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04-0679
Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Dorothy Ellen Willis No. c2..1 - ()L( - l.D,q also known as I Deceased Social Security No. 172-01-3754 Jeffrey E. Lutz and John T. Lutz Petitioner(s), who islare 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW,) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or named in the last Will of the Decedent, dated 03/04/1992 and codicil(s) dated None \J'lJ . :0 :: $" ~ ~~ -1, m, S I. .'dhf' .~,O tate re evant circumstances, e.g., renunCiation, eat 0 executor. et ~,,'j F 0; <1 . ~-'i':tt': ~,; "7 ~w Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after e~clJtion of ~docum~Uilt$'" ,"",'~ ,:....:,. -",-;' '....1 offered for probate; was not the victim of a killing and was never adjudicated Incompetent: () vi' - :~:~ ,i:~:! p ~',;:: ~ ~~ ':,:,:: '..} ~ 0 - )> ;':~~ \D D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner{s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationshio Residence J Jeffr"Y E. Lutz Nephew Mechanicsburg, PA John T. Lutz N~hew Newport, PA (COMPLETE IN ALL CASES,) Attach additional sheets If necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 133 W. Locust Street, Apt. CO2, Mechanicsburg, PA 17055 (list street, number, and municipality) Decedent, then ~Y€lars of age, died 07/06/2004 at Mechanicsburg, PA (location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property $ 700,000.00 (If not domiciled in PAl Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Wherefore, Petitioner{s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si n re T ed or rinted name and residence Jeffrey E. Lutz 400 S. Market Street, Mechanicsbur , PA 17055 John T. Lutz 230 N. Fifth Street New crt, PA 17074 Prepared by the PennsylvanIa Bar Association Copyright (cl 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner{s) above-named swear{s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate Be ording to la Sworn to or affirmed and subscribed ~ before me thi day of ,-y, \ '6 ' .9. oo~ J.lt",~" .~,~ ~"'" Fort ~'r _ i No. ,;). , - 01-\- lJl'~ Estate of Dorothy Ellen Willis Deceased Social Security No: 172-01-3754 Date of Death: 07/06/2004 AND NOW, ~~'\16 .:2.1 ,~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [!] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Jeffrey E. Lutz and John T. Lutz in the above estate and that the instrument(s) dated 03/04/1992 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES ~~'oA~,~~ Letters. $YIO .00 Short Certificate(s). $ \5.00 Register of Wilo/V"" . Renunciation. $ Attorney: Michael L. Bangs Affidavits ( ) $ I.D. No' 41263 Extra Pages ( I ) $ :-z, OU Address: 429 South 18th Street Codicil. . $ Camp Hill, PA 17011 JCP Fee. $ la.oo Telephone: 717/730-7310 Inventory. $ Other $ TOTAL. $ 438.c::x::J Prepared by the Pennsylvania Bar Association Copyright(c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) . ~ REGISTER OF WILLS OF CUMBERLAND COUNTY REPORT OF STATUS OF ADMINISTRATION (For Resident Decedents Dying after July 1, 1984) ESTATE NO. 21 - 04 - 0679 Name of Decedent: DOROTHY E. WILLIS Social Security No,: 172-01-3754 Date of Death: July 6, 2004 Name of Personal Representative: Jeffrey E, Lutz John T. Lutz Capacity Executors _X_ Administrator c.I.a. (check one) Administrator Administrator d,b.n. Is the administration of the estate complete? Yes_X_ No_ If "Yes", how was the administration ended? (check one) By court accounting By account stated to parties in interest _X_ Did the parties release the personal representatives? Yes Other (explain) Total amount paid to date to creditors and for funeral and $118,415,04 administrative expenses Total value of distributions to date to beneficiaries $262.781,95 If administration is not complete, estimated value of assets $ still in administration NOTE: This status report is due no later than the due date for filing of the Pennsylvania inheritance tax return or, if no inheritance tax return is required, nine (9) months after the date of death; ifthe administration of the estate has not been concluded, a summary report shall be filed annually thereafter until the administration is complete. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. .." Date: 7)))os- 7 11/) . I / 'l~ (I) . ~egiliter of WiUli of <!Cumbertanb <!Count!' . . . -. . OATH OF NON-SUBSCRIBING WITNESS Estate ofJJoRclli 1r <C.ful'\.. t ili~~ No,~' - ()J4-lc!:Si ~ ::tl:O :j~ (1)~ CT1 <00 Also lrnown as CD "'J F i:;:;"o ~ ,Deceased ~ q:; 0) -"" Q,,, N - ~C' :J;> ~ b' co ~* .. ~ i#khcr- ~l ~'~ ~c 0 l.l~)>;" \Q (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ...Jc'l{\ .~CJ-\llfamiliar with the signature of~,*'" 'er fjl a 0" , ~\\\~, testat~ of (one of t e subscribing witnesses to) the codicil/will presented herewith and tha~believ~ , the signature on the codicil/will is in the handwriting of~ . ,f ~ Q Q , (AJ, i1.15 , a . to the best o~ lrnowledge and belief. &J/;Y-t (Address) Sworn to or affirmed~d subscribed ~~~ Before me this ..:L.t daVf ~~ ~'I:S' ,20~ (Address) U'il~,~I\~ q,r:.v ',l,1SI, Thi, is to certify that the infonnation 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 I'>r this certificate. $2.00 ~~~ K-~ .f)~ Local Registrar p 10544986 ~~ ~.,l.,CJ?J"1 No. Date :2/- 04- lolq 09 ~w ~ :0:0 cr~ ~8 !':;:l F _....... <00 !!?-'.( (tJ m ~J i ~q. n N ~~l (:,) - ?? ::;;t :>;:0 i'f CO c:, j; i::) 0 - \0 H'Q.')14lR".2J87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS Ifl'EIPRIIH CERTIFICATE OF DEATH 41...reflUlNUolIlffl: " NAMEOFOECEDEhIT(FrII.~.laC) '" SOClALSECURlTVNUMBER DATEOFDEATti(MWlIh,Da"YeaiJ I'''-RMA''lE''lT B~ACK INK 1,Doroth Ellen Willis 2. Female , 7 - 01 - 3754 4. Jul 200 ..oE (~aoIE\lllllda,) BIRTHPLACE (ClI1.nd St&lBor FOrBignCounlI)') 86 ,,, 7.Harrisbur q,......D R.~d"".1XI ='1,,0 .. P .. COUNTY OfOEATH FACILlTYNAME(lrrlOlinsliMlon,glYellraa1.ndnumbllr) RACE-AmerlCBr1lnd1an,BI.li<,V.Me,il (Speaf}ol Ill. Cumberland 1d.133 West Locust " White OECEDENT'S lISUAl. OCCUPA1'lOH ,I,S OECEDENT EVER IN MARlTAlSTATUS-Io\aIliad. SURVlVINGSPOUSE '.. - USARMEDFORCES1 Newr~~. (It_,go,..",..O"....) ~- velD NoIXI I1LSU isar " (H...") 1..Wi~ 0" , , ( - . ) DECEDENTS llc.DYR._IIVBd,n . 133 West Wcust street Apt CO2 ~~~~NCE "" ., - l~csburg, PA 17055 (SIIIIlnlUII::lklna 17b. CounI. CWnber land .... 17d.IXI~~m~ol Mechanicsburq onOlhwIkla) -' CIl1/W'0 FATHER'SN.\UE(Firal.IIIlddIa,LUl) r.tOTtlER'SNAME(FnI.~.MaldenS_) ,&. John M. Lutz ... Anna L. Dra er '" ON """ I INFORMANT'S MAlUNGADORES8 ($1_, ClIylTown, SIaIa, lip Coda) 201. Jeffr E Lutz "". hanic PA 17 5 . ." I PlACEOFOlSPOSI7ION-N....ol~.Cf'MIaIOI)' LOCATIDN-CilylTown.Slale,ZIpC<><te Buo1alIXlClwndan~"""".lromsl..D orOlharPl_ ot>lIf(Specify) 0 ul 10 2004 2'.cones a Mem:>rial Park PA 17603 '"'" LICENSE NUMBER NAME AND ADDRESS OF FACILITY 22b. FD 014669 ...!'Ial zzi 8 _ Pla7a ffi 17055 TolhllbMlolm11lncJo1IBdga.dlatnOCCUll'adIl1\1)11im1t,da18andpla".1l1ll1Kl UCENSENUMBER DATE SIGNED (SignlllutIand TitIa) (MOOlh,Day.Ya",) ,~. .... 'k. T(MEOFDEATH DATE PRONOUNCED DEAD (Mon1l, Da1. V....j W,I,SCASE REFERRED TOA MEDICAL EXAMINER ICORONE~ uA 11:10 A. 2I.Jul 6 2004 2t. YelD No n, !'~.!'!T!; ~_""d" "",,_...~.....k:tl...._..._. Do__.........."'.yOoo..."".......iIIoor..._"'.""...._lor__... .Appro~m.. PART It: CIhe< s~rwfic8m COMIIIOi1' comn~ulinQ to death bu' L..._.............__ :~M11 OOlr.WIllngihltilllUlda"I"'\l"au.e9",,"'" ~AHI I . janlManddlMh E 'M:RE .wrOPSY F1NDNQS MANNER OF 7" DATEQFINJURY TIME OF INJURV INJUflYAT'MJRK? OESCRIBlHQWINJURYUC{;URflllJ AVAH.ABLEPRIORTO (M""t>,o.y.V"l COMPt.ETIONOFCAUSE N.......I I'1orrOCid8 0 OF DEATH? AcdoMnl D P...-.dingln.BlbgBtlDn 0 mD Nczf Y"'O NoD SlIIQd8 D Could 001 ltB dalB_ D~CEDFINJURY 'h "" H. ...-......(_"l ... ~ CERTIFIER (GhlockontronaJ 8 :~~':t.r:F':;:OJ~~=~::~f.:=I:r.=~1.."':r'~,,h.=Ci~~.~.~~..~.~.~~.~~.~~).., 8 81,Y.") 0 '''fo~=~:=='''=~~~':'~la~.'';:d-::t::::Z;~U~~.::a=.:.,..IIIalact... ~ '" " "flIIEl:*:ALEllAlllNEl'lICOAONER , On....llalaofUllIlllnallClll.ndlGrlmraatlgallon,lnmrQplnlan,dutII~rndM....t1....,dat.,.lldpl.Cf,anddu.IoUl.ca~.11nd < z ..."".....-.. .................. Jt.. LAST WIu.. AND TEST AMENT OF DOROTHY L. WIT T TS I, DOROTHY L. WILLIS, currently residing in the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct my Personal Representatives to convert the rest, residue and remainder of my estate into cash, and after the payment of all costs in connection therewith and after payment of all the debts of my estate and the cost of administrntion thereon, I then give and bequeath the proceeds remaining in their hands in the following proportions to the following named individuals: A. One-half (1/2) thereof to my nephew, JEFFREY EARL LUTZ, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania. Should JEFFREY predecease me, then his share shall go to his brother, JOHN THADDEUS LUTZ. If JOHN has also predeceased me, then to his daughter, AMY REBECCA LUTZ, and any other after-born children. B. One-half (1/2) thereof to my nephew, JOHN THADDEUS LUTZ, of the Borough of Newport, Perry County, Pennsylvania. Should JOHN prede- cease me, then to his daughter, AMY REBECCA LUTZ, and any other after-born children. 