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Home My WebLink About03-0241 Register of Wills of PETITION Estate of Blaine E. Chrise also known as Blaine Edward Chrise Edwin L. Stone Cumberland County, Pennsylvania FOR GRANT OF LETTERS , Deceased Social Security No. 273- 32 - 7252 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 or the Decedent, dated 02/'28/03 and codicil(s) dated None named in the last Will of 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: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.ta; 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: 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 301 Kay Road, Hampden Twp. 0ist street, number, and municipality) Decedent, then 71 years of age, died 03/07 , 03,at 301 Kay Rd., Mechanicsbur~, (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in 'Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania PA 100,000.00 situated as follows: 301 Kay Rd., Mechanicsbur~, Hampden Twp., Cumberland County, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last'Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: S i~ nat u re ~.-~;1~.,~_~ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. IEdwin L. Stone, 18202 Apt. J Willow Creek Way, Gaithersbur~, Typedorprintednameandresidence ND 20886 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 ~-~'~-~~~ ~ Edwin L. Stone before me this ! ~ day of For the Relgister No. 21-03-0241 Estateof Blaine E. Chrise A/K/A BLAINE EDWARD CHRISE Social Security No: 273- 32- 7252 Date of Death: 03/07/03 Deceased AND NOW, I~AjlCH 19, 2003 ,Yl~[X , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters J-~ Testamentary [] Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Edwin L. Stone in the above estate and that the instrument(s) dated 02/28/03 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ 270.00 Short Certificate(s).. · 6 , $ 18 · 00 Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( 2 ) .... $ 6.00 Codicil ........... $ '" l-Regist~r Of Wills / ' Attorne Wiley, Esquire I.D, No: 06298 .... Add~ress: , The Wiley Group One S. Baltimore St. Dillsburs, PA 17019 JCP Fee .......... $ 10 · 00 Telephone: 717/432-9666 Inventory .......... $ Other ........... $ TOTAL ......... $ 304.00 MAILED LETTERS Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. TO ATTORNEY MARCH 20, 2003 Form RW-1 (1991) his is to certify that the information here given is correctly copied fi'om an original certificate of death Local Rcgiswar. The original certificate will be forwarded to the Sta~c \/ital Records ()i)~ce for pcrmanct~r WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee fbr this certificate, $2.00 P 8921003 No. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 71 ,,, : i Aug3, 1931 Markeysburg ~,~D O~CE .. Hampden Twp .. 301 Kay Road Sales Manager ... Automotive ,a. J,,~'~~. ~'~}12 I ACTUAL 11.. a.,. Pennsylvania 301 Kay Road ~S~E ~ '..~ ~,~ Hampden echamcsburg, Pennsylvama 1705~, .... ~ ,m.~m Cumberland Unknown ,.. Dorothy Chrise ~,. 18202 Apt. J Willow Creek Way Gaithersburg MD 20886 J:,~ Conolite Crematory I=" Schaefferstown, Pa. 17088 Edwin L. Stone Mar 10, 2t~)3 FD-012662-L I~. Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055 ~'"-""' ,[:,J ,~ ~,o a-~ss-c ,I ~y, ~a~ m e~ll [ ~E ~ ~ AS A C~SE~E NCE ~: ~ I / A~AS AN 21-03-241 ~ESS: 21-03-241 OF BLAINE E. CHRISE BE IT REMEMBERED, that I, BLAINE E. CHRISE, of 301 Kay Road, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof made by me at any time heretofore. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: I give my 1992 Toyota to my son, JOHN E. CHRISE, providing he survives me. ITEM 3: Ail the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my four children, EDWIN L. STONE, JOY E. SHIREY, JOHN E. CHRISE, and JEANETTE E. EGERER, in equal shares, per capita. ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise BLAINE E. CHRISE -1- passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 4: I appoint my son, EDWIN L. STONE, as Executor of this my Last Will and Testament. ITEM 5: I direct that my Executor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. this IN WITNESS WHEREOF, I have hereunto set my hand and seal ~day of ~~~_ , 2003. /~~~ ~/~L~S EAL BI~INE E. CHRISE -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK : SS : We, BLAINE E. CHRISE, JAN M. WILEY, ESQUIRE and SHERRY A. FITZKEE, the Testator 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 Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly (or willingly directed another to sign for him), and that he executed it 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 this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this ~~ay of NOTARY PUBLIC MY COMMISSION EXPIRES: Notarial Seal S. D~.a..w.n Gla...dfelter, NO _t~ry Public ui~sourg t~oro, York County My Commission Expires May 17, 2005 Member, Pennsylvania Association ot Notaries ~f WILEY & LENOX, P~C. ATTORNEYS AT LAW ONE SOUTH BALTIMORE ST. DILLSBURG, PA 17019 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: ~/'~/0 Admin. No. Pursuant to Rule 6.1 2 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 administr/ation of the estate is complete: Yes No I/ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: _h~/ ~---~f]d.. ~/~,h~d~-/' 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 . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No may be filed with the Clerk of the Orphans' Court and may be attached to this report. ire ~: ,. 'Please type offprint) ~ Copies of receipts, releases, joinders and approvals of formal or informal accounts Tel. No. Capacity: Personal Representative Counsel for personal representative CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Blaine E. Chrise Date of Death: March 7, 2003 Estate Number: 21-03-0241 To the Register: I certify that notice of beneficial interest 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 28, 2003: Nalne Edwin L. Stone Joy E. Shirey John E. Chrise Jeanette E. Egerer Address 18202 J. Willow Creek, Gaithersburg, MD 20886 424 S. 13th St., Las Vegas, Nevada 89001 117 Geneva Rd., New Bern, NC 28562 301 Kay Rd., Mechanicsburg, PA 17055 Notice has now been given to all persons entitled ther~b~:[er Rule 5.6 (a)except N/A. ~..~qamre Name: Jan M. Wiley, Esquire Address: One S. Baltimore St. Dillsburg, PA 17019 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: ~/"7 - 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 ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No t,,//. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~" No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed w't~ the Clerk of the Orphans' Court and may be attached to this report. Name (Please type or I~rint) Address ~/~~ Tel. No. Capacity: Personal Representative Counsel for personal representative Jan M. Wiley David J. Lenox Timothy J. Colgan Christopher J. Marzzacco August 26, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 THE VVILEY GROUP Attorneys at Law '04 ~,Lll3 30 Wiley, Lenox, Colgan & Marzzacco, P.C. P12:02 David E. Hershey Diana Woodside Bradley A. Winnick In Re: Estate of Blaine E. Chrise, deceased File Number 21 03 00241 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $11,952.07, representing the tax due, and a check in the amount of $25.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, /dg encl. 130 W. Church Street, Suite 100 ,, Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale www. wileygrou plaw.com REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 03 00241 DECEDEN'I"S NAME (LAST, FIRST, AND MIDDLE INITL~L) SOCIAL SECURITY NUMBER Chrise, Blaine E. 273-32-7252 03/07/2003 08/03/193 1 REGISTER OF WILLS [] 1. OdglnalReturn [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of deat~ after [] 9. Litigation Proceeds Received [] 10. Spousal PovertyCredit(dateofdeathbetween Jan M. Wiley, Esq. The Wiley Group ELEPHONE NUMBER 717/432-9666 [] 5. Federal Estate Tax Return Required [] 11.Election to tax under Sec. 9113(A) (AUach S~h O) I S. Baltimore St. Dillsburg, PA 17019 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal Property (5) (Schedule E) 6. Jointly Owned Pmparty (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 125,486.34 Non~ 133,116.52 55,046.4~;' 53,573.88 5,656.11 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) (11) (12) (13) (14) OFFICIAL USE ONLY 313,649.30 59,229.99 