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02-0207
PETITION FOR PROBATE and GRANT OF LETTERS FStatP O~ c~~"{'!=G GOB, ~h . L~1' } 'E.. also kiroirn as _.~~"~~:- ~~i--.t-~ _ _ _ _ Deceased. Social Sec•url t ~ .~'Vo. _~~ - ~Y ~` - `~ ~'7 ~ -- To: Register of 'Wills for the, County of ~~~'~~~ in the Commonwe~afth of Pennsylvania The petitici~ ~~i the undersigned respectfully represents that: 1 <~ur pcuti;~ner(>), ~~ho is~are 18 years of age or of er an the execut;~~S~ - nan~cd in the last will of the above decedent, dated ~'-" h v~ _ _ ___, 19~ and codicil(s) da-ted - - _ ~ ~~~~~-~~~ -- - -_-~~I /~ --- (state relevant cirenmstances, e.g. renunciation, death of e.cecutor, etc.) Decendent was domiciled at death in ~~ ~"^-~~" l cam. ~- ~ County, Pennsylvania, with ham' _ last family or principal residence at 1~ ~ r ~',1,~ ~~-~ (list street, number and muncipality) Decendent, then ~ years of age, died ~"~ r2 1 _ a i~9 ~" Z, at ---~: r o ~ t ~~ y c • I ; ~ j.'~; ~ ,2~..~ ~ .J , l ~c+.. f_~-- Except as Collows, ecedent did of mart ,was n"o~diw~or~ced nd did not have a chil born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: _ Decendent 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: - WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~ ~= ~`''rO'` `i (testamentary; administration e.t.a.; administration d.b.n.c.t.a.) theron. - J ~ ~~ i P,~r~~`~ h't~~,2c~ ~;, i ~i N u=st ~,2. J ~~ - ~ _- - ~` ~` :~ r 3G C~i J i9 .: OATH OF PERSONAL. REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ~~ COUNTY OF _G-~-j''~b~ ~~~- The petitioner(s) above-named swear(s) or 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 represen- tative(s) of` the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this .___ 25th-_ day of Februa~ 19 Mary L is Register ~~ J ~ rv ~ r~; ~ ~~, ,ZL= ~ r -- ~0. 21-2002- 207 Estate Of Sara Qooding Pease, Sara G. Pease , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW February 26th, ~ 2002 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~o~-ff- l (--~ described therein be admitted to probate and filed of record as the last will of andLetters ~ T~-,~r~--~T,,-,~ are hereby granted to FEES Probate, Letters, Etc .......... $ 235.00 Short Certificates( 1~9 .......... $ 30.00 Renunciation ................ $ X-Pages ( 2 ) $ 6.00 JCP 5. O0 TOTAL __ $ Filed ~.e.b...~n..a.~y..2:.6 ~.h.,.2.0..0.2... $..2.7.6. :0..0... _ ~.~ster of Wills ry C. Lewi s ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE EXECUTRIX WILL PICK UP [,E'"'J~ 2r26-2002 ~., fQ d I REGISTER OF WILLS OF C~OUNTY OATH OF SUBSCRIBING W/J/T~ESS codicil / ' (each) a subscribing witness to the will present~nerewith, (each) being duly qualified according to law, depose(s) and say(s) that / present and saw, the testat__, sign the same and th~J/ ........ signed as a witness at the request of testat in h p~ence and (in the presence of each other) (in the presence of the other subscribing witness(es)).~ Sworn to or affirmed and sub~ribed before .... me this // day of (Narn~c~ ~ Register . ~ !: ~/~-- (Name) ~] 21-2002-2007 (Address) REGISTER OF WILLS OF ~,_~e___M~,_~,~_ COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, leach) being duly qualified according to law, depose(s) and say(s) that ~lt~~ W~-/~/Q ~ familiar with the signature of ~'/~10_. ~ 6Ot:>~0/~ /0~S~-,~'-' codicil testat~OIg- of (one of the subscribing witnesses to) the ~ presented herewith and codicil that ~ ~' believel the signature on the (~is in the handwriting of to the best of ~P b~ ~ knowledge and belief. Sworn to or affirmed and subscribed before me this 25th day of Fj~bru~ry ~, x ,o ~ 2002~ rName) . _ (Address) (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Ix)afl 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 8~68861 No. B ~ ~ 2002 Date mos. wu ~,. ~ COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT OF HEALTH * VITAL RECORDS .T CERTIFICATE OF DEATH ~ ~ : ~ -- ..... ~ ....... I I ~O ~ IE~~I ~ I ~ .............. ~s ~~ c~. ~.~ ; ....~T'S ' B I J 210 ~z9 Sp~z~g Rd. I~ ~,~Ne~tlle, PA 17241 ~~ Janet P. Moore ~ ~ ~[9/99/~9 ~nll~"" F~n~- ........ Mt. Holly Sprzngs PA ~ 'W- (~ ~ ~ I~ FD ]3895 L I~ger.~e~Z,Home Inc. 15 Big Spring Ave ~~'~. I'~"" I' --' ::"* =-'-' '1: 17 i~' --..~.-___._,. .... _ ...................................... ~ ~ /~~ 0 F 21-2002-207 SARA GOOD ING PEASE I, SARA GOODING PEASE (Social Security Number 224-90-9279 ) of Frederick County, Maryland, being of sound mind and fully aware of this deposition and being capable of executing a valid deed or contract, and not acting under duress, coercion or undue influence of any person, do hereby declare that this is my Will and revoke all Wills and Codicils at any time heretofore made by me. FIRST I direct my Personal Representative to pay such of my debts as may not be barred by limitations, and my funeral expenses, without the necessity of an Order of Court approving the same. All such debts shall be paid before distribution is made and no apportionment of such debt, tax or expense shall be made against any particular person or class or property. SECOND I am married to DONALD FREDERICK PEASE. JANET PEASE MOORE and MARCIA P. LEBHAR. We have two daughters, THIRD Ail the rest of my estate and property, whether in possession, expectancy or remainder, including all property over which I may have any power of appointment, I give, devise, bequeath and appoint to my husband, DONALD FREDERICK PEASE, absolutely and free of trust, provided PAGE 1 of 3 ~_~ he shall survive me. In the event my husband, DONALD FREDERICK PEASE, has predeceased me or shall fail to survive me for a period of thirty (30) days, then and in that event, I give, devise and bequeath all the rest of my estate and property unto my two daughters, JANET PEASE MOORE and MARCIA P. LEBHAR to share and share alike. In the event either of my said dau§hters shall have predeceased me, then I direct that the share of my residuary estate to which my said deceased daughter would have been entitled, shall be given, devised and bequeathed to her then living issue in equal shares to share and share alike. In the further event that either of my said daughters shall have predeceased me without leaving issue her to survive, then I direct that her share of my residuary estate shall be distributed to my surviving daughter or her surviving issue as above provided, as the case may be. FOURTH I nominate and appoint my daughter, JANET PEASE MOORE, as Personal Representative, without bond, of this Will. In the event she should predecease me or is unable to serve for any reason, then I nominate and appoint my daughter, MARCIA P. LEBHAR, to serve in her place. I request that my Personal Representative be allowed to serve without bond