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Home My WebLink About03-0688 Cumberland Register of Wills of / County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Donald H. Lehman, Sr. also known as , Deceased NO. Social Security No. 164-30-3350 Petitioner(s) who is/ars 18 years of age or older apply(ies) for: (COMPLETE '%" OR "B" BELOW:) ' [~ A. Probate and Grant of Letters Testamentary and aver that Pet~o?.~r(s) is/are the execute~_j_~amed in the last Will of the decedent, dated 2 / 1 8 / 02 and codicil(s) dated ( State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [~ B. Grant of Letters of Administration (d.b.n.c. ta.; pe,de~t~ lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLh_ ! ~- IN ALL CASES:) Attach additional sheets if necessary Decedent was domiciled at death in Cumberland or principal residence at 1~768 ?eyton Randolph County, Pennsylvania, with his/her last family Court, New Cumberland, PA 17070 situated as follows: (list street, number, and municipality) (Lower Allen Twp. ) Decedent, then 70 years of age, died July 26 ,2003 , at Dauphin County, Decedent at death owned property with estimated values as follows: (Location) (If domiciled in PA) All personal property $ 5 ~ 000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of Real Estate in Pennsylvania $ 7 h ~ h ~ C) _ CJ ~ 1768 Peyton Randolph Court, New Cumberland, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I i / . Typed or printed name and residence I KarCn S. Churchey 669 Churchey Lane Lewisberry, PA 17339 snace/WIIlsPetGrantLt/2001 Oath of Personal Representative Commonwealth of Pennsylvania County of 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 or Petitioner(s) and that, as personal representative(s) of the Decedent, Petition(s) will well and truly administer the estate ac~Q to law. Sworn to or affirmed and subscribed - - befo~,e me this I L.[_-+..~ day of - For the Regia~rO No. ~t--~)~,~ -- ~ ~ Estate of Dona].d [-1. T,ehman r Sz'. Deceased Social Security No.: 1 6 4- 3 0-.3 3 50 Date of Death: 7 / 2. 6 / 03 AND NOW, ,20 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary [~ Of Administration are hereby granted to Kal:eh S. Chu~'chey d.b.n,c.t.a.; pendente lite; durante absentia; durante minoritate in the above estate and that the instrument(s) dated ~'et:)~'ua~'¥ 1 8 v :20 0:2 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES }~~_ f/,/, ~ ~ "~ -~ Letters ............ $ ~1 ~. ~ ~Y,,~~-~.-~']'~L~J~[~,' ~.~ Short Ce~ificate(~ ~. :~ ~ R~st~lls~'~'?~ Renunciation ....... $ A~orney ~ ~~ Affidavits ( ) ....... $ I.D. No~ 1 5 609 E~ra Pages (I) ..... $ ~ '~ Address: 568 Old Yo~k Road Codicil ............ $ ~t[e~s r ~A 1 7 31 9 jcpFee ........... $ ~ '~ Telephone: (717) 938-3396 Inventory ........... $ Automation Fee ..... $. Other - ,, .... ' .... $ TOTAL ........ $ i Ltrl~.. ~ snace/VVIIIs PetG rantLt/2001 .Cumberland REGISTER OF WILLS / COUNTY OATH OF SUBSCRIBING WITNESS Joel O. Sechrist (each) a subscribing vdtness to thc will presented herewith, (each) being duly qualified accordinl to law, depose(s) and say(s) that_]2e__w~ls__._~present and saw Donald H. Lehman, Sr. , the testat or request of testator in hi~ other subscribing witneas(es)). Sworn to or affirmed and subscribed before me this i l Jr -L..