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HomeMy WebLinkAbout04-0184PETITION FOR PROBATE and GRANT OF LETTERS also known as Social Security No. \ c(% _ ~'n, -'\\xD~eased' No. To: Register of Wills for the County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age.or older an the executfftx in the last wilt of the above decedent, dated and codicil(s) dated in the named ,19. (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Q ~,~(n,,c( C~ounty, Pennsylvania, with her last familyor principal residence at :,~LlC3 ¢~, ~_i i E~. (~rc~,a [4~ I / (list street, number and muncipality) Decendent, thet~ ~ / years of age,Atied ~-~_ ~. I ~ , }xg' ~c_, ~/, Except as ~ollows, decedent d~d not marry, was not dtvorced 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 (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 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 truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~.~z) day of Estate Of I I~ ~ b~ ~-, ~z_~,~-¥ ~ ~ d , Deceased No. DECREE OF PROBATE AND GRANT OF LETTERS the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ,//-c~-/- described therein be admi~ed to probate and filed of record as the last will of and Letters '---~ .q3--~ r~ e ~5-~ ~ ~. ct ] ~e hereby granted to ~~{~ ()/~7~T~c) kq'~c~ ~, in consideration of the petition on FEES Probate, L~tters, Etc .......... ,~, _/j~ ?q_5 . . . Short Certificates( (~iation ................ $ TOTAL . $ ,/~'0, Filed .,~..~.;'q..~.~...~.~.'.. :~o."~z.. ...... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE i0q.805 REV 9/86 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 9963519 No. Local Registrar Date COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Phyllis A. Fitzgerald ,. Female~,. 193 -- 24 -- 1114I'.Fefi~;~,,,, Chambersburg ~~ ~'~ ~ ~ ~ ~ Cumberland .~. East Pennsboro ~. ~-O1~ ~ ~O5~ ],~.~o~. I,*. White HaSrdresser .~ Cosmetolog~ ~. ~ ~ ~a. ~'~ 12 .. ~Sdow ~,. ~TU~ ~.~ Pennsylvania ~ ...~ ~.~ 210 April Drive ~ Camp Hill, PA 17011 ~'~ ,m.~ Cumberland ~ 'v".~-"v' m=~ Hill Paul Reader ,,. Ella Armstrong Kimberly Mrozinski ~. 210 April Drive, Camo Hill, PA 17~11 ,~U ~ . ~1 Februar ...... ~Cremation Society of - . ~ ~ ~ % I,IL y zu, zOO~ ~,~ennsylvania Crematory ,,~ Harrisburg, PA 17~09 ~u~~~;~m~ t~R ___ C emation Society of Pennsylvania ~.f~I ~~~~ ~ [~. m. 4100 Jonesto~ Road, Harrisburm. PA 171oq LAST WILL AND TESTMAENT PHYLLIS A. FITZGERALD I, Phyllis A. Fitzgerald, a resident of Guilford Township, Franklin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument as and for my last will and testament, hereby revoking any and all wills and testaments by me at any time heretofore made. ITEM I: I direct that all expenses of my last illness, including hospital expenses, expenses for medical care, funeral expenses and the cost of the grave marker, as well as all debts or obligations owed by me at the time of my death, which in the opinion of my Executrix is not subject to either a legal or equitable defense, shall be paid from my residuary estate, unless otherwise provided herein as soon as practicable after my decease, as part of the expense of the administration of my estate. ITEM I1: I give, devise and bequeath all of my estate real, personal and mixed of every nature and wherever situate to my Granddaughter, Kimberly S. Umstead. ITEM II1: I appoint Kimberly S. Umstead, Executrix of this my last will and testament. ITEM IV: I direct that my Executrix, as well as her successors, shall not be required to give bond for the faithful performance of her duties in any jurisdiction and that she shall receive compensation in accordance with her schedule of fees in effect from time to time during the period over which her services are performed. ITEM V: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property shall be paid out of the principal of my general estate, as if such taxes were administration expenses and shall be paid without apportionment or right of reimbursement. this IN WI~.T~SS WHEREOF, I have, hereunto set my hand and seal 2// dayof -t~ l ~-,.,,.--J~ 2002. Phylli~'A. F tzgeral~ ~ ~ The preceding instrument consisting of this and other typewritten pages, identified by the signature of the testatrix was the day and date thereof signed, sealed, published and declared sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of Phyllis A. Fitzgerald, the testatrix, herein named, as and for her last will and testament in the presence of each other, have hereunto subscribed our names as witnesses. Carolyr~eibert-Drager ~ STATE OF PENNSYLVANIA: :SS COUNTY OF FRANKLIN We, Phyllis A. Fitzgerald, David W. Rahauser, Carolyn Seibert- Drager, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and testament and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of their knowledge, the testatrix was at that time eighteen years of age or older of sound and disposing mind and under no constraint or undue influence. Phylli~ A. Fitzg.era[c~/~,,2, Dag, id W. ,. ahauser ~ . Carolyn S~ert'Drager ~ Subscribed, sworn to and acknowledged before me by Phyllis A. Fitzgerald, Testatrix and David W. ~d Carolyn Seibert-Drager, witnesses, this o?,/,,~z day of ,2002. Notary l~ublic ~' 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 003934 UMSTEAD KIMBERLY 210 APRIL DRIVE CAMP HILL, PA 17011 NKA ........ fold ESTATE INFORMATION: SSN: 193-24-1114 FILE NUMBER: 2104-01 84 DECEDENT NAME: FITZGERALD PHYLLIS A DATE OF PAYMENT: 05/13/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/11/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,358.04 TOTAL AMOUNT PAID: $1,358.04 REMARKS: SEAL CHECK# 15719 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV. i so,0 EX (~-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Fitzgerald, Phyllis A. DATE OF DEATH (MM-DD-YEAR) O2/11/04 DATE OF BIRTH (MM-DD-YEAR) 12/29/32 O ~:oo < (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 193-24-1114 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS [~1. Original Return E~]4. Limited Estate r~6. Decedent Died Testate (Ar, ach copy of Will) e~9, Litigation Proceeds Received ---] 2. Supplemental Retum E]4a. Future Interest Compromise (date of dealh after 12-12-82) [~]7. Decedent Maintained a Living Trust (A~ach copy of T~st) E~10. Spousal Poverty Credit (cate of death be~eer~ 12-31-91 and 1-1-95) E~]3, Remainder Return ,'date ) death pdor to 12-13-82) E~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes E11,Election to tax under Sec. 9113(A) (At~aci~ Sch O) NAME Andrew C. Sheely, Esquire FIRM NAME (if Applicable) Andrew C. Sheely, Attorney at Law TELEPHONE NUMBER (717) 697-7050 COMPLETE MAILING ADDRESS Andrew C. Sheely, Esquire 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Pmpecty (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 & Ad ministrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10} 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Nel Value Subject to Tax (Line 12 minus Line 13) 4,701.77 44,163.O0 (8) 2,729.00 30,686.04 (11) (12) (13) (14) 48,864.77 33,415.04 15,449.73 15,449.73 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x.0 15,449.73 x .0 45 x .12 x ,15 (15) (16) (17) (18) (19) 695.24 695.24 FILE NUMBER 21 _ 04 0184 Decedent's Complete Address: STREET ADDRESS Phyllis A. Fitzgerald 210 April Drive C~TYcamp Hill J STA'h-pA ziP17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Pnor Payments C. Discount (1) 1,358.o4 3. Interest/Penalty if applicable D. Interest E. Penaity 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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. B. Enter the tota! of Line 5 + SA. This is the BALANCE DUE. Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 695.24 1,358.04 662.80 695.24 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred; .......................................................................................... [] [] b, retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c, retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2, if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" 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 penal§es of perjury, I declare that I have examined this ratum, induding accompanying schedules and statements, and to the bast of my knowledge and belief, it is true, correct and complete, Declaration of preparer other than the personal representa~ve is based on all information of which preparer has any knowledge, SIG~ P~ERSON RESPONSIBLE FOR FILING RETURN ADDRESS S'~ Kimberly Mrozinski, 210 April Dr., Camp Hill, PA 17011 DATE Andrew C. Sheely, Esquire ~1.~2.7.S Marke~ St. P.Q:..Bpx 95, Mecha.n.i~sburg, PA 17055 For dates of death on or after July '. 1994 and before Januan] 1 1995, the lax rate imposea on the net value of transfers to or for the use of the surviving sBouse ~s 3% [72 P.S, ,69116 (a} (1,1) (i)] For dates of death on or a/tar Januanj 1 1995. the tax rate ~moosed on the net value of transfers to or for the use of the surviving spouse s 0% [72 P,S, §9116 (a) (1,1} (ii)], The statute does not exempt a transfer to a surviving spouse fi.om 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 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 ~rnposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(13)], 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. 1508 EX+ (6-98) ~ GOMMONVV'EALTH OF PENN.,SYLVANIA INHERFYANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PHYLLIS A. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FITZGERALD 2 1 - 0 4~ - 0 0 1 8~LE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT CATE NUMBER DESCRIPTION OF DEATH e Fulton Bank Savings Account #1371-02826 Principal Balance at date of death Accrued Interest Date Of Death Balance $ 2,494.15 $ .37 Fulton Bank Checking Account #3621-94134 Principal Balance at date of death Accrued Interest Date Of Death Balance $ 157.25 $ .00 1997 Mercury Tracer LS VIN #1MFLM13PlVW610508 As appraised per New Harrisburg Tuck Body Co. Personal Property At the time of death, decedent owned a minimal amount of personal property limited to a bedroom set and misc.costume jewelry TOTAL (Aisc enter on line 5, Recapitulation) $ $ 2,494.52 $ 157.25 $ 1,850.00 $ 200.00 4,701.77 (If more space is needed, insed additional sheets of the same size) l llt, ofl Bank ~PITAL DIVISION · LANCASTIffi[CI~F~Th'I1 DIVISION DROVERS BANK DIVISION · GREAT VALLEY DIVISION (717)291-2589 April 2, 2004 Andrew C. Sheely 127 South Market St, PO Box 95 Mechaniosburg, PA 17055 Dear Mr. Sheely: RE: Phyllis A. Fit. zger~dd, deceased February 11, 2004 In response to your recent inquiry coneexaing the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Savings #1371-02826, open 11/30/02, balance $2,494.15 plus accrued interest $ .37, Power of Attorney Kimberly S. Mrozin~ri. Checking #3621-94134, open 11/30/02, balance $157.25, Power of Attorney Kimberly S. Mrozinski. Installment Loan #022138978 I, open 6/14/03, balance owing $29,414.70, t~ns 181 pymts @ $270.27, secured by a collateral mortgage, in her name only. If you should have any further questions, please do not hesitate to contact me. Very truly yours, Credit Confirmation Processor P 0 Box 4887 futtonbank,com Lancaster, PA 17604 I'800-FULTON.4 The New Harrisburg Truck Body Company NHTB co. March 31, 2004 REF: Appraisal To Whom It May Concern: Having seen the 1997 Mercury Tracer L$ vehicle, brought by Mr. Jay Mrozinski 'to my dealership today, I offer the following fair market value appraisal. Our PA Vehicle Dealer's License number is #85-65z~ 1. 1997 Mercury Tracer LS White - A/T - A/C - AM-FM 53,000 miles 4~ Door Sedan -- $ :t,850.00 This information was taken from the April 2004 Eastern Edition of the N.A.D.A. Official Used Car Guide. This publication is approved by the PA Dept. of Tranaportation. Sincerely, W. Stephen Forrest, President New Harrisburg Truck Body Co. 408 SHEELY LANE, P.O. BOX 568 ' MECHANICSBURG, PA, 170,5,5-0568 · PHONE: (7'~ 7) 766-765'1 FAX: ('717) 766-4289 SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH 0~: PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT , , ~:STATEOFpHYLLIS A. FITZGERALD ....... FILEI~B.-E~)4-O0184~ If an asset was made joint within one year of the decedent'e date of death, It mtmt be reported on Schedule G, SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A, KJmbeHy S. Mrozinski Iranddaughter Co 210 April Drive Camp Hill, PA 17011 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE include name of frnancial institution a~d bank account number or similar idenUfying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT c~eed for ioifltly-held, real,estate. , .... VALUE OF ASSET INTEREST DECEDENTS INTERES~ 1, A. 12/16/02 210April Drive Camp Hill, PA 17OI 1 Phyllis A. Fitzgerald/Kimberly S. Mrozlnski, Jt. Ten. with rights of survivorship County Assessment $84,120J}0 "1.05 (O.R) 88,326 .50 44,163.00 This residential property was pun:based Jointly by the decedent and her granddaughter on December 16, 2002. The COmmon Level Ratio (CLR) for Cumberland County is 1.05 TOTAL (Also enter on line 6, Recapitulation) $ 44,163.00 (if more space is needed, insert additional sheets of the same size) CO--WEALTH OF PENNBYLVANIA INHERITANCE TAX ~N ~81~ ~NT ESTATE OF P~LLZB ~. ~/TZGER~LD SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 1 FILE NUMBER I Ir' 21-04-0184 Debtiofdecedentmu~bemportedon Schedule I. rTEM NUMBER 5. 6, 7. DESCRIPTION FUNERAL EXPENSES: CaEMA~eXON SOCZBTI~ Or ]~ENNS~?.VA~IZA ADMINISTRATIVE COSTS: Personal Repmmeme~e's Commlnlons Name of Personal Representative Social Security Number(a) I E1N Numbs' of Personal Rspreaentallva(s) StmetAddres~ 310 APRIL DRIVE CAMP HiLL c~y 8mta Year(a) Commission Paid: AttomeyFeaa AMOREW C. BREEL~, EBOUIRE, PER AGREEMENT Family Exem~lon: (If decedents addre~ Ia net the same am dalmaflt'a, attach explanation) C/etmant ooo-oo-ooo ZIp Street Addm.qs Relationship of Ctalm~mt to Decedent SMta __ Zip Probate Fee~ CUMBERLAND COUNT~ REGIBTER OF WILLS Accountant's Fees Tax Return Pmpm~e~s Fee~ FXLXNG FREB FOR INHERITANCE TAX RETURN Accounting Fees, ttaxes, preparatXon/mniling and aopy aharges of'necessary F~duoXary Tax Return TOTAL (Also enter on line 9, Re~p.u.,_dallon) (If r~)or= space ~ needed, h~ri add,iraqal sheets of the same sJze) AMOUNT $1,449.00 $ 0.00 $ 625.00 $ 140.00 15.00 $ SOO.e0 2,729.00 Nationwide "The Simple Dignified Choice" 1-800-722-8200 2-12-2~EI4 24~196 Mrs. Kimberly Mroztnski 210 April Drive Camp Hill, PA 17811 Phyllis A. Fitzgerald - Deceased X Direct Cremation Special 48 Hour Or Weekend Cremation Service Nationwide Guarantee Program Worldwide Travel Protection Program Private Family Viewing/Witnessing Cremation Cremation Container X Medical Document/Courier Fcc X Painted Steel Chest Urn Burial Vault Arranic For Burial Personal Delivery of Cremated Remains Arran$c/Dellver Remains To A National Cemetery Cremated Remains 18 ~ Scattering Charge Packa~in~ And Forwarding Of Express Mail X Certified Copies Register Book Memorial Folders Thank You Cards # Memorial Service Package Flowers Newspapers X Chambcrsburg Public Opinion $1,158.