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Home My WebLink About02-0529PETITION FOR PROBATE and GRANT OF LETTERS Estate of Carol A. Conner No. also known as C~r~ a. nl.~n To: Deceased. Social Security No. 342-37-2297 o2.- Register of Wills for the County of Cumberlan0 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 or in the last wilt of the above decedent, dated October 3, and codicil(s) dated n/~ in the named ,1988 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumherlan~ County, Pennsylvania, with h er East family or principal residence at 656 All env~ ew Dr{v~. (list street, number and muncipality) Decendent, then 61 years of age, diedApri! 17 ,~:92002 , atHarrisburq Hospita!r Harrisburq, PA' 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 request(s) the probate of the last will and codicil(s) pre~ented herewith and the grant of letters tp.~-~,~on+.~ ry (testamentary; administration ¢.t.a.; administration d.b.n.c.t.a.) theron. D. Bruce Conner 656 Allenview Drive, Hechanicsbur~, PA 17055 Sworn to or affirmed and subscribed before me this 31 st __ __ day of _ivey_ 2002..-~ ~ D~ · MARrf lc LE~ -- ~- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF Cumberlana The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the k~owledge and belief~of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well a~ administer ~ estate according to law. No. ~ I- 02 -~'29 Estate of ~,~ro~ ~- ~o~.r , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 3UNE 3, 2002 1~2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Oc~ober ?, ! 988 described therein be admitted to probate and filed of record as the last will of c~ rc~ ~_ c'nnnor and Letters ~ry are hereby granted to D. Bruce Conner FEES Probate, Letters, Etc .......... $ 80.00 Short Certificates( ) .......... $ 30.00 ~~a~x., .e~r~. ~.a.g.e~. $ 6. o o jcp $. 5.00 TOTAL__ $ ]21.00 Filed 6-3-2002 ...... &hYifa' ;ffti£f/'6'-3-02 ....... [Vl/~ C~q~gJster of Wills Ruby D. Weekst Esquire 23901 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS 7-2~3-129~ PHONE I f ,.~!/!..! _70. 2 -oz-5;zq T, CAROL A. ~c8~, ~ ~ ~iti~, ~ ~ ~m, ~bli~ ~ ~1~ ~8 ~ ~t Will ~ T~~t, h~ ~~ ~ ~ ~id all Wills ~ ~ at ~y t~ ~fo~ ~. I ~ ~i~ ~ D. B~ ~, ~ all ~fe~s ~ ~ h~ ~ ~ ~. ~~ly I w~ ~i~ ~ ~ ~~ f~ A~ J. OLS~. FIRST I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. S~Cf~D I give, devise and bequeath all my estate, real, personal and mixed, of any k/nd whatsoever and wheresoever situate, to my beloved husband, D. BRUCE O3NNER, absolutely. In the event my said husband uredeceasas me or is not liv/ng on the 6Oth day following my death, I then give, devise and bequeath my entire estate to my ch/ldren, STEVEN ERIC OLSEN and LINDA JOANNE OLSEN, in equal shares. Page 1 of 3 had signed willingly and that she executed it as her free and voluntary act for the purposes t~in expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constr~int or undue influence. CAROL A. CONNER Testatrix SEAL ) Witness ~Witness at Subscribed, sworn to and acknowledged before me by CAROL A. OONNER, the Testatrix, and subscribed and sworn to before me by ~ J ~ ~ DIANE L. MASENHEIMER, and SHIRLEY P. CLEVENSER, witnesses, this j'-~ day of c.c.t~- , 1988. Notar~ Public SHARON A. DIEHL, Notary Public Carlisle, ~, Cumberland County My Commission F. xp~res Jan. 16, 1989 Page 3 of 3 CERTIFICATION OF NOTICE UNDER RULE Name of Decedeiit: carol A. Conner Date of Death'. April 17, 2002 To the ReglsLer~ I certify that notice of be;~eficial interest required by Rule 5.6(a) of the OrDhans' Court iRules was served on' or mailed to the £ollowing bene£iciaries of the above-captioned estate on Name Address D. Bruce Conner 656 Allenview Dr~.ve, Mechanicsburq~ .PA ~7055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Name Ruby D. Weeks, Esquire Address 10 west Hiqh Street ~1 ~ ~1 ~...PA ~ 701 9 . Telephone (717) 243-1294 Capacity:__ Personal Representative Counsel for personal represen tat ire NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY In re Estate of Carol A. Conner NO. of TO~ D. Bruce .Q.onner 656 Allenview Drive , PENNSYLVANIA , deceased, (beneficiary) (address) Mechanicsburg, PA 17055 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: Ail of estate, real personal and mixed, of any kind whatsoever and wheresoever situate. (if additional space is needed, use back of page) Name of decedent ~rol A. ~onner Last known address 6~ ~nv(~w. nr~ve of decedent_ Mechan]csburo, PA 17055 Date of death 4/17/02 Place of death Harrisburq. H0sPita%.