The URL can be used to link to this page

Home My WebLink About04-0158PETITION FOR PROBATE and GRANT OF LETTERS Estate of MARJORIE KIRK McELHENY also known as Marjorie K. McElhen¥, a/k/a Marjorie E. McElhen¥ Deceased. Social Security No. 204-03-7845 To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: n Your petitioner(s), who is/are 18 years of age or older anc~ executrix* in the last will of the above decedent, dated May 28 and codicil(s) dated July 3, 1990. in the named ,1976 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 4837 East Trindle Road, Hampden Township (list street, number and muncipality) Decendent, then 88 years of age, died December 11 ,10~ 2003 , at Holy Spirit Hospital, East Pennsboro Township 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: no exceptions Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in P..ennsylvania $ situated as follows: rqone 75,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. *Donna Gay Nerlinger has renounced in favor of Petitioner. A~len~ Winifre~ Lopert-/ r 424 South High Street Mechanicsburg, PA 17055 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~- ss COUNTY O1: '~ .. 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 ac%ording to law. Sworn to or affirmed and subscribed .,- before, f_~A~L~/me thins /~T,~'. >I~daY2004of J ..... ~ R (~ter Estate 0[ MARJORIE KIRK McELHENY, a/k/a Marjorie K. ,Deceased McElheny, a/k/a Marjorie E. McElheny DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~-~_,C.,~U~o.~.c/ /~O F$ 20q4in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) datedMay 28, 1976, and Codicil dated July 3, described therein be admitted to probate and filed of record as the last will of Marjorie Kirk McElheny, a/k/a Marjorie K. McElhe.n.'y, a/k/a Marjorie E. McElheny 1990 and Letters Testamentary areherebygrantedto Arlene Winifred Lopert FEES te, Letters, Etc .......... $/X~-~, ~[Y~tion ................ $ ~C~ S t~.oo TOTAL __ $ [ ~, oO Marlin R. McCaleb (~06353) _ ATTOR~EY(Sup. Ct.[.D.N,0.) 219 ~ast Maxn St., P.O. Box 230 Mechanicsburg, PA 17055 ADDP~ESS (717) 691-7770 PHONE L~:6~ £t ~]3] 170. REGISTER OF WILLS OF cu~,w,~o COUNTY OATH OF SUBSCRIBING WITNESS JOHN M. EAKIN codicil dated July 3, 1990, (~ a subscribing witness to the ~titk/p'resented herewith, (each) being duly. quahfied according to law, depose(s) and say(s) that I was present and saw Marjorie Kirk McElhen¥ , the testat rix , sign the same and that I signed as' a witness at the request of testat rix in h er presence and (~a4-,~la~X~c~xffx~oXtmr) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this /f-~YT~ day of ~~ .m ~u FO_ 200_4 ~'/3Z~//~/~z~r~/ Register John M. Eakin (Name) Market. quire Bu±ld±ng, Mechan±csburg, (Address) (Name) (Address) PA 17055 REGISTER OF WILLS OF ~'~OUNTY OATH OF NON-SUBS~ING WITNES~ (each) a subscriber h alified according to . .,~ose(s :~_ familiar Withe signature of ?NN, ' ~ codicil testat__~ ~ibing witnesse~) the ~in presente~erewith and ~ ~ ' codicil ~stat b~ pres~e~with ~ that ~ ' - ~ codici~ '% ~ ' ~elie~e__signa=e = thrill is in%h=dwfiting of~ .~ . ._ S~ ~d s~ribed before ~ . ' me~is ~~~ ~ (Address)(Name)X 19~ ~ . (Name) (Address) REGISTER OF WILLS OF CUMBERI,AND COUNTY 'OATH OF SUBSCRIBING WITNESS JOHN R. NERLINGER, JR. codicil dated July 3, 1990, ~1~) a subscribing witness to the ~/presented herewith, (~) being duly: qualified according to law, depose(s) and say(s) that I was present and saw Marjorie Kirk McElheny , the testat rix , sign the same and that I signed as a witness at the request of testat rix in h er presence and (~i~Xt~¢t~~aXh~r) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me t~s 7 ~ day of _ 0 L- 2004 : m~* ~ State of Florida I ~ mmm~'::~es Aug. 11, 2004 ~ gohn ~. ~ml~ger; J~<. 