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HomeMy WebLinkAbout04-0435PETITION FOR PROBATE and GRANT OF LETTERS Estate of William L. Kent No. also known as To: , Deceased Social Security No, 102-18-0730 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the execut rices in the last will of the above decedent, dated 9/10/2001 and codicil(s) dated Register of Wills for the County of ~;umbedand Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at Bridoes at Bent Creek 2100 Bent Cree~ Blvd.. Mechanicsburo. PA 17050 ~ (list street, number and municipality) Decedent, then 78 years of age, died 4/2112004 at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent 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: $ $ $ $ 120.000.00 NONE WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Tqstamentarv thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t, a0 2122 St. Clair Court '~ /~/'/]f Z~,,,#z4~,~,~,.~ .arrisbum PA 17110 G~I Sau,man p.., ~ 37 W. Clea~eld ~ ~ ~i~J~/~ ,9~~ Have,own :: PA ~083 '~ ~ - ~ , ~ ~ Suzadn~Kent .... . ' ~3 OATH OF PERSONAL REPRESENTATIVE COMMO~ALTH OF PENNSYLVANIA ~r SS COUNTY OF Cumberland 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 truly administer the estate according to law. Sworn to or aff'mnL~a~_~d~ subscribed (- '7(''.~Oj~. ~'/lz/3/Yt~. ti_/ b~f~lre me this~m .~'l"-' ~ day of I Estate of William L. Kent , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~L~ , c~ L)/.~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 011012001 described therein be admitted to probate and filed of record as the last will of William L. Kent and Letters Testamentary are hereby granted to Gail Sausman~ 2122 St. Clair Ct., Harrisbur.q, PA 17110 and Suzanne Kent, 37 W. Clearfleld Rd.~ Havertown, PA 19083 FEES Probate, Letters, Etc ......... $ ~ Short Certificates (10 ) ...... $ ~ ~P $ lO. oO TOTAL ~ $~' oo ............ ~,e§ister of Will;'~ r ~- ~ Mafielle F. Hazen, Esquire 68003 ATTORNEY (Sup. Ct. I.D. No.) 2000 Linglestown Rd., Suite 303 Harrisbura PA 17110 ADDRESS 717-,540-4332 PHONE his is to certify that the inforination here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 10328815 No. APR 2 . _ f104 Date -.-< I · ,, [] ,,, I-1 ~ I-I ,,...,.,~..-.,.,, .......................................................................... : ....................... [] ,=. ~ rant I~L u. m H~0S.;~I~W. Z'~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,. W~ll~ L. ~t ,. M ,. 102 -- 18 --073~ , 4/21/04 I~t ..... ~ I ~"3~ I ~p'~ I o~E~. m ~~ I~.~ ........ ~ ' -- - M 78 *~.1 : I { 18/6/1925 IRic~nd Hill, I~ ~ I ~ I ~ I,. I~. N~ Yn~k m~ i ~,~ ~ ~h~ ~ Su~~ ~. ~he ~ml~ Cro~n Sl~e ~s~ ~~. ~te ,, Sale~ G.S. Ele~r~c ~. ~ ~ I ~,~ ] ,.~., [ w~., ] i~u~ ,,..s,~ rn ~ ,~,.~.~ ~ v=~ pxlng 2100 ~t Cr~k 1~. [~ ,t ~c~ic~q, PA 17050 [~' ,~.c~ ~rl~d ~' ,,d.~~ ,,. ~nard - K~t ~m~,.~,,. ,,. ~therine E. S~fe ~ ~il M. Sau~ ~ 2122 St. Clair ~; ~rrls~g, PA 17110 '~ ~rl~d Valley ~ ~ ~+~ ~ ,,L 4/24/2004 h,~rial Garbs ~u~le~{,,~ ~rlisle, PA 17013 ~~~~~ [,,,.FD 012633 L{~q B~ers ~eral H~, Inc., ~lisle, PA LAST WILL AND TESTAMENT OF WILLIAM L. KENT I, WILLIAM L. KENT, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. made. I revoke all other wills and codicils tha;,J-may have previously ...< I Article I -"o My just debts and expenses of my last illness, funeral, and administration oFthy estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any fight which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which ! have the power of appointment. Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath IN TWO EQUAL SHARES to my daughters, GAIL SAUSMAN, of Harrisburg, Pennsylvania, and SUZANNE KENT, of Havertown, Pennsylvania. However, if a beneficiary does not survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, per stirpes, the share the beneficiary would have received had he or she survived me by thirty (30) days. Article V I nominate, constitute, and appoint my daughters, GAIL SAUSMAN and SUZANNE KENT, as Co-Executors of my Last Will and Testament. I direct that my Co-Executors be permitted to serve without bond and in addition to those powers granted by law, I grant them power to -2- distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Co-Executors shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Co-Executors in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Co- Executors; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, WILLIAM L. KENT, hereby set my hand to this my Last Will and