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Home My WebLink About03-0477HERSHEY TRUST COMPANY' s~AN s. hmo,om TRUST T~ MANAGER (717) 520-1105 · F~(717) 520q111 March 9, 2004 Cumberland County Courthouse Register of Wills 1 Court House Square Carlisle, PA 17013 RE: Edna Durbeck File Number: 21-2003-0477 Gentlemen: Enclosed are the PA Inheritance Tax Returns for Edna H. Durbeck, deceased. A copy of the return is provided for filing with the Commonwealth of Pennsylvania. A check in the amount of $473.10 representing the payment on the balance of Pennsylvania Inheritance Tax due is enclosed. If you have any questions, please contact me at 717-520-1105. Sincerely, Trust Tax Manager 100 MANS1ON ROAD EAST · P. O. Box 445 · HERSHEY, PENNSYLVANIA 17033-0445 · (717) 534-3225 *, FAX (717) 520-1111 PLEASE DETACH KEEP THIS VOUCHER AS YOUR RECORD. DEPOSIT OUR CHECK ONLY. Account 2404 Edna H. Durbeck Allocation PA Inheritance Tax-Principal Desc~pti0n:Add']_ tax due for PA Inheritance Tax Payee: Cumberland Co., Register of Wills, Agent Credit: Edna H. Durbeck File ~ 21-2003-0477 HERSHEY TRUST COMPANY HERSHEY, PENNSYLVANIA 17033-0445 TRUST COMPANY PENNS'i'LV, q~m 17033 2402 Edna H. Durbeck T/U/A.~.~r~ :' c<'7~ .:.-_:.-:;~!. _~qtllti0 Pennsylvania Inheritance Tax Payt for Edna H. Durbeck - SSN: 134-28-2240 ~;0: Zbt 0t U~/14 m. Paid For: 14275807 03/O9/O4 $472.10' Cumberland Co., Register of Wills, A!;j~r~t; Credit: Edna H. Durbeck File # 21-2003-0477 065787 HER'sH~Y, f'e~nsYew~n~a 17033 0 ~ ~ 7 8 8 2402 Edna H. Durbeck T/U/A Administration Expense Filing Fee for PA Inheritance Tax Return Paid For: 14275808 ~ "¢.~--~ ~,,_~i~_aqu. illC3 $15.oo* ~O:Zld Ol ~t~ Cumberland Co., Register of Wills, COMMONWEALTH OF PENNSYLVANIA DE~ARTMENT 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 003662 HERSHEY TRUST COMPANY ROBERT K REITZEL VP/TR OFFICER 100 MANSION RD EAST PO BOX 445 HERSHEY, PA 17033-0445 ........ ford ESTATE INFORMATION: SSN: 134-28-2240 FILE NUMBER: 2103-0477 DECEDENT NAME: DURBECK ENDA H DATE OF PAYMENT: 03/10/2004 POSTMARK DATE: 03/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/10/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $472.10 101 $1.00 REMARKS: CHECK# 69663/65787 SEAL TOTAL AMOUNT PAID: $473.10 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS HERSHEY TRUST COMPANY ROBERT K. REITZEL VICE PRESIDENT AND TRUST OFFICER (717) 520-1109 rreitzel@hersheytmst.com q77 June 10, 2003 Register of Wills of Cumberland County Cumberland County Court House High and Hanover Streets Carlisle, PA 17013 Re: Estate ofEnda H. Durbeck ':"' 'Tri~.. SS# 134-28-2240 Dear Sir or Madam: We enclose with this letter a payment on account of Pennsylvania Inheritance Transfer Tax for the late Edna H. Durbeck who expired on March 10, 2003. As there are no probate assets, the Last Will and Testament will not be probated. The residue of the estate passes entirely to the two sons of the decedent. We are estimating the estate assets at $145,000. At 4.5% tax rate, the tax would be 6,525 less a 5% discount of $326.25. Therefore, our check in the sum of $6,198.75 is enclosed with this letter. Mrs. Durbeck died at Messiah Village in the township of Upper Allen. Sincerely, Vice President & Trust Officer RKR/lp Enclosure 100 M^NSION ROaD EaST * P. O. BOX 445 · HERSHEY, PENNSYLV^NI^ 17033-0445 * (717) 534-3225 · FAX (717) 520-1111 * www. hersheytrust.com HE~I:~HEY, I:'ENNSYLV/~IIA 17033 06578 2402 Edna H. Durbeck T/U/A '~ Administration Expense Filing Fee for PA Inheritance Tax Return Paid For: Cumberland Co., Register of Wills, Ag~.r~ !:~:~: ' ~:~t:,.iO:~9~ 14275808 03/09/04 $~5.oo* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002664 HERSHEY TRUST COMPANY ROBERT K REITZEL VP/TR OFFICER 100 MANSION RD EAST PO BOX 445 HERSHEY, PA 17033-0445 ........ fold [-ESTATE INFORMATION: SSN: 134-28-2240 FILE NUMBER: 2103-0477 DECEDENT NAME: DURBECK ENDA H DATE OF PAYMENT: 06/10/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/10/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 J $6,198.75 REMARKS: TOTAL AMOUNT PAID: HERSHEY TRUST COMPANY C/O ROBERT K REITZEL VP/TR OFF $6,198.75 SEAL CHECK#061151 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS 2402 Edna H. Durbeck T/U/A Pennsylvania Inheritance Tax L~::,'- Prepayment of PA Inheritance Tax for Estate of Edna H/Durbeck Paid For: ~: ['cJ 0[ ~Jll" ['0. Register of Will, Agent 14105264 06/10/03 $6,198.75' REV-1500 FrmJ((6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUI',n~ CODE -- 2003 0477 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Durbeck, Edna H 134-28-2240 UJ DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DC-YEAR) TI-IS RETURN MUST BE FILED IN DUPLICATE WITH THE U.I 03/10/2003 6/3/06 REGISTER OF WILLS III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER uJ oo I- z uJ z O Z I-. ,< I,- n O I x 11 m Original Return ~ 2. Supplemental Return r'~ 3. Remainder Return (date of death prior to 12-13-82) ~-~ 4. Limited Estate [~ 4a. Future Interest Compromise (date of death after 12-12-82) ~-~ 5. Federal Estate Tax Return Required ~--"] 6. Decedent Died Testate (Attach copy of Will) J'~ 7. Decedent Maintained a Living Trust (Attach copyof Trust) -- 8. Total Number of Safe Deposit Boxes ~'~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between 12-31-9t and t-~-~) ['~ 1 1. Election to tax under Sec. 9113(A)(Attach Sch O) TiS SEGTION MUST BE COMPLETEDi ALE ~ES~NDE~ ~D cON~E~ 'T~ iNFORMATION SHOU~ BE DIRECTED TOi NAME Hershey Trust Company FIRM NAME (If Applicable) TELEPHONE NUMBER 717-520-1105 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnemhip or Sole-Proprietomhip (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property(Schedule F) (6) [~ Separate Bilfing Reduested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) COMPLETE MAILING ADDRESS PO Box 445 100 Mansion Road East Hershey, PA 17033 0. 