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Home My WebLink About05-12-1015056071120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0192 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174 20 3225 12 02 2009 04 04 1926 Decedent's Last Name Suffix Decedent's First Name MI DICKSON JAMES A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i~ 1 Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4 Limited Estate qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required ^ ^ (date of death after 12-12-82) I , I Decedent Died Testate ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes ~~-I 6 (Attach Copy of Will) ^ (Attach Copy of Trust) 9 Liti ation Proceeds Received ^ 1p. Spousal PovertYYCredit date of death 11,Election to tax under Sec, 9113(A) 9 between 12-31-y1 and 1<-1-95) (Attach SCh. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 717) 761 454 ., EDMUND G . MYERS ~ ~~ ~_ -cT Firm Name (If Applicable) JOHNSON DUFFIE First line of address 301 MARKET STREET Second line of address PO BOX 109 City or Post Office LEMOYNE State ZIP Code PA 17043 -~» REGISTER OF V!I#~~.S USE C},~ILY -~ ~ w - - ;--, ._ .- , N --~ ~--,1 ---I .. - -:i - DATE FILED "' __ ~ -, ;_J .,. ;,-, r ,- , , ~T'. - ~) ~~ Correspondent's a-mail address: egfll@JdSW.COnI _ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGt~TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~ (~ .~~ ~ CARL A. DICKSON ~~ ~ ~ .~.~(~ c ADDRESS 3602 N. THIRD STREET HARRISBURG PA 17110 SIGN E OF PREPARE OTHER THAN REPRESENTATIVE DATE `~~„y,~ ~ ~}'!~_ EDMUND G. MYERS ~~~( d ADDRESS 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 L,~, 15056071120 15056071120 ~ ~ L 15D5607212D REV-1500 EX Decedent's Social Security Number ~ecedenrsName JAMES A. DICKSON 174 20 3225 RECAPITULATION ....................... 1. Real Estate (Schedule A) ............................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 891.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6 1,459.90 Separate Billing Requested............ 6. Jointly Owned Property (Schedule F) ^ . 7. Inter-Vivos Transfers & Miscellaneous f~o~ Probate Property a Separate Billing Requested............ 7. 1 182 554.21 r ~ !Schedule G) ,.,. $ 1 , 184 , 905 . 11 , ... ............................................................ Total Gross Assets (total Lines - g - . -- ------_--___-- 6, 7 2 4. 3 7 Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9 9. . 3,187.85 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 9 , 912.22 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12 1,174,992.89 . ..................... 12. Net Value of Estate (Line 8 minus Line 11 ................................. . Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 13 . an election to tax has not been made (Schedule J) ....................... . . 14 1 174,992.89 ~ .............................. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ . - -- __ ----- TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 0 . 0 0 (a)(1.2) X .00 16. Amount of Line 14 taxable 1 184 , 014.11 1s. 53 , 280.63 at lineal rate X .045 ~ 17. Amount of Line 14 taxable 0 . 0 0 17. 0 . 0 0 at sibling rate X .12 18. Amount of Line 14 taxable 0 _ 0 0 18. 0 . 0 0 at collateral rate X .15 .... . 19. .. 53 , 280.63 .. 19 Tax Due ........................................................................................................ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^^ Side 2 15D56D72120 15D5607212D File Number 21-10-0192 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME _ _ _ --- __ JAMES A. DICKSON __ STREET ADDRESS __-_______ BETHANY VILLAGE WEST - -- 325 WESLEY DRIVE STATE ZIP CITY pA 17055 MECHANICSBURG Tax Payments and Credits: 11) __ __ 53,280.63 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 48,000.00 B. Prior Payments _ C. Discount 2,526.32 (2) 50,526.32 Total Credits (A + B + C) __ ___ _ -__- -- 3. Interest/Penalty if applicable p, Interest -- E. Penalty - 3 _ __ _. Total Interest/Penalty (D + E) ( -. __-__ 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) ____.