3. Should both JEFFREY and JOHN predecease me and should JOHN not leave any -- surviving children, then all the rest, residue and remainder of my estate shall go to VIKI ELLEN ACRI and T AMELA LUTZ, the wives of my said nephews in equal shares. Should VIKI predecease me, her share shall go to T AMELA. Should T AMELA predecease me, her share shall . 4. I hereby nominate, constitute and appoint my nephews, JEFFREY EARL LUTZ and JOHN THADDEUS LUTZ, to be the Co-Executors of this, my Last Will and Testament and as I have entire confidence in my said Personal Representatives, I desire that they shall be excused from the necessity of giving bond for the faithful performance of their duties as said Personal Representatives further than shall be required by law to secure the payment of all debts, taxes and assessments properly chargeable upon my estate after my decease, and I do also authorize and empower my said Personal Representatives to sell and dispose of all or any part of my said estate, real or personal, that they may deem advisable in the proper administration of my estate, at either public or private sale or sales, at such time, for such prices and upon such terms and conditions as they may deem to be to the best interest of my estate, and to execute and deliver such deeds or other written instruments as may be necessary or desirable to effectively convey title thereto to the purchaser or purchasers without the necessity of said purchaser or purchasers looking to the application of the said purchase money and without requiring any previous application to any Court. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my seal, this Jf-lt day of March, A.D. 1992. ..7~ A'. J/J.I,. ~. (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, DORarHY L WILLIS, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. /Jm/X/L a JjIA~~ /8 W. fmver ~-I. Mechan~~c1l41Z[E6 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DOROTHY ELLEN WILLIS Date of Death: July 6, 2004 Will No.: 21-04-679 Admin. No: To the Register: I certify that notice of beneficial interest (estate administration) required by Rule 5.6(a) ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 23, 2004. NAME ADDRESS Jeffrey E. Lutz 400 South Market Street. Mechanicsburg, P A 17055 John T. Lutz 230 North Fifth Street, Newport, P A 17074 Notice has ~w bel!lJl4iven to all persons entitled thereto under Rule 5,6(a) except: none, '7~) ..?o.:.: ;" :;: <! ,j f 11 JJ 7 :~1. ~ (~ VVL i. //) D~.., -' ,~ e In 9 '. .;E MICHAEL L", BANGS, Esquir 8 g> ..;:; ~ 429 South 18 Street, Camp I, P A 17011 ~a:.: i3~::::; (717) 730-7310 UU Capacity: Counsel for Personal Representative V........... COMMONWEALTH OF PENNSYLVANIA REV-1162 EX{11~96l DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004424 BANGS MICHAEL l 429 S. 18TH STREET CAMP Hill, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ______n fold n_n_n__ n_.'_.. 101 I $100,906.59 ESTATE INFORMATION: SSN, 172.01-3754 I FILE NUMBER: 2104-0679 I DECEDENT NAME: WilLIS DOROTHY EllEN I DATE OF PAYMENT: 09/24/2004 I POSTMARK DATE: 09/24/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/06/2004 I I TOTAL AMOUNT PAID: $100,906.59 REMARKS: CHECK#102 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS BANGS LAW OFFICE 129 SOUTH ISTH STREET PHONE: 717-730-7310 CAMP HILL, PA 17011 FAX, 717-730-737+ E-mail: mikeban2S@verizon.net MICHAEL L. BANGS, Attorney-at-Law WILLIAM E. MILLER, JR. WENDY S. CHESBRO, Paralegal Of Counsel September 20. 2004 DC:. ;; (I' g ::1'.' ,~::: C/} m -0 N .l:>. -.-. Glenda Farner Strasbaugh, Register of Wills -.- ~ L ~; Cumberland County Courthouse (ir -J One Courthouse Square Carlisle, PA 17013 RE: Estate of Dorothy E. Willis File No. 21-04-0679 Dear Mrs, Strasbaugh: Enclosed for filing as a part ofthe above-referenced estate please find the following: I, Two original Inheritance Tax Returns; 2. The original Inventory; 3. A check in the amount of $1 00,906,59September 20,2004 to pay the inheritance tax shown to be due in the discount period; and 4, A check in the amount of $25.00 to pay the filing fee. Kindly file this return accordingly and return a paid receipt to me in the enclosed, stamped, pre- addressed envelope. If you have any questions or require anything further, please contact me directly, Thank you for your assistance. Very truly yours, wsc Enclosures cc: Mr. Jeffrey E. Lutz Mr. John T. Lutz . OFFICIAL USE ONLY REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA 21-04-0679 DEPARTMENT OF AEVENUE RESIDENT DECEDENT DEPT. 280601 COUNTY CODE YEAR NUMBER HARRISBURG, PA 17128-0601 DECEDENT'S NAME{lAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 Willis Doroth Ellen 172 - 01- 3 754 E C DATE OF DEATH (t.H..1.0D-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE E 0 REGISTER OF WILLS E SOCIAL SECURITY NUMBER N T X 1. Original Return 2. Supplemental Return 3 date of death . Remainder Return prior to 12-13-82) CAPB 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) S. Federal Estate Tax Return Required HpRL X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes EplO - CRAC (Attach copy of Will) (Attach copy of Trust) KOTK o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A) ES (date of death between 12-31-91 and 1~ 1~95) (Attach Sch 0) ~.. J~fl:QJ!l~~T!!!&i$'i'!"il~l:fiil~~Il!E.iI:::tf;p.tj)\ P COMPLETE MAILlNGADORESS C 0 0 Michael L. Ban s R N FIRM NAME (If Applicable) 429 South 18th Street R 0 E E Camp Hi 11 , PA 17011 N S T TELEPHONE NUMBER nG- 30- 3 0 :; ri' g -c :~' Real Estate (Schedule A) (1) one OFFIC:JA,L~QSE ONL y Stocks and Bonds (Schedule B) (2) 348,09~.89 Vl C8 Closely Held Corporation, Partnership or (3) N:one N Sole-Proprietorship .,. 4. Mortgages & Notes Receivable (Schedule D) (4) N.one B R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 70'3.73 ~ E (Schedule E) Ui C )".' A 6. Jointly Owned Property (Schedule F) (6) 1,695,59 --J P D I Separate Billing Requested T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 372,416.08 U L (Schedule G or L) A 8. Total Gross Assets (total lines 1-7) (B) 722,909.29 T I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,540.01 0 N 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (10) 252.85 11. Total Deductions (total lines 9 & 10) (11) 14.792.86 12. Net Value of Estate (Line 8 minus Line 11) (12) 708,116.43 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) (14) 708,116,43 C SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0 M P 15. Amount of line 14 taxable at the spousal tax T U A T rate, or transfers under Sec. 9116{a)(1.2) X .0 0 (15) 0.00 X A 0.00 .0 45 (16) 0.00 T 16. Amount of Line 14 taxable at lineal rate X I 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 0 N 18. Amount of Line 14 taxable at collateral rate 708,116.43 X .15 (lB) 106,217,46 19. Tax Due (19) 106,217.46 20. X tiH;;:;::; 'MjiiLp: '!", ~ Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) \)- Decedent's Complete Address: STREET ADDRESS 133 W. Locust Street, Apt. CO2 CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 106,217.46 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 100,906.59 C. Discount 5,310.87 Total Credits ( A + B + C ) (2) 106,217.46 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. Is) 0,00 A. Enter the interest on the tax due. (SA) 0,00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (sB) 0.00 Make Check Payable to: REGISTER OF WillS, AGENT ,!il:::il::!i!::iilil:il!:iil!!!,III!i!W.!W:Wmmmii..ii11!!!II!!!!!@!:mmmW.!i!I!!!!II'!!:II.mmmmmW:I:I::I:I::::11::: 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 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? [K] 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. 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,lt is true. correct and complete. Declaration of preparer other than the persona) representative is based on all Information of which preparer has any knowledge SIG T"]#RSON ~ESP ffrey E. Lutz John T. Lutz DATE U _~9u~:c!'1,'O,,~!'_t:_?~_,____ ____~3_~_~_._~~h_ ~t~:\7074 r p 'f'! ChanlCsbur , PA 17055 ewpor, ~fRERO Michael L, Bangs DATE 429 South 18th Street - - -C~- uHil-i;' PA - - fiail' - - - - - - -... - - - - - -. - - - - - - -- For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (al (l1)(il]. 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S, 9116 (a) (1,2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P,S. 9116( 1.2) [72 PS. 9116(al(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)j. A sibling;s defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX + (1-97) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSI! 172-01- 3754 07/06/2004 21-04-0679 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE NUMBER OF DEATH 1 3 shares Agere - 3 Shares (Agrere A) 2.03 6.09 2 87 shares Agere - 87 shares (Agere B) 1. 