Loading...
HomeMy WebLinkAbout02-0223Register of Wills of Cumberland PETITION FOR GRANT OF Estate of Donald E. Kaufmann also known as , Deceased Randall D. Kaufmann County, Pennsylvania LETTERS ' EST ARY Social Security No. 182 - 16 - 9931 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 01/22/199~nd codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. F!xcept as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Randall D. Kaufmann leon 1356 Equus Drive, Camp Hill, PA Sally Ann Newton Idau~hter 13607 Buffin~ton Place, Greensboro Rick D. Kaufmann leon 1191 Shoreham Road, Camp Hill, PA I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland NC County, Pennsylvania with his/her last family or principal residence at 307 Allendale Way, Lower Allen Township (list street, number, and municipality) Decedent, then 79 years of age, died_02/06/2002 at Lower Allen To,reship, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) 140,000.00 situated as follows: 'Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in th? appropriate form to the undersicjned: I / ~ Si~lnat~ure.. Typed or printed name and residence //~,~ /~=~.~',,~ Randall D. K au fro ann ~////// ~ 356 gquus Drive, Camp Hill, PA 17011 Copyright (c) 1996 form software only CPSystems, Inc. Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statement~in the foregoing Petition are true and correct to the best of the knowledgerand belief of Petitioner(s)~nd that,~as personal the Decedent, Petitioner(s)will well and t. uly administer the esT/~ccordin~/~ law. Sworn to or affirmed and subscribed //~~'~ . j before me this 2Stay of F~h~]ary 2002 esentative(s) of dall No. Estate of Donald E. Kaufmann Social Security No: 182-16- 9931 AND NOW, March ~7, Date of Death: 02/06/2002 21-2002-223- of the Petition on the reverse side hereon, satisfactory proof having been presented before me, D~¢eased 2002 , in consideration IT IS DECREED that Letters ~l Testamentary [~ Of Administration ~:D (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Randall D. Kaufmann in the above estate and that the instrument(s) dated 01/22/1997 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s).5 · · · $ Renunciation .... 2. . . . $ Affidavits ( ) .... $ Extra Pages ( 5 ) .... $ Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... Prepared by the Pennsylvania Bar Association 235.00 15.00 10.00 Attorney: I.D. No: 15.00 5.00 Michael L. Banss 41263 Address: 302 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 $ 280.00 Copyright (c) 1996 form software on~ CPSystems, Inc. Form RW-1 (1991) his is to certify that the' information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Date , ~ nBv ~87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH · I I. · I ~ Cumberland ~ ~o~er Allen ~p. ~ BO7 Allendale ~ay ~~. ,t ~hite ' ~CEmNT'SUSUAL~CUP~ION "l KINO~S~ES~STRY ' I~S~CE~NTEVER~ I ~CE~m'SE~ ' ~LST~US-~ I o,~,f, ~er,~ I I ~ ~ ~n I ~~ ~ . - . I 307 Allendale Way Camp Hill, PA 17011 IOECEOENT'SACTU^t Penn sylvan i a ~ ,,,.~ ~.. ~ ~, ~ o.o,~.l ,m.c~ Cumberland "~"~? t?d.[] wN~fi~IC~Ci Lower Allen ,,. Herbert G. Kaufmann ~,. Cora I. Chappell ~. Randall D. Kauf~nn m. 356 Equus Drive, Camp Hill, PA 17011 ~,~ =..,~.~ Dl,,.~ebruary 9, 2002 ],Rg~[~ng Green Hemorlal Parkl~er Allen ~p., PA 17011 SIGNR'Ufl FUN RAL SER ELI EE ERSON ACTING AS SUCH LICENSE NUMBER NAUE AND ADDRESS OF FACIUTY ~ Tu,~! "1 ~Ryc U~S~E_~ -- .--/ r~ I I Parthemore FH & CS, Inc. ~22..~~ ~ 7-'~f~ ~ I-~'~ ["' 22b. FD 013 340 L 122~.O. Box 431, New Cumberland~ PA 17070-0431 I ~ele ~e~s ~< ~y w~n ani¥~ ' I~ I~ ~11 ~ my k~w~d~. ~i~ ~curr~ al t~ time. dale ~ HI~ sal~, [LICENSE NUMBER ID~E S~D 2b. 12lb. lag. DUE TO DUE TO ((~R AS A CONSEQUENCE OF): 'MEDICAL EXAMINER/CORONER On the bllll of ex aminllion and/or Investigation, in my opinion, delth occulred at the lime, date, and place, and due Io the cause(s) and manner al stated .................................................................................................. flEC~'~.~AR S SIGNA~41~O h NAm ~D A~ESS ~ PERS~ ~O COMPLETED mU~ ~ OEAIH Penn State ~ilton S. Hershey ~ed~ca~ .~00 Hn~ver~sty DrSve~ Hershey, PA 17033 LAST WILL OF DONALD E. KAUFMANN 21-2002-223 I, DONALD E. KAUFMANN, presently of 307 Ailendale Way, Camp Hill, County, Pennsylvania, declare this to be my last Will hereby revoking all Wills and Codicils previously made by me. I declare that I have three children born to me, all of whom are now living: Randall Kaufmann, born July 3, 1947 and presently of Camp Hill, Pennsylvania; Sally K Newton, born March 20, 1951 and presently of Greensboro, North Carolina and Rick D. Kaufmann, born May 17, 1964 and presently of Camp Hill, Pennsylvania. All references in this Will to my children include only the above named children. ARTICLE I Payment of Debts/Expenses: I direct the paymem of my debts, including the expenses of my last illness and funeral, from my estate as soon after my death as conveniently may be done. ARTICLE H Residuary Estate: I do give and bequeath the rest, residue and remainder of my estate, both real, personal and mixed, &whatsoever kind and wheresoever situate equally to my children, subject to the following. If my daughter, Sally K. Newton, predeceases me, then of her share of my residuary estate shall be distributed to my surviving children and the remaining one-half is to be distributed equally to my grandsons, Michael and Matthew Newton. -2- my son, Randall D. Kaufmann, predeceases me, then one-half of his share of my residuary estate shall be distributed to my surviving children and the remaining one-half is to be distributed equally to my grandsons, James and Todd Kaufmann. If my son, Rick D. Kaufmann, predeceases me, then his share of my residuary estate shall be distributed equally between my daughter, Sally, and my other son, Randall. ARTICLE HI Personal Representative: Personal Representatives of this Will. I nominate and appoint my children to serve jointly as my ARTICLE IV Fiduciary's Performance and Powers: No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. Any such fiduciary shall have the following powers, in addition to those given by law: 1. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to distribute property in kind, to compromise claims, and to sell any property at public or private sale; 2. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; 3. To engage in litigation and compromise, arbitrate or abandon claims; 4. To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributee on a non-prorata basis, and for such purposes to make reasonable determinations of current values; -3- 5. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of a any person affected thereby; 6. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 7. To manage, control, repair and improve all estate property; 8. To procure and carry at the expense of the Estate, insurance of the kinds, forms and amounts deemed advisable by the Personal Representatives to protect the Estate against any hazard; 9. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of the Personal Representatives and to pay from my estate reasonable compensation for all services performed by any of them. ARTICLE V Death Taxes: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, other than any generation skipping taxes, (including any interest and penalties thereon), which may be payable by reason of my death with respect to property passing under this Will, shall be paid out of the property giving rise to such taxes on an incremental tax basis. ARTICLE VI Protection from Improvidence: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. -4- ARTICLE VII Invalidity: If any provision of this Will or of any codicil hereto is held to be invalid or illegal, it is my intention that all of the remaining hereof shall cominue to be fully operative and effective so far as it is possible and reasonable. IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will, consisting of six (6) typewritten pages, including this attestation clause, to be executed, declared and published this 22nd day of January, 1997, at Mechanicsburg, Pennsylvania. DONALD E. KAUFMANN WITNESSES: Residing at Residing at 4 1.~ ~c.x ~-~,-,,,,~ C-T, -5- ACKNOWLEDGMENT OF PENNSYLVANIA: DF CUMBERLAND : SS I, DONALD E. KAUFMANN, Testator, whose name is signed to the attached or instrument, having been duly qualified according to law, do hereby acknowledge that I and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as flee and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by DONALD E. KAUFMANN, / '14ota~y Public My Commission Expires: AFFIDAVIT FH OF PENNSYLVANIA: COUNTY OF CUMBERLAND : and SS. We, ~"~o,~¢,,~r&,,> .. ~-,'c A~, ~:k (2. {[~[¢5; the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw DONALD E. KAUFMANN sign and execute the instrument as his Last Will, that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, that each of us in hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge, the Testator was at the time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me, by~/TC/~'~z ~?(~:?d~/~ O , this~ 7~ay of January, 1997. "Notary Public Notarial Seal Debra K. Donadee, Notary Public Lemoyne Boro, Cu~erland Coun~ My Commission Ex~i.os June 22, 19v8 Member, Pennsylvar~ia Association of Notaries Register of Wills of Cumberland County, Pennsylvania Estate of also known as RENUNCIATION Donald E. Kaufmann The undersigned, RICK D. KAUFMANN, son No. 21-2002-223 , Deceased of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Randall D. Kaufmann WITNESS hand this ~.~ ~ day of (Signature) (Address) RICK D. KAUFMANN (Signature) 1191 Shoreham Road Camp Hill, PA 17011 (Address) (Signature) (Address) Sworn to or affirmed and subscribed ~o~ pu~,~ ~ ' I ~.~ ~.,~ T~$., ~~ c~ ~ My Commission ~pires: ! My ~m~~n ~. ~ i0,~~~ (Signature and seal of Nota~ or other official qualified to administer oaths. Showdateof NOTE: Renunciations executed outside the Office of Register of Wills expiration of Nota~'s commission.) in some counties are required to be notarized. Prepared by the Pennsylvania Bar Association Col~yright (c) 1996 form software only CPSystems, Inc. Form #RW-4 (1991) FROM : BANGS LAW OFFICE FAX NO. : 717+730+7510 Feb. 13 2002 03:36PM P4 Register of Wills of Cu.,b=r~and Estate o~ Donald E. Kaufmann also known as RENUNCIATION County, Pennsylvania 21-2002-223 The undersigned, . Deceased SALLY ANN NEWTON, daughter (Relationship) (Capaci~/) ~he above Deceder4, hereby renounce(s) the right to adr~nis~er the estate and fespec~luliy request(s) ~hat Lelters be issued to Randall O. Kaufmann of day of 3607 Buffington Place Greensboro, NC 27410 (Address) (Signature) (Address) (Signal;urn) (Address) Sworn to or affirmed am:l subscr;bed before .me thi~; ,/'zf~'';~ day qua~fieCI ta ;IdrffiN.~ter eaths, Show date of NOTE: Renunciatio~ executed outside ~he Otfice of RegiSter of Wills in some counties are required to be notarized. I.~yri~ht (c) 1996 tQ4'm ~oftw~e only CPSyatema. Inc. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: To the Register: DONALD E. KAUFMANN FEBRUARY 6, 2002 21-2002-223 Admin. 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 March 13, 2002: NAME Randall D. Kaufmann Rick D. Kaufmann Sally Ann Newton ADDRESS 356 Equus Drive, Camp Hill, Pennsylvania 1191 Shoreham Road, Camp Hill, Pennsylvania 3607 Buffington Place, Greensboro, NC 27410 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Signature: ~Pl/~/~/(~'~ Michael L. Bhngs, A~to~ey-at-Law 302 South 18th Street~// Camp Hill, PA 171M1 (717) 730-7310 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-11 62 EX(11-96) CD 001 252 BANGS MICHAEL L 302 S. 18TH STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 182-16-9931 FILE NUMBER: 2102-0223 DECE-'DENT NAME: KAUFMANN DONALD E DATF OF PAYMENT: 06/05/2002 POSTMARK DATE: 06/04/2002 COUNTY: CUMBERLAND DATI-- OF DEATH: 02/06/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,948.80 TOTAL AMOUNT PAID: 5,948.80 REIVIARKS: RANDALL D KAUFMANN C/O MICHAEL L BANGS ESQUIRE SE!AL CHECK# 513 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS MICHAEL L. BAN S ATTORNEY AT LAW 302 SOUTH 18TH STREET CAMP HILL, PA 17011 PHONE 717-730-7310 FAX 717-730-7374 E-mail: bangslaw~paont]ne.com June 3, 2002 Mary C. Lewis, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of Donald E. Kaufmann File No. 21-02-223 Dear Mrs. Lewis: Enclosed please find the original and one copy of a completed Pennsylvania Inheritance Tax Return for the above-referenced decedent together with a check in the amount of $15,948.80 to pay the tax shown to be due. I am also filing an Inventory along with a check in the amount of $25.00 to pay the filing fee for these documents. Kindly return a paid receipt to me in the enclosed, stamped, pre-addressed envelope. Thank you very much. V ry truly yours, ~el L~.' B~gs WSC -( ~'-; Enclosures cc: Mr. Randall D. Kaufmann 0 0 hoe ~ ~.) ~ -9931 ~ ~ ~ ~,.