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04-0481
Estate of also known as Clifford L. Groy cial Security No. 2007-03-1658 The petition of the undersigned respectfully represents that: PETITION FOR PROBATE and GRANT OF LETTERS To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Your petitioner(s), who is/are 18 years of age or older and the executors named in the last will of the above decedent, dated February 16~ 1982 and codicil(s) dated N/A (state relevenat circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with the Decedent's last family or principal residence at 443 Mill Race Road (South Middleton Township) Carlisle~ Pennqylvania 17013 (list street, number and municipality) Decedent, then 86 years of age, died May 16~ 2004 at Carlisle~ Cumberland County~ Penn~ylvanla 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: Betty J. Groy died ~ o~,~,,-..~--~ q t 7._ o o t See Renunciations of Donna Wike & Denise Bowman 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 situated as follows: 443 Mill Race Road $ 30,000.00 $ $ 90~000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) printed herewith and the grant of letters Testamentary .~ 26 Bentley Place Carlisle~ Pennsylvania 17013 (testamentary; administration c.t.a.; adrr~.~stration d.b.n.c.t.a.) OATH OF PERSONAL REPRSENTATIVE COMMONWEATLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition 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 admipister the estate according to law. Sworn to or affirmed and subscribed before me this>q. I$~ay of May, 2004 Register Estate of Clifford L. Groy , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ o'~ [ - ,2004 in consideration of the petition on the reverse side hereof, ~atisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 16, 1982 described therein be admitted to probate and filed of record as the last will of Clifford L. Groy and Letters Testamentary are hereby granted to Sandra A. Martini ~ ~Etc Probate, . Short Certificates( ) Renunciation FEES $ Total $ c9,Co I 6ND Filed..~r.&l.-r.©..~ .................. ' Register of Wills ~.r Robert G. Frey, 46397 ATI'ORNEY (Sup. Ct~ I.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE and ~~ig. ned as ~s at the request of testatrix in ]~p~sence and (in the price of each other) O~ce ~f t~bscribing witness(es)). ~ Sworn to or affirmed and's~scribed befor~ me this % dayof ~ ~.. ,1999 Register REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NONSUBS£RIBING WITNESS __y-.Iz_O'qz_cIX7 ............ Sandra A. Martini and Robert G. Frey (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Clifford L. Groy, the Testator to the will presented herewith and that each believes the signature on the will is in the handwriting of Clifford L. Groy to the best of our knowledge and belief. Sworn to or affirmed and subscribed before me this ~t ~t-- ' - Sandra A. Martini Robert G. Frey ~' 5 South Hanover Street, Carlisle, PA 17013 RENUNCIATION In Re Estate of Clifford L. Groy, deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Denise J. Bowman, nominated to serve as Executrix by Article V of the Last Will and Testament of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Sandra A. Martini. WITNESS my hand this 17th day of May, 2004. Denise J. Bow .n~ 1046 East Main Street Annville, Pennsylvania 17003 (717) 867-2307 RENUNCIATION In Re Estate of Clifford L. Groy, deceased. To the Register of Wills of Cumberland County, Pennsylvania. Thc undersigned Donna L. Wike, nominated to serve as Executrix by Article V of the Last Will and Testament of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Sandra A. Martini. WITNESS my hand this 17th day of May, 2004. Donna L. Wike 1040 East Main Street Annville, Pennsylvania 17003 (717) 867-1086 105.112 REV. 8/88 ~FEE FOR THIS CERTIFICATE $2.00) Name of Decedent 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 T 563~ 771 Clifford Le Groy May 17, 2004 Date of Issue of This Certlfic~tiorl Male Sex Date of Birth Place of Death First Social Security No. Aug. 28, 1919 Birthplace Carlisle ManOr Care Middle 207-03-1658 Lebanon, Penna. Last Date of Death May 16,2004 Cumberland Co. Carlisle Pennsylvania Facility Na~"~ County City Borough or Township White Systems Dispatcher Race Occupation Armed Forces? (Yes or No) Widowed Decedent's 443 Mill Race Road, Carlisle, Pa. 17013 Marital Status Mailing Address Number Street City or Town Sandra Martini Steven R. Kreamer Informant Funeral Director Name and Address of Kreamer F.H , 618 E. Main St , Annville, Pa 17003 Funeral Establishment ' ' ' YES State Pa~l: Part Ih Immediate Cause (a) (b) (c) (d) Renal Failure Diabetes Mellitus Interval Between Onset and Death Months Years Other Significant Conditions .Congestive Heart Failure,Cellulitis, Legs,Per,feral Vascular Manner of Death Natural ~: Accident [] Suicide [] Homicide [] Pending Investigation [] Could not be Determined [] Describe how injury oc.curred: Name and Title of Certfier William S. Kauffman Address 1921 Spring Road, Carlisle, Pa. 17013 (M.D., D.-~~ 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 or, j~ginal certificate will be forw/~rded to the State Vital Records Office for permanent filing. /'~/)/') .~ ~ Local Re ]Tstrar of Vi~'~Records Dirdrict No. May 17,2004 159 N. Railroad St., Palmyra, Pa.17078 Date Received by Local Registrar Street Address City, Borough, Township LAST WILL AND TESTAMENT I, CLIFFORD L. GROY, of the Borough of Palmyra, County 6f Lebanon and Commonwealth of Pennsylvania, being of sound mind, do hereby declare this to be my Last Will and Testament, hereby revokin~ all Wills or Codicils by me at any time heretofore made. ARTICLE I I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. ARTICLE II All the rest, residue and remainder of my estate, real, personal or mixed, wheresoever situate, I give, devise sd bequeath unto my beloved wife, BETTY J. GROY, to be hers absolutely. ARTICLE III In the event that my beloved wife has predeceased me, or in the event that she and I die in a common disaster, then I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal or mixed, wheresoever situate, in three (3) equal shares, share and share alike, unto my three daughters, DENISE J. BOWMAN, SANDRA A. MARTINI and DONNA L. GROY. In the event that either of my three daughters has predeceased