0.00 0.0'0 0.00 166,714.18 ~ OFFc~L US~NLY 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) 6,617.59 8,849.80 (11) (12) (13) (14) 170,980.68 15,467.39 155,513.29 0.00 155,513.29 SEE INSTRUCTIONS ON EEVERSE SIDE FOR APPLICABLE RATES 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 1 7. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate. 19. Tax Due 0.00 x.00__ (15) 0.00 155,513.29 x .045 (16) 6,998.10 0.00 0o00 x .12 (17) 0.00 0.00 x .15 (18) 6,998.10 (19) 20. 2W4645 1.000 Decedent's Complete Address: ~IA~ADDRE~ 100 Ht Allen Drive Cl~ STAT I ZIP Mechanicsburg PA I 17055 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 0.00 6,198.75 326.25 0.00 0.00 (~) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 6,998.10 6,525.00 0.00 473.10 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4?3 o 10 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; ......... E~] c. retain a reversionary interest; or ................................ E~ 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 secudty at his or her death? ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ [~ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. DATE SIGNORE OF PREPARER O~ER NAN REPRESENTA~VE Hershey, PA 17033 DATE For dates of death on or after July 1, 1994 and before January 1, 1996, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. § 9916 (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 im posed 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 stepparant 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. § 9116(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. W4646 1.000 CG~MMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002664 HERSHEY TRUST COMPANY ROBERT K REITZEL VP/TR OFFICER 100 MANSION RD EAST PO BOX 4.45 HERSHEY, PA 17033-0445 ........ fold ESTATE INFORMATION: SSN: 134-28-2240 FILE NUMBER: 2103-0477 DECEDENT NAME: DURBECK ENDA H DATE OF PAYMENT: 06/10/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/10/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 -')6,198.75 REMARKS: TOTAL AMOUNT PAID: HERSHEY TRUST COMPANY C/O ROBERT K REITZEL VP/TR OFF $6,198.75 SEAL CHECK# 061151 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS TAXPAYER ~-~,'ss is to ccrti£y that the infbrmadon here given is correcdv copied fi'om an (,riginal certificate of' death duly filed with me as I.,~cal Re, gistrar. The original certificate will be forwarded to') thc State Vital P, ccords (3f'fice for permanent f~Jing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8921025 No. COMMONWEALTH OF PENNSYLVANIA ,, OEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH '. Edna H. Durbeck L Femal4, 134-- 28- 224j~ March in "~n03 ,,, -Mkdi~aTS~ketawl Education / ~Q ~Q x I "~/ ~,~ I '~--~' ] ....... ~TUA 17a. aa. ' ,~ ~~ Unner Allen Twp 100 Mt. Allen Drive ~ ~ .. Mechanicsburg. Pa. 17055 Adolph Hohl Cumberland ~. Mary Scherer 19 Bragg Drive East Berlin, Pennsylvan a 17316 ~,~-~.~ Conolite Cremato~ ]~,. Schaefferstown Pa. 17088 FD-O12755-L I~,. Myers Funeral Home, Inc. 37 East Main Street Mechanicsburq, Pa 1 / REV-I;;;,08 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF FILE NUMBER Durbeck, Edna H 21-2003-0477 Include the ~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 2W46AD 2000 DESCRIPTION Cash refund from GE Life and Annuity Assurance Co Coin collection and paper money per attached appraisal at D & S Coins Personal property and household goods per attached appraisal from Linden Hall Antiques TOTAL (Aisc enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 18.50 3,443.00 805.00 $ 4,266.50 'Customer's Order No. SOLD TO ADDRESS SALESMAN CASH CHARGE QUAN I) & S COIl, S 224 FOURTH STREET NEW CUMBERLAND, PA. 17070 (7]7) 774-4182 C.O.D. TERMS, PAID OUT RETD. MDSE. RECD. ON ACCT. DESCRIPTION PRICE AMOUNT BUYING · SELLING · APPRAISING · TRADING COINS · CURRENCY ° GOLD o SILVER 224 FOURTH STREET NEW CUMBERLAND, PA 17070 ALL Claims and Returned Goods MUST be accompanied By This Bill SIGNATURE To: From: Re: Robed K. Reitzel Hershey Trust 100 Mansion Road East Hershey, PA 17033 William G. Rowe, Appraiser 211 Old Stone House Rd. Carlisle, PA 17013 Personal Property Appraisal Estate of Edna H. ~)urbeck Lake Meade, PA Date: May 22, 2003 LINDEN HALL ANTIQUES 211 OLD STONE HOUSE ROAD CARLISLE, PA 17013 717-249-1978 Appraisal of personal property stored at: 19 Bragg Ddve, Lake Meade, PA Drop leaf table Tea table Wash stand Trunk Vanity