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Home My WebLink About04-0040Jean N. Kauffman, a/k/a Jean Elizabeth Kauffman Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS also known as Jean Elizabeth Kauffman Ellen Coldsmith Petitioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased Social Security No. 207221468 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or [] Decedent, dated 1/26/1996 and codicil(s) dated no exceptions named in the Last Will of the State re evant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a, d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the 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 Cumberland residence at 331 Walnut Street, Shippensburg Borough, Cumberland County, Pennsylvania (list street, number and municipality) Decedent, then 91 years of age, died January 6 ,2004 , at Chambersburc~ Hospital Decedent at death owned property with estimated values as follows: (Location) (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 ..................................................................................................................... $ Real Estate situated as follows: 331 Walnut Street, Borough of Shippensburg, Cumberland County, PA County, Pennsylvania, with his/her last family or principal 15~000.00 87~000.00 102~000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I Typed or printed name and residence Signature Ellen Coldsmith, 1565 Coldsmith Rd.~ Shippensburg, PA 17257 RW-7 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 estat~.ording to_..~.,,,.., Sworn to and affirmed and subscribed Ellen Coldsmith before me this 14th day of January, 2004 DECREE OF REGISTER CUMBERLAND COUNTY Estate of Jean N. Kauffman also known as Jean Elizabeth Kauffm~n Social Security No: 20722146~ AND NOW, January 14 Deceased No. 21-2004-40 Date of Death: 1/6/2004 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters (~ Testamentary I~ of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to Ellen Coldsmith in the above estate and that the instrument(s), if any, dated January 26, 1996 described in the Petition be admitted to probate and filed of record as the last Will o[ Decedent. FEES Letters .................................... $ Short Certificate(s) 2 $ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages( 4 ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ 235.0O 6.00 12.00 10.00 TOTAL ............................. $ 263.00 MAIr.RDLETTERSTOATIIDRNEYON 1/14/2003 RW-7A Attomey Attorney: Joel R. Zullinger, Esq. I.D. No: 17516 Address: 14 North Main Street, Suite 200 Chambersbur9 Telephone: 717-264-6029 PA 172O1 DATE FILED: 1/14/2004 105.805 REV 9~86 This is to certify that the information here given is correctly copied £rom 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 ~cal Registra~'-O~ P 9913051 No. ~/ Date H105.143 Rev. 2/87 PERMANENT COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~ rankl~n . Cha~ersburg . C~mhersburg Hospital I.~ ~.--. ~ Whi~- Laborer I,,,. Stanley Company ],, ,a e a 8 o.,.s., ......... ~u~ ~..~ Pennsylvania ~ ,~.~ ~.~ 331 Walnut Street ~ ~ Shippensbur~. ~ PA 17257 '~} ,..~ C~berland ~' ,.~ ~'. - Shippensbur~ Wallace McClelland Nye ,,. Sarah Jane West S. Ellen Coldsmith [~.1565 Coldsmith Road, Shippensbur~ PA 17257 ,~ ~.,--~ ,---,,-~-s I,~;.,,.,.'-., I~~'~'~ ..... ~ ........ I~-c~.~.~,~ ~ ~ ~],~.01/10/2004 I I C~berland County, [a,~.Spring Hill Cemetery [~,. Shippensburg~ PA 17257 " I~- Im ' ' .................................................... .~. ~x ~ ~ JRZ:cb - November 6, 1995 21-2004-40 L~ST WILL ~kND TESTAMENT I, Jean N. Kauffman, of 331 Walnut Street, Shippensburg, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my will, hereby revoking any and all former wills and codicils thereto by me heretofore made. FIRST I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. BECOND I give and bequeath those items listed on a separate unsigned memorandum which refers to this my will by date to the individuals named therein. In the event that no such memorandum shall be found within thirty days following my death, this bequest shall lapse. THIRD I give, devise and bequeath the residue of my estate of every nature and wherever situate in eight equal shares as follows: Page 1 ao Do E. F. G. H. I. One share to my daughter, Ellen Coldsmith; One share to the children of my deceased son, Walter Kauffman, to be divided equally among the children living at the time of my death; One share to the son of my deceased son, Bernard Kauffman, if he is living at the time of my death; One share to my son, Wayne Kauffman; One share to my daughter, Thelma Kauffman; One share to my son, Carl Kauffman; One share to my son, Garnet Kauffman; One share to my daughter, Lois Keissling; In the event any of my aforementioned children predecease me or die on or before the thirtieth day following my death, their share shall be distributed to his or her issue, per stirpes, living on the thirtieth day following my death, and in default of any such then-living issue, to be divided equally among the remaining equal shares as set forth above. FOURTH Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including