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HomeMy WebLinkAbout03-0031 :~ PETITION FOR PROBATE and GRANT OF LETTERS Estate of Martha Jane Smith No. a.~/-t~-~:~! also known as To: Register of Wills for the , Deceased. County of Cumberland in the Social Security No. 209-12-5586 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ar named in the last will of the above decedent, dated November 22. ,19 94 and codicil(s) dated none (state relevant circttmstance~, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 429 Apoletree Road, Camp H±ll, PA 17011 (list street, number and muncipality) ' Decendent, then 81 years of age, died December 13 .,~1~. 2002., at Manorcare Nursing Home, Chambersburg, 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: mecendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 20,000 (If not domiciled in. Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 85 ~ 000 situated as follows: 429 Appletree Road, Camp Hill, PA 17011 " WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters res tamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF , C_IJMBERLAND ) SS 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 and tru!y adn~i,'nister the ~Xate according to law. Sworn to or affirmed and subscribed ,-... \,:a'~'''¥ ~..~~~".:¥ - be{ore me this r~O~ ~ day of q -N C "'~ ~q' UNDER RULE 6 12 Name of Decedent: Martha Jane Smith Date of Death: 12/13/02 Will Nc. 2003-00031 Admin. Nc. Pursuant to Rule 6. !2 cf the Supreme Court Orphans' Cc .... Rules · ?=~-- c~= ~ll~,w~. ~h ~=~..~=~ to c~!=-~ the a~inistraticn cf the above-captioned estate: .......~ State wh=~h=~ a~inistration of the estate is tempi Yes Nc X 2. If the answer is Nc, state when the personal = =cnab!v be] ~=v== tha the a~inistration will be re~resentati-ze ~ ~ . - .... ccm~!ete: May 1, 2005 T; the answer to Nc ~ ~s Yes, state the ~ a. Dil the oerscnal recresen%ative file a final ~= seuarate Cruhans' Ccur~ Nc. (~ f any) the persona] ~=~esentati~;e's account is: c. Did the personal reor~sentative state an account informa!!v tc th=.._ parties in ~'~=-==t? vo__s Nc d. Copies of receipts, releases, joinders and' apprcva!s o~_ fora! or info,a! accounts may_ be f~]=~___~ · '~w~=h Cork of the Orphans' Court and mai' be attached to this remcrt. ..=: S igna~ure Debra K. Wallet, Esq. ' Name (Please type or print 24 N. 32nd St., Camp Hill, PA 17011 " Address i:il!- (717) 737-1300 Capacity: __Personal Representative X Counsel for personal representative ( M_~H: rmf/A~M3 ) ,~ John and Carol Herman 50 Windy Court P. O. Box 956 Oriental NC 285 71 Tel~Fax 252-249-2869 November 16, 2004 Debra K. Wallet 24 N. 32na Street Camp Hill, PA 17011-2917 Re: Martha Jane Smith Estate Dear Ms. Wallet: Enclosed is a communication I received from the Cumberland County, Register of Wills office. I have assumed that all legal work was completed by your office. Copies of receipts, releases, joinders and formal and informal accounts were forwarded to you at an earlier date. Please file the necessary documents with the Commonwealth of Pennsylvania. Sincerely, erman, Jr. ¢:: ~cc' G :: :; · . F. Strasbaugh ~3 Estate of Martha Jane Smith , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW k.~g~9~,~,~,~, / /~ ~l~,.~ao~. in consideration of the petition on the reverse side l~reof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 22. 1994 described therein be admitted to probate and filed of record as the last will of Martha Jane Smith ; and Letters Testamentary are hereby granted to John P. Herman, Jr. FEES ~Pro/~t~e~.Letters, Etc .......... Sa.~,.~,~ Debra K. Wallet, Esq. (23989) '~dunciation ................ $ lo.om 2~ ~. 32nd St., Camp ~&~, PA 17011 . TOTAL $~ oo ~.- vusa ~ .... ~..~...~.] ....c7~7~ 7~7-~0[~o~ REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat__ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF CUm~ERL~qD COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that [~ m~ familiar with the signature of l,{artha .Tnno_ .qm-~ eh , testat rix of (c. nc,.,-~ thco~.,o,~,,~,.,~ ............... ...,,.oo~: ....... te), the will presented herewith and that he. believes the signature on the will is in the handwriting of Martha Jane Smith to the best of knowledge and belief. Sworn to affirmed and subscribed before - ,~ ' day o( Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat__ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19__ (Address) Register (Name) (Address) REGISTER OF WILLS OF C~ERnA~ COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~ 'J.~ familiar with the signature of Marth~ .lane gm~ ~-h , testat r-ix of (onev.