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HomeMy WebLinkAbout03-0590PETITION FOR PROBATE & GRANT OF LETTERS Es~ of G. ROBERTUMBERGER also known as Social Security No. 195-16-4078 , deceased. No. 21-03- k_~'~O To: Register of Wills for the County of Cumber/and Comrnonwea/th of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Executrix named in the Last Will of the above decedent dated December 6, 2001 , and codicils dated none The Executor named none died Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 111 Locust Way, Carlisle, Middlesex Township Decedent, then 79 years of age, died June 30 East Pennsboro Township, Cumberland County, Pennsylvania ,2003, at Holy Spirit Hospital, Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: 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 PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: 111 Locust Way, Carlisle, PA 17013 $45,0OO.OO $ $120,000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. Signature(s) and Residence(s) of Petitioner(s): Nancya~n Sheaffer Il 486 N. Locust Point Road Mechanicsburq, PA 17055 717-691-7552 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 02/ day of July ,2003. - ~ N'ancyann Sheaffer Estate of G. ROBERT UMBERGER , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, July ~ , 2003, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated December 6, 2001 described therein be admitted to probate and filed of record as the Last Will of G. Robert Umberqer ; and Letters Testamentary are hereby granted to Nancyann Sheaffer FEES Probate, Letters, Etc ........ $ 235.00 Short Certificates(-3- ) .... $ 9.00 Renunciation(s) ........... $ JCP .......... ' .......... $. 10.00 Other Will Pages (-2-) .... $6.00 TOTAL: .... $ 260.00 Filed ............................ ( ,iq~,~T'(25476) ATTORNEY (Sup. Ct. LD. No.) 60 West Pomfret St., Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE I.E: £ ~ LZ ']Fir' ~0. Z~Z:[~t LZ 'Iff? ~'0, LAST WILL AND TESTAMENT I, G. ROBERT UMBERGER, of Middlesex Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. ONE: I direct my personal representative to pay all of my debts, administrative expenses as soon as may be done conveniently after my decease. funeral and TWO: I give, devise and bequeath all of my estate of every nature and wherever situate in equal shares to my daughter, NANCYANN SHEAFFER and my son-in-law CHARLES L. SHEAFFER. If one of them has predeceased me, the survivor of them will receive the balance of the sum of my estate. THREE: I nominate and appoint NANCYANN SHEAFFER to be the Executrix of this my Last Will and Testament. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate CHARLES L. SHEAFFER, as substitute Executor.. unadministered, I nominate and appoint Should he die, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint the FIRST NATIONAL BANK OF MARYSVILLE, Marysville, Pennsylvania, as the Executor of my estate. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as he may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he may deem proper; and invest estate property and income without restriction to legal investments. FIVE: No Executor or Executrix, acting hereunder shall be required to post bond or enter security in this or any jurisdiction. SIX: In the event of a common disaster causing the death of myself, my daughter and my son-in-law, all within a period of sixty (60) days, then I give, devise and bequeath the rest, residue and remainder of my estate to the CARLISLE FIRST CHURCH OF GOD, which, at this writing is located at 705 Glendale Street, Carlisle, Pennsylvania 17013 or the successor of that church. IN WITNESS WHEREOF, December 2001. I have hereunto set my hand and seal this __ ~ ~day of, .