property held for minors, exercisable without Court approval, and effective until actual distribution of all property: A. To retain any and all of the assets of my estate, real Page 2 Be Ce De or personal, without regard to any principle of diversification of risk. To invest in all forms of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. To sell at public or private sale, to exchange or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. To compromise any claim or controversy. To distribute in cash or in kind or partly in each. To hold property in their names without designation of any fiduciary capacity or in the name of a nominee or unregistered. FIFTH I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. Page 3 SIXTH I appoint Ellen Coldsmith as executrix of this my will. Should my daughter predecease me, fail to qualify or cease to act, I appoint Wayne Kauffman as executor of this my will. SEVENTH No bond shall be required of any fiduciary hereunder in any jurisdiction. purpose of IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of five typewritten pages, the first three of which bear my signature in the margin for the identification this ~_~_ day of , 19~. Signed, sealed, published and declared by the above-named testatrix, as and for her last will and testament in our presence, who in her presence, at her request and in the presence of each other have hereunto set our hands as attesting witnesses. ~Fli~. ~~~j,residing at We, Jean ~. Kauffman, -~C~L ~, 7_t~cul~GeT~ , and Page 4 ~-RJ~ /77. ~oZ~uS , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly (or directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and to the best of their knowledge, the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testat~i~ Witnes~ Subscribed, sworn to and acknowledged before me by the above-named testatrix and subscribed and sworn to before me by the above-named witnesses this day of ~ , 19 q ~ . ~ ' No%ary ~blic ~TAffiAL L~ A. ~~R, No.fy Public E~rg ~o, C~m~dand Co., My ~~ ~pir~ March 3~ Page 5 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Jean N. Kauffman. a/k/a Jean Elizabeth Kauffman Date of Death: 1/6/2004 Will No. 2004-00040 Admin. No. 21-04-0040 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 1/20/2004 · Name Address Gregg E. Kauffman 413 Sunset Lane Shippensburq PA 17257 S. Ellen Coldsmith 1565 Coldsmith Lane Shippensburq PA 17257 Barbara J. Tyler 8606 Pincliff Drive Frederick MD 21704 Carol A. Jordan 3494 Adgate Drive liamsville MD 21754 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions Date: 1/20/2004 Capacity: Signature Name: Joel R. Zullinqer, Esquire Address: 14 North Main Street, Suite 200 Chambersburq PA Telephone( ) Personal Representative Counsel for Personal Representative 17201 Continuation of Certification of Notice Under Rule 5.6(a) Jean N. Kauffman, a/k/a Jean Elizabeth Kauffman Page 1 1/6/2004 Names and addresses Name Address Dean M. Kauffman 303 Lanafield Circle Boonesboro MD 21713 Wayne B. Kauffman Box 16 Saltillo PA 1725;'~ Thelma J. Kauffman Rt. 309-5002 Lot 610 Center Valley PA 1803,1 Carl M. KauEf, an 18260 New Cut Road Mt. Airy MD 21771 Garnet N. Kauffman 20415 Riverbend Sq. #201 Sterling VA 2016,', Lois E. Kiessling 2525 Stillhouse Hollow Road Shippensbu r,q PA 1725 / LAW OFFICES OF ZULLINGER- DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Suite 200 Chambersburg, PA 17201 717-264-6029 Fax: 717-264-1884 zuln~rlaw@earthlink.net Dale F. Shughart, Jr. ofc0unsel HAMILTON C. DAVIS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 717-532-5713 Fax: 717-530-5222 davish('~_,cvn.net April 5, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Dear Register: RE: Estate of Jean N. Kauffman a/k/a Jean Elizabeth Kauffman File No. 21-04-0040 Enclosed is check payable to you as agent in the amount of $3,633.75, representing prepayment on PA Inheritance Tax for the above estate. The prepayment is based on an estimated taxable estate of $85,000.00, taxable at 4.5% or $3,825.00, less 5% discount of $191.25, for a net payment of $3,633.75. Thank you. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O03782 ZULLINGER JOEL R 14 NORTH MAIN STREET, SUITE 200 CHAMBERSBURG, PA 17201 ........ fold ESTATE INFORMATION: SSN: 207-22-1468 FILE NUMBER: 2104-0040 DECEDENT NAME: KAUFFMAN JEAN N DATE OF PAYMENT: 04/07/2004 POSTMARK DATE: 04/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,633.75 REMARKS: CHECK//124 SEAL TOTAL AMOUNT PAID: $3,633.75 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Joel R. Zullinger 14 North Main St., Suite 200 Chambersburg, PA 17201 Register of Wills Cumberland County Cou:thouse Carlisle, PA 17013 LAW OFFICES OF ZULLINGER- DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Suite 200 Chambersburg, PA 17201 717-264-6029 Fax: 717-264-1884 zuln ~law(&earthlink.net Dale F. Shughart, Jr. of counsel HAMILTON C. DAVIS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 717-532-5713 Fax: 717-530-5222 davish(~cvn.net October 6, 2004 Register of Wills Cumberhnd County Courthouse Carlisle, PA 17013 DearRegister: RE: Estate of Jean N. Kauffman a/k/a Jean