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HomeMy WebLinkAbout04-0492 PETITION Estate of.DOROTHY ELIZABETH FORSTER Social Security No. 015 - 18 - 59 ~. 7Deceased' The petition of the undersigned respectfully represents that: Your petitioner(x), who isz~mexl 8 years of age or older an the execut r i x in the last will of the above decedent, dated July I 5th FOR PROBATE and GRANT OF LETTERS No. To: Register of Wills for the County of _C1/lllb~ in the Commonwealth of Pennsylvania named ., 1995 (state relevant circumstances, e.g. renunciation, death of execUtor, etc,) D~e~ndenl miciled at death in Curaberland County, Pennsylvania, with .......... was do . he]: last family or principal residence at 325 ~/esley Drive, Mechanicsburq, (list street, number and muncipality) Decendent, then 8 4 years of age, died May 1 5th , at__~~.~.b.~l.!r..~t._.!-io_s.l~J, taJ., Harrisburg, PA 17104 Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: There are.. no exceptions 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: $ Unknown SNot Applicable $. None WHEREFORE, petitioner(~) respectfully request(s) the probate of the last will >~tlliX~lHl~3~ presentec[,¥rewith and the grant of letters Testamentary c,q (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~ ~o BEVERI,~YLER FORSTER 615 SMITH ROAD DANVILLEt PA 17821 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3,.. ~ COUNTY OF CUMBERLAND 3 The petitioner00 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~) and that as personal represen- tative00 of the above decedent petitioner(~ will well and truly administer the estate according to law. Sworn to or affirmed and subscribed f'"~9/'~"~{~'x 7-~ ta-m'~,- before me this __ ~ __ day of | Beverlee T~vler_ Forster , . ~. Mav _ _ ' , ,. }9.20043 No. Estate Of DOROTHY ELIZABETH FORSTER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 1:92004,, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(g) dated July I 5, 1 995 described therein be admitted to probate and filed of record as the last will of DOROTHY ELIZABETH FORSTER ; and Letters To~g~-am~nta ry are hereby granted to BEVERLEE TYLER FORSTER FEES Probate, Letters, Etc .......... Short ~Certificates( ) .......... TOTAL __ Filed ~X~..~,.. ~~ ......... C. JAMES RUFFENNACH, ESQUIRE A~'ORNEY (Sup. Ct. I.D. No.) PA ID NO. 10989 275 Curry Hollow Road ADDRESS Suite 280 Pittsburgh, PA 15236-4631 PHONE (412) 650-9120 OATH OF NON-SUBSCRIBING WITNESS Estate of DOROTHY ELIZABETH FORSTER , D~ceasP.,d BEVERLEE TYLER FORSTER and DAVID ALAN FORSTER JR. (each) a subscriber hereto, (each) being duly qualified according to law, depose(~) and ~y(~) that (~xlax/we are) familiax with the signature of DOROTHY ELIZABETH FORSTER ,, ,testat r±x_ofO~amofX}~ $~a;~r~pmil~w~__~t~) the will/c~i~il presem~ h~ewith and thatthey believ~ the si~a~ on the wiH/~ismfl~ehand~tingof DOROTHY ELIZABETH FORSTER to ~e ~st of their ~o~ledge an4 belief. Sworn to or affirmed and subscribed before me this o~9,/_~ day of' ,~.e.m~/_a_t 7~'~. ~ ~ MAY ., 20 0 4 ' -- (Si~mturc) Beverl~e Tyler~rster Sworn to or affirmed and subscribed before me this ~ day of ,20 (Signam-e) For the Regi6tcr (Signature) his is to certify that the information here given is correctly copied/'rom an original certificate of death duly filed witl-, mc as Local F:egistrar. 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 thif,icertificate; $2.00 '04 IiAY 26 Pi :19 P 1037182S Loc;~l Registrar Date mos ~43 R~v 2~z COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~[T ,. uorothy Elizabeth Forster ,. Female I~-~s~c~rrm~ 5927 I~I~;~ ~. 84 v~. ep 14, 1919~.New York City, New. *['~ ~'~ ~ I ~ D ........ts,..,~ .... m'.. Harrisburg Hospital i~.. ) ~ ~ ~R~, ~ l( ~eS, 8~ ,~ C~R,I RACE 10. ............ .l~k White ~ Dauphin Harrisburg DECEitS ~ ~PAT~ m KiND OF ~INESS I IN~STRY ~IS DECEOENT EVER INI ._~E~S~TI~ . m~CE~S E~TI~ ~RITAL STATUS * M~fl~. ] SURVIVING SPOUSE I I Bankin- ,,,. Financial Manager I.b y v.,n Non ,.~,o=.l ~9!9)-[,m -,. s~,o Pa-----.~nt -*. D~-. ~.u,~ ~. Lower Allen 325 Wesley Drive ~,. Mechanicsburg, Pa. 17055 ~) t~. Coua~ ~llmh~rl~nd I~p? t1~.~ m, omml,v~ ~. Jesse TYler p~ddock ~. Florence Elizabeth Chichester zo.. Beverl~ Tvler Forster 20b. RIR gmith Rn~fl ~anville PA 17R?1 ~, ~ ~M(~)~~ 121b. Mnv 91 9nna 2to. Albany Rural Cemete~ 21~/ ~ /~ (~ ~ ~ 22b, FD*D1 9RR?-t1 2~ · ..o.o..~,....0~...,...~.......,~ .... ~ ........................ , ~ ~. ~, ~ ,-/I~ ~ ~,~ ~  *MEDICAL E~NEmCORONER (il; ~y~ ~ Print / ~--~ / ~ I~ / exlmin~on I~ ~vl~on, In my opinion, del~ ~CU~ at the time, date and place, and due to the cau~s) and ~ · /~ ~ v~ PERI~%NENT BLACK INK OF DOROTHY ELIZa%BETH FORSTER I'~~ DOROTHY ELIZABETH FORSTER, of 2520 Shenandoah Drive, Upper St. Clair Township, Allegheny County, Pennsylvania, being of sound mii~, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any an~' all Wills h~etofore made by me. FIRST: I direct that all my just debts and funeral expenses be fully paid and satisfied as soon as may be convenient after my decease. SECOND: All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and wheresoever situate which I may own or have the right to dispose of at the time of my death, I give, devise and bequeath unto my children, in equal shares, share and share alike. THIRD: Should either of my children predecease me, then the share hereinbefore given, devised and bequeathed unto them, I give and bequeath unto their issue per stirpes. Should a child of mine die leaving no issue to survive them, then and in that event, said share shall not lapse but shall pass unto my surviving child or to the issue per stirpes of said child, predeceases me. if said child ~OURTH: Should anyone entitled to receive under this my Last Will and Testament be under the age of twenty-five (25) years, then it is my request that said funds be placed in Trust to be used for the care, support, education and maintenance that may be required and it is my request that said funds be held in Trust by Mellon Bank, N.A. Should Mellon Bank, N.A. decline to act as said Trustee, then it is my request that my daughter, BEVERLEE TYLER FORSTER, act as said Trustee. LASTLY, I hereby name, constitute and appoint my daughter, BEVERLEE TYLER FORSTER as Executrix of this my Last Will and Testament. Should my daughter, BEVERLEE TYLER FORSTER, predecease me or be unable to serve for any reason whatsoever, then I hereby name, constitute and appoint my son DAVID ALAN FORSTER, JR. as Executor of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~.~ day of ~~ , 1995. WITNESSES: 2 Tel: 412-650-9120 C. James Ruffennach Attorney at Law Arbor Professional Centre 275 Curry Hollow Road - Suite 280 Pittsburgh, Pennsylvania 15236-4631 Fax: 412-650-9255 July 28, 2004 Cumberland County Register of Wills One Courthouse Square Carlisle, PA 17013 Attention: Vickie Zuna IN RE: Estate of Dorothy Elizabeth Forster, Deceased No. 2004-000492 PA No. 21-04-0492 Dear Ms. Zuna: In reference to the above estate, enclosed please find a check payable to "Register of Wills, Agent" in the amount of $19,237.50 as payment on account of Inheritance Tax due and payable to the Commonwealth of Pennsylvania. Payment is being tendered within ninety days from date of death, namely, May 15, 2004, in order to obtain the discount afforded by the Commonwealth of Pennsylvania. Any Receipt to be issued should be forwarded to my care. Should you have any questions kindly contact me. ~ffennach Enclosure CJR/slr COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECFIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004219 ........ fold FORSTER BEVERLEE TYLER 615 SMITH ROAD DANVILLE, PA 17821 ESTATE INFORMATION: SSN: 015-18-5927 FILE NUMBER: 2104-0492 DFCEDENT NAME: FORSTER DOROTHY ELIZABETI DATE OF PAYMENT: 08/02/2004 POSTMARK DATE: 08/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/15/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $19,237.50 REMARKS: FORSTER BEVERLEE TOTAL AMOUNT PAID: $19,237.50 SEAL CHECK# 9019 INITIALS: CP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 09/01/2004 RUFFENNACH CYRIL JAMES 275 CURRY HOLLOW RD SUITE 280 PITTSBURGH, PA 15236-4631 RE: Estate of FORSTER DOROTHY ELIZABETH File Number: 2004-00492 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS, COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans, Court his/her Certification of Notice. This filing will become delinquent on 09/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Judge Representative(s) Sincerely, Clerk of the Orphans, Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 09/01/2004 FORSTER BEVERLEE TYLER 615 SMITH ROAD DANVILLE, PA 17821 RE: Estate of FORSTER DOROTHY ELIZABETH File Nuraber: 2004-00492 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5 7 (a) in the above captioned estate. As per the ~4ENDMENTS TO SUPREME COURT ORPHANS, COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans, Court his/her Certification of Notice. This filing will become delinquent on 09/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, Clerk of the Orphans' Court 9~j/83/2004 88:45 41~65092§5 C JAMES RUFFENNA(]H PAGE Nam~ W D~o~; DOROTHY. ,ELI, ZABETH FORSTER Da~WD~a~: MAY 15, 2004 ..... ~ No. Adu~. No. ,2..'1-04-492 To ~ June 2~. 2004 Beverlee TI{let Forster Da,vid Alan Fors~art Jr. 615 Smith Road, Danville, PA 17821 934 West ~oxcrof.~ Drtve~ Cam~ Hill~.~A 17011 There are no exce~tions. D~; ~eptember 3; ,2004, N~me C. James R~ffennach, Esquire 275 Curry Hollow Road, Suite 280 Pittsburgh, PA 15236 C41)2 650-9120 INVENTORY of all real and personal estate of DOROTHY ELIZABETH FORSTER, deceased, late of 325 Wesley Drive, Mechanicsburg, Pennsylvania 17055, Cumberland County, who died May 15, 2004 9x-044 . PERSONAL ESTATESCHEDULE STOCK AT&T Wireless Services, Inc. BellSouth Corporation BP Plc Consolidated Edison Company of New York Delphi Corp. Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fomme Brands, Inc., formerly American Brands, Inc. Gallaher Group Plc General Motors Corporation Lucent Technologies, Inc. Norfolk Southem Corporation SBC Communications, Inc. Vefizon Communications (formerly Bell Atlantic Corp.) Asbury Services, Inc. & Affiliates (Bethany Village) 370 Shares ~ $13.95 1008 Shares ~ $25.58 328 Shares @ $52.75 168 Shares ~ $25.60 100 Shares ~ $9.95 100 Shares ~ $45.26 315 Shares ~ $25.17 187 Shares ~ $37.08 480 Shares ~ $73.31 480 Shares ~ $47.51 100 Shares ~ $43.79 400 Shares ~ $3.20 405 Shares ~ $23.70 702 Shares ~ $24.39 528 Shares ~ $36.25 Refund per Residency Agreement 1991 Buick Skylark PNC Investments - IRA Account No. 3360-3155 BFABX 701.754 units ~ 13.14 AEGBX 100.015 units @ 29.43 IFABX 406.756 units ~ 16.51 Citizens Investment Services Corp. Brokerage Account No. 57353445 Federated Capital Income Fund Class B, 826.446 shares ~ 6.74 Citizens Bank Checking Account No. 6102405092 Total Personal Estate $ 5,161.50 25,784.64 17,302.00 4,300.80 995.00 4,526.00 7,928.55 6,933.96 35,188.80 2_~804.80 ? ',6,379.00 '' 1,280.00 ~,598.50 :17;!21.78 19,,140.00 143,400.00 525.00 9,221.05 2,943.44 6,715.54 5,570.25 7,826.53 $ 358.647.14 REAL ESTATE SCHEDULE REAL ESTATE 1N PENNSYLVANIA (Description must be adequate to identify the property. Mortgages, judgements and other encumbrances on real estate should be noted.) NONE TOTAL REAL ESTATE IN PENNSYLVANIA .... $ 0.00 MEMORANDUM OF REAL ESTATE OUTSIDE THE COMMONWEALTH OF PENNSYLVANIA (Do not include value in total of the Inventory) NONE TOTAL REAL ESTATE OUTSIDE OF PENNSYLVANIA .... $ 0,00 AFFIDAVIT OF EXECUTRIX Commonwealth of Pennsylvania County of Allegheny ) ) SS: ) Personally before me, the undersigned authority, a Notary Public, in and for said County and State, appeared BEVERLEE TYLER FORSTER, who, being duly sworn according to law, deposes and says that she is the Executrix of the estate of DOROTHY ELIZABETH FORSTER, deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of DOROTHY ELIZABETH FORSTER, deceased, except real estate outside the Commonwealth of Pennsylvania, that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death. Sworn and subscribed to before me this ) I ? ~b day of September ,2004. ) ) ) Notary Public BEVERLEE TYLER FORSTER, Executrix CERTIFICATION OF NOTICE UNDER RULE 5.6(~) Name of Decedent: DOROTHY ELIZABETH FORSTER Date of Death: MAY 15, 2004 Will No. Admin. No. 21 - 04 - 492 To the Register: I certify that notice of (beneficial interes0 estate a~m~nistration 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 Address Beverlee Tyler'Forster 615 Smith Road, Danville, PA 17821 David Alan Forster, Jr. 934 West Foxcroft Drive, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except - There are no exceptions. Date: September 3, 2004 Name C. James Ruffennach~ Esquire Address 275 Curry Hollow Road, Suite 280 6tz: L- rt3S Capacity: -- Pittsburgh, PA 15236 Telephone ( 41)2 650-9120 Personal Representative X Coansel for personal representative C. James Ruffennach Attorney at Law 2 75 Curry Hollow Road- Suite 280 Pittsburgh, Pennsylvania 15236-4631 Cu~nberland Chunk_Register of Wills One Courthouse Square Carlisle, PA 17013 Attention: Vickie Zuna Tel: 412-650-9120 C. James Ruffennach Attorney at Law Arbor Professional Centre 275 Curry Hollow Road - Suite 280 Pittsburgh, Pennsylvania 15236-4631 Fax: 412-650-9255 October 19, 2004 Cumberland County Register of Wills One Courthouse Square Carlisle, PA 17013 Attention: Vickie Zuna Estate of Dorothy Elizabeth Forster, Deceased No. 2004-000492 PA No. 21-04-0492 Dear Ms. Zuna: In reference to the above estate, enclosed please find the original and one copy of the REV-1500 Inheritance Tax Return, Resident Decedent, concerning the above estate together with a check attached payable to "Register of Wills, Agent" in the amount of $1,494.31 representing the balance of Inheritance Tax due and payable the Commonwealth of Pennsylvania. Also enclosed is a separate check payable to the Register of Wills in the amount of $15.00 representing the fee for filing this Return. The Receipt to be issued should be forwarded to my care. Should you have any questions kindly contact me. Yours truly, CS,J6xnes Ruffennach Enclosures CJR/slr COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ 04 0492 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-' FORSTER, DOROTHY ELIZABETH 015-18-5927 Z DAT~ OF DEATH (MM-DB-YEAR) /' BATE OF BIRTH (MM-DB-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU 05/15~2004 109/14/1919 REGISTER OF WILLS LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 Not Applicable ~:oo Il. [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death pdor to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy of ~ill)[] 7. Decedent Maintained a Living Trust (Attach copy of Trust) O 8. Total Number of Safe Deposit Boxes [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31~91 and 1-%95) [] 11. Bection to tax under Sec. 9113(A)(Attach Sch O) THISSECTION MUST BE ~OMP~ NAME I COMPLETE MAILING ADDRESS C. James Ruffennach, Esquire I 275 Curry Hollow Road FIRM NAME (If Applicable) Suite 280 TELEPHONE NUMBER Pittsburgh, PA 15236-4631 (412) 650-9120 (1) - (2) 182,445.33:' 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 176,201.8 t (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 155,094.20 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 30,534.54 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 0 0 X 513,741.34 30,534.54 483,206.80 483,206.80 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 483,206.80 x .0 45 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20. 