISBURG PA 1712B-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCC'''''~I)ED STATEMENT OF ACCOUKT REY-1607 EX AFP (03-05) ANNA M DILLER 4531 STATE RT 410 LOWVILLE NY 13367 D~r: ,:~."_ :~J P~652~005 Est'ATE" OF SCHRUM DATE OF ,~EATJi._1I1-19-2004 FILE J:U,litBeR \~l..lJ4-0101 COU~TY CUM~RLAND ACN~ 04000185 Anount Reni tted DOROTHY M 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, subnit the upper portion of this forn with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... ......................................._.......................................................................1 REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF SCHRUM DOROTHY M FILE NO.21 04-0101 ACN 04000185 DATE 06-27-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-06-2005 PRINCIPAL TAX DUE: 404.55 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-29-2005 CD004924 .00 404.55 . ANCE OF UNPAID INTEREST/PENALTY AS OF 01-30-2005 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. 4.86 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE c-: 4.86 II SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT, Detach the top portion of this Notice and submit with your payment made payable to the name and address printsd on the reverse side. If payment if for a RESIDENT DECEDENT, make check or money order payable to: Register of Wills, Agent If payment if for a NON-RESIDENT DECEDENT~ make check or money order payable to: Commonwealth of Pennsylvania Failure to pay the tax, interest, and penalty due ~y result In the filing of a liBn of record in the appropriate county, or the issuance of an Orphan"s Court citation. REFUND (CRl: A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of PennsYlvania Inheritance and Estate Tax" (REV-1313). Applications are available online at www.revenue.state.pa.us# any Register of Wills or Revenue District Office 1 or from the Department's Z4-hour answering service for forms orders: 1-800-36Z-Z050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (IT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of RsvQnue# Bureau of Individual Taxes, ATTN: Post Assessment Review unit# P.O. Box 280601, Harrisburg, PA 17128-0601# phone (717) 787-6505. DISCOUNT, If any tax dUB is paid within three (3) calendar months after the decedent"s death, a five percent (5%) discount of the tax paid is allowed. PENALTY, The 15% tax a_nasty non-participation psn.lty is computed on the total of the tax and interest assessed 1 and not paid before January 18, 1996, the first day after the end of the ta~ amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and ana (1) day from the date of death 1 to the date of payment. Taxes which became delInquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate Which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. Ths appliCable interest rates Interest DailY Year Rate Factor 198Z ZO% .000548 1983 16% .000438 1984 11% .000301 1985 13% .000356 1986 10% .000Z74 1987 9% .000Z47 Interest Daily Year Rate Factor 1988-1991 11% .000301 199Z 9% .000Z47 1993-1994 77- .00019Z 1995-1998 9% .000Z47 1999 77- .00019Z ZOOO 8% .000Z19 for 1982 through 2005 are: Interest DailY Vear Rate Factor ZOOl 9% .000Z47 ZOOZ 6% .000164 Z003 5% .000137 Z004 4% .000110 ZOOS 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to ~ifteen (15) days beyond the date of the assessment. If payment is made after the interest computation dete shawn on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DILLER ANNA M 4531 STATE RT 410 LOWVILLE. NY 13367 ____hh told ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-0101 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 07/28/2005 POSTMARK DATE: 07/25/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 NO. CD 005633 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04000185 I $4.86 I I I I , I I I TOTAL AMOUNT PAID: $4.86 REMARKS: CHECK# 1394 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS 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 ~,~ .,/,,";~7, · [t~//-! Local Reg,s~ P 9 8 4 9 8 5 4 ~~.~,~ ~:,,, JAN 2 2 200~ No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Dorothy N.. Schrum ,. Female ,.la3 -- la- 6546 *'~ff/0U~ /(~, ~c'o(/ I Dauphin County ~Lower Paxton Twp .Community General Hnspttal Business ~er I,~uto Service StatiC,. ~ I,,- ~" I ....... l-N~r ~ r,~ ~----(~rsw~a,zx~ass~....c.~.o--.m...zec.o,, I~.cE~a's~c*u~ ,ia. m~. Pennsylvania ,..~.~ Lower Allen To.shin 2413 Massachusetts Avenue ~ Camp H%ll PA 17011 ~' ,~.~ Cumberland Oscar L. Schrum ". ~ 311 W. Ridge Road, Dillsbur~, PA 17019 anuary 23, 200, I,,.. Barrens Salem Union Cern. ],,~Dillsburg, PA 17019 -012975-L ~Mr. Robert g. Schrum 1lo,71o 004280-0000'[/10.1.98/E, GM/DLM/115419.1 ·ast ill ¢stamCat OF DOROTHY M. SCHRUM I, DOROTHY M. SCHRUM, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of my legally enforceable debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II I give and bequeath my motor vehicles(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my nephew, ROBERT E. SCHRUM, provided he survives me ARTICLE III I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate, unto my nephew, ROBERT E. SCltRUM, provided he survives me. ARTICLE IV If my nephew, ROBERT E. SCHRUM, predeceases me, I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, unto my nephew, CHARLES SCHRUM, my niece, ANNA MAE DILLER, my niece, JANE GERBER, my nephew, DONALD GERBER and my niece, NANCY BLOUSER, provided that should any of the foregoing predecease me, I direct that his or her share shall be distributed unto his or her then-living issue, per stirpes. ARTICLE V In the event that any beneficiary of my Will shall not have reached the age of twenty-one (21) years at the time for distribution of his or her share, distribution of said share may be made in the discretion of my Personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the time such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. ARTICLE VI I name, constitute and appoint my nephew, ROBERT E. SCHRUM, Executor of this my Last Will and Testament. In the event that my nephew, ROBERT E. SCHRUM, fail to qualify or cease to so act, I name, constitute and appoint my nephew, CHARLES SCHRUM, Alternate Executor to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. WITNESS WItEREOF, I have hereunto set my hand and seal to this, my Last Will Testament, this ~ day of 0~ , 1998. 'DOROTitYAf~. ~cltRUM - x,, ) and Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, DOROTHY M. SCHRUM, '~. ~ ~ ~ and ~~ ~-~,.Na~x..~,A....~x ,, the Testatrix and the witnesses, respectively, whose names ~r~ signed to the attached or foregoing"ff~strument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as his Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of thc witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. W~tness Subscribed, sworn to and acknowledged before mc by DOROTHY M. SCHRUM, Testatrix, and ~ ~, ~ ~ and ~%O-, ~",.,~,"~31C~,~ _,~ :, witnesses, this ~C~day of ~ , 1998.r'''~ Notary Public NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21, 2001 VINVA-IASNN3d ":1NAOI/,i':I-I MV'I .IV SA3NblO.I..I.¥ 'bl",:lNaI3M ~ .I.J:IYM31$ '3l.-l_-lrla 'NOSNHOr' NflSHD$ 'N XHEO~O~ ~0 tI!I CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No. DOROTHY M. SCHRUM JANUARY 19, 2004 2104-0101 To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiary of the above-captioned estate on Feburary 5, 2004 .maine Robert E. Schmm Address 311 West Ridge Road Dillsburg, PA 17019 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none. Date: b. SCfmXCK, m, ESQUIRE 124 West Harrisburg Street P.O. Box 310 Dillsburg, PA 17019 (717) 432-9733 Counsel for the personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: THE ESTATE OF: DOROTHY M. SCHRUM ESTATE NO. 2104-0101 TO: ROBERT E. SCHRUM Please take note: The Decedent, DOROTHY M. SCHRUM, died on the 19th day of January, 2004, at Community General Hospital, Lower Paxton Township, Dauphin County, Pennsylvania. The personal representative of the Decedent is: Robert E. Schrum 311 West Ridge Road Dillsburg, PA 17019 (717) 432-8541 The Decedent died testate (with a Will)and the Will was filed with the office of the Register of Wills of Cumberland County. Register of Wills of Cumberland County 1 Courthouse Square Carlisle, Pennsylvania 17013 (717) 697-0371 the Register of Wills and paying Date: . ~. ~ . additional copy of the Will may be obtained by contacting the c~.rg~ for duplication. W~ D. ~~CK, III, ESQUIRE 124 West Harrisburg Street P.O. Box 310 Dillsburg, PA 17019 (717) 432-9733 Counsel for Personal Representative $CHRACK & LINSENBACH LAW OFFICES 124 W. HAILRISBURG ST. P.O. BOX 310 DILLSBURG, PA 17019-0310 PHONE (717) 432-9733 FAX (717) 432-1053 A ttortl c..t~$ WM. D. SCHRACK III BRIAN C. LINSENBACH April 19, 2004 Register of Wills of Cumberland County Cumberland County Court House Carlisle, PA 17013 Dear Ladies: Re~ The Estate of Dorothy M. Schrum Date of Death: January 19, 2004 PA. File No. 21-04-0101 Cumberland County File No. 2004-00101 "' You wilt-find en(~[0sed herewith Executor Robert E. Schrum's check number 948, payable to the Register 0~fWills-Agent for the sum of $14,300.00. This is remitted on account of payment of inheritance t~l~ obligations. .