(S~AL) Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, G. ROBERT UMBERGER, CHERYL L. CLELAND and SHARON L. SCHWALM, the testator and witnesses respectively, whose names are signed to the 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 that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~HARON L. SCHW~LM COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by G. ROBERT UMBERGER, the testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and SHARON L. SCHWALM, witnesses, this t_~% day of December, 2001. Mombr~r o~nn~vlv2tnir., ~ssoc, iation Ot Notaries LABT I~LL AND TI~ST~ OF G. ROBERT UI~BF.~GER LAW OFFICES IRWIN, MCKNIGHT & HUGHES WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMFRET STREET CARLISLE, PENNSYLVANIA 17013-3222 (717) 249-2:353 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: G. ROBER'[i UMBERGER JUNE 30, 2003 21-03-0590 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 27, 2003 . Name Nancyann Sheaffer Charles L. Sheaffer Address 486 North Locust Point Road, Mechanicsburg, PA 17050 486 North Locust Point Road, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto und~,l~le 5.6(~except _none. Date: ' 08/27/03 ~'//~{~Y//~A ~ IRWIN, McKNIGHT &'"Iq~GHES Name Marcus A. McKnight III, Esquire Address 60 West Pomfret Street Carlisle, PA 17013 Telephone (717) 249-2353 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 003071 MCKNIGHT MARCUS A III ESQUIRE 60 W POMFRET STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 195-16~4078 FILE NUMBER: 2103-0590 DECEDENT NAME: UMBERGER G ROBERT DATE OF PAYMENT: 09/30/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,500.00 REMARKS: TOTAL AMOUNT PAID: MARCUS A MCKNIGHT III ESQUIRE $7,500.00 SEAL CHECK# 020286 INITIALS' JA 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 003328 MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 195-1 6-4078 FILE NUMBER: 2103-0590 DECEDENT NAME: UMBERGER G ROBERT DATE OF PAYMENT: 12/11/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $478.21 TOTAL AMOUNT PAID: $478.21 REMARKS: MARCUSA MCKNIGHT SEAL CHECK# 020594 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-03-0590 COUNTYCODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Umber~er G. Robert DATE OF DEATH (MM-DD-YEAR) J DATE OF BIRTH (MM-OD-YEAR) 06/30/2003 12/09/1923 (IF APPLICABLE) SURV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) cAPB upRL ~=lO ~AC ES SOCIAL SECURITY NUMBER 195-[6-4078 Co. R 5. E C A 6. P I T U 7. L A T 8. I O 9. N 10. 11. 14. C O M mr, T I O N THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. OrigirlalReturn ~ 2~! SupplementalReturn H 4. Limited Estate · Future lnterest Compromlse (date of death after 12-12-82) 8. Decedent Died Testate Decedent Maintained a Living Trust 0 (Attach copy of Will) (Attach copy of Trust) ~ 9. Litigation Proceeds Received ~] 10. Spousal Poverty Credit ~ (date of death between 12-31-91 and 1 - 1-95) NAME Harcus ^. McKnight Esq. FI R M NAM E (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717/249-2353 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11 ) (date of death 3. Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 140,000.00 None None None 67,699.24 None None 20,251.06 823.30 · * OFFICIAL USE ONLY (8) 207,699.24 (11) 21,074.36 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) (12) 186,624.88 186,624.88 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00 16. Amount of Line 14 taxable at lineal rate 186,624.88 X .0 45. (16) 8,398.12 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 111 Locust Way CITY Carlisle ISTATE ?^ ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 7,500.00 419.91 (4) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If 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. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 8,398.12 7,919.91 0.00 0.00 478.21 0.00 478.21 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER 'THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No ;i retain the use or income of the property transferred; ......................... 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? ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideratiol3? ................................ J--J J~l 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. J"--J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designatior{? ................................ J---J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Nancyann Sheaffer DATE ,/~/~/~ /+86 N. Locust Point ........... SIGNATUREOFP~OTH~HANR~SENTATIVE IRWIN & Mc~IG~ DATE _~~~/,/t ~ ~ 60 West Pomfret Street /" % ........................... For dates of death on or after July 1, 1994 and before Janua~ 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 aher Janua~ 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 s~tute does not exempt a transfer to a surviving spouse from tax, and the statuto~ requiremen~ for disclosure of assets and filing a tax return are ~ill applicable even ~ the surviving spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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(I [72 P.S. a~ ~ 6(a)( ~ )]. 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(aXl.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) ZOO0 form software only The Lackner Group, Inc. Form REV-lSD0 EX (Rev, 6-00) REV- 1502 EX'+ (1-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER G. Robert Umber~er SS~; 195-16-4078 06/30/2003 21-03-0590 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 knowledcje of the relevant facts. Real property which is iointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION ITEM NUMBER 111 Locust Way, Middlesex Township, Cumberland County - (settlement sheet attached) (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH 140,000.00 $ 140,000.00 Copyright (c) 1996 form software only CPSysterns, Inc. Form REV-1502 EX (Rev. 1-97) RE"V- 1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT F. SYATE OF G. Robert Umber~er SS~/ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 195-16-4078 06/30/2003 FILE NUMBER 21-03-0590 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 5 Cornerstone Cornerstone Cornerstone First National Miscellaneous Federal Credit Union - savings Federal Credit Union - checking Federal Credit Union Bank of Marysville - checking personal property sold TOTAL (Also enter on line 5, Recapitulation) 18,842.50 855.50 21,132.82 6,446.42 20,422.00 $ 67,699.24 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97) REV- 1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF G. Robert Umber~er SS# SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 195-16-4078 06/30/2003 FILE NUMBER 21-03-0590 Debts of decedent must be reported on Schedule I. ITEM NUMBER 2 1 2 3 4 DESCRIPTION FUNERAL EXPENSES: Carlisle Memorial Service Michael J. Shanolis Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / ElM Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees IRWIN & McKNIGHT 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 Other Administrative Costs Cumberland Law Journal estate notice publication Magee Auctions - commission Register of Wills filing fee The Sentinel - Legal - estate notice publication TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 456.80 5,234.40 8,290.00 260.00 75.00 5,807.75 25.00 102.11 $ 20,251.06 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REv-1512 EX' + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT F. STATE OF G. Robert Umber~er SS~/ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 195-16-4078 06/30/2003 FILENUMBER 21-03-0590 Includ~ ITEM NUMBER 1 2 3 4 5 unreimbursed medical expenses. DESCRIPTION Armesto Eye Associates Middlesex Township Municipal Authority Penn Power & Light Co. Sprint Telephone York Waste Disposal (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 10, Recapitulation) $ AMOUNT 200.00 157.50 370.08 58.13 37.59 823.30 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REv-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF G. Robert Umber~er SS~/ NUMBER I. 2 II. SCHEDULE J BENEFICIARIES 195-16-4078 06/30/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Ss. 9116(a~1.Z)] Charles L. Sheaffer 486 N. Locust Point Road Mechanicsburg, PA 17050 Nancyann Sheaffer 486 N. Locust Point Road Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT De Not List Trustee(s) Son-in-Law Daughter FILE NUMBER 21 - 03- 0590 AMOUNT OR SHARE OF ESTATE 1/2 remainder 1/2 remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00) LAST WILL AND TESTAMENT I, G. ROBERT UMBERGER, of Middlesex Pennsylvania, declare this instrument to be my Last Will revoking all Wills and Codicils heretofore made by me. Township, Cumberland County, and Testament, hereby expressly ONE: I direct my personal representative to pay all of my debts, 'funeral and administrative expenses as soon as may be done conveniently after my decease. 'TWO: I give, devise and bequeath all of my estate of every nature and wherever situate in equal shares to my daughter, NANCYANN SHEAFFER and my son-in-law CHARLES L. SHEAFFER. If one of them has predeceased me, the survivor of them will receive the balance of the sum of my estate. THREE: I nominate and appoint NANCYANN SHEAFFER to be the Executrix of this my Last Will and Testament. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint CHARLES L. SHEAFFER, as substitute Executor.. Should he die, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint the FIRST NATIONAL BANK OF MARYSVILLE, Marysville, Pennsylvania, as the Executor of my estate. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as he may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he may deem proper; and invest estate property and income without restriction to legal investments. FIVE: No Executor or Executrix, acting hereunder shall be required to post bond or enter ~ecurity in this or any jurisdiction. SIX: In the event of a common disaster causing the death of myself, my daughter and my son-in-law, all within a period of sixty (60) days, then I give, devise and bequeath the rest, residue and remainder of my estate to the CARLISLE FIRST CHURCH OF GOD, which, at this writing is located at 705 Glendale Street, Carlisle, Pennsylvania 17013 or the successor of that church. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~day of, December 2001. (SEAL) Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, G.' ROBERT UMBERGER, CHERYL L. CLELAND and SHARON L. SCHWALM, the testator and witnesses respectively, whose names are signed to the £oregoing 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 that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. CHERYL,. C~LELAND COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by G. ROBERT UMBERGER, the testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and SHARON L. SCHWALM, witnesses, this l~% day of December, 2001. Notarial Sea-'~ Martha L. Noet, Notary Public Carlisle Boro, Cumberland County My Commission Expires Sept. 18, 2003 ~lemr, er .:',~nn~v~v~ni~ ~.,~soc. iatJorl Of Notaries LAW OFFICES IRWIN, MCKNIGHT & HUGHES 14lEST POMFRET PRQ~:ESSIONAL BUILDING 60 VVE S T PQ~fFRET STREET CARLISLE, PENNSYLVANIA 17013-3222 C. Note: A. Settlement Statement U.S. Department of Housing and Urban Develo0ment OMB No. 2502-0265 _B. TYPE OF LOAN I. [~FtIA 2. L~Fm}IA 3. E]Conv. Unins. 4, ~VA _5. [:]Conv, b~s. 6. FILE NUMBER T 7. LOAN NUMBER CHAPLINSKIN11/0M. AM __ [ 10959 8, MORTGAGE 1NSUILANCE CASE NUMBER This form is furnished to g va you a statement of actual settlement costs Amounts paid to and b the se terns marked "(p o c "were aid ou ' ' ' y [1lament agent are shown· · · .} p tside the c oalng; they are Ihown hare for lnfomlatlen purpoles and are not included in the totall. WARNING:)tisacrimetoknowinglymakefaleeatatementslotheUnrmdStalesonthisoran otherst i D. NAME OF BORROWER: __ ADDRE.~L~: E NAME OF SELLER: __~ADDRES$: F. NAME OF LENDER: ADD~?