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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
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Cl
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Cl
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ood e, Frances E.
DATE OF DEATH (MM-DD.Year)
DATE OF BIRTH (MM-DD-Year)
07/05/2002 04/25/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
[R] 1, Original Return
D 4. limited Estate
(R] 6. Decedent Died Testate (AlIachcopyoIWill)
D 9. Litigation Proceeds Received
D 2, Supplemental Return
o 4a, Future Interest Compromise (date aldeath after 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copyofTrust)
o 10. Spousal Poverty Credit (dateo/death between 12.31-91 and 1-1-95)
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SECTION' UST BEO MPUTE . ALl. OOR ESPO
NAME
R. Mark Thomas, Es
FIRM NAME (If Applicable)
EliICE:ANF tllil,,"':i'If~'r'iIlMiIlijj" 'l'i.lIlli
COMPLETE MAILING ADDRESS
101 S. Market Street
'liE TOr,
TELEPHONE NUMBER
717 796-2100
Mechanicsbur
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule Dj
5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (8)
o Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14laxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
229,069.20 X .045 (16)
X .12 (17)
X 15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
OFFICIAL USE ONL Y ~
i7- 71...- 'i
FtLE NUMBER "/1
o ;z - OOb$t/
C'OUNTY"C05E ---YEA~ - - NUi:iBER- -
SOCIAL SECURITY NUMBER
o 8 - 0 5 - 2 3 5 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Relurn (date of death prior to 12-1J-82)
D 5. Federal Estate Tax Return Required
_ 8, Total Number of Safe Deposit Boxes
D 11. Election 10 tax under Sec. 9113(A) (Attach Sch 0)
PA 17055
I
89,000.00
OFFICIAL USE ONLY
2,364.37 !
169,584.43
(8)
260,948.80
22,923.92
3,955.68
(11)
(12)
(13)
26,879.60
234,069.20
5,000.00
(14)
229,069.20
10,308.11
10,308.11
20. 0
',;:;;;H% i:;,H'"
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d' t' C
I t Add
ece en s ample e ress:
STREET ADDRESS 19 L h rth 0 .
17 etc wo nve
CITY Camp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
10,308.11
9.500.00
475.00
Total Credits (A + 8 + C)
(2)
9,975.00
3.
Interest/Penalty it applicable
D. Interest
E. Penalty
4.
TotallnteresUPenaity (D + E)
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 Ihe difference This Is the TAX DUE.
(3)
(4)
(5)
(5A)
(58)
AGENT
5.
333.11
A. Enter Ihe interest on Ihe tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF
333.11
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; ........ .............. ................................................... 0 IXI
b. retain Ihe right to designate who shall use the property transferred or its income; ........................................ 0 IXI
c. retain a reversionary interest; or ..... ................... ................... ,................................ ...................... D l&J
d. receive the promISe for life of either payments. benefits or care? ... ............................ ............................ 0 IXI
2. If dealh occurred after December 12, 1982, did decedent transfer property within one year of death
...............................0
o
................0
without receiving adequate consideration?......... ..... .............. ..... ................. ...
3. Did decedent own an "In trust for" or payable upon death bank account or security at his or her deafh? .............
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.. .................... .................. ........................
IXI
IXI
IXI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, includinQ accompanying schedules and statements, and to the bestcf my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all Information of which preparer has an knowledge
SIGNATU F PERSON RE NSIBL OR FILING RETURN DATE
X ~
ADD
1711/1
ER THAN REPRESENTATIVE
SI
ADDRESS
101 S. Market Street
Mechanicsburq
DATE
/,,;J.t1:?.:2.
PA 17055
For dates of death on or after July 1, 1994 and before January I, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS 99116 (a) (11) (i)].
For dates of death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary,
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 PS. 99116(a)(I.2)].
The tax rate Imposed on the net value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)].
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. 99116(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.
",.,"",.,,".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Dodge Fmnces E
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real property which is jointly-owned with
right of
survivorshill must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
89,000.00
Single family home
1917 Letchworth Drive, Camp Hill, PA
TOTAL (Also enter on line 1, Recapitulation) $
89,000.00
''''""''.".,''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
DodO" FrAnces E
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,078,00
Personal belongings
2,
Reimbursements for property taxes, sewer and refuse
(See HUD-1)
828,59
3,
Blue Cross insurance refund
363,78
4,
Homeowner's insurance refund
Traveler's Insurance Company
94,00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,364,37
,,,.,"m'''I''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
DodQe Frances E
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELA TIQNSHIP TO DECEDENT
A. Sharon A. Boyer
343 Herman Ave.
Lemoyne, PA 17043
Daughter
B Kathleen Garrett
1709 Edgar Lane
Camp Hill, PA 17011
Daughter
c
JOINTLY-OWNED PROPERTY
LETTER DATE DESCRIPTION OF PROPERTY "Io0F DATE OF DEATH
ITEM FOR JOINT MADE Include name affinancial institution and bank account number or similar identifying number, Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for)ointly-held real eslate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 12/13/0 Joint Share/Savings Accl. #29517-019 133,449,67 100. 133,449,67
Pennsylvania Central F.C.U,
959 E. Park Dr., Harrisburg, PA 17111
'2. B 8/28/64 Checking Account #0028734459 1,290,57 50, 645.29
allfirst
PO Box 900, Millsboro, DE 19966
3. A 12/10/0 Checking Account #0950915191 4,055.15 100, 4,055.15
allfirst
PO Box 900, Millsboro, DE 19966
4. A 12/10/0 Savings Account #80000002184337 31,434.32 100, 31,434.32
allfirst
PO Box 900, Millsboro, DE 19966
TOTAL (Also enter on line 6, Recapitulation) $ 169,584.43
(If more space is needed, insert additional sheets of the same size)
''''''''''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DodO" Fr~nces E
Debts of decedent must be reported on Schedule I.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES
1 Parthemore Funeral Home 7,661.30
2. Flowers (Olde Town Florists) 215.17
3. Luncheon 13.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees R. Mark Thomas, Esq. 7,000.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 310.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7.
8. Jim Bistline, Auctioneer (Appraisal of personal items) 100.00
9. Cumberland Law Journal (Legal advertisement) 75.00
10. Patriot News (Legal advertisement) 119.95
11. Realtor's commission (See HUD-1) 6,230.00
12. Real estate closing costs (See HUD-1) 59.00
13. Real estate transfer tax (See HUD-1) 890.00
14. Richard Castle (Attic cleaning) 250.00
TOTAL IAlso enter on line g, Recapitulation) $ 22,923.92
IIf more space is needed, insert additional sheefs of fhe same size)
;""""''';''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
FILE NUMBER
Dodge Frances E
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
/ J.C. Penney
65.99
Verizon
63.06
Com cast Cable
48.04
PP&L Utilities
175.03
PP&L Utilities (Final bill)
10.88
UGI Utilities
108.46
Verizon (Telephone)
28.48
PA American Water
11.10
St. Theresa's Church monthly contribution
(Payment made prior to decedent's date of death)
40.00
Joe's Tree Service
400.00
Patriot News Co.
19.00
Pennsylvania Blue Cross/Blue Shield
189.17
George Clauser, Real Estate Appraisal
100.00
Com cast Cable
191.33
J.C. Penney
v
90.99
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,955.68
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Dodge, Frances E.
