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03-0641
PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Social Security No. ,/?~'-'-- Register of Wills for the County of ~t~nberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut,'~/" in the last wilt of the above decedent, dated and codicil(s) dated in the named ,~_c.~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) domiciled at death in ~tien _bet /a~ Cou ennsylvania, with Decendent was nJ~,r~ h C r" last family or prjgcipal residence at / ¢/ 3 .~,~:$~/'-¢ . v /! ' / (list street, number and muncipality) Decendent, ~,',the~n ~q' _ years J~ ~c/¢,~0, fi~te~gJ°f age, died at /9~3 ~,o,~ ff- ~d. '~,~,,~, Except as follow/s, decedent did not marry, w/as not diVorCed and ~l{denot have a ~hild born or adopted ~,/~///~ after execution of the will offered for probate; was not the victim of a killing and was never adjudicated__~ "~, incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $. situated as follows: WHEREFORE, petitioner(s) respectfully ,~.egue~s)_ the ~ob.~o,~f t~ and codicil(s) presented herewith and the grant of letters ~z~,.~,~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~° OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ 8s COUNTY OF Ct~nberland The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and tru_ly administer/~the esta~te according to law. Sworn to or affirmed and subscribed fi)~y~~)~ ~. ~ before me this 6th day of | __ _ ~ Donna M. Otto, 1St Deputy / (~ I-- [~iste~'- ;~X~_ , ~ /7--/'~Co -/o No. 21-2003-641 Estate Of MARY STILWELL , Deceased DECREE OF PROBATE AND GRANT OF LETTERS August 6th AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 3une 15th, 2000 described therein be admitted to probate and filed of record as the last will of Mary Stilwell and Letters Testamentary are hereby granted to WS] l ~ ~n A _ ~arrt q n~r 2003, in consideration of the petition on FEES Probate, Letters, Etc .......... $. 200.00 Short Certificates(2) ... '. ...... $ 6.00 t~ ~-lPa~t~s · ( 3.)... $. 9.00 JCP $. 10.00 TOTAL __ $~ Filed Au. ~3..%t.. 6..t.h.,.2.Q Q .3 ................. Mailed Letters to Executor on 8/6/2003. - - Donna M..ott0,1st Deputy % ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Off]ce for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. '21-2003-641 m~CK ~K Mary COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ,.Female13' 195-- 10 --1735 Stilwell 94 v~. ; : ~03/23/1908 ?. 01yphant, PA Cumberland k. Southampton Twp. ~.143 Airport Road ' te.~'~"~"'~' s~ ~ite Homemaker I,-- , I"- I--- ~ I ..~ow,d ,~ Pennsylvania · ,~ ~.~ Southampton 143 Airport Road ~ Shippensburg, PA 17257 ~ ,~.~ Cumberland ~' ,,~~ William B. Gardiner I,L Margaret Tyson ~ll~am ~. Gardener ~ 14~ hir~rt Road~ Sh~ppon~bur~ P~ 17257 ~ ~ ~ ~.~ ~.~.~ ~Indiangown Gap I ~obanon Coungy, ~ ~ ~,,L 03/26/2003 I~'~. ~ational C~meter7 ~ ....~. Hanover ~wp., LAST WILL AND TESTAMENT I, MARY STILWELL, of 145 Airport Road, Southampton Township, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I direct that all my just debts (except as may be barred by a Statute of Limitations) and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. SECOND. I give and bequeath the balances in any and all checking and savings accounts which I may have at the time of my death which are a part of my probate estate or which are taxable in my estate to BILLIE JO GARDINER, wife of my nephew, WILLIAM A. GARDINER. THIRD. I give, devise and bequeath my home residence known as 145 Airport Road, Southampton Township, Cumberland County, Pennsylvania, to my nephew, WILLIAM A. GARDINER, subject to a life estate interest in my niece, LENORE GARDINER, who presently resides with me in my home for and during the term of her natural life or until she no longer desires to live in said real estate or is unable to live in said real estate with assistance. FOURTH. I give, devise and bequeath the sum of ONE THOUSAND DOLLARS ($1,000.00) to my late husband's niece, JOAN THOMAS, if she survives me. In the event that the said Joan Thomas predeceases me, I direct that this pecuniary request shall lapse and become a part of the rest, residue and remainder of my estate. FIFTH. I give, devise and bequeath the following items of personal property BILLIE JO GARDINER, who is the wife of my nephew, William A. Gardiner, absolutely: My china cupboard, '-,,md the dishes contained therein, which is located in the dieting room of ray home; B. My glass punch bowl and cups; and C. My antique orange bowl with artificial fruit contained therein. (SEAL) WEIGLE, PERKINS ~ ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET I SHIPPENSBURG, Pa 17257-1397 SIXTH. I give, devise and bequeath the remainder of my household contents including but not necessarily limited to furnishings and appliances to my nephew, WILLIAM A. GARDINER; his wife, BILLIE JO GARDINER; or to the survivor(s) thereof with the understanding and direction that my niece, LENORE GARDINER, shall have the right to the use of said items as long as she lives in my home real estate known as 145 Airport Road, Southampton Township, Cumberland County, Pennsylvania 17257, or until she replaces said items or until she no longer has any use for said household contents individually or collectively. SEVENTH. I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to the following persons as follows: A. One (1) share to my niece, LENORE GARDINER; B. One (1) share to my nephew, WILLIAM A. GARDINER; and One (1) share to BILLIE JO GARDINER, who is the wife of my said nephew, William A. Gardiner, or to the survivor(s) thereof. EIGHTH. I nominate, constitute and appoint my nephew, WILLIAM A. GARDINER, to be the Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint his wife, BILLIE JO GARDINER, to be the Executrix of this my Last Will and Testament. NINTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. TENTH. I hereby direct that all federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of administration of my estate and that such be paid out of the rest and residue of my estate. IN WITNESS WHEREOF, I, MARY STILWELL, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for identification only, this [ ~" day of ~ ,2000. (SEAL) WEIGLE, PERKINS ~ ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KiN(~ STREET -- SHIPPENSBURG, PA 17257-1397 This instrument was by the Testatrix, on the date hereof, signed, published and declared by MARY STILWELL to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · I, MARY STILWELL, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by MARY STILWEJqL, the Testatrix, this /O~g~ day of ~ ,2000. My ~mml~sio~x~res June 7, ~, I Notarial Seal I Rebecca L. Holtr~, No. tery P~u~l_c .... ! Sh ppensburg Boro, (.;umoerlano ~gu..