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HomeMy WebLinkAbout02-0739PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~ ^rn .. C~~S~~ No. (~I `~~ - 7 3 9 also known a To: Register of Wills for the Deceased. County of Caw,-~c~s-~~v~.~. 'n the Social Security No. ~_l - ©~ - `~'~ ~~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of a e or older an the execut~t`(1'E~Q-~'R~~. ~~'~=b~1a~ in the last will of the above decedent, dated ~ - ~_ ~t.~ , 19 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~~-~~~~ ~.~~ County, Pennsylvania, with h last family or principal ~idence at ~ <~"S~ _ . ~ :r,,,~_~~ - ~ (list street, number and muncipality) Decendent, then ~,_ ~-. years of age, died Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: '~ R Decendent at death owned property with estimated values as fallows: (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 situated as follows: $ o~.~-} O ~O O a . O cJ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~~' ~ cs, (testamentary; administr on .a.; administration d.b.n.c.t.a.) theron. v~ x~ ~.o ~ ._ ~~ v~ ~o a ' nq OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF Ctunberland ~` ~s The petitioner(s) above-named swears} or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirr~~~h and before me this Donna M. Otto, ~"~ot 12egister of Wills i1 .~-~ subscribed dayy of °q' ~9x Z002 R' a ' R i " eg s r NO. 11 ~UU~-/.~y Estate of 1 M. carson ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August 16th ~ 2002 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 4th, 1998 described therein be admitted to probate and filed of record as the last will of Opal M. Carson , and Letters PGtamPnta,-fir --- are hereby granted to Mary Ann Harshbarger FEES Probate, Letters, Etc. ......... ~ ~~n nn Short Certificates( 6) .......... ~ 18.00 Renunciati n ................ $ x-Pages ~5) ~ JCP TOTAL X308.00 Filed Au~sut 16th, 2002 Register of Wills ~G2 ~ L,,~l:.~~c~' Donna M. Otto, acting Register of Wills Thomas D.Gould, Esquire ~3~Sv~ ATTORNEY (Sup. Ct. LD. No.) 2 cast Main Street, ADDRESS Shiremanstown, PA 17011 (717) 731-1461 PxoNE Mailed Lettez-s to >r~ecutrix on August 16, 2002 his is to terrify that. the information here given is correctly copied from an olr(>inal certificate of death duly filed with me as LL>cul Registrar. The original certificate will be forwarded to the Stare Vital Rcwrds Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8386261 No. ~ ,~ Rey ve7 N OF ~~ 2 e- ~9TMfNT Q~~tiPll ~` r'rJ v ~ xr LUU late COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • 41TAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT (F,rsr. M,Odle. Lastl ~_.~ ~ ~ ~ SE% SGCIAL SECURITY NUMBER DATE OF DEATH ,MCnN. Day, read ~• U a~ M. Ccu(~on 3• fema.~e ~- 207 - 07 - 8509 ~- Au u~~t 8, 2002 _ AGE (Last e+trway) UNDER 7 YEAR UNDER t OAY DATE OF BIRTH BIRTHPIACE (C•ry and PUCE OF DEATH ICnecl, only nne - ,ee ~nwtwlar,s,m ether vMl ,MOrxh. Oay,'~eetl ~lalep FCregn L'ounnyl MonNa I Days Flours . Marutp - -- HOSPITAL: OTHER: 10-25-1919 Hcvln~bun PA 82 Y° w twrn^ EWOrapak.ra DDA^ "~,,'"'"'9a ^ Rsadanul~ aso~"tayl^ . g, , , s _ COUNTY OF DEATH CRV, BOHO. TWP OF DEATH FACILR,' NAME (II not in9~Meln. give Slreel antl number, NNS ECEDENy OF HISPANIC ORIGIN? D RACE -Amancan Indwn, 81ack, MR,Ra. ste. R t No C3 Mn ^ n yae, wacM CYDan ISpech) ' Cumbeh~and Cowen A b~en T(UP 40 (U~ 2 2~ am Penn Dn~ ve , ;'""'"~P""'°R~'"•"° ~e tVh~ ,b. . k- ,d- . . . ,,. . DECEDENT'S USUAL OCCUPQION KIND OF BUSINE$SIINDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MMITAL STATUS-Hamad SURVIVING SPOUSE (Give landdwork done dxvg U. S. ARMED FOR ES? C S , on n ode tom ed Navw Mango, Widowed, pl wne, give rtw,den rurtral d waaaro 6h; M na use retied ~xa- p ~, Yse ^ No CY ENmantary/Secondary Cowge Drvorcad ($pecny) ton Veh~e~e en Ma S ta te o PA '°'~' "a"$" 10 (U~daw • ~ m~.n ,,.. „b. • ~ :. ,~. ,.. ,~. DECEDENT'S MAILING ADDRESS (Scree. COy/rp.m,SUr.Zp Cadel DECEDENT'S PA ~ Cowen A den lT d d li dn Y 40 (V~~2~.am Penn Dn.~ve Iwp C. ea, .c. .N ye R~ETS OUENCE lTa.suta a~ecsa«a Camp H~..~~, PA 17011 ~~e;" Cumbeh hand t'~,;,~p? Np. Md.dNn w.d ^ ,~, witnnt xTUallmnad cnytmro i7b. Gorr ,7d. FQHER'S NAME (Fist. Mode. Last) MOTHER'S NAME IFwsl. M,ddle. Ma Wen Surname) Hanny C GJeaven G.2adye Kneb~ . „- „- INFORMANT'S NAME (Type~PrnQ INFQRMANT'S MA41NG ADDRESS ISaeM. Cnyfww.,, Stee. Zp Cadel ~ P t C ~ 8 122 C t D d FL 335 ~ en~ cveo ann e~ 30.. mon oo .ve nan on 1 n 11 :Bb. METHOD OF DISPOSITION Btrriel^ Cnma,an~ RerrovalMOmSIW^ DATE OF OISPOStT10N IMOre+.DeYMaar) PLACE OF DISPO ION - N pl C ry. Crams q aotnNPlxa Cnema~(.Un"'"~oe.ce`~y ob LtJC/QION ~ CnylTown, Stan. Zq Cade ^ °""k"'~ Dlnrespeteyl PA Cnerna~ton Hana~~bun PA 17109 ' SIGNATURE UNEMLSERV `ILENSEE RaONACTINGASSUCN IIGENSENUMBER NAMEANOADORES$OFFACILITYC~IemaL•(.Un oe~.e .y a ' 33.. ' :3b. na.4100 Jane~~tawn Road Hcvcn~~sbun PA 17109 Conp4ta name 23ac wuy when can,rying b ttre Gat d my Mnowl•dge. loam occurred at the urns, date and pace uated. LICENSE NUMBER DATE SIGNED physrcwn 4 nd wanada N tmre OI Math to ISiOnatur Title) (MOnlh, Osy, Mead calM uu+e d Math. ~ ;, _s R ~ ~ ~ ` T Sae. . Iv z3b. _) Olo - • L xx. O QG - Rama 2a~28 mrW G completed Ity IME OF ATH DATE ONOUNCED DEAF (Mann, Day. Year) YMAS C REFER r h th M REO70 MEDICAL EXAMI ER/CORONERT o pronourKaa pa son w a . v 8 a o:~ ~ ~ N S "" ~ t3tt z.. M :s. ,,. 