me, I direct that that daughter's share shall be received by the surviving daughters. I direct that my Executrix shall not be required to enter security in any jurisdiction in which she may act. ARTICLE V I nominate, constitute and appoint my beloved wife, BETTY J. GREY, to be Executrix of this, my Last Will and Testament. In the event that she is unable or unwilling to serve in that capacity, I nominate, constitute and appoint my three (3) daughters, DENISE J. BOWMAN, SANDRA A. MARTINI and DONNA L. GREY, or the survivor of them, to be Co-Executrices of this, my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~day of F_~£U~./ , A.D. 1982. ~61if~ord nj Gr0~ (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by Clifford L. Grey, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, all being present at the same time, have subscr~b~d~ur_/~ames as witnesses. ~'~ L ~~'~"~ //-Address: ,. ~q~ ...... . ~ 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 REV 1162 EX(11 96) NO. CD 004259 MARTINI SANDRA A 26 BENTLEY PLACE CARLISLE, PA 17013 fold ESTATE INFORMATION. SSN: 207 031658 FILE NUMBER: 2104-0481 DECEDENT NAME: GROY CLIFFORD L DATE OF PAYMENT: 08/11/2004 POSTMARK DATE: 08/11/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,555.00 TOTAL AMOUNT PAID: $7,555.00 REMARKS: S D MARTINI SEAL CHECK# 993 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURNIleF,LE.UM.E. 21-04-0461 RESIDENT DECEDENT O. CODE' NUM"" ~ECEDENT~S NAME (LAST, FIRST, AND MIDDLE INITIAL) Clifford L. Groy SOClAL SECURITY NUMBER 207-03-1658 DATE Of BIRTH (MM-DD-YEAR) DATE OF DEATH (MM-DD-YEAR) 5/16/2004 : APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE Wll~H THE REGISTER OF WILLS Robert G. Frey FIRM NAME (tf Applicable) [~2 Supplemental Return [~4e. Future Interest Compromise (date of death after 12-12-82) [~7, Decedent Maintained a Living Trust (Attach copy of Trust ) COMPLETE MAILING ADDRESS 5 South Hanover Street Carlisle, PA 17013 [~11. Election lo tax under Sec, 91131A) (At[ach Sch O) 717-243-5838 1. Real Estate (Schedule A) 11) 2 Stocks and Bonds (Schedule B) (2).NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NON E 4. Mortgages & Notes Receivable (Schedule D) (4).NONE 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) 16) NONE [~Sedarate Billing Requested 7 Inter-Vivos Transfer & Miscellaneous Non-Probate Property (Schedule G or L) (7) 8. TOTAL GROSS ASSETS (total Lines 1-7) 9. Funeral Expenses & .N:lministraflve Costs (Schedule H) (9) 90,000 51,738 45,434 18). 187,172 10,898 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) [10) NONE 11. TOTAL DEDUCTIONS (total Lines 9 & 10) 111 ) 12 NET VALUE OF ESTATE (Line 8 minus Line 11 ) 112). 13. Chadteble and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 113). 14 Net Value Subject to Tax (Line 12 minus Line 13) 114). 10,898 176,273 176,273 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)11.2) x .0 115) 16, Amount of Line 14 taxable at lineal rate 176,273 x .0 45 116) 17. Amount of Line 14 taxable at sibling rate x .12 117) 18. Amount of Line 14 taxable at collateral rate x .15 118) 19. Tax Due 119) 7,932 7~932 217 Clifford L. Gray 207-03-1658 Decedent's Complete Address: STREET ADDRESS 443 Mill Race Road CITY Carlse STATE ZIP PA 17013 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2 Credits/Payments A. Spousal Poverty Credit B Pdor Payments C. Discount 7,555 378 (t) Total Credits ( A + B + C ) (2) Interest/Penalty if applicable D. Interest E, Penalty Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If line I + 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, (5B) M~k~ Chec~ Payablo to: ?EGISTER OF WIL~L$, 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 progerty transferred; ........................ [] [] b. retain the dght to designate who shall use the property transferred or its income; ............. L~ ~ c. retain a reversionaP/interest; or ................................ [~] ~ d. receive the promise for life of either payments, benefits or care? .................. I ~ ~ 2. If death occun'ed after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ............................. [] [] 3. Did decedent own an "in t~ust for'' or payable upon death bank account or security at his or her death? ...... L.-J ~ 4. Did decedent own an Individual Retirement Account, annuity or other non-probafe property which contains a beneficiaP/designation? ................................ [] [] IF THE ANSWER TO ANY OF T~IE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 7,932 7~933 1 Under panagies of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the bas{ of my knowledge and belief, i[ is true, and corollate. I~ectaration of preparer other than the personal rep,'esenta0ve is based on all informeftan of which preparer has any knowledge. 26 Bentley Place, Carlisle, Pennsylvania 17013 For dates of death on or after duly 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 spause is 3% [72 P.S. Section 9ff6 (a)(f.l){i)]. For dates of death an or after January 1.1995, the tax rate imposed on the net value of transfers to or for the use of the SL~rviving spouse is 0% [72 P.S. Section 9116 la)(1,1 )(ii)] The statute does not exempt a {ransfer to a sur~ving spouse from tax. and the statutory requirements th~ disclosure of assets and filing a tax return are still applicable even if the sunawng spouse is the only beneficiary, For dates of death on or after July 1, 2000: The ~x rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or far the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%[72 P.S, Section 9116(a)(1.2)] The tax lite imposed on the net value of transfers to or for the use of the decedenfis lineal beneficiaries is 4.5%, except as noted in 72 P.S, Section 9f 16(1 2) [72 P.S. Section 9116(e)(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, Section 91 f 6(a)(1.3)] ,A sibling is dedned, under Section 9102, es an individual who has at least one parent in common with the decedent, whether by blood or adoption, DATE December~...~2004 DATE December /..~, 2004 AT R;EV-1502 EX'+ (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Clifford L. Groy 21-04-0481 ALL REAL PROPERTY OWNED SOLELY or AS A TENANT IN COMMON MUST BE REPORTED AT FAIR MARKET VALUE. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. REAL PROPERTY WHICH IS JOINTLY-OWNED WITH RIGHT OF SURVIVORSHIP MUST SE DISCLOSED ON SCHEDULE F. ITEM NUMBER DESCRIPTION Condominium unit: 443 Mill Race Road, Carlisle, Pennsylvania, see HUD-1 settlement statement attached. VALUE AT DATE OF DEATH 90,000 TOTAL (Also enter on line 1, Recapitulafion)~ 90,000 (If more space is needed, insert additional sheets of the same size) 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Clifford L. Groy FILE NUMBER 207-03-1658 This schedule must be completed and filed if the answer to any of questions 1 throul h 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM iNCLUDETHENAMEOFTHETP. ANSFEREE, Tt4EIRRELATIONSHIpTODECEDENTANDTHEDATEOF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE' VALUE OF ASSET INTEREST <~F ~uc*~) VALUE 1. l'ransamerica Annuity # 02SFD030469 37,354 100.00% 37,354 2. 2003 Buick Century. See Bluebook valuation attached 11,080 100.00% 3,000 8,080 TOTAL (Also enter on line 7 Recapitulation) $ 45,43, (If more space is needed, insert additional sheets of the same size) 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Clifford L. Groy 21-04-0481 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. 8. 9. FUNERAL EXPENSES: Kreamer Funeral Home Funeral Luncheon and Honoraria ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: State Attorney Fees Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Zip City State Zip Relationship of Claimant to Decedent Probate Fees Accountant*s Fees Tax Return Preparer's Fees Expenses associated with real estate held for sale Final medical expenses Expenses associated with real estate held for sale included w/atty fee included w/atty fee 3,028 452 4,000 261 1,127 665 1,365 TOTAL (Also enter on line 9, RecapitulationI $ 10,89,~ (If more space is needed, insert additional sheets of the same size) 217 REV-1513 EX + (9430) CO MMON'v~EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Clifford L. Groy FILE NUMBER 21-04-0481 NUMBER 1. 2. 3. II. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Sandra A. Martini 26 Bentley Place 3arlisle, PA 17013 3enise J. Bowman 1046 East Main Street ~,nnville, PA 17003 Z)onna L. Wike 1040 East Main Street ~,nnville, PA 17003 33.33% Daughter Daughter Daughter AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18~ AS APPROPRIATE~ ON REV-1500 COVER SHEET ~ION-TAXABLE DISTRIBUTIONS: SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ). CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 33.33% 33.33% (If more space is needed, insert additional sheets of the same size) Medical Expenses Carlisle Regional Medical Center Spring Road Family Practice West Shore EMS Pinker Assoc. Vascular Assoc. CV Nephrology Assoc. Spring Road Family Practice 306 10 71 21 14 132 111 Total Medical Expenses 665 Expenses Associated with Real Estate Monthly Condominium fee Vapor jet carpet cleaner PP&L PP&L Expenses from HUD-1 settlement statement 75 117 24 22 1,127 Total Real Estate Expenses 1.365 , AT REV-1508 EX ~- (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Clifford L. Groy 21-04-0481 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Wachovia Account No. 247402050612147 accrued interest on above account Wachovia Account No. 247402041329307 accrued interest on above account Wachovia Account No. 247402062416944 accrued interest on above account Wachovia Account NO. 1000302577667 accrued interest on above account Wachovia Account No. 1010080652548 accrued interest on above account Real estate tax and condominium fee proration. See HUD-1 settlement statement. Comcast cable refund 10,000 99 1,013 3 1,012 3 12,790 1 26,624 17 151 25 TOTAL (Also enter on line 5, RecapitulationI $ 51,73~3 (If more space is needed, insert additional sheets of the same size) 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Clifford L. Gray 21-04-0481 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. 8. 9. FUNERAL EXPENSES: Kreamer Funeral Home Funeral Luncheon and Honoraria ADMINISTRATIVE COSTS: 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: Attorney Fees 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 Accountant's Fees Tax Return Preparer's Fees Expenses associated with sale of real estate (see HUD-1 settlement statement) Final medical expenses Expenses associated with real estate held for sale 3,028 452 4,000 261 included w/arty fee included w/arty fee 1,127 665 1,365 TOTAL (Also enter on line 9, Recapitulation', $ 10,898 (If more space is needed, insert additional sheets of the same size) June 9, 2004 Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 Estate of Clifford L Groy c/o Frey & Tiley 5 S Hanover St Carlisle PA 17013 RE: Annuity Number(s) 02SFD030469 Dear Estate of Clifford L Groy: Our office has received your request concerning the above listed non- qualified tax deferred annuity. The value as of May 16, 2004, the date of death, was $37,354.22. interest portion of this amount is $4,354.22. According to our records this was the only annuity for Clifford L Groy with our company. The Any additional questions regarding this annuity can be directed to the Annuity Service Center at 800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, Glynda Harman Transamerica Life Claims Insurance Company M~, of ~h~ ~ONo Group WACHOVIA Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 922998 June 2, 2004 FREY & TILEY ATTORNEYS AT LAW 5 SOUTH HANOVER STREET CARLISLE, PA 17013 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: CLIFFORD L GROY (SSN# 207-03-1658) Date of Death: May 16, 2004 Deposit Account Information Account Account Date of Death Average Date Maturity Interest Accrued Type Number Balance Balance* Opened Date Rate Interest CERTIFICATE OF DEPOSIT 247402050612147 $10,000.00 3/4/1999 3/4/2007 $99.15 LEGAL TITLE: CLIFFORD L GRO¥ YTD Date ~restPaid Closed $246.06 CERTIFICATE OF DEPOSIT 247402041329307 LEGAL TITLE: CLIFFORD L GROY CLOSING BALANCE: $1015.59 $1,012.59 9/14/2000 $2.82 $4.00 5/21/2004 CERTIFICATE OF DEPOSIT 247402062416944 LEGAL TITLE: CLIFFORD L GROY CLOSING BALANCE: $1015.26 $1,012.00 3/8/1985 $3.09 $3.99 5/21/2004 CHECKING 1000302577667 LEGAL TITLE: CLIFFORD L GROY SANDRA A MARTINI - POA CLOSING BALANCE: $12791.74 $12,790.49 12/10/1982 $1.10 $3.10 5/21/2004 CHECKING 1010080652548 LEGAL TITLE: CLIFFORD L GROY CLOSING BALANCE: $26643.40 $26,624.30 7/23/2003 $16.92 $66.51 5/21/2004 ANNUITY * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Date of Balance Date Date Number Opened Closed TASESO2SFD030469 2/28/2002 Ledger Collected 0000 000614 WAC I--IO~fL~k LEGAL TITLE: CLIFFORD L GROY BETTY J GROY TRANSAMERICA - For information regarding annuities, please call 800-641-6804 Re~rencelD:922998 No Safe Deposit Box found for customer. * Date of death balance does not include accrued interest. * If d~'~eath occurrs on a weekend or a holiday, date of death balance does not include any transactions that were ~~~~~~ng tha o i period . Phone: (540)563-7323 abs; ag 0000 000614 BLUE BOOK PRIVATE PAR'iT REPORT Pennsylvania. Juno 23, 2004 ~ ~.U~I,.