54 Kano Court~ Ft. Myers, FL 33912 (Address) (Name) (Address) ~'-.q~q- 72 ~? :~: RI~IS OF WILLS OF COUNTY :r (~H OF NON-SUBSCRIBING WITNESS testat` .. believes the signcaot~e wilt presented~ ! that Register (Name) (Address) REGISTER OF WILLS OF CUMB~,R~,ASD COUNTY OATH OF SUBSCRIBING WITNESS WILLIAM H. THOMAS (~a~l~) a subscribing witness to the will presented herewith, :~xah) being duly qualified according to law, depose(s) and say(s) that I was present and saw Marjorie Kirk McElheny , the testat -- i ,~ , sign the same and that I signed as a witness at the request of testat rix in h er presence and (~l~r~xffam~:olfla~) (in the presence of the other subscribingwitness(es)). The other subscribiBg witness, Elfleda C. Thomas, is deceased. Sworn to or affirmed and subscribed before me this ..~-r'~. day of -¢,,c~..*-.~,-~ /_ ~. 2004 ~n R.~,~~ ~~~~.~4,~ ~r, p~n~ ~ ~ ~md~ William H. Thomas (Name) 21 White Oak Blvd., Mechanicsburg, PA (Address) (Name) (Address) 17055 REGISTER OF WILLS OF COMB~.Rr.AMD COUNTY OATH OF NON-SUBSCRIBING WITNESS Arlene Winifred Lopert (mao~ a subscriber hereto, (eml~hr) being duly qualified according to law, depose(s) and say(s) that I am familiar with the signature of Marjorie Kirk Mc~.lheny , testat rix of (~xofx~t, xmJt~a~flSklgxa~ilm~x~O the will presented herewith and codicil that I believ~ the signature on the will is in the handwriting of testat rix l~gi~~i~a~g~:~g:gi:~t~l~r'~R~tR~t to the best cf __ my --_ knowledge and belief. Sworn to or affirmed and subscribed before -- Arlene ~i.~fr,ed-Lo[:~r"~'/~- me this /~ 7-// day of t~amej ~_ *~/~.~~X,~_ ~;~. w ~~~.~.24 S. High St. , Mech___anicsburg, PA 17055(A ddres$) (Name) (Address) RENUNCIATION In Re Estate of MARJORIE KIRK McELHENY, a/k/a MARJORIE K. McELHENY, a/k/a MARJORIE E. McELHENY deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned daughter of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Arlene Winifred Lopert WITNESS my hand this ~7 day of Fc_ ~) ., ~ 2004. (Sisnat~re) Donna Gay Nerlinger 54 Kano Court Ft. Myers, FL 33912 (Address) (Signature) (Address) (Signature) (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Local Registrar No. '~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Marjorie E. McElhenv IsEx 4837 E. ~t~e R~d ,, ~c~g, PA 17055 ,,. ~1~ Kirk I,~st ~rt~ ~te~ J:,~ris~g, PA ~~ 8 ~kst Plaza Way ~.. Arlene _Ix:)pe_rt ~ ~ } [ I 2003 LAST ~;ILL AID l, t'.A?JO.~IE Ki~iK ~.~C~2,JWh'ff, a resident of ~.~echamicsburg, Ctnnb~rl~md Coumty, Pe~.~-sylv~mia, beimg of sou~d ~,,d disposimg mired, memory ~d u~derst~n~i~, Co hereby make, publish decl~..re this a~s a~d for my l~=~st ~/Jil! ~ Testame~.t hereby z~cvoki~g ~uy ~md sll ~rior ~.,~ills by me heretofore m~m~de. .~-~. i direct my ~xecutrix, herei~.~fter ~m~d, soo~ ~,s cozveaiently m~:~y be after my deck,se, to p~y ali my just debt;~ aad funeral expenses out of ~y estate. ~u~,~: ~ the rest, residue ~:~d re, milder of my estate, of every ~ature, ki~d ~d description, whether ~'~d b~queath "~to my two child~-~., i~o~-~:~a '~;~v :~rli'. .... ' A;'~ ' iu!fr~d Lo~rt ~-q'~s~llv, sh~~- and she~e ,like. T,..~: [ do hereby ~omi~at~, co, statute s~ld ~ppoi~t my d~ughter Do~a ~y ~(er[iage~, ~xecutrix of this, my ~o=~Y. [ ~irect th-t my said l~xecutrix shell ~.ot be r~quir~ to file a~y bo~d or bo~cs i~ Zhi.~ or a~y other juris~!ctioa for th~ f~ithful p~rforms~c, of h~r duties, ~d ~hall h~ve full powe~ ~d ~,uthority to s~ll s~y r~sl property of which [ may di~ possessed, either ~t ~:ublic or ~rivst~ a~d fo~ such p~ic~ or ~ic~s ~s sh~ shsll d~m sd~quet~. hereunto s~t my he~.d an.d sesl this ~d~y of [f~y, A. ~. FIRST CODICIL I, MAllJORIE IGIRKMCELHENY, hereby make, publish, and declare this First Codicil to my Last Will and Testament dated May 28, 1976. 1. I revoke paragraph "Third" of said will. 2. I nominate, constitute and appoint Donna Gay Nerlinger and Arlene Winifred Lopert to be the executors of this, my Last Will and Testament, and if for any reason one is unable to act as such, the other shall be the sole executrix. IN WITNESS W~EREOF, I set my hand and seal this 3rd day of July, 1990. · ' rjorie lcm-- e y f Signed, sealed, published and declared by the above-named MARJORIE I~I~KMCgLMEN-Y, as and for the First Codicil to her Last Will and Testament, dated May 28, 1976,in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. LAST I~ILL AND TESTAI4EI~ AND FIRST CODICIL OF 14APJORIE KIRK MCELHEN~ EAKIN & EAKIN ATTnRNEY~ AT LAW MARK[T SQUARE BUILDING MECHANICSBURG, PA. 1'7055 LAW