(.Please a~ept the ~eck and forward a receipt to me at the address noted on this letterhead. ~ank y6u for ~ attention to this request. Sincerely, Wm. D. Schrack III SCHRACK & LINSENBACH WDS/jct Enclosure CC: Robert E. Schrum COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003853 SCHRACK WM D III ESQ 124 W HARRISBURG ST P O BOX 310 DILLSBURG, PA 17019 ........ fold ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-0101 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 04/21/2004 POSTMARK DATE: 04/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 19/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $14,300.00 REMARKS: TOTAL AMOUNT PAID' 4,300.00 SEAL CHECK# 948 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS $CHRACK & LINSF~BACH LAW OFFICES POST OFFICE Box 310 DILLSBURG, PA 17019-0310 '04 ,r',PE' 21 '-' ,:2 :C'3 REGISTER;OF WILLS OF CUMBERLAND COUNTY CUMBERLAND COUNTY COURT HOUSE CARLISLE, PA 17013 "7..'0 $ ~+.a30 i 02 h,,ilh,,llh,,,,,lh,lh,,Ih,,Ihll,,,,,,llhh,hh,, IN RE: THE ESTATE OF DOROTHY M. SCHRUM LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS COURT DIVISION NO. 2104-0101 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that I, as the beneficiary and heir of the Last Will and Testament of DOROTH¥ M. SCHRUM, late of Lower Allen Township, Cumberland County, Pennsylvania, deceased, do hereby acknowledge that I am about to receive from the Executor of the Last Will and Testament of the decedent, a distribution, representing the current balance of my share of distribution in said Will, in full, as total satisfaction and payment of such sum of the Estate of DOROTHY M. SCHRUM. I desire that the shares of the Estate be distributed without the formality of a court adjudication and final accounting, in order to save expense, publicity, and delays incident to such court proceeding, and authorize the said Executor to make such distribution upon return of the Receipt and Release. AND, THEREFORE, I, by these presents, remise, release, quitclaim, and absolutely discharge, indemnify and hold harmless the Executor, his executors, heirs, and administrators~ of, and from said legacy, and of and from all action, whatsoever, for or by reason thereof or relating in any way to his administration of the Estate or of any other act, matter, cause, or thing whatsoever from the beginning of the world to the date of these presents. INTENDING to be legally bound hereby, I have hereunto set my hand and seal this 1st day of October 2004. ROBERT E. SCHRUM COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128q)601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 _ 04 0101 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-- SCHRUMM, Dorothy M 183-18-6546 Z LLJ DATE OF DEATH (MM DD-YEAR) I DATE OF BIRTH {MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLJCATE WITH THE LU 01/19/2004 li06/22/1922 REGISTER OF WILLS (.~ Iii (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER t~ [] 1 ©riginal Return ~ 2 Supplemental Return ~ 3. Remalnder Return Cate ~'~.~' ~rt~ 1243-82 ce E~ 4, Limltsd Estata ~ 4a. Future Interest Compr0m,se(~,:.o'~ea.~"~r,*.l~-~2) ~ 5. Federal Estate Tax Return Required ~0, [] 6 DecedentDiedTestata[~-2~-~;~'w,0 ~ 7. DecedentMaintainedaLrv[ngTrustF*H.~'=;y~'~r~tl 8. Total Number of Safe Deposr~ Boxes ~ [] 9. Lhigation Proceeds Received F~ 10, SpousalPover~Credrt(~,t~¢0o,.be~w~,.1,-3,-9, andl-l-95) ~ lt. Election to tax under Ser~ 9113(A) (Am¢ S~. O) NAME Wm. D. Schrack Ill FIRM NAME (l'^mli=bl,} Schrack & Linsenbach Law Offices TELEPHONE NUMBER (717) 432-9733 P. O. Box310 D Ilsburg, PA 17019-0310 1. RealEstats(ScheduleA) 84,900.00 OFFICIAL USE ONLY (1) ..................................................................... Z 2. Stocks and Bonds (Schedule B) (2) 3 Closely Held Corporation, Pa'~nership or Sole-Proprietorship (3) 4. Modgages & Notes Receivable (Sd'edule D) (4) 5. Cash, Bank DeposEs & Misc¢lar, eous Personal Propert7 (5) (Schedule E) 2,245.07 0,00 0.00 1,661.62 6. Jointly Owned Propecy (Schedule F) L.~_~. Separate Biiling Requested 7. Inter V'r~os Transfem & Miscellaneous Non-Pro~ata Property (Schedule G or L) 8 Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H} 10. Debts of Decedent, Mortgage Liabiiides, & Liens (Schedule l) 11, Total Deductions (total Lines 9 & ,0) 12. Net Value of Estate/Line 8 minus Line 11) (7) 0.00 (6) (9) 33,254.06 88,806.69 13. Charitable and Governmenta, Bequests/Sec 9113 Trus~ for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tm( (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line ~4 fc~(able at the spoussl tax rate, or transfers under Sec. 9116 (a)(1.2) 16, Amount of Line 14 t~ab[e at lineal rate 17, Amount of Line 14 t~xab[e at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. 'rax Due 33,837.42 (12) 54,969.27 (13) 0.00 04) 54,969.27 ........................................................ x .O ....... (15) ..................................................................... ............... x .0 .. (16) ............................................................. x .12 (17) 54,969.27 x .tS (19) 8~245.39 (~9) 8,245.39 Decedent's Complete Address: STRE2E~ ~D~EaSsSsa ch u sorts Avenue CTYcamp Hill I STATEpA I ZtP17011 Tax Payments and Credits: 1. Tax Due(Page I Line 19) (1) 8,245.39 2. Credits/Payments A. Spousal Pevedy Credit B. Prior Payments 14,300.00 C. Discount Total Credits (A + B + C ) (2) 14,300.00 3. Interest/Penalty r[ applicable D. Interest E. Penalty Total InteresL/Penalty ( D + E ) 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) 6,054,61 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANOE BUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Bid decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................................ [] [] b. retain [he hght to designate who shah use the property transferred or its income; ........................................... [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the premise for life of either payments, benefits or care? ................................................................... [] [] 2. If death occur'ed after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................... [] [] 3. Did decedent own an "in trust for'' or payable upon death bank account or secudty at his or her death? .............. [] [] 4. Bid decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Robed E. Sch~m, 311 W. Ridge Road, Dillsburg, PA 17019 '~'~*~E~~, ~'~'~AT'~ ............................................... ~A~ ....................... Wm. ~. Schrack IH, ~. O. Box 3~0, Dil[sbur~, ~A ~70~-03~0 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, I995, the tax rats imposed on the net value of tra:~sfers to or for the use of Ihe surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer Io a surviving spouse from lax, and the statulory requirements for disclosure of assets and filing a tax re/urn are still applicable even if the surviving spouse is the onty beneficiary. For dates of death on or after July 1, 2000: The tax tale 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 stepparenl of the child is 0% [72 PS. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers lo or for the use of the decadents lineal beneficiaries is 4.5%, except as noted in 72 RS §9116(1.2) [72 RS §9116(a)(1)]. The tax rate imposed on the net value of transfers Io or for the use of the deceden['s siblings is 12% [72 RS. §9116(a)(13)]. A sibling is defined, under Section 9102, as an individuat who has al least one parent in common with the decedent, whether by df cod or adoCJon 004280-00001/10.1.98/EGM/DLM/115419.1 OF DOROTHY M. scml. LrM I, DOROTHY bi. SCI:{RU3,1, of Lower Allen Township, Cumberland Count),, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of my legally enforceable debts and the expenses of my last illness and funeral from my Estate as soon aRer my death as conveniently may be done. ARTICLE I give and bequeath my motor velncles(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my nephew, ROBERT E. SCHRUM, provided he sm'ives me ARTICLE I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate, unto my nephew, ROBERT E. SCH~RU~I, provided he survives me. ARTICLE IV If my nephew, ROBERT E. SCItRU3$, predeceases me, I give, devise and bequeath ail the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever s/mate, unto my nephew, C~ES SCItRLBI~, my niece, A~N~'A MAE DILLER, my niece, JANE GERBER, my nephew, DONALD GERBER and my niece, NANCY BLOUSER, provided that should any of the foregoing predecease me, I direct that his or her share shall be distributed unto his or her then-1/ving issue, per sfirpes. .