~ on · ~ 0 ~ ned ,~0~ ,9 RESERV PURPOSE NOT[CE: PAYMENT: REFUND £10L[ Vd'*I o~unbS osnoql~no2) ouo osnoql.moD Xluno~) puul~oqtun~3 sli!A5 jo :~ols!8*~t 's~.~oq 'D I[0LI Vd 'II~.H dml~D ~ooJ~fi q~ffi q~nofi gOt; ~OI~V~I '~I ~I~VHgI~ = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNItUENT X DAILy INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment, if payment is made after the interest computation date shown on the Notice, addJtiona! interest must be caZcuZated. :O.L COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ' Kaufmann Donald E. DATE OF DEATH (MM-DP-YEAR) DATE OF BIRTH (MM-DD-YEAR) 02/06/2002 11/26/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) cAPB HpRL ~pIO ~=AC ~TK R E C A P I T U L A T I O N C O R R I-' S C 0 M · r T I 0  1. Original Return ~ 247! Supplemental Return 4. Limited Estate . Future Interest Compromise (date of death after 6. Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) ~l 9. Litigation Proceeds Received I 110. Spousal Poverty Credit (date of death between 1:>-:31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER 21-02-223 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 182-16-9931 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER U (date of death 3. Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [--~ Election to tax under Sec. 9113(A) 1 1, (Attach Sch O) NAME Michael L. Ban~s, Esq. FIRM NAME (If Applicable) TELEPHONE NUMBER 717/730- 7310 1. Real Estate (Schedule A) (1) COMPLETE MAILING ADDRESS 9. 10. 11. 13. 2. Stocks and Bonds (Schedule B) (2) ' 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) 14. 302 South 18th Street Camp Hill, PA 17011 138,10~' :3 4 None None 5,414.35 5,232.79 227,615.83 12,969.51 ~, OFFI,~IA['0SE ONlY 8,976.92 (8) 376,364.31 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) (11) Net Value of Estate (Line 8 minus Line 11) (12) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) 21,946.43 354,417.88 354,417.88 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 354,417.88 X .0 0 (15) X .0 45 (16) X .12 (17) X .15 (18) (19) 0.00 15,948.80 0.00 0.00 15,948.80 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 307 Allendale Way CITY Camp Hill STATE ZIP PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 (~) Total Credits ( A + B + C ) (2) 15,948.80 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 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. (5) A. Enter the interest on the tax due. (hA) B. Enter the total of Line 5 + hA. This is the BALANCE DUE. (hB) 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. retaintheuseorincomeofthepropertytransferred; ......................... ~ ~ 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? .............................................. [] r~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~ r-"-] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 0.00 15,948.80 0.00 15,948.80 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 a?Fcomplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, S1GNA~JREOtCPERSONRESPONSIBLEFORFILINGRETURN Randall D Kaufmann DATE · ~//~- ~ // -- 356 Equus Drive ,~'~/e'~}/(//,~, ~ , ~e,~~7-~--Hii'f;-~X--lV6ii- ......................... ~/3~/ ~G~%~EPrl ~HA*REPRESENTATIVE mchael L Bangs, Esq ~ A . * ~% ~ ~ ; 302 South 18th Street Y ::- ....................... For Oatos of death ~ ~ after Jul~ 1, 1~04 and boforo 3anua~ ~, 1~5, the tax rate imposod on tho net va~u, of transf*rs t0 0r for tho uso 0f tho survivin~spouseis~ 72RS. Ollfi(a)(~.l) 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)J, 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)1. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 P.S, 911611.21 [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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form RI::V-1500 EX (Rev. 6-00) REV-1502 EX + (1-97) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Kaufmann SS# 182-16-9931 02/06/2002 21-02-223 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable __knowledge of the relevant facts. Real property which is jointly-owned with ric~ht of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM NUMBER DESCRIPTION Real Estate 307 Allendale Way, Camp Hill TOTAL (Also enter on line 1, Recapitulation) OF DEATH 138,101.34 $ 138,101.34 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) OMB NO, 2502-0263 IU,S, O~PA~T~4Em OF' HOUSt~O & u~N DEVELOPMEUTI 1.~FHA 2.~FmHA 3.~CONV. UNINS. 4.OVA 5.~CONV, INS i 16,FILE NUM6~R; ..... I 7 LOAN NUMBSR: - I' , SE~LEMENT STATEMENT ~MANN,ESTA L" ~~E ,NS CASE NUMBER: lc; NOTE: Tn~ form Is furn~t~ to ~ .you a ~ate~nt of a~ual ~e~l~ment ~NA~E AND ADLqRE~ OF BUYEq: E. NAME ~'.JCK O K_~[.FMANN ~STATE OF DO.LO O. KAUFMANN I -~-- PROPER~'Y LOCATIONi -! H. SETTLEMENT AGENT: 2.3-2402310 I SETTLE~EN"T DA'E:'- 307 ALLEI'IDALE WAY PURITY ABSTRACT COMPANY CAMP HIL_ PA 1 7011 May 3c, 20o2 CiJL'BERLAND Counb/. Pennsylvania PLAOE. OF SETTLEMENT t,~,~--~ 3329 Maeke! Street ~' ~ Cam~ HiII, PA ' 701 ~ J, SUMMANy LJ;~ ~UYER'~ TFLANSAtJI ;UN " K, ~UMMAI~T (J~- :SP.L.L~,~'5 ThlAI'~SAC.;TION 100, GR-L"T~.;~ AMC~UNT DUE FROM BUYER;' " 400. GROSS AMOUNT DUE TO ~IELLER; ~n-~iCt falee, Price 130,000,~0 '4.D1 C~nlract Sales Price ~'02, P'ers0'~al Property i ,, 4d2, Personal l-'rop~rty '4-~3, 5etllement Charges ~ E, uyer (Line 14'00} I "T41,5.6:3 -403, -- '" -- Ac~/.~'s~me,~t:; Por-T~gm$ Pa/o' By Sgl;er in adv~hce --~ Adju~tment~ ~-¢r Item~ Paid By Se#er ~0'~n-['v,q'wD Ta~es 05/30;02 to 01/01/03 ;~;4.~ 4.06. County/Twp Taxes 05130/02 to 01/01/03' I I '" I 334.5- T¢'Z'-CF..~ - to i 40r. 06, tax to ' · ,"'I~-~'-~ '~'Ar'RE =3:SE/SEWEr< $67%0 05F307'0'2 to 07/01/ I 22.?4' -4'-~)9. 2ND QTR RP-,,FUsE/LSEWER ~6I?.