Upholstered chair Lamps Yellow ware mold Foot stool Family paintings Cups/saucers Silver plate items Flatware Mirror Luggage Pdnts Glass/stemware Knick knacks Small appliances Pattern glass Misc. household Pocket watches (2) Costume jewelry $165.00 $150.00 $95.00 $25.00 $30.00 $15.00 $25.00 $15.00 $10.00 $5O.OO $10.00 $15.OO $25.OO $2.OO $4.00 $10.00 $16.00 $25.00 $8.00 $20.00 $15.00 $50.00 $25.OO TOTAL $805.00 William G. Rowe Burbeck Appraisal 05122/2003 t REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Durbeck, Edna H 21-2003-0477 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION Of PROP~-K i Y % OF ITEM INCU. E3E THE NNVE OF Tt-E 'i3~NqSFEREE THEIR RELATIONSHIP TO DECEDF_NT AND'I3-1E DA3E OF TRANSFE~ ATTACH A COPY OF THE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMB ER DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 1. Revocable Trust Agreement of 166,714.18 100.00 0.00 166,714.18 Edna H. Durbeck, deceased, dated May 14, 1998 as emended October 22, 1998. (See attached list of assets) TOTAL (Also enter on line 7, Recapitulation) $ 1 6 6,7 14.18 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 Edna H. Durback 21-2003-0477 PA Inheritance Tax Schedule G Item #1 - Edna H. Durbeck RevocableTrust Agreement dated May 14, 1998 with First Amendment to Revocable Trust Agreement dated October 22, 1998 Unit Item Description Cusip Value Value at date of Death 1 137 units Common Trust Fund - Fixed Income 2 17,925.85 units Temporary Investment Fund Accrued interest to date of death 1086.0226 1.00 148,785.09 17,925.85 3.24 TOTAL VAL U E 166,714.18 REV-I~I 1 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & A D M IN ISTRATIVE COSTS COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Durbeck, Edna H 21-2003-0477 Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. 10 yNERAL~XPENSE~: ers muneral Home Inc 37 East Main Street Mechanicsburg, PA 17055 DESCRIPTION Donald C Durbeck, MD - reimbursement family gathering following services Donald C Durbeck, MD - reimbursement charges for services for expenses for for minister's ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: AttorneyFees Neme.' McNees Wallace & Nurick Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationshipof ClaimanttoDecedent ~obate F~s Accountant'sFeas Name: Hershey Trust Company Ts Return Preparers Fees Hershey Trust Company - fiduciary services through 4/30/03 Linden Hall Antiques - appraisal fee Hershey Trust Company - fiduciary fees 2/29/04 Hershey Trust Company - preparation of 2003 income tax returns from continuation pages .... through final life TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 3,337.00 708.03 200.00 0.00 742.00 0.00 0.00 750.00 0.00 208.33 85.00 192.23 175.00 220.00 6,617.59 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) Estate of: Durbeck, Edna H Schedule H, Part A -- Funeral Expenses Item No. Description Barre Memorials services provided for inscription Page 2 21-2003-0477 Amount 120.00 TOTAL. (Carry forward to main schedule) ...... 120.00 Estate of.' Durbeck, Edna H Schedule H, Part B -- Administrative Costs Item Description 11 Filing fees Page 2 21-2003-0477 Amount 100.00 TOTAL. (Carry forward to main schedule) ...... 100.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Durbeck, Edna H 21-2003-0477 Include unreimbursed medical expenses. ITEM NUMBER 2 3 5 9 10 DESCRIPTION PharMerica - balance due statement dated 2/28/03 Verizon balance due on account Messiah Village - balance due for nursing home care Hershey Trust Company - fiduciary services through 2/28/03 Messiah Village - balance due for nursing home care per statement dated 3/31/03 PharMerica - balance due on account per statement dated 3/31/03 Hershey Trust Company - fiduciar~ services through 3/31/03 Hershey Trust Company - preparation of 2002 federal and state income tax returns Verizon - balance due on final statement Messiah Village - dry cleaning cost from January 2003 TOTAL (Also enter on line 10, Recapitulation) AMOUNT 1,105.79 13.82 4,825.?5 208.33 1,570.00 538.53 208.33 350.00 19.85 9.40 $ 8,849.80 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Durbeck, Ecb"ta H 21-2003-0477 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLEDISTRIBUTIONS[inclu~ ~tdghtspousaldi~d~tions, andtmn~em underS~.9116(a)(1.2~ Durbeck, Donald C 19 Bragg Drive East Berlin, PA 17316 Durbeck, Richard C 277 Lakeside Drive Hancock, NY 13783 Son Son 77,756.65 77,756.64 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DIS'~ ~<~BUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) 10/22/98 WILL OF EDNA H. DURBECK I, EDNA H. DURBECK, of Cumberland County, Pennsylvania, declare this to be my will and hereby revoke all prior wills and codicils made by me. 1. Residue. I bequeath, devise, and appoint all of my property, of whatever nature and wherever situated, including property over which I hold a power of appointment, to HERSHEY TRUST COMPANY as Trustee of that Revocable Trust Agreement established by me as Settlor on May 14, 1998, as amended, to be held by said Trustee and added to and administered as part of the Trust established by said Agreement. Said Trust is in existence as of the date of execution of this Will, and it is my intention, if necessary to validate the foregoing gift to the Trustee, to incorporate herein by reference its terms and any amendments thereto. 