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Home My WebLink About04-0631 PETITION FOR PROBATE and Estate of Charles C. Chapman, Jr. also known as To: Social Security No. Deceased. 179-12-566~ GRANT OF LETTERS No. Zl--O' l- ¢31 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/a~:~ 18 years of age or older an the execut or in the last wilt of the above decedent, dated July 9, 2002 and codicil(s) dated in the named ,Xl~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at Church of God Home, Borough of Carlisle, Cumberland county, PA (list street, number and muncipality) Decendent, then 82 years of age, died June 2/4, 200/4 .,~la~X , at Church of God Home, Carlisle Borough, Cumberland Cmmty, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 321 Fifth Street~ New Cumberland Borough, County, Pennsylvania 50,000.00 120,000.00 Cumberland WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~?,'~_////JMES' ~RDNER C~NAN , = 8/ 101 Sunset View Drive ~'= New Cumberland, PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ; 88 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 represen- tative(s) of the above decedent petitioner(s) will well/a~td truly administer the estate according to law. before me this (I . day of ~ [ ~ES ~NER C~ ~ ~ - . tt .... . ~ Estate Of Charles C. Chapman, Jr. , Deceased DECREE Ok, PROBATE AND ~R2_NT OF LETTERS AND NOW __ ' , in consideration of the petition on the reverse side hereof, satisfactory proof having been ?resented before me, iT [q L~. At.~ED ~b.a~ the instrument(s) dated July 9, 2002 described therein be admitted [o probate and filed of record as the iasr will af Charles C. Chhpman, Jr. and Letters Testamentary_ are hereby granted to JAMES GARDNER CHAPMAN FEES Probate, Letters, Etc .......... Short Certificates( )t~..' ....... TOTAL Filed ................................... ATTORNEY(Sup. Ct.I.D. No.) 414 Bridge St., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE 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 for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photogragh.. Local Registrar No. JUN 2 6 2004 Date ~105 43Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH ° VITAL RECORDS CERTIFICA'I'E OF DEATH J SEX JSOCIAL ECURITY, MBER · ' ' -- lq __ 5662 , Charles C. Chapman Jr , Male · 17~ r(~D~TEOFDE^IH(MOnth'Da¥'YeaO · ~.~4June 24, 2D04 I .bCumberland. Carlisle I~.Church of God Home i~.~,~.~'' , ite Fuel Oil ,a. Proprietor Service DECEDENTS 101 Sunset View Drive ACTUAL RESIDENCE New Cumberland,PA 17070 (se..,,.~., 16. on o~he¢ side) FATHER'S NAME (First. Middle, Last) ,..Charles C. Cha Sr. m. James G. Cha 21a. O~er (Specify) IVVuAS DECEDENT EVER IN I DECEDENT'S EDUCATION I MARITAL STATUS - Mare°d, .S. ARMED FORCES? I (SeecifY °~t hi~el~ ~'ad* ¢°n~cl~ I / v..D"l ~.1--1 I E~..~,,S.~.,..~ co~, I ' ' ( fY) ....... I,,. ,-'t2 I' .... '" ,,.wi o bW ,,. PA State ~d ,7c. [] Yes. decedent ,red ~n decedent ,rD. c~ Cumberlandlo.,n,,~p? ,d. lXt No.~=,~nt,,~ Carlisle lwp c~ty/boro DATE OF DISPOSITION ( . Day. Y~ ',~.~ne 28, 2004 TIME OF DEATH IMMEDIATE CAUSE (Final res~4.~g .~ death)---*, a, .~[lr.. WAS AN AUTOPSY I WERE AUTOPSY FINDINGS I MANNER OF DEATH PERFORMED? I AVAILABLE PRIOR TO I ICOMPLETIOR OF CAUSE I Natu~a~ ~ .om*Ode I OF DEATH? I Accident [] Pe~ InveslJgat~n Yes[] No~J~ Yes[] NoD ~L~_~ [] Cou~cI not de Oeterrmrmd CERTIFIER (Check O~lfy Gee) IMOTHER'S NAME (First, Mi~Jle. Maiden Surname) ~,. Rose M. Wagner INFORtA~NT~'S MA~ILING ADDR.ESS.(~trpe(, Cityff~?n, ~tate. Zip ~. u/ aunset view Drive, New Cumberlan, ~)I~Op~.eSPOSITION-Name o~ Cern°leeL Crsmato(y ILOC^T, ON.¢,,,.o~., st... z,, c~ Mt. (livet (~metery I New Cumberland, PA 21c. I 21d. INAME AND ADDRESS OF FACIt ITY 342-L Ig~.one&MurrayFH408 3rd St. ~e time, dele and place stated DATE PRONOUNCED DEAD (Month, Day, Year) LICENSE NUMBER DATE SIGNED (Month. Day. Yea~) WAS CASE REFERRED TO A MEDICAL EXAMINER Y- [] No [] DATE OF INJURY I TIME OF INJURY ,.J~.Y AT ~oR.? I DESCR,BE "O~,.JUR~ OCCURRED LOCATION (SEEM, City/Town, State) b~ ~ e~lm~aaon ln~ Inv~ltlon. In my apish, dll~ occad al ~l fl~. ~tl, ~ place. ~d dui to the Causal and LICENSE NUMBER I DATE SIGNED (Month. Day. Year) NAME AND ADORESS OF PERSON WHO COMPLETED CAUSE OF DEATH ep\wills\CHAPMANcharles\6-02 LAST WILL AND TESTAMENT OF CHARLES C. CHAPMAN, JR. I, CHARLES C. CHAPMAN, JR., of the Borough of New'Cumberland, Cumberland County, Pennsylvania, declare this to be my'~iast will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I hereby give and bequeath my hunting rifles, shotguns and equipment unto my son, JAMES GARDNER CHAPMAN, with instructions that he allow his brothers and sister to use the same for hunting and recreational purposes and that the guns be kept in the Chapman family. ITEM III: I hereby give and bequeath all of my furniture, house- hold equipment and tangible personal property unto my then living children, to be divided among them as they may agree, or if they cannot agree then as my Executor shall determine. ITEM IV: I direct that my son, JAMES GARDNER CHAPMAN be given an option to purchase all of my real estate at 321 Fifth Street in the Borough of New Cumberland for a price of $120,000.00. My said son shall exercise this option within 90 days after my death, after which time the option shall expire. My son may have a period of two years Page 1 of 5 after my death in which to pay the purchase price, during which time interest at the rate of 5% per annum shall accrue on the unpaid balance. ITEM V: I hereby give and bequeath the sum of $2,000.00 to each of the following named grandchildren provided, however, should any of the following named grandchildren be indebted to me, the gift shall be reduced by the amount of the indebtedness. Should the indebtedness exceed $2,000.00, any balance over $2,000.00 shall be forgiven at my death: AARON CHAPMAN, GREGORY CHAPMAN, MICHAEL ZEIGLER, JEFFREY ZEIGLER, and STEVEN ZEIGLER. ITEM VI: I hereby give, devise and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, as follows: A. One-fourth (1/4) in equal shares unto the then living children of my deceased daughter, CAROL A. ZEIGLER, to wit: MICHAEL ZEIGLER, JEFFREY ZEIGLER, and STEVEN ZEIGLER. B. One-fourth (1/4) unto my son, CHARLES ROBERT CHAPMAN, or if he is not living, then unto his children, JANELL CHAPMAN and GREGORY CHAPMAN, in equal shares. C. One-fourth (1/4) unto my son, THOMAS EUGENE CHAPMAN, or if he is not living, then unto his son, AARON CHAPMAN. Page 2 of 5 D. One-fourth (1/4) unto my son, JAMES GARDNER CHAPMAN, or if he is not living, then unto his children, JOEL G. CHAPMAN and AMELIA C. CHAPMAN, in equal shares. ITEM VII: I hereby nominate, constitute and appoint as guardian for any minor who may take a share under this will, the parent of said minor. ITEM VIII: I appoint my son, JAMES GARDNER CHAPMAN, Executor of this my last will. Should my son, JAMES GARDNER CHAPMAN, fail to qualify or cease to act as Executor, I appoint my son, CHARLES ROBERT CHAPMAN, Executor of this my last will. ITEM IX: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, CHARLES C. CHAPMAN, JR., have hereunto set my hand and seal this ~ day of ~~, , 2002. CHART,ES Co cHAp~AN, JR.~' SIGNED, SEALED, PUBLISHED and DECLARED by CHARLES C. CHAPMAN, JR., the Testator above named, as and for his Last Will and Testament, Page 3 of 5 and in the presence of us, who at his request, in his presence and in the preser~c~ of each other, have subscribed our names as witnesses. iddress COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : I, CHARLES C. CHAPMAN, JR., the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. CHARLES C. C . CHAPMAN, JR., the Testator, this Sworn to or affirmed to and acknowledged before me by CHARLES C. ~ day of ~ , 2002. · Notary Pubic Page 4 of 5 NOTARIAL SEAL PATRICI-IIA L. YOTEFI, Notary Fu5lic e~vOCun~berland~oro. Cumi~erland Co emn~Js~ion ~xpires Nov. 18, COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. witnesses, this Sworn to or affirmed to and acknowledged before me by O~9n-I~''~ ~-~~ and k~ ~ iF__'-j~ , Lc{c_ day of ~~ , 2002. Notary Pub~~ Page 5 of 5 NOTARIAL SEAl. ?ATRICNIA L. YOTER, No!ary Public New Cumberland Boro. Cumberland Co. MX Commi~ion Expires Nov. 18, 2.002 STONE, LAFAYER ~ SHEKLETSKI A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 414 BR~'~WEET NEW GIII~IBERLA_,NrD, PA 17070 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name ef Decedent: CHARLES C. CHAPMAN, JR. Date of Death: JUNE 25, 2004 Will No. 21-04--0631 Te the Register: I certify that notice of beneficial interest required by Rule 5.6(a) ef the Orphans' Court rules was served en or mailed to the following beneficiaries ef the above captioned estate en July 12, 2004. Charles Robert Chapman 12607 Beech Fern Lane Bowie, HD 20715 Gregory Chapman 12601 Beech Fern Lane Bowie, MD 20715 Thomas Eugene Chapman 5330 Gibble Road Harrisburg, PA 17112 Aaron Chapman 5330 Gibble Road Harrisburg, PA 17112 James Gardner Chapman 101 Sunset View Drive New Cumberland, PA 17070 Hichael Zeigler 810 Bridge Street New Cumberland, PA 17070 Jeffrey Zeigler 3050 Old Trail Rd., Box D-4 York Haven, PA 17370 Steven Zeigler 463 Granite Quarry Road New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Date: Dav~!