21,744.31 21,744.31 Deced~nt's Complete Address: STREETADDRESS 325 Wesley Drive CITY Mechanicsburg 1-STATE-p-A-- .................. Zip 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 1 9,237.50 C. Discount 1,012.50 I nterestJPenalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) 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 (3) (4) 21,744.31 20,250.00 1,494.31 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 1,494.31 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 615 Smith Road, Danville, PA 17821 DATE ADD~' R'oa~d. Suite 280. Pittsbur h PA 15236-4631 2~C rry Hollow Road, ui e , ' g , DATE For dates of death on or affer July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04~0492 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 2. 3. 4. 5. 6. 7. 8. 9. 10. 12. 13. 14. 15. AT&T Wireless Services, Inc. Bell South Corporation BP PIc Consolidated Edison Company of New York Delphi Corp. Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc., formerly Amedcan Brands, Inc. Gallaher Group PIc General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications, Inc. Verizon Communications formerly Bell Atlantic Corp.) 370 Shares @ $13.95 1008 Shares @ $25.58 328 Shares @ $52.75 168 Shares @ $25.60 100 Shares @ $9.95 100 Shares @ $45.26 315 Shares @ $25.17 187 Shares @ $37.08 480 Shares @ $73.31 480 Shares @ $47.51 100 Shares @ $43.79 400 Shares @ $3.20 405 Shares @ $23.70 702 Shares @ $24.39 528 Shares @ $36.25 TOTAL (Also enter on line 2, Recapitulation VALUE AT DATE OF DEATH 5,161.50 25,784.64 17,302.00 4,300.80 995.00 4,526.00 7,928.55 6,933.96 35,188.80 22,804.80 4,379.00 1,280.00 9,598.50 17,121.78 19,140.00 $ 182,445.33 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Dorothy Elizabeth Forster, Deceased 21 04-0492 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Asbury Services, Inc. & Affiliates (Bethany Village) - Refund per Residency Agreement 1991 Buick Skylark PNC Investments - IRA Account No. 3360-3155 a. BFABX 701.754 units @ 13.14 b. AEGBX 100.015 units @ 29.43 c. IFABX 406.756 units @ 16.51 Citizens Investment Services Corp. - Brokerage Account No. 57353445 Federated Capital Income Fund Class B, 826.446 shares @ 6.74 Citizens Bank Checking Account No. 6102405092 143,400.00 525.00 9,221.05 2,943.44 6,715.54 5,570.25 7,826.53 TOTAL (Also enter on line 5, Recapitulation) $ 176,201.81 (If more space is needed, insed additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04-0492 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDETHENAMEOFTHETRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBERi THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE i. The below listed assets were in the name of the decedent in trust for, payable on death, or transferrable on death unto her son, DAVID ALAN FORSTER JR and daughter, BEVERLEE TYLER FORSTER, and as such said assets are fully taxable. 1. AARP Investment Program from Scudder Investments Fund name (Class AARP) a. Growth & Income Fund 358.874 shares @ 19.76 7,091.35 100 7,091.3,' b. Capital Growth Fund 64.697 shares @ 40.55 2,623.46 100 2,623.4C c. S & P 500 Index Fund 526.102 shares @ 14.5 7,636.37 100 7,636.3~ 2. PNC Investments- Account No. 3360-3153 a. FALDX 401.580 units @ 22.50 9,035.55 100 9,035.55 b. LEIFX 452.570 units @ 15.62 7,069.14 100 7,069.14 c. SINBX 2,290.951 units @ 8.28 18,969.07 100 18,969.07 d. FHBBX 2,242.610 units @ 7.75 17,380.23 100 17,380.23 e. FDBAX 509.764 units @ 8.84 4,506.31 100 4,506.31 f. FDBBX 926.999 units @ 8.86 8,213.21 100 8,213.21 3. Citizens Bank - Account No. 6204178869 72,569.51 100 72,569.51 TOTAL (Also enter on line 7 Recapitulation) $ 155,094.20 (If more space is needed, insert additional sheets of the same size) REV-1511EX+(12-99~ COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dorothy Elizabeth Forster, Deceased 21 04-0492 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1. 2. 3. 4. 5. 6. 5. 6. 7. 8. 9. 10. 11. 12. FUNERAL EXPENSES: Myers Funeral Home Tebbutt Funeral Home Albany Rural Cemetery Empire Monument Company Cafe Magnolia Menand's Diner Funeral Expenses Funeral Expenses Budal Expense Marker Memorial Service Meal Burial Luncheon ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Beverlee Tyler Forster Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 615 Smith Road City Pittsburgh .State PA Year(s) Commission Paid: 2004 Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees MBNA America Credit Card Balance MCI Telephone Bill Bethany Court Apartments May Rental MCI Telephone Bill Federated Department Store Refund of June Pension M & T Bank Duplicate Statement Fee Zip 17821 . Zip TOTAL (Also enter on line 9, Recapitulation 7,100.00 1,368.00 675.00 1,320.00 144.68 71.23 5,000.00 12,750.00 800.00 133.73 28.90 1,053.00 18.27 69.73 2.00 30,534.54 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Dorothy Elizabeth Forster, Deceased 21 04-0492 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, and transfers under Sec. 9116 (a) (1.2)] BEVERLEE TYLER FORSTER 615 Smith Road, Danville, PA 17821 DAVID ALAN FORSTER JR. 934 West Foxcroft Drive, Camp Hill, PA 17011 Daughter Son 50% 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insed additional sheets of the same size) OF DOROTHY ELIZABETH FORSTER I, DOROTHY ELIZABBTH FORSTER, of 2520 Shenandoah Drive, Upper St. Clair Township, Allegheny County, Penn~ylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills heretofore made by me. FIRST: I direot that all my just debts and funeral expenses be fully paid and satisfied as socn as may be convenient after my decease. ~ECOND[ All %he rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and wheresoever situate whish I may omi or have the right to dispose of at the time of my death, I give, devise and bequeath unto my children, in equal shares, share and share alike. THIRD: Should either of my children predecease me, then the share hereinbefore given, devised and bequeathed unto them, I give and bequeath unto their issue per stlrpes. Should a child of mine die leaving no issue to survive them, then and in that event, said share shall not lapse but shall pass unto my surviving child COPY or ~0 the issue per stirpes of said child, if said child predeceases ~e. ~OURTM:_ Should anyone entitled to receive under this my Last Will and Testament be under the age of twent¥-£ive (25) years, then it is my request that said funds be placed in Tr~st to be used for the care, support, education and maintenance that may be required and it i$ my request that said fund~ be held in Trust by Mellon Bank, N.A. Should Mellon Bank, N.A. decline to act as said Trustee. then it is my request that my daughter,. BEVE~LEE TYLER FORSTER, act as said Trustee. S_~_~, I hereby name, constitute and appoint my daughter., BEVERLEE TYLER FORSTER as Executrix of this my LaSt Will and Testament. Should my daughter, BEV~RLEE TYLER FORSTER, predecease me or be unable to serve for any reason whatsoever, then I hereby name, constitute and appoint my son DAVID ALAN FORSTER, ~R. as Executor of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal _ day of . .., 1995. WITNESSES: 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 004535 FORSTER BEVERLEE TYLER 615 SMITH ROAD DANVILLE, PA 17821 ESTATE INFORMATION: SSN: 015-18-5927 FILE NUMBER: 2104-0492 DECEDENT NAME: FORSTER DOROTHY ELIZABET DATE OF PAYMENT: 1 0/22/2004 POSTMARK DATE: 1 0/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/1 5/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,494.31 REMARKS: FORSTER TOTAL AMOUNT PAID: $1,494.31 SEAL CHECK#II0 INITIALS: CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF 'rNDTV'rDU~L PO BOX 2806~]~ HARRISBURG, COHHONWEALTH OF PENNSYLVANIA BEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX 200qDEC29 AH 9:08 DATE 12-27-2004 ESTATE OF FORSTER DATE OF DEATH 05-15-2004 FZLE NUHBER 21 04-0492 COUNTY CUHBERLAND ACN 101 F Amount Remitted DOROTHY E HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -.~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF FORSTER DOROTHY E FILE NO. 21 04-0492 ACN 101 DATE 12-27-Z004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE IN m=KEST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. ReaZ Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Hortgages/Notes Receivable (Schedule D) (~} S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED BEDUCTZONS AND EXEHPTIONS: 9. Funeral Expensas/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgaga L/abilities/Liens (Schedule I) (10) 11. TotaZ Deductions 12. Net Value of Tax Return 1821445.$$ .00 176¢201.81 .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of this form with your tax payment. 155~094.20 (8) $0,554.54 15. lq. NOTE: 515,741.$4 DATE 08-02-2004 10-20-2004 .00 (11) 3l] .534.5~ (1~) 483,206.80 Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Sub~ect to Tax (1~) If an assess;ant ,as lssued previously, lines 14, 15 and/or 16, 17, .00 483,206.80 AHOUNT PAID 19,257.50 1,494.$1 TOTAL TAX CREDIT BALANCE OF TAXDuEI . o o INTEREST AND PEN. I .00 TOTAL DUE I .00 ( TF TOTAL DUE TS LESS THAN $1, NO PAYHENT 'rs REI~UTRED. .rF TOTAL DUE .rS REFLECTED AS A "CREDTT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE S.rDE OF TH'rS FORH FOR 'rNSTRUCT'rONS. )~..<~---~ ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT'rON OF ADD'rT'rONAL 'rNTEREST. (15) .00 X O0 = .00 (16) 485,206.80 X 045: 21,744.$1 (17) . O0 x 12 = . O0 (lB) .00 x 15 : .00 (19)= 21,744.$1 ASSESSHENT OF TAX: 15. Amount of L/ne 1~ at Spousal rate 16. Amount of Line lI taxable at Lineal/Class A rate 17. Amount of Line 1~ et Sibling rate 18. Amount of Line 1~ fa/ab're at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYflENT RECEZP1 DISCOUNT (+J NUNBER 'rNTEREST/PEN PAID (-) CD004219 1,012.50 CD004535 .00 reflect figures that include the total of ALL returns assessed to date. 18 and 19 wil1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: Estate of Dorothy Elizabeth Forster, ) ) ) No. 0492 of2004 Deceased FAMILY SETTLEMENT AGREEMENT RECEIPT. RELEASE AND WAIVER OF ACCOUNTING We, the undersigned, BEVERLEE TYLER FORSTER, Executrix, BEVERLEE TYLER FORSTER, individually, and DAVID ALAN FORSTER JR., beneficiaries and daughter and son ofthe above named decedent, do hereby acknowledge the following: I. That Dorothy Elizabeth Forster died on the 15th day of May, 2004, at the Harrisburg Hospital, City of Harrisburg, County of Dauphin, State of Pennsylvania, and at the time of her death resided at 325 Wesley Drive, Mechanicsburg, PA 17055. 2. That I, Beverlee Tyler Forster, was duly appointed Executrix of said estate on the 26th day of May, 2004, by the Register of Wills of Cumberland County, Pennsylvania, at which time the Last Will and Testament of Dorothy Elizabeth Forster was duly probated, a copy of which is attached hereto and marked as Exhibit "A". 3. That said estate has been duly advertised in The Sentinel, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, on May 28th, June 4th and June 11th, 2004; and in the Cumberland Law Journal in the Borough of Carlisle, County and State aforesaid, on June 4th, June 11th and June 18th, 2004, as evidenced by the Proofs of Publications attached hereto and marked as Exhibit's "B" and "C". v- 10. That the following costs were paid by the Executrix on behalf of the estate during its administration as set forth on Exhibit "K". II. That the following income was received by the Executrix on behalf of the estate during its administration as set forth on Exhibit "L". 12. That during the administration of the estate, David Alan Forster, Jr., elected to take in kind and received the 1991 Buick Skylark valued at Five Hundred Twenty Five and OOIlOOths ($525.00) as evidenced hereto and marked as Exhibit "M". 13. That we, the undersigned, acknowledge that disbursement has been made without the filing of a formal account and we hereby agree to waive the filing, audit, adjudication and confirmation of that account by the Court and our right to compel such an accounting. 14. That we, Beverlee Tyler Forster and David Alan Forster, Jr., hereby release and forever discharge Beverlee Tyler Forster, the Executrix of the estate of our deceased mother, Dorothy Elizabeth Forster, and from any and all liability which may from time to time arise in connection with her service and do hereby agree to indemnify and hold harmless Beverlee Tyler Forster, Executrix from any and aHliability which may arise against the estate from creditors or claimants. 15. This Agreement shaH be governed by the laws of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /:2... day of /'~aa/'~I ,2005. f' ~ Lv.. T.k F~tv., ~Q.uA/V.y BEVERLEE TYLEf{ FORSTER, Executrix ~fu .~ 6-t/JL BEVERLEE T LER FORSTER /2t/f~i/-/Y1 ~Aj DAVID ALAN FORSTER JR. 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: Estate of Dorothy Elizabeth Forster, ) ) ) No. 0492 of2004 Deceased AFFIDAVIT Before me, a Notary Public, the undersigned authority, personally appeared BEVERLEE TYLER FORSTER, Individually, and BEVERLEE TYLER FORSTER, Executrix appointed under the Last Will and Testament of Dorothy Elizabeth For~ter, who being duly sworn according to law deposes and says that the averments of fact contained in the Family Settlement Agreement, Receipt, Release, and Waiver of Accounting, are true and correct. dwe,.k Tk F~~ II BEVERLEE TYLER FORSTER ~G.e Tj&.. ~ 1.-- f fy~4 BEVERLEE TYLER FORSTER, Executrix SWORN AND SUBSCRIBED to before me this jJfh day of FebruQry ,2005. NclIIiII SeBI Sui!lIln L IbIBId. Nl*lY~..... ~... ElcIO. /lIefI'eIrf ~"' ~ c:x.....&Wo.. EJIliIl8~ 'D. 2005 .......I'Io...,lWRB- I & ..or...... ~Ul/J~ X ~~-L. Notary Public 4 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: Estate of Dorothy Elizabeth Forster, ) ) ) No. 0492 of2004 Deceased AFFIDAVIT Before me, a Notary Public, the undersigned authority, personally appeared DAVID ALAN FORSTER, JR., who being duly sworn according to law deposes and says that the averments of fact contained in the Family Settlement Agreement, Receipt, Release, and Waiver of Accounting, are true and correct. //e1Ad ~~ ~ ~ / DAVID ALAN FORSTER, JR. SWORN AND SUBSCRIBED to before me I )- day of ~..g this ,2005. ~\~~ Notary Public _ r'-'-~JTARiAL9EAL Public \ 0< I '<' 1'. K~RBOLD, NOlatounty \ "MAR '\-I\iI Bora, cumberland 30 2006 Camp .' n Expires Dec. , My commlSSIO 5 lllast ~ ill anb W:esfamrnt OF DORO~HY EL1ZABE~K ~ORSTER I , DOROTHY ELI ZABETH FORSTER, of :2 5:2 0 Shenandoah Drive, Upper St. Clair Township, Allegheny County, Pennsylvania, being of sound mind, memory and understanding, do hereby ma~e, publish and dQclare this to be my Last will and Testament, hereby revoking any and all wills heretofore made by me. FIRST: I dir..ct that all my just debts and funeral expenses be fully paid and satisfied as soon as may be convenient after my decease. SECONO. All the rest, residue and remainder of my estat., real, personal and mixed, of whatsoever kind and wheresoever s1 tuate which I may own or have the right to dispose of at the time of my death, I give, devise and be~eath unto my children, in equal shares, share and share alike. THIRD: Should either of my children predeeease me, then the share hereinbefore given, devised and bequeathed unto them, I give and bequeath unto their issue per stirpes. ShOUld a child of mine die leaving no issue to survive them, then and in that event, said share shall not lapse but shall pass unto my surviving child 1 EXHIBIT "A" c-J COpy '\,"''''''f'~ \J i/ ',,:, t, "~ ~. 'l>li,'~,:::J - ..