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HomeMy WebLinkAbout03-0756PETITION Estate of' ~yl-/-'t S ¢, t.~,dP t also known as · Deceased. Social Security No. i g 8.. / ~. - .~ :~/ (o The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execute ~ in the last will of the above decedent, dated and codicil(s) dated ~'dd~ FOR PROBATE and GRANT OF LETTERS NO. To: Register of Wills for the County of ~o,°1_g,-cff-c~'r') in the Commonwealth of Pennsylvania named ,19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~ 0 ,'YI 6f~- t.-,4-~ U) County, Pg0nsylvania, with h f~- last family or principal residence at (list street, number and muncipality) Decendent, then ~ 0)- years of age, died tot~0 & 0%';- '/~ ? , '~ , Except as follows, decedent aid not marry, was not divorced and did not have a child born or adopted after execution of ~?Jl offered for probate; was not the victim of a killing and was never adjudicated incompetent: _ /. -. Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ /,~0, ODO, (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ $ Value of real estate in P~nnsylvania situated as follows: WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. r.~t~est(s) the probate of the last will and codicil(s) (testamentary; admin{stration c.t.a.; administration d.b.n.c.t.a.) Sworn to or affirmea and subscribed before me this/~ 15{:~ day of /~ ~4~ptj~?.ber Z -z A 1~ 2003 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF Ctanberland The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. NO. 21-2003-756 Estate Of Phyllis E. Waite , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW September 16th, - l~3X 2003in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 15th, 2000 described therein be admitted to probate and filed of record as the last will of Phyllis E. Waite ; and Letters Testamentary are hereby granted to Marcia E. Delafield FEES Probate, Letters, Et¢ .......... $ 270.00 Short Certificates(6) .......... $ 1 a_ 00 ~ x~t~ages..(.3)... $ 9.00 JCP $ 10.00 TOTAL __ $. 307°00 Filed $~p.~.~..1.6.t.h.,.2.99.3 . ............ Mailed Letters to Executrix on 9/16/03. · ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l,ocal 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.i'b · Fee for this certificate, $2.00 P 9572210 No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTiFiCATE OF DEATH ,. PHYLLIS' E. ~AITE l,.Female {,. ,~ : : Sept 5,192 W~con~sco, PA ~rl~d [Lower Allen I~. ~". I" ~--~, ,.: m ~...,.~) Con, un[cat ions ,,t Telephone Operator i,,m EC~O~ NT' $..M~.lt~ ~A~i)J~_ S~ ~ e~. Ch/To~. ~,a~- Z~ Co~e1 ID~cJEID~HT'S 12 Cltaoel DElve ~TU~ C~ Hill, PA 17011 ~ ,,. E~ar C. Warfel C. [,,. 12 I ,.Widowed ,,. ,,..s~. PA ~ ,~1[3 ~..----~ Lower Allen CUMBERLAND ~? 17~ ~ ,~.c~ ~Marcia~'s~¢~E. ~lafleld' I~ 331 ~n St., Middlet~, PA 17057 29, 2~3 ,,,~olling Green Cemte~ ,,,.~ Hill,PA 17011 I ~~"' t~' I~. 21-2003-756 LAST WILL AND TESTAMENT OF PHYLLIS E. WAITE I, PHYLLIS E. WAITE, of Lower Allen Township, Cumberland County, Pennsylvania, 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 former Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all my funeral expenses and estate or inheritance taxes be paid by my hereinafter named Executor as soon after my death as may be found convenient. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, wherever situate, in equal shares to my children, MARCIA E. DELAFIELD and JONATHAN A. WAITE. If either of my children predecease me, I give that child's share to his or her issue, per stirpes. For the purposes of this, my Last Will and Testament, "issue" shall be interpreted to include grandchildren who have been legally adopted by my said children and the issue of such grandchildren, but shall not be interpreted to include step-children of my said children or the issue of such step-grandchildren. ITEM III: In the event that I am not survived by my children, my grandchildren, or any other issue, I give and bequeath my entire estate, in equal shares, to the following persons: so MARK EDGAR WARFEL; RICHARD WILLIAM BRAY; ANGELA PEREZ; ANGELICA PEREZ; ROSANGELES PEREZ. ITEM IV: I appoint my daughter, MARCIA E. DELAFIELD, Executrix of this, my Last Will and Testament. If my said daughter is unable or unwilling to serve, or, having been appointed is unable or unwilling to continue to serve, I appoint my son, JONATHAN A. WAITE, as Executor of my Will. ITEM V: I direct that no personal representative hereunder shall be required to provide security, surety or bond in any jurisdiction for the faithful performance of any duty under this Will. This clause is applicable only to such personal representatives as are specifically named in this Will. ITEM VI: Ail federal, state and other death taxes payable on the property forming my gross estate for those purposes shall be paid out of the principal of my estate just as if they were my - 2 - debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment for federal estate tax purposes. IN WITNESS WHEREOF, I, PHYLLIS E. WAITE, have set my hand and seal to this, my Last Will and Testament, this ~-~ day of '~ , 2000. PHYLLIS~ E. WAITE (SEAL) Signed, sealed, published and declared by PHYLLIS E. WAITE, the Testatrix, as and for her Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, we believing her to be of sound mind, memory and understanding, have hereunto subscribed our names as witnesses. - 3 - COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : SS: We, PHYLLIS E. WAITE, Testatrix, ~ gJ~ ~0~/5 and ~c~ /~/~/~ , Witnesses, respectively, whose names are si~ned to the attached or foregoin~ instrument, bein9 first duly sworn, do hereby declare to the undersigned authority that the Testatrix si~ned and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearin9 of the Testatrix, signed the Will as witnesses and that to the best of their knowledge, the Testatrix was at that time eighteen (18) years of a~e or older, of sound mind and under no constraint or undue influence. PH<~Q~YLL~s E. ~ aG a~ WAITE - Testatrix Subscribed, sworn to and acknowledged before me by PHYLLIS E. WAITE, the Testatrix, and subscribed and sworn to before me by /~ ~ ~/.