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HomeMy WebLinkAbout04-0495 and GRANT,OFLETTERS PETITION FOR PROBATE Estate of Mar Elizabeth Crumlich No. To: also known as Register of Wills for the Deceased. County otCumb e r 1 and in the Social Security No. _ 203-10--~ ~- 3 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: named Your petitioner(s), who is/are 18 years of age or older an the executo-r- in the last will of the above decedent, datedliar ch 19~, 19_8 5 - and codicil(s) dated _JbIJ_A_ ~ ~_ cu_t~_r__Eb o r 1 y . ___~_DoaaLd__Cr4~4~!i~_h__i_s__~ae S~accesccr~xccu-~or and (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cum~b er 1 and ~~ County, Pennsylvania, with eh~r_~ last family or principal residence at _4_0_5__0 r cJa_a r d I. a n o~ 3kezAa~a.a&~ b u r g~,-- (-iJ4z¢mr AJ_ien_T~_~istC,_~mberland Ceunty,~-A street, number and muncipality) 'd c~ ~,~-- y. ears or' .age, die ~~w&Xhy~2- Decendenili,ot~n ~ ~osplta±, camp n.l-*-, Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted at after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ___4_~5 0_rch_ay.J__!.ane M~_ch a n J ~ ~~pA---L705~- $ 1,000.00__ $_4_9, Q00.0o ~ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters_~ request(s) the probate of the last will and codicil(s) of Administration C.T.A. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. -o © Dale F. Shughart_2- J~r. __ 35 _Ea~ Stre.__et~ S_u_iJz_e __C_a_LkJ-i~e_- PA 1701_3 ~-- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF _ CUMBERLA-~ND~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are d e and belief of petitioner(s) and that as personal represen- true and correct to the best of the knowle, .g ......... ,~ .... 1,, administer the estate according to law. tative(s) of the above decedent petitionerts) Will Well ctli .... a ~ . Sworn to or affirm_e.d ~atnd subscribed_ '-'~' '~'"-' da,; ot / "-" - ..... before me this _~ ^~ ,'~-"~ ~,~ J / ~Dale Y · SBu narc May, zuu~ ~~ 5 203 Estate Of MARY ELIZABETH CRUMLICH , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~C~-xA. ~L~ ~ C)(~ k~ the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) datecL M a r c h 1 9, 1 9 8 5 described therein be admitted to probate and filed of record as the last will of Mar Elizabeth Crumlich and Letters of Administration C.T.A. are hereby granted to ~ , in consideration of the petition on Probate, Letters, Etc .......... ~ Short CertificatesCS) $_ C~, _c~ Renunciation ................ $, 5. c, ~- Filed ...~Z'.~r.~ ................. ]. Register of Wills ~ '~~A~ Dale F. Shughart, ,.Ir. A~ORNEY(Sup. Ct.I.D. No.) 19373 35 East High Street, Ste 203 Carlisle, PA 17013 ADD.SS _ (717) 241-4311 PHONE RENUNCIATION In Re Estate of MARY ELIZABETH CRUMLICH deceased. To the Register of Wills of CUM B E R L A N D County, Pennsylvania. E. The undersig~l/DONALD CRUMLICH~ SUCCESSOR EXECUTOR of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters · OF ADMINISTRATION C.T.A. be issued to DALE F. SHUGHART, JR. WITNESS hand this 26th .dayof May ,~.... 2004 (Signature) E o D o n a 1 d '~'Y'm~l ± c h 11301 Coachman's Way Rale±gh, NC 2761/4-8410 (Address) (Signature) (Address) (Signature) (Address) 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, $2.00 10328248 No. Registrar 18 2004 Date 143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH I NAME OF OECEOENT (First. Middle. Last, ,SEX [SOCIAL SECURiT;' ;;EM';~;NuuaaR DATE OF DEATH (Month Day Year) · Mary Elizabeth Crumlich I I [ -, · I:.Femal¢ 13. 203-- 10 -- 6613 ]i /~ ~JAGE(tastBirtt~ay) ] UNDER1YEAR I UNDER1DAY [ DATE OF BIRTH I BRTHPLACE(C~tyand IPLACEOFOEATHtCheckonlvone-seeinstmctionsonofhersidel Iii,. 85 ~,,. I [ I I I, zo-zg-18 I, Enola, PA I~' EY' ,~,--,EI ~[] ~ ~ , El' cou.~oFo~^T. I C,T~ SORO TW~OF ........ I' I'" I """' '' "~"' ' ~:"~ '' a,-~ I , . ut:A/t-I [ PACILITY NAME (If not institution, give street and ilumbef) IWAS DraCEDENT OF HISPANIC OR/GiN? [ RACE - Amancan Indian. Black. White. et Cumberl n · · · No Yes Ifya$.spec~fyCdaan. (Specify) ~J DECEOENTS USUAL OCCUPATION I KIND OF BUSINESS I INDUSTRY ~WAS OI~EDEN'I~EVER IN I OE~t~=~T'~ ~r~ t~'a"r,~-~a I ~1, ! ........ c'r*'r, ,e · ] 10. B,,.. Cafeteria .or[er I,,b ~.d.~ation [,:Y..L~ .o~ I %, T'I ,,%"f., I ~.~(s~*,, I ~DECEDENT'S MAILING Al)DRESS (Str~eL Cllyrr~n, 'State, Zip Code) [ DECEOENT'S [1;. [ 13. ~ [ [ 14. wldow~ d [ t~. M 405 Orchard Lane }~ECsT~LNcE '?..,'-te PA ~,nt ,,o.a Y..,e~nt,*v.i. Upper Allen Mechanicsbur , PA 17055 (sce~n,t,~s ,vei, a ~l~. g Iono~r~d.) iYb. Cour,~ Cumberland t~,n~p? lrd [] ~,: .......... · , Hrr '(~' -][~r~ v MOmHER'SNAUE(First, Middle, MaidetiSumarne) {2Da. l~h~rlv B. Cmml'ich [ MET,OD OF ms~OSmON ' I:~- 11}01 coachrnan~ Way, Raleigh, NC 2761~ ~ ~-~ · [P-[ - -. ~ ~ I DAlE OF DISF~2ISITION { PLACE OF DIS~ITION- Name of Cemetery. Cre~to~ LOCATION - Cily/Town State Zip Code :}onation L_J ounm~ $.--1 ~remauon ~..$qamova{ from Stale L.J I ¢,~:nth. c,,y. Y,,O . I or Oth~ Place ra ..... j ~ . - I ' om~ s -- ~ e a[lon ~oc ec ,~a. (~)"" [~l~,b. ,)-If-0q ~,~ o~ ~ennsylvan[a y L.~ Harrisburo, PA 17 SIGNATUR.~E ~i~RAL SERVICE UC,~NSEE O1~ PERSON ACTING AS SUCH LICENSE NUMBER ' ' NAME ...... RESS ~F ....... ~ I'~u'.. . . · · u r,~,.H'r L, em E 1 n ~ C certify ceu, se of death. [ ~...- ....... e~ [ ](Month. Da)'. Year) s..an,,,,y,,t~,,o., b. C,.,¢¢~.~,..,., C¢-I=~'" /'~ (;;'~/PC ?/"'~'¢"' [ CAUSE (Disease or iqury c., t/ ""k~2~ ~t'~, ~ WAS AN AUTOPSY I W~RE AUTOPSY FINDINGS ~ MANNER OF DEATH DATE OF N JURY TtME F PERFORMED? ~ AVAILABLE PRIOR TO I I Monlfl Day Yeart I o INJURY I INJURY AT V~ORK? I DESCRIBE HOW INJURY OCCURRED COMPLETION OF CAUSE Natural ~_. Homicide [] .... ~o .,. be.t of .,¢~.o,~I,~,[ ............................... ....... ~..