or sureties, except as required by law. In addition to all other powers, duties and discretions granted to, or imposed upon my Personal Representative by law, Representative shall have particularly the power to reinvest, sell, assign, mortgage, exchange, lease, PAGE 2 of 3 my Personal invest and transfer or otherwise dispose of all or any part of my estate, all in the sole discretion of the Personal Representative, without application to, the approval of, or the ratification by, the Court having jurisdiction over the administration of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal , 1991. SARA GOO~NG PERSE (SEAL) SIGNED, SEALED, PUBLISHED, AND DECLARED by the above named Testatrix, SARA GOODING PEASE, as and for her LAST WILL AND TESTAMENT, in the presence of us, who, at her request, in her presence, and in the presence of each other, have hereunto subscribed our hands as witnesses. WITNESSES: ADDRESS ADDRESS DATE ADDRESS ADDRESS DATE PAGE 3 of 3 ~& ~ 0 0 H 0 Name of Decedent: Date of Death: To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) &-drrr~. No. ~ I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on .~t~ ~ t~'~ ;l~.~"z_ : Nalne Address Notice has now been given to all persons entitled thereto under Rule 5.6(a)o~CCpt · ) Date: Signature Name Address ~::~.0 5f"~ L4Jy Capacity: ~rsonal Representative Counsel for personal representative Whether you will receive any money or property will be deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or prop- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. P~A$ t.~ , deceased, In re Estate of ~gl, tl~A Estate No. (Name and Address) TO: I~A ~Ze..., n Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent 5 ~/kA- ~- . ~t~:~a'~ day of ~t~ t[~,"l.,J~A¥ , ~o~, at ~~ ~ Pennsylvania. Decedent died testate (with a Will); or The person~ representative of the Decedent is (name, address ~d telephone number). , died on the, County, If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Dec~d~_ .t died intestate, a Pe~t~_ n for the Grant of Lett~. of Administration was fil~t.-~rith ~ of the Register of~ZC[lls of Cumberland Comfy, 1 ,Courthouse Square,.L:~i~sle, Pa. 17013. Phone ~17-240-63~5 ~,~ ,,.~r-.~ · _ ....... ........ .... ~ ...... · - A copy of the Will - ' tSr. g t~c. R,~ ...... fWth~ aha paytng m,~ ,.k~o fur 4vphcat~ogu Date: 1"[~/1-c-44' I~"t 7...,~''l-- Signature: Name (print) Address Capacity: Telephone (q~ Personal Represent ative/~ ~ ~..oTa '~.- 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 0011 24 MOORE JANET PEASE 920 STANLEY DRIVE EARLYSVILLE, VA 22936 ........ fold ESTATE INFORMATION: SSN: 224-90-9279 FILE NUMBER: 2102-0207 DECEDENT NAME: PEASE SARA GOODING DATE OF PAYMENT: 04/29/2002 POSTMARK DATE: 04/26/2002 COUNTY: CUMBERLAND DATE OF DEATH: 02/21/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,605.63 TOTAL AMOUNT PAID: $7,605.63 REMARKS: JANET PEASE MOORE SEAL CHECK# 115 INITIALS: CW RECEIVED BY' MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-I$00 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER COUNTY CODE YEAR NUMBER I-- Z U.I UJ uJ o 0 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-~D-YEAR) I DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER TELEPHONE NUMBER [~"'~. Original Return [] 2. Supplemental Return [] 4. Limited Estate [--] 4a. Future Interest Compromise (date of death after 12-12-82) [~. Decedent Died Testate (Attach copy of Will) [] 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~---~ 9. Litigation Proceeds Received ~--~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) COMPLETE MAILING ADDRESS FIRM NAME (If Applicable) 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) J~ ~-,~ ~" [---~ Separata Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata 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. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) -~3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required _L 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach Sch O) OFFICIAL USE ONLY (8) 1 ¢iq. · (11) (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) x .0 (15) 16. Amount of Line 14 taxable at lineal rate [~?i ~-~'_ ~"O . ,_~",/ x .0 I..~:~' (16) 1~ ~O '~o ~? 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20.[~ · , · - 'el ,- ' ~1 ~ , - I~l · ,~ e~ '','' ~ Decedent's Complete Address: STREET ADDRESS CITY STATE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount ~397. 6~ 3. Interest/Penalty if applicable Total Credits (A + B + C ) D. Interest E. Penalty Total Interest/Penalty ( D + E ) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (2) 3~ '7, ~ ~ 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 properly transferred or its income; ............................................ [] c. retain a reversionary interest; or .......................................................................................................................... [] J~ 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. SIGNATURE OF PERSON~ESPONSIBLE FOR FILING RETURN DATE ADDRESS V4:~ / SIGNATURE OF PREPARER OTHER THAN~EPRESENTATIVEz DATE ADDRESS For dates of death on or.after July 1, 1994 and before January 1 1995 the tax rate imposed on the net value of t~~ [72 P.S. {}9116 (a) (1.1) (0]. ' , ~ ........ ~ o~ ....... /o 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 decedenrs 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-I,~3 EX + (1-97) j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER FILE NUMBER DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ;;;2 q, 5"*, l. 2o REV-1504 EX+ (1-97) COMMONWEALTH OF ~ENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER DESCRiPTiON 1. TOTAL (Also enter on line 3, Recapitulation) VALUE AT DATE OF DEATH (If more space is needed, insert additional sheets of the same size) · ' ~ I SCHEDULE E / oo~o.~~v~.,^ / c~s...~.~ ~.os,~s. & ~,sc. [ INHRE~NCTEi~EA~EDR~NTTURN PERSONAL PROPERTY FILENUMBER ~ PO2 - r__.~_ c,"7 ESTATE OF include ~e pro.ds of libation and ~e date ~e p~eds were r~ived by ~e es~te. All prope~ ~in~-o~ed ~ ~e right of su~ivomhip must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF O~TH NUMBER TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) c~ 'Sb,. oo REV-1511 EX+ (12-99) ,; COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Debts of decedent must be reported on Schedule I. DESCRIPTION iTEM NUMBER 4.. 5. 6. 7. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal F~esentative's Commissions Name o" ersonal Representative(s) ~" s:cmiae~ :~:::(s)/EIN Number of Personal Repre~ Street Address ~ City ~ ~"S~te __ Year(s) Commission Paid: ~ Attorney Fees Zip Family Exemption: (If dec,ss is not the same as clai~ach explanation) Claimant Street Address State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees AMOUNT TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIE% & LIENS Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. TOTAL (Also enter on line 10, Recapitulation) $ J/..