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Home My WebLink About03-0766Register of Wills of Cumberland PETITION FOR GRANT OF Estate of Thomas E. Conn also known as , Deceased Mary Drew County, Pennsylvania LETTERS No. Social Security No. 189- 09-4015 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut namL~Lin the last Will of the Decedent, dated 03/13/20~a codicil(s) dated None 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: none B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritata) 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: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 57 West North Street, Borough of Carlisle, Carlisle, PA (list street, number, and municipality) Decedent, then 89 years of age, died 08/30/200~at 57 West North Street, PA 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 17013 (Location) 20,000.00 31,400.00 situated as follows: 57 W. North Street, Boro of Carlisle, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of le~ersintheappropriatefo~totheundersi~n~: Signature Typed orprinted nameandresidence Mary Drew ~ ~_~_x.4.) 142 West Penn Street, Carlisle, PA 17013 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. 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 before me this I ~'~ay of "" For the Register ~ar~ DreW--- /' Estate of Thomas E. Conn Deceased Social Security No: 189 - 09 - 40 lr~te of Death: AND NOW, .~~ ~ n_. ,~,p 08/30/2003 , ~ ,~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [-~--'~tamentary (~ministration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Mary Drew in the above estate and that the instrument(s) dated 03/13/2000 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ 115. Short Certificate(s) ..... $ q . Renunciation ........ $ Affidavits ( ) .... $ Pages ( ) .... $ Extra Attorney: (~0b C. Saidis I.D. No: 21458 Saidis, Shuff, Flower & Lindsay 2109 Market St. Address: Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Telephone: Camp Hill, PA 17011 717/737-3405 .oo Copyright (c) 1996 form software only CPSystems, Inc, Form RW-1 (1991) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9609582 No. Local Registrar Date H~0S.:43R~, 2,~? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS .T CERTIFICATE OF DEATH ~ Thc~as E. Conn ~ 89 ~. : 10/18/1913 Carlisle, PA ~ . ~rl~d ~ ~lisle ~. . 57 West No~h Strut [~ ..... ~,.... ' ~'s ~u~ ~ * ' I,~ Black ,,~ Tile ~r [,,~l~r~q ~. [,, ~ '~-- 57 West No~ Strut ~ ,t~lisle, PA 17013 ~ ~rl~d John T. Conn A. Drew ~,~[] c-.-~. O 9/4/2003 Bertha - Hinton 142 West Penn Street, Carlisle, PA Valley Mem. 17013 Carlisle, PA 17013 SAIDIS, SHUFF & MASLAND ATroIL~IYS,,AT,LAW 26 W. High Street Carlisle, PA LAST WILL AND TESTAMENT OF THOMAS E. CONN I, THOMAS E. CONN of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative ~hall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. 1 SAIDIS, SHLIFF & MASLAND ATroP. J~YS*AT,LAW 26 W. High Slreet Carlisle, PA SECOND I specifically devise the real estate with improvements thereon erected known and numbered as 57 West North Street, Carlisle, Cumberland County, Pennsylvania unto MARY DREW. I also give, devise and bequeath unto the said MARY DREW any motor vehicle owned by me at the time of my death. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate as follows: a. $5,000.00 to each of the following persons who are living at the time of my death: MARY DREW, APRIL FURMAN, TP~ACY SEGP~A, MARTY GRIMES and DONALD CALLOWAY. b. $4,000.00 to each of the following living at the time of my death: TENO BARNETT and DERRICK DREW. c. All the rest, residue and remainder unto MARY DREW, per stirpes. FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH SAIDIS, SHUFF & MASLAND ATrORI~YS*AToLAW 26 W. High Street Carlisle, PA In addition to the powers conf.erred by law, I authorize any personal representative acting under this