~ ...... .?th ,~_~,,.a..o,r. ~y .... ~ p~o,~,,~ death ,nd ~-,~t.d d~ =a~ ~ ~ .., ........... ............................. .............. .. ............. ' P~oOt~.O~UN__C.?.G_A..N~D- _CE~_R~TIFYt~NG..PHYSIClAN' (Physician both pronouncing death and c.e~fying, .....of death) LICENSE~NUMBER I DATE s,gu~o {u~th. ' g. atthetlme, date. andpl ...... ,,uetoth ...... S($).., ......... tare, ...................... ~;~1' 31c.0-fZ)~.1..~2~..)'~--- 151,' .~-~.~t *MEDICAL EXAMINER/CORONER Oo the basis of examination and/or InveaBgatlon, in my opinion, death occun, ed at the Brae, date, and place, and due to the causes(s) and manner as ~tated ............................................................................... [] NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (Item 27) Type or Prip~/~'' DATE F LED (Month. Day. Year) LAST WILL OF MARY ELIZABETH CRUMLICH I, MARY ELIZABETH CRUMLICH, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and'dispo~ng mind, memory and understanding make and publish this writing to be my Last Will and hereby revoke and make void any and ai~~ for- mer Wills or Codicils made be me at any time prior hereto. · ::~ ITEM I: I direct the payment out of my estate of all my just debts and funeral expenses as soon after my decease as convenient. ITEM II: I give, devise and bequeath my entire estate, both real and personal of whatsoever nature and wheresoever the same may be situated at the time of my death to my husband, EBERLY B. CRUMLICH, if he should survive me by more than Sixty (60) days. ITEM III: In the event that my husband, EBERLY B. CRUMLICH, shall predecease me or die before the 60th day, I de- vise and bequeath my entire estate, both real and personal of whatsoever nature and wheresoever the same may be situated at the time of my death to my son, E. DONALD CRUMLICH, of Raleigh, North Carolina, per stirpes. ITEM IV: I authorize and direct my Executor to sell any and all real estate of which I die possessed. ITEM V: All taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction SEAL) imposed, shall be considered a part of the expense of the admin- istration of my estate, and my Executor shall have the absolute power in his discretion to pay the same at once whether or not the law under which they are imposed permits the postponement of payment of all or part of them at a later time. ITEM VI: I appoint my husband, EBERLY B. CRUMLICH, of Lower Allen Township, Cumberland County, Pennsylvania, as Execu- tor of this, my Last Will. Should my husband, EBERLY B. CRUMLICH, for any reason fail or not qualify as Executor, I ap- point in his place as Executor my son, E. DONALD CRUMLICH, of Raleigh, North Carolina. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 19th day of March, A.D., 1985. The preceding instrument, consisting of this and one other typewritten page identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by MARY ELIZABETH CRUMLICH, the Testatrix therein named, as and for her Last Will in the presence of us, who, at her re- quest, in her presence and in the presence of each other, have subscribed our names as witnesses hereto; residing at residing at -2- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mary Elizabeth Crumlich Date of Death: May 16, 2004 Estate No. 21-04-0495 To the Register: I certify that notice of 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 May 28, 2004. Name E. Donald Crumlich Address 11301 Coachman's Way Raleigh, NC 27614-8410 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: May 28, 2004 /~~~~,~ ~ ~l~a~ ~h~treec, ~uite~h~'~'~r'l 203 Carlisle, PA 17013 Telephone (717) 241-4311 Capacity: Counsel for Administrator C.T.A. Dale F. Shughart, Jr. IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Mary Elizabeth Crumlich, deceased Estate No. 21-04-0495 TO: E. Donald Crumlich 11301 Coachman's Way Raleigh, NC 27614-8410 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent Mary Elizabaeth Crumlich, died on the 16th day of May, 2004, at Carlisle, Cumberland County, Pennsylvania. The Decedent died testate. The personal representative of the Decedent is: Dale F. Shughart, Jr. 35 East High Street, Suite 203 Carlisle, PA 17013 {717) 2491-4311 The will has been filed with the Office of the Register of Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA 17013. Phone No. 717-240-6345. Date: May 27, 2004 A copy of the Will or Petition may be obtained by contacting the Register of Wills and pa ing the ~ar~uplication. Dale F. Shughar~, Jr. Attorney Supreme Court I.D. #19373 35 East High Street, Suite 203 Carlisle, PA 17013 Telephone (717) 241-4311 Capacity: Counsel for Administrator C.T.A. Dale F. Shughart, Jr. COMMONWEALTH OF PENNSYLVANIA DE?ARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT28060T HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11 96) NO. CD 004254 SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 ESTATE INFORMATION; SSN: 203-10-6613 FILE NUMBER: 2104 0495 DECEDENT NAME: CRUMLICH MARY ELIZABETH DATE OF PAYMENT: 08/11/2004 POSTMARK DATE: 08/1 1/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2004 ACN ASSESSMENT CONTROL NUMBER 101 AMOUNT $6,650.00 REMARKS: D FSHUGHARTESQ TOTAL AMOUNT PAID: $6,650.00 SEAL CHECK//527 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CO"MC"WE~O~.~".SYLV^.,^INHERITANCE TAX RETURN "LE"U"SER DEPT ~, RESIDENT DECEDENT 21 04 00495 DECEDENTS NAME (LAST. FIRST. AND MIDDLE iNITiAL) SOCIAL SECURITY NUMBER Cmmlich, Mary Elizabeth 203- l 0 - 6613 DATE O~= DEATH (MM-DD-YEAR) DATE OF BIRTH (MM:DD-YEAR) r 05/16/2004 10/19/1918 REGISTER OF WILLS (IF APPLICABLE) EDnVIVINa SPOUSE'S NAME ( L~ST, FIRST AND MIDDLE INITIAL) ~IAE ~EDU~iTY NUMEE~ [] 1. Original Ream [] [] 4. Limited Estate [] 4~. 