The URL can be used to link to this page

Home My WebLink About02-0717PETITION FOR PROBATE and GRrA~~NT OF LETTERS Estate of MARTHA C. EPPLEY No. rG+ ~ ' ~ :2- -1 ~ 7 also known as To: Deceased. Social Security No. 183-12-2485 Register of Wills for the County of CUMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 1$ years of age or older an the executrix named in the last will of the above decedent, dated JUNE 24. 1996 and codicil(s) dated NONE (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with h er last family or principal residence at 4307 PARK STREET. CAMP HILL, HAMPDEN TOWNSHIP, PENNSYLVANIA (list street, number and municipality) Decedent, then 80 years of age, died 8/2/02 at BETHANY VILLAGE. MECHANICSBURG. PA _ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing artd was never ajudicated incompetent: NONE Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 400.000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ _ 197.000.00 situated as follows: 4307 Park Street, Camp Hill, PA 17017 294 Woods Drive, Mechanicsburg, PA 17050 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) C N b y d b C C O ~ 'G ~ ~ „a ~ 4.. o c on ~~ f,~~ ~~~ ~. s ROBERTA LOUISE EPPLEY BIESECKER 'V ~~ NEW CUMBERLAND PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS The petitioner(s) abcve-naru~d s.vear(s) or affirm(s) that the statements in the foregoing petition are true and correct to ttte best of the know ;edge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmec: and subscribed ~~'~"~~ ~~~ . ~,ru~. a<<~ befoArUGUST s 2 n~tt].- day of Regi e _ 3 1 No. ~l -02-'t 1'1 Estate of MARTHA C. EPPLEY ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AUGUST 9 , 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me„ IT IS DECREED that the instrument(s) dated 6/24!96 described therein be admitted to probate and filed of record as the last will of MARTHA C. EPPLEY and Letters TESTAMENTARY are hereby granted to ROBERTA LOUISE EPPLEY BIESECKER FEES Probate, Letters, Etc.. .. .. .. $ 375.00 Short Certificates ( } . $ 1 R nn ~~~„ extra. pac3es , $ 9.00 jcp $ 5.00 TOTAL $ 407.00 Filed . . 8-9-2002 called' atty' 8=9'-2002' ' ' (717) 697-4650 PHONE 54 EAST MAIN STREET MECHANICSBURG PA 17055 ADDRESS lo, sn~ ~1'~° ~iac "Chic 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 Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ 84~3~.3~ No. YPE PRINT IN PERMANENT BLACK INK y 9 • ,(/~ Local Registrar 1 r/ (~~ •EL c't.LLa~ .'S ~ ~. ~ % t~ ,~-. ~ i1 ~ Date COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT Of HEALTH • VITAL RECORDS CERTIFICATE OF DEATN Hlos,..TR.r ue7 NAME OF DECEDEM IF vm. Mdaa Laml SE% SOCIAL SECURITY NUMBER DATE OF OEAM JACwI. my. 1n) t. (1~a2TLx,.._ C. EPPl~~Y a.~£mal~ a. l83 - l2 - 24 $S •• O8 02. o? AGE (Lam BrmoaYl UNDER t YEAR UNOEA t Op DAE OF &RTN BIITTNPIACE ICay one PLACE OF DEAN ICne cY or+1' ena ^ ,ea mwuclMa moMn meal ~y ( OM Nollra I Mawl•a ,Mwun. DaY'wl SlavdFdapn Caadryl NOSM7AL: OTNER' r a ~5 O rte. E OS`' 1 y 14 22 T 0.2 (_ i~ ~ £.. ^ EWOMptlrm G ooa ^ Da.IrrN Ilon~b ~ R.rd.nu ~ fSP•LM ^ COUNTY OF OEAM CRY. BO(q.1WPOF DEAN FA:ERY NAME (N nd ur9~Ntgn.yw glen Mte++wnwr NRS D ECEDENT OF NISPMIIL ORIGIN? RACE ~Amncan bban.BNCk. WNb. M[. ' ~ y No C l Na ^ p ya. FgcIY CWn ISp%hl CLLIT,r3FlZlan~ - .~ 61,~r: mcchL„T QE-nc~t Y Villa s . . . . I 1.Mpl,.PUnIORIUn.Mt wh'I~ _:~ » k ^ ~ M E ' ,E, DECEDEM'S USUAL OCCUPAION KIND OF BUSINESSANDUSTRY YYIS DECEDENT EW:RW DECEDENT'S EDUCATION MARILt1 STAUS~Martue StNiVIVNKi SPOUSE IGne YareW rpkeorr eur rrmm oLeakin kN do nd wi Erael U.S ARMED FOArCaE^57 EM IS W Nayn Martlae.WWpaaq a~M M ~~IS C Iq •aa, qra nwean runyl E ; a na^ No eJ r^mNW ka rY t2 o P O. Ta S sb. T.`_Q!.'