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HomeMy WebLinkAbout02-0249Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Mary E. Wentzel No. 21-02-249 also known as Gary Fleisher Petitioner(s), who is/are 18 years of age or older, apply(ies) for: , Deceased Social Security No. 164- 50 - 0038 (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 10/14/1 980 and codicil(s) dated None Helen M. Fleisher died named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: none [] B. Grant of Letters of Administration (c.ta.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship I Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland or principal residence at Church of God Home, Carlisle County, Pennsylvania with his/her last family Decedent, then lO0 years of age, died 02/23/2002 (liststreet, number, and municipality) at Church of God Home, PA Decedent at death owned property with estimated values as follows: /If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania /If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) 100,000.00 situated as follows: none Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature IGary Fleisher 10 Hemlock Drive, Mechanicsbur~, Typed or printed name and residence PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,/,,/A~ ~_ dary F'I e i sher before me this 7t~ay of MARCH 2002 No. 21-02-249 Estate of Mary E. Wentzel Deceased Social Security No: 164-50- 0038 Date of Death: 02/23/2002 AND NOW, MARCH ], ~ , ~002 in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ~ Of Administration (c.t.a.; d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate) are hereby granted to Gary Fleisher in the above estate and that the instrument(s) dated 10/14/1980 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ 200;00 Short Certificate(s) ..... $ 24. O0 Renunciation ........ $ 5 ~ 00 Affidavits ( ) .... $ Extra Pages ( ) .... $ 3.00 Codicil ........... $ JCP Fee .......... $ 5.00 Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association /~"///x - ~// R~gister of Wills ' ~-/ Attorney: Gresory K. Richards I.D. No: 69335 Address: JAMES, SMITH, DURKIN & CONNELLY 134 Sipe Avenue Hummelstown, PA 17036 Telephone: 717/533-3280 237.00 Copyright ~) 1996 form software only CPSystems, Inc. Form RW-1 (1991) ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5096990 Name of Decedent Mary E. 2-26~2002 Dale of Issue of This Certification Wentzel Sex Female Social Security No. 164~50~0038 Date of Birth Jan. 27, 1902 Birthplace Spring Twp. , Place of Death Church of God Home Cumberland Race White ~ .. ............... uccupauon Marital! Status Widow Informant 6ary W. Name and Address of Funeral Establishment Date of Death 2~23-2002 Perry Co., PA Homemaker Decedent's Mailing Address 1984 Landisburg Road Fleisher Funeral Director Sally A. David Myers Funeral Home, Newport, PA Carlisle ....... ..pe_n_nsylvania Armed Forces? (Yes or No) No Landisburg PA 17040 Myers 17074 Interval Between Onset and Death Part I: Pad I1: Immediate Cause (a) Pneumonia (b) (c) (d) Other Significant Conditions Manner of Death Natural Accident Suicide 7 ] Homicide [] Pending Investigation [] Could not be Determined [] Describe how injury occurred: Name and Title of Certfier Douglas J. Bower M,D. Address Carlisle, PA 17013 (M.D., D.O., Coroner, M.E.) This 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. 2_~26_2002 101 Barnett St., New Bloomfield, PA 17068 105.112 REV 8;88 (FEE FOR THIS CERTIFICATE $2 00) WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. 397562'2 21-02-249 Name of Decedent 1-1q_QQ Datl~ of ~u~ of Tl~s"~erflfication Helen Lorene Fleisher First Middle Sex Female Social Security No. 191-18-3765 Last Date of Death 1 - 7 - 99 Date of Birth 6-24-1922 Birthplace Loysville, PA R.R.#1 Place of Death Hershey Medical Center Facility Name Race White Occupation Clerk/Secretary Decedent's Marital Status Married Mailing Address Informant Harold E. Fleisher Name and Address of Funeral Establishment Nickel Funeral Part I: Immediate Cause Dauphin County (a) Multiple Trauma Derrv TWD, City, B~ou~ or ~w~hip · Pennsylvania Armed Forces? (YesorNo) No R.R.