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HomeMy WebLinkAbout03-0650 Register of Wills of County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of ~ / I I(~//'J)l 1~ l ~' ~/' ~ ~I~'~'-~v NO. also known as ' ~] - , Deceased Social Security No. ~/~).- - ,-~. ~- ~0/..._~ Petitioner(s) who is/are 18 years of age or older apply(les) for: (COMPLETE"A" OR B BELOW:) Q~A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execute decedent, dated _'-)-~ ~3.~ .~' ~ [clc~--7 and codicil(s) dated named n the last Will of the ( State relevant circun3stances, 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 (d.b.n.c.t.a.; pendente lite; durante abse.~a, du¢a~tu minodtate) 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 (COMPLE I ~- IN ALL CASES;) Attach additional sheets if necessary Decedent was domici{ed at death in ~.~V~;;:~V_ ~[_%4.__d Coun~,Pennsylvarfia, with his/her last family orprincipalresidenceat 5 ~ c;'~' '(c~ ]~ {2 ~ [1 Yk~ C C~ I A._ ~i/-'~ - (list street, number, and municipality) Decedent, then 7/~ years of age, died /'~b I.~J ~ ~, ,20~.~ ,at 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 (Location) $ -' 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: I ~ Signature . Typed or printed name and residence snace/WIIIsPetGrant Lt/2001 Oath of Personal Representative Commonwealth of Pennsylvania County of "/7~t-k 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 or Petitioner(s) and that, as personal representative(s) of the Decedent, Petition(s) will well and truly administer the estate according to law. Sworn tooraffirrnedandsubscribed /z~/~ ~0 ~)l~)/ ~'~ ~ before me this 7th day of ~ .... -/~ "- ~ / FAr the Reg Estate of NO. VIRGINIA M ANDERSON Deceased Social Security No.: 102 - 24 5013 Date of Death: 7-26-2003 AND NOW, AUGUST 7 ,20 03 of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters G~ Testamentary (~ Of Administration are hereby granted to CAROLYN KIMMEL , in consideration d.b.n.c.ta.; pendente lite; durante absentia; durante minodtate in the above estate and that the instrument(s) dated 7-3-19 9 7 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ............ $ Short Certificate(s)...$ Renunciation ....... $ Affidavits ( ) ....... $ Extra Pages ( ) ..... $ Codicil ............ $. JCP Fee ........... $. Inventory ........... $ Automation Fee ..... $ Other .............. $. TOTAL ........ $ snace/~llsPetGrantLt/2001 -- L RediSter gVVllls ('] Attorney: I.D. No: Address: Telephone: 0~.sf s REV 9~86 This is to certify that the informat:on here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be ~orwarded to the State Vital Records Office for permanent filing. WARHING: It i$ illegal to duplicate this ¢op¥ blt photostat or photograph. Fee for this certificate, $2.00 P 9504885 No. Local Registrar ~,,z- JUL 3 0 £003 Date '~ 143Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Virginia May Anderson ,. 74 v. i 11-6-1928 ,.Rockport, MA ~ York~cE~m.susu~up~ ~. Monag~n ~. 221 Loc~t Lane ,,.. College Professor~,~. Education 5528 Moreland CouAt ~UDE~E Mecha~icsbmtg, PA 17055 ~ *. Ju~y 26, 2003 ~ DECEDENT EVER IN DECEDENT'S EDUCAEION Ye* [] ~ ~ Ekmema~y/Seeona~y I~ N.v~ Ja~,~. I,, '-~ j,=.12 ,~'a Jg ""'~' I,,.Neuer Married J(,Spec,h,) J,.. White. I,. Ra.~nar Anderson MOT H E It'S NAME IF, ~1. M,:JOle. M,i ~ .~ na;.ne} ' ~'s~,~,,.,~ ,,. Math~Ide Ad~ ~ C~olyn Klmmel r.~.rs~~.c~.~.~*~ - i~.221 Locm~t Lane, Dll~b~q~ PA 17019 I C~o~ Soc~ o~ I ~/ · ~ -- ~ ~L ~. . ~ I I E~D~FAC~I~ C~O~ .... ~) ' ~ ~ ~l ~alh. J ~ ~ / 0 j [-~ , u m~ IMam. Uay. YeaO J~ C~E REFE~ED TO UEBC~ E~INE~O~R? I-. ' ~. I,,~z~-~,~co ~ I ~.~.~ , ~ ......... ~0~ ................. ;~?___ - .... : ~,S~~c~ ,,~m.~ ~ ~ e~ ( ~ a C~E~E ~: /2"~' . ~. ~. ,~,~} - lt~m ~. c~. ~,~,;.,c ....... , ' //- ~ SIGNAl' IIFIER ,~iAM E AND ADORE;$ OF PERSON WHO COMPLETEO )AlE FILED IMomh Oa~ Yeet~ LAST WILL AND TESTAMENT OF VIRGINIA M. ANDERSON I. I, Virginia M. Anderson, presently of Mechanicsburg, ~,mherland County, Co-~onwealth of Pe--sylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, revoking any all previous Wills and Codicils, and hereby will and dispose of all the property which I own at my death in the following manner: II. As Executrix of this my Will I n~me and nominate Carolyn K~---el presently of Dillsburg, Pennsylvania; if she shall for any reason fail or be unable to serve as Executrix, either before or during her service as Executrix, either before or during her service as Executrix, then I b-me Suza--e Charland, presently of Groveland, Massachusetts as Executrix. III. I direct that my debts and the expenses of my last illness and funeral shall be paid by my Executrix as soon after my decease as may be convenient. IV. I bequeath and devise all the rest, residue and r-m, inder of my estate, real, personal and mixed including any property of which I may have power of appointment unto Suzanne M. Charland, presently of 23 King Street, Grovel~nd, Massachusetts and Carolyn A. Et ...... el, presently of 221 Locust Lane, Dillsburg, Pe-nsylvania to be divided equally among them as they may determine. If, however, either Suzanne M. Charland or Carolyn A. Ei.