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HomeMy WebLinkAbout03-0842Register of Wills of Estate of Elise B. also known as Steven R. Deller Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Deller No.~/--~-- _.~.~F~ , Deceased Social Security No. 577- 26- 6972 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 02/03/1981 and codicil(s) dated None Husband, Clarence R. Deller, predeceased decedent named in the last Will of 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 incompetent: 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 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 325 Wesley Drive, Lower Decedent, then 81 years of age, died 10/03/2003 Allen Township, Mechanicsburs, PA 17055 (liststreet, number, and municipality) at Health South, Mechanicsbur~, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) 184,300.00 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 undersi~lned: Si~lnature Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Typedorprintednameandresidence Steven R. Deller 594 Shore Acres Road, Arnold, MD 21012 Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or 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 e~i?,~ law. ~/~ ~ //,// Sworn to or affirmed and subscribed Steven R. Deller ~ before me this ,/CLX_) day of Estate of El"ise B. Deller Deceased Social Security No: 577-26- 6972 Date of Death: 10/03/2003 AND NOW, (~_~3Z.~,///'~ ,~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~'] Testamentary r-~ of Administration (c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Steven R. Deller in the above estate and that the instrument(s) dated 02/03/1981 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... Short Certificate(s) ..... Renunciation ........ Affidavits ( ) .... Extra Pages ( ) .... Codicil ........... JCP Fee .......... Inventory .......... Other ........... TOTAL ......... $ $ 57o o $ Prepared by the Pennsylvania Bar Association Register of Wills Attorney: Jennifer B. Hipp I.D. No: 86556 Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717/737- 8761 Copyrig ht (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) RENUNCIATION In Re Estate of deceased. To the Register of Wills of County. Pe.,msylvania. The undersigned Rogor J. Del_le~ and George F. Deller, n,:~aed Co-Executors of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testanemtary Steven R. Deller be issued to WITNESS ttmir hand this 7th day of October , 2003 461 Central Park West, Apt. 3 G New York, New York 10025 (Addr~s) George F. ~kler { (Signature) 718 Russia Avenue San Francisco, Cai iforDia 94112 (Addr~s) (Signature) (Address) t05.805 REV 9/86 This is to certdy that the information here given is correctly copied from an original certificate of death duly filed with me as Local Re, gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 9496851 Date Cumberland .... Artist/Writer 325 Wesiey unve/-'.pT.;~Z;~l Ac'ruAL Mechanicsburg, Pa. 17055 ',~.[..s.~e~...~.~..L.=~ George Solomon Deller COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Mechanicsburg I ~ ..~.~uu~ ~v.ec.anlcsuurg 1~ ~,~ ps~ White Graphics -~ '~ (~,2 1lb, i12' I~a' / _~ I'4. Lower ~n Cumberland ~1. MOTHEFI'SNAM~'F"sII~'i~4H~Suf'~T~} Neoma EIIswo~h ~.'~NT'S~'~ Steven Deller [~'" ~m's~~~ ~D 21012 ~,~u ~(~ DI Oct6,2003 [ ConohteCremato~ [ Schaefferstown, Pa. 17088 ~.. ~~ ~~~ [~ FD-012662-L ~E ~O~~me' Inc. 37 East Main Street Mechanicsburg, Pa 17055 Ii .............. , ........... I / ~ ~., ~ .~ I ~. D ~ ~ I~ ~ ~.~ ~ [3 [~ I~. ~-/~.. __ I~. ,,,. MC>HI'7"/oO I,,,. o,c.'roe, e~ G.