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Home My WebLink About03-0274 . Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Evelyn Sarah Berkeley No. r::;/- CJ.3-c:27Y , also known as , Deceased Social Security No. 195 - 28 - 8900 Carol Lee Brackbill Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) []] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix named in the last Will of the Decedent, dated 04/02/1980 and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I Carol Lee Brackbill Daughter 69 Clouser Rd. , Mechanicsburg, PA Patricia Ann Mondello Daughter 17 Clark Ave. , Lvnbrook, NY 11563 (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 1103 A Ie Drive, Borou h of Mechanicsbur , Mechanicsbur , PA 17055 ~\\ (list street, number, and municipality) Decedent, then ~years of age, died 03/01/2003 at Mechanicsburg, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property $ 330,000.00 (If not domiciled in PAl Personal property in Pennsylvania $ (If not domiciled in PAl Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: T ed or rinted name and residence Carol Lee Brackbill 69 Clouser Road, Mechanicsbur , PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems.lnc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~~", ;(3~,,~u rrr Carol Le Brackbill before me thi~ day of ~ ~.:J _ A{)y4?~t2i: LJ!Z:t..)~~ ~ Au ~egister No. 02/-03 - ~ 7 y' , Estate of Evel yn Sarah Berkeley Deceased Social Security No: 195-28-8900 Date of Death: 03/02/2003 AND NOW, mA-efPJ./ r2.8. ~o6l.!J , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [R] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Carol Lee Brackbill in the above estate and that the instrument(s) dated 04/02/1980 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . $ Q3'Q5-; t"JO UI.?/d'.d Pi /J~ . //.J1: ~-'h/4: Short Certificate(s). . . . . $ /.:L.CJ6 Register OfWil~;au~ Renunciation. . . . . $ ~CJO Attorney: James D. Bogar, Esquire Affidavits ( ) . . . $ I.D. No: PA 19475 Extra Pages ( ). . . . $ b.~O Address: One West Main Street Codicil. . . . . . . . . . . $ Shiremanstown, PA 17011 JCP Fee. . . . . . . . . . $ /6.CJO Telephone: 717/737-8761 Inventory. . . . . . . . . . $ ~ ~~ Other. . . . . . . . . . $ TOTAL. . . . . . . .. $ 0....::].f? LJ~.J Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) -9/-C.:S-~7~ / RENUNCIATION In Re Estate of Evelyn Sarah Berkeley deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Patricia Ann Mondello , Co-Executrix of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Carol Lee Brackbill, who is a named Co-Executrix WITNESS her hand this I q 'iL day of '/') )tiit/~ ,20~. /'1 ./1 '-.-" .1 ,) I a[;'t c.t-11.. ~ I)t.t 4.. (.( -1 , Ij 'oIL I)~, /. C. (Signature) patricia Ann Mondello 17 Clark Avenue Lynbrook, NY 11563 (Address) (Signature) (Address) (Signature) (Address) .. OECEOENT'SMAlllNO__. .......Z1pCodo) 1103 Apple Drive =-.. Iwp Mechanicsburg, PA 17055 I".-......-land ~ <\Ii No __ Mechani burg ". 17b. Coun ..........11l..Jt:L 17cU!!I wlhin ~ IIl'nltI 01 CS .\Qo FATHER'S NAME IFiIII. MiddII, ~ MOTHER'. NAll!EJFiftf. Midc:I8. ,Maiden SUllwne) 11. Percival Rhoads 11. Katnerine SChreffler 'NFORMANT'S NAME (T~ INFORMAH'''S UAlUNO IS . COy/Town. _. z.. Codo) Carol L. Brackbill 69 Clouser Road Mechanicsburg, PA 17055 PlACE OF . Homo ~. c...n..oiY lOCRION. COy/Town. ....., Zip Codo 010lhlr PIece ~ 1. March 5, 2003 1. Hollinger Crematory 1 .Mt.Holly Springs, PA PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDAESSOF MCII..ITY : 22.. FD-014889-L . .Malpezzi 8 r-miet Pla2a W3y~, m. 17055 1b the bMt 01 my knowtedge, dlNth OOCUIred al the tiIM, date and place staled lICENSE NUMBER DATE SIGNED (&gnature and rille) (Month, Day, ~af) aa.. 23b. TWe OF DEATH Ap rx . DATE PRONOUNCED DEAD !Month, Day, '$at) VMS CASE REFERRED 10 MEDJ5.AL .. 10:00 A. M .1. March 1, 2003 '"'jIlj NoD 27. PART I: Enter I.... diM&Ns, injurlee, Of ~ wNcn cauted the death. Do not eneallne mode 01 dying, such aa cardiK or rnplralory .'flllt, Ihock or haiart Idur., AppIoxlmata PART II: 1..ia1 only OM cau.. on aach 11na. lImeN., betwMn i DnMt and deaIh . M ocardial Infarction ' DUE TO fOR AS A CONSEQUENCE OF): I .. OUElO(OR AS A CONSEOUENCE OF), I . DUE 10 (OR AS A. CONSEQUENCE OF): WERE AUTOPSY FINDINGS MANNER OF DEATH ORE OF INJURY TIME OFlNJUAV INJURV 1fl WORK? AWdLABlE PRIOR 10 (Month, Day, Year) ~~OFCAUSE Natu,. ~ ~ 0 Yea Acddanl: 0 P.ooIng inN_ligation 0 ... 