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Home My WebLink About02-0205PETITION FOR PROBATE and GRANT OF LETTERS Estate of Paul E. Fry No. also known as To: ,Deceased Social SecuriO~ No. 199-05-9187 21-02-205 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rix in the last will of the above decedent, dated January 9, 1995 and codicil(s) dated None in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in eumberlancl County, Pennsylvania, with h is last family or principal residence at 210 Biq Sprinq Road, Nowville, West Pennsboro Twp, Cumberland County, Pennsylvania (list street, number and municipality) Decedent, then 86 years of age, died 2/15/02 at Chambersburq Hospital, Chambersburq, Franklin County, Pennsylvania Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim ora killing and was never ajudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 95,000.00 0.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. (tcstalnentary: admullstratlon ct a. adnlmt~t)at~m~ d Louise Helm 1245 Baltimore Road Shippensburq Pa. 17257 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA; ss COUNTY OF Cumberland The petitioner(s) above,named swear(s) or affirm(s) that the statements in the tbregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn tooraffirmedandsubscribed ~' ~~ '~/~ before me this 26. th _ day of / February. 20012 .... .~_ ,~ / .7 Register ~[~ No. 21-02-205 Estate of Pain E Fry ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW February 26 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, 1T 1S DECREED that the instrument(s) dated 1/9/95 described therein be admitted to probate and filed of record as the last will of Paul E. Frv and Letters Testamentary are hereby ~~ranted to 1 ni Pico Holm .~ 7 ~~~ /fie::ister o Wllls FEES H. Anthony Adarr:s Probate, Letters, Etc.. $ 200.00 25502 Short Certificates ( ). $ 12.00 - ATTORNEY (Sup- Ct. LD No ) x-pages $ ~00 128 East King Street Renunciation . Shippensbu~ Pa 17257 JCP $ 5.00 ,~uulii.5s TOTAL $ 226.00 717-532-3270 Filed . 2-26.-2002. hIlt~Nl I ~~ his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8167896 No. Local Registrar COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '. PAUL E. FRY ........... ...... sex . . *',~ala Z ,19~9.,...~,~a ..., ~91,~7 I~ 02-15-2007 , ' , Blain ~ ~ Fra~lin ~. Chambersbu~ e., .{~ Ch~mhe~b~ .Houri, Cai I.~~'~ {~ Wh~t~ 210 Big Spring Rd. ~ ,.. John ~. FrY ,$. Annie, M. ~ Louisa Helm ~.1245 BalC&mo,=.,.~d~,, 8hius,uu'ahurm. PA 17257 ~ ~ ~m~l~l 02-19-200~' "~ J South~pton Township ,,,. Cleve.rsbu~.C~u-.te.rv [,~.. ~umberland County, PA .......................... m,~. ~ ~~., ,~k~ LAST WILL ~ND TESTAMENT I, PAUL E. FRY, being of sound mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils made at any time before by me. FIRST: I direct that all my funeral expenses and just debts be paid as soon as practical after my death. SECOND: I give and bequeath all my property, be it real, mixed or personal, to Zora B. Helm. THIRD: If Zora B. Helm should predecease me or if we should die in a common disaster, then in either of those said events, I give and bequeath the rest and residue of my estate, be it real, mixed or personal, whatsoever and wheresoever situate as follows: A. I give and bequeath the sum of $500.00 to each of the children of William and Hazel Handshew, per capita. B. The rest and residue of my estate I give, devise and bequeath to Shirley Blackburn, Junita Gale Alexander, Louise Helm and Carole L. Baldoni, in equal shares, share and share alike, as to Shirley BlackbUrn and Junita Gale'Alexander these gifts shall be considered to lapse if they are not alive at the time of my death, remaining beneficiaries these gifts are given per as to the stirpes. FOURTH: I nominate, constitute and appoint, Louise Helm, to be the Executrix of this, my Last Will and Testament. If she should fail to serve or be unable to serve, then in either of those said events, I nominate and appoint, Carole L. Baldoni, as the Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I, Paul E. Fry, to this my Last Will and Testament, set my hand and seal, this ~ day of January, 1995. Paul E. Fry (SEAL) Sworn