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04-0235
Estate of also known as Social Security No. 198-30-4907 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the executors in the last will of the above decedent, dated April 16, 2003 and codicil(s) dated N/A PETITION FOR PROBATE and GRANT OF LETTERS JEPTHA B. WOOLUMS No 21-04- o235 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania named (state relevenat circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland with his last family or principal residence at 770 South Hanover Street, Borough of Carlisle ~ (list street, number and municipality) .m. i ii~6 years of age, died Feb. 29, 2004 Decederit~¢ Hen . m at · c~BorOughsof Carlisle, Cumberland County Except aS follows,c~ecedent did not marry, was not divorced and did not have a child born or adopted after execution of the M, ill offered for probate; was not the victim of a killing and was never adjudicated incompetent: :'~ [~t/o Exceptions Decedent at:?~th owated pr~.~c~, =-~y with estimated values as follows: (If not domiciled in Pa.) .D ~ All personal property $ Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: $ County, Pennsylvania, Total: 0.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary ther~n. 'el P. ,¢t61/~s - ~ ob t t~ ~., ~ 1722 Walnut Bottom Road Carlisle PA 17013 (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~ J~el D. Woolums ~ ~ '"q722 Walnut Bottom Road Carlisle PA 17013 OATH OF PERSONAL REPRSENTATIVE COMMONWEATLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition 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 th ~ e~/~ng to law. Sworn to or affirmed and subscribed -~,~ ~~~ before me this c~t-/x, day of March, 2004 ~~ _~ _ _. ~/~ Register No. 21-04- Estate of JEPTHA B. WOOLUMS , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~tl/~.a .A~..~ /0 20 0q/ , in consideration of the petition on the reverse side l~er~)f, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated__ April 16, 2003 described therein be admitted to probate and filed of record as the last will of JEPTHA B. WOOLUMS and Letters Testamentary are hereby granted to Daniel P. Woolums and Joel D. Woolums FEES Probate, Letters, Etc. $ Short Certificates(l ) $ ~nm*'i'a~sn~,~toc~, $ $ Total $ Filed ~- Jo -~ o3.0r3~ .5 0, O0 /O. or.) Register~i41~. 2 -/'-' Robert M. Frey ~ ATTORNEY (Sup. Ct. I.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. -~'-~ ' MAR 1 2004. No. ~ Date · i/,/,..; '"~"t~aMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS ~-O'-= CERTIFICATE OF DEATH ,. 3eptha B. ~ ~-~le ,-198 -- 30 --4907 I,-~eb. 29, '2~04 a~ ,-I ~ I ~ 13/31/1917 ;ersailles,KY I ~ u I~rlisle ~m. I~rlisle ~ional ~i~l ~nter ,,~ Minist~ ,,, ~urches ,, 770 South H~o~r Strut ,,~ ,~rlisle, PA 17013 ~'~ ,m.~ ~rl~d ~, ~.~ ,,,~ ~ ~rlisle ~. ,,. ~ard W~i~ ,, ~h ~;~22&;~ ...... ~'~ I~. 1722 Walnut ~tt~ ~d; ~rlisle, PA 17013 ~,. .... I,,,.3/q/2004 I,~esmlnster ~te~ '1' ~rlisle, PA 17013 ~~ ~ ~~ I=, FD 012633 L la,~ing Brothers ~neral H~, Inc , ~rlisle, ., I~ ~ "~ .... Ul I I' D '~1 ......,.,-~..,...._.,.... .... ,,,.,. ......... . ............................. [] ::~. ,~z..//.,,2"~p · . · ..,~, ................................... ~f;,,. ~o~-I°to'%~ I,. ~ t~ bllll of ,xlmlniflon ,nd/M Invesflgit~. In my opinion, del(h occurrtd it ,he time. dlle. and plmc,, and due to the cause(s ,nd ~ ~ ~ ~ ~ ~' ~ LAST WILL AND TESTAMENT I, JEPTHA B. WOOLUMS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. ~ e~:: ~ x~ ~ 2. I authorize and empower my Executors to sell any realty oWned by me at mydeath, and not specifically devised herein, at either public or private sale, ~d to ~tve gdbd~'~.and sufficient deeds therefor, in fee simple, as I could do if living. I devise and bequeath all of my estate of every nature and wherever situate as follows: (a) Assuming there is enough cash in my estate at the time of my death, I give the sum of $1,500.00 to each of my grandchildren, MEREDITH L. WOOLUMS, MICHAEL P. WOOLUMS and MATTHEW D. WOOLUMS; and (b) All the rest, residue and remainder to my two (2) sons, JOEL D. WOOLUMS and DANIEL P. WOLLUMS, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint JOEL D. WOOLUMS and DANIEL P. WOOLUMS to be the Executors of this my Last Will and Testament; they are to serve as such without bond. 5. I hereby suggest that my personal representative McKnight & Hughes as attorneys for the settlement of my estate. retain the services of Irwin, IN WITNESS WHEREOF, I have hereunto set my hand and seal this April, 2003. day of 4.~-'"" ~' JEPTHA~ B. WOOLUMS Signed, sealed, published and declared by JEPTHA B. WOOLUMS, the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscribed our names as wimesses hereto. ~4 CKNO WLEDGEMENT AND AFFIDA FIT WE, JEPTHA B. WOOLUMS, JACQUELINE L. DRAWBAUGH and MARTHA L. NOEL, thc testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of thc testator, signed the Will as a witness and that to thc best of their knowledge thc testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by JEPTHA B. WOOLUMS, the testator, and subscribed and sworn to before me by JACQUELINE L. DRAWBAUGH and MARTHA L. NOEL, witnesses, this ttf day of April, 2003. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Jeptha B. Woolums Date of Death: Will No. February 29, 2004 Admin. No. 21-04-0235 To the Register: I certify that notice of (beneficial Interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: May 6, 2004 Name Daniel P. Woolums Joel D. Woolums Matthew D. Woolums Meredith L. Woolums((Brehm) Michael P. Woolums Address 1722 Walnut Bottom Road, Carlisle PA 17013 1722 Walnut Bottom Road, Carlisle PA 17013 73 Patterson Rd, Hanscom AFB,MA 01731-2611 19 Hillside Drive, Carlisle PA 17013 161 Texaco Road, Mechanicsburg PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: May 6, 2004 Name: Address: Capacity:__ 1 Signature Robert M. Frey 5 South Hanover Street Carlisle, Pennsylvania 17013 Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003975 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 198-30-4907 FILE NUMBER: 2104-0235 DECEDENT NAME: WOOLUMS JEPTHA B DATE OF PAYMENT: 05/25/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $49,122.00 REMARKS: CHECK//120 SEAL TOTAL AMOUNT PAID: 549,122.