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03-0334
PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills for the , Deceased. County of ('"~.,,,~'g,t.-/f~r~ in the Social Secarity No. _1 -7 ~ -t~ -/a .~-S- 7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner{s), who is/are 18 years of age or older an the execul ;ax/.?<,. named in the last will of the above decedent, dated /'o// ~///? %,/ , 19.__ and codicil(s) dated (state relevam circnmstances, e.g. renunciation, death o1' executor, etc.) Decendent was domiciled at death in CO ,44 ~,£ & z_ A-~c~ 0 County, Pennsylvania, with h. ~'R_ last family or principal residence at /t'Id--[}o/h e-4-/? ~ r't v g.~t ~¢ (list street, number and muncipality) Decendent, then of.q, years of age, died ,~,/v 5/_~ ~, o .z<. ,19_ , at ,,'~.'~NO'?-- ~.-'¢R,~ ~ v t~c / m d- q~ ~ £1,~ 4~ t~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted 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 $ / ~'~629o~ (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters "/-~'3 theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) =~ 3~'+q Cw,~B~L~No Fx~y OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF ~_'0_dL3__£t2~/i-~t0 ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ ~ befog--his /ff ~ day of ~O ~ & ~. ~ K, ff ~ ~/ ~' Register ~ ~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Name of Decedent: Catherine L. Miller Date of Death: September 18, 2008 File Number: ~ ~' O ~ - ~ ~ ~3 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of tl~e', administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................. ~ Yes ®No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ' January 31, 2011 ' 3. If the answer to No. 1 is YES, state the following: a. Did the rsonal re resentative file a final account with the Court? ..... . ~ p ~ ~ ^ Yes.. _0 No b. The se crate _ _ __ __ ....__ _M P 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 ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal filed with the Clerk of the Orphans' Court and may be attached to this red c ~ ~ c.~ aD O C. _-~ :: ~ ~-- ~ C.a n- ~ C~ C7 ~, U ~ ~ ~~o ~=- ~.~ Cam. c °3 V "1.. C Q N ~ ~: Form RW-10 rev. 10.13.06 may be 7-0 -^ - r - . ..............a ..w i yr m Capacity: ~ersonal ARepresentativ~e ~ ]Counsel ~r,An~n,Ca 4 I rli 11 ~ r' Name of Person Filing this Form ~ ~ _ I c S~.. 1 ~~ Address Telephone i ~ __ No. 21-03-0334 Estate Of CATWARINE L. MILLER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 15 ~ ~ 2003.., in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated OCTOBER 11, 1994 described therein be admitted to probate and filed of record as the last will of CATHARINE L. MILLER ; and Letters TESTAMENTARY are hereby granted to DONNA L. GRIFFIN xeg~s~er of Wills FEES Probate, Letters, Etc .......... $. 50.00 Short Certificates(2) .......... $ 6.00 ^'rrORNE¥ (Suo. Ct. I.D. JCP $ 10.00 ADDRESS TOTAL __ $ 81.00 Filed . .A .P .R. I. L. . .1.5. ,. . .2 .0.0.3. ................. PHONE CALLED EXECUTRIX APRIL 15, 2003 ~O~:~P,~-V ~ WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR iFEE FOr~'U!S TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. CER¥IFICA FE 32 Of;' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5 2 4 Z 9 7 9 ' "' ' ,,i~.,,7 9-05-02 ~.. ..~'r D .... '' ..... f This Certification Name of Decedent m~m~'r~,'rE - ' --'--'L"~i'-' ' Sex ____E_E, MAL.E___ Social Security No. 1 79-1 ?_.-6~7 Date of Death 9-0_3-02 Date of Birth 10-29-0V Birthplace P~-~.T$¥T_.V~_NTA Place of Death M~O_RC_~_?_~ ~3_RSI~G & _~_~_~_~ C'_T__T~.i~T_,~]~"r~ (?_ATvI'P ~TT,T, Pennsylvania Race __W}-T_ !TE __Occupation ICd~ORER Armed Forces? (Yes or No) NO Decedent's Marital Status ___~__ Mailing Address ~.700 Nr~ET S"PR~..~..m P. ANI'P T-TTT,T._ PA Informant _PM3 _NTN__A G?TFFTN Funeral Director I'CRIRT'FN'E M. BOSTZAN Name and Address of Funeral Establishment BOYER FT_~_.']"I~-~_'Z~T_.~, HOME 144 "~._ _T'{_TGT-T Interval Between Part I: Immediate Cause Onset and Death (a) A T ,~.T--TE TM~.R.q (b) (c) (d) Pad Ih Other Significant Conditions Manner of Death Describe how injury occurred: Natural ~ Homicide [] Accident ~ Pending Investigation [] Suicide [] Could not be Determined [] Name and Title of Certfier MARYJO SZADN: M.D (M.D., D.C., Coroner, M.E.) Address 381 S. FRONT STREET STEELTON 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 9-05-02 25 IRIS CIRCLE ELIZABETHTOWN 21-03-334 LAST WILL AND TESTAMENT OF CATHARINE L. MILLER I, CATHARINE L. MILLER, of Borough of Elizabethtown, County of Lancaster, Ponnsy!vani~, do make~ publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executor out of the property passing under ITEM IV of this Will, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. I direct that I be buried in the family cemetery plot located in Greenwood Cemetery, Tower City, PA. ITEM III: (a) I devise and bequeath all my household goods, personal property, and jewelry to my daughters, JEAN HELFRICH, and DONNA GRIFFIN, as they may choose in equal shares, per stirpes. In the event either daughter predeceases me, their share shall be divided equally among their issue, per stirpe~. (b) I further indicate that I have been acting as decision maker relative to Administration of the family plots existing at Greenwood Cemetery. These plots exist pursuant to the deed of Lloyd Schoffstall (Section B, Lot 8, Row 8); of Mrs William Howard (Section B, Lot 8, Southhalf, Row 7); and of Carrie R. Hess (Section F, Lot 23, Northhalf, Row 6). I appoint my Executor to take all responsibilities and make all future decisions relative to these cemetery plots including but not limited to, decisions concerning persons to be buried there and the practices of perpetual care. ITE! IV: I devise and bequeath all ~he rest, residue and remainder of my estate in equal shares to my children, JEA! R. HELFRICH, DONNA L. GRIFFIN, ROBERT I. MILLER and EROW E. M2LLER. In the event either child shall predecease me or, in the event he or