to and subscribed, declared and published by Paul E. Fry, as his Last Will and Testament, and so done in the presence of we the witnesses, who sign at his request, and in his presence, and in the presence of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : I, Paul E. Fry, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. P~ul E. Fry Sworn to and acknowledged, before me, /b~Pau~. Fry, the Testator, DAWN MARIE SHOOP Notary Public Shippensburg, Cumberland County, PA M), Commission Expires Feb. 5, 1e~'' COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : We, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses, and that to the best of our knowledge and the Testator was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. H. An~hony~ // Sharon Coleman Adams Sworn to and subscribed before me by, H. Anthony Adams and Sharon Coleman Adams, t~itnesses,i this ~ day of January, Notary Public ~ 1995. .- .... ....... ' ,~JP, Notary Public i' ~ :':" ".:;:'. ,,,~, Cumbgr~and County, PA ~.L:, ' ,;:~'?,.,'~,ission Expires Feb. 5 19,;L~ Z .H '1- 0 Z CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Paul E. Fry Date of Death: 2/15/02 Will No. 2002-00205 Admin. No. 2002-00205 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 3/27/02 Name Address Louise Helm 1245 Baltimore Road Shippensburg Pa. 17257 Carole Baldoni 10 Pine Lane Newville, Pa 17241 Juanita Kostyk 11580 Cedar Lane Ashland Va 23005 Shirley Blackburn 5757 Columbine Road Prescott AZ 86305 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 3/27/02 Capacity: Signature Name: H. Anthony Adams Address: 49 West Oranqe Street, Suite 3 Shippensburg Pa. 17257 Telephone(717) - 532- 327 ~-.~.' Personal Representative Counsel for Personal Representative Paul E. Fry Continuation of Certification of Notice Under Rule 5.6(a) Page 1 2/15/02 Names and addresses Name Hazel Kunkleman Address 1355 Centerville Road Newville Pa 17240 Angela Handshew Gail Crumbling Mary Wadel Zora Handshew Janet Grove William Handshew 206 Senior Drive Shippensbur,g 111 Cottage Road Shippensbur§, 14960 Burnt Mill Road Shippensburg 206 Senior Drive Shippensburg 26 Naugle Road Shippensburg 1842 Walnut Bottom Road Newville Pa. 17257 Pa. 17257 Pa 17257 Pa 17257 Pa. 17257 Pa. 17240 REV-1500 EX + (6-00) Z LU Z 0 UJ 0 0 Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Paul E. Fry DATE OF DEATH (MM-DD-Year) 02/15/2002 DATE OF BIRTH (MM-DD-Year) 01/04/1916 OFFICIAL USE ONLY H,5 ~iLE NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER 1 9 9-- 0-5 NUMBER 9 1 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 r~l. Original Return [-'-~ 4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) ~---] 9. Litigation Proceeds Received [~2. Supplemental Return E~4a. Future interest Compromise (date of death after 12-12-82) '--]7. Decedent Maintained a Living Trust (Attach copy of Trust) r-~ lO. Spousal Poverty Credit (date of death between 12-31-91 and1-1-95) ] 3. Remainder Return (date of death prior to 12-13-82) E~5. Federal Estate Tax Return Required 1__ 8. Total Number of Safe Deposit Boxes r-~l t. Election to tax under Sec. 9113(A) (Attach Sch Ol THIS SECTION MUST BE COMPLE~EDi ALL COREESpONDENCEAND CON~IDENTIAE ~ iNFORMATION SHOUED BE DIRECTED TO: NAME H. Anthony Adams FIRM NAME (If Applicable) TELEPHONE NUMBER 717-532-3270 COMPLETE MAILING ADDRESS 49 West Orange Street, Suite 3 Shippensburg Pa 17257 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 Properb/ (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate 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 (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY 30,090.11 143,753.74 (8) 173~843.85 31 ~301.07 (11) 31~301.07 (12) 142~542.78 142,542.78 (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) X __ (16) X .12 (17) 142,542.78 X .15 (18) (19) 21~381.42 21~381.42 Decedent's Complete Address: ~ STREET ADDRESS 1239 Baltimore Road CITY Shippensburg I STATE Pa. I zip 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (1) 21,381.42 (2) No Interest/Penalty if applicable D. Interest E. Penalty 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. (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 