OFFICES MARLIN R. McCALEB CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Marjorie Kirk McElheny, a/k/a Marjorie K. McElheny, a/k/a Marjorie E. McElheny Date of Death: December 11, 2003 Will No. 21-04-0158 To the Register: I certify that notice of beneficial interest and estate administration required by Rule 5.6(a) of the Orphans' Court Rules was personally served on the following beneficiaries of the above-captioned estate on February 25, 2004. Name Address Arlene Winifred Lopert 424 South High Street Mechanicsburg, PA 17055 Donna Gay Nerlinger 54 Kano Court Ft. Myers, FL 33912 Notice has now been given to all persons entitled thereto under Rule 5.6(a) . Date: February 25, 2004 Marlin R. McCaleb Attorney I.D. No. 06353 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 (717) 691-7770 FAX: (717) 691-7772 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: ARLENE WINIFRED LOPERT being duly sworn according to law, deposes and says that she ~.~ eh~ RY~,,triw _ of the Estate of MARJORIE K. McELHENY late of -- Hampden Township , Cumberland County, Pa., deceased and fhaf the within is an inYenfory made by her , the said Executrix 'of +he entire estate of said decedent, consisting o{ all the personal property and real estate, except real estate outside the Commonwealth of Pen.sylva.ia, and fha~ fhe figures opposite each Jfem of fha I.ve.fory ~epresenf it's f~;r value es of the date of decedenf's death. and subscribed before me, ~9 2004 Date of Death Marlin R. McCaleb, Notary Public IVlechanicsburg Bom, Cumberland County My Commission Expires Dec. 14, 2006 Member, Pen?~e Association Of Notates .... Execu~r ~'Adminlsfra~r -/ Arlene Winifred Lopert 424 South High Street Mechanicsburg, PA 17055 Address December 2003 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after apporntmenf of personal representative. 2. A supplement inventory must be filed wlth;n thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduclar;es Act of 1949. ~0 u~ r-~ 0 I 0 I C~ ).. ,,, < O ,,, Z u. ~ < 0 Inventory of the real and personal estate of MARJORIE K. MCELHENY deceased 1. Reclining Chair 2. 14k gold diamond engagement ring and wedding band. 3.· Myers Funeral Home, pre-need funeral agreement. 4. U.S. Treasury, 2003 federal income tax refund. 5. 4,938 Shs. Allied Irish Banks PLC Common, CUSIP 019228 40 2, @ $14.849.: F TOTAL 5 550 6,743 136 73,324 80,758 O0 O0 00 05 36 41 ~Ev-1500 EX (6-0~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I.u I-- O . I.u REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) McELHENY, ~JORIE K. (a/k/a Marjorie E.) DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) December 11, 2003 January 8, 1915 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 2 1 -- 0 4 0 0 1 5 8 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 204 -- 03 -- 7845 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~1. Odginal Return [--~ 4. Limited Estate --] 6. Decedent Died Testate (A~ac~ copy o~w~l~ E~9. Utigation Proceeds Received ~"~ 2. Supplemental Ratum r-'] 4a. Future Interest Compromise (date ~f dea~ ~ter 12-12-82) ['--~ 7. Decedent Maintained a Living Trust (^tach c~w of Trust) E~10. Spousal Poverty Credit (da of d~ath between 12-31-91 and 1-1-95) NAME Marlin R. McCaleb¢ Esq. FIRM NAME (if Appl~) Law Offices - Marlin R. McCaleb TELEPHONE NUMBER (717) 691-7770 [] 3. Remainder Ret~um (date ~f death p~or to 12-13-82) ['-~ 5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes ~11. Election to tax under Sec. 9113(A) (A~c~ Sc~ O) COMPL~EMAILINGADDRESS 219 East Main Street Mechanicsburg, PA 17055 9. 10. 11. 12. 13. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4t Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposib & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) F--'] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Unes 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Uabilifies, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) 73,324.36 7,434-.05 -~. 