Testament, on ~ ~' t~ ,2001, at Harrisburg, Pennsylvania. WILLIAM L. KENT In our presence, the above-named WILLIAM L. KENT signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Address I, WILLIAM L. KENT, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by WILLIAM L. KENT, the Testator, on ~ - fi) ,2001. C~XlDtta~Publi~ ' - WILLIAM L. KENT Notarial Seal ~ anetle F Hazon, Notary p_ubliC_~. M ' · Dauphin County ~¥ CorBffil~lon t:xpn~ r' .... ~ We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and heating signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before n~_ by ~'-' e D~ :CPo_ ~-r'~ {~2~ . witnesses, on ~-/~ ,2001. Notarial Seal Mariello F. Hazen Notary Public Lower Paxton Twp., Dauphin County My Commission Expires Sept. 23, 2002 -5- Cumberland County, Pennsylvania Register of Wills CERTIFICATION OF NOTICE UNDER RULE 5.$(a) Name of Decedent: William L. Kerlt Date of Death: 4/21/2004 Will No. 21-04-0435 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the O/phan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on -~./[I/~ ('--// · Name Address Gail Sausman Suzanne Kent 2122 St. Clair Court Herri,~burq PA 17110 37 W. Clearfield Road Hevert~)wn PA 19083 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except., NONE Date: Capacity: Si{Inature Name: Marielle F. Hazen. E~q. Address: 2000 Lin(31estown Road, Suite 303 Harrisburq PA Telephone(717) - 540- 433 1711Q Personal Representative Counsel for Personal Representative The Law Office of Certified Elder Law Attorney by the National Elder Law Foundation 2090 Linglestown Road Suite 303 Harrisburg, PA 17110 Attorney at Law ~r: (717) 540-4332 g~x: (717) 5404313 www. hazenelderlaw, com July 19, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of William L. Kent File No. 21-04-0435 Enclosed please find check number 101 in the amount of Three Thousand Dollars ($3,000.00) for early payment of inheritance tax on the above-referenced estate. Please forward the receipt for this payment to my office in the enclosed envelope~ If you have any questions, please do not hesitate to contact me. Sincerely, Legal Assistant :icc Enclosures cc: Suzanne Kent, Executrix Gail Sausman, Executrix The Law Office of ARorney at Law 2000 !Anglestown Road Suite 303 Harrisburg, PA 17110 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004179 ........ fold HAZEN MARIELLE F ESQUIRE SUITE 303 2000 LINGLESTOWN ROAD HARRISBURG, PA 17110 ESTATE INFORMATION: SSN: I02-18-0730 FILE NUMBER: 2104-0435 DECEDENT NAME: KENT WILLIAM L DATE OF PAYMENT: 07/20/2004 POSTMARK DATE: 07/19/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/21/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,000.00 REMARKS: TOTAL AMOUNT PAID: ~3,000.00 CHECK# 101 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS LAW OFFICE OF MARIELLE F. HAZEN 2000 Linglestown Rd., Suite 303 Harrisburg, PA 17110 TO: Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004443 KENT SUZANNE 37 W. CLEARFIELD ROAD HAVERTOWN, PA 19083 fold ESTATE INFORMATION: SSN: 102-18-0730 FILE NUMBER: 2104-0435 DECEDENT NAME: KENT WILLIAM L DATE OF PAYMENT: 09/30/2004 POSTMARK DATE: 09/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/21/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $452.28 REMARKS: CITIZENS BANK TOTAL AMOUNT PAID: $452.28 SEAL CHECK# 106 INITIALS' CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS The Law Office of Attorney at Law Certified Elder Law Attorney by the National Elder Law Foundation 2000 Linglestown Road Suite 303 Harrisburg, PA 17110 ~: (717) 540-4332 FAX: (717) 540-4313 www. hazenelderlaw, com September 24, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of William L. Kent File No. 21-04-0435 Inheritance Tax Return To: The Register of Wills: Enclosed for filing please find the original and one copy of the above-referenced Inheritance Tax Return and Inventory, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and a copy of the Inventory and return them to my office in the enclosed self-addressed envelope. Also enclosed are two checks, one in the amount of $452.28 for the inheritance tax owing and the other in the amount of $25.00 for payment of the filing fees associated with the return and the Inventory If you have any questions or require any additional information, please do not hesitate to contact me. .'jcc Enclosures cc: Gail Sausman, Executrix Suzanne Kent, Executrix Legal Assistant REV-1500 EX + (e-00) Z iii LU ILl iii lU Z D- UJ h' h' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL Kent, William L DATE OF DEATH (MM-DD-Year) 04/21/2004 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I 08/06/1925 OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 0 4 3 COUNTY CODE YEAR NDMBER SOCIAL SECURITY NUMBER 1 0 2- 1 8-0 7 3 0 DATE OF BIRTH (MM-DD-Year) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~] 1. Original Return ~-~4. Limited Estate [~]6. Decedent Died Testate (AtMch copy of Will) Q9. Litigation Proceeds Received [-'] 2. Supplemental Retum r'-~ 4a. Future Interest Compromise (date of dea~ after 12-12.82) E~7. Decedent Maintained a Living Trust (A~tach copy of Trust) E~] 10. Spousal Poverty Credit (date of death between 12-31-91 and I-1.95) Marielle F. Hazen FIRM NAME (If Applicable) Law Office of Marielle F. Hazen TELEPHONE NUMBER 717-540-4332 E~]3. Remainder Retum (da of~e~ p~or to 12-13-82) E~]5. Federal Estate Tax Retum Required __ 8. Total Number of Safe Deposit Boxes ['--] 11. Election to tax under Sec. 9113(A) (A~tach Sch O) COMPLETE MAILING ADDRESS 2000 Linglestown Road Suite 303 Harrisburg, PA 17110 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) '--] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 2.4~,~1-9..38 25'744.72 31i152.35 ! OFFICIAL USE ONLY £/?, (8) (11) (12) 101,021.11 11,476.42 9~318.64 20,795.06 80,226.05 (13) (14) 80,226.05 SEE INSlKUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at lhe spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x __ (15) 80,226.05 x .045 (16) x .12 (17) x .45 (18) 3,610.17 (19) 3,610.17 20. Decedent's Complete Address: STREETADD, RESS 2100 Bent Creek Blvd. CITY Mechancisburg ISTATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3,000.00 157.89 Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) I zlP1705 (3) 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) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 3~610.17 3~157.89 0.00 452.28 452.28 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer preperty within one year of death without receiving adequate consideration? ............................................................................................... [] [] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penaltJas of perju~7, I decla'e lhat I have examined this relum, including accompanying schedules and statements, and to the Pest of my knowledge and belief, it is true, correct and complete. Decla'ation 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 ADDRESS 2122 Saint Clair Court Harrisbur9 SIGNATURE OF P~EPARE~TATIVE DATE PA 17110 DATE ADDRESS ~)000 Li~gles'{own"R'd., Suite 303 Harrisburg PA 17110 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. {}9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}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. REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Kent. William L 21 04 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 24,519.38 Alliance Bernstein Fund# 4700289571 3473 Shares @ 7.06 TOTAL (Also enter on line 2, Recapitulation) $ 24,519.38 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Kent. William L FILE NUMBER 21 q4 0436 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE DESCRIPTION OF DEATH 9,420.02 ITEM NUMBER 1. o Waypoint Bank Checking Acc~1700020127 Waypoint Bank Savings Acct.1760003830 M&T Bank Savings Acct.1205218 Hospice Refund ROBC - Bridges Refund TOTAL (Also enter on line 5, Recapitulation) $ 6,336.05 2,001.35 6,900.00 1,087.30 25~744.72 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Kent. William L 21 04 043,5 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Gail Sausman 2122 St. Clair Court Daughter Harrisburg. PA 17110 c JOINTLY-OWNED PROPERTY: LEI I ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT~S INTERES 1. A. 4~30~02 ,Waypoint Bank 62,304.69 50. 31,152.35 Savings Acc~5500024123 TOTAL (Also enter on line 6, Recapitulation) 31 ~152.35 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MlSC, NON-PROBATE PROPERTY FILE NUMBER Kent. William L 21 04 0435 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is, 'es. DESCRIPTION OF PROPERTY ITEM ~NCLUDE THE NAME OF THE TRANSFEREE, ]'HEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE O1: TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APR_ICABLE) VALUE 1. First Colony Life 19,604.66 100. 