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 217 REV-I~00 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1500 .,E.U..E, OFFICIAL USE ONLY INHERITANCE TAX RETURN 21-04-0235 RESIDENT DECEDENT cou. coDE YE,e .u eEe DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Jeptha B, Woolums 198-30-4907 OmC3'" DATE OF DEATH (MM-DD-YEAR)2/29/2004 DATE OF BI RTH (MM-DD-YEAR)3/31/1917 ..,s .E~u.. REGISTER MUS* SE F,.ED OF '" .u..,c^*E WILLsW~*" I.U ¢3 IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z LU Z LU Z Z [~]1. Original Return [~4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) [----~ 9. Litigation Proceeds Received NAME Robert M.Frey FIRM NAME (If Applicable) Frey and Tiley TELEPHONE NUMBER (717)243-5838 [~2. Supplemental Return ~--~4a. Future Interest Compromise (date of death after 12-12-82) r"-'~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) [~10. Spo~al Poverty Credit (date of death between 12-31-91 and 1-1-95) ['~3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach Sch O) ~,T,~)( !I{IFORM~,~ON SROUED BE DIRECTED TO: COMPLETE MAILING ADDRESS 5 South Hanover Street Carlisle PA17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. MOrtgages & Notes Re~ceivable (Schedule D) 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [~Separate Billing Requested 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property (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) (3) NONE (4) NONE (7) NONE 12. NET VALUE OF ESTATE (Line 8 minus Line 11 ) 13. Charitable and Governmental 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) 200,000 16,501 952,118 10,555 (8) OFFICIAL USE ONLY 28,651 4,151 (11) 32,802 (12) 1,146,372 (13), (14) 1,146,372 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rate 1,146,372 X .0 45 (16) 17. Amount of Line 14 taxable at sibling rate X . 12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 51,587 51,587 Jeptha B. Woolums 198-30-4907 217 De~:edent:s Complete Address: ISTREET ADDRESS 11533 Sprin.q Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 49,122 2,585 (1) Total Credits ( A + B + C ) (2) Interest/Penalty if applicable D. Interest E. Penalty 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 1 Line 20 to request a refund (4) If line I + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 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. 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 property within one year of death without receiving adequate consideration? ............................. 3. Did decedent own an "in trust for' payable upon death bank account or security at his or her death? ...... or 4. Did decedent own an Individual Retirement Account, annuity or other non-probate property which contains a beneficiary designation? ................................ [-'-I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 51,587 51,707 120 Under penalties of pequry, I declare that I have examined this return, including accompanying schedules a, nd statements, and to the best of my knowledge and belief, it is true, and complete. Declaration of preparer other than the personal representative is based orl~ll informatio~hich preparer has any knowledge. ...S'I~'¢NAfURE OF PERSO..N,~.~.SFff~qSIBL.~ FIL~RN \~' !(~' \ 'i ~ ~ DATE ADDRESS -- (1)1722 Walnut Bottom Road, Carlisle PA 17013 (2) 1722 Walnut Bottom Road, Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 5 South Hanover Street, Carlisle PA 17013 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. Section 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. Section 9116 (a)(l.1)(ii)}. The statute does not exempt a transfer to a surviving spouse fram 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. Section 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. Section 9116(1.2) [72 P.S. Section 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. Section 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. AT ____L REV-1502 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J~tha B. Woolums SCHEDULE A REAL EST~ 21-04-0235 ALL REAL PROPERTY OWNED SOLELY OR AS A TENANT IN COMMON MUST BE REPORTED AT FAIR MARKET VALUE. Fair market value is defined as the price 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 DESCRIPTION VALUE AT DATE OF DEATH 1. Real Estate, 1529 and 1533 Spring Road, N. Middleton Township and Cumberland County SEE ATTACHED TOTAL(Also enter on line~ (If more space is needed, insert additional sheets of the same size) 200,000 200 0..~..~00 Estate of :: CLARENCE H. BILLOW IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION NO. 21-81-351 pECREE AWARDING REAL ESTATE AND NOW, this ay of September, 1986, the first and final account of The Commonwealth National Bank, Surviving Executor of the Estate of Clarence H. Billow, late of North Middleton Township, Cumberland County, Pennsylvania, together with statement of proposed distribution thereon, having been confirmed by the Court on August 26, 1986, and distribution ordered: IT IS THEREFORE ORDERED AND DECREED, that in accordance with the said final account and statement of proposed distribution as confirmed by the Court, the distribution of the following real estate to Miriam E. Woolums and Jeptha B. Woolums, husband and wife, is hereby confirmed and the same is awarded to Miriam E. Woolums and Jeptha B. WoOlums' husband and wife, their heirs and assigns: ALL that certain tract of land, with the improvements thereon erected, situated in North Middleton Township, Cumberland County, Pennsylvania, bounded and described as fo3.1ows~ BEGINNING at an iron pin on the eastern right of way line of Carlisle Springs Road (Pa. 34, L.R. 40) at line of Pennsylvania Turnpike Commission (Interstate 76); thence by line of Pennsylvania Turnpike Commission North 71 degrees 37 minutes 0 seconds East 548.56 feet to an iron pin; thence by land previously conveyed to Cumberland County Industrial Development Authority South 16 degrees 31 minute 55 seconds East 216.03 feet to an iron pin; thence by same South 69 degrees 31 minutes 24 seconds West 39.90 feet to an iron pin; thence by same South 05 degrees 08 minutes 22 seconds West 55.33 feet to an iron pin; thence by same North 84 degrees 42 minutes 39 'seconds West 231.82 feet to an iron pin set in the center line of Bryn Mawr Road; thence by same and the center line of Bryn Mawr Road South 05 degrees 10 minutes 30 seconds West 80.21 feet to an iron pin; thence by land about to be awarded to Beatrice E. Fickes North 84 degrees 