instrument, in his/her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal property; (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his/her sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (e) To make settlements and compromises on such terms as my personal representative in his/her sole discretion may deem wise without the necessity of obtaining any court approval thereof; SAIDIS, SHUFF & MASLAND ATI'ORNEYS*AT*LAW 26 W. High Street Carlisle, PA (f) To make distribution hereunder either in cash or kind, as my personal representative in his/her discretion may deem wise. SIXTH I do hereby nominate, constitute and appoint MARY DREW to act as Executrix of this my Last Will and Testament. SEVENTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, THOMAS E. CONN have hereunto set my hand and seal to this my Last Will and Testament, consisting of four(4) typewritten pages, the first three (3) of which bear my signature in the margin for identification, this /~ day of .~'Z'. ~ ~.j~'~ 2000. ...~C~g,~.~ /__x~ ~ ~ THOMAS E. CONN Signed, sealed, published and declared by the above-named Testator, THOMAS E. CONN, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, In the presence of said Test~ each other. AdDDRE S S SAIDIS, SHUFF & MASLAND ATrORNEVSeAT~LAW 26 W. High Street Carlisle, PA COMMONWEALTH OF PENNSYLVANIA: : SS COUNTY OF CUMBERLAND WE, THOMAS E. CONN, Robert C. Saidis and Renee L. Murray, the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witness and that to the best of their knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. THOMAS E. CONN k Rob~fl C. Sardis, Witness Rdnee L. g~r~ay , Wit~essJ Subscribed, sworn to and acknowledged before me by THOM~S E. CONN, the Testator, and subscribed to and sworn or affirmed to before me by Robert C. Saidis andRenee L. Murray , witnesses, this /~-~day of ~7~,~~. ~ , 2000. Notary ~fblic REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Thomas E. Conn Date of Death: August 30, 2003 Will No. 21-03-00766 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 beneficiary of the above- captioned estate on October 10, 2003. Salne Mary Drew April Furman Tracy Segars Martha Grimes Donald Calloway Antonio Barnett Derrick Drew Address 142 West Penn St., Carlisle, PA 17013 40-05 College Point Blvd., Apt. 1, Flushing, NY 11354 3003 Pennwood Rd, Harrisburg, PA 1701~] 5418 Twin Lake Terrace, Crystal, MN 55429 150 West Penn St., Carlisle, PA 17013 51 West North St., Carlisle, PA 17013 142 West Penn Street, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none ~ Date: (~,~ct;'/ .. Robert. Saidis, Esquire 2109 Market Street Camp Hill, PA 17011 i i; i/'.. '~ '~ (717) 737-3405 Capacity: X Personal Representative Counsel for Personal Representative REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CORRECTED CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Thomas E. Corm Date of Death: August 30, 2003 Will No. 21-03-00766 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 beneficiary of the above- captioned estate on November 4, 2003. Name Address Mary Drew 142 West Penn Street, Carlisle, PA 17013 April Furman 931 Park Ave., Schenectady, NY 12308 Tracy Segars 3003 Pennwood Rd., Harrisburg, PA 17011 Martha Grimes 5418 Twin Lake Terrace, Crystal, MN 55429 Donald Calloway 150 West Penn St., Carlisle, PA 17013 Antonio Barnett 51 West North St., Carlisle, PA 17013 Derrick Drew 142 West Penn Street, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: ., //; ~ CR'Bt~e"l't C. Saidis, Esquire 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: X __ Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O3262 DREW MARY 142 WEST PENN STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 189-09-4015 FILE NUMBER: 2103-0766 DECEDENT NAME: CONN THOMAS E DATE OF PAYMENT: 11/20/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $10,800.00 REMARKS' MARY DREW TOTAL AMOUNT PAID: $10, 800.00 SEAL CHECK# 103 INITIALS: AC RECEIVED BY: DONNA M. OTTO 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. REV-1162 EX(11-96) CD 003349 DREW MARY 142 WEST PENN STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 189-09-4015 FILE NUMBER: 2103-0766 DECEDENT NAME: CONN THOMAS E DATE OF PAYMENT: 12/19/2003 POSTMARK DATE: 12/18/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,061.29 REMARKS: MARY DREW TOTAL AMOUNT PAID: $2,061.29 SEAL CHECK# 107 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS (k.