~0 05!30/D2 to 07/01/ 2,3.74 ~20 O,~©*.;$AMOUNTD(cEFROMBU:¢F_~ + ~40,906,84 420. QRQ~SAMOUNTDUETOSELI. ER 139491 34 : , 20'-'3, AMOL:NT~ PAID BY OR IN BEHALF OF BUYER:- i ~00, REDUCTION8 IN AMOUNT DUE TI::) SELLER: ...... .~.,'T. Oepos t or earne'.4t n'~bney ? ,501 Excer.8 oepoeit (See Inetructions) ' 'Z~.2. PrJl3Ct[l~l Amour~t cf NewLoan(s} 502. fa~lef~ent Charges I0 Sellec~Line 1400) ' " 503. Exisltn¢ tdan(s) t~l~en fubJed! 1o I '2c'5 5oe, "', .,,',, ----- ----~:i?"stment$ FOr I,ern~ Un~ a d ~y Se/te~ ...... Adjustment~ ~or ltanq~ Unpaid ~ty /TwpTaxe~ ...... t0 '" 510, C~ntyRwp Tax~ ........ ~00, CASH AT SE~ENT FRO~O BUY~R: .... ~~ moaq ue rom uy~~- ~ 140.~BB4 601. gro~ A~o~ht'Due lo ~ll~r (L~e 420) ....... 139',491'.~ '~77 t~,mouqt Paid By/~or Buy~~--~ ( 602. L~ Reduction~ Due 8~1~ (LI~ ~- ~'- 1,3~,~ 303. CASH( X FROM)( TO)SUYffR ~40,~0,84 003, CASH( X ~)( FROM)SEL~R ~ 138,101 34 hereby acknow!ed§e rec~l~t of a completed co~y of pages 18.2 of this statement & any attachmenl~ ref~er~d ID hereln ESTATE OF DONALO E KAU--MANN BY: RAh'bALL D, KAUFMANN. E×ECUTOE 700. TOTAL COMMISSION Based --" L~w~,or, ot {.;ommt~$ron fi/ne /uu) TgZ. ~ ~ ~O L, $~,rTLEMENT CHARGES 8{)0 ITEM~I PAYABEE 1N CONNI~CTION WITH LOA~ 801 Loan ~)~l~inat~ Fee % to ~, Lo~n D~nt % - to uuJ, Appra~l re~ ~ ~,g7. Tbx 6e~i~ Fee -u-u~ JOcume~( ~-'rep 903. 905, n'EMS REQUIRED BY LENDER TO BE PAID IN ADVANCE MG~g~tge I,~su~n~ ~re~'lumror ---' mOnt~s to Haza~l Insu~n~ Premium for ~eS~ to Il000. R~S~RV~S DEPOSITED WITH LENDER' 110C'~. H~a~d lnsura~e '9002. ~9~ lns~an~ 1003. ~n~wp T~~' ~,4. ~ty 1~6, ~ Tax p~- per per p~- per I008, A(3G;;(EGA~i E ~SCRO'W' ADJ. 11~0. TITLE CHARGES BANGS, ESQ. 11(:1. Settlement or CIO$1¢<j Fee to 103. Tit'le Examination tO I04. ln~ured ClosTng Letter to 105, Doc, u~nent PfCpara~i6n ~~y Fees -~0 ~ LenOeKs 1 lO; ~r'a ~¢T1: I 111~. qllJ, il,, 13¢J0. GO~L"RNMENT RECORDING AND TRAN{FER CHARGES 12~i1~ ReCO~n9 Fees: ~ $ 25,50; MO~a~ S ,m, ; , ~E~RDER OF DEEDS ~ECO~DER OF D~EDS ~3e0/AOD~TIO~L SETTLEMEhT' CHARGE5 ' - 1301. Survey to Re.es $ ~'3rj2. Pest Inspection tO 1~00-. TOTAl_ BETTLEMENT CHARGES (Enter on LI~ 103, Seotlon ~Jl'~'l~l~ ~O2. 5action K) 2550 ~ .'~-gb':~0 1,390.00 ~'LIE i I Y A~5 ! NAC l CO M[-'aNY Settlement A~ent REV-1508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Kaufmann SS# 182-16-9931 02/06/2002 21-02-223 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 5 6 Allfirst Bank - IRA Distribution Sale of 1989 Buick Automobile Department of Veterans Affairs Department of Veterans Affairs MetLife Insurance Policy Proceeds Refund Blue Cross/Blue Shield Refund TOTAL (Also enter on line .5, Recapitulation) 1,300.50 2,800.00 127.96 22.99 1,050.45 112.45 $ 5,414.35 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, thc. Form REV-1508 EX (Rev. 1-97) REV- 1509 EX + (1-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Kaufmann SS# 182-16-9931 02/06/2002 21-02-223 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Randall D. Kaufmann son B. Rick D. Kaufmann C. 356 Equus Drive Camp Hill,.PA 17011 1191 Shoreham Road Camp Hill, PA 17011 son JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH Include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF ITEM :OR JOINT MADE account number or similar identifying number. UMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 A kllfirst Bank Checkihg 5,505.67 50.00% 2,752.84 Ac count 2 B Allfirst Bank - Money Fund 4,959.90 50.00% 2,479.95 Alternative TOTAL (Also enter on line 6, Recapitulation) $ 5,232.79 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1509 EX (Rev. 1 REV* 1510 EX + (1-97) · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Donald E. Kaufmann SS# SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 182-16-9931 02/06/2002 FILE NUMBER 21-02-223 This schedule must be completed and filed if the answer to any of questions 1 throu¢ h 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF I'EM INCLUDE THE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. MBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 Allfirst Bank - Individual 223,651.61 100.00% 223,651.61 Retirement Account 2 Allfirst Bank - Individual 3,964.22 100.00% 3,964.22 Retirement Account TOTAL (Also enter on line 7, Recapitulation) $ 227,615.83 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-971 allfirst March 20, 2002 Michael L. Bangs Attorney At Law 302 South 18th Street Camp Hill, PA 17011 Allfirst Financial Center N.A. PC). Box 900 Millsboro, DE 19966 Estate of Donald E. Kauffman Date of Death: February 6, 2002 Social Security Number: 182-16-9931 Dear Mr. Bangs: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Ykjpe ........................... Checking Account (Non Interest Bearing)/' Account Number. ...................... 0050306898 Ownersh/p (Names of) ..............Donald E. Kauffman, Randall D. Kauffman Opening Date ........................... 08/28/64 Balance on Date of Deatk ......... $5,505.67 Accrued Interest $ 0.00 Total ....................................... $5,505.67 Account 7~pe ........................... Money Fund Alternative -;'" Account Number. ...................... 0098111078 Ownership (Names of) ..............Donald E. Kauffman or Rick D. Kauffman Opening Date ........................... 07/16/97 Year to Date Interest ................. $ 4.79 Balance on Date of Deattz .........$4,959.90 Accrued Interest $ 1.43 Total ....................................... $4,961.33 · · Page 2 March 20, 2002 These accounts were converted from the acquisition of another financial institution. Unfortunately, we are unable to access any information pertaining to the date the accounts were made joint. Account Type ........................... Revolving Unsecured Line of Credit Account Number. ...................... 102069700001 Ownership (Names of) .............. Donald E. Kauffman Opening Date ........................... 08/27/98 Line of Credit ........................... $3,000.00 Balance on Date of Death. ......... $ 0.00 Account Type ........................... Personal Unsecured Loan Account Number. ...................... 23000000049666 Ownership (Names of) .............. Donald E. I~auffman Opening Date ........................... 07/11/01 Original Loan Amount ............... $9,600.00 Principal on Date of Death. ........ $7,481.59 Interest $ 31.96 Total ....................................... $7,513.55 Account Type ........................... Individual Retirement Account Account Number. ...................... 87000101286002 Ownership (Names of) .............. Donald E. Kauffman Opening Date ........................... 03/16/84 Year to Date Interest ................ $ 0.00 Balance on Date of Deattz ........ $223,651.61 Accrued Interest $ 4,022.84 Total ...................................... $227,674.45 ' · Page 3 March 20, 2002 Account 7'~jpe ........................... Individual Retirement Account Account Number. ...................... 87100101286002 Ownership (Names of) .............. Donald E. Kauffman Opening Date ........................... 11/01/00 Year to Date Interest ................ $ 0.00 Balance on Date of Deattt ........$3,964.22 Accrued Interest $ 76.01 Total ...................................... $4,040.23 Account Type ........................... Safe Deposit Box Account Number ....................... 1000535100004321 (closed 02/08/02) Ownership (Names of) .............. Donald E. Kauffman This letter does not include any accounts in which the deceased may have been listed as power of attorney, custodian of uniform transfers, representative payee, or trustee under a written trust agreement. For any additional information on these accounts, please contact our branch at: 344 South l0th Street Lemoyne, PA 17043-1707 Phone: (717) 737-3322 Sincerely, Charlene Warrington, Associate I (302) 934-2722 REV- 1511 EX + (1-97) 'COMMONWEALTH OF PENNSYLVANfA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Donald E. Kaufmann SS¢~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 182-16-9931 02/06/2002 FILE NUMBER 21-02~223 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Parthemore Funeral Home - Funeral Bill ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney's Fees Michael L. Bangs, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State__ Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal - Advertising Fee The Sentinel - Advertising 7,389.20 5,000.00 280.00 125.00 75.00 100.31 TOTAL (Also enter on line 9, Recapitulation) $ 12,969.51 (If more space is needed, insert additional sheets of the same size) Copyright It) 1996 form software only CPSystems, Inc. Form REV-1511 EX ('Rev. 1-97) REV- 1512 EX + (1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Kaufmann SS~/ 182-16-9931 02/06/2002 21-02-223 Include unreimbursed medical expenses, ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Allfirst Bank Allfirst Personal Unsecured Loan Bonnie Miller 2002 County/Township Taxes Bonnie Miller 2002 Personal Tax Comcast Cable Expense - PAWC Expense - Lower Allen Township (Sewer/Refuse) Expense - PP&L Expense - Verizon Expense AT&T Expense Comcast Cable Expense Service Oil Expense Comcast Cable Expense AT&T Expense - PP&L Expense - Ruell's Lawn Care PA American Water Company - Water Bill PP&L - Electric Bill Service Oil Company Phone Bill 7,481.59 565.26 9.80 33.80 11.29 67.50 32.82 19.79 36.28 35.91 258.95 39 04 6 26 35 84 78 00 40 41 43 63 160.09 20.66 TOTAL (Also enter on line 10, Recapitulation) $ 8,976.92 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (1-97) · SCHEDULE J ' COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Donald E. Kaufmann SS# 182-16-9931 02/06/2002 NUMBER II, NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLEDISTRIBUTIONS(includeoutrightspousaldistributions): Randall D. Kaufmann 356 Equus Drive Camp Hill, PA 17011 Rick D. Kaufmann 1191 Shoreham Road Camp Hill, PA 17011 Sally Ann Newton 3607 Buffington Place Greensboro, NC 27410 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Son Daughter FILE NUMBER 21-02-223 AMOUNT OR SHARE OF ESTATE one-third one-third one-third ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS $ 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1513 EX (Rev. 1-97) LAST WILL OF DONALD E. KAUFMANN I, DONALD E. KAUFMANN, presemly of 307 Allendale Way, Camp Hill, Cumberland County, Pennsylvania, declare this to be my last Will hereby revoking all Wills and Codicils previously made by me. I declare that I have three children born to me, all of whom are now living: Randall D. Kaufrnann, born July 3, 1947 and presently of Camp Hill, Pennsylvania; Sally K. Newton, born March 20, 1951 and presently of Greensboro, North Carolina and Kick D. Kaufmann, born May 17, 1964 and presently of Camp Hill, Pennsylvania. All references in this Will to my children include only the above named children. ARTICLE I Payment of Debts/Expenses: I direct the payment of my debts, including the expenses of my last illness and funeral, from my estate as soon after my death as conveniently may be done. ARTICLE H Residuary Estate: I do give and bequeath the rest, residue and remainder of my estate, both real, personal and mixed, of whatsoever kind and wheresoever situate equally to my children, subject to the following. If my daughter, Sally K Newton, predeceases me, then one-half of her share of my residuary estate shall be distributed to my surviving children and the remaining one-half is to be distributed equally to my grandsons, Michael and Matthew Newton. -2- If my son, Randall D. Kaufmann, predeceases me, then one-half of his share of my residuary estate shall be distributed to my surviving children and the remaining one-half is to be distributed equally to my grandsons, James and Todd Kaufmann. If my son, Rick D. Kaufmann, predeceases me, then his share of my residuary estate shall be distributed equally between my daughter, Sally, and my other son, Randall. Personal Representative: Personal Representatives of this Will. ARTICLE IH I nominate and appoint my children to serve jointly as my ARTICLE IV Fiduciary's Performance and Powers: No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties, Any such fiduciary shall have the following powers, in addition to those given by law: 1. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to distribute property in kind, to compromise claims, and to sell any property at public or private sale; 2. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; 3. To engage in litigation and compromise, arbitrate or abandon claims; 4. To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributee on a non-prorata basis, and for such purposes to make reasonable determinations of current values; -3- 5. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, girl or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of a any person affected thereby; 6. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 7. To manage, control, repair and improve all estate property; 8. To procure and carry at the expense of the Estate, insurance of the kinds, forms and amounts deemed advisable by the Personal Representatives to protect the Estate against any hazard; 9. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of the Personal Representatives and to pay from my estate reasonable compensation for all services performed by any of them. ARTICLE V Death Taxes: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, other than any generation skipping taxes, (including any interest and penalties thereon), which may be payable by reason of my death with respect to property Passing under this Will, shall be paid out of the property giving rise to such taxes on an incremental tax basis. ARTICLE VI Protection from Improvidence: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. -4- ARTICLE VII Invalidity: If any provision of this Will or of any codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining hereof shall continue to be fully operative and effective so far as it is possible and reasonable. IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will, consisting of six (6) typewritten pages, including this attestation clause, to be executed, declared and published this 22nd day of January, 1997, at Mechanicsburg, Pennsylvania. DONALD E. KAUFMANN WITNESSES: Residing at Residing at oq.o~! ~ Residing at ACKNOWLEDGMENT OF PENNSYLVANIA: OF CUMBERLAND : SS I, DONALD E. KAUFMANN, Testator, whose name is signed to the attached or instrument, having been duly qualified according to law, do hereby acknowledge that I and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as free and voluntary act for the purposes therein expressed. DONALD E. KAU~ Sworn or affirmed to and acknowledged before me, by DONALD E. KAUFMANN, 99 . / 'Nota~ P~b'~c - My Commission Expires: l'~r~ . Nota,-ial Seal eora K. Donadee, Notary Public Lemoyne Boro Cum~,r,r~an , My Commiss on 'c .,..7- d C~n~ ~l.'~r,-:3 ,June 22, 1~8 Mem~c Pennsy~.van~a Ass~c~af?~n of No~ -6- AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND : SS. and We, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw DONALD E. KAUFMANN sign and execute the instrument as his Last Will, that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, that each of us in hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge, the Testator was at the time eighteen or more years of age, of sound mind and under no constraint or undue influence. ,and ~/~%',7~ ~. /~-~,,i~.~ thiso~'~c~(ayof January, 1997. / Notary Public Notarial Seal Debra K. Donadee, Notary Public Lemoyne Boro, Cumberland County My Commission Ext.'ires June 22, 1998 Member, Pennsylvar. a A%aziation of Notanes MICHAEL L' BAN S ATTORNEY AT LAW 302 SOUTH 18TM STREET CAMP HILL, PA 17011 PHONE 717-730-7310 FAX 717-730-7374 E-marl: ban~]aw(~paonline.com September 26, 2002 Mary C. Lewis, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of Donald E. Kaufmann File No. 21-02-223 Dear Mrs. Lewis: Enclosed please find the following documents that I file as a part of the above-referenced estate: 1. The original Status Report Form; and 2. Six (6) Receipts and Releases together with a check in the amount of $42 to pay the filing fee for these documents. Please file these documents accordingly. This will conclude the administration of this estate. If you have any questions or if you require anything further, please contact me directly. Thank you very much. I/~ery truly yours, Michael L. Bangs wsc Enclosures cc: Mr. Randall D. Kaufmann Register of Wills of CUMBERLAND INVENTORY Estate of Donald E. Kaufmann Personal Representative f Signature: all D. Kaufma Signature: also known as Address: 356 Equus Drive Randall D. Kaufmann, Per<_~onal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the per<.;onal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I /We verify that the statements made in this Inventory are true and correct. I/We understand ghat false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to auth ties. Attorney: Michael L. Bangs I.D. No.: 41263 Address: 302 South 18th Street Camp Hill, PA 17011 Telephone: 717/730 -.7310 County, Pennsylvania No. 21-02-223 Date of Death 02/06/2002 Deceased Social Security No. 182 -16 - 9931 Camp Hill, PA 17011 Telephone: Dated: ~ D NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) INVENTORY ]Estate of: Donald E. Kaufmann Date of Death: 02/06/2002 County: Cumberland CASH: Allfirst Bank - IRA 1,300.50 Distribution Sale of 1989 Buick Automobile 2,800.00 Department of Veterans Affairs 127.96 Department of Veterans Affairs 22.99 MetLife Insurance Policy 1,050.45 Proceeds Refund - Blue Cross/Blue ~ 112.45 Shield Refund REAL ESTATE/PA: --------------- Real Estate - 307 Allendale 138,101.34 Way, Camp Hill TOTAL RECEIPTS OF PRINCIPAL ............... 5,414.35 138,101.34 143,515.69 BUREAU OF INDIVIDUAL TAXES ZNHERTTANC~ TAX DTV~TSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 RANDALL D KAUFNANN 356 EQUUS DR CAHP HILL COHNONgEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX RECORD ADJUSTNENT JOINTLY HELD OR TRUST ASSETS PA 17011-8357 REV-I&04 EX AFP (01-OS) DATE 05-06-2003 ESTATE OF KAUFHANN DONALD E DATE OF DEATH 02-06-2002 FILE NUHBER 21 02-0223 COUNTY CUNBERLAND SSN/DC 182-16-9931 ACN 02119086 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REHIT PAYNENT TO= REGISTER OF gILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THXS LXNE RETAIN LONER PORTION FOR YOUR RECORDS REV-1604 EX AFP ~ INHERITANCE TAX RECORD ADJUSTHENT JOINTLY HELD OR TRUST ASSETS x~ DATE 05-06-2003 ESTATE OF KAUFHANN DONALD E DATE OF DEATH 02-06-2002 COUNTY CUHBERLAND FILE NO. Z1 02-0223 S.S/D.C. NO. 182-16-9931 ACN 02119086 ADJUSTHENT BASED ON: ADHINISTRATIVE CORRECTION dOINT OR TRUST ASSET INFORHATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0050306898 