#1, Box 160 Landisburo PA 17fl40 Number Street City or Town ~ State FuneralDirector Kenneth Gene Merrit~ Home, Loysville, PA 17047 Interval Between Onset and Death (b) i (c) ' (d) Part Ih Other Significant Conditions Manner of Death Natural [] Homicide [] Accident [~X Pending Investigation [] Suicide [] Could not be Determined [] Describe how injury occurred: Veh±cle vs. pedestrian Name and Title of Certfier Graham S. Hetrick Address 1205 S. 28th St., Harrisburg, PA 17111 Coroner (M.D., D.O., Coroner, M.E.) This 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~~ ~z),,,~~j 50-455  ~ocal Registrar of Vital Records District No 1-11-99 101 Barnett St.:New B]mnmfJeld= PA Date Received by Local Regi$1rer Street Address City, Borough, Township 17068 21-02-249 LAST WILL AND TESTAMENT BE IT REMEMBERED, that I, MARY E. WENTZEL, of RD 1, Landis- burg, Spring Township, Perry County, Pennsylvania, being of sound and disposing mind and memory, considering the uncertainty of life, and being desirous to settle my worldly affairs while I have strength and capacity, do make this, my Last Will and Testa- ment, hereby revoking and making null and void any and all Wills and Testaments or writings in the nature thereof by me at any time heretofore made. 1. I direct that my body be respectably interred, and that my funeral be conducted in a manner corresponding with my estate and situation in lif e. 2. I order and direct my Executors to pay all my just debts ;and funeral expenses as soon as they conveniently can do so after my decease. I direct my Executors to pay inheritance tax, State and Federal, if any be due, from the corpus Qf my estate. 3. I give and bequeath my stock in H. R. Wentzel Sons, Inc. to my nephew, Harold E. Fleisher. 4. I give and bequeath the sum of Five Thousand ($5,000.00) Dollars to David H. Wentzel. 5. I give and bequeath my Bank of Landisburg stock to Helen A9. Fleisher, she to have the income therefrom, and at her death ar at anytime she may desire, the said stock shall pass to her three sons, Gary, James and John, in equal shares. 6. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to Helen Fornwald. ?. I give to St. Peters Reformed Church, RD 1, Landisburg, Pennsylvania, the sum of Three Thousand ($3,000.00} Dollars. $. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to Dorothy Gault. 9. I give to St. Peters Cemetery Association the sum of One Thousand ($1,000.00) Dollars. 10. I give to Gary Fleisher, James Fleisher and John Fleisher, the sum of Five Thousand ($5,000.00} Dollars, each. 11. All the rest, residue and remainder of my estate, real and personal of every nature whatsoever, I give and bequeath to Harold E. Fleisher and Helen ,UI. Fleisher. Should they both pre- decease me, then the rest, residue and remainder of my estate shall pass to their children, Gary, James and John Fleisher, in equal shares. 12. I name Harold E. Fleisher and Helen M. Fleisher as Executors of this my Will. Should they predecease me, or be un- ;able to act, I then name Gary Fleisher as Executor. IN WITNESS WHEREOF I have hereunto set my hand and seal this ti, C `~ day of October, 1980. ,~,,1 l ((,~w=-i ~u ~ ,;~~,~ ~ , ( ( SEAL ) ~~ ,- ~'~.ITNESSES: r ~`~ ' ~, Register of Wills of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of Mary E. Wentzel also known as No. 21-02-249 , Deceased William S. Morrow Hazel A. Morrow (each) a subscribing witness to the r'~ codicil(s) [] will(s) presented herewith, (each) being duly qualified ~ccording to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of Testator(rix) in his/her/their presence and r~ in the presence of each other [~] in the presence of the other subscribing witness(es). RR 1 New Bloomfield, PA 17068 (Address) - v - (Signature) New Bloomfield, PA 17068 (Address) Sworn to or affirmed and subscribed before me this ~ day of (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Notarial Seal Gregory K. Richards, Notary Public · _Derry Twp., Dauphin County My commission Expires Dec. 22, 2003 NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form ~RW-;~ (1991) Register of Wills of Perry County, Pennsylvania Estate of also known as RENUNCIATION Mary E. Wentzel No. 21-02-249 , Deceased Theundersigned, Harold E. Fleisher, Nephew (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Gary Fleisher a/k/a Gary W. Fleisher WITNESS hand this day of of R.D. 1, Box 160 Landisbur~, PA 17040 (Address) (Signature) (Address) (Signature) Sworn to or affirmed and subscribed before me this day of (Address) Notary Public My Commission Expires: (signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills in some counties are required to be notarized. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-4 (1991) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. MARY E. WENTZEL February 23, 2002 '02 At'~2 15 iC! :22 G z.., Adm. No. 2002-00249 To the Register: I certify that notice of estate admhfistration required by Rule 5.6(a) of the O:phan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 11, 2002. Name Gary W. Fleisher Address 10 Hemlock Drive Mechanicsburg, PA 17055-4744 Harold E. Fleisher 1984 Landisburg Road Landisburg, PA 17040 James R. Fleisher 38 Dunkleberger Road Elliottsburg, PA 17024 John K. Fleisher 1728 Pisgah State Road Shermans Dale, PA 17090 David H. Wentzel 664 Bridgeport Road Landisburg, PA 17040 Helen Fomwald 2206 Regal Drive Wilmington, DE 19810 Dorothy Gault 1518 Chatham Road Camp Hill, PA 17011 St. Peters United Church of Christ P.O. Box 343 Landisburg, PA 17040 St. Peters Cemetery Association c/o Wayne Dingle 51 Hower Lane Elliottsburg, PA 17024 Notice has now been given to all personal entitled thereto under Rule 5.6(a) except Signature Name Address 134 Sipe Avenue Hummelstown, PA 17036 Telephone ( 717 ) 533-3280 Capacity: Personal Representative X Counsel for Personal Representative ' 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 001201 JAMES SMITH DURKIN & CONNELLY 134 SIPE AVENUE HUMMELSTOWN, PA 17036 ........ fold ESTATE INFORMATION: SSN: 164-50-0038 FILE NUMBER: 2102-0249 DECEDENT NAME: WENTZEL MARY E DATE OF PAYMENT: 05/22/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 02/23/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $230,000.00 REMARKS: GARY FLEISHER C/O JAMES ETAL TOTAL AMOUNT PAID: $230,000.00 SEAL CHECK//105 INITIALS: VZ RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 II cAPB c~AC k-~TK "-ES Co. REV-1500 NHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'SNAME(LAST FIRST.ANDMIDDLEINITIAL) Wentzel Mary E. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) I 02/23/2002 01/27/1902 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)  1. Original Return ~ 247! Supplemental Return 4, Limited Estate · Future lnterest Compromise (date of death after lZ.1Z_82) 6, Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) r~ 9. Litigation Proceeds Received ~-] 10. SpousaIPoverty Credit (date of death between 1Z-31-91 and 1-1-95) NAM E Gregory K. Richards Esq. FIRM NAME (If Applicable) JAMES, SMITH, DURKIN & CONNELLY, TELEPHONE NUMBER 717,/533 - 3280 LLP R 5. E C A 6. P I T U 7. L A T 8. I O 9. N 10. 11. 12. 13. 14. C O M Real Estate (Schedule A) (1) Stocks and Bonds (Schedule B) Closely Held Corporation, Partnership or (3) Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property ($) (Schedule E) Jointly Owned Property'(Schedule F) (6) ['~ Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) OFFICIAL USE ONLY FILE NUMBER 21-02-0249 COUNTY CODE YEAR N U M BER SOCIAL SECURITY NUMBER 164-50-0038 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER = (date.of death ~, 3. Remainder Return prior To 12-13-o4) 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) 17036 COMPLETE MAIL(NG ADDRESS 134 Sipe Avenue Hummelstown, PA None 563,669.98 291,800.00 33,386.34 27,143.12 100,000.00 620,131.14 73,669.36 828.59 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY (8) 1,636,13.0.58 (11). 74,497.95 (lZ) 1,561,632.63 (13) 4,000.00 (14) 1,557,632.63 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES T PU 15. Amount of Line 14 taxable at the spousal tax A X I rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) T 16. Amount of Line 14 taxable at lineal rate X .0 45 (16) OII 17. Amount of Line 14 taxable at sibling rate X .12 (17) N I 18. Amount of Line 14 taxable at collateral rate 1,570,140.35 X .15 (18) 235,521.05 / 19. TaxDue ...... (19) 235,521.05 Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-150~ Decedent's Complete Address: STREET ADDRESS 1984 Landisburg Road CITY Landisbur~ Tax Payments and Credits: STATE PA ZIP 17040 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 230,000.00 11,776.05 Total Credits ( A + B + C ) (2) (1) 235,521.05 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................ ~ ~ b. retain the right to designate who shall use the property transferred or its income; .......... c. retain a reversionary interest; or .................................... d. receive the promise for fe of either payments benefts or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r-] I-~ 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, 241,776.05 6,255.00 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 Gary Fleisher DATE · 'J _--. ,-'"-'h Mec han i c S-I~--~; - ~p~ - - ~.