_ , ElFquire 414 Bridge '~treet New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative Est\mis\CHAPMANexercise IN RE: ESTATE OF CHARLES C. CHAPMAN, JR., LATE OF THE BOROUGH OF NEW CUMBERLAND, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2004-00631 EXERCISE OF OPTION The undersigned, JAMES GARDNER CHAPMAN, hereby exercises the option to purchase 321 Fifth Street, Borough of New Cumberland, Cumberland County, Pennsylvania, under the terms and conditions as set forth in Item IV of the Last Will and Testament of Charles C. Chapman, Jr. Sworn to and sub;~gr~bed before me this '=~k%% day of September, 2004. Notary Public NOTARIAL SEAL I C~qOL L. TROXELL. Not~ry Public J !~ Clll~befla~l Ooro. Cumbe~,lan~ Ce. I Mycemm~mo. Exper. ~C. aT, 2005 1 :/' ~AME's ~ARDNER C~[~MAN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CHAPMAN JAMES GARDNER 101 SUNSET VIEW DRIVE NEW CUMBERLAND, PA 17070 ______u fold ESTATE INFORMATION: SSN: 179-12-5662 FILE NUMBER: 2104-0631 DECEDENT NAME: CHAPMAN CHARLES C JR DATE OF PAYMENT: 04/15/2005 POSTMARK DATE: 04/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/24/2004 NO. CD 005211 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,500.00 I I I I I I I I TOTAL AMOUNT PAID: $1,500.00 REMARKS: J CHAPMAN CHECK# 1019 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY , Deceased No.21 04 0631 Date of Death 6/24/2004 Social Security No. 179-12-5662 Estate of Charles C. Chapman, Jr. also known as James Gardrler Chapman 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. If\Ne verify that the statements made in this inventory are true and correct If\Ne understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Personal Representative: Name of Attomey: David H. Stone, ESQuire 1.0, No.: 39785 James Gardner Cha Address: 414 Bridge Street New Cumberland Telephone: (717) 774-7435 Dated PA 17070- Description Church of God Home-refund Furniture and household goods to be sold N Hunting rifles shotguns and equipment 1500.00 152 shares Met-life stock @ $35.49 per share 5394.48 Money due decedent from Michael Zeigler 800.00 Money due decedent from Jeffrey Zeigler 2,000.00 Total 131,909.48 (Attach Additional Sheets if necessary) 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. RW-4 rf\J Continuation of Inventory Charles C. Chapman, Jr. 21 04 0631 Page 1 Description of Inventory Description Money due decedent from Steven Zeigler Value 2,000.00 Property located at 321 Fifth St., New Cumberland, Cumberland County, PA herein giving the son, James Gardner Chapman, he option to purchase the property @ $120,000 120,000.00 Subtotal $ Grand Total $ 122,000.00 131,909.48 REV-1500 EX. (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o w o w o w ~ :w:-II) (.)ll::W: wGo(.) J:OO (.)ll:...I GolD Go c( DECEDENTS NAME (lAST, FIRST, AND MIDDLE INITIAL) Cha man Jr. Charles C. DATE OF DEATH (MM-DO-Year) DATE OF BIRTH (MM-DD- Year) OFFICIAl USE ONLY N f\ P 0 FILE NUMBER 2 1 -0 4 0 6 3 1 COONTYCOOE -YEAR- - - NUiiiiER- - SOCIAL SECURITY NUMBER 1 79- 1 2 - 5 6 6 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (dateoldeathpriorto12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See. 9113(A) (Attach Sell 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS David H. Stone Es uire 414 Bridge Street FIRM NAME (If Applicable) Stone La Faver & Shekletski New Cumberland, PA 17070 TELEPHONE NUMBER 717 774-7435 z o ~ ~ ::::>> !:: D. <C o w D:: 0.00 X _(15) 0.00 183,328.66 x .045 (16) 8,249.79 0.00 x .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 8,249.79 6/24/2004 5/24/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 1. Original Return D 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy oIWoII) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (AUach copy 01 Trust) D 10. Spousal Poverty Credit (date 01 death belween 12-31-91 and 1-1-95) (8) (11) (12) (13) (14) 120,000.00 5,394.48 OFFICIAL USE ONLY .... Z W C Z o Go II) W ll: ll: o (.) (1) (2) (3) (4) (5) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or SoIe-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ <C I- ::::>> D. ::E o o ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 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. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < . Ai\),} 4,800.00 1 ,715.00 883;25 -."., 93,813.41 #.,."1 N 226,606.14 25,338.98 17 ,938.50 43,277.48 183,328.66 183,328.66 o d t' C I t Add ece, en s omPle e ress: STREET ADDRESS . 101 Sunset View Dnve . CITY I STATE I ZIP New Cumberland PA 17070- Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 8,249.79 Total Credits (A + 8 + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty (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 request 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. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 8,249.79 8,249.79 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; ........................................................................... D 00 b. retain the rightto designate who shall use the property transferred or its income; ......,................................. D 00 c. retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?...... ............... ........ ................. ......... ............ ....... ..................... D 00 3. Did decedent own an "in trust for" or payab~;upon death bank account or security at his or her death? ................. D 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............,......................................................................................... 00 D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PA 17070 DATE ADDRESS 414 Bridge Street New Cumberland PA 17070 For dates of death on or atter July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or atter 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 return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or atter 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(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1 ,3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX + (6-98) . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ChaDman. Jr.. Charles. C. 21 04 0631 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wilting buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real DrODertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. ITEM NUM8ER 1 DESCRIPTION Property located at 321 Fifth St., New Cumberland, Cumberland County, PA herein giving the son, James Gardner Chapman, the option to purchase the property @ $120,000 VALUE AT DATE OF DEATH 120,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 120 000.00 REV-1503 EX + (6-98) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles. C. FILE NUMBER 21 04 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0631 ITEM NUMBER 1 DESCRIPTION 152 shares Met-Life stock @ $35.49 per share VALUE AT DATE OF DEATH 5,394.48 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5 394.48 REV-1007 EX + (6-98) . SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles. C. FILE NUMBER 21 04 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. 0631 ITEM NUMBER 1. DESCRIPTION Money due decedent from Michael Zeigler 2 Money due decedent from Jeffrey Zeigler 3 Money due decedent from Steven Zeigler VALUE AT DATE OF DEATH 800.00 2,000.00 2,000.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 800.00 REV-,l508 EX + (6-98) '. - COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles. C. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0631 ITEM NUMBER 1 2 3 DESCRIPTION Church of God Home-refund Furniture and household goods to be sold Hunting rifles shotguns and equipment VALUE AT DATE OF DEATH 15.00 200.00 1,500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 715.00 REV-1509 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Chaoman. Jr.. Charles. C. FILE NUMBER 21 04 0631 If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Charles Robert Chapman 12607 Beech Fern Lane Son Bowie, MD 20715- B James Gardner Chapman 101 Sunset View Drive Son New Cumberland, PA 17070- C JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ""OF DATE OF DEATH ITEM FOR JOINT MADE INCLUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENl'S INTEREST 1. A,B 11/06/97 Waypoint Bank-Checking Acct. #700034566 2,251.89 33.34 750.78 Princ. $2,251.87. Int. $.02 joint w/James G. Chapman or C. Robert Chapman 2 A,B 11/03/98 Waypoint Bank-Savings Account #770001065 397.34 33.34 132.47 Princ. $397.28, Int. $.06 joint w/James G. Chapman or C. Robert Chapman TOTAL (Also enter on line 6, Recapitulation) $ 883.25 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 0631 ESTATE OF Chaoman. Jr.. Charles. C. FILE NUMBER 21 04 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY ITEM tICLUIlE TIE NAME OF TIE TRAN5FEREE. TIER RflATlONSHP TO DECEDENT ANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TlWlSFER. ATTAClI A Cf:RY OF TIE DEED FOR REAl. ESTATE. VALUE OF ASSET INTEREST (IF APPlICAl!lE) VALUE 1 MetLife Contract No. 077904957 AB 84957.46 100. 84,957.46 2. Property located in Abbott Township, Potter County, PA 13,137.60 100. 6,000.00 7,137.60 at assessed value (5520 times CLR 2.38) transferred to James G. and Denise L. Chapman, his wife, on Lf-;l1-oL/ 3 Waypoint Bank-IRA Aeeount, Prine. $1,121.35, Int. $$.87 1,122.22 100. 1,122.22 4 Waypoint Bank-IRA Aeeount #125501940, Prine. $595.67, 596.13 100. 596.13 Int. $.46 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 93813.41 (If more space is needed, insert additional sheets of the same size) R~V-1511 EX + (12-99) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles. C. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 0631 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: James R. Gingrich-inscription on stone 100.00 Stone Murray Funeral Home-funeral expo 7,327.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Corrvnission Paid: 2. Attomey Fees David H. Stone, Esquire 11,330.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 275.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 1 Pinker Assoc.-footcare prior to death 36.55 2 Brockie Parmtech-debt of decedent for medications 618.88 3 Steven M. Zeigler, CPA-2003 inc. tax prep 367 4 PA Dept. of Revenue-underpayment for 2003 11.65 5 Travelers Life & Annuity Ins.-ins. premium 49.66 6 Shellby Casualty Insurance Co.-property ins. 569 7 James G. Chapman-oil, invoices & dumpster 1003.02 8 PNC Bank-check printing fee 27.6 9 Robin Gasperetti-personal taxes 11 10 Robin Gasperetti-real estate taxes on properpty 932.43 11 Robin Gasperetti-school taxes on property 1583.17 12 Verizon-telephone service 6.75 TOTAL (Also enter on line 9, Recapitulation) $ 25,338.98 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Chapman, Jr., Charles, C. Decedent's Name Page 1 21 04 0631 File Number Schedule H. Funeral Expenses & Administrative Costs. B7. ITEM NUMBER AMOUNT 13 14 15 16 17 18 19 20 21 22 23. 24. 25. 26. DESCRIPTION Borough of New Cumberland-sewer & trash PAWC-water services at property Waste Management-extra trash service PPL Utilities-electric service at property UGI-gas service at property UGI-gas service at property Borough of New Cumberland-sewer and trash UGI-gas service PPL Electric-electric services at property PAWC-water services at property Cumberland Law Journal-advertising grant of letters The Patriot News Co.-advertising grant of letters Register of Wills-filing Inheritance Tax Return and Inventory Reserve for closing expenses 123.35 37.48 1 57.62 101.6 26.53 11.69 63.45 18.32 112.15 23.78 75.00 109.30 30.00 200.00 SUBTOTAL SCHEDULE H-B7 1,090.27 REV-1~12 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles. C. FILE NUMBER 21 04 0631 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 . Church of God Home-personal care VAlUE AT DATE OF DEATH 17,938.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17.938.50 REV"513EX'" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ChaomalL .Ir. r.h~rIAl': C. 21 04 0631 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)\ 1. Charles Robert Chapman Lineal 44,632.16 12607 Beech Fern Lane Bowie MD 20715- 2 James Gardner Chapman Lineal 44,632.17 101 Sunset View Drive New Cumberland PA 17070- 3. Thomas Eugene Chapman Lineal 44,632.16 5330 Gibble Road Harrisburg, PA 17112 4. Michael Zeigler Lineal 15,677.39 810 Bridge Street New Cumberland, PA 17070 5. Jeffrey Zeigler Lineal 14,877.39 3050 Old Trail Rd., Box D-4 York Haven, PA 17370 6. Steven Zeigler Lineal 14,877.39 463 Granite Quarry Road New Cumberland, PA 17070 7. Aaron Chapman Lineal 2,000.00 5330 Gibble Road Harrisburg, PA 17112 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SldeET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Chapman, Jr., Charles, C. Decedent's Name Page 2 21 04 0631 File Number Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. Gregory Chapman Lineal 2,000.00 12607 Beech Fern Lane Bowie, MD 20715 ~l. ep\wills\CHAPMAllcharles\6-02 . H .. LAST WILL AND TESTAMENT OF CHARLES C. CHAPMAN, JR. I, CHARLES C. CHAPMAN, JR., of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I hereby give and bequeath my hunting rifles, shotguns and equipment unto my son, JAMES GARDNER CHAPMAN, with instructions that he allow his brothers and sister to use the same for hunting and recreational purposes and that the guns be kept in the Chapman family. ITEM III: I hereby give and bequeath all of my furniture, house- hold equipment and tangible personal property unto my then living children, to be divided among them as they may agree, or if they cannot agree then as my Executor shall determine. ITEM IV: I direct that my son, JAMES GARDNER CHAPMAN be given an option to purchase all of my real estate at 321 Fifth Street in the Borough of New Cumberland for a price of $120,000.00. My said son shall exercise this option within 90 days after my death, after which time the option shall expire. My son may have a period of two years Page 1 of 5 , l after my death in which to pay the purchase price, during which time interest at the rate of 5% per annum shall accrue on the unpaid balance. ITEM V: I hereby give and bequeath the sum of $2,000.00 to each of the following named grandchildren provided, however, should any of the following named grandchildren be indebted to me, the gift shall be reduced by the amount of the indebtedness. Should the indebtedness exceed $2,000.00, any balance over $2,000.00 shall be forgiven at my death: AARON CHAPMAN, 'GREGORY CHAPMAN, MICHAEL ZEIGLER, JEFFREY ZEIGLER, and STEVEN ZEIGLER. ITEM VI: I hereby give, devise and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, as follows: A. One-fourth (1/4) in equal shares unto the then liv~ng children of my deceased daughter, CAROL A. ZEIGLER, to wit: MICHAEL ZEIGLER, JEFFREY ZEIGLER, and STEVEN ZEIGLER. B. One-fourth (1/4) unto my son, CHARLES ROBERT CHAPMAN, or if he is not living, then unto his children, JANELL CHAPMAN and GREGORY CHAPMAN, in equal shares. C. One-fourth (1/4) unto my son, THOMAS EUGENE CHAPMAN, or if he is not living, then unto his son, AARON CHAPMAN. Page 2 of 5 I, II D. One-fourth (1/4) unto my son, JAMES GARDNER CHAPMAN, or if he is not living, then unto his children, JOEL G. CHAPMAN and AMELIA C. CHAPMAN, in equal shares. ITEM VII: I hereby nominate, constitute and appoint as guardian for any minor who may take a share under this will, the parent of said minor. ITEM VIII: I appoint my son, JAMES GARDNER CHAPMAN, Executor of this my last will. Should my son, JAMES GARDNER CHAPMAN, fail to qualify or cease to act as Executor, I appoint my son, CHARLES ROBERT CHAPMAN, Executor of this my last will. ITEM IX: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WiTNESS WHEREOF, I, CHARLES C. CHAPMAN, JR., have hereunto set my hand and seal this q , 2002. ~v~ day of -~ )( (~-%~ C~C. .. ? CHARLES C. CHA N, JR.- SIGNED, SEALED, PUBLISHED and DECLARED by CHARLES C. CHAPMAN, JR., the Testator above named, as and for his Last Will and Testament, Page 3 of 5 I' and in the presence of us, who at his request, in his presence and in of each other, have subscribed our names as witnesses. 