^c ..................... ,,,~ ~,,,~,.,,~,-,~ -,,,,,.oo~.o to) the will presented herewith and that 6'he,. believes the signature on the will is in the handwriting of Mar,tha Jane Sm±th to the best of ~- _ knowledge and belief. Sworn to or affirmed and subscribed before v ._. _~-ev~-(-~- ~ me this ___._~ ~-~ day of _ (~ame) ~~~ Register (Name) (Address) BOND DEC 2 co 2002 REGISTER OF WILLS OF Cumberland COUNTY BOND AND SURETY FOR PERSONAL REPRESENTATIVE KNOW ALL BY THESE PRESENTS, That John P Herman, jr' as principal(s) and Travelers Casualty And Surety Company Of America as surety (sureties) are held and firmly bound unto the Commonwealth of Pennsylvania in the sum of Forty Thousalt~llars ($4 0,0 0 0 ) to be paid to the Commonwealth, for which payment we do bind ourselves, jointly and severally, our heirs, executors, administrators and successors, the condition of this obligation being that if John P. He.rman, Jr. as (state fiduciary capacity) Executor of the estate of Martha Jane Smith , deceased, or any of them, shall well and truly administer the estate according to law, then this obligation shall be void as to the personal representative or representatives who shall so administer the estate and his or their surety or sureties; but otherwise it shall remain in full force. Signed and sealed this 23rd day of December , 19 2002 , each intending to be legally bound hereby. John P. Herman, Jr. ~~C~.~~- (Seal) (Seal) Robert L. Creason ~~' '~ ~(Seal) Attorney-In-Fact ' - Travelers Casualty And Surety Company Of America (Seal) (Seal) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY llartford, Connectlcut 06 i 83-9062 TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS · ~ Naperville, Illinois 60563-8458 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITy OF ATTORNEY(S)-IN-FACT KNOW ALL PERSONS BY THESE PRESENTS, TIIAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, corporations duly organized under the laws of tile Statc of Connecticut, and having their principal offices in tile City of Hartford, County of Hartford, State of Connecticut, and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, a corporation duly organized under the laws of the State of Illinois, and having its principal office in tile City of Naperville, County of DuPage, State of Illinois, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make, constitute and appoint: Robert L. Creason, Donald R, KJngsbury or James D. Pace * * of Camp Hill, PA, their true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within the United States, or, if the following line be filled in, within the area there designated the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature ora bond, recognizance, or conditional undertaking and any and all consents incident thereto not exceeding the sum of ONE HUNDRED TIIOUSAND ($100,000. 00) DOLL4RS ' and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now in full force and effect: VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certil~cate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the n.ature of a bond, recognizance, or conditional undertaking, and any of said offcers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her. VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary. VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile under and by authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETy COMPANY, FARMINGTON CASUALTY COMPANY and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, which Resolution is now in full force and effect: VOTED: That the signature of each of the following offccrs: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affxcd by facsimile to an)' power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secrctarics or Att~orneys_in. Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and an.v such power of attorney or certificate bearing such facsimile signature or l'acsimile seal shall be valid and binding upon thc Company and an), such power so executed and certified by such t3csimile signature and facsimile seal shall be valid and binding upon thc Company in the future with respect to any bond or undertaking to which it is attached. (8-97) IN WITNESS WllEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY a,d TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS have caused this inslrument to be signed by their Senior Vice President, and their corporate seals to be hereto affixed this 30th day of November, 1999. STATE OF CONNECTICUT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY }SS. Hartford FARMINGTON CASUALTY COMPANY COUNTY OF HARTFORD TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS ;EAL ~"~1 By. ,~ _ /~Ol George W. Thompson ._~ Senior Vice President On this 30th day of November, 1999 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, the corporations described in and xvhich executed the above instrument; that he/she knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; and that he/she executed the said instrument on behalf of the corporations by authority of Ms/her office under the Standing Resolutions thereof. My commission expires June 30, 2001 Notary Public Marie C. Tetreault CERTIFICATE 1, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, stock corporations of the State of Connecticut, and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, stock corporation of the State of Illinois, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority remains in full force and has not been revoked; and furthermore, that thc Standing Resolutions of the Boards of Directors, as set forth in the Certificate of Authority, are now in force. Signed and Sealed at the Home Office of the Company, in the City of Hartford, ]~[l~ of Connecticut. Dated this 2 3 rd day of December, 2002 , EAL ~'~/ By "' - /~/ Kori M. Johanson .... ~ ~ Assistant Secretary, BOnd_.: This is to certify that the information here given is correctly copied from an original terrific'ate of death duly filed with mc as l~ocal Registrar. The original certificate will be fb~arded to thc State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. F 8 81 8 7 4 4 ~-:~.,~ ~,,,,~ ....j~ -/O -~ ~ ~ ~.