254,419.31 254,419.31 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 (16) 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 254,419.31 11,448.87 11,448.87 Copyright 2000 form software only The Lackner Group, Inc. Form REV-'IS00 EX (Rev. 6-00) Decedent's Complete Address: STREE~TADDRESS 301 KayRoad CITY Mechanicsburg STATE PA Iz~ 17055 Tax Payments and Credits: 1. TaxDue (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest 503.20 E. Penalty Total Interest/Penalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) 11,448.87 (2) 0.00 (3) 503.20 (4) (5) 11,952.07 (5A) 11,952.07 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .................................................................................. ~ I b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a revemionai7 interest; or ................................................................. d. receive the premise for life of either payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death w~hout receiving adequate consideration? ....................................................................................................................... [] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ......... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-prebate preperty which contains a beneficiar/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. S~GNATLIRE OF PERSON RESPONSIBLE FOR FILING RETURN Edwin I~ Stone ADDRESS 12149 Flag Harbour Drive Germantown, MD 20874 DATE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 1 S. Baltimore St. ~ . Dillsburg, PA 17019 dates of death on or after July 1, 1994 and before Januai7 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the · ' spouse is 3% [72 P.S. §7116 (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 exemot 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 decadent'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 decadent, whether by blood or adoption. OF BLAINE E. CHRISE BE IT REMEMBERED, that I, BLAINE E. CHRISE, of 301 Kay Road, Mechanicsburg, Cun~berland County, ~ennsylvania, being of sound mind, memor, y and understanding, do make, publish and declare this as and for my Last Will a~d Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nauure thereof made by me at any time heretofore. I direcE that all my just debts and funeral paid as soon after my demise as may be ITEM 1: expenses be convenient. I glve my 1992 Toyo5a to my son, JOHN E. CHi~ISE, providing he survives me.. ITEM 3: All the rest, residue and remainder of my ~state, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including propersy over which I. havw a power of appointment, I g~ve, devise and bequeath unto my four children. EDWIN L. STONE, JO~ E. SHIREY, JOHN E. CHRISE, and JF2tNETTE' E. E~, in equal Shares, per capita. ITEM 3: I direct my hereinafter n~ed Executor re pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate o~ the transfer of any property passing hereunder or otherwise BLAI~E E. C~ISE -1- passing by reason of my demise, may be subject and to?harge such taxes against my residuary estate, it being my intention that hone of the aforesaid taxes, either federal or state, on any property requ%red to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall'be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. I~ 4; I appoint ~y son, EDWIN L. STO~{E, as Executor of ~his my Last Will and Testament. ~ I direct that my Executor shall not be required to give bond .for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~day of , 2003. ESS: ' . -2- CO~4ONWF2%LTH OF PENNSYLVANIA COUNTy OF YOP. K : SS We, BI.