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Home My WebLink About03-0927Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of SARA JANE SELLERS No. ~/~J',"~ also known as DONNA LEE CROWELL Petitioner(s), who is/are 18 years of age or older, apply(ies) for: , Deceased Social Security No. 164305623 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut RIX E Decedent, dated 2/1/99 and codicil(s) dated n/a named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.ta.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 857 HILLSIDE DRIVE, CAMP HILL, WORMLESYBURG BORO Decedent, then 91 years of age, died April 8 Decedent at death owned property with estimated values as follows: (Location) (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 ........................................................................................ $ Total Real Estate situated as follows: n/a (list street, number and municipality) ,2003 , at SELECT SPECIALITY MEDICAL HOSPITAL 9,900.00 9,900.00 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: Signature RW-7 Typed or pdnted name and residence DONNA LEE CROWELL 857 HILLSIDE DRIVE CAMP HILL, PA 17011 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed November 2003 __ ~ _ Donna M. Otto,lst DECREE OF REGISTER Estate of SARA JANE SELLERS also known as Deceased No. 21-2003-927 Social Security No: 16430562;~ Date of Death: 4/8~03 AND NOW, November 7th , 2003 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary I'-I of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to DONNA LEE CROWELL in the above estate and that the instrument(s), if any, dated 2/1/1999 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ Short Certificate(s) i $ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages ( 5 ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ RW-7A 40.00 3.00 15.00 10.00 Donna M. Otto'~°f~-PU~V Attorney TOTAL ............................. $__ _~' ~0¢J Mailed Letters to Attorney: SUSAN H. CONFAIR I.D. No: 70241 Address: 2331 MARKET STREET CAMP HILL PA 17011 Telephone: 717-763-1383 DATE FILED: November Attorney on 11/7/03 7th, 2003 105 112 REV 8,68 (FEE FOR TI-dS CERTIFICATE S2 00' WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. 3OMMONW.~ALTF O¢ PENNSYLVANIA DEPARTI~IENT OF hE Al ]'H VtTAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5386348 April 11, 2003 Date of Issue of This Certification Name of Decedent __ First Sex Female Social Security No. 164-30-5623 Middle Sellers Last Date of Death April 8, 2003 Date of Birth Nov. 20; 1911 Birthplace Altoona, PA Place of Death Race White Marital Status Select Soecialtv HoSDital Occupation Clerk Decedent's Widow --- Mailing Address Informant Donna Crowell Name and Address of Funeral Establishment Cumberland County Camp Hill Oount'¢ City, Borough or Township Armed Forces? (Yes or No) NO R57 Hill_~ide Drive. Caren Hill. PA 17'011 Nur~be~ - Street ' · ' City or Town Funeral Director Richard H. Seater Richard H. Searer Funeral Home, inc., 115 W. 10t" St., Tyrone, PA 16686 Pennsylvania State Part I: Part I1: Immediate Cause (a) Cardiopulmonary Arrest (b) Failure to thdve / Malnutrition (c) Chronic Obstructive Pulmonary. dx (d) Pneumonia Other Significant Conditions Interval Between Onset and Death Manner of Death Natural ~ Homicide [] Accident ~ Pending Investigation [] Suicide Iii Could not be Determined [] Describe how injury occurred: Name and Title of Certfier Claudette Jatto, MD Address_ 207 House Avenue, Camp Hill, PA 17011 (M.D., D.C., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. o -o o Local Registlar of Vita'iT~Records · Distllct NO April 10, 2003 1616 Hamilton Avenue- Tyrone, PA 16686 fiat(, Re~, ,,,ed ,~¥ Lcca Re,}ishar Street Address City Borough, Township 21-2003-927 JAM\WILLS\SELLER.WIL January 28, 1999 LAST WILL AND TESTAMENT OF SARA JANE SELLERS I, SARA JANE SELLERS, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. F_AMILX. I have three children whose names are DONNA LEE CROWELL, DAVID E. SELLERS and JUDITH ANN GREEN. As used in this Will, the terms "my Child" or "my Children" refer to my natural children but shall specifically exclude my daughter, JUDITH ANN GREEN. As used in this Will, the term "issue'' refers to all lineal descendants of the indicated person of all generations, with the relationship of parent and child at each generation determined by the definition of "Children" set forth in this paragraph. 2. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 3. DISPOSITION OF TANGIBLE PERSONAL PROPERTY. I direct my executor to divide my tangible personal property into two parts. The first part shall contain all items that my executor determines to be of no present or future value or use to my Child. The second part shall contain the balance of the personal property. My executor shall dispose of the first part by sale, abandonment, destruction, or gift to any charity or person. The proceeds of any sale shall be added to my residuary estate. All property in the second part I give to my daughter, DONNA LEE CROWELL, if she survives me; if she should fail to survive me, then to her issue, in equal shares. The decision of my executor shall be conclusive and binding on all persons interested in my estate. JAM\WILLS\SELLER.WIL January 28, 1999 4. DISPOSITION OF RESIDUARY ESTATE. I leave all the rest, residue and remainder of the property that I own at the time of my death, both real and personal, and of every kind and description, wherever situate, to which I may be legally or equitably entitled at the time of my death (my "residuary estate") as follows: Ninety percent (90%) of my residuary estate to my Daughter, DONNA LEE CROWELL and Ten percent (10%) of my residuary estate to my Son, DAVID E. SELLERS. PROVIDED THAT, if DONNA LEE CROWELL shall predecease me, then I leave her share to my son-in-law, GARY CROWELL. If he shall fail to survive me, then I leave that share to my grandson, ERRIN CROWELL. PROVIDED THAT, if DAVID E. SELLERS shall predecease me, then I leave his share to his issue, MICHAEL SELLERS, CRAIG SELLERS and KELLY WHITSEL, in equal shares. 