~l~ ~ ,. ,,¢' No. ~ l>atc mos.:~,l R~ ~7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,~c~ Idartha Jane S~i~ ,. Female .. ,. 209 -- 12 -- 55~ ,.D~m~r 13, 2~ 81 ~ : : ~p 1, 1921 Hague. PA Q E~  Manor. re Nursing Home Franklin ~ Cham~mburg . ~lf~plo~ I ~ '~ I ~'a I 1 ~"~*'~ Ne~r~ Ch;m~ur~ PA 17201 ~ ,,.c~ F;nkl~ =, ,,~{ =.~ Cha~be~ur~ ~s~.t~ Edwaffi H. Sm~ Ellen T. Burns ~s~¢~. L~I~ ~ H, Cul~n ~ ~ ~.s~~_c~.~,~ .... 17201 ~ 5135 Gr~n~llage ~ ~~ 0, 2002 ~=~.. Holy Cr~s Ceme~ COMMO.WEALT. OFPE..SWVA.,A INHERITANCE TAX RETURN F,.E.UMeE. DEPARTMENT OF REVENUE DEPT. 280~0, RESIDENT DECEDENT 2] 03 003] HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Smith, Martha Jane 209-12-5586 DATE Of DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ]2/]3/2002 09/01/]921 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Numberof Safe Deposit Boxes of Will) copy of Trust) [] 9. S Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and COMPLETE MAILING ADDRESS Debra K. Wallet FIRM NAME (If applicable) Law Offices of Debra K. Wallet 24 North 32nd Street tELEPHONE NUMBER Camp Hill, PA 17011 717/737-1300 1. Real Estate (Schedule A) (1) 135,017.26 ; 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5,912.04 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) None [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) ]40,929.30 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 29,706.55 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 2,392.13 11. Total Deductions (total Lines 9 & 10) (11) 32,098.68 12. Net Value of Estate (Line 8 minus Line 11) (12) ]08,830.62 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 108,830.62 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 (16) 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate 108,830.62 x .15 (18) 16,324.59 19. Tax Due (19) 16,324.59 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: r STREET ADDRESS 429 Road Appletree CiTY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 16,324.59 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 16,324.59 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ]6~324.:~9 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ................................................................................ D [] b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest; or ............................................................................................................... LJ d. receive the promise for life of either payments, benefits or care? ...................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefic ary des gnat on? ................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE F~I~ILING RETURN ADDRESS Jo~n P. H~n, Jtr.~Exeeator [ y DATE P.O. Box 936 \,e~4 ~1'~_,~ ~:~,,,_~,.^__.,.1-,''/ , Oriental, NC 28571 ~UR~"~F"~ERSt~I~q R~SPON(~= ~rlLING RETURN ADDRESS · ~A'rE · · SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS Debra K. Wallet DATE 24 North 32nd Street ~-QI,~. ~ Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempla transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (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. ,~ SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Martha Jane 21 - 03- 0031 All real property owned solely or as a tenant in common must be rel~orted at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compe ed to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 429 Apple Tree Road, Camp Hill, PA 17011 135,017.26 (based on actual proceeds from sale - see attached HUD-l) TOTAL (Also enter on Line 1, Recapitulation) ]35,0]7.26 .... A., B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.[~FHA 2.~-~FmHA 3.~--IcoNv. UNINS. 4.[--~VA 5.[~]CONV. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: SETTLEMENT STATEMENT P-134054 I 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the sefflement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (P- 134054.PFD/P- 134054/23) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: COLIN C. CONNER, II ESTATE OF MARTHA JANE SMITH CitiMortgage, Inc. LEILA A CONNER 429 Appletree Road 12855 N. Outer 40 Drive 503 Lincoln Boulevard Camp Hill, PA 17011 Saint Louis, MO 63141 Freedom, PA 15042 G. PROPERTY LOCAT ON H. SE'I-I'LEMENT AGENT: 25-1722090 I. SE'I-I'LEMENT DATE: 429 Appletree Road Capital Region Land Transfer, Inc. Camp Hill, PA 17011 July 25, 2003 Cumberland County, Pennsylvania PLACE OF SET-I'LEMENT 3310 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION ~100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 145,500.00 401. Contract Sales Price 145,500.00 102. Personal Property 402. Personal Property '103. Settlement Charges to Borrower (Line 1400) 5,786.81 403. 104. 404. 105. 