The URL can be used to link to this page

Home My WebLink About02-0759~- PETITION FOR PROBATE and GRANT OF L~IETTERS Estate of DAIL H. OWEN jvp, ~~ "Oa - 75 9 also known as ORA DAIL H. OWEN To: Deceased. Social Security No. 229-38-1554 Register of Wills for the County of CUMBERLAND in the 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 executors named in the last will of the above decedent, dated OCTOBER 12. 2000 and codicil(s) dated NONE (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with her last family or principal~}~esidence at 1709 Letchworth Road, Camp Hill, Pennsylvania 17011 ~. uw~r/2 /t LLL~.dl `~ cd /V~h`~ ~ (list street, number and municipality) Decedent, then 68 years of age, died 617/02 at Hospice of Central Pennsvvlania. Susquehanna Township, Dauphin County. PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never ajudicated incompetent: NONE Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 30.000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 120.000.00 situated as follows: 1709 Letchworth Road, Camp Hill, Lower Allen Township, Cumberland County, Pennsylvania WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) i...` U a ~~ _- x ;, b C C O ctl ~ ~ y 0. O cd C 00 James M. Thumma, 1730 Bristol Ave. #304 State College PA 16801 Sara Leslie Wills, 64 W. Keller, Mechanicsburg PA 17055 I ~ ~. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTI-I OF PENNSYLVANIA l COUNTY OF CUMBERLAND J 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 petitio r(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and trul minister the e to according to law. Sworn to or affirmed and subscribed ~-~- ~ before me this 21st day of Au st ?_002 ~ t, nna - o s c> Deputy egi er, -ia ~' ;; .~ No. 21-2002-759 Estate of DAIL H. OWEN , aka ,Deceased Ora Dail H.Owen DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August ~ 1st 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 10/12100 described therein be admitted to probate and filed of record as the last will of DAIL H. OWEN also known as ORA DAIL H. OWEN and Letters Testamentary _ are hereby granted to James M. Thumma Sara Leslie Wills FEES ~, ~~ Donna M. Otto 1St D2pll~egister of Wills ~ Probate, Letters, Etc.. .. .. $ 235.00 Short Certificates ( 2 ) . $ 6.00 Renunciation . $ x-Pages (3) $ 9.00 JCP TOTAL $ 5.00 Filed. AugusL.2lst, .2D02 . . . .?55.00 Murrel R. Walters, 111, Esquire 24829 ATTORNEY (Sup. Ct. LD. NoJ 54 East Main Street Mechanicsburg PA 17055 ADDRESS (717) 697-4650 PHONE CALL FIRST' AND THEN PUI' LETTERS IN ATTORNEY'S FILE ON 8/21/2002 ~~~s is to certifi' that the information here given is correctly copied ti-om an original certificate of death duly tiled with me as l,~>ccl Registrar. The original certificate will be forwarded ro the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for :his certificate, SZ.00 ....-' Local Registrar ~1 ~ N 1 ~ Z002 -~' ~.--. N[~. ~~ar~ ;aJRev. 2197 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH $IAIE r4E NIrMBER .-~v~~~..y.:anm. :-~_ -___:~~__~_ __._..-__._~~_ .__- __. NAME OF OECEDENT(r nsl MidWe :asl SE% SG:IAL SECUHIiV NUMBER DATE OF UEATH,MCnN Day. marl +. Ora Dail H. Owen z Female 7 229 - 38 - 1554 ~' June 7, 2002 _ ___ _ AGE (Lass evlnuay) UNDERIYEAR UNDERIDAY~ DATE OF BIRTH BWTNPUCE:[~~W and PUCF OF DEATHNt~ex.x m+y ~.» .~~.i,~u,,,:u.~, r.%nei ,nisi _~ __ _ ~-~----~--~ -----~- T- Monln. UaY h«I iWltl Jr .~:reyn t;ouMiVl OTHER: MonIM Days Hours r Mtrwlss MOSPIUL. PA w '""'^ ER,owpa"`"';' ooAC; NHan~. ^ R°'°'Fib`SpiceaR~~ 68 Yra. Macungie 11-6-1933 ence , . , a COUNTY OF DERH CfTY. BORO. fWP OF DEATH FA f!Y NAktE Ilt nnl ~ y~ Ica, ~;,ve ureel ar rn, ner~ o~ C `h l P WAS DECEDENT OF HISPANIC ORIGINi RACE -AmerKan Inman. BaKk. Nmae. Nc ospice entra ennsylvania . ,,~~ ,a,^„ye,,~,~G,,,,n. Ispecnl D hi Sus uehanna Tw Carol n Croxton Slane Residence M.aKan•PuenoRica"'«` White au s w. P .~. 4 P~ w. Y __ ,. _ le. pECEDENT'SUSUAL OCCUPRION KING OF BUSINESS/INDUSTRV YMS DECEDENT EVER IN DECEDENT'S EDUCATION MARITaI STRU$-Marrwd SURVIVING SPOUSE IGne krd d vrr%k dew duug rn°O U S ARMED FURCESi ( d adv nrcy~esl i a1.4 ca„ eif Nev« Manr°. WrOow.Q Collage Divorced (SpccaN /Secondar ENmenla III .rJB. eve rtwnen name) a wwkap W; do i,ol use reload 1 ~ Y0"-~ "° ry y .ab. o,z . ,,,. Rece tionist „e_ Medical ,,, l , , o ,,. 