The URL can be used to link to this page

Home My WebLink About04-0168 EST A TE OF EDWARD J. DODSON : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : ORPHANS COURT DIVISION : : NO. 21-04-0168 : PRAECIPE FOR ENTER OF APPEARANCE To Glenda Farner-Strasbaugh, Register of Wills: Please enter my appearance on behalf of the Estate of Edward J. Dodson, date of death January 23, 2004. 0\ ~ Respectfully submitted, (Y': D- r- UGHES & FISHMAN PC I >- = :c , _1 ~ }.: p II ~ ~ '\ I" ... .~\-..# Date: May 7, 2004 01-. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: EDWARD J. DODSON Date of Death: JANUARY 23.2004 Estate No.: 21-04-0168 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 28. 2004 Name Address Charles W. Dodson 1125 W. Wynnewood Road. Wynnewood, P A 19096 Jean Dalesio 39 Hillcrest Road, Barto, P A 19504 Dorothy Dodson 309 N. Bishop Avenue, Clifton Heights, PA 19018 Notice has now been given to all persons entitled thereto under Date: OS/28/04 c..O ~.. . . C'.J 0__ N I tlress 95 Alexander Spring Road. Suite 3 -".. 'S -:J Carlisle. PA 17013 ~ .'"- p . - Telephone (717) 249-2353 --- '\" .... oJ '-' Capacity: Personal Representative X Counsel for Personal Representative J"-... - PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of <C)U'~J ~~dsH) No. oV-C).y- /6i? also known as et.U,? To: Register of ~llS for the J Deceased. County of {)..;i11 (,-dlt.l4-"". in the Social Security No. ;;0-'7 -Lj'i- !cl-7 ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl f(;.,S for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in r1 U)1'1(,C/')~Q County, pennsy,lvani~with h P:5 last family or principal residence at 1/ Jl1/Gft I1-UY: Ot') /V~t.UUIt.LG 4-. (list street, number and municipality) Decendent, then 6/ years of age, died ;- J 3- ,196f , at Decendent at death owned property with estimated values as folllows: %702,3;1 (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 . jJ(l. N<-.i.UUi LLG.. P, $ 0$> DO 0 situated as follows: // JY) /(OJH )4~X . il- / 7,;} I Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence )Cll '1~/~ cr60,-! J,;"rC THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ~ ~ [Uj)~ ~ '" u <= '" :9~ "'~ "'.... ~'" <= -00 ='.0 C':S ";:: ~~ "''- ao ~ <= OJ) rn OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF (l Um be.v l~nJ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ UJU~ Swom to 0' affirmed and subscribed f .-.. before me this t-J.-O TH day of '" '-' q) ... 1:..;; . J Wi: ::s .... 1 _) - -:J AI tU d 'U&> fi.u ~~ZL/Regi fer L tlO Ci3 No. ,:2/- C)~- /6j? Estate of ~L)LU/J;<D J nn j) .5/' /7 , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW fi:..A/Z. /.)):7/(' Y' ".,2u ~o;t', in consideration of the petition on the reverse side hereof, satisfactory proof ~ng been presented before me, IT IS DECREED that Ci.-IRR JF5 Lbd~n is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to (l HARI E.S Lv \::b~\.sOh in the estate of E.DLII Pit D .J lJ::,d 5(')Y1 M t~ ~Af~'~///~4/~<!/-JZj'- - c;:::? o{/) :::10: 0 ~J 8" "') - . / Register f W~.L.u /(l~' ~[.t'X"1 ~ ',' 0 (J 0 N .....'-~ " CO .. . F"l S -----< Lett~rs of ~mini!itr~on ..... $ / /~. 00 Short Certificates()-,S . . . . . . .. $ / c2 . LY'J ATTORNEY (Sup. Ct. 1.0. No.) r!j!t . . Qi .:..: ~ $ I 0 I")() ..' ph . . . . .;iJ ::;:. . . . . . . . . '....' . ".... $ /000 ' ~ ::.,)n . ADDRESS TOTAL _ $ /,y'-? /7t'? Filed FtW.. ~......... A.D. .w-~r PHONE c:;,/-o ~-/h1!' RENUNCIATION In Re Estate of :e;\ U ') ~ RC'l j l\-x.l,so h deceased. To the Register of Wills of C 1 IYn bQ..v-!>Clnc-) County, Pennsylvania. The undersigned 01lc-rhr /'1, /70 J s c /1/ , MMTHEI~ of - the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters CJF Ron))\) \ SlRA\\C,T\ be issued to h WITNESS hand this -4=- day of .fe-6 ' ur2!j JM~i?:~'~~ ':. (Address) \0 (Signature) ::~ ':'t !5!f 0\ 0 :~;; c:::t" ) 0- 0 U N 9 - CO (Address) WJ (\3 u- .i> .' .,.0 f3 ;::; s;:: ~}) ~ ".-,.,., '-'* ,:.)0 (Signature) --.--. (Address) e:2/-a -s/- ., RENUNCIATION /~i!' In Re Estate of LDwAKlJ ~ U~ ~Y\ deceased. To the Register of Wills of C urn bey-- ( A/lei County. Pennsylvania. The undersilned -1 EAJ1/ Dn(.eSiO , S STEIe_ of the above decedent, hereby renounce(s) the daht to administer the estate and respectfully ask(s) that letters f\dm In l STR..HT1011 be issued to (l ~\A R\ ~S Lu ~9:)n -- WITNESS hand this day of ,20_. ~ KY'&:~- (Slln.tuft) (^ddr~") (Signaturt) - (Address) 'C::t t:~ ~ :::Ja: J:2 0\ :) , ...... (1) ~::.;;, c:::t: '6 (,,)':'.':-iIO U (Si,o.ture) 0 N ffi LJ.... G.) ,,0 (Address) p ~ .... tJ '_" (,;.-:::n, '.',C.