Paqe 1
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. Sharon Boyer, Care Provider 375.00
(Decedent's daughter gave up her employment in 2001 to care for the decedent who lived
at home pending her death. Decedent agreed to pay her daughter for her services)
17. Verizon 60.77
18. PA American Water 28.53
19. Sharon Boyer, Care Provider 1,500.00
(See #16)
20. Visa 45.00
21. Verizon 69.97
22. PA American Water 18.52
23. UGI 98.21
24. UGI 34.12
25. UGI 25.11
26. Verizon 25.03
27. PA American Water 6.69
28. Keystone Maintenance 63.60
(Lawn care of decedent's property)
29. Keystone Maintenance 63.60
(See #28)
SUBTOTAL SCHEDULE I 2,414.15
GRAND TOTAL SCHEDULE I $ 3,955.68
REV'1513EX'19.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
.F'
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
L TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (12)]
1. Sharon A Boyer Daughter 1/3
343 Herman Ave.
Lemoyne, PA 17043
2. Kathleen J. Garrett Daughter 1/3
1709 Edgar Lane
Camp Hill, PA 17011
3. Mary E. Patton Daughter 1/3
2240 Columbine Trail
South Lake Tahoe, CA 96150
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Oral bequest by decedent to St. Theresa's Church, New Cumberland, PA 5,000.00
TOTAL OF PART II - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 5,000.00
(If more space is needed, Insert additional sheets of the same size)
LAST WILL ANn TESTAMENT
13E IT REMEM13ERED THAT
I, FRANCES E. DODGE, n resident of Cumberland County, Pennsylvania, being of sound
and disposing mind, memory and understanding, do mnke, publish and declare this to ':Je my LAST
WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously r~lade by me.
I declare that I am not married, my beloved husband, RICHARD H. DO'oOE having
predeceased me, and that I have three children, SHARON ANN 130YER, MARY !C\LIZABETH
,
PETERS and KATHLEEN JEAN GARRETT.
II
I direct that all my just debts amI funeral expenses shall be paid from my residuary estate as
soon as practicable after my decease.
III
I directlhat all taxes lhalmay be assessed in consequence of my death, of whatever nature
and by whatever jurisdiction imposed, shall be paid from my residuary estate ai: a part of the
expense of the administration of my estate.
IV
I have already informed my children that it is my desire that certain identified items of my
personal property shall be given in kind to some or each of my children. My children s:lall have the
right to select any of my remaiuing personal property in the form of jewelry, c10thi .'lg, personal
possessions or personal papers which (hcy would like to have. Should there be a disp'.Ite over any
particular item, then that item shall be placed with the remaining items to be sold either at public or
private sale.
V
All the rest, residue and remainder of my property, whether real or personal, wherever
situate, including any property over which I llIay have a power of appointment I give, devise and
bequeath to my children, SHARON ANN BOYER, MARY ELlZABETH"ETERS and
KA TIILEEN JEAN GARRETT in eqoal shares, per stirpes.
nominate, constitute and appoint my children, SHARON ANN BOYER, MARY
ELIZABETH PETERS and KATI (LEEN JEAN GARRETT as Co-Executrixes of this LAST
WILL, to serve without bond. If any of my children are unable or unwilling to act in that capacity,
then I nominate, constitute and appoint my remaining children to act as Co-Executrixes of this
LAST WILL, to serve without bon(1.
fN WITNESS WHEREOF, I, FRANCES E. DODGE, have set my hand to this LAST WILL
this ;/l/Jdayof M~~
, 200 I.
b~,~,/{f~C/
FRANCES ~. DODGE
Signed, sealed, published and declared by the above-named FRANCES E. DODGE, as and
for her Last Will and Testament, in the presence of us, who, at her request and in ber presence, and
inlhe presence of each olher, have herculllo subscribed our names as wiluesses.
~~~
.' -~~ .-.~ ",~"",~
.
COMMONWEALTIl or PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, FRANCES E. DODGE, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that 1 signed and
executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the
purposes therein expressed.
-/ f?
,r ~.~..:.' .. --.t: ",,;.;1, <i2~..e---/
c FI~ANCES E. DODGE ,
Swom or affirmed to and acknowledged before me by FRANCES E. DODGE, Testatrix,
thi:P?9 day of ~m.L<." r ,200 I. .
(&/kLJ ~
Notarial Saal
Anna Carmody, Notary Public
Machanlcsburg Born, Cumberland County
My Commission Explras Mar. 11, 2002
AFFlIJAVIT
COMMONWEALTH or PENNSYLV ANIA
ss.
COUNTY OF CUMI3ERLAND
We, fJ1M ~1>->tL5 and ma<,,'e. 0: ~V/~ ,
the witnesses whose names are signed to the allached or foregoing instmment being duly qualified
according to law, do depose and say that we were present and saw Testatrix sign and execute the
instnnnent as her LAST WILL; that FRANCES E. DODGE signed willingly and that she executed
it as her free and voluntary act j()r the purposes therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the
Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue
influence.
~J~
-~-~~
Sworn or affirmed to and acknnwledged hefiJrc me
this.5''1 dayof J::'!t.JU61ft..tu;J;/ ,200/,
A. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMS No. 2502.0265
SETTLEMENT STATEMENT TITLE PRO
SECURED LAND LllS8rprinl
TRANSFERS, INC. B. TYPE OF LOAN
5006 East Trindle Road 1. il<IFHA 2. [ I FMHA 3. I I CONY. UN INS.
Suite 203 4. [ IVA 6. [ I CONY. INS.
Mechanicsburg, PA 17055 6. FILE NUMBER: I 7. LOAN NUMBER,
504164 0020206058
Phone: (717) 591-8500 FAX: (717) 591.8506 8. MORT. INS. CASE NO.:
441-7004692-703
C. 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.D.C.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
O. NAME ANO AOORESS OF BORROWER, E. NAME ANO AOORESS OF SELLER F NAME AND ADDRESS OF LENDER,
Steven G. Hoffman Estate of ERA Mortgage
Frances E. Dodge
3000 Leadenball Road
Mount Laurel NJ 08054
G. PROPERTY LOCATION, H. SETTLEMENT AGENT: I. SETTLEMENT DATE,
1917 Letchworth Drive Secured Land Transfers, Inc. 09/27/02
Lower Allen TOWNSHIP PLACE OF SETTLEMENT,
CUMBERLAND County 3915 Market Street Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400 GROSS AMOUNT DUE TO SELLER
101. Contract sales price 89000.00 401,Contract sales price 89000.00
102. Personal property 402,Personal property
103. Settlement charges to borrower (line 1400) 3890.30 403
104 404
105 405
Adjustments for items paid by seller in advance Adjustmenls for items paid by seller in advance
106. Cily!Town tax to 406,City{fown lax 10
107. County tax 09/27/ 02to 12/31/02 95.71 407,County lax 09/27/021012/31/02 95.71
108. Assessments to 408,Assessments to
109 School 09/27/ 02to 06/3 0 / 0 3 730.66 409 School 09/27/ 02to 06/3 0/03 730.66
110 Swr/Ref:~67.50/~ ena 9/30 2.22 410 Swr/Ref:$67.50/~ ena 9/30 2.22
111. 411
112 412
120. GROSS AMOUNT DUE FROM BORROWER 93718.89 420,GROSS AMOUNT DUE TO SELLER 89828.59
200, AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500 REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 1500.00 sOl,Excess deposit (see instructions)
202, Principal amount of new loan(s) 88301.00 502,Settlement charges to seller (line 1400) 7179.00
203. Existing loan(s) taken subject to s03,Existing loan(s) taken subject to
204 504.Payoff of First Mortgage Loan
None
205 505 Payoff of Second Mortgage Loan
206 506
207 507.