49 minutes 30 seconds West 315.00 feet to an iron pin at or near the eastern right of way line of Carlisle Springs Road; thence by same North 05 degrees 10 minutes 30 seconds East 133.80 feet to an iron pin, the place of Beginning. BEING Parcel "B" as shown on a Final Subdivision Plan for the Clarence H. Billow Estate, by Stephen G. Fisher, which plan is recorded in the Office of the Recorder of Deeds in Plan Book No. 42, Page 97. TOGETHER with all right, title and interest of Clarence H. Billow in 'and to the portions of Bryn Mawr Road and "M" Street included within the above described tract of land as shown on said subdivision plan. TOGETHER with, and subject to, the right of ingress, e r and regress together with Bea ' assigns, over t · .A. _ trice E. Ficke . g ess Lots 51 =~ ~ he ~lV~way ~rom CarliSle ~_s~ her heirs and ~,,u ~z on Plan of Oakland Manor r~~ ~ ~h~ Office of a hrough the Recorder of Deeds in Plan Book 3, Page 18, and through the western portion of Lots 69, 70A, 70, 71, 72 and 73, to the land herein conveyed as the same presently exists. , The tract of land above following: conveyed being composed of the 1. Lots 74, 75 and 76 on Plan of Oakland Manor, recorded.~in the office aforesaid in Plan Book No. 2, Pages 53 and 54, which Leam Ora Kruger, by her deed dated January 3, 1928 and recorded in Deed Book "M", Vol. 10, Page 309, ' conveyed to Clarence H. Billow and Ruth M. Billow, his wife, less however, the portions of those lots which Clarence H. Billow and Ruth M. Billow, his wife, by their deed dated November 29, 1940, and recorded in Deed Book "G", Vol. 12, Page 13 conveyed to PennsyLvania Turnpike Commission. ' 2 ~ 32 406 2. Lots 103 and 104 on Plan of Oakland Manor, recorded in the office aforesaid in Plan Book No.~ Page which Oakland Manor Realty by deed dated June 12, 193~ and recorded in Deed Boo~ "N", Vol. 11, Page 593, ' conveyed to Clarence H. illow, less however, the portions of these lots which Clarence H. Billow and Ruth M. Billow, his wife, by their deed recited in 1 above conveyed to Pennsylvania Turnpike Commission. 3. Lot 62 and part of Lot 73 on Plan of Oakland Manor recorded in the Recorder's Office in Plan Book 3, Page 54, which Edythe M. Wa§oner, et al. by deed dated October 26, 1945, in Deed Book "B" · Vol. 13, Page 381, conveyed to Clarence H. Billow and Ruth M. Billow, his wife. 4. A triangular piece adjacent and to the north of Lot 104 being part of Tract No. 1 which C. W. Anderson and Edna B. Anderson, his wife, by deed dated December 5 1940 recorded in Deed Book "G" ~ , , and Clarence H Billow and ~u~h~?' 12, Page 170, conveyed to · Billow, his wife. Ruth M. Billow died the 7th day of May 1980, thus vesting title in Clarence H. Billow. State of Pennsylvania County of Cumberland } SS Recorded in the office for the recording of Deeds etc., ir~p,~r Cum~ar, d Co~'.g~)Pa. witness my ha~ and seal f~ at this ~ . . day,e[~'~". 19~ Recorder 407 R~V-~ ~o3 ~+ (~-9~) / I / SCHEDULE B / OO"MONW~'THOFPEN.S~LVA.,A / STOCKS & BONDS INHERITANCE TAX RETURN I ESTATE OF ~ B. Woolums FILE NUMBER 21-04-0235 All property jointly-owned with right of survivomhip must be disclosed on Schedule F. ITEM NUMBER Pursell Associates, Inc. DESCRIPTION Waypoint Financial Corp(447 shares @25.15) Cash and/or Money Market PP&L (84.125 shares @46.53) Series U.S. Savings Bonds Q2037453447E $25.00 (2/20/1964) Q2098347949E $25.00 (12/23/1964) Q2330238117E $25.00 (3/16/1970) Q5052428178E $25.00 (11/22/1972) Q5065265687E $25.00 (3/15/1973) Q5148461683E $25.00 (2/20/1974) Q5228223365E $25.00 (2/17/1975) Q6044481959E $25.00 (2/23/1976) VALUE AT DATE OF DEATH 11,242 127 3,914 1,218 TOTAL Al_(_~_enter on line: (If more space is needed, insert additional sheets of the same size) 16,50~ Financial Consultants May 6, 2004 Frey & Tiley Attorney Robert M. Frey 5 South Hanover Street Carlisle, PA 17013 Dear Mr. Frey: We received your letter requesting date of death values for the account of Jeptha B. Woolums. Mr. Woolums had one account with us which was owned soley by him. His holdings and their values on the date of his death, February 29, 2004, are as follows: Cash and/or Money Market 447 shares of Waypoint Financial Corp $ 127.36' no accrued $11,242.05' no accrued Should you require any additional information, please feel free to call me at 717-243-0619. Sincerely, arbara J Miller, Associate Pursell Associates, Inc. * The above summary of prices/quotes/statistics has been obtained from sources believed to be reliable, but is not necessarily complete and cannot be guaranteed. Prices may not reflect the value at which securities could be sold. This summary is for informational purposes only. Past results do not indicate future performance. 205 York Road · Carlisle, PA 17013 · (717) 243-0619 · 1-866-443-0619 · Fax (717) 243-3216 Securities are offered through Wachovia Securities Financial Network, LLC, Member NASD/SIPC Date May 10, 2004 PPL Corporation Two No~th Ninth Street Allentown, PA 18101-1179 http://www, pplweb.com/ Investor Services Toll Free Number 800-345-3085 Re: Value of PPL Stock Account Type of Stock: Account Number: 3097115829 Account Registration: Jeptha B. Woolums Date of Death: February 29, 2004 Number of Shares Currently Held: In Certificate Form 84.866 In Dividend Reinvestment Plan 84.886 TOTAL SHARES Number of Shares Held as of Date of Death: PPL Corporation Common Stock CUSIP: 69351T-10-6 Social Security Number: 198-30-4907 & Miriam E. Woolums Jt Ten 84.125 84.125 $46.53 of death or last business day prior to date of death. In Certificate Form In Dividend Reinvestment Plan TOTAL SHARES Closing market price of Common Stock on New York Stock Exchange on date Other Comments PPL Corporation INVESTOR SERVICES (/ Cynthia A. Buchman . Sr. Investor Services Representative ~:: :SERIES ~ "--'=F---"~~-'~., Q 2 330 238 ~ 1 AT REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Jeptha B. Woolums 21-04-0235 Include the proceeds of litigation and the date the proceeds wero roceived by the estate. ALL PROPERTY JOINTLY.OWNED WITH THE RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 4. 5. 6. 7. 