The URL can be used to link to this page

Home My WebLink About04-0473Estate of MILDRED E. SHERIFF Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS MILDREDE. KIMEa/k/a No. ~.,i -0q- q'-']~"2~ Deceased Social Security No. 490-34-9338 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of the Decedent, dated December 20, 2001 and codicil(s) dated State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Decedent, then Cumberland County, Pennsylvania, with his last family or pr!n_.c~pal residence at 1906 Rutland Street, Borough of Camp Hill (List street, number and municipality) 79 years of age, died May 6, 2004 at Holy Spirit Hospital, Camp Hill, PA (location) Decedent 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 ...................................................................................................................... $ Total ......................................................................................................... $ 287,000.00 125,000.00 412,000.00 Real Estate situated as follows: 1906 Rutland Street, Borou.qh of Camp Hill, Cumberland County Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence David A. Sheriff 219 Fox Grove Place Hummelstown, PA 17036 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed Before me this ~ ~ day of DAVID A. SHERIF~_._~ ~("~ ,2004. Estate of MILDRED E. KIME a/k/a MILDRED E. SHERIFF Social Security No: 490-34-9338 Date of Death: May 6, 2004 ,Deceased. AND NOW, ~ \Ok ,2004, in consideration of the Petition on the reverse side hereon, satisfactory ~oof having been presented before me, IT IS DECREED that Letters Testamentary d.b.n,c.t.a.; pendente lite; durante absentia; durante minoritate are hereby granted to DAVID A. SHERIFF in the above estate and that the instrument(s) dated December 20, 2001 described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES Letters ........................... Short Certificate(s) Renunciation .............. Affidavit ( ) .................. Extra Pages ( ) ....... Codicil ............................ JCP Fee ....................... Inventory ...................... Other .............................. TOTAL ......... $ $ Register of Wills ' ~ . ~.~ $ lo. ~ Attorney: Jerry R. Duffie $ I.D. No: 09601 Address: Johnson, Duffie, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- Telephone: 717-761-4540 h;.* is to certi~/that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. W~RNING: It is illegal to duplicate this copy by photostat or photograph. Calvin B. Johnson, M.D., M.P.H. Secretary of Health 3218168 No. CORRECTED ITEM(S): 3 Charles Hardester State Registrar CERTIFICATE OF DEATH [] [] Cumberland Nurse lffaamp Hill, PA 17011 ,^mE~s~z.~(m....~..~ M.L. Kurtz ~L Esther M. Smith David A. Sheriff 1 .ST & rgve ~ace~umme~stown PA 17036 ~) , ~l,,~ 5-11-04 ,,~ollin~ Green M~ Park I~.~ Hill PA 17011 ~ ~/~ ~ I=. z=~-~ I~ye=s-~e= ~, [903 ~[ SI? ~ ~A [70[[ 048687 Mildred E. Kime ~_emaie I,. 490- 34 -9883 l( ~ ~ ~ (~ ,m ~C~rland ~ln' ~?d.~ W'~'~ ~ Hill 009041-00002/12.18.01/JRD/LAR/152154.1 · ast i[l aah ¢stam¢nt OF MILDRED E. KIME I, MILDRED E. KIME a/k/a MILDRED E. SHERIFF, of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I direct that all my legal debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. II. I bequeath my automobiles, household goods and personal effects and other tangible personalty of a like nature (not including cash or securities), together with any existing insurance thereon, except for those items of tangible personalty which are specifically bequeathed pursuant to this, my Last Will and Testament, to my sons, DAVID A. SHERIFF and GARY L. SHERIFF, to be divided between them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. III. I bequeath my eighteen (18") inch bisque doll to my niece, NANCY HOFFMAN. IV. I bequeath my eighteen (18") inch bisque doll to my niece, KAREN KURTZ. 009041-00002/12.18.01/JRD/LAR/152154.1 I bequeath my two stone ruby ring VANESSA KIME-AVAKIAN. and diamond ring to my step-granddaughter, VI. I bequeath the sum of Ten Thousand ($10,000.00) Dollars to TRINITY EVANGELICAL LUTHERAN CHURCH, Camp Hill, Pennsylvania, in memory of Delmar C. Kime and Mildred E. Kime, to be used and applied by the Congregational Council for general church purposes. VII. I devise and bequeath the residue of my estate of every nature and wherever situate, in equal shares, to my sons, DAVID A. SHERIFF and GARY L. SHERIFF, per capita. Should either my sons, DAVID A. SHERIFF or GARY L. SHERIFF, predecease me, then I devise and bequeath the share of any such deceased son to my then living son. If both of my sons shall predecease me, even if survived by issue, I devise and bequeath the residue of my estate of every nature wherever situate, in equal shares, to my brothers, KENNETH L. KURTZ and ROBERT L. KURTZ. If either of my brothers, KENNETH L. KURTZ or ROBERT L. KURTZ, shall predecease me, I devise and bequeath his share to his then living issues, per stripes, and in default of said issue said share shall be distributed to my surviving brother or his then-living issue, per stirpes. VIII. Should any person entitled to a share in my estate not attain the age of twenty-five (25) years at the time of distribution to him or her, I devise and bequeath the share of each such person to PNC BANK, National Association, to hold, manage, invest and reinvest the share so received and any accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee's sole and absolute discretion, may be necessary and appropriate for such person's support and education (including trade school and college education, both graduate and undergraduate) without regard for his or her parent's ability to provide for such support or education, or to make payments for these purposes, without further responsibility, to such person or to such person's parent or to any person taking care of such person. Any principal or income not so applied shall be distributed to such person absolutely 2 009041-00002/12.18.01/JRD/LAPJ152154.1 when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age