45,288.96 432.19 (8) · 13~126.62 (11) OFFICIAL USE ONLY 126,479.56 · (12) 13,126.62 113,352.94 113,352.94 Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an elec~on to tax has not been made (Schedule J) 14. Net Value Subject te Tax (Line 12 minus Line 13) (14) (13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 113,352.94 45 16. Amount of Line 14 taxable at lineal rate x .0 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 5,100.88 5,100.88 19. Tax Due (19) Decedent's Complete Address: ISTREETADDRESS 4837 East Trindle Road Mechanicsburq ISTATE PA IZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest' E. Penalty 4. If Line 2 is greater than Line 1 -+ Une 3, enter the difference.. This is the OVERPAYMENT. 'Check box on page I Line 20 to request a refund . If Line 1 + Line 3 is greater than Line 2, enter th~ ditfereflce. This'is the TAX DUE. A. Enter the interest on the tax due. (1) Total Credits (A + B + C ) (2) 5,100.88 Total Interest/Penalty ( D + E ) (3) -O- 5,100.88 ~0- (4). (5) (5A) 5,!00~88 B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. .. (58) · 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 t~ansferred;~. ...................... : ...................... il ......................................... [] [] b. retain the right to designate who shall use the property transferred orits income;'. .................... ;; .................... [] [] ~. retain a revers onary interest; or....: .......... ; ............................. ~. ................. ~ ....................................................... r-]. . [3q.... d. receive the promise for life of either payments, benefits or care? ......... ;... .................. ~ .................... : .......... L'. .... [] [] 2. If. death occu~d afterDecember 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 ~ccouht or security at his or her death? .......... L. [] '[]' 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, Y0U MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE?URN. · Under penates of perjury, I declare that I have examined this retum, including a~.T. pon~thg schedules a~d ~:-[.,~, and to the best of my knowledge and belief, it is trna. ~c~Te~. and complete. ,., re u~.,,muve is h~l on all ,,,,u,.,...~, of which preparer has any knowledge "* ' Ded~,~,, of preperer other than the Pui~~' ~ .... __~ . ....... . /~ ' DATE 7/// SIGNATURE OF PEI~ RESPONSIBLE FO~ F/IL~NG RETURN ~ ~ ~ /~ · 424 South ~±cj'h Street~ Mecha~'ics~urg, PA 17055 ADDRESS 219 Rast Ma±~ Street~ Hecha~±csbur9'r :PA 17055 For dates ofdeath 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. ,.A~l:.~ .... ~ ...... ' .......* ]~: '-~svlva::ii8 ~ bci. i.~ c,~' so~l~lc ;:, ~d d ' ' [ 2_' L;. b"?~.oc'm.~: v direct my ...... "'~ !'~e',';~fLer ~t ~,.~c ~o.~ aa ' ~.''t,z h,:~ a~t~, %o pay o,.,U~N~,: 2.11 -" ,-. .... '~t l'e~:!d]_ie ~'~. _d :r, err'_ai~:~der of ~."~ ¥~ whethe-~ .... ~1 ~ ~-~ .... ~'~ .... -'oever itu~:te i Rive cerise a;N.C h~OkLeath .... ,L,_, m~ tV,;O r'~'~'~ '3 ...... ....... ~ ~om~-,~.t~, constitute end apFoi~.t my "': iw,D; ~ do hereby .... ~ ~' '~ - daughter l)o~.a (~y i<er!i~g~r, ~xecutrix of this, my Last '.:fill e~d ~'.STLY: i airect tiP, z my saia D~x~cuzrix shall not be requirec to file any boxd or boia. ds i.~ this or cny other shall have full power ~:~s~d f~utho-rity to sell any real pPoperty of .... wn~ch i may die pose~sed,..,.~ either a~t Ft.tblic or pr!w~u~' n~Teunto se'b my La, nd a:~.~d seal this >ac,~/( a?y of Ldav,, ~.,. FIRST CODICIL I, MARJORIE KIRK MCELHENY, hereby make, publish, and declare this First Codicil to my Last Will and Testament dated May 28, 1976. 1. I revoke paragraph "Third" of said will. 2. I nominate, constitute and appoint Donna Gay Nerlinger and Arlene Winifred Lopert to be the executors of this, my Last Will and Testament, and if for any reason one is unable to act as such, the other shall be the sole executrix. IN WITNESS WHEREOF, I set my hand and seal this 3rd day of July, 1990. / ~arjorie Kirk McElhenY ~ Signed, sealed, published and declared by the above-named MARJORIE RZIRK MCELHENY, as and for the First Codicil to her Last Will and Testament, dated May 28, 1976,in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. REV-1503 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Marjorie K. McElheny D.O.D. 12/1!