405. Adjustments For Items Paid B~/ Seller in advance Adjustments For Items Paid B~/ Seller in advance .106. City Taxes to 406. City Taxes to 107. County Taxes 07/25/03 to 01/01/04 229.71 !407. County Taxes 07/25~03 to 01/01/04 229.71 108. School Taxes 07/25103 to 07/01/04 1,366.01 408. School Taxes 07/25~03 to 07/01/04 1,366.01 109. Sewer 07/25/03 to 01/01/04 52.17 409. Sewer 07/25/03 to 01101/04 52.17 110. 410. 111. ~411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 152,934.70 420. GROSS AMOUNT DUE TO SELLER 147,147.89 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO S~=1 i ~=R: 201. Deposit or earnest money 3,000.00 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s) 138,225.00 502. Settlement Charges to Seller (Line 1400) 12,130.63 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. Employer paid lender charges 2,220.25 504. Payoff of first Mortgage 205. Employer paid title charges 2,881.75 505. Payoff of second Mortgage 206. 506. 207. 507. IDeposit disb. as proceeds) 208. 508. 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. City Taxes to 510. City Taxes to 211. County Taxes to 511. County Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 146,327.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 12,130.63 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 152,934.70 601. Gross Amount Due To Seller (Line 420) 147,147.89 302. Less Amount Paid By/For Borrower (Line 220) ( 146,327.00) 602. Less Reductions Due Seller (Line 520) ( 12,130.63' 303. CASH( X FROM)( TO)BORROWER 6,607.70 603. CASH( X TO)( FROM)SELLER 135,017.26 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower ' ~ Seller-~,-,-,~.-- .r COL~ C. CONNF_.~, II ESTATE OF MARTHA JANE SMITH · LEIr~ A CONN~I~' L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 145,500.00_~ 6.0000 % 8,730.00 PAID FRO~ PAID FROM Division of Commissio~ as Follows: .701. $ 4,390.00 to RE/MAX REALTY ASSOCIATES BORROWER'S SELLER'S 702. $ 4,340.00 to HOWARD HANNA DETWEILER REALTY FUNDSAT FUNDSAT 703. Commission Paid at Settlement SETTLEMENT SETTLEMENT 8,730.00 704. Transaction fee to Howard Hanna Delweiler Realty/ReMax Realty Asso 125.00 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee 1.0000 % to CitlM~c. 1,382.25 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Commitment Fee to CitiMort aga.,qe,., Inc. 488.00 807. Application fee to CitlMortgage, Inc. 808. Document Prep. Fee 350.00 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 07/25/03 to 08/01/03 @ $ 18.460000/day ( 7days %) 129.22' 902. Moll a._~g.~g~nsurance Premium for months to State Farm Insurance 399.00 poc 903. Hazard Insurance Premium for 1.0 ~ears to ~ 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months ~ $ 33.25 per month 99.75 1002. Mortgage Insurance months~$ per month 1003. City Taxes months ~ $ per month ~ 1004. County Taxes 6.000 months.~._~_ $ 48.04 ,Der month 288.24 1005. SchooITaxes 2.000 months @ $ 134.01 per month 268.02 1006. months._~_ $ Der month 1007. months~ ep_e_r_ month ~~ ~ustment months_=.~ $ ._p..e_r__month -225.42 1100, TITLE CHARGES 1101. Settlement Attendance to Debra K. Wallett, E_~._q_ 1102. Abstract or Title Search to 200.00 1103. Title Examination to ,1104. Title Insurance Binder to 1105. Document Preparation to ~ 1106. Nota~ Fees to Linda McBeth 1107. Attorney's Fees to 14.0( 8.00 ~ (includes above item numbers: 1108. Title Insurance to Ca ital Re ion Land Transfer Inc. )-- ~ (includes above item numbers: 1 088.75 1109. Lender's Coverage $ 138,225.00 ---)-- ~er's Coverage $ 145,500.00 1111. 100,300,8.1 to Capital Region Land Transfer, Inc. 150.00 1112. Deed Preparation to Debra K. Wallett, Esq. ~ 1113. Overnight to Debra K. Wallett, Esq 85.0~0 1114. Closing protection letter to Capital Region Land Transfer, Inc. 35.00 30.00 1115. Tax certification to ReMax Realty Associates 1116. , Capital Region Land Transfer, Inc. 5.00 1117. 2003/2004 School taxes to Michael W. Harflng 1,432.63 1118. Home Warranty HSA POC 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 39.50; Mortgage $ 64.50; Releases $ 104.00 : Deed 1,455.00 ~ 1,455.00 203. State Tax/Stamps: Deed 1,455.00; Mortgage 1,455.00 1204. Record Mortgage Assignment Recorder of Deeds 1205. 1300. ADDITIONAL Si- ~ ~ LEMENT CHARGES 1301. Survey to 1302. Pest Inspection to Tdton Pest Control 35.00 1303. S~wsr to Camp Hill Borough Authority . #2592 60.00 1304. Wire Fee Capital Region Land Transfer, Inc. 1305. 1400. TOTAL S~ ~ I LEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K! 5,786.81 12,130.63 By signing page 1 of this stalement, the slgn&;~. ;~s acknov, fedge fete;u; of a ~,,...;.;..rl nnnv nf n=na '~ n~ Ihl. ~ .... -~-~ - · ~ · ~ pag~ ~_~a,p.!tal I:~.. ton Land Tra~f~r, I~nc. settlement Agent ( P-1340541 P-134054123 )  ~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. 0OMMON',~ALTN OF,ENNSYLVAN,* PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Martha Jane 21 - 03 - 0031 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 F & M Trust 1,539.19 Checking Acct. #34-25827 2 F & M Trust 1,945.27 Irrevocable Burial Acct. #08-12632 3 Personal property (based on proceeds from auction) 2,227.58 4 1988 Chevrolet Spectrum 200.00 TOTAL (Also enter on Line 5, Recapitulation) 5,912.04 ..~ SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ,..E.,TANOE T.~.E~U.. ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Smith, Martha .lane FILE NUMBER 21 - 03 - 003 l Debts of decedent must be reported on Schedule I. ITEM NUMBEr: DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Gilbert L. Dailey Funeral Home, Inc. 4,472.40 650 S. 28th St., Harrisburg, PA 17103 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Debra K. Wallet, Esq. 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 313.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Mona Kay Sadler, CPA 105.00 7. Other Administrative Costs 1 Mark Heckman (real estate appraiser) 300.00 2 First Citizens Bank (monthly bank charges) 43.30 Total of Continuation Schedule(s) 21,472.85 TOTAL (Also enter on line 9, Recapitulation) 29,706.55  Schedule H COMMONWEALTH OF PENNSYLVANIA Funeral Expenses & INHERITANCE TAXRETURN Administrative Costs continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Martha Jane 21 03 - 0031 3 PP&L (electric bill) 272.70 4 Death Certificates 10.00 5 Keystone Oil (heating oil) 932.61 6 Cleaning supplies 20.63 7 Cleaning of home to prepare for sale 4,740.00 8 Christian-Baker Company (Executor's bond) 210.00 9 Liability for Appletree Road property 21.00 10 Lowes (materials purchased for home repair prior to sale) 129.12 11 Home Depot (materials purchased for home repair prior to sale) 730.54 12 Pressure wash and painting of exterior of home prior to sale 2,500.00 13 Painting of interior of home prior to sale 8,600.00 14 Borough of Camp Hill (sewer) 60.00 15 Snow removal 170.00 16 Trash removal 90.00 17 Lawn mowing 200.00 18 Telephone charges incurred by Executor (from NC to PA) 216.84 19 Michael W. Harling, Tax Collector (2003-04 school taxes) 576.43 20 Penn Waste (trash) 81.48 21 PAWC (water) 122.20 22 Lodging charges for Executor 349.30 23 Travel charges incurred by Executor for trips between NC and PA 1,440.00 Page 2 of Schedule H  SCHEDULE I DEBTS OF DECEDENT, MORTGAGE COMMON,,~A'TH OF.ENNSY'VAN,A LIABI LITI E S, & LIE N S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Martha Jane 21 - 03-0031 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 PP&L (electric) 30.04 2 Keystone Oil (heating oil) 257.21 3 HCR Manor Care 1,218.00 4 Holy Spirit Hospital 840.02 5 Quantum Imaging 6.00 6 Pulmonary Associates 40.86 TOTAL (Also enter on Line lO, Recapitulation) 2,392.13 REVo1513 EX+ (9-00) ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA B E N E FI C IA RI E S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Martha Jane 21 - 03- 0031 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List Tr,,~ee(s) ], TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 John P. Herman, Jr. Nephew 100% of residuary P.O. Box 936 Estate Oriental, NC 28571 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BE NG MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Smith, Martha Jane No. 21 - 03 - 0031 also known as Date of Death 12/13/2002 , Deceased Social Security No. 209-12-5586 John P. Herman, Jr., Executor The 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 located 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 the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. ~l,d~.~,.i,d;;;._~ Personal Represer~ative ~i ! [ Attorney: Debra K. Wallet Signature.~_~ ~'_ ~ d Jo ,P..erman, Jr., Exe or I.D. No.: 23989 Signatul~,,) Signature: Address: 24 North 32nd Street Address: P.O. Box 936 Camp Hill, PA 17011 Oriental, NC 28571 Telephone: 717/737-1300 Telephone: (258) 249-2869 Dated: Personal Property F & M Trust 1,539.19 Checking Acct. #34-25827 F & M Trust ~ 1,945.27 Irrevocable Burial Acct. #08-12632 Personal property (based on proceeds from auction) ~_5 2,227.58 1988 Chevrolet Spectrum 200.00 Total Personal Property $5,912.04 Real Estate 429 Apple Tree Road, Camp Hill, PA 17011 135,017.26 (based on actual proceeds from sale - see attached HUD-l) Total Real Estate $135,017.26 (Attach additional sheets if necessary) Total Personal Property and Real Estate $140,929.30  PRID OR I ENTRL, NC 2857 ! SEP 09, ' 03 oooo $129 z.,,,, ©ff~ .... f DEBRa, K. WALLET CAMP HILL PA 17011 'ro: Register of Wills · Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 COMMONWEALTH Of PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003002 WALLET DEBRA K ESQUIRE 24 NORTH 32ND STREET CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $16,324.59 ESTATE INFORMATION: SSN: 209-12-5586 FILE NUMBER: 2103-0031 DECEDENT NAME: SMITH MARTHA JANE DATE OF PAYMENT: 09/11/2003 POSTMARK DATE: 09/09/2003 COUNTY: CUMBERLAND DATE OF DEATH: 12/13/2002 TOTAL AMOUNT PAID: $16,324.59 REMARKS: JOHN PHERMAN C/O DEBRA K WALLET ESQUIRE CHECK# 1036 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~,~-//~/-~/ COHHONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCT/OHS AND ASSESSNENT OF TAX ~V-~S~EX~CO~-OS~ BATE 10-21-2005 ESTATE OF SHZTH HARTHA J BATE OF BEATH 12-15-2002 FILE NUNBER 21 05-0051 h:.: ~ ~ COUNTY CUHBERLAND DEBRA K WALLET ACN 101 DE~RA K WALLET LAW OFC Amoun~ Remi~ed 24 N 5ZND ST CANP HILL PA ~11 HAKE CHECK PAYABLE AND RENIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LINE ~ RETA/N LOWER PORTION FOR YOUR RECORBS REV-1547 EX AFP (01-03) NOTICE OF /NHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS ANB ASSESSHENT OF TAX ESTATE OF SHZTH HARTHA J FILE NO. 21 05-0051 ACN 101 BATE lO-Il-ZOOS TAX RETURN NAS: (X) ACCEPTED AS FILED { ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 155~017.Z6 NOTE: To insure proper 2. S~ocks and Bonds (Schedule B) (2) .00 credi~ ~o your account, S. Closely Held S~ock/Par~nership In~eres~ (Schedule C} ($} .00 subei~ ~he upper portion 4. Not,gages/No,es Receivable (Schedule D) (4) .00 of ~his fore wi~h your 5. Cash/Bank Deposits/Nisc. Personal Proper~y (Schedule E) (5) 51912.04 ~ex payment. 