~E~-~500 EX + (6-00) cAPB HpRL EpIO cRAC EoTK " ES cg S T R E C A P I T U L A T I O N C O M A COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Conn Thomas E. DATE OF DEATH (MM-OD-YEAR) I DATE OF BIRTH (MM-DO-YEAR) 08~/~03 10/18/1913 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21-03-0766 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 189-09-4015 REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return 4. Limited Estate . 6. Decedent Died Testate (Attach copy of Will) r'~ 9. Litigation Proceeds Receivedl----110. Supplemental Return ~ 3. f ~F~)~r~l~8~ Compromise (date of death after 12-12- 5. Beqei/edt Maintained a Living Trust 0 8. i~'fam'k~3py of Trust) Spousal Poverty Credit ~'1 11. ~f death between 12-31-91 and 1-1-95) Remainder Return (d~ pn Federal Estate Tax Return Total Number of Safe Depo Election to tax under Sec. 9 (Attach Sch O) NAME Robert C. Saidis FIRM NAME (If Applicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER 717/737- 3405 1Real Estate (Schedule A) 2Stocks and Bonds (Schedule B) 3Closely Held Corporation, Partnership or Sole-Proprietorship 4Mortgages & Notes Receivable (Schedule D) 5Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6Jointly Owned Property (Schedule F) [~eparate Billing Requested 7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8.Total Gross Assets (total Lines 1-7) 9Funeral Expenses & Administrative Costs (Schedule H) 1O;)ebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 111'otal Deductions (total Lines 9 & 10) l~let Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 2109 Market St. Camp Hill, PA 17011 (1) 45,000. O0 743.88 (3) (4) None (5) None (6) 49,708.91 (7) None (9) None 5,921.37 (10) 13Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 1,1tlet Value Subject to Tax (Line 12 minus Line 13) None OFFICIAL USE ONLY (8) 95,452.79 (11) 5,921.37 (12) 89,531.42 (13) (14) 89,531.42 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 150,mount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00 T 16~,mount of Line 14 taxable at lineal rate 0.00 X 0 45 (16) 0 OI 17Amount of Line 14 taxable at sibling rate -- ~ v .~ · ,, ,__, _. 00 N, ]~mount of Line 14 taxable at collateral rate 8~9,53__~ .-~ ; ii; I;;I' 13,42~.~10 . ~ ........ ~,,.~...~.:~.~ ~ ...... ~:!,: ,~..~.?i:..~ !..ii!.! Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREETADDRESS North Street STATE ZIP PA 17013 Tax Payments and Credits: 1.Tax Due (Page 1 Line 19) ZCredits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 10,800.00 568.42 (1) Total Credits ( A + B + C ) (2) 13,429.71 3Jnterest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4Jf 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) 5Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1Did decedent make a transfer and: Yes No b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [] ~'~ 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~-] ~ 4Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 11,368.42 0.00 0.00 2,061.29 0.00 2,061.29 Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Mary Drew ~'Y'x_ . ~ ~ 142 West Penn Street SIG NATU R E 'OF PJ;tE'~AP,~,.~;U~rH ~ TH,Q~B Ep R ES ENTATiVE Saidis .......... /~ /./j~ - , onus[, ~zower e Llnc[say ~., . 2109 Market St .................... _. .......................... ....... ~ .