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Home My WebLink About03-0825PETITION FOR PROBATE and GRANT OF LETTERS Estate of Pauline V. Lebo also known as Deceased. SocialSecurity No. 192--34--6102 No. To: Register of Wills for the County of Cumberland Coramonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor in the last will of the above decedent, dated October 6: 1998 and codicil(s) dated 2003 in the named ,19,, (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with last.family or principal residence at 2/43 Allen Road) Carlisle, PA 17013 (list street, number and muncipaiity) Decendent, then 92 years of age, died September 29 ,zlx) 2003 at C,~rl i,~l ~ P~nn~y 1 v.~ni a ' Except as follows, decedent did not marry, was not divorced and did not have a ch/Id born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled irt Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: Pa3 Allon gc~rt. C..qrlde]~=pA 17a13 50 + Acres McC~ures Gap Roads $ 150~000.00 $ $ $ Cariisle~ PA 17013 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary theron. (testamentary; admin/stration c.t.a.; adm/n/strat/on d.b.n.c.t.a.) Manufacturers and Traders Trust Company .qug~a~.~or to F~nancial Trus~ Services Co. ,,/-- . OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA '~ COUNTY OF Cumberland .j~ S~ The petitioner(s) above-named swear(s) or affirmis) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well ar~rul.y administer the estate according to law. ~ before me this _, 10th day o~ | l~'av~_-d C. 'Gor±FJr~ V/f ce Pres±dent o¥' .~) October , , ~ ~_ ~003 J ~anufacturer~ an Traders Trust Ca ~/~ ~J~-/4f~z~"~r/~-~ '~c. ~_/~4~',t] Successor t 43onna M. otto, 1st ~pu~y ~" Re mft~ 21-2003-825 Estate of Pauline V. Lebo , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW October 14th xl/)_20.Q3., 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 October 6, 1998 and September 8, 2003 described therein be admitted to probate and Fried of record as the last will of Pauline V. Lebo .; and Letters Testamentary ~eherebygrantedto Manufacturers and Traders Trust Company Successor to Financial Trust Services Co. Donna M. Otto, lS~~~s ,~ ~ FEES Probate, Letters, Etc .......... $ 375.00 Short CertificatestO)'. ......... $ 30. O0 x-Pages (4) $ 12.00 OCP TOTAL $. Filed .. October - 14t_h, 2003 ........... Call Bank'when let-[etS-a~e ~eady on 10-14-03 Robert R, Black ATTORNEY (Sup. CL I.D. No.) .~DDR.ESS 717.,24~--3727 PHONE 105,805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate o£ 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 9610100 No. OCT COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ~r~a I ~..~i.~ I .... '~ .......... I'~c'~'~,., ~ ...... ~ .... ~,m~r~.) I I ~ . ~ ~~ J ~.~ ~ J .~~ 243 Allen R~d ,L Carlisle PA 17013 ,,. Th~s Roy Lebo 013144-L ,,. Irene Boyer i~, z M~lures ~p Road, ~rlisle PA 17013 ~ ~to~r 2, 2~3 I Westminster ~te~ ~rlisle PA 17013 J~. 219 N. Hanover St., ~rllsle PA 17013 ~;:~-y. so, ~X_% 21-2003-825 CODICIL TO LAST WILL and TESTAMENT OF PAULINE V. LEBO I, PAULINE V. LEBO, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, do make, publish and declare this as ~and for a Codicil to my Last Will dated October 6, 1998. FIRST: I add the following sub-paragraph "E" to Bequests paragraph THIRD: Eo To Nancy Martz, my niece, Ten Thousand and no/100 ($10,000.00) Dollars. SECOND: Except as herein modified, I hereby republish and redeclare my said Last Will dated October 6, 1998. I have signed this Codicil this ~'3'~ day of September, 2003. Pauline V. Lebo Witneff ~'~~ itness ~ F/ ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Pauline V. Lebo, the Testatrix in and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, having been duly qualified according to law do depose and say. (a) that I, the Testatrix, do hereby acknowledge that I signed and executed the instrument as Codicil to my Last Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and that we, the witnesses, were present and saw the Testatrix sign and execute the instrument as Codicil to Last Will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Codicil to Last Will as a witness and that to the best of our knowledge the Testatrix was at that time 18 of more years of age, of sound mind and under no constraint or undue influence. Pauline V. Lebo, Testatrix ' 'Witn~j~ Notary Public Notarial Seal ~ R.o.~n R. Black, No~-y . ~Et~s~e, .l~o. Cumbegalgl lvly commisston Expires SepL 10, LAST WILL AND TESTAMENT OF PAULINE V. LEBO I, PAULINE V. LEBO, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. BEQUESTS THIRD: I give the indicated amounts to the following individuals who survive me.' B. C. D. To Patricia Gildner, my niece, Ten Thousand ($10,000.00) Dollars, To Shirley Lebo, my niece, Ten Thousand ($10,000.00)Dollars, To Susan Lancia, my niece, Ten Thousand ($10,000.00) Dollars, and To Roy T. Lebo, my brother, Ten Thousand ($10,000.00) Dollars. if any beneficiaries shall not survive me, ',nen the gift to such beneficiary shall be divided among my surviving beneficiaries. DISTRIBUTION OF RESIDUE FOURTH: organizations: I give the residue of my estate, in equal shares, to the following initials mo B. C. D. E. F. G. Ho First Lutheran Church, 21 South Bedford Street, Carlisle, Pennsylvania, Salvation Army, Carlisle Pennsylvania Chapter, American Red Cross, Cumberland County Pennsylvania Chapter, YMCA, Carlisle Pennsylvania Chapter, YWCA, Carlisle Pennsylvania Chapter, and Billy Graham Foundation, American Cancer Society, Commonwealth Division, Inc., to be used within the Cumberland Unit, Cumberland County, Pennsylvania, American Diabetes Association, Cumberland County Chapter. POWERS OF EXECUTOR FIFTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments"; to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF EXECUTOR/RIX SIXTH: I appoint Financial Trust Services Company, executor of my will. WAIVER OF BOND SEVENTH: I direct that no fiduciary hereunder shall be required to furnish bond in any jurisdiction, and if any bond is necessary, no surety shall be required. VL_ initials INTERCHANGEABILITY OF LANGUAGE EIGHTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS NINTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this ~0 ~'~/ ~~ day of ,1998. Pauline V. Lebo Wimess Wimess ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Pauline V. Lebo, the testatrix in, and , the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the wimesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Pauline V. Lebo, Testatrix Witness Witness LAST WILL AND TESTAMENT OF PAULINE V. L~-~qO LAW OFFICES LANDIS & BLACK -~6 SOUTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 M _T Investment Group Private Client Servkes P.O. BOX220 ONE WEST HIGH STREET CARLISLE, PA 17013 717-240-4504 Toll Free 1-800-822-2155 Register of Wills Cumberland County Court House One Court House Square Carlisle, PA 17013 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Pauline V. Lebo Date of Death: September 29, 2003 Will No.: 21-03-0825 To the Register: I certify that notice of beneficial interest and estate administration required by Rule 5.6(a) of the Orphans' Court Rules was mailed to the following beneficiaries of the above captioned estate on October 21, 2003: Patricia M. Gildner 16 McNaughton Drive Duncannon, PA 17020 Shirley A. Lebo 111 McClures Gap Road Carlisle, PA 17013 Susan M. Lancia 6020 Dubai Place Dulles, VA 20189 Roy T. Lebo 111 McClures Gap Road Carlisle, PA 17013 Nancy I. Martz 3532 Telegraph Avenue Oakland, CA 94609 First Lutheran Church 21 South Bedford Street Carlisle, PA 17013 Salvation Army Citidel Office 125 South Hanover Street Carlisle, PA 17013 American Red Cross Cumberland County Chapter 1710 Rimer Highway Carlisle, PA 17013 American Cancer Society PA Division P.O. Box 897 Hershey, PA 17033-0897 YMCA 311 South West Street Carlisle, PA 17013 Billy Graham Evangelist Assn. P.O. Box 1270 Charlotte, NC 28201 YWCA 301 G Street Carlisle, PA 17013 American Diabetes Assn. Cumberland County Chapter 3544 North Progress Avenue Harrisburg, PA 17101 Notice has now been given to all persons entitled thereto under Rule 5r~6(a). Date: October 21,2003 Signature I J J~lne F. Burke, Vice President Address: Manufacturers and Traders Trust Company Robert R. Black, Esquire CC: One West High Street Carlisle, PA 17013 Telephone: (717) 240-4504 Capacity: Personal Representative Manufacturers and Traders Trust Company Private Client Services COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O3371 MANUFACTURERS & TRADERS TR CO ONE WEST HIGH STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 192-34-6102 FILE NUMBER: 2103-0825 DECEDENT NAME: LEBO PAULINE V DATE OF PAYMENT: 12/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $11,500.00 TOTAL AMOUNT PAID: $11,500.00 REMARKS: M &TINVESTMENTGROUP SEAL CHECK//200147295 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS LOOK FOR US. WE'LL GET YOU THI~RE. February 23, 2004 ?g :02 Commonwealth of Pennsylvania Department of Revenue Inheritance Tax Division Bureau of Individual taxes Dept. 280601 Attn: T/C 340 Harrisburg, PA 17128-0601 Re: Inheritance Tax Notice: Susan M Lebo 2844 Ritner Hwy Carlisle, PA 17013-9434 Dear Sir or Madam, Please be advised that Waypoint Bank provided incorrect co-owner information on a Decedent report filed upon the death of Pauline V. Lebo. We improperly identified Susan M. Lebo of 2844 Ritner Hwy, Carlisle, PA 17013-9434 as a co-owner on a certificate of deposit account maintained at Waypoint Bank. In fact, a different Susan Lebo is the co- owner and an amended Decedent report will be filed to state this corrected information. As stated by Waypoint Bank and in respect to the documentation we have on file, please recognize that the above mentioned Susan M. Lebo of Carlisle is in no way associated with the certificate of deposit owned by the deceased Pauline V. Lebo. Please refer any questions in this matter to Laura Burridge or the undersigned at 717-909-2633. Respectfully submitted, Robert W. Garrison -.%~.Vice President, Deposit Operations %. cc.~Register of Wills Cumberland County Court House Carlisle, PA 17013 Susan M. Lebo 2844 Ritner Highway Carlisle, PA 17013-9434 OPERATIONS CENTER 449 (-=ISENHOWER BOULEVARD, HARRISBURG. PENNSYLVANIA lTIll 717/909-i~657 · 717/909-7481 fax · vvvvvv, wagpointbank.com SUSAN M LEBO Z84q RITNER H~Y CARLISLE 'rNFORMATTON NOTICE AND TAXPAYEr: RESPONSE OF:~PaULZ~E V LEtO PA 17025-945q PILE ND. ~1 05-08Z5 ACN O&IOS34G DATE 02-lG-ZOOq TYPE DF ACCOUNT [] SAVZNG$ [] CHE~Z~ ~TRV~ RE&~STE~ OF ~2LLS ~UMBERLANO C0 COURT H~U$~ CARLISLE, PA 170I~ ~uleul~ ~ ~&un:lul ~ ~u. Thane ~Q~; ~ndic~tG ~ ~ ina dOm~ O~ ~. ~ba~ da~m~M~, ~ou ~r~ m ~O~ ~r/b.~ic~ COMPLETE PART 1 ~ELO~ ~ ~ X SEE REVERSE S~E FOR FZLING AND PAYMENT INSTRUCTIONS PerC~h~ ~able X ~ O . D O D Amou~ ~jec~ ~0 T~x ~,I~8 .~ (~ ~nth~ of ~e ma~O~nt's caXe af PART TAXPAYER RESPONSE PART ~ and/or TAZ RETURI~ - CONPL~T_~AATZ.0.N_ OF TAX ON d_OINT/TRUST ACCOUNTS PAYEE PART OATE PAI~ ~EBTS AND ]]EOUCTIONS CLAIMEm AHCUN¥ PAID TOT~L P. B~ FEB-~3-~BBA 1~: }iP~ F~X: 71~15A595 ID: ~YPOINT P~GE: ~B~ R=97~ COHNONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-1G45 EX AFP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. Z1 03-0825 ACN 0q1053q$ DATE 02-16-Z00q PATRICIA L GILDNER 16 MCNAUGHTON DR ",,,~ DUNCANNON PA 170Z0~.1~ ' !5 EST. OF PAULINE V LED0 S.S. NO. 19Z-$q-6102 DATE OF DEATH 09-29-2005 P3 :~UNTY CUMBERLAND TYPE OF ACCOUNT []SAVINGS [CHECKING []TRUST []CERTZF. REMIT PAYHENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NAYpOTNT BANK has provlded the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you Here a joint owner/beneficiary of this account. If yOU feel this information is incorrect, please obtain written correction free the financial institution, attach e copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coamoneealth at Pennsylvania. Guestlons may Re answered Dy calling COMPLETE PART ! BELON x # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1761505q55 Date 01-Z$-1997 Establ 1shed Account Balance 8, $76.85 Percent Taxable X S 0.0 0 0 Amount Subject to Tax q, 188. q3 Tax Rate X .15 Potential Tax Due 6?8.26 To insure proper credit to your account, tNo (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you amy deduct a 5g discount of the tax due. Any inheritance tax due Hill become delinquent nine (9) months after the date of death. PART TAX L/NE PART TAXPAYER RESPONSE A.~The above information and tax due is correct. . You may choose to remit payment to the Register of Hills eith two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of -~ gills and an official assessment mill be issued by the PA Department of Revenue. ONE BLOCKJ D. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. []The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. Zf you ~ndicata a different tax rata, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOiNT/TRUST ACCOUNTS 1. Data Established 1 2. Account Balance $. Percent Taxable q. Amount Subject to 5. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne 5 of Tax Computation) Under penalt/as of perjury, T declare that the facts I have reported abovli ar~ true, correct and coe, le~l:a to the best. o~ ey know/edge and belief. HOME z.. %/ '*"'7' ~. ,, /'.,1' TAXPAYER SIGNATURE TELEPHONE NUMBER GENERAL INFORHATZON 1, FAZLURE TO RESPOND NZLL RESULT ZN AN OFFZCZAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedant's date of death. 3. A joint account is taxable even though the decadent's name was added as a matter of convenience. ~. Accounts (including those held between husband and wife) which the decedent put in joint names eithin one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - [f the information and computation in the notice are correct end deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15qB EX) upon recelpt of the return from the Register of Hills. Z. BLOCK D - Tf the asset specified on this notice has been or ~11 be reported and tax paid ~ the Pennsylvania Inheritance Tax Return ~Jled by the decedent's representative, place an "X' ~n block 'B" o~ Part I o; the "Taxpayer Response" section. S~gn one copy and return to the PA Department o~ Revenue, Bureau o~ ZndlvJdual Taxes, Dept Z8060~, Harrisburg, PA 17128-0601 ~n the envelope provided. ~. BLOCK C - ~ the notice in~oraatJon is incorrect and/or deductions are being cla~med, check block "C" and complete Parts Z and according to the instructions heleN. Sign tho copies and ~bm~t them Nith your check ~or the amount o~ tax payable to the Register of Hills o~ the county 1nd~cated. The PA Department o~ Revenue NJ11 issue an o~fJc~al assessaent (Form REV-15q8 EX) upon receipt ~; the return ;rom the Register o~ Hills. TAX RETURN - PART 2 - TAX CONPUTATZON L~NE 1. Enter the date the account originally Nas es~blished or tJtled ~n the manner exlstJng at date of death. NOTE: For a decedent dylng a~ter 12/1Z/BZ: Accounts which the decedent put in ~o~nt names NJthJn one (1) year o~ death are taxable fully as trane{ers. HoNorer, there is an exclusion not to exceed $~00 per transferee regardless of the value o~ the account or the number of accounts held. 1f a double asterisk (~) appears before your ~rst name Jn the address portion o~ thls notice~ the $~,000 excluslon already has been deducted ~roa the account balance as reported b~ the f~nancial ~nst~tut~on. Enter ~e total balance o~ the account including interest accrued to the date o; death. The percent o~ the account that ~s taxable ~or each survivor is determined as ~olloNs: A. The percent ~xable ~or ~oint assets established more than one year pr~or to the decedent's death: I DZVZDED BY TOTAL NUHBER OF DZV~DED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOZNT ONNERS SURVZV[NG JOINT ONNERS Example: A joint asset regJstered in the name o~ ~e decedent and t~o other persons. I D~VZDED BY S (JOINT ONNERS) DZVIDED BY Z (SURVZVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent ~xable ~or assets created aith~n one ~ear o~ the decedent's death or accounts o~ned by the decedent but held ]n trust for another individual(s) (trust bene~iclarJes): I DZV~DED ~Y TOTAL NUHBER OF SURVZVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFZCZARZES Example: Joint account registered in the name o~ ~e decedent and tho other persons and established Nith~n one veer o~ death bv the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 1~0 50Z (TAXABLE FOR EACH SURVZVGR) The amount sub~ect to ~x (llne ~) Js determined b~ multiplying the account balance (line Z) by the percent taxable (line S). 