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HomeMy WebLinkAbout04-0167Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of THOMAS J. BAKER Deceased JAMES I BAKER No. _~./_~4~_/~ 7 Social Security No. 204-03-5803 Petitioner, who is 18 years of age or older, applies for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of ~ the Decedent, dated June 22, 2000 State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (d.b,n,c,t.a,: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence I COMPLETE IN ALL CASES: Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 15 Market Street, Borough of Wormleysburg, Cumberland CounW, Pennsylvania (List street, number and municipality) Decedent, then 83 years of age, died February 8, 2004 at Holv SDirit Hosoital, Camp Hill, Pennsylvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ..................................................................... $ (If not domiciled in PA) Personal property in Pennsylvania ..................................... $. (If not domiciled in PA) Personal property in County .................................................... $. Value of real estate in Pennsylvania ...................................................................................................................... $ Tota~ ......................................................................................................... $ 26,088.00 90,100.00 116,188.00 Real Estate situated as follows: 15 Market Street, WormleysburR, Cumberland County, Pennsylvania Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence JAMES L. BAKER 4802 Winsford Road Harrisburl~, PA 17109 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and subscribed Before me this ,,/c'~ 7,,~: . day of ,,~--~5//,~'.z2~ ?' ,2004. J~,~S L. BAKER Estate of THOMAS J. BAKER ., Deceased Social Security No: 204-03-5803 Date of Death: February 8, 2004 AND NOW, ,,Z-~.~,~zl'.,~/~ ?- ,_~ z~ ,2004, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritete are hereby granted to JAMES L. BAKER in the above estate and that the instrument dated June 22, 2000 described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES Letters ........................... Short Certificate(s) Renunciation .............. Affidavit ( ) .................. Extra Pages ( ) ....... Codicil ............................ JCP Fee ....................... Inventory ...................... Other. ............................. TOTAL ......... $ Register of Wills ~ ~ . ~- J .~" - / $ /o. OO Attorney: RALPH H. WRIGHT1 JR. $ I.D. No: 56113 Address: Johnson, Duffle, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- Telephone: 717-761-4540 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 filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00' P 9963168 FEB 1 (;2004 Local Registrar (~' No. Date 35143 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH STATE FILS NUMBER NAME OF DECEDENT (First, Middle. Last) [BE× SOCIAL SECURITY NUMBER DA~J[ OF DEATH {~,lorlth Day Yearl ,. ~holnas J. Baker l~.le 1204 - 03 - SS03 AGE (Last Birthday) UNDER I Y~R I UNDER 1 DAY [ DATE OF B~RTH BIRTHP~CE C~ and [P~CE OF DEATH ~k on v one s~ nstm~ons on =th~[ side~ i ' [ Months [ Days [ ~rs ] M n~es [ (Month, Day, Year) [ State or Foreign Count~) I HOSPlT~ / ~,' COUNTY OF DEATH [ CITY. BORO, T~ OF D~TH[ FACILI~ NAME (If not tnstil~lon, give s~eel and numar] [WA~ DECEDENT OF HISPANIC ORIGIN3 [ RACE - American Indian, Ble:k ~ile, et DECEDE~'S USUAL OCCUPATION ~ [ KIND O~ BUSINESS 1 INDUSTRY I ~AS D~EDENT EVER N [ DECEDENT'S EDUCATION ] }' [ MARITAL STATUS Maned [ [ 1~" SURVIVING SPOUSE DECEDENT'S MAILING ADDRESS (S r~t, Ci~own, Slate, Zip C~e)ACTuALDECEDENT'S 17a. SlatePe~sylv~&a Did 17c. ~ Yes, decedent Iwed in ~p 15 ~ket Street ,ES~D~NC~ dece~nt (S~ inst~ions ~~ t~nship~ 17d.~ within actual limits of "~'"~ ~ ci{y~oro ~sNo~eysb~g,PA 17043 o,o~.,de ~. county FATHER'S NAME (Fiat, Middle, Last) MOTHER'S NAME (First Middle, Maiden Surname) I~T'S~ArL NG A~ESS~SImet ~l~own State, ~ C~ INFORMANTS NAME2Da. (mypemdnt) S~a Force 2~P. D~CK UlrcleF ~vllle,~a METHOD OF FION DATE OF DIS~SITION ~ P~CE OF DISPOSITION- Name of ~mete~ Cremato~ ~LOCATION - C ~own. S ate, Zip C~e ~emoval from State ~ ~Mo,~. Day. Year) or Oth~ Pla~ ~.13,2004 ~11in9 Green ~~ ~er Allen ~.