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HomeMy WebLinkAbout02-1129PETITION FOR PROBATE and GRANT OF LETTERS Estate of _ _ ~ f-' ~~ t~^~ ~ u ~ ~- S No. ~ ~ - Q 2,- 11 also known as 9 _ To: Register of Wills for the Deceased. County Of CilMRFRT A m Social Security No. ~ f~'~- ~ ~ - ~ C%rT C~_ Commonwealth of Pennsylvania in the The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executr ~ x in the last will of the above decedent, dated ~ ~~ Zcj ~ c ~~ ~ named and codicil(s) dated - ` , 19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in L u iM ~ ~ r \ ~,~,~-~ h ~ r last family or principal residence at ~-7 I ~ ~ County, Pennsylvan k~ with (list street, number and muncipality) Dec ndent, then ~ ~~ years of a e died ~~•' ' ) k- r ~'~ i -C Except as follows decedent did not marry, was not divorced and did not have a child born or adopted after execution of th will offered for probate; was not the victim of a killing and was never adjudicated incompetent: hl Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania $ ~ ~~ ~~~ ~ ~~' ~~ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: $ WHEREFORE, petitioner(s) respectfully requ st(s) the probate of the last will and codicil(s) presented herewith and the grant of letters c~ ~~t~~ r~n~ ~~}~{ Y ~ theron. (testamentary; administration c.t.a.; administration d. b.n.c.t.a.) ~~ ~ v - r ,, , ~, ~~'~, ~` ~ ~ ~v C ~ C ~ ~ ~ r i .~ ~ ,L~ l ~a v 'SC%~' UL' cC G 00 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF cuMBERLAND ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well nd truly ad_inister the estate according to law. Sworn to o~ affirmed and subscribed ~ f ~ ~ J before me this 12th day of DECEMBER 2 0 ~_ ~• - o Register Na. ~.~ - oa- ~~~g Estate of JEAN MYERS ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW DECEMBER 12, 2002 xggx in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 12 - 2 9 -19 8 4 described therein be admitted to probate and filed of record as the last will of JEAN MYERS and Letters TESTAMENTARY are hereby granted to SHERRIE M BARTELL FEES Probate, Letters, Etc.......... ~ 18 • 0 0 Short Certificates( ) .......... $ 6 .0 0 Renunciation ................ $ JCP ~ 10.00 TOTAL ~ 34,00 Filed ... 12-12-2002, . , .. . ............. mailed to exec 12-12-2002 Register of Wills ATTORNEY (Sup. Ct. LD. No.) ADDRESS PHONE hhis is to ccrtiii~ that the information here given is correctly copied from an original certificate or ctz }7 tiui~~ flied ~ I .. ;; ti ;.~, Local Regisn-ar. The original certificate will be forwarded to the State Vital Records OtTice for r~r.-nk- '~"~ WARNING: It is illegal to duplicate this copy by photostat ar pho~og<:: Ere f%>r this certit)r.r:_, w2.00 f :, -.___-_. __. _ ._ _.___-_._ -_.__._ t _.. ,~ ~ 8628934 - ~'~. CEP ~ ~ 2002 __ _-__ __ 3 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NNMBER NAME OF DEC ENT IFrt51 Mddle. Lave SE% SGCIAL SECURITY NUMBER DATE Of DEATH ,MCnm. Day. rear) /. ~-!~ ~ e 2S x. Fema•~e 7.107 - 52 - 509 a• Se ~temben 20 2002 AGE ILap Benhday) UNDER t YEAR UNDER 1 DAY OA7E OF BIRTH BIRTHPLACE +Gry and PLACE OF DEATH IChe ck app one -- ;ee ~,nyvua~ors On Ol"ee sbel Mrudhs . Days Maws . Minutes i.MOnlh. OaV 'roan Stdlea FCregn Cournryl HOSPIUL: OTHER: Vrs- 89 5-15-1913 Ba~s ton MA Inpalwnl ~ ERIOutpaheM iJ DOA ^ ^t Home ^ Reabenw ^ 'Speceryl ^ a. ,_ ,. ~ , ,.. COUNTY OF DEQH CITY, BORO. TWP OF DEATH FACILfTV NAME (n rbt iny~lutron. give 5beel and sambas WAS DECEDENT OF HISPANIC ORIGIN? RACE ~ Amarecan Indian, &ack, Wnae. etc. No ® Yes ^ n yn, apecery taboo lSPecMI Cumbers land Mechan ~c~b( uc Hea ~ th So th R b H h ~ t ~ , sealcan. PUeno Rican, ac wl_~~e a,. k. - . ,d. . . u e a ays . . a 'o DECEDENT'S USUAL OCCUPQION HIND OF BUSINESSlINOUSTRV WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS~Manwd SURVIVING SPOUSE (Give kentldwak done durng rnop U.S. ARMED FORCES7 $ , One M r:5t rode Can Bled Neva Marrwd, Widowed. 111 wda. grvo maben name) of waking N/e; do trot use ref ed.) ^ ® Ewmanwry/Secondary Coaege Divorced (SPeceryl Hamemahen Yes No (D,2) (,<a5.1 (V~daw . ,,,. „b. ,x. ,a. ,.. ,a. DECEDENT'S MAILING ADDRESS (Slrewt. Gery7TOwn. Slate. Zp Codel DECEDENT'S ,Ta ^ Y li M i d 4 712 A2~.~san Avenue • v n ~ «. aCa M RESIDENCE ,Ta Stat° d~eceaaM Meehan~e~sbung PA 17055 fSee,npructeaw live ln. °"°'"ef51tl8' Cumbe.a?and ~«•^anlP? ~•~ Mechan~.e~Jbung ~ ta. / 1Tb. County ,Td. ( watts actualNmaa of cnyppro_ FATHER'S NAME IFlrst. Meddle. Last) MOTHER'S NAME tFnsl. Mitldw, Mabee Surname) Max i)~ztic2eh Scv ah R ~e b „• ,,. c a n ex INFORMANT'S NAME RyperPrinq INFORMANT'S MAILING ADDRESS ISUrwI. GrylTown, Slaw, Zip Cadet Shehh Ce M Bcvc te ~f? 712 A2~ean Ave e M h ~ b ~ ~ . . xg,. x,,. nu ec an c~s un PA 17055 METHOD OF DISPOSITION DATE OF DISPOSITION PUCE OF DISPOSITION ~ N arpe of Cemetery. Q amatory LOCATION ~ CnylTown, Slaw. Zip Coda Burial^ Cremation® RanovallromSlare^ (M°nm.Dey,Maar) ~~ ,' // . /. aO1WrPlacaCf(emaL~Lan Sae~.e~rl a~ Donatian^ aMrlSpecMl ^ // ,,,~ `~ •~ ~ 4• PA CxematanL H ~ b P . 2 V 2/D. x,e. axn .~ LUt x,d. A 17109 ' SIGNRURE~j FUNERAL SERVICE LICENSEE OR PERSON AC INGASSUCH LICENSE NUMBER NAME ANDAOORESSOFFACIUTY JCema4-,Lan aC~(.e~~ 0y1 PA Compwte hams 23ac only woes wrtiryrnq To the twat M my Nrbwwdge, death occurtad at the tome, date orb pwca staved UCENSE NUMBER DATE 5 EO pnysician a nd avaiwble a1 Ume of deals to urory rauae of death. 1&gnpure and Tenet f ~ l 1 y/' ~/I 1' ~ ~ ~ ~ ~ ~ 1 ~ ~ (MOM". Day, Yeal /~ I L ~~ ~. / / ~ ~ , ` ~ 27a. `% 27b. 1 _ • ~' ~`- J Lv 2ae. I"Il~ t v' Z, Items 24-26 map W complpad try TIME OF DEATH DATE PRONOUNCED DEAD IMonrh. Day. year) WAS CASE REFERRED TO MEDICAL E%AMINERICORONER? ~pereon woo Pronouruws Mom. _- y 21. ,~ ~ 1 `~ M. Vas ®n ~ No tJ 21. ~ Z~~yN.l-lA'l, .C.. V Z u ~T 'ti- ri. /Yy 27. PAiiT I: Enwr lM diseaaes, i - - - - - _ - - _--- _ rryurias or compGCatbns which caused Ina OeaN Do not enter IW mode of dying auto as cardiac or respuawry arrest, mock or heap ladure. Approaenare PART 11: Odler spnilkent corbilione caMributerg to death, aN ~~ r Uat orey oM cauae on eaU Gres. I interval bel'wMn M% rewkirq n tW urrderlyirrg Grove fli•en n PART I. ~ I onep and MaN IMMEDIATE CAUSE (Penal u l deseasea POndeuon .