89 164.43 3 124 shares AT&T Wireless - 124 shares AT&T Wireless 14,30 1,773.20 4 11 shares Avaya Inc. - Avaya Inc. Stock 15.12 166.32 5 83 shares Lucent Technologies - 83 Shares Lucent 3.45 286.35 Technologies 6 249 shares Lucent Technologies - 249 Shares Lucent 3.45 859.05 Technologies 7 140 shares Lucent Technologies - Lucent Technologies 3.49 488,60 Stock 8 44,597.38 shares Morgan Stanley - Active Assets Money 1. 00 44,597.38 Trust 9 4,108.246 shares Morgan Stanley - Balanced Growth Fund 12.85 52,790,96 B 10 32.173 shares Morgan Stanley - Dividend Growth 37.27 1,199.09 Securities B 11 636.31 shares Morgan Stanley - American Opportunities 21. 07 13,407.05 Fund B 12 4,891.139 shares Morgan Stanley - Van Kampen Equity and 7.84 38,346.53 Income B 13 585.307 shares Morgan Stanley - American New 24.34 14,246.37 Perspective C 14 483.99 shares Morgan Stanley - American Wa. Mutual C. 28.72 13,900.19 15 16.188 shares NCR Corp. - 16.1880 shares NCR Corp. 48.19 780,10 16 27 shares 27 shares (Avaya) 15.16 409.32 17 77 shares 77 shares AT&T 14.48 1,114.96 18 100 shares Vodaphone Stock 21.85 2,185.00 Total of Continuation Schedule(s) 161,372,90 TOTAL (Also enter on line 2, Recapitulation) 348.093.89 (If more space is needed, insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) Estate of: Dorothy Ellen Willis Soc Sec If: 172-01-3754 Date of Death: 07/06/2004 Continuation of Schedule B (Stocks and Bonds) Item Description Unit Value at Date II Value of Death 19 335 shares SBC Communications Stock 24.13 8,083.55 20 60 shares Tenneco Automotive, Inc. Stock 12.76 765.60 21 302 shares Pactiv Corp. Stock 24.24 7,320,48 22 140 shares Verizon Communications Stock 36.06 5,048.40 23 6 shares NCR Corporation Stock 47.95 287.70 24 56 shares El Paso Corp. Stock 7.89 441.84 25 39 shares AT&T Corp. Stock 14.45 563.55 26 63 shares Comcast Corp. Class A Stock 27.26 1,717.38 27 70 shares Qwest Communications Int'l Inc. 3.52 246.40 28 1,600 shares Exxon Mobil Corp. 45.10 72,160.00 29 1 share Agere Systems Class A 2.00 2.00 30 63 shares AT&T Wireless Services, Inc. 14.31 901. 53 31 37 shares Agere Sys. Inc. Class B 1. 84 68.08 32 961 shares Pepco Holdings Corp. 18,17 17,461.37 33 180 shares Bellsouth Corp. 25.88 4,658.40 34 30 shares Northrop Grumman CP 53.45 1,603.50 35 556 shares Verizon 556 shares Verizon 36.01 20,021. 56 36 556 shares Verizon 556 Shares Verizon 36.01 20,021. 56 -------------- 161.372,90 Estate for Dorothy L. Willis acct, 043876 Closing Price Fund Symbol Qty, 7/6/2004 Market Value Active Assets Money Trust nla 44597,38 1 4459738 Balanced Growth Fund B BGRBX 4108.246 12,85 52790.9611 DIVidend Growth Securities B DIVBX 32,173 37,27 1199.08771 American Opportunities Fund B AMOBX 636,31 21,07 13407.0517 Van Kampen EqUity and Income B ACEQX 4891,139 7,84 38346.52976 American New Perspective C NPFCX 585,307 24,34 14246,37238 American Wa, Mutual C WSHCX 483,99 28,72 13900.1928 Total MlJrket VBlue of MutU8/ FUfl(is: $178,487.58 Security Vodaphone VOD 100 21,85 2185 SBC Communications SBC 335 2413 808355 Tenneco Automotive Inc, TEN 60 12,76 765.6 Pactiv Corp. PTV 302 24,24 732048 Venzon Communications VZ 140 36,06 50484 ,\vaya Inc. AV 11 15.12 16632 NCR Corp. NCR 6 47,95 287.7 EI Paso Corp, EP 56 7,89 441.84 Lucent Technologies LU 140 3.49 488.6 AT&T Corp. T 39 14,45 563.55 Com cast Corp, Class A CMCSA 63 27,26 1717.38 Owest Communications IntI. Ino, Q 70 3,52 2464 Exxon Mobil Corp, XOM 1600 45,1 72160 Agere Systems Class A AGR'A 1 2 2 AT&T Wireless Services Inc, AWE 63 14.31 901.53 Agere Sys, Inc, Class B AGR'B 37 1.84 68.08 Pepco Holdings Corp. POM 961 18,17 17461.37 Bellsouth Corp, BLS 180 25.88 46584 Northrop Grumman CP NOC 30 53.45 1603.5 Total Market Value In Stock.: $124,169,70 Variable Annuity 2 No Riders Total Annuity >372,416.08 Total Estate Value: $675,072,36 .,.................. ...... ....................................................................................-. ................. Frank R. Baker 146 Springhouse Lane Phone: 7] 7/ 225-5450 Spring Grove, P A 17362 Fax: 717/225-0494 e-mail: frankr.baker@Suscom.net August 11,2004 Michael L. Bangs Attorney At Law 429 South 18th Street Camp Hill, PA 17011 Here is the information you requested concerning the stock values owned by Dorothy Ellen Willis as of July 6, 2004, Eauities Hll!:h Low Averal!:e Shares Value Lucent Technologies LV .3.51 3,39 3.45 83. 286.35 Lucent Technologies LV 3.51 3,39 3.45 249'" 859.05 Agere AGR.A 2,07 1.98 2,03 3'" 6.09 Agere AGR.B 1.95 1.83 1.89 87" 164.43 A vaya AV 15.29 15.Q2 15,16 27'" 409.32 AT&T T 14,55 14.40 14.48 77.'" 1,114.96 Verizon VZ 36.19 35,83 36,01 556. 20,021.56 Verizon VZ 36.19 35,83 36.01 556." 20,021.56 AT&T Wireless AWE 14.35 14,25 14,30 124**** 1,773.20 NCR Corp NCR 48,67 47,70 48.19 16,1880"'''' 780.10 Total: 45,436,52 .Shares held in certificate · '"Shares held by The Bank of New York ."'Shares held by EquiServe ......Shares held by Mellon Investor Services This evaluation is an estimate and is subject to change. We will not know the exact value until the equities are placed into an account and the transfer agent give us an exact total. If you have any questions, please call me. Sincerely, ~~~1)Jtw Frank R. Baker REV-1508 EX + (1497) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSIf 172-01-3754 07/06/2004 21-04-0679 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Verizon Stock Dividend 428.12 2 AT&T Dividend 18.29 3 Dividend from Morgan Stanley Account 105,50 4 State Farm (Refund) 130.00 5 Comcast Cable Refund 21. 82 TOTAL (Also enter on line 5, Recapitulation) S 703.73 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1509 EX ~ (1-97) SCHEDULE F COMMONWEAL TH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSII 172-01-3754 07/06/2004 21-04-0679 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURViVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jeffrey E. Lutz 400 South Market Street Nephew Mechanicsburg, PA 17055 B, John T, Lutz 230 North Fifth Street Nephew Newport, PA 17074 C, Tamela Lutz 230 North Fifth Street Newport, PA 17074 JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank: DATE OF DEATH DECO'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 08/05/95 Waypoint Bank - Account 6,782.37 25.00% 1,695.59 111800011223 Joint Owners: Jeffrey Lutz (25% ownership); John Lutz (25% ownership) and Tamela Lutz (25% ownership) TOTAL (Also enter on line 6, Recapitulation) I $ 1,695.59 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) VlWaYRqint 7/26/2004 BANGS LAW OFFICE 429 S 18TH ST CAMP HILL PA 17011 The infonnation which you requested on the account(s) of DOROTHY L WILLIS (Social Security Number 172-01-3754) is/are as follows: Account Number 1800011223 C lass of Account CHECKING Date Opened 080595 Principal Balance 6782,29 Accrued Interest .08 Balance at Date of 6782.37 Death Account Ownership JTO Name of Joint JOHN LUTZ Owner. if any JEFFREY Date Ownership ~~~r5 Was Established 1. \ C-. \2. L ~ r\--L Account Number \ 0.. (l'V- Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional ttrJbJJX In fonnation Requested ERIN E WATTS SENIOR SERVICES REP, po. Box 1711, HARRISBURG, PeNNSYllIANIA 17105-1711 Toll Free I-B66-WAVPOINT (I-B66-929-7646) , IN YORK AREA 717/815-4500 . www.waypointbank.com REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSfl 172 - 01- 3 754 07/06/2004 21-04-0679 This schedule must be completed and filed jf the answer to any of questions 1 through 4 on page 2 is yes. DESfRIPTIC(,N OF PR&PERTY % OF ITEM INCLUOE TH NA.ME F THE TRA. SFEREE THEIR DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. VALUE OF ASSET INTEREST (IF APPLICABLE) ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Variable Rate Annuity 372 ,416.08 100.00% 372 ,416,08 (Morgan Stanley) TOTAL (Also enter on line 7, Recapitulation) S 372 ,416.08 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) Estate for Dorothy L. Willis acct, 043876 Closing Price Fund Symbol Qty, 7/6/2004 Market Value Active Assets Money Trust nla 44597,38 1 4459738 Balanced Growth Fund B BGRBX 4108246 12.85 52790.9611 Dividend Growth Securities B DIVBX 32,173 37,27 1199.08771 American Opportunities Fund B AMOBX 636,31 21,07 13407.0517 Van Kampen Equity and Income S ACEQX 4891,139 7,84 38346,52976 American New Perspective C NPFCX 585,307 24,34 14246,37238 American Wa, Mutual C WSHCX 483,99 28,72 13900,1928 To/al Mark6/ Val"o of Mutuol F"nd8: $178,487,58 Security Vodaphone VOD 100 21,85 2185 SSC Communications SBe 335 2413 8083,55 Tenneco Automotive Inc, TEN 60 12,76 765,6 Pactiv Corp, PTV 302 24,24 732048 Varizon Communications VZ 140 36,06 50484 ,\-Jaya Inc. AV 11 15.12 16632 NCR Corp, NCR 6 47,95 287.7 E! Paso Corp. EP 56 7,89 441,84 Lucent Technologies LU 140 3.49 488,6 AT&T Corp. T 39 14.45 563,55 Com cast Corp, Class A CMCSA 63 27,26 1717.38 Owest Communications IntI. Inc, Q 70 3,52 246.4 Exxon Mobil Corp, XOM 1600 45,1 72160 Agare Systems Class A AGR'A 1 2 2 AT & T Wireless Services Inc, AWE 63 14.31 901,53 Agere Sys. Inc, Class B AGA'B 37 1.84 68,08 Pepco Holdings Corp, POM 961 18,17 17461,37 Bellsouth Corp, BLS 180 2588 4658.4 Northrop Grumman CP NOC 30 53.45 1603.5 Total Market Value In Srocks: $124,169,70 Variabie Annuity 2 No Aiders Total Annuity $372,418,08 Total Estate Value: $675,072,36 ................... .::::::::::::::::........................................................ REV-1511 EX + (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSfI 172-01-3754 07/06/2004 21-04-0679 Debts of decedent must be reported on Schedule l- ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Funeral Luncheon 476.80 2 Malpezzi Funeral Home 7,779.94 3 Headstone Engraving 125.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: Z, Attorney's Fees Michael L. Bangs 5,000.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4, Probate Fees Register of Wills 438.00 5, Accountant's Fees 300.00 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Cumberland Law Journal 75.00 2 The Sentinel 95.27 3 Frank Baker/The Investment Center - Stock Valuation and 250.00 Liquidation TOTAL (Also enter on line 9, Recanitulation) $ 14,540.01 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX +(1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE liABiliTIES, AND liENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy Ellen Willis SSI! 172-01-3754 07/06/2004 21-04-0679 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 West Shore EMS/BLS 45.53 2 Susquehanna Internal Medicine 15.79 3 Verizon 33.38 4 Home Care Companions 72,00 5 PP&L Electric Utilities 76.06 6 Pinnacle Health - Medical Bill 10.09 TOTAL (Also enter on line 10, Recapitulation) $ 252.85 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems,lnc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX +-(9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Doroth\1 Ellen Willis SSfI 172-01-3754 07/06/2004 21-04-0679 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSH.IP TO DEC~qENT AMOUN, OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116{a)(1.2)] 1 Jeffrey E. Lutz Nephew One-half 400 South Market Street Mechanicsburg, PA 17055 2 John T. Lutz Nephew One-half 230 North Fifth Street Newport, PA 17074 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) LAST WILL AND TEST AMFNJ' OF DORafHY L W1LlJS I, DORafHY L, WIlliS. currenUy residing in the Borough of Mechanicsburg, Cumberland County. Pennsylvania, being of sound and disposing mind, memory and understanding. do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made, I. I direct the payment of all my just debts and funeral expenses as soon afler my decease as the same can conveniently be done, 2. I direct my Personal Representatives to convert the rest, residue and remainder of my estale into cash, and afler the payment of all costs in connection therewith and afler payment of all the debts of my estale and the cost of administration thereon. I then give and bequeath the proceeds remaining in their hands in the following proportions to the following named individuals: A, One-half (1/2) thereof to my nephew, JEFFREY EARL LUTZ, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Should JEFFREY predecease me, then his share shall go to his brother, JOHN THADDEUS LUTZ, If JOHN has also predeceased me, then to his daughler, AMY REBECCA LUTZ, and any other after-born children, B, One-half (112) thereof to my nephew, JOHN THADDEUS LUTZ, of the Borough of Newport. Perry County, Pennsylvania, Should JOHN prede- cease me, then to his daughler, AMY REBECCA LllTZ, and any other after-born children. 3, Should both JEFFREY and JOHN predecease me and should JOHN not leave any - surviving children, then all the rest. residue and remainder nf my estale shall go to VIKI ELLEN ACRI and T AMELA LUTZ, the wives of my said nephews in equal shares, Should VIKI predecease me, her share shall go to T AMELA, Should T AMELA predecease me, her share shall go to VIKI, If both VIKI and T AMELA should predecease me. then all the rest, residue and remainder of my estale shall go to MARY JANE BEARD. of the Borough of Camp Hill, Cumberland County, Pennsylvania Should she also predecease me, then to the SALVATION ARMY, - . 4. I hereby nominate, constitute and appoint my nephews. JEFFREY EARL LUTZ and JOHN THADDEUS LUTZ, to be the Co-Executors of this, my Last Will and Testament and as I have entire confidence in my said Personal Representatives. I desire that they shall be excused from the necessity of giving bond for the faithful perfanoance of their duties as said Personal Representatives fW1her than shall be required by law to secure the payment of all debts, taxes and assessments properly chargeable upon my estate after my decease. and I do also authorize and empower my said Personal Representatives to sell and dispose of all or any part of my said estate, real or personal. that they may deem advisable in the proper adminislration of my estate, at either public or private sale or sales. at such time, for such prices and upon such tenos and conditions as they may deem to be to the best interest of my estate. and to execute and deliver such deeds or other written instruments as may be necessary or desilllble to effectively convey title thereto to the purchaser or purchasers without the necessity of said purchaser or purchasers looking to the application of the said purchase money and without requiring any previous application to any Court. IN TESTIMONY WHEREOF. I bave hereunto subscribed my name and affixed my seal, this 'fit day of March. A.D. 1992. ~ A'. tJ~' (SEAL) SIGNED. SEALED, PUBUSHED and DECLARED by the above-named Testatrix. DOROTHY 1. WilliS. as and for her Last Will and Testament, in the presence of us. who, at her request, in her presence and in the presence of each other. bave hereunto subscribed our names as witnesses. IJmhtll a Jj}jyT /8 IA/. aoveI' $fw~-t, Jv1er.hmOsbIl~ PA 17(t:6 CfmAJt jfl~ A-' (J1 -1.55J' J)~Q~ o.A oJrn-e- fMd)p~ ;( /J. ;;~QJi.~~ ~,4 /1tJSS- Witnesses Addresses - Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Dorothy Ellen Willis No. 21-04-0679 also known as Date of Death 07/06/2004 , Deceased Social Security No. 172-01-3754 Jeffrey E. Lutz and John T. Lutz, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I Nle verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of Michael L. Bangs ~ Attorney: Signature: LD. No.' 41263 Signature: J n T. Lutz Address: 429 South 18th Street Address: 400 S. Market St. Camp Hill, PA 17011 Mechanicsburg, PA 17055 Telephone: 717/730-7310 Telephone' 717/319-8400 Dated: r/.o Iv,,.. .~~ :'C) . f ~ 0 , ~.,. ) "'" ( Description CSalue N .z:,. ~ ~ en --.J (See continuation page(s) attached) (Attach additional sheets if necessary) Total: $348,797.62 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bat Association Copyright (c) 1996 form software only CPSystems, Inc. Fotm#RW-7 (1992) INVENTORY Estate of: Dorothy Ellen Willis Date of Death: 07/06/2004 County: Cumberland CASH: ----- State Farm (Refund) 130.00 AT&T Dividend 18.29 Comcast Cable Refund 21.82 Verizon Stock dividend 428.12 Morgan Stanley Account dividends 105.50 703.73 STOCKS/LISTED: -------------- 3.00 shares Agere 3 Shares 6.09 (Agrere A) 87.00 shares Agere - 87 shares 164.43 (Agere B) 124.00 shares AT&T Wireless - 124 1,773.20 shares AT&T Wireless 11.00 shares Avaya Inc. - Avaya Inc. 166.32 Stock 83.00 shares Lucent Technologies 286.35 83 Shares Lucent Technologies 249.00 shares Lucent Technologies 859.05 249 Shares Lucent Technologies 140,00 shares Lucent Technologies 488.60 Lucent Technologies Stock 44,597.38 shares Morgan Stanley - Active 44,597.38 Assets Money Trust -1- 4,108.25 shares Morgan Stanley - 52,790.96 Balanced Growth Fund B 32.17 shares Morgan Stanley - 1,199.09 Dividend Growth Securities B 636.31 shares Morgan Stanley - 13,407.05 American Opportunities Fund B 4,891.14 shares Morgan Stanley - Van 38,346.53 Kampen Equity and Income B 585.31 shares Morgan Stanley - 14,246.37 American New Perspective C 483.99 shares Morgan Stanley - 13,900.19 American Wa. Mutual C. 16.19 shares NCR Corp. - 16.1880 780.10 shares NCR Corp. 27.00 shares 27 shares (Avaya) 409.32 77.00 shares 77 shares AT&T 1,114.96 100.00 shares Vodaphone Stock 2,185.00 335.00 shares SBC Communications 8,083.55 Stock 60.00 shares Tenneco Automotive, 765.60 Inc. Stock 302.00 shares Pactiv Corp. Stock 7,320.48 140.00 shares Verizon Communications 5,048.40 Stock 6.00 shares NCR Corporation Stock 287.70 56.00 shares El Paso Corp. Stock 441.84 39.00 shares AT&T Corp. Stock 563.55 -2- . 