~PA17011 ~,SON ACT~N~ AS S~H I NAME AND ADDRESS OF FACILITY ~sel~ ~&C8,324 ~el Ave.,~e,PA TO ~e best ~ my k~ledge, dea~ ~ed et ~e time, date and place slated. LICENSE NUMBER DATE SIGNED Items 24-26 must be ~mplet~ by TIME OF ~E~T~ 23b. ~ 23c. WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONERq Enter UNDERLYING CAUSE (Dlse~e ~ inju~ ~s~ting on death ) ~ST d PERFORMED~ AVAI~BLE PRIOR TO ~ ~ I M~ ~y Year) I oFCOMPLETDEATH?ON OF CAUSE Natural ~ Homi~ I I Accident ~ Pending Imvesegation ~ I t Yes D No D CERTIFIER (Ch~ only o.~) ~ ~ ~ StGNAT~D TITI F G~ffTI~I~ *PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying to cause of death) To the beet ct my knowledge, death occurred at the time, date, and place, and due to the cauees(s) and manner as stated ...................... [] *MEDICAL EXAMINER/CORONER On the basis of examination and/or Investigation, in my opinion, death OCCurred at the time, data, and place, and due to the cauees(s) and manner as stated ......................................................................................................................................................... [] 3ts. REGIST~I~ SIGNATURE,~I~U~ LICENSE NUMB~ER DATE SIGNED (Mo[lth Day, Year) NAME AND ADDRESS OF PERSON ~O COMPLETED CAUSE OF DEATH (Item 27) Type or Pdnt ~ 0 ~ DATE FILE~ Month, Day, Year) 0033104)0003/06.22.00/RHW/KLT/135833.1 East ill anb eatament OF THOMAS J. BAKER I, THOMAS J. BAKER, of the Borough of Wormleysburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and fimeral from my Estate as soon after my death as conveniently may be done. ARTICLE II I give and bequeath my motor vehicle(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my nephew, JAMES L. BAKER. Should my nephew, JAMES L. BAKER, not be living on the thirty-first (31st) day after my death, I give and bequeath the same unto my niece, MARGIE BAKER, of Anderson, Califomia. ARTICLE III I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate unto my nephew, JAMES L. BAKER, provided that he survives me by thirty (30) days. 009564-00001/April 12, 1994/EGM/AAK/34622 ARTICLE IV Should my nephew, JAMES L. BAKER, not be living on the thirty first (31st) day following my death, I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate to my nice, MARGIE BAKER. ARTICLE V I name, constitute and appoint my nephew, JAMES L. BAKER, Executor of this my Last Will and Testament. Should my nephew, JAMES L. BAKER, fail to qualify or cease to so act, I name, constitute and appoint my niece, MARGIE BAKER, alternate Executrix to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of her duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this "~ day of June, 2000. /~I'I~I6MAS J. l~R ' (SEAL) Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. 009564-00001/April 12, 1994/EGM/AAK/34622 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ' COUNTY OF CUMBERLAND · SS (ct ~h dq , the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as wimess and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witnes-s . ~-: ~ -- Subscribed, sworn to and acknowledged before me by THOMAS J. BAKER, Testator, and subscribed and sworn before '03 , witnesses, this ,~ ~n{ day of June, 2000. Dada C. Parmer, NotmY Public Lemoyne Boro,_Cu .rnbe~fland ~C~2u~n,~1 My CommiSsion Expires I.,'e~. ,~,, ,~w '. Member. pennsvIvanna AssOciation O! ,",%'q,~,q~ Notary Public OF JOHNSON, DUFFLE, STEWART & WEIDNER ATTORNEYS AT LAW LEMOYNE, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: THOMAS J. BAKER Date of Death: February 8, 2004 Will No.: 2004-00167 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 March 3, 2004. Name James L. Baker Address 4802 Winsford Road Harrisburg, Pa 17109 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: March 3, 2004 Name Ralph H. Wright, Jr. Johnson, Duffle, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Counsel for personal representative JERRY R. DUFFLE RICHARD W, STEWART C. ROY WEIDNER. IR. EDMUND G. MYERS DAVID W DELUCE JEFFERSON J. SHIPMAN RAI,PH H. WRIGHT, JR MARK C. DUFFIE JOHN g. NINOSRY MICItAEL J. CASSIDY MELISSA PEEL GREEVY ROBERT M. WALKER WADE D, MANLEY LAW OFFICES DUFt IF=,, :,o August 20, 2004 OF COUNSEL HORACE A. JOHNSON E LEE SItIPMAN BRUCE } GROSSMAN Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Thomas J. Baker SSN: 204-03-5803 Our File No. 3310-3 Your File No. 21-04-00167 Dear Register of Wills Office: Enclosed for filing please find the following documents for the above referenced decedent: maffer. 1. 