The URL can be used to link to this page

Home My WebLink About02-0405 PETITION FOR GRANT OF LETTERS Estate of Alverna H. Strohm No. 2.1- 02.. J..ID.t:i also known as , Deceased Social Security No. 170-50-6179 Petitioners, Charles R. Strohm and Janet S. Myers Petitioner(s), who is/are 18 years of age or older, apply)ies) for. (COMPLETE "A" OR "B" BELOW:) o A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors Decedent, dated 6/1/82 and ~icil(s) dated Charles Ed ar Strohm died rior to his wife's death on !)el'e~..,. 5 named in the Last Will of the State relevant circumstances, eg., renunciation, death of executor, ete 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: o B. Grant of Letters of Administration (c,t.a.. d.b.n,c.ta.. pendente lite, durante absentia; durante minorilale) 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: I Name Relationship Residence I (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 121 Walnut Bottom Road, ShippensburQ, Pennsylvania (ShippensburQ Township) (list street, number and municipality) Decedent, then 94 years of age, died April 10 , 2002 , at ShippensburQ Health Care Center, ShippensburQ (Location) Decedent at death owned property with estimated values as follows; (if domiciled in PA All personal property (if not domiciled in PA Personal property in Pennsylvania. (if not domiciled in PA Personal property in County. Value of real estate in Pennsylvania. Total Real Estate situated as follows: None 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" $ $ $ $ $ 175,000.00 0.00 175,000.00 Typed or printed name and residence Pa. 17257 17266 RW_1 ,,- 5B- /3 Oath of Personal Representative Commonwealth of Pennsylvania County 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 23 day of a~~.:d~~--- Q~ ~ ,'---;;r-Cf'/fd 1/ (/ ~ . (I'~aU/f{:f Mary C ewis I DECREE OF REGISTER Estate of Alverna H. Strohm Deceased No. 21- 0 2,,-I-f05 also known as Social Security No: 170-50-6179 Date of Death 4/10/02 AND NOW, April 24, 2002 reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 1&1 Testamentary 0 of Administration , in consideration of the Petition on the ((cta, d,bnct, pendente lite: durante absentia durante minoriate) are hereby granted to Charles R. Strohm and Janet S. Myers in the above estate and that the instrument(s), if any, dated June 1, 1982 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters. $ 235.00 ~c. ~Nf~::l)1; Short Certificates(s) . 4 12.00 Renunciation $ $ $ $ $ $ $ $ Extra Pages (1 ). 3.00 Signature I.T.R.... JCP Fee. 5.00 Attorney: H. Anthony Adams I.D No: 25502 Address: 49 West Oran~e Street, Suite 3 Shippensbur~ Telephone 717-532-3270 DATE FILED April 24, 2002 Inventory. Other. Pa. 17257 TOTAL. .....$ 255.00 CALL ATTORNEY AND PUT IN THEIR FILE rox IN PROTHONOTARY J--!1()).!lO) REV <J!!lli This is to certify that the information here given is ccrrecdy copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. Fee f()r this certiflcate, $2.00 p 8258573 ~ jr2.. /}.A..>-o~ Date -= COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH UNOf 'YEAR ..... .... '" aFemale 'TAlI"~EN'-1'I SOCl.6.LSECIJfll1"fWJ~P. 3. 170 -50 6179 O"'''OI'OE,IOTll,M.",....Oa',_l .. April 10, 2002 Wul<<OFDECEOl"lTlf"..._,C.., I. Alverna M. Strohm DEDl!HT'lulUAL~ .....:::.:.;r:..":::::~ UL Housewife It ~Ot:HT'I"""'-lHG~SSlSlr-.CIlyIboo>._~Codo1 121 Walnut Bottom Road &hippensburg. fA 17257 ~RHEII"S_lf...._,lWl 1 . Marshall McCulloch Humme 1 .." 'I_~ Charles R. Strohm ....., UIOOFBU!llNES MIllE HTEVEAIN \U.,AAtoIE'Df~' ...0 ,.,19 OEc:EllEtff.s _0 =~IO _Il__rl UNIlIl!A,O,t& - .- .."" ,...",,,,,'0..-,.....) ==-= I'\..ACIOFOEIlf..iC_.(>f">y""".-.........,"","""""__,_ N. Newton Twp. 1..........0 E~ 0 , "'-'ME(tt""""'"""--'.QM..'.....ncl....-' Shippensburg Health Care Center IU.CE-__.eo..;lo._",_ ",eo, White 94 ..-.. ~n ~H Cumberland """"~. """"' ....."'" - onr#'f1l_f t. 13. lhl.S!M. PennsYlvania .'. ]2 MAIIItll.l.lJS._ -""""'.