%INE E. CF~tISE, JAN M. W-/LEY,' ESQUIRE and ' S~EP~RX A. FITZKEE, the Testator 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 Testator signed and executed the instrument as his Last Will and Testament a~d tha~ he had signed willingly (or willingly directed another to sign f~r him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and h~aring of the Testator, signed this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no ~'T~S S Sworn to and subscribed before me this ~ay of . NOTARY PUBLIC MY C0~fMISSION' EXPIR.ES: SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ChHse, BlaLnc E. 21 - 03 - 00241 All real proper~ owned solely or as a tenant In common must be m..j~orted at fair market value. Fair market value is defined as the price at which propert~ would be exchanged between a willing buyer and a wiling 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 2 Sale of property situate at 103 Kay Road, Mechanicsburg, PA: Tax/Sewer Proration due Seller: 125,000.00 486.34 TOTAL (Also enter on Line 1, Recapitulation) 125,486.34 SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Cltdse, Blaine E. 21 - 03 - 00241 Include the .proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomhlp must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH Members First Savings Account 81054-00: Members First Checking Account 81054-11: Prudential Financial Account 011-536921-37: Harrisdirect Account 630-966844: 1992 Toyota: 3,388.37 68.89 81,035.26 46,624.00 2,000.00 TOTAL (Also enter on Line 5, Recapitulation) 133,116.52 SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE T.~X RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Chrise, Blaine E. 21 - 03 - 00241 This schedule must be completed and filed If the answer to any of questions 1 througl 4 on page 2 Is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF Include the name of th~ tra~.sfefee, their relaflenship ~ deCedent and the date of transfer+ VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE NUMBER Attach a copy of tile deed for mai estate+ INTEREST IF APPLICABLE) I Prudential Financial IRA 010-R27830: 21,436.4,~ 100% 21,436.44 2 Harrisdirect Annuity #631-786225: 33,610.0£ 100% 33,610.00 TOTAL (Also enter on line 7, Recapitulation) 55,046.44 SCI'-E~LE H ~EXPBdSES& ADI¥II~TRATIVE COSTS ESTATE OF FILE NUMBER Ckfiso, Blaine E. 21 - 03 - 00241 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers Funeral Home: ADMINISTRATIVE COSTS: Personal Representative's Commissions Edwin L. Stone S~cial Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2004 Attorney's Fees Jall M. Wiley, Esquire: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address c~y Relationship of Claimant to Decedent Probate Fees Register of Wills: State Zip Accountant's Fees Tax Retum Preparer's Fees Other Administrative Costs Cumberland Law Journal: The Sentinel (advertise): Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 3,298.50 15,650.00 15,650.00 304.00 75.00 91.85 18,504.53 53,573.88 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ScheduleH ESTATE OF FILE NUMBER Chrisc, Blaine E. 21 - 03 - 00241 3 4 5 6 7 8 Register of Wills (filing fee): Real Estate settlement costs: Kurt Eby (appraisal): US Post Office: Lany Rhodes & Andrew Manoney (Driveway, and repairs): Kathryn Fetrow, Tax Collector: 25.00 9,777.97 300.00 11.30 6,978.75 1,411.51 Page 2 of Schedule H SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Chrise, Blaiae E. 21 - 03 - 00241 Include unmlmbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 9 10 11 12 13 Members First FCU: Jenny Egerer (reimbursement for bills paid): VA (reimbursement): T-Mobile (phone): Metro Medical Services (ambulance): Geico (car insurance): PAWC (water/sewer): Comcast (cable): Verizon (phone): PP&L (electric): First North (credit card payoff): Hampden Township (trash): Travelers (homeowners insurance): 242.31 500.00 63.00 26.66 1,450.00 4.54 213.36 164.94 94.08 1,811.05 400.00 443.31 242.86 TOTAL (Also enter on Line 10, Recapitulation) 5,656.11 SCHEDULE J BENEFICIARIES FILE NUMBER ESTATE OF CErise, Blaine E. 21 - 03 - 00241 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE 'l'. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Edwin L. Stone son one-fourth of residuary estate 2 Joy E. Shirey daughter one-fourth of residuary estate 3 John E. CErise ~on one-fourth of residuary estate 4 Jeanette E. Egerer :laughter one-fourth of residuary estate Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee~ II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET and Urban 0ev~;opmest · B, Type of Loan 1,[ ]FH~ ~-[ ]FmHA 3.[ ]Conv. Unins, 6. Fi[eNun~er: 7. L0anNumbq~ 4.