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? ....................................................................................................... [] 21,381.42 21,381.42 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. SIGNATJ~RE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 1245 Baltimore Road t Shi_pj~ensbur~t ADDRESS 49 West Orange Street Shippensburg, Pa. 17257 Pa. 17257 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-1502EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER P~ul E. Fry All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Tract of Mountain Land lying and being situate in Southampton Township, Franklin County, Pennsylvania being 15 acres 145.7 perches as per deed book G17 page 113 VALUE AT DATE OF DEATH 30,090.11 TOTAL (Also enter on line 1, Recapitulation) $ 30~090.11 (If more space is needed, insert additional sheets of the same size) REV-I~8 EX *(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Paul E. Fry Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1954 Ford DESCRIPTION 1988 Dodge Truck (excess of 100,000 miles) Mellon Bank (now Citizen Bank) checking account #8842056601 Refund from PHI Cash $53.00 from wallet & $5.00 quarters from lock box Refund on truck and automobile insurance Mellon Bank Savings account #00355-100698 Mellon Bank CD # Bl1555 C Mellon Bank CD #41-a300291.-C VALUE AT DATE OF DEATH 500.00 2,50000 9,325.67 764.94 58.00 230.4O 30,374.73 50,000.00 50,OOO.OO TOTAL (Also enter on line 5, Recapitulation) i $ 143~753.74 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Paul E. Frv Debts of decedent must be reported on Schedule I. iTEM NUMBER A, 1. 2. 3. 4, 8. 9. 11. 14. 18. DESCRIPTION FUNERAL EXPENSES: Fogelsanger Bricker Funeral Home Eby Granite Works (grave marker) Spring Hill Cemetary (grave opening) Reverend Horst (service) ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Louise Helm Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 1245 Baltimore Road City Shippensbur,cj State Pa. Year(s) Commission Paid: 2002 Attorney Fees U. Anthony Adams Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Zip 17257 Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Newspaper advertisement Mellon Bank (lock box fee) Clugston's mower service Vivian Coy Tax Collector IRS - income tax Continuing Care RX (last illness) Cardiovascular Associate (last illness) Graham Medical Clinic (last illness) Carlisle Regional Medical Clinic (last illness) Lancaster HMA Physician Managment Omega Labs Lancaster HMA Physician Managment State Zip TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 5,897.50 3,282.00 300.00 75.00 6,200.00 4,800.00 241.00 44.60 23.00 143.06 9.50 9,585.OO 162.16 26.21 267.17 lO0.00 13.22 7.54 14.61 31,301.0/ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Paul E. Fry Pacje 1 Schedule H - Funeral Expenses & Administrative Costs - B7 ITEM NUMBER 19. DESCRIPTION Chambersburg Hospital SUBTOTAL SCHEDULE H-B7 AMOUNT 109.50 109.50 REV 1513 EX ~ (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Paul E. F RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Shirley Blackburn 5757 Columbine Road Prescott, Az 86305 Juanita Kostyk 11580 Cedar Lane Ashland Va 23005 Carol Baldoni 10 Pine Lane Newville, Pa. 17241 Louise Helm 1245 Baltimore Road Shippensburg, Pa. 17257 William Handshew 1842 Walnut Bottom Road Newville, Pa. 17257 Janet Grove 26 Naugle Road Shippensburg, Pa. 17257 Mary Wadel 14960 Burnt Mill Road Shippensburg, Pa. 17257 niece niece friend friend friend friend friend 25% of residue 25% of residue 25% of residue 25% of residue ;500.00 ;500.00 ;500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inlleritance Tax Return Resident Decedent Paul E. Fry Pa.qe 2 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. Zora Handshew friend $500.00 206 Senior Drive Shippensburg, Pa. 17257 9. Gall Crumling friend $500.00 111 Cottage Road Shippensburg, Pa. 17257 10. Hazel Kunkleman friend $500.00 1355 Centerville Road Newville, Pa. 17257 11. Angela Handshew friend $500.00 206 Senior Drive Shippensburg, Pa. 17257 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 00186O ADAMS H ANTHONY ESQUIRE 