63.00 shares Comcast Corp. Class A 1,717.38 Stock 70.00 shares Qwest Communications 246.40 Int'l Inc. 1,600.00 shares Exxon Mobil Corp. 72,160.00 1.00 shares Agere Systems Class A 2.00 63.00 shares AT&T Wireless Services, 901.53 Inc. 37.00 shares Agere Sys. Inc. Class B 68.08 961.00 shares Pepco Holdings Corp. 17,461.37 180.00 shares Bellsouth Corp. 4,658.40 30.00 shares Northrop Grumman CP 1,603.50 556.00 shares Verizon - 556 shares 20,021. 56 Verizon 556.00 shares Verizon - 556 Shares 20,021.56 Verizon -------------- 348,093.89 ---------------- TOTAL RECEIPTS O~ PRINCIPAL........ ....... 348,797.62 ================ -3- -. -~_. '-C;'---~"T -.'- ...",.. ....~.._~.. '..""'.,.. C'.. ~.'.;. ~-' :,r . I "III'JI. ~', . ; " ./1:. . t; ..,...7", {t- '..' . . .~ .,; r, ~ .. " .~ tL ,~ . ~, . , h,; ..\ ~ ~"'; 'l ~ ~ ;.} .~ , .h.. .~ l~ ill...., ~:.... - ~,~ "- .'J '.. i_ .)- t. ~ ..t I. It:)J i' o '"1'. non Q ='~r 'j~ ,. m ~ e - ~, . ::!.. (]) B g ._ 0;' n cr 0.. ~." ~c' ~o(])m = . ~ " '" ::!.. 'Tl '- ,_ "" :4 '" '" "'... .... , >- ~ 5. s Ql ~ 2: .1.. l .., o (]) = w ~ r.... - '" n" "0 W " , -...) '" 0 UJ '" S I:"' 'c l o (]) '" ~ S:r > .. '. . ..f.,......... -UJ~Zl .~... 1 I' w..o-<,,,, "co ..., ., g; g- ,.;. 0 '., . . i '. " n '" ~w _ ',> (]) 0 - -.l ~', " . !i cro 0 , "l ...ii,' _ ,.. ~ r' ~..... _ - ~ 0 _ " ,...." r' ~ it t"l ~_' _ _ V J ~ ~;;o t"l ~!'. rrJ .1'.- o _ .. . .~ '" " ~ 115 '8.].'. \l j; '" "- ~ 1 ~~ ~ ~ . . ' ", ~ ~J"H Ifto;. ._ ~( ti I:i~ b..~ 'f. 11Ji'. M i,l~H l ,-~~ .: ~ ." _ "...... ...... -. ,_. --. - ....~-- ~~"J - \\': K COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION PO BOX Z80601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 171Z8-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP (09-04) DATE 11-22-2004 ESTATE OF WILLIS DOROTHY E DATE OF DEATH 07-06-2004 FILE NUMBER 21 04-0679 COUNTY CUMBERLAND MICHAEL L BANGS ACN 101 429 S 18TH S1 I AlloUl11~elli Hed I CAMP HILL PA 17011 0 ~ MAKE CHECK PAYABLE AND ~IT PAYMENT TO: REGISTER OF WILLS <,;::' CUMBERLAND CO COURT~OUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~. REV=is4-j-i;f-AFP--foY:oiY-NOYici-OF-YtiHiififAifcl!-TAX-A-PPRjrisii'-€NT~--Ar.i.OWAN~-irR------------- ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX -' ESTATE OF WILLIS DOROTHY E FILE NO. 21 04-0679 ACN 101 DATE 11-22-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 348.093.89 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 703.73 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) 1.695.59 7. Transfers (Schedule G) (7) 372.416.08 8. Total Assets (8) 722,909.29 APPROVED DEDUCTIONS AND EXEMPTIONS: 14,540.01 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 252.85 11. Total Deductions (11) 14.792 86 12. Net Value of Tax Return (12) 708,116.43 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 708,116.43 NOTE: If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 708,116.43 X 15 = 106,217.46 19. Principal Tax Due (19)= 106,217.46 TAX CREDITS: l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-24-2004 CD004424 5,310.87 100,906.59 TOTAL TAX CREDIT 106,217.46 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 1lI IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)~ RESERVATION: 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 Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and subMit with your paYMent to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by cOMpleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available online at www.revenue.state.oa.us, any Register of Wills or Revenue District Office, or frOM the DepartMent's 24-hour answering service for forMs orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIDNS: Any party in interest not. satisfied with the appraisment, allowance or disallowance of deductions or assessMent of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date froM the Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the Matter determined at the audit of the account of the personal representative. ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA DepartMent of Revenue, Bureau of Individual Taxes, ATTN: Post AsseSSMent Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of adMinistratively correctable errors. DISCDUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% 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: Interest is charged beginning with first day of delinquency, or nine (9) Months and one (1) day frOM the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ zor- :ooom mlI-1991 """"'TIr- :1Jirni!" Z1i01 "9r- ."liDrnr 1983 16% .000438 1992 9% .000247 2002 6% .000164 1984 11% .000301 1993-1994 n .000192 2003 5% .000137 1985 13% .000356 1995-1998 9% .000247 2004 4% .000110 1986 10% .000274 1999 n .000192 1987 10% .000274 2000 n .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. INRE: ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ESTATE OF ) DOROTHY E. WILLIS ) ORPHANS' COURT DIVISION Deceased ) ) NO. 21-04-0679 RECEIPT AND RELEASE I, JEFFREY E. LUTZ, the undersigned, being a beneficiary under the Estate of Dorothy E. Willis, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums to which I am entitled as a beneficiary of the Estate of Dorothy E. Willis; 4. To the extent of said distribution, release Jeffrey E. Lutz and John T. Lutz, Co- Executors, of the Estate of Dorothy E. Willis, and their heirs and personal representatives, from aJlliabilities, whether due to their negligence or otherwise. which they may have by reason of their administration of the Estate; 5. Agree to refund to the Estate and to the said Jeffrey E. Lutz and John T. Lutz, Co- Executors, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify them and the Estate for claims made against them and to reimburse them and the Estate all expenses and costs incurred in connection with any such claim; and ~,L 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. J WITNESS WHEREOF, T h,,, hcr='" ~, my rumd """ =1 ""' ?7 day of U1. ,2005. (SEAL) COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) On this, the ~ day ~L 1L( ,2005, before me, the undersigned officer, personally appe JEFFREY E. LUTZ, known to me (or satIsfactonly proven) to be the person whose name is subscribed to the within instrument and acknowledged that (s )he executed same for the purposes therein contained. iYlo NOTARIAL SEAl. WENDYS. CHE~PubIlc LowerAllenTwp" Coun~ My Commls8Ion ElcpAs May 10. 200 INRE: ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ESTATE OF ) DOROTHY E. WILLIS ) ORPHANS' COURT DIVISION Deceased ) ) NO. 21-04-0679 RECEIPT AND RELEASE I, JOHN T. LUTZ, the undersigned, being a beneficiary under the Estate of Dorothy E. Willis, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums to which I am entitled as a beneficiary of the Estate of Dorothy E. Willis; 4. To the extent of said distribution, release Jeffrey E, Lutz and John T. Lutz, Co- Executors, of the Estate of Dorothy E. Willis, and their heirs and personal representatives, from all liabilities, whether due to their negligence or otherwise, which they may have by reason of their administration of the Estate; 5. Agree to refund to the Estate and to the said Jeffrey E. Lutz and John T. Lutz, Co- Executors, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify them and the Estate for claims made against them and to reimburse them and the Estate all expenses and costs incurred in connection with any such claim; and .. , ~,,>>l- 6. Declare that this instrument shall be legally binding upon me, my personal representatives. and assigns. J WITNESS WHEREOF, I h." bore,",. 00' my """ """ =I ilii. Q1L d,y .f I Jv 'fl1 ' 2005. ~.-: JOHN T. LUTZ ~ 4 (SEAL) COMMONWElli OF PENNSYLVANIA ) COUNTY OF Yl~h.A ( SS: ) On this, the 'J7fVt day of lQ 2005, before me, the undersigned officer, personally appeare HN T. LUTZ. known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that (s)he executed same for the purposes therein contained. IN WITNESS WHEREOF, I have he e tosetmYhr~~ / NOTARIAl. SEAl WENDY S. CHESBRo := PubIc Lower Allen Twp., Cumbe. fD My Co.,.,:! Illn ExpiIes May 10, 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 BANGS MICHAEL L 429 S 18TH STREET CAMP HILL, PA 17011 __nnn fold ESTATE INFORMATION: SSN: 172-01-3754 FILE NUMBER: 2104-0679 DECEDENT NAME: WILLIS DOROTHY ELLEN DA TE OF PAYMENT: 03/04/2008 POSTMARK DATE: 03/03/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 NO. CD 009370 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $195.54 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RECEIPT MAILED TO A TTY CHECK# 95 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $195.54 GLENDA FARNER STRASBAUGH REGISTER OF WILLS ('l ~ a: 00 a: 0.. 0 \Ii .,j::""~ oc.;:\oC"l:::l o..<i::cl'-O~ .;,0. 0..- ~a: ='~x: w 'ta~ -=~ tRg ~ --= - == M o l'- I" o o o o == ~ 4-< o l-< Q) ..... r:n Q) 051 ;g ~..2 ~ ~ ...r:: ;:l OJ) 0 Q) ~ U a ..0 ;:l r:n .0 O"'M ~t:ir/J c/5gQ)R ~ U ;g ...... E--o..2<r:: ('j~~A.. ~"""";:l ~ ('j~o~ --o..oUr:n t:iEQ):'::: ~ ;:l t:i a ouou r- ;'J ('...~ ::;:: ::: ~-:, / -;-:.:" - I' " ~ ..