The URL can be used to link to this page

Home My WebLink About04-0076 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Virqinia Lucille Myers No. ~/-t::Jy.. /~ also known as To: Register of Wills for the Deceased. County of Cumber land in the Social Security No. 162- 32-3 5 8 2 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 execut ors named in the last will of the above decedent~ted Oc tober 30 ,19~ and codicil(s) dated nl a . c (~rl.. 7".. ltJ-l741 1:'A~(" /h "~l I'Jl{ dU (.fl~ f)~'~1 I)N JJ4/1A11If"" n 2001. ' . (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ('llmhp.rlrlnc1 County, Pennsylvania, with h er last famila or principal residence at 116 W. Springville Road, South Mid leton Township (list street, number and muncipality) Decendent, then 64 years of age, died Dec ember 25, 2003 ,~ , at 116 W. Springville Rd. . Boiling Spring~, PA 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: n/a ,- .. Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 4,500.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 81,291.00 situated as follows: 116 W. Springvi11e Rd - 1 SOllth Mic1c11PTon 'T'wp WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters 'restamenti'lry (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~ ~dr. '" ~ <I) u ':.~~J C-~.g~ l':: <I) -o~ ._ U) U)~ <I).... David Earl'M rs ~<I) l':: 116 W. Sprinqville Rd. -00 c::",o 1. W. in v Ie Rd. <<S": Boiling Springs, PA 17007 Boiling Springs, PA 17007 :E~ <1),- 30 <is l':: tlO Vi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA }ss COUNTY OF Cumberland The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~=:: ~1'Z~; ~ Dij' ::s . fiYf!lF l:l - li:: ~ ~ No,,""'/-L7~ 76 . Estate of Virqinia Lucille Myers , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW , in consideration of the petition on the reverse side ereof, satisfa tory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 30. 1987 described therein be admitted to probate and filed of record as the last will of Virq inia L. Myers ; and Letters 'T'p~TPmpnTrlry are hereby granted to David Earl Myers and Ri'lngy T,p'p' Myp.r~ r,L.;f9//~M~b Register of "lis FEES ~~te, Letters, Etc. ......... ~... t::!/ 0 James K. Jones - 39031 -. ~t:;$ ~. 00 A TIORNEY (Sup. Ct. LD. No.) Short ertlficates( ).......... $ / -..;...> -: c:JO Renunciation ................ $ . 7 Irvine Row. Carlisle. PA 17013-3019 ~ $ /O,CJO ~ TOTAL_s23Y"'o ADDRESS (717) 240-0296 . . ~" Flle .::r.,-/.'..~./o..... .'('?j!...... PHONE 1, .;2/-Qy_ /6 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS , codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw , the testat , sign the same and that signed as a witness at the reqUest of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness( es)). Sworn to or affirmed and subscribed before me this day of (Name) 19_ (Address) Register (Name) (Address) REGISTER OF WILLS OF Cumberland COUNTY OATH OF NON-SUBSCRIBING WITNESS David E. Myers and Randy L. Myers , (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Virqinia Lucille Myer,s ~GlUlUC test at r ix of (one of the subscribing witnesses to) the will presented herewith and }f;RwPik that they believes the signature on the will is in the handwriting of Virqinia Lucille Myers to the best of ~e ir _ knowledge and belief. Sworn to or affirmed and subscribed before ~A~{/C-~ this .?l L; 7?'/ day of orne) At9~ ''rr}!'' P fJ ~ I 70() I 11 h W, Boiling Springs, Pl\ 17007 H 1 P'\)W'\ REV ll/::;:(, 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. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 2L~~~;,~~ P 9899024 DEe 27 2003 No. Date H105.144 Rev, 1191 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS 'E/PAINT CERTIFICATE OF DEATH IN (Coroner) "ANENT 1129-169 S1A1E FilE NUMeER "CKINK NAME OF DECEDENT (F'rsl. t.,A'CldIe, last) SEX SOCIAL SECURITY NUMBER DATE OF DEATH (MonIh, Day, .,..) L '.Female ,. 162-32-3582 .. December 25, 2003 UNDEA 1 YEAR BIRTHPLACE (C~y and PLACE OF DEATH (Chc.::k only one see 'rlSlfuC:.ons on 01hel SlOe) Monlhs Da)l's Hours SlafeorForeignCoo.mlry) HOSPITAL' aJrdneJr-6, PA InpaHenl 0 ~o 7. ... FACILITY NAME (II nOf institution. give streel and number) RACE. American Indian, Black, Whhe, e1C. (Spec"" WhUe 'c. ,. DECEDENT'S USUAL OCCUPATION MARITAL STATUS. Married SURVIVING SPOUse (G~ k,nd 01 work doI'le duri~ most NIIVilr Married, Widowed. (11 Wife, give maiden name) {' WOlo:lnkme; do not use r Ired) ,Manuoa"tuJr.{ng Divorcltd (Specify) a 0 eJr ",;,).i.dowed 11.. DECEDENT'S MA.ILlNG A.DDRESS (Slteet. CitylTowt'\, State. ZiP COde) DECEDENT'S 17e,!Xl Yes, decedenl lived in Scuth. 116 W. SpJr.{ngv.{Ue Rd. ACTUAL 17.. Slate Did 1.(bM.fet"l! .... RESIDENCE decedem Bo.i..f.i.ng SpJr.{ng-6, PA 17007 (See InstllJClions CumbeJr.fand live in. onOlherside) township? 11d,O ~~h~e~:~~~i';:i~ 01 ,.. 11b.Coun _0 FATHER's,~rQt~'e.l!tanu(t MyeJr/') ,.. INFORMANT'S NAME (Typa/Print) Removallrom Slate 0 0 23a. 23b, 23c, TIME OF DEATH DATE PRONOUNCED DEAD (Month. Day, Yeill) WAS CASE REFERRED TO MEDICAL EXAMINER/COAONER? 3:20 December 25, 2003 Yeo,~ NoD ... M. 25. ,.. 27. PART I: Enter The d'seases, in/urles 01 complications which causeclthe death, Do nOT enter the mode of dying, such as cardiac or respiralory arrest, shock Or heart lailure :~pprOlimare P....RT II: OIhel signifitl!lnt eondltiOM tontributil'lg to death, buI lis' only one ause on each line ,rnlervaltle!ween nol resuhlng in Ihe undertylng cause gtven In PART I. Metastatic Carcinoma !Ons9t...nddealh .. DUE TO (OR ASA CONSEQuENCE OF) ! b. Lun Cancer DUE TO (OR AS A CONSEQUENCE Of): , c. : DUE TO (OR AS A CONSEQUENCE OF)' , , d. WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. AVAILABlE PRtOR TO (Month, Day, Year) COMPLETION OF CAUSE ~ 0 ""s 0 NoD OF DEATH? Natural Homicide ""s 0 No rj:J. "",0 No 0 Accident 0 Pending Investigation 0,. o . M. 30e. 'Od. 0 o PLACE OF INJURY .AI home, 'arm, slreel, factory. ollice LOCATION (Street. C'ly/Town. Stale) Suicide Could nol be determined building, e1C. (SpecIfy} 28a. 2Ib. ". ,... CERTIFIER (Check only one) .CEATIFYING PHYSICIAN (Physician gertilying cause 01 dealh wf'Ien another physician has pronounced dealtl and comple1eclllem 23) 0 Coroner To Ihe best of my knoW''-dge, d.ath occurI'M due 10 Ihe causecs) and manner ""ated, .. ,., , , ,. , , , , .,., , , ,., ." , , ,.." , " ..."".".",., DATE SIGNED (Month, Oey, 'lMr) 'PRONOUNCING AND CERTIFYINQ PHYSICIAN [Physician bOIh pronouncing dealh and cert,tymg 10 cause of clealh) o 31e, 31d.December 26, 2003 To the but 01 my knowledga, death occurred 811he 11m., datil, and place, and dlHf 10 Ihe cause(a) and manne, a. Itated., . , , " "...,..."",..., NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSEOF' OE,Q'H .MEOICAl EXAMINER/CORONER (ll.m27)TYP."P';nl Michael L. Norris, Coroner On the ~.I. of eumlnatlon and/or Inve.Ugatlon,I" my opinion, death occurred at the time, date, and place, and due to the Clule(l) and p( 32. 6375 Basehore Road, Suite #1 manner as st.ted,. , . , , , . . . , , . . , . . . . , . . . , . . . , . . . , , , . . . . , . . , , . , . , , , , . . . , , , . . , , , . . . , , , , . , . . , . , , , . . , , , , , , . . , , . . , , , , . , . Mechanicsburg, Pa. 17050 31., .- REGiSTRAR'S SIGNATURE AND NUMB ~. ~eu..~~\~~. 