---- ---- Check box on Page 2 Line 20 to request a refund (5) 2,754.31 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5A) _ - _ _____ _ A. Enter the interest on the tax due. (5B) 2,754.31 g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. ------- - - Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No a. retain the use or income Yethe property transferred :............................................................................. ~ ~ 1. Did decedent make a transfer and~ho shall use the property transferred or its income :......................... ...... ^ u b. retain the right to designa c. retain a reversionary interest; or ................................................~............................................................. x 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 ........................ x 3. Did decedent own an "in trust for" or payable upon death b Y k account or security apt his or whidh ath?....... IJ -l 4. Did decedent own an Individual Retirement Account, annuit or other non-probate roperty ^ r x ... .... I ............. . contains a beneficiary designation __ _- IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RET _-_ 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 three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1' The statute doesen_ of exerrigt attransfer toua sure wing spouse f~om taxsand the statutory req~urementsro (0) percent [72 P.S. §9116 (a) (1.1) O] for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child t ascent [72 PeSrs§9116e(a) (1 2)]ger at death to or for the use o a natural parent, an adoptive parent, or a stepparent of the child is zero (0) p The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. ercent [72 P.S. §9116 (a) (1.3)]. A The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) p sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+,6.98, SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN o~cinFniT nF(:FnFNT ESTATE OF DICKSON. JAMES A FILE NUMBER 21-10-0192 Include the proceeds or Iulgauun a~ w ~~ ~o ~a,~ ~~ ~~ r~ ~----- - All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION NUMBER 1 Internal Revenue Service - 2009 Individual Income Tax Refund 2 Pennsylvania Department of Revenue - 2009 Individual Income Tax Return Refund TOTAL (Also enter on Line 5, Recapitulation) needed additional pages of the same size) VALUE AT [?ATE OF DEA7 H 856.00 35.00 891.00 (If more space Is , Form PA-1500 Schedule E (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. Rev-1509 EX+16-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF DICKSON, JAMES A. A. Carl A. Dickson B. C LE NUMBER 21-10-0192 3602 N. 3rd St. Son Harrisburg, PA 17110 PROPERTY JUIIV I LT JWNED ITEM NUMBER LETTER FOR JOINT TENANT DATE I MADE JOINT DESCRIPTION OF PROPERTY NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE of DEATH VALUE OF DECEDENT'S INTEREST 1 A 1/31/2005 PNC BANK -Checking Account No. 50-0489 -4067 -Date of death balance. 2,919.80 50.000% i 1,459.90 TOTAL (Also enter on Line 6, Recapitulation ) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. If an asset was made joint within one year of the decedent's date of death, it must be reported on scneouie ~. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT 1,459.90 Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+t6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-10-0192 DICKSON, JAMES A. hedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET .s yes. i s sc Th DATE OF DEATH DESCRIPTION OF PROPrRTY `% OF DECD'S ExcLUSION TAXABLE INTEREST IF APPLICABLE) VALUE I ITEM NUMBER THELDADTE OFnTRANSFERSATTACFiTA COPYEOF T~E DEIED FOOR REAL ESTATE. VALUE OF ASSET 21 554 142 1 1,142, 554.21 r . , , ment to Revocable L v ng Trust - 1 8/03/1998e LAmend October 27, 2000. Beneficiaries: Barbara A. Kennedy, daughter; Carl A. Dickson, son; James A. Dickson, son; Robert A. Dickson, son. Date of death value. Copy of valuation statement attached). opY of Trust attached. Kennedy, Daughter -Gift -Cash - 1/0212009 13,000.00 Barbara D 3,000.00 10,000.00 . 