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HomeMy WebLinkAbout02-0690 ... Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS No 2, -0'2..- lo~C Estate of Guy W KOSER, SR. also known as , Deceased Social Security No. 182229851 Petitioner(s), who is/are 18 years of age or older, app\y(ies) fOf: GJ (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or Decedent, dated 6/25/2002 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: o B. Grant of Letters of Administration (c_t.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 North Newton Twp., Cumberland County, Pennsylvania, with his/her last family or principal residence at 98 Sprin~field Road, Shippensbur~ PA 17257 (list street, number and municipality) Decedent, then 85 years of age, died July 16, ,2002 ,at 98 Sprin~field Road, Shippensbur~ PA 17257 (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PAl 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. $ $ $ $ $ 150,000.00 000 150,000.00 Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(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: Signature Typed or printed name and residence I I ~~~ '-' Forest N Mvers 137 Park Place West Shinnensbura PA 17257 RW-7 \\-1<:1- d- , 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 estate according to law. ~& Forest N Myers Sworn to and affirmed and subscribed before me this 31st day of Julv. 2002 MD.RV (" TRWT~n'6~~~~ DECREE OF REGISTER Estate of Guv W KOSER SR. Deceased No. 21-0'Z.-LDQO also known as Social Security No: 182229851 AUGUST 1" 2002 Date of Death: 7/16/2002 , in consideration of the Petition IT IS DECREED that Letters IZl Testamentary 0 of Administration (c.t.a.. d.b.n.C.t. pendente lite; durante absentia; durante minoritate) are hereby granted to Forest N Myers in the above estate and that the instrument(s), if any, dated June 25,2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Short Certificate(s) ............... $ 1/ 00 Renunciation .................. $ Affidavit ( ).. $ Extra Pages ( ).. $ h 00 Codicil ......... ............... $ JCP Fee ...................... $ 5.00 Inventory & Tax Forms...... $ Other ..................... ................ $ ~ e2(j""^'i?9I ga.~ CLEWI Regist r of Wills Letters ........... $ 235.00 < Attorney: Forest N Myers ID. No: 18064 Address: 137 Park Place West ~d- mailed to atty 8-1-2002 ShippensburQ Telephone: 717.532.9046 DATE FILED: 8-t-2002 PA 17257 TOTAL .............................$ '}t:;Q (\(\ RW-7A . , 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 estate according to law. ~& Forest N Myers Sworn to and affirmed and subscribed before me this Julv. 2002 31st day of MnRV (" T=l~n~~th~~ DECREE OF REGISTER Estate of Guv W KOSER SR. Deceased No. 21-02- u,qo also known as AND NOW, on the reverse side hereon, satisfactory proof having been presented before me, Social Security No: 182229851 AUGUST 1. 2002 Date of Death: 7/16/2002 2002 , in consideration of the Petition IT IS DECREED that Letters I&l Testamentary 0 of Administration (c.t.a., d_b.n.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to Forest N Myers in the above estate and that the instrument(s), if any, dated June 25,2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ...... $ 235.00 ~ri*"~^'~M g.,.~ CLEWI Regist r of Wills _ Short Certificate(s) ..... Affidavit ( )... $ 17 nn $ $ $ h nn $ $ 5.00 $ $ Renunciation.... . Extra Pages ( Codicil.. Inventory & Tax Forms............ Other . Attorney: Forest N Myers 1.0. No: 18064 Address: 137 Park Place West ~d- JCP Fee mailed to atty 8-1-2002 Shippensburq Telephone: 717.532.9046 DATE FILED: 8-,,-2002 PA 17257 TOTAL .......$ ')~o fin RW-7A ** LAST WILL AND TESTAMENT ** '2\- 0 2 - loGo I, GUY W KOSER, SR, of North Newton Township, Cumberland County, Pennsylvania, revoke my prior wills and declare this to be my Last Will: FIRST: PAYMENT OF EXPENSES - I direct that the expense of my last illness and funeral be paid from my estate as soon as may conveniently be done. SECOND: BEQUEST - If my wife, GLADYS M KOSER, shall survive me, I give the sum of One Hundred Fifty Thousand Dollars ($150,000.00), IN TRUST, however, upon the following terms and cond itions: (a) The entire income from said trust shall be paid to, or for the benefit of Gladys M Koser, not less frequently than monthly; (b) Upon the death of Gladys M Koser, I direct that the principal and