12 3 ,e, Married ,,. Robert D, Owen DECEDENT'S MAILING ADDRESS(slrea, Coy/Town. Slala. Zy Codel DECEDENT'S ~''~1I 4cWw+4w°m j,(1WQT A~ ~ PTt Iw LJ Yaa Penn lvan is ,TC 1709 Letchworth Road p . . ~ o«i ACTUAL 17a. Stale RESIDENCE - osceMn ISeeYxlruclms k,r.ala Cam Hill PA 17011 P ,~. ~ nndmersdel Cumb__e__r_land '°w"`"'Pi "`.°a`w«"ar° 1Tb. Counq-...-- _..-____-- ne.^ warun anrw hmaaoL_- _-._--.--- cayAloo FRHER'S NAME IFYSt Mxkae. Last) MOi//EH'S NAME ,! nsl. Mnldk~. MaiOCr, Swn,untll u. Macon L. Hard Sr. n. Gertrude Hannum WFORAUNT'S NAME (IypeiPmq INFORMANT'S MAILWG ADDRESS ISlitlel. Cay/TOwn. Style. Zip Coos) 1709 Letchworth Road Cam Hill PA 11 Robert D Owen 2,e _ . ,,,, . ORE OF DISPOSITION PLACE OF DISPOSITION ~ Nanw a Cem«ery. Crsmaldry LOCRION ~ CMlTown. Sure. Zy Co4 METHOD OF DISPOSITION *~T laomstal.^ (Ma,m.wy'YBir' °'Oibe1PliCe Cremation Society of l^ c ,lo (3 Remw e t.ma n ww a DOrwlon^ a1Wl5peceY ^ i C Ha i PA J 11 2002 P l t b . = van rema or :,d. ur enns a rr s une :,~. a,e U OF FUNE SE JCE JtFISEE OFa PER ACT SSUCH LICENSE NUMBER NAMF ANp ACKlRE55 OF FACILITY Cremation Society Of Penns lvania '+C' _ z:e. zzc. 100 Jo '' TO G amy w4dgs, dawn oc<wrxl altM Ume. date aiw macs slalad LICENSE NUMBER DRE GNED Hams 23a< plywMn ng e not aq al nma o dNln la cal! Y,d frlle) (MOrYb. OaY. Yaarl a N-28 mlltl W comple by \ TIME OF DEATH ORE PRO OUNCED DEAD IMOndr. Day. Pearl WAS C REFERRED IU ME AL EXAMINERICORONER7 who Rondo tn. yp ~ !b ^ 2e. ~ r 2a. ~1~% ~~ 2,. 27. PART 1: Enwr tM mseases. Inryrws a tompkcatnrR wnKn caused the deals Do rot enter Ina mode cal dying, sur:n es tarmac or respuatury ai itlst. shuck ar snarl ladura i Appoamuw PART 11: OUwr slgniTKanl rnntlArona conui0atrrg to MaN, DIA LuA day one cause on eaU krw. ~ unarral between not nw,mq m,w uridenyup cotes given n PART I. l onset and dash IYYEDIATE CAUSE (FUaI ` oaease«coraidkm ~ .~< r - - ~ Ci ~ ~ . I . I Ci [~ [ L ~ reauwgndwlnl-- a- ____-__-_- ______.~.~-_~_ -__ OUE TO lUR AS A CONSEQUENCE OF)'. -_ ____. ---.-- Seplwmla,Y lW CwldAbns D. ' I Y arty, Nadlrg b arwnemele DUE TO [17li AS A CONSE0IIENCE OYY _ ~.Emer UNDERLyHi6 I CAUSE IDrsease a ~nryry c. __. ___ l ~- Hat aMwed eveMa DUE TOIOR AS A CONSEQUENCE QFI: I reaJSrq n deam)LAST d _~___.___--_.__.___.____-___-._-__-__.__~__ - UA.S AN AUlOPSV WERE AUTOPSY fINgNGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE MOW INJURY OCCURRED. PERFORMEDi AWLABLE PRIOR TO (Mare,. Oay. Year1 COMPLETION OF CAUSE OF ERHi Na,ual ~ Nomn:rda D . 1~ r Yy ^ ~ `~ AccdeM ^ Parrbng,nWalgalpn U MM ^ No Yes ^ Nd ^ SurclM ^ Coukf np be delermm«1 ^ M. PUCE OF uuURY A, none. l"arm, vreel, fa tort. olaca IOCATK)N IStreat. Gryy,ovw,, Sulel bmkaig, ea.ISPeadvl 2w. zee. r. 70.. _ 7a. CERTIFIER ICneck pvy onel SIGNATURE AND TITLE OF CER TER 'CERTIFYING PHYSICIAN IPnysician cwutyinq causedaeam caner anomur onvsic~an Has grxwr.nceu ~IeaR, anu r.anl,ule0 hwn 231 To,M Oeet olmykmw40ge, death occurred dwbdw causele, and manor!rue,at.d ..................................................... ~ ~ /' .. ~.1."-"s''"'Y~`." yll 710. i.,--` G'-)C _ DRE $IGNEDIMp~n Oay. Veml IK;ENSE MBE V ~ 'P1gNOUNCING AND CERTIFYING PNYSN:IANIPnystwn f. iin ,,tor ,>,x ~cnx death and ~enl to reuse of neeu~i 1 ~ _ J ~ .~ l 3 C - C . 71e ) ~ I )~ 710 ~ ~-) 1 ' To the beat o, my krow{Wga, deals occurred al ltr 11me. date, arM place, and dW to 1M cauaels) and manner y Na1ed .......................... -_,__-__„- - _ .._ __ _~ -_ _ NAME ANU ADDRESS OF PE. HSON WJ-10 COMPLETED CAUSE OF DEATH ' (Iirn 2/1 Type or Pnnl ~~i - L ~ ` Lt -~.'lc~.. 1 MEDICAL EXAMINER/CORONER - On the basis of eaamination and/w investi ation in m inion death occurred a, the time o dale and lace and due Id the cause(s) and ) - L ~ ~ L /C ~ g y , p , , p , , manner as eta,ed t, ~j l I : ~ . ..c_ ............................................................................ .. .......... ... .. ..... 71 a. 72. {'.C^ ~..~ it ~1~~1~ ~ i REGI RAR'S SIGNEANDNUMBER ~1~-~~~ ]]. r.X11f/N/ ~ DATEf1LED1M.n,s, Day veeil ~ ) /~ - - _ - __ ~,~ __ - - - - - -- - Sri ~ f LAST WII.,L AND TESTAMENT 2.1-7.002.-759 BE IT REMEMBERED THAT I, DAIL H. OWEN, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all. Wills and Codicils previously made by me. I I declare that I am married to ROBERT D. OWEN, and that I have a son, JAMES M. THUMMA, and a daughter, SARA LESLIE WILLS. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III 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. IV If, at the time of my death, I am survived by my husband, ROBERT D. OWEN and if I die seized (as the only owner) of the real estate I presently own and occupy, located at 1709 Letchworth Road, Camp Hill (Lower Allen Township), Cumberland County, Pennsylvania, and if my husband, Robert, is then residing therein, I direct, pursuant to an ante-nuptial agreement dated February 16, 1983, that my husband, Robert, shall have the privilege of continuing to reside in said residence for a period of two (2) years from the date of my death or until the remarriage of said Robert, whichever shall first occur. I direct that Robert shall have the privilege of occupying said residence rent free, and during such time as he shall reside therein, my Estate shall bear the burden of the maintenance and upkeep of said property, including the payment of any and all real estate taxes levied thereon, and the payment of the premium for fire and extended coverage insurance; however, so long as he shall reside therein in accordance herewith, he shall bear all responsibility for any and all other expenses related to his use of said property, including but not limited to utilities and telephone. During the time he resides therein pursuant hereto, my Executor shall have the right, upon reasonable notice, to inspect the premises. At such times as Robert dies, remarries, abandons the property or the time period set forth herein shall have passed, the privilege of occupancy shall expire. V All the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my son, JAMES, and my daughter, SARA LESLIE, in equal shares, per stirpes. VI I give an option to my daughter, SARA LESLIE, to purchase my house located at 1709 Letchworth Road, Camp Hill at its fair market value. She may utilize what she receives under this Will as an offset against her purchase of my house. VII I nominate, constitute and appoint my son, JAMES M. THLTNIlVIA, and my daughter, SARA LESLIE WILLS, as Co-Executors of this LAST WILL, to serve without bond. If either is unable or unwilling to act in that capacity, the other may act alone as Executor of this LAST WILL. IN WITNESS WHEREOF, I, DAIL H. OWEN, have set my hand to this LAST WILL this ,f ~ day of `~ ~~ -~~y , 2000. DAIL H. OWEN 2 Signed, sealed, published and declared by the above-named DAII., H. OWEN, Testatrix, 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 names as witnesses. ,~ 1 ~.~ , ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, DAIL H. OWEN, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. '~ DAIL H. OWEN , Sworn or affirmed to and acknowledged before me ~ ,2 day of C'c-~.,? , 2000. Notary ., N, '~,sfa ,this /~F /~ ~,~' r ,~ Notarial Seal Murrel R. Walters, Notary Public Mechanicsburg Boro, Cumberland County My Commission Expires March 12, 2001 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, ~Ti~,~L~~ N >~~.P~9USS~ and ~~,~i C~,v~ /Y/ . ~~~rx ~ `r-~.. the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL, that DAIL H. OWEN signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. ,, I ` ~? ~l (' ~- Sworn or affirmed to and acknowled ed before;m~'this ~'L- day of ~ ~ ~',~'c-~_ ~ 0,, ~~,%~` ~' ~ ,~ r / ~' i /~ /" ~ , A~ 1 Notary Public Notarial Seal Murrel R. Walters, Notary Public Mechanicsburg Boro, Cumberland County My Commission Expires March 12, 2001 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DAIL H. OWEN Date of Death: June 7, 2002 Will No. 21-02-0759 Admin. No. 2002-0759 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.b(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 22, 2002. Name James M. Thumma Sara Leslie Wills Address 1730 Bristol Avenue, Apt. 304 State College, PA 16801 64 W Keller Street Mechanicsburg, PA 17055 Notice has now been given to all persons entitled tl ,s Date: August 22, 2002 i under Rule 5.6~ except: None Murrel K. Walters, 111, J/squire 54 East Main Street Mechanicsburg, PA 17055 (717) b97-4650 Capacity: Personal Representative X_ Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WALTERS MURREL R III 54 E MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: z29-3s-554 FILE NUMBER: 2102-0759 