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Home My WebLink About03-0728Register of Wills of Dauphin County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Robed J. Fitzpatrick No. also known as Scott R. Fitzpatrick Petitioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased Social Security No. 194161031 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or ~-~ Decedent, dated 04/23/2003 and codicil(s) dated named in the Last Will of the 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 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 County, Pennsylvania, with his/her last family or principal residence at Manor Care Health Services, 1700 Market Street, Camp Hill (list street, number and municipality) Decedent, then 83 years of age, died July 15 ,2003 , at Manor Care Health Services 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 ..................................................................................................................... $ Reap Estate situated as follows: 49,000.00 49,000.00 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: Si ~re Typed or printed name and residence Scott R. Fitzpatrick 1917 Felker Road Middletown, PA 17057 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 theestate.~.~,~.~ ~ ~ording to law Sworn to and affirmed and subscribed Scott R. Fitzpatrick ~ before me this 15th day of August 2003.~ DECREE OF REGISTER Estate of Robert J. Fitzoatrick Deceased No. 21-2003-728 also known as Social Security No: 194161031 Date of Death: 07/15~2003 AND NOW, September 5th , 2003 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary I-II of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to Scott R. Fitzpatrick in the above estate and that the instrument(s), if any, dated 04/23/2003 describedin the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ 70.00 Short Certificate(s) .....~.. ........ $ 9.00 Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages ( 5 ) .............. $ 15.00 Codicil .................................$ JCP Fee .................................$ 10.00 Inventory & Tax Forms ............. $ 10.00 Other ...................................... $ TOTAL ............................. $114.00 Mail letters to attorney o 9-5-03. RW-7A Donna 1st Deputy Attorney Attorney: Jan L. Brown I.D. No: 67993 Address: 845 Sir Thomas Court Harrisbur~l PA 17109 Telephone: 714-541-5550 DATE FILED: { 9-5-200;~ I I I his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as I.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office fbr permanent filing. WARNING: It is illegal to dUplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local Registrar Date NAME OF DECEDENT (First. Middle. Last) COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH STAT~ FlEE NUMBER i -- Robert J. Fitzpatrick ~Se I S_OC21QL SECURITY_N_UMRER l DATE OF DEATH AGE (Las1 Birthday) ~ ~ATEO ....... ' ..... - .... ut r o[~, I B RTHPLACE C..y and_1=~ o-, I ..o..~e I uays I Ho.., I Mb,,.., I (~on,,, Day, Year) I State (~ F~eign Country) s. o.~ Yr..I I I I I.July6,1920 IShamokin,PA COUNTY OF DEATH CITY. BORO. ~1:; OF DEATH T'c~r. ~ ~' ~-J ~' ~ ~ ,,.i~ence [--1 I ................... I ........... ~: Ut no. tnsGt`"leo· give street and .umber) gumberlana L camp mn /Manor earo KIND OF BUSINESS / INDUSTRY AS DECEDENT EVER IN DECEDENT'S EDUCATION ~.v. iation inspector federal qoverrLme~d Yos[~. Nol--] I I · ""' = 1". ~2 ,.t,, [ , ..... , Div~lSpe.~l ].widowed 3026 Harvard Ave. ACTU~ ~" s,a%Penns¥1vania D~ ~. [] Ye..de~e,Uived~, Camp Hill, PA 17011 (seei,s~,~ms count~_Cumberland ,ivei. a (m `"her side) 17b. township? l?d.C~ No. decedentlived Camp Hill ]'MOTHER'S NAME (First· Middle. Maiden Surname) ~". Robert Edward Fitzpatrick /~rrie Mae Rebel IN T' M I INGAD SS( ee ' /TState ' [] ;DMjI~;i~O~.~.Sa ,P~( ;';I O N2 0 0 ] /P(~rL~t~Ee~S POSITION - N .... , Cemetery. ~ _ , LOCATlOl~:Cily/Town. Stale, Zip Code · /,,~ddlbtownCelnetery I~.ddletown,Pa17057 Items 24-26 must be completed by 20,. Scott R. Fitzpatrick [:~emoval ~rom State [] · ~ FFffi23,324 }tlllre/Ax~.,~,PA17043 I To the best of my knowledge death occurred a the time date and place stated ' I LICENSE NUMBER ~DATE SIGNED physi~an is not available at ~ime of dea h o I (Signature and '~be) ' · ce.d~ .... o~dee.,. I I I(Mo..,. Da~, Yea,) ,.~...., mu., be =.pie,ed,, I;,t;- pe,*oo~or~ .... dee",. I "~*~ ~'~ -- I DAlE PF~ONOU.NCED DEAD (Momh, Day, Year) I~}' 123c. S CASE REFERRED TO A MEDICAL EXAMINER/CORON[R?