19,604.6( Annuity Contract No. 2654379 Gail Sausman & Suzanne Kent, Beneficiaries TOTAL (Also enter on line 7 Recapitulation) $ 19,604.6C, (If more space ~s needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Kent. William L Debts of decedent must be reported on Schedule !. ITEM NUMBER DESCRIPTION FILE NUMBER 21 04 FUNERAL EXPENSES: Ewing Bros Funeral Home Funeral Reception ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees Marielle F. Hazen Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills - Open Probate Accountant's Fees Tax Retum Preparer's Fees The Sentinel - Legal Advertisement Cumberland Law Journal - Legal Advertisement Zip AMOUNT 6,682.60 268.15 4,000.00 287.00 163.67 75.00 TOTAL (Also enter on line 9, Recapitulation) i $ 11,476.42 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) COMMONWEALTH OFPENNSYLVAN~ INHERITANCETAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUUBER Kent. William L 21 04 Include unreimbursed medical expenses. DESCRIPTION ITEM NUMBER 1. West Shore Pathology Medical Bill American Express Prescription Co-Pay Moffitt Heart and Vascular Group Medical Bill SPX Corp Overpayment of Pension Hospice of Central PA Waypoint Chk #374 Cleared After Death MSCHMC Medical Bill TOTAL (Also enter on line 10, Recapitulation) 0435 VALUE AT DATE OF DEATH 10.20 40.00 49.52 168.44 9,000.00 50.48 9,318.6,1 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-nn~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Kent. W liam L NUMBER I. 1. 2. II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DtS/I~IBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] Gail Sausman 2122 St. Clair Court Harrisburg, PA 17110 Suzanne Kent 37 W. Clearfield Road Havertown, PA 19083 FILE NUMBER 21 04 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter 0436 AMOUNT OR SHARE OF ESTATE 1/2 Residue 1/2 Residue (If more space is needed, insert additional sheets of the same size) TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIV~DUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HAZEN MARIELLE F ESQUIRE SUITE 303 2000 LINGLESTOWN ROAD ~ARRISBURG, PA 17110 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER NO REV-1162 EX(11-96) CD 0041 79 ~ :;~...L,...,,!,,, ,~ AMOUNT 101 $3,000.00 ESTATE INFORMATION: SSN: 102-18-0730 FILE NUMBER: 21 04-0435 DECEDENT NAME: KENT WILLIAM L DATE OF PAYMENT: 07/20/2004 POSTMARK DATE: 07/1 9/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 04/21/2004 REMARKS' TOTAL AMOUNT PAID: $3,000.00 · '- SEAL CHECK//101 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER September 23, 2004 Departmem of Revenue Bureau of Individual Taxes Dept 280601 Re: Estate of William L. Kent File No. 21-04-0435 Please note that the joint account, Waypoint Number 5500024123, has been included on the above inheritance tax return on Schedule F. We attach a copy of the Information Notice for your information. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171ZB-060Z REV-1545 EX AFP [09-a0) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 Oq-Oq$5 ACN 0q150966 DATE 08-$O-ZOOq GAIL M SAUSNAN 2122 SAINT CLAIR CT HBG PA 17110 TYPE OF ACCOUNT EST. OF WILLIAM L KENT ~]SAVINGS S.S. NO. 102-18-0750 [] CHECKING DATE OF DEATH Oq-Zl-ZOOq [] TRUST COUNTY CUMBERLAND [] CERTTF. REMTT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND C0 COURT HOUSE CARLISLE, PA 17015 NAYPOZNT BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you mars a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-a327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS PART Account No. 550002q123 Date 0q-30-2002 E stabl i shed Accoun~ Balance 62,30q. 69 Parcen~ Taxable X 50. 000 Aaoun~ Subject to Tax 31 · 152.35 Tax Ra~e X .15 Potential Tax Due q· 672.85 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Hake check payable to: "Register of Wills, Agent". NOTE: If tax payments ara made within three (3) months of the decedent's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LiNE A. []The above information and tax due is correct. 1. You cay choose to remit Payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return v\t° be filed by the decedent's representative. C. []The above information is incorrect and/or debts and deductions were paid by you. You must complete PART []and/or PART []below. Zf yOU indicate a differen{ {ax re{e· please s{a{e your relationship to decadent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I 2. Account Balance 2. 