~,/..]0 J .. ~,,'~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (1-97) ~ ~ .~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER II. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outdght spousal distributions) FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) aZ/- 02- AMOUNT OR SHARE OF ESTATE 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 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) Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2002-00207 PA No. 21-02-0207 ESTATE OF PEASE SARA GOODING a/k/a PEASE SARA G. Late of WEST PENNSBORO TOWNSHIP , Deceased Social Security No. 224-90-9279 WHEREAS, on the 26th day of February 2002 an instrument dated August 16th 1991 was admitted to probate as the last will of PEASE SARA GOODING (~S'~', ~'~'~', ~~) a/k/a PEASE SARA G. late of WEST PENNSBORO TOWNSHIP , CUMBERLAND County, who died on the 21st day of February 2002 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to MOORE JANET PEASE who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 26th day of February 2002. ~egzs~er ~ **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) OF 21-2002-207 SARA GOODING PEASE I, SARA GOODING PEASE (Social Security Number 224-90-9279 ) of Frederick County, Maryland, being of sound mind and fully aWare of this deposition and being capable of executing a valid deed or contract, and not acting under duress, coercion or undue influence of any person, do hereby declare that this is my Will and revoke all Wills and Codicils at any time heretofore made by me. FIRST I direct my Personal Representative to pay such of my debts as may not be barred by limitations, and my funeral expenses, without the necessity of an Order of Court approving the same. All such debts shall be paid before distribution is made and no apportionment of such debt, tax or expense shall be made against any particular person or class or property. SECOND I am married to DONALD FREDERICK PEASE. JANET PEASE MOORE and MARCIA P. LEBHAR. We have two daughters, THIRD Ail the rest of my estate and property, whether in possession, expectancy or remainder, including all property over which I may have any power of appointment, I give, devise, bequeath and appoint to my husband, DONALD FREDERICK PEASE, absolutely and free of trust, provided he shall survive me. In the event my husband, DONALD FREDERICK PEASE, has predeceased me or shall fail to survive me for a period of thirty (30) days, then and in that event, I give, devise and bequeath all the rest of my estate and property unto my two daughters, JANET PEASE MOORE and MARCIA P. LEBHAR to share and share alike'. In the event either of my said daughters shall have predeceased me then I direct that the share of my residuary estate to which my said deceased daughter would have been entitled, shall be given, devised and bequeathed to her then living issue ~in equal shares to share and share alike~ In the further event that either of my said daUghters shall have predeceased me without leaving issue her to survive, then I direct that her share of my residuary estate shall be distributed to my surviving daughter or her surviving issue as above provided, as the case may be FOURT~ I nominate and appoint my daughter, JANET PEASE MOORE, as Personal Representative, without bond, of this Will. In the event she should predecease me or is unable to serve for any reason, then I nominate and appoint my daughter, MARCIA P- LEBHAR, to serve in her place. I request that my Personal Representative be allowed to serve without bond or sureties, except as required by law. In addition to all other powers, duties and discretions 9ranted to, or imposed upon my Personal Representative by law, my Personal Representative shall have reinvest, sell, assign, particularly the power to mortgage, exchange' lease, PAGE 2 of 3 invest transfer and or ~'"~?~'~'- - , - ~' ion to, the discretion of the~Pers°nal Representative?~with°ut applicat approval of, or th& ratification by, the Court having jurisdiction over the administration of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal , 1991. SIGNED, SEALED, PUBLISHED' AND DECLARED by the above named Testatrix, SARA~ GOODING PEASE, as and for her LAST WILL AND TESTAMENT, in the presence of us, who,'at her request, in her presence, and in the presence of each other, have hereunto sUbscribed our hands as witnesses-- WITNESSES: ADDRESS DATE ADDRESS c lT( I ADDRESS bATE ADDRESS PAGE 3 of 3 r- m r~r?1 I"rl m o ~ m m I I I I II zO z-.i American Funds PO Box 2280 Norfolk VA 23501-2280 Account Statement March 28, 2002 SARA G PEASE C/O JANET PEASE MOORE 920 STANLEY DR EARLYSVILLE VA 22936-9600 3176 Your financial adviser KELLYflIJFO JOHNSTON, LEMON & CO. INCORPORATED 1101 VERMONT AVE., N.W., WASHINGTON DC 2OOO5-3521 #80O Transactions SMALLCAP I/VoHd Fund - Class A .............. ' ................................................................................................. Fund number 35 Account number 58299067 Trade date Description Shares this Dollar amount Share price transaction Share balance Beginning Share Balance ........................................................... 03/28/02 Shares Redeemed -$42,319.28 $23.44 1,805.430 1,805.430 03/28/02 Change of Address ' 0.000 Ending Share Balance 0.000 0. 000 For more account information · Call your financial adviser · 24-hour automated information and services American FundsLine ® 1 800 325-3590 American Funds Web site www.americanfunds.com · Personal assistance - 8 a.m. to 8 p.m. Eastern time M-F Shareholder Services 1 800 421-0180 To add to your investment Make check pay~b, le to Amertcan Funds SARA G PEASE If investing in a new fund, please obtain a Service Company Please write your account number on your check. Do not send cash. prospectus from your financial adviser or our Web site. American Funds Service Company PO Box 2280 Norfolk VA 23501-2280 000623468 010 0000000 Fund Account Investment Fund number number amount ....................................... i'i ............... .................. .................................................... Check total $ 0000 83168110 000582990670 0000035 SCHEDULE K-I (Form 1065) ! Partner's Share of Income, Credlts, Deductions, Etc. Departmept of the Treasury > See separate instructions [nternal Revenue Servlce For calendar year 2001 or tax year beginning and endlng I Partner's Identifying number > 295-01-1554 Partnershlp's Identifying number > OU6 No. 1545-0099 2001 04-2839837 Partner's name, address, and ZIP code I,,,111,,,1,,1,1,1,,I,,,111,1,,,I,,11,,I,,I,,1,,,11,,11,,11,,I DONALD F & SARA G PEASE 113 GREEN RTDGE LN NEWV[LLE PA 17241-9484 A This partner lsa [ ] general partner [X] limited partner [ ] 11mlted liability company member Partnersh/p's name, address, and ZZP code B What type of entlty ls thls partner? > [NBZVZDUAL C Is thls partner a £X] domestic or a [ ] ?orelgn partner? (1) Before change (11) End of D Enter partner's percentage of: or termination year Proflt sharlng ......... 