HomeMy WebLinkAbout04-0547PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~$ttg 2}. -Z~f~NI4$
also known as
Deceased.
Social Security No.
No. ~-~ "~ "~q'[
To:
Register of Wills for the
County of Cra n~ ber'la~nd
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner00, who is/ar.~18 years of age or older an the executor'
in the last will of the above decedent, dated
and codicil(s) dated
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Ct~al~.c]attd County, Pennsylvaqja, with
h~, last f, amily or principal residence at '"11{ ~inedqir' ltd.
(list street, number and muncipality)
Decendent then o0[ years of age, died ~. O'u ~.~
Except as .follows, decedent did~ot'mhrr-y~ ~as not divor~d and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows.'_
$
WHEREFORE, petitioner(s) respectfully rgquest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ;~$;6g/g~t.?~t'u ,~.-~ ~
(testamentaryff; administration c.t.~.; administ~l:~.'on d.b.n.c.tla.)
theron. -
Sworn to or affirmed 'and subscribed
before me this ~Otz~ day of
'-~ C_~. .~~ ~e~t~r
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF C N nn tSt~.Z.si-tv.D
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 we~..~_nd truly administer the estate according to law.
Estate
No. , l-Oq -
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ,.~ .~.x.cx.~ \C) OZ~ 1~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having,been presentedtbefore me,
IT IS DECREED that the instrument(s) dated !]-r-~9/~L-
described therein be admitted to probate and filed of record as the last will of
;
and Letters
are hereby granted to
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ...
Renunciation ................ $
,..30~P
TOTAL __ $. I
Filed ...... ~..0.'~ !.0. 7.~. O.Q ~ .............
PHONE
REGISTER OF WILLS OF C/A~/~Pd.A~ t) COUNTY
OATHOF SUBSCRIBING WITNESS
4em~ a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that /$/~' ~ present and saw
the testate,_ ? , sign the same and that H'~ signed as a witness at the
request of testator' in h/,5 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 ~~-v~r~ day of
(Address)
(Name)
(Address)
REGI~R OF WILLS OF% COL~TY
O~F NON-SUBSC~G WITNESS ~
,
(each~r hereto, (each~y qualified accord~epose(s)and say(s)that
familiar x~ the signature of ~ ,
t .. ~ ..... ~ .. codic!!. ~' erewith and
that _~ ~%%~elieves the s~the will is in the ha~ of
tojhe best of ~knowledge and b% % X~
Sw~to or affirmed and sul~ed _before~ % ~N
me this~ ~ayof ~ (Nam%
(Address)
~ . codicil ~
(each) a sub__duly qualified a~rding to
ltahi',teii~se(s) and sly(s~ ,' % % present ~aw,
request of
other subscribi.~~es)!. - % ' ' ~ ........ '
S~to o
R~ster
(Add. res_s)
REGISTER OF WILLS OF C_, ttm t3b-Tet~_0 COL~TY
OATH OF NON-SUBSCRIBING WITNESS ;~
(:~c,~ a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
~ f~ familiar with the signature of ~ ~L ~. ~~s ,
testa~ of ~ne cf tSe sx5gzriEing wi~.cssc, iu) the will presented herewith and
that ~ believes the signature on the will is in the handwriting of
to the best of ~(~ knowledge and belief.
Sworn to or affirmed and subscribed before
me this ~C)~x- day of
~ ~ L~h~k. (Address)
(Name)
(Address)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed v~ith 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
P ,t0372008
No.
' ' Local Re=istrar
Date
PLRMANENT
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Paul D. Thomas 2. Male ~. 188- 12 -- 5472 _ 4, June 4, 2004
['~GE (Last fi~n~y) UNDER 1 YEAR UNDER I 0AY DATE OF BIRTH BIRTHP~CE
~. 81 Y,, ep 26, 1922 Carlisle, PA.
COUNTY OF DEATH
I
Cumberland Upper Allen Twp. I i~, Pu~o R~, etc
~ S~. sa. 711 Sinclair Road . , ~ , White
uaggage .~ Radroad ,~v~ffi .o~ . {~'=~ 8 o-~,.~ I- Widowed
Allen
T n
711 Sinclair Road
Mechanicsburg, Pennsylvania 17055
Unknown
Unknown
,,. .. ~argare[
Dale L. Thomas 2m. 114 Butler Street Mt. Holy Spr ngs, Pa 17065
;~ / O~(S~y) ~ .U 2tb. Jun 8, 2004 2~.. vvestmmster cemete~ 1:,.. Carhsle,*' Pa. 17013
~m~/~U~RAL SERVI~L~CTINGAS SUCH ] LICENS ...... ~D 014318 L [ ~ME ANDADDRESS ~ FACILITY
22a.&4 ~ ~'~ ~ ~ [22b. - - I zzc. Myers Funeral H~e, Inc. 37 East Main Street Mechanicsburg, Pa. 17055
AUSE (O~sea~ ~ q~ ~ ~ ~, ~ ' I I
' C[RIiFIER {Ch~ ~lv ~e) SI~ATURE~~R
REGtS~R'S SIGNATURE AND NUMBE~
LAST WIIJ. AND TESTAMENT OF PAUL D. THOMAS
I, PAUL D. THOMAS, of the Upper Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testamem, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath my said estate in equal shares unto my children,
DALE L. THOMAS, EDWARD P. THOMAS, and my foster daughter, LISA A. LAWYER.
3.
In the event any of the above-named beneficiaries predeceases me, his/her share shall go to
his/her issue, p~r sfirpes. In the event he/she is not survived by issue, his/her share shall go to the
above-named beneficiaries in proportionl shares, per stirpe_ s.
4.
I nominate, constitute and appoint my son, DALE L. THOMAS, to be the Executor of this
my Last Will and Testament. In the event that he should predecease me or for any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint my son, EDWARD
P. THOMAS, to be Executor in his place and stead. In the event that he should predecease me or
for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint
my foster daughter, LISA A. LAWYER, to be Executrix in his place and stead. I further direct that
they shall not be required to file bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
, A.D. 1994.
_
FAUL D. ~rIO1VI~S~' - -
day of
(SEAL)
fi Signed, sealed, publis, ,h, ed and declared by the above-named PAUL D. THOMAS as and
or his Last Will and Testam~t, in the presence of us, who at his request and in his presence, and
in the presence of each other,'have hereunto subscribed our names as wimesses.
CERTIFICATION OF NOTICE UNDER RUI JE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
Paul D. Thomas
June 4, 2004
Admin. No.
21-04-0547
TO THE REGISTER:
I certify that notice of beneficial interest 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
8, 2004:
Name Address
Dale L. Thomas
114 Butler Street, Mt. Holly Springs, PA 17065
Edward Thomas
711 Sinclair Road, Mechanicsburg, PA 17050
Lisa Byers
1171 Cross Creek Drive, Mechanicsburg, PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: July 8, 2004
OlqA)b, LES E. SHIELDS, III -
6 Clouser Road
Mechanicsburg, PA 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
Charles E. Shields
Attorney - p~t-La~W
6 CloUS~r ~;~, PA
Mechamcsu ~'
GEORGE M. HOUCK
(1912-1991)
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
TELEPHONE (717) 766-0209
FAX (717) 795-7473
September l, 2004
Attn: Vicky
Register of Wills Office
Cumberland County Court House
One Courthouse Square
Carlisle, Pennsylvania 17013
In Re:
Estate of Paul D. Thomas
File # 21-04-0547
Dear Vicky:
Please find enclosed check #1008 in the amount of $4750.00 for estimated inheritance tax
on the Estate of Paul D. Thomas.
Thank you.
Very truly yours,
Charles E. Shields, III
CES:dab
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11 96)
NO. CD 004339
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
....... fold
ESTATE INFORMATION: SSN: 188-12-5472
FILE NUMBER: 2104-0547
DECEDENT NAME: THOMAS PAUL D
DATE OF PAYMENT: 09/02/2004
POSTMARK DATE: 09/01/2004
COUNTY: CUMBERLAND
lATE OF DEATH: 06/04/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
$4,750.00
TOTAL AMOUNT PAID:
$4,750.00
REMARKS:
SEAL
CHECK# 1008
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CWUSER ROAD
Corner ofTrindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
June 17,2004
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, P A 17013
~:~""
_c-
Re: Estate of Paul D. Thomas
No. 21-04-547
Dear Register of Wills:
Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Paul D.
Thomas Estate as well as Check No. 1012 in the amount of $522.05 for the Inheritance Tax
Balance due, Check No. 1013 in the amount of$120.00 for Additional Probate Fee, Check No.
5237 in the amount of$15.00 for Filing Fee, and Check No. 1446 in the amount of$55.07 for
Interest Payment due.