DECEDENT NAME: OWEN DAIL H DATE OF PAYMENT: 1 2/ 10 f 2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2002 REV-1162 EX(11-96} NO. CD 001932 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 5, 620.50 TOTAL AMOUNT PAID: REMARKS: SECURED LAND TRANSFER INC C/O MURREL R WALTER III ESQ CHECK# 260868 SEAL INITIALS: RECEIVED BY: DONNA M. OTTO $5,620.50 DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-uao =x~. is-ool COMMONWEALTH OF - +-~ -- REV-1500 v OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 ' - ° 2 ° ' S 9 _ COUNTY WOE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N Z W OWEN, DAIL H. alkla OWEN, ORA DAIL H. 2 2 9- 3 8- 1 5 5 4 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W (~ 06/07/2002 11/0611933 REGISTER OF WILLS W 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Q ^X 1.Original Return ~ 2. Supplemental Return ~ 3 Remainder Return (date of d th o 2 ~ a Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date ordeatn after tz-tz-a2) . ea p or to 1 -13-82) ~ 5. Federal Estate Tax Return Required W o0 ~ a m ~ 6. Decedent Died Testate (Attach copy of wllq ~ 7. Decedent Maintained a Living Trust (Anacn copy or Trust) _ 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 10. SpOUSaI POVerty Credlt (date of death behveen 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A) (A¢acn scn o) ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS °zo MURREL R. WALTERS III ESQ y FIRM NAME (If Applicable) W ~ 54 EAST MAIN STREET p TELEPHONE NUMBER U 7171697-4650 MECHANICSBURG PA 17055 1. Real Estate (Schedule A) (1) _ 112x49 OFFICIA SE ONLY 2. Stocks and Bonds (Schedule B) (2) - O ~ ~ i W ...e} 4~ ~~ ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) l`~' ~ 4. Mortgages & Notes Receivable (Schedule D) (4) I ~ ~ 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 40,81.92 I (Schedule E) "L1 _ Z -~ ~`~ ~ 6. Jointly Owned Property (Schedule F) (g) p ~ 4=~ Q ~ Separate Billing Requested ~ J ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Proba te Property (7) I ~ a U W ~' Z O H Q F- a U X Q F- 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 8. Total Gross Assets (total Lines 1-7} (g) 153,582.41 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2,774.95 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (11) 2,774.95 (12) 150,807.46 (13) (14) 150,807.46 14. Net Value Subject to Tax (Line 12 minus Line 13) stt Ins I rcuc I wns UN RtVtKSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X (15) 16. Amount of Line 14 taxable at lineal rate 150,807.46 X .045 (16) 6,786.34 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate X .12 (17) X .15 19. Tax Due (18} (1 g) 6,786.34 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 1709 LETCHWORTH ROAD CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19} 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 5,620.50 C, Discount (1) 6,786.34 Total Credits (A + B + C) (2) 5,620.50 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 tine 20 to request a refund (4) 5. If Line 1 + tine 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 1,165.84 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. {56) 1,165.84 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 : ........................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ 0 c. retain a reversionary interest; or ...................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 0 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 perjury, I declare that I have examined this return, including accompanying scheduies 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 PER RESPONSI6 DR FILING RE URN DATE _ ~ ~ ADDRESS JACMES M. THUMMA 8. SARA LESLIE WILLS 1730 Bi;{STO~, ~S"~ATE OLLEGE,PA -64 W. KELLER. MECHANICSBURG,PA SIGNATURE OF ATIVE O ADDRESS MURREL . WALTERS ill ESQ 54 EAST MAIN STREET, MECHANICSBURG PA 17055 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)J. 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 adaptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)J. 