208. SOB
209. 509
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Gityrrown lax to 510Cilyrrown tax , to
211,Countytax to 511,Countytax to
212. Assessmonts to 512.Assessments to
213 school to 513, school to
214 5t4
215 515.
216. 515
217 517
218 518
219 519
220 TOTAL PAID BY/FOR BORROWER 89801.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 7179.00
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600 CASH AT SETTLEMENT TO OR FROM SELLER
301, Gross amount due from borrower (fine 120) 93718.89 601.GroSS amount due to seller (line 420) 89828.59
302. Less amount paid by/for borrower (line 220) 89801.00 ti02,Less reduction amount due seller (line 520) 7179.00
303. CASH (IX] FROM) ([ ] TO) BORROWER 3917.89 603GASH ([Xl TO) ([ ] FROM) SELLER 82649.59
'/.. / ~HA
-/
Buyer or Borrower's Signature
'{;&fJ
el r's Signature
,
~ r2 ;? 7" ,--
HUD.1 Rev. 5/86
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
OMB No 2502.0265
Pago 2
L. SETTLEMENT CHARGES 504164 PAID FROM PAID FROM
TOTAL SALES/BROKER'S COMMISSION based on price $ 89000.00 BORROWER'S SELLER'S
700. FUNDS AT FUNDS AT
Division of Commission (line 700) as follows: Total: $6,230.00 ~
701. $ 3090.00 to ERA-NRT, Inc.
702. $ 31.40.00 to D'Anqelo Realty Groun
703. Commission paid at Settlement
704. Trans Fee ERA-NRT, Inc. I 100.001
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % ERA Mortqaqe ($250 POC-B) 76.24
802. Loan Discount %
803. Appraisal Fee to
804. Credit Report to
805. lenders Inspection Fee
806. Mortgage Insurance Application Fee 10
807. Assumption Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAlO IN ADVANCE
901. Interest from 09/27/02 to09/30/02 @$ 15.72/day 62.88
902. Morlgage Insurance Premium for mo. to Department of HUD 1.304.96
903. Hazard Insurance Premium for lyrs. 10 Allstate Ins, (POC-B)
904. yrs. to
905.
000. RESERVES DEPOSITED WITH LENDER FOR
001. Hazard Insurance 3 mo. @$ 21.. 36 Imo. 64.08
002. Mortgage Insurance mo. @$ 36.03 Imo.
1003. Cily{T own tax mo. @$ Imo.
004. County tax 8 mo. @$ 30.59 Imo. 244,72
1005. Assessments mo. @$ Imo.
1006. School Tax 4 mo. @$ 80,52 Imo. 322.08
007. mo. @$ Imo.
008. Aqqreqate mo. @$ Imo. -233.41.
w,
1100. TITLE CHARGES
101. Selllement or closing fee to
102. Abstract or tille search 10
1103. Title examination to
f 104. Tille insurance binder to
1105. Document preparation to R. Mark Thomas (POC-S)
1106. Notary fees to Cash 20.00
1107, Attorney's fees to
I (includes above items No.:) @!~Kf: !i~i@!NMgtt@iUf@!~i:~nM~~f*~:t:~~M~~~:~~}~~~(;~~A~i;
11108, Title Insurance to Secured Land Transfers ...
(includes above items No.:) end. 100, 300, 900
109. Lender's coverage $ 88,301.
1110. Owner's coverage $ 89,000
11111.
~ 112.
1113.
11200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 28.50 Mortgage $ 42.50 Misc. $ 71.,00
1202. City/county taX/stamps: Deed $ 890.00 Mortgage $ 890.00
1203. Slate tax/stamps: Deed $ 890.00Mortgage$ 890.00
204.
1205. Home Insp Beichler & Tillery (POC)
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to I
1302. Pest Inspection to J.C. Ehrlich Co. , Inc. 45.00
1303. Tax Cert Secured Land Transfers 4.00
1304. Wire Fee Secured Land Transfers 20.00
11305. Mail Fee Secured Land Transfers 1.5.00
1400. TOTAL SETTLEMENT CHARGES (enter on tines 103 and 502, Sections J and K) 3890.30 71.79.00
Parties agree Ihat no liability is assumed by Selllemenl Agent lor lhe accuracy 01 inlonnalion lurnished by oU,ers as shown onlhe HUD-l Setllement Slatemant, Selllernent Agent hereby
e~pressly
reserves the righlto deposit any amounls collected lor disbursement in an interes\ bearing account in a Federally insured instilution and to credit any illleresl so earned to its own
accounl as additional
compensation for lis services in this transaclion.
HUD CERTIFICATION OF BUYERS AND SELLERS
; I have carefully reviewed the HUD.1 SeUlemenl Statement and to the best or my knowledge and belief, it is a (rue and accur~te statement of all receipts and disbursements
made on my account by me in this transaction. t further certify that t have received a copy of the HUD.1 Settlement Statement.
Buyer or Borrower's SignallJre
Buyer's Address & Phone:
Seller'sSignaluHI
Seller's New Address & Phone:
The HUD.1 SetUemenl Slatemenl which I have prepared is a true and acclJrate accounl 01 this transaclion. I have caused or will calJse the lunds to be disbursed in accordance wilh this
slalemenl.
Setllemenl Agent Dale
WARNING: II is a crime 10 knowingly make false slalements 1.0 lhe United States on 'his or aflY similar lorm. Penallies upon conviction can lIlcllJde II line and imprisonmont. For details
see
Tille 18: U.S. Code Secllon 1001 and Section 1010 HUD.l Rev. S/86
JIM BISTLINE, AUCTIONEER
61 SUNSET DRIVE, CARLISLE, PA 17013
PHONE (717) 243-7794
July 17, 2002
To Whom It May Concern:
On July 17, 2002, at the request of KatWeen Garrett, I conducted an appraisal of the
personal items in the estate of Frances E. Dodge. The appraisal was done at 1917
Letchworth Drive, Camp Hill P A, 170 II. Sharon Boyer and Mary Patton were present at
the time of the appraisal.
Values cited reflect what one could reasonably expect to receive if the items were sold at
public auction.
Inquiries may be directed to me at (717) 243-7794 or the above address.
