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HomeMy WebLinkAbout04-0128 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' OO]~O Ttl~' L, PT~'A/,~t{O. No. e~'~/--/~,e-~- also known as To: Register of Wills for the Deceased County of Sociai Security No. /2,2 ~0~' -'~ 2~7 ' - Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut~.TK in the last will of the above decedent, dated A tYF. t/$ T' I ~ and codicil(s) dated ' in the named , 9g.a (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in_ /n' (.2'/n lg~/¢ Lj,~t/?..~ County, Pennsylvania, with hr{/_ last family or principal residenc~ at /o- (list street, number and muncipality) Decendent, then _~ 7 _ years of age, died_ ]/[~/.700~ ,19 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $_ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: ~ $ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. request(s) the probate, of the last will and codicil(s) (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF-PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF ~ss 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 ~he knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will we~nd trUly administer the estate according to law. ~vf~ roteo th~'~ afl,ed and subs~ribed~ .~- J_~_~,~_),~...~. ~ ~'TXJ~_~4~n}.~ No. Estate Of ~'~-~, [ [ ~]e~ ~-~ .., Deceased DECREE OF PROBATE AND GRANT OF LETTERS the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~ ~c~ ~(.,, /~~' W described therein be admitted to probate and filed of record as the last will of and Letters ~ are hereby granted to~ ~k9~.2~, in consideration of the petition on FEES Probate, Letters, Etc .......... Short Certificates( ) .......... on ................ Filed ~ l(£Rv/fA/£sq ATT©RNEY (Sup. Ct: I.D. No.) ADDRESS PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat. , sign the same and that signed as a witness at the request of testat, in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19 (Name) (Address) (Name) (Address) Register REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he_'L~ familiar with the signature of ~_~-,q-h,, L f~)iz n~, codi~ I testat~.~ of ~ s,2b~cr~b~ng witnesse~¢o) the will presented herewith and that to the best of Sworn to or affirmed and subscribed before me this day of - ~ ,.~- codicil believes the signature on the will is in the handwriting of __ knowledge and belief. ~XAd~dress) f (Address) os.so~ ~v 9m 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 for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9990486 No. Local Registrar JAN 1 6 Date NAME OF D~CEDENT (Fits. Mille. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 1 E. Epply Drive ,,.Carlisle~ Pa 17013 ,e. Unknown Hami l 1 ~,, Dorohty L. Myers Jan. 20, 2004 FD-O 12909-L Pennsylvania md , ~:.~--~ *., ~.*.., u,~ ~. South Middleton Cumberland ] ,,. Sarah H~ ]~ i ~. ~pp~y ur~ve ~ar~s~e, Pa 17013 ~:~ ..... ~ ......... ~,~. ,~,.c~.~..~ ~. ~ F~ral ~ 255 York ~. ~lisle, Pa 17013 'DOROTHY 'L. 'MENARD I, DOROTHY L. MENARD, of 3509 Hiltcrest Road, Harrisburg, Dauphin County,. Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by.me at any.time heretofore made. FIRST: I direct my hereinafter named Executrix to pay all my.legally enforceable deb,ts, funeral expenses, administration expenses, and inheritance, estate, succession or excise taxes, which I owe or may .become due on account of my death, as. soon as maybe convenient after my decease. SECOND: I give, devise and bequeath all of my property, be it real, personal or mixed, whatsoever and wheresoever the same may .be situate at the time of my death, to my husband, EARL J. MENARD. 