1.)11 ~ \ 101 DATE FILED (Mor'rh. Day, Year) ,I ". ~.d~ C(CX).~ LAST WILL AND TESTAMENT OF VIRGINIA LUCILLE MYERS II VIRGINIA LUCILLE MYERS1 a resident of 116 W. Springville Road1 Boiling Springs1 Cumberland CountYl Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM 1: I direct that all my just debts, the expenses of my last illness and funeral expenses be paid as soon after my decease as the same can conveniently be done. ITEM 2 : I direct that there shall ,be paid out of my residuary estate all estate1 inheritance and like taxes together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof1 or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such govern- ments, whether the property passes under this Will or otherwise, excluding, however, any property over which I have a taxable power of appointment 1 provided, however, that no residuary beneficiary shall by reason of this provision be denied the benefit of any deduction, credit, favorable rate of tax or other benefit which by law enures to such beneficiary. d // /"', .--- / v~tJf~ff ~~~(E~H{;~;/~ ,,~ LAST WILL AND TESTAMENT OF VIRGINIA LUCILLE MYERS ITEM 3: I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature1 and wheresoever situate at the time of my death 1 unto my husband, RONALD EARL MYERS, provided, however 1 that he survives me and is living sixty ( 60 ) days after the date of my death. ITEM 4: If and in the event that my husband, RONALD EARL MYERS, does not survive me and is not living sixty ( 60) days after the date of my death, then and in such event, I glve, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, in equal shares1 unto my children, RHONDA LUCILLE CARBAUGH 1 TENA LOUISE WELSH, DAVID EARL MYERS, RANDY LEE MYERS, provided however 1 that they survive me and are living sixty ( 60) days after the date of my death. ITEM 5: If and in the event that any child of mine does not survive me and is not living sixty ( 60) days after the date of my death, then and in such event, I give1 devise and bequeath the interest in my estate, which such deceased child would have received, if living, to the issue of said deceased child, per stirpes. -2- LAST WILL AND TESTAMENT OF VIRGINIA LUCILLE MYERS ITEM 6: I hereby nominate, constitute and appoint my husband, RONALD EARL MYERS1 Executor of this my Last will and Testament1 with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for his performance of this office. If and in the event that my husband1 RONALD EARL MYERS, does not survive me and is not living sixty (60) days after the date of my death, or does not complete his duties as Executor, then and in such event, I hereby nominate, constitute and appoint DAVID EARL MYERS and RANDY LEE MYERS, Co-Executors of this my Last will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of them in this or any other jurisdiction for their performance of this office. ITEM 7: If any provision of this Will or of any Codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable. /// ///- ~ ~ ~ /..,,/ . /....~"._. . ? .- ~~fNIk1ucitfE2'~ S;:;/~ -3- LAST WILL AND TESTAMENT OF VIRGINIA LUCILLE MYERS IN WITNESS WHEREOF, II VIRGINIA LUCILLE MYERS, the Testatrix, have to this my Last Will and Testament, typewritten on four ( 4 ) consecutively numbered pages, subscribed my name and affixed my seal this .3c d. day of !?'~~ , 1987. ~.::r~;~-.2<(~7"'~ (SEAL) /' Signed, sealed, published and declared by the above named VIRGINIA LUCILLE MYERS1 as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and of each other. residing at A;~~~1tft an '. a ().jle~,yesiding at L&.:L"~9 ~;7/. y~, c:0''WO-Z-Lh {I ~ ' J . -4- R~V-1500 EX (6-00" REV-1500 OFFICIAL COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 ot:~ 0 4 ~ O~~_ COUN~~ yair :0 ~ER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) I- MYERS, Virginia Lucille 2 Z W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS ~.TURN MUS+-8E FILED IN,DUFILlCATE WITH THE C W 12/25/2003 10/10/1939 REGIfrER OF~WlLLS 0 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C :....:. w [J 1. Original Return Q 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13,82) I- :.:SlJl [J 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12,82) D 5. Federal Estate Tax Return Required uO:::': wl1.U J:OO [J 6. Decedent Died Testate (Attach copy of Willi D 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes uO::...J l1.lD - l1. [J 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12-31,91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) < I- Z w NAME COMPLETE MAILING ADDRESS c James K. Jones z 0 l1. FIRM NAME (lfAPPllcaf!E . lJl of James K. Jones 7 Irvine w Law 0 lce Row 0:: 0:: TELEPHONE NUMBER Carlisle, PA 17013-3019 0 (717) 240-0296 u r' '--OFFICi'ALTisE ONly---".... 1. Real Estate (Schedule A) (1) I I 2. Stocks and Bonds (Schedule B) (2) , ! 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) i i 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) i Z (Schedule E) I 0 6. Jointly Owned Property (Schedule F) (6) i ~ I D Separate Billing Requested ...J (7) => 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property i ---~-'--.-'~"-'~" ---,~"'~.. ,,--,,-,-. ._.---- t: (Schedule G or L) D. ~ 8. Total Gross Assets (total Lines 1-7) (8) 118,7?9.14 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17,235.60 W 0:: (10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) 68.998.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 49.731.34 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 ~ rate, or transfers under Sec, 9116 (a)(1.2) x .0 (15) 49,731.34 x .O~ (16) 2.237.91 ~ 16. Amount of Line 14 taxable at lineal rate => D. 17. Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) 0 X 19. Tax Due (19) 2,237.91 ~ 20_~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decledent's Complete Address: \ STREET ADDRESS 116 W S CITY STATE Boilin Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 2,237.91 2. Credits/Payments A. Spousal Poverty Credit 2,502.16 B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 2,502.16 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) 264.25 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;.......................................................................................... 0 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 0 c. retain a reversionary interest; or.......................................................................................................................... 0 0 d. receive the promise for life of either payments, benefils or care? ...................................................................... 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death wilhout receiving adequate consideration? .............................................................................................................. 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 0 4. Did decedenl own an Individual Relirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN David E M ers R nd L M er A[)J:I!E51SGreentree Village 1101 Lebanon PA 17042 Mec SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV James K. Jones Es . ADDRESS 7 Irvine Row 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 [72 P.S. 99116 (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. 