~'..~el or both predeceases me then the deceased beneficiary's share shall pass to their issue per stirpes. If Suzanne M. Charland predeceases me without issue, then I bequeath and devise the share she would have received had she survived me, to Carolyn A. Ki .... ~.el. If Carolyn A. Kimmel predeceases me without issue, then I bequeath and devise the share she would have received had she survived me, to Suzanne M. Charland. If both Suzanne M.Charland and Carolyn A. Ki--~el predeceases me without issue, then I bequeath and devise all the rest, residue and remainder of my estate, real, personal, and mixed including any property of which I may have power of appointment unto Gordon College, Massachusetts. V. No principal or income payable under this Will shall be subject to anticipation or assignment by any beneficiary thereof or to attachment by or to the interference or control of any creditor of any such beneficiary, or be taken or reached by any legal or equitable process in satisfaction of any debt or liability of such beneficiary prior to the actual receipt by the beneficiary. VI. My executrix shall pay out of the residue of my Estate as 2 an expense of administration all estate taxes, i-heritance taxes and other death taxes of any nature which may be imposed upon or with respect to the following: A. Any devise, legacy or appointment made in this Wi11~ B. Any real or personal property which at my death I may own~ C. Any life insurance upon my life. In the absolute discretion of my Executrix, she may pay such taxes i---ediately, or may postpone the time of payment of taxes on future or remainder interests until possession accrues to the beneficiaries. VII. I give to my Executrix the following powers, in addition to and not in limitation of c~--~on law and statutory powers: A. To retain any property, real or personal which my Executrix may receive as Executrix, even though such property (by reason of its character, ~mount, proportion to the total trust estate or otherwise) would not be considered appropriate for a fiduciary apart from this provision. B. To sell, exchange, give options upon, partition or otherwise dispose of any property which my Executrix may hold from time to time, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and such consideration as my Executrix shall see fit, and to transfer and convey the same free of all trust. C. To invest and reinvest the trust estate from time to time in any property, real or personal, including securities of domestic and foreign corporations and investment trusts, bonds, preferred stocks, common stocks (whether fiduciary or non-fiduciary), mortgages, mortgage participations, even though such investment (by reason of its character, amount, proportions to the total estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision. D. To make loans, secured or unsecured in such ~mounts, upon such terms, at such rates of interest, and to such persons, fi~as or corporations as my ~xecutrix shall think fit. E. In dividing into separate trusts or shares or in distributing the same, to divide or distribute in cash, in kind or partly in cash and partly in kind, as my Executrix thinks fit. For purposes of division or distribution, to value the trust estate and any part thereof, reasonably and in good faith, and such valuation shall be conclusive upon all parties. To whatever extent division or distribution is made in kind, my Executrix shall, so far as my Executrix finds practicable, allocate to the respective beneficiaries approximately proportionate amounts of each kind of security or other property in the trust estate. F. To use her discretion to elect the most propitious settlement option with regard to ~ny qualified employee benefit plans available to me at my death so long as such election shall be in accordance with the Plan's Administrative Committee or Administrator as the case may be. G. To borrow money without liability on the part of the lenders to see to the application thereof, and to mortgage or pledge any real or personal property. All such powers and discretions may be exercised by my Executrix without application to any court. VIII. I direct that no bond or other security be required of my said Executrix in any jurisdiction in which she m~y act. Further, I direct that no bond required of any alternate Executrix. 4 IX. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ p~ ~~ day of , 1997, to this My Last Will end Testament typewritten on sheets of paper (including witness's signatures) . Vir~Ania M. Anderson On the ~ day of ~/~ , 1997, Virginia M. Anderson declared unto us, the undersigned, that the foregoing instrument was her last Will and Testament, and she requested us to act as witnesses to the same and to her signature thereon. She thereupon signed this Will in our presence, we all being present at the same time, and we now, on the same date, at her request and in her presence and in the presence of each other, hereunto subscribe our names as witnesses and each of us declares that we believe this Testator to be of sound mind and memory. W~tne~ ~ ~' 6 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF YORK I, Virginia M. Anderson, Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will and Test-ment; that I signed it willingly; and that I signed it as my free _and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by Virginia M. Anderson, the Testator, this ~ day of <~, 1997. Notary Public (Seal) My co---ission expires: COMMONWEALTH OF PENNSYLVANIA.. COUNTY OF YORK : , the witnesses whose n~es are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as her Last Will and Testament~ that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed~ that each of us in the hearing and sight of the Testator signed the Will as witnesses~ and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound ~~~straint or undue~j~flu~ence, p Witness~ i m .~~.~, Address Addre s s Address ~ Swo~ or affixed to and s~scribed to before Notary Public # 1997. 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 003122 KIMMEL CAROLYN 221 LOCUST LANE DILLSBURG, PA 17019 ........ fold ESTATE INFORMATION: SSN: 012-24-5013 FILE NUMBER: 2103-0650 DECEDENT NAME: ANDERSON VIRGINIA M DATE OF PAYMENT: 10/15/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/26/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $19,500.00 REMARKS: TOTAL AMOUNT PAID: CAROLYN A KIMMEL EXECUTRIX $19,500.00 SEAL CHECK# 1016 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE Date of Death: 0-7- ~-c,- 03 Admin. No. ~7-/- c~ '~ - 0 (o ~ To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on /~ - '7~ ~9 ~ : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except /'x( ~ ~.~ ~_ Date: /0--'7 Telephone (,'~t~) l..~"~ ~ . Capacity: ~",Personal Representative ~.Counsel for personal representative REV-1500 EX (600) COMMONWEALIH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN I-- Z W r~ Li.I LLI U.I RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE Of DEATH (MM-DO-YEAR)~ DATE OF BIRTH (MM-DO-YEAR) (If APPLICABLE) SURVIVI~IG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) · [--]2. Supplemental Return [-'-~ 4a. Future Interest Compromise (date of death after 12-12-82) [~7. Decedent Maintained a Living Trust (Attach copy of Trust) r--~ lO. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ]~1. Original Return -'-J 4. Limited Estate [6. Decedent Died Testate (Attach copy of Will) [~]9. Litigation Proceeds Received NAME FIRM NAME (IfApplicable) ~ ~ ~ C...N.~,.-'T-r~.\ ,-~ TELEPHONE_~t 7-NUMBER/'~ ..~ ~_..~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) ~'-'] Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11, Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) 13. (1) (2) (3) (4) (5) (6) (7) (9) (10) Charitable and Governmental Bequests/Sec 9113 Trusts for wh, ich an election to tax has not been made (Schedule J) ,"."' ' -; '" ' ~,,hC:,:i , ?,. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSEIS~I~ F(iR'APPLICABLE RATES 14, OFFICIAL USE ONLY FILE NUMBER E~3. Remainder Return (date ol death prior to 12-13-82) [~5. Federal Estate Tax Retum Required O 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS USE ONLY (8) (11) (12) (13) / (14) x .12 x .15 (15) (16) (17) (18) (19) 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount o1 Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due SOCIAL SECURITY NUMBER _;Lq THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER COUNTY CODE YEAR NUMBER beced~nt's Complete Address: STREET ADDRESS ~--._~.-~Z_(~7, ~'~ '% CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) '~, O /~ ~ ~ Total Interest/Penalty ( D + E ) 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. (3) (4) (5) (5A) -7/'7 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. a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [~ c. retain a reversionary interest; or ......... . .................... [] J~ 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 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-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. 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. S~_~RE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS - - U ...... SIGNATURE OF PREPARER OTHEB,'fHAN REPRESENTATIVE -- - -' _ Yr,:l,(NrON M MARLIN, JR., I,J v/ ' ~. ~ --' ~ ;::'--;~-::,".!.'r"]'-'?,:-"'-' . CPA DATE DATE :z_i-od ADDRESS ~' DII. LSBUI~G, PA l;l~:J~J) ,~!7-7~.81~6 _~ ll~l~jj. 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 sullying spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii) The statute does not exempt a transfer to a sullying spouse from tax, and the statuto~ requirements for disclosure of assets and filing a tax return are still applicable even the sullying 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 ~om a deceased child ~en~-one years of age or younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The ~x rate imposed on the net value of transfers to or for the use of the de~denrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 RS. {9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. {9116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in ~mmon with the decedent, whether by blood or adoption. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real prope~y owned solely or as a t6i~id, in common must be reported at fair market value. Fair market value is defined as the pdce 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 NUMBER VALUE AT DATE DESCRIPTION OF DEATH TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-15~ E~ + (1.97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sun~ivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) $ ~',~ ~ l (If more space is needed, insert additional sheets of the same size) REV-IS09 EX* (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: D- ~ I EH DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number, Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTERES' TOTAL (Also enter on line 6, Recapitulation) $ / / ! ~ O -7 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAME OF THE TRANSFEREE, THEIRRELATiONSHIPTODECEOENTANDTHE DATE OF TRANSFER, DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST TOTAL (Also enter on line 7, Recapitulation) $ (If more space ~s needed, insert additional sheets of the same size) REV-1511 EX+ (12-99~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City ~ ~ ~5" ~,.r~ ~ Year(s) Commission Paid: ~-,00 '~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Zip TOTAL (Also enter on line 9, Recapitulation Tax Return Preparer's Fees (If more space is needed, insert additional sheets of the same size) '% z/coo -zj'7;;L.- / /oo ¥ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~'~r ~ ~ ~zf. ,~ ~ NUMBER II. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) FILE NUMBER ;Zo j - 00(05"o RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET 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 PAET li. 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) OMB NO. 2502-0265 '~1 A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT I.E]FHA 2.[~]FmHA 3. [~]CONV. UNINS. 4. E]VA 5. E]CONV. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: SETTLEMENT STATEMENT MESSINO,JI 50104457 8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER: 6.375%/F/$766 SKS C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (HAW KINS.J.PFD/HAWKINS.J116} D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: JUDITH M. MESSlNO ESTATE OF VIRGINIA M. ANDERSON WAYPOINT BANK 5528 MORELAND COURT MECHANICSBURG, PA 17055 G. PROPERTY LOCATION: H. SE'FI'LEMENT AGENT: 25-1857112 I. SETTLEMENT DATE: 5528 MORELAND COURT Mldstate Abstract Company MECHANICSBURG, PA 17055 October 24, 2003 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 122,900.00 ! 401. Contract Sales Price 122,900.00 102. Personal Property = 402. Personal Propert~ 103. Settlement Charges to Borrower (Line 1400) 4~179.19 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. City/i'own Taxes to ! 406. City/Town Taxes to 107. County Taxes 10/24/03 to 01/01/04 79.48 407. County Taxes 10/24/03 to 01/01/04 79.48 108. SchoolTaxes 10/24/03 to 07/01/04 798.07 408. SchoolTaxes 10/24/03 to 07/01/04 798.07 109. SEWER ACCOUNT CREDIT 20.23 409. SEWER ACCOUNT CREDIT 20.23 110. OCTOBER CONDO FEE 10/24/03 to 11/01/03 22.21 410. OCTOBER CONDO FEE 10/24/03 to 11/01/03 22.21 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 127,999.18 420. GROSS AMOUNT DUE TO SELLER 123,819.99~ 200. AMOUNTS PAiD BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 1 ~000.00 501. Excess Deposit (See Instructions) I 202. Principal Amount of New Loan(sI 122,900.00 502. Settlement Charges to Seller (Line 1400)I 8,838.00 203. Existing/oan(s~ taken sub,/ect to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortgage 206. 506. 207. 507. (Deposit disb. as proceeds) 208. SELLERS ASSIST 1~850.00 508. SELLERS ASSIST 1,850.00 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. City/Town Taxes to 510. City/Town Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514, 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 125,750.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,688.00 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 127,999.18 601. Gross Amount Due To Seller (Line 420) 123,819.99 302. Less Amount Paid By/For Borrower (Line 220~ 125,750.00) 602. Less Reductions Due Seller (Line 520) 10,688.00'~ 303. CASH( X FROM)( TO)BORROWER 2,249.18 603. CASH( X TO)( FROM) SELLER 113,131.99 The undersigned hereby acknowledge receitst of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Borrower ~'~ ~'~~-.~ Seller ~.~~., ~,~~ JUDITH M. MESSINO ESTATE OF'VII~GrNIA M. ANDERSON L. SE I i LEMENT CHARGES ./TAL COMMISSION Based on Price $ 122,900.00 (~ 6.0000 % 7,374.00 PAID FROM PAID FROM Division of Commission (line 700) as Follows: BORROWER'S SELLER'S .. $ 3,712.00 to ERA-NRT, INC. FUNDSAT FUNDSAT J2. $ 3,662.00 tO RE/MAX REALTY ASSOCIATES SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 7,374.