~ ; Approximate PART II; O",~' significant coodgions conttlb`"ing to deaU1, b`" IMM~=DIATE CAUSE (Final ,, interval betwee not msulliog in Ihe underlying cause given in PART I. resuRing in deal/a)-'---l, a. cause. Enter UNDERLYING CAUSE (Disease or injury c. resulting on death ) LAST d. WAS AN AUTOPSY'rWERE AUTOPSY FINDINGS rMANNER OF DEATH PERFORMED, /~VO~f~R~O~.,,o / ~, ~RY TT'ME oF'NJURY -] INJURY AT WORK: DESCRIBE HOW iNJURY OCCURRED / CAUSE JNaturat [~ Homicide /oFoEAT.? ~ ~ nl ' / / Y-[] .o1,~4 Ye,[] No[] /Sui=de [] Cou:d,ot,,,et,=i,ed nl,o', CERTIFIER (Che~ ~ly ~e) SIGNA ~D TITLE O TIFI · CERDFYING PHYSlC~N (Phy~n ~i~ing ~use ~ dea~ when ano~er ~y~an has renounced dea~ and ~m~eled item 23 . 'MESCAL EXAMINE~CORONER ~ MP D ~US ~,. . ................ :.~.~ ..................................................................................... ~ ~,~.~ ~ ~ / ~/~ ~A DATE FILED (Men/h, Day. Year) 21-2003-728 LAST WILL AND TESTAMENT OF ROBERT J. FITZPATRICK I, ROBERT J. FITZPATRICK, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that ! may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any fight which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article IH I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Girls may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my son, SCOTT R. FITZPATRICK, of Dauphin County, Pennsylvania. In the event that SCOTT R. FITZPATRICK predeceases me or does not survive me by thirty (30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever nature and wheresoever situate to my son, DENNIS J. FITZPATRICK, of Berks County, Pennsylvania. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. Article V I nominate, constitute, and appoint my son, SCOTT R. FITZPATRICK, as Executor of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my son, DENNIS J. -2- FITZPATRICK as successor Executor of my Last Will and Testament. I direct that my Executor or successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executor and successor Executor shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executor and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, -3- (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, ROBERT J. FITZPATRICK, hereby set my hand to this my Last Will and Testament, on L/--- ~.~ ,2003, at Harrisburg, Pennsylvania. ROBERT J. FITZPATRICK In our presence, the above-named ROBERT J. FITZPATRICK signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name Address -4- I, ROBERT J. FITZPATRICK, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by ROBERT J. FITZPATRICK, the Testator, Not~ublic ROBERT J. FITZPATRICK We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me and witnesses, on t~ - ~ '~ Nt~y Public ,2003. Witness Witness -5- I am unable to sign my name. The above pages have been read to me, in the presence of the undersigned witnesses, and they correctly express my intent. I therefore have had my name written for me in my presence and at my direction by Jessica A. Holland, whereupon without assistance I have made my mark in the space between my first and last names on q -~Q-~ ,2003. ROBERT J~" '~- -'~'"~ITZPRTRICK ROBERT J. FITZPATRICK, on the above date in our presence declared this instrument to be his Last Will and Testament and, being unable to sign his name, directed his name to be written for him, which the undersigned, Jessica A. Holland did subscribe as directed in his presence, whereupon ROBERT J. FITZPATRICK in our presence made his mark without assistance in the space provided between his first and last names, and we, in his presence have subscribed our names as witnesses. Witness Wimess ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN · SS On this, - c2~ ~ ,2003, before me a notary public, the undersigned officer, personally appeared ROBERT J. FITZPATRICK, known to me (or satisfactorily proven) to be the person whose name has been written and who has executed by mark the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~.