Thank you for your kind attention to this matter.
Very truly yours,
~p~
Charles E. Shields, III
CES/mii
Enclosures
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV"1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
u_u fold
EST A TE INFORMATION: SSN: 188-12-5472
FILE NUMBER: 2104-0547
DECEDENT NAME: THOMAS PAUL 0
DATE OF PAYMENT: OS/20/2005
POSTMARK DATE: OS/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 06/04/2004
NO. CD 005352
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $55.07
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1446
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$55.07
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
----- fold
ESTATE INFORMATION: SSN: 188-12-5472
FILE NUMBER: 2104-0547
DECEDENT NAME: THOMAS PAUL D
DATE OF PAYMENT: OS/20/2005
POSTMARK DATE: OS/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 06/04/2004
NO. CD 005351
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $522.05
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$522.05
REMARKS:
CHECK#1012
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
RE\I.:5oJOEX/600\
. COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FiRST, AND MIDDLE INITIAL)
Tf../o#lIrS ?.4UL "J>_
DATE OF DEATH (MM-DD-YEAR)
010 - 0'1- .;Je>"'~
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-YEAR)
09- .?~- I'1Z2.
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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lZJ1, Original Return
D 4. Limited Estate
1Z]6. Decedent Died Testate (AlIaeh eopy or Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale or death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Altacl1 eopyofTrust)
o 10. Spousal Poverty Credit (datil of death between 12-31-91 and 1-1-95)
,:',F;::iC:;\L USE <~i\;:_
FILE NUMBER
';<L-~!L
COUNTY CODE YEAR
o 0 Slf 7
~~--~
NUMBER
SOCIAL SECURITY NUMBER
11',1' - 1;:<.
5'172-
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death p~orto 12.13-82)
o 5. Federal Estate Tax Return Required
1.- 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Altaen Sell 0)
THIS SECTION MUST BE COMPLETED_ ALL CORRE$PONDEIlC
NAME e.I(/I~LFS .E. Sflll:--z.OS 7.lr
$ OOLD ~EtlIREC [) TO:
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FIRM NAME (lfAj)plicabl'-'l
TELEPHONE NUMBER
7/7- 7~~ -020f
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
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14. Net Value Subject to Tax (Line 12 minus line 13)
fD C-L e> u.s €7( ;eJ>.
M€CII/fAllcsL3vA?6;, ~A /7os.s-
(1)
(2)
(3)
(4)
(5)
l' /~f; tJ()tJ, De>
l' t J'7'?_ "/0
D-
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (tolallines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
0-
~
If, 03(,. '+'j
(6)
~
10, 7 ZZ. &"3
(7)
1013. J33.3f?
(9)
'I
If? 173'/./5
'I .
/. I~/J. 82
(10)
(11)
(12)
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
!9. Tax Due
CHECK HERE IF vOU ARE REQUESTING. REFUND OF AN OVERPAYMENT
0 x.oD- (15)
1"
/ ::<2,7/2. /3 x .0':15... (16)
() x .12 (17)
() x 15 (18)
,19}
6FFTcrAL~J.SE '.'.}~~L:f
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-
(B)
t
I 4/1 '812. 10
,
'l'ft1. 17"1. '17
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5, szz. as
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> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS 7/1 SINCtJf/If' /ClJ. -
CITY /J/ECII/lAI /t:s 6tt,f'(;. I STATE ~/I PiP /7055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(II
o
7 St). DO
:; St). De>
(2)
11.1,
f
Total Credits (A + 8 + C)
3. InteresUPenatty if applicable
D. Interest
E. Penalty
o
19
TotallnteresUPenalty ( 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)
~
SS-Z;Z. oS
,
~
S; &'00. .DO
o
19
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
(SA)
(58)
8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
s ZZ. oS-
5S-.47
}It S-7 7. 12
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
.....0
............0
o
.0
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..........
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or .... .. .................... .................
d. receive the promise for life of either payments, benefits or care? ...... .... .........................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............. ...................... .. ......................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................... ......................... ........................... ....................
....0
IXI
o
No
IZI
IZI
IZI
IXJ
IRJ
o
I8J
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 pefJury, 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 preparerother than the personal representative is basecl on all information of which preparer has any knowledge.
SIGNATURE"6li. ~ERSO!Y'ESPONSIBL~G_RETURN
)c . / ~ c7 . ('~.,.-,.
ADDRESS PII-t.I!F t.. 7liDI11IfS
11'1 Bun 6'( Sr., mr: HOLLY SfJIUIV6 S, 'pH 17FJ4S
SIGNATU F PR PARE%JTHE A.N PRE~IVE
)C t::. Z
ADDRESS I-/A~('ES e SH/El-PS 7lr
.. CL.ous~ ,Rh., mEC!H.I'1A//Csd/.(II?G.,PA I1OSS'
DATE
5""./7-0 S-
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 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. S9116 (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. s9116(a)(I.211.
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. S9116{1.2) [72 P.S. s9116(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. s9116(a)(1.3)}. A sibling is defined, under Section 9102, 3S an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
ES T or fl.4ttL b. /dc41d5" 2./-0 <('-5<(7
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.= #55:.07
REV.1502EX+ !1.97)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
':21-0'1- 5'17
/"iP/Il/fS; ,,?lAIIL 2>.
FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair mari:et 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
survivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
fi.GSIPE!NTIHt- /Z/:~L e..5mn; srn{/lTE AT 711 SINCLAIR
IU>., /J1EeH/lAlle.58Jf~G (u PilEI( /fi.t.av 7/jUJAJSHIP~ (!UI11/OBe-
LAlli/) C!Pttlf/rY- fl~lf/AJ.s YLJIIf,(/f/f./ As /05 /J1pRE F<-fay bEScR/~-
1:;l) /;11 71t4T L'E.<lr/1/A/.J)E7:J) f7'.?P/11 /J1ERJ//I/J~. /ll(!c;UIK'F
.-
d VlX, no /--fttL D. 7H.R#//fS _/ "c)t/1/11ee- /1-. 7r1,:}/J1~S
./
A/s U!,'k./ /Rk"t/ ,4;?;tIL .73- /'160 MU/ "f'ECPRLJa> //1/ A'€
O~r:/CE t!>r mG'" A?Ed?-?L!EJe t!>F 'z>.:6Z>S /A) 4NLJ ~A?
C.?t///h.E7ZL./IA/.i> t!PqATy fA) l/6!:D BOOK r'T./" I/rU. /9- ,,:}/f'6€
5St r/?AA/C!ES,1. /"iMI/tS rA?E/)EeG71SeD a:CElJ€Nr f/9?FrW
(SEF /t?tJFESS/N}'A( A/I;?R/f/S& LJP $'?/f!K E:. Hlt..S-
EJ<r f /f.55PC5. Ai'T7/f-Cr'l~.f) #atE7P).
~
/ 0 ~ OQ:). 00
TNFPtJI/t-Tio#HL Noll:: 7#/S f?-etJ;?EZ?TY /S Ct(IlIIEN7ZY t{AiI>&l
M tJR/Ii.. t!&vrd/fCT ()F SA-LG -n> /81;; de;t)u~ /I? b.RtnN6
/0 SEZL.. AT 77,//$ .r4P'r'A".#/SS ?XZI!:!E.
TOTAL (Also enter on line 1. Recapitulation) I S /0 r,. 000 . ...,
(If more space is needed, insert additional sheets of the same size)
Mark E. Hilbert & Associates
04-259M1 S
File No 04-259MiS
********* INVOICE *********
File Number: 04-259MiS
Summay Appraisal Report
Charles Shields III Esq.
6 Clouser Road
Mechanicsburg, PA 17055
Borrower:
Paul D. Thomas (ESTATE)
Invoice # :
Order Date:
Reference/C ase # :
PO Number:
04-259M1 S
August 10, 2004
04-259M1 S
711 Sinclair Road
Mechanicsburg, PA 17055
Appraisal
$
$
300.00
Invoice Total
State Sales Tax @
Deposit
Deposit
$
$
($
($
300.00
0.00
Amount Due
$
300.00
Terms: Balance due upon receiptof invoice add15% fee if paid 30 Days past receipt.
Please Make Check Payable To:
Mark E. Hilbert & Associates
219 East Main Street
Mechanicsburg, PA 17055
Fed. I.D. #: 23-2391423
TO INSURE PRPOER CREDIT
PLEASE RETURN A COPY OF THIS INVOICE WITH YOUR PAYMENT.