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 08-Z8-1964 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions - Taxable Amount .Tax Rate ~ Tax Due TAX CRED'rTS = PAYHENT DATE RECEIPT NUHBER .00 NOTE= 0.500 .00 .00 .00 .15 .O0 DISCOUNT (+) INTEREST/PEN PAID (-) TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNIT THE UPPER PORTION OF THIS NOTICE gITH YOUR TAX TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE 1S LESS THAN $1, NO PAYHENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .00 .00 .00 .00 REGISTER OF WILLS OF CUMBERLAND COUNTY REPORT OF STATUS OF ADMINISTRATION (For Resident Decedents Dying after July 1, 1984) ESTATE NO. 21 - 223 - 2002 Name of Decedent: Social Security No.: DONALD E. KAUFMANN 182-16-9931 Date of Death: February 6, 2002 Name of Personal Representative: Randall D. Kaufmann Capacity Executor __X__ (check one) Administrator Administrator c.t.a. Administrator d.b.n. Is the administration of the estate complete? Yes X No If "Yes", how was the administration ended? (check one) By court accounting By account stated to parties in interest Did the parties release the personal representative? Yes Other (explain) X Total amount paid to date to creditors and for funeral and $29,709.05 administrative expenses Total value of distributions to date to beneficiaries $126,249.38 If administration is not complete, estimated value of assets $ still in administration NOTE: This status report is due no later than the due date for filing of the Pennsylvania inheritance taxYeturn or, if no inheritance tax return.is required, nine (9) months after the date of death; if the administration of the estate has not been concluded, a summary report shall be filed annually thereafter until the administration is complete. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. Date: Attorney for Estate ESTATE OF DONALD E. KAUFMANN Deceased ) ) ) ) ) ) ) NO. 21-2002-223 RECEIPT AND RELEASE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION I, SALLY ANN NEWTON, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums of money and personal property to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this S~L'T_,Y AI'~ NEWTON (SEAL) day of STATE OF NORTH CAROLINA ) ( SS: COUNTY OF C ~r'''(-~x/ ~3 ) ~ r-~P) / / ' 2002 befo On this, the ] ~/ day of ,,._.~~. m~"-- , , re me, the undersigned officer, personally appe~ed S~LLY A~ NEWTON, ~om to me (or satisfactorily proven) to be the person whose nme is subscribed to the within instrument and ac~owledged thru (s)he execmed sine for the pu~oses ~erein contained. IN WI~ESS ~E~OF, I h unto set m~h~d ~ official seal. ~{~ Public IN RE: ESTATE OF DONALD E. KAUFMANN Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-2002-223 RECEIPT AND RELEASE I, RICK D. KAUFMANN, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums of money and personal property to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this , CK D. KAUFMANN __ day of COMMONWEO(L~H OF PENNSYLVANIA ) ' ? ( ss: COUNTYOF( /11 tq~ h/"' //]_~1 ~. , ' , Onthis, the ~~d, d~'~~~-- ,2002, beforeme, the undersigned officer, personally appe~ed ~K D. ~UFMA~, ~om to me (or satishctorily proven) to be the person whose nme is subscribed to the within inst~ent ~d ac~owledged that (s)he executed same for the pu~oses therein contained. IN WI~ESS ~E~OF, ~ hJreunto~set ~v ~d and official seal. IN RE: ESTATE OF DONALD E. KAUFMANN Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-2002-223 RECEIPT AND RELEASE I, RANDALL D. KAUFMANN, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums of money and personal property to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this __ day of .(SEAL) COMMONWEt(~,TH OF pENNS.YLVANI~ ) COUNTY OF On this, the _ ~[~I day of X~,~, ~~ , 2002, before me, the undersigned officer, personally appeared RAlgDALL D. KAUFMANN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that (s)he executed same for the purposes therein contained. IN WITNESS WHEREOF..g.hatve ~ereunto setnn~htmd and official seal. "N~)tary Publi~..~... IN RE: ESTATE OF DONALD E. KAUFMANN Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-02-223 RECEIPT AND RELEASE I, RICK D. KAUFMANN, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received the sum of $37,500.00, as a partial distribution to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN under the Will; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .-5,,, ~ e_ 2002. day of RICK D. KAUFMANN (SEAL) COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) On this, the _.~.~?~ day of (.:'X~'";~-~-z e ..... ,2002, before me, the undersigned officer, personally appe, .t~.e/.~RICK D. KAUFMANN, known to me (or satisfactorily proven) to be the person whose nam~ is subscribed to the within instrument and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I have her.etm~;o set my hand and official sepal. Notary Publi/e/ /'?/ ,""" '- !M NOTARIAL SEAL ' ' i I AJICY SUZETTE STEWART, 101tlff PUBIJC! I HARRISBURG, DAUPHIN IX)UNTY I . , . l MY COMMISSION EXPIRF.3 JAN. 31.2005 I IN RE: ESTATE OF DONALD E. KAUFMANN Deceased ) ) ) ) ) ) ) NO. 21-02-223 RECEIPT AND RELEASE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION I, SALLY ANN NEWTON, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received the sum of $37,500.00, as a partial distribution to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN under the Will; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribmion, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this __ ,2002. S.a~Y AlX~ NEWTON (SEAL) day of STATE OF NORTH CAROLINA ) ( SS: COUNTY OF ~q,t~ '~rC[_ ) On this, the ! ~ day of ~ ,2002, before me, the undersigned officer, pe~k-0-onally appeared SALLY ANN NEWTON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed same for the purposes therein contained. IN WITNESS WHEREOF, ESTATE OF DONALD E. KAUFMANN Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-02-223 RECEIPT AND RELEASE I, RANDALL D. KAUFMANN, the undersigned, being a legatee under the Will of DONALD E. KAUFMANN, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received the sum of $37,500.00, as a partial distribution to which I am entitled as an heir of the Estate of DONALD E. KAUFMANN under the Will; 4. To the extent of said distribution, release RANDALL D. KAUFMANN, Executor, of the Estate of DONALD E. KAUFMANN, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said RANDALL D. KAUFMANN, Executor, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of COMMONWEALTH OF PENNSYLVANIA ) (SS: COUNTY OF CUMBE/RI. jANDI ~ ,., ,~.