5. Enter ~e total o~ the debts and deductions listed in Part S. 6. The amount taxable (line 6) ~s determined by subtracting the debts and deductions (l~ne 5) ~rom the amount sub,act to tax (l~ne ~). 7. Enter ~e appropriate tax rate (l~ne 7) as determined below. Data of D--ath [ Spouse Lineal 07/01/9~ to 12/$1/9~ SZ 6Z 15Z 01/01/95 to 06/S0/00 O~ 07/01/00 to prasen~ mThe tax rate imposed on the net value of transfers from e ~uc~ younger at death to er for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of hairs includes grandparents) parents, children) and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents) #hether or not they have been adopted by others, adopted descendents and their descendants end step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent) whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIHED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIHED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. Bo You actually paid the debts after death of the decedent and can ~urnish proof of payment.. C. Debts being claimed must be itemized fully in Part 3. If additionat space is needed, use plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. h,,lli,,,llh,,,,,Ih,lh,,li,,,Ih,,hl,,lhhh,hh, COHNONREALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB0601 HARRISBURG, PA 1712B-0601 REV-154S EX I'FP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0825 ACN OqlO5$q$ DATE 02-16-200q PATRICIA L GILDNER 16 NCNAUGHTON DR DUNCANNON PA 17020-97 EST~~ OF PAULINE V LEBO S.~'. NO. 192-3~-6102 DATE OF DEATH 09-29-2003 ~.~_~ CUNBERLAND TYPE OF ACCOUNT ~-~SAVINGS []CHECKING [~TRUST []CERTIF. RENIT PAYNENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 #AYPOINT BANK has provided the Department aith the information listed belom ~hich has been used in calculating tho potential tax due. Their records indicate that et the death of the above decedent, you mere a joint o~ner/beneficiary of this account. If you feel this information is incorrect, please obtain arittan correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax LaNe of the Coaeon~salth o; Pennsylvania. ;uastior.~ idy b~ b;tSWel aG by calling (7171 787-~$27. CONPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS Accoun~ No. 1761305~53 Date 01-23-1997 E s ~abli shad Accoun~ Balance 8,376.85 Percen~ Taxable X 50. 000 Amount SubSact to Tax ~, 188. ~3 Tax Re~e X .15 Potential Tax Due 628.26 To insure proper credit to your account, too (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Rills, Agent". NOTE: If tax payments are made eithin three [5) months of tho docedent's date of death, you may deduct a 52 discount of the tax due. Any inheritance tax due ~ill become delinquent nine (9) months after the data of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY A. ]~(~ The above information and tax due is correct. . You may choose tc remit payment to the Register of Rills with tad copies of this notice to obtain a discount or avoid interest, or you say check box "A" and return this notice to the Register of Rills and an official assessment mill be issued by the PA Department of Revenue. B. ~ The above asset has been or Hill be reported and tax paid ~ith the Pennsylvania Inheritance Tax return to be filed by the dacedent's representative. C. [] The above information is incorrect and/or debts and deductions ~ere paid by you. You must complete PART [] and/or PART [] belo~. PART If you indicate a differen~ ~ax ra~e, please s~a~e your relationship ~o deceden~: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Da~a Established I 2. Accoun~ Balance 2 $. Parcan~ Taxable $ ~ q. Aeoun~ SubSec~ ~o Tax q 5. Debts and Deductions 5 - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 ~ 8. Tax Due 8 PART DAlE PAID DEBTS AND DEDUCTIONS CLAZNED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ ~nder penalties of perjury~ Z declare ~ha~ ~ha fac~s I have reported above_are ~.rue~ corrg_c~ co,~fl~*e/*o *ha be$*/of,.,,ay knowledge and belief. HOHE C7/7 ) ~-~/~'3 ATURE' ' WORK C 7/7 ) 7 7 -7/7 TA R SZ TELEPHONE NUHSER and I~1£ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11~96) CD 003735 PATRICIA GILDNER 16 MCNAUGHTON DRIVE DUNNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 192-34-6102 FILE NUMBER: 2103-0825 DECEDENT NAME: DATE OF PAYMENT: LEBO PAULINE V O3/29/2OO4 03/27/2004 POSTMARK DATE: COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04105343 9628.26 REMARKS: L GILDNER CHECK# 4639 SEAL TOTAL AMOUNT PAID' 9628.26 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003735 PATRICIA GILDNER 16 MCNAUGHTON DRIVE DUNNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 192-34-6102 FILE NUMBER: 2103-0825 DECEDENT NAME: LEBO PAULINE V DATE OF PAYMENT: 03/29/2004 POSTMARK DATE: 03/27/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04105343 $628.26 . R~EMARKS: .... SEAL L GILDNER CHECK#4639 TOTAL AMOUNT PAID: $628.26 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS OpErations CEntEr 449 EisenhowEr BoulEvard, Harrisburg, PEnnsglvania 17111 Register of Wills Cumberland County Court House Carlisle, PA 17013 REV. I~ EX (S-Oq COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDEN'FS NAME (LAST, FIRST, AND MIDDLE INITIAL) i-. LEBO PAULINE V Z · ~ DANTE OF BIRTH (MM-DD-YEAR) r'l DATE OF DEATH (MM-DD-YEAR) U.I 09/29/2003 02/07/1911 ILl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Q N/A [] 1. Odghal Ratum J--] 4. Limited Estate [~]6. Decedent Died Testate (Attach ropy Of Wll) r-'-~ 9. Litigation Proceeds Received OFFICIAL USE ONLY ~'~'~J~i~ ................................................ __21___ __03 0825 COUNT¢ CODE YEAR NUMB'---'~ SOCIALSECURITYNUMBER - 192-34-6102 THIS RETURN MUST BE RLED IN DUPLICATE WITH THE REGISTER OF VVILLS SOCIAL SECURITY NUMBER Manufacturers and Traders Trust Company FIRM NAME Attn. Jane F. Burke, VP TELEPHONE NUMBs-( (717) 2404504 E~2. Supplemental Return [] 3. Remainder Return (date of dealh p~ia-to 12-13-82) E] 4a. Fatum Interest Compromise (~a~ of dean ar~ 12-12-s2) [] 5. Federal Estate Tax Return Required [] 7. Decedent Maintained a Living Trust (^~a~ cop~ofTr~ 1 8, Total Number of Safe D6posit Boxes [] lO. Spousal PovertyCmdit(da~-ofdeanbatwe~12-31-~la,dl_l.gS) [] 11. Eleclion to tax under Sec. 9113(A)(A~tachscho) ~' '"K: ........ ~"i~ ......... ~-~::~:h.' ';; ~.-' '" ':?: .............. ;:-- ........... :.:;'..~- :~-~,..w::. - · :.: - -- --, ..................... :....---,-:.:-x ICOMPLETE MAILING ADDRESS One West High Street P.O. Box 220 Carlisle, PA 17013 1. Real Estate (Schedule A) (i) 2. Stocks and Bonds (Schedule B) (2) 3. Cbsely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal Properly (5) (Schedule E) 6. Jointly Owned Pmpe~j {Schedule F) (6) LJ Separate Billing Requested 7. Inter-V'wos Transfom & Miscellaneous Non-Probate Property (7) (Schedae G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrate Costs (Schedule 14) (g) 10. Debts of Decedent, Mortgage Lial~'llfies, & Liens (Schedule I) (1 O) 11. Total Deductfons (total lines 9 & 10) 1Z Net Value of Estate tune 8 minus Line 11) 13. Chan~ble and Governmental Bequests/Sec 9113 Trusts for which an elec[ion to tax has not been made (Schedule J) 14. Net Value Subjec~ to Tax (Line 12 minus line 13) 742,666.67.'¢~..' 35,834.08: 0.00 0.00 257,273.36 38,887.30 0.00 (8) 1,074,661.41 69,682.97 48,389.84 (11) 118,072.81 956,588.60 (12) (13) 867,___7_01.3~0 (14) 88,887.30 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Une 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rote 19. Tax Due 10,251.62 x .12 78,635.68 x .15 (15) 0.00 0.00 (16) (17) 1,230.19 (18) ,. 11,795.35 (19) 13,025.54 Decedent's Complete Address: STREET ADDRESS 243 Allen Road cffYcarlisle STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 11,500.00 C. Discount 605.26 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 (1) 13,025.54 12,105.26 0.00 920.28 920.28 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) (5Al (5Bi Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property 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? ........................................................................................................................ [] [] 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 retum, 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 persona,,I representative is based on all information of which preparer has any knowledge. SIGNATURE OF~°ERSON RE,?hDOJ(I~IBLE FOR FILING RE'[URN DATE ....... ....... ............................................................................................................................................ Manufacturd'rs and Traders Trust Co., One West High Street, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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 RS. §9116 (al (1.1)(il]. 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 RS. §9116 (al (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0% [72 RS. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98).~,~ '~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 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 pdce 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 survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ::House and Lot, 243 Allen Road, Carlisle, Cumb. County, PA--Settlement Sheet Attached i::i 76,000.00 i2/3 Interest in 53.03 acres Vacant Land, McClures Gap Rd, Carlisle, PA--Settlement Sheet ::,' :i~iiiii 666,666.67 TOTAL (Also enter on line 1, Recapitulation) :i:i "'"'"'"'"'"'"'"'"'iii 742,666.67 iii (If more space is needed, insert additional sheets of the same size) ! U,S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT SETTLEMENT STATEMENT Phone: SECURED LAND TRANSFERS, INC. 5006 East Trindle Road Suite 203 Mechanicsburg, PA 17055 (717) 591-8500 FAX: (717) 591 OMB No. 2502-0265 TITLEPRO Laserprinl B, TYPE OF LOAN 1. | 1 FHA 2. [ ] FMHA 3.~] CON'V, UNINS. 4. [ 1 VA S. [ ] CONV. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: 505901 I 641955457 "~. INS. CASE NO.: · NOTE: This form is furnished to give you a statement of actual settlement costs, Amounts paid to and by the settlement agent are shown. Items marked '(p.o.c.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NAME AND ADDRESS OF BORROWER: .obert W. House ridgett M. House PROPER~ LOCATION: ,or 18 Plan Book 6-21 43 Allen Road arlisle BOROUGH UMBERLAND County E. NAME MD ADDRESS OF SELLER: Pauline V. Lebo Estate R NAME AND ADDRESS OF LENDER: ABNAMRO Mortgage Group, Inc. 2600 W. Big Beaver Road Troy MI 48084 H. SETTLEMENTAGE~: Secured Land Transfers, Inc. PLACE OF SETTLEME~: 101 01d Schoolhouse Lane, Mech. PA 17055 I. SETTLEMENT DATE: 11/25/03 J, SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: GROSS AMOUNT DUE FROt{ BORROWER 400. GROSS AMOUNT DUE TO SELLER L Contract sales price 76000.00 4or.Contract sales price 76000.00 .~. Personal property 1. Settlement charges to borrower (line 1400) 4100.53 402.Personal property 403. City/Town tax 404. 405. Adjustments for itoms paid by seller in advance Adiustments for items paid by seller in advance [o 405. City[rown lax ID z. Coumytax 11/25/03to12/31/03 43.80 Assessments te 3. eohool 11/25/03to06/30/04 ~. Deposit or earnest money 4o?.Countytax 11/25/03,o12/31/03 408.Assessments to 43.80 619.96 400. School 11/25/03to 06/30/04 619.96 tO 410. ta 412. 3. GROSS AMOUNT DUE FROM BORROWER 80764.29 420. GROSS AMOUNT DUE TO SELLER 76663.76 AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 10 0 0 · 0 0 5bl.Excess deposit (see instructions) 60800.00 Principal amount of new loan(s) Existing loan(s) taken subject to Proceeds from 2n~ Mtq. 11251.94 50zSettlement charqes to seller (line 1400) s03.Existinc~ loan(s) taken subject to 604.Payoff of First Mortgage Loan ~TOI~T~ 50s. Payoff of Second Mortgage Loan i. 506. t. 507. I. 508. Adjustments for items unpaid by seller 509. 6470.08 Adjustments for items unpaid by seller ]. City/Town {ax to :. County tax to :. Assessments to I. School to L I. TOTAL PAID BY/FOR BORROWER 73051.94 !. l~ess amount p aid by/for borrower (Line 220) , 7 3 0 5 1 . 9 ~ 3. CASH ([~ FROM) ([ ] TO} BORROWER' 7712'. 35 s 10. City/Town tax to 511, County tax to 512. Assessments I0 513. School to 514, 515. 516. 517. 518. 519. 520.TOTAL REDUCTION AMOUNT DUE SELLER 6oo. CASH AT SETTLEMENT TO OR FROM SELLER sO,.Gross amount due to seller (line 4~0)~ ~'~ I 6o2.tess reduction ~mount due seller (line 520) so3. CASH ([~ TO) ([ ] FROM) SELLER 6470.08 76663: 76 . .. 6zi70.08 70193.6§ ~yer or Borrower's Signature Seller's Signature HUD-1 Rev. 5/86 'F U S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETI-LEMENT STATEMENT OMB No. 2502-0265 Page 2 g SETTLEMENTCHARGES 505901 700.' TOTAL SALES/BROKER'S COMMISSION based on price $ '7 6 0 0 0 · 0 0 · Division of Commission (line 700) as follows: Tot 91: $ 5 t 2 2 0.0 0 70t. $ 2255.00 to ERA-R-ET, Inc. ?02. $ 2965.00 to Coldwell Banker HSG 703. Commission ~aid at Settlement 704. Trans Fee ERA-N-ET, Inc. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 8Ol, Loan Origination Fee % 902. Loan Discount % a03. Appraisal Fee to S .W. Barrett Real Estate 100.00 804. Credit Report to 805. Lenders Inspection Fee 806. Mortgage Insurance Application Fee Io 007. Assumption Fee PAID FROM I PAID FROM BORROWER'S I SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 100.00 I 5220 00 i9os. ProcessFee 5og. Broker Fee !510. Def'd Prem ACAMortqage Services ACAMortqaqe Services ABNAMRO-ACAMtq ( $13 68. POC) 1511. Lndr Admin ABNAMRO Mortgage Group gOO. ITEMS REQUIRED BY LENDER TO BE PAID tN ADVANCE 300'00I 1100.00 375.00 901, Interestfrom 11/25/03 go2. Mortgage Insurance Premium for Io11/30/03 aS 10.13/day mo. to 903. Hazard Insurance Premium for 1yrs. to 904. yrs. to 905. Esc Waiver· ABN AMRO Mortgage Group 60.78 152.01 000. RESERVES DEPOSITED WITH LENDER FOR 001. Hazard Insurance mo, @ $ /mo. 002. Mortgage Insurance mo. O $ /mo, 003. City/Town tax mo. ~3 $ /mo. ~004. County Iax mo. @ $ /mo, i005. Assessments mo. ~ $ /mo. 1009, School tax mo. ~ $ /mo. I0O7. mo. @ $ /mo. loo9. Aggregate mo. @ $ /mo, 1100. TITLE CHARGES 10.00 1101. Settlement or closing fee to 1102. Abstract or title search to ! 