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Home My WebLink About04-0385 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of C..J1.cu-l-e.. e- f<... r"y also known as No. ~-,~Rc; To: Deceased. Social Security No. ~ cr- Y4 - 3r'-fS- Register of Wills for the County of c.v.. '" ~ 'l. r rCLNL. in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner}sr. who is/~8 years of age or older, appIL-e ~ for letters of administration on the estate of (d.h.n.; pendente Jill'; duranle absentia: durante lIlinClril:lle) the above decedent. Decedent was domiciled at death in h ~r last family or principal residence at C<-t..vnhe ,.-{~ County, Pennsy,lvania, with 5""2.. l.0. !V~ Sr- I ea.....lr.sl:e. A tJ"rQ . (list street, number, Twp. or Boro.) Decedent, then at c:....a ...<1 c; k 5"2 years of age, died _ t6<;:.p" t-&. ( A-pr,r( I~ , t'r zoo,/ 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 Pennsvlvania situated as follows: ri-).. W..AI cr"'tt! j-r. C~ , $ ~-~ $ $ $ 3 q q DD I 4 '], r~ Petitioner__ after a proper search ha~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence ::r v II "J; IS ern,! ku...ohr-t>.r 5""O:l /If. LJ.o S-t <.-t . I Q C<>-r{ ,. .s (e P4 ( 7013 I THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. on ., u C '" ~3 '" ... 00:'" c 't:l0 c';:; ~.::: -v;~ "lJ... 30 OJ c 00 Vi !J;c~ .s-tl N. e S S'-r Co..rl,'slf- fA "o/~ I Q(~.' :-J - , g ::= --0 :-\' ,,' N :L"::' C) VI OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA f' L COUNTY OF ;J,-,CY'\~D-^ ~ n,V1 } 55 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed ~nd subscribed f ~ me <Pis ~~_ day or ~ D~ 18 v .. '):hI;) ,.1'-:~:u~~ ~'Zr,~~j l ry J P"t - '" 'U' .. :s ... cIS Q tii No. ;<J- 04. ~~..5 Estate of L~ 0 () \0 ,s}\..')\.~ ' Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW C\.. f~ 6)...3 ~()()Li 19 ,in consideration of the petition on the reverse side hereo ,sa factory proof hav g been presented before me, IT IS DECREED that is/are entitled to Letters of Admim trat" n, and in accor ith such finding, Letters of Administration :e,::r:;a:a:;ed ~~~ ~ i~~ FEES Letters of Administration ..... $ $3') .~ Short Certificates(~) .. .. . . . . .. $ l;l .00 Renunciation ................ $ ~9 $ \0. OC> 1..\ TOTAL - $Jo~ . a.:::> Filed ..:-.~~:-.~ool-...... A.D. 19_ { ,0. "117 - 2- f '3 -(1.5'7 if PHONE CERTIFICA TION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Charlee R. Ivy Date of Death: April 13, 2004 Will No.: Admin. No.: 21-04-0385 To the Register: I certify that notice of estate administration 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 April 23, 2004: Name Address Ivy J. Berry 502 N. West Street, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto unde Date: April 30, 2004 JOM . roujos, Esquire #06268 4 North Hanover Street Carlisle, P A 17013 (717) 243-4574 Capacity: '.0 Personal Representative .~ . ~ .... J CL X Counsel for Personal Representati ve .---, iV1 r:c: C' .- ''3' P ..,... ,- :~~ c.~ v' ... Register Of Wills Cumberland Cnty. Crthse #1 Courthouse Square Carlisle, PA 17013 IN RE: ESTATE OF Charlee R. Ivy 502 N. West St. Carlisle, PA 17013-0000 File Number: Division: e:z {)O Lf - OtV g:;- DECEASED DATE: 04/13/04 STATEMENT OF CLAIM The undersigned hereby presents for filing against the above estate this statement of claim and alleges: 1. The basis of the claim is goods and services provided Charlee R. Ivy and charged on account number #534110480. 2. The name and address of the claimant is: Credit First National Association Revolving Charge Account for Expert Tire Customers BK13/Credit Operations PO Box 818011 Cleveland, Ohio 44181-8011 3. The amount of the claim is $677.10 which amount is now due and owing. 4. The cl?1m is not c~ntingent. 5. The claim is not secured. 6. A statement of the account is attached. Under penalties of perjury, I declare that I have read" the fo:r-egoing and the facts alleged are true, to the best of my knowledge and belief. L Executed this 9th day of June, 2004. ~ ,-I CREDIT FIRST NATIONAL ASSOCIATION REVOLVING CHARGE ACCOUNT FOR EXPERT TIRE CUSTOMERS ? Claima~. L~~~ ~ !t~h Credit Represen~a ive BY: ~~py m~~~o~~sonal repre~~;;~~e / ~ 06/09/04 534110480 PAGE 1 TEMP: CD 282 POC AceT: 534110480 PRIV ID: 314150384 CHARLEE R IVY 502 N l."EST ST PL~ E CARLISLE PA 17013-0000- TYPE DATE STORE T I Ci(ET AMOUNT FC INS P/A P/D BALANCE STMT 05/15/04 12.11 .00 29.00 53.00 718.21 LPF 05/15/04 29.00 LATE PAYMENT FEE STMT 04/15/04 11.64 .00 27.00 ,~6. 00 677. 10 LPF 04/15/04 29.00 LATE PAYMENT FEE SALE 04/01/04 28223 145200 8.95 Be I ACCIDENT PROTECTION 1-800-265-4390 ACH 03/26/04 0000 2141 24.00- CFNA ACH PAYMENT - THANi'~ YOU STMT 03/15/04 10.85 .00 :26.00 24.00 651.51 LPF 03/15/04 29.00 L.ATE PAYMENT FEE SALE 03/01/04 28223 145200 8.95 BC I ACCIDENT PROTECTION 1-800-265-4390 STMT 02/15/04 10.98 .00 24.00 .00 602.71 SALE 02/01/04 ......('\."'\.~l 145200 8.95 Bel ACCIDENT PROTECTION 1-800-265-4390 c.ae. c...-, ACH 02/05/04 0000 22526 25.00- CFNA ACH PAYMENT - THANK YOU STMT 01/15/04 11.11 .00 24.00 .00 607.78 ACH 01/08/04 0000 79598 25.00- CFNA ACH PAYMENT - THANi~: ~"OU SALE 01/01/04 28223 145200 8.95 Bel ACCIDENT PROTECTION 1-800-265-4390 STMT 12/15/03 12.84 .00 25.00 .00 612.72 ACH 12/09/03 0000 42845 35.20- CFNA ACH PAYMENT - THANi~: YOU SALE 12/01/03 28223 145200 8.95 Bel ACCIDENT PROTECTION 1-800-265-4390 STMT 11/15/03 10.20 .00 25.00 .00 626.13 SALE l1l01/03 28223 145200 '0 QC BCI ACCIDENT PROTECTION 1'-800-265-439G< '..1.. ....J ACH 11/06/03 0000 1720 37.00- CFNA ACH PA'{MENT - THANi~: YOU CLAIM FORM ESTATE OF rHARLEE R. IVY THE BON TON Notice of claim by in the amount of S 421.08 ORPHANS' COURT DIVISION 0 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO.21-04-385 filed pursuant to section 3384, Probate, Estates and Fiduciariee Code Laws of 1972, Act No. 104 effective July 1, 1972 ae amended. Date Enter the claim of THE BON TON (Claimant and Address) 9441 LBJ FREEWAY Lock Box 30 Dallas. TX 75243 19_ TO TH~ CLERK OF THE ORP~S' COURT DIVISION, in the amount of S 4?1 OR against the above entitled Estate. Ths decedent who resided at 502 N. WEST ST., CARLISLE, PA (Address) 17013 died on 4/13/04 (Date) ESQ. ) Written notice of said claLm was given to at 4 N. HANOVER ST., CARLISLE PA (Address) The basis of aforesaid claim is as tollows: {Personal 17013 on (Date) (Itemize fully to enable personal representative to make proper investigation). Acct.#115-403-065 ClaLmant'a Counsel (Name) (Address) -ifd. .. ,'r'C- ,. lV: Zld 9l 'j\1~ va. /~'i2~d _\ ),~",,;}.,t) 0 \0 v PROBATE COURT Cumberland County, State of Pennsylvania Charlee R. Ivy, Deceased Case #21-04-385 Proof of Mailina I mailed the creditors claim to the fiduciary (and attorney, if applicable) as follows: I deposited a copy/copies of the claim with the United States Postal Service in a sealed envelope with the postage fully pre-paid. I used first-class mail. I am employed in the county where the mailing occurred. The envelope(s) was/were addressed and mailed as follows: Ms. Ivy Berry c/o John Brojous, Esq. 4 N. Hanover St. Carlisle, PA 17013 Date of Mailing: ~~ County of Mailing: Dallas, Texas :a::~lar~~alty of perjury that the foregoing is true and correct. for The Bon Ton P.O. Box 741026 Dallas, TX 75374 PACKET BTS-C02. NAME + ADDRESS ADDRESS CITY STATE SPOUSE EMPLOYER ADDRESS CITY STATE PHONE: E: ,F-001 69 RUN ON: BI 2/2004 23:45:03 CHARLEE R IVY 502 N WEST ST CARLISLE PA17013 DISABLED *********************** ****************** EXT: COMMENTS: PREV-BAL 421.08 CUR "'........... PURCHASE .00 HOME PHONE DATE OPEN OTHER ACCT REQ PAYMENT AIR BAL CURR PAY MEMO PUR MEMO CR HOL-BON TOTAL PAY/RET .00 ,TON v. THE NRA - LOP ACCT# 115-403-065 F COLLECTOR 1: 717/243-8169 09103 00000000 453 o o o 453 FIN-CHRG 32,31 NEW BAL 453.39 - -, ."