$8 X Cumberland County Coroner Cremation Approval DNA Preservation X As per Shawn, wait for funds to be released from account at bank. $25.00 TOTAL $1,449.88 2-12-2004 PAID BALANCE DUE $1,449,08 www.cremationsocietyofpa.com RECEIPT FOR PAYMENT umberland_Coun~y - Register Of Wills anover and HiGh Stree= Carlisle, PA I7013 _Recei.~.t : : 16 ~ecelpu No.: 1035692 FITZGERALD PHYLLIS A Estate File No.: Paid By Remarks: Fee/Tax Description PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE Check# 429 Total Received ......... 2004-00184 KIMBERLY MROZINSKI AC Receipt Distribution Payment Amount 115.00 6.00 9.00 10.00 8140.00 $140 00 Payee Name CUMBERLAATD COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D REV-1512 EX - (1-9;') ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESiOENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS FILE NUMBER P~YLLIS ~. FITZGERALD 21-04-0184 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 2 3 4 5 6 7 8 Fulton Bank (Decedent solely liable) Installment Loan ~0221389781 Balance as of 4/2/04 West Shore EMS VISA #4121449991374625 UGI - final bill Nationwide - final homeowner's insurance bill Nextel - final bill PP & L - final bill Verizon - final bill TOTAL {Also enter on line 10, Recapitulation) $29,414.70 517.01 227.75 196.65 86.54 84.87 79.08 79.44 30,686.04 (If more space is needed, insert additional sheets of the same size) CAPITAL DIVISION ' LANCASTER/CHESTER DIVISION DROVERS BANK DIVISION ' GREAT VALLEY DIVISION (717)291-2589 April 2, 2004 Andrew C. Sheely 127 South Market St. PO Box 95 Mechanicsburg, PA 17055 Dear Mr. 8heely: RE: Phyllis A. Fitzgerald, deceased February 11, 2004 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Savings #1371-02826, open 11/30/02, balance $2,494.15 plus accrued interest $ .37, Power of Attorney Kimberly S. Mrozinski. Checking #3621-94134, open 11/30/02, balance $157.25, Power of Attorney Kimberly S. Mrozinski. Installment Loan #0221389781, open 6/14/03, balance owing $29,414.70, terms 181 pymts ~ $270.27, secured by a collateral mortgage, in her name only. If you should have any further questions, please do not hesitate to contact me. Very truly yours, Christine Putt Smith Credit Confirmation Processor P O Box 4887 Lancaster, PA 17604 fultor~bank.com 1-800-FULTON-4 FULTON FINANCIAL CORPORATION BOX 4887 · LANCASTER, PENNSYLVANIA 1'7604 (717) 291-2852 March 26, 2004 Andrew Shecly, Esq. 127 South Mm'ket Street Mechanicsburg, PA 17055 RE: Phyllis Fitzgerald; Klm Mrozinski Dear Mr. Sheely: I understand from Mary Lowe at Fulton Bank that you represent Kim Mrozinski personally, as well as in her capacity as the appointed executrix of the Estate of Phyllis Fitzgerald, her late aunt. Ms. Fi~gerald was the sole debtor under Fulton Bank loan #0221389781, which was secured by the subject property. Ms. Lowe has asked me to reply to some of your assertions and questions, as relayed to me. First, since Ms. Mrozinski mad Ms. Fitzgerald reportedly held title to the property in question as "joint tenants," and as you have discussed with Ms. Lowe, title vested by operation of law in Ms. Mrozinski at the time of Ms. Fitzgerald's death. Contrary to your reported suggestion, however, that change in property ownership had no effect on the loan to Ms. Fitzgerald. In fact, Ms. Fitzgerald's passing constituted an event of default under the loan, now an obligation of her estate. Fulton Bank consequently may demand payment thereof in full at any time, in addition to having other rights. I understand that Ms. Mrozinski wishes to obtain a loan from Fulton Bank, or assume the existing loan. I speculate that the reason for this request is an inability of the estate to satisfy the loan obligation on its own. While Fulton Bank would like to be able to assist Ms. Mrozinski in her financing needs, it regrettably cannot due so under its credit policy and guidelines. Fulton Bank will continue to accept installment payment of the subject loan, as due, for the next sixty (60) days, but it absolutely reserves all rights that it possesses under any documents related to the subject loan. Should you have any questions, please feel free to contact the undersigned. Thank you. Very truly yours, H. Scott Poole Associate Legal Counsel cc: Mary Lowe DISCLOSURE STATEMENT uorr , __ ....... t on.. ower. PHYLU~ FITZGERALD (BBN: 1B~-24-1114) 210 APFllL DRIVE - Lender: Fulton Sink CAMP HILL, PA 17011 Wlmt 6ho~e Office N. 12th lit. & RM. 11 & 11~ Lemoyne, PA Total of Payments The amount t w0l have paid Payment8 08 a©haduled. $48,648.60 PAYMENT SCHEDULE. My Payment ach.dole will be 180 monthly ~eyme~. of e270.27 aa=h, b.ginni~ July 29, 2003. VARIABLE RATE ~RE. My loan .om,l~ a varJ,bJe r,te ~ture. D;~=f~ures about the PROP~TY INSURANCE. I may ob~eln ~ro~y tns~anae from anyone I went th;t ~ECURITY. A seaurlty ~terest is bei~ given in my ~our) ~ee; pro;tory. In e~l~n, ~der ha, eisa re~w~; ;~tr~tu~ right of ;etof~ In my ~epo.t~ accounts. ~TE CH~GE. If a peym~t M 16 day; M ~e late, I will be ~ed 10.0~ of the unpaid ~lon e20.