6. Jointly Owned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. To~el Asse~s (8) 140,929.50 APPROVED DEDUCTIONS AND EXEHPTZONS: 29,706.55 9. Funeral Expenses/Adm. Cos~s/Nisc. Expanses (Schedule H) (9) 10. Deb~s/Hor~gage Liabilities/Liens (Schedule I) (10) 2,592.15 11. To,al Deductions (11) 12. Ne~ Value of Tax Re*urn (12) 108,850.62 15. Chari~eble/Governeen~el Bequests; Non-elec*ed 9115 Trusts (Schedule J) (15) .00 14. Ne~ Value of Es~a~e Sub~ec~ ~o Tax (14) 108,850.62 NOTE: Zf an assessaent ,as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ,111 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 14 e~ Spousal re~e (15) .00 X O0 = .00 16. Amoun~ of Line 14 ~axeble a* Lineal/Class A ra~e (16) .00 X 045 = .00 17. Amoun~ of Line 14 a* Sibling ra~e (17) .00 x 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 108,850.62 X 15 = 16,324.59 19. Principal Tax Due (19)= 16,524.59 TAX CREDITS: PAYMENT RECE/PT DZ$COUNT (+) ANOUNT PAID DATE NUHBER ZNTEREST/PEN PA~D (-) 09-09-2005 CDOOSOOZ .00 16,$24.59 TOTAL TAX CREDIT I 16,524.59 BALANCE OF TAX DUEl .00 INTEREST AND PEN. . O0 TOTAL DUE . O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED. FOR CALCULATION OF ADDTTZONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. ) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoeeonHealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laHful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (TI P.S. Section 91q0). PAYNENT: Detach the top portion of this Notice and submit Hith your payment ta the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS, AGENT REFUND (CR): A refund of a tax credit, which HaS not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ansHering service for forls ordering: 1-800-36Z-lOS0; services for taxpayers Hith special hearing and / or speaking needs: 1-800-4~7-30Z0 (TT only). OBJECTIONS: Any party in interest not satisfied Hith the appraisement, alloHance~ or disalloHance of deductions, or assessment of tax (including discount or interest) as shoHn on this Notice must abject Hithin sixty (60) days of receipt of this Notice by: --Hritten pretest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171ZS-iOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should ba addressed in HriUng to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment ReviaH Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (7173 787-6303. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01} for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacadent's death, a five percent (5Z3 discount of the tax paid is allowed. PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you Hould appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning Hith first day of delinquency, or nine (9) months and one (1) day fram the date of death, to the date of payment. Taxes Hhich became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent par annum calculated et · daily rate of .000164. All taxes which became delinquent an and after January 1, 198Z will bear interest at a rate mhich will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .0005~8 1987 9Z .000247 1999 7Z .O0019g 1983 16X .000438 1988-1991 llg .000301 gOOO 8Z .000Z19 198~ 1IX .000301 X99Z 9Z .OOOZ~7 ZOO1 9Z .000247 1985 13Z .000356 1993-199q 7Z .00019Z 200Z 6Z .00016~ 1986 IOZ .000274 1995-1998 9Z .000247 2003 5X .000137 --Interest is calculated as fOI1OHS: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINgIUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment Js made after the interest computation data shoHn on the Notice, additional interest must bm calculated. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/10/2004 WALLET DEBRA K 24 N 32ND ST CAMP HILL, PA 17011 RE: Estate of SMITH MARTHA JANE File Number: 2003-00031 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6 12) in the above captioned estate. ' As per the AMENDMENTS TO SUPREME COURT ORPHANS, COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent,s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 12/13/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Deced~nt: Martha Jane Smith Date of Death: December 13, 2002 Will No. 2003-00031 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3. If the answer to No.1 is Yes, state the following: a. Did-the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informal.ly to the parties in interest? Yes No d. Copies of receipts, releases, joinders and. approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 11/8/05 ~# 4.~ Signature l..i- C' U.J C) 0:. w- e c.j L' ; C::J CC o (_J LLJ CC Debra K. Wallet, Esq. Name (Please type or print) 24 N. 32nd St., Camp Hill, PA 17011 Address o N (717) 737-1300 Tel. No. If'> C"::) c;::; c--J Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3) \JkJ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: December 13, 2002 File Number: 2003-00031 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . .. 