\, '>'~'r; This is to certify that the information here given is correctly copied from an original certificate of death dul~ flied with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fllmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ \\. ~~.. ,,,"'t"~~ Local Registrar p 9990942 FEB 2 200+ No. Date H1OS.144 Rev. '"' COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS IJPllINT CERTIFICATE OF DEATH IN # 29-197 (Coroner) MANENT STATE FILE NUMBER 'CK INK SEX SOCIAL SECURITY NUMBER .. Male .. 207-44-1278 23 2004 BIRTHPlACE (City and PLACE OF DEATH (Chook only one see insl'UC!loos on omer Side) Slate or Foreign Counlfy) HOSPITAL: Darby, Pa 1....''''''l!1 =.,)0 7. 10. CI FACilITY NAME (II nol instilullOO. give Sf,eel and numbel') RACE. Amerlc.In Indi.n. &aek, Whit.. etc. -) Ie. ,..White WAS DECEDENT eVER IN MARITAl STATUS. M.rried SURVIVING SPOUSE U,S. ARMED FORCES? Naver Married, Widowed, (If wile. give maiden name) ...0 No~ Divorced (Specily) ". Never Marri d DECEDENT'S Penn ACTUAL 17a. Sial. Ili. lWp 11 Michaux Drive RESIDENCE doc..... (See inll'UClioos livaina Newville, Pa 17241 on other side) Cumberland lown.hip? 17d.D :h:=~~~of 11. 17b. Coun . -., FATHER'S NAME (First. Middle. Last) MOTHER'S NAME (First Middle. Maiden Surname) 11. Charles Dods n 11. Doroth Ber en INFORM'ir~'\:"~~YD'6dson INFORMANT'S MAILING ADDRESS ($lreel, CityfTown. Stale, Zip COde) 309 Bishop Avenue, Clifton Hei hts Pa 19018 METHOD DISPOSITION PLACE OF DISPOSITION. Nameol Cemet.ry, Crematory LOCATION. CIfyITown, Stat.. Zip Code ......0 c......""n Ao......'_Slat.o Of Other P1ace ou.lSI>oc'" ",.Hollinger FH & Crematory SEE OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY ....FD-<l12909-L 17013 To the bell of my knowledge. death OCCLKTec:l It the time. dlte and place stated. (SignaturelndTiUe) .... 23b. .... TIME OF DEATH D.....e PRONOUNCED DEAD (Month. Day. Year) ,,",,5 CASE REFERRED 10 MEDICAl EXAMtNERlCORONER? 10:01 P January 23, 2004 ...~ NoD 'c. .... '5. .,. 21. MIlT I: E,.erthe d.......lnjunH Of complCatioM which caUMd the death. 00 not ent.f lhe mode of dying, .uch a. cardiac or respiratory 1ffes1. .hock or hurl railure. IApproxlmat. PAATII: 0lMr" Significant conc:tItioIw contributing to dMth. but Lilt only one ClIUM on each line. : Interval be1wMn not rnuhing In the underlying cauM given in PART I. lonsatanddealh I a. i , .. ! oue 10 (OR AS A C()tIISEOUENCE OF): I . : DUE 10 (OR AS A CONSEOUENCE OF): , , I . WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? .ulLABlE PRIOR 10 (Month, Day. Year) COMPLETlON OF CAUSE 0 0 OF DERH? N....oI HomiCide -...0 No~ A- D P.nding lnvntigMion g .... 0 o PlACE OF INJUR~. AI hOme. larm, arm, lactory. otrlce SuIcIdo Could not be ditterrntned building, etc. (Specify) - .... ... _. CIRT....p-. """ eno) .CIJI'TI'YIHCI ~AN (PhyIician certifying ~ 01 dee1h when MOther physician hal pronounced du.1h and completed hern 23) 0 To......ot...,ItnowtlIdte.ct.ethoccunwcldueto..~.).ndlftalWMt...tated..,...........................,..................... . .PfIONOUNCINQ AND CUlTIFYING PHYSICIAN (Phyticien both pronouncilg deeth and certifying 10 cauee 01 deeth) 0 2004 To"'~of""knowtMge.deelhoocurNd..tM......,...,anclplace,andduetotheceUM(.).ndlft8llMr..................,.............. . 'IIEDICAI. EXAMINEIlICOAONEA On tile.... of ..~ anellOI' In~ion.ln my opinion, dellth occurred" the time, d.... and pI8ce. and dua to the cauH(l) and ~ .........aIIIIed....... ...................................................,.......................,............... ItL ~ REGISTRAR'S StGN.fJURE AN.D (:\. ~~&...~-tAl ~ I A..i\ I 01 . .c. COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION PO BDX ;'80601 APPRAISEHENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSHENT OF TAX REY-15~7 EX AFP (O9-0~) DATE 11-29-2004 ESTATE OF DODSON EDWARD J DATE OF DEATH 01-23-2004 FILE NUMBER 21 04-0168 "CO~TY CUMBERLAND JAMES D HUGHES ESQ ACN 101 SALZMANN ETAL I Allount Rellitted I 95 ALEXANDER SPG RD 3 CARLISLE 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:[54-j-E3f-AFP-(oY:oiT-NoYicE--OF-ytiHERifAirCE-'~"-Ai-A-PPRA-isEifiNT~--Ai:.D)WAirCE-(rR------------- ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DODSON EDWARD J FILE NO. 21 04-0168 ACN 101 DATE 11-29-2004 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) (1) 80.000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 7.003.00 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 87,003.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 21,956.00 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 5.618.00 11. Total Deductions (11) 27.574 00 12. Net Value of Tax Return (12) 59,429.00 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (4) 59,429.00 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate US) .