...... ..." LIMIT AO~ CODE AO~ AMT INICOLL STATUS CYCLE MPI HIMPITY HIMPILY HIMPIMO PAST IDUE 31.43 o 44.00 $OLTZH 79 2 2 1 5 WAC AMT-OUE 53.4:':: COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: CHAALEE A IVY Court File No: 04-0385 Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. !j3532(b)(2). FASHION SERVICE CORPORATION 1) Claimant's name: CIO BALOGH BECKER LTD, 4150 OLSON MEM HWY Claimant's address: STE 200 MINNEAPOLIS, MN 55422 866-884-2862 'J ,"0 < .-'''1 Creditor listed below is the owner and holder of a claim in the amounf6f. $ 379.47 2) 3) 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached' Affidavit of Account Stated. ~~"'-, 'o) Decedent'::; dltdress. 502,1)" V'IEST $1' CARliSLE, FA rnli3 i,":".) (,.../i 6) Date of Death: 04113104 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly declare and affirm under the penalties of perjury that they Information and representations made herein are true and correct to the best of my knowledge, information and belief. 1 4 Dated: Chelsea A. WhitleyJAngela M. Horn/Mary Ellen Weeman/Chad Bofinskerrhersia Le Attorney-in~Fact Written notice of claim was given to Personal Representative and/or his/her co as stated below: IVY BERRY Name 502 N WEST ST Address CARLISLE. PA 17013 City/State/ ip '2. oS- Date notic m i1ed ,)., IN RE EST A TE OF: CHARLEE R IVY AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: I. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of hislher duties. 3. The Decedent purchased merchandise in the amount of $ 379.47 account number 6004660094779117 evidenced by 4. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not BALOGH BECKER, LTD. By: ~ _ .Attorneys-in-Fact ~ , Chelsea A. Whitley _ Angela M. Horn ~ - Michael D. Johnson Mary Ellen Weeman ~,: Thersia O. Lee Chad J. Bolinske c.:' (Ji 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 Subscribed and sworn before me This /If day of ~, ,2005. v-- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE p=rl'w["YlIlIllij:liiIQl' ~ERITANCE TAX "~l#t(~~. ~~ ~)i:;. .L. ,DWANCE OR DISALLOWANCE lll'J~IC)NS.ANIl ASSESSMENT OF TAX ON " .., .JOINTLY HELD OR TRUST ASSETS *' REY-lS48 EX AFP (06-05) BERRY ST 200" I UG I pH 12' 27DATE , J h' - n. ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 0LEP'/ ',-,' -'''~' 08-01-2005 IVY 04-13-2004 21 04-0385 CUMBERLAND 169-44-3745 04131880 APPEAL DATE: 09-30-2005 (See reverse side ""der ObjectiollS) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CHARLEE R OFP;--::..'\ IVY 502 N WEST CARLISLE CI."" ,. " PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS - REY=is4S-EX"AFP-lo3=OSj-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-01-2005 ESTATE OF IVY CHARLEE R DATE OF DEATH 04-13-2004 COUNTY CUMBERLAND FILE NO. 21 04-0385 TAX RETURN WAS, S.S/D.C. NO. 169-44-3745 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04131880 FINANCIAL INSTITUTION, MEMBERS 1ST FCU ACCOUNT NO. 43629-11 TYPE OF ACCOUNT, ()SAVINGS O() CHECKING (>TRUST ()TIME CERTIFICATE DATE ESTABLISHED 03-01-1985 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 2,282.74 0.500 1,141.37 .00 1,141. 37 ,45 51,36 NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO, "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 08-09-2005 TOTAL TAX CREDIT ,00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 51.36 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.46 TOTAL DUE 52.82 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDlr' ( CRJ, YDU MAY BE DUE A REFUND. S~~ R~V~RS~ SID~ OF THIS FORM FOR INSTRUCTIONS. ) ~"- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 BROUJOS JOHN 4 NORTH HANOVER STREET CARLISLE, PA 17013 RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, G~~a~~ Clerk of the Orphans' Court cc: File Personal Representative(s) fy Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 / BERRY IVY J 502 N WEST ST CARLISLE, PA 17013 RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Si~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BERRY IVY J 502 N WEST ST CARLISLE1 PA 17013 -------- fold ESTATE INFORMATION: SSN: 169-44-3745 FILE NUMBER: 2104-0385 DECEDENT NAME: IVY CHARLEE R DATE OF PAYMENT: 03/13/2006 POSTMARK DATE: 03/03/2006 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 NO. CD 006427 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04131880 I $54.61 I I I I I I I I TOTAL AMOUNT PAID: $54.61 REMARKS: CHECK# 5436 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF COLLECTIONS & TAXPAYER SERVICES PO BOX 281041 HARRISBURG PA 17128-1041 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-870 AFP (10-05) IVY J BERRY 502 N WEST ST CARLISLE, PA 17013 ';'::3 DATE 2/23/2006 Estate of: IVY CHARLEE R Date of Death: 4/13/2004 File Number: 21 04-0385 .-:""'~ :'.~.., ., f os . ~ ;' i " / I MAR n h 'Inns U\k::. I)EP:~\t::;, _ __ (\t..:L;>,~_' .._ ...... ~ - ~-_-.J E:J,. .j E n~~I~ +0 ~At1u CJ4-/.3! fJ'O j .:1 }l'" Dear IVY J BERRY: This is to advise you that the above estate is in a delinquent status. According to Department records the estate is still not settled. As of this date, you have failed to respond to prior contacts to resolve this matter. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by the personal representative, transferee, or beneficiary of the estate within nine months of the decedent's death. The Department's records show that this estate remains open because: CURRENT TAX LIABILITY OF $ 54.61 CALCULATED TO 3/20/2006 INCLUDING INTEREST HAS NOT BEEN PAID. Accordingly, you are directed to pay all tax due including interest within ten days from the date of this letter. If you fail to comply with this directive, your case will be referred for local enforcement and may result in the filing of a citation by this Department with the Orphans' Court Division of the Court of Common Pleas, requiring you to appear in court to show cause for your failure to comply with the law. In order to protect the Commonwealth's interest, the DepartlTlent of Revenue may also file a lien in Cumberland County. MAKE CHECKS PAYABLE TO: REGISTER OF WILLS. AGENT Sincerely, Harrisburg Call Center Any questions regarding the tax liability of this estate, please CONTACT: cc: \t\, ".,_,) _. n \. >;:.-iU {'dO J 0 H N H B'R'O![iJlb'0:\::.>;(~a 4 N HANOVE'R' ~T}\dj \J CARL ISLE, PA 1 7013 ,q af'n7 (' \ 'h"..... '.....~ "\ Iv v \ t~ C \' {\ ". u ('" h-7 .J d .J :1'\.v f. Harrisburg Call Center (717) 783-3000 TDD# 1-800-447-3020 (Service for taxpayers with special hearing and/or speaking needs) ~~~ '"i; , '.,\ ',' I j} , . "('i.{ ~ ~ ~\ . '~l "\ .~.. f,{) ~ i'~: V~ "M 4~ ;~ ~ L~. s..(: t' ~ ,..J! t;"..; u.. r~J ~C( if) ;t;f H ~: fi: ;;,'". ~ t?\ ~;1", ~ - .;..... ~ 1~ ~~ ,''-3 ~ ' ~ 1~ -z: \1\ n~ ~ ~ t ~ --..- -= 4 --- ~ ~ \ t>o ~ '" -- - .-:: .-: - - .~ .- :; .-:: ::: .- .--:: .