0 Yes ~ No ") If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3. If the answer to No. I is TIS, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. 0 Yes 0040 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... 0 Yes ONo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date 12/5/06 ~It..~ Signature of Person Filing this Fonn Capacity: 0 Personal Representative 00 Counsel Debra K. Wallet, Esq. Name of Person Filing this Fonn \id ' ltn ',lnJ 'dO 24 N. 32nd St. Address Camp Hill, PA 17011 (717) 737-1300 "0:1 i' f{_",: (, . ",$ -L; v_~;-...." ~7 j '- Telephone c;i:. , ',> I L: I,]f\ ,". Form Rw~ifi ~'v:t1J:l~,66<:'; qj PHONE: (717)737-1300 .Law tDffiCE.j. of DEBRA K. WALLET 24 N. 32nd STREET CAMP HILL, PA 17011-2917 Email: Walletdeb@aoJ.com FAX: (717) 761-5319 December 5, 2006 Glenda F. Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Martha Jane Smith File No. 2003-00031 Dear Ms. Strasbaugh: Enclosed is a Status Report Under Rule 6.12 for filing in the above-captioned estate. I apologize for the delay in filing this, but as you can see from the enclosed, a status report was mailed to you on November 2,2006. I have no idea what happened to it. We never got a stamped-in version returned to us. I have also enclosed a copy to be stamped and returned in the enclosed pre-addressed envelope. Sincerely yours, ~~.~ Debra K. Wallet DKW/mml Enc. -'r-!l '-'!- ,~'-~ !dj'Ui 'r,\ n I\!' ., ',dUO I 0. ~VI'1 u >J3l8 20 : I Hd b-J 9DOZ PHONE: (717) 737-1300 ..i!a.w Dffr.cH of DEBRA K. WALLET 24 N. 32nd STREET CAMP HILL, PA 17011-2917 Email: Walletdeb@aol.com FAX: (717) 761-5319 November 1,2006 Glenda F. Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Martha Jane Smith File No. 2003-00031 Dear Ms. Strasbaugh: Enclosed is a Status Report Under Rule 6.12 for filing in the above-captioned estate. I have also enclosed a copy to be stamped and returned in the enclosed pre-addressed envelope. Sincerely yours, Debra K. Wallet DKW /mml Ene. \ ,'-' .. \.TJHd80 '18 2U."\ I . . j .. r t.;- J < '~:-:GZ L ./ ''I . S~ATUS REPORT UNDER RULE 6.12 Name of Decedent: Martha Jane Smith Date 0 f Death: December 13, 2002 Will No. 2003-00031 AdInin. No. Pursuant to Rule 6.12 of the Supreme Court Or?ha~s' Court Rules, I repor~ t~e follo~ing with respect to completion of the administration or the above-captioned estate: 1. State Yes whe~her aciIninistration of the estate No X complete: is 2. If the answer is No, reoresentative reasonably believes co~plete: unknown state when the personal that the admini;tration . - ill vv___ be 3 . If state the following: the ans'wer to No. 1 lS Yoc:: ----, a. Cie.-the pe::-scne..l rep::-esentative =-:.le e.. fine..l e..ccount with the Court? Yes No b. The sepa::-e..te Orphe..ns' Court No. (if any) Ie::- the personal =ep=ese~~a~ive's account is: ccccunt c. "~ 1 1 In.rODTIa_~y Did the person21 representative state to the parties in interest? Yes an No d. Copies of receipts, releases, joinders ane aoprovals of fo=mal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 11/1/06 ~~I-~' w~ Signa ture Debra K. Wallet, Esq. Nc.me (Please type or print) lUI <'!n8 'ldO 24 N. 32nd St., Camp Hill, PA 17011 Address (717) 737-1300 Tel. No. 20 :! ('" c- Capacity: Personal Representative i..; (-;" : ,J ! i, ..J-'I J/- _~r: (:", .'~'" ( l'l.::A::H -:lrm -f-'/ ~3'") .. Counsel for personal representative X Pa. a.c. Rule 6.12 STATUS REPORT REGISTER OF \VILLS OF CUMBERLAND CO lFNTY, P El'll'I S Y LV .-\ :.11.-\ Martha Jane Smith Name of Decedent: Date: 0 f De:J.th: 12/13/02 File Number: 2003-00031 Pursuant to Pa, O.c. Rule 6.12, I report the following with respect to completion of the adminisrr3.tlon at' the above-captioned estate: 1. State w'hether adminisrration ofehe esr3.te is complete: . . . . . . . . . '.' . . . . . . . .. CJ Yes :X10io ") If the answer is No, state when the personal represenCJ.tive reasonably believes that the administration will be complete: unknown J. If the answer to ~o. 1 is 'YES. stJ.te the following: a. Did the personal representative file a final account with the Court': . . . . . .. 0 Yes ':J No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c, Did the personal representative state an account informally to the parties in interest? ,........,.........,........... 10 Yes !:J 'No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this reporr, Dale 12/4/07 ~a.~ Signature of Person Filing IhlS Fonn Capacity: 0 Personal Representative il1 Counsel Cebra K. Wallet, Esq. Name of Person Filing thIS Fonn - "('('\ "I 11lJ Hilt:).:; J~] H&IO :10 7:ti318 , C ~ II U\1 ~.~ ~r-1n I nUl 24 N. 32nd St. Ackiress Camp Hill, PA 17011 (717) 737-1300 Telephone Form RW-/O rev. 1.1J,n,.,06 ..". I i-'I r..rY-' \ ~ P1. O.C. Rule 6.1? ST:~TL~S REPORT R.EGIST.~ OF ~~~ILLS GF CUMBERLAND CO(,~T~". PE~+~iSYL~~:~.~+i.-~ dame or Decedent: Martha Jane Smith Date o[ Death: 12/13j02 ciie ~~umber: 2003-00031 Pursuant to Pa. O.C. Rule 6.1?. [ . :Qr C,"... i0ii0~4in? wlCa ,eS~eCt tt} COtTlCiet:On Ot the admlil!StratiCC Ji the above-cactioned estate: 1. St~t.