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Home My WebLink About10-22-09^ COMMONWEALTH OF ,~~' R E ~ -15 0 0 . f ,, ' ~ PENNSYLVANIA ` y' '' ~'" DEF'AR REVENUE T INHERITANCE TAX RETURN ILE NUMBER DEPT 2806 ~ ~° = ~ ,•s:y V~ HARRISBURG, PA 17128-0601 ~ - RESIDENT DECEDENT 9- 0 4 9 0 --°, l --_ oZ ,F,, oE ~ Ty ~' DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUM6ER z w BOWMAN , --_..-------------__---- -- JEAN E • 17 g - 16 -- 5 9 O 1 Q DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) __ _ _ _ _ THIS RETURN MUST BE FILED IN DUPLICATE WiTN T-;E w 02-1-2009 09-13-1919 REGISTER OF WILLS (IFAPPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) _----- SOCIAL SECURITY NUMBER ~ N/A ~ _ w ~X~ 9 ~ ~ t Ori final Return ~ 2. Su lemental Return PP ~ 3. Remainder Return ,:,~r.->~ ~., ~, w a ~ ~ 4 Limited Estate ~ 4a. Future Interest Compromise (date or deafn after fz-taazl ~ 5. Federal Estate Tax Rehirn Rec -~ . ~ a m L~ 16. Decedent Died Testate Inna~n Dopy or win; ~ 7. Decedent Maintained a Living Trust (niracb copy of crust) Q 8. Total Number of Safe De; acs : =•oxe~. n- ~ ---, i J 9. L~figation Proceeds Received ~ 10. Spousal Poverty Credit (date o(deau,between t2.3t-91 and i-t-95) - ~ 11. Election !e tax under Sc, 7'. !?~ c, _, , -_ _ z 'THIS S,~GTIpN;II~, ,~,TBE CO;lyl L..~'G~C},.,~ 1; -Cc : ~~ ~~' ~ * ~ ... ~~1; N:SNQ~d1:4 BE D~tR~ECTED TO: i o NAMGeOr e W. Porter Es wire - COMPLETE MAILING ADDRESS ~ -- ~ FIRM NAME p,App~icab~e) 909 East Chocolate Avenue W __ _ o TELEPHONE NUMBER Hershey , PA 17 0 3 3 U Z Q J H a U W fY i. Real Estate (Schedule A) (1) 0 2 Stocks and Bonds (Schedule B) (2) 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 4. Mortgages & Notes Receivable (Schedule D) (4) Q 5 Cash, Bank Deposits & Miscellaneous Personal Property (5) 14 , 3 0 3.9 2 (Schedule E) 6 Joinlty Owned Property (Schedule F) (6) 0 Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (~) 0 (Schedule G or L) ., , N -- ~ ~ ':-~ ~. "7 _....{ .p 'g ~is,.t r~,:~ _., r _ •. ' < , ~.~ .. - - _.. ... F_.t _ J t`.) ~ r C'.3 8. Total Gross Assets (total Lines 1-7) (8) 14 , 3 0 3 . 9 2 _ 11. Total Deductions (total Lines 9 & 10) (11) 31.9 3 6 . 4 ~~ _~ __-_=s 12. Net Value of Estate (Line 8 minus Line 11) Insolvent estate (12) (17 , 632 , 52 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) _~ _ made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (17 , 6 3 2 . 5 2 ----- --- 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 10 , 9 3 6 . 5 7 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 2 0 , 9 9 9 . 8 7 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 15 Amount of line 14 taxable at the spousal tax ® rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) ___-__. {a- 16 Amount of Line 14 taxable at lineal rate x .0 4 55 (16) --- 0----- - ~ 1? Amount of Line 14 taxable at sibling rate x .12 (17) _.__.__.._-__._ .. 0 Q 1d ,4mount of Line 14 taxable of collateral rate x .15 (18) ~ nx-~~..~.,,:_--,_~___-..__- 0 ~ ~ 19 Tax Due (19) -------- -- ._ ._ _ - -- ----- --- ~ . ~ - ~ ~ u, I ~ w . 1. _.._.__._ _._._.Y_____. ~ ~ EtE SURE TO AN~VVEF2 A~L:I ~ ;,, `i7 FtlECM1=GK iV{~TI{ <... Decedent's Complete Address: - ---. _ __ ___ .J.ea~__E_,-_ _Boy~tn~_ _-. ------------ v T __. __ _ Church Carlis Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit .- B. Prior Payments C Discount ZIP 1701 (1) 0 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E Penalty Total InterestlPenalty (D + E ) 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 5. If Line t + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) 0 0 0 (5) 0 (5A) _~ (5B) 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWfNG QUES710NS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b retain the right to designate who shall use the property transferred or its income :............