~ Public LAST WILL & TESTAMENT OF ROBERT J. FITZPATRICK JAN L. BROWN & ASSOCIATES ATTORNEYS AT LAW 845 SIR THOMAS COURT, SUITE 12 HARRISBURG, PENNSYLVANIA I7109 717-541-5550 Jan L. Brown, Esquire ADMTTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES A'I-I'ORNEY AND COUNSELOR AT LAW OLDE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 Email: jlbassoc@ptd.net TELEPHONE (717) 541-5550 FACSMILE (717) 541-9223 Brenda F. Kephart, Legal Assistant Paula K. White, Legal Assistant Jacqueline A. Kelly, Law Clerk September 3, 2003 Cmnber!and County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of Robert J. Fitzpatrick Social Security No. 194-16-1031 Gentlemen or Ladies: We represent Scott R. Fitzpatrick, Executor for the Estate of Robert J. Fitzpatrick, who died on July 15, 2003, a resident of Camp Hill Borough, Cumberland County, Pennsylvania. In mid to late August, Scott Fitzpatrick was sworn in as Executor of his father's estate. Subsequently, our office was advised that because Robert Fitzpatrick signed his Last Will and Testament with a mark, it was not considered self-proved. The witnesses to the Will would be required to appear before the Register of Wills. In fulfillment of this request, Kathryn A. Karam and Rosalie W. Asch, the witnesses to Robert Fitzpatrick's Will, appeared before the Register of Wills of Dauphin County today and affirmed Mr. Fitzpatrick's signature. The original affidavit is enclosed with this letter. Mr. Fitzpatrick's file should now be complete, and we request that you issue Letters Testamentary for the Estate. Please send the probate documents to this office. office. Thank you for your cooperation. If you have any questions, please feel free to contact this Sincerely, JLB/bfk Enclosure OATH OF SUBSCRIBING WITNESS Estate of Robert J Fitzpatrick also known as Robert J Fitzpatrick , Deceased Kathryn A Karam Rosalie W Asch (each) a subscribing witness to the I~ codicil(s) ~ will(s) presented herewith, (each) duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of the Testator(rix) in her/his/their presence anc~ in the presence of each other I~ in the presence of the other subscribing witness(es). (Signature) 126 Wyndham Way Harrisbur,q PA 17109 (Address) ~ ~ (Signature) 56 West Willow Street Apt 1 Carlisle PA 17013 (Address) Sworn to or affirmed and subscribed before me this ~ ~--~ day of ! · I~tary Public ~ / - / - My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Nota~s commission.) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. RW-2 Estate of Robed J. Fitzpatrick also known as INVENTORY , Deceased Date of Death 07/1512003 Social Security No. 194-16-1031 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 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. I/We verify that the statements made in this inventory are true and correct. I/We 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: I.D. No.: Jan L. Brown 67993 Personal Representative: Scott R. Fitzpatrick Address: 845 Sir Thomas Court Harrisbur~l PA 17109 Dated 08/13/2003 Telephone: 717-541-5550 Checking and savings accounts Description Total Value 49,000.00 (Attach Additional Sheets if necessary) 49,000.00 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-4 BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Robert J Fitzoatri(;k Date of Death: 07/15/2003 Will No. 2003-00728 Admin. No. 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 09/22/2003 · Name Address Scott R Fitzpatrick Dennis J Fitzpatrick 1917 Felker Road Middletown PA 17057 731 Penn Avenue Sinkinq Sprinq PA 19608 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 09/22/20Q;~ Capacity: Sig Name: Jan L Brown & Associates Address: 845 Sir Thomas Court Suite 12 Harrisburq pA 17109 Telephone(717) 541- 5550 X Personal Representative Counsel for Personal Representative Jan L. Brown, Esquire ADMTTED IN PA AND DISTRICI' OF COLUMBIA JAN L. BROWN & ASSOCIATES ATTORNEY AND COUNSELOR AT LAW OLDE ENGLISH GAP 845 S~R THO~U~S COURT SUITE 12 HARRISBURG, PA 17109 Email: jlbassoc@ptd.net TELEPHONE (717) 541-5550 FACSMILE (717) 541-9223 Brenda F. Kephart, Legal Assistant Paula K. White, Legal Assistant Jacqueline A. Kelly, Law Clerk October 14, 2003 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Robert J. Fitzpatrick Soeial Security No. 194-16-1031 File No. 2003-00728 PA File No. 21-03-0728 Gentlemen or Ladies: Enclosed please find the following items for filing with the Register of Wills: 1. Inventory. Please note that the inventory filing fee was paid when the Will was admitted to probate. 2. An original and one copy of the Inheritance Tax Return. 3. Check 98 in the amount of $2,223.82 to cover the inheritance tax shown to be due. Make sure the check is marked as received within the 3 month prepayment period. 4. Check 99 in the amount of $15 to cover the tax return filing fee. Please time stamp and return our file copies of these documents. A return envelope is provided. If you have any questions, feel free to contact this office. bfk Enclosure Sincerely, Brenda F. Kephart -- Legal Assistant COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003124 BROWN JAN L ESQUIRE 845 SIR THOMAS COURT HARRISBURG, PA 17109 ........ fold ESTATE INFORMATION: SSN: 194-16-1031 FILE NUMBER: 2103-0728 DECEDENT NAME: FITZPATRICK ROBERT J DATE OF PAYMENT: 10/15/2003 POSTMARK DATE: 10/14/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/15/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,223.82 TOTAL AMOUNT PAID: $2,223.82 REMARKS: SCOTT R FITZPATRICK C/O JAN L BROWN ESQUIRE SEAL CHECK# 98 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REd-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I-- Z LLI I.U I.U Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL Fitzpatrick Robert J DATE OF DEATH (MM-DD-Year) 07/15/2003 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT IDATE OF BIRTH (MM-DD-Year) 07/06/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY ~MB~R 2 1 -0 3 0 7 2 8 COUNt( CODE yE. AR NUMBER SOCIAL SECURITY NUMBER 1 9 4-1 6-1 0 3 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~]1. Odginal Retum [~4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) --]9. Litigation Proceeds Received J---~ 2. Supplemental Return [~4a. Futura Interest Compromise (date of death after 12-12-82) [~]7. Decedent Maintained a Living Trust (Attach copy of Trust) ] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) NAME Jan L Brown FIRM NAME (If Applicable) Jan L Brown & Associates TELEPHONENUMBER 717-541-5550 ]3. Remainder Return (date of death pdor te 12-13-82) ]5. Federal Estate Tax Retum Required __ 8. Total Number of Safe Deposit Boxes E] 11. Election to tax under Sec. 9113(A) (A~ch Sch O) COMPLETE MAILING ADDRESS 845 Sir Thomas Court Suite 12 Harrisbur,q ' PA 17109 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r-] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-?) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental 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) 71.70 OFFICIAL USE ONLY 61~082.73 (8) 8~810.84 324.59 (11) 61~ 154.43 9~135.43 52~019.00 52,019.00 (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X ~ (15) 52~019.00 X .045 (16) X .12 (17) X .15 (18) (19) 2~340.86 2~340.86 Decedent's Complete Address: ISTREET ADDRESS 3026 Harvard Avenue Camp Hill Borough CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount ISTATE PA I ziP 17011 21340.86 117.04 2~223.82 (1) 117.04 2~223.82 Total Credits ( A -,- B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. 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. (5B) 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 perjury, 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, ADDRESS 1917 Felker Roa~ ~"' Middleto~ ~ a-t SIGNATURE OF PREPAR,~T~E~ ADDRESS 845 Si T~mas Court Suite 12 Harrisburg DATE 10/14/2003 PA 17057 DATE 10/14/2003 PA 17109 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 still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1 2) [72 P.S. §9116(a)(1)]. The tax rate 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-1503 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Fitzpatrick Robert ~1 All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 03 ITEM NUMBER 1. DESCRIPTION EE United States Savings Bond Serial No L188472173; issue date 6/1985; denom $50 TOTAL (Also enter on line 2, Recapitulation) 0728 VALUE AT DATE OF DEATH 71.70 71.70 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Fitzpatrick Robert J 21 03 0728 Include the proceeds of litigation and the date the proceeds were received by the estate. All proper~ jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank; Checking Account 33358788 10,098.15 10 11 M&T Bank; Savings Account 15004208555845 M&T Bank; Certificate of Deposit 31003913916680 M&T Bank; Certificate of Deposit 31003914014756 M&T Bank; Certificate of Deposit 31003914015548 Penn Treaty Network America Robert J Fitzpatrick, beneficiary of insured Ardella N Fitzpatrick Principal Life Insurance Company Robert J Fitzpatrick, beneficiary of insured Ardella N Fitzpatrick Pennsylvania Blue Shield; reimbursement The Patriot-News; credit refund United States Treasury; tax refund American Water; credit refund 6,416.48 15,641.16 11 640.64 12,377.98 2,000.00 2,424.40 3.33 19.40 458.00 3.19 TOTAL (Also enter on line 5, Recapitulation) $ 61 ~082.73 (If more space is needed, insert additional sheets of the same size) REV-1511EX + (1o97) j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Fitzpatrick Robert J Debts of decedent must be reported on Schedule I. FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Musselman Funeral Home Funeral luncheon 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 