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Home My WebLink About03-0566PETITION FOR PROBATE anti GRANT OF afate of Helen A. Worman No. __ ~/- ~ - ~'~g g also known as To: Dece~ed. Soczat Securtty No. 176-34-9397' The Petition of the undersigned r~pecffully repreaents that: Your petitioner(s), who is/'&xe 18 years of age or older an the executrix in the last will of the above decedent, dared September 19 and codicil(s) dated Reg~ter of Wills for the Co~lty of Cumberland Commonwealth of Pennsylvania in the 19 "~ (slate relevant circumstancc~, c.g. r~nunciaUon, dea~ of executor, Decendent was domiciled at death in Cumberland · -- u ,Pc s Iv ' with h_er __ last fam_ily or principal residence at Messiah Vxliag~,-~~ '~en ~al~'~, .~_.Cumberland uounty, Pennsylvania (iht street, number and muacipality) Decendent, then 95 . . years of age, died July 6, 2003 at Messiah Village, wecnanics~urg, ~flmberland County, ' ---------. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; wan not the victim ofa kll/ing and was never adiudicated incompetent: . Decendent at death owned property w/th estimated valu~ as follows: (If domicile~ in Pa.) All personal proper~y (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Persona/property in County Value of real eSr. ate in Pennsylvania situated as fo/lows: $195,000.00 $ $, WHEREFORE, petitioner, s) respectfully presented herewith and the grant of letters theron. . request(s) the probate of the last will and codicil(s) testamentary (testau~m,,y; adrnimstration c.t.a.; administration d.b.n.c.t.a.) '~ _ Mfir~W. Raub ~ 1159 Dawes St., Libertyville, IL 60048 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF CUMBE~LAN_.D ~ The ~etitioner(s) above-named swear(s) or afHrm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as persona/represen- tative/s) of the above decedent petitioner(s) will well amd truly administer the e~tate according to/aw. Sworn to or afF~'med and subscribed be, I~} me this ._ ~,,~ day or - Mfiry~. Raub No. Estate of Helen A. Worman , DeceaSed DECREE OF PROBATE AND GRANT OF LETTERS ~/z./ /5/ .-'~$'~ in consideration of the petition on AND NOW the reverse side hereof,/ /s~tisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 19, 1991 described therein be admitted to probate and filed of record as the last will of Hel_en A. Worman and Letters Testamentary are hereby granted to Mary W. Raub FEES Probate, Letters, Etc .......... ~ Short Certificates( ) .......... $ ~,ggO lL~],'~un'~tion ................ $.~.~2~, TOTAL ~ Fried ATTORNL~" (~up. Ct. i.D' No.} 414 Br±dge S~., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE 6g:gd 6-qFIF {'0. REGISTER OF WILLS OATH COUNTY ~CI~IIIING WITNESS each) a subm witness to the w/Il present~erewith, (each) being duly qu fled accordin to aw, d,:l: ~se(sI say(s) that ,/ qu~ g em ~ --_ sign the same and that ~' requ/~ of testaL in h /~sence and (in the presence of eagK/othe~ig(in~ha~ ~reWs/te~S;oa~ tlhh~ · trus / day of (Name) (Name) (Addre. rs) REGISTER OF WILLS OFCUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Mary W. Raub and Richard A. Raub (each) 'a subscriber hereto, (each) being duly qua/ffled according to law, depose(s) and say(s) that they are familiar with the signature of --Helen A. Worman testat r±...r..~__x~x of (~m~x~x~n~mx~i~i~x~l~x~ the will presented herewith and that they believes the signature on the will is in the handwriting of Helen A. Worman to the best of their__ knowledge and belief. SmWe°:~i:°°r~fi~_~andsubs¢fibedbefore ,~'~ ~L~.~2 /~~ ~ 1159 Dawes'St., Libertyville, IL 60048 (Name$RZ C~ A. ~9 Bawes St., L~bertyv~ZZe, IL 60048 (~ddress) 6g:gd 6-q~q? _cO. his is to certify that the information here given is correctly copied fi:om an original certificate of death duly filed with me as [.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $2.00 No. Local Registrar Date : ituv 2J87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH SEX ~IAL SECUR,~ NUMe~R u~.,v~ u.o..,.