~03 21-04-00158 All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 73,324.36 4,938 Shs. Allied Irish Banks PLC Common, CUSIP 019228 40 2, @ $14.849. TOTAL (Also enter on line 2, Recapitulation) $ 73,324.36 (If more space is needed, insert additional sheets of the same size) R£'V-1508 EX+ (7-83) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE "E" CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Marjorie K. McElheny D.O.D. 12/11/03 FILE NUMBER 21-04-00158 (All pro~,e~Ly jointly-owned with the Right of Survivorship must be disclosed on Schedule "F") ITEM NUMBER DESCRIPTION vALUE AT DATE OF DEATH 2. 3. 4. Reclining Chair 14k gold diamond engagement ring and wedding band. Myers Funeral Home, pre-need funeral agreement. U.S. Treasury, 2003 federal income tax refund. TOTAL (Also enter on line 5, Recapitulation) 5.00 550.00 6,743.00 136.05 7,434.05 (If more space is needed insert additional sheets of ~ame slze) Joseph James Jewelers 301 East Main Street · Mechanicsburg. PA 17055 · (717) 795-9224 PRENEED FUNERAL AGREEMENT AND ASSIGNMENT EXHIBIT I ~ STATEMENT OF FUNERAL MERCHANDISE AND FUNERAL SERVICES (FuneralRecipient/Insumcl) .4~ ! (Address) ~ ~_ , . .~. /t (Phone) GUARANTEED PROFESSIONAL SERVICES Services of Funeral Director and Staff Transfer of Remains to Funeral Home $ If beyond a ~Y~5-~, mile radius, which is our service area, there will be a charge of $: per mile one way. Family Car(s) . at $ each~., $ Limousine Hearse ~ $ , Cremation $ Forwarding/Receiving Re. maim $ Other Services/Facilities/Equipment TOT^L ARANTEED SERV'CES " /'~" at c>?'~ Death Certi~¢ates ~ $ Music -- Hairdresser $ Shipping Container $ Other (Specify) $ We charge you for our servicm;i~"obtaining~ GUARANTEED MERCHANDISE Casket $ M°d N I , M~ N~ ~ ~/~ M~el N--~I ~S I ~ Gu~ M~~ (S~) ' ' ] TOTAL/GuARANTEED MERCHANDISE Is o~7,30, ~, ' NON-G~J~bI~TEED CASH ADVANCES $ ,'~,~.' - meort ~ , $ /~- ~ Grave ~g ~d 0~-.-~ ~' $ ~ ~o~ ~/~~~ $ ~ ~on~t/~ $ ~ .TOTAL NoN'G'U,,ARANTEEO CASH AOVANC__F,,S..-..! I' /X'SaO0,, I ' ! ,"' TOTAL GUARANTEED AND NON-GUARANTEED FUNERAL PRICE 1$ ~, . ~ *REQUIRED PUicHAsis Charges are only for those items that you selected or that are ~ If We are required by Jaw or i by a cemetery or crematory to use any ibnxts, we will explain the reasons in writing below. EXHIBIT 1 ABOVE AND THE PRENEED FUNERAL AGREEMENT AND ASSIGNMENT ON THE REVERSE SIDE SHALL CONSTITUTE THE TERMS AND CONDITIONS OF THIS AGREEMENT. (ca~y, mtn) / (zap) ////'Az//z (c~,, suite) (z~) HOME SALES oNLY: You, the Buyer, may cancel this transaction at any time prior to the thLrd business day a~ter the date of this transaction. See the attached Notice of Cancellation form for an explanation of this right. P001 SHLC, 1995, All fights r-,=,erved. No use or reproduction without express permission. Rev. 03/10/95 REV-I~ EX + (1-gT) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F, JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Marjorie K. McElheny D.O.D. 12-11-03 21-04-00158 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G, SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Arlene W. Lopert Daughter B. Donna Gay Nerlinger 424 South High Street Mechanicsburg, PA 17055 54 Kano Court Ft. Myers, Florida 33912 Daughter JOiNTLY-OWNED PROPERTY: LE~ER DATE DES~I~ION OF PROPER~ % OF pATE OF D~TH ffEM ~R JOINT ~DE Include nme ~ flnancia in~ ~d b~k account num~ ~ simil~ iden~i~ numar. Attach DATE OF D~TH DECD'S ~LUE OF NUMBER TENET JOINT deed ~r join§~held md ~. ~LUE OF ~S~ I~EREST D~EDE~'S INTERES' 1. A. 1979 Checking Account #5070082294, PNC Bank, 1,478.46 50% 739.23 in names of Decedent and Arlene W. Lopert. 2. A. 1997 Savings Account #5000920029, PNC Bank, in 2,635.27 50% 1,317.64 names of Decedent and Arlene W. Lopert. Principal balance as of D.O.D.: $2,635.17; interest accrued to D.O.D.: $0.10. 3. A. 2001 Regulars-Savings Account #205458-00, 52.26 50% .26~13 Members 1st FCU, in name~ of Decedent and Arlene Lopert.:. :Principal balance as of D.O.D.: $52.25; interest accrued to D.O.D.: $0.01. 