accrued interest be distributed to my children, except my son, Guy W Koser, Jr. who shall survive me by thirty (30) days in as nearly equal shares as possible, per stirpes. (c) I have not provided for Guy W Koser, Jr. since I have previously provided him with a home and land and many other funds over the years. THIRD: RESIDUE OF ESTATE - I give, devise and bequeath all the rest, residue and remainder of my estate to my children, except my son, Guy W Koser, Jr. provided they shall survive me by thirty (30) days, in as nearly equal shares as possible, per stirpes. FOURTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual payment to a beneficiary, no interest in income or principal shall be (i) assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. FIFTH: DEATH TAXES - All federal, estate and other death taxes payable on the property forming my gross estate, whether or not it passes under this will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment of federal estate tax purposes. SIXTH: MANAGEMENT PROVISIONS - I authorize my Executor, as follows: A. Retain/Invest: To retain and to invest in all forms of real estate and personal property, including common trust funds, mutual funds and money market deposit accounts and certificates of deposit, regardless of any limitations imposed by law on investments by executors or any principle of law concerning investment diversification; B. Compromise: To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; Page 1 of 3 C. Borrow: To borrow from and to sell property to my wife or others, and to pledge property as security for repayment of any funds borrowed; D. Sell/Lease: To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property and to give options for sales of leases; E. Capital Changes: To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; F. Distribute: To distribute in kind and to allocate specific assets among the beneficiaries (including any custodian hereunder) in such proportions as my Trustee may think best, so long as the total market value of any beneficiary's share is not affected by such allocation. These authorities shall extend to all property at any time held by my Executor or my Trustee and shall continue in full force until the actual distribution of all such property. All powers, authorities and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without court authorization. SEVENTH: I nominate and appoint Forest N Myers, Esquire, as trustee of any trust created under this Will. EIGHTH: EXECUTOR - I appoint Forest N Myers. Esquire, Fxecutor of my Will. Neither my Executor, nor any successor shall be required to give bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal thisZ:S*- day of June, 2002. ./-;A.A -1M. 11,4.P1l.t. GUY W ~gSER, SR, Testator (SEAl) In our presence, the above-named Testator signed this and declared it to be his will, and now, at hi, "q'''' "d io hi' pc"eo" "d io <he pc"eoce of ch ofh c, we 'i,"" """"'1- ~~~t~:tJ\~ Page 2 of 3 STATE OF PENNSYlVANIA SS COUNTY OF CUMBERLAND I, GUY W KOSER, SR, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for the purposes therein expressed. 1; /MfA-I, )<d4.V>~. GUY W'KOSER, SR, Testator We, GUY W KOSER, SR, the Testator in and the undersigned witnesses to the Will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the Testator, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his Will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ", ., ( , ~; \...,;~~ Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testator and by the witnesses whose names appear on this 4;t>- day of June, 2002. ~~ No(ary ublic NOTARIAL SEAl FOREST N. MYERS, NOTARY PUBLIC SHIPPENSBURG BOROUGH, COUNTY OF FRANKLIN wrr COMMISSION EXPIRES DECEMBER 17, 2005 Page 3 of 3 t' QI III ("I" ~ III ~ ;"'11 1-" -00 I-' ~ ;1\;0 I-' " Z[T\ r S " UlOO ,. QI " tD...j ~ =' tIl '" ~Z 0 0- !:3 " ~ <0 Q' :'! ..., . 0 . l:: 0 (l) ~ -0 -< '" ~ tIl ~ :l>[T\ ("I" ::j;o i . ",(1\ \ll ..., =' ("I" 1.':.