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Home My WebLink About03-0476 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Ardella N Fitzpatrick also known as Ardella Wells Fitzpatrick No. Ardella N Fitzpatrick Linda Kay Deitzel Petitioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased Social Security No. 189090082 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix ~-~ Decedent, dated 01/15/2002 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 incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minodtate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 3026 Harvard Ave, Camp Hill~ PA 17011 (list street, number and municipality) Decedent, then 87 years of age, died April 13 ,2003 , at Manor Caret Camp Hill~ Cumberland Co~ PA Decedent at death owned property with estimated values as follows: (Location) (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania Total Real Estate situated as follows: 3026 Harvard Avenue, Camp Hill Borough, Cumberland County, Pennsylvania, Parcel Identifier 01-22-0533-072 13~000.00 120~000.00 133,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Linda Kay Deitzel 3413 Chestnut Street Camp Hill~ PA 17011 6£:z~ oL Nnr Oath of Personal Representative Commonwealth of Pennsylvania Courlty of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this.. ~,~-~-~- day of DECREE OF REGISTER Estate of Ardella N Fitzpatrick Deceased No. ~ also known as Ardella Wells Fitzoatrick Social Security No: J 89090082 Date of Death: 04/13/2003 AND NOW, ~ /O , .2003 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary I~1 of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to Linda Kay Deitzel in the above estate and that the instrument(s), if any, dated January 15, 2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. Letters Short Certificate(s),~. ...... ~... Renunciation ...~..~....'~.,.~.. ........ Affidavit ( ) ....................... $ Extra Pages (5 x $3) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other. FEES TOTAL ............................. $ .. RW-7A 235.00 9.00 10.00 15.00 10.00 279.00 Attorney: Jan L Brown I.D. No: 67993 Address: 845 Sir Thomas Court Suite 12 Harrisbur,q PA 17109 Telephone: 717-541-5550 DATE FILED: ~J)-10- ~)~ L~-10--05 6E':ZI~ O[ Nnr BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of Ardella N Fitzpatrick also known as Ardella Wells Fitzpatrick Ardella N Fitzpatrick , Deceased The undersigned, Elois Mae Dunham~ niece and named Co-Executor (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamenta.,,! Witness my of be issued to Linda Kay Deitzcl hand this O~ day of May ,2003 (Signature) P.O. Box 334 Mansfield OH 44901 (Address) (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this Z~) day of I~ary Public .~.~ (,~ My Commission Expires: 7t/~ /7, (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission,) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of Ardella N Fitzpatrick also known as Ardella Wells Fitzpatrick Ardella N Fitzpatrick , Deceased The undersigned,.'l'heodore I WeSson and named beneficiary_and Co-Executor (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamentarv be issued to.Linda Kay Deitzel Witness ' -~' . day of_May . ~ 2003 . - /(,~nature) 602 20th Street S 6,/ Arlington VA 22202 (Address) (Sig.~[ure) (Address) (Signature) (Address) . of Sworn to or affirmed and subscribed before me this '~- ~ day of My Commission~.j~s: ) _ ~ / - ~_~© (~_~ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's COmmission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 6F_.: gkl fit Nfl? ~0. 6£:~W Ot NOr £0. 002004-00003/1.14.02/RWS/DCP/153564.1 OF ARDELLA N. FITZPATRICK I, ARDELLA N. FITZPATRICK, of the Borough of Camp Hill, 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 all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE H I bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities) as are set forth in a separate unsigned memorandum which I shall place with my Will to the persons therein designated, i bequeath the residue of such items to my son, THEODORE I. WELLS, JR., if he is then living. If he is not then living, I bequeath such items to my grandson, THEODORE I. SWEENEY. ARTICLE IH I devise and bequeath the residue of my estate of every nature and wherever situate as follows: 002004-00003/1.14.02/RWS/DCP/153564.1 A. Thirty (30%) percent thereof to my son, TI-IEODORE I. WELLS, JR., if survives me. If my son, THEODORE I. WELLS, JR., fails to survive me, his share shall be added to and treated as a part of the share created in paragraph B below. B. Ten (10%) percent thereof to my grandson, THEODORE I. SWEENEY, if he survives me. Should my grandson, THEODORE I. SWEENEY, fail to survive me, his share shall be added to and treated as a part of the share created in paragraph A above. C. Sixty (60%) percent thereof to the Trustees hereinafter name IN TRUST for the following uses and purposes: 1. To invest and administer the fund in accordance with the Probate, Estates and Fiduciaries Code of Pennsylvania. 2. To consult with my nieces, ELOIS MAE DUNItAM and LINDA KAY DEITZEL, with respect to the circumstances and needs of my daughter, SItEILA WELLS SI-IULER, and on the basis of such consultation, make a determination as to whether her circumstances and needs are such as to require a regular allowance fi.om the Trust Fund to meet the needs of her daily living, and if so, the amount of such allowances (the discretion of the Trustee to be determinative in the matter) and to pay such amount throughout her lifetime, adjusted fi.om time to time as her circumstances indicate. 3. Should my said daughter SHEILA WELLS SItULER, experience a medical or other emergency which requires the expenditure of funds for her in addition to the regular allowance, if any, determined in accordance with the previous paragraph, to expend fi.om the principal of the Fund the amounts required to meet such special needs or circumstances. 4. Should my daughter require extended confinement or residence in a hospital or convalescent home, the Trustee shall not be empowered to expend principal for her benefit. 5. Upon the death of my daughter, SI-IEILA WELLS SItULER, the principal or any accumulated or undistributed income shall be distributed as follows: 002004-00003/1.14.02/RWS/DCP/153564.1 A. One-half thereof to my son, THEODORE I. WELLS, JR., if he is living and if he is not then living, his share shall be added to the share created in subparagraph B below. B. One-half thereof by my grandson, THEODORE I. SWEENEY, if he is then living and if he is not then living, his share shall be added to and treated as a part of the share created in subparagraph A above. 6. The interest of any beneficiary while in the Trust shall not be subject to assignment, anticipation, pledge or alienation by or against the beneficiary. 7. I direct that for the purposes of administration, this Trust be combined with any Trust I have established during my lifetime with the Trustee herein named. ARTICLE IV I appoint BARBARA STEPHENSON and JANICE KOHLER, Trustees of any Trust created under this my Last Will. ARTICLE V I appoint my nieces, ELOIS MAE DUNHAM and LINDA KAY DEITZEL, and my son THEODORE I. WELLS, JR., Executors of this my Last Will and Testament. Should all of the foregoing individuals fail to qualify or cease to act as Executors, I appoint BARBARA STEPHENSON and JANICE KOHLER, Co-Executors of this my Last Will. ARTICLE VI I direct that no fiduciary shall be required to post bond in connection with their duties. 