~o~/.) and ~,~ ~7/~ ~?/~ ~ ~ , witnesses, the /~ day of /~¢~ , 2000. - 4 - /Notary Public I Notaria Seal '1 Jenny A. Tobias, Notar.~ Public Harrisburg, Dauphin uounty My Commission Expires Feb. 15, 20_0~J PHYLLIS E. WAITE ANN E. RHOADS, ESQUIRE CLECKNER AND FEAREN ATTORNEMS AT LAW 31 NORTH SECOND STREET HARRISBURG, PENNSYLVANIA I?lOI Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Will No. 21-2003-756 Admin. No. To the Register: 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 : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature ~// Address *elephone ¢'/Y- CZ Capacity: /~ Personal Representative __Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171 :;'8-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003260 DELAFIELD MARCIA E 331 ASPEN STREET MIDDLETOWN, PA 17057 ........ fold ESTATE INFORMATION: SSN: 188-12-3716 FILE NUMBER: 2103-0756 DECEDENT NAME: WAITE PHYLLIS E DATE OF PAYMENT: 11/20/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/24-/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $22,511.22 REMARKS: MARCIA E DELAFIELD TOTAL AMOUNT PAID: $22,511.22 SEAL CHECK# 1761 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV - ~5~o EX + (6-~0) / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARR[SBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I Oi::F:IC. IAL liS~! ONI Y FILE NUMBER 21 03 00756 COUNTY CODE YEAR NUMBER ~:oo < DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Waite, Phyllis E DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 08/24/2003 09/05/1920 SOCIAL SECURITY NUMBER 188-12-3716 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) ] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-I-95) AME John S Davidson =IRM NAME (If applicable) Yost & Davidson tELEPHONE NUMBER 717/533-5101 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12. Net Value of Estate (Line 8 minus Line 11 ) OF:F'iCIAL LIE;!:: ONLY COMPLETE MAILING ADDRESS 320 West Chocolate Avenue Hershey, PA ]7033 122,500.00 109,802.12 None None 39,151.34 11,979.81 260,390.83 48,051.99 2,839.51 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate x .045 17.Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 492,932.60 20. [] (8) 543,824.10 (11) 50,891.50 (12) 492,932.60 (13) (14) 492,932.60 (15) (16) 22,181.97 (17) (18) (19) 22,181.97 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) D6cedent's Complete Address: STREET ADDRESS !2 Citadel Drive CITY Camp Hill STATE PA ziP 17011 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 22,511.22 1,109.10 Total Credits (A + B + C) (2) (1) 22,181.97 23,620.32 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 1,4 3 8.3 5 Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0 o00 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; .................................................................................. ~ ~j] 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 SIGNATURE ~)F PERSON-RESPONSIBLE FOR FILIN~ RI[ ADDRESS DATE 331 Aspen Street ~D~T Et,/,/{.) Middleiown, PA 17057 ADDRESS SIGNATURE OF PREPARER/~THER THAN REPRESENTATIVE ADDRESS DATE John S D~d~.e.n/ Il. ..~ _ 320 West Chocolate Avenue ~,. . For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 All real property owned solely or as a tenant in comm, on must be r.e, ported, at fair market value. Fair market value is defined as the price at which property wou d be exchanged between a willing buyer an(] a wimng seher, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is joint y-owned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 12 Citadel Drive, Lower Allen Township, Camp Hill, Pennsylvania - decedent's personal residence - 122,500.00 value per market analysis attached TOTAL (Also enter on Line 1, Recapitulation) 122,500.00 SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE At DATE OF ITEM DESCRIPTION UNIT VALUE NUMBER DEATH 1 106 shares Prudential Financial, Inc. 36.0625 3,822.63 2 3 shares Agere Systems, Inc. Class A 2.88 8.64 3 87 shares Agere Systems, Inc. Class B 2.705 235.34 4 332 shares Lucent Technologies, Inc. 1.835 609.22 5 157 shares Comcast Corp New Class A 28.7955 4,520.89 6 97 shares AT&T Corp. New 21.6625 2,101.26 7 565 shares SBC Communiccations, Inc. 23.1975 13,106.59 8 United States Savings Bonds Series HH 5000 15,000.00 9 304 shares Bell South Corp. 25.5875 7,778.60 10 United States Savings Bonds Series HH 1000 1,000.00 11 156 shares AT&T Wireless Services, Inc. 8.1225 1,267.11 12 United States Savings Bond Series HH 500 500.00 13 170 shares Vodafone Group PLC New 18.535 3,150.95 14 119 shares Qwest Communications International, Inc. 4.3675 519.73 15 240 shares Verizon Communications 35.2875 8,469.00 16 4196.32 shares Oppenheimer Multi State Municipal Fund 11.37 47,712.16 TOTAL (Also enter on line 2, Recapitulation) 109,802.12 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 Include the j3roceeds 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2 3 4 5 6 7 8 9 Susquehanna Valley Federal Credit Union regular share account Susquehanna Valley Federal Credit Union - 3 year certificate 2000 Ford Taurus SE Sedan Household goods and furnishings 2003 Federal income tax refund due 2003 Pensylvania personal income tax refund due Lutheran Church Extension Fund account # 143006454 Lutheran Church Extension Fund account #3300084313 Lutheran Church Extension Fund account #3300084893 1,065.33 6,887.30 4,965.00 7,560.00 920.00 386.00 4,204.85 11,045.09 2,117.77 TOTAL (Also enter on Line 5, Recapitulation) 39,151.34 SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 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 Marcia E. Delafield Daughter B Jonathan A. Waite 331 Aspen Street Middletown, PA 17057 12 Citadel Drive Camp Hill, PA 17011 Son JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % OF DATE OF DEATH LETTER DATE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF ITEM FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST NUMBER TENANT JOINT estate. 