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 P.S. §9116(a)(1.3)]. Asibling 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-1502EX t(1 $7) 1 SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER OWEN. DAIL H. a/k/a OWEN. ORA DAIL H. 21 02 0759 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. RESIDENCE 112,690.49 1709 LETCHWORTH ROAD CAMP HILL, PA CUMBERLAND COUNTY NET SALE PRICE TOTAL (Also enter on line 1, Recapitulation) ~ $ 11 (If more space is needed, insert additional sheets of the same size) a. U 5. DEPARTMENT OF HOUSING end URBAN DEVELOPMENT SETTLEMENT STATEMENT OMB No, 2602.0 62 6 SECURED LAND nr7J:Pao ""'°Mnt TRANSFERS, INC. B. TYPE OF LOAN 5006 East Trindle Road SU~tIB 203 ,. ()FHA z. I t FMHA 3. [ ) CONV. UNINS. a. [) vA 5. I) CONY. INS. Mechanicsburg, PA 17055 6. FILE NUMBER: 504332 7. LOAN NUMBER: Phone: (717) 591'8500 FAX: (717) 591-8506 e.MORT.INS.CASENO.: C NOTE: This lorm Is furnished to give you a statement 01 actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '(p o c.)' were Daid outside the closing; they are shown here for iMormational purposes and are not included in [he totals. D NAME AND ADDRESS OF BORROWER: Janet L. Pritchard E. NAME ANO ADDRESS OF SELLER: James M. Thumma Sara Leslie Wills F NAME AND ADDRESS OF LENDER: CASH G. PROPERTY LOCATION: 1709 Letchworth Road H, SETTLEMENT AGENT: Secured Land Transfers, Inc. I. SETTLEMENT DATE: 11/22/02 Lower Allen TOWNSHIP CUMBERLAND County PLACEOFSETTLEMENi; 5050 Linglestown Rd.,Harrisburg,PA 1711 2 J. 9UMMARY OF BORROWER'S TRANSACTION; ~ K. SUMMARY OF SELLER'S TRANSACTION: ,tro. GROSS AMOUNT DUE FROM BORROWER 4oo.OROSS AMOUNT DUE TO SELLER ,o,. Contract sales price 1 4 aD7.Contract sales price 1249 00 . ,oz Personal property 4oz.Personal property ,03 Settlement charges to borrower (line 1400) 8.25 403. 10a, 104. 10.5. 405. Adjustments for items paid by seller in advance AdJustmente for items paid by seller in advance 1D6. Clly/70Wn tax IO 406. CIIy/rOWrl lax to Im.Countytax 11 22 021D1 31 02 44.55 4o7.Counrytex 11 22 02to12 31 0 44.55 7De.Ass~ssments [0 4o9.Asses6ments Io ,09 school 11 02ta 06 30 0 665 .50 409, echoel 11 22 to 0 3 6 5 .5 „D. wr: 26.40 q e 12 31 11.26 470. wr: 26.40 q e 1 1 11.28 ,,,. Re : . 85 q en 1 31 .45 a,,. Re 47. q en 12 31 20 .45 nz, 472. t2D.GR09SAMOUNTDUEFROMBORROWER 128420.03 ~20.GR08SAMOUNTDUETOSELLER 125641.78 zoo. AMOUNTS PAID BY OR IN BEHALF OF BORROWER soo. REDUCTIONS IN AMOUNT DUE TO SELLER 20, Depositor earnest money 2000.00 ao7.Excess deposit (aee instructions? 202 Principal amount of new loan(s) sa2.Settlement charges to seller (line 1400) 17 1.79 ao3 Existing loan(s) taken subject to so3.Existing loan(s) taken subJect to zn. soe.Paycf of First Mortgage Loan NONE zos sosPayoff of Second Mortgage Loen 706. S to B Repairs 1500.00 sob, S to B Repairs 1500.00 207 Sol. Zoe. 508. 209. 509. Adjustments for Items unpaid by seller AdJustments for items unpaid by seller 2,0. City/Town tax to s7D.Clty/1'own lex to 2n. County tax tc 57 tCounty tax [o 2,z. Ass,tssmonts l0 572.Aasessmen[s to 277. Echool [O 573. School to z+c. ste. z t s. 51 i. 2,6 E76. 277, 517. 21 tl 519. 2, 9. 519. 220, TOTAL PA1D BY/FOR 80RROWER 3500.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 18571.79 300. CASH AT SETTLEMENT FROM OR TO BORROWER 6oD,CASH AT SETTLEMENTTO OR FROM SELLER 3D, Gross amount due from borrower (linet20) 128420.03 so7.Grossamountduetoseller(line420) 25641.7 3oz. Less amount paid by/for borrower (line 220) 5 0 0 . 0 0 so2.Less reduction amount due seller (line 520) 1 5 1.79 303. CASH (Q{J FROM) ([ ] TO) 80RAOWER 124920.03 coz.CASH (Oq TO) ([ ]FROM) SELLER 107069.99 Buyer or Borrower's Slgnaturo ~e--ze•d 56~6G69 Ol 9058 T6S LIL Sellor's SlgnaNre HDD•, Rov. 6/86 QNti~ Q3bf103S a3 L0:60 i'00z Gz flOtJ hJO,I 27 2002 0909 FR SECJRED LAND 717 591 °505 ''^ 597Q?~~ -. __ __ 97/9'^o!i l•OnH 'OIOt Vg1ooS Puv tppL uv~la+4 rpoO Sn '.a4 elul rr9 el!Si°p,dJ 'Wawu04UA W pUB eup a rPnpul Ue] u01p1^°qa V°~n snia6dbd 'YIIDI IB!IwIB A(Ir IO rryi d~ ir,Cl$ p°pun b41 el YlubwtltBlB sale{ ew 618q,^ou win d d q',~NINtlV ate0 rvaev wa u .col-2.L /~ •luowvlels aryl yuµ a]vePtoYJV ul D°angalp aq °l spool oyl sneo pl lv pBBOB] BneV I'VO1gKVtn xlyl to lult0]]P BlPlll]Dr Dur BOII s 51 D+JtdnJa dAly 1 uewelPiS luawalll L nH e41 :rvoy~I S aeaJDP V ^^'N : ,ol!]g 'aUOila y ,,xu1DPd s ,dFng ufi!g s~epeS mnleu6!g s IeJnonoe Jo,e,(nB ~Ibowolo,S luawaWoS L•O(1H ay1 l0 6doo a panle]aJ enoy 11041 NPloo JDyUn, t ~uopoesueJl slyt w w 6q iunoeae Fw uo epeui swewesmgslP Poe ejdleooJ Ile to wowelets al'am00e pus enA a sI p ge!Iaq pas o9polMOU,I6w lo,soq eyl o, ptre,uewe1B15 luowolnaS t •OnH eyl paene!JUeJ dpnlaJeo eney I Stl31135 gNtl Stl3Af19 d0 NOiltlOljlltl30 OnH u°y],rub,l a!yl v. eao~,vba a{I ,al uolip and woo IeuglpPe ae lunaa]o 4MO tp q pvulee o4lSelelul Rue ypeq of puB ugN111aV1 DBJneUI ~IlelaD°y r, w tuna»e fiwreq IemaWl ue VI luauleamgslp !ol Dal]apo] slunowb Jud gmodp u11VOp eVl ae,unvoi AleeeJdda RgeleV luo8y Iv°u,°Iilog ~{uowOldls lu°WO!1ly° i•OnH eu(uo UNGVa ee e1Wto Lq paytlu,nl uo!