002004-00003/1.14.02/RWS/DCP/153564.1 IN WITNESS WHEREOF, I have hereunto set my hand and seal, this jSft~ day of .)a ~ ~ ~ , 2002. ARDELLA N./F~~ - SIGNED, SEALED, PUBLISHED AND DECLARED, by ARDELLA N. FITZPATRICK, the Testatrix above named, as and for her Last Will and Testament and in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Witness '~~ Witness -- 002004-00003/1.14.02/RWS/DCP/153564.1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : I, Ardella N. Fitzpatrick, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Ardella N. Fitzpatric~//~/ ~4~ Sworn t~.~ar affirmed and acknowledged before me, by Ardella N. Fitzpatrick, the Testatrix, this [ D v ~day of ,~ )~ CIO O, fxI ,2002. Notary Public ~ C. Pmmer, Notary Public ~ Bo¢o. Cu~ County 002004-00003/1.14.02/RWS/DCP/153564.1 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : We,. ~ ,¢¼~.,.J ~, ~'+~,,:,,~k-- and ~_'~34~;x,,~ ,a e. 1., e. ,., ~,~ , the wimesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~C[-~-4 ~,~. ~}txt.r~c¥ , witnesses, this 15 ~x day of ,-'3'-~C~ ar,I ,2002· and Notar~l Se~ Dada C. Parmer, Notary Public Lemoyne Boro, Cumbe~and Counly My Cornmissi(m Expires Dec. 29, 2005 Notary Public OF ARDW..r.rA N. FITZPATRICK JOHNSON, DUFFIt~, STEWART & WEIDNER ATTORNEYS AT LAW LEMOYNE, PENNSYLVANIA 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 002786 BROWN JAN L 845 SIR THOMAS COURT HARRISBURG, PA 17109 ........ fold ESTATE INFORMATION: SSN: 189-09-0082 FILE NUMBER: 2103-0476 DECEDENT NAME: FITZPATRICK ARDELLA N DATE OF PAYMENT: 07/10/2003 POSTMARK DATE: 07/09/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,000.00 TOTAL AMOUNT PAID: $6,000.00 REMARKS: SEAL CHECK# 91 INITIALS: AC RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ' JAN L. BROWN & ASSOCIATES ATTORNEYS AT LAW OLDE ENGLISH GAP 845 S~R THOMAS COURT SUITE 12 HARRiSBURg, PA 17109 '03 J'.JL't0 "' ~' Register of Wills ,,t ~'~' . Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ardella N Fitzoatd(;k Date of Death: 04/13/2003 Will No. 2003-00476 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 08/26/2003 · Name Address Theodore I Wells Jr Theodore I Sweeney Sheila Wells Shuler cio Carole L Conn0r POA Robert J Fitzpatrick c/o Scott R Fitzoatrick Executor 602 20th St S Arlinqt0n VA 22202 1081 Camellia Ln Sui~un (~ity CA 94585 3387 Braemar Dr Chamb~rsburq PA 17201 1917 Felker Rd Middletown PA 17057 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 08/26/200;~ Capacity: Name: Jan L Brown & Associ{it~, Address: 845 Sir Thomas Court Suite 12 Harrisburq PA 17109 Telephone(717) 541- 55~50 Personal Representative Counsel for Personal Representative EV-1500 EX + (6-00) DECEDENT~S NAME (LAST, FIRST, AND MIDDLE INITIAL) .~lla N DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 04/13/2003 02/10/1916 {iF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Robert J Fitzpatrick L'--~i. Odginal Retum [~4, Limited Estate r~6. Decedent Died Testate (Ntach copy of Wi#) [] 9. Litigation Proceeds Received --']2. Supplemental Retum [-'"~ 4a. Futura Interest Compromise (d~ ofde~ a~r 12-12-82) r-~7, Decedent Maintained a Living Trust (A~ach copy orTrust) O 10. Spousal Poverty Cradit (da~e of ~eat~ bet'~ee. 12.31.gl and 1.1.gS) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 4 7 6 · COUN37 CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 8 9-0 9-0 0 8 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Retum (dateofdeathp~orto 12-13-82) ["--~ 5. Federal Estate Tax Return Requirad ~ 8. Total Number of Safe Deposit Boxes ~ 11. Election to tax under Sec. 9113(A) (^ach Sch O) NAME Jan L Brown FIRM NAME (If Applicable) Jan L Brown & Associates TELEPHONE NUMBER 717-541-5550 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 845 Sir Thomas Court Suite 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIBE FOR APPLICABLE RATES 120~000.00 27~178.89 PA 17109 OFFICIAL USE ONLY (8) 26~617.83 190.44 (11), (12) (13) (14) 1477178.89 267808.27 1207370.62 120~370.62 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 120~370.62 x (15) x .045 (16) x ,12 (17) (18), (19) X .15 57416.6R 5~416.68 Decedent°s Complete Address: S ~ ~ET ADDRESS 3026 Harvard Avenue CITY Camp Hill ISTATE PA J ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 6,000.00 270.83 (1) 5,416.68 Total Credits ( A + B + C ) (2) 6~270.83 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 854.15 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 BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .............................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEBULE G AND FILE IT AS PART OF THE RETURN. Under I~. nalties of perjury, I declare lhat I have examined this return, includin~l accompanying schedules and s~e[Te,,i~ and to lhe be knowledge and belief, it is flue, correct and complete. Declaration of preparer other than the personal representative is based on all ~nformalJon of which preparer has any knowledge, st of my SIGNATUR~E OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS' 3413 Chestnut Street~ ~ ' ' ' Carr~ Hill SIGNATURE OF PR A EROT,'~"~T REPEE n~ PA 17011 .~'DDRESS 8~_~' Thomas Court Suite 12 01/09/2004 H~,i~ur,q 01/09/2004 ~ ~ ~ ~ PA 17109 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) ti)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502EX + (1-97} ESTATE OF FILE NUMBER FiLzDatrick Ardella N 21 03 0476 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 properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, beth having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of ) must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 3026 Harvard Avenue, Borough of Camp Hill, Cumberland County, Pennsylvania See Settlement Statement dated 12/29/2003. TOTAL (Also enter on line 1, Recapitulation) $ VALUEAT DATE OF DEATH 120,000.00 120~000.00 ('If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) I ' COMMONWEALTH OF PENNSYLVANIA ICASH, BANK DEPOSITS, & MISC. ESTATE OiNHERITANcE TAX RETURN Fitzpatrick Ardella N FILE NUMBER 21 03 047~ Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship roust be ¢~i~c;osed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Waypoint Bank OF DEATH Certificate of Deposit 455300213 5,585.17 2 Waypoint Bank Certificate of Deposit 453269391 7,357.49 Waypoint Bank Certificate of Deposit 456272254 8,688.44 4 Jan L Brown & Associates Check 5259 dated 4/24/03 representing refund 3,725.00 5 Real estate tax/sewer reimbursements See Settlement Statement dated 12/29/2003. 822.79 6 Household goods 1,000.00 TOTAL (Also enter on i) $ (If more space is needed, insert additional sheets of the same size) 27,178.8,9 REV-1511EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fitzpatrick Ardell{I H Debts of decedent must be reported on Schedule I. ITEM NUMBER 7 8 9 10 11 12 13 14 15 16 17 FUNERAL EXPENSES: SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 03 DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pemonal Representative ts) Linda K Deitzel Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 3413 Chestnut Street 284-40-5401 City Camp Hill state PA Year(s) Commission Paid: 2004 Attorney Fees Jan L Brown & Associates Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip 17011 Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Register of Wills, Cumberland County Accountant's Fees Tax Return Preparers Fees Clarke American; estate check order Cumberland Law Journal; legal advertising The Patriot-News; legal advertising Vital Records, additional death certificates Michael W Harling, Tax Collector; school taxes at 3026 Harvard Ave Erie Insurance Group; homeowner's insurance at 3026 Harvard Ave PPL Electric Utilities; electric at 3026 Harvard Ave Pennsylvania American Water Co; water at 3026 Harvard Ave Borough of Camp Hill; sewer at 3026 Harvard Ave HB McClure Company; fuel oil at 3026 Harvard Ave Landscape maintenance at 3026 Harvard Ave Joseph Solomon; household contents packaging! and removal TOTAL (Also enter on line 9, Recapitulation) $ 0476 AMOUNT 4,959.00 7,359.00 316.00 8.50 75.00 193.87 9.00 1,580.79 164.50 176.15 93.39 60.00 23.73 1,034.90 750.0t) (If more space is needed, insert additional sheets of the same size) 26~617.83 Continuation of REV-1500 Inheritance Tax Return Resident Decedent Fitzpatrick Ardella N 21 03 Pa,qe 1 Schedule H - Funeral Expenses & Administrative Costs - B7. 