~, w~ahevm I, PR~AYMENT. If l ~y off easy, I will n~ have to pay · penalty. I will ~ok at my contract d~umems for ;ny additional tnforme~;~ .bout nonpayment, ;cheduied date, e~ pr~aym~t ref~de. I read end wail given a ooml)loted eopy of thle Dlaeioitwa Statement on June 10, 2003, prior to aignlno the Nm. BORROWER: Amount Finanoed Itemization Amount plid t~ me dlreotfy: $$,264,gl Oepo,lted to AoGount # 3621-g4134 Amount paid on my so,aunt: ~24,735.0g Payment on Loan # 0221386438 06,204.gl 024,735.09 Note Principal: t30,000.00 Pm~old Flnanoo Charge,: 00.00 In Cash: ~)0.00 Amount ~qnonood: 030,O00.00 Other Chargea Paid In Cash: 036.50 035.50 Eotlmoted Future LIEN RELEASE FEE PATIENT NAME: INSURANCE: WEST SHORE EMS - ALS 2O& GRANDVIEW AVE SUITF 21t CAMP I-IilLL, PA 4 TM 4 Phone #: (896) 3,67,..eM2 INVd~.al Tax ID: 23.24.63007 EMERGENCY MEDICAL SERVICES PHYLLIS FITZGERALD MEDICARE B FEP 3019359A PHYLLIS FITZGERALD 210 APRIl. DR CAMP HILL. PA 17011 1932411 t 4A R02128420 PATIENT NUMBER: 21404 CALL NUMBER: 301935gA DATE OF CALL: 02/04/2004 TIME OF CALL: CALLER: FROM: 210 APRIL DR TO: HOLY SPIRIT HOSPtTAL REASON(S) SHORTNESS OF BREATH FOR C.O,P.D. TRANSPORT REJ RJ PARAMEDIC INTERCEPT A0424 1 .O 488.08 488.08 EKG ELECTRODES A0390 1 .Q 4.{32 4.02 NEBULIZER AQ422 I .Q ,3.7§ 3.75 OP SITE AO3g4 t .O 4.47 4.47 ANGIOCATH (~4-24) AO3g4 1 .O 4.75 4.75 NORMAL SAUNE 50QCC AQ304 1,0 2 84 2,84 10GTT TU BI N G A0394 1.0 7 .§$ 7.§8 PRC'~ENTIL AQ3G4 I .ri 1.52 1,52 'oral Charees 517~11 PLEASE PAY THI8 AMOUNT DI~TA~H ~LONG PERFORMATION AND 'RETURN STUB WITH PK(M~NT AMOUNT' :D~ .~:.;; ~,~.*4 ~ .~.. ~: e~CcO~a' ,,,,., ::,,,, :: .~:~. TI-liS ACCOUNT IS PAST DUE! Send your payment now or contact our office to make payment arrangements. VISA AND MASTER CARD ACCEPTED 8END INQUIRIES TO'. CUSTOMER SERVICE ~ ~,~; ~' ~ ' :~;i :f ~', [ PO BOX 30495 TAMPA FL 33630 02/24/04 4121 4499 9137 46~ 6000 5772 (717) 7956032 YOU H~ EAR~B $6.18 IN CASH~OK SO F~ THIS YEAR! * THE TOTAL ~ANCE ~QE PAID ~ YOUR AC~T DURING THE PAST YEAR * * WA8...$ 9.40 * ~EASE NOTE MI~M~ PAYM~T NOW GET SOMETHING IN ~TURN ~EN Y~ PAY YOUR TAXE6. PAY Y~ PER,AL INCOME TAXES WITH YOUR MEMBER~ 1ST VBA CA~ AND GET EVERY ~AR Y~R PAY. FIND ~T ~W AT VIS~ff~AY. (CASHIER6 ~ BE ~8~O A 8E~E FEE, ~H WI~ VARY BASED ~ON THE TAXES ~E A~ PAY~ PROVIER 8EECTED.) CAS~ACK CAN BE YOUR8 IN A HWTBEAT WEH 6CORECO. TO REPORT A L~T OR STOLEN CARD PLEASE CALL: 800-326-3678 LST 8TLN ARER TO O;A~ ACCOUNT ~FORMA~ ~ ~URS A DAY C[L: cuaa ,URCH 223.73 0.7017~ 9.50% 1.~ CURR CASH O.00 0.7017~ e.S~ 0.~ ~t~t~ ~ 225.98 Goo PREV PURCH O.OO 0.7917% 0.50% 0.~ , )n nn g~l~, ~il~l 0.~ PREV CASH 0,~ 0.3325% 3.99% 0.00 [~[[~[~[[~[~':~~ 0.00 OLD PURCH 0.~ 0.7917% 9.5~ 0.00 ~n nn ,~~., ,~:'[~[~i :[ 0.00 OLD CASH 0.~ 0.7017% 9.5~ 0.~ i~~ . ~ ~,~ 0,00 FEES/FINANCE CHAR.E O. O0 ~~~ 0.0O DAYS IN CYCLE 32 ~ TOTAL ..... 1~? .... , 1.77 FINANCE CHARGE CALCULATION METHOD* CREDIT PURCHASES: G CASH ADVANCE: A *BEE REVER~E SIDE FOR EXPLANATION NOTE: IF YOU HAVE A VARIABLE RATE ACCOUNT THE PERIODIC RATE AND ANNUAL PERCENTAQE RATB (APR) MAY VARY. BIHIngSummery for 6styles to: PHYLLT~ FITZGEP~'LD 210 APRIL DR CAMP HtLL. PA 17011 Rate Claesificetloa: Residential Heating Billing Period: 01/22/2004 to 02/23/2004 (32 days) Remote Device Read Questions? Call ? 17-232-1811 or write to LIGI at PO BOX 13006 Reading, PA 19612-3009 Your currant UGI charges include State taxes totaling $ 6.33. CP? 216 562 242967 1 Past Bill Information - Uel Utility The account balance mi your lest biJl was ............... $ 281,81 Thank you for your payment of .................................... 7201.81 Ymir halenco as of 02/26/2004 .................................. O,OO Current Illll Information - UOI Utility Customer Charge .............................................................. 6,65 Commodity Charge ( 179 CCF at $0.74698) ............ 133.71 Distribution Charges (First 60 CCF at $0,36200> ... 17.60 Distribution Charges (Next 129 CCF at $0,26736). 37.07 PA State Tax Sumha rge ................................................. -0.28 Total Current Charges - LIGI Utility .............................. 196.66 UG!,Utility' ¢ll.llea' owed this bill ........................................................................ Total Amount Due, Please Pay by Dee Date (03/17/2004) ................................ $190,65 10.80 9.72 6,64~ 0.00 2003 Months 2004 · "Estimated Usage last This Average Year Year CCF/day 8.57 5,69 Daily temperature Meter Information - Next Read Date A~I122, 2004 Meter Number Prevlo~e Reading Present Reading CCF Used 1339103 471 (estimated) 650 (remote) 179 Messages from UGI · Your current price to compare is $ 0.74699 tCCF. · Your tatal annual usage is 1,252 {::CF. Your average monthly usage is 104 CCi:. · We can make your energy costs easier on yeur budget with our 12 month l~udget Billing plan. Your monthly payment would be approximately $107,00. For mom information about this plan cell UGI. · Help prevent pipatine damage, accidents and service disruptions. If you see someone digging near your home please call UGI. if you pay at a payment agent'P[eaes take your entire bill. Make check psychic to I~. Keep this'part for ~our records, import~nt Inform-rich I. ~fl 91~ k,,,~k ,~ ,kl. kllJ O091S DONALD FI MC, OLUFIE 8Fl ~,064 WAYNE RD CHAMBERSBUflG PA 17201.883~ Total Due: $86.64 Due by: February 21, 2004 Account Number: 5800906140 PrepPed: Februarv 08, 2004 Nationwide Representative: DONALD R MCCLURE SR 717-263-8418 Claim Servlce:('~ TTY numbs': 1'~22:,'~'~p~1~' Internet: nationwide, corn Any.check, ei.ectr, onlc p. ayment,or .deblt/credlt cora payment retuse.d, by your. Dan.l( may.os _ .subject to a $20 fee. you.may De charges a. Ss res for any payment reoalveopast the ~ue elate. fPeayments.are applied to any ex. latins .balances/ es first, then to the current'balance clue. Save time.& mon.ey, Contact your Natlonwi.ds .aggnt tg. sign up tot Electronic Funds Transtar moayl..¥ou can pay-Your~.remlum.el~i~tronlcafly from your ,savings .or check!ns account. - ........ No more stamps. No more ~ It's Freell - nstallment fees. h,,llh,,llhl,,l,lh:llhhhlh.lh.,lh,,,,lllh,,h,hl 210 APRIL DR CAMP HILL PA 17011-5008 Previous Amount Billed Silting Amount Payment Received . Thank Youl Remaining Balance Current Charges (see aocount detail) Inetallmen~ 8ervl~ Fee $86.63 - 86.53 $82.64 +4.00 Total Due $88.64 Nationwide Is On Your Sid¢ NEXTEL ITM Customer Care Please call: 1-888-566.6111 Web site: www. nextel, com Account number 116476087 Statement date February 23, 2004 Billing period January 19 - February 18, 2004 Your Monthly Account Statement Account Summary Page 1 Amount Paid Date Paid Check # ................................................. Approved ................................................. Previous balance Adjustments to previous balance Payments as of 02/19/04 New charges I~otal~. Amount Due ll~leaoe pay immediat~Jy upon receipt $201.34 - 20. O0 0,00 $181,34 t04.87 Summary of New Charge= Nextel ~'.c...~,: Pis=se ese the next page for imporlant updates about your Nexlel service. Adjustments, access and other charges 79.99 Unit taxes, fees and assessments 22.30 Total Wireless Services $102.29 Misc. additional charges 2.58 Account taxes, fees and assessments O. O0 Adjustments to new charges O. O0 Account Level Equipment Charges O. O0 Next~l'Retail Stores. Charges Third Party Charges, Adjustment and Taxes ................. o. oo Total NeW ~..~;~ t.,~-..t .~ ~, $104.87 ~'~-7 Electric Use Tliis graph shows your electric use over the last months, l~tePeS of r Readings: Actual 1 Estimated Customer [-'"] DDI "' Page I Summary Page Balance as of Feb 9, 2004 $ 0.00 Char~es: Totaf'PPL ELECTRIC LrHLITIES Charges $ 79.08 Total Charges $ 79.08 Account Balance $ 79.08 36 KWH - Average Per Day 30 24 Average - Feb I8 Temperature KWH Per Day 12 Yearly Use: 6 Mar 2003- Feb 2004 0 FMAMJ JASONDJF 2003 Months 2004 Meter Reading lntbrmation Fe t e r #77051548 b 9 Actual 6840 n 12 Actual 5918 I 28 Days KWH Bill,exl , ~ 2003 2004 24I: 22F 28 33 Total Average Use Monthly 9113 759 Other important information on back "~ PHYLLIS FITZGERALD Account Summary Previous Charges Payments Received thru Mar 9 . nn Past Due Charges (Please Pay Now) $25.86 New Charges Verlzor~ (page 3) $26.18 Other Providers (pegs 5) 27,40 Total Now Charges due Apr 1 Total Due (past hue + New) $79.44 Billing Date 03/07/04 Page 1 of 5 Telephone Number: 717 730 0528 Account 717 730 0528 985 13 Y How to Reach Us: See page 2 Manage Your Verizon Account Onlinel View & pay bills, request repairs, place orders. It's quick and easy: Go to vertzon,com Click "Si~n in" under "Manage My Account". First time user? Get started with ... User ID: 71773805285 Password: JFKR~D ... and customize your ID as you register. Then follow the step.by-step instructions. To ants# in the Verizon Direct Payment Option please read and sign the agreement on the reverse side of the payment form below, Mall payments to: Verlzon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of btaing address? Go to veHzon.com/bllIIngaddress o~ see page 2. "ir Detach & refurrl peNrnerlt ails with un,.' REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Phyliss A. Fitzgerald 21-04-0184 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ] TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Kimberly S. Umstead, now Kimberly S. Mrozinski 210 April Drive, Camp Hill, PA 17011 Rest, Residue and Remainder of Estate (100%) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - 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) LAST WILL AND TESTMAENT PHYLLIS A. FITZGERALD I, Phyllis A. Fitzgerald, a resident of Guilford Township, Franklin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument as and for my last will and testament, hereby revoking any and all wills and testaments by me at any time heretofore made. ITEM I: I direct that all expenses of my last illness, including