2. Survival. If any beneficiary should die within sixty (60) days after me, then he or she shall be deemed to have predeceased me for all purposes of this will. 3. Spendthrift Clause. No interest (whether in income or principal, whether or not a remainder interest, .and whether vested or contingent) of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her said interest, nor shall the said interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries for any liability of such beneficiary, whether such liability arises .from his or her debts, contracts, torts, or other engagements of any type. 4. Powers. In addition to such other powers and duties as may be granted elsewhere herein or which may be granted by law, my fiduciaries hereunder shall have the following powers and duties, without the necessity of notice to or consent of any court: (a) To retain all or any part of my property, real or personal, in the form in which it may be held at the time of its receipt, including any closely held business in which I have an interest and the stock of any corporate fiduciary hereunder, as long as in the exercise of their discretion it may be advisable so to do, notwithstanding that said property may not be of a character authorized by law. (b) To invest and reinvest any funds held hereunder in any property, real or personal, including, but not by way of limitation, bonds, preferred stocks, common stocks and other securities of domestic or foreign corporations or investment trusts, mortgages or mortgage participations, mutual funds with or without sales or redemption charges, and common trust funds, even though such property would not be considered appropriate or legal for a fiduciary apart from this provision. (c) To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at the time held by them, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and for such price as they may determine, and to convey such property free of all trusts. (d) To borrow money from any person, including any fiduciary hereunder, for any purpose in connection with the administration hereof, to execute promissory notes or other obligations for amounts so borrowed, to secure the payments of such amounts by mortgages or pledges of any property, real or personal, which may be held hereunder. (e) To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, and to such persons, firms, or corporations as they may deem advisable. (f) To renew or extend the time for payment of any obligation, secured or unsecured, payable to or by them as fiduciaries, for as long a period or periods of time and on such terms, as they may determine, and to adjust, settle, and arbitrate claims or demands in favor of or against them. (g) In dividing or distributing any property, real or personal, included herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind. (h) Without limitation of powers elsewhere granted therein, to hold, manage and develop any real estate which may be held by them at any time, to mortgage any such property in such amounts and on such terms as they may deem advisable, to lease any such property for' such term or terms and upon such conditions and rentals as they may deem advisable, whether or not the term of any such lease shall exceed the period permitted by law or the probable period of retention under this instrument; to make repairs, replacements and improvements, structural or otherwise, in connection with any such property, to abandon any such property which they may deem to be worthless or not of sufficient value to warrant keeping or protecting, and to permit any such property to be lost by tax sale or any other proceedings. (i) To employ such brokers, banks, custodians, investment counsel, attorneys, and other agents, and to delegate to them such duties, rights and powers as they may determine, and for such periods as they think fit. (j) To register any securities at any time in their own names, in their names as fiduciary, or in the names of nominees, with or without indicating the trust character of the securities so registered. (k) With respect to any securities forming a part of the trust, to vote upon any proposition or election at any meeting of the corporation issuing such securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, merger, voting trust, consolidation or exchange, and to deposit any such securities with any committee, depository, trustee or otherwise, and to pay out of the assets held hereunder, any fees, expenses and assessments incurred in connection therewith, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any such reorganization, readjustment, merger, voting~trust, consolidation, exchange or exercise of conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. '(1) To exercise all elections which they may have with respect to income, gift, estate, inheritance and other taxes, including without limitation election to deduct expenses in computing one tax or another, and election to pay or to defer payment of any tax, in all events without their being bound to require contribution from any other person. 