0476 ITEM NUMBER 18 DESCRIPTION Real estate closing costs; see Settlement Statement dated 12/29/03 AMOUNT 9,814.00 SUBTOTAL SCHEDULE H-B7 9,814.00 REV-1512 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fitzpatrick Ardella N SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIESr & LIENS Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, Mobile X-Ray Imaging Inc; outstanding medical bill 2 Penn Waste Inc; refuse for year 2003 FILE NUMBER 21 03 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 047~ AMOUNT 27.48 $ 190.44 162.96 I SCHEDULE J J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN / ESTATE OF FILE NUMBER NUMBER [. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal dls~ibutions, and transfers under Sec. 9116 (a)(1.2)] Theodore I Wells Jr 602 20th St S, Arlington, VA 22202 Theodore I Sweeney 1081 Camellia Ln, Suisun City, CA 94585 Testamentary Trust fbo Sheila Wells Shuler cio Barbara Stephenson & Janice Kohler, Trustees Under Will 21 03 04.7{~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE son grandson daughter household goods 30% residuary Estate 10% residuary Estate 60% residuary Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: =~~==~==~= A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Ii - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) A. Settlement Statement B. Type of Loan U.S. Department of Housin~ and U~en Development ~ -ir' OMB No. 2502-0265 1. [] FHA 2. [] FmHA 3. [] Conv. Unins IFile Number Loan Number I Mortgage Insurance Case Number 4. [] VA 5. [] Cony. Ins. I 25966 C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "p.o.c" were paid outside of closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: DOROTHYH. LAYTON E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: ,PA ES TA TE OF ARDELLA N. FITZPA TRICK ,PA G. PROPERTY 3026 HARVARD AVENUE LOCATION: CAMP HILL, PA 17011 H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: TIN: CEDAR CLIFF ABSTRACT AGENCY, INC. 4f4 Bridge Street, New Cumberland, PA 17070 23-2133165 I. SETTLEMENT DATE: 12/29/2003 J. SUMMARY OF BORROWER°S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 101. Contract Sales Price 102. Personal Property 103. Se01ements charges to borrower: (from line 1400) $2,297.25 104. 105. $5.60 $816.54 $0. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 106. City/town taxes to 107. County Taxes 12/29/2003 to 01/01/2004 106. Assessments12/29/2003 ~o 07/01/2004 109. ,.w~'w~'R PRORATION 110. 111. 112. 120. GROSS AMOUNT DUE FROM BORROWER: $123,120.04 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 201. Deposit or earnest money 202. Principal amount of new loan{s) 203. Existing loan(s) taken subjecl to 204. 205. 206. 207. [%~:n~T TO ~uz~ FOR RADON MITIGAT. 208. 209. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/town taxes to 211. County laxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. 220. TOTAL PAID BY/FOR $2,000.00 BORROWER: 300. CASH AT SETTLEMEN~ 301. Gross amount due from borrower (Fine 120) 302. Less amount paid by/for borrower (line 220) ~303. CASH ( ~FROM ) ( ~] TO ) BORROWER: I RESCISSION DATE: SUMMARY OF SELLER'S TRANSACTION 400. GROSS AMOUNT DUE TO SELLER: 401. Contract SaFes Price 403. 404, 405. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 406. City/town Taxes to 407. County Taxes 12/29/2003 to 01/01/2004 408. Asse&~,%~nts12/29/2003 tO 07/01/2004 409, ,'.w~w,a;R PRORATION 410. 411. 412. 420. GROSS AMOUNT DUE TO BF~ t eR: 500. REDUCTIONSINAMOUNTDUETOSFIIFR: 502. Settlement charges to seller (line 1400) n subject to Payoff of lirst mortgage loan loan 506. $5.60 $816.54 $0. 65 $120,822. 79 $9,164.00 507. ~,~Z)IT TO BUZZER FOR RADON MITIGAT. $650. O0 508. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: I. City/town taxes to County taxes to 512. Assessments to 513. 514. 515. 516. 517. 518. $9,814. O0 $120,822.79 $9,814.00 $111,008.79 519. $2~ 650. O0 520. TOTAL REDUCTIONS IN AMOUNT DUE TO SELLER: ~' TO/FROM SELLER $123,120.04 601. Gross amount due to seller (line 420) 602. Less reductions in amt. due seller (line 520) $120,470.o4 603. CASH (~-]FROM) (~]TO) SELLER: HUD-1 (3-86) - RESPA, HB 4305.2 PAGE 1 HUD-1 (Rev. 3/86) L. SE I I LEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION 8ASEDONPR[CE $120,000'00 ~ 6 %~ $7,200.00 DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: 701.$7r200.00 to Ei~A-NRT~ .~NC. 702. to 703. to 704. to 705. Commission pale at seffiement 706. ~ EINCONN TIONWITHL AN: 801. Loan origination fee 802. Loan discount % 803. Appraisal fee to: 804. Credit report to: 80§. Lender's inspection fee 806. Mortgage insurance application fee to 807. Assumption fee 808. 809. 810. 811. 902. Mortgage insurance premium for m~s. to 903. Hazard insurance premium 1er yra. to 904. Flood insurance premium for yrs. to 905. 1000. R V P T D O R: 1001. Hazard insurance months ~ per month 1002. Mortgage insurance months @ per month 1003. City property taxes months ~ per month 1004. County properly taxes months ~ per month 1005. Annual assessments months ~ per month 1006. Flood insurance months ~ per month 1007. months I~ per month 1008. months ~ per month 1009. Aggregate Accounting Escrow Adjustment 1101. Settlement or dosthg tee to 1102. Abstract or itUa search iD 1103. Title examlea~ion to 1104. Title insurance bleder to 1108. D~cumen[ preparation to 1107. Attomey*s tees to (includes above items Numbers: $120,000.00 ) PAID FROM BORROWER'S FUNDS AT SETTLEMENT OM8 NO. 2502-0265 PAID FROM SELLER'S FUNDS AT SETTLEMENT $7,200.00 $958.75 I · ~""~1~ ; Mortgage ; Releases Deed - $1,200.00 $1,200.00 Seller or Date: Borrower: Date: ~ Agent: The HUD-1 Settl .... t Stat .... t which I have prepared is a t ..... d ...... t ...... t Of this t ...... lion. I h ...... se~.,.~.~se the f~nds to be disbursed ...... d .... Da Date: ~ Settlement Agent!/GERAi:~..~.~ SHEKLETSKI WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a line and imprison- ment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. 1201. Recording fees: 1202. City/county lax/stamps: Deed $2,400.00; Mortgage 1203. State taldstampe: Deed ; Modgage 1204. 1205. 130 ~,DDI INA SE LEMEN HAR : 1301. Survey to 1302. Pest ~lspectinn to $260. O0 1303. O]~D P~ & ~Z, ID~I~. - ~ L. BHO~ & A$$0C $100. O0 $100. O0 1304. TI~I~$ACTZON F~.E - ER~.-NHT, ZHC. $5. O0 1305. TAX CERT FEE - ~CHAEL W. HARLZNG $399. O0 t306. HOME W~J~J~NTY - AON HOME W~RR~NT~ 1307. RADON & HOME ZNSPECT. - ENVZROQUEST - POC $2,297.25 $9,164.00 l, 4ha0v% cTar%TfuAil~ rSevEeTwTweLdEthMeEH%TD.C1HsAeRttlGemEe%t Statam,t and to the bast of my knowledge and belief, it isa Irue ~m"~r,ta stat .... t of all .... ipts a.~d disb ....... ts made onmy ...... t or by..me in this t ...... ,ion,/~ further l;~'r, ttfy that ' h ..... calved a coPY of the HUO'I Sitt~'~n&1~~-- Bo ...... -~'~'~,~'~/~/.Z/~"-~ ~-rJ '~.