Elizabeth Kauffman File No. 21-04-0040 Enclosed for filing in your office is an original and one copy of the PA Inheritance Tax Return and one copy of the Inventory. Also enclosed are following checks: · $329.63, balance of PA Inheritance Tax due; · $28.00, filing fee for return. If anything further is required, please advise to my Chambersburg office. Thank you. Encls. REV-1500 EX + Z LU ILl ILl Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT*S NAME (LAST, FIRST, AND MIDDLE INITIAL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Kauffman, Jean Elizabeth DATE OF DEATH (MM-DD-Year) 01/06/2004 DATE OF BIRTH (MM-DD-Year) 08/26/1912 OFRCIAL USE ONLY FILE'-~IUMBER 2 1 -0 4 0 0 4 0 SOCIAL SECURITY NUMBER 2 0 7-2 2-1 4 6 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER [~]1. Odginal Return E~4. Limited Estate ~-]6. Decedent Died Testate (AttaCh copy of Will) ~]9. Litigation Proceeds Received El2. Supplemental Return E~] 4a. Future Interest Compromise (date of dea(h after 32-12-82) [---I 7. Decedent Maintained a Living Trust (A~ach copy oiTrustl ] 10. Spousal Povedy Credit {date of deaU~ between 12-31-9~ and 1-1-95) E~3. RemainderRetum Ida~eoldeathpr~=rto12-13-82} E~]B. Federal Estate Tax Return Required 0__ 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (^tt~h Sch O) NAME Joel R. Zullin,Djer FIRM NAME (If Ap¢cable] Zullin,qer - Davis, P.C. TELEPHONE NUMBER I717)264-6029 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, PaAnemhip or Sole-Prepdetorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscel]aneoos Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. inter-Vivos Transfers & Miscellaneous Non-Prebate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (lotal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 14 North Main Street, Suite 200 Chambersbur9 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 minas Line 13) r~ PA 17201 126.48 ! ~ 2~0,543.24 ? 1~567.36 (8) 109~654.32 16~604.05 725.10 (11) 17,329.15 (12) (13) 92~325.17 0.00 (14) 92,325.17 BEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(t2) X __ (15) 16. AmountofLine14taxableatlinealrate 92~325.17 X .045 (16) 17. AmoantofLine14taxableatsibiingrata O.00 X .12 (17) 18. AmountofLine14taxableatcollateralrate O.O0 X .15 (18) 19. Tax Due (19) 0.00 4,154.63 0.00 0.00 4~154.63 Decedent',s Complete Address: ISTREETADDRE~S 331 Walnut Street C~TY I Shippensburg J STATE PA I ZIP 17257 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments ^. Spousal Poverty Credit B. Prior Payments C. Discount 3,633.75 191.25 3. Interest/Penalty if applicable D. Interest E, Penalty (I) Total Credits ( A + B + 6 ) (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. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB} Make Check Payable to: REGISTER OF WILLS, AGENT 4~154.63 3~825.00 0.00 0.00 329.63 329.63 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 Acoount, annuity, or other non-prebate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return, includth~ accompanying schedules and statements and to he des o my knowledge and de~ief, it is ~e correct and comCe[e. Declaration of preparer other than the personaJ representative is based on ali ~nforma ~n of wh ch predarer has any knowledge. SIGNATURE OF ~RSON RESPONSI~I~ FOR FI,LING RETURN DATE ADDRESS 1565 Coldsmith Road Shippensbur9 SIGNATURE,~,J~PREPARER O/~HER ~t~ REPR,,~E~TA"r~VE ADDRESS //1" N 'r h ~ Chambersbur9 -- PA 17257 DATE PA 17201 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% ~2 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 exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets aDd 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 stepperent 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 decedect'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*I50S EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Kauffman. Jean Erizab~h :~1 04 0040 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properly 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 properbj which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Gross proceeds from sale of real estate situate at 331 Walnut St., Shippensburg, PA, to Edgar J. O'Sullivan and Patricia O'Sullivan Received from proration of real estate taxes from above sale of real estate VALUE AT DATE OF DEATH 87,000.00 417.24 TOTAL (Also enter on line 1, Recapitulation $ 87,417.24 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) ', COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Kauffman. Jean Elizabeth FILE NUMBER :~1 04 All property jointly-owned with right of sun~ivorship must be disclosed on Schedule F. 0040 ITEM NUMBER DESCRIPTION U.S. Savings Bond #Q5214528685E, issue date 12/1974 VALUE AT DATE OF DEATH 126.48 TOTAL (Also enter on line 2, Recapitulation) $ 126.48 (if more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWF~,LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Kauffman. Jean Elizabeth FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0040 ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION Refund, Alterra, nursing home care Refund, Highmark Proceeds from private sale of personal property