0.00000 % 0.03889 Loss sharlng ......... 0.00000 % 0.03889 Ownership of capltal ...... 0.00000 % 0.03889 E ZRS Center where partnershLo fl/ed return: MEMPHZS, TN WTNTHROP GROWTH INVESTORS ! 55 BEATT!E PLACE GREENVTLLE SC 29602 F Partner's share of llab/lltles (see Xnstructlons): Nonrecourse ........................... $ 0.00 J Analysls of partner's capltal account: (a) I Guallfled nonrecourse financing ....... $ 7,689.42 Other ................................. $ 0.00 Tax Shelter Registration Number · 84289001772 Check here if thls partnership is a publicly traded partnersh/p as defined in sectlon 469(K)(2) ....... [ ] Check applicable boxes: (1) [ ]Flnal K-1 (2) [ ] Amended K-I I(c) Partners shar& of llnes Capltal account at (b) Capltal contr/buted 3, 4, and 7, Form 1065, beginning of year I durlng year I Schedule M-2 ( 606.70) 0.00 I 53.94 (d) Withdrawals and dlstr/butlons ( 1,386.25)J (e) Caplta! account at end of year (com~lne columns (a) through (d)) ( 1,939.01) (a) Distributive share 1rem 2 Net lncome (loss) from rental real estate activity(les) .......... 4A Portfolio Income (Loss) Interest 1481 (1) !nvestment lncome lncluded on llnes 4a through 4f above ...... 16A Depreciation Adjustment on property placed in servlce after 1986 ................................................ 16E Other adjustments and tax preference items (attach s;~;~;~;;:;;;; 21 Nondeductible expenses ........................................... 22 01str/butlons of money (cash and merketable securities) ......... 25 SUPPLEMENTAL !NFORUAT!OtJ: Your share of the partnersh/ps E&P depreciation adjustment 2 4A 148 16A ( 16E ( 21 22 (b) Amount 31.83 22.24 22.24 93.08) 24.46) 0.13 1,386.25 0.00 204.03 (c) 1040 f~ters enter the a~ount in column (b) on: Bee Form 1065 !nstructlons Sch. B, Part I, llne 1 See Form 1065 !nstructlons See Fora 1065 & 6251 Instructions See Form 1065 & 6251 Instructions See Partner's !nstructlons for Schedule K-1 (Form 1065). See footnotes below. 1. Llne 16e, ACE Depr AdJ, and Line 25, E&P Oepr Ad], are applicable to corporations and pass-through entitles only, 2. For tax exempt partners your UBTI per unlt ls $23.59. 3. Sunflower (DEK Assoc/ates) was fully dlsposed of. 4. FOR INFORUATION ONLY-THE FOLLOWING !NFORUAT!ON IS APPL!CABLE ONLY TO THOSE PARTNERS TRANSFERR!NG OR SELLING TNE!R PARTNERSH!P !NTEREST DURING 2001: At the end of the year, the potential Sectlon 1250 galn recapture per unlt ls $26.74. At the end of the year, the potential unrecaptured Section 1250 galn per unlt ls $885.41. 5. UD state tax withheld, if applicable, ls reported below and may be cla/med as a credlt on your 2001 MD income tax return. 6. Separate actlvlty & state reporting: Ueadow Wood/FL-L/ne 2-39.188~;Llnes 4a&1461-29.993~;Llne 16a-40.48~;L1ne 16e-77.683~: Stratford Place/MD-Line 2-438.882~;Llnes 4a&1461-38.487~;Llne 16a-41.57%;Llne 16e-11.546%;Sunflower/TX-Llne 2-(256.74)%; Stratford Village/AL-(121.50)%; Llnes 4a&1461-31.52~;Llne 16a-17.94%;Llne 16e-10.775% ** Partner admlt date: 11/30/1984 Unlts at end of year: 10.00000 00034124 / W05 / 000561 2001 Maryland tax wlthheld 7.12 484 FARMERS NATIONAL BANK OF NEWVILLE - A DIVISION OF ADAMS COUNTY NATIONAL BANK NEWVILLE PA 17241 OWNERSHIP OF ACCOUNT - PERSONAL PURPOSE J~INDIVIDUAL [] [] JOINT - WITH SURVIVORSHIP (and not aa tenants in common) [] JOINT - NO SURVIVORSHIP {as tenants in common) [] TRUST - SEPARATE AGREEMENT: ! [] REVOCABLE TRUST DESIGNATION AS DEFINED IN THIS AGREEMENT Name and Address of Beneficiaries: lACCOUNT 2077310 NUMBER ACCOUNT OWNER(S) NAME & ADDRESS SARA G PEASE ESTATE JANET PEASE MOORE EXEC 920 STANLEY DRIVE EARLYSVILLE VA 22936 [~NEW [] EXISTING TYPE OF ~CHECKING [] SAVINGS ACCOUNT [] MONEY MARKET [] CERTIFICATE OF DEPOSIT [] NOW ~-~ BASIC CHECKING This is your (check one): ~Permanent [] Temporary account agreement. OWNERSHIP OF ACCOUNT - BUSINESS PURPOSE [] SOLE PROPRIETORSHIP [] CORPORATION: [] FOR PROFIT [] NOT FOR PROFIT [] PARTNERSHIP BUSINESS: COUNTY & STATE OF ORGANIZATION: AUTHORIZATION DATED: DATE OPENED .. 02/26/2002 BY RDC INITIAL DEPOSIT $ 18,249,54 [] CASH [] CHECK [] HOME TELEPHONE #., 717-776-3953 BUSINESS PHONE # 404-5(~2 -23?2 DRIVER'S LICENSE # E-MAIL EMPLOYER MOTHER'S MAIDEN NAME Name and address of someone who will always know your location: Number of signatures required for withdrawal 1 FACSIMILE SIGNATURE(S) ALLOWED? [] YES [~NO [× ] SIGNATURE(S) - The undersigned agree to the terms stated on every page of this form and acknowledge receipt of a completed copy. The undersigned further authorize the financial institution to verify credit and employment history and/or have a credit reporting agency prepare a credit report on the undersigned, as individuals. The undersigned also acknowledge the receipt of a copy and agree to the terms of the following disclosure(s): ~Deposit Account [] Funds Availability [] Privacy [~Electronic Funds Transfer [] Truth in Savings I.D. # 029382417 D.O.B. 3/22/44 BACKUP WITHHOLDING CERTIFICATIONS TIN: 224-90-9279 [~ TAXPAYER I.D. NUMBER - The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number. ~ BACKUP WITHHOLDING - am not subject to backup withhoding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. [] EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. ' SIGNATURE: I certify under penalties of perjury the statements checked in this section and that I am a U.S. person (including a U.S. resident alien}. - ' - /(Date) ' FORN ~ © 1992 Sankers Systems, Inc., St. Cloud, MN Form NIPSC-LAZ-PA 11/22/2000 (3): I.D. # D.O.B. [× ] (4): I.D. # D.O.B. Ix ] I.D. # DmO.B. J~uthorized Signer (Individual Accounts OnlyJ L ] JANET PEASE MOORE EXEC I.D.# D.O.B. [page I of 2} Print Key Output 5769SS1 V4RSM0 000526 ACNBANK Display Device ..... : NVMTEL25 User .......... : COLDSMIR Page 1 02/26/02 11:43:48 2-26-2002 Checking Account Inquiry Next display: 02 20-0700-1 11:43:45 Basic Account Data NVMTEL25 * ......... Account Name/Address .......... . Account number: 176036 REL SARA G PEASE Short name: PEASE SARA G SPECIAL ACCT TIN: 224-90-9279 TIN Crt: C BR: 801 920 STANLEY DRIVE * ........... Balance Data ............ , EARLYSVILLE VA 22936 Current balance: Available balance: Available tomorrow: Memo balance: Hold amount: Check CR balance: Interest due: Int paid this year: 12,048.18 12,048.18 12,048.18 12,048.18 0 .00 .00 .00 * .......... Customer Activity ............ . Stops/holds active: Date last contact: 2-12-02 Date last active: 2-12-02 Date last deposit: 2-04-02 Int paid last year: .00 Amount last deposit: * ........... Account Data ............ , . ..... Account status: 1 Product type: 16 Statement code/cycle: C / 30 Date opened: 9-23-96 Processed thru: 2-25-02 F3=Exit F10=Acct inquiry charge 11,918.23 --Previous Statement Data ......... * Last stmt date: 1-31-02 Last stmt balance: 4,175.41 Checks/deposits since: 8 / 2 Service charge type/plan: A 15 Combined stmt/nbr copies: N 0 F13=Inquiry window F15=Restart Print Key Output 5769SS1 V4R5M0 000526 ACNBANK Display Device ..... : NVMTEL25 User .......... : COLDSMIR Page 1 02/26/02 11:43:22 2-26-2002 Checking Account Inquiry Next display: 02 20-0700-1 11:43:15 Basic Account Data NVMTEL25 * ......... Account Name/Address .......... . Account number: 176028 REL SARA G PEASE Short name: PEASE SARA G 920 STANLEY DRIVE TIN: 22~-90-9279 TIN Crt: C BR: 801 EARLYSVILLE VA 22936 * ........... Balance Data ............ . Current balance: Available balance: Available tomorrow: Memo balance: Hold amount: Check CR balance: Interest due: Int paid this year: 333.96 333.96 333.96 333.96 0 .00 .00 .00 * .......... Customer Activity ............ . Stops/holds active: Date last contact: 2-05-02 Date last active: 2-05-02 Date last deposit: 2-05-02 Int paid last year: .00 Amount last deposit: * ........... Account Data ............ . . ..... Account status: 1 Product type: 16 Statement code/cycle: C / 2 Date opened: 9-23-96 Processed thru: 2-25-02 F3=Exit F10=Acct inquiry charge 100.00 --Previous Statement Data ......... * Last stmt date: 2-05-02 Last stmt balance: 333.96 Checks/deposits since: 0 / 0 Service charge type/plan: A 15 Combined stmt/nbr copies: N 0 F13=Inquiry window F15=Restart Print Key Output 5769SS1 V4R5M0 000526 ACNBANK Display Device ..... : NVMTEL02 User .......... : KOUGHC Page 1 02/26/02 12:02:45 2-26-2002 Savings Account Inquiry Next display: 02 20-0700-1 12:02:35 Basic Account Data NVMTEL02 * ......... Account Name/Address .......... , Account number: 5003086 IBA SARA G PEASE Short name: PEASE SARA G 920 STANLEY DRIVE TIN: 224-90-9279 TIN Crt: C BR: 801 EARLYSVILLE VA 22936 ........... Balance Data ............ . Current balance: Available balance: Available tomorrow: Memo balance: Hold amount: Check CR balance: Interest due: Int paid this year: 5,779.09 5,779.09 5,779.09 5,779.09 0 .00 15.71 .00 * .......... Customer Activity ............ , Stops/holds active: Date last contact: 6-19-01 Date last active: 12-13-96 Date last deposit: 12-13-96 Int paid last year: 137.86 Amount last deposit: * ........... Account Data ............ . , ..... Account status: 5 Product type: 17 Statement code/cycle: M / 12 Date opened: 12-13-96 Processed thru: 2-25-02 F3=Exit F10=Acct inquiry charge 5,046.40 ..... Passbook Information .......... , Passbook balance: 5,679.42 Date last update: 6-03-01 Open items exist for this account F13=Inquiry window F15=Restart SWAIM HEALTH CENTER 210 BIG SPRING ROAD NEWVILLE PA 17241-9486 (717) 776-8256 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 01/31/2002 Presbyterian Homes, Inc. Balance Due: 5,389.69 SARA PEASE cio JANET MOORE 920 STANLEY DRIVE EARLYSVILLE VA 22936 Account Number: 60693 Balance Forward: 2,663.67 Pdvate Room Difference 899.00 3,562.67 Shampoo/Cut/Set 19.00 3,581.67 Shampoo & Set 11.00 3,592.67 Shampoo & Set 11.00 3,603.67 Manicure 6.00 3,609.67 Shampoo & Set 11.00 3,620.67 Telephone 16.02 3,836.69 Meal Plan - 260 270.00 3,906.69 Monthly Fee-HCTF 843.00 4,749.69 Health Protection Plan Fee 640.00 5,389.69 TOTAL: ~ ~'"~-0'00~'~ 5,389.69 01/01/2002 - 01/01/2002 01/02/2002 - 01/02/2002 01/09/2002 - 01/09/2002 01/16/2002 - 01/16/2002 01/23/2002 - 01/23/2002 01/23/2002 - 01/23/2002 01/31/2002 - 01/31/2002 02/28/2002 - 02/28/2002 02/28/2002 - 02/28/2002 02/28/2002 - 02/28/2002 SWAIM HEALTH CENTER: SARA PEASE 60693 SWAIM HEALTH CENTER 210 BIG SPRING ROAD NEWVILLE PA 17241-9486 (717) 776-8256 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 01/31/2002 Presbyterian ~-lomes, Inc. Balance Due: 7,337.84 SARA PEASE cio JANET MOORE 920 STANLEY DRIVE EARLYSVlLLE VA 22936 Account Number: 224909279PC Balance Forward: 7,337.84 SWAIM HEALTH CENTER: SARA PEASE 224909279PC March 18, 2002 Presbyterian Homes Re accounts for Sara Pease The statements dated 2/28/2002 posted the payments I made to my mother's accounts incorrectly. $100 was paid to Account Number 224909279PC; and $2,663.67 was paid to Account Number 60693. The bottom line is the same; I am, however, trying to keep the disposition of the two accounts separate and correct. I have also subtracted the amount paid on March 3 (and received too late for your February statement) from the balance due. Sincerely, Jan tfft~/e'ase Moore 920 Stanley Drive Earlysville, VA 22936 SWAIM HEALTH CENTER 2i0 BIG"SPRING ROAD NEVVVILLE PA 17241-9486 (717) 96o-7702 ~, ..... ^ccou. Ts .ECE(~AaLE STATEM E-~T-~ y . Statement Date: 0~28/2002~ .. ~res~jteria~ ~es, Inc. Balance Due: 4,674.17 SARA PEASE c/o JANET MOORE 920 STANLEY DRIVE EARLYSVILLE VA22936 Account Number:. 224909279PC ,674.17 TOTAL: 0.00 SWAIM HEALTH CENTER: SARA PEASE 224909279PC SV~AI'M H"'EALTH CENTER 210 BIG SPRING ROAD NEWVILLE PA 17241-9486 (717) 960-7702 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 02J28/2002 Presbyterian .?-lomes, Inc. Balance Due: 5,410.93 SARA PEASE cio. JANET MOORE 920 STANLEY DRIVE EARLYSVlLLE VA 22936 Account Number: 60693 i~ ' : . 01/30/2002 - 01/30/2002 Shampoo & Set 11.00 5,400.69 02/06/2002 -02/06/2002 02/11/2002 - 02/1112002 02~11/2002 -02/11/2002 02/13/2002 - 02/13/2002 02/15/2002 -02/15/2002 02/20/2002 - 02/20/2002 02/20/2002 o. 02/20/2002 02/20/2002 - 02/20/2002 02/21/2002 - 02/21/2002 02/21/2002 - 02/21/2002 02/21/2002 - 02/21/2002 02/28/2002 - 02/28/2002 02/28/2002- 02/28/2002: 02/28/2002 - 02/28/2002 Shampoo/Cut, Set , 19.00 Payment from statement 01/02 5,419.69 5,319.69 Recomb 5.50 5,325.19 Shampoo & Set 11.00 5,336.19 Pdvate Room Difference 435.00 5,771.19 Telephone 31.10 5;802.29 Food & Supplies 22.50 5,824.79 Pdvate Room Difference 87.00 5.911.79 Monthly Fee-HCTF 602.14 6,513.93 Meal Plan - GRV-AI_/SNF 192.86 6,706.79 Health Protection Plan Fee 457'.14 7,163.93 Meal Plan - 260 (270.00) 6,893.93 Monthly Fee-HCTF (843.00) 6,050.93 Health Protection Plan Fee (640.00) 5,410.93 121 .: 100.00 5,410.93 SWAIM HEALTH CENTER: SARA PEASE 60693 SWAIM HEALTH CENTER 210 BIG SPRING ROAD 7) ¢'~3'~I6'L'E PA 17241-9486 ACCOUNTS RECEIVABLE STATEMENT I~:_~l,l,[.(qel,[=.~,l.