-:: - - ~ ~ ~:;:. ~ ----~ ~ -- ''''- ~~~ ~~. .~ ~~-} .r') .::t. C) .:..1 .~ .,,, \,1.\ . -,... r'" .r<i (\1"\ "'-\\~"\\ \J ,\:)v1 0 ;',~~~~ ~ ',.,\'~.,..;: .., jU j~ .'-1',\ 1~V.L (' \ "c'1 \ \..J' 1 \~;o S~ "v t, Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name ofDecedent: (I.-htVIee..~. "'7V~ Date ofDeath: +l /.3, ~(Jl)9- Estate No.: dltJ04-- tJOS~S:- 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 admin~ion of the estate is complete: Yes 0 No ~ 2. If the ans\ver is No, state when the personal representative reasonably believes that the administration will be complete: /p rn~ 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 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. 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. 4/~/~ -/1- ~ Signatlr; - d ! 71~ Name - - Date: ~:2 N. aid:- Sf-. Address t!arhs/e- (1J1~ -~C/9-R'f7{) Telepfione o. Capacity: ~sonal Representative o Counsel for personal representative t Z : J .1],1 , ,.:J C - it ii'll 90D2 Q ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Date of Death: (Ii-twitI' R.T \Ii \ ,April 17-),. I ;:(JCY~ I ,~~)I-CA -0,30,5 Name of Decedent: Estate 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 0 No g 2. If the an.s~er is. No, ~tate when the personal reRres~ntativ~ rea~on~~Y.believes that the admInIstratIOn wIll be complete: --.Je l L~J 13 I co'/( C z:. 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 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c, Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approvfllof formal or informal accounts may be filed with the Ckrk ofthe Orphans' COl.c!rt and may be attached to this report. .(J~~/; Signature Date: ApC'l ( l.~ I ,:,-;;ac ,John +1. Oml~'c-) Name I} N{jr+~~ HCUiC ,-" <7t ( C{\t" U () l12 I p,1\ I 7 C [3 Address '( ('1 ~.;2J'13- 4 ~=) '74 Telephone No. Capacity: o Personal Representative gtounsel for personal representative (# BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENTOF ACCOUNT REV-1607 EX AFP (03-05) IVY BERRY 502 N WEST ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-10-2006 IVY 04-13-2004 21 04-0385 CUMBERLAND 04131880 CHARLEE R Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF IVY CHARLEE R FILE NO. 21 04-0385 ACN 04131880 DATE 04-10-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY DF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-01-2005 PRINCIPAL TAX DUE: 51.36 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-03-2006 CD006427 3.09- 54.61 TOTAL TAX CREDIT 51.52 BALANCE OF TAX DUE .16CR INTEREST AND PEN. .00 TOTAL DUE .16CR " IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) {) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charlcc R. Ivy Date of Death: April 13, 2004 Estate No.: 21-04-0385 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 D No [X] 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: October 15, 2007 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 D No D b. The separate Orphans' Court No. (if any) for the personal representative's account IS: c. Did the personal representative state an account informally to the parties in interest? Yes D NoD c. Copies of receipts, releases, joinders and app..r oval Of.. D.. grID. as informal accounts may be filed with the! e.rk the. orPhan1' ~?urt an may be attached to this report. ) \ \ :( .... / ~ -- July 14, 2006 ~ Date: John H. Brouios Name 4 North Hanover Street. Carlisle, P A 17013 Address .', ,'J 717-243-4574 Telephone No. -;,i(' cr.uZ g.., .., Ud ~ \ \111 h v ~(I Capacity: D Personal Representative [Xl Counsel for personal representative 1\ L/ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 (") Date: 3/13/2008 BROUJOS JOHN c.) 4 NORTH HANOVER STREET CARLISLE, PA 17013 ( RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, t' (.tP ~J~t - Z",,-_ ,&'~, ,'-' ,,-,.-.,- /(~,6.. l7.~d'Ljf,;.,,~I,' /', ' · Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/13/2008 BERRY IVY J '} 502 N WEST ST CARLISLE, PA 17013 ", C) -'.'1 nj-i (...,~; RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 4/13/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ! ~, b.. \.~<) @i~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF C'uYYJh~ r/o n d COUNTY, PEN~SYL VANIA Date of Death: ~ /3. O~ f? r '7 File Number: ~ / -(}/j-t:/r3?~ Name of Decedent: c-'hor/~e Pursuant to Pa. O.c. Rule 6.12, I report the follO'.'ling with respect to completion oftlle administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . .. D Yes ~'No 2. If the answel~is No, state when the personal representative reasonably believes that the administration will be complete: LtJ;th in ..$.; X ft;) YY!OJ1 t ;'0' 3. If the answer to No.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. DYes D No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account info11l1ally to the parties in interest? ................................ DYes 0 No d. Copies of receipts, releases, joinders and approvals of fonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repOlt. Date Signature of Person Filing this Form Capacity: DPersonal Representative ~ Counsel 07 \ \,).,d 6 \ uv :' '"~ r. N;;~;;;;AiSFOS~ ree-t- Address Car/isf2 trl /'10/3 'l/7--d (3-/j0/!,tj Telephone \,_1 '~\r:) . IU(\ ;:JUV Form RW-IO rev. 1013.06 Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF ~rla.1'(L COUNTY, PENNSYLVANIA Name ofDecedent: f'Jw.rlee. R. -:Z;;t Date of Death: ~I /3, dOOtf File Number: caOOtf - (J03<65 Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. DYes ~ 2. lfthe answeris No, state when the personal representative reasonably believes that the administration will be complete: I/) n-t iTJ1.~S 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a finaI' account with the Court? . . . . . .. 0 Yes 0 No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account info11l1ally to the parties in interest? ................................ DYes DNo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repmt. Dale 4f1~v w! ' Vel , ItJilG:] S,I\J\iH&JO I'> "ld' =r,~ ::JU I' :J iJ Capacity: ~rsonal Representative D Counsel Name oZtFili7!::~m ~~ M?-I:h ~ ~t-4 Address (!.A..r/;s/e,' f'A 11~/3. /"/1'1) - ~LJ'l- .flLf'7fJ Telephorle 2 I : I bold fJ I ~dV BOOl POi'''' RW-IO rev.IO,/J06 J IN RE ESTATE OF CHARLES R. IVY DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO.2.1 - e~ ~1- C~ 3~ S TERM ~ ~~ . ~ a ~' - ~ ~.~z~ ~ ~. ~ ~'?~ ~ C7 G7 ;-~~rn ~ PETITION FOR CITATION ~: ~~ -~ ~.~ r-, ,'..7 -x~ ~_- -` ~ t.~.~ TO THE HONORABLE THE JUDGES OF SAID COURT:-.~ ~"''~, AND NOW, this ~,''~~ day of '~c`..~~- ~~ , comes the Commonwealth of Pennsylvania, by Robert Freedenberg, Deputy Secretary for Taxation, for Stephen H. Stetler, Secretary of Revenue, who avers: 1. That Charlee R. Ivy, deceased, (hereinafter referred to as "the Decedent"), died on April 13, 2004. 2. That a Petition for Letters of Administration was made by Ivy J. Berry, Administrator (hereinafter referred to as "the Administrator"). Letters of Administration were granted to the Administrator on April 23, 2004. Attached hereto and made a part hereof is a copy of a document attesting to said date on which Letters were granted marked Exhibit "A." 3. That on June 27, 2008, a certified demand letter was sent to the Administrator, advising that the Inheritance Tax Return for the Decedent had not been filed. A receipt was signed and returned to the Department of Revenue. Attached hereto and made a part hereof is a copy of said letter and receipt marked Exhibit "B." L ..