{ew,ol°1 to ~(]eln]]e ey11o11ueOV IVewBIIIeS Aq PPwnssc n J:Y,i!gtq au 16u1 ddJ09 crlu&1 6L'tLOGt SZ'BLLZ (ylpuat'auopoaS'Z09PllEfDtseupuoJetua)S30tlVHO1N3W3111361V1O100t 00' 66E ~ua.zzl?M awoH Hp~ 1z2M ,uH yoe 00 " 599 aTtx,~ ~ zaTUoaig ~T~yuopag 'toe 00'OLE ~aTTTz '~ .zaZUoaTg peg uz,ux Eot: 00"SE aZTis ~? zaTUoatg of uolioedsu(,sed zoe o, FanJng 'toE S3otlVH01N3N3111351vN01110av 'oDE 65"bZZT 9Ea3y '3aTZTjn( .x aTLtLIOg jOOL(OS ZO ~ 'SO2 OS' OZ95 SITTM 30 .za~st ag x2,~ sat[uI vaz 00'6~ZI Se0e6uoyy00'6bZ'L $pee0 sdwels/xe,atetg Eot 00'6bZT $eBeB1JaW00'6~ZT $peep sdwels/xe,,(lunoo/qi0 zazl OS ' 8 E $'~slyy $ ebe6lJOyr 05 " 8 E $ peep :sea} fiu(p,ooab loz~ 530tltlH0 tl3dSNrtl1 ONV tJNlOtl003tl 1N3NNtl3A00 'ooz 00' OS zaxZ2M an2Q as.zngwTag'elll 9Z'bL igevLeoZ uatT~ saMO2 Z~-OZ~2I ~S'ztt OS' OOZ Btang s.zn2uausg xaTtog ttt 006 ~ bZ'C $ a6e,enoo s,Jeump 'ot l l $ e6e,eno~ s iepue~ 'sot (: oN awe,( enoge sepn(ow) 5L'E86 s~a~sul?.zy pul?~ paxnnag of eoueJnsujepil eotl (roN swell enoge sapnl~w) 0, SBB) S~/SaWD11y 'LOl 00 " S 00 ' Z LjSL~ o, seel,t,eloN 'got ~,7,~d) S$'SSa~ZeM ja.zznW of uoyeJedeJd luewnood 'SOL D, Jepulq eoueJnsul ep1 'vot of uolleulwexe agll 'EOl I of ll0Jea5 e~lq JO lDe,lsgy ZO[ l Dl eel fiu!solo Jo luewepieg 'tot S39tlYH0 31111 ~OOL t ow/ $®'ow soa 'OW/ $®'OW 'L00 'OW/ $ ®'OW '900 'OW~ $ ®"Ow S1U9WSSBSSIJ '5001 'DW/ $®'OW XPI ,(lunOJ 000 'OW/ $ ®OW Xal UMOUA,I'J 'EDO 'ow/ $ ®'ow e~ueJnsul e6e51JOW 'zoo ow/ $ ® ow eDUe,nsul pJezeH fool tlOd tl30N31 H11M 031160d30 S3Atl333tl 'OODt SO6 ol'sJR toa of ~sJR Jol wrnwaJd eDUeJnsul pJez¢ 'eos of 'ow Jol wn)waJd eouaJneul e6nBlJOIry 'zoe LeP/ So ZO OE Tool ZO ZZ tt wal3seJelul'to6 30N~AOtl NI Ollld 3B Ol H30N31 A9 03tlif103tl SW311 'OOe lt8 '015 60B soa eej uolldwnssb 'LOa o, eaj uo(,eollddy eoueJnsul a6e6uoW 'sos 6ej uOlloedsu~ sJapue~ 'SOB o, Lodey npeJO v0e of aaj )esie,ddy toe g(, lunonst0 ueo~ 'Zoe ~ 06 j u0112uIB(JO UBO~ 't OB Ntl01 HlIM N01103NN0~ N13ll3VAVd SW311 'OOB 00'OOZ 00"OOZ 'oui 'ygH yg~ aag su21y'roL QQ i~6fiL IuOWB(1185`le pled LDlSS1WW0~'EOL 01 $ 20L •ou= 'ygH ~t~ of 00'b6fiL $'tDL 1N3W31J13S 1N3N311135 00'i~6b LS =IE~Oy smollolse(OOLeuIOua(ss(wwoOIDUO)s(nir) lY SONHd lV SONfl~ S tl31136 S tl3MOtltlOB 00'006~Zt Sealud uo Deaeq NOIS6111W00 S.tl3HOtl6J531e'6l'e',101 'OOL , . ~cc~.nc S3JNVHO1N3W3 _ S'~ z eBed iN3W31b'1S iN3W3l1i3S 59Z0•ZOSZ 'oN BWO 1N3WdOl3A30 Ntl6yf1 ONd `JNISf10H d01N3W1kldd30 S'fl ** TOTAL PAGE. 03 *+ REV~1508 EX ~ )1-97) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER OWEN DAIL H a/k/a OWEN ORA DAIL H 21 02 0759 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. WAYPOINT BANK 14,620.24 2 JANNEY MONTGOMERY SCOTT 13,135.84 1 RA JAMES M THUMMA (BENEFICIARY) 3 JANNEY MONTGOMERY SCOTT 13,135.84 IRA SARAH LESLIE WILLS (BENEFICIARY) TOTAL (Also enter on line 5, Recapitulation) I $ 40,891.92 (If more space is needed, insert additional sheets of the same size) REV-1511 EX `E~~9~) . . • r' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF f•ILt NUMfiER OWEN DAIL H a/k/a OWEN. ORA DAIL H. 21 02 0759 Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. CREMATION SOCIETY OF PENNSYLVANIA 5.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Z. Attorney Fees MURREL R. WALTERS 11l ESQ 2,250.00 3, Family Exemption: ((f decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees REGISTER OF WILLS CUMBERLAND COUNTY 325.00 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. CUMBERLAND LAW JOURNAL ESTATE NOTICE PUBLlCAT10N 75.00 8 PATRIOT NEWS ESTATE NOTICE PUBLICATION 119.95 TOTAL (Also enter on line 9, Recapitulation) I $ 2774.95 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + fp_nm SCHEDULE J ' • ~ BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WEN DAIL H. a/k/a W N ORA RAIL H. 21 02 0759 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. JAMES M. THUMMA SON 50°l0 1730 BRISTOL AVE., APT 304 STATE COLLEGE, PA 16801 2 SARA LESLIE WILLS DAUGHTER 50% 64 WEST KELLER STREET MECHANICSBURG, PA. 