'THIRD: In the event my husband, EARL J. MENARD, predeceases me, or fails to survive me, I give, devise and bequeath all of my property, real, personal or mixed, whatsoever and wheresoever the same may be situate at the time of my death, to my daughter, DOROTHY L. MYERS. In the event my daughter, DOROTHY L. MYERS, also predeceases me, I direct that her share of my .estate shall pass to her. surviving children, in equal shares. Surviving children being those children who are living at the time of my death. Page I of 2 Pages Dorothy L'. ~na'rd 'FOURTH: I nominate, constitute and appoint my~daughter, DOROTHY L. MYERS, as Executrix of this my iLast Will and Testament, authorizing, and empowering her to sell and convey any.and all real estate of which I may die seized and possessed.' I hereby direct that my Executrix. shall not be required, to post bond to act in said capacity. IN WITNESS WHEREOF, I, DOROTHY L. MENARD, have hereunto set my hand and seal, to this my Last Will and Testament, this /~7'~ day ~of _ ./~'X~'$7' "A.D., 1984.~ SIGNED, SEALED, PUBLISHED and DECLARED by .the above named Testatrix, DOROTHY L. M~NARD, as and for her Last Will and Testament, in the presence of us, who, at her request, and in the presence of each other, have hereunto set our names as witnesses: 'Res~'~,f at: ' DOROTHY L~,~- MENARD (SEAL) Page 2 of 2 Pages ''DOROTHY iL.' 'MENARD KERWIN AND KERWIN ATTORNEYS AT LAW ~UITE :301, $00 CHESTNUT STREET HARRISBURG, PA. $7~01 PHOI~= 238-47~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dorothy L. Menard Date of Death: January 14, 2004 Estate Proceedings No.: 2004-00128 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 24, 2004 Name: Address: Dorothy L. Myers One Epply Drive Carlisle, PA 17013 Notice has now been given to all persons entitled thereto 7~ Rule 5.6(a) except: NONE Date: February 24, 2004 Signature://tQ*SEPH D. KERWIN, ESQUIRE Address: ~245 Route 209 /Elizabethville, PA 17023 Telephone: (717) 362-3215 Capacity: Personal Representati,vg X Counsel for Person~ ~' · Representative ~ .. ~ ~;~,. i ~,0 C,~,, ch c, . KERWIN & KERWIN ATTORNEYS AT LAW 4245 ROUTE 209 ELIZABETHVILLE, PA 17023 (717) 362-3215 (717) 896-9089 FAX (717) 362-4459 E-mad: kkl@epix.net Please Reply To: ~ ELIZABETHVILLE OFFICE ~ HARRISBURG OFFICE GOVERNORS' ROW 27 NORTH FRONT STREET HARRISBURG, PA 17101 (717) 238-4765 FAX (717) 238-8455 May 3, 2004 PATRICK E. KERWIN (1913-1987) HOLLY GREGORYM. KERWIN - TERRENCE J. KERWIN - JOSEPH D. KERWIN - McCLURE KERWIN GMK@Kerwinlawfirm.com KK@Kerwin]awfirm.com JDK@Kerwinlawfirm.com - KK@Kerwinlawfirm.com Register of Wills of Cumberland County Cumberland County Courthouse South Hanover Street Carlisle, PA 17013 Re: Estate of Dorothy L. Menard Estate File No.: 2004-00128 Dear Sir or Madam: Please find enclosed herewith for filing in your office the original and two copies of the Inheritance Tax Return with respect to the above-captioned estate. Also enclosed is a check payable to "Register of Wills" in the amount of $725.27 representing the inheritance tax due. Would you kindly time-stamp the enclosed copy and return it to me in the enclosed self-addressed, stamped envelope. Thank you for your assistance. JDK:tll Enclosures Very tru/~urs, JOSEPH D. KERW1N 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 OO3901 KERWlN JOSEPH D 27 NORTH FRONT STREET HARRISBURG, PA 17101 ........ fold ESTATE INFORMATION: SSN: 172-05-7787 FILE NUMBER: 2104-01 28 DECEDENT NAME: MENARD DOROTHY L DATE OF PAYMENT: 05/04/2004 POSTMARK DATE: 05/03/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 01/14/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $725.27 REMARKS: TOTAL AMOUNT PAID: $725.27 SEAL CHECK//103 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) CAPB HpRL EpiC c~AC ~TK Co. R E C A P I T U L A T I O N C 0 M T I 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712:8-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Menard Dorothy L. DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-OD-YEAR) 01/14/2004 I 09/08/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)  1. Original Return ~ 247! Supplemental Return 4. Limited Estate , Future Interest Compromise (date of death after 12-12-82) 6, Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) [] 9. Litigation Proceeds Received [----110, Spousal Poverty Credit (date of death between 17-31-91 and 1 - 1-95) NAME Joseph D. Kerwin, FiRM NAME (If Applicable) Kerwin & Kerwin TELEPHONE NUMBER 717/362-3215 1. Real Estate (Schedule