~ o*~o~ ~ "F~o - 176 -- 34 -- 397 "O' 6 2 ' ~ ......... o~. ,~, I ~'-T~~'~ ...... ~ ~.ic ................ 9 ' ~t 3, 07 Pa c,~.~.~o~oE~. ~c,~ .................. [~; ..... ~ ~ I~' ~ ..~ ~s~,~ ' . 100 ~ ~lon Drive RESIOE~E -- ~ lr~ Y".~m~in -- Pa 17055 ~.., ~ ,--.. -~. ~ W. ~ub .~ 1159 ~s Steer ~ ,~,~, ~ t~et DUE ~ ~ AS A C~CE ~: ~u~. Emro ~YI~ I UE ~ (OR AS A C~SEOUENCE O~:- ~s*..~s~ w....,,~ ............... I LICENSE NUMRER /y~"~ ~ ~ r JDATESIGNED)Monm. Oa¥.Year) "'ME'~o ADO"ESS O"PE.SO. O, DE,T. DATE FILED(Mo~ Day Yea,) LAW OFFICES JON F. LAFAVER $17 THIRD STREET NEW CUMBERLAND, PA O LA'x,V OFFICES 317 THIRD 5TRSET ~EW CUMBERL~D, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF HELEN A. WORMAN I, HELEN A. WORMAN, of Upper Allen Township, Cumberland County, iPennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other wills by me at any time heretofore made. I. I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. Ail the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my daughter, MARY W. RAUB. III. I hereby nominate, constitute and appoint my daughter, MARY W. RAUB, as Executrix of this, my Last Will and Testament. If the said Mary W. Raub should predecease me, fail to qualify or cease to act as such, then I nominate, constitute and appoint BEVERLY A. BEDARD as Executrix. IV. No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, HELEN A. WORMAN, the Testatrix, have unto this, my Last Will and Testament, set my hand and seal this / ~ day of - . , A. D., 1991. \ Page one of two Pages HELEN A. WORMAN LAW OFFICES 317 THIR. D STR-EET NEW CUMBERLAND, PENNSYLVANIA 17070 STONE, LAFAVER ~ SHEKLETSKI A PROFESSIONAL CORPORATION ~1 ~I~/~.:~S AT LAW 414 BRIDGE STREET NEW GUI~IBERLAND, PA 17070 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) :ameef Decedent- Helen A. !4orman l,ak,e oi Death: July 6, 2003 20:O~$-O0.: ~ 66 Register- I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on er mailed :o the following beneficiaries of the above captioned estate en July 21 2003 ] i:, l'av:es Street Li,.." .... ..... '-wi ! Lc, iL 60048 Notice has now been given to all persons entitled thereto under Rule 5. 6(a) ' t' [~/ Da t e · , , . . ,.. , .;:~,../ ~ David H.'Stone, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative ,3 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 003088 STONE DAVID HEAN ESQUIRE 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ........ fold ESTATE INFORMATION: SSN: 176-34-9397 FILE NUMBER: 2103-0566 DECEDENT NAME: WORMAN HELEN A DATE OF PAYMENT: 10/06/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $9,000.00 TOTAL AMOUNT PAID: $9,000.00 REMARKS: MARYWRAUB C/O DAVID HEAN STONE ESQUIRE SEAL CHECK# 3804 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Richard A. Raub 1159 Dawes St. Libertyville, IL 60048 REV-1500 E.X (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE -- 2003 0566 YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Worman, Helen A 176-34-9397 Z LIJ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR THIS RETURN MUST BE FILED IN DUPLICATE WITH THE [U 07/06/2003 09/03/1907 REGISTER OF WILLS W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER LU -roo Q. rn Q. Z z L~ 1. Original Return [~] 4. Limited Estate [~ 6. Decedent Died Testate (Attach copy of Will) [~ 9. Litigation Proceeds Received E~2. Supplemental Return [-~ 3 Remainder Return (date of death prior to 12-13-82) E~] 4a. Future Interest Compromise (date of death after 12-12-82) r~ 5. Federal Estate Tax Return Required [~7. Decedent Maintained a Living Trust (Attach copy of Trust) -- 8. Total Number of Safe Deposit Boxes 10. Spousal Poverty Credit (d .... f death b ...... 12-31-91 and 1-1o95) ~ 11. Election to tax under Sec. 9113(A)(AttachSchO) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME David H. Stone FIRM NAME (If Applicable) Stone LaFaver & Shekletski TELEPHQNE NUMBER 717-774-7435 COMPLETE MAILING ADDRESS 414 Bridge Street New Cumberland, PA 17070 0.00 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 175,287.8.'6') 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0. 