~ 2. oo~ ,LAST WILL AND TESTAMENT OF ELISE B. DELLER I, ELISE B. DELLER, 1708 Chatham Road, Lower Allen Township, Cumberland County, Pennsylvania, being of sound, disposing mind, memory and understanding do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all Wills by me at anytime heretofore made. ITEM i - I direct my personal representative or representa- tives to pay all of my debts, funeral expenses, estate and inheritance taxes as soon after my death as may be found convenient. ITEM II - I give, devise and bequeath my entire estate unto my husband, CLARENCE R. DELLER, if he survives me by sixty (60) days. ITEM III - If my husband does not so survive me, I give, devise and bequeath my entire estate in equal shareS to my three sons, namely, GEORG F. DELLER, STEVEN R. DELLER and ROGER J. DELLER. If any son should fail to survive me, the share of my estate to which such deceased son would be entitled, I give in equal shares to such of his children as survive me. If any son dies leaving no children who survive me, the share of my estate to which he would otherwise be entitled shall be added to the shares of my other sons. ITEM IV - In the event that my huSband should fail to survive me as above provided, my personal representatives shall distribute my household furnishings, personal effects and other tangible personal property in kind to those entitled thereto giving consideration ¢,gcK.E. ar£~rever possible to personal preferences. In the event that they ATTORNEYS AT LAW HARRIEEURG, PENNSYLVANIA shall be unable to agree upon the distribution of any particular item, entitlement thereto shall be determined by lot. Such personal property shall not be distributed to the issue of a deceased son unless my living sons shall agree unanimously to do so. ITEM VI - In the event that any minor shall be entitled to a share of my estate, I appoint the DAUPHIN DEPOSIT BANK and TRUST COMPANY, Harrisburg, Pennsylvania, as guardian of the estate or estates of such minors. ITEM VII - I hereby appoint my husband, CLARENCE R. DELLER, as Executor of my estate, and if he is dead or unable to serve then I appoint GEORG F. DELLER, STEVEN R. DELLER and ROGER J. DELLER, as joint Executors. No personal representative appointed under this Will shall be required to file a bond in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ' day of February, 1981. ELISE B. DELLER (SEAL) Signed, sealed, published and declared by the above Testatrix as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other, we believing her to be of sound mind and memory have hereunto sub- scribed our names as witnesses. -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ) ) SS: ) We, ELISE B. DELLER, Testatrix, ~'//,~ ~e¢ce~ and' ;~~ ~ ~/~ , Witnesses, respectively, whose names are signed to the attached 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, 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 Testator, signed the Will as a witness and that to the best of his/her knowledge, the Testatrix was ak that time of age, of sound mind and under no constraint or undue influence. WITNESS ~--~.-'-;'~ :~k? .g~..~-~ .... S~ORN and subscribed and acknowtod~ed before mo by EBISE B. DELLER, Testatrix, ~,'//,'~m D~r¢- and ~¢ , Witnesses, respectively, this ~day of CLECKNER & FEAREN ATTORNEYS AT LAW HARRISBURG, PENNSYLVANIA February, 1981. I Notary Public My Commission Expires: ELISE B. DELLER CLECKNER AND FEArEN ATTORNEYS AT LAW 3I NORTH SECOND STREET HARRISBURG, PENNSYLVANIA I?lOI CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Elise B. Deller Date of Death: October 3, 2003 Will No. 21-03-0842 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 23, 2003: Name Address Steven R. Deller 594 Shore Acres Road Arnold, MD 21012 Georg F. Deller 6116 Merced Avenue, No. 22 Oakland, CA 94611 Roger J. Deller 461 Central Park West Apt. 3G New York, NY 10025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 10/24V03 Capacity: Jennifer'. Hipp, Esquire One West Main Street Shiremanstown, PA 17011 (717) 737-8761 Personal Representative X Counsel for Personal Representative JAMES D. BOGAR JENNIFER B. HIPP* *Also admitted to New Jersey Bar J^M~S D. B ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN, PENNSYLVANIA 17011 e-marl mafl@bogarlaw.com December 29, 2003 TELEPHONE (717) 737-8761 FACSIMILE (717) 737-2086 Direct e-mail Jhipp@bogarlaw. com VIA HAND DELIVERY Donna Otto Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: The Estate of Elise B. Deller No. 21-03-0842 Date of Death: October 3, 2003 Dear Ms. Otto: I represent the Estate of Elise B. Deller. Enclosed is a check made payable to the Register of Wills in the amount of $7,987.79, same constituting a prepayment at discount on account of Pennsylvania inheritance taxes in the above-captioned estate. The prepayment is determined as follows: $186,848.95 multiplied by 4.5% or $8,408.20, less discount in the amount of 5% or $420.41, resulting in payment of $7,987.79. Please provide me with the appropriate receipt in this matter. Your time and consideration in this matter are greatly appreciated. Ver~ truly yours, jEt'IF ?B~.' ~HiPP JBH/blw Enclosure cc: Steven R. Deller, Executor COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003383 BOGAR JAMES D ESQUIRE ONE WEST MAIN STREET SHIRMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 577-26-6972 FILE NUMBER: 2103-0842 DECEDENT NAME: DELLER ELISE B DATE OF PAYMENT: 12/29/2003 POSTMARK DATE: 1 2/29/2003 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,987.79 TOTAL AMOUNT PAID: $7,987.79 REMARKS: STEVEN RDELLER-C/OJAMESD BOGAR ESQ-TAX PAYMT SAME DAY CHECK# 101 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 REV-1500 INHERITANCE TAX RETURI RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-03-0842 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER T A X D E C E D E N T cAPB RL ~AC ~TK Co. R 5. E C A 6. P I T U 7. L A T 8. C O M T I 0 HARRISBURG, PA 171Z8-0601 DECEDENT'SNAME(LAST, FIRST, ANDMIDDLEIN[TIAL) Deller Elise B DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 10/03/2003 11/19/1921 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 577-26-6972 THIS RE I URN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (date of death , 3. Remainder Return prior to 1Z- 13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) 4. Limited Estate · Future Interest Compromise (date of death after 12-12-82) 6. Decedent Died Testate Decedent Maintained a Living Trust 1 (Attach copy of Will) (Attach copy of Trust) [] 9. Litigation Proceeds Received [~ 10. Spousal Poverty Credit ~ (date of death between 1Z-31-91 and 1 - 1-95) NAME COMPLETE MAILING ADDRESS Jennifer B. Hipp Esquire FI RM NAM E (If Applicable) TELEPHONE NUMBER 717/737- 8761 1. Real Estate (Schedule A) One West Main Street Shiremanstown, PA 17011 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) (z) (3) 13. Charitable and Governmental Bequests/Sec 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) None 164,194.91 None None 35,29J~!77 None None 11,986.03 ::: 289.76 (11):~: (12) (13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 0 16. Amount of Line 14 taxable at lineal rate 187,212.89 X .0 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 (14) (15) (16) (17) (18) OFFICIAL USE ONLY 199,488.68 12,275.79 187,212.89 187,212.89 0.00 8,424.58 0.00 0.00 19. Tax Due I Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 325 Wesley Drive Apt. 3231 CITY Mechanicsbur5 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) Z. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty I STATE ZIP ?A 17055 (~) 7,987.79 420.41 8,424.58 Total Credits ( A + B + C ) 8,408.20 0.00 0.00 16.38 0.00 16.38 Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to re~luest a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... ~ ~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either a merits benefts or care? . .. PY ..... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [---] ~-] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. [---] ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ r-~ ~'~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATUREOFPERS~.~..____~,~.7 ONRESPON_SIB_.) /.L/~FORFIj .~JNGRETURNSteven R. Deller DATE ~~_~ ///~///. 594 Shore Acres Road s .... Z.._,r~_._~_~ - -v t__/,~c,.t.,c.~ --~(~A~-f~--~---2-i6l-2- ............................. IGN;ATUREOFIPREPAREROT~ERTHANREPRESENTATIVE Jennifer B Hipp Esquire DAT--~Y~-- /I'-'~/.L' (-- One West M~in Street _ . . C"~ . / "' v-~ ~' ---s-~¥~-s-~-~X--i-fdii- .................... i~,~ :.