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1962, 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. ;oiler ue"aU~es o' p«;qur}. I ;leclare that I hav examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is True, correct and complete ~eclara;:or of preparer other than the per epresentative is based on all inform or which preparer has any knowledge, ~__ ____ SIGNATURE OF PE SIBLE FOR F1LI ,RETU DATE ADDRESS __ 1740 Brookline Drive, Hummelstown, PA 17036 SIGNATURE OF PREPARES OTHER THAN R~P~SENTATIVE DATE ADDRESS 909 East Chocolate Avenue. HersheX, PA 17033 - . - <~ - For dates of death on or after July 1, t994 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% i72 P.S. 59'16 (a) (1.11 (Q]. Fcr dates o` :leach 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 PS §9116 (~~) It1? '~i The statue 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 eves ` the surviving spouse is fhe 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 pare~~t. or a stepparent of the child is 0°ro [72 P.S. §9116(a)(t2)}. .~ r:,`e ~r-:poses! or. the net value of 4ransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §91~6(t2) (77_ P-S ~~,91^~6ia1('~)~ "-~e ,a;< rate ~I7tpcs?ci ors the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. §9116(a)(1.3)]. Asibling is defined. under Section 9'02. as z^ ~ndiwduai who has at !east one parent in common with the decedent, whether by blood or adoption. REti~1508 EX ~ (L97 ti ( " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Jean E. Bowman SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-09-0490 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 ~ Refund - Prescription Solutions 199.09 2. Refund - Caiptal Blue Cross 150.82 3. Susquehanna Bank - checking account ~~1612694609 5,669.47 4. Susquehanna Bank - Irrevocable Burial Reserve - C.D. ~~403800001295 7,326.25 5. Wachovia Bank - account ~~1010180695887 958.29 (Bank letters attached.) TOTAL (Also enter on line 5, Recapit~iacion~ I $ 14 , 3 0 3 . 9 2 (If more space is needed, insert additional sheets of the same size) Susquehanna Susquehanna Bank June 3, 2009 GEORGE W PORTER ATTORNEY AT LAW 909 EAST CHOCOLATE AVE HERSHEY, PA 17033 RE: Jean E Bowman SS#: 178-16-5901 DOD: February 1, 2009 To Whom It May Concern: Q n G•s"~9Uf 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of May 28, 2009, here is the above customer account information as of February 1, 2009. • Account Title: Account #1 Jean E Bowman • Account Type/# Ckg-1612694609 • Date Opened /Maturity Date: 3/07/00 • Interest Rate: 25% • Account Balance*: $5,668.66 • Accrued Interest: $0.81 • YTD Interest: $1.53 *Account balance does not include accrued interest. There is no safe deposit box in the name of this decedent. If I can be of further assistance, please feel free to call. Si erely, ~~ ~ ~-~~ `~ J net M. Peters upport Services Supervisor 1-717-625-6295 JMP/kklo Account # 2 Jean E Bowman Irrevocable Burial Reserve CD-403800001295 5/30/07 5/30/13 2.72% $7,325.16 $1.09 $16.88 WACHOVIA Deposit Account Close Confirmation (Debit) WACHOVIA BANK, N.A. Date Customer Name(s) and Address Taxpayer ID Number 05/27/2009 JEAN E BOWMAN BY S178165901 THOMAS BOWMAN LEGAL CUSTODIAN 1740 BROOKLINE DR HUMMELSTOWN PA 17036 ACCOUNT NUMBER: 1010180695887 Available Balance $958.29 + Accrued Int : $0.00 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0.00 -Closing Fee : $0.00 Paid To Customer : $958.29 566596 CUSTOMER COPY OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Jean E. Bowman Debts of decedent must be reported on Schedule I. FILE NUMBER 21-09-0490 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Dimon Funeral Homes, Inc. (7,468.80) Accepted 7,326.25 (copy of funeral bill attached.) B. ADMINISTRATIVE COSTS: 1, Personal Representathre's Commissions Name of Personal Representative (s) Thomas E . Bowman Soaal Security Number(s) / EIN Numt~er of Personal Representative(s) Street Address 1740 Brookline Drive city Humme 1 s t own state PA Zip 17 0 3 6 Year(s) Commission Paid: 2 0 0 9 Z AttomeyFees George W. Porter, Esquire 3, Family Exemption: (lf decedent's address is not the same as claimant's, attach explanation) Claimant None Street Address City State Zip Relationship of Claimant to Decedent q Probate Fees Register of Wills, Cumberland Co. - Letters Register of Wills - additional fee for letters 5 Accountant's Fees None g Tax Retum Preparers Fees None 7. The Sentinel - advertise letters 8. Cumberland Law Journal - advertise letters 9. Church of God Home, Inc. -medical bill 10. Register of Wills - Cumberland Co. - file Inventory 11. 'Register of Wills - Cumberland Co. - file Inheritance tax return 715.20 2,500.00 72.00 30.00 113.20 75.00 74.92 15.00 15.00 TOTAL (Also enter on line 9, Recapitulation) I s 10 , 9 3 6 . 5 7 (If more space is needed, Insert additional sheets of the same size) SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS Dimon Funeral Homes, Inc. 644 East Grand Avenue Tower City, Pennsylvania 17980 (717) 647-2741 Wanda L. Berger, Supervisor Tuesday, February 5, 2008 Mr. 7`homas Bowman t 740 Brookline Drive Hummelstown, PA 17036 Dear Mr. Bowman, 20I E. Market Street Williamstown, Pennsylvania 17098 (717)647-2422 Paul Fi. Dimon, Super isor Thank you for sel~aing our funeral home to pnrviuk services tier }-our family during your time of bereavement. 1 hope; that you tbund our services. so far. to be: of the highest standards that we ahvays tn~ to achieve. l~he following is a summary of the service charges as prcviousl} explained and provided in written forn~ on the sen•ices for: JEAN E. BOWMAN PROFESSIONAL SERVICES, FACILITIES & AUTOMOTIVE EQUIPMENT Basic service of funeral din~ctor a~ staff, Embalming. Other Preparation of Body. Uu: of Stat~'and Facilities for Viewing /Visitation, t3se of Staff and Facilities for Funeral Cerenxxty, . 7'ranstiY remains to funeral hcxrre, hearse. Lead car for funeral procession. TOTAL SERVICE CHARGES $2,790.00 MERCHANDISE C ~tisket: $1,495.00 Outer Fiurial Container $L200.00 Monument Cutting $ 185.00 $2,880.00 SPECIAL SERVICES Dayton s'4tarket S 298.80 5298.80 CASH ADVANCES Cemeten Chargti~s $ 800.00 Paid Alewspaper Notice S 156.00 5 64.00 Church or Clergy $ 1OO.W Certit+ed Copies of Death Certificate $ 48:00 Flowers $ 202.00 Church [kmation $ 100.00 {lairdres cr $ 30.00 $1500.00 TOTAI.OF SERVICES $7,468.80 BALANCE DUE 57.~•~ if there are any questions or concerns that remain unanswered, please call me. S incerely. 644 East Grand Avenue Tower City, Pennsylvania 17980 (717)647-2741 Wanda L. Berger, Supervisor Tuesday, February 17, 2009 Mr. Thomas Bowman 1740 Brookline Drive Hummelstown, PA 17036 Dear Mr. Bowman, 201 E. Market Street Williamstown, Pennsylvania 17098 (717)647-2422 Paul H. Dimon, Supervisor Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Jean E. Bowman SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED $7,468.80 LESS: Total Payments 7,468.80 CURRENT BALANCE $0.00 If there are any questions or concerns that remain unanswered, please call me. Sincerely, ,~ ~/ f; a \\ i~ ~ ,~~ ~~~~, ~~ Vl"s )N'NLAL 1I I I;)( i 1 . ''. vAiJi, INFilkilANC[ TAR Id!