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HomeMy WebLinkAbout03-0924PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as LEIDA A. GLEIM Deceased. Social Security No. 207-03-7350 No. To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners are 18 years of age or older and the Executors named in the last will of the above decedent, dated July 2, 1992, and codicil dated May 20, 1997. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 450B Sherwood Drive, Middlesex Township. Decedent, then 82 years of age, died October 20, 2003, at Harrisburg Hospital, Harrisburg, PA. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None $ unestimated $ WHEREFORE, petitioners respectfully request the probate of the last will and codicil presented herewith and the grant of letters testamentary thereon. John W. Gleim, Jr. 3:'.;~z'.', ~ ,re ./21 ,~t_~ Carlisle, PA 17013 Tracy K. Gleim ~' 450 Sherwood Drive Carlisle, PA 17013 (717) 243-2392 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above decedent, petitioners will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this day of Register John W. Gleim, Jr. Tracy K. Gle~ NO. Estate of LEIDA A. GLEIM, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated July 2, 1992 and May 20, 1997, described therein be admitted to probate and filed of record as the last will of Leida A. Gleim and Letters Testamentary are hereby granted to John W. Gleim, Jr. and Tracy K. Gleim. Will Book # Page FEES Probate, Letters, Etc. $ Short Certificates( ) $ Renunciation $ $ TOTAL $ Filed Register of Wills John B. Fowler III (06273) ATTORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 F:~ILES~DATAFILEX, ESTATES~O969-2.1~tt~r~.tes I0~.R0S REX,' This 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 photograph. Fee for this certificate, $2.00 P 974S864 No. Local Registrar OCT 2 3 2003 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH 82 ,,,, i : [apr.7, zg21 JLower Frank'%rd[ ' J : J : I. I~.'D , dumb f'~ ~ [~ ~arrzsDurg J Harrisburg Hospital ~E ~]S USUAL ~U~ KIND ~ BUSINES~N~S .... S DECE~NT EVE. IN ~CEO'NT 450 B She~ D~ive ' ACTUAL " ~. S,, PA ~ .... In~S,~ rlls~e, PA 17013 William warner W. gleim, Jr. Oct Cumberland Pheobe 224 North Middlesex Rd., Carlisle, PA 17013 2003 013144 L Hoffman-Roth Funeral Home CODICIL I, Leida A. Gleim, of Middlesex Township, Cumberland County, Pennsylvania, declare this to be the sole Codicil to my Last Will and Testament dated July 2, 1992. ITEM I: I hereby revoke Item II of my last Will and in lieu thereof provide as follows: ITEM II: I bequeath any automobiles or motor vehicles I may own at my death to my son, Tracy K. °Gleim. I direct that my household goods, personal effects and other tangible personal property of like nature (not including cash or securities) shall be sold at public sale by my personal representative(s), and I further direct that the net proceeds thereof shall be administered and distributed as a part of the residue of my estate. ITEM II: In all other respects, I hereby ratify, confirm and republish my last Will dated July 2, 1992, together with this sole Codicil, as and for my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~0~ day of ~ , 1997. Signed, published and declared on the date thereof by the above named Leida A. Gleim as and for the sole Codicil to her last Will dated July 2, 1992, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA : : ss. COUNTY OF CUMBERLAND : We, Leida A. Gleim, John B. Fowler, III, and Mary M. Price, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her sole Codicil and that she has signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Codicil as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix - ! ~ Witness Subscribed, sworn to and acknowledged before me by Leida A. Gleim, the Testatrix, and subscribed and sworn to before me by John B. Fowler, III, and Mary M. Price, the witnesses, this /.)0~~ day of ~ , 1997. Notary Public I J I I II II I II .....~ ! ' .OTA.,AL' SE~ I MICHAEL R. RUNDLE. NOTARY PUBLIC ! BORO OF CARLISLE. CUMBERLAND COUNTY I_MY COMMISSION EXPIRES DECEMBER 20. 1998 LAST WILL AND TESTAMENT OF LEIDA A. GLEIM I, Leida A. Gleim, of Middlesex Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke all Wills and Codicils previously made by me. ITF~ I: I direct that all my legally enforceable debts and funeral expenses, including all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITF~ II: I direct that any automobiles or motor vehicles I may own at my death, my household goods and personal effects, and other tangible personal property of like nature (not including cash or securities) shall be sold at public sale by my personal representative(s), and I further direct that the net proceeds thereof shall be administered and distributed as a part of the residue of my estate. ITEM III: I direct that the advancements which I have made to my sons, John W. Gleim, Jr. and Tracy K. Gleim, and which are secured by mortgages on the farm properties conveyed to them by me during my lifetime, shall not be considered assets of my estate or deducted from their respective shares. Otherwise, I direct that all other advancements which I have made to the beneficiaries of my residuary estate, including my said sons, whether such advancements are evidenced by note or other form of indebtedness, shall be considered assets of my estate in calculating their respective distributive shares at the time for distribution to them. ITEM IV: I devise and bequeath the residue of my estate of every nature and wherever sit.uate as follows: A. Twenty-nine (29%) percent thereof to my son, John W. Gleim, Jr., or his issue, per stirpes. B. Ten (10%) percent thereof to my granddaughter, Cindy Gleim-Pool, or her issue, per stirpes. C. Five (5%) percent thereof to my grandson, James W. Gleim, or his issue, per stirpes. D. Five (5%) percent thereof to my grandson, John T. Gleim, or his issue, per stirpes. E. Forty-nine (49%) percent thereof to my son, Tracy K. Gleim, or his issue, per stirpes. F. Two (2%) percent thereof to St. James Lutheran Church, of Bloserville, Pennsylvania. ITEM V: Ail Federal, State and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether passing under this Will or otherwise, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of the administration of my estate and shall be paid out of the principal of my residuary estate without apportionment or right of reimbursement. ITEM VI: I appoint my said sons, John W. Gleim, Jr. and Tracy K. Gleim, or the survivor, Executors of this my last Will. ITEM VII: I direct that all fiduciaries acting under this Will, whether or not named herein, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~, day of July, 1992. [SEAL] The preceding instrument, consisting of two (2) typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Leida A. Gleim, the Testatrix therein named, as and for her last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : We, Leida A. Gleim, John B. Fowler, III, and Mary M. Price, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~- Testatrix ~ 'Witness Subscribed, sworn to and acknowledged before me by Leida A. Gleim, the Testatrix, and subscribed and sworn to before m~y John B. Fowler, III, and Mary M. Price, witnesses, this ~ day of July, 1992. Notary ~lic LEIDA A. GLEIM John B. Fowler, III, Esq. /~O%WL~R, ADD--S, SHUG~RT AUORNEYS AT ~W ~. O. BOX ~O~ CAR~SLE, PENNSYLVANIA 17013 F:\FILES~DATAFILE~ESTATES\9969-2.notice.ce~ Name of Decedent: Date of Death: File No. To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Leida A. Gleim October 20, 2003 21-03-0924 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about January /b", 2004. Mr. John W. Gleim, Jr. 224 North Middlesex Road Carlisle, PA 17013 Mrs. Cindy Gleim-Pool 216 North Middlesex Road Carlisle, PA 17013 Mr. John T. Gleim 312 South Pitt Street Carlisle, PA 17013 Mr. Tracy K. Gleim 450 Sherwood Drive Carlisle, PA 17013 Mr. James W. Gleim 214 North Middlesex Road Carlisle, PA 17013 St. James Lutheran Church 717 Bloserville Road Newville, PA 17241 Date: January /~,2004 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Signature jo o~wler~,~'~~ Name Esquire M3d~SON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FiLE NUMBER 21 03 00924 COUNTY CODE YEAR NkrMBER SOCIAL SECURITY NUMBER ~, LEIDA A. ~ ~EATH (MM-DP YEAR) [ DATE OF BIRTH (MM-DP Y~AR) ~ 110/20/2003 04/07/1921 ] 2 Supplemental Return ] 4 Limited Estate [] 4a FuturelnterestCornpromise(dateofdeathafler 12 12-82) [] 6 Decedent Died Testate (Attach copy [] 7 Decedent Maintained a Living Trust/Attach of Wi:l) copy of Trust) [] 9 Litigation Proceeds Received [] 10 Spousal Poverty Credit (dale of death between 12 31-91 and 1-1-95) 207-03-7350 REGISTER OF WILLS SOCIAL SECURITY NUMBER ] 5 Federal Estate Tax Relurn Required 8 Total Number of Safe Deposit Boxes [] 11 Election to tax under Sec. 9113(A) (A[taeh Sch O) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD qAME COMPLETE MA~LING ADDRESS Jolm B. Fowler, III, Esquire :[RN NAME (If applicable) Martson Deardorff Williams & Otto Ten East High Street ELEPHONE NUMBER Carlisle, PA 17013 717/243-3341 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Padgnership or Sore-Proprietorship 4, Mortgages & Notes Receivable (Schedure D) 5. Cash, Dank Deposits & Miscellaneous Personal Properly (Schedule E) 6. Jointly Owned Properly (Schedule F) [] Separate Billing Requested 7. Enter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines %7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule [) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) None BE DIRECTED TO: (2) I 1,905.82 (3) None (4) 207,147.85 (5) 27,823.22 (8) None (7) None (9) 20,462.90 (10) 202.00 13. Chardable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14, Net Value Subiect to Tax (Line 12 minus Line 13) (8) 246,876.89 (11) 20,664.90 (12) 226,211.99 (13) 4.122 51 (14) 222,089.48 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x .00 (15) 16.Amount of Line 14 taxable at lineal rate 222,089.48 x .045 (16) 17. Amount of Line 14 taxable at siblin9 rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Copyright 2000 form software only The Lackner Group, Inc. 9,994.03 %994.03 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 450B Sher~vood Drive Carlisle ~E PA ZIP 17013 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) ,994.0a 9,000.00 473.68 Total Credits (A + B + C) (2) Total ]nteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. If Line l + 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) 9,473.68 0.00 520.35 520.35 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ............................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ................................... [] [] c. retain a reverslonaryinterest; or ............................................................................................................. [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? [] [] 3. Did decedent own art"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 properly which contains a beneficiary designation? .................................................................................................................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. p,~ ~ r% r o~ter tDan the personal repres er/tativ( preparer has any knowledge ~IGNATU~'E O~" PERSON RESPONSIBLE F~ ADDRESS /¢', t' 7 , ' 224 Nortl~ Middlesex Road ~'~ ,' ~ ' :/ ',- " , , Cmlisle, PA 17013 g SIONATUR~OF PERSdN RESPONSIBLE FOR FILING RETORN ADDRESS DATE /Tra~. Glenn . ...~..:;~.,~: :,/~/) ..~. ' 450 Sherwood A~cnue ~' '~ ~5 ~ ,,':' / Carlisle, PA 17013 ' .'/~',: / ~[G~TU RE OF PR<~ARER Of heR T~&N R~FR~SE&fATIVE ADDRESS John B, ~6 ler 111, Es~u~:~. ~}/ ~ I / ...... Ten East High Strcct /~' / ~ - ~,, ' Carlisle, PA 17013 surviving spouse is 3% [72 P,S, §9115 (a) (1 1) (i)J. 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) (iJ)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and firing a tax return are stilt applicable even if the survivin9 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 8 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 tile 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 B STOCKS& BONDS ESTATE Of FILE NUMBER GLEIM, LEiDA A. 21-03-00924 All property joingy-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 share, Agway, Inc. Class 4C unsecured claim against Agxvay Inc. Chapter 11 Ba~tkmptcy paid at 29.5% (See Proof of Claim, Claim Form Statement and letter flora Agway Liquidating Trust) (Claim of $40273.98 at 29.5%) UNIT VALUE VALUE AT DATE OF 25A)0 DEATH 25.00 11,880.82 TOTAL (Also enter on line 2, Recapitulation) 11,905.82 SCHEDULE D i MORTGAGES & NOTES RECEIVABLE ESTATE OF GLEIM, LEIDA A. FILE NUMBER i 21 - 03- 00924 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 2 DESCRIPTION Mortgage fi'om Michael & Cindy Gleim Pool dated I/1/1992, original principal of $90,000, payable in 207 payments of $700.00 at 6% per ammm (principal balance of $38,480.24 + 102.61 accrucd interest) Mortgage secured by famr property and Pronfissory Note fi'om John W. Gleim, Jr., dated I/1/1994, original principal $37,872.01, payable in 188 payments of $300.00 at 5.5% per anmnn (principal balance of $18,141.76 + $44.35 accrued interest) Promissory Note from Jolm W. Gleim, Inc. dated 5/17/2001, principal of $85,000 due 12/31/2004, xvitb interest payable qnarterly at 7% per annum (principal balance of $85,000.00 + 198.33 accrued interest) Promissory Note fi'om John W. Gleim, Jr. dated 10/1/2001, principal of $65,000 xvitb interest payable quarterly at 5% per annum (principal balance of S65,000.00 ~ $180.56 accrued interest) VALUE AT DATE OF DEATH 38,582.85 18,186.11 85,198.33 6~ ,I80.>6 TOTAL (Also enter on Line 4, Recapitulation) 207,147.85 SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF GLEIM, LEIDA A. Include the proceeds of litigation and the date the proceeds survivorship must be disclosed on schedule F. FILE NUMBER 21 - 03 - 00924 were received bythe estate. All property jointly-owned with the right of ITEM NUMBER 1 2 3 4 5 DESCRIPTION Orrstown Bank, checking account #14300022 Onstown Bank, C.D. #143000022 1994 Mercury Sable Erie Insurance, refund of premium Household furnishings and personal property of nominal value VALUE AT DATE OF DEATH I5,610.21 !0,00401 1,900.00 59.00 250.00 TOTAL (Also enter on Line 5, Recapitulation) 27,823.22 ESTATE Of GLEiM, LEIDA A. SCHEDULEH FUNERALEXPENSES& ADMINISTRATIVECOSTS IFILE NUMBER 21-03 ~00924 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Hofllllan-Roth Funeral tlolne Westminstcr Cemetery, Gm'ce Opcning Mmister AMOUNT 7._*04.'*0 945.00 500.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / ffIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Martson Deardorff Williazm & Otto (estimated) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills of Cumberland Coullty Zip 11,150.00 98.50 Accountant's Fees Tax Return Preparer's Fees Stott & Stott Financial Services, 2003 income tax returns Other Administrative Costs Register of Wills, filing fce, inheritance tax rctnm Reserved fur additiooal probatc, filing fees and miscellaneous expenses 100.00 15.00 350.00 TOTAL (Also enter on line 9, Recapitulation) 20,462.90 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE Of GLEIM, LEiDA A. FILE NUMBER 21 03-00924 Include unreimbursed medical expenses. ITEM NUMBER U.S. Treasury, 2003 income tax PA Dept. of Revenue, 2003 income tax DESCRIPTION AMOUNT 98.00 10400 TOTAL (also enter on Line 10, Recapitulation) 202.00 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER GLEIM, LEIDA A. 21-03-00924 NUMBER AMOUNTORSHARE OF ESTATE 2 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Tracy K. Gleim 450 Sherwood Drive Carlisle, PA 17013 John x,V. Gleim, Jr. 224 North Middlesex Road Carlisle, PA 17013 Jolm W. Gleim, Jr. 4 Cindy Gleim-Pool 216 Ninth Middlesex Road Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Son iSon Soo Granddaughter 51,900.00 (vehicle) $18,186.11 (forgiveness of Item 2, Sch. D) $55,776.50 (29% estate residue) $20,612.59 (10% estate residoe) II. See Continuation Schedule(s) attached i Enter