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Repod to 805. Lender's Inspection Fee to 806. Mortgage Ins. App. Fee to '807. Assumption Fee to 808. Underwriting Fee to WAYPOINT BANK 115.00 809. Document Preparation to WAYPOINT BANK 290.00 810. Tax Service Fee to WAYPOINT BANK 91.00 811. Application Fee to WAYPOINT BANK POC $350.00b 812. Flood Cerification to WAYPOINT BANK 14.00 813. 814. 815. 816. 817. 818. 819. 820. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10/24/03 to 11/01/03 @ $ 21.760000/day ( 8 days %) 174.08 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to INSURANCE COMPANY POC $256.00b 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months ~ $ per month 1002. Mortgage Insurance months (~ $ 111.63 per month 1003, City/'rownTaxes months ~ $ per month 1004. County Taxes 9.000 months ~} $ 34.34 per month 309.06 1005. SchooITaxes 5.000 months @ $ 95.04 per month 475.20 1006. months (~ $ per month 1007. months ~,, ~ per month -137.46 1008. Aggregate Accountin~ Adjuslmen months ~ $ per month 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104, Title Insurance Binder to 1105. Document Preparation to 1106. Closing Service Letter to Midstate Abstract Company 35.00 1107. A~omey's Fees ' to (includes above item numbers: ) 1108. Title Insurance to MIDSTATE ABSTRACT 973.75 (includes above item numbers.1102, 1103 & 1104 ) 1109. Lender's Coverage $ 122,900.00 1110. Owner's Coverage $ 122,900.00 973.75 1111. Endorsements 100, 300, 8.1,800 to Midstate Abstract Company 200.00 1112. Notary Fee to Cash 10.00 1113. Notary Fee to Cash 5.00 1114. TRANSACTION FEE to ERA-NRT, INC. 100.00 1115. 4TH QTR SEWER to LOWER ALLEN TOWNSHIP 24.00 1116. TRASH -10/24 THRU 12/31/03 to LOWER ALLEN TOWNSHIP $36.61 - $20.231 16.38 1117. Document Preparation to C.W. Junkins Associates, Inc. 85.00 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 72.50; Releases $ 111.00 1202. City/County Tax/Stamps: Deed 1,229.00; Mortgage 1,229.00 1203. State Tax/Stamps: Revenue Stamps 1~229.00; Mortgage 1,229.00 1204. Cert of Substantial Completion to RECORDER OF DEEDS 17.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspec§on to 1303. TAX CERTIFICATION to BONNIE K. MILLER, TREASURER 4.0(3 1304. CONDO INITIATION FEE to VILLAGE OF MORELAND II, A CONDOMINIUM 258.18 1305. Overnight Fee to Midstate Abstract Company Pak 15.00 1400. TOTAL SETTLEMENT CHARGES IEnter on Lines 103, Section J and 502, Section K) ~ 4,179.19 8,838.00 Commerce Commerce Bank/Harrisburg N.A 100 Senate Avenue Camp Hill Pa 17011 888-937-0004 Page I of 2 VIRGINIA M ANDERSON CAROLYN KIMMEL 5528 MORELAND COURT MECHANICSBURG PA 17055 mmm mmm mmm mmm mm! 7 c!~6~ ~ ~_ *** uHECKINS *** 50 PLUS CLUB ACCOUNT NUMBER 0513089029 PP,~VIOUS STATEMENT BALANCE AS OF 07/25/03 ............. PLUS 4 DEPOSITS AND OTHER CREDITS ......... ' .......... LEss 15 cREcKs ~ OTHER DE~I~S .......... ' ......... cuB~NT STATEMENT ~U,.NCE AS oF 08/22/03 .......... ~i~i ....... NU~mER OF DA~S IN THIS ST~MENT PERIOD 28 .......... CYCLE-016 4,327.71 2,098.03 *** CHECK TRANSACTIONS *** SERIAL DATE AMOUNT SERIAL DATE 1301 08/01 180.00 1304 08/11 1302 07/29 1,245.00 1305 08/14 1503 07/29 50.00 1306 08/12 AMOUNT 272.00 267.78 86.06 *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION o8/o1 os/o1 o8/o1 O8/01 o8/ol 08/04 08/04 De/OS o8/o5 08/o7 os/18 os/19 08/22 AC-TIAA-CREF DISTR.-ANNUITY AC-US TREASURy 303 -SOC SEC AC-TIAA-CREF DISTR.-ANNUITY AC-LOWER ALLEN TOWN-UTILITY AC-LOWERALLEN TOWN-UTILITY AC-VERIZON -PAYMENT ACH RETURN ITEM 8/1 AC-PAWC -PAYMENT AC-AARP HEALTH CARE-PREMIUM AC-UGI UTILITIES -UGI BILL AC-PP -ELEC BILL DEBIT MEMO INTEREST PAYMENT *** BALANCE BY DATE *** DEBITS 24.00 49.35 35.32 ... 904.00-~' 10.65 127.00 9.66 2~,92TM CREDITS 209.62 .<-- 904.00 984.04 07/25 os/os o8/14 4,327.71 3,800.05 3,164.55 07/29 3,032.71 08/01 4,877.02 08/04 08/07 3,790.39 08/11 3,518.39 08/12 08/18 3,127.12 08/19 200.00 08/22 PAYER FEDERAL ID NUMBER 23-2324730 INTEREST PAID YEAR TO DATE 5.41 *** INTEREST EARNED THIS STATEMENT PERIOD *** DAYS IN PERIOD .............. INTEREST EARNED ........... 28 ............ .37 3,93~.70 3,432.33 200.37 BEGINNING SEPT. 1, FUNDS DEPOSITED INTO A COMMERCE BANK ATM BY 3:00. PM WILL NOW BE AVAILABLE ON THE NEXT BUSINESS DAY UNLESS SPECIAL CIRCUMSTANCES ARISE. NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC Commerce Bank/Harrisburg N.A. 100 Senate Avenue Camp Hill, PA 17011 888-937-0004 VIRGINIA ANDERSON CAROLYN KIMMEL 5528 MORELAND COURT MECHANICSBURG PA 17055 STATEMENT DATE 08/21/03 CLOSED *** SAVINGS *** PREMIER SAVINGS BEGINNING RATE 0 99500 ACCOUNT NUMBER 0616095694 ' PREVIOUS STATEMENT BALANCE AS OF 07/31/03 20,676.97 PLUS I DEPOSITS AND OTHER CREDIT~ ....................... 10.15 LESS 1 WITHDRAWALS AND OTHER DEEIT~ .................. 20,687.X2 CURRENT STATEME ANCE AS 08/21/03 ...... :iii::ii:iiiiiii .... 