99116 (a) (1.1) (ii)]. The statute does not exemDt 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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. REV'1511 EX+ (12-99) , . SCHEDULE H )i '% COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral arrangements - Hollinger Funeral Home 5,872.20 (opening grave expense previously claimed) 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 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 57,634.60 (If more space is needed, insert additional sheets of the same size) <--'l': '~,..,l ~l'~J!nJQ.~!J!oIl~~J." .' I, ':" """"",,.!!!,,/:~-~:' IiIIIIII- . . ._'~,:~{i~9.:;~::L;_:.,,": ,~:~.', :;: ~ - ,,'-. ...~','"' > !:t'f.i,>,"t$' U f:." . "J".. '. >, ", '. .,'..... ~,1~~~'jf,"!i\"~':'~.'~1~::i"~ "Q";~.;,,,,")t~'.... ,. .....,' u,1 '.::'..{;' ,o;j..~; ..:._..-. " ,.. . 1..-'ff:ltj~'~ '~\ I" '~#"*'i" I." ..,-',.." .j :.o ";~ ~4:;~~\~~ y~~. lit: j ~~,"';!$'),",~ )'\.t ~ I.....~~ ;"4~1 !.'~'1~:'~~ ~f ~,~ - ": ,,/':\?~Tf.:::,~i::t~:~ljj.ll~~~~~;::i~~~T~~:<Ho,.: . ~l1~eraI Home & Crematory, Inc. "'~,,,, 't~<.~ ,..~~..\( 'k\'~<fi,,,,,'h'k.>l;' r~" :.,,', ,~..:\;~~~~it:t'-.il~:$'" "i~ i'-~;fIlll':B" L H u.s. ',' "" '''''I.'''''.'-",(",~, '.'''';;." """I~~ } ,f~'1\l'~' nc 0 l~r uperv1sor .":~.1l..~.'~~~'. {.....,.!~~..,~:f.',.,~""t:~ ~ ~~~I.rI~~J~(-I"~~:,ff'_~'"'' . .'~f ''f.. ,{~ ~:I~ .' ~~., "'r/,~';i:; ~ ;.. ~< ..}, ~~J~' ~~~. , ~1l,:~~~.;:~~. :':'~.' ~l" ," oj;: ~t#~,~.J'"',;o;,.,",v;~ ..~~.>:. .'~)~ I', ~H'f>!j,.~f1~~~>':,;(!!! ....... '" ~<..t'" ~. '-1"1':' ;1 ..t. ! ''',.~''(' \~.f.;f~l~h"J~ '\:V~~f;';t' ~~l(l;~\2 ~),"C( ~~~~ (~"_:'iI~'J~' ,"" " ,-,',~~/.~~(.~r '~f~:+;L...:) ;:l,~'l';I..'j~'I..r'i#' ~~' '~"f~< .'i' J, , ., ;.' "~.~1"'~ , ~.~" ": \:pv",~, ~1~~! "~~ . j;~J~",~' ~ ;.,.:~, <l-,~,;; J ""lJ"Z~'t"''Il!f'" 1\;,.,'1~" 'I' :~""~'q , ,,', ~ t/ :l\'i'~~'~"~~"J~ k......,' '[ , ~~~~,+,~ ~~,,:';;jJ.l'i't''''.t'<I,, ;",,.,.,,'1;,' i,.. ." ", .. "'''"l'''''''l: '':f~' , . 1" t$.f ~.,.,~.~t. 'j\''''.' .;: )",pi.;:-:, ~)v.;.);.~.i ~1, ~"~,. ,.:!fi~~fri)g~~~-~~,<:; ">' . .". ..;~~".l>,!;tllii$ ,~').~'\;'t,1,~..(~at'~'/':"':"'}'i:' '~" 'll.~ I,. .,;: A ._\ P c; .~.., :. f . L" M ~ " ..' ~i.'):. '~",",;~,("4,d.',.!!;'r,l'{,"" ,,,,,,, 1 '",'.. . '~Boiling~SPfiq~~.AH.7P07;., ' ", I ",." , '~,.'< ". ...." , ;,.~':.r .. Please !f "feeffreeto contac u . . . . . . . . . . . $3420.00 . . . . . $3410.00 '.. ,:,.,; ,.:,\." .... . . . . . $2195.00 . . .... . . . . . . . . . . . . . . . . . . . . . . $945.00 " . . . . . . . . . . . . . . . $100.00 . . .' . . . . . . . . . . . . . $30.00 ; . . . . .. . .~'. ',.' . . . . <. . . . . . . . . . . . $127.20 . . . . . . . 51202.20 .... -', '.~.. . . 56817.20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56817.20 _0. (( A", ~ 'I....\:.. \\ Q. \<. ",...Ie t1. I" \ ~~ "t.,.... I ~It,.... 501 NORTH BALTIMORE AVENUE. MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 . (717) 486-3433. FAX (717) 486-3215 www,holIinQerfuneralhome.com ---'--~'------'---"----'-'- JRD/June 30, 1992/17858 JUN 1 8 2004 ~ In Re: Estate of VIRGINIA LUCILLE MYERS ORPHANS' COURT DIVISION Late of SOUTH MIDDLETON TOWNSHIP COURT OF COMMON PLEAS OF CUMBERLAND COUNTY Estate No.: 21-04-76 PENNSYLVANIA NO. 21-2004-76 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: DAVID E MYERS AND RANDY L MYERS Counsel for Personal Representative: JAMES K JONES, ESQ Date of Grant of Original Letters: 01-26-2004 Date of Delinquency Notice: 05-06-2004 The undersigned, Glenda Famer-Strasbaugh, Clerk of the Orphans' Court, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on 05-06, 2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 06-11-2004 Glenda Farner Strasbaugh ~ 1 Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File t1 J,!J J4tJ.f A hearing is scheduled fo " at 9; 3c>Ar:'Courtroom No.3. Ifthe Certification of Notice is filed prior to the hearing date, the hearing will automatically b c I CERTIFICATION OF NOTICE UNDER RULE 5.6Ia) Name of Decedent: Virginia Lucille Myers December 25, 2003 Date of Death: Will No. 2004-00076 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 July 15, 2004 : ~ Address Rhonda L. 'Carbaugh 116 Springville Road, Boiling Springs, PA 17007 Tina L. Welsh 920 W. Limekiln Road. New Cumberland, PA 17070 David E. Myers 715 Greentree Village, Lebanon, PA 17042 Randy L. Myers 1101 LIndham Court, #705, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except A//II Date: 7 /g loy . Signa r Name James K. Jones, Esquire Address 7 Irvine Row Carlisle, PA 17013-3019 J\ .,.... Telephone (71 Y) 240-0296 J-\ ~ _J Capacity: _ Personal Representative --::J ") '<r ~Counsel for personal representative ? ;)... COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 171 28-0601 PENNSYLVANIA R~C~IV~D J:ROM, INI-1~RITANC~ AND ~STAT~ TAX OFFICIAL RECEIPT NO. CD 004216 MYERS RANDY L 116 W SPRINGVILLE ROAD BOILING SPRINGS, PA 17007 ACN ASSESSMENT AMOUNT CONTROL NUMBER nnnn fold ________n n_nu_ 101 I $2,502.16 ESTATE INFORMATION: SSN: 162-32-3582 I FILE NUMBER: 2104-0076 I DECEDENT NAME: MYERS VIRGINIA LUCILLE I DATE OF PAYMENT: 07/30/2004 I POSTMARK DATE: 07/30/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 12/25/2003 I I TOTAL AMOUNT PAID: $2,502.16 REMARKS: R MYERS CHECK# 111 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~C'.. REV-1 500 , COMMONWEALTH OF ~. PENNSYLVANIA ", .......~. . DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER " DEPT 280601 ,,;:' ". . .' HARRISBURG. PA 17128.0601 RESIDENT DECEDENT ~L--"LL iL...li .:J...fL_ cour.. TY C:)D~ VEAR ~.~MW~ DECEDENTS NAME (LAS:, FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- V,irginia Lucille ~ 162 - 32 - 3582 Z MYE RS , UJ DATE OF DEAT~ I:MM-DD.YEAR) 1 DATEOFBiRTH IMM-DD-YEARi C I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE UJ 12/25/200~ ~0/10/1939 ----l-- REGISTER OF WILLS U UJ IIF APPLICABLE) SURVIVING SPOUSE'S NAlv1E ILAS I, FIRST. AND r-",1IDDLE INITIAL::I 1 SOCIAL SECURITY NUMBER C '" =-~ ~ Original Return [J 2. Supplemental Return D 3. Remainder Return "jHte 8tDeatl viJ' ': '2-'3-S2 ... ::s::::f(/) Q 4,L;mitedEstate D 4a. Future Interest Compromise .:jate d d",at1 "he 12- 2-82 D 5, Federal Estate Tax Return Recuired u"'''' ",o.u ,,00 ~ 6, Decedent Died Testate,~!la:ll TJi ~',';i I: c- O 8 Total Number of Safe Deposit Boxes u"'''' ~ 7, Deceden~ Maintained a living Trust:,^'.ldCrcoe"c:TcJ,: a.'" a. D 9UtigationProceedsReceived D 10, Spousal Poverty Credit ,:"te u: dU" t,o.:'.'eeIl12-31-W a"c '-'-;lSI L 11 Election to tax under See 9113(Al ~A%c', S~r << ... THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z COMPLETE !.'1AILlNG ADDRESS '" NAME " James K. Jones z 0 a. FIRM NAME I r Ar;Oolcatf . "' of 7 Irvine '" Law 0 flce James K. Jones Row '" ---- '" TELEPH9NJ rUffER2 4 0 - 0 29 6 Carlisle, PA 17013-3019 0 u Real Estate (Schedule A) (1) 81,000 00 2 Stocks and Bonds (Schedule B) (2) nnn P .........r-, ::-~ d ~, 3 Closely Held Corporation, Partnership or Sole-Propnetorship 13) _. none ~ ..". 4 Mortgages & Notes Receivable (Schedule 0') (4:1 _.-- 1.280.10 '--- = 5 Cash Bank Deposits & Miscellaneous Personal Property (51 34.449.24 .. Z (Schedule E) vJ 0 0 6. Jointly Owned Property (Schedule F) (6) none ~ ~SeparateBillingRequested ;:.::;' .