103. Title examination to 1104. Title insurance binder to 105. Document preparation to t 106. Notary fees to Ca sh 10.0 0 1107. Attorney's fees to Landis & Black (POC) (includes above items No,:) 1105 ~~ 1108. Title Insurance to Secured Land Transfers 864.75 (includes above items No.:) End. 100,3 00,900, ~ 1109. Lender's coverage $ 72, 2 0 0 111o. Owner's coverages 76 r 000 ,1111 Wire/Mail Secured Land Transfers 35.00 tl12. Doc Print Secured Land Transfers 50.00 ~113. ICPL Fee First American Title Ins. 35.00 t200, GOVERNMENT RECORDING AND TRANSFER CHARGES 12Ol. Recording fees: Deeds 38.50 Mortgages 64.50 Misc.$ 103.00 12o2. City/countytax/stamps: Deeds 760 . 00Mortgages 760 . 00 12o3, State tax/stamps: Deeds 760 . 00Mortgages 760 . 00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES [301. Survey to 13o2. Pest Inspection to Home Paramount 55.0 0 :3o3. I-[ome Wrnty is/ES Home Warranty 465.00 1304. FinalSewer Carlisle Borough Office 15.08 1305. 1400. TOTAL SETTLEMENT CHARGES (artier on lines 103 and 502. Sections J and K) ~: 1 0 0.5 3 6 4 7 0. 0 8 HUD CERTIFICATION OF BUYERS AND SELLERS 'he~~~ch ,~r~d~ .............. tot Ih~ ........ io~./~~use the [u~ds Io be disbumed i ...... d ..... ilh this slat .... L LAW OFFICES A. Settlement Statement IR WIN & McKNIGHT OMB No. 2502-0265 REV~ HUD-1 {3/86) B. TYPE OF LOAN WESTPOIVr=RETPROFE$$1ONAL BUILDING 1. I'IFI-~ 2. I-'IFmHA 3. DConv. Unins. 60 WEST POMFRET STREET 4. DVA 5. 0Cony. Ins.. CARLISLE, PENNSYLVANIA 17013-3222 6. FILENUMBER 17. LOANNUMBER (7~7) 24~-2353 _NOLLASSOC4-04 'I ' 8. MORTGAGE INSURANCE CASE NUMBER WAI~. I_NG: it h · trim. to Imewlngly make fab. stat~n~ b t~'~ dh~ !-°,r-'-' ~-~-"-'~j'on I~m .o~. u and are not Inaud.d In the torah. TitleExpmss SetUemant System D. NAME OF SORROWER: NOLL ASSOCIATES ' Printed 04/27'/2004 at 15:44 JMR ADDREss: 906 NL=WVILLE ROAD, CARLISLE, PA '17013 E. NAME OF SFI [ ER: ROY T. LE_~O and MABEL M. LEBO ESTATE OF PAUUNE V. LEBO ADDRESS: F. NAME OF LENDER: ORRSTOWN BANK ADDRESS: 77 EAST KiNG STREET, SHI~PF-.NSBURG, PA, 1}'257' '~ ' ' G. PROPEKry ADDRESS: 111 MCCCURE$ GAP ROAD,Carlisle, PA 17013 63.03 ACRES! North Mlddleton Township N. SETTLEMENT AGENT: I&M REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717-249-6354 NT: 60 West Pomfret Street Carlisle PA 17013 West Pomfrst Pmfesdonal Bid 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER ' 101. Contract sales rico ~000000,0~ 401. Contract sales ce 102. Personal Pm e . I03. Settlement ch es to borrower ina1400 17330.88 402. PersonalP . 104~ 403. 105. 404~ I 405. Ad'ustment~ forItems aidb seller in advance Adjustments for Item~in advance 108. School Tax 04/29104to06/30/04 46.36 408. School Tax 04/29104to06/30104 46.36 109. 409, 120. GROSS AMOUNT DUE FROM BORROWER '1,017,377.04 420. GROSS AMOUNT DUE TO ,Sm PR ~ ~000,046.36 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO ~=~ ~ 201, Do~i[ or earnest money 6~000,00 501. Excess n,~2o~__~ (see instructions) 202. Principal amount Of new loans ~,000,000.00 502. Sett;~ii,~,t char[leS to seller [line 1400) 60,000.00 203. Existincl Ioants'} taken sub~ect to 503. F_xJstin(~ loan(s) taken subject to 204. 504. Payoff of Rmt Mo~t.q,~e Loan 205. 505. 206. 506. 207. 507. 203. 508. 209. 509. Adjustments for items Unrn~id by seller AdjUstments for ~eai~. unpaid b,, seller 211. Countytaxes 01/0tl04to04/29104 24.42 511. County taxeS 0~101104to04129104 24.4'2 213. 513. 214. 514. 215/ 515. 216. 516. 217. 517. 218. 518. 220. TOTAL PAID BY/FOR BORROWER 1~005,024.42 620; TOTAL REDUCTION AMOUNT DUE Sm ~ PR 60~024.42 300. CASH AT SEHLEMENT FROM OR TO BORROWER 600. CASH AT SETTI I=MENT TO OR FROM Sm ~ PR 301. Gross amount due from boh,.,w, er {line 120) 'I,0'17,3TL04 601. Gross amount due.to seller (line 420) 1,000,046.36 302. Less amounts paid by/for bon'°Wer (fine 220) '1~006,024 ,42 602. Less reduction amount due seller {fine 520) 60,024142 303. CASH FROM BORROWER 12,352.62 603. C~,SH TO .qm ~ FR .. 940,021.94 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:, NOLLASSOC4-04 PAGE 2 SETTLEMENT STATEMENT REV. HUD-1 (3/86) ~ L. SETIt. EMENT CHARGES . ,-w, ...... ~ ..... .,=,,=,,~ o¥.~cm r..L~J u~/~//zuw a[ ~o:~ PAID FROM PAID ~ROM 700. TOTAL ~RO~R'S CO~ISSION based on pHce $~000~000.00 = 50~000.00 BORROWER'S SEER'S DNisi~ ~ ~mmi~lon (li~e 7~) ~ ~: ~NDS AT FUNDS AT 701. $ 50,000.0~ t~ B-H AGENCY GMAC R~L E~ATE 'S~EME~ S~EME~ 702, $ to 703, Commisslon paid ~ ~t~ent 800. ff~S PAYABLE.IN CONNECTION WI~H LOAN ' 50,000,00 ~1. ~ Od~ nation F~ % ~ ~000.00 ~ 80~ ~ Di~nt 803. Ap~i~a~ Fee {o O~STOWN,BANK 900.00 ~4. C~ ~ ~6: MoH~a~ App~on F~ ., 808, O~UME~ PR~ ~ ORRSTOWN BANK ~9, ' v 350.00 810, "; 900. flEaS REQUI~D BY ~NDER TO BE PND IN ABVANCE f000. R~ER~S DE~SffEB WffH ~NDER FOR 1~2, MoSqUe Ins~ra,~ mo. ~ $ /mo 1~, ~ Tax mo, ~ $ ~ ~ ~o ~ ~ 00. T~E C~GES 0.00 ~107, A~s Ond~ a~ Eems ~o: 110~ ~e Insumnm to FI~ A~e~ca~ Title Insurance Company 4~733.75 (ind~ ab~ ~ms No: 11~. ~nd~s Por~ t~00r~0.~ ' - 1111. End 1~, End.~, End 9~ to Flint American Title Insu~ce Company t50.00 J 113. C~,,~ to R~ American T~e I~umn~ Company 35.00 J200. ~RNME~ ~CORDING ANQ T~S~ C~Rr~ . ~0 000.00 l~3.-S~eT~stam ~ ~ed ~0000.00 'U~ a e ~000.00 ~5. t300. ADD~IONAL S~LEME~ CH~GES J~. 2~ CO~P T~S b ROBIN [ SOLLEN~COLLECTOR ~ ~. ~ 74.93 t3~. ~ ~ 13~. ~ ~ ~3~.' ~400. TOTAL S~EME~ CH~GES [ent~ on Bnes 1~, S~on J and 502, Se~on ~ REV-1503 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ::~2~.504 shs. Van Kampon H8 Govomment Fund A ~0 ~. 8,83~ '$2,200 par ~.S. Series tiff Bonds ~ :::::: .............................................................................................. par ~.S. Safios fi 8ond i~ ............................................................................................................................................................................-......~-.........................................~.............~......................................................................................~.....-........................ ;~[~:[:~;~:~[:~:~:~[:~[[;[~?:.:.:.:.:.:.:.~[~[~?::::::::::::::::::::::::~ ............................................................................................................................................................................................................................................. ~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~:.~ :....`.........................................................................................................~.....................................................................'.........................`.....'.............................................................................................;..........?............~..................: ~[~[~j~[j~[[~[~ '"'"'"'"'""'"'"'""'""'"'"'"'"'"'"'"' '" "'"' '" '"'"'"'"'"" '"'"'"'"'" '"'"'"'"'"'"'"" "" "'" "' "' "'"'"'"" "'"" '""'~' '"'""'"'"'"'"' ~'"" "'"' '" "'"' "'""'"'"'"'"" '"'""~" '" "'"'"" "'"'""'"" "'-'-'-'-~-'""-'-'~' ""-' "'"' ~'"'"-"-' "'"'""-'""-'".'.'.'.'.' .' .~ ~ ~ ~ [~ [~ ~ [~ ~ ~[~[ ~ ~ ~ [~ ~[~ lOT~ (Also enter on lino 2, Recapitulation)$?:~ 35,834.08 ================================================================================================== (if more space is needed, insert additional sheets of the same size) REV-1508 F_X+ (e-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM I VALUE AT DATE NUMBER J DESCRIPTION OF DEATH iJ iPro-rated Real Estate Taxes, 243 Allen Road, carlisle, PA 2- ~!'~i iPro-rated Real Estate Taxes, 111McClures Gap Road, Carlisle, pAij iM&T Bank, Checking Account 2670024013 ........ ........................ ~'i'iJ ~'~'~est'~al~'~;;it~ Ceni;ri";;~'~'~"P';~el~i,; ~'ul~d ................................................................................... ................. i Nationwide Mutual Fire Insurance Co., homeowners premium refund 243 Allen Road property iMarsh Advantage America, liability insurance premium refund, 243 Allen Road property 8.i !Rowe's Auction Service, proceeds sale of Personal Property 663.76 14.62 973.24 ....................................................... ..................................................... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ................................................ 5,469.00 10.! 12. 13.i 14. 16. 17. 18. .: 19.i 20. i . 23.! 25. i iCumberland Goodwill Fire Rescue EMS, refund 2/13/03 service paid by Medicare iCapital Blue Cross, premium refund .......... iGuidepost, subscription refund 3.49 2,985.55 ................................................................................................................ ......................................... ::M&T Bank, Ce~fi~te of Deposit 31003910747046 ...... ' .............................................. 1 835.72 ~M&T Bank, Ce~fi~te of Depos~ 31003914492746 ~M&T Bank, Ce~,,te of Deposit 31003914498645 ' ~?. ......................................... ~'~'~"~'~"~'~"~ iM&T Bank, Certificate of Deposit 31003914529846 iM&T Bank, Certificate of Deposit 31003914589410 !M&T Bank, Savings Acct. 15004198250571 · !Wachovi a, Certificate of Deposit 247412041106150 iWachovia, Certificate of Deposit 247412050860000 iWachovia, Certificate of Deposit 247412051168497 iWachovia, Certificate of Deposit 247412051270042 :: TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insed additional sheets of the same size) 4,926.11 ~-"~ 3,032.08 il. 10,641.83 iii 8,570.54 iii 9,072.10 13,009.11 30,949.22 !ii 257,273.36....:I' REV-1508 EX+ (6-98) ~ -~- COMMOI',~VEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER PAULINE V. LEBO SCHEDULE E CONTINUED 21-03-0825 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with right of survivorship must he disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH iWachovia, Checking Acct. 1010049591190 26. :: 27.~ i~;~i'~i'~ ~i~'g",~ii'i' ~'~ '{~,~'~ i ~'~ ................................................................................................................... 28.1 iWaypoint Bank, Certificate o~ Deposit 1700004782 : 29.1 ~Waypoint Bank, Certificate of Deposit 170004670 30.i iWaypoint Bank, Certificate of Deposit 1755302658 31 .i Waypoint Bank, Certificate of Deposit 1755305449 21,875.09 13,027.52 1,486.33 4,503.76 36.i iWaypoint Bank, Certificate of Deposit 1758321313 iWaypoint Bank, Certificate of Deposit 1760254991 iWaypoint Bank, Certificate of Deposit 7000003811 37.i iWaypoint Bank, Cert ficate of Depos t 7000004697 38. iWaypoint Bank, Certificate of Deposit 8000036093 39.~ Waypoint Bank, Certificate of Deposit 800003863 4o.i 41 ::Orrstown Bank, Certificate of Deposit 60055071 42.i ::Orrstown Bank, Certificate of Deposit 5060057397 Waypoint Bank, Certificate of Deposit 1755314726 3,502.73 ::Waypoint Bank Certificate of Deposit 1756286631 ~ 4,040.42 1,193.97 928.76 iil 4 374.39 iiii 6,865.91 iii ......................................... iii .................................... iWaypoint Bank, Checking Acct. 1703011206 il 32,569.91 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 533.96 M&T 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 M&T Investment Group Private Client Services 1 West High Street PO Box 220 Carlisle, PA 17013 Phone (302) 934-2909 F ax (302) 934-2955 November 5, 2003 Re: Estate of Pauline V Lebo Social Security: 192-34-6i02 Date of Death? September 29, 2003 Dear Sir or Madam: Per your inquiry dated October 21, 2003, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: Type of Account Account Number Ownership (Names 099 Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003910170403 Pauline V Lebo Susan M Lancia (added 08/18/03) Roy TLebo, POA 08/21/98 $6,725.69 $ 7.19 '--~'~7~58¥ ............................... Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Certificate of Deposit 31003910554524 Pauline V Lebo Roy TI_mbo, POA 11/17/99 $2,980.71 $ 4.84 Total $2,985.55 o Type of Account Account Number Ownership (Names oj) Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names oj) Opening Date Balance on Date of Death .4ccrued Interest Total Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names Opening Date Balance on Date of Death Accrued Interest Certificate of Deposit 31003910628858 Pauline V Lebo Roy TLebo, POA 01/07/00 S2,172.00 $ 19.44 $2,191.44 Certificate of Deposit 31003910685.527. Pauline V Lebo Roy T Lebo, POA 02/11/00 $6,000.00 $ 5.27 Certificate of Deposit 31003910747046 Pauline V Lebo Roy T Lebo, POA 03/17/00 $L800.00 $ 35. 72 835. 72 Certificate of Deposit 31003910829290 Pauline V Zebo Roy T Lebo, POA 05/06/00 $15,000.00 $ 12.20 Total $I~012.20 10. Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued Interest Type of Account Account Number Ownership (Names oJ) Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003914492 746 Formerly Allfirst #870081 O1034889 Pauline V Lebo Roy TLebo, POA 02/26/96 $8,000. O0 $ 1.18 $8,001.18 Certificate of Deposit 31003914498645 Formerly Allfirst g87008101 I58715 Pauline V Lebo Roy TLebo, POA 04/I 6/96 $2,815.23 $ 1.70 .............................. Certificate of Deposit 31003914529846 Formerly Allfirst #87008140401196 Pauline V Lebo Roy TLebo, POA 07/30/96 $4,922.07 $ 4.04 .............................. Certificate of Deposit 31003914589410 Formerly Allfirst g87008141004859 Pauline V Lebo Roy T Lebo, POA 11/25/97 $3,031.68 $ .40 $3, O32, 08 11. 12. Type of Account Account Number Ownership (Names oJ~ Opening Date Balance on Date of Death Accrued Interest Total Type of Account Account Number Ownership (Names Opening Date Balance on Date of Death Accrued Interest Total Checking Account 2670024013 Pauline V Lebo Roy T Lebo, POA 09/01/67 $14,218.56 $ 5.64 --S-[4-,'~:t?~O ................................. Savings Account 15004198250571 Pauline V £ebo Roy T Lebo, POA 08/07/01 $10,634.84 $ 6.99 ---~?~7~[.~ ................................. For further account information, closures and/or reimbursement of funds please call the High Street-Carlisle Office at g717-240-4598. Records Management Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference 1D: 748752 Account Type November 10, 2003 M & T INVESTMENT GROUP 1 WEST HIGH ST CARLISLE, PA 17013 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: PAULINE V LEBO (SSN# 192-34-6102) Date of Death: September 29, 2003 Deposit Account Information Account Date of Death Average Date Maturity Interest Accrued YTD Date Number Balance Balance* Opened Date Rate Interest Interest Paid Closed CERTIFICATE OF DEPOSIT 247412041106150 LEGAL TITLE: PAULINE V'LEBO CLOSING BAI_ANCE: $8577.59 $8,568.19 3/20/2000 $2.35 $78.53 10/30/2003 CERTIFICATE OF DEPOSIT 247412050860000 LEGAL TITLE: PAULINE V LEBO CLOSING BALANCE: $9079.56 $9,065.39 9/3/1999 $6.71 $204.70 10/30/2003 CERTIFICATE OF DEPOSIT 247412051168497 LEGAL TITLE: PAULINE V LEBO CLOSING BALANCE: $13009.10 $13,000.00 4/24/2000 $9.11 $416.44 10/30/2003 CERTIFICATE OF DEPOSIT 247412051270042 CLOSING BALANCE: $31014.66 $30,929.61 7/21/2000 $19.61 $590.97 10/30/2003 CHECKING 1010049591190 LEGAL TITLE: PAULINE V LEBO CLOSING BALANCE: $3205.79 $3,158.17 4/9/2002 $1.36 $76.15 10/30/2003 CHECKING 1010049591200 LEGAL TITLE: PAULINE V LEBO CLOSING BALANCE: $1.00 $1.00 4/9/2002 $0.00 $0.00 10/30/2003 0000 000614 * Due to system limitations, we can only provide a twelve month average balance on depository accounts. ... Other Account Information Account Type Account Date of Balance Date Number Opened Date Closed Reference ID: 748752 Ledger Collected SAFE DEPOSIT BOX LEGAL TITLE: PAULINE V LEBO LOCATED ~ CARLISLE 604 E HIGH STREET CARLISLE PA 17013 07585516002776 3/30/1978 CAP, BROKERAGE and SELF-DIRECTED IRA ACCOUNTS HAVE BEEN CONVERTED TO WACHOVIA SECURITIES. YOUR REQUEST HAS BEEN FORWARDED FOR PROCESSING and WILL BE MAILED UNDER SEPARATE COVER. FOR QUESTIONS REGARDING CAP, BROKERAGE, or SELF-DIRECTED IRA ACCOUNTS PLEASE CALL WACItOVIA SECURITIES at 1-866-874-2717. * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that timezgeriod. Servicenter Associate Phone: (540)563-7323 chc;js 0000 000614 LOOK FOR US. WE'LL GE~T YOU THERE. 