~y l My Commission Expires June 7, 2003 Member, Pennsylvania Association Of Nolari~ WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA / · § the witnesses whose n~s ~e signed to the~ fprq ting inst~i~d~ ~cording to law, do depose and say that we were preseqt/~d saw MARY STIL~LL, the Testatrix, sign ~d execute the instrument as her Last Will; ~at s~ signed willingly ~d ~at she executed it as her free ~d volunt~ act for the pu~oses therein expressed; that each of us in the heming ~d sight of the Testa~ix, signed the will as ~vitnesses; tuna that to t,he best afo~ ~owledge ~e Testatrix was at the time~ighteen (18) or more yems ofage and ofso~d mind ~d~no constraint or ~due influe~e] ~ (] witnes(es, this/~ay of ~ , 2000. Notarial Seal Rebecca L. Holtry, Notary Pub!ic Shippensburg Bom, Cumberland C,~,.:,W [ My Commission Expires June 7~ Member, Pennsylvania Association o! No* ,~ ::::; WEIGLE, PERKINS & ASSOCIATES -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 NARY STILI~ELL MARK, WEIGLE AND PERKINS ATTORNEYS AT LAW 126 EAST KING STREET SHIPPENSBURG, PA. 17257- 1397 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Mary Stilwell March 22nd 2003 Date of Death: Will No. 2003-00641 Admin. No. 21 -03-0641 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on : Name Address William Gardiner 145 Airport Road Shippensburg, PA 17257 Billie jo Gardiner 145 Airport Road Shippensburg, PA 17257 Lenore Gardiner 143 Airport Road Shippensburg, Pa 17257 NoticehasnowbeengiventoallpersonsentitledtheretounderRule5.6(a)except Joan Thomas New Braunfels TX 78130 I have enclosed my documantation of death Joan Thomas died 7/01/2001 Date: August // 2003 Social security #206-14-2434 Signature/~y~ ~ ~e~ Name William Gardiner 145 Airport Rolo Address Shippensburg, PA 17257 Telephone (~l~ 7,~' ~ - ~& ~-- Capacity: J Personal Representative __Counsel for personal representative N 2.ii1 Date Will foE:' Date: zcedent: STATUS REPORT UNDER RULE 6.12_ Mary Stillwell March 22ndt 2003 2003-00641 Admin. No.: 21-03-0641 t~.ant to Rule 6.12 of the Suprkme Court Orphans' Court Rules, I report the respect to completion of the administration of the above-captioned estate: ; rote whether administration of the estate is complete: '/es ~ No ; the answer is No, state when the personal representative reasonably believes :hat the administration will be complete: the answer to No. 1 is Yes, state the following: Did the personal representative file a final account with the Court? Yes No [] The separate Orphans' Court No. (if any) for the Personal representative's account is: ~ Did the personal representative state an account informally to the parties in interest? Yes [--1 No [-'] c. Copies of receipts, releases, joinders and approval of formal or Ln.formal accounts may be filed with the Clerk of the Orphans' Court · and may be attached to this report, .~ ~~~~ Signature William Gardiner Name 145 Airport Road Shippensburg, Pa 17257 Capacity: Address 717-532-7557 Telephone No. Personal Representative Counsel for personal representative Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Mary Stilwell March 22nd 2003 Date of Death: Will No. 2003-00641 Admin. No. 21 -03-0641 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ' Name Ad.ess William G~rdiner 145 Airport Road Shippensburg, PA 17257 Billie jo Gardiner 145 Airport Road Shippensburg, PA 17257 Lenore Gardiner 143 Airport Road Shippensburg, Pa 17257 Joan Thomas Noticehasnowbeengiventoallpersonsentitledtheret°underRule5'6(a) except New Braunfels TX 78130 I have enclosed my documantation of death Joan Thomas died 7/01/2001 Social security #206-14-2434 Date: August c 2003 William. Gardiner Name ~ 145 Airport Ro~ Address Shippensburg, PA 17257 Telephone ~7/) Capacity: J Personal Representative Counsel for personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FrROM THIS ESTATE OR OTHERWISE. WHETHER YOU WILL RECEIVE ANY MONEY OR PROPERTY WILL BE DETERMINED WHOLLY OR PARTLY BY THE DECEDENT~S WILL. II"r THE DECEDENT DIED WITHOUT A WILL, WHETHER YOU RECEIVE ANY MONEY OR PROPERTY WILL BE DETERMINED BY THE INTESTACY LAWS OF PENNSYLVANIA, BEFORE THE REGISTER Of WILLS, COUNTY Of CUMBERLAND, CARLISLE, Pa. In Re Estate of Mary Stiwell, deceased. TO: William A. Gardiner 145 Airport Rd. Shippensburg Pa. 17257 Billie Jo Gardiner 145 Airport Rd. Shippensburg Pa. 17257 Lenore Gardiner 143 Airport Rd. Shippensburg Pa. 17257 Please take notice of the death of decedent and the grant of letters to the personal representative named below. William A. Gardiner 7557 145 Airport Rd. Shippensburg Pa. 17257 Phone (717)532- The decedent Mary Stilwell, died on the 22nd day of March,2003, at Cumberland County, Shippensburg Pa. 17257 The Decedent died testate (with a Will). The personal representative of the Decedent is; William A. Gardiner 145 Airport Rd. Shippensburg Pa. 17257 (717)532-7557 The Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle Pa. 17013. Phone (717)240- 6345 a copy of the Will may be obtained by contacting the register of Wills and paying the charges for duplication. //~~¢~ ~~~~ Date 08-05-2003 William a. Gardiner 145 Airport Rd. Shippensburg Pa. 17257 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 l m-v-1 bUU INHERITANCE TAX RETURN RESIDENT DECEDENT 21 FILE NUMBER COUNTY ~ IIUlO~.~ aJ z U.I z O O3 Ill O 0 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Mary Stilwell DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 03-22-2003 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURll7 NUMBER 199-10-1735 THIS RETURN MUST BE FILED IN DUPLICATE wrrH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I~1. Odginal Return ~]4. Limited Estate [~6. (~ copy of Decedent Died Testate ~]9. Proceeds Received Litigation NAME William FIRM NAME D2. Supplemental Return r'--] 4a. Future Interest Compromise (dml~ of death alte~ 12-12-82) ~]7. Decedent Maintained a Living Trust (,~:h ~ of Tn:=:) ---]10. Spousal Poverty Credit (~ of ~th ~n 12-31-91 and 1.1.~5) COMPLETE MAILING ADDRESS 145 Airport Road Shippensburg, Pa TELEPHONE NUMBER7 1 7 - 5 3 2 - 7 5 5 7 --]3. Remainder Return (date of death p~o~* t~ 12-13-82) [---~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes l--'-] 11. Election to tax under Sec. 9113(A) (~ sch o) 17257 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. CaShl Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) --]Separate Billing Reduested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Prope~ (7) (Schedule G or L) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. 15. 80: 000 _ Of) OFFICIAL USE ONLY (9) 6,863.96 (8) (10) 1~924_3q Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES N~ount of Une 14 taxable at l~e spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 96,811.52 (11) ; 8r788.35 (12) 88,023,1 7 (13) : 80,02~117 (14) x .o_ (15) ,N-nount of Line 14 taxable al lineal rate x .0 (16) 16. 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate 44, ,* 011 . 5~8 x .15 (18) 19. Tax DueI (19) v,..l .73 6,601 .73 tecedent's CompJete Address: -;TREETADDRESS. ~ITY 143 Airport Road Shippensburg, 'ax Payments and Credits: Tax Due (Page 1 Line 19) Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount ISTATE pA Interesl/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the dilfemnce, This is the OVERPAYMENT, Check box on Page I Line 20 to request a refund If Une 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) A. Enter the interest on the tax due. Total Credits ( A + B + C ) (2) (3) (4) (5) (5A) (5B) 17257 6,601 .73 0 0 6,601 .73 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 6,6 01.7 3 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 . ~ a. retain the use or income of the property transferred; .......................................................................................... [~. b. retain the dght to designate who shall use the property transferred or its income; ............................................ c. retain a reversionary interest; or .......................................................................................................................... [] [;~ d. receive the promise for life of either payments, benefits or cam? ...................................................................... [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] ~ 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designalJon? ........................................................................................................................ [] [] IF THE ANSVVER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~' ¢'=--~ of PedprY, I declare that I have eXa,T,W,e~ ~is return, including acc~npanying scheduie~ and statements, and to Ibe best of my knov,4edge and belief, it is true, correct and compiele. ~daralmn of ~rer o~he~ than the jpejpejpejpejpejpe?onal representalJve is based o~ all informal~on of which preparer has any knowledge. GNATURE OF PERSON RESPON$1BI I;; EOR FILING RETURN// /, ]DRESS 145 Air Port ROad Shippensburg, Pa 17257 GNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 11/06/03 DATE 2)DRESS dates of death on or after July 1, 1994 and before January 1, 1995, lhe tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% P.S. §9118 (a) (1.1} (i)]. 