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HomeMy WebLinkAbout03-0069Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Jennie A. Kelly also known as No. 2,~- Petitioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased Social Security No..175-18-7213 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix [-~ Decedent, dated 9/1/98 and codicil(s) dated none ' named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: 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 the Decedent left no Will and was survived by the following spouse (if any) and heirs: I" Name Relationship Residence (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 402 Deerfield Road, Camp Hill, B-2~_t -~-~q..."._~bor9 Twp, PA 17011 ~,~'~ ,~;~ (list street, number and municipality) Decedent, then 83 years of age, died Janua'r~ 12 , .2003 at Ho ¥ Spirit Hospital Decedent at death owned property with estimated values as follows: (Location) (if domiciled in PA) All personal property ......................................... $. (if not domiciled in PA) Personal property in Pennsylvania .................... $ (if not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania Total Real Estate situated as follows: 402 Deerfield Road, Camp Hill, PA 17011 341,452.49 175,000.00 516,452.49 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 appropriate form to the undersigned: Signature RW-7 Typed or printed name and residence ~ M. Conard 186 Alant_..~hia Lane Et._.ters, PA 17319 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and 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 according to law. Sworn to and affirmed and subscribed before me this day of DECREE OF REGISTER Estate of Jennie A. Kelly also known as Deceased Social Security No: 175-18-721;~ Date of Death: AND NOW, ~.~., ~. c~ , ~ , in consideration of the Petition on the reverse side hereon, satisfactory(~roof having been presented before me, IT IS DECREED that Letters ~ Testamentary I-I of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to Jacclueline M. Conard in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... Shod Certificate(s) ............... $ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages ( ) .............. $. ~. 0(3 Codicil JCPFee ................................. $ 10.OO Inventory & Tax Forms ............. $ Other ...................................... $ 18.oo TOTAL ............................. RW-7A k Register °f Wills 0 ! 0 I0 Attorney: Linus E. Fenicle I.D. No: 20944 Address: 2331 Market Street Camp Hill PA 17011 Telephone: 717-763-1383 DATE FILED: I -a~ ~-03 Cumberland County, Pennsylvania OATH OF NON-SUBSCRIBING WITNESS 2.1- o$- R Jacqueline M. Conard and Leticia A. Mancini (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of ,Jennie ^. Kelly subscribing witnesses to) the will presented herewith and that they will is in the handwriting of her to the best of their Sworn to or affirmed and sub- scribed before me thisoQ~'E~ day of . ~k_ bbr the Reg~ter Jac(q/ueline M. Conard (Name) (Name) Leticia A. Mancini 186 White Doe Drive, Lincoln University (Address) , testat rix of(one of the believes the signature on the knowledge and belief. PA 17319 PA 19352 his is to certify that the information here given is correctly copied fi'om an original certifict~te o£ dcadi duh' filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Of}ice for permanent iiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8911796 No. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH · Jennie A. Kelly . female · 175 -- 18 -- 7213 ~ Cumberland L E. Pennsboro ~l ~1., ~,,~.~ d.o~,l - I [~~~". I'~' ..~ ,,~ home.ruer I-*. Domestic [,~. [,, 10~,*~ [ o,~s., [,. Widowed k. .......... ]~IY~. 17,.~, rennsylvanla ~ ,~.~~ Lower Allen ~uz ueerzleza xoaa [~ ' ,.. Camp Hill, PA 17011 [~' ,m.