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00 17. Allount of Line 14 at Sibling rate un 59,429.00 X 12 = 7,131.48 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 7,131.48 TAX CREDITS: KI:l,;I:.L1"1 l+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 10-05-2004 CD004469 .00 7,503.00 TOTAL TAX CREDIT 7,503.00 BALANCE OF TAX DUE 371.52CR INTEREST AND PEN. .00 TOTAL DUE 371.52CR II IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. (J~ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) \It- . \ RESERVATION: Estates Df decedents dying Dn Dr befDre December lZ, 198Z -- if any future interest in the estate is transferred in pDssessiDn Dr enjDYMent tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CDmmDnwealth hereby expresslY reserves the right tD appraise and assess transfer Inheritance Taxes at the lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: TD fulfill the requirements Df SectiDn Zl40 Df the Inheritance and Estate Tax Act, Act Z3 Df ZOOO. (n P.S. SectiDn 9140). PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDur paYMent tD the Register Df Wills printed Dn the reverse side. --Make check Dr mDney Drder payable tD: REGISTER OF HILLS, AGENT REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDMpleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available Dnline at www.revenue.state.Da.us, any Register Df Wills Dr Revenue District Office, Dr frDM the DepartMent.s Z4-hDur enswering service fDr fDrms Drders: 1-800-36Z-Z050; services fDr taxpayers with special hearing and/Dr speaking needs: 1-800-447-30Z0 (TT Dnly). OBJECTIONS: Any party in interest nDt satisfied with the appraisment, allDwance Dr disallDwance Df deductiDns Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice May Dbject within 60 days Df the date Df receipt Df this nDtice by filing Dne Df the fDIIDwing: A) PrDtest tD the PA Department Df Revenue, BDard Df Appeals. YDU may Dbject by filing a prDtest Dnline at www.bDardDfappeals.state.pa.us Dn Dr befDre the expiratiDn Df the sixty-day appeal periDd. In Drder fDr an electrDnic prDtest tD be valid, YDU must receive a cDnfirmatiDn nUMber and prDcessed date frDm the BDard Df Appeals website. YDU May alsD send a written prDtest tD PA DepartMent Df Revenue, BDard Df Appeals P.O. BDx Z810Z1, Harrisburg, PA 171Z8-10Z1. PetitiDns may nDt be faxed. B) ElectiDn tD have the matter determined at the audit Df the accDunt Df the persDnal representative. ADMIN- C) Appeal tD the Orphans' CDurt. ISTRATIVE CORRECTIONS: Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue, Bureeu Df Individual Taxes, ATTN: PDSt Assessment Review Unit, P.O. 8DX Z80601, Harrisburg, PA 171Z8-0601 PhDne (717) 787-6505. See page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs. DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5Z) discDunt Df the tax paid is allDwed. PENALTY: The 15Z tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax aMnesty periDd. This nDn-participatiDn penalty is appealable in the same Manner and in the the same time periDd as yDU wDuld appeal the tax and interest that has been assessed as indicated Dn this nDtice. INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDM the date Df death, tD the date Df paYMent. Taxes which becaMe delinquent befDre January 1, 198Z bear interest at the rate Df six (6Z) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after January 1, 198Z will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 198Z thrDugh Z004 are: Interest Daily Interest Daily Interest Daily Year Rate FactDr Year Rate FactDr Year Rate FactDr 1m ~ ~ ~-1991 --rrr- :'11i'6!iiT" Zli1il --gr- . "OOo'Z4'r 1983 16Z .000438 199Z 9Z .000Z47 ZOOZ 6Z .000164 1984 11Z .000301 1993-1994 7Z .00019Z Z003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000Z47 Z004 4Z .000110 1986 10Z .000Z74 1999 7Z .00019Z 1987 10Z .000Z74 ZOOO 7Z .00019Z --Interest is calculated as fDIIDWS: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDMes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated. I REV-1470 EX (6-66) ',* INHERITANCE TAX . EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Edward J. Dodsonl 2104-0168 REVIEWED BY ACN ANITA MCCULLY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H Total on Schedule H was not correctly carried forward to recapitulation page. ROW Page 1 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphans' Court One Courthouse Square Carlisle, PA 17013 Marjorie A. Wevodau First Deputy Phone: (717) 240-6345 Kirk S. Sohonage, Esq. Fax: (717)240-7797 Solicitor OFFICES OF ~egister of Wills anb <tlerk of tbe <!t)rpbans' <tourt Qtountp of Qtumberlanb TO: Credij First National Association BKl3/Credit Operation, Box 818011 Cleveland OH 44181-8011 IN RE: Estate of Edward J. Dodson Date: 03/02/04 I am in receipt of your Statement of Claim on the above referenced estate. Our fee for filing such claim is $ 5.00. Please forward this amount to the attention of Margie. Your claim will be place on hold and not filed until the fee has been received. Thank you. ("') C. g ::D ",.... '."'