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 RS. §9116 (a) (1.1) (ii) ~e statute does not exemot 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 surviving spouse is the only benefidary. dates of death on or after July 1, 2000: 3e tax rate imposed on the net value of banders from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paten a stepparent of the child is 0% [72 RS. §9116(a)(1.2)]. ~e tax rate imposed on the net value of transfers Io or for the use of the decedent's lineal boneficiades is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)]. ~e tax rate imposed on the net value of transfers to or for the use of the dacedenrs siblings is 12% [72 RS. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a dMdual who has at least one paint in common with the decedent, whether by blood or edoption. ~ SCHEDULE A I · ~L,. o~ PENN~YLV*.~ REAL ESTATE INHEPJTANCE TAX RETURN RESIDENT DECEDF t,'T ESTATE OF FILE NUMBER Mary Stillwell 21 All mai propolty owned ~,~lely or as a tenant in common must be reported at fair ma~st value. Fair madcet value is defined as the price at which prope~ would be exchanged survlvomhip must be disclo s :d ITEM NUMBER 1. buyer and a '~ ii,, ,j seller, neither being compelled to buy or sell, both having reasonable knowledge of ~ relevant facts. Real pm~rty which ts jointyewned wilh right of Schedule F. DESCRIPTION p~-~):per~at 143 Airport Road Shippensburg, Pa 17257 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $80,000.00 $ 80,000.00 SCHEDULE E ' ~~'.o~,.SYLW,~, J CASH, BANK DEPOSITS, & MISC. ~ INHERITANCE TAX RETURN .~s,~rr DECEDE.r PERSONAL PROPERTY ESTATE OF Ma r y S t i 1 we 11 FILE NUMBER 21 Include ITEM NUMBER 2. 3. 4. 5. 6. 7. 3roceeds of litigation and the date lhe proceeds were received by the estate. All property,ip_!_mJy_ .e.:~.__.~ with the right of survi-~orih; ~ must be ~___l~c_._~_~ on Schidale t DESCRIPTION checking account saying's account (copy enclosed Life Insurance Funeral Home gave a reund of overpayment Federal Income Tax return 1040 refund for 2002 Thompson Energy refund for american gas Personal property in home value by report enclosed TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets d the same size) VALUE AT DATE OF DEATH $1 , 1 24 . 68 $7,110.91 $3,516.26 $1,575.76 $1,191.00 $ 512.91 $1 , 780.00 $ 16,811.52 SCI EOULE H COMMONWEALTH OF PENNSYLVAN A J FUNERAL EXPENSES & ' J INHERITANCE TAX RETURN / ADNIINIS ,'rIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary-- Stilwell 21 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 5. 6. 7. FUNERAL EXPENSES: DESCRIPTION Fogelsanger Bricker reciept copy enclosed ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(si Street Address City Year(s) Commission Paid: State. · Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City __ Relationship of Claimant to Decedent State Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees Ruth Ann Mooney 1250 Baltimore Road Shippensburg, Pa 17257 TOTAL (Aisc enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT $6,613.96 250.00 REV-I5~2 p_~ · (1-~Tj ' ' ~' I i~ · CO"MO"J~:^LT.O~PE..SYLV..,^ / DEBTs OF DECEDENT, '"~~?~ I MOR~E ~[~ES. & LIENS Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. AMOUNT Valley Heating Furnace re~air 2. Vivian Coy $75.00 3. Electric Bill $195.70 $ 96.00 4. Imaging Medical for decedent $ 52.00 5. Dan Hershey aprraisal of personal property 6. CFJMA $ 45.00 7. Phone calls $ 26.00 $ 10.00 8. Aero Energy New tank purchased prior to death $694.69 9. Appraisal for house 10. Troy Mills $225.00 11. Recording Will $280.00 $225.00 TOTAL (Also enter on line 10, Recapitulation) $ 1,9 2 4.3 9 (If more space is needed, insert addiUonal sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M~ry Stilwell SCHEDULE J BENEFICIARIES FILE NUMBER 21 NUMBER ! 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DiSTRiBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Billie Jo Gardner 145 Airport Road Shippensburg, Pa 1725' Joan Thomas She is deceased Lenore Gardner 145 Airport Road Shippensburg, Pa 17257 William Gardner 145 Airport Road Shippensburg, Pa 17257 with the condiction Lenore Gardner can use house and personal effects until her death or is unable to live there with out asst. RELATIONSHIP TO DECEDENT Do Not List Trustee(e) wife of Nephe% late husband' niece niece nephew AMOUNT ORSHARE OF ESTATE $8,235.59 $;,000.00 Sto live at residence $81,780.00 (If more space is needed, insert additional sheets of the same size) TOTAL OF PART 1'I - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE STATE OF PENNSYLVA/~IA COUNTY OF CUMBERLA/~D estate of STILWELL MARY (hAS'f, ~'i~s'r, MiUULE) in said county, deceased, to SHORT CERTIFICATE DONNA M. OTTO Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County~ of CUMBERLAiWD do hereby certify that on the 6th day of Auqust A.D., Two Thousand'and Three, Letters TESTAMENTARY in common form were granted by the Register of said County, on the , late of SOUTH3tMPTON TOWNSHIP GARDINER WILLIAM A (~'i', ~'i~'r, Mi~Ub~) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this A.D., Two Thousand and Three. File No. 2003-00641 PA File No. 21-03'-0641 Date of Death! 3/22/2000 S.S. # 6th day of August 195-10-1735 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL O STOWN BANK ate 3/25/03 PRIMARY ACCOUNT ENCLOSURES Page 2 672564 MARY STILWELL BILLIE JO GARDINER 145 AIRPORT ROAD SHIPPENSBURG PA 17257-9467 RMA CHECKING ACCOUNT W/SAFE 672564 ACTIVITY IN DATE ORDER DATE DESCRIPTION TRACE NO 3/25 CLOSE INTEREST BEARING ACCOUNT 004068600 (Continued) AMOUNT BALANCE 1,339.41- .00 --- CHECK SUMMARY --' DATE CHECK NO AMOUNT REFERENCE DATE CHECK NO 2/28 1504 67.75 002075090 3/05 1509 2/28 1505 30.10 002053170 3/12 1510 3/05 1506 700.00 003084520 3/21 1511 3/07 1507 26.00 002078140 3/24 1512 AMOUNT REFERENCE 69.00 003086740 30.00 002027390 32.53 003039220 18.00 004028510 3/10 1508 71.07 003083560 * Denotes missing check numbers ******************************************************************************* SAVINGS A. CCOUNT S 788406 7,110.91 .00 .00 .00 .00 7,110.91 0 Statement Dates 2/26/03 thru 3/25/03 DAYS IN THE STATEMENT PERIOD 28 AVERAGE LEDGER 7,110.91 AVERAGE COLLECTED 7,110.91 Interest Earned 4.09 Annual Percentage Yield Earned 0.75% STATEMENT SAVINGS ACCOUNT NUMBER PREVIOUS BALANCE DEPOSITS/CREDITS CHECKS/DEBITS SERVICE CHARGE INTEREST PAID ENDING BALANCE O STOWN BANK MARY STILWELL BILLIE JO GAl{DINER 145 AIRPORT ROAD SHIPPENSBURG PA 17257-9467 Date 4/25/03 PRIMARY ACCOUNT ENCLOSURES Page 1 788406 WE PUT THE LOW IN LOANS! ASK ABOUT OUR SPECIAL LOW RATE HOME EQUITY LINE TODAY! CALL 1-888-ORRSTOWN ABOUT THIS LIMITED TIME OFFER! ACCOUNT TITLE SAVINGS ACCOUNTS MARY STILWELL BILLIE JO GAR]DINER STATEMENT SAVINGS ACCOUNT NUMBER PREVIOUS BkLANCE DEPOSITS/CREDITS 1 CHECKS/DEBITS SERVICE CHARGE INTEREST PAID ENDING BALANCE 788406 7,110.91 .00 7,110.91 .00 .00 .00 0 Statement Dates 3/26/03 thru 4/27/03 DAYS IN THE STATEMENT PERIOD 33 AVERAGE LEDGER .00 AVERAGE COLLECTED .00 DATE DESCRIPTION REFERENCE 3/26 CLOSE INTEREST BEARING ACCOUNT 050368610 AMOUNT BALANCE 7,110.91- .00 P. O. BOX 316 WARWICK, RI O2886-0316 Notice of Claim Payment MARY STIIWFI [ NAME OF DECEASED DATE DF DEATH o3/2~/2oo3 WILLIAM A GARDINER 145 AIRPORT RD SHIPPENSBURG PA 17257 Please See Important Notice on Reverse Side Policy Number Codes Refer to Messages Below. Items Payable Policy Amount One-Year Term Insurance Additional Insurance Dividends With