Year(s) Commission Paid: AttomeyFees Jan L Brown & Associates Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal; legal advertising The Patriot-News; legal advertising Attorney/witness travel to courthouse 4,740.90 584.50 3,000.00 161.00 75.00 193.87 55.57 TOTAL (Also enter on line 9, Recapitulation) $ 8,810.84 (If more space is needed, insert additional sheets of the same size) REV-1512 EX +(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIESr & LIENS ESTATE OF Fitzpatrick Robert J Include unreimbursed medical expenses. FILE NUMBER 21 0~ ITEM NUMBER 1, 4 6 7 8 DESCRIPTION HB McClure Co; oil PAWC; water PPL Electric Utilities; electric Verizon; telephone D&F Lawn Care; landscape maintenance invoice Brockie Pharmatech; medicine Veterans Life Insurance; premium M&T Checking Account 33358788 balance adj TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 072~ AMOUNT 130.00 14.38 23.99 23.88 74.20 19.75 8.66 29.73 324.59 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Fitzoatric < Robert J NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ]. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. Scott R Fitzpatrick 1917 Felker Road Middletown PA 17057 II. 1. son FILE NUMBER 21 03 072~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 100% residue TOTAL OF PART Il - 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) 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 LAST WILL AND TESTAMENT OF ROBERT J. FITZPATRICK I, ROBERT J. FITZPATRICK, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I Myjust debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor fi:om the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement fi:om any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who sm'vive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my son, SCOTT R. FITZPATRICK, of Dauphin County, Pennsylvania. In the event that SCOTT R. FITZPATRICK predeceases me or does not survive me by thirty (30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever nature and wheresoever situate to my son, DENNIS J. FITZPATRICK, of Berks County, Pennsylvania. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. Article V I nominate, constitute, and appoint my son, SCOTT R. FITZPATRICK, as Executor of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my son, DENNIS J. -2- FITZPATRICK as successor Executor of my Last Will and Testament. I direct that my Executor or successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executor and successor Executor shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executor and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or Private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising fi.om the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax remm for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, -3- (h) to employ any attorney, investment advisor, or other agent, deemed necessary bY my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, ROBERT J. FITZPATRICK, hereby set my hand to this my Last Will and Testament, on q '" ~_~_~., 2003, at Harrisburg, Pennsylvania. ROBERT J. FITZPATRICK In our presence, the above-named ROBERT J. FITZPATRICK signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Nalne Address -4- I, ROBERT J. FITZPATRICK, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by ~ ROBERT J..FITZPATRICK, the Testator, Not/a%tbablic ROBERT J. FITZPATRICK We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein exPressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me and witnesses, on __ ,2003. Wimess Witness -5- the undersigned wimesses, and they correctly express my intent. I therefore have had my name written for me in my presence and at my direction by Jessiea A. Holland, whereupon without assistance I have made my mark in the space between my first and last names on /~ -~05 ,2003. ROBERT '~- -""'-~TZP~TRICK . ROBERT J. FITZPATRICK, on the above date in our presence declared this instrument to be his Last Will and Testament and, being unable to sign his name, directed his name to be written for him, which the undersigned, Jessica A. Holland did subscribe as directed in his presence, whereupon ROBERT J. FITZPATRICK in our presence made his mark without assistance in the space provided between his first and last names, and we, in his presence have subscribed our names as wimesses. Witness Witness ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA · · SS COUNTY OF DAUPHIN · On this, ~ ~ ~3 ,2003, before mca notary public, the undersigned