~ Cumberland ~' mn~_~.' ~t ~ ,,. u~c~ ~nes~o [,, Mary Trotz ~. Jacaueline M. Conard [~ 186 Alanthia Lane Etters P ~l~ms~T~ '~o, .......... ' , , A 17319 ~,~ ~"' ~l,,~anuary 16, 2003 [ Cate of Heaven Cemetery [Upper Allen ~p., PA 17055 ~1 ~'~ ~ ~=~. iL~ENSENUUeER I~uE~°~F~t'~Parthemore FH & CS Inc ~m ~~e~ [,~ FS 012 849 L p ' ' ~;"' - - ' ~ ~ . [,, 0 Box 431, New Cumberland, PA 17070 0431 /--'[~, . ~[ I~l m ~am ~ /~ufe ~ Trim) [ ~ENSE NUMBER c4ume, em~ ~RLYIMG ~ ~' ' ~ & a I OATE OF INJURY TiME OF INJURY (~ H~ ~:i~lm [] (Ml~r,. Oay, Ye;N ) L~1~ I, JENNIE A. KELLY, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I devise and bequeath all of my estate of every nature and wherever situate to my daughter, NANCY J. MOORE, providing she shall survive me by thirty days. II. Should my daughter, Nancy J. Moore, predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate in equal shares to such of my two granddaughters, LETICIA A. MANCIN! and JACQUELINE M. CONARD, as survive me by thirty days. III. Should my granddaughter, Leticia A. Mancini, or my granddaughter, Jacqueline M. Conard, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such granddaughter to her children, JACOB /~'.~K~. MANCINI and JARED L. MANCINI, in equal shares, or CHARLES M. CONARD, respectively, living on the thirty-first day following my death; and should either of my said adult granddaughters leave no such issue living on the thirty-first day Eollowing my death, devise and bequeath the share of such granddaughter to my other granddaughter, or to her children above named living on the thirty-first day following my death. III. I appoint MELLON BANK N.A. of Harrisburg, PennsFlvania, or its successor in business, guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. IV. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid as a part of the expense of the administration of my estate. V. I appoint my granddaughter, JACQUELINE M. CONARD, executrix of this my last will. Should Jacqueline M. Conard fail to qualify or cease to act as executrix, ! appoint my granddaughter, LETICIA A. MANCINI, as executrix of this my last will. Should both Jaqueline M. Conard and Leticia A. Mancini fail to qualify or cease to act as executrixes, I appoint MELLON BANK N.A. of Harrisburg, Pennsylvania or its successor in business, executor of this my last will. VI. I direct that my executrix and my guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, JENNIE A. KELLY, was on the day and date thereof signed, published and declared by JENNIE A. KELLY, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her~Dx~sence, and in the presence of each other have_subsg~ibed ou~na~es as witnesses hereto. JENNIE A. KELLY L_~w OI~FXCE S HUMER ~c DA/~IELS ~o5 FAI/14ERS TRUST BUILD~G ONE WEST HIGH STREET CA~LISLE~ PENNSYLVAN~ 17010 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Jennie A. Kelly Date of Death: January 12, 2003 Will No. 21-03-0069 Admin. No. To the Register: I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 19, 2003: Name Leticia A. Mancini Jacqueline M. Conard Address 186 White Doe Dr. Lincoln University, PA 19352 186 Alanthia Lane Etters, PA 17319 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Date: March 19, 2003 L[nus E. Fenicle, Esquire Reager & Adler, PC 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003129 FENICLE LINUS E ESQ REAGER & ADLER PC 231 MARKET STREET 1265 CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 175-18-7213 FILE NUMBER: 2103-0069 DECEDENT NAME: KELLY JENNIE A DATE OF PAYMENT: 1 O/1 6/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 1 2/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,357.08 TOTAL AMOUNT PAID: 91,357.08 REMARKS: JACQUELINE M CONRADC/O LINUS E FENICLE ESQUIRE SEAL CHECK# 1 26 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-'[500 EX + (6-00) · ~! COMMONWEALTH OF I ' ?