~ -- c. ~ _:y c... ; i -~ t ~ '~ ~ 3 ~.... ten./ ., ., t v .~ 4. That as of the date of this Petition no Inheritance Tax Return has been filed by the Administrator of this estate as required by Section 1736 of the Act of December 13, 1982, P.L. 1086, No. 255, (72 P.A. C.S. § 1736). 5. That under Section 2176 of the Act of August 4, 1991, P.L. 97, No. 22, (72 P.S. § 9176), the Secretary of Revenue is authorized to request the Court to issue a Citation directed to those subject to any duty imposed by the aforesaid Act, commanding such persons to appear and show cause why the requirements of this Act should not be met. WHEREFORE, your Petitioner prays your Honorable Court to issue a Citation upon the Administrator, directing the Administrator to appear and show cause why said Inheritance Tax Return in the estate of the Decedent should not be filed as required by law; and to further direct that the costs of this action shall be borne by the Administrator. COMMONWEA~,TH ~OF PENNSYLVANIA BY "1 -. , Deputy Secretary for Taxation FOR: Stephen H. Stetler Secretary of Revenue COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF DAUPHIN Robert Freedenberg, Deputy Secretary for Taxation, for Stephen H. Stetler, Secretary of Revenue, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct to the best i ~wledge, information and belief. Deputy Secretary for Taxation For: Stephen H. Stetler Secretary of Revenue Sworn to and Subscribed before me this day of ~~,~G=~ c~~q r~ Member, Pennsylvania Association of Notaries Page 1 of 1 OA'~'~ GF PERSONAL REPRESENTATIVE CUIV~MONWEAI.TH Off' pENNSYLYANIA ss COUNTY OF . ~ ~~,~,ti-~.a1s~,~rsc~ ._._. ~ , . Tht petitioner(:) above•nxmed swear(s) or aftlrm(s} that th+r statements in the fore~oin~ petitbn ale true and carrcct to the ixst of the knowledge and belict of pctittvner(s} and that as pctsonttl rcpresentoti-c{s} of the about decedtnt petitionsr(s) will wcli and tntiY administer the tstate arradins to law. Sworn to or atfiratec! #nd subscribed bcfo c mt this .» -*~~hn day of ~.Qwn ~tt~tsrtt .~~'r~ u, ~~ N No. ~t - S~ri~~'~ Estate of C.~~~~.s. ~ ~ ~t~..~,---.._._..........__.._..___ , dt~t~~ated GRANT OF LE'1'I'ERS (~~' AlDM1N1STRATION AN1) NOW ~~ [1.a ~- ~3 K~~~ Id! _.... in ronsidtratic~n of tha petition +an tht: rc+rctse side hcreo , stt factory proof ha g been ptestrtttd before me, iT IS Dt±CR[iL~f) that _ _,..z~ i3/ire rr+titted to tet-ers of Adrnin ra n. and in +rrror ith :uch finding, t.tttcfs of AdmMistr~tion are hereby =ranted to .,~;~W in tha state of ~c~lts ~ ~ a Ff?F~4 Lrtters of AdmtnistrAtion ..... S~~? Short Ccrtffkatas{y) „ ........ f1~..~ Renundatiors ...... 3 TOTAL 3LQ~.:.S3~~? ~:~r ~. e~ cr o! ~ ~..1 ~ ~ !j ~/ ~nattrre tsuo. cf. t.n. No.) ~at,t;FSS i ~ci j ~r-~-?s/3 -r/~y~ - pttarae PI~~T[TI()N I~'Qlr GRANT UF' I..H:1'TEItS UI~` At)~y1NISTItA'TlON Eslate of _.__ ~`- ~ • ~!t'(___. _~-- Na. ~~.,.Q!-~~~~~~____-._...~,,.._.... atf0 known a.r _.._. _.....•--.._..•..~ .- _- To: itcgiiter ttf waits tar the ---- _~.~__..____.......----- --, G~ ~n~ t r,,,(~~. in the ~•' 1)[re~uccrt. Ccsurtly t~! "~---""~'-~--~_"i'~~ t:bittm+~n~-caltfi of t'cnn:ytvgnta Satat,Sec•riitr,> N.._ ...a.d.(~~'~..~.~`i.:.~.=L`~~-• -- The petition of the undersigned rtipccth~ily reprttertts that: Yuur pttitiorrcr~ who islara.iti y'cnrs of agc t:r oWet, opplttt tar letitr; of adnthtisttatio~ _ _ _ ~.~.~, an the rstatc of Id.b.n C t-r~lci-er tail. dui+nit afi~t~+lia: duratnt ~s~~~u+rl~:~te~-- the abuvo dc~:cdcnl. peccdent was damiciicd at death ir- _ -~....--..' - e a~'~---County, Pert~n~s~•_iva~fa~,.~wit~ ~r test famiiy a prtnsipri resWcnrc of ._..,~..~~- .mss-~--~~•- s-t~--•-~~~~,'' • s--~=s-°-' tli~t ~treN, numt~r.'i'rrp, or t)ata.t Zt~a peccdcnt, then ~~ years of agc, died . _._._~_ .~--.MT ~~-~----~ t'~ . ar .~. S,ral.rli-i.{s--~~r.t~a~t ..~.,__...~ .._~_ _ -- t7ccedent at dcatit owncd propcrty with tstimttitd r•siuc3 as loilowf: i ~~.~~ ~If dontictted in 1'a,) Ali pcrsonol property (If not damicilcc! in t'a.t Personal praperty itt f'ettn~>Ivania S ilf not domieiltd in Pa.- t'crsanat properly in Caunly S Valet o! rear titatc fn Pcnnsyt-•ania S-- situatcd as folluwt: ~~.~1-----bC~~~ t t'`,N•'"P~.J:~ 3 ~? oc~ """'.... Petttioner_- after tt proper ~enrch hum . Ascrrfaintd thnt dece~iertt icll no Wiii and waS turs~ircd ray the lniiarvirtg xpousc (i[ airy) arrd hcirc: Nurrte i ttclatfonsttit~ ~ ttcsidrnce ----- 7fiFRliF()iiL, pctitiontttsl respeclfullr rcc;urstis) the grant of ictters of administration in the apptapriatr corm to the unsicrsignsci. .-- _ y~_e. S.l:...._ 57:_.._ .- - ---- r~ r; ~ , ~ • ~, _ _ i' _.. ___ - -...A..wys~ _. ..- - iii Page 1 of 1 ..~ w ,~-- ~~ •~ ..fir ~~."~' IiARRiSBURG D1SiRICi' Of1~7CE3 S'I'R1-WBBRRY SQ_ 47}i ~t \\'ALtRUT HARRISBURG PA 17128-0101 COMMONtiVEALTI~~ OF PENNSI'LVANIA DEPARTMENT OF REVENUE RSV•869F0 AFP (01-06) DATE: 6/ 2 7/ 2 0 0 8 IVY J BERRY 502 N WEST ST CARLISLE PA 17013 Dear IVY J BERRY Estate of IVY CHARLEE R Date of Death: 4/ 13 / 2 0 0 4 File Number: 21 0 4- 0 3 8 5 tCertified Mail-Return Receipt Requested) A review of Department records has disclosed that you are responsible for the settlement of the above estate, or that you represent the responsible party. As of this date, you have failed to respond to prior contacts to resolve this matter, This is to again advise you that the above estate is in a delinquent status. According to Deparhnent records, as of this date, the estate is still not settled. The Inheritance and Estate Tax Act mandates the filing of a tax rehi2•n and payment of all outstanding liabilities by a personal representative of the estate or a h-ansfe~•ee within nine month of the decedent's death. The Depa~ttnent's records show that this estate remains open because: AN INHERITANCE TAX RETURN HAS NOT BEEN FILED. If the retuY•n has been filed, it is important that you contact us i~unediately. If this estate was opened for the purpose of filing a Lawsuit, please provide this office in writing with the tel•~n and docket number of the lawsuit so that we may postpone any furthe;• action. This notice shall serve as a formal demand on you or your client from the Department of Revenue. If you fail to file the return, the Department may institute legal action requil•ing you to appear in court to show cause for your failure to comply with the law. A finding of contempt in this matter could subject you to additional penalty andlor incarceration by the Orphans' Court of Cumberland County. RETURNS SHOULD BE PILED AND CHECKS IYIADE PAYABLE TO: ~~(,~ISTER OIL` ~'4~II.LS, AGENT Any questions regarding this estate, please C{3NTACT; Sincerely, Anastasia DiBartolorneo HARRISBURG DISTRICT OFFICE {717}787"3863 STRAWBERRY SQ cc' 4TH & WALNUT STS JOHN H BROUJDS HARRISBURG PA 17128-0101 4 N HANDVER ST CARLISLE PA 17013 ~T b ~i81T r 'h r, `y r 1 ~ •~ E~~3~~ . 8 ~° ~ om ~- ~ ~~ o o~ ~~ ~~'~~~~ ~~~~~ ~-p~ ~ r Q~~~~ H, ~ ~ ~ ~ .:~~ ~ ~~~/~~ ~ ~ ~ L ~ .Y i f 'r..~o3~~ ~~~~ ~ ~~~~~~ ^ ^ ^ w o O M r- O " °° ~ ~Na ~ o ~ m~ ~~~ ~ ,,; ~ U c #i ~~ v U 1C]O t i ~oo 0 a ~iIT e „q~ %~ k i .. '. ~ J ~~'~~ .