_'.U12^J ~~~ :,~u~NT r~ECE r~r ^~ r ESTATE OF Jean E. Bowman include unreimbursed medical expenses. I-I E Ni NUMP,Ei~ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS DESCRIPTION FILE NUMBER 1 Commonwealth of Pennsylvania - Department of Public Welfare Lien i Note: See attached letter. 21-09-0490 " M 1, $20,999.87 TOTAL (Also enter on line 10, Recapitulation] 3 2 0, 9 9 9. 8 7 ----------------- (If more space is needed, insert additional sheets of the same size) R~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 May 21, 2009 GEORGE W PORTER ESQUIRE 909 EAST CHOCOLATE AVE HERSHEY PA 17033 ;;-zz~ Re: JEAN BOWMAN CIS #: 320198645 SSN: 178-16-5901 Date of Death: 02/01/2009 Dear Attorney Porter: Please be advised that the Department of Public Welfare maintains a claim in the amount of $46,327.24 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $25,327.37, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $20,999.87, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~~ r'5~+7 f Karen P. Georgoulis Claims Investigation Agent 717-214-1283 717-772-6553 FAX ~, ., Enclosure " ~ ~ ~ .~ ~ ; `r ~' „~w,~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 May 21, 2009 STATEMENT OF CLAIM SUMMARY NAME Estate of BOWMAN, JEAN ID 320 198 645 MEDICAL CLASS 3 CLASS 5.1 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE 25,304.70 20,999.87 46,304.57 DRUG 22.67 .00 22.67 REIMBURSEMENT TO DPW 25,327.37 20,999.87 46,327.24 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE EIN - 23-6003113 REV t5t3 E% • 1197) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean E. Bowman 21-09-0490 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) i Thomas E. Bowman son 1/2 residue 1740 Brookline Drive Hummelstown, PA 17033 2. Wayne A. Bowman son 1/2 residue 313 West Maple Avenue Shiremanstown, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II • ENTER TOTAL NON-TAZ(ABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I S (If more space is needed, insert additionaLsheets of the same size) ~Op~ LAST WILL AND T$STAMSN'P of JEAN E. BOWMAN I, JEAN E. BOWMAN, of Williamstown, the County of Dauphin and the Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and Codicils heretofore made by me. FIRST: I direct my funeral and last sickness expenses and my just debts to be paid as soon as possible after the probate of this my Will. After the payment of my debts and said expenses, I give, devise and bequeath my property and estate as hereinafter provided. SECOND: All the rest, residue and remainder of my property and estate, real, personal or mixed, wheresoever situate and of whatsoever the same may consist, I give, devise and bequeath to my sons, THOMAS E. BOWMAN and WAYNE A. BOWMAN, in equal shares per stirpes. THIRD: I hereby authorize and empower my Executor to lease, mortgage, pledge, sell or convey any and all of my estate, real, personal and mixed, using his -_ i ~ i ~ Jea E . Bowatan Page 1 of 5 pages discretion as to the manner, time and terms thereof, and to convey the same by proper deeds or other instruments, and no person dealing with my said Executor shall be responsible for the application of any proceeds or purchase monies. I further authorize my Executor to manage my estate and property and to invest and reinvest the principal thereof at his discretion in such form of investment as may commend itself to the best judgment of my said Executor. FOURTH: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid out out of the principal of my general estate, as if such