12ot2-~2)Fmure Inmresl Gomprc~ise (~l~te ~ ~le~th ~Ber [] $. Federal Estate Tax Ftaturn Fiequired [] 6. DecedentDiedTestate(Attachcopy [] 7. DecedentMaintainedaLivingTrust(Adach 0 8. Tota, NumberofSafeDepositBoxes of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Pove fly Credit (date ~ death between [] 11.Election to tax under Sec. 9113(A) {Attach Sch O) O NAME Dale F Shughart, Jr. Esquire FIRM NAME (if appliCable) i 35 E. High Street, Suite 203 TELEPHONE NUMBER 717/241431 l 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sola-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilitfes, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) Carlisle, PA 17013 12. Net Value of Estate (Line 8 minus Line 11 ) (t) 141,000.0~ {2) None (3) Non~ (4) None (5) 51,932.33 (6) Non~; (7) None (9) 31,297.36 (10) 1,246. l l 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 APPMCABLE RATIOS 15. Amount of Line 14 taxable at the spousal tax rate, x .0~ or transfers under Sec. 9116(a)(1.2) (8) 192,932.33 (11) 32,543.47 (12) 160,388.86 (13) (14) 160,388.86 (15) 16. Amount of Line 14 taxabre at lineal rate x .04~ 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 160,388.86 (lO) 7,217.50 (17) (18) (19) 7,217.50 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)  SCHEDULE A REAL ESTATE COMMONWEALTH OF Pi~JNSYI.VANIA ESTATE OF Crumlich, Mary Elizabeth FILE NUMBER I 21 - 04 - 00495 All real property owned solely or as a tenant in common must be r.e.l~orted at fair market value. Fair market value is defined as the price at which property would be excnanged between a willing buyer and a wilnng seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship muat be disclosed on schedule F. ITEM NUMBER DESCRIPTION I House and lot located at 405 Orchard Lane, Mechunicsburg (Upper Alien Township), Cumberland County, PA, having Tax Parcel ff42-28-2423-071. Property was sold on July 28, 2004. HUD-I attached. VALUE AT DATE Of DEATH ]41,000.00 TOTAL (Also enter on Line 1, Recapitulation) 141,000.00 ~.l I~-n~ Z.L.jrmn,,~ -~,1 I~;UNV. UNIN~. 4. LJVA 5, J._JCONV. INS. U,S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6. FILE NUMBER: ' SETTLEMENT STATEMENT NGUYEN.T I 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C, NOTE: This fonn is fumished fo give you a sfotement of actua/ settlement eoats. Amounte paid fo and by the seff/ement agant are shown. Items marked "[POC]" were paid outside the closing; ~hey are shown here for informational purposes and are not thcluded kl the totals. 1.0 3/98 INGUYEN.T.PFDINGUYEN.T/rO) D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: TRI MINH NGUYEN and ESTATE OF MARY E. CRUMLICH MAi THI NGUYEN 405 ORCHARD LANE MECHANICSBURG, PA 17055 G. PROPERTY LOCATION: H. SETTLEMENTAGENT: 25-1857112 I. SE~I'LEMENTDATE: 405 ORCHARD LANE MECHANICSBURG, PA 17055 Midstate Abstract Company CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT July 28, 2004 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO S~=LLI=R: 101. Contract Sales PHce 141,000.00 401. Contract Sales Price 141,000.00 102. Personal ProperbJ 402. Personal Property 103. Settlement Cha~es to Buyer (Line 1400) 2~644.25 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance AdjusJments For Items Paid By Seller in advance 106. City/Town Taxes to 406. City/Town Taxes to 107. County Taxes 07/28104 to 01/01/05 129.71 407. County Taxes 07/28/04 to 01/01/05 129.71 108. School Taxes 07/28/04 to 07/01/05 1~371.64 408. School Taxes 07/28/04 to 07/01/05 1,371.64 109. SEWER PRORATION 07/28/04 to 10/01/04 70.65 409. SEWER PRORATION 07/28/04 to 10/01/04 70.65 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 145,216.25 420. GROSS AMOUNT DUE TO SELLER 142,572.00 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 800. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit orearnest money 3,000.00 501. Excess Deposit (Seelnstructions) 202. Principal Amount of New Loan(s) 502. Settlement Charges to Seller (Line 1400) 10~600.21 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortgage 206. 506. 207. 507. (Deposit disb. as proceeds) ~08. 508. 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Ite,ms Unpaid By Seller 210. City/Town Taxes to 510. City/Town Taxes to 211. County Taxes to 511. CountyTaxes to 212. School Taxes to 512. School Taxes to 213. CREDIT FOR PLUMBING 100,00 513. CREDIT FOR PLUMBING 100.00 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 819. 220. TOTAL PAID BY/FOR BUYER 3,100.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,700.21 300. CASH AT SETTLEMENT FROM/TO BUYER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Buyer (Line 120) 145,216.25 601. Gross Amount Due To Seller (Line 420) t42~572.00 302. Less Amount Paid BylFor Buyer (Line 2201 ( 3,100.00 602. Less Reductions Due Seller (Line 5201 10,700.211 303. CASH( X FROM)( TO)BUYER 142,116.25 603. CASH(X TO)( FROM)SELLER 131,871.79 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein, Buyer Se,er TRI MINE NGUYJL~N/~'- I / . ;00. TOTAL COMMISSt0N Based on Price $ 141~000.00 ~ 6.0000 % 7,609.00 PAID FROM PAID FRO~I Division of Commission (line 700) as Follows: BUYER'S SELLER'S 701. $ 3,404.00 tO B-H AGENCY GMAC REAL ESTATE 702. $ 4,205.00 to RE/MAX REALTYASSOClATES FUNDSAT FUNDSAT 703. Commission Paid at Settlement SETTLEMENT SETTLEMENT 704. to 7,609.00 800. ITEMS PAYABLE IN CONNECTION WtTH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mortgage ns App. Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. MIP Totlns. for LifeOfLoan for months to 903. Hazard Insurance Premium for 1.0 },ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months (~ $ per month 1002. Mortgagelnsurance months (~ $ per month 1003. City/TownTaxes months ~ $ per month 1004. County Taxes months ~ $ per month 1005. SchooITaxes months @ $ per month 1006. months (~ $ per month 1007. months @ $ per month 1008. months (~ $ per month l~J00. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. CIosin~l Service Letter to 1107. Attorney's Fees to (includes above item numbers: 1108. Titlelnsurance to MIDSTATEABSTRACT 1,063.75 (includes above item numbers.l 102, 1103 & 1109. Lender's Coverage $ 1110. Owner's Coverage $ 141,000.00 1,063.75 1111. 1112. Notary Fee 1o Cash 5.00 1113. Notary Fee 1114. PROCESSING SERVICE FEE to RE/MAX REALTY ASSOCIATES 125.00 1115. 1116. 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50; Mortgage $ ; Re~,e,~e~ $ 40.5 1202. City/Count~ Tax/Stamps: Deed 1~410.00; Mortgage 1~410.0C 1203. State Tax/Stamps: Revenue Stamps 1~410.00; Mortga£1e 1~410.00 1204. 1205. t 300. ADDITIONAL SETI'LEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. 2004 SCHOOL TAXES to MARLIN A. YOHN~ SR.~ TREASURER 42-28-2423-07' 1,481.21 1304. 3RD QTR. SEWER to UPPER ALLEN TOWNSHIP AUTHORITY #534014 100.0{~ 1305. ~1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 1931 Section J and 5921 Section KI 2,644.25 10,600.21 Certified to be a tr~e copy. Settlement Agent SCHEDULE E CASH, BANK DEPOSITS, & MISC. c~o.w~T, o. ~..~VLVA.,A PERSONAL PROPERTY INHERITANCE TAX }~E~IJRN ESTATE OF Cmmlich, Mary Elizabeth i FILE NUMBER 21 - 04 - 00495 Include the proceeds of I tigation and the date the proceeds were received by the estate. All property jointly, owned with the n ht of survivorship must be disclosed on schedule F. 'g ITEM NUMBER 1 2 3 4 7 8 9 10 11 12 13 14 15 DESCRIPTION Household goods and furniture distributed in kindl Value based uPon attached apP~sal 0fwiliiam o. Rowe. Household goods and furniture sold at public sale, Value based on sale proceeds. 1992 Chevrolet sedan automobile. Value based upon sale price to third party. PNC Bank Checking Account #5000984292 Principal 7,800.51 Accrued Interest .60 PNC Bank Savings Account #5003698662 Principal 11,552.55 Accrued Interest 3.44 Waypoint Bank, Checking Account #200004669 Principal 16,674.23 Accrued Interest .06 Waypoint Bank, Certificate of Deposit #1016059444002.M Principal 5,000.00 Accrued Interest 4.97 Public School Employees Retirement System, final pay Waypoint Bank, interest check on hand MetLife, Inc., proceeds from sale of 47 shares of MetLife, Inc., owned by E.B. Crumlich. MetLife, dividend check ofE. B. Crumlich, on hand Commonwealth of PA, tax rebate Travellers, auto insurance premium retired Travellers, homeowner's insurance premium refund Boscov's, credit balance Total of Continuation Schedule(s) TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 285.00 5,178.25 1,500.00 7,801.11 11,555.99 16,678.29 5,004.97 56.41 10.27 1,700.68 10.81 155.68 48.00 99.00 50.00 1,797.87 51,932.33 COMM O~JWE~t. TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEOENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF Cmmlich, Mary Elizabeth FILE NUMBER 21 - 04 - 00495 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 NUMBER DESCRIPTION , VALUE AT DATE OF DEATH 16 Comcast, credit balance 7.79 17 Verizon Wireless, credit balance 31.02 18 Capital Blue Cross, refund of insurance premium 187.06 19 Tax and Sewer prorations on sale of real estate 1,572.00 Page 2 of Schedule E Rowe's Auction Service 2505 Ritner Highway Carlisle PA 17013 71%249-2677 249-1978 697-4794 To: Dale F. Shugart Jr. Esquire 35 E. High St. Carlisle, Pa. 17013 From: William Rowe Rowe's Auction Service Carlisle PA RE: Mary Cmmlich Estate July 13, 2004 Items removed from property at 405 Orchard Lane, Mechanicsburg PA Custom made drop leaf table Nest of stands Television Antique plates Total $200.00 15.00 35.00 35.00 $285.0O William G. Ro(''~-'''-'''--~''-~we 8/10/2004 DALE F SHUGHART JR 35 E HIGH ST STE 203 CARLISLE PA 17013 The information which you requested on the account(s) of MARY B CRUMLICH (Social Security Number 203-10-6613) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 1016059444 200004669 CERTIFICATE CHECKING 012585 010482 5000.00 16674.23 4.97 .06 5004.97 16674.29 SOLE 012585 010482 Additional Information Requested SENIOR SERVICES REP. RO. Box 171 I. HARRISBURG, PENNSYLVANIA 17105-1711 Toll Fr~ 1-1366-WAYPOINT (I-866-929-7646) · IN YORK ARF-A 717/815-4500 · vvww. waypointbank.com P~01×0~ PNCBAN< June 4, 2004 Dale F. Shughart., Jr. 35 E. High Street, Ste. 203 Carlisle, PA 17013 Estate of Mary Crumlieh, deceased SSN: 203-10-6613 DOD: 5/16/2004 Dear Mr. Shughart: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5000984292 MARY CRUMLICH DOD balance: $7,800.51 + $.60 accrued interest Established 11/15/1998 Savings Account Accoum #5003698662 MARY CRUMLICH DOD balance: $11,552.55 + $3.44 accrued interest Established 01/23/2002 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-885-PNC-BANK (1-888-762-2265) or stop by your local PNC Ba_,-xk branch Sincerely, Kachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 fim~ Ave. Pltt~bm'gh PA 15219 Member FDIC TOTAL P.O1 ESTATE OF ~ ~ ~ ~ ~ ~ :: ~ :~ ~ ~ ::~ ':~:~ ~ : Cmmlich, Mary Elizabeth ! FILE NUMBER 21 - 04 - 00495 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION I i AMOUNT A. FUNERAL EXPENSES: I Cremation Society, cremation and funeral 2 Mechanicsburg Cemetary Association, interment 1,593.20 200.00 3 4 5 Brothers Family Dining, family meal E. Donald Crumlich, reimburse for gratuities for Pastor and pianist, plus travel expense to arrange funeral, etc. (E. Donald Cmmlich was named Executor under Will. Renounced in favor Gingrich, engraving headstone 234.74 427.67 95.