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) 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 REV-1162EX(11-96) N0. CD 002543 WALTERS MURREL R III ESQUIRE 54 EAST MAIN STREET MECHANICSBURG, PA 17055 toltl ESTATE INFORMATION: ssN: 22s-38-~ 554 FILE NUMBER: 2102-0759 DECEDENT NAME: OWEN DAIL H DATE OF PAYMENT: 05/08/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 06/07/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 51,165.84 TOTAL AMOUNT PAID: REMARKS: JAMES M THUMMA MURREL R WALTERS III ESQUIRE CHECK# 1012 INITIALS: CW SEAL RECEIVED BY: DONNA M. OTTO 51,165.84 DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~- ~O~- ~~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX ~FP (O1-OS) DATE 07-07-2003 ESTATE OF OWEN DAIL H DATE OF DEATH 06-07-2002 FILE NUMBER 21 02-0759 •'~~~~ -~~~~~ ` ~ ~t9UN~' CUMBERLAND MURREL R WALTERS III ESQ ACN 101 54 E MAIN ST ~ Amount Remitted `=i MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 --------------------------------------- ______________ ------ ----------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF OWEN DAIL H FILE N0. 21 02-0759 ACN 101 DATE 07-07-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 112,690.49 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 ofi this fora with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 40,891.92 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 582.41 153 8. Total Assets (B) , APPROVED DEDUCTIONS AND EXEMPTIONS: 2,774.95 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Totai Deductions (11) 2.774.95 150,807.46 12. Net Value of Tax Return (12) 00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) [13) . 14. Net Value ofi Estate Subject to Tax (14) 150,807.46 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 .00 15. Amount of Line 14 at Spousal rate (15) • = X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 150,807.46 X 045. 6,786.34 17. Amount ofi Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00 19. Principal Tax Due (1q)= 6,786.34 DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 12-10-2002 CD001932 .00 5,620.50 05-08-2003 CD002543 .00 1,165.84 BALANCE OF UNPAID INTEREST/PENALTY A5 OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 05-09-2003 TOTAL TAX CREDIT 6,786.34 BALANCE OF TAX DUE .00 INTEREST AND PEN. 9.90 TOTAL DUE 9.90 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) J W v ~ 3 F Z p ~ W X ~ O J~ F (a/I r z~ v°s WOWG aoN r W LLu. 0~C v N 1~0 W2a = Z N O Q J ~ 0 4 N Qf- 1„ ,p WOC vrw ~A N W ,~ G O O '1 ~ O a N W X r .a J Z o G H o M w aO ~ N N c n A ~ 1Z'1 ~ a ~ Z o C ~ r N m W ~ ."-+ O S s J M a A ~1~ -_~' M N O~ A 0 0 1n Z 0 o n N N O J I 1 1 ~ I~ n N W o Z o o pq I W 1 ~ --1 t~ 3 ~o '-1 O o O O O N V .-I Q ~ O A ~ +.,^~ LL ~ W O Z 5~'-` F- F+'" W Q W W Z rrrJ~Z Q y Q H V aWaLLCi-a _W ~~, 111 d 111 N O W 1~ .-~ N N Q H 0.. N Q N ~ 3 = N ~ rI U J ,~ Z W Q OC W 2 ~ U ~ ~t W ~ Ilt ~ 1 ' .,, O ~ f• 1 1 F, I ~' ~ ui 1 ~: I ~- <C i G~ W i h~ N ~ 1 j O uu = ~ W CC f. M 1 i Z ~ ~ IQ InOO I$ ~ J O I~ IO J V r-1 y ~ J j 3 O ~iQ h0 U Q O 1 ,a ~ ~ ~ '~ O Z W 11"' a ~ ~Q W ~iW W J J ~~.~ ~~ F- ~ N O I W' N W i W F -1 p q J ~ N , = c~E~ ~a C1 W ~ a ~ V U Did W IL ~d. ~ E X O H ~Q F-1F- ~ p W a 'z W 1r 31H I J i= I Z ~Z I..~ M I FILL W ~O 1 _ Ir' J 1Z 1 1 1^ iM 10 I W ~~ ZIO F~;V+ J1 Q. (/~ i LL I-. ~ a F- ~ YC IW 1 Z il~ J i1[) Q Irl 1 I 1 V 1~ V M O 0 N 1 n O I n O W H A Q O r-i LL O •~ W z a ~ W u Z d3 ^ W .. t` O I N O N O ~. W J M LL x J N Q O Z W 3 O {L O W t- Q N W O W J N Q O W F- 0. W v a X N 6 3 z OG r W 0.' X F ^ o ¢ L ~+ •.i L W a ~ i o ~ o,^ L U a T ri ~O O ~O ~ ' O ~7' O O •7 a ~ ~ .t .root ~ orn-oo M ,y o O o mz L L d 2 N 1` I~ ~D ~O M O fT O+ , y N 7 L 7 a A O O ~, ~ O CD ~ ~ ~ W L U N 0 7 i ll1 CO CD h h C •~ T L L D i+ O ^ M ^ O O C ~O ^ ~O ~ ~ O H O Lf1 111 tl'1 ~ ~ W ~' L a + •, w v ~ • r ~ .F ° ~~ o ~ ~ ~- ~ m I a_ Z V N O *' -+~ n 11 II 11 11 lil. Z ; E ''1 ~ Lf1 0~ W 1•~ OC .^ .. .. .. ., ~ O V" N 111 v S -•~ O 0. O'~ O O O N O O ~ O V v v y -~ O O r••1 ri O ~r Q W ~r O O O O~ O O ~ O ~~ ~ ~~ X X X X F A Z O C S ~ ~ ^ 0y o ~ o o a .