dollar amounts for distributions shown above lines 15 1 on through 8, as appropriate, Rev 1500 cover sheetI !NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS St. James Lutheran Church (2% of estate residue) 717 Bloscrville Road, Nex,,ville, PA 17241 TOTAL OF PART I1 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 4.122.51 4,122.51 COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES continued ESTATE OF GLEIM, LE1DA A. I FILE NUMBER - 21 - 03 - 00924 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE DO Not List Trustee(s} O F ESTATE NUMBER I. 5 6 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ~'AXABLE DISTRIBUTIONS [include outright spousal distributions, and transters under Sec 9116(a)(1 2)1 James W. Gleim 214 North Middlesex Road Carlisle, PA 17013 John T. Gleim 312 South Pitt Street Carlisle, PA 17013 Tracy K. Gleim Grandson $10,306.o0 (3 ~o estate ]csidue) S10,306.30 (5% estate residue) S101,001.68 (49% estate residue) Page 2 of Schedule J COMMONWEALTH OF PENNSYLVANfA DEPARTMENTOFREVENU[ BUREAU OFINDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128 0601 RECEIVED FROM; PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11 96) NO. CD 004173 GLEIM TRACY K 450 SHERWOOD AVENUE CARLISLE, PA 17013 ESTATE INFORMATION: SSN: 207-03-7350 FILE NUMBER: 2103-0924 DECEDENT NAME: GLEIM LEIDA A DATE OF PAYMENT: 07/19/2004 POSTMARK DATE: 07/1 9/2004 ;OUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $520.35 TOTAL AMOUNT PAID: $520.35 REMARKS: T K GLEIM SEAL CHECK# 3 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. 280601 HARRISBURG, PA 17128-0601 JOHN B FONLER III HARTSON ETAL 10 E HIGH ST CARLISLE COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I~i7 EX AFP (01-05) ESQ '04 SEP 15 DATE 09-1q-200q ESTATE OF GLEIH ~:~ DATE OF DEATH 10-20-2005 FILE NUHBER Z1 03-092q COUNTY CUHBERLAND ~:~ ACN !0! Amount Raa~ttad LEIDA A HAKE CHECK PAYABLE AND REH'rT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~* RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GLETH LEIDA A FILE NO. 21 05-092q ACN 101 DATE 09-1~-200~ TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedu/e A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Hald Stock/Partnership Interest (Schedule C) ($) q. Mortgages/Notas Receivable (Schedule D) (q) 5. Cash/Bank Deposits/MAsc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To*al Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funera! Expensas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/L/ans (Schadule 1) (10) 11. Total Deduct/ohs 12. Na~ Value of Tax Return .00 11~905.82 .00 207/1~7.85 27~825.22 .00 .00 (8) 20,~62.90 ZOZ.O0 NOTE: To /nsura proper crad/t to your account, subm/t the upper port/on of th/s form w/th your tax payment. 2q6,876.89 15. 1~. NOTE: (11) 2o.6~4.90 (3L2) 226,211.99 reflect flgures that /nclude the total of ALL returns assessed to date. ~,122.51 9,000.00 520.55 ZF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ASSESSHENT OF TAX: 15. Amount of Lina 1~, at Spousal rate 16. Amount of L/ne 1~ taxable at L/naal/Class A rate 17. Amount of Line lq at Sibl/ng rata 18. Amount of L/ne lq taxabla at Collateral/Class B rata 19. Princ/pal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN pATD (- 01-20-200q CD005~59 ~,75.68 07-19-200~ CD00~17~ . O0 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 9,99~.05 .00 .00 .00 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR}, YOU NAY BE DUE ~ A REFUND. SEE REVERSE STDE OF THIS FORM FOR TNSTRUCTTONS.) L/~, AMOUNT PAID (~5) .00 x O0 = .00 (16) 222,089.q8 x 0~,5= 9,99q.05 (17) .00 x 12 = .00 (18) .00 x 15 : .00 (19)= 9,99q.. 03 Char/table/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Net Value of Estata Subject to Tax (lq) 222,089. q8 If an assessaent was Sssued prev$ously, 1Shes la, 15 and/or :16, 17, 18 and :19 .$11 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADNZN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaaanaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of HilIs printed on the reverse side. --Hake check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Mills, any of the 25 Revenue District Offices, or by calling the special lC-hour answering service for forms ordering: 1-800-$6Z-Z050; services for taxpayers with special hearing and / or speaking needs: Z-800-¢47-$020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016¢. A11 taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Deperfd~ent of Revenue. The applicable interest rates for 1981 through ZO0¢ are: Interest Da i ly Interest Daily Year Rate Factor Year Rate Factor Year ~ 2OZ .0005¢8 ~'&- 1991 llZ .000301 1983 162 .000¢38 1992 92 . O002¢7 2001 198¢ 111 .000301 1993-199¢ 77. .00019Z Z003 1985 13Z .000356 1995-1998 91 .000247 ZOO¢ 1986 10Z .00027¢ 1999 77. . OOO19Z 1987 IOZ .00017¢ ZOO0 71 .000191 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR Interest Daily Rate Factor 9Z .000147 6Z .000164 57. .000137 CZ .000110 --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bo calculated. z OFFICIAL USE ()NY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDSNT'S NAME (LAST, FIRST, AND MIDDLE iNITIAL) GLEIM, LEIDA A. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD'YEAR) FILE NUMBER 21 03 00924 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 207-03-7350 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 10/20/2003 04/07/1921 REGISTER OF WILLS F 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) [] 6. DecedentDiedTestate(Atmchcopy [] 7. DecedentMaintainedaLivingTrust(Atmch [] 9. Litigafion Proceeds Received [] 10. SpousalPovertyCredit(dateOfdeathbebneen NAME John B. Fowler, III, Esquire FIRM NAME (If applicable) Martson Deardorff Williams & Otto 717/243-3341 [] 5. Federal Estate Tax Return Required I 8. Total Number of Safe Deposit Boxes [] 11,Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS Ten East High Street Carlisle, PA 17013 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietarship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) None (2) 3,423.29 (3) None (4) None (5) None (6) None (7) None (9) (10) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) 3,423.29 (11) (12) 3,423.29 (13) 68.47 (14) 3,354.82 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 3,354.82 x .00 (15) x .045 (16) 150.97 x .12 (17) x .15 (18) (19) 150.97 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 450B Sherwood Drive CITY Carlisle [STATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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 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 I50.97 0.00 0.00 150.97 150.97 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes No a. retain the use or inccme of the property transferred; .................................................................................. ~ ~ b. retain the fight to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest or ....................... d. receive the promise for life of either payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one yaar of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decadent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. John W. Glelm Jr. 224 North Middlesex Road Carlisle, PA 17013 DATE DATE ~ -- Ten, E,ast High Sb'eet ~~s~ers to or for ~e use o~ t~e g epousa ie 3% [?2 P.S. §gl ~ (a) 0.1) (i)]. ~or flatas of flaath on or a~r da~uary 1, ~ 995, ~e tax m~ imposed o~ tha net vacua of transfers [72 P.S. §gl ~ 9 (a) (1.1) (ii)]. The statute does not a×empt a transtar tea Su~i¥ing spouse from tax, and ~e statutory requimmants ~or disclosure ~or data$ o~ daath on or a~r July ~, 2000: parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rata 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 B STOCKS & BONDS ESTATE OF FILE NUMBER GLEIM, LEIDA A. 21 - 03 - 00924 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE O NUMBER DESCRIPTION UNIT VALUE DEATH 1 Class 4C unsecured claim against Agway Inc. Chapter 11 Bankruptcy - second 3,423.29 payment TOTAL (Also enter on line 2, Recapitulation) 3,423.29 SCHEDULE J COMMO"W~LT. OF P~"S~LVA.I^ BENEFICIARIES ESTATE OF FILE NUMBER GLEIM, LEIDA A. 21 - 03 - 00924 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I, TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 John W. Oleim, Jr. ~on $992.75 (29% estate 224 North Middlesex Road residue) Carlisle, PA 17013 2 Cindy Gleim-Pool Granddaughter $342.33 (I 0% estate 216 North Middlesex Road residue) Carlisle, PA 17013 3 James W. Gleim Grandson $171.16 (5% estate 214 North Middlesex Road residue) Carlisle, PA 17013 4 John T. Gleim Grandson $171.16 (5% estate 312 South Pitt Street residue) Carlisle, PA 17013 See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 St. James Lutheran Church (2% of estate residue) 68.47 717 Bloserville Road, Newville, PA 17241 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE' 68.47 SCHEDULE J COUMO.W~L~. OE PENNaV~vANI^ BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE DO Not List TruJltee($} OF ESTATE 'AXABLE DISTRIBUTIONS Tracy K. Gleim 450 Sherwood Avenue Carlisle, PA 17013 [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Son $1677.41 (49% estate residue) Page 2 of Schedule J 30 200~ 5:02P~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004810 FOWLER JOHN B III 10 E HIGH STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 207-03-7350 FILE NUMBER: 2103-0924 DECEDENT NAME: GLEIM LEIDA A DATE OF PAYMENT: 01/07/2005 POSTMARK DATE: 01/07/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $150.97 REMARKS: TOTAL AMOUNT PAID: 9150.97 SEAL CHECK# 10626 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXIES' INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0001 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE "O~ I?EDUCTIONS AND ASSESSMENT OF TAX ,}: i q. DATE ESTATE OF DATE OF DEATH FILE NO. COUNTY ACN 03-01-2005 GLEIM LEIDA 10-20-2003 21 03-0924 Cumberland 501 A JOHN B FOWLER III ESQ MARTSON ET AL 10 E HIGH ST CARLISLE P A 17013 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ . -Ffev~1547 EX -(ii6-97fPC - - - - - - - - - - - - - -Notit-E -iiF -'-N~fERIT ANCE - lA;( AP-PFfAis-eMENt: -"i:C.OWANce- OR - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GLEIM LEIDA A FILE NO. 2103-0924 ACN 501 DATE 03-01-2005 TAX RETURN WAS: (i:8I) ACCEPTED AS FILED (D) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnershio Interest (Schedule C) 4. MortoaQes/NotEls Receivable (Schedule D) 5. Cash/Bank Deposits/ Misc. Personal Property (Schedule E) 6. Jointly Owned Prooerty (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 0.00 10. Debts/Mortoaoe Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions (11) 0.00 12. Net Value ofTax Return (12) 3.423.29 13. Charitable/Governmental BeQuests: Non-elected 9113 Trusts (Schedule J) (13) 68.47 14. Net Value of Estate Subiect to Tax (14) 3,354.82 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures that include the total of ALL returns assessed to date. (1) (2l (3) (4) (5) (6) (7) 0.00 3,423.29 0.00 0.00 0.00 0.00 0.00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 3.423.29 ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Siblino rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) 0.00 X .00 0.00 (16) 3,354.82 X .045 150.97 (17) 0.00 X .12 0.00 (18) 0.00 X .15 0.00 (19) 150.97 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID H 01-07-2005 CD004810 0.00 150.97 TOTAL TAX CREDIT 150.97 BALANCE OF TAX DUE 0.00 INTEREST 0.00 I TOTAL DUE 0.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR) , YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .-1. Q:? . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV- 1162 EX(11-96) RJ;CJ;IVJ;D ~ROM, PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FOWLER JOHN Bill 10 E HIGH STREET CARLISLE, PA 17013 nnnn fold ESTATE INFORMATION: SSN, 207-03-7350 FILE NUMBER: 2103-0924 DECEDENT NAME: GLEIM LEIDA A DATE OF PAYMENT: 08/02/2005 POSTMARK DATE: 08/02/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 NO. CD 005645 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $88.80 I I I I I I I I TOTAL AMOUNT PAID: $88.80 REMARKS: MARTSON ET AL CHECK# 10978 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS UY.uoo u. (""1 . OFfiCIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT fILE NUMBER 21 03 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00924 NUMBER COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG, PA 17128-06f11 ~ Z W Q W U W Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GLEIM, LEIDA A. 207 -03-7350 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 0 ,. Original Return 181 2. Supplemental Return w ~ 0 Limited Estate 0 4a. Future Interest COIl1promise (date of death after :.l:~!2 4. fdILO 12-12-82) ,,00 181 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach u"'... ~.. of WiJI) copy of Trust) ~ ~ 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 12.31-91 1-1.95 DATE OF DEATH (MM-Qo.VEAR) DATE OF BIRTH (MM-DD-YEAR) o 3. Remainder Return (date of death priOf \0 12-1'3-82) o 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Attach Sch 0) COMPLETE MAILING ADDRESS Ten East High Street Carlisle, PA 17013 (1) None OFFIClAl USE ONLY f"'o...') (2) 2,013.70 () c.~ <:<-':'::1 ::''0 ,:';-1 ;-n (3) None ;:r-... c) ~-::.: 1-:-) 0 <"J l'J (4) None I \~-j .,..., r", '.::::1 (5) None c:-> " 11 (6) None -Tl , . c-5 .; c..) .. l'Tl (7) None ")(J N (8) 2,013.70 (9) (10) (11) (12) 2,013.70 40.27 1012012003 04/07/1921 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Line 13) (13) (14) 1,973.43 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES Copyright 2000 form software only The Lackner Group, Inc. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL) .s; rllw il!Q OZ u~ AME John B. Fowler, III, Esquire IRM NAME (If applicable) Martson Deardorff Williams & Otto ELEPHONE NUMBER 717/243-3341 ,. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship Z o ~ => ~ Ii: ~ [rl '" 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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 1,973.43 x .045 (16) 0 16. Amount of Line 14 taxable at lineal rate g ~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) '" 8 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 88.80 88.80 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. 0 ~q"'"., ':i'~"'liIii';"';;'" ' "'~:"" ", ',,; ,.:1>2/: ~\ 1:' ;LT; s"tift,A'd 'c';'': '.bh ""","" Form REV-1500 EX (Rev. 6'()0) Decedent's Complete Address: STREET ADDRESS 450B Sherwood Drive CITY Carlisle ISTATE PA 1ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 88.80 Total Credits (A + 8 + C) (2) 0.00 3. Interest'Penalty if applicable D. Interest E. Penally (3) 0.00 (4) (5) 88.80 (5A) (58) 88.80 Total InteresUPenalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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;....,..................,.......................................................... ~ II ~: ~:::~ ~;e~~~i~n:~:~~;:s~~.~~~~~.~~~.~~~.~~:.~.~~~~~~~~~~.~~.i~.~.~~~~~~~:::::::::::::::::::::::::::::::::::: 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? ....................................................................................................................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 181 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... 0 181 IF THe ANSWER TO ANY OF THE ABove QUESTIONS IS YES, YOU MUST COMPLETe SCHEDUle G AND File IT AS PART OF THe RETURN. preparer other than the personal representative is based on 811 information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FIl.ING RETURN ADDRESS John W. Gleim Jr. f!,V: Thu't(- f<. ~~~ SIGNATURE OF PERSON RESPONSIBLE FOR FIl.ING RETURN Tra~lelm DATE 224 North Middlesex Road Carlisle, PA 17013 ADDRESS DATE ~L1z-~ 450 Sherwood Avenue Carlisle, PA 17013 'i/~ 05 ADDRESS DATE Ten East Rig!) Street Carlisle, PA 17013 '1 k/bS F 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 rviving spouse is 3% [72 P.S. ~9116 (al (1.1) (ill. 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .8. ~9116 1.2) [72 P.S. ~9116 (a)(1)J. 