0 No 0 SuIcIda d Could not be datermlned 0 ~~;=:~~=;;~I norn., farm, ..., 1ect0ly. otfIce Ha. za. II. JOe. CIlITIF1ER (ChedI "'" 000' -c::IRTIFYING PHYIICIAN (Phyaiaan teftiIyiog cauN 01 de&th when anoiher physician has pronounced death and complalad .'em 23) Co rone r To...bettof""~'''''''OOCUI'nNIdueto1haceuae(.)andm.nner................,....,.,..,...,............ .,............ ~ DATE SIGNeD (Month, Day, 'lHtl :~ -PAOHOtJHC:artQAHDCEllTIPYINGPHY8ICIAN(Ptl)'tlicillnboth Pf'onoufICingdealhand C8I1IIy1ngtocause01 dflalh) 0 March 3, 2u03 :~ Tolhe....totm}'~.....tI'IoecunMatthetftM, dII...ncf~a,.ncfduetoIheCllUM(.)anct.....,.,.,...tatM........",..,.,........., H~AHDADDRESSOFPEASONWHOCOUPl.ETe~CAUSEOf'DERH :~ (1!em271T..,.....",. Michael L. Norris, Coroner :J '~~~~"":.===""'''''''''".n,'n mfoplnlon, .....h............ '''"m., ......... pl........ du....... ._.,.... 6375 Bssehore Road, Sui te #1 :! m..M............. .......... ............, ..'.................. ..............,.. ...... ,.. ............... .......... Mechanicsburg, Pa. 17050 ...: 31.. Z REGISTRAR'S S",NATURE AND NUMBER ~ l.?r 11..;lr I ~ M, -'V V. ~/-C:;03- C:;7Y . , Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Evelyn Sarah Berkeley No, r::;/- CJ.3-c:27Y , also known as , Deceased Social Security No, 195-28-8900 Carol Lee Brackbill Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) []] A, Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix named in the last Will of the Decedent, dated 04/02/1980 and codicil(s) dated None State relevant circumstances, e.g" renunciation, death of executor, etc, Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A D B. Grant of Letters of Administration (c,t.a,; d,b,n,c,t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I Carol Lee Brackbill Daughter 69 Clouser Rd. , Mechanicsburg, PA Patricia Ann Mondello Daughter 17 Clark Ave., Lynbrook, NY 11563 (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 1103 A 1e Drive, Borou h of Mechanicsbur , Mechanicsbur , PA 17055 ~\\ (list street, number, and municipality) Decedent, then ~years of age, died 03/01/2003 at Mechanicsburg, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property $ 330,000.00 (If not domiciled in PAl Personal property in Pennsylvania $ (If not domiciled in PAl Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 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 a ro riate form to the undersi ned: Si nature T ed or rinted name and residence Carol Lee Brackbill 69 Clouser Road, Mechanicsbur , PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, I nc, Form RW-1 (1991) - c:;:2/- C:?S - ~7j/ LAST WILL AND TESTAMENT I, EVELYN SARAH BERKELEY, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, being of sound and dis- posing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void . all former wills and codicils by me at any time heretofore made. ~~ FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Co-Executrices, as the case may be, i " hereinafter named, as soon as conveniently may be done after my decease. ~ SECQ~~. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and where- soever situate, unto my husband, WARNER PATRICK BERKELEY, absolutely and in fee simple, if he survives me. THIRD. If, however, my husband shall fail to survive me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my Estate, rea I, personal and mixed, whatsoever and where-. soever situate, in equal shares unto my daughters, namely: CARO L LEE ~ BRACKBILL and PATRICIA ANN MONDELLO, share and share alike, absolutely and in fee simple, if they survive me. If either of my said daughters shall fail to survive me, then and in that event I order and direct that the share which she would have received had she survived me shall be paid and distributed unto my other daughter who survives me, absolutely and in fee simple. ;FOURTH. If, however, my husband and my daughters shall all fail to survive me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my Estate, rea 1 , personal and mixed, whatsoever and wheresoever situate, in equal shares unto my then living grandchildren, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my