~~ Camp Hill, PA 17011 ...... For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)], The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1502 EX + (1-97) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Thomas E. Conn SS~/ 189-09-4015 08/30/2003 21-03-0766 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 57 West North Street, Carlisle, PA 17013 45,000.00 (value based appraisal see attached) TOTAL (Also enter on line 1, Recapitulation) $ 45,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1502 EX (Rev, 1-97) REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Thomas E. Conn SS# 189-09-4015 08/30/2003 21-03-0766 All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION UNIT VALUE NUMBER OF DEATH 1 3 Series E Savings Bonds, face value $50 247.96 743.88 (L1091546891E, L1091546896E, L1091546860E) TOTAL (Also enter on line 2, Recapitulation) 743.88 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) REV-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Thomas f.. Conn SS# 189-09-4015 08/30/2003 21-03-0766 Include the proceeds of litigation and the date theproceeds were received by the estate. All property jointly-owned with the right of survivorsh,l~ must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION MbT Bank, checking acct. 705705 M&T Bank, savings acct. 978489 accrued interest M&T Bank, CD #31003910789907 accrued interest M&T Bank, CD 31003911181194 accrued interest 1994 Chevrolet sedan, VIN 47825172602 Corsica LT, 4D (value based on Kelley Blue Book ) Refund from Ewing Bros. Funeral Home, Household goods and personal property prepaid plan TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSysterns, Inc. VALUE AT DATE Of DEATH 2,942.20 3,343.08 1.77 26,800.00 21.89 13,908.95 16.02 1,175.00 1,000.00 500.00 49,708.91 Form REV-1508 EX (Rev. 1-97) EVo1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thomas E. Conn SS# 189-09-4015 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 08/30/2003 FILENUM~ER 21-03-0766 Debts of decedent must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A, :UNERAL EXPENSES: (pre-paid) 5. 6. 7. kDMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Mary Drew Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 142 West Penn Street City C ar 1 i s 1 e State , 184-38-1172 PA Zip l7013 Year(s) Commission Paid: Attorney's Fees Saidis, Shuff, Flower & Lindsay 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 Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees ~herAdministrativeCos~ The Patriot New, estate notice Cumberland Law Journal, estate notice Register of Wills, filing fee Recording fees Cost of real estate appraisal TOTAL (Also enter on line 9, Recapitulation) 3,275.00 2,000.00 146.00 112.37 75.00 15.00 48.00 250.00 5,921.37 (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) REV-1513 EX + (9-00) ESTATE OF Thomas E. NUMBER I. Conn SS~/ 189-09~4015 08/30/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Mary Drew 142 W. Penn Street Carlisle, PA 17013 2 April Furman 931 Park Ave. Schnectady, NY 12308 3 Tracy Segars 3003 Pennwood Rd. Harrisburg, PA 17011 4 Martha Grimes 5418 Twin Lake Terrace Crystal, MN 55429 5 Donald Calloway 150 West Penn Street Carlisle, PA 17013 Do Not List Trustee(s) niece wife's niece great, great nephew niece friend (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 3 SHOWN ABOVE ON LN. 15 THRU APPROPR II. qON-TAXABLE DISTRIBUTIONS: ~, SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE LE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET FILE NUMBER 21~03-0766 OF ESTATE 0.00 specific devise of house and car plus $5000 and residue 5,000.00 5,000.00 5,000.00 5,000.00 Form REV-1513 EX (Rev. 9-00) Estate of: Thomas E. Corm Soc Sec #: 189-09-4015 Date of Death: 08/30/2003 Item Continuation of Schedule J, Part I (Taxable Bequests) Name and Address of Beneficiary Relationship Amount or Share of Estate Antonio Barnett 51 West North St. Carlisle, PA 17013 Derrick Drew 142 W. Penn St. Carlisle, PA 17013 neighbor great, great nephew 4,000.00 4,000.00 SAIDIS, ;HUFF & MASLAND 26 w. Hi~ C~rlisle, PA LAST WILL AND TESTAMENT OF THOMAS E. C'ONN 2.! I, THOMAS E. CONN of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,' publish and' declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my'personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. 