~'~/:'( Date: ~ Ag : - .... N. FITZ-P-ATRiCK ' (/DOROTH~AYt6N / / / ESTATE OF ARDIz£I-A OF ARDELLA N. FITZPATRICK I, ARDELLA N. FITZPATRICK, of the Borough of Camp Hill, 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 all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE I1 I bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities) as are set forth in a separate unsigned memorandum which I shall place with my Will to the persons therein designated, i bequeath the residue of such items to my son, THlgODORE I. WELLS, JR., if he is then living. If he is not then living, I bequeath such items to my grandson, THEODORE I. SWEENEY. ARTICLE IH devise and bequeath the residue of my estate of every nature and wherever situate as follows: A. Thirty (30%) percent thereof to my son, THEODORE I. WELLS, JR., if surmves me. If my son, TI:I]gODORE I. WELLS, JR., fails to survive me, his share shall be added to and treated as a part of the share created in paragraph B below. B. Ten (10%) percent thereof to my grandson, TI:W. ODORE I. SWEENEY, if he survives me. Should my grandson, THEODORE I. SWEENEY, fail to survive me, his share shall be added to and treated as a part of the share created in paragraph A above. C. Sixty (60%) percent thereof to the Trustees hereinafter name IN TRUST for the following uses and purposes: 1. To invest and administer the fund in accordance with the Probate, Estates and Fiduciaries Code of Pennsylvania. 2. To consult with my nieces, ELOIS MAE DUNHAM and LINDA KAY DEITZEL, with respect to the circumstances and needs of my daughter, SHEILA WELLS SHULER, and on the basis of such consultation, make a determination as to whether her circumstances and needs are such as to require a regular allowance from the Trust Fund to meet the needs of her daily living, and if so, the amount of such allowances (the discretion of the Trustee to be determ/native in the matter) and to pay such amount throughout her lifetime, adjusted from time to time as her circumstances indicate. 3. Should my said daughter SHEILA WELLS SHULER, experience a medical or other emergency which requires the expenditure of funds for her in addition to the regular allowance, if any, determined in accordance with the previous paragraph, to expend from the principal of the Fund the amounts required to meet such special needs or circumstances. 4. Should my daughter require extended confinement or residence in a hospital or convalescent home, the Trustee shall not be empowered to expend principal for her benefit. 5. Upon the death of my daughter, SHEILA WELLS SHULER, the principal or any accumulated or undistributed income shall be distributed as follows: A. One-half thereof to my son, TllEODORE I. W-ELLS, JR., if he is then living and if he is not then living, his share shall be added to the share created in subparagraph B below. B. One-half thereof by my grandson, TltEODORE I. SWEENEY, if he is then living and if he is not then living, his share shall be added to and treated as a part of the share created in subparagraph A above. 6. The interest of any beneficiary while in the Trust shall not be subject to assignment, anticipation, pledge or alienation by or against the beneficiary. 7. I direct that for the purposes of administration, this Trust be combined with any Trust I have established during my lifetime with the Trustee herein named. ARTICLE IV I appoint BARBARA STEP[IE, NSON and JANICE KOltLER, Trustees of any Trust created under this my Last Will. ARTICLE V I appoint my nieces, ELOIS MAE DUNBAM and LINDA KAY DEITZEL, and my son TItEODORE I. WELLS, JR., Executors of this my Last Will and Testament. Should all of the foregoing individuals fail to qualify or cease to act as Executors, I appoint BARBARA STEPItENSON and JANICE KOltI,ER, Co-Executors of this my Last Will. ARTICLE VI I direct that no fiduciary shall be required to post bond in connection with their duties. IN WITNESS WItEREOF, I have hereunto set my hand and seal, this i5-pt' .)~ ~ ~r~ ~d0 , 2002. -! ARDELLA N. ~F~qi~I~2 - - day of SIGNED, SEALED, PUBLISHED AND DECLARED, by ARDELLA N. FITZPATRICK, the Testatrix above named, as and for her Last Will and Testament and in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Witness Witness ~ t:b e.3kddres~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : I, Ardella N. Fitzpatrick, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. / - Ardella N. ~ ~'r, Sworn t~ar affu'med and acknowledged before me, by Ardella N. Fitzpatrick, the Testatrix, this I~1'~ . $ _ day of ~ )12t CIO 03-~I _, 2002. Notary Public Notal~al Seal Da~ C. Panner, Notary Public Lemoyne Bom, Cumberland County My Commissio~ Ex~re~ Dec, 29, 2005 COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : We, ~,c¼~.~_~ [/.~ ~;+e,~::,.~ and ~'~Sx~a,o_ ~ ~,e.~~l'~ , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by "~C¥~"~6 \,1-~3~xt~r¥ '~'~¢Ar~,_ ~i ~ , wimesses, this i5 ~x day of ,"~CL~ G.r..~ ,2002. and Notarial Seal Dada C. Parmer, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Dec. 29, 2005 Notary Public BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Fitzpatrick Ardella N also known as Fitzpatrick Ardella Wells Ardella N Fitzpatrick , Deceased No. 2003 00476 Date of Death 04/13/2003 Social Security No. 189090082 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Jan L Brown 67993 Personal Representative: Linda Kay Deitzel Address: 845 Sir Thomas Court Suite 12 Harrisburg Telephone: 717-541-5550 PA 17109 Waypoint Bank Certificate of Deposit 455300213 Description Waypoint Bank Certificate of Deposit 453269391 Waypoint Bank Certificate of Deposit 456272254 Jan L Brown & Associates Check 5259 dated 4/24/03 representing refund Real estate tax/sewer reimbursements Household goods Dated 1/9/04 Value 5,585.17 7,357.49 8,688.44 3,725.00 822.79 Total 1,000.00 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 147,178.89 Fitzpatrick Ardella N Continuation of Inventory Pa,qe 1 Description of Inventory Description 3026 Harvard Avenue, Borough of Camp Hill, Cumberland Co, Pa 2003 00476 Subtotal Grand Total Value 120,000.00 $ 120,000.00 $ 147,178.89 BUREAU OF ZND'rV'rDUAL TAXES TNHERTTANCE TAX DTV1[SI*ON DEPT. Z80601 HARRTSBURE, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-I~07 EX 4FP (01-05) JAN L BRONN '(.~ APR 20 J L BRONN & ASSOCIATES 8q5 SZR THOMAS C~i~Z, .' DATE O$-29-ZOOq ESTATE OF FZTZPATRZCK DATE OF DEATH 0q-15-2003 FILE NUMBER Z1 03-0q76 :33 COUNTY CUMBERLAND ACN 101 Aeoun~ Reei~ed ARDELLA N HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMDERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ to your account, submi'¢ the upper porte-on of this form wi~h your tax payment:. CUT ALONG TH'rS L'rNE ~* RETAIN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) xxx INHERITANCE TAX STATEMENT OF ACCOUNT xxx ESTATE OF FITZPATRICK ARDELLA N FILE NO. 21 03-0q76 ACN 101 DATE 03-Z9-ZOOq THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELO# TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APPLTCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPL/CABLE, A PROJECTED 'rNTEREST F'rGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: O2-23-ZOOq PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 5,q16.68 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 270.83 07-09-2003 03-11-ZOOq CD002786 REFUND .00 6,000.00 85q.15- IF PAKD AFTER THKS DATE, SEE REVERSE SKDE FOR CALCULATKON OF ADDKTKONAL XNTEREST. { KF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REQUKRED. KF TOTAL DUE KS REFLECTED AS A "CREDXT" TOTAL TAX CREDIT 5,~16.68 