5. POWERS OF ADMINISTRATION. 5.1 Grant of Powers. My executor, in the administration of my estate (my "fiduciary") shall have the powers and authorities set forth in this Article 5. These powers and authorities may be exercised by my executor in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 5.2 Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property. 5.3 Transfer of Assets. My fiduciaries shall have the power to sell, transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate at or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciary deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 5.4 ~. My fiduciary shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds, JAM\WILLS\SELLER.WIL January 28, 1999 5.5 5.6 5.7 5.8 5.9 interests in investments, trusts, mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciary deems advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. Power to Hold Property in Nominee Form. My fiduciary shall have the power to hold any property in the name of a nominee or in bearer form. Distribution in Cash or in Kind. My fiduciary shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary. Distribution to Minors and Persons Under Disability. My fiduciary shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciary's judgment is incapacitated. The distributions or payments shall be made in any one or more of the following ways: (1) directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciary. Emplo.vment of Agents. My fiduciary shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciary deems advisable in the administration of my estate. Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any JAM\WILLS\SELLER.WIL January 28, 1999 transaction or the expediency or propriety of any transaction entered into by my executor. 6. PAYMENT OF DEATH TAXES. 6.1 Payment of Estate Taxes. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 6.2 Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will, shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. 7.1 A!~ll~llme~. I name, constitute, and appoint my daughter, DONNA LEE CROWELL, as executor of my estate. If she shall not survive me, shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, GARY CROWELL, my son-in-law, shall act as executor in her place. 7.2 Bond Not Required. The individual named in Paragraph 7.1 shall not be required to furnish a bond for the faithful performance of her duties as executor. 8. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me or another person a person shall not be deemed to have survived me or another person if he or she dies within sixty (60) days of my death or of the death of the other person. 9. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 4 JAM\WILLS\SELLER.WlL January 28, 1999 10. INTERPRETATION. 10.1 10.2 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person acting as my executor, co- executor, or administrator, as the case may be. Number and Gender. If required by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. 10.3 H_e_adiags. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 10.4 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of five (5) typewritten pages, the fir.:~r..~tt four (4) of which bear my signature in the margin for the purpose of identification, this ~,"~- day of February, 1999. S~RA JANF~Ei_,LERS, TESTATRIX Signed, sealed, published and declared by the above-named Testatrix, SARA JANE SELLERS, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subs~nesses. Address Address ~Bt ~ ~, JAM\WILLS\SELLER.WIL January 28, 1999 COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) I, SARA JANE SELLERS, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; 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 A_~qD ACKNOWLEDGED BEFORE ME BY SARA JANE SELLERS, THE TESTATRIX THIS ~'~ DAY OF FEBRUARY, 1999. COMMONWEALTH OF PENNSYLVANIA SARA JANF~sELLERS, TESTATRIX ~0%RY PUBLIC I Notarial Seal Deborah L. Brenneman, Notary Public ) Camp Hill Boro, Cumberland County · SS. My Commission Expires June 18, 2002 COUNTY OF CUMBERLAND ) Meml~r, P~n~ ~a~n o! Notaries WE, ~~.