~ci~ W ?C a ^ N a V Q A W q 'iHo N o ^ ~ SU ! ~ 111 r+ F - Z A mQ I+J c ~ N m C ~ o Z 'Q Q W M i y . l S O ~ ?C lL J ~ N ~ Q H p srvf L ~ tl1 a W (/~ F JN L 7 ~ N y -. Q Z ~ ~ W W W N ~ O n . i ~ W v . . v .• . r . . . . Q. V N .-+t L p J Z G N N O .}+ F` Q 1 ,~ H N IA N J n n n ~ W Z L c a ~ ~ v .~ M A W N ~ ~ ., ~ v W Z W L1 .~ .i e-1 O .y+ .. O O N I- f- ~ ~ w L ~ ~ m m m ~~ ~ ~~ J . i s r1 10 m + O Q ~ V V •Y N'N m ~ 6 1 NN6 Z m V ~ ^ U ~ C• L N N ~ Z O `r ~ N T N m m '~ < ~ 0, v ~ LL L N 7 G d t N \ F- O G N o a m m z c' ~+ m ~ iu a . + cn ~ i z u • ~ N ~ m w 'a m ^ W ~' / ~~ ~ C 'O 'i Z N O m m m d N ~-- W F- F•I m m m v p N m Y N v •~+ C •~+ ~••1 J 7 N A a t cl C o N ~ N ~•+ •~ C m 7 c •1+ N C m •N L . J m L O v Q .. ri N y 'O ~.. Z •'1 m O •rl•r1 . Z X W ~ m L ~ L m d\ J fA m rl Y pl i+ W W 1~ 'a m ~ m d ~ E +~ w c rl a m m c ~ m N M a1 .•1 m .-1 N W y m L m~ fC f0 ~ m .~ + m \ a ~ 4 Z m L > H W V N m m '~ N~ ~ N M N A ~ m C m ••+ •+ T ++ n C9 .i K m i •v •FJ x N x ~ pC M ~t W W Z ~ .•i . V o. m E t A i •~+ C m W m a ~••~ 7 N \ O \ m m z y d lq X L i+ d! m •r m •++ 1 r-1 N W ( 3 F W m y V ~ U O Q\ N O H 7 E ~' ' ' O O !- N M ~ L N O i + •.1 L 7 •O N • J •N W O y~ J ~ H ei S ri ~7 r•i ~ J O O Z O O O y V O •V N N m N 4 0. m N u (A m Z ~ •!+ 'N 7 0 C9 4• m 0 UI Ol C G C C A A U V H p V • i + 'fl m p C • N IF• X X q W u act v o m m ul N m F+ m O m rl m ~- •+ •~ a •~ •N m H . O m W •r v .•I m z \ c c s ~- m a a 1- x v. ++ m~ O r+ a ~ m .~ ~~+ ~ .~ F J J r Q Q 1m+ J W C O L ~ W > ti> O Z • m ~-t O N COI LL O O O m X H Q W q T r~ of m m m T ti m m w •N .-+ A m z \ m •r •r L m •v+ ~~ p •w •r+ •r -r a •N A ~ -i Y O m IA O) •F+ \ i+ C N O F W L H + O m t m ~F' C C CC 7 ~ V f/f N M Q . 0 L C - (a m i F•• Z Li Z 4- d ~••• 7 7 C F O O LL Q m + O O ~ O L 7 m ~ L z S G G i •L ~ 0 0 O Ll N K i N . i V E U 7 !•• W 0. O ~ eC Q 4 G 0.~ N N O .~ F W ~u .-+ c~i Ivi r an .o n cC Q` ° ~ ~ ~ ° ~ . a •1 ~ r ~ ~ W •I ~ W r ~ e -1 ~ ~ ' 1'' ° Q o t~ d a ~•- to x N In J 1"I ~ a a o to Q •-+ o Q Q Q Z Q t- 00 >K Wii ~I WTI WI ~' F y W W H Z N W f LL !9 H Z W V Z O V Z O M H a COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEP7.280607 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N4. CD 002812 WALTERS MURREL R III ESQUIRE 54 E MAIN STREET MECHANICSBURG, PA 17055 -------- Fold ESTATE INFORMATION: ssrv: 22s-sa-7554 FILE NUMBER: 2102-0759 DECEDENT NAME: OWEN DAIL H DATE OF PAYMENT: 07/ 1 7/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $9.90 TOTAL AMOUNT PAID: REMARKS: MURREL R WALTERS III ESQUIRE CHECK#10343 SEAL INITIALS: JA RECEIVED BY: DONNA M. OTTO REV-1162 EX111-96) 59.90 DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT MURREL R WALTERS III ESQ ~```~' ~"~~ I 54 E MAIN ST MECHANICSBURG PA 170~.~ REV-1607 EX ~FP (R1-RS3 DATE 07-28-2003 ESTATE OF OWEN DAIL H DATE OF DEATH 06-07-2002 FILE NUMBER 21 02-0759 FOUNTY CUMBERLAND ACN 101 ~- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-03) ~*~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~~ ESTATE OF OWEN DAIL H FILE N0. 21 02-0759 ACN 101 DATE 07-28-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW I5 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: 07-07-2003 PRINCIPAL TAX DUE :........................................................................................................................................................................................................................... 6,786.34 PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 12-10-2002 CD001932 .00 5,620.50 05-08-2003 CD002543 .00 1,165.84 07-17-2003 CD002812 9.90- 9.90 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 6,786.34 .00 .00 .00 i~ PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: DAIL H. OWENS Date of Death: JUNE 7, 2002 Estate No.: 21-02-0759 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 (date) 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 Date: May 13, 2004 B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C.' Did the personal representative state an account informally to the parties in interest: Yes X No D. Copies of receipts, releases, joinders and approvals of formalp`r informal accounts maybe filed with the Clerk of the Orphans' Courtl~nd maybe attached to this report. ~~~ ~ %, a ~ ~, MURREL R.~VVALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative ,X Counsel for Personal Representative b. ~}4 ~.