~ :D == (\' ,',-) -1 -- i'::: .., ',.1 ::3: ::t:' ;:c --" U1 -::9 !'oJ --" 0 - Glenda F"'arner Strasbaugh Register of Wills & Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 Marjorie A. Wevodau First Deputy Phone: (717) 240-6345 Kirk S. Sohonage, Esq. Fax: (717)240-7797 Solicitor OFFICES OF 3Register of Wills nub QClerk of tbe <!&rpbaus' QCourt <!Count!' of <!Cumberlanb TO: Credit First National Association BK13/Credit Operation, Box 818011 Cleveland OH 44181-8011 IN RE: Estate of Edward J. Dodson Date: 03/02/04 I am in receipt of your Statement of Claim on the above referenced estate. Our fee for filing such claim is $ 5.00. Please forward this amount to the attention of Margie. Your claim will be place on hold and not filed until the fee has been received. Thank you. RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Re~ister Of Wills Rece~pt D~te: 3/16/2004 Hanover and Hi1h Stree Recelpt Tlme: 09:04:40 Carlisle, PA 7013 Receipt No.: 1035934 DODSON EDWARD J - -- - -- Estate File No. : 2004-00168 Paid By Remarks: CREDIT FIRST NATIONAL MW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name CLAIM AGAINST EST 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 090325516 ~5.00 Total Received......... 5.00 ... , Cumberland County Courthouse Register Of Wills I Courthouse Square Carlisle, PA 17013 IN RE: ESTATE OF Edward J. Dodson 11 Michaux Dr. Newville, PA 17241-0000 File Nu.b.., ~\\. Ci.)\lI!~ Division: ~~ DECEASED DATE: 01/23/04 STATEMENT OF CLAIM The undersigned hereby presents for filing against the above estate this statement of claim and alleges: l. The basis of the claim is goods and services provided Edward J. Dodson and charged on account number #531526449. 2. The name and address of the claimant is: Credit First National Association Revolving Charge Account for Expert Tire Customers BK13/Credit Operations PO Box 818011 Cleveland, Ohio 44181-8011 3. The amount of the claim is $268.34 which amount is now due and owing. 4. The claim is not contingent. 5. The claim is not secured. 6. A statement of the account is attached. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. Or:" :n ",.. ",'- g =: (1) ::0(1) Executed this 25th day of February, 2004. =1 :;~ oc rr .. <''") o. CREDIT FIRST NATIONAL ASSOCIATION G.> :x ::J::::> REVOLVING CHARGE ACCOUNT FOR EXPERT TIRE CUSTOMERS ::0 ^--~~ I --" BY. -u Credit Represent.tive N COpy lII.iIed to p.rson~r.~.~. N 0\ on -'. - .. .- .-. ~ ,.,. ,~-, .,.. -. ~ -.- .-. '"7 J':~ ,. -- ," .' .... _' _ "_ .~:. ., '_ ~~~. :.:.. . '.. - - - '.. ,;. . ~..;' '._' .~.~, "H"~' ',- - _. -_ [(li'.F.'" DenSer, , ;::( D ,'FlJ\{ "_' p..;, ~7<::41-0CCC- BALAr~{:E~ $301,04 -:-vPE. L;::,TE ~,TCJF.'"... TIChET AtF'OUNT FC INS FiA F'/D BAl.ANCE SfMT O~!1"5.i~ 4.60 ~oo 12800 21~OO 301m94 LPF U~ 3.5 04 29.00 ~ATE PAYMENT FEE STMT 01:15/04 15.65 .00 11.00 10.00 268.34 LPF 01,f15j'(}d 29~OO L.A'fE PAYMENT FEE STMT 12/15 03 ~oo yOO lQ~OO ~oo 223,69 STMT 11/15/03 .;::0 ~uv 10.00 ~vv 223~69 (:ASH 11/03,/03 19003 162570 112~25- STMT 10,/:5/03 ,00 ~oo 13.00 ~oo 335~94 90DA 10/1.0/0: 652059 1()7289 94.30 EXPERT TIRE 90DA lO!(~J!03 652059 107080 241,64 EXPERT TIRE STp'!T 05 J.5/()?; "C~G :<OCt ,GO .,OC{ ...00 CASH 04/24/03 19003 901029 131.~67- {:ASH 04/17/03 19003 452774 55s00- STMT 04/15/03 ~oo sUU 10.00 10~OO 186~67 LPF 04/15/03 25.00 LATE PAYMENT FEE STMT OJ/15/03 .00 wOO 10.00 tOO 161.67 90DA 02/21/Q3 652059 100873 161~67 EXPERT TIRE STMT 01/15/03 .00 ~OO .00 aDO ~OQ {:ASH (~1!.141!03 19003 900022 22~45- STMT 12/15/02 ~OO $00 10.00 .00 22.45 90DA 12:07/02 652059 98788 22~09 EXPER'r TIRE . REV-1500 EX (6-00) OFFICIAl. USE ONLY COMMONWEALTH OF REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 - 04 0168 ----- COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Dodson Edward J 207-44-1278 Z w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 1/23/2004 11/3/1952 REGISTER OF WILLS u w (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w 00 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) ~ ~:$(/) D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required uJX:~ wC1.U :cOO D 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes uJX:...I C1.lD D 9. Litigation Proceeds Received D 10. Spousal POlll!rtyCredit (d.'. of d8O'h b.tw.." 12.31-9' .....,.1-95) D 11. Election to tax under Sec. 9113(A)(AIl8ChSchO) ~ rIiIS.SECTION..MUSTBE. COMPI.ETED...ALI..'CORRE.SPONDENCe.'ANO.CoNFIDENTIALTAX'INFORMATIONSHOOI..D'ae'bIRECTEDTO: I- NAME COMPLETE MAILING ADDRESS z w c James D. Hughes, Esquire 95 ~exander Spring Road, Suite 3 z 0 FIRM NAME (If Applicable) Q. tn ~ SALZMANN , HUGHES & FISHMAN PC Carlisle, PA 17013 8 TELEPHONE NUMBER 717-249-6333 80,00 . ..... 