Interest Dividend to Policyholder Terminal Dividend Premium in Advance Interest on Claim Deductions Premium in Arrears Loan Loan Interest A 15127053 A 1COO.CO 2435.10 31.66 40.00 9.50 TOTAL 3516.26 A. OUR CHECK FOR THE BALANCE DUE IS ATTACHED BELOW. This claim has been approved for the total of the amounts appearing in the boxes below. Items determining these amounts are listed to the left. Amount Held for Deferred Payment Check Issued by Cuslomer Service Center : -5S7~ (iC~3) Plint~u in U~q.A. Detach stub before cashing JY4518&CRE(06/01 ) APPRAISAL OF PERSONAL PROPERTY OF THE ESTATE OF MARY STILWELL, 143 AIRPORT ROAD, SHIPPENSBURG, PA ON MARCH 27, 2003: Miscellaneous lawn & garden tools Wooden step ladder Kenmore automatic washer (older model) Kenmore dryer Common sofa Floor light Table light Sanyo portable color television Television stand Common platform rocker Singer console sewing machine (older model) Small record cabinet 7-Piece mahogany-finish dining room suit "Nautilus" dish set for 8 Miscellaneous stemware Oneida silver-plated flatware set for 8 Glass compote with plastic fruit Carnival bowl 2 Amber candleholders (set) Walnut-finish secretary desk Miscellaneous knick-knacks 6 Modem kerosene lamps ~$ 8.00 Empire-style sofa Small coffee table Miscellaneous pictures & frames Phyfe-type drum stand Common recliner Upholstered chair Barrel-back chair 8 Modern dolls ~$10.00 2 Table lights ~$ 5.00 Phyfe-type 2-tier stand 2 Carnival bowls ~$ 25.00 Porcelain top kitchen table Office desk chair Kitchen chair Frigidaire refrigerator Hotpoint gas stove Miscellaneous pots & pans Miscellaneous common dishware in cupboards Miscellaneous small kitchen electrical appliances G.E. portable color television Matching dresser & chest of drawers (set) $ 5.00 $ 5.00 $ 35.00 $ 60.00 $ 30.00 $ 8.00 $ 5.00 $ 60.00 $ 5.00 $ 20.00 $ 15.00 $ 5.00 $175.00 $ 25.00 $ 5.00 $ 25.00 $ 8.00 $ 25.00 $ 10.00 $ 75.00 $ 20.00 $ 48.00 $ 95.00 $ 15.00 $ 25.00 $ 15.00 $ 20.00 $ 15.00 $ 20.00 $ 80.00 $ 10.00 $ 25.00 $ 50.00 $ 25.00 $ 10.00 $ 8.00 $120.00 $ 65.00 $ 20.00 $ 25.00 $ 30.00 $ 40.00 $ 75.00 Common night stand Double bed with mattress & box spring Round tea-type table Common vanity light Emerson portable color television Miscellaneous bedding & linens Maple-finish chest of drawers Painted chest of drawers Double bed with mattress & box springs Vanity light Small plastic-frame glider Miscellaneous lawn furniture Impulse upright vacuum cleaner -2- APPRAISED BY: Dennis L. Gotshall, Auctioneer/Prop. Dan Hershey Auctioneering Service PA Lic. #AU-002306-L 3 Brown Road Shippensburg, PA 17257 TOTAL: $ $ $ $ $ $ $ $ $ $ $ $ $ $ 10.00 35.00 40.00 8.00 35.00 35.00 25.00 20.00 35.00 5.00 20.00 25.00 30.00 1,780.00 ORIGINAL ' 1 1 0 ACCT. NO. F ,~RATED .. Funeral Services CREDIT CARD Name of Deceased FOGELSANGER-BRICKER FUNERAL HOME, INC. ~OTHER~ LAST BALANCE INTEREST ] ~ATE PAYMENT CHARGE SUB TOTAL CREDITS LESS PAYMENT NEW BALANCE 04358 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mary Stillwell Date of Death: March 22ndt 2003 2003-00641 WillNo.' Admin. No.: 21-03-0641 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [] No [-] 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: Did the personal representative file a final account with the Court? Yes _ No [] b. The separate Orphans' Court No. (if any) for the Personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [--] No [-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this repo~,//f~, //~// j ~ Signature William Gardiner Name 145 Airport Road Shippensburg, Pa 17257 Capacity: Address 717-532-7557 Telephone No. [5~ Personal Representative ['-1 Counsel for personal representative 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 OO3291 GARDINER WILLIAM A 145 AIRPORT ROAD SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 195-10-1735 FILE NUMBER: 2103-0641 DECEDENT NAME: STILWELL MARY DATE OF PAYMENT: 1 2/01/2003 POSTMARK DATE: 11/08/2003 COUNTY: CUM BERLAN D DATE OF DEATH: 03/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,601.73 TOTAL AMOUNT PAID: $6,601.73 REMARKS: BILLIE JO GARDINER SEAL CHECK//119 INITIALS' AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS PENNSYlVANiA DEPARTMEI~ OF REVENUE OEPT. 280~1 HARRISitURG, PA 17128-O601 Z UJ UJ 0 UJ iii HI--V-1OUU INHERITANCE TAX RETURN DECEDENTS NAME (LAST, FIRST, AND BIDOLE ~NR'IAL) 03-22-2003 FILE NUMBER SOCIAL SECURITY NUMBER 195'--10-17-35 TI'lIB RETURN ~4J~T BE FILED ~t ~UPUCATE 9~ITH THE REGISTER OF WILLS -~OCIAZ SECURITY NUMBER [~ 1. Original Retum [] 4. Lk.ited Estate E] 6. Decede~ Died TeslaM ~ crow M win) C3 2. Suppl~nenlal R.etum ~ 4a. Future Interest Comlxomise ~ o~ H~ 12-12~) [~] 3. RmTmindm' Relum (da~ddMhlMorlot2-13-a~ E~ 5. Federal Estate Tax Relum Required ; 8. To~l Number ot Safe Deport Boxes r-'] 11. Elect]on to tax under Sec. 9113(^) ~am Sch O) Ill NN~E Will,nm RRM NAME ~'-PHONE NUMBER7 1 7-532-7557 1. Re~ E.~mts (Sci. mdule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Ckmaiy I-~ Coq~, ~iP or ~ (:3) 4. Uo~ages & Nora ReceiVe (Schedule D) (4) 5. Ca~. Ba~ Delx)slts & Mbcellane~Js Persomi Prof~lY (5) (Sched~ E) s. ~ Owned Property (Sc~du~ F) (S) 7. Inter-V~vos Transfem & MiriaM=uS No~.Probate Propen'y (7~ (Sch~lule G o~ L) Funeral Expenses & Adn~tratJve CMts (Sc~ H) (9) Oebt~ of ~e~,~t, ~ ~ & L~ns (~ ~ (~0) T~ ~ (~1 ~ 9 & 10) ~WI~ ~neS~ 11) 9. 10. 1t. 12. 13. COMPLETE MAILING N~ES8 145 ~:L~po:r[ ~oad Shippensburg¥ Pa 17257 ~NLY ~0:000_00 16,811. 52 ~) (11) 6,863,96 1:924_3q Chmila~ a~ Govemmm~ Bequests/Sec 9t13 Tnmls for whi;h a~ ete~3n l° tax has n°! been made (Schedule J) NM Value 8.bJKt ~ T~ ~ 12 minus Line 13) (t2) (13) 8F.E INSTRUC'llON~ ON REVER~ SIDE FOR APPLICABLE RATES (14) 15, Amount o~ Une14 taxab~ at the alX~Ud mx ' 0 (15) rate, o~ Irarmfem unde~ Sec. 9116 (aX1.2) x. 16. AmoantofUne 14 laxal~ atll,ealmW x .O (16) 17. Amount of Une 14taxable at sliding'rate x .12 (17) 16. Amount of Une14 imxabk at c~llaiaml rMa ~"~,;0;1:1 ,~8 . x .15 (18) 19. Tax Due (19) 20.[-"'"1. ' ' ' "'' ' " "~ ' " -~lJ-~- ' 96~8!!.52 8;788.35 88,023.17 $8,023.17 6,601.73 ~ AMOUNT ............... 0000 i,.dii,..i.di,,i,li,,I.,,l~i mc~lent's Complete Address: 143 Air rt Road' Shi ensbur ~x Payments and Credits: c.~ To~ C.,m~(^+ e + c) (2) (1) 6,601.73 IfUml '~ Um 3is gre,~ lhen Une 2, enter ~ dlflmm~. Thb .b. be TAX DUF_ Total Irdemsf/Psf~Ky i. D + E) 0 0 6,601.73 6,'601 ..73 Make Check Payable tO: REGISTER OF WILLS, AGENT · · ........... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X' IN THE APPROPRIATE BLOCKS 1. Did demdmt m~e a Iraru~ md: d. receive Ihe Iwomise ~' Ire of e~l~r paymenl% ~ or care? ...................................................................... [] 3. Did (~sdent otto m qn ~'ust for" or peys~ u~on deMh imnk sa~o~nt or secu~ ~t hb ~ ~ ~? .............. '[---] F THE ANGWER TO ANY OF THE ABOVE QUESTIO~ 18 YES, YOU MUST ¢_._n~PLETE 8CH_FPL~I: G AND FILE ri' AS PAILq' OF THE ~-~.~. ~ .11 06 03__~~__~ -------- 145 Air Port Road Shi ensbur Pa 17257 ~NATURE O~ PREPgRE~ OTHE~ ~N REPP~ENTAT~DATE~ ~ dakin cd' deat~ off or a~er January t 190~, me ~j( role impoeed on the net value c~ bmm~ ~ ~ ~r ~ ~ ~ ~e ~ ~ ~ ~ ~ p.s. ~116 (a) (1.9 ~: .8k~0en~ o~h~ chid k~ F2 P.s. e tax n~ Imposed oa the riel ValUe of imnet~ to or'for ihe use of ~m demdent% lineal ~ ~ 4,~, ~ ~ ~ b ~ RS, ~11~1~ ~2RS, ~l~a~l~, SCHEDULE A REAL ESI'ATE ' ' FILE 21 _n~.?.CRIPTION proper~at 143 Airport Road Shippensburg, Pa 17257 TorN. (Also enlsr o. line 1, ~lalion) (If more space 18 needed, insed ,;K~litional sheets of the same size) YAI_IJE AT DATE OF DEATH $80,000.00 $ 80,000.00 ~TH OF IzB'~YLV~ INHIg~TANCE TAX ~ E~i'ATE OF Mary Stilwell SCHEDULE E CASH, BANK DEPOSITS, 8, MISC. PERSONAL PROPERTY. 21 iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. 6. 