-:t , I_~-j ;~ Ul~\-':'~' a::. - 0"'., C-) ((... ....,.. c.::' ;'~J ~- ~ ./ o S . .. --:5: 2:) \ -- C\J ~ u ...... ~\~ ... ~=:: en ~ [ ~ 0'", ~ ""'u -< -1' ~ BANGS LAW OFFICE 429 SOUTH 18TH STREET CAMP HILL, P A 17011 E-mail: mikebangs@verizon.net PHONE: 717-730-7310 FA}(: 717-730-7374 MICHAEL L. BANGS, Attorney-at-Law WENDY K. STRAUB, Paralegal WILLIAM E. MILLER, JR. Of Counsel March 3,2008 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PAl 7013 RE: Estate of Dorothy Ellen Willis File No. 21-04-0679 Dear Mrs. Strasbaugh: Enclosed you will find the following: 1. The original Inventory; 2. The original and one copy of a Supplemental Inheritance Tax Return; 3. A check in the amount of $ 195.54 to pay the tax shown to be due; and 4. A check in the amount of $30.00 to pay the filing fee. Kindly file the supplemental inheritance tax return and return a paid receipt to me in the enclosed, stamped, pre-addressed envelope. If you require anything further, please contact me directly. V11t~ Michael L. Bangs wks Enclosures C) c.:; 0 -::n i.~~o 1 ~I~ to . ,-,-~~:! " .,'." /......, -'(2 . :5 m --I .I "':",:'..: '-" c;:: .",:;: >'C; I J:"- -:J :;: !""'.) (..) --: -.J 15056041147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX.280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY . County Code '. . '. INHERITANCE TAX RETURN ,1 RESIDENT DECEDENT ex. I Year File Number 01 &7 Date of Birth 172013754 07062004 01011918 Decedent's Last Name Suffix Decedent's First Name MI WILLIS DOROTHY E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW D 1. Original Return D 4. Limited Estate 2. Supplemental Return D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required [!] D 6. Decedent Died Testate (Attach Copy of Will) [!] D D D 4a. Future Interest Compromise (date of death after 12-12-82) 7 Decedent Maintained a Living Trust . (Attach Copy ofTrust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10 Spousal Poverty Cred~ (date of death . between 12-31-91 and 1-1-95) D 11.Election to tax under Sec. 9113(A) (Attach Sch. 0) ~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number MICHAEL L. BANGS 7177307310 C) to",) Firm Name (If Applicable) C___"1 r-::..'\ First line of address REGISTER.,(j)~ILLS U$.fg:ONL Y ; :r~p ::.;; . ,":, I .~.) -4:.'. 7~', 429 SOUTH 18TH STREET Second line of address :_-=--: f::-; City or Post Office c.) DATE FILED -...J CAMP HILL State PA ZIP Code 17011 Correspondent's e-mail address: Jeffrey E. Lutz ~:,) ()r 17055 Michael L. Bangs 429 South 18th Street, Camp Hill, PA 17011 Side 1 L 15056041147 15056041147 -.J ..-J 15056042148 REV-1500 EX DecedenfsName Dorothy Ellen Willis Decedent's Social Security Number 172 01 3754 RECAPITULATION 1. Real Estate (Schedule A)............................................... 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) D Separate Billing Requested.............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested.............. 7. 8. Total Gross Assets (total Lines 1-7)....... 9. Funeral Expenses & Administrative Costs (Schedule H)................................... 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).. ....................................................... 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J).................................................... 12. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................... TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2)X~. 0.00 14. 1. 5,097.62 13.79 8. 5,111.41 766.00 9. 766.00 4,345.41 4,345.41 15. 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate )( .15 16. 4,345.41 0.00 17. 0.00 18. 19. Tax Due 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 0.00 195.54 0.00 0.00 195.54 D 15056042148 ..-J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Dorothy Ellen Willis STREET ADDRESS 133 W. locust Street, Apt. C02 I--------~_u__ File Number 21-04-0679 CITY I STATE PA IllP 17055 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 195.54 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 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 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 195.54 (5A) (5B) 195.54 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.... ...................................................... ........................................................... [J 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. 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 receiving adequate consideration?................................................................................................................ ......... No D D D [] D D 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. 99116 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 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Willis, Dorothy Ellen IFILE NUMBER ESTATE OF All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 187 shares of Comcast Corporation - These shares 27.26 5.097.62 were discovered after the original inheritance tax return had been filed and approved. The shares resulted from a 3 for 2 stock split according to a statement received dated February 21, 2007. TOTAL (Also enter on Line 2, Recapitulation) 5.097.62 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE"ruRN RESIDENT DECEDEI'IT ESTATE OF FILE NUMBER Willis, Dorothy Ellen Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Comcast Corporation - Dividend check received from stock split after filing and approval of original inheritance tax return. VALUE AT DATE OF DEATH 13.79 TOTAL (Also enter on Line 5, Recapitulation) 13.79 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(12-99) ~ ~- SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX FtETURN RESIDENT DECEDENT Willis, Dorothy Ellen Debts of decedent must be reported on Schedule I. I FILE NUMBER 21-04-0679 ESTATE OF ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Michael L. Bangs 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 16.00 TOTAL (Also enter on line 9, Recapitulation) 766.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDa,,- Willis, Dorothy Ellen FILE NUMBER ESTATE OF ITEM NUMBER DESCRIPTION 1 Register of Wills - Short Certificates required in order to liquidate book shares of stock discovered after approval of original inheritance tax return. AMOUNT 16.00 Subtotal 16.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) REV-1513 EX+ (9'{)O) . SCHEDULE .. BENEFICIARIES COMMONWEALTH OF I'ENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER Willis, Dorothy Ellen NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Jeffrey E. Lutz 400 South Market Street Mechanicsburg, PA 17055 Nephew One-half John T. Lutz 230 North Fifth Street Newport, PA 17074 Nephew One-half Total 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 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) @omcast. lomputershare + == - -- == -- - - == - --- --- == - --- - -- 041752 Computershare Shareholder Services, Inc. 250 Royall Street Canton Massachusetts 02021 Within the US, Canada & Puerto Rico 1 888 985 2054 Outside the US, Canada & Puerto Rico 1 781 5754730 www.computershare.com DOROTHY LINGLE WIL.L1S 400 S MARKET ST MECHANICSBURG PA 17055-6420 111.111'11111'1111.1111.11.\111.1111..\.111'111111111.111\,111 Holder Account Number - - C3001593624 N 0 - - == III ~II W 11~llllml ~llll~1 Uncertified accounts are subject to withholding taxes on dividend payments and sales proceeds. Company ID SSNJT!N Certified CUSIP Number CMCS Yeg 20030N101 Comcast. Direct Registration Advice. Class ACommon Shares Retain for your records Effective Date: February 21, 2007 3-for-2 Stock Split Pre-Split I Total Shares 125 Stock Split Rate I 3-for-2 Common Stock I Credited 62 Fractional Share I 0.5 Post-Split Total Shares 187 Transaction Description The check below represents the payment of eash-in-Iieu of the fractional share Comeast common stock due to you as part of the 3-for-2 stock split. The check was ealculated using 1/3 of the closing price of this class of Comeast shares as reported on NASDAQ on February 14,2007, the record dale. . 