2 13,000.00 Gift -Cash - 1/0212009 3,000.00 10,000.00 3 Carl A. Dickson, Son - 13,000.00 Dickson, Son -Gift -Cash - 1102/2009 James A 3,000.00 10,000.00 . 4 13,000.00 Son -Gift -Cash -1102/2009 Dickson t A 3,000.00 10,000.00 , . 5 Rober TOTAL (Also enter on Line 7, Recapitulation) 1,182,554.21 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) COMMONWEALT OF PENNSYLVANIA INHERITAN~E~FA~(FR FNTRN ;SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF DICKSON, JAMES A. Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION N MBER p~ FUNERAL EXPENSES: See continuation schedule(s) attached g, ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative(s) FILE NUmtstrc 21-10-0192 AMOUNT 1.010.37 Street Address State Zlo City Year(sl Commission raid 5,000.00 2 Attorney's Fees JOHNSON DUFFIE g Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zio City Relationship of Claimant to Decedent 4, Probate Fees 5, Accountant's Fees 484.00 g. Tax Return Preparer's Fees 230.00 7. Other Administrative Costs See continuation schedule(s) attached 6,724.37 TOTAL (Also enter on line 9, Recapitulation) Form PA-1500 Schedule H (Rev. 10-06) Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued (FILE NUMBER ESTATE OF 21-10-0192 DICKSON, JAMES A. ITEM DESCRIPTION AMOUNT NUMBER Funeral Exaenses 470.27 1 Auer Cremation Services 540.10 2 Bethany Village -funeral brunch H-A 1,010.37 Other Administrative Costs 30.00 3 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return ($15.00) and Inventory ($15.00) 200.00 4 Reserves: Additional Administrative Costs H-B7 7.30.00 Form PA-1500 Schedule H (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF DICKSON. JAMES A FILE NUMBtK 21-10-0192 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 2,599.62 1 Bethany Village -balance -decedent's account. 2 I Continuing Care RX -balance due -medication account 3 I Holy Spirit Hospital -account balance TOTAL (Also enter on Line 10, Recapitulation) d dditional pages of the same size) 583.23 5.00 3,187.85 (If more space Is neede , a Form PA-1500 Schedule I (Rev. 12-08) Copyright (c) 2009 form software only The Lackner Group, Inc. REV-1513 EX+ (11-08) COMMOR R Tp NCNE T~EDEN~RN ANIA EST ETA OF SCHEDULE J BENEFICIARIES DICKSON, JAMES A. NAME AND ADDRESS OF NUMBER PERSON(Sl RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal I~ distributions, and transfers under Sec. 9116 a 1.2 1 James A Dickson 241 Meadow View Road Durango, CO 81301 2 Robert A Dickson 36 Simon Atherton Row Harvard, MA 01451 3 Barbara D Kennedy 9410 Locust Hill Road Bethesda, MD 20814 4 Carl A Dickson 3602 North 3rd Street Harrisburg, PA 17110 FILE NUMBER 21-10-0192 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Son 1114th of Residue Son 11/4th of Residue 114th of Residue Son ~ 114th of Estate I ~ Total ~ Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro r NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 F OIVEP 1500 Schedule J (Rev. 11-OS) Copyright .;c) 2009 form software only The Lackner Group, Inc. Informational +~opy Do Not File SCHEDULE Y-19A Inheritance Tax Paid @ 5% Discount ESTATE OF (FILE NUMBER DICKSON, JAMES A. 21-10-0192 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. ESTATE OF JAMES N. DIEHL SCHEDULE OF EXHIBITS EXHIBIT A Copy of the Last Will and Testament of James A. Dickson dated October 27, 2000. There was no need to probate the Will. This is a conformed copy. -10093 / EX~IIBIT A O 1 ? 