31. PANT I: Enter IM disaasas. injuries ar COrrIplKalrmS which Wused tG Math. Do not amb IM rr,oM o1 dymq, 5uC11 as carduc or respnalory arrest, stbca or bean lanew. ~ Appoavnata PART N: OUNr agniBaM corldeiora oodribWlnp b Math, but Liar only ono cause on earn ins. ~ irdaml between nd nstr4ittq in tM tardarlyirg Data given n PART I. IYYEOUTE CAUSE (Fnal t °"~ ar,0 Maur ' dsaasea candnm ! ` raauerrg rn deaml --+ a. `~ "2~~ /~l ~~ /'1.~(.~ ~ / /`~ ~ ~ /n•• A Dl1E (OR AS A CONSEQUENCE OFD: ~~ ' " - ~ ' . ~~ .r C ~<% f?A •" u Z 1. n U r= `i-t Saatwrriaay lit wr,dniona b. [ •'E it arh, I•edarguamweiaM DUE 70 (OR ASACONSEOUENCE OF): I taut. Erner IINOERLYRaG , CAUSE IOseaseavyury c. • s ~ e m a DUE iO (OR A$ACONSEOUENCE OF): )~T ata ea l i d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF IWURY IWURY AT WORKS DESCRIBE 110W IWURY OCCURRED. PERFORMED? AWIUBLE PRIOR 10 (Mmm. Day. Pearl ~ ION OF CAUSE Nat r l ~ H id ^ H u a omv: a Yw ^ 1i1o ^ AttrMru ^ PerWirp Investigation ^ ^ ^ ~ i i ^ ^ 70e. 30b. M. 300. 30d. Yas No Yea No Srr c ea Could not M deNrmmed PUCE OF IWURY ~ Al Noma, larm, skeal, taclory, otfKa LOCATION (Skeet C,ry/iovn. Slats) Ouileinq, ec. ISpec,Nl 2M. 2ab. 39. 34. 301. CERTIFIER ICneck only anal $IGNAi DTITLE OF CERTIF R 'CERTIFYING PHYSICIAN fPhys,c,an cerdyrnq evuse d dean when andner pnvs,c~an nos prorqunced deem ono can(Meled nem 231 T d O t f k Nd ^ ~ ° ra ea o my rgw ga, deem occurred dw b Ura cau•e(al and manner sa atatM ... . ...................................... ........ ... ~ 1"~ 710. >'vt~ r-~~ - 'PRONOUNCING AND CERTIFYING PHYSICIAN IPhysrcan born ~rono,rr,cing seam andcMnymglo caused dead+l LICENSE NUMBER _ GATE SIONED(MOM.OaY Mead ~ . ~'~ To the Mat of my knowledge, OeaM oeturred a, Ora Wrra, dale, antl place, and due to lM cause(s) and manner as staled .......................... ~ ~ / j~ 31 ~ ,5 ~ 7,d. GJ" l 2 s~(J U T/ _ NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH Item 27) T ype a Print ~~ 'MEDICAL EXAMINER/CORONER On the 0aaia f eaa tnetl n a Uor i ti i i li i d h ` -7"JL. ~~p.s 7C.L1~F ,E ~G ~n / l7U ' ru nvea ga o m o on, n my op on, eat n occurred a1 the Ilma, date, and place, and due to the cause(s) and .... manner a atated........... ......................... ..... ........... ........ .. . ^ ,,(/ _; .. /,. ~ l- '' i ~ A ~ ~ . .. ....... . 3,a. . . ~~ ~ T /G LL tLGia, ~~~~~1• ~i>,=~~ v. v 33 ,~I/.,.~~sai/~Ti REG/I'S7TRAR'S SIGNATURE AND N/UMBER ~/ /~ DATE FILED IMOnth, Oay. Yaarl 1 LAST WILL AND TESTAMENT OF OPAL M. CARSON ~~~~~~~ v ~~~ I, OPAL M. CARSON, currently residing at 5 Sussex Road, Camp Hill, Cumberland County, Pennsylvania 17011, being of sound mind, memory and understanding do hereby make and publish this my Last Will and Testament hereby revoking all previous Wills and Codicils made by me. Item I. I order and direct that all of my just debts, funeral expenses and inheritance taxes may be paid as soon as conveniently possible immediately after my death. Item II. I give and bequeath all my property of any kind, wherever located to be distributed in the following manner. Item III. I give and bequeath all of my Real Estate, personal property and assets of whatever kind and wheresoever located, equally to my dear friends, Harold and Mary Ann Harshbarger. Item IV. Should both of the Harshbargers not survive me, in that case, I give and bequeath my entire estate equally, per capita, to the children of the Harshbarger. Item V. I hereby nominate and appoint my trusted friend, Mary Ann Harshbarger, to be the Executrix of my estate. If she is unable or unwilling to serve, I appoint Harold Harshbarger. If he is unable or unwilling, I appoint Mellon Bank. Item VI. I direct that the Executrix or Executor appointed under this Will shall not be required to post any bond or provide any security to serve in that capacity. ITEM VII. I confer on my Executrix, in addition to those powers granted by law, the following powers to be exercised in a prudent manner and applicable to all property constituting a part of my estate: A. To retain and to invest in all forms of real and personal property, without being confined to investments authorized by a statutory list, without being required to diversify and regardless of any principle of law limiting delegation of investment responsibilities by executors or trustees; B. to compromise claims and to abandon any property which, in my executrix's opinion, is of little or no value; C. To sell at private or public sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; D. To borrow from anyone, even if the lender is an