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Home My WebLink About03-0793Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Betty J. McClure also known as , Deceased petition~(s),,~ is/are 18 years of age or older, apply(ie~) for: (COMPLETE "A" OR "B" BELOW:) Social Security No. 189-09-1511 A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executrix Decedent, dated April 28, 1999 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.~., 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 incompetent: E~ B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; duronte absentia; durante mir~odtate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 4713-B Charles Road, Mechanicsbur.q, PA 17055 (list street, number and municipaJity) Decedent, then 84 years of age, died September 27, 2003, at Manor Care, 17th and Market Streets, Camp Hill, PA 17011 (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ................................... $ 210,000.00 (If not domiciled in PA) Personal property in Pennsylvania ............... : ......... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ..................................................... $ -0- Total ...................................................................... $ 210,000.00 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: Si~lnature Typed or pdnted name and residence Lisbeth M. Bonner 701 Sharon Street New Cumberland, PA 17070 Form RW-I Page 1 of 2 (Dauphin County - Rev. 9/92) 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. Sworn to and affirmed and sul3scribed before me this ~ 7"z/ day of ~. '-~ ~~,. j 2003. Estate of /~'~e---J'T,, _ / I also known as DECREE OF REGISTER r~,.~l L~ ~, ~.. Deceased No. Date of Death: ~o c~. ~'- ~ Social Security No:/,~-~.~- AND NOW, (/'~('~(2~z,~,~/~. ~J/ ,2003, in consideration of the Petition on the reverse side hereon, satisfacto~)qaro~)f having'been presented before me, IT IS DECREED that Letters E]"Cestamentary [] of Administration (c.ta.; d.b.n.c.t.; pendente lite; durante absenfia; durante minodtate) are hereby granted to 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. FEES Letters ........................... Short Certificate(s) .......... Renunciation .................. Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... JCP Fee ........................ Inventory & Tax Forms... Other ............................ TOTAL ................ $ $ $ $ $ $,,¢/,_e. Attorney: I.D. No: Address: Telephone: DATE FILED: Elizabeth J. Goldstein 73779 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011 717-612-5803 ['his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office fbr permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9496736 No. Registrar [)ate mos ~,3~e~ ~? COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH * VITAL RECORDS ~.~PB,.T CERTIFICATE OF DEATH .... '." .... BLACK INK ~,. '~ / "1 ~ i I.J- I1~ I,~m'~.~ I~T ........... I~ ~ '~ ' 1 I LAST WILL AND TESTAMENT OF BETTY J. McCLURE I, BETTY J. McCLURE, of 4713-B Charles Road, Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I give to the issue of my late sister, Margaret L. Wiest, the sum of Ten Thousand Dollars ($10,000), free and clear of death taxes. I give this Ten Thousand Dollars ($10,000) to her issue, per stirpes, and authorize my Executor to make dis- tribution directly to said issue, regardless of age. SECOND: I give my tangible personal property to my children to be divided as they may agree. I have complete confidence that my children will carry out any written instructions that I may leave with regard to said tangible personal property, and that my children will give such furnishings as neither of their families may need to the issue of my late sister, Margaret L. Wiest. Should only one child survive me, that child shall be the sole beneficiary of said tangible personal property. Should no child survive me, I authorize my Executor to make such distribution hereunder as it deems appropriate and equitable. THIRD: I specifically exercise my power of appointment under Trust A of the Trust Agreement between my late husband, J. Robert McClure, and Hamilton Bank, now by merger First Union -1- National Bank, Trustee, and give, subject to payment of all death taxes, my entire estate, real, personal and mixed, as follows: A. To my son, James R. McClure, or his issue, all of my shares of stock of Rogele, Inc. (including any rights that I may have to receive funds from any sales agreements with regard to Rogele, Inc. stock that I may have executed or that the Trustee under Trust A as aforesaid may have executed). B. To my daughter, Lisbeth M. Bonner, or her issue, all of the rest and remainder. C. Should either of the above subparagraphs fail, the other shall correspondingly increase. D. Should both fail, I give my entire estate, real, personal and mixed, as follows: (1) Twenty percent (20%) to the issue of my late sister, Margaret L. Wiest, or her issue; and (2) Forty percent (40%) to The Boys Club of