~,g rS ~ /GcJ,C: rewlunq n dean)-~ a. C~Ch ~~ R'l~-es~-p ~ , _~ DU 70IOR AS A CONSEQUENCE OF): ~SegwMlally Gp condillOna b. v,~~-~ y` ~~ Q.d~~ r vL~` it any, w+an9 w Immedww DUE TO (OR AS A CONSEQUENCE OFI: 1 cause. EMa UNDERLYING 1 CAUSE (Desease a,nF,ry c. ~ mat xutiped avwas DUE TO (OR AS A CONSEQUENCE OF)'. resWwlq n deals) )AST I d. WAS AN AUTOPSY ! WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY tNJURV AT WORK? DESCRIBE HOW INJURY OCCURRED. _ PERFORMED? AVAILABLE PRIOR TO ' IMOnm. Oay, vearl s COMPLETION OF CAUSE Nature Momecba ^ Of OEATH7 Vss ^ No ^ ACCedeM ^ Pending Inweligelbn ^ / ^ ^ 70e. 70b. M. Ves ^ No Ves ^ No 9 Suicide Could rot W delennined pUCE OF INJURY - At home, wrm, preeL laclory, orrice LOCATION (Buser. CayR . $ulel - buewing, e,c. SPeonvl Asa. xsb. zs. aa. 7a. -CERTIFIER ICneck rvVy asst SI AT TITLE OF CF~T~IER ~ 'CERTIFYING PHYSICIAN IPhysecean cerWyeng cause or death woos anomer onysc,an has gonWnced tleam and competed Item 231 ~ ~t. ,~ y ~i,,' J ~/D - To Ilte Wet of my knowledge, rleeN oecurted des w we cauae(sl and manner ae stated ..................................................... +~C-.~' ~ Q~ l.- i Pa ]tb. ' ' LICENSE NUMBER T ~ DATE SIp~aN D IMa/~ m., Day. Vearl ~ PRONOUNCING AND CERTIFYING PHYSICIAN (Pnysecan Horn °ranounc,ng Oeam arW certdyeng to cause of tleaml To 1M beet of my knowledge, deaM occurred al me tlma, dale. and place, and duo to Ne cauw(sl and manner as staled .......................... ^ /~~~ Z 7Gx-f 71e. , / ,~-y /(J ~.- 710. NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (Item 27) Type Print `~ ~ ~ fi r. • 'MEDICAL E%AMINER/CORONER ~~,r,/. ~.,~ /a .(E~~~~ ~a. r . r. ~ .ti+ ~. ~ ~ On the basin of eaaminatbn anNw Inveatigstton, in my opinion, death occurred al the Ilme, dale, and place, and due to the cause(s) and .. . . . manner as atated ^ ~ _ , ., ~ ~G nn y •-/Z ~ ~ 7 ~ C ........ ... .. . ....... ................................................................... 71a. . l7 l / p` 890 ~ /4r ..fZ~7 ~ '7CY/ 71. REGISTRAR'S;IGNATURE AND NUMBER . ~~+ DATE FILED IMOnm. Day. Years 77. - as _~ ~ - r~ LAST WILL AND TESTAMENT OF JEAN MYERS -- 2~-o2-It29 I, JEAN MYERS, of the Township of Susquehanna, County of Dauphin and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situa- ted, I give, devise and bequeath to my uaughter, Sherrie i°i. Bar- tell, absolutely and in fee simple. 3. I nominate, constitute and appoint my daughter, Sherrie 1~i. Bartell, to be the ~:xecutrix of this, my Last Will and Testa- ment. IN WITNESS WhEREOF, I have hereunto set my hand and seal this ~yf~ day of December, A. D. 1984. ~. , __ ".,~' ~=~ (SEAL) Jean Mye s Signed, sealed, published and declared by the above- named JEAiJ MYERS, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. --~~ ~r , } ~ ~_ _. ~ REGISTER OF WILLS OF COUNTY OATH~~SUBSCRIBING WITN S (each] ubscribing witness to the ' 1 presented herewith~ach) being duly qualified accd~,ding to law, depose and say(s) that present an~saw the testat , si the same and that signed as a witness at the re est of testat in presence and (in a presence of each outlier) (in the presence of the others scribing witness(es)). Sworn to or a firmed and subscribe etore me this da of 19 ~tegister (Name) (Address) REGISTER OF WILLS OF C'UMBERT,AND _ COUNTY OATH OF NON-SUBSCRIBING WITNESS 021 - O a.- 11 a.9 ~~1,e~ ~ ~ ~.. (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of ~~~d -r~arT MvF,R~ > THFY ARF codicil testat~R of (one of the subscribing witnesses to) the will odicil ted herewith and that TH1aY believes the signature on the will is in the handwriting of 1F.AN MYERS to the best of THEIR knowledge and belief. .. ,- r/, , Sworn to or affirmed azd subscribed before me this ~~ 12~1z day of -~ DECEMBFi2~ 2 0 C 2 X~x t ~orr~.~~ ! - C~ `~~~a~~ Registe ~- ~. !Name) (Name) (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) y l 4 ~...~ t!`o `1 _ - Name of Decedent: ~`' ~ ~ ~` Y ~ " ~~ ~' -~ ~~) -~ ) ~ ,.~ ~~~ ~_~ ~. ~ f J Date of Death: ~ ~ Will No. ~~ ~ ` ~ ~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name ,, ~' s ~~=, ~_ , i' ~ ~. Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ._ i l - Date y I ->~ - C,~ ~ ~`~ V~ ~ T /~, r ~ ~ ,~ Signature r~ Name ~) l'1 ~' 'v ~ i * ~~~ 1_~a ~:"t. ~` ~~fi`~~ f" Address -_ ( ~ ), ~ ~ t ~_, ~`' ~~' ~ I~~ \' ~__ Z f t_ S -~~ Telephone (/ ~ ~ (~~ `~' ~ ~- 1'~ { `~ I Capacity: Personal Representative Counsel for personal representative CDFiMONWEALTH OF PENNSYLVANIA ~~PARTMEi.r OF REVENUE INFORMATION NOTICE FILE NO. 21-~- ~ ~~~ BUREAU OF INDIVIDUAL TAXES AN D DEPT. 2sobol TAXPAYER RESPONSE ~-CN 02148406 HARRISBURG, PA 171zs-obol DATE 11-25-2002 REV-1545 E% ~FP (09-007 TYPE OF ACCOUNT EST . OF JEAN MYERS ^ savlNGs S.S. N0. 107-52-5089 ® CHECKING DATE OF DEATH 09-20-2002 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: SHERRIE M BARTELL REGISTER OF WILLS C/0 712 ALISON AVE CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055 CARLISLE, PA 17013 FULTON BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from 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 Commonwealth of Pennsylvania. Questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1818-08998 Date 10-09-1979 To insure proper credit to your account, two Established (2) copies of this notice must accompany your 5 3 9 .1 7 Payment to the Register of Nills. Make check Account Balance payable to: ^Register of Nills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax 269.59 (3) months of the decedent's date of death, TaX Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 12 • 13 nine (9) months after the date of death. PART TAXPAYER RESPONSE ^ ..... ..:.. ::::::: , .:.: :::: ~ .....:.:.: :.:.:. ~~::~~ :a~I~~~~::.:fi~~::~~.~.~. ..~ ...:.:.:.:.:.:.:.:.:.:.:::::::::::::::::::::.:::::::~:::.:.:.:.:.:.:.,.:.:.:.:......................:, A. ® The above information and tax due is correct. 1. You say choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE BLOCK B. ^ The above asset has been or will 6e reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your 2 relationship to decedent: T.^,X ~CE T::€'~.`J - COM~'UTF:TION OF TAX ON ,lOINT!TFUST ACCOUNTS '`~} LINE 1. Date Established 1 ~'~~~~`~_ 2. Account Balance 2 ~~~iSi== 3. Percent Taxable 3 X 'z= 4. Amount Subject to Tax 4 ~~'~_~~°'~` 5. Debts and Deductions 5 - '•~~?~' 6. Amount Taxable 6 ~`~`~~ ~` 7. Tax Rate 7 X ~~= 8. Tax Due 8 `~~~~`_'~' . . . . . . . . . . . . . . . . . . . . . . . . . . . DEBTS AND DEDUCTIONS CLAIMED PART nnTr onrn PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are tr/uJe,-7c//o~~rrect and c nplete to t best o ny k`n~o'wled a and belief. HOME ( 7/7 ) ~~ ""lJ / 7 .~/1i1 ~~~ WORK ( );~~i __ _ ~~~f _ TGI FPNf1NF NuMRFR DATE COMMONWEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 * 3 REV-1545 EX ~FP f09-00) INFORMA ANp NOTICE FILE N0. 