7. checking account saying's account (copy enclosed Life Insurance Funeral Home gave a reund of overpayment Federal Income Tax return 1040 refund for 2002 Thompson Energy refund for american gas Personal property in home value by'report enclosed $1 , 1 24.68 $7,110.91 $3,516.26 $1 , 575.76 $1,191.00 $ 512.91 $1 , 780.00 TOTAl'(Ns°enmr°nlineS,Recai~ulatio") $ 1 6,811.5'2 (If II10~ apO(~ b n(ledod, kraft ~ 8he~ of tho 8;i1~ id~) COMMONWEALTH OF PENNSYLVANIA INHEF~I'ANGE TAX RETURN RESIDENT DEGEDENT ~-~ATE OF Mary Stilweli SCHEDULE H r-te4ERAL EXPENSES & ADMINISYRA11VE COSTS FIlE NUMBER 2,1 DESORIPTION AMOUNT ITEM NUMBEFI 1. 4. $. 6. 7. FUNE~LEXPENSE$: Fogelsanger Bricker reciept copy enclosed ADMINISTRATIVE COSTS: Personal ~'s ~s Name o~ PeeaM aepmaemaeve(~). Social Secu~ty Number(a)/EIN Number of Peraonal Repreaentatlue(s), Street Addre~ Year(e) Commmke Pae Atmmey Fees Family E. xeml~on: Of de~'eclenf8 acklrelm b not the acme a~ daimanfe, attach exl~nalkm) 8lmm Addrmm Probate Fees Tax Return Preparer'a Fees Ruth Ann Mooney 1250 Baltimore Road Shippensburg, Pa 17257 TOTAL (Also enter on $6,613.96 250.00 6.863.96 Mary StilWell SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ,.E lin:Itoh tmmimburud modk:al ~pmmm. field UBER 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. DESCRIPTION Valley Heating Furnace repair Vivian Coy Electric Bill Imaging Medical for decedent Dan Hershey aprraisal of personal property CFJMA Phone calls Aero Energy New tank purchased prior to death Appraisal for house Troy Mills Recording Will TOT~ (^~0 e,~ on h ~o, (If rmxe space is needed, inmt ao~llonal sheets ~f ~ same size} $75.00 $195.70 $' 96.00 $ 52. O0 $ 45. oo $ 26.00 $ 10.00 $694..69 $225.00 $280.00 $225.00 $ 1.,924.39 SCHEDULE J INHEFIITANOE TAX RETURN tale OF FILE NUMBER Mary Stilwell 21 NUMBE]: NAME ~ ~ OF PEI~8) R~ING PROPERTY Do Not UMTnlMI) OF ESTATE ! TAXABLE DISTRmUTK)~ [Indude 0might qx~eef ~ end tmnmra a-,,~ See. 911a (a) (1.2)] Billte Jo Garclner 145 Airport Road 8hippensburg, Pa 1725~ wife of Nephe~ $8,235.59 Joan Thomas *late husband' $3,000.00 She is deceased niece Lenore Gardner 145 Airport Road Shippensburg, Pa 17257 niece Sro live at residence William Gardner 145 Airport Road Shippensburg, Pa 17257 nephew $81,780.00 with the condiction Lenore Gardner can use house and personal effects until her death or is unable' to live there with out asst. A, 8POUSAL OISTRIBtJTICN8 UNDER 8ECT1ON 9113 FOR WHICH AN ELECTION TO TAX 18 NOT BEING MADE BUREAU OF 'rNDZVZDUAL TAXES TNHERTTANCE TAX DTVISION DEPT. Z80601 HARRISBURG,, PA 171Z8-0601 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF /NHERZTANCE TAX APPRA/SEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX WILLIAM GARDINER lq5 AIRPORT RD SHIPPENSBURG PA 17Z57 CUT ALONG THXS LINE ~ DATE ESTATE OF DATE OF DEATH FZLE NUHBER COUNTY ACN 01-1Z-200q STILWELL 05-22-2005 21 05-06~1 CUHBERLAND 101 Amoun'lc Rem J.'~ ~:ed = o/ ?y,,,, . HAKE CHECK PAYABLE AND RENZT P REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA I7013 RETAZN LOWER PORTXON FOR YOUR RECORDS *~ 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. CD REV-1162 EX(11-96) 003470 GARDINER WILLIAM A 145 AIRPORT ROAD SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 195-10-1735 FILE NUMBER: 2103-0641 DECEDENT NAME: STILWELL MARY DATE OF PAYMENT: 01/22/2004 POSTMARK DATE: 01/21/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,601.75 TOTAL AMOUNT PAID: $6,601.75 REMARKS: CHECK//128 INITIALS: JA RECEIVED BY. GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDTVTDUAL TAXES ZNHER/TANCE TAX DTVTSION DEPT. Z80601 HARRTSBURG,, PA 171Z8-0601 WILLIAM GARDINER lq5 A[RPORT RD SHIPPENSBURG COMMONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE TNHERTTANCE TAX STATEMENT OF ACCOUNT '04 I AR -5 P 3 :z13 REV-1607 EX AFP (01-OS) BATE 03-01-ZOOq ESTATE OF ST[LNELL BATE OF BEATH OS-[Z-ZOOS FZLE NUMBER 21 05-06ql COUNTY CUMBERLAND ACN 101 I Amount Remitt®d MARY MAKE CHECK PAYABLE AND REM/T PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submAt the upper portion of thLs form with your tax payment. CUT ALONG TH'tS LZNE ~ RETA'rN LONER PORT'rON FOR YOUR RECORBS ~ REV-1607 EX AFP [01-033 ~#N 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF STILNELL MARY FZLE NO. 21 O$-06ql ACN 101 BATE 05-01-200q TH'rS STATEMENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELO# TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND,. TF APPLTCABLE, A PROJECTED TNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-1Z-ZOOfi PR[NC[PAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): PAYMENT RECE[PT DISCOUNT (+) AMOUNT PAID DATE NUMBER [NTEREST/PEN PA[D [-) 11-08-2003 01-Zl-Z00q CDOO3291 CDOO3q70 .00 .00 6,601.73 6,601.75 BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-ZZ-ZOOq ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQU/RED. ZF TOTAL DUE IS REFLECTED AS A "CRED/T' (CR), TOTAL TAX CREDZT 13,ZO3.q8 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. Z3.39 TOTAL DUE 23.39 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTN OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Hills, any of the Z$ Revenue District Offices ar from the Department's Iq-hour answering service for fores ordering: 1-800-~6Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-q~7-3020 CTT only). REPLY TO: 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. 280601, Harrisburg, PA 17128-0601, phone (7173 787-6505. DISCOUNT: If any tax due is paid within throe (3) calendar months after the decedent's death) a five percent [SZ) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid 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 (1) day from the date of death, to the date af payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1) 1982 will bear interest at a rate which will vary from calender year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .0005~8 1987 9Z .0002q7 1999 72 .000192 1983 lBZ .gOOqS8 1988-1991 1II .OOO301 2000 8Z .O00Z19 198q llZ .000301 1992 9Z .O00Zq7 ZOOl 9Z .0002q7 1985 132 .000356 1993-199q 7Z .000192 2002 62 .00016~ 1986 lOX .00027~ 1995-1998 9Z .0002~7 2003 52 .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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. BUREAU OF TND'rVZDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CONNONHEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT NILLZAN GARDINER lq5 AIRPORT RD SHIPPENSBURG PA 17257 BATE 05-01-200q ESTATE OF STILNELL BATE OF DEATH O$-ZZ-ZO0$ FZLE NUNBER Z1 05-06ql COUNTY CUNBERLAND ACN 101 Amount Rsm J.t ted MAR~ MAKE CHECK PAYABLE AND REMZT PAYME REGI'STER OF NTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 NOTE: To /nsure proper credit to your account, submit the upper portion of th/s fore wLth your I,,,111,,,111,,,,,,11,,11,,,11,,'11,,,I,1,, BUREAU OF ZNDTVIDUAL TAXES INHERITANCE TAX DTVXSXON DEPT. Z80601 HARRISBURG, PA 17118-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-iSiS7 EX AFP {01-05) WILLIAH GARDINER 145 AIRPORT RD SHIPPENSBURG F ,~i :~ of DATE 01-12-2004 &~:,~ ,~4 Wills ESTATE OF STZLNELL DATE OF DEATH FILE NUNBER 21 0:5-0641 '04 FEB 25 A8:31 COUNTY CUHBERLAND ACN 101 Amount HARY HAKE CHECK PAYABLE AND RENIT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~'~ RETAIN LONER PORTION FOR YOUR RECORDS ~.~ DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF STILNELL HARY FILE NO. 21 0:5-0641 ACN 101 DATE 01-12-2004 TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN DASED ON: ORIGINAL RETURN I Real Estate (Schedule A) Stocks and Bonds (Schedule B) $ Closely HeZd Stock/Partnership Interest (Schedule C) Nortgages/Notas Receivable (Schedule D) $ Cash/Bank Daposits/Nisc. Personal Proper*y (Schedule E) 6 Jointly O~nad Property (Schedule F) 7 Transfers (Schedule G) 8 Total Assets APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H} 10. Dabts/Nortgaga Liabilities/Liens (Schedule I) 11. Total Deduct ions 12. Net Value of Tax Re*urn (1) (2) ($) (~) (5) (6) (7) 80~000.00 O0 O0 O0 16~811.52 O0 O0 (9) (8) 6,86:5.96 (10) 1,924.