husband, WARNER LAW OFFICES SNELBAKER, PATRICK BERKELEY, Executor of this, my Last Will and Testament, but if McCALEB Be ELICKER for any reason he shall fail to qualify as such Executor or cease so - to serve, then I nomin~te, constitute and appoint my daughters, CAROL LEE BRACKBILL and PATRICIA ANN MONDELLO, Co-Executrices, to serve in his place and stead, all to serve without bond in this or any other jurisdiction. If either of my said daughters shall fail to qualify as such Co-Executrix, or cease so to serve, it shall not be necessary to appoint a substitute Co-Executrix to serve in her place, but in such event the remaining or surviving Co-Executrix shall serve with full power and authority under this, my Last Will and Testament. IN WITNESS WHEREOF, I, EVELYN SARAH BERKELEY, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my signature this ~ day of ~ A.D., One Thousand and Nine Hundred Eighty (1980) . 1l7+ Ja~~7L) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by EVELYN SARAH BERKELEY, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. JL~fIu (7~uJ:-' '}n- \~~, LAW OFFICES SNELBAKER, McCALEB a ELICKER COMMONWEALTH OF PENNSYLVANIA ) : SSe COUNTY OF CUMBERLAND) We~ EVELYN SARAH BERKELEY, MARLIN R. McCALEB and JANET M. FORRY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument~ being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix~ signed the Will as witness and that to the best his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ,/ ,/7 /,( a~/~~ Testatrix ~ ~tlu PJVl ct )11. ,,;I tyVd ' Wltness Subscribed, sworn to and acknowledged before me by EVELYN SARAH BERKELEY~ the Testatrix, and subscribed and sworn to before me by /) NO MARLIN R. McCALEB and JANET M. FORRY ~ witnesses, this (.:X.. day of C/f~f(/~ ~ 1980. .' I U ~. \,~.' / /; ""- ~-.' ~.,"~ ex! ~~u , N6tary PUblic FLORENCE B. toSCHER, NOTARY PUBUC .\ MrCHANICSBURG BOROUGH: CUMBfRLMW COUNTY,. MY CQMMISSlfJN E/FtRES .^PR. 6. 1987 LAW OFFICES SNELBAKER. McCALEB 8c ELICKER -' ~ u..l ~ LD LD >- U 0 ~ - t'-. .....l - ~ l-Ll ::; ~ ~ Z p:: ~ ~ J:.Ll ~ I- P=l "' ;.-l ~ 0 o-l "' >-- 0( ::c: u..l 0. ~ ~ [/) ~ .....l '" ~ ~ ~ <( 8 ~ I ~ "-I = Ci5 u ~ ~ ~ Il. ttt u 6 2 ~ 0' ~ ~~ ~ 2 ~ ::> "' i:Q ~ 0 ~ '<1 J:.Ll ~ '" '<1 [/) :> u..l 0. U J:.Ll ~ <: ~ <( :r: ~ u .....l "-I u..l ~ Z V) -, ~ .I CERTIFICATION OF NOTICE UNDER RULE 5.6 ( a) Name of Decedent: Evelyn Sarah Berkeley Date of Death: March 1, 2003 Will No. 21-03-0274 Admin. No. To the Register: I certify that notice of 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 March 31, 2003: Name Address Carol Lee Brackbill 69 Clouser Road Mechancisburg, PA 17055 patricia Ann Mondello 17 Clark Avenue Lynbrook, NY 11563 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 3/31/03 r, Esquire Street , PA 17011 737- 61 Capacity: Personal Representative X Counsel for Personal Representative ~ JAMES D. BOGAR ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN, PENNSYLVANIA 17011 e-mail mail@bogarlaw.com TELEPHONE (717) 737-8761 JAMES D, BOGAR FACSIMILE JENNIFER B, HIPP. (717) 737-2086 .Also admitted to New Jersey Bar Direct e-maliJbogar@bogarlaw.com May 6, 2003 Or:- :0 ,,- .-"" 8 = (\~ m ::1 :"i.. VIA HAND DELIVERY 0.'. (') .' () ~V 3 I""~' fe' :J::oo 'i':. Donna Otto -< Register of Wills i::'_~;!: I ..... Cumberland County Courthouse ;a One Courthouse Square ,. 0 Carlisle, PA 17013 I" W ......, ..... RE: The Estate of Evelyn S. Berkeley No. 21-03-0274 Date of Death: March 1, 2003 Dear Ms. Otto: I represent the Estate of Evelyn S. Berkeley. Enclosed is a check made payable to the Register of Wills in the amount of $13,851.00, same constituting a prepayment at discount on account of pennsylvania inheritance taxes in the above-captioned estate. The prepayment is determined as follows: $324,000.00 multiplied by 4.5% or $14,580.00, less discount in the amount of 5% or $729.00, resulting in payment of $13,851. 