executor hereunder, and to pledge property as security for repayment of the funds borrowed; 2 E. To join in any merger, reorganization, trust or other concerted action of security holders, and to delegate discretionary duties with respect thereto; F. To employ and to rely upon the advice given by investment counsel, to delegate discretionary authority to make changes in investments to investment counsel, and to pay investment counsel reasonable compensation in addition to any fees otherwise paid to my executrix; G. To employ a custodian, to hold property unregistered or in the name of a nominee (including the nominee of any institution employed as custodian), and to pay reasonable compensation to the custodian in addition to any fees otherwise payable to my executrix; H. To procure and carry at the expense of my estate insurance of kinds, forms and amounts deemed advisable by my executrix to protect my estate and my executrix against any hazard; I. To commence or defend at the expense of my estate any litigation affecting my estate deemed advisable by my executrix; 3 ~. To conduct alone or with others any business in which I am engaged or in which I have any interest at my death, with all the powers of any owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry out such business; and K. To distribute in cash or in kind. IN WITNESS WHEREOF, I, Opal M. Carson, have to this my Last Will And Testament hereunto set my hand and seal this ~~ day of /~1~~ Opal M. Carson 4 SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, OPAL M. CARSON, as and for her Will, in the presence of us who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereto set our hand as witnesses: NAME /i'J~n'la .r ~ _ (~JO~,c~ RESIDING AT ~ ~ L~1 . /lea i~ S I ~'~ = 1' ~~ //'PM ~Y~/ STt~W~7~ ~A ~ 7©!~ NAME 1~°~ - ,~~ ~V (Y1 ~~RESIDING AT ~~ ~~QS~~ M4'vt _C~rep.7` ~~ ~ ~ ~~z~/r~~.t/yr ~ftt 17otC 5 STATE OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, OPAL M. CARSON, to law, acknowledge that I Will, and that I signed it purposes therein expressed. having been duly qualified according signed the foregoing instrument as my as my free and voluntary act for the M. SO We, having been duly qualified according to law, depose and say that we were present and saw OPAL M. CARSON sign the foregoing instrument as her Will; that she signed it as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and at her request signed the Wi11 as witnesses; and that to the best of our knowledge she was at the time 18 years or more of age, of sound mind, and under no constraint or undue influence. Witness j Witness Subscribed, sworn to, or affirmed, and acknowledged before me by the above-na~n~ed testatri a d b the witnesses whose names appear, on this ~ _ day of 1998• Notar Pub1iG,lotarialSeal Leola M. Gould, Notary Public Shiremanstown Boro, Cumberland County 6 My Commission Expires Spril d, ~OOb E\'1500D(6-j(1) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128,0601 r'_ I I '-'~-6;J- '0 REV-1500 U~;C c:\~;~ I- Z W C W U W C DECEDENT'S NAME (LAST FIRST AND MIDDLE INITIAL) INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ,~ L- O.a.. COUNTY CODE YEAR .0. Q 'L 3. '1.. NUMBER SOCIAL SECURITY NUMBER :1(, )- en - 3501 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) o 7 Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death betwee~ 12-31-91 and 1.1-95) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) !;j: D Separate Billing Requested ..J :J 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G or L) t:l. Total Gross Assets (tolal Lines 1-7) <( 8. U Funeral Expenses & Administrative Costs (Schedule H) W 9. 0:: 10 Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I} 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) DATE OF BIRTH (MM,DD,YEAR) ~I 'tlc",- Ie 0<"11') (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, Mm MIDDLE INITIAL) lA"lrso....... ) ()D DATE OF DEATH (MM'DD'YEAR) ('f) D 3. Remainder Return id~te o' oea:hpriorto 12-13-82) o 5. Federal Estate Tax Return Required 8_ Tolal Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) {Attach SenO) I-hrshh',Jt" J-.j a rshba ~:rr, Teo.::AU.CORRESPONDE.NCE Al!ijj~AAlPli!i(up; !'TAJ(illlFoRMATION SHOOLD~8E tllRECTEDTO:'i' COMPLETE MAILING ADORESS 1$10 (w/~", RI C''''flI/.1l, f'1i /7c'// rPA (1) (2) (3) (4) (5) r w >- ~~(f) u"'" wo.u :roo u"'''' 0.'" 0. " IX] 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Wi I!) D 9. Litigation Proceeds Received 7 ~ C>o<J ./L/!.'i-L9t.'ZL- (6) (7) (8) 42,/'11...7]__ >- z w o z o 0. '" W '" '" o u THIS~.CT)ON MUST liE"C.OMe, NAME (9) (10) ')713 So Jo.$c n rrl FIRM NAME (If Applicable) "(, ('fl TELEPHONE NUMBER '7&',-/0'",0 (11) (12) (13) ..57 /35.0 ,21d. '17227._ 'S:'70.00 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) d/~ C}Qg;~7 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) z o ~ I- :J t:l. :ii: o u X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1 2) -.-.----- x.O~ (15) 16 Amount of Line 14 taxable at lineal rale x.O_ (16)_. 