.,
Mark E. Hilbert & Associates
04-259M1S
File No. 04-259MiS
APPRAISAL OF
I, 1:"
j' I,~ ,
j ,r . ,. r
'.;
,
Summery Appraisal
LOCATED AT:
711 Sinclair Road
Mechanicsburg, PA 17055
FOR:
Charleds Shieids III Esq.
6 Clouser Road
Mechanicsburg, PA. 17055
BORROWER:
Paul D. Thomas (ESTATE)
ASOF:
June 4, 2004
BY:
Mark E. Hilbert
MARK E. HILBERT & ASSOCIATES
Pronettv Descrintion File No. 04-259MiS
PrODerty Address '711 Sinclair Road Citv Mechanicsbura State P A ;;JDGode 17055
Leoal DesaiDtion Attached Countv Cumberland
Assessor's Parcel No, Tax Year R.E. Taxes $ Soecial Assessments $
Borrowar Paul D. Thomas tESTATE) Current Owner Estste Occuoant: I I Owner Ixl Te~ant r I Vacant
.. Pronertv rinhts annraised IX I Fee SimDle I I Leasehold I ProleetTvne I I PUD I I Condominium IHUDNA only) HOA$ /Mo.
Neinhborhood or Proleet Name Upper Allen Township MaD Reference Census Tract 116 --
Sale Price $ Estate Date of Sale Desaintion and $ amount of loan charaes/concessions to be paid bv seller
Lender/Client Charleds Shields III Esq. Address 6 Clouser Road, Mechanicsburg, PA. 17055 --
Annraisar Mark E. Hilbert Address 219 East Main Street Mechanicsbura PA 17055
Location U Urban ~ Suburban W Rural Predominant Single family housing Present land use % land use change
BuiJtup (RJ Over 75% o 25-75% 0 Under 25% occupancy PRICE AGE One family 68% o Not likely o Likely
$(000) (yrs)
Growth rate o Rapid o Stable o Slow o Owner 120 Lnw New 2-4 family 15% o In process
Property values 0 Increasing [RJ Stable 0 Declining o Tenant 375 Hinh 65 Multi-family 4% To: Residential
Demand/supply 0 Shortage !KJ Inbalanre 0 Oversupply o Vacant ((){j%) Im;imimj! Predominant ;'i;:!;:'li' Commercial 3%
Marketinn time M Under 3 mJS. iXl 3-6 mos. n Over 6 mos. nVacanIIO'lfK5%) I I -
195 30 V. Land I 20%
Note: Race and the racial composition of the neighborhood are not appraisal factors.
Neighborhood boundaries and characteristics: Subiect Praperty is located along Sinclair Road in Upper Allen Township, Cumberland Countv,
. Pennsvlvania.
. -
. Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.).
, Pronertv has oood access to emplovment and services. Churches ,Schools and Recreational areas are within a reasonable..distance._.
.
..
-----
-- --
Subiect is next to the PA. Turnpike. - -.-
-~
Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time
- - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.):
With the improvino markets the seller are not required to offer sales or financino concessions. Financing is readly available from a
variety of sources. ,.---
-
. Project Information for PUDs (If applicable) - -Is the developer/builder in control of the Home Owners' Association (HOA)? U YES ONO
Approximate total number of units in the subject project Approximate total number of units for sale in the subject project
Describe common elements and recreational facilities:
Dimensions 277.4 x 220 x 211.4 x 210 Topography Basicallv Level -~
Site area 1.2 Acres Corner Lot 0 Yes (RJ No Size 1.2 Acres -~
Specific zoning classification and description Residential Shape Rectangular --~
Zoning compliance [KJ Legal 0 Legal nonconforming (G"andfathered use) o Illegal o No zoning Drainage Appears adequate
Hiahest & best use as imnroved: rxlPresent use n Other use (explain) View Residential
Utilities Public Other Off~site Improvements Type Public Private Landscaping Typical --
Electricity 0100 AMP Street Macadam 0 0 Driveway Surface Macadam --.
Gas o None Curbfgutter None 0 0 Apparent easements None apparent
Water o Private Sidewalk None 0 0 FEMA Special Flood Hazard Area DYes lxJ No
Sanitary sewer R Private Streetlights None R R FEMA Zone II C" Map Date 02-15-04
Storm sewer Alley None FEMA Map No. 420372
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning, use, etc.): None Apparent
Subiect however to reservations easements, conditions and rioht of wav of record.
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNOATION BASEMENT INSULATION
No. of Units One Foundation Block Slab NONE Area Sq.Ft 1308 Roof c:J
No. of Stories One Exterior Walls Brick O1>MSpare NONE % Finished Unfinished Ceiling Cncld -0
Type (Det./Att.) Detached Roof Surface Composition Basement Full Ceiling Joist Walls Unkn 0
Design (Style) Ranch Gulters & Dwnspts. Aluminium Sump Pump Yes Walls Block Floor 0
Existing/Proposed Existinq Window Type ObI. Hunq Dampness None noted Floor Concrete None 0
Age (Yrs.) 40 Storm/Screens YES YES Settlement None noted Outside Entry Unknown 0
Effective Ane Yrs.\ 12-15 Manufactured House No Infestation None noted
. ROOMS Fover Livino Dinino Kitchen Oen Familv Rm. Rec. Rm. Bedrooms # Baths Laundrv Other Area Sq.Ft.
, Basement 1 Storage 12Qfl
Level 1 1 1 1 3 1 1,30.8
. Level 2
.
Finished area above arade contains: 6 Rooms; 3 Bedroom s ; 1 Bathls\; 1 308 Square Feel of Gross Livina Area
, INTERIOR Materials/Condition HEATING KITCHEN EQUIP ATTIC AMENITIES CAR STORAGE
Floors H/W-CoUAva Type FWA Refrigerator 0 None 0 Fireplace(s)# _ 0 None [J
. Walls Plaster / Averaoe Fuel Oil Range/Oven 0 Stairs 0 Patio 0 Garage # of cars
Trim/Finish Wood / New ConditionA vg. Disposal 0 Drop Stair 0 Deck 0 Attached
Bath Floor Vinvl / Avo COOLING Dishwasher 0 Scuttle 0 Porch Front 0 Detached 2
Bath Wainscot Fiberolass Central None Fan/Hood 0 Floor 0 Fence 0 Built-In -.--
Doors Hollow Core / Avg Other None Microwave 8 Heated R Pool In Gr.Pool 0 Carport
Gondit~nAvq. Washer/Orver Finished n Orivewav 6
Additional features (special energy efficient items, etc.): Pool needs a new liner, Roof needs to be replaced. Basement shows siqns of dampness,
Interior is in need of a comolete redecoratina, Including Floorina, Furnace is onlv 3 Years old.,24X30 2 Car Garaqe~ --
Condition of the improvements, depreciation (physical, functional, and external), repairs needed, quality of construction remodeling/additions, etc' . No evidence
of functional or external obsolescence
----
- -^-~._-
. -~-
Adverse environmental condrtions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the
immediate vicinity of the subject property: There are no visible or apparent adverse enviornmental conditioins that would negatively impact__
the value of the subiect
UNIFORM RESIDENTIAL APPRAISAL REPORT
04-259M1 S
Freddie Mac Form 70 6.93
PAGE 1 OF 2
Produced using ACI soflware, 800.234.8727 www.adweb.com
Fannie Mae Form 1004 5-93
Valya'tion Section
UNIFORM RESIDENTIAL APPRAISAL REPORT
04.259M1S
File No 04-259MiS
ESTIMATED SITE VALUE . . . . . . . . . . . . . . . . . . . . . . . = $
ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS:
Dwelli", 1 ,308 Sq. Ft. @$ 65.00 = $ 85,020
Bsml. 1308 Sq. Ft. @$ 12.00 = 15,696
. Porch Pool = 13,000
, Ga-age/C")XJrt ~Sq.Ft. @$ 15.00 = 10,800
Total Estimated Cost New = $ 124,516
. Less Physical "1 Fu~~tio.n~I' r . E~t~r~~I' Est. Remaining Econ. Life:
Del'Ociatbn 50,000 I $8,000 1$0 = $ 58,000
Depreciated Value of Improvements . = $ 66 516
"As-is" Value of Site Improvements, = $ 2,000
INDICATED VALUE BY COST APPROACH. = $ 123500 Estimated remaininn economic life is 30-35 years.
ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
711 Sinclair Road 915 Park Place 1905 Good Hope Road 1353 Zimmerman Road
-eo r"'";~""'~ ~j -"'";~""., '^ : ".", '^ ~",. '^
Proximity to Subiec! 3 Miles+/- 7 Miles+/- 10 Miles+/-
Sales Price $ Estate $ 110 l!1!illillill[$ 115 000 'x $ 98,000
Price/Gross LoUvea $ 0.00 III $ 115.29 III $ 102.86 Ill' $ 92.80 Ill.... .., ...',
Data and/or C.P.M.L C.P.M.L. C.P.M.L.