11/4/2003 M&T INVESTMENT GROUP PO BOX 220 ONE W HIGH ST CARLISLE PA 17013 The information which you requested on the account(s) of PAULINE V LEBO (Social Security Number 192-34-6102) is/are as follows: Account Number 1700004782 170004670 1703011206 1755302658 1755305449 Class of Account CERTIFICATE CERTIFICATE CHECKING CERTIFICATE CERTIFICATE Date Opened 042398 020698 100899 032097 012397 Principal Balance 21839.29 13000.00 32556.98 1485.20 4500.00 Accrued Interest 25.80 27.52 12.93 1.13 3.76 ) Balance at Date of 21875.09 13027.52 32569.91 1486.33 4503.76 Death Account Ownership SOLE SOLE SOLE SOLE SOLE SOLE Name of Joint Owner, if any Date Ownership 042398 020698 100899 032097 012397 Was Established 1756286631 1758321313 1760254991 1761305452 1761305453 Account Number CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE Class of Account 040296 101597 110494 012397 012397 Date Opened 4037.79 1191.36 922.04 8367.93 8367.93 Principal Balance 2.63 2.61 6.72 8.92 8.92 Accrued Interest 4040.42 1193.97 928.76 8376.85 8376.85 Balance at Date of Death SOLE SOLE SOLE JTO JTO Account Ownership SUSAN M PATRICIA L Name of Joint LEBO GILDNER Owner, if any 040296 101597 110494 O12397 012397 Date Ownership Was Established 1755314726 CERTIFICATE 062097 3500.00 2.79 3502.73 062097 1761305454 CERTIFICATE 012397 8367.93 8.92 JTO SHIRLEY A LEBO 012397 RO. Box 171 I, HARRISBURG, PENNSYLVANIA 17105-1711 Toll Fr~ 1-866-WAYPOINT (I-8.66-9;~9-7646)· IN YORK AREA 717/815-4500 · www. wagpointbank, com LOOK FOR US. WE'LL GET YOU THERE. 11/4/2003 Account Number 1761305455 Class of Account CERTIFICATE Date Opened 012397 Principal Balance 8367.93 Accrued Interest 8.92 Balance at Date of 8376.85 Death Account Ownership JTO Name of Joint NANCY I Owner, if any MARTZ Date Ownership 012397 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested 7000003811 7000004697 8000036093 800003863 9600016275 CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE 082696 111596 092297 062797 081503 4367.26 6857.03 3000.00 10791.73 13931.26 7.13 8.88 2.96 9.85 14.85 4374.39 6865.91 3002.96 10801.58 13946.11 SOLE SOLE SOLE SOLE 082696 111596 092297 062797 OWN/BNF NANCY MARTZ BNF 081503 Sincerely, ,- . SENIOR SERVICES REP. P.O. Box 171 I, HARRISBURG. PENNSYLVANIA 17105-1711 Toll Fr~ 1-866-WAYPOINT (I-866-9;=9-7646) · IN YORK AREA 717/815-4~;00 · vvww. wagpointbank, com ORRSTO BANK TO: M&T Investment Group One West High Street Carlisle, PA 17013 FROM: ORRSTOWN BANK P.O. BOX 250 SHiPPENSBURG PA 17257-0250 RE: ESTATE OF Pauline V Lebo DECEASED DATE OF DEATH: September 29, 2003 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE DATE OPENED DATE OPENED FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT SAVINGS ACCOUNT ACCOUNT NO. TITLE OF ACCOUNT DATE OF DEATH PRINCIPLE & ACCRUED INTEREST DATE OF DEATH PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED 60050376 Pauline V Lebo 12/7/94 Roy T Lebo 60055071 Pauline V Lebo 10/8/96 4000001896 Pauline V Lebo 8/14/03 Shirley A Lebo 5060057397 Pauline V Lebo 6/17/97 DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 500.00 3.23 1,305.57 .64 1,202.72 .25 3,532.69 1.27 Date: 11/25/03 By: Timothea Customer Service Operator NUV ZOO3 P.O. BOX 250 · SHIPPENSBURG, PA 17257 · TEL. (717) 532-6114 REV-1509 EX+ (6-98~,~. ,.~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A'~Susan M. Lancia B'~Patricia L. Gildner 16 McNaughton Drive Duncannon, P^ 17020 i6020 Dubai Place iNiece ~Dulles, VA 20189 iNiece iShirley A. Lebo il 11 McClures Gap Road ~Niece iCarlisle, PA 17013 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S iNTEREST i iii:':':':':'~'~':':':'~':':':':'~':':':':':':':':':':':':':?: . i ::ii 1. A. 08/18/2003 ~M&T Bank, Certificate of Deposit 31003910170403 :: :::::: 6,732.88 ::i:: 100i :::::: 6,732.88 2.i i A 101/23/1997 iWaypointBank, Certificate of Deposit1761305452 8,376.85::::::'50i :::::: 4,188.43ii:: 3.i B ! 01/23/1997 ~WaypontBank, Certificate of Deposit1761305453 ~ 8,376.85::i:: 50:: ::i:: 4,188.43:::::: 4.:: C i 01/23/1997 ::WaypointBank, Certificate of Deposit1761305454 ~: 8,376.85~::~ 50:: ::?: 4,188.43iii 5/: C i 08/14/2003 iOrrstown Bank, Certificate of Deposit4000001896 :: :::: 1,202.97 ili 100:: i::i 1,202.97 iii 6.1 D ! ::01/23/1997:: iWaypointBank, Certificate of Deposit1761305455 :: :::i 8,376.85 ::i::50:: ii:: 4,188.43 i! 7.i ; D i i08/13/2003:: iWaypointBank, Certificate of Deposit 9600016275 !:: 13,946.117:i 100:: ii:: 13,946.11 i 8.i E i 12/07/1994 ::Orrstown Bank, Certificate of Deposit 60050376 ::::: 503.23 :?: 50:: i::i 251.62 : .......... . .................... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::: ...... i.:.:.:.:.:.:.:+:,:.:.:.:.:.:.:.:.:,:,:.:.:.:.:.:.:.:.:.:. TOTAL (Also enter on line 6, Recapitulation)$ :::::: 38 887.30 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER PAULINE V. LEBO SCHEDULE F CONTINUED 21-03-0825 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT 'T'.' I-e'5~ ....................................................... Oakland, CA 94609 'i~Brother 111 McClures Gap Road Carlisle, PA 17013 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATI'ACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. .................... : i iliiii ..........................................................................: i .............................................................. ......... '.'"'.. '. ....' ' ".... '.. ::::::::::::::: ::::::: ::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .'.'.'.'.'.'.'.'-'.'".' i~i[~J iiiiiiiii~ii~ i~[ ........ i'"-'" ..........: ..................................................................................... ~ ................................. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::.v:.v.=.'.v:. i,i.~.~.i.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~.~. TOTAL (Also enter on line 6, Recapitulation)$}i: ............................................................................................ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 Debts of decedent must be reported on Schedule I. DESCRIPTION ITEM NUMBER 1. iHoffrnan Roth Funeral Home, funeral expenses 2.:: ::Hoffman Roth Funeral Home, Death Certificates 3.1 i Roy Lebo reimburse for Intemment Fee at Westminster Cemetery AMOUNT ============================================================================================= 6,396.50 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ============================================================================================= 20.00 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 945.00 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ADMINISTRATIVE COSTS: Personal Representative's Commissions ii}i ......................................... Name of Psrsona Repre n at ve(s) ........................ Serial Secufi~ Number(s)/EIN Number of Pemonal Repmsonta~ve(s) Street Address ~One West High Street Year(s) Commission ~aid: ~:: ....................................................................................................................................... Family ~emp~on: (If decedent's address is not *e same as claimants, at.ch explana~o,) Claimant S~et Address Ci~ :. ........... ~ S~te ~ .............. ~. ~p ~ Relationship of Claimant to Decedent Acmuntant's Fees } ~:.~ ~ ::::?: .......................................................................................... .......................................................................................................................................................................................... ...................................................... :: Re~ist~r of Wills, [~ors lestamenta~ ..... ~Cumbedand Law Journal, Advedising Le~em Testamenta~ ~ I ~? 75.00 ~The Sentinel, Adve~sing Le~em Tes~menta~ ::~ ~::~ 225.00 ::S W. Barrett Real Estate, appraisal fee ! ........ ............... : ........... .. ........ .... ................... ........................... . ............................... .........:. ................................................ ....... ::Closing and Filing Costs TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-'[5t2 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER PAULINE V. LEBO 21-03-0825 ITEM NUMBER 12. 14. 47. 20. 22. 23. Re )crt debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE DESCRIPTION OF DEATH iERA-NRT, Inc., realtor's commission sale of 243 Allen Road, Carlisle, PA property ::Coldwell Banker, realtor's commission sale of 243 Allen Road, Carlisle, PA property !iNotary fees, Allen Road property settlement iiil !.0.'.0.0 ..... 11% Real Estate Transfer Tax, 243 Allen Road, Carlisle, PA property AHS Home Warranty for 243 Allen Road, Carlisle, PA property 465.00 iBomugh of Carlisle, final sewer bill 15.08 :::~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~iii iB-H Agency GMAC Real Estate, realtor's commission sale of 2/3 Interest 111 McClures Gap Road, 33,333.33 1% Real Estate Transfer Tax, 111 McClures Gap Road, Carlisle, PA property 6,666.67 Shana Gilbert, lawn care Allen Road, Carlisle, PA property 60.00 :..............................-...-........-..-......-...........................-...............-..-..-.................. ....... -.... .. ......'....'.' ....... .'.-...'..'...'...'..'.....-.--...-..: I PPL, service Allen Road, Carlisle, PA property iBorough of Carlisle, water and sewer service Allen Road, Carlisle, PA properly Hilton's Lock Service, change locks at Allen Road, Carlisle, PA property Verl Williams, trash removal 425.00 ::Robin k. Sollenberger, Tax Collector, copies of tax receipts for McClures Gap Road property 2.00 iShevlin's Maintenance Service, Inc., cleaning 243 Allen Road, Carlisle, PA property 95.40 iSmith's Appliance & Electronic Center, appliances as per Sales Contract for Allen Road prope~ 571.34 Central Penn Medical Group, medical expense 38.90 iShipley Energy Co., fuel oil for Allen Road, Carlisle, PA property iMarsh Advantage America, liability insurance premium 243 Allen Road, Carlisle, PA property ?~ 13.00 i Marsh Advantage America, liability insurance premium 111 McClures Gap Road, Carlisle, PA property ~ 13.00 ::M&T Bank, check 2941 presented for payment after DOD on Chk. Acct. 2670024013 ~ 275.00 ::Andorra Radiology Assoc., PC, medical expense iiii 6.94 iil iSmith, Elliott, Keams & Co., 2003 tax preparation fee ........................ TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) EEV-1513 EX+ (9-90) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF PAULINE V. LEBO FILE NUMBER 21-03-0825 NUMBER I RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal disl~ibutions, and transfers under Patricia M. Gildner, 16 McNaughton Drive, Duncannon, PA 17020 i' !::Niece Shidey A. Lebo, 111 McClures Gap Roari, Carlisle, PA 17013 "ii"iiNiece iSusan M. Lancia, 6020 Dubai Place, Dulles, VA 20189 ii' !!Niece ................................................................................................................................ ~ I ? ............. '. .......... .:.:.:.:.:.:.:.:.:.:~:.:.:.:.:.:.:.:.:.:.~.:.:.:.:.:.~.:.:.:.:.:.:.:.:.~.:.:.~.:.:.:.:.:.:.:.:.: ~..................................................`...........................................................................................................................~...........................................................................................~ I ~'. ........... '". ......... . ....................... .'' ~:.~:.~:.~:~:.~:.~:~:.~:.~:.~:.~:.~:.~ :.~:.~:. ~:~:.~:.~.~.~:.:.~:.~:.~:.~.~:.~:.~:.~:.~:.~.~:.~:.~:.~:.~.~:.~:.~:~ ...........................................................................................................................................................................................................................................................................:. ~..' .............. fi~ DOk~R~OU~IS FOR DIS~IBUTIOR8 SHOW~ ~BOVE O~ II,ES ~5 IHROHGH ~8, AS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERN MENTAL DISTRIBUTIONS iSalvation Army, 20 East Pomfi'et Street, Carlisle, PA 17013 !i! 108,462.66 American Red Cross, 1710 Ritner Highway, Carlisle, PA 17013 ~! 108 462 66 ii American Cancer Society, P.O. Box 897, Hershey, PA 17033-0897 108,462.66 !ii YMCA, 311 South West Street, Carlisle, PA 17013 108,462.67 iYWCA, 301 G Street, Carlisle, PA 17013 ~ii 108,462.67 :i: ................................................. :~: TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $iil 867,701.30 (If more space is needed, insert additional sheets of the same size) REV-'I513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER PAULINE V. LEBO SCHEDULE J CONTINUED 21-03-0825 NUMBER I RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ............................................ .S.e.c.~.~.!~.i.a.).Q.~)] ................ : ............................................................................................ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FORWHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i/~nedcan Diabetes Assn., 1701 N. Beauregard St., Alexandria, VA 22311 ::B y Graham Evangelist Assn., P.O. Box 1270, Charlotte, NC 28201 First Lutheran Church, 21 South Bed[ord St., Carlisle, PA 17013 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) 108,462.66 108 462.66 iii ............................................. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004053 MANUFACTURERS & TRADERS TR CO ONE WEST HIGH STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 192-34-6102 FILE NUMBER: 21 03-0825 DECEDENT NAME: LEBO PAULINE V DATE OF PAYMENT: 06/1 6/2004 POSTMARK DATE: 06/1 6/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $920.28 TOTAL AMOUNT PAID: $920.28 REMARKS: SEAL CHECK# 200184087 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jane F. Burke, Vice President Manufacturers and Traders Trust Company being duly sworn according fo law, deposes and says'that' he Executor" of the Estate of Pauline V. Lebo late of North Middleton Township ., Cumberland County, Pa., deceased and that the within is an inventory.made bY Manufacturerm mhd ?rmdmrs Trl~LCnmp~ny , the said of the enflre estate of sa~d decedent, cons~sflng of all +he personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, *and that the figures opposite each item of the InventOry represent it's fair value as of the date of decedenf's death. Sworn and subscribed before me. i'l ' ' I 29th Sep~embe= Date o{ Death J~ne F. Burke;cuf°r' Ac~m;nisfrafor Vice President Manufacturers and Traders Trust Company One W~.~ Righ R~r~ Carlisle, PA 17013 Address 2003 Day Month Year INSTRUCTIONS I; An inventory must be filed within three months after appointment of personal repres~-~'fetlve. 