1 SECOND I specifically devise the real estate with improvements thereon erected known and numbered as 57 West North Street, Carlisle, Cumberland County, Pennsylvania unto MARY DREW. I also give, devise and bequeath unto the said MARY DREW any motor vehicle owned by me at the time of my death. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate as follows: a. $5,000.00 to each of the following persons who are lying at the time of my death: MARY DREW, APRIL FURMAN, 0~RACY~ SEGRA, MARTY GRIMES and DONALD CALLOWAY. ~ll~3~p~) b. $4,000.00 to each of the following living at the /time of my death: TENO BARNETT and DERRICK DREW. c. All the.rest, residue and remainder unto MARY DREW, per stirpes. SAIl)IS, HUFF & .VIASLAND !6 W. mgh S~ree~ Cerlf~le~ PA FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH SAIDI$, HUFF & I~_ASL~D ~.arltsle, PA In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his/her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal property; (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his/her sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (e) To make settlements and compromises on such terms as my personal representative in his/her sole discretion may deem wise without the necessity of obtaining any court approval thereof; SAIDIS, HUFF & .~IASLAND I~AToLAW ~,6 W. ltf~h Street Carflsle, PA (f) To make distribution hereunder either in cash or kind, as my personal representative in his/her discretion may deem wise. SIXTH I do hereby nominate, constitute and appoint MARY DREW to act as Executrix of this my Last Will and Testament. SEVENTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, THOMAS E. CONN have hereunto set my hand and seal to this my Last Will and Testament, cOnsisting of four(4) typewritten pages, the first three (3) of which bear my signature in the margin for identification, this /3 day of THOMAS E. CONN Signed, sealed, published and declared by the above-named Testator, THOMAS E. CONN, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, In the presence of said ach ~ ~ ~, ~ other 4 COMMONWEALTH OF PENNSYLVANIA: : SS COUNTY OF CUMBERLAND : WE, THOMAS E. CONN, Robert C. Saidis and Renee L. Murray, the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witness and that to the best of their knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. THOMAS E. CONN -~ Subscribed, sworn to and acknowledged before me by THOMAS E. CONN, the Testator, and subscribed to and sworn or affirmed to before me by Robert C. Saidis andRenee L. Murray witnesses, this /~day of '-c~,_-Z~--'-.~ , 2000. .' ~tary ~lic "' Inventory Report Active Inventory Bonds: r Date ~___~ce .~ ~ ~_~? .L! 091546860E 01/-7'~5 .J__ ~ ~ _~? .L1091546896E ~ J_ 37.5~ '-' '- bo L1091546891E ~_J_ 37.~0-] Inventory Totals: 21o.4e_L Print Date: 12/03/2003 File Pricino Date: 08/2003 ~ Next Int--~S~l-M--~ri~ Value ~ Date ] Date- J Note I 247.96~ ~ ~~ Price $112.50 Interest $631.38 Value $743.88 · Cl- bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment (it's < 6 months old) · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondary education · () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 1 Page 1 of 1 Kelley Blue Book Used Car Values Page 1 of 2 Kelley Blue me tr steo resource BaildaCar Blue Book Trade-In Report [~ Pennsylvania · November 4. 2003 Ow~hlp Cost 1994 Chevrolet Corsica LT Sedan 4D Ny ~s v~ue ~ ~r ~il B~a ~r ~ll Yeur ~r ~~ Engine: ~-~1. ~.