--' -- 14. Widowed 17c.RtJ__.....,,,, .........""'" '"-,~-_I ,~ Cumberland ~ - ~.. ~ ,Till ~-==.::.. !,I()THEff"SN.....(f....r.t_._s...'-"'l '" Mary Hoch _~l"..__H;lOI'IUl';lS\twl.~,SlMo.~C>olOOl 44 High Road, Shippensburg, PA 17257 Pl.ACf:CI'OIS/'OSI'TIO"I._oIC-..y;C......-.,- l .~._.lIpc:o.. "'Olnor~ . hiwensburg, at SprJ.ng HJ.ll Cemetery a1. C mbe land Count PA N,wE.vlD as I'lloCILITY ,?gelssnger-Bdcke.1: F .R. ,Inc. ,P .0. P10x 3'36, Shbg. ,PA. 17257 llCENSe"lUMllEA om-SfONED RN :3.;!{3&iP I.- """"''''''00;;'''' ..l:Y" , ShiDDensbuu - -- _0 " ...... ......KJ~O oa-lSl>--<I. r7 ... ~ ~_~.....,._00fIIty;1'IO .".,....,......_.._01......... ~_...- _M-"____...., NEOI''Dl_ __~-1Il It ~1::3' III II. 11._', E...........__injuneo..."'"""*-_""_'...<Jo.."Do""'..................oId1r1ng,'uc!I...c_cOI'...,;..'mY."...._m............. L"IItlIf__oneacn... --- '--."'- _E_~'I'IHO ~~........ .....-- ,....-ng..~l.AaT I: /J-~ ,e......"'''-./'oo, 0Uf: 'l'Dl"'v..+CCt&.QUHICt OFf. llUIETOlORlIS14CONSf:auENCf:OF): /Y........... \===-. i--- ] H.fltM: OlMo"""""_-"'IIIO_,lIolI ....~"'....~__..po,RTl ~I~(F_ _...~ .....-ng.._,-- OUE1D{Ol'lllSACON8I:OOENCEOF): \WoSANAU1OPtl... -... FI"IOINGS MAHNEAOI'OEIlfH ........." .-..uaEI'AIOR1D COMUTJONCFCAI.ISE - EI' --. 0 ~....... ,fJ"'- - 0 -- 0 ~O .. ~~..~ -- 0 CeIM""'too............... 0 I).II1tOF~Rv llolon".o.y,_1 TIM(CFI~I'IV fN.IlII'I"'1IfWQAl('?I)l"SCAl8E_flUJlI'V~D .. 0 ,.,0 .. - - 'CPl'lilf"lM~",,",_ .C&fr......_I'HYSlCtANlPII_c....__d______Il'_""...onoc_IIom;>31 1lo__.......---......._-u.-_....c-...elOJ__.-. .. a Pl..ACEOF'INJUl't....I4I................_.I"""""_ -.....,~ _. 'IIf:DlCAl.EllAMINllIt/COlIt01oIEl'l O"_~ol...V'lIna\\O"_otl"".IIt\fI._,IIl"',OC!Ilnlo"....""OI:Ctl_lIt ..............1.'.... J'.. REOISTflAFl'SSIG..ATlII'IE....OtlVlolIlEfl .d.IO,_pll/l.._d...totlloO.......,.... , \C1!~~....4LrQ. ~)~~:.;:I 0' ,r :=.~~~=~QF.fjToW11Oj~,';!i~OF'~ .J"~~~, /:4- /? L..o1 .,rl _NoIGCUl1'...,__'lCUlM~"""'''''''''''''''''''';l__""'"'-to.,.,.Ol_\ 1lo.._.."'r~,du...__...._,_......pIoce.__..............I_'"_.._. o . D ~( ,:(1 sf 21_2002-405 < \},\ ,~) .~.) V \: \\" Cl (\,\\1 i'D. ;,O!~ - ~ LAST WILL AND TESTAMENT '2.1-02. - 1-\05 I, ALVERNA H. STROHM, of 707 Brenton Street, Shippensburg, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils, heretofore made by me. FIRST: I direct that my funeral expenses be paid as soon as practicable after my death. SECOND: I give, devise and bequeath all my property, be it real, mixed or personal, to my husband, Charles Edgar Strohm, to have and to hold absolutely. THIRD: If my said husband should predecease me or if we should die in a common disaster, then in that event, I give, devise and bequeath all my property, be it real, mixed or personal to my three children, Charles R. Strohm, Janet S. Myers and Jay A. Strohm, in equal shares, share and share alike, per stirpes. FOURTH: I nominate and appoint my husband, Charles Edgar Strohm, as the Executor of this my Last Will and Testament, should he be unable to serve or fail to serve, then in that event, I nominate and appoint Charles R. Strohm and Janet S. Myers as the Executors of this my Last Will and Testament. IN WITNESS WHEREOF, I, ALVERNA H. STROHM, set my hand and seal this I~~ day of June, 1982. Signed, sealed, published and declared by Alverna H. Strohm as her Last Will and Testament and so done in the presence of we the witnesses, who sign at her request and in her presence and in the presence of each other. -, q!l~1 ," · ,;J(, ~-Tt-~~. _.i~ ~ ::::s (/~'lA/n1" ;;( ~o A .{~ (SEAL) , , COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, ALVERNA H. STROHM, the Testatrix, whose name is subscribed 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; and that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. OJ~I''' ~ ~ - ,*,~ Sworn and acknowledged, before me by Alverna H. Strohm, the Testatrix, this 1>1- day of June, 1982. '~ ,7 "' / ,,/ ",' ;J ,-"t 2~ftc~~~~~~ Notary Publl'Shipponsburg, Cumberland Co" Pa, Illy "'mmission Expir.. April 25. 