¥-x day of' - For the Reg~r , sign the same and that he si&ned as a witness at the presence and (in the presence of each other) (in the presence of the ¥ork~Rd., Etter$, PA 17319 REGISTER OF WILLS - ZOUNTY OATH OF NON-SUBSCRIBING WITNESS (a,~.,h.) a subscriber hereto, (-eae+r)-,being duly qualified according to law, depose(s) and say(s) that ~<~ familiar with thc signature of' ~'~L~D. ta . c~il :u~N~g wkn=::: to) tne(wiil TM) presented herewith and that ~e_ Sworn to or affirmed and subscribed before me mis I L~3c:t,q day of - - For the Reg~r of~ bqlieves the signature on knowledge and belief. REGISTER OF WILLS YORK COUNTY OATH OF WITNESS TO WILL EXECUTED BY MARK , (each) codicil a subscribing witness to the will presented herewith, (each) being duly qualified according .to law, depose(s) and say(s) that: testat was unable to sign h name thereto; testat 's name was subscribed thereto in testat 's presence; testat made h mark thereon; testat and dependents(s) was (were) present when testat 's name was subscribed and when testat made h mark; and testat was present when the undersigned codicil signed the will will as witness(es). Sworn to or affirmed and subscribed before me this day of .20. For the Register 10~.805 REV 9186 This 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 Office fbr permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8504877 No. Local Registrar JUL 3 0 2003 Date Rev. 1/01 NAME OF DECEDENT (F~'st. Middle. Last) COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) ST.~TE FILE NUMBER Donald AGE (Last Bklhday) UNDER 1 YEAR Mo~he Days 70 COUNTY OF DEATH Dauphin DECEDENT'S USUAL OCCUPATION JSEX J SOCIAL SECURITY NUMBER Harrison Lehman, Sr. ,. male 3. 164 - 30 - 3350 Hours Minutes I(MOnlh. Day. Year)BIRTHPLACE (Csy and PLACEOFDEATH(Checkoniyone--seein~tuctionsonoth~s~Oe) [January 17, Highspire, PA I,. 1933 ~. . S~que~nna ~. [. 4~ block of Front Street ,o~ ~,~,.~c~, KIND ~ 8USINES~NDUSTRY ~S DECEDENT EVER IN DATE OF DEATH (Mo~th. Day, Ye~') ,,. July 26, 2003 l~,,%:,;,,..,-,.... Si,,c,,. w,,il ...... ,0.white SURVIVING SPOUSE (I/wile. give maiden name} Pennsylvania Did ,Yc.~ v.. da~..,,~ed ~ Fairview 1768 Peyton Randolph Court RESIDENCE New d. PA 17070 ,7,.c~..~ York ,o,..ship? No, d~nt,Ned c~,'b MOTHER'S NAME (Fkst, M ,3~ile. Maiden Surname) Merle Lehman Im. Besse gett[~ INFORMANT'S NAME (Type/P¢inl) IINFORMANT'S UAILING ADDRESS (Street. City/Town. Slate. Zip Code) Karen S. Churchey (Uo.~,Oay, Y~a,) ]~. 669 Churchey Lane, Lewtqberry, PA 17339 ,~.~ c ..... ~ ...~v~.~.~.t.r~ OATEOF~POS~,O. o%%O~f.*POSIT'O"'"~'o'~'~.'.~,,C ........ ~ 'OCAT,O.-C~,/T~..,S,.,.,Zip~. ~,~.O o~,s~l r]l,,,. July 30, 2003 l',T. ri-c°unty Memorial Garden/jtd. Lewtsberry, PA 17339 ~SUCH LICENSE NUMBER [NAMEANOADORESSOFFAClUTY ParthemoreFH & CS, Inc. ,,,. FD 012 848 L ~3~.P.O. Box 431, New Cumberland, PA 17070-0431 ITc the best of my kr~owiedge, daalh occurred at the time date and place s a ed LICENSE NUMBER DATE SIGNED 31ftllypllYslciancausei~ nOtof dea~h.aV&ilable al tirml gl death to I (Signature. and T Ue) (Month. Day. Year) 23e. ....... "'~--' ' ' 7~ ' . , [WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? .... I*~. :UO p.m.s. ,,. July 26, 2003 I'" Ye,~ Nor] ,--~"=c°~"'°~ d,~)--+ ,. Arteriosclerotic cardiovascular disease d, WAS AN AUTOPSY ~ W'~Rr AUTOPSY FIN DING S MANNER OF DEATH DATE OF INJURY TIM F COMPLET ON OF CAUSE ( . ay. Year) PERFORMED? AVAILABLE PRIOR 10 Mo~th D E OINJURY N JURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Yes I~ No [] I J::l_ ~ I ACCident ri Pendingtnvesh0m~nr] I~da. laob M 13~ ~"'. 120b, 12o. 13da. -- J~,,.,-*~ - ~lE.l? ~ ? Th&ig PHYSICIAN (PhF-a4c~an c~-lJyf~l cause gl death when eno#mr phy~C~an has p~onot*nced death a~d COml~e~ed Ilea 231 SIGNATURE AND TJ~4~E~L~Ir~I"iFIER ~ ~ ~omel~ltof mykno~,dellhoecuwedduetolheclule{I)lnd menner aBetated ............. : ' ,... ~1 /~/'-/ ~J-/~ ~ /~--~F------~ .................. 3~u. /-f ///?./t~_ i .. /'// *P _.l~O4J. N~JH~ AND C~RTIFYIN~ PRYSlClAN {ph¥~c~an both pronouncillg death a~l ceflilying ~o CauSe gl death) LICENS~ I~UMB~' V '1'DATE SIGNED (~th, gay, ....... Y~.'~-,...~"o~..ed.,t,....,..,.-~F~.,.ndd. to..¢.~.~.~.nd ........ ~ .......................... r] "" I*'~ July 28, 2003 *MEDICAL EXAmINER/CORONER (Item 27) Type or Print ~theba~f~x~m~nati~n~nd/m.