21'©`~-~~~y ACN 02148405 ~ REV ISEDENOTRICEPO* *E* DATE 01-02-2003 TYPE OF ACCOUNT ® SAVINGS EST . OF JEAN MYERS ~ CHECKING S . S . N0 . 107-52-5089 ~ TRUST DATE OF DEATH 09-20-2002 ~ CERTIF. COUNTY CUMBERLAND - • REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS SHERRIE M BARTELL CARLISLENDPA 17013 HOUSE C/0 712 ALISON AVPA 17055 MECHANICSBURG has provided the Department with the information listed below which has been used in the potential tax due. Their recordn indicate that at the death of the above decedent, you were a joint owner/beneficiary o FULTON BANK correct, please obtain written correnCe With thehInheritance TaxtLaws1of~thetCommonwealth calculating this account. If you feel this information is i of Pennsylvanian rGuestionstmayhbe answe edrbYSCa)ting (717)n78758327ab1e in actor se-~nw ac ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS .n4 _ 4Y0 COMPLETr r„R' ----"- Account No. 3180-60188 Account Balance Percent Taxable Amount Subject to Tax Tax Rate _ _t.-7 Tw DUe A. CHECK ONE [ BLOCK B• ONLY C, Date 10-09-1979 Established 1,181.17 x 50.000 590.59 x .045 26.58 TAXPAYER RESPON To insure proper crec~< <~ ~~-• -- C2) copies of this notice must accompany Your payment to the Register of Wills. ante check payable to: °Register of Wills, A9 NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Idl The above information and tax due is correct. 1, You may choose to remit payment to the Register of Wills with two copies of this notice too aim ~J or avoid interest, or you may check box °A" and return this notice to the Register of a discount Wills and an official assessment will be issued 6Y the PA Department of even The above assetthesdecedent'slrepresentative,and tax paid with the Pennsylvania Inheritance Tax return to be filed by The above information is in and/ort PARTor3~ belownd deductions were paid by You. must complete PART ~ •~ - : ~ ~~ °° •°°- You .:' ~~i':i.~ii':~si Ifi ou indicate a different tax rate, please state your PART y relationship to decedent: :::: .::.......:€isiisi: ,,: ON JOINT/TRUST ACCOUNTS `;1 ION TAX RETURN - COMPUTAT OF TAX :_..:::_;; ~ LINE 1. Date Established l .~~.', !`~~' ... 2. Account Balance 2 ~<~~?` .., 3, Percent Taxable 3 ~=~~"~t.~..* 4 , Amount Subject to Tax 4 ~ ';~ ~~ 5 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~~= 7, Tax Rate 7 ~~'=~`~` ~ 3s ~ i:;-;;ass::: g, Tax Due B DEBTS AND DEDUCTIONS CLAIMED PART Q DESCRIPTION DATE PAID PAYEE on Line 5 AMOUNT PAID .-+ and I declare that the fiacts I have repo ~ d~ do ~ 7.7 •' V°~ (i / / - Under penalties ofi Perknowledge and beliefi. ~i~~~ ( `I _f" Z r ~f Z~ ~ c plate to ,the best of ~~^t/~~~~ n ~ WORK ~ ~ DATE- /~ ~,~ /~ / ~ , /, +~/~('/'/ TELEPHONE NUMBER 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 REV-1162 EX~11-96) NO. CD 00221 1 BARTELL SHERRIE M 712 ALISON AVE MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: X07-52-5oss FILE NUMBER: 2102-1 129 DECEDENT NAME: MYERS .LEAN DATE OF PAYMENT: 02/24/2003 POSTMARK DATE: 02/22/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/20/2002 02148406 ~ $12.13 TOTAL AMOUNT PAID: REMARKS: SHERRIE M BARTELL SEAL CHECK#3104 INITIALS: AC RECEIVED BY: DONNA M. OTTO 512.13 DEPUTY 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 002210 BARTELL SHERRIE M 712 ALISON AVE MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssrv: io7-52-5oas FILE NUMBER: 2102-1 129 DECEDENT NAME: MYERS JEAN DATE OF PAYMENT: 02/24/2003 POSTMARK DATE: 02/22/2003 couNTY: CUMBERLAND DATE OF DEATH: 09/20/2002 REMARKS: SHERRIE M BARTELL CHECK# 3105 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 02148405 ~ 526.58 TOTAL AMOUNT PAID: INITIALS: AC RECEIVED BY: DONNA M. OTTO REV-1162 EX111-96) 526.58 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION N OT I C E BUREAU OF INDIVIDUAL TAXES DEPT. 280601 AN D HARRISBURG, PA l~lz8-o6o1 TAX PAYER R E S PO N S E REY-1545 E% ~FP (09-007 FILE N0. 21 02-1129 ACN 03103881 DATE 02-19-2003 EST. OF JEAN MYERS S.S. N0. 107-52-5089 DATE OF DEATH 09-20-2002 ,COUNTY CUMBERLAND TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. REMIT PAYMENT AND FORMS T0: SHERRIE M BARTELL REGISTER OF WILLS 712 ALISON AVE CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055-665.2 CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICE has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from 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 Commonwealth of Pennsylvania. questions may be answered by caiiir~y (7i7) 78i-:,3~7. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4932710666 Date 08-28-1979 To insure proper credit to your account, two Established C27 copies of this notice must accompany your Account Balance 916.38 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. Percent Taxable X 50.000 4 5 8. 1 9 NOTE: If tax payments are made within three Amount Subject t0 Tax (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Potential Tax Due 20.62 Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE ..~~:!~!i[:~~R#E:::::T#k..~R~~#YLsu~,:Y:hMa#;:;:;:;iwz+~l3..~...:wa~~a~~~~t::::v~(:~~~r:a<+:~:~:~:a:a....~...._~..~:.:.t.:r,<.Jr•~t:~_-~ ~~;:;'_,3:-:y:_.y_........_ ............................................... ... A. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will he issued by the PA Department of Revenue. B L 0 CK 0 N LY B. ~ The above asset has been or will be reported and tax ' paid with the Pennsylvania Inheritance Tax return to b e filed by the decedent s representative. C. ~ The above information is incorrect and/or debts and deducticns were paid by you. You must complete PART 2^ and/or PART 3^ below. PART 2 If you indicate a different tax rate ::::::.........:::::.............. Please state Your :::::~::~:::::::::~:~~:~::::::s:: ::':iii nisi€ i€i€i':€iifiii::::`:`€€€°f'i relationshi to deco ::::::~~ :::::::::::::~~::::::::::::~: P dent. ~ :: : .....:::-::::::::::--::::::::::~:::-::::-::::::::::::::::~:::::-....::::::::::::~:::::: ::#~#!~ .:.:: ...::.:::::~:: ,.,.,.,,.:. . ;i;lER^ ~i~~i? :: '"~?i€i = .. , :~:::::::::::::~~::::::::::::::~:::::::::~~.'~._:~'€~€€ =sip; i?€j~~` ... ...... ,::::::: : : : ; : : . . . . . : : _ = - : ;; ; i€€~€~ ~€ssi~~ €€f€~€_€€_i~i;~`i~iii ~ ; ; ; ; : . :::::~: ,# , ~, , ,:;,:,~::~:;: # ~ ; . :: : :_;;~:,;:::~::s:=; ii~iSA~17€i€i€.' ::~ . ~:.', •: s -si€=iiiii=~. TAX R - ETURN COMPUTATION OF ::::~:~:~:...::__::~ ~:~~:: TAX ON JOINTiTRUST ACCOUNTS A~~ ,,:.:.:.: ~~::::~::::::::;::~::_:~~:;~::~::~::~~::~::~~:::::;:;::~~:~:~:~:°:;;:;:;:__ :<::~:::;:: :: ~::::::::,:~::_::~::,:,:;::::~:=:; ::::~::~ ::::::::::::::.:~:::::::;::;:;::::,~;:;:;: LINE 1. Date Established 1 E, ::::::::::: ' ~~' 2. Account Balance 2 s _-~ ~ €€~ ~ ii iii€s ~;~ iii:€° s;~~:~~;:~:::.