1 A,B 2000 Belco Community Credit Union checking and savings 35,932.24 33.34% 11,979.81 TOTAL (Also enter on line 6, Recapitulation) 11,979.81 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Waite, Phyllis E FILE NUMBER 21 - 03 - 00756 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH % OF ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECD'S EXCLU SION TAXABLE VALUE NUMBER Attach a copy of the deed for real estate. NTEREST (IF APPLICABLE) 1 Sun Life Financial Regatta Extra Fixed/Variable Annuity 245,099.61 100% 245,099.61 //75-7500-029367 payable to decedent's son and daughter, Jonathan A. Waite and Marcia E. Delafield 2 SmithBarney Citigroup IRA account payable to decedent's 15,291.22 100% 15,291.22 son and daughter, Jonathan A. Waite and Marcia E. Delafield TOTAL (Also enter on line 7, Recapitulation) 260,390.83 SCHEDULE H FUNERAL EXPENSES & ADMIN~mATNE COSTS COMMONWEALTH OF PENNSYLVANIA INHERiTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT ITEM NUMBER 1 2 3 4 FUNERAL EXPENSES: Fackler Wiedman Funeral Home Rolling Green Cemetary Johathan Waite - reimburse funeral luncheon expense Marcia Delafield - reimburse funeral flowers ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees John S. Davidson, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address C~ty Relationship of Claimant to Decedent Probate Fees Register of Wills State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Patriot News - advertise grant of letters Bureau of Vital Statistics - death certificates Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 42,590.60 221.00 400.00 475.00 3,500.00 307.00 154.39 194.00 210.00 48,051.99 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Waite, Phyllis E Schedule H FILE NUMBER 21 03-00756 Register of Wills - short certificates Paul Steinberg - lawn care Jansen Associates - preparation of decedent's final local, state and federal income tax remms 54.00 51.00 105.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Waite, Phyllis E SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 03- 00756 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 DESCRIPTION Paul Steinberg - lawn care Steve - home maintenance Bank of America - decedem's credit card account balance due Bonnie Miller, Treasurer - 2003 school taxes due Pinnacle Health - home infusion therapy Pennsylvania American Water - water utility service ?P&L - electric utility service D. McCormick - decedent's debt for theatre tickets UGI - natural gas utility service Andrews and Patel - physician's services AT&T - telephone service Comcast - cable tv service TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 68.00 45.00 298.25 1,373.87 312.61 83.89 87.89 414.00 18.58 33.17 24.97 79.28 2,839.51 REV:1513 EX+ (9~00) ~ SCHEDULE J COMMON~VEALT' OF PENNSVLVAN'A B E N E F I C IARI E S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Waite, Phyllis E 21 - 03 - 00756 RELATiONSHiP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List Trustecqs) ~, TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Jonathan A. Waitel2 Citadel Drive Son one-half Camp Hill, PA 17011 2 Marcia E. Delafield Daughter one-half 331 Aspen Street Middletown, PA 17057 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 Date of Death: 08/24/2003 valuation Date: 08/24/2003 Processing Date: 01/30/2004 Shares Security or Par Description Estate Valuation High/Ask Low/Bid 1) 106 2) 3 3) 87 4) 5) PRUDENTIAL FINL INC (744320102) New York Stock Exchange 08/22/2003 08/25/2003 AGERE SYS INC (00845V100; AG~A) CL A New York Stock Exchange 08/22/2003 08/25/2003 AGERE SYS INC (00845V209; AGRB) CL B New York Stock Exchange 08/22/2003 08/25/2003 200 ~IT~CH CORP NEW (026804104) COM New York Stock Exchange 10/08/1999 Last price available on 10/08/1999 332 LUCENT TECHNOLOGIES INC (549463107) C0M New York Stock Exchange 08/22/2003 08/25/2003 6) 157 7) 97 8) 565 9) 304 10) 156 COMCAST CORPNEW (20030N101) CL A NASDAQ - Industrial 08/22/2003 08/25/2003 AT&T CORP (001957505; T) C~NEW New York Stock Exchange 08/22/2003 08/25/2003 SBC COI4M~NICATIONS INC (78387G103; SBC) COM New York Stock Exchange 08/22/2003 08/25/2003 BELLSOUTH CORP (079860102; BLS) C~ New York Stock Exchange 08/22/2003 08/25/2003 36.69000 35.75000 H/L 36.08000 35.73000 H/L 3.05000 2.84000 H/L 2.89000 2.74000 H/L 2.87000 2.66000 H/L 2.71000 2.58000 69.25000 66.43750 H/L 1.90000 1.81000 H/L 1.90000 1.73000 H/L 29.65000 28.41000 H/L 28.94200 28.18000 E/L 21.87000 21.57000 H/L 21.90000 21.31000 23.81000 23.07000 H/L 23.17000 22.74000 ~/L 26.05000 25.47000 H/L 25.69000 25.14000 H/L AT&T WIRELESS SVCS INC (00209A106; AWE) New York Stock Exchange 08/22/2003 8. 