1985, COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND We, H. Anthony Adams and Carma L. Cooley, the witnesses whose names are subscribed 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 instrument as her Last Will and Testament; and that she signed willingly and that she executed it as her free act and deed for the purpose 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 Teatatrix was at that time at least eighteen (18) years of age and of sound mind and under no constraint or undue influence. i~~~ .t:' &.~< , I?/bv~ Sworn ,and subscribed before me by H. thony Adams.and Carma, L. Cooley the i1nesses / th . s I,""" ;"y of 'June, 1982. .----.,. l~ Notary Public o ary PubliC Shippensburg Cumberland Co., Pa. Illy COnlnllSsl~n expires April 25. 1985 8 CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name of Decedent: Alverna H. Strohm Date of Death: 4/10/02 Will No. aa-l..io."- 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 8/12102 Name .A.ddress Jay A Strohm 1051 Hendricks Road, Halifax VA 24558 Janet S. Myers Box 115 Walnut Bottom PA 17266 Charles R. Strohm 44 High Road Shiooensbura Pa. 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 8/12/02 '- ~~. -=::> - Signature H. Anthony Adams Name: 49 West Oranoe Street Suite 3 Address: Shiooensbura 17257 Telephone(717) - 532- 327 x Personal Representative Counsel for Personal Representative Capacity: '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 17 - fOg'.- ! 3 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-\500 El'+ (il.OO) DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) .... z w c w () w c Strohm Alverna H. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) "- OFFICIAL USE ONLY FILE NUMBER G'l ,}J ~I -~t}.O-~ dOI.S:. CQ\JNT'tCOCE YEAR ~R SOCIAL SECURITY NUMBER 1 70- 5 0 - 6 1 7 9 THIS RETURN MUST BE FILED IN DUPUCA TE WI1H THE REGISTER OF WILLS SOCIAL SECURITY NUMBER OJ !;i ",_<Il u"'''' OJO-u ",00 ulfa:: 0- '" 04/10/2002 09/16/1907 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) o 3. Remainder Return (dale ofoealh prior to 12.13-82j o 5. Federal Estate Tax Return Req\.Jired 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) IX] 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. S\.Jpplemental Retum o 4a. Future Interest Compromise [dateofoeatllafleri2.12.82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date ofdealh between 12-31.91 and 1-1-95) THIS SECl"ION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO; NAME COMPLETE MAILING ADDRESS H. Anthon Adams 49 W, Orange Street FIRM NAME (If Applicable) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) ... 2: OJ o 2: o 0- <Il OJ '" '" o u Suite 3 PA 17257 TELEPHONE NUMBER 717-532-3270 Shi OFFICIAL USE ONLY 180,851.41 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 113,883.31 (6} 66,68267 z o ~ ..J => .... e: <l: () W 0:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly 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) (7) (8) 361,417.39 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,339.88 10. Debts of Decedent, Mortgage L'tabHities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental8equests/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 SIDE FOR APPLICABLE RATES z o ~ .... ::::l a. :! o () >< <l: .... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) 19. Tax Due X _115) 349,077.51 X .045 (16) X .12 (17) X .15 (18) (19) (11) (12} (13) 12,339.88 349,077.51 16. Amount of line 14 taxable at lineal rate (14) 349,077.51 17. Amount of line 14 taxable at sibling rate 15,708.49 15,708.49 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT :>:> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 18. Amount of line 14 taxable at collateral rate Decedent's Complete Address: STREET ADDRESS 121 Walnut Bottom Road CITY I STATE I ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credils/Paymenls A. Spousal Poverty Credil