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate f2J jr9LJ~ x 15 (18) O{ 7J'G...2.~ 19 Tax Due (19) h.=?( 7f&.~~' 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ",::,;.,.,~ .;.' .. 4',.:'....,. >> BE.-SORETO -ANSllV.ER"Att;:Q~STiON$ ,O~f'REilERSE5S'D~?<JiID RECHECK MATH' <: < J" <" ,.. ,. Decedent's Complete Address: STRED. A. DDRESS_ C f! ~___~~.').~.x ,,,,-d CITY ('am ZIP /7<'JtI Tax Payments and Credits: 1. Tex Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) ,'1( 7fl62L__ Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enler the difference This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _._..:3~ ~,/2'1 __~__ A. Enter the Interest on the tax due. JJ1 "'::1s e .0130/" % (SA) /0/ g. 9 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) __ --.:. .3d~ ,6'05. . Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.. 0 LX] b. retain the right to designate who shall use the property transferred or its income;.. [J IKJ c. retain a reversionary interest; or... 0 [i] d. receive the promise for life of either payments, benefits or care?.. . ...... 0 [.8 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. ................................... ................................................ D [KJ 3. Did decedent own an "in trust for" or payable upon death bank account or security al his or her death?. . .... D [KJ 4. ~~~t~~;se:e~~:;:i:~ I~:~~:nu;:o~~ti~ement ACC.O~.~.~'. .~~~.~.it.~:.~~. .~t.~.~.~.~.~~.~:.r~~~~~. ~~.~.~.~.~~..~~:~h. ... .... ..... .......... 0 ~ 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 relurn, mcluding accompanying scl1edules and statements. and to tile best of my knowiedge and belief, it is true, correct and complete. Declaration of pre parer other than the persollal represenlative is based on all information of which preparer has any knowledge 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 PS. s9116 (a) (1.1) (i)]. For dates of death on or after Janual)' 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. S9116 (a) (1, 1) (il) The statute does not exemDt 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 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 paren or a stepparent of the child is 0% [72 P.s. s9116(a)(1.2)I. 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. S9116(1.2) [72 P.S. s9116{a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12<t/o [72 P.S. s9116{a)(1.3)]. A sibling is defined, under Section 9102, as a' individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1502 EX+ 16'9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is de1ined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant lacts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM NUMBER 1 S 5",,~(,~ f(,..,j ('(..,p H.tt . PA ,7el/ DESCRIPTION ~'<f' (<-ftJ ,At>c 19.(,(:" VALUE AT DATE OF DEATH 73(00_ (~{>'f. ((Hoe/-v'9 (enJusl;iv:.T ~(.j(i -0111 R'R~J ti 13-.:<,/. (!'7?7'()/~ TOTAL (Also enter on line 1. Recapitulation) $ 7 ~ (X)(:~, - (If more space is needed, insert additional sheets 01 the same size) 09-17-02 Mary Ann Harshbarger 40 William Penn Drive Camp Hill, PA 17011 File Number: 5sussexr Dear Sir: In accordance with your request, I have personally inspected and appraised the real property at: 5 Sussex Road Camp Hill, PA 17011 The purpose of this appraisal is to estimate the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the estimated market value of the property as of September 9, 2002 is: $73,000 Seventy-Three Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Since'flly, c:i/ / 1 , . V'v/\ Rclfund D. Joh~ Stale Certified Appraiser '~'~"''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM NUMBER 1. DESCRIPTION R,sfmrvK. Cred,f Lt'V6,,- (5& cJiN.~) ('.t'Z.MS~' (...., fltbCM:L) rnOJ (Y/rvhf ('.rc/~ Gold VALUE AT DATE OF DEATH ';N,37G./'1 119.0'/7 (Q 7 /1. IS;Z. 0; / 8,-;nv../ P..p<j ($.., ,ttkc/-l'd) (pIS oC TOTAL (Also eoter on line 5, Recapitulation) (If more space IS needed, Insert additional sheets of the same size) $ 14!!; /9/.77 .POSTMARK CREDIT UNION , 2630 L1nglestown Road HClrrisburg, PA 17110-3666 Phone: (717) 671-5119 CALL NOW FOR YOUR HOLIDAY HELPER LOAN WITH A 9.9% RATE. SAVERS CAN EARN 2.53% APY ON A 1 YEAR CERTIFICATE WITH A BONUS COUPON. NOW IS THE TIME TO APPLY FOR A LOW RATE HOME EQUITY OR AUTO LOAN. HOLIDAY CLOSINGS 10-14,11-11,11-28,12-24 & 1-1-03 CLOSE EARLY:12-24 & 12-31 OPAL M CARSON 5 SUSSEX RD CAMP HILL PA 17011-6644 1",111",111"""11",11,11."11,,,1,,1,1,,111.,,.1,1.,1,1,1 ACCOUNT NUMBER SOCIAL SECURITY NUMBER FROM THROUGH -104.02 107.48 -107.48 107.4 -107. 1 -843 PAGE 1 Of 1 NEW BALANCE 8,,1j{;6.33 84362.31 84469.79 84362.31 84469.79 84376: 19 592 CONFIDENTIAL . TRANSACTION DESCRIPTION 07-01-02 09-30-02 TAAN EFFECT MODAY MO'OYY~ , I " UFF I X:OO REGULAR , " 70102 SHARE WITHDRAWAL 7'3102 DIVIDEND ~Ol'02 SHARE WITHDRAWAL 0.3102 DIVIDEND 9:03:02 SHARE WITHDRAWAL 9;o5Q2 SHARE 01 VI OENO 90502 SHARE WITHDRAWAL AMOUNT . Y-T-D DIVIDENDS: : I ' TRUTH IN SAVINGS INFORMATION : I : : A NUAL PERCENTAGE YIELD 0.0000% I 'A NUAL PERCENTAGE YIELD EARNEO 1.5093% : 'I : : F R THE PERIOD 07/01/02 THROUGH 09/04/02 --1- -- -1- -t - -- - - - - - - - - - - - - - - - - -.