[ ]VA 5,[ ]Cony. Ins. 400400532-TK e. Mortgsae Insurance Case Number:, C. NOTE: THIS NOTE IS FURNISHED TO GIVE YOU'A STATEMENt OF ACTUAL SE-ITLEMENT COSTS. AMOUNTS PAID TO AND SY THE' SETTLEMENT AGENT ARE SHOWN· ITEMS MARKED '(P.O.C.)' WERE PAID OUTSIpE THE CLOSING; THEY:ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS. " ' D. Name and Address of Sorro~er ' WILLIAM J, THOMA~S AND MERED~ A. THOMAS 5217 COBBLESTONE DRIVE MECHANICSBURG. PA 17055 EDWIN g STONE. EXECUTOR OF ESTATE OF , . ~ : ' H. SeUJem~t Agent K. SUMMARY OF SELLER'~- T~ANsAOT ONS $125000.00 $194.70 $79.62 112. t20. ,G~oea Amount Due From Elor~owlr [ $127,865.5g 412. 4,20, I~ross Amount Du~ To ~eller $194.70 $79.62 $125,486.34 205. 213. 214. 215. 216. 218. 514. $125,8B5.591603. C.h [ X ] To [ ] From S~li.r ,j 1203. StateD eedTax$!250.O0 · Page 1 ot 1 Sherie From: To: Sent: Attach: Subject: "Dawn Gladfelter" <DawnGladfelter@WileyGroupLaw.com> "Sherie A. Minich" <sherieminich@wileygrouplaw.com> Wednesday, June 11,2003 7:43 AM CHRISE.xls; C.htm Fw: Estate of Blaine E. Chrise --- Original Message ..... From: Alicia C. Bruce To: Dawn Glad felter(~.wileyqrou plaw.com Sent: Wednesday, June 04, 2003 2:47 PM Subject: Re: Estate of Blaine E. Chrise Hi Dawn: Attached you will find the values you requested. This is on the individual account not the retirement account. I will send the retirement account numbers shortly. If the account needs to be viewed by the executor he can do so at our website, www.pmdential.com. Thanks Lila (See attached file: CHRISE.xls) "Dawn Gladfelter" <DawnGladfeltcr(~_~wileygrouplaw.com> Tuesday June 3, 2003 10:12 AM To: <alicia_bmce~pmsec.com> cc: Subject: Estate of Blaine E. Chrise Per our conversation, please provide me with Date of Death Values for the individual and retirement accounts of Blaine E. Chrise. My address is: Dawn Gladfelter, The Wiley Group, One S. Baltimore St., Dillsburg, PA 17019. I will also need to know the beneficiary of the retirement account, and the instructions for this account to be rdeemed. Thanks for your help. Daxrol (See attached file: C.htm) 6/11/2003 1 26 2O0 5O 100 3OO 100 2O0 3O 189 5O 3OO 6O 100 1000 100 474 244 100 200 30 900 15 244 100 AGRA AGRB BOBE CSCO CGA DELL DOCC DUK EMRG HPQ INTC IBM ICGE LU MMT MSFT NI NSE OAOT OXY PACW SFE USITQ VZ 1.68 1.61 22.75 13.24 2.24 26.01 4,01 12.75 0.38 15.8 16.01 77.9 0.29 1.61 6.23 23.56 16.91 1.96 1.53 30.15 0.5 1.23 0 34.06 47.6 1.68 41.86 4550 662 224 7803 401 2550 11.4 2986.2 800,5 23370 17.4 161 6230 2356 8015.34 478.24 153 6030 15 1107 0 8310.64 4760 TOTAL 81035.26 Page 1 of 2 Sherle From: To: Sent: Subject: "Dawn Gladfelter" <DawnGladfelter@WileyGmupLaw.com> "Sherle A. Minich" <sherieminich@wileygrouplaw.com> Wednesday, June 11, 2003 7:30 AM Fw: Estate of Blaine E. Chrise Sherie, Please print this for me. Thanks, Dawn ..... Original Message ..... From: "Alicia C. Bruce" <alicia_bruce~prusec.com> To: <DawnGladfelter~,_,wileygrouplaw.com> Cc: "Norm Sanner" <norm sarmer._F'~rusec.com> Sent: Tuesday, June 10, 2003 3:48 PM Subject: Re: Estate of Blaine E. Chrise > Just wanted to let you know the bene info on the IRA. > > John E. Chrise is primary and > Ed Stone is the contingent bene. > > If you have any questions....just give me a call. > > Thanks > Lila > > > > This e-mail is being sent to you for your information or at > your request. The information is not warranted as to > completeness or accuracy, nor does it serve as an official > record of your account. Your official Trade Confu'rnation > and/or Client Account Statement are the official records > of your account. Further, since the confidentiality of > Internet e-mail cannot be guaranteed, please do not include > private or confidential information (passwords, account numbers, > social security numbers, etc.), or instructions requiring your > authorization (orders, address changes, funds transfers, etc.) > in your e-mail communications to us. For additional important > information about privacy and Internet terms and conditions, > please visit us at (http://www.prudential.com). If you do > not wish to receive any further e-mail from us, please > send an e-mail to do_not_emailCCprudential.com. 6/11/2003 Page 2 of 2 Prudenfi~ Securities Incorpor~ed, Member S~C, One Seapo~ Plaza, New York, NY 10292 6/11/2003 