0~ 4. Mortgages & Notes Receivable (Schedule D) (4) 0.0~0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 25,979.79 6. Jointly Owned Property (Schedule F) (6) 0 . 00 ~-----] Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0 . 00 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,027 . 84 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,396.84 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) OFFICL~J_ USE ONLY 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 201,267.65 13,424.68 187,842.97 0.00 187,842.97 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1 5. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 1 7. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19 Tax Due 0.00 x .00 (15) 187,842.97 x.045 (16) 0.00 x .12 (17) 0.00 x .15 (18) (19) 20. > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 0.00 8,452.93 0.00 0.00 8,452.93 2W4645 1.000 Decedent's Complete Address: S~EET ADDRESS Il00 Mt. Allen Drive ~Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty STATE PA 0.00 9,000.00 473.68 0.00 0.00 (1) Total Credits (A + B + C) (2) ziP 17055 Total Interest/Penalty (D + E) (3) 8,452.93 9,473.68 0.00 1,020.75 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the taxdue. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B) 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; ....................... E~ ~ b. retain the right to designate who shall use the property transferred or its income; ......... E~ r~ c. retain a reversionary interest; or ................................ [~ ~-~ d. receive the promise for life of either payments, benefits or care? ................. ~ [~J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ E~ [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [~ [~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ J-~ ~7~ 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 ] have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 1159 Daw~s Street Libertyville, IL 60048 New Cumberlafid, PA 17070 DATE ~-t'~,o~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S.§ 9916 (a) (1.1)0)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. §9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2W4646 1.000 REV-150.3 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Worman, Helen A 21-2003-0566 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 79,071.86 Merrill Lynch-Allied Irish Bks-2758 shs. @ $28.67 per sh. (average for 7-3 and 7-7-03) Merrill Lynch-Comerica Cap Tr 1-800 shs. @ $27.30 per sh. (average for 7-3 and 7-7-03) Merrill Lynch-Public Storage Inc.-800 shs. @ $27.05 per sh. (average for. 7-3 and 7-7-03) Merrill Lynch-USB Cap III-1100 shs. @ $27.80 per sh. (average for 7-3 and 7-7-03) Merrill Lynch-Verizon New Eng Inc.-800 shs. @ $27.695 per sh. (average for 7-3 and 7-7-03) 21,840.00 21,640.00 30,580.00 22,156.00 TOTAL (Also enter on line 2, Recapitulation) $ 175,287.86 2W46963.000 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Worman, Helen A 21-2003-0566 Include the ITEM NUMBER )roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE DESCRIPTION OF DEATH Merrill Lynch-MM Acct. PNC Bank-Checking Acct. Refund TOTAL (Also enter on line 5, Recapitulation) $ 23,629.00 2,349.34 1.45 25,979.79 2W46AD 2.000 (If more space is needed, insert additional sheets of the same size) REV-151~1 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Worman, Helen A 21-2003-0566 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 8 FUNERAhEXPENSES: Myers-Hamer Funeral Home-funeral expenses Rolling Green Cemetery-services rendered ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State__ Zip Year(s) Commission Paid: Attorney Fees Name: David H. Stone, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Mary