~nve$t~gat~n~nmy~9~n~n~de~th~ccurr~d"tt~t~me~date~ac~a~d~t~t~c~u~)~d ~ Gra~ So He~rick~ Corot)er ...... '"'"*'~ .................................................................................................. ~. 1271 S. 28th St., Harrisburg, PA 17111 LAST WILL AND TESTAMENT OF DONALD H. LEHMAN, SR. 1, DONALD H. LEHMAN, SR., of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all wills by me heretofore made. FIRST: I order and direct that all of my just debts and funeral expenses be paid by my hereinafter named Executrix as soon after my death as may be found convenient. SECOND:. To my son, DONALD H. LEHMAN, JR. I give the sum of Five Hundred ($500.00) Dollars. THIRD: I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which ! may own or have the right to dispose of at the time o£my death unto my daughter, KAREN S. CHURCHEY. FOURTH: ! hereby nominate, constitute and appoint my daughter, KAREN S. CHURCHEY, as Executrix of this, my Last Will and Testament, and I do direct that no bond shall be required of such Executrix hereunder. My said Executrix shall have full power at her discretion to do any and all things necessary for the complete administration of my estate, including the power to sell at public or private sale and without order of Court, any real or personal property belonging to my estate, and to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and demands, whatsoever, against or in favor of my estate, as fully as ! could do if living. 1 Donald H. Lehman, Sr. IN WITNESS WHEREOF, I, DONALD H. LEHMAN, SR., the above Testator have set my hand and seal to this my Last Will and Testament, which consist/s of two (2) pages, to each of which I have affixed my signature this day of ,2002. D'-~nald U. Lehm~tn, -- (SEAL) Signed, sealed, published and declared by the above named Testator as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other have hereunto subscribed our names as witnesses. 2 DONALD H. LEHMAN, SR. JOEL O. SECHRIST ATTORNEY AT LAW CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DONALD H. LEHMAN, SR. Date of Death: July 26, 2003 Will No. 2003-00688 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court ! / Rules was served on or mailed to the following beneficiaries of the above captioned estate on // Name Karen S. Churchey Donald H. Lehman, Jr. Address 669 Churchey Lane, Lewisberry PA 17339 669 Churchey Lane, Lewisberry PA 17339 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No Exceptions Date: December 3, 2003 J~.~Sechrist, Esquire 568 Old York Road Etters PA 17319 (717) 938-3396 Supreme Court ID #15609 Capacity: _ Personal Representative X Counsel for Personal Representative Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters PA 17319 May 3, 2004 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013 RE: Estate of Donald H. Lehman To Whom It May Concern: Enclosed are two copies of the Inheritance Tax Return together with a check made payable to Register of Wills, Agent in the amount of $1,604.49 and a check in the amount of $130.00 representing $15.00 for the filing of the return and $115.00 for additional probate fee. JOS:lm Enclosures ~hrist ~ 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 003905 SECHRIST JOEL O 568 OLD YORK ROAD ETTERS, PA 17319 ........ fold ESTATE INFORMATION: SSN: 164-30-3350 FILE NUMBER: 2103-0688 DECEDENT NAME: LEHMAN DONALD H SR DATE OF PAYMENT: 05/05/2004 POSTMARK DATE: 05/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/26/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,604.49 REMARKS' CHECK# 1159 SEAL TOTAL AMOUNT PAID: $1,604.49 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX.. (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 Z z Rev-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 'DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) County Code Year Number SOCIAL SECURITY NUMBER Lehman, Donald H; srI I DATE OF BIRTH (MM-DD-YEAR) ' 164~30~3350 ; DATE OF DEATH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH Ju~ 26! 