~_ I N R E ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHARLEE R. IVY ORPHANS' COURT DIVISION DECEASED NO. ~" ~ ~~ `~ a .~°::-~ TERM ORDER Now, to wit this the T ~ G ~ day of ~~ ~,-- ~ Zo~, upon consideration of the ~~~~~ foregoing Petition, it is ORDERED and DECREED that YOU, Ivy J. Berry, Administrator for the Estate of Charlee R. Ivy, deceased, are hereby cited to be and appear at Courtroom No.' , ,~~~'y on the,,~.~2~~.- day of ~,~-~a~~n.in the Courthouse of Cumberland County, Pennsylvania, at ~/%t'C~ .M., then and. there show cause, if any there be, why the Inheritance Tax return in said estate should not be filed; aid to further direct that the cost of this action be borne by the said Administrator; said citation returnable at ~-/ ~ ~`,~~ ~~ .M., on the ~~~`;~"°,, day of ~'~ ^~~? y 20~`~ ~~ .. _.. ~_ , -~ _._~ ...._ a 1. I .. \_~, u~~~ .' 1 } ~-,~ ~,~ ~ --, M BY THE COURT .:~-:,fi-~: ~~~ cW.~ ~~, ~ ~ ~ r O ANS' COURT ISIaN J. ~,~~ In Re: CHARLEE R. ORDER DATE: JUDGE'S INITIALS: TIME STAMP DATE: IN RE: ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA N0.21-04-0385 CERTIFICATE OF SERVICE OF ORDER SERVICE TO: IVY. J ERRY. JOHN BROUJOS M~rtiuli Ur~ M 1 1 mac': ENVELOPES PRQVIDED BY: ® USPS ®PETITIONER ^ RRR ^ JUDGE ^ HAND DELIVE D ^ CLERK OF ORPHANS COURT ^ OTHER MAILED: 0 /13/ SERVICE TO: ANAS ASIA DIBARTOLOMEO M~~~-tiv~u ~r~ MA1L ENVELOPES PROVIDED BY: URRR ®PETITIONER ^ HAND DELIVE I) ^ JUDGE ^ OTHER ^ CLERK OF ORPHANS COURT MAILED: 08/1 /09 Dep Clerk of Orphans' Court i i .~ W U u. ~ O H oC O I N Q .~:. ~ ~ O + '~ ~ I ~ U r W -~ W «:, ti N ~, - ~ W a ,. ' : l '" o 0 ~ ~ ~ J { ` ~ ~ V ~ ~ ~ ~~ U~~ J 1 H O H '. ,~-~ w ~ W ..1 H Q W W ...1 3 ~ o ~ W ~ 1 H # y I I ~ ~' I 1 -... W LL O I LL C ~ ~~ O . in + Z -,~ ,Q a ~ o l ~~ ° ~ ~k J ~ W ° •s.1 W N ~. F- a ° ~~`°` ~ ~~yr ~ ~. - Ir~`~~ . W e--~==~. x- 2 0 0 J O U ~ ~ ~ ~ (~ Z -., _ v~ V ~ f Q . U U W ~ W i ~ - ~ ~ ~ a W~ m ~ ~ zz = m f Z W° W ~ ~ ~ W U ~ [ LU WUW M. oti-W-~U in~JU ~ ~ t c~~p~ d ~WOp~ OiZ~t~ ~g~w rQWQ W U ~ ~ ww~Q W W j >~~x ~ ~ f ~om~ ~ > ~ ~om~ ,~ ° o o z a s~~ o L ~ : ~ ~ ~ a_. W o } ~ Q. ~ ~ z ~ a `r f F" z ''~T Q 1 f W Q z W f ~~ W~ W °~ II ~ Q~ J o ~ p, ° w ~ U 4 ~ ~ f ~ _ OFFICIAL USE ONLY COMMONWEALTH OF REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE I N H E RITAN C E TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 4 0 0 3 8 5 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL} SOCIAL SECURITY NUMBER W IVY, CHARLEE R. 1 6 9- 4 4- 3 7 4 5 Q DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W REGISTER OF WILLS U 04/13/2004 12/02/1951 LL.I (IF APPLICABLE} SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL} SOCIAL SECURITY NUMBER 0 NA - - W F- 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) Q cYi a v ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of deatn after 1z-12-62) ~ 5. Federal Estate Tax Return Required W ~O ~ a m ~ 6. Decedent Died Testate (Anson copy of wu) ~ 7. Decedent Maintained a Living Trust (Attaon Dopy of Trust) ~ 8. Total Number of Safe Deposit Boxes a d ~ 9. Litigation Proceeds Received ~ 1 O. SpoUSal POVerty Cfedlf (date of death between 12-31-91 and 1-1-95} ~ 11. Election to tax under Sec. 9113(A) (Attacn sob o) ~ THIS SEGTIQN MUST BE CQMPIrI*TED, ALL CQ-F~RESPpMp~NGE AND CQNFIDENTIAL TAX INFQRMATIUN SHQULD BE DIRECTED TO: Z w NAME COMPLETE MAILING ADDRESS °z JOHN H. BROUJOS, ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Appicable) W Q' p TELEPHONE NUMBER 717-243-4574 CARLISLE PA 17013 1. Real Estate (Schedule A) (1} 23,704.55 OFFIC~ USE ONLY 2. Stocks and Bonds (Schedule B) (2) ~ ~ '~7 y''~ ~ -x~ '+~ ~ _ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~? --~ ~ -'~ ..~ ~-~ 4. Mortgages & Notes Receivable (Schedule D) (4) ~ ' -_' t.'~ ~= . ~:~.~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 750.00 t ``~ -T7 - -,~,~ (Schedule E} -- ~`' " O 6. Jointly Owned Property (Schedule F) (6) 0.00 t --; _.._ I ~ ~ ,,,--; ~_ _;-~ ~ Q ~ Separate Billing Requested I ..., ~ ~,,,; ~ ~ ~ ~~ ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 _ H {Schedule G or L) Q 8. Total Gross Assets (total Lines 1-7) (8) 24,454.55 U ~ 9 Funeral FxnPnsPS R Administrativ? Costs (Schedule H) (9) 10, 597.26 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 8,796.49 11. Total Deductions (total Lines 9 & 10) (11) 19,393.75 12. Net Value of Estate (Line 8 minus Line 11) {12) 5,060.80 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14} 5,060.80 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 0 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X (15) H ~ 16. Amount of Line 14 taxable at lineal rate 5,060.80 X .045 (16) 227.74 a 17. Amount of Line 14 taxable at sibling rate X 12 (17) 0 18. Amount of Line 14 taxable at collateral rate X 15 {18) X Q 19. Tax Due {19) 227.74 > > BE<SURE TO ~NS~IIIER ALL QUESTIC3NS ON: REVERSE SIDE AND RE~:HECK hAATH < -ecedent's c:ompiete Haaress: STREET ADDRESS 52 W. North Street STATE PA ZIP 17013 cITY Carlisle Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) (1) 227.74 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 500.00 C. Discount Total Credits (A + B + C) (2) 500.00 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 1 Line 20 to request a refund (4) 272.26 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT ....................................... __ __ __ __ ................... ....... . __ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRO PRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the properly transferred :.............................................................. ........... ^ 0 b. retain the right to designate who shall use the property transferred or its income; ........................... ........... ^ 0 c. retain a reversionary interest;.or ....................................................................................... ........... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................... ........... ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................... ........... X^ ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death .... ........... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designatian~ ....................................................................................... ........... ^ 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 befef, it is true, correct and com plete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE ON RE PONS BLE FOR FILING RETURN DATE ~~ ADDRESS Ivy . Ber , Ad istratrix, 502 N. West Street C rli e PA 17013 SIGNATURE OF P A ER OT ER HA RESENTATIVE DATE O Q ~ ADDRESS 4'~ anover Street Ca le PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ' SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER IVY CHARLEE R. 21 04 00385 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Property: 52 West North Street, Carlisle, PA 23,704.55 HUD Settlement Sheet Attached TOTAL (Also enter on line 1, Recapitulation} ~ $ 23, 704.55 (If more space is needed, insert additional sheets of the same size) . A. Settlement Statement rs ir....e s i .,~., U.S. Department of Housing and Urban Development C~MR Nn 75A7~17F,5 RFV HI ll~_1 f3/RRl 1=1NAI 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 4. VA 5. ^Conv.lns. 6. File Number ST2004-214GD 7. Loan Number 