165UDR CMCS OI2021_PRODUCT _ 4_110411521041152/; 1 + 002CD70001 0003KK Estate for Dorothy L. Willis acct. 043876 Closing Price Fund Symbol Qty, 7/6/2004 Market Value Active Assets Money Trust n/a 44597.38 1 44597.38 Balanced Growth Fund B BGRBX 4108.246 12.85 52790.9611 Dividend Growth Securities B DIVBX 32.173 37.27 1199.08771 American Opponunities Fund B AM08X 636.31 21.07 13407.0517 Van Kampen Equity and Income B ACEQX 4891.139 7.84 38346.52976 American New Perspective C NPFCX 585.307 24.34 14246.37238 American Wa. Mutual C WSHCX 483.99 28.72 13900.1928 Total M/Jrk6t Vnlu6 of MututJl Fund8: $178,487.58 Security Vodaphone VOO 100 21.85 2185 SSC Communications SBC 335 2413 8083.55 Tenneco Automotive Inc. TEN 60 12.76 765.6 Pactiv Corp. prv 302 24.24 7320.48 Verizon Communications VZ 140 36.06 50484 I\vaya Inc. AV 11 15.12 16632 NCR Corp. NCR 6 47.95 287.7 EI Paso Corp. EP 56 7.89 441.84 Lucent Technologies LU 140 3.49 488.6 AT&T Corp. T 39 14.45 563.55 Com cast Corp. Class A CMCSA 63 27.26 1717.38 Owesl Communications IntI. Inc. a 70 3.52 2464- Exxon Mobil Corp. XOM 1600 45.1 72160 Agere Systems Class A AGR'A 1 2 2 AT & T Wireless Selrvices Inc. AWE 63 14.31 901.53 Agere Sys. Inc. Class B AGR'B 37 1.84 6808 Pepco Holdings Corp. POM 961 18.17 1746137 Bellsouth Corp. BLS 180 2588 4658.4 Nonhrop Grumman CP NOC 30 53.45 1603.5 Totsl Market Value In Stocks: $124,169.70 Variable Annuity 2 No Riders Total Annuity $372,416.08 Total Estate Value: $675,072.36 .................................................................................................. ................... LAST WILL AND TESTAMENT OF DOROTHY L WILLIS I, DOROTHY L. WILLIS, currently residing in the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct my Personal Representatives to convert the rest, residue and remainder of my estate into cash, and after the payment of all costs in connection therewith and after payment of all the debts of my estate and the cost of administration thereon, I then give and bequeath the proceeds remaining in their hands in the following proportions to the following named individuals: A. One-half (1/2) thereof to my nephew, JEFFREY EARL LlITZ, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania. Should JEFFREY predecease me, then his share shall go to his brother, JOHN THADDEUS LlITZ. If JOHN has also predeceased me, then to his daughter, AMY REBECCA LlITZ, and any other after-born children. B. One-half (1/2) thereof to my nephew, JOHN THADDEUS LlITZ, of the Borough of Newport, Perry County, Pennsylvania Should JOHN prede- cease me, then to his daughter, AMY REBECCA LlITZ, and any other after-born children. 3. Should both JEFFREY and JOHN predecease me and should JOHN not leave any surviving children, then all the rest, residue and remainder of my estate shall go to VIKI ELLEN ACRl and TAMELA LlITZ, the wives of my said nephews in equal shares. Should VIKI predecease me, her share shall go to T AMELA. Should T AMELA predecease me, her share shall go to VIKl. If both VIKl and T AMELA should predecease me, then all the rest, residue and remainder of my estate shall go to MARY JANE BEARD, of the Borough of Camp Hill, Cumberland County, Pennsylvania Should she also predecease me, then to the SALVATION ARMY. 4. I hereby nominate, constitute and appoint my nephews, JEFFREY EARL LUTZ and JOHN THADDEUS LUTZ, to be the Co-Executors of this, my Last Will and Testament and as I have entire confidence in my said Personal Representatives, I desire that they shall be excused from the necessity of giving bond for the faithful performance of their duties as said Personal Representatives further than shall be required by law to secure the payment of all debts, taxes and assessments properly chargeable upon my estate after my decease, and I do also authorize and empower my said Personal Representatives to sell and dispose of all or any part of my said estate, real or personal, that they may deem advisable in the proper administration of my estate, at either public or private sale or sales, at such time, for such prices and upon such terms and conditions as they may deem to be to the best interest of my estate, and to execute and deliver such deeds or other written instruments as may be necessary or desirable to effectively convey title thereto to the purchaser or purchasers without the necessity of said purchaser or purchasers looking to the application of the said purchase money and without requiring any previous application to any Court. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my seal, this "1ft day of March, A.D. 1992. J~ tf. tJ~. (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, DORafHY L WILLIS, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. bnJm.o. a.Jjj~ ~ejfl~~ ~p~ Witnesses /8 W. @ver 6Ire.d./ttdxmCsbC%;i'tJ;JD:6 ~ o.~ cu. oYnn-e- :< tJ. !LamQJi.;jj~ ;:',4 mS.. Addresses . - .. .. INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Jeffrey E. Lutz and John T. Lutz Personal Representative(s) of the Estate of } SS } File Number 21-04-0679 Dorothy Ellen Willis deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent' death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a em dum at the of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. S 4904 relating to unsworn falsification to authorities. Attorney -- (Name) (Firm) (Address) (Telephone) Michael L. Bangs (Supreme Court 1.0. No.) 429 South 18th Street, Camp Hill, PA 17011 717/730-7310 DATE OF DEATH 07/06/2004 LAST RESIDENCE 133 W. Locust Street, Apt. C02 Mechanicsburg, PA 17055 FIGURES MUST BE TOTALED DECEDENTS SOC. SEe NO. 172-01-3754 Personal Property Cash ... ........................................... ......... ...... ... ........... ... ........... ... ........ Pe rsonal Property........................................ .............. ................. ...... Stocks/Listed..................................................................................... Stocks/Closely Held......................................................................... Bonds................................................................................................. Partnerships and Sole Proprietorships ........................................ ,:Mortgages and Notes Receivable.................................................. IMI OtherrP-r'c>perty ........................................... .............. .................... ~ C~. . 13.79 5,097.62 ....- . Total Personal Property........................................... 5,111.41 c~ --:Y:i"~ ;f '~.: '~~\ f :Total Real Property................................................... 00> 0:- , (,= ~ [j>tal Personal and Real Property........................... 5,111.41 I ...::!" I .~~::: NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. c.s. ~ 3301 (b)) Form RW-09 Rev. 10-13-2006 ;J .. . '.. INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 21-04-0679 DATE OF DEATH 07/06/2004 LAST RESIDENCE 133 W. Locust Street, Apt. C02 Mechanicsburg, PA 17055 DECEDENTS sac SEC. NO. 172-01-3754 Cash Comcast Corporation - Dividend check received from stock split after filing and approval of original inheritance tax return. 13.79 Total Cash 13.79 Stock I Listed 187.0000 shares Comcast Corporation - These shares were discovered after the original inheritance tax return had been filed and approved. The shares resulted from a 3 for 2 stock split according to a statement received dated February 21, 2007. 5.097.62 Total Stock / Listed 5.097.62 (Attach additional sheets if necessary) Total Personal Property and Real Estate 5.111.41 BUREAU elF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 2811601 HARRISBURG PA 17128- 0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,"-r,""'- ,,,,.r.INHERITANCE TAX tfrlj)~s1ATEHENT OF ACCOUNT REV-1607 EX AFP (03-05) Z008 APR II PM I: 02 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2008 WILLIS 07-06-2004 21 04-0679 CUMBERLAND 101 DOROTHY E CLERK OF ORPHtt\!'(~ ('ill iDT MICHAEL L BANGSrl !~,:\~i-:t:: ~.j_''''--'I 'IDA 429 S 18TH ST ..hi'.' , , CAMP HILL PA 17011 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS +- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF WILLIS DOROTHY E FILE NO. 21 04-0679 ACN 101 DATE 03-31-2008 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: 11-15-2004 PRINCIPAL TAX DUE: 106,217.46 PAYMENTS (TAX CREDITS): PAY:MENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-24-2004 CD004424 5,310.87 100,906.59 03- 0~;-2008 CD009370 .00 195.54 TOTAL TAX CREDIT 106,413.00 BALANCE OF TAX DUE 195.54CR INTEREST AND PEN. .00 TOTAL DUE 195.54CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ ' * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~,,~-_ .-, ~QTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ~ ' ','yi i ~1pp~pa~SEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION - `0~`p~DUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 i-t; ..,~:_~"i \~: _ HARRISBURG PA 17128-0601 ` Z~!~B I~~Y 27 F~ I ~ 48 ~. ~ ~ i OR~~ ~-.r~ ~ ~ 0' l~T MICHAEL L BANGS ~l~!!, `"~~„ ~/~ 429 S 18TH ST CAMP HILL PA 17011 REY-1547 EX AFP (06-05) DATE 05-26-2008 ESTATE OF WILLIS DOROTHY E DATE OF DEATH 07-06-2004 FILE NUMBER 21 04-0679 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 07-25-2008 (See reverse side under Objections Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~-- RETAIN LOWER PORTION FOR YOUR RECORDS ----------------------------------------------- ~ ----- -------------- ---- --------------------- REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WILLIS DOROTHY E FILE N0. 21 04-0679 ACN 101 DATE 05-26-2008 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 5,097.62 credit to your account, 00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) ~3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 13.79 6. Jointly Owned Property [Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 e. Total Assets ~B) 5, 111.41 APPROVED DEDUCTIONS AND EXEMPTIONS: 766.