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HomeMy WebLinkAbout02-0199PETITION FOR PROBATE and GRANT OF LETTERS Estate of William H. Worley, Jr., Deceased No. ,2!- 02_ - ic~. Social Security No. 169-38-5222 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the under, signed respectfully represents that: Your petitioner, who is 18 years of age or older presents for probate the last will of the above decedent, dated June 1, 1989. The Decedent, at the time of his death was divorced from Susan Michele Worley, his then wife who is the named Executrix of said will. The Successor James Wilson Deimler has renounced the position of Executor and the petitioner, Melissa J. Worley, is one of the three surviving children of the Decedent and is the only child that is an adult with a date of birth of 1/11/80. The other surviving children, Samantha Nicole Worley (D.O.B. 11/22/85) and Robyn KristineWorley (D.O.B. 1/29/88) are minors in the custody of Susan Michele Worley, their mother, the former spouse of the Decedent. Decedent was domiciled at death in Lemoyne, Cumberland County Pennsylvania, with his last family or principal residence at 111 S. 3rd Street, Apt 3, Lemoyne, PA 17043. Decedent, then 50 years of age, died December 1, 2001, at home (111 S. 3rd St., Apt 3, Lemoyne, PA 17043. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Divorced after execution of will. Decedent at death owned property with estimated value as follows: (If domiciled in Pa.) All personal property $4,000.00 Value of real estate in Pennsylvania situated as follows: None WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters of Administration c.t.a, thereon. - Melis4,arJ. 4252 B Wagon Wheel Ct. Harrisburq, PA 17109 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND : ss The petitioner above named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 22nd day of ..--,.F~E~RUARY ~ '~,.¢¢ 2002. ~A~7~-~I S ~/~egister Melissa J. Worley Estate 6f No. o°/- William H. Worley, Jr. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOWFEBRUARY 2 5, 2 0 0 2 -I'9' , 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 June 1, 1989 described therein be admitted to probate and filed of record as the last will of William H. W. 6rley, Jr. ;' and Letters of Administration c.t.a. are hereby granted to Melissa J. Worley La~n~c~E S qr...~D ~ 7 I.D. No.) Ix.../ FEES Probate, Letters, Etc .......... 5 Short Certificates( ) .......... 5 Renunciation ................ $. jcp $ 25.00 12.00 108-119 kTnlnut' ._q~-,; lqa'r'r'inhurg: PA 17101-160! 5. 00 ADDRE55 3 .00 (717) 238-4798 PHONE extra paqes TOTAL__S bO.UU Filed 'FE'BRUARY"22',"2002 .......... mailed to attorney on 2-25-2002 REGISTER OF WILLS OF /' COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented tierewith, (each) being duly qualified according to law, depose(s) and say(s) that · present and saw the testat , sign the same and that · signed as a witness at the request of testat__ in h~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19 Register (Address) (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, testat o~ of (one of that ~J~'¢f / (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of the subscribing witnesses to) the will presented herewith and codicil believes the signature on the will is in the handwriting of to best of '2~4e x-.v-- knowledge and belief. '. or 22nd me this ..... day of (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of William H. Worley, Jr., Deceased No. ~/- The undersigned, James Wilson Deimler of 131 N. 3rd Street, Steelton, PA 17113- 2210, the named Successor Executor of the Decedent, hereby renounces the right to administer the estate and respectfully requests that Letters of Administration be issued to Melissa J. Worley, the daughter of the Decedent. Witness my hand this ~/.s ~aay of January, 2002. Witness: ...... (S'ig nat-u rei (Address) / his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ .-/.. ? /.:-&/~"~ ';i'"~5'"~ ~~~ Local Registrar P 7 8 8 S 3 S 5 ~~~ BE~ 0 4 2001 No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) SEX ISOClAL SECURITY N UZsET*~ERFILE NUMBER DA~E OF DEATH (Month Day Year) ~JvlE OF Lasl) . Worley, Jr. I'..