and Richard Raub-Reimb. on expenses for funeral arrangements and funeral ie airline tickets ($1,345.00), rental car ($232.51), hotel ($316.83), and taxi and parking charges ($135.00) Register of Wills-filing Inheritance Tax and Inventory Reserve for closing expenses 1,812.00 1,207.50 0.00 1,500.00 0.00 254.00 0.00 0.00 2,029.34 25.00 200.00 TOTAL (Also enter on line 9, Recapitulation) $ '7,027.84 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1512 EX + ('i-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS ESTATE OF FILE NUMBER Worman, Helen A 21-2003-0566 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT Doctor's consultation prior to death Messiah Village-nursing care Messiah Village-dry cleaning services Pharmacy-medicines Dentist-services rendered prior to death X-rays done prior to death TOTAL (Also enter on line 10, Recapitulation) $ 15 O0 6,152 46 4 45 110 00 80 00 34 93 6,396.84 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-15i3 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Worman, Helen A FILE NUMBER 21-2003-0566 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Raub, Mary W 1159 Dawes Street Libertyville, IL 60048 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter AMOUNT OR SHARE OF ESTATE 187,842.97 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 2W46At 1.000 (If more space is needed, insert additional sheets of the same size) OFFICES · LAFAV ER 11~ ERLAND, PA L A",~/OFFICES 317 THIR.I~ STR. EET CUMBER. LAND, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF HELEN A. WORMAN I, HELEN 'A. woRMAN, of Upper Allen Township, Cumberland county, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other wills by me at any time heretofore made. I. I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. Ail the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my daughter, MARY W. RAUB. III. I hereby nominate, constitute and appoint my daughter, MARY W. RAUB, as Executrix of this, my Last Will and Testament. If the said Mary W. Raub should predecease me, fail to qualify or cease to act as such, then I nominate, constitute and appoint BEVERLY A. BEDARD as Executrix. IV. No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS k~EREOF, I, HELEN A. WORFLAN, the Testatrix, have unto this, my Last Will and Testament, set my hand and seal this ~ ~ day of , A. D., 1991. (SEAL) Page one of two Pages SIGNED, SEALED, PUBLISHED and DECLARED by HELEN A. WORMAN, the above- named Testatrix, as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and in the presence of each other. ~W OFFIC ES F. LAFAVER THIRD STREET UMBERLAND, pA Page two of two Pages PNCBARK August 27,2003 David H. Stone 414 Bridge Street P.O. Box E New Cumberland, PA 17070 Estate of Helen A. Worman, deceased SSN: 176-34-9397 DOD: 7/6/2009 Dear Mr. Stone: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5070102013 HELEN A WORMAN DOD balance: $2,349.34 (non-interest bearing) Established 05/23/1988 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checldng and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1488-762-2265) or stop by your local PNC Bank branch office. Sincerely, Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh PA 152 l 9 Member FDIC TOTAL P.O1 August 4, 2003 Mr. David H. Stone 414 Bridge Street New Cumberland, PA 17070 RE: Estate of Helen A. Worman Mr. Stone, As per the request of Mary Raub, executrix, I am sending you the date of death value of the above referenced account as of July 3, 2003. The actual date of death was a Sunday and the 4-th was a holiday so the market was not open. Enclosed is the historical pricing sheet that shows the quantity and value of all securities held in the account on that date. I have also included the money market value. Please contact me with any questions you may have. Client Associate to Richard Coffee Financial Advisor Encl. We are providing the above/~formation as requestec¥. The information provided is obtained from sources we befieve to be reliable. 