~RTICLE V In the event that any beneficiary of my Will shall not have reached the age of twenty-one (21) 3,ears at the time for distribution of his or her share, distr/bution of said share may be made in the discretion of my Personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniforna Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gi2s to Minors Act or Uniform Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the time such dislr/bution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my PersonaI Representative, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. AR ,'IffCLE WI I name, constitute and appoint my nephew, ROBERT E. SCItRUM, Executor of this my Last Will and Testament. In the event that my nephew, ROBERT E. SCHRUM, fail to qualify or cease to so act, I name, constitute and appoint my nephew, CHARLES SCHRU31, Alternate Executor to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful adminislzation of the duties required in any jurisdiction. 2 VVlTNESS WI:IFRREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~'~ day of 0(.,~c/.~ , 1998. DOROTHY,~I~CHRUM - Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as Mmesses. ACI~NOa,VLED GMiENT CO~MMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAxN'D : We, DOROTHY M. SCHRL~I, -~.~. g~ ~rx'~ and ~ ~.~k~., the Tesm~x and the wimesses, respecdx ely,'~ whose names ~ si~ed to the a~ched or foregoing~s~ment, being first duly sworn, do hereby declare to the ~dersi~ed au~otiW that the Tesm~x si~ed and executed the Ns~ent as his Last Will and that she had si~ed willingly and that she executed it as her ~ee and vol~ta~ act for the pu~oses thereN expressed, and that each of the wimesses, in the presence and heating of the TesmMx, si~ed the Will as wi~ess and that to the best of his&er ~owledge ~e Tesm~x was at that time eighteen years of age or older, of sold mind and under no cons2aint or undue influence. DOROT~ SC~I ~ Subscribed, sworn to and acknowledged before me by DOROTHY M. SCFfRUM, Testatrix, and ~ ~, ---tx--. ~ and -~Q. 4~.._'k--."~,'N..5.r-7~k...'~.~ ~, wimesses, this ko 5JO'day of ~ , 1998.k~ Notary Public 4 NOTARIAL SEAL DiANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. .,My Commission Expires Dec. 21, 2001 REV4 502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy M. Schrum SS¢/ 183-18-6546 SCHEDULE A REAL ESTATE 01/19/2004 FILE NUMBER 21-04-0101 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION ITEM NUMBER 1 Sale of real estate at 2413 Massachusetts Avenue, Camp Hill, PA (Lower Allen Township, Cumberland County) - Tax Parcel No. 13-23-0549-131 and Tax Parcel No. 13-23-0551-098 (see HUD-l) TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH 84,900.00 $ 84,900.00 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form $ohware only CPSy$1ems, Inc. Form REV-lS0Z EX (Rev 1-97) U, S. DEPARTMENT OF HO~J SING and URBAN DEVELOPMENT SETrLEklENT STATEMENT Schrack and Linsenbach Law Offices 124 w. Harrisburg Street * PD. Box 310 Dillsburg, PA 17019 Phone (717) 432-9733 Fax (717) 432-1053 MORT, INS CASE NO: B, TYPE OF LOAN --] 1. FHA [] 2 FMNA [] 3. CONV.UNINS E]4VA []S. CONV.~HS. 3. FILE NUMBER; 17 LOAN NUMBER: 1576 _ower Alien Township, PA =LACE OF SETTLEMENT: 2O4 124 West Halrisburg Street DiJIsburg, PA 17019 K. SUMMARy OF SELLER'S TRANSACTION 4O5 Adjuslments for i~ems paid in advance by seller(s) Adjustments for items paid in advance by seller(s) 205 420 Gross Amount Due 1o Seller 500 Reductions In Amount Due TO Seller 682780 AOjustment$ for items unpaid by seller 514. 515 518 517 518. 519. 520. Total Reduction Amount Due Seller 600. CASH AT SETTLEMENT To/From SELLER 601 Gr~ss Amount due Sel~er (line 420) 303. ~ FROM I I TO Borrower 85,242.77 603, Cash [] TO [] FROM Seller 85,154 R? 77,125.73 SETTLEMENT CHARGES Case i~ 1576 ~s Commission based on Price: $ 84,500.00 6.00 % /Day 1007 Janets Gore Wm D Schrack III SCHRACK & L~NSENBACH 1109. Lender'scoverage $ 1113 849 O( 1301, Pestlnspection ~o HomeSpec HomeSpec 1303 Su~ey to HUD CERTIFICATION OF BUYERS AND SELLERS Buyers Address & Phone: Segler's New Address & Phone; REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Dorothy M. Schrum S$# 183-18-6546 01/19/2004 21-04-0101 All property jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 48 shares Prudential common stock @ 47.0014, minus 2,245.07 $11. O0 fee TOTAL (AJso enter on line 2, Recap~:ulation) 2,245.07 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1 ~ form software only CPSystems, Inc. Fora1 REV- 1503 EX (Rev. EquiServe, Inc. P.O. Bc× z.3010 PROVIDE.'~.~E, ,RI C'29z.0-3010 PRUDENTIAL FINANCIAL, INC. 2300 30689-7539 ORDER ©F 12196360 q8.000 qT.OOlq 11 .00 DATE 03/10/0q 0.00 9429126125 ROBERT E SCHRUM EX UW DOROTHY M SCHRUM 311 W RIDGE RD DILLBURG PA 17019-9315 To Fleet National Bank, Boston, MA ~,~ U, DEPARTMENT OF THE TREASURY - INTERNAL REVENUE SERVICE Proceeds From Brokerand SmderExchange Transactions Copy B For Recipient This is important tx information and is being furnished to the 200q 03/08/0q Form 1099.B $ 0.00 lbCUSJPNo 12S122k. boq=s, etc. Rep~.ledto[R$ }.~, aro$$pro=ee:s 7q4320 1 0 2 J $ 2, 2S6 . 07 '~' andGr°ssPr°r'eed$~essc°mm]ssi°nSoption premiums ROBERT E SCHRUM EX UW DOROTHY M SCHRUM 311 W RIDGE RD DILLBURG PA 17019-9315 J SALE OF STOCK K230030689-7539 I PRUDENTIAL COMMON EQUISERVE, INC. PRUDENTIAL FINANCIAL, INC. P.O. B0X q3033 PROVIDENCE, RI. 029q0-3033 1-800-305-gq0q Fo~n 1099-B q3-690819q q3-19127q0 INSTRUCTIONS FOR RECIPIENT ON R~ERBE SIDE DETACH BEFORE CASHING CHECK SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy M. Schrum SS~/ 183-18-6546 01/19/2004 21-04-0101 Include the proceeds of [itigation and tho date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 Blue Cross-Blue Shield - insurance refund Erie Insurance Company - refund Reimbursement of taxes, sewer and refuse at sale of property (see HUD-l) Household contents (see appraisal) TOTAL (Also enter on line 5, Recapitulation) 394.00 224.00 254.62 789.00 1,661.62 (If more space is needed, insert additional sheets of the same size) Copyright (C) 1996 fO~ software only CPSysterns, Inc. Form REV-1508 EX {Rev. I U. S. DEPARTMENT OF HOUSING end URBAN DEVELOPMENT SETTLEMENT STATEMENT OMB No, 2502.0265 Schrack and Linsenbach Law Offices 124 w. Harrisburg Street * PO. Box 310 DJllsburg, PA 17019 Phone (717) 432-9733 Fax (717) 432-1053 B TYPE OF LOAN "'~I.FHA [~2 FMRA r~3 CONVUNINS Fl. vA 1-19. CONV INS. ~ FILE NUMBER: 17 LOAN NUMBER: PLACE OF SETTLEMENT: 124 West Harrisburg Street OJllsburg, PA 17019 K. SUMMARY OF SELLER'S TRANSACTION 403 404 405 84900 00 99 65 40 O0 5 27 87,442.77 1,000 00 1,20000 506. 507. 508. 509, 209 505. Payoff oi Second Mortgage Loan Sur~ey to JarmoJenko & Assoc. '20 Tolal Paid By/For E~orrower 300 CASH AT SETTLEMENT From/To BORROWER 516 517. 518 519 2,200,00 87,442.77 520. Total Reduction Amount Due Seller 600. CASH AT SETTLEMENT To/From SELLER 601. Gross Amount due Seller {line 420) rio SETTLEMENT DATE: Jun 11 2004 Friday 200 PM 303 Cash[]EROM I'~TO Sorrower 603. Ca,hi'TO DFROM Seller 77.126.73 8,027.89 E,H~iI~ Of D~i'Ot[~/S~ ITEM AMOUNT TABLE & CHAIRS 7.0C DESK 10.0C POTS - PANS - DISHES - UTENSIL 25.00 REFRIGERATOR 100.00 MICROWAVE & CART 6.00 SM. ELECTRICAL APPLIANCES 12.00 WATERFALL BEDROOM SUITE 80.00 STEREO 1~00 ALBUMS 2.00 METAL FILE CABINET 1.00 STAND 1.00 SWEEPER 5.00 CHAIR PICTURES 1.00 5.00 STAND i .00 RECLINER 2.00 OHAIR 1,00 SOFA 500 POLE LIGHT 1,00, TV W/REMOTE 25.0C END TABLE 25.0C STANDS 5.00 CHAIR W/O'I-rOMAN 3.00 BLANKET CHEST 35.00 LIGHTS 5.00 PICTURE 5.00 FAN 2.0( JEWELRY BOX 3.00 SEWING MACHINE 3.00 WATERFALL BLANKET CHEST 50.00 CHEST OF DRAWERS 35.00 SINGLE BED 5.00 SHEETS - BLANKETS - TOWELS - ETC 25.00 UTILITY CABINET 10.00 SARD TABLE 1.00 4 DRAWER FILE CABINET 3.00 STANDS 1.0C KEROSENE HEATER 15.00 UTILITY CABINET 2.00 RIDER MOWER 150.00 CHIPPER SHREDDER 15.00 SO FA 10.00 CHAIRS 10.00 LAWN CHAIRS 5.0( LONG HANDLED GARDEN TOOLS 10.00 I)l~HoMibJ~i~ PATIO SET 15.00 DBL LADDER 10.00 GARBAGE CANS 5.00 TOOLS 10.00 WASHER 20.00 TOTAL 789.001 REV-150~ EX + (1-67) SCHEDULE F OOM,~O.WE~_~ OF PE..SVLVAN,* JOINTLY--OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy M. Schrum SS~/ 183-18-6546 01/19/2004 FILE NUMBER 21-04-0101 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Robert E. Schrum Nephew B. Charles D. Schrum Jane Louise Gerber 311 W. Ridge Road Dillsburg, PA 17019 573 Polecat Road Landisburg, PA 17040 6600 Harmony Grove Road Dover, PA 17315 Nephew Niece JOINTLY-OWNED PROPERTY: LET-FER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH iTEM =OR JOIN; MADE include n~e of ~nanci~ institution