~le I,.~69_3S_S222 I, December'l; 2001 I Lemoyne I 111 South Third Street I~D_.~c~, [(~[ .  KIND ~ ~U~INES~INOOSTRY [ ~8 ~ E~R IN D~CE~NT'~ [~[~T'S ~sylv~ia ~2 Wa~n ~i ~;,~is~,PA17109 __ ~ 8:00 P..... December 2, 2001 L William UNDER 1 YEAR 50 ~". Cumberland ~O~,--.T'S USUAL occu.AT,oN 111 S. Third St.Apt. 3 ,PA 17043 William Worley 'NFOma~NT'S N~"£ CYP'~"~) Melissa Worley 5 144 Rev. 1/91 Diabetes Mellitus .. Presumed Myocardial Infarction DUE 70 (OR AS A CONSEQUENCE OF): leading to immediate DUE TO (OR AS A CONSEQUENCE OF): CAt~E ~M~m o~ i~y c. , d. I~o~'~EO? qVAIL~6LE PF#O~ TO MANNER O~ DEATH ~A~t OFINJUR¥ JTIME OFtNJJRy INJURY AT WORK? IDESCRIBE HOW INJURY OCCURRED. DOMPLETIO~ OF CAUSE ~-~ I( onto. Day. Year) ~=DF..~H? Natu,. ~ Homicide []I I I ~- [] .~ [] I . _~.~ .o,. s.. [] c~.~....._ •{L~%~,;~°"-,"'m.-,-,,.~°~, ''~'~'~"~"~,~'.~m-..~-~.~,~-.~.,~ .......................... ~ ,~. [.~, December 3, 2001 ................................................................ ~ Hechantcsburg~ Pa. 17050 21-02-199 Last Will and Testament 4 Husband with Minor ChiMren l, ~,/_,) t///~/'71 /Q/' ,//--)Or '~57,, ,7~, presently residing at do hereby make, publish and declare th~s to be my Last Will and ~sta~ent and do hereby revoke any and all other Wills and Codicils heretofore made by me. The members of my immediate family are ~ ,Q&XO~ -- , First. my wife, and m~ ~/~ers. wife shall predecease me or fails to survive me or fails to serve as such Guardian, then in such event, I nominate and appoint ~ua~dian/Co-~di~m o:t~e person ~n~ p:ope~ty o[ my ~ino~ o~i[d:en, l f~t~e: direct that .o bon~ ~e ~eq~i:ed of the G~a~di~n(s) ~.de~ t~is Will. Filth. ] nominate and appoim my wife as [xecutrix of this Will. In the event that my wile shall Fedeeease me o~ :~i[s to suture me o~ fails to serve ~s sue~ :~ee~t~ix t~e. in s~e~ evem. l nominate and appoint Executor/Executrix o[this my Last Will and Testament. l [urther direct that no appointee hereunder shall be required to five any bond Eot the [aith[ul performance of his/her duties. ~iil~. I hereby authorize my Executor/Executrix to exercise all the powers, rights, discretions, duties and immunities conferred upon fiduciaries to the extent permitted by law with full power to sell, lease, mortsaSe, in,est, reinvest, or otherwise dispose o[ the assets o[ my estate. at ~_~ Day of (Sign here) 1 subscribe my name tO this Will this __ © 1988 by AFBP. All rights reserved. Signed, sealed, published and declared to be his Last Will and Testament by the within named Testator in the presence of us, who in his presence and at his request, and in the presence of each other, have hereunto subscribed our names as witnesses: fi.,,/- k.~ (State) ? ,~te) (State) State of ~Tfr~ k~ ~ County of AJL.{I~,QJLc~ Affidavit ) City Personally appeared (1) ~_t,J,~_J_J_La,..?e-, '~ ~ [ (2) and (3) who being duly sworned, depose and say that they attested the said Will and they subscribed the same at the request and in the presence of the said Testator and in the presence of each other, and the said Testator, signed said Will in their presence and acknowledged that he had signed said Will and declared the same to be his Last Will and Testament, and deponents further state that at the time of the execution of said Will the said Testator appeared to be of lawful age and sound mind and memory and there was no evidence of undue influence. The deponents make this Affidavit at the request of the Testator. (l) (2) Subscribed and sworn to before me this (Notary Seal) (3) day of c5~/~c~,~.c./ , 19 '1 , Nd.~j~l~,~U blic) BETH ANN TI~$, NOT~Y PU~IC H~R[S~RG, DAUPHIN MY COMMISSION EXPIRES MAY ~, 1~1 Member, Permsyl, vania A,~tion of Notaries CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: William H. Worley, Jr. Date of Death: December 1, 2001 Estate No.: 00199 of 2002 To the Register of Wills of Cumberland County: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was mailed to the following beneficiaries of the above-captioned estate on: February 26, 2002; Name Melissa J. Worley Samantha N. Worley Robyn K. Worley cio Susan M. Worley Address 4252 B Wagon Wheel Court, Harrisburg, PA 17109 152 Meadowbrook Court New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 101~/112 Wa,l~t Street .