2 Original PA Inheritance Tax Returns. There is tax due in the amount of $15,256.63. The check is attached to the Return. 2. Estate Check in the amount of $31.00 as follows: a. $15.00 Inheritance Tax filing fee b. $16.00 Inventory Fee ($10.00) and $6.00 for 2 additional pages 3. 2 copies of Pages 1&2 of the Pa Inheritance tax return, which we ask that you time-stamp and retum to us in the enclosed envelope. 4. Inventory 5. Inventory (1 copy, which we ask that you time stamp and return to us in the enclosed envelope. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this ~,_~,03ry truly y°um' ~- ~,,~Vi~.se ~q.~.n.-..-.~-, .----......._..- Legal Assistant c: James L. Baker, Executor 8234242 501 MARKET STREET P.O. BOX 109 LEMOYNE. PENNSYLVANIA 17045-0109 WWWJDSW. COM 717.761.4540 FAX: 717.761.5015 MAIL@JDSW. COM JOHNSON, DUFFLE, STEWART & WEIDNER, P.C. Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Thomas J. BAKER also known as No. 00167 Date of Death 02/08/2004 , Deceased Social Security No. 204- 03 - 5803 Ja~es L. BAKER~ Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and a~l of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of Attorney: Ralph H. Wright, Jr. Signature: BAKER I.D, No.: 56113 Signature: Address: P. O. Box 109 Lemoyne~ PA 17043-0109 Telephone: 717/761-4540 Address: 4802 Winsford Road Harrisburg, PA 17109 Telephone: 717/540-1655 Dated: Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value Total: 121,508.93 NOTE: The Memorandum of real estate outside the Commonweaith of Pennsylvania may, at the election of the personal representative, include the value of each itern~ but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystem., Inc. Form//Ri-7 (1992) Estate of: Date of Death: County: Thomas J. BAKER 02/08/2004 Cumberland INVENTORY CASH: IRS Refund M&T Bank Cash Bonus - Refund to Account M&T Bank Checking Account No.13351370 Residence located at 15 Market Street, Borou§h of Wormleysburg, Cumberland County, Pa. Tax Parcel No. 47-20-1858-159. - Reimbursements made to Estate for County Taxes. Settlement Sheet from Sale on July 2, 2004 is attached to this Return. 513.00 25.00 15,371.94 210.97 PERSONAL PROPERTY: 1997 Dodge Grand Caravan - Valued using Kelly Blue Book at KKM.COM. The Report is attached to this Return 4,000.00 16,120.91 4,000.00 -1- STOCKS/LISTED: 35.000 shares Metlife Inc. Common Stock - Statement Shares - Valued using EstateVal. Valuation is attached to Return 1,215.20 BONDS: 2 United Stated Series E Savings Bonds. - Valued using Savings Bond Calculator. Such assessment is attached to this Return 172.82 1,215.20 REAL ESTATE/PA: Residence located at 15 Market Street, Borough of Wormleysburg, Cumberland County, Pa. Tax Parcel No. 47-20-1858-159. - Property sold on July 2, 2004. Settlement Sheet is attached to this Return 100,000.00 172.82 TOTAL RECEIPTS OF PRINCIPAL ............... 100,000.00 121,508.93 -2- REV- 1500 EX * (6-00) D E C CApB HpRL EpIO CRAC KOTM ES R E C A P I T A T I 0 N C 0 M xl T I 0 N COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, ANe MIDDLE INITIAL) BAKER Thomas J. DATE OF DEATH (MM -OD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 02/08/2004 ! 08/31/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNITIAL)  1. OrlglnalReturn [~ 247a.. SupplementalReturn 4. LlrnltedEstate · FuturelnterestCompromise(dateofdeathstter 12-1Z-82) 5. Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of WlI0 (Attach copy of Trust) r-~S. LltlgatlonProceedsRecelved [~10. SpousaIPovertyCredlt (date of death between lZ-31-91 and 1-1-95) NAME Ralph H. Wri~ht~ Jr. FIRM NAME (If Applicable) Johnson, Duffle, Stewart & Weidner OFFICIAL USE ONLY FILE NUMBER 21-04-0167 COUNTYCODE YEAR NUMBER SOCIAL SECURITY N UMBER 204-03-.5803 THIS RETURN MUST BE FILED IN DUPUCATE'4%qTH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 0 COMPLETE MAILING ADDRESS P. O. Box lOg (date of death 3. Remainder Return prior to 12-13-82) 5, Federal Estate Tax Return Required 0, Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) 301 Market Street Lemoyne, PA 17043-0109 TELEPHONE NUMBER 717/761-4540 1. Real Estate (Schedule A) (1) 100,00~ ~-~ 2. Stocks and Bonds (Schedule B) (2) 1138~ {}2 3. Closely Held Corporation, Partnership or (3) ~o~e Sole -Proprietorship ~ 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 0. Jointly Owned Property (Schedule F) ($) ] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (7) (Schedule G or L) 8. Total Gross