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Home My WebLink About01-25-11~~ 1505610101 REV-1500 ~ (01-10~ ,~ PA Department of Revenue Pennsylvania Bureau of Individual Taxes DEPARTMENT OF INuHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY ~1 C~1~3~ ? `~ o s~ (~ I U C ~~~v Decedent's Last Name Suffix ~ Zv U~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY Decedent's First Name MI f. ~r Spouse's First Name MI ~~~^ ~~~~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit {date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 1r1 f~ L C ~~ U J s 7 1 `7 ~' ?~ 1 -:~, .... 1 9 REGISTER ~'fiffF LS USE bNLY - ~' -~ t--~ ' ~,- .: , First line of address - ~ ~~ ~... - -! ,,-~... ; T - _ ~_ - , __; Second line of address - '_- ~: ~`• Cit or Post Office DATE FILED Y State ZIP Code SJ-) ?~~~st~~R ~ R ~-~ ~s7 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT PERSON ONS FOR FILING RETURN DATE AD ESS Lon U ec.u ~~ 12) ~ S I ~ `~ ~ I ? a 13 SIGNAT OF PR A OTHER THAN REPJ~ESENTATIVE DATE ADDRESS a o ~ Ast ~~,z.st ~ ~ . C9. 3Gx ~ ~. c ~~ ~. ~1 s ~ u ~e. A ~~ 1 ~ a ~7 PLEASE USE OItIdINAL FORM dNLY OFFICIAL USE ONLY Code Year File Number Side 1 1505610101 150561011 J ADDITIONAL Personal Representatives Blouin, Marcel E SS# 106-36-7905 1/1/2010 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. -a, ~, ;~ ~ . -----~ i` 2 Signature ~--~-••• '~-~. Name Sara J. Flo Address 678 Meadow Road city, state, zip Bridgewater NJ 08007 Date I "` ~ ~ ~ ! ~ 3 Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date J 150561,0],05 REV-1500 EX Decedent's Social Security Number :, /~ JU Ulm R A~~ ~• ~ 1 ,~~ ~ ~.~ ,~ `~ 7~°~~ ~ Decedent's Name: 1 ~ U ~ ~ ~ ~ k ~ ` RECAPITULATION ~p I `' ~ ~ 1. Real Estate (Schedule A) ............................................. 1 t 7"~ U _~ ~ G `•~ U~ 6 ~s ~'A Z l'~... ~ ". :~ M F ~ ~:.VT rYka~t bu~,.~E.Y~Xk'{sVFk~~l~k Y Y~wF' ~~~ ~ r ~G ~~ ~ x ~~ j 1 2. Stocks and Bonds (Schedule B) ....................................... 2 1P~t 1 ~ • ~o ~ ... ~_ ~ ~ ~ ,~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~ ~~ ~~~~ ~ -w~~ 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5 ~4 ~ ~ ~r~~~p~~ f 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. ~~ ~ ,~j ~ g 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property ,~~`~'~~~`' (Schedule G) p Separate Billing Requested........ 7. ~ ~ ~° w 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ .~ ~ ~~ ......~ ..., <:.:n.. 9. Funeral Ex enses and Administrative Costs Schedule H 9. - 7 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. t 1~+ ~ 11. Tota! Deductions (total Lines 9 and 10) ................................. 11. ~ ~~ `7 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. f, f 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which y an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICASLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 15. 16. Amount of Line 14 taxable at lineal rate X .0 4S 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable 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 1505610105 1505610105 J RE~,1-1 X00 EX ,Page 3 Decedent's Complete /~-ddress: File Number ~ ~ - ~(~ - ,J CJ f DECEDEN ' NA E U ! v~ YYl ~ ~ CLC ~~ _ STREET ADDRESS ~-~~. a ~ ~ v ~' CITY ~c ~ is 1~ S E ~~ ZIP 16/3 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 1 ~, ~ 3 7 • 0 ~ B. Discount ~ ~ ~ 7 , ~ Q 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. (1) 13. 3 ~ • ~B Total Credits (A + B) (2) (3) ~.~: ~o ~ . is G.vo (4) a, d Cod . 0 a. (5) U . 0 b Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ [~ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ~] 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [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 percent, 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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '~ ' ,~;~ ~.~ - COMIvIONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF B~OUIn, Marcel E 21 - 10 - 0012 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Tract of land and condominium located in South Middleton Township, 122 Strayer Drive, Carlisle, Cumberland County, PA, prior Deed reference Deed Book 255, Page 409, Cumberland County Tax Parcel #40-23-0602-064. Value based upon actual sale price. VALUE AT DATE OF DEATH 140, 000.00 TOTAL (Also enter on Line 1, Recapitulation) ~ 140,000.00 1' .±. . , ,.;,, ~:~~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF BIOUICI, Marcel E 21 - 10 - 0012 All property jointly-owned with right of survivorship must be disclosed on Schedule F. i i ITEM DESCRIPTION UNIT VA~E VALUE AT DATE OF NUMBER DEATH 1 256.374 shares Capital Income Builder Fund CUSIP #140193013 @ 47.89 47.89 12,277.75 per share. 