{ Harrisburg, PA County of grant of original letters Cumberland Decedent died x testate intestate. A copy of the will x is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone D...~ruce ~onner 656 Allenview Drive, Mechanicsbur~, PA 17055 717-697-2938 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA17128-0601 REV - 1500 [ ...................... ...................... ~'[!i[~'~'~'~ ...................................................... INHERITANCE TAX RETURN ID-/ I $"ol RESIDENT DECEDENT Ic°u" c°°E I I .uMs IDATE OF DEATH 4/17~02 SOCIAL SECURITY NUMBER 342-32-2297 JTHIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS JSOCIAL SECURITY NUMBER ~195-16-2591 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Conner, Carol a. r-~Oo IDATE Of BIRTH 12/30/040 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Conner, D. Bruce Limited Estate Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received _ I 13. Remainder Return (dateofdeathpdor to 12-13- 2. Supplemental Return M82) [ ,,~4a. Future Interest Comprise (dateoi'death after 12-12-82) U5. Federal Estate Tax Return Required M7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes L j10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [~ 11. Election to tax under Sec. 9113(A) L~J (Attach Sch O) Z Z 0 0 THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME Ruby D. Weeks, Esquire FIRM NAME (If Applicable) Law Office Of Ruby D. Weeks TELEPHONE NUMBER 717-243-1294 COMPLETE MAILING ADDRESS 10 West High Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) ]~'l Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) (Schedule G or L) $0.00 :.': $O.OO $o.oo $0.00 $55,409.18 $0.00 $0.00 OFFICIAL USE ONLY B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (8) $7,670.11 $2,499.97 (11) (12) (13) $55,409.18 $10.170.00 $45,239.10 $1.0o 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $45,238.10 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) 16. Amount of line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20. ~ $45,238.10 x 3% x x .12 x .15 (15) (16) (17) (18) (19) $1,357.14 $0.00 $0.00 $0.oo $1,357.14 Copyright 2000 David James Thorpe, Esq, Oec,edent's'Complete Address: .I S, TRE. ET ADORE,SS 656 Allenview Drive IClTY ]Mechanicsburg STATE PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $1,357.14 $0.00 $10.41 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest $10.41 E. Penalty Total InterestJPenalty (D + E) (3) 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) 5. If line I + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT $1,367.55 $1,367.55 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary interest; or d. receive the promise for life of either payments, benefits or care? 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? 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? Yes No 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 declar~ 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 thaffthe pe~rsonal representative is based on all the information of wh ch preparer has any knowledge. SIGNATURE OF PERS~I~-'~F-.~.~?SIBLE FOR FIL~ RETURN D. Bruoe Conner ~o. /&,Z-L<,~ -- ~ ADDRESS t 656 Allenview Drive, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER (~q~ER THAN REPRESENTATIVE DATE Ruby D. Weeks, Esquire ADDRESS 10 West High 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. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does no exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs 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 decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN 'RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER 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 N/A TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $0.00 Copyright 2000 David James Thorpe, Esq. · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ' RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER N/A DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $0.00 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ' RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (Including all suppoding