4~, h'^~t~k) .;( ress ~t ~ ~~;~ Wi nrJs 0 1:1:;/</ (},~ /L ddress ), COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, CHARLES C. CHAPMAN, JR., the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. c~-t'. ~ ~~ CHARLES C. CHAP N, JR.v Sworn to or affirmed to and acknowledged before me by CHARLES C. ~ CHAPMAN, JR., the Testator, this day of :ru'(r ~4- y~ . Notary Pub c , 2002. Page 4 of 5 I NOTARIAL SEAL i PATRICHlA l. YOTER, ~Jolary Public I NeVI Cumb~rf?nd Bora. Cumberland Co. I My C.ommlS!lOn Expires Nov. 18,2002 I . .I[ COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, ~J\n lc\ s~ , and k 'a'( P ~ . L uc...k l!:>, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. ~ '.-" -~"'- es ~ -;e. ~~~i2f Wl.t.n s Sworn to or affirmed to and acknowledged before me by \)pnh'l ~~~ witnesses, this ~ day of and Y~<t~ "l?. L4C kef <"3~ ' 2002. ?twkY~ . Notary Publ' , Page 5 of 5 I NOTARIAL SEAL PATRICHIA L YOTER, Notary Public New Cumberland Bom. Cumberland Co My CommiS!lon Expires Nov. 18, 2002 Est\mis\CHAPMANexercise IN RE: ESTATE OF CHARLES C. CHAPMAN, JR., LATE OF THE BOROUGH OF NEW CUMBERLAND, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2004-00631 EXERCISE OF OPTION The undersigned, JAMES GARDNER CHAPMAN, hereby exercises the option to purchase 321 Fifth Street, Borough of New Cumberland, Cumberland County, Pennsylvania, under the terms and conditions as set forth in Item IV of the Last Will and Testament of Charles C. Chapman, Jr. ~ft~ ~. Sworn to and sub~r~ed before me this '~~ day of September, 2004. ~~.~ Notary Public 00 ::::(b' 3""' 0" .' Ct: ~ ......, ~1,: C/:l fT1 -0 N W -0 W b. (.1 Vi .. . ' a: PEht6tlVAfM NOTARIAL SEAl. CAROL L. TROXell. Notary Public New Cumberland 8oro. Cumberland Co. My Commission Expires Dee. 27. 2005 MSN Money - MET Chart: Investor Page 1 of2 ! Sign Inner! 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Name or Symbol: MET ','.::::; f:,'ll ~J:'~ Quote, Chart, News Snapshot MetUfe Inc Quotes Date High Charts 6/30/2004 35.9700 Historical Real-Time Intraday 6/29/2004 35.7200 Key Developments 6/28/2004 35.9400 Recent News 6/25/2004 35.6900 Research 6/24/2004 35.7200 Company Report SEe Filings 6/23/2004 35.4900 Advisor FYI 6/22/2004 35.5400 Stock Rating 6/21/2004 35.3500 Earnings Estimates Analyst Ratings 6/18/2004 35.8900 Financial Results 6/17/2004 35.7700 Insider Trading Ownership 6/16/2004 36.0000 Community 6/15/2004 36.3000 Guided Research 6/14/2004 36.1800 Research Wizard 6/10/2004 36.1300 Find Stocks 6/9/2004 36.3400 Stock Screener 6/8/2004 36.4500 Power Searches Top Rated Stocks 6/7/2004 36.5000 Related Links 6/4/2004 35.9800 E-mail & Alerts 6/3/2004 35.7900 IPO Center Message 8Qgrds 6/2/2004 36.0100 Capital Gains Analysis 6/1/2004 35.7600 . Find Symbol Print Report Download File Shov.,' Chart adv, A, Low Close Volume 35.4300 35.8500 1,288,100 35.4100 35.6000 924,600 35.4700 35.5100 944,900 35.1600 35.5200 2,281,900 35.3000 35.4900 1,381,900 35.0900 35.4300 1,374,900 34.8500 35.4800 1,431,400 34.9400 35.0000 2,136,200 35.0800 35.2600 2,256,500 35.0600 35.7700 1,636,900 35.4800 35.4800 1,494,100 35.7100 35.8500 1,711,800 35.7500 35.9200 1,256,300 35.7900 36.0500 908,200 35.7400 35.7600 1,606,600 36.0600 36.1500 2,345,800 35.8200 36.4000 1,557,400 A.M ER ITRAD E 35.5800 35.7300 1,160,000 FRE 35.4200 35.5800 1,597,200 TRAD 35.3800 35.8200 1,324,200 35.3000 35.7200 1,513,100 http://moneycentra1.msn.comlinvestor/ charts/chartd1.asp ?Symbol=MET &DateRangeF orm... 3/24/2005 ~IWay~i!1J LOOK FOR US. WE'LL GET YOU THERE. 7/12/2004 STONE LAF AVER & SHEKLETSKI 414 BRIDGE ST PO BOX E NEW CUMBERLAND P A 17070 The information which you requested on the account(s) of CHARLES C CHAPMAN JR (Social Security Number 179-12-5662) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name ofJoint Owner, if any Date Ownership Was Established Additional Information Requested 125501940 RETIREMENT 011383 595.67 .46 596.13 011383 700034566 CHECKING 110697 2251.87 .02 2251.89 770001065 SAVINGS 110398 397.28 .06 397.34 781524300 RETIREMENT 022795 1121.35 .87 1122.22 JTO JTO JAMES G JAMES G CHAPMAN OR CHAPMAN OR SOLE ,., nnn'n'nrr 110398 022795 \ ~~~ e-c...~' - 110697 1 ~ ~~- 1\().1't'U- s&v..,~ k c. . ~bb-elt ChOf\'Y\~ ,... nnnnn"'r ~I\~ ~YTS SENIOR SERVICES REP. P.O. Box 1711, HARRISBURG. PeNNSYUfANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) , IN YORK AREA 717/815-4500 ' www.waypointbank.com 08/25/2004 13:47 3035723535 METLIFE PAGE 01/Bl I Individual Bus;+ Operations Annuity Admlnls\r.llion P.O. Box 17010 ! DGtl'ler. CO 80217-0010 , MetLife@ , August 25, ~004 . I i David Stonei Attorney at taw i I FACSIMILft: 717-774,3869 I ! i RE: Chat\les Chaptnan, Deceased Metl-ife Contract No. 077904957 AB i ~ Dear Mr. S~e: At the requeJt of the MetLife agent Jerry WaIn, I am providing the following infonnation on the above refer~ced non-qualified annuity contract: I I Val~ as of date of death 06124/04: $84,957.46 ! i Cost ~asis as of date of death: $55,000.00 ! If you have ai1,y questions regarding your account or the information contained in this letter, please contact our Customer Service Department at 1-800-638-7732. i I ! Sincerely, : ~ ! Miri Stein~ Field Support; i I i ! _r.....-_.-_~ .........- r.l."":::~~""t::I,..t;: 1".l:l;Z .~ .......--..-....-............-..--,,,. !! ~t~1 [ . :~. mJNiBODN ubl'AGE ntur :~.~ .! t r .~: ~~l : : ~ .... I I I f '~/,~ : THE ;- .3 0 ~ .,1' ./ March , ill 'II, 7,t/' ~f ./1' L.r-t/ j : 1jt~.,-aft !ii", H,It,drrtl """ FUtr-ti,.. (19") I. , . .:":: iii!: A1IlIA IWlY SO>>Wf and ALBIRT C. scmwr, h.Z' hUlbusd, .t J :: '1 .: 01' tll. BoI'OUIh of lev C1IIb.Z'land, Countr 01' Cuaber- . J . ~V I . land, and st~t. ot penn.rlvaDia, GR.AJn'OIlS, parU.. : - 1 I.. i. ;'1 i ot the tir.t part,' i i . ":. f . j I .; ;,~: .:; , A II D .IL '; iLl: ~C..~':< =:':ion':~l' .1/11.; .~~ t:! : ot ClIIber1ancl, and State or P4Iln'71Y&n1a, CIU.N'1'IZS, ',: j \,'" j : 1'&"'1.. i, ! I J-.~'! . i : ~ : . ~..j : :' I' e ~: 'I~ :'~-I' j.,,: .itIf."tIr, '7"'" "it ,dill1-,/1.. ./IIt, JI'St "",, /" -"J. i~ ! .. i~/;'~ ~/'''' ,,,'" ./ !ftIXJmII 'ftI<<ISDD AID 10/100($1)000.00) DOLLARS, . .~: ~ : ';' l ~ i i i ! ~ . !;.~: : I: . .: ::;. ~ ...,,~ ~/I'" U"i,tJ SIIII" _/""",u., .,1/ flIUI '''''I? ,.ill 6~ lA, ,.ill ;.,t1ee .,i,It".1 : .......',/. ~/" I.ill ;.",1e. _, lA, ,i,.", I"", ., ".iI H/'" III, .1ott,1i"1 _,," tkliv,/'7 ., li",1 . . I, 'i +111 _/t,,.,,/ is Iu"fy M~'''~II, hav, I'd.,td, ..'Il'if.,.... i . j /;Ii,iu , ~1I/"I,tI, "',,,,ttl, ,,"~lId"tI HIIJ,.""tI, ./HI ~ Ilm'I",m", tI, 1'''''', H,.t-i"J. . ;,Ii''', II/PI. n".", ""f1O ..i ,."J,.", ..." ,.t, ,.ill ,.,,1.' _/1'" I'rtllltI ",,.,, ! ~; ~ '.! ~1Jo .Mj~, 1I11t1 fI,lip', . 1 i ',,". !. t.~. i '!itel't&1n loti of land ,u._t. 11\ .th. IloZ'QUP ot M..w C\ab.r~, c~..ll' ii; '~. . ot .bel'luId, and State of Pennerl".l_, lion p&J'tlculaZ'17 lIounde!l MCl I! g .. toll"",; to vit: . ~ ; ,i ,', .' I j I ,..t. .! ). i ~ BlGIIOIIJIC ata ~t .....t7'-OU en) t.et. trca t.b. nort.hveat. cIor-i I ! j. DeZ' ot tocut. u4 r1Rh S\1'..ta; tbtooeveat.waI'dl7,aloq toh. ~i i I SW-.e\, titt.7-tow (54) tee\ \0 11ft. ot tot No. ,0, an h.n1na~ r I . .., P.).us ~eao. DCribwai-dlJ, a.lont tha ...., on. bundHclt.veat.7 (120) :t: '. ~ '. b. I ~htI'ft .u. ot a tea (10) 100\ all.,; theno. ...t.,~, alODI the. ! i " ~t. i~54) t..t to a pol8t; th.., .o\ltb an. ~ tvent7 (120) tIft '0 . , I ! , t . plac. of IIGIJDI1IC. ! j' I ! .:1:. *" i.o.. 31, 32 u4 the Wltem tOUl' (4) teet of tot No. 33 ot tb. l'~ Iii :'1 i . ; noOl'dtcl1Jl th. CNIb.l'lUlll CO\IDt7 Reoordar" ortic. 1A Plan Book- I, 1 1 e. '" 1Unn, th'I'.OQ, tI'"t.tcl . t~ 1114 olle-half 1'017 briok the1liA1 hov.". t. . f ;.1..:.: ~L ~... pr.... 1IlhS.cb 11MI' SII\Cla7 and Kar1 Irene Sundq, bia wit., ~1. j ~ ! . : d.~~Iept.ber 28, 1944. ucll'tCOried 1ft the c., berland COWItr R.CON~r'.j 1 i . ~.: i;I r.'ed look """, Vol. 12, ,.,. 109, g&Dt.cl aDCl OOllY-,.cl unt.o ADn& ~. : I: : .:. tr;s4:,.ubert C. SoDu. h.r bubMd, p'rt.1e. otthe fir.t pan her.too. ~ :!;: I; ". BEOlJilNIHO at the aonbwut.em oomer ot ntth -- Loou.t. St".~.all'l! 'j . ~ th.na. wut,r1r, alODl tbe aort.hll'D ,:lIl. of Fifth Str..t.,..y to i ~ ,.(11 ..t, .ore 01' 11.., t.o. liD. 01' propert7 now 01" lata or AMa Mv7. i~, '. .;_ ill 1'UI.band, vh10h po1ftt 1. fCllU' (4) tte\, 801'1 or 1..., ...t ot t.,,\' . (' ~ .UHs' ot Lot 10. 32, \henct IWI'th.I'17, along tht Un. of .aid SoIMn ,. : ,,: .:.~ li1, ~"'allel vitoh the ,..t..,n 11ft. ot tot 10. )2, 011. hunctr.d twent.7 . I . . i .;r. I~ (10) toot. aU'fl \btDO. tUt.er17, alOI1<< th. ....t ..ventJ-Oft.:( (' ..i ,: , !.