of twenty-five (25) years, the Trust shall terminate and such share shall be distributed to his or her personal representative. IX. I direct that the interest of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. Xl. I direct that all taxes that may be assessed in consequence of my death, of whatever nature or by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. Xll, I appoint my son, DAVID A. SHERIFF, Executor of this, my Last Will. Should my son, DAVID A. SHERIFF, fail to qualify or cease to act as Executor, I appoint my son, GARY L. SHERIFF, Executor of this, my Last Will. Further, if my son, GARY L. SHERIFF, shall fail to qualify or cease to act as Executor, I appoint PNC BANK, NATIONAL ASSOCIATION, Executor of this, my Last Will. Xlll. I direct that my Executor and his successor shall not be required to post bond for the faithful performance of their duties in any jurisdiction. XlV. I direct that my corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in effect from time to time during the period over which its services are performed. 3 009041-00002/12.18.01/JRD/LAPJ152154.1 IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~day of M~LSR~D E. KIME t (SEAL) MII_CDR~D-E~ SHERIFF- - ~',~ (SEAL) Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. 4 009041-00002/12.18.0 l/J RD/LAR/152154.1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA · SS: COUNTY OF CUMBERLAND · I, MILDRED E. KIME a/k/a MILDRED E. SHERIFF, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. MILbR[::D E. KIME ~- ' - MIILDRED E. SHERIFF Sworn or affirmed to and acknowledged befor~..me, by MILDRED E. KIME a/k/a MILDRED E. SHERIFF, the Testatrix, this .~".'~'" day of ~..~,~...~..~.u[,-~ ,2001. Notary Public NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21,2005 009041-00002/12.18.01/JRD/LAPJ152154.1 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : : SS. : We, ~ '-O,,_~ and ~ .('~..~'z,~,~ , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she 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 that time at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and "',,-~.r..,-.-.~ ~'z.~ and witnesses, this C~,.-%"~'-"day of ~ ~ subscribed to before me by ,2001. Notary Public NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberlar~d Co. My Commission Expires Dec, 21, 2005 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MILDRED E. KIME Date of Death: MAY 6, 2004 Will No.: 21-04-00473 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was ss.~rved on or mailed to the following beneficiaries of the above-captioned estate on June ~'/'-' ,2004. Name Nancy Hoffman Karen Kurtz Weyl Vanessa Kime-Avakian Trinity Evangelical Lutheran Church Gary L. Sheriff David A. Sheriff, Executor Address 846 W. South St., Carlisle, PA 17013 7 Charles Point, Newark, DE 19702 5053 LeCedona Circle Delray Beach, FL 33484 2000 Chestnut St., Camp Hill, PA 17011 11967 N. 111th Way, Scottsdale, AZ 85259 219 Fox Grove Place Hummelstown, PA 17036 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: ~/¥/0 ~/ jhmnature ~'~ __ e Jerry R. Duffie, Attorney nson, Duffle, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFtNDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128 0603 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004238 DUFFLE JERRY R 301 MARKET ST P O BOX 109 LEMOYNE, PA 17043-0109 ESTATE INFORMATION: SSN: 490-34-9338 FILE NUMBER: 2104-0473 DECEDENT NAME: KIME MILDRED E DATE OF PAYMENT: 08/04/2004 POSTMARK DATE: 08/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $ 15,500.00 REMARKS: TOTAL AMOUNT PAID: t~ 15,500.00 CHECK#210 -- INITIALS: JA ' ' SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 SUBJECT: Estate of Mildred E. Kime No. 21-04-00473 DOD: Ma), 6, 2004 FROM 3OHNSON, DUFFZE, STEWART & WEZDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 Fax: (717) 761-3015 DATE: August 3, 2004 ~s a ~.;~ntne amountoT~lb,bUUU0asa;'~'"'-":'-'~"---A-- a ment ' T ' ~' "~ ~'"" · · ' P y on account of Inhentan~ ax ~he, ~ a~e-c~l~ned~ Estate, being made w~thin the 90 days to allow for the 5% discount. DUFHE 301MARKET STREET RO BOX 109 LEMOYNE. PA 17043-0109 REGISTER OF WILLS OFFICE CUMBERLAND COUNTY COURTHOUSE 1COURTHOUSESQUARE CARLISLE, PA17013_3387 "~ ~ h"llh"llh',-lh,lh,,Ih,,lhlh,.,,llhh,hi..,ihl tl~f'Q$r~ 1!!J!!I~ ,~~~'~~ .; '\'5~OO<; OZ '~QZ~ ~ -~ _,lOA' QQOAo,ee~..... ~(j<JV- lA~\~~fl""""- ..~.\ " '~~ ~"V ' k' ~ ',~~ ,~~, $~~,f,,:tr:.' ",i-)1'~.'~ ~;; ii \ ".......'#..,~~ ..,. ......... ,q...r \".' ...-,," "". .~ ~ ~ f'> "~so~ \ODUtt\t. ,0\ 1'I,~\l.,1 ~1",\.,,1 ~O.Y,O' \O~ '",,"\O~""~' \iO~"O\O~ 'to'. ",,1-Cf. 0" 'li1- \>\>S OCO\11'-'t\\O\1Sf. f.G1-S'tf.1'- D CO\1~'t~ ~\1~~f.1'-:;:O\1Sf. SQ1\1::':: '3'3~1 'I. CO\1" f. 1'1>> 'I. C1>>"'\;~S\> ' .off f<'S (;2,;,1;6 J't:;' <\(i" \,,""\('-'i <1' . " ,( .., '.1 ";;;'(' _.,"\,....."A " ~ 't,;, c';~p. '<;:., Q. +-",,\-"':- <;>"--''\ 4,~~'-~ ,,\.' ,\\1' _c,. '\"a\b0'!- x..~'\'- ~~_~~' ~""V:'. ~ '_ "->/~ \.-<;;:~~ . ),:,\.\l ~'\""bV :\~b.,') ~~,,~ ' ,. TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisie, PA 17013-3387 SUBJECT: Estate of Mildred E. Kime No. 21-04-00473 FROM JOHNSON, DUFFIE, STEWART & WEIDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 Fax: 717 761-3015 DATE: March 18,2005 Enclosed for filing in the above-captioned Estate are the following: 1. Original Inventory. 2. Original and copy of Inheritance Tax Return. 3. Check in the amount of $30.00, for the filing charges. ;;:;P 4. Check in the amount of $2,262.49, Inheritance Tax, plus interest. ........ CC-:l3 5. Copy of letter granting an extension of time to file the Inheritance Tax R.~tifrI110r _,...,r"j this estate. c>c) , 6. Envelope to mail the filing receipt and Inheritance Tax Receipt to me. "c, Thank you. SIGNED: Cindy Hubler, Estate Le al Assistant r",) N N COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 Johnson, Duffle, Stewart & Weidner, PC 301 Market Street PO BOX 109 lemoyne, PA 17043 RECEIVED FEB 1 1 2005 JOHNSON, DUFFIE STEWART AND WEIDNER Telephone (717) 787-3930 FAX (717) 772-0412 February 9, 2005 '\ /'-~~'" -., ,i ;-",\'\ \\ ./; .,=.