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 B STOCKS & BONDS COMMONWEAL~ Of'" PENNS't'\..VAN~ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 All property jolntfy-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 Class 4C unsecured claim against Agway Inc. Chapter II Bankruptcy - payment 2,013.70 dated 6/23/05; received 7/15/05 TOTAL (Also enter on line 2, Recapitulation) 2,013.70 REV.1513 EX+ <'-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) I John W. Gleim, Jr. Son $ 583.97 (29% estate 224 North Middlesex Road residue) Carlisle, PA 17013 2 Cindy Gleim-Pool Granddaughter $201.37 (10% estate 216 North Middlesex Road residue) Carlisle, PA 17013 3 James W. Gleim Grandson $100.69 (5% estate 214 North Middlesex Road residue) Carlisle, P A 17013 4 John T. Gleim prandson $100.69 (5% estate 312 South Pitt Street residue) Carlisle, P A 17013 See Continuation Schedule(s) attached 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 BEING MADE B. CHARITABLE ANO GOVERNMENTAL DISTRIBUTIONS 1 St. James Lutheran Church (2% of estate residue) 40.27 717 Bloserville Road, Newville, PA 17241 TOTAL OF PART 11_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15DD COVER SHEET 40.27 *' SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Trostee(sl OF ESTATE I. IrAXABLE DISTRIBUTIONS Bnclude outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 5 Tracy K. Gleim Son $986.71 (49% estate 450 Sherwood Avenne residne) Carlisle, PA 17013 Page 2 of Schedule J Agway Liquidating Trust PO Box 4933 Syracuse, New '( ork 13221 -iECErVEl JUl 15 2005 '\I10wr Re: Agway, Inc., et at ("Agway") Chapter 11 Case Nos. 02-65872 through 02-67877 Dear Creditor: Enclosed please find a check representing your third distribution as the holder of a Class 4C allowed general unsecured claim in the Agway Chapter 11 bankruptcy cases. Pursuant to the terms of Agway's Chapter 11 Plan, which was confirmed by an order of the Bankruptcy Court dated April 28, 2004, holders of allowed Class 4C claims shall receive distributions from the Agway Liquidating Trust. The enclosed check represents 5.0% of the allowed amount of your claim. While there is no guarantee of future distributions, it is expected that additional distributions will be made approximately every 6 months. Please cash or deposit the check as soon as possible, as checks that are not negotiated within 180 days from their date of issuance will not be honored by the bank. If you have any questions, please contact The Debtors' Disbursing Agent, DRX Distribution Management, Inc. at 800-253-6729. Sincerely, Agway Liquidating Trust By: D. Clark Ogle, Liquidati DRX DISTRIBUTION MANAGEMENT, INC. AS AGENT FOR AGWAY,INC., ET AL. CHASE MANHATTAN BANK USA, N.A. WilMINGTON, DE CREDITOR 000047441 LEIDA A GLEIM CHECK NO. CHECK DATE 00050458 06/23/2005 -,} 703.00 40,273.96 $2,013.70 $.00 $2,013.70 ~OSO~SB~ I:O~~~002~?I:~~O~S~~~2BSO~~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/15/2005 FOWLER JOHN BIll 10 E HIGH STREET CARLISLE, PA 17013 RE: Estate of GLEIM LEIDA A File Number: 2003-00924 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 is due by: 10/20/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, 1/; C ,0' ...-.. ~.(~~~ oj GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge . \-V REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) (-, r-..> C~ C.::jI ."::,,,..1 '~ ~:~J -:(~ : C!J ,- -) Name of Decedent: LEIDA A. GLEIM Date of Death: October 20, 2003 File No. : 21-03-0924 Social Security No.: 207 -03-7350 (...0 \.D 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: Upon receipt of complete payout on Agway Certificates from trustee in bankruptcy and filing and approval of inheritance tax return thereafter. Unknown date at this time. 3. If the answer to No.1 is Yes, state thefollowing: a. Did the personal representative file afinal account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerkof the Orphans' Court and may be attached to this report. 1f<<, /) (/;~. ? Signature: Name: Address: John B. Fowler ill, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative Date: October 5-, 2005 F:IFILESIDA T AFILEIEST A TESI9969.2.srep \.J;' 01-24-2006 GLEIM 10-20-2003 21 03-0924 CUMBERLAND 101 APPEAL DATE: 03-25-2006 ( 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 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LEIDA A FILE NO. 21 03-0924 ACN 101 BUREAU OF INDIVIDUA~-TAXES INHERITANCE TAX DIVISION' , PD 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 "r, I 2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JOHN B F.QWLER MARTSONETAL 10 E HIGH ST CARLISLE I II ESQ PA 17013 ESTATE OF GLEIM TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 .00 2.013.70 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage 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 .00 .00 (1lJ (12) (13) (14) REV-1547 EX AFP (06-05) LEIDA A DATE 01-24-2006 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 2,013.70 00 2,013.70 40.27 224,062.91 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ 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. .00 X 00 = .00 224,062.91 X 045 = 10,082.83 .00 X 12 = .00 .00 X 15 = .00 (19)= 10,082.83 . , .... ...... n.......... I (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-20-2004 ~ CD003459 473.68 9,000.00 07-19-2004 " CD004173 .00 520.35 08-02-2005 CD005645 .00 88.80 08-02-2005 ......... WRITEOFF .00 4.21 TOTAL TAX CREDIT 10,082.83 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 04-24-2006 GLEIM 10-20-2003 21 03-0924 CUMBERLAND 502 APPEAL DATE: 06-23-2006 (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 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LEIDA A FILE NO. 21 03-0924 ACN 502 COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF REVENUE ('---'f'\- -:.:..,r'~:-'r-" \ :t-;-i1dl. NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXJ!Sr _',.v ,/ i (~PPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION c" OF DEDUCTIONS AND ASSESSMENT OF TAX PD BOX 280601 HARRISBURG PA 17128-0601 2UUfl APR 2l+ Pl" 3: 5 9 CLtRK Or ORPH~~N:~,~Cf~~1 pj\ JOHN B FOWLOJ~,ffitri'\ESrr' MARTSON ETAL 10 E HIGH ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17013 ESTATE OF GLEIM REV-1547 EX AFP (06-05) LEIDA A TAX RETURN WAS: I X) ACCEPTED AS FILED ) CHANGED DATE 04-24-2006 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate ISchedule A) II) 2. Stocks and Bonds ISchedule B) (2) 3. Closely Held Stock/Partnership Interest ISchedule C) (3) 4. Mortgages/Notes Receivable ISchedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property ISchedule E) (5) 6. Jointly Owned Property ISchedule F) (6) 7. Transfers ISchedule G) (7) 8. Total Assets .00 1.610.96 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses ISchedule H) (9) 10. Debts/Mortgage Liabilities/Liens ISchedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts ISchedule J) 14. Net Value of Estate Subject to Tax .00 .00 Ill) (12) (13) (14) NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL 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: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,610.96 DO 1,610.96 32.22 1,578.74 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 1,578.74 X 045 = .00 X 12 = .00 X 15 = (19)= .00 71.04 .00 .00 71.04 RECEIPT T+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 1-) 02-09-2006 CD006315 .00 71.04 TOTAL TAX CREDIT 71.04 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 I/" IE IF PAID AFTER DATE INDICATED, SEE REVERSE I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~{ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY BE DL ~ REV. 1500 EX + (6-00) *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 FILE NUMBER 21 03 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00924 NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GLEIM, LEIDA A. 207-03-7350 .... z Ul o Ul o Ul o DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 10/20/2003 04/07/1921 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 0 1. Original Return 181 2. Supplemental Return Ul .... 0 li m ited Estate 0 4a. Future Interest Compromise (date of death after >::~CI) 4. 