she does not survive me by thirty (30) days, his or ~er share shall be divided equally among their children, per stirpes. For purposes of this paragraph, I 2 specifically direct that children be defined to include any stepchild of my issue. ITEM V: In the settlement of my estate, my Executor shall possess, among others, the following powers: (a) To retain any investments I may have at my death, as long as the Executor may deem it advisable to my estate to do so; (b) To sell either at private or public sale and upon such terms and conditions as the Executor may deem advantageous to the estate, any or all real or personal property or interest therein owned by the estate; (c) To pay all costs, taxes, expenses and charges in connection with the administration of my estate; (d~ To compromise controversies; and (e) To do all other acts in the Executor's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the estate. ITEM VI: Any person who shall have died at the same time as I shall have, or in a common disaster with me, or under circumstance that the order of deaths cannot be established by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me. ITEM VII: I appoint my daughter, JEAN R. HELFRICH, to be the Executrix of my Estate. In the event my daughter cannot act or refuses to act as Executrix for any reason, I nominate, constitute and appoint my daughter, DONNA L. GRIFFIN, as alternate Executrix. The Executrix is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding 3 pages, at the end of each page of which I have also set my initials for greater security and better ident!fication this _/I day of ~~ , 1994. CATHARINE L. MILLER We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound mind and memory. .~~~~'~~ ~~ Residing at: ~ ~ ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : I, CATHARINE L. MILLER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. CATHARINE L. MILLER Sworn to and subscribed bef~~~is // day NOTARY PUBLIC My Commission Expires: ( SEAL ) AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, 7~ ~, ~ ~. F~ ~.'~ , ~>?,~/~/~ ~ ~/~(J~/v / , the Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, CATHARINE L. MILLER, sign and execute the instrument as her Last Will and Testament; that Testatrix signed willingly and she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. W~TNESS Sworn to and subscribed before me this // day ~OThRY PHBBIC ~ Commission ~xpires: ( SEAL ) I m~m Sum~leSuiWan. ~ P?bl,c. I I New Cum~da~J ~ro. C~ m~da~ ~;<~ ns' I ~ My Comm,s~io,, E, xc, res ~ 9 !~5 ~ ~em~r, Pennsyivania ~ia~o ', .... ~ ill ani CATHARINE L. MILLER LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 BRIDBE STREET NEW CUMBERLAND, PEN~NSYLVANIA 17n70 STATUS REPORT UNDER RULE 6.12 NameofDecedent: ~ .~-T/C/)-~,J]}t,F- ~' ,/~//~L-~c-/ Date of Death:, ~ ~O,.~ - Will No.: ~ / - O ...T -- ~ 3 .a~ Admin. No.: 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 wh._~er administration of the estate is complete: Yes }.d 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 re_p_p.r~e~tative file a final account with the Court? Yes _ No .. 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 .[~ No [~] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~,.'"': Telephone No. Capacity: ~ersonal Representative ~] Counsel for personal representative REV-1500 l PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601INHERITANCE TAX RETURN o _ RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-DM-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER ~. Original Roturn ~ 2. 8upplomontal ~oturn ~ 3. ~emaindor Rotum {o,t, o*~oat, p~orto 12d3-82) ~ ~ 4. Umited ~stato ~ ~ 4a. Future Intomst Compromiso (~ato o, ~at, a~er ~2-~2-02) ~ 5. Foderal ~stato Tax ~etum ~. Decedent Died Testate (Anach copy of WilL) ~ 7. Decedent Maintained a Living Trust (A~ach copy of Trust) 8. Total Number of Safe Deposit Boxes ~ 9. Litigation Proceeds Received ~ 10. Spousal Pove~y Credit {date of death bel .... 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A)(Attach Sch O) FIRM NAME (IfApp[i~ble) V& ' ~ ~ C ~ TELEPHONE NUMBER ~, ~Z~ -~ ~ / ~ 1. Real Estate (Schedule A) (1) ~[ O ~1 E OFFICIAL USE ONLY 2. Stocks and Bonds (Sche0ule B) {2) ~} O'~} ~-- 3. Closely Held Corporation, Pa~nership or Sole-Proprietorship (3) ~ ~ ~} ~ ~ ~;~'~':..,.~ 'Z~ :'.:,.. 4. Modgages & Notes Receivable (Schedule D) (4) ~ O ~1 ~ ~-- i ~ . 5. Cash, Bank Deposits & Miscellaneous Personal Prope~y (5) ~ ~ ) ~ ~ ~, / ~¢ ;' (Schedule E) '., 6. Jointly Owned Prope~y (Schedule F) (6) ~ ~ ~[ ~ ~ Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Prope~y (7) )~ O Fl ~ ~ ~ ~ (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) ~ B /~ ~ 9. Funeral Expenses& Administrative Costs (Schedule H) (9) ~1 2¢ /, ~ ~ ~0. Debts of Docodant, Mo~a~o Uabilities, $ Uens (Schedu~o I) (~0) ~ ~ ~ 11. Total Deductions (total Lines 9 & 10) (11) ~p ~& /, 12. Net Value of Estate (Line R minus Line11) (12) / ~ ~, O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) ~ ~ ~ made (Schedule J) 14. ~tValueSubjeetto~ax(Une~2minusUne~3) (~4) } ~ / ~ ~ ~, 8fi~ 1~STRHClIO~80~ R~VfiR8~ 81~fi FOR ~klC~BLE ~ 5. Amount o[ line ~4 taxable at tho spousal tax rate, or transfors undor 8~c. 0~ (a)(~.2) x .0 ~ (~5) 16. Amount of Line 14 taxable at lineal rate / ~/ ¢~ ~ ,~ ~ x .0 ~ (16) ~ R ~' ~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due . (19) b ~ ~' ~ Decedent's Complete Address: STREET ADDRESS Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit ; B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest ~,~, ~/ E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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 life of either payments, benefits or care? ...................................................................... [] [~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ' [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSON~ESPONSIBLE FOR FILING RETUBN -- DATE~ tO ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESb-'~N~ATIVE BATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii) The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 RS. §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 RS. §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 a individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX'+ (1-97) ~ ~ <~ ~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~'y jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH C D ~ "~.