----'" Dear Jerry R. Duffie: Re: Estate of Mildred (E,. Kime File Number210~3 :;13?o ; --..~, r-""- :-rT'! """';:":""1 """u f".J If.) ;' '.,..... "-~ ~"'.:::''':~'! -'r'l This is in response to your request for an extension of time to file the Inheritll~de'tax ~eturn "'j the above estate. :::, f'<) In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, H'I'e time for' filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 08/06/05. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. ~__""'-':I .J Sincerely, <~~'-1~-----/ 12 ~ 'ft;' - r /f J / C!/.-L-L.A- '" '/."-' ('-~~'7t;(--'--'c' f.//j Claudia Maffei, Supervisbr" Document Processing Unit Inheritance Tax Division -;;:::_~ , ,'~,::::/ Register of Wills of Cumberland County, Pennsylvania INVENTORY , Deceased No. 21 - 04 - 00473 Date of Death 5/6/2004 Social Security No. 490-34-9883 Estate of KIME, MILDRED E. also known as SHERIFF, MILDRED E. DAVID A. SHERIFF The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that faise statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: JERRY R. DUFFIE Personal Represe:1rtiv: ""~. " , Signature: ~ I. ". .,' ~Ecu-'\t'..~_ DAVID A. SHE Signature: I.D. No.: 09601 Signature: Address: Address: 219 FOX GROVE PLACE 301 Market St. Lemoyne, PA 17043-0109 Telephone: 717/761-4540 HUMMELSTOWN, PA 17036 Telephone: (717) 583-0139 Dated: 312..105 Personal Property SmithBarney Investment Account No. Date of death value: Common Stocks: $ Mutual Funds: Bank Deposit Program - cash: Closed end funds - Zweig 724-13226 233,208.07 66,309.50 163,604.71 3,264.29 29.57 PNC BANK - Interest Checking Account No. 51-4003-4328 Date of death balance, plus acclued interest. ~ 7,542.32 -'t,l M&T Bank - Certificate of Deposit No. 031003913823637 Date of death balance, plus accrued interest. __"". "'." ..1 ,,-.' 5,044.5[ ~ ':/ ; ,tl Househoid Goods - appraised value P'J l" 3,910.00 1992 Buick Park A venue Sedan - 4D - Sale Price 4,000.00 Lady's Ring: 10kt yellow gold with 2 round faceted, 4.5mm synthetic rubies. Item V of the Will. - Appraised value. 65.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate $418,905.89 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of KIME, MILDRED E. also known as SHERIFF, MILDRED E. , Deceased No. 21 - 04 - 00473 Date of Death 5/6/2004 Social Security No. 490-34-9883 550.00 Lady's Ring - 18kt white gold with cut diamond of .34 cts. Item V of the Will- Appraised value. Eighteen (18") inch bisque doll. Item III of Will- Appraised value. Eighteen (81") inch bisque doll. Item IV of the Will - Appraised value. Internal Revenue Service - 2003 income tax refund V erizon - refund - telephone charges Cash - decedent's possession/refunds ChemLawl1 - lawn service refund Peerless Insurance - refund Cash - Purchaser's down payment - sale of 1906 Rutland Street- Purchaser did not fulfill obligations set forth in Sales Agreement. Internal Revenue Service - refund - 2004 income tax. 100.00 100.00 458.00 6.09 606.41 183.53 134.00 2,000.00 97.95 Total Personal Property $268,005.89 2 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of KIME, MILDRED E. also known as SHERIFF, MILDRED E. No. 21 - 04 - 00473 Date of Death 5/612004 Social Security No. 490-34-9883 , Deceased Real Estate Real Estate - Vacant Lots 262, 263, 264 - Borough of Camp Hill, (formerly in East Pennsboro Township), Cumberland County, PA. (Decd Book E, Volume 21, Page 634; Deed Book 1, Volume 18, Page 164). Sale Price - Copy of Settlement Statement attached. Real Estate - No. 1906 Rutland Street (Lots Nos. 265, 266, 267), Harrisburg Gardens, Borough of Camp Hill (formerly East Pennsboro Township) Cumberland County, PA. (Deed Book H, Volume 17, Page 39). Sale Price - copy of settlement statement attached. 21,000.00 129,900.00 Total Real Estate $150,900,00 3 R"V.1l00exOI5-ll01 '* .~ ,-1\ i-'.D REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG,PA__1!1?8-0501 DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) KIME. MILDRED E. DATE OF DEATH (MM-DD~YEAR) DATE OF BIRTH (MroI-DD-YEAR) 05/06/2004 03/12/1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) " U w , U [gI 1 Original Return D ~ D 2 SupplemE~ntal Return 4 Limited Estate NUMBER 21 04 COUNTY CO_Q~___ YEA.!3. SOCIAL SECURITY NUMBER 00473 J.j1!MBER 490-34-9883 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 6 Decedent Died Testate (Attach copy of Will) 9 litigation Proceeds Received 4a. Fulure Inte-est Compromise (date of death afler 12-12-82) Decedent Maintained a living Trust (Attach copy of Trusll o 3. Remainder Relurn (date of death priorto i-2~13-82) o 5 Federal Estate Tax Return Required 8 Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) {Attach Sch 0) NAME JERRY R. DUFFIE FIRM NAME (If applicable) JOHNSON, DUFFIE, STEWART & WEIDNER TELEPHONE NUMBER 717/76]-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 301 Market St. Lemoyne,PA 17043-0109 (1) 150.900.00 (2) 233,208.07 (3) None (4) None (5) 34,797.82 (6) 7.504.12 (7) 44,650.06 (9) (10) 49,841.55 543.57 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 409,859.95 x .045 (16) 17. Amount of Line 14 taxable at sibling rate x ,12 (17) 18. Amount of Line 14 taxable at collateral rate 815.00 x ,15 (18) 19. Tax Due (19) 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 'J' C;\l .....r"l ~',- ) -"::J f".,J f"".) (8) 471,060.07 (11) 50,385. ]2 (12) 420,674.95 -------- (13) ]0,000.00 (14) 410,674.95 ] 8,443.70 122.25 18,565.95 -:':Emili~2TJm:!im]1n\:1m\;illi~ttmjl~~.~__1_m.!"lQi~19l!gu!l!l1.,,~l!mill\m!!ji!!;mjl!!mjijdblfJ1U!hllillllW Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev, 6-00) Decedent's Complete Address: STREET ADDRESS \906 RUTLAND ST. CITY CAMP HILL STA TE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 18,565.95 \ 5,500.00 815.79 Total Credits (A + B + C) (2) \6,315.79 3. Interest/Penalty \f applicable D. Interest E. Penalty 12.33 TotallnteresUPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Check box on Page 1 Line 20 to request 3: refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (3) 12.33 (4) (5) 2,262.49 (5A) (58) 2,262.49 Make Check Payable to: REGISTER OF WILLS, AGENT [!mmlillbmnnm..iili!mn....nIl1U _ 'ii ""'~. ..m . , ~ n mnni'.'-- PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.. ............... ~ I b. retain the right to designate who shall use the property transferred or its income;.. c. retain a reversionary 'lnterest; or..... d. receive the promise for life of either payments, benefits or care?...... 2. Ii death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.. ................. ............... ............... D o ~ 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?.. . ................ ~ ~ o 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 ex.amined thiS return, including accompanying ~chedules and statements, and to the best of my knowledge and belief. it is true. correct and complete. Deciaration preparer other than the personal repre~~~t~~i_~~ is based. o~.~~iflforn1ation of 'N~ich_ preparer.~~~ any knowled~{;. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS I)A~~~ e:><eC'-llbR. SIGNATURE OF PERSON SPONSIB~FiLING RETURN ADDRESS 219 FOX GROVE PLACE HUMMELSTOWN, PA 17036 DATE oI11t?5_- L-m o HER THAN REPRESENTATIVE .5/16Ios - AD6tE;S DATE 301 Market St. Lemoyne, PA 17043,0109 !n!!mi'!!~...iiIi!U[!nnL ~ _ _ .L,~,~ '~-' ~ ,~- For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the riet value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)1. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. [72 P .S. 99116 {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. 99116 1.2) [72 PS. 'i9116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 120/0 [72 P.S. 99116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KIME, MILDRED E. FILE NUMBER 21 - 04 - 00473 All real property owned solely or as a tenant in common must be reported at fair market valuEf."air 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 survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 21,000.00 Real Estate - Vacant Lots 262, 263, 264 - Borough of Camp Hill, (formerly in East Pennsboro Township) Cumberland Couuty, PA. (Deed Book E, Volume 21, Page 634; Deed Book 1, Volume 18, Page 164). Sale Price - Copy of Settlement Statement attached. 2 Real Estate - No. 1906 Rutland Street (Lots Nos. 265, 266, 267), Harrisburg Gardens, Borough of Camp Hill (formerly East Pennsboro Township) Cumberland County, PA. (Deed Book H, Volume 17, Page 39). Sale Price - copy of settlement statement attached. 129,900.00 TOTAL (Also enter on Line 1, Recapitulation) 150,900,00 OMS NO. 2502-0265 '"I. r~".-""^,m~, 0> "'"""" · ",,^' '"""'".~, B. TYPE OF LOAN: 1DFHA 2.0FmHA 3. DCONV. UNINS. 40VA 5.0CONV.INS. 6. FILE NUMB~:;'R 17. LOAN NUMBER: SETTLEMENT STATEMENT PHO",04A i 8. MORTGAGE INS CASE NUMBER: !C NOTE: This fann is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement C!gent are ,shown. I Items marked "[POCr were paid outside the closing; they are shown heretor informational purposes and are not Included In the totals. ~ a 3/a~ (P~Q.13Q4A_sr.1P..PfC'fPH04304P._SMPJ~) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: NEELU ENTERPRISES. INC. ESTATE OF MILDRED E. KIME G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1648139 I. SETTLEMENT DATE: LOTS 262. 263 & 264 PENN HERITAGE TRANSFER COMPANY CAMP HILL, PA 17011 December 28, 2004 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 3464 TRINDLE ROAD CAMP HILL. PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 101. Contract Sales Price I 21,000,00 401. Contract Sales Price I 21.000.00 102. Personal PropertY I 402. Personal Propertv I 103. Settlement Charaes to Borrower (Line 1400) I 15,915,50 403. I 104. I 404. I 105. I 405. I ustments r em 1 arm v n men r In v 106. Gitv Taxes to I 406. City Taxes to I , 107. Countv--Taxes 12/28/04 to 12/31/04 i 1.02 407. County Taxes 12/28/04 to 12/31/04 I 1.02 108. School Taxes 12/28/04 to 06/30/05 134.26 408. School Taxes 12/28/04 to 06/30/05 I 134.26 109. 409. I 110. 410. I 111. 411. I 112. 412. i 120. GROSS AMOUNT DUE FROM BORROWER i 37.050.78 420. GROSS AMOUNT DUE TO SELLER I 21.135.28 , 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money I 501. Excess Deoosit (See Instructions) I 202. Princioal Amount of New Loanls) , 502. Settlement Charoes to Seller lLine 1400) I 1,474.00 , 203. Existino loan(sl taken subiect to 503. Existing loanls\ taken subiect to i 204. 504. Payoff of first Mortgage I 205. 505. Payoff of second Mortoaae I 206. I 506. I 207. I 507. I 208. I 508. I 209. Closina Costs Paid Bv SeUer I 509. Closinq COSls Paid BV Seller I Ad.ustments or/terns n al eller Ad ustments or ltem,ST,n am e er 210. Cltv Taxes to I 510. City Taxes to I 211. Countv Taxes to I 511. CountvTaxes to ! 212. School Taxes to , 512. School Taxes to I , . 213. i 513. , 214. , 514. I 215. I 515, I 216. ! 516. , 217. , 517. I 218. , 518. 219. I 519. I , 220, TOTAL PA/O BY/FOR BORROWER , 520. TOTAL REDUCTION AMOUNT DUE SELLER I 1,47400 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 37.050.78 601. Gross Amount Due To Seller (Line 420) 21,135.28 ,302. Less Amount Paid By/For Borrower (Une 220) i( ) 602. Less Reductions Due SeUer (Line 520) ( 1,474.00 1303. CASH ( X FROM) ( TO) BORROWER :9tf' 37.050.78 603. CASH ( X TO) ( FROM) SELLER ; 19,661.28 The undersigned herebr/cknO~dgo:..ecey~ nmPleted copy of pages 1&2 of this statement & any,~tt~h~~ r~~rred to herein Borrower Seller ili-~(t..:.. :7, f..i(; 6::....t~ NEELU ENTERPRISES. iNC..J- ESTATE OF MILD ~~IME I' . """ HUD-1 (3-86) RESPA. HB4305.2 paae2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price < "" ,,~ 1--;;;;;;- nn PAID FROM PAID FROM Division of Commission ({ine 700) as Follows: BORROWER'S SELLER'S 701. $ 655.00 to RE/MAX REALTY PROFESSIONALS FUNDS AT FUNDS AT 702. $ 605.00 to RSR REALTORS SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 1,260.00 704. to BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriqinatiori Fee n,l. 10 B02. Loan Discount % to 803. Appraisal Fee 10 B04. Credit Report to 805. .Lender's Inspection Fee to 806. Mortca e Ins. ADD. Fee to 807. Assumption Fee 10 BOB. 809. 