- - -- ---- --.- --- - - - - - -- - - -... - -- - - - -.- -.- - - - -- - - - -- - - - -- - - - -- - - -- I I I I , I' , FOR 2002 , " EPDRTING * SSN I ' : ~##-##-8509 I ' ! I :,'\::1 ' " ~1tj--j .- : I ' : , , , , , , , , I , 856.39 IRA YTD DIVIDENDS .00 f, OTHER YTD D I VI DENDS 856.39 * TOTAL YTD * TOTAL YTD DIVIDENOS WITHHOLDING 856.39 .00 * TO AL YTD * FORFEITURES .00 NOTICE: SEE REVERSE FOR IMPORTANT INFORMATION. SEND ALL INQUIRES TO THE CREDIT UNION AT THE ADDRESS SHOWN ABOVE. RETAIN THIS FOR YOUR FILES 1-888-910-4100 (aU Citilc!ns'PhoneBank . current rates and ilnytlme for aCCOunt information ans.wers to YOur que5tion&. ' US002 BR291 ! OPAL M CARSON 5 SUSSEX RD CAMP HIll PA 17011-6644 Checking Account Statement . OF Beginning August 10, 2002 through September 11, 2002 Ch etking . 5UMM.RY Balance Calculation Previous aaLance Checks Withdrawal, Depo,it, & Addition, Interest Paid Current Balance 49,047.67 .00 49,047.67 .00 + .00 + .00 . Balance Average Daily Balance 41,136.75 OPAL M CARSON Money Market 610011-308-3 PtevlOllS Balance TRANSACTION DETAILS Withdrawals Other Withdrawals O.1l.te.~t Description 09;flL.___!!M4J-'.6l...I'Iithdrawal -----<.,_..~. Daily Balance Date 09/05 Balance .00 Oat~ Intertst Current Interest Rate Annual Percentage Yield Earned Number of Days Interest Earned Interest Earned Interest Paid this Year .25% ,00% 31 .00 80.44 Balance. Date Ralarl'l:e 49,047.67 o o Tota! Withdrawals 49,047.67 Current Ila!.i!.fl{;e .00 n. ", \-\ ~ 1.800-773.1313 (all. Citizens' PhoneBank anytime for account information. current rates and answers to your questions. US059 BR291 OPAL M CARSON 5 SUSSEX RD CAMP HILL PA 11011-6644 5 1 Citizens Circle Gold Account Statement . OF 2 Beginning August 10, 2002 through September 11, 2002 Contents Summary Checking Page 1 Page 2 C;t;70n. c r;,.,.IA<::Hm_m~:tnk .... a...... ~....." .......... ......."" ,WO'} Account Account NumbeT Balance last Statement BaLance Thts Statement DEPOSlT BAlAHCE Checking Money Market Citizens Circle Gold 610071-308-3 610071-415-2 } C-49:047:6~ Cll,152.~ \ r OPAL M CARSON Citizens Circle Gold 610071-415-2 .00 .00 o o Total DepQsit 9atance .00 Tobl Relattonshlp Balance .00 Citizens Circle Gold Account Statement 1-800-77 3-73 73 . OF 2 (aU Citizens' PhoneBank anytime for account Information, current rate~ and answers to your questions. Beginning August 10, 2002 through September 11,2002 Checking Balance Calculation OPAL M CARSON Citizens Circle Gold 610071-415-2 SUMMAR'f Previous Balance Checks Withdrawals Deposits & Additions Current Balance 11,152.91 11,152.91 .00 .00 + .00 - TRANSACTION DETAILS Checks'" There i.s a break in Cfleck sequence Check It Amount Date o 9,658.10 09/.05 515' 979.21 08Z14 518' 2.80 08;16 Check # 519 520 Previous Balance 11,152.91 Amount Date 500.00 08/.14 12.80 08;14 e Total Checks 11,152.91 <9 Current Balance .00 Batance .00 Daily Balance Date 08/14 Balance 9,660.90 Date 08/16 Ba!al1ce 9,658.10 Dat. 09/05 APPRAISAL Personal Property of cJ ?/fL- C-1jl..sJN CsTA-fE Ss 1/5517)( I-d, cAI7;7 /IiI-I- tAL Appraised by Chuck E. Bricker AU094.L Date q - -tJ J ITEM VALUE ITEM VALUE 0,IJD JI),O/) S";6a /iJ, Ji,) blJ (.b /O,oD ,Oil / 6t:> IS. D" JS;tJl) !(),6D UJ \ OD Oil \ --------- REV-1511 EX+ (12-99) ~ COMMONWEALTH OF PENNSYLVAN1A INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. f{M'-. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Persona! Representative{s) Social Security Number{s)/EIN Number of Personal Representative(s) Street Address City______~_ Slate ___ Zip Year(s) Commission Paid: fJ,H.r"'j 11150- 2. Attorney Fees 3. Family Exemptiorl'. (If decedent's address 'IS not the same as claimant's, attach explanation) Claimant Street Address Ci\y___~.______~_ _ State ____ Zip Relationship of Claimant to Decedent 4. PlObate Fees HM,,_ Jt30g 5. Accountant's Fees Ik'J II/57 6. Tax Return Preparer's Fees R""J ed4eJ rr,a,,;j"INl,L d.u"j :;KJIterIWlrT ~ 3tQfd/. 9., 7. 'I Acd m(ui\1ul./.VluL "/5.n(.) 'I. f(taJ E'<J<'h'';'''<<, d~",,,, .s<1J(e>v.Jij:- tS/8.53 .J TOTAL (Also enler on line 9, Recapitulation) $ S7t.:J, 5'0 Debts of decedent must be reported on Schedule I. (II 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 RELATIONSHIP TO OECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not UstTrustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 la) 11.2)] 1. 