128 E KING STREET SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 199-05-9187 FILE NUMBER: 2102-0205 DECEDENT NAME: FRY PAUL E DATE OF PAYMENT: 11/19/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/15/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $21,381.12 REMARKS: TOTAL AMOUNT PAID: H ANTHONY ADAMS ESQUIRE $21,381.12 SEAL CHECK//1007 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS 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 O02O39 ADAMS H ANTHONY 128 E KING ST SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 199-05-9187 FILE NUMBER: 2102-0205 DECEDENT NAME: FRY PAUL E DATE OF PAYMENT: 01/14/2003 POSTMARK DATE: 01/1 3/2003 COUNTY: CUMBERLAND DATE OF DEATH: 02/15/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $14.33 REMARKS: TOTAL AMOUNT PAID: $14.33 SEAL CHECK# 10170 INITIALS: CW RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS m TH OF PENNSYLVANIA lENT OF REVENUE )F INHERITANCE TAX ~LLO#ANCE OR DZSALLO#ANCE AND ASSESSHENT OF TAX RE¥-II:;¢? EX AFP (01-05) DATE 01-15-2003 ESTATE OF FRY DATE OF DEATH 02-15-2002 FZLE NUHBER 21 02-0205 'COUNTY CUHBERLAND ACN 101 I Amount Remitted PAUL E HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 PORTION FOR YOUR RECORDS ~ iCE TAX APPRAISENENT, ALLOWANCE OR JCTIONS AND ASSESSHENT OF TAX NO. 21 02-0205 ACN 101 DATE 01-13-2003 EPTED AS FILED ( ) CHANGED EE REVERSE 4AL RETURN idule C) Schedule E) APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Hist. Expenses (Schedule H) 10. Debts/Nortgege Liabilities~Liens (Schedule Z) 11. Total Deductions 12. Net Velue of Tex Return (1) 30~090.11 (z) .00 (3) .00 (~) .00 (~) ld3z753.7d (6) .00 (7) .00 (8) 31,301.07 (9) (10) . O0 NOTE: To insure proper credit to your account, subeit the upper portion of this fore ~ith your tax payment. 173,8~$.85 (11) 31 .sol. 07 (12) 142,5q2.78 13. NOTE: ASSESSHENT OF TAX: 15. Amount of Line 16. Amount of Line Zq taxable at Lineal/Class A rate 17. Aeount of Line lq at Sibling rate 18. Aeount of Line lq taxable et Collateral/Class B rate 19. Princi)al Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUHBER INTEREST/PEN PAID (-) 11-19-2002 CD001860 .00 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Velue of Estate Subject to Tax (lq) .00 1~2,5q2.78 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. (15) .00 x O0 = .00 (16) .00 x Od. 5= .00 (17) .00 x 12 = .00 (18) 142,5~2.78 x 15 = 21,381.~2 (19)= 21,381.~2 ANOUNT PAID 21,381.12 TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 21,381.12 .$0 1~.03 INTEREST IS CHARGED THROUGH 01-28-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDIT/ONAL INTEREST. lq.33 TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTXCE: PAYNENT: REFUND OBJECTIONS: ADHZN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after tho expiration of any estate for life or for years, the Coaaonmoalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lamful Class D (collateral) rate on any such future interest. To Fulfill the requirements of Section Z160 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 9160). Detach the top portion of this Notice and submit mith your payment to the Register of Hills printed on the reverse side. --Hake chock or money order payable to: REGZSTER OF #ILLS, AGENT A refund of a tax credit, ahlch was not requested on the Tax Return, may be requested by completing an "Application For Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special Z6-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~67-3010 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment cf tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1021, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. OR Factual errors discovered on this assessment should be addressed in writing to: PA Department cf Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6SOS. See page S of the booklet "Instructions for ~nharitance Tax Return for a Resident Decedent" (REV-1501) For an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the First day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal tho 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, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 