- -l (7) -O- N ::::l 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property !:: iScheduleGorLi 0\ 0- (8) <( 8 Total Gross Assets (total Lines 1-n 118 7?q 14 U . UJ 9. Funeral Expenses & Adminislrative Costs (Schedule H) (9) 1 1 1h1 41 [k: . 10 Debts of Decedent Mortgage Liabilities & Liens (Schedule I) (10) Sl . 7h? 40 11. Total Deductions (total Lines 9 & 10) (11) 63.125.81 12 Net Value of Estate ILine 8 minus Line 11) (12) 55.603.53 13 Charitable and Governmental Bequests/See 9113 Trusts for which 3'1 election to tax has not been (13) made (Schedule Ji 14 Net Value Subject to Tax ~Line 12 minus Line 131 (14) 55,603.53 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15 Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec. 9116 (a)(1,2) x oiL. (1SI < 55,603.53 x oi2 (16) 2,502.16 I- 16 Amount of Line 14 taxable at lineal rate ::::l 0- 17 Amount of Line 14 taxable at Sibling rate x 12 (17) :2: 0 18 Amount of Line 14 taxable at collateral rate x 15 (18) U >< 19 Tax Due (19)_2,502.16 ;:: 20D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlDE AND RECHECK I\l,ATH < < Decedent's Complete Address: STREET ADDRESS 116 Sprinqville Road CITY Bailin rin S s Tax Payments and Credits: 1 Tax Due (Page 1 line 19) (1) 2,502.16 2 CreditsfPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 ----- Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) (3) 0.00 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) 2,502.16 A. Enter the interest on the tax due (5A) B. Enter the total of line 5 + 5A. This IS the BALANCE DUE. (5B) 2,502.16 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;. 0 [ZJ b. retain the right to designate who shall use the property transferred or its income:. 0 [J'] c. retain a reversionary interest; or,. 0 lXI d. receive the promise for life of either payments, benefits or care? .. n lliI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 5J 0 3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........0 IX] 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . L-.J lliI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. U"dw ;)enalties of pe~Jury' : declare that I ~'ave examinee tr,is returr inclucing accon'pa~ying schedules ard s:atemerts, and io :he bes: 01 my knowledge and belief, tis ':ue, correct and complete Declaralio~ of preparer othe' ihar the personal ~eprese, ' ba d on all i,",fomla'.,on o",.'lhich preparer!'asary ~"owledge SIGNATURa OF 'lRSON RESPONSIB F DATE /j~ ~ Ran y . Myers ADCJl3~~id . , , E. Myers 7/291o'f SIGNATURE OF PREPARER OTHER TH DATE James K. Jones -- .2'1~y ADDRESS etllCliSle, 7 Irvine Row, For dates of death on or after July 1 1994 and before January 1, 1995, the tax rale imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS S9116 (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, 39116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, C'lnd 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 dales 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. s9116(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. 39116(1.2) [72 P,S. 39116(a)(1)]. The lax rate Imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116(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,1ti02 EX+ (6-98) ~ 0. ", .~l1i~ SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 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 knowledge of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 116 Springville Road 83,000.00 S. Middleton Twp. , Cumberland Co. , PA TOTAL (Also enter on line t Recapitulation) S 83,000.00 (If more space is needed. insert additional sheets of the same size) A. Settlement Statement U,S. Department of HousinQ and Urban Development ~ ,r OMS No. 2502-0265 B. Type of Loan 1.0 FHA 2. 0 FmHA 3. L>9 Cony. Unlns File Number Loan Number Mortgage Insurance Case Number P135-985/Carbaugh 0000077552 4 OVA 5 0 Cony. Ins. C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "p.a,c" were paid outside of closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWERMarlin L Carbaugh Rhonda L Carbaugh 117 South East Street, Carlisle, PA 17013 117 South East Street, Carlisle, PA 17013 E. NAME AND ADDRESS OF SELLER: Estate of Virginia L. Myers 116 West Springville Road, Boiling Springs, PA F. NAME AND ADDRESS OF LENDER: American Home Bank, N.A. 805 Estelle Drive, Ste 101, P.O. Box 4454, Lancaster, PA 17604~4454 G. PROPERTY 116 WestSpringville Road LOCATION Boiling Springs, PA 17007 H. SETTLEMENT AGENT: O'Brien, Baric & Scherer PLACE OF SETTLEMENT: 17 West South Street, Carlisle, PA 17013 TIN' 25-1708515 I. SETTLEMENT DATE: 06/30/2004 RESCISSION DATE J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price "83 000,00 401. Contract Sales Price $83 000.00 102. Personal Property 402. Personal property 103. Settlements charges to borrower 403 (from line 1400) $2,806,16 104 404 105. 405 ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE 106. City/town taxes to 406. City/town Taxes to 107. County Taxes 06/30/2004 to 01/01/2005 $91. 14 407. County Taxes 06/30/2004 to 01/01/2005 $91.14 108. Assessments 06/30/2004 to 07/01/2004 $4,60 408. Assessments 06/30/2004 to 07/01/2004 $4.60 109 409. 110. 410. 111 411 112 412 120. GROSS AMOUNT DUE FROM BORROWER $85,901.90 420. GROSS AMOUNT DUE TO SELLER $83,095.74 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money $1,000.00 501, Excess deposit (see instructions) $1,000.00 202. Principal amount of new loan(s) $63,000.00 502. Settlement charges to seller (line 1400) $103.00 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first mortgage loan 205 505. Payoff of second mortgage loan 206. 506. 207 507. 20B SOB 209 509 ADJUSTMENTS FOR ITEMS UNPAID BY SELLER ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210, City/town taxes to 510, City/town taxes to 211, County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. 513. 214 514. 215. 515. 216 516 217 517. 218 518 219. 519. 220. TOTAL PAID BY/FOR $64,000.00 520. TOTAL REDUCTIONS $1,103.00 BORROWER' IN AMOUNT DUE TO SELLER: 300. CASH AT SETTLEMENT FROMrrO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER 301. Gross amount due from borrower (line 120) $85,901. 90 601 Gross amount due to seller (line 420) $83,095.74 302. Less amount paid by/for borrower (line 220) $64,000.00 602. Less reductions in ami. due seller (line 520) $1,103.00 303. CASH ( IZlFROM) ( OTO) BORROWER: $21,901. 90 603. CASH ( 0 FROM) ( IZl TO) SELLER: $81.992.74 HUD-1 (3-86) - RESPA, HB 4305,2 PAGE1 HUD-1 (Rev 3186) OMB No. 2502-0265 L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM BASED ON PRICE $83 fOOD. 00 @ %" BORROWER'S SELLER'S FUNDS FUNDS DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: AT AT 701 te SETTLEMENT SETTLEMENT 702 to 703. Commission paid al settlement .--- 704 800 ITEMS PAYABLE IN CONNECTION WITH LOAN 801, Loan originalion fee % B02, loan discount % 803 Appraisal lee to Susan B. Burkholder $275.00 804, Credit reporl to Credco $19.08 eOS.Lender'sinspectionfee 806, Mortgageinsuram:e application fee lo BOl,Assumption/ee 808 Lender Administration Fee to ARB $390.00 809 FHLMC Loan Prospector Fee to ARB $21.20 810 Flood Cert Fee to First American $16.50 811 Tax Service Fee to First American $96.00 900 ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE' 901,lnlerestlrom 06/30/2004 to 06/30/2004 @ $11.16/day $11.16 902, Mortgage Insurance premium for mas to 903. Hazard insurance premium for yrs.lo 904 Flood insurance premium for yrs,jo 905 1000. RESERVES DEPOSITED WITH LENDER: 1001, Hazard insurance 3.00 months@ $31.25 per month $93.75 1002,Mortgageinsurance months@ per month 1003. City property taxes monlhs@ per month 1004. Counly proper1ytaxes 5.00months@ $14. 