Refund, Peerless Insurance Refund, Comcast Cable PA Department of Revenue, tax rebate Certificate of Deposit #31003914667886, M&T Bank, including interest accrued to date of death Checking Account #97336181, M&T Bank, incuding interest accrued to date of death Personal property appraised by Dennis L. GotshaJl, with copy attached VALUEAT DATE OF DEATH 2,083.20 221.18 325.00 75.00 7.98 500.00 6,938.58 5,824.30 4,568.00 TOTAL (Also enter on line 5, Recapitulation) $ 20,543.24 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Kauffman. Jean Elizabeth 21 04 If an asset was made joint within one year of the decedent's date of death, ~t must be reported on Schedule 0040 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. S. Ellen Coldsmith 1565 Coldsmith Road daughter Shippensburg, PA 17257 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE Of DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTERF 1. A. 1/1991 Certificate of Deposit f~140878144, Citizens Bank, 3,134.72 50. 1,567.3~ including interest accrued to date of death TOTAL (Also enter on line 6, Recapitulation) ...... 1~567.36 (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 Kauffman. Jean Eli~;sbeth Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 0040 ITEM NUMBER 3. 4, 5. 8. 9. 10. 11. 12. 13. 14. 15. 16. 18. DESCRIPTION FUNERAL EXPENSES: Fogelsanger Bricker Funeral Home, funeral service Spring Hill Cemetery Robert Wyrick, grave opening Crider Meats, food for meal after funeral Gordon's Memorials, cleaning grave marker ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees Joel R. Zullinger Family Exemption: (If decedenfs address is not the same as ¢Jaimant's, attach explanation) C~aimant Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees probate petition 235.00; short certificates 6.00; extra pages 12.00; JCP fee 10.00; filing return 28,00; additional short certificates 12.00 Accountant's Fees T~R~um PmpamfsF~s Postage for estate mailing Comcast, cable service to decedent's residence Sprint, telephone service to decedent's residence Penelec, utilities to decedent's residence Cumberland Law Journal, advertise letters News-Chronicle, advertise letters Sprint, telephone service to decedent's residence Comcast, cable service to decedent's residence Penelec, utilities to decedent's residence Penelec, utilities to decedent's residence Comcast, cable service to decedent's residence T&C Hauling, removing refuse from real estate AMOUNT 7,975.00 500.00 100.00 690.70 175.00 4,300.00 0.00 303.00 25.00 18.26 31.88 327.39 75.00 125.75 30.29 18.91 176.62 164.33 18.92 340.00 TOTAL (Also enter on line 9, Recapitulation) $ 16~604.05 (If mom space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Kauffman, Jean Elizabeth 21 Decedent's Name Page 1 04 0040 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. Borough of Shippensburg, water and refuse service to decedent's residence Lisa Helm, Tax Collector, county real estate taxes due Sprint, telephone service to decedent's residence Marc Rideout, cleaning attic prior to sale Advantage ChemDry, carpet cleaning prior to sale Back Door Glass, repair glass at residence prior to sale John Nickey, snow removal at decedent's residence Borough of Shippensburg, water and sewer; dumpster for trash removal Sprint, final telephone service bill Bryan Kyner, yard work at residence prior to sale Rachel Coldsmith, removing junk from attic AMOUNT 92.68 424.26 36.31 95.00 100.00 20.00 75~00 213.30 1.45 100.00 50.00 SUBTOTAL SCHEDULE H-B7 1,208.00 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Kauffman. Jean Elizabeth FILE NUMBER 21 04 Include unreimbursed medical expenses. 0040 ITEM NUMBER 2. 3. 4. 5. 6. DESCRIPTION Penelec, utilities due at death 3omcast, cable service due at death Borough of Shippensburg, water and refuse service due at death Sprint, telephone service due at death Norland Pharmacy, balance of account due at death Alterra, balance due on nursing home care TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ 725.10 246.95 18.26 92.53 31.99 158.07 177.30 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFIClAEIES ESTATE OF Kauffma , Jean Elizabeth NUMBER [. 1. 2. 3. 4. 5. 6. 7. II. 1, 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Ellen Coldsmith 1565 Coldsmith Road Shippensburg, PA 17257 Gregg E. Kauffman 413 Sunset Lane Shippensburg, PA 17257 Wayne B. Kauffman Box 16 Saltillo, PA 17253 Thelma J. Kauffman Rt. 309-5002 Lot 610 Center Valley, PA 18034 Carl M. Kauffman 18260 New Cut Road Mt. Airy, MD 21771 Garnet N. Kauffman 20415 Riverbend Sq. #201 Sterling, VA 20165 Lois E. Kiessling 2525 Stillhouse Hollow Road Shippensburg, PA 17257 FILE NUMBER :~1 Q4 0040 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal Lineal Lineal Lineal Lineal Lineal Lineal one-eighth of residue one-eighth of residue ~ne-eighth of residue ~ne-eighth of residue one-eighth of residue one-eighth of residue one-eighth of residue 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 Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 0.00 0.00 (if more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Kauffman. Jean Elizabeth 21 04 0040 Decedent's Name