8FICIAl. US~~ 1. Real Estate (Schedule A) (1) \- ... {,~~ OZ_ ~ ,"', :'.. 2. Stocks and Bonds (Schedule B) (2) I. 0'.' c::J 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 --I 4. Mortgages & Noles Receivable (Schedule D) (4) 0 I \...l1 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 7,003. (Schedule E) -0 Z 0 W 1..,' e 6. JO Owned Property (Schedule F) (6) ~ t= Separate Billing Requested 0 :5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0 ;:) (Schedule G or L) l- ii: 8. Total Gross Assets (total Lines 1-7) (8) 87,003 <( U 18,864 w 9. Funeral Expenses & Administratilll! Costs (Schedule H) (9) 0:: 10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10) 5,618 11. Total Deductions (total Lines 9 & 10) (11 ) 24,482 12. Net Value of Estate (Line 8 minus Line 11) (12) 62,521 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 0 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 62,521 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0 x,O ~ (15) 0 Z rate, or transfers under Sec. 9116 (aX1,2) 0 i= 16. Amount of Line 14 taxable at lineal rate 0 x.o 45 (16) 0 < ~ :J 62,521 7,503 C1. 17. Amount of Line 14 taxable at sibling rate x.12 (17) :::IE 0 0 0 U 18. Amount of Line 14 taxable at collateral rate x.15 (18) ~ 19. Tax Due (19) 7,503 ~ 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 's; >:....BE SURE TO.ANSVVERALI..QUESTIONS.OH...REVERSE.SID.E.ANO..RECH ECK.MATH....<(.-< 3W4645 1.000 Decedent's Complete Address: STREET ADDRESS 11 Michaux Drive Cumberland CITY I STATE I ZIP Newville PA 17241- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 7,503 2. Credits/Payments A. Spousal Poverty Credit 0 8. Prior Payments 0 C. Discount 0 Total Credits (A + 8 + C) (2) 0 3. Interest/Penalty if applicable D. Interest 0 E. Penalty 0 TotallnteresUPenalty (D + E) (3) 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7,503 A. Enter the interest on the tax due. (5A) 0 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 7,503 Make Check Pa able 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;. . . . . . . . . . . . . . . . . . . . . D og b. retain the right to designate who shall use the property transferred or its income;. . . . . . . . D og c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . D og d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . D og 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Qg 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D Qg 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D []g IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have llllamined this retum. induding accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct and complete. Oeclaration of preparer other than the personal representati 's based 00 all informalioo of which preparer has any knowledge. SIG E 0 PERSON PONSIBLE FOR FI\,.ING RN tC) .P Wynnewood, PA 19096 Carlisle, PA 17013 For dates of de h on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is 3% [72 P.S. ~ 99 (a) (1.1) (i)]. or of death on or after January 1, 1995, the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is 0% [72 P.S. ~ 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stRI applicable ewn 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 chid is 0% [72 P.S. ~ 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~ 9116(1.2) [72 P.S. ~ 9116(a)(1)). The tax rate imposed on the net value oftransfers to or for the use ofthe decedent's siblings is 12% (72 P.S. ~ 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Edward J. Dodson 21-04-0168 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 joinlly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. 11 Michaux Dri.ve Newvi.lle, PA 17241 (settlement sheet attached) 80,000 TOTAL (Also enter on line 1, Recapitulation) $ 80,000 3W4695 1.000 (If more space is needed, insert additional sheets of the same size) REV-150B EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Edward J. Dodson 21-04-0168 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1992 Ford Ranger 4x4 ( sold) 800 2 1995 Chevrolet ( sold) 2,500 3 ~scellaneous household goods & personal property 2,700 4 Waypoint Bank 797 5 Waypoint Bank, savings 206 TOTAL (Also enter on line 5 Recaoitulalion\ $ 7,003 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-151.1 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Edward J. Dodson 21-04-0168 Debts of decedent must be reported on Schedule J. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Archdiocese of Philadelphia 30 2 Brill's Flowers 75 Total from continuation pages 3,107 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 4,000 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 147 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Charles w. Dodson 1,130 2 Hernan Plumbing 147 3 Register of Wills 25 4 Settlement charges 10,188 TOTAL (Also enter on line 9, Recapitulation) $ 18,849 3W 46AG 1.000 (If more space is needed, insert additional sheets of the same size) Schedule H part 1 (Page 2) Estate of: Edward J. Dodson Item No. Description Amount 3 Catholic Cemeteries 550 4 Lamb Tavern 252 5 Ronan Funeral Home 1,847 6 Stefan Memorials 458 Total (Carry forward to main schedule) 3,107 REV-1512 EX + (6-98) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX REruRN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Edward J. Dodson 21-04-0168 Include un reimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Andorra Radiology Assoc. PC 401 2 Apria Healthcare 29 3 AT&T Wireless 31 4 BSAH Cobra Health Insurance 207 5 Bureau of Account Management 14 6 Carlisle Neuro Care 267 7 Central Penn Medical Group Emergency 1,168 8 Credit First National Assoc. 268 9 Lane. HMA Phys. Mgmt. 63 10 Lentz, Cantor & Massey 197 11 Mable Stitt, Tax Collector 10 12 Mechanicsburg Family Practice 141 13 Met-Ed 680 14 PA Department of Revenue, 2003 income tax due 16 15 Pennsylvania Neuro Assoc. Ltd. 33 16 Pinnacle Health Hospitals 324 17 Quantum Imaging & Therapeutic 167 18 Sprint Telephone 211 19 Waste Management of Central PA 1,028 20 West Shore EMS 363 TOTAL (Also enter on line 10, Recapitulation) $ 5,618 3W46AH 1.000 (If more space is needed, insert additional sheets of the same size) . REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Edward J. Dodson 21-04-0168 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Jean Dalesio 39 Hillcrest Road Barto, PA 19504 Sister one-half 2 Charles W. Dodson 1125 W. Wynnewood Road Wynnewood, PA 19096 Brother one-half ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) A. SettJement Stltoment U.S. Dopal1monl al Hau.lng OMS Approval No, Z50Z.0Z6! . and Urb.n Oovttlopmont B. TYPlI of Loan 1{ J FHA 2.[ ]FmHA 3, r I Conv.Unlns /6. File Num~r: /7. Loan Numb.r: 18' Mortgage Insurance Caso N"mbor: o ( IVA 5. ( J Canv,lns. 400400884-SK C. NOTE: THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETILEMENT COSTS AMOUNTS PAID TO AAO BY THE SEiTLEMENT AGENT ARE SHOWN. ITEMS MARKED "(p.O.C.r WERE PAID OUTSIDE THE CLOSING: THEY ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND NOT INCLUCED IN THE TOTALS. D. Nom. .nd Add,.ss al galTaw.r , E. Nama ond Add..... a' S.U., I F. Nam. ond Addr.o. at L.nd., JANET K GLESSNER CHARLES W DOOSON. AOMINISTRATOR OF ESTATE OF EDWARD J. DODSON 5015 SANTA CRUZ AVENUE ~9 SAN DIEGO. CA 92107 .pA G. PROPI<RTY LOCATION H. Senlemont Agont 11 MICHAUX DRIVE, SECURED LAND TRANSFERS. MECHANICSBURI3 NEIM/H.LE. PA 17241 PI.ce alSottlomenl I. Son/emenl Date I 1068 HARRISBURG PIKE OI.Dunoment Oet. CARLISLE, PA 5/21/20043:00:00 1'1.1/5/2112004 J. SUMMARY OF aORROWI<R'S TRANSACTIONS I(, SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Du. F,a," Ba"......' .00. 0'0" Amount Due To SoU., 101. P,,'chaso Prico 580,000.00 401. Purchase Price 580,000.00 102. Persane' Property 402. Personel Property 103. S.ttl.ment Cha,;..to BOlrow.1 52.0&425 403. H)4 404. 105. 405. AdJullmlnla Fa, 111m. P.ld By Siller In Advan.o AdJullmonla For II.ml PaId By Soll.r In Adllln.. 106. ClrylTown Tax.. 406. ClrylTown Tax"" 107 County Taxos 204. 1200'yr for 05121/04 lhru 01101106 5125.48 407. Counly TlUes 204,' ~OO/yrfor 05'21104 lhru 01/01/05 $125.48 108, Aneumanls 408. AIGasomenlo 109. Senool Tax8I 9S4.2900/yr for 05121/04 1~11J 07/01/04 5106,90 409. Sehaal Taxes 954.2900iyr to, 05121104 thru 07/01/04 $106.90 110. 410. 111, 411. 112 412. 120. GrO.1 AMount Due F'am Borrowe, I 582,316.63 420. Gro.. Amounl Du. To SOUII I 580.232 38 200. Amount. P.ld By Or In BehaN Of So"......, :100. R.due"onl In Amounl Du. To SI"O' 201, Eerneal Money 51.500.00 SO 1, Exca oa depooll 202. Princlpel Amaunl of Now Laan(s) :IOZ. So"'-mont Ch.rg.. To Soll.r (IInl 1400) 58,388.10 203. ExiSllng 10en(l) teken subject 10 503. ex;01,n9 Loeneo) leken Subject To 204. 504. Nel Payoll to Wavpalnl Sonk $27,400 23 205. 505. Peyoff of Seeond Mortgaga Loen 206. 506. 207, 501. 208. 508. 209. 509. Ad,uotm.nlll Far It.m. Unpold By S.II.r AdJu..m.nll For I..ms Unpold By 8811.. 210. Cll\IlTown Tax.s 510. Cl1yITown Texes 21 1. Count)' Toxes 51 I County Toxe. 2' 2 Assessmonls 5' 2 As:t9G&ments 213. 513. 214. Repair & Ooons Removal 5' ,800.00 514. Repelr & Dob"~ Removal 5',80JOO 215. 515. 21S. 518. 217. 517. 218. 518. 219 519. 