~K' 2003 Buick Century Sedan 4D Engine: V6 3.! Liter Trana: Automatic DHve: Front Wheel Drive Mileage: 3,599 Search Listings for This Car List Your Car For Sale Online Buy a New Car Free Lemon Check Auto Loans from 3.85% APR Insurance Quote Print "For Sale" Sign Payment Calculator Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel AM/FH Stereo Dual Front Air Bags Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Host recent model cars owned by consumers fall into this category. Private Party Value Search Local Listings for This Car $1t,080 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value Get Invoice & MSRP on New Cars Get a Person to Person Auto Loan Copyright © 2004 by Kelley alue Book Co., All Rights Reserved. Hay-Jun 2004 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular c~rcumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the Individual use of the person generating this report only and shaft not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.(v.04057) LAST WILL kND TESTA3iENT I, CLIFFORD L. GROY, of the Borough of Palmyra, County Of Lebanon and Commonwealth of Pennsylvania, being of sound mind, do hereby declare this to be my Last Will and Testament, hereby revokin~ all Wills or Codicils by me at any time heretofore made. I direct security ARTICLE I I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. ARTICLE II All the rest, residue and remainder of my estate, real, personal or mixed, wheresoever situate, ~ give, devise a~d bequeath unto my beloved wife, BETTY J. GROY, to be hers absolutely. ARTICLE III In the event that my beloved wife has predeceased me, or in the event that she and I die in a common disaster, then I give,~ devise and bequeath all the rest, residue and remainder of my estate,! real, personal or mixed, wheresoever s!tuate, in three (3) equal shares, share and share alike, unto my three daughters, DENISE J. ~.O. WMAN, SANDRA A. MARTINI and DONNA L. GROY. In the event that either of my three daughters has predeceased me, I direct that that daughter's share shall be received by the surviving daughters~,I that my Executrix shall not be required to enter in any jurisdiction in which she may act. ~ ARTI C~E V I nominate, constitute and appoint my beloved wife, BETTY J. GREY, to be Executrix of this, my Last Will and Testament. In the event that she is unable or unwilling to serve in that capacity, nominate, constitute and appoint my three (3) daughters, DENISE J. BOW~4AN, SANDRA A. MARTINI and DONNA L. GROY, or the survivor of them, to be Co-Executrices of this, my Last Will and Testament. this IN WITNESS WHEP~OF, I have hereunto set my hand and seal lC day of F~_~/~ , A..D. 1982. /~lifford L, Gr~ (SEAL) SIGNED, SEALED, PUBLISHED and DECLAPd~D by Clifford L.' Grey, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, all being present at the same time, have subscri:b~d ~ur~ames as witnesses. ..__~ '~ Address: REV-1500 EX + (6~OO) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST,AND MIDDLE INITIAL) Huntsber er Robert DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 206-32-1172 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE OFFICIAL USE ONLY 21-03-0481 NUMBER REGISTER OF WILLS SOCIAL SECURJTY NUMBER X 1. Original Return 4. limited Estate 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12.-12.-82.) 7. Decedent Maintained a Living Trust (Attach copY of Trust) 3. (date of death . Remamder Return prior to 12~ 13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 010. Spousal Poverty CredIt 0 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Seh O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS CopyrIght (e) 2000 form software only The Lackner Group, Inc. (Attach copy of Will) o 9. litigation Proceeds ReceIved 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER R E C A P I T U L A T I o N 249-2353 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule S) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Sch~dule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate SiUing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G ar L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (10) 11. Total Deductions (tatal 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) (1) (2) (3) 41,500.00 None None 1""\,) ()"l (8) 45,420.23 (11) 32.653.45 (12) 12,766.78 (13) (14) 12,766.78 (15) (16) (17) (18) (19) 0.00 574.51 0.00 0.00 574.51 (4) (5) None 2,539.64 (6) 1,380.59 None 19,195.45 13,458.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX 1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 12,766.78 0.00 0.00 x X X X o 0 .045 .12 .15 FormREV-1500 EX (Rev_ 6-00) Decedent's Complete Address: STREET ADDRESS 2199 Pine Road CITY I STATE I ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 574.51 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 30.76 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. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 30.76 0.00 605.27 0.00 605.27 """"":':;':;i:;'HHi:!i!i:iji::::::i:i:::::'i>"" !lli~,!! i~~m~~i~ii!~i~~~i~!ii~~~!'~L~2,~~mm!i:i Ves No ~~ Did decedent make a transfer and: 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 G AND FILE IT AS PART OF THE RETURN. D D D ~ ~ ~ Under penaltles 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. S,IGNATU":JE OF ~ERSON RESP.ONSIBLE FOR FILING RETURN Bobby J. Huntsberger 1123 Centervi11e Rd - - -Ne;;';;iiie-,- - PA - - i "i2"i- - - - - - - - - - - - - - - - - - - - - - - - - -- SIGNATURE OF"' IRWIN McKNIGHT & HUGHES 60 West Pomfret Street - - -Car i-{sie-; - PA - - i "i6i3 - - - - - - - - - - - - - - - - - -. - - - - - - -- DATE surviving spouse is 3% [72 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) (in]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(0)(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) 2000 form software oniy The Lackner Group. inc. Form REV-1500 EX (Rev. 6-00) REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert L. Huntsberger SS# 206-32-1172 04/11/2003 21-03-0481 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledae of the relevant facts. Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 2199 Pine Road, Newville - SOLD - 1/2 Interest with Ruth A. 41,500.00 Graver SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 41,500.00 (If more space is needed, insert additional sheets of the same size) Copy tight (c) 1996 form software onlyCPSystems, Inc. Form REV-1502 EX (Rev. 1-97) REV-1S08 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert L. Huntsberger SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SS!I 206-32-1172 04/11/2003 FILE NUMBER 21-03-0481 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Orrstown Bank - Certificate of Deposit VALUE AT DATE OF DEATH 2,522.86 2 Patriot Federal Credit Union - Prime Share Account 554420 16.78 TOTAL (Also enter on line 5. Recapitulation) $ 2,539.64 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAA RETURN RESIDENT DECEDENT ESTATE OF Robert L. Huntsberger SCHEDULE F JOINTLY-OWNED PROPERTY 55!ft 206.32 -1172 04/11/2003 FILE NUMBER 21-03-0481 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Bobby J. Huntsberger ADDRESS 1123 Centervi11e Rd Newville, PA 17241 RELATIONSHIP TO DECEDENT son B. c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY %QF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF account number or similar identifying number. NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 08/23/96 Orrstown Bank . checking 2,761.18 50.00% 1,380.59 account TOTAL (Also enter on line 6, Recapitulation) S 1,380.59 T (If more space is needed insert additional sheets of the same size) Copyrlght(c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1511 EX +(1-97) ESTATE OF Robert L. Huntsberger COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS SS# 206-32-1172 04/11/2003 FILE NUMBER 21-03-0481 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Ewing Brothers Funeral Home 7,115.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions 2,975.00 Name of Personal Representative(s) Bobby J. Huntsberger Social Security Number(s) I EIN Number of Personal Representative(s) 184-54-3480 Street Address 1123 Centerville Rd City Newville State PA Zip 17241 - Year{s) Commission Paid: 2. Attorney's Fees IRWIN McKNIGHT & HUGHES 2,975.00 3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) 3,500.00 Claimant Ryan Huntsberger Street Address 2199 Pine Road City Newville State ~ Zip 17241 Relationship of Claimant to Decedent Son 4. Probate Fees Register of Wills 43.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 250.00 7. Other Administrative Costs 1 Central Penn Appraisals Inc. 200.00 2 Closing Costs 1,991.95 3 Cumberland Law Journal - Estate Notice Publication 75.00 4 Register of Wills - Short Certificates 7.00 5 Register of Wills - Fil ing Fee 25.00 6 The News Chronicle Co. - Estate Notice Publication 38.50 TOTAL (Also enter on line 9, Recapitulation) $ 19,195.45 (If more space is needed. insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, 1m;. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Robert L. Huntsberger SCHEDULE I DEBTS OF DECEDENT, MORTGAGE liABiliTIES, AND liENS SSfJ 206 - 32 -1172 FILE NUMBER 21-03-0481 04/11/2003 Include unreimbursed medical expenses. ITEM NUMBER 1 Andorra Radiology Assoc. 10 11 12 13 14 15 16 17 18 DESCRIPTION Medical AMOUNT 724.00 2 Blue Mountain Anesthesia Medical 126.00 3 Carlisle Digestive Disease Associates - Medical 29.39 4 Carlisle Regional Medical Center 423.79 5 Central Penn Medical Group - Medical 576.00 6 Chambers burg Imaging - Medical 6.06 7 Cumberland County Tax Claim Bureau 970.69 8 First North American National Bank Credit Card 2,918.20 9 Forest Park Health Center - Medical 136.00 Lancaster HMA Phys. - Medical 1,078.74 Mable G. Stitt Tax Collector 919.88 Masland Associates - Medical 12.70 MBNA America - Credit Card 3,629.41 Moffitt Heart & Vascular Group - Medical 66.96 Rehab Medicine Associates - Medical 109.84 State Farm Insurance Fire Policy 2003 762.00 State Farm Insurance Fire Policy 2004 804.00 Three Springs Family Practice - Medical 164.34 TOTAL (Also enter on line 10, Recap"ulation) $ 13,458.00 (If more space is needed, insert additional sheets of the same size) Copyrlght{c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX t (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Robert L. Huntsber~er NUMBER I. SS!! 206-32-1172 04/11/2003 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116{a)(1.2)] Bobby J. Huntsberger 1123 Centervi11e Road Newville, PA 17241 Son FILE NUMBER 21-03-0481 AMOUNT OR SHARE OF ESTATE 1/2 Remainder 1/2 remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2 Ryan Huntsberger c/o Nancy Shearer 2199 Pine Road Newville, PA 17241 Son TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 Form REV-1513 EX (Rev. 9-00) 01/20/2005 11:55 71 72431850 MDWO PAGE 02/03 ~.~ OMB NO. Z50Z-0265 ..r B. TYPE F LOAN: ,. 1.oFHA 2.nFmHA 3.DcONV. UNINS. 4.nVA 5. DCONV. INS. I.S. DEPARTMENT OF HOuSING & URBAN Dl:VELOPMENT 6. ;~~~.t'~~~~~~ J7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUM6ER: ~. NOTE: ThIs form is furnished to give you a statement of ~ctuClI settlement costs. Am,!unt$ pa~d to and by the settf"menl ~gBnt ara. shown. Items marked 'TPOC)" we/9 paid outside the cJosmg' they ani' shown h6fQ for mformatlonal purposes and are not Includad In the totals. I 1,0 3.lee (1145f1.1.HUR&T.PFDI1'4~6,UiURsr/1\l1 ). NAME AND AODRESS OF BORROWER: E. NAME AND AODRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: !lJvln N. Hurst and Robert L. Huntsberger Estate and =.llen M. Hurst Ruth A. Graver 96 Station Road ~.",,"II., PA 17241 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATe: 2199 Pine Road Martson Deardorff Williams & Otto Newville, PA 17241 January 25, 2005 Cumberland CounlY, Pennsylvania F'LACE OF SETTLEMENT 10 East High Street Carlisle. PA 17013 . SUM MY OF SELLE~'S~ NSACTI N J. SUMMARY OF B RROWE 'S TRANSACT ON 101. ContractSalesPr;ce 83.000.00 401. Con....c. Saleo f>nce 83.000.00 102. Personal prol'.lQrtv 402. f>ersonal F'roDertv 103. Settlemant Chames to Borrower ILln.14001 1.654.35 403. 