4. A. 2001 Checking Account #205458-11, Members 1st 5,338.09 50% 2,669.05 FCU, in names of Decedent and Arlene Lopert. Principal balance as of D.O.D.: $5,337.93; interest accrued to D.O.D.: $0.16. 5. A. 2001 Investment Savings Account #205458-05, 67,345.05 50% 33,672.53 Members 1st FCU, in names of Decedent and Arlene Lopert. Principal balance as of D.O.D.: $67,322.81; interest accrued to D.O.D.: $22.24. 6. A, B 2002 Certificate of Deposit Account #205458-40 20,593.13 33.33~ 6,864.38 Members 1st FCU in names of Decedent, Donna Nerlinger and Arlene Lopert on 12/20/02 (see Schedule G, Item 1). Decedent's one-third (1/3) interest, which passed at death, to the surviving owners, included herein. 45,288.96 TOTAL(Alsoen~ronline6, Re~pitul~ion) $ (If more space is needed, insert additional sheets of the same size) I~RY-16,-2131:J4 '1~5:$'? FT, ICBRNK 412 75~ PN CBAN May 17, 2004 MarLLe R Me~aleb A~omcy ~ Law 219 £ Maia St PO ~x 230 M~csb~ PA 17055 Eslate of M~jorie K MoF._,llumy (D~mmed) $SN: 20403-7845 DOD: 12-11-2003 D~ Mr. McC~lob: la r~sl:o~e to your request for Da~ of Death b~lanc~ for th~ oustomer aot~d ~bov~, oar record~ ~ow ~ fotlowi~: Account A~,ouat~$070082294 Established 01-01-1979 MAIUO~ K MCELHEIqY ARLENE W LOPERT DOD bal~ace: $1,478.46 non interest be. ari~ Savings Account Ac~oum~5000920029 F~abli~heA 03-21-1997 MAIUORIE K MCELHE1VY ARLENE W LOPERT DOD balance: $2,635.17 + $0.10 Interest paid 01.01-2003 to 12-11-2003:$5.$0 Pleas~ note that thi~ o~ce only provides dste of de~Ih b~mce~ £or ~ aoc. ounts (IRAs, CDs, Checking ~ Savin~ accou~). We cio not process any financial t~'ansactiom or provide statements. If you need assistance with any of these items, please call 1-8$$-PBIC-BANK (1-$$8.762-2265) or stop bi,' your local PNC Bank:~tanch office. 1-800-762-I 775 P7-PFSC-O4-F .~00 Itjnt Ave. 4~ Fl CIF Pittsbuegh PA !$219-~128 TOTRL P.01 REGULAR,SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT; Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued interest Name of Joint Owner Date Joint Ownership Established INVE,STMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATES. OF, DEPOSIT; Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established MEMBERS 205458 4)0 05/25/2001 $52.25 $.01 $52.26 Arlene Loped 05/26/2001 205458 -11 05/25/2001 $5,337.93 $.16 $5,338.09 Arlene Loped 05/26/2001 2054548 4)5 05/25/2001 $67,322.81 $22.24 $67,345.05 Arlene Loped 05/26/2001 205458 -40 12~2O~2002 $20,576.22 $16.91 $20,593.13 Arlene Lopert/Donna Nerlinger 12/20/2002 Wo.e Insurance Supervisor March 22, 2004 Estate of: MARJORIE E. MCELHENY Date of Death: 12/1112003 Social Security Number: 2044)3-7845 REV-1510 EX * (1-971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marjorie K. McElheny SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER D.O.D. 12/11/03 21-04-00158 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPER~ ITEM INCLUDE THE N~E OF THE T~NSFEREE, THEIR RE~TIONSHIP TO DECEDENT AND THE DATE OF T~SFER. % OF NUMBER AWACH A COPY OF THE DEED ~R R~ ESTATE. DATE OF DEATH DECD'S EXCLUSION ~BLE ~LUE ~LUE OF ASSET INTEREST (IF APelikE) 1. Certificate of Deposit Acct. #205458-40, 3,432.19 100% 3,000.00 432.19 Members 1st FCU established 12/20/02 in names of Decedent, Arlene Lopert and Donna Nerlinger. Principal balance as of D.O.D.: $20,576.22; interest accrued to D.O.D.: $16.91. Prior history: Certificate of Deposit #18-31-171168, Waypoint Bank, issued 04/11/90 in names of Decedent and Donna Gay Nerlinger, liquidated 12/20/02 in amount of $21,063.17, the proceeds of such liquida- tion being deposited in Members 1st FCU Acct. #205458-40 as a transfer of one-sixth (1/6) from Decedent and a transfer of one- sixth (1/6) from Donna Gay Nerlinger, both gifts to Arlene Lopert. Value transferred by Decedent to Arlene Lopert within one year of D.O.D.: $3,432.19. TOTAL(Alsoen~ronline7,~pitulmion) $ 432.19 ~pace is needed, insert additional sheets of the same size) REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Data of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING AccOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Data of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFI(~ATES OF DEPOSIT: Account