Verificalion Sources Inspection Aoent Aaent Aaen!
.--
VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION 1 +(.)$Adjustment DESCRIPTION 1 +(.)$Adjustment DESCRIPTION 1 +(-}$~djustmenl
Sales or F;"nancing 117 DOM 9 DOM : 97 DOM
Concessions Conventional: Conventional, Conventional
Date of SalelTime 3/22/04: 2/27/04 : 5/21/04
Location Suburban Suburban' Suburban' Suburban
LeaseholdiFeeSIroIe Fee Simole Fee Simole: Fee Simole 1 Fee Simole
Site 1.2 Acres 0.72 Acres+/- : +2,400 0.52 Acre+/- : +3400 0.99 Acres+/. :
View Residential Residental' Residental' Residental:
Desir1n and Anneal Ranch I AVQ. Ranch I Ava.: Ranch I AVQ.' Ranch I Avq. :
Qu""'ofCmslnxfu1 Brick Aiuminum: Brick : Stane / Vinlv :
Ane 40 Years 38 Years+/-' 43 Years+/-' 22 Years+/- :
Condition Fair ta Ava. Averaoe : -10000 Averaae : -10,000 Fair to Ayg :
Above Grade Total' Ba'rms' Baths Total' Bdrms' Baths : Total' Bdrms' Baths : Tolal ' 8drms I Baths :
Room Count 6: 3: 1.00 6: 3: 1.00: 6: 3: 1.00: 5: 3: 1.00:
Gross LivinoArea 1,308So.FI. 1040Sn.FI.: +2700 1,118Sn.Ft.: +1,900 1,056.S!liLi___+2,500
. Basement & Finished Full Full-Walkout: -2,000 Full : Full
Rooms Below Grade Unfinished RecRm/Bath' -3,000 RecRm/Bath : -3,000 Unfinished
, Functional Utilitv Averaae Averaae : Averaae ' Averaae
. Heatino/Coolina Oil H, Water/No Radiant/No: Oil H.Air/CA : -1,500 Oil H.Air/No
. Enerov Efficient Items Averaae Averane Averaae' Averaae
GaraDe/CarDort 2 Car Det Garaae Carnort/1 Car Gar: +1,000 1 Car Carport : +2,000 Off Sl. Parkina
Porch, Patio, Deck, Porch Porch : None +1,000 None
Fireolace(sl, et.c. None Fireplace' -1,500 None ' None
Fence, Pool, etc. In Gr. Pool None : None : None
None None : None : None
Net Adi.ltotalt + X. '$ 10'400~X - '$ 6,200mXI+ I.
Adjusted Sales Price
ofComDarable $ 109500 $ 108,800
Comments on Sales Compartson (tncludtng the subject property's compatlblhty to the neighborhood etc) See Attached Addendum.
55,000
Comments on Cost Approach (such as, source of cost estimate,
site value, square foot calculation and for HUD, VA and FmHA, the
estimated remaining economic life of the property):
In the reproduction cost of improvements, Marshall & Swift
Residential Cost Handbook and local contractors are
referenced.
---
+1,000
--
,
,
,
,
,
,
,
,
,
:
:$
$
+5,000
+1,000
-.-
9,5QQ.
.1QZ2QQ.
ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
Date, Price and Data None None None None
Sourcefcq,-iorsales N/A N/A N/A N/A
",thinvearofaD[)"aisal Owners Deed C.P.M.L,/Court House C.P.M.L,/Court House C.P.M.L,/Court House
Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any pior sales of subject and compa-ables within one year of the dale of appraisal:
The sales comparison approach carries the most weiaht in determing market value as it is based on historical infirmation and is not as
subiective as in the income approach
INDICATED VALUE BY SALES COMPARISON APPROACH . . . . . . . . $
INDICATED VALUE BY INCOME APPROACH IIf Aoolicablel Estim~t~d .Ma~kei R~~t. $. . N/ A /Mo. x Gross Rent Multinlier N/ A - $
This appraisal is made [RJ "as is" 0 subject to the repairs, alterations, inspections or conditions listed below 0 subject to completion per plans and specifications.
Conditions of Appraisal: ~ ~---
."
Final Reconciliation: The market approach reindorced by the cost approach is a Qood indicator of fair market value. The fact that the seller is
or is not pavina any portion of the closina casts has no effect an this aooraisai.
. DATE OF DEATH JUNE 4, 2004
The purpose of this appraisal is to estimate the market value of the real property that is the subject of this report, based on the above conditions and the certification, contingent
and limiting conditions, and market value definition that Cf"e stated in the attached Freddie Mac Form 439IFannie Mae Form 10048 (Revised 6/93 )
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THATlS THE SUBJECT OF THIS REPORT, AS OF D.O. D. June 4, 200.4_
. (WHICH IS THE DATE OF INSPECTIO AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ 109,000 .
, APPRAISE~. .,/'..L1 '/ .4' / i SUPERVISORY APPRAISER (ONLY IF REQUIRED):
Sinnature "H~c;:Ji9i"7 Signature
Name Mark E. Hilbert I" Name
Date Report Signed Auqust 17, 2004 Date Report Signed
State Certification # RL-000388-L State PA State Certification #
Or State License # RB029755A State PA Or State License #
109,000
o
ODid OOid Not
Inspect Property
Freddie Mac Form 70 6-93
State
State
PAGE20F2
Producedu.ingAClsoftware.800.234.B72iwww.adweb.com
FannieMaeForm1004 6.93
Mark E. Hilbert and Assoc.
REV-l503 EX + (1-97)
'*
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
.;2/ -0 l.f -5'17
EST ATE OF
7J; t7 /J!.If >- //1-/1 L
J:>.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PPG- XN D/AS TR.. I E"S eLlS IP No.
, INc. fo<J3Spl., 10 7
11-) C If",( 1/ r. AlP. P'X 36oSI/ /q st,. ",f Cp/I1tY}on
8) " " Ix 35"/760 / q .sh. of
CDmmon
c.) " " Ix 32%0/ 3Z Sh. of
CommDn
7j) r#t. 76 sh.
tl-I!>.'/' nrluh;'/1 /,/ , , f4 "t
6t?, s6 It> .su.'! av~__ '0. ZO = 'f .57 S. 2-0
.:2.. CUM 1.JE:CI(LA,vj) }//fC-tE'Y &{)~,9?.4 TirE" /153/1/.
'" ~
d 'I <5~4re5 ~ c/.tJ.c/ n.-lUe ",j' /0."'<' eAch - ;;( 7',!). 00
.3.
I/- cerutti }/J//-h/ld en /ljOG ~ "oAj"'lZhk ~ !""(!.brgl/iolder.r
c/ ~Aj' /~ Z(JoEj
l'
3'/.20
TOTAL (Also enter on line 2, Recapitulation, I $ 4, rr'l. io
ilf more space IS needed, insert additional sheets of the same size)
00175069350610THOMAS---PAULDOOOO
6025
Please Note: The check below represents a Dividend Payment
w
Pl'GINOUSTRIES,INC
ONEPPGPUCE
PfTTSBURGH,PA.15272
Have you considered having your Dividends Directly Deposited into your bank
account instead of receiving checks by mail?
If you would like to participate in this free program, please complete the form below:
........
-
........
-
001 750 69350610
PAUL D THOMAS
711 SINCLAIR RD
MECHANICSBURG PA 17055-4053
PLEASE MAIL COMPLETED ENROLLMENT FORM TO:
MELLON INVESTOR SERVICES
PO. BOX 3316
SOUTH HACKENSACK, NJ 07606-1914
==
=
........
........
=
-
-
-
-
-
-
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-
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-
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........
!!!!!!!!!!!!!!!
AUTHORIZATION FOR DIRECT DEPOSIT OF DIVIDENDS
I (we) authorIZe Mellon Investor Services to direct future dividend payments to the institution listed on the attached voided personal check or on this form. I (we)
acknowledge that the origination of ACH transactions to my (our) account must comply with the provision of US Jaw.
Taxpayer Identification Number or Social Security Number Daytime Contact Telephone Number:
I i O=CCO::-~_II=LT]
Financial Institution Name:
Branch Address:
City, State, Zip:
Indicate Account Type:
Checking/5.avingsJ
Other Account
Number:
Financial Institution ABA
Bank Routing Number:
D Checking
D
I I
Savings
CCIIJ
!IIIIIIIIJ
.:
:.