Harrisburg, without restriction as to use; and (3) Forty percent (40%) to The Program for Female Offenders, Inc. of the Greater Harrisburg Area, without restriction as to use. Should subparagraph (1) fail, the other subparagraphs shall correspondingly increase. Should The Boys Club of Harrisburg or its successor not be an active Section 501(c) (3) entity, its gift shall go instead to Market Square Presbyterian Church, -2- Harrisburg, Pennsylvania. Should The Program for Female Offend- ers, Inc. of the Greater Harrisburg Area not be an active 501(c)(3) entity, its gift shall go instead to Market Square Presbyterian Church, Harrisburg, Pennsylvania. FOURTH: Other than my gift in Item FIRST, if any individual beneficiary who would otherwise receive an interest in my probate estate through Item THIRD is under twenty-five (25) years of age, I direct that his (the masculine to include the feminine) inter- est be held in trust by my Trustee, hereinafter named, until such beneficiary reaches twenty-five (25) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate any unexpended balance of income to the extent permitted by law. Without the intervention of a guardian, such amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or to the person who has the care and control of such beneficiary. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a beneficiary, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administration be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, -3- without the intervention of a guardian, to the beneficiary, to the person with whom such beneficiary resides, to the person who has the care and control of such beneficiary, or may deposit such share in the beneficiary's name in a savings account in a savings institution of its choosing, payable to the beneficiary at majority, which I define as twenty-one (21) years. Should a beneficiary die prior to reaching the age of twenty-five (25) years leaving issue, his interest shall be allocated among said issue by my Trustee and held in trust for said issue, subject to the same trust provisions of this Will, but subject to the additional qualification that final distribu- tion be made to each said issue upon his reaching the age of twenty-one (21) years, or to his estate in the event of his death. Should a beneficiary die after reaching the age of twenty- one (21) years, but prior to reaching the age of twenty-five (25) years, leaving no issue, his interest shall be distributed as he may specifically direct in a valid Last Will and Testament. Unless such specific direction is made, the interest of a bene- ficiary who dies at any age prior to reaching the age of twenty-five (25) years leaving no issue shall be divided among his brothers and sisters and the issue of deceased brothers and sisters, per stirpes, or, if none exists, among my issue, per stirpes, or, if none exists, among the persons and in the propor- tions set forth in the final paragraph of Item THIRD, provided -4- that, any portion of such interest payable to a person who is the beneficiary of a subsisting trust under this Will shall be added to said trust, and be paid over to said beneficiary in accordance with the provisions of said trust. FIFTH: I appoint my son, James R. McClure, as my Executor, hereinafter referred to as my Executor, regardless of number or gender. If he is unable or unwilling to serve, I appoint my daughter, Lisbeth M. Bonner, as my Executrix. If she is unable or unwilling to serve, I appoint First Union National Bank, 30 North Third Street, Harrisburg, Dauphin County, Pennsylvania, as my Executor. I direct that my Executor serve without bond in any jurisdiction in which called upon to act. I name First Union National Bank as my Trustee, herein referred to as my Trustee, regardless of number or gender. I direct that my Trustee serve without bond in any jurisdiction in which called upon to act. SIXTH: I give to any Executor or Executors and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the Common- wealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the administration and until the comple- tion of the distribution of my estate, and until the termination of all trusts created hereunder and until the completion of the distribution of the assets of such trusts, including the power to -5- hold and to invest in any corporate fiduciary's stock, notes, certificates of deposit, and common funds, and the power to register securities in the name of a nominee. SEVENTH: I direct that this Last Will and Testament control the distribution of my property irrespective of whether there are children born to me or adopted by me subsequent to the execution of this Last Will and Testament. EIGHTH: The words "issue" and "children" whenever used in this Last Will and Testament shall include adopted children. IN WITNESS WHEREOF, I have set my hand and seal on this my and Testament this ~'~day of ~ , 1999. Last Will BETTY J. /M~C~.URE- (SEAL) SIGNED, SEALED, PUBLISHED, and DECLARED by BETTY