_.h F_r TA. ~1~. v,.CLAT 10~ ta. 1 l2 ta. ~ a (~ I .l ta. ru~1DU~A/F,7 Ia. DECEDENT'SMAdLNa[i AOORESSLSaM.CaylTOam. SNaa. 79Cad1 DECEDENTS d n U a rn /» F,ry tT AcT Pr a m k u n s ~n w /~ 1 ~J~ P~t2I< S• t .c a .. w. a. m U, we RESxYNCE rMtrln% b° rr l~1 t l l l l : c "l t' G i5ty vWrucvxra M n a m oMer areal rn r3 f a lGn ~ anwloT Yine L ^ ~ l . I o ts. ~ r. s trd. eam. pmka ITS. cam ww t•Ym•m FANER'$ NAME (Frm. MvlOa. La91) MOTHER'S NAME IFam. MqW. Nelson Surwrwl la. l~.tl+c U~Tl~.1 L C2.U\",.J` N. FLi a~E.74. ~t:c.hL./ac da,xr NIFORMANT' tiypaiP/lm) INFORMANT aIAYJIIIi AOOAE3915YaaL CNy/fowl, $IMa. ZO Coeal ~ ]a. ~'~oi5 i_2TC, (31E,5EC('Cf`IZ., SDI CooL'.oG+/ S~~• NEw CIAn.f3t 2\<.-n;~ 5 ~.._ I'lo c, METHOD OF DISPOSITION BraW l!J GarrM40n^ NMIMaI hen SlMa^ DATE OF pSPOSITM)N Mar.1. DaY NY) PLACE OF DISPOSITION ~ Nayrb a1CNIMar% Crematory arONw Plat. IOCRK]N. City/brr4 Slab. Zp Caw Dennort ^ oeur RoatNrt ^ 71a 0~ I o v~ o? a/D. L L_T o 2 i e e rY, i~ ~ rLY 71t. C c~ r L~ i l .SL C'<--_ 7/d. ' SIGNATU OFFVNERA RVICE LICENSE PERSON ACTING AS SIICN LICENSE NUMBER NAYS ANO ADDRESS OF FAC0.ITY (V [,i(L ~~H a,..aA, N~,M ".L ~rC . r •-t,,,-a ~ ,sa,.-a_- ~-"--~ a D ol3G 8 ' - 1_ . ax. ~ v ~ i m ~-.,LEA`. r r. p,,l, ; ~ ~ t , , . CompMl dams 29aC Omy NY•q tlY Datmmyk bepa,aam occwrtl MLM tma. seta orb pop mates. LICENSE NUMBER GATE SIGNED pDymr: s mL araaaNla n 1aM d eNID b •t.ndy waaaam. (SpIMw1 MW T~ ) ]t , - 1 C~ 1 . DaY Ywl ~ 2O ~-1 ~S~f 31 1 f1' A ~- ~ . ~o -- 7 . L JC10 Y Qc)-. - aa.. /V~ %ama2a36 munGpmPMIae PY OF DEA EPRONOUN CEO fMOrpn. Day. nor) RRS CASE REFERRED TO MEDICAL E%AMWERICORONEA parmn wb pronountea MaIII. ` L Yq ^ Ro^ r o A uc r t ~ ~ ~ r ~ a .. , C a.. r a ~, M. 7a. >r. a7. MRT I: Emar Nra baaaMa. VrNaiaa or cr%rlpktMrorla d+ck posse IM OaaID. Do rbl MIn TIM moss of auto as careiac w raspvalory anam. aMp or Man laiura ~ ApgoaimaM PART E: OlDar siorllACanl oorreYar mmrwtq b MM. Dul LW OMY Ono pool al aarJl Mra. tWanYOMwa•n mmMlbE'n Nra t•Id•11Y•q saw P'••N PART?. IYMEOIATE CAUSf IFnn ; mrM arW 0aW rasaasa orc«aaon ~r v ,~' i raa.wpna.anl•-• F J ~~ ~~ ~N ~ t` ~7 L I 1 r~ (.~ U {I ~ __ DuETO(aR'~C ~~ICEaI: ~1~E~E I ~ ~ ' r / / SarAreiaay Yn WrleaiwN o. 1 J .•s ~ IN / 1 Y N art%kbeingbn•rMdNa pw Emar 11NDERlYBIB OllE 7p 10R ASA CONSEQUENCE OFl: 1 CAUSE IDrwb a aMAY ; t • nal vr.mee avrw -_. _._~._ OUE TOIOR AS A CONSEQUENCE OFT: _ realvq n swot IAET I e _ ' MMS AN AUTOPSY WERE AUTOPSY FNWBI(iS WNNERa DEATH DAE OFIWURY TIME OFINWAT' WALRYAYgRKT DESCRIBE IlOWINJURY OCCURRED. PEi1FORMEDT AWIABIE PRgfl TO IMmm, Day Yan) ETgN OF CAUSE NnvM ~lJ N c e ^ ~ ~A . om l a waa ^ No ^ ACCdaN ^ PandnElmempalgn ^ M. ,Ya ^ No,~ YH ^ No ,~ SuciW ^ Coub real Da OSUrminae ^ PLACE Of INJURY - Al Mme. term, aV•al. laclory. o1M LOCAION (Seen. Cp/bm. 51n.1 7N. aEe. ---_- r. ~ Wi1}rp, nC. ISPeavl 7Ee. IOf. CERTIFIER iCnetk arty d+•1 'CFATIFYING PNY61GA yscan cerMyuy wmltl eaaM.Man ananm Pnyvc~an nos paw~ncae eealn ono complete111 2]I SILiNAURE TITLE OF CERTIFIER J ~ • / ~~~t ~ ~ y~ To NM Deal of mr knoer doom aecomee dw b M cauwlsl and manNr N alal•A .......................... ~ ........................ ~~NG ~ ~ ~~~ / ~. e ' 7t /// G~ LICE BER DAE SK3NEOIMmn. Day. earl '-RONOUNCING AND CEATIFTING PHYSICIAN FT 1 Yscan DOM;NOnprrc~nq rleaM one cemlyvq to causeW eeaml To IM Deal of my knorMdpa, e•alA otcurrW al Nu meta, seta, one place, one ew Io IM GauN(a) •nd manner as alalM ................ . ....... ^ D ~ ~' ~ /C/~ ~- (~ {( - Z -C ~. 710. ]td. / _ _ NAME AND ADDIIESS!)f PERSIN/ WN0 COMPLETED CAUSE OF DEAN (Item 271 Typa M Print 'MEDICAL E%AYINER/CORONER O D D i f i l dl i f i i ^ ~ j t ~ N'~ ~ ~ g ~ 7 7 ~ 'V r ~ '~ n t a a o aaam nal on an w nvesl gal on, u n my oPmion, Oaath otcocpd atlM Ilme, daU, and plat.. one dw to LM puNlp and .. manner aa »aUd ... . .. ^ - ~7 ~ . ... ... ......... ............. . ......................................... ............. ...... n. >h ~ u. Z'`~7 ~wtiSC /~Nyt C4An~?/~:/% f _ HEGISTRA~ IGNATURE AND NUMBER DAE FKEDIMa~M. Day. Pearl a7 __ % 1t?<l~.-cttft Ja ~a~r !\RC~CCQ-1 _._ ]a.