104. 404. 105. 405. v 105. Countv/Two. Taxos to 405. Coun wn, Taxes to 107. School Taxes 01/26/05 to 07/01105 393.04 407. Sohool Taxes 01125105 to 07/01/05 393.04 108. Assessments to 408. Assessments tc 109. , 409. 110. 410. '11. 411. 112. 412. 120. GROSS AMOUNT DUE FROM SORROWER 65,047.39 420. GROSS AMOUNT DUE TO SEU.ER 83.393.04 200. AMOUNTS PAlO BY ORIN BEHALF OF BORROWER: SOD. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deoosit or earnest monev 8.300.00 501. Exces. Denosit IS.. InstrucuonSl 202_ Princiosl Amount of New Loan(s 502. Settlement Chames tc SellerQine 1400\ 1.977.17 203. ExistinD loanls\ taken subiect to 503. ExisUno loanls\ lai<el1 subieel to 204. 504. F'ayoff of first Mortgage 205. 50S. Pa ef second Mortcatl8 206. 506. 207. 507. CDeMsi! disb. as ',ooeeds' 208. 508. 209. 509. .ustments r sms Un(Jsi~ . Br 'ustmems rltems n idS e .r 210. Counht/T"". Taxos 01101/05 to 01/25/05 14.78 510. CounhtlTwo. Taxes 01/01/05 to 01/25/05 14.78 211. Schoal Taxes to 511. School Taxes to 212. Assessments to 512. Assess.ments tc !213. 513. 214. 514. .215. 515. 216. 515. 217. 517. 218. 518. 219. 519. 220. TOTAL PA/D BYIFOR BORROWER 8,314.78 620. TOTAL REDUCTION AMOUNT DUE SELLER 1.991.95 300. CASH AT SETTLEME FROMrrO BOR WER: 600. CASH AT SETTLEMENT O/FROM SE LER: 301. Gross Amount Due From Borrowerh.lne120' 65,047.39 601. Gross Amount Due To Seller 'Line 4201 83,393.04 302. L.ess Amount PaId Bv/For Borrower (LIne 220) ( 8,314.78) 602. Less Reductions Due Seller iLine 520) ( 1,991.95 303. CASH ( X FROM ( TO) BORROWER 7S 732.61 503. CASH ( X TO)( FROM! SELLER 81,401,09 The underslsned hereby acknowledge I'ecelpr. of a completed copy of pages 1 &2 of this statement & any attachmanlS referred ro hereIn. Borrower Seller Robert ~, Huntsbe'ller Estate AI.;n N. Hurst !;.lIen M, Hurs[ Ruth A. Graver 01/20/2005 11:55 71 72431850 MDWO PAGE 03/03 . - ~- L.. SETTLEMENT CHARGES DO. TOTAL COMMISSION B_d on Price . Oil ... PAID FROM PAID FROM Oivlsion of Commission 'lins 700) as P~/Jcws; 80RROWS-R'S SEU.eFl'S 01,$ 10 FUfIIOS A. T FUNOS"T 02. $ to SEmEMENT S~E~NT 03. Commission PaId at Settlement - 04. ~ to IOn ITEMS P,i\VMiLE IN C ION H LOAN ~01. loan Orialnatlon Fee 0.0000 to ,02. Loan Discount % to 103. Appraioal Fee to 104. Credit Report 10 105. L.nde~s Inspec:tion Fee 10 m6. Mor\Qane Ins. Ann, Fee to m7. Assumption Fee to ~O8. l09. l10, l11. O.IT RE"UIR , BY LEND n BE paIn IN ADV :xl1. Interest From to @ $ Id.y { days o/,} ,02. Mo a e Insurance Premium for months to 903. Hazard Insurance Premium fer 1.0 ""'r! to 904. 305. ~ 1 nno. VES D 0 WITH I "NDER 1 001. Hazard Ins\lrance $ "'" 1002. MormaJJ8 Insurance $ er 1003. Counfu{T~. Taxes $ er 1004, School Taxes $ ner 1005. Assessments , @ $ per 1006. $ r 1007. @ $ per 1008. .,;, $ ner 1100. HAR 1101. Setuement or Closlno Fee 10 1102. Abstract or nUe Search to 1103. T'rtIe Examination 10 Niven J. Baird 130.00 1104.lnherilanceTaxes to Estate of Robert L Huntsbe"'e and Ruth A. Graver 212.56 1105.2004-05 DelinauentSchool Tax 10 Cumberland Countv Tax Claim Bureau 934.61 1106. Attorne.. Fe.. to Martson Oeardorff Williams & Otto 440.00 , 107. Attorneis Fees to Irwin & McKnight POC t;ncJudes above item numbers: ) 1108. Title Insurance to (includes above item numbsrs: I ! 1109. Lender's Ccver'age $ 11110. Owne!", Coverage $ 11111. 1112. 1113. RDIN" AND T N"FER c~ 1200. GOVERN MEN' 1201. Recordin9 Fees; Deed $ 38.50; Mortgage $ ; Releases $ 38.50 1202. CitvlCounlvT.xJStam : Deed 630.00' Monn.ne 830.00 1203, State TaxlStanms: Revenue Stamns 830.00; Mo""a"e 830,00 1204. 1205. 13 DITIOIIAL ~ ENT HARG 1301. Survey to 1302. Pest Insnection 10 1303, 1304. 2005 CounlvrTcwnshio TllXes to Mable G. stitt 31-12-0328-024 215.85 1305. 1400. TOTAL SCTTLEMENT CHARGES (Enler on Lines 103, Seellon .I and 502, SeclJon Kl 1.654.35 1,977.17 ey signing pagE: 1 of tnis $larement, the signalories acknowledge receipt of a completed eopy of page 2 of this two psge staleme"t Martson Deardorff Williams & Otto $etuement Agent Certified to be a true copy. ( 111156.1,HU~S"'1114l)6.1.HURST /10) l3oo(\, tfJ. <<'I ;:;"';617 loge, P-UI-A.T-W.rn.atJ' 0..1. Shoon Fc:rrm. Act tit Jlot--ArTlll,.,J lor f'hoto-Rl!cordln. H.nrr Hall. Ino.. Iadl&.a&. P.. ijJbi~ 1Sttb, 'j i I I ! , MADE THE 10 th of our Lord one thouaand nine hundred riayof JanClnry si:-.ty four (lSl64) In the year . BETWEEN DOHOTHY M. KECK, now DOROTHY M. MARKLEY, in her right, and HICHARD A. MARKLEY, her husband, of Penn Township, Cumberland County. Pennsylvania, parties of the first part, D1VdYWd fl~/f~tors,. and HOBERT L. l/UNTSBEltGER and RUTH A. HUNTSBERGER, hus13and and wife, of Penn Township, Cumberland County, Pennsylvania, parties of the second part, Grantees WITNESSETH, that in COflBideration of . -One ($1.00) - Do/wrs, in hand paid, the receipt whereof is hereby acknowledged, tke said grantors do hereby grant a1lft eonvell to the said grantee s, their heirs and assigns, as tenants by the entireties, ALL that certain tract of land situate in Penn Township, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at an iron pin in the intersection of the Pine Hoad and the public road leading from Hays Grove to the Walnut Bottom Hoad; thence along said road, Northwardly, Two Hundred Ninctcen and One - half (21 n 1/2) feet, more or less, to a point in line of lands of W. p. Donovan; thence along said Donovan lands, East- wanlly, Threc IIUl\(lrt~d Seventy-five and O.w-half (375 1/2) feet, morc or less, to a point at corner of lands of this trad, said Donovan traet, and lands now or formerly of George W. lIays; thence along said Hays land, Southwa.rdly One Hundred Ninety-four (UJ4) red, marl! or less, to an iron pin in said Pine Road; thence along th" Pin" Hoad, Westwardly Three lIundred Eighty-three (383) feet, more or less, to the Place of BEGINNING, CONTAINING One and One-half (1 1/2) Acres, more or less, and having thereon el','cted a 2 1/2-story frame dwelling house, barn, chicken house and other outbuildings. BI';ING Uw dame p1'op"r\.y which Robert Glenn Highlands and 1I"lcn ~laril! lJir:hlands, husband and wife, by their deed bearing da\<, the 10th day of l\1arcl1, lOGO, said deed being recordcd in the Office of the Heeonler of Deeds in and for Cumberland \OtHlty at" ('3Tlislp. Pl'nl1.syJvn~iaJ in Di'ed Rook 11[{.ll, Volume 1 H, Page 55~i, granted and conveyed to Dorothy 1\1. Keck. THE said Dorothy 1\1. Kcck intermarricd with Hichard A. Markley on the 12th ciav of il.lt,:'.l"t . 