-/1(0 /' ~ll~V=~,~ ~,~,~,~ ' ~ PENNSYLVANIA ~ · ~ "~VV DEPARTMENT OF REVENUE INHERITANCE RETURN RESIDENT DECEDENT I11 p.. Z ILl Z o U.I o Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) KELLY, JENNIE A. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 01/12/2003 07/24/1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL} OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 0 6 9 C--'~'~'TY C"~"~" YEAR NUMBI~R' SOCIAL SECURITY NUMBER 1 7 5-1 8-7 2 1 3 THIS RETURN BUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r~l 1. Odginal Retum [~4. Limited Estate J'~-'~ 6. Decedent Died Testate (Attach copy of Will) E~9. Litigation Proceeds Received LINUS E. FENICLE FIRM NAME (If Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER '"-] 2. Supplemental Return -'-] 4a. Future Interest Compromise (date of deaffl after 12-12-82) J--"] 7. Decedent Maintained a Living Trust (Attach copy of Trust} E~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95} -'13. Remainder Return (date of death pd~to 12-13-82) [--~ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes J~111. Election to tax under Sec. 9113(A) (A~ach Sch O) COMPLETE MAILING ADDRESS 2331 MARKET STREET CAMP HILL 189,900.00 0.00 104,690.58 140,423.45 (8) 3O, O73.16 1,450.29 (11) (12) , (13) . (14) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES PA 17O11 OFFICIAL USE ONLY 435,014.03 31,523.45 403,490.58 403,490.58 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x .. (15) .. 403,490.58 x .045 (16) x .12 (17) x .15 (18) (19) 18,157.08 18,157.O8 REV-1502 EX + ~6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER KELLY. JENNIE A. 21 03 0069 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properbj which is iointl¥.owned with ri~]ht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. 402 DEERFIELD ROAD, CAMP HILL, PA 17011 contract sales price TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 189,900.00 189,900.00 REV-1509 EX +,(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER KELLY. JENNIE A. 21 0:3 if an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY OO69 SURVIVING JOINT TENANT(S) NAME A. JACQUELINE CONARD B c 186 ALANTHIA LANE ETTERS, PA 17319 JOINTLY-OWNED PROPERTY: ADDRESS RELATIONSHIP TO DECEDENT GRANDDAUGHTER Lc i I I:hl DATE DESCRIPTION OF PROPERTY % OF DATE Of DEATH ITEM FOR JOINT: MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTERE$ 1. A. 10/2000 CERTIFICATE OF DEPOSIT - M&T BANK 50,034.27 50. 25,017.14 2. A. 4~2000 CHECKING ACCOUNT - CITIZENS BANK 52,804.32 50. 26,402.16 3. A. 4~2000 CERTIFICATE OF DEPOSIT - CITIZENS BANK 85,457.61 50. 42,728.81 4. A MONEY MARKET ACCOUNT - COMMERCE BANK 21,084.94 50. 10,542.47 TOTAL (Aisc enter on line 6, Recapitulation) $ 104,690.58 al sheets of the same size) REV-1510 EX + ~6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER KELLY. JENNIE A. 21 07 006~) This schedule must be completed and filed if the answer to any of questions 1 thmu =h 4 on the reveme side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 0E ~PUC~LE) VALUE 1. WESTERN-SOUTHERN LIFE ANNUNITY 39,873.36 100. 39,873.36 2. AMERICAN GENERAL ANNUITY 50,128.18 100. 50,128.18 3. GLENBROOK LIFE 50,421.91 100. 50,421.91 TOTAL (Also enter on line 7 Recapitulation) $ 140,423.45 (If more space is needed, insert additional sheets of the same size) REV-1511 EX +,(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF KELLY. JENNIE A. Debts of decedent must be reported on Schedule FILE NUMBER 21 03 ITEM NUMBER 8. 9. 10. 11. 12. 13. 