With current market and world events, this is an ideal time to reexamine your asset allocation. A well-diversified portfolio can help you manage risk and earn potentially higher returns than a non-divemRied one. Over time your portfolio may become unbalanced, and per od ca y examining it will ensure that your asset allocation is precisely where you want it, To learn more about keeping your portfolio balanced, contact your Financial Advisor and ask for a free copy of Solutions for Investors: Rebalancing Your Portfolio, This Solutions discusses finding the right balance in your asset allocation, figuring out when is a good time to rebalance, and how to go about actually rebalancing your portfolio. Your Financial Advisor will be happy to sit down with you afterward and examine your porffo o. So call for your Solutions for Investors: Rebalancing Your Pomlfolio today! As of: April 30, 2003 Page 1 Your Financial Advisor: ROBERT J HARDIN FIRST V.P. INVESTMENTS 30 SOUTH WACKER DRI~,qE SUITE 4000 CHICAGO IL 60606 312-630-7022 BLAINE E CHRISE 301 KAY ROAD MECHANICSBURG PA 17050-30tl8 I.,,lll,,,llh,.I,l,lh,,,,Ihll,,.I,,Ih,hll,,.,.ll,,,lll 011-536921 BLAINE E CHRISE $88,510.87 ($20,981.79) $67,529.08 $100.12 $665.64 COMMAND The above summary does not include futures or futures related accounts held in your name at Prudential Securities, ~ - Total includes Short Balance. * - Current account balances are d splayed, although no statement was produced this month. # - Annuities & nsurance and/or 529 Account assets included. bllUii I. ~ Li~ LUIIIUII L ['r UUI~I114~!1 ~ ~ 11 !~1.1U.~I~ll For The Pedod: April 1 - April 30, 2003 Priced Securities Value $17,498.45 $17,389.25 Money Market Funds $4,016.00 $4,047.00 Cash Balance $28.33 $.19 Total Net Worth $21,542.78 $21,436.44 Unrealized Gain (Loss) As Of April 30 ($8,422,70) Money Fund Dividends $2.86 $10.76 Dividends $.00 $57.20 Total Income $2.86 ~ Opening Cash & Fund Balance $4,044.33 Income & Distributions In Cash $2.86 $67.96 Funds Added $.00 $.00 Funds Withdrawn $.00 $.00 Closing Cash & Fund Balance $4,047.19 Account Number: 010-R27830-37 Page 1 of 5 Your Financial Advisor: E-mail Address; ROBERT J HARDIN FIRST V.P. iNVESTMENTS 30 SOUTH WACKER DRIVE SUITE 4000 CHICAGO IL 60606 mbeK._hardin~prusec.com Phone; 312-630-7022 PRUDENTIAL SECURITIES C/F BLAINE E CHRISE IRA DTD 12/18/84 301 KAY RD NECHANICSBURG PA 17050-3048 I,,,111,,,111,,,,I,1,11,,,,,11,11,,,,I,,11,,I,I1,,,,,,11,,,111 Money UId Funds-' fixed Inc. Funds- [ q ult le s-60.1Z I. IlenT ;)TaTemenT yru(lem;lal lnanclal For The Pedod: April I -April 30, 2003 BLAINE E CHRISE ORIGINAL TRADE DATE QUANTITY Account Number: 010-R27830-37 Page 3 of 5 PRICE OR CURRENT COST OR CURRENT UNREALIZED ADJ COST PRICE OTHER BASIS VALUE GAIN OR (LOSS) Equities .,B~,,.~.R..I~I~.H.,E,.,S. NC 07-30-98 100 25.5625 28.000 $2 624.00 $2 800 00 S 76 00 .N.~..?.~.P. ................................................................. ~ ............................... ¥~ .................. ;i~';~'~ .............. ~;§'~ ....................... ~:'~'~ ~ .................... ~¥'~ ~ ................... i~','~'~:~ MICROSO~:'~: ~'~,~{'ii~:~l' ..................................... i~-~ ............................... ~ .................. ~i~'~'": ......... ~;~ ....................... ~'~;~ .................... {~"i'i~ ~ ...................... i~'4 ~) ,P,,A..,R,.K..E...R, .D.,.R..L,,L.I ,N,?. ~ ........ 07-30-98 ....... 900 .................. ~;§'~'~ ................ ;{;~ ....................... {~'~'i ~ .................... ~i"~ ~ ................... i{~,':~ ~) TRANSOCEAN INC .............................................. '{~'-~ ................................. ~1'~' .................. ~i~'~' ............ '~ ~i~{~ .......................... ~i~:~ ....................... ~;~'ii~ ...................... Total 1,619 $20,999.12 $12,894.95 ($8,104,17) Fixed Income Mutual Funds PRUDENTIAL GLOBAL TOTAL RETURN FUND INC 02-08-91 604.885 8.4303 7.430 $4,812.83 $4,494.30 ($318.53) O CLASS A Cost of Current Holdings (excluding reinvestments) Current Value of Total Holdings (including reinvestments) $5,099.35 $4,494.30 Total 604.885 $4,812.83 If a portion of your fund position was sold or converted, the "Current Value of Total Holdings" may include reinvestments from previously held posiSons. TOTAL UNREALIZED GAINS (LOSSES) $25,811.95 O - Based on informaSon provided by you or your Financial Advisor. $4,494.30 ($318.53} $17,389.25 ($8,422.70} DATE TRANSACTION Income and Distributions COMMAND MONEY A CLASS 03/26-04/27 04/25 Mone;/Fund Dividend QUANTITY PRICE/COMMENTS AMOUN'r DEBITED AMOUNT CREDITED For Reinvestment $2.86 L, IIOI1T TaTemenT yruoen lal inanclal PnJden§alSecudiJes ncomoraf~d {"}n~ R~,'~nnn* pl='~= N~Y~ U~V.~ dn~o~ -. . ~=~u;~??~=~==es~l~ cm~mqg~ea~m~el~[ ~I~G). ~1~ pmtecb ~st s~fles m ~ maJ~l~ Of, but not ~1 accoun~ for E-mail S~.~- T. .................. . . =so~at~d ~mtzed 1~ ~s.b~ ~ ~ ~;de~ ~ Inl~est e~ected ~ be c~ered, · $~,~ ~l~ng to $1~,0~ for cash in U,e ~ikel ;v~[ of ..... ~u ,~u~?~ ~e[~e, oo ~[ ~ ~ F~a Se~es ~c~l Yield ~ based ~ ~s~ca ~s~a~ ~er ~ Fec~ng 12 ~ p~od ~ fff se~es. TNS cw~a e does not ~robc ~ou3t Eon o~ses ~re__sb~.o~..: ....... ~ .. ., -- ~, ~ds ~m~,re~es~lare~fc~. Past~els ~[l~ca~e a b~, and secedes off. ed ~Ou ~ ~d~al Sec~es are not backed or Your statement may ~ntain th. fnll~nn ~i~n-' a~O~. ~ .~0~ ~as pb~ ~ ~ s~ces ~ie~d to ~ F~ ~aced in deposil accomb al ~l~ts~ im~tous a~e imbed by . , . ~.~,,m~u ~. ~e ~% Wl~a ~ m~. A ~o ~o (~ of fees} I~ ~ ~denaaed sev~ ~ d~ pen~. ~ad ~ nt record of ~ aa Me~ ~coun[ as re ~red , R~ m Gain (Loss) Summa~ refl~b re~ ~m 0~ses) ~ ~, s~es ~s~ sec~6es ~ ~n e~ asset, ~ ~ed ~ ~e ~e~t ~ce, ~le prop~ ack.ted f~ on ~ books or recede, is not ~ ~emE~ gem Uo~s) m ~es ~d as of ~ dose of ~e s~te~nt d ~om o~er cash baizes ~ld by ~s c~on (wi~ he excep~ of p~. co~o~ ac~ and ~ be used in ~e ~ coquet of busi~ss. s~ al ;re~l b~a~e is p~e o y~ up~ w~en ~flficaS~ Io us. Income & Dl~b~ons refl~ ~ to~ d ~, in.est geneml~ camot be s~d ~10~ in~t p~od runs ~om ~ ~rd FHd~ of ~ last m~ o ~ ~rd ~d~ of ~s~ ~ o~ i~ ~t~ to yo~ ~c~ ~g as wall ~ ye~-t~. R~ of ~p~ Inf~5~ ~pe~ ~. ~t ~. In.rest is c~cda~ d~ based on ~ net d~ly debit i~ed ~ ~ d ~ To~ I~.' ~ ~e~e K-1 ~ . . . .~ ' , . ~. , ~ Cash Acfiyi~ Hlghligh~ aspl~ F~ Ad~s ~ fu ~ ~ ' ~'- ' flw. r~m[~aaon, ~1 ~ ~ed a~(360).,~'Js sh[em~w,lJs~eavamge~td~]yd~ ~l~J~ ~ Y~;~d ~e Fe~ F~ wires, ~t~ted Cle~ng ~ .. .s~; ........ h in.rest ram meal to ~ve ~t ~e ~t o[interest ~g~. [nWestis ~ged ~e tA~fl~ ~s .~ ~a en~es be~een sep~ e ~c~ N Ma~n T ~i~.~a[mce ~ ~}. [T ~rable, c~ent m~et pnce mw in a~e wi~ ~e int~est c~uh~ s~dae F~ous[ ~ded ~ you [~[e. r~ s~ a~b, mW~[ ~ges ~ in a s~te sec~. ~ ~ ~.~ ow~ ~e ~e~ Fo~a~ Dy me ~o's ~ ~ ~d ~ ~ ~bR b~e in ~ur acc~ for ~e ne~ pe~od, ~ed s~6es ~a(c~ ~ed ~ (A~ ~1~. fee. Re6re~l ~ ~si~ssEdge Kc~ ~e ~L ~o~ ~ ~US o~ces ~..~... ~ZLJ~'L~-~.~P~ ~?~s ~ o~= m~ =e m~ea ~ most secmEes. ~ cost baas used In ~te~ ~m (1~) eff~b, a sMekeeDina fee of $25 Der ~=le ' ~.d y u ~r~ mason3ble ~ s~es ~ ~e g~ ~ "~d nde' ~ ~isted se~Ees at wi~ ~.~H....~ ~ ..................... L% ._. ~. ~ Pre~ ~cm6e~ re.esL A tin--cia s~te~n~of Pruden~al Se~6es Inc~omEd will be ~Jled ~o ~ ,,p-[p, ~...a~ ap ,~[~c~ s~es ~ ~ ~ ~a, ~ ~s ~be r~uire add~6on~ adJus~en~. We do not repr~en{ ~e ~cula~ons ~f ~s s~lemenl is ~ o~d~ r~d o[ ~ · . ...... f r~ and unr~l~ g~ns 0ossa) as an offi~ ~ a~undng ~ such ~[ be cons ~red bi~n ~ ~ if .... ~ ' ~se ~t ~e ~e e~ ~d at ~ ~lc off~ ~ ~d~ ~o 'cN ~s [~ ' 'Y . . . ~ . y~ v~fl~6on m ~ comp~e~ ~ofle. For . HARR]Sdirect Harrlsdlrect 4235 South Stream Bird., Suite 200 Charl~l~,"Ngrth Carolina 28217 Apfilll, 2003 Thc Wiley Group Attn: Jan M~ .Wiley 1' South BaJfimore Street Dillsburg, PA 1701~ Re: Estate o'f Blsine E. Chrise Acct3 Nos..630-9668.44., 631-7862~5 Dear Mr, Wile3: Hanisdirect has received the letters of administration and leZt~ of authorization for the above zefereaced accounts ~0m Edwin Stone executor, Please note that in my corresp~nclenca dated. Maxcl-/31., 2003, I made a typugraphical'error in relafion to the second accaunt__The correct account number/s 631-786225, not 637-786225. On March 7, 200.2, account.6.30-966844 had a.total, valua'don of $46,624.00 with $46,541.00 in-marketable se~mifies and the balance of $'83.00 in money fun&. - .,,/-'On March 7, 2003, account 631-786225 