AssctE (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) X ,0 0 15. Amount of Line 14 taxable at lineal rate 0.00 X .0 4.5 17. Amount of Line 14 taxable at sibling rate X ,12 18. Amount of Line 14 taxable at collateral rate 101,710.88 X .iS 19. Tax Due 201120 91 None None 11,304.62 8,493.43 ~ OFFI:~i~ E ONLY · ~J (0) 121,508.93 (11) 19,798.05 (12) 101,710.88 (13) (14) 101,710.88 (15) O. O0 (18) O. O0 (17) 0.00 (18) 151256.63 15,256.63 Copyright (c) Z000 form software oniy The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 15 Market Street CITY Wormleysbur~ Tax Payments and Credits: I. Tax Due (Page 1 Line 19) ~. Credits/Payments A. Spousal Poverty Credit B. Prior Payments Co Discount STATE ZIP PA 17043 (1) 15,256.63 Total Credits ( A + B + C ) (2) 0.00 3. interest/Penalty if applicable rt. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line Z0 to requeat a refund (4) 0,00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ($) 15,256.63 A. Enter the interest on the tax due. (gA) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 15 ~ 256.63 Mak. Cl~k Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yea No e. retain the use or income of the property transferred; ......................... [] ~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. ~ [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ F~ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNA/T~R£OFPER$~J..~E~PONSIBLEFORFILINGRETURN Jaste$ L. BAKEE o~'rE {'~,,~, ~ ]~ 4802 Winsford Road ~ "~ "~i~'f~6A~;'~-'Yiib~ ........................ Ol~/~ SIG~T~EOLPREPAREROT~THANREPRESENTATIVE Johnson, Duffie, Stewart & Weidner DAT~ For date~ of death on or a~er Jul2 1, lgg4 and before Janua~ 1, lggS, the tax rate imposed on the net value of tran~fer~ to or for the u~e of the ~u~iving ~pou~e i5 3% [72 P.~. gl 16 (a) (1.1) (i)]. Fo~ dates of death o~ o~ after Janua~ 1, lgg5, the ~x rate i~osed on the net va ue of t~ansfer~ to or for the use of the ~urviving ~pou~e [72 P.S. ~116 (a) (1.1) (ii)]. The ~tuta doe~ not exert a transfer to a ~iving ~use from ~x, and the s~tuto~ require~nts for di~cio~um of a~sets and filing a ~x return are ~till appl~able even ~ the ~viving ~pou~e i~ the on~ beneficial. Yo~ data~ of death on or a~er Ju~ 1, The ~x rate impoged on ~e net value of tran~er~ from a deceased child twen~-one yea~ of age o~ younger at death to or for the u~e of a natural parent, an adoptive parent, or a stappamnt of the child is 0% [72 P.$, ~116 (a) (12)]. The tax rata imposed on the ~t value of tran~fe~ to or fo~ the use of the decedent% lineal b.neficiade~ i~ 4.5%, except a~ noted in 72 P.~. gl 16(1.2) [72 P.S. 9~ ~6(aX~ )]. The ~x rate im~sed on the net wl~e of tran~ers to or for the u~e of the decedent% ~ibling~ i~ 12% [72 P.~. g116(aXl.3)]. A ~ibling i~ defined, under ~eclion g102, as an i~dividual who ha~ at least one parent in com~n with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANrA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thomas J. BAKER SS~ 204-03-5803 SCHEDULE A REAL ESTATE 02/08/2004 FILE NUMBER 21-04-0167 All real property owned solely or as · tenant In common must be repo~ted at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowled(, ~ of the relevant facts. Real propert}/which IE ~olntl]/-owned with ri~lht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residence located at 15 Market Street, Borough of Wormleysburg, Cumberland County, Pa. sold on July 2, 2004. Return Tax Parcel No. 47-20-1858-159. - Propert Settlement Sheet is attached to this TOTAL (Also enter on line 1, Recapitulation) 100,000.00 $ 100,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPS/stems, Inc. Form REV- 1502 EX (Rev. 1-97) I~EV- 1503 EX * (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RE$1DENTDECEDENT EETATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Thomas J. BAKER SS{~ 204-03-5803 02/08/2004 21-04-0167 All proper~y jointly-owned with right of uurvlvomhlp muet be discloeed on Schedule F. ITEM VALUEATDATE NUMBER DESCRIPTION UNITVALUE OFDEATH 1 35 shares Metlife Inc. Common Stock - Statement Shares, 34.72 1,215.2¢ CUSIP #59156R108 - Valued using EstateVal. Valuation is attached to Return 2 2 United Stated Series E Savings Bonds. - Valued using 172.82 Savings Bond Calculator. Such assessment is attached to this Return ,.. TOTAL(Alsoenteronline2, Recap~ulafion) 1~388.02 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software