~~ AND~~ ~[~~ , THE WITNESSES WHOSE NAMES ARE~ED TO THE F6REGOI~ INSTRUME~OBEING DULY QUALIF~D ACCO~ING TO LAW, DEPOSE AND SAY THA~WE WE~ PRESENT AND SAW THE AFO~SAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER F~E AND VOLUNTARY ACT FOR THE PU~OSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEA~NG AND SIGHT OF THE TESTAT~ SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONST~INT OR UNDUE INFLUENCE· SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS [~DAY OF FEBRUARY, 1999. ~OTARY PUBLIC Deborah L. Brenneman, Notary Public Camp Hill Bom, Cumberland County My Commission Expires June 18, 2002 Member, Pennsylvania Association of Notaries SARAH JANE SELLERS REAGER & ADLER, PC. 2331 MARKET STREET CAMP HILL, PA 17011-4642 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Sara Jane Sellers Date of Death: April 8, 2003 Will No. 21-03-0927 To the Register: I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on November 7, 2003. Salne Donna Lee Crowell Address 857 Hillside Drive Camp Hill, PA 17011 David E. Sellers 546 Shively Road Huntingdon, PA 16652 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) excep[ N/A Date: November 17, 2003 [~eaaVigder~~AR~~, r~sq~'ire 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative 03118/2004 88:44 7179094939 REAGER & ADLER PC PAGE 01 REAGER & ADLER, PC Theodore A. Adler David W. Reager Charles E. Zaleski Linus £. Fen/cie Debts Den/son Cantor ATTORNEYS AND COUNSELORS A T LA W 2331 Market Street Camp Hi//, PA 17011-4642 Telephone: (717) 763- ~ 383 Telefax: (717) 730-7356 Thomas O. Williams Susan H. Confsir Joanna Hardson Clough Susan J. Smith Date: March 18, 2004 From: Brooke Burlison Same to Follow by Mail: I .... II III ~1 I FACSIMILE COVER SHEET IT o; Ann JFox No.: 717-240-7797 Page(s/ to Follow; I II Message: Please see attached cancel/ed check from Donna Crowell regarding the Estate of Sara J. Sellers. if you have any questions, please feel free to contact me. Thank. _you for your ass/stance! II IIIIIIIII III P/ease cai! Brooke at (717) 763-1383 Ext, ~ 21 if there is any problem in transmission. The information contained in this telefocsimffe is t, ensmi~led by an attorney. It is privileged aR confidential, intended only for the uae of the individual or en~'t¥ named above, ff the reader of this message i; not the Ifl~ed recipient, you are hereby notified that any dissemination, diatribub'on or copying of this communication ]~ strictly prohibited. If this communication has been rec~eived in error, please immediately notify us by telephone, collect if nece~ery, and retl. lm the original message to ge et the above eddre~ vis the U.$. Postal Service (we will reimburse postage). Thank you. Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor OFFICES OF One Coudhouse Square Carlisle, Pa. 17013 (717) 240-6345 FAX (717) 240-7797 t ,egister of tills Ieri of ®rp ans' ourt ~ountp of ~umh£rlanh March 22, 2004 Donna Lee Crowell 857 Hillside Drive Camp Hill, PA 17011 IN RE: Estate of Sara Jane Sellers File No. 21-03-927 Check No. 1 Dear Ms. Crowell: It has been brought to my attention that a tax payment was never credited to your account on the above referenced estate. Please accept this letter as a sincere apology for an inconvenience you may have experienced regarding this matter. A clerical error was located and rectified on the receipt orS 1,402.91. This money has now be applied to your accom~t and reported to the Pennsylvania Department of Revenue. If you have any questions or concerns, please feel free to call. Respectfully, Glenda Famer Strasbaugh Register of Wills and Clerk of the Orphans' Court GFS :maw Cc: Brooke Burlison Reager & Adler, PC COMMONWEALTH OF PENNSYLVANIA DEP; ~TMENT 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 003702 CROWELL DONNA LEE 857 HILLSIDE DRIVE CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 164-30-5623 FILE NUMBER: 21 03-0927 DECEDENT NAME: SELLERS SARA JANE DATE OF PAYMENT: 03/1 9/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 04/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,402.91 REMARKS: - SEAL RECEIVED ON 1/8/04 CHECK#01 TOTAL AMOUNT PAID: $1,402.91 INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~REV~1500 EX~- (6-00) REV-1500 PENNSYLVANIA DEPARTME.T OF REVENUE INHERITANCE RETURN DEPT. 280601 .ARRISBURG, PA 1 128 6Ol RESIDENT DECEDENT 14.1 ~:Oo I- Z Z o UJ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SELLERS, SARA JANE DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 04/08/2003 11/20/1911 (IF APPLrCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE HUMBER 2 1 -0 3 0 9 2 7 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER I 6 4-3 0-5 6 2 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ["'-~ 1. Odginal Retum [--~ 4, Limited Estate r~6. Decedent Died Testate (Attach copy of Will) F--J9. Litigation Proceeds Received F-J2, Supplemental Return m-] 4a. Futura Interest Compramise (date of death after 12-12-82) ['"--~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) [] 10. Spousal Poverty Credit (d~ of beath between 12-31.91 and 1-1-95) '--J 3, Remainder Return (dateofdeathpfiorto 12-13-82) "-J 5. Federal Estate Tax Retura Requirad ~ 8. Total Number of Safe Deposit Boxes [] 11, Election to tax under Sec. 9113(A) (A~ach Sch O) NAME SUSAN H. CONFAIR FIRM NAME (If Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER 717-763-1383 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Beductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 2331 MARKET STREET CAMP HILL 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIBE FOR APPLICABLE RATES 10,367.20. 32,390.99 PA 17011 OFFICIAL USE ONLY (8) 42,758.19 11,582.46 (11) , (12) (13) (14) 11,582.46 31,175.73 31,175.73 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 of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x (15) 31,175.73 x .045 (16) X .12 (17) X .15 (18) ,, (19) 1,402.91 1,402.91 Decedent's Complete Address: STREET ADDRESS 857 HILLSIDE DRIVE CITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty JSTATE PA ZIP 17011 (1) 1,402.91 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 1,402.91 1,402.91 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 ...................................................................................................... [] [] 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, ~ declare that I have examined th s 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 wh ch preparer has any knowledge. SIGNATJo~R~e,OF PERSON RESPONSIBLE FOR FILII~ RETURN DATE ADDRESS 857 HILLSIDE D'RIVE CAMP HILL SIGNATURE OF PREPARER OTHER THAN R.r~I~ESEhJ,TAT.