87 per month $74.35 1005. Annual assessments monlhs@ per month 1006 Flood Insurance months @ per month 1007 School taxes 13.00months@ $70. 18permonlh $912.34 1008 months@ per month 1009 Aqre ate Accountin Escrow Ad ustment ($121.97) 1100 TITLE CHARGES 1101. Seltlement or closing lee 10 1102. Abslracl orlitle search to 1103 Tille examinatIOn to 1104,Tilleinsurancebinderto -, ' 1105. Documenl preparation to 1106. Notary lees to Cash $14.00 $4.00 1107. Atlorney'sfees lo James K. Jones, Esquire -- - .- - - .. -- (includes above items Numbers 11C8.Titleinsuranceto O'Brien, Baric & Scherer __ - .-- (inclu~es above items Numbers 1101-1105 1107-1111 1109, Lender's coverage ($63,000.00 ) 1110 Owner's coverage $756.75 ( $83,000.00) 1111 Ends #300-$50 #900-$50 1112. Insured Closing Ltr. $35.00 1113 1200 GOVERNMENT RECORDING AND TRANSFER CHARGES' 1201. Recording fees Deed $38.50 ; Mortgage $64.50 ; Releases $103.00 1202 City/counly tax/stamps Deed : Mortgage 1203. Staletaxlstamps Deed ,Mortgage 1204 1205 1300 ADDITIONAL SETTLEMENT CHARGES 1301. Survey 10 1302. Pest inspection to 1303 O'Brien, Baric & Scherer (Overnight Fee) $10.00 1304 Application Fee to ARB ($345.00 POC) 1305 SMTMA (water/sewer act#003049) $99.00 1306 1307 1400. TOTAL SETTLEMENT CHARGES $2,806,16 $103. DC __L--_._____. I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a tnwand accurate statement of all receipts and disbursements made on my account or by me in this transaction. ! further certify that! have received a copy of the HUD-1 Settlerneht Statement.' .' ..' ,/ /. .J /' .I . .//>;.... /.r '.,",",'. /. /.. /. .' . /.....,. ../, S"lIer . 1'~ ... //".. . . , -' ..:.'"'./ . .. ".." _.. - - . ~.. . Borrower ~~..""//0.' /'. (, J-/~';.;:(4:<Y/c1 Date' IJ"/';'/,: l' Agent '-.. _ ..,,~_ . Date' Marlin .~. Carbaugh ;/ /' Estate of Virginia L Myers )/ / " , /.,. " { - /,',. " " .J\ ( / ( { .". i: f \. Seller~.___~___ '--~"'7A. ../ /' /', -- Borrower: .,,(/fJ.1C/' r"~"Date: ~(Agent: I ~..f,.-, r.' i -/.,/) Date:/~. ~(. ,.J" Rhonda L Carbaugh /). /' ' / The HUD--1 Settlement Statement which I have prepared is a true and accurate account of this transaction 1 have caused or will cause the funds to be disbursed in accordance wilhthisstatement 1:1A . / /' . /, //1 h[!.<>I"Ct Date' Settlement Agent: " ,it Date David A, Barict WARNING: It is a crime to knowingly make false statements to the United Slates on this or any other similar form Penalties upon conviction can include a fine and imprison-- ment. For details see: Title 18 U.S. Code Section 1001 and Section 1010 REV-1507 EX+ (1-97) ~& SCHEDULE D "% , COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 All property jointly-owned with right of survivorship must be disclosed on Schedule F ITEM VALUE AT DAlE NUMBER DESCRIPTION OF DEATH 1. Debt of Jeremy Carbaugh 1,280.10 TOTAL (Also enter on line 4, Recapitulation) $ 1,280.10 (If more space is needed, insert additional sheets 01 the saMe size) REV-I508 EX + 1'-9/i . SCHEDULE E , , CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVMJIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ING pension account 23,914.51 2 . Misc. personal property sold at estate auction 6,127.85 3. 1993 Geo Prizm Sedan 1,500.00 4 . F&M Bank Checking account 1,494.96 5 . Highmark Blue Cross/Blue Shield refund check 456.88 6. Federal income tax refund 449.00 7 . Homeowner's insurance refund 140.44 8. State income tax refund 131.00 9. Mutual of America Pension 128.06 10. Property tax refund 102.00 11. School tax refund 4.60 TOTAL (Also enter on line 5, Recapitulation) $ 34,449.24 (If more space IS needed, Insert additional sheets of the same size) Fi::'i-15'OEX+i1-91) '* SCHEDULE G ~~' -, " '-,- INTER.VIVOS TRANSFERS & COMMONWEALTH OF PEN~jSYLVANi/\ MISC. NON.PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT D~CEDENT I ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 - This schedule must be completed end filed ifthe answer to any of questions i lhrcLi;h 4 on the reverse side ofthe REV-1500 COVER SHEET is yes I ------- DESCRiPTION OF PR.oPERTY %OF ITEr'i1 '~'c_ Eo '~~ ,,~',i:: (;c THE ~\',,~oo,~~::, "i"EoI~ "",_""'-J1;:"W -U DE:;',-C,_ : ,~h:': ~;--':: ~~-, 8F ;:;~\2,~F DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ~l-~,:~.' -:;~TY J "+ :'ec", f':-Y ~D_ os-,.-~ NU~'16ER i .-- -'i!~U;f= OF ASSET INTEREST c.'cc'''~______ 1 I Ring 85.00 100% 85.00 0.00 2 . Mother's ring 30.00 100% 30.00 I 0.00 i I I ! I i I i ! I , I ! I i I I I I I I I -- ~ TOTAL (Also enter on line 7. Recapitulation) $ (if more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~ C c.. SCHEDULE H ;.?\i.r !~~ ..._,-:J!~ COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 Debts of decedent must be reported on Schedule I. - ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1 Westminster Cemetary - opening and closing grave 945.00 2. Funeral rec eption 225.00 B ADMINISTRATIVE COSTS' 1 Personal Representative's Commissions Name of Personal Representative(s) David E. Myers Randy L. Myers 3,500.00 Social Security Number(s)iEIN Number of Personal Representative(s) 2 06 - 4 8 - 0 0 91 206-48- 3443 Street Address 715 Greentree Villaqe City _L~bal1~_ --- ----. _____ State ~ Zip 17042 Year(s) Commission Paid' 2004 2 Attorney Fees 3,500.00 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 234.00 5 Accountant's Fees 6 Tax Return Preparer's Fees 7. Other Administrative Costs a. Roy D. Gutshall - personal property appraisal 50.00 b. Judy A. Campbell - Real estate taxes (2003-2004) 891. 56 c. Larry E. Foote - Real estate appraisal 275.00 d. Misc. runners - auction help 180.00 e. The Sentinel/Cumberland L.J. - Advertising Letters 136.07 Testamentary TOTAL (Also enter on line 9. Recapitulation) S 11,363.41 (If more space is needed. insert additional sheets of the same size) Schedule H - continued f. Homeowner's insurance premium 108.56 g. S. Middlton Twp. Municipal Authority - 99.00 water & sewer h. Roy D. Gutshall - Auction expenses 1,191.00 i. Misc. cards, envelopes & postage 24.22 j. Notary fees 4.00 R~','_'5'2~X+,I_"', " fJ> ~'~~ ~~~ SCHEDULE I CC\';\1C~j'NEALTH OF PE!mSY1...VAr,;. DEBTS OF DECEDENT, 't;>iC.'l.11 ANCE TAX RUUR'I MORTGAGE LIABILITIES, & LIENS R~S;D[NT DECE~H,'T ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION A~,.~OU:'~T 1. Mortgage balance - F&M Trust 47,489.44 2. State Farm Bank - credit card 4,272.96 TOTAL (Also enter on line 10, Recapitulation) $51,762.40 (If more space IS needed, Insert additional sheets of the same size) REV-1513 EX+ (9-00) , . SCHEDULE J , ~ . COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MYE RS , Virginia Lucille 21-04-0076 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE J TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Rhonda L. Carbaugh Daughter one-quarter 116 Springville Road Boiling Springs, PA 17007 2. Tina L. (Welsh) Cantu Daughter one-quarter 970 W. Limekiln Road New Cumberland, PA 17070 3 . David E. Myers Son one-quarter 715 Greentree Village Le~anon, PA 17042 4 . Randy L. Myers Son one-quarter 1101 Lindham Ct., #705 Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV,1500 COVER SHEET " NON, TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - 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) -.