and ban DATE OF DEATH DECD'S VALUE OF NUMBEF TENANT JOINT A~ach deed forj~ntly-held ie~ e$1me. VALUE OF ASSET INTEREST ~ECEDENT'S INTEREI 1 A 07/03/90 PNC Bank - checking account 1,808.64 50.00~ 904.32 ~5140055938 2 A 12/01/82 PNC Bank - savings account 12,477.09 50.00% 6,238.55 ~5130210746 3 B 06/25/98 US Savings Bond V5405791EE 3,202.00 50.00% 1,601.00 - denomination $5,000 4 B 06/25/98 US Savings Bond V5405792EE 3,202.00 50.00% 1,601.00 - denomination $5,000 5 B 06/25/98 US Savings Bond V5405793EE 3,202.00 50.00% 1,601.00 - denomination $5,000 6 B 06/25/98 US Savings Bond V5405794EE 3,202.00 50.00% 1,601.00 - denomination $5,000 7 B 06/25/98 US Savings Bond V5405795EE 3,202.00 50.00% 1,601.00 - denomination $5,000 8 B 06/25/98 US Savings Bond V5405796EE 3,202.00 50.00% 1,601.00 - denomination $5,000 9 B 06/25/98 US Savings Bond V5405797EE 3,202.00 50.00% 1,601.00 - denomination $5,000 10 B 06/25/98 US Savings Bond V5405798EE 3,202.00 50.00~ 1,601.00 - denomination $5,000 Total of Continuation Schedule(s) TOTAL(AIsoenteronline6, Recapitulation1 $ (If more space is needed inser~ additional sheets of the same size) Icl 1996 fo~ software only CPSystems, Inc. Form REV-1509 EX (Rev. t-§7} Estate of: Dorothy M. Schrum Soc Sec #: 183-18~6546 Date of Death: 01/19/2004 Continuation of Schedule F (Jointly Owned Property) Item Ltr for Date Description of property # Jt Ten Joint Total Val of Asset Dollar Val of Decds Interest 11 B 12 A 13 A 14 A 15 A 16 A 17 A 18 A 19 A 20 A 21 A 22 E 23 C 24 D 25 B 06/25/98 US Savings Bond V5405801EE denomination $5,000 06/28/90 US Savings Bond V1961790EE denominanion $5,000 05/17/96 US Savings Bond V4998995EE denomination $5,000 05/17/96 US Savings Bond V4998996EE denomination $5,000 05/17/96 US Savings Bond V4998997EE denomination $5,000 06/17/96 US Savings Bond #V5007090EE denomination $5,000 06/17/96 US Savings Bond #V5007091EE denomination $5,000 06/17/96 US Savings Bond #V5007092EE denomination $5,000 11/20/96 US Savings Bond #VS093568EE denomination $5,000 11/20/96 US Savings Bond #VS093569EE denomination $5,000 11/20/96 US Savings Bond #V5093570EE denomination $5,000 06/28/90 US Savings Bond V1961788EE denomination $5,000 07/09/90 US Savings Bond V1962256EE denomination $5,000 07/09/90 US Savings Bond V1962259EE denomination $5,000 06/25/98 US Savings Bond V5405790EE denomination $5,000 3,202.00 5,394.00 3,408.00 3,408.00 3,408.00 3,408.00 3,408.00 3,408.00 3,332.00 3,332.00 3,332.00 5,394.00 5,394.00 5,394.00 3,202.00 50.OO% 50.00% 50.OO% 50.00% 50.00Z 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.0O% 50.00% 50.O0% 50.00% 1,601.00 2,697.00 1,704.00 1,704.00 1,704.00 1,704.00 1,704.00 1,704.00 1,666.00 1,666.00 1,666.00 2,697.00 2,697.00 2,697.00 1,601.00 (Contimuation) SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-04-0101 ESTATE OF Dorothy M. Schrum SS# 183-18-6546 1/19/2004 ~anassetw3smadejointwithinoneyearof~edecede~sdateofdea~,~must~repo~ onSchedu~eG. SU~IVtNGJO]NTTE~NT(S}NAME ADDRESS RE~TIONSHIPTODECED~k'T D. Anna M~e Diller Niece E. Andrew Schrum 4531 State Route 410 Low-ville, NY 13367 132 Blue Hill School Road Dover, PA 17315 Nephew JOiNTLY-OWNED PROPERTY: TOTAL (Also enter on line 6, Recapitulation) $ (If more space ~s needed, insert additional sheets of the same size) APR-OS-2004 22:22 PNCBAb~< 412 ?68 3458 April 7, 2O04 Wm. D. Schra¢l~ 124 W. }-inrr~shurg Street P.O. Box 310 Dillsbuk'g, PA 17019-0310 Estate of Dorothy M. Sckmm, deee~ed SSN: 183-18-6546 DoD: 1/19/2004 Dear Mr. Schrack: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5140055938' DOROTHY M SCHRUM ROBERT SCI{RUM DOD balance: $1,808.64 + SO,iX) accrued intere~ Established 07/03/1990 Savings Account Account #5130210746 DOROTHY M SCH~UM ROBERT S C I-~.LrM DOD hals,ce: $12,475.76 + $1.33 ~ccmed interest .Established12/01/1982 Please note that th/s office only pray/des da~e of death balances for deposit accounts (IRAs, CDs, Checking and Savingz accounts). We do not process Slay financial transactions or provide statements, If you need assistance ~Sth any of these items, please cail 1-888-PNC-BANK (i-888-762-2265) or step by your local PNC Bank brauch Sincerely, Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 fu~ Ave. Pit. burgh PA 15219 Memb*r FDIC TOTAL P.O1 Savings Bond Calculator Page 1 of 2 Series Denomination Serial Number # Bonds Total Price Total Interest Total Value 23 $57,500.00 $26,540.00 S84,040.00 Issue Interest Serial Number Issue Date Series Denom Price Interest Walhe Rate v5405801ee 06/1998 EE $5,000 S2,500.00 $702.00 $3,202.00 2.61% _v5405798ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% ~v5405797ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% ~v5405796ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% v5405795ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% v5405794ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% . v5405793ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% .,-5405792ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% v5405791ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% v5405790ee 06/1998 EE 5,000 2,500.00 702.00 3,202.00 2.61% v5093570ee I1/1996 EE 5,000 2,500.00 83200 3,332.00 2.46% v5093569ee 11/1996 EE 5,000 2,500.00 832.00 3,332.00 2.46% v5093568ee 11/1996 EE 5,000 2,500.00 832.00 3,332.00 2.46% v5007092ee 06/1996 EE 5,000 2,500.00 908.00 3,408.00 2.46% v5007091ee 06/1996 EE 5,000 2,500.00 908.00 3,408.00 2.46% v5007090ee 06/I996 EE 5,000 2,500.00 908.00 3,408.00 2.46% v4998997ee 05/I996 EE 5,000 2,500.00 908.00 3,408.00 2.46% ,,,y~4~998996ee 05/1996 EE 5,000 2,500.00 908.00 3,408.00 2.46% v4998995ee 05/1996 EE 5,000 2,500.00 908.00 3,408.00 2.46% v1962259ee 07/I990 EE 5,000 2,500.00 2,894.00 5,394.00 4.00% v1962256ee 07/1990 EE 5,000 2,500.00 2,894.00 5,394.00 4.00% I v1961790ee 06/1990 EE 5,000 2,500.00 2,894.00 5,394.00 4.00% v1961788ee 06/1990 EE 5,000 2,500.00 2,894.00 5,394.00 4.00% i'~!~.'."!.'O.'.~] Viewing Bonds -23 Note Description NI Not Issued NE Not Eligible for Payment Savinc Issue Date YTD In* $412. Next Final Accrual Maturit1 04/2004 06/202f 04/2004 06/202I 04/2004 06/2021 04/2004 06/202I 04/2004 06/2021 04/2004 06/202I~ 04/2004 06/202~ 04/2004 06/202f. 04/2004 06/202L 04/2004 06/202f 05/2004 11/2,02(~ 05/2004 11/202~ 05/2004 11/202(, 06/2004 06/202(~ 06/2004 06/202(a 06/2004 06/202(1 05/2004 05/202( 05/2004 05/202( 05/2004 05/202(~ 07/2004 07/202( 07/2004 07/202( 06/2004 06/202( 06/2004 06/202( http://wwws.publicdebt.treas.gov/B C/SBCPrice 03/25/2004 ~v-~5. EX + tt-s?) ] SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Dorothy M. Schrum SS¢; 183-18-6546 01/19/2004 FILE NUMBER 21-04-0101 Debts of decedent must be reported on Schedule I. iTEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 :UNERALEXPENSES: Cocklin Funeral Home ~DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Wm. D. Schrack, III Esquire Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress Ci~ State Zip Relationship ~ Claimantto Decedent PmbateFees Register of Wills Accountant's Fees Tax Return Preparer's Fees OtherAdministrativeCosts Blue Cross-Blue Shield - health insurance payment due Buchanan Oil Company - heating fuel Clerk of Orphans' Court - Release fee Cumberland Law Journal - estate advertisement Erie Insurance - homeowner's premium due Expense of sale of real estate (see HUD-i) 7,176.98 9,500.00 301.00 98.58 142.96 15.00 75.00 258.00 8,027.89 Total of Continuation Schedule(s) 7,658.65 TOTAL (Also enter on line 9. Recapitulation) 33,254.06 (If more space is needed, insert additional sheets of the same size) Copyd ghl (c) 1996 form software only CPSystems, Inc. Form REV- 1511 EX (Rev. 1-97) Estate of: Dorothy M. Schrum Soc Sec #: 183-18-6546 Date of Death: 01/19/2004 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description 7 Hardy's Auction Service (contents appraisal) 8 Lower Allen Town/ship sewer and refuse bill 9 Miscellaneous expense (postage, Notary, copies, etc.) 10 Niven J. Baird, Paralegal (title work) 11 Pennsylvania American Water - service during administranion 12 PP&L - electric service during period of administration 13 Register of Wills - additional short certificates 14 Register of Wills - filing fee 15 Removal of debris and repairs to property prior to sale 16 Reserve for future administrative expense 17 The Patriot News - estate advertisement 30.00 70.35 25.00 465.00 42.41 41.89 16.00 15.00 6,756.00 100.00 97.00 7,658.65 U. S. DEPARTMENT OF HOUS)NO a~d URSAN~'~E LOPMENT SETTLEMENT STATEMENT Schrack and Linsenbach Law Offices 12,4 w, Harrisburg Street * P.O Box 310 Dillsburg, PA 17019 Phone (717) 432-9733 Fax (717) 432-1053 B TYPE OF LOAN ~'~I.PHA ~2 FMHA r~3 CONVUN~NS E] 4. VA El5, CONV INS. 6 FILE NUMBER: J7. LOAN NUMBER: 1576 SORT INS CASE NO: PROPERTY LOCATION r SETTLEMENT DATE: Jun 11 2004 Friday 0200 PM Lower A]~en Townsh p PA PLACE OF SETTLEMENT: 124 West Harrisburg Street Dirrsburg, PA 17019 J, SUMMARY OF BORROWER'S TRANSACTION K, SUMMARY OF SELLER'S TRANSACTION 2,288 ~5 403 507. 