~.: 01' 1.... \0 Loo\l't. A.,en\lts thtl\oe 'O\l~her17, alOllS LocI&'t. Avenu~ r. ,f. r": t"t., (120) t.et. to t.b, p1&.. of BmIDItfG. . ,~: l!l' I I . I .; . .. . I' .",' O'~i': 1fol. ", 34,'&l'IlI the .utern ~wat.1-llD. (21) teet. of Lot No. 3', ;o~ i I . : I~r:' PlaA, J'tcorded 111 t.b. CuIb.Z'lMcl COWl~ Reoo.rder '. otno. 1ft Plan i ! . 1, . 6. . . .1; . ::".Jo~: .1 .!i.... pr.u..1.1Ilh1ob w..t. Ibort ~ &DCl Coutr\lCUOIl CcapuI1, ~:1t1.'~: '.. . ~ 2, 19~, IftCl r.-or4ecl1ll t.h. c.ber1aftcl COUllt~ 1teoorcl.r" ot~,... .' .' .... ::1!1-, Vol. 13, ,.,.. 63, put.td u4 oOATertcl Imt.o .. Ku7 SoxMa. . ,; ~.:.SoxII&Jl, heZ' bubaDcl, partie, ot ihe f~,t. part. herlt.o. : ~ j: 1 ~ ; : J: ~ : (~(:":::"'''::''''l:Irl:l P.03 . ::'l 'It . :;. IIMH r.AI:E ~ ' Ii. 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".~ , ...L." : ;' ,~~ D()j~, cl 4-J.~-DY OJtd f\u.ur~d . THIS DEED MADE THE day of thousand four (2004). in the year of our Lord two BETWEEN CHARLES C. CHAPMAN, JR., by and through his agent, JAMES G. CHAPMAN, by Power of Attorney dated April 4, 2000, Grantor, .' and JAMES G. CHAPMAN and DENISE L. CHAPMAN, husband and wife, Grantees, WITNESSETH, that in consideration of ONE and NO/100------------------- --------------($1.00)-----------------------------------------Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, ALL THAT CERTAIN piece, parcel or tract of land situate, lying and being in Abbott Township, Potter County, Pennsylvania, bounded and described as follows: BEGINNING at a point the same being the Southwest corner of Lot No. 18 containing Sections 5, 7, 3, and 50 in Warrant 5078 in Abbott Township; thence along the westerly boundary of Lot No. 18 North 51.7 rods to a point therein; thence at right angles thereto along the centerline of that certain 50 foot right-of-way East 31 rods to a point; thence at right angles thereto South 51.7 rods to a point in the southerly boundary of the aforesaid Lot No. 18; thence along said southerly boundary West 31 rods to the place of BEGINNING. Being a portion of Lot No. 18 in Warrant 5078 in Abbott Township, Potter County, Pennsylvania. ALSO CONVEYING HEREBY a right-of-way over and across a portion of Lot No. 108 identified as Section 2 in Warrant 5078 from that certain Township Road 428 to the lands herein described for the purpose of ingress, egress and regress in common with others. This conveyance is SUBJECT to a certain 50 foot right-of-way as same now exists along the westerly boundary of the lands conveyed hereby -1- being an extension of that certain right-of-way from the Township Road 428 over and across Section 2 as hereinbefore identified, to the northerly boundary of the lands conveyed hereby, thence continuing on a width of 50 feet to the easterly boundary of the lands conveyed hereby the centerline of which is the northerly boundary of the lands conveyed hereby, for the purpose of ingress, egress and regress to other lands of the grantor herein, his heirs or assigns, as well as in common with others on land adjacent to said right-of-way. EXCEPTING AND RESERVING all the oil, gas and minerals in, on or under the subject premises. This conveyance is SUBJECT to that certain oil and gas lease heretofore granted to Trend Exploration Limited dated September 18, 1971, and recorded December 13, 1971, in Misc. Docket E-5, Page 47, records of Potter County. BEING the same premises which Frank J. Aster and Allen Passerin, under Power of Attorney dated October 2, 1972, by deed dated October 2, 1972, and recorded October 6, 1972, in the Office of the Recorder of Deeds in and for Potter County, Pennsylvania, in Deed Book 191, Page 199, granted and conveyed unto Charles C. Chapman, Jr., and Vera V. Chapman, husband and wife. The said Vera V. Chapman died August 28, 1990, thus vesting title by operation of law in her husband, Charles C. Chapman, Jr., Grantor herein. This is a conveyance between parent and child and is exempt from all realty transfer taxes. AND the said Grantor hereby covenants and agrees that he will warrant specially the property hereby conveyed. -2- IN WITNESS WHEREOF, said Grantor has hereunto set his hand and seal the day and year first above written. Signed, Sealed, and Delivered in the Presence of (SEAL) JAMES G. CHAPMAN, agent for CHARLES C. CHAPMAN, JR., by Power of Attorney dated April 4, 2000. COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND On this, the day of , 2004, before me the undersigned officer, a Notary Public, personally appeared, JAMES G. CHAPMAN, agent for CHARLES C. CHAPMAN, JR., by Power of Attorney dated April 4, 2000, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written. Notary Public -3- I hereby certify that the precise residence and complete post office address of the within named Grantee is: 101 Sunset View Drive, New Cumberland, PA 17070. DATED: Attorney for -4- r.r-r-'......,;-.,--.,-........ BUREAU OF INDIVIOU.i\i 'TAXIls'-') INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 10-03-2005 CHAPMAN JR 06-24-2004 21 04-0631 CUMBERLAND 101 APPEAL DATE: 12-02-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 f~!_~~9~~_!~~~_~~~~______~___~~!~!~_~9~~~_~9~!!9~_~9~_Y9~~_~~f9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX CHARLES C FILE NO. 21 04-0631 ACN 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ZT:5 [''-'T -3 n:.' -~ I I ~~: 25 DAVID HISTONE STONE ETAL 414 BRIDGE ST NEW CUMBERLAND ESQ PA 17070 ESTATE OF CHAPMAN JR TAX RETURN WAS: ) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cesh/Benk Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets x) CHANGED REV-1547 EX AFP (06-05) CHARLES C SEE ATTACHED NOTICE DATE 10-03-2005 ll) (2) (3) (4) (5) (6) (7) 148,830.12 5.394.48 .00 4,800.00 1.715.00 883.25 93,813.41 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: IT an assessment was issued previously, lines reTlect Tigures that include the total oT ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at 17. Amount of Line 14 at Sibling 18. Amount of Line 14 taxable at 19. Principal Tax Due TAX CREDIT : Lineal/Class A rate rate Collateral/Class B rate + INTEREST/PEN PAID (-) .00 DATE 04-15-2005 NUMBER CD005211 INTEREST IS CHARGED THROUGH 10-18-2005 AT THE RATES APPLICABLE AS OUTLINED ON REVERSE SIDE OF THIS FORM (9) 1l0) 25,338.98 17.938.50 (11) 112) 113) 114) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 255,436.26 43. ')77 48 212,158.78 .00 212,158.78 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. 115) 116) 117) 118) .OOXOO= 212,158.78 X 045- .00 X 12 = .00x15= 119)= AMOUNT PAID 1,500.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE THE * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 9,547.15 .00 .00 9,547.15 1,500.00 8,047.15 233.84 8,280.99 Pi- IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV,1470'EX (6-88) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME REVIEWED BY Charles C Chapman Jr Sandra J Eslinger FILE NUMBER ACN 2104-0631 101 ITEM SCHEDULE NO. A 1 EXPLANATION OF CHANGES The value of the real estate is increased form $120,000.00 to $148,830.12 as escrow for inheritance tax is not an allowable deduction. ROW Page 1 ------- -:. - -:. ~ -:: -:: 0- ~- tt ~ \Ii ~. ct, (t Ci j: (\) tn 5 ';I\ ~ \-I 5 o ("l ,-\ tn ';>-1 0 ~ ~ r- ~B'-\ .r-! 0 ';>o~ P. 1.\-1'0 o ~ (\) \-1,-1,-1 (\) \-I tn ~ (\)'M tn ~ .r-! ~ \-I tJ) ? ro (\) 00 ~ == -:; II'l ~ t'i ~ :$ -:; - - - - -:; - - -:; ~ ~ ~ ~ ~ti~~ ~ \11 0 . O~~lSlO lIl->o)lJ)'B~ I1IQQ\1I_.J ~""Cl'it~ \t,,",,~go~ ( o ~ _ '. 5;~lSl'iii~ 3~~~~ ,..Jot ~ ~ ~ ~ f".r..\"7 ~ ,- ;\.;U'..J -:; - -:: -:: ~ -:. -:: :::::. - -:: # - -:: - ~ -:;:::; -:. -:;:::; ~ - i"! \11 -'\ \:;:\ \ ' ,~" ..~.\ \ ' -z.,,} ,"\ \.,' r" ",-I W ea: ~x H CC Z ! I- ea:.... -I II. >;:) ~~O ~Z I-IIlI- >.... MZ (I)> WQW Z.... U z:: ffirx: ~~~ A.u. ~W~ u.0 ffi~~ 0.... i~Q _Z MOZ ....... -I C ~s: ~ ~ III ea:~ W ..l5 .... ell. ,to) I- lot :a:~MZI- Z I-W U ~g 'i,Q S ::E ( ~~ o C CJ ,: f~ a.. C III W x C I- \ -Iz ... C c a ::)... '" QUI a ~;: ~ ....~ ~ i~ ~ 1-I~....t<C aD. II.\JJ'" O!i!~~ ~~:~ I.I.I~O"" !i~~! a:tMa.:z::: '"' '" a I '" a ~ U CI. ll.. < X \JJ ,... .... .., ... I > \JJ II:: '" LIJ ...I Q::: <C X U III ........ Cl'" Cl= N"~ I I.l N"~ Cl~ llIQ:::oar-4l:l I~ Cl..,Cl""Z N... Cl Cl \Q <C r-4 ~ NZNCl...l ~ I <C I I Q::: = ""::EoaoaLIJ ..::S ~ ~ ~ Cl ~ r-4........ ~ Cl X >0 r-4 :;) Cl CC "tl r-4 U Cl N U r-4A ~ "a ~ ~ = :i ~ ~ A. ~ i ~~ rx: - ~ ::I.... Olll: ECC CC::E ::r:: .... ccrx: ........ U.AIQ o ::E u.;:) ....OZ> .... .... .... CC ....r.... Z ............