00. Please provide me with the appropriate receipt in this matter. Your time and consideration in this matter are greatly appreciated. Very truly yours, iQ~ohtr J ES D. B JDB/blw Enclosure cc: Carol Lee Brackbill, Executrix patricia Ann Mondello COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 PENNSYL VANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002531 BOGAR JAMES D ESQUIRE 1 WEST MAIN STREET SHIREMANSTOWN, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER __h____ fold ---------- -------- 101 I $13,851.00 ESTATE INFORMATION: SSN: 195-28-8900 I FILE NUMBER: 2103-0274 I DECEDENT NAME: BERKELEY EVELYN SARAH I DATE OF PAYMENT: 05/07/2003 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 03/01/2003 I I TOTAL AMOUNT PAID: $1 3,851 .00 REMARKS: CAROL LEE BRACKBILL C/O JAMES D BOGAR ESQUIRE CHECK# 101 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS , /7-13 i-5 GJ OFFICIAL USE ONL Y / REV -1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA 21-03-0274 DEPARTMENT OF REVENUE RESIDENT DECEDENT DEPT,280601 COUNTYCODE YEAR NUMBER HARRISBURG. PA 17128-0601 DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER D E Berkeley Evelvn S. 195-28-8900 C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE E D 03/01/2003 08/l8/l9l3 REGISTER OF WILLS E N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOqALSECU~TYNUMBER T ~ 1. Original Return 2. Supplemental Return 0 3' (date of death = 4a. Future Interest Compromise (date of death after 12-12-82) . Remainder Return prior to 12-13-82) CAPB 4. Limited Estate 5. Federal Estate Tax Return Required HpRL - EplO X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes - - - CRAC (Attach copy of Will) (Attach copy of Trust) KOTK o 9. Litigation Proceeds Received D 10. Spousal Poverty Credit 0 11. Election to tax under Sec, 9113(A) ES (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) .......l'J.lISS~e'tIPj\J:MOstBEcbMPl.ETEDU:ALL..CbRRESPONjjEN~E&iCfPj\JFIDENTiAl..TAx)INf:'ORMATIQNSHbtll.o'SE.OIRECTEOiTO: p NAME COMPLETE MAILING ADDRESS C 0 0 James D. Bogar Esquire R N FIRM NAME (If Applicable) R D One West Main Street E E Shiremanstown, PA 17011 S N T TELEPHONE NUMBER 717/7~7-8761 1. Real Estate (Schedule A) (1 ) None OFFICIAL USE ONL Y 2. Stocks and Bonds (Schedule B) (2) N6ne 3. Closely Held Corporation. Partnership or (3) None Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None - R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 334,537.42 ( . E (Schedule E) ," C A 6. Jointly Owned Property (Schedule F) (6) None P 0 I Separate Billing Requested T 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7) None U L (Schedule G or L) ~ A T 8. Total Gross Assets (total Lines 1-7) (8) 334,537.42 I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10,929.88 0 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) None 11. Total Deductions (total Lines 9 & 10) (11 ) lO,929.88 12. Net Value of Estate (Line 8 minus Line 11) (12) 323,607.54 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 323,607.54 C 0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M P 15. Amount of Line 14 taxable at the spousal tax T U A T rate, or transfers under Sec. 9116(a)( 1,2) X ,0 0 (15) 0.00 X A 16. Amount of Line 14 taxable at lineal rate 323,607.54 .0 45 (16) l4,562.34 T X I - 0 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 N 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 14,562.34 20. rx1 IW:~~EqK!~ERE:~fXq9!~RE',$:Eq9~~tjN~'~!~~~~~P:~~:~N!fq~RP.~YM$:NI!WI ~i.'.lE+;" ..............................;}..!................}.U:i.}:.J.\....>i...~ial$$lJaEiTq.::.~NSWER):.~lft..QIJE$TlQi\Js.~N;IR)t;Me:a$E!$IPr::'ANP!:tQir:tI::CaEC:j<i.MAl'H!i~i.~,n:i..!... . Copyright (c) 2000 form software only The Lackner Group,lnc, Form REV-1500 EX (Rev, 6-00) Decedent's Complete Address: STREET ADDRESS 1103 A Ie Drive CITY STATE ZIP Mechanicsbur PA l7055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 14,562.34 2. Credits/Payments A. Spousal Poverty Credit 0 . 00 B. Prior Payments 13,851.00 C. Discount 728.12 Total Credits (A + B + C) (2) 14,579.12 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 0 . 00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 16. 78 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due, (SA) 0 . 00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 0 . 