508 509 Adjustrnen[s for items unpaid by seller City/Town tax County/City tax 215 513 School Tax 515. 216 L SETTLEMENT CHARGES Case # 1576 ~ommission based on Price: $ 84,900.00 6.00 % 807 Assumption Fee to 608 1003 City/Town Taxes 1004 County Taxes 0 Months ~ $ 14 92 /Month 1007 0 Months @ $ /Monlh 1008 Janet S Gore SCHRACK & LINSENBACH 180C 3950 1111 1205 RecofderotDeed$ 38 50 / 849 00 192 50 Pennsylvania American Water 1305 REV-151~ EX + (1-971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy M. Schrum SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSf/ 183-18-6546 01/19/2004 FILE NUMBER 21-04-0t01 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 Blue Cross - premium due Buchanan Oil Company - heating fuel Erie Insurance Company - homeowners policy Harrisburg Gastroenterology Associates - last illness Lower Allen Township - sewer service PA American Water Company PP&L - electric service Verizon - telephone service TOTAL (Also enter on line 10, Recapitulation) 98.58 179.70 5.00 100.00 70.35 33.69 82.59 13.45 583.36 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1 S12 EX (Rev 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA ESTATE OF Doroth M. Schrum SS~/ 183-18-6546 01/19/2004 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, FAXABLE DISTRIBUTIONS [include o~dght spousal distributions, and 1 Robert E, Schrum 311 West Ridge Road Dillsburg, PA 17019 SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Nephew ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18T AS APPROPRIATE, ON II, qON-TAXABLE DISTRIBUTIONS: SPOUSAL DISTRIBUTIONS UNDER SEC, 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET FILE NUMBER 21-04-0101 AMOUNT OR SHARE OF ESTATE residuary estate REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyfi ght (C) 2000 form Software only T~e Lackner Group, Inc, Form REV- 1513 EX (Rev. 9-00) PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH. REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: DOROTHY M. SCHRUM 01/09/2004 Esmte No.: 2104-0101 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: State whether administration of the estate is complete: Yes xx No Date: o lo/n~ If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 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 xx B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes xx 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. Signature ROBERT E. SCHRUM :~! Name (Please type or print) : ~ ,,~' '", 311 W. Ridge Road ..... Dillsburg PA 17019 Address (MAH:rmt/~M3) (717) 432-8541 Telephone No. Capacity: xx Personal Representative Counsel for Personal Representative BUREAU OF ZNDZVTDUAL TAXES )NHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 COHNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-I;47 EX AFP (09-04) NH D SCHRACK 12~ N HARRISBURG ST PO 80X $10 DZLLS8UR$ DATE 11-15-200q ESTATE OF SCHR,.UH DOROTHY H DATE OF DEATH 0171'9-200~ FILE NUHBER 21 COUNTY CUHliER LAND?: ACN 101 Amount Remitte .~_ I HAKE CHECK PAYABLE AND REH~T PAYHENT TO: REGTSTER OF NI'LLS CUHBERLAND CO COURT HOUSE CARLTSLE, PA 1701:5 PA 17019-0:510 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SCHRUH DOROTHY H FZLE NO. 21 06,-0101 ACH 101 DATE 11-15-2006, TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) {1) 2. S~ocks and Bonds (Schedule B) (2} :5. Closely Held S~ock/Par~narship Znteres* (Schedule C) ~+. Hor~cgages/No~ces Receivable (Schedule D) 5. Cash/Bank Deposits/H/sc. Personal Proper~y (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7), 8. To~al Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Deb~s/Nortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deduc~cions 12. Net Value of Tax Re~urn 86,/900.00 Z~ZG,5.07 O0 00 1~661.62 O0 O0 (8) :5:5, Z56,. 06 585.$6 NOTE: To /nsure proper credit *o your account, submit the upper port/on of ~his form wi~h your tax payment. 1:5. 1~. NOTE: 88,806.69 (11) 33.837.~2 (12} 56,,969.27 CharA~able/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) Net Value of Estate Sub.~ec~ ~o Tax Zf an assess.ent ~as issued prev/ously, 1/nes 14, 15 and/or 16, 17, reflect flgures that /nclude the total of ALL returns assessed to date. .00 56,,969.Z7 ASSESSHENT OF TAX: 15. Amoun~ of Line lq a~ Spousal rate 16. Amount of Line lfi taxable at Lineal/Class A ra~e 17. Amoun~ of Line 1~ at Sibling rata 18. Aeount of Line 1~ taxable at Collateral/Class D ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT I RECEIPT DATE NUHBER 06,-20-2006, CD00:5855 18 and 19 Nill (15) .00 X O0 = .00 (16) .00 X 06,5 = .00 (17) . O0 x 12 = . O0 (18) 56,,969.Z7 x 15 = 8,Zq5.$9 (19)= 8,2q5.:59 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT INTEREST/PEN PAID (-) .00 AHOUNT PAID 16,,:500.00 TOTAL TAX CREDIT 16,,:500.00 BALANCE OF TAX DUEI 6,056,.61CR INTEREST AND PEN. .00 TOTAL DUE 6,056,.61CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' {CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.~4~.~._, RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND ICR3: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B lcollateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section gl40 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 91403. Detach the top portion of this Notice and submit with your payment to the Register cf Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, 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-IS13). Applications ara available online at wow.revenue.state. Da.us, any Register of Mills or Revenue District Office, or from the Department's Z4-hour anseering service for forms orders: 1-800-36Z-gOSO; services for taxpayers with special hearing and/or speaking needs: 1-80g-447-30ZO iTT only). Any party in interest not satisfied with the appraismant, allowance or disallowance of deductions or assessment of tax iincluding discount ar interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing cna of the fallowing: A) Protest to the PA Department of Revenue) Board of Appeals. You may object by filing e protest online at www.boardcfappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to ba valid, you must receive a confirmation number and processed date frae the Board of Appeals wmbsite. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box Z810Z1) Harrisburg, PA 171Z8-10Z1. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box Z80601, Harrisburg, PA 171Z8-0601 Phone I717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for 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 (5Z) discount of the tax paid is alloeed. 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 end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same ties perlod as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of slx (6Z) percent per annum calculated at a daily rata of .000164. All taxes whlch became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Dally Interest emily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOX .000548 TE~'~-1991 llX .000301 ~ 92 .000247 1985 162 .000438 199Z 92 ,000247 ZOOZ 62 .000164 1984 112 .000301 1993-1994 72 .00019Z 2003 52 .000137 1985 15Z .000356 1995-1998 92 .000247 2004 42 .000110 1986 102 .000Z74 1999 72 .O0019Z 1987 102 .000274 2000 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen IlS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. REV-1470 EX  INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Schrumm, Dorothy M, 2104-0101 REVIEVVED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES F All To be billed Directly by the Department. ROW Page 1 CGHRON#EALTH OF PENNSYLYANZA DEPARTMENT DF REVENUE CHARLES D SCHRUM 573 POLECAT RD LANDISBURG PA 170q0 I~l~__ / ZNFORMATZON NOTZCE n~u,;~ [1'f L- ;'¥1LL~ DATE 20 ) DEC 27 or DOROTHY M SCHRUM S.S. NO. 183-18-65q6 CLERK OF DATE OF' DEATH Ol-X9-ZOOq ,'~, ~'~ ~ F~U~I' COUNTY CUMBERLAND REN'rT PAYMENT AND FORMS TO: REGTSTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701R FZLE NO. Z1 0~-0101 0q000185 1Z-O9-ZOOq TYPE OF ACCOUNT --I SAVINGS [] CHECKZNG []TRUST [] CERTZF. COMPLETE PART I BELOW K w # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1831865q6 Data 06-2:5-1998 Estmbl/shed Account Balance 32,020. O0 Pircent Texeble X S0 · 000 Amount Subject to Tax 16,010.00 Tax R&te X * 15 Potential Tax Dun :~, ~01.50 PANT TAXPAYER RESPONSE PART If you indtoate i d/fferent tax rate, please state your TAX RETURN - COMPUTATION OF PART DATE PAID TAX ON dOINT/TRUST ACCOUNTS DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on LLne K of Tax Computation) $ Undir;penaZties o~perjury~//~eclare that the facts ! have reported above are ~rue, correc~ ~d TAXP~ER SIGNATURE / TELEPHONE NUMBER DATE ' GENERAL ZNFORHATZON 1, FA/LURE TO RESPOND HILL RESULT ZN AN OFFICZAL TAX ASSESSNENT NlthapplJcable interest based on Jnforwation REPORTING ZNSTRUCTIONS - PART I - TAXPAYER RESPONSE TAX RETURN - PART Z - TAX COHPUTATTON CLATMED DEDUCTTONS - PART $ DEBTS AND DEDUCTIONS CLAIMED COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ~NDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1 162 EX( l 1-96) NO. CD 0O4768 SCHRUM CHARLES D 573 POLECAT RD LANDISBURG, PA 17040 ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-01 01 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 12/27/2004 POSTMARK DATE: 1 2/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04000183 $2,401.50 REMARKS: TOTAL AMOUNT PAID: $2,401.50 SEAL CHECK# 2401.50 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004758 GERBER JANE 6600 HARMONY GROVE RD DOVER, PA 17315 ........ fold ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-01 01 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 12/21/2004 POSTMARK DATE: 12/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04000184 $404.55 TOTAL AMOUNT PAID: $404.55 REMARKS: SEAL CHECK# 3018 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COI~qONk~ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE JANE L GERBER 6600 HARMONY GROVE RD DOVER PA 17315 ~L ZNFORMATZON NOTZCE *F ~ AND ~~) - D ,~_'~(~:'E R RESPONSE ACN 200iIOFC g I P~ ~.~OF DOROTHY M SCHRUM S.S. NO. 18~-18-65q6 ORP fS CUMBERLAND REMIT PAYMENT ~D FORMS TO: REGZSTER OF ~LLS CUMBERLAND CO COURT HOUSE C&RLZSLE, P~ Z70~ FILE NO. 21 04-0101 04000184 12-09-zooq TYPE OF ACCOUNT [~SAVZNGS E~CHECKING [~TRUST E~CERTZF. COMPLETE PART i BELOW/ # # . SEE REVERSE SZBE FOR FXLTNS AND PAYMENT ZNSTRUCT:ZONS Account No. 18:~186546 Date 07-09-1990 Established Account Balance 5,394.00 Percent Taxable X 50.000 Amount Subject to Tax 2,697.00 Tax Rate X .15 PotantLal Tax Due 404.55 PART TAXPAYER RESPONSE ONE You musE complete PART ~ and/or PART ~ below. PART If you ~ca~e a d~fferen~ tax rate, please s~a~e your ] relationship to decedent: TAX RETURN - COMPUTATION OF LZNE Z. Data Established 2. Account Balance 3. Parcm~t Taxable $ q. Amount Subject to Tax ~. Debts arid Decluctlons 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due PART DATE PAID TAX ON JOTNT/TRUST ACCOUNTS BEBTS AND BEBUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under penal~ias of perjury, ! declare ~hat the fac~s I have reported above ara true, correct and complete to the best of my knowledge and belief. HOME ("1~-~) R~ ~ . "d~., ~.~.,...-~ WORK ( ) TAXPAYE E TELEPHONE NUHBER DATE GENERAL INFORHATZON 1. FAILURE TO RESPOND WILL RESULT ZN AN OFFICIAL TAX ASSESSHENT with applicable ] REPORTING TNSTRUCTTONS - PART I - TAXPAYER TAX RETURN - PART 2 - TAX COHPUTATIO Date of Death Spouse Lineal SiblJ 01/01/9S to 06/30/00 OZ 07/01/00 to prosent OZ ~.$~# 12~ CLAIMED DEDUCTTONS - PART 3 DEBTS AND DEDUC1 msmd on information NSE Collutorml 1SZ :LAIMED - %v. ~Ye r~p~ 1:. ~ ~ ~ .:.. \J\ ~ .:.. ," ." .. -.J o ..... (',\ \ \ \ \ \ \ ;s - - f :::. :::: ':.- - - t - :::: :::: - \ .-0 O:II::l g :::CO~.gS ~.tJj% ~ % ~~O~~ ~ tJ r--1') ';j "'" C10 ~ ~ ".. UOOt:1oe. >-d0"le-:~g. ';>> e $. ?O 0 -- A-~l-+') --J ,:; ~ .-0 W e.~(1) 00 ....,~g , ^' V> o ::< "'" 0'- ('J _ o V> "'- - ~, '" ~~~ ~.y~ ~, ,~ l"'gm~ ~B~Thg ...... c. m\>'l m tn'e\ ~~ ~~ :t' g 0,>\ '<:I'm '>\-e. :t'mB~s l"'tn ......m ;;O()~';Xl ~ ~tn ~ C. ~ ,- ("'l c~ .- ..t._ (.>- r ,~ r=: -,.; S 8 :~~_ ~;_~~ ~~ > 1:.,<' ="~, ;-;: lp ~'. ~, ~ :~~ ~~: G') ;"f"1 ." <!C. .,. R1(\: t1fH":SO, A~}C.' FIRST CL \~, },~\ :t*v,._,., ... ",\',~F' ~, ,r ~,- rJ '" <::) ~ C21 ~ r-<~ " ;.. -...03 OJ \!' ICO eo' ....... ;. * >I-~, ,......-,... ~ - - - - - - [ :: - - - - - - r ? =- - - - =- =- :: i g ., a 8 ;02~J m~:slO ~~~~ '2!N'='C::~ ~lJt~o~ c CSi (') "" !: ~9.rn2~ 'G -;9."'1 )P )(~o ... ..,0"" :l. :2,C::':S:I ~ ~~~ i i~i ... rnrn (/) 'l' ~ 'II 1 . - ~ Q) ~.JU , ~ ".J 0;;; ~ Z ) ~ ::--< ) ~ l' ~ ,/>..... -v "- ?-~ /> .........~ - - - - ''''l~ ..... / r 'd,~, - <)~~;;;~~ ""o--".~ '.~lw'C" --....".,'C\ \ \ ',.s.,.,,,,,,, V" ~~ "'.... . ~ ~ r ~ ',,, l.:.~~:::~ . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DILLER ANNA MAE 4531 STATE ROUTE 410 LOWVILLE, NY 13367 -- told EST A TE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-0101 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 02/07/2005 POSTMARK DATE: 01/29/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 NO. CD 004924 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $404.55 I I I I I I I I TOTAL AMOUNT PAID: $404.55 REMARKS: CHECK#1314 SEAL INITIALS: CCP RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8D6Dl HARRISBURG~ PA 171Z8-D6Dl oAd.. "~ ,.., INFORMATION NOTICE AND C'T":l'A?(PAYER RESPONSE FILE ACN DATE NO.21 04-0101 04000186 12-09-2004 REV-l!i43 EX AFP [D9~DDl CLERI( ! ORPHNn EST. OF DOROTHY M SCHRUM 5.5. NO. 183-18-6546 DATE OF DEATH 01-19-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST o CERTIF. 2""5 ',~\,I /9 U" '..>1". ANDREW 132 BLUE DOVER SCHRUM HILL SCHOOL RD PA 17315 C;..);\/~.I~f~'1 .1,: REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 SAVING BOND has provided the Department with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the ebove decedent~ YOU were a joint owner/beneficiary of this account. If you feel this information is incorrect~ please obtain written correction fro~ the financial institution~ attach a COpy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co~monwaalth of Pennsylvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INS7RUCTIONS Account No. 1962256 Data 06-28-1990 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,394.00 50.000 2,697.00 .15 404.55 To insure proper credit to your account, two (Z) copies of this notice must acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x NOTE: If tax payments are .ade within three (3) months of the decedent's date of death~ you may deduct a SX discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. Tax PART TAXPAYER RESPONSE [!].li~~.liiii.iiil_.lili~~~!i!i!.~~lllli~~liliMiliHI~1~Uil~~~lilll~.III_iiil.l!1il!I~I~I~~~ilil!l1~R1I!il~ [CHECK ] ONE BLOCK ONLY A. ~ The above information and tax due is correct. ~ 1. You may choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent of Revenue. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART ~ below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate~ please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF LINE 1. Data Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 S. Debts and Deductions S 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Comput.tion) I $ Under penalties of perjury~ I declar. that the facts I complete to the best of my knowledge and belief. ~GN~T~R~ have reported above are true~ correct and (717 ) a<jJ.-7I7L{ WORK ( ) TELEPHONE NUMBER HOME ,- 8-as DATE E.143 EX (3-99) e ANDREW C SCHIlUIl 132 BLUE HILL SCHOOL RO DOVER PA 17315 tD LL ...., C) ....... Lt..;! ~' ',~ t~_.- ~n: T~340:" t~) ;- 0: t:, ~~,," '" ; C"' ",,- r:'" CL C) 2.) <.) ;..i --'J \.r::> c::-:; c:;, C-.l Zip Code eJ~? IHI " y , . '''-l, . '-...- ~_. PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 :.:::'"..""'" MonoM,(<;,l\<ry""" :;"C) <,,'_".r~ ,"<1'11 ~ ."-' (/ .~b __ i_~.-)C).J ~ I"", ~. ') f;? -.r 1"IIIIIIII"III'II,II,II.II""II'IIIIIIII.II,I,.Ifl:1 i t..... r~S '1 ". c::::J ") r-, I ~-::2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' ~'~.':- ,.", /~" f"~'.'-: ~.. :-"" BUREAU OF INDIVI~L\J~~ INHERITANCE TAX DIVISiDNC;~ PO BOX Z80601 -- HARRISBURG PA 171Z8-060i --- - NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOMANCE OR DISALLOMANCE OF DEDUCTIONI:i<!..AND ASSESSKENT OF TAX ON JOINTLY nELD OR TRUST ASSETS REY-1548 EX AFP 112-00 LUUS ~..."""" [J 29 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-01-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 183-18-6546 04000186 Allol.lnt Rellitted DOROTHY M ANDREW SCHRUM 132 BLUE HILL SCHOOL RD DOVER PA 17315 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE;;=is4-i-EX--AFii-roi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-01-2005 ESTATE OF SCHRUM DOROTHY M DATE OF DEATH 01-19-2004 COUNTY CUMBERLAND FILE NO. 21 04-0101 TAX RETURN WAS: S.S/D.C. NO. 183-18-6546 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04000186 FINANCIAL INSTITUTION: SAVING BOND ACCOUNT NO. 1962256 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 06-28-1990 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 5.394.00 0.500 2.697.00 .00 2.697.00 .15 404.55 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-10-2005 CD004859 .00 404.55 BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-11-2005 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. 