~;:)Z CC(l)CCHOCJ A"" AU. CJCC CD .. o .... .... Z ... ::E > CC a. LIJ (f) :;) o X 1-"" Q:::r-4 (f):;)Cl ...10..... ...IUr-4 I-t 30 UCC L\.. 11. Ol:l Z .. Q:::CCLIJ LIJ...I...I I-Q:::(f) (f)LIJI-t I-tlQ...I C!)::EQ::: L1J:;)c:t Q:::UU rx:1 ;:)1 01 >1 I rx:1 01 U.I I ZI 01 HI ....1 rx:1 01 0.1 I rx:1 ....1 3a 01 ~I I ZI HI CCI ....1 ....1 rx:1 I I tr I I I I I I ....1 ZI HI' ~I I Clh HI :1:1 ....1 I C!ll ZI 01' ~I CCI I I ....1- ;:)1 CJI STONE LAFAVER & SHEKLETSKI ATTORNEYS AT LAW DAVID H. STONE GERALD J. SHEKLETSKI ELIZABETH B. STONE 414 BRIDGE STREET POST OFFICE BOX E NEW CUMBERLAND. PA 17070 www.stonelaw.net OF COUNSEL CHARLElS H. STONE JON F; LAFAVER October 14, 2005 TELEPHONE! (717) 774-7435 FACSIMILE :(717) 774-3869 Register of Wills Cumberland County Court House Carlisle, PA 17013 RE: Estate of Charles C. Chapman, Jr. No. 21-04-0631 Greetings: Enclosed please find estate check #1013 in the amount of $8,280.99 representing payment for Inheritance tax due for the above mentioned estate. Please send the receipt to my office In the stamped addressed envelope enclosed. Your attention to this request is certainly appreciated. Very truly yours, STONE LaFAVER & SHEKLETSKI /( DHS/tmb Enclosures [_.:--j "",,~, 1 c CD t ._..... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005899 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT CONTROL NUMBER AMOUNT nnn__ fold 101 , $8,280.99 I ESTATE INFORMATION: SSN: 179-12-5662 FILE NUMBER: 2104-0631 DECEDENT NAME: CHAPMAN CHARLES C JR DATE OF PAYMENT: 10/17/2005 POSTMARK DATE: 10/14/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/24/2004 TOTAL AMOUNT PAID: $8,280.99 REMARKS: CHECK# 1013 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAL)GH REGISTER OF WillS REGISTER OF WILLS REV.,\'SOO EX... t6-QQ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT W I- ~ :$(1) ult:~ wl1.u J:OO ult:..J ~a1 <I: z o i= < .... ::) a. :E o CJ x < .... .... z w c w CJ w c DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Cha man Jr., Charles C. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 0 6 3 1 'C<luN"rYCOOE" -VEAR- - - NUMBER- - SOCIAL SECURITY NUMBER 1 7 9 - 1 2 - 51 6 6 2 THIS RETURN MUST BE FilED IIiI DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (~*e otdeath prior 10 12-13-82) o 5. Federal Estate Tax R~lurn Required _ 8. Total Number of SafalDeposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE 01 ECTED TO: NAME COMPLETE MAILING ADDRESS David H. Stone, Es uire 414 Bridge Street FIRM NAME (If Applicable) Stone LaFaver & Shekletski TELEPHONE NUMBER 7177747435 New Cumberland iPA 17070 z o .... < ...J ::) t: a. < CJ w 0::: 0.00 X _(15) 0.00 27,052.28 x .045 (16) 1,217.35 0.00 x .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 1,217.35 06/24/2004 OS/24/1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) o 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Willi o 9. Litigation Proceeds Received IXl 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ot Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W o Z o l1. (I) W It: It: o U 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (1) (2) (3) (4) (5) (6) (7) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 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) 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. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < l USE ONLY. !l' ,. ;-1 27,067.28 (8) 27,067.28 15.00 (11) (12) (13) 15.00 27,052.28 ! I I (14) 27,052.28 I' o d · C Add ece ents om pi ete ress: STREET ADDRESS CITY I STATE I ZIP Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1,217.35 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable O. Interest E. Penalty 0.00 Total Interest/Penalty (0 + 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 request 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. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1,217.35 1,217.35 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes Nllll a. retain the use or income of the property transferred; ........................................................................... 0 I ~: ~::::~ :h~e~;~~i:~:~s:~~e~=s~~~ ~.~~.I~ .~~~. ~~.~. :.~~~~.rtfi:~n~fu7o~~;n~:,;. .... ... ..... ... ..... ... ........ ... ..... 80 . d. receive the promise for life of either payments, bene Its or care. ............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?..................... ... ............... ............................................... ........ 0 rnJ 3. Did decedent own an "in trust forn or payable upon death bank account or security at his or her death? ................. 0 m 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 00 ~ 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 complett', Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. . , SIGNATURE OF PERS SPONSIBLE FOR F ING RETURN DATE SIGNATURE ADDRESS P A 17070 DATE ~. ADDRESS PA 17070 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving ~pouse is 3% [72 P.S. 99116 (a) (1.1) (i)). ' , For dates of death on or after January pi J\ LJe of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9,9116 (a) (1.1) (ii)]. The statute does not exempt a transfE ~ II ~ tutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only bene' For dates of death on or after July 1, ./1 .MS) The tax rate imposed on the net valu "7 or a stepparent of the child is 0% (7~ The tax rate imposed on the net val' ~nt's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [721'.S. 99116(a)(1)J. The tax rate imposed on the net value VI UU.._._. ent's siblings is 12% [72 P.S. 99116(a)(1.3)). A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the deceaem, WtIt7l1_ wy blood or adoption. , :me years of age or younger at death to or for the use of a natural parent" $n adoptive parent. 11 I, REV-~5~O EX + (6-98) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles C. FILE NUMBER 21 04 0631 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTiON OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE Of TRANSfER ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Met-Life Annuity-beneficiaries are all living chidren as 27,067.28 100. 27,067.28 follows: Charles Robert Chapman, Thomas Eugene Chapman, and James Gardner Chapman 'i , i ; \ , I'I TOTAL (Also enter on line 7 Recapitulation) $ 27,067.28 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chaoman. Jr.. Charles C. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. II FILE NUMBER 21 04 0631 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees 3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills-filing Sup. Inheritance Tax Return 15.00 " TOTAL (Also enter on line g, Recapitulation) $ 15.00 (If more space is needed, insert additional sheets of the same size) REV"''''E''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF II SCHEDULE J BENEFICIARIES FILE NUMBER Ch:mman Jr. r.h~r1p.!'; r.. 21 04 0631 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Charles Robert Chapman Lineal 9,017.43 12607 Beech Fern Lane Bowie, MD 20715 2. Thomas Eugene Chapman Lineal 9,017.43 5330 Gibble Road Harrisburg, PA 17112 3. James Gardner Chapman Lineal 9,017.42 101 Sunset View Drive New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-150a COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) I I' I II Ii I ~p\Wllls\:~APt~Jrcharles\6-02 LAST WILL AND TESTAMENT OF CHARLES C. CHAPMAN, JR. 11 I, CHARLES C. CHAPMAN, JR., of the Borough of New Cumbe~land, + f Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named sh~ll pay all my just debts and funeral expenses as soon as convenientl~ may be done after my decease from the residue of my estate. ITEM II: I hereby give and bequeath my hunting rifles, spot guns and equipment unto my son, JAMES GARDNER CHAPMAN, with instr~~tions that he allow his brothers and sister to use the same for hu~ting and recreational purposes and that the guns be kept in the Chapman family. , , ITEM III: I hereby give and bequeath all of my furnitur~t house- I hold equipment and tangible personal property unto my then l~ting children, to be divided among them as they may agree, or if ~~ey cannot agree then as my Executor shall determine. ITEM IV: I direct that my son, JAMES GARDNER CHAPMAN be :given an option to purchase all of my real estate at 321 Fifth Street ~n the Borough of New Cumberland for a price of $120,000.00. My sai~ son shall exercise this option within 90 days after my death, aft~r which time the option shall expire. My son may have a period of twoi years Page 1 of 5 :11 III i I 1 t after my death in which to pay the purchase price, during which time interest at the rate of 5% per annum shall accrue on the unpaid balance. ITEM V: I hereby glve and bequeath the sum of $2,000.00 to each of the following named grandchildren provided, however, shou~d any of the following named grandchildren be indebted to me, the gif~ shall be I reduced by the amount of the indebtedness. Should the indebbedness exceed $2,000.00, any balance over $2,000.00 shall be forgiven at my I i I death: AARON CHAPMAN, GREGORY CHAPMAN, MICHAEL ZEIGLER, JEFFR~Y I ZEIGLER, and STEVEN ZEIGLER. ITEM VI: I hereby give, devise and bequeath all the res, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, as follows: A. One-fourth (1/4) in equal shares unto the then living children of my deceased daughter, CAROL A. ZEIGLER, to wit: MtCHAEL ZEIGLER, JEFFREY ZEIGLER, and STEVEN ZEIGLER. B. One-fourth (1/4) unto my son, CHARLES ROBERT CH4PMAN, or if he is not living, then unto his children, JANELL CHAPMAN and GREGORY CHAPMAN, in equal shares. C. One-fourth (1/4) unto my son, THOMAS EUGENE CHA~MAN, or if he 1S not living, then unto his son, AARON CHAPMAN. Page 2 of 5 j Ii I II D. One-fourth (1/4) unto my son, JAMES GARDNER CHAPMAN, or if he is not living, then unto his children, JOEL G. CHAPMAN and AMELIA C. CHAPMAN, in equal shares. ITEM VII: I hereby nominate, constitute and appoint as guardian for any minor who may take a share under this will, the pareht of said minor. ITEM VIII: I appoint my son, JAMES GARDNER CHAPMAN, Executor of this my last will. Should my son, JAMES GARDNER CHAPMAN, fail to qualify or cease to act as Executor, I appoint my son, CHARLtS ROBERT CHAPMAN, Executor of this my last will. ITEM IX: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. my hand and seal this q day of ~<J'(r , 2002. l I -j I I I IN WITNESS WHEREOF, I, CHARLES C. CHAPMAN, JR., have hereunto set ? ~ )( C<;..~ C)C:~___,? CHARLES C. CHA N, JR.~ SIGNED, SEALED, PUBLISHED and DECLARED by CHARLES C. CHAPMAN, JR., the Testator above named, as and for his Last Will and T~stament, Page 3 of 5 ) I II I II and in the presence of us, who at his request, in his presence and in of each other, have subscribed our names as witnesses. 4~liW-~,~k) ;( I.. , . I . ress i .... , .. ~if ';('. ~U? Wl n s ~~ (jJ~/,L ddress COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, CHARLES C. CHAPMAN, JR., the Testator whose name is s!igned to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and exec~ted this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. C:~.~ c ~~ --~ :-L CHARLES C.. C~~ JI ./ Sworn to or affirmed to and acknowledged before me by CHARLES C. CHAPMAN, JR., the Testator, this "\ day of :ru'(r y~ Pub c .' 2002. ........-) ~A Notary j ~- -1 Page 4 of 5 I NOTARIAL SEA.L -I PATRICHIA l. YOTER Nolerv PubJi" ! New Cumb.erland Bora. 'Cumberland .C~JI My c.omm)~ion Expires Nov. 18, 2002 :'1 II COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, ~hn tc.\ S~ and ka'f~ ~. Lu..c-ke~: signed to the attached or fore4oing the witnesses whose names are instrument, being duly qualified according to law, depose an~ say that we were present and saw Testator sign and execute the instru~ent as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator wa~ at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. ~l~ es ~-'-~. ~ Wit:n s Sworn to or affirmed to and acknowledged before me by \)pn /V1 '-\~ and k'~ly'~ 1<. . LL.tc kef{ ~~ ' 2002. !ltwkYJj~ Notary PUbyc witnesses, this ~ day of Page 5 of 5 j NOTARIAL SEAIL I PATRICHIA L YOTER, Nof(jry Public New Cum~rl~(j Bom. Cum~erland Co. My CommlS!/on Expires NOM 18, 2002 I =1 MetLife October 26, 2005 DAVID STONE, ATTORNEY 414 BRIDGE ST NEW CUMBERLAND PA 17070 RE: Metropolitan Life Insurance Company Contract#: 007 061 779 MA Deceased: Charles Chapman Dear Mr Stone This is in response to a request for information on the above contract. The date of death value of the contract (June 24, 2004) was $27,067.28. The cost basi~ in the contract was $14,652.26. The contract lists four beneficiaries, C Robert Chapman, Carol Zeigler, Thomas Chapman, and James Chapman. Upon receipt of the claim forms, we processed three fourths of the contract value to C Robert, Thomas, and James. The death claim was processed July 7, 2004. The value prior to the claim payment on that date was $27,105.74. After processed to three beneficiaries, there was $6776.43 remaining in the contract for the last beneficiary, Car'Q1 Zeigler. i On July 15, 2004 we received a copy of the obituary for Carol Zeigler showing she predeceased Charles Chapman. At that time the remaining contract value was $6,782.35. This was paid out in equal shares to the three surviving beneficiaries. If you have any questions, please feel free to call our toll free number, 1-800-638-7732. One of our Customer Service Representatives will be happy to assist you. Sin~.c~reIY .~.. . 0. .~. ., ~~ I" Diane Kosechata, ACS, ALHC Payout Specialist IV Annuity Operations 918-252-8864 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 II REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 _n__~n fold ESTATE INFORMATION: SSN: 179-12-5662 FILE NUMBER: 2104-0631 DECEDENT NAME: CHAPMAN CHARLES C JR DATE OF PAYMENT: 11/04/2005 POSTMARK DATE: 11/04/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/24/2004 NO. CD 005969 ACN ASSESSMENT CONTROL NUMBER \ I AMOU~T I \ i ~----~-- 101 I $1,217. 35 I \ I I. ! I I ! ! I \ I \ I I \ I I II I I I TOTAL AMOUNT PAID: $ 1 ,21 7.3\5 I REMARKS: CHECK#1034 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS I I I i I I GLENDA FARNER STRASBAU~H REGISTER OF WILLS BUREAU OF INDIVIDUAL-'Tiies'-rr INHERITANCE TAX DIVISION ' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) 2r ~ ~ ~. " ii, j ..,. I,: 03 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-07-2005 CHAPMAN JR 06-24-2004 21 04-0631 CUMBERLAND 101 CHARLES C DAVID H STONE ESQ STONE ETAL 414 BRIDGE ST NEW CUMBERLAND Amount Remitted PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS 4- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF FILE NO. ACN DATE THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND. IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-03-2005 PRINCIPAL TAX DUE: 9,547.15 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-15-2005 CD005211 .00 1,500.00 10-14-2005 CD005899 229.43- 8,280.99 TOTAL TAX CREDIT 9,551.56 BALANCE OF TAX DUE 4.41CR INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 4.41CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ 12-12-2005 CHAPMAN JR 06-24-2004 21 04-0631 CUMBERLAND 101 APPEAL DATE: 02-10-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~YI_~~9~~_I~~~_~~~~------~--_~~!~!~_~9~~~_~9~!!9~_E9~_Y9Y~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX CHARLES C FILE NO. 21 04-0631 ACN 101 BUREAU OF INDIVIDUAL-fAXES INHERITANCE TAX DIVISloN - - PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX 2C=J5 DEe J G P" If"':! "-1'.- ", ,,' ~'O !'I k." v DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLe,";: ~_',r-~< !,~ \ ~'e, ni-'rJ-',.! '.J ':: DAVID H rS ~&mE:IESQ STONE E-rALl' ' , 414 BRIDGE ST NEW CUMBERLAND PA 17070 ESTATE OF CHAPMAN JR REV-1547 EX AFP (06-05) CHARLES C TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 12-12-2005 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: ..~ 'U;"~...r I (+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-15-2005 ~ CD005211 .00 1,500.00 10-14-2005 " CD005899 .00 8,280.99 11-04-2005 CD005969 233.84- 1,217.35 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-05-2005 TOTAL TAX CREDIT 10,764.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. 