8. Mortgage Insurance Case Number rs is i o give you a s em u men s. s pai a y e emen agen are C. Note: Items marked "(p.o.c.)" were paid outside the dosing; they are shown here for information purposes and are not included in the totals. WARNING: ft is a cxime to knowingly make false statements to the United States on this or any other similar form. PenaRies upon conviction can include a fine and im isorxnent. For details see: Title 18 U. S. code section 1001 and section 1010. TltleExpfeSS Settlement System Printed 11/03/2004 at 10:47 KLL D. NAME OF BORROWER: Carlisle Opportunity Homes, Inc. ADDRESS: E. NAME OF SELLER: Estate of Charlee R. Ivy ADDRESS: F. NAME OF LENDER: Cash ADDRESS: G. PROPERTY ADDRESS: 52 W. North Street, Carlisle, PA 17013 Carlisle Borou h H. SETTLEMENT AGENT: Saidis, Shuff, Flower 8< Lindsay, Telephone: 717-243-6222 Fax: 717.243-6486 PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013 I. SETTLEMENT DATE: 1110312004 J. SUMMARY OF ORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 27 000.00 401. Contract sales rice 27 000.00 102. Personal Pr rt 402. Personal Pro rt 103. Settlement char es to borrower line 1400 2 379.11 403. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 29 379.11 420. GROSS AMOUNT DUE TO SELLER 27 000.00 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De sit or earnest mone 501. Excess De sit see instructions 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 616.34 203. Existin loan s taken sub'ect to 503. Existin loans taken sub'ect to 204, 504. Pa off of First Mort a Loan 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 213. 513. 214. 514. ° L/ .~' i1 215. 515. 216. 516. 217. 517. ~.'~ ~ ~ ~~. 218. 518. ~ 219. 519. 220. TOTAL PAID BYIFOR BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER 616.34 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 29 379.11 601. Gross amount due to seller line 420 27 000.00 302. Less amounts aid b/for borrower line 220 602. Less reduction amount due seller line 520 ....~:.-..6'16,34 303. CASH FROM BORROWER 29 379.11 603. CASH TO SELLER °' 26 383.66 i ;~ .~ ~ '~ a: d k ~7G~ ~ ~ 4M~~¢! •~. ~. SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished bo the Internal Revenue Service. ff you are required to file a return, a negl~'penoe penalty or other sanction will be imposed on you N this item is required to be reported and the IRS determines that ft has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: M this real estate was your principal residence, file Form 2119, Sele or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions, .........i...., a..........n....-.b......a....t r....., w~c» c....., c~cb ....ai... e.....,a..~., n ir....., ~nwrn U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: ST2004.214 FINAL PAGE 2 CFTTI FYL`WT CTATFI~FIJT eev w ~n ~ read r.~_r.._____ n_..~____.n._.__ .~__._~..,,.~...,.,.. _......~,... L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice S27 000.00 0.000 = BORROWER'S SELLER'S Division of cortxnission Gne 700 as fellows: FUNDS AT FUNDS AT 701. to SETTLEMENT SETTLEMENT 702. to 703. Commission Settlement 800. REMS PAYABLE IN CONNECTION WITH LOAN 801. Loan ' 'nation Fee % 802. loan Discount X 803. 'sal Fee 804. Credit R 805. Lender's I Fee 806. Mat Fee 807. Assum Fee 808. B09. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to /d 902. Mort Insurance Premium fa to 903. Hazard Insurance Premium fa to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insu mo. Imo 1002. Mat Insurance mo. hra 1003. C' Tax mo. Ina 1004. Coon Pr Tax mo. Ina 1005. School Taxes mo. Imo 1009. A ate Anal 's Adustment 1100. TITLE CHARGES 1101. Settlerrlent a dosi fee 1102. Abstract a title search 1103. Titte examination 1104. title insurance hinder 1105. Document Pr oration 1106. Fees to Saidiis Shoff Flower b Lindsa 4.00 1107. Attome s fees to Brou'os 8 Gilro 600.00 includes above items No: 1108. title Insurance to ACCP Inc. 420.00 includes above items No: 1109. Lender's Pd' 1 t 10. Owner's Pd' 27 000.00 •420.00 1111. 1t12. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Reoord' Fees Deed 38.50 • Mort • Release 38.50 1202. Cfl /Coon taxlstam Deed 70.00 • Mort 270.00 1203. State Taxlstam tked 70.00 • Mort 270.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Final WatedSewer to Carlisle Borou h 16.34 1302. 2004 Ct R Tax to Darlene Mo er 239.28 1303.2004-05 Scholl Tax to Darlene Mo er 557.40 1304.2003-04 Scholl to Tax Claim Bureau 579.93 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 2 379.11 616.34 HLa CERTFICATION OF BUYER AND SELLER I Mw erdul y rwi~wW lM HW-1 StrIM«n«k StNwntrnl trrW b IM WN d my WnwlWptr rM bNiN, X s a trw rW ~curMtr uaHmuM d aM nupts trnC tli~b~rftrmtrMS mrdtr on my ateouM w Dy ms ~ nrs ura~aan I hrrMr o~Fily srt I I»w r,F.wa . Dopy d In. Huo-r s.lw~«w sll. U COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER IVY. CHARLEE R. 21 04 00385 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 1992 Ford Taurus sedan, VIN 1 FACP52UKNA182397 approx. 500.00 Advertised in paper. Appraisal $250.00 - $500.00 (Family Ford) 2. Household Furnishings 250.00 TOTAL (Also enter on line 5, Recapitulation) I $ 750.00 (If more space is needed, insert additional sheets of the same size) REV-1 S10 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER IVY CHARLEE R. 21 04 00385 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. Ivy J. Berry, daughter --- Made joint 4.12.04 2,282.74 50. 3,000.00 0 Members 1st FCU Checking acct #43629-11 S 5000 Louise Drive, Mechanicsburg, PA 17055 2. Members 1st FCU Savings acct #43629-OOS 146.18 0.00 5000 Louise Drive, Mechanicsburg, PA 17055 TOTAL (Also enter on line 7 Recapitulation) I $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER IVY CHARLEE R. 21 04 00385 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral: Ewing Brothers Funeral Home, 630 S. Hanover St., Carlisle, PA 17013 3,885.00 Cumberland Valley Memorial Gardens, 1921 Ritner Highway, Carlisle, PA 17013 Opening/Closing Vault 995.00 Cumberland Valley Memorial Gardens: Headstone 1,418.09 The Sentinel, P. O. Box 130, Carlisle, PA 17013 Notice of Pub 80.17 Cumberland Law Journal, 32 South Bedford Street, Carlisle, PA 17013 Notice of Pub 75.00 B. ADMINISTRATIVE COSTS: ~ Personal Representative's Commissions Name of Personal Representative (s) IVy J. Berry Social Security Number(s)/EIN Number of Personal Representative(s) 20-6189040 Street Address 502 North West Street ~;ry Carlisle state PA Z;p 17013 Year(s) Commission Paid: 2. Attorney Fees John H. Broujos, 4 North Hanover, Carlisle, PA 17013 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees ReglSter Of WIIIS 2,000.00 2,000.00 102.00 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. Inheritance Tax Return filing fee - Register of Wills 15.00 8. Inventory filing fee - Register of Wills 10.00 9. Family Settlement Agreement filing fee -Register of Wills 17.00 TOTAL (Also enter on line 9, Recapitulation) I $ 10,597.26 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RESIDENTEDECED NT N MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER IVY CHARLEE R. 21 04 00385 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. General Creditors: See Attached 3,694.04 2. Medical Expenses: See Attached 2,098.00 3. Utilities: See