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORM FOR ZNSTRUCTZONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- if NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, nay be requested by completing an "'Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1S15). Applications are available at the Office of the Register of #ills) any of the Z3 Revenue District Offices or from the Department's Zq-hour answering service for fores ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. IS0601) Harrisburg, PA 17lIS-g601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within throo (5) calendar months altar the dacedant's doeth, a five porcont (SZ) discount of the tax paid is allowed. PENALTY: 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .000164. AL1 taxes which became delinquent on and after January l, 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 ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year__ Rate Factor XeBZ lOX .000548 1988-1991 XXZ .O003Ol gOOX 9Z .000247 1983 16Z .000q38 1992 9Z .O00Zq7 ZOOZ 6Z .O00X6q 198q llg .000301 1993-199q 72 .O00IeZ 2005 52 198S 13Z .000356 1995-1998 92 .O00Zq7 2004 qg .000110 1986 XOZ .O00Z7q 1999 7Z .O0019Z 1987 9Z .000Z47 ZOO0 82 .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shoan on the Notice, additional interest must be calculated. REV*15OO EX + (6-00} COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 COUN'Pf CODE YEAR 0 4 7 6 -- -- ~'UMBER-- DECEDENTS NAME {LAST, FIRST, AND M~ODLE (NITIA[ SOCIAL SECURITY NUMBER Z FitzpatdckAFdel~a N 1 8 g - 0 g - 0 0 8 2 K") DATE OF DEATH IMM-DD-Year) DATE OF B)RTH/MM-D[~Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U,I REGISTER OF WILLS (,) 04/1 3/2003 02/1 0/1 916 I-- Z UJ Z ILl ~Y (IF APPLICABLE) SURV VING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Robert J Fitzpatrick ['-~ 1. Odginal Return F-"] 4. Limited Estate r~6. Decedent Died Testate (AttachcopyofWill) [] 9. Libation Proceeds Received r~2. Supplemental Return --'] 4a. Futura Interest Compromise (date of death al~r 12-12-82) [~7. Decedent Maintained a Living Ti'ust (Attach copy of Trust) [] 10. Spousal Poverb/Credit (date of death be~een 12-31-91 and I-1-95) Z Z X I- SOCIAL SECURITY NUMBER I II --]3. Remainder Return (date old, am prior te 12-13-82) --]5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes C~l 1. Election to tax under Sec. 9113(A) (^~tach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION sHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS NAME Jan L Brown FIRM NAME (If Applicable) Jan L Brown & Associates TELEPHONE NUMBER 717-541-5550 845 Sir Thomas Court Suite 12 Harrisburq ~ ',, ' 'BA'~;.: 17109 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Uodgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Propert7 (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properb/ (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Chadtable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 4~362.00 OFFICi~L QSE ONLY (11) (12) (13) 4~457.50 552.50 3~905.00 3,905.00 469.00 83.50 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 X __ (15) 3,905.00 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 0.00 175.73 0.00 0.00 175.73 > > BE SURE TOANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 3026 Harvard Avenue CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount JSTATE PA I ZIP 17011 175.73 Total Credits ( A + B + C ) (2) 0.00 0.00 0.00 175.73 2.16 177.89 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. tEA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (ED) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the dght to designate who shall use the property transferred or its income; ........................................ [] [] c~ retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .............................................................................................. [] [] 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalltes of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS' 3413 Chestnut Street(~ ~ ~ Cam. E Hill SIGNATURE OF PR,~OT~Tt~~ ADDRESS 8¢~.-r Thomas Court Suite 12 H~.r4~urq 4/30/2004 PA 17011 DATE 4/30/2004 PA 17109 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-15(~3 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Fitzpatrick Ardella N 21 03 O476 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Principal Financial Group Inc (PFG) 4,362.00 150 shares @ $29.08/sh TOTAL (Also enter on line 2, Recapitulation) $ 4,362.00 (if more space is needed, insert additional sheets of the same size) REV-15~08 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Fitzo~trick Ardella N 21 03 0476 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Erie Insurance Group; homeowners insurance cancellation refund 95.50 TOTAL (Also enter on line 5, Recapitulation) $ 95.50 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Fitzpatrick Ardella N 21 03 0476 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of PersonaI Representative (s) Linda K Deitzel Social Secudty Number(s)/EIN Number of Personal Representative(s) StreetAddress 3413 Chestnut Street city Camp Hill state PA Year(s) Commission Paid: 2004 AttomeyFees Jan L Brown & Associates Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip 17011 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County additional short certificate and filing fees Accountant's Fees Tax Retum Preparer's Fees 223.00 223.00 23.00 TOTAL (Also enter on line 9, Recapitulation) $ 469.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Fitzpatrick Ardella N 21 03 0476 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Community Life Team EMS; outstanding medical bill 83.50 TOTAL (Also enter on line 10, Recapitulation) $ 83.50 (If more space is needed, insert additional sheets of the same size) REV-151'3 EX + (9-nn~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Fitzpatri¢ NUMBER Il. ~ Ardella N NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [includeoutrightspousaldistdbutions, andtmnsfers under Sec. 9116 (a) (1.2)] Theodore I Wells Jr 602 20th St S, Arlington, VA 22202 Theodore I Sweeney 1081 Camellia Ln, Suisun City, CA 94585 Testamentary Trust fbo Sheila Wells Shuler c/o Barbara Stephenson & Janice Kohler, Trustees Under Will 21 03, RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal Lineal Lineal 0476 AMOUNT OR SHARE OF ESTATE 1,171.50 30% residuary Estate 390.50 0% residuary Estate 2,343.00 ;0% residuary Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) OF ARDELLA N. FITZPATRICK I, ARDELLA N. FITZPATRICK, of the Borough of Camp Hill, 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 all my legal debts, and the expenses of my last illness and funeral fi.om my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid fi.om my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE II I bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities) as are set forth in a separate unsigned memorandum which I shall place with my Will to the persons therein designated, i bequeath the residue of such items to my son, THEODORE i. WELLS, JR., if he is then living. If he is not then living, I bequeath such items to my grandson, TltEODORE I. SWEENEY. ARTICLE devise and bequeath the residue of my estate of every nature and wherever situate as follows: A. Thirty (30%) percent thereof to my son, THEODORE I. WELLS, JR., if surv/ves me. If my son, TIrEODORE I. WELLS, JR., fails to survive me, his share shall be added to and treated as a part of the share created in paragraph B below. B. Ten (10%) percent thereof to my grandson, THEODORE I. SWEENEY, if he survives me. Should my grandson, T[rEODORE I. SWEENE¥, fail to survive me, his share shall be added to and treated as a part of the share created in paragraph A above. C. Sixty (60%) percent thereof to the Trustees hereinafter name IN TRUST for the following uses and purposes: 1. To invest and administer the fund in accordance with the Probate, Estates and Fiduciaries Code of Pennsylvania. 