2. A supplement inventory must be filed within thlrfy days of discovery of additional assets. 3. Additional sheets may be affached as to personalty or realty 4. Se6 Article IV, Fiduciaries Act of 1949. O z Inventory of the real and personal estate of PAULINE V. LEBO deceased House and Lot, 243 Allen Road, Carlisle, PA 2/3 Interest in 53.03 acres Vacant Land, McClums Gap Road, Carlisle, PA 32 shs. Prudential Financial, Inc. 7680.394 shs. Delaware Group Delchester A #24 621.504 shs. VanKampen US Government Fund A ~40 $2,200 par U.S. Series EE Bonds $50 par U.S. Series E Bond M&T Bank Checking Acct. 2670024013 M&T Bank M&T Bank M&T Bank. M&T Bank M&T Bank M&T Bank M&T Bank M&T Bank M&T Bank M&T Bank Wachovia Wachovia Wachovia Wachovia Wachovia Wachovia Waypoint Bank, Waypoint Bank, Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Wayp0int Bank . Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Orrstown Bank Orrstown Bank Certificate of Deposit Certificate of Deposit Certificate of Deposit Certificate of Deposit Certificate of Deposit Certificate of Deposit Certificate of Deposit Certificate of Deposit 31003910554524 31003910628858 31003910685527 31003910747046 31003910829290 31003914492746 31003914498645 31003914529846 Certificate of Deposit 31003914589410 Savings Account 15004198250571 Certificate of Deposit 247412041106150 Certificate of Deposit 247412050860000 Certificate of Deposit 247412051168497 Certificate of 'Deposit 247412051270042 Checking Acct. 1010049591190 Checking Acct. 1010049591200 Certificate of Deposit 1700004782 Certificate of Deposit 170004670 Certificate of Deposit 1755302658 Certificate of Deposit 1755305449 Certificate of Deposit 1755314726 Certificate Certificate Certificate Certificate Certificate Certificate of Deposit 1756286631 of Deposit 1758321313 of Deposit 1760254991 of Deposit 7000003811 of Deposit 7000004697 of Deposit 8000036093 Certificate of Deposit 80003863 Checking Acct. 1703011206 Certificate of Deposit 60055071 Certificate of Deposit 5060057397 170, 76,000.00 366,666.67 !,205.76 23,655.61 8,831.57 1,688.72 247.96 14,224.20 2,985.55 2,191.44 6,005.27 1,835.72 15,012.20 8,001.18 2,816.93 4,926.11 3,032.08 10,641.83 8,570.54'~ 9,072.10 13,009.11 30,949.22 3,159.53 1.00 21,875.09 13,027.52 1,486.33 4,503.76 3,502.73 4,040.42 1,193.97 928.76 4,374~39. 6,865.91 3,002.96 10,801.58 32,569.91 1,306,21 3,533.96 027,743;80 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004072 LEBO SHIRLEY A 111 MCCLURES GAP ROAD CARLISLE, PA 17013 ........ fold i ESTATE INFORMATION: SSN: 192-34-6102 FILE NUMBER: 2103-0825 DECEDENT NAME: LEBO PAULINE V DATE OF PAYMENT: 06/22/2004 POSTMARK DATE: 06/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04105344 $628.26 REMARKS: SHIRLEY A LEBO TOTAL AMOUNT PAID: $628.26 SEAL CHECK# 1196 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CONNONNEALTH OF PENNSYLVAN/A DEPARTNENT OF REVENUE BUREAU OF /ND/V/DUAL TAXES DEPT. Z80601 HARR/SBURG, PA 17128-0601 REV-16~iS EX AFP SHIRLEY A LEBO 111HCCLURES GAP RD CARLISLE PA 17q~5 ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 03-0825 ACN 04105544 DATE 02-16-2004 EST. OF PAULINE V LEBO S.S. NO. 192-$4-6102 DATE OF DEATH 09-29-2005 ,~,.~ :~6 COUNTY CUNBERLAND TYPE OF ACCOUNT ~-~SAVINGS []CHECKING --]TRUST ~-~CERTIF. REH/T PAYHENT AND FORHS TO: REGISTER OF WILLS' CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701S NAYPOZNT BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decadent, you wars a joint owner/beneficiary of this account. If you faa1 this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Punnsylvania. guastiuns may be answered by calling £717) 7aT-ESZ7. CONPLETE PART I DELOW # K K SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 1761505454 Date 01-25-1997 Established Account Balance 8,$76.85 Percent Taxable X 50.000 Aeount Subject to Tax 4,188.43 Tax Ra~e X .15 Potential Tax Due 628.Z6 To insure proper credit to your account, tho (Z) copies of this notice oust accoapany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made w~thin three (3) months of the dacadant's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due will bacoaa delinquent nine (9) aonths after the date of death. PART TAXPAYER RESPONSE A. r~ The above information and tax due is correct· · You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box 'A" and return this notice to the Register of CHECK ~ NitIs and an official assessment will ba issued by the PA Department of Revenue. ONE BLOCK B. [] The above asset has been or will be reported and tax paid ~ith the Pennsylvania /nharitanca Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/ar debts and deductions were paid by you. You must complete PART [] and/or PART F~-'lbelow. PART zf you indicate a different tax rate, please state your relationship to decedent: TAX RETURN - COHPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS L/NE 1. Date Established I 2. Account Balance 2. $. Percent Taxable $ ~ q. Amount Subject to Tax ~ 5. Debts and Deductions $. - 6. Aeount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DAlE PAID DF.~TS AND DEDUCTIONS CLAINED PAYEE DESCRIPTION ANOUNT PAID TOTAL (Enter on L/ne $ of Tax Coaputation) $ Under penalties of perjury, Z declare that the facts Z have reported above are true, correct end complete to the best of my kno.ledge and bellef. HOHE ( ~/7 ) 2 Z/?o~O 0 TAXPAYER S~.~NATURE TELEPHONE NUNBER DATE ' 6ENERAL INFORHATION 1. FA/LURE TO RESPOND #ILL RESULT IN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedant's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife aero than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTTNG 1'NSTRUCTTONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions ara not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Nills of the county indicated. Tho PA Department of Revenue will issue an official assessment (Form REV-154B EX) upon receipt of the return from the Register of Nills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dacedant's representative, place an "X" in block "D" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZOO601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts g and $ according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1S4B EX) upon receipt of the return from the Register of #ills. TAX RETURN - PART Z - TAX COHPUTATION LINE 1. Enter the date the account originally ems established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts ehich the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (wx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as folloes: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHDER DF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT O#NERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadant's death or accounts oened by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. ! DIVIDED BY 2 (SURVIVORS) = .SO X 100 = SOX (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. De~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~o 12/31/9q 3Z 6Z 01/01/95 to 06/50/00 OX 6Z 07/01/00 ~o presen~ OX q.$Z~ 12Z NTha tax rate imposed on the nat value of transfers from a deceased child t~enty-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 OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children mbether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendants, whether ornot they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes all other beneficiaries. CLATMED DEDUCTTONS - PART $ - DEBTS AND DEDUCTIONS CLATMED Allowable debts and deductions ara determined as follows: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufflciant to pay the deductible items, B. You actually paid the debts after death of the decedent and can furnish proof of payment, C. Debts being claimed must ba itemized fully in Part 5. If additional space is needed, usa plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. i CONNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB06OZ HARRISBURG, PA 17128-0601 REV-Z;iiS EX AFP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. Z1 05-0825 ACN 0q105171 DATE 02-06-200q SHIRLEY A LEBO 111 MCCLURES GAP RD CARLISLE PA 17015 EST. OF PAULINE A LEBO S.S. NO. 19Z-$~-6102 DATE OF DEATH 09-Z9-ZO05 TYPE OF ACCOUNT []SAVINGS [] CHECKTNG [] TRUST CUMBERLAND [] CERTZF. REHTT PAYHENT AND FORHS TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 ORRSTONN BANK has provided the Department Nith the information listed beloa ahich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you care a joint emmet/beneficiary of this account. If you feel this information is incorrect, please obtain mritten correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance mith the Inheritance Tax Lams of the Cosmonmealth of Pennsylvania. Questions may be ansmered by calling [717} 787-8~27. COMPLETE PART 1 BELON ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. ~000001896 Date 08-1~-2005 Established Account Balance .00 Percent Taxable X lO0.O0 Amount Sub~ect to Tax .00 Tax Rate X Potential Tax Due .00 To insure proper credit to your account, tmo (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made mithin three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due mill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. 1~ Tho above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills mith tmo copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of ~ ONE ~ Hills and an official assessment .ill be issued by the PA Dapartaent of Revenue. BLOCK s. [] The above asset has been or mill be reported and tax paid mJth the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. ~ The above information is incorrect and/or debts and deductions mere paid by you. You must complete PART [] and/or PART [] beloa. PART zf you /nd/cate a different tax rate, please state your ralate-onship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS L/NE 1. Data Established I 2o $ $ 6 7 8 Account Balance ~ Percent Taxable ~ ~ Amount SubSact to Tax q. Debts and Deductions ~ Amount Taxable ~ Tax Rate 7 ~ Tax Due ~ PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of par.~ury, T declare that the facts T have reported above ara true, correct and co.plate to the bast of m~ kno.ledge and belief. HOME ( 7/7 ) ,,~/~-27O0 TAXPAYER S~J3NATURE ~ TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FA/LURE TO RESPOND N/LL RESULT IN AN OFF/CIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. ~. Accounts (including those held between husband and mite) ~hich the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and ~ife more than Dna year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART I TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit thee aith your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue mill issue an official assessment (Fora REV-15q8 EX) upon receipt of the return free the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept 280601, Harrisburg, PA 171Z8-060! in the enveZope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts according to the instructions below. Sign two copies and submit thaa with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lSd8 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z TAX COMPUTATION LTNE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/1Z/BZ: Accounts which the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (mx) appears before your first name in tho address portion of this notice, the $3,000 exclusion already has been deducted free the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable ~or joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 : PERCENT TAXABLE JOINT OWNERS SURVTVTNG JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DTVIDED BY 3 (JOTNT OWNERS) DTVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACW SURVIVOR) B.The percent taxable for assets created within one year of the decadent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JDTNT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established ~ithin one year of death by the decedent. ] DIVIDED BY Z (SURVIVORS) = .SO X 10g = 5OZ (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (1ina 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line q). 7. Enter the appropriate tax rata (line 7) as determined below. De~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~o 12/$1/9q 5X 6X 15X 15Z 01/01/95 ~o 06/30/00 OX 6Z 15Z 15Z 07/01/00 ~o presen~ OX q.SZ~ 12Z 15Z xTha tax rate imposed on the net value of transfers from a dec. ;y years younger at death to or ~or the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, childran, and lineal descendents. "Children" includes natural children mhethar or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendants, whether or not they have been adopted by others, adopted descendents and their descendants and stap-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper B l/Z" x n". Proof of payment may be requested by the PA Department of Revenue. BUREAU OF TND'rV/DUAL TAXES TNHERTTANCE TAX DIVTSZDN DEPT. Z80601 HARRISBURG, PA 17128-0601 SHIRLEY A LEBO 111HCCLURES GAP RD CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLONANCE OR DISALLO#ANCB OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-Z6-ZO0~ ESTATE OF LED0 DATE OF DEATH 09-29-2005 FILE NUMBER Z1 05-0825 COUNTY CUMBERLAND SSN/DC 19Z-$~-6102 ACN 0~1055~ Amoun~ Rem/~ed PAULINE V MAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-26-200~ ESTATE OF LEBO PAULINE V DATE OF DEATH 09-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0825 S.S/D.C. NO. 19Z-$~-6102 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION 0~1055~R FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 1761505~5~ TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TINE CERTIFICATE 01-25-1997 Accoun~ Balance 8,576.85 Percen~ Taxable X 0.500 Amoun~ Subjec~ ~o Tax ~,188.~$ Debts and Deductions - .00 Taxable Amoun~ ~,188.~5 Tax Ra~e X .15 Tax Due 628.26 TAX CREDTTS: NOTE: TO ~URE ~0PE~DIT TO YO~'~CCOU~T, S~T THE UPI~.~,R:iiPOR~N OF~!iT~IS NOTICE WI_~ iYouR ~'AX P~.NT TO THE RE~STER ~HILLS AT THE AB~E:'ADDEESS. ,,,~;~k E CHECK OR~O~EY ~ER P~:~BLE TO: "R~TER ~ NIL~ AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 08-05-ZOOq AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REi)UZRED. TF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 628.26 Z.