[.l,l~:=~[~i;[~'-nt Date: 03/31/2002 'l res yte rian $ omes, ]nc. Balance Due: 1,508.47 SARA PEASE cio JANET MOORE 920 STANLEY DRIVE EARLYSVlLLE VA 22936 Account Number: 60693 Balance Forward: 5,410.93 02/01/2002 o 02/01/2002 02/01/2002 - 02/0112002 03/06/2002 - 03/06~2002 03/21/2002 - 03/21/2002 03/21/2002 - 03/21/2002 Meal Tax Guest Meals Payment from statement 01/02 Payment from statement 02/02 Payment from statement 02/02 1.78 29.72 300.00 121.24 3,512.72 5,412.71 5,442.43 5,142.43 5,021.19 1,508.47 TOTAL: 31.go--~-~ 3,933.96 1,508.47 SWAIM HEALTH CENTER: SARA PEASE 60693 SWAIM HEALTH CENTER 210 BIG SPRING ROAD 7) -~~LE PA 17241-9486 ACCOUNTS RECEIVABLE STATEMENT []-'~lP. lm[~=~ela[=~w~~~ Date: 03/31/2002 resby e Inc. Balance Due: (1,476.97) SARA PEASE cio JANET MOORE 920 STANLEY DRIVE EARLYSVlLLE VA 22936 03/06/2002 - 03/06/2002 03/21/2002 - 03/21/2002 Payment from statement 01/02 Payment from statement 02/02 Account Number: 224909279PC Balance Forward: 4,674.17 2,726.02 1,948.15 3,425.12 (1,476.97) TOTAL: o.oo 6,151.14 (1,476.97) SWAIM HEALTH CENTER: SARA PEASE 224909279PC Caah or Credit Available Po~lng ~ ~ 02/09/02 Date Transectlona FEBRUARY 2002 STATEMENT PURCHASES ~D ADJUSTMENTS 01/12 01/09 3471 MC C OLD SALEM [NC ~[NSTON-SALEMNC MA[L/PHONE 01/12 01/12 0233 ~C C ANNUAL FEE/FZNANCE CHARGE TOTAL FOR BILLZNG CYCLE FROM 01/12/2002 THROUGH 02/09/2002 AL $15.00 I 03/10/02 Charge= I Credits (CR) ~.~_68.45 · i J rl~.O0 (~'$ 36.45 $0. O0 IMPORTANT NEWS EVEN THE BEST CREDIT RATING CAN BE THREATENED· CALL 1-800-295-3455 ~(-~<--'~-~'.,-- FOR INFORMATION ABOUT OPTIONAL CREDIT PROTECT[ON. ACCESSING ADDITIONAL CASH IS EASY! PRESENT YOUR CREDZT CARD AT THE BANK COUNTER, OR CALL 1-866-222-8358 TO REQUEST A PIN CODE FDR USE AT AN ATM. LOG INTO WWW.MBNACASH.COM TO CONSOL[DATE BALANCES TO YOUR MBNA CREDIT CARD ACCOUNT. IT'S A FAST AND CONVENZENT WAY TO SAVE TIME AND MONEY. SUMMARY OF TRANSACTIONS and Credits ~;o.oo $o.oo FINANCE CHARGE SCHEDULE Advances Adjustments FINANCE CHARGES FINANCE CHARGE Tntal Past Due Amount ................. $ 0.00 5....[ ~ l Current Payment .................. $15.00 $0. O0 $ 36.4 $0. O0 . . To*al Minimum Payment Due ..... $25.00 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY Cat~ P~odlcRato Cash Advances A. BALANCE TRANSFERS, CHECKS.O.043753% DLY B. ATM, BANK ................. 0.043753% DLY CPURCHASES. · ' ................. 0.043753% DLY Corresponding ~nual Pemantage R~e 15.97% 15.97% 15.97% Balance Subject to Finance Charge $0.00 $0. O0 $0·00 ANNUAL PERCENTAGE RATE.. ................ SEE ABOVE PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. 5329 0012 0349 7533 · Fa' Customer Salisfaclim and up lo Ihe minule automated infa'malian including, ~,~c~,;.a~,~/_a?.e_~ _e~i_'l: pay man.ts.r .ec~?, .p~y. men.ts due, due dale, aymant ~ mlU~.laUUll, ~l' lO Ireq~es][ anp,ca[e slalem~l$, ~ ~. · Mail paymanls to: MBNA AMERICA P.O. BOX 15019 WILMINGTON, DE 19886-5019. ' ' · .Billing rights are Ixesaved oaly by wfiltm inqu~. M~ biling inqui4ies, using [am an Ihe back. and olhe~ ia~iries to: MBNAAMFRCA PO BOX 15026 WILMINGTON DF 19850-5026 : - - : : 442 04F OGQ 0508 0910 04 PAGE 1 OF I Cards Senior Member Statement of Account Prepared For Ck:~ing Date SARA G PEASE February 15, 2002 Customer Service 800-528-4800 (24 hours / 7 days) www.amedcanexpress.com Page 1 of 5 Did you know you can pay your American Express bill By Phone? Just call 1-800-I-PAY-AXP or 1-800-472-9297. ~count Nurn~er It's easy and ready 3720-356335-24000 whenever you are. Account Summary New Charges/ Previous E~Jance $ Payment Activ~y $ Adjuslments $ Due in Full I 14~ -1, +29.00 * Indicates posting date. Pa)~iients New Balance please Pay By March 3, 2002 Please refer to page 2 for important information regarding your account Total of Payment Activity -140.43 Due in Full Transactions for SARA G PEASE Card 3720-356335-24000 January 30, 2002 45 Day Late Payment Fee 29.00 Re~erence: 320020300684000181 Activity for SARA G PEASE 29.00 Total of Due in Full Activity 29.00 Continued on reverse * ~ S T A T E M E N T ,.~.. Statement Date: 2/.28/0Z. Pa,ge: A,z c o u r, t #: 100000 T'.-.? 9 Name: SARA PEASE dANET MOORE 920 STANLEY DRIVE EARLYSVILLE? VA 22~3~ I¢ you have ar, y quest~c, ns r'egar, d~ng yc, ur. ?:,~1'1 please (717) 567-:-.-"14'?' or'. 1-L-]00-SZS-2:--"7'r.?. Thank yc, u.! Da te 2/0B/02 ~/08/0~ ~/09/02 2/0~/02 2/0~/02 2/0~/0X 2109102: 2/0?/02 2t0~/02 Des,-r. ~ ,~' ~c ,_. ~ c,n 0 t¥' Amc, ur; t F'r. ev ~ c, us Rai ar, ce RF~ 1055212 ADVAIR DISKUS 250/50MC:G /60 DOC#388 PAYMENT - THANK YOU RF# '.;'732'75 PREMARIN O.c~.25MG TAB 30 RF# '.-.-"7:--~2:78 DILTIAZEM C:D 300MG CAP :30 RF# 1024702 KCL ER 10MEQ TAr-: (KLOR-CO :BO RF# 10:':":3177 ACETAMINOF'HEN .500MG C:APLE 24.("~ RF# 103:'::178 F'REVACiD 30MG CAP 60 RF# 1033179 C:EI_EXA 20MG TAr:LET :BO RF# 104~'-','.-.75.S LEVOXYL 0.05MG TAB (50MCG 30 RF# 1055217 FUROSEMIDE 40MG TAB 30 RF# 1068440 CELEXA 40MG TABLET :B() :B .~ 478.94 13!. 04 ! , 638.:36- 24. :39 75.76 1 1..'..-.'0 5.85 2.--"44.59 10.02 67.3! ** 'continued on next page ** CONTINUING CARE RX · ~.o S 2ND ~"r /F'O _._. ~¢'~v .~ ~ NEWPORT F'A 17074 Statement ,date: Ac ':o ur,'b #: 10(}OC~CrF'r.?'? GRE Name: SARA PEASE .JANET MOORE 92:(') STANLEY DRIVE EARLYSVZLLE, . VA 22:'.-.?:':;6 * * S T A T E M E N T ~.. ta~ement Date: 2/ZS/()Z Ar'-cc, unt #: 10000079'F~ F'a'2e: Name: SARA PEASE .JANET MOORE '~ZO STANLEY DRIVE ARLYoVILLE~ VA ZZ~':,~: IP y,z,u have any quest.~ons r'egar, dir, g ye, ur. I:,J 1'! please ca11 (717) 567-£147 of 1-800-675-ZZ79. Thank you! Da te 2:/0'?102: ~i09/02: ~ / 09 / O.-.'r-' :.'-" / (')'F: / 0 ? '..-.' / (') ,-~ / t"~.'.-'- 2:/1'.310::-"' Z / 15 / O:-:Z Z/15/02: ;~/1L=.' / OL;!: 2:/18 / 0:.:" 2:/:1.8/0~ ;.'2 / ~ 1 / O;T.:: D e s c r- ~ p t J o r, ................................................. Qty RF# 106,8441 RF# 1058442 RF# 1095504 RX# 110C):38:3 RX¢." 1100384 RX# i 1 RX# 1114770 RX~ 1114947 RX# 11 ld, 8~8 RX# 111'T540 RX# 1117.545 RX# 11;Z;--Z077 NEURONTIN 100MG CAP 90 MOBIC 7.SMG TABS 100 30 DAILY VITE TAB W/IRON 30 ALTACE 10MG CAP 120 F'I_AVIX TSMG TABLET :30 OXYCONTIN 80MG TABLET ~0 FUROSEMIDE 40MG/4ML VIAl_ 4 MORPHINE 4MG/ML CP.J LL 10 FUROSEMIDE 40MG/4ML VIAL 4 DURAGESIC ZSMCG/HR PATCH 10 ROXANOL 20MG/ML SOLN :30ML :30 LORAZEPAM 1MG TAB A rn,-, u r~ t 45.64 I .~ 1~7'. :31 0.50 445}. ~4 o 17 4 ~ '') 9.17 9. :3:3 4.7~ ** cc, ntJnue,J on r, ext page C:ONTINUING CARE RX ..... S '.ZND ST /F'O £u']X 355 NEWPORT PA 17C, 74 Statement ,date: 2/28/02: Acc:,ur, t #: 10000079'~.) GRE Name: SARA PEASE · JANET MOORE 9ZO STANLEY DRIVE EARL-YSVZLLE~ VA 22[~36 * * S T A T E M E N T * * Sta'temer, t Date:--' /..' o/0.."'" A,_-,zour~t #: 1 c)0000]r'~'.--.~ Page Name: SARA PEASE · JANET MOORE ~20 STANLEY DRIVE EARLYSVILLE~ VA 2~36 I.P y,:,u have any ,questions r'egar.,Jing y,-,ur, bill please cal'l (7 J '?' ) ?, ...... ..... c. 7-~147 c,r- 1-800-~,75-.'