~,.~.~.~a " /%000,00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1511EX ,+ (1-97) ~ SCHEDULE H '~ FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM , NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ?//0 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) j~ O' h~ )',-~ ~ /-~, L~ Social Secud~ Number(s)~E~N Numbcr cf Pc~o~a'. R~r~;~ ~. O ~ c~ ~, fl~ s~te [/~ Year(s) Commission Paid: ~ /~ 2. A~orney Fees 3, Family Exemption: (If de~denffs address is not the same as claimant's, a~ach explanation) Claimant Street Address Ci~. State ~ Relationship of Claimant to De.dent 4. Probate Fees 5. A~unmnt's Fees 6. Tax Return Preparers Fees TOTAL (Also enter on line 9, Recapitulation) $ ~' ~ ~ 1, ~"~ (If more space is needed, insert additional sheets of the same size) 04/17/2003 09:46 7179443939 COBLEREBER PAGE 82/82 BOYER FUNERAL HOME, LTD. · 'Yl LIFE CELEBR.~TION HOME" Mrs. Donna L. ~ 3849 Cumberland Parkway Virginia Beach, VA 23452- 2219 FOR THE I~LTNERAL SF~RVICE OF: CA~ L. MILLER~ September 03, 2002 PROFESSIONAL SERVICE CItARGE: 2,255.00 O~R STAFF & I~LATED FACILITIES ~GE: 921.00 ~SPORTA~ON ~GE: 500.~ ~RC~~E: Batesville, H79 ~ R~e, 18 ~e Mono~ C~et. 2,795.00 E~e, Seville, Co~e~ B~ VaSt ~ N~la~ 1~95.~ M~o~ ~oug 200.~ To~ ~ ~ges 8,066.~ ~s: D~co~ 451.11 No~ ~ ~ges 7,614.89 Ceme~ 375.00 C~fied ~pi~ 40.~ C~ 200.~ Flowers 365.70 ~i~b~g Pa~iot ~ew~ t 15.20 ~c~r N~a~s 59.~ L~eoa 100.43 Trot V~g~ni~ Pilot 143.93 To~ ~h D~s~m~ 1,494.26 B~oe 9,109.15~ ~ ~d F~& 9,180.68 Balance Due $ -71,53 ******* PAID ENI~FLL ****** THANK YOU 144 East High Sf~eet · EIizabethtown, PA 17022 (717)~,,_;_._367-1380_ ,. ~ .FAX.. (~7) ,567-3040 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART I!- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ /.~ / ~'~ ~, ,~ ~; (If more space is needed, insert additional sheets of the same size) Register of Wills ©f CUMBERLAND County, Pennsy!va~ia Certificate ef Grant ef Letters No. 2003-00334 PA Ne. 21-03-0334 ESTATE OF HILLER CATE~RINE L (LAS'±', ~"±~s'r, Late of CAHP HiLL BOROUGH , Deceased Social Security No. 179-12-6557 WHEREAS, on the 15th day ef April 2003 an instrumen~ ated October !!th 1994 as admitted to probate as the last will of MILLER CATN~RINE L (LAs'r, ~'~s'r, ate ef CAMP HiLL BOROUGH , CUMBERLAND County, who died en the 3rd day of September 2002 and, WHEREAS, a urue copy ef ~he will as probaEed is annexed hereto. THEREFORE, i, DONNA M. OTTO , Register ef Wills in and for he County of C~BERLAND in the Commonwealth cf Pennsylvania, hereby hat I have this day granted Letters TESTAMENTARY o GRIFFIN DONNA L ho has duly qua!ifiet as Executor(rix) nd has agreed to administer the estate according to law, all of which fully ppears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, ARLISLE, PENINSYLVAiqIA. IN TESTIMONY WHEREOF, i have hereunto set my hand and affixed the seal f my Office the 15tk day of April 2003. HeglsE~gr oZ }~i!is **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002766 GRIFFIN DONNA L 384.9 CUMBERLAND PARKWAY VIRGINIA BEACH, VA 234-52-2219 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $629.09 ESTATE INFORMATION: SSN: 179-12-6557 FILE NUMBER: 2103-0334 DECEDENT NAME: MILLER CATHARINE L DATE OF PAYMENT: 07/03/2003 POSTMARK DATE: 07/01/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/03/2002 TOTAL AMOUNT PAID: $629.09 REMARKS: CHECK# OO82 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: C/]~Ti¢/gl'-~x.~gl-~'' ].--.. ]'"'71/IL-p,. Date of Death: (~t/ ~//~ ~ Will No. A /-- Og --'~ ~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a_) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on C~-Tht,~-~ }/'1~- ~/,,/~[I/-/.l~flz Name Address Notice ha~ now been given to all persons entitled thereto under Rule 5.6(a) except Date: ~ //.,) ~00 Signature ',.O . w Telephone ( ._;: .., ,-- Capacity: Personal Representative I __Counsel for personal representative 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 deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or prop- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of C.J~'T ~/~. ~i~ ~/x.} ~F- ]. , ~'/[ i L 1-- ~' ~x... , deceased, OG//~/O ~ Estatemo. 0~-- ~3 22~ / B 7 ~ 0~0~.~ -~ (Name and Address) Cou'~T ~ous ~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. TheDecedentC dr ¥ ~.4 v, ~ a P/.. , }~ , L t }z,~[~ ,diedonthe__ 0,...~ day of .5'~ 7- ,400 4' at Co t~ 8 ~:-V./--4 ~ s County, Pennsylvania. r-. (7 The Decedent died test~~ cc'r~ ~:~.~ ..!:. -';:V ~ " ~.: .: The Decedent died intestateS-without a Will). :' ~ ., ~e personal representative of the Decedent is :. I (nme, address and telephone number). If the Decedent died testate, 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 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 A copy of the Will or Petition may be obtained by contacting the Register of Wills a~l paying the charges for duplication. Date: (~t~/.C,],~(3~ Signature: ~~h~ ~~.~_~t~?) Telephone (7/7 ' 5 4~- 73 o / Capacity: Personal Representative Counsel for personal representative ?,.,C- 7 r~:;~~Ex {~ DEP~ 280601 I INHERITANCE~---- I vv ~TAX RETURN RFV. nn OFFiCiAL USE ON,Jr ~ PENNSYLVANIA ~~~ DEPARTMENT OF REVENUE 'FILE NUMBER ~HARRISBURG, PA 17128-0601 RESIDENT DECEDENT /co,,.coo~ SOCIAL SECURI~ NUMBER DATE OF D~TH (MM-DD-Y~) E I (MM-DD-Y~R) THIS EETUEN RUST BE FILED IN BUPLI6ATE WITH THE (IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER -, ~--~ 1. Original Return [~;~'Z'-~pplemental Return [] 3. Remainder Return (da~ ofdea~ p~o 12-13-82) ii~ ~-~ 4' Limited Estateo ~'---~ 4a. Future Interest Compromise (~ate ~f deR, a~er ,2.,2.a2) ~] 5. Federal Estate Tax Return Required mO, [~: Decedent Died Testate (Attech copy of Will) J~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received [~ 10. Spousal Poverty Credit {date of derail bet~men 12-31-91 and 1-1-95) ~'~ 11. Election to tax under Sec. 9113(A)(At~:h Sch O) I- Z ~ NA . Z 14' COMPL E MAI,.ING DRESS " FIRM NAME (IfAp¢icable) '¥ TELEPHONE NUMBER O '-' / - 7,.