1981 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 ZOOS are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 lOX .000568 1987 91 .000167 1999 71 .000192 1983 161 .0006S8 1988-1991 111 .000301 2000 81 .000119 198q 111 .O00SOl 1992 91 .OOOZq7 ZOO1 91 .000267 1985 1SI .000356 1993-1996 71 .000191 ZOOZ 61 .00016q 1986 101 .O00Z7q 1995-1998 9Z .O00Zq7 ZOOS 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELIN;iUENT X DALLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Zf payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. BUREAU OF TND'rV.rDUAL TAXES INHERITANCE TAX DTVISION DEPT. 28060! HARRISDURG, PA 17118-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT ANTHONY ADAMS .... COUNTY STE $ ACN W ORANGE ST SHIPPENSBURG PA 172~7 DATE ESTATE OF DATE OF DEATH FZLE NUMBER REV-i&O? EX AFP ¢D1-~$) 02-18-2003 FRY PAUL E 02-15-2002 21 02-0205 CUMBERLAND 101 Amoun~ Remi~ed I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/~ ~o your account, submi~ ~he upper por~/on of ~hLs form wL~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~# INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF FRY PAUL E FTLE N0.21 02-0205 ACM 101 DATE 02-18-2003 TH'rS STATEMENT TS PROV.rDED TO ADV.rSE OF THE CURRENT STATUS OF THE STATED ACN .rN THE NAMED ESTATE. SHO#N BELO# .rS A SUMMARY OF THE PR.rNC.rPAL TAX DUE, APPLZCAT.rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE, A PROJECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-13-Z003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): Z1,381.~2 PAYMENT DATE 11-19-2002 01-13-2003 RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 21,381.12 lq.33 .rF PAID AFTER TH.rS DATE, SEE REVERSE SIDE FOR CALCULAT.rON OF ADDZTZONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORM FOR ZNSTRUCTZONS.) INTEREST AND PEN. .00 TOTAL DUE .00 21,381.fi2 .00 CDOOZ039 CD001860 lq.03- .0O BALANCE OF TAX DUE TOTAL TAX CREDIT PAYMENT: Detach the top portion of this Notice and submit ~ith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REG/STER OF N/LLS, AGENT. -- If NON-RES/DENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, ahich ~as not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices or free the Depart~aent's Z4-hour anseering service for forms ordering: 1-800-56Z-ZO50; services for taxpayers #ith special hearing and / or speaking needs: 1-800-q47-50ZO (TT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. Z80601) Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (SX) discount of the tax paid is allo~ed. PENALTY: 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 end of the tax amnesty period. INTEREST: Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahlch became delinquent before January 1, 198Z bear interest at the rata of six (6Z) percent par annum calculated at a daily rate of .00016~. All taxes ~hich became delinquent on and after January 1, 198Z ~il1 bear interest at a rate ~hich ~il1 vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO5 ara: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year__ Rate Daily Factor 1982 ZOZ .000548 1987 9Z .000Z47 1999 7Z .O0019Z 1983 I6Z .000438 1988-1991 llZ .000301 ZOO0 8Z .OOOZ19 1984 llZ .000501 199Z 9Z .000247 ZOOZ 9Z .000247 1985 15X .000356 1993-199~ 7Z .00019Z ZOOZ 6Z .000164 1986 XOZ .OOOZ7~ 1995-1998 9Z .000Z47 2003 5Z .000157 --Interest is calculated as follo~s: TNTEREST = BALANCE OF TAX UNPAZD X NUtlBER OF DAYS DBLZNQUENT X DA/LY ZNTEREST 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 sho~n on the Notice, additional interest must be calculated. STATUS I~F. PORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State w~ether administration of the estate is complete: Yes ¢ No IZ1 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: ao Did the personal representative file a final account with the Court? Yes_ No ["] b. The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal~resentative state an account informally to the parties in interest? Yes ~ No [-] ' c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~el "o0 pue!~oquw~f3 Signature Nme Address Telephone No. Capacity: rsonal Representative unsel for personal representative