5. Taxes. I direct that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, other than generation-skiPping taxes, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration, and all other property includible in my taxable estate for federal or state tax purposes, whether or not passing under this will, shall be free and clear thereof; provided, however, that my executor may in the discretion of my executor request that any portion or all of said taxes (to be paid out of the principal of my general estate) shall instead be paid out of the principal of any trust established by me, to the extent expressly authorized under the terms of said trust. - 3 - 6. Fiduciaries. I appoint as executor hereunder HERSHEY TRUST COMPANY. My executor shall serve as guardian of the property of any minor beneficiaries hereunder, under any instrument of trust executed by me, under any policies of insurance on my life, and in any other situation in which the power to make such appointment exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary. No fiduciary named herein shall be required to furnish bond or other security for the proper performance of duties hereunder. 7. Gender. Unless the context indicates otherwise, any use of the masculine gender herein shall also include the feminine gender. IN WITNESS WHEREOF, I, EDNA H. DURBECK, herewith set my hand to this, my last Will, typewritten on five (5) sheets of paper including the attestation clause and signatures of witnesses, this 22nd day of October, 1998. Edna H. Durbeck (SEAL) Witnessed: ~/~ k~- //~~' residing at ~~~J~ - 4 - COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF ~._~ ~ I, EDNA H. DURBECK, the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by EDNA DURBECK, the testatrix, this 22~d day of October, 1998. ~ENNSYLV~IA -[ .... ' -- COMMONWEALTH OF PENNSYLVANIA COUNTY OF -~;m SS: We, Richard W. Stevenson, Jn~ ~ ~Qoo~ and 25-e~£ ~.-~i¢1~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act of the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and'under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Richard W. Stevenson, A~-~. ~oor~ and - 5 - October, 1998. witnesses this ~%~ day of Wftness Wit. s ~-~ ~/% ~ RICHARD W. STEVENSqN, ESQUIRE PENNSYLVANIA · COMMONWEALTH OF PENNSYLVANIA COUNTY OF -'~¼;~ SS: On this, the 2~ day of October, 1998, before me A~¢~ ~. ~o~o , the undersigned officer, personally appeared RICHARD W. STEVENSON, ESQUIRE, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgment and affidavit were signed by the testatrix and witnesses. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~. · ~ NOTAR~ C I NOTARIAL SF..AL ANGELA M. ALONZO, NOt~y Public Harrisburg, PA Dauphin Coanty My Commission Expires Oct 26, 2000 - 6 - COPY REVOCABLE TRUST AGREEMENT THIS TRUST AGREEMENT, made the 14th day of May, 1998 between Edna H. Durbeck of Hershey, Dauphin County, Pennsylvania, (herein called Settlor), and Hershey Trust Company, of Hershey, Pennsylvania, and its successors, (herein called Trustee), WITNESSETH THAT: I. Trust Property. The Settlor does hereby transfer and deliver to the Trustee the property listed on the schedule annexed hereto, to have and to hold the same, and any cash, securities or other property which the Trustee may, pursuant to any of the provisions hereof, at any time hereafter hold or acquire, all of such property being herein referred to as the trust estate, in trust, for the uses and purposes and upon the terms and conditions following: 2. Dispositive Provisions. The Trustee shall hold, manage, invest and reinvest the trust estate, and shall collect the income thereof and dispose of the net income and principal as follows: (a) During the lifetime of the Settlor, the Trustee shall pay to or for the use of the Settlor such amounts ~'rom the income of the trust estate as he shall request. Any income not so distributed may be accumulated and invested in the same manner as the corpus of' the trust estate. In addition to the income, there shall be paid to the Settlor or applied for his use out of the corpus, at any time and from time to time, such amounts, if any, as the Trustee in its discretion shall determine to be necessary for his 'maintenance, medical, dental, surgical, nursing, hospital, institutional and psychiatric care, comfort and welfare. In addition to such discretionary invasions of principal, the Trustee shall pay to Settlor at any time and from time to time such portion or all of the principal as he may request for any purpose including gifts to others. (b) Upon the death of Settlor, to distribute the trust estate to Settlor's personal representative to be disposed of in accordance with Settlor's will or applicable law. (c) The primary purpose and intent in creating this trust is to provide for the income beneficiary. The rights and interests of remaindermen and/or the Settlor's Estate are subordinate and incidental to that purpose. The provisions of this Agreement shall be construed liberally by the Trustee in the interest and for the benefit of the income beneficiary. 