<.,......., or to the issue per stirpes of said child, if said child predecQas...s me. rOURTH: Should anyone entitled to reoeive under this my Last Will and Testament be under the age of twenty-rive (25) years, then it 1s my request that said funds be placed in Trust to be used for the care, support, education and maintenance that may be required and it is my request that said funds be held in Trust by Mellon Bank, N.A. Should Mellon Bank, N.A. decline to act as said Trustee, then it is my request that my daughter, BEVERLEE TYLER FORSTER, act as said Trustee. LASTLY, I hereby name, cOn/;;titute and appoint my daughter" BEVERLEE TYLER FORSTER as Executrix of this my Last Will and Tastament. ShOUld my daughter, BEVERLEE TYLER FORSTER, predecease me or be unable to serve for any reason whatsoever, then I her_by name, oonstitute and appoint my son DAVID ALAN FORSTER, JR. as Executor of this my Last Will and Testament. this IN WI'I'NESS ~ . 1$ day of WHEREOF, I have hereunto aet my hanq and seal J~ . 1995. /9'Y"tt. kll;~:R ~~e((SEAL) DORO'I'BY LI ETH FORSTER WITNESSES: 2 ... ',0.._......." PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tammy Shoemaker, Customer Care Sales manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following date(s): Mav 28 , June 04, 11, 2004 . COPY OF NOTICE OF PUBLICATION EXECUTRIX ltQIK&E. LeUers Testamentary on U.EalateolDOROTHY . ELIZABETH FORSTER I... of the Township of Lower Allen, Cumber- land county, Pennsylva- nla, deceased, have beengranted to the undel'8lgned. All persons knowing them- selves to be Indebted to said Estate will make payment Immediately, and those having claims will present them tor settlement. 8everlee Tyler Forster Executrix 615 Smith Road Danvlll.. PA 17821 C. James Ruffennach, Anomey 275 Curry Holk)w Rd. Suite 280 Pittsburgh, PA 15236 Affiant further deposes that he/ she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of J::\~ Sworn to and subscribed before me this 16 th day of .!!!D~, 2004 our My commission expires: NOTARIAL SEAL JACQUELINE M. WORLEY, Notary Public Carlisle, Cumberland County My Commission Expires Jan. 10, 2005 EXHIBIT "B" CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 JUNE 18, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication oflegal notices. TO: C. James Ruffennach, ESQUIRE RE: Dorothy Elizabeth Forster, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. -------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement inserted on following dates: JUNE 4, II, 18,2004 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 Total Amount Due $ 0.00 --------- --------- Payment received JUNE 2. 2004 by Beckv H. Morgenthal/Executive Director EXHIBIT "e" PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L1784 STATEOFPENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Joumal on the following dates, V1Z: JUNE 4, ll, 18,2004 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. It ter DorotbY EUzabetb. dec'd. or~te' of the 'Townsh1p of Lower Allen. triX' Beverlee Tyler Forster, ExecU . vill P A 615 Smith Road. DaIl e, 17821. h . C James Rl.lffennac , Attorney. . 11 Rd Esquire. 275 Curry Ho ow ., suite 280. Pittsburgh. PA 15236. - SWORN TO AND SUBSCRffiED before me this 18 day of JUNE 2004 NOTA ALSEAL LOIS E. SNYDER, Notary Public Carlisle BOlO. Cumbe~and County My Commission EJcpires March 5. 2005 LJ COpy INVENTORY of all real and personal estate of DOROTHY ELIZABETH FORSTER, deceased, late of 325 Wesley Drive, Mechanicsburg, Pennsylvania 17055, Cumberland County, who died May 15, 2004 PERSONAL ESTATE SCHEDULE STOCK AT&T Wireless Services, Inc. BellSouth Corporation BP Pic Consolidated Edison Company of New York Delphi Corp. Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc. , formerly American Brands, Inc. Gallaher Group Pic General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications, Inc. Verizon Communications (formerly Bell Atlantic Corp.) Asbury Services, Inc. & Affiliates (Bethany Village) 1991 Buick Skylark 370 Shares @ $13.95 1008 Shares @ $25.58 328 Shares @ $52.75 168 Shares @ $25.60 $ 5,161.50 25,784.64 17,302.00 4,300.80 100 Shares @ $9.95 100 Shares @$45.26 315 Shares @ $25.17 187 Shares @ $37.08 480 Shares @ $73.31 995.00 4,526.00 7,928.55 6,933.96 35,188.80 480 Shares @ $47.51 100 Shares @ $43.79 400 Shares @ $3.20 405 Shares @$23.70 702 Shares @ $24.39 528 Shares @ $36.25 22,804.80 4,379.00 1,280.00 9,598.50 17,121.78 19,140.00 Refund per Residency Agreement 143,400.00 525.00 PNC Investments - IRA Account No. 3360-3155 BF ABX 701.754 units @ 13.14 AEGBX 100.015 units @29.43 IFABX 406.756 units@ 16.51 9,221.05 2,943.44 6,715.54 Citizens Investment Services Corp. Brokerage Account No. 57353445 Federated Capital Income Fund Class B, 826.446 shares @ 6.74 Citizens Bank 5,570.25 Checking Account No. 6102405092 7,826.53 Total Personal Estate $ 358,647.14 EXHIBIT "D" REAL ESTATE SCHEDULE REAL ESTATE IN PENNSYLVANIA (Description must be adequate to identify the property. Mortgages, judgements and other encumbrances on real estate should be noted.) NONE TOTAL REAL ESTATE IN PENNSYLVANIA .... $ 0.00 MEMORANDUM OF REAL ESTATE OUTSIDE THE COMMONWEALTH OF PENNSYLVANIA (Do not include value in total of the Inventory) NONE TOTAL REAL ESTATE OUTSIDE OF PENNSYLVANIA .... $ 0.00 AFFIDAVIT OF EXECUTRIX Commonwealth of Pennsylvania ) ) SS: ) County of Allegheny Personally before me, the undersigned authority, a Notary Public, in and for said County and State, appeared BEVERLEE TYLER FORSTER, who, being duly sworn according to law, deposes ilnd says that she is the Executrix of the estate of DOROTHY ELIZABETH FORSTER, deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of DOROTHY ELIZABETH FORSTER, deceased, except real estate outside the Cormnonwealth of Pennsylvania, that the figures opposite each item of real and personal estate in thc foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date ofthe decedent's death. Sworn and subscribed to before me this i7fIJ day of September ,2004. V'lu~ ,1f ~A-/VU';/L' Notary Public ) ) ) ) ) ! ~lu rye.... FI"U 6.... I'~~ BEVERLEE TYLER FORSTER, Executrix NaIariaI Seal 8llSan L RIcciaRI, I>tJ!aIy PuIlIlr: PIeasanI HIs Bao, /IIeI;to1nt Col.rit> My Co......... Eli*8sQ:l. 71, ZlO5 ........ PorIr-yf1.8I1&~,OfNctariP' ~ Q i"< I'Ll Eo-< r:/l 0 ge <C 00 I'Ll N 0 U " " - N ""' I'Ll '" 'S 0- >- 'S '" ""' =:: Q r:/l 0 ~ cr< "1:J" 0 0 '" 0 Eo-< on N 0 on 0 i"< I'Ll oj 'D I oj E-< i"< :;j .ci 0 '" 0- '" a.. Eo- ~ N , Z g 0 0 <C ~ V') <n 0 ~ N @ - 'D N Eo-< .... ..s r:/l ...< <C ~ ~ 0 N i"< i"< a.. 0 :>- ~ :r: '" ~ Z =:: ~ ih '" on " "0 Eo-< " '" 0 > 0 ~ u '" ..c:: .D a.. .::: on >-, V') .1:: 0 cJ r-- ~ N a.. >> '" " .", '" ..!l '" 0 '" tJ i.i: "- <C REY.\SOO EX 1&.00) LJ co~y REV-1500 * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 "" HARRISBURG, PA 17128-0601 w ... ~S(l) u"'" w"u ",00 u"... .." .. " INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04 COUNTY CODE YEAR .... Z W C W U W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) FORSTER, DOROTHY ELIZABETH SOCIAL SECURI1Y NUMBER 015-18-5927 DATE OF DEATH (MM-DD-YEAR) 05/15/2004 DATE OF BIRTH (MM-DD.YEAR) 09/14/1919 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURI1Y NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Not Applicable 0492 NUMBER ... z w o z o .. '" w " " o u ~1.0riginaIReturn D 4. limited Estate 06. Decedent Died Testate (AtlachOOJlyofWin) D 9. litigation Proceeds Received THfSSEttrtCiN1iMClS!l:i EI~~. NAME C. James Ruffennach, Esquire - FIRMNAME (Wftwlicable) o 2. Supplemental Return D 4a. Future Interes! Compromise (daleo/dealh afler 12.12.82) D 7. Decedent Maintained a Living Trust (Atl"chcopyofTrust) D 10. Spousal Poverty Credit (date of d"alh between 12-31.91 and 1.1-95) o 3. Remainder Return (dale of death prlor to 12-13-82) D 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax Linder Sec. 9113(A) (Attach Sr./1 0) 'TELEPHONE NUMBER--- (412) 650-9120 .N COMPLETE MAILING ADDRESS 275 Curry Hollow Road Suite 280 Pittsburgh, PA 15236-4631 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 176,201.81 182,445.33 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o !;;: ..J ::l !:: a. <( u W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G orL) B. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) (11) (12) (13) (6) (7) 155,094.20 (9) (10) (8) 30,534.54 13. Charitable and Governmental Bequests/See 9113 Trusts for whicn an election to tax has not been made (Schedu\eJ) 14. Net Value Subject to Tax (Line 12 minus line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' ::l a. ::E o u ~ 15. Amount ofUne 14 taxable at the spousal lax rate, or transfers under Sec. 9116 (a)(1.2) ',0_ (15) 483,206.80 '.0 45 _ (16) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 141axable at sibling rate , .12 (17) 18. Amount of Line 141axable at collateral rate , .15 (18) 19. Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT EXHIBIT "E" 513,741.34 30,534.54 483,206.80 483,206.80 21,744.31 21,744.31 Decedent's Complete Address: STREET ADDRESS __..3.25 We.slev Dfi~_ CITYM h . b ee ames urg I STATE PA I ZIP 17055 'Tax Payments and Credits: t Tax Due (Page 1 Line 19) '2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 21,744.31 19,237.50 1,012.50 Totel Credits (A + B + C) (2) 20,250.00 .3. InteresUPenalty if applicable D.lnterest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 1,494.31 (5) (5A) (5B) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A This is the BALANCE DUE. 1,494.31 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;..........".......................................................... ... 0 b. retain the right to designate who shall use the property transferred Of its income; ................................... . 0 c. retain a reversionary interest; or.........................................................................................,.....,.. ...................... 0 d. receive the promise for life of either payments, benefits or care? ......... ........................,.............. .......... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................... ......................................,......... ............. 0 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? ................................................................................,................ ....................... ~ No ~ ~ ~ ~ ~ o o 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 pe~ury. I declare that I have examined thIs return. including accompanying schedules and statements, and to the best of my knowledge and belief. il is true, correct and complete. Declarallon of preparer other than the personal representative is based on all illformalioo of which preparer has any knowledge. SIGNATUR;j OF PERSON RESPONSIBLE FOR FILING RETURN v'u .1~~ Tr Lu rl1"4~ .U~ ADDRESS '615 Smith Road, Danville, PA 17821 :::~~1=-~:::::~ 275C~:;rrlOIlOW R~d, Suite.280, Pittsburgh, PA 15236-4631 DATE /O-/:l,-:IJY DATE 10 -l-z.-<"}t 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. 99116 (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. 99116 (a) (1.1) (ii)]. The statute does not exemot 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. 99116(a)(1.2)]. ' , i 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. 99116(1.2) [72 P.S. 99116(a){1)]. Th~ tax rale imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined under Seclion 9102 as an IndiVidual who has at least one parent in common with the decedent, whether by blood or adoption. " REV-1S03 EX. 16-9'. CQMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04-0492 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ,. AT&T Wireless Services, Inc. 370 Shares@$13.95 2. Bell South Corporation 1008 Shares @ $25.58 3. BP Pic 328 Shares @ $52.75 4. Consolidated Edison Company of New York 168 Shares @$25.60 5. Delphi Corp. 100 Shares@$9.95 6. Eastman Chemical Company 100 Shares @ $45.26 7. Eastman Kodak Company 315 Shares@$25.17 8. FirstEnergy Corp. 187 Shares@$37.08 9. Fortune Brands, Inc., formerly American Brands, Inc. 480 Shares@$73.31 10. Gallaher Group Pic 480 Shares@$47.51 11. General Motors Corporation 100 Shares @ $43.79 12. LucentTechnologies, Inc. 400 Shares @ $3.20 13. Norfolk Southern Corporation 405 Shares @ $23.70 14. SBC Communications, Inc. 702 Shares @ $24.39 15. Verizon Communications formerly Bell Atlantic Corp.) 528 Shares @ $36.25 VALUE AT DATE OF DEATH 5,161.50 25,784.64 17,302.00 4,300.80 995.00 4,526.00 7,928.55 6,933.96 35,188.80 22,804.80 4,379.00 1,280.00 9,598.50 17,121.78 19,140.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 182,445.33 REV-150. EX+ (6-98) '*' COMMONVv'EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04-0492 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly~owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Asbury Services, Inc. & Affiliates (Bethany Village) - Refund per Residency Agreement 143,400.00 2. 1991 Buick Skylark 3. PNC Investments - IRA Account No. 3360-3155 525.00 a. BFABX 701.754units@13.14 9,221.05 2,943.44 6,715.54 c. IFABX 100.015 units @ 29.43 406.756 units@ 16.51 b. AEGBX 4. Citizens Investment Services Corp. - Brokerage Account No. 57353445 5. Citizens Bank Federated Capital Income Fund Class B, 826.446 shares@6.74 Checking Account No. 6102405092 5,570.25 7,826.53 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 176,201.81 REV.1510 EX+ 16.98. COMMONVJEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04-0492 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERlY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH ACOf'Y OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLlCABLE) VALUE 1 The following accounts were established more than one (1) year prior to the death of the decedent, Dorothy Elizabeth Forster, and the accounts were transferrable on death to her son, DAVID A. FORSTER, JR. and her daughter,BEVERLEE TYLER FORSTER, and therefore fully taxable 1. PNC INVESTMENTS-Account No. 3360-3153 (payable on death to David A. Forster, Jr. and Beverlee T. Forster FALDX 401.580 UNITS @ 22.50 9,035.55 100 0.00 9,035.55 LEIFX 452.570 units @ 15.62 7,069.14 100 0.00 7,069.14 SINBX 2,290.951 units @ 8.28 18,969.07 100 0.00 18.969.07 FHBBX 2,242.610 units @ 7.75 17,380.23 100 0.00 17,380.23 FDBAX 509.764 units @ 8.84 4,506.31 100 0.00 4,506.31 FDBBX 926.999 units @ 8.86 8,213.21 100 0.00 8,213.21 2. AARP Investment Program from Scudder Investments Fund name (Class AARP) Growth & Income Fund 358.874 shares@ 19.76 7,091.35 100 0.00 7,091.35 Capital Growth Fund 64.697 shares @ 40.55 2,623.46 100 0.00 2,623.46 S & P 500 Index Fund 526.102 shares@ 14.515 7,636.37 100 0.00 7,636.37 3. CITIZENS BANK - Dorothy Forster In Trust For Beverlee and David Forster Account No. 6204178869 72,569.51 100 0.00 72,569.51 LJ COpy TOTAL (Also enter on line 7 Recapitulation) $ 155,094.20 (If more space Is needed, Insert additional sheets of the same size) REV-1511 EX. 112-99* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04-0492 ESTATE OF Dorothy Elizabeth Forster, Deceased Debts of decedent must be reported on Schedule I. ITEM NUMBER A. AMOUNT DESCRIPTION 1. FUNERAL EXPENSES: Myers Funeral Home Tebbutl Funeral Home Albany Rural Cemetery Empire Monument Company Cafe Magnolia Menand's Diner Funeral Expenses Funeral Expenses Burial Expense Marker Memorial Service Meal Burial Luncheon 7,100.00 - 1,368.00 675_00 - 1,320_00 - 144_68 71.23 __ 2 3. 4. 5. 6_ B. ADMINISTRATIVE COSTS: 10 11. 12. 1. Personal Representative's CommissIons Name of Personal Representative(s) Beverlee Tyler Forster Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 615 Smith Road 5,000.00 Cily Pittsburgh Year(s) Commission Paid: 2004 Slale PA Zip 17821 2. Allorney Fees 12,75000 3. Family Exemption: (If decedent's address is nol the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees 800.