2 2184.21211 shares Exxon Mobil Corp CUSIP #302316102 @ 68.605 per 68.605 149,847.87 share. TOTAL (Also enter on line 2, Recapitulation) ~ 162,125.62 SCHEDULE E ,h~,~,-; CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF B~OUIn, Marcel E 21 - 10 - 0012 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. I I _ ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Household goods, furniture and furnishings, value based upon appraisal of IBIS Appraisals. 3,395.00 2 M & T Bank checking account #23511524 7,280.62 Principal 7,280.62 Accrued interest 0 3 ~ Erie Insurance Group, refund of catastrophe policy ~ 96.00 4 ~ Hoffman-Roth Funeral Home and Crematory, reimburse advertisement in Newark Star Ledger ~ 97.42 5 Vehicle, actual sale price 11,000.00 6 US Treasury 2009 income tax refund 96.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 21,965.04 ,;~ SCHEDULE H %y ~"~~ FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT FILE NUMBER ESTATE OF Blouin, Marcel E 21 - 10 - 0012 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT i A. 1 Hoffman-Roth Funeral Home and Crematory, funeral 2 Janis Gillard, reimburse grave opening to St. Patrick's Cemetary (500.00); reimburse family get together (290.58) 3 George's Flowers, flowers for funeral 4 Carlisle Memorial Service, lettering marker B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Janis Marie Gillard Sara J. Flood Street Address 30 Long View City Carlisle State PA Zip 17013 Year(s) Commission paid 2. Attorney's Fees Dale F. Shughart, Jr., Esq./Hamilton C. Davis, Esq. 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Re{ationship of Claimant to Decedent 4. Probate Fees Register of Wills, probate fees paid 5. Accountant's Fees 6. Tax Return Preparer's Fees Klingler & Associates 7. Other Administrative Costs 1 Register of Wills, Short Certificates 790.58 71.02 185.00 0.00 6,500.00 315.00 275.00 4.00 TOTAL (Also enter on line 9, Recapitulation) 24,328.13 .. . Schedule H ~~:: : ' ~ Funeral Exper~s & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Adminisfi~tiv~e Costs oorr6nued RESIDENT DECEDENT FILE NUMBER ESTATE OF Blouin, Marcel E 21 - 10 - 0012 2 Cumberland Law Journal, advertise Letters I 75.00 3 The Sentinel, advertise Letters I I I 176.92 4 Postmaster, certified mail ~ 12.00 5 Janis Gillard, reimburse reimburse drycleaning (167.32); reimburse trash hauling ' 352.32 (185.00) f 6 Sara Jane Flood, reimburse reimburse PPL bill (225.80}; reimburse advertisement in ` 527.80 Newark Star Ledger (302.00) 1 7 i Register of Wills, filing Income Tax Return and Inventory ( L 30.00 8 Bonnie Coyle, notary fees ~ I 25.00 9 Carlisle Regional Medical Center, medical bill ~ 728.82 10 'Carlisle HMA Physician Management, doctor appointment 95.32 11 Masland Associates, Inc, medical bill 71.64 12 Bronstein Jeffries PA, doctor bill i 49.26 13 .Andrews & Patel, medical bill f ~ 100.34 14 Kinetic Imaging 9.65 15 'Alexander Springs, medical bill , 33.81 16 'South Middleton Township Mun. Auth, water and sewer bill 423.60 17 ExxonMobil, credit card 142.04 18 PPL, electric bill ~ 716.43 19 Shipley, fuel oil I 191.12 Page 2 of Schedule H Schedule H :b :. ' Funeral Expenses & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN w~'n;,~,a,,,~ „~ ~'+~...,~. ~n~ I~IL.A 1, 1~~lQYYG VWI.~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Blouin, Marcel E 21 - 10 - 0012 20 Shipley, propane and tank rental fee 4.00 21 CenturyLink, phone bill I ~ 63.14 22 Comcast, final cable bill i i 6.44 23 IBIS Appraisal Services, personal property appraisal f 240.00 24 M & Z Carpet, installing carpet j 851.22 25 ChemDry, rug cleaning 315.68 26 Bob Rowe, painting home ~ 1,230.00 27 'Robert Cairns, Tax Collector, 2010 county and township taxes i 430.38 28 Forest Meadows Assoc, condo association dues i j 2,140.38 29 Michael Flood, reimburse car parts 1,006.00 30 Spring Road Family Practice, Inc., medical bill ? 58.13 31 Genzyme Genetics, analysis i ` 319.45 32 Janis Gillard, reimburse hospital bill 1 109.26 33 Lebo Plumbing 3,197.88 34 ,Robert Cairn, 2010 real estate taxes 1,656.68 35 Carlisle Electronics, refrigerator 712.32 36 Erie Insurance, homeowner's policy ~ 85.50 Page 3 of Schedule H REV-1513 EX+ (11-OS) '~ ' ' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blouin, Marcel E 21 - 10 - 0012 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) I DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not ListTn,stee(s) I .TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers I under Sec. 9116 (a) (1.2)] ~ 1 Janis Marie Gillard 30 Long View Carlisle, PA 17013 2 Sara J. Flood 6778 Meadow Road Bridgewater, NJ 08007 3 Elizabeth Ann Jones 10 Old Forge Road Oxford, NJ 07863 Daughter One-quarter Daughter ~ One-quarter Daughter ~ One-quarter Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+ (9-00) °_~;~' ~~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blouin, Marcel