Page 2 File Number Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ][ TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. Barbara J. Tyler Lineal 8606 Pincliff Drive one-third of a one-eighth Frederick, MD 21704 share of residue 9. Carol A. Jordan Lineal 3494 Adgate Drive one-third of a one-eighth Ijamsville, MD 21754 share of residue 10. Dean M. Kauffman Lineal 303 Lanafield Circle ~ne-third of a one-eighth Boonesboro, MD 21713 share of residue JRZ:cb - November 6, 1995 LAST WILL AND TESTA/~ENT I, Jean N. Kauffman, of 331 Walnut Street, Shippensburg, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my will, hereby revoking any and all former wills and codicils thereto by me heretofore made. FIRST I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. SECOND I give and bequeath those items listed on a separate unsigned memorandum which refers to this my will by date to the individuals named therein. In the event that no such memorandum shall be found within thirty days following my death, this bequest shall lapse. THIRD I give, devise and bequeath the residue of my estate of every nature and wherever situate in eight equal shares as follows: Page 1 E. F. G. H. I. One share to my daughter, Ellen Ccldsmith; One share to the children of my deceased son, Walter Kauffman, to be divided equally among the children living at the time of my death; One share to the son of my deceased son, Bernard Kauffman, if he is living at the time of my death; One share to my son, Wayne Kauffman; One share to my daughter, Thelma Kauffman; One share to my son, Carl Kauffman; One share to my son, Garnet Kauffman; One share to my daughter, Lois Keissling; In the event any of my aforementioned children predecease me or die on or before the thirtieth day following my death, their share shall be distributed to his or her issue, per stirpes, living on the thirtieth day following my death, and in default of any such then-living issue, to be divided equally among the remaining equal shares as set forth above. FOURT~ Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including approval, A. property held for minors, exercisable without Court and effective until actual distribution of all property: To retain any and all of the assets of my estate, real Page 2 Bo or personal, without diversification of risk. To invest in all forms regard to any principle of of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. To sell at public or private sale, to exchange or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. To compromise any claim or controversy. To distribute in cash or in kind or partly in each. To hold property in their names without designation of any fiduciary capacity or in the name of a nominee or unregistered. FIFTH I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. Page 3 SIXTH I appoint Ellen Coldsmith as executrix of this my will. Should my daughter predecease me, fail to qualify or cease to act, I appoint Wayne Kauffman as executor of this my will. SEVENTH No bond shall be required of any jurisdiction. fiduciary hereunder in any IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of five typewritten pages, the first purpose of identification three of which bear my signature this , 19~ Signed, sealed, in the margin for the ~_~_ day of published and declared by the above-named testatrix, as and for her last will and testament in our presence, who in her presence, at her request and in the presence of each other have hereunto set our hands as attesting witnesses. We, Jean N. Kauffman, _--~C~[~ ~, ~_~s~3GeT~_ , and ¢ Page 4 -~1~ ;~. ~R~c~:~ , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly (or directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and to the best of their knowledge, the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. /~ _ Test~t~i~ /y Subscribed, sworn to and acknowledged before me by the above-named testatrix and subscribed and sworn to before me by the above-named witnesses this ~ W~ day of ~~ , 19_~- Notary Public ~ Page 5 Redemption Date: 1/2004 Serial Number Denomination Q5214528685E $25 Inventory 1 Inventory Detail Series Issue Date Value E 12/1974 $126.48 Interest $107.73 N/E = Not yet eligible for redemption; less than six (6) months between issue date and redemption date. * See footnote on Inventory Totals page. .. Inventory 1 Inventor~ Totals Redemption Date: 1/2004 Pre-January 1990 Issue Dates: January 1990 and Later Issue Dates: Number Redemption of Bonds Value Interest 1 $126.48 $107.73 0 $0.00 $0.00 t $126.48 $107.73 The interest earned on Series EE bonds issued on or after January 1990 may be wholly or partially exempt from Federal income tax under the provisions of the U.S. Savings Bond Education Benefit Program. For further information concerning the benefits and restrictions that apply, please contact the Internal Revenue Service. 