Number/Suff'~x Date Certificata Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 205458 -00 05/25/2001 $52.25 $.Ol $52.26 Arlene Lopert 05/26/2001 205458 -11 05/2512001 $5,337.93 $.16 $5,338.09 Arlene Lopart 05/26/2001 2054548 -05 05/25/2001 $67,322.81 $22.24 $67,345.05 Arlene Lopert 05/26/2001 205458 -40 12/2012002 $20,576.22 $16.91 $20,593.13 Arlene LOpert/Donna Nerlinger 12/20/2002 ~~~ ~tERS I~~RA~ CREDIT March 22, 2004 UNION Estate of: MARJORIE E. MCELHENY Date of Death: 12/11/2003 Social Security Number: 204-03.7845 :'Date Opened: ~/1~/~OOl Certificate of Deposit Amount of Deposit: ~ ~o~,~ This Cea~ifi~ate is Issued to: MARJORIE K MCELHENY DONNA ~AY NERLINGER 212 W blARBLE ST MECHANI CSBURG PA 17055-6422 Certificate Nmnber: A~count Number: SSN/TIN Nmnber: 1831171168 1831171168 204-03-7845 $ 20t 073.64 MECHANICSBURG BRANCH, WAYPOINTBANK 798 EAST SIMPSON STREET MECHANICSBURG PA 17055 Not Negotiable- No~ Transferable. This account is subject to all the terms and conditions stated in the Certificate of Deposit Disclosures, as they may be amended from time to time, and. incorporates the Certificate of Deposit Disclosures by reference into this agreement. This certificate may be redeemed on The interest rate of this certif'~a~e ofdelmsit b 4.62 % with an annual percentage yield of The rate on this certificate is ~ fixed [] variable. The interest will be: ~]~added to principal [] paid to account (No. ) []] mailed to the owner(s) 7 / 12/2001 only upon presentation of the certificate to the Financial Institution. 4.72 %. 1994 Bankem Systm~,~, Inc.. St. Cloud, MN (1-800-397-2341} Form CO-GEN 812/94 ~ I of 2) Wa~j Bett;r Banking onl~j fi`om Wa~jpoint Bank RECEIPT Rcct~t 183i171168 T Irt 1802 21,058.51 72Certi{icate Debit TERN# 132 014 12/20/2002 12/20/2002 12:10:08 Ledger Ba Iance 21,0G3.17 Checks and other items received for deposit are subject to the provisions of the Uniform Commercial Code. Certain deposits are subject to delays in availability accotcling to Bank Thank You For Banking At Waypoint ~c REV-1511EX +, (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Marjorie K. McElheny D.;O.D. 12/11/03 FILE NUMBER 21-04-00158 Debts of decedent must be reported on Schedule I. ITEM NUMBER 4. / 7. 8. 9. 10. 11. DESCRIPTION FUNERAL EXPENSES: Myers Funeral Home, funeral expenses. Hoss's Restaurant, funeral dinner. Rebecca Askey, funeral music. 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 Year(s) Commission Paid: AttomeyFees Marlin R. McCaleb, Esq. Family Exemption: (if decedent's address is not He same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent PmbateFees Register of Wills Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal, advertising Letters. Sta~ Zip The Patriot-News, advertising Letters. Register of Wills, Short Certificates. Register of Wills, filing Inventory and Appraisement. Reserve for filing Account, releases, etc. TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 7,702.20 253.32 50.00 4,500.00 143.5_0 75.00 121.60 6.00 25.00 250.00 13,126.62 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marjorie K. McElheny SCHEDULE J BENEFIClAP. IES FILE NUMBER D.O.D. 12/11/03 21-04-00158 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Bo Not Mst Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outdght spousal distributions) Arlene Winifred Lopert ' 424 South High Street Mechanicsburg, PA 17055 Donna Gay Nerlinger 54 Kano Court Ft. Myers, Florida 33912 Daughter Daughter 77,159.35 36,193.59 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ri. 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) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004117 LOPERT ARLENE WlNIFRED 424 SOUTH HIGH STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 204-03-7845 FILE NUMBER: 2104-01 58 DECEDENT NAME: MCELHENY MARJORIE KIRK DATE OF PAYMENT: 07/02/2004 POSTMARK DATE: 07/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/11/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,100.88 REMARKS: A LOPERT TOTAL AMOUNT PAID: $5,100.88 SEAL CHECK# 154 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~4~~/'-~'~ ~~ Date of Death: ~C~, /~ ~ Will No. ~/- O~-- ~/~--~ Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes ~ No__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes__ No _)~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes__ No ~ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Signature Name (Pleas.e~ type__o; print) ~ddress f ' Tel. No. (MAH:rmf/AM3) ~ ~/.Capacity: . . ,.