{} ~'~l ) On this, the I~['~ day of ~JI,~LK,__. ,2002, before me, the undersigned officer, pe?sohally appeared R2ANDALL D. KAUFMANN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I have ~ereuntolset my hcmtl*and offiFial seal. I{o"t'~ar~ P~tblic /~ ' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060! HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAXSEMENT. ALLOHANCE OR DISALLOWANCE OF DEDUCTXONS, AND ASSESSMENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS RICK D KAUFMANN 1191SHOREHAM RD CAMP HILL PA 17011-6156 DATE 04- 07 -2005 ESTATE OF KAUFMANN DONALD DATE OF DEATH 02-06-2002 FILE NUMBER COUNTY SSN/DC ACN Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE 21 02-0225 CUMBERLAND 182-16-9951 02119087 CARLISLE, PA 17013 CUT ALONG THXS LXNE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP COl-OS) NOT[CE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-07-2003 ESTATE OF KAUFMANN DONALD E DATE OF DEATH 02-06-2002 COUNTY CUMBERLAND FILE NO. 21 02-0223 S.S/D.C. NO. 182-1&-9931 ACN TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED 02119087 JOXNT OR TRUST ASSET INFORMATXON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0098111078 TYPE OF ACCOUNT: C ) SAVINGS (~ CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-16-1997 Account Balance 4,961.35 Percent Taxable X 0.500 Aeount Subject to Tax 2,480.67 Debts and Deductions - .00 Taxable Amount 2,480.67 Tax Rate X .15 Tax Due 372.10 TAX CREDXTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-15-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN, TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN #1, NO PAYMENT XS REQUIRED. TF TOTAL DUE IS REFLECTED AS A "CREDIT" C CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 572.10 8.71 380.81 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060] HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLOHANCE DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS RANDALL D KAUFMANN 556 EQUUS DR CAMP HILL PA 17011-8557 DATE 04-07-2005 ESTATE OF KAUFMANN DATE OF DEATH 02-06-2002 FILE NUMBER 21 02-0225 COUNTY CUMBERLAND SSN/DC 182-16-9951 ACN 02119086 Amount Remitted DONALD MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOI*/ANCE OR DISALLO~/ANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-07-2005 ESTATE OF KAUFMANN DONALD E DATE OF DEATH 02-06-2002 COUNTY CUMBERLAND FILE NO. 21 02-0225 S.S/D.C. NO. 182-16-9951 ACN 02119086 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0050506898 TYPE OF ACCOUNT: ¢ } SAVINGS (~ CHECKING ( ) TRUST ( } TIME CERTIFICATE DATE ESTABLISHED 08-28-1964 Account Balance 5,505.67 Percent Taxable X 0.500 Amount Subject to Tax 2,752.84 Debts and Deductions .00 Taxable Amount 2,752.84 Tax Rate X .15 Tax Due 412.95 TAX CREDITS.' NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID NTEREST IS CHARGED THROUGH 04-15-2005 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN #1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. } .O0 412.95 9.66 422.59 ~~-~~-4s BUREAU OF INDIVIDUAL TAXES INHERITAN ISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS RANDALL D KAUFMANN 356 EQUUS DR CAMP HILL PA 17011-8357 REY-1604 E% ~FP (O1-OS) DATE 05-06-2003 ESTATE OF KAUFMANN DONALD DATE OF DEATH 02-06-2002 FILE NUMBER 21 02-0223 COUNTY CUMBERLAND SSN/DC 182-16-9931 ACN 02119086 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-03) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~~ DATE 05-06-2003 ESTATE OF KAUFMANN DONALD E DATE OF DEATH 02-06-2002 COUNTY CUMBERLAND FILE N0. 21 02-0223 S.S/D.C. N0. 182-16-9931 ACN 02119086 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT N0. 0050306898 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-28-1964 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: .00 X 0.500 .00 - .00 .00 X .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT T E REGISTER OF WILLS AT THE AD~SS S WN A80V~. MAKE CHEC~. ~R MO~Y ORS PAYABLE T0: "RE(~STER OFD WILL~r.',~GENT." ~` : ~ ~._, -< .. `D PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAtD ~a.Y t.. .fir .. ~% r.~ 'H. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL TAXES ZNHERI'TANCE TAX D?~TSTON DEPT. 280601 HARR/SBURG, PA 17128-0601 RICK D KAUFHANN 1191SHOREHAH RD CAMP HILL PA 17011-6156 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX RECORD ADJUSTHENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY SSN/DC ACH 05-06-2005 KAUFNANN 02-06-2002 210Z-OZZ$ CUHBERLAND 182-16-9951 02119087 Amount: Rem f.'t'ted REV-160~i EX AFP (01-03) DONALD E HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I70I$ CUT ALONG THIS LINE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS REV-1604 EX AFP (01-03) ~ INHERITANCE TAX RECORD ADJUSTHENT JOINTLY HELD OR TRUST ASSETS ~ DATE 05-06-2003 ESTATE OF KAUFHANN DONALD E DATE OF DEATH OZ-06-ZOOZ COUNTY CUHBERLAND FILE NO. 21 02-0223 S.S/D.C. NO. 182-16-9931 ACN 02119087 ADJUSTMENT EASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0098111078 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 07-16-1997 Accoun~ Balance Percen~ Taxable X Amount Subject ~o Tax Debts and Deductions Taxable Amoun~ Tax Ra~e X Tax Due TAX CREDZTS: PAYMENT DATE RECEIPT NUHBER .00 NOTE: 0.500 .00 .00 .00 .15 .00 DISCOUNT (+) INTEREST/PEN PAID (-) TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORTION OF THIS NOTICE #ZTH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE A,~DD~.ESS SHOWN ABOVE. HAKE CH~OR Hc~NEY OR.Z)yf~ PAYABLE TO: "R~:,~TER~gF gl~ AGENT." TOTAL TAX CREDIT J I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .00 .00 .00 ,00 ,Ev-.7o~l.8~ ' ~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 FILE NUMBER DECEDENT'S NAME Kaufmann, Donald E. 2102-0223 ACN REVIEWED BY Steven Johnson 0219086 & 0219087 ITEM EXPLANATION OF CHANGES SCHEDULE NO. Above-referenced ACN(s) are being adjusted to reflect zero tax due since they have bs~n reported on the probate return. ~ ~r~ ROW Page 1