5o'ii;> j-h,-.'fd J+.C$h~r F:=, end rfI"j I/"n 1-I~(5'\ :J" F.',o"d 5C,itl ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 !ll6f"O: "-3'1c; - Vol.utTPV5 <f 1/'11""0:< N0/.7C - TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 570- (If more space is needed, insert additional sheets of the same size) BUREAU OF ZNDZqZDUAL TAXES TNHERTTAHCE TAX DZVTSTON DEPT. 180601 HARRISBURG, PA 17118-0601 JASON H HARSHBARGER 1510 CHATHAH RD CANP HILL CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ;,. Of DATE 03-01-200~ ..:: "~¢¥i!iS ESTATE OF CARSON DATE OF DEATH 08-08-Z001 FILE NUHBER 21 02-0759 FEB 2'7 ?1:00 COUNTY CUNBERLAND ACN 101 PA 1~tl' ., ~JO~Jr[ ,,t:l~e~ ~:~;:O GO., PA Amoun'l: Rami¥1:ad REV-I;~? EX AFP (BI-OS) OPAL H HAKE CHECK PAYABLE AND RENIT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I7013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 4 REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF CARSON OPAL H FILE NO. 21 02-0739 ACN 101 DATE 03-01-200~ TAX RETURN NAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a*a (Schodula A) (1} 2. S~ocks and Bonds (Schedule B) 3. Closely Held S~¢ock/Par~narship Zn~ares* (Schedule C) {$) 4. Nor~cgagas/No~:as Receivable (Schedule D) (4) 5. Cash/Bank Daposi~s/Nisc. Personal Proper~y (Schedule E) 6. Jointly Owned Propar~y (Schedule F) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expansas/Adm. Cos:ts/Nisc. Expenses (Schedule H) (9) 10. Dob~s/Hor~gaga Liabilities/Liens (Schedule 1) (10) 11. To,al Daduc*ions 12. N®* Value of Tax Re*urn 1:3. 14. Charitable/Governmental Bequests; Non-elected 911:3 Trusts (Schedule J) Na~ Value of Es~a~a Sub~ac~ ~o Tax 73~000.00 .00 .00 .00 145~191.77 .00 .00 (8) 5,713.50 .00 NOTE: To insure proper cradi~ ~o your account, submi~ ~ha upper portion of ~his form with your tax payment. 218,191.77 (11) ~.7]S. 5fl (12) 212,~78.27 (1:3) . O0 (~4) Z1Z, ~78.27 NOTE: reflect figures that lnclude the total of ALL returns assessed to date. I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, ASSESSNENT OF TAX: 15. Amoun"t of Line 14 a~ Spousal ra~a (15) 16. Amoun't of Line 14 ~axabla a~: Lineal/Class A ra~o (16) 17. Amoun~ of Line 14 a~ Sibling ra~o (17) 18. Amoun'l: of Line 14 *axable a~ Colla*eral/Class B ra~e (18) =al Tax Duo D[$COUNT (+) /NTEREST/PEN PAID (-) 933. c~9- 19. Prin¢i TAX CREDITS PAYIIENT DATE 18 and 19 #ill BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-2q-2003 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE AHOUNT PAID 32,805.23 12-23-2003 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 31,871.7~ .00 66. ~Z 66.~2 ( TF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REQUIRED. TF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU HAY BE D .U~.~<, A REFUND. SEE REVERSE SIDE OF TH/S FORH FOR INSTRUCTIONS.} ,~ ~ CD003365 NUNBER · O0 x O0 = .00 · 00 x 0~5= .00 . O0 x 12 = . O0 212,~78.27 x 15 = 31,871.7~ (~)= 31,871.7~ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred in possession or enSoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life ar for years, the Common#ealth hereby expressly reserves the right to appraise end assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, uhich uae not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available et the Office of the Register of Mills, any of the 15 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-561-2050; services for taxpayers ~ith special hearing and / or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shoun on this Notice must object ~ithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA l?lZB-lOZ1, 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 ~riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid ~ithin three (5) calendar months after the decedent's death, a five percent (51) discount of the tax paid is alloued. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB) 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 ~ould 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 ~hich became delinquent before January 1, 19BI bear interest at the rate of six (67.) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1981 ~ill bear interest at a rate which will vary free calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z005 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea.~r Rate Factor 1982 207. . 000548 1987 91 . 000247 1999 77. . 000192 1985 162 .0004S8 1988-1991 117. .000301 ZOO0 81 .000219 1984 112 . 000501 1992 92 . 000247 2001 91 . 000247 1985 151 .000356 1993-1994 71 .000192 2002 62 .000164 1986 lOZ .000274 1995-1998 92 .000247 2003 52 .000157 --Interest is calculated es follous: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELIN~)UENT X DAllY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shoun on the Notice, additional interest must be calculated. F 'V-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER Opal M. Carson 2102-0739 REVIEWED BY ACH ANITA MCCULLY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the charitable bequest has been disallowed. The decedent's Will did not J II-B contain a specific bequest to the charity. Row Page 1 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DIVISION DEPT. Zso6nl HARRTSBURG, PA ].71ZS-D601 COMMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT JASON M HARSHBARGER '04 A~ 26 ].5].0 CHATHAH RD CAMP HILL PA 17Q1[.