~Ul~ c~ ~Z UO ~'~ ~' d ~~s t `ii1 ~~t~ y e~#~Ttt e1t# OF MARTHA C. EPPLEY I, MARTHA C. EPPLEY, Widow, of the Township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM 1: I direct that the expenses of my last illness, my funeral and inheritance, transfer, succession, legacy, and/or estate taxes for which my estate or any property transferred hereunder may be subject be paid from the residue of my estate as soon as practicable after my death. ITEM 2: I give, devise and bequeath all of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate to my beloved daughter, ROBERTA LOUISE EPPLEY BIESECKER. ITEM 3: If my daughter, ROBERTA LOUISE EPPLEY BIESECKER, should predecease me, I give, devise and bequeath all of my estate, real, personal and mixed, of whatsoever :nature and wheresoever situate to the issue of my daughter, ROBERTA LOUISE EPPLEY BIESECKER, per stirpes. ITEM 4: If my daughter, ROBERTA LOUISE EPPLEY BIESECKER, should predecease me without leaving any issue that survive me, then I give, devise and bequeath all of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate to my son- in-law, GARY MARTIN BIESECKER. ITEM 5: If, under the provisions of this Will, a share of my esta~e shall become payable to any person under the age of twenty- one (21) years, or if share of my estate shall become payable to any person who, by reason of illness or other incapacity, is incompetent to receive any or all of the share to which he or she is entitled hereunder without the appointment of a guardian or other fiduciary or the delivery of security, I hereby appoint the MELLON BANK, N.A., of Harrisburg, Pennsylvania, trustee for such beneficiary, to hold in trust for the benefit of such beneficiary his or her share of my estate, and in this respect the said truste shall have power to use principal as well as income in such amount. and at such times that it in its sole discretion, deems advisabl~ for the welfare, support and education, including college or trad~ school, of such beneficiary. AND, further, the said Trustees shall have the full power an. authority to retain, sell, exchange, lease, invest, and reinves~ any property, real or personal, of said trust without the necessit~ of petitioning any court for permission to make such retention sale, exchange, lease, investments, or reinvestments in any manner it deems best, without being limited to such investments prescribe by the laws of the Commonwealth of Pennsylvania, then in force fog investment of trust funds. AND, further, the said Trustee shall have the full power anc authority to borrow money from any person or institution, includinc its own lending department, and to mortgage or pledge any or al: real or personal property comprising the trust, if such borrowinc is necessary to prevent the sale of any or all of the real o~ personal property comprising the trust at a price less than the fair market value of such property. AND, further, the said Trustees shall have the full power anc authority to compromise any claim or controversy, without the necessity of petitioning any court for permission to make sucY compromise. The aforesaid Trustees shall pay to any beneficiaries, when they individually reach twenty-one (21) years, and to and other beneficiaries subject to any other incapacity, when sucr incapacity is removed, or to his or her estate if he or she shoulc die before reaching the age of twenty-one (21) years or before suci- incapacity is removed, all the property or funds then in its hands which represent the said beneficiaries' share of my estate. In the event that any beneficiary under this Will and I shall die under such circumstances that there is no sufficient evidence that we died otherwise than simultaneously, such beneficiary shall be deemed to have predeceased me. ITEM 7: I appoint my beloved daughter, ROBERTA LOUISE EPPLEY BIESECKER, Executrix of this Will and direct that she be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executrix to sell, encumber, mortgage, invest, distribute in kind, or retain any item of property of my estate in such manner as she shall deem proper, limited only by her own discretion. If for any reason my Executrix appointed under this Will should fail to serve in that capacity, I appoint my son-in-law, GARY MARTIN BIESECKER, my Executor with the same powers and privileges set forth above. IN WITNESS WHEREOF, I have at Harrisburg, Pennsylvania, this 1. '~ day of f, ~ t.