~2 650.68 PURPOSE OF NOTICE= PAYMENT: REFUND [CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section glqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TZ P.S. Section 91q0). Detach tho top portion of this Notice and submit Nith your payment to the Register of Nills printed on tho reverse side. -- Make check er money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, Nhich was not requested on the tax return, amy be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Mills, any of the 23 Revenue District Offices or by calling the special gq-hour answering service for fores ordering: 1-800-56g-gOSO; services for taxpayers with special hearing and or speaking needs: 1-800-q47-30ZO iTT only). Any party in interest not satisfied with tho appraisement, allowance, or disallowance cf deductions or assessment of tax [including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 17128-lOZ1, OR --electing to have the matter determined at the audit of the account of the personal representativej OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. gE0601, Harrisburg, PA 171Z8-0601 Phone [717) 787-6505. See page 5 of tho 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 (3) 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 and of tho 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 is charged beginning with first day of delinquency, or nine (9) months and one [1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at tho rate of six (6g) percent per annum calcuIated at a daily rate of .OO016q. Ali taxes ~hich became delinquent on or after January l, 1982 will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by tho PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor X98Z ZOZ .OOOSq8 198-~8-1991 llZ .000501 ZO0~ 9Z .OOOZq7 1985 16Z .000458 199Z 9Z .O00Zq7 200Z 6Z .000Z19 198q 112 .000501 1995-199q 72 .O0019Z ZOO3 5Z .000157 1985 152 .000356 1995-1998 92 .000247 ZOOq qZ .000110 1986 10Z .O0027~ 1999 7Z .OOOlgZ 1987 9Z .OOOZq7 ZOOO 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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 ba calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX RE¥-1547 EX AFP DATE 08-09-200q ESTATE OF LEtO DATE OF DEATH 09-Z9-2003 FILE NUNBER 21 03-0825 COUNTY CUHBERLAND H 8 T TRUST CO ACH 101 C/O JANE F BURKE ] Aeount RaeAtted PO BOX Z20 CARLISLE PA 17013 PAULINE V HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I7013 CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV'1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRA/SENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF LEBO PAULINE V FILE NO. Z1 03-0825 ACN 101 DATE 08-09-ZOOq TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) 3. Closely Meld Stock/Partnership Interest (Schedule C) (3) q. Nortgages/Notes Receivable (Schedule D) (q) E. Cash/Bank Deposi~s/N/sc. Personal Property (Schedule E) (5) 6. Jo/ntly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Nisc. Expanses (Schedule H) (9) 10. Dabts/Nortgage Liab/1/ties/Lians (Schedule Z) (10) 11. Total Daduct/ons 12. Net Value of Tox Return 7~2~666.67 35~83~.08 .00 .00 Z57~Z73.36 38~887.30 .00 (8) NOTE: To /nsure proper credit to your account, submit the upper port/on of this fore with your tax payeent. 1,07q,661.ql 69,682.97 q8~389.8q (11) ]18.072.81 (12) 956,588.60 13. NOTE: Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 867,701 Net Value of Ese:ate Subject to Tax (lq) 88,887.30 If an assess, ent was lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of L/ne lq et Spousal rate 16. Amount of Line lq taxable at Lineal/Class A rata 17. Aaount of Line lq at Sibling rate 18. Amount of L/ne lq ~axable at Collateral/Class B rata DISCOUNT (+) INTEREST/PEN PAID (-) 605.26 .00 (15) .00 X O0 = (16) .00 x Oq5= (17) 10,251,'~X (18) 78,635~6~ x 1 ~' ~ ~19)= AMOUNT P/~D :' 11 ,~'00. O0 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. I TOTAL DUE 19. Pr/ncipal Tax Due TAX CREDITS: PAYNENT RECEIPT DATE NUNBER 12-Z3-ZO03 CD003371 06-16-200~ .00 .00 __1,230.19 ~,~ 025.5q 13,025.5~.00.00.00 { IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE{UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. PAYMENT: Oatach the top portion of this Notice and submit with your payment made payable to the name and address printed an the reverse side. -- Make check or money order payable to: REGTSTER OF NTLLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-I:SI$). Applications ars available at tho Office of the Register of Mills, any of the Z:5 Revenue District Offices or from the Department's Iq-hour answering service for fores ordering: 1-800-:56Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-BOO-~47-:50ZO (TT REPLY TO: Questions regarding errors contained on thls notice should be addressed to: PA Department of Revenue) Bureau of Individual Taxes) ATTN: Post Assessment Revise Unit, Dept. Z80601, Harrisburg, PA 171Z&-0601, Phone (717) 7B7-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death) a five percent (5Z) discount of the tax paid is allowed. PENALTY: 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. INTEREST: Interest is charged beginning aith first day of delinquency or nine {9) months and one (1) day fram the date of death to the date of payment. Taxes which became delinquent before January l, lgBz bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z wlll bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO:5 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Yea__r Rate Factor Year Rate Factor 1982 ZOZ .000548 1987 92 .000247 1999 7Z .000192 198:5 16Z .0004:5B 1988-1991 112 .O00$Ol ZOO0 8X .O00Zl9 1984 llZ .000301 1992 9Z . O00Z~7 ZOO1 9Z .000Z47 1985 l:sZ .000356 1993-1994 72 .000192 ZOOZ 6Z .000164 1986 102 .000274 1995-1998 9Z .000247 :~003 5Z .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNQUENT X DAXLY XNTEREST 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 bo calculated. ~EV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 ~)ECEDEN~S NAME FILE NUMBER Lebo, Pauline V 21 03-0825 REVIEWED BY ACN Steven James 04105344 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The above referenced ACN has been adjusted to $0 as it was reported and paid on the probate return. A request to refund the overpayment has been submitted, ROW Pa.cle 1 BUREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DTVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 SHIRLEY A LEBO 111MCCLURES GAP RD CARLISLE PA 17013 COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT DATE 07-26-200q ESTATE OF LEBO DATE OF DEATH 09-29-2003 FILE NUMBER 21 03-0825 COUNTY CUMBERLAND ACN 0q1053~ Amoun'l: Reei ~:'l:ed REV-I&O7 EX AFP (01-05) PAULINE V MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA i7013 NOTE: To insure proper credit: ~:o your account, submi~ ~he upper portion of ~his form wt~:h your ~:ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~.~ REV-1607 EX AFP (01-03) xax INHERITANCE TAX STATEMENT OF ACCOUNT ax~ ESTATE OF LEBO PAULINE V FILE ND. Z1 03-0825 ACN OqlO53qq DATE 07-Z6-ZOOq THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELOtf 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: 07-26-ZOOq PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREOITS): 628.26 PAYMENT RECEIPT DISCOUNT C+) AMOUNT ~-B DATE NUMBER INTEREST/PEN PAID (-) = ~'~; 06-ZZ-ZO0~ CDOOq072 .00 6~.26 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDZT 628.26 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) BUREAU OF 'rNDZVZDUAL TAXES TNHERTTANCE TAX DTVZSION DEPT. Z80601 HARRISBURG, PA 17128-0601 PATRICZA L GZLDNER 16 MCNAUGHTON DR DUNCANNON CONNONHEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE '04 ~UG 17 P1:04 NOTXCE OF XNHERXTANCE TAX APPRAXSEHENT, ALLOHANCE OR DXSALLONANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOXNTL¥ HELD OR TRUST ASSETS ' ?// DATE 08-16-200~ ,i~ ESTATE OF LEBO PAULINE V DATE OF DEATH 09-29-2005 FILE NUMBER 21 05-0825 COUNTY CUMBERLAND SSN/DC 19Z-$~-6102 ACN 0~1055~3 Amoun~ RemL*~ed MAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 REV-1;4$ EX AFP CUT ALONG THIS LINE RETAIN LO#ER PORTION FOR YOUR RECORDS REV-IS48 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-16-200~ ESTATE OF LEBO PAULINE V DATE OF DEATH 09-29-2003 COUNTY CUMBERLAND FILE NO. 21 03-0825 S.S/D.C. NO. 192-3~-6102 ACN 0~1053~3 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET XNFORNATXON FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 1761305~53 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 01-23-1997 Account Balance .00 Percent TaxabZe X 0.500 Amount Subject to Tax .00 Debts and Deductions - .00 Taxable Amount .00 Tax Rate X .15 Tax Due .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 03-Z7-200~ CD003735 .00 628.26 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE TF PAID AFTER THTS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR TNSTRUCTZONS. ) 628.Z6CR .00 628.Z6CR PURPOSE OF NOTICE: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TZ P.S. Section 91~0). PAYMENT: Detach the top part[on of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. REFUND (CR): A refund of a tax cred[t, which was not requested on the tax return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-131$). Applications are available at the Off[ce of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Iq-hour answering service for forms ordering: 1-BOO-36Z-ZO50; services for taxpayers with special hearing and or speaking needs: 1-800-qqT-30ZO (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2BI02l, Harrisburg, PA lT1gB-lOZl, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. lB0601, Harrisburg, PA IT1ZB-0601 Phone (7[7) 787-6505. See page 5 of the book[et "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is pald within three (3) calendar months after the decedent's death, a five percent discount of the tax paid is allowed. The 15g 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 tiaa period as you would appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one ([) day from the date of death, to the date of payment. Taxes ahich became delinquent before January l, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of All taxes which became delinquent on or after January l, 198Z vii! 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 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 lOX .O005qB 198"~&-1991 Ill .000301 2001 92 .000247 1983 16Z .00043B 1992 9Z .000Z47 200Z 6Z .O00Z19 19Bq XXZ .000301 X993-X99q 72 .000192 2003 Sg .000137 1965 13Z .000356 1995-1996 9Z .000Z47 ZOO4 ~2 .000110 1986 lOX .000274 1999 72 .O0019Z 1987 92 .000247 2000 8Z .O00Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTVZSTON HARRISBURG, PA 17128-0601 SHIRLEY A LEBO 111MCCLURES GAP RD CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUNTY SSN/DC ACN 09-15-200q LEBO 09-29-2005 21 05-0825 CUMBERLAND 192-3q-6102 0~1053~ Amoun'l: Remi~ed REV-lGOgl EX &FP (01-0,5) PAULINE V MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~* RETA'rN LOWER PORTION FOR YOUR RECORDS *~ REV-1604 EX AFP (01-03) ## INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE 09-15-Z00q ESTATE OF LEBO PAULINE V DATE OF DEATH 09-29-2003 COUNTY CUMBERLAND FILE NO. 21 03-0825 S.S/D.C. NO. 192-3q-6102 ACN OqlO5$qq ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORMAT/ON FINANCIAL INSTTTUTION: WAYPOINT BANK ACCOUNT NO. 1761305q5q TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING DATE ESTABLISHED 01-23-1997 Account Balance Percent Taxable X. Amount Subject to Tax Debts and DeductAons - Taxable Amount Tax Rate X, Tax Due ( ) TRUST .00 NOTE: 0.500 .00 .00 .00 .15 .00 (X) TIME cL~FZC/i~T~E ,: ~ ' TO ZNSUREPROPER-~EDZT TO YOUR ACCOUNT, SU~MZT '1~ UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE R~STER:OF WILLS AT THE AD.ESS SI'~/N AB'0'VE. MAKE CHECK' oR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) 06-22-200q CDOOq072 .00 628.26 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 628.26 6Z8.Z6CR .00 628.26CR ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on er 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 B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed an the reverse side. --Hake check or money order payable to: REGISTER OF NILLS, 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 Inheritance and Estate Tax" (REV-ISiS). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with speclal heatlog and / or speaking needs: 1-800-447-~020 (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 oust object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-lOZ1, 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 writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. 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 (3) 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 flrst 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 mould appeal the tax and interest that has been assessed as indicated on this notice. Interest ls 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, I98Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after January 1, 1982 mill bear interest at a rata which mill 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 Dally Interest Dally Year Rate Factor Year Rate Factor ~ 20Z .000548 '1"~'/~-1991 IIX .000301 1983 16Z .000458 1992 92 .000247 1984 llZ .000301 1993-1994 7Z .O0019Z 1985 132 .000356 1995-1998 9Z .000247 1986 IOZ .000Z74 1999 72 .O0019E 1987 102 .O0027~ ZOO0 72 .O0019E --Interest is calculated as follows: INTEREST = BALANCE OF Interest Dally Year Rate Factor ~ 9Z .000247 200Z 62 .000164 ZOO5 52 .000157 Z00~ 42 .000110 TAX UNPAID X NUHBER OF DAYS DELTNI;~UENT 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVTSION P.O. Box Z80601 HARRISBURg, PA 171Z8-0601 H & T TRUST CO C/O JANE F BURKE PO BOX Z20 CARLISLE PA 17015 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FZLE NUNBER COUNTY ACN 11-08-200q LEBO 09-Z9-Z005 Z1 05-0825 CUHBERLAND 202 Amoun/c Remi'l"ied I REV-73& EX AFP C09-O~) PAULINE V HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, subm/~ ~he upper portion of ~:his for. wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV-736 EX AFP (01-02) #x NOTICE OF BETERNZNATZON AND ASSESSNENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .x ESTATE OF LEBO PAULINE V FILE N0.21 05-0825 ACN 202 DATE 11-08-ZOOq ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verified .00 Z. PennsyZvania Inheritance Tax Assessed (ExcZuding D/scount and/or Interest) 1Z,~20.Z8 .00 Inher/tance Tax Assessed by Other States or Terr/tor/es of the Un/ted States (Exclud/ng D/scount and/or Interest) q. Total Inher/tance Tax Assessed 12~fi20.28 5. Pennsylvan/a Estate Tax Due .00 .00 .00 6. Amount of Pennsylvan/a Estate Tax Prev/ously Assessed Based on Federal Estate Tax Return 7. Add/t/Dna1 Pennsylvan/a Estate Tax Due TAX CREDITS: PAYMENT DATE r"RECEIPT ~NUMBERi ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE (IF TOTAL DUE ZS LESS THAN SI, NO PAYNENT ZS REI~UZRED ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .00 .00 .00 .00 PURPOSE OF HOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act) Act Z$ of ZOO0. (7Z P.S, OBJECTIONS: Section 9140)o PAYHENT: Detach the top portion of this Notice and submit eith your payment to the Register of Hi116 printed on the reverse slde. -- Hake check or money order payable to: REGXSTER OF NXLLS, AGENT. REFUND (CR): A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and and Estate Tax" (REV-IS13). Applications are available online et ,~,.revenue.