~ __Personal Representative .__~W Counsel for personal representative BUREAU OF ZNDTVTDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. 180601 HARRTSBURG, PA 17118-0601 HARLIN R MCCALEB ESQ M R HCCALEB LAW OFCS 219 E HAIN ST NECHANICSBUR$ PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-1~¢7 EX AFP (01-05} DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-30-Z00q MCELHENY 101 9~: ~ ~:' :' Am°un~[?:Rem/**e~ t MARJORIE K HAKE CHECK PAYABLES:: AND REI~T PAyHENT TO: REGISTER OF Wl~.:iLS ~ ~:' '::. COHBERLAND C0 '~;00RT HO~JSE CARLISLE, PA 1701S CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15~7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MCELHENY MARJORZE K FILE NO. 21 0q-0158 ACN 101 DATE 08-S0-200q TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A} (1) 2. Stocks and Bonds {Schedule B) (2) 3. Closely Hold Stock/Partnership Interest (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) S. Cash/Bank Deposits/M/sc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgage L/ab/1/t/es/L/ens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 15. lq. Chari~able/govarneental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Sub~ect ~o Tax 75~32q.$6 .00 7~qSq.05 q5~288.96 q$2.19 .00 NOTE: To Lnsure proper crad/~ to your account, sube/t tho upper portion .00 of th/s fore w/th your tax payeen~. (8) 13,126.62 .O0 NOTE: 126,q79.56 (11) ]3.126. ~:~ (12) 115,352.9~ (~3) . O0 (lq) 11~5,352.9q If an assessment was issued previously, 11nas 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. 18 and 19 Nill 5,100.88 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT I! 5,100.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FOR. FOR INSTRUCTIONS., ASSESSHENT OF TAX: 15. Aeount of L/no 1~ at Spousal rata 16. Aeount of L/ne lq taxable a~ Lineal/Class A rata 17. Aeount of L/ne 1~ at S/bl/ng rata 18. Aeoun~ of L/nm 1~ ~axabla at Collateral/Class B ra~a 19. Principal Tax Duo TAX CREDITS PAYMENT RECEIPT DISCOUNT (+J DATE NUHBER INTEREST/PEN PAID 07=02-Z00q CD00q117 .00 AMOUNT PAID (151 .00 x O0 = .00 (16) 115,$52.9q x Oq5= 5,100.88 (171 .00 x 12 = .00 (18), .00 x 15 = .00 (19)= 5,100.88 RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class D (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 futura interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on tho reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Raturn~ 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 Hills, any of the Z3 Revenue District Offices, or by calling the special Z~a-hour answering service for forms ordering: 1-800-~BZ-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~q7-30ZO iTT only). 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 abject within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of AppeaIs~ Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanatlon of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. The 15Z 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 and 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 an this notice. 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 [6Z) percent pst annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January l, 19&Z mill 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 far 19BI through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor ~ ZOZ .O00Sq8 ~'~r8-1991 llg .O003Ol ~ 9X .OOOZ~7 1983 16g .000~8 199Z 9Z .O00Zq7 ZOO2 6Z .O0016q 198q llZ .OOOSOl 1995-199q 7X .OOOXgZ 2003 52 .D00137 1985 13Z .OOO~S6 1995-1998 9Z .OOOZ~7 ZOOq qZ .000110 1986 102 .O0027~ 1999 72 .O0019Z 1987 lOX .O00Z7q ZOO0 7Z .OOOlgZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessaant. If payment is made after the interest computation date shown on the Notice, additional interest must be calculatad,