810 811. 900. ITEMS REDUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ Iday ( days %) 902. MIP Totlns. for LifeOfLoan for months to 903. Hazard Insurance Premium for 1.0 vears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ per month 1002. Mortgage Insurance months $ oer month 1003. Citv Taxes months $ ~D"r month 1004. CountvTaxes months $ ner month 1005. School Taxes months @ $ per month 1006. months (cj) $ ner month 1007. months @ $ per month 100B~ months (fj) $ per month 1100. TITLE CHARGES 1101. AssionmentFee to GORDON BANZHOFF 15,1B5.00 1102. Courier Fee 10 1103. Wire Transfer Fee to 1104. Title Insurance Binder to 1105. Document Preoaration to 1106. Notarv Fees to STEPHANIE RIDER 4.00 1107. Closing Fee to PENN HERITAGE TRANSFER COMPANY 150~00 (includes above item numbers: I 110B~ Title Insurance to (includes above item numbers: 1109. Lender's Coverage $ 1110. Owner's Coverage $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50: Mortgage $ Releases $ 40.50 1202. City/County Tax/Stamos: Deed 210.00' Mortn"ne 210~00 1203. State TaxlSlamDs: Revenue Stamos 210.00: Mortnane 210.00 1204. Citv/CountvTax/Slamps to RECORDER OF DEEDS 165.00 1205. Slate Tax/Slamps to RECORDER OF DEEDS I 165.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 15,915.50 1,474.00 By Signing page 1 of this statement, the slgnatones acknowledge receipt of a completed co~age 2 of this two page statement. f') )1:=::1<1:</ Certified to be a true copy. SHELLY J. KUNKEL!.ESQUIRE Settlement Agent (PH04304A_SMR I PH04304A_SMR / a ) A. U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LOAN 0: ~~....> \':--"/ "::j/ T.A. of Harrisburg, LLP 4775 Linglestown Road Harrisburg, Pennsylvania 17112 717-671-671Sfax:717-671-6718 J, 0 FHA 4.LJVA 6,F'1leNumt;;;; 2. 0 fMHA 3 0 CONY. UNINS. ~. DCONV, INS. 7. loan Nutnber' HAR125-3445 8,Morts"selnll.C...No' C NO'TE: -Thisform isjU;:;'ished to give you a statement ojactuai seulement costs. Amounts paid /0 and by tlrese;t/ement agent are shown.-'ltems marked ____ __~~E!!..P_aid outside tire closin&..Jlt'!Loreshown here (or informoli'!!!!!!.Eurposes and ar.e_ not included in the totals. ~________ Philip J: Knepper and Rendy L. Knepper, husband and wife 1906 Rutland Street Camp Hill. Pennsylvania 17011 _ Mildred E. Sheriff Estate, aka Mildred~. Kime Estate lP Morgan Chase BankN.A. 512 Townshipline Road Blue B~IJ}.R.ennsylvan!~.J94~2 1906 Rutland Street Camp Hill, Cumberland County, Pennsylvania 17011 East Pennsboro Township Lot 265, 26~ AND 26, Harris~r~ Gardens, Book1~~e 86 Cumberland C~unty..!...P~nnsylvania TA. of Harrisburg, LLP 4775 LinJ!;lestown Road, l!...-3!!~.~u.!8L Pennsylvani~~-.!.!2 Dauphin County ~J:E.bruary 28, 2005__ D. Borrower: ~Sel!.(lr.:.___ F. Lender: G. Property: H.-S~t1em~nt Agent: ~!lce of Settlement: I. Settlement.I?~__ --.- -- K. Sum -- 400. Gross Auto J.?9 900.00 401. ContractSaI 402. Persona!Pro 5902.64 .. 403. .:vJ!~e: ~dlustments 406. City / Town 407. ~County I P ... 450.16 408. School Tax 40.77 409. Sewer Feb "2 _ 136.29.~.S2 .~<!.20. Gross Amo _..- SOD. Reduc~ions " 1,000.00 501. _ Excess Dep 12~&~.1n'OO 502. Settlement 503. Existin.;-Lo -- __21}00.00 504. PayoffofFi !05. Payoff of Se --- 506. Purchase M __~_ Adjustments .- 510. C~/Town ---- -.------ 72.97 511. County/P 2005 --- -51"2. S~hool T~x.e -- 0- 131.953.97 520. Total Red -. Sell_er: ~,'.'-_.- .600. ..Cash at Set .-- 1 ~~~~~.57 601. Gross Amou 131,953.22. 602. Less Reducti $4,339.60 603. Cash To -- - - - J. Summary of Borrower's Transaction mary of Seller's Transaction lOa. Gross Amount Due From Borrower: loi:n Contract Sales Price-----..- 102. Personal !roperty _ I 03. ~eltlement Chan~es to Borrower (line 140.QL _~Ilstm~}~.ts for Ite~s :raid by Seller tn Ad -.1~ ft!r I Town Taxes .. __~.___ -.J07. County I. Parish TaxES _ !Q!.....~chool Taxesf_eb 28, 2005 thm Jun}Qtl905 .1.22:_ Sewer Feb 28. 2005 thru lun 30. 2005 I~O. Gross A~Q.II..!!.~from Borr.~w...!!": 200. Amounts Paid by or in Beha!fii"iorrowe - 201. Deposit/EamestMon~__ 202. Principal Amount of New Loan 203. ExistinR LO!!ll(s) "__ 204. Clo~_C:;ostAssistancefro'!!.fHFA _ 205. 206."~-- _u Adiust~~-for Items t!,~J!&~J)J'._~~lle.r: ~_~1h'!]own Taxes..___~______ 211 County I Parish Taxes Ian 1,2005 thru Feb 27 . 2005 7jX=-s.cI!.(l~1 Taxes----:-.:___.~-=~.=~ unt Due To Seller: esPrice p~-- __..___'--=:129,900.00 for ltel!!!Xaid .~y',_Seller in Advance: Taxes arishTaxes-~-- --~~---- C!..feb2U005thru Jun 30, 20Q.?~.__ .....-'450.16 ~_~005 th!:l:lJun 30, 2005 __ ___ 40.77 unt.!?~..t_~_~!!.!ler: _~.Q,390.93._ in Amount Due to Seller: ._~___ osit(seeinstructi~_"_...~_ __ Ch!!!&.~.!9~cjler(Line 1400)~__9-,-~~1:9.Q_ l!!1!.s) ___._______._ rstMortA3Ae~__ ________ cond MortJ!;3J!;e to.... .~ ._.,~___ ont:Y_M:.2!!g~~'!~ __..__._ for Items Un.p!!t.lJ!L~!!!~__." T""" arish Taxes Jan 1,2005 thru Feb 27, 72.97 220. Total Paid by / for Borrower: _s__ uclions in Amount Due 9,363.97 300. Cash at Settlement from / to Borrower: 301."" Gross Amount due fro_m Borrower (liJ;leI20) " _ 302. Le~_AmQ.Il;'HR.~d by/for Borrow.~(I~.J20) tJement to / from Seller: nt ~~ to Se!~ii~42~ Q!1~ ~.~.lJnt d~~ Seller (line 520) 130d.2Q;?t ____~,~?~L 303. Cash From Borrower: Seller: $121,026.96 I have carefully reviewed the HOD.. Settlelllent Statement and to the best of Iny knowledge and belier, it is a troe IInd accurate statement of all receipts and disbursements made on my coun r by in this ttansaction. I further certify that 1 have received a copy of HUD.J Settlement Statement. Seller: &<Ec.u ~@....__ ildredE.KimeEstate Borrower: ared is a true and accurate account of this transaction. I have caused or will cause the fUllds to be disbursed Date: February 28, 2005 File No.: HAR125-3445 Deborah K. Bocian TA K520111 WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar fonn. Penalties upon conviction can include a fine or imprisonment. For details see: title 18 V.S. Code Section 1001 and Section 1010. Settlement Agent: HUD-I April 2003 February 28, 2005 8:44 AM OM8 No. 2502-0265 RESPA handbook 4305.2 Settlement Date:February 2S,2005 L. Settlement Charges 700:- Totalsaiesl Broker's Commisslon:- Based on Price $129,900.00 @ 6.00% = $7,794.00 Division of Commission as follows --101.1;794.00 Jo_RE/MAX _I!t:l!