02030 - ALLIED IRISH BKS P L C Date High Prici~ 07/03/2003 28.890 52BR3 - USB CAP III Date High Price 07/03/2003 28.040 Historical Pricing Inquiry Low Price Close Price 28.300 28.690 Cusip: 019228402 Volume 7560O Low Price Close Price 27.820 27.820 Cusip: 90335H208 Volume 13500 52F56 - COMERICA CAP TR I Date High Price 07/03/2003 27.350 Low Price Close Price 27.220 27.240 Cusip: 20034Y202 Volume 6900 52GC5 - VERIZON NEW ENG INC Cusip: Date High Price Low Price Close Price 07/03/2003 27.930 27.650 27.740 92344R201 Volume 11400 59FH2 - PUBLIC STORAGE INC Date High Price Low Price Close Price 07/03/2003 27.100 26.950 27.060 Cusip: 74400D687 Volume 31800 The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past performance is not indicative of future performance. rill Lynch Senate AYenu¢; Suite 501; Camp Hill, Pcnn.~ylvania 17011 (800) 937-o735 // (717) 975-4638 (717) 975-4663 - Fax Richard M. Coffee Vice President Finaneial Advisor Gn~n Wertz Client Associate To: 'l'ina Company: Stone LaFaver & Shekletski Fax: 717-774-3869 Phone: Date: O2/12/2OO4 # Pages (including cover: 2 Message: Per your request, here are the date of death values you requested on the Worman ES ta ~e. Please contact me if you need anything else. Gwyn Note: The information contained in this facsimile Ira~smission is confidential and intended only for the use of the addressee. If the reader of this communication is not the intended recipient, you are hereby m~tified that any retention, dissemination, distribution, copyin~o or other use of the facsimile is · strictly prohibited. If you receive this facsimile in error, please notify us by telephone and return the original transmission to us at the address above via Uaited S~ates Postal Service. "7- 020.30 - ALLIED IRISH BKS P L C Date High Price Low Price 07/07/2003 28.7!0 28.220 52BR3 -USB CAP III Date High Price Low Price 07/07/2003 27.880 27.720 52F56 - COAAERICA CAP TR I Date High Price Low Price 07/07/2003 27.410 27.200 '7- Cusip: 019228402 Close Pdce Volume 28.650 47300 Cusip: 90335H208 Close Price Volume 27.780 12100 52GC5 - VERIZON NEW £NG IHC Date High Price Low Price Close Price 07/07/2003 27.910 27.560 27,6S0 59FH2 - PUBLIC STORAGE INC Date High Pdce Low Price Close Price 07/07/2003 27.100 27,010 27.040 Cusip: 2OO34Y202 Close Price Volume 27.360 ,17. ,,t Cusip: 923~R201 .~.. Cusip: 74460D687 The information has been obtained from sources we believe to be reliable but we do not 9uarantee its accuracy. Past performance is not indicative of future performance, TOTAL P.02 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Mary W. Raub being duly sworn accord;ag to law, deposes and says that She is the Executrix of the Estate of Helen A. Worman late of Upper A_ll_e_n__T__w_p_. , Cumberland County, Pa., deceased and that the within is an inventory made by Mary W. Raub the said Executrix of the entire estate of said decedent, cons;sting of all the personal property and real estate, except real estate outside the Commonwealth o{ Pennsylvania, and that the f{gures opposite each Jfem of %he Inventory represent it's fa~r value as of %he date of 8ecedenf's death. and subscribed before me, 19 Mary W. 1159 Raub ;~cus~ .-A~dm~r~f~r - rix Dawes Street Libertyville, IL 60048 Address Date of Death 06 07 2003 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. L~ 0 I 0 I -'o -.