B. Prior Paymenls C. Discount (1) 15,70849 TOlal Credils (A + B + C) (2) 3. inleresVPenally If applicable O.lnteres! E. Penalty TolallnleresVPenally ( 0 + E) (3) 4. If Line 2 is grealer Ihan Line 1 + Line 3. enler the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is grealer Ihan Line 2, enler Ihe difference. This is the TAX DUE. (5) A. Enler the inleresl on Ihe lax due. (5A) B. Enler the total of Line 5 + 5A. This is Ihe BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 15,70849 15,70849 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Old decedenl make a Iransfer and: Yes No a. retain the use or income of the property transferred; ...... 0 [KJ b retair. the rlght to designate who shall use the property transferred or its income; ." ...... 0 00 c. retain a reversionary interest: or . ..... 0 00 d receive the promise for life of either payments, benefits or care? . 0 [RJ 2 If dealh occurred after December 12, 1982, did decedenl Iransfer property wilhin one year of death without receiving adequate consideration?.. ... 0 [KJ 3. Old decedent own an "in trust for" or payable upon death bank account or security al his or her dealh? .nn n.n. 0 [2S] 4. Did decedenl own an Individual Reliremenl Account, annuity, or olher non-probate property which contains a beneficiary designation?... .............. 0 IX] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE 10 \J0 .' ~~ s-C I <~",~~P\!'-""'\olN~r-__~__,L7a'(7 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 10 or for the uS~he surviving spouse IS 3% [72 PS 99116 (a) (1.1) (ill ADDRESS L.-\~ For dales of dealh on or after January 1. 1995. Ihe tax rale imposed on Ihe nel value of Iransfers 10 or for the use of Ihe surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (011. Tile statute does not exemo\ a transfer to a surv',v'lng 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 dales of dealh 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 adoptl\l8 parent, or a slepparenl of Ihe child is 0% [72 P.S. 99116(a)(1.2)). The fax rate imposed on the nel value of transfers to or for the use at Ihe decedent's lineal beneficiaries is 45%, except as noled in 72 PS 99116(1.2) [72 PS 99116(a)(1)] The lax rale imposed on Ihe nel value of Iranslers 10 or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.311. A sibling is defined, under Section 9102, as an ind'lvidual who has at least one parent in common with the decedent, whether by blood or adoption, "V'~"H''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES1DENT DEe DENT SCHEDULE B STOCKS & BONDS ESTATE OF Strohm Alverna H. All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 171,211.6D Legg Mason Wood Walker, Inc. Asset management account # 360-00063 2. Beistle Company 21 shares common stock @ 222.58 4,674.18 3. SBC Communications common stock 16.7772 shares 437.75 4. AT&T common stock 341 shares @ 14.42 4,52788 TOTAL (Also enler on line 2, Recapitulation) $ (If more space is needed, insert addilional sheels of the same size) 180,85141 ""'50m."",. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES1DENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Strohm Alverna H. FILE NUMBER Include the proceeds of litigation and the date the proceeds 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 31,23473 American General Financial Contract #A 100954487 2. Allfirst Bank Checking Account 51,387.94 3. Zurich Life Annunity Contact #5005462889 31,26064 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same Size) 113,883.31 R""~""'''I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF Strohm Alverna H. FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Charles R. Strohm 44 High Road Shipensburg, PA 17257 Son B Jay A Strohm 1051 Hendricks Road Halifax, VA 24558 Son c Janet A Myers Box 115 Walnut Bottom, PA 17266 Daughter 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 deed forjoinlly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 9/25/00 Allfirst Financial Services CD 10,10241 50. 