~ ::~::::~::::::~ €i's€s€i €t'_-~ ~ €€ ~ ~ ~ ~ =iiii€i€i€='i€i?s€'s=€€€€iti€; ~ its€~~ €~ ~ iii ~ ~ ii : ;:==[?i :::::_.;::::~::~:_;:; ::~::~ ::: :::::::::::::::::::::::::::::::::.:::::::::::~:::::::::::-:::::_:_:..:. t Taxable 3 X :~:~::~::€:~::..•~::::~;::~;:;:~ ;:~~;:~ ::::::::::::::~;::;:::~::~:;:~~:~;:~;::~~:::::::::::::::::::::::~:::::::::::::-:::::::::: 4 . Anoun t Sub ect to Tax ::::::::, ::::::.:::::.:::: ~:i:i:€s:€~:::° °:;:€::•:i:° ..:.: :.::, ~:::::::::::.,.,:,..:::::::: ,-,-,-:-,.,.,.,.,-,.,.,.,.,.,.,.,.,.,.,.::::, :::::::::::::: :;:€~: €~~;:;:~;:~~::~ ::::::::::::::::::::::::s:~s:~:~:~~::~~::~::::,:,:,:,:,:,:.:.::.:.:.:.:.:.:.:.:.:.:.::. 5. Debts a :::- Anoun t Taxable 6 :: • :::::.:.:.:...:.::.:.:.:.:.:.:...:.:. ::::::;:€€:€:_~ ~_:_:;:~~;:~ :.:.:.:.:: ~:,:,:,:.:,:.:,.,:;:,:,:,:.:,:,:,:,:,:,:,:,;:::~:::::, ::~:::::::: ~:::::::~ ~ s:::::::~:::,:.:,:,:,:;. ;:~;:~;:~ :::::::::::::::::~~::~::~::~~::~::::~::~::~:::::::,,,.,.,.,.,.,.,.:..............:.:.:.:.:.:.:: 7. Tax Rate 7 :::::::::::~ :::::::::::::-::::::::: X ;:is~;:~;:~::~:::.:::::::~::::~:: ::~~~: ~: ~: : ~: ::::::~:::::::::::~::~:::::::: ~:~..:::::::::~:::::::::::~::::::::::::~ ~:::::-:::::::::~:::::,: ~:, ~~::::~:_~:~ :::::::::::::::::::.:::.s::::::::::::~:::~::::::~::::~::~::::~::::~:::::,;:,:,:,:,:, . 8. Tax Due 8 : : :~ : ::::::::~ :::: :;;_, ~_;€ii: ~~::~ :::::::::: ::::::::::::::~:::::::::::::::::::::::: :::: ::::~_:::::::::~::::::::::::::::::::::::::::::::::::::~:::::::::~:-:::::::::~::::::::::::::~:::::::::::::::::: :::€:::;::::_~:~~s::::::~::~ :::::~:::~::::s:;::~:~s:_ :::::~~;~~::::s::ss:::a::s:z:~::s::s:: : ~ ~:::::::::::::t:;: ~t: ;a:;; ~ ~::~ ::~ ~ :; ~:::::::z::: PART DEBTS AND DEDUCTIONS CLAIMED : :::::::;s:::~::_:~:;:::::::;;;:~::::::~;:; 0 DATE P AID PAYEE DESCRIPTION AMOUNT Porn Under penalties of perjury, I declare that the facts I have reported above are true,-correct and onplete to the e t of n knowled a and b lief. c ~` /P s _ % HOME (7 1 7) Cia ~ ~ ~ ~G' ~ (~ ~J~~f~~l/j-~~ ~1 • .t"l~'- ~,F'~/ WORK ( ) `; -`'_~-t) __i TAXPAYER SIGNATURE TELEPHONE NIIMRFR nnrr ~ / ~- /D~ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SHERRIE M BARTELL C/0 712 ALISON AVE MECHANICSBURG PA 17055. DATE 04-14-2003 ESTATE OF MYERS JEAN DATE OF DEATH 09-20-2002 FILE NUMBER 21 02-1129 COUNTY CUMBERLAND SSNiDC 107-52-5089 ACN 02148406 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-14-2003 ESTATE OF MYERS JEAN DATE OF DEATH 09-20-2002 COUNTY CUMBERLAND FILE N0. 21 02-1129 S.S/D.C. N0. 107-52-5089 ACN 02148406 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: FULTON BANK ACCOUNT N0. 1818-08998 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-09-1979 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 539.17 X 0.500 269.59 - .00 269.59 X .45 12.13 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 02-22-2003 CD002211 .00 12.13 ^ TOTAL TAX CREDIT 12.13 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 S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FnRM Fnw rucTOi~rrrnuc COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOWANCE OR DISALLOWANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 EX RFP (R1-03) i~ ion ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-8601 SHERRIE M BARTELL 712 ALISON AVE MECHANICSBURG PA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE APPRAISEMENTE ALLOWANCETORCDISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% pFV (81-85) ~ 1` - ~s DATE 06-09-2003 ~' _ ESTATE OF MYERS DATE OF DEATH 09-20-2002 JEAN FILE NUMBER 21 02-1129 ~Q3 ~~`~ _6 ~1 ~ •~ ~ SSNNDC CUMBERLAND 107-52-5089 ACN 03103881 ~,7,!p~5-.6652 Amount Remitted C:l'ttl~4: r MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ! RETAIN LOWER PORTION FOR YOUR RECORDS -i ------------------- AFP (01-03) REV- 1548 EX --------------------------------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-09-2003 ESTATE OF MYERS JEAN DATE OF DEATH 09-20-2002 COUNTY CUMBERLAND FILE N0. 21 02-1129 S.S/D.C. N0. 107-52-5089 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED ACN 03103881 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT N0. 4932710666 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-28-1979 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 916.38 X 0 500 458.19 - .00 458.19 X 45 20.62 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 03-26-2003 CD002348 .00 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 T0: "REGISTER OF WILLS, AGENT.' AMOUNT PAID 20.62 TOTAL TAX CREDIT 20.62 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTERES DUE .00 ( IF TOTAL DUE I5 REFLECTED AS~AN~CREDITNTfICRREQYOUEMAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS_ ~ ~ -lC? ~- ~ BUREAU OF INDIVIDUAL TaxES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1~12a-o6o1 NOTICE OF INHERITANCE TAX OFPDEDUCTION~,AANDNASSESSNENTSOFLTAXNON JOINTLY HELD OR TRUST ASSETS REV-1548 E% AFP (01 -03) DATE 11-17-2003 ESTATE OF MYERS JEAN DATE OF DEATH 09-20-2002 FILE NUMBER 21 02-1129 COUNTY CUMBERLAND SHERRIE M BARTELL SSN/DC 107-52-5089 C/0 712 ALISON AVE ACN 02148405 MECHANICSBURG PA 17055 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR -------------- REV-1548 EX------------------------------------------------------------ RECORDS -~ AFP (01-03) --------------- - NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-17-2003 ESTATE OF MYERS JEAN DATE OF DEATH 09-20-2002 COUNTY CUMBERLAND FILE N0. 21 02-1129 S.S/D.C. N0. 107-52-5089 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED ACN 02148405 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: FULTON BANK ACCOUNT N0. 3180-60188 TYPE OF ACCOUNT: ( ~ SAVINGS ( ) CHECKING C J TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-09-1979 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 1,181.17 ~ 0 500 590.59 - .00 590.59 ~ 45 26.58 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-~ 02-22-2003 CD002210 .00 AMOUNT PAID 26.58 TOTAL TAX CREDIT 26.58 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 ~ IF PAID AFTER THIS DATE, SEE ( IF TOTAL DUE IS LESS THAN 8 REVERSE FOR CALCULATION OF DU E ADDITIONAL N .00 1, IF TOTAL DUE IS REFLECTED AS NO PAYMENT IS REQUIRED. A "CREDIT" I TERES SEE REVERSE SIDE OF THIS FORM ( CR), YOU MAY FOR INSTRUCTIONS. ) BE DUE A REFUND. REV-1162 EX111-96) ~~O't1Y~e~.