--~-'L.`~-"~ 1996, set my hand and seal to this my Last Will a Testament. ~, .~`'~ GZ,-,-~~,. ~ ~ ~~ t MARTHA C. EPPLEY Signed, sealed, published and declared by the above named Testatrix, MARTHA C. EPPLEY, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~-~-~--- Residence d"x,~ ~ Residence ~G(~~ ~~--~L~~~~~ /a //,L~,vL/~ t Lt~r,» COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN MARTHA C. EPPLEY (the testatrix), ROBERT D. HANSON, and CONNIE L. KOPP (the witnesses) whose names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. TESTATRIX WITNESS: -~ Jt i -~ " s-~,,,,, MARTHA C. EPPLEY WITNESS: ~~~ .~ Subscribed, sworn to and acknowledged before me by MARTHA C. EPPLEY, the Testatrix, and subscribed and sworn to before me by ROBERT D. HANSON and CONNIE L. KOPP, the witnesses, this day of n 1996. ;> Q.Jtd3~ Notary Public Notarial Seal Sharon R. Kyle, Notary Public Harrisburg, Dauphin County My Commission Expires Jan. 22, 2000 Member, Pennsylvania Association of Notaries V1500 EX + (6-001 * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV_1500i1-~C-l'~ INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 0 7 1 7 COUNTY"COOE ----yEAR- - - NUMBeR-- I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) EPPLEY MARTHA C. DATE OF DEATH (MM-DO-Year) DATE OF BIRTH (MM-DO-Year) SOCIAL SECURITY NUMBER 183-12-2485 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w !;: ",_Ul u"'''' w"-u ,,00 U"''''' "-Ill "- .. 08/02/2002 05/14/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INlTIAl) lXJ 1. Original Return o 4. Limited Estate lXJ 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-82) D 7. Decedent Maintained a Living Trust (AtlachcopyofTrusl) o 10. Spousal Poverty Credit (date o/death between 12.31-91 and 1-1-95) 03. Remainder Retum (date of death prior 10 12.13-82) o 5. Federal Estate Tax Return Required !... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AnachSchO) THI5 5ECTION MU5T BE COMPLETED. ALL CORRESPONDENCE ANO CONFIOENTIAL TAX INFORMATION 5HOULO BE OIRECTED TO: NAME COMPLETE MAILING ADDRESS MURREL R. WALTERS III ESQ FIRM NAME (If Appl;cab~1 z o i= :5 :::l l- ii: c( o w It: z o i= ~ :::l 0.. :E o o S I- Z W C Z o "- Ul W '" '" o u 54 EAST MAIN STREET 513,059.40 PA 17055 OFFICIAL USE ONLY TELEPHONE NUMBER 717/697-4650 MECHANIC5BURG d 'AI :rJ ,'-, ~.: r" I 420,996.08 I." 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 (total Lines 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/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) -.'" .. .~~>~ ,) (7) (9) (10) 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 (a)(1.2) 19. Tax Due X _(15) 907 ,345.53 X .045 (16) X .12 (17) X .15 (18) (19) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (1) (2) (3) (4) (5) (8) 934,055.48 19,054.92 7,655.03 (11) (12) (13) 26,709.95 907,345.53 16. Amount of Line 14 taxable at lineal rate (14) 907 ,345.53 17. Amount of Line 14 taxable at sibling rate 40,830.55 40,830.55 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 18. Amount of Line 14 taxable at collateral rate D d t' C I t Add ece en s om Die e ress: STREET A1lDRESS 4307 PARK STREET CITY I STATE I ZIP CAMP HILL PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 40,830.55 Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 40,830.55 40,830.55 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... D IZI b. retain the right to designate who shall use the property transferred or its income; ........................................ D IZI c. retain a reversionary interest; or ........".......................................................................""..""