A) Esq. (1) OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r'~ 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. FILE NUMBER 04 I COUNTY CODE YEAR NUMBER 14, SOCIAL SECURITY NUMBER 172-05-7787 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER  (date of death 3. Remainder Return prior to 12-13-82) · ~. Federal Estate Tax Return Required 0 8. Total Number of Safe Oeposit Boxes r--] 11. Election to tax under Sec. 9113(A) (Attach Sch O) None COMPLETEMAILINGAODRESS 4245 Route 209 Elizabethville, None None None None 25,611.52 None 7,773.47 1,721.00 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) PA 17023 OFFICIAL ~ ONLY ?) (8) 25,611.52 (11) 9,494.47 (12) 16,117.05 (13) (14) 16,117.05 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 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 16,117.05 X .0 0 x .0 45 x .12 X .15 (15) 0.00 (16) 725.27 (17) 0.00 (18) 0.00 (19) 725.27  . Copyright(c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS One Eppley Drive CItY Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE I ZIP PA 17013 Total Credits ( A + B + C ) (1) 725.27 3. Interest/Penalty if applicable 0. O0 D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 72_5.27 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + .SA. This is the BALANCE DUE. (5B) 725.27 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retaintheuseorincomeofthepropertytransferred; ......................... 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'~ Z. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary 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 ts based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Dorothy L. Myers · ~') . ,,~ · ~' / -- One Epple]~ Drive DATE SlGNATU~OF~"OTHERT~EP,ESENTAT,VE Kerwin & Kerwin OATE--~ . .......... ,/ / For ~eath Oho or after July 1, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for t~~: surffi~ ~ouse is3Yo [72 P.S. 9116 (a)(1 1)( )] For"dates of death on o ' ' '' ................ r after Janua~ 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 statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if the survivin9 spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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 siblin9 is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form ~EV-1500 EX (Rev. 6-00) REV- 1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy L. Menard SS~/ SCHEDULE F JOINTLY-OWNED PROPERTY 172-05-7787 01/14/2004 FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reposed on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Dorothy L. Myers One Eppley Drive Daughter Carlise, PA 17013 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed foriointly-held real estate. VALUE OF ASSET INTEREST }ECEDENT'S INTERES 1 A 02/07/97 Certificate of Deposit 8,598.36 50.00% 4,299.18 ~/3103914553275 at M&T Bank 2 A 04/28/85 Checking Account No. 42,624.68 50.00% 21 312 34 5031473 at M & T Bank ' ' TOTAL (Also enter on line 6, Recapitulation) $ 25,611.52 sl .~rt additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1509 EX (Rev. 1-97) REV- 1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy L. Menard SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS SS# 172-05-7787 Debts of decedent must be reported on Schedule I. ITEM NUMBER 0i/i4/2004 FUNERAL EXPENSES: DESCRIPTION Ronan Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: State ~ Zip Attorney's Fees Kerwin & Kerwin Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Accountant's Fees Register of Wills Tax Return Preparer's Fees OtherAdministrativeCosts Advertisement of Estate Advertisement of Estate The Sentinel - Cumberland Law Journal TOTAL (Also enter on line 9, Recapitulation) 5. 6. 