officer, personally appeared ROBERT J. FITZPATRICK, known to me (or satisfactorily proven) to be the person whose name has been written and who has executed by mark the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I~ Public BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Fitzpatrick Robert J also known as Robert J Fitzpatrick , Deceased No. 2003 00728 Date of Death 07/15/2003 Social Security No. 194161031 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 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. I/We verify that the statements made in this inventory are true and correct. I/We 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: I.D, No.: Jan L Brown 67993 Personal Representative: Scott R Fitzpatrick Address: 845 Sir Thomas Court Suite 12 HarrisburR PA 17109 Dated 10/14/03 Telephone: 717-541-5550 Description EE United States Savings Bond Serial No L188472173; issue date 6/1985; denom $50 M&T Bank; Checking Account 33358788 M&T Bank; Savings Account 15004208555845 M&T Bank; Certificate of Deposit 31003913916680 M&T Bank; Certificate of Deposit 31003914014756 M&T Bank; Certificate of Deposit 31003914015548 (Attach Additional Sheets if necessary) Value , 71.70 6,416.48 15,641.16 11,640.64 12,377.98 Total 61,154.43 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-4 Fitzpatrick Robert J Description of Inventory Continuation of Inventory Pa,qe 1 2003 00728 Description Penn Treaty Network America Robert J Fitzpatrick, beneficiary of insured Ardella N Fitzpatrick Principal Life Insurance Company Robert J Fitzpatrick, beneficiary of insured Ardella N Fitzpatrick Pennsylvania Blue Shield; reimbursement The Patriot-News; credit refund United States Treasury; tax refund American Water; credit refund Subtotal Grand Total Value 2,000.00 2,424.40 3.33 19.40 458.00 3.19 $ 4,908.32 $ 61,154.43 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX JAN L BROWN J L BROWN & ASSOCIATES 8q5 SIR THOMAS CT 12 HBG PA 17189 DATE 12-01-2005 ESTATE OF FITZPATRICK DATE OF DEATH 07-15-2005 F'rLE NUMBER 21 05-0728 COUNTY CUMBERLAND ACH 101 I Amount Ram/fred ROBERT J HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV'1547 EX AFP (01-03) NOTICE OF ~NHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FITZPATRICK ROBERT J FILE NO. 21 03-0728 ACN 101 DATE 12-01-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON= ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (E) 3. Closely Held Stock/Partnership Interest (Schedule C) ($) 4. Nortgages/Notes Receivable (Schedule D) (4) E. Cash/Bank Deposits/MAsc. Personal Property (Schedule E) ($) 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expansas/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga Liabili~Aas/Lians (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Re~urn .00 71.70 .00 .00 61~082.73 .00 .00 (8) 8,810.8q 324.59 NOTE: To insure proper credit to your account, submAt the upper portion of ~his form with your ~ax payaant. 15. 14. NOTE: ASSESSNENT OF TAX: 15. A.ount of LAne 14 at Spousal rate 16. Aaount of LAne lq taxable at LAnaal/Class A rata 17. Amount of LAne 14 et SAbling rata 18. Amount of LAne 14 taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: DAT( NUHB(R INTEREST/PEN PAID (-) 10-1~-200~ CD00312~ 117.0~ 61,15q.43 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 x O0 = .00 (16) 52,019.00 X 045= 2,340.86 (17) . O0 x 12 = . O0 (18), .00 x 15 = .00 (19)= 2,340.86 AHOUNT PAID 2,223.82 reflect figures that lnclude the total of ALL returns assessed to date. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 2,340.86 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) Charitabla/Govarneantal Bequests; Non-elected 9115 Trusts (Schedule J) (1-~) . O0 Net Value of Estate SubSact to Tax (lq) 52,019.00 Zf an assessBent was issued previousZy, l~nes 14, 15 and/er 16, 17, 18 and 19 wail (11) 9.135. ~3 (12) 5Z,019. O0 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTZONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 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 Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B :collateral) rate on any such futura interest. To fulfill the requirements of Section 21qO of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9lqO). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse sidm. --Make check er money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which wes net requested on the Tax Return, may be requastmd by complmting an "Application for Rmfund of Pennsylvania Inheritance and Estate Tax" (REV-131:5). Applications ara available at the Office of thm Rmgister of Hills, any of the Z:5 Revenue District Offices, ar by calling the special Iq-hour answering service for forms ordering: 1-800-:562-Z050~ services for taxpayers mith special hearing and / or speaking needs: 1-BOO-~qT-:5020 (TT only). Any party in interest not satisfied with the appraisement, allomance, or disallowance of deductions, or assessment of tax (including discount ar 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. 261021, 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. 28060I, Harrisburg, PA I7128-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an expIanation of administratively correctable errors. If any tax due is paid within three (:5) calendar months after the decedent's death, a five percent ESI) discount of the tax paid is a11owed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 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 (61) percent par annum calculated at a daily rate of .00016q. 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 2005 arm: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 Z07. . 0005a, 8 1987 9;: . 0002~,7 1999 77. . 000192 198:5 167. . 000q:58 1988-1991 117. .000:501 ZOO0 67. .000Z19 198~ 117. .000::501 1992 97. .0002~,7 2001 97. .0002q7 1985 1:57. .000556 199:5-199~, 77. · 000192 ZOOZ 67. .00016~, 1986 107. . OOOZ7q 1995-1998 97. . OOOZq7 200:5 57. .0001:57 --Interest is caXculated as follows: ZNTEREST = BALANCE OF TAX UNPAZD X NUI~BER OF DAYS DELZNI~UBNT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent wi11 reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Xf payment is made after the interest computation date shown on the Notice, additional interest must be calcutated. Jan L. Brown, Esquire* Jacqueline A. Kelly, Esquire JAN L. BROWN & ASSOCIATES A'I-I'ORNEY AND COUNSELOR AT LAW OLDE ENGLISH GAP 845 S~R THOI~U~S Coum SUITE 12 HA"R~S~U,O, PA 17109 Email: jlbassoc@ptd.net TELEPHONE (717) 541-5550 FACSM~LE (717) 541-9223 Brenda F. Kephart, Legal Assistant Paula K. White, Legal Assistant *ADMITTED IN PA AND DISTRICT OF COLUMBIA December 17, 2003 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of Robert J. Fitzpatrick File No. 2003-00728 Gentlemen or Ladies: Enclosed please find the following item for filing with the Register of Wills: Family Settlement Agreement together with Check 1010 in the amount of $17 to cover the filing fee. Please time stamp and return our file copy of this documem. A return envelope is provided. If you have any questions, feel free to contact this office. Sincerely, Brenda F. Kephart Legal Assistant bfk Enclosure IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF ROBERT J. FITZPATRICK, DECEASED FILE NO. 2003-00728 FAMILY AGREEMENT AND FINAL RELEASE THIS AGREEMENT by and between SCOTT R. FITZPATRICK, as Executor of the Estate of ROBERT J. FITZPATRICK, Deceased and SCOTT R. FITZPATRICK. WHEREAS, ROBERT J. FITZPATRICK, late of Camp Hill Borough, Cumberland County, Pennsylvania, deceased, died testate on July 15, 2003, having first made his Last Will and Testament, which was duly executed April 23, 2003, and is duly recorded in Cumberland County Courthouse, Register of Wills, File No. 2003-00728; and WHEREAS, SCOTT R. FITZPATRICK has been duly appointed as Executor of the Estate of Robert J. Fitzpatrick, Deceased; and WHEREAS, the party in interest under the Last Will and Testament of Robert J. Fitzpatrick, Deceased, is Scott R. Fitzpatrick, son; and WHEREAS, Scott R. Fitzpatrick, the sole party in interest, is entitled to one hundred percent (100%) of the residuary estate; and WHEREAS, the Executor has gathered the assets of the estate of the said decedent, and the assets consist of personal property to a total value of $61,266.05 as set forth in Exhibit A, which is a statement of account of the Executor, and which is attached hereto and made a part hereof and marked Exhibit A; WHEREAS, it is the desire of the sole beneficiary that final distribution of this estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the sole beneficiary to avoid the expense, delay and publicity of a formal accounting; and WHEREAS, the sole beneficiary acknowledges to have received a proposed Schedule of Distribution attached hereto and marked as Exhibit "A." NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants and agreements recited herein, the sole beneficiary agrees as follows: 1. I do hereby release and forever discharge SCOTT R. FITZPATRICK, Executor, his heirs, executors, and administrators and assigns; JAN L. BROWN & ASSOCIATES, attorneys at law; and JAN L. BROWN, ESQUIRE from any and all liability which may from time to time arise in connection with their service as Executor and Attorneys of the Estate of Robert J. Fitzpatrick, Deceased. I do further agree to indemnify and hold them harmless from any and all liability which may arise against the estate from creditors or claimants. 