Respectfully,
~ne
~~c# AU 001408L
JIM BISTLINE, AUCTIONEER
61 SUNSET DRIVE, CARLISLE, PA 17013
PHONE (717) 243-7794
Appraisal for Frances E. Dodge Estate
Page I
LIVING ROOM
WALNUT OVAL TABLE
4 SET OF LADDER BACK CHAIRS
STRIPED WINGBACK CHAIR
TAN COUCH AND CHAIR
PAINTED ROCKER
MIRROR (pLASTIC)
SHELF CLOCK (BATTERY)
STEREO
DOUGHTRAYENDTABLE
COLOR TV FLOOR MODEL(DAMAGED)
SHARP VCR
3 MISC PRINTS
FLOOR LIGHT
3 MISC TABLE LIGHTS
3 WOODEN SHELVES
110.00
100.00
20.00
40.00
20.00
5.00
15.00
1.00
25.00
35.00
25.00
1O.00(LOT)
5.00
15.00(LOT)
20.00(LOT)
STORAGE ROOM
DRESSER
KNEEHOLE DESK
SERVICE FOR 8 (SILVERPLATE)
BOX OF HANDTOOLS
ELEC HEDGE TRIMMERS
ELECTRIC SEWING MACHINE
METAL SHELVING UNIT
WOOD CABINET
KENMORE MAGIC BLUE VACUUM
WOODEN CHAIR
HAMPER
15.00
20.00
10.00
15.00
7.00
30.00
5.00
5.00
50.00
5.00
5.00
PARENTS BEDROOM
5 PIECE BEDROOM SUITE
HASSOCK FAN
100.00
5.00
SIDE BEDROOM
WALNUT VICTORIAN TABLE (DAMAGED)
2 WHITE SET OF DRAWERS
35.00
15.00(PAIR)
page 2
DINING ROOM
FORMICA TABLE W/6 CHAIRS
PINE HUTCH
COTTAGE STAND (pAINTED)
35.00
75.00
40.00
KITCHEN
KITCHEN TABLE W/DRAWER
WHIRLPOOL HEAVY DUTY GAS DRYER
ROPER WASHER (13 YEARS OLD)
21 CU.FT. GIBSON REF/FRZ (20 YEARS OLD)
25.00
75.00
25.00
25.00
Al''IlC
STEAMERl'RUNK
35.00
JIM BISTLINE, AUCTIONEER
61 SUNSET DRIVE, CARLISLE, PA 17013
PHONE (717) 243-7794
July 17,2002
R. Mark Thomas, Esq.
101 S. Market St.
Mechanicsburg, P A 17055
To Whom It May Concern:
Charges for the appraisal of the personal items in the Frances E. Dodge estate at 1917
Letchworth Drive, Camp Hill, PA are $100.00.
Thank you for the referral.
Respectfully, ~
~B~~
)f~~~
PA Lic# AUOOl418L
~
.:.. #,
FEDERAL CREDIT [INION
Main - 959 East Park Drive
Harrisburg, PA I7lll
Branch - 25 West Main St.
Shire mans town, PA 170 II
Serving Members since 1938
www.pacentra.fcu.com
email Pacenfcu@aol.com
717-564-4661 or 800-356-3875
fax 717-564-1503
August 13,2002
R. Mark Thomas
101 South Market Street
Mechanicsburg, PA 17055-3851
RE: Frances E. Dodge
Account #295] 7-019
Dear Mr. Thomas:
Francis Dodge maintained a joint share/savings account with our credit union.
The joint owner of the account is Sharon A. Boyer. The balance as of the date of her
death was $133,449.67. The account was opened December 13,2001 as ajoint account.
If you have any further questions, you may contact our office at (717) 564-4661
or toll free (800) 356-3875 extension 112.
Sincerely,
c~~:l ,{)~J
Tina Dechert
Supervisor, Member Services
!l allflrst
August 5, 2002
R. Mark Thomas
Attomey at Law
1 0 1 S. Market Street
Mechanicsburg, PAl 7055
RE: Estate of Frances E. Dodge
Date of Death: July 5, 2002
50dal Security Number: 108-05-2352
Dear Mr. Thomas:
i\lIfil'~l Fitl<lllcial Critter N..'\'
l'.U]>,oxl)lJ(]
!,\.lillshom, ] H~ I'J<)(}6
In response to your request, please be advised of the following accounts the above-named
decedent had with this bank and their balances on the date of death.
1. Account Type........................... Golden Age Checking Account
Account Number....................... 0028734459
Ownership (Names 01)................ Frances E. Dodge or Kathleen Garrett
Opening Date........................... 08/28/64
Balance on Date of Death...........$ 1,290.57
Accrued lnterest......................
00.00
Total......................................$ 1,290.57
2. Account Type........................... Relationship w/lnt. Checking Account
Account Number....................... 0950915191
Ownership (Names 01)................ Frances E. Dodge or Sharon A Boyer
Opening Date........................... 12/10/01
Balance on Date of Death...........$ 4,054.76
Accrued Interest....................... .39
Total......................................$ 4,055.15
. Page 2
August5,2002
3. Account Type........................... Statement Savings Account
Account Number....................... 80??oo02] 84337
Ownership (Names 01)................ Sharon A. Boyer or Frances E. Dodge
Opening Date........................... 12/10/01
Balance on Date of Death...........$ 31,417.41
Accrued Interest ....................... 16.91
Total.......................................$ 31,434.32
ThiS response doos not apply to a'lY assets held with .4.lIfirst Brokerage, where Allfirst Bank is serving as a trusteP., nor to
any credit cards owned by Bank of America bearing AI/first Bank's name.
For further account information, closures and/or reimbursement of funds refer to below
branch:
1200 Market Street, Lemoyne, PA 17043, telephone 717-255-2271.
Sincerely,
')/1 d. ~t'~j'
Mary Anne Macielag
Associate I/CIS
(302) 934-2240
A Family Traditioll O/,Carillg
PARTHEMORE Funeral Home & Cremation Services, Inc.
July 22, 2002
1 JOJ Bridge Street
P,O. Box 431
New Cumberland. PA [7070
(717) 774-7721
(rax) 774-5546
www.parthemore.com
Gilbert W. Parthemore,
Founder
Gilbert J. Parthemore,
Supervisor
Stephen K. Parthemore,
CFS?
Bruce R. Parthemore,
erc, Pre-Need Coordinator
Professional Memberships:
NFDA.PFDA
DCFDA . CCFDA
G~
The Rule Ylm Know,
The People YrJU Tru.~t
;{~~=-
~l t ..- J~~
Mr. R. Mack Thomas
101 S. Market Street
Mechanicsburg, PA 17055
Dear Mr. Thomas;
For the services of Frances E. Dodge:
(12) Death Certificates
@ $2.00/each
Total Due: $24.00
$24.00
We are happy to assist you. Please call
if you have any questions or we can
help in any other way.
Thank you.
Sincerely,
/3.. t LLC:~I,,-,
Bruce R. Parthemore
klc
A Family Tradition Of Caring
PARTHEMORE Funeral Home & Cremation Services, Inc.
July 25, 2002
Mrs. Sharon D. Boyer
343 Herman Avenue
Lemoyne, P A 17043-
13m Bridge Street The Funeral Service for Mrs. Frances E. Dodge
P,O, Box 431 '. I . d" . .
N c. bid I'A 17 7 ) We slllcerely appreCiate the confidence you have p aced III us an will contlllue to assist you III
C\VLlIll cr an , () ( .. .
(7 t 7) 774.7721 every way we can. Please feel free to contact us if you have any questIOns III regard to this
statement.
(Fax) 774.5546
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE
EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL
ARRANGEMENTS.
,,,,'ww.parthelllore.COIll
(iilbcrt W. Parthcmllrc,
FOlIl/der
Gilbert.l. Parthclllorc.
Slfl'crl'isor
Stephen K. ParthcIlHll\'.
CLI!'
Bruce R. Parthc11lon.'.
jlrc-,Vccd ('oordil1u!o/", CPC'
Professional Memberships:
NFDA . PFDA
[)CFDA . CCfDA
G~
1I1,'I<II/ci'''IIf.:II''lI'.
lI,l' PC"!,/" rOll 7'111-"1
"
Facility,Staff, and Equipment
Traditional Service . . . . . . . . . . .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
18Ga. Steel Caskel,CoralMisl. . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
$4565.00
$4565.00
$2450.00
$7015.00
Cash Advances
Certified Copies of Death Certificate .
Clergy Honorarium
Flowers, .
Hairdresser.
Organis( .
Soloist. .
Altar Servers
Death Notice, Harrisburg Patriot (Run Twice)
Death Notice, Elmira, NY . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$20.00
$125.00
$150.00
$35.00
$75.00
$50.00
$15.00
$183.60
$109.00
$762.60
Total
Total Cost. . . . . . . . . . . . . . . . . . . . . . . . . .
History
07/08/2002 Immediate Pay Discount. . . .
07/08/2002 Payment, Check #3862 -- Thank you!
TOTAL AMOUNT DUE. . . .
$7777.60
$-140.30
$-7637.30
$0.00
The unpaid balance over 0 days is subjected to a 1.25 % service charge per month - 15.0000 % per annum.
1\ '\"\: >
~' III".' ~
. "";"~"~'~,zil1.:f"
"1""
i - J:.~~~..J
Mrs. Frances E. Dodge
Page 1
. ~\\I//<<
~ -::::--
-::- eo_
~ ~
'-.... ,__
. . .
PARTHEMORE
July 8, 2002
Mrs. Sharon D. Boyer
343 Herman Avenue
Lemoyne, P A 17043-
A F amity Tradition Of Caring
Funeral Home & Crelnation Services, Inc.
1303 Bridge Slree! The Funeral Service for Mrs. Frances E. Dodge
P,O, Box 431 W' I . h fid hied' d '11' . .
N C. b P e slllcere y appreciate t e con I ence you ave p ac III us an WI contlllue to assIst you III
ew llll1 erland. A 1 7070 I fr . h .. d .
every way we can. P ease feel ee to contact us If you ave any questIons III regar to this
(717)774-7721 t
sta ement.
(Fax) 774-5546
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE
EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL
ARRANGEMENTS.
WW\\'.parthemore.com
Gilbert W. Parthcmorc.
FIJllllelel'
Ciilbcrt.l. Parthcmorc,
5;/I/}(T\'isor
Facility,Staff, and Equipment
Traditional Service . . . . . . . . . . .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
18 Ga. Steel Casket, Coral Mist. . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
$4565.00
$4565.00
$2450.00
$7015.00
Cash Advances
Certified Copies of Death Certificate .
Clergy Honorarium
Flowers
Hairdresser .
Bruce R. Parthcmorc, Organist.
pj"('-/'v'('cd Coordinoto/', ere Soloist
Altar Servers
Death Notice, Harrisburg Patriot (Run Twice)
Death Notice, Elmira, NY . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
Stephen K. Parthcmllrc.
(,FSf'
Profcssional Mcmberships:
NFDA' PFDA
DCFDA . ('('FDA
,,,",,,'",ti,,,wtOrth"fth,
Ge\\)LDEN
RQg/
IJ"'/?/II,' )UIlf...:1I011
IJ,,.I'''I!I,I,' rOil II'!!sl
.f"
'-~,
$20.00
$125.00
$150.00
$35.00
$75.00
$50.00
$15.00
$183.60
$109.00
$762.60
Total
Total Cost. . . . . . . . . . . . . . . . . . . . . . . . . .
History
07/08/2002 Immediate Pay Discount .
07/08/2002 Payment, Check #3862 -- Thank you!
TOTALAMOUNTDUE. . . .
$7777.60
$-140.30
$-7637.30
$0.00 J- \
~(y \,,'-'
o
'fJ
The unpaid balance over 0 days is subjected to a 1.25 % service charge per month - 15.0000 % per annum.
'J
UlI\J'J
; 1'~1-'. --
',',",-- r,:,s----,..;--~I-'-
'1'; "j:';"..J. '1
1_ JJ.~..Jiil,
Mrs. Frances E. Dodge
Page 1
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Reqister Of Wills
Hanover and Hiqh StreeE
Carlisle, PA 17013
Rece~pt Date
Rece:J-pt Time
Recelpt No.
7/19/2002
11:44:44
1029994
DODGE FRANCES E
File Number 2002-00650
Remarks R. MARK THOMAS
JA
------------------------ Distribution Of Receipt ------------------------
Transaction Description Payment Amount Payee Name
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
RENUNCIATION HEIRS
JCP FEE
270.00
6.00
24.00
5.00
5.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Check# 1648
Total Received..... ....
$310.00
$310.00
QQ.iLQ CL-4(j 'l Cj lc - 21cO
COMMO'NWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128.0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 SOUTH MARKET STREET
MECHANICS BURG, PA 17055
_n_____ fold
ESTATE INFORMATION: SSN: 108-05-2352
FILE NUMBER: 2102-0650
DECEDENT NAME: DODGE FRANCES E
DATE OF PAYMENT: 10/07/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/05/2002
NO. CD 001693
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $9,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$9,500.00
REMARKS: R MARK THOMAS ESQUIRE
CHECK# 1665
SEAL
INITIALS: JA
RECEIVED BY:
TAXPAYER
MARY C. lEWIS
REGISTER OF WillS
STATUS REPORT UNDER RULE 6.12
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA
Name of Decedent: FRANCES E. DODGE
Date of Death: 7/5/2002
File No. 2002-00650
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to the completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
YES X NO
2. If the answer is "No", state when the personal representative reasonably believes that the
administration will be complete:
If the answer to No. 1 is "Yes", state the following:
a. Did the personal representative file a final account with the Court? YES
b. The separate Orphan's Court No. (if any) for the personal representative's account is:
NO
Date:
6/18/2004
Did the personal representative state an account informally to the parties in interest?
YES X NO
Copies of receipts, releases, joinders and approvals of formal or informal accounts may
be filed with the Clerk of the Orphans' Court and may be attached to this report.
Signature
R. MARK THOMAS, ESQ.
Name (Please type or print)
101 S. MARKET ST. Address
MECHANICSBURG
717-796-2100 Tel. No.
PA 17055
Capacity: Personal Representative
X Counsel for personal representative
PETITION FOR GRANT OF LETTERS
Estate of Dodge, Frances E.
No. 2 l- 0 2- l.n50
also known as
, Deceased
Social Security No. 1 08-05-2352
Sharon A. Boyer and Kathleen J. Garrett
Petitioner(s), who is/are 18 years of age or older, apply}ies) tor:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rixes named in the Last Will of the
Decedent, dated November 29. 2001 and codicil(s) dated
State relevant circumstances, e,g., renunciation, death of executor, ale
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.l.a" d.b.n.c.t.a.: pendente lite, durante absentia: durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
residence at 1917 Letchworth Dr., Cam Hill, PA 17011
Decedent, then 88
years of age, died July 5
(list street, number and municipality)
,2002 ,at 1917 Letchworth Dr., Camp Hill, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property..
(if not domiciled in PA Personal property in Pennsylvania "..............
(if not domiciled in PA Personal property in County..... .. .. ....
Value of real estate in Pennsylvania ........... ... .... ..........
Total.
Real Estate situated as follows: 1917 Letchworth Dr., Camp Hill, PA 17011
Wherefore, Petltioner{s) respectfully requesl{s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
150,000.00
$
$
$
$
$
90,000.00
240,000.00
Signature
Typed or printed name and residence
l-l-lG,-L~
.
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the es~~c/Or~ing to~~ /2
Sworn to and affirmed and subscribed. . ~
. 19th ~
before me this day of
. JUL..'!iL;;2 ctnfff/fli'" - 0, ~;; ,~i1&
ljJJ~" {~~ - 7l t/
o IS if
DECREE OF REGISTER
Estate of Dodoe Frances E
Deceased
No_
21-0Z.-l.p50
also known as
Social Security No: 108-05-:>352 Date of Death: 7/5/2002
AND NOW, JULY 19, 2002 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary 0 of Administration
TESTAMENI'AR't
((c.t.a.. d.b.n.c.t.; pendente,.Jit,e;-duran1e absentia; durante minoriate)
are hereby granted to
SHARON ANN BOYER AND KATHLEEN JEAN GARREIT
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent
11-29-2001
Letters .u
$
270.00
~ (1j(~~!JzzDI!!~
FEES
Inventory
$
$
$
$
$
$
$
$
24.00
5.00
6.00
;WJ~
Short Certificates(s) uuuu.u.u.
Renunciation _
Extra Pages (
Signature
I.T.Ru.__.__.__._.._._.
JCP Fee
5.00
310.00
Attorney: R. Mark Thomas
1.0_ No: 41301
Address: 101 S_ Market Street
Mechanicsburg
Telephone: 796-2100
Other uuu
PA 17055
TOTAL
$
called atty 7-19-2002
DATE FILED:
7-19-2002
RENUNCIATION
Estate of Frances E. Dodge
No.
21- O~- (o5D
also known as
, Deceased
The undersigned, Mary E. Patton, daughter, Co-executrix
(Relationship)
of
(Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters Testimentary be issued to Sharon A. Boyer and Kathleen J. Garrett
Witness my
hand this 19th day of July , 2002
~ Cp~
, 2t40~mbine Trail (Sig,ature)
South Lake Tahoe
CA 96150
(Address)
(Signature)
i
,
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this
JULY
1 9th day of
2002
Notary Public MARY CLEWIS
My Commission Expires:
(Signature and seal of Notary or other
official qualified to administer oaths. Show
dale of expiration of Notary's commission.)
NOTE: Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
RW-3
l'hj~ is to certify that the information here given is com.xliy copin{ from all original ccniflGltc of death duly filed with
Ie 'II I f j j tI1" SLttt' Vilal Records OHICI.' f(H permaneIlt fding.
Ll)ul Registrar." The origina certlilcatc \VI 1C (}[Warl Cl to '- .
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph,
No.
A.(~(1KiiI1t,t,p""
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Local Registrar (/
Fee for this certillcate, $2.00
f:..- 8385580
JUL 0 9 ZOO2..
Datc
4JR.~ 2187
COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT Of HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
.,
Frances
E.
S'ATEF1lf"UMBEA
~Odg~- ~~-~~-=---~---~=- :Ex-female-J:~l~~CUR:NU~~R
UNDER I DW - ~TE-OfIiiRTH- - eIfiTHPL.AC-" ,c."r -;;;;- PlACE OF DEATH.(r'''''.'"';-;;;;;--~'I....,,,,,.-,,,,,,, ,o<JOI)
Hour. ! ~WMJl" Ap;ri 025~1 3Ial.'"t~'~n'-'<X#'''YI :::L[~---:~I'.n1 L~ ---..:;--
.. 1914 1 Groton, NY ...
CfTY, IlOAO, TWP OF DEATH FACILIT'l' NAME;II ""1 ","'IIJ......... g..e il,...1 and "'",,""',
g:-tyJO
DECEDENT'S USUAL OCCUMIQN
(~=:k:io~"::,"3.:i'
11.. Le al Secretar m.. Le
DECEDENT'S "'AIUNG AOORESS (Shell_ C~no.....~, lopCOdeI
w,o.SOECEDEN1EI/'ERIN
US. AAMED FOOCES?
_0 No~
------OEciDENT'S EDUCATION u.\RITAL STMUS. Manotd
onl !'~.!l~_D!" eoJ N._Man-otd.W_
EI__ryJS4K_.'V Col~ o."""cIOd,SpecolYI'
lJ_ 1i012) jl."'~'1 '4. widowed
Pennsylvania _ Did uc.9!3 ......__nl_in Lower Allen
-
_..
__,~1l.I!!~..rlal"!L_~ -..nip?
2002
NAMEOf' DECEDENTj""', 1.4,,,,,,,,. '~"l
AGE (laS/8wth<lay)
UNDER 1 YEAR
...... ~,.
88 Y..
COUNTY OF ~H
"'-
Cumberland
Lower Allen Twp.
k.
1917 Letchworth Drive
white
SURVIVING SPOUSE
,II..... iI'''''''--''''''''.J
"
U..SIa..
...
1917 Letchworth Drive
,.. Camp Hill, PA 17011
fRHER'S NAIIE (f..., 1.4000l<O, Lasll
,__ Michael F. Kean
1Nf0000000'SNALlE (TJ'P8IPlIfllI
ML Sharon D. Boyer
UETHOOOF OlSPOSIT~
O Bun-' I,.Iit c......lion 0 '*'-aI......Slal.O
00nMi0n OU-(SpM:IIy\
:....
00_'
.~,
17".D':;""~~oI
_____._.,___~c...,_
2002
MOTHER'S NAYE of.,,,. M<l<lIe, Md.<l."Sut_1
1'. Eli.zabeth Mahoney
INfQRII"",rs "'''lUNG AOORESS (SIr_, Cftltffown. SlltIe, Z", Codel
2Gb. 343 Herman Avenue J Lemoyne, PA 17043
PlACE OF DISPOSITIOt4. N.....,oI C_..-v. C"rn,alol'y LOCATION. CilyITown. Slal..l.ipCodto
oo-OIr...-P1.,.
2,,Itolling Green Memorial Par 21.tower Allen Twp., PA 17011
NAMEANOAOOAESSOfFAClLITY Part emore , nc.
2k.P.O. Box 431, New Cumberland, PA 17070-0431
LICENSE NU"'SER DMESIGNED
RNd.27070 L ..~ .
,..
.
PART", OtMI~condilionaconl.IbulingIO_I~.bul
f;r;;)Jj~-;-_."'"'
,
WERE AUTOPSY FIl\IOINGS
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COtolPLETIOH OF CAUSE
OF OERH?
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OESCRlIlC HOW' IN.JURY OCCURRED
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To'he_olmyk_..~". "".IIlOC......-.I.......... dal. arwl pIK. andd".,olheu""Cajarwlm..nna..a.lalltd
'MEDICAL EXAMINER/CORONER
Ontheba.,.of...m,n.tlon.ndlorlnvelugOl',on Inmyop.mon,d..lho""',.dallhelune dal. OIndpl.,e,.udd".'olhec."ee(l)and
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"
LAST WILL AND TEST AMENT
BE IT REMEMBERED THAT
I, FRANCES E. DODGE, a resident of Cumberland County, Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish and declare this to be my LAST
WILL and TEST AMENT, hereby revoking any and all Wills and Codicils previously made by me.
I
I declare that I am not married, my beloved husband, RICHARD H. DODGE having
predeceased me, and that I have three children, SHARON ANN BOYER, MARY ELIZABETH
PETERS and KATHLEEN JEAN GARRETT.
II
I direct that all my just debts and funeral expenses shall be paid from my residuary estate as
soon as practicable after my decease.
III
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 the administration of my estate.
IV
I have already informed my children that it is my desire that certain identified items of my
personal property shall be given in kind to some or each of my children. My children shall have the
right to select any of my remaining personal property in the form of jewelry, clothing, personal
possessions or personal papers which they would like to have. Should there be a dispute over any
particular item, then that item shall be placed with the remaining items to be sold either at public or
private sale.
V
All the rest, residue and remainder of my property, whether real or personal, wherever
situate, including any property over which I may have a power of appointment I give, devise and
bequeath to my children, SHARON ANN BOYER, MARY ELIZABETH PETERS and
KATHLEEN JEAN GARRETT in equal shares, per stirpes.
,. "
VI
I nominate, constitute and appoint my children, SHARON ANN BOYER, MARY
ELIZABETH PETERS and KATHLEEN JEAN GARRETT as Co-Executrixes of this LAST
WILL, to serve without bond. If any of my children are unable or unwilling to act in that capacity,
then I nominate, constitute and appoint my remaining children to act as Co-Executrixes of this
LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, FRANCES E. DODGE, have set my hand to this LAST WILL
this ;/l.PdaYOf /1/~kr ,2001.
b-,~~/~4C/
FRANCES- . DODGE
Signed, sealed, published and declared by the above-named FRANCES E. DODGE, as and
for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
~
~~~
2
"., .'0
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
55,
COUNTY OF CUMBERLAND
I, FRANCES E, DODGE, Testatrix, whose name is signed to the attached or foregoing
instrwnent, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrwnent as my LAST WILL; that I signed it as my free and voluntary act for the
pwposes therein expressed,
J .'
~7- ---</~ ~/" --,/e/
RANCES E, DODGE
Sworn or affirmed to and acknowledged before me by FRANCES E, DODGE, Testatrix,
thi~9 dayof~~r ,2001. .
J '
~J1 x (!lc7kd d(/'
N Public
Notarial Seal
Anne Carmody, Notary Public
Mechanicsbur~ Bora, Cumberland County
My CommiSSIon Expires Mer, 11, 2002
AFFlDA VIT
COMMONWEALTH OF PENNSYLVANIA
ss,
COUNTY OF CUMBERLAND
We, /'m~ I7,~LS and mtM'I'e v: 1kvlJ0
the witnesses whose names are signed to the attached or foregoing instrwnent being duly qualified
according to law, do depose and say that we were present and saw Testatrix sign and execute the
instrwnent as her LAST WILL; that FRANCES E, DODGE signed willingly and that she 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 witnesses; and that to the best of our knowledge, the
Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue
influence,
~J~
~~~
Sworn or affirmed to and acknowledged before me
this .3 (i day of JQr;;(%?1KLU7/ ~ , 200 I,
./7
3
(f2alu/'rkl
o
v/17,~
No(ary Public
Notarial Seal
Anne Carmody, Notary Public
Mechanlcsbur~ Bora, Cumberland County
My CommiSSIOn Expires Mar. 11, 2002
j
CERTIFICATION OF NOTICE UNDER RULE 5.6la\
Name of Decedent: Frances E. Dodge
Date of Death: 7/5/2002
Estate No. 21-02-650
SSN: 10805-2352
File No.
2002-650
Date Letters Granted: 7/19/2002
Will or Administration No.
To the Register:
I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served
on or mailed to the following beneficiaries of the above-captioned estate on 8/7/2002
Name Address
Sharon A. Boyer 343 Herman Ave.
Lemoyne PA 17043
Kathleen Garrett 1709 Edgar Lane
Camp Hill PA 17011
Mary (Peters) Patton 2240 Columbine Trail
South Lake Tahoe CA 96150
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 8/7/2002
~}?~
Signature
Capacity:
x
Personal Representative
Counsel for Personal
Representative
Name (Please type or print)
R. Mark Thomas, Esq.
Address
101 S. Market St.
Mechanicsburg
PA 17055
Telephone No. 717-796-2100
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE'
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1162 EX{11-96}
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 SOUTH MARKET STREET
MECHANICSBURG, PA 17055
------~- fOld
ESTATE INFORMATION: SSN: 108-05-2352
FILE NUMBER: 2102-0650
DECEDENT NAME: DODGE FRANCES E
DATE OF PAYMENT: 10/07/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/05/2002
NO. CD 001693
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $9,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$9,500.00
REMARKS: R MARK THOMAS ESQUIRE
CHECK#1665
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
MARY C. lEWIS
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV-1 162 EX{1 1-96}
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
R MARK THOMAS ESQUIRE
101 S MARKET STREET
MECHANICSBURG, PA 17055
nnnn fold
ESTATE INFORMATION: SSN: 108-05-2352
FILE NUMBER: 2102-0650
DECEDENT NAME: DODGE FRANCES E
DATE OF PAYMENT: 11/06/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/05/2002
NO. CD 001814
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $333.11
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: R MARK THOMAS ESQUIRE
CHECK# 1711
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$333.11
MARY C. lEWIS
REGISTER OF WillS
"'- /'7- '/6 - -s/
BUREAU OF INOIVIOUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-06Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-IU1EX AFP (01-05)
R M THOMAS ESQ
101 S MARKET ST
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-13-2003
DODGE
07-05-2002
21 02-0650
CUMBERLAND
101
FRANCES
E
Amount Remi H:ed
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV :i60TEx--Aj:p--(iiFo3y------ii...--fNiiiRi~.._ANC:E--Tiix-sTA_rE~iE-N'niF-Ac-coiiiif--..ii"ii---------------------
ESTATE OF DODGE
FRANCES
E FILE NO.21 02-0650
ACN 101
DATE 01-13-2003
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-16-2002
PRINCIPAL TAX DUE:
10,533.11
PAYMENTS (TAX CREDITS):
PAY
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-04-2002 CDOO1693 500.00 9,500.00
11-06-2002 CDOO1814 .00 333.11
ME NT MUST BE MADE BY 04-06-2003*. TOTAL TAX CREDIT 10,333.11
BALANCE OF TAX DUE 200.00
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 200.00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
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 .ake check or .oney order payable to: REGISTER OF WILLS, AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEALTH OF PENNSYLVANIA.
REFUND CCR): A refund of a tax credit~ which was not requested on the Tax Return~ may be requested by completing an
wApplication for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at
the Office of the Register of Wills~ any of the 23 Revenue District Offices or from the Department"s 24-hour
answering service for forms ordering: 1-800-362-Z0S0; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 (TT only).
REPLV TO:
Questions 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 17128-0601, phone
(717) 787-650S.
DISCOUNT:
If any tax due is paid within thrBS (3) calendar months after the decedent"s death, a five percent (SX) discount
of the tax paid is allowed.
PENALTV:
The lSX 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 a.nesty period.
INTEREST:
Interest is charged beginning with first day of delinquencY~ or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January I, 198Z 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, 1982 will bear interest at a rate which will vary from calendar year to calendar Year with that rate
announcQd by the PA Department of Revenue. Tha applicable interest rates for 1982 through 2{J{J3 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOX .000548 1987 9% .000Z47 1999 7% .000192
1983 161- .000438 1988-1991 ll7- .000301 2000 8X .000219
1984 117. .000301 1992 9X .000247 ZOOl 9% .000247
1985 137. .000356 1993-1994 7% .000!92 20D2 6% .000164
1986 lOX .000274 1995-1998 97. .000247 2003 5X .000137
--InterQst is calculated as follows:
INTEREST ; BALANCE Of TAX UNPAID X NURBER Of DAYS DELINQUENT X DAILY INTEREST fACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of the asseSSMent. If payment is .ade after the interest co.putation date shown on the
Notice~ additional interest must be calculated.
/?- ?{, - Y
~BU~,AU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
" DEPT. 280601
, HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
R M THOMAS ESQ
101 S MARKET ST
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-23-2002
DODGE
07-05-2002
21 02-0650
CUMBERLAND
101
*'
REV-1547 EX AFP I Ol-UZl
FRANCES
E
PA 17055
Allount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RW=i:S4"j-iiniF:p-[oFozl--Noi'"ici--oF-YNHiRITANcrTAinfPPRAIsit.fENT:--AU-OWANCE-cfli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DODGE FRANCES E FILE NO. 21 02-0650 ACN 101 DATE 12-23-2002
TAX RETURN WAS,
( X) CHANGED
SEE ATTACHED NOTICE
) ACCEPTED AS FILED
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class 8 rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 . .00
234,069.20 X 045. 10,533.11
.00 X 12 . .00
.00 X 15 . .00
(19)' 10,533.11
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
ll)
(2)
(3)
(4)
(5)
(6)
(7)
89.000.00
.00
.00
.00
2,364.37
169,584.43
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
1l0)
22,923.92
3.955.68
(11)
(12)
113J
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
260,948.80
?6.R79 60
234,069.20
.00
234,069.20
n...u , '" AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-07-2002 CDOO1693 .00 9,500.00
11-06-2002 CDOO1814 .00 333.11
PAYMENT MUST BE MADE BY 04-05-2003~. TOTAL TAX CREDIT 9,833.11
BALANCE OF TAX DUE 700.00
INTEREST AND PEN. .00
TOTAL DUE 700.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before Dece_ber 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for Years, the Co~onwealth herQby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAVMENT:
Detach the top portion of this Notice and sub~it with your payment to the Register of Wills printed on the reverse side.
--Hak& check or lIoney order payable to: REGISTER OF MILLS" AGENT
REFUND (CR):
A refund of a tax credit, which was not requested on the Tax Return, ~ay be requested by co~pleting an ~Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISI3). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraIsement, allowance, or disallowance of deductions, or ~ssess.ent
of tax (including discount or interest) as shown on this Notice .ust object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Depart~ent of Revenue, Board of Appeals, Dept. 281021, HarriSburg, PA 17128-1021, OR
--election to have the matter deter_ined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS:
Factual errors discovered on this assessment should be addressed in writIng to: PA Depart_ent of Revenue,
Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, Dept. 280601, HarriSburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the book.let ~Instructions- for Inheritance Tax Return for a Resident
Decedent~ (REV-1501) for an explanation of administratively cOrrectable errors-.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) ~iscount of
the tax paid is allowed.
PENALTV:
The 15% tax a.nesty 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 a~nesty period. This non-partiCipation
penalty is appealable in the salle lIanner and in the the same tilllS period as YOU would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
sil< (67.) percent per annum calculated at a daily rate of .000164. All taxes Which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calend~r year to calendar year with that rate
anhounced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Vel:lr Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20Z .000548 1992 'X .aOOZ47
1983 16Z .000438 1993-1994 77- .000192
,- UX .000301 1995-1998 'X .000247
1985 13% .000356 1999 77- .000192
1986 107- .000274 2000 8X .000219
1987 97. .000Z47 ZOOl 'X .000247
1988-1991 11Z .000301 2002 6Z .000164
- - 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 assess_ent. If payment is made after the interest computation date shown on the
Notice, additional interest .ust be calculated.
REV.1470EX~.881
t
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
FILE NUMBER
REVIEWED BY
ACN
2102-0650
101
DODGE,FRANCES E
Kathryn Harbilas
ITEM
SCHEDULE NO.
J
EXPLANATION OF CHANGES
The value of the charitable bequest has been disallowed. The decedent's Will did not
contain a specific bequest to the charity.
ROW
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128.0601
REV-1 162 EX(ll-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
THOMAS R MARK
101 SOUTH MARKET STREET
MECHANICSBURG, PA 17055
___u_~_ fold
ESTATE INFORMATION: SSN: 108-05-2352
FILE NUMBER: 2102-0650
DECEDENT NAME: DODGE FRANCES E
DATE OF PAYMENT: 08/13/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/05/2002
NO. CD 002894
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $203.69
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$203.69
REMARKS: R MARK THOMAS ESQUIRE
CHECK# 2000
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WillS
/'}- '?t - 'l'
"'"
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
RE~-l"l E~ ~F~ UI-BS)
~<
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C' COUNTY
ACN
08-25-2003
DODGE
07-05-2002
21 02-0650
CUMBERLAND
101
FRANCES
E
r't
"-
R M THOMAS ESQ
101 S MARKET ST
MECHANICSBURG
Amount Rellitted
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-'Fir.oTEX--AFP--foFo3Y------..;;-iNHERi,.-ANCE--fAX-ST'ATEH'Etif-oF"-A"c-couiiT--;;...---------------------
ESTATE OF DODGE FRANCES E FILE NO. 21 02-0650 ACN 101 DATE 08-25-2003
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 12-23-2002
PRINCIPAL TAX DUE,~ 10,533.11
PAYMENTS (TAX CREDITS),
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-04-2002 CDOO1693 500.00 9,500.00
1l-06-2002 CDOO1814 .00 333.11
08-13-2003 CD002894 3.56- 203.69
TOTAL TAX CREDIT 10,533.24
BALANCE OF TAX DUE .13CR
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .13CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
PAVMENT:
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 WILLS} AGENT,
If NON-RESIDENT DECEDENT .ake check or .oney order payable to: COMMONWEALTH OF PENNSYLVANIA.
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-1313). Applications are available at
the Office of the Register of Wills~ any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for for.s ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLV TO:
Questions 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 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar .onths after the decedent.s death, a five percent (57.) discount
of the tax paid is allowed.
PENALTV:
The 157- tax amnesty non-participation penalty is co.puted 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) .onths and one (1) day fro. the date of
death~ to the date of payment. Taxes which beca.e delinquent before January I, 1982 bear interest at the rate of
six (67.) percent per annum calculated at a daily rate of .000164. All taxes which beca.e delinquent on and after
January l~ 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Depart.ent of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Vear Rate Factor Vear Rate Factor Vear Rate Factor
1982 207- .000548 1987 ., .000247 1999 71.: .000192
1983 167. .000438 1988-1991 II:< .000301 2000 ., .000219
1984 117. .000301 1992 97. .000247 20Dl 97- .000247
1985 137- .000356 1993-1994 71.: .000192 2002 67. .000164
1986 107- .000274 1995-1998 ., .000247 2003 57- .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUftBER 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 .ade after the interest computation date shown on the
Notice, additional interest must be calculated.