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions C11) 766.00 12. Net Value of Tax Return (12) 4,345.41 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax C14) 712,461.84 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 . .0 0 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) 712,461.84 X 15 = 106,869.28 19. Principal Tax Due rwv rornrr~. c19)= 106,869.28 ~~PAYMENT ~ V DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 09-24-2004 CD004424 5,310.87 100,906.59 03-03-2008 CD009370 .00 195.54 INTEREST IS CHARGED THROUGH 06-10-2008 TOTAL TAX CREDIT 106,413.00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 456.28 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 138.36 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL DUE 594.64 C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 DECEDENTS Dorothy E. Willis INHERITANCE TAX EXPLANATION OF CHANGES 2104-0679 REVIEWED BY ACN Anita McCully 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES Changed tax rate from 4.5 percent to 15 percent since a nephew is a collateral beneficiary. Row Page 1 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 010174 BANGS MICHAEL L 429 S 18TH STREET CAMP HILL, PA 1701 1 ACN ASSESSMENT AMOUNT CONTROL NUMBER ________ fold __________ ___ ESTATE INFORMATION: Ssly: 172-0~-3754 FILE NUMBER: 2104-0679 DECEDENT NAME: WILLIS DOROTHY ELLEN DATE OF PAYMENT: 08/21 /2008 POSTMARK DATE: 08/20/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 REMARKS: RECEIPT TO ATTY CHECK# 97 101 ~ 5600.69 TOTAL AMOUNT PAID: INITIALS: AK 5600.69 SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ ~ • f _ BUREAU pF INDYVIDIIAL TAXES INHERIT,INC1: TAX DIVISION po nox 2eobal N0.RRIS8ll{i~G PA 17128-Db01 MTCNAEL L BANGS 4'29 S 1$'PH ST CAMP HILL COMMt1Nti'tEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .NOTIGE.OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE dF DEDUCTIONS AND ASSE55MENT OE TAX '~ REY-1547 E]C APP COF-R51 DATE 05-26-2D09 f~~t ~} ~~~ ~ { ~J~ ~' ~~ ESTATE OF WILLIS i~[1R07HY E RATE DF DEATH 07-06-2Q04 ;! ~-;~;.~ ,~~= FILr NUMBER 2I a~-D~7~ GF;~-'~" !' _'~ '~..; 1~ JFi i GQUNTY CUMBERLAND ~~_;~,~_ ~,:,,~ ~';t ACN iDl AAPEAT. T}ATE: 07-25-200$ P A 17 D 11 t S~ r~}else side under (?hjec~io~~ ~ A~naunt Remitt8d --~~ MAKIr C~#EClG PAYABLE ANi3 REHIT PAYMENT T0: REGISTER bF WILLS CUMBERLAND CO CQURT W0115E CARLISLE. PA 17013 ~ R_ETA_TN Lf3WER PO_RTIDN FOR YOUR REG©RD$ s TNIS LINE CUT ALON ~ - 4^ _ _ _______ _____ - - __ _ ALLDWANCE TAX APPaAISEMENT. REV-15y7 EX~AFR C03-05a NOTICE OF INHERIT`ANGE OR ~ISAlLd1>lANCE OF DEiIUCTI0N5 AND ASSESSMENT DF TA]C ESTATE OF WILLIS Dl]ROTNY E FILE N0. 2I fl4-D674 ACN LD1 DATE D5-2b-anD$ TAX RETURN WAS: f ] Acc6PTE0 As FIL~n [ X) CNANt3ED SEE ATTACHED NaTICE RESERVATION caNCERNIN6 FUTURE INTEREST - 5EE REVERSE APPRAISED VALUE DF RETURN BASED ON: SUPPLEMENTAL RETURN N0. D1 1• i~na1 Estate CSc»adula A] fi] •DU NOTE: To insure proper 2. s and Sands CSthoduls S] C2] S,a 9 $tpck ~~ €~2 credit to your account. . DD submit the Uppor portion b. CZota7.y Neld Stock/PartnorshiR Interest fSchadule C:} C3) . pf this Hors +rfth Your 4. Mortgai}as/kotes Receivabxo [Schedule D} C4} .D D tax payment. 5. Gash/Bank riopaaitslNiac. Personal Property (SchAdulo E] C5] 1 3.79 f,. .lointly Owned Prepmrty CSchaQula F) t6] •00 ~. Tra~sfars CSchetlula g} t7] .D D 8. Total Assets Cg) 5.111.41 APPROVED DEI]UCTIOPIS ANII EXEMPTIONS: 766.OD 9. Funarai ExpencaslAds. CostsfHist• Expanses CSChadL116 Id] f4] 1Q. DottalNortgage LiahilitisslLia»5 fSchodule I] f1D) .0d 11. Total Dsduct3onv {11) 766.0 12. Nat Value of TaX Return tit) 4,345.41 13. CharitabAn/Gavernmeht~l Boquosts; No»-eloCtad 4113 Trust: [Schedule J) C13) •D D iG. Net ValuQ of Estate Subject to Tax C14) 712,461_.$4 NOTE: iF an assasseent xas issued previausly-, lines 14. 15 sndfar 16, 17, 18 and 19 ti-1I1 hefleGt tinures that include the tOtai of ALL returns assessed to date. ASSESSMENT' aF rAX: 15. Amount of Limo 14 at Spousal rata {15) ' DD X DD ~ ' DO 16. nseunt of LI»a 14 taxable at Linoal.lClass A rate C16] • Uty X $t`S ~ • DD 17. Amount of Lino 14 at SihlinA h8ta (17) -QD X ~~ _ .DD 18. Amount of Line 14 tax4hla at Co11AtAra1lClass B rat9 Cln) 712, 461 .84 X 15 ~ 106+$~`~ • 2B 14. Pri»CiPal Tax 71ue C14]= 105,$69.28 Y DATE NUMBER INTEREST/PEN PAID (-) 09-24-2DOG CDDD4424 5,31a.a7 03 03-200$ CpD09370 .DO INTERESY IS CHARGIwU THIIl~U6H 06-10-209 AT THE RATES APPLICABLE AS OUTLINED DN THE REVERSE SIDE OF THIS FORM AMOUNT PAIR +906.59 195.54 TOTAL TAX CREDIT 1(16,413.00 aAt,AWCE OF TAX DUE 45G.28 INTERESt AND PEN . 13>i . 35 TOTAL, DUE 594.b4 x IF PAID AFTER DATE INDICATED SEE REVERSE f IF TOTAL DIJE LS LE55 THAN al, NO PAYMENT Is REQUIREA• .-..w ...~ t.~..T.,.~ ~c ~nnr*~nur. YNTGOCL+T TF T07Ai_ nllE IS REFLECTEX7 AS A "CREDIT" CCR), YDU MAY 7E DUE ~. CC~MMON1Af~ALTN QF PENNBYLVAWIA ¢EPARTTNENT Qf REbENUE HUREA4! Of (N~NIOUA67AX@$ PO BOX 480601 Dorothy E, Willis Anita McCully fTEM SCHEDUt~E Np, INHERII"~-NCE TAX EXPLANATION t~l" GHANOE~ 210Q-Oi;79 1 {~1 EXPLANATtON OF CHANGES Changed tax rate from 4.5 percent to '15 percent since a nephew is a calla~eral beneficiary. Flt.e Page t 1'j' =1~,n ~ ~ ~ , _n?7~ ~.;T-ATE Gr L`E~T~ C~ 7-05-20C~ G~ILLy~ i ~~~k~~~~ r~, . ~*J,.~•~*-+kir:r'k'~-k:~.*~k~'r*~F'~k~k**~t*,k~t~; ;t*~'~f***t*yrir±e:r~1'~4'~;'-kdr*•~k*~kirt***'.k~r~dr'k-~~r*:k**1~t~,t**:~:Y-it TA:~, DUE -~ IP~TERESa - FA`tP~tEl~~'C'S - DISC~i,~TT - E-+e"~~r~~~i;~E 1,~~~,,~,~~.~~ a?9.G~ 101,102.1 5,310.87 ~ 585.°7 'L~U:~ 1i~Tr~F?EST FRC)2~1 C13-0~-2048 TO 08x1.8-008 + 1~ . 72 J. ~ ~ ~~L~~ ~ T J ©~TAI, L~t~YS I.~~TE * ~ * * * * * * * CUR~~~NT r3A:~ANCE _ ~ 4~ C . a" 9 * FNL ** -7 PAGE i0 $~NCS I.~~ 0~~'IC~ 429 SOUTH 18TH STREET CAMP HII.L, PA 17011 E-mail: mikebangs (~verizon.net PHONE: 717-730-7310 FAX: 717-730-7374 MICHAEL L. BANGS, Attorney-at-Law WENDY K. STRAUB, Paralegal August 20, 2008 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Dorothy E. Willis File No. 21-04-0679 Dear Mrs. Strasbaugh: WILLIAM E. MILLER, JR. Of Counsel ` ~ ~: ~ , . ( ; ~~ C, l , '.~ -~ rv ~- r r .) ,` _.~ ~~ ~ i -~ = -;~ : N Enclosed you will find a Notice of Inheritance Tax Appraisement indicating a balance due in the amount of $594.64. For some reason neither my office nor my client ever received this notice although it is dated May 26, 2008. I have been advised by the Inheritance Tax Office that the current amount due is $600.69 (see copies attached) and therefore enclosed is a check in that amount. Please apply this payment accordingly and provide me with a payment receipt in the enclosed, stamped, pre-addressed envelope. Thank you. Very truly yours, ~~~~~ Michael L. gs wks Enclosures cc: Mr. Jeffrey E. Lutz c.} {=:c~ ~'} /~ /~ /~ /~ Sy ~ ~ N ~ ~ ~ ~ _. c O K ~ ~ ~- ~ ~ ~, ~~ ~~ c ~ C' ; 0 Q ~ ~ ~ .~ V? ~ 'K w ~ ,~ Q' c~u O ~ ~ o ~ ~ t~ v: l'7 ^t F-h '.a . ~, a S~ m i~~ __,~ i `J rv CC N ~ '~ ~ `~ C~ ,~ '" U, ~~ ~ ~~ C o~ ~ ~, n. ~~ (. ' f~ f._ L. ¢~ ~ ~ ~ ~ ~ ~: ~.°' ;,. G''. .~• i.~. _, ~=:. ~. ~iY f~?i 1..r Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Dorothy Ellen Willis Date of Death: 07/06/2004 File Number: 21-04-0679 ~~~~ ~ r '/ !`~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Q Yes ^ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ^ Yes ^X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. '^J (:,, .. ~-- r• _. _ .- Date i w'- ~-- e-. ~_= - =~ r: } - ~...3 C> ,--~ ~ i . - }~ Form RW-10 Rey. ~o-~s-loos Signature o/Person Filing this Form Capacity: ^ Personal) Michael L. Bangs ^X Counsel Name o/Person Filing this Form 429 South 18th Street Address Camp Hill, PA 17011 City, State, Z/p 717/730-7310 Telephone Copyright (c) 2006 form software only The Lackner Group, Inc COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAxES ~ _ ~, ~.NHE,RITANCE TAX INHERITANCE TAX DIVISION ~ ~_ $-TAT.EMENT OF ACCOUNT PO BOX 280601 ~ ,-- -~. HARRISBURG PA 17128-0601 REV-1607 EX AFP (03-05) ~~~:'~ ~,-~ ~'. '~~ I` ~ DATE 09-15-2008 ESTATE OF W:[LLIS DOROTHY E r~ :: ~ r,r DATE OF DEATH 0'1-06-2004 ,~, -:- `; ~~ .;,- FILE NUMBER 2:L 04-0679 ~,`~ ~~ - ~ ~ ~., COUNTY CUMBERLAND MICHAEL L BANGS ~ ACN 101 429 S 18TH ST Amount Remitted CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: 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 WILLIS DOROTHY E FILE N0. 21 04-0679 ACN 101 DATE 09-15-2008 THIS STATEMENT IS PRDVIDED 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: 08-22-2008 PRINCIPAL TAX DUE: 106,869.28 PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 09-24-2004 CD004424 5,310.87 100,906.59 03-03-2008 CD009370 .00 195.54 08-20-2008 CD010174 144.41- 600.69 09-12-2008 SBADJUST .00 .17 TOTAL TAX CREDIT BALANCE OF T'AX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 106,869.28 .00 .00 .00