343-00001 / 10.16.00/EGM/KLT/ 139727.3 ~~~f t1I ~t~d ~.e~#~n~.e~t~ OF JAMES A. DICKSON I, JAMES A. DICKSON, of Fairview Township, York 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 alid all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS AND EXPENSES 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 conveiuently may be done. ARTICLE II TANGIBLE PERSONAL PROPERTY 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 those of my children who survive me, to be divided among them by my Personal Representative with due regard for their personal preferences in as nearly equal shares as practicable. If there shall be disagreement as to the disposition of any item or items described in this Article, I direct that the same shall be disposed of in accordance with Article III hereof. 011343-00001/10.016.00/EGM/KLT/139727.3 ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate in equal shares unto my children, ROBERT A. DICKSON, BARBARA D. KENNEDY, JAMES A. DICKSON AND CARL A. DICKSON, provided that should any of my children predecease me, I give, devise and bequeath such deceased child's share unto his or her then-living issue, per stirpes, and if there be a failure of same, then such deceased child's share shall be distributed pro rata unto my surviving children, or the then-living issue of deceased children. ARTICLE IV TRUST PROVISIONS If, at the time of my death, any of my property shall pass, either under this Will or otherwise, to a beneficiary who has not attained the age of thirty (30) years, I give, devise and bequeath the share of each such beneficiary unto MELLON BANK, N.A. IN SEPARATE TRUST, to hold, manage, invest and reinvest the share(s) so received and the accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee's discretion, may be necessary or appropriate for such beneficiary's support and education (including college education, both graduate and undergraduate, and vocational training beyond high school) after considering all resources reasonably available to him or her, or to make payment for these purposes without further responsibility, to such beneficiary or to any person taking care of such beneficiary. Trustee shall distribute one-quarter (1/4) of the then- remaining principal and any income accumulated thereon unto such beneficiary when such beneficiary shall reach the age of twenty-one (21) years. After the beneficiary has reached the age of twenty-one (21) years, the Trustee shall pay and distribute to him or her the net income of such Trust periodically, but not less frequently than quarterly. Trustee shall distribute one-half 2 011343-00001 / 10.016.00/EGM/KLT/ 139727.3 (1/2) of the then-remaining principal and any net undistributed income unto such beneficiary at the age of twenty-five (25) years, and the balance of principal and any net undistributed income unto such beneficiary when such beneficiary shall have achieved the age of thirty (30) years. In the event any beneficiary dies before receiving his or her final distribution hereunder, the Trust as to that beneficiary shall terminate and the balance of principal and any net undistributed income shall be paid over to such beneficiary's personal representative. ARTICLE V SPENDTHRIFT PROVISION -TRUSTS I direct that the interest of the beneficiaries shall not be subject to anticipation or to voluntary or invohintary alienation. ARTICLE VI POWER TO TERMINATE SMALL TRUST If at any time during the continuance of any Trust created hereunder, the Tnistee in its sole and absolute discretion determines that the size of any individual Trust has become so small as to be impractical to continue to hold in Trust and uneconomical to continue to administer as a Tnist, then in such circumstances, the Tnistee may without further authorization distribute the balance of the principal and income in such Trust to the beneficiary then-entitled to the income therefrom, and upon such distribution the Trustee shall be released from further obligation with respect to that Trust and shall not be subject to any claim from any person who may have had a future interest in such Tnist had it been continued in Trust. 3 011343-00001 / 10.016.00/EGM/KLT/ 139727.3 ARTICLE VII POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE My Personal Representative(s) and Trustee(s) shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. B. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. C. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. E. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. F. To compromise any claim or controversy. 4 311343-00001/ 10.016.00/EGM/KLT/ 139727.3 G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax refimds and the payment of such taxes without obligation to adjust the distributed share of any person thereby affected. H. To combine, without prior court approval, any Trust contained in my Will with any other Trust with substantially similar provisions, although such Tnist may have been created by separate instrument. ARTICLE VIII APPOINTMENT OF PERSONAL REPRESENTATIVE I name, constitute and appoint my daughter, BARBARA D. KENNEDY, Executrix of this my Last Will and Testament. Should my daughter, BARBARA D. KENNEDY, fail to qualify or cease to so act, I name, constitute and appoint my son, CARL A. DICKSON, alternate Executor to complete the administration of my Estate. If my son, CARL A. DICKSON, also fails to qualify or ceases to so act, I name, constitute and appoint MELLON BANK, N.A., alternate Executor 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 the duties required in any jurisdiction. My corporate Executor and Trustee shall receive compensation in accordance with its standard schedule of fees while its services are performed. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will ~ ~'~ , 2000. and Testament, this ~~ day of ~j ` v}L~ - ~'J,~i"'~. (SEAL) JAM S A. DICKSON 5 011343-00001/10.016.00/EGM/KLT/139727.3 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. 01133-00001/10.016.00/EGM/KLT/139727.3 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We, JAMES A. DICKSON, C~~7. ~ ~d C1 ~ y ~' ~-~ and ~~~~t~h~~~ ~"~ y' _ ,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 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. sl ~ ~ ~. ~,~~~.~ JAME jJA. DICKQ}SON (~~ 9 Witness -s.J ~~ , ,~ 1~1 f~~~~. ~~ Witness Subscribed, sworn to and acknowledged before me by JAMES A. DICKSON, Testator, and ~~ d ~ ~l~c<.~ and subscribed and sworn to before me by ~~ II 11 ~( witnesses, this~~ ~ day of `.~.. ~~~' ~ ~ , 2000. ~~ti ~ ~ ~'1, 1J~1(t!i h~~ J l - ~ ~ ^ ~~ ~C~~~~L1~ Notary Public 7 May 11, 2010 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of James A. Dickson Date of Death: December 2, 2009 Our File No. 11343-1 Dear Register: Enclosed for filing please find the following documents for the above referenced decedent: 1. 2 Original PA Inheritance Tax Returns. There is remaining tax due, after the prepayment was made, in the amount of $2,754.31. BNY Mellon Trust Check No. 11270668 is attached. 2. Inventory 3. Two copies of Page 1 of the Pa Inheritance tax return and Inventory, which we ask that you time-s amp and return to us in the enclosed envelope. 4, BNY Mellon Trust Check No. 11270669 in the amount of $30.00 representing the filing fee for the Inheritance Tax Return. Should you have any questions, please do not hesitate to contact our office. Thank you for your assistance in this matter. Very truly yours, JOHNSON, DUFFIE, STEWART &WEIDNER Dana Wieseman Estate Administration Paralegal Enc. cc Carl A. Dickson, Executor .400910 ~0] \(;A:ih}:l~ SThEi:~i~ i'.7. ~il)~ '.~i~~ !.Ftilt!1`~l:. PE.tiySlt\ ~~Ia 1 ~~~,'; JOHNSON, DUFFIE, STEWART &WEIDNER, P.C :..'~ -~ : O _ :~ '_ ~a ~ _,, ", :'- ,.~ ~: =•i r~ c~ ~c N O (rT1 r _.-i i„~~~ -% ~_=~ - .., °~ >:'-~~ a,~ , .. ~, _ 1. ice. i .~ ~'' ~ -o ----~-~ o ~"~'~' o- ------- m _- _-_ ~~ - -~ ~- .~--- ~~ ~.~.-.~. r ~~' __--- ~ ..~~~ ~- e i A t_:,,,~ r, .._. lS-~ ~-- C~~_ C.. ~ °-,- C.-' is`; m a a a 0 0 0 0 r 0 ~.~ ,.-- N c? ~,_ -- ~~_~,_i 7 4 t.l.- r ' ~ -... ~~ ~ ~, ~,~', r~:: W L~ ~_ t.~ N N r® s r _. ~~ r. ~~ f~ r A+'l ,we ma•~ r s~~w Ji~w =~`f'w l ~I O ~~ 0 ~ U ~ ~y p ~ cn r~ ~oNo ~~ ~~ ~~Q O ~ ~ ~ L L ~~U cn .~ ~ ~ ~~ ~ U O U 1~,. ~.. :< ~~