8. M&T Bank, Checking Acct.446076 M&TBank, Savings Acct.15004200018297 Accrued interest to date of death Wachovia Bank, Acct #1010008383611 1988 Holiday Rambler 1984 Chevrolet 20 Pickup,Long Bed Refund, N. Middleton Authority, Credit on February Water Charge Rent, February 2004 Financial Service Group, Acct #2848 TOTAL (Also enter on line 5, Recapitulation) 1,003 1,569 5 642 2,000 2,000 25 575 944,299 952,118 (If more space is needed, insert additional sheets of the same size) m MetT March 17, 2004 499 Mitchell Street, Millsboro, DE 19966 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, PA 17013 Estate of Jeptha B. Woolums Date of Death: February 29, 2004 Social Security Number: 198-30-4907 Dear Mr. Frey: 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. Account T!ipe ........................... Checking Account Account Number ....................... 9830138203 Ownership (Names o~ .............. Evangelistic Fund (organization) Jeptha 13. Woolums (signator) Opening Date ........................... 04/08/02 (account closed 03/12/04) Balance on Date of Deatlt .........$0.00 Accrued Interest $0.00 Total ...................................... $0.00 Account T~dpe ........................... Checking Account Account Number. ...................... 446076 Ownership (Names oJ) ..............Daniel P. Woolums, Jeptha B. Woolums, Miriam E. Woolums Opening Date. .......................... 09/01/67 (account closed 03/12/04) Balance on Date o f Deattt ......... $1,003.06 Accrued Interest $ 0.00 Total ...................................... $1,003.06 Page 2 March 17, 2004 Account Type ........................... Checking Account Account Number. ...................... 860034 Ownership (Names o~ .............. Daniel P. Woolums, Jeptha B. Woolums Opening Date ........................... 12/16/87 (account closed 03/16/04) Balance on Date o f Deatlt ......... $21,109.95 Accrued Interest $ 0.00 Total ...................................... $21,109.95 Account Type ........................... Savings Account Account Number ....................... 15004200018297 Ozonership (Names oJ~ .............. Daniel P. Woolums, Jeptha B. Woolums, Miriam E. Woolums Opening Date ........................... 12/15/82 (account closed 03/16/04) Balance on Date of Death~ .........$1,569.46 Accrued Interest $ 5.39, Total ...................................... $1,574.78 Sincerely, Charlene Warrington, Records Management 1-888-502-4349 ~Y-Z4-ZD04 10:I?~M FROM-M & T BANK LIQJ~T VL..~.~J ' · · TYPF. OF A~U~r .... U - - ~[ OF ACqUiT (Buiinml ~ W~ OF ~R~CE . ~~d~ln .. .... ~aYm~o. I * T~lt~n~ DORMA~ A~ FEE . · . ~h ~ ~ . '+717240451B SIGNATURE CARn T-230 P.004/004 F-102 T-Z30 P.002/004 F-102 FROM-U & T BANK ,.~,.~...~,.,.S. o00~ O0 $' f~ ~/~#f*~J · ~OL~ pJIMqlJI~TMiSNiii FARMEII~ TRUST COMPAJJY, Cor~ds,/'Nns,/fwda ~g~l/'. ~'. IR. 0~' M';'v";Am ]~, l~OOlt~m,~ 1529 ~rm'.i.ng Road, (~a~'!~Ze, PA 17013 P.005/004 F-102 WACI-IOVIA Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 904239 May 10, 2004 FREY & TILEY ATTORNEYS AT LAW 5 SOUTH HANOVER STREET CARLISLE, PA 17013 SUBJECT: Verification / Confu-mation of Account and Balance Information provided for: Customer: JEPTItA B WOOLUMS (SSN# 198-30-4907) Date of Death: February 29, 2004 Account Type CHECKING LEGAL TITLE: JB WOOLUMS Deposit Account Informatlon Account Date of Death Average Date Maturity Number Balance Balance* Opened Date 1010008383611 $ 641.64 11/24/1998 Interest Accrued YTD Date Rate Interest Interest Paid Closed N/A 3/12/2004 Account Type * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Date of Balance Date Date Number Opened Closed Ledger Collected BROKERAGE LEGAL TITLE: JEPTHA B WOOLUMS PLS CALL REP RICHARD PURSELL ~ 717-243-0619 23262552 10/17/2002 0000 000614 FINANCIAL SERVICES GROUP qFirecting ~od-give~ ~esources to C;od-given ~oals April 15, 2004 Frey & Tiley Attorneys at Law Attn: Carol Wert 5 S Hanover St Carhsle, PA 17013 Dear Carol, It was nice talking with you today! Per your phone call and letter request, here is the account balance as of 3/1/04 of the Personal Savings Account held by ReverendJeptha B. Woolums including interest: $944,299.33 For reference, this was the only account that Rev Woolums had with Ministers Benefit Association. If you need anything else, please give me a call. Blessings, Stephine 15. Hendrix AG Financial MBA MINISTERS BENEFIT ASSOCIATION ~etirement (Plans · ,Savings · Term L(fe qnsurauce 1661 North Boonville Avenue, Suite C . Springfield, Missouri 65803 ] P.O. Box 2515 · Springfield, Missouri 65801-2515 Phone: 41Z831.4776 · Fax: 417,831.7429 · Toll-Free: 1.800.622.7526 · E-maih mba@agfsg, org· Web: www. ministersbenefit.~iom MINISTERS BENEFIT ASSOCIATION · ASSEMBLIES OF GOD LOAN SERVICES · MASTERPLAN STEWARDSHIP SERVICES ,, ASSEMBLIES OF GOD FOUNDATION 217 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeptha B. Woolums SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 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. Daniel P. Woolums 1722 Walnut Bottom Road Son Carlisle PA 17013 JOINTLY-OWNED PROPERTY: LE ~ I ~-R 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 OFASSET INTEREST DECEDENT'S INTERES~ 1. A. 12.16.87 M&T Bank,Acct #~60034 21,110 50.00% 10,555 TOTAL (Also enter on line 6, Recapitulation) $ 10,555 (If mnr~_ ~n~-~ ie ,~,~,~,~,~ ;~.~,.; -.~-~,.:__ _, .... ', insert additional sheets of the same size) · Page 2 March 17, 2004 Account Type. .......................... Checking Account Account Number. ....................... 860034 Ownership (Names o~ .............. Daniel P. Woolums, Jeptha B. Woolums Opening Date ........................... 12/16/87 (account closed 03/16/04) Balance on Date of Death. .........$21,109.95 Accrued Interest $ 0.00 Total. ...................................... $21,109.95 Account Type ........................... Savings Account Account Number ....................... 15004200018297 Ownership (Names od~ ..............Daniel P. Woolurns, deptha B. Woolums, Miriam E. Woolums Opening Date ........................... 12/15/82 (account closed 03/16/04) Balance on Date of Death. .........$1,569.46 Accrued Interest $ 5.32 Total. ...................................... $1,574.78 Sincerely, Charlene Warrington, Records Management 1-888-502-4349 ~Y-Z4-20Od ]0:17~ FROH-&4 & T BANK ~E OF AC~T ~BusMe~: ~K OF ~R~CE . t2) _ Tarn. ~ ATM ~Dfl~LS KeV. d. D. ~O]~s or '+?172404518 SIGNATURE CARn I'! ,Joint - No S~n~h4~lnlp T-230 P.004/004 F-102 198 30 4907 C4tom r. mm 1Mg Rev~ ?MS 217 . .. REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jeptha B. Woolums 21-04-0235 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 12. 