32.43 TOTAL DUE 32.43 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Hortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 .00 .00 .00 .00 .00 .00 27,067.28 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 15.00 .00 (11) (12) (13) (14) NOTE: .00 X 239,211.06 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 27,067.28 15 00 27,052.28 .00 239,211.06 .00 10,764.50 .00 .00 10,764.50 pt ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) - 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 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ______n fold ESTATE INFORMATION: SSN: 179-12-5662 FILE NUMBER: 2104-0631 DECEDENT NAME: CHAPMAN CHARLES C JR DA TE OF PAYMENT: 12/16/2005 POSTMARK DATE: 12/1 5/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/24/2004 REMARKS: CHECK# 41940 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: JA RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 006118 AMOUNT $32.43 $32.43 GLENDA FARNER STRASBAUGH REGISTER OF WILLS STONE LAFAVER & SHEKLETSKI ATTORNEYS AT LAW DAVID H. STONE GERALD J. SHEKLETSKI ELIZABETH B. STONE 414 BRIDGE STREET POST OFFICE BOX E NEW CUMBERLAND. PA 17070 www.stonelaw.net OF COUNSEL CHARLES H. STONE JON F. LAFAVER December 15, 2005 TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 Register of wills Cumberland County Courthouse Carlisle, PA 17013 RE: Estate of Nancy H. Goodall No. 21-05-0261 Greetings: Enclosed please find an original and one copy of the Inheritance Tax Return and Inventory for the above mentioned estate. Please clock in the copy of the Inventory and send it back to my office along with any receipts in the enclosed stamp addressed envelope. Also, enclosed is check #1557 In the amount of $30.00 for filing the return and inventory. I am also enclosing a check in the amount of $32.43 on the Charles C. Chapman, Jr. Estate for additional tax due and a Status Report for the Estate of Margaret E. Miller. Please clock in the copy and send it back to my office. Your attention to this matter lS certainly appreciated. 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PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) DAVID H STONE ESQ STONE ETAL 414 BRIDGE ST NEW CUMBERLAND PA 17070 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-09-2006 CHAPMAN JR 06-24-2004 21 04-0631 CUMBERLAND 101 CHARLES C Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *-- ESTATE OF CHAPMAN JR CHARLES C FILE NO.21 04-0631 ACN 101 DATE 01-09-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-12-2005 PRINCIPAL TAX DUE: 10,764.50 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-15-2005 CD005211 .00 1,500.00 10-14-2005 CD005899 .00 8,280.99 11-04-2005 CD005969 233.84- 1,217.35 12-15-2005 CD006118 32.43- 32.43 TOTAL TAX CREDIT 10,764.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR1, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 1 .~ I' 1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charles C. Chapman, Jr. Date of Death: June 24, 2004 Will No. 21-04-0631 To the Register: 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. Yes ~ State whether administration of the estate is complete: 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: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes~ No Date: (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. ~ i;)....I~I.or Dav.,..... e, qUi-re 414 Bridge Street New Cumberland, PA 17070 717-774-7435 "\ <. Capacity: Personal Representative X Counsel for Personal Representative ~b II ,#' est\rel\CHAPMANthomas , ( IN RE: ESTATE OF CHARLES C. CHAPMAN ,TR. LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, THOMAS EUGENE CHAPMAN, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution In any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed In a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, THOMAS EUGENE CHAPMAN, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as afore- . , .'1 said, and of and from all actions, suits, payments, accounts, reckon- ings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. day IN WITNESS WHEREOF, of ~~to,.&'v .'7l~ I have hereunto set my hand and seal the , 2005. Witness COMMONWEALTH OF PENNSYLVANIA: COUNTY OF ( ~~~1I1D1J SS: On this, the ,1h day of ~/\-I"~v , 2005, before me a Notary Public, the undersigned officer, personally appeared THOMAS EUGENE CHAPMAN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ~ Notary Public r',""\), ,- I -J ,__,.ty Ii , ___;!Jb -2- ; 1- ""'-' , '::_\,~~ M;j;>jb:-r - . II. est\rel\CHAPMANcharles IN RE: ESTATE OF CHARLES C. CHAPMAN, TR.. LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, CHARLES ROBEFT CHAPMAN, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution In any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, CHARLES ROBERT CHAPMAN, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as afore- . ~ said, and of and from all actions, suits, payments, accounts, reckon- lngs, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the~ day of IJCJv' , 2005. ,rhA'; fszl ~ tness C~~K~ca CHARLES ROBERT CHAPMAN ~ STATE OF MARYLAND COUNTY OF If;j;te. /klAU d t".1 SS: On this, the el9 , 2005, before -f~o V eY'lA. /; e r . day of me a Notary Public, the undersigned officer, personally appeared CHARLES ROBERT CHAPMAN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. '6 i ~ l} /M'{f'/Lt'J OA.l AhA': / No ry Public -2- est\rel\CHAPMANjames IN RE: ESTATE OF CHARLES C. CHAPMAN, TR. LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, JAMES GARDNER CHAPMAN, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby walve my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed In a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, JAMES GARDNER CHAPMAN, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as afore- said, and of and from all actions, suits, payments, accounts, reckon- ings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the ~+.( day of O$6~A ~ , 2005. Witness ~ COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF Q~e1-LMVj) On this, the ~ ~ day of ()dhtu/ , 2005, before me a Notary Public, the undersigned officer, personally appeared JAMES GARDNER CHAPMAN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ;Z;;!;,>YY\ ~ Notary Public etj . P VANIA NOTARIAC SEAL TIN Ii M. BURKEY, Notary Public New Cumberland Boro, Cumberland Co, My Commission Expires April 15, 2009 -2- f II est\rel\CHAPMANjeffrey IN RE: ESTATE OF CHARLES C. CHAPMAN, TR. LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, JEFFREY ZEIGLER, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, JEFFREY ZEIGLER, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as aforesaid, r, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day ot1~f\U\\~~ y'th , 2005. "- wif~e~ tj"'l ~~~ JE./ R~ '.. ft GLER COMMONWEALTH OF PENNSYLVANIA: COUNTY O~ClLl~lln SS: On this, the ~~ day Of\\lf\\tnlM( I , 2005, before me a Notary Public, the undersigned officer, personally appeared JEFFREY ZEIGLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. --m---.-N~~I Seal ----.--- . Vickie l. Kulp, Notary Public i ! Susquehanna Twp., Dauphin County I '--""7 My <??~~~ion Expires Dec. 24, 2005 , :(;~~1"1~\:;,; P?nn:;\+.,'r:, ,,;:?A'sSfj(~~e~f~'\;'l Of Notaik-;s '-tJ..L/Jiu-" y, ~ Vi,,) Notary Public I -2- II est\rel\CHAPMANsteven IN RE: ESTATE OF CHARLES C. CHAPMAN, rR. LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, STEVEN ZEIGLER, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, STEVEN ZEIGLER, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as aforesaid, II I and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of NDJg',l.-t~"""" JL , 2005. , //} --~~ ..-1. _ d I . t:i-c..-~"~>~ ! Wl tness ~~~ STEVEN ZEI ER COMMONWEALTH OF PENNSYLVANIA: COUNTY OF )?oJ(...j/" SS: On this, the ,-!L day of ;eJcv 6"'-l:,.~ I , 2005, before me a Notary Public, the undersigned officer, personally appeared STEVEN ZEIGLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Patrj~aA Gordon, Notary Public FaIN~~Twp., York County My CommissIOn Expires July 31,2009 Member, Pennsylvania Association of Notaries /J 7~~ ( Notary Public -2- ~ est\rel\CHAPMANmichael IN RE: ESTATE OF CHARLES C. CHAPMAN, rR, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-0631 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, MICHAEL ZEIGLER, being one of the beneficiaries under the will of CHARLES C. CHAPMAN, JR., do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of CHARLES C. CHAPMAN, JR., in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby walve my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, MICHAEL ZEIGLER, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as aforesaid, ~ Ii I I I and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. "r IN WITNESS WHEREOF, I have hereunto set my hand and seal the eVe h~ 31 day of , 2005. rg~ !II;J :ft MICHAEL ~EIGLER Witness 0~ I COMMONWEALTH OF PENNSYLVANIA: COUNTY OF tlurn 6ui"-'- d C1r On this, the 3 J day SS: {p e Iv be~ of , 2005, before me a Notary Public, the undersigned officer, personally appeared MICHAEL ZEIGLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have nereunto set my hand and seal the day and year first above written. /) /C' x: h~A".):6 ~t<J / ~Dtary p~l~l!J-SEAL SUSAN B. EVANS. NOTARY PUBLIC HAMPDEN TWP., COUNTY OF CUMBERLAND MY COMMISSION EXPIRES JANUARY 2, 2006 -2-