..'"Z7'.-.9. Thank y,z,u! Da Ce 21 / ~:.' 1 / 02 F AY, ,~zN F PATIENT NAME: INSURANCE: WEST '.SHORE Ei~$ - CARLISLE 50:3 N 21ST .'=_;'r CAI~.P HILL~ PA 17011 PHONE (800) :36'7-0512 TAX ID 2:3--246:~:002 INVOICE PATIENT NUMBER: P~',A'.:_";E ~'..2;ARA (3 CALL NUMBER: ,:,._,:,.~4 DATE OF CALL: 'B0:.2:7706 =' ~ 02 / 16 / 02 HED I CARE B 2'95011 ...... 4D TIME OF CALL: AARP 11958663~. 1 CALLER: FROM: TO: '.:.;ARA G :2I(.) BIG '.i:.;PRIHG RD NEWVILLE, PA 17241 PIDIP B 2:10 BI(3 SPRIN(3 RD CARLI:.:;LE REGIONAL lIED ICAL cra REASON(S) FOR DY?];PNEA TRANSPORT FEBR I LE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT Base Rate-Non Tr-ans~ o r.t. i n 1.0 ::~:43.78 343.7:-2: CARD 1AC HONITOR 1.0 68.80 68.80 3CC SYRINGE 1.0 1.46 1.46 EKG ELECTRODES 1.0 4.02 4.02 IHFECTION CONTROL SUPPLIE 1.0 16.:38 16.:38 OP :5;ITE 1.0 4.47 4.4-7 TOTAl] CHARGE:S THIS CAI]Ii $ 4:5:8.91 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT TOTAL PA¥'I~EI,ITS THI'.=; CALL 0.00 PLEASE PAY THIS AMOUNT ~ ~; 4:3:=:. 91 Ridge llll/Newville, Pennsylvania A UNIT OF PRESBYTERIAN HOMES, INC. [ .,¢." ~' [' Big Sp ri n~;~;[ ~" ~. N e wv.i ~e~ P.~GsJ/I va~ i a .~'41~6.3192 DONALD J. GRISEWOOD, CPA 5058 LAVISTA ROAD TUCKER, GEORGIA 30084 EI # 58-1559197 678-937-1715 FAX 678-937-9591 Sold To: Sara G. Pease c/o Janet Pease Moore 920 Stanley Drive Earlysville, VA 22936 Document Number: 009770 Document Date: 04/10/02 Page: 1 Ship To: Sara G. Pease c/o Janet Pease Moore 920 Stanley Drive Earlysville, VA 22936 Ship Via.: Ship Date: 04/10/02 Due Date.: 04/10/02 Terms .... : NET DUE Cust I.D ..... : peases P.O. Number..: P.O. Date .... : 04/10/02 Job/Order No.: Salesperson..: Item I.D./Desc. Ordered Shipped Unit 1.00 1.00 Preparation of 2001 federal and state income tax returns Price Net TX 150.0000 150.00 E Schedule D prep 1.00 1.00 75.0000 75.00 E Schedule B prep 1.00 1.00 50.0000 50.00 E ALL BILLS DUE UPON RECEIPT 1.5 % PER MONTH WILL BE CHARGED ON ALL BILLS ~NPAID AFTER 30 DAYS FROM BILLING DATE Subtotal: Tax ..... : Total...: 275.00 0.00 275.00 I¸'- , .~.: ~ ~,~.~ BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTVZSZON DEPT. 180601 HARRISBURG, PA 17128-0601 JANET PEASE NOORE '0;i~ 920 STANLEY DR EARLYSVILLE VA 22~6 COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTTCE OF TNHER/TANCE TAX APPRATSENENT, ALLONANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUNSER JLiL --] ",",-' ;i,;,~! COUNTY ACN RE¥-IE47 EX AFP (D1-D2) 06-24-2002 PEASE SARA OZ-Z1-200Z 21 02-0207 CUHBERLAND 101 = Amount Remitted HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 REV 1547 EX AFP (01 02) NOTICE OF INHERITANCE TAX APPRAISENENT~'/~[[~'~- ................. ESTATE OF PEASE DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX SARA GFZLE NO. 21 02-0207 ACN 101 DATE 06-24-2002 TAX RETURN NAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 2. Stocks end Bonds (Schedule B) (2) 172;204.~- $. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 q. Nortgeges/Notes ReceivabZe (Schedule D) (q) .00 S. Cash/Dank Daposits/Nisc. Personal Property (Schedule E) ($). 21;850.92 6. Jointly O~ned Property (Schedule F) (6) O0 7. Transfers (Schedule G) ' 8. Total Assets (7) .00 APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expanses/Ada. Costs/Nisc. Expanses (Schedule H) (9) 1,782.99 10. Dabts/Nortgege Liabilitlas/Lians (Schedule Z) (10) 11. Total Deductions 12. Ne~ VaZua of Tax Return 14,401.78 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. 194,055.28 1~.]~.77 (la) 177,850.51 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) O0 Z~. Net Value of Estate Sub~ect to Tax ' (1~) 177,850.51 NOTE: I~ an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 reflect figures that lncZude the total of ALL returns assessed to date. ASSESSNENT OF TAX: (15) .00 X O0 = (16) 177,850.51 x 045= (17) .00 X 12 = (18) .00 X 15 = (19)= TNTEREST/PEN PAID (-) ANOUN~T PAID D_ALANCE OF TAX DUEI ., INTEREST AND PEN. J TOTAL DUE 400. Z--~'Z'~ 15. Amount of Line 1~ et Spouse1 rate 16. Amount of L/ne 1~ taxabZe et Lineal/Class A rate 17. Amount of Line 1~ et Sibling rate 18. Amount of Line 1~ taxable et CollatareZ/Class B rate 19. PrincipaZ Tax Due DATE I NUNBER 04-26-Z0~ CD 00 Z Z ~--~'~'~'~ ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. .00 8,005.27 .00 .00 8,003.27 8,005.79 ] Z.5ZCR .00 2.52CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REI)UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December II, 1981 -- if any futura interest in the estate is transferred in possess[on or enjoyment to Class B (cot[stere1) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoamonNaa[th hereby expressly reserves the right to appraiSe and assess transfer Inheritance Taxes at the lamful Class 8 (collateral) rate on any such futura interest. of Z000. (71 P.S. PURPOSE OF NOTICE: To fulfill the requirements of Section Z[qO of the Inheritance and Estate Tax Act, Act 13 Section 9[¢0). pAYHENT= Detach the top portion of this Notice end submit aith your payment to the Rag[star af N[lls printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS) AGENT REFUND (CR)= A refund of a tax credit, which ems not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-IS13). Applications ara available at the Office of the Register of Rills, any of the 13 Revenue District Offices, or by calling the spec[a[ lC-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers e[th spec[a[ hearing and / or speaking needs= 1-800-q~7-3010 (TT on[Y). OBJECTIONS: Any party in interest nat satisfied with the appraisement, allowance, or disel[owance of deductions, or assessment of tax (including discount ar interest) as shown on this Not[ce must object within sixty (60) days of receipt of this Notice by: OR --written protest to the PA Departamnt of Revenue, Doard af Appeals, Dept. 181011, Harrisburg, PA 17118-1011, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADH[N- of Revenue, ISTRATIYE CORRECTIOHS: Factual errors discovared on this assessment should be addressed in writing to: PA Dapartaent Dureau of Individual Taxes, ATTN: Post Assassaant Rev[aw Un[t, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (7173 787-6505. See page 5 of the booklet -Znstruct[ons for Inheritance Tax Return for a Res[dent Decedent" (REV-la01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due Ks paid within three (3) calendar months after the decedant's death, a five percent (SX) discount of the tax paid Ks allowed. PENALTY: The leg tax amnesty non-participation penalty Ks 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 per[od. 