~'.~-c ~;";d~t;; '~f i~' ;~ '~;' ;'~t'e'r' 5~i~, 'i i' i'~9'4 ~a~cl' ~;f0'rg"~l;~a~ 'i,' i'9'9'5 'il~; Ya'x ;;ie 'i~np~;e~' o~ ting' ~';i '~aiu'g'of'ir;ngf'ers io '0; io;. t~; ug; 'of il~e .... surv~wng spouse is 3% [72 P.S. 9116 (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% [7;) 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 return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 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(aX1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-485 EX+ (9-00) ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 SAFE DEPOSIT BOX INVENTORY HARRISBURG, PA 17128-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE ~=~ FILE NUMBER ~,~ SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER 577-26-6972 DECEDENT'S NAME (LAST, FIRST, MIDDLE) Deller, Elise B. , DATE OF DEATH October 3, 2003 ADDRESS OF DECEDENT (STREET) (CITY) (STATE) (ZIP CODE) Bethany Court, Apt. 3231, 325 Wesley Drive, Mech~nicsburg, PA 17055 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) Jennifer B. Hipp, Esquire (S'l ~EET NAME) (CITY) (STATE) (ZIP CODE) One West Main Street Shiremanstown PA 17011 NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) Jennifer B. Hipp, Esquire None (STREET NAME) (CITY) (STATE) (ZIP CODE) One West Main Street Shirem~nstown PA 17011 b. (NAME) (RELATIONSHIP) Steven R. Deller Son (STREET NAME) (CITY) (STATE) (ZIP CODE) 594 Shore Acres Road Arnold MD 21012 c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT aox IS LOCATED (NAME) PNC Bank (STREET NAME) (CITY) (STATE) (ZIP CODE) NAME OF PERSON MAKING LAST ENTRY DATE OF CONTRACT TO RENT BOX ~ NUMBER OF BOX NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO SOX a. (NAME) Steven R. Deller (STREET ADDRESS) 594 Shore Acres Road (CITY) (STATE) (ZIP CODE) Arnold MD 21012 NAME AND TITLE OF EMPLOYEE T~AKING THE INVENTORY A W, LL,. THE [] YES ,..s, M~.h~ n i csburg PA DATE AND TIME OF LAST ENTRY TITLE UNDER WHICH BOX IS REQUESTED 17055 b. (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) a. Date of will: b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) SAFE DEPOSIT BOX INVENTORY Page, of__ INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appea~ing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COUPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSI.~BOX~NVENTORY: /~ v/~ / // PRINT NAME ' \ ' ~ PRINT NAM~AND CHECK APPROPRIATE E~OX BELOW v Jennifer B. Hipp, Esquire Steven R. Deller PRINT TITLE DATE CHECK APPROPRIATE BOX: Attorney ~[~Ex.cutor(t,x~ [] ^d~n~stmto~x/ [] Estate Representative [] Joint owner of safe deposit box NOTE: Attach additional 8V=' x 11" sheet(s) if necessary or use duplicates of this page of form. - - REV- 1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS Elise B Deller SSf~ 577-26-6972 10/03/2003 All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-03-0842 ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 MFS Municipal Limited Maturity Fund A Municipal Fund, 41,486.00 Account No. 0037-08189276790, date of death balance $41,486.00 2 MFS Pennsylvania Municipal Bond Fund A - Municipal 114,536.78 Fund, Account No. 0030-08189276786, date of death balance $114,536.78 3 Putnam Investments Asset Alloc. Conserv C1-A, Account 6,004.62 No. B13~3-264-0447644619, date of death balance $6,004.62 4 Schwab Securities Account No. 27525731, date of death 2,167.51 balance $2,167.51 TOTAL(Alsoenteronline2, Recapitulation) 164,194.91 nee( d, additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) Guardian Angel Financial AdVisory "Mutual fund advice for all the wodds opportunities" online 24/7/365 at www.gafamufualfun.ds;com Document COnfidentiality Agreement The recipient of this document agrees that all information cOntained, inclUded, related, or foll°whtg this document and its tolai COntents are Subject to the document COnfidentially agreement at the "doCCOnf link of the website Shown above. 