5. Percen~ Taxable $ ~ q. Amount SubSect ~o Tax q_, 5. Debts and Deductions $ - 6. Aeoun~ Taxable 6 7. Tax Re~e 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZME~ PAYEE DESCRIPTION AHOUNT PAID TOTAL (Enter on Line S of Tax Computation) $ Under penalties of perjury, I declare ~ha~ the fac~s I have reported above are true) correc~ and ~~~ mY know ladD. and belief. HOME ( ) TELEPHONE ' NUMBER ' TE GENERAL INFORMAT/ON 1. FAILURE TO RESPOND #ILL RESULT IN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name ems added as a matter of convenience. ~. Accounts (including those held between husband and mile) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly batsmen husband and eife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I TAXPAYER RESPONSE 1. BLOCK A - If the information end computation in the notice ers correct and dsductions are not being claimed, plecm an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two capias and submit them with your check far the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lSd8 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or mill be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section· Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payable to the Register of Wilts of the county indicated. The PA Department of Revenue will issue an effioiml assessment (Form REV-1548 EX) upon receipt of the return from the Register of ~ills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after II/II/BI: Accounts which the decedent put in joint names within one (l) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (x~) appears before your first name in the address portion of this notice, the $3,000 extrusion already has been deducted from the account baIance as reported by the financial institution· Z. Enter the total balance of the account incIuding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NURSER OF DIVIDED BY TOTAL NURSER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the dscedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NURSER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .BO X 100 = 50X (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line q) is determined by multiplying the account balance (line Z) by the percent taxable (line S. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line · (line 7) as determined below. 07/01/9q ko 12/31/9q 3Z 6Z 1SI 15Z 01/01/95 ko 06/30/00 OX 6Z 15Z 07/01/00 to present OX q.SZ~ 12X ~ ..+ ,,~i.~ of transfers from a deceased child twenty-one years of age or: 7. Enter the approl younger at aThe tax rate iapc death to or for the use of a natural parent, an adoptive parent, or a stepparent of the c The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants- "Siblings" are defined as individuals who have at least one parent in common eith the decedent, whether by bLood or adoption. The "Cotlaterat" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration bY a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fulIY in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11". Proof of BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX D/VTSTON PO BOX Z&O601 HARRTSBURG, PA 17128-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRA/SEMEMT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I;47 EX AFP (00-04) HARIELLE F HAZEN M F HAZEN LAW OFFICE 2000 LINGLESTOWN RD HBG PA 17110 DATE 11-ZZ-Z00q ESTATE OF KENT DATE OF DEATH Oq-Zl-ZOOq FILE NUMDER 21 Oq-Oq$5 COUNTY CUM]}ERLAND ACN 101 I Aeoun .~._/~,;m i .1: .l. ecrL.4 WILLIAM L MAKE CHECK PAYADLE AND R ,E~K~.T PAYMENT TO: REGISTER OF WILLS ~ CUMIIERLAND CO COURT I-~USE CARLISLE, PA 17015 ~: CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~..- ~ m m m m m m m mmNmmmmmmmmm mmm mmm m mmmmmmmmmmmmmmmm m mm mmmmmmmmmmmmmmmmm m mmmmmmmmmmmmmmmmmmm(mm N mmmmm~mmmmmmmmmmmmm m m mm m m REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOWANCECDR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KENT WILLIAM L FILE NO. 210q-Oq35 ACN 101 DATE 11-22-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERN:KNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~e~e (Schedule A) (1) 2. S~ocks end Bonds (Schedule B) (2) $. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) ($) q. Mortgages/No,es Receivable (Schedule D) (q) B. Cash/Bank Deposits/Misc. Personal Propar~y (Schedule E) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage L/ablli~/as/L~ens (Schedule I) (10) 11. To~el Daduc~/ons 12. Ne~ VaZue of Tax Re~urn Zq;5Z9 .$8 .00 Z5~7qq.72 31z152.