~'- 7-..~,¢¢ -73 o/ /',/¢,, ~ '~ "h.~ - ,4 ~ / ¢ 1. Real Estate (Schedule A) (1) ,~ 7';/~ OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Propdetorehip (3) T'~ 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Prope~y (5) (Schedule E) i 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested ~:) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) '~'~ ~ (Schedule G or L) <1: 8. Total Gross Assets (total Lines 1-7) (8) ..~ LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) ~ ) O '~) J~'-' 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line a minus Line11) (12) ~ ~ ,J.~..~., ~ / 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) J~'l ~ 7'"l ,/,,-"' made (Schedule J) 14. Net Value Subject to Tax (Line 12minus Line13) (14) ~. ~,~ / .~>.~, =,~ // SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rate , c,~ ) x .0,J'~,.~-~'~ (16) 17. Amount of Line 14 taxable at sibling rate ....... x .12 (17) 18. Amount of Line 14 taxable at collateral rate ....... x .15 (18) 19, Tax Due ,19) ? ? "~ ..' ~"~ 20. I-'--1 ..... II *' ' II ~ · ' I:~l · ,,~ i~' ..,,~, ~ SCHEDULE E COM~O.W~LTH~''~"~OF "E..SYLV^.~^ CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDE~ PERSONAL PROPERTY Include ~e p~ of I~a~n a~ ~e da~ ~e'p~s ~em ~ by ~e ~. All pm~ ~i~ ~ ~e ~ht ~ su~o~hi m~ ~ d~b~ on ~h~ub F. ITEM VALUE AT DATE NUMBER DESCRIPTIO~ OF D~TH IIf mom .~nnce is needed, insert additional shee. t.~ nf the same size/ ""'~'"'~ ~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & ~N.ER~TANCE T~X ~URN ADMINISTRATIVE COSTS RESIDENT DECEDENT k~ of ~ed~l m~ ~ r~po~ ~ ~h~al~ I. ITE~ ~U~BE~ DESCRIPTION ~OUNT A. FU~E~L EXPENSES: ,. 9/o B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ~'~'J ~( ~ ~. CuR// So~a~S~Number(s) .......................... p~ ~d-5----~ Year(s) Commission Paid: ~'"'} ~ 2. Attorney Fees 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explana~n) --..--- Claiman{ Street Address C~y State Zip Relationship of Claimant to Decedent 4. Probate Fees 5, Accountant's Fees '~, 6. Tax Retum Preparer'$ Fees I ~'~'~ TOTAL (Also enter on line 9, Recapitulation) (If mom space is needed, insert additional sheets of the same size) REV-15.13 EX+ (9-00~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE Di.~¥HIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 3849 Camhex:lmad Pk3vy. Virginia Bch, VA 23452-2219 I,,,lll,,,I,,,ll,,hll,,I , ,!1,,,,,,1111 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002867 GRIFFIN DONNA L 3849 CUMBERLAND PARKWAY VIRGINIA BEACH, VA 23452-2219 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $370.26 ESTATE INFORMATION: SSN: 179-12-6557 FILE NUMBER: 2103-0334 DECEDENT NAME: MILLER CATHARINE L DATE OF PAYMENT: 08/04/2003 POSTMARK DATE: 07/22/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/03/2002 TOTAL AMOUNT PAID: $370.26 REMARKS: DONNA L GRIFFIN CHECK# 0083 INITIALS: CW SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~//~./~Z---~ CONNONWEALTH OF PENNSYLVANIA BUREAU OF Z~DZVZDUAL TAXES DEPARTHENT OF REVENUE E~-~ INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 NOT/CE OF ZNHER/TANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCT/ONS AND ASSESSHENT OF TAX RE¥-l~47EXAFP(01-O$) DATE 08-18-2005 ' ESTATE OF HILLER CATHARINE L DATE OF DEATH 09-05-2002 '*- COUNTY CUMBERLAND DONNA L GRIFFIN ACN 101 $849 CUHBERLAND PKY Aeount Reeitted VIRGINIA BEACH VA Z$~SZ HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 170~$ CUT ALONG TH~S LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15&7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF MILLER CATHARINE L FILE NO. 21 05-0554 ACN 101 DATE 08-18-2005 TAX RETURN WAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED HOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLENENTAL RETURN NO. 01 1. Real Estate (Schedule A) (1) .00 NOTE: To Ansure proper 2. Stocks and Bonds (Schedule B) (2) .00 credAt to your account, $. Closely Held Stock/Partnership /nterest (Schedule C) ($) .00 subeit the upper portAon q. Mortgages/Notes ReceAvable (Schedule D) (q) .00 of thAs fore wAth your $. Cash/Bank DeposA~s/MAsc. Personal Property (Schedule E) ($) $2;897.29 tax payment. 6. Jolntly O~ned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) $2,897.19 APPROVED DEDUCTIONS AND EXENPTZONS: 10,744.08 9. Funeral Expenses/Ada. Costs/MAsc. Expenses (Schedule H) (9) 10. Debts/Mortgage LiabilAtAes/LAens (Schedule 1) (10) .00 11. Total Deductions (11) 1~.7~.08 12. Net Value of Tax Return (12) 22,15~.21 15. CherAtable/Governeen~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 1~. Net Value of Estate Subject to Tax (1~) 22,155.21 NOTE: If an assessment ~as issued previously, 1/nes 14, 15 and/or 16, 17, 18 and 19 ~111 reflect flgures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of LAne 1~ at Spouse1 re~e (15) .00 X O0 = .00 16. Amount of LAne 1~ taxable at LAneel/Class A rate (16) 22,15~.21X 045 = 996.89 17. Amount of Line 1~ at Sibling rate (17) .00 x 12 = .00 18. Aeount of LAne lq taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Pr/nc/pal Tax Due (19)= 996.89 TAX CREDZTS: PAYM[NT RECEIPT DISCOUNT (+} AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-01-2005 CD001766 .00 629.09 INTEREST IS CHARGED THROUGH 09-02-2005 TOTAL TAX CREDIT I 629.09 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl $67.80 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.99 TOTAL DUE $74.79 ~ IF PAID AFTER DATE TNDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITTONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORM FOR INSTRUCTIONS.) RESERVATION; Estates of decadents dying an or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment ta Class B (collateral} beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To {ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the 13 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-$SZ-ZOSO; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-50Z0 (TT only}. OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 171Z8-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid aithin three (3) calendar months after the dacedant's death, a five percent (5l) discount of the tax paid is allowed. PENALTY: The 15l 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 would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (613 percent per annum calculated at a daily rate of .000164. A11 taxes ~hich became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOO3 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1983 16Z .00043B 1988-1991 llZ .000301 ZOO0 81 .000119 1984 111 .000501 1992 9l .000247 ZOOX 9Z .000247 1985 15l .000356 1993-1994 71 .000192 2002 61 .000164 1986 101 .000174 1995-1998 9Z .000147 2005 51 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond tho data of tho assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ~EV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 FILE NUMBER DECEDENT'S NAME Catharine L. Miller 2103-0334 ACN REVIEWED BY John Kuchinski 101 ITEM EXPLANATION OF CHANGES SCHEDULE NO. Accepted revised return. ROW Page 1 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171 28-0§01 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002934 GRIFFIN DONNA L 3849 CUMBERLAND PARKWAY VIRGINIA BEACH, VA 23452-2219 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 ~4.53 ESTATE INFORMATION: SSN: 179-12-6557 FILE NUMBER: 2103-0334 DECEDENT NAME: MILLER CATHARINE L DATE OF PAYMENT: 08/22/2003 POSTMARK DATE: 08/20/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/03/2002 TOTAL AMOUNT PAID: $4.53 REMARKS: DONNA LGRIFFIN CHECK# 87 INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CONNON#EALTH OF PENNSYLVANIA BUREA OF ZNDZVZDUAL TAXES DEPARTHENT OF REVENUE INHERITANCE TAX OIVISION ".~T. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCT/ONS AND ASSESSHENT OF TAX REV-ZE4?EXAFP(01-O$) DATE 08-18-2005 ESTATE OF HILLER CATHARZNE I }~-/c~--~'~'-'~ DATE OF DEATH 09-O$-ZOOZ FILE NUNBER Z1 05-0354 COUNTY CUHBERLAND DONNA L GRIFFIN ACN 101 $849 CUHBERLAND PKY Amoun~ VIRGINIA BEACH VA 25452 HAKE CHECK PAYABLE AND RENIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 3849 Cumberland Pkwy. Virginia Bch, VA 23452-2219 ~/'~-/----~--~'~"~ CON.ON.EALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DZVIS/ON DEPT. Z80601 ZNHERZTANCE TAX HARRISBURG, PA 171Z&-0601 STATEMENT OF ACCOUNT REV-1607 EX &FP (01-03) ::i DATE 08-18-Z005 ESTATE OF MILLER CATHARINE L DATE OF DEATH 09-05-2002 FILE NUMBER 21 ? ;~i ~OUNTY CUMBERLAND DONNA L GRIFFIN ACN 101 :58q9 CUMBERLAND PKY Amoun* VIRGINIA BEACH VA Z:sqSZ_ HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF ~ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credi~ *o your account, submit tho upper por~Aon of this for. w/th your tax payment. CUT ALONG THIS LINE ~' RETAIN LOHER PORTION FOR YOUR RECORDS REV-1607 EX AFP (01-03) -~ INHERITANCE TAX STATEHENT OF ACCOUNT ESTATE OF MILLER CATHARINE L FILE NO. 21 03-0:5:5q ACN 101 DATE 08-18-200:5 THTS STATEMENT TS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELO# TS A SUMMARY OF THE pRTNCTpAL TAX DUE, APpLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLTCABLE., A PROJECTED INTEREST FTgURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-18-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 996.89 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-01-Z00:5 CDOOZ766 .00 629.09 07-22-200:5 CDOOZ867 Z.q6- :570.26 BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-2:5-200:5 TOTAL TAX CREDIT 996.89 BALANCE OF TAX DUE .00 INTEREST AND PEN. Z.qZ ~ TF pATD AFTER THTS DATE, SEE REVERSE TOTAL DUE 2. q2 SIDE FOR CALCULATTON OF ADDIT/ONAL TNTEREST. ( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REDUZRED. TF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THI'S FORM FOR TNSTRUCTTONS. ) PAYNENT: Oatach the top portion of this Notice and submit .ith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax cradit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Rills, any of the 23 Revenue District Offices or from the Department's Z4-hour answering service for fores ordering: 1-800-562-Z0502 services ~or taxpayers with special hearing and / or speaking needs: 1-800-4~7-3020 (TT only). REPLY TO: Questions ragarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assess~ent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax dua is paid eJthin three (3) calendar months after the decadent's death, a five percent (52) discount of the tax paid is a11owad. PENALTY: The lSZ tax amnesty non-participation panalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, tha first day after fha end of the tax amnesty period. INTEREST: Interest is charged baginning with first day of delinquency, or nine (9) months and one (1) day from tho date of death, to the date of payment. Taxes which became dalinquant before January l, I982 bear interest at the rate of six (62) percent per annum calculated at a daily rats of .000164. AIl taxes which became delinquent on and after January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Daparteent of Revenue. The applicable interest rates for I982 through 2003 are: Intarast Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19S2 20Z .000;48 1987 9Z . OOO 247 1999 7Z .000192 I98'~ 16X . OO0O..'~8 1988-I99'1 III .000301 2000 8Z .000219 1984 112 .000301 1992 9Z .000247 Z001 9Z .000247 1985 132 .000356 1993-1994 72 .000192 2002 62 .000164 1986 102 .000274 1995-1998 92 .000247 2003 5Z .000137 --Interest is calculated as felZows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will raflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must ba calculated. ~.