-lty Professio_nals _~ _ 702. -7'03. Commission ~ettlement --.--.-- _204. Deed Preparation to ~.Eh H. WriJ;tht, Esg~ire (PaC so.ooi===:-=' - --- --- 70S. TransactionlProc~sin,g Fee to ReMax Realty Professionals _____~_____ 800. ,Items Payable in ~onnection wHh Loan:_ J!QI.LoanQ!iginationFee,to JPMon::anChaseBl!l!kNA __ ______________ 802. Loan Discount to JP Mor&...an Chase Bank NA J!.Q1~i!.al Fee to l!l;ck D. Taylor Apprais!!s..JPOC $350.0~1___~====___,. 804. Credit Report to KTCN - $50.00 pac 805. Lender's 11!spection Fee - to Jack D. Ta~~_1\ppraisals--'-'--------- 806. Mort,gage Insurance Apl!!I~ation Fee 807. Assumption Fee 808. Tax Service Contract Fee 809: F]oo~ Certification to Quaiiti;xLi~---- -- -- J!!Q. Documen! Preparation to JP MO['Ji:an Chase Bank N.A. 811. UnderwrilinRFee to JP MOrRall Chase Bank N.A. 812. Processin,g Fee to JP MorJ;tan Chase B8J!k N.A. 900. Items Required by Lender to be P&.Id in Advance: _2Q.L Interest from Feb 28, 2005 to Mar 1.1 2005 @ 0.0000 Z~l!Y-__ _202. M_o~ge Insurance Premium 903 _!:laz~<! Insurance PrerDlum (poc 334.00L 904. FloodInsurnnceP~~________~_ !OOO. Resen-es Deposited witb Lender: ___ . !OOI.Hazard In.surance 3 _!!IQ~!!t~__~~7,84 per month _____ 1002. Mort,gaJ;telnsurance __________ ~3.CityPr:o~Taxes___. __ 1004. County ProE...~Taxes l~..1!I_~n_th~ @l 39.05 permont~_. _1005,-~chool Taxes 2 months (aJ 111.3_U~_f!lonth____ ___ ---1.9?2:__~e Accountin2 A..ilil!.~~~.!!.( _____ .____ 1100._!!!le Charges:._ __ ____.____,__.___ 1101. Settlement or Clo~i!!&E~~___.._______~ _~______ ___ ] ] 02. Abstract or Title Search iTo3. Title Examination-- I I o4~ernsuranceafrldcr~---- -fj05~-bocwnent Preparation _.___ _ p06. Notary Fees to Deb~!!l.h$. Bocian 1107. Attorney Fees _______Ji~]udes above ite_,!! numbers: 1108. Title Insurance to T.A. of Harrisburg, LLP (includes above item numbers: .1101-1104 State Bond Rate -"11'09.' Lender's C;:;~era,ge , ]28,881.00 Risk Premium 0.00 ~i Ilg. Owner's Covern~~.JOO.OO Risk PremJ.I,IEl___ _ 680.91 J_I] I. EndoI'Sef!lents 100, 30~0.Qi~ to T.A. ofHanisburR, I"Ll'____ _!! 12. Closin&.iervice Letter ~,T~8::,_'fi~~.!nsurance Company _. _ 1]13. _______._._ ____________._~ -_!!!..'!:- - --.- 1200. Government Recordinl! and Transfer Char2es: - 1201. Recordi,!g Fees: . Deed 38.50 MortJ;taKe _!~02. City/County tax/stamps: Deed ].299.00 MortJl'aKe 1203. ~tatetax/stamps: Deed 1,299.00 Mort,gaJte _ 1204~~cord A~siKnment to. Recorder of Deeds - CumbC!land County g~Record 2nd }~.1..2rtKaKe to Recorder qfDeeds ~ Cumberland Coul!ty --.!_~OO~ Ad~t!~nal SettIemenJ Charges: ~9L~~~._. _,____._____ .!~Q~est Inspection to Biechl~~},i.ll~_ Inc. ~~x1'-..ressMaiIFee__ ]304. Electronic Transmittal Fee. Loan Documents J305.~-17i.to~to Borou,gh of Camp Hill 1306. Home Insp_~ction to!!!~chler &_!iIlery Inc. __..____ _ 50.50 0.00 0.00 Releases 1400. Totai Settlement Charges (Enter on line 103, Sedlon J and line 502, Section K) Borrower Initials: RrJ<. ~ Mildred E. Sheriff Estate, aka Mildrep. E..Kime Estate PhilipJ.Knepper tlJC- Rendy L. Knepper Seller Initials: HUD-l Apri] 2003 February 28, 2005 8:44 AM _0.00 File Number: HAR]25.3445 TAK52011l Paid from Borrower's Funds at Settlement --=35.12- -------.15.00 ___!~:99 15.89 --i;90(65 _~51. 507,65.- 1001.88 .323.24_ - Paid from Seller's Funds at Settlement -- ,2,794.00 !~5.00 25.00 _____-.i3:oiL 680.91 ]50.00 35.00 _,_89.00 1,299.00 27.00 -'!SO 35.00 275.00 55,902.64 1299.00- -~. 6g~ 59,291.00 OMB No. 2502-0265 RESPA handbook 4305.2 ESTATE OF '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT KIME, MILDRED E. SCHEDULE B STOCKS & BONDS i FILE NUMBER 21 - 04 - 00473 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER ] SmithBarney Investment Account No. Date of death value: Conullon Stocks: $ Mutual Funds: Bank Deposit Program - cash: Closed end funds - Zweig DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 233,208.07 233,208,07 724-]3226 66,309.50 163,604.7] 3,264.29 29.57 TOTAL (Also enter on line 2, Recapitulation) ESTATE OF .. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT IOME. MILDRED E. . FILE NUMBER 21 - 04 - 00473 Include the proceeds of litigation and the date the proceeds were received by the estatEAII property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 7,542.32 PNC BANK - Interest Checking Account No. 51-4003-4328 Date of death balance, plus accrued interest. 2 M&T Bauk - Certificate of Deposit No. 031003913823637 Date of death balance, plus accrued interest. 15,044.52 3 Household Goods - appraised value 3,910.00 4 1992 Buick Park Avenue Sedan - 4D - Sale Price 4,000.00 5 Lady's Ring: 10kt yellow gold with 2 round faceted, 4.5mm synthetic rubies. Item V of the Will. - Appraised value. 65.00 6 Lady's Ring - 18kt white gold with cut diamond of .34 cts. Item V of the Will - Appraised value. 550.00 7 Eighteen (18") inch bisque doll. Item III of WiII- Appraised value. 100.00 8 Eighteen (81") inch bisque doll. Item IV of the Will - Appraised value. 100.00 9 Internal Revenue Service - 2003 income tax refund 458.00 10 Verizon - refund - telephone charges 6.09 ]1 Cash - decedent's possession/refunds 606.41 12 ChemLawn - lawn service refund 183.53 13 Peerless Insurance - refund 134.00 14 Cash - Purchaser's down payment - sale of 1906 Rutland Street- Purchaser did 110t fulfill obligations set forth in Sales Agreement. 2,000.00 15 Internal Revenue Service - refund - 2004 income tax. 97.95 TOTAL (Also enter on Line 5, Recapitulation) 34,797.82 '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF KIME, MILDRED E, FILE NUMBER 21 - 04 - 00473 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Rodney A. Kime 55 Ringneck Dr. Harrisburg, PA ]7112 Stepson 13 Douglas L. Kime 1359 Concord Road Mechanicsburg, PA 17050 Stepson c Natalie A. Kime 820 Lisbum Rd., Apt. 512 Camp Hill, PA 17011 Stepdaughter JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT ---- DESCRIPTION OF PROPERTY , F I' - --- Include name of financial institution and bank account number DATE OF DEATH D~C<1,S I DA0~~~ED6~TH or similar identifying number. Attach deed for jointly~held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST estate. ; , 25%' M&T Bank - Certificate of Deposit No. 031003913823629 Date of death balance, plus interest 30,0]6.47 7,504.12 02/27/2002 , I TOTAL (Also enter on line 6, Recapitulation) 7,504.12 '. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KIME, MILDRED E. FILE NUMBER 21 - 04 - 00473 ITEM NUMBER This schedule must be completed and filed if the. answer to any of questi~ns 1 throul!h 4 on page 2 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH I % OF ' Include the name of the transferee. their relationship 10 decedent and the date of transfer. SSE DECO'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate. VALUE OF A T INTEREST (IF APPLICABLE) I SunLife Assurance Co. of Canada US Key Annuity - Policy No. KAOOl24167 Beneficiaries: David A. Sheriff, Son Gary L. Sheriff, Son Date of death value. 10,593.151 10,593.15 2 SunLife Assurance Co. of Canada US Key Bonus 100 Annuity - Policy No. KA00782386 Beneficiaries: David A. Sheriff, Son Gary L. Sheriff, Son Date of death value. 22,931.94 22,931.94 o ., PNC Investments - Met Life Annuity Control No. A2072611 Beneficiaries; David A. Sheriff, Son Gary L. Sheriff, Son Date of death value. 11,124.97 11,124.97 TOTAL (Also enter on line 7, Recapitulation) 44,650.06 . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE$IDENTDECEDENT ESTATE OF KIME, MILDRED E. FILE NUMBER 21 - 04 - 00473 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers-Harner Funeral Home - funeral expenses. 2 Trinity Evangelical Lutheran Chnrch - food for funeral bnmch .' Myers-Harner Funeral Home - corrected death certificates B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions DAVID A. SHERIFF Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 219 FOX GROVE PLACE, City HUMMELSTOWN State PA Year(s) Commission paid 2005 Zip 17036 2. Attorney's Fees Johnson, Duffie, Stewart & Weidner 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Register of Wills of Cumberland County Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Cumberland Law Journal - Legal Advertisement 2 The Patriot-News - Legal Advertisement Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 7,199.00 128.52 56.00 15,500.00 12,500.00 380.00 75.00 109.30 13,893.73 49,841.55 .". ' . , , Schedule H Funeral Expenses & Mninistraliw Cos1s continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KIME. MILDRED E. FILE NUMBER 21 -04-00473 , .- Register of Wills - Short Certificates 4 Chuck Bricker - household goods appraisal and bisque dolls 5 Jeweler's Bench - appraisal of Rings () PP&L - electric service 7 PA American Water Co. - water service 8 ReMax/RSR - real estate commission - sale of vacant lots 9 PNC - charge for Estate checks 10 David Sheriff - postage - estate mailings - copies 11 Wonders, Ltd. - canopy for auction - sale of household goods 12 V crizon - final charges 13 Borough of Camp Hill - sewer charges 14 Janet L. Miller, Tax Collector - School District Real Estate Taxes 15 Recorder of Deeds - 1 % Transfer Tax - sale of vacant lots 16 Stephanie Rider - notary fees - sale of vacant lots 17 ReMax/RSR - commission - sale of 1906 Rutland St. 18 Recorder of Deeds - 1 %l transfer tax - sale of 1906 Rutland St. I<J ReMax Realty - Transaction Fee - sale of 1906 Rutland St. 20 Deborah K. Bocian - notary fee - sale of 1906 Rutland St. 21 Janet L. Miller, Tax Collector - County/Borough real estae taxes due at settlement (1906 Ruthland St.) - 1/1/05 - 2/27/05 22 J. J. Skelton - oil deliveries 21 Registcr of Wills, File Inventory & Inheritance Tax Return 24 Reserve for close-out costs Page 2 of Schedule H 6.00 75.00 64.00 163.78 156.54 1,260.00 15.99 32.42 137.80 16.29 79.23 1,760.81 210.00 4.00 7,794.00 1,299.00 125.00 13.00 72.97 527.90 30.00 50.00 ESTATE OF 'w SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT KIME, MILDRED E. Include unreimbursed medical expenses. ITEM NUMBER I 2 3 4 5 (, 7 8 9 10 DESCRIPTION Beverly HealthCare - decedent's account balance Susquehanna Internal Medicine - decedent's account balance AT&T - telephone charges - decedent's account PP&L - electric service charges - decedent's account PA American Water Co. - water servIce charges - decedent's account Verizon - telephone charges - decedent's account HealthSouth Rehab. - decedent's account Lnited States Treasury - decedent's 2002 Form 1040 - tax, penalty & Interest Holy Spirit Hospital - decedent's account balance Associated Cardiologists - decedent's account balance FILE NUMBER 21 - 04 - 00473 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 15.00 20.07 25.61 28.74 12.10 16.29 14.38 322.04 87.60 1.74 543.57 REV-1513 EX+ (9-00) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF KIME, MILDRED E. FILE NUMBER ! 21-04-00473 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) David A. Sheriff - 219 Fox Grove Place Hummelstown, PA 17036 Son One-half - automobiles; household goods and one-half residue. 2 Gary L. Sheriff - 11967 N. 111th Way Scottsdale, AZ 85259 Son One-half - automobiles; household goods and one-half residue. o -' Nancy Hoffman - 846 W. South St. Carlrsle, P A 17013 Niece 18" Bisque Doll 4 Karen Kurtz Weyl- 7 Charles Point l\ewark, DE 19702 Niece 18" Bisque Doll Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate. on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Trinity Evangelical Lutheran Church- 2000 Chestnut St., Camp Hill, PA 17011 10,000.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 10,000.00 ,,* SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KIME, MILDRED E. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under . Sec. 9116(a)(1 .2)] 5 Vanessa Kime-Avakian - 5053 LeCedona Circle Delray Beach, FL 33848 FILE NUMBER 21 - 04 - 00473 I RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Step- Granddaughter AMOUNT OR SHARE OF ESTATE Ruby & Diamond Rings Page 2 of Schedule J COMMONWEAlTH OF PENNSYlVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-l162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUFFIE JERRY R 301 MARKET ST POBOX 109 LEMOYNE, PA 17043-0109 ____un fOld ESTATE INFORMATION: SSN; 490-34-9883 FILE NUMBER: 2104-0473 DECEDENT NAME: KIME MILDRED E DATE OF PAYMENT: 03/21/2005 POSTMARK DATE: 03/18/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/06/2004 NO. CD 005102 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,262.49 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 250 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $2,262.49 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX - APPRAISEHENT, ALLOIIANCE OR DISALLOIIANCE --OF' DEDUCTIONS AND ASSESSHENT OF TAX BUREAU OF INDIVIDUAL TAXES " INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-07-2005 KIME 05-06-2004 21 04-0473 CUMBERLAND 101 , -; i ~. 1 it CLEF;: JERRY R DUFFlljQR!CH!\NS JOHNSON ETAL U\.. 301 MARKET ST LEMOYNE PA 17043 Tn *' REY-lSilf7 EX AFP (03-05) MILDRED E Dount R..ltt.d I XI CHANGED SEE MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ /I!V-"MI:"Yf.WII.m~'.'Wft'l!\!.w.!MftA1:"t'.M.'!'.'IW.lW/llTftMMt':.YCtW.M.'!'.Drr.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MILDRED E FILE NO. 21 04-0473 ACN 101 ESTATE OF KIME TAX RETURN WAS: I I ACCEPTED AS FILED DATE 06-07-2005 ATTACHED NOTICE I~ an assessment was issued previously, lines 14, IS and'or 16, 17, 18 and 19 will r~le~ ~igures that include the tatal ~ abb returns assessed to date. ASSESSMENT OF TAX: IS. AIIo...,t of Line 14 at Spousal rat. (lS) 16. ABount of Line 14 taxable .t Lineal/Class A rat. (16) 17. ADount of Line 14 at Sibling rate 1171 18. ABount of Line 14 taxable .t Collateral/Class B r8t. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R.al Estate ISchodul. Al 2. Stocks and Bonds ISchodul. BI 3. Closely H81d stock/Partnership Interest (Schedul. C) 4. Mortgages/Notes Receivable (Schedule Dl S. C.shlBank Deposits/IUsc. Personal Property (Schedul. E) 6. Jointly o.nad Property ISchedule FI 7. Transfers (Schedule Sl 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. F...,eral ExPtll1ses/A.m.. Costs/tUse. Expenses (Schedule H) 10. Debts/Mortgage Li8billties/Liens (Schedule I) 11. Total Deductions 12. Net Velue of Tax Raturn 13. Charlteble/Goyern..ntal Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax NOTE: III 121 131 141 151 161 17J 150.900.00 233.208.07 .00 .00 34.797.82 7.504.12 44.650.06 181 1191= NOTE: To insure proper eradi t to your account, sub.it the upper portion of this form with your tax p.ynant. 471,060.07 IiO.3A5 1? 420,674.95 10,000.00 410,674.95 .00 18,471.37 .00 30.00 18,501.37 TAX CREDITS: ".~.n . .. '.J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID I-I 08-04-2004 CD00423}-:::: 815.79 15,500.00 03-18-2005 CD005102 11 .98- 2,262.49 TOTAL TAX CREDIT 18,566.30 BALANCE OF TAX DUE 64.93CR INTEREST AND PEN. .00 TOTAL DUE 64.93CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 191 1101 49,841. 55 I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE J A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.I Qc~ 'r- 543.57 1111 1121 1131 1141 ISchedule ,)1 .00 410,474.95 .00 200.00 X 00 = X 045 = X 12 = X 15 = REV.1470EX(6-3lI) . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF 'NDMDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME Kime, Mildred E. FILE NUMBER 2104-0473 REVIEWED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J 5 Changed tax rate from 15 percent to 4.5 percent since a Step-granddaughter is a lineal beneficiary. , ,.... , .. ROW Page 1 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: MILDRED E. KIME alk/a MILDRED E. SHERIFF Date of Death: MAY 6. 2004 Will No.: 21-04-00473 Admin No.: 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 tS No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to NO.1 is yes, state the following: A. Did the personal representative file a final account with the Court? Yes No tS B. The separate Orphans' Court No. (if any) for the personal representative's account is:. C. Did the personal representative state an account informally to the parties in interest? Yes tS No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 1/ t.t(1J ,r I Sig t re J R. Duffie, Attorney Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemovne, PA 17043-0109 Address C'? c::> c_ "~ ! (-j (',J (717) 761-4540 Telephone No. -: :~--:; ~:C) Capacity: Personal Representative tS Counsel for Personal Representative (____J - C~ o<-f BUREAU OF INDIVIAIQifJ) OFFICE OF ItIERITAHCE TAX DIYISI (:'!CTCD n;::- '~,nl ! (\ PO lOX 2I0601.'.-'.'...)Il...r1 VI (/i,.,...) HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT . REV-1607 EX AFP (05-051 2005 JUL 22 P~I 2: 10 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-27-2005 KIME 05-06-2004 21 04-0473 CUMBERLAND 101 Mount ...itted MILDRED E CLERK OF ORPHN~'S COURT JERRY iRUWfF.IfT' U). RA JOHNSON ETAL 301 MARKET ST LEMOYNE PA 17043 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure p.--r credit to !four _aunt. subIIit the _r portion of this fa... with !four t_ _to CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ..........................~................~...,'........................~...................................... REV-1607 EX AFP (03-05) ... INH~RI ANCE TAX STATEMENT OF A~COUNT ... ESTATE OF KIME MILDRED E FILE NO.21 04-0473 ACN 101 DATE 06-27-2005 THIS STATEItEJIT IS I'IlOVIDED TO ADVISE OF THE CUIlllENT STATUS OF THE STATED ACN IN THE HAHED ESTATE. SIIllIIII BELOlI IS A sutlIIARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIeuRE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-31-2005 PRINCIPAL TAX DUE: 18.501.37 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER I~TEREST/PEN PAID (-) 08-04-2004 CD004238 815.79 15.500.00 03-18-2005 CD005102 11.98- 2.262.49 06-13-2005 REFUND .00 64.93- v TOTAL TAX CREDIT 18.501.37 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN .1. NO PAYltENT IS RElIUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l ';JZ. "",'''''',C'.,,' -." Il;W,,,j,,:,. "