-f(~.~- .................... SIGNAT['I'I~rEOI~PREPAI~ROTHE~THANREPRESENTATIVE J~ES, SMITH, DURKIN & CO~ELLY, LLP ~~-- ~ / ( /~ ~ 134 Sipe Avenue ~ ~ · .. ~ ~. E~e[s~o~, ~A [7036 ...................... /[ ~ ~ Fo~date~ death on or a~er July 1, 1994 and before. Ja~ua~ 1 1995, the tax r;te' i~P;sed' 0~ the ne[ va~ue ;~ ~r;n;~e .................... surv~pouse is 3% [72 P.s. 9116 (a) (1.1) (i)]. rs to or for the use of the For dates of death on or after Janua~ 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 statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficial. For dates of death on or aher July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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. Copyright (c) ZOOO form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX + (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Mary E. Wentzel SSf/ 164-50-0038 02/23/2002 21-02-0249 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNITVALUE OF DEATH 1 18,441.555 shares American Express - Mutual Fund 4.827397 89,024.71 #01127689390 3 002; Held in decedent's name individually 2 87,947.5 shares American Express Mutual Fund 1.00 87,947.50 #01137689390 2 002; Held in decedent's name individually 3 808 shares Harsco Corp, CUSIP #415864107 - traded on 35.8325 28,952.66 the NYSE, common; held in IMA account at American Express in decedent's name individually 4 2,760 shares Honeywell Inc, CUSIP #438506107 traded 35.2075 97,172.70 on the NYSE, common; held in IMA account with American Express in decedent's name individually 5 1,375 shares Pfizer Inc, CUSIP #717081103 traded on 40.8675 56,192.81 the NYSE, common; held in IMA account with American Express in decedent's name individually 6 538 shares PNC Bank Corporation, CUSIP #693475105 54.1175 29,115.22 traded on the NYSE, common; held in IMA account with American Expess in decedent's name individually 7 511 shares SBC Communications Inc, CUSIP #78387G103 - 36.8525 18,831.63 traded on the NYSE, common; held in IMA account with American Express in decedent's name individually 8 $90,000 West Shore PA Area HSP, 6.15%, matures 1/1/2021 89,100.00 value of close of business on 2/22/2002 based on a bid of $99.00 9 $90,000 West Shore PA Area HSP, 6.15%, matures 1/1/2021 924.75 - accrued interest on bond 10 17 US Series HH and H Savings Bonds 43,500.00 11 5 US Series E $1,000 Savings Bonds 3,750.00 Accrued interest on item 11 to date of death 19,158.00 TOTAL(Alsoenteronline2, Recapitulation) 563,669.98 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1503 EX (Rev. 1-97) R,EV-~S04 EX+/1-97) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PARTNERSHIP or SOLE-PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF Mary E. Wentzel SS~/ 164-50-0038 02/23/2002 FILE NUMBER 21-02-0249 Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH limited 80,400.00 Fleisher Family Limited Partnership Decedent's 12% partnership interest (See attached appraisal letter) WF Family Limited Partnership Decedent's 38.174% 211,400.00 limited partnership interest (see attached appraisal) TOTAL (Also enter on line 3, Recapitulation) $ 291,800.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1504 EX (Rev. 1-97) R[~V-'1507 EX * (1-97) SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E. Wentzel SS~/ 164-50-0038 02/23/2002 21-02-0249 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 H R Wentzel Sons, Inc. Demand Note - Dated 2/29/1965 H R Wentzel Sons, Inc. Demand Note - Dated 1/1/1983 Accrued interest on items 1 and 2 28,000.00 5,000.00 386.34 TOTAL (Also enter on line 4, Recapitulation) $ 33,386.34 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1507 EX (Rev. 1-97) R.EV-'1508 EX + {1-97/ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E. Wentzel SS# 164-50-0038 02/23/2002 21-02-0249 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 5 2001 U.S. Income tax refund - applied Church of God - personal cash account Church of God - nursing home refund The Bank of Landisburg Checking Account #0617571; 2/10/1992 Accrued interest on item 4 to date of death The Bank of Landisburg - Certificate of Deposit opened 01/04/01 Accrued interest on item 5 to date of death The Patriot News - subscription refund opened #700010723; TOTAL (Also enter on line 5, Recapitulation) $ 345.00 66.67 3,724.50 2,795.72 8.02 20,000.00 194.61 8.60 27,143.12 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software