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Dale F. Shughart, Jr. Social Security Number(s) / LIN Number of Personal Representative(s): 25-1802515 Street Address 35 East High Street, Suite 203 City Carlisle State PA Zip 17013 Year(s) Commission paid 2004 Attorney's Fees Dale F. Shughart, Jr. (estimated) Family Exemption: (If decedent s address s not the same as c almant s, attach exp anatlon) Claimant Street Address C~ty Relationship of Claimant to Decedent Probate Fees Register of Wills State ~ Zip 3,000.00 9,750.00 288.00 Tax Return Preparer's Fees (Estimated) Other Administrative Costs Register of Wills, Short Certificates Cumberland Law Journal, advertise Letters Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recepltulatlon) 500.00 18.00 75.00 15,115.75 31,297.36 8chadu H i RESIDENT DECEDENT Cmmlich, Mary Elizabeth FILE NUMBER 21 - 04 - 00495 3 The Sentinel, advertise Letters 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 4 5 6 Register of Wills, filing Inheritance Tax and Inventory Bonnie Coyle, notary fees Linden Hall Antiques, auctioneer's commission Tri Nguyen, plumbing credit B-H Agency, realtor's commission Re/Max Realty, commission Recorder of Deeds, realty transfer taxes Marlin Yohn, tax collector, school district taxes Upper Allen Township, sewer bill Lowe's, repair materials Postmaster, certified mail Charles Comrey, lawn care Ness Garage, auto repair Verizon, phone United Water, water hill Glassmaster's, window repair PP&L, electric Veryl Williams, trash removal Shirley Harrison, house cleaning Jane Wallace, house cleaning and supplies E. Donald Crumlich, reimburse out of pocket expenses of transporting items to beneficiary in North Carolina. U Haul, track rental to deliver items to beneficiary. Page 2 of Schedule H 115.79 25.00 25.00 1,603.25 100.00 3,404.00 4,205.00 1,410.00 1,481.21 100.00 4.74 10.00 280.00 145.97 52.28 26.50 195.00 138.99 250.00 142.50 184.92 187.12 525.48 SchadubH COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~ C~ ~ RESIDENTDECEDENT : : : : : : ESTATE OF i FILE NUMBER Cmmlich, Mary Elizabeth 21 - 04 - 00495 26 Waypoint Bank, checks 27 Reserve for filing Account 3.00 500.00 Page 3 of Sc~ ESTATE OF Cmmlich, Mary Elizabeth SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS iFILE NUMBER 21-04-00495 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 DESCRIPTION Checks written before death, clearing after death: 1596 United Water 15.41 1598 Verizon 24.52 1599 Chuck Comrey, lawncare 70.00 1600 BankCard Services 50.00 on account, Visa Verizon, phone United Water, water bill Comcast, cable/intemet Verizon Wireless, cell phone PP&L, electric BankCard Services, Visa credit card, balance Waste Management, trash removal Boswell, Tintner, et al, Legal fees, incurred prior to death Travellers, balance of homeowner's insurance premium due at death Upper Allen Township, sewer bill Chuck Comrey, lawn care AMOUNT 159.93 27.31 24.07 80.02 35.44 52.26 289.69 35.39 359.00 13.00 100.00 70.00 TOTAL (Also enter on Line 10, Recapitulation) 1,246.11 COM~EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER L 1 SCHEDULE J BENEFICIARIES ............. ' ~ i I-- --IFLENUMBER Crumlich, Mary Elizabeth 21 - 04 - 00495 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ! RELATIONSHIP TO AMOUNT OR SHARE DECEDENT ; OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal distributions) E. Donald Crumlich Son 100% 11301 Coachman's Way Raleigh, NC 27614-8410 II. 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 LAST WILL OF MARY ELIZABETH CRUMLICH I, MARY ELIZABETH CRUMLICH, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding make and publish this writing to be my Last Will and hereby revoke and make void any and all for- mer Wills or Codicils made be me at any time prior hereto. ITEM I: I direct the payment out of my estate of all my just debts and funeral expenses as soon after my decease as convenient. ITEM II: I give, devise and bequeath my entire estate, both real and personal of whatsoever nature and wheresoever the same may be situated at the time of my death to my husband, EBERLY B. CRUMLICH, if he should survive me by more than Sixty (60) days. ITEM III: In the event that my husband, EBERLY B. CRUMLICH, shall predecease me or die before the 60th day, I de- vise and bequeath my entire estate, both real and personal of whatsoever nature and wheresoever the same may be situated at the time of my death to my son, E. DONALD CRUMLICH, of Raleigh, North Carolina, per stirpes. ITEM IV: I authorize and direct my Executor to sell any and all real estate of which I die possessed. ITEM V: All taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be considered a part of the expense of the admin- istration of my estate, and my Executor shall have the absolute power in his discretion to pay the same at once whether or not the law under which they are imposed permits the postponement of payment of all or part of them at a later time. ITEM VI: I appoint my husband, EBERLY B. CRUMLICH, of Lower Allen Township, Cumberland County, Pennsylvania, as Execu- tor of this, my Last Will. Should my husband, EBERLY B. CRUMLICH, for any reason fail or not qualify as Executor, I ap- point in his place as Executor my son, E. DONALD CRUMLICH, of Raleigh, North Carolina. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 19th day of March, A.D., 1985. ~ Ma~!