00 Make Check Payable to: REGISTER OF WILLS, AGENT 'pLEASE'ANSWERT~g:~6[:t6!1'~dciG~~Y~~~~':~~:~[~2il;~:a::~~ il,:~i,,;: ,~i!:;~';;:;~g!6~:~:i~f~i;'~~66~;'" 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...,.....,.... ~ ~ b. reta~n the right to de~ignate who shall use the property transferred or its income; , X c. retain a reversionary Interest; or. . . . . , . . . , , . . , , . . . , . , . , , . , X d. receive the promise for life of either payments, benefits or care? . , . , , , . . . X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . , . . .. ".,.....",.." D [R] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ..,.,.."...."...".......,..",.". ,..". D [R] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . , . . , . , , . . . . . , . . , . , , , . , , . , , . . . . D [R] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative Is based on all information of which pre parer has any knowledge. Carol Lee Brackbill DATE - - _E!. ~ - s:_~ C?'}~_~~ - !<_~c:?-_ - - - -- - - - - - - - - - - -- -- - - - - -- - - - - -- J 0 _ Z 1- 03 Mechanicsbur , PA 17055 James D. Bogar Esquire DATE One West Main Street ----------------------------------------------------- Shiremanstown, PA 17011 For dates of death 0 er July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S, 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P,S, 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S, 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P,S, 9116( 1.2) [72 P.S. 9116(aX1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P ,S. 9116(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, Copyright (c) 2000 form software only The Lackner Group,lnc, Form REV-1500 EX (Rev, 6-00) REV-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERIT ANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn S. Berkeley SSfI 195-28-8900 03/01/2003 21-03-0274 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Comcast Cable - Refund 25.08 2 Patriot News Co. - Refund 20.81 3 Penn National Insurance - Refund of Renter Insurance Premium 35.00 4 PNC Bank, N.A. - Certificate of Deposit No. 31400194068, date of 50,048.45 death balance $50,000.00, accrued interest $48.45 5 PNC Bank, N.A. - Certificate of Deposit No. 31500198388, date of 50,000.00 death balance $50,000.00, accrued interest $0.00 6 PNC Bank, N.A. - Checking Account No. 5070077583, date of death 92,826.26 balance $92,813.88, accrued interest $12.38 7 PNC Bank, N.A. - Savings Account No. 5000628001, date of death 137,957.39 balance $137,904.71, accrued interest $52.68 8 United States Treasury - Social Security Payment 752.00 9 United States Treasury - 2002 Federal Income Tax Refund 2,362.00 10 Verizon - Refund 10.43 11 Contents of home and personal property 500.00 TOTAL (Also enter on line 5, Recapitulation) $ 334,537.42 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc, Form REV-1508 EX (Rev. 1-97) l'IHT-'(,J'::::-'::::'c:J'c:J..5 11; 4'( ~NL~HNK Llr Uc~HHIMcNI 41d '(ld::' 00::"( r'.01/02 ~ PNCBAN< . ~, - -thr , ;, /rc:./1tr ~': \,L. . - .\-- /\ \.J i ~1 /)1 ,'-.... 1---' . I ......... V f ./~ ._\:..... May 2, 2003 James D. Bogar One West Main Street Shiremanstown, P A 17011 RE: Estate of Evelyn Sarah Berkley, deceased SSN: 195-28-8900 DOD: 3/1/2003 Dear Mr. Bogar: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certifieates of Deposit Account #31400194068 Established 07/19/2000 EVELYN S BERKELEY DOD balance: 550,000.00 + $48.45 accrued interest ,- Account #31500198388 Established 08/28/2000 EYEL YN S BERKELEY DOD balance: $50,000.00 + $0.00 accrued interest Checldng Account Account #5070077583 Established 08/23/1973 EVELYN S BERKELEY DOD balance: $92,813.88 + $12.38 accrued interest Savings Account Account #5000628001 Established 08/30/1996 EVELYN S BERKELEY DOD balance: $137,904.71 + $52.68 accrued interest Page 1 of2 MAY-02-2003 11:48 PNCBANK CIF DEPARTMENT 412 705 0057 P.02/02 Please note that this office only provides date of death balances for deposit accounts (lRAs, CDs, Checking and Savings accounts). We do Dot process any fiDaDcial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Gh~~ Rachelle Wells 1-800- 762-1775 P7 -PFSC-04-F 500 first Ave. Pittsburgh PA 15219 ,- Page 2 of2 Member FDIC ----. - -- REV-1511 EX +(1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERIT ANCE T IV( RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn S. Berkeley SSff 195-28-8900 03/01/2003 21-03-0274 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Malpezzi Funeral Home - Funeral 5,187.