~,- BATE ESTATE OF BATE OF DEATH FILE NUMBER COUNTY ACN REV-I6O7 EX AFP C01-03) 0~-Z2-2004 CARSON OPAL H 08-08-2002 21 02-07:59 CUHBERLAND 101 Amoun'l: Rem'i '~'l:md HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper cred/~ ~o your account, submi~ ~he upper pore/on of ~his form ~i~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORBS -~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF CARSON OPAL N FILE NO. 21 02-07:59 ACN ].01 DATE 04-12-2004 THTS STATENENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELON ZSA SUHNARY OF THE PRZNCZPAL TAX DUE, APPLZCAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE, A PROJECTED INTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 0:5-01-2004 PRINCIPAL TAX DUE: .......................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): PAYHENT DATE 12-2:5-200:5 0:5-0:5-2004 :51,871.74 RECEIPT NUMBER CD00:5565 CD00569]. D].SCOUNT (+) INTEREST/PEN PAID (- 933.49- ANOUNT PAID 66.42- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT 1S REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CRED/T" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 32,805.23 66.42 TOTAL TAX CREBZT :5Z,871.74 BALANCE OF TAX BUE .00 INTEREST AND PEN. .00 TOTAL BUE .00 PAYMENT: 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 sake check or money order payable to: REGISTER OF HILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CR): REPLY TO: DISCOUNT: PENALTY: 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-1313). Applications are available at the Office of the Register of #iIls, any of the 23 Revenue District Offices or from the Department's Iq-hour ansaaring service for forms ordering: 1-800-362-2050~ services for taxpayers with special hearing and / or speaking needs: l-DOO-q47-3020 (TT only3. Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 2B0601, Harrisburg, PA 17lZB-060l~ phone (7173 787-6505. If any tax due is paid within three (33 calendar months after the decsdent's death, a five percent (SX) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one ([3 day from the data of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 ara: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor 1982 202 .OOOS4B' 1988-1991 Ill .00030~ 2001 9Z .000247 XaB3 16Z .000438 1992 9Z .000247 2002 6Z .000164 1984 llZ .000301 1995-1994 72 .000192 2005 5Z .000137 1985 132 .000556 1995-1998 92 .000247 2004 4Z .OOOllO 1986 ZOZ .000Z74 1999 7Z .000192 1987 9Z .000247 ZOO0 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NURBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. 2002-00739 TO THE REGISTER: Opal M. Carson August 8, 2002 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was serviced on or mailed to the following beneficiary of the above-captioned estate on September 30, 2002. Name MARY ANN HARSHBARGER HAROLD HARSHBARGER Address 40 WILLIAM PENN DRIVE CAMP HILL, PA 17011 40 WILLIAM PENN DRIVE CAMP HILL, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: ~tr 3~ 20vZ Thomas D. Gould, Esquire I.D. # 36508 Attorney For Mary Ann Harshbarger 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 `~.. IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or party by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In the Estate of Opal M. Carson, deceased, No. 2002-00739 TO: MARY ANN HARSHBARGER HAROLD HARSHBARGER 40 WILLIAM PENN DRIVE CAMP HILL, PA 17011 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The decedent, Opal M. Harshbarger, died on the 8th day of August, 2002, at Camp Hill, Cumberland County, Pennsylvania. The decedent died testate (leaving a Will}. The personal representative of the Decedent is Mary Ann Harshbarger 40 West Penn Drive Camp Hill, PA 17011 (717) 737-5525 The Decedent died testate, the will has been filed with the Office of the Register of Wi11s of Cumberland County, Cumberland County Court House, Carlisle, Pennsylvania 17013, (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: ~~~{r 30 Zooz ~~tag ~.,-~~:~oteL~ Thomas D. Gould, Esquire I.D. # 36508 Attorney For Mary Ann Harshbarger 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HARSHBARGER MARY ANN 40 WILLIAM PENN DRIVE CAMP HILL, PA 1 701 1-6669 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: sSN: 20~-07-8509 FILE NUMBER: 2102-0739 DECEDENT NAME: CARSON OPAL M DATE OF PAYMENT: 1 2/ 23/ 2003 POSTMARK DATE: 1 2/23/2003 couNTY: CUMBERLAND DATE OF DEATH: 0$/08/2002 REV-1162 EX111-96) NO. CD 003365 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 532,805.23 1 TOTAL AMOUNT PAID: REMARKS: MARY ANN HARSHBARGER CHECK#1069 SEAL INITIALS: DO RECEIVED BY: DONNA M. OTTO 532,805.23 DEPUTY REGISTER OF WILLS REGISTER OF WILLS IN THE MATTER OF THE ESTATE IN THE COURT OF COMMON PLEAS OF OPAL M. CARSON, OF CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ORPHANS" COURT DIVISION NO. 2002-00739 PA NO. 21-02-0739 STATUS REPORT UNDER 6.12 Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of t:he estate is complete: Yes ~ No 2. If the answer is no, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is yes, state the following: a. Did the personal representative file a final account with the court? Yes No b. The separate Orphan's 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 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: ~2,~29~03 Thomas D. Gould Attorney for Administrator I.D. # 36508 2 East Main Street Shiremanstown, Pa 17011 (717) 731-1461 /~ IN THE MATTER OF THE ESTATE IN THE COURT OF COMMON PLEAS OF OPAL M. CARSON, OF CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ORPHANS" COURT DIVISION NO. 2002-00739 PA NO. 21-02-0739 ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT, made this _~.