The Bank's ABA Routing Number is the first 9 digits of the MICR code
located on the bottom of your check. If you are unsure, we encourage you 10
contact your financial institution or attach a voided check to your request
Obtain your shareholder information online via a secured Internet site
www.melloninvestor.com/isd
To access our Interactive Voice Response System dial:
~ Toll Free Number: 80000648-8160
a:.a~ Outside U.S.: 201-329-8660 ~
Hearing Impaired: 800-231-5469
~
'"
"'
'"
8
Signature of Registered Holder
Date
Signature of Registered Holder
..
'"
"'
'"
o
Date
6025
125087284567
00175069350610THOMAS---PAULDOOOO
-----------------------------------------------------------------------------------------------------------------------------------------
RETAIN FOR YOUR RECORDS
SHAREHOLDER OF
, TRANSACTION DESCRIPTION
CUSIP
001 750 69350610
RATE PER SHARE
$0.4500000
TAX WITHHELD YEAR TO DATE
$0.00
PPG INDUSTRIES, INC.
INVESTOR 10
125087284567
NO. OF SHARES OWNED
76.0000
ACCOUNT KEY ISSUE/CLASS OF STOCK
THOMAS--PAULDOOOO COMMON
I GROSS AMOUNT I TAX WITHHELD
$34.20 $0.00
I AX IDENTIFICATION NUMBER ON FILE
ON FILE
DIVIDEND
RECORD DATE
05/1012004
CURRENT DIVIDEND
$34.20
PAYABLE DATE
06111/2004
DIVIDEND PAID YEAR TO DATE
$67.64
Please detach and retain this form for your records.
PLEASE DETACH BELOW
_:I.,I~'l:I:r'..I=-'['II"I.hllr::a~I.:"\......:.r.'~...It1:"l:J:.:::t::r..'.,I:I=-I:I..:'.l..~.II=_.:I~.I.I...,IlIII::a~I.M']~I...ll~......'li'.'l:J.I:::lI..'.l.II".".:::I:II'Jr.l:I~..:[tJ....".'l.'.
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PPGINOOS1RIES,INC
ONEPPGPlACE
PIITS8URGl,P~, 1S27t
PAYABLE DATE'
06/11/2004
CHECK NUMBER
42104776
60-160
433--
PO. BOX 2314
SOUTH HACKENSACK, NJ 07606-1914
PAYABLE AT MELLON BANK NA PITTSBURGH, PA.
IN U.S. DOLLARS
001 75069350610
THOMAS-PAULDooOO
101358401 AT 0.292 "AUTO T1 2611317055-4053118 DOMOOoa01
1...111...111"..1.1..1.1.,1..111....1.1...11....11".111..1,1
PAY TO THE
ORDER OF:
PAUL D THOMAS
7 1 1 SIN C LA I R R D
MECHANICSBURG PA 17055-4053
i PAY*********fII**-*S34.20 I
~
IZED SIGNATURE
11'1. 2.01.77bll' ':01.:1:10 lobO .1:0'1 ."''11.01.11'
,~''"~'",''' '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~
l#tJ/J1;fS. //llIL :D.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
;U-Olf-5lf7
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
d.
3.
5-
t..
VALUE AT DATE
OF DEATH
DESCRIPTION
Ir7Y t!IIEy/tUGT s. w. Y//Y'. # IL 3StlJ'.T .33S" ,U'I
(See JltI/J(tJhdn ~IttIe/llMt q!hrcAul)
~
I) (00.00
If,
j}1 <j T 8A-NK:
t4.J C/'u;:'iy ,leer: AlP. 374/:/.8 J'S/S
(/3.) Aeu. :In!: ~ /'0, /. hi Ir~;., 2/1-,)
(~~ fft!ttqhP/1 k.#er 4'#.rcAu/)
e{(jh a;,u/ (!.pi/15 in rSaf clCjJosit 170)(
(see r!lPy tf .:t/lvenh>ry IPrhf tl (fa dreel)
:IrPlen~ry rI ;1em6 of fl.ersO/Itllly (:1/fadtetl)
p~ -- VDu.c.hu-: - G,ntroU..r a-t Cu....'au-J......tl ~Ll.\'I~
'D:v.-derv/ ~ "'" PPf-G :::.~~
~
loo.ov
,
3 'f. 20
':? :3" '1. 7'J
,
00.(')0
,-
%",~
~
117. 00
TOTAL (Also enter on line 5, Recapitulation) $ .'1, 0 :3 4. 'ff{
(If more space IS needed, Insert additional sheets of the same sIZe)
Ju'l 13 'O'f 02: O'fp
CIS
13028342136
p.l
~M&rBank
.jl,)" ,v(itdll.:!l R\l<1J. !\1ill,';(lflw. Dr': J 'J'.:V'i6 MIl;l (\l(l( !W-MB- i::
[Inom: P;:-;,\l:' ~C'i-4:;..!')
I::-tx (.;02; '.1.).1-2')\)
Jllly ij.l(1IH
F~x: i]7-795-7473
Ch.l rlc, E. Shield" II!
Attorney At Law
6 Clouser Road
:Vll-chanicsburg, FA 17055
Rc: I~'sla/(' or l'rll!l D Thonuls
Socit.n' '\'ecur;/r /:"\8-12-5';72
Dati' n(JJCIIlh June./, 2011,]
Dear tvlr. Shields:
Per :,'uur lnqulI'Y d,ncd .Iuiy 07, :20CJ4, plcJ5e b~~ ,Hivisl.'J that III the time of JC~lth the aho\'e-n<1mt.~d Jt'e~~dcnt h;1d on ,k'pu~il
wnh This b<Ulk lhl~ J{)llowin'~:
I.
T\'/-J(' u[.;!CCOllnl
Chcckmg ,1('(.'011171
,~ccuunJ N/UJ/hcf'
374;::,""2515
Ownership (NamL's /)/1
Paul f) 'f11Otna.\'
U,m:mng Oafe
OSlO/lUll
Eo/ano..! on Dale (!/DeUlh
'>2,3{)V/i)
/Icnwd In/ere,"!
.3
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fIlial
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0/5()(}.;204092700
(J-.I.'f]ership (N{~m('s uf;
Fau/ f) Thomas
Da/e L Ihr:mar
()fJ('.'un'<.Date
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Jul 13 04 02: 04p
CIS
13029342136
p.2
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TI:ne ({Au..'O//n!
('crt/ieOll.! I{ !\pc's:t
AcCt'.JUJlt /v'ultlhc!"
OJ .!0030 / j /5j,150
(Ja'f1crsh:f-' /.'\,'~IIIIC::; </.J
P(Jul D Thm,llus, I'n(;;(ee
Dale ( T/u;ma\'. f}<..'J/(://uu/1'
.f~jH:ard P Thomas. lk-nc/ic!(JIY
Opcning DUk'
05/()//IJ(j
!Jaium.\..' un OWe 0/ n/.'ath
'5/,071_>)1)
AU-'r/lc:..i Iflfi...'h'S/
,',
7.37
TUld
$!,U8U6
P\c:1.<;e ;)i..~ :IJviscJ, there wa::. flU ;i~di.: dCPOSH box r"unu till' the aDO....!.; decedellt. h.Jr funl'lcI' JCCowll in/(}mlGtiqn, r(~g;ln..iing:
t)wn~r:;hlr, closures .;lm!/or rcjlllburs~rmmt oj fund5, pleJst call the 1 Jlgh Stfl..'ct Carhsle OtTicc /" -: 17,,'~'~O""'15}6.
Smccn:-.Iy,
?!d /r~ ('~t'1dJ.-
1/ {;
Nanc:: C~I1;t:.ll
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~~9!02!2004 17:27
I R~ghtFax
7175913112
8/30/2004 10: 28
OFFI CEMAX
PAGE 001/002
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APPLlCA1IOllFOR TAX >lS:S1'T
Serial: AMaFlerl:tage
373633 "'~ortbeBJ.ii(d
2011 FIatb....h _...... Su"" 63. Brooklyn. NY 112341.100.2_13 FIlde..1 TAX II)" !lll21_
NOT A VALID TAX RECEIPT! UNLESS STAMPED ABOVE
IMPORTANT! For your protection complete and mall ort.ax to 11lJ.ll51-5463 within 24hrs to our office!