onty CPSystems, ~nc. Form REV-1508 EX (Rev. 1-97) REV-{509 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Wentzel SS# 164-50-0038 02/23/2002 FILE NUMBER 21-02-0249 Co Ifanassetwas madejointwithinoneyearofthedecedent'sdate ~ death, itmustberepo~edonScheduleG. SURVIVINGJOINTTENANT(S)NAME ADDRESS RELATIONSHIPTO DECEDENT David H. Wentzel 664 Bridgeport Road Nephew Landisburg, PA 17040 JOINTLY-OWNED PROPERTY: LE~ ~EH DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identi~ing number. DATE OF DEATH DECD'S VALUE OF NUMBER' TENANT JOINT Attach deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 A 12/14/45 Real estate situate at 60,000.00 50.00% 30,000.00 Spring Township, Landisburg, Perry County, Pennsylvania 72 acres Joint with nephew, David Wentzel; Tenants in Common Sale value of 1/2 interest (see attached Agreement of Sale) 2 A 12/14/45 Real estate situate at R.D. 134,000.00 50.00%~ 67,000.00 !#2, Greenbriar Road, Elliotsburg, Perry County, Pennsylvania; 58 acres - Joint with nephew, David Wentzel; Tenants In Common; Sale value of 1/2 interest (See attached Agreement of Sale) 3 A 12/14/45 Real estate situate at Warm 6,000.00 50.00% 3,000.00 Springs Road, Spring township, Perry County, Pennsylvania; 8.7 acres Joint with nephew, David Wentzel; Tenants in Common; Sale value of 1/2 interest (see attached Agreement of Sale) TOTAL(Alsoenteronline6, Recapitulation) $ 100,000.00 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) .~v-~s~0 EX,(~-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPER'I~ RESIDENT DECEDENT ESTATE OF Mary E. Wentzel SS# 164-50-0038 02/23/2002 FILE NUMBER 21-02 -0249 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 % OF ITEM INCLUDE THE NAME OF THE TRANSFERE~THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER, NUMBER ATTACH ACOPYOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 Gifts to the Fleisher 582,900.00 100.00%. 9,000.00 573,900.00 Family Limited Partnership dated within 1 year of death; 3 gifts of 29% interest in limited partnership to: Gary W. Fleisher James R. Fleisher John K. Fleisher 29% = $194,300.00 (see attached schedule) 2 Gifts to the WF Family Limited 64,231.14 100.00% 18,000.0C 46,231.14 Partnership - dated within 1 year of death; 6 gifts of 1.9% interest in limited partnership to: Carol H. Fleisher Charlotte K. Fleisher Susan K. Fleisher Gillian D. Hayden Thomas B. Fleisher Harold E. Fleisher TOTAL(Alsoenteronline7, Recapitulation) $ 620,131.14 (If more space ~s needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) REV~'1511 EX + (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E. Wentzel SS~/ 164-50-0038 02/23/2002 21-02-0249 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 David M. Myers Funeral Home - funeral bill 1 2 3 4 5 6 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Gary Fiei sher Social Security Number(s) / ElM Number of Personal Representative(s) Street Address l0 Hemlock Drive City Mechanicsbur~ State PA Year(s) Commission Paid: __Zip 17055 Attorney's Fees JAMES, SMITH, DURKIN & CONNELLY, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Bank of Landisburg - charge for checkbook with checks Cumberland Law Journal estate notice L.W. Brodisch Real Estate - fee for appraisals on three lots The Patriot News estate notice Value Management, Inc. - valuation fee for Fleisher Family LP Seligman, Friedman & Company, P.C. valuation fee for WF Family Limited Partnership 8,421.68 Copyright (c) 1996 form software only CPSystems, Inc. (If more space is needed, insert additional sheets of the same size) 25,000.00 25,000.00 237.00 14.25 75.00 975.00 108.43 11,338.00 2,500.00 TOTAL (Also enter on line 9, Recapitulation) $ 73,669.36 Form REV-1S11 EX (Rev. 1-97) Estate of: Mary E. Wentzel Soc Sec #: 164-50~0038 Date of Death: 02/23/2002 Continuation of Schedule H-B1 (Personal Representative's Commissions) Item Description Amount 1 Gary Fleisher Executor commission 25,000.00 25,000.00 Estate of: Mary E. Wentzel Soc Sec #: 164-50-0038 Date of Death: 02/23/2002 Item Description Continuation of Schedule H-B2 (Attorney's Fees) Amount James, Smith, Durkin & Connelly, LLP attorney fees 25,000.00 25,000.00 Estate of: Mary E. Wentzel Soc Sec #: 164-50-0038 Date of Death: 02/23/2002 Item Description Continuation of Schedule H-B4 (Probate Fees) Amount Register of Wills probate fee 237.00 237.00 REV- 1{; 1Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Wentzel SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 164-50-0038 02/23/2002 FILENUMBER 21-02-0249 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 2 3 Brockie Pharmatech - final drug bill PA Department of Revenue 2001 State Income Tax Robert W. Morris & Co., P.C. - 2001 income tax preparation charge TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 443.59 150.00 235.00 828.59 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) , REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Wentzel SSf/ 164-50-0038 NUMBER 4 II. SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 02/23/2002 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116~)(1.