$9 (11) (12) 13. 1~. NOTE: ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spousal rate 16. Aeount of Line 1~ taxable at Lineal/Class A rata 17. Aeount of Line 1~ at Sibling rata 18. Aeount of Line 1~ taxable st CollateraX/CXass B ra*e CharitabXe/Govarneantal Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Net Value of Esta*e Sub~ect *o Tax (1~) If an assessment ~as issued previously, lines 14, 15 and/er 16, 17, reflect flgures that include the total of ALL returns assessed to date. 19. Principal Tax Due TAX CREDITS.' PAYHENT RECe.I.r I NOTE: To insure proper credit to your account, subeit the upper portion of this fore ~ith your tax payment. DATE 11-08-2005 NUNBER CD005291 DXSCOUNT INTEREST/PEN PAID (-) .O0 INTEREST IS CHARGED THROUGH 01-17-2004 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH 96,811.52 8.788.~6 88,023.17 .00 88,023.17 18 and 19 Nlll (15) .00 X O0 = .00 (16) .00 X 045 = .00 (17) .00 X 12 = .00 (18) 88,025.17 x 15 = 1~,20:5.48 (19)= 1:5,203.48 AHOUNT PAID 6,601.7~ 6,601.7:5 6,601.75 27.75 6,629.50 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE ( XF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF THTS FORH FOR TNSTRUCTTONS.) ~'~ ~/ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TZ P.S. Section 9140). Detach the tap portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGXSTER OF NXLLS, AGENT A refund of a tax credit) ahich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices, ar by calling the special Z4-hour ansmering service for fores ordering: 1-800-36Z-ZOSO~ services for taxpayers mith special hearing and / or speaking needs: I-&OO-447-30ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171ZB-lOZI, OR --election to have the matter determined at audit of the account ef the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Oapt. ZB060I, Harrisburg, PA I71ZB-0601 Phone (717) 787-6S05. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SO1) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (5Z) 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 and 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 free the date of death, to the date of payment. Taxes which became deIinquent before January 1, 198Z bear interest at the rate of six (DZ) percent par annum calculated at a daily rata of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate ahich 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 ZOO5 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 207. .000548 1987 9Z .000247 1999 7Z .000192 1983 162 .000438 1988-1991 llZ .000301 2000 87. .000Z19 1984 11Z .000301 1992 9Z ,000Z47 2001 9Z .000Z47 1985 15Z .000356 1995-1994 77. .00019Z 200Z 67. .000164 1986 IOZ .000Z74 1995-1998 97. . O00Z47 ZOOS S7. .000157 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAILY TNTEREST 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. :~EV-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 DECEDENTS NAME FILE NUMBER Mary Stilwell 2103-0641 REVIEWED BY ACN Sheila Megonnell 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Taxable at 15%. The tax rate change for siblings is effective for dates of death J on or after 07-01-2000. ROW Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REC'EIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-9 CD 00368' GARDINER WILLIAM A 145 AIRPORT ROAD SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 195-10-1735 EILE NUMBER: 2103-0641 DECEDENT NAME: STILWELL MARY DATE OF PAYMENT: 03/1 6/2004 POSTMARK DATE: 03/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $23.39 i R:EMARKS: WILLIAM A GARDINER CHECK# 132 TOTAL AMOUNT PAID: $23.39 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDTVTDUAL TAXES TNHERTTANCE TAX DTVISTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 WILLIAM GARDINER 145 AIRPORT RD SHIPPENSBURG COMMONWEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT ~-~:-;~.. ? DATE ~-i~ ESTATE OF DATE OF DEATH FILE NUMBER '04 APR 26 ? 1:39 COUNTY ACN REV-I$07 EX AFP (01-05) 04-12-2004 STILWELL 03-22-2003 21 03-0641 CUMBERLAND 101 Amount Rem'i tted NARY HAKE CHECK PAYABLE AND REMIT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portAon of this fore wAth your tax payment. CUT ALONG THTS LZNE ~ RETA'rN LOWER PORTION FOR YOUR RECORDS -.~ REV-1607 EX AFP (01-03) ~ ZNHER~rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF STILWELL MARY F'rLE NO. 21 03-0641 ACN 101 DATE 04-12-2004 THTS STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHOWN BELO# TS A SUMMARY OF THE PRTNC*rpAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND,, TF APPLTCABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 01-12-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 13,203.48 PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 11-08-2003 01-21-2004 03-15-2004 CDOO3291 CD003470 .00 .00 CD003681 23.39- 6,601.73 6,601.75 23.39 ZF PAID AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE 1S LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDTT 13,203.48 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR TNSTRUCTTONS. ) 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 make check or money order payable to: REGZSTER OF #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application ~or Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the 13 Revenue District Offices or from the Department's gA-hour answering service for fores ordering: 1-800-361-ZOBO~ services for taxpayers with special hearing and / or speaking needs: 1-agO-qq7-BOZO iTT only]. REPLY TO: 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. 180601, Harrisburg, PA 1711B-0601, phone (717) 787-6505. DISCOUNT: 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. PENALTY: The 1BI tax amnesty non-participation penalty is coaputad on the total of the tax and interest assessed, and not paid before January 18, [996, 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 CZ) day from the date of death, to the date of payment. Taxes which became deIinquant before January I, 1981 bear interest at the rate of six (6Z) percent per annum caIculated at a daiIy rate of .000164. Ali taxes which became delinquent on and after January l, 1981 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 I982 through 200q are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 198Z 20Z .0005q8 1988-1991 llZ .OOO~Ol 2001 1983 162 .000438 1992 92 .000247 2002 198q llZ .OOO301 1993-199q 7Z .OOO19Z ZOO3 1985 13Z .000356 1995-1998 9Z .000247 2004 1986 lOX .O00Z7q 1999 71 .O00lgz 1987 92 .OOOZq7 ZOO0 BZ .O00Z[9 Interest Daily Rate Factor 92 .000Z47 6Z .O0016q 5Z .000137 qZ .000110 --Interest is calculated as fallows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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. BEINHAU December 20, 2005 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Mary Stilwell- Estate No. 21030641 Dear Sir or Madam: Enclosed for filing are an original and three copies of the Status Report Under Rule 6.12 as well as a Settlement Agreement along with our check in the amount of $20 which represents the filing fee for the Settlement Agreement. Please time-stamp and return all additional copies to me in the enclosed self-addressed, stamped envelope. Thank you for your consideration. Very truly yours, BEINHA'Ef CURCILLO Jo:le~~ JRB:tlk Enclosures JOSEPH A. CURCILLO. III. ESQUIRE JOHN R. BEINHAUR. ESQUIRE PARALEGALS: ANNE E. HOUSER TAMMY L. KELLY NICOLE M. FARLING 3964 LEXINGTON STREET HARRISBURG. PA 17109 Ph: 717.651.9100 Fax: 717.651.9200 WWW.BEINHAURCURCILLO.COM PHILADELPHIA AREA OFFICE. 