------,. ....-..--." -~ -~-~ LAST h'ILL Al':D TE ST I\.MENT OF VIRGINIA LUCILLE MYERS I , VIRGINIA LUCILLE MYERS, a resident of 116 vi. Springville Road, Boiling Springs, Cumberland County, Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and T(::'stament, hereby revoking all Wills and Codicils heretofore made by me. ITEM 1 : I direct that all my just debts, the expenses of my -~-- last illness and funeral expen.ses be paid as soon after my decease as the same:- can conveniently be done. ITEM 2 : I direct that there shall be paid out of my ~---- residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdjvision thereof, ln respect to all property required to be lncluded ln my gross estate for estate, inheritance or like tax purposes by any of such govern- ment s, whether the property passes under this Will or otherwise, excluding, however, any property over ',..;h i ch I have a taxable power of appointment, provided, however, that no residuary beneficiary shall by reason of this provision be denied the benefit of any deduction, credit, favorable rate of tax or other benefic which bv law enures 1:0 such beneficiary. ,_..... < // ;.:..". ,-"::....-->.' // ":/ /c. ~~-/~ >--tC~--- VTRGINIA LUCILLE MYERS LAST WILL AI'\D TESTAMENT OF VIRGINLll. LUCILLE MYERS ITEM 3 : I gIve, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and y..}hcresoe'Ier situate at the time of my death, unto my husband, RONp.LD EARL MYERS, provided, however, that he survives me and is living sixty (60 ) days after the date of my death. ITEM 4 : If and in the event that my husband, RONALD EARL ~~-~ MYERS, does not survive me and is not living s i xt Y ( 60) days after the date of my death, then and In such event, I gIve, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed! of whatsoever kind and nature, and wheresoever situate at the time of my death, In equal shares, unto my children, RHONDA LUCILLE CARBp,UGH, TENA LOUISE WELSH, DAVID EARL MYERS, RANDY LEE MYERS, provided however, that they surVIve me and are living sixty (60 ) days after the date of my death. ITEM 5 : If and in the event that any child of mine does not surVIve me and is not Ii ving sixty (60 ) days after the date of my death, then and In such event, I gIve, devise and bequeath the interest In my estate, o"Jhich such deceased child would have received, if living, to the Issue of said deceased child, per stirpes. . -".,- . --:: ~- '.,-,' ...c ./ ~/_> ~-' VIRGINIA LUCILLE MYERS -2- Li',ST T1-vILL F,ND TESTAMEt;T OF VIRGINIA LUCILLE ~YERS ITEM 6 : I hereby nominate, constitute and appoint my -~-,--- husband, RONALD EARL MYERS, Executor of this my Last \Vill and Testament, with full power to do any and all things necessary for the complete administration of my estate, and di. rect that no bona or other surety is required of him :Ln this or any other jurisdiction for his performance of this office. If and in the event that my husband, RONALD EARL MYERS, does not surVIve me and 1S not living sixty (60 ) days after the date of my death, or does not complete his duties as Executor, then and in such event, I he'reby nominate, constitute' and appoint DAVID EARL MYERS and RANDY LEE MYERS, Co-Executors of this my Last Will and Testament, ,,'lith full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety 1S required of them 1n this or any other jurisdiction for their performance of this office. ITEM 7 : If any provision of this Will or of any Codicil hereto 1S held to be inoperative, invalid or illegal, it 1S my intention that all the remaInIng prOVISIons thereof shall continue to be fullv operative and effectlver so far as IS possible and reasonable. " ,/-~ ,. .._-.~~ ~ ? " VIRGINIA LUCILLE MYERS -]- Lfl,ST ":,JILL Ar~D TE S'I'.!.:..!JiEI'JT OF V':::RGII~I71. LUCILLE ,~, 7....,..... ,... l'llLd\.21 IN WITNESS WHEREOF, I, VIRGINIA LUCILLE MYERS, the 'Testatrix, have to this my Last will and Testament, typewritten on four (4 ) consecutively numbered pages, subscribed my name and affixed my this ~ of ~- seal day 1987. . (SEAL) - -"~-"-=~-'--'----~----'-'-'--'--- Signed, scaled, published and declared by the above named VIRGINLZ', LUCILLE MYERS, as and for her La:-:;t Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, In the presence of the said Testatrix, and of each other. ~ - ~ /~ / J' i-"'" ~ , ", /~~;, /, '~'~.'~~ _ ,,!~- - _ f ..I.. ~ I residing at - -,"1~:I,1:7l~_;A !/.;.;~ ---''-...:.. _ _,~...:. /'''----.!LJ5..:;,,~L ""- .' ,.- \. i I -;, I :,..' .: residing at - ., . .~ ~.;(. i ~- ~ . .w _, -'.~- '\.- - .----.-----._-_._-.._-. ,. -4- '.<, ~ "i - 9-, ':;~ COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 ,;-t"l NOTICE OF INHERITANCE TAX HARRISBURG, PA 171Z8-0601.- -' .. ,.,,",w_ APPRAISEMENT, ALLOWANCE OR DISALLOWANCE "" OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP IDl-D5l 0- r- DATE 09-27-2004 I ESTATE OF MYERS VIRGINIA L f-- DATE OF DEATH 12-25-2003 0 c:J FILE NUMBER 21 04-0076 ~4 _t ::-: COUNTY CUMBERLAND JAMES"K JONES . .- ACN 101 -..;0 LAW OFC OF J K JONES I Allount Rellitted I 7 IRVINE ROW CARLISLE 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=is4j-ix-AFPTfff':oiY-No'Tici--oF-YNHiifiTANcE-'TA;c-A-PPRAisiMENT~--AiLOWAt"-CE-OR----------- - -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MYERS VIRGINIA L FILE NO. 21 04-0076 ACN 101 DATE 09-27-2004 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) (1) 83.000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) 1.280.10 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 34,449.24 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 118,729.34 APPROVED DEDUCTIONS AND EXEMPTIONS: 11,363.41 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 51. 762.40 11. Total Deductions (11) 63.125 81 12. Net Value of Tax Return (12) 55,603.53 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 55,603.53 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 55,603.53 X 045 = 2,502.16 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 2.502.16 TAX CREDITS: KC\,C.Lr l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-30-2004 CD004216 .00 2,502.16 TOTAL TAX CREDIT 2,502.16 BALANCE OF TAX DUE .00 ~ INTEREST AND PEN. .00 TOTAL DUE .00 iii IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Zl40 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT 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 and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (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. Z810Z1, Harrisburg, PA 171Z8-10Z1, 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 asses~ent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% 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 one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z 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 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1m ~ ~ nill-1991 -rrr- :lID'mT zon ~ .DiiOZ4'f 1983 16% .000438 199Z 9% .000Z47 ZOOZ 6% .000164 1984 11% .000301 1993-1994 n .00019Z Z003 5% .000137 1985 13% .000356 1995-1998 9% .000Z47 Z004 4% .000110 1986 10% .000Z74 1999 n .00019Z 1987 10% .000Z74 ZOOO n .