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03-0073
PETITION FOR GRANT OF LETTERS Estate of Moore, Lawrence J. No. ~/- ~ ~" ~,,~ also known as , Deceased Social Security No. 187-32-2521 Sharon A. Rinesmith Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) '-] A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut __ named in the Last Will of the Decedent, dated and codicil(s) dated 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: Name Relationship Residence Sharon A. Rinesmith Daughter 6 Maple Ln., Newville, PA 17241 (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 5 Park Circle, Newville, PA 17241 (list street, number and municipality) Decedent, then 63 years of age, died January 8 ,200:3, at Chambersburg Hospital, Chambersbur~], PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ 182,600.00 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ 131,500.00 Total ..................................................................................................................... $ 314,100.00 Real Estate situated as follows: 5 Park Circle, Newville, PA and 612 B Street, Enola, PA 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: I Signature Typed or printed name and residence I L~ ("~. /~_~~~ Sharon A. Rinesmith I 16 Maple Lane, Newville, PA 17241 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 ~_~/'7/'2./(J?~ ~ ./~/~-/')¢¢_~ before me this ~:~.~,¢.//~',,~' , day of DECREE OF REGISTER Estate of Moore. Lawrence J. Deceased No. ~ j-~,~- ~ also known as Social Securit~No: 187-32-2521 Date of Death: 1/8/2003 AND NOW, .~/,¢'~../....../, .~-¢,¢' , ~ , in consideration of the Petition on the reverse side hereon, satisfa~ory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary ~ of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to Sharon A. Rinesmith 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 $ Short Certificates(s) ............... $ Renunciation .......................... $ Extra Pages ( ) ...............$ I.T.R ....................................... $ Signature JCP Fee ................................. $ ,/4::~,~::::~2 Attorney: Thomas, R. Mark Inventory ................................ $ I.D. No: 41301 Other ...................................... $ Address: 101 S. Market Street Mechanicsburg PA 17055 TOTAL ............................. $ ~ Telephone: (717) 79~6-2100 DATE FILED: his is to certify that the information here given is cor,'ectly copied (rom an original certificate of' death duly tiled ',vit!n m<' :ts Local Registrar. The original certificate will he forwarded to thc 51tare Vital Records Office for permane,~t WARNING: It is illegal to duplicate this copy by photostat or photograph. COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (~' O k . ' ,. 187 -- 32 -- 2521 . Janua~ 8, ~OOS 63~ ; May25 193 KnoxDae Pa ~ Franklin County Chambersbur~ Chambersbur~ ~ospital ~ ~ ~'~' ~ Wh te ~ ~2~. I State Government I ~,, fi ~ ~ I ~~ / ~ ,~,,,,,~,~,, i [ ' '-' [ ~'~ .~ "'~*) , ~d~ed , ~c[~..'s ~,~ ~[ss(~,~ c~ ~,z~c~ ~c[~..'s Pennsylvania Newville, Pennsylvania 17241 ,s~.~. ...... , Cumberland ~, Newville ..~E t~,,.. ~.,~., ~ Thomas a Moore ~THER'S ' · Helen Zajac Sharon A Rmesm~th · 1 ~ 16 Maple Lane ~ewwlle, Pa 1724 ~.,~LI~~ ~-~l Jan 11 2003 I Chestnut H Cemete~ I Mechan csburg, Pa 17055 ~/ ~, ' [~,c. J~,d. ~ q ~ ~ % X ~ Jz2b FD-014318-L COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002390 THOMAS R MARK ESQUIRE 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $23,500.00 ESTATE INFORMATION: SSN: 187-32-2521 FILE NUMBER: 21 03-0073 DECEDENT NAME: MOORE LAWRENCE J DATE OF PAYMENT: 04/03/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/08/2003 TOTAL AMOUNT PAID: $23,500.00 REMARKS: R MARK THOMAS ESQUIRE CHECK# 1897 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Lawrence J. Moore January 8, 2003 Date of Death: 2003-73 Will No. Admin. No. To the Register: I certify that notice of (beneficial interest) estate _administration required by Rule 5.6(a) o[ the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 1 /30/0'3 . Name Address Sharon Rinesmith 16 MaDle Lane~ Newville: PA 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: May 1, 2003 Signature Name ¢:~ ¢~ '' ~: ,~..) ~ Address 101 S. Market St. =::~ = Mechanicsburcl, PA 1 7055 ~ m Telephone (71 ~ 796- 2100 Capacity: __ Personal Representative x Counsel for personal representative COHNDNHEALTH OF PENNSYLVANTA ~ BUREAuDEPARTHENToF 'rNDI'VTDUALOF REVENUETAxES ZNFORMATZON NOTZCE FILE NO. 21 05-0075 DEPT. Z80601 AND HARRTSBURG, PA 171Z8-0601 TAXPAYER RESPONSE ACN 05120065 DATE 06-06-2005 REV-I~q$ EX AFP [*i;~i : ~:i' TYPE OF ACCOUN:r ¢~r: * :~ST. OF LAWRENCE J HOORE [] SAVINGS S.S. NO. 187-32-2521 [] CHECKTNG DATE OF DEATH 01-08-200:5 [] TRUST '0} JUN 23 /~1~0~TY CUMBERLAND [] CERTTF, REHTT PAYHENT AND FORHS TO: HELEN K MOORE REOISTER OF WILLS 269 OLD MILL RD ~.:~. CUMBERLAND CO COURT HOUSE APOLLO PA 15615 .