~ Ell~beth Crumlich The preceding instrument, consisting of this and one other typewritten page identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by MARY ELIZABETH CRUMLICH, the Testatrix therein named, as and for her Last Will in the presence of us, who, at her re- quest, in her presence and in the presence of each other, have subscribed our names as witnesses hereto; residing at residing at -2- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17126-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004399 SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 ESTATE INFORMATION: SSN: 203-10-6613 FILE NUMBER: 2104-0495 DECEDENT NAME: CRUMLICH MARY ELIZABETH DATE OF PAYMENT: 09/17/2004 POSTMARK DATE: 09/17/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $217.50 TOTAL AMOUNT PAID: $217.50 REMARKS: CHECK//533 · INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Crumlich, Maxy Elizabeth also known as , Deceased Dale F. Shughart, Jr. No. 21 - 04- 00495 Date of Death 5/16/2004 Social Security No. 203-10-6613 The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the pemonal assets wherever situate and all of the reel estate located 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 the 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/VVe verify that the statements made in this Inventory are true and correct. INVe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authorities. Attorney: I.D. No.: Signature: Signature: Address: Address: 35 East High Steer, Suite 203 Carlisle, PA 17013 Telephone: Telephone: (717)241-4311 Dated: Personal Property Household goods and furniture distributed in kind. Value based upon attached appraisal of William G. Rowe. 285.00 Household goods and furniture sold at public sale, Value based on sale proceeds. 1992 Chevrolet sedan automobile. Value based upon sale price to third party. PNC Bank Checking Account #5000984292 Principal 7,800.51 Accrued Interest .60 PNC Bank Savings Account #5003698662 Principal 11,552.55 Accrued Interest 3.44 5,178.25 ; - ;,5oo.oo ; ~,801.11 i:l ~,555.99 Waypoint Bank, Checking Account #200004669 Principal 16,674.23 Accrued Interest .06 16,678.29 (Attach additional sheets if necessary) Total Personal Property and Real Estate $192,932.33 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Crumlich, Mary Elizabeth No. 21 - 04 - 00495 also known as Date of Death 5/16/2004 ,Deceased Secial Security No. 203-10-6613 Waypoint Bank, Certificate of Deposit #1016059444002.M 5,004.9? Principal 5,000.00 Accrued Interest 4.97 Public School Employees Retirement System, final pay 56.41 Waypoint Bank, interest check on hand 10.27 MetLife, Inc., proceeds from sale of 47 shares of MetLife, Inc., owned by 1,700.68 E.B. Cmmlich. MetLife, dividend check orE. B. Cmmlich, on hand 10.81 Commonwealth of PA, tax rebate 155.68 Travellers, auto insurance premium refund 48.00 Travellers, homeowner's insurance premim refund 99.00 Boscov's, credit balance 50.00 Comcast, credit balance 7.79 Verizon Wireless, credit balance 31.02 Capital Blue Cross, refund of insurance premium 187.06 Tax and Sewer prorations on sale of real estate 1,572.00 Total Personal Property Real Estate Hoase and lot located at 405 Orchard Lane, Mechanicsburg (Upper Allen Township), Cumberland County, PA, having Tax Parcel ~42-28-2423-071. Property was sold on July 28, 2004. HUD-1 attached. $51,932.33 141,000.00 Total Real Estate $141,000.00 2 BUREAU OF INDIVIDUAL TAXES ZNHERXTANCE TAX DTVXS/OH PO BOX Z80601 HARRISBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CE OF ZNHERTTANCE TAX APPRATSEMENT, ALLO#ANCE OR DTSALLO#ANCE OF DEDUCTTONS AND ASSESSMENT OF TAX RE¥-iGI~? EX AFP (09-0~i) DALE F SHUGHART JR ESQ STE ZO$ $5 E HIGH ST CARLISLE PA 17015 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 11-15-2004 CRUHLICH 05-16-2004 21 04-0495 CUHBERLAND 101 Amount Ram i~'l:ed HARY E HAKE CHECK PAYABLE AND REHZT PAYHENT TO.' REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS -~ REV-1547 EX AFP (01-03) NOTICE OF XNHERZTANCE TAX APPRAXSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF CRUHLTCH HARY E FZLE NO. 21 04-0495 ACN 101 DATE 11-15-2004 TAX RETURN #AS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATZON CONCERNING FUTURE XNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock~Partnership Tnteres~ (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits~Misc. Personal Property (Schedule E) ($} 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Nortgage LZabAlit/es/LAens (Schedule T) (10) 11. To,al Deductions 12. Net Value of Tax Return 141/000.00 .00 .00 .O0 51/932.33 .00 .00 (8) 31,297.56 NOTE: To Ansure proper credAt to your account, submit the upper portAon of thAs fore wAth your tax payment. 13. NOTE: 192,95Z.$5 1~246.11 (~t) 32.5~3.~7 (~2) 160,388.86 CharAtable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Sub~ect to Tax (lq) Zf an assessment ~as issued previously, 11nes 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 160,388.86 18 and 19 ~ill ASSESSHENT OF TAX: 15. Amount of L/ne lq at Spouse1 rate 16. Amount of LAne lq taxable at Lineal~Class A rate 17. Amount of Line lq at SAbling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due, TAX CREDITS: PAYMENT RECEIPT ~ DISCOUNT (+) DATE NUHBER 08-11-200~ CD00~25~ ~ ~:~. 350. O0 o9-27-zoo~ c~99 q~ '~ . (2s) .00 x O0 = .00 (26) 160,:388.86 x 045= 7,Z17.50 (~7) .00 x 12 = .00 (~e) .00 x 15 = .00 (~9)= 7,217.50 TF PATD AFTER DATE TNDTCATED, SEE REVERSE FOR CALCULATTON OF ADDITTONAL TNTEREST. AMOUNT PAID 6,650.00 217.50 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 7,217.50 .00 .00 .00 ( XF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REiIUTRED. ZF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORN FOR XNSTRUCTZONS.) RESERVAT/DN: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for Zife or for years, the Com~onaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the la~ful Class S (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of 1000. (71 P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, ~hich ~as not requested on the Tax Return, may be requested by completing an "Application for Refund