//~-//~-'-2 COMMONHEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTMENT OF REVENUE ZNHERZTANCE TAX DZVZSZON DEPT. 280601 ZNHERZTANCE TAX HARRISBURG, PA 171ZS-G601 STATEMENT OF ACCOUNT REV-1607 EX AFP {01-05) DATE 09-08-2005 ESTATE OF MILLER CATHARINE L DATE OF DEATH 09-05-2002 FILE NUMBER 21 05-055q '~.)~i i.i:~i --,~! COUNty? CUMBERLAND DONNA L GRIFFIN ACN 10! $8q9 CUMBERLAND PKY VIRGINIA BEACH VA ZSq52 ~ I Aeoun~ Remi~ed I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, subei~ ~he upper portion of ~h/s form wASh your ~ax payment. CUT ALONG THZS LZNE ~ RETAZN LOHER PORTZON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ### ZNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF MZLLER CATHARZNE L FILE NO. 21 05-033q ACN 101 DATE 09-08-2005 THIS STATEMENT ZS PROVZDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHO~/N BELO# ZSA SUMMARY OF THE PRTNCZPAL TAX DUE, APPLZCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE.. A PROJECTED INTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-18-2005 PRINCIPAL TAX DUE: ......................................................................................................................................................................................................................... 996.89 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID ¢-) AMOUNT PAID 07-01-2005 CDOOZ766 .00 629.09 07-Z2-ZO05 CD002867 Z.q6- 570.26 08-20-2005 CDOOZ95q 2.q2- 09-08-2005 REFUND .00 Z.11- TOTAL TAX CREDTT 996.89 BALANCE OF TAX DUE .00 TNTEREST AND PEN. . O0 TF pATD AFTER THTS DATE, SEE REVERSE TOTAL DUE . O0 STDE FOR CALCULATION OF ADDTTZONAL INTEREST. TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REqUTRED. TF TOTAL DUE TS REFLECTED AS A 'CREDTT' YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF TNTS FORM FOR TNSTRUCTTONS. ) PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an 'Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Rills, any of the 13 Revenue District Offices or from the Department's Iq-hour answering service for forls ordering: 1-B00-361-1030; services for taxpayers with special hearing and / or speaking needs: 1-800-0*q7-30Z0 (TT only). REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. lBO601, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid be~ore January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day fram the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at tho rate of six (61) percent per annum calculated at a daily rate of .000160.. Ali taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z003 are: Interest Dally Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor ZgBZ Z07. . O0050*8 1987 91 .0002¢7 1999 71 .000192 1983 167. .000¢38 1988-1991 117. .000301 2000 87. .000219 198¢ IZZ .000301 1991 97. .0002¢7 ZOO1 91 .0002¢7 1985 131 ,000556 1993-199°* 71 . O0019Z ZOOZ 61 .000160* 1986 lOX .000270* 1995-1998 9Z . O0010*7 Z003 51 .000157 --Interest is calculated as foZloas: I'NTEREST = BALANCE OF TAX UNPA/D X NUI~BER OF DAYS DELTNQUENT X DATLY TNTEREST FACTOR --Any Notice issued after tho tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. I{ payment is made after the interest computation date shown on the Notice, additional interest oust be calculated. COHMONNEALTH OF PENNSYLVANZA ~BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 INHERITANCE TAX HARRISBURg, PA 17128-0601 STATEHENT OF ACCOUNT RE¥-i~O? EX &FP DATE 09-22-2005 ESTATE OF MILLER CATHARINE L DATE OF DEATH 09-05-2002 FILE NUNBER 21 05-055q 'CL~ ii!~' ~(~ ~'~ 'i *,'-~ COUNTY CUMBERLAND DONNA L GRIFFIN ACN 101 58q9 CUMBERLAND PKY Amoun~ VIRGINIA BEACH VA~25q5Z MAKE CHECK PAYABLE AND REMZT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper crodi~ ~o your account~ submi~ ~he upper portion of ~his form wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LO~ER PORTION FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~## INHERITANCE TAX STATENENT OF ACCOUNT ESTATE OF MILLER CATHARZNE L FILE ND. Z1 05-055q ACN 101 DATE 09-22-2005 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHOt/N BELO# ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE., AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADdUSTHENT: 08-18-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 996.89 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-01-2005 CDOOZ766 .00 629.09 07-22-2005 CDOOZ867 2.q6- 570.26 08-20-2005 CD00Z95q 2.qZ- q.55 09-08-Z005 REFUND .00 Z.11- TOTAL TAX CREDIT 996.89 BALANCE OF TAX DUE .00 INTEREST AND PEN. . O0 ZF PATD AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN NO PAYNENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTTONS. ) PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Xf RESXBENT DECEDENT make check or money arder payable to: REGZSTER OF RILLS, AGENT. -- if NON-RESIDENT DECEDENT make check or money order payable to: CONNON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by ccmplating an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at tho Office of the Register of Hills, any of the 23 Revenue District Offices or free the Department's 24-hour answering service for forms ordering: 1-800-362-Z050; services ~or taxpayers with special hearing and / or speaking needs: 1-&00-447-3020 (TT only). REPLY TO: guastions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTR: Post Assessment Review Unit, Dept. 2B0601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the tota! of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. iNTEREST: Tntarest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 19BZ bear interest at the rata of six (61) percent per annum calcuIated at a daily rate of .000164. AIl taxes which became delinquent on and after January l, 1982 wilI bear interest at a rata which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through ZOO3 ara: Interest Daily Tnterest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 202 .000548 1987 92 .000247 1999 77. .000192 1983 162 .000438 1988-1991 117. .000301 2000 82 .000219 1984 117. .000301 1992 92 .000247 2001 92 .000247 1985 132 .000356 1993-1994 72 .000192 Z002 62 .000164 1986 102 .000274 1995-1998 92 .000247 2003 52 .000137 --Xntarest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELXNQUENT X DA'rLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must ba calculated. STATUS REPORT UNDER RULE 6.12 NameofDecedent: ~ > TJ'/-,~?]'