........... D [X] d. receive the promise for life of either payments, benefits or care? ............................................................. D IZI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........ .................. .................. .................................................. D IZI 3. Did decedent own an "In trustfor" or payable upon death bank account or security at his or her death? ................. D IZI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................... ................................................. D IZI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, includinQ accompanying schedules and statements, and to the best of my knowledge and belief, il is true, correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN DATE ,-' r"c:"' c..- -0 ADDRESS PA 17070 DATE '1' '7'~3 ADDRESS PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are stlil applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)]. The tax rate imposed on the net value oftransfers to or for the use of the decedenfs siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV1ro~'(1~(. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R ( T ESTATE OF FILE NUMBER EPPLEY, MARTHA C 21 02 0717 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshin must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. 2 DESCRIPTION 294 WOOOS DRIVE, MECHANICSBURG, SILVER SPRING TOWNSHIP, CUMBERLAND COUNTY 1/2 INTEREST established by DECREE AWARDING REAL ESTATE NOV 27, 1984 CUMBERLAND COUNTY COURT ORPHANS COURT 21.84-107 per market analysis total value $800,000. (assessed $169,650. x 1.01 (common level ratio factor) = $171,346.50) 4307 PARK STREET, CAMP HILL, HAMPDEN TOWNSHIP, CUMBERLAND COUNTY (assessed $111,940 x 1.01 (common level ratio factor) VALUE AT DATE OF DEATH 400,000.00 113,059.40 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 513 059.40 '''''''".':.'w . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF EPPLEY MARTHA C FILE NUMBER 21 02 0717 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ORRSTOWN BANK 50,042.19 CERTIFICATE OF OEPOSIT 2 PNC BANK 101,580.54 SAVINGS 3 WAYPOINT BANK 50,022.06 CERTIFICATE 4 WAYPOINT 29,421.68 CERTIFICATE 5 PENNSYLVANIA STATE BANK 73,506.63 SAVINGS 6 CITIZENS BANK 5,741.53 CERIFICATE 7 CITIZENS BANK 2,196.47 CERTIFICATE 8 CITIZENS BANK 920.79 CERTIFICATE 9 CITIZENS BANK 6,182.86 CERTIFICATE 10 CITIZENS BANK 391.56 SAVINGS 11 CITIZENS BANK 16,679.73 CHECKING 12 CITIZENS BANK 79,700.04 CHECKING 13 HOUSEHOLD GOODS 4,610.00 APPRAISAL BY CHUCK BRICKER, AUCTIONEER TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 420 996.08 '''''''''.(~'". . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF EPPLEY MARTHA C FILE NUMBER 21 02 0717 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NEILL FUNERAL HOME 8,364.92 2 CARLISLE MEMORIAL SERVICE GRAVE MARKER 490.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ROBERTA LOUISE EPPLEY BIESECKER renounced Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees MURREL R. WALTERS III ESQ 8,400.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS CUMBERLAND COUNTY 825.00 5. Accountanfs Fees 6. Tax Return Prepare(s Fees AL WHITCOMB, P.A. 900.00 7. CHUCK BRICKER, AUCTIONEER APPRAISAL OF PERSONAL PROPERTY 75.00 TOTAL (Also enter on iine 9, Recapitulation) $ 19.054.92 (If more space is needed, insert additional sheets of the same size) ''''''''''1:'". COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF EPPLEY MARTHA C FILE NUMBER 21 02 0717 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. WAYNE MARTENS LAWN CARE AND SNOW REMOVAL 2 MBNA AMERICA CREDIT CARD 3 PA AMERICAN WATER 4 VERIZON TELEPHONE 5 PPL ELECTRIC 6 WEST SHORE EMS MEDICAL 7 BETHANY VILLAGE RETIREMENT CENTER RESIDENTIAL CARE 8 AT&T TELEPHONE 9 HOLY SPIRIT HOSPITAL MEDICAL 10 HAMPDEN TOWNSHIP SEWER & REFUSE 11 LEFFLER INC FUEL OIL 12 ADT HOME SECURITY SYSTEM 13 QUANTUM IMAGING MEDICAL 14 NATIONWIDE INSURANCE HOMEOWNER~INSURANCE 15 .I.C. ERLICH TERMITE CONTRACT 550.00 105.97 122.93 262.52 464.88 120.40 400.00 58.20 12.72 414.62 1,007.20 3,119.79 3.50 226.50 204.16 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7 655.03 Continuation of REV-1500 Inheritance Tax Return Resident Decedent EPPLEY, MARTHA C. 21 02 0717 PaQe 1 Schedule I . Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16 STORAGE DEPOT 306.49 STORAGE 17 HERITAGE MEDICAL GROUP 17.46 MEDICAL 18 KATHRYN FETROW, TAX COLLECTOR 257.69 REAL ESTATE TAX SUBTOTAL SCHEDULE I 581.64 GRAND TOTAL SCHEDULE I $ 7,655.03 REV-1513E:,('. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER FPPI FY MARTHA r. ?1 n? 0717 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (aJ (1.2)) ,. ROBERTA LOUISE EPPLEY BIESECKER DAUGHTER 100% 800 COOLIDGE STREET NEW CUMBERLAND, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRiBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TI\)( 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 $ (If more space is needed, insert additional sheets of the same size) Rev-346 EX (8-92) ~_ PA DEPARTMENT OF REVENUE ~ ESTATE INFORMATION SHEET FOR REGISTER'S OFFICE USE ONLY County Code Year File Number DECEDENT INFORMATION: Enter data as It will appear on all documents submitted to the department. Name (Last) (First) (Middle) EPPLEY MARTHA C. Decedent's Social Security Number Dale of Death Date of Birth 1 8 3 I . 1 I 2 . 2 4 8/2102 5/14/22 TYPE FILING: Enter check (v') mark to Indicate the nature of the return to be filed with the department. !XI Probate Return OJoint Assets Only o Estate Tax Only o Litigation Purposes (No Other Assets) LETTERS GRANTED: Enter check (v') mark to indicate the nature of the proceedings at the Register of Wills Office. (Attach additional sheets if explanation is necessary.) !XI Testamentary o Administration o No Letters o Other (Please Explain) ATTORNEY/CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all tax information and correspondence. Name (Last) (First) (Middle) Supreme Court 1.0. # WALTERS III MURREL R. 24849 Street Address 54 EAST MAIN STREET City State Zip Code Telephone Number MECHANICSBURG PA 17055 697 4650 PERSONAL REPRESENTATIVE INFORMATION: Executor/Administrator Enter all data concerning the personai representative(s) of the estate authorized by the Register of Wills Name (Last) (First) (Middle) Social Security Number BIESECKER ROBERTA LOUISE EPPLEY 1 9 3 I 3 8 ,5 2 1 4 Street Address 800 COOLIDGE STREET City State Zip Code Telephone Number NEW CUMBERLAND PA 17070 774 3185 Co-Executor/Administrator Name (Last) (First) (Middle) Social Security Number I I Street Address City State Zip Code Telephone Number Co-Executor/Administrator Name (Last) (First) (Middle) Social Security Number r I Street Address City State Zip Code Telephone Number 1 Prepared By I Date 8/9/02 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARTHA C. EPPLEY Date of Death: AUGUST 2, 2002 Est:ate No.: 21-02-0717 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes __Xi No If the answer is No, state when the personal representative reasonably believes that the administration will be complete (date) 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 Date: Bo Co D The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties in interest: Yes __X__ No Copies of receipts, releases, joinders and approvals of forma/k6/r informal aa;~Oc~s tmo tahYisb;epffloedrt?ith the Clerk~ the .G~Thans' C~/9~ and may be MURREL R. WALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 1 7 7 28-0607 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ND. CD 002763 WALTERS MURREL R III 54 E MAIN STREET MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SsN: ~ 83-~ 2-2485 FILE NUMBER: 2102-0717 DECEDENT NAME: EPPLEY MARTHA C DATE OF PAYMENT: 07/03/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 08/02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 540,830.55 TOTAL AMOUNT PAID: REMARKS: C/O ROBERTA L EPPLEY CHECK# 168 SEAL INITIALS: VZ RECEIVED BY: DONNA M. OTTO REV-1162 EX111 96) 540,830.55 DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~~ ^~d /~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DI4ISION DEPT. 286601 HARRISBURG, PA 17128-0661 MURREL R WALTERS 54 E MAIN ST MECHANICSBURG NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% AFP (P1-OS) DATE 08-18-2003 ESTATE OF EPPLEY MARTHA C DATE OF DEATH 08-02-2002 FILE NUMBER 21 02-0717 ~ r ~ ~ ~`~ - ~ COUNTY CUMBERLAND III ESQ ACN 101 Amount Remitted PA 17,055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EPPLEY MARTHA C FILE N0. 