- -> CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: To the Register: Guy W Koser, Sr. July 16, 2002 21-02-0690 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Novmeber 08, 2002. Name Gladys Koser Delbert Koser Frank Koser Robert Koser David Koser Roger Koser Charles Koser Shirley Bishop Address 97 Springfield Road Shippensburg PA 17257 29 Koser Road, Shippensburg PA 17257 1 Koser Road, Shippensburg PA 17257 130 Springfield Road, Shippensburg PA 17257 46 Springfield Road, Shippensburg PA 17257 123 Mainsville Road, Shippensburg PA 17257 400 Sand Bank Road, Mount Holly Springs PA 17065 114 Springfield Road, Shippensburg PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date:'~~ Forest N. Myers, Esquire 137 Park Place West Shippensburg, PA 17257 (717) 532-9046 Capacity: _X Counsel for Personal Representative -=:.r;::::---"-.---.'- - -------.::..:::::=:--.--------- ., i DECfDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Koser, Sr. , Guy W IDATE:'OF DEATH (MM-DO-YEAR)---:~bATE orEifRTH (MM:OD-YEAR) .07/16/2002 110/2111916 !(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST AND MIDDLE tNITi.A~---- I ! Koser, Gladys m - -------~~ Original Fi-etur-;--~---O 2. Supp~men.tal Return -_.,-~~O 3. Remainder Retum (date of eeath prior \0 12-i3-82)--- w :.:: S U) 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death stier 0 5, Federal Estate Tax Return Required u II:: lIl: 12-12-B2) !;!~g 101 0 0 u f ffi IClI 6. Decedent Died Testate (Attach copy 7. Decedent Maintained a Liying Trust (AIlach 8. Total Number of Safe Deposit Boxes c.. of Will) copy of Trust} <. : 0 9. lrtigation Proceeds Received 0 10. Spousal Poverty Credit (dale of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0) _n_~--+~______~_---,-___ .... _______1~31-9.1..!tnd 1-1-951__ .. : i THIS SECTION MUST BE COMPLETED~ ALL CORRESPONDENCE AND CONFIDENTIA.L TAX INFORMA nON SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS i Forest N Myers ~IRM NA-ME (If appjicablej -..----~_.---~- -----.---~-.-~--; . Law Offices of Forest N Myers _~==~===.====~==~==C=C=C=CC'===C====.====~=;"-'=~===.'==~=c==-l : :::~k:S~:: ~::::d(~:h:~ule B) ::: ____~_;;; I 0i"" "Sf ')',CY I None I I ::: _=-_---?:50:.::e I -~-- :::~-l REV.,n'U.l'~ .. /1,. 79~ ~ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT all I , FILE NUMBER (~FrICit.L :'~;C '.:'~'. y COMMONWEALTH Of PE.NNSYLV.o..NtA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, l'. 17128.0601 ! I , ----r 21 02 COUNTY CODE 'fEAR SOCIAL SECURITY NUMBER 00690 NUMBER ] 82-22-985] ~ z W Q W U W Q THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER .~ ~z Ww ~Q ~z 00 u~ , TELEPHONE NUMBER , 717/532-9046 137 Park Place West Shippensburg, PA 17257 3, Closely Held Corporation, Partnership or Sore~Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) z o ~ :I ~ ~ ~ < " w ~ 5, Cash, Bank Deposits 8. Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested ? Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8, Total Gross Assets (total lines,1M?) 173,502.56 -~-~-- (6) (7) (8) 9, Funeral Expenses & Administrative Costs (Schedule H) (9) 13,133.04 ---_.--_._-_."---- 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule f) (10) 11. Total Deductions (total Lines 9 & 10) i' (11) 13,133.04 12. Net Value of Estate (Line a minus line 11) (12) 160,369.52 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 160,369.52 SEE INSTRUCTIONS ON REVERSE SIDE fOR APPLICABLE RATES i 15. Amount of Une 14 taxable at the spousal tax rate, cr transfers under Sec. 9116(a)(1.2) 44,234.00 x .00 (15) 0.00 z o ~ < ~ ~ ~ . o u x ;0 1..1~136,\lQ.. x ~ (16) 5,226.00 16.Amount of Line 14 taxable at lineal rate (y) " x ,12 17. Amount of Line 14 taxable at sibling rate ~'__.__~_~_.....-~v.~ 1B. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 5,226.00 20. 0 CHECK HERE If YOU ARE REQUESTING A REfUND Of AN OVERPAYMENT. >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << form REV.1500 EX (Rev, 6.00) Copyright 2000 form software only The Lackner Group, Inc. Decedent's Complete Address: STREET ADDRESS 98 Springfield Road ciTY~ --~~-~-;;~~---~----~---~-~-~-ISTAi'E~-~--;ZW~;-;----- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,226.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (0 + E) 4. If Line 2 is greater than line 1 + line 3, enter the difference. This is thEOVERPA YMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is theTAX DUE A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA This is theBA-LANCE DUE (3) (4) (5) (SA) (5B) 0.00 5,226.00 -_..._--~.~-- 5,226.00 Make Check to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE BLOCKS Yes No ~ I 1. Did decedent make a transfer and: 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. Old decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?;... .............. o 181 181 0 o 181 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Unde( penalties of pe~jury, t declare that I have examined this retum,fincluding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration p:eparer other than the personal representative is based on all in'lOl111atlon of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS DATE ADDRESS 137 Park Place West Shippensburg, PA 17257 --- DATE --- ~... :J..-- 'SIGNATURE-OF PERSONRE~:iNSIBlE FOR FlUNG RETURN SlGNATUREOF'PREPAREROTHER THAN REPRESEN1ATiVE~----;;:DDRESS----------'~-'~--'~- ~-------'-~---------OATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. S9116 (a) (1.1) (i)}. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or fo[ the use of the 4urviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, arid' the statutoI)' requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spoLlse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P.S. ~9116 (a) (12)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116 1.2) [72 P.S. 99116 (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. S9116 (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. '. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSVLVANlA INHERITANCE TAX RETURN RESIDENT DECEDENT -L- ---- 'FILE NUMBER I 21-02-00690 ESTATE OF Koser, Sr. , Guy W 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. VALUE AT DATE OF DEATH 5,768.00 ITEM NUMBER -.--- t DESCRIPTION Allfirst Bank, checking account #0097350117, balance and accrued interest 2 AlIfirst Bank, money market checking account #0098172441 11,145.00 3 Orrstown Bank, checking account # 1 03002883 779.00 4 Orrstown Bank, checking account #103002886 996.00 5 Orrstown Bank, investment account # 1297 153,815.00 6 Pride Hurricane Mobility Scooter ] ,000.00 t i,;..j. I , " TOTAL (Also enter on Line 5, Recapitulation) 173,503.00 . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMON'V'JEAL TI-I OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _._--~~~._~~---- - - ! FILE NUMBER I 2 I - 02 - 00690 ESTATE OF Koser, Sr. , Guy W Debts of decedent must be reported on Schedule I. . ITEM I----~----OESZRIP~~---~---~--------~--- NUMBER i I AMOUNT .~____ ______________..L...___. ________~__ A_ I FUNERAL EXPENSES: \ B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Forest N Myers, Esquire Social Security Number(s) I EIN Number of Personal Representative(s): 23 Street Address 137 Park Place West City Shippensburg State P A Year(s) Commission paid Attorney's Fees Law Offices of Forest N Myers Zip 17257 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Gladys M Koser. Street Address 98 Springfield Road City Shippensburg Relationship of Claimant to Decedent State PA Spouse 17257 Zip 4. Probate Fees Register of Wills probate fees Register of Wills filing fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Gladys Koser, income ~- v ~_ 'I , ., 2 I News Chronicle advertisement of Estate Total of Continuation Schedule(s) 13,133.04 TOTAL (Also enter on line 9, Recapitulation) 2,500.00 5,500.00 3,500.00 333.33 15.50 449.00 53.00 781.00 '. Schedule H Funeral Expenses & Administrative Costs continued COMMONVv'EAlTH OF PENNSYLVANIA INHERITANCE TAX ReTURN RESIDENT DECEDENT ---~-~-,-"- ~,-,.- ESTATE OF FILE NUMBER Koser, Sr. , Guy W i 21 _ 02 _ 00690 3 rDa;;~ne P;~anr~al est~etaxe~----~-~-~--~--i--- 746.00~ 4 Daniel Hershey Auctioneer, sale of scooter 35.00 5 .. i ,;,~. I i'\ .:\- Page 2 of Schedule H COMMONwEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) _._._.--.L..-__ : FILE NUMBER I 21 - 02 - 00690 '. ESTATE OF Koser, Sr. , Guy W This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. Intervivos Deed of Trust Gladys Koser ----, NAME(S) OF NEAREST AGE AT I LIFE TENANT(S) iDATE OF BIRTH i DATE OF DEATH .. ~--==---=--~-I IO/l()iI9}8_I=-~- 84_ ---~- ------------"--1----' "'-'i- 181 Life or p Life or o Life or o Life or PAYABLE o Term of Years o Term of Years o Term of Years o Term of Years 1. Value of fund from which life estate is payable $ 150,000.00 2. Actuarial factor per appropriate table Interest table rate - 03 1/2% 06% 0 10% 0 Variable Rate 3, Value of life estate (Line 1 multiplied by Line 2) .29549 5.6% $ 44.324.00 . ANNUITY INTEREST CALCULA nON NEAREST AGE AT! DATE OF BIRTH' DATE OF DEATH I --.-J~_."____------.! ___.~_~_____ ' o Life or .0 Life or o Life or ..__...~_.. -_.._~-_.__._..~--. ..0 Life or TERM OF YEARS ANNUITY IS PAYABLE NAME($) OF ANNUITANTS o Term of Years o Term of Years o Term of Years o Term of Years -1 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) o Semi-annually (2) 0 Annually (1) 3. Amount of payout per period 4. Aggregate annual payment. Line 2 multiplied by Une 3 o Monthly (12) 0 Quarterly (4) o Other 0.00 5. Annuity Factor (see instructions) Inlerest table rate - 03 1/2% 06% 010% 0 Variable Rate 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10% or if variable rate and period payout is al end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x line 6) + Line 3 NOTE: The values of the funds which create the above future interests must be reported as part of the estate aSiels on Schedules A through G 01 this tax return. The resulting life or annuity interest(s) should be reported at the appropr;al~tax rate on [jnes 13, 15, 16 and 17. '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 43 on Rev-1500 Cover S~eet) I FILE NUMBER , 21 - 02 - 00690 .--- ESTATE OF Koser, Sr. , Guy W This schedule is appropriate only for Estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which wjll be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return 181 Will 0 Trust 0 Other I i. IBe"eficiaries -;-~----.I AGE TO I ,DATE OF BIRTH, NEAREST BIRTHDAy '--1011 Oh918 84 ------I NAME OF BENEFiCIARY RELATIONSHIP ..' ---"----,-.-..----.-----~- .--------r---..---...---.------- 1. Gladys M Koser ' wife ________.,m __________.__._____~_ _ ~____ ..-----------. ----~~~- 2. , I i _~~:=~=._____"'___-==~==~=_-==-_=_==--- i___.-=_~==~==_ :.__o==--=~~-.-~~____~ 4. .", --5~- ___~_~__o' o.-----~-----------.~T------- __~~___.___._.________,_o.______ II. For decedents dying on or after July 1, 1994, if a sUNiving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal risbt. ____ _..~_.!dUnlimit~d rightof wi!hdraw~_181 LJrnited r~~ht of withdrawa_~___._~__ III. Explanation of Compromise Offer: Estate offers a compromise since the surviving spouse will recieve all income from the estate for a period of years which is indeterminate. Spouses date of birth is 10/1 0/1918. Based on mortality tables a factor of.29549 is determined. The factor times the estate yields a value of $44234.00. y IV. Summary of Compromise Offer: 1. Amount of Future Interest: 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 0 6% 0 3% 181 0% (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of line 1 Taxable at 6% Rate (also include as part of total shown on line 16 of Cover Sheet) 5. Value of line 1 Taxable at 15% Rate (also include as part of total shown on Line 17 of Cover Sheet) 6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line 1) 150,000.00 0.00 44,234_00 . I "YO,:""" __~~,,_~_ 44,234.00 .------- ':-:L ;',\1 R~"..' '("',L~')' ',\-,;\ c-'. Fn,c,'",;, \:'.. <<,'_ ',',,".".,' ~:" \ ,:)1.., '.~-'J.--:'_":)"'--l : 1" :~ \. ',". \\f ~':'\ ,.n!'.)::- ,\;",r ** LAST Will AND TESTAMENT ** .2. J -02-la90 I, GUY W KOSER, SR, of North Newton Township, Cumberland County, Pennsylvania, revoke my prior wills and declare this to be my Last Will: F1L.f COpy FIRST: PAYMENT OF EXPENSES -I direct that the expense of my last illness and funeral be paid from my estate as soon as may conveniently be done. SECOND: BEQUEST - If my wife, GLADYS M KOSER, shall survive me, I give the sum of One Hundred Fifty Thousand Dollars ($150,000.00), IN TRUST, however, upon the following terms and conditions: (a) The entire income from said trust shall be paid to, or for the benefit of Gladys M Koser, not less frequently than monthly; (b) Upon the death or Gladys M Koser, 1 direct that the principal and accrued interest be distributed to my children, except my son, Guy W Koser, Jr. who shall survive me by thirty (30) days in as nearly equal shares as possible, per stirpes. (c) I have not provided for Guy W Koser, Jr. since I have previously provided him with a home and land and many other funds over the years. r--:... THIRD: RESIDUE OF ESTATE -I give, devise and bequeath all the rest, residue and remainder of my estate to my children, except my son, Guy W Koser, Jr. provided they shall survive me by thirty (30) days, in as nearly equal shares as possible, per stirpes. FOURTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual payment to a beneficiary, no .interest in income or principal shall be (i) assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. , FIFTH: DEATH TAXES - All federal, estate and other death taxes payable on the property forming my gross estate, whether or not it passes under this will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which 1 have a general power of appointment of federal estate tax purposes. SIXTH: MANAGEMENT PROVISIONS -I authorize my Executor, as follows: A. Retain/Invest: To retain and to invest in all forms of real estate and. personal property, including common trust funds, mutual funds and money market deposit accounts and certificates of deposit, regardless of any limitations imposedbt law on i~estments by . . executors or any principle of law concerning investment diversification; B. Compromise: To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; Page 1 of 3 , . "V, ,,',1 1')[. ;~,(,,, : ~ ,:"-.. :~I'" ,:' ..:t'", r'" h ',;:: < ..~, " >," '- :>" 'I '[,. ~,: '\' ,',', ,', i'; 'f', -' I '1:" J : (:. ,( C. Borrow: To borrow from and to sell property to my wife or others, and to pledge property as security for repayment of any funds borrowed; D. Sell/Lease: To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property and to give options for sales of leases; E. Capital Changes: To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary dU1ies with respect thereto; F. Distribute: To distribute in kind and to allocate specific assets among the beneficiaries (including any custodian hereunder) in such proportions as my Trustee may think best, so long as the total market value of any beneficiary's share is not affected by such allocation. These authorities shall extend to all property at any time held by my Executor or my Trustee and shall continue in full force until the actual distribution of all such property. All powers, authorities and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without court authorization. c) '-.,:.;.- SEVENTH: I nominate and appoint Forest N Myers, Esquire, as trustee of any trust created under this Will. EIGHTH: EXECUTOR - I appoint Forest N Myers. Esquire, Fxecutor of my Will. Neither my Executor, nor any successor shall be required to give bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7-Sir-- day of June, 2002. , .;/-;AAAb.M/;~' GUY W K SER, SR, Testator (SEAl) In our presence, the above-named Testator signed this and declared it to be his will, and now, at h', <eq"" ood '0 h', p",,",coo' '0 ,h, p''''"'' pf ch P'h, ;~ ~ljfJ~~~~ Page 2 of 3 ".',', j ',,', ".," \. I:..'" "-' ,"" .1.., STATE OF PENNSYlVANIA SS COUNTY OF CUMBERLAND I, GUY W KOSER, SR, having been duly qualified according to law, acknowledge that 1 signed the foregoing instrument as my Will, and that 1 signed it as my free and voluntary act for the purposes therein expressed. 1; />>j jJ.h ){ ~ ~~ GUY W'KOSER, SR, Testator We, GUY W KOSER, SR, the Testator in and the undersigned witnesses to the Will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the Testator, do hereby acknowledge that 1 signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his Will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence.. . ,I,l ;1\:"".,." " ,-: ;- \.J,f,' ."-'1, .\ ,.... <.. ..~;...<.'. ct.;::::..,~.\.<_\ - '::l ~ - . . ..:..:,"~.::,,':-;.'..~~. :~:.',~; \.:~~(/.... c, J.,' "" ..\" , Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testator and by the witnesses whose names appear on this Z,;;~ day of June, 2002. ~~UbliC .-.;.- ~. NOTARiAl SEAl FOREST N. MYERS, NOTARY PUBUC SHIPPENSBURG BOROUGH, COUNTY OF FRANKLIN MY COMMISSION EXPIRES DECEMBER 17, 2():J5 Page 3 of 3 '. SCHEDULE J BENEFICIARIES COMMONweALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT '--~-'-- 'FILE NUMBER I 2 I - 02 - 00690 ESTATE OF Koser, Sr. , Guy W RELATIONSHIP TO , DECEDENT -+-_Oo_N01U$UfUsteeI5L_-+- i AMOUNT OR SHARE OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. i TAXABLE DISTRIBUTIONS (include outright spousal distributions) : Delbert E Koser i 29 Koser Road ': Shippensburg P A 17257 I 'son I lone -sevenh residuary !estate I 2 Frank Koser i I Koser Road Shippensburg PAl 725 7 3 ; Robert G Koser , 130 Springfield Road I Shippensburg PA 177257 4 'David W Koser . 46 Springfield Road , Shippensburg PA 177257 I son lone-seventh residuary estate son 'one-seventh residuary estate son one-seventh of 'residuary estate 5 Roger L Koser i 123 MainsviIIe Road I Shippensburg PA 17257 I I son one- seventh of :residuary estate See Continuation Schedule(s) attached II. . , Enter dollar amounts for distributions' shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet I . NON-TAXABLE DISTRIBUTIONS: i A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT ,BEING MADE t B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ...: ~.~. I . . TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 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 MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 _nnn_ fold EST A TE INFORMATION: SSN: 182-22-9851 FILE NUMBER: 2102-0690 DECEDENT NAME: KOSER GUY W SR DATE OF PAYMENT: 04/24/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/16/2002 NO. CD 002486 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,226.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: FOREST N MYERS ESQUIRE CHECK# 60-1503/313 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $5,226.00 DONNA M. OTTO DEPUTY REGISTER OF WillS . '~ t :\[ .." ~\\~'l' \ . l!!~ ~ "~.[~ ~.\I '('I~ S i' , '~'" if ~ \:t': 1"'""", c ~ . "'m f\l l L.l- 'U> ''''''$ ,""' ......~ '\:tr~".",,,,;,, ~ $'(,'--".':1'.11 t"",- -I< -I< -I< ,",I" 'A <:::) ~ , ~ ~ \ r-- If) N . .... r-- tl'en... en III UJ$:< ii<ll~ ~ (.l tll III III ~ > - :1 :E~.c en . "'" c: %lolll .... ~ Co en 0. III r-- ._ ~C'l,t: o...l/l u.. III ~ III :1 _ >tl'C'l"":: el/l.......:: en:1~o=:: - 0 f"'oo_ ::U~...=:: $:"t:l-5< : -c:..^ _ 0<0:1_...:: ~i:oO): IllIllUin...:: ....&J. :.:== en"'Ill.._ 'C>~c:<o: 1ll:10U"':: a:.U .~ ~- -=--"" ~ FJ- -;; ,/-0.1/ , . BUREAU OF INDIVIDUAL TAXES \, INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128.0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 'OJ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-23-2003 KOSER SR 07-16-2002 21 02-0690 CUMBERLAND 101 JUIJ 20 (,'1 '-'0 ." .Ju FOREST N MYERS FOREST N MYERS 137 PARK PLACE SHIPPENSBURG LAW DFC W L .~F PA [MH. *' REV-1541 EXAFP (OI-03l GUY W Amount 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 ___ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOSER SR GUY W FILE NO. 21 02-0690 ACN 101 DATE 06-23-2003 TAX RETURN WAS: ( X) CHANGED SEE ATTACHED NOTICE ) ACCEPTED AS FILED 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 16. Amount of Line 14 taxable at Lineal/Class A ~ate 17. Amount of Line 14 at Sibling ~ate 18. Amount of Line 14 taxable at Collate~al/Class B ~ate RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Pa~tne~ship Inte~est (Schedule C) (3) 4. Mo~tgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Pe~sonal P~ope~ty (Schedule E) (5) 6. Jointly Owned P~ope~ty (Schedule F) (6) 7. T~ansfe~s (Schedule G) (7) .00 .00 .00 .00 173.502.56 .00 .00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 13,133.04 9. Fune~al Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mo~tgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Retu~n (9J (10) .00 (11) (12) (13) (14) 13. 14. Cha~itable/Gove~nmental Bequests; Non-elected 9113 T~usts (Schedule J) Net Value of Estate Subject to Tax NOTE: (15) (16) 42,214.50 X 118,155.02 X .00 .00 (17) (18) 00 045 = X 12 X 15 19. P~incipal Tax Due TAX CREDITS, NOTE: To insu~e p~ope~ c~edit to you~ account. submit the uppe~ po~tion of this fo~m with yoU~ tax payment. (8) 173.502.56 1 ~. 1 ~~ O'i 160,369.52 .00 160,369.52 (19)= .00 5,316.98 .00 .00 5,316.98 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-24-2003 CD002486 .00 5,226.00 INTEREST IS CHARGED THROUGH 07-08-2003 TOTAL TAX CREDIT 5,226.00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 90.98 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.76 TOTAL DUE 97.74 * 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.) REV-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 DECEDENT'S NAME FILE NUMBER Guy W. Koser, Sr. 2102-0690 REVIEWED BY ACN Bill Lyons 101 SCHEDULE ITEM EXPLANATION OF CHANGES NO. K 2 The life estate factor is .28143 ROW Page 1 -- -' ~ BUREAU OF INDIVIDUAL TAXES oj INHERITANCE TAX DIVISION DEPT. tl30601 HARRISBURG, PA 17128-U601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHEHT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-23-2003 KOSER SR 07-16-2002 21 02-0690 CUMBERLAND 101 FOREST N MYERS FOREST N MYERS 137 PARK PLACE SHIPPENSBURG LAW OFC W PA 17257 *' y REV-IS47 EX AFP (Ol-a~) GUY W Amount Remitted 11 q"l, '7~ 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 __ R it,,: i 54TEX--AFP--coi-:03j--iiiii-YCE--o,,-YN"HERTri.t"-cE- T-AX-A-P,;R'A-fsEHENr-,--ALi-oWIIN-cE-o-R"----------- - ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOSER SR GUY W FILE NO. 21 02-0690 ACN 101 DATE 06-23-2003 TAX RETURN WAS: ( ) ACCEPTED AS FILED SEE ATTACHED NOTICE ( XJ CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 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 APPROVED DEDUCTIONS AND EXEMPTIONS, 9. 10. ll. 12. 13. 14. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) OQbts/Mortg3g6 Liabilities/Liens (Schedule IJ Total Deductions Net Value of Tax Return ClJ (2) (3) (4) (5) CO) (7) .00 .00 .00 .00 173.502.56 .00 .00 (9) (10) 13,133.04 .00 (11) (12) U3} (14) Net Value of Estate Subject to Tax Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. (a) 173,502.56 13.133 n4 160,369.52 .00 160,369.52 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 !hh returns assessed to date. ASSESSMENT OF TAX, 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due (15) 42,214.50 X 00 .00 (16) 118,155.02 X 045 = 5,316.98 (17) .00 X 12 .00 (18) .00 X 15 .00 (19)= 5,316.98 TAX CREDITS: pAYMENT RECEIPT DISCOUNT C+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-24-2003 CD002486 .00 5,226.00 INTEREST IS CHARGED THROUGH 07-08-2003 TOTAL TAX CREDIT 5,226.00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 90.98 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.76 TOTAL DUE 97.74 . 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 ^ ~l:"l:"lIU1'\ <''''''' 0"'11""0<'''' <'T....,. ,.,.,. ....".,.. .......,.,.. ......,., ..........n"............"... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0501 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 u____n fold ESTATE INFORMATION: SSN: 182~22~9851 FILE NUMBER: 2102-0690 DECEDENT NAME: KOSER GUY W SR DATE OF PAYMENT: 07/11/2003 POSTMARK DATE: 07/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/16/2002 NO. CD 002791 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $97.74 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: FOREST N MYERS ESQUIRE CHECK#19004 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $97.74 DONNA M. OTTO DEPUTY REGISTER OF WillS r i'"r~ Rt;>..< II f'\i , ~ ',-" - O -;:u l.. ~ ro:::. o C _ !l) O~<.9.. b ~o~~_ ::=: c: ro:. ~~g?,..... '" (\) ~ill9..? -uo~Z? J:>~O:=':=- ~.." -- -J (\) 0 (/l -: o(J>c ~ ~.o~ ~ t>> .:.::; :c- . - <0S s:: == \'J ~ ~ t>> 0 :c- ~ -;: :c- :c- -n (fl'>o ~~?J "'6-o~ -0):>=-\ ~~~ ~-o:<. cr-~ ?J2.(fl Gl -0 ):> .> -.\ tv ::l , ~'1,J . ,. \ . , \ ) -)/ '., " .' I ~ - "79'-.:v '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-D601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV~lU7 Ell AFP (Ol-OS) FOREST N MYERS FOREST N MYERS 137 PARK PLACE SHIPPENSBURG 'CL i 2 LAW OFC W ',"'PA 17257 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-28-2003 KOSER SR 07-16-2002 21 02-0690 CUMBERLAND 101 GUY W Allount RellittBd 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 form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i60Tix-AFP-'oFo3y------...--iilHERi''r:ANCif-TAXSTA-iEMENT-iinii:-couiii--..-,(.--------------------- ESTATE OF KOSER SR GUY W FILE NO.21 02-0690 ACN 101 DATE 07-28-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHEO 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: 06-23-2003 PRINCIPAL TAX DUE: ........ 5,316.98 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-24-2003 CD002486 .00 5,226.00 07-10-2003 CD002791 6.76- 97.74 TOTAL TAX CREDIT 5,316.98 BALANCE OF TAX DUE .00 INTEREST AND PEN. .03 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .03 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (eR)} YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: K09l<'''. Gl.IY W ar Date of Death: July 16. 2002 Will No.: Admin. No.: 2007-00690 'Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State whether 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 account with the Court? Yes No @ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ill No 0 . c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Date:~O~ \ ~ - Signature Fnr~~r N My~r~. p~~. Name 137 Park Place West Address Shippensburg PA 17257 ",' ,.',- ,~, 717.532.9046 Telephone No. Capacity: Ga Personal Representative o Counsel for personal representative , '. .