~ ~ o ~ o Inventory of the real and personal estate of Helen A. Worman deceased Inventory Estate of Helen A Worman From 07/06/2003 To 02/20/2004 Description Accrued Income Form 706 Schedule B Common Stocks Herri!l Lynch-Allied Irish Bks Merrill Lynch-USB Cap III Merrill Lynch-Comerica Cap Tr I Merrill Lynch-Verizon New Eng Inc. Merrill Lynch-Public Storage Inc. Form 706 Schedule C Checking Accounts PNC Bank-Checking Acct. Honey Market Accounts Merrill Lynch-MM Acct. Form 706 Schedule F Refunds Refund Value 79,071.86 30,580.00 21,840.00 22,156.00 21,640.00 Total 175,287 ~6 2, 349 34 23, 629 O0 25, 978 34 145 201, 267 65 BUREAU OF INDIVIDUAL TAXES THHERTTANCE TAX DIVISION DEPT. Z806n! HARRISBURG, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-15~7 EX AFP (01-D3) DAVID H STONE STONE ETAL ~14 BRIDGE ST NEW CUMBERLAND PA 17070 DATE 05-03-Z004 ESTATE OF NORMAN DATE OF DEATH 07-06-Z003 FILE NUHBER Z1 03-0566 COUNTY CUHBERLAND ACM 101 Amount Remitted HELEN A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~'~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR BZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NORHAN HELEN A FILE NO. 21 05-0566 ACN 101 DATE 05-05-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Mortgages/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets 175~287.86 .00 25~979.79 .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of this form with your tax payment. .0O (8) 201,267.65 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hist. Expanses (Sohadula H} 10. Debts/Mortgage Liabilities/Liens (Schedule Z) 11. 12. 15. 1~. NOTE: ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spousal rate 16. Amount of Line 1~ taxable at Lineal/Class A rata 17. Amount of Line 1~ at Sibling rate 18. Amount of Line 1~ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDZTS: PAYHENT RECEIPT DZSCOUNT (+J DATE NUHBER ZNTEREST/PEN PAZD (-) 10-06-2003 CD005088 422.65 7,027.84 (9) (lO) 6,396 Total Deductions (11) ]3. ~2~. 68 Net Value of Tax Return (12) 187,84Z. 97 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Nat Value of Estate Subject to Tax (lq) 187,84Z. 97 Z~ an assessment ~as issued previously, lines 14, 15 and/o~ 16, 17, 18 and 19 re~=lect ~igures that include the total o~ ALL ~etuPns assessed 'co date. (15) (16) (17) (18) . O0 x O0 = . O0 187,84Z.97_x 045= 8,452.93 .oo .~0'x 15~= ~:: ~!. .00 '~ (19~= ' 8,452.93 AMOUNT PAID IF PA/D AFTER DATE /NDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. 9,000.00 TOTAL TAX CREDIT I BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 9,4ZZ.65 969.7ZCR .00 969.7ZCR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B [collateral] beneficiaries of the decedent after the expiration of any estate for life or for years, the Coemon~aaZth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the la~fu! Crass B (collateral) rate on any such futura interest. To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which Has not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hilts, any of the 23 Revenue District Offices, or by calling the special Zo`-hour answering service for forms ordering: 1-800-561-Z050~ services far taxpayers with special hearing and / or speaking needs: 1-B00-~O`7-3010 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as sho~n 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. 181021, Harrisburg, PA 1711B-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 ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ravie~ Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the dscedent's death, a five percent (SI) discount of the tax paid is a11o~ed. The 151 tax amnesty non-participation penalt'~ 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 ~ith first day of delinquency, ar nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ~hich became delinquent before January 1, 1981 bear interest at tho rate of six (61) percent par annum calculated at a daily rate of .00016O`. All taxes ~hich became delinquent on and after January 1, 1982 will bear interest at a rata ~hich ~111 vary from calendar year to calendar year ~lth that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOO` are: Interest DeiZy Interest Daily Year Rate Factor Year Rate Factor ~ ZOZ . O005O`B '[i~"~5-1991 117. .000301 1983 16Z .000q.58 199Z 97. . O002o,7 198O` llZ .000501 1993-199O` 72 .000192 1985 151 .000556 1995-1998 92 .0002~7 1986 IOZ .00027~. 