00 NUMBER OF DAYS IN THIS STATEMENT PERIOD 21 *** SAVINGS ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 08/20 INTEREST PAYMENT 08/20 ~LOSING WITHDRAWAL DEBITS CREDITS  10.15 *** BALANCE BY DATE *** 07/31 20,676.97 08/20 .00 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE 23-2324730 182.39 *** INTEREST EARNED THIS STATEMENT PERIOD *** DAYS IN PERIOD ......................... 19 INTEREST EARNED ........................ 10.15 ANNUAL PERCENTAGE YIELD EARNED (APY) .... 0.95% BEGINNING SEPT. 1, FUNDS DEPOSITED INTO A COMMERCE BANK ATM BY 3:00 PM WILL NOW BE AVAILABLE ON THE NEXT BUSINESS DAY UNLESS SPECIAL CIRCUMSTANCES ARISE. NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND estate of ANDERSON VIRGINIA M (hAS'r, ~'i~s'±', in said county, deceased, to SHORT CERTIFICATE DONNA M. OTTO Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 7th day of August A.D., Two Thousand and Three, Letters TESTD~4ENTARY in common form were granted by the Register of said County, on the , late of MECHANICSBURG BOROUGH KIMMEL CAROLYN (i~AS'I', ~'l~S'i',~ MiDDb~) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 3rd day of September A.D., Two Thousand and Three. 2003-00650 21-03-0650 7/26/2003 012-24-5013 File No. PA File No. Date of Death s.s. # NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL VIRGINIA M. ANDERSON I. I, Virginia Il. Anderson, presently of Yechi~icshurg, Cumberland County, Commonwealth of Pennsylvania, being of sound mind and disposin9 memory, realizing the uncertainty of this life, but with confidence in ~od ~nd trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to Justify me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, revoking any all previous Wills and Codicils, and hereby will and dispose of all the property which I own at my death in the following manner .- II. As Executrix of this my Will I name and nominate Carolyn Kimmel presently of Dillsburg, Pennsylvaniai if she shall for any reason fail or be unable to serve as Executrix, either before or during her service as Executrix, either before or during her service as Executrix, then I hame Suz*--e Charland, presently of Groveland, Iiassachusetts as Executrix. III. I direct that my debts and the expenses of my last illness and funeral shall be paid by my Executrix as soon after my decease as may be convenient. IV. I bequeath and devise all the rest, residue and remainder of my estate, real, personal and ~ixed including any property of which I may have power of appointment unto Suzanne M. Charland, presently o£ 2~ ~int~ ~treet, (~rovel~nd, ~ss&chusetts ~nd C&rolyn &. Et~el, pz~s~tly of 22~ ~cust ~, Dillsbuz~, P~n~sylv~i~ to b~ divided e~ally ~ng th~ ~s they ~y A. Xi~el or both predeceases ~ bh~ the deceased b~eficia~'e e~=e ~11 pass to theic issue ps= stiles. Xl Suz~--e M. Chazl~d predeceases me ~ithout issue, th~ X beneath ~d devise the e~ce she would ~ve zeceived ~d abe su~ived me, to Ca=ol~ ~. Xi~el. Xi Cazol~ ~. X~el p=edeceaee~ me without issue, th~ X beneath ~d devi~e the s~=e abe would ~ve received ~d she su~ived me, to Suz~-ne M. ~rland. If both Suz~e M.C~rl~d ~d Carol~ A. K~--el predeceases me without issue, th~ I beneath ~d devise all the rest, residue ~d r~inder of ~ estate, real, person1, ~d ~xed includin~ ~y property of which I ~y ~ve power of appointer ~to ~ordon Collie, ~ssachusetts. V. No principal or income pay~le ~der this Will shall be s~ject to ~ticipation or assi~t by ~y b~eficia~ thereof or to attac~t by or to the interfer~ce or control of ~y creditor of any such b~eficia~, or be tak~ or reached by any le~al or e~it~le process in satisfaction o~ ~y d~t or li~ility of such b~eficia~ prior to the actual receipt by the b~eficia~. VI. My ~ecutrix s~11 ~ay out of the residue of ~ Estate as an expense o£ a&ainistration all estate taxes, taxes end other death taxes o£ a~y ~ature which ~ay he is~osed upon or with respect to the following, A. ~.my devise, legacy or appointment made in this #All; B. Any real or personal property which at mM death ! may C. Any life insurance upon mM life. Xn the absolute discretion o£ mM Executrix, shem ay pay such taxes t,-,-ediately, or may postpone .the tine of payment of taxes on future or remainder interests until possession accrues to the beneficiaries. VZZ. give to mM Executrix the following powers, in addition to and not in limitation of common law and statutory powers: &. To retain any property, real or personal which my Executrix may receive as Executrix, even though such property (by reason of its character, amount, proportion to the total trust estate or otherwise) would not be considered appropriate for a fiduciary apart fro~ this provision. B. To sell, exchange, give options upon, partition or otherwise dispose of any property which mM Executrix may hold from time to time, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such term~ and such consideration as my Executrix shall see fit, and to transfer and convey the sm free of all trust. C. To invest and reinvest the trust estate from time to time in any property, real or personal, including securities of domestic and foreign corporations and investment trusts, bonds, preferred stocks, common stocks (whether fiduciary or non-fiduciary), mortgages, mortgage participations, even though such investment (by reason of its character, amount, proportions to the total estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision. 