3.80 ~ TOTAL DUE 3.80 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl. YOU MAY BE DUE A REFUND. --- ft_""""" "'Tnl: nl: T"'Tc:. J'nRM FOR YNSTRUCTIONS. l BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z8D6Dl HARRISBURG PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT ",'1100 -- C") \11M D .:~~CHRAC!t 124 ~~HARRISBURG ST PO BIl~ 31'0,.... DILLSBURS PA 17019-0310 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '* IEY-ln1 EX iFP (12-041 02-07-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 101 Amount Rellitted DOROTHY M 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... ~~:r&~~.!5r.i'~..rnl~.6!'........;..:rA~!~e1r~A5r.~tl~Alnrf.b~.A~l:~O~...ii..........._.......... ESTATE OF SCHRUM DOROTHY M FILE NO.21 04-0101 ACN 101 DATE 02-07-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARV OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAVHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-08-2004 PRINCIPAL TAX DUE:. PAYMENTS (TAX CREDITS): 8,245.39 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-20-2004 CD003853 .00 14,300.00 01-20-2005 REFUND .00 6,054.61- TOTAL TAX CREDIT 8,245.39 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 lIE IF PAID AFTER THIS DATE, SEE REVERSE "S SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, vnu MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIV1~lnX~' INHERITANCE TAX DIVISltlN . , PO BOX 280601":~ . HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEKENTL ALLOKANCE OR DISALLOKANCE OF DEDUCTIONIS. AND ASSESSIIENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-15~1 EX IFP 112-00 2r] DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-14-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 183-18-6546 04000183 Anount Re..i Hed DOROTHY M ORPHi.::: :/. .' CHARLES'! !t\'fncSCHRUM .....j\), . 573 POLECAT RD lANDISBURG PA 17040 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iifv:is4-i-EX--AFP--coi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-14-2005 ESTATE OF SCHRUM DOROTHY M DATE OF DEATH 01-19-2004 COUNTY CUMBERLAND FILE NO. 21 04-0101 TAX RETURN WAS: S.S/D.C. NO. 183-18-6546 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04000183 FINANCIAL INSTITUTION: SAVINGS BONDS ACCOUNT NO. 183186546 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 06-25-1998 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 32.020.00 0.500 16.010.00 .00 16.010.00 .15 2.401.50 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-22-2004 CD004768 .00 2.401.50 BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-23-2004 TOTAL TAX CREDIT 2.401.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. 16.91 TOTAL DUE 16.91 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR). YOU "AY BE DUE A REFUND. -pp R",.."'a.,., "Tn~ n~ TNYS FORM FOR INSTRUCTIONS. ) , , \ , \ \ - - c-:; ~', ...<~ "".., ?::) '. ^, ~ ..-' ~-- ,.1 ~.-, '-~' . '~ ~ ~ --+- '-t 5 r0 (") c.-) e. ~ '-- Sc8 ,s :fi~ ~~ ") ~~ ;l cI, ~/' ) '>'- - ) -::: - ~ - - - - - - ::;. - - <' o i'} i') .... ,"-' <' o t;. 4. .. 'i ~i ~... s;i i"" Do... ...0 0.. $i ':os. ~~ It i~ $ 5 s. .. ~ ~ " ~ '0 .. o '" .., 1 ....r"c::.otr .... \l\ ... %\1\ ~ C) ClJC= 4""..0 .,.. o O~-,\tO' r.I N1D'CO.-4D' ,$~..:tW~~ ~ ~&...-c:t~}.O \ \~I~:)t04' rnt,.)..-'" _..0",,",0 Cl' tn Q ,- .4. e~ ~~ ~..~ ~~'a\'A ...~...~ i\ ~~cg ;\~j '8 """ ...i\~ 'bl!lt'6 "'\ii'!!... ~l;1 ~.. .. '!a'a $ 'd,o: ",Ill '612' "'i,..U ",0 ...12 "'~"'S~S .........6l/lU 4.~~~U!!l4. 12'l", . \Z. ~ ... ~a ~ a~ ~ ;:~ ~ ""'~ t: i" ... j..4~~t ~~t~ ~~~; i\~\ ., o .. 'i ~ ~ Do u.I ';. % y^ \ ~ ... 'J '\ ~"'~~L\ '5. oj B ~ ~\ \II Io-'l 0 u.~ ... " t.l 4. I 5\ cA u- .. -< I'l' ~ 0 ca .. ~ fit \ ~D'4W-"cJ ~ Do u.I ...... -) ~. ~ ~ ~ ~ ? ~\ ~....~-;., ' '$. CD ':) 4: ~\ () ~ u u u.\ u1 s\ "'~ ,~ 0' ~ ...\ ;;;! ... 1~ { 0--;1\ o 'f'-.- ~ ~ '\; ~~ ( f'-.-.~~ ~ ''"7- - ~ t. V) f ~ i 0 r .J f...-J ~\ r... ...1 -.. J,\ J ~. ~ '- ;;. ~\ P ~ f> $\ ~~ ,,/,....\ r'ci\ <:>! /.. 's 0\ ~ ':j 2. ~\ ..r:. 1\ ~ ';\ \ll u\ G~ c> '" \' ~ ~ '" .... ",tI> ...... .... ~'" $0<>- ~'5 :SO"' t.l... "'-, .... :so u.I '" 7'-'.. "''''", '" ",,,, ~tI>C:> "'....'" \-\ ~ H ~ ~.. [<iii .. '" .. , " Ii "'~ , ~ . 0 ~ . l ~ . C. t ". !} g ':; . . " . . ~ ..~ p: ~~ " . ~ ~~ ". 0 0 .. " '& ~. ~ , . :r. 0 , '" , \ . . , ~ il' ~ ~ . , . 1 . ~ '" ~ 'C . ... :r. . ~ :r. . . . . ~ ~ , ~ " 'g. 0 1i\ . '" e. ~ ~ !!\ " SO !:l . . ~ ~ .. '" ~ ~ ~ i :: , '!' l . p ~ g ~ ~ .. II '" . ~ I! I! " ~ . ~ 'e. . l\' I! ~ , . l\' ~ ~ " t: tl . . .. ~ ~. N 0 , 0 [ 'f' ~ g ~ N ~ .. .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SCHRUM ROBERT E 311 WEST RIDGE ROAD DlllSBURG, PA 17019 -------- fold ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-0101 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 03/31/2005 POSTMARK DATE: 03/30/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 NO. CD 005136 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04000186 I $3.80 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2316 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $3.80 GLENDA FARNER STRASBAUGH REGISTER OF WillS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEP\RTME~T OF REVENUE INliE.RITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS '* REV-1604 EX AFP (03-05) CHARLES D SCHRUM 573 POLECAT RD LANDISBURG PA 17040 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-24-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 183-18-6546 04000183 Allount Rellitted DOROTHY M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT ~OUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 03-24-2005 ESTATE OF SCHRUM DOROTHY M DATE OF DEATH 01-19-2004 COUNTY CUMBERLAND FILE NO. 21 04-0101 ADJUSTMENT BASED ON: S.S/D.C. NO. 183-18-6546 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 04000183 FINANCIAL INSTITUTION: SAVINGS BONDS ACCOUNT NO. 183186546 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 06-25-1998 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 32.020.00 0.500 16.010.00 .00 16.010.00 .15 2.401.50 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR:. TAX PAYMENT TO THE'.R.~.~ISTE~;:.F WILLS! AT THE ADDRESS' SHeWN AB.OVE.\, MAKE CHECK OR MO~E~~ORD.Ei PAY4B~t TO: IIREGISTER OF:lrI~LLS,I AGENt~'I: TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) . AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) .' . (") 12-22-2004 CD004768 .00 2.401.50 (>"'1 12-22-2004 WRITEOFF .00 16.91 TOTAL TAX CREDIT 2.401.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE 00 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). . ..~.. UAV R~ rufF A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) ~s"'" REV.1470 EX (fHl8) '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FilE NUMBER REVIEWED BY ACN 21 04-0101 04000183 Dorothy M. Schrum Steven James ITEM SCHEDULE NO. EXPLANATION OF CHANGES The accrued interest on the above referenced ACN has been waived by the department. ROW PaQe 1 ----~-,---"-----,- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIIIlIQ;(WS!fn INHERITANCE TAX DIVISIDIf-","-i' "0-_'''_ PDIOX 210601 -~ '--. ' HARRISIURS PA 17121-0601 ,"C NOTICE OF INHERITANCE TAX ',;'APPIlAISENENT, ALLIIIIANCE OR DISALLIIIIANCE :<OF DEDUCTIONS, AND ASSESSMENT OF TAX ON " ' .llIINTL Y HELD OR TRUST ASSETS REV-lS41 EX AFP (03-05) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN'DC ACN 05-02-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 183-18-6546 04000184 -..t R_1 tt... DOROTHY M C. JANE (-I.' GERBER 6600 HARMOMv GROVE RD DOVER PA 17315 I MAKE CHECK PAYABLE AND REMIT PA~MENT TO: REGISTER OF WILLS I CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1~-~'1ri!!r~~1r~""'.................................................................................... NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ABSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS D T 05 ESTATE OF SCHRUM DOROTHY M DATE OF DEATH 01-19-2004 COUNTY FILE NO. 21 04-0101 TAX RETURN WAS: S.S/D.C. NO. 183-18-6546 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04000184 FINANCIAL INSTITUTION. SAVINGS BOND ACCOUNT NO. 183186546 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-09-1990 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Allount Tax Rate X Tax Due 5,394.00 0.500 2,697.00 .00 2,697.00 .15 404.55 i NOTE: TO INSURE PRDPER CR~DIT TO YOUR ACCOUNT, SUBMI~ THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYME~T TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAkE CHECK DR MONEY ORDER PAY~LE TO: "REGISTER OF WILLS,I AGENT." I i TAX CREDITS: ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2004 CDo04758 .00 404.55 I BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-21-2004 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE ! .00 INTEREST AND PEN. I 2.76 TOTAL DUE 2.76 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . IF TOTAL DUE IS LESS THAN 11, NO PAYMENT IS RElIUIRED. IF TOTAL IlUE IS REFLECTED AS A "CREDIT'" ( CR), YOU IIAY BE IIllE A REFUND. SEE REVERSE SIDE OF THIS FORlt FOR INSTRUCTIONS. ) BUREAU OF INDIVIOUAL- 'fAXEIN INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 '. .1"1'..,: -I' . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE :INHER:ITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05 ,...",,..," t,.f~. '/ be,. " l; 7 O;JJ11i\, 1- In z: DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-09-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 04000186 Allount R_i ttlld DOROTHY M r\ -0'( /",1= ..,_t", ;~h. O n ',~t"-0 01;; D R"..+J1,\;\ I.,J 1..1 ,.1\..,1 (1 ANDREW rl !,.Ae~RUM) I"G 132 BLUEttrll SCHOO RD DOYER PA 17315 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper cred t to your account, subnit the upper portion of this fo~ with your tax payment. CUT ALONG THIS LINE _~~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ............................... ................................................................................ REY-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHRUM 1l0ROTHY M FILE NO.21 04-0101 ACN 04000186 DATE 05-09-2005 THIS STATEHENT IS PROVIDED TO AD ISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMEO ESTATE. SHOWN BELOW IS A SUHftARY OF THE PRINCIPAL TA DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT 0 RECORD ADJUSTMENT: 03-01-2005 PRINCIPAL TAX DUE: 404.55 PAYMENTS (TAX CREDITS): PAYMENT DATE 01-10-2005 03-30-2005 RECEIPT NUMBER CD00485 CD00513 DISCOUNT (+) INTEREST/PEN PAID (-) .00 3.80- AMOUNT PAID 404.55 3.80 TOTAL TAX CREDIT 404.55 .00 .00 BALANCE OF TAX DUE INTEREST AND PEN. . IF PAID AFTER THIS OATE, SE REVERSE SIDE FOR CALCULATION OF ADD TIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $ , NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTEO A A "CREOIT" (CRI, YOU HAY BE DUE A REFUND. SE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I TOTAL DUE .00 ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .. BUREAU OF INDIvtii.!JAL.TAXE$ INHERITANCE TAX DIVISIOK PO BOX 280601 HARRISBURG PA 11128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON .JOINTLY HELD DR TRUST ASSETS REY-1548 EX AFP (03-05) ,~ ~ I fij: "'") ,--- "" DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 06-13-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 183-18-6546 04000185 AoIaunt R_itted DOROTHY M ANNA ClJH.l'fDXLLEif 4531 STATE RT 410 LOWVILLE NY 13367 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1~-iCI'1ri!!:~~~a~~1.................................................................................... NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-13-2005 ESTATE OF SCHRUM DOROTHY M DATE OF DEATH 01-19-2004 COUNTY CUMBERLAND FILE NO. 21 04-0101 TAX RETURN WAS: S.S/D.C. NO. 183-18-6546 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04000185 FINANCIAL INSTITUTION: SAVINGS BOND ACCOUNT NO. 183186546 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-09-1990 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 5,394.00 0.500 2,697. 00 .00 2,697.00 .15 404.55 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CRED:ITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 06-21-2005 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 404.55 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 12.78 TOTAL DUE 417 . 33 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REIllIIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I oS~ i :I ~ ~}? ! :] ~ : 5 ~~oJ:: ~=== "'0 0:::0J ~& e~ Qj(?~ -e :>, {Y) (/)0 C: "- (?E.... fl!<a~ ro::r ....' , -, 8-ifl ' (I) <0 0 ~<oa - ~ CY::UcJ .#..J o (,., j',:, "~.. - .-- . -- . f':r .....J () ,..... , ',-1 ,.... III 0 X I '" 0 ~ 0 Q. > J- "- oCt :c: J- x I- Z '" 0 III 0Cl ~ :IE: 4- 0 III >- ... Q I C ". 0. '" '" J- H \0 '0 ..,9. :IE: III ll\ o,$'r-4Qo,$' . r: 0:: CI ClCIZll\ +' CI Clr-4C\Oo,$' +' ... r6 A N NCI..JICO II Z I XI 1~Cl)r-4 . 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CD 005536 GERBER JANE l 6600 HARMONY GROVE RD DOVER, PA 17315 ACN ASSESSMENT CONTROL NUMBER AMOUNT ___nn_ fold 04000184 $2.76 ESTATE INFORMATION: SSN: 183-18-6546 FILE NUMBER: 2104-0101 DECEDENT NAME: SCHRUM DOROTHY M DATE OF PAYMENT: 07/07/2005 POSTMARK DATE: 07/05/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/19/2004 TOTAL AMOUNT PAID: $2.76 REMARKS: CHECK# 3051 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS BUREAU OF INDIVIDUAL tAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-16D7 EX AFP (03-051 'n DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-27-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 04000185 Anount R_i U.d DOROTHY M ANNA M DILLER 4531 STATE RT 410 LOWVILLE NY 13367 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, sub.it the upper portion of this fora with your tax paYMent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ...............................................................................................................1 REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHRUM DOROTHY M FILE NO.21 04-0101 ACN 04000185 DATE 06-27-2005 THIS STATEMENT IS PROVIOEO TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE MANED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAVHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-13-2005 PRINCIPAL TAX DUE: 404.55 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-29-2005 CD004924 .00 404.55 ANCE OF UNPAID INTEREST/PENALTY AS OF 01-30-2005 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. 4.86 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 4.86 . SIDE FDR CALCULATION DF ADDITIONAL INTEREST. ( IF TOTAl DUE IS LESS THAN $1, NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I ~ BlIIlEAU OF INDIVlDUA~ TAXES INHERITANCE TAX DIVISION PO lax 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT " it; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN WM D SCHRACK 124 W HARRISBURG ST PO BOX 310 DILLSBURG PA 17019-0310 *' REV-16D7 EX AFP (03-05) 06-27-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 101 AIIount Re.i tt.d DOROTHY M 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, sub.it the upper portion of this for. with your tax paYMent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHRUM DOROTHY M FILE NO.21 04-0101 ACN 101 DATE 06-27-2005 THIS STATENENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHDHN BE~OlI IS A SUNNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-15-2004 PRINCIPAL TAX DUE: 8,245.39 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-20-2004 CD003853 .00 14,300.00 01-20-2005 REFUND .00 6,054.61- TOTAL TAX CREDIT 8,245.39 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . ~ SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, ND PAYMENT IS REqUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE A REFUND. SEE REVERSE SmE OF THIS FOHN FOR INSTRUCTIONS. I nr-('f,D'yn n[[I('r- rr' BUREAU OF INDIVIDUALrr:AxES;......:~, Vi'! :\J~ .J: INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I:NHERI:TANCE TAX STATEMENT OF ACCOUNT *' REV-16D7 EX AFP (03-05) eLEGY c= OP~: ' JANE CL'GERBER 6600 HARMONY GROVE RD DOVER PA 17315 ',\ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-08-2005 SCHRUM 01-19-2004 21 04-0101 CUMBERLAND 04000184 A.aunt R..ittad DOROTHY M zeDS t~UG 12 Pi~ I: 08 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 t.x payment. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS - --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHRUM DOROTHY M FILE NO.21 04-0101 ACN 04000184 DATE 08-08-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SunHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 05-02-2005 PRINCIPAL TAX DUE: 404.55 PAYMENTS (TAX CREDITS): PAYMENT RECEI PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2004 CD004758 .00 404.55 07-05-2005 CD005536 2.76- 2.76 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J :::.~ ~ BUREAU OF INDIVIDUAL fliiOORDED OFFiCE CF INHERITANCE TAX DIVISION ' . "", PO 80X 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I:NHERI:TANCE TAX STATEMENT OF ACCOUNT * REY-16D7 EX AFP (03-05) ( , DATE ESTATE OF DATE OF DEATH FILE NUIUlER COUNTY ACN 08-22-2005 SCHRUM 01-19-2004 21 04- 01 01 CUMBERLAND 04000185 Amount R_i tted DOROTHY M lO'O' ,'I 'C: 10 r", ',' li: 23 U h,., '.; ..., ANNA III) !lILLER 4531 STATE RT 410 LOWVILLE NY 13367 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, sub.it the upper portion of this for. with your tex paYMent. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS - ---------------------------------------------------------------.--.-------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHRUM DOROTHY M FILE NO. 21 04-0101 ACN 04000185 DATE 08-22-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, TNE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-13-2005 PRINCIPAL TAX DUE: 404.55 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-29-2005 CD004924 .00 404.55 07-25-2005 CD005633 4.86- 4.86 TOTAL TAX CREDIT 404.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS. )