information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER N/A DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $0.00 Copyright 2000 David James Thorpe, Esq. ~OMM~NWEALTH OF PENNSYLVAN A INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER 1. Name of Corporation N/A State of Incorporation Address Date of Incorporation Total Number of Shareholders Business Reporting Year City 2. Federal Employee I.D. Number 3. Type of Business State Zip Code Product/Service STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE Voting/Non-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK Common Preferred Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ~-J Yes No If yes, Position Annual Salary 6. Was the Corporation indebted to the decedent? N Yes No If yes, provide the amount of the indebtedness 7. Was there life insurance payable to the corporation upon the death of the decedent? Yes If yes, Cash Surrender Value Net proceeds payable Owner of the policy Time Devoted to Business --]No 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827 ~ Yes ~ No If yes, [] Transfer J--'] Sale Number of Shares Transferee or Pumhaser Consideration Date Attach a separate sheet for additional transfers and/or sales 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? r--"l Yes No If yes, provide a copy of the agreement. 10. Was the decedents stock sold? ~ Yes [--'1 No if yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent s death? ['--] Yes J-"'l No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? [---1 Yes [--1 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuations of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. Copyright 2000 David James Thorpe, Esq. ~3OMMONWEALTH OF PENNSYLVANIA I~HERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER 1. Name of Partnership N/A Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employee I.D. Number 3. Type of Business Product/Service ~ General E~ Limited partner. If decedent was a limited partner, provide initial investment Decedent was a PERCENT OF PERCENT OF BALANCE OF PARTKIER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest 7. Was the Partnership indebted to the decedent? r'~ Yes E~ No if yes, provide the amount of the indebtedness 8. Was there life insurance payable to the partnership upon the death of the decedent? ~ Yes ~ No If yes, Cash Surrender Value Net proceeds payable Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31- 82? ~ Yes J~ No If yes, E~] Transfer r'~ Sale Percentage transferred/sold Transferee or Purchaser Consideration Date Attach a separate sheet for additional transfers and/or sales 10. Was there a written partnership agreement in effect at the time of the decedent's death? ~ Yes ~ No If yes, provide a copy of the agreement. 11. Was the decedents partnership interest sold? ~ Yes [~] No if yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ~ Yes ~'~ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ~ Yes ['--'] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? E~] Yes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuations of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the partnership interest. Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN · RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 1.' N/A TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $0.00 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ' RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 2. 3. 4. 5. DESCRIPTION New York Life Annuity N 3175825 Merrill Lynch - Family Life Annuity (301B)//896053478 Reimbursed medical expenses check numbers 3790905, 3790904, 3789536 Personal Clothing & Items Social Security Death Benefit TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $18,317.32 $35981.84 $784,99 $100.00 $225.00 $55,409.15 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF 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 A. D. Bruce Conner 656 ^llenview Drive, Mechanicsburg, PA 17055 B. C. JOINTLY-OWNED PROPERTY: RELATIONSHIP TO DECEDENT !Spouse ITEM L~- ~ i ER DATE DESCRIPTION Of PROPERTY DATE OF DEATH % OF DATE OF DEATH NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach VALUE OF ASSET DECD'S VALUE OF 1. TENANT JOINT deed for jointly-held real estate. INTEREST DECEDENT'S INTEREST 2. 3. 4. 