1.0/5/2003 Jenifer Hipp Esq. Bogar law firm fax 737-2086 Dear Jennifer Thanks for your time on the phone, giise Dollar had 3 mutual fund accounts, via my firm on 10/3/2003. All were es~ab.lished in her name alone in t-~,e sp. rinq of 2003 after her husband"s d'ea~h. They were jtwros clients of mine si]~ce apex 1984. The accounts and values cn 1.0/3 were: MFS pa tax free MFS muni limited mat Putnam conservative aa 124,536.78 4!,~4'86.00 6,004.62 The Putnam account was a rol!over from :Clarence D~iller's IRA. The valumark annuity policy was closed Out Via C'larence.,s death and its~ proceeds PUt in the MFS. funds. Hope that is helpfu~l, emaii me if u need anything else. CarPe diem, Mike O'Bri~n C~fC office: 1.9 Houston Drive Mechanicsburg p~. 17050-16i2 VOice. i-SQQ.4:79~-HFC fax: 1-888-fax-mike pager. 1-80Q-PAGE. DAD pager (P~7t7~2t3-51.06) securities transactions via Financial West'Group member NASOiSiPciMSRB Schwab Secur/tt;es Ya/uation Service ® Date of Death: Valuation Date: Processing Date: 10/03/2003 10/03/2003 12/26/2003 Shares or Par Security Description 1) 2) 1474.51 Cash (CASH) 600 HANDSPRING INC (410293104; HAND) COM NASDAQ - Industrial 10/03/2003 Estate Valuation High/Ask Low/Bid 1.19000 1.12000 H/L Estate of: ELISE B DELLER Account: 27525731 Report Type: Date of Death Number of Securities: 2 File ID: 27525731 Mean and/or Div and Iht Adjustments Accruals Security Value 1,474.51 1.155000 693.00 Total Value: Total Accrual: Total: $2,167.51 $0.00 ACCOUNT TITLE: ELISE B DELLER Portfolio Endnotes $2,167.51 Page 1 Please visit your local Schwab office with questions or call (800) 435-4000. tlistorical quote inl'brmation will be ohtained frour sources believed to be reliable, but its accuracy and completeness cmmot be guaranteed. The in/brmation is heing provided for your personak mmCOlnmercial use only. Charles Schwab & Co., Inc. does not give tax advice and is not responsible/hr perlbrming mathematical compulations heyond Ihose presented. ©2003 Charles Schwab & Co., Inc. All rights reserved. Memher SIPC/NYSE. 1;1'R13319-02(07/03) REV- 1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Elise B Deller SS~/ 577-26-6972 10/03/2003 21-03-0842 Include the proceeds of litigation and the date the proceeds were received by the estate. All propel~y jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 2 3 4 5 6 DESCRIPTION Asbury Services, Inc. & Affiliates Bethany Village Deposit Refund Guideposts - Refund Pennsylvania State Employees' Retirement System PNC Bank, N.A. - Checking Account No. 5080033146, balance $24,912.68, accrued interest $0.87 USAA Insurance - Renter's Policy Refund Contents of home and personal property - Retirement date of death TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) copyright (c) 1996 form software only CPSystems, Inc. VALUE AT DATE Of DEATH 7,500.00 11.23 414.00 24,913.55 154.99 2,300.00 $ 35,293.77 Form REV-1508 EX (Rev. 1-97) PN CBANK November 28, 2003 James D Bogar Attorney at Law One West Main St Mechanicsburg, Pa 17011 Scp Estate ofElise B Deller (Deceased) SSN: 577-26-6972 DODi 10/03/2003 Dear Mr Bogar: In response to your request for Date of Death baIances for the customer noted above, our records show the following: Checking Account Account~5080033146 Established 12/28/1995 ELISE B DELLER CLARENCE R DELLER DOD balance: $24,912.68 + $0.87 accrued interest Interest earned 01-01-03 thru 10-03-03 $27.62 YTI) Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Louise A Rump PNC Decedent Reporting Firstside Center 500 First Ave, 4m F1 CIF Pittsburgh PA 15219-3128 1-800-762-1775 Member FDIC TOTAL P.01 ESTATE OF Elise B Deller SS# 577-26-6972 10/03/2003 Debts of decedent must be reported on Schedule I. ITEM FILE NUMBER 21-03-0842 NUMBEF A. FUNERAL EXPENSES: DESCRIPTION Myers Funeral Home Funeral Romberger Memorials Memorial Marker 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 Year(s) Commission Paid: ~Zip Attorney's Fees Jennifer B. Hipp Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees State ~ Zip Accountant's Fees Register of Wills Tax Return Preparer's Fees Other Administrative Costs Bethany Court Apartments Final Bill Pennsylvania State Employees' Retirement System - Overpayment of Retirement RESERVES: Costs to conclude administration of Estate including filing fee for PA Inheritance Tax Return, Inventory and First & Final Account; preparation of Personal and Fiduciary Income Tax Returns 4 Verizon - Bill-Final TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 870.00 295.00 7,875.00 283,00 1,034.50 372.60 1,250.00 5.93 11,986.03 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV- 151Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Slise B Deller SS~/ 577-26-6972 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 10/03/2003 Include unreimbursed medical expenses. ITEM NUMBER 1 Alert Pharmacy - Bill-Final 2 Silver Spring Ambulance - DESCRIPTION FILE NUMBER 21-03-0842 Bill-Final (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 10, Recapitulation) AMOUNT 100.66 189.10 289.76 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) .EV-~5~3 EX+(9-O0) I I SCHEDULE J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN I .ENE ,c,^R, s ESTATE OF Elise B Deller SSf/ 577-26-6972 10ff03/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1 1 Ceorg F. Deller 6116 Merced Ave., No. 2 Oakland, CA 94611 NUMBER I. II. Roger J. Deller 461 Central Park West Apt. 3G New York, NY 10025 Steven R. Deller 594 Shore Acres Road Arnold, MD 21012 Do Not List Trustee(s) FILE NUMBER 21-03-0842 Son S on Son OF ESTATE One-third of entire estate One-third of entire estate One-third of entire estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET ('if more space is needed, insert additional sheets of the same size) Copyright (c) ?000 form software only The Lackner Group, Inc. $ 0.00 Form REV-1513 EX (Rev. 9-00) ~LAST WILL AND TESTAMENT OF ELISE B. DELLER I, ELISE B. DELLER, 1708 Chatham Road, Lower Allen Township, Cumberland County, Pennsylvania, being of sound, disposing mind, memory and understanding do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all Wills by me at anytime heretofore made. ITEM I - I direct my personal representative or representa- tives to pay all of my debts, funeral expenses, estate and inheritance taxes as soon after my death as may be found convenient. ITEM II - I give, devise and bequeath my entire estate unto my husband, CLARENCE R. DELLER, if he survives me by sixty (60) days. ITEM III - If my husband does not so survive me, I give, devise and bequeath my entire estate in equal shareS to my three sons, namely, GEORG F. DELLER, STEVEN R. DELLER and ROGER J. DELLER. If any son should fail to survive me, the share of my estate to which such deceased son would be entitled, I give in equal shares to such of his children as survive me. If any son dies leaving no children who survive me, the share of my estate to which he would otherwise be entitled shall be added to the shares of my other sons. ITEM IV - In the event that my huSband shOuld fail to survive me as above provided, my personal representatives shall distribute my household furnishings, personal effects and other tangible personal property in kind to those entitled thereto giving consideration cLEc~,~,aF~k~rever^~0,..~sA,~w possible to personal preferences. In the event that they ~ARRISBURG, PENN~LYAN[A shall be unable to agree upon the distribution of any particular item, entitlement thereto shall be determined by lot. Such personal property shall not be distributed to the issue of a deceased son unless my living sons shall agree unanimously to do so. ITEM VI - In the event that any minor shall be entitled to a share of my estate, I appoint the DAUPHIN DEPOSIT BANK and TRUST COMPANY, Harrisburg, Pennsylvania, as guardian of the estate or estates of such minors. ITEM VII - I hereby appoint my husband, CLARENCE R. DELLER, as Executor of my estate, and if he is dead or unable to serve then I appoint GEORG F. DELLER, STEVEN R. DELLER and ROGER J. DELLER, as joint Executors. No personal representative appointed under this Will shall be required to file a bond in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ..... day of February, 1981. ELISE B. DELLER (SEAL) Signed, sealed, published and declared by the above Testatrix as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other, we believing her to be of sound mind and memory have hereunto sub- scribed our names as witnesses. CI.