14. DESCRIPTION FUNERAL EXPENSES: PARTHEMORE FUNERAL HOME ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees REAGER & ADLER, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS Accountant's Fees H&R BLOCK - Final Income Tax Preparation Tax Return Preparer's Fees Zip THE SENTINEL CUMBERLAND LAW JOURNAL REAL ESTATE COMMISSION TRANSACTION FEE - JACK GAUGHEN REALTOR SELLER HELP - SALE OF HOME 2003 COUNTY/-F - BONNIE MILLER, TAX COLLECTOR CITIZENS BANK - CHECK CHARGE TOTAL (Also enter on line 9, Recapitulation $ AMOUNT 8,724.89 2,500.00 409.00 155.00 81.59 75.00 11,394.00 100.00 5,958.00 643.68 32.00 30,073.16 (Ifmorespaceisneeded, inse~additionalshee~ofthesamesize) REV--1512 EX + '(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF KELLY. JENNIE A. Include unreimbursed medical expenses. FILE NUMBER 21 03 0069 ITEM NUMBER DESCRIPTION VERIZON - last lifetime bill and bills until real estate was sold PP&L - last lifetime bill and bills until real estate was sold PENNSYLVANA AMERICAN WATER COMPANY - last lifetime bill and bills until real estate was sold COMCAST CABLE - final cable bill INTERNISTS OF CENTRAL PA CENTRAL PA MRI CENTER QUANTUM IMAGING LOWER ALLEN TOWNSHIP - SEWER AND TRASH HOLY SPIRIT HOSPITAL TOTAL (Also enter on line 10, Recapitulation) VALUE AT DATE OF DEATH 110.81 795.36 69.08 73.86 135.55 37.64 18.06 73.35 136.58 1,450.29 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KELLY. NUMBER JENNIE A, SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY FILE NUMBER TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] JACQUELINE CONARD 186 ALANTHIA LANE ETTERS, PA 17319 LETICIA A. MANCINI 186 WHITE DOE DRIVE LINCOLN UNIVERSITY, PA 19352 21 03 0069 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do NotListTmstee(s) OFESTATE GRANDDAUGHTER GRANDDAUGHTER 1/2 OF THE ESTATE 1/2 OF THE ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) D.ecedent's Complete Address: STREET ADDRESS CiTY 402 DEERFIELD ROAD CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 16~000.00 800.00 (1) Total Credits ( A + B + C ) (2) 18,157.08 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page '1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,357.08 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB) 1,357.08 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receivino adeouate cons derat on? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under p~nalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledg~° the best of my knowledge and belief, it is true, correct and complete. 16,800.00 SIGNATURE OF PERSON RESPONSIBLE ,~,(~R FILING RETURN ..~J~DRE~ ~331 MARKET STREET /// .......... CA HILL, PA 17011 · ,~DDRESS 186 ALANTHIA LANE DATE /o. DATE . -- ETTERS, PA 17319 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. IU./Ub/"/UUJ 1U.'~B Z17-761-1495 JACK GAUGHEN PAGE I;~'.,I HUD - 1 UNIFORM SETTLEMENT STAT£M£NT OMB Approval No. 2502,026~ were paid nut.~ide the closing: they are shown here for informat{orml pu~oSes and a~ not inaI~ded in thc totals. NO' Et. _~ ' Tax,aver% [denfi~ca~ion D. NAM~ AND ADDRESS OF gO,OWED: U.S. DEPARTMF. NT .07 HOUSING...5]qD UP. BAN DEVELOPMENT SE.'T~'LEMENT STATEMENT TYPE OF LOAN 6, File Number: 7. Loan Numbs: I. F~A 2. FmHA 1._0.3-33465.8 3. Cony. Unin8. 4. X VA 5. Cony. [n~. 8, .Mo~gage Insurance Cas~ Number .~. LIO - 10 - ~ 05_69 ~ 0 0 NOTE: Thi~ [o~ i. ~mi~hed to give you a ~tatemcnt o{ac~l ~e~l~eat costa. Amounm paid m snd by t~c ~=~l~m~ agent are ~ho~. lt~m~ ma~k~d "(p.o.c.)" E. NAME, ADDRESSANDTIN OFSELLER: E~tate of Jennie A. Kelly J. M, Conrad, Executrix 402 Deerfield Road TONY t~..NZ~,LER P. O. Box 2S New C~n%berland, PA 17070 G. PROPERTY LOCATION:[. 402 Deerf~eld Road Camp Hill, PA l~011 · Parcel I.D. 13-24-0809-033 Camp ~ill, PA 170~! F. NAMEAND ADDP, ESSOFLENDER: WASRINGTON MLrfUAL BkNK FA 2000 Oxford Drive Bethel Park PA 15102 H. SETTLEMENT AGENT NAME, ADDKESS AND TIN PA R~AL ESTATE SERVICES, INC. PLACEOFSETTLEMENT II. SETTLEMENT DATE 10 We~t Pomfret StreeE 04/30/2003 Ca~li$3~e pA 1~013 J. SUMMARy_OF BORROWER'S/T..R.ANSACTION _100. GROSS_AMOUNT DUE FRO~_I_B_ORROWER: I01 ..C.ontract_sales price 189,9.0.0_. 00 102. Pemoonal..pr9 _p5:~'/ 103. Settlement .char%es- to borrower O. me 1400) 7,9 8 7.26 ~04. 105. · Adjustments Fo~.itc_~s~aid bv seller in advancc ] 06, C.i.ty/town taxes 107. Counly tax.e/;. 