220. Total Paid By/Fa, Barra....' , 53,300.00 520. Total ReduClJon Amount Ou. SoUer I 531.588.33 300. Cuh At S.m.m.nt FremITo Borrow., 800. Ca." At S8mem.nt To/FrGm Sell.( 301. Gross Amounl Duo From Barrow., Qlne 120) I 582,3' 8.63 601. GrolS Amount Due To Seller (line 420) I 580,232.38 302. Less Amaunll Palo By,Fa, Borrower (line 2201 I 53.300.00 602. Less Deaucllons In AIlll. Due To SaUor (Ilno 520) I 537.588 33 303. cun [ x I From [ I To 80'"''''.' $19,016.63 i03. coon [X I To I I From S.II., 542.8".05 Payoll(o). ,--/ M~"-:?l '-700J 1.:;;00 717 5'31 aSP',:1 76;; p.02 MH\ 21 2804 14:81 =R SECURED '_LIND '7l '7 5='1 8588 TO DI~~5BURG "'."'~/i<l~ 400400884 - SK Page 2 ~. SlltIlmlnl Slallmlnl 700. TGIaI SIll' CGmmlulGn 10000.00 It 7 14 . 5800.00 OMolon 01 Commlulon IlInl 700) AI Follow" PaId From Borrower's Paid From SIII.fs 701 S2825.00 10 CB'Homll81e Service. Group FundS A! SettJemeJ1t FundS A' Se~lement 702. $2775.00 '0 e:RA-NRT, Inc. 703. Commission paid at uftlemont $5.600.00 705, Tr8l1caetiol'1 Fee to C8IHomesele SeNICU Group $195,00 707. Transaction Fee to ERA-NRT, tnc. $125.00 100. 'Ioml Payable In Conneotlon Wllll LOIn 801. LOGn OrlglnGt;on FOe 1102. Loan D,scoun' 80l AppraISal Fee 804 Credll Report 1105. LBnoefa Inspection Foe 900. 'Ilms Rlqulrwd By Linder To Be Plld In "'<lVenoe 90 ,. 'n'8'0C! From 902. Mongege InsurencI Premium lor 90l. Hezartllnsurance ~ramlum lor 1000. RUONI. a,po.llld WIlli Londl' 1001. Huertlln,urenee , 002. Monoage Inaurance 1003. CUy Property Texes 1004, Coun!y Proporty Taxo. 1100. TllIl Charg.. ,,01. Sentlmon' or Clo.lng Fee I 102. ...bSlloct or Till" Search 1103. Tml EJramlnlllon 1108. NotIfy Feo.'O Ca.h $2.00 $5.00 11 OJ. Anorney'. Fee. 1108. Title InsurancI to Socured Land T.an.'.... - Mechanicaourg $738.75 1109. L"nder'. Covlreg" $ (51 " I O. Owner's coverage SBOOOO.OO (5738.751 t 1 14, Overnlghl Delivery & proc.s~ng Fee 10 SetureCl Land Tran&fers.. Meeh3niest)ufg 515.00 11 Z2. Tox Cert to Securad Lond T"'n.r~. Mechon,csburg $2.00 lZ00. Govornmlnl Rlcordlng ...nd Tranofer Chargel 1201, Recording Fee" Deed 5 38.50; Mortgage $ 538.50 1202, C,ty/CounlY Ta.JSremps 800.00 S800.00 1203. Stete Deed To. $ 800.00 $BOO .00 1205. 1300. Addltlona' SllllDlTl9ll1 Chorgoa 1302. Po.tln.peel"'n to Home Spec $40,00 1303, Home WarranlY to AON Homo We,,,,nly 5409.00 1304. Homl In.poc~on 10 Homo Soec 524500 1305. Soollc IneplCort, to DEW & Sono Sepl,c Service $95.00 $85.00 1308. ~esl Treolment 10 Home Spec $726.10 1301. Oewintl.izerion 10 He""1n ~Iumbing $66.00 1308. Ooed Prep to Salz",.n, Hugh., & FI.hm.n, P.C. (POC by Seller) 1309. Plumbing Repeir, to He""en Plumbing $4B5,00 1400. Total S.ltl.mlnl Chargn(En..r On ~Inn 10'. SIc:1ton J And 502, Slellon K) 52,084,25 S8,3aS.10 I MSYd carefully revlewa"!tIe HUD-1 Senlemenl Stll!ement arlO to tn. bllt of m,; knowledge and belief Ills true and accura~e statement of all receipts and dl5bur"$8metltS on my account or by me rn this transaction. I furtt'1er certify 11'181 I hive received. copy Of the HUe..' Setllement Stalemen!. rh.RS & ~P'/~ ~<YIA' IbL {Jnet K. 1.laner I ** TOT~L PRGE.03 ** MA\'-;:>1-;:>~?l4 14:01 717 591 eSQS '75~'~ P.03 . ~IWay~qi!1J 8/3/2004 SALZMANN HUGHES & FISHMAN PC 95 ALEXANDER SPRING RD STE 3 CARLISLE PA 17013 The information which you requested on the account(s) of EDWARD J DODSON (Social Security Number 207-44-1278) is/are as follows: Account Number 100425883 5500030107 Class of Account CHECKING SAVINGS Date Opened 091102 091102 Principal Balance 796.81 205.59 Accrued Interest 0.00 .02 Balance at Date of 796.81 205.61 Death Account Ownership SOLE SOLE Name of Joint Owner, if any Date Ownership 091102 091102 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional ~1,tzdb{ Information Requested . - E WATTS SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG. PENNSYlVANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com COMMONWEALTH OF PENNSYLVANIA , L 55: COUNTY OF CUMBERLAND J Charles W. Dodson being duly sworn according to law, deposes and says that he is the Adminstrator of the Estate of Edward J. Dodson late of -Penn--'I'oWRship-- -_._---~------_.- , Cumberland County, Pa., deceased and that the within is an inventory made by him th 'd Administrator ~- -, e sal of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. and subscribed before me, ~ W j)~ - -" 004 Executor. Administrator 11?S W. Wynnewood Road OF PENNSYLVAN Notarial Seal Wynnewood, PA 19096 Jacqueline L. Drawbaugh, Notary Public Address South Middleton Twp., Cumberland County My Commission Expires Aug. 14, 2007 Member, Pennsylvania Association of Notaries January 2004 23 Date of Death Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal repre:.sJ(ftative. . -.- -. 0 ...... 2. A supplement inventory must be filed within thirty days of discovery of additional a!J~s. ..t::>- r.