~,t.I, ,.-,~-~.~ : · ',..'- CARLISLE, PA 17015 FIRST COHHONNEALTH has provided Ge Department with Ga information Xisted beloe whlch has been used in caXcuXating Ge potential tax due. Their records indicate Gat at the death of the above decedent~ you were a joint owner/beneficiary of this account. If you feel this information is incorrect, pXease obtain written correction ~rom the ~inancial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws o~ the Commonwealth CONPLETE PART 1 BELON ~ # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. 01006000000716 Da~e 12-12-2001 To insurepropercradittoyoureccount, two Established ~2) coplas o~ this notice must accompany your payment to the Register o~ Nills. Hake chalk Accoun~ Balance 15,651.76 payabla to:"RegisterofRills, Agent". Percen~ Taxable X 50.000 NOTE: I~ tax payments ara eada aithin three Amoun~ Subjec~ ~o Tax 7,8Z5.88 ¢$)monthsofthadacedant'sdateo~daaG, Tax Ra~e X .0~5 you may deduct a 5Z discount o~ the tax due. Any inheritance tax due will becoea delinquent PoSen*ia1 Tax Due 552.16 nine(9]monthsa~tarthedatao(death. PART TAXPAYER RESPONSE A. ~lTha ebeva in{ormation and te~ due i~ carraot. 1. You may choose to remit payment to the Register of Rills with twa copies of this notice to obtain CHECK a discount or avoid interest, or you cay check box ~ONE~ RillsandanofficialassessmantwillbaissuedbythePADeparteentofRavenue. BLOCK ~. [] The above asset has been ar ail1 be reported and tax paid ~ith the Pennsylvania inheritance Tax return ONkY to be filed by the decedent's representative. C. ~ The above information is incorrect and/or debts and deductions ~ere paid by you. You must complete PART [] and/or PART ~ below. PART Zf you ind/ca~e a differen* *ax re*e, please s*a~e you~ relationship ~o decedent: TAX RETURN - CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Da~e Es*ablished 1 2. Accoun* Balance 2 $. Percen* Taxable $ ~. Aaoun* Subjec~ *o Tax S. Debts and Deductions 6 - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 8. Tax Due 8 PART DE~TS AND DEDUCTZONS CLAIMED DATE PAID PAYEE DESCRIPTION AHOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare ~ha~ ~he fac~s I have reported above ara true, correc~ and co,plet~ *o *ha bls* of ay kno.ledge and belief. HOME TAXPAYER SZ~ATURE TELEPHONE NUHBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFF/CZAL TAX ASSESSMENT .1th applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decadent's date of death. 3. A joint account is taxable even though the decadent's name ams added as a matter of convenience. 4. Accounts (including those held betHeen husband and Hire) which the decedent put in joint names Hithin one year prior to death ara fully taxable as transfers. 5. Accounts established jointly batHaen husband and Hire more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notlce are correct and deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Mills of the county indicated. The PA Department of Revenue Hill issue an official assessment [Form REV-15q8 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or Hill be reported and tax paid Hith the Pennsylvania Inheritance Tax Return filed by the dacedent's representative, place an "X" in block "B" of Part i of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZB0601, Harrisburg, PA 17128-060! in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions baloa. Sign two copies and submit them eith your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue ail1 issue an official assessment [Form REV-15q8 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 TAX COHPUTATION LINE 1. Enter the date the account originally Has established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/1Z/BZ: Accounts Hhich the decedent put in joint names within one (1) year of death are taxable fully as transfers. HoHevar, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (ex) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as folloHs: A. The percent taxable for joint assets established more than one year prior to the decedant's death: i DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and tho other persons. ! DIVIDED BY 3 [JOINT ONNERS) DIVIDED BY Z [SURVIVORS} = .167 X 100 = 16.TI [TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the dacedent's death or accounts oHned by the decedent but held in trust