3 D. ?O BAke lo.al, lecured or unlec~L~ed in such encysts, upon luch teral, at lUCh rltel o! interelt, &nd to such persons, rim or corporations as my Ixecutrix shall think fit. E. Xn dividing into separate trusts or shares or in distributing the same, to divide or distribute in cash, in kind or partly in cash and partly in kind, as ~Y Executrix thinks fit. For purposes of division or distribution, to value the trust estate and any part thereof, reasonably end in good faith, end such valuation shall be conclusive upon all parties. To whatever extent d/vision or distribution is made in kind, ~y Executrix shall, so far as ay/ Executrix finds practicable, allocate to the respective beneficiaries approxtw~_tely proportionate a~ounts of each kind of security or other property in the trust estate. F. To use her discretion to elect the most propitious settlement option with regard to ~ny qualified employee benefit plans available to me at my death so long as such election shall be in accordance with the Vlen's Administrative Co---ittee or Administrator as the case may be. G. To borrow money without liability on the part of the lenders to see to the application thereof, end to mortgage or pledge any real or personal property. All such powers and discretions may be exercised by my Executrix without application to any court. VIII. direct that no bond or other security be required of my said Executrix in any Jurisdiction in which she ~y act. Further, I direct that no bond required of eny alternate Executrix. 4 xl~ WXTtrgSS N~R~Olr, X have hereunto met my ~d ~d meal ~h~. ~ ~ ~ ~y o~ , X997, ~o ~h~l ~ ~al~ N~XX ~d Testat t~e~ttt~ on B sheets o~ paper (including wi~esm's m ignaturem). Andermon o= the r declared unto us, Vi~inia M. Anderson £oregoing instrument was her lest Will and Testament, and she requested ua to act as witnesses to the sa~e a~d to her signature thereon. Bhe thereupon signed this Will in our presence, we all being present at the same tine. and we now. on the sane date, at her request and in her presence and in the presence o£ each other, hereunto subscribe our names as witnesses and each o£ us declares that we believe this Testator to be o~ sound mind and memoz=y~ 6 CONM~'I~ OF I~qMSW.,vAIqzAt COUNTY OF YORK s ~r, Virginia M. Anderson, Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that T signed _And executed this instrument as n~ Last #ill and Testament; that T signed it willingly; and that I signed it es n~ free end voluntar~ act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, bF Virginia M. Anderson, the Testator, this J~ day of ~, 1997. ~otar~ Public (Seal) ll~ co,,~ission expires~ 7 CO~M~I'H OF COUNTY OF YORK , , ,ad the witnesses whose names are si~ned to us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound Witnes~ Witness 0 C-~ Address Addr es s Wi tn~ Sworn or affirmed to and subscribed to before 1997. Notary Public (Seal) ~ C~iss~on ~=es this ....~_ day of ~~ , voluntary act for the purposes therein expressed; that each of the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as her Last Will and Testament; that she signed Willingly and that she executed it es her free and COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: being duly ~'~ ¥~ C..'~ according to law, deposes and say,s/that ~'he I J ~-'~-"~ C- ~=~~t~ of the Estate of . ~s~ ~ ~. ~~'~C late of ~ ~--~ ..... ~ ~ ~----~ ~ , Cumberland County, Pa., deceased and that the within is an inventory made by ~ ~ ~ ~, the said ~ ~~ of the entire estate of seld decedent consisting of ell the personal property end re~l estate, except real estate oufslde the Commonwealth of Pen~,sylvenle, end that the figures opposite each item of the Inventory represent it's felt value es of the de+e of decedent s death. end subscribed before me, 19 Adi~ress Day Idonfh Year INSTRUCTIONS 1. An inventory must be filed within three months after appolnfmenf of personal representative. 2. A supplement inventory must be filed within fhlrfy days of discovery of additional assets. 3. Additional sheets may be attached as fo personalty or realty 4. See Article IV, Fiduciaries Act of 1949., Z o o I.,U 0 ~ E .4- Inventory of the real and personal estate of deceased I1o Name of Decedent: STATUS REPORT UNDER RULE 6.12 Date of Death: Will No.: 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 E1 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 r_~_.