~`µ'day of ~ ~, 2003. WITNESSETH: THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: 1. OPAL M. CARSON (the "Decedent"), died testate on August 8, 2002, and MARY ANN HARSHBARGER duly qualified with the Register of wills of Cumberland County, Pennsylvania, as the Executor (the "Executor") of the Decedent"s probate estate (the "Estate") 2. The Third paragraph of the Decedent's Last Will and Testament (the "Will") provides for the distribution of all of the Decedent`s estate equally to MARY ANN HARSHBARGER and HAROLD HARSHBARGER. 3. Mary Ann Harshbarger and Harold Harshbarger were the friends of the Decedent (collectively, the "Ieneficiaries") . The Beneficiaries desire the Executor to settle -the Estate informally in order to avoid the expense and delay involved with the formal adjudication of a First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "Court"). 4. The Beneficiaries desire to forever settle and compromise any and all claims and rights which they may possess, now or hereafter, in the Estate and to confirm their acceptance of the Informal Account (the "Account"), attached hereto as Exhibit "A" and incorporated herein by this reference, and the Schedule of Proposed Distribution (the "Schedule"), attached hereto as Exhibit "B" and incorporated herein by this reference. The Beneficiaries desire that the distributions, as set forth on Exhibit "B," be in full satisfaction of their rights in the Estate. 5. The Beneficiaries wish to release the Executor and to indemnify her against any and all claims that may be asserted against the Estate or the Executor after the date hereof. 6. The Executor is willing to settle the Estate informally in consideration of the indemnifications hereinafter provided by the Beneficiaries. NOW THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, t:he Beneficiaries, for themselves, their successors and assigns: 1. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 2. Declare that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. 3. Acknowledge that the distributive share or amount set forth on the Schedule shall be in full satisfaction of their respective entitlements under the Will. 4. Release, remise, quitclaim and forever discharge the Executor, her heirs, personal representatives, successors and assigns, from and against all claims that they, as legatees of the Estate and in connection with the Estate, had, now have or may in the future have in connection with the Estate. 5. Agree to refund, on demand, all or any part of any aforesaid distribution, which has been determined by the Executor, or by the Court, or by any court of competent jurisdiction, to have been improperly made. 6. Agree to indemnify and hold harmless the Executor, h er heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executor-) that may hereafter be asserted against the Estate or against the Executor. 7. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. 8. Acknowledge that this Agreement shall be governed by and construed in accordance with the laws of t:he Commonwealth of Pennsylvania. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have read and agreed to the terms and conditions set forth in this Estate Settlement Agreement and intending to be legally bound hereby placed their hands and seals. WITNESS ~~IpI"ARY ANN HARSHBARG ~._ .~ '~ ~ ~ ~u~~ WITNESS T COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND HAROLD HARSHBARGER SS On this, the ~. day of 2003, before me, the undersigned officer, personally appeared MARY- ANN HARSHBARGER and HAROLD HARSHBARGER, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. :, ,.. ,. ,,i 9 ~J _ '~_~ - : ~J r~,_ ~ , .,_~ __ INFORMAL ACCOUNT ESTATE OF OPAL M. CARSON ITEI"I VALUE AT DEATH ASSETS: Real Estate $ 73,000.00 Cash, Bank deposits & financial accounts $ 145,191.77 Total $ 218,191.77 DEBITS: Funeral & Administration Expenses LH Inheritance `l'ax Interest Total CHARITABLE CONTRIBUTION: Hospice Volunteers of America Total Net Value of Estate at time of Death $ 5,713.50 $ 31,786.29 1,018.99 $ 38,518.73 $ 300.00 $ 270.00 570.00 $ 179,103.09 The value of the bank deposits and financial accounts has fluctuated during the administration of the estate and a final value will be determined at the time of actual distribution. A PROPOSED DISTRIBUTION OF ASSETS OF ESTATE OF OPAL M. CARSON BENEFICIARY SHARE Mary Ann Harshbarger 500 Harold Harshbarger 50% Total 1000 B