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. MBNA America Credit Card Balance 133.73 28.90 1,053.00 18_27 . 69.73 2_00 8. MCI Telephone Bill May Rental Telephone Bill Refund of June Pension 9. Bethany Court Apartments MCI Federated Department Store M & T Bank Duplicate Statement Fee 30,534.54 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy Elizabeth Forster, Deceased FILE NUMBER 21 04-0492 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LIst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outrIght spousal distributions, and transfers under Sec. 9116 (aJ (1.2)] 1. BEVERLEE TYLER FORSTER Daughter 50% 615 Smith Road, Danville, PA 17821 2. DAVID ALAN FORSTER JR. Son 50% 934 West Foxcroft Drive, Camp Hill, PA 17011 - ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTiONS UNDER SECTiON 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MAOE B. CHARITABLE AND GOVERNMENTAl DlSTRI8UTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES INHERITANCE TAX DIVISION PO BOX Z8D60l HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR OISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX C JAMES RUFFENNACH ESQ STE 280 275 CURRY HOLLOW RD PGH PA 15236 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-27-2004 FORSTER 05-15-2004 21 04-0492 CUMBERLAND 101 *' REV-1541 EX lFP U9-04) DOROTHY E Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4rj-EX-AFP--fiiFo3Y-iiiiYicE-.oi'-YNHER"iTiiifc"E"TAx-iiPPR1iisEii€iiT~-ArrowiiiicE-cji----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FORSTER DOROTHY E FILE NO. 21 04-0492 ACN 101 DATE 12-27-2004 TAX RETURN WAS, (X) ACCEPTED AS FILED } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest {Schedule CJ 4. Mortgages/Notes Receivable {Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule fJ 7. Transfers (Schedule GJ 8. Total Assets ll) (2) (3) (4) (5) (6) {7} .00 182.445.33 .00 .00 176.201. 81 .00 155.094.20 (S) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) IlO} 30,534.54 .00 Ill} 112} 113} 114} NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. A.ount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class 8 rate (18) 19. Principal Tax Due NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 513,741. 34 30.~34 ~4 483,206.80 .00 483,206.80 14, lS and/or 16, 17, 18 and 19 will returns assessed to date. Tax CR TS: PAY (+, AMOUNT PAlO DATE NUMBER INTEREST/PEN PAID (-) 08-02-2004 CD004219 1,012.50 19,237.50 10-20-2004 CD004535 .00 1,494.31 TOTAL TAX CREDIT 21,744.31 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 EXHIBIT "F" TOTAL DUE .00 .00 X 00 = 483,206.80 X 045 = .00x12= .00 X 15 = 119)= . IF PAID AFTER OATE INDICATED, SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST. .00 21, 744.31 .00 .00 21,744.31 IF TOTAL OUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTEO AS A "CREDIT" (CR), YOU MAY SE DUE A REFUNO. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} RESERVATION: Estates of decedents dying on or before December lZ~ 1982 -- !f any future interest in the estate is transferred in possession or anjoY~ent to Class B (col1aterall beneficiaries of the decedent after the expiration of any estate for life Dr for Years~ the Co.-onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND {CR1: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritanca and Estate Tax Act~ Act Z3 of 2000. {72 P.S. Section 91401. Detach the top portion of this Notice and sub.it with your pay.ent to the Register of Wills printed on the reverse side. - -Halc:e check or ..oney order pay8bb to: REGISTER OF MILLS ~ AQENT A refund of a tax credit~ whIch was not requested on the Tax Return~ may be requested by complating an -Application for Refund of Pennsylvania Inheritance and Estat. Tax. {REV-13131. Applications are aVailable onlina at www.ravenue.state.oa.us~ any Register of Wills or Revenue District Qffice~ or fro. the Depart.ent's 24-hour answering service for forms orders: lw800-362-2050J sarvices for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the apprais.ent~ allowance or disallowance of deductions or assess.ent of tax (including discount or interestl as shown on this Notice .ay Object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Depart..nt of Revenue, Board of Appeals. You ~ay object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you gust receive . confir~tion nu.ber and processed date fro. the BOBrd of Appeals website. You .ay also send a written protest to PA Depart.ent of Revenue, Board of Appeals P.O. Box 281021, HarriSburg, PA 17128-1021. Petitions gay not be faxed. B) Election to have the gatter determined at the audit of the account of the personel representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone {7!71 787-6505. See page 5 of the booklet -Instructions for Inheritance Tax Return for a Rssident Decedent" (REV-15011 for an explanation of administratively correctable errors. If any tax due is paid within three {31 calendar Months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. Th. 15~ tax a~nesty non-partiCipation penalty is co.puted 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 sa.e ti.e period as YOU would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine {91 months and one (1) day fro. the date of death, to the date of paYMent. Taxes which becage delinquent before January 1, 1982 bear interest at the rate of six (61.) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate Which will vary from calendar year to calendar year with that rata announced by the PA Depart.ent of Revenue. The apPlicable interest rates for 198Z through 2004 are: Il1terest Daily Interest Daily Inter.st Rate Factor Year Rate Factor Year Rate ~ =m mll-1991"""'IIr"":mrn!rr mn ---w.- 161. .000438 1992 91. .000Z47 Z002 6% 11% .000301 1993-1994 7X .000192 2003 5% 131. .00D356 1995-1998 9X .000Z47 2004 41. lOX .000274 1999 17. .00Dl9Z lOX .000Z74 2000 7X .000192 Year ~ 1983 1984 1985 1986 1987 Daily Factor .~ .000164 .000131 .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU/fBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becoges delinquent will reflect an interest calculation to fifteen (151 days beyond the date of the assessment. If payaant is made after the interast computation date shown on the Notice, additional interest must be calculated. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: ESTATE OF ) ) DOROTHY ELIZABETH FORSTER, ) ) DECEASED ) NO. 0492 OF 2004 ELECTION TO TAKE IN KIND I, BEVERLEE TYLER FORSTER, do hereby elect to take in kind the following: 1. 185 Shares 2. 504 Shares 3. 164 Shares 4. 84 Shares 5. 50 Shares 6. 50 Shares 7. 157 Shares 8. 93 Shares 9. 240 Shares 10. 240 Shares 11. 50 Shares 12.200 Shares 13. 202 Shares 14.351 Shares 15. 264 Shares AT&T Wireless Services, Inc. BellSouth Corporation BPPlc Consolidated Edison Company of NY Delphi Corporation Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc. Gallaher Group, Pic General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications Verizon Communications 3~,) Dated this day of August, 2004. 15.ux....1 D' ~~ F,....ti.-,. (SEAL) BEVERLEETYL RFORSTER EXHIBIT "G" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: ESTATE OF ) ) DOROTHY ELIZABETH FORSTER, ) ) DECEASED ) NO. 0492 OF 2004 ELECTION TO TAKE IN KIND I, DAVID ALAN FORSTER, JR., do hereby elect to take in kind the following: I. 185 Shares 2. 504 Shares 3. 164 Shares 4. 84 Shares 5. 50 Shares 6. 50 Shares 7. 158 Shares 8. 94 Shares 9. 240 Shares 10. 240 Shares 11. 50 Shares 12. 200 Shares 13. 203 Shares 14.351 Shares 15. 