5,051.21 #2731134 2. B. 7/17/98 Allfirst Financial Services CD 10,10226 50. 5,05113 #8141207520 3. C. 9/25/00 Allfirst Financial Services CD 10,10241 50. 5,05121 #2731133 4. A 8/99 M&T Bank CD 31003910404167 11,595.88 50. 5,797.94 5. B. 8/99 M&T Bank CD 310039,10404125 11,595.88 50. 5,797.94 6. C. 8/99 M&T Bank CD 31003910404084 11,59588 50. 5,797.94 7. A 10/99 M&T Bank CD 31003910487478 22,756.87 50. 11,37844 8. B. 10/99 M&T Bank CD 31003910487569 22,756.87 50. 11,37844 9. C. 10/99 M&T Bank CD 31003910487585 22,756.84 50. 11,37842 TOTAL (Aiso enter on line 6, Recapitulation) $ 66,682.67 T (If more space is needed, insert additional sheets of the same size) """"",{,e,,* COMMONWEAL1H OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Strohm Alverna H. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1. Fogelsanger Bricker Funeral 7,804.90 2. Meal at Funeral to Sunday School Class 250.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State lip Year(s) Commission Paid: 2. Attorney Fees H. Anthony Adams 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register 250.00 5 Accountant's Fees 6. Tax Return Prepare~s Fees 7 Allfirst-check for Estate 1311 8. Chambers burg-West Shore EMS 412.58 9. Chambersburg Hospital 8579 10. Shippensburg Healthcare Center 23.50 TOTAL (Also enter on line 9, Recapitulation) $ 12,339.88 (If more space is needed, insert additional sheets of the same size) REV,,513EX<t,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Strohm Alverna H SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (al (1.2)] 3-"',3-::,'10 1. Charles R Strohm son 44 High Road Shippensburg, PA 17257 33 3370 2. Jay A Strohm son 1051 Hendricks Road 33 33<"?0 Halifax, VA 24558 3. Janet A Myers daughter Box 115 Walnut Bottom, PA 17266 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 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed. insert additional sheets of the same size) LAST WILL AND TESTAMENT '2.\-0;2..- YDS I, ALVERNA H. STROHM, of 707 Brenton Street, Shippensburg, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils heretofore made by me. FIRST: I direct that my funeral expenses be paid as soon as practicable after my death. SECOND: I give, devise and bequeath all my property, be it real, mixed or personal, to my husband, Charles Edgar Strohm, to have and to hold absolutely. THIRD: If my said husband should predecease me or if we should die in a common disaster, then in that event, I give, devise and bequeath all my property, be it real, mixed or personal to my three children, Charles R, Strohm, Janet S. Myers and Jay A. Strohm, in equal shares, share and share alike, per stirpes. FOURTH: I nominate and appoint my husband, Charles Edgar Strohm, as the Executor of this my Last Will and Testament, should he be unable to serve or fail to serve, then in that event, I nominate and appoint Charles R. Strohm and Janet S. Myers as the Executors of this my Last Will and Testament. IN WITNESS WHEREOF, I, ALVERNA H. STROHM, set my hand and seal this Is!.. day of June, 1982. Signed, sealed, published and declared by Alverna H. Strohm as her Last Will and Testament and so done in the presence of we the witnesses, who sign at her request and in her presence and in the presence of each other. - ~ (p1:-<~--..i(.:. ',,-";;'~, .tC?%~ ~~ ~ 4'i.~ ;(. &~.. ,. .. / "JI4....r I .../ " (SEAL) COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, ALVERNA H. STROHM, the Testatrix, whose name is subscribed 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; and that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Oj~... ,I A.< - ~,-k~~ Sworn and acknowledged, before me hy ~~verna H. Strohm, the Testatrix, this l>i day of June, 1982. ~ 1 " /'- /' /"/",,' ~~...~CtL_'t.., 4--C' _././ 4 .' {.. ,1[ARml C9lEI'.'N 'D"~'''N""J'y-1'<Jlilll: Notary Publi~hippensburg, Cumberland Co" Pa. IIrt Cornrnlsolon Expires April 25, 1965. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND We, H. Anthony Adams and Carma L. Cooley, the witnesses whose names are subscribed 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 instrument as her Last Will and Testament; and that she signed willingly and that she executed it as her free act and deed for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Willas witnesses and that to the best of our knowledge the Teatatrix was at that time at least eighteen (18) years of age and of sound mind and under no constraint or undue influence. ~\~~CQ~,-o ". 1'1 ,(f:'t--o[ A' /,' {!.,.,-<"-U-.,. ". Sworn ...nd subscribed before me by H. Anthony Adams-and Carma L. Cooley the f1;nesses/ this IS!, ay of -June, 1982. l"",- Notary Public ':w3rj 1':J:.!ic Shipp~n5bul"~, Cum~er\and ~o" Pa. M! Commissior\ E.xplres April 25, 1985 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT_ 280601 HARFHSBURG, PA 17128-0601 REV-1162 EX( 1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ADAMS H ANTHONY ESQUIRE 128 E KING STREET SHIPPENSBURG, PA 17257 --------IQld EST A TE INFORMATION: SSN: 170-50-6179 FILE NUMBER: 2102-0405 DECEDENT NAME: STROHM AlVERNA H DATE OF PAYMENT: 02/11/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/10/2002 NO. CD 002153 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $15,708.49 I I I I I I I I TOTAL AMOUNT PAID: $15,708.49 REMARKS: H ANTHONY ADAMS ESQUIRE CHECK# 302 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WillS \, /"}-$P- /2> BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVISION IlEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA D~PARTMENT OF REVENUE NOTICE Of INHERITANCE TAX APPRAISEKENT, ALLOWANCE DR DISALLOWANCE Of DEDUCTIONS AND ASSESSKENT Of TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-14-2003 STROHM 04-10-2002 21 02-0405 CUMBERLAND 101 Al\O\mt Rami t:ted H ANTHONY ADAMS STE 3 49 W ORANGE ST SHIPPENSBURG PA 1725.7 *' REV-1S~1 EX iFP [01-05) ALVERNA H I CHANGED III 121 131 141 151 161 171 .00 180.851. 41 .00 .00 113.883.31 66.682.67 .00 181 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiif,;:E;4-jTCAFP-foFoiT"NorIcniF-YtiiiERIi';.ifcn:'A"in-pjiRAIsEiiENT~--Amjw;.ifcE-OR--------______m DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STROHM ALVERNA H FILE NO. 21 02-0405 ACN 101 DATE 04-14-2003 TAX RETURN WAS: I X I ACCEPTED AS fILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property ISchedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgaga Liabilities/Liens ISchedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-alected 9113 Trusts ISchedule J) 14. Net Value of Estate Subject to Tax 191 [101 12,339.88 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYllent. 361,417.39 17.:\39 A8 349,077.51 .00 349,077 .51 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of Abh returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rat. (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due .00 X 00 = .00 349,077.51 X 045 = 15,708.49 .00 X 12 = .00 .00 X 15 = .00 1191= 15,708.49 .00 1111 1121 1131 1141 AX CR ITS: "AYI {" AKDUNT PAID DATE NUI1BER INTEREST/PEN PAID I-I 02-11-2003 CD002153 .00 15,708.49 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-12-2003 TOTAL TAX CREDIT 15,708.49 BALANCE OF TAX DUE .00 INTEREST AND PEN. 68.87 TOTAL DUE 68.87 . If PAID AfTER DATE INDICATED, SEE REVERSE fOR CALCULATION Of ADDITIONAL INTEREST. I If TOTAL DUE IS LESS THAN $1, NO PAYKENT IS REQUIRED. If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI, YOU KAY BE DUE A REfUND. SEE REVERSE SIDE Of THIS fORK fOR INSTRUCTIONS. I n/1.{ , ~\.v BU~~AU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION DE.?T. Z8D60l HA~ISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEKENT, ALLOWANCE OR DISALLOHANCE OF DEDUCTIONS AND ASSESSKENT OF TAX H ANTHONY ADAMS STE 3 49 W ORANGE ST SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-14-2003 STROHM 04-10-2002 21 02-0405 CUMBERLAND 101 * kEV-1S41 EX AFP [Dl-OSl ALVERNA H AlK>Unt R...i't'ted PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV:i54rEif-AFP--(iiFli3"n~oYicE--OF-YNHEifi;:ANCE-TAX-iipPRiiiSEii€NT~--AL1-oWAi-fcE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STROHM ALVERNA H FILE NO. 21 02-0405 ACN 101 DATE 04-14-2003 TAX RETURN HAS: [X I ACCEPTEO AS FILED I CHANGED NOT~' I~ an assessment was issued previouslY. lines 14. 