~E / ADDRESS 2331 MARKET STREET CAMP HILL, PA 17011 DATE t- PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9118(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~EV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER SELLERS. SARA JANE 21 03 0927 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 1. INHERITANCE FROM THE ESTATE OF THOMAS F. KEARNEY 9,966.74 REFUND OF HEALTH INSURANCE PREMIUM TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 400.46 10,367.20 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER SELLERS. SARA ,JANE 21 03 0927 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 A. DONNA L. CROWELL 857 HILLSIDE DRIVE DAUGHTER CAMP HILL, PA 17011 JOINTLY. OWNED PROPERTY: LI: ~ ~ ~K DATE DESCRIPTION Of PROPERTY % OF DATE Of DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERE~c 1. A. 1991 PNC BANK - CERTIFICATE OF DEPOSIT 47,496.89 50. 23,748.4,~ 2. A. 1991 PNC BANK - CHECKING ACCOUNT 17,285.08 50. 8,642.5z TOTAL (Aisc enter on line 6, Recapitulation) $ 32,390.9c~ (If more space ~s needed, insert additional sheets of the same size) REV-15~I1 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA I FUNERAL EXPENSES & INHERITANCE TAX RETURN AD ESTATE OF FILE NUMBER ITEM NUMBER Debts of decedent must be reported on Schedule L DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. RICHARD SEARER FUNERAL HOME 7,068.13 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City .. State Year(s) Commission Paid: AttomeyFees REAGER & ADLER, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant DONNA L. CROWELL Zip Street Address 857 HILLSIDE DRIVE City CAMP HILL Relationship of Claimant to Decedent DAUGHTER State PA Zip 17011 Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS Accountant's Fees Tax Retum Preparer's Fees CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING THE SENTINEL - LEGAL ADVERTISING 800.00 3,500.00 68.00 75.00 71.33 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11,582.46 REV~1512 EX + (6-98) ESTATE OF SELLERS. SARA JANE ITEM NUMBER 1. FILE NUMBER ~1 03 Include unreimbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) O927 YALUEAT DATE OF DEATH · REV-1513 EX + (9-00) COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF NUMBER ~[. U. SCHEDULE J BENEFICIARIES FILE NUMBER 21 O3 RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] DONNA LEE CROWELL DAUGHTER 857 HILLSIDE DRIVE CAMP HILL, PA 17011 DAVID E. SELLERS SON 546 SHIVELY ROAD HUNTINGDON, PA 16652 ESTATE 0927 AMOUNT OR SHARE OF ESTATE 90% OF RESIDUAL ESTATE 10% OF RESIDUAL ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 PART [1 - 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) COHNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURg, PA 17118-0601 DONNA L CROWELL 857 HILLSIDE DR CANP HILL PA 17011 ZNFORMATZON NO,_CE AND TAXPAYER RESPONSE FZLE NO. 21 ACN 05135545 DATE 10-02-2003 TYPE OF ACCOUNT EST. OF SARA J SELLERS [] SAVINGS S.S. NO. 164-30-5623 [] CHECKING DATE OF DEATH 04-08-2003 [] TRUST COUNTY CUMBERLAND [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PHC BANK has provided the Department with the information listed beloa which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were m joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE FART 1 BELOW N ~ # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. :51700226229 Data 08-14-2001 Established Account Balance 47,496.89 Percent Taxable X 5 0.0 0 0 Amount Subject to Tax 2:5,748.45 Tax Rata X .045 Potential Tax Due 1., 068.68 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Hake check payable to: "Register of gills, Agent". NOTE: Xf tax payments are made within three (3) months of the decmdent's date of death, you may deduct a 51 discount of the tax due. Any inheritance tax due mill become delinquent nine (9) months after the data of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of ~ ONE ~ Hills and an official assessment will be issued by tho pA Department of Revenue. BLOCK B. [] The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decmdent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART [] below. PART Zf you /nd/cato a d[fforont tax rats, please state your [] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Data Established I 2. Account Balance 2 3. Percent Taxable $ X 4. Amount Subject to Tax 4 $. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Duo 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computation) $ Under penaXt/os of perjury, Z declare that tho facts I have reported above are true, correct and complato to tho best of my knowledge and boX'imf. HONE ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL ~NFORHAT~ON 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSNENT aith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. 5. A joint account is taxable even though the decedent's name mas added as a matter of convenience. q. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife aero than one year prior to death are nat taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable ~ully. REPORTING [NSTRUCTIONS- PART ! TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Rills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15q8 EX) upon receipt of the return froa the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dacedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt Z80601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and coeplata Parts Z and 3 according to tho instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Rills of the county indicated. The PA Department of Revenue mill issue an official assessment (Fora REV-15~8 EX) upon receipt of the return from the Register of gills. TAX RETURN - PART 2 - TAX CONPUTATION LINE 1. Enter the date the account originally aaa established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (l) year of death arm taxable fulZy as transfers. However, there is an exclusion not to exceed $3,000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (aa) appears before your first name in the address portion of this notice, the S3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the dacadent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 PERCENT TAXABLE JOINT ORNERS SURVIVING JOINT ONNERS Example-' A joint asset registered in the nasa of the decedent and two other persons. I DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the dacedant's death er accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ORNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 31. 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line ~). 7. Enter the appropriate tax rata (line 7) as determined below. Date of Death Spouse Lineal Sibl[ng Collateral 07/01/9q to 12/$1/9q 01/01/95 to 06/30/00 OX 6X 15Z 15Z 07/01/00 to prosont OX q.SZ~ 12X aTha tax rate imposed on tht net value of transfers from a younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether ar not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes ali other beneficiaries. CLAINED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIHED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COHHON#EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-15q$ EX AFP (09-00) DONNA L CROWELL 857 HILLSIDE DR CAMP HILL PA 17011 INFORMATION NO._CE AND TAXPAYER RESPONSE I FILE NO. 21 ACN 031555q6 DATE 10-02-2005 TYPE OF ACCOUNT EST. OF SARA J SELLERS [] SAVINGS S.S. NO. 16q-$0-5625 [] CHECKING DATE OF DEATH 0~-08-Z005 [] TRUST COUNTY CUMBER LAND [] CERTIF. REMIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PHC BANK has provided the Department aith the information listed bmloN which has bean used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1BELOH N N N SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 51~OZ83q55 Date 01-29-1991 Established Accoun~ Balance 17,285.08 Percen~ Taxable X 5 0.0 0 0 Aaoun~ Sub~ec~ ~o Tax 8,6~2.5q Tax Ra~e X . Po~en~ial Tax Due 388.91 To insure proper credit to your account, tHO (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the dacadent's data of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the data of death. PART TAXPAYER RESPONSE i. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of ~ ONE ~ Mills and an official assessment ail1 be issued by the pA Depart.ant of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be iliad by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions ware paid by you. You must cowplete PART [] and/or PART [] below. If you indicate a differen~ ~ax ra~e, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established i PART TAX LINE 2. Account Balance 3. Percent Taxable ~. Amount SubSect to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under pmnalties of parjur~, I declare ~hat the facts I have reported above are true, correc~ and complete ~o the best of ay knowledge end belief. HOME C ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedant's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter cf convenience. q. Accounts (including those held betaaen husband and wife) which the decedent put in joint names within one year prior to deaU1 are fully taxable as transfers. 5. Accounts established jointly bet#men husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - If tho information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15q8 EX) upon receipt of the return from the Register of Wills. Z. BLOCK D - If the asset specified on this notice has been or mill be reported and tax paid aith the Pennsylvania [nharitanca Tax Return filed by the decadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign cna copy and return to the PA Oapartaent of Revenue, Bureau of Individual Taxes, Dept 260601, Harrisburg, PA 17128-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to tho instructions beloa. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Mills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally ams established or titled in the manner existing at date of death. NOTE: For a decadent dying after 11/11/81: Accounts which the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (a~) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted free the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the dacedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT OMNERS SURVIVING JOINT O#NERS Example: A joint asset registered in the name of the decadent and two other parsons. I OIVZDED BY 5 (JOINT OMNERS) DIVIDEO BY Z (SURVIVORS) = .167 X 1nO = 16.77. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the dacedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OMNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = ROI (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line ~). 