04/30/2003_-03,/_0]-/2004 { 4.23....B.$ I OS. Assessme'~ts ..I.09. School taxes 4/~30/03-7/1/03 / 292.80 IlL 120. GROSS AMOUNT DUE FROM BQRR~WER :1.98.60~. 91 K.' SUMMAR.Y..Og SELFgg'S TRANSAC~J,Q~ 400. GROSS AM,O.L.~J,T.D~J E TO SELLER: _ 401. Con.'aet sales price , 1.8.,,9,900.00 402, Per~onal p~ol~.crmy_ _ 1403. . 404. 495: Ad}ustments'for i,tem~ paid by sells, r in advance 406. QitT/.t. own taxes , 407, CounWtaxm 04/30/20.0.3-01/01/2_0_04 423.85 I 408. Assessments { 29.2.80 ~.0~_._$ chool taxe.~3 ~ 30 / 03 - 7751 410. 411. 412. 420. GROSS AMOUN.T.D_U.E.TO SELLER 190,61.6.65 _200. AMOUNTS P. _AI_D BY'OR IN BEHALF QiF BURRO.% 201. Dcp_osit or earnest, mo,ney 202. Princ~Ea, I amount of new loan(s) 2~3.. Existing loan(s) taken subjec: to , 20~. 205. 206. 201. 203. Adjustments For item_s unpaid by seller 2tO. CiIy/lgwn taxus ~21J. County taxes 2 i 2,_ ~AS~cssmcnts 213. 214. 21.5, 216, 17. 21g. 220. TOTAL PAID BY/F©R I~OKR.gWER 'E · 3`.,_5 9.0. on 1.95.,.198,00 590~KEDUCTIONS IN_O~_OUNT DUE TO SELLER: $0l.,.EFccss deposit ,. 502. Setti~cnt cha~es to seller ~Linc 1400) ~03. ExistinR Io.a0Ls) taken sobiect .S04, Pavoff of first mo~qagc loan 505. Paxqff of second mo~aKc.Joan 506. , 507. 508. 514, 515, ~17. ! $20,_T.O. TAL P..EDU,CTION AMOUNT DUE SEL[eER 17,452.00 i 301, G ross amounl due from.bsn, owcr (Line_l.2i)) 1~8,603'. 9,~ 601, G ross amount due to.SClml.er f Line 420} iD0,616.65 { { 302. Less amoun~.paid by/for bo~wcr (Line 220) I ~ 5,198.0 0 . 602. L~s reductlon,in amount due ~cller (Line.,520} , 17 ,.4.52.0 0 303..~ASH FROM BO_~.QWER { 3~395,91 { 603._CASH TO SEL. L~R ~73,16~. 65 _ SELLEK'S STATEMENT Thc in format{on contained in Bl~ks E. G. H, and ] and on llne 40t (or. ifline 401 b asterisked, line 403 and 404) i$ impomant tax info~ation and is being Fumiuh~ t0 thc {memo{ Revenue Service (sue Seller Ce~iHcatlon), If you are required to file a ~tum, a negligence punahy o~ other ma~tlon will be {reposed on you if lh[I imm is required ~o be mpo~ed and ~h¢ IRS detu~ines that it ham not been re~, You are r~uired to p~vide thc Settlement Agent with your co~l taxpayer iduntifica6ofl number. Ityou do not p~viO¢ thc Settlement A~ent with your co.cut taxpayer identification number, you may be subject to civil or criminal penalties imposed by law, Under penaH{es or pcrju~', I ce~{~v Ihal thc number shown on this statement i~ my co.eot taxpayer {dcnti~calion number. (Seller'sSignatutc) Essa~e of Jennie A. Kelly (Seller's Signature) J, M. Conrad, Executrix EASY SOFT, Inc. 2001 Prcvi 18/86/2883 18:83 717-781-1495 JACK GAUGHEN ERA PAGE 80,.' L, SETTL£M£NT CHARGES 700._T_QTALSALE,S/BRO_KRR's CO,M,, MI$$~ON ba%e.d on .rice $ 189, 90_0_._00 (~ g. 00,0% Division of'Commission (line ?00] as.fpllows: 701._$_5,722,00 _~O_RP.A-NRT~_%nc, (J_~_¢k Gauc~hen_?RA Rea!eof) ?OZ, .~ 5, ~72 .O0 .~.0 ,R._E/Max St~rlin~ 70-%. Cor,~ni~sion paid at. SKttlem:nt 704. Tra,n.~¢ction .P.e.: to ERA-NRT, In:, 8_990~. IT£MS P. AYABL£ IN C_ON~ECTION, W~TH LO,AN .3.91, Loan Orj'zinatiq. Fcc 1 , .0.0_0% $ Lend_er 80.2. Loan Dis¢0.unt $ , ~03_~u_rai~al Fee.t0_Ridc~e Marketinq ~04. Credit ,c~,u,'~ ID 805, Lender's Inspection.F_:.: 80___6. ?ina,! ~_nspecti,q~ ~o Ridq,e Marke~_ir%~ 807. Flood Ce~i~icati~ te Le,~eEa CorD, 808, PAID FP,0M ' PAID rRO,~' ' FL~NDS AT . FUNDS AT $ ~_TTt.£M £NT ~ I , ~0o .oo B09. : ~10. 311 "" 8t.%. ' 900. ITEM,~ R£OUIRE.D_BY LEND_ER TO BE PAID ~N ADVANCE 901. Interest.frgm 04/30/_2003-0fi/__03,/_2003 _(~ $2~, 850 p.e~ Clay ,9.0.2. Murt~age,,ln, s. urance Prcmi.um for 12 .mort. th ( (~{').~. Hazard insurance Premium for gq~_. 694.86 3,00 ._ 0 .~ G5.00 13.00 105 4 i.~095-50 + 905.,%~,A Fundinq Fee to Veterans_~ff~irs 1000, RESE. RYES DEPOSITED WITHJ. gNDER -IO01.Hazardinsurance 2 month{s,.}. ¢' $38.~83 D~r mo. nth _L002. NlorI~aRe insurance I003. City Prop: .rt'cTzxes 'i , 3,798.0_0 366.60 (004, C nt¥ prope,rw_Taxes 2 ,m,,onth (s) ~ S~2: 82~er month l OOS. Annual.a$Segsments 1006. School taxes_~0 mont,h, (~) ~ $.