onty CPSysterns, Inc. Form REV-I$03 EX (Rev. 1-97) I~EV- 1508 EX + (1-97) COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Thomas J. BAKER SS~ 204-03-5803 02/08/2004 21-04-0167 Include theproceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of eurvlvorshll~ muet be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 25.00 1 2 3 4 5 Copyright (c) 1996 form software only CPSystems, Inc. M&T Bank Cash Bonus - Refund to Account IRS Refund M&T Bank Checking Account No.13351370 Residence located at 15 Market Street, Borough of Wormleysburg, Cumberland County, Pa. Tax Parcel No. 47-20-1858-159. - Reimbursements made to Estate for County Taxes. Settlement Sheet from Sale on July 2, 2004 is attached to this Return. 1997 Dodge Grand Caravan - Valued using Kelly Blue Book at KKM.COM. The Report is attached to this Return 513.00 15,371.94 210.97 4,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 20,120.91 (If more space is needed, insert additional sheets of the same size) Form REV-1!i08 EX (Rev. 1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEOENT ESTATE OF Thomas J. BAKER SS~/ 204-03-5803 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 02/08/2004 FILE NUMBER 21-04-0167 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 2 3 4 5 FUNERAL EXPENSES: Musselman's Funeral Home Rolling Green Cemetery ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address city State Zip Year(s) Commission Paid: A~orney's Fees Johnson, Duffie, Stewart & Weidner Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs CCR Remodeling & Painting - Costs for improvements made to house for sale Cumberland County Register of Wills Office - Filing Fees for Inheritance Tax ($15.00) and Inventory ($16.00) Don Paul Sheaffer - Appraisal on Residence Lowe's Home Improvement Store The Cumberland Law Journal - Notice of Estate Administration Total of Continuation Schedule(s) Copyright (c) 1996 form software only CPSystems, Inc. 5,907.50 960.00 3,000.00 266.00 400.00 31.00 275.00 270.27 75.00 119.85 TOTAL (Also enter on line 9, Recapitulation) $ 11 ~ 304.62 (If more space is needed, insert additional sheets of the same size) Form REV-l$11 EX (Rev, 1-97) Estate of: Thomas J. BAKER Soc Sec #: 204-03-5803 Date of Death: 02/08/2004 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) 6 The Patriot News - Notice of Estate Administration 119.85 119.85 REV- 1512 EX + {1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thomas J. BAKER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ AND LIENS SS# 204-03-5803 02/08/2004 FILE NUMBER 21-04-0167 Include unrelmbumed medical expensee. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 AT&T Telephone Company Borough of Wormleysburg Sewer Payment Carlos R. Leffler Oil Company Checks clearing Decedent's M&T Account after date of death Comcast Cable Television Cooks Illustrated - Overdue book order Dennis Friestak, Tax Collector - Real Estate Taxes Dennis Friestak, Tax Collector - Personal Taxes Gary Cole - Payment for painting services at Residence GS Limited - Payment of the final Telephone Hirsch's Tree Service Joetta Maddox - Final Care Giver Check MarJorle Baker - Transmission Service Mellon Bank Home Equity Loan No. 0275-040702-738 - Account Payof~ Pant Baker - Reimbursement - Reimbursements made for payments of Truck Rentals and Storage Units Pennsylvania American Water Company Pennsylvania Power & Light Pulmonary Critical Care Unit Settlement Charges for sale of Residence. Settlement Sheet is attached. The GM Card Account No. 5121070161301086 UGI Gas Company Uncle Bob's Storage - August payment for storage of personal Total of Continuation Schedule(s) 25.61 112.00 364.00 462.67 9.56 30.90 413.49 9.80 400.00 25.93 300.00 300.00 700.00 2,893.01 630.65 125.96 139.17 27.35 1,014.69 157.47 52.35 105.59 193.23 TOTAL (Also enter on line 10, Recapitulation) 8,493.43 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 formsoftware only CPSystems, Inc, Form REV-1512 EX (Rev. 1-97) Estate of: Thomas J. BAKER Soc Sec #: 204-03-5803 Date of Death: 02/08/2004 Continuation of Schedule I (Debts of Decedent, Mortgage Liabilities and Liens) Item Description Amount items 23 Verizon Telephone 24 West Shore EMS 143.63 49.60 193.23 R'EV-151;I EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF Thomas J. BAKER SS~ 204-03-5803 NUMBER II. SCHEDULE J BENEFICIARIES 02/08/2004 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Ir~lude