~ESS; G. PROPERTY ADDRESS: H SE/TLENtENT AGENT: PLACE OF SETTLEMENT_. _-___ I. SE'ITLEMENT DATE; __ 11/14/2003 _ J. SUMMARY O~F BORROWER'S TRANSACTION: 100. GROSS AMOUNT DUI:~:ROM BORROWER 101. Contract sales nrlce [ 14 0 ~ 0 0 0 · 0 0 102. Personal P~ertv ~. Settlement charoes to borrower [line 1400} zl. · 8 8 5 · 14 --104, NATHANIEL L. CHAPLINSKI and JENNIFER L. CHAPLINSKI 3276 SPRING ROAD. CARLISLE. PA. 1__7013 ESTATE OF G. ROBERT LrMBERGER 111 LOC_UST WAY, CARLISLE, PA 17013 WAYPOINT BANK 101 S. GEORGE STREET. YORK. PA, 17401 111 LOCUST WAY, Carlisle, PA 17013 LOT 12 EVERG~REE~N_ ESTATES, Middlesex Township IMH REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717-249-6354 West Pomfret Profe~_sional Bldm 60 West Pomfret Street,~_Carlisle, PA 17013 ~Q0~-MOUN~SJ°AID BY OF{ ON BEHALF OF BORROWER 201. DePosit or eari3est money -~J~, Principal amount ofnew IOaQ~ __ 112 · 000 . 00 ~,~0~.~a loan(s) taken sut~JTJ;_t~ J04. S ~¢ond Mort _ueg. e_ _ 21,000.00 WAYPOINT BANK 207. L /~;[j~J:~n~.,.i for items unoaid by selllr 215. 217, ..~18. ~.20. TOTAL PAID BY/FOR~,~OWER 133,000.00 _~ CASH AT SE'I-rLEMFbJT~OM OR TO BORR(~WER ._.~01. Gross afflOunt due fro~.borrower [line 120J ~ 145 ~ 618.25 302. Less amounts oald bv/fo]:jza[rJ3~er [llne ~Oj I 133,000.00 L_303. (;A.~-LFROM BORR_Q~R / 12 , 618 . 25 K=SUMMARY OF SELLER'S T_PANS_ACTION: 400. GROSS AMOUNT DUE TO SELLER: 401~ Contract sales ~ 40-~, Personal Prooer~ 403. 404. 407, 408. 409. 410, Ad_iustments fpr items paicLt~/A I~ ~.mtv taxes 11/14/03t01~2/31/_03 8cl,,,ul Tax 11/14/031006/30_0~_~_ 411, ~ 412· '420. 'GROSS AMOUNT DUE T~) SELLl~R~__. 500. REDUCTIONS IN AMOUNT DUE T~$J~I. LER 501. Excess Den~-~*,[see InstructionsI 502. Settlem~rtt charoes to seller [line 14001 503. Existing_ Ioan(s}laken subject to 5q4~ Payoff of FJ)'at MortGage Loan 501~. 509 513. 514. 516. 517. 518. 519. _ Ad!ustments fQLJ/ems uno)aid b~/sell~r___ 140~000.00 48.79 684.32 140,733.1_~1. 1,438.94 520. TOTAL REDUCTION AMOI JNT DUE ,$J~LLER .. 1,4_3 8.94 600. CASH AT SETTLEMENT TO OR FF~OM SELLEI~ 601. Gross .... nt due t ~ sellp, j'_(Jlne 42o1 t 1~0,733.1~ 602. L ..... dueflon ~t d .... I'., flirt. ~ ~ 603. CASH TO SEI I~R ~ 139.294.17 TitleExpress Settlement Syslem Printed 11/13/2003 at 16:01 REV. HUD-1 (3/86) O0'S~ ~6'8£ 00'009'T I~epu~ Aq DO4 00'00t'T 00'~0T O0'SE S3E)BVi~O IN316139 m m aS 9VIO_1~00~ '90£1 - 'ZO%~' '90Ti '~HDIAHHS ~SH ~HH H~I m '- 9Md q~'W IHDIN~AO ~B~¥HO IN]1~39113~ 9VNOIIIOOV '00£ t 00'0GT SL'SSO'T SC'BS0'T - 00'000'0DT 00'000':TT ( ( 00'0 006 pu3 'OOt; pu3 'OOl pug ~O*.lOd a~au~o 'Oll I. ~OllOd s,Japua'l '60l :ON stUell eAoqe sepnloUl) a:*ueJnsul sill1 '8014 :O~l stuall aAOCla sapnlout) see~ s,~etuottV 'ZO t I. seed/u alON UOlle~ada~d ~.uetunooo 'gOl. I. ~apulq saue~nsu! sbt1 't'Ol uoBsultuexa alii 'TOt L qtuaas all.q Jo loeJlsqv ':01,~ eel ~u!solo Jo lUatuall.l.aS 'LOt L 0:'60E OS' ~:B omt OS' 06 omt ~'6' 0£ ow/ 0 ~eAnE 00'0E£ ('D'O'a) JOJ tun!maJd aoueJnsul ~eL~q.I JOJ tunll~aJd a3ueJnSUl 00La'BT $~ £00[:/T0/[:T 01 £00::/~T/T~UOJ~ 3ONVAOV NI C]IVd :18 Ol ~lqON3~ O3~llflO3B S~1311 00'~T 00'T6 00'06~ H~ 2,HIOdA~M ol 00'SIT M~ ~RIO~AY~ m O0'OOL IN3PJ391 I~$ IV ~lOB-t OlYd ~eAnE 00'0S£ ('D'0'6) '906 -- 'lro6~ 'C06 %06 '006 HH~ -T-HIO~AY~4 ol 1~3o 0009=1 'Lt5~- HR~E ~.RIO~AY~4 ol ga-1 '::131^ag$ X~£ 'Otg dgl:ld OOO '60g ' aa4 uoRdttlt~sV 7.08-- aad uoBoadsul S~lapue9 'SOB ]Jode~ llPaJD 'eOB aa4 leSleJddv HHY~ /~HIO~AYM% lunoaslO ueo'l % aa4 UOlleU!SpO ueo'l NVO'I HIIAA NOW33NN(~-NI q-18VAVd SI~F:]II luatualga$ ~e p!ed IN31~:a'IJ_L3S iv SaNn~ I~10~.,-I OlVd ~ 3OVd 0/[ 1NI ,"fSNI'IdVItD :J~qtunN ~l!:l 'gOB '~08 'lOB 'OOg 'gOZ $ '~0/. ~Lr~ :S~OllOl se (OOZ CUll) uo!sslmmO3 ;o UOlSlAIO ~ 0 0 · 0 0 0 · 0DT$ eopo u0 peseq NOiSSi~OO S,~g~O~B/S39VS 9ViO~0Z S3~BVHO IN~39~3S '9 IN3~31VIS IN3~39~3S iN3tfldOq~A~O NV~N QNV ONI~NOH dO lN~fll.~Vd~lCl 'S'N MAGEE AUCTIONS FINAL SETTLEMENT SELLER NAME/xIA,.