7. FILE NUMBER AMOUNT 5,850.00 1,650.00 69.00 129.47 75.00 7,773.47 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV~1511 EX (Rev. 1-97) ESTATE OF Dorothy L. Menard SS# 172-05-7787 01/14/2004 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Hampden Township Ambulance FILE NUMBER Pinnacle Health Hospitals Coble's Transfer & Storage Co. TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. AMOUNT 330.00 876.00 515.00 1,721.00 Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (1-97) I I SCHEDULE J I COMMONWEALTH OF PENNSYLVANIA ~ BENEFICIARlES INHERITANCE TAX RETURN I ESTATE OF Doro~ L. Henard SSf/ 172-05-7787 01/14/2004 FILENUMBER NUMBER Ih NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLEDISTRiBUTiONS(includeoutrightspousaldistributions): 1 Dorothy L. Myers One Eppley Drive Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter AMOUNT OR SHARE OF ESTATE 100% of estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, inser~ additional sheets of the same size) Copyright (c) 1996 form software only CPSystem$, [nc. Form REV-1513 EX (Rev. 1-97) 'DOROTHY L .' 'MENALRD I, DOROTHY.L. MENARD, of 3509 Hillcrest Road, Harrisburg, Dauphin County,. Pennsy!uania, being of sound mind, memory.and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by me at any.time heretofore made. FIRST: I. direct my hereinafter named Executrix to pay all my !ega!ly enforceable deb~ts, funaral expenaes, administration expenses, and inheritance, estate, succession, or excise taxes, which I owe or may become due on account of my death, aa soon as may be convenient after my decease. ' SECOND: I give, devise and bequeath all of myproperty, be it real, personal or mixed, whacsoever and wheresoever the same may be situate at the time of my death, to my husband, EARL J. MENAP, D/ THIRD: In the event my ~husband, EARL J. MENARD, predeceases me, or fails to survive me, I gi~e,, devise and bequeath all of my property, real, personal or mixed, whatsoever and wheresoever the same may be situate at the time of my death, to my daughter, DOROTHY L. MYERS. In the event my daughter, DOROTHY L. MYERS, also predeceases me, I direct that her share of my.estate shall pass to. her~.surviving children, in equal shares. Surviving children heing those children who are living at the time of my death. Page I of 2 Pages DOrothy L. ~nard ~FOURTH: I nominate, constitute· and appoint my ·daughter, DOROTHY L. MYERS, as Executrix of this my Last Will and Testament, authorizing and empowering her to sell and convey ~ny ~nd all real estate of which I· may diel seized and possesaed. I hereby direct that my Executrix shall not B~e required to post bond to act in said capacity. IN WITNESS WHEREOF, I, DOROTHY L. MEN~iRD, have hereunto set my hand· and seal, to this myLast Will and Testament, this /~r~ day of )~f/~O'$~ A.D., 1984. SIGNED, SEALED, PUBLISHED and DECLARED by .the above named Testatrix, DOROTHY L. MENARD, as and for her Last Will and Testament, in the presence of us, who, at her request, and in the presence of each other, have hereunto set our names as witnesses: DOROTHY L(,O MENARD (SEAL) March 3, 2004 Kerwin & Kerwin Attorneys At Law 4245 Route 209 Elizabethville, PA 17023 499 Mitchell Street, Millsboro, DE 19966 Estate of Dorothy Lane Menard Date of Death: January 14, 2004 Social Security Number: 172-05-7787 Dear Mr. Kerwin: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Certificate of Deposit Account Number. ...................... 31003914553275 Ownership (Names of) ..............Dorothy Lane Menard, Dorothy Myers Opemng Date ........................... 02/07/97 Balance on Date of Deattt .........$8,597.13 Accrued Interest $ 1.23 Total ....................................... $8,598.36 2. Account Type ........................... Checking Account Account Number. ...................... 50031473 Ownership (Names of) ..............Dorothy Lane Menard, Dorothy Myers Opening Date ........................... 04/28/85 Balance on Date of Death. .........