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 not[ca. INTEREST: Interest is charged beginning with first day of delinquency, or nine [9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20Z .OOOSq8 1991 91 .ooogq7 1983 161 .000q38 1993-199¢ 71 .000191 [98¢ llZ .000301 1995-1998 91 .0002q7 1985 131 .000356 1999 7Z .000191 1986 lOX .00027¢ 2000 8Z .000219 1987 9Z .O00Zq7 ZOO1 9Z .0002¢7 1988-1991 11Z .000301 2002 6X .O0016q --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DEL/NQUENT X DA/L¥ [NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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 Name of Decedent: ~%~ ~/~ ~.~ ; Date of Death: ~r~%u~/ ;al~ ~oc~ 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 ~-~ 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. ! is Yes, state the following: a. 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: ------ 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 Cerk of the Orphans' Court and may be attached to this report. Date Sign ~u~~re~ Name (Please type or print) Address Tel. No. Capacity: w'~'-Personal Representative (MAH:rmf/AM3) __Counsel for personal representative CO %0£ ~2-1811 0000 U.S. POSTRGE PRID ERRLYSV!LLE,VR 22936 RRR 26.'02 RMOUNT $3.50 000J52[2-03 BUREAU OF TND'rVTDUAL TAXES ZNHER/TANCE TAX DZVTSTON DEPT. 280601 HARRISBURG,, PA 17128-0601 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOT/CE OF /NHERITANCE TAX APPRA/SEMENT) ALLO#ANCE OR D/SALLO#ANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-B;') JANET PEASE MOORE 920 STANLEY DR EARLYSVILLE '0;i! JUL --1 VA 2 2 [I.~ 6 DATE 06-/q-ZOO2 ESTATE OF PEASE DATE OF DEATH 02-21-2002 FILE NUHBER 21 02-0207 /=,*!~'i}:!i/}.COUNTY CUHBERLAND ACN 101 Amount: Reai~:~:ed SARA G HAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THTS LTNE ~ RETA/N LOWER PORT'rON FOR YOUR RECORDS *-~ REV-15q7 EX AFP [01-02) NOT/CE OF ZNHERZTANCE TAX APPRATSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF PEASE SARA GFZLE NO. 21 02-0207 ACN 101 DATE 06-2q-2002 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~e~e (Schedule A) (1). 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S*ock/Par~nership /n~eres~ (Schedule C) ($) fi. Mortgages/No*es Receivable (Schedule D) (q) $. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) ($) 6. Jointly Owned Proper*y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabili*ias/Liens (Schedule /) (10) 11. To,al Deductions 18. Na~ Value of Tax Re~urn .00 17Z~ZOq.$6 .00 .00 21~850.92 .00 .00 (8) 1,782.99 1~,~01.78 (11) (12) 15. lq. NOTE: Cheri~able/Governaen*al Bequests; Non-elected 9115 Trusts (Schedule J) (13) Na~ Value of Es~a~e SubSec~ ~o Tax (lq) Zf an assessment ~as lssued previously, lines lq, 15 and/er 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. NOTE: To insure proper credi~ ~o your account, subaL~ ~he upper portion of ~his form wi~h your ~ax payment. 19~,055.Z8 ASSESSHENT OF TAX: 15. Aaoun~ of Line 1~ a~ Spousal ra~e 16. Aaoun~ of Line lq ~axable a~ Lineal/Class A ra~e 17. Aaoun~ of Line lq e~ Sibling ra~e 16. Aaoun~ of Line lq ~exeble a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYflENT RECEZPT D/$COUNT DATE NUMBER ZNTEREST/PEN PA/D (-) 0q-26-2002 CD00112~ ~00.16 16.18q.77 177,850.5! /F PAZD AFTER DATE ZNDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDZTIONAL INTEREST. .00 177,850.51 18 and 19 N';11 (1s), .00 x O0 = .00 (15). 177,850.51 X Oq5 = 8,00:3.27 (17). .00 X 1Z = .00 ('18), .00 x 15 = .00 (19)= 8,003.27 AMOUNT PAZD 7,605.65 TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 8,005.79 2.52CR .00 2.52CR TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQU/RED. TOTAL DUE IS REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE REFUND. SEE REVERSE S/DE OF TH/S FORM FOR ZNSTRUCT/ONS.) RESERVATION: PURPOSE OF NOTICE= PAYMENT: REFUND (CR): DDJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or far 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 future interest. To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, amy ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of tho Register of Hills, any of the 23 Revenue District Offices, or by calling tho special Z~-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing end / or speaking needs: 1-800-qq7-30220 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --mrittan protest to the PA Department of Revenue, Board of Appeals, Dept. 1810221, Harrisburg, PA 17118-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171228-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ZSO1) for an explanation of administratively correctable errors. any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (51) discount of the tax paid is alloaad. The 15Z tax amnesty non-participation penalty is computed on the tote1 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 nan-participation penalty is appealable in the same manner and in the the same time period as you mould 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 Dna (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 .000160`. All taxes ahich became delinquent on and after January 1, 1982 will bear interest at a rate which ail1 vary free calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOZ ara: Year Tntarast Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1981 201 .0O05q. B 19922 91 .00020`7 1983 16Z .0000`38 1993-199o, 71 .000192 1980` 11Z .000301 1995-1998 97. .00010`7 1985 13X .000356 1999 71 .000192 1986 101 .00027¢ 2:000 BT. .00022219 1987 9Z . O00Zq7 Z001 9Z .0001~,7 1988-1991 llX .000301 ZOOZ 61 .000160` --Interest is ceIculatad as foXZows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DA/LY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will 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 bm calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent:_, P~ ~D Date of Death: ~u~/ ~1~ ~ Pursuant to Rule 6.12 of the Supreme Court Orphans, Court Rules, ! report the folZo~Zng ~±th respect to completion of the adm£n~stration of the above-capt±oned estate: 1. State ~hether adm±nZstrat±on of the estate Zs complete: Yes t~' No 2. If the answer Zs No, state ~hen the personal representative reasonably beZ±eves that the adm£n£strat~on ~Z1 be complete: 3. If the answer to No. ] Zs Yes, state the follo~£ng~ a. D±d the personaZ representatZve f±le a fZnal account ~th the Court? Yes No__L_~_~. b. The separate Orphans' Court No. (~f any) for the ~ersonal re~resentatZve,s account c. D~d the personaZ ~epresentat±ve state an account Znformall¥ to the part,es ~n ±nterest7 Yes~ No d. CopZes of rece±pts, releases, jo£nders and approvals of formal or ±nformaZ accounts ma~ be fZZed ~£th the Cerk of the Orphans' Court and may be a[tached to th~s report Name (Please Address (MAH:rmf/AM3) Capacity: _w~-'-~Personal Representative _ _Counsel for personal representative