5. TOTAL (Also enter on line 6, Recapitulation) $0.00 , insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~l: ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. VALUE Of ASSET INTEREST (IF APPLICABLE) VALUE 1. Merrill Lynch IRA Account 87271008 - Surviving spouse benefit 109900.70 100% Joint with rights of -0- FOR INFORMATIONAL PURPOSE ONLY survivorship 2. 18317.32 100% Joint with rights of -0- New York Life #N3175825 lump sum paid to surviving spouse - Listed on survivorship 3. Schedule E 34959.49 100% Joint with rights of Merrill Lynch - Evergreen Funds #896053478 lump sum paid to surviving survivorship -0- spouse - Listed on Schedule E TOTAL (Also enter on line 7, Recapitulation) d, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. .COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN · RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of ~.~cedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER A. FUNERAL EXPENSES: 1. Bo ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: Attorney Fees Ruby D. Weeks, Esquire (5%) Family Exemption: (If decedent,s address is not the same as claimant's, attach explanation) Claimant BRUCE CONNER Street Address 656 ALLENVIEW DRIVE City MECHANICSBURG Relationship of Claimant to Decedent SPOUSE Probate Fees a. Legal advertising- The Sentinel $67.91 b. Legal advertising - Cumberland Law Journal 75.00 c. 5/31/03 $131.00 d. 3/14/03 $10.00 State PA Zip 17055 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 1116.20 2770.00 3500.00 283.91 $7,670.11 Copyright 2000 David James Thorpe, Esq. .COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ' RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER IncJude unreimbursed medical expenses. ITEM DESCRIPTION NUMBER FINAL MEDICAL BILLS: 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. CRITICAL CARE SYSTEMS, INVOICE NUMBERS 8824 & 8826 JOHNS HOPKINS UNIVERSITY CLINICAL PRACTICE ASSOC. ACCOUNT NUMBER 30-3135725 ANDREW & PATEL ASSOCIATES, P.C. ACCOUNT NUMBER 5634 1 JOHN HOPKINS HOSPITAL ACCOUNT NUMBER 801976903 JOHN HOPKINS UNIVERSITY CLINICAL PRACTICE ASSOC. INVOICE NUMBERS 30-25231487 &30- 25372931 OAKWOOD CENTER RADIATION ONCOLOGY JOHN HOPKINS UNIVERSITY CLINICAL PRACTICE 30-25034422, 31-25111993 ANDREWS AND PATEL ASSOCIATES. ANDREWS AND PATEL ASSOCIATES JOHN HOPKINS UNIVERSITY CLINICAL PRACTICE INV. #'S 30-24639297, 30-24809809 B. DOUGLAS SMITH, MD SOPHIE M. LAN ZHRON, MD. TOTAL (Also enter on line 10, Recapitulation (If more space is needed, insert additional sheets of the same size) AMOUNT 938.75 258.00 55.00 31.22 129.00 105.00 266.00 185.00 75.00 367.00 90.00 $2,499.97 Copyright 2000 David James Thorpe, Esq. " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN · RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY NUMBER I. TAXABLE DI$¥1~.IBUTIONS (include outright spousal distributions) 1. I1. n/a RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE :NTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE D. BRUCE CONNER E~. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS N/A 100% $1.00 TOTAL OF PART II - END-~ TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. · COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. r'~ Will r'~ Intervivos Deed of Trust ~ Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF DATE OF BIRTH NEAREST AGE AT TERM OF YEARS LIFE ESTATE LIFE TENANT(S) DATE OF DEATH IS PAYABLE N/A Life Term of Years or Life Term of Years or Life Term of Years or Life Term of Years or payable 2. Actuarial factor per appropriate table Interest table rate- ~ 3 1/2%o N 6% [] 10% E~ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) $0.00 ANNUITY INTEREST CALCULATION NAME(S) Of DATE OF BIRTH NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF DEATH ANNUITY IS PAYABLE x Life Term of Years or Life Term of Years or Life Term of Years or Life Term of Years or [Y PaL 2. Check appropriate block below and enter corresponding (number) Frequency of payout- E~ Weekly (52) ~ Bi-Weekly (26) ~ Quarterly (4) [~] Semi-annually (2) LJ~ Annually (1) 3. Amount of payment per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate- ~'~3 1/2% ~ 6% ~'~ 10% ~ Variable Rate 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 ¼%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period calculation is: (Line 4 x Line 5 x Line 6) + Line 3 B Monthly (12) Other (x) lump sums $0.00 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128~601 SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER II. III. IV. This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. [] Will [~ Trust r'-] Other Beneficiaries NAME OF RELATIONSHIP DATE OF BIRTH AGE TO BENEFICIARY NEAREST BIRTHDAY 1. 