~-{ PENNSYLVANIA R J RITANCE AND ESTATE TAX w FZ,p ~ ~ ~ ~ OFFICIAL RECEIPT ~-~-1: 1 e.,-~ ~e N (, Z ~~ ~~ ' ~'` ~U ... 1- ~ ~ _ d ,,-' ~`, y ~ ~~ ~ C N ~t ~ ~~ AS SSMENT ~' ,,- ONTROL ~ NUMBER r -------- fold ESTATE INFORMATION: ssN: ion-52-5oas FILE NUMBER: 2102-1 129 DECEDENT NAME: MYERS JEAN DATE OF PAYMENT: 01 / 29/ 2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/ 20/ 2002 REMARKS: R MARK THOMAS, ESQ = CHECK# 2135 SEAL AMOUNT 101 ~ $36.93 TOTAL AMOUNT PAID: _....~ INITIALS: AC RECEIVED-~Y: REGISTER OF WILLS 536.93 4> ~ °j~a~i ~l~ GLENDA EARNER STRASBAUGH REGISTER OF WILLS N0. CD 003491 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BARTELL SHERRIE M 712 ALISON AVE MECHANICSBURG, PA 17055 fold ACN SSESSMENT ~ !~ CONTROL '~~ `~ ~ NUMBER '~ I ESTATE INFORMATION: 0 52-5os. FILE NUMBER: 2102-1 129 DECEDENT NAME: MYERS .)EAN DATE OF PAYMENT: 01 /29/2004 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 09/ 20/ 2002 ~_ REMARKS: R MARK THOMAS, ESQ CHECK# 2135 SEAL TOTAL AMOUNT PAID: INITIALS~~ AC ...........:.. RECEIVED ~Y: REGISTER OF WILLS AMOUNT 536.93 GLENDA EARNER STRASBAUGH REV-1162 EX(11-96) NO. CD 003491 TAXPAYER R~111500 EX , (6-W) '* '" ~ ",_<n ,,"'''' ",""" :tOO lJf~ "" " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 ..... Z W Cl W U W Cl DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) M ers, Jean DATE OF DEATH (MM-DD-Year) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD-Year) 09/20/2002 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) lliJ 1. Original Return o 4. limited Estate o 6. Decedent Died Testate (Attach copy of Will) o g, Litigation Proceeds Received o 2. Supplemental Return o 4a, Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust \P-t\acn tcpy c\Tr\)$\) o 10, Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95) I OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 1 2 9 ""'COUiTTY"'C'05E ----vEA~ - - NUidBER-- SOCIAL SECURITY NUMBER 107-52-5089 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE: REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death prior to 12-13-82) o 5, Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11, Ejection to tax under Sec. 9113(A) (Attach SehO) T IS S OTION MUST BE 0 MPLETED. ALL OOR ESPO NAME R. Mark Thomas, Es FIRM NAME (II Applicable) EN E AN 0 I EN 1 iNF RM ON HOU D BE 'DIRE 'ED TO: COMPLETE MAILING ADDRESS 101 S. Market Street ,.. z '" o z o "" <n '" '" '" o " TELEPHONE NUMBER 717-796-2100 1, Real Eslate (Schedule A) 2, Slocks and Bonds (Schedule 6) Mechanicsbur PA 17055 (1) (2) (3) (4) (5) (See Schedule F) 4. Mortgages & Notes Receivable (Schedule D) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 5. Cash, Bank Deposits & M(scellaneous Personal Property (Schedule E) 6. Jo'lntly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) g, Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (lioe 8 minus line 11) z o ~ ::l ..... ii: <l: U w a: (6) (7) (9) (10) 13, Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ..... ::l Q. :E o U ~ ..... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See, 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 X _(15) 820.66 X .045 (16) X ,12 (17) X ,15 (18) (19) 20, ~ OFFICIAL USE ONLY 269.50 2,713.47, (8) 2,982.97 2,000.00 162.31 (11) (12) (13) 2,162.31 820,66 (14) 820.66 36.93 36.93 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND REOHEOK MATH <:.: . Decedent's omplete ddress: STREET ADDRESS 712 Alison Avenue CITY . I STATE PA I liP 17055 Mechanlcsburg C A Tax Payments and Credits: 1 Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousai Poverty Credit B. Pilar Payments C. Discount (1) 36.93 59.33 Total Credits (A + B + C) (2) 59.33 3. Interest/Penalty if appiicable D.lnterest E. Penally 4 Total Interest/Penalty (D + E) If line 2 is greater than line 1 + line 3, enter Ihe difference This is Ihe OVERPAYMENT. Check box on Page 1 Line 20 to request. relund If line 1 + line 3 is greater than line 2, enter Ihe difference This is Ihe TAX DUE. (3) A. Enter the interesl on the tax due B. Enter the totai of line 5 + 5A. This IS the BALANCE DUE. Make Check Payable to: REGISTER OF PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transter and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 IRI b. retain the right to designate who shall use the property transferred or Its income; ........................................ 0 IRI c. retain a reversionary interest; or ,............................................................................................,........ 0 (g] d. receive the promise for life of either payments, benefits or care? .......................... ............... 0 IRI 2. It death occurred afler December 12, 1 982, did decedent Iransfer property within one year of death without receiving adequate consideration?......... ........................., .................................................,......... 0 IX] 3. Did decedenl own an "in Irust for" or payable upon death bank account or security at hiS or her death? ................. 0 IRI 4 Did decedenl own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................... ...................,... , ............................................ 0 (&J (4) (5) (5A) (58) AGENT 22.40 5 0.00 0.00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare thai I have examined this return, includin~ accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Declaration of pre parer other than the personal representative IS based on all Information of which preparer has any knowledge. SIGNATU F PERSON RESP iSLE FO~N~ R~_ IN; ) DATE -L7~ I~ ~~ 712 Alison Ave. Mechanicsbur PA P RER OT ADDRESS PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rale imposed on the net value of transfers to or for the use of the surl/il/ing spouse is 3% [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or afler January 1, 1995. the tax rate imposed on Ihe net vaiue of transfers to or for the use of the surviving spouse is' 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax relurn are still applicable even if the surviving spouse is the only beneficiary, For dates at death on or after July 1, 2000: The tax rate imposed on the net vaiue of Iranslers from a deceased child 1wenty-one years at age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chiid is 0% [72 P.S. 99116(a)(1.2)]. The tax rale imposed on the net value of transfers to or for the use at the decedent's lineal beneficiaries is 4.5%, excepl as noted In 72 P.S 99116(1.2) [72 P.S. 99116(a)(I)]. The lax rate imposed on the net vaiue at transfers 10 or lor the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, ";'~m.""r. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Myers .Jean 21 02 1129 Include the proceeds of litigation and the date the pmceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 10.00 Cash 3. Safe Deposit Box Allfirst Acct #1000553100004785 (This safe deposit box was rented jointly with Sherrie Bartell. decedent's daughter. It contained only documents with no monetary value) Refund from Blue Cross/Blue Shield 0.00 2. 259.50 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert addItional sheets of the same size) 269.50 ";,wm.",,,-. COMMONWEALTH OF PENNSYLVANIA INHERiTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Myers .Je;:m If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21 02 11?9 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Sherrie M. Bartell 712 Alison Ave. Mechanicsburg, PA 17055 Daughter B c JOINTLY-OWNED PROPERTY LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deedforjointly-heldrealestale, VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A. 8/16/80 Members 1 st Savings Accl. #24971-00 236.04 50. 118.02 2. A. 9/3/83 Members 1 st Checking Accl. #24971.11 104.18 50. 52.09 3. A. 8/28/79 allllrst Savings Accl. #87004932710666 916.38 50. 458.19 4. A. 10/9/79 Fulton Bank Accl. # 1818-08998 539.17 50. 269.59 5. A. 10/9/79 Fulton Bank Accl. #3180-60188 1,180.49 50. 590.25 6. A. 1984 PPL Stock 2,450.66 50. 1,225.33 (See attached statement Irom PPL) TOTAL (Also enter on line 6, Recapitulation) $ 2,713.47 (If more space is needed, insert additional sheets of the same size) ";,,,,,,.,,,,,,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Myp.r!=> ,JeF.ln 21 02 11?!'l Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1. Cremation Society 1,835.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Sherrie Bartell 0.00 Social Security Number(s) I EIN Number of Personal Representative(s) SlreelAddress 712 Alison Ave. City Mechanicsburg State PA Zip 17055 Year(s) Commission Paid: 2. Attorney Fees R. Mark Thomas 100.00 3 Family Exemption: (If decedent's address is notlhe same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 49.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 Commonwealth oj PA VCN Vital Records (Extra death certificates) 16.00 TOTAL (Also enter on line 9, Recapitulation) $ 2,000.00 (If more space is needed, insert additional sheets of the same size) REV~"13EX'i9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~A",,,o ~ I,~n SCHEDULE J BENEFICIARIES FILE NUMBER ?1 O? RELA TrONSHIP TO DECEDENT Do Not Lisl Truslee{s) NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (al (1.2J] 1. Sherrie M. Bartell 712 Alison Ave. Mechanicsburg, PA 17055 Daughter 11?Q AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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 slle) ~"""".""';. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS Myers ,188n FILE NUMBER 21 02 1129 EST ATE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Holy Spirit Hospital 12.72 2. HealthSouth Rehabilitation Center 25.44 3. West Shore EMS 124.15 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 162.31 M,I\.TION SOc! :~. ~ PeIvNSYLvl\.'A "The Simple Dignified Choice" Nationwide 1-800-722-8200 9-21-2002 221072 BRANDlE She~~ie M. Ba~tell 712 Alison Avenue Mechanicsburg, PA 17055 Jean Myers - Deceased X Di~ect C~emation Special 48 Hou~ O~ Weekend C~emation Se~vice Nationwide Gua~antee Prog~am Wo~ldwide Travel P~otection Program P~ivate Family Viewing/Witnessing C~emation C~emation Containe~ Medical Documents/Cou~ier Fee Honorarium X Trinity Gold Keepsake 144696 Urn Burial Vault A~range For Bu~ial Cemete~y Charges Arrange/Deliver Ashes To National Cemetery Burial At Sea Scatte~ing Cha~ge Packaging And Forwarding Cremated Remains Express Mail X Certified Copies 10 @ $2.00 Registe~ Book Memorial Folders Thank You Ca~ds t Do-It-You~self Memorial Se~vice Flowe~s Newspape~ Placement Fee X Eve~lasting Gold Keepsake #144706 X Mllan 1100059 X Eng~aving X County Co~one~ C~emation App~oval Fee DNA P~ese~vation X Discount $895.00 $195.00 $20.00 $195.00 $525.00 $35.00 $25.00 -$55.00 TOTAL 9-23-2002 PAID BALANCE DUE $1,835.00 $1,835.00 $0.00 Fax (717) 541-9943 With five office locations to serve you... in Harrisburg, Philadelphia, Pittsburgh & Scranton. PPL Corporation Two North Ninth Street Allentown, PA 18101.1179 http://www.pplweb.ooml , ' , \ ,I, f ",..'; '. ........# ... P P. I .~::-- :...... . ~~ ~ . , , .~ Investor Services Toll Free Number 800-345-3085 Date April 3, 2003 Re: Value of PPL Stock Account Type of Stock: PPL Corporation Common Stock CUSIP: 69351T-10-6 Account Number: 3060570175 Social Security Number: 082-22-0090 Account Registration: Jean Myers & Sherrie Myers Bartell Jt Ten Date of Death: September 20, 2002 Number of Shares Currently Held: 52 In Certificate Form 28.170 In Dividend Reinvestment Plan 80.170 TOTAL SHARES Number of Shares Held as of Date of Death: 52 In Certificate Form 25.651 In Dividend Reinvestment Plan 77 . 651 TOTAL SHARES $31.56 Closing market price of Common Stock on New York Stock Exchange on date of death or last business day prior to date of death. Other Comments Transfer instructions are enclosed. PPL Corporation INVESTOR SERVICES ~~ ti~ fLu.A'.L....vvz~ U Cynthia A Buchman Sr. Investor Services Representative BOREAU iF INDIVIDUAL TAXES /NHERITANCE TAX DTVTSIDN DEPT. 180601 HARRTSBURG, PA 17128-0601 CONNON#EALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-I$417 EX AFP (01-03) R HARK THOHAS ESQ 101S HARKET ST NECHANICSBUR$ DATE 05-15-200~ ESTATE OF HYERS DATE OF DEATH 09-20-1001 FILE NUNBER 11 02-1129 COUNTY CUHBERLAND ACN 101 Amoun'l: Remi~:'lced dEAN HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF ~ILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LZNE ~ RETAIN LOVER PORTION FOR YOUR RECORDS ~ DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF NYERS dEAN FZ~E NO. 21 02-1129 ACN 101 DATE 05-15-200~ TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e {Schedule A) (1) 2. S~:ocks and Bonds (Schedule B) (2) :3. Closely Held S~ock/Par~nership In~eres~ (Schedule C) ($) ~. Hor~cgages/No*es Rmceiveble (Schedule D) (~) S. Cash/Bank Deposi~:s/Hisc. Personal Proper~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s APPROVED DEDUCTTONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9) 10. Deb~s/Hor~gage Liabili~cies/Liens (Schedule I) (10) 11. To*al Dmduc*ions 12. Nm'l: Value of Tax Re~urn 269.50 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 submi~ ~he upper portion .00 of ~his fore frith your ~ax payment. 