2518 HUNTINGDON PIKE SUITE E HUNTINGDON VALLEY PA 19006 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: -Jv{ l{\ ~ \.,\ ~\-\ I w e-ll Date of Death: b~- d--o. - ~L)D"3 Estate No.: "d \ v"3 -f'Jh~ , Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 3. If the answer to No.1 is yes, state the following: A. B. Did the personal representative file a final account with the court? Yes No K The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties in interest? Yes p<.. No 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. ~7'Jj'- ] Ii /. .~~ If 4~ c. D. Date: ld-IILt} O~ I Signature ~',J \A]\'- U l 01-Vl-\ Ii. r;.A YLi 1\ v\.p r Name (Please type or print) ~. ~;-- (MAH:rmtJ AM3) ~5 A\ r:P()~+- 0()J\d ~~~Sl~f)~-QVlS blJv~~ (p." ri-;;).51- ~\1-~ 53--;)- r-::rCS'5:.:t- Telephone No. Capacity: 1X. , Personal Representative Counsel for Personal Representative R.W. - 58 v&- SETTLEMENT AGREEMENT THIS AGREEMENT, made this ;.1..14aYOf /J;~ 2005, by and between WilliamA. Gardiner, individually and as Executor of the Last Will and Testament of Mary Stilwell, of145 Airport Road, Shippensburg, Pennsylvania, I 7257; Billie Jo Gardinerof I 07 Neil Road, Shippensburg, Pennsylvania, 17257; and Lenore Gardiner of 145 Airport Road, Shippensburg, Pennsylvania, 17257. WHEREAS, the parties hereto are the beneficiaries of the Estate of Mary Stilwell; and WHEREAS, William A. Gardiner was named Executonlllderthe Last Will and Testament of Mary Stilwell, filed to the Register of Wills of Cumberland County, Pennsylvania, at Docket Number 03-0641; and WHEREAS, the said Executor has caused an Inheritance Tax Return, in the form attached hereto as Exhibit "A," incorporated herein by reference and made a part hereof, to be duly prepared for filing with the Register of Wills of Cumberland County, Pennsylvania, which retumreflects all assets ofthe Decedent known to the said Executor excepting income to the Estate and all debts of the Decedent known to her NOW THEREFORE, INTENDING TO BE LEGALLY BOUND, the parties hereto agrees as follows: 1. The Executor ofthe Estate of Mary Stilwell hereby releases and waives any right which he may have to a commission or fee in connection with his duties as Executor. 2. The Estate shall be distributed pursuant to the Last Will and Testament of Mary Stilwell as set forth in the Informal Accounting as attached hereto and incorporated herein by reference. In summary, the distribution is as follows: 3. The Residual Estate shall be distributed pursuant to the Last Will and Testament of Mary Stilwell, as follows: (a) - , ., (b) (c) (d) To Billie J 0 Gardiner shall go a china cupboard, and the dishes contained therein; a glass punch bowl and cups; and an antique orange bowl with artificial fruit contained therein and one-third of the residual estate; To Lenore Gardiner shall go one-third of the residual estate; To William A. Gardiner shall go one-third of the residual estate. Note: The distribution to Joan Thomas of$I,OOO.OO is void as she is deceased. .~ c." , u!t: 4. Each of the parties hereto acknowledges notice, that, pursuant to the laws of the Commonwealth of Pennsylvania, such party is entitled to the filing of an accounting with the Court of Common Pleas of Cumberland County, Orphan's Court Division, by which the Executor, by sworn statement and affidavit, verifies the assets received by herJhim in administering the Estate and the expenses incurred in connection with its administration. Notwithstanding such notice, and in the interest of economy and conservation of Estate assets, each ofthe parties hereto waives and relinquishes such party's right to require such an accounting and hereby releases and discharges the Executor from any and all claims, demands or liabilities of any kind or character relating to or arising from the failure to file such accounting, it being the intention of all parties hereto that no such accounting shall be filed. 5. This Agreement relates to an Estate being administered in Pennsylvania, and to a Decedent of the Commonwealth of Pennsylvania. Accordingly, this Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. 6. This Agreement shall be binding upon the parties hereto, their heirs, successors and assigns. 7. This Agreement shall be legally effective and legally binding whether the original hereofis signed by all parties, or whether signed in counterpart by the parties hereto. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first written above. WITNESS: , I~J . I /, (~>~ L{.~/'v"" A1 ir) / 1:5 . , ,-J.t~.J .,/ /1- ,? Id ~' C .-+- ',i/,~/t~{( ~~t. ~ Z~A'~ /t~~ 1 ~ W" i,I,li~~A'"G, ard,iner, EX, ecuto r "~//J /);;Z ". t~/ d'i~~~{/ .~)!t~/z.-/~ William A. Gardiner ~?t7~ Billie Jo ardmer [VA/itCh f) ~/~-rj~ ", d:1 ~. /J' ' '1 ///' " l~.4~t~ ;J // ~A~-v , ~~J,:J!~v'~- t ~.~1_ ... " ./ - ,:{v,o/~ ~~ Lenore Gardiner COMMONWEALTH OF PENNSYLVANIA SS.: COUNTY OF DAUPHIN On this, theJ9t.. day of N(JI/~"vnhJ!.1L- ,2005, before me, a Notary Public, the undersigned officer, personally appeared William A. Gardiner, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NC'It;F\IAl ~;tf\L iOHN R B[!NHi\!jR Notary Public I, ',., , Pel , j,)'1 Twp Dauphin County ':_>r:!:';;~s M2.rc~ fun? Not!{ffJ(iur My Commission Expires: (SEAL) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~lf1lt.tt SS.: On this, the~ day of AJM..tl/klUIL. ,2005, before me, a Notary Public, the undersigned officer, personally appeared Billie Jo Gardiner, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that she executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~ 7 t4lr!J LiJv N tary Pub~ My Commission Expires: (SEAL) , , l NOTARIAL SEAL : JOHN R BEIt\IHAUR. Notary Public J Lower Paxton Twp Dauphin County . M, Com,",,,,,, ",,,OS """0.3. ?ffl7 . COMMONWEALTH OF PENNSYL VANIA COUNTY OF t;YX1.lJP#1 tJ On this, the It day of NCW.tfN~ L ,2005, before me, a Notary Public, the undersigned officer, personally appeared Lenore Gardiner, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes herein contained. SS.: IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SeAL JOHN R BEINH,\UR. Notary Public lOW('f Pax ten Twp Dauphin County r.,b CornTlssion Expires Mdrcil13, 2007 ~_.__.!..-~------->.......---- qfAC-!(;wr- N~ Publi~ My Commission Expires: (SEAL) BUREAU OF INDIVIDUAL TAXES INHERITANCE. TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REY-I6D7 EX AFP (01-03) WILLIAM GARDINER 145 AIRPORT RD SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-12-2004 STILWELL 03-22-2003 21 03-0641 CUMBERLAND 101 MARY Amount Remitted PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -- ifiv =i61fj-E3t-AFP--foY:oiY------..iE--iNHERiYANC'E--fAX--STA-fEM'E-N'f-o-F'-AC-cof.iiff--iE-i.---------------- -- --- ESTATE OF STILWELL MARY FILE NO.21 03-0641 ACN 101 DATE 04-12-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-12-2004 P R I N C I PAL TAX DUE: ._.._.................____..........._........___...._--.....-.....-..............-.-..--........................-...-...---.-.-.....-....-.............---.......... 13,203.48 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 1l-08-2003 CD003291 .00 6,601.73 01-21-2004 CD003470 .00 6,601.75 03-15-2004 CD003681 23.39- 23.39 TOTAL TAX CREDIT 13,203.48 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 Kt:V-' :>UU INHER;TANCE TAX RETURN RESIDENT DECEDENT w ..... lol::~Ul uIX:lol:: wn.u J:oo uIX:..J n.al n. <( DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) I- Z W C W U W C Mar Sti1 DATE OF DEATH (MM-DD-YEAR) 03-22-2003 DATE OF BIRTH (MM-DD-YEAR) 03 . .,2 3 - /9'0 Z; (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 21 FILE NUMBER COUNTY CODE - ~ -l-;2~ -- [J 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (AIlach copy ofWjl) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (date of death afIef 12.12-82) D 7. Decedent Maintained a Living Trust (_ropyofTrusl) D 10. Spousal Poverty crectn (date of death between 12.31.91 and 1.1-95) SOCiAl SECURITY NUMBER 1 95--1 0 -1 r-35 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCiAl SECURITY NUMBER D 3. Remainder Return (date of death prior III 12-13-a2) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposn Boxes o 11. Election to tax under Sec. 9113{A) (Alla:h Sch 0) ..... z w o z o n. Ul w IX: IX: o U COMPLETE MAILING ADDRESS 145 Airport Road Shippensbur~, Pa 17257 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) e~:~1.