2003 IJanuary i7, 1933 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N10ng'nal Return ~2. Supplemental Retum ~ 3. Remainder Return (date of death prior to 12. 4. L~m~ted Estate ~4a. Future Interest Compdse (date of death after 12-12-82) U5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach copy of Will) ~7. Decedent Maintained a Living Trust (Attach a copy of True1) 8. Total Number of Safe Deposit Boxes U9. Litigation Proceeds Received Ul0. Spousal Poverty Credit(date o, death between 12-31-91 and ~-~-95) ~11. Election to tax under Sec. 9113(A) NAME Kare~ S. Churchey FIRM NAME (If Applicable) TELEPHONE NUMBER 717 938:3396 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 &Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) (Schedule G or L) 8. Total (]ross 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES $91,500.00 i OFFICIAL USE ONLY ,o.oo ~ (8) $118,392.65 $12,941.85 $69,834.61 (11) $82.776.46 $35,616.19 $o.oo (12) (13) (14) $35,616.19 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aX1.2) 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 20. ~ $35,6i6.i9 x .12 .15 (15) (16) (17) (18) (19) $0.00 $1,602.73 $0.00 $0.00 $1,602.73 Decedent's Complete Address: STREET ADDRESS 1768 peytOn Ra ~duph Court STATE CITY 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 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (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 + 5A. This is the BALANCE DUE. (5B) $1,602.73 $0.00 $0.00 $1,6O2.73 $1,602.73 $1~6 $1,604.49 Make Check Payable to: REGISTER OF WILLS, AGENT i PLEASE ANSWER THE FOLLOWING QuESTIoNS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 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 revisionary 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 property within on 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 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which Yes No contains a benefic ary designation? ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any know edge. SI U ~.~1 R PONSlBLE FO FILING RETURN DATE 68~Fork ROad, Etters pA 17319 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. LAST WILL AND TESTAMENT OF DONALD H. LEHMAN, SR. I, DONALD H. LEHMAN, SR., of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all wills by me heretofore made. FIRST: I order and direct that all of my just debts and funeral expenses be paid by my hereinafter named Executrix as soon after my death as may be found convenient. SECOND: To my son, DONALD H. LEHMAN, JR. I give the sum of Five Hundred ($500.00) Dollars. THIRD: I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time of my death unto my daughter, KAREN S. CHURCHEY. FOURTH: I hereby nominate, constitute and appoint my daughter, KAREN S. CHURCHEY, as Executrix of this, my Last Will and Testament, and I do direct that no bond shall be required of such Executrix hereunder. My said Executrix shall have full power at her discretion to do any and all things necessary for the complete administration of my estate, including the power to sell at public or private sale and without order of Court, any real or personal property belonging to my estate, and to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and demands, whatsoever, against or in favor of my estate, as fully as I could do if living. 