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney's Fees James D. Bogar Esquire 4,375.00 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 of Wills 338.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 AT&T - Final Bill 0.36 2 Comcast Cable - Final Bill 36.93 3 PP&L - Final Bill 88.13 4 RESERVES: Costs to conclude administration of Estate including 850.00 filing fee for PA Inheritance Tax Return, Inventory and First & Final Account; preparation of Personal and Fiduciary Income Tax Returns 5 United Parcel Service - Overnight Service to P. Mondello l4.21 Total of Continuation Schedule(s) 40.05 TOTAL (Also enter on line 9, Recapitulation) $ 10,929.88 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Evelyn S. Berkeley Soc Sec i!: 195-28-8900 Date of Death: 03/01/2003 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount if 6 Verizon - Final Bill 40.05 -------------- 40.05 REV -1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIAR IES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelvn S. Berkelev SSff 195-28-8900 03/01/2003 21-03-0274 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(a)(1,2)] 1 Carol Lee Brackbill Daughter One-half (1/2) 69 Clouser Road of rest, Mechanicsburg, PA 17055 residue and remainder 2 Patricia A. Mondello Daughter One-half (l/2) 17 Clark Avenue of rest, Lynbrook, NY 11563 residue and remainder ENTER DOLLAR AMTS, FOR DISTRIBUTIONS SHOWN ABOVE ON LN, 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group,lnc, Form REV-1513 EX (Rev. 9-00) IAST WILL AND TESTAMENT I, EVELYN SARAH BERKELEY, of the Borougl1 of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, be:ing of sound and dis- posing mind, memory and understanding, do make, publi.sh and declare this as and for my Last Will and Testament, hereby revoking and making voi.d . all former wills and codicils by me at any time heretofore made. }~ FIRST. I order and direct that all my just debts and funeral -.."" .~ ~ expenses be paid by my Executor or Co-Executrices, as the case may be, "'-\:;\ ~ hereinafter named, as soon as conveniently may be done after my decease. i"i SECOND. I give, devise and bequeath all the rest, residue and ,. , " / ----- remainder of my Estate, real, personal and mixed, whatsoever and where- soever situate, unto my husband, WARNER PATRICK BERKELEY. absolutely and in fee simple, if he survives me. THIRD. If, however, my husband shall fall to survive me, then and in that event I give. devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and where- soever situate, in equal shares unto my daughters, namely: U\RO L LEE BRACKBILL and PATRICIA ANN MONDELLO, share and share alike, absolutely and in fee simple, if they survive me. If either of my said daughters shall fail to survive me, then and in that event I order and direct that the share which she would have received had she survived me shall be paid and distributed unto my other daughter who survives me, absolutely and in fee simple. FOURTH. If, however, my husband and my daughters shall all fail to survive me, then and in that event I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, in equal shares unto my then 1 iving grandchildren, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my husband, WAfu~ER LAW OJll"II'TC~5 SNEt.SAKER. PATRICK BERKELEY, Executor of this, my Last Will and Testament, but if MCCAL.EB .! EL.ICK!:R for any reason he shall fail to qualify as sur.h Executor or cease so . to serve, then I nominate, constitute and appoint my daughters, CAROL LEE BRACKBILL and PATRICIA &~ MONDELLO, Co-Executrices, to serve in his place and stead, all to serve without bond in this or any other jurisdiction. If either of my said daughters shall fail to qualify as such Co-Executrix, or cease so to serve, it shall not be necessary to appoint a substitute Co-ExecutrL~ to serve in her place, but in such event the remaining or surviving Co-Executrix shall serve with full power and authority under this, my Last Will and Testament. IN \VITNESS WHEREOF, I, EVELYN SARAH BERKELEY, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my /) I. ' 1 signature this '-"<--- day of jlul...A-i. A.O., One Thousand and Nine Hundred Eighty (1980) . J: . t. 7(7' L!...'.yt./ r . a Lc'.