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03-0552
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF ZNHER/TANCE TAX APPRAISENENT, ALLO#ANCE OR DISALLOHANCE OF DEDUCT/ONS AND ASSESSNENT OF TAX CHARLES E SHIELDS III 6 CLOUSER RD HECHANICSBURG PA 171~55. DATE 05-10-200~ ESTATE OF REESE DATE OF DEATH 06-27-2005 FILE NUHBER 21 05-0552 COUNTY CUHBERLAND 'C'4ACN 101 Amount RE¥-15~? EX kFP FLORENCE J HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRATSEHENT, ALLO#ANCE OR D~SALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF REESE FLORENCE J FILE NO. 21 05-0552 ACN 101 DATE 05-10-200q TAX RETURN #AS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) q. Nortgages/Notes Receivable (Schedule D) $. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) ($} 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Nlsc. Expenses (Schedule H) (9) 10. Debts/Nortgago L/ab/1/t/os/L/ans (Schedule ~) (10) 11. Total Deductions Not Value of Tax Return 75~519.69 .00 180~566.85 .00 .00 NOTE: To /nsure proper credit ~o your account, submit the upper port/on .00 of th/s form with your tax payment. 11,270.80 12~761.78 (11) 2~.032.~i8 (12) 27q,$60.23 15. 14. NOTE: ASSESSHENT OF TAX: 1.6. Amount of Line 14 at Spousal rate 16. Amount of L/ne 14 taxable a~ Lineal/Class A rata 17. Aeount of L/ne 14 at S/bl/ng rate 18. Amount of L/ne 14 taxable at Collateral/Class B rata 19. Princ/pal Tax Due TAX CREDITS: PAYNENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN pAID (-) 09-18-200:5 CD00:50:5:5 250. O0 0~-01-200~ CD00:5750 .00 BALANCE OF UNPAID INTEREST/PENALTY AS OF IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. (1.6) .00 x O0 = .00 (16) 27~,:560.Z:5 x 0~5 = 12,:5~6.21 (17). .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 12,:5~6.21 0R-02-200c~ ANOUNT PAID ~,750.00 7,:5~6.21 TOTAL TAX CREDZT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedul® J) (13) . O0 Nat Value of Estate Subject to Tax (14) 27~,:560.25 Zf an assessment was issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 w111 re~lect ~igures that lnclude the total of ALL returns assessed to date. 12,:5~6.21 .00 ~.0~ ~.0~ ( TF TOTAL DUE 'rs LESS THAN $1~ NO PAYNENT TS REQUIRED. 'rF TOTAL DUE IS REFLECTED AS A "CREDIT" ¢CR), YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF THIS FORN FOR 'rNSTRUCTIONS. ) RRz306.29 (8) 298,:592.81 RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral} beneficiaries of the decedent after L~ne expiration of any estate for life or for years, the Cemmon#aelth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafu[ Class B (collateraJ) rate on any such futura interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Sac[ion 9140). PAYMENT: Detach the top portion of this No[ica and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS, AGENT REFUND (CR): A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of #ills, any of the Z3 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: l-BOO-56Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: l-BOO-447-30ZO (TT only). OBJECTIONS: Any party in interest not satisfied aith the appraisement, alioaance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this No[ica must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZelOZl, Harrisburg, PA 17IZe-IOZI, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviaa Unit, Dept. Z&0601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (S) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SX tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This nan-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine [9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for I98Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 ~'~-199X lXX .OOO301 ~ 9Z .flOOZY? 1963 16X .000438 199Z 9Z .000247 ZOOZ 62 .OOO164 1984 X1Z .000301 1993-1994 7Z .00019Z 2003 52 .000137 1985 132 .000356 1995-1998 9Z .000247 ZOO4 42 .000110 1986 lOX .000274 1999 7X .00019Z 1987 lOX .000274 ZOO0 7Z .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bm calculated. GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 TELEPHONE (717) 766-0209 FAX (717) 795-7473 May 15, 2004 Attn: Sue Register of Wills Office Cumberland County Court House One Courthouse Square Carlisle, Pennsylvania 17013 In Re: Estate of Florence J. Reese 21 03-0552 Dear Sue: Please find enclosed check #1225 for payment regarding inheritance tax with the copy of the invoice in the above-mentioned estate. Thank you. ~~~Very truly yours, Charles E. Shields, III CES/mj Enclosure BUREAU OF INDIVIDUAL TAXES /NHERITAHC£ TAX DZVTSZON DEPT. 280601 HARRTSBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR D/SALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-03) CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG '04 i~iA~ 18 DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUNTY ACN 05-10-200q REESE 06-27-2005 21 03-0552 CUMBERLAND 101 FLORENCE J I / Amoun~ Rali~ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF I~ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LINE ~ RETAIN LONER PORTZON FOR YOUR RECORDS REV-15~7 EX RFP (01-03) NOTICE OF ZNHERTTANCE TAX APPRAISEMENT, ALLOgANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF REESE FLORENCE J FILE NO. 21 03-0552 ACN 101 DATE 05-10-ZOOq TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnersh/p q. Mortgages/Notes Receivable (Schedule D) 6. Cash/Bank Deposits~Misc. Personal Property (Schedule E) (6) 6. Jointly Owned Property {Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expansas/Adm. Costs/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgagm L/ab/1/t/es/L/ans (Schedule 1) (10) 11. Total Daduc~/ons 12. Nat Value of Tax Return 75~519.69 .00 180~566.85 .00 .00 NOTE: To /nsurm proper crad/t to your account, subm/t the upper port/on .00 of th/s form w/~h your tax payment. qq~$O6.Z9 (8) 298,592.81 11,270.80 12,761.78 (11} 24.032.58 (12) 27q,360.25 1:5. NOTE: ASSESSMENT OF TAX: 15. Amount of L/ne lq at Spouse1 rata 16. Amount of L/ne lq taxable at L/naal/Class A rata 17. Amount of L/nm lq at S/bl/ng ra~a 18. Amount of L/ne lq ~axabla at Collateral/Class B rata 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT RECEIPT DTSCOUNT DATE NUHBER INTEREST/PEN pATD (-) 09-18-2003 CD005035 250.00 0~-01-20§~ CD003750 . O0 Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Nat Value of Ese:ate SubSact to Tax (lq) 27~,$60 Z~ an assessment Has issued prev$o.~s[y- !~nes ~&, 15 and/er 16, 17, 18 and 19 re~lect ~igures that lnclude the tOtal o~ ALL returns assessed to date. BALANCE OF UNPAID INTEREST/PENALTY AS OF Oq-OZ-ZOOq .00 .25 will (1;) .00 x O0 = .00 (16) 27q,560.25 x Oq5 = 12,$q6.21 (17) . O0 x 12 = .00 (tS) .00 x 15 = .00 (19)= 12,$q6.21 AHOUNT pAID q,750.00 7,$q6.21 TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. 12,$q6.21 .00 q.0q q.0q ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession er enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). PAYMENT: REFUND (CA): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: Detach the top portion of this Notice and submit eith your payment to the Register of Hills printed an the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, ahich was nat requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Nills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour anseering service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied with the appraisement, elloaanca, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty [60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacadent's death, a five percent (SI) discount of the tax paid is allowed. The I~Z tax Gene=fy ncn-p=rticip=tio~ pansZty ~s computed on the ~o~! oS the tax and interest assassad~ and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penaZty is appealable in the same manner and in the the same time period as you aouZd appeal the tax and interest that has bean assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. Al! taxes which became delinquent on and after January 1, 198Z ailZ bear interest at a rate ahich wilZ vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .000548 ~'~-1991 11Z .000501 ~ 9Z .000247 1985 161 .000458 1991 9Z .000247 2002 6Z .000164 1984 llZ .000501 1995-1994 72 .000192 1005 5Z .000157 1985 152 .000556 1995-1998 92 .000247 2004 42 .000110 1986 10Z .000274 1999 7Z .000192 1987 10Z .000174 ZOO0 7Z .000192 --Interest is calculated as folloas: /NTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be caZculatad. 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 003950 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 204-26-9185 FILE NUMBER: 21 03-0552 DECEDENT NAME: REESE FLORENCE J DATE OF PAYMENT: 05/1 8/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4.04 TOTAL AMOUNT PAID: $4.04 REMARKS' CHARLES E SHIELDS III ESQ SEAL CHECK#1225 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, ! report the following with respect to completion of the administration of the above-captioned estate: 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 r~presentative file a final account with the Court? Yes No _~. . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative s~te an account informally to the parties in interest? Yes,~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: Si'gnature Name (Please type or print Address /JA 1 Tel. No. (MAH:rmf/AM3) Capacity: __Personal Representative Counsel for personal representative GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 July 20, 2004 TELEPHONE (717) FAX (717) 766-02O9 795-7473 Register of Wills Office Cumberland County Court House 1 Courthouse Square Carlisle, Pennsylvania 17013 Re: Estate of Florence J. Reese Admin. No. 21-03-552 Dear Register of Wills: Please find enclosed two copies of the Status Report for the above referenced Estate. Please clock-in both copies and place one in my mailbox for me to pick up at a later date. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III CES:slk Enclosures PETITION FOR PROBATE and GRANT OF LETTERS also known as ~ To: Register of Wills for the · Deceased. County of C~mC, E',~c.z#,o/> Social Security No. ~ '/- ~, -- 5~/~°~' Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petiTioner(s), x~ho is/are 18 years of age or older an the execu! r;x in the last wilt of the above decedent, dated _fl2_~,~artr Re' and codicil(s) dated ,b'/~ in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~/~/~R,~'L:, County, Pennsylvania, with her last family or principal residence at io~0 (list street, number and muncipality) Decendent, then __ 71 years of age, died at ~ei41~ I%~.rial Hosf~+al - ' 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) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF C:~r~t~i~L~tV2> f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and ~dminister ~e estate according to law. Sworn to or affirmed and subscribed X :;:.':. '-~:~ :~-.~: bef~ ~his _. .~ day of ~ / Regi:ted ~ tO No. 21-03-0552 Estate Of FLORENCE J. REESE , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JULY 8th 1[~ 2003, 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 FEBRUARY 28, 2000 described therein be admitted to probate and filed of record as the last will of FLORENCE J. REESE ; and Letters TESTAMENTARY are hereby granted to MALINDA J. REESE FEES Probate, Letters, Etc .......... $ 40.00 Short Certificates(5) $. 15.00 JCP $ 10.00 TOTAL . $ 6R.ao Filed . .J.U.L..Y..8.t.h.,..2.0.0.3. ................. Registe~ of Wills ATTORNEY (Sup. Ct. I.D. No.) ~g',b~l~' ADDRESS PHONE MAILED LETTERS TO ATTORNEY JULY 8, 2003 21-03-552 REGISTER OF WILLS OF C/~/~/~--7~g~a~ COUNTY OATH OF SUBSCRIBING WITNESS .(~nieh) a subscribing witness to the will presented herewith, (.~ae-h) being duly qualified according to law, depose(s) and say(s) that ~' ~'~..~ present and saw the testatt-Lx , sign the same and that /o~ signed as a witness at the request of testatrix in ~ presence and Un *~'" ~rcscncc of .... ,, ..... , ,-- ~.r.zcncc ...... u~,, ..... the olher subscribing ............ Sworn to or affirmed and subscribed before me this /~ day of Register (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OAiH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) bem~,d.~qualified according to law, depose(s) and say(s) that fam' '~.,with the signature of e~scri '" codicil ' testat.~ of (one of th bing ~i~nesses to) the will presented herewith and codicil / that ./ believes ~ signature on the will is in the handwriting of / . to the best of ~'" knowledge and belief. "~'" Sworn to ofl,/hffirmed and subscribed before this//// day of (ma~ed me ,. 19 ~',, Register (Address) (Name) (Address) 21-03-552 ~i~EGISTER OF WILLS OF /COUNTY (ach) a subscribing wime%o the will pressed herewith, (each) being duly qualified according to law, depose(s) and say(s) that ",, // present and saw the testat , sign the same~ signed as a witness at the request of testat ___ in b_.... ...... presence a~in the presence of each other) (in the presence of the other subscribing witness(4~j). ~ Sworn to or affirn¥6d and subscribed before %, me this // day of ..... (Name) / 19 .. Register (Address) (N~n~e) (Address) REGISTER OF WILLS OF C/gt~B~ COUNTY OATH OF NON-SUBSCRIBING WITNESS ~ a subscriber hereto,-(cach) being duly qualified according to law, depose(s) and say(s) that :5-,~ J,5 familiar with the signature of f:/~revnce ~.. ~ee~ testat~;g of (o-e of tke dub:crib!ag ';,'i:ncaaca ~) the will presented herewith and codicil that ~ ~g$ believes the signature on the will is in the handwriting of to the best of ~ knowledge and belief. Sworn to or affirmed and subscribed before ~ 3 ~'~'~;~ 5' ' >-:'- .' %-5.~ ,,c~ ~ ,-', -(_~ ~ .~' me this /~ day of m~U~/~ ~ ~~ .... ~ -'- RegiSter (Address) (Name) (Address) 105.805 REV !)/8(> ~":n s is to certify' that the information here given is correctly copied from an original certificate of death duly filed with me as !, ~al Rvgistran The original certificate will be forwarded to the State Vital Records Office for permanent ~ding. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee ~br this certificate, $2.00 P 9331134 No. Local Registrar Date COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Jo medical clinic 120 S. Filbe~ Stree~ PA 17055 C. Arthur Hertzler J. Reese Memorial Hospital ,.,.c,,.,~ C~lml'~rlanr] __ m,,.,.~p? me 30,2003 011667 L widowed ,~hite I,,.Alda Weaver 1~07m~,~4 Lancaster Blvd. MeChanicsburg' PA 17055 ,~Slate Hill Cemetery ,, .I~0wer A]]en Twp., Pa Funeral Home 8 Market Plaza Way 21-03-552 21-03-552 LAST WILL AND TESTAMENT OF FLORENCE .I. REE~;E I, FLORENCE J. REESE, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my beloved husband, BERT W. REESE, to his own use and benefit absolutely. 3. In the event my said husband, Bert W. Reese, should predecease me or die at about the same time I do, such as in an accident or disaster common to both of us, I hereby direct all the rest, residue and remainder of my Estate to be distributed to my daughter, MALINDA J. REESE. In the event she predeceases me, then to her issue, per stirpes. In the event she is not survived by issue, then my estate is to be divided into two (2) equal shares. One (1) share is to go to my niece, JANICE E. CUSTER and STEPHEN C. CUSTER, her husband, by the entireties. In the event they both predecease me, then to their issue. The other share is to go to my niece, PHYLLIS A. GROSS and her husband, STEVEN GROSS, by the entireties. In the event they both predecease me, then to their issue. 4. I nominate, constitute and appoint my husband, BERT W. REESE, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, MALINDA J. REESE, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my husband's niece's husband, STEPHEN C. CUSTER, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~/~ day of , A.D. 2000. Signed, sealed, published and declared by the above-named FLORENCE J. REESE as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our najpes as wimesses. 2 CERTIFICATION OF NOTICE UNDER RU! JF. 5.6(a) Name of Decedent: Date of Death: Will No. Florence J. Reese June 27, 2003 Admin. No. 21-03-0552 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 4, 2003: Name Address Malinda J. Reese 1075-4 Lancaster Blvd., Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: August 4, 2003 L.Et CHARLES E. SHIELDS, III 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, III A TTORNEY-A T-LA W 6 CLOUSER ROAD Corner of Trindle and Ch>user Roads MECHANICSBURG, PA 17055 TELEPHONE (717) FAX (717) 766-0209 795-7473 September 17, 2003 Office of the Register of Wills Cumberland County Court House 1 Court Square Carlisle, PA 17013 Re: Estate of Florence J. Reese #21-03-0552 Please find enclosed check #2706 in the amount of $4,750.00 to be placed on accoum for the inheritance tax regarding the above estate. Thank you for your assistance with this matter. Very truly yours, Charles E. Shields, III CES:mmh Encs. 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 003033 SHIELDS CHARLES E III ESQUIRE 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 204-26-9185 FILE NUMBER: 2103-0552 DECEDENT NAME: REESE FLORENCE J DATE OF PAYMENT: 09/18/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,750.00 TOTAL AMOUNT PAID: $4,750.00 REMARKS: MALINDA J REESE C/O CHARLES E SHIELDS III ESQUIRE SEAL CHECK# 27O6 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, III A TTORNE Y-A T-LA W 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 TELEPHONE (717) FAX (717) 766-0209 795-7473 April 1, 2004 Register of Wills Cumberland County Court House 1 Court Square Carlisle, PA 17013 Re: Estate of Florence J. Reese 21-03-552 Dear Ann: Please find enclosed three (3) checks, #159 in the amount of $230.00 for Additional Probate, check # 160 in the amount of $15.00 for the filing fee, and check # 158 in the amount of $7,346.21 for the dkt file 21-03-552 for the Estate of Florence J. Reese. Thank you for your assistance with this matter. Very truly yours, Charles E. Shields, III CES:mmh Encs. BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. Z80601 HARRTSBURG,, PA 171Z8-0601 COHHON~/EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERTTANCE TAX STATEMENT OF ACCOUNT REV-160? EX AFP (01-OS) NZCHAEL J HANFT ESQ HANFT &KNZGHT 19 BROOKUOOD CARLISLE :48 BATE 05-15-2006 ESTATE OF HETRICK BATE OF HEATH 05-21-2005 FILE NUHBER 21 05-0522 COUNTY CUHIIERLAND ACN 101 Amoun~ Remi~ed OLIVE HAKE CHECK PAYADLE AND REHZT PAYHENT TO: REGISTER OF MILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To lnsure proper credit: ~o your account:, subm:~: ~:he upper por~:ion of *hAs form wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LO~/ER PORTION FOR YOUR RECORDS ~ ESTATE OF HETRICK OLIVE ii FILE NO. Z1 05-05ZZ ACM 101 BATE 05-15-Z006 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELON ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 02-16-2006 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 10,956.26 PAYMENT RECEIPT DISCOUNT (+) DATE NUNIIER INTEREST/PEN PAID (-) AMOUNT PAID 08-21-2005 12-05-2005 02-17-2006 CD002927 CD005315 CD003567 675.68 .00 .00 9,000.00 1,567.06 95.62 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE ZS LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' TOTAL TAX CREDIT 10,956.36 BALANCE OF TAX DUE .10CR INTEREST AND PEN. .00 TOTAL DUE .10CR YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PAYMENT: Detach the top portion of thls Notice and submit with your payment made payable to the name and address printed on the reverse slde. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices ar from the Department's Iq-hour answering service for fores ordering: 1-BOO-362-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-q47-3OZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. gBO6gl, Harrisburg, PA ITIZB-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 1SI tax amnesty non-participatian penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 19aZ will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 ZOZ .0005~8 1988-1991 llX .OOO3Ol ZOO1 1983 162 .000438 199Z 92 .O00Zq7 ZOOZ 198q llZ .000301 1993-199q 7Z .O0019Z ZOO3 1985 132 .000356 1995-1998 92 .O00Zq7 ZOOq 1986 1DX .O00Z7q 1999 72 .00019Z 1987 92 .000Z47 ZOO0 82 .O00Z19 The applicable interest rates for 1982 through ZO0~ are: Interest Daily Rate Factor 92 .0002~7 62 .00016q 52 .000137 q2 .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must be calculated. REVo1500 EX (6-00) COMMONWEAl_IH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COUNTY CODE YEAR NUMBER I-- Z ILl UJ LU F- Z o o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER - - r~l. Original Return r--'l. Limited Estate []6. Decedent Died Testate (Attach copy of Will) E~9. Litigation Proceeds Received [~2. Supplemental Return [~4a. Future Interest Compromise (date of death alter 12-12-82) r--] 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~'~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ---]3. Remainder Return (date of death pdor to 12-13-82) ~---] 5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec, 9113(A)(Attach Sch O) THIS SECTION MUST .JB_~=~p__,~P~Ep~,A!~L~ CORRESPONDENCE A FIRM NAME (IfApplicable) TELEPHONE NUMBER ID CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO COMPLETE MAILING ADDRESS 10. 11. 12. 13. 14. 1. Reat 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 & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [-~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) OFFICIAL USE ONLY Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) Charitable and Govemmentat Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) ¢1) ,,if/, ~ ~ ;z. ~S (12)~ ;2 7~/'~ 3 ~,o. -~3 (13) O 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 x .o 0 (15) /' 3-7'/, $~,o. ,13 x .o ¥5' (16> /~'. 3Y(,,. z/ 0 x .12 (17) ~:) x .15 (18) (19) ~ t,,Ttt 39&.zl 19. Tax Due 20. [] ......... > ~;.BE SURE.TO .~NSWER~LL QUESTIONS ON REVERSE SIDE AND Rr=~HECK MATH < < Decedent's Complete Address: STREETADDRESS 5'~ i D I ~ /~'/~'~I,/ ~ J~ /,~ l.. H ~ ~ I° / ~"/~['~. " / ~_~ 5. ~'l/_,~',~"r 577. CITY ,~"/,~'~'~'H,~i',/V/' C,.~' Z~ ~''t~'' STATE p~ ZIP /7Z:)5'5- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) (5) (5A) (ED) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;..i..i .................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?: ............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under pena t es of perjury, I declare that I have exam ned this return, including accompanying schedules and statements, and to the best of my~ledge and belief, it is true, correct and complete, Declaration of preparer other than the personal representative is based on all information of which preparer hasta~'ne~edge. '" J SIGNATURE OF PER,SDN RESPONSIBLE Ek)~ FILING RETURN _ ~../~ x. J .,~ .4 /~,,-~/' ~ DATE ~/r a=a/ W~zr/~o~e~ ,et,., ~/P/~a~u~ , ,~',~ SIGNATURE ~i P~EPARrr_,8 OTHER THAN REP~N.T/~IVJiii , DATE ADDRESS {~/~/,,~--~Z.,E'~ ~ ~/.//_-~'Z.g:).~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the 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 decedent's siblings is 12% [72 RS. §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. REV4503EX+Jl-97~ ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH Savings Bond Calculator Up date Help Savi, 8/4/03 4:4~ PM Bond Series I ££Bonds Denomination Serial Number *1 200 I *1 i J Issue Date Add # Bonds Total Price 11 $1,100.00 Serial Number Issue Date Series Denom R87566307EE 04/1992 EE $200 R85577968EE 02/1992 EE 200 R84014135EE 12/1991 EE 200 R81314076EE 10/1991 EE 200 R137846536EE 08/1991 EE 200 R78234678EE 06/199! EE 200 R77127159EE 04/1991 EE 200 R72667119EE 02/1991 EE 200 R71357539EE 12/1990 EE 200 R69313624EE 10/1990 EE 200 ViewAll [ .~<Prev Viewing Bonds 2-11 Total Interest Total Value $1,097.36 $2,197.36 Issue Interest Next Price Interest Value Rate Accrual $100.00 $91.68 $191.68 6.00% 10/2003 100.00 91.68 191.68 6.00% 08/2003 100.00 97.36 197.36 6.00% 12/2003 100.00 97.36 197.36 6.00% 10/2003 100.00 97.36 197.36 6.00% 08/2003 100.00 103.28 203.28 4.00% 12/2003 100.00 103.28 203.28 4.00% 10/2003 100.00 103.28 203.28 4.00% 08/2003 100.00 107.36 207.36 4.00% 12/2003 100.00 107.36 207.36 4.00% 10/2003 YTD Interest $59.84 Final Maturity Note 04/2022 O el 02/2022 D el 12/2021 D el 10/2021 D el 08/2021 D el 06/2021 D el 04/2021 D e! 02/2021 D el 12/2020 D el 10/2020 D e! Note Description ~'f ~3 NI Not Issued Va/ue NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) M~ Matured (Not Exchangeable for HI-I) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Savings Bond Calculator (~ (~ (~ [.Submit $.~vc~,l ~ Poor http://wwws, publicdebt.t teas. gov/BC/SBCPrice Page I of I SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY REV-I~8 EX.~ {I-97} ~ COMMONWFALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,~52~.~.5,~, ,,~..~,p,,,t~,~_/V.~.~.._ c~. FILE NUMBER 2/-~3 Include the )roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi must be dlsck.~_-d on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) ~11, ss?. si POLICy/UNIT INSURED ' 0,11789zM1 'MR BERT W REESE JR DC 0 AGENT NAME O22443, JT LAUER ASU PPA TRANSACTION TYPE DEATH CLAIM BASIC DEATH BENEFIT TERMINATION DIVIDEND VOLUNTARY INTEREST DIVIDEND ADDITIONS POST MORTEM DIVIDEND CHECK AMOUNT FEDERAL ID 11-6586123 DEATH CLM NO 315342 LDC 20030915 REGISTER DATE FEB 28,1944 POliCY TYPE 1,000.00 18.55 48.59 903.00 29.74 CHECK DATE SEP 17,2003 INSURANCE 1,999.88 CHECK TYPE: ELAS-M IJ~'TACri 'FHIS ~TATEMENT BEFORE CHECK NO. 200553506 ,'O 80055~,sor~,' ~:O ;I, i, qOOL, L, 5~: August 29, 2003 BERT W REESE 824 LISBURNE RD APT 302 CAMP HILL, PA 17011 John Hancock Revolution Value Variable Annuity Certificate Number: RV02715179 Participant(s): BERT W REESE DATE "AUGUST""Z9 ;':r 2005 : CK#380-0700128710 PURPOSE OF CHECK CERTZFTCATE NUHBER AHOUNT ES~A~E¥OF:iTF£.ORENCE:' REESE PA~' TO 'rHE:,,ii HAL'IiNDA~;iilJ:~;REESE; EXECUTOR OR. DEE OF: 80], BAL'TIHORE RD .-: ,;'i~,,. ':.5.H]~-FPENSBURG, PA ~ 17257~{~ · ~ ~-: :::?:ii;i ~ ~7,.3, ,rneriChoice FEDERAL CREDIT UNION Building Relationships For Life September 23, 2003 Charles E. Shields, III Attorneys At Law 6 Clouser Road Mechanicsburg, PA 17055 RE: Estate of Florence J. Reese Account # 16569 & 16568 The accounts are as follows: Account Type Date opened DOD Balance Dividend YTD 6/30/03 Account # 16569 Share (Savings)-01 02-1976 Certificate of Deposit-60 07-1997 Account #16568 Share (Savings)-01 05-1970 Draft (Checking)- 13 04-1997 $ 11,599.51 $ 53.45 $ 24,266.67 $583.26 $121,800.98 $503.73 $ 1,148.,94 $ 2.37 The deceased, does not have a safe deposit with the credit union. Please call me at (717) 795-0248 if you need further assistance. Sincerely, Beth M. Yorlets Head Teller Main Office: 20 Sporting Green Drive, Mechanicsburg, PA 17050 * Phone: (717) 697-3474 * Fax: (717) 697-3713 Pennsboro Commons Office: 326 East Penn Drive, Enola, PA 17025 · Phone: (717) 909-0460 · Fax: (717) 909-0465 Website: www.americhoice.org CRI~IT UNIONS' MALINDA REE,SE AS EXECUTOR OF THE ESTATE OF FLORENCE REESE ATTORNEY AT LAW 6 CLOUSER RD MECHANICSBURG PA 17055 DATE:lO-22-03 RES ST: PA DZSTRZCT: PA4? AGENCY: 0890 APPROVER: dXL 631578437-1 ZNSURED: BERT'W REESE dR CCL 252-1129400062 REMARKS: ZNTEREST AT THE RATE OF POLZCY NO: 0000370200 BENEFZT DESCRZPTZON AMOUNT DTH CLM - ORD LZFE 7,000.00 PREM REFUND 143.37 ZNTEREST ON BENEFITS 251.55 DZVZDEND ACCUMULATNS 496.59 AMOUNT OF CHECK $7,891.51 3.50% HAS BEEN ADDED TO THE BENEFITS PAZD. 1129400062 52 AMERZCAN GENERAL LZFE AMD ACCZDENT SECURITY FEAI~JRES INCLUDE MICROPRINT BORDER AND VOID BACKGROUND. ABSENCE OF THESE INDICATE A COPY. ~:EST~E~'.:OE':~ F:~OEE~E~ ~Sg~"'.. ~ ::.....'.':':**.:;' .. 52 CCL 0000370200 BERT W REESE dR SUNTRUST'BANK~ NASH¥1[LE; TENNESSEE SuN;rRu$'F '8ANK~ SEVrERVli:LE.. TENNESSEE TREASURER~= AMERICAN GENERAI~:LIFE'AND; ACCIDENT AMERICAN GENERAL LIFE AND ACCIDENT Member of American International Group, Inc. AMERICAN GENERAL CENTER NASHVILLE, TN 37250 MALINDA REESE, AS EXECUTOR OF TH ESTATE OF BERT REESE 6 CLOWER ROAD MECHANICSBURG PA 17055 110574o37-8 11-o7-03 FOR: PAID-UP ADDITIONS CHECK AMOUNT 5,198.00 CLM 0221817 52 ~.~ /;i,'=~= /.=::~. =~..=.~=.~-;:-:~..:.!;.:~:.:=. !i='~.i..~= 61., CLOW~R ':ROAD: M~CfffANI'.C S:BIJRG [' : PA :~ BORDER AND VOID BACKGROUND. ABSENCE OF TH~SE INDICATE A COPY, 170'55 5'2 CLN 02,21817 SUNTRUST BANK, NASHVILLE, TENNESSEE SUNTRUST BANK, SEVIERVlLLF_, TENNESSEE -.~ ii!:::'i: :~':' :: ~:~ I~'''' :''"' ::~ii. ~ :o~ s ~!:~ ~, a:i!~'.'.",: ~ ~:r~ ~'."~:o TREASURER AMERICAN GENERAL LIFE AND ACCIDENT REV-1510 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ~c:~,~_~..~_~..5~ /~?~-~::/v/C~' ~. 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-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OETHETRANSFEREE, THEIRRELATIONSHIPTODECEDENTANDTHE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST I~F AP".~CAaLE) 1. 5 monf~s pr;er -i, d.o.d. ~z, ooo TOTAL (Also enter on line7, Recapitulation) $ /'~/'~, ,~e~,, ,,~ (If more space is needed, insert additional sheets of the same size) · s~.~ ar,,=.- ~o ~ 7~s. Fo~t Wa3~le IN 48801-787S -. FAX COVER SHEET I=hone Number:. . - 'Fax.Number:. - Rena B~ Lincoln Retireme'r~t s~4 Annuity Operations 1-260-485487~ ~b~com 348 1212 RE¥-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVAN A FUNERAL EXPENSES & RESIDENT DECEDENT INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ESTATE OF ., - /V'~'~-~"- . FILE NUMBER ~'l-- Debts of decedent must be reported on Schedule I. ITE~V NUMBER A. 1. DESCRIPTION FUNERAL EXPENSES: AMOUNT 5. 6. 7. ~,. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) ,4~,~//,~D,/j~ ~.. Social Security Number(s)/EJN Number of Personal Re Street Address City Year(s) Commission Paid: State , P,~f' Zip Attorney Fees E/~-/,~,,~Z~.~' ~ ,S'/~//~',~)..y ~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ~_/~//:2~/~.~' ~'*Z/~-/~' t ~c' Street Address City Relationship of Claimant to Decedent State _ Zip Probate Fees Accountant's Fees Tax Return Preparer's Fee TOTAL (Aisc enter on line 9, Recapitulation I~o 7.Z (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGELIABILITIES,&LIENS ESTATE OF ~,~_.~. ~._ FILE NUMBER 2/-03- Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ I ~ SELECTED DETAIL DATA USER ID: WXH1 03/29/04 0900 PT NO: 233097 *REESE ,FLORENCE MR NO: 204269185 ACCT TYPE: A SVC: SSN TOT CHRG: 717.50 ~EG: 07/17/02 DSCH: 06/27/03 FC: S PT: W EXP IND: * ACCT BAL: .00 .................................................................. PAGE NO: 1 ACCT BAL H60 V 701 V B42 V A02 V PT BAL · 00 .00 .00 .00 .00 .00 SVC POST SVC CD INS CD-DESCRIPTION/COMMENT-REF DATE QTY AMOUNT 082903 082903 11015 1 PAYMENT-PVT INS -1 -84.00 082903 082903 11015 1 PAYMENT-PVT INS -1 -41.00 100703 100703 11010 0 PAYMENT-PATIENT -1 -512.57 ! (PF14) SEL PT ! (PF3) DTL SUMM ! (PFll) ACCT CASH ! (PF15) RETURN TO PT OVERVIEW ! (PF10) ACCT CMNTS PF16 D/E PAQDTL01 1330 Pinnacle Health Hospitals PO Box 2353 Harrisburg PA 17105-2353 SELECTED DETAIL DATA USER ID: WXH1 03/29/04 0900 PT NO: 233097311 *REESE ,FLORENCE MR NO: 204269185 ACCT TYPE: A SVC: SSN TOT CHRG: 7361.06 REG: 07/17/02 DSCH: 05/31/03 FC: S PT: W EXP IND: ACCT BAL: .00 .................................................................. PAGE NO: 1 ACCT BAL 701 V B42 V A02 V PT BAL .00 .00 .00 .00 .00 SVC POST SVC CD INS CD-DESCRIPTION/COMMENT-REF DATE QTY AMOUNT 062403 062403 11013 1 PAYMENT MEDI B VERITUS -1 -88.47 073003 073003 11010 0 PAYMENT-PATIENT -1 -6927.06 ! (PF14) SEL PT ! (PF3) DTL SUMM ! (PFll) ACCT CASH ! (PF15) RETURN TO PT OVERVIEW ! (PF10) ACCT CMI~TS PF16 D/E PAQDTL01 1330 Pinnacle Health Hospitals PO Box 2353 Harrisburg PA 17105-2353 SELECTED DETAIL DATA USER ID: WXH1 03/29/04 0900 ?T NO: 233097312 *REESE ,FLORENCE MR NO: 204269185 ACCT TYPE: A SVC: SSN TOT CHRG: 5849.27 {EG: 07/17/02 DSCH: 06/23/03 FC: S PT: W EXP IND: ACCT BAL: .00 .................................................................. PAGE NO ACCT BAL 701 V B42 V A02 V : 1 .00 .00 .00 .00 PT BAL .00 SVC POST SVC CD INS CD-DESCRIPTION/COMMENT-REF DATE QTY AMOUNT 072303 072303 11013 1 PAYMENT MEDI B VERITUS -1 -19.07 073003 073003 11010 0 PAYMENT-PATIENT -1 -5282.20 ! (PF14) SEL PT ! (PF3) DTL SI/MM ! (PFll) ACCT CASH ! (PF15) RETURN TO PT OVERVIEW ! (PF10) ACCT CMNTS PF16 D/E PAQDTL01 1330 Pinnacle Health Hospitals PO Box 2353 Harrisburg PA 17105-2353 SELECTED DETAIL DATA USER ID: WXH1 03/29/04 0858 T NO: 233097203 *REESE ,FLORENCE MR NO: 204269185 ACCT TYPE: A SVC: SSN TOT CHRG: 6960.00 .EG: 07/17/02 DSCH: 09/30/02 FC: S PT: W EXP IND: ACCT BAL: .00 ................................................................. PAGE NO: 1 ACCT BAL 701 V B42 V A02 V PT BAL .00 .00 .00 .00 .00 SVC POST 110502 110502 110702 110702 120402 120402 073003 073003 SVC CD INS CD-DESCRIPTION/COMMENT-REF DATE QTY AMOI/NT 11013 1 PAYMENT MEDI B VERITUS -1 -206.74 11010 0 PAYMENT-PATIENT -1 -6230.74 11010 0 PAYMENT-PATIENT -1 -34.26 11010 0 PAYMENT-PATIENT -1 -8.95 ! (PF14) SEL PT ! (PF3) DTL SUMM ~ (PFll) ACCT CASH ! (PF15) RETURN TO PT OVERVIEW ! (PF10) ACCT CMNTS PF16 D/E PAQDTL01 1330 Pinnacle Health Hospitals PO Box 2353 Harrisburg PA 17105-2353 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF b~b6~,/ ~'~! O~ ~/t/O~' ,~. FILE NUMBER .7./- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Bo Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outdght spousal distributions) SCHEDULE J BENEFIClAEIES Z)I~'Z> //-/p. Zooz. ["/1~ E=$7'~1'7'~ I,~ ,~"/4~"0 .2/-e,..z 79. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINEI 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 [[. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2003-00552 PA No. 21-03-0552 ESTATE OF REESE FLORENCE J (LAs'±', ~'±~S'±', ~±~) WHEREAS, on the 8th dated February 28th 2000 Late of MECHANICSBURG BOROUGH Deceased Social Security No. 204-26-9185 day of July 2003 an instrument was admitted to probate as the last will of REESE FLORENCE J late of MECHANICSBURG BOROUGH , CUMBERLAND County, who died on the 27th day of June 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to REESE MALINDA J who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 8th day of July 2003. or WillS **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) 21-03-552 LAST WILL AND TESTAMENT OF FLORENCE .I. REESI~, I, FLORENCE J. REESE, of the Borough of Mechanicsburg, Cumberland ~ounty, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my beloved husband, BERT W. REESE, to his own use and benefit absolutely. 3. In the event my said husband, Bert W. Reese, should predecease me or die at about the same time I do, such as in an accident or disaster common to both of us, I hereby direct all the rest, residue and remainder of my Estate to be distributed to my daughter, MALINDA J. REESE. In the event she predeceases me, then to her issue, per stirpes. In the event she is not survived by issue, then my estate is to be divided into two (2) equal shares. One (1) share is to go to my niece, JANICE E. CUSTER and STEPHEN C. CUSTER, her husband, by the entireties. In the event they both predecease me, then to their issue. The other share is to go to my niece, PHYLLIS A. GROSS and her husband, STEVEN GROSS, by the entireties. In the event they both predecease me, then to their issue. I nominate, constitute and appoint my husband, BERT W. REESE, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, MALINDA J. REESE, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my husband's niece's husband, STEPHEN C. CUSTER, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of /2~. : , A.D. 2000. FLORENCE J. REi~E ' (SEAL) Signed, sealed, published and declared by the above-named FLORENCE J. REESE as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the 3resence of each other, have hereunto subscribed our nallaes as witnesses. 2 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 0O375O SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 204-26-9185 FILE NUMBER: 2103-0552 DECEDENT NAME: REESE FLORENCE J DATE OF PAYMENT: 04/01/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,346.21 TOTAL AMOUNT PAID: $7,346.21 REMARKS: ...... SEAL CHECK//1 58 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF 'rND'rVZDUAL TAXES I'NHERTTANCE TAX DTVI'S'rON DEPT. Z80601 HARRISBURG, PA 17].Z&-0601 CHARLES E SHIELDS III 6 CLOUSER RD HECHANICSBURG PA 17055 COHNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT BATE 06-1~-2004 ESTATE OF REESE BATE OF BEATH 06-27-Z005 FILE NUHBER 21 05-0552 COUNTY CUHBERLAND ACN 101 Amoun~ Remit'l:ed RE¥-1607 EX &FP ¢01-05) FLORENCE J HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment, CUT ALONG THZS LINE ~* RETAIN LONER PORTION FOR YOUR RECORDS *-~ ~¥v-: [ ~-f- r=¥ -/,p~--[ B-1---~3- ..... -~--[~h-E~=r-~E~' -f~,~:- -~ i'~,¥~: Ri~-~f - ~¥' 7~-~5 ~¥ - - ~-~; ..................... ESTATE OF REESE FLORENCE J FILE NO. 21 05-055Z ACN 101 DATE 06-1~-Z00~ THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHONN BELO# ZSA SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHEHT: 05-10-200~ PRINCZPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 1Z,$46.21 PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID 09-18-200~ 04-01-2004 05-18-2004 CD005055 CD005750 CD005950 250.00 .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. IF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), R,750.00 7,$~6:'21 4.04 TOTAL TAX CREDIT 12,$46.21 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PAYMENT: Detach tho top portion of this Notice and submit mith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money arder payable to: REGZSTER OF #ZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHMON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which Nas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Zq-hour answering service for fores ordering: 1-80g-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-BO0-q~7-3OZO (TT only). REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviem Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (33 calendar months after the decedant's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and lnterest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9} months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 19Bg bear interest at the rate of six (6X} percent per annum calculated at a dai~y rate of .00016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which wi~l vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .OOOSqB 1988-1991 11Z .000301 ZOO1 9Z .O00Zq7 1953 16X .000~38 199Z 9Z .O00Zq7 ZOOZ 6Z .00016~ X98q 112 .000301 1993-199q 7Z .00019Z 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .O00Zq7 200q qX .000110 1986 lOX .O00Z7~ 1999 7Z .O0019Z 1987 9Z .O00Z~7 ZOO0 8Z .000Z19 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DAILY /NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 1505610101 REV-1500 IX (os-so) PA Department Of Revenue perlnsylvaMe OFFICIAL USE ONLY Bureau of Individual Taxes °`"~"""`"`°"""`"°` County Code Year File Number PO sOx a.8D6oi INHERITANCE TAX RETURN liaristwra. PA s~s~e-o6oi RESIDENT DECEDENT ~ 0 3 D Social Security Number Date of Death MMDDYYYY 6 9 ~ ~ 7 C~o 3~ DecedeM's Last Name Suffix S ~D-ate~of~Birt~h - ~MMDDYYYY 1`~I I' I ot~~~ 1 y 13~ Decedent's First Name~~c MI (If AppNpble) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Sodas security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL iN APPROPRIATE OVALS BELOW O 1. Original Retum O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) r 9. Litlgation Proceeds Received O 2. Supplemental Retum O 4a. Future Interest Compromise (date of death after 12-12-82) Q 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty CredR (date of death between 12-31-91 and 1-1-95) O 3. Remainder Retum (date of death prior to 12-13-82) O 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THI.4 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED TO: Name _ ~ Daytime Telephone Number L S ~ D3 ~ ~ / 7 / 7 766 REGISTER OF WILLS USE ONLY rV n O First line of address ~ ~ ~ _T 7 r-r-t ~ C r ~ ~ - Second line of address , . n, ~ `„ <_~ ~ ~ r : J ~~ m ~ __' ' ~~ ; ~ i ~~ C ._ ~ DX7E FILED W City or Post Office e q ~ c State ZIP Code C.. ,.. ~ ~ o g~ ~ `~' ~' , Correspondent's e•nraN address: CP.S ~ ~ e /4~S ~7( ~/ W mC a ~• ne Under penalties of perjury, t declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, k is true, correct and complete. Dedaretion of preparer other than fhe personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PfiR~69N•tiESPON816LE FOR FILINGiT2ETURN DATE ADDR Mgt~Np~q, dZe•E3~E ~.~~~ /,~ Sprl f: t/d Rai(- •K•A• Maltn~ phi s~H 1 S SIGNAT R OF OTH ESENTATIVE DATE x ~ ADDRESS ~,~ E' SN/R~s ~i C~ONiC/' IQ~ ... _ _ ~ _ . ild rs..~ ~ Side 1 1505610101 1505610101 J 1505610105 REV 1500 EX Decea«~rs tom: ~~, o~Q FNCir ' .T F 1. Real Fatale (Schetlule A) ............................... .:.........' 1. ~~~ . '~ O 2. Stocks and Bonds. (.Schedule. B) .. .. ........................... 2. ~ 3. Closet' Held Corporation, Partnership or Sole-Proprietorship (Schedule G} ..... 3. 4. Mortgages and Notes Reoaivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. (e $' ~ q 6. Jointy Owned Property (Schedule F) p Separate BiNing Requested ...... , 8. 7 Inter-Vivos Transfers 8 Miscellane s Non P b e P . ou - ro at roperty (Schedule G) O Separate Billing Requested........ 7. ~ 8. ToW Gross Assets (total Lines 1 through 7) ............................. 8. a .~ b 9. Funeral Expenses and Administrative Costs (Schedule H) .:................. 9. _ 1 3 1 0 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~ ~ 11. Total Deductlons (total Lines 9 and 10) .............................:... 11. ~ O 0 O 12. Net Velw ol` Estats (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Be uestslSec 9113 T t f h 8 ' (~, C q rus s or w ich an elecdor- to-tax has itot been made (Schedule J) ... ~ .......:........:.... , 10. .. ' 14. Nst VMve Subject to Tax (Line 12 minus Line 13) ........................ 14. TAY f`~1 Clu sTV-u _ erc ~ue~ro~~nrw..e ...... . 8- ( {~, 15. Amount of Line 14 taxable at the spousal tax rate, or Decedent's Soaal Security Number 19. TAX DUE ..............................,.........._......,.......... 19. 15. 18. 17. 18. transfers under Sec. 9118 (ax1.2) X .0~ 18. Amount of Line 14 taxable at lineal rate X .0~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14'taxable• at collateral rate X .15 20. FILL IN THE OYAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~. L 1505610105 Side 2 1505610105 O J REV 1500 EX Page 3 File Number Decedent's Complete Address: DECmENrs NAME _ - -- - -- __- r ~ orentt S QeCsG sTREETADDRESS 11 - - - __ - - -- Se~dlt, ~'1G1'nOrll~I ~~S ~TGI loo ~. Fi Ibcr~ St. -_ C{TY ~ "~~~ STATE Z!P ~err1.iM1,lCSburq _ __ /~ i 1705 Tax •Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CredilslPayments A. Prior Payments B. Discount 3. Interest 0 ~. M Line 2 is greater than Line 1 + Line 3, enter the deference. This is the OVEtZPAYtMENT. FNI M dual on Page 2, Line 20 to ngwst a refund. 5. N Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) _ 1_~~ (_S_~_. ~9 Total! Credits (A + B) (2) fl (4) D (5) lob, fv5(o,-4 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deoedeM make a trarx~ and: Yes No a. retain the use or income of the property tr~ar-sferred :.......................................................................................... ^ b. retain the right to designate who shah use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for liie of either payments, benefits or care? .................................................................... ^ ~{ 2. If death occurred after Dec. 12,1982, did decedent trensfer property within one year of death without receiving adequate considerafion? .............................................................................................................. ^ 3. Did decedent own an 'in trust for" or payable-upon~eath bank aaxwnt or seatrity at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate p-nperiy, which contains a benefiaary designation? ..................................................................................................... ^ ................... ~ THE ANSMIER TO ANY Of THE ABOVE QUESTI~IS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving 3 percent [72 P.S. §9116 {a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 172 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 a~ filing a tax return are stt'N applicable even if the survivirxf spouse is the only benefiaary. For dates of death on or after July 1,2000: The tax rate imposed on the net value ~ transfers from a deceased child 21 years of age a younger at death to or for the use of a natural P~ adoptive parent or a stepparent of the tad is 0 peroent [72 P.S. §9116(aK1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except ass T2 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent {72 P.S. §9116(a)(1.3)]. Asibling is defin: Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. O REV•1~OE IX • (79n COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE t)F E ES E j FLD/T G11I ('.E .?. FILE I~R 2./-O3 -SSA, Include the proceeds of litigatleon and the dale the proceeds were n3ceived by the estate. AN property joirMhrowrred with the right of w ITEM rvhronlri~ ~ ~ disclosed on Schedule F. NUMBER DESCRIPTION VALUE AT DATE ~, ~ OF DEATH r~lort11nct '~tese v. Mtrtrk }~ Co,, Zn c . TA1s Wes ~Olrrrf .~ /ytass ~yr't GQ.in'~ 0.~A1rAt~d t%i4 t/ L'oct„~,Sr /7r.A7ari~y 7NiY`Dtsf~ ~ur~sd~cfivn ccntert~ tii ~ Sfit~e .~° loa.isian4. '', i4 •) C°~ y .F ~~tfir eF ~'Kn t ~ ~ ~ dto/ o t^a: f'le Cwr rer,~ ou~~1~, ' ~ ~. C~~ qc ~) R1GF~r~ecJtl~ioq ~~ s/'~ow;rty a tte~n°Ys ~ 4iru1 a s: or~lol ids o~ e~ptn5ts. O C.~ (!espy af' ac.>'~rai/ n~ pnoceedr chic . II~' ~~ g2 S S 68, q TOTAL (Also enter on line 5, Recapitulation) s je; ~aj JtbB ro (If more space is needed, insert additions sheets of the same size) ~ 7 JUN-24-2010 THU 08:32 AM P. 002/OOS andlar. ennin9~ ~ sanberg.~- ATTORNEYS June 22, 2010 Melinda Parson M 156 Springfield Rd. Shippensburg, PA 17257 Re; Vioxx Litigation -Estate of Florence Reese HHR File #210732 Dear Melinda: ..,,.;~; .~_... . ~,.~,, Gxsgox~- M. Feather Feaths~llhrla,r.com We have received the final determinations regarding your case from a Claims Administrators. I have enclosed two copies of a Recapitulation and Distributioi~i schedule (settlement memo). As you can see from the settlement memo, the final point value was increased from the estimated point value.of $1,810.00 to a final point value of 1,833.32. This means that your final settlement value has increased over the projected ettlement value:.,..._..................... .. . . .. .• :. Out of ttte final settlement distribution, the Claims Administrators are required-~~o vrithhold fillY~s~,~6~rf1°y'~d'tjr•"sbttlert~ent~.ta:~pay ~back~any:Medicare, Medicaid, and/or pr' to health insurarsce`I~ns.'in' addition; the Courf 17rdered common benefit fee of 896 is wi held from ouTatforney'fee#s:'..pur:fee.is~reduced~.from:ttie.orjgin~1140% pe~~d~ir~fee'agr ent~with~ you to 32%. In~addition,'•.a Court:Ordered.l%~Common benefit g~perise is wit ,held from your settlement by the Claims Administrators. ~ ~ ~ ~ ~ ~ ~. ~ ~~ ~ •~.~~; . Please sign and return~one copy of the Distribution Schedule. pnce t calve the signed distribution sheet from you, l will send your final settlement chec~i to you We have also enclosed a medical records acknowledgrnentform for.you tosi n hd return to my office. Please indicate on the form if we have your permission to desk your file or if you would prefer to pick up your medical records at my office or make arts ~~ ements to have your records mailed to you. ~ g It has been our pleasure to represent you throughout this long and tedious ettlement process. I believe we achieved.:a~..~alr:ar-d reasonable settlement on your be elf. I am confident that we aggressively fought on .your behalf to achieve the ~ maxim m .award ppssibly~i~nder~ the Vioxx Settlement Agreement, ; ~~~ ~ ... .. '.,., . ~ •; , . , Handler, Henning ~ Roaanborq, LLP 1300 Lir-ylestown Road, Suits 2, Harrisburg, PA 17110 Phone: 717-238-2000 * Fax 717-233-3029 ' Tdi Free 1-800-a22-2224 Carob OfRce 717,241-2244 • Lancaster Office 71W4~31-4000~~wk pr11Ce 717-a46.79pp • Hanover Otaca 717-~30.82ep JUN-24-2010 THU 08:33 AM June 22, 2010 P• 003/005 If you, a friend, or family member needs legal representatlon in the future, I arh~ confident that either myself or one of the other experienced attorneys at Handler, Henning & Rosenberg can provide the necessary legal representation. Very truly yours, HANDLER, HENNINO& ROSENBE~iG, LLP ~~~ .r Gregory M.•Feather, Esquire GMF/bsv Enclosures Handler, Henning b Rosenberg, LL,P 1300 Linglestawn Road, Suite 2, HaMsburg, PA 17110 Phone; 717-23&2000' Fax 717 233-3029 • Toq Free 1-800-422 2224 G1b1o OR1oo 717-241-2244 * ~~~ p~ 717-40pp~ C00~~ 717.845.7800 • F(enpver O(fioe 717~630.820p JUN-24-2010 THU 08.33 AIU FLORENCE REESE v. MERCK & CO., INC ' CATION AND DI RIBTI'1Rnty SCHEflTtt r TOTAL (IROSS AMOUNT AWARDED: (10096 Award Value at $1,833.32 per Po:iz~t) Total Attorney fee pursuamt to PTp b0 at 3296 less 896 common benefit fee =24/0 Attorn®y fee previously recovered ATTORNEY FEE DUE Prior Interim Payment to Client Prior Attorney Fee on Interim payment Prior Coats on Irtte~ p~tynaent~ Medicare Reimburseuxent Medicaid Reimbureeraemt Government.Liena Private Tien Resolutiion Program Holdback* Common Benefit Fee (896) Common Benefit Cost (1%) TOTAL OF ALL DEDUCTIONS: SUBTOTAL: Qlbtal C~roes .AabOYAC Awardd miaw Total of A]1 Deductions. This 10 ~ amount diebuswd by t}1e pahps Admiaishrator to Aandler. Aenning, b Roeonbers, Li.P., on your behalf.) Less Out of Pocket Case Coats: COSTS TOT,A,L CI'o Handler, Henning lk Rosenberg, LLP) NET SUBTOTAL OF FINAL PAYMENT: $439,006.81 $105,361.63 •$0.00 -$105,361.63 •$0.00 •$0.00 =$0.00 •$8,502.00 -$0.00 -$0.00 . '$2,092.45 -$35,120.54 -$4,390.0? -$166,466.69 $ 283,b40.12 $ 971.53 ................. $ 971.53 $282,!568.69 NET AMOUNT CLIENT PREVIOUSLX RECIEVED~ $ 0.00 NET AMOUNT DUS TO CLIENT: $282,668.69 AL FINAL NET: $282,1588. ff 9 This subtotal mots 161i o[ tba total seWemeat award t.bat was wit>>held undwr Jndss P'alba'~ ad+r uAtai the lac. ooioapl~e oa tlae Px~f vats Lien Reaolut3on program. Vpon raolnt3oa apt this issue, Ym+ mq b. it.a.d addltioaal p yo0~,~0 which would re6sat aa~y ba4noe owed to you on tLs amount withheld to satisq- s,y, prxvab WAa. I have read the above Schedule of Distribution and I t1il13- understand it. I authorize my attomiey's, Handler, Hennaing $ ItOSenbarg, I,I,p, to settle my case and disburse the monies obtained in oonneation with my clafm end the injuries I sustained, as net forth in the Schedule of Distrbukion. l~rthermore, I ackeaowledge that Hautdlar. Henning & R~oeenberg, LLP, is paying on1lr those e7 from my settlement as set forth in this Schedule of Diatributio~a and any medical bibs that m~- be outstanding will be my responsibility. DATE: Name- MAIdNDA PAR80N,ADMIIVISTBA X OF TH$ BS'fATlg OF FLORENCB RhFBEI P. 005/005 HANDLER HENNING & ROSENBERG, LLP 153903 210732 Parson, Melinda ESTATE OF FLORENCE REESE VIOXX -FINAL IS PAYMENT HANDLI~R HENNING & ROSENBERG, LLP Citizens Bank A7"f'ORl~1fS AT LAW """'~'"~'~' f3EIQ ~,N~lf~Li~1'MJINN F~ 3-7615-~0 . ~. PA 471.10-28.98 CHffdC NO. E1'~pC 'AY 213620. .06/25) Two hundred eighty-two thousand five hundred sixty-eight and fifty- `~ nine/100 n THE ESTATE OF FLORENCE REESE 21362 1362a VEMDOFi NO. p10 TEMP k~ouHr 82,568.59 REV-1511 EX+ {12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~~,., SCHEpt~LE H FUNERAL EXPENSES ~ ADMINISTRATNE COSTS C.71A1 C Vt R FLSSF~ FLO17 ENC F ~'. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A• FUNERAL EXPENSES: DESCRIPTION 1. a~-o3-ssz e. ADMINISTRATIVE COSTS: t • Personal Representative's Commissions Name of Personal Representative(s) n'la,~rh q4 ~~,~ oh waived Social Security Numbers EIN Number )/ of Personal Representatives Street Address Cdy State Zap Year(s) Commission Paid: I 2• Attorney Fees ~1t,1"~2.5 ~: SF~ieJclS ~ ~stt~i+•M~ I t ~ ?.oo. eo 3• Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant No pA/E' Et/6/,QLE NONE Street Address City State 7~p '~ _ Relationship of Claimant to Decedent 4. Probate Fees 5• Accountants Fees s• Tax Return Preparer's Fees ~. Rdd:fionor pn.b~~ ~~ g• F.I. n~ ~~ BIOS. 00 1 S; 00 TOTAL (Also enter on line 9 Recapitulation) I S Y ~ 3 a0 •O~ (I( more space is needed, msert add~lonal sheets of the same size) PEK1571IX • ryb~ SCHEDULE J co-~oNwEa.T-+oFPENNSr~vnNw BENEFICIARIES INHERITANCE TAX RETURN RE OENTDE NT ESTATE OF R&ESE~ FLoREweE ,T. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (indude outright spousal distributions) 1 ~ AI ~LlND I~ o% iQF~$Lc liviw ~trAtirvo,* ,T ,o~si~r/ BY ~~/T ~-~~~~ ~S4 ~SPR/ivGFiEZa ~e~ Sy/PPErf~s~quRG, ~i~ / 757 ~ /w'q- ~Gb~ ; ~86'+~T 4~ . RFESE l~E'dECE'/K- ~D /y/S iv/Fit, 7~i/E' aECE-,p~vT +s/~!'E/.tom ~YF Di ~ /i-/8- zoe:. His Esn~~ /s ~-ic~ /N G anrBE~ttc.~.vb Couary ~, tbckEr yo. -x/-0.7 - /D 7 ~. RELATIONSHIP TO DECED Do Not List Trustee(s) ~uGH~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROF II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET C S (If more space Is needed, InSBft additronal sheets. of the same size) ~ /- 03 -ssz AMOUNT OR SHARE OF ESTATE io©~ ON REV 1500 COVER SHEET _._ _. Register of Wills of CUMBERLAND County, Pennsylvani Certificate of Grant of Letters No. 2003-00552 PA No. 2',1-03-0552 ESTATE OF REESE FLORENCE J Late of MECHANICSBURG BOROUGH + ran ., Deceased Social Security No. 204-26-9185 WHEREAS, on the 8th day of July 2C}03 an instrument dated Februa 28th 2000 - was admitted to probate as the last will of REESE FLORENCE J ( late of MECHANICSBURG BOROUGH 27th day of June- CUMBERLAND County, who died on the 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO the County of CUMBERLAND in the Commonwealth of Pen sylvaniaf hells in and for that I have this day granted Letters TESTAMENTARY ~'eby certify to REESE MALINDA J who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of~lwhich appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, fully CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and aff' of my Office the 8th day of July ixedthe seal 2003. #*NOZB** ~~ NAMES ABOVE SPEAR (LAST, FIRST, MIDDLE) 21-03-S52 I, FLORENCE J. REESE, of the Borough of Mechanics ~'8, Crunberhutd County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prim Wills by me at any time heretofore made. 1. I direct the paytttent of all my just debts and funeral expenses as soon ~~•. my d~,~ as the same can conveniently be done. ~'"' t 2 All the rest, residue and remainder of my Estate, ~ p aad mix w hatsaever and wheresoever situate, I give, devise and bequeath to my beloved husband, B ~ ; REF.4E, to his own use and benefit absolutely. 3. '~ In the event my said husband, Bert W. Reese, should lnedeoea~ me or c~ie at about the same time I do, such as in an accident or disaster common to both of us, I h~ d;~ all the rest, residue and remainder of my Estate to be distributed to my dwghter, MAIdND~A J. RE&SE. In the event she ptedecea~s ~~ then ~ ~ issue Pa' . In the event she is ~ survived by issue, then my estate is to be divided into two (2) equal shares. One (I) share is go to my niece, JANICE E CUSTER and STEPHEN C. CUSTER, her husband, by the en ' 'es. In the event they both predecease me, then to their issue. The other sham is to go to my niece Pgy~,I,S A. GROSS and her husband, STEVEN GROSS, by the entireties. In the event they both pnedece~e me, then to their issue. 4. I nominate, constitute and appoint my husband, BERT W 1REESE, to be lfte Executor of this my Last Will and Testament. In the event that he should predecease me or fot~ any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my ~~., MALINDA J REESE, to be Executrix in his place and stead. In the event that should predecease me or for any reason be unwilling or ratable to act as such Executrix, I omin~, constitute and appoint my husband's niece's husband, STEPHEN C, CU ST'ER, be Executor in her place and stead. I further direct that they shall not ~ required ~ ~ bond ~ security in the Office of the Register of Wills for the purpose of administering my gs~, ~, IN WITNESS WHEREOF, I have hereunto set my hand and seal this I ~ day of --~ , A.D. 2000. %~~~%~/l ~ r wx~t-'"a~ ~ ~ ~ ,t D ~ A, (SEAL) and for he~L t Will ~d~ Tes ~~t, m' meld ~ ~e abovanamed I~7,pR~(~ J. g~SE as and in the presence of each other, have heneuntosubsc~n~ bod ~ ~ ~ !and in her presence, as ~tid-esses. 2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 17128-0601 RECEIVED FROM: PARSON MALINDA J 156 SPRINGFIELD ROAD SHIPPENSBURG, PA 17257 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 204-26-9185 FILE NUMBER: 2103-0552 DECEDENT NAME: REESE FLORENCE J DATE OF PAYMENT: 07/29/2010 POSTMARK DATE: 07/28/2010 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 TOTAL AMOUNT REMARKS: SEAL CHECK#1280 INITIALS: SAP RECEIVED BY: REV-1162 EX~11-96) NO. CD X13122 AIV~OUNT GLENDA EARNER STRA~BAUGH REGISTER OF WILLS REGISTER OF WILLS ACN ASSESSMENT CONTROL CHARLES E. SHIELDS, III ATTORNEY-AT-LAW GEORGE M.HOUCK (1912-1991) 6 CLOUSER ROAD Corner of Trindle and Cbuser Roads MECHAMCSBURG, PA 17055 July 28, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Cazlisle, PA 17013 Deaz Register of Wills: Re: Estate of Florence J. Reese No. 21-03-0552 TELEPH~NE (717) 766-0209 ~AX (717) 795-7473 • Please find enclosed for filing 2 copies of the Supplemental Inheritance Tax Rey the Florence J. Reese Estate as well as Check No. 1280, in the amount of $12,656.19 fc Inheritance Tax due, Check No. 1281, in the amount of $105.00 for additional Probate Check No. 1282 in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. CES/mjj Enclosures Very truly yours, Chazles E. Shields, III ~ Attorney-At-Law ~q ~~ ,r~~C-~ ::-n °':~ ~~ ~-'c~ JC~~ rn for the ~ - ~ ~ `=.~ ~ C~. ``=~ '~~3 W ~ ~ - ~i Q ° T ~ J ''W^^ V/ N a ,~ o ~ N ~ O _ ~_ N ° ~ i. ~ Q F" ~ .° ~ ~ ~ ~ °~ ~ ~ ~ N Q O _ T ~ ~ ~ v /VVV/~~,, } ~ N F- ~ M t ~ a Z ~;, ~ o U o ~ O J O oNO ~ ~ ~ ~ V ~ r -_ o m~"c H ~ = a " ~ZOa - M~co-m N ~ W~F-J= F--WAN= ~ ~ r ~ m ~ J Q rL ~~OoC ~ W ~ U Q - w ~a o =gym .. ~tYV O N ~ F W ~ Z Q Z = U w y U cc ~ > , • +.. =. .~ ~ ~,: ,,,,, ~' -~ .~ . ~, _-~" `, , ... _ ~'`~ `~: ~~.? .9 tl'J ~r1 a r9 11'1 1u fU O O O O m ti m m 0 0 N BUREAU OF INDIVIDU/~t' ~TAXE~$ ~ ~' ~~' INHERITANCE TAX INHERITANCE TAX DIV1S1oN ~ ~- STATEMENT O F A C C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 ~? f~ ~ ~ ~ 1 I ~ t~, -~ ~;, r~ i ~• `}; - ~~ CHARLES ~~~'~SHIELDS IIT 6 CLOUSER RD MECHANICSBURG PA 17055 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1607 EX AFP t12-09) DATE 08-23-2010 ESTATE OF REESE FLORENCE J DATE OF DEATH 06-27-2003 FILE NUMBER 21 03-0552 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-09) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:REESE FLORENCE J FILE N0.:21 03-0552 ACN: 101 DATE: 08-23-2010 THIS STATEMENT PROVIDES CURRENT STATUS DF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-03-2004 PRINCIPAL TAX DUE: 12,346.21 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-18-2003 CD003033 250.00 4,750.00 04-01-2004 CD003750 .00 7,346.21 05-18-2004 CD003950 4.04- 4.04 07-28-2010 CD013122 .00 12,656.19 TOTAL TAX PAYMENT I 25,002.40 BALANCE OF TAX DUES 12,656.19CR INTEREST AND PEN. ~ .00 TOTAL DUE 12,656.19CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .~~~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: FLORENCE J. REESE Date of Death: 06/27/2003 File Number: 21-03-0552 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the ad~inistration 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? ....... I~Yes ®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? .............................. ®Yes ®No d. Copies of receipts, releases, joinders and approvals of formal or informal a counts maybe filed with the Clerk of the Orphans' Court and maybe attached to this repot. ..a Hare October 13, 2010 ,,.~. N ~ G.v ~ cV i.,_ -- _ C.~..:~ ~~ `7= in I^''~. :... .~~ ~:~ r~ v ~:• ~ ~~ O ~L a 0 N Signature ojPerson Filing thin Form Capacity: ^Personal Represeniatiad ®Counse! Charles E. Shields, III Q ~ Name of Person Filing this Form ~-- [~ 6 Clouser Road ~ C ~0~;. ~ Address U~r ,.- Mechanicsburg, PA 17055 ~C~_ ~t~~~. Uzi. ~'`', U Form RW-I D rev. 10.!3.06 (717) 756-0209 Telephone Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND Name of Decedent: FLORENCE J. REESE COUNTY, PENNSIYT,VANIA Date of Death: 06/27/2t?03 File Number: 21-03-0552 Pursmmant to Pa. O.C. Rule b.12,1 report the following with respect to completion of th~,e administration of the above-captioned estate: i 1. State whether administration of the estate is complete :................... a 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: p p ~ ~~ (Yes ®No a. Did the ersonal re resentative file a final account with the Court....... . 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? ............................... ~ jYes ®No d. Copies of receipts, releases, joinders and approvals of formal or informal acc~ubts may be filed with the Clerk of the Orphans' Court and maybe attached to this report. I ', vote October 13, 2010 Signature of Person Filing this Fi Capacity: ©Personal Representative ~ cv ~ ~., i , . _. _ Q = N i,,.,. - ~t ./ ~r~ ~ ~ ~ ~: ~ C~ c~j U 2: ~~i~ ~ O v CV U Form RW-10 rev. !0,!3.06 Charles E. Shields, III Name afPerson Filing this Forne 6 Clouser Road j Ass ~~ Mechanicsburg, PA 17055 ~ (717) 766-0209 , _ Telephone - - ,-~1{1T~CEE OF INHERITANCE TAX ' ~-fA~P'PRAIS£MEN~T'~f~ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES , INHERITANCE TAX nrv1S1oN ,_ `QF ~E:DU~TI`dNS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 ~~.~IaC~~~ !5 ~'~~ 1~ r~ i [ -. , , ... J~.-. L.,~.,_ i CHARLES E SHIELDS ~~'I 6 CLOUSER RD MECHANICSBURG PA 17055-9735 pennsylvania ~ , DEPARTMENT OF REVENUE RE~~-1547 EX AFP (12-09) 7` DATE 10-11-2010 ESTATE OF REESE FLORENCE J DATE OF DEATH 06-27-2003 FILE NUMBER 21 03-0552 COUNTY CUMBERLAND ACN 501 APPEAL DATE: 12-LO-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND RE:MIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------------------------------------------------------------------- REV-1547 EX AFP (12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE: DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: REESE FLORENCE JFILE N0.:21 03-0552 ACN: 501 ----------------- OR DATE: 10-11-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) (1) •0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) (2) credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) •0 0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 282,568.59 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) (7) .0 0 8. Total Assets (8) 282 , 568 .59 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 1,3 2 0.0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 11. Total Deductions (11) 1,320.00 12. Net Value of Tax Return C12) 281 , 248.59 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0 14. Net Value of Estate Subject to Tax (14) 281 , 248.59 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 d ate. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate (16) ?S1 48.9 X 04Fi = 12,656.19 17. Amount of Line 14 at Sibling rate (17) _ 00 X 12 = . 00 18. Amount of Line 14 taxable at Collateral/Class B ra te (18) .0 0 X 15 = .0 0 19. Principal Tax Due C1`i)= 12, 656.19 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 07-28-2010 CD013122 .00 12,656.19 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX PAYMENT 12,656.19 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~,-,~ q: ~a