$42,622.04 Accrued Interest $ 2.64 Total. ...................................... $42,624.68 Sincerely, Charle~, R~ec~O2 M~~ ~ag~ement 1-888-502-4349 IIIIIIIIII RWIN aw 17023 ;UMBERLAND COUNTY ~THOUSE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280&01 HARRISBURG, PA 17128-0&01 JOSEPH D KERWIN ESQ KERWIN & KERWIN q245 RTE 209 ELIZABETHVILLE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE PA 17025 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 06-21-2004 ESTATE OF MENARD DOROTHY L DATE OF DEATH 01-14-2004 FILE NUMBER 21 04-0128 COUNTY CUMBERLAND ACN 101 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 COl-OS) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MENARD DOROTHY L FILE NO. 2i 04-0128 ACN lOI DATE 06-21-2004 TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN [. Real Estate (Schedule A) 2. Stocks and Bonds CSchedule B) C2) $. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable CSchedule D) 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) (5) 6. Jointly Owned Property CSchedule F) 7. Transfers CSchedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your · 00 tax payment. 25~611 .52 .00 C8) 7,775.47 15. 14. NOTE 25,611.52 05-05-2004 PAYMENT DATE 19. Princt TAX CREDITS RECEIPT NUMBER CD005901 DISCOUNT C+) INTEREST/PEN PAID C-) .00 ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) l&. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate C17) 18. Amount of Line 14 taxable at Collateral/Class B rate C18) ~al Tax Due .00 x O0 = .00 16,117..05 X 0~5 = 725.27 .00 x 12 = .00 · 00 x 1~; = .o0 c~9)= 725.27 AMOUNT PAID 725.27 ~F PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. reflect figures that include the total of ALL returns assessed to date. TOTAL TAX CREDIT I 725.27 BALANCE OF TAX DUEI .00 INTEREST AND PE..I .oo TOTAL DUE I .00 C IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) (15) .00 Net Value of Estate Subject to Tax (142 I6,I17.05 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wi1! lt721.00 c~t) 9.~9q,~7 c~2) 16,117.05 RESERVATION= PURPOSE OF NOTICE= PAYHENT= REFUND CCR)= OBJECTIONS= ADHIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B Ccollateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 25 of 2000. C72 P.S. Section 91~0). 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: REGISTER OF NILLS~ 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-1515). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special 2~-hour answering service for forms ordering= 1-800-562-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-~7-5020 CTT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sho~n on this Notice must object within sixty C&O) days of receipt of this Notice by= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, 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 in writing to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone ¢717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three C$) calendar months after the decedent°s death, a five percent C5~) discount of the tax paid is allo~ed. 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 in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine C9) 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 (SI) percent per annum calculated at a daily rate of .000164. All taxes which became deIinquent 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 1982 20?. . 0005,q8 ~"8-1991 IIX .000501 ~ 9X · 0002~7 1985 167. .000~$8 1992 9?. . O002~7 2002 6X .00016~ 198q ZlY, .000501 1995-199~ 7?. .000192 2005 5?. .000157 1985 15X .000556 1995-1998 9X . O002~7 200~i ~ .000110 1986 10X .00027~i 1999 7?. .000192 1987 ' lOX .00027~ 2000 7X .000192 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Estate No.: Dorothy L. Menard January l4,2004 2004-00128 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: 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. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X bo account is · The separate Orphans' Court No. ( if any) for the personal representatives' Co in interest? Yes d~ar~ d. Copies of receipts, releases, joi accounts may be filed with the Clerk of the OrphaT.///~d Date: 06/24/04 / ,., Signhl~e Did the personal representative state an account informally to the parties X No lnd approvals of formal or informal may be attached to this report. JOSEPH D. KERWIN, ESQUIRE 4245 ROUTE 209 ELIZABETHVILLE, PA 17023-9765 (717) 362-3215 Capacity: __ Personal Representative x Counsel for personal representative RW-27