[ff- '~' "~ Date of Death: 7 ~c.>~ - Will No.: ,~, / - O ~ -- 33:3 -~ Admin. No.: Pursuant to Rule 6.1 2 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 wh__~er administration of the estate is complete: Yes ~ No F-] 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 r[~tativ¢ file a final account with the Court? Yes _ No 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 ~' No [-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature '" Address ~/0. Telephone No. Capacity: ~Personal Representative · [~1 Counsel for personal representative ~untoer±an~ County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 GRIFFIN DONNA L 3849 CUMBERLAND PARKWAY VIRGINIA BEACH, VA 23452-2219 RE: Estate of MILLER CATHARINE L File Number: 2003-00334 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. t, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 9/03/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Darlien M. Frev 00334 of 2005 No. also known as Date of Death March 15. 2005 , Deceased Social Security No. 195-32-1305 Personal Representatlve(s) of the above Estate, deceased, verify that the items appearing in 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. lIWe verify that the statements made in this Inventory are true and correct. lIWe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Shaun E. O'Toole 1.0. No.: 44797 Address: 2813 North Second Street Dated Harrisbura. PA 17110 Telephone: (717) 213-6653 Description Value (1) Members 1 st Federal Credit Union Checking Account $ 1,642.39 (2) Members 1 st Federal Credit Union Savings Account $ 25.45 (3) Members 1 st Federal Credit Union Money Management Account $ 3,716.03 " ,~ ,;:-::, C':J C:.)'-". , C'I 'I c'") W (Attach Additional Sheets if necessary) Total: $ 5,383.87 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. Form RW-7 (Doouphin County - Rw. fIIlI21 'r) , f'l ,;':3 :0 . ,::',) i ,~"-T"1 I::J , ,") : '::":\ ~.~~ . ,:') n. ,'''') ,"T'l RE'/.15iJ0EX ,O-CCi' COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 W I- 1l:::$IIl t)Cl:1l:: w15g altai ~ INHERITANCE TAX RETURN RESIDENT DECEDENT t- Z W C W o w c DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) FREY, DARLlEN M. DATE OF DEATH (MM-DD-YEAR) 03/15/2005 DATE OF BIRTH (MM-DD-YEAR) 08/17/1941 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1. Original Return D 4, Limited Estate D 6, Decedent Died Testate (Allaeh copy 01 Willi D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a, Future Interest Compromise (dala 01 daalh after 12-12.82) D 7. Decedent Maintained a Living Trust (Allaeh copy ofTru,l) D 10, Spousal Poverty Credit Idale 01 dealh balween 12-31-91 and 1.1-95) FILE NUMBER 21 05 00334 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 195-32-1305 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remeinder Return Idale oldealh pnor 10 12-13-821 D 5, Federal Estate Tax Return Required JL 8. Total Number of Safe Deposit Boxes D 11, Election to tax under Sec. 9113(A) tAllaeh Seh 01 I- Z ~ Z o ~ w Cl: Cl: o t) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Shaun E. O'Toole, Esquire 2813 North Second Street FIRM NAME (II AppHeaDlej Harrisburg, Pennsylvania 17110 TELEPHONE NUMBER (717) 213-6653 1, Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ~ ;:) t- o: <( o w c::: 4 Mortgages & Notes Receivable (Schedule D) 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 Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (6) (7) 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) 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 z o ~ ~ ;:) Q. :E o o ~ 15, Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) 15,393.09 X.o ,45" (15) 16 Amount of Line 14 taxable at lineal rate x .0 (16) 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19, Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 0.00 0.00 j- ...... 0.00 0.00 5,383.87 0.00 17,000.00 (8) 6,064.00 1,014.83 (11) (12) (13) (14) ~....;l C) ., 1_-" "'T"" -) i~'n .;;-, f-.~".--) , 2:) ::u ;:::7 i-r, '::::.::J c.) I ()1 -"';'"1 I --,-' :. ,.) -','J () ill c..) <::::-) rOt 22,383.87 7,078.83 15,305.09 0.00 15,303.09 688.73 (17) (19) 688.73 Decedent's Complete Address: STREET ADDRESS 401 F rant Street CITY Harrisburg STATEpA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3. Total Credits ( A + B + C ) (2) InterestJPenalty if applicable D. Interest E. Penalty 4 TotallnteresUPenalty ( D + E ) 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 (3) (4) (5) (SA) (58) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ZIP 17025 688.73 0.00 0.00 0.00 688.73 0.00 688.73 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred:......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest: or.............................................,............"..,.........".,.....................,'..,.................... 0 d. receive the promise for life of either payments, benefits or care? ................................................................, 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ... ...........,...,................,.............. ...........,..................., ......... ...... ....... ...... [!l 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............,........,...................,...,.........,...........,...,....,.......,.".,..,...,.....,...,............ 