1 Donald H. Lehman, Sr. IN WITNESS WHEREOF, I, DONALD H. LEHMAN, SR., the above Testator have set my hand and seal to this my Last Will and Testament, which co~is~s of two (2) pages, to each of which I have affixed my signature this day of ,2002. Signed, sealed, published and declared by the above named Testator as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other have hereunto subscribed our names as witnesses. REV-1502EX = (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald Hi, SCHEDULE A REAL ESTATE All real property owned solely or as a tenant in c~,i~iiion must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 1768 Peyton Randolph Court, New Cumberland, PA as sold TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $91,500.00 $91,500.00 REV-1503EX = (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald H., Sr. SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. Met Life at 28.86/share DESCRIPTION TOTAL (Also enter on line 2, Recapitulation (If more space is needed, insert additional sheets of the same size) VALUE AT DATE Of DEATH $288.60 $288.60 REV-1508 EX + (1-97X1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald H., Sr. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-03-0688 IncludescheduletheF.proceeds of litigation and the date the proceeds were received by the estate. All prope~y jointly-owned with the right of survivorship must be disclosed on ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. DESCRIPTION Personal Property Refund of Real Estate Tax Escrow Pennsylvania Convenience Store Council Deferred Compensation Plan Pennsylvania Convenience Store Council Profit Shadng Plan Proration of Taxes on sale of house M&T Bank Checking Account M&T Bank Checking Account 1992 Ford E-150 van TOTAL (Also enter on line 5, Recapitulation (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $3,365.00 $738.37 $7,140.00 $911.03 $420.57 $3,046.33 $8,982.75 $2,0OO.OO $26,604.05 REV-1511 EX + (1-97X1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald H., Sr. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-03-0688 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: Parthemore Funeral Home DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name Df Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees 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 8. 9. 11. 12. Probate Fees Accountant's Fees Tax Retum Preparer's Fees Register of Wills - File Return Clerk of Orphan's Court - Releases Patriot News Cumberland Law Journal Robert Ensminger, Appraiser Register of Wills - Additional Fee AMOUNT $6,654.80 $5,517.00 $140.00 $15.00 $8.00 $182.05 $60.00 $250.00 $115.00 TOTAL (Also enter on line 9, Recapitulatior (If more space is needed, insert additional sheets of the same size) $12,941.85 REV-1512 EX + (1-97X1) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald H., Sr. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS FILE NUMBER DESCRIPTION Include unreimbursed medical expenses. ITEM NUMBER 1. Goodyear Credit Card 2. PPL 3. Veterans Administration 4. Comcast 5. PA Amedcan Water 6. PTC Death Benefit 7. Hunter's Ridge Association 81 PPL 9' Hunter's Ridge Association 10. PA American Water 11, Progress Avenue Exxon, Inc. - towing and storage fee 12. PPL 13. PA American Water 14. Hunter's Ridge Association 15. PPL 16. Lower Allen Township Sewer & Refuse 17. PA American Water 18. Daniel's Construction for repairs to home 19. Hunter's Ridge Association 20. Sears for repairs to house 21. Lower Allen Township Sewer & Refuse 22. PPL 23, PA Amercian Water 24. PPL 25. PA American Water 26. 27. 28. 29. 