~] Gary W. Fleisher 10 Hemlock Drive Mechanicsburg, PA 17055 Harold E. Fleisher 1984 Landisburg Road Landisburg, PA 17040 James R. Fleisher 38 Dunkleberger Road Elliottsburg, PA 17024 John K. Fleisher 1728 Pisgah State Road Shermans Dale, PA 17090 Grand Nephew Nephew Grand Nephew Grand Nephew FILE NUMBER 21-02-0249 AMOUNT ORSHARE OFESTATE $5,000 100% of residue $5,000 $5,000 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLEAND GOVERNMENTALDISTRIBUTIONS St. Peters United Church of Christ - specific bequest: United Church of Christ, P.O. Box 343, Landisburg, PA Tax-exempt no. 75-19758-1 St. Peters 17040, St. Peters Cemetery Association - specific bequest to St. Peters Cemetery Association, c/o jason Twigg, Treasurer, 3665 Pleasant Valley Road, Elliotsburg, PA 17024 EIN: 23-2270998 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 3,000.00 1,000.00 $ 4,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Estate of: Mary E. Wentzel Soc Sec #: 164-50-0038 Date of Death: 02/23/2002 Continuation of Schedule J, Part I (Taxable Bequests) Item Name and Address of Beneficiary Relationship Amount or Share of Estate 5 6 Helen Fornwald 2206 Regal Drive Wilmington, DE 19810 Dorothy Gault 1518 Chatham Road Camp Hill, PA 17011 David H. Wentzel 664 Bridgeport Road Landisburg, PA 17040 Niece Niece Nephew 1,000.00 1,000.00 5,000.00 EXHIBIT 1 WF FAMILY LIMITED PARTNERSHIP EIN: 25-1847220 Gifts as of January 1, 2002 Total Combined Valuation Discounts = 31.74% Total Value of Assets owned by the WF Family Limited Partnership as of 1/1/02 = $825,418.81 Limited Parmership Interests gifted to each applicable donee = 1.9% 1.9% Limited Partnership Interest = $10,705.19 (after application of discounts) 1. Gifts of 1.9% Limited Partnership Interest made to: Harold E. Fleisher Carol H. Fleisher Charlotte K. Fleisher Susan K. Fleisher Gillian D. Hayden Thomas B. Fleisher (1.9% x $825,418.81 x 68.26% = $10,705.19) EXHIBIT 2 FLEISHER FAMILY LIMITED PARTNERSHIP EIN: 25-1900549 Girls as of January 1, 2002 1% interest = $6,700.00 per attached appraisal 29% Limited Partnership Interest = $194,300.00 (after application of discounts) (29 x 6700 = $194,300.00) 1. Girls of 29% Limited Partnership Interest made to: John K. Fleisher Gary W. Fleisher James R. Fleisher (29 x $6,700.00 = $194,300.00) Register of Wills of INVENTORY County, Pennsylvania Estate of Mary E. Wentzel also known as , Deceased No. 2002-00249 Date of Death.. 02/23/2002. Social Security No. 164- 50- 0038 Gary Fleisher, Personal Representative(s) of the above Estate, deceased, ver~y that the iterns appearing Jn the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Gregory K. Richards Esq. 69335 Address: 134 Si?e Avenue Hummelstown, PA 17036 Telephone: 717/533-3280 Personal Representative Signature: Address: 10 Hemlock Drive Mechanicsbur~, PA 17055 Telephone: 717/697- 3141 Dated: Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value Total: 915,999.44 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Sar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) Estate of: Date of Death: County: Mary E. Wentzel 02/23/2002 Perry INVENTORY CASH: 2001 U.S. Income tax refund - applied Accrued interest on Savings Bonds 345.00 19,158.00 Church of God - personal cash account Church of God - nursing home refund Accrued interest on Demand Notes 66.67 3,724.50 386.34 The Bank of Landisburg - Checking Account #0617571; opened 2/10/1992 Accrued interest through date of death Accrued interest through date of death The Bank of Landisburg - Certificate of Deposit #700010723; opened 01/04/01 The Patriot News - subscription refund 2,795.72 8 . 