%46,27 p.er ~Qnth 1.0,07. . i 005..A.g~re~,ate ,~,cc0untln~; Adjustment l100. TI'TLE CHARGF.,$ - 3.6.6.60 (in:Iud,c} linc nurnber~: i"[ 0~. Titl~lnsuranccto Con:scOtia Tit.l_e Ina/P), Real Es.t.a.te Ser¥ice$ · ( includes li,~e numbers: 11.0_~_' 1105 ) : IJ09.[.,endeFs¢OVemEe .~ 1936~:00 ,. lI I 10. Own:es coveraqc._$ 19369~8_. OO I~ )2. Closi/3_q Prote.c,tion L~;~r CO Conestoqa~_Ti~le Ins'uranc~ _C_omDanv ; 1.%00. QOVE~T R£CO. RDINC AND TI~ANSF.~I~ CHARCES i 1201,_Rc¢ordinz Fees: Deeds 38.,_50 MorrO;aReS . t 1202. City/.ent¥ rax/stannp? Deed $ ;1., 8 9 9 ..0.0 _ _N4.ortRagc $ i;~'~O~ State la.x/stereos: Deed $ 1~ 8~ · O0 MortRaR. e $ 1203, 7.00 15_0, o o 19 51 83.fi9~ ~4,50 Releases J ...... .1,899.0.0 1,8.9.9.00 _ 1300. ADDITIONAL. S.E_TTLER4E~ii' ~HARUllb I 3(JJ. Survey to "' I 4 0 · 00 .:.~02. Pest n, soection to Mor~gChek 55.9 - 0 0 _ 13~!3.- Mome .w~rant¥ ,.~0 AON i 130~.._~hole Mgm;se Inspection ~9 H~meCbek 235.,00 !305, Home reD. a~.rs tiny, 49058' ~ 1306, Fin,~l Wat=~/$ewer LSe!ler POC) 1400, TOTAL SETT[.E~F~T CH~kRGES (enter o. line~ LO3, Section ~ nn~ 502, Sretion~) 7,987.26 17,452...Q 0 CERTIF[C^~'ION: I have ca/'cfully reviewed the HUD-1 Settlement Statement and to thc best 0fray knowledge and belief, a tree disbursements made on my account or by mc in this tran.~action. [ further certit~ that I received a copy of the H~,D-I Settlement Stoa, foment. ~ellcr ' - ~ Es~ate~of'(Jrennie A. -Kelly ~ norrower //T ' / '~,,~ 0" %, ~. con/_~ The I'lL,ID. I Scttlerllent Statement which I have prepared iS a Vue and accurate account of the fund5 dlsbursed or to 'be disbursed by the under*cig, ned as part orthe setfi~-ment of' th~s transaction, ScltJomcnlAgenl PA Real Estate Services, Inc. Datc V.'ARNING: It is a crime to knowingly make False statemenU to thc United States on this or any other similar rom:. Pens[tics upon conviction ca. include a fine end imprisonment. For details sec: Title l l~ U.S. Code g¢ction.100l and Section 1010. ',% EASY SOFT, Inc. 2001 Pr:vi Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters WHEREAS, on the 23rd dated September tst 1998 No. 2003-00069 PA No. 21-03-0069 ESTATE OF KELLY JENNIE A (LAS'±', ~'±MS'±', MIDDLE) Late of LOWER ALLEN TOWNSHIP ~UM~AI',JD CUU~'I'~, Deceased Social Security No. 175-18-7213 day of January 2003 an instrument was admitted to probate as the last will of KELLY JENNIE A late of LOWER ALLEN TOWNSHIP , CUMBERLAND County, who died on the 12th day of January 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to CONARD JACQUELINE M who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 23rd day of January 2003. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) I, JENNIE A. KELLY, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I devise and bequeath all of my estate of every nature and wherever situate to my daughter, NANCY J. MOORE, providing she shall survive me by thirty days. II. Should my daughter, Nancy J. Moore, predecease me or die on or before the thirtieth day following my death, devise and bequeath all of my estate of every nature and wherever situate in equal shares to such of my two granddaughters, LETICIA A. MANCINI and JACQUELINE M. CONARD, as survive me by thirty days. III. Should my granddaughter, Leticia A. Mancini, or my granddaughter, Jacqueline M. Conard, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such granddaughter to her children, JACOB ~l/~'~. MANCINI and JARED L. MANCINI,, in equal shares, or CHARLES M. CONARD, respectively, living on the thirty-first day following my death; and should either of my said adult granddaughters leave no such issue living on the thirty-first day following my death, devise and bequeath the share of such granddaughter to my other granddaughter, or to her children above named living on the thirty-first day following my death. III. I appoint MELLON BANK N.A. of Harrisburg, Pennsylvania., or its successor in business, guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. IV. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid as a part of the expense of the administration of my estate. V. I appoint my granddaughter, JACQUELINE M. CONARD, executrix of this my last will. Should Jacqueline M. Conard fail to qualify or cease to act as executrix, I appoint my granddaughter, LETICIA A. MANCINI, as executrix of this my last will. Should both Jaqueline M. Conard and Leticia A. Mancini fail to qualify or cease to act as executrixes, I appoint MELLON BANK N.A. of Harrisburg, Pennsylvania or its successor in business, executor of this my last will. VI. I direct that my executrix and my guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this. /? day of~/~A , 1998. ,; JENNIE A. KELL~ The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, JENNIE A. KELLY, was on the day and date thereof signed, published and declared by JENNIE A. KELLY, the testatrix therein named, as and for her last will, in the presence of us, who, at of each other her request, in her/p~sence, and in the presence have subscribed ou~nag~s ~s witnesses hereto. INVENTORY Estate of KELLY, JENNIE A. also known as ., Deceased No. 21 03 0069 Date of Death 1/12/03 Social Security No. 175187213 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative; Name of Attorney: LINUS E. FENICLE I.D. No.: ,~lg~ f~/~,~/' U ~ 2331 MARKET STREET CAMP HILL PA 17011 Address: Dated Telephone: Stocks & Bonds Description Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property Real Estate 402 DEERFIELD ROAD, CAMP HILL, PA 17011 contract sales price (Attach Additional Sheets if necessary) Total Value 189,900.00 189,900.00 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTVISZON DEPT. 280601 HARRTSBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1S47 EX RFP (01-05) DATE 12-01-2003 ESTATE OF KELLY DATE OF DEATH 01-12-2003 FILE NUHBER 21 03-0069 '~ :iCOUNTY CUHBERLAND LINUS E FENICLE ACH 101 2331REAGERHARKET& ADLERsT J Aeount Reeitted r CAHP HILL PA 17011 JENNIE A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETA/N LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF KELLY dENNIE A FILE NO. 21 03-0069 ACN 101 DATE 12-01-2003 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURH 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. CZosely HeZd Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) (4) E. Cash/Bank Depos/ts/N/sc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/Adm. Costs/H/sc. Expenses (Schedule H) (9) 10. Deb~s/Hortgage L/ab/1/t/®s/L/sns (Schedule I) (10) 11. Total Deduct/ohs 12. Net Value of Tax Return 189;900.00 .00 NOTE: To /nsure proper cred/t to your account, .00 sube/t the upper port/on .00 of this fore with your .00 tax payeent. 104;690.58 140;423.45 (8) 30,073.16 13. 14. NOTE: 435,01q. 03 IF PAID AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULATION OF ADDZTIONAL INTEREST. (15) .00 X O0 = .00 (~e) 403,490.58 x 045= 18,157.08 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 18,157.08 .72- .00 ANOUNT PAID 16,000.00 1,357.08 41.39- TOTAL TAX CREDIT 18,157.08 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS RE~UZRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORN FOR INSTRUCTIONS.) ASSESSHENT OF TAX: 15. Aeount of L/ne 14 at Spousal ra~a 16. Aeount of L/no 14 taxable at L/nmal/Class A rate 17. Aeount of L/no 14 at Sibl/ng rate 18. Aeount of L/no 14 taxable at Collateral/Class B rata 19. Pr/nc/pal Tax Duo rAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) 03-28-2003 CD002355 842.11 10-16-2003 CD003129 11-24-2003 REFUND Cher/tablo/govorneontal Bequests; Non-elected 9113 Trusts (Schedule J) (15) . O0 Not Value of Estate Sub,oct to Tax (14) 405,490.58 Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. lr450.29 (12) 403,490.58 