30, Mortgage Payments to M&T Mortgage for Aug, Sept, Oct. Nov, Dec, Jan, & Feb Mortgage payoff at settlement Proration of unpaid County/Township taxes Settlement charges on sale of house Final fees to Hunter's Ridge Association TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT $137.32 $56.18 $120.00 $39.69 $20.82 $11.25 $75.00 $268.62 $251.00 $64.77 $125.00 $43.O7 $10.65 $75.00 $56.18 $73.35 $84.85 $1,586,00 $160.00 $386.77 $73.35 $t95.28 $20.00 $108.19 $30.06 $3,532.27 $55,53~60 $49.84 $6,566.50 $80.00 $69,834.61 REV-1513 EX + (9-00)) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lehman, Donald H., Sr. SCHEDULEJ BENEFICIARIES FILE NUMBER 21-03-0688 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE DO Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY k TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Donald H; Lehmanl jr, SOn Chu eyLa. L~s~r~ PA t7339 2~ JKaren S~ churCheY ; Daugh~r ~669 chUr~ey La~ ; J ~P~7339 I1. 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 (If more space is needed, insert additional sheets of the same size) $0.00 A. OMB NO. 2502-0265 B. TYPE OF LOAN: U.S. ~EPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.r-]FHA 2.[-1FmHA 3. ~-ICONV. UNINS. 4. []]VA 5. []]CONV. INS. 6. FILE NUMBER: SETTLEMENT STATEMENT ~RONS.A I 7. LOAN NUMBER: 77773808IRONS 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnisl~ed to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (IRONS,A.PFD/IRONS.N18) D. NAME AND ADDRESS OF BQRROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: ANDREW L. IRONS COMMERCE BANK, HARRISBURG N.A. KAREN S. CHURCHEY, EXECUTRIX of the Estate of Donald H. Lehman, Sr. G. PROPERTY LOCATION: H. Sb I I LEMENT AGENT: 23-2402316 1768 PEYTON RANDOLPH COURT I. SETTLEMENT DATE: PURITY ABSTRACT COMPANY NEW CUMBERLAND, PA 17070 February 27, 2004 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 3329 Market Street Camp Hill, PA 17011 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: ~e 91,50---~.00 ~e 91,500.00 ~operty 402. ~ropedy ~arges to BorroWer ~ 3,71-~.32 403. ~ -~ 38176~- 404. 405. Adjustments For ~nce Adjustments For lt~ance ~ty/Twp~ to ~406. to 107. City Tax to 407. City Tax to 108. School Tax 02/27/04 to 07/01/04 302.49 4D8. School Tax 02/27/04 to 07/01/04 302.49 109. 1ST QTR. SEWER/REFUSE 02/27/04 to 04/01/04 27.41 409. 1ST QTR. SEWER/REFUSE 02/27/04 to 04/01/04 27.41 110. HCA FEE FEB. & MARCH $160.00 02/27/04 to 04/01/04 90.67 '410. HCA FEE FEB. & MARCH $160.00 02/27/04 to 04/01/04 90.67 111. , 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 96,012.52 420. GROSS AMOUNT DUE TO SELLER 91,920.57 !200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 1201. Deposit or earnest money 2,000.00 501. Excess Deposit (See Instructions) ;202. Principal Amount of New Loan(s) 73,200.00 502. Sett{emen~: Charges to Seller (Line 1400) 6,566.50 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 2ND LOAN PROCEEDS 8,865.07 504. Payoff of first Mortgage to M&T MORTGAGE CORPOR; 205. 55,533.60 505. Payoff' ct second Mortgage 206. 506. 207. 507. (Deposit disb. as proceeds) 2O8. 508. .209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210· County/Twp Taxes 01/01/04 to 02/27/04 49.84 510. County/Twp Taxes 01/01/04 to 02/27/04 49.84 211. CityTax to 511· CityTax to 212. School Tax to 512. School Tax to 213. 513. 214· 514. 215. 515. 216. 516. 217. 517. HCA FINAL FEES to HUNTER'S RIDGE HOMEOWNER 80.00 218. 518. 219· 519. 220. TOTALPAIDB¥/FORBO~?ROWER 84,114.91 520. TOTALREDUCTIONAMOUNTDUESELLER 62,229.94 300. CASH AT S~ ~ I LEMENT FROM/TO BORROWER: 600. CASH AT S~- ~ ! LEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 96,012.52 601. Gross Amount Due To Seller (Line 420) 91,920.5/ 302. Less Amount Paid By/For Borrower (Line 220) ( 84,114.91 602. Less Reductions Due Seller (Line 520) 62,229.94 303. CASH( X FROM)( TO)BORROWER 11,897.61 603. CASH( X TO)( FROM)SELLER 29,690.63 The undc. r.