Attached 3,004.45 TOTAL (Also enter on line 10, Recapitulation) I $ 8,786.49 (If more space is needed, insert additional sheets of the same size) Charlee R. Iw Date of Death -April 13.200 ATTACHMENT TO SCHEDULE I GENERAL CREDITORS: BALANCE: 1. Columbia House (CD's) $ 78.34 1400 North Fruitridge Avenue Terre Haute, IN 47811-1131 Account #: 91140672741 2. Columbia House (DVD's) $ 29.00 1400 North Fruitridge Avenue Terre Haute, IN 47811-1114 Account #: 50217538664 3. Expert Tire $ 718.21 c/o Credit First National Bank P.O. Box 81344 Cleveland, OH 44188-0344 Account #: 534110480 4. Bon-Ton $ 421.08 P.O. Box 17598 Baltimore, MD 21297-1598 Account #: 115403065 S. Walmart $ 2284.94 P.O. Box 530927 Atlanta, GA 30353-0927 Account #: 6032 2075 4019 0691 6. T-Mobile $ 57.62 P.O. Box 742596 Cincinnati, OH 45274-2596 Account #: 295012052 7. AT&T Wireless $ 104.85 P.O. Box 129 Newark, NJ 07101-0129 Account #: 159-2203259649 GRAND TOTAL: $ 3694.04 Charlee R. Iw Date of Death -April 13.200~f ATTACHMENT TO SCHEDULE I MEDICAL EXPENSES: BALANCE: 1. Hershey Medical Center $ 1588.00 Patient Financial Services P.O. Box 854 Hershey, PA 17033-0854 Account #:3194708 2. MSHMC Physicians Group $ 240.00 Billing Services P.O. Box 854 Hershey, PA 17033-0854 Account #: 249768 3. Fox Chase Cancer Center $ 270.00 Health Services P.O. Box 827193 Philadelphia, PA 19182-7193 Account #: 0287515 GRAND TOTAL: $ 2098.00 Charlee R. Iw Date of Death -April 13.200~4- ATTACHMENT TO SCHEDULE I UTILITIES: BALANCE: 1. Comcast Cable $ 164.52 P.O. Box 3006 Southeastern, PA 19398-3006 Account #: 09547 364261-02-8 2. Sprint $ 361.57 P.O. Box 740463 Cincinnati, OH 45274-0463 Account #: 717-243-8169-130 3. UGI Utilities Incorporated $ 508.20 P.O. Box 13009 Reading, PA 19612-3009 Account #: 210 766 4433 26 4. Sprint PCS $ 1970.16 c/o FBCS 841 East Hunting Park Avenue Philadelphia, PA 19124-4824 Account #: 0154437838 GRAND TOTAL: $ 3004.45 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER niv rueQi ~~ Q ~~ nd nn~R~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a} (1.2}J 1. Ivy J. Berry Daughter 100% 502 N. West Street Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~Ir more space Is neeaea, Insert aaaltlonal sheets of the same size) IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLES R. IVY, DECEASED ORPHANS' COURT DIVISION NO. 21 04-0385 PRAECIPE TO DISCONTINUE WITHOUT PREJUDICE To Glenda Farner Strasbaugh, Clerk of Orphans' Court and Register of Wills: The above-captioned action is a Citation for failure to file an inheritance tax return. Please mark this action discontinued as the Administratrix of the Estate filed the inheritance tax return. DATE: October 29, 2009 Lora I k Attorney for Petitioner PA Department of Revenue Office of Chief Counsel P.O. Box 281061 Harrisburg, PA 17128-1061 Attorney I.D. No. 69436 ..~ Q~~ ~~ S£ ~ZI Hd t- AON 6UOt: :: i r ~ ~_f ~..ala_- ~~V 0 ~ 2.09 G IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF CHARLEE R. IVY, DECEASED NO. 21 04-0385 ORDER OF COURT AND NOW, this ,~~. day of ~~L ~ 2009, upon consideration of a Praecipe to Discontinue the within action, the Motion is granted, the Rule is dismissed and the Citation is discharged. BY THE COURT: ~ J r~ ~~ _.. C5 ~.TJ i ~' ~ ~> (-- ~• { ) ("~ "S'1 $~ ~' ~ ~) ~ ~ ~ 1 S In Re: Charlee R. Ivy, Deceased ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-04-03 85 ORDER DATE: 11 JUDGE'S INITIALS: TIME STAMP DATE: CERTIFICATE OF SERVICE OF ORDER IN RE: Order of Court SERVICE TO: Lora A. Kulick METHOD OF MAILING: ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 9/09/09 ENVELOPES PROVIDED BY~ ^ PETITIONER ^ JUDGE ® CLERK OF ORPHANS COURT SEF:VICE TO: METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ENVELOPES PROVIDED BY: ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT Deputy Clerk of Orphans' Court Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 .~.-~- _,~~ ~~ ~~"~~'~~ '~~ ";~ , ti~:~ Phone : (717) 240-6345 = ~~ ~~ _ ..~ _.~ a `.~li : ~~~ ....~ 2 ~ Q APB - i ~ {a~ 5 ~ ;~rAr n _., Jl. r C~; . , ..: P~, Date: 3/29/2010 BERRY IVY J 502 N WEST ST CARLISLE, PA 17013 RE: Estate of IVY CHARLES R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~n~ ~~ ~ Glenda Farner Strasbaugh~~ Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square „•- Carlisle, PA ];-7-O~fi3wf ~~ `~~'~~~ `"~ Phone . (717 ) 2 4 b'- 6 ~:~ 5; % ~ ~ ~- ~R _ ~ ~~~ ~~' ~~ ~~~~ ' ~~,~ ~, ~ t 1 ' ~ Y 1 ~~ f Date: 3/29/2010 BROUJOS JOHN 78 E RIDGE STREET CARLISLE, PA 17013 RE: Estate of IVY CHARLES R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~f2 ~~~ Glenda Farner Strasbaugh~~~ Clerk of the Orphans' Court cc: File Personal Representative(s) R~CISTEP. OF ~ViLLS OF ~~,-~;,~° ~^„~ __ COU'_vTI', FL'vT1SYLtiAN?~ Nance of Decedent: U Datz o Death: a File Number: ,~~D~ DD ~ D.,.•.........++.. D.. (\ r^ D..1= ~ 1'1 T .•_.,~,+-1 thc+ $~ll~~zrino u; ith ~-=c~?r_.? to C.flrr7pli_'.tli~ll of cl;e administration of i ut~uaiu w i u. v.~,.•. ~u~iv v. a:.,, a i.,rw...,.. ~ ..J -- C the above-captioned estate: Mate whether administration of the estate is complete :.................... Yes ~ No 1. 2. If the a>iswei 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 withthe Courl? ...... b. The separate Orphans' Court No. (if any) for the personal representative's account is: Yes ~ No /- 0 035 c. Did the personal representative state an account ~ Yes ONo infom~ally to the parties in interest? .:............. • • • • d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerlc of the Orphans' Court and maybe attached to this report. Dnre ~ 3/O{~lF/ ~ ~•` . ~ _. ~ =~ ~ r ~~~ ~ '~ ~~ t- _ I~...S t ~~. L.L,~ ~ ~ ~KyC- tf7 i~~i~., ~ •~'~ ~~ ~ cl~ ~~ ~ C~ , y l~ C3 ~ ~ ~~ ~ i o ~ Signanrr of Per n Filing lhit orm Capacity: ~ Personal Representative QCounsel Nmne Person Filin his Fora, .~2 Alerdi l ~=~" Address ~,-~~~1~, PA- /~Q~ - ~?Q T y Telephone ~,~,,~/ ' J ~-~yy~ ~ ~r../I~.t•~ ~L'~s~nw ~ns~ `7N,gy_ `i~tv~E.. A..~ ~n,c.6(.~-~ TES ~ . ~lN'AS Fora; RW'-l0 ren. l0 /3.06 i Via. v.~`. ~~~ti v.1~ S~_~.i~;S ~-'~~~ R.ECISTEF. OF ~ViLLS OF~~ ~P_r1Q~'ld -- COU'viTY, FL?vTiSYLVAi\IA iame of Decedent: ~/,~Q/'/~E n.~- ~~~-- - Date o Death: 13 File NulnUer:s~~~1L-'.e'~~~~ D....,.......~ ~„ D.. t^ r-' D„la ~ 1 ~ T ,-~.,:.,i tho 41~llmzrina ~z;ifl; _=cnar•.t to ~.mm~lzi;ign (1f th'e adl~'liril~tl'dt1011 Of i u:~ua:u w i u. v.~.•. a~~..., v.._, . a..t.v....................~ t"'-'- r the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~] Yes ,~NO 2. If the aiisweris No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to I~To. 1 is YES, state the following: a. Did the personal representative file a final~account with the Court? ....... Yes ~No b. The separate Orphans' Court No. (if any) for the personal r'epresentative's account is: c. Did the personal representative state an account informally to the parties in interest? .:..... ... ~ Yes (~No d. Copies of receipts, releases, joinders and approvals of formal - ' •onr:al accounts maybe filed with the Cleric of the Orphans' Court an~nay~attach tot report. il'! c CV pC - ~'j C.:a y l~ ~ ~ t/7 ~ '~ J N ~~-- ''.~~ iu +aaC <- -.