34000 08/25/2003 8.14000 8.03000 H/L 7.98000 H/L Estate of: Phyllis E. Waite Report Type: Date of Death Number of Securities: 14 File ID: YOSTWAIT Mean and/or Divand Int Security Adjustments Accruals Value 36.062500 3,822.63 2.880000 8.64 2.705000 235.34 67.843750 N/A 1.835000 609.22 28.795500 4,520.89 21.662500 2,101.26 23.197500 13,106.59 25.587500 7,778.60 8.122500 1,267.11 Page 1 This report was produced by the Mail-In Service of Estate Valuations & Pricing Systems, Inc. please contact EVP Syste~ at (818) 313-6300, ext. 105. If you have questions, Date of Death: 08/24/2003 Valuation Date: 08/24/2003 Processing Date: 01/30/2004 Shares Security or Par Description High/Ask 11) 170 VODAFONE GROUP PLC NEW (92857T107; VOD) SPONSORED ADR New York Stock Exchange 08/22/2003 18.94000 08/25/2003 18.48000 12) 119 QWEST COI~iUNICATIONS I~TL INC (749121109; Q) CO~ New York Stock Exchange 08/22/2003 4.63000 08/25/2003 4.35000 13) 240 VERIZON CC~4ML~ICATIONS (92343V104; VZ) COM New York Stock Exchange 08/22/2003 36.25000 08/25/2003 35.26000 14) 4196.32 OPpf~q{EIMER MULTI ST MUNICIPAL (683940100) PA MUN FD CL A Mutual Fund (as quoted byNASDAQ) 08/22/2003 Low/Bid 18.43000 H/L 18.29000 H/L 4.28000 H/L 4.21000 H/L 35.05000 H/L 34.59000 H/L 11.37000 Mkt Estate of: Phyllis E. Waite Report Type: Date of Death Number of Securities: 14 File ID: YOSTWAIT Mean and/or Div and Int Security Adjustments Accruals Value 18.535000 3,150.95 4.367500 519.73 35.287500 8,469.00 11.370000 47,712.16 Total Value: Total Accrual: Total: $93,302.12 $0.00 $93,302.12 Page 2 This report was produced by the Mail-In Service of Estate Valuations & Pricing Systems, Inc. please contact EVP Systems at (818) 313-6300, ext. 105. If you have questions, CapWatch Report for AMERITECH CORPORATION (03095410) OPT:01: "AMERITECH CORPORATION" "SBC COMMUNICATIONS, INC." ANNOUNCED THAT THEY HAVE COMPLETED THE ACQUISITION OF AMERITECH CORPORATION, EFFECTIVE OCTOBER 11, 1999. TERMS: FOR EACH AMERITECH CORPORATION COMMON SHARE, HOLDERS WILL RECEIVE 1.316 SHARES OF SBC COMMUNICATIONS COMMON STOCK: CASH IN LIEU RATE:0050.5625000000: DEPOSITARY: FIRST CHICAGO TRUST COMPANY OF NEW YORK ADDRESS: 14 WALL STREET 8TH FLOOR NEW YORK NY 10005 TELEPHONE: 800-251-4215 [UPDATED CASH IN LIEU RATE] UPDTEXT: 327790: Page 1 Copyright © 1997-2003 Xcitek, Inc. Ail Rights Reserved. DaCe o£ Death: 08/24/2003 C',L~m'~_. DaCe~ 05/']8/2004 Total Interest for ~ear of Death to the Deceased Owne~e/~ene~cAarie~ 08/24/03 4,204.85 0.00 4,204-8SI X5?.X$1Bn~: FL~RCIA ~ DEDAFIELD I IBn~= JONATHAN A NAITE 08/14/03 $~,03~.87 X3.2~ x~,o45.o91 3ss.4a~= ~E DR~ 06/0S/03 2,028.&~ ~.30 2,L~7.771 63.071~[t ~CSA E D~B~ I ~t~S 17,33S.19j 32.S2 I7,267.711 586.70 USE T~E II~POI~ATZO~ COntAINED ZN THIS S~I~DULE TO I~EPORTANY TAXABL~ INCOME. USQUEHANNA FEDERAL CREDIT UNION 3850 HARTZDALE DRIVE CAHP HILL, PA 17011-7809 LOCAL: (717) 737-q152 TOLL F~*P.: (800) 9q8-1~Sq FAX: (717) 737-0589 NemberJ: 503 Social Security J: 188-1X-XXXX Statement Date: 09/30/2003 PageJ: 1 Nail Code: Web Code: PHYLLIS E WAXTE 12 CITADEL DRIVE CAHP HILL, PA 17011-7615 YTD TAXABLE DIV: 6179.10 YTD TAXABLE Ih'T: G.O0 YTD FINANCE CHG: $.00 TRAN POST TRANSACTION DATE DATE DESCRIPTION TRAN FEE FINANCE LOAN AHOUNT AMOUNT CHARGE PRINCIPAL BALANCE 07/01 Type: O0 - REGULAR SHARES - O0 09/30 09/30 Dividend Post/ng lz ANNUAL PERCENTAGE Y/ELD EARNED: 09/30 PREVIOUS BALANCE 2.1q 0.80 X FOR A PERXOD OF 92 DAYS ss NE~ALANCE 1063.19 1065.33 1065.33 07/01 TyPe: 53 - 4892 - 3 YEAR CERTIFICATE - 53 07/31 07/31 Dividend Post/ng 16.09 08/31 08/31Div/dend Post/rig 16.13 09/30 09/30 Dividend Post/rig 15~'6q 09/30 Hattu:ity Date:~3/06/2006 APY:'~ 2.81X PREVIOUS BALANCE NEW BALANCE 6839.44 6855.53 6871.66 6887.30 6887.30 Do you have our VISA card in Four wallet? If not, call a loan offtcere today. Our Pla~lnum card has a low 9.9X f/xed rate. 6400136 2 eeUg~ue. Book Used Car Values Page 1 of 2 Kelley Blue Book THE TRUSTED RESOURCE Blue Book Trade-In Report Pennsylvania · Janua~ 28, 2004 Ny Car's Value Used Car Retail Bm/a Used Car Sell Your (:ar Lemon CJteck Car Revkew~ (:ar Previews 2000 Ford Taurus SE Sedan 4D Engine: V6 3.0 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 15,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FH Stereo Cassette rmw car? people are .B_u_y a New Car Buy a Used Car List Your Car For Sale Online Free Lemon Check Auto Loans from 3.85% APR Insurance Quote Payment Calculator Dual Front Air Bags ABS (4-Wheel) Power Seat Alloy Wheels Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Host recent model cars owned by consumers fall into this category. Trade-In Value $4,965 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Oetthe latest Blue Book http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb. PA;172831;PA043&lT057;sed+t;&39;Ford;2000%20Taums-.. 1/28/2004 SMITH BARNEY ot group ReP. 00000691 00003563 72410341060926000000691 303269AE01 IRAFOO34A PHYLLIS E. WAITE CGM EASY IRA CUSTODIAN 12 CITADEL DRIVE CAMP HILL PA 1'2011-7615 Individual Retirement Account June 30 - September 28, 2003 Page I of 4 Account number 724-60926-16 410 Your Broker/Dealer Is CITIGROUP GLOBAL MKTS INC. Your Financial Consultant DOUG SMITH P.O. BOX 12057 11 N 3RD ST-2ND FL HARRISBURG PA 17101 717480-1700 Branch: 800-237-1700 Email: dougles.e.smlth(~smithbarney.com Cltlgroup Global Markets Inc., member NYSE, NASD, and other principal exchanges. Smith Barney Is a division and service mark of Cltlgroup Global Markets Inc. and Its affiliates and is used and registered throughout the world. CITIGROUP and the Umbrella Device are trademarks and service marks of Citicorp or Its affiliates and are used and registered throughout the world. Cltlgroup Global Markets Inc. is a member of the Securities Investor Protection Corporation (SIPC). Money funds $15,264.01 $15,287.62 Accrued money fund dividends 3.66 3.60 Fair Market Value 12/31102 16,223.62 :::::: :" ' ":"-" '"-' '" "-' **':' '- ':-'-' ":: D' '- -' ':×" ' '~'' ""'"" "'*t-?' '.'