~tate.on-us. any Register of Hills or Revenue District Office, or from the Department's Z4-hour ansmering service for forms orders: 1-800-362-Z050; services for taxpayers aith special hearing and/or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied aith the appraisment, allowance or disalloaance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object eithin 60 days of tho date of receipt of this notice by filing one of the follo~ing: A) Protest to the PA Department of Revenue, Doard of Appeals. You may object by filing a protest online at ~e.boardofeppaals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to ba valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a eritten protest to PA Department of Revenua~ Board of Appeals P.O. Box Z&lOZl, Harrisburg, PA 171Z8-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. ADH/N- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Asses~ent Revie~ Unit, P.O. Box ZB0601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. The 1Si tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 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 ties period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase in Federal Estate Tax is received. Taxes ~hich became delinquent before January 1, 1982 beer interest at the rate of six (Bi) percent per annum calculated at a daily rate of .000164 All taxes ehich became delinquent on or after January 1, 1982 mill bear interest at a rate which will vary from calendar year to calendar year Nith that rate announced by the PA Department of Revenue. The applicable interest rates for 19Bi through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 196Z ZOZ .000548 1988-1991 llZ .000301 ZOO1 9Z .000247 1963 16X .000438 1992 1984 112 .000301 1993-1994 7Z .00019Z 2003 5Z .000137 1985 13X .000356 1995-1998 9Z .000247 ZOO4 4X .000110 1986 IOZ .000274 1999 72 .O0019Z 1967 9Z .000Z47 --Interest is calculated as folloas: :INTEREST = BALANCE OF TAX UNPAI'D X NUI~BER OF DAYS DELTNQUENT X DA/LY i[NTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest eust be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DZYZSTON DEPT. Z80601 HARRXSBURG, PA 171Z8-0601 SHIRLEY A LEBO 111 HCCLURES GAP RD CARLISLE COHNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRATSEHENT. ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 0?-?6-?004 ESTATE OP LEB0 DATE OF DEATH 09-Z9-ZO05 PILE NUHBER 21 05-0825 COUNTY CUMBERLAND SSN/DC 192-5q-6102 ACN 04105171 Amoun~ Rem/~ed PA 17015 RE¥-1548 EX AFP COl-OS) PAULINE HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS 4 REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-26-2004 ESTATE OF LEBO PAULINE V DATE OF DEATH 09-29-2005 COUNTY CUHBERLAND FILE NO. 21 05-0825 S.S/D.C. NO. 192-54-6102 ACN 04105171 TAX RETURN WAS: ex) ACCEPTED AS FILED ¢ ) CHANGED JOINT OR TRUST ASSET INFORHATION FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 4000001896 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ( ) CHECKING ( ) TRUST C~ TIME CERTIFICATE 08-14-2005 Account Balance .00 Percent Taxable X 1.000 Amount Subject to Tax .00 Debts and Deductions - .00 Taxable Amount .00 Tax Rate X .15 Tax Due .00 TAX CREDITS: PAYHENT RECEIPT DISCOUNT C+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) NOTE: TO ~RE [~OPER~I~DIT TO YOU~'-~'CCOUI~', SUng THE UPP~R!iliiPORT~,~gN OF~S NOTICE N[T~'~OUR ~'~X PA~T TO THE RE~:rS~ER O~NILLS~ THE ABO~E:,~ADDRESS. HAKE CHECK TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS RE~UIREDo IF TOTAL DUE IS REFLECTED AS A "CRED/T" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCT/OHS. .00 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): 'OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of lOgO. (?Z P.S. Section 91fiD). Detach the top port[on of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was nat requested an the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Apptications are available at the Office of the Register of Nills, any of the g$ Revenue District Offices or by calling the special Zq-hour answering service far forms ordering: 1-800-$6Z-ZO50; services for taxpayers with special hearing and or speaking needs: 1-800-qq7-$020 (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 amy object within sixty (60} days of receipt of this Not[ca by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, DEPT. lBO601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. Sas 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 (3) calendar months after the dacedent's death, a five percent discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa 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, 198Z bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .00016q. Ali taxes which became delinquent on or after January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Dapartaantaf Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest DaLly Year Rate Factor Year Rate Factor Year Rate Factor 198""~ lOX ,O005qB 198""~-1991 112 .000301 200-'-~ 9Z .OOOZq7 1983 16Z .000q38 199Z 9X .O00Zq7 ZOOZ 6X .000Z19 19&q 11Z .goo301 199~-199q 7Z .00019Z ZOO3 SZ .000137 1985 Z3Z .000356 1995-1998 9Z .O00Zq7 ZO0~ ~Z .000110 1986 IOZ .00027~ 1999 7X .O0019Z 1987 9Z .000Z~7 ZOO0 8Z .OOOZ19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond tho date of the assessment. If payment is made after tho interest computation date shown on the Notice, additionat interest must be calculated. BUREAU OF TNDZVZDUAL TAXES INHERITANCE TAX DTVZSTON DEPT. Z80601 HARRTSBURG, PA 17liB-a601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMZNATZON AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN R£V-~i83 EX AFP CDI-O3) M & T TRUST CO C/O JANE F BURKE PO BOX ZZ0 CARLISLE DATE 11-01-200q ESTATE OF LEBO PAULINE DATE OF DEATH 09-29-2005 FILE NUMBER 21 05-0825 :IC~OUNTY CUMBERLAND ACN 201 q Amoun~ Rem~ed I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~c ~o your account, submit: ~:he upper portion of ~his for. with your ~:ax paymen~c. CUT ALONG THZS LZNE ~,~ RETAIN LONER PORTION FOR YOUR FZLES *'~ OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~# ESTATE OF LEBO PAULINE V FILE NO.Z1 05-0825 ACM 201 DATE 11-01-Z00~ ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verified 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 5. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) ~. To~al Inheritance Tax Assessed 5. Pennsylvania Estate Tax Due TAX CREDITS: 12~Z0.28 .00 .00 1Z~ZO.28 .0O PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 (IF TOTAL DUE ZS LESS THAN $1,, NO PAYMENT TS REQUIRED ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR),, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORM FOR INSTRUCTIONS. ] PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIDNS: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO (b) of the Inheritance and Estate Tax Act, Act 13 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-Ii15). Applications ere available at the Office of the Register of #i115, any of the 13 Revenue District Offices or free the Department's Z4-hour answering service for forms ordering: 1-600-361-Z050~ services for taxpayers mith special hearing and / or speaking needs: 1-BO0-qq7-3010 (TT only). Any party in interest not satisfied mith the assessment of tax as shown on this notice may object eithin sixty (60) days of receipt of this Notice by: --mritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17116-1021, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Drphans' Court. OR Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-lSD1) for an explanation of administratively correctable errors. The 15Z tax amnesty nan-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 mould appeal the tax and interest that has been assessed as indicated on this notice. For dates of death on or after 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (18) months from the date of death. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 mill bear interest at a rate ehich miZ1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The appZicable interest rates for 1982 through Z004 are: Interest Daily Interest Daily Interest Daily Yea~ Rate Factor Yea.~_r Rate Factor Yea~ Rate Factor 1982 207. .000548 1988-1991 117. .000'~01 ZOO1 97. .000247 1983 167. .00043& 1991 97. .000247 ZOOZ 67. .000164 198q 117. . O00'~O1 1995-1994 77. .000191 2003 57. .000137 1985 137. .000356 1995-1998 92 .000247 2004 47. .000110 1986 107. .000274 1999 77. .000191 1986 107. .000274 2000 87. .000219 --Interest is calculated as follows: 'rNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNg~UENT X DATLy /NTEREST 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 sho~n on the Notice, additional interest must be calculated. BUREAU OF /NDTV/DUAL TAXES TNHERTTANCE TAX DTV/STON DEPT. 280601 HARRISBURG, PA 171Z8-0601 CONHONI*/EALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEI*IENT OF ACCOUNT REV-1607 EX AFP (01-03) SHIRLEY A LEBO 111NCCLURES GAP RD CARLISLE DATE 11-01-200~ ESTATE OF LEBO DATE OF DEATH 09-29-2005 FZLE NUNBER 21 05-0825 COUNTY CuI~B~LAND.~_~ ACH 0~1~5'3~ PAULINE V Amoun* PA 1701:3 HAKE CHECK PAYABLE AND REi~XT PAYNENT TO: REGISTER OF ~/ILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 1701:3 NOTE: To insure proper crmdi~ ~o your eccoun~, submi~ ~he upper por~on of ~his form ~l~h your ~ax payment. CUT ALONG TH'rS L/NE I1~ RETATN LOI*/ER PORT'rON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~ TNHER'rTANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF LEBO PAULINE V F'rLE NO. 21 0:3-0825 ACN 0q. 105:3~ DATE 11-01-200c, TH/S STATEHENT TS PROV/DED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN 'rN THE NANED ESTATE. SHONN BELOI./ TS A SUHHARY OF THE PR/NC/PAL TAX DUE, APPL/CAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, I'F APPL/CADLE, A PROJECTED 'rNTEREST FI'GURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 09-10-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): .00 PAYHENT RECEIPT DISCOUNT C+) DATE NUHBER INTEREST/PEN PAID (-) ANOUNT PAID 06-22-200~ 10-12-200~ CD00~072 REFUND .00 .00 628.26 628.26- ZF PAID AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULATION OF ADDZT/ONAL /NTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT 1S RE~UIRED. 1F TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SXDE OF TH/S FORH FOR ZNSTRUCT/ONS. ) 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 or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RES[DENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CA): REPLY TO: DISCOUNT: PENALTY: A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Oeparblent's Iq-hour answering service for fores ordering: 1-BOO-36Z-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-BOO-qq7-3OZO (TT only). guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171ZB-0601, phone (717) 787-6505. if any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is alloaed. The 1SX 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 (l) day from the date af death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated et a daily rate of .00016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at e 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 ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor. 1982 ZOZ .0005~ 1986-1991 X1Z .000301 ZOO! 9Z .ooogq7 1983 162 .000¢38 1992 92 .0002q7 ZOOZ 6Z .O0016q 198q llX .O00SOI 199S-199q 72 .O0019E 2003 SZ .000137 1985 13X .000356 1995-1996 92 .000247 ZOOq ~Z ,000110 1986 lOX .O0027~ 1999 72 .000192 1987 92 .O00Z~7 ZOO0 82 .OOOZ19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. - - - ...-. - - iO-II-06 b Account Conftl"mAd a Solutely and distribut. -. In accordance With' JOn decreed ul. 01 dlalrl ,,' propoaed ached- . U IOn herewith. Ill. Court (5 1-1 t::l ~ C":l~",o,;~",zOC":lC":l :> o C":lH "'0i:l~0 = >C >-3 ~ i:C >C >-3 >-3' ~ 0 '" '" c::"''''''':> ~ III 0' ~l":l:jt::::lt-3 t-3N t:tj1-3 '" 0 0 :>? 0"'.... ~ .... 0,; 0,; n I-:lj I en a l"t ... t-3 t::l ~ 00- I":l:j 0,; t::l c:::: !-3:t:l:jw >C H '" "'[:l0 i:C I C":l C":l " t-' :> :>< 0,;0,;"''d00 0 H >-3 tI=:l~ H >ooc::::n~ '" Z i:C nen"l:lZb:l~N~O ..... C) c:: >Cf:;0t-''''>-3~0 .. >-35;0 >CH Z n o 'd oz t::l::i B S=. i'<" '" ~t::::IO>Ct:l:j H '"tI . '" " en n C") <:... t-I " 'tl Ht:ljn::c<: H '" '" 'tl l"t ~t::l 0 . "''d:> , '" l"t . t::l~:;:jt-' H"'''' ~ .~ ,0 OZ " N "'H>-3 '" ZZO ..... N '" :~~~? "'0,; .... . . >< " t-' N N ~ 0 0 >C'" Ht::l 0 0 c::c:: "'" '" w "'>-3 t-'n H >-3H "''' :> 0 " Z '" ~ " .. :5~: ,-~. ~. 'oJ <: S- ;. _'1J _:J <.2..... ;:Tarm ~ !!Jitg i(! ~~~ all_} ~lllll~!! II l!lii~ q!Sllflli'~ g.~il lOa Q:!!" ...= ~~!I!er!~ ~!t~.; ~ia.:r _ocp<,- ",. g.3-....ol~ 'll"'O::J~O ::J '<~tD_:!.5 c . ... 0 =_ ~ ~ a ::J ilf!-'ii~'f ~~JJ ti~! 1JiflSfll I i 'IS] i~.!l I 'i 2. h ~ : i II t:l'fl~!- 1 , i s '"s. ~ . ;3 j!s~~ lr _!r _~ VI !It 0- L-: (~,.. '- L-lJ c:' _ I ~_d I.-~-- '. (~-) ; ) Register of Wi Us of Cumberland County STATUS REPORT UNDER RULE 6.12 Name ofDecedent: $ll/{~ V. L-EfJJ (j q~~d'Z-003 700 -- ogzs Date of Death: Estate No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State~ether administration of the estate is complete: Yes~ No 0 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. ~ccol;U}t wi~ the Court? Yes 0 No 0 ~~ M'I/tGfft:[) b. The separate Orphans' Court No. (ifany) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 ..s c-.J c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be Date: 4' fw f 6';;:ChOO to this report ~ at?Er<I (2. Nall}; . c __ I.A ::::>~ ::>. i:m7J!V& It€- C/rt<Lt~L-;;;;- fh ' Address ( r/7-- ~Lf?/5(7r7 Telephone No. .~< ~1: .' -- -- ..~~:-- \...'J \ c.; L-r'" (-:--, c.~) C-.-t Capacity: ~ersonal Representative . Counsel for personal representative c: G? 11 F!1 M&r Investment Group tt o u Private Client Services P.O. BOX 220 ONE WEST HIGH STREET CARLISLE, PA 17013 717-240-4504 Toll Free 1-800-822-2155 September 9, 2005 Salvation Army of Carlisle 440 West Nyack Road P.o. Box C635 West Nyack, NY 10994-1739 American Red Cross Cumberland County Chapter 1710 Ritner Highway Carlisle, P A 17013 Marcia Drozdowski YMCA 311 South West Street Carlisle, P A 17013 Barbara Kohutiak YWCA 301 G Street Carlisle, P A 17013 American Cancer Society P.O. Box 897 Hershey, PA 17033-0897 First Lutheran Church 21 South Bedford Street Carlisle, P A 17013 American Diabetes Association Estate Administration Attn. Ronnie Mills 1701 North Beauregard Street Alexandria, VA 22311 Billy Graham Evangelistic Assn. Legal Department Attn. Justin T. Arnot One Billy Graham Parkway Charlotte, NC 28201-0001 RE: Estate of Pauline V. Lebo NOTICE is hereby given that Manufacturers and Traders Trust Company, Executor of the estate of Pauline V. Lebo, has filed the First and Final Account and Schedule of Proposed Distribution in the aforesaid estate at the Office of the Register of Wills, in the Court House of Cumberland County, at Carlisle, Pennsylvania, and that said First and Final Account and Schedule of Proposed Distribution will be presented for confirmation to the Orphans' Court of Cumberland County, Pennsylvania, October 11,2005 unless exceptions or objections are filed thereto. Very truly yours, ~ Jane F. Burke Vice President Enclosure: First and Final Account and Schedule of Proposed Distribution cc: Robert R. Black, Esquire Office of Attorney General, Charitable Trusts and Organizations Section Manufacturers and Traders Trust Company Private Client Services Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Date: 8/30/2005 BLACK ROBERT R 36 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of LEBO PAULINE V File Number: 2003-00825 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 9/29/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerelyu ~""~.WAP ~~J~T GLENDA FARNER STP~,SBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge CP IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION EST ATE OF PAULINE V. LEBO, DECEASED ~ \ - ~ j ~ ~..~ RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this ~if Day of October, 2005, by 'tMvr'r.L Elr-1,Lil on behalf of the AMERICAN CANCER SOCIETY, P.O. Box 897, Hershey, Pennsylvania 17033-0897 (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon ..~livery to::::'t~e _'.. ' ,~.. I, ': " . "::", undersigned of the property shown as distributable, acknowledges receipt of such~t~rty. I::) , } ..