0 [KJ 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 rebJm, including accompanying schedules and statements, and to tihe best of my knowledge and belief, il is true, correct and complete. Declaration of preparer otiher than tihe personal representative is based on all information of which preparer has any knowledge. , ~TURE OF PERS N RESPONSIBLE FORFILlNG RETURN 'AtiR~SS lp~O loh 61" \Des\- fQ'Lru ~et.0 ~'GNAT E F p~. RER O~HAN REPRESENTATIVE 1.,. <'y,,)~ RESS 2813 N_~rth Sec~nd_~tr~~, 'iClrrisbu,.9,~enn~ylva_nLaJ?110 No [KJ [KJ [iJ [iJ o [KJ DATE q-03--~ ____ ___m_. __.___m__.____._________~ PA IfJ03S DATE otti 102/0S" For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (i1)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child Is 0% [72 PS. ~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 PS. ~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)J. 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. REV.1508 EX+ (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FREY, DARLlEN M. FILE NUMBER 21-05-0334 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 . Members 1st Federal Credit Union; Checking Account #112777-11 1,642.39 25.45 3,716,03 2. Members 1st Federal Credit Union; Savings Account #112777-00 3. Members 1st Federal Credit Union; Money management #112777-05 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5.383.87 Send Inquires to: 1 5000 Louise DrIve PO Box 40 Mechanlcsburg, PA 17055 www.members1sLorg Main SwItchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) ~72 TOO: (717) 697-5312 or (800) 283-2328 ext. 5312 TeloBranGh: (717) 7llS-6049 or (800) 237-7288 MEMBERS 1st FEDERAL CREDIT UNION DARLlEN M FREY 401 FRONT ST ENOLA PA 17025-3220 Statement of Accounts Mar 01, 2005 thru Mar 31, 2005 Account Number: Account Balances at a Checking: Savings: Certificates: Loans: Money Management: 112777 Glance: 1,629.40 25.45 0.00 0.00 3,719.94 Page: 1 of 2 We have partnered with Carlisle Events to provide you with the opportunity to attend one of their events free of charge! See the enclosed insert for more information. CHECKING ACCOUNTS 11 - CHECKING Date Mar 01 Mar 01 Mar 01 Mar 01 Mar 02 Mar 02 Mar 11 Mar 16 Mar 31 Transaction Description Balance FolWard Deposit Transfer From Share 00 Check 001771 Tracer 0301005457 Check 001775 Tracer 0301015248 Check 001774 Tracer 0302006766 Check 001773 Tracer 0302019360 Deposit Transfer From Share 00 Withdrawal ACH PEOPLES LIFE INS TYPE: INS- PREM 10: 1520670766 Ending Balance CHECK SUMMARY Check # Amount Date 001.771 47.74 Mar 01 001773* 41 . 81 Mar 02 * Asterisk next to number indicates skip in number sequence 4 Checks Cleared for 281 . 21 Date Mar 16 Date Mar 01 Additions Subtractions 70.76 47.74- 161.94- 29. 72- 41. 81- 248.29 12.99- Check # 001774 001775 Amount 29.72 161.94 Amount Description 12. 99 Withdrawal ACH Date WITHDRAWALS AND OTHER CHARGES Amount Description DEPOSITS AND OTHER CREDITS Amount Description 70. 76 Deposit Transfer 2 Deposits and Other Credits for 319. 05 Date Mar 11 Amount Description 248 . 29 Deposit Transfer - - - Continued on following page - - - Balance 1,604.55 1,675.31 1,627.57 1,465.63 1,435.91 1,394.10 1,642.39 1,629.40 1,629.40 Date Mar 02 Mar 01 tv 1st ~...!: Mar 01, 2005 thru Mar 31, 2005 Account Number: 1127n Page: 2 of 2 SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Mar 01 Mar 01 Mar 11 Mar 31 Transaction Description Balance Forward Deposit ACH CIVIL SERV 10:3121736156 Withdrawal Transfer To Share 11 DepositACH COMPASS GROUP TYPE: PAYROLL 10: 1561874931 DATA: CANTEEN CORP12-11082 Withdrawal Transfer To Share 11 Ending Balance Additions Subtractions Balance 25.45 70.76 96.21 70. 76- 25.45 248. 29 273.74 248 . 29- 25.45 25.45 Mar 01 Mar 11 05 - MONEY MANAGEMENT 3.91 Balance 3,716.03 3,719.94 3,719.94 Date Transaction Description Mar 01 Balance Forward Mar 31 Deposit Dividend 1.240% Annual Percentage Yield Earned 1. 250% from 0310112005 through 03131/2005 Mar 31 Ending Balance Additions Subtractions YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 05 MONEY MANAGEMENT 11 CHECKING 1.36 43.53 0.58 Total Year To Date Dividends Paid NOTE: Total includes closed shares 45.47 REV-1510 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FREY, DARLlEN M. FILE NUMBER 21-05-0334 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-l500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO PECEPENT ANP DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE PATE OF TRANSFER ATTACH A COpy OF THE PEEP FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Transfer of $17,000 cash to Decedent's daughter, Brenda Hess, on February 17,000.00 100 0.00 17,000,00 24,2005 TOTAL (Also enter on line 7 Recapitulation) $ 17,000,00 (If more space IS needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FREY, DARLlEN M. FILE NUMBER 21-05-0334 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Michael J. Shalonis Funeral Home 4,573.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City , State Zip Year(s) Commission Paid: 2. Attorney Fees 1,400.00 3. 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 4. Probate Fees 91.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (II more space is needed, insert additional sheets of the same size) 6,064.00 REV-1512 EX+ (12-03) '* SCHIDULI I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREY, DARLlEN M. FILE NUMBER 21-05-0334 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Dell Financial Services 1,014.83 TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,014.83 REV-1513 EX+ 19-001 '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER 21-05-0334 ESTATE OF FREY, DARLlEN M. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] A. John McConnell, 401 Front St., West Faiview, PA 17025 Son 0.20 B. Linda Schonemann, 2316 Northeast Third St., Boynton Beach, Fla. 33345 Vlo....~~k,- 0.20 C. Brenda Hess, 244 West Dauphin St., Enola, PA 17025 1)~....~,,~ 0.20 D. Jay Max McConnell, 401 Front St., West Fairview, PA 17025 ~""" 0.20 E. Tracy Hoffman, 620 High Street, West Fairview, PA 17025 t>..,,'0~~ 0.20 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size)