° bL'Y?et.,~. aC%,!:!.Si:aliGC Gt ..... ~S3te tS CCC:C~e.... J . ~.. ~ ~`+iv _. Ii the 2r.StiVer IS ~0. S_'te ~N:-:en i_`_Z ;;'Z:SOr'ia1 r'CrC.;~-a1ri~` ~ ~ V I' ~.~ n ar--i ic--~ri0n b~•i!i r.Z C;,f;iCiet°: re_.s,.,n::bi, be !eves t„~t th_ ~..::...~..... . un~:cwn ~. 1. t:ie 3^S~:ver tC ~~:. ~ :$ Y ~.~. ~t=_...~e iCI~C'.'v'i-, r-. a. DIG ti`:e CC.~OP.r! r Cr°Se::t.Cse ::i2 a %ai 3C C:.i::a '~L"iii; t::e CJU%~ .. _..1 Y eS ~i ~~: b. i ne se~arste Or~nans' Ccu-. ~+c. (ir ar_~) er the ~e;sorai re~r~sentative's account is: c. Did L+~e personal : cresen~,s ve ;,,ate an account irser-.na11v to the ~a~-res r ;`__-e~° ............................... '~ _ es _t ~;;: d. Copies oL receicLS, recesses, joinders and approvals of orusl or in'or~al accounts aav be Hied wi'tt'i the Cleric oT tre Ort~.ans' Court and .m_,sv be a~~ched to tf-,is repot. o~~ 11/24/08 ~' n~ < <~ I '1 Iv ~, , ~j_ .J sz : i cad sz ~~=~ ~~~ Form.4:V•!0 rtv. !0.lJ.Od' ~r ~ ~n ~ ~-'~ ~~r.-, . ~~.4~{~ ~ignG'ure of ?'r:aR : iifng J1(S ..^at7n Cscac:rv: ~ Personal Resr°sentative ~ Course: >/ebra K. Wallet, Esq. :Name of ?rr:an Filing :hu Farm 24 N. 32nd St. .~a~w Cantu Hill, PA 17011 (717) 737-1300 i L1eDnant Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND - COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: 12/13/02 File Number: 2003-00031 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... ^ Yes ^ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... ^ Yes ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. mate 1/28/10 ;~F~, ~ c L,I:Mt - ,. ~; " .. "~~ ~' -w : ~ a s ,..~ - ~..~~. '1 ~~ ~,. i ~._.~ t- '.' For m -]0 rev. 6 N ~ ~cor-. K. ~~1- Signature of Person Filing this Form Capacity: Personal Representative ~ Counsel Debra K. Wallet, Esq. Name of Person Filing this Form 24 North 32nd Street Address Camp Hill, PA 17011 (717) 73 7-1300 Telephone Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: December 13, 2002 File Number: 2003-00031 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Unknown 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ... o ... ^ Yes ^ No b. The separate Orphans' Court No. (if any) for the personal representative's account is; c. Did the personal representative state an account informally to the parties in interest? ............................... ^ Yes ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date 12!01!2011 G:.. ~ V? `"'' ~_ "7 C ; u..Qc_. t ~I ! : i.7 ,_.. ~ J~ 2 y _ ~ --. i L1J _ _ ~ -x= -~__ ~ C.] Signature of Person Filing this Form Capacity: Personal Representative Counsel Debra K. Wallet, Esquire Name of Person Filing this Form 24 North 32nd Street Address Camp Hill, PA 17011 (717) 737-1300 Telephone Form RW-10 rev. 10.13.06 ~, ~ `{~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: 12/13/2002 File Number: 21 - 03 - 00031 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: ^ Yes ^X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3, If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ^ Yes ^ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ^ Yes ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. ~1e 11 /16/2012 r~ V'? `~ tr".) , ` ~ _ ~ moo ~- r' ~ L.L. S L.:- ~ - -,- ~. ~- ,~ ~- r t L_. c C- Li; c-, ~ : x_ c CI cr _ -v ~_ Form RW-10 Rev. ~o-~s-zoos Signature o/Person Filing this Form Capacity: ^ Personal Representative ~ Counsel Debra K Wallet Name of Person Filing this Form 24 North 32nd Street Address Camp Hill, PA 17011 City, Sfate, Zip 7171737-1300 Telephone Copyright (c) 2006 form software only The Lackner Group, Inc J~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: 1211312002 File Number: 21 -03 -00031 Pursuant to Pa. O.C. Rule 6.12, 1 report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: ❑ Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ❑ Yes ❑ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ❑ Yes ❑ No d. Copies of receipts, releases,joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date 11127/2013 6Ju e^A�- Signature of Person Filing this Form © U) L& Capacity: ❑ Personal Representative Counsel - J N t" U 1 C> L E o ° � Debra K Wallet � w cL c Name of Person Filing this Form M N w _j Lu N � y w 24 North 32nd Street Cr r, m address CD C>> w G o Camp Hill, PA 17011 l� V City,State,Zip 7171737-1300 Telephone Form RW 10 Re,10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. °J Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Martha Jane Smith Date of Death: 12/13/2002 File Number: 21 -03 -00031. Pursuant to Pa. O.C. Rule 6.12, 1 report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: ❑ Yes ® No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: unknown 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ❑ Yes ❑ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ❑ Yes ❑ No d. Copies of receipts, releases,joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date 11/12/2014 Signature of Person Filing this Form Capacity: ❑ Personal Representative ❑X Counsel OG'? r-) <Debra K Wallet E,!.- GName of Person Filing this Form nNorth 32nd Street 0— no © damp Hill, PA 17011 L.Lt — rfy,State,Zip c` 17/737-1300 Telephone Form RW-10 Rev.10-13-2006 copyright(c)2006 form suftwa;e only The Lackner Group,Inc.