cf Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available online at aa~.revenus.state.pa.us, any Register of Hills or Revenue District Office, or from the Department's Z4-hour answering service for forms orders: 1-800-36Z-Z050~ services for taxpayers aith special hearing and/or speaking needs: 1-800-~47-50Z0 (TT only). Any party in interest not satisfied aith the appraisaant, a11oeancs or disallowance of deductions or assessment cf tax (including discount or interest) as sheen on this Notice may object ~ithin 60 days of the date of receipt of this notice by filing one of the folloaing: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at ~aw.bcardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals ~ebsite. You may also send a #ritten protest to PA Department of Revenue, Board of Appeals P.O. Box ZBIOZ1, Harrisburg, PA 17128-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Rsvie~ Unit, P.O. Box Z80601, 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 within three (S) calendar months after tho decedent's death, a five percent (51) discount of the tax paid is allowed. 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 Nould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes ~hich became delinquent on and after January 1, 1981 ~ill bear interest at a rate ~hich will vary from calendar year to calendar year .ith that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO4 ars: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1'~ ZOZ .000548 1988-1991 llX .000301 2001 91 .000247 1985 16X .000458 1991 9Z .000247 ZOOZ 67. .000164 1984 llZ . OOOSO1 1995-1994 71 .00019Z 2005 51 .000137 1985 151 .000556 1995-1998 92 .000247 2004 ~Z .OOOllO 1986 102 .000274 1999 71 .000192 1987 lOZ .000174 ZOO0 71 . O00XQZ --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY /NTERBST FACTOR --Any Notice issued after the tax becomes delinquent mill 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. . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF DANIEL R. CALIFANO No. cO..I- 05. OtjQS- AFFIDAVIT OF NOTICE UNDER RULE 5.6(al Name of Decedent: Date of Death: To the Register: Daniel R. Califano Mav 13. 2005 I certify that notice of beneficial interest 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 Mav 31. 2005 : (attach additional sheets, if necessary). Name Pete Califano Margaret Cal ifano Address 17 Kingwood. Mechanicsburg. PA 17055 17 Kingwood. Mechanicsburg. PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except t~;l- ()J--- /L:~ Pete Califano ",-' Date: , ;() ,"'r) (-- Date: 6 -2 -0 1~ r..,', Mar c::' r"'. ......'.. J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-~6) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 unnn fold ESTATE INFORMATION: SSN: 203-10-6613 FILE NUMBER: 2104-0495 DECEDENT NAME: CRUMLlCH MARY ELIZABETH DATE OF PAYMENT: 07/20/2005 POSTMARK DATE: 07/20/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2004 NO. CD 005599 ACN ASSESSMENT CONTROL NUMBER AMOUNT I I L____ I 101 I $77.62 i , I I , I I I I I , I , , TOTAL AMOUNT PAID: $77.62 REMARKS: DALE SHUGHART CHECK# 557 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS REV. 1500Ell.(6-OOj w ~ 1Il:!:(fl U~~ W~U ~OO U~~ ~m ~ c ,. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT_280601 HARRISBURG. PA 17128.0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ ~ w c w U w c DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) Crumlich, Mary Elizabeth DATE OF DEATH (MM-D[}-YEAR) DATE OF BIRTH (MM-DD-YEAR) 05116/2004 10/1911918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL) o o 06 09. 1. Original Return 4. Limited Estate Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received FIRM NAME (II applicable) TELEPHONE NUMBER 717/241-4311 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o ~ 5 => ~ ~ c u w ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assels (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (iP le:."\; USF (ALl' FILE NUMBER 21 04 00495 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 203-10-6613 THIS RETURN MUST BE ALED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBEA o o 3. Remainder Return (date or death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 35 E. High Street, Suite 203 Carlisle, PA 17013 (1) None (2) None (3) None (4) None (5) 1,739.65 (6) None (7) None (9) 15.00 181 2. Supplemental Return o 4a. Future Interest Compromise (dale 01 death after 12.12-82) D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) o 10. Spousal Poverty Credit (date a/death between 0 11.Election to tax under Sec. 9113(A)(Attach Sch 0) .. ~.'.c..,1.3::3:1::~tiilI1dJ;.1::~.!:it:.::..... :"",':':' '.:..:.,:',.:':. ...,:.....::..' ::_:. .:c,':', .':>>., ',':: .0'" :: .:.:'",', .':::', ',:,:: ",',-:" ",- THISSECTlONMlISTlIECOMPLEml. ALL~~JINIlC~ TAX~1ION~~JltIilo(;l"';TO, NAME" ....... ... .--..... - --.... ........ ..,.. ..d. .., .. .... - om --- - -- - - .. '- - mc;6MPLETE~MAIUNG'ADDRESS -.., -----'. ,..~----~, .:~"-,-, Dale F Shughart, Jr. Esquire 13. Charitable and Governmental Bequests/See 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 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c; ()f-Ti( 1;(, ~ Cq; S:;:n U1 i~ -0 c- ,.'r---;-, . "-'-~.:J:J ':J)7.: F~< C"J C-) ::CJ ~----; C.J :-ili;---j -., c:J --)CJ ",..:..:r, --n o __ CTI -/) (J -71 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 1,724.85 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ~ c ~ => ~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u x 18. Amount of Line 14 taxable at collateral rate c x .15 (18) ~ 19. Tax Due (19) <-~ <= r- r......., o () ..0:, -v ~"3 ~-j c ~, r" -.J (8) 1,739.65 (11) 15.00 (12) 1,724.65 (13) (14) 1,724.65 77.62 77.62 >>BE SUAETO_.ALL__GIIIIl__8lDItAIlD~_<< Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 405 Orchard Lane CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 77.62 Total Credtts (A + B + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty (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 1 + Une 3 is greater than Line 2. enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 77.62 (SA) (5B) 77.62 ,.,~J ;<\;iiI1\;j^':;'~~~;., 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;.................n............................................................. ~ B ~: ~:::~ :;e~~:~:~s~~~~:;:~.