J. McCLURE, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -6- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : WE, BETTY J. McCLURE, and Heath L. Allen , ShawnW. Weis , and Patricia D. 01yarnik , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. BET~Y 2. ~C~.URE, Testatrix Witness Witness Subscribed, sworn to, and acknowledged before me by BETTY J. McCLURE, the Testatrix, and subscribed and sworn to before me by Heath L. Allen , Shawn W. Weis , and Patricia D. 01yarnik , witnesses, this 28th day of April , 1999. -7- Oynthla J. Rule, Notary Public Camp Hill Boro Cumberland County My Commission Expires Jan. 24, 2000 LAST WILL AND TESTAMENT OF BETTY J. MC'CLURE KEEFER, WOOD, ALLEN ~, RAHAL ~. I 0 WALNUT STREET P 0 BOX 11963 HARRISBURG. PA 17101~"1963 Heath L. Allen CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Betty J. McClure Date of Death: September 27, 2003 Will No. Admin. No. 21-03-0793 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 II/~,/o ~ ' Name Address Lisbeth M. Bonner Steve Wiest Julie Saviano Kay Von Etten Nancy Wiest 701 Sharon Street, New Cumberland, PA 17070 7512 Clover Lee Blvd., Harrisburg, PA 17112 73 Fenimore Drive, Harrison, NY 10528 200 Birdie Lane, Etters, PA 17319 Avenida Guadalajura 110 B-l, San Sebastian de Los Reyes, 28700 Spain Notice has now been given to all persons entitled thereto under Rule 5.6(a). Signature Elizabeth J. Goldstein, Esquire Name 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011 Address (717) 612-5803 Telephone Personal Representative X Counsel for Personal Representative HEATH L. ALLEN N. DAVID RAHAL CHARLES W. RUBENDALLTT ROBERT L. WELDON EUGENE E. PEPINSKY, JR. JOHN H. ENOS ~ GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. L£WlST~' BRIDGET I~1. WHITLEY JOHN ~ FEICHTEL ANN MCGEE CARBON ELIZAB£TH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEEFER WOOD ALLEN & RAHAL, 415 FALLOWFIELD ROAD, SUITE 301 CAMP HILL, PA 17011-4906 PHONE 717-612-5800 FAX 717-612-5805 EIN NO. 23-0716135 www. keefe~vood.com L L P ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY HARRISBURG OFFICE: ;BIO WALNUT STREET HARRISBURG, PA 17101 PHONE 717-2§5-8000 December 16, 2003 717-612-5808 cswindler~keeferwood.com Via: Certified Mail Cumberland County Register of Wills Cumberland County Courthouse I Courthouse Square Carlisle, PA 17013 Re; Estate of Betty J. McClure File #21-03-0793 Dear Sir/Madam: Enclosed you will find a check in the amount of $16,150 as prepayment of Pennsylvania inheritance tax for the above estate. Thank you for your assistance. Please return a receipt in the enclosed envelope. Sincerely yours, C~le D. Swindler, Legal Assistant to Elizabeth J. Goldstein /cds 91128 Enclosure KEEFER WOOD ALLEN & RAHAL, L 415 FALLOWFIELD ROAD, SUITE 301 CAMP HILL, PA 1701 1-4906 I lll Iii I tlllllll Ii1111 Illlt 1 Il/!il I'1 ~. ~ ~:~ ~ ~6/2003 ~~...~ faa ~',~:d ~: ~om 1 ~:'01 7002 1000 0005 0062 Cumberland County Register of Wills Cumberland County Courthouse '1 Courthouse Square Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIWDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003338 GOLDSTEIN ELIZABETH J ESQUIRE 415 FALLOWFIED ROAD SUITE 301 CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 189-09-1511 FILE NUMBER: 21 03-0793 DECEDENT NAME: MCCLURE BETTY J DATE OF PAYMENT: 12/17/2003 POSTMARK DATE: 12/16/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $16,150.00 TOTAL AMOUNT PAID: $1 6,150.00 'REMARKS: LISBETH M BONNEREXEC-C/O " ELIZABETH J GOLDSTEIN ESQUIRE SEAL CHECK#NONE INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Betty J. McClure No. 21-03-0793 also known as Date of Death 09/27/03 , Deceased Social Security 189-09-1511 No. Lisbeth M. Bonner Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. lANe verify that the statements made in this Inventory are true and correct, lANe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Bizabe~thx~l. Go~d,~teij.~ / , ,* Personal Representative: Lisbeth M. Bonner 41274 I.D. No.: Address 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011 Telephone 717-612-5801 DESCRIPTION VALUE 1. Aquila Inc. 2. Govt Securities Inc. Fund 3. Harsco Corporation 4. Health Care Ppty 5. ML Low Duration Fund CI C 6. Piedmont Natl Gas 7. Tyco International Ltd 8. MCI Capital I Series A 06/30/26 $ $ 138.00 $ 30,140.08 $ 9,072.00 $ 33,216.12 $ 11,692.50 $ 5,503.31 $ 4,137.00 TOTAL $334,447.10 (Attach Additional Sheets If Necessary) See Attached Sheet ESTATE OF BETTY J. MCCLURE FILE #21-2003-00793 CONTINUATION OF INVENTORY o 10. 11. 12. 13. 14. 15. 16. 17. 