3. Additional Property. The Settlor may at any time or from time to time transfer and deliver to the Trustee cash, securities and any other property to be added to the trust estate. All such property hereafter delivered and transferred to the Trustee by Settlor shall be held, administered and disposed of by the Trustee in accordance with the provisions of this Agreement without the execution of any further instrument or declaration. 4. Accounting by Trustee. The Trustee may at any time render an account to the income beneficiary, whose written approval shall be final, binding and conclusive upon all persons then or thereafter interested in the trust estate. The Trustee may also at any time render a judicial account of its administration. 5. Security. No bond or other security shall be required of the Trustee in this or any other jurisdiction. 6. Successor Trustees. No change in name of the Trustee hereunder nor any merger of its corporate powers with another corporation shall affect its appointment or powers hereunder. The Trustee or any of its substitutes or successors may at any time resign the trust. -2- Whenever in this Agreement reference is made to Trustee, such reference shall be deemed to include not only the Trustee expressly named herein, but also any and all substitutes and successors at any time qualified and acting hereunder, and all rights and powers given in this Agreement to the Trustee shall be vested in substitute and successor trustees. 7. Payments to Persons Under Disability. Whenever income or principal hereunder is to be paid to a person under legal disability, or to a person not adjudicated incompetent but who by reason of illness or mental or physical disability is unable in the opinion of the Trustee properly to administer such payments, then payment may be made (a) directly to such beneficiary; (b) to the legally appointed guardian or representative of the beneficiary; (c) to some near relative of the beneficiary to be applied for the benefit of the beneficiary; or (d) by expenditure by the Trustee directly to those furnishing property or services to the beneficiary. The receipt of any of the foregoing shall be a complete discharge to the Trustee which shall not be bound to see to the application of any such payment. 8. Situs. This Agreement and trust estate shall be governed and construed in all respects according to the laws of the Commonwealth of Pennsylvania. 9. Powers. Without regard to any legal restrictions otherwise applicable to Trustees, the Trustee and its substitutes and successors are authorized and empowered in their sole and absolute discretion to exercise the following discretionary powers as well as any other powers conferred by law: (a) To retain, whether originally a part of the trust estate or subsequently acquired, and to purchase or otherwise acquire and to retain, any property, whether -3- or not such property is authorized for investment under the Pennsylvania Fiduciaries Investment Act of 1949 or by other law, all without diversification as to kind and amount. (b) To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon or otherwise dispose of any property at any time held by them, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and conditions, with our without security, and for such price as they may determine. (c) To hold any part of the trust estate in cash or uninvested for any period deemed advisable. (d) To borrow money for any trust purpose, create a security interest in, or pledge all or part of the trust estate to secure such borrowing without incurring any personal liability therefor. (e) To pay, extend, renew, modify or compromise, upon such terms as they may determine, and upon such evidence as they may deem sufficient, any obligations or claim, including taxes, either in favor of or against the trust estate. (f) To register any securities at any time in their names as Trustee, or in the names of nominees, with or without indicating the trust character of the Securities so registered. (g) With respect to any securities held hereunder, to vote upon any proposition or election at any meeting of the person or entity issuing such securities, and to grant proxies, discretiona~ or otherwise, to vote at any such meeting, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any reorganization, readjustment, merger, voting trust, consolidation, exchange or exercise of -4- conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (h) To make allotments or distributions in kind. 10. Amendment and Revocation. Settlor may any time and from time to time amend, modify or revoke this trust in whole or in part. 11. Attorney to Acknowledge. Hershey Trust Company hereby appoints Robert K. Reitzel as its attorney-in-fact to acknowledge this Agreement before any officer authorized to take such acknowledgement. 