<v4,.,~ ADDRESS /// DATE OF SALE PHONE ~9/-" ZIP /7~ / ~ LOCATION OF SALE AUCTIONEER PHONE SELLER'S EXPENSES RECEIPTS PROFESSIONAL FEES AUCTIONEER A ~'r~ PERS PROP REAL ESTATE CLERK CASHIER OTHER EXPENSES EXPEDITER RUNNERS PREP LABOR TRUCK TENT ADVERTISING A~v. £~ /~t~.~ ~4~.~ DATE SIGN BAR $ lee ~ee $ s J55.~o $ $ /3.2~ PORT-A-POT MISC TOTAL EXPENSES CASH $ CHECKS $ TOTAL RECEIPTS $ ~.~q ~- LESS TOTAL EXPENSES $ NET PAY TO SELLER $ j L-IL( £/~L. I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds fi.om the auction of my goods and property sold on the above date. I accept all respo~iblli~ for providing merchantable title to all goods, and property sold, and for delivery of tit]e/to]the ,Prlrchajcr, ' Auetloaeer / ~ashier's Signature (Sell~r's Sigaall~e) Date Date (Seller's Signature) MAIN OFFICE: 101 Lincoln Street Phone: (717) 957-2196 Fax: (717) 957°4578 of ~arysville-'~- P.O. Box B Marysville, PA 17053-0017 RIDGEVIEW OFFICE: 500 S. State Road Phone: (717) 957-2114 Fax: (717) 957-4678 SEPTEMBER 30, 2003 IRWIN MCKNIGHT & HUGHES WEST POMFRET PROFESSIONAL BUILDING 90 WEST POMFRET STREET CARLISLE PA 17013-3222 RE: ESTATE OF G ROBERT UMBERGER HERE IS THE iNFORMATION YOU REQUESTED: CHECKING 30-595-2 G ROBERT UMBERGER OPENED: 10-31-80 IN-T RATE: .60% DOD BAL: $6,446.42 DOD INT: .74 OCT - 7 2003 IRWIN & McKNIGHT IF YOU REQUIRE ANY FURTHER INFORMATION, PLEASE FEEL FREE TO CONTACT US. SINCERELY, BARBARA RECHER CUSTOMER SERVICE CORNERSTONE RO. Box I 18 I, 5 East Gate Drive, Carlisle, PA 17013 F e d e r a I C r e d i t U n i o n Telephone (717) 249-1661 FAX (717)249-8208 3dember founded-- Service based www. cornerstonefcu.org July 28, 2003 Irwin, McKnight, & Hughes 60 West Pomfret Street Carlisle, PA 17013 Dear Sir: JUL ,"50 200~ Robert Umbe~N' McKNIGHT & HUGHES An account, number 643, was opened with our financial institution on September 15, 1976 in the name of G. Robert Umberger, individually. The following is his account information: Account Type Balance 06/30/03' Interest Earned thru 06/30/03 Date of Death Balance Savings $18,842.50 Checking $ 855.50 Certificate $ 21,103.33 $ 29.49 $18,842.50 $ 855.50 $ 21,132.82 *Date of last dividend posting. Per our records there have been no changes in the account ownership since opened and no accounts have been closed in within one year. Please let me know ifI can be of further assistance. Sincerely, Molly L. Frohm Members Service Rep./Admin. MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $100,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION Inventory of the real and personal estate of G. ROBERT UMBERGER deceased 1. 111 Locust Way, Middlesex Township, Cumberland County ............ 2. Cornerstone Federal Credit Union - Savings ................. 3. Cornerstone Federal Credit Union - Checking ................. 4. Cornerstone Federal Credit Union ...................... 5. First National Bank of Marysville - Checking ................ 6. Miscellaneous personal property sold .................... TOTAL ................. 140,000 18,842 855 21,132 6,446 20,422 207,699 00 5O 5O 82 42 00 24 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Nancyann Sheaffer being duly sworn according fo law, deposes and says that she is the Executrix of the Estate of G. Robert Umberger late of ..... Mi.d_dl_es_ex _To ~wnship _ , Cumberland County, Pa., deceased and fhaf fha within is an inventory made by Nancyann Sheaffer __, the said Executrix of the enflre estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedenf's death. this Sworn  nd subscribed before me, / ,y ~f Deg~m~er, ~ ~003 ' I1, _ _/'1_ I ~ ~, ~~ ~n~ I , ~~ ~~. 14~7 ] Date of Death Nancyann~Sheaffer, Excgc~utr'x 486 North Locust Point Mechanicsburg, PA_____17055 Address 30 06 2003 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as +o personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , O 0 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003522 ........ fold ESTATE INFORMATION: SSN.' 195-16-4078 FILE NUMBER: 2103-0590 DECEDENT NAME: UMBERGER G ROBERT DATE OF PAYMENT: 02/03/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $25.17 REMARKS: CHECK# 020723 SEAL TOTAL AMOUNT PAID: $25.17 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERTTANCE TAX STATEHENT OF ACCOUNT R6c!7~3~- :" ~f DATE 05-08-2004 ~- ' ESTATE OF UMBERGER DATE OF DEATH 06-50-2005 FILE NUMBER 21 03-0590 COUNTY CUMBERLAND ACN 101 Amoun~ Rem/~ed '04 12 P1:47 MARCUS A MCKNIGHT ES~ IRWIN 8 MCKNIGHT 60 W POMFRET St CARLISLE PA I RE¥-1607 EX AFP COl-OS) G R HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/~: ~:o your account, submi~ ~he upper portion of ~his form wi~:h your ~ex payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1607 EX AFP (01-03) ### INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF UHBERGER G R FILE NO. 21 03-0590 ACN 101 DATE 05-08-2004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELO# ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROdECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-02-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 8,398.12 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID $94.74 09-30-Z005 1Z-11-2005 0Z-0~-2004 CD00507! CDOO$$Z8 CDOO~5ZZ .00 .00 7,500.00 478.21 25.17 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 8,398.12 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGTSTER OF #TEES, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHNON#EALTH OF PENNSYLVANTA. REFUND (CR): A refund of a tax credit) which Nas not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Nills) any of the 23 Revenue District Offices or from the Department's Z4-hour ansaering service for forms ordering: 1-SOO-36Z-ZO50~ services for taxpayers with special hearing and / or speaking needs: 1-SO0-qq7-30ZO iTT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes) ATTN: Post Assessment Raviea Unit, Dept. 280601) Harrisburg) PA 17IZS-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid aithin three ($) calendar months after the decadent's death) a five percent (SZ) discount of the tax paid is alZowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning aith first day of delinquency) or nine (9) months and one (1) day from the data of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate Nhich ail1 vary from calendar year to caZendar year with that rate announced by the PA Department of Revenue. The appZicable interest rates for 1982 through ZOOq arm: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 198Z 2OX .0005q8 1988-1991 11X .000301 ZOOX 1983 16Z .OOOq38 199Z 9Z .O00Z~7 ZOOZ 198q 112 .000301 1993-199q 7Z .00019Z 2003 1985 13Z .000S56 1995-1998 9Z .O00Z~7 ZOOfi 1986 lOX .O00Z7q 1999 7Z .00019Z 1987 9Z .0002q7 ZOO0 8Z .000Z19 Interest Daily Rate Factor 9Z .O00Z~7 6Z .00016~ SZ .000137 qZ .000110 --Interest is calculated as folloms: I'NTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAZEY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice) additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: G. ROBERT UMBERGER Date of Death: JUNE 30, 2003 No. 21-003-0590 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: X Yes ~ 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 X 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? X Yes No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be 3/25/04attached to this report~(~~~.~~ ' '~' IRWIN & McKNI"G?}¥-~ ~ ~ M~cus A. Mc~ight m, Esquire ~ Name (please type or print) ~ 60 West Pomfret Street ~ .. Address ~ C~lisle, PA 17013 ~ _ ¢~ City, State, Zip D ~ (717) 249-2353 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative BUREAU OF ZND/VTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 MARCUS A MCKNIGHT ESQ IRWIN & HCKNIGHT 60 W POMFRET ST CARLISLE PA 17013 CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR D~SALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH F/LE NUMBER COUNTY ACN OZ-OZ-ZOOq UMBERGER 06-50-2005 21 05-0590 CUMBERLAND 101 Amount Roe'ltted REV-I~G? EX AFP G R HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~.