taxes were administration expense, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. FIFTH: I nominate, constitute and appoint THOMAS E. BOWMAN to be the Executor of this my Last Will 4 J E. Bowman Page 2 of 5 pages and Testament. In the event, THOMAS E. BOWMAN is unwilling or unable to serve as Executor of this my Will, I appoint WAYNE A. BOWMAN as Executor of this my Last Will and Testament. SIXTH: I direct that no Executor shall be required to give any bond, and that if, notwithstanding this direction, any bond is required by any law, statute or rule of court, no surety shall be required thereon. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of ~~~~ 1-I ,A.D. 2000. ~ )) ~~ /) J E. Bowman r> 7 Address : / `~'~ ~~'~~ ~ /~~ ~{,~ ~ze,~ ,~~ Te 1 ephone • 4' y 7 ~ :~ ~ ~ ~ SIGNED, SEALED, PUBLISHED and DECLARED by the Testatrix above named, as and for her Last Will and Testament, and we, at her request, in her presence, and in the presence of each other, have subscribed Page 3 of 5 pages our names as attesting witnesses thereof. ~ ~ ~.~ witness Addre s s ~~~ 1 ~A witness Addre s s ~O~ 13 ~ ~t ~~~~5 ~~ ~li~ ~'/~ 17 a33 ~~ Page 4 of 5 pages COIrIlrlONWEALTH //,,O,,F PENNSYLVANIA } ~~L L~L. } s s COIINTY OF ~ ~ } o we ~ ~~~ ~ ~ ~~-~--. , ~p-c1 l/(/ ~`r-~-c. and r~ ~ 7 /U-'~-~ ~~ ~ -~. the Testatrix and the witnesses, respectively, whose names are signed to the aforegoing Will, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the fore-going instrument as her Last Will and Testament in the presence and hearing of the witnesses 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 and each other, signed the Will as witness and that to the best of their knowledge, the Testatrix was at the time eighteen years of age or older, being of sound mind and under no constraint or un ue influence. r ~ ~ J Testa- rix j W ~~ Witness <__~~- ~ - witness Subscribed, sworn to and acknowledged before me by ,, ~ ~~,,,~,, the Testatrix, and subscribed and sworn o before me by - ~ ~ and ~-~- ~~~ witnesses, this 5c'~ day of~,~~l~~L~ 2000. NOTARY PIIBLIC Cora R. Davaes,iNota'r P West Lebanon Twp., Lebanon b~ic My Commission Expires De County c 1, 2001 Member, Pennsvlvan~a e~~,.,,:...:_ Page 5 of 5 pages C~eor e ryV. porter ~[t~rrcey at Law 909 fast Chocolate 9lvereue ~lershey, Penruylvania 17033 I.D. #42752 October 20, 2009 (717J 533-7130 ~?{X (717J 533-9209 Register of Wilis for Cumberland County Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Jean E. Bowman, deceased. File No. 2009-00490 State File No. 21-09-0490 Dear Sir/Madam: Enclosed please find for filing with your office the following: The original and one copy of the Inventory in the above-refer- enced estate. Please date-stamp the copy and return to my office in the enclosed envelope. Also enclosed please find two originals and one copy of the PA Inheritance Tax Return in the above-referenced estate. Please date-stamp the copy and return to my office in the en- closed envelope. Lastly, enclosed please find a check in the amount of $60.00 to cover the additional cost for letters ($30.00) and the filing fees for filing the Inventory ($15.00) and the inheritance Tax Return ($15.00). Thank you for your cooperation and assistance in this matter. Very truly yours, /, Georg Porter n GWP/ve ~ ~ ,~ Enclosures ~? ~ _ ,-~ -'~; CC: Mr. Thomas E. Bowman, Executor =~~:? -"-, `~ N N _ _ ~ ti , _ -. ..~~. _; ~~ ~ - ~ _e .. ~ .:_J - _. i_i ~ ' - -:. r'i N , _ r' y; '~. ~~ ~ ~ • ~~ }~ ,_ U A ~ ~ ~~ N ~ W N ~ ~+ ~ ~ ~ ~ ~U c4 e(, 4-. ~ ~ a 0 d a N v, ~ Zj. ai ° T oV '~ '~ W O ~ "~' r ~ W ~ U w x W = ~ o ~ ~A H w~ o~ ~ ~ ~~ w ~ ~