196L. AND, the 8air! urantors, du hereby covenant and agree. to and with the said grantees, that lI\(,y , the grantors, t/J"irheirs, executors and adminutrat01"s, shall and wilt waffam gl.'neraUy and forever defend the herein abot'e described prcmt.'fe", with the hereditaments and appu.rtenaneea, unto the said grantee s, their heirs and a.,aiUnB, againat the said urantor s, and auainst every other person IawfuU1I claiming or whu shall hereafter claim the same 01" any part therrof. IN WITNESS WHEREOF, said grantors ha ve hlTeunto let their the d411 and 1Iear {irst above written. hand 5 and SM!; , , I I , ! I 1 .; , , I I I &Ign.~, lih.I.~ ."b D,II.n,b I In I~' 1I.."mlt .1 \ . . J ., .' ~~0':(~:~:::\ } j., ') !' ," ; . ". ./. /" .'" . ~ ~ . 'l.:/""- ."", "(.'" '.' -/'.. ~ . ........nJ..".Tio..roti,y.}ir:n.Ktj.,J,.......n..n.n:...n........ SEAL ,. ....,)) F. ~ II " ,-,. ',' 1.' ,I.' _'~~, /< 1/ :;.----~ ........ .n.n"rfO';~t liy"'Kt...~ i'u.r'iileY".'.... '<."'''l..w S S A I, i . - /. , . " '.. ~ .....n.n.~.....f~~~~~r-it/~~'*Nt'nn.................. ~ ........u.............~nu~__............._._..._...~......_....n.._............ ~ State of }S8' Cuuntyof CUMI3l"HLAND On this, the 10th day of Jonunry a ~;;)t[lr~,1 PLl~:l.lc r(".lt(~ln ~ ~n !-l~_i. ccunty, the under8igned officer. per801Ullly appeared Dorothy M. Keek, in her right, and Richard A. Markley, her husband, I'ENNSYL VANIA ,l9f,4 ,before me, now Dorothy 1\1. Marklef, k.lOwn to me (or 8atisfacI1,'i/1I proll.n) to be tire per80ns within instrument, and aclmowledg.<1 that they contained. wh08e name s are 8ubscribed to tile executcd 8ame for the purposes therein ...,..i1l1J'!.WITNESS WHEREOF. 1 hercunto set my hand and official seal. 6'.~~,.,.~,:~~,{, .-., ." ORRSTOWN BANK TO: Law Offices Irwin McKnight & Hughes 60 West Pomfret Street Carlisle, PA 17013 , " ,,ic~ i >,,-. ); FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Robert L Hunstberger DECEASED DATE OF DEATH: April 11 , 2003 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD. ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED 412090 Robert L Huntsberger 8/23/96 Bobby J Huntsberger DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 2,761,18 DATE OF DEATH ACCOUNT NO, TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST SAVINGS ACCOUNT (3) CERTIFICATES OF DEPOSIT ACCOUNT NO, TITLE OF ACCOUNT DATE OPENED 4000000406 Robert L Huntsberger 10/25/02 DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 2,520,54 2,32 Date: 5/5/03 By: Timothea Customer Service Operator P,O, BOX 250 SHIPPENSBURG, PA 17257 TEL, (717\ 532-6114 February 17, 2004 ~~~~uw~~ FEB 20 2004 lRW1N & McKNiGHT Irwin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, P A 17013-3222 RE: Estate of Robert L. Huntsberger Dear Mr. McKnight: I am writing in response to your request for date of death values on the above referenced member. This account was owned individually. Account Date of Death Accrued Interest to Date Accouut 554420 Principal DOD Opened Prime Share (00) $16.78 $0.00 2-20-1974 There was no change in ownership for this account and no accounts were closed within one year of the date of death. If you have any questions with regard to the above balances, or need additional information, please feel free to contact me at 263-4444, extension 4144. Sir\relY, ~ /Vi t1i~1 Dixie Kelley Manager of Admin. strative Services SOO \Vayne Avenue, Chamhersburg, PA . (717) 263-4444. Mailing Address: P.O. Box 778, Chambcrshurg, PA 17201-077R Ewing Brothers Funeral Home Since !853 63!) South Hanover Street CJrlisle, PA 17013-4103 (717)243-2421 Sl.:ymeur A. E\-ving, FD Willi<:im M. Ewing. FD Sf''':VClI A. Ewing, FD .\;:,ril ~.~, 200] F~ohby J. Huntsoergt'J' i ;23 C\:llkrville Rd. ;~('w\'ille, PA 1724 I ! he Funeral Service for Roher.. L. Huntsberger \,)v'e sincerdy appreciate the contidence you have placed in us and will continue to assist you in every way we can. Pkr:lse kd free to contact us if you have any questions in regard to this statement. C',IE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQU[PMENT, A \:0 MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. L PRO.-ESS10:'IAL SERVIO:S StT',1iCr:~' of Ft:llcraJ DiiectoriStatf fUNERAL flOME SERVICE CHARf;':S SELECTED MERCHANDISE: SoliJ !-\;pbr ~"lilhogany fini"h 5 Ref;. Vault TIlE COST OE OUR SERVICES, EQUIP.\IENT, A:'<D MERCHANDISE THAT YOU IIA VE SELECTED ,-;- THE TI:VIE fUNERAL ARRANGEMECJTS WERE MADE. WE ADVANCED CERTAIN PA YMENTS TO OTHERS AS ,\N '\CCO~IMODAT!ON. THE FOLLOWINC; IS AN ACCOUNTING FOR THOSE CHARGES. CASH i~OV.\NCES $332j,OO S3325,~O ~::'5DO.no 5925.0\1 $~)750.fiO '..)pelling GrJ\'1: C\"r:ificu C')pi~s or,hc Dt:atil C~:rtiril.:atc TOTAL CASH ADVANCES A';D SPECIAL CHARGES $.~2j_l'~J S-l~).{)O SJ(;5.0n .;;e. ih~: .~t,H~~lr,~:H is lwt a:1d payable in full on or b...~fcrt" ~\I!:..ty !!:.2tlOJ. SUB-TOTAl [NIT[AL PA YMENT / D[SCOUNT I CRED[TS TOTAL AMOlJNT DlJE $71 [S.UO $7115,O(J Member of National Funeral Directors Association 695 Rancocas Road Wcstampton, 1\J OX060 Return Service Requested Phillips and Cohen Associates, Ltd. Ph (302) 355-3500 Fx (302) 36X-0970 03/01/0.\ Office Hours Ivl - Th 8am - 9pm Fri: Xam - 6pm Sat: Xam-12pm ROBERT L HUNTSBERGER 1123 CENTERVILLE RD NE'NVILLE PA 17241-9554 1..,1/1..,1../.1,1"1,..11/,1...1.1..1,1..1,,1,,/,1..11,1,,,1/ Phillips and Cohen Associates, Ltd 695 Rancocas Road Westampton, NJ 08060 1/1",1,,1,1/,..,1/..1/,../,1..,1,1..,/,1/ Aecount#: 4053550012626877 Balance: $2918.20 H* PLEASE DETACH .'