-J...' /iv.fJ.'7\L) I 0 . The preceding instrument, consisting of this and one (1) other type\~ritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by EVELYN SARAH BERKELEY, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. AZ0i '~~~. /tY~U 'l n I. \::::/ ""-''--''-'-- . /o......uJ- / - d LAW O,....'CES SNEL.3AKER. McCALlt9 a: ELICi<:E:R . COMMONWEALTH OF PENNSYLVAJ.'HA ) : 5S. COUNTY OF Cill'IBERlA'lD ) We, EVELYN SARAH BERKELEY, 1'!ARLIN R. McCALEB and JANET ~I. FORRY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrwnent, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best his or her knowledge the TestatrLx was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. )1"- '" l Li: . h1. \ -IIJ-^-I'--'J Wltness Subscribed, sworn to and acknowledged before me by EVELYN SARAH BERKELEY, the Testatrix, and subscribed and sworn to before me by ........., /It/) l'!ARLIN R. ~lcC..\LEB and JANET 1'1. FORRY, witnesses, this ,.:x.. day of /U' . , 1980. l. /,c..--L. -/ ,/ l' '~ '--7-' .J -, y'::. / ' / " -. ..:Z~u, L -f' ~/. ,---;{'-"~'--"~".:...,,' Notary Pub lic fliJHPlrf B l!!~r'!'E~, IIrlftl;Y rUGue \ M~ ill,)q';~C~!.lllrr~ 11' 'O:lf IGII Cl:~:urRl.'.rin ~ "::nIy ...... MY rr)~.!Mr:,~:~\tl ~'('~"t~ .~;::: ~ l'.'l'l:" LAW O"tC!S SNEL9AKER. ",-:,,:,\:..,n it ~'.::t!:1 . ,. Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Evelyn S. Berkeley No, 21-03-0274 also known as Date of Death 03/01/2003 . Deceased Social Security No, 195-28-8900 Carol Lee Brackbill, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I /We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa, C,S, Section 4904 relating to unsworn falsification to authorities. Name of James D. Bogar Esquire P"';::,~::'~'~~~ Attorney: Carol Lee Brackbill I.D. No,: 19475 Signature: Address: One West Main Street Address: 69 Clouser Road Shiremanstown, PA 17011 Mechanicsburg, PA 17055 Telephone: 717/737-8761 Telephone: 717/766-7590 Dated: fO-Z.l-03 Description Value .' . \..... (See continuation page(s) attached) -- (Attach additional sheets if necessary) Total: 334,537.42 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, [nc, Form #RW-7 (1992) . . INVENTORY Estate of: Evelyn S. Berkeley Date of Death: 03/01/2003 County: Cumberland CASH: ----- Comcast Cable - Refund 25.08 Patriot News Co. - Refund 20.81 Penn National Insurance - 35.00 Refund of Renter Insurance Premium PNC Bank, N.A. - Certificate 50,048.45 of Deposit No. 31400194068, date of death balance $50,000.00, accrued interest $48.45 PNC Bank, N.A. - Certificate 50,000.00 of Deposit No. 3l500198388, date of death balance $50,000.00, accrued interest $0.00 PNC Bank, N.A. - Checking 92,826.26 Account No. 5070077583, date of death balance $92,813.88, accrued interest $l2.38 PNC Bank, N.A. - Savings 137,957.39 Account No. 5000628001, date of death balance $137,904.71, accrued interest $52.68 United States Treasury - 752.00 Social Security Payment United States Treasury - 2002 2,362.00 Federal Income Tax Refund -1- , . Verizon - Refund 10.43 -------------- 334,037.42 PERSONAL PROPERTY: ------------------ Contents of home and personal 500.00 property ----..--------- 500.00 ---------------- TOTAL RECEIPTS OF PRINCIPAL. .............. 334,537.42 ---------------- ---------------- -2- ~ COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG. PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP <01-03' DATE 12-22-2003 ESTATE OF BERKELEY EVELYN S DATE OF DEATH 03-01-2003 FILE NUMBER 21 03-0274 - COUNTY CUMBERLAND JAMES D BOGAR ESQ ACN 101 I W HAIN ST I Aoo""' R..itt.. I SHIREMANSTOWN PA 17011 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-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BERKELEY EVELYN S FILE NO. 21 03-0274 ACN 101 DATE 12-22-2003 T AX RETURN WAS: (X) ACCEPTED AS F I LED () CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (I) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposi ts/Misc. Personal Prope rty (Schedule E) (5) 334 ,537.42 tax payment. 6. Jointly Owned Property (Schedule F) (6).00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 334,537.42 APPROVED DEDUCTIONS AND EXEMPTIONS: 10,929.88 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions <ll) 1 n. 9~9. 