~ RETA/N LOWER PORTION FOR YOUR RECORDS ~"~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF UMBERGER $ R FILE NO. 21 03-0590 ACN 101 DATE O2-OZ-Z00q TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REV~kSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) 2. Stocks end Bonds (Schedule B) $. Closely Held S~ock/PartnorshAp Interest (Schedule C) ($) q. Mortgages/Norms Receivable (Schedule D) (q) $. Cash/Bank Deposits~Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers {Schedule G) (7) 8. To,al Assets APPROVED DEDUCTIONS AND EXENPTXONS= 9. Funeral Expenses/Ado. Costs/M/sc. Expenses (Schedule H) (9) 10. Dobts/Hortgago Liabil/~es/L~ons (Schodulo 1) (10) 11. Total Deduct/ohs 12. Not Value of Tax Return 1~0~000.00 .00 .00 .00 67~699.2q .00 .00 (8) 20,251.06 823.30 NOTE: To insure proper credit to your account, submit tho upper portion of this form w/th your tax payment. 13. lq. NOTE: 207,699.2q (11) 21.07~.36 (:].2) 186,62q.88 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) Not Velum of Estate Subjoc4: to Tax (lq) Zf an assessaent was issued previously, lines 14, 15 and/or 16, 17, reflect figures that /nclude the total of ALL returns assessed to date. .00 186,62q.88 18 and 19 will ASSESSNENT OF TAX: 15. Aeoun~ of Line lq et Spousal rate 16. Amount of Line lq taxable mt Lineal/Class A rata 17. Amount of Line lq mt S/bling rata 18. Amount of L/no lq taxable et Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT D/SCOUNT (+) DATE NUMBER INTEREST/PEN PAZD (-) 09-30-2003 CD003071 39~.7q 12-11-2003 CD003328 .00 PAYMENT MUST BE MADE BY 03-30-Z00q~. ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL INTEREST. (26) .00 x O0 : .00 (16) 186,62q..88 x Oq5: 8,398.12 (~7) .00 x 12 = .00 (28). .00 x 15 = .00 (19)= 8,398.12 AMOUNT PAID 7,500.00 q78.21 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 8,372.95 25.17 .00 25.17 ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYMENT KS REgUZRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE ./) A REFUND. SEE REVERSE SIDE OF TH/S FORM FOR INSTRUCTIONS.) ~ ~ RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR) OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 11~0 of the Inheritance and Estate Tax Act, Act ZS of ZOOO. (7Z P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILLS, AGENT : A refund of a tax credit, which mas 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 Register of Rills, any of the ZS Revenue District Offices, ar by calling the special Z~-hour answering service for forms ordering: 1-800-S6Z-ZOSO; services for taxpayers eith special hearing and / or speaking needs: 1-DOO-~qT-30ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object eithin sixty (60) days of receipt of this Notice by: --Nritten protest to the PA Departd~ent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bo addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB06Ol, Harrisburg, PA 17118-0601 Phone (717) 787-6503. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (S) calendar months after the decadent's death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes ahich became delinquent before January l, 19DZ bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .OOOl6q. Ali taxes ehJch became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOS are: Interest Daily Interest Daily Interest Daily Year Rate Factor Yaa._._r Rate Factor Year Rate Factor 1982 ZOZ .0005¢8 1987 91 .OOOZq7 1999 71 .00019Z 1983 161 .000~58 1988-1991 llZ .O00SO1 ZOO0 81 .000219 198q llZ .OOOSO1 1992 92 .O00Zq7 2001 92 .0002~7 1985 152 .000356 1993-199q 71 .000191 Z002 62 .00016~ 1986 102 .000274 1995-1998 92 .OOOZq7 ZOOS 51 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.