2 Settlement Statement ·. O.S. Department of Housing and Urban Development B. T~pe of Loan OMB No. 2502-0265 REV. 1. E]FHA 2. FIFmHA 3. DConv. Unins. ] 6. File Number I 7. Loan Number 8. Mortgage lnsurance Case Number 4. DVA 5. OConv. Ins. 04990OSULLIVAN J c. Note: Ilems marked "(p.o.c.)" were paid outside the dosing they are shown here fo n orma on pu poses and are not included in the totals, mitleExpress Settlement System WARNING: I/is a cdme to kno~ngly make false statements to the United States on this or an olher similar form. Penalties upon con'.q ¢tion can include a fine and imprisonment. For details see; Title 18 U. S. Code eection 1~01 and Section 1010. Printed 05/03/2004 at 16:21 RLH D. NAME OF BORROWER: Edgar J, O'Sullivan and Patricia O'Sullivan ADDRESS: 8325 JoMarcy Drive, Las Vegas, NV 89131 E. NAME OF SELLER: Estate of Jean N. Kauffman Kauffman ADDRESS: 331 Walnut Street, Shippensburg, PA 17257 F. NAME OF LENDER: M & T Mortgage Corporation ADDRESS: 2270 Erin Court~ Lancasteh PA 17601 G. PROPERTY ADDRESS: 331 Walnut Street, Shippensburg, PA 17257 Borough of Shippensburg H. SETTLEMENT AGENT: South Central Home Settlements, Inc,, Telephone: 717-532~7387 Fax: 717-532-6552 PLACE OF SETTLEMENT: 126 East King Street, Shippensburg~ PA 17257 I. SETTLEMENT DATE: 05104/2004 J, SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO .qF! ! DR 101. Contract sales price 87~000,00 401. Contract sales price 87~000.00 102. Personal Property 402. Personal Property 103. Settlement charqes to borrower (line1400) 3,751.71 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106, City/towntaxes 051041041o12131104 287,03 406. City,'lowntaxes 051041041o12131104 287.03 106. SchooITaxes 051041041o06130104 130.21 408. SchoolTaxes 051041041o06130104 130.21 109. 409, 110. 410. 111. 411. 112, 412. 120. GROSS AMOUNT DUE FROM SORROWER 91,168,95 420. GROSS AMOUNT DUE TO SF~ ~ FR 87,417.24 200. AMOUNTS PAID BY OR ON BEHALF OF SORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 2~000.00 501. Excess Deposit (see instructions) 2~000.00 202. Prlncipal amount of new loans 57~000,00 502, Settlement charqes to seller (line1400) 1~415.37 203. Existing loan(s) taken subiect to 503. Existinf:lloan(s)takensubiectto 204. Closin;I Cost Saver 71.25 504. PayoffofFirstMortgageLoan 205. 505. 206. 506. 207. 507. 208. 508. 209. 509, Adjustments for items unpaid by seller Adjustments for items unpaid by seller 213. 513, 214. 514. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Fite Number: 04990OSULLIVAN PAGE 2 .__ '3~TTLEMENT STATEMENT REV. HUD-1 (3/86) mitleEx '-~'. SE:i'TLEMENT CHARGES ' PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $87~000.00 ~ 0.000 = BORROWER'S SELLER'S Division of commission (line 700) as fellows: FUNDS AT FUNDS AT 701, $ to SETTLEMENT SETTLEMENT 702, $ to 703. Commission paid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ofif:!ina ion Fee % 802. Loan Discount % 803. Appraisal Fee to M & T Mortgage (P.O.C.) 250.00 Buyer LR 25.00 804. Credit Report 805. Processinq Fee to M & T Mortgage LR 195.00 806. Application Fee to M & T Mortgage (P.O.C.) 100.00 Buyer LR 807. Tax Service Fee to M & T Mortgage LR 82.00 808. Flood Cedification to M & T Mortga_qe LR 12.00 809, Document Preparation Fee to M & T Mort,cage LR 385,00 810. 811. 900. ITEMS REQUIRED BY LENDER TO SE PAID IN ADVANCE 901. Interest From 05/04/2004 to 06101/2004 ~,,$ 8.5890/day 28 Days LR 240.49 902. Mortfla.cle Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. ~,, $ 47.92/mo LR 143.76 1002. Uort,cla,qe insurance mo. ~ $ /mo 1003. City Properly Tax mo. ~,, $ 36.08/mo 1004. County Property Tax 4 mo, ~ $ 35.36/mo LR 141.44 1005. School Taxes 12 mo. ~.. $ 68.29/mo LR 819.48 1009, Acl~ra~ate Analysis Adiustment LR -285.21 1100. TITLE CHARGES 1101. Settlement or closing fee 1102. Abstract or title search 1103, Title examination 1104, Title insurance binder 1105. Document Preparation to Joel Zullinger~ Esquire 1106. Notary Fees 1107, AttorneY's fees (includes above items No: 1108. Title Insurance to SCHS Agent for Old Re@ublic Title Ins. Co. 780.75 (includes above items No: 1109. Lender's Policy 57~000.00 - 1110. Owner's Policy 87~000,00 - 780.75 CITIZENS BANK Account Number 6140878144 Account Title JEAN N KAUFMANN & S ELLEN COLDSMITH Date Opened 1/7/91 Account Type Time Deposits Principal Balance as of DOD $3132.92 Interest from Last Posting to DOD $1.80 Accotmt Balance as of DOD $3134.72 YTD Interest to DOD $ .00 MaTBank February 2, 2004 Law Offices Zullinger-Davis Professional Corporation 14 North Main Street, Suite 200 Chambersurg, PA 17201 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Jean N. Kauffman Date of Death: January 6, 2004 Social Security Number: 207-22-1468 Dear Mr. Zullinger: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type. ................. : ........ Certificate of Deposit Account Number. ...................... 31003914667886 Ownership (Names o~ .............. Jean N. Kauffman Opening Date ........................... 12/02/91 Balance on Date of Death. .........$6,932.12 Accrued Interest $ 6.46 Total. ...................................... $6,938.58 2. Account T!~pe ........................... Checking Account Account Number. ...................... 97336181 Ownership (Names o~) ..............Jean N. Kauffman Opening Date ........................... 01 / 28 / 80 (account cIosed 01 / 21 / 04) Balance on Date of Death. .........