had a total valuation of $33,610.00 with $30,890 . of $2,720.00 in money funds. ' &x~m markptable aecufities and the balance Please find attached a copy of the Mm-ch accaunt;sta~aments for-each of these accounts. If you r, equire further assistance yo~ may contact the Undersigned at 704/998.4435. Brant P~ddy Compliance Manager 1 Harrisdirect Secufltle$ offerbd through Harris Investor Services, LLC A member of 'i'rte Harris family of wealth management services ' Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1;800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner VISA CREDIT CARD ACCOUNT: Account Number Date Account Established Balance at Date of Death Name of Joint Cardholder 81054 -00 05/22/1986 $3,387.68 $.69 $3,388.37 None 81054 -11 01/06/1989 $68.89 $.o0 $68.89 None 4287590000810545 04/21/1995 $242.31 None Insurance Supervisor April 1,2003' ' Estate of: BLAINE E. CHRISE Date of Death: 03/07/2008 Social Security Number: 273-32-7252 Register of Wills of Cumberland County, Pennsylvania INVENTORY , Deceased Estate of Cb. rise, Blaine E. also known as No. 21 -03- 00241 Date of Death 3/7/2003 Social Security No. 273-32-7252 Edwin L. Stone The 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 located 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 the Decadent 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 unswom falsification to authorities. Personal Representative Attorney: Jan M. Wiley, Esq. Signature: Edwin L. Stone I.D. No.: 06298 Signature: Address: 1 S. Baltimore St. Dillsburg, PA 17019 Telephone: 717/432-9666 Personal Property Members First Savings Account 81054-00: Members First Checking Account 81054-11: Prudential Financial Account 011-536921-37: Harrisdirect Account 630-966844: 1992 Toyota: Signature: Telephone: Dated: 3,388.37 68.89 (Attach additional sheets if necessary) Total Personal Property and Real Estate $258,602.86 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVlOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD O0432O WILEY JAN M 1 S BALTIMORE STREET DILLSBURG, PA 17019 ........ fold ESTATE INFORMATION: SSN: 273-32-7252 FILE NUMBER: 21 03-0241 DECEDENT NAME: CHRISE BLAINE E DATE OF PAYMENT: 08/30/2004 POSTMARK DATE: 08/27/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/07/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 911,952.07 REMARKS: TOTAL AMOUNT PAID: 911,952.07 SEAL CHECK# 2034 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS THE XVILEY GROUP Attorneys at Law Wiley · Lenox Co[gan · Marzzacco · P.C. 130 W. Church Street · Suite 100 Dillsburg, PA 17019 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF TNDIVIOUAL ~RDED OFFICE OF INHERITANCE TAX INHERITANCE TAX DIVISION ,r, ~ ~,~!Iq STATEMENT OF ACCOUNT HARRISBURg, PA 17128-0601 .~ -:'~ ~ DEC 29 AH 9:12 CLERK OF ORPHAN'S COURT THE WILEY GROUP I S BALTIMORE ST DILLSBURG PA 17019 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-IG07 EX AFP (09-0~) 12-06-200q CHAISE BLAINE E 03-07-2003 Z1 03-OZql CUMBERLAND 101 Amoun~ RemA~ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To /nsure proper credit: ~:o your accoun~c, submi~ ~hm upper potation of ~:hLs form wi~:h your ~ax payment. CUT ALONG THIS LINE I~ RETAIN LOWER PORTTON FOR YOUR RECORDS ~11 R~r-';&SY '1~' '~iq~' 'lq~t'-Y:~5 ...... ';~' ~i;ir~q~t rAq;~' ~ '; f~Yl~R~f ' ~q~';;~Yis0r~IY ' ' ~; ..................... ESTATE OF CHAISE BLAINE E F'rLE NO. 21 03-02ql ACN 101 DATE 12-06-ZOOq THTS STATEMENT TS PROVIDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELO# IS A SUMMARY OF THE pRINCIPAL TAX DUE, APpLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPL'rCABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-18-200q PRINCIPAL TAX DUE: ................................................................................................. PAYMENTS (TAX CREDITS): 11,q48.87 PAYMENT DATE 08-27-200q 11-15-Z00~ RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) ~COOOq3ZO REFUND 339.89- .0O AMOUNT PAID 11,952.07 163.31- ZF PAID AFTER THIS DATE, SEE REVERSE STDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), TOTAL TAX CRED'rT 11,qq8.87 ~ALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THTS FORM FOR TNSTRUCTTONS.