~ ~~ Drive: ~ ~1 ~i~ ~n ~k Mileage: 52,172 ~r ~ Equipment ~ Gu~ Power Steering ~ Power Door Locks Iue _B u y__a__New C_a_r '"" --B u~Y-~-U s ed--C a---_rK List_ Yo___ur Ca~r F__Qo_r. Sale Online_ ~] .Free._ ~em_o.n.._C_b.eck.. ", Auto Loans from 3 59% AP° Wa [[an~y..Q.u.._o._t.e ' Se!.! ..~/o.u.r.. c~.~...o n....e.B.a...v....~.o_t-or~ AH/FM Stereo ABS (4-Wheel) Consumer Rated Condition: Good Almut i~b "Good" condition means that the vehicle is free of any major defects. The l~m~i paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be Shop over $0 very minimal, and a deduction should be made to correct it. The tires match models fllom and have substantial tread wear left. A clean title history is assumed. A 7 gretlt bl"g~d$ "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Host recent model JBody Style j~ cars owned by consumers fall into this category. [Zip Code .} ~ Trade-In Value $1,175 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, r arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. I~: ........... :-:--~;-- O et the latest BhJe Book. ~ ~ ..i i http//www kbb com/kb/kl dll/kw kc ur?kbb PA 498036 P : ' ' ' ..... ; ; A041&17013;sed+t;&278;Che... 11/04/2003 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Saidis, Shuff, Flower & Lindsay A Professional Corporation 2109 Market Street Camp Hill, PA 17011 Phone (302) 934-2774 F ax (302) 934-2955 October 21, 2003 OCT 2 7 2003 Re: Estate of Thomas E. Conn Social SecuriW: 189-09-4015 Date of Death: August 30, 2003 Dear Sir or Madam: Per your inquiry dated September 26, 2003, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names 099 Opening Date Balance on Date of Death Accrued Interest Total Checking Account 705705 Thomas E Corm Mary A Drew, POA 09/01/67 $2,942.20 $ 0.00 $2,942.20 Type of Account Account Number Ownership (Names Opening Date Balance on Date of Death Accrued Interest Total Savings Account 021000000978489 Thomas E Corm Mary A Drew, POA 05/01/75 $3,343. O8 $ 1.77 $3,344.85 Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Certifcate of Deposit 031003910789907 Thomas E Corm Mary A Drew, POA 04/12/00 $26,800.00 $ 21.89 $26,821.89 Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 031003911181194 Thomas E Corm Mary A Drew, POA 07/21/97 $13,908.95 $ 16.02 $13,924.97 19. Type of Account Account Number Ownership (Names o~9 Opening Date Safe Deposit Box 0002156 at High Street Thomas E Conn Mary A Drew, POA 02/07/92 For further account information, closures and/or reimbursement of funds please call the High Street, Carlisle Office at 0717-240-4598. Sincerely, / Nancy Clagett Records Management (a02) 9a4-2774 ~,470 DEPARTMENT OF TR:ANSPORTATION CERTIFICATE OF TITLE FOR a VEHICLE 951t'60'072002245-001 CHEVROLET I 47825172602 MAKE OF VEHICLE T~TLE NUMBER GVWS I GCWR I TISLEBRANDS 5/lO/951 014437 I 0 ODOM PABCO DATE ODOM. MILE ~ ODOM. STATUS B~y TYPE DU SEAT GAP UNLADEN WEIGHT DATE PA TITLED DATE OF ISSUE PRIOR T~TLE STATE 'BANK 17013 CO DAUPHIN DEPOSIT BANK TRUST CO 3607 DERRY ST PO BOX 4190 HARRISBURG PA 17111 b ~ AC1 UAL MILEAGE 1 = MILEAGEEXCEEDS THE MEGHANIOAL 3 - HOT THE ACTUA~cAGE~.OBOMETF~9 TIT~ BRA~DS G-- OR~I~y ~GDJFOR P - F~MERLY A ~ICE .~LE ~mnno~r m~t ~wa~'thm T~to '~ ~mau,of ~tor ~les TO BEFORE DAY YEAR S~GNATURE Of PERSON ADMINISTERING OATH The undersigned hereby makes applicaik>n fo, CertiflCale of T~tle tc the venlcJe DeScriBeD above, subject Io the encumbrances anc~ other ~ega~ claims set forlh here S~GNATURE OF APPLICANT OR AUTHORIZED SIGNER S~GNATURE OF CO-APPL~CANT/TITLE OF AUTHORIZED SIGNER ~RST LIENHOLDER: SKATE ZIP [ CHECK BOX SECOND LIENHOLDER S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES File No. 0 October 29, 2003 Ms. Mary Drew 142 West Penn Street Carlisle, PA 17013 File Number: 03-1021 Dear Sir or Madam: In accordance with your request, I have personally