~innc_d h~r~hw '~,'~kn~^~l~rt~ .... i~- ~,~ ..... ~_~.4 ...... ~ Borrower pt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Seller · CHURC'FfEY~EXECUTRIX - ~L for Schedules A and I Exh~,bit Page L. SETTLEMENT CHARGES sed on Price to $ 91,500.00 @ 6.0000 % 5,490.00 O t . SE~DLEM~ count to ITEMS~ 901. Interest From 02/27/04 to 03/01/04 @ $ 11.690000/day 245.0-0 ( 3 days %) surance ~or 1.0 years to 1000. RESl Insurance 3.000 months months 2.000 ~ ax months 9.000 ~ 22.67 per month per month 31.7,~ per month per month 1101. E-Mail Document Retrieval DEED COPY 73.81 per month ~ per mo~ months ~ per month months ~ per month to PURITY ABSTRACT COMPANY to to ~ ent Preparation to to ~surance Co. to CA~-'~ ~ to RE/MAX REALTYA S CIATES, INC. surance (~e item numbers: to PURITY AB TRA PANY 9rage $ 9rage ge 68.0' 63.5_.0 664.2~ 10,00 6.00 5.00 ,RGES 1200. GOVERI' ~ECORDING 1201. Recording Fees: Deed $ 38.50; Mortgage $ 62.50; Releases $ 12.0 810.7 ~gage ps: Revenue Stamps 915.00; ~"ortgage to RECORDER OF DEEDS , REC~ 1300. ADDITIONAL SETTLEMENT-"'~"~'~-RGES 1301. Survey to spection to B 1E U~'~' PO~ ~ ~'~ RE/MAX REALTY ASSOCIA ES, INC. ~ ~ ECURIT ~- HUNTER~ ----Jr' 82.0~ 14~;nT~.T~L~EMENT CHARGES (Ente~,e~'~'~ne,~. , .0 PU ~ITY/~B.~'I RACT COMPANY Certified to be a true copy. Settlement Agent ( IRONS,A / fRONS.A / 19 ) M&T 499 Mitchell Road, Millsboro, DE 19966 Mail Code 501-120 Joel O. Sechrist Attorney At Law 568 Old York Road Etters, PA 17319 Re: Estate of Donald H Lehman, Sr. Social Security: 164-30-3350 Date of Death: JulF 26, 2003 Dear Sir or Madam: Phone (302) 934-2909 F ax (302) 934-2955 September 9, 2003 Per your inquiry dated August 19, 2003, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: Type of Account Checking Account Account Number 1954067 Ownership (Names oj~ Donald H Lehman, Sr Peg M Lehman Opening Date 12/28/82 Balance on Date of Death $3,046.33 Accrued Interest $ O. O0 Total $3,046 33 Type of Account Checking Account Accotmt Number 98185640 Ownership (Names 099 Donald H Lehman, Sr Opening Date 10/19/98 Balance on Date of Death $8,982.43 Accrued Interest $ .32 Total $8,982.75 (302) 934-2909 EXkibit for Schedule E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DONALD H. LEHMAN, SR. Date of Death: July 26, 2003 Will No. 2003-00688 To the Register: Rules I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court was served on or mailed to the following beneficiaries of the above captioned estate on / Name Karen S. Churchey Donald H. Lehman, Jr. Address 669 Churchey Lane, Lewisberry PA 17339 669 Churchey Lane, Lewisberry PA 17339 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No Exceptions Date: December 3, 2003 J~. Sechrist, Esquire 568 Old York Road Etters PA 17319 (717) 938-3396 Supreme Court ID #15609 Capacity: _ Personal Representative ~X Counsel for Personal Representative ¢5 , ~,R:' ~71 MAY 4 2004 e ~ HARRISBURG PA 171 PROM Jo~ O, ~oh~ist, Esquire 568 Old York Road Etters PA 17319 TO Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 KAREN S CHURCHEY C/O JOEL 0 SECHRIST 568 OLD YORK RD ETTERS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PA 17319 DATE 06-21-2004 ESTATE OF LEHMAN SR DATE OF DEATH 07-26-2003 FILE NUMBER 21 03-0688 COUNTY CUMBERLAND ACN 101 Amount Remitted REV-15~i7 EX AFP ¢01-05} DONALD H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~' RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWA~'~-~- ................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEHMAN SR DONALD H FILE NO. 21 03-0688 ACN 101 DATE 06-21-2004 TAX RETURN WAS: (X} ACCEPTED AS FILED ( } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A} 2. Stocks and Bonds (Schedule B} (2} 288.6 5. Closely Held Stock/Partnership Interest (Schedule 4. Mortgages/Notes Receivable (Schedule D} (4} .0 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E} 6. Jointly Owned Property (Schedule F} 7. Transfers (Schedule G} 8o Total Assets (8} APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H} (9} 10. Debts/Mortgage Liabilities/Liens (Schedule 11. Total Deductions 12. Net Value of Tax Return 12,941.85 NOTE: To insure proper credit to your account, submit the upper portion of this form with Your tax payment. 