~resentative 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 r~presentative state an account informally to the parties in interest? Yes ~ No ['-] Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Signature U Name Capacity: Personal Representative Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17118-0601 CAROLYN A KIHHEL 211 LOCUST LN DILLSBURG CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF /NHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 06-14-200~ ANDERSON 07-26-2005 21 05-0650 CUHBERLAND 101 Amoun~ RamJ.'~ted PA 17019 REV-15~i7 EX AFP C01-05) VIRGINIA HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~-- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF ANDERSON VIRGINTA HFZLE NO. 21 05-0650 ACN 101 DATE 06-14-200R TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) 5. Closely Held Stock/Partnership Interest (Schedule C) (5) ~. Nortgagas/Notes Receivable (Schedule D) (~) 5. Cash/Bank Daposits/NLsc. Personal Property (Schedule E) ($) &. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 AssaYs APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expensas/Adm. Costs/Hisc. Expanses (Schedule H) (9) 10. Dabts/flor~gage LLabilities/Lians (Schedule Z) (10) 11. Tote1Daduc~Lons 12. Nat Value of Tax Return 15. 1~. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Na~ Value of Estate Subjac~ to Tax 115/152.00 .00 .00 .00 9/571.00 11/807.00 7/000.00 (8) 9,519.00 .0O NOTE: To insure proper cred/t ~o your account, subm/t ~he upper portLon of ~his form wi~h your tax payment. NOTE: lql,$10.00 (11) 9.519. §o (~2) 1~1,791.00 (15) . O0 (1~) 151,791. O0 Zf an assessment was lssued previously, lines 14, 15 and/or 16, 17, re~lect ~igures that /nclude the total o~ ALL returns assessed to date. 18 and 19 will ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lr* taxable at Lineal/Class A rata 17. Aaount of LLna lr~ et Sibllng rata 18. Amoun~ of Line 1~ taxable a~ Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHENT RECETP1 DATE NUHBER 10-15-200~5 C])O05122 i. '~' (15) .00 x O0 = .00 (16) .00 x Oq5 = .00 (17) . O0 x 12 : .00 (:].8) 151,791.00 x 15 = 19,769.00 (~9)= 19,769.00 ANOUNT PAID IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT (+) INTEREST/PEN PAID (-) - 988.~5 19,500.00 TOTAL TAX CREDIT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE 20,~88.~5 719.~5CR .00 719.~5CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS RE~UIRED. ~l,~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DU:~/~' A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~/ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of tho 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 tho lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of Z000. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT 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-IS15). Applications are available at the Office of the Register of #ills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-BOO-362-Z050; services for taxpayers eith special hearing and / or speaking needs: 1-BOO-44?-30ZO (TT only). Any party in interest not satisfied with the appraisement, alloaance, or disallowance of deductions, or assessment of tax (includiag 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. Z810Z1, Harrisburg, PA 171lB-lOll, 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 be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6S05. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an axplanatlon of administratively correctable errors. If any tax due is paid within three (3) calendar months after tho decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calcuIated at a daiIy rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 1988-1991 IZZ .000301 2OOl 9Z .O00Zq7 1983 16Z .000438 199Z 9Z .000247 2002 6Z .000164 1984 llZ .000301 1993-199q 72 .O0019Z 2003 52 .000137 1985 132 .000356 1995-1998 9Z .000247 2004 42 .000110 1986 IOZ .000274 1999 72 .000192 1987 lOX .O0027~ ZOO0 7Z .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) 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. BUREAU OF INDIVIDUAL TAXES I'NHERZTANCE TAX nIV]*STON DEPT. :~8060:]. HARRISBURG., PA 171Z8-060! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (01-03) CAROLYN A KIMMEL ZZ1 LOCUST LN DILLSBUR$ PA 17019 DATE 07-12-2004 ESTATE OF ANDERSON DATE OF DEATH 07-26-2003 F'rLE NUMBER 21 03-0650 COUNTY CUMBERLAND ACN 101 I Amount VIRGINIA M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper cred//; to your account, submi~c the upper portion of ~his form wi~h your ~:ax payment. CUT ALONG THIS L/NE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ ESTATE OF ANDERSON VIRGINIA M FILE NO. 21 03-0650 ACN 101 DATE 07-12-2004 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELO# ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-07-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 19,769.00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 10-15-2003 06-22-2004 CD003122 REFUND 988.45 .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. ~F TOTAL DUE IS REFLECTED AS A "CREDIT" 19,500.00 7~"9 0 5 - TOTAL TAX CREDIT 19,769.00 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.