inspected and appraised the real property 57 West North Street Carlisle, PA 170'13 The purpose of this appraisal is to estimate the market value of the subject property, as improv~ The property rights appraised are the fee simple interest in the site and improveme~ In my opinion, the estimated market value of the property as of October 7, 2003 it $45,000 Forty-Five Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusio~ final estimate of value, descriptive photographs, limiting conditions and appropriate certificatio Respectfully submitted, Certified Residential Appraiser TO: SAIDIS SHUFF, FLOWER & LINDSAY _ATTOKNEYS-AT. LA~ 2109 Market Street Camp Hill, PA 17011 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: Thomas E. Conn Date of Death: August 30, 2003 Will No. 21-03-0766 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 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 Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X ; No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature ~ Name: Robert C. Saidis, ,~. uire I.D. No. 21458 ' SAIDIS, SHUFF, FLOWER & S 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: Personal Representative~ X Counsel for Personal Representative BUREAU OF TNDZVZDUAL TAXES ZNHER/TANCE TAX DTVZSZON DEPT. 280601 HARR/SBURG, PA 17128-060! COMHONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15¢? EX &FP COl-g5) ROBERT C SAIDIS SAIDIS ETAL 2109 MARKET ST CAMP HILL ~ ~.,~ii~ESTATE OF DATE OF DEATH FILE NUMBER PA 17011 0UI¥iDu~;,:,,-'":U bo,, PA 02-2q-200q CONN 08-50-2005 Z1 03-0766 CUMBERLAND 101 THOMAS E Amoun{ Ramit~ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LINE I1~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF CONN THOMAS E FZLE NO. 21 05-0766 ACN 101 DATE 02-2q-ZOOq TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S*ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership Interest (Schedule C) (3) q. Mortgages/No,es RecaAvable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expensas/Adm. Costs/MAsc. Expanses (Schedule H) (9) 10. Dab~s/Mor~gege LAab/li~ias/Liens (Schedule Z) (10) 11. To~el Deduc~/ons 12. Ne~ Value of Tax Re~urn 15. lq. Char/table/Governmental Bequests; Non-elec{ed 9115 Trus{s (Schedule J) Ne{ Value of Es~a~e Subjec{ to Tax q5~000.00 7q3.88 .00 .00 q9~708.91 .00 .00 (8) 5,921 .~7 .00 (11) (12) (13) NOTE: Z~ an assessment was issued prev/ously, lines 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. NOTE: To insure proper credA~ ~o your account, submi~ ~ha upper por~Aon of ~his form w/th your ~ax payment. 95,q52.79 ASSESSMENT OF TAX: 15. Amoun~ of L/ne lq a~ Spousal ra~e 16. Amoun{ of L/ne lq {axable a{ Lineal/Class A ra{a 17. Amoun~ of Line lq a~ Sibling ra~e 18. Amoun* of LAne lq ~axabla a* Collateral/Class B ra~a 19. Prlnclpal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (*) DATE NUMBER INTEREST/PEN PAID (-) 11-20-2005 CD005262 568.q2 12-18-2005 CDOO~q9 .00 5.921.37 89,551.q2 .00 89,531.q2 18 and 19 will ZF PAID AFTER DATE ZNDZCATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (1~) .00 x O0 = .00 (16) .00 x Oq5= .00 (17) .00 x 12 = .00 (18) 89,551.~2 x 15 = 15,q29.71 (19)= 15,q29.71 AHOUNT PAID 10,800.00 2,061.29 TOTAL TAX CREDIT I 13,q29.71 BALANCE OF TAX DUE; .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( ZF TOTAL DUE TS LESS THAN $1~ NO PAYMENT TS REIIUZRED. TF TOTAL DUE TS REFLECTED AS A 'CREDIT" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR /NSTRUCTTONS.) .