{__ J I~'rrisbu rg ~__ 17101-1~0,~ ('717)238-4~98 (717)238-4793 - Fax PA I.D. No. 25827 Counsel for Personal Representative REV-1500 EX (6~0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 J OFFICIAL USE ONLY REV-1 500 INHERITANCE TAX RETURN I 'LE"uMBE" RESIDENT DECEDENT ~:oo I- Z ,r", Z O ILl o 0 x DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Worley, William H., Jr. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) December 1, 2001 April 28, 1951 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 169 _ 38 _ 5222 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~-'~1. Odginal Return ---]4. Limited Estate ~']6. Decedent Died Testate (Altach copy of Will) [~9. Litigation Proceeds Received ~"] 2. Supplemental Return --] 4a. Future Interest Compromise (date of death alter 12-12-82) r~7. Decedent Maintained a Living Trust (A~tach copy of Trust) [----~10. Spousal Poverty Credit (dale of death be[ween 12-31-91 and 1-1-95) []3. Remainder Return (date of death prier to 12-13-82) ~-~5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [11.Election to tax under Sec. 9113(A) (Attach Sch O) NAME Lawrence J. Neary, Esquire FIRM NAME (ffApplicable) TELEPHONE NUMBER (717)238-4798 COMPLETE MAILING ADDRESS 108-112 Walnut Street Harrisburg, PA 17101-1609 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) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (t~tal Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) (2) (3) (4) (5) (6) (7) (9) ,,$_1_ ,-.~29. O0 (lo) $2,286.79 13. ~Charitable and Governmental Bequests/Sec 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) (8) $572.95 (11)~$3,815.79 $572.95 (12) 0 (13) (14) 0 OFFICIAL USE ONLY SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 16. Amount of Line 14 taxable at lineal rate x .0 __ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Decedent's Complete Address: STREET ADDRESS 111 S. Third Street Apt. 3 CllYLemoyne ISTATE PA I zIP17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount interest/Penalty if applicable D. Interest E. Penalty O) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......................... : .................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perju~/, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. · ,--. , DATE SIGNATURE OF P, ERSON RES, PO~SIE)LE~'OR FJklNG RETURN ADDRESS - f/ .... / ) P.O. BOX 7508,~Steelton, PA~7113 SIGNATUR.E OF ADDRESS 108~12 rrisburg, PA 17101-1609 D/~TE / For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are sfill applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV. 1508 EX. D-g;') ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER William H. Worley, JR. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH landlord 2. 3. 4. 5. Security Deposit refund from CNA Insurance W.C. check Patriot News refund Waypoint - checking account 1980s Oldsmobile (towed in exchange for parts) $61.17 $267.79 $15.2o $228.79 0 TOTAL (Also enter on line 5, Recapitulation) $ _5 7 2.9.5 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF William H. Worley, Jr. FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERAL EXPENSES: Musselman Funeral Home, Inc. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees _ Lawrence J. Neary Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip $1,215.00 Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Bank charges (post death) TOTAL (Also enter on line 9, Recapitulation) $1',.529.00 more space is needed, insert additional sheets of the same size) $60.00 $4.00 $250.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT OECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER William H. Worley, Jr. Include unreimbursed medical expenses. ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. DESCRIPTION AMOUNT UGI Utilities Reportment of Veterans Affairs Verizon District Justice Clement Holy Spirit Hospital West Shore School District PP&L MS Hershey Medical Center Comcast Quantum Imaging West Shore Emergency Shaffer Cardiovascular Associates $51.82 $280.62 $111.51 $136.45 $45.12 $10.00 $34.22 $6.oo $60.52 $1,316.00 $232.53 $2.oo TOTAL (Also enter on line 10, Recapitulation) $ 2,286.79 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER William H. Worley, Jr. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Bo Not List Trustee(s) OF ESTATE ! 1, Be ~XABLEDISTRIBUTIONS[includeoutrightspousaldistdbutions, andtransfersunder Sec. 9116(a)(1.2)] Melissa J. Worley P.O. Box 7508 Steelton, PA 17113 Samantha N. Worley 152 Meadowbrook Court New Cumberland, PA 17070 Robyn K. Wortey 152 Meadowbrook Court New Cumberland, PA 17070 Daughter Daughter Daughter 1/3 = 0 1/3 : 0 1/3 : 0 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LOOK FOR US. W6E'LL GET YOU THI~REL -03/04/2002 LAWRENCE NEARY 108-112 WALNUT ST HARRISBURG PA 17101 The information which you requested on the account(s) of WILLIAM WORLEY DECEASED (Social Security Number 169-3 8-5222) is/are as follows: Account Number 500040864 Class of Account CHECKiNG Date Opened 10/28/96 Principal Balance 228.79 Accrued Interest Balance at Date of 228.79 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued lnterest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 P.O. Box 171 I. HARRISBURG. PENNSYLVANI/~q~/~J~IERV]CES REP. Toll Fete I-B66-WAYPOINT (1-B66-929-7646) · www. wagpointbank.com Last Will and Testament 4 Husband with Minor Children do here~by make, publish and declare this to be my Last Will and TOestar~ent and do hereby revoke any and all other Wills arid Codicils heretofore made by me. First. The members of my,immediate family my' wife, and my ~,' daughters. Second. I order and direct that my just debts and funeral expenses, expenses for administration of my' estate and any' inheritance and succession taxes, state or federal, utYon my estate shall be paid as soon after mx' death as may be practical. Third. I give all my estate to my wife. In the event that my said wife shall predecease me or fails to survive me for sixty' (60) days, I give all my estate to my natural children, adopted or afterborn, in equal shares, per stirpes. Fourth. I nominate and appoint mv wife as Guardian of my minor children, lntheevontthatmv wife shall predecease me or fails to survive me or faits to serve as such Guardian, tt~en in such event, I nominate and appoint , Guardian Co-guardians of th0 person and property of my minorchildren. I further direct that no bond shall be required of the (iuardian(s~ under this Will. l:iflh. 1 nominate and appoint my v, ife as Executrix of this Will. In the e~ent that my wife shall predecease me or fails to survixc me or fa~ls to serve as such Executrix then in such cxent. I nominate and appoint ., Executor/Executrix of this mx Last % tll and Te~tam,nt. I further direct that no appointee hereunder shall be - required to give any bond for the faithful performance of his/ho duties. Sixth. I hereby' authorize my Executor/Executrix to exercise all the powers, rights, discretions, duties and immunities conferred upon fiduciaries to the extent permitted by' law with full power to sell, lease, mortgage, in~est, rginvest, or otherwise dispose of the assets of my estate. I subscribe my name tb this Will this ~./4- ~ Day' of W' CoZ//~ , 19 (Sign here) © 1988 by AFBR All rights reserved. ;. ~>. : ':. ~ = : -~-. .. - Signed, s~aled, published and ddclfired to be hig Lhsf Will and Testament by the within named Testator in the presence of us, who in his presence and at.his request, and in the presence of each other, have hereunto subscribed our names as witnesses: State of Count)' Personally appeared (1) Affidavit (2) ) City or )To,,.. and (3) who being duly sworned, depose and say that they attested the said \Vill and they subscribed the same at thc request and in the presence of the said Testator and in the presence of each ot her, and the said Testator, signed