21 OZ-0717 ACN 101 DATE 08-18-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED t )CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1] 513,059.40 NOTE: Ta insure proper 2. Stocks and Bonds [Schedule 8) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 ofi this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 420,996.08 tax payment. 6. Jointly Owned Property (Schedule F] (6) .00 7. Transfers (Schedule G) (7)_ .00 S. Totai Assets (g) 934, 055.48 APPROVED DEDUCTIONS AND EXEMPTIONS: 19,054.92 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 7,655.03 11. Total Deductions tll) 26.709.95 12. Net Value of Tax Return (12) 907,345.53 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 907,345.53 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 .00 15. Amount of Line 14 at Spousal rata [15) • X = 16. Amount of Line 14 taxable at Lineal/Class A rate tl6) 907,345.53 X 045. 40,830.55 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 - . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 1 5 .00 19. Principal Tax Due (19)= 40,830.55 Twv rnen*TC. DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 07-03-2003 CD002763 .00 40,830.55 BALANCE OF UNPAID INTEREST/PENALTY AS OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 07-04-2003 TOTAL TAX CREDIT 40,830.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. 346.81 TOTAL DUE 346.81 [ IF TOTAL DUE IS LESS THAN 51, 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.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed an the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty C60) days of receipt of this Notfce by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election tc have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Deft. 280601, Harrisburg, PA 17128-0601 Phone C717) 7B7-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident Decedent^ (REV-15017 for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months alter the decedent's death, a five percent (5%) disccunt of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6'!.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Oaily Year Rate Factor Year Rate Factor Year Rate Factor 1982 2D% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1488-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9'1. .000247 2001 9'!. .000247 1985 13% .000356 1993-1994 7% .000192 2002 6'f. .000164 1986 LO% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUItBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Ill-L~v'~" ~~~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL rnxES DEPARTMENT OF REVENUE r , INHERITANCE TAX UIVISIDN ~/ DEPT. 280601 NOTICE OF INHERITANCE TAX ~ HARRISBURG, PA 17128-0601 APPRAISEMENT: ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% AFP (01-337 DATE 08-18-2003 ESTATE OF EPPLEY MARTHA C DATE OF DEATH 08-02-2002 FILE NUMBER 21 02-0717 COUNTY CUMBERLAND MURREL R WALTERS III ESQ ~ ACN 101 54 E MAIN ST Amount Remitted MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EPPLEY MARTHA C FILE N0. 21 02-0717 ACN 101 DATE 08-18-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Bchedule A) (1) 513,059.40 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Hald Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 42 0,996.08 tax payment. 