- ii,~~ f ~ Ci. O O N Form 26K10 r¢~,. /0.!3.05 Si~nnture orPer~on Filin, this Form Telepkone Capacity: ]Personal Representative Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 ~~ ~~~~{~ ^~` '~`' Phone . (717 ) 2 4 0 - 6 3 4 5 '~ -~~ ~~ ~ ~ r ~J. ,, ,. , 2~ 0 APR - 3 ~, !0~ 5 7 (~-'y( t i ^~`'~1' ~~i le 1U~ \1 ~.. Date: 3/29/2010 BERRY IVY J 502 N WEST ST CARLISLE, PA 17013 RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh~ Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square »•- ,, Carlisle, PA 17-(~fi3'iY ~'~,~`~ -~; Phone . (717 ) 2 4 b' ; ~ ~,~~5, ~ ;- ;. ~- ~- ',.,: .,v ;~:_ .. PR r ~ A~~ t~• ~~ ~~10 A u , ~, ,, ~j~, l . . Date: 3/29/2010 BROUJOS JOHN 78 E RIDGE STREET CARLISLE, PA 17013 RE: Estate of IVY CHARLEE R File Number: 2004-00385 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ''~ Glenda Farner Strasbaugh~~~ Clerk of the Orphans' Court cc: File Personal Representative(s) ~ i BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 JOHN H BROUJOS ESQ 4 N HANOVER ST ~;.,~, ,~-. ,#;IQF~~ , ~j~ INHERITANCE TAX pennsy van~a ~ Ap~RA'YS'EM~`N~~ ArL' LOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE _. ,; ;_~~ l~.~~~1CTI~~ ~ AND ASSESSMENT OF TAX REV-1x47 EX AFP C12-o9) 2~~4 APR 30 ~~ ~~• J4. DATE 04-26-2x10 ESTATE OF IVY CHARLEE R C~E~~ ~jr DATE OF DEATH 04-13-2 04 QRPi`',~;'~'`S ~~J~~T FILE NUMBER 21 04-0 85 (;(~J~,;"~ '-~ ~~', ~~~` , PA, COUNTY CUMBERL ND ACN 101 CARLISLE PA 17013 APPEAL DATE: 6-25-2010 (See reverse side unde Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 170113 CUT ALONG THIS LINE _ ~- R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWA DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TA ESTATE OF: IVY CHARLEE RFILE N0.:21 04-0385 ACN: 10 CE 1 _ _______________ OR DATE: 04-26-2010 TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED S E ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) C1) 24, 004.5 NOTE• To ensure proper 2. Stocks and Bonds (Schedule B) C2) .0 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 7 5 0.0 6. Jointly Owned Property (Schedule F) C6) .0 7. Transfers (Schedule G) (7) .0 8. Total Assets 8) 24 , 754.56 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 8 7 9 6.4 11. Total Deductions C 1) 19, 393.75 12. Net Value of Tax Return C 2) 5, 360 .81 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C 3) .0 0 14. Net Value of Estate Subject to Tax ( 4) 5, 360.81 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) ~ .;60 . S1 x 45 = 241 .24 17. Amount of Line 14 at Sibling rate C17) _0 0 X 2 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 5 = .0 0 19. Principal Tax Due C19 )= 241.24 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID I I I I INTEREST IS CHARGED THROUGH 05-11-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX PAYMENT .00 BALANCE OF TAX D E 241.24 INTEREST AND PE 80.32 TOTAL DUE 321.56 IF TOTAL DUE IS REFLECTED AS A "CR~DIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS (FORM FOR INSTRUCTIONS. ~ 1 ~ REV-1470 EX ((E'f0) ~ ~:;. • ~ pennsylvan~a INHERITANCE TAX ;' DEPARTMENT OF REVENUE EXPLANATION BUREAU OF INDIVIDUAL TAXES OF CHANGES PO Box 280601 DECEDENTS NAME Fl E NUMBER Charlee R. Ivy 2104-0385 REVIEWED BY AC Sheila Megonnell 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES A The value of the estate has been adjusted as the result of the co ection of an error in arithmetic. ROW ~ Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: BERRY IVY J 502 N WEST ST CARLISLE, PA 17013 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SS-v: 169-44-3745 FILE NUMBER: 2104-0385 DECEDENT NAME: IVY CHARLES R DATE OF PAYMENT: 1 1 / 22/ 2010 POSTMARK DATE: 1 1 / 10/201 0 COUNTY: CUMBERLAND DATE OF DEATH: 04/ 13/2004 REV-1162 EX111-96) NO. CD 013682 ACN ASSESSMENT ,AMOUNT CONTROL NUMBER 101 ~ $326.84 TOTAL AMOUNT PAID: REMARKS: CHECK# 7296 SEAL INITIALS: DB $326.84 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF COLLECTIONS & TAXPAYER SERVICES PO BOX 281041 HARRISBURG PA 17128-1041 IVY J BERRY 502 N WEST ST CARLISLE PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _ ....., ~; ~.- - ~ ~,. ~_; - C~ ~ ~ ~. .. _ ', .'1 ..~ ~J Z~ 3 ~ ~~'r ~6 ~ t~ F'~-~ 12~ S 2 ORS ~± ~- ~ ~F ~., P~ DATE: 11/1/2010 Estate of: IVY R.EV-870F0 AFP (]0-07) CHARLEE R Date of Death: 0 4/ 13 / 2 0 0 4 File Number: 21 0 4- 0 3 8 5 ACN(s): (See Reverses Side) Dear IVY J BERRY: This is to advise you that the above estate is in a delinquent status. According to Department records the estate is still not settled. As of this date, you have failed to respond to prior contacts to resolve this matter. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by the personal representative, transferee, or beneficiary of the estate within nine months of the decedent's death. The Department's records show that this estate remains open because: CURRENT TAX LIABILITY OF $ 3 2 6.8 4 INCLUDING INTEREST CALCULATED TO i i/ 2 6/ 2 0 l o HAS NOT BEEN PAID. Accordingly, you are directed to pay all tax due including interest within ten dlays from the date of this letter. If you fail to comply with this directive, your case will be rf:ferred for local enforcement and may result in the filing of a citation by this Department with t-he Orphans' Court Division of the Court of Common Pleas, req»iring yo?~ tin appear in rn~ar~ to show cause for your failure to comply with the law. In order to protect the Commonwe'alth's interest, the Department of Revenue may also file a lien in Cumber 1 a n d Count y Under Act 40 of 2005, additional collection costs including but not limited to fees of up to thirty-nine percent (39%) of the amount due, and attorney fees incurred in securing payment, may be imposed on any liability not paid prior to referral to a collection :agency or contract counsel. MAKE CHECKS PAYABLE TO REGISTER OF WILLS, AGENT Sincerely, Harrisburg Call Center Any questions regarding the tax cc: liability of this estate, please JOHN H B R O U J O S E S Q CONTACT: 4 N HANOVER ST Harrisburg Call Center CARLISLE PA 17 013 (717) 783-3000 TDD# 1-800-447-3020 (Service for taxpayers with special hearing and/or speaking needs) i~gk ~' ^ e%t v• Q ~' MJ F.~ '~ G. ~.~ r~ ~+ c.~ ~ ~ p ~ Cn R W ~ ~G r,. ;i, 4' ~,~ .~~t ~ ~ ~ , ~;Ci `.~. ~~. '~• . ~ `b ~~ °~ ~--.~ rI"~ ~ ` ~~ ~~ I^ ~~ ~~ ~~ W ~~ ~"" M` ~~~ y ~~~ ~' ~~ M f~ ~r M ~~ C~ M ~~ ~N N r ~~ ~~ ~~ ~~ ~~ ;;.;~ "~ :~ ~~s !'~ S ~:i .4~ ~.~ 1 ~tf: ~~ r .' {{~ ~~i i~~} ;4K wS i N~~ ~+f•. ~% i~ 'y~ f. X~r/. j,Clit i}~ ~~ LY v.{s>. § BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 R~~~ ~ ANCE TAX ~ ~;~* ~~ OF ACCOUNT i 0 ~~G 2 7 P~ i~~ 3 ~~ ~~~~ ~~ ~~ ~ ~~~~~ JOHN H BROUJOS ESQ~I~~~~'w1~~~ ~~ ~ P~ 4 N HANOVER ST CARLISLE PA 17013 pennsylvan~a ~ ~ ~~ DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) DATE 12-20-2010 ESTATE OF IVY CHARLEE R DATE OF DEATH 04-13-2004 FILE NUMBER 21 04-0385 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE _~_ RETAIN LOWER PORTION FOR YOUR RECORDS ~_ _ _ _ REV X1607 SEX AFP C12 10~ ~ ~ ~ *** INHERITANCE TAX STATEMENT~OF ACCUUNT ~~*** ~~~~~~ ~ ~ ~~~~w~~~~ ESTATE OF:IVY CHARLEE R FILE NO.: 21 04-0385 ACN: 101 DATE: 12-20-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-23-2010 PRINCIPAL TAX DUE: 241.24 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 11-10-2010 CD013682 85.17- 326.84 TOTAL TAX PAYMENT 241.67 BALANCE OF TAX DUE .43CR INTEREST AND PEN. .00 TOTAL DUE .43CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.