$5 19~60q.66 (8) 11,q76.q2 9~$18.6q (11) (12) 15. lq. NOTE: .00 NOTE: To insure proper cred/~ ~o your account, subm/~ ~ha upper por~/on .00 of ~his form w/~h your ~ax payment. Charitable/governmental Bequests; Non-elec4:ed 9115 Trus4:s (Schedule J) (15) Ne~ Value of Es4:a4:e Subjec~ ~o Tax (lq) Zf an assesseent was issued prevlously, lines 14, 15 and/or 16, 17, reflect f/gures that include the total of ALL returns assessed to date. 101,0Z1.11 20.795.06 80,226.05 .00 80,226.05 ASSESSMENT OF TAX: 1.;. Amoun~ of L/ne 1~, a~ Spousal ra~e 16. Amoun~ of Line lq ~axable a~ L/neal/Class A ra~e 17. Amoun~ of L/ne 1~ a~ Sibling ra~e 18. Amoun~c of L/ne lq ~axable a~ Colla4:eral/Cless B ra~e 19. Principal Tax Due TAX CRED]:TS: PAYMENT RECEIP1 DT$COUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 07-19-200q CD00~179 157.89 09-29-200q CDOO~q:5 . O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 ~/.11 (15) .00 x O0 = .00 (16) 80,226.05 x Oq5= :5,610.17 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (1~)= 5,610.17 AMOUNT PAID ~,000.00 q5Z.28 TOTAL TAX CREDIT $,610.17 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REQUIRED. IF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR /NSTRUCT/ONS.) RESERVATION: Estates of decedents dying on or before December 12, 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (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 S (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed an the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return~ may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-lB15). Applications are available online at wwe.revenue.state.oa.us, any Register of Hills or Revenue District Office, or from the Department's Z4-hour answering service for forms orders: 1-600-$61-Z050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied with the appraisment) allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice say object within 60 days of the date of receipt of this notice by filing one of the folloeing: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at #we.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals wabsite. You say also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 181011, Harrisburg, PA 171IA-lOll. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) far an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacedent's death, a five percent (51) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This nan-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 eith 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, 1982 bear interest at tho rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .000548 ~1)'8-8-1991 111 .000501 ~'~ 9Z .000247 1985 162 .000458 1992 9Z .000247 2002 6Z ,000164 1984 112 .000501 1995-1994 72 .000191 2003 52 .000157 1985 152 .000556 1995-1998 92 .000247 Z004 42 .000110 1986 lOZ .000274 1999 7Z .O00IgZ 1987 X0Z .000274 ZOO0 7Z .O0019Z --Intmrest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER 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. Z I -04 -o~ FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN THE EST ATE OF WILLIAM L. KENT, DECEASED KNOW ALL MEN BY THESE PRESENTS, that WHEREAS WILLIAM L. KENT, late of Mechanicsburg, Cumberland County, Pennsylvania, deceased, died testate on April 21, 2,004, " having first made his Last Will and Testament, which was duly executed SePtci!iber 10;2.001, :: i:iJ(", . ,.' .. ~- 1994 and is duly recorded in Cumberland County Courthouse, Register ofWills,Fil~n~o. 2t-04- ,.,.1.":...,, 0435; 1-,,) I WHEREAS, Gail Sausman and Suzanne Kent were named as C~~Executrices of"' N WILLIAM L. KENT'S Last Will and Testament; WHEREAS, Letters Testamentary on the estate of said decedent were duly issued by the Register of Wills of Cumberland County, and Letters were granted to Gail Sausman and Suzanne Kent, hereinafter called Personal Representatives; WHEREAS, the said Personal Representatives have gathered the assets of the estate of the said decedent, and the assets consist of personal property to a total value of$50,457.13 as set forth in Exhibit A, which is a statement of account of the Personal Representatives, and which is attached hereto and made a part hereof and marked Exhibit A; WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that we, Gail Sausman and Suzanne Kent, being the beneficiaries and heirs of the said decedent, and being those persons entitled to inherit under said 1 v- Last Will and Testament, do hereby acknowledge that we have this day had and received from the aforesaid Personal Representatives, in full satisfaction and payment, all sum or sums of money, legacies, bequests and devices as are given, devised and bequeathed to us, which amounts we