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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 the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. , COMMONWEALTH OF PENNSYLVANIA '* BURE~U OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-15~7 EX AFP IDl-U31 DATE 11-01-2004 ESTATE OF MYERS VIRGINIA L DATE OF DEATH 12-25-2003 FILE NUMBER 21 04-0076 '0" "F' 1 P ~2 :"16 COUNTY CUMBERLAND JAMES K JONES I..j. r"u~i - ACN 101 J K JONES LAW OFFICE I Allount Rellitted I 7 IRVINE ROW [ '" CARLISLE r~r17-o13 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 =is4-j-ix-iFP-foY=oiY-NoTIci--oF-YNHirfiTANcE-YAX-A-PPRAisii.fENT:--iLrOWANCE-oi------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MYERS VIRGINIA L FILE NO. 21 04-0076 ACN 101 DATE 11-01-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 5.872.20 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 5.872 20 12. Net Value of Tax Return (12) 5.872.20- 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 49.731. 33 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 15. Allount of Line 14 at Spousal rate (15) .00 X = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 49.731.33 X 045 = 2,237.91 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 2,237.91 TAX CREDITS: II:CL.C.LI'" I+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-30-2004 CD004216 .00 2,502.16 TOTAL TAX CREDIT 2,502.16 BALANCE OF TAX DUE 264.25CR '~'1 INTEREST AND PEN. .00 TOTAL DUE 264.25CR It IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . . RESERVATION: Estates Df decedents dying Dn Dr befDre December lZ, 198Z -- if any future interest in the estate is transferred in pDssessiDn Dr enjDyment tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CDm.Dnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes at tha lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: TD fulfill the requirements Df SectiDn Z140 Df the Inheritance and Estata Tax Act, Act Z3 Df ZOOO. (n P.S. SectiDn 9140). PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDur payment tD the Register Df. Wills printed Dn the reverse side. --Make check Dr mDnay Drder payabla tD: REGISTER OF HILLS, AGENT REFUND (CR): A rafund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cD.pleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns ara available at the Office Df the Register Df Wills, any Df the Z3 Revenue District Offices, Dr by calling the special Z4-hDur answering service fDr fDrms Drdering: 1-800-36Z-Z0S0, services fDr taxpayers with special hearing and I Dr speaking needs: 1-800-447-30Z0 (TT Dnly). OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns, Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df this NDtice by: --written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --electiDn tD have the matter deter.ined at audit Df the accDunt Df the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discDvered on this assessment should be addressed in writing tD: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6S0S. See page S of the booklet "Instructions for Inheritance Tax Return fDr a Resident Decedent" (REV-lSOl) for an explanation of ad.inistratively cDrrectable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The lSZ tax amnesty non-participatiDn penalty is co.puted 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 a.nesty period. This non-participation penalty is appealable in the same manner and in the the sa.e 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 one (1) day fro. the date of death, tD the date Df payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rata which will vary from calendar year tD calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ Zii7."'"""" ~ tm-1991 ~ :1i'li"mT mn ---w- .00imr 1983 16Z .000438 199Z 9Z .000Z47 ZOOZ 6Z .000164 1984 llZ .000301 1993-1994 7Z .00019Z Z003 SZ .000137 1985 13Z .0003S6 1995-1998 9Z .000Z47 Z004 4Z .000110 1986 10Z .000Z74 1999 7Z .00019Z 1987 10Z .000Z74 ZOOO 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assess.ent. If payment is made after the interest co.putation date shDwn on the NDtice, additional interest must be calculated. REV-1470 EX(S.BB) . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Virginia L. Myers 2104-0076 REVIEWED BY ACN Destiny S.R.Brown 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Accepted additional expenses. ROW Page 1 RIi:V-1500t:X(6-00)' T REV-1500 OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 4 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ MYERS, Virginia Lucille 82 Z W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS Ri.rURN MUS+-8E FILED IN,D~.IlLlCATE WITH THE C W 12/25/2003 10/10/1939 REG&rER OFrwlLLS (,) w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C - . . - w D 1. Original Return Q 2. Supplemental Return D 3. Remainder Return (date of death prior to 12,13-82) to-, lr::~lJ) D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12,12,82) D 5. Federal Estate Tax Return Required ull::lr:: wD.U :1:00 D 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ull::..J D.lll - D. D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12,31-91 and 1,1,95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) <( NAME COMPLETE MAILING ADDRESS James K. Jones FIRM NAME (lfAPPlicarl . of 7 Irvine Law 0 flce James K. Jones Row TELEPH?NE NUMBER Carlisle, PA 17013-3019 717) 240-0296 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) (6) !;;: D Separate Billing Requested ...J (7) :J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property t:: (Schedule G or L) a.. <( 8. Total Gross Assets (total Lines 1-7) (8) 11R,7?,Q 14 (,) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17,235.60 W 0:: (10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) 68.998.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 49.731.34 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 ~ rate, or transfers under Sec. 9116 (a)(1.2) x.O _ (15) 49,731.34 x .0 4 5 (16) 2.237.91 ~ 16. Amount of Line 14 taxable at lineal rate :J a.. 17. Amount of Line 14 taxable at sibling rate x .12 (17) ::E 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) (,) ~ 19. Tax Due (19) 2,237.91 20.~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: T " STREET ADDRESS 116 W S CITY STATE Boilin Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2,237.91 2. Credits/Payments A. Spousal Poverty Credit 2,502.16 B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 2,502.16 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) 264.25 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;.......................................................................................... D D b. retain the right to designate who shall use the property transferred or its income; ............................................ D D c. retain a reversionary interest; or.......................................................................................................................... D D d. receive the promise for life of either payments, benefits or care? ...................................................................... D D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ... ... .......................................... ......... ....... ...... ......... .................. ............. D D 3. Did decedent own an "in trusl for" or payable upon death bank account or security at his or her death? .............. D D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN David E M e 5 R nd L M e AD].l!!!5lSGreentree Village 1101 Lebanon PA 17042 Mec SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE James K. Jones Es . ADDRESS 7 Irvine Row Carlisle, PA 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) (ii)]. The statute does not exemot 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(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RI'-V-1511 EX+ (12-99) , . SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MYERS, Virginia Lucille 21-04-0076 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral arrangements - Hollinger Funeral Home 5,872.20 (opening grave expense previously claimed) 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 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 57,634.60 (If more space is needed, insert additional sheets of the same size) '"Jl::,iifiQ-'" ..." ij)!!ri\li.Jl,~!I\"~'iI!,'!'!I'l!:~i"M'~i!J\('ot-...;'Cp,,,c,'-"~' -............... '~;~r~'::~';'::'ijJ';'~>;~~~~,;;;.:,r~~';'~~~~,~:'~,~':~',~'_,' ,'~~:'\."::".~' \~~,~~ ~ .c/',: .. .~. - .--,. ". / ~.'1.' ~;tE.(~(}i}~.t'~11:1l>,~,\...~ ~ L '< .: llf Hp~'~, \' \ :;. \1" , ~ '\.j/"<",'? ....:f::t<<~ ~"" , , ~ "" .., d'_~ _i ~ '''A ..,~~l ~~'~h-r",,~./~<.:'~' _t, '<;) ".",}... ~ ; > ::'~i;.l"'l'\f''''' '~~j;.~~~;. ; ..._ l>....".....f-~t~~i. fi,:..v~lA,)~"l\~..~. ;'~f~/f~.~\,;"'.~;l'" (o! ;.1, '. ~,!",::~::;,~,~,;-t~. \:'J/~" "I"".""'"';t.i;'\~''''''''~~E;~ .,$..~f'.,.,""'""..!, ".."'.'",,. '" ,....... .. '\;]1 .~V:~~~r,:~~~ ~'f,,' 'ra;'~~':f~"{ 11,. '.~." JI\-;,,!~~~-i.i~~F,~J"~~'~~~~~I"~" '~'f!'t<f.":~~1~~"~ ..~~'J.'. '11;t" ,l!~>!";,i'l~}<"m'l""~~' Ji'..,';,!. ;' "'~,~:^,~t?~;lJk~A~;Y,;\:~\4~~';f~~t{\~,~~;,~~Ho .""" .. ~~'~"'eraI Home & Crematory, Inc. . ~ ::(;~~.-~~ ~"):t'~, ~.t' .,.f: t,.,lJ'itt _I ,':fi;!""1! _ ~~..l '-'f""",~6":"'*r~V~ ~~Ji '1.1'~\:.~IX",~7;"\...,,,1;\\';t'~~""~"i'; ..,., .j~,fu.. . :, "'~;.'-':"JYifl':, ,Mf-lo't.'l'4\t~~.;;t:, ;:~-~!"""""!' ~~II~ . ~(..t'Enc L. Holli~r. Supervisor .. ~;~,~'~:; ~t~~~''4f~''~~.(.~''f~;~i;,J.~4~~'~~;~~~.rr ~tt,,:~~i~f<<' '.l't,-("~~;{,,~::;, ,~ ~'" ~./J1i?~~~J1~~'1r~~'P~t~~1.-'7't~~(~::d.~tj;':~~~~';:~"~~ ~:)*~t-4;;;f~j~" .'; ~ . < ~',':~I'~:.~~:.'; !'<~"""j~'(~~~~~~\;'t:~~~1~ar~~ll~ !f.;t{tr_U, ~~~':71;~Jib;~ 1 . ' ,'Ji.,c:;.,."t"'~~~'l,i',~"'..\iJil"" '~~'''''ii' ~~'1'''''\'\!~~0:'''1~;:'' , l' ,.... "'~':'f\':'/~ ~Pj",\.r'>1t'^'l' 4 If' ",f, ' ....,.,,"JI:f!':1"1'N . ,,~'it <~ . .'.~~ """J'" 1>, ~ .~ ,..~ "~~~#:P lit' 1 2k'"ff~' .~~.:ll"'ri}'~.:"?4r;i,<:\ . , aJ1111l1ru'" ~,., "'..,,"'" :....'.~.. " _, .'" .:; . . .~s w);.,,"r~.~il ~" ~ 1,~l';" ,"j~;$J~j~~~r.~~~t'~ri.~::~f';~ ",lif.!' .....r,(...l''Yo}~,:~{'fW.r~, . ~::!i:.~:%,.. ""::o.t~~5 ,);,~~ -~$,.~"'~l..,~...,J."'f': ~ . ' :t:'H"\~" . .. ~ .. ~~::~j;~>,Y7~~J"',~,,,, ,;,;:.... ~;";<:I:',I~",'~' , It ,,~$li., r.- ....~. .t + ~.'. . "~*",.\I~ ,.i',~1 f.:.~'. .,,'. .' "'~' t'\~1\'i>>~;;~~;~.c "t.,. " '~, ,,,.,,..,'\.~~~ ~..~~ ~~""l,f. ~,..,'. " " ':Boilmg'Sp~iIig.~/p~\~do07 t~:t>,.-::,. : :;;; 1)i}~~t;i;f;t;~{, ::.> ~::,;.,. .:, ". Please . . . . . . . . . . . $3420.00 ~~{~~~~~S;i;i:~.' ,. '.~ ... ,..~ :~:.~,.,. ',..:"" ,...... .' .,. . . . $2195.00 lJJp,tIENT,'~ MERCHANDISE ~:~~j{~~;~~~;i\~':;t:',~~;",~. ,.' ~.; .', ." . . . $5615.00 . , . 'MAnI(WE'ADV ANCED CERTAIN PAYMENTS TO OTI-IE~"A$N'l,~~~~~ ,,'.. . ~~\.YINGlS AN ACCOUNTING FOR rnOSE CHARGES. CA8~~,,~~fi~~':;'";;':~':;,';:~:~7~~Fi,~'f~~:~~;?i:~''' .' Openmg Grav~. .' ..~"'. ...... .............. $945.00 Clerov~s Offering' . .,.::'}' $100 00 ,brl'; ',.,. _ '''' ~''',' , ,"~".', ;.;,;,~ ".~" .,:''"':.-,,,.,:'' __"~,'~,. . . . . . . . . . . . . . . . . Certified Gopies of the Deathceni~caic~ . ,.............. $30.00 Flowers c':.:.,' ..;' ; "',~' '<:\~::'r'" $12720 . --,,~, ,,; ',! "":',.. . . .: :,'." '. . ~,' . ::".<~'''.. . . . ~. . . . . . . . . . . . . ; .'lJ>TAL f:ASHAP.Y,AN,~,~ SPECIAL CHARGES. . . . . . .. S1202.20 " J ",~ ,\ ,:i~":' it-~. ':; ,"\'.'{ ,\,'-;, ,.; .,-~_'\J,rM;~~" ,::,:,;<,.;,1;t~Yf~~~',}_c';F-\"~: ;>" ,," - CO~8'~!U,.CE :.......,.'.... . . . . . . . . . . . . . .. S68 1 7.20 ~ '.', ,'.. '-'"' ~<."..t~ "", ,I ,~.,.. . ;-;rOTA.L\~.A.'IOuNr DUE. . . . . . . . . . . . . . . . .. S6817.20 ,"" _ ell'" <? A.. ~ '1 .... \:.. \.\ <: \<. ~&oolc t:t. Il) \ ~'" 't........ 1 ~lt\... ....".~.!.j '." .,..... .. '.' " "i,.':~~~i5~r~t~~:t':7f~~';r;,~ P';!i;:; 501 NORTH BALTIMORE AVENUE · MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 . (717) 486-3433. FAX (717) 486-3215 www.hoIIin~erfuneralhome.com STATUS REPORT UNDER RULE 6.12 Name of Decedent: Virginia Lucille Myers Date of Death: 12/25/03 Will No.: 2004-00076 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion ofthe administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes lKl No 0 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. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes - No JXJ 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 ua No 0 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~ Date: II n/V) /' '-- .. ~ Si e N ,Tr\mp!:: K .TOT"lPS, FS'1"ire L.l_ Name C) ,~' '" l.1..J .. r"j 7 Irvine Row C_,::. Ci-':': tl. C1- Carlisle, PA 17013-3019 ( C~ ' c::;, ,- !.',-:~- Address 1.. ; - L;'~: (:'- _....J"'",. C) u:,: [L (717) 240-0296 Cj G'::: 1..1.. l.r;, 0 c:~ C:'';} Telephone No. C:) "'" Capacity: 0 Personal Representative JiO Counsel for personal representative J COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INOIVIOU1,qT~:'-, INHERITANCE TAX INHERITANCE TAX DIYISIC)til'". ,.!d :" -' ~ '" STATEMENT OF ACCOUNT PO BOX 280601 IV'"l'..: HARRISBURG~ PA 17128-0601"- REY-U07 EX AFP (09-04) 7015 I'." 'I Pi; 3: l,a DATE 12-13-2004 ...~ -.' VI i;'i ! ,} ESTATE OF MYERS VIRGINIA L C' r:-" '1'- DATE OF DEATH 12-25-2003 .LCcr\ l/ FILE NUMBER 21 04-0076 C1Q[;'~!t',!"':' 'Jl'ifi",,"'il...i COUNTY CUMBERLAND JAMES K G~NES ACN 101 J K JONES LAW OFFICE I Allount Rellitted I 7 IRVINE ROW CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forI! with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... ft!\r:!&~~'~5r.l'~"rnl~'63'."""i;.':rA~!~flr"fX5r'~~"r~~'b1r'Xcl:60~".j(i..""""..."""'. ESTATE OF MYERS VIRGINIA L FILE NO.21 04-0076 ACN 101 DATE 12-13-2004 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 PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 1l-01-2004 PRINCIPAL TAX DUE,. 'N""'.'.'.'.'.'"''~'.'.'.'M'M''"'.'.'''''''''''''''''''''''''''''''"",",,,,,,,,,. 2,237.91 PAYMENTS CT AX CREDITS), PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-30-2004 CD004216 .00 .~ 2,502.16 11-22-2004 REFUND .00 264.25- TOTAL TAX CREDIT 2,237.91 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 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" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ~<:.'i. -,