264 Shares AT&T Wireless Services, Inc. BellSouth Corporation BPPlc Consolidated Edison Company of NY Delphi Corporation Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc. Gallaher Group, Pic General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications Verizon Communications Dated this J?;;:t2i day of August, 2004. ayWkX;~~ DAVID ALAN FORSTER,.:fR. (SEAL) EXHIBIT "H" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DOROTHY ELIZABETH FORSTER, ) ) NO. 0492 OF 2004 DECEASED ) INRE: Receipt Know AIl Men By These Presents, that I, BEVERLEE TYLER FORSTER, do hereby acknowledge to have received from BEVERLEE TYLER FORSTER, Executrix of said Estate, the following stocks: AT&T Wireless Services, Inc. BellSouth Corporation BP Pic Consolidated Edison Company of New York Delphi Corp. Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc. Gallaher Group Pic General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications, Inc. Verizon Communications 185 Shares @$13.95 504 Shares @ $25.58 164 Shares@$52.75 84 Shares @$25.60 50 Shares @ $9.95 50 Shares @ $45.26 157 Shares@$25.17 93 Shares @ $37.08 240 Shares @ $73.31 240 Shares @$47.51 50 Shares @ $43.79 200 Shares @$3.20 202 Shares @$23.70 351 Shares @ $24.39 264 Shares @ $36.25 $ 2,580.75 12,892.32 8,651.00 2,150.40 497.50 2,263.00 3,951.69 3,448.44 17,594.40 11 ,402.40 2,189.50 640.00 4,787.40 8,560.89 9,570.00 having a total value of NINETY ONE THOUSAND ONE HUNDRED SEVENTY NINE AND 691100ths ($91,179.69) DOLLARS, as partial distribution from the above estate, And I do further authorize and direct the Clerk of the Orphans' Court Division to enter a Receipt on the Audit Docket in my name, place and stead. Witness my hand and seal this J...,;( day of August, 2004. fl.w.v.~ ~"- rP1A~ (SEAL) / BEVERLEE TYLER FORSTER EXHIBIT "I" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DOROTHY ELIZABETH FORSTER, ) ) NO. 0492 OF 2004 DECEASED ) INRE: Receipt Know AIl Men By These Presents, that I, DAVID ALAN FORSTER, JR., do hereby acknowledge to have received from BEVERLEE TYLER FORSTER, Executrix of said Estate, the following stocks: AT&T Wireless Services, Inc. BellSouth Corporation BPPIc Consolidated Edison Company of New York Delphi Corp. Eastman Chemical Company Eastman Kodak Company FirstEnergy Corp. Fortune Brands, Inc. Gallaher Group Pic General Motors Corporation Lucent Technologies, Inc. Norfolk Southern Corporation SBC Communications, Inc. Verizon Communications 185 Shares @$13.95 504 Shares @ $25.58 164 Shares @ $52.75 84 Shares @$25.60 50 Shares @ $9.95 50 Shares @ $45.26 158 Shares @ $25.17 94 Shares @ $37.08 240 Shares @ $73.31 240 Shares@$47.51 50 Shares @ $43.79 200 Shares @ $3.20 203 Shares @$23.70 351 Shares @ $24.39 264 Shares @ $36.25 $ 2,580.75 12,892.32 8,651.00 2,150.40 497.50 2,263.00 3,976.86 3,485.52 17,594.40 11,402.40 2,189.50 640.00 4,811.10 8,560.89 9,570.00 having a total value of NINETY ONE THOUSAND TWO HUNDRED SIXTY FIVE AND 64/100ths ($91,265.64) DOLLARS, as partial distribution from the above estate, And I do further authorize and direct the Clerk of the Orphans' Court Division to enter a Receipt on the Audit Docket in my name, place and stead. Witness my hand and seal this Z;t.( day of August, 2004. ~ DAVID ALAN FORSTER, EXHIBIT "J" , (SEAL) COSTS PAID ON BEHALF OF ESTATE 2004 May 19 David A. Forster, Jr. Costs advanced for funeral expenses $ 183.91 19 Cafe Magnolia Memorial Service Dinner 144.68 21 Menand's Diner Burial Luncheon 71.23 26 Register of Wills Probate and 10 Short Certificates 61.00 26 Register of Wills 10 Short Certificates 30.00 26 Cumberland Law Journal Legal Advertising 75.00 26 The Sentinel Legal Advertising 98.69 June 2 MBNA America Credit Card Bill 133.73 7 MCI Telephone Bill 28.90 11 Bethany Court Apartments Rental for May 1,053.00 17 Empire Monument Co. Grave Marker 1,320.00 30 Register of Wills 10 Short Certificates 30.00 30 Susan L. Ricciardi Notaries-Stock Transfer 22.00 July 1 Postmaster Certified Mail-Stock Transfer 74.58 5 MCI Telephone Bill 18.27 10 Federated Department Store Return of June Pension 69.73 27 M&T Bank Statement Fee 2.00 August 2 Register of Wills, Agent Payment on account of Inheritance Tax 19,237.00 5 UPS Overnight Delivery-Stocks 18.44 5 UPS Overnight Delivery-Stocks 16.56 Sept. 17 Susan L. Ricciardi Notaries-Inventory 5.00 18 Myers Funeral Home Funeral Expenses 7,100.00 18 Tebbutt Funeral Home Funeral Expenses 1,368.00 18 Albany Rural Cemetery Burial 675.00 22 Register of Wills Filing Inventory 303.00 Oct. 12 Register of Wills, Agent Balance ofInheritance Tax 1,494.31 19 Register of Wills Filing Inheritance Tax Return 15.00 23 Beverlee Tyler Forster Executor's Fee 5,000.00 Dec. 9 C. James Ruffennach Attorney's Fee on account 5,750.00 2005 January 21 C. James Ruffennach Balance of Attorney's Fee 7,000.00 31 Register of Wills Filing Family Agreement 17.00 31 Frank Connell Preparation of Federal, State, Individual and Fiduciary Tax Returns 300.00 31 Beverlee Tyler Forster Funds withheld for payment of Income Tax 300.00 Total Expenses .................. $ 52.016.03 EXHIBIT "K" INCOME RECEIVED ON BEHALF OF ESTATE 2004 May 28 Gallaher Group P Dividend $ 686.69 June 1 Fortune Brands Dividend 144.00 1 Firstenergy Corp. Dividend 70.13 1 Federated Department Store Dividend 69.73 1 Firstenergy Corp. Dividend 21.75 4 Citizens Investment Activity Interest 19.01 7 Bp P.L.C. Dividend 132.84 10 General Motors Dividend 50.00 10 Norfolk Southern Dividend 32.40 15 Consolidated Edison Dividend 94.92 16 Highmark Blue Shield Health Insurance Refund 181.89 25 State Farm Insurance Refund 9.04 25 State Farm Insurance Refund 101.10 25 State Farm Insurance Refund 198.39 30 AT&T Refund 32.43 July 1 Eastman Chemical Dividend 44.00 2 Citizens Investment Activity Interest 18.18 30 Eastman Kodak Dividend 78.75 August 3 Citizens Investment Activity Interest 19.01 3 Delphi Corporation Dividend 7.00 Sept. 1 Firstenergy Corp. Dividend 21.75 2 Citizens Investment Activity Interest 19.01 Oct. 4 Citizens Investment Activity Interest 18.18 Dec. 1 Firstenergy Corp. Dividend 21.75 Total Income .................. $ 2.091.95 EXHIBIT "L" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INRE: ESTATE OF ) ) DOROTHY ELIZABETH FORSTER, ) ) DECEASED ) NO. 0492 OF 2004 ELECTION TO TARE IN KIND AND RECEIPT I, DAVID ALAN FORSTER, JR., do hereby elect to take in kind and acknowledge receiving the 1991 Buick Skylark valued at Five Hundred Twenty Five and OO/IOOths ($525.00) Dollars, and I hereby further authorize and direct the Clerk of the Orphans' Court Division to enter a Receipt on the Audit Docket in my name, place and stead. Witness my hand and seal this /:2.-.. day of February, 2005. (SEAL) DAVID ALAN FORSTER, EXHlliIT "M" Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 RUFFENNACH CYRIL JAMES 275 CURRY HOLLOW RD SUITE 280 PITTSBURGH, PA 15236-4631 RE: Estate of FORSTER DOROTHY ELIZABETH File Number: 2004-00492 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992~ the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/15/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~ #;~j."r~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 FORSTER BEVERLEE TYLER 615 SMITH ROAD DANVILLE, PA 17821 RE: Estate of FORSTER DOROTHY ELIZABETH File Number: 2004-00492 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/15/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY ELIZABETH FORSTER Date of Death: MAY 15, 2004 Estate No.: 2004-000492 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 whether administration of the estate is complete: Yes lli1 No 0 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: a. Did the personal representative file a final account with the Court? Yes 0 No lil FAMILY SETTLEMENT AGREEMENT WAS FILED 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 0 No llil FAMILY SETTLEMENT AGREEMENT 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. ~<~1?r/I~<4~~ Date: 4 / 3 / 0 6 C. JAMES RUFFENNACH, ESQUIRE Name 275 CURRY HOLLOW ROAD Address SUITE 280 PITTSBURGH, PA 15236 Telephone No. (412) 650-9120 Capacity: 0 Personal Representative .lKl Counsel for personal representative @