hospital expenses, expenses for medical care, funeral expenses and the cost of the grave marker, as well as ail debts or obligations owed by me at the time of my death, which in the opinion of my Executrix is not subject to either a legal or equitable defense, shall be paid from my residuary estate, unless otherwise provided herein as soon as practicable after my decease, as part of the expense of the administration of my estate. ITEM I1: I give, devise and bequeath all of my estate real, personal and mixed of every nature and wherever situate to my Granddaughter, Kimberly S, Umstead. ITEM II1: I appoint Kimbedy S. Umstead, Executrix of this my last will and testament. ITEM I¥: I direct that my Executrix, as well as her successors, shall not be required to give bond for the faithful performance of her duties in any jurisdiction and that she shall receive compensation in accordance with her schedule of fees in effect from time to time during the period over which her services are performed. ..... ITEMV: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property shait be paid out of the principal of my general estate, as if such taxes were administration expenses and shall be paid without apportionment or right of reimbursement. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ....... ,~ / _ day of .~'~?..~_,~.--~,-,~.~-,~.' -, 2002, /=! 'pb?~'l'i- A. Fitzgerald Phyllis A. Fitzgerald The preceding instrument consisting of this and other typewritten pages, identified by the signature of the testatrix was the day and date thereof signed, sealed, published and declared sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of Phyllis A. Fitzgerald, the testatrix, herein named, as and for her last will and testament in the presence of each other, have hereunto subscribed our names as witnesses. /6! ~.v;i.~ ,,W,; ~ahause: David W. Rahauser /s/ Carolyn Seibert-Drager Carolyn Seibert-Drager STATE OF PENNSYLVANIA: 'SS COUNTY OF FRANKLIN We, Phyllis A. Fitzgerald, David W. Rahauser, Carolyn Seibert- Drager, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and testament and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of their knowledge, the testatrix was at that time eighteen years of age or older of sound and disposing mind and under no constraint or undue influence. Phyllis A. Fitzgerald Phyllis A. Fitzgerald David W. Rahauser David W. Rahauser /s/ Carolyn Seibert-Drager Carolyn Seibert-Drager Subscribed, sworn to and acknowledged before me by Phyllis A. Fitzgerald, Testatrix and David W. Rahauser and Carolyn Seibert-Drager, witnesses, this day of ,2002. Notary Public CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: Date of Death: Will No. 184 Phyllis A. Fitzgerald February 11, 2004 Estate No.: 21-04-0184 To the Register: I hereby certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans Court Rules was served or mailed to the following beneficiaries of the above-captioned Estate on June 18, 2004. Kimberly S. Umstead, a/k/a Kimberly S. Mrozinski Granddaughter 210 April Drive Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: June 18,2004 ~~eel~y~~ Andrew PA ID NO 62469 P.O. Box 95 127 S. Market Street Mechanicsburg, PA 17055 717-697-7050 Counsel for Personal Representative, Kimberly S. Mrozinski, Executrix BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRZSBURG, PA 17128-0601 COHMONNEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01~03) ANDREN C SHEELY ESQ 127 S MARKET ST PO BOX 95 MECHANTCSBURG PA 17055 DATE 06-28-2004 ESTATE OF FTTZGERALD DATE OF DEATH 02-T1-2004 FILE NUMBER 21 04-0184 COUNTY CUMBERLAND ACN 101 Amount Remitted PHYLLTS A MAKE CHECK PAYABLE AND REMTT PAYMENT TO: REGTSTER OF NTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 1701:5 CUT ALONG THTS LTNE ~ RETATN LONER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP C01-03) NOTTCE OF [NHERTTANCE TAX APPRATSEMENT, ALLONANCE OR DXSALLONANCE OF DEDUCTTONS AND ASSESSMENT OF TAX ESTATE OF FTTZGERALD PHYLLTS A FTLE NO. 21 04-0184 ACN 101 DATE 06-28-2004 TAX RETURN NAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATTON CONCERNTNG FUTURE TNTEREST - SEE REVERSE APPRATSED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate CSchedule A) 2. Stocks and Bonds (Schedule B) $. Closely Held Stock/Partnership Interest CSchedule C) 4. Mortgages/Notes Receivable CSchedule D) 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) 6. Jointly Owned Property CScheduZe F) 7. Transfers CSchedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTTONS: 9 Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) 10 Debts/Mortgage Liabilities/Liens CSchedule I) i1 Total Deductions 12 Net Value of Tax Return .00 .00 .00 .00 4r701.77 .00 (8) 2,729.00 cio) NOTE: To insure proper credit to your account, submit the upper port/on of this form with your tax payment. 864.77 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 17. Amount of L/ne 14 at Sibling rate C17) 18. Amount of L/ne 14 taxable at Co/lateral/Class B rate (18) 19. Princt)al Tax Due RECEIPT DISCOUNT C+) NUMBER INTEREST/PEN PAID C-) CDO 0:59:54 . O0 TAX CREDITS I P ADYAHTEEN T 05- 1:5-2004 .