7. Enter the appropriate tax rate (Line 7) as determined below. De~e of Death Spouse Lineal Sibling I Collateral 07/01/9~ ~o 12/$1/9~ 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ OX ~.~X~ 12Z NThe tax rate imposed on the net value of ~..~ a ,/ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparant of the child is The lineal class of heirs incIudas grandparents, parents, children, and Llneal descendents. "ChtIdran" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes ail children of the natural parents end their descendents, whether or not they have been adopted by others, adopted descendents and thelr descendants and step-descendants. "Siblings" are deflned es individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ara determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed lust bo itemized fully in Part 5. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. LAST WILL AND TESTAMENT OF SARA JANE SELLERS I, SARA JANE SELLERS, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. ~. I have three children whose names are DONNA LEE CROWELL, DAVID E. SELLERS and JUDITH ANN GREEN. As used in this Will, the terms "my Child" or "my Children" refer to my natural children but shall specifically exclude my daughter, JUDITH ANN GREEN. As used in this Will, the term "issue" refers to all lineal descendants of the indicated person of all generations, with the relationship of parent and child at each generation determined by the definition of "Children" set forth in this paragraph. 2. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 3. DISPOSITION OF TANGIBLE PERSONAL PROPERTY. I direct my executor to divide my tangible personal property into two parts. The first part shall contain all items that my executor determines to be of no present or future value or use to my Child. The second part shall contain the balance of the personal property. My executor shall dispose of the first part by sale, abandonment, destruction, or gift to any charity or person. The proceeds of any sale shall be added to my residuary estate. All property in the second part I give to my daughter,. DONNA LEE CROWELL, if she survives me; if she should fail to survive me, then to her issue, in equal shares. The decision of my executor shall be conclusive and binding on all persons interested in my estate. January 28, 1999 4. DISPOSITION OF RESIDUARY ESTATE. I leave all the rest, residue and remainder of the property that I own at the time of my death, both real and personal, and of every kind and description, wherever situate, to which I may be legally or equitably entitled at the time of my death (my "residuary estate") as follows: Ninety percent (90%) of my residuary estate to my Daughter, DONNA LEE CROWELL and Ten percent (10%) of my residuary estate to my Son, DAVID E. SELLERS. PROVIDED THAT, if DONNA LEE CROWELL shall predecease me, then I leave her share to my son-in-law, GARY CROWELL. If he shall fail to survive me, then I leave that share to my grandson, ERRIN CROWELL. PROVIDED THAT, if DAVID E. SELLERS shall predecease me, then I leave his share to his issue, MICHAEI4 SELLERS, CRAIG SELLERS and KELLY WHITSEL, in equal shares. 5. POWERS OF ADMINISTRATION. 5.1 Grant of Powers. My executor, in the administration of my' estate (my "fiduciary") shall have the powers and authorities set forth in this Article 5. These powers and authorities may be exercised by my executor in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 5.2 Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property. 5.3 Transfer of Assets. My fiduciaries shall have the power to sell, transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate at or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and cOnditions, including selling price and credit, in such manner, and for any reason that my fiduciary deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 5.4 Investment. My fiduciary shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds, interests in investments, trusts, mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciary deems advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 5.5 5.6 5.7 5.8 Power to Hold Property in Nominee Form. My fiduciary shall have the power to hold any property in the name of a nominee or in bearer form. Distribution in Cash or in Kind. My fiduciary shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary. DistribUtion to Minors and Persons Under Disability. My fiduciary shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciary's judgment is incapacitated. The distributions or payments shall be made in any one or more of the following ways: (1) directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciary. Employment of Agents. My fiduciary shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciary deems advisable in the administration of my estate. 5.9 Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 6. PAYMENT OF DEATH TAXES. 6.1 6.2 Payment of Estate Taxes. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will, shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. 7.1 Allgo. intment. I name, constitute, and appoint my daughter, DONNA LEE CROWELL, as executor of my estate. If she shall not survive me, shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, GARY CROWELL, my son-in-law, shall act as executor in her place. 7.2 Bond Not Required. The individual named in Paragraph 7.1 shall not be required to furnish a bond for the faithful performance of her duties as executor. 8. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me or another person a person shall not be deemed to have survived me or another person if he or she dies within sixty (60) days of my death or of the death of the other person. 9. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 4 10. INTERPRETATION. 10.1 10.2 10.3 Successors of Fiduciaries. All pronouns referring to an executor and the' term "executor" shall be construed to mean any person acting as my executor, co- executor, or administrator, as the case may be. Number and Gender. If required by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. tteading~. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 10.4 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of five (5) typewritten pages, the fk_~t four (4) of which bear my Signature in the margin for the purpose of identification, this~'- day of February, 1999. S~RA JANF~Ei.,LERS, TESTATRIX Signed, sealed, published and declared by the above-named Testatrix, SARA JANE SELLERS, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subs~nesses. Address C:~ t ~xa,,~~ Address a~B[ ~ 5 COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) I, SARA JANE SELLERS, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; 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 A_~qD ACKNOWLEDGED BEFORE ME BY SARA JANE SELLERS, THE TESTATRIX THIS I"~t'DAY OF FEBRUARY, 1999. , COMMONWEALTH OF PENNSYLVANIA 1~0"~ RY PUBLIC Notarial Seal Deborah L Bmnneman, Notary Public ) Camp Hill Bom,'Oumbefland County : SS. My Commlsalon E~lms June 18, 2002 COUNTY OF CUMBERLAND ) Member, I~nnaytvenla ~o~t~o. o! Notaries THE WITNESSES WHOSE NAMES ARE.$.L~ED TO THE F6REGOI~D3 INSTRUME-Ng0BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THATWE WERE PRESENT AND SAW THE AFORESAID TESTATRIX 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 TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS ]~ DAY OF FEBRUARY, 1999. ~ WI~N SS D ~ d(~OTARY PUBLIC' ' INotarial Seal Deborah L Brenneman, Notary Public Camp Hill Bom, Cumberian(I County My Commission Expires June 18, 2002 Member, Pennsylvania Association of Notaries INVENTORY Estate of SELLERS, SARA JANE also known as. , Deceased No. 21 03 0927 Date of Death 4/8/03 Social Security No. 164305623 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: SUSAN H. CONFAIR 2331 MARKET STREET CAMP HILL PA 17011 Personal Representative: Dated Telephone: 717-763-1383 Stocks & Bonds Description Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property INHERITANCE FROM THE ESTATE OF THOMAS F. KEARNEY REFUND OF HEALTH INSURANCE PREMIUM (Attach Additional Sheets if necessary) Total Value 9,966.74 400.46 10,367.20 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory SELLERS, SARA JANE Pa,qe 1 21 03 0927 Description of Inventory Real Estate Description Value Subtotal $ Grand Total $ 10,367.20 BUREAU OF TNDIVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMHON~/EALTH OF PENNSYLVAN.rA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT RE¥-1607 EX AFP (01-05) f,;~ DATE 0q-19-200~ ~'; ; ESTATE OF SELLERS SARA DATE OF DEATH 0~.-08-Z005 F.rLE NUNBER Z1 05-09Z7 '04 APR 26 P1 :}~ COUNTY CUMBERLAND SUSAN H CONFATR ACN 101 REAGER & ADLER I Amoun~ Remi~ed 2551 HARKET ST L,~ .:: CANP H~LL PA ~0~[~,:. MAKE CHECK PAYABLE AND REH'rT PAYMENT TO: J REG]'STER OF NTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 NOTE: To /nsure proper credi~ ~o your account, subm/~ ~he upper portion of ~his fore wi~h your ~ex payment. CUT ALONG TH'rS L.rNE ~ RETA.rN LO~/ER PORT.rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~x~ ZNHER.rTANCE TAX STATEMENT OF ACCOUNT ESTATE OF SELLERS SARA J F.rLE NO. 21 05-0927 ACN 101 DATE 0R-19-200~ THZS STATEHENT ZS PROVZDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHO#N BELOW/ ZS A SUNNARY OF THE PRZNCZPAL TAX DUE, APPLZCATZON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE, A PROJECTED /NTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 05-08-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 1,~02.91 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-19-Z00~ CD005702 .00 1,~02.91 BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-20-200~ ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT" (CR), TOTAL TAX CRED'rT 1,~02.91 BALANCE OF TAX DUE .00 .rNTEREST AND PEN. 10.96 TOTAL DUE 10.96 YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR ZNSTRUCT/ONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payabla to tha name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may bm requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of #ills, any of the 25 Revenue District Offices or from the Department's Zq-hour answering service for forms ordering: 1-DOO-36Z-Z050; services for taxpayers with special hearing end / or speaking needs: 1-800-447-$020 (TT only). REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060[, Harrisburg, PA [7[gD-060[, phone (7[7) 787-6S0S. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid befora January ID, [996, the first day after the and of the tax amnesty pariod. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to fha date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (DZ) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which wilI vary from caIandar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 20Z .000S48 1988-1991 11Z .000301 2001 1983 16Z .000438 199Z 9X .000Z47 2002 1984 llg .000301 1993-1994 7Z .000192 2003 1985 13Z .000556 1995-1998 92 .000247 2004 1986 IOZ .000274 1999 7Z .O0019Z 1987 9Z .000247 2000 8Z .000219 Interest Daily Rate Factor 92 .000247 62 .000164 5Z .0001S7 4Z .