15. 14. NOTE: 118,392.65 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. reflect figures that include the total of ALL returns assessed to date. .00 x O0 = .00 35'616,'~!,9 X 045 1,602.73 ~oo x 1~~ = .oo C~)= 1,602.73 AMOUNT PAID 1,604.49 BALANCE OF TAX DUE ' .35CRI INTEREST AND PEN. .00 TOTAL DUE .35CR IF TOTAL DUE IS LESS THAN ~l, NO PAYMENT IS REQUIRED. TOTAL DUE IS REFLECTED AS A "CREDIT" (CR}, YOU MAY BE DU~v~.~ REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID 05- 04-2004 CD003905 1.41- Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15} .00 Net Value of Estate SubSect to Tax (1~) 55,616.19 If an assessment ~as issued Previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill 69r834.61i (Il) B~.77~.46 el2} 35,616.19 RESERVATION= Estates of decedents dying on or before December 12, 1982 -o if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE= PAYHENT= REFUND OBJECTIONS= ADNIN- ISTI[~TIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST= To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of NiLls printed on the reverse side. --Hake check or money order payable to= RECIS~I~ OF HILLS, &~N~ 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-ISIS). Applications are available at the Off,ce of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering= 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-447-3020 (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. 28[021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed Jn writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0~01 Phone (717) 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 (3) calendar months after the decedent°s death, a five percent (5~) discount of the tax paid is al/o~edo The 15X 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 non-participation penalty is appealable Jn the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (EX) percent per annum calculated at a daily rate of o000164. All taxes which became delinquent on and after January 1, 1982 wJl! bear interest at a rate which ~Jll 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. ~ 20% .000546 ~Y~'~-1991 11% .000501 ~ 9% .000247 1983 1~ .000438 1992 9~ .000247 2002 6% .000164 1984 11~ .000301 1993-1994 7~ .000192 2003 5~ .000137 1985 13% .000356 1995-1998 9% .000247 2004 4% .000110 1986 10~ .000274 1999 7% .000192 1987 10% .00027~ 2000 7~ .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION IN RE: Estate of DONALD H. LEHMAN, SR. No. 21-03-00688 Late of Lower Allen Township, Cumberland County, Pennsylvania RELEASE KNOW ALL MEN BY THESE PRESENTS, that I, Donald H. Lehman, Jr., do hereby acknowledge that I have this date received from Karen S. Churchey, Executrix of the Estate of Donald H. Lehman, Sr., my share of the Estate of Donald H. Lehman, Sr.. I therefore release and forever discharge the said Karen S. Churchey, individually and as Executrix of the Estate of Donald H. Lehman, Sr., her heirs, executors, and administrators, of and from all actions, duties, claims and demands whatsoever from the beginning of the world to the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County, Pennsylvania, may discharge the said Executrix upon application and without further notice to me. AND the undersigned, in consideration of said payment and transfer, does hereby agree, upon written request of the Executrix to refund to the said Estate pro-rata whatever assets, in kind or in cash, that may be necessary in the future to discharge any liabilities of the Estate. IN WITNESS WHEREOF, I have hereunto set my hand this ,2005. day of WITNESS: i)~cf(/l~ Donald H. Lehman, Jr. SSN: 1:;' 1..{ - Sy -iu,-1t.o I\".:; ;~"") 'I C._) o