~.;~ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 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 S (collateral) rate on any such future interest. To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Rag[star of Rills, any of the 15 Revenue District Offices, or by calling the special Zq-hour answering service for forms ordering: 1-800-361-2050; services for taxpayers with special hearing and / or speaking needs: 1-BOO-4qT-30ZO (TT only). Any party in interest nat 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, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. OR 1982 ZOZ 1985 161 198~ 111 1985 1986 IOZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of individual Taxes, ATTN: Post Assessment Review Unit, Dept. gE0601, Harrisburg, PA 17118-0601 Phone (717) 787-6SOS. See page 5 of the booklet "Instructions for inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation af administratively correctable errors. If any tax duo is paid within three (5) calendar months after the decedant's death, a five percent (5Z) discount of the tax paid is allowed. The 151 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 and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the tho same time period as you would appeal tho tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent par annum calculated at a daily rate of .O0016q. Ali taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2003 ara: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor .O005qa 1987 91 .O00Zq7 1999 71 .000191 .000q58 1988-1991 llZ .000301 2000 81 .000219 .000501 1991 9Z .O00Zq7 ZOO1 91 .0002~7 .000356 1995-199~ 71 .000192 2001 61 .000164 · 00027q 1995-199B 92 .0002q7 1005 52 .000157 X NUffBER OF DAYS DELINQUENT X DAZL¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. NOTICE OF INHERITANCE TAX ~ ~ Pennsylvania BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX DEPARTMENT OF REVENUE ~..__. ;. PO BOX 280601 REV-1547 IX AFP C12-12) HARRISBURG PA 17128-0601 ~_-~~~ . '°°D,A~E 01-21-2013 ,~ ~ ~ = ~ .,, s~. E-STATE OF WHITE MAR I E E D7~TE OF DEATH 08-27-2003 ,~ n r-- _~ : , :~ ''`` }._ ,-~; 'Ru J ~ 't ~ ~~ ,-, FIE NUMBER 21 03-0765 I a v WILLIAM S DANIELS 40UNTY CUMBERLAND STE 205 ~ ` g ACN 101 '~ ` ~ .' APPEAL DATE: 03-22-2013 1 WEST H I G H S T ~...1 $ ' ~ -- _ (See reverse side under Objections ) CARLISLE PA 1701 ~t~~~~~ ',i ~ '~ - _~~ount Remitted " ,MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---- --~ R_ETA_IN LOWER POR TION FOR YOUR RECORDS f-- _ REV-1547 EX AFP C12-12~ NOTICE OF INHERITANCE _ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTI ONS AND ASSESSMENT OF TAX ESTATE 0F: WHITE MARIE EFILE N0 .:21 03-0765 ACN: 101 DATE: 01-21-20 13 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON• ORIGINAL RETURN 1. Real Estate (Schedule A) ~1) 149, 250 00 2. Stocks and Bonds (Schedule B) . NOTE: To ensure proper (2) ,Q Q credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) of this form with your C4) 0 0 5. Cash/Bank Deposits/Misc. Personal Property (Sched . tax payment. ule E) (5) 129, 111 .47 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) C7) 296, 980.02 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: c8) 575,341.49 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)__ 1 4 4 6 0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 12,0 0 0.0 0 11. Total Deductions 12. Net Value of Tax Return (11) 27,446.00 C1 547 895 49 2) , . 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax (14) 547,895.49 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 ALL returns assessed to date ASSESSMENT OF TAX: . 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = 0 0 16. Amount of Line 14 taxable at Lineal/Class A rate . (16)_ .0 0 x 0 4 5 = .0 0 17. Amount of Line 14 at Sibling rate C17)_ X47 .895 49 X 12 = 65, 747.46 18. Amount of Line 14 taxable at Collateral/Class B ra te (18) .0 0 X 15 = .0 0 19. Principal Tax Due C19)= 65 747 46 TAX CREDITS: , . PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 11-26-2003 CD003 286 3,184.21 60,500.00 INTEREST IS CHARGED THROUGH 02-05-2013 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX PAYMENT 63,684.21 BALANCE OF TAX DUE 2,063.25 INTEREST AND PEN. 922.94 TOTAL DUE 2,986.19 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. V