£¢KN£R & FEAR£N A'I'TORN s'YS AT I-'A'W ~,~/ /~ -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ) ) SS: ) We, ELISE B. DELLER, Testatrix, ~V/~//,'~.v% and ~u~[ ~ ~/~ , Witnesses, respectively, whose names are signed to the attached 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, 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 Testator, signed the Will as a witness and that to the best of his/her knowledge, the Testatrix was a[ that time of age, of sound mind and under no constraint or undue influence. T STATRIX SWORN and subscribed and aCknowledged before me by ELISE B. DELLER, Testatrix, W*'//,'~ ~¢~¢m and ~otl< , Witnesses, ~espectively, this ~day of February, 1981. CL£¢KNER Jr FEAREN Notary Public My Commission Expires: Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Elise B Deller No. 21-03-0842 also known as Date of Death 10/03/2003 , Deceased Social Security No. 577-26-6972 Steven R. Deller, Personal Representative(s) of th~ 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. I AVe verify that the statements made in this Inventory are true and correct, lAVe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Nameof A~orney: Jennifer B. Hipp Esquire I.D. No.: 86556 Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717/737-8761 Personal Representative Signature: S~l~~~--ff/~. Signature: Address: 594 Shore Acres Road Arnold, MD 21012 Telephone: 410/757- 6924 Dated: (See continuation (Attach additional sheets if necessary) Description page(s) attached) Value Total: 199,488.68 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) Estate of: Date of Death: County: Elise B Deller 10/03/2003 Cumberland INVENTORY CASH: Asbury Services, Inc. & Affiliates - Bethany Village Deposit Refund Guideposts - Refund Pennsylvania State Employees' Retirement System - Retirement PNC Bank, N.A. - Checking Account No. 5080033146, date of death balance $24,912.68, accrued interest $0.87 USAA Insurance - Renter's Policy Refund PERSONAL PROPERTY: Contents of home and personal property 7,500.00 11.23 414.00 24,913.55 154.99 2,300.00 32,993.77 2,300.00 STOCKS/LISTED: MFS Municipal Limited Maturity Fund A - Municipal Fund, Account No. 0037-08189276790, date of death balance $41,486.00 MFS Pennsylvania Municipal Bond Fund A - Municipal Fund, Account No. 0030-08189276786, date of death balance $114,536.78 Putnam Investments Asset Alloc. Conserv C1-A, Account No. B13-3-264~0447644619, date of death balance $6,004.62 Schwab Securities - Account No. 27525731, date of death balance $2,167.51 41,486.00 114,536.78 6,004.62 2,167.51 TOTAL RECEIPTS OF PRINCIPAL ............... 164,194.91 199,488.68 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004105 HIPP JENNIFER B. ESQ. ONE WEST MAIN STREET SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 577-26-6972 FILE NUMBER: 2103-0842 DECEDENT NAME: DELLER ELISE B DATE OF PAYMENT: 07/01/2004 POSTMARK DATE: 07/01/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $16.38 TOTAL AMOUNT PAID: $16.38 REMARKS: SEAL CHECK# 121 INITIALS: JA RECEIVED BY.' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STEVEN R. DELLER, EXECUTOR 121 594 SHORE ACRES ROAD 410-757-6924 _ Pay to the ~~ 041 Order of_ ~' $ ~.PNCBAN< Dollars Pi,4C lta~ ~.& 040 Choice _~~ Central PA ~or ~e~;~e 7-~ _ =_.~: ......... ~-'0 3' I' ~ i' 2 ? 