\Once _Vlld it ...81 be stamped and ftltUmlld to you .. your ""''''.. tax receipt)
DQNOR ~"FORMATION
REF fI:: 3!4600
PAUL (DEC) DALE THOMAS
711 SINC-LAIR RD
MEClIAJilCSBURG.. PA 17055
TOW TRUCK DRIVER INFORMATION
NATIONAL TOWING SERVICE (945)
r.' I I'. r I. I II . I I ~ f I' - ~ J,' I,.,
JASON WILSON
TEL': 7f77nS290TEL2:jPr1....;;l'irsl,."m. "-..",,,.. ..... J....t~.. If"" ,,,""-":---
~ ;; ~...u"""".. :2"" 13<;-10/7,,,, _
'Rrst~ to _ IClftlly_I"ldclldupvehlc1e._.bel....'"b.ih8lt'"
:: ~ ~~ i~(6:J5]: :.~~J~~Jl~~~=~J(ETS.2oJ~lm:EASE.l:C
Phone .. J.9' ofBlrtl1ll'l! " ~tut""~2-: ()f. .,,">4
1 y~/../~ ~ _.>.L.LJ.;::..L..
SllIn,"",. "'th. T... Trude criYoor 00.. of ,",ck Up
~~J_"tERUQI ~,"RO"JCEU,."'~ }lOOK
,....~r".;t... ,:~v: :,,-::~'=.c::~II.~ ~;:.:=:..... :z:.~~~..-;..;..-....,,::..~
'.\'~, ~.......) ~_ ........... '..:0 ~....~.. '''''": ~ ~ ';;"
"""''"'A V. '....ID. T".'" .............T.l __. .\~""_"';_",,=,.~~(ilo_''''....IlI'_~'''''..' """':.... .;. ......; I'~. .. _~....fofhf
.~.." - ~~.......,. ~ ....-........................... ~...~."""
-.........___........III!"".....,.,..... . '1tw .nlan at th..."..... m..,..,mlftt GI
tftIt' Kelly SlUe SOak. AdJu....... c.n b.
--.Idered fOr cendftl. and ~tot\ f!If ihe
...,,_.
1'ERIIS 01' OONA'TlON-D_ ...._... _"""" far_ 811.... _ D...or......_""" de.. _ "'the _..... h_1hw ...lI1ty..... ,,""...
........ .,d ."....... DM"IM'!Ihlp Gt 'h .......Ua. Donm- ___ll!:Iftc=lln, lICknowI..... 1h1ll ......... far the 81Jnd ,~ rwlyfng 01"1 _ abDW
III.....A. .,tflllana 1ft ....-..sng Into ..... 1._ ......Dn. If.. I..,. ot yau.. sbIIa raqan . .n., of .. ...tornabI.. to ~ ...... ~.....~
iii..... _:dc:brw. yaI rm.st do -.0. pt.... be .... to NntOW ilndIor AUl'WIiItdItrttwm -"' Obtain . reottptfrOt'n tt.a dlpMtIIi~fI/f metaI'~. .md
... It\ft ...... opIIIDe M ..I'oafol..........,.,of _wA.L...... Of,.r whlcM.. DonofU....II'*__. ~ Md 1n"'lfn4tletr, ....t1...forh 8ft.- end
l....towIn' ~plddn.lJp 1M .........fI"em... to..."..: (A) 8efng rHpClhSlbI.tD,..".,.. ttJ.-1........ ""_,anyoa.,.~ p"..-ty
[... wwy haW...... ~ tn 1ht VlIhIct.: no..... can be ~ under QR~ ~....-'\_~.... Denor "'1\ .. ~0h!I1b" far all dllft'l.... arising allt of
I no< -lying ..... - '- ........... ..... 001 limited ... 11_ .... ........._ ......... by OIly ,-..- ....~ (Bl Any 1I....,11y ,... ..y
~ ~ m87' OOCUr' dIB1ng pfdeup _ tDWfna "". W1hfd.. (C) Donor a.... t" DbbIn neVlrldUpllc. 1ftIe. H thtJ 'tIh 1:1 ml....~..ty wgnect lit
I M'OnI' pI_. If done..-..... "01.......... ~ ...... II!) p.y lilt 'ncu..... ch.... .... stcrage fttttL (OJ Claims ...... tWlnt any m"_~ or
Im--.... In OIlY of"'" _........_.....0 _ trII_ oflhw __..... .ncludl......... _n_ to _ow. IlIIgtItI.... _'trotIon,
"Us. CI....... dMMnds... _ 11..J.... AeIIon, Of MY kind. Should darter not "",.,._.. VMI. ft. 01' lien rei... Wllhi'n" dll'ilS of dondon __p,
!danar ....". RaDle foI'~tonIoe chtqe GtSSp<< d*YstM'ttn. '""" _ UyGtpickUp. ~ 180 d~. Nhtd. wtn be d1~!!!ut II" "'dld,.,..
icostto~OI'or_.
KELLY BLUE BCICM VALUE .__.......
$ 1100 _00
VEHICLE INFORMATION ______
TEAR: 1978 MAKE: CHEVY MODEL: IMPALASW
IMPORTANT:
1"1..... Enter Vehicle lnfonnallon Numtler (VlN 11);
,......_no....""'......._,.... I ( I L , 31"-, U I B ,]""'.3 I J IS-, &,B 14,
F"~ofAtbwn....!!lt
fo Wham It~ eo;....... J ....... ~nt_ ..m.... at ,...., __ _ andIOr
.....TlONAI.. TOWING SERVIce
.. act _ mylour _~In -. toslOn........ __ _....,.... '---V In or...'" tranl>fwr 1"1/ I......... ."._In
ilupllc:.....".."IJ..:.:h...mor......A~ ..:UDn~.t...,..,\cM list........ ...tD~~:' ,a;t}dDnmtDf't _ I.... *'""-_
DonorJOrlRt__, OAIf. -:1l4.l2 M8-S SIgn""'" ~~"'""'0 o.r.......L.J-LJ~
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page
of
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
ITEM
NO.
Cash: Report total only.
Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
All other contents.
ITEM DESCRIPTION
7n.-
dJ.
~/Z. Aro.r /-~/'f71).$"
II
"
~ .
,JI., /zT3o
rH:
$
"
"
..
H
iH
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
SIGN
PERSON RECEIVING COPY OF
SAFE OEPOSIT BOX INVENTORY:
SIGNATURE
P~;/~s:
PRINT TITLE
:5H'~/d~
.--
ljf.
PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
i DATE
: CHECK APPROPRIATE BOX:
o Executor(trix) 0 Admiflislrator(trix)
o Estate Representative 0 Joint owner of safe deposit box
NOTE: Attach additional 8'//' x 11" sheet(s) if necessary or use duplicates of this page..of form.
KITCHEN
Old microwave stand alone
Toaster
Assorted pots and pans
Assorted kitchen utensils and silverware
Small kitchen table and 2 chairs
SUB TOTAL
LIVING ROOM
Old recliner chair
Old lift chair
2 end tables (small)
Upholstered chair
OldTV
SUB TOTAL
DINING ROOM
Small wheeled table
Formica table
3 semi-card table style chairs
Small desk and chair
Assorted knick-knacks
SU8 TOTAL
BEDROOM OF SON
All his items
DAD'S BEDROOM
Single bed
Foldable walker
Old filing cabinet
Set of drawers - medium height
Small desk and chair
Small set of drawers - low height
SUB TOTAL
MASTER BEDROOM
Plastic waste can
(8ed, belonged to daughter)
Fold top small desk
Fold up cot
Small lamp
I small piece luggage
2 shotguns - 12 gauge
SUB TOTAL
BASEMENT
Old washer
2 Old deep freezers ($15 each)
Wooden shel ves and drawers
Small ladder
Miscellaneous hand tools
Old deep freeze - junk
Small fan
SUB TOTAL
GARAGE
Utility dolly
Assorted lawn chairs
3 small aluminum ladders
Assorted hand tools, shovel and rake
Old liding lawn mower
Old hand lawn mower
Several hoses
SUB TOTAL
TOTAL
SCHEDULE E
$ 4.00
1.00
5.00
3.00
22.50
$ 35.50
$ 15.00
10.00
5.00
5.00
5.00
$ 40.00
$ 7.50
7.00
12.50
24.00
3.00
$ 54.00
NO VALUE TO EST ATE
$ 10.00
4.50
4.00
12.50
25.00
17.50
$ 73.50
$ .50
NO VALUE TO EST A TE
10.00
1.00
2.00
2.00
35.00
$ 50.50
$ 20.00
30.00
10.00
2.00
5.00
-0-
1.00
$ 68.00
$ 2.50
25.00
15.00
7.00
70.00
5.00
1.00
$125.50
$447.00
Estate of Paul D. Thomas
REV.t">l9EX+(t-971
'*
SCHEDULE F
JOINTL Y.OWNED PROPERTY
COMMONWEALTH OF PENNSYLVAN1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tr;/?/11A-s, /A<< L lJ.
FILE NUMBER
21 - OLf- Sf( 7
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RElATIONSHIP TO DECEDENT
A.