said Will in their presence and acknowledged that he had signed said Will and declared the same to be his Last Will and Testament, and deponents further state that at the time of the execution of said \Vill the said Testator appeared to be of lawful age and sound mind and memory and there was no evidence of undue influence. The deponents make this Affidavit at the request of the Testator. (1) (2) Subscribed and sworn to before me this (Notary Seal) (3) BETH NqN TITUS, NOTARY PUBLIC HARRI$BURG, DAUPHIN CCXJN'P¢ MY COMMISSION EXPIRES MAY 2'3,1991 Membor, Penas~,~ania Association BUREAU OF INDIVIDUAL TAXES /NHERZTANCE TAX DTyTSZON DEPT. 280601 HARRISBURG, PA 17128-0601 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF /NHERZTANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ItEV-Z$47 El( AFP cff1-02) - DATE 06-17-2002 ~ ESTATE OF WORLEY WILLIAM H DATE OF DEATH 12-01-2001 FILE NUNDER 21 02-0199 CUHBERLAND ,~ ) LAWRENCE J NEARY ESQ 'OS jlji~ 2t ?i~'~''~* COUNTY ~*' ACN 101 108 112 WALNUT ST I A.ount ,.,tad I HBG PA ~!01 I I HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-0:~) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF WORLEY WILLIAH H FILE NO. 21 02-0199 ACN 101 DATE 06-17-2002 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) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) ~. Hortgagas/Notas Receivable (Schedule D) S. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga Liabilities~Liens (Schedule Z) (10) 11. Total Deductions 12. Nat Value of Tax Return .00 .00 .00 .00 572.95 .00 .00 (8) 1,529.00 NOTE: To insure proper cradi~ ~o your account, submit the upper portion of this form ~ith your tax payment. 572.95 2,286.79 (11) (12) $,2~2.8~- 15. lr~. NOTE: Charitable~Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (13) Nat Value of Estate Sub~act to Tax (1~) Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .0O $,2~2.8~- 18 and 19 w111 ASSESSNENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line 1~ taxable at Lineal/Class A rata 17. Amount of Line lq at Sibling rata 16. Amount of Line 14 taxablo at Collatoral/Class B rate 19. Princi=al Tax Due TAX CREDITS: PAYHENT REC[ZPT DISCOUNT DATE NUNBER ~NTEREST/PEN PAID (-) (15) .00 x O0 = .00 (16) .00 X 0~5 = .00 (17) .00 X 12 = .00 (18) .00 x 15 = .00 (19)= . O0 AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. .oo .oo .oo .oo ( ZF TOTAL DUE TS LESS THAN $1, NO PAYNENT ZS REI~UZRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCTZOHS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaaonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which was nat requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ansaering service for fores ordering: 1-800-$6Z-2050~ services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-5020 (TT only). Any party in interest not satisfied with the appraismaant, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at e daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 207. .000548 1992 92 .000247 1983 167. .000436 1995-199q. 77. .000192 198q 11Z .000301 1995-1998 97. .000247 1985 13Z .000356 1999 72 .000192 1986 lOX .00D274 ZOO0 8Z .000219 1987 9Z .000247 ZOO1 97. · O0 0 2~,'7 1988-1991 112 .000301 Z002 62 .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 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 0R Name of Decedent: William H. Worley, Date of Death: December 1, 2001 Estate No.: 2002-00199 Jr. 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: State whether administration of the estate is complete: Yes x No o Date: November 14, 2003 If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No x B. The separate Orphans' Court No. (if any) for the personal representative's account is: (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 formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Estate was insolve . Lawrence J.-Neary, Esq~/ Name (Please type or print) (MAH:rmt/AM3) 108-112 Walnut St., Harrisburg, PA 17101-1609 Address (717)238-4798 Telephone No. Capacity: x Personal Representative Counsel for Personal Representative R.W. - §~