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIJBER OF DAYS DELINQUENT X DALLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF /NDIVZDUAL TAXES ZNHERITANCE TAX DTVTS]ON DEPT. 180601 HARRISBURG, PA 17118-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF ZNHER/TANCE TAX APPRA/SENENT, ALLOWANCE OR D/SALLO#ANCE OF DEDUCT/OHS AND ASSESSNENT OF TAX REV-l;47 EX &FP C01-05) SUSAN H CONFAIR REAGER A ADLER 2331HARKET ST CAHP HILL *04 MAR-5 DATE 05-08-2004 - ESTATE OF SELLERS DATE OF DEATH 04-08-2005 FILE NUNBER 21 05-0927 COUNTY CUHBERLAND P3 242ACN 101 Amoun~ Remitted I SARA J HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SELLERS SARA J FILE NO. 21 03-0927 ACN 101 DATE 03-08-2004 TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNTNG FUTURE TNTEREST - SEE REVERSE APPRA/SED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) 3. Closely Held Stock/Par~nership Interes~ (Schedule C) (3) 4. Nortgages/No~as Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) ($) 6. Joln~ly Ovned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expanses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9) 10. Dabts/Nor~gaga Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Na~ Value of Tax Ra~urn 15. 14. Charitable/Governmental Bequests; Non-elec*ed 9113 Trus*s (Schedule J) Na~ Value of Estate Sub~ec~ ~o Tax .00 .00 .00 .00 10~$67.20 32/390.99 .00 (8) 11,582.46 .0O NOTE: To insure proper cradi~ to your account, submi~ the upper portion of ~his form wi~h your ~ax payment. 42,758.19 NOTE: ASSESSHENT OF TAX: 15. Amoun~ of Line 14 a~ Spousal ra~a 16. Amoun~ of Line 14 ~axable et Lineal/Class A rate 17. Amoun~ of Line 14 et Sibling ra*e 18. Amoun~ of Line 14 taxable at Calla*oral/Class B ra~e 19. Principal Tax Duo TAX CREDITS: PAYNENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) (11) 11.582.46 (la) 31,175.73 (13) .00 (14) 31,175.73 Z'f an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect flgures that include the total of ALL returns assessed to date. (15) .00 x O0 = .00 (16) 31,175.73 x 045 = 1,402.91 (17) . O0 x 12 = . O0 (18) .00 X 15 = .00 ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE (19)= 1,402.91 INTEREST IS CHARGED THROUGH 05-25-2004 AT THE RATES APPLICABLE AS OUTLINED ON THE .00 1,402.91 11.57 1,414.48 REVERSE SIDE OF THIS FORH ~F PAID AFTER DATE ZNDZCATED~ SEE REVERSE ( IF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT ZS REQU[RED. FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ~NSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE= PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred in possession ar enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate far life or for years, the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laeful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit Nith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, NhJch Nas not requested on the Tax Return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special 24-hour ensnaring service for forms ordering: 1-B00-362-Z050~ services for taxpayers Nith special hearing and ! or speaking needs= 1-B00-447-3020 (TT only). Any party in interest nat satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shoNn on this Notice must object Nithin sixty [60} days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlOZ1, Harrisburg, PA 17128-1021, 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 RevieN Unit, Dept. 280601, Harrisburg, PA lTiZB-060l Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid Nithin three (3) calendar months after the dscadent's death, a five percent (52) discount of the tax paid is allowed. The 152 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 Nould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning Nith first day af delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes Nhich became delinquent before January l, 1982 bear interest at the rata of six (62) percent per annum calculated at a daily rate of .000164. All taxes Nhich became delinquent on and after January 1, 1982 ail1 bear interest at a rate which Nill vary from calendar year ta calendar year Nith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rata Factor 1982 207. . 000548 1987 92 . 000247 1999 77. · 000192 1983 162 .000¢38 1988-1991 IIZ .000301 2000 82 .000219 1984 llZ .000301 199Z 92 .000247 ZOOl 92 .000247 1985 132 .000356 1993-1994 72 .000192 2002 62 .000164 1986 107. .000274 1995-1998 9Z .000247 2003 52 .000157 --Interest is calculated as folloNs: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Nill 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. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/03/2005 CONFAIR SUSAN H 2331 MARKET ST CAMP HILL, PA 17011 RE: Estate of SELLERS SARA JANE File Number: 2003-00927 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. 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: 4/08/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge cJ PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Sara Jane Sellers Date of Death: April 8. 2003 File No.: 21-03 0927 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 ofthe estate is complete: Yes X No 2. Ifthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: C. Did the personal representative state an account informally to the parties in interest? Yes No X D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:- 3/1 Lf/o5 Wk~ Susan H. Confair, Esquire Reager & Adler, P.C. 2331 Market Street Camp Hill, P A 17011 (717) 763-1383 Counsel for Personal Representative j