02 194.61 20,000.00 8.60 46,687.46 -1- STOCKS/LISTED: 18,441.56 shares American Express - Mutual Fund #01127689390 3 002; Held in decedent's name individually 87,947.50 shares American Express Mutual Fund #01137689390 2 002; Held in decedent's name individually 808.00 shares Harsco Corp - traded on the NYSE, common; held in IMA account at American Express in decedent's name individually 2,760.00 shares Honeywell Inc - traded on the NYSE, common; held in .IMA account with American Express in decedent's name individually 1,375.00 shares Pfizer Inc traded on the NYSE, common; held in IMA account with American Express in decedent's name individually 538.00 shares PNC Bank Corporation - traded on the NYSE, common; held in IMA account with American Expess in decedent's name individually 511.00 shares SBC Communications Inc - traded on the NYSE, common; held in IMA account with American Express in decedent's name individually 89,024.71 87,947.50 '28,952.66 97,172.70 56,192.81 29,115.22 18,831.63 407,237.23 -2- BONDS: $90,000 West Shore PA Area HSP, 6.15%, matures 1/1/2021 - value of close of business on 2/22/2002 based on a bid of $99.00 Accrued interest on muni bond 17 US Series HH and H Savings Bonds 5 US Series E $1,000 Savings Bonds 89,100.00 924.75 43,500.00 3,750.00 PARTNERSHIP INTEREST: Fleisher Family Limited Partnership Decedent's interest in partnership WF Family Limited Partnership Decedent's interest 38.174% with a 30% discount; Partnership worth $795,570.41 80,4O0.00 211,400.00 137,274.75 MORTGAGE/NOTE RECEIVABLE: H R Wentzel Sons, Inc. Demand Note - Dated 2/29/1965 H R Wentzel Sons, Inc. Demand Note - Dated 1/1/1983 28,000.00 5,000.00 291,800.00 33,000.00 -3- STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARY E. WENTZEL Date of Death: February_ 23.2002 Will No. Admin. No. 2002-00249 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: State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: December 31. 2003 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 b. The separate Orphan's 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 No Date: d. 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~. 2-- ~ / Sign Gre~0trv~~rards. Esouire JAMES. SMITH. DURKIN & CONNELLY :5:5 134 Sipe Avenue Hummelstown. PA 17036 (717) 533-3280 Capacity: X Personal representative Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX GREGORY K RICHARDS JANES ETAL 154 S[PE AVE HUMNELSTOWN PA 17o3d DATE 12-50-2002 ESTATE OF WENTZEL DATE OF DEATH 02-25-2002 ~ .' . FILE NUMBER 21 02-0249 COUNTY CUMBERLAND ACM 101 I Amount Remitted REV-1547 EX AFP (01-05) NARY E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA I7015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS -~ REV-lB47 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WENTZEL MARY E FILE NO. 21 02-0249 ACN 101 DATE 12-50-2007 TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Rea! Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) C2) $. Closely Held Stock/Partnersh/p Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposlts/Misc. Personal Property CSchedu/e E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) CIO) 11. Total Deductions 12. Net Value of Tax Return .00 B65r669.98 291r800.00 27r145.12 lOOrO00.O0 620r151.14 75,669.56 MOTE: To insure proper credit to your account, submit the upper port/on of this form with your tax Payment. 15. 14. NOTE: 1,656,150.58 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 16. Amount of L/ne 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of L/ne 14 taxable at Collateral/Class B rate 19. Principal Tax Due RECEIPT DISCOUNT (+) NUMBER INTEREST/PEN PAID (-) CDO01201 11,682.25 TAX CREDITS PAYMENT DATE 05-22-2002 AMOUNT PAID 250,000.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 241,682.25 8,057.55CR c IF TOTAL DUE IS LESS THAN 41, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) C13) 4,000.00 Net Value of Estate Sub3ect to Tax C14) 1,557,652.65 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111 reflect figures that include the total of ALL returns assessed to date. .00 .00 .00 255,644.90 255,644.90 ASSESSMENT OF TAX: 15. Amount of L/ne 14 at Spousal rate C15) .00 X O0 = (].6) .00 x 045 = (17) . O0 x 12 = c18). 