2. 3. 4. 5. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. [ ~'] Unlimited r'~ Limited right of withdrawal right of withdrawal Explanation of Compromise Offer: N/A Summary of Compromise Offer: 1. Amount of Future Interest 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) 3. Value of Line 1 passing to spouse at appropriate tax rate Check One O 6%, [~3%, N0% (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 Taxable at 6% Rate (also include as part of total shown dn Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at 15% Rate (also include as part of total shown on Line 17 of Cover Sheet) 6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line 1) $0.00 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act, If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. Description Value N/A Part A Total $0.00 PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. Description Value Part B Total ~;0.00 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND being duly sworn according to law, deposes and says that he i_= ~he e~ecu~or of the Estate of Carol A. Conner late of ~6~1~ en~L~__nr~._~{ech~n~a~%,_,r~ , Cumberland County, Pa., deceased and that the within is an inventory made by D. Bruce Conner , the said E~ecutor of the entire estate of said decedent, consisting of all the personal property and real esfMe, except real estate outside the Commonwealth of Pen~,sylvanle, and that the figures opposite each item of the Inventory represent it's fair value as of ~he date of decedent s death. Sworn and subscribed before me, ~ ~ D. Bruco Connor Executor . A~minlsfrafor ~20~ Address Date of Death 17th Apr~l 21')1'12 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. o 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 002288 WEEKS RUBY D ESQUIRE 10 W HIGH STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 342-32-2297 FILE NUMBER: 2102-0529 DECEDENT NAME: CONNER CAROL A DATE OF PAYMENT: 03/14/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/17/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,367.55 TOTAL AMOUNT PAID: $1,367.55 REMARKS: D BRUCE CONNER C/O RUBY D WEEKS ESQUIRE SEAL CHECK# 103 INITIALS: CW RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS JRD/June 30, 1992/17858 APR 3 u ZI 04 " In Re: Estate of Carol A. Conner Late of Upper Allen Township Estate No.: 21-2002-0529 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2002-0529 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Ruby D. Weeks, Esquire Date of Decedent's Death: 04-17-2002 Date of Delinquency Notice: 03-25-2004 The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on 03-25, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 04-30-2004 Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is schedul at in Courtroom No. 3. If the Status Report is filed prior to the hearing date, the hearing will automatically be//t][;c~d~'---ti~:.~/~.~ll~-- Geo~e ~/~17o f~r, ~. J.~ / [ JRD/June 30, 1992/17858 APR 3 u 2004¢ In Re: Estate of Carol A. Conner Late of Upper Allen Township Estate No.' 21-2002-0529 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-2002-0529 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Ruby D. Weeks, Esquire Date of Decedent's Death: 04-17-2002 Date of Delinquency Notice: 03-25-2004 The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on 03-25, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 04-30-2004 Glenda Famer S~rasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is schedul at in Courtroom No. 3. If the Status Report is filed plor to the hearing date, the hearing will automatically be can~,~c~e~/I ~ ,~ Name of Decedent:. Date of Death: STATUS REPORT UNDER RULE 6.12 Will No.: ~ 0(0 ~) -0(5 ~ q Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [~ No 1-] 2. I/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: ao bo Did the personal representative file a final account with the Court? Yes7 No[~ 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 [~ No [-] Co