]).4L.€ 4. T;fNJ1/1S
11'1
/J17.
StiTt. E,f ST.
H/!JL./.Y 5PFl/N6S, piA
/70..5"
..so #
8.
c.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed far ioil'1tly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A I";',z.f /J1f-T 13,4/vK 54Y/"j.I A-d# CISoo'lzolfa<j 700
flr//7c,/?ol ...~/. 4'13.I.r,
/lee;. ~I/t. 2~t!J>D
!' :r SZl/o fllq, 7 zz. [}
7,rAl. ;1/ , f("!>. b{, .;1.1, Lflf S. "',
(su. Yit4"'!';/l /e/f't;r g//;/Ckal ;f. [;cJut/. F)
TOTAL (Also enter on line 6, Recapitulation) $ 10, 72Z..?3
-
3
(If more space is needed, insert additional sheets of the same size)
""""""'""w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
TII/J/J1,45" P/l-UL JJ_
FILE NUMBER
cZl-oLf- 'S'f7
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.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE.THEIRRELATlONSHIPTO DECEDENT AND TH EDATEOFTRANSFER
ATTACH A COPV OF THE DEED FOR REAL ESTATE.
5€Jf/ES EE V.s. SAY/II/(;S /.30A/i)S
P. 0.1>. To L/SA LA.wV~ 4n~ .KA/"'.-vIl//lS
Lis/! ,(JYt9'?S ])A-tl6H"TE-e aF DECE'IJG/IIT
"
.1.
S~~/ES E _"/ E~ <<-S. .9!Y//VGS &/1//)S
P (). j). To Z>"?{t; ;ZY-"'m-?s, 5:>,-t/ Cr lJECGl)
E)JT.
3.
SE7l/ES ~ 4'UI' El; QS. S/lnA/6S {j,,/II})S
p. d. lJ. 7i:> EDwA/lO 7J,<'04l'A->, SON I!JF
DECEOt=7VT
(s"'€ E>~G7'I-/CLJot<o/V OF J/"HL..t.lGS" A.1//)
LIS7?NC OF A!EC//'/ElVrs ft 7//lt!#E-j))
If ' "
. IN 7RJlsr lPe CeU1F, OF ~€poSlr
#' t!3//JtJ 39/// 55.f~0
jJ/h!I/. 1>. ;W",,?fA':r 7i!i!USTa: h:>"(:
:I>At.E L. ~'A'7~
'JCtJhI#/liJ /'.. 7J.I/JIJ1/J-s
P. , I ';<
~'nc,p": 1,013.'1'1
I/-ecr. I:nt · 7. 37
TbrA-t. ' I, b 9/. 3/.
(SE"€ VIH-UI/-77DN LC=TTE7( /I-rr"'CH/,o-z)
"To SC.HE"l). E.)
DATE OF DEATH
VALUE OF ASSET
"
~, 6, 70. ,fl/
~
'I-. ?2z. 5S"
,
~
~ '-38: (;,3
II,D/?/.3'
%OF
DECD'S
INTEREST
/bO/'o
I/)O~
/""~
/00%
EXCLUSION
IF APPLICABLE)
-D -
-D -
-0 -
-0 -
TAXABLE VALUE
!'
~ (,7o. J>l/
,.
~ J' ZZ. 5.5"
,..
~ 638: l.3
~ /, on. 51,
TOTAL (Also enter on line 7, Recapitulation) $ /3, :;;33.3$
(If more space is needed, insert additional sheets of the same size)
Savings Bond Calculator
Value As Of
I 061200~
Update
Help
Bond Info
Series
I EE Bonds
Denomination
Serial Number
~ 1,000 I~
li]
Results
# Bonds
23
Total Price
$4,075.00
Total Interest
$8,077 .02
Serial Number Issue Date Series Denom Issue Interest Value
Price
(,J M41578664EE 10/1990 EE $1,000 $500.00 $578.80 $1,078.80
('.2) D24135484EE 10/1989 EE 500 250.00 311.20 561.20
(3) D19515431EE 11/1988 EE 500 250.00 333.80 583.80
(If) R52836592EE 11/1988 EE 200 100.00 133.52 233.52
(SJ R528.36593EE 11/1988 EE 200 100.00 133.52 233.52
m M41761040EE 11/1990 EE 1,000 500.00 578.80 1,07880
'-1) D26286174EE 04/1990 EE 500 250.00 300.20 550.20
,
~ll) D13167066EE 10/1986 EE 500 250.00 453.00 703.00
(,,) R599752EE 02/1980 EE 200 100.00 422.72 522.72
170) R206932832E 01/1979 E 200 150.00 560.64 710.64
(ir) C530203484E 01/1972 E 100 75.00 428.52 503.52
pz-) K12744842E 01/1972 E 75 56.25 321.39 377.64
(i3) L2080935053E 05/1977 E 50 37.50 210.08 247.58
(J.t) Q2185753416E 10/1967 E 25 18.75 109.70 128.45
U~J M43757318EE 11/1991 EE 1,000 500.00 536.80 1,036.80
'in D26286173EE 04/1990 EE 500 250.00 300.20 550.20
(/1) D24135482EE 10/1989 EE 500 250.00 311.20 561.20
r~) R599753EE 02/1980 EE 200 100.00 422.72 522.72
~,) R206932833E 01/1979 E 200 150.00 560.64 710.64
:lo) C530203485E 01/1972 E 100 75.00 428.52 503.52
::uJ K12744843E 01/1972 E 75 56.25 321.39 377.64
a~) L2080935052E 05/1977 E 50 37.50 210.08 247.58
~.3) Q5052428394E 12/1972 E 25 18.75 109.58 128.33
'\riew 10 I Viewing Bonds 1-23
1!lp :," ViWWS. publlcdebl treas,gov I Be ,"SBCPric<,
7/27/043:25 P,vl
Total Value
$12,152.02
Issue Date
Add
YTD Interest
$198.76
Interest Next Final
Rate Accrual Maturity Note
4.00%
400%
400%
400%
400%
4.00%
400%
400%
400%
4.00%
400%
4.00%
400%
400%
400%
400%
400%
10/2004 10/2020 Wlf Del
10/2004 10/2019 LISA Del
11/2004 11/2018 ~rs~ Del
11/2004 11/2018 LIsA Del
11/2004 11/20 18 LfS-+ Del
11/2004 11/2020 DJIoLE" D el
10/2004 04/2020 DA-LG'D el
10/2004 10/2016 ML,.. Del
08/2004 02/2010 DALI: Del
07/2004 01/2009 DA<.,;- Del
DME"
01/2002 MN Del
MuF
01/2002 MN Del
11/2004 OS/2007 1Ht<€ Del
llII<E
10/1997 MN Del
11/2004 11/2021 t<[) Del
10/2004 04/2020 E:./) Del
10/2004 10/2019 E.!> Del
08/2004 02/2010 E'D Del
07/2004 01/2009 ED Del
ED
01/2002 MN Del
o 1/2002 1\1~ Del
11/2004 OS/2007 /ED Del
~J)
12/2002 MN Del
Pap.eI nf:'
AEV-1511 EX+ (12-99) ,.
C>,,~,"
1f.~.:}"~).1\.
4.;,~~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
M,? /J1 /t5> ;:/ /f- tIL )).
FILE NUMBER
21-0'1- 5Y7
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
,.
FUNERAL EXPENSES:
/Ylyer~ F/.1'Jlt1a/ j/p~ 4" /JkdM/t!S/tUJ
cjJen'1j 01 c;n;We aI NesbH'mler {!elnefcrJ
FU/Jem/ tur~ /lka/ aI- cSf; /kuls {{lulul cJ;urdt if {!JIJ./J/
br IJ! edwlIc S 6u r;;
:?,
3.
B. ADMINISTRATIVE COSTS:
(P,
If.
1. Personal Representative's Commissions
Name of Personal Representalive(s) DALE 7){LfH/,AS
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
IN BuTLG"? 57
f{oLty SP,f!/N6S
/7/JC,S
State ;://1- Zip
City /J1r
Year(s) Commission Paid:
2.
Attorney Fees CJI/l2LI:S E: .:5N/e-ZDs ill
3
Family Exemption: (It decedent's address is \lot the same as claimant's, attach explanalion)
Claimant -,=DHI~/I!.j) 7N"'J1~S
Street Address 7// S/NClAI/C 121>.
City mE t!1i/fA//es /:Jt(,f!G-
State PH Zip
/7oSS-
Relationship of Claimant to Decedent ..5.0#
4.
Probate Fees {).M.c/ o";Jlnt1.1 ;S5lA~ of sh.d C.e.rf,'hca.Tt!s
5.