1,557,652.65 x 15 = C19)= 828.59 c11) 74,~97.9~ c12) 1,561,652.65 REV-1470 EX (6-88) '~  INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OF CHANGES DEPT, 280601 HARRISBURG~ PA 17128-0601 DECEDENTS NAME Wentzel, mary E, FILE NUMBER REVIEWED BY 2102-0249 Daniel Heck ACN 101 ~fl=M SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ROW Page 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA ]7128-0&0] GREGORY K RICHARDS ;!' JAMES ETAL I$4 SIPE AVE HUMMELSTOWN ~ 17056 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN FILE NUMBER COUNTY ACN DATE 12-30-2002 ESTATE OF WENTZEL MARY DATE OF DEATH 02-23-2002 21 02-0249 CUMBERLAND 201 Amount Remitted HAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~' RETAIN LOWER PORTION FOR YOUR FILES "~ REV-483 EX AFP C01-03) ~ NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ** ESTATE OF WENTZEL MARY E FILE NO.21 02-0249 ACN 201 DATE 12-30-2002 ESTATE TAX DETERMINATION 19~887.06 1. Credit For State Death Taxes as Verified 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 221t962.65 Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 5. Pennsylvania Estate Tax Due TAX CREDITS: PAYMENT DATE RECEIPT NUMBER ~IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEI .00 INTEREST AND PEN. J .00 TOTAL DUE J .00 CIF TOTAL OUE IS LESS THAN 41, NO PAYMENT IS REQUIRED IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 221t962.65 .00 BUREAU OF TNDZVTDUAL TAXES TNHERTTANCE TAX D/Y/SION DEPT. 280601 HARRTSBURG, PA 17128-0601 GREGORY K RICHARDS JAHES ETAL 154 SIPE AVE HUNNELSTOWN PA 170S'6 COHHONWEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT DATE 01-27-2005 ESTATE OF WENTZEL DATE OF DEATH 02-25-2002 ..-, ~ FILE NUMBER 21 02-0249 '~COUNTY CUMBERLAND ACM 101 Amoun~ RE¥-1607 EX AFP NARY E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~o :your eccoun~, submi~ ~he upper por~:ion of ~his form wi~h :your ~:mx pe:ymen~:. CUT ALONG THIS L/NE ~ RETAZN LOWER PORT'tON FOR YOUR RECORDS REV-1607 EX AFP (01-03) #N# TNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF WENTZEL NARY E FZLE NO. 21 02-0249 ACM 101 DATE 01-27-2003 THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELON ZS A SUMMARY OF THE PR/NCKPAL TAX DUE, APPLKCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, /F APPLKCABLE, A PROJECTED INTEREST F/GURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-25-2002 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 233,644.90 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-22-2002 CD001201 11,682.25 01-09-2005 REFUND .00 250,000.00 8,057.55- KF PAKD AFTER THIS DATE, SEE REVERSE SKDE FOR CALCULAT/ON OF ADDKTKONAL /NTEREST. ( KF TOTAL DUE /S LESS THAN $1, NO PAYMENT KS REQUKRED. ZF TOTAL DUE KS REFLECTED AS A "CREDKT" (CR), TOTAL TAX CREDIT 233,644.90 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR /NSTRUCTZONS. ) BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DZVTSZON DEPT. 280601 HARRISBURG, PA Z71Z8-0601 GREGORY K RICHARDS JANES ETAL 154 SIPE AVE HUHHELSTOWN PA 17056 COHHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE 02-09-2004 ESTATE OF HENTZEL HARY E DATE OF DEATH OZ-ZS-ZOOZ FILE NUMBER COUNTY ACN 21 02-0249 CUMBERLAND 2O2 Amoun'l: Romi~ed REV-TS,S EX AFP C01-0~) HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To Ansure proper credi~ ~o your account, submA~ ~he upper portion of ~his form ei~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR FILES REV-736 EX AFP (01-02) #" NOTICE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~. ESTATE OF HENTZEL MARY E FILE N0.21 02-0249 ACN 202 DATE 02-09-2004 ESTATE TAX DETERHZNATZON Credit For State Death Taxes as Verified Pennsylvania Inher/tance Tax Assessed (Excluding Discount and/or Interest) Inheritance Tax Assessed by Other States or Territories of the Un/ted States (Excluding Discount and/or Interest) 4. Total Inheritance Tax Assessed 221,962.65 .00 5. Pennsylvan/a Estate Tax Due Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return TAX CREDITS: Add/tiona! Pennsylvania Estate Tax Due PAYNENT DATE RECEIPT NUMBER i DISCOUNT (+) INTEREST/PEN PAID (-) ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) 19,887.96 221~96Z.65 .00 .00 .00 -°°l .00 .00 .00 STATUS REPORT UNDER RULE 6.17 Name of Decedent: MARY E. WENTZEL Date of Death: Will No. February 23, 2002 Admin. No. '04 FEB 17 P2:02 2002_0~¢berland Co., PA 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: 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: Date: 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 rphan s Court No. (if any) for the O ' personal r ' ' epresentat~ve s account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. 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 DIETTERICK& CONNELLY, LLP J ~A~I. ,~E S, S~}~;i~H, DI: 134 '~Oe Avenue Hummelstown, PA 17036 ~717) 533-3280 Capacity: Personal representative Counsel for personal representative X