2. To consult with my nieces, ELOIS MAE DUNHAM and LINDA KAY DEITZEL, with respect to the circumstances and needs of my daughter, SFIEILA WELLS SHULER, and on the basis of such consultation, make a determination as to whether her circumstances and needs are such as to require a regular allowance from the Trust Fund to meet the needs of her daily living, and if so, the amount of such allowances (the discretion of the Trustee to be determinative in the matter) and to pay such amount throughout her lifetime, adjusted from time to time as her circumstances indicate. 3. Should my said daughter SHEILA WELLS SItULER, experience a medical or other emergency which requires the expenditure of funds for her in addition to the regular allowance, if any, determined in accordance xvith the previous paragraph, to expend from the principal of the Fund the amounts required to meet such special needs or circumstances. 4. Should my daughter require extended confmement or residence in a hospital or convalescent home, the Trustee shall not be empowered to expend principal for her benefit. 5. Upon the death of my daughter, SHEILA WELLS SHULER, the principal or any accumulated or undistributed income shall be distributed as follows: UU:,'UU4-U00OL~/1.14.02/RWS/DCP/153564.1 A. One-half thereof to my son, TIt~ODORE I. WELLS, JR., if he is then living and if he is not then living, his share shall be added to the share created in subparagraph B below. B. One-half thereof by my grandson, TI:IEODORE I. SWEENEY, if he is then living and if he is not then living, his share shall be added to and treated as a part of the share created in subparagraph A above. 6. The interest of any beneficiary while in the Trust shall not be subject to assignment, anticipation, pledge or alienation by or against the beneficiary. 7. I direct that for the purposes of administration, this Trust be combined with any Trust I have established during my lifetime with the Trustee herein named. ARTICLE IV I appoint BARBARA STEPltENSON and JAN'ICE KOltLER, Trustees of any Trust created under this my Last Will. ARTICLE V I appoint my nieces, ELOIS MAE DUNttAM and LINDA KAY DEITZEL, and nay son TItEODORE I. WELLS, JR., Executors of this my Last Will and Testament. Should all of the foregoing individuals fail to qualify or cease to act as Executors, I appoint BARBARA STEPHENSON and JANICE KOltI,ER, Co-Executors of this my Last Will. ARTICLE VI I direct that no fiduciary shall be required to post bond in connection with their duties. uuz:uu,.+~uuuu~./'1.1 4.UZII"(VV~511.J~,I~I 1 5',J5t54.1 IN WITNESS WltE~OF, I have 3~ ~ ~r~ ~ , 2002. hereunto set my hand and seal, this i,5f-t, day of -~ ARDELLA N./F~(~k - -' SIGNED, SEALED, PUBLISHED AND DECLARED, by ARDELLA N. FITZPATRICK, the Testatrix above named, as and for her Last Will and Testament and m the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as wimesses. Witness Ad'ess Witness ~ ~ Okddres~.~ 002004-00003/1.14.02/RWS/DCP/153564.1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVA.NI4 : :SS: COUNTY OF CUMBERLAND : I, Ardella N. Fitzpatrick, Testatrix, whose name is signed to the foregoing instrument, hav/ng been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Ardella N. Firzpatric~_,/D7 --~,, Sworn t~.~r affirmed and acknowledged before me, by Ardella N. Fitzpatrick, the Testatrix, this ,t'~ I' ~day°f ~ )Ol ('It) O.~¢xI ,2002. Notary Public Notarial Seal Dafla C. Parmer, Notary Public Lemoyne Bom, Cumberland County My Commission Explres Dec. 29, 2005 002004-00003/1.14.02/RWS/DCP/153564.1 COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : We, ~ ,¢¼~ b2, ~+e~.~k'- and ~._'~5-;i'~ ~ e. ~., e. ,= -~.~ the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn to or affirrned and subscribed to before me by '~C~"xr6 \,.[. '~' , wimesses, this i5 '~ day of .-~"(ihO O_r,.[ ,2002. and Notarial Seal Dada C. Parmeq Notary Public Lemoyne Bom, Cumberland County My Commission Expires Dec. 29, 2005 Member, Penn.~t~ AssodatJon Of Nola~s Notary Public BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA AMENDED INVENTORY Estate of Fitzpatrick Ardella N also known as Fitzpatrick Ardella Wells Ardella N Fitzpatrick , Deceased No. 2003 00476 Date of Death 04/13/2003 Social Security No. 189090082 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attorney: I.D. No.: Jan L Brown 67993 Personal Representative: Linda Kay Deitzel Address: 845 Sir Thomas Court Suite 12 Harrisburq PA 17109 Telephone: 717-541-5550 Description Waypoint Bank Certificate of Deposit 455300213 Waypoint Bank Certificate of Deposit 453269391 Waypoint Bank Certificate of Deposit 456272254 Jan L Brown & Associates Check 5259 dated 4/24/03 representing refund Real estate tax/sewer reimbursements Household goods (Attach Additional Sheets if necessary) Dated 4/30/04 5,585.17 7,357.49 8,688.44 3,725.00 822.79 1,000.00 Total 151,636.39 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Fitzpatrick Ardella N Continuation of Inventory Page 1 Description of Inventory Description 3026 Harvard Avenue, Borough of Camp Hill, Cumberland Co, Pa 2003 Erie Insurance Group; homeowners insurance cancellation refund Principal Financial Group Inc (PFG) 150 shares @ $29.08/sh 00476 Value 120,000.00 95.50 4,362.00 Subtotal $ 124,457.50 Grand Total $ 151,636.39 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU QF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003892 BROWN JAN L 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 fold ESTATE INFORMATION: SSN.' 189-09-0082 FILE NUMBER: 2103-0476 DECEDENT NAME: FITZPATRICK ARDELLA N DATE OF PAYMENT: 05/03/2004 POSTMARK DATE: 05/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $177.89 REMARKS: TOTAL AMOUNT PAID: $177.89 SEAL CHECK//1027 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ESTATE OF ARDELLA N. FITZPATRICK LINDA KAY DEITZEL, EXECUTRIX 845 SIR THOMAS CT., STE 12 HARRISBURG, PA 17109 / iallfirst A.~t~a.k R/T 031300834 www.allfirst.com ,'OOl, Oi~?,, ~=O~OOS~hl= 1027 §0-83/0313 5321 Jan L. Brown, Esquire* Jacqueline A. Kelly, Esquire *ADMITTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES ATTORNEY AND COUNSELOR AT LAW OlDE EN~IS. G~ 845 &. T. OMAS COURT SU~E 12 H~w~ssu.e, PA 17109 Email: jlbassoc@ptd.net TEL~P.O.E (717) 541-5550 FACS~M~U~ (717) 541-9223 Brenda F. Kef)hart, Legal Assistant Paula K. White, Legal Assistant Judilh A. Ebersole, Administrative Assistant April 30, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 170 ! 3 Re: Estate of Ardella N. Fitzpatrick Social Security No. 189-09-0082 File No. 2003-00476 PA File No. 21-03-0476 Gentlemen or Ladies: Enclosed please find the following items for filing with the Register of Wills: 1. Amended Inventory. 2. Supplemental Inheritance Tax Return in duplicate. 