~ . 3. Additional sheets may be attached as to personalty or realty CJ c-J 4. See Article IV, Fiduciaries Act of 1949. --l I U1 -0 L0 .c::,. 0 ~ >- -0 . ! CD I- W ~ ... ()I I >- 0:: I- III f2 CD w -<( Q) 1.0 ~ 0.. I- ~ U CD U) 0 Q) ..-l 0 V) C 01 .. ;;-~ 0 W 0:: W III ~ I t- ::r 0.. 0.. C <::r Z I- ...J U. . III Ci<<S 0 U. ...J -<( 0 IJ! 0.. ~~ I W 0 -<( w ~' .;. ..-l > 0:: N I Z .... I z 0 c: C :;, . 0 - V) Z ~ 0 Q $ 0:: U z II w -<( - I 0.. -0 .. I c: ~ III I .... -.: I 0 Q) ~ -0 ..w Q) E .... CD 0 ~ I III :;, 0 I ...J U i.i: m Inventory of the real and personal estate of Edward J. Dodson deceased I ! 1. 11 ~tichaux Drive, Newville, PA $80,000 00 2. 1992 Ford Ranger 4X4 800 00 3. 1985 Chevrolet 2,500 00 4. Miscellaneous household goods & personal property 2,700 00 5. Waypoint Bank, checking account 797 00 6. Waypoint Bank, savings account 206 00 I TOTAL: I $95,516 00 I I COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004469 HUGHES JAMES D 95 ALEXANDER SPRING RD SUITE 3 CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER _nn___ fold ---------- -------- 101 I $7,503.00 ESTATE INFORMATION: SSN: 207-44-1278 I FILE NUMBER: 2104-0168 I DECEDENT NAME: DODSON EDWARD J I DA TE OF PAYMENT: 10/05/2004 I POSTMARK DATE: 10/05/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/23/2004 I I TOTAL AMOUNT PAID: $7,503.00 REMARKS: . ..-,. CHECK# 3121 INITIALS: MW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS .~~ ~ ""'- COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF IN~~A(:tA~-:iCE INHERITANCE TAX INHERITANCE TAX 1!I\q$I(lI!' PO BOX Z8D6Dl RECORD ADJUSTMENT HARRISBURG PA 171Z8-D6Dl REY-159S EX AFP 112-84) lfJGS ?O DATE 02-10-2005 _:;J ESTATE OF DODSON EDWARD J DATE OF DEATH 01-23-2004 FILE NUMBER 21 04-0168 ~r _ COUNTY CUMBERLAND JAMES D HUGHES ESO ACN 101 SALZMANN ETAL I Allount Rellitted I 95 ALEXANDER SPG RD 3 CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ...... RE-v:i59:i-E)f~Fii-(Oi-:o3i------iii-iiiHERiifANc-i-T;ri-RE1:0R:Ii~Dj-USTMiENT--i.----------------------------- ESTATE OF DODSON EDWARD J FILE NO. 21 04-0168 ACN 101 DATE 02-10-2005 ADJUST"ENT BASED ON: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Estate (Schedule A) (I) 80,000.00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. "ortgages/Notes Receivable (Schedule D) (4) .00 S. Cash/Bank Deposits/"isc. Personal Property (Schedule E) (5) 7,003.00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 87,003.00 DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adllinistrative Costs/ "iscellaneous Expenses (Schedule H) (9) 18,864.00 10. Dabts/Kortgage Liabilities/Liens (Schedule I) (10) 5,618.00 11. Total Deductions (llJ 24,482.00 12. Net Value of Tax Return (12) 62,521. 00 13. Chariteble/Governnental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 62.521. 00 TAX: IS. Amount of Line 14 at Spousal rate (IS) .OOX 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) .OOX 045= .00 17. ADount of Line 14 at Sibling rate (17) 62.521.00X 12 = 7.502.52 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19) 7,503.00 TAX CREDITS: . ~...-... R.......U l'l'J A"OUNT PAID DATE NU"BER INTEREST/PEN PAID (-) 10-05-2004 CD004469 .00 7,503.00 TOTAL TAX CREDIT 7,503.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) . REV-1470 EX (6-88) '* >- INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Edward J. Dodson 21 04-0168 REVIEWED BY ACN Steven James 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES > The above referenced ACN has been adjusted to correct the Schedule H total incorrectly increased at assessment. ROW PaQe 1 -- STATUS REPORT UNDER RULE 6.12 Name of Decedent: EDWARD J. DODSON Date of Death: January 23. 2004 No. 21-04-0168 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the estate is complete: ~ Yes _ 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 X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No d_ Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Cler Orphan's Court and may be attached to this report. Date: 6/30/05 Capacity: Personal Representative X Counsel for Personal Representative cA ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: EDWARD J. DODSON Date of Death: Januarv 23. 2004 No. 21-04-0168 Pursuant to RuJe 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: -L Yes _ No 2. If the answer is No. state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? - Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No d. Copies of receipts, releases,joinders and approvals of formal or informal accounts may be filed with the Cler Orphan's Court and may be attached to this report. Date: 6/30105 Capacity: Personal Representative X Counsel for Personal Representative c?<