outright spousal distributions, and transfers under Sec. g 116(aX1 James L. Baker 4802 Winsford Road Harrisbur§, PA 17109 RELATIONSHIP TO DECEDENT DO Not List Truetee(e) Nephew ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE1 ON REV 1500 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC, 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ FILE NUMBER 21-04-0167 AMOUNT OR SHARE OF ESTATE Entire Estate COVER SHEET 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only T he Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00) LISTING OF EXHIBITS FOR ESTATE OF THOMAS J. BAKER EXHIBIT Last Will and Testament for Thomas J. Baker signed and dated June 22, 2000 EXHIBIT B Agreement of Sale for sale of residential property located at 15 Market Street, Borough of Wormleysburg, Pennsylvania EXHIBIT C EstateVal Valuation for 35 shares of Metlife Stock EXHIBIT D Savings Bond Calculator for the 2 Series E $25 Savings Bonds. EXHIBIT E Kelley Blue Book Report for 1997 Dodge Caravan acquired at kkb. com :234245 OF THOMAS J. BAKER I, THOMAS J. BAKER, of the Borough of Wormleysburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, )ublish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE I1 I give and bequeath my motor vehicle(s), household and personal effects and other tangible ~ersonalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my nephew, JAMES L. BAKER. Should my nephew, JAMES L. BAKER, not be living on the thirty-first (31*) day after my death, I give and bequeath the same unto my niece, MARGIE BAKER, of Anderson, California. ARTICLE III I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate unto my nephew, JAMES L. BAKER, provided that he survives me by thirty (30) days. ARTICLE IV Should my nephew, JAMES L. BAKER, not be living on the thirty first (31s) day following my death, ! give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate to my nice, MARGIE BAKER. ARTICLE V I name, constitute and appoint my nephew, JAMES L. BAKER, Executor of this my Last Will and Testament. Should my nephew, JAMES L. BAKER, fail to qualify or cease to so act, ! name, constitute and appoint my niece, MARGIE BAKER, alternate Executrix to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithfifl administration of her duties required in any jurisdiction. IN Vv'ITNESS WItEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this '~ day of June, 2000. ,/TI216 MAs J. Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS /%~6/¢i,~\ ~ (q. ~lt~.k , the Testator and the wimesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his flee and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Wimess Subscribed, sworn to and acknowledged before me by THOMAS J. BAKER, Testator r ]~j~t{ ' J and and subscribed and sworn to before me by ~ tc~,-~.teI f~. 0~x~ifi, , wimesses, this ,~4 day of June, 2000. Notary Public OF JOHNSON, DUFFLE, sTEwART & WEIDNER ATTORNEYS AT LAW LEMOYNE, PENNSYLVANIA OMB NO. 2502-0265 ~ A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENq[ I~E]FHA 2.E]FmHA 3. E]CONV. UNINS+ 4.I-]VA 5.OCONV, INS 6. FILE NUMBER: I 7 LOAN NUMBER: SETTLEMENT STATEMENT CROPF,JAMES I 3. MORTGAGE INS CASE NUMBER: C~ NOTE: This fotm ts fomtshed fo give you a stetement of actual seElement cost$ Anmunts paid to and by the seffiement agent are shown Items marked '[POC]" were paid outside the closing; they ate shown here for Infonllational purposes and am nol included in fhe fotels D. NAME AND ADDRESS OF BORROWER: E NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: TERENCE E. LEHRMANN, II 15 MARKET STREET WORMLEYSSURG, PA 17043 G. PROPERTY LOCATION: H. SETTLEMENTAGENT: 25-1857112 I. SETTLEMENTDATE: 15 MARKET STREET MIdstate Absb'act Company WORMLEYSBURG. PA 17043 July 2, 2004 CUMBERLAND County, Pennsyivanla PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION t0{), GROSS AMOUNT DUE FROM BORROWER: 400. GROBB AMOUNT DUE TO SELLER: 101. ContractSelesPdce I00r000.00 401 ContmctSelesPdCe 100,000.00 The undersigned hereby acknowl~reby acknowledge ge ~ecelp[ ol a completed copy of Pages 1&2 ut fols s~etement & any apachments referred to herein. L. SETTLEMENT CHARGES 702, $ to 703, Commission Paid at SetUement 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Odginahon Fee % to 802. Loan Discount % to 800. 809. 810. 811. 900, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 1002. Mortgagelnsurance months 1003. Clty/TownTaxes monks 1004, Coun~ Taxes monks 1005. Schc~lTaxes monks 1008 rP~nths I~ $ per month Ii00, TITLE CHARGES 1103. Title Examination 1105. Document Pmparauon to 1108. Title Insurance to MIDSTATE ABSTRACT (includes above item number~ 102, 1103 & 1104 1111. Endorsements 100, 300, 8.1 1112. Notary Fee Cash 1113. Notary Fee to Cash 858,75 1200, GOVERNMENT RECORDING AND TRANSFER CHARGES 1201, Recording Fees: Deed $ 40.00; Mortgage $ ; Releases $ 40.00 Ir000.0[ 1300. ADDITIONAL SEttLEMENT CHARGES 1301, Survey to 1302. Pest Inspection to 1303. 3rd Quarler Sewer Bill #407301 2,911.99 to Wormieysburg Borough 112.00 1304 Tax Information to Dennis P. Freistak, Treasurer 6.0C 1305. 2004/2005 Sch~31 Taxes to Dennis P, Freistak, Treasurer ~31.24 1,011.0[ 1400. TOTAL SETTLEMENT CHARGES IEnter on Lines 103, Section J and 502, Sectio, lJ3-1~ Date of Death: 02/09/2004 Valuation Date: 02/09/2004 Processing Date: 02/19/2004 Estate Valuation Shares Security or Par Description High/Ask Low/Bid Estate of: Baker, Estate of Thomas J. Report Type: Date of Death Number of Securities: 1 File ID: BAKERT Mean and/or Div and Int Security Adjustments Accruals Value 1) 35 METLIFE INC (S9156R108) COM NYSE 02/06/2004 35.00000 34.28000 H/L 02/09/2004 34.97000 34.63000 H/L 34.720000 1,215.20 Total Value: Total Accrual: Total: $1,215.20 $0.00 $1,215.20 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. )Revision 7.0.1) Savings Bond Calculator ~ ~ ' ~" · $avinc i02/2004 Series Denomination E Bonds $; 25 Serial Number # Bonds Total Price 2 $37.5O Serial Number Issue Date Series Q6357727835E 09/1979 E Q6357726911E 09/1979 E Total Interest Total Value $135.32 $172.82 Issue Interest Dehorn Price Interest Value Rate $25 $18.75 $67.66 $86.41 4.00% 25 18.75 67.66 86.41 4.00% Issue Date YTD Iw $0.0 Next Final Accrual Maturity 03/2004 09/2009 03/2004 09/2009 Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HI-I) MN Matured (Not Exchangeable for I-H-I) Please rate this service. (Please print and/or save this page before submitting your survey) Service Exce;lent Good Fair Poor Savings Bond Calculator C) C_) C) C} [, ,Submit Survey ] ~ http://wwws.publicdebt.treas.gov/BC/SBCPrice 02/19/04 Kelley Blue Book Used Car Values Page I of 2 Car Li~tings ( BLUE BOOK PRIVATE PARIY REPORT Pennsylvania · May $, 2004 Engine: V6 3.0 Liter Trans: Automatic Drive: 2 Wheel Drive Mileage: 75,000 1997 Dodge Grand Caravan Minivan See Loca! Listin.g~ of This Car List Your Car For Sale Online Buye New Car Free Lemon Check Auto L0ans ~rom 3,85% APR I~surance Quote Print "For Sale" Sign Payment Ca!~ulator Equipment 7 Passenger Air Conditioning Power Steering AM/FH Stereo Dual Front Air Bags Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems, in states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean t!Ue history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Host recent model cars owned by consumers fall into this category. Private Party Value $4,000 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value Get Invoice & HSRP on New Cars Get a Person to Person Auto Loan Copyright © 2004 by Kelley Blue Book Co., All Rights Reserved. Hay-3un 2004 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual http://www.kbb.comJkb/~i.dl]/]~v.kc.ur?kbb. PA;525484;PA041 & 17043 ;va~+p&722;Dodge... 05/05/04 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 EXIll-96) NO. CD 004299 WRIGHT RALPH H JR ESQ 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 ........ ford ESTATE INFORMATION: SSN: 204-03-5803 FILE NUMBER: 2104-0167 DECEDENT NAME: BAKER THOMAS J DATE OF PAYMENT: 08/23/2004 POSTMARK DATE: 08/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/08/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,256.63 TOTAL AMOUNT PAID: $15,256.63 REMARKS: CHECK//1030 · INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS )UFFIE, STEWART ~ WEIDNER ATTORNEYS AT LAW 310! MARKET STREET Ia. O. BOX 109 ,YNE, PENNSYLVANIA 17Oa~ First Class Mail REGISTER OF WILLS OFFICE CUMBERLAND COUNTY COURTHOUSE Re C~urthouse Square Carlisle, PA 17013 BUREAU OF ZNDZVZDUAL TAXES ZNHERTTANCE TAX DIVTSTOH DEPT. 180601 HARRTSBURG, PA 17118-0601 COHHONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-1547 EX AFP RALPH H WRIGHT JR JOHNSON ETAL PO BOX 109 t,i~ LENOYNE P4]t~?