00::>:: 12-12-82) UlII.O 181 0 ;1:00 6. Decedent Died Testate (Attach copy 7. Decedent Maintained a living Trust (Attach 00::-' 11.01 of Will) copy of Trust) II. <( 0 9. litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 1 - 1-1-95 o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THI.$SE<:;T( AME U, ~ John B. Fowler, III, Esquire ~ ~ IRM NAME (If applicable) O::z 8 ~ Martson Deardorff Williams & Otto ELEPHONE NUMBER 717/243-3341 COMPLETE MAILING ADDRESS Ten East High Street Carlisle, P A 17013 (1 ) None :---1 (2) 1,610.96 (3) None (4) None (5) None (6) None (7) None (8) (9) (10) 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) --r-} :~.: z o ~ :::l .... e;:: <( o Ul 0:: 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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) r......" c. 1,610.96 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11 ) 12, Net Value of Estate (Line 8 minus Line 11) (12) 1,610.96 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) 32.22 (14) 1,578.74 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) z 1,578.74 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ~ :::l II. 17. Amount of Line 14 taxable at sibling rate x .12 (17) ::l! 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) .... 19. Tax Due (19) 71.04 71. 04 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. .'" i>: "i'I;i";'j" >;;'..;...1X;li;~,~,jtInRIi~~li;~~_.9k~MATHi.c:,.c:-.."Y., i"+"><i;::;l~~;;:;';~0;;' Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 450B Sherwood Drive CITY Carlisle I STATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 71.04 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) (5) 71.04 (5A) (5B) 71.04 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;.................................................................................. 0 ~ ~: ~:::~ :h~e~~~:i~on~~:~~;~s~~~. .~~~~~. ~~~. ~~~. :.~~.~.~.~. .t.~~.~.~.~~~~~~. ~~ .i.t.~. ~~~~~~~::::::::::::::::::::::::::: ::::::::: ~ ~ d. receive the promise for life of either payments, benefits or care?.............................................................. D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS DATE 224 North Middlesex Road Carlisle, P A 17013 ADDRESS DATE 450 Sherwood Avenue Carlisle, P A 17013 2 jtJ6 ADDRESS D TE --;;M Ten East High Street Carlisle, PA 17013 ""I ~/o(, or ates 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 s rviving 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P .S. ~9116 (a) (1 )]. The tax rate imposed on the net value of transfers to orfor 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 B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 Class 4C unsecured claim against Agway Inc. Chapter 11 Bankruptcy - payment of 1,610.96 4 % of claim dated 01/25/06 (copy attached) TOTAL {Also enter on line 2, Recapitulation} 1,610.96 REV-1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE nnNn' I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 John W. Gleim, Jr. Son $ 467.18 (29% estate 224 North Middlesex Road residue) Carlisle, PA 17013 2 Cindy Gleim-Pool Granddaughter $ 161.10 (10% estate 216 North Middlesex Road residue) Carlisle, P A 17013 3 James W. Gleim Grandson $ 80.55 (5% estate 214 North Middlesex Road residue) Carlisle, PA 17013 4 John T. Gleim Grandson $ 80.55 (5% estate 312 South Pitt Street residue) Carlisle, PA 17013 See Continuation Schedule(s) attached 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 BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 St. James Lutheran Church (2% of estate residue) 32.22 717 Bloserville Road, Newville, P A 17241 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 32.22 g;: 0 ('), ~< ." 0 n E: > 0 :D :lid -< 0 m mi 0 ~i ... ::j ;sl: m ..., 0 n.:-r- >< .:- :D r-:z:' >U1m > .t' Z i:.i 9 z::l' ;;go..... n ... Cl~' r-D'O -4 -l I - > r- OlD. ~~ 00( ~il r-:t:> g I mm * Jl . :;01;") * .. z:r- * ... ~l "Vom * .... I 0 >0- * IV I Q"":I 03: * \JI I n.J .... * .... $ I L11 ...,0 * N I 0:;0 * Q I - ... ... 0 l L11 W .. l)- I .. Q\ I .... i - 0 .. * 0 * I .... 0 0 - ~ g - r- 0'. i ; 0 > N j 0 :;0 \JI I ~ .... 5 I n.J * \JI I Q"":I *' ~ "l ...:J >' ill - z .. Q"":I G .... * ;II . 0 ..Q - 0" L11 * .... * n ~ .;41 Q"":I m :..B - Z n.J ... ~! I:XI II' ~ I, L11 ~/ 0 ~ ~ .c 11 .. ~: ~ I I ~: ... * * * I )> * I .... lSJi :D .. ~I~ 0- ...~ .... CJ> 0 Ii! . ~ ~ ..0 $ 0- ff! s.c..,..,. "'"t. 1ndtIdMt. DeteiI on beck. COMMOI'JWEAL TH OF PENNSYLVANIA DEPARTMENT UF REVENUE 6URE~U OF INDIVIDUAL TAXES DEPT 220601 ri,L,RRISe,URG, 17123-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLV ANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FOWLER III JOHN B 10 E HIGH STREET CARLISLE, PA 17013 ESTATE INFORMATION: SSN: 207-03-7350 FILE NUMBER: 2103-0924 DECEDENT NAME: GLEIM lEIDA A DA TE OF PAYMENT: 07/19/2006 POSH/ARK DATE: 07/19/2006 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 L. NO. CD 006994 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $ 36.44 I I I I I I I I TOTAL AMOUNT PAID: REMARI<S: CHECI<# 11532 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $ 36.44 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV. 1,'00 EX ~ (6-001 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 _~_~RR'SBURG, PA 17128-0601 FILE NUMBER 21 COUNTY CODE 03 YEAR 00924 NUMBER 207-03-7350 ~ECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GLEIM, LEIDA A. I- ~ 1 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) - ~ Ll..9/20/2003 04/07/1921 Cl I (IF AP'F>L1CABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) -w--LI D 1 ~ Original Return 2. Supplemental Return >:: ~ '" ' D 4 Limited Estate D 4a, Future Interest Compromise (date of death after &l g: 13 12-12-82) 13 ~ g ~ 6. Decedent Died Testate (Attach copy D 7. Decedent Maintained a Living Trust (Attach ~ '" of Will) copy of Trust) < D 9, Litigation Proceeds Received D 1 D. Spousal Poverty Credit (date of death between D 11, Election to tax under See, 9113(A) (Attach Sch 0) t~ 12-31-91 and 1-1-95) - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: AME I COMPLETE MAILING ADDRESS ~ ~ ~lm B. Fowler, 1II, Esquire I c.: Cl FIRM t\,AME (If applicable) 8 ~ ~ Manson_ Deardorff Williams & Otto T en East High Street Carlisle, PA 17013 I ELEPHONE NUMBER 717 /243-3341 - I 1. Real Estate (Schedule A) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ---- SOCIAL SECURITY NUMBER 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4, Mortgages & Notes Receivable (Schedule D) z o ~ ;;;J l- ii: < () w c.: 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) 8, Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) I I : ! -----i 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) I D 3, D I Remainder Re'turn (date of death prior to 12~- . 5, Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes (1 ) None (2) (3) (4) (5) (6) (7) 1,208.22 None None None None ~, ,"--,' None (8) 1,208.22 (9) (10) 382.00 (11 ) 382.00 (12) 826.22 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) 16.52 (14) 809.70 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) z 809.70 .045 (16) 36.44 0 16, Amount of Line 14 taxable at lineal rate x >= --,._---- < I- ;;;J c.. 1,'. Amount of Line 14 taxable at sibling rate x .12 (17) :. 0 () ~ 1c:. Amount of Line 14 taxable at collateral rate x .15 (18) I- Hl, Tax Due (19) 36.44 _.~--..'- ! 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWERALlQUESTIONS ON REVERSE SIDE AND RECHECK MATH<< Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Dec,edent's Complete Address: I STREET ADDRESS 450B Sherwood Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) ___ 36.44 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4)_~_ 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 36.44 A. Enter the interest on the tax due. 36.44 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: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or................................................. .................................... ............................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receivi ng adequate consideration?............................................................................................................... ....... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?... ........... ...................................................... ................................. ................ Yes No o ~ B ~ o ~ o ~ o ~ o ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS DATE 224 North Middlesex Road Carlisle, P A 17013 ADDRESS 450 Sherwood Avenue Carlisle, P A 17013 DATE 7//,2l~~ / ~ 7):;/U( ADDRESS Ten East High Street Carlisle, P A 17013 F r d s 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 ing spouse is 3% [72 P.S. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. S9116 (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. S9116 1.2) [72 P.S. S9116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. S9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE B STOCKS & BONDS ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION UNIT VALUE Class 4C unsecured claim against Agway Inc. Chapter 11 Bankruptcy - payment of 3% of claim dated 06/26/06 (copy attached) TOTAL (Also enter on line 2, Recapitulation) I VALUE AT DATE OF DEATH 1,208.22 1,208.22 ~ ~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEAL TH OF PENNSYl VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 03 - 00924 ESTATE OF GLEIM, LElDA A. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION 1_ AMOUNT 2 3 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Martson Deardorff Williams & Otto 382.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL (Also enter on line 9, Recapitulation) 382.00 REV-1513 EX+ (9_00)" 1 COMMONWEALTH OF PENNSYLVANIA Ir,HERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF GLEIM, LEIDA A. I FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO II . AMOUNT OR SHARE DECEDENT OF ESTATE Son ,.n ,. ,"....., I $ 239.60 (29% "tal' I residue) I NUMBER I NAME AND ADDRESS OF PERSON(S) RECE'V'NG PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) John W. Gleim, JI. 224 North Middlesex Road Carlisle, PA 17013 2 Cindy Gleim-Pool 216 North Middlesex Road Carlisle, P A 17013 Granddaughter $ 82.62 (10% estate residue) 3 James W. Gleim 214 North Middlesex Road Carlisle, P A 17013 Grandson $ 41.31 (5% estate residue) 4 , John T. Gleim 312 South Pitt Street Carlisle, P A 17013 Grandson $ 41.31 (5% estate residue) I See Continuation Schedule(s) attached I Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate. on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS St. James Lutheran Church (2% of estate residue) 717 B10serville Road, Newville, P A 17241 16.52 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 16.52 1 SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLEIM, LEIDA A. -~--r'~' NUMBERi NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. r AXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116(a)(1.2)] 5 I Tracy K. Gleim 450 Sherwood Avenue Carlisle, P A 17013 I FILE NUMBER 21 - 03 - 00924 RELATIONSHIP TO-1-: - DECEDENT AMOUNT OR SHARE Do Not List Trusteej!L OF ESTATE I $ 404.85(49% estate residue) Son ~__-----1-_ Page 2 of Schedule J Agway Liquidating Trust PO Box 4933 Syracuse, New York 13221 Re: Agway, Inc., et al ("Agway") Chapter 11 Case Nos. 02-65872 through 02-67877 Dear Creditor: Enclosed please find a check representing your fifth distribution as the holder of a Class 4C allowed general unsecured claim in the Agway Chapter 11 bankruptcy cases. Pursuant to the terms of Agway's Chapter 11 Plan, which was' confirmed by an order of the Bankruptcy Court dated April 28, 2004, holders of allowed Class 4C claims shall receive distributions from the Agway liquidating Trust. The enclosed check represents 3.0% of the allowed amount of your claim 1. While there is no guarantee of future distributions, it is expected that additional distributions will be made approximately every 6 months. Please cash or deposit the check as soon as possible, as checks that are not negotiated within 180 days from their date of issuance will not be honored by the bank. If you have recently moved to a new address or have any questions, please contact The Debtors' Disbursing Agent, DRX Distribution Management, Inc. at 800-253-6729. Sincerely, lL~4~ ~ D. Clar Ogle, liquid ng Trustee Agway Liquidating Trust 11f any of your prior distributions were held because they fell below the $100.00 deminimus, those payments are reflected in the enclosed check as well. )RX DISTRIBUTION MANAGEMENT, INC. \S AGENT FOR AGWAY, INC., ET AL. CHASE MANHATTAN BANK USA, N.A. WILMINGTON, DE CHECK NO. CHECK DATE :REDITOR '~" C '~l~'" t~ ,'i.:, ~, 1 .~ ~\ ,- L r o,A ALLOWED AMOUNT CALCULATED AMOUNT PER PLAN 0'J074114 -------, WITHHOLDING I AMOUNT ':)6/26/ Z :::/:)6 ~LASS 1---'. CL~'M ! CODE NUMBER f- ~t Y f I .\. I I I CHECK AMOUNT " i i ~ I I ~r),,~13.rle $1,208.22 ~.oo $1,2(;~.22 CHASE MANHATTAN BANK USA, N.A. WILMINGTON. DE DRX DISTRIBUTION MANAGEMENT, INC. AS AGENT FOR AGWAY, INC., ET AL. ~~361209 311 CHECK DATE '__ CREDITOR NO'1 .,:"{' '7' i.1J . u '-} J 4.- .+ ,-~ 1 CHECK NO, ~ AMOUNT---1 S*:b:>;t*1.20SeZZJ VOID AFTER 180 DAYS ~/pCJ~~.1.,..'. . .;--...... ,f\., $ , ':. ,.r-,~~", ) ',i_.:. ,,"" . ",:,'/" i oJ '---__" - "- ',:nt*.,;",'r,~' ..............- ~ )()!.:?S/ :'OC6 OOG74114 /' ~. Y E 'i ,:\ C r L Y ~..*.****1,?O~**GQLLARS**ANO**2Z**CENTS PAY TO THE ORDER OF: BY: AUTHORIZED SIGNATORY '_ .'[~) i1 .~ ~~ L :: r ~.~ ~~()~ S~~EQ~~cn r~ ',t..c'L::Li.., ''"A 17()lJ BY, , ...." lip ~i // ( (/J / .,;.Lw.<.., ........ K ;; ", ,-;,4,- -LL__ . AUTHORIZED SIGNATO'Rv II- 0 7 ~ ~ ~ ~ III I: 0 l ~ ~ 0 0 2 b 71: b :Ii 0 ~ 5 :Ii b ~ 2 a 50 q III Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 FOWLER III JOHN B 10 E HIGH STREET CARLISLE, PA 17013 RE: Estate of GLEIM LEIDA A File Number: 2003-00924 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 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 is due by: 10/20/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ~ cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 GLEIM JOHN W JR 224 N MIDDLESEX ROAD CARLISLE, PA 17013 RE: Estate of GLEIM LEIDA A File Number: 2003-00924 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 is due by: 10/20/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~a::::t~ Clerk of the Orphans' Court cc: File Counsel cE Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 GLEIM TRACY K 450 SHERWOOD AVENUE CARLISLE, PA 17013 RE: Estate of GLEIM LEIDA A File Number: 2003-00924 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 is due by: 10/20/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel '" ~~ REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: LEIDA A. GLEIM Date of Death: October 20, 2003 File No.: 21-03-0924 Social Security No. : 207-03-7350 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 at this time. Decedent continues to receive assets in a bankruptcy payout which requires filing of supplemental inheritance tax returns. 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies ofreceipts, releases, joinders and approvals offormalor informal accounts may be filed with the Clerk ot. he Orphans' Court and may be attached to this report. Date: October/1,2006 Signature: Name: Address: - ~.t Vd . 'OJ G!\V'lbj8V\~n8 H:1n08 S.NV'HdOO :10 ~8310 hn B. Fowler ill, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative F:\FILES\DAT AFlLE\EST ATES\9969.2.srep CO :E Wd 91130900l '"'l~' ~. ,.- \..1"" (">.f"l' I ~ . Ed! .::,) b:~L~!::)j:; jO 3JI:BO 03080838 \ G: \ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ~fp'RA:i:SEHEHfr:/~l1.~WANCE DR DISALLOWANCE , OFDEDUCTlO~S'AND ASSESSMENT OF TAX REV-1547 EX AFP (06-05) 10-17-2006 GLEIM 10-20-2003 21 03-0924 CUMBERLAND 503 APPEAL DATE: 12-16-2006 ( 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 9Y!_~~9~9_!~~~_~~~~______~___~~!~!~_~9~~~_~9~!!9~_~9~_Y9~~_~~~9~~~__~____________________ REV-1547 EX AFP [03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LEIDA A FILE NO. 21 03-0924 ACN 503 ,') ") ,! 1'-1,'" t ;-): DATE I '-:.ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN LEIDA A JOHN B FOWLER III ESQ ",",. MARTSON ETAL TEN E HIGH STREET CARLISLE PA 17013 ESTATE OF GLEIM DATE 10-17-2006 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 1.208.22 .00 .00 .00 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,208.22 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 (9) (10) 382.00 .00 (11) (12) (13) (14) 382 00 826.22 16.52 809.70 NOTE: If an assessment was issued previOUSly, lines reflect figures that include the total of ALL 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: 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 809.70 X 045= .00 X 12 = .00 X 15 = (19)= .00 36.44 .00 .00 36.44 n"m::n, {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-19-2006 CD006994 .00 36.44 INTEREST IS CHARGED THROUGH 11-01-2006 TOTAL TAX CREDIT 36.44 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE .00 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .01 TOTAL DUE .01 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~(. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE E A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) o So ::.:;: ::0 -'-UO __ :I l.-)>r- -- '-7 !Tl '""-:. :IJ (./)^ r-..) = = ...... Name of Decedent: LEIDA A. GLEIM no Q-n _ ::D -n --i ~> -0 :x: L c:: r- w o U1 Date of Death: October 20, 2003 File No.: 21-03-0924 Social Security No.: 207 -03-7350 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Unknown at this time. Decedent continues to receive assets in a bankruptcy payout which requires filing of supplemental inheritance tax returns. 3. If the answer to No.1 is Yes, state thefollowing: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may befiledwith the Clerk a e Orphans' Court and may be at ched to this report. Date: July.:3l, 2007 Signature: Name: Address: ..... HJ B. Fowler ill, Esquire TSON DEARDORFF WILLIAMS & OTTO en East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative F:\ALESIEST A TES\9969\9969.2.srep ~ 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 MARTSON LAW OFFICES 10 E HIGH STREET CARLISLE, PA 17013 _u___n fold -: ESTATE INFORMATION: SSN: 207,03-7350 FILE NUMBER: 2103-0924 DECEDENT NAME: GLEIM LEIDA A . DATE OF PAYMENT: 10/24/2007 POSTMARK DATE: 10/24/2007 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 NO. CD'008849 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $821.23 I ;,.' " I I I I I I I TOTAL AMOUNT PAID: HEMARKS: RECEIPT TO A TTY CHECK# 12174 , SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS $821.23 GLENDA FARNER STRASBAUGH REGISTER OF WILLS -I 15056041125 REV-1500 EX (06-05) PA Department of Revenue*, ~~~~~~~~~~~uaITaxes INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 3 File Number o 0 924 Date of Birth 20703 7 350 10202 0 0 3 04071921 GLEIM LEI 0 A MI A Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW o 1. Original Return o 4. Limited Estate o o 2. Supplemental Return o o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received llil o o o 8. Total Number of Safe Deposit Boxes J 0 h n B . Fowler, I I I 717 243 334 1 Firm Name (If Applicable) Mar t son REGISTERil~wli.i.S~NI..Y- . -- Law Off ice s First line of address l') 1 0 E a s t H i g h Street ~ Second line of address City or Post Office State ZIP Code ., -'1 .. -=-:'1)~TE~I!:~~_UJ _ \.0 Car 1 i s 1 e P A 17013 Correspondent's e-mail address: Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepareI' other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT~F PERSON RES PO ISLE ORoFILlNG RETURN TE vV'l/ Carlisle PA 17015 DATE Carlisle PLEASE USE ORIGINAL FORM ONLY PA 17013 Side 1 L 15056041125 15056041125 .-I --.J 15056042126 REV-1500 EX Decedent's Name: LEIDA A. GLEIM RECAPITULATION 1 . Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous N,Q[l;Probate Property (Schedule G) U Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............. . ... 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 o . 0 0 (a)(1.2) X.O _ 15. 116. Amount of Line 14 taxable 1 8 2 4 9 . 5 5 at lineal rate X .012....- 16. 17. Amount of Line 14 taxable o . 0 0 at sibling rate X. 12 17. 18. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 20703 735 0 2 0 1 3 6.9 9 2 0 1 3 6.9 9 1515.00 1515.00 1 8 6 2 1.9 9 374.44 18247.55 O. 0 0 821.23 O. 0 0 O. 0 0 821.23 o 15056042126 -I REV -1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME LEIDA A. GLEIM STREET ADDRESS 450 B Sherwood Drive File Number 21 03 00924 ~ -- II STATE PA CITY Carlisle ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 821.23 Total Credits ( A + B + C ) (2) 0.00 3. (3) (4) (5) (5A) (5B) 0.00 0.00 821 .23 4. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 821.23 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 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. 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 three (3) percent [72 P.S. 99116 (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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in 72 P,S. ~9116(1.2) [72 P.S. 99116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P,S, 99116(a)(1.3)]. A sibling is defined, under Section 91O;~, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503"EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF LEIDA A. GLEIM FILE NUMBER 21 03 00924 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Class 4C unsecured claim against Agway Inc. Chapter 11 Bankrutpcy, balance due, not yet taxed VALUE AT DATE OF DEATH 20,136.99 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 20136.99 REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LEIDA A. GLEIM SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 03 00924 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Numbe~s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Martson Law Offices (estimated) 1,515.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attacl1 explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Prepare(s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 1 515.00 (If more space is needed, insert additional sheets of the same size) "".,"""... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LEIDA A GLEIM SCHEDULE J BENEFICIARIES 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. John W. Gleim, Jr. Lineal 5,400.38 224 North Middlesex Road (29% of estate residue) Carlisle, PA 17015 2. Cindy Gleim-Pool Lineal 1,862.20 216 North Middlesex Road (10% of estate residue) Carlisle, PA 17015 3. James W. Gleim Lineal 931 .10 214 North Middlesex Road (5% of estate residue) Carlisle, PA 17015 4. Tracy K. Gleim Lineal 9,124.77 450 Sherwood Drive (49% of estate residue) Carlisle, PA 17015 5. John T. Gleim Lineal 931.10 312 South Pitt Street (5% of estate residue) Carlisle, PA 17013 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 BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. St.James Lutheran Church (2% of estate residue) 372 .44 717 Bloserville Road Newville, PA 17241 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 372.44 .. FILE NUMBER 21 03 00924 (If more space IS needed, Insert additional sheets of the same size) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 1712B-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Ri=r:nRf'iFD (JRe~~ITANCE TAX ~~:;~i:~:';'~;r!A:r~;~I5~n OF ACCOUNT ;:_.I,,~,i _.' 1-...." y'l " ..., *' REV-1607 EX AFP (03-05) 2001 OEe - 5 AM II: 42 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-26-2007 GLEIM 10-20-2003 21 03-0924 CUMBERLAND 101 LEIDA A CLERK OF ORPH!\N'S COi.JRT JOHN B FOWLER III ESQ CU;,',-- "-'.~'-, D,A, MARTSON HAL TEN E HIGH STREET CARLISLE PA 17013 Amount Remitted , I 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 GLEIM LEIDA A FILE NO. 21 03- 0924 ACN 101 DATE 11-26-2007 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: 01-17-2006 PRINCIPAL TAX DUE: 10,082.83 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) *** SUMMARY OF "LL 005 PAYMENTS *** 10-24-2007 473.68 10,434.59 TOTAL TAX CREDIT 10,904.06 BALANCE OF TAX DUE 821.23CR INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 821. 23CR 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" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l ~