18. Pimco Strategic Global Govt Fund NM Bank America Corp 09/26/02 Merrill Lynch Money Market PNC CD #21001032392 PNC Checking Account #51-4027-5172 PNC Money Market Account #51-3021-3234 GE Long Term Care Refund HCR Manor Refund Highmark Refund Neighbor Care Pharmacies Refund $ 19,277.45 $ 19,656.10 $ 33,688.00 $ 13,733.75 $ 13,210.10 $135,660.25 $ 2,404.39 $ 60.00 $ 325.26 $ 444.79 Total Inventory $334,447.10 REV-1500 EX (6-00) COMMONWEALTH OF · PENNSYLVAN IA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -- 2003 00793 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ McClure Betty J. Z · 189-09-1511 LLI DATE Of DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DO-YEAR) ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU 09/27/2003 09/03/3.919 C.; REGISTER OF WILLS LI,I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ SOCIAL SECURITY NUMBER ~ I~__~1' Original Return ' I 2. Supplemental Retum ' ] 3- Remainder Return (date of death pdor to 12.13.82) ~ 4, Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~-~ 5. Federal Estate Tax Return Required -,- OO I~ CD ~ I ~ 6. Decedent Died Testate (Attach copy of Will) I--'--] 7. Decedent Maintained a Living Trust (Attach copy of Trust) I- z uJ z O UJ Z ~ 9. Litigation Proceeds Received THIS SECTION MUST BE COMPLEYP-D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Elizabeth J. Goldstein 8. Total Number of Safe Deposit Boxes ~ 10. Spousal Poverty Credit (da~e of death between 12-31-91 and 1-1-95) ~ 1 1. Election to tax under Sec. 9113(A)(AuachSchO) FIRM NAME (IfApplicable) Keefer Wood Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011 TELEPHONE NUMBER 717-612-5803 OFFICIAL USE ONLY 13,221.3~, ~ 0.00 ; 134,920.56 0.00 0.00 199,526.54 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. J~ Owned Property (Schedule F) (6) [~J Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 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) (11 ) 12, Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 347,668.48 6,823.76 2,354.09 9,177.85 338,490.63 0.00 (13) Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 338,490.63 14. 0.00 x,00__(t5) 0.00 328,490.63 x,045 (16) 14,782.08 0.00 x.12 (17) 0 · 00 10,000.00 x.15 (18) 1,500.00 (19) 16,282.08 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 20. 2w4645 1.00o ,,.>. Decedent's Complete Address: ADDRESS 4713' B Charles Road Mechanicsburg STATE ~P 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 0.00 16,150.00 850.00 (1) Total Credits (A + B + C) (2) 0o00 0.00 Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 16,282.08 17~000.00 0.00 717.92 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Che to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... r~ ~ 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? ............................ ~"~ r~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ r~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiarv desionation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. s,o.. RE oF E ..so. RESPO.S,B.E FOR F,L,.O RE RN ADORESS 701 Sharon Street DATE New Cumberland, PA 17070 SIG NATU RE y.~,~,~TH~TATiVE ADORESS~i"5 Fallow~ield Road Suite 301 DATE Camp Hill, PA 17011 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 P.S. § 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax ratum ara 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 stepparant of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfera to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2w4646 1,0oo REV-1503 EX + (1-97) · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER McClure, Betty J. 21-2003-00793 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER Aquila Inc. DESCRIPTION 2 Govt Securities Inc. Fund 3 Harsco Corporation 4 Health Care Ppty 5 ML Low Duration Fund C1 C 6 Piedmont Natl Gas 7 Tyco International Ltd 8 MCI Capital I Series A Per Estate Val 9 Pimco Strategic Global Per Estate Val 10 NM Bank America Corp E Per Estate Val 06/30/26 Govt Fund 09/26/02 TOTAL (Also enter on line 2, Recapitulation) 2w4696 3.000 (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 2,088.00 138.00 30,140.08 9,072.00 33,216.12 11,692.50 5,503.31 4,137.00 19,277.45 19,656.10 $ 134,920.56 ILA. CSV "Historical stock prices provided by csI, Inc. Historical mutual fund and industry prices provided by Media 6eneral Financial Services." "Aquila, Inc. (ILA)" Daily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,3.480,3.480,3.250,3.430,741600 Page 1 HSC. CSV "Historical stock prices provided by csI, Inc. Historical prices provided by Media General Financial Services." "Harsco Corporation (HSC)" Daily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,38.300,38.490,38.070,38.270,131800 mutual fund and i ndust ry Page 1 HCP. CSV "Historical stock prices provided by CSI, Inc. Historical mutual fund and industry prices provided by Media General Financial Services." "Health Care Property Investors Inc. (HCP)" oaily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,45.120,45.600,44.950,45.600,110800 Page 1 PNY. CSV "Historical stock prices provided by CSI, Inc. Historical mutual fund and industry prices provided by Media General Financial Services." "Piedmont Natural Gas Co. (PNY)" Daily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,38.760,39.190,38.690,39.140,109100 Page I TYC. CSV "Historical stock prices provided by CST, Tnc. Historical prices provided by Media (;eneral Financial Services." "TyCO International Ltd. (TYC)" Daily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,20.830,21.180,20.660,21.000,7504300 mutual fund and industry Page 1 MCDUX. CSV "Historical stock prices provided by csI, Inc. Historical mutual fund and industry prices provided by Media General Financial Services." "Merrill Lynch LOW Duration C (MCDUX)" Daily prices (9/29/2003 to 9/29/2003) DATE,OPEN,HIGH,LOW,CLOSE,VOLUME 9/29/2003,10.290,10.290,i0.290,10.290,0 Page i Date of Death: 09/27/2003 Valuation Date: 09/27/2003 Processing Date: 12/03/2003 Estate Valuation Shares Security or Par Description High/Ask Low/Bid 2) 9811 GOVERNMENT SECS INCOME FD (383743267) UT GNMA SER iA OTC 08/26/2003 Carryover & daily interest: Last price available on 08/26/2003 1615 PIMCO STRATEGIC GBL GOV FD INC (72200X104) NYSE 09/26/2003 11.93000 09/29/2003 11.90000 Div: 0.074 Ex: 09/26/2003 Rec: 09/30/2003 Pay: 10/09/2003 3) 20000 BANK AMER CORP SUB INTNTS BE (06050XHT3) OTC DTD: 09/26/2002 Mat: 09/15/2027 6% 09/26/2003 09/29/2003 Int: 09/15/2003 to 09/27/2003 4) 400 MCI CAP I (55267Y206) PFD QUIPS A NQB 09/26/2003 09/29/2003 O.02O00 A/B 11.83000 H/L 11.79000 H/L 98.35640 Bid 97.80460 Bid 10.47000 10.40000 H/L 10.50000 10.00000 H/L Estate of: Estate of Betty J. McClure Account: 91128 Report Type: Date of Death Number of Securities: 4 File ID: McClure, Betty J. Estate Mean and/or Div and Int Security Adjustments Accruals Value 0.020000 N/A N/A 11.862500 0.074000 11.936500 19,277.45 98.080500 40.00 19,616.10 10.342500 4,137.00 Total Value: Total Accrual: $43,030.55 Total: $43,070.55 $40.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricin9 Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 6.4.3) REV-1508 EX + (1-97) C, OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER McClure, Betty' J. 21-2003-00793 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2 3 4 5 6 7 8 Merrill Lynch Money Market PNC CD #21001032392 PNC Checking Account #51-4027-5172 PNC Money Market #51-3021-3234 GE Long Term Care Refund HCR Manor Refund Highmark Refund Neighbor Care Pharmacies Refund TOTAL (Also enter on line 5~ Recapitulation) $ 33,688.00 13,733.75 13,210.10 135,660.25 2,404.39 60.00 325.26 444.79 199,526.54 2W46AD 2.000 (If more space is needed, insert additional sheets of the same size) 3RN-13-2004 ~8:47 4~2 ?~8 3458 PN CBANK January 14, 2004 Cayle D, Swindler 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Estate of Betty 3. MeClure, deceased SSN: 189-09-1511 DOD: 9/27/2003 Dear Ms. Swindler: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5140275172 BETTY l MCCLURE DOD balance: $13,209.40 + $.70 accrued interest Established 03/15/1989 Savings Account Account #5130213234 BETTY J MCCLURE DOD balance: $135,637.09 + $23.16 acenled interest Established 10/12/1989 Certificate of Deposit Account #21001032392 BETrY I MCCLURE DOD balance: $13,645.58 + $88.17 accrued interest E,~ablished 01/24/1995 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Cheeldng and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these i~ems, please call I-sg8-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office, Sincerely, RacheIle Wells 1-800-762. 1775 P7-PFSC-04-F 500 firs~ Ave. Pitt.~burgh PA 15219 M~mb~r FDIC TOTRL P. 01 REV-1509 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER McClure, Betty J. 21-2003-00793 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ,ADDRESS RELATIONSHIP TO DECEDENT A. Bonner, Lisbeth M. Daughter 701 Sharon Street New Cumberland, PA 17070 JOINTLY-OWNED PROPERTY: LE'rTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDEN'T'S IN II::~I::ST 1. A 07/11/1996 M&T Bank CD 31003914525935 26,442.76 50.00 13,221.38 owned jointly with decedent f s daughter, Lisbeth A. Bonner TOTAL (Also enter on line 6, Recapitulation) $ 13,2 2 1.3 8 ;pace is needed, insert additional sheets of same size) MaTBank December 11, 2003 Keefer, Wood, Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 499 Mitchell Street, Millsboro, DE 19966 Estate of Betty J. MeClure Date of Death: ~eptember 27, 2003 ~ocial Security Number: 189-09-1511 Dear Ms. Swindler: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Certificate of Deposit Account Number. ...................... 31003914525935 Ownership (Names oJ) .............. Lisbeth A. Bonner Betty J. McClure Opening Date ........................... 07/11/96 (account closed 11/05/03) Balance on Date of Death. .........$26,433.63 Accrued Interest $ 9.13 Total. ...................................... $26,442.76 The decedent did not have a safe deposit box. Sincerely, Charlene Warring'ton, Associate I (302) 934-2722 REV-1511 EX + (1-97) C6MMONW~LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER McClure, Betty J. 21-2003-00793 Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. 8 9 10 DESCRIPTION FUNEPJ~EXPENSES: Nell Funeral Home, obituary Neill Funeral Home Inc., check #140 written prior but clearing after decedent's date of death to, ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: AttorneyFees Name.- Keefer Wood Allen & Rahal, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City RelationshipofClaimanttoDecedent Probate Fees Accountant's Fees ~xReturnPreparer'sFees Cumberland Law Journal, The Sentinel, legal PA American Water Check printing fee legal advertising advertising State ~ Zip TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 88.00 3,155.00 0.00 3,000.00 0.00 313.00 0.00 0.00 75.00 115.79 28.17 48.80 6,823.76 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1512 EX + (1-97) SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McClure, Betty J. 21-2003-00793 Include unreimburs~ medi~l expenses. I~M NUMBEF 1. NeighborCare Pharmacy 2 PA Department of Revenue, DESCRIPTION final PA 40 TOTAL (Also enter on Fine 10, Recapitulation) $ AMOUNT 2,213.09 141.00 2,354.09 2W46AH 2.000 (if more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER McCluz NUMBER II. e, Betty J. NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY underSec. 9116(a)(1.2)] Bonner, Lisbeth M. 701 Sharon Street New Cumberland, PA 17070 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers Wiest, Steve 7512 Clover Lee Blvd Harrisburg, PA 17112 Saviano, Julie 74 Fenimore Drive Harrison, NY 10528 Von Etten, Kay 200 Birdie Lane Etters, PA 17319 Wiest, Nancy Avenida Guadalajura 110 B-1 San Sebastian de Los Reyes 28700 Spain 21-2003-00793 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Nephew Niece Niece Niece AMOUNT ORSHARE OFESTATE 328,490.63 2,500.00 2,500.00 2,500.00 2,500.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHH- ~ LAST WILL AND TESTAMENT OF BETTY J. McCLURE I, BETTY J. McCLURE, of 4713-B Charles Road, Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I give to the issue of my late sister, Margaret L. Wiest, the sum of Ten Thousand Dollars ($10,000), free and clear of death taxes. I give this Ten Thousand Dollars ($10,000) to her issue, per stirpes, and authorize my Executor to make dis- tribution directly to said issue, regardless of age. SECOND: I give my tangible personal property to my children to be divided as they may agree. I have complete confidence that my children will carry out any written instructions that I may leave with regard to said tangible personal property, and that my children will give such furnishings as neither of their families may need to the issue of my late sister, Margaret L. Wiest. Should only one child survive me, that child shall be the sole beneficiary of said tangible personal property. Should no child survive me, I authorize my Executor to make such distribution hereunder as it deems appropriate and equitable. THIRD: I specifically exercise my power of appointment under Trust A of the Trust Agreement between my late husband, J. Robert McClure, and Hamilton Bank, now by merger First Union -1- National Bank, Trustee, and give, subject to payment of all death taxes, my entire estate, real, personal and mixed, as follows: A. To my son, James R. McClure, or his issue, all of my shares of stock of Rogele, Inc. (including any rights that I may have to receive funds from any sales agreements with regard to Rogele, Inc. stock that I may have executed or that the Trustee under Trust A as aforesaid may have executed). B. To my daughter, Lisbeth M. Bonner, or her issue, all of the rest and remainder. C. Should either of the above subparagraphs fail, the other shall correspondingly increase. D. Should both fail, I give my entire estate, real, personal and mixed, as follows: (1) Twenty percent (20%) to the issue of my late sister, Margaret L. Wiest, or her issue; and (2) Forty percent (40%) to The Boys Club of Harrisburg, without restriction as to use; and (3) Forty percent (40%) to The Program for Female Offenders, Inc. of the Greater Harrisburg Area, without restriction as to use. Should subparagraph (1) fail, the other subparagraphs shall correspondingly increase. Should The Boys Club of Harrisburg or its successor not be an active Section 501(c) (3) entity, its gift shall go instead to Market Square Presbyterian Church, -2- Harrisburg, Pennsylvania. Should The Program for Female Offend- ers, Inc. of the Greater Harrisburg Area not be an active 501(c) (3) entity, its gift shall go instead to Market Square Presbyterian Church, Harrisburg, Pennsylvania. FOURTH: Other than my gift in Item FIRST, if any individual beneficiary who would otherwise receive an interest in my probate estate through Item THIRD is under twenty-five (25) years of age, I direct that his (the masculine to include the feminine) inter- est be held in trust by my Trustee, hereinafter named, until such beneficiary reaches twenty-five (25) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate any unexpended balance of income to the extent permitted by law. Without the intervention of a guardian, such amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or to the person who has the care and control of such beneficiary. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a beneficiary, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administration be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, -3- without the intervention of a guardian, to the beneficiary, to the person with whom such beneficiary resides, to the person who has the care and control of such beneficiary, or may deposit such share in the beneficiary,s name in a savings account in a savings institution of its choosing, payable to the beneficiary at majority, which I define as twenty-one (21) years. Should a beneficiary die prior to reaching the age of twenty-five (25) years leaving issue, his interest shall be allocated among said issue by my Trustee and held in trust for said issue, subject to the same trust provisions of this Will, but subject to the additional qualification that final distribu- tion be made to each said issue upon his reaching the age of twenty-one (21) years, or to his estate in the event of his death. Should a beneficiary die after reaching the age of twenty- one (21) years, but prior to reaching the age of twenty-five (25) years, leaving no issue, his interest shall be distributed as he may specifically direct in a valid Last Will and Testament. Unless such specific direction is made, the interest of a bene- ficiary who dies at any age prior to reaching the age of twenty-five (25) years leaving no issue shall be divided among his brothers and sisters and the issue of deceased brothers and sisters, per stirpes, or, if none exists, among my issue, per stirpes, or, if none exists, among the persons and in the propor- tions set forth in the final paragraph of Item THIRD, provided -4- that, any portion of such interest payable to a person who is the beneficiary of a subsisting trust under this Will shall be added to said trust, and be paid over to said beneficiary in accordance with the provisions of said trust. FIFTH: I appoint my son, James R. McClure, as my Executor, hereinafter referred to as my Executor, regardless of number or gender. If he is unable or unwilling to serve, I appoint my daughter, Lisbeth M. Bonner, as my Executrix. If she is unable or unwilling to serve, I appoint First Union National Bank, 30 North Third Street, Harrisburg, Dauphin County, Pennsylvania, as my Executor. I direct that my Executor serve without bond in any jurisdiction in which called upon to act. I name First Union National Bank as my Trustee, herein referred to as my Trustee, regardless of number or gender. I direct that my Trustee serve without bond in any jurisdiction in which called upon to act. SIXTH: I give to any Executor or Executors and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the Common- wealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the administration and until the comple- tion of the distribution of my estate, and until the termination of all trusts created hereunder and until the completion of the distribution of the assets of such trusts, including the power to -5- hold and to invest in any corporate fiduciary,s stock, notes, certificates of deposit, and common funds, and the power to register securities in the name of a nominee. SEVENTH: I direct that this Last Will and Testament control the distribution of my property irrespective of whether there are children born to me or adopted by me subsequent to the execution of this Last Will and Testament. EIGHTH: The words "issue" and "children" whenever used in this Last Will and Testament shall include adopted children. IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament this ~'~day of ~ , 1999. BETTY J. /M~C~URE- (SEAL) SIGNED, SEALED, PUBLISHED, and DECLARED by BETTY J. McCLURE, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -6- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : WE, BETTY J. McCLURE, and Heath L. Allen Shawn W. Weis , and Patricia D. 01yarnik , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. BET~Y 3. ~C~.URE, Testat-rix Witness Witness Patricia D. 01yarnik of April , 1999. Witness ~_5 Subscribed, sworn to, and acknowledged before me by BETTY J. McCLURE, the Testatrix, and subscribed and sworn to before me by Heath L. Allen , Shawn W. Weis , and , witnesses, this 28th day -7- / ~ Notarial Seal ~~ b'~ynthla J. Rule, Notary Public Camp Hill Boro, Cumberland Cou My Commission Expires Jan. 24, 20r~00f BUREAU OF INDIVIDUAL TAXES [NHERTTANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLOgANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-l;47 EX &FP ELIZABETH d GOLDSTEIN KEEFER ETAL 415 FALLOHFZELD RD $0 CAMP HILL PA 17011 DATE 08-16-2004 ESTATE OF MCCLURE DATE OF DEATH 09-27-2005 FILE NUMBER 21 05-0795 COUNTY CUMBERLAND ACN 101 Amount Remit'l'ed BETTY HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG"~.~ZS L__~IE ~ RETAZN LONER PORTI'ON FOR YOUR RECORDS ~'~J r :: ~* DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF~, CLUR~ := ~: ~,~ = BETTY J FILE NO. 21 05-0795 ACN 101 DATE ;~ RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED J 08-16-Z004 RESERVATZON CONCERNZNO FUTURE ZNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership ];nterest (Schedule C) ($) q. Hortgagas/Notes Recelvable (Schedule D) (~) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/MAsc. Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities~Liens (Schedule Z) (10) 11. Total Deduct ions 12. Net Value of Tax Return 154z920.56 .00 199z526.54 15t221.58 .00 .00 NOTE: To insure proper credi~ to your account, submit the upper portion .00 of this form ~th your tax payment. 547,668.48 15. 1~. NOTE: (8) 6,825.76 2~554.09 (11) 9.]77.8~ (12) 558,490.65 .00 338,490.63 18 and 19 wi11 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Sub,~act to Tax (1~) Zf an assess.ent ~as issued previously, lines 1~, 15 and/or 16, 17, reflect flgures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 1~ at Spousal rate 16. Amount of Line 1~ taxable at Lineal/Class A rate 17. Amount of Line 1~ at Sibling rate 18. Aeount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT D/SCUUNT (+J DATE NUMBER INTEREST/PEN PAID (-) 12-16-2005 CD005558 814.10 ZF PAID AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. (~). .00 x O0 = .00 (16) 528,490.65 x 045 = 14,782.08 (17) .00 x 12 : .00 (lB), 10,000.00 x 15 = 1,500.00 (19)= 16,282.08 AHOUNT PAID 16,150.00 TOTAL TAX CREDIT BALANCE OF TAX DUEt INTEREST AND PEN. TOTAL DUE 16,964.10 682. OZCR .00 682. OZCR { 1'F TOTAL DUE TS LESS THAN $1,, NO PAYHENT TS REI~U]'RED. TF TOTAL DUE TS REFLECTED AS A "CRED'rT" (CR),, YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCT'rONS. RESERVATION: Estates of decadents dying on or before December 1Zt 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years) the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (72 P.S. Section 91qO). Detach the top portion of this Notice and submit Nith your payment to the Register of Hitls printed on the reverse side. --Hake check or money order payable to: REGISTER OF WILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania [nheritance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special 2~-hour answering service for forms ordering: 1-800-56Z-ZD50; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-5020 [TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171Z8-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996t the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period es you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to tho date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (OZ) percent per annum calculated at a daily rata of .00016~. All taxes which became delinquent on and after January 1, 1982 w]11 bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by tho PA Department of Revenue. The applicable interest rates for 198Z through ZOO~ are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor ~ 20Z .0005~8 ~)'~'8-1991 11Z .000301 1983 162 .000~58 1992 92 .0002q7 198~ 11X .000501 199S-199~ 7Z .00019Z 1985 15Z .000556 1995-1998 92 .O00Z~7 1986 XOZ .OOOZ7~ 1999 7Z .00019Z 1987 IOZ .O00Z7~ ZOO0 7Z .000192 --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAID Daily Year Rate Factor ~'~ 9Z .0002~7 ZOOZ 6Z .00016~ 2005 5Z .000157 200~ ~Z .000110 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 data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES [NHERTTANCE TAX DTVTSTON DEPT. 280691 HARRTSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-160? EX &FP (Ol-OS) ELIZABETH J Gd~ST~ i5 KEEFER ETAL 415 FALLOWFIELD RD 30 CAMP HILL' ~:'~ ~PA 17011 DATE 09-13-2004 ESTATE OF NCCLURE DATE OF DEATH 09-27-2003 FILE NUNBER 21 03-0793 COUNTY CUNBERLAND ACN 101 Amount Rem 'i 'l:'lced BETTY J HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credt~ to your account, submit the upper port/on of ~his fore w/th your ~ax payment. CUT ALONG THIS LINE ~' RETAIN LOWER PORTION FOR YOUR RECORDS ~ ESTATE OF HCCLURE BETTY J FILE N0.21 03-0793 ACN 101 DATE 09-13-2004 THIS STATENENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH IN THE NAHED ESTATE. SHO#N BELO# IS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 08-§9-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYNENTS (TAX CREDITS): 16,282.08 PAYNENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 814.10 12-16-2003 08-24-2004 CD003338 REFUND .00 16,150.00 682.02- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 16,282.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. STATUS REPORT UNDER RULE 6.12 Name of Decedent: BetW J. McClure Date of Death: September 27, 2003 Will No. Admin. No. 21-2003-00793 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. State whether administration of the estate is complete: Yes X No 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 X 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 X No d. 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. Date: Signature Elizabeth J. Goldstein, Esquire Name (Please type or print) 415 Fallowfield Road, Suite 301 Address Camp Hill, PA 17011 (717) 612-5801 Telephone Capacity: ~ Personal Representative X Counsel for Personal Representative