3. Estate Check 1027 in the amount of $177.89 in payment of the additional tax shown to be due. 4. Estate Check 1028 in the amount of $20 for the filing fee. Please time stamp and return our file copies of these documents. A return envelope is provided. If you have any questions, feel free to contact this office. Sincerely, Brenda F. Kcphart Legal Assistant bfk Enclosure ,,,,., :¢~'PA ].7. APR 20 2004 , e HARRIS JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW OLDE ENGLISH GAP 845 SIR THOMAS COURT, SUITE 12 HARRISBURG, PA 17109 REGISTER OF WILLS CUMBERLAND CO COURTHOUSE ONE COURTHOUSE SQ CARLISLE PA 17013 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF ARDELLA N. FITZPATRICK, DECEASED FILE NO. 2003-00476 FAMILY AGREEMENT AND FINAL RELEASE ~ THIS AGREEMENT by and between LINDA KAY DEITZEL, as Executrix o£ the Estate o£ ARDELLA N. FITZPATRICK A/K/A ARDELLA WELLS FITZPA.~RICK, Deceased, and THEODORE I. WELLS, JR. and THEODORE I. SWEENEY, individually, and BARBARA STEVENSON and JANICE KOHLER, Trustees o£ the Testamentary Trust for the benefit o£ SHEILA WELLS SHULER. WHEREAS, ARDELLA N. FITZPATRICK, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on April 13, 2003, having first made her Last Will and Testament dated January 15, 2002, which instrument was admitted to probate and is recorded in Cumberland County Courthouse, Register o£ Wills, File No. 2003-00476; WHEREAS, LINDA KAY DEITZEL has been duly appointed as Executrix of the Estate o£ Ardella N. Fitzpatrick, Deceased; WHEREAS, the parties in interest under the Last Will and Testament of Ardella N. Fitzpatrick, Deceased, are: 1. Theodore I. Wells, Jr., son; 2. Theodore I. Sweeney, grandson; and 3. Barbara Stevenson and Janice Kohler, Trustees o£ the Testamentary Trust created for the benefit o£ Sheila Wells Shuler, daughter. Page 1 of 8 WHEREAS, THEODORE I. WELLS, JR. is entitled to household and personal effects and other tangible personalty of like nature and thirty percent (30%) of the residuary estate; WHEREAS, THEODORE I. SWEENEY is entitled to ten percent (10%) of the residuary estate; WHEREAS, BARBARA STEVENSON AND JANICE KOHLER, TRUSTEES OF THE TESTAMENTARY TRUST are entitled to sixty percent (60%) of the residuary estate for the circumstances and needs of SHEILA WELLS SHULER pursuant to the terms and conditions set forth in the Last Will and Testament ofArdella N. Fitzpatrick, Deceased; WHEREAS, the parties to this Agreement have been furnished with a complete listing of the estate assets, receipts and disbursements as set forth on the Statement of Account as attached hereto and marked as Exhibit A; WHEREAS, it is the desire of the parties to this Agreement that administration of this estate be completed and accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting; WHEREAS, the parties to this Agreement each acknowledge to have received a proposed Schedule of Distribution attached hereto and marked as Exhibit A. NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants and agreements recited herein, the parties do agree as follows: 1. The beneficiaries do hereby release and forever discharge the said Executrix, LINDA KAY DEITZEL, her heirs, executors, administrators and assigns, JAN L. BROWN & Page 2 of 8 ASSOCIATES, attorneys at law, and JAN L. BROWN, ESQUIRE from any and all liability which may from time to time arise in connection with their service as Executrix and Attorneys of the Estate of Ardella N. Fitzpatrick, Deceased. The parties do further agree to indemnify and hold them harmless from any and all liability which may arise against the estate from creditors or claimants. 2. The beneficiaries do hereby acknowledge receipt of the assets described on the Schedule of Distribution attached hereto. 3. Each of the parties acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. 4. The beneficiaries do further agree with the aforesaid Executrix that should any liability come due to the estate of the said decedent after the signing of this Agreement, each will contribute their proportionate share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Executrix after the signing, sealing and delivery of this Agreement. 5. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. Page 3 of 8 IN WITNESS WHEREOF, I have hereunto set my hand and seal this '~0,.. ~ ,2004. day of WITNE S S: LINDA"KAY DEITZ~L, Executri~ ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF On this the L./ day of J~6[ SS: ,2004 before me, a Notary Public, the undersigned officer, personally appeared LINDA KAY DEITZEL, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Page 4 of 8 IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of '~I2IEODORI~ I.-~~ JR., Beneficiary STATE OF P'~//~,6 7.4/J,4 ' COUNTY OF /,~ g ',,rd6 r'C9/6/ · On this the day of ss: /,7 Yo- 7or ,2004 before me, a Notary Public, the undersigned officer, personally appeared THEODORE I. WELLS, JR., known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Page 5 of 8 IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of /Bo,/ ,2004. WI SS: THEODORE I. SWEENEY, Beneficiary STATE OF · .:~.~ SS: COUNTY OF On this the day of ~Q_.0_.,,~'~ , 2004 before me, a Notary Public, the undersigned officer, personally/~eared THEODORE I. SWEENEY, known to me or satisfactorily proven to be the pe~r~so'fi whose name is subscribed to the within instrument, and acknowledged that he execut..~he same for the purposes therein contained. IN WITNESS .~HEREOF, I hereunto set my hand and official seal. Notary Public MARY L, RICHARDSON COMM # 1286522 th NOTARY P~IIC-~OR~A ~ ~ so oco Page 6 of 8 IN WITNESS WHEREOF, I have hereunto set my hand and seal this P"]/~ 2/ ,2004. day of WITNESS: BARBARA STEVENSON, Trustee of the Testamentary Trust lbo SHEILA WELLS SHULER COMMONWEALTH OF PENNSYLVANIA COUNTY OF /~x/'~ On this the g ~' day of SS: ,2004 before me, a Notary Public, the undersigned officer, personally appeared BARBARA STEVENSON, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public NOTARIAL SEAL ROBERT C. GALL, NOTARY PUBLIC GUILFORD TWP., FRANKLIN COUNTY MY COMMISSION EXPIRES NOV. 18, 2006 Page 7 of 8 IN WITNESS WHEREOF, I have hereunto set my hand and seal this A/J/f ~ ,2004. day of WITNE S S: Jg2~CE KOHLER, Trustee of the Testamentary Trust fbo SHEILA WELLS SHULER COMMONWEALTH OF PENNSYLVANIA COUNTY OF On this the Z~-- day of SS: ,2004 before me, a Notary Public, the undersigned officer, personally appeared JANICE KOHLER, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public NOTARIAL SEAL ROBERT C. GALL, NOTARY PUBLIC GUILFORD TWP, FRAt,IKLIN COUNTY MY COMIVilSSION EXPIRES NOt,'. 18, 2006 Page 8 of 8 STATEMENT OF ACCOUNT OF THE ESTATE OF ARDELLA N FITZPATRICK Real Property 3026 Harvard, Camp Hill, PA Personal Property Principal Financial Group; 150 shs ~ $29.08/sh Waypoint Bank CD 453269391 Waypoint Bank CD 455300213 Waypoint Bank CD 456272254 Household goods Reimbursements/refunds Total Assets Income Earned Since Date of Death Dividend income Interest income Realized gain on sale of Principal Financial Group Total Income Expenses Legal fee; Jan L Brown Executrix fee; Linda Kay Deitzel Administrative costs Debts of decedent Inheritance Tax Total Expenses Net Assets Available for Distribution $120,000.00 $4,362.00 $7,357.49 $5,585.17 $8,688.44 $1,000.00 $4,643.29 $48.60 $31.73 $755.60 -$7,582.0O -$5,182.00 -$14,322.83 -$273.94 -$5,323.74 $151,636.39 $835.93 -$32,684.51 $119,787.81 DISTRIBUTION TO BENEFICIARIES ACCORDING TO TERMS OF WILL* Theodore I Wells Jr, son Household goods, personal effects, tang personalty 30% residue Theodore I Sweeney, grandson 10% residue Barbara Stevenson and Janice Kohler, Trustees of the Testamentary Trust fbo Sheila Wells Shuler, daughter 60% residue Total Distribution $1,000.00 $35,636.34 $11,878.78 $71,272.69 $119,787.81 *Final cash distribution may be increased or decreased based on interest accrued, market value of assets, presentation of an obligation and/or payment of additional charges. After final distribution is made, the beneficiaries agree to reimburse the personal representative if called upon to pay further liabilities of the decedent in the future. 