~Q~5~ DATE 10-25-2004 ESTATE OF BAKER THOHAS J BATE OF BEATH 02-08-2004 FILE NUHBER 21 04-0167 COUNTY CUHBERLAND ACN 101 Amoun~ Rami~ed I HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~'~ RETAIN LOWER PORTZON FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR D/SALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF BAKER THOHAS J FILE NO. 21 04-0167 ACN 101 DATE 10-25-2004 TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es*a~e (Schedule A) (1) 2. S*ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par*nmrship Zn~erms* (Schedule C) ($) ~. Hor~gagas/No~as Receivable (Schedule D) (~) E. Cash/Bank Daposi*s/Hisc. Personal Propar~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Cos~s/Nisc. Expanses (Schedule H) (9) 10. Deb~s/Nor~gage Liabilities/Liens (Schedule Z) (10) 11. To'al Deductions 12. Ne~ Value of Tax Ra~urn lOOzO00.O0 1~$88.02 .00 .O0 20~1Z0.91 .00 .00 (8) 11,$04.62 NOTE: To insure proper credi~ ~o your account, subei~ ~ha upper portion of *his form wi~h your ~ax payment. 15. 1~. NOTE: 121,508.95 (11) 1~) .79B. 05 (1;) 101,710.88 Chari*able/Governmen~al Bequests; Non-elec*ed 9115 Trusts (Schedule J) (1:5) Na~ Value of Es~a~a Sub,~ac~ ~o Tax (lq) Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aaoun~ of Line lfi a~ Spousal ra~a 16. Amoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e 17. Amoun~ of Line 1~ a~ Sibling re~e 18. Amoun~ of Line 1~ ~axable a~ Collateral/Class B ra~a 19. Principal Tax Due TAX CREDZTS PAYNENT RECEZPT D/SCOUNT DATE NUNBER /NTEREST/PEN PAZD (-) 08-25-2004 CD004299 .00 .00 101,710.88 ZF PAID AFTER DATE ZNDICATED, SEE REVERSE FOR CALCULATZON OF ADD/T/ONAL ZNTEREST. 18 and 19 ~ill (15) .00 x O0 = .00 (16) .00 x 045 = .00 (~7) .00 x 12 : .00 (18) 101,710.88 x 15 = 15,256.65 (19)= 15,256.65 AHOUNT PAZD 15,256.65 TOTAL TAX CREDZT 15,256.65 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 TOTAL DUE 1S LESS THAN $1, NO PAYNENT ZS RE~U/RED. TOTAL DUE ZS REFLECTED AS A "CRED/T' (CR), YOU HAY BE DUE REFUND. SEE REVERSE S/DE OF THIS FORN FOR ZNSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR]: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: iNTEREST: 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 B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral] rate on any such future interest. To ~ulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z5 of gOOO. (72 P.S. Section 91403. Detach the tap portion of this Notice and submit with your payment to the Register of gills printed on the reverse side. --Make check or money order payable to: REG/STER OF NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Xnheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-562-2050; services for taxpayers eith special hearing and / or speaking needs: 1-800-447-50Z0 (TT 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 object within sixty (60] days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 171Z8-1021, 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 be addressed in eriting to: PA Department cf Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent'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 end of the tax amnesty period. This non-participation penaIty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest 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, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after January 1, 1982 will bear interest at a rata which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOg .000548 ~"~"~'8-199! 11Z .000501 ~ 9Z .000247 1983 16Z .000458 1992 9Z .000Z47 200Z 6Z .00016~ 198~ 112 .000501 1995-199~ 72 .O0019Z 2005 5X .000157 1985 152 .000556 1995-1998 92 .000247 2004 42 .000110 1986 lOX .000274 1999 7X .OOOIgZ 1987 IOZ .OOOZ74 ZOO0 7Z .00019Z --Interest is calculated as follows: TNTEREST -- BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAI~LY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Lt_ C"") r-,'; 2.-; C> ~~{:~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: THOMAS J. BAKER Date of Death: Februarv 8.2004 Admin No. 2004-00167 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the Estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the Yes No X Executor was sole beneficiary d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ,.0 -, ,(. O!1te: Jailij<).l)' 18, 2005 c.... (,,:1 en $~~ -'RALPH H. WRIGHT, JR. JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 Lemoyne, P A 17043 (717)761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative uJ C,:, -0 If::l .r::::, C:_::J '"