15 and/or 16. 17. 18 and 19 will re~lect ~igures that include the total o~ abh returns assessed to aate. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate lIS) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. A.ount of Line 14 .t Sibling rat. (17) 18. AMount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 349,077.51 X 045 = 15,708.49 .00 X 12 = .00 .00 X 15 = .00 \191= 15,708.49 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks end Bonds [Schedule Bl 3. Closely Held stock/Partnership Interest (Schedule C) 11\. Kortgsges/Noi,es Receivable (Schedule Dl 5. Cash/Bank Deposits/Hisc. Personal Property {Schedule El 6. Jointly Owned Property (Schedule Fl 7. Transfers (Schedule G) 8. Total Assets III 121 [31 141 [51 161 [71 .00 180.851.41 .00 .00 113 .883.31 66.682.67 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdR. Costs/Hisc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernRental Bequestsj Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax [91 [101 12,339.88 .00 [111 [121 [131 [141 NOTE: To insure proper credit to your account, subRit the upper portion of this for. with your tax paYllent. 361,417.39 1?339 88 349,077.51 .00 349,077.51 TAX CR"DITS: " ,.. AHOUNT PAID DATE NUI1BER INTEREST/PEN PAID [-I 02-11-2003 CD002153 .00 15,708.49 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-12-2003 TOTAL TAX CREDIT 15,708.49 BALANCE OF TAX DUE .00 INTEREST AND PEN. 68.87 TOTAL DUE 68.87 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. [ IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. I 1'11'"'1'1"1'11'1'"'1'1'11"'11"'11"11"""111"'111"'1 Z.E.::::E:#~~OL 1 HOH Vd 'alslpe:) asnoH I.JnO:) Aluno:) puepaqwn:) SII!M}O JalSI6aCl -_'_~--._,~....-~.-- - /" -....... ....,. ,f" .,1~ ----',.-"-..--.- --.....0 "0/_"-- + /', :;,J'f t','; ~) LS,<::LI VINVA"l:ASNNad '~:::nH"H(SNaddU-l . H.LlflS '.L3a"ll.LS 3:DNVlIO .LS3i\'\6" """'"-'<.. ~'" ~- {- V 'Id swvay ANOH.LNY "H -' g;:)lddO MV, ~- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ADAMS H ANTHONY 128 EKING ST SHIPPENSBURG, PA 17257 ___nn_ fold ESTATE INFORMATION: SSN: 170-50-6179 FILE NUMBER: 2102-0405 DECEDENT NAME: STROHM AlVERNA H DATE OF PAYMENT: 04/22/2003 POSTMARK DATE: 04/21/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/10/2002 NO. CD 002477 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $68.87 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: H ANTHONY ADAMS ESQUIRE CHECK# 10314 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $68.87 DONNA M. OTTO DEPUTY REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0001 REV-1 162 EX{1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ADAMS H ANTHONY ESQUIRE 128 E KING STREET SHIPPENSBURG, PA 17257 u______ fold ESTATE INFORMATION: SSN: 170-50-6179 FILE NUMBER: 2102-0405 DECEDENT NAME: STROHM ALVERNA H DATE OF PAYMENT: 05/02/2003 POSTMARK DATE: 05/01/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/10/2002 NO. CD 002522 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $68.87 I I I I I I I I TOTAL AMOUNT PAID: $68.87 REMARKS: H ANTHONY ADAMS ESQUIRE CHECK# 10335 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS 04-14-2003 STROHM 04-10-2002 21 02-0405 CUMBERLAND 101 I Amount Remitted 11 (oK <?,'J MAKE CHECK PAYABLE AND REMIT PAYMENT TD: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... riE"Y=i5'4-j-EiCAFP-fiiFo3'n:jo"-IcniF-i:-N"HE'ifITAifcrr"Ainip"PRAISEMEtl'i':--AL'i.