88 12. Net Value of Tax Return <l2) 323,607.54 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax <l4) 323,607.54 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 !bh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate <l5) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate <l6) 323,607.54 X 045 = 14,562.34 17. Amount of Line 14 at Sibling rate <l7) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate <l8) .00 X 15 = .00 19. Principal Tax Due <l9) = 14,562.34 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (_) AMOUNT PAID 05-07-2003 CD002531 728.12 13,851.00 12-15-2003 REFUND .00 16.78- TOTAL TAX CREDIT 14,562.34 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION, Estates of decedents dying on or before December 12. 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years. the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE, To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act. Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS, AGENT REFUND (CR): A refund of a tax credit. which was not requested on the Tax Return. may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills. any of the 23 Revenue District Offices. or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement. allowance. or disallowance of deductions. or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue. Board of Appeals. Dept. 281021. Harrisburg. PA 17128-1021. OR --election to have the matter determined at audit of the account of the personal representative. OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue. Bureau of Individual Taxes. ATTN: Post Assessment Review Unit. Dept. 280601. Harrisburg. PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DI SCOUNT : If any tax due is paid within three (3) calendar months after the decedent's death. a five percent (5X) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed. and not paid before January 18. 1996. the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST, Interest is charged beginning with first day of delinquency. or nine (9) months and one (1) day from the date of death. to the date of payment. Taxes which became delinquent before January 1. 19B2 bear interest at the rate of six ('X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20X .000548 1987 9% .000247 1999 7% .000192 19B3 16X .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9X .000247 2001 9% .000247 1985 13X .000356 1993-1994 7% .000192 2002 6X .000164 1986 10% .000274 1995-1998 9% .000247 2003 5X .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice. additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ~~:~iS~~~~DlpA 17128-0601 INHERITANCE TAX , STATEMENT OF ACCOUNT REY-1607 EX AFP (01-051 DATE 12-29-2003 ESTATE OF BERKELEY EVELYN S DATE OF DEATH 03-01-2003 FILE NUMBER 21 03-0274 COUNTY CUMBERLAND JAMES D BOGAR ESQ ACN 101 1 W MAIM ST I '..unt I.m.. I SHIREMANSTOWN PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6Cfj-E3f-AFP--CoY=03y------...--iNifERITANCE--TAX-STATEME-NT-ifF'-Ac-couiff--.-..--------------------- ESTATE OF BERKELEY EVELYN S FILE NO.21 03-0274 ACN 101 DATE 12-29-2003 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 PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-15-2003 PR I NCI PAL TAX DUE: .....................................................,..............................................,.....,................................................................................................................ 14 . 562 . 34 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (_) AMOUNT PAID 05-07-2003 CD002531 ........ 728.12 13.851. 00 12-15-2003 REFUND .00 16.78- TOTAL TAX CREDIT 14.562.34 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" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) Vl:: 0 Iv' tJ;( STATUS REPORT UNDER RULE 6.12 Name of Decedent: Eve 1 yn S. Berkeley Date of Death: March l, 2003 Will No. 2l-03-0274 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes XX 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 XX b. The separate Orphans' Court No. ( i f any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties .in interest? Yes XX No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. \.0 (d". Date: 3/3l:L2004 In '=-.:c N James D. agar, Esquire I 0':: Name JPlease. ty~e or print) 0. <:::: One est Maln t. p f,:: Shiremanstown, PA 17011 ... Address . r' ...-............ (717 ) 737-8761 Tel. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3)