for another individual(s) [trust beneficiaries): ! DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OMNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and tho other persons and established Hithin one year of death by the decedent. i DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50X [TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax [line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6, The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined beloH. De{e of Death Spouse LAnea! [ SiblAng I Collateral 07/01/9q ~o 12/$1/9q SZ 6X lex 01/01/95 ~o 06/50/00 OX 6X 15Z 15X 07/01/00 ~o presen~ OX q.SZ~ 12Z death to or for the usa of a natural parent, an adoptive parent, or a stepparent of the child is The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahather or not they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, Hhather or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals Hho have at least one parent in common Hith the decedent, Hhsther by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIHED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIHED AlloHable debts and deductions are determined as folloHs: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment amy be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002723 MOORE HELEN K 269 OLD MILL ROAD APOLLO, PA 15613 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 03120043 $352.16 ESTATE INFORMATION: SSN: 187-32-2521 FILE NUMBER: 2103-0073 DECEDENT NAME: MOORE LAWRENCE J DATE OF PAYMENT: 06/23/2003 POSTMARK DATE: 06/1 9/2003 COUNTY: CUM BERLAN D DATE OF DEATH: 01/08/2003 TOTAL AMOUNT PAID: $352.16 REMARKS: HELEN K MOORE CHECK# 2819 INITIALS: JA. SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~. ~ CONHONHEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 NOTZCE OF INHERITANCE TAX APPRAZSEHENT. ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-IG~eEXAFP(O~-DS) DATE 09-29-2005 ESTATE OF HOORE LAWRENCE J DATE OF DEATH 01-08-2005 FILE NUNBER 21 05-0073 '(}~i ~' ' *~ ,~ .~COUNTY CUHBERLAND ~-~ "*'~ * ' * SSN/DC 187-32-2521 HELEN K HOORE ACN 03120043 269 OLD HILL RD APOLLO PA 15613 Amoun~ Remi~ed HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~.~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF XNHERZTANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 09-29-2003 ESTATE OF HOORE LAWRENCE J DATE OF DEATH 01-08-2003 COUNTY CUHBERLAND FILE NO. 21 03-0073 S.S/D.C. NO. 187-32-2521 ACN 03120043 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET XNFORHATXON FINANCIAL INSTITUTION: FIRST COHHONWEALTH ACCOUNT NO. 01006000000716 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 12-12-2001 Account Balance 15,651.76 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBHTT THE Amount Subject to Tax 7,825.88 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYHENT TO THE Taxable Amount 7,825.88 REGISTER OF WILLS AT THE Tax Rate X .45 ABOVE ADDRESS. HAKE CHECK Tax Due 352.16 OR HONEY ORDER PAYABLE TO: '*REGISTER OF WTLLS, AGENT.** TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PATD 06-19-2003 CD002723 . O0 35:;'. 16 TOTAL TAX CREDIT I 352.16 BALANCE OF TAX DUEI .00 INTEREST AND PEN. I .00 TOTAL DUE I .00 IF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. ~ ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A "CRED/T' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTIONS. ) PURPOSE OF NOT[CE: To ~ulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): A refund of a tax credit, ehich aaa not requested on the tax return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Mills, any of the 25 Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: 1-800-562-Z050~ services for taxpayers eith specie1 hearing and or speaking needs: 1-800-447-5020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions ar assessment of tax (including discount or interest) as sheen on this Notice may object eithin sixty [60) days of receipt of this Notice by: --eritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171Z8-1021, OR --electing to have the matter determined at the audit of the account of the persunal representative, OR --appeal to the Orphans' Court ADMIN- [STRATIVE CORRECTTONS: 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 17128-0601 Phone [717) 787-6505. Sea page 5 of the booklet "Instructions for inheritance Tax Return for a Resident Decedent" (RE¥-lS013 for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the decadant's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the total of the tax and lntarast 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 tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six [67.