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT= PENALTY: INTEREST: Estates of decedents dying on or before Dacembmr 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (TI P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ZLLS, AGENT A refund of a tax crmdit, 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 ara available at the Office of the Register of Nills, any of the Z3 Revenue UistrJct Offices, or by calling the specie1Z~-hour answering service far forms ordering: 1-BO0-$BZ-ZO50; services for taxpayers ~ith special hearing and / or speaking needs: 1-BO0-q~7-3OZO (TT onIy). Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, ar assessment of tax (including discount or interest) as sho~n on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. OR 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, Dept. 280601, Harrisburg, PA 17126-060! Phone (717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three IS) calendar months after the dmcedent's death, m five percent (JZ) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of thm 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 seam manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith 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 (BX} percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 19aZ will bear interest at a rate ~hich will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2005 are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .OOOSq8 1987 9Z .0002~7 1999 7Z .00019Z 1983 16Z .000¢38 1988-1991 11Z .000501 2000 8Z .000219 198~ 11Z .000301 199Z 9Z .O00Z~7 ZOO1 9Z .OOOZq7 1985 13Z .000~56 1993-199~ 7Z .O0019Z ZOOZ 6Z .00016~ 1986 IOZ .OOOZT~ 1995-1998 9Z .O00Z~7 2003 5Z .000137 --Interest is calculated as follows: XNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELXNQUENT X DATLY 'rNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is mode after the interest computation date sho~n on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jennie Kelly Date of Death: January_ 12, 2003 Will No.: 21-03-0069 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: Date: 1. State whether administration of the estate is complete: Yes X No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X Bo The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes X No Do attached to this report. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be Lite'us E. Fenicl ,e~E~quire Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative BUREAU OF TNDZVZDUAL TAXES ZNHERTTANCE TAX D/VISION DEPT. Z8060! HARRISBURG,, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHER'rTANCE TAX STATEHENT OF ACCOUNT REV-1607 EX &FP COl-OS) LINUS E FENICLE REAGER ~ ADLER 2331HARKET ST CAHP HILL PA 17011 DATE 12-08-2005 ESTATE OF KELLY DATE OF DEATH 01-12-2005 FXLE NUHBER 21 03-0069 COUNTY CUHBERLAND ACN 101 Amount JENNIE A HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper port/on of this form teith your tax payment. CUT ALONG TH'rS LZNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS *.~ ESTATE OF KELLY JENNIE A F'rLE NO. 21 05-0069 ACN 101 DATE 12-08-2005 THTS STATEHENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHONN BELON TS A SUNHARY OF THE PR/NC/PAL TAX DUE, APPLICATTON OF ALL PAYNENTS, THE CURRENT BALANCE., AND., TF APpLTCABLE, A PROJECTED INTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 1Z-O1-Z005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 18,157.08 PAYHENT DATE 05-28-2005 10-16-2005 11-2~-2005 RECEIPT NUHBER CD002555 CDOO5129 REFUND DISCOUNT INTEREST/PEN PAID (-) 8~2.11 '- .72- ', .00 AHOUNT PAID 16,000.00 1,557.08 ~1.59- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDZT/ONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN NO PAYNENT ZS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' TOTAL TAX CREDIT 18,157.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORN FOR TNSTRUCTTONS.