-owAi.fcrcfR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ALVERNA H FILE NO. 21 02-0405 ACN 101 BUREAU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17125-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX H ANTHONY ADAMS STE 3 49 W ORANGE ST SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17257 ESTATE OF STROHM *' REV-1541 EX lFP <Dl-OSl ALVERNA H TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 04-14-2003 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount 'Of Line 14 at Spousal rate (15J 16. Amount of Line 14 taxable at Lineal/Class A rate {16J 17. Allount of Line 14 at Sibling rate (17J 18. Allount of Line 14 taxable at Collateral/Class B rate (18J 19. Principal Tax Due .00 X 00 = .00 349,077.51 X 045 = 15,708.49 .00 X 12 = .00 .00 X 15 = .00 (19)= 15,708.49 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate {Schedule AJ 2. Stocks and Bonds {Schedule BJ 3. Closely Held Stock/Partnership Interest {Schedule CJ 4. Mortgages/Notes Receivable {Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property {Schedule EJ 6. Jointly Owned Property {Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets ll) (2J (3) (4) IS) (6) (7) .00 180,851.41 .00 .00 113,883.31 66,682.67 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses {Schedule Hl 10. Debts/Mortgage Liabilities/Liens {Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax (9) llO) 12,339.88 .00 ll1l ll2) ll3) ll4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYllent. 361,417.39 17.339 RR 349,077.51 .00 349,077 .51 ~TS: I+J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-J 02-11-2003 CD002153 .00 15,708.49 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-12-2003 TOTAL TAX CREDIT 15,708.49 BALANCE OF TAX DUE .00 INTEREST AND PEN. 68.87 TOTAL DUE 68.87 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) LAW OFFICE ".'-'~'''-'._.,,,,,. "'~'--" 0,;2- "'/00'-"' H. ANTHONY ADAMS .. ... ., - _',,~.~..,^- I, ........ "'.".,', 49weST ORANGE STREET, SUITE 3 HIPPENSl3l.JRO.. PENNSYLVANIA 17257 I. '.~ .-"l" Register of Wills Cumberland County Courthouse Carlisle, PA 17013 i?Oi3:i'3~'32 1...III...III..I..III..II...II...II.I.I....i.II.I..I.I,...II.1 //)-6S'-,(S ~ BUREAU OF INDIVIDUAL TAXES IHHERIT~NCE TAX DIVISION DfPT. 2806111 HARRISBURG~ PA 17128-116111 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-1601 EX AFP UI-D5J H ANTHONY ADAMS STE 3 49 W ORANGE ST SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-05-2003 STROHM 04-10-2002 21 02-0405 CUMBERLAND 101 ALVERNA H Amount R.mitted PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your Rccount, sub..it the upp.r portion of this for. with your tax pay.ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=i6rj;-ixAFP--foFiiiY------.ii.-iiilifERI'fANCE--;:Aif-SYIifEHEN";:-oTACciiuNf--...--------------------- ESTATE OF STROHM ALVERNA H FILE NO. 21 02-0405 ACN 101 DATE 05-05-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-14-2003 PRINCIPAL TAX DUE,_ 15,708.49 PAYMENTS (TAX CREDITS), PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-11-2003 CD002153 .00 15,708.49 04-21-2003 CD002477 68.87 - 6B.87 . TOTAL TAX CREDIT 15,708.49 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l STATUS REPORT UNDER RULE 6.12 -\ c/ of<. Name ofDecedent: ----H \ lH' {' !-..X)._ ~, S~O ~ VV'\ Date ofDeath: _~ ~\ ~ ( {(') I ;:) (')n.)- Will No.: Admin. No.: :1.-1- () (}~()'-(Ob Pursuant to Ru1e 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1: Stat~ether administration of the estate is complete: Yes~ No 0 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. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. ~i~ the personal wesentative state an account informally to the parties m mterest? Yes ~ No 0 . c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk ofthe. Orphans' Court and may be attached to this report. Date:d25r!OV . \~~-P~ ~' SIgnature \~. ~~~I'~ ~ 'fV'S, Name j::"!~ lf9 OJ Ofu../p S~e?f. Address 3u \ k. '3. ~ sC"''<.~Qt....)~'-''-S'''''1 '\--'~.... (/2>57 r")//- C;~J-~ ~d-7() Telephone No. n"''C\lIII):) vi]: l d [- Hd\i \70. Cflpacity: lliersonal Representative ',. ~ounsel for personal representative