-'i""'-1 Cash Distribution Principal - 56,804.01 c:::' Income 1..806.17 !::J . " $58,610.18 t. ::.1 (,.") The Beneficiary does further acknowledge that the aforesaid distribution represents ths,:I.3eheficiart;s entire interest in the above referenced Estate and is being made in full and complete satisfactiOh thereof. 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata pt , .. . ~ share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its contlict of laws provision. This Release sh~ll bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first above inscribed. ~~~ ON BEHALF OF ~~JMC~rfi~CQ ~RqfJahcial Officer Employee Identification No. 25-1798733 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF DAUPHIN On this ..J!I- day of October, 2005, before me, the undersigned authority, personally came David Ehrlich on behalf of the AMERICAN CANCER SOCIETY known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. ~ (SEAL) COMMONWEALTH OF PENNSYLVANIA ~PUbliC JeanA~~PubIc My commissio expIres: Deny Twp., Dal4)hin Cot.I1ty My Ccmmission Expires June 11, 2008 Member,'f' .. ~1 anl8 Association Of NotIrtea IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this c96~ Day of October, 2005, by IticbardD. ADen , on behalf o1fALV ATION ARMY OF CARLISLE, 440 West Nyack Road, P.O. Box C635, West Nyack, New York 10994-1739, (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distributi<>;n,:~of the fol!~wing ,." .....-; property (adjusted for subsequent income and expenses) and effective UpOl1',~~~IJ~ery Ig, the undersigned of the property shown as distributable, acknowledges receipt of such'pt~rty. ::: "....'. ..: , \....-' Cash Distribution " /) " . Principal - 56,804.01 Income 1,,806.16 $58,610.17 (.,..) -.J The Beneficiary does further acknowledge that the aforesaid distribution represents the Beneficiary's entire interest in the above referenced Estate and is being made in full and complete satisfaction thereof. -0 <",'I~) 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata pt I.... . .. . . share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed y tIme at the Bank, with any court of competent jurisdiction, and the Beneficia to n); uch filin . IN WITNESS WHEREOF, the Beneficiary has executed a eal ease on the ate first above inscribed. ON BEHALF F 1li SALVATION ARMY(OF CARLISLE) By Richard D. AIIeri, Asst. Secretary Employee Identification No. ~-'5~ o9'Y61 STATE OF NEW YORK COUNTY OF r.orU'A~lb On this c::RJb day of October, 2~, before me, the undersigned authority, personally came RichardD.AJ1en on behalfoffALVATION ARMV(OF CARLISL~ known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. JESSICA -Kef ~IKOV";BKI ~ NOTARY PUBLIC. STATE OF NEW YORK NO. 01 K0604880B QUALIFIED IN ORANGE COUNTY MY COMMISSION EXPIRES .JO-.8-CU \ ~J(SEAL) Notary Public My commission expires: !f)d-CU .. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this 20th Day of October, 2005, byJOEL B. AARSVO~Rt>~].ff1>tfuerB1LLY GRAHAM EVANGELISTIC ASSN., One Billy Graham Parkway, Charlotte, North Carolina 28201-0001 (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the foHqwing property (adjusted for subsequent income and expenses) and effective up~Jdplivery~i~ the :;'i'~ ::;:j :::::.....:.\ undersigned of the property shown as distributable, acknowledges receipt ofsuclipi'q.~rty.::;.~" ..... r'''-'' Cash Distribution .' '. ; ,'~,i "..- ,.,~ Principal - 56,804.01 Income 1..806.17 $58,610.18 The Beneficiary does further acknowledge that the aforesaid distribution represents ffi~ Benefici~'s entire interest in the above referenced Estate and is being made in full and complete satisfaction thereof. ......-.\ l",-..... -0 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata pt . share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first \\".....,"~ ~ above inscribed. ",'\\~~"GeLJ8';""'~ ~ '" ,,_\0. ~ ........ ~ ~ ~ ~.... ~-' By: ~~'. \12- f~.!cop.PORAr~ Qi J EL B. AARSVOLD, Secretary : CJ : EAL ~ = ON BEHALF OF ~~ \. S HI BILLY GRAHAM EVANGELISTIC ASSN. ~(9 .. """lIIi;"~ ~ -. ~ ~. .,. ~"" AlINNES~~,"'''' T a x identification No. 4 1 -06922 30 I"".""""" STATE OF NORTH CAROLINA COUNTY OF Mecklenburg JOEL .B. On this 20 t h day of October, 2005, before me, the undersigned authority, personally came AARSVOLD S. . , on behalf of the BILLY GRAHAM EVANGELISTIC ASSN., known to me (or ecretary satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. ...;~ JUSTIN T ARNOT NOTARY PUBLIC ~-~ MECKLENBURG COUN'r(, Ne (SEAL) Not ublic commission expires~..., ~ ~ .'t ,; IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this -li-- Day of October, 2005, by BARBARA KOHUTIAK on behalf of the YWCA, 301 "G" Street, Carlisle, Pennsylvania 17013, (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery~J~ the undersigned of the property shown as distributable, acknowledges receipt of su4~ ~perty. L::< . .," \...r Cash Distribution '. .', :' Principal - 56,804.01 Income 1,,806.17 " ,. i -"f"i $58,610.18.,... _,,, The Beneficiary does further acknowledge that the aforesaid distribution represents th6~~nefici~'s entire interest in the above referenced Estate and is being made in full and comp"f€te satisfa~n thereof. --'I ,,,-,,,,I 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata pt . share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first above inscribed. ~. KufvJ! ~~ BARBARA KOHUTIAK " ON BEHALF OF THE YWCA Employee Identification No. J~- /1J.q~ (p ~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND On this JL day of October, 2005, before me, the undersigned authority, personally came BARBARA KOHUTIAK on behalf of the YWCA, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and date oresaid. (SEAL) AlTH F NOTARIAL SEAl ANN FREHN, NOTARY PUBLIC CARl~LEBOROUGH.CUMBERLANDCOUNTV SION EXPIRES FEB. 2. 2008 I ., ! IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT ;~Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this ---!-L..!.-:- Day of October, 2005, by MARCIA DROZDOWSKI on behalf of the YMCA, 3 I 1 South West Street, Carlisle, Pennsylvania 17013, (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust COlnpany, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and TestaInent of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting sublnitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in alI respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery to the undersigned of the property shown as distributable, acknowledges receipt of su~~ property.'< Cash Distribution- Principal - 56,804.01 Income 1.,806.16 ,__J $58,610.17 -l..,..,l The Beneficiary does further acknowledge that the aforesaid distribution represents t~e:~~riefic~9"s entire interest in the above referenced Estate and is being made in full and comp,l~t~' satisfafijon -.......j thereof. 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata RK ( , . \-. share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first above inscribed. '~~ ~tc MARCIA DROZDOWSKI ON BEHALF OF THE YMCA Employee Identification No. COMMONWEAL TH OF PENNSYL VANIA: COUNTY OF CUMBERLAND On this J'I day of October, 2005, before me, the undersigned authority, personally came MARCIA DROZDOWSKI on behalf of the YMCA, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. n Witness my hand and official seal the day and date a e. said. / . (SEAL) Notary Public My commission expires: COMMONWEAlTH OF PENNSVL~ANIA NOTARIAL SEAL DAINN M. SHUGHARt Notary Public Boro of CaIIIIe. Cumberfand County My Commission ExpIres Nov. 28, 2006 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this IT- 1t\.. Day of October, 2005, by 7)~tfs: \j\I~ \~ , on behalf of FIRST LUTHERAN CHURCH, 21 South Bedford Street, Carlisle, Pennsylvania 17013, (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: I. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the fotl,?wing property (adjusted for subsequent income and expenses) and effective up~~ ~~Iivery~.:t..~ the "'.' ...J.} ."','" undersigned of the property shown as distributable, acknowledges receipt of sucH, p~rty. ;.:,:L:: Cash Distribution . : ','0; C] (._/'-.'.~ Principal - 56,804.01 Income 1..806.16 $58,610.17 'TJ ~ The Beneficiary does further acknowledge that the aforesaid distribution represents the Beneficiiqr's entire interest in the above referenced Estate and is being made in full and complete satisfaction thereof. 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata Rt: - . share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its adm inistration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: I. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first above inscribed. MAv\J~ TH-aJ~ ON BEHALF OF FIRST LUTHERAN CHURCH Employee Identification No. COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND \\. O~ this J1-ttt day of October, 2005, before me, the undersigned authority, personally came 1J(\\I{\'S ~\b. \ tv\' on behalf of FIRST LUTHERAN CHURCH, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. (SEAL) Nota Pu .c M . MON\^!Ft\!,TH OF PENNSYLVANIA Y comGXPlreS~',.;al Seal ;')~ry Public M, . . '-md County My . ~1, 2008 Member. Pefl:,~ " '~otaries ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Release and Indemnification Agreement (hereinafter called the "Release") is given this 1')..J1:;- Day of October, 2005, by Sherne... ~\ ~ IS , on behalf of AMERICAN RED CROSS, CUMBERLAND COUNTY CHAPTER, 1710 Ritner Highway, Carlisle, Pennsylvania 17013, (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of the f<';~\Jwing property (adjusted for subsequent income and expenses) and effective up~(-gelivery~~tP the .......:. "'J .~"'\ undersigned of the property shown as distributable, acknowledges recei pt of suc~~~rty .:0:0 Cash Distribution., '\ c' ,- ...: ./ ,/"""" Principal - 56,804.01 Income 1,,806.16 $58,610.17 .',"\ w The Beneficiary does further acknowledge that the aforesaid distribution represents the BeneficiMY's entire interest in the above referenced Estate and is being made in full and complete satisfaction thereof. -0 ........','.'~ _""',, (~,? 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata RK " : ,,,-.. ... 'at share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its adm inistration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Release on the date first above inscribed. <---~. . . '- l~~ . ~ ~~ - \ S:.l<---~ ON BEHA -OF AMERICAN RED CROSS CUMBERLAND COUNTY CHAPTER Employee Identification No. ~~-'.35 dO) (p COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND .~ On this 1'7 day of October, 2005, before me, the undersigned authority, personally came Shf'rr i e J . 'hAt"> \ '\ on behalf of AMERICAN RED CROSS, CUMBERLAND COUNTY CHAPTER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that s/he executed the same for the purpose therein contained. Witness my hand and official seal the day and~~:d. ~ huJ COMMONWEALTH OF PENNSYLVANIA ~publ~ 3 Notarial Seal My commission expires: Judy L. Yaw, Notary Public Carlisle Boro, Cumberfand County My Commission Expires May 16, 2006 Member, Pennsylvania Association of Notaries (SEAL) '. . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE V. LEBO, DECEASED RECEIPT, RELEASE AND INDEMNIFICATION AGREEMENT This Receipt, Re.kslse and Indemnification Agreement (hereinafter called the "Release") is given ~ c,V\V~l_ :>~ (0 this \~ Day of'" . I, ~ by RONNIE MILLS on behalf of the AMERICAN DIABETES ASSOCIATION, 1701 North Beauregard Street, Alexandria, Virginia 22311 (hereinafter called the "Beneficiary") to and in favor of Manufacturers and Traders Trust Company, Executor of the Pauline V. Lebo Estate (hereinafter called the "Bank"). WITNESSETH: WHEREAS, the Beneficiary, pursuant to the Last Will and Testament of Pauline V. Lebo is beneficially interested in the above referenced estate; and WHEREAS, it is the intention and desire of the Beneficiary that the Bank make the distribution described herein; NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Examination of Formal Accounting. The Beneficiary does hereby declare that they have examined and approved the formal accounting submitted to the Beneficiary by the Bank and finds the same to be true, correct and satisfactory in all respects. 2. Receipt. The Beneficiary requests the above named Bank to make distribution of tqf;:,:~following :...... .,~."J property (adjusted for subsequent income and expenses) and effectivtf:~~~~n deli~~fy to ,the .,:. -'..J ......:"\ undersigned of the property shown as distributable, acknowledges receipt of ~liEiryropm!ty. "':";"~"1''''''1 ~ Cash Distribution:'7 '..:..i, CJ' P':./) :;: Principal - 56,804.01 Income 1~806.17 $58,610.18 (-;":' :~ (...n.) The Beneficiary does further acknowledge that the aforesaid distribution represerits the Ben~iary's entire interest in the above referenced Estate and is being made in full and complete satisfaction thereof. 3. Release. Having reviewed and examined the said formal accounting, and upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit- claim and forever discharge the Bank, its employees, successors and assigns, from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason of its administration of the above referenced Estate, or any other act, matter, cause or thing whatsoever. 4. Indemnification. The Beneficiary agrees to indemnify the Bank and hold it harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's pro rata Rf: ~ . . share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which the Bank may be subjected by reason of its administration of the Estate, as well as the settlement thereof by means of an informal distribution. The Beneficiary further agrees to: 1. Refund or return, promptly upon the Bank's written demand, any funds or assets distributed by the Bank to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. 2. Modify and displace any otherwise applicable period limiting the time within which the Bank's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Bank need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Bank shall have obtained actual knowledge of such error or negligence. The provisions of this Release shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Release shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. This Release shall bind the Beneficiary, their heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. The Beneficiary hereby acknowledges that this Release may be filed at any time, at the discretion of the Bank, with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has execu d and sealed this Release on the date first above inscribed. RONNI ILLS ON BEHALF OF AMERICAN DIABETES ASSN. Employee Identification, No. \s-\ to ~Sgtt COMMONWEAL TH OF VI~GINIA C;~ GOUNTY OF ----A~~" : ~'^~'l \~\.d~b On this day ofu"'" ] 7 .Jij&, before me, the undersigned authority, personally came RONNIE MILLS on behalf of the AMERICAN DIABETES ASSOCIATION, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that slhe executed the same for the purpose therein contained. Witness my hand and official seal the day and date aforesaid. (SEAL) \ \ (z 0/2. 001- ~ ~ IB III -I CJ~t%1 o en H~ ~c::~ Zt%1 t::lCJ g ~t-rj~ t%1t%1 ~F;t%1 2~ '" ~ 0 H~ t%1~t-rj t-rj'" H ~t%11-d CJ~ ~ t%1~> >t%1 8en~ ~t""" Ht%1 ~~H 0> Zen t-+ ~t::l~ >t%1 ~ ~<: ~~ ~~ t%1t::l t%1 t:tjt%1 ~ 8 ~O:l t%1 enO Z ~ ~ ~ ~ I I en I ~ I