~'0'x O0 _ .00 15,449.7:5 X 0~-~ 695.24 .00 X 12 = .00 .00 x 15~_ = .00 c 1,~= 695.24 AMOUNT PAID 1, :558 TOTAL TAX CREDXT { 1,:558.04 BALANCE OF TAX DUEI 662.80CR TNTEREST AND PEN. I .00 TOTAL DUE I 662.80CR c IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) C15) ,00 Net Value of Estate Sub3ect to Tax C14) 15,449.7:5 Tf an assessment uas lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~tll 15 NOTE: reflect figures that include the total of ALL returns assessed to date. 30~686.0~ c11) RESERVATION= Estates of decedents dying on or before December 12, 1982 -* if any future interest in the estate is transferred in possess/on or enSoyment 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= PAYMENT= REFUND CCR)= OBJECTIONS: ADHIN- ISTUTIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Sect/on 9140). Detach the top portion of this Notice and submit w/th your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to= REGXSTEi~ OF NILLS, AGENT 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-ISIS). Applications are available at the Off/ce of the Register of NiZls, any of the 25 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering= 1-800-562-2050; services for taxpayers w/th special hearing and / or speaking needs= 1-800-447-$020 (TT only). Any partY in interest not satisfied w/th the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Not/ce must object within sixty (60) days of receipt of this Notice by= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --elect/on 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 writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Un/t, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Res/dent Decedent°° (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allo~ed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Januar~ 18, 1996, the first day after the end of the tax amnesty per/od. This non-part/c/pat/on penalty /s appealable /n the same manner and /n the the same t/me per/od as you would appeal the tax and /nterest that has been assessed as /ndicated on th/s not/ce. Interest /s charged beg/nning w/th f/rst day of delinquency, or n/ne (9) months and one (1) day from the date of death, to the date of payment. Taxes wh/ch became del/nquent before January 1, 1982 bear /nterest at the rate of slx (6~) percent per annum calculated at a dally rate of .000164. All taxes wh/ch became delinquent on and after Januar~ 1, 1982 w/11 bear /nterest at a rate wh/ch w/Il vary from calendar year to calendar year w/th that rate announced by the PA Department of Revenue. The appl/cable /nterest rates for 1982 through 2004 are= Interest Da/iv Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 ~'~'~'8-1991 XIZ .000501 ~-~ 9Z .000247 1983 16Z .000438 1992 9Z .000247 2002 6Z .000164 1984 11Z .000301 1995-1994 7Z .000192 2003 5Z .000137 1985 15Z .000356 1995-1998 9~ .000247 2004 4Z .000110 1986 lO/ .000274 1999 7Z .000192 1987 lO/ .000274 2000 7Z .000192 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Not/ce /ssued after the tax becomes del/nquent will reflect an interest caXculat/on to fifteen (15) days beyond the date of the assessment. If payment is made after the /nterest computat/on date shown on the Not/ce, add/t/Dna1 /nterest must be calculated. BUREAU OF ZNDZVZDUAL TAXES ZNHERTTANCE TAX DIYZSTON DEPT. 280601 HARRISBURG, PA 17128-0601 CONMONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHER'rTANCE TAX STA'TEHENT OF ACCOUN.T REV-/6O7 EX &FP ~01-05) ANDREN C SHEELY ESQ 127 S MARKET ST PO BOX 95 MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUHDER COUNTY ACN 08-09-200~ FITZGERALD 02-11-Z00~ 21 0R-018~ CUHBERLAND lO.~: PHYLLIS HAKE CHECK PAYABLE AND REd'lIT PAYHENT TO: REGISTER OF W,~:'LLS CUMBERLAND C0 COURT ~:~USE CARLISLE, PA .... 1701:5 .. o: .. .... NOTE: To insure pr-oper- c~-edit to your- account`, subeit fha upper' por'tion of this 'form Nh your tax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS *-~ REV-1607 EX AFP [01-03) ~ INHERITANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF FITZGERALD PHYLLIS A FILE NO. 21 0~-018~ ACN 101 DATE 08-09-Z00~ TH/S STATENENT TS PROVIDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHONN BELO# 'rs A SUNNARY OF THE PRTNCTpAL TAX DUE`, APPLTCAT'rON OF ALL PAYNENTS,, THE CURRENT BALANCE,, AND`, TF APPL'rCABLE`, A PROJECTED /NTEREST F.rOURE. DATE OF LAST ASSESSNENT OR RECORD ADJUSTHENT: 06-Z1-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYNENTS (TAX CREDITS): 695.2~ PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID .00 05-13-200~ 07-19-Z00~ CD00595~ REFUND .00 662.80- .rF PA'rD AFTER TH'rS DATE`, SEE REVERSE S'rDE FOR CALCULAT'rON OF ADD'rT'rONAL INTEREST. ( 'rF TOTAL DUE 'rS LESS THAN NO PAYNENT 'rS REgUIRED. ZF TOTAL DUE 'rS REFLECTED AS A "CRED'rT" TOTAL TAX CREDIT 695.2~ BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORH FOR /NSTRUCT'rONS. }