Accountant's Fees
6.
lJanet !3,..",c.kla:1/ f-l t-R 1310c./<.f
Tax Return Preparer's Fees b~ ~. (t,.Jh'm.) J
. ~lrer 'hs';,q ;'1 {!q/'hsle Svrh~d
I rJ
I/ltIyerfiS/"! I" {!ulIIl,,'/1IIU! kw fillMal
mlu-K E. I/:/krt f /!-5S01:!';. ~"I /i:si ~nlJ:Sa 1
I /ldel/-h'bf/../ shurt Cuf,'{;adi~
/Yll:.ch an ;c.s-
7.
1.
1.
If-tiel/;'ol1al prtJbtde ~u
I
I
Recapitulation) I $
(' (J,."ff/;w.u! '"' ~,,~ ski)
TOTAL (Also enter on line 9.
(If more space is needed, insert additional sheets of the same size)
AMOUNT
:I
10, 030. 7;2
1i9 'f;;; 110
J'C_
-5 a!). GO
7:
(. , :Zoo. 00
J4
3, SOC>. 0<>
"
I'fCl.i90
,
35"0.00
Jf
9S:ZT
" 7S:oo
"300. bO
,c'f.ot)
,.
I ~().tJO
I~ 039. IS-
,
.5e11eJ..."/, eed cI
.. ~ST. t?F 77Ytt$Af;1 tlNttL D. /-:ILc /I/o. .;21-CJ'I-S~
I.;?.. hhr k,hr h,/{(:/". ~ A;{mr t- 1?~'Jb ( ~/11 ~jS:NJ
13.. fYf1f-L / E/ec-h-/c..,/ ~/'h;'e.. 6'"o,7J
JI
It} .. ,tJ/lrL {!'. SI
!:J-.. ~~I-L ~s: 92-
7
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REV-1512 EX< ('-9.7j .~
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COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
;JAtft- :1>.
'7i-!ontIl-S,
FILE NUMBER
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Include unreimbursed medical expenses.
ITEM
NUMBER
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DESCRIPTION
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TOTAL (Also enter on nn. 10, Recapitulation) S I, 1'1 f), ,f';J.,
(If mere space is needed, Insert additional sheets of the same size)
R8J_1513EX+(1_971
'*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
.;2/ -0,/- Sy'7
THt? /I//rs/ ;4 /It{ L ]).
NUMBER
L
NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trusteels)
AMOUNT OR SHARE
OF ESTATE
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARiTABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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(It more space is needed, insert add'ltionalsheets of the same size)
,
,
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2004-00547 PA No. 21-04.0547
Esta te Of: THOMAS PAUL D
(Las(, First, Middlel
Late Of:
UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 188-12-5472
WHEREAS, on the lOth day of June 2004 an instrument dated
November 21st 1994 was admitted to probate as the last will of
THOMAS PAUL D
(Last. First Middle)
late of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 4th day of June 2004 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
THOMAS DALE L
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 10th day of June 2004.
fu \...A . 0
.' n(in ~<.l.".,^"'h" fu~~
Register 0 Ills
t if . .
1~
.
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
,
. .
,"'---'--~l
~._~
LAST WILL AND TESTAMENf OF PAUL D. THOMAS
I, PAUL D. THOMAS, of the Upper Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills by me at any time heretofore made.
I.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath my said estate in equal shares unto my children,
DALE L. THOMAS, EDWARD P. THOMAS, and my foster daughter, LISA A. LAWYER.
3.
In the event any of the above-named beneficiaries predeceases me, his/her share shall go to
his/her issue, per sth:pes. In the event he/she is not survived by issue, his/her share shall go to the
above-named beneficiaries in proponionl shares, ~ stiI:pes.
4.
I nominate, constitute and appoint my son, DALE L. THOMAS, to be the Executor of this
my Last Will and Testament. In the event that he should predecease me or for any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint my son, EDWARD
P. THOMAS, to be Executor in his place and stead. In the event that he should predecease me or
for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint
my foster daughter, LISA A. LAWYER, to be Executrix in his place and stead.! funher direct that
they shall not be required to file bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this .:2.;;/" day of
Mi".
, A.D. 1994.
-9-~~~...~
PAUL D. OMAS
(SEAL)
Signed, sealed, published and declared by the above-named PAUL D. THOMAS as and
for his Last Will and Testamerit, in the presence of us, who at his request and in his presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
~. i;: i !-.J. U L [\:f"lf" :'/0,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
F:c;(!prm (1If1:l~EOfF INHERITANCE TAX
;:,:,:::~~~~.:r,,-,ALLOIIANCE OR DISALLOIIANCE
,', 01"',IlEDuttJolIS AND ASSESSHENT OF TAX
08-08-2005
THOMAS
06-04-2004
21 04-0547
CUMBERLAND
101
APPEAL DATE: 10-07-2005
( See reverse side under Objections)
Amount Remitted I I
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 -
REY:is4;-Ex-AFp-co3:osi-NOTICE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLONANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
PAUL D FILE NO. 21 04-0547 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX ZS06Dl
HARRISBURG PA 17128-0601
2005 rl~}G -5
ri:': II: "'4'
hll . oJ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
.""" .-
CHARLES E SHIELDS
6 CLOUSER RD
MECHANICS BURG
IIIv;
PA 17055
ESTATE OF
THOMAS
*'
REV-1547 EX AFP (06-05)
PAUL
D
TAX RETURN liAS: I X I ACCEPTED AS FILED
DATE 08-08-2005
I CHANSED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..1 Est.t. (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
5. CashlBank DeposltsIHisc. Personal Property (Schedule E)
6. .Jointly O_d Property ISchedul. Fl
7. Transfers (Schedule en
8. Total Assets
III
121
131
141
151
161
171
109,000.00
4.899.40
.00
.00
4.036.49
10.722.83
13,233.38
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedul. H)
10. Debts/Hortgag. Liabilities/Liens (Schedule X)
11. Total Deductions
12. Net Value of Tax Return
13. Chariteble/Sovernaental Bequestsi Non-elected 9113 Trusts (Schedule J)
14. Net Value of Est.t. Subject to Tax
I~ an asses~ent was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will
reflect ~igures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. A~unt of Line 14 at Spousal rate (IS)
16. ~ount of Line 14 taxable at Lineal/Class A rate (16)
17. Aeount of Line 14 at Sibling rat. 1171
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax ou.
C n.
191
1101
NOTE:
T
IlUItBER
CD004339
CD005351
CD005352
INTEREST/PEN PAID I-I
250.00
.00
5.51-
DATE
09-01-2004
05-20-2005
05-20-2005
18,039.15
1.140.82
1111
1121
1131
1141
.00 X
122,712.13 X
.00 X
.00 X
AHOUNT PAID
4,750.00
522.05
55.07
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
00 =
045 =
12 =
15 =
1191=
NOTE: To insure proper
crec:li t to your account I
suai t the upper portion
'of this for. with your
tax payment.
141,892.10
19.179 97
122,712.13
.00
122,712.13
.00
5,522.05
.00
.00
5,522.05
5,571.61
49.56CR
.00
49.56CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE DF THIS FOR" FOR INSTRUCTIONS. I
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
r,r('r> r,,",.r-'"' 0.l:~r.,l.;. ~,-
h.:iU~.:_,:-U U:S:II~] ~MENT OF ACCOUNT
REV-1607 EX AFP (03-05)
?p1r; rr'-' _ -ry
L..'~ . ~
, '. '? ()
. cU
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-12-2005
THOMAS
06-04-2004
21 04-0547
CUMBERLAND
101
PAUL
D
/,"",- ...,
CHARLES E SHIELDS I)l
6 CLOUSER RD
MECHANICSBURG PA 17055
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF THOMAS PAUL D FILE NO.21 04-0547 ACN 101 DATE 09-12-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-01-2005
PRINCIPAL TAX DUE: 5,522.05
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-01-2004 CD004339 250.00 4,750.00
05-20-2005 CD005351 .00 522.05
05-20-2005 CD005352 5.51- 55.07
08-29-2005 REFUND .00 49.56-
TOTAL TAX CREDIT 5,522.05
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
If 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" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
0-~
STATUS REPORT UNDER RULE 6.12
Paul D. Thomas
Name of Decedent:
Death: June 4, 2004
Date of
Admin. No. 21-04-0547
Will No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
Stat~hether administration of the estate is complete:
Yes-A- 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 r~resentative 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 s~e 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.
~b~
Date:
1]..IVf/~r--
Charles E. Shields, III
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717) 766-0209
Te 1. No.
Capacity:
Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
Vt-