Date: Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Name- J ' Capacity: Address '-/ ; : ~eleph~ne No. ersonal Representative ounsel for personal representative FAMILY SETTLEMENT AGREEMENT WAIVING FILING OF ACCOUNT AGREEMENT executed this '2,'3 rd day of ~ctrcg , 20 o~, by and between D. Bruce Conner, Executor of the Estate of Car--0q X] Conner, ~teceased, and D. Bruce Conner, husband of deceased, Steven Eric Olsen, son of the deceased and Linda Joanne Olsen, daughter of the deceased. WITNESSETH: WHEREAS, Carol A. Conner died on April 17, 2002, testate, hers Will dated October 3, 1988, and, WHEREAS, on June 3, 2002, the Register of Wills of' Cumberland County, Pennsylvania, issued Letters Testamentary thereon to D. Bruce Conner, Executor; and, WHEREAS, the Executor has proceeded with the administration of said estate and has prepared his First and Final Account and Schedule of Distribution. A true and correct copy thereof is attached hereto, made a part hereof and marked Exhibit ..... A , and, WHEREAS, the parties hereto desire that the Execuor shall not be required to file said Account with the Orphans' Court of Cumberland County in order to save additional administration expenses, and that the estate of the decedent shall be distributed without the necessity of filing a formal account. NOW THEREFORE, the parties hereto intending to be legally bound hereby, mutually agree as follows: 1. The parties hereto, and each of them, agree and acknowledge that they have fully and carefully examined the First and Final Account of D. Bruce Conner, Executor of the estate of Carol A. Conner deceased, and Schedule of Distribution relating thereto, and find them to be true and correct, and acceptable to the parties hereto and each of them, and further that each of them has received a copy of this Agreement and of the said Account and Schedule of Distributions. 2. The parties hereto do hereby release, remise and forever discharge the Estate of Carol A. Conner of deceased, and D. Bruce Conner, Executor of and from all manner of acts, suits, claims, accounts, accounting, debts, dues and demands whatsoever which they or any of them or their legal representative or assigns may at any time hereafter have, against the Executor, the said Estate or the assets thereof, from, for touching or concerning any of the assets and property of the said Estate and/or any claim or interest thereto or therein, and the administration, management, collection, sale or distribution of any of the said assets and for or on account of any money interest, income, assets or proceeds out of the same, from the time of the death of the said decedent to and including the date of this Agreement and release. 3. This instrument is a full and final Family Settlement Agreement by and among the parties hereto, both fiduciary and individual, all of the same having been arrived at, concluded and executed after a full and complete disclosure of the assets of the said estate and the rights of the parties therein and thereto and all of the parties hereto, and each of them, agrees to abide by the terms hereof. 4. The parties hereto, and each of them, agree that they will at all times in the future and whenever necessary, appropriate or convenient, make, execute and deliver to the said Executor, and/or to the other party or persons, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention of this Agreement and/or to permit, assist and enable the Executor to fulfill his duties with reference to the said estate and all of the assets thereof. 5. This Agreement constitutes the entire understanding among the parties hereto, and each of them acknowledges that no representations or statement of any kind, written or oral, have been made to them or any of them prior hereto by the Executor or by any other person or party upon his behalf. · 6. This Agreement shall enure to the benefit of and shall be binding upon, the parties hereto, and each of them, their heirs, executors, administrators, successors and assigns. IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. In the presence of: D. Bruce Conner Executor of the Estate of Carol A. Conner And for himself as beneficiary under the Will. Steven Eric ~son of the deceased x ava:4.3ol nne Olsen, daughter 6f the deceased Po~ge I CerUfied Fee r-~ Return Reciept Fee r-'l (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Postrnmk Here Sent To ~ ~ ~ I oro.