have received this day, and which amounts are set opposite our names in the table and schedule of distribution in said statement attached hereto and marked Exhibit A; AND, we do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we agree that no account is necessary, and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if it had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas, Cumberland County Branch. THEREFORE, we and each of us do hereby remise, release, quit claim and forever discharge the said Personal Representatives, their heirs, executors, administrators, assigns and Marielle F. Hazen, Esquire of and from the said estate and from all actions, suits, payment, accounts, reckoning, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent; and each of us do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, each of us do hereby covenant and agree with each other and the aforesaid Personal Representatives that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representatives after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. 2 IN WITNESS WHEREOF, we have hereunto set our hands and seals this _ day of ,200_. Witness Gail Sausman Witness Suzanne Kent COMMONWEALTH OF PENNSYLVANIA County of ) ) ss: ) On this the _ day of , 200_, before me, a Notary Public, the undersigned officer, personally appeared Gail Sausman, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public COMMONWEALTH OF PENNSYLVANIA ) ) ss: County of ) On this the _ day of ,200_, before me, a Notary Public, the undersigned officer, personally appeared Suzanne Kent, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public 3 STATEMENT OF ACCOUNT OF THE EST ATE OF WILLIAM L. KENT Assets Alliance Bernstein Annuity Refunds (Hospice & Bridges) Cash, Bank Deposits, & Dividends $24,519.38 $ 7,987.30 $17,950.45 $50,457.13 EXDenses Funeral Expenses Administrative Costs Inheritance Tax Hospice Medical Bills SPX Pension Refund $ 6,950.75 $ 4,550.67 $ 3,452.28 $ 9,000.00 $ 150.20 $ 168.44 $24,272.34 Net Distributable Estate $26,184.79 DISTRIBUTION TO BENEFICIARIES Name Gail Sausman Suzanne Kent Amount $13,092.40 $13,092.40 EXHIBIT "A" IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~qJh day of [)/Nrmlxll , 200~. ~.,. II! [0""".- Wi ess !1rxLQ !J(JJJ/)(fft{~ Gail Sausman Witness Suzanne Kent COMMONWEALTH OF PENNSYLVANIA ) ) ss: ) , 200t, before me, a Notary Public, the , County of 'Dou DJ., J n . On this the &~ay of ))t('en,h-er undersigned officer, personally appeared Gail Sausman, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARJAL SEAl JUliA R. ERa, NotaIy Pullh Suoquehanna Twp.. Dauphin County My Commission Expkes Nov. 5, 2005 COMMONWEALTH OF PENNSYLVANIA ) ) ss: County of ) On this the _ day of ,200_, before me, a Notary Public, the undersigned officer, personally appeared Suzanne Kent, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public 3 . .. IN WITNESS WHEREOF, we have hereunto set our hands and seals this L day of JCd\\Lary , 200~. Witness ;/twt,! r;(;d.,;;J Gail Sausman ~ t~ ~~e~te COMMONWEALTH OF PENNSYLVANIA County of ) ) ss: ) On this the day of , 200_, before me, a Notary Public, the undersigned officer, personally appeared Gail Sausman, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public COMMONWEALTH OF PENNSYLVANIA ) ) ss: County of m&i~~U"r ) On this the'!:L day of~nwtr+ ' 200{: before me, a Notary Public, the undersigned officer, personally appeared Suzanne Kent, 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 therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~~~ Notary Public NOTARIAL SEAl PATTI LYNN ATTANASIO, NOTARY PUBLIC LOWER MERION TWP, COUNTY OF MONTGOMERY MY COMMISSION EXPIRES APRil 16, 2007 3 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Kent William L Date of Death: 4/21/2004 Will No. 21-04-0435 Admin. No. 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: I . 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: 3 . If the answer to No. I is Yes, state the following: a. account with the Court? Did the personal representative file a final 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 X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of ~he :rp;~~;rt and may be attached to this ~eport. Ii J~ Date: Uvt }ll~ Signatur " Marielle F Hazen ESQuire Name (Please type or print) 2000 Linglestown Road Harrisbura PA 17110 Address ( 717 ) - 540- 433 Tel. No. (; ("") C0 Personal Representative Capac ity : C'~J x Counsel for personal representative 0- C") .'-") o cI'