12. Compensation of Trustee. Trustee shall receive compensation for its services under this Agreement at the same rate as is charged from time to time by Trustee in accordance with its published fee schedule for performing as trustee of revocable agreements of trust of approximately the same size and complexity as the within Trust. IN WITNESS WHEREOF, this Agreement has been executed by the Settlor and Trustee on the date first above mentioned. WITNESS: ATTEST: ~ssis~t S~:cretary EDNA H. DURBECK HERSHEY TRUST COMPANY By: Vi~ce ~residet~ ar(~ -5- Schedule "A" Common Stock Number of Shares Description Market Value 28O Bankers Trust New York Corp $34,5480.00 Preferred Stock 100 Central Hudson Gas & Electric 7,012.50 Certificates of Deposit 10,330.83 18,367.92 6,342.95 18,504.46 10,726.39 35,846.68 18,230.57 65,149.89 37,402.55 AmSouth Bank C/D #7114050768 AmSouth Bank C/D #3287728405 NationsBank C/D #02885070 SunTrust C/D #00000010526 AmSouth Bank C/D #7113334646 NationsBank C/D #0500000029 AmSouth Bank C/D #3002752190 Barnett Bank C/D #4141580 AmSouth BankC/D #7113324010 10,330.83 18,367.92 6,342.95 18,504.46 10,726.39 35,846.68 18,230.57 65,149.89 ~7,40_.55 FIRST AMENDMENT TO AGREEMENT OF TRUST BY THIS FIRST AMENDMENT, executed on October 22, 1998, EDNA H. DURBECK, as Settlor, and HERSHEY TRUST COMPANY, as Trustee, hereby amend the Agreement of Trust between them dated May 14, 1998, as follows: 1. Section 2(b) of the Trust is hereby deleted and the following provision is hereby inserted in its place: "(b) Upon the death of the Settlor, all of the property then he~d hereunder, together with any additional property as shall pass into this Trust under the terms of the Settlor's will, shall be distributed to the Settlor's issue, per stirpes." 2. In all other respects, the said Agreement of Trust shall remain unchanged. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment on the date first set forth above. WITNESS: SETTLOR: Edna H. Durbeck J (SEAL) TRUSTEE: HERSHEY TRUST COMPANY BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-1547 EX AFP (01-05) HERSHEY TRUST COHPANY 100 HANSION RD EAST PO BOX HERSHEY PA 17033 DATE 04-26-2004 ESTATE O"r ' DURBECK 'DATE OF DEATH 05-10-200:5 FZLE NUHBER 21 05-0477 Aj-~'~C~J~TY? ] :~_. CUHBERLAND101 ~ Amoun~ / ENDA H HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WTLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LOWER PORT~ON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRA/SEHENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF DURBECK ENDA H FZLE NO. 21 05-0477 ACN 101 DATE 04-26-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Esta*e (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Znteres~ (Schedule C) ~. Hortgages/Notas Racalvabla (Schedule D) 5. Cash/Bank Daposits/Hisc. Persona! Property (Schedule E) 6. Joln~ly O~nad Property (Schedule F) 7. Transfers (Schedule E) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPT/ONS: 9 Funeral Expanses/Adm. Costs/Hisc. Expanses (Schedule H) 10 Debts/Nortgage Liabilitias/L1ens (Schedule I) 11 To,al Deductions 12 Nat Value of Tax Return (1) . O0 NOTE: To insure proper (2) . O0 credit to your account, ($) . O0 submit the upper port/on (~) . O0 of this fora w/th your ($) 41266.50 tax payment. (6) .00 (7) 166z714.18 (8) 170,980.68 (9) (10) 6,617.59 8~849.80 (~2) 155,515.29 NOTE: Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:5) Nat Value of Estate Sub~ect ~o Tax (1~) Zf an assess;ant ~as issued pr*-=viously, 11nas 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lfi at Spousal rata 16. Amount of Line lq taxable at Lineal/Class A rata 17. A,oun~ of Line 1~ at Sibling rata 18. Aeount of L/ne lq taxable at Collateral/Class B ra~a 19. Principal Tax Due TAX CREDZTS: PAYHENT RECELPT DXSCOUNT (+) DATE NUHBER ZNTEREST/PEN PAZD (-) 06-10-2005 CD002664 $26.25 05-09-2004 CD005662 .00 .00 155,515.29 05-10-2004 18 and 19 will (~5), .00 x O0 = .00 (16). 155,515.29 X 045 = 6,998.10 (~7). .00 x 1Z = .00 (18), .00 x 15 = .00 (19)= 6,998.10 ANOUNT PAZD BALANCE OF UNPAID INTEREST/PENALTY AS OF 6,198.75 475.10 TOTAL TAX CREDZT BALANCE OF TAX DUE[ ZNTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL ZNTEREST. 6,998.10 .00 4.95 4.95 ( IF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS REQU'rRED. TF TOTAL DUE 1'S REFLECTED AS A 'CREDTT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORN FOR ZNSTRUCTTONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND [CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY= INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z1~0 of the Inheritance and Estate Tax Act, Act Z3 of 2000. (TZ P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF RILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-X313). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-56Z-Z050; services Eot taxpayers with special hearing and / or speaking needs: 1-800-~7-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloeance of deductions, or assessment of tax (including discount er interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171ZB-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bm addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. 