~or~.~~.- ..... " .... ': I.[ ' · ~" I~'"-/'~.~ 1. -~cle.~,~,~edto: !1 D. Isdeliveryaddmesdifl~,m~fmmlteml? r'Iyes T~l~e 4. Restricted D~_~.,_~ ~,~..~,) [] Yes '~~~ Ii L 7003 1010 0001 1204 0499 ~ lI~,~-~t-'~ ........ " ' ' ;'! ~il "" :::-~'": '' ' ,BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2806O1 HARRISBURG, PA 17128-0601 RUBY D WEEKS ESQ R D WEEKS LAW OFFICE 10 W HIGH ST CARLISLE PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 07-05-2004 ESTATE OF CONNER DATE OF DEATH 04-17-2002 FILE NO. 21 02-0529 COUNTY Cumberland ACN 101 REV-I~47 EX (t2-97) PC CUT ALONG THIS LINE REV-1547 EX (06-97) PC CAROL A Amount Remitted I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 RETAIN LOWER PORTION FOR YOUR RECORDS C= NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR ESTATE OF CONNER DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX CAROL A FILE NO. 21 02-0629 ACN 101 DATE 07-05-2004 TAX R= I ~JRN WAS: ( [] ) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE )CHANGED SEE ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 0.00 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 0.00 4. Mortgages/Notes Receivable (Schedule D) (4) 0.00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 55,409.18 6. Jointly Owned Property (Schedule F) (6) 0.00 7. Transfers (Schedule G) (7) 0.00 8. Total Assets (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 7,670.11 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2,499.97 11. Total Deductions (11 ) 12. Net Value of Tax Return (12) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Subject to Tax (14) If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. NOTE: To Insure proper credit to your account, submit the upper portion of this form with your tax payment. 13. 14. NOTE: 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 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: 55,409.18 10,170.08 45,239.10 0.00 45,239.10 (15) 45,239.10 X .00 0.00 (16) 0~00' X.045 0.00 (17) 0~00 X.12 0.00 (18) 0.00 X.15 0.00 (~9). 0.00 PAYMENT RECEIPT DISCOUNT (+) ~ DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 03-14-2003 CD002288 0.00 1,367.55 TOTAL TAX CREDIT 1,367.55 BALANCE OF TAX DUE 1,367.55 CR INTEREST 0.00 TOTAL DUE 1,367.55 CR FOR CALCULATION OF ADDITIOI~L INTEREST. (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS P. EFLECTED AS A CREDIT (CR), YOU MAY BE DUE A EEFOND. SEE REVERSE SIDE OF THIS FOi~M FOR INSTRUCTIONS. ) ~EV-1 ~ ~ (6-88) INHERITANCE TAX EXPLANATION COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME FILE NUMBER Carol A. Conner 2102-0529 REVIEWED BY ACN ANITA MCCULLY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Spousal tax rate for dates of death from 12-31-94 to present is 0%. Row Page 1 BUREAU OF ZNDZVI'DUAL TAXES ZNHERTTANCE TAX D'rVTSTON DEPT. Z80601 HARR*I*SBURG,, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT RE¥-16D7 EX AFP ~81-0S} RUBY D WEEKS ESQ R D WEEKS LAW OFFICE 10 W HIGH ST CARLISLE PA 17013 DATE 08-0Z-Z00~ ESTATE OF CONNER DATE OF DEATH O~-IT-ZOOZ FILE NUNBER Z1 0Z-05Z9 COUNTY CUHBERLAND ACN 101 I Amount Remitted CAROL A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:3 NOTE: To insure proper credit to your account:' subeit the upper port/on of this fore with your tax payment. CUT ALONG TH]:S L'rNE ~* RETA'rN LOWER PORT'rON FOR YOUR RECORDS *-~ ESTATE OF CONNER CAROL A FZLE Ne. z1 02-0529 ACN 101 DATE 08-0Z-200~ THTS STATEHENT TS PROVTDED TO ADV*rSE OF THE CURRENT STATUS OF THE STATED ACN *rN THE NAHED ESTATE. SHO#N BELO# 'rs A SUHHARY OF THE PR/NC/PAL TAX DUE:, APPL*rCAT'rON OF ALL PAYHENTS:' THE CURRENT BALANCE:' AND:, .rF APPL*rCABLE:' A PROJECTED *rNTEREST F'rGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-05-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): .0O PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID 05-1~-2005 07-15-200~ CDOOZZ88 REFUND .00 .00 1,$67.55 1,$67.55- TOTAL TAX CREDIT *rF PA*rD AFTER TH*rS DATE:' SEE REVERSE S.rDE FOR CALCULAT*rON OF ADD'rTIONAL *rNTEREST. *rF TOTAL DUE *rS LESS THAN $1:' NO PAYNENT 'rS REQU*rRED. IF TOTAL DUE .rS REFLECTED AS A "CRED.rT" ¢CR):' YOU HAY BE DUE A REFUND. SEE REVERSE S*rDE OF TH*rS FORH FOR 'rNSTRUCT*rONS. ) .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00