E 21 - 10 - 0012 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) I DECEDENT (Words} ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal ' distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Patricia K. Czarnecki ~ Daughter One-quarter 69 Claridge Place Colonic, NJ 07067 i Page 2 of Schedule J LAST WILL AND TESTAMENT QF MARCEL E. BLOIIIN I, Marcel E. Blouin, (also known as Mike Blouin), of South Middleton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament ,and revoke all Wills and'.. Codicils previously made by me. t. :? ~' ~. ,; ~ ITEM I: I direct that my legally enforceable debts;~id `;,, funeral expenses, together with the expenses of the ~_-~ a~,.,-~, ~ .... ~°~ administration of my estate shall be paid from my resid~ai:~r~~, -~ estate as soon as practicable after my decease, as a part<~f the =~~ ~:~ expense of the administration of my estate. ~~~~~'' r r ITEM II: I~bequeath all of my tangible personal property,` including all household goods, furniture and furnishings, vehicles, china, silverware, jewelry, ornaments, works of art, pictures, wearing apparels, tools and similar equipment and personal effects (but excluding cash, motor vehicles, and tangible evidences of intangible property) together with <~ny policies of insurance applicable thereto, in equal shares unto my four daughters, Sara Jane Flood, Janis Marie'Gillard, Elizabeth Ann Blouin, and Patricia Kathleen Czarnecki, who shall be living on the thirty-first day following my death, to be divided among them as they shall agree. ITEM III: I devise and bequeath the rest, residue and remainder of my estate of. nature and wherever situate, in equal shares, unto my four (4) daughters, Sara Jane Flood, Janis Marie Gillard, Elizabeth Ann Blouin, and Patricia Kathleen Czarnecki, who shall survive me by thirty (30) days. Should any of my daughters predecease me or die on or before the thirtieth .,day following my death, her share shall be added to the shares for my other daughters who shall be living on the thirty-first day following my death, in the same proportion in which they share in my residuary estate. - - ~, =- ~-; ~k f c^1 - -~, -~= ~:~ ~. _. Y I ~~~ ITEM IV: All 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 TriTill or. otherwise, including any interest or penalty imposed in connection with such taxes, such 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 apportionrnent or right of reimbursement. ITEM V: I appoint my said daughters, Sara J. Flood, and Janis Marie Gillard, Executrices of this my last Will. Should either of my said daughters, Sara J.~Flood and Janis Marie Gillard, fail to qualify or cease to act as Executrix, I appoint my daughter, Elizabeth Ann Blouin, co-Executrix of this my last Will and Testament. ITEM VI: I direct that all fiduciaries acting under this Will, whether or not named herein, shall not be required t:o 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 February, 2007. [SEAL ] Marcel E. Blouin -2- The preceding instrument, consisting of two (2) other typewritten pages, each identified by the signature of the Testator, was on the date thereof, signed, published and declared Marcel E. Blouin, the Testator therein named, as and for his last Will, in the presence of us, who, at his request, in his ;presence and in the presence of each other, have subscribed our names as witnesses hereto. -3- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ~ We, Marcel E. Blouin, Dale F. Shughart, Jr., and /Cr~~/ ~ the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigra.ed authority that the Testator signed and executed the instrument as his last Will and that he had signed willingly, and that rie executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence. and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind anal under no constraint or undue influence. Testa Wines Witness Subscribed, sworn to and acknowledged before me by Marcel E. Blouin, the Testator, and subscribed and sworn to before me by Dale F . Shughart , Jr . and ~CG-~~I.t~ d witnesses, this lJ~'"~ day of February, 2007. NOTARtAI.. SEAL aoNn~l~ ~ con>~. NorAIN Puauc O OF GgRLISL.E, CUMBERLAND CO. PA ,~;,~Y ~OMMISSIC?N piP1RES OCTOBER 17, 2010 Notar blic -4- 'COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: GILLARD JANIS MAR{E 30 LONG VIEW CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT F',EV-1162 EX111-961 NO. CD 012549 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: 106-36-7905 FILE NUMBER: 2110-0012 DECEDENT NAME: BLOUIN MARCEL E DATE OF PAYMENT: 03/31 /2010 POSTMARK DATE: 03/31 /2010 COUNTY: CUMBERLAND DATE OF DEATH: 01 /01 /2010 101 ~ $14, 737.00 TOTAL AMOUNT PAID: REMARKS: RECEIPT GIVEN TO ATTY SEAL CHECK# 129 $14, 737.00 INITIALS: JN RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER