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HomeMy WebLinkAbout03-0942Register of Wills of Cumberland PETITION FOR GRANT OF Estate of Charles D. Vance also known as Patricia H. Vance County, Pennsylvania LETTERS .o. , Deceased Social Security No. 160- 22- 3541 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) I--~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix the Decedent, dated 10/16/2003 and codicil(s) dated None named in the last Will of 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 incompetent: I-'-'1 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 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 21 Willow Mill Road, Silver Sprtn~ Township, Mechanicsbur~, PA 17055 Decedent, then 72 years of age, died :].0/'27/2003 (list street, number, and municipality) at Home, Mechanicsbur~, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as follows: 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 ned: Typed or pdt;ted name and residence Patricta H. Vance Mill Road, Mechanicsbur~, PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 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 I of the Decedent, Petitioner(s) will well and truly adrnin~*A- '~? ? .......... dina to Sworn to or affirmed and subscribed ~m~~'~~ ~ Pa%ricia }{. Vance before me this 13t]aay of Novemb~r 200.3 '-- For the R~oist~r ~"""~'J ~ ~~ ~nna M. Otto,lst ~put7 NO. Estate of Charles D. Vance Social Security No: 160- 22- 3541 Date of Death: AND NOW, November 13th 10/27/2003 21-2003-942 Deceased ?(~q , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary ~ Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Patr i cta iq. Vance in the above estate and that the instrument(s) dated 10/16/2003 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ 865.00 Short Certificate(s) ..... $ - 12.00 Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( 5 ) .... $ 15.00 Codicil ........... $ JCP Fee .......... $ 10.00 ~ Register of v(/ills ~ II oonna M. Otto,lst Deputy Attorney: Ronald M. Katzman, Esquire I.D. No: 07198 Goldberg, Katzman & Shipman, PC Address: 320 Market Street P.O. Box 1268 HarrisburG, PA 17108-1268 Telep~ne: 717/234-4161 Inventory .......... $ Other ........... $ TOTAL ......... $ 902.00 Mail Letters to Attorney on 11/13/2003 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8749856 No. Local Registrar OCT 2 8 2003 Date mos.~ .~. z,~7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Va ne. e jsEx js~c~t s~cu..r~ .u~eE. io~ ~ ~. ~ ~ '~ ,. Char~es D. I,. Ma~ l,. 160 --22 --3541 , I0 ' ' ~'su~~c~-~.z~ ~CE~NT'S ' ' ~' ' ]" ~ P~ I,e. P~x~4a HO~S~O~ 21 W~ow M~ Park Rd. ~,u~ .,.s,,. Po..~Y.a.~a ,~cchanicsburg, PA 17050 ~ .... Chartes Vance Patricla Vance Atice Bauchman 21Wittow Mitt Park Rd. Mcchanicsbur~, PA 17050 .er Crcmaro~ ~ff~.Hotgf Sprin~s,PAlT065 011589£ crF.H.$CrematoryMt. Hotty Springs,PAlT065 6:00 27/2003 D~ TO ((~fAS A CO~OUE NCE OF~ - 21-2003-942 LAST WILL AND TESTAMENT OF CHARLES D. VANCE I, CHARLES D. VANCE, of Silver Spring Township, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null all prior Wills and Codicils made by me at any time heretofore. ITEM I. All federal, state, and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of the administration of my estate, and shall be paid from my residuary estate without apportionment or fight of reimbursement. All such taxes shall be paid at such time as my Executor, hereinafter named, may think proper. ITEM II. I acknowledge that, as of this time, the home in which I reside with my wife, PATRICIA H. VANCE, is titled in us as tenants by the entirety, so that it, and all personal property therein not otherwise identified as being solely owned by me, including all antiques, shall not pass under this Will, but shall pass to her by operation of law in the event that I predecease her. ITEM III. I bequeath any household and personal effects, jewelry, automobiles, and other tangible personalty of like nature that are not within ITEM II. above, to my wife, PATRICIA H. VANCE. ITEM IV. I give, devise and bequeath all the rest, residue and remainder of my estate, of whatever nature and wherever situate, to my Wife, PATRICIA H. VANCE. ITEM V. In the event my Wife, PATRICIA H. VANCE, fails to survive me, I give, devise and bequeath all the rest, residue and remainder of my estate, of whatever nature and wherever situate, to my son, CHARLES D VANCE, JR. ITEM VI. I hereby appoint my Wife, PATRICIA H. VANCE, as the executor of this, my Last Will and Testament. In the event she is unable to serve, I appoint my son, CHARLES D. VANCE, JR., as my Executor. ITEM VII. I director that my Executor shall not be required to give bond or post any other security for the faithful performance of her duties in any jurisdiction. ITEM VIII. My Executor shall have the following powers in addition to those invested in her by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: ::ODMA'xPCDOCS'xDOCS\I 01808\1 2 A. To retain any investments I may have at my death, so long as my Executor may deem it advisable to my Estate so to do. B. To vary investments, when deemed desirable by my Executor, and to invest in such bonds, stocks, notes, real estate, mortgages, or other securities or in such other property, real or personal, as my Executor deems wise, without being restricted to so-called legal investments. C. To make divisions or distributions of the personalty and realty of my Estate partly or wholly in kind. D. To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal property or interests therein owned by my Estate severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as is deemed reasonable. ::ODMAXPCDOCS\DOCS\I 01808\1 3 F. To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate. My Executor shall pay expenses of last illness and funeral expenses. G. To vote any shares of stock which form a part of my Estate, and to otherwise exercise all the powers incident to the ownership of such stock. H. In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of four (4) typewritten pages, this ,/~ day of October, 2003. ~ S D. VANCE ~ We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator, CHARLES D. VANCE, as and for his Last Will and Testament, in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~ Q' ~~~_~ residingat ::ODMALPCDOCS~DOCS\I 01808\1 4 COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : SS. We, the Testator, and ~5)C10~/~. /~/-7-~0/~, and ~rP~({d,~ t~_.d~d//[, the witnesses, respectively, whose names are signed to the foregoing ingfrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged bgfore m.e the Testator, CHARLES D. VANCE, and subscribed and s.wor/t to before me by __~_~t/c~l' t~a/Z~t~q ~d ~~/~ [~/~ , witnesses, this /~ ~day of October, 2003. (SEAL) Notarial Seal Jennifer L. Boltz, Notary Public City of Harrisburg, Dauphin County My Commission Expires May 30, 2005 Member, Pennsylvania Associa~on of Notaries ::ODMALPCDOCS\DOCS\I 01808\1 5 COMMONWEALTH OF PENNSYLVANIA · COUNTY OF DAUPHIN · SS On this, the/(~ day of October, 2003, the undersigned officer, a Notary Public in and for said county and state, personally appeared, Ronald M. Katzman, Esquire, known to me (or satisfactorily proven) to be a member of he bar of the highest court of said state holding PA Supreme Court I.D. No. 07198, and a subscribing witness to the within Last Will and Testament and Living Will, Medical Power of Attorney and Medical Proxy and certified that he was personally present when Charles D. Vance, whose name is subscribed to the within Last Will and Testament and Living Will, Medical Power of Attorney and Medical Proxy, executed the same, and that said acknowledged that he executed the same for the purposes therein contained. This Acknowledgement is being taken of an attomey-at-law in accordance with the Pennsylvania Judicial Code, 42 Pa. C.S. § 327 as added by the Act of July 1, 1987 (P.L. 180, No. 21), § 1, and the Pennsylvania Uniform acknowledgments Act, 21 P.S. § 291.7, as added by the Act of July 10, 1981 (P.L. 226, No. 71), § 1. Acknowledged: / Ronald M. Katzman'O ~r~ Pu~c - (SEAL) Notarial Seal Jennifer L. Boltz. Notaw Public City of' Hamsburg. Dauphin County My Commissioz~ Expires May 30, 2005 Member, Pennsylvania Associal~on of Notaries ::ODMALPCDOCSkDOCS\I 01888\1 IN RE: ESTATE OF CHARLES D. VANCE, Deceased : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DMSION : No. 2003-00942 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Charles D. Vance, deceased Date of Death: October 27, 2003 Will No. Admin. No. 2003-00942 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 28, 2004: Patricia H. Vance 21 Willow Mill Road, Mechanicsburg, PA 17055 Charles D. Vance, Jr. 67 Johns Drive, Enola, PA 17025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Eric H. Vance, son, predeceased Decedent. Date /-2-8'- O~ Signature Name Address Telephone Ronald M. Katzman,(F~quire Goldberg, Katzman & Shipman, P.C. P.O. Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 Capacity: X Personal Representative __ Counsel for personal representative OMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-t 500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY 2'1 0._~3 0942 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Vance, Charles D 160-22-3541 CATE OF DEATH (MM-CD-YEAR) CATE OF BIRTH (MM*DD-YEAR} THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 10-27-2003 08-23-1931 REGISTER OF WILLS ',IF APPLICABLE} SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER Vance, Patricia H. 171-28-7207 Z [~1. Original Return [~4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) []9. Litigation Proceeds Received ] 2. Supplemental Return [] 3. Remainder Return (date of death pdor ~o 12-13-82) ] 4a. Future Interest Compromise (date of death after [] 5. Federal Estate Tax Return Required [] 7, DecedentMaintainedaLivingTruSt(Atmch 1 8. TotalNumberofSafeDepositBoxes · 1 ~D~ -9 and -~*r~5 [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) Ronald M. Katzman, Esq IRM NAME (If appliCable) Ooldberg, Katzman PC ELEPHONE NUMBER 7171234-4161 ;OMPLETE MAILING ADDRESS 320 Market Street POB 1268 Harrisburg, PA 17108 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Modgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (1) None (2) 859,718.00 (3) (4) (5) 272,199~$3 (6) (7) N o1~ e (9) 24,740.58 (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) OFFICIAL USE ONLY (s)~ 1,13~,917.33 (11) 24,740.58 (12) 1,107,176.75 (13) 0.00 (14) 1,107,176.75 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 1,107,176.75 x .00 (15) 0.00 0.00 x .045 (16) 0.00 0.00 x .12 (17) 0.00 0.00 x .15 (15) 0.00 09) 0.00 Copyright 2002 form software only The Lackner Group, Inc. Form REV-f500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS 21 Willow Mill Park Road C~TY Mechanicsburg ISTATE PA Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C, Discount 0,00 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT IzlP 17050 (1) 0,00 (2) 0.00 (3) (4) (5) 0.00 (5A) (SB) O. O0 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 premise for life of either payments, benefits or care? .............................................................. [] [] 2. If death occun'ed after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an"intrust for" or payable upon death bankacoountorsecudtyathisorherdeath? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is t~Ja, correct and c~mplet e DeClara0on of pr- .......... ,~--'~ ina personal representative is ~ased on all information of which preparer has an)' knowledge PERSi ~~II~PERSON RES FO ETURN ADDRESS DATE '"- ~' ~,, ~ ,~L~,.. ~ ~ Mechanicsburg, PA 17050 "7~ I~. ~ Ronald M. Katzman, Esq ADDRESS DATE ADDRESS 320 Market Street DAT~ POB 1268 Harrisburg, PA 17108 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 ara 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. COMMONWEALTH O~= PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 VALUE AT DATE ITEM DESCRIPTION UNIT VALUE OF DEATH NUMBER I 100,000 bonds Carlisle Boro. Pa. FGIC 4% due 1011110 - Janney 1.02581 102,581.00 Montgomery Scott Brokerage Account #8397-0505 2 50,000 bonds Hamilton Twp. Pa. Municipal Auth. 4.05% due 911104 - 1.02206 51,103.00 Janney Montgomery Scoff Brokerage Account #8397-0505 3 100,000 bonds Hanover Boro. Pa. AMBAC 4% due 1011110 - Janney 1.0301 103,010.00 Montgomery Scott Brokerage Account #8397-0505 4 100,000 bonds Lackawana County Pa Serise A 99 FGIC BIE NIC OlD 1.03236 103,236.00 4.05% due 111105 - Janney Montgomery Scott Brokerage Account #8397-0505 5 400,000 bonds U. S. Treasury Bill, due 418104 - Janney Montgomery .9956 398,240.00 Scoff Brokerage Account #8397-0505 6 100,000 bonds Wrigtsville Pa. Boro. Munic. Auth. Water & Sewer 1.01548 101,548.00 4% due 12115105 -Janney Montgomery Scoff Brokerage Account #8397-0505 TOTAL (Also enter on Line 2, Recapitulation) 859,7t 8.00 (if more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-IS00 Schedule B (Rev. 6-98) COMMONWEALTH OF PENNSYLVANIA tNHERITANCE TAX RETURN RESIDENT DECEDENT 8CHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 Include the proCeeds of litigation and the date the proceeds were receive(l by the estate. VALUE AT DATE ITEM DESCRiPTiON OF DEATH NUMBER I 6,811.85 2 3 4 Janney Montgomery Scott Brokerage Account #8397-0505, Account Balances - Valued per statement ending 10131103 Janney Montgomery Scott Brokerage Account #8397-0505, Money Market - Valued per statement ending 10131103 1999 Ford F150 4WD - Valued per Kelley Blue Book 2002 Buick LeSabre Coupe - Valued per Kelley Blue Book 226,673.48 22,178.00 16,636.00 TOTAL (Also enter on Line 5, Recapitulation) 272,199.33 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-IS00 Schedule E (Rev, 6-98) KEV-11~1 EX+ (t2-$$) ~l~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 8CHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 5. 6. 7. See continuation schedule(s) attached None ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Secudty Number(s) / EIN Number of Personal Representative(s): Street Address City State __ Zip Year(s) Commission paid Attorney's Fees See continuation schedule(s) attached Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Patricia H. Vance Street Address 21 Willow Mill Park Road City Mechanicsburg State Relationship of Claimant to Decedent Spouse See continuation schedule(s) attached Probate Fees See continuation schedule(s) attached Accountant's Fees PA Zip 17050 Tax Return Preparer's Fees Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 5,108.97 15,100.00 3,500.00 908.00 123.61 24,740.58 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1602 EX+ (6-98} SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANLA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 American Stationery - Thank you notes Debra Keys - Honorarium Hollinger Funeral Home & Crematory - Funeral Services JDK Catering, Inc. - Catering Services for post-funeral dinner TransAmerica Printing - Print memorial program U. S. Postmaster - Postage for thank you notes Wine and Spirits Shoppe - Supplies for post-funeral dinner 228.80 132.80 2,272.80 2,063.55 282.97 57.38 70.97 Subtotal 5, t 08.97 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B2 ATTORNEY'S FEES continued ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 ITEM DESCRIPTION AMOUNT NUMBER 1 2 Goldberg Katzman - Closing Costs Goldberg Katzman - attorneys fees 100.00 15,000.00 Subtotal 15,100.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B3 FAMILY EXEMPTION continued ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 ITEM NUMBER DESCRIPTION AMOUNT 1 Patricia H. Vance - Family Exemption 3,500.00 Subtotal 3,500.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B3 (Rev. 6-98) SCHEDULE H-B4 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE'DENT DECEDENT ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 ITEM NUMBER DESCRIPTION AMOUNT Register of Wills - Probate estate Register of Wills - Short Certificates 902.00 6.00 Subtotal 908.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Revol$02 EX+ (6-98) COMMON~*~.ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Vance, Charles D 21-03-0942 iTEM DESCRIPTION AMOUNT NUMBER 1 2 Cumberland Law Journal - Estate Notice - Legal Advertisement Patriot News - Estate Notice - Legal Advertisement 6.00 117.61 Subtotal 123.6t Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-'1500 Schedule H-B7 (Rev. 6-98) ESTATE OF NUMBER SCHEDULE J BENEFICIARIES Vance, Charles D NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY JFILE NUMBER 21-03-0942 RELATIONSHIP TO DECEDENT ~ Not i.l~t Tru~) AMOUNT OR SHARE OF ESTATE TAXARLE DISTRIRUTIONS [include outright spousal distributions, and - ...................... transfers under Sec. 9116(a)(1.2)] Patricia H. Vance wife entire estate 21 Willow Mill Park Road Mechanicsburg, PA 17055 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 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Estate of Charles D. Vance Date of Death 10/27/03 List of Exhibits attached to Form Rev. 1500 2. 3. 4. 5. 6. 7. Copy of Will and Letters Testamentary Valuation statement on Janney Montgomery Scott Brokerage Account Bank Account Valuation Statement, M & T Bank Bank Account Valuation Statement, Orrstown Bank Real Estate Assessment Valuation of Automobiles Valuation Statements for Annuities Register of Wills of CUMBERLAiJD County, Pennsylvania Certificate of Grant of Letters No. 2003-00942 PA No. ESTATE OF ~ANCE CHARLES D 21-03-0942 Late of SILVER SPRING TOWNSHIP Deceased Social Security No. 160-22-354'1 WHEREAS, on the 13th day of November 2003 an instrument dated October 16th 2003 -- was admitted to probate as the last will of VANCE CHARLES D late of SILVER SPRING TOWNSHIP , CUMBERL~_~D County, who died on the 27th day of October 2003 and, WHEREAS, a true copy of the will as probated THEREFORE, I, DONNA M. OTTO the County of CUMBERLAND in the Commonwealth of Pennsylvania, that I have this day granted Letters TESTAMENTARY to VANCE PATRICIA H is annexed hereto. Register of Wills in and for hereby certify 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 13th day of November 2003. ~egzs~er of '.~i~i.s ' **NOTE** ALL NAMES 3~BOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND TESTAMENT OF CHARLES D. V.4aN'CE I, CHARLES D. VANCE, of Silver Spring Township, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null all prior Wills and Codicils made by me at any time heretofore. ITEM I. All federal, state, and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of the administration of my estate, and shall be paid fi.om my residuary estate without apportionment or right of reimbursement. All such taxes shall be paid at such time as. my. Executor, here/nafrer named, may think proper. ITEM II. I acknowledge that, a~ of this time, the home in which I reside with my wife, PATRICIA H. VANCE, is titled in us as tenants by the entirety, so that it, and all personal property therein not otherwise identified as being solely owned by me, including all antiques, shall not pass under this Will, but shall pass to her by operation of taw in the event that ;[ predecease her. ITEM III. I bequeath any household and personal effects, jewelry, automobiles, and other tangible personalty of like nature that are not within ITEM II. above, to my wife, PATRZCIA H. VANCE. ITEM W. I g/ye, devise and bequeath all the rest, residue and remainder of my estate, of whatever nature and wherever situate, to my Wife, PATRICIA H. VANCE. ITEM V. In the event my Wife, PATRICIA H. VANCE, fails ~o survive me, I g/ye, devise and bequeath all the rest, residue and remainder of my estate, of whatever nature and wherever situate, to my son, CHARLES D VANCE, JR. ITEM VI. I hereby appo/nt my Wife, PATRICIA H. VANCE, as the executor of this, my Last Will and Testament. In the event she is unable to serve, I appoint my son, CH.AR_LES D. VANCE, JR., as my Executor. ITEM VII. I director that my Executor shall not be required to ~ve bond or post any other security for the faithful performance of her duties in any jurisdiction. ITEM VIII. My Executor shall have the following powers in addition to those invested in her by law and bv other provisions of rev Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distr/bution of all property: ODMAkPCDOCS~DOCS\I 01808\1 '~ A. To retain any investments I may have at my death, so long as my Executor may deem it advisable to my Estate so to do. B. To vary investments, when deemed desirable by my Executor, and to invest in such bonds, stocks, notes, real estate, mortgages, or other securities or in such other property, real or personal, as my Executor deems wise, without being restricted to so-called legal investments. C. To make divisions or distributions of the personalty and realty of my Estate partly or wholly in kind. D. To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal property or interests therein owned by my Estate severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instnm~ents to the purchaser or purchasers, conveying a fee simple title, free and clear of ail trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary, or desirable, in carrying out any of the powers conferred upon my Executor in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as is deemed reasonable. ::ODMA~PCDOCS\DOCS\I01808\1 5 F. To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate. My Executor shall pay expenses of last illness and funeral expenses. G. To vote any shares of stock which form a part of my Estate, and to otherwise exercise all the powers incident to the ownership of such stock. H. In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. IN WITNESS WItl~.REOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of roar (4) typewritten pages, this /i;~3day of October, 2003. ~H~ES D. VANCE ~ We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator, CHARLES D. VANCE, as and for his Last Will and Testament, in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. :ODMA~PCDOCS\DOC£\I O1808\1 4 COMI~ONWEALTH OF PENNSYLVANIA : COUN~Y OF DAUPHIN : SS. wumesses, respect2vely, whose names are signed to the foregoing ing~rument, bering first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hear/rig of the Testator, signed the Will as witness and that to the best of his/her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. r). rANch Witness Subscribed, sworn to and acknowledged be/ore me tho Testator, CHARLES .D. ,VANCE, and sc}bscribed and s,wo .rn~ to before me by ~/~ /~a~,/and/]'7d~.e/C-~[~-~7~$f/ , w~tnesses, this /O C//day of October, 2003. Notanai Seal Jennit~r L. Boltz. Notary. Public City of H~tmsburg, Dauphin County My Commission Expires May 30, 2005 Member. Pennsylvania A~oc!a~er~oi Nota~.s ::ODMA~PCDOCS\DOC£\i 01808\1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS On this, the ,'~. day of October, 2003, the undersigned officer, a Notary Public in and for said county and state, personally appeared, Ronald M. Katzman, Esquire, known to me (or satisfactor/ly proven) to be a member of he bar of the highest court of said state holding PA Supreme Court I.D. No. 07198, and a subscribing witness to the within Last Will and Testament and Living Will, Medical Power of Attorney and Medical P/'oxy and certified that he was personally present when Charles D. Vance, whose name is subscribed to the within Last Will and Testament and Liv/ng Will, Medical Power of Attorney and Medical Proxy, executed the same, and that said acknowledged that he executed the same for the purposes therein contained. This Acknowledgement is being taken of an attorney-at-law in accordance with the Pennsylvania Judicial Code, 42 Pa. C.S. § 327 as added by the Act of July 1, 1987 (P.L. 180, No. 21), § 1, and the Pennsylvania Un/form acknowledgments Act, 21 P.S. § 291.7, as added by the Act of July I0, 1981 (P.L. 226, No. 71), § 1. Acknowledged: Ronald M. Katzman :O D MA\PCDOCS\DOCS\I 01888\1 Ii ]: t.//:[ fi '[' l~IA R{} I ,J Pi ~} LI.:C ACCOUNT NO. 1SOOq2OOO1SSD6 ACCOUNT TYPE MARKET INDEX ACCOUNT O0 017 STATERENT PERIOD SEP.20-OCT.20,2003 PAGE CHARLES D VANCE PATRTC]*A H VANCE 21 NTLLO~/ NTLL PARK RD MECHANTCSBURG PA 17055-1757 TNTEREST pATD YEAR TO DATE 20.17 =|ZG~I STREET-CARLZSLE S ACCOUNT SUMMARY * DATE TRANSACTZON!DESCRZpTZONi ~ OTHER ADD~ZOMS SUSTRACTZONSi BALANCE ANWUAL PERCENTAGE YIELD EARNED = 0.~ Z R&T NEB BANKTNG PROVIDES YOU If'rTH ONLZNE, UP-TO-DATE TNFORNAT*rON ON PEACTZCALLY ALL OF YOUR MST ACCOUNTS - AND TT'S FREE! YOU CAN ALSO SAVE TTNE AND HONEY DY pAyTNG YOUR STLLS ONLI*NE NZTH MST WES BI'LL PAY - FREE FOR THE FZRST HONTH. AFTER THAT, TT'S O~LY $2.98 A HONTH FOR 20 PAYHENTS - LESS THAN THE COST OF 20 STAMPS! YOU CAN SCHEDULE AUTONAT'rC RECURRZNG PAYHENTS SUCH AS CAR LOANS, RENT UT~'LTTTES TO SE SENT #HEN YOU SPECTFy, NAKTNG YOUR FINANCES EASTER TO HANAGE. TO s'rGN UP FOR N&T WEB BANKZNG & N~T HEB B'rLL PAY, VISZT RW#.NANDTBANK.CUN~ STOP BY ANY HBT BANK BRANCH OR CALL N&T'S TELEPHONE BANK'rND CENTER AT O~0/24/03 Y ACCOUNT ENCLOSURES PATRICIA H VANCE CHARLES D VANCE 21 WILLOW MILL PARK RD MECHANICSBURG PA 17055-1757 Page 106202614 WE PUT THE LOW IN LOANS! ASK ABOUT OUR SPECIAL LOW RATE HOME EQUITY LINE TODAY! CALL 1-888-ORRSTOWN ABOUT THIS LIMITED TIME OFFER! CHECKING ACCOUNTS ACCOUNT TITLE PATRICIA H VANCE CHARLES D VANCE HOMETOWN INVESTMENT ACCOUNT ACCOUNT NUMBER 106202614 PREVIOUS BALANCE 13,701.35 1 DEPOSITS/CREDITS 520.44 CHECKS/DEBITS .00 SERVICE FEE .00 INTEREST PAID 6.01 CURRENT BALANCE 14,227.80 CHECK SAFEKEEPING Statement Dates 9/26/03 thru 10/26/03 DAYS IN THE STATEMENT PERIOD 31 AVERAGE LEDGER 14,154.63 AVEP~AGE COLLECTED 14,154.63 Interest Earned 6.01 Annual Percentage Yield Earned 0.50% 2003 Interest Paid 127.49 ACTIVITY IN DATE ORDER DATE DESCRIPTION 9/30 ACH CREDIT PNC ADVISORS PPD 10/26 Interest Deposit TRACE NO AMOUNT BALANCE 029359516 520.44 14,221.79 6.01 14,227.80 Fc~rm View - public tax file 12-31-2003.fp5 Page 1 of I Form View public tax file 12-31-2003.fp5 38-07-0459-008 smaet WILLOW MILL PARK ROAD o~,mer_h~ame_l VANCE, CHARLES D & PATRICIA H h~q~://2~5~247~227~59:59~/FMRes/FMPr~?-db=Pub~ic%2~tax%2~e%2~2-3~-2~3.£~5&-~¥. [/28/04 KelIey Blue Book - Trade-In Pricing Report - Buick, LeSabre Page 1 of 2 Kel ue Book ....... Introducina the 2005 Buick LeSabre THE TRUSTED RF.5OURCE J C.q~ose¢' ¥'ou~ color al: Buick.corn BLUE BOOK TRADLIN VALUE Pennsylvania · ,July 20, 2004 Engine: V6 3,8 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 40,000 2002 Buick LeSabre Custom Sedan 4D See Local Listing_s__of This Car List Your Car For Sale Online Buy a New Car Free Record Check Auto Loans from 3.85% APR Tnsurance Quote ~ment Calculator Current Model Features Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control ABS (4-Wheel) AM/FM Stereo Leather Cassette Dual Power Seats Dual Front Air Bags Sliding Sun Roof Front Side Air Bags Premium Wheels ~BUICK When you've bee~ fulbsize car for 12 Every side is your Introducing the Consumer Rated Condition: Excellent "Excellent" condition means that the vehicle looks great, is in excellent mechanical condition and needs no reconditioning. It should pass a smog inspection. The engine compartment should be clean, with no fluid leaks. The paint is glossy and the body and interior are free of any wear or visible defects. There is no rust. The tires are the proper size and match and are new or nearly new. A clean MU_e_ .h_i_st~o~r~. is assumed. This is an exceptional vehicle. Trade-In Value List Your Car For Sale Online $9,550 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb. PA;047279;PA041 & 17043;+t&278;Buick;20... 7/20/2004 · Kellffy Blue Book - Trade-In Pricing Report - Buick, LeSabre Page 2 of 2 Copyright © 2004 by Kelley Blue Book Co., All Rights Reserved. Jul-Aug 2004 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generetlng this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.(v.04072) http://www.kbb.corn/kb/ki.dll/kw.kc.ur?kbb.PA;047279;PA041 & 17043;+t&278;Buick;20... 7/20/2004 . Kelley Blue Book - Retail Pricing Report - Ford, Fl50 Page 1 of 2 Kelley Blue Book THE TRUSTED RESOURCE BLUE BOOK RETAIL R£PO RT Pennsylvania · July 20.2004 1999 Ford F160 Short Bed Engine: V8 5.4 Liter Trans: Automatic Drive: 4 Wheel Drive Mileage: 10,000 Equipment XL Air Conditioning Power Steering Se~arc~h_L._st_ngs for This Car Free Record Check Auto Loans from 3.85% APR Insurance Quote Payment Calculator Review of This Car Tilt Wheel AM/FM Stereo Dual Front Air Bags 1099 babysitting Retail Value Search Local Listinqs for This Car $12,360 The Kelley Blue Book Suggested Retail Value represents the amount an auto dealer might ask for a specific vehicle. The Suggested Retail Value is a starting point for negotiation therefore the actual sale price will vary. Popularity, condition, warranty, color and local market conditions will be factors involved in determining a final price. This retail value is not a trade-in or private party value. This Suggested Retail Value assumes that the vehicle has been fully reconditioned and has a clean title history. The Suggested Retail Value also allows for advertising, sale commissions, insurance and other costs of doing business as a dealer. Most vehicles being offered at this price have passed an inspection and some may carry a warranty. Get Invoice & iqSRP on New Cars Get a Private Party Value Get Financino Before You Shgp Copyright © 2004 by Kelley Blue Book Co., All Rights Reserved. Jul-Aug 2004 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;815985;PA041 & 17011 ;pic+r&40;Ford; 19... 7/20/2004 ' Kelle~ Blue Book - Retail Pricing Report - Ford, Fl50 Page 2 of 2 Kelley Blue Book assumes no responsibility for errors or omisslons.(v.04072) http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb. PA;815985;PA041 & 17011 ;pic+r&40;Ford; 19... 7/20/2004 MetLife GOLDBERG, KATZMAN & SHIPMAN, P.C. ATTN: CHERYL BAKER P 0 BOX 1268 HARRISBURG PA 17108-1268 RE CONTRACT 50164886 ANNUITANT CHARLES VANCE Dear Ms Baker Thank you for notifying us of the death of our annuitant. Please relay our sincere condolences to the family on their recent loss. This letter is in response to your letter of January 28, 2004. Enclosed you will find a completed Account Report for the contract as requested. The beneficiary designation for the contract is Patricia Vance. To process the settlement, we will need the following items: ,, Completed Claimant's Statement Claim Election Form and Tax Withholding Form · Original or Certified Death Certificate · Contract if available Contract 50164886 is a non-qualified tax deferred annuity. All monies over the cost basis are considered taxable in the year received. The date of death value as of October 27, 2003 is $60,537.04. The current value is $61,195.80. The cost basis is $ 15,000.00. If you have questions, please feel free to call our toll-free number at 1-800-638- 7732. One of our Customer Service Consultants will be happy to assist you. Sincerely Diane Kosechata Annuity Death Claims Unit Annuity Administrative Operations February 5, 2004 ACCOUNT REPORT RE: ESTATE OF CHARLES D. VANCE (SSN 160-22-3541) DATE OF DEATH: October 27, 2003 INSTITUTION: MetLife Account No. 1 Type of Account: Annuity Accrued Interest from 1/1/01 to Date of Death Other comments: Account No. 2 Type of Account: Account No. Opened Ownership Name(s) Date current ownership established Balance of principal as of Date of Death Accrued Interest as of Date of Death ('Not included above) Accrued Interest from 1/1/01 to Date of Death Beneficiaries Other Comments: VERIFI~r~ AS TRUE, COMPLETE AND ACCURATE: INSTITUTION: ]/~~ TITLE: ACCOUNT REPORT RE: ESTATE OF CHARLES D. VANCE (SSN 160-22-3541) DATE OF DEATH: October 27, 2003 INSTITUTION: Janney Montgomery Scott (Putnam Investments) Account No. 1 Type of Account: Profit Sharing and Savings Plan Policy No. ! (~ O- 2,2_' .---~4/ Ownership Name(s) ~--~ ~v' } e.5 Date current ownership established Balance of principal as of Date of Death Accrued Interest as of Date of Death (Not included above) Accrued Imerest from 1/I/01 to Date of Death Beneficiaries ?C,X,.L, CtCLI(~ I'~. ~/O~.r~C(~ Other commems: Account No. 2 Type of Accoum: Account No. Opened Ownership Name(s) Date current ownership established Balance of principal as of Date of Death Accrued Interest as of Date of Death (Not included above) Accrued Interest from 1/1/01 to Date of Death Beneficiaries Other Comments: VERIFIED AS TRUE, COMPLETE AND ACCURATE: INSTITUTION: TITLE: ?'XC ~l 105806.2 ~ .]auney Montgomery Scott STATEMENT OF ACCOUNT CHARLES D VANCE (IRA) J M S LLC CUST FBO ACCOUNTNUMBER HS23 8396-9290 STATEMENT PERIOD 10/01/03- 10/31/~:~ JMS RETIREMENT PLAN ACCOUNT P~g~ 1 of 3 FIXED FUND ALAN S MEMINGER 717-731-4400 20 ERFORD ROAD,SUITE 315 LEMOYNE, PA 17043 ACCOUNT BALANCES ** MONEY MARKET BALANCE EQUITIES AND OPTIONS MUTUAL FUNDS & UNIT TRUSTS FIXED INCOME SECURITIES OTHER INVES'I~IENTS TOTAL