13. FUNERAL EXPENSES: Ewing Brothers Funeral Home Funeral Luncheon George's Flowers Westminster Cemetery ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) N/A Social Secudty 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 N/A Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Additional Probate Fees Pa Inheritance Tax Return, Filing Fee Filing Fee for Final Account The Sentinel, Advertising Cumberland Law Journal, Advertising Register of Wills,(7) Short Certificates Checks cleared after Date of Death State __ Zip TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 7,215 2OO 159 995 18,806 377 525 15 110 92 75 21 61 28,651 REV-1512 EX+ (12-03) 217 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER .Jeptha B. Woolums 21-04-0235 Report debts incurred by the dece~eiil prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. DESCRIPTION VALUE AT DATE OF DEATH Wachovia Bank, Bank Charge Diversified Appraisal Service, Appraisal of Real Estate N. Middleton Authority, Water and Sewer Spdnt, Telephone PP&L, Electricity Moffitt Heart & Vascular Group, Medical BMC, Medical The Sentinel, Misc (Thank You Ad) Robin K. Sollenberger, Tax Collector, 2004 County Taxes Nationwide Insurance Co., Homeowners John P. Hassler, P.C., Tax Accountant Cohick and Associates, Consultation Daniel Woolums, Supplies for Estate accounting Robin K. Sollenberger, Tax Collector, 2004 School Taxes State Farm Insurance Co., Homeowners Policy Daniel Woolums, Repairs to Home 2 275 100 10 28 38 62 64 429 301 35O 7O 6O 1,618 726 18 TOTAL (Also enter on line 10 (If more space is needed, insert additional sheets of the same size) 47151 217 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Jeptha B. Woolums NUMBER II. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Daniel P. Woolums 1722 Walnut Bottom Road Carlisle PA 17013 Joel D.Woolums 1722 Walnut Bottom Road Cadisle PA 17013 Matthew D. Woolums 73 Patterson Road Hanscom AFB, MA 01731-2611 Meredith L. Woolums (Brehm) 19 Hillside Drive Carlisle PA 17013 Michael P. Woolums 161 Texaco Road Mechanicsburg PA 17050 Son Son Grandson FILE NUMBER 32-04-0235 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Granddaughter Grandson 1/2 residue of estate 1/2 residue of estate Bequestofl,500 Bequest of 1,500 (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 CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: ~,. 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 Bequest of 1,500 LAST VrlZ£ AND TESTAMENT I, JEPTHA B. WOOLUMS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executors to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate as follows: (a) Assuming there is enough cash in my estate at the time of my death, I give the sum of $1,500.00 to each of my grandchildren, MEREDITH L. WOOLUMS, MICHAEL p. WOOLUMS and MATTHEW D. WOOLUMS; and (b) All the rest, residue and remainder to my two (2) sons, JOEL D. WOOLUMS and DANIEL P. WOLLUMS, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. A__ CKNO W'LEDGEMENT AND _AFFIDAVIT WE, JEPTIEA B. WOOLUMS, JACQUELINE L. DRAWBAUGH and MARTHA L. NOEL, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed w/llingly, and that he executed it as his fi'ee and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, ,qigned the Will as a W/mess and that to the best of their knowledge the testator Was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMO~ALTH OF PENNSYLVANIA : COUNTY' OF CUMBERLAND : SS: Subscribed, sworn to and acknowledged before me by JEPTltA B. WOOLUMs, the testator, and subscribed and sworn to before me by JACQUELINE L. DRAWBAUGH and /VIARTHA L. NOEL, witnesses, th/s t~'~_ day of April, 2003. ~"'~otarial Seal Roger B. Irwin, Notary Public Carlisle Bom, Cumberland County My Commission Expires Oct. 3. 200¢ Member, Pennsylvania &~ciaP. on Ot,~otades Jan 25 05 03:04p FREY and TILEY 7172436441 FREy & TILEY ATTORNEYS-AT-LAW 5 SOUTH HANOVER STREET CARUSLE, PENNSYLVANIA 1'1013-338S ROBERT M. FREY OF COUNSEL PHONE (711) 243-~8 FAX (717) 243-6441 STEPHEN D. TILEY ROBERT a. FREY FACSIMILE TRANSMIITAL MEMORANDUM TO: FAX: FROM: DATE: RE: Register of Wills 240-7797 Carol Wert January 25,2005 Estate of Clara S. Dum(21-04-0006) Estate of Jeptha B. Woolums(21-04-0235) We are transmitting a total of 3 pages to you, including this cover page. Please advise if the copy quality is not adequate. -------------------------------------Message-------------------------------------- I am faxing you infonnation that you will need to put into the above files so that you wiIl know what has happened to each of the estate PA Inheritance Tax Return. If you have any questions let me know! :." V- Q ~-,'l . ~'2 ......., D 71 Cl (..) Cj C> p.1 '" C:! c.'.' en ~-; :J:; rTl CJ .-, ~'l 1'0 Ul 1 r-~) J~n 25 05 03:06p FREY and TILEY 7172436441 p.7 FREY & TILEY ATTORNEYS-AT.LAW S SOUTM IWOII!R smI!ET CAIUll.E. PltlNlM.V_ 11013 .. I'IOeeRT M, FIlEY OF COUNSEl ST'EPHEII 0, TII.EY ROBERT G. FREY "",~ONE (717) ll43l583l! FACSIMILE (711) 2434441 1anuary 25. ZOOS PenDsylvania Inheri1aoce Tax Division Attn: John C. MurphY. OIicf Department t:4 Revenue Bureau of Individual TUCB Department 280601 Harrisburg PA 17128-0601 Re: &tate of 1eptha B, Woolums File #21-04-0235 C) -0 ~~~) "--:,':C2 -;~n /'~: ....., ~ C~.:J en ,- ::'_H ::n r"n .-") , ~~?t i\:"j 1",,) (Jl . T-\ ") w ., ,'I ._," ~T, " (~:.) ""IT" , Cj) c) -T'1 -0 ," !.,.) o Dear Mr, Murphy: I contacted you last week in regards to the above estate in ref~noe to a "Personal Savings Account" in the amount of $944,299.33, at Mr, Woolums date of death, was reported on Schedule "E" on the Inheritance Tax Return we filed with the Register of Wills on December 21, 2004, In the convClSlltion I asked if the "Personal Savings Account" could be transferred to Schedule "0" because Mr. Woolums bas two SODS, which W~ named as the beneficiaries of this account You asked that I send something that could prove that this account should be tr8Dsferred to Schedule "0", I have enclosed all that we have to go with this "Personal Savings Account" which is a "DesigoatiOD of Beneficiary" and a letter from AO F1JI8lIcial Services Oroup notifying our office that the beneficiaries had each received their portion of the account I appreciate you giving me your time and I hope that the enclosed will be suffieient to transfer this account to Schedule "0", If you should have any questions please contact me at the above telephone number, Sincerely, ~4JWd:- Carol Wert ec: Register of Wills v-- Jan 25 05 03:07p FREY and TILEY 7172436441 . EIR~J~~~~~~ 'Directillg gad-gil'clI 'lI..csOU"ei to god-give" g.