\..:'-:0 RETCRX G'i THE EI\jCLOSED EXVELOPE WITH 'lOCR Pi\. YME:\T *"'* Re Client: ECAST SETTLEMENT CORP Original Creditor: Fleet/Circuit City Original Acct#: 4053550012626877 Our File #: 2119163 Balance: $2918.20 Dear The Estate of ROBERT L HUNTS BERGER Our client ECAST SETTLEMENT CORP, now 0\\11S the debt previously owed to Fleet/Circuit City. ECAST SETTLEMENT CORP reccntly received notd'ication that Fleet/Circuit City passed away. Initially, on behalf of our client please accep.t our congolences. . . . . '. At the time of the passIng of Flcet/CIrcUlt CIty, an outstandIng debt m the amount 01'$2918.20 was owed to To resolve this matter and prevent any nlrther collection activity, either full payment must be sent to this office at the above address or information regarding the Estate of Fleet/Circuit City must be received, by mail or telephone, by our office. IF YOU HAVE ANY QUESTION, YOU MAY CONTACT OUR OFFICE AT THE ABOVE TELEPHONE NUMBER Sincerely, Howard A. Enders Executive Vice President .. IMPORTANT CONSUMER INFORMATlON ** Unless you notit) this office within tl1irtv (30) days after receiving this notice that you dispute the validitv of this debt or any portion tl1ereof, this office will assume this debt is valid If vou notify this office in writing within tl1irtv '(30) davs from receiving this notice. tl1is office will: obtain verification of the debt or obtain a copy of a Judgment and'mail you' copy of such venfication or judgment. If you request this office in writing within thIrty (30) da\ s of receiving this notIce, this office will provide you with tl1C name and address of the original creditor, if different from tl1e current credItor. This communicatIOn is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. p~!et aJ!:jOu alea cc:y /~!z/a:)e:)s/,I.!:) ~vGL~ 'td '3111/lM3N ssaJ PPV' aB 311IM,3l.N3::l 8Z~ ~ aweN <l3~<l3SSl.NnH r Assoe :MOlaq pa.e.s 512 lasunOJ JaLl/S!Ll Jo/pue aAne.uasaJda<t leUOSJad Ol uaA!6 seM w!ep )0 aJ!.ou ua..!JM Eo"aw't 'tNSVl JO~ a^lrejuasaJda\,l paz"o - sClJal ""!S Is~aqO<l all!Onl/l8zUaJ,j al^>f fJr1 ~ fo11.- 5/ :pa.ea 'Ja!laq pue UOi.eWJ04U! 'a5paIMOU>! Aw JO .saq aLll O:j paJJOJ pue anJ:j aJe u!aJalj apew SUOlle:juasaJdaJ pue uoneWJ04UI AaLl:j :)elj:) Nn[Jad JO Sa!:jleuad aLl:) Japun WJwe pue aJepap AluwalOS op I ':juew!ep aljl JO 41eLlaq uo ,Iq paJnJas S! w!ep aLll :jeLl.l (8 :jnoqe JO uo :)uapaJap aLl:) JO Ll:)eap aLl:) O:j Jopd aSOJe w!ep alj:j :jelj.l (L 80/WvO :Ll:jeaa JO a:jea (9 ~vZH 'td '3111AM3N OB 311IA<l3l.N3:J 8Z~ ~ : ssaJppe s,:juapaJaa (5 'pa:jl2:)S luno::>JV' 40 :j!Aep!4N paljJe:):j12 aLl. Aq paJUap!Aa .!paJJ JOJ wnWJe ue S! paseq Sl w!ep S!Ll:j LlJ!LlM uodn speJ alj.l (v W6Z98 $ 40 .unowe aLl. U! w!ep 12 40 JaPlolj pue JaUMO alj:j S! MOlaq palS!! Jo.!p;:uJ (E S8S6L9LLL9 LS~9--0986~ 3G 'N018NIVljllM :ssaJppe s,:)uew!elJ (Z L819~ X08 Ud VOltJ3V1jllllN8V1j :aweu s,wew!elJ (1 '(Z)(q)ZESES 'V'S'J'V'd OZ 'apo) sapepnp!:J pue 'sa:je:js3 'a:)eqoJd aLl:j 40 (Z)(q)ZESE uOlpas o. .uenSJnd 'Jo,lpaJJ Aq w!ep JO aJqoN INOISIAIO .1l1no:) .SNYHdllO :lH.1 :10 >111:11:) :lH.1 10.1 ~8l>COOZ~Z :ON al!:! :jJno) pasea:Jao tJ38tJ38S1NnH 1183808 IjO a~e~S:l all.L :all UI WI/ro dO 3:Jn ON NOISIAIO .1l1no:) .SNYHdllO A.1Nno:> ON'tl\,l38V'In:J :10 SYJ1d NOHHO:) :10 .11100:> YINVA1ASNN:ld :10 H.L1YJMNOWHO:) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 11128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 _nn'__ told ESTATE INFORMATION: SSN: 206-32-1172 FILE NUMBER: 2103-0481 DECEDENT NAME: HUNTSBERGER ROBERT l DATE OF PAYMENT: 01/28/2005 POSTMARK DATE: 01/28/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/11/2003 NO. CD 004895 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $605.27 I I I I I I I I TOTAL AMOUNT PAID: $605.27 REMARKS: CHECK# 021771 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Clifford L. Grey Date of Death: May 16.2004 Will No. 21-04-0481 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 whether administration of the estate is complete: Yes (X) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes () No (X ) (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes ( X) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: March 2. 2005 ... ,r -,'\. A <1\-j... 'i~ ! ( Signature Robert G. Frey 5 South Hanover Street Carlisle. Pa 17013 (17) 243-5838 o QI Capacity: ( ) Personal Representative ("') ( X) Counsel for Personal Representative J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* :-: r- r\ _r., . ~- ,"-, NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP 112-04) BUREAU OF INDIVIDUAt:_:fAX~S__ INHERITANCE TAX DIVISION'- PO BOX Z8060 1 - . HARRISBURG PA 171Z8-0601 Ol+ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-21-2005 GROY 05-16-2004 21 04-0481 CUMBERLAND 101 CLIFFORD L ,r\! ROBERT S'FREY FREY & TILEY 5 S HANOVER ST CARLISLE Allount Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV :1A~.E)t.AFp..r~r:oJ'r.NOT.fcE.OF.i:'N'HE'tI.flNCE.T.AX.A.PPRA.fsE'rEN'~..A[towlNcE.oR.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GROY CLIFFORD L FILE NO. 21 04-0481 ACN 101 DATE 02-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 90.000.00 .00 .00 .00 51. 738.00 .00 45.434.00 (8) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 187,172.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitab1e/Gover~enta1 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 10,898.00 .00 (11) (12) (13) (14) 10.898 00 176,273.00 .00 176,273.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect figures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principel Tax Due (15) .00 X 00 = .00 (16) 176,273.00 X 045 = 7,932.00 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 7,932.00 ~ TAX CREDITS: .n........ . \+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-11-2004 CD004259 396.60 7,555.00 02-14-2005 REFUND .00 19.60- TOTAL TAX CREDIT 7,932.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) V>-,'''',-'-"'-- .,_.- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* BUREAU OF INDIVIDUAL\TAXES INHERITANCE TAX DII/ISION'- PO BOX Z80601 HARRISBURG PA 171Z8-0601 REV-liD7 EX iFP 112-D~) r-... ~....... 1 ~..r. DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-28-2005 GROY 05-16-2004 21 04-0481 CUMBERLAND 101 CLIFFORD L ROBERT GCFREY FREY & TILEY 5 S HANOVER ST CARLISLE Allount Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IN :r~tJ".lrA'fJ..rG1.:6J'..........'"fAftW!n'N~r"'Ar.!t~YtAm.b'l!'.ltcc50F/f....................... ... ESTATE OF GROY CLIFFORD L FILE NO.21 04-0481 ACN 101 DATE 02-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-14-2005 PRINCIPAL TAX DUE:. 7.932.00 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-11-2004 CD004259 396.60 7.555.00 02-14-2005 REFUND .00 19.60- TOTAL TAX CREDIT 7.932.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 II SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l