$5,824.07 Accrued Interest $ 0.23 Total. ...................................... $5,824.30 Sincerely, Charlene Warrington, Records Management 1-888-,502-4349 APPRAISAL OF PERSONAL PROPERTY OF JEAN N. KAUFFMAN, 331_ WALNUT STREET SHIPPENSBURG PA ON OCTOBER 6 2003: $ 90.00 Cedar blanket chest made by John Warren 2 Flattop trunks OS 35.00 Hexagon stand (broken leg) Stand with fancy base 4-Drawer softwood bureau (needs re-finished) 4 Twin size beds (complete) OS 35.00 Large oak dresser with mirror & fancy gingerbread Oak bureau 4-Drawer bureau with added mirror 2-Tier stand Dark finish dresser with mirror Painted wooden wardrobe Maple drop leaf table Small 2-tier stand Walnut magazine stand (made from organ top) Drop leaf table with turned legs Wooden cradle Maple slant-front desk 2 Old pictures OS 15.00 Kerosene lamp 2 Cherry lamp stands OS 25.00 Small electric student's lamp 2 Other lamps (lot) Softwood dry sink with lift top (re-finished) China shoe German china bird Needlework picture in frame Oak bench made by John Koser Oak pressed-back arm rocker 5-Leg oak extension table with pull-out sides 5 Nixon-made plank bottom chairs OS 40.00 Modem pine comer cupboard German hair receiver Soft paste handle-less cup German flow blue plate Saxon china plate Ironstone covered tureen Bavaria creamer (crocked) konstone teapot Ironstone pitcher Ironstone sugar with broken top Wooden butter bowl 2 Butter paddles OS 20.00 $ 70.00 $ 15.00 $ 25.00 $ 45.OO $140.00 $150.00 $ 65.00 $ 85.00 $ 20.00 $ 25.00 $ 15.00 $ 45.00 $ 15.00 $ 20.00 $ 60.00 $ 85.00 $ 65.00 $ 30.00 $ 25.00 $ 50.00 $ 5.00 $ 3.00 $ 475.00 $ 15.00 $ 20.00 $ 30.00 $ 45.00 $ 65.00 $ 275.00 $ 200.00 $150.00 $ 15.00 $ 30.0O $ 55.00 $ 15.00 $ 35.00 $ 8.00 $ 70.00 $ 50.00 $ 15.00 $ 40.00 $ 40~00 -2- Yellow-ware bowl Redware bowl (glazed exterior - some chips) Handled crock jar with lid Small brown crock (chipped) Pie board Yard long picture (Roses) (cracked glass) Paint-decorated coffee mill 2 Rolling pins ~$ 8.00 3-Drawer mahogany bureau Beveled wall mirror Ladderback chair with reed seat 2 Round glass pictures with metal frames ~$ 20.00 Maytag automatic washer Frigidaire dryer (older model) Barn lantern Hose/hose reel 4-Piece rattan patio set Stand with glass top Oak stand (chipped) Marble ashtray Old oscillating fan with brass blades Nursing rocker with reed seat & back · 1976 2-door Ford Elite APPRAISED BY: Dennis L. Gotshall, Auctioneer/Prop. Dan Hershey Auctioneering Service PA Lic. #AU-002306~L 3 Brown Road Shippensburg, PA 17257 TOTAL: $ 30.00 $ 45.00 $ 22.00 $ 8.00 $ 10.00 $ 75.00 $ 25.OO $ 16.00 $ 55.00 $ 25.00 $ 20.00 $ 40.00 $ 40.00 $ 20.00 $ 10.00 $ 5.oo $ 60.O0 $ 8.00 $ 20.00 $ 3.00 $ 20.00 $ 15.00 $1,200.00 $ 4,568.00 TO: DATE: RE: FROM: S. Ellen Coldsmith 1565 Coldsmith Road Shippensburg, PA 17257 October 10, 2003 Fee for appraising personal property of Jean N. Kauffman, 331 Walnut Street, Shippensburg, PA on October 6, 2003: $ 45.00 Dennis L. Gotshall, Auctioneer/Prop. Dan Hershey Auctioneering Service 3 Brown Road ' Shippensburg, PA 17257 Register of Wills - Cumberland County Estate of Jean Elizabeth Kauffman INVENTORY Estate of Kauffman, Jean Elizabeth also known as , Deceased No. 21 04 0040 Date of Death 1/6/2004 Social Security No. 207221468 Pemonal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. I/~Ve understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Joel R. Zullin,qer I.D. NO.: 17516 Address: 14 North Main Street, Suite 200 Chambersbur,q PA 17201 Personal Representative: Ellen Coldsmith Dated 10/6/04 Telephone: (717)264-6029 Description Stocks & Bonds U.S. Savings Bond #Q5214528685E, issue date 12/1974 Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property Refund, Alterra, nursing home care (Attach Additional Sheets if necessary) Total Value 126.48 2,083.20 108,086.96 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW~ Kauffman, Jean Elizabeth Description of Inventory Continuation of Inventory Refund, Highmark Description Page 1 21 04 0040 Proceeds from private sale of personal property Refund, Peerless Insurance Refund, Comcast Cable PA Department of Revenue, tax rebate Certificate of Deposit #31003914667886, M&T Bank, including interest accrued to date of death Checking Account #97336181, M&T Bank, incuding interest accrued to date of death Personal property appraised by Dennis L. Gotshall, with copy attached Real Estate Gross proceeds from sale of real estate situate at 331 Walnut St., Shippensburg, PA, to Edgar J. O'Sullivan and Patricia O'Sullivan Received from proration of real estate taxes from above sale of real estate Value 221.18 325.00 75.00 7.98 500.00 6,938.58 5,824.30 4,568.00 87,000.00 417.24 Subto~l $ 105,877.28 Gmnd Toml $ I08,086.96 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11-96) NO. CD 004479 ZULLINGER JOEL R 14 NORTH MAIN STREET,SUITE 200 CHAMBERSBURG, PA 17201 ........ fold ESTATE INFORMATION: SSN: 207-22-1468 FILE NUMBER: 2104-0040 DECEDENT NAME: KAUFFMAN JEAN N DATE OF PAYMENT: 10/07/2004 POSTMARK DATE: 10/06/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $329.63 REMARKS: CHECK# 144 SEAL TOTAL AMOUNT PAID: $329.63 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JOEL R. ZULLINGER, ESQ. 200 Chambersburg Trust Co. Chambersburg~ P~t7201 Tr' Register of Wills Cumberland County Courthouse Carlisle, PA 17013 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVZSTON PO BOX 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-I~I~7 EX AFP C09-0~) JOEL R ZULLINGER ZULLINGER DAVIS 1~ N HAIN ST STE 200 CHAHBERSBURG PA 1~?. ~0'! DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 11-29-200~ KAUFFHAN 01-06-200~ 21 0~-00~0 CUMBERLAND 101 Amoun~ Ramii:i:ed JEAN N HAKE CHECK PAYABLE AND REHIT PAYHENT 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 (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF KAUFFHAN JEAN N FILE NO. 21 0~-00~0 ACN 101 DATE 11-29-ZOOq 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. S~ocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Intares~ (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) E. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) lO. Dab~s/Mortgaga Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 87~17.2~ 126.~8 .00 .00 20/5~$.2~ 1~567.$6 .00 (8) NOTE: To insure proper credit ~o your account, submit the upper portion of this fora with your tax payment. 109,65q.32 16,60~.05 725.10 (11) (12) 17.32q.15 92,$25.17 15. NOTE: CharitabXe/Govarnmental Bequests; Non-eXacted 9115 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (lq) X~ an assessaent was issued previously, Zines 14, 15 and/or 16, 17, re~lect ~igures that include the totaZ of ALL returns assessed to date. DISCOUNT INTEREST/PEN PAID (-) .00 .00 .00 92,325.17 18 and 19 will (la) .00 x O0 : .00 (XG) 92,325.17 X OqS= ~,15~.6~ (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= ~,, 15~. 6:5 AMOUNT PAID ASSESSNENT OF TAX: IS. Amoun'l: of Line lq at Spousal rata 16. Amount of Line lq taxable at Lineal/Class A rata 17. Amount of Line lq at Sibling rata 18. Amount of Line lq taxable a~ Collateral/Class B rata 19. Principal Tax Duo TAX CREDITS: PAYNENT ] RECEIPT DATE NUMBER Oq-OT-ZO0~ CDO0578Z 10-06-200~ CD00~79 INTEREST IS CHARGED THROUGH 12-1~-200~ AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH 5,655.75 529.65 TOTAL TAX CREDIT BALANCE OF TAX DUE] INTEREST AND PEN. TOTAL DUE 3,963.38 191.25 1.t5 192.70 IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT XS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- 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 Coamonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B ¢collataral) rate on any such future interest. To fulfill the requirements of Section 21qO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed en the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may bo requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-l~13). Applications are available online at ww~.ravenue.state.oa.us, any Register of Hills or Revenue District Office, or from the Department's 24-hour answering service for fores orders: 1-800-362-2050; services for taxpayers ~ith special hearing and/or speaking needs: 1-800-447-30Z0 [TT only). Any party in interest not satisfied aith the appraiseent, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at waw.boardofappeals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date free the Board of Appeals ~ebsita. You may also send e eritten protest to PA Department of Revenue, Board of Appeals P.O. Box 2810Z1, Harrisburg, PA 17128-10Z1. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) 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, P.O. Box gA0601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount ef the tax paid is allowed. The 15Z 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 and 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, 19BI bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .000164. All taxes ahich became delinquent an and after January 1, 198Z will bear interest at a rate which wili vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 ara: Interest Daily Interest Daily Year Rate Factor Year Rata Factor ~'~ 207. .000548 ~'~- X991 XXZ .000301 xgB3 167. .000438 1992 97. .000247 1984 117. .000501 1993-1994 77. .000192 1985 137. .000356 1995-1998 97. .000247 1986 107. .000274 1999 72 .000192 1987 107. ,000274 ZOO0 77. .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~ 9x .oooz47 ZOOZ 62 .000164 2003 52 .000137 2004 47. .O001lO 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. STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF FRANKLlN_, PENNSYLVANIA Name of Decedent: Jean N. Kauffmalh a/k1a)~<lJl Elizabeth Kauffman Date of Death: 1/6/2004 File No. 21::04-0040 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES X NO__ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: n _______ 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 _~_ b. The separate Orphan's 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 __ ~___ 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: 6/21/200Q;-, (,-) '((.~~ U-O ":'J cJ Jo . Zullinger Name (Please type or print) Hllorth-'"/ljlin Str~ Suite 200 Address Chambers!:Jurg _ _ PA...17201 L. (717)264-6929 Tel. No. Capacity: Personal Representative _X. _ Counsel for personal representative :r