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 within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the tot;1 of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated et a daily rate of .00016~. All taxes which became delinquent on and after January 1, 198Z mil! bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200~ ere: Interest Daily Interest DaJ. ly Year Rate Factor Year Rate Factor 1982 ZOZ .0005~8 ~J~'8-1991 11x .000301 1983 16Z .000~58 1992 9Z . oooz~7 198q 11Z .000301 1993-199~ 7Z . OOOl9Z 1985 13Z .0003S6 1995-1998 97. . O00Z~7 1986 lOX .OOOZ7~ 1999 7Z .00019Z 1987 IOZ .000ZT~. ZOO0 7Z . Ooozgz --Xnterest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~ 9X .OOOZ~7 ZOOZ 6Z .00016~ ZOO3 SZ .000137 ZO0~ ~Z .000110 X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made a;tar the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003886 ........ fold HERSHEY TRUST COMPANY ROBERT K REITZEL VP/TR OFFICER 100 MANSION RD EAST PO BOX 445 HERSHEY, PA 17033-0445 ESTATE INFORMATION: SSN: 134-28-2240 FILE NUMBER: 2103-0477 DECEDENT NAME: DURBECK ENDA H DATE OF PAYMENT: 04/30/2004 POSTMARK DATE: 04/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/1 0/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4.95 REMARKS: TOTAL AMOUNT PAID: $4.95 SEAL CHECK# 067055 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF 'rNDZVZDUAL TAXES TNHERITANCE TAX DIVZSZON DEPT. 280601 HARRZSBURG,, PA 171Z8-0601 HERSHEY TRUST COMPANY 100 MANSION RD EAST PO BOX qq5 HERSHEY COHHONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX '04 ~?~ 30 PA 1705~ i~L DATE Oq-Z6-ZO0~ ESTATE OF DURBECK DATE OF DEATH 03-10-2003 FZLE NUNBER 21 05-0~77 COUNTY CUHBERLAND :A~N 101 J Amoun* Remi*~ed I~EV-I~,I7 EX AFP c01-0S) ENDA H MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGZSTER OF WILLS CUMBERLAND CO COURT HOUSE CARLZSLE, PA 17013 7033 0 6 7 0 5 ~ 2402 Edna H. Durbeck T/U/A .' Filing Fees Late fee assessed for PA Inheritance Tax Retu~ni: Paid For: Register of Wills, Agent Re: 21-03-0477 cumberland County Court House Carlisle PA 17013 14306866 04/29/04 $4.95* HERSHEY TRUST COMPANY 100 MANSION ROAD EAST - P.O. Box 445 H E RSHEY, PENNSYLVANIA 17033 -0445 682500=37o APR 3 ~ 72 ,~A~LED FRO~/{ZIP CODE ~GISTER OF WILLS C~MBE~AND CO COURTHOUSE CA. ISLE, PA 17013 ' r .... i F-pffr,IEfBO~E5/ U.S. POSTAGE PB5551821 29 2004 iF033 17ot3+3323 o2 i,,,iii,,,ili,,,,,,li,,li,,,ll,,,li,,,i,i,,il,i,i,,i,h,i,i,,l CERTIFICATION OF NOTICE UNDER RULES $.6(a) Name of Decedent: Date of Death: Will No: Lou Ann Good May 13, 2004 21-04-0477 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 July 22, 2004: William B. Harral 937 Factory Street Carlisle, PA 17013 Leslie B. Mathieson 1185 Latrobe Drive Annapolis, MD 21401 Notice has now been given to all persons entitled thereto under Rule 5.6(a)except: No/~xceptions. Date: July 22, 2004 ~~~/~~ Ro~ld E. Johnson,~E/~]e 78/West Pomfret St~,,St Carlisle, PA 17013-- Phone: 717-243-0123 Capacity: Counsel for personal representatives 1~"? '-' ~ ~0~0 BUREAU OF INDIVIDUAL TAXES ~[NHERTTANCE TAX DTV/SZON DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1617 EX &FP (01-05) HERSHEY TRUST COMPANY 100 MANSION RD EAST PO BOX qq5 HERSHEY PA 17055 DATE 06-01-Z00q ESTATE OF DURBECK DATE OF DEATH 05-10-2005 FILE NUMBER 21 0~5-0~77 COUNTY CUMBERLAND ACM 101 I Amoun~ Rmmi ~c~ced ENDA H MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper crmdi~ ~o your account, submi~ ~hm upper portion of ~his form wi~h your ~ax pmyeen~c. CUT ALONG THIS L'rNE 1~* RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ESTATE OF DURBECK ~x INHERITANCE TAX STATEMENT OF ACCOUNT ~xa ENDA H FILE ND. Z1 05-0q77 ACN 101 DATE 06-01-Z00q THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELON ZSA SUMMARY OF THE PRZNCZPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: Oq-Z6-ZOOq PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 6,998.10 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) $26.25 06-10-2005 05-09-200q Oq-$O-ZOOq CD00266q CD005662 CD005886 .00 q.95- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE 1S LESS THAN $1, MO PAYMENT 1S REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 6,198.75 q73.10 q.95 TOTAL TAX CREDIT 6,998.10 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF HILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: CONHONNEALTH OF PENNSYLVAN/A. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: Z-800-562-2050; services far taxpayers with special hearing and / or speaking needs: 1-800-447-501D (TT only). REPLY TO: Ouestions regarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601, phone (717) 787-6S05. DISCOUNT: Zf any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. PENALTY: The 151 tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. A11 taxes which became delinquent an and after January 1, 1981 will bear interest at a rate which will vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z004 ara: Interest Daily lntarest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 201 .000548 1988-1991 111 .000301 Z001 91 .000247 1985 16Z .000~38 1992 91 .000247 ZOOZ 6Z .00016~ 1984 111 .000301 1993-1994 71 .O00X9Z Z005 51 .000137 1985 131 .000556 1995-1998 91 .000247 2004 41 .000110 1986 101 .000Z74 1999 71 .OOOleZ 1987 91 .000147 ZOO0 81 .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DBLZNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.