.: -.-' '-" ;.: :.;:: :.. :::<-:,::>:,,:-:< ::::::::::::::::::::::::::::.:-:.:*: :;::: ::::::-.:.::: ,, ~.~:.<. ':~:::e:::~.~:'::. · ,::. -~: :::. -:::~:':~:: :3 ': '::: :;::: :-::: Money ~unds earnings $ 23.$1 $ 74.10 Total $ 23.61 S 74.10 I Jlllllillllllllllllllllllllllllllllilllillllllilllllllll JllJlllllll .J Sun Life Financial" PREPARED FOR: i NVW.~TIilENT liANA~IEMENT 815~-12 PHYLLIS E WAITE 12 CITADEL DRIVE CAMP HILL PA 17011-7615 I,,,111,,,111,,,,,,11,,,111,,,I,I1,,,,,11,1,1,,,,11,,I,I1,,I,I Sun Die Assurance Com peny of Canada (U.S.) P.O. Box9133 Wellesley Hills, MA 02481 Tel: (SO0) 752-72~$ Websi~: www. sufllle-usa, com FmA,CUU. ADVISOR: QUARTERLY STATEMENT FRANK H KELLY H D VEST INC 400 BRIDGE STREET #4 NEW CUMBERLAND PA 17070 Your contract is issued by Sun Life Aesumnce Company of Canada (U.S.), e member of the Sun Life Financial group of companies. 12/31/2002 Value I $215,518,82 I Contract No. 75 - 7500 - 029367 09/30/2003 Value $245,099.61 MFS Regatta Extra Fixed/Variable Annuity Issue Date: Annuitant Primary Beneficiary: Price Level: November 07, 2000 PHYLLIS E WAITE BENEFICIARY ON FILE 01 Agent Number: Dealer Number: Total Extra Credit Amount Paid: 3000-387868 0640-374485-1 $15,762.29 Beginning Ending Variable Value Cuwent Year Number Value Net Change bveatment Option 12/31/2002 Net AcUvity of Units Unit Value 09/30/2003 in Value Mass Investors Growth $58,790.31 $0.00 11891.51583 $5.5968400 $66,578.69 $7,788.38 Ulililies $45,414.19 $0.00 7744.01357 $7.0831530 $54,852.03 $9,437.84 Managed ,~rs $33,670.94 $0.03 8759:48680 $4.3577110 $38,171.31 $4,500.37 Mass Investors Trust $77,643.38 $0.00 11953.43536 $7.1525530 $85,497.58 $7,854.20 Grand Total $215,518.82 SO.m) $24s,090.61 $20,.f80.70 November 07, 2000 - September 30, 2003 January 01, 2003 - September 30, 2003 (issue Date to Present) (Year to Date) Investment Option Investments Withdrawals Investments W'dhdrawals Mass Investors Growlh $118,21721 $0.00 $0.00 $0.00 Ulililies $78,811.47 $0.00 $0.00 $0.00 Managed Sectors $78,811.47 $0.00 $0.00 $0.00 Mass Investors Trust ' $118,217.21 $0.00 $0.00 $0.00 Total $394~6 $0J)0 $0J)0 $0.00 If you find an error in this statement, you should notify us at the address or telephone number provided on the statement. Unless we receive notice of any such error from you within 60 days of the period ending date of this statement, we may not be responsible for correcting the error. ii]~-_ll -" l :~:10 I:1;~ Il I g I :Il] :i ~T~lr_'ll II] ~ You have elected the Basic Death Benefit and chosen not to have the available Death Benefit Riders applied for your account. For detailed information, please consult your prospectus. PARF 1 OF 9 WHEREAS, on the 16th dated November 15th 2000 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2003-00756 PA No. 21-03-0756 ESTATE OF WAITE PHYLLIS E (/~'1', ~'1~'1', Late of LOWER ALLEN TOWNSHIP CU~L~tN~ ~UUN~'X, Deceased Social Security No. 188-12-3716 day of September 2003 an instrument was admitted to probate as the last will of WAITE PHYLLIS E (h~', ~'±~T, late of LOWER ALLEN TOWNSHIP , CUMBERLAND County, who died on the 24th day of August 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to DELAFIELD MARCIA E who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, ~ARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal )f my Office the 16th day of September 2003. ' ~eglster OZ ~F£~S~ x, **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND OF PHYLLIS E. TESTAMENT ~AITE I, PHYLLIS E. WAITE, of Lower Allen Township, Cumberland County, Pennsylvania, 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 former Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all my funeral expenses and estate' or inheritance taxes be paid by my hereinafter named Executor as soon after my death as may be found convenient. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, wherever situate, in equal shares to my children, MARCIA E. DELAFIELD and JONATHAN A. WAITE. If either of mY children predecease me, I give that child,s share to his or her issue, per stirpes. For the purposes of this, my Last Will and Testament, "issue" shall be interpreted to include grandchildren who have been legally adopted by my said children and the issue of such grandchildren, but shall not be interpreted to include step-children of my said children or the issue of such step-grandchildren. ITEM III: In the event that I am not survived by my children, my grandchildren, or any other issue, I give and bequeath my entire estate, in equal shares, to the following persons: a. MARK EDGAR WARFEL; b. RICHARD WILLIAM BRAY; c. ANGELA PEREZ; d. ANGELICA PEREZ; e. ROSANGELES PEREZ. ITEM l'V: I appoint my daughter, MARCIA E. DELAFIELD, Executrix of this, my Last Will and Testament. If my said daughter is unable or unwilling to serve, or, having been appointed is unable or unwilling to continue to serve, I appoint my son, JONATHAN A. WAITE, as Executor of my Will. ITEM V: I direct that no personal representative hereunder shall be required to provide security, surety or bond in any jurisdiction for the faithful performance of any duty under this Will. This clause is applicable only to such personal representatives as are specifically named in this Will. ITE~VI: All federal, state and other death taxes payable on the property forming my gross estate for those purposes shall be paid out of the principal of my estate just as if they were my - 2 - debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment for federal estate tax purposes. IN WITNESS W~REOF, I, PHYLLIS E. WAITE, have set my hand and seal to this, my Last Will and Testament, this ,~-~.