PORTFOUO 0.00 0.00 80,791.63 14.1% 80,292.82 25,270.00 4.4% 23,482.00 346,994.65 60.4% 328,858.41 121,234.00 21.1% 121,379.80 0.00 0.00 J 574~290.28 100.0% 554~013.03 · * Account debit balances are deducted from the total valuation and account credit balanoes are added to the total valuation DIVIDENDS CURRENT PERIO~) iNTi=RF~T 6.31 49~ ~9 TOTAL INCOME I 498.81 3,858.29 8,724.55 10/01/03 BALANCE FORWARD INCOME AND EXPENSE ACTIVITY MONEY MARKET PURCHASE & SALE AOTIVITY ~10/31103 ENDING BALANCE I 498.81 FOR THE TAX YEAR E~03 YOU C~AN CONTRIBUTE MORE TO YOUR IRA OR RO 774 IRA THAN EVER BEFORE - $~-~)0.00 OR ~3500.00 IF YOUR'RE OVERA(3ESO. TAKEADVANTAC?iEOFTHEOPPORTUN/TYTODATDH. up ON A SA VINGS AND INVESTMENT PROGRAM FOR THE FUTURE. BUILD YOUR RETIREMENT ..qEOURITY ONE DONTRIBUTION A T A TIME. 0.00 80,292.82 498.81 498.81 0.00 80,791.63 8396-9290 9828389 [~'~-~).~: Y~UR~jP~C~VERAG~S$UPPL~MEt~ED~¥ADDiT~NALPR~TECT~N~E$49~BYAM~R~NS~A~CE~PANY` FORIMPORTANTINFORMATtONPLEASESEEREVERSESIDE. J ,lanney ]~lontgomery Scott ,.~: STATEMENT OF ACCOUNT CHARLES O VANCE (IRA) ALLIANOEBERNSTEIN Estimated Estimated Acct 80,79t .63 80.79 0.100% CASH Lona 2OO 3,000 DU PONT E.LDE NEMOUR&CO DD 40.4000 8,080.00 280.00 3.4% CASH RITE AID CORPORATION RAD 5.7300 17.190,00 CASH ] TOTAL EQUITIES AND OPTIONS I 25,270.00 280.00 1.t% 4,594.411 245.066 8,758.124 Shoq NEW PERSPECTIVE FD INC ANWPX 22.6500 CLA PIMCO FDS MULTI MCR PQNAX 20.6500 SER PEA RENAISSANCE FD OLA WASH MUTL INVS FD INC AWSHX 27.1600 CLA ["' TOTAL MUTUAL FUNDS & UNIT TRUSTS ] Value 104,063.40 5,060.61 237,870.64 346,994.65 767.26 0.7% CASH 2.20 0.0% CASH 4,729.38 1.9% CASH 5,498.84 1.5% 100,000 20,000 GMAC SMARTNOTES B/E N/O MONTHLY DEATH PUT CPN 4.500% DUE 08/15/04 DTD 08/20/02 FC 09/15/02 RATINGS-S&p BBB MDY A3 BANK OF AMERICA INTERNOTES B/E MONTHLY DEATH PUT CPN 7.050% DUE 03/15/16 DTD 03/01/01 FO 04/15/01 GALL 03/15/04 @ 100.000 RATINGS-S&P A MDY AA3 TOTAL FIXED INCOME SECURITIES TOTAL POFi I POLLO 09/15/04 101.0570 03/15/16 100.8850 101,057.00 4,500.00 4.4% CASH 20,177.00 t ,410.00 6.9% CASH 121,234.00 5,910.00 4.8% 574,290 28 11,760.63 2.0% CHARLES D VANGE (IRA) J M S LLC OUST FEO 10/15 INTEREST 10/15 INTEREST 10/15 DIVIDEND 10/15 REINVEST DIV 10/16 PURCHASE ACCOUNT NUMBER HB23 8396-9290 6TATEMENT PERIOD 10/01/03- 10/31/03 BANK OF AMERIOA INTERNOTES B/E MONTHLY DEATH PUT OPN 7.050% DUE 03/15/t6 DTD 03/01/01 FO 04/15/01 101503 20,000 GMAO SMARTNOTES B/E N/O MONTHLy DEATH PUT OPN 4.500% DUE 05/15/04 DTD 08/20/02 FO 09/t5/02 101503 100,000 ALLIANCE GOVT RESERVES 101503 80,292 ALLIANCE GOVT RESERVES ALEANCE GOVT RESERVES A©ct 375.00 6.31 TOTAL 498.81 1.0000 6.31 1.0000 492.50 TOTAL 498.81 OASH OASN Acct CASH OASH Paqe 3of3 BUREAU OF INDIVIDUAL TAXES XNHERTTANCE TAX DXVTS~ON DEPT. 280601 HARR[SBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERHINATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN R£V-~SS EX AFP (01-05) RONALD H KATZHAN ESQ GOLDBERG KATZHAN PO BOX 1268 HBG PA 17108 DATE 09-20-2004 ESTATE OF VANCE DATE OF DEATH 10-27-2005 FILE NUNBER 21 05-0942 COUNTY CUHBERLAND ACN 201 Amnount Remi'l'~ed CHARLES D HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR FILES ~'~ REV-&83 EX AFP (01-03) NN NOTICE OF DETERHINATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN N~ ESTATE OF VANCE CHARLES D FILE N0.21 03-0942 ACN Z01 DATE 09-20-2004 ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verified .O0 Z. PennsyZvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 .00 Inheritance Tax Assessed by Other States or Territories of the Un/ted States (Excluding Discount and/or Interest) 4. Total Inheritance Tax Assessed .00 .00 5. Pennsylvania Estate Tax Due TAX CREDITS: *:3" PAYHENT RECEIPT DISCOUNT (+) AHOUNT PA:~TM DATE NUMBER INTEREST/PEN PAID (-) .~.~ ;IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. - TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE .00 (IF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REQUIRED IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) PURPOSE OF NOTICE: PAYMENT: REFUND CCR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: To fulfill the requirements of Section glqO (b) of the Inheritance and Estate Tax Act, Act g$ of 2000. (72 P.S. Section 91403. Detach the top portion of this Notice and submit with your payment to the Register of Nills prlnted on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Hills, any of the Z5 Revenue District Offices or from the Department's g4-hour ansaering service for forms ordering: 1-BOg-36Z-ZOSO; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in in[aras[ not satisfied with the assessment of tax as shown on this notice may 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 171ZB-lOZ1, --electing to have the matter determined at audit 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. ZB0601, Harrisburg, PA 17liB-0601, Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-iSO1) for an explanation of administratively correctable errors. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this no[ica. For dates of death on or after 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (lB) months from the date af death. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January l, 19BI 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 19BI through 2004 ara: Interest Daily Interest Daily Interest Daily Yea..._r Rate Factor Yaa~ Rate Factor Yea~ Rate Factor 198Z ZOZ .000548 1988-1991 1lZ .000301 ZOO1 9Z .000Z47 1985 16Z .000458 199Z 9X .000Z47 ZOOZ 6Z .000164 1984 llZ .000301 1993-1994 7Z .00019Z 2005 5Z .000137 1985 13Z .000556 1995-1998 9Z .000Z47 ZOO4 42 .000110 1986 lOX .000Z74 1999 7Z .O0019Z 1986 lOX .000274 ZOO0 8Z .OOOZ19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY TNTEREST 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. STATUS REPORT UNDER RULE 6.12 Name of Decedent: CHARLES D. VANCE Date of Death: OCTOBER 27.2003 Will No. Admin. 2003-00942 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: I. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orphans' Court and may be attache~ort. . ~A~^' Sign"ature Date: f-IL. oS' N ..::r ~ L.L~ C) U..J -- C) 1':-- [c. -"'j(- Ronald M. Katzman. Esquire Goldberg Katzman. P.C. 320 Market Street. P.O. Box 1268 Harrisburg. PA 17108-1268 Telephone (717) 234-4161 U__I ,'-_ O() x::.()) [.'!:: ;:"'~ ' ~;~:, uci-~~. U::'-. o:::~') D ,--.'" Cl... ~~=: I,Ll C.:-~ c:: r'") (..:) L\j LL M .,~... -, or> C'~ = ,,~ Capacity: _ Personal Representative ...K..- Counsel for personal representative 117529.1 ) l! ; L: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 REV-7S' EX AFP (12-114) i. 03-14-2005 VANCE 10-27-2003 21 03-0942 CUMBERLAND 202 Allount Rellitted CHARLES D RONALD MKATZMAN ESQ GOLDBERG KATZMAN PO BOX 1268 HBG PA 17108 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, subllit the upper portion of this for. with your tax paYll8nt. CUT ALONG THIS LINE ...... RETAIN LOWER PORTION FOR YOUR FILES ~ riE-v=736-E5rAFP--Coi:.-o2r----..-Ncffic'E-oj:--IiEf"ERMINATIcfri-iifIi-isSEssMENY------------------------ ---- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF VANCE CHARLES D FILE NO.2l 03-0942 ACN 202 DATi 03-14-2005 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) c; BUREAU OF INDTVTDUAL TAXES IHHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMNONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-lSd? EX AFP C01-03) RONALD H KATZHAN ESQ GOLDBERG KATZMAN PO BOX 1Z68 HBG PA 17108 DATE 09-20-2004 ESTATE OF VANCE DATE OF DEATH 10-27-2003 FILE NUHBER 21 03-0942 COUNTY CUHBERLAND ACN 101 Aeoun'l: Ram/'l:'l:ad CHARLES D HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF ~LZS CUMBERLAND C~'~OURT dc~OUSE ::~,, :,~:-~ CARLISLE, PA?.~7013 ~ ,:~ ,~=:, CUT ALONG THIS LINE ~ RETAIN LONER PORTZON FOR YOUR RECO~S ~ ,; D[SALLONANCE OF DEDUCT;ONS AND ASSESSHENT OF TAX ~ ESTATE OF VANCE CHARLES D FZLE NO. 21 03-0942 ACN 101 DATE 09-Z0-2004 TAX RETURN NAS: (X) ACCEPTED AS F'rLED ( ) CHANGrED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1. Real Es~a~a [Schedule A] 2. 3. 4. 5. 6. 7. 8. ORIGINAL RETURN (1) Stocks and Bonds {Schedule B) (2) Closely Held S~ock/Parinership lniarest (Schedule C) (3) Hor~gagas/No~as Receivable (Schedule D) (4) Cash/Bank Deposi~s/Hisc. Personal Propar~y (Schedule E) ($) Jointly Owned Propar~y (Schedule F) (6) Transfers (Schedule G) (7) To,al Assa~$ APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Cos:ks/Hisc. Expanses (Schedule H) 10. Dab~s/Hor~gage Liabili~:ias/Liens (Schedule T) 11. To~el Deductions 12. Ne~ Value of Tax Re~urn 1:5. 14. (9) (10) 859~718 Z7Z/199 .33 O0 O0 NOTE: To insure proper O0 credi~ ~o your account, O0 subai~ ~he upper pore/on O0 of ~h/s fore w/~h your ~ax payment. 00 24,740.58 (8) 1,131,917.33 .00 (11) 2~.7~0 (l~) 1,107,176.75 (13) . O0 (1~,) 1,107,176.75 Char/~abla/Govarnman~al Bequests; Non-elected 911:5 Trusts (Schedule J) Na~ Value of Es~a~a Sub~ac~ ~o Tax NOTE: Zf an assessment was issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 will reflect flgures that include the total of ALL returns assessed to date. (15) 1,107,176.75 x O0 = .00 (16) .00 x 045= .00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= . O0 AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE ASSESSMENT OF TAX: 15. Aaoun'lc of L/ne 14 a~ Spousal ra~:a 16. Aeoun'l: of L/ne 14 ~exabla a~ Lineal/Class A ra~e 17. Aeoun~ of L/ne 14 a~ S/bl/ng ra~e 18. Aeoun~ of L~na 14 ~:axable a~ Colla~caral/Class B re~e 19. Pr/nc/pal Tax Due TAX CREDZTS: PAYHENT REC[TpT DISCOUNT DATE NUHBER INTEREST/PEN PAID ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL INTEREST. .00 .00 .00 .00 { 'rF TOTAL DUE "rs LESS THAN $1, NO PAYHENT 'rs RE~U'rRED. 'rF TOTAL DUE 'rS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TH'rS FORH FOR /NSTRUCT'rONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneflciarias 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 laaful Class B (collateral) rate an any such futura interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF ~ILLSj AGENT 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 at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ansmaring service far forms ordering: 1-800-362-2050~ services for taxpayers mith special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallomance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. 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-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (5X) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 1982 mill bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .0005q8 ~'8-1991 1XZ .OO030X ~ 92 .000247 1983 162 .000438 1992 92 .000247 ZOOZ 62 .000164 1984 llZ .000301 199~-1994 72 .000192 Z003 52 .000137 1985 132 .000356 1995-1998 92 .000247 Z004 42 .000110 1986 10Z .000274 1999 7Z .000192 1987 lOg .000274 ZOO0 7Z .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINilUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the flotice, additional interest must be calculated.