<I/' ,~ )<'.\:f~\' ":'~;"'i('" . ',l,i,gn:1' !;t1:il:1'~'" ':.;',J;',," . April 6, 2004 Robert M. Ftet ,. 5 South~St Carlisle, P A lro13 '-'::. ~ Tl ,,~--~ --,~' ':/.)::~ C) ~-~;o -1~o , "-. ~ ;"">- Re: Estate ofJeptha B. Woolums Dear Robert, In receipt of your letter dated Mal:ch 30, 2004 on behalf of the Estate of Jeptha Woolums al:lli'the certificate you enclosed. please be advised that the Personal Savings account that Reverend Woolums held with Ministers Benefit Association has been closed and transferred to his appointed designation of beneficiary. The beneficiaries include Daniel and Joel. The account was closed and checks were issued upon receipt of the necessary documents obtained from J eptha's sons. Your letter wingo on file for reference-If there is anything else we can do for you, plea$elet 'Us know. Respectfully, qYb<i)L~ Stepliine E. Hendrix AlG Financial Ministers Benefit Association MINISTERS BEN::FIT ASSOCIATION 'l{t.'tirenu:llt rplntt$ . .5t1l'ing$ . 'T ~"m Lif~ <1/WlrtZ"r:" p.8 ...., ~;il~I'. :: (,,....',:i"c,~~ -, '~'l.; 5;' " h':'~:~:r'~~)'r~ (", 1',) .,".... (...'1 C:,) :2~ ..~l,.. ":? ~.~ o 1661 North Booftvillc A.venue, Suilr C. Sprillgfleld, Missollri 65803 J RO. /lox 2515. Sprin.(/ietd, Missouri 65861.1515 Piton", 417.831.4776' ...'" 417.831.7429 . 'fol/-FI''': 1.800.622.7526 . E-mail: mba<<.ugftg.org' Wob: WW1Y.minisl<rslnn<fit.c.", ; ('---, ; t ':'-('J ~"-l C-J "~ I"" c_fJO -T"} M~"'IST~-~Efrl" As'SOC',,":ON . AS$EM.LU~S OF Goo L.OA'-I SERVICES. MAS":"'ERPLAN STEWAROS"'I~ seJtvlCES . AiSSII!Ml!IL'" 0" GoO FouNOATfOH ~.n 25 05 03.07p '7lf-_w l:3:~ MINISTERS BENEFIT ASSOCIATION FREV and TILEV 7172436441 p.9 DESIGNATION OF BENEFICIARY For Assemblies a/God Ministers &- Employees flrv. CEI'fERA~~I~~BMATION .. ,. .Nlmo U h ~ L lj ~.s First J E? T /Y /t MicIdIe B ss, 1<;$ - 30-t~'l-. BirthOate~n-~ ?/-/~? Gender. }\MaIe DFemaIe MallincAddress 1.5":1_~~R ~6 /P ~t;t' __' A" ",.. .rt r-.L L '" ~ I I f!i -, !l I CIty '---" IT" (S &' Slate r-'A~ Zip Counlly t'. "J""AG"R'L/tN&; H_PIIone0'?~#~-?!;"'/~ Work Phone ( ltj!r=--77/r€P _ PleuulI.werooeoCtM followinc: 0 Th~~~rsrnme'li1e ~~Of~g[~J'':w'ijf; MB~ ~F ~ o This is a change to my current Designation of Benefic:iary tbrm filed with MBA I would like this Desisnadon of Bencfic:iery \0 apply.1O (If no election Is "",de. the benqiciary deslgtllllion bGaw will ctmIroI all. ,,,,,.): ....AlI of my _ with MBA 0403(1)) SELECT Retirement Plan only o Penonal Savinp A_.only .0 ~ Compenurion PIan- MRabbi" TtUSt 0Il1y S2 ~ (/?S-r,./'l'C'O S.;zOl!'Yq,S"J AI: c. 'r.~ 2$4'8'" . ~o ~5i DESICNA nON OF BENEFICIARIES ~ :11 C) fOE The following irtdividual(s) shall be my beneficiary(ies). PltNlSe cJw:k primary or contingent for each intJlvldua/~~fary;:' If any primary beneficiery predeceases me, the contingent beneficiary(ies) shall ""'luJre the designated sbano ofmy~unt. UI o Primary N~ u.koL~m$ J fUeL DAv,D SOCiaISec~ty'" I p~i3'i"1?f>/~.Jf; o CoIItlngent ,~ddress 17:l.'!L (.,VAU'.~B~IT'.r DateOfBiJtho/~~ t.!Jj(l, ,,;~~~ ~,1"'.c1 $~ ,or p~ I? () /..7 Relationship ::SON' c.,)n ,? 1:1 Primary NIlIlle - Social Security '" C), o Contingent Address Date of Birth Share % Relationship Social Se<:urity '" ". ~2 -~-" 7:2 fL Date of Birth/ (V~8" ..ct''llIare .5"4 % Relationship Social Security '" Dale of Birth Relationship Social Security '" DateofBIrIh Relationship Social Security '" Date of Birth Relationship Attach cul4i1ioMl ,,,..to if _tied. JOt' bonejlciary dnig1fQtians. Q If a child of mine" n.ted as a primary beneficiary or contingent beneficiary and filils to survive me, his or her share shall go to my otl1erchildren in equal shares. ~ ~~ <:: e _ . - e [fa child of mine is listed as a primary beneficiary or cootingent beneticiary and failJ to suJ'Yive me, his or h... share shall go to. his or her iSSlle (my grandchildren) by right of representation The payor may rely fully on this designation and I &glCe to promptly notifY the payor if there is any change in the stalUS of any primary or contingent beneficiary. o Primary o COIltingent Name t-v'i!"~GC '-:; 04/Y/GL p~~ Address /?' 2.::1 t-tfll P - - . 0 1'- P ...-~ /f' q' ~~r'?L/~~t!r ,..cL ;,'70/~ Name Addtus e Primary o Contingent Sbere % Q Primary Name e ConliogeDt Acidre.ss Share % Q Primary Name a Contingent Add=! Share % SIGNATURE Q Puticipant's Signa~ /y"?,;1t, fi7. c~ ~ - -- r.J Date . L./ PltNlSe keep a CO(IY lor your records AsscmtllidS of God Ministers Iknclit Associaltc.ln.....( Oi....isit)1J oj'tlN! AlSemb/ia o((ind FilttJlICia( .'itr.'ices Group poBox 2S1S -SprinJ,1.r.~::f. M06.4aol..Z.4!S... Phone: (800l612-1:'li26or(417\R31.'t.776 - Fax: (417) 831..742\) . E-mail: mhlK'~lS..org -www.minif.lcnbcnetir.c:om ~r f"~():z, . Glenda Farner Slrasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle. PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 138 December 22nd. 2004 leotha B. Woolums 21-2004-0235 Frey & Tiley Law 5 South Hanover Street ," Carlisle, P A 17013 Qty 1 Fee Description Additional Probate Fee Total 525.00 $525.00 Total: $525.00 :'-,) Cd '0 Checks should be made payable to the Register of Wills. Please return one copy of this invoice with your payment. Thank you. ---- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE DF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DF DEDUCTIONS AND ASSESSMENT OF TAX ROBERT M FREY FREY & TILEY 5 S HANOVER ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-01-2005 WOOLUMS 02-29-2004 21 04-0235 CUMBERLAND 101 *' lEV-15~7 EX AFP 112-D~1 JEPTHA B A.ount Re,1i tted PA 17013 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 :m".Eic..AFp..rDr-.6!')".NaT.icE.iiF.1:'N'R~rtYfAilcl!.TAx.7ipPR7ii'SEMYN't~..Ar.l'bj;/ANCI!.bR.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WOOLUMS JEPTHA B FILE NO. 21 04-0235 ACN 101 DATE 03-01-2005 TAX RETURN WAS: I X I CHANGED SEE ATTACHED NOTICE I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks- and Bonds {Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable {Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~olntly Owned Property (Schedule FJ 7. Transfers {Schedule GJ 8. Total Assets III (21 131 (41 (51 (61 (7) 200.000.00 16.501. 