~ day of ~u~ , 2000. C~£. ~ (SEAL) PHYLLISVE. WAITE Signed, sealed, published and declared by PHYLLIS E. WAITE, the Testatrix, as and for her Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, we believing her to be of sound mind, memory and understanding, have hereUnto subscribed our names as witnesses. - 3 - COMMONWEALTH OF PENNSYLVANIA : COUNTY OF DAUPHIN : : SS: We, PHYLLIS E. WAITE, Testatrix, -~ L~ '~%~'/5 and ~-P~d~ ~/~/~.~_ , Witnesses, respectively, whose names are si~ned to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge, the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. p~yLL~~S E. £. c6^'.~ WAi-i'~- Testatrix- witnesses, the ../.~ day of ~~~ , 2000. --' /NoSa~ Public - 4 - Nolarial Seal Jenny A. Tobias, Notary Public Hardsburg, Dauphin County My Commission Expires Feb. 15, 2001 Register of Wills cuMBERLAND COUn:4T¥ CouRTttOUSE one Courthouse Square carlisle, PA 1'/013 JON A. YOST JOHN S. DAVIDSON YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P.O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 E-Mail: yost.davidson~verizon.net October 7, 2004 TELEPHONE 717-533-5101 ~^x 717-534-1293 Register of Wills CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, PA 17013 RE: Estate of Phyllis E. Waite No.: 21-03-0756 Dear Ms. Strasbaugh: Enclosed is a check in the amount of $1,649.19 to be applied toward inheritance tax in the referenced estate. I also enclose a self-addressed, stamped envelope for your convenience in returning your receipt to me. Thank youfor your assistance. JSD/rlb Enclosure cc: Marcia E. Delafield, Executrix Very truly yours, YOST & DAVIDSON Jb-hn S. Davidson 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. CD 004485 DAVIDSON JOHN S 320 WEST CHOCOLATE AVE HERSHEY, PA 17033 ESTATE INFORMATION: SSN: 188-12-3716 FILE NUMBER: 2103-0756 DECEDENT NAME: WAITE PHYLLIS E DATE OF PAYMENT: 10/12/2004 POSTMARK DATE: 10/08/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 81,649.19 TOTAL AMOUNT PAID: $1,649.19 REMARKS: SEAL CHECK# 1024 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ZNHERZTAHCE TAX DTVTSZON DEPT. Z80601 HARRZSBURG, PA 171Z8-0601 COHHONHEALTH OF PENNSYLVANIA BEPARTHENT OF REVENUE NOTICE OF INHERZTANCE TAX APPRAISENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-IGC7 EX AFP (01-05) JOHN S DAVZDSON YOST & DAVZDSON 520 W CHOCOLATE AVE HERSHEY PA 17055 BATE ESTATE OF DATE OF BEATH FILE NUNBER COUNTY ACN 07-19-2004 WAZTE 08-24-Z005 21 05-0756 CUHBERLAND 101 Amount PHYLLIS E HAKE CHECK PAYABLE AND REH]:T PAYNENT TO: REGTSTER 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) NOTZCE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR BZSALLOWANCE OF BEBUCT/ONS ANB ASSESSHENT OF TAX ESTATE OF WAZTE PHYLLIS E FILE NO. 21 05-0756 ACN 101 BATE 07-19-Z004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATXON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASEB ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) ,. Hortgagas/Notas Reca/vable (Schedule D) $. Cash/Bank Dapos/ts/Hisc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEBUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/N/sc. Expanses (Schedule H) (9) 10. Dabts/Nortgaga Liabilities/L/aris (Schedule I) (10) 11. Total Daduct/ons 12. Nat Value of Tax Return 1ZZ7500.00 109~802.1Z .00 .0O 59~151 11~979.81 260~590 (8} NOTE: To /nsure proper credit to your account, subm/t the upper port/on of this fora w/th your tax payaent. 48,051.99 543,824.10 Z,859.51 (11) 50.891.~0 (12) 49Z,95Z.60 Char/table/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Nat Value of Estate Subject to Tax (1,) 492,95Z. 60 Zf an assessment Nas lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 Nill to date. 13. 1,. NOTE: reflect figures that lnclude the total of ALL returns ASSESSHENT OF TAX: 15. Amount of L/ne 1, at Spousal rata (15) 16. Amount of L/no 17. Amount of L/ne 1, at S/bl/ng rata (17) 18. Amount of L/ne 1, taxable at Co11.taral/ClassB rata (18, 19. Principal Tax Due TAX CREDITS= n~SCOUNT PAYHENT RECEIPT AHOUNT DATE NUHBER INTEREST/PEN PAID (-) 11-Z0-200~ CD00~260 1,109.10 TOTAL TAX~CREDZT I 25,620.5Z BALANCE OF TAX BUE 1,458.55CR ZNTEREST AND PEN. .00 TOTAL DUE 1,458.55CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) XF PAID AFTER DATE XNDXCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaaoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (71 P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, ehich ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estate Tax" (RE¥-1515). Applications ara available at the Office of the Register of Hills, any of the 13 Revenue District Offices, or by calling the special lq-hour anseering service for forms ordering: 1-800-562-2050; services for taxpayers Hith special hearing and / or speaking needs: 1-800-qqT-50ZO iTT only). Any party in interest not satisfied Hith the appraisement, alloaance, or disallowance of deductions, or assessment of tax (including discount or interest) as shoHn on this Notice must object Hithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ~riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. 280601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is aIIoHed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you ~ould appeal the tax and interest that has been assessed as indicated on this notice. 1985 198q 1985 152 .000556 1986 lOZ .00027q 1987 IOZ .00027~ --Interest is calculated as folloHs: INTEREST = BALANCE OF TAX UNPAID Interest is charged beginning Hith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes .hich became delinquent before January 1, 1981 bear interest et the rate of six (61) percent par annum calculated at a daily rate of .O0016q. All taxes .hich became delinquent on and after January 1, 1981 ~ill bear interest at a rate ahich Hill vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor lOX .OOO5qB ~'~-1991 11X .000501 ~ 91 .OOOZq7 ISZ .000&58 1992 9Z .O00Zq7 ZOOZ 61 .00016q Ill .OO05Ol 1993-199q 7Z .OOO19Z ZOO5 SZ .000157 1995-1998 9Z .0002~? 200q ~Z .00011D 1999 71 .00019Z ZOO0 7Z .000191 X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation ta fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shoHn on the Notice, additional interest must ba calculated. BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTV/SZON PO BOX ZIS0601 HARRISBURG.,, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-1607 EX AFP (DB-B4) JOHN S DAVIDSON YOST & DAVIDSON $20 N CHOCOLATE AVE ~. HERSHEY gA ii7033 DATE 11-Z9-Z004 ESTATE OF NAITE DATE OF DEATH 08-24-Z005 FILE NUMBER Z1 05-0756 COUNTY CUHBERLAND ACN 101 Amount Remitted PHYLLIS E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portLon of this fore with your tax payment. CUT ALONG TH'rS L'rNE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ ESTATE OF WAITE PHYLLIS E FILE NO. 21 03-0756 ACN 101 DATE 11-29-2004 TH*rS STATEMENT *rS PROV'rDED TO ADV*rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHOWN BELOW TS A SUMMARY OF THE pRTNCTpAL TAX DUE, APPL*rCAT*rON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, TF APPL*rCABLE, A PROJECTED TNTEREST F'rGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 10-26-2004 PRINCIPAL TAX DUE: ...................................................................... PAYMENTS (TAX CREDITS): 25,906.86 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 11-20-2005 08-04-2004 10-08-2004 CD003260 REFUND CD004485 1,184.80 .00 .00 22,511.22 1,458.55- 1,649.19 BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-09-2004 *rF PA*rD AFTER TH*rS DATE, SEE REVERSE S*rDE FOR CALCULAT*rON OF ADD*rT*rONAL *rNTEREST. ( *rF TOTAL DUE *rS LESS THAN $1, NO PAYMENT *rS REQUIRED. *rF TOTAL DUE *rS REFLECTED AS A "CRED*rT" TOTAL TAX CREDIT 2S,906.86 BALANCE OF TAX DUE .00 INTEREST AND PEN. 15.46 TOTAL DUE 13.46 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF TH*rS FORH FOR TNSTRUCT*rONS. ) PAYHENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on tho reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: CONNON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, ehich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1313). Applications are available online at wee.revenue.state.em.us, any Register of Hills or Revenue District Office, ar from the Department's 24-hour anseering service for forms orders: 1-800-362-Z050; services for taxpayers with special hearing and/or speaking needs: 1-800-qq7-3020 (TT only). REPLY TO: DISCOUNT: PENALTY: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, P.O. 8ox 280601, Harrisburg, PA 17128-0601, phone [7173 787-6505. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (93 months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q ara: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 lOX .O00Sq8 1988-1991 llZ ~O003Dl 2001 1983 16Z .000~38 1992 9Z .0002~7 ZOOZ 198q llZ .000301 1993-199q 72 .000192 2003 1985 132 .000356 1995-1998 92 .0002~7 ZO0~ 1986 102 .00027q 1999 71 .000192 1987 9Z .OOOZ¢7 ZOO0 82 .000219 Interest Daily Rate Factor 91 .O00Zq7 61 .O0016q 52 .000137 qZ .000110 --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINilUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen £15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P.O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 E-Mail: yost.davidson@verizon.net JON A. YOST JOHN S. DAVIDSON December 13, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Phyllis E. Waite No.: 21 03-0756 TELEPHONE 717-533-5101 FAX 717-534-1293 Dear Ms. Strasbaugh: Enclosed is our check in the amount of $13.46 in payment of the inheritance tax statement of account which is enclosed. JSD/rlb Enclosures Very truly yours, YOST & DAVIDSON Davidson BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVTSTON DEPT. Z&O6nl HARRTSBURG,, PA 171Zaq-0601 JOHN S DAVZDSON YOST & DAVIDSON 520 W CHOCOLATE AVE HERSHEY PA 17055 COHMONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN REV-Ii;07 EX AFP (01-03) 08-Z3-200~ ~AITE PHYLLIS E 08-Z~-2003 21 05-0756 CUMBERLAND 101 Amoun~ Remi~ed MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF ~I:I~S CUMBERLAND C~" ~:DURT c:~OUSE ?....,.%' CARLISLE, PA~ i-7015-~ NOTE: To znsure proper credi~ to your account, submi~ ~he upper por~ion of ~is form ~h you~ ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOgER PORTION FOR YOUR RECO~S ~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF ~AITE PHYLLIS E FILE NO. 21 03-0756 ACN .~r91 ~"'~ DATE;;'OS-Z3-2004 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN Tile NAHED ~TATE. SH~/N BELO# TS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-12-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 22,181.97 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 1,109.10 11-20-2003 08-04-2004 CD003260 REFUND .00 22,511.22 1,438.35- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 22,181.97 BALANCE OF TAX DUE .00 [NTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORH FOR INSTRUCTIONS. ) BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX D]'VZSTON PO BOX 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I&07 EX AFP C99-0~) JOHN S DAVIDSON YOST & DAVIDSON 320 W CHOCOLATE AVE HERSHEY PA 17033 DATE 11-29-200~ ESTATE OF WAITE PHYLLIS DATE OF DEATH 08-2~-2005 F'rLE NUHDER 21 05-0756 COUNTY CUHBERLAND ACN 101 Amoun'l: Rom i"l:"l:ed HAKE CHECK PAYABLE AND REHZT PAYHENT TO: E REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper crmdi( (o your account, submi~ ~ho upper portion of ~his form wi*h your *ax paym®n*. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~Y:~SY'~";P~' '(ST'-'~]J ...... '~' '~r~ ~ YA~ ~" 'f~' '~?AYgRA'h'f ' ~ ';b~'60kY ' ' ~; ..................... ESTATE OF WAZTE PHYLLIS E FILE NO. 21 05-0756 ACN 101 DATE 11-29-200~ THTS STATEHENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELO# TS A SUHNARY OF THE PRTNCTpAL TAX DUE, APPLTCAT*rON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, TF APPL'rCABLE, A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 10-26-200~ PRINCIPAL TAX DUE: ............................................................................... PAYHENTS (TAX CREDITS): 23,906.86 PAYHENT RECEIPT DISCOUNT (+) DATE NUH~ER INTEREST/PEN PAID (-) AHOUNT PAID 11-20-2005 08-0~-200~ 10-08-200~ CD00$Z60 REFUND CD00~85 1,18~.80 .00 .00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-09-200~ TOTAL TAX CREDIT 23,906.86 BALANCE OF TAX DUE .00 /NTEREST AND PEN. 15.~6 TOTAL DUE 15.~6 ZF PA/D AFTER TH/S DATE, SEE REVERSE S/DE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REQUIRED. IF TOTAL DUE 1S REFLECTED AS A "CREDIT" YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- if RES[DENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, which mas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania inheritance and Estate Tax" (RE¥-[$15). Applications are available online at awe.revenue.state.pm.us, any Register of Wills or Revenue District Office, or from the Department's gq-hour ansaaring service for forms orders: 1-800-36Z-ZOBO; services for taxpayers mith special hearing and/or speaking needs: 1-SO0-qq7-3OZO (TT only). REPLY TO: DISCOUNT: PENALTY: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue) Bureau of individual Taxes, ATTN: Post Assessment Review Unit) P.O. Box 280601, Harrisburg) PA 17liB-0601, phone (717) 787-6505. If any tax due is paid aithin three (3) calendar months after the dacedent's death~ a five percent (5X) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996) the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency) or nine (9) months and one (1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1) 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O00[6q. Al! taxes ahich became delinquent on and after January 1~ 19BE aiZt bear interest at a rate which ~i11 vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The app[icable interest rates for 198Z through goOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor.. 1982 ZOZ .O005q& xgs~-X99X XlZ .O00~O[ ZOOZ 9Z .OOOZq7 1983 16Z .000q38 199Z 9Z .O00Zq7 ZOOZ 62 .O0016q 19Bq 11Z .000301 1993-199q 7Z .00019Z 2003 5Z .000137 1985 lSZ .000356 1995-1998 9Z .O00Zq7 ZOOq qZ .000110 1986 lOX .O00Z7q 1999 7Z .00019Z 1987 9Z .O00Zq7 ZOO0 8Z .goo[19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 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 0O4733 DAVIDSON JOHN S 320 WEST CHOCOLATE AVE HERSHEY, PA 17033 fold ESTATE INFORMATION: SSN: 188-12-3716 FILE NUMBER: 2103-0756 DECEDENT NAME: WAITE PHYLLIS E DATE OF PAYMENT: 1 2/1 4/2004 POSTMARK DATE: 1 2/1 312004 COUNTY: CUMBERLAND DATE OF DEATH: 08/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13.46 TOTAL AMOUNT PAID: $13.46 REMARKS: YOST & DAVIDSON SEAL CHECK//23426 INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P.O. BOX 43,7 HERSHEY, PENNSYLVANIA 17033-0437 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 h,,lih,,tll,,,,,,Ih,tl,,,lh,,lh,,hl,,Ihhl,,I,h,hi,,i PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Phyllis E. Waite Date of Death: August 24, 2003 Will No.: Admin. No.: Estate No.: 21-03-0756 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the above-mentioned estate: 1. State whether administration of the estate is complete: Yes X No 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: mo Did the personal representative file a final account with the court? Yes No X Bo The separate Orphans' Court No. (if any) for the personal representative's account is: Co Did the personal representative state an account informally to the parties in interest? Yes X No Do Date: / "1.///J// Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. John S. Davidson, Esquire Name (Please type or print) R.W. -27 Capacity: 320 West Chocolate Avenue, P.O. Box 437, Hershey, PA 17033-0437 Address (717) 533-5101 Telephone No. Personal Representative X Counsel for Personal Representative BUREAU OF INDlliill~.::;U.r ~,~~:H:CE OF INHERITANCE TAX DI~,t~ji(""" ,- I PO BOX 280601 ~',', '_' i HARRISBURG PA 17128-06111 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT 2D05 JMJ 24 Mi 3: 21 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLEnK 01=- ORP' 'jl~.I'~.. t;, ""'.' JOHN ~UP'AvrDSON YOST & DAVIDSON 320 W CHOCOLATE AVE HERSHEY PA 17033 *' REV-1601 EK iF' U2-0~J 01-10-2005 WAITE 08-24-2003 21 03-0756 CUMBERLAND 101 PHYLLIS E AMount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your accountJ submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... ~~:r&~,r'l5r'K~~"rBl~iS!l"""'.;.':rA~!~~1r"fA1r'~'~~Alnrr'b1r'A~1:60~".j(."""""""""". ESTATE OF WAITE PHYLLIS E FILE NO.21 03-0756 ACN 101 DATE 01-10-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-26-2004 PRINCIPAL TAX DUE:. '.'.''''.'",.,.,.ng..,.,.,.,un'''.....,.,N''''"".,.,.,.._."""HU.'.. PAYMENTS (TAX CREDITS): 23,906.86 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2003 CD003260 1,184.80 22,511.22 08-04-2004 REFUND .00 1,438.35- 10-08-2004 CD004485 .00 1,649.19 12-13-2004 CD004733 13.46- 13.46 TOTAL TAX CREDIT 23,906.86 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATIDN OF ADDITIONAL INTEREST. { IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J q.,s"-