5/10/2004 Exhibit A STATUS REPORT UNDER RULE 6.12 Name of Decedent · Ardella N Fitzoatrick Date of Death · 4/13/2003 Will No. 2003-00476 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate' State whether administration of the estate is complete' Yes X No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · 3. If the answer to No. 1 is Yes, state the following: account with the Court ? Did the personal representative file a final Yes ~ No * b. The separate Orphans' Court No. (if any) for the personal representative's account is' c. Did the personal representative state an account informally to the parties in interest ? Yes ~ 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 tothis r~ort ,O ~__ _ .~, Date' 5/26/2004 Signaru~o, Jan L Brown & Associates Name (Please type or print ) 845 Sir Thomas Court Suite 12 Harrisburq PA Address 17109 (717) 541-5550 Tel. No. Capacity · __ Personal Representative X Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280&01 HARRISBURG, PA 17128-0601 JAN L BROWN J L BROWN & ASSOCIATES 845 SIR THOMAS CT 12 HBG PA 17109 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN I 06-21-2004 FITZPATRICK 04-15-2005 21 05-0476 CUHBERLAND 10! Amount Remitted I REV-ISG7 EX AFP (01-05) ARDELLA N MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA i7015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS -.~ REV-1547 EX AFP COl-OS) NOTICE OF INHERITANCE TAX APPRAISEMENTT-~[[~'~E~-~-~ ................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FITZPATRICK ARDELLA N FILE NO. 21 05-0476 ACN lOI DATE 06-21-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate CSchedule A) (1) 2. Stocks and Bonds CSchedule B) C2) $. Closely Held Stock/Partnership Interest CSchedule C) C$) 4. Mortgages/Notes Rece/vable CSchedule D) 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) (5) 6. Jo/ntly Owned Property CSchedule F) 7. Transfers CSchedule G) C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule 10. Debts/Mortgage LlabiZ/t/es/Liens (Schedule I) CIO) 11. Total Deductions 12. Net Vaiue of Tax Return NO. O1 · 00 · 00 · 00 .00 .00 469.00 NOTE: To Insure proper credit to your account, subm/t the upper port/on of this form w/th your tax payment. 4,457,50 13. 14. NOTE= ASSESSMENT OF TAX: 15. Amount of L/ne 14 at Spousal rate 5,905.00 Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) C15) .00 Net Value of Estate SubSect to Tax ¢14) 124,275.62 If an assessment was issued pre¥iously, llnes 14, 15 and/or 16, 17, 18 and 19 wlll reflect f~gures that include the total of ALL returns assessed to date. 16. Amount of L/ne 1~ taxable at Lineal/Class A rate C16) 17. Amount of L/ne 14 at Slbl/ng rate C17) i8. Amount of L/ne 14 taxable at Collateral/Class B rate C18) DISCOUNT C+) INTEREST/PEN PAID C-) CD002786 REFUND CD005892 · O0 x O0 = . O0 124,275,62 X 045= 5,592.41 ~00 x z~= , .00 ~200 x 15~*= .00 c~)= 5,592.41 AMOUNT PAID ~,. 6,000.00 177 TOTAL TAX CREDIT BALANCE OF TAX INTEREST AND PEN. / TOTAL DUE 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT I RECEIP'I' DATE HUMBER 07-09-2005 05-11 2004 05-05-2004 5,602.59 9.98CR .00 9.98CR IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 279.62 .00 .97- C IF TOTAL DUE IS LESS THAN $I, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR}, YOU NAY BE DU A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enSoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE= PAYMENT= REFUND CCR)= OBJECTIONS= ADflIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST= To fulfill the requirements of Sect/on 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. C72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to= BE~XS~R OF #ILLS, 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" CREV-I$1$). Applications are ava/lable at the Office of the Register of Wills, any of the 25 Revenue D/strict Offices, or by calling the special 24-hour answering service for forms ordering= 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-4~7-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax Cincluding discount or interest) as sho~n on this Notice must obSect within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determ/ned at audit of the account of the personal representat/ve, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in wr/ting to= PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Un/t, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instruct/ors for Inheritance Tax Return for a Res/dent Decedent" CREV-1501) 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 CSX) d/scount of the tax pa/d is allowed. The 15~ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not pa/d before January 18, 1996, the first day after the end of the tax amnesty period. Th/s non-part/cipation penalty Ks appealable /n the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as ind/cated on this notice. Interest Ks charged beginn/ng with first day of delinquencY, or nine C9) months and one (1) day from the date of death, to the date of payment. Taxes wh/ch became del/nquent before January 1, 1982 bear interest at the rate of six (6~) percent per annum calculated at a da/ly rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear /nterest at a rate which wi/l vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are= Interest Daily Interest Da/ly Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 195~ 20% .000548" I98~-1991 Ill .000301 ~ 9X .0002q7 1983 16~ .000438 1992 9X .000247 2002 ~. .000164 1984 11~ .000301 1993-1994 7X .000192 2003 5~ .000137 1985 1~ .000356 1995-1998 9X .000247 2004 4~ .000110 1999 7~ .000192 1986 lOX .000274 1987 lOX .00027q 2000 7X .000192 --Interest Ks calculated as follows: /NTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELI'N~UENT X DA1'Ly TNT'ERE:ST FACTOR --Any Not/ce issued after the tax becomes delinquent w/ll reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment Ks made after the interest computation date sho~n on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES ZNHERTTANCE TAX DZVZSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEt4ENT OF ACCOUNT REV-I&O7 EX AFP cOl-OS) dAN L BROWN d L BROWN 8 ASSOCIATES 8q5 SIR THONAS CT 12 HBO PA 17109 DATE 07-12-Z00q ESTATE OF FITZPATRICK DATE OF DEATH 0~-15-Z005 FILE NUNBER Z1 05-0R76 COUNTY CUHIIER LAND ACN 101 I Amoun'l: Remi'l:'l:ed ARDELLA N HAKE CHECK PAYABLE AND REHIT PAYNENT TO: REGISTER OF WILLS CUHIIERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~c ~he upper portion of :~hLs form wi~ch your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATENENT OF ACCOUNT ESTATE OF FITZPATRICK ARDELLA N FTLE NO. 21 05-0~76 ACN 101 DATE 07-12-Z00~ THIS STATENENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHONN BELON IS A SUHNARY OF THE PR/NC/PAL TAX DUE, APpLTCATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APpLTCABLE, A PROJECTED INTEREST F/OURE. DATE OF LAST ASSESSNENT OR RECORD ADJUSTHENT: 06-1q-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 5,59Z.~1 PAYNENT DATE 07-09-2003 03-11-200~ 05-03-Z00~ 06-Z8-200q RECEIPT NUHBER CD002786 REFUND CD00389Z REFUND DISCOUNT (+) INTEREST/PEN PAID (-) 279.62 .00 .97- .00 IF PAID AFTER TH/S DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REQUIRED. IF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), AMOUNT PAID 6,000.00 ~5- TOTAL TAX CREDZT 5,592.ql BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS.