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HomeMy WebLinkAbout02-0144COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF DAUPHIN ) We, ~ .... _ _ Li~ ~CU [O~ ~qQ~ and ["~ ~ ~i~,~ ~:. ~/ ., the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed this instrument as his Last Will and Testa- ment and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, in that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and to the best of their knowledge, the Testator was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. SWORN and Subscribed to and before me this ~ day of '~<~r~C1 , 1995. ON~tary Pu~ic i Not~ri~ sca~ Joyce E. Fry, Notary Public Harrisburg, Dauphin County L_~ commission Expires Auo. 3, 197 The preceding instrument, consisting of this and two other typewritten pages identified by the signature of the Testator, ROBERT E. ROHRBACH, was on the day and date thereof signed, published and declared by ROBERT E. ROHRBACH, the Testa- tor therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other have subscribed our names as witnesses hereto. N~m~ ' Name Addre s s Addr e s s shall not be required to give bond for the faithful performance of their duties in any jurisdiction, and should, notwithstanding this direction, a bond be required, I direct that a surety bond not be required. IN WITNESS WHEREOF, I have hereunto set my hand this day of , 1995. - 2 - 21-2002-144 LAST WILL AND TESTAMENT OF ROBERT E. ROHRBACH I, ROBERT E. ROHRBACH, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, hereby make, publish and declare this to be my Last Will and Testament hereby revoking all former Wills and Codicils made by me. ITEM I: I direct that all my legal debts and funeral expenses shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I direct and bequeath all of my estate of every nature and wherever situate to my wife, MARY C. ROHRBACH, providing she shall survive me by thirty days. ITEM III: In the event my wife predeceases me or dies on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate, in equal shares, to: BOBBY JEAN ROHRBACH, CHRISTINA ROHRBACH and VICTORIA ROHRBACH. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM V: I appoint my wife, MARY C. ROHRBACH, Executrix of this my Last Will. Should she fail to survive me or is otherwise unwilling or unable to serve then I appoint my daugh- ter, BOBBY JEAN ROHRBACH, as Executrix, of this my Last Will. ITEM VI: I direct that my Executrix or her successor 21-2002-144 'OZ FEB-6 P3:36 os.sos ~v This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7887179 No. Local Registrar Date AGE (LaM Robert E. Rohrbach : ; 4-7-28 . COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Dauphin Hbg. Harrisburg DECEDEHT'S USUAL OCCUPAT~N KIND OF BUSINESS~IND~STRY ; DECEDENT EVER IN (Give k*n~ d **,~*k ~ du~,9 ? 7407 Wertzvi~e Rd. Oanberland ( .... s+, ,,. Mary C. Heckard Wwnlhi{)? , ?d.~] -~i~Ma~ ~ Carlisle ~ Carlisle,PA 17013 F/~HER'SNAME{Fi~"M"Jdle'La$1IWilson Rohrbach "- ~,th ~d ~'s~P,-, ~ C. ~hr~ch I~ 7407 Wert~lle Rd. ~rlisle: Pa 17013 i~E ~ DIS~T~ ~ ~,.O ~..O O{,,, 1/4/2002 ,,. ~, PA e_._~-~ ~ ,,~ Sh~p' s ~u~u~t~~~~~ .... [~~93 ~~~T~ R. Enola ~.,~ PA 17025 .... /, , J~ . I°~-~u~ I~ ~ ~ ~l I I ~ ~ ~ I I I~ ~ ..~'~ I I.- ~ 1~ I~- . . u ~{ .... I I~'''~"' ~ I-. ~ ./: Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 Decedent, Petitioner(s) will well and truly administer the estate accordin%to I~¢~. ,//// Sworn to or affirmed and subscribed ~_/~-~/' (~ ~¢__~ _ before me this 6TH day of / February , ~gx 2002 F~r the Register ~~ varec. Lewis // No. 21-2002-144 Estate of Robert ~__~hrbach Deceased Social Security No~201-1g-Tg02 Date of Death: AND NOW, February 8th ,iCj: 2002 in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary of Administration d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate are hereby granted to Mary ~ Rohrbach in the above estate and that the instrument(s) dated Febmmry 25, 1995 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES '//Letters ........................ $ 40/00 J,/Short Certificate(s) ..... $ ].2.00_ ........ Renunciation .............. $ N/A Affidavits ( ) ............... $ N/A / Extra Pages (3) .......... $ 94-0.0 /Codicil ....................... $ N/A JCP Fee ..................... $ 5.00 Inventory .................... $ 0~ _0_0_ _ Other ......................... $ 0.00 Total ................... $ 66.00 MAILED LETTERS TO ATTONNEY ~/Register of Wills Mary · Attorney: Robert C. l~_y I.D. No: 65602 Address: 3438 'l'~indle Road; Suite 201 Telephone: Cat-tp Hill, PA 17011 717-612-0102 ~ C; Estate of also known as Register of Wills of Cumb~l~d County, Pennsylvania PETITION FOR GRANT OF LETTERS , Deceased Social Security No. 20~-Z8-7802 Mary Catherine Rohrbach Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' OR 'B' BELOW:) I~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the executor-ix named in the last Will of the Decedent, dated 2/25/95 and codicil(s) dated N/A State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A El B. Grant of Letters of Administration (d.b.n.c.ta.; pendente lite; durante absentia; durante minodtate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in C~rt~)erlcqnd County, Pennsylvania, with his/her last family or principalresidenceat 7Zt07 Wertzv-ille Road, C~'r'lisle ('~-'~)/7_-~/~/--d-~- (list street, number and municipality) 73 ,:X~l~ Deca~Aer 31, 2001, at Harrisburg Hoso~tal Decedent, then years of age, died Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 9 679.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 7407 Wertzville Road, Carlisle, PA 17013 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the ~]rant of letters in the appropriate form to the undersigned: ..~Typed or printed name and residence '~'~--?/ ~ ' - ~- ' 17407 Wertzville Road ~ Carlisle, PA 17013 Form #RW-1 Page I of 2 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Robert E. Rohrbach Date of Death: December 31,2001 Will No. 21-02-0144 Admin. No. 2002-00144 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 February 19, 2002. Name Mary C. Rohrbach Bobby Jean Rohrbach Christina Rohrbach Victoria Magaro (nee Rohrbach) Address 7407 Wertzville Road, Carlisle, PA 17013 420 Meadow Lane, Shermansdale, PA 17090 115 Wheatfield Lane, Shermansdale, PA 17090 431 Meadow Lane, Shermansdale, PA 17090 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: February 20, 2002 Name: Robert C. May, Esquire Address: 3438 Trindle Road, Suite 201 Camp Hill, PA 17011 Telephone: (717) 612-0102 Capacity: Counsel for personal representative C OMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURNI2 I-o 2 o i 4 4 RESIDENT DECEDENT .u..E. DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Roh.~bach, Robert, g. OATE OF DEATH (MM-DB-YEAR) I DATE OF BIRTH (MM-DB-YEAR) 12/31/2001 I 04/07/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAS% FIRS% AND MIDDLE INITIAL) Rohrbach, ~, C. ~--11. Original Retum [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date ofdaalh after 12-12-82} [] 6. Decedent Died Testate (A,ach copy of Will) [] 7. Decedent Maintained a Living Trust (A~tach copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death belween 12.31.91 and 1.1-95) ;~Ht$ SEGTiON MUjST ;~ CO~ ALL C ~ NAME Robert C. May, Esquire I.- 'Z U.! U.I 14.1 FiRM NAME (IfAp~aae) May and May, P.C. TELEPHONE NUMBER 717-612-0102 2. 3. 4. 5. SOCIAL SECURITY NUMBER 201 - 18 - 7802 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 8. 9. 10. 11. 12. 13. 14. Real Estate (Schedule A) (1) Stocks and Bonds (Schedule B) (2) Closely Held Corporation, Partnership or Sole-Prophetorship (3) Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) D Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gmee Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) Charitable and Govemmentel 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) ]3. Remainder Retum {date of death prior to 12-13-82) ]5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Dll. Election to tax under Sec. 9113(A) (At~ach Sch O) COMPLETE MAILING ADDRESS Robert C. May, Esquire The Law Firm of May & May, P.C. 3438 Trindle Road; Suite 201 Camp Hill, PA 170t~ C~ :? 4; 5°,0_ 6D 0.00 O. O0 5,140.00 ' 0.00 O. O0 (8) 6;~21_ 50 0.00 (11) (12) (13) 9,679.60 6,421.50 3,258.10 (14) 3,258.10 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rote 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rote 3,258.10 0 x .o 0 (15) x .0_ (16) x .12 (17) x .15 (18) 0 0 0 0 0 0 19. Tax Due (19) Decedent's Complete Address: ISTRr'ETADDRESS7z,~07 Wertz-cille Road -C~WCarlisle ISTATE PA z~P 17013 Tax Payments and Credits: 1: Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount InterestJPenalty if applicable D. Interest E. Penalty 0 0 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 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. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 0 (4) (5) 0 (5A) 0 0 (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] ~] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the premise 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 penalties of perju~/, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBL.~ FOI~ FILINC~,~IETURN ADDRESS - / ..... 7407 Wertzv lle Road~ Carlisle, PA 17013 DATE SIGNATURE OF PREPARER OTHER THA~ REPRESENTATIVE ADDRESS- ~_ .~_~ 3438 Trindle Road; Suite 201~ Camp Hill~ PA 17011 DATE 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 RS. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 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. REV-1503 EX + (1-97) (I) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert E. Rohrbach SCHEDULE B STOCKS & BONDS FILE NUMBER 21-02-0144 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 78 shares Prudential Financial at $58.20 per share ~4,539.60 TOTAL (Also enter on line 2, Recapitulation) $ 4,539.60 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE T~X RETURN RESIDENT DECEDENT ESTATE OF Robert E. Rohrbach SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-02-0144 Includa 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. 1984 1986 01dsmpbile Coupe 2D Chevrolet 10 Pickup longBed $1,500.00 $3,640.00 TOTAL (AJso enter on line 5, Recapitulation) $ 5; 140.00 (If more space is needed, insert additional sheets of the same size) EV-1511EX + (1-97) (I) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert E. Rohrbach SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-D2-0144 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: Sullivan Funeral Home ADMINISTRATIVE COSTS: Personal Representative s Commissions Name of Personal Representative (s) ~ C. Rohrbach social Security Number(s) / EIN Number of Personal Representative(s) 186-34-2591 Street Address 7407 Wertz~i'lle Road City ("'~1"'~ '~ .q.] iA State PA Year(s) Commission Paid: None Attorney Fees 'l'~"te ~ Firm of [Vj~y (~ May, P.C. Family Exemption: (If decedent s address is not the same as claimant s, attach explanation) Claimant Zip 17013 Street Address city Relationship of Claimant to Decedent Probate Fees Accountant s Fees Tax Return Preparer s Fees State Zip $5,155.50 0.00 1,200.00 N/A 66.00 0.00 0.00 TOTAL (Also enter on line 9, Recapitulation) $ 6,421.50 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert E. Rohrbach BENEFICIARIES FILE NUMBER 21-02-0144 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I 1. Il TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] None. 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL D,STmBUT~ONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX ,S NOT BaNG MADE Mary C. Rohrbach (spouse) 7407 Wertzville Road Carlisle, PA 17013 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 3 , 258.10 (If more space is needed, insert additional sheets of the same size) $3,258.10 0.00 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Robert E. Rohrbach also known as , Deceased No. 20D?-(~O1Af~ Date of DeathDecen]ber 31, 2001 Social Security No. 201-18-7802 Mary C. Rohrbach Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attomey Robert C. May I.D. No.: 65602 Address: 3438 ~indle Road, Suite 201 Camp Hill, PA 17011 ~ry C. Rohrbach Dated Telephone: (717) 612-0102 Description 1984 Oldsmobile Tornado Brouyham 1986 Chevrolet 10 PickUp 78 Shares of Prudential Financial Stock at $58.00 each (Attach additional sheets if necessary) Value $[,5oo.oo $3,640.00 ~i';' ~-f< ' Total:S9,679.60 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal rep- resentative, include the value of each item, but such figures should not be extended into the total of the Inventory. BUREAU OF INDIVIDUAL TAXES ZHHERTTANCE TAX DXVTSZOH DEPT. ZB06D! HARRISBURG, PA 17116-0601 'O2 ROBERT C MAY ESq MAY & MAY 3~38 TRINDLE RD ZO~ CAHP HILL CONHONNEALTH OF PENNSYLVAN/A DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN 04-29-Z002 ROHRBACH 11-31-Z001 21 01-01~4 CUMBERLAND 101 Amount Remitted ROBERT E HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETATN LONER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-0:~) NOTTCE OF TNHERTTANCE TAX APPRAZSENENT, ALLONANCE OR DTSALLONANCE OF DEDUCTTONS AND ASSESSNENT OF TAX ESTATE OF ROHRBACH ROBERT E FTLE NO. 21 01-01~ ACN 101 DATE 04-29-2002 TAX RETURN NAS.' (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNING FUTURE /NTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) 2. $. 4. 5. 6. 7. 8. ORIGINAL RETURN (1) Stocks end Bonds (Schedule B) (2) Closely Held Stock/Partnership Interest (Schedule C) (3) Nortgagas/Notas Receivable (Schedule D) (4) Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) Jo/ntly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Tote1 Assets APPROVED DEDUCTTONS AND EXEMPTXONS: 9. Funeral Expensas/Adm. Costs/N/sc. Expenses (Schedule H} 10. Dabts/Nortgage Liab/1/tias/Lians (Schedule T} 11. Total Deduct/OhS 12. Net Value of Tax Return 1:5. 14. (9) (10) Char/table/Governmental Bequests; Non-aZectad 911:5 Trusts (Schedule J) Net Value of Estate Subject to Tax 4;539.60 .00 5~1~0.00 .00 .00 NOTE: To /nsura proper credit to your account, submit the upper portion .00 of th/s form w/th your tax payment. .0O (8) 6,~21.50 .00 NOTE: 9,679.60 (11) 6.421.50 (12) 3,258.10 (1:5) . O0 (14) 3,158.10 Zf an assessment ,as issued previously, 11nas 1~, 15 and/er 16, 17, reflect figures that include the total of ALL returns assessed to date. (15) 3,258.10 x O0 = (16) .00 x 045 = (17) .00 x 12 : (18) .00 x 15 = (19)= ASSESSMENT OF TAX: 15. Amount of L/ne 14 at Spousal rate 16. Amount of Line lq taxable et Lineal/Class A rate 17. Amount of Line 14 et Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYHENT RECEIPT DISCOUNT DATE NUNBER INTEREST/PEN PAID (-) IF PAID AFTER DATE /NDICATED, SEE REVERSE FOR CALCULATION OF ADD/T/ONAL [NTEREST. ANOUNT PAID 18 and 19 wtll .00 .00 .00 .00 .00 TOTAL TAX CREDTT BALANCE OF TAX DUE ~NTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN 91, NO PAYNENT ZS REgUIRED. ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE DF NOTICE: PAYNENT: REFUND [CR]: OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying an or baR)re December 12, 198Z -- if any future interest in the estate is transferred in possas~ion or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for 1ifa or for years, the Coaeanmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class D (coIlateral) rate on any such futura interest. To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit mith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, ahich mas not requested on the Tax Return, amy ba 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 22 Revenue District Offices, or by calling the special 24-hour enamoring service for fores ordering: 1-800-562-2050; services for taxpayers alth special hearing and / or speaking needs: 1-800-~47-5020 (TT only). Any party in interest net satisfied with the appraisement, allomance, er disallowance of deductions, or assessment afthistaXNotica(includingby: discount or interest) as sheen on this Notice oust object mithin sixty (60) days of receipt of --mritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. 1982 202 .0005~8 1992 92 1982 162 .000~58 1995-199~ 72 198q llZ .000501 1995-1998 92 1985 152 .000556 1999 72 1986 102 .000274 2000 82 1987 92 .OOOZ~7 2001 92 1988-1991 112 .000501 ZOOZ 62 --Interest is calculated as folloms: INTEREST = BALANCE OF TAX UNPAZD Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions ~or Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid mithin three (2) calendar months after the dacadant's death, a five percent (52) discount of the tax paid is allomad. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penaZty is appealable in the same manner and in the the same time period as you mouZd appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (93 months and one (1) day from the date of death, to the date of payment. Taxes mhich became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .00016fi. A11 taxes mhich became delinquent on and after January l, 1982 mill bear interest at a rate which mill vary from calendar year to calendar Year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOZ ara: Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor .0002~7 .000192 .DOOZY7 .000192 .000219 .O00Zq7 .O0016q X NUNBER OF DAYS DELINQUENT X DAILY /HTEREST 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 date sheen on the Notice, additional interest must be calculated. Name of Decedent: Date of Death: Will No. REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 Robert E. Rohrbach December 31,2001 21020144 Admin. No. 2002-00144 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1.State whether administration of the estate is complete Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties-in-interest? Yes No X The executrix is the sole beneficiary of the estate. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Not applicable. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. Signature Robert C. May, Esquire Name (Please type or print) 3438 Trindle Rd.; Suite 201 Camp Hill, PA 17011 (717) 612-0102 Capacity: ~ Personal Representative X Counsel for personal representative