1999 72 .000192 1987 102 .00027O` 2000 77. .000191 --Interest is calculated as folXo~s: XNTEREST= BALANCE OF TAX UNPAZD Interest Daily Year Rate Factor ~ 97. .O00Z~7 ZOOZ 62 .00016O` 2003 52 .000137 200~ O`Z .000110 X NURBER OF DAYS DELINQUENT X DAZLY ZNTEREST 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 sho~n on ~he Notice, additional interest must be caXcuIatad. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen A. Worman Date of Death: July 6, 2003 Will No. 21-03-0566 To the Register: 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: Yes 1. State whether administration of the estate is complete: X 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 X (b) The separate Orphans' Court No. (if any) for personal representative's account is: N/A the (c) Did the personal representative state an account informally to the parties in interest? Yes X No Date: the Clerk of the Orphans' report. (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with Cour~ be a:ched to this 414~-i~ge-Street New Cumberland, PA 17070 717-774-7435 dApacity: Personal Representative X Counsel for Personal Representative BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVZSION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVAN:[A DEPARTMENT OF REVENUE ZNHERITANCE TAX STATEMENT OF ACCOUNT REV-Z607 EX AFP ¢Ol-0S) DAVID H STONE STONE ETAL 414 BRIDGE ST NEW CUMBERLAND PA 17070 DATE 06-01-2004 ESTATE OF NORMAN DATE OF DEATH 07-06-2005 FZLE NUMBER 21 03-0566 COUNTY CUMBERLAND ACN 101 Amoun~ RemL ~:~:ed HELEN A HAKE CHECK PAYABLE AND REHIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper por~:ion of ~chis fore wt~h your ~:ax payment:. CUT ALONG THZS L'rNE ~* RETAIN LONER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) #NN ZNHERTTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF NORMAN HELEN A FTLE NO. 21 03-0566 ACN 101 DATE 06-01-2004 THTS STATEHENT TS PROVIDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACH TN THE NAHED ESTATE. SHO#N BELON TS A SUHHARY OF THE PR/NC/PAL TAX DUE, APPLTCATTON OF ALL PAYHENTS, THE CURRENT BALANCE, AND., TF APpLTCABLE, A PROJECTED TNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-26-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 8,452.93 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-06-2003 05-10-2004 CD003088 REFUND ZF PAID AFTER TH/S DATE, SEE REVERSE S~DE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE 1S REFLECTED AS A "CREDIT" 422.65 .00 9,000.00 969.72- TOTAL TAX CREDZT 8,452.93 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR INSTRUCTIONS. 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 NTLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: CONMONNEALTN OF PENNSYLVANIA. REFUND (CR): 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-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Iq-hour answering service for forms ordering: 1-&OO-36Z-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-BO0-qqT-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should bm addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZS0601, Harrisburg, PA 171ZB-0601, phone (717) 767-650S. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid 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 of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six [6Z) percent per annum calculated at a daily rate of .00016¢. All taxes which became delinquent on and after January l, 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 applicabZe interest rates for 198Z through ZOOq are: Interest Daily Interest gaily Interest Year Rate Factor Year Rate Factor Year Rate 198Z ZOZ .0005q8 1988-1991 llZ .000301 ZOO1 9Z 1983 16Z .000438 199Z 9Z .000Z47 2002 6Z 1984 11Z .000301 1993-1994 7Z .00019Z ZOO3 5Z 1986 10Z .000274 1999 7Z .OO019Z 1987 9Z .000Z47 ZOO0 BZ .000219 Daily Factor .000247 .000164 .000137 .000110 --Interest is calculated as follows: 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 an the Notice, additional interest must be calculated.