3P'~.' SO0 ~ 2 ~ 7qg~, 0~2~ BUREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DZVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-'I6~? EX AFP C01-05) JI~:N~TFER ~'~HTPP ESQ :Wi :mmmN"'~ "--" ~ , i SHI REMANSTFI~IWN 'PA 17011 DATE 08-25-200q ESTATE OF DELLER DATE OF DEATH 10-05-2005 FILE NUHBER 21 05-08qZ COUNTY CUHBERLAND ACN 101 Amount Remi'l:ted ELISE B HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LOWER PORTION FOR YOUR RECORDS ~ CUT ALONG THIS LINE REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF DELLER ELISE B FILE NO. 21 05-08q2 ACN 101 DATE 08-25-200~ TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schodule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Mor~gages/Notes Receivable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Propor~y (Schedule E) (5) 6. Jo/ntly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Asse~s APPROVED DEDUCTIONS AND EXEHPTIONS: 9 Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10 Debts/Mortgage Liabilities/Liens (Schedule I) 11 Total Deductions 12 Net Value of Tax Return 16q~19~.91 O0 35~293.77 O0 00 NOTE: To insure proper cred/t to your account, sube/t ~ho upper port/on 00 of this form w/th your tax payment. 00 (8) 11,986.05 (lo) 289.76 13 NOTE: ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rata 199,q88.68 (11) 12.27~;,7~ (la) 187,212.89 Charitable/Governmental Bequests; Non-olec~ed 9115 Trusts (Schedule J) (15) .00 Net Value of Estate Subject ~o Tax (lq) 187,212.89 Tf an assessment was issued prev/ously, lines lq, 15 and/or 16, 17, 18 and 19 wlll reflect flgures that include the total of ALL returns assessed to date. 16. Amount 17. Amount 16. Amount 19. Princi TAX CREDITS PAYMENT DATE (15), .00 X O0 = .00 (16). 187,212.89 X Oq5 = 8,qZq.58 (17). .00 x 12 = . O0 (lB), .00 x 15 = .00 (19)= 8,qZq.58 AMOUNT PAID 7,987.79 16.58 12-29-2005 07=01-ZOOq of L/nB lq taxable a~ Lineal/Class A rate of L/ne lq at Sibl/ng rate of L/ne lq taxable a~ Collateral/Class B rata =al Tax Due RECETpT DISCOUNT [+) NUMBER INTEREST/PEN PAID (-) CD005585 q20.ql CD00~105 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 8,qZq.58 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any future intmrmst in the estate is transferred in possession 6r enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of NilIs printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Hills) any of the Z3 Revenue District Offices, or by calling the special Z4-hour ansearing service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (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. ZBIOZ1, Harrisburg~ PA l?lZB-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (GZ) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1~ 1982 wilZ bear interest at a rate which will vary from calendar year to calendar year with that rats announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ~ .000548 1988-1991 llZ .000301 ~ 9Z .000247 1983 162 .0004'~8 199Z 92 .000247 ZOOZ 62 .000164 1984 llZ .000301 1993-1994 7Z . OOO19Z 2003 57. .000137 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOZ .000274 1999 7Z .O0019Z 1987 IOZ .000Z74 ZOO0 7Z ,00019Z --Interest is calculated as fallows: INTEREST = BALANCE OF TAX UNpATD X NUtlBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notlce issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calcuIated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Elise B. Deller Date of Death: October 3, 2003 Will No. 21-03-0842 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration 'of the above-captioned estate: 1. State 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. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separa te Orphans' Court No. (i f 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 Cerk of the Orphans' Court and may be attached to this report. ~~. Sign tour}. Date: 1/11/05 Ll_ C)(j.~ LU ~ C) :~:-~ [7':- L:~ _I C~) I,_~. :E:: .,,;;:: Jennifer B. Hipp, Esquire Name (Please type Or print) One West Main St. Shiremanstown, PA 17011 Address ("') C'-.l o~ r-"'" ~l-:i C) C,._ a C) U.J CY" "'-,- ,,",,~.t -J I,JJ c:;;) = "'" ::::::::,n ~~~: uo::~ CC'.;,;e;- 00'; U (717) 737-8761 Te I. No. ("') Capacity: Personal Representative x Counsel for personal representative J (MAH: rmf/ AM3)