1/985.69 .00 (8) Z,O00.O0 162.$1 1:3. NOTE: ASSESSNENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal 16. Amoun~ of Line 1~ ~exable a~ Lineal/Class A ra~e 17. A,oun~ of Line lq e~ Sibling re~e 18. Amoun~ of Line lq ~axeble e~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PA~D 2,255.19 (11) 2.1~2. ~1 (12) 92.88 Charitable/Governmental Bequests; Non-elected 911:3 Trusts (Schedule J) (15) . O0 Ne"E Value of Es~a~e Sub~ec~ ~o Tax (1~) 92.88 Zf an assessment ~as issued prev/ously, 1/nes 1~, 15 and/or 16, 17, 18 and 19 .ill reflect figures that include the total of ALL returns assessed to date. (15) .00 x O0 = .00 (16) 92.88 x 0~5= R.18 (17) . O0 x 12 = . O0 (18) .00 x 15 : .00 (19)= ~. 18 INTEREST IS CHARGED THROUGH 05-$0-200~ AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH .00 1.18 .15 4.35 AHOUNT PAID TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. . FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTIONS.) ~ ~EV-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURGI PA 17128-0601 3ECEDENT'S NAME FILE NUMBER Jean Myers 2102-1129 REVIEWED BY ACN Deborah Washington 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES F 3 The value of the jointly held assets is being stricken from the assessment of this return since they were previously assessed on 06-09-2003 under ACN 03103881. F 4 The value of the jointly held assets is being stricken from the assessment of this return since they were previously assessed on 04-14-2003 under ACN 02148406. ROW Page 1 BUREAU OF ZNDTVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171Z8-0601 R MARK THOHAS ESQ 101S MARKET ST ~'~:~ MECHANICSBURG PA 170~:: COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT ?'- * DATE ESTATE OF DATE OF DEATH '04 ~i~ ~0 :~ ' *- ~FZLE NUMBER COUNTY ACN 04-05-200~ MYERS 09-20-2002 21 02-1129 CUMBERLAND 101 Aeount Remi'l'~ed R£V-1607 EX &FP (01-0S) JEAN MAKE CHECK PAYABLE AND REHZT PAYNENT 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 fore with your tax payment. CUT ALONG TH'rS L'rNE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~,~ REV-1607 EX AFP (01-03) #~N 'rNHERZTANCE TAX STATEMENT OF ACCOUNT N~ ESTATE OF MYERS JEAN FILE NO. 21 02-1129 ACN 101 DATE 0~-05-2004 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELO# ZSA SUItNARY OF THE PRINCIPAL TAX DUE., APPLICATION OF ALL PAYItENTS*, THE CURRENT BALANCE*, AND., ZF APPLICABLE*, A PROdECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-$1-2004 PRINCIPAL TAX DUE: PAYHENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-22-2003 02-22-2003 03-26-2003 04-05-2004 CD002211 CDOOZZIO CD002348 REFUND .00 .00 .00 .00 12.13 26.58 20.62 55.15- ZF PAID AFTER THIS DATE*, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { ZF TOTAL DUE ZS LESS THAN NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' TOTAL TAX CREDIT 4.18 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TH'rS FORH FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRTSBURG, PA 17128-0601 R HARK THOMAS ESQ 101S MARKET ST MECHANICSBURG COHHONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Z~HERZTANCE TAX RECORD ADdUSTMENT *O4 PA 1705r~ :, 'DATE ESTATE OF DATE OF DEATH FILE NUHBER :~OUNTY ACN I 04-01-200~ MYERS 09-20-2002 21 02-1129 CUMBERLAND 101 Amoun4: Remi{~:ed REV-159S EX AFP (01-05) JEAN MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submit: ~:he upper portion of ~his for. wit:h your ~ax payment. CUT ALONG THIS LTNE ~ RETAIN LOgER PORTTON FOR YOUR RECORDS ~ REV-Z593 EX AFP (01-03) #~ INHERITANCE TAX RECORD ADJUSTMENT ESTATE OF MYERS JEAN FILE NO. 21 02-1129 ACN 101 DATE 0~-01-200~ ADJUSTHENT BASED ON: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Es~a~e (ScheduZe A) (1) 2. S{ocks and Bonds (Schedule B) (2) 3. Closely Held S~:ock/Par:tnership In*eres~: (Schedule C) (3) fi. flor*gages/No~:es Receivable (Schedule D) (q) 5. Cash/Bank Deposi:ts/Misc. Personal Proper~y (Schedule E) (5) 6. Jo/n~:ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm/nis~cre~:/ve Costs/ N/scellaneous Expanses (Schedule H) (9) 10. Debts/Hot*gage Liab/1/:t/es/L/ens (Schedule Z) (10) 11. To,al Deduc~/ons 12. Ne~ Value of Tax Re~:urn .00 .00 .00 .00 269.50 1/985.69 .00 (8) 2,255.19 2,000.00 162.$1 (11) (12) 2/162.$1 92.88 13. TAX: TAX Charitable~Governmental Bequests; Non-eZec~ed 9113 Trusts (Schedule J) (13) Ne~ Value of Es~e~e Subjec~ ~o Tax (lq) .00 92.88 .00 ~.18 15. Amoun~ of L/ne lq a~ Spousal ra*e (15) 16. Amoun~ of L/nm lq ~axable a* Lineal/Class A ra~e (16) 17. Amoun~ of Line lq m~ S/bling re~e (17) 16. Amoun~ of Line Zq *axable m{ Colla{eral/Class B ra{e (lB) 19. Princi CREDITS YAYfl~NI DATE 02-22-2005 OZ-ZZ-Z00$ 05-26-Z005 Tax Due K~IPI NUflBER CDOO2211 CDOOZ210 CD002~8 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. UI~UUNI {~ INTEREST/PEN PAID (-) .OOx O0 = 92.88x 0~5= .OOx 12 = .OOx 15 = (19) .00 .00 q.18 ANOUNT PAID .00 12.15 .00 26.58 .00 20.62 TOTAL TAX CREDIT I 59.33 BALANCE OF TAX DUEl 55.15CR INTEREST AND PEN. .00 TOTAL DUE 55.15CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY DE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) REV-1470 EX (6-88)  iNHErITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG~ PA 17128-0601 ~ECEDENT'S NAME FILE NUMBER JEAN MYERS 2102-1129 ~EVIEWED BY ACN Dianne McClain 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax has been adjusted to reflect the inclusion of Joint Bank Accounts on Schedule F that were previously assessed under ACN'S 02148405, 02148406, and 03103881. ROW Pacie 1 BUREAU OF INDIVIDUAL TAXES THHERZTANCE TAX DTVZSZON DEPT. 280601 HARR/SBURG., PA 17128-060! SHERRIE M BARTELL C/O 712 ALISON AVE MECHANICSBURG CONMON,EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~*~/~'~" DATE 0~-01-2004 ESTATE OF MYERS DATE OF DEATH 09-20-2002 'O4 PA FILE NUMBER ACN 21 02-1129 CUMBERLAND 107-52-5089 021~8405 Amoun*{: REV-i&D*i EX &FP JEAN MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF ,ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 ~__~2_N_~__T_H_~__L_~_... ~ RETAIN LO.ER PORTION FOR YOUR RECORDS REV-1604 EX AFP C01-03) ~# INHERITANCE TAX RECORD ADJUSTMENT dOZNTLY HELD OR TRUST ASSETS DATE 0~-01-200~ ESTATE OF MYERS JEAN DATE OF DEATH 09-Z0-2002 COUNTY CUMBERLAND FILE NO. 21 02-1129 S.S/D.C. NO. 107-52-5089 ACN 021R8~05 ADJUSTHENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: FULTON BANK ACCOUNT NO. 3180-60188 TYPE OF ACCOUNT: (X) SAVINGS ( ) CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 10-09-1979 Accoun~ Balance Percen~ Taxable X Amoun~ Subjec~ ~o Tax Debts and Deduct/ons - Taxable Amoun~ Tax Ra~e X Tax Due TAX CREDTTS: .00 0.500 .00 .00 .00 .R5 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORTION OF THIS NOTICE ,ZTH YOUR TAX PAYMENT TO THE REGISTER OF ,ILLS AT THE ADDRESS SHO,N ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: 'REGISTER OF "ILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgU/RED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF TH/S FORM FOR ZNSTRUCTZONS.) .00 .00 .00 ,00 BUREAU OF ZNDZVZDUAL TAXES /NHERZTANCE TAX DTV[SZON DEPT. 280601 HARRTSBURG, PA 17128-0601 SHERRIE H BARTELL C/O 712 ALISON AVE NECHANICSBURG PA 17055 COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE ZNHERZTANCE TAX RECORD ADdUSTNENT JO'rNTLY HELD OR TRUST ASSETS DATE 04-01-2004 ESTATE OF HYERS DATE OF DEATH 09-20-2002 F'rLE NUHBER 21 02-1129 COUNTY CUNBERLAND SSN/*DC 107-52- 5089 ACN 02148406 Amoun~ Remi~ed REV-i&O~i EX AFP (01-0S) JEAN HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF gILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS L/NE ~ RETA'rN LONER PORTION FOR YOUR RECORDS *~ REV-1604 EX AFP (01-03) ~ ZNHER'rTANCE TAX RECORD ADJUSTNENT JO'rNTLY HELD OR TRUST ASSETS DATE 0~-01-Z00~ ESTATE OF NYERS JEAN DATE OF DEATH 09-20-2002 COUNTY CUHBERLAND FILE NO. 21 02-1129 S.S/D.C. NO. 107-52-5089 ACN 021~8406 ADJUSTNENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: FULTON BANK ACCOUNT NO. 1818-08998 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING DATE ESTABLISHED 10-09-1979 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deduct/ohs - Taxable Amount Tax Rate X Tax Due ( ) TRUST .00 NOTE= 0.500 .00 TAX CRED'rTS: .00 .00 .R5 .00 ( ) TIHE CERTIFICATE TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNZT THE UPPER PORTION OF THIS NOTICE NZTH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ADDRESS SHONN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT."" PAYHENT RECEIPT DISCOUNT C+) DATE NUHBER INTEREST/PEN PAID (-) ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULAT/ON OF ADD/TZONAL INTEREST. ZF TOTAL DUE IS LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCT/ONS.) .00 .00 .00 ,00 BUREAU OF ZNDZVTDUAL TAXES TNHERZTANCE TAX DTVZSZON DEPT. 280601 HARRISBURG, PA 17128-0601 SHERRIE M BARTELL 712 ALISON AVE HECHANICSBURG PA 17055-6652 CONNONNEALTH OF PENNSYLVANTA DEPARTNENT OF REVENUE I'NHERITANCE TAX RECORD ADdUSTHENT dOTNTLY HELD OR TRUST ASSETS DATE Oq-O1-2OOq ESTATE OF HYERS DATE OF DEATH 09-20-2002 FILE NUNBER 21 02-1129 COUNTY CUHBERLAND SSN/DC 107- 52-5089 ACN 05105881 Amount: Remi~ed REV-100q EX AFP (01-05) JEAN HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG'~TH/s LINE .Jl~- RETAIN LONER PORTION FOR YOUR RECORDS -M .......... ~ ..... ~3- .... ~ ................................................................................. REV-1604.~X'AFP (~1-03)~ ~ ~ ZNHERZTANCE~lC/~X RECORD ADJUSTHENT JOINTLY HELD OR TRUST ASSETS ~ DATE Oq-O1-ZOOq ESTATE OF HYERS JEAN DATE OF DEATH 09-20-2002 COUNTY CUHBERLAND FILE NO. 21 02-1129 S.S/D.C. NO. 107-52-5089 ACN 0510~881 ADJUSTHENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORNATZON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT NO. ~952710666 TYPE OF ACCOUNT: (X) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 08-28-1979 Accoun~ Balance Percen~ Taxable X Amoun~ SubSec~ ~o Tax Debts and Deductions - Taxable Amoun~ Tax Ra~e X Tax Due TAX CRED'rTS: .00 NOTE: 0.500 .00 .00 .00 .q5 .00 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORT/ON OF THIS NOTICE NZTH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ADDRESS SHONN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT.ff PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT I I BALANCE OF TAX DUE TNTEREST AND PEN, TOTAL DUE TF pATD AFTER THIS DATE] SEE REVERSE FOR CALCULATTON OF ADDITIONAL TNTEREST. ZF TOTAL DUE TS LESS THAN $1) NO PAYHENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)) YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF T. HZS FORN FOR INSTRUCTIONS.) .00 .00 .00 ,00 :~EV-1470 EX (6-88)  'INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 :)ECEDENT'S NAME FILE NUMBER JEAN MYERS 2102-1129 '~,EVIEWED BY ACN Dianne McClain 02148405 02148406 03103881 ITEM ~..HEDULE NO. EXPLANATION OF CHANGES The Notices of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions of Tax on Jointly Held or Trust Assets for the above referenced Account Control Numbers have been adjusted to zero since the Joint Bank Accounts were reported on the Inheritance Tax Return. FILE Pa~e 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZBO60Z HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I~07 EX AFP (01-03) R MARK THOMAS ESQ 101S MARKET ST HECHANICSBURG PA 17055 ::-; DATE 04-19-2004 ~. ESTATE OF MYERS DATE OF DEATH 09-20-2002 FILE NUMBER 21 02-1129 '04 ~fl~ ~ 4 CI:~IUN. T~2 CUMBERLAND ACN 101 JEAN Amoun'l: RemL*l:*l:ed HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To :insure proper credit: ~:o your account:, submit: ~he upper por~ion of ~his fore wi~h your ~:ax payment:. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF MYERS JEAN FILE NO. 21 OZ-11Z9 ACN 101 DATE 04-19-Z004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELOW ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS`, THE CURRENT BALANCE,, AND`, ZF APPLICABLE`, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-$1-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 4.18 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-22-2005 02-22-2005 05-26-Z005 04-05-2004 CD002211 CDOOZZIO CD002548 REFUND .00 .00 .00 .00 12.15 26.58 20.62 55.15- ZF PAID AFTER THIS DATE`, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" TOTAL TAX CREDIT 4.18 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) r~, ~ i (~~, ~ STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND ,PENNSYLVANIA Name of Decedent: JEAN MYERS Date of Death: 9/20/2002 File No. 21-02-1129 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES X NO 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to No. 1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES NO X b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES X NO d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Grphans' Court and may be attached to this report. Date: 4/26/2004 Signature R. Mark Thomas, Esq. Name (Please type or print) 101 S. Market Street ~ Address rt,. Mechanicsburg PA 17055 717-796-2100 Tel. No. Capacity: Personal Representative X Counsel for personal representative