6. Jointly Owned Property (Schedule F) [6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (g) 934, 055.48 APPROVED DEDUCTIONS AND EXEMPTIONS: 19,054.92 9. Funeral ExpenseslAdm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens [Schedule I) (10) 7,65 5.03 11. Total Deductions (11) 26.7D9.95 12. Net Value of Tax Return (12) 907,345.53 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J] (13) .00 14. Net Value of Estate Subject to Tax (14) 907,345.53 NOTE: if an assessment was issued previously, lines 14, 15 andi4r 16, 17r 18 a!~es! 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) •0 0 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 9D7,345,53 X 045 = 40,830.55 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = ,00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 40 830.55 ~ TeY CRFIITTC• DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 07-03-2003 CD002763 .00 40,830.55 BALANCE OF UNPAID INTEREST/PENALTY AS OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 07-04-2003 TOTAL TAX CREDIT 40,830.55 BALANCE OF TAX DUE ,00 INTEREST AND PEN. 346.81 TOTAL DUE 346.81 ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS RE@UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT'' (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 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 WALTERS MURREL R III 54 E MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: t83-t2-2485 FILE NUMBER: 2102-0717 DECEDENT NAME: EPPLEY MARTHA C DATE OF PAYMENT: 10/30/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/02/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 5352.50 TOTAL AMOUNT PAID: REMARKS: MURREL R WALTERS III ESQUIRE CHECK# 10429 SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO 5352.50 DEPUTY REGISTER OF WILLS REV-1162EX(11-96) NO. CD 003181 REGISTER OF WILLS ~ ~- ~~ ~ ~~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-1607 E% ~FP [01-03) DATE 11-24-2003 ESTATE OF EPPLEY MARTHA C DATE OF DEATH 08-02-2002 FILE NUMBER 21 02-0717 COUNTY CUMBERLAND MURREL R WALTERS III ESQ ACN 101 54 E MAIN ST Amount Remitted MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: 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 (01-03) ~** INHERITANCE TAX STATEMENT OF ACCOUNT *~* ESTATE OF EPPLEY MARTHA C FILE N0. 21 02-0717 ACN 101 DATE 11-24-2003 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: 08-18-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 40,830.55 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 07-03-2003 CD002763 .00 40,830.55 10-30-2003 CD003181 346.81- 352.50 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE ~ TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ~- ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT I5 REQUIRED. IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 40,836.24 5.69CR .00 5.69CR PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check ar money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money ardor payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CRI: A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and / or speaking needs: 1-SDO-447-3020 (TT only). REPLY TD: questions regarding errors contained on this notice should be addressed ta: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. 286601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3l calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1] 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 (6%l percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARTHA C. EPPLEY Date of Death: AUGUST 2, 2002 Estate No.: 21-02-0717 Pursuant to Rul~° 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes _X; No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete (date) 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: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest: Yes _X No , D. Copies of receipts, releases, joinders and approvals of forma r informal accounts may be filed with the Clerk of the Orphans' Co and maybe attached to this report. ~;'~ ,~i, ~~~ ' G Date: ~ ,~~~, „~ / MURREL R. WALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, PA 17055 717-697-4650 Capacity: Personal Representative X_ Counsel for Personal Representative