~~~~~.~~.~..~~.~..~.~~~~_~.~~~~~~~.~~~.~~.~~_~~~~:~~~~.............................~~::::::::::..:~~~... 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? ............. .... ...................................................................................................... 0 o o ~ ~ ~ 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 ALE IT AS PART OF THE RETURN. Under penalties 01 perjury, I declare that I have examined this retum, 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. SIGt\l"TUAE OF PEA9 AESPQNS18lE FOR FlUNG RETURN ADDRESS ~F. Sb ba..v.p,JJrr. ~ 35 East High Street, Suite 203 A Carlisle, PA 17013 SIGNATURE OF EAs6N RESP 16 FOR FliNG RETURN ADDRESS OATE 7/ Z //(j:)" DATE AOORESS 35 E. High Street, Suite 203 Carlisle, P A 17013 //?:ft~ For dates 01 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 01 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}l. The statute does not exemot a transfer to a surviving spouse from tax, aoo 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 01 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 12QIQ (72 P .8. ~9116 (a) (1.3)1. A sibling is deiined, under Secti()n 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Crumlich, Mary Elizabeth FILE NUMBER 21 - 05 - 00495 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 NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 1,739.65 Bureau of Unci aim Property, Met Life demutilization stock value. This check dated July 13,2005 was just received. Copy attached. Please waive interest and penalties. TOTAL (Also enter on Line 5, Recapitulation) 1,739.65 *' SOEU.EH R.J\IERAL EXPENSES & ACIVINSTRA11VE lU:) I::; COMMONWEAL T\1 Of PENNS'fL'VANlA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Cmmlich, Mary Elizabeth FILE NUMBER 21 - 05 - 00495 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Register of WilIs, filing Supplemental Return. 15.00 TOTAL (Also enter on line 9, Recapitulation) 15.00 . 9 9 6 C L ~ 0 0 000 e s . 111"'''''1\1\1111\11\\1\ 0"'00 '" )>CJ'l.'Q::O . ::om C lJ'\ !::I:(Il;;:: 0 (Il_:I:r- r-GlC- -.J m:I:Qo D;I (Il~:I: ... ~~~ ... '" ~ lJ'\ 00 """,,,.111 lJ'\ ". r-m '" ~ moo . .... ,,-\ - 0 ....~ .'. ~ 0 '" ::Om ~ ;0 ... ;;::-n ~ Z 0 ... r ru ru - .. ... ru ... .JJ lJ'\ ~ DJ r -.J :;, 1; -< o c g . ~ c.:t _",. rn ~;:? ~ ~ :~); g gf~~~ ~ ?g :5 {~ Q) o ",/" 0 g -~<'[ ~ ali . ~;: ~ ~_:,',~_i ~~ Gl <.-1 21:;; :!i,'" '~,~ m ,t:k,~ ~~ ~\~ my,~ ()- Q ";",J!? jt,tl ,,- '" .111 '" ._-, '--i~ ---:+'fi~ ;t,;;--">' n ,;.,_,':::::":jS,,:, :t. :,_:_:r~-, 0 ~\f' ~ ! ~~ ." 3 ClO !1 fJ'I 0)> 2'3 o c :I ... . o o " 0 g g d --I :I: m o ~ o " < S:;~ ~ z~ ';j s: 0 ~ en Z is ~~ i Z "U ",-- ~- )> . ". s:- '-.-:J~::;,:;: '-';"1' 't .,'.:;,:~:::{'-' err .;.3':,": -;lj--- t.- _ -0- . _-_.::0 _ .-- l; f-.- -fh ... ... ... ... ... ... < ... 0 ... 6 ... ~ ... 0 .... .. " " ~ ..... ~ :; ;;; = g m --- '" 0 0 . ~ 0 .,. '" '" fJ'I . 9 9 6 C L ~ 0 0 0 0 0 c S . 1\'"\"~II\'\lI\I\I\II"I\ ~~ Sl ClO z .... ~ .... ~U\ fJ'I '" ... ..... ~ ... '" STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mary E. Crumlich Date of Death: May 16, 2004 Admin. No. 21-04-0495 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to NO.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. approvals of Clerk of the Copies of receipts, releases, joinders and formal or informal accounts may be filed with the Orphans' Court and may be attached to this report. Date: October 17, 2005 Shughar , J. . Court I. 373 35 East High Street, Suite 203 Carlisle, PA 17013 (717) 241-4311 Counsel for Personal Representatives " ! '('I -'-'y 91 :i; I)) ..,J 81 1JO SOUl ,".', 1.\, -'n :V'L.1.'0."-'( ::'1"-"-' -v ..JVU...JU JJl...JbuJ:d ~t BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 1",r-,,,.,,,.,,,,r-;: (-~-:-:;@rIC'E OF INHERITANCE TAX ::-u'.); 'A;PR'AISEHENT, ALLOWANCE OR DISALLOWANCE 'OFDEDOCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (06-05) 10-10-2005 CRUMLICH 05-16-2004 21 04-0495 CUMBERLAND 501 APPEAL DATE: 12-09-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~~!_~~9~~_!~!~-~!~~------~___~~!~!~_k9~~~_~g~!!9~_E9~_yg~~_~~~g~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARY E FILE NO. 21 04-0495 ACN 501 ~.: "] DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN MARY E r..- DALE F SHUGHART STE 203 35 E HIGH ST CARLISLE JR ESQ PA 17013 ESTATE OF CRUMLICH DATE 10-10-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 1.739.65 .00 .00 (8) NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 1,739.65 (9) (10) 15.00 .00 (11) (12) (13) (14) 15 00 1,724.65 .00 1,724.65 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal 16. Anount of Line 14 taxable at 17. Anount of Line 14 at Sibling 18. Anount of Line 14 taxable at 19. Principal Tax Due TAX CREDITS: rate Lineal/Class A rate rate Collateral/Class B rate (15) (16) (17) (18) .00 X 1,724.85 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 77 .62 .00 .00 77 .62 ,,~..~.... (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-20-2005 CD005599 .00 77 .62 TOTAL TAX CREDIT 77 .62 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUECIN\ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 'W.,