~J (19) G, . 7 NAME FIRM NAME (If Applicable) TELEPHONE NUMBER 717-532-7557 OFFICIAL USE ONLY (8) 96,811.52 (1) (2) (3) (4) (5) 80,000 00 z o ~ ..J :J !:::: a. <( u w ex: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) ! 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) (12) ! (13) 8,788.35 88,023.17 16,811.52 (14) (6) (7) (9) 6,863.96 (10) 1,924 19 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;t .... :J Cl. ~ o u >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable al sibling rate 18. Amount of Une 14 taxable at collateral rate ---1~iOl1 ,~8 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT lecedent'~ Complete Address: STREET ADDRESS . JIIY 143 Airport Road Shippensburg, I STATE PA 'ax Payments and Credits: Tax Due (Page 1 Line 19) (1) CreditsIPayments A. Spousal Poverty Credit B. Prior Payments C. Discount I ZIP 17257 6,601.73 Total Credits (A + B + C ) (2) o Interest/Penalty if applicable D. Interest E. Penalty o TotallnterestJPenalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) If Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6,601.73 A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 6,601.73 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ ~ c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................~.................................... 0 .~ ~ ~ ~ 153 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Ider penalties 01 peIjury, I declare lhat I have examined this return. including accompanying Schedules and statements. and to !he best of rny knowledge and belief, it is true. correct and complete. !CIaration of preparer other lhan !he personal representative is based on all information of which preparer has any knowledge. GNATURE OF PERSON RESPONSIBLE FOR FILING RETURN x JDRESS 145 Air Port Road Shippensburq, Pa 17257 GNATURE OF PRE PARER OTHER THAN REPRESENTATIVE DATE 11/06/03 JDRESS DATE ..; )~~~in;fmt:::- ,.J';~~:,:::,:..; " , . ':i;:~;;r:~!;;;:i:t1~~~5im?{~a~~~~~~~ty;~~~lrI~~~:f~f~J:-;~}(;~~.:;-:.:~,~:;~}!Tf~~::ff~(~ )_~~~~?f-..~~7~7~r~:~:~t~~.;~~~f8r:~:': :.~'~V:}rf,~?~~:;~'~:~4f~~.;':O:~ ';:~~~~-~;.';:t-:~ )r dales of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 3% 2 P.S. ~9116 (a) (1.1) (i)]. )r 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. 99116 (a) (1.1) (ii) 1e statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even 'Viving spouse is the only beneficiary. ), uales of death on or after July 1, 2000: le 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 a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)). le tax rate imposed on the net v~lue of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S, 99116(1.2) [72 P.S, 99116(a)(1 )). le tax rate imposed on the net value of transfers ,to or for the use of the clecedenfs siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a dividual who has at least one parent in common with the decedent, whether by blood or adoption. . ~..., SCHEDULE A REAL ESTATE COUMONWEALTHOF Pc'" YLVANIA INHERITANCE TAX JRN RESIDENT DE ere ,T FILE NUMBER ESTATE OF Ma2'l Stillwell 21 All real property o",;,"~ between a willing buyer and Q ,. survlvorshl must be d is c ' ; ITEM NUMBER 1. ,dy or as a tenant in common must be reported at fair market value, Fair rnaOOlt value is defined as the price at which property would be exchanged . seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of I Schedule F, VALUE AT DATE OF DEATH J' ,- ~.1 .... DESCRIPTION Jert.9 at 143 Airport Road Shippensburg, Pa 17257 /. d cr 4J p 1"7;;1.,.( S c,J e j-JC- <vS c' , {/ $80,000.00 , c-ve.. TOTAl (Also enter on line 1, Recapitulation) $ 8 0 , 0 0 0 . 0 0 (If more space is needed. insert additional sheets of the same size) . ......~__~9\1~11 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONwEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Stilwell FILE NUMBER 21 Include the proceeds 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 I ITEM V AWE AT DATE NUMBER DESCRIPTION OF DEATH 1. checking account $1 , 124.68 2. saving's account (copy enclosed $7,110.91 3. Life Insurance $3,516.26 4. Funeral Horne gave a reund of overpayment $1,575.76 5. Federal Income Tax return 1040 refund for 2002 $1,191.00 6. Thompson Energy refund for american gas $ 512.91 7. Personal property in home value by report enclosed $1,780.00 111____ _____ l~ __ TOTAl (Also enter on line 5, Recapitulation) $ 1 6, 81 1 . 52 '. . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Stilwell ITEM NUMBER A. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 1. FUNERAL EXPENSES: Fogelsanger Bricker reciept copy enclosed DESCRIPTION AMOUNT $6,613.96 8. ADMINISTRATIVE COSTS: 1. 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: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Rel~tionship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees Ruth Ann Mooney 1250 Baltimore Road Shippensburg, Pa 17257 250.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 6 _ 863 96 (If more space is needed, insert additional sheets of the same size) _."D.,~ . COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT .. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Mary Stilwell FILE NU~~ER Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 . DESCRIPTION Valley Heating Furnace repair Vivian Coy Electric Bill Imaging Medical for decedent Dan Hershey aprraisal of personal property CFJMA Phone calls Aero Energy New tank purchased prior to death Appraisal for house Troy Mills Recording Will AMOUNT $75.00 $195.70 $ 96.00 $ 52.00 $ 45.00 $ 26.00 $ 10.00 $694.69 $225.00 $280.00 $225.00 TOTAL (Also enter on line 10, Recapitulation) $ 1, 924. 39 (If more space is needed, insert additional sheets of the same size) . ,. SCHEDULE J BENEfiCIARIES ESTATE OF NUMBER I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Marv Stilwell NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. FILE NUMBER 21 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Billie Jo Gardner 145 Airport Road Shippensburg, Pa 1725 wife of Nephe~ $8,235.59 Joan Thomas She is deceased Lenore Gardner 145 Airport Road Shippensburg, Pa 17257 William Gardner 145 Airport Road Shippensburg, Pa 17257 with the condiction Lenore Gardner can use house and personal effects until her death or is unable to live there with out asst. late husband' ~ $ J ,000.00 niece niece nephew $to live at residence $81,780.00 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. 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. NoAJ l B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. AJON [ TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF~i~ `o ~ -~-e-t2,Zl,~ ~ COUNTY, PENNSYLVANIA Name of Decedent: ~~~~~ ~ . ~3 File Number:_ ~3 "- G~ ~~ Date of Death: C~ ~'- Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to c`bmpletion of the administration of the above-captioned estate: 1. State whether administration of the 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 Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ...........:.................. ®Yes ~No 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 report. Dnre ~ f~ ~ vv c ` ~j,~ ~-~..~ Signature ojPerson Filing this Form ~. Capacity: Personal Representative .Counsel Cr _-~' .` Name ofrerson ilinglhisForm _ ~ .- LV _ :J. ==, ~ = > ~ 1 WEST HIGH ST.'STE. 20S :~. ~~ _, Telephone Form RW-!0 rev. 10.13.00