00 .00 .00 7.819.00 10.555.00 938.299.00 (BI APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule Jl 14. Net Value of Estate Subject to Tax (91 1101 28,651. 00 4.151.00 (111 1121 U31 1141 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,173,174.00 3;;>.80;;> 00 1,140,372.00 .00 1,140,372.00 NOTE: If an assessment was 1ssued prev1ously, 11nes 14, 15 and/or 16, 17, 18 and 19 w111 reflect f1gures that 1nclude the total of Abb returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due 1151 .00 X 00 = .00 1161 1,140,372.00 X 045 = 51,316.74 1171 .00 X 12 = .00 UBI .00 X 15 = .00 1191= 51,316.74 TAX ....EDITS: rA"n<nl K<~<L' 1+T AMOUNT PAID DATE NUMBER INTEREST/PEN PAID I-I 05-25-2004 CD003975 2,565.84 49,122.00 TOTAL TAX CREDIT 51,687.84 BALANCE OF TAX DUE 371. IOCR INTEREST AND PEN. .00 TOTAL DUE 371. IOCR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIV~b,C~E~:V{::'(':: Or. INHERITANCE TAX DIVIS-ION-i' .......... j.' . 'j~ j, PO BOX Z806Dl._ HARRISBURG PA 171Z8-0641 NOTICE OF INHERITANCE TAX APPRAISEMENT, AllOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 2B DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-01-2005 WOOLUMS 02-29-2004 21 04-0235 CUMBERLAND 101 f\n'.:',' ROBER1"MFREV FREY 8 TILEY 5 S HANOVER ST CARLISLE *' REY-1547 EX AFP (U-041 JEPTHA B Allount Rellitted PA 17013 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':r!~.E;t.AFp.r~1.:6!'..N5TicE..d'F.iNHErtI.fli(CE.YAX.APPRAfsEMENi'~..ALlowaitCE.OR......_..._.._..- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WOOLUMS JEPTHA B FILE NO. 21 04-0235 ACN 101 DATE 03-01-2005 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. CashlBank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets I~ an assessmen~ was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 19 will reflec~ figures ~ha~ include ~he ~o~al of ALL re~urns assessed ~o da~e. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. AlIOunt of line 14 taxable at lineal/Class A rate (16) 17. Allount of line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due R T: U) (2) (3) (4) (5) (6) (7) 200.000.00 16.501. 00 .00 .00 7.819.00 10.555.00 938.299.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/lians (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 28,651.00 4.151. 00 (11) (2) (3) (4) NOTE: .00 X 1,140,372.00 X .00 X .00 X T + INTEREST/PEN PAID (-) 2,565.84 AMOUNT PAID 49,122.00 DATE 05-25-2004 NUI1BER CD003975 ~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, subllit the upper portion of this for.. with your tax pay..ent. (8) 1,173,174.00 32.802 00 1.140,372.00 .00 1,140,372.00 00 = 045 = 12 = 15 = .00 51.316.74 .00 .00 51,316.74 (9)= 51,687.84 371. IOCR .00 371.10CR IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-66) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Jeptha B. Woolums REVIEWED BY ACN 2104-0235 101 Sheila Megonnell ITEM SCHEDULE NO. G EXPLANATION OF CHANGES Item #8, Schedule "E" was moved to Schedule "G" as a Transfer to decedent's sons per correspondence dated 01/25/2005, from lawyer's office. Transfers are entitled to a $3,000.00 exclusion to the total amount transferred per transferee per calendar year. ROW Page 1 BUREAU OF INDIVIDII,A!,r~!\l!!l!=" INIEAJTANCE TAX DIVISIPlt ,)\./: .'__'_.V PO BOX Z806Gl HARRISBURG Pi 17128-0601\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT .. REV-I'.7 EX AFP (03-05) H=53 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 WOOLUMS 02-29-2004 21 04-0235 CUMBERLAND 101 A_t R_l.tted JEPTHA B ROBERT M"fft~' '., FREY II TllEY 5 S HANOVER ST CARLISLE :01 j, ~ I; PA 17013 KAKE CHECK PAYABLE AND REMIT PAyMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper cr.dlt to your eccount, subBit the upper portion of this fo~ with your t.x ~t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF WOOLUMS JEPTHA B FILE NO.21 04-0235 ACN 101 DATE 04-04-2005 THIS STATEHENT IS PROVIOED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACN IN THE NAllEO ESTATE. SHllIIN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURREHT BALANCE, AND, IF AP~ICABLE, A PROJECTED IHTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-01-2005 PRINCIPAL TAX DUE, '51,316.74 PAYMENTS (TAX CREDITS), "\ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-25-2004 CDo03975 2,565.84 49,122.00 , 03-15-2005 REFUND .00 371.10- : TOTAL TAX CREDIT 5~,316.74 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAlO AFTER THIS DATE, SEE REVERSE TOTAL DUE : .00 SIDE FOR CALCULATION OF ADDITIONAL IHTEREST. I IF TOTAL DUE IS LESS THAN $1, ND PAYMEHT IS REllUIRED. IF TOTAL DUE IS REFLECTED AS A ''CREDIT" ICR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) Cumberland County - Register Of Wills One Courthouse Square Carlisle, FA 17013 Phone: (717) 240-6345 Date: 1/13/2006 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of WOOLUMS JEPTHA B File Number: 2004-00235 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 2/28/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, 4 G9~,. )":..UM0~ ;\2ftJU&Aj . /. . . / GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) .Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: JEPTHA B. WOOLUMS Date of Death: February 29, 2004 Will No. Admin. No. 21-04-00235 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (X ) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes () No (X). (b) The separate Orphans' Court no. (if any) for 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 the Orphans' Court and may be attached to this report. Date: February 2, 2006 ~~- ~. /h Signature ~ ."~;. ~. '.,J Robert M. Frey Name (Please type or print) l. .~ 5 South Hanover Street Carlisle, Pa 17013 Address .. -~'-..:: (717) 243-5838 Telephone No. Capacity: ( ) Personal Representative ( X ) Counsel for personal representative ~t COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD 014068 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 198-30-4907 FILE NUMBER: 2104-0235 DECEDENT NAME: WOOLUMS JEPTHA B DATE OF PAYMENT: 0 ~IZ1l~ ~'~~~ POSTMARK DATE: 03/02/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 02/ 29/ 2004 101 ~ S 183.09 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY SEAL CHECK#10700 183.09 INITIALS: HMW RECEIVED BY; GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS t 155610145 REV-1500 ~` `°'-'°' FFICIAL USE ONLY PA Department of Revenue ~e ~s oFV~rlia O County Code Year File Number Bureau of Individual Taxes PO BOX 28060, INHERITANCE TAX RETURN ~, Harrisburg PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 198-30-4907 02292004 03311917 Decedent's Last Name Suffix Decedent's Firs t Name MI Woolums Jeptha B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW Q 1. Original Retum ~x 2. Supplemental Retum ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 0 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) © 6. Decedeht Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robert G. Frey 7172435838 .. First line of address 5 South Hanover Street Second line of address City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's a-mail address: rf reyC~f reyt i ley . com REGISTER ILLS USE ONLY ,.. T T ~ i. ~A..l y. ~ J ~i~; ~ t~,M . ~ ~~ -~ ~ .~ ~ TT i } - ~ _ ~ ~--- --pp DA]~FILED !~`' -.z~ r> ~ ~ti 'h .. ~ a r~. _ ?r- ~~~ ""'i"i 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 corn fete. Declaration of re aver other than the rsonal re resentative is based on all information of which re aver has an knowled e. S16;NATU F PERSON RESPONSIBLE FOR FILING RETUR _ _ DAT~ ~ ~, .3 Z ADDRESS SIGNAT~~U PREPQ~R THER AN E ESENTATI ~ /L~ATZE / ! I 5 South Hanover Street~arlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 7 L 1505610145 1505610145 J 1505610245 REV-1500 EX Decedent's Social Security Number Decedent's Name: J2ptha B WOOlumS 198-30-490'7 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 5 5 5 0 . 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ...... 5. NONE 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers S Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 5 5 5 O . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 2 5 7 8 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. NONE 11. Total Deductions (total Lines 9 and 10) ............................... 11. 2 5 7 8 . 0 0 12. Net Value of Estate (Line 8 minus Line 11 } ............................. 12. 2 9 7 2 . 0 0 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. 2 9 7 2 . 0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2} X .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 4 5 2 9 7 2. 0 0 16. 13 3.7 4 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 , 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE ....................................................... 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 133.74 L 15U561U245 1505610245 J REV-1500 EX Page 3 File Number 198-30-4907 Decedent's Complete Address: DECEDENT'S NAME Je tha B Woolums STREET ADDRESS 770 South Hanover Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (3) 0.00 49.35 (1) 133.74 Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5. If Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) 0.00 (5) 183.09 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. retain the use or income of the property transferred : ............................................................................. L~] b. retain the right to designate who shall use the property transferred or its income : ................................ rC] (ate c. retain a reversionary interest; or ............................................................................................................ LJ t.~`J d. receive the promise for life of either payments, benefits or care? .......................................................... C] 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................. C~ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .... C~ 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. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 21 years of age or younger at death to or far the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [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 percent, 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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood ar adoption. Practitioner Portal Penalty and Interest Calculations CALCULATION DATES- 11/29/04 TO 3/3/2011 TAX DEFICIENCY $ 133.74 CALCULATED INTEREST $ 49.35 BALANCE AS OF 3/3/2011 $ 183.09 ~tdrt Over 2/16/11 11:24 AM https://www.doreservices.state.pa.us/pitservices/Default.aspx Page 1 of 1 REV-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jeptha Woolums All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price 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. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jeptha Woolums Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. 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 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Recording fees 2,375 15 188 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 2,578 If more space is needed, use additional sheets of paper of the same size. ZIP REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jeotha Woolums RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Joel D. Woolums 1 ~ 125 Oakhill Road, Carlisle, PA 17015 Son one half Daniel P. Woolums 2~ 1722 Walnut Bottom Road, Carlisle, PA 17015 Son one half ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed, use additional sheets of paper of the same size. BUREAU OF INDIVIDUAL~'fdX'~s ,`', ~ ~ INHERITANCE TAX INHERITANCE TAX DIVISION ^`" . ~'~STATEMENT OF ACCOUNT PO BOX 280601 ~ ;: .. - ' HARRISBURG PA 17128-0601 F. 1~~~F~( ~.~~^ ,, ;~. ROBERT M F~~esE ~~. ... _' , ~;:; FREY ~ TILEY 5 S HANOVER ST CARLISLE PA 17013 Pennsylvania ~ ,'Y DEPARTIMENT OF REVENUE REV-1607 EX AFP (12-10) DATE 03-2$-2011. ESTATE OF WOOLUMS JEPTHA B DATE OF DEATH 02-29-2004 FILE NUMBER 21 04-0235 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND RE=MIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS REV-1607 EX AFP C12-10~ *** INHERITANCE TAX STATEMENT OF ACCOUNT ~*~ ESTATE OF:WOOLUMS JEPTHA B FILE NO.: 21 04-0235 ACN: 101 :DATE: 03-28-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUI'IMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-22-2005 PRINCIPAL TAX DUE: 51,316.74 PAYMENTS (TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+~ DATE NUMBER INTEREST/PEN PAID (-~ 05-25-2004 CD003975 2,565.84 03-15-2005 REFUND .00 03-02-2011 CD014068 .00 AMOUNT PAID 49,122.00 371.10- 183.09 TOTAL TAX PAYMENT 51,499.83 BALANCE OF TAX DUE 183.09CR INTEREST AND PEN. .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE 01= 1"HIS FORM FOR INSTRUCTIONS. 183.09CR • A; ~ )