2. I acknowledge receipt of the assets described on the Schedule of Distribution attached hereto. 3. I agree as the sole beneficiary and as the Executor that should any liability come due to the estate of the said decedent after the signing of this agreement, I will contribute my share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the Executor after the signing, sealing and delivery of this Agreement. -2- I acknowledge that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon my respective heirs, successors, administrators and assigns. 5. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /r~ "~C C ~,m/9d£ ,2003. Witness - ' -I / day of SBeCnOeTficTi Rar~FITZP~T~K, E-xecutor and~ COMMONWEALTH OF PENNSYLVANIA · COUNTY OF DAUPHIN · SS: On this the ] 7 day of ~)~/T)~/" ,2003 before me, a Notary Public, the undersigned officer, personally appeared SCOTT R. FITZPATRICK, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. IW COMMmS N 2e, STATEMENT OF ACCOUNT OF THE ESTATE OF ROBERT J. FITZPATRICK Personal Property (using date of death values) EE US Savings Bond; denom $50 M&T Bank; Ckg 33358788 M&T Bank; Svgs 15004208555845 M&T Bank; CD 31003913916680 M&T Bank; CD 31003914014756 M&T Bank; CD 31003914015548 Penn Treaty; benef of Ardella N Fitzpatrick Principal Life; bene£ofArdella N Fitzpatrick Reimbursements/refunds Life Insurance Veterans Life Insurance Total Assets Income earned since date of death Interest Total Income Expenses Funeral Legal fee; Jan L Brown Administrative costs Debts of decedent Inheritance Tax Reserve for additional obligations Total Expenses Net Available for Distribution $71.70 $10,098.15 $6,416.48 $15,641.16 $11,640.64 $12,377.98 $2,000.00 $2,424.40 $501.31 $94.23 $75.85 -$5,325.40 -$3,000.00 -$569.01 -$333.86 -$2,223.82 -$1,000.00 $61,266.05 $75.85 -$12,452.09 $48,889.81 SCHEDULE OF DISTRIBUTION ACCORDING TO TERMS OF WILL* Scott R. Fitzpatrick, son, 100% residue Cash distribution 10/30/03 Cash distribution 12/17/03 Total Distribution $5,000.00 $43,889.81 $48,889.81 *Actual cash distribution may be increased or decreased based on interest accrued, market value of assets, presentation of an obligation and/or payment of additional charges. Any reserve will be distributed to the residuary legatee after final payment of all obligations. 12/17/2003 Exhibit A I_______Jan L. Brown & Associates ATTORNEYS AND COUNSELORS AT LAW 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PENNSYLVANIA 17109 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE ~ONE COURTHOUSE SQ CARLISLE PA 17013 Jan L. Brown, Esquire* Jacqueline A. Kelly, Esquire *ADMITTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES A'I'rORNEY AND COUNSELOR AT LAW OLDE ENGliSH GAP 845 S~R THOaAS COURT SUITE 12 HA.mSeU.O, PA 17109 Email: jlbassoc@vedzon.net TELEPHONE (717) 541-5550 FACaM~LE (717) 541-9223 May 19, 2004 r, / Brenda F. Kephart, Legal Assistant Paula K. While, Legal Assistant Judi~ A. Ebersole, Adminislrative Assislant Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Robert J. Fitzpatrick File No. 2003-00728 Gentlemen or Ladies: Enclosed please find the Status Report Under Rule 6.12 advising that administration of the above-referenced estate is complete. Please time stamp and return our file copy of this document. A return envelope is provided. If you have any questions, feel free to contact this office. Enclosure Sincerely, Brenda F. Kephart Legal Assistant STATUS REPORT UNDER RULE 6.12 Name of Decedent- Robert J FitzDatrk3k Date of Death · 07/15/2003 Will No. 2003-0072~ 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' State whether administration of the estate is complete' Yes )q 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: account with the Court ? Did the personal representative file a final Yes ~. No X 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 }{ 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. Family Settlement Agmt filed 12/18/03. Signature Scott R Fitzpatrick Name (Please type or print ) 1917 Felker Road Middletown PA Address 17057 0g ~,~!~4 /70. (717) 944- 7774 Tel. No. Capacity' X Personal Representative Counsel for personal representative