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on ar after January 1, 1982 ail1 bear interest at a rate which ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interast Daily [ntarest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rate Factor 198Z ZOZ .000548 1987 92 . DO 0247 1999 72 .000192 1985 167. .000458 1988-1991 llZ .000501 ZOOO 8Z .OOOZ19 1984 117. .000501 1992 9X .000247 2001 92 .000247 1985 I$Z .000356 1995-1994 72 .000192 2002 62 .000164 1986 102 .000Z74 1995-1998 92 .000247 2005 57. .000157 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DATLy /NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (la) 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. REV-1500 PENNSYLVANIA OEPARTMENTOF REVENUEDEPT. 280601 INHERITANCE TAX RETURN 'ARRISBURG, P^ 7128-0601 RESIDENT DECEDENT 2 1 - o 3 7 3 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) j... SOCIAL SECURITY NUMBER 2: Moore, Lawrence J. I.U 1 8 7-3 2-2 5 2 1 t'"t DATE OF DEATH (MM-DD-Year) J DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE r~ 01/08/2003 J 05/25/1939 REGISTER OF WILLS ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER '" r~l 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death priorto 12-13-82) I-- ~'"Orr ,,, BI 4. Limited Estate E~ 4a. Future Interest Compromise (,ate o, death after 12-12-82) BI 5. Federal Estate Tax Return Required ~oo rr ..j BI 6. Decedent Died Testate (Attach copy otWill) D 7. Decedent Maintained a Living Trust (Attach copy o1Trustl __ 8. Total Number of Safe Deposit Boxes ~: [--'"1 9. Litigation Proceeds Received E~ 10 Spousal Povedy Credit (~ate of death between t2-31-91 and 1-1-g5) E~ 11. Election to tax under Sec. 9113(A)(Attach Sch O) ~_ THIS:SECT ONMUST BE COMPLETED. ALL CORRESPONDENCE AND :coNFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z NAME .......... '" COMPLETE MAILING ADDRESS z R. Mark Thomas 101 S. Market Street o o. FIRM NAME (il'Applicable) 0 TELEPHONE NUMBER 0 717-796-2100 Mechanicsburg PA 17055 1. Real Estate (Schedule A) (1) 139,416.78 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 79,387.58 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Mortgages & Noles Receivable (Schedule D) (4) r 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) 10,718.85 i 'i:' (Schedule E) - - 6. Joinlly Owned Properly (Schedule F) (6) 71,884.551 ..... E~] Separate Billing Requested ~) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 67,055.57 [ : · I-. (Schedule G or L) .- ~ 8. Total Gross Assets (total Lines 1-7) ~ (8) 368,463.33 LLI 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 16,284.36 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 1,148.91 11. Total Deductions (total Lines 9 & 10) (11) 17,433.27 12. Net Value of Estate (Line 8 minus Line 11) (12) 351,030.06 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 351,030.06 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 ~.. rate, or transfers under Sec. 9116 (a)(1.2) X ~ (15) I'-- 16. Amount of Line 14 taxable at lineal rate 351,030.06 x .045 (16) 15,796.35 n 17. Amount of Line 14 taxable at sibling rate ~ X .12 (17) ~~.~ 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19, Tax Due (19) 15,796.35 20. > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 5 Park Circle CITY NewvJlle I SLATE pA I ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 15,796.35 A Spousal Povedy Credit B Prior Paymenls 23,500.00 C. Discount 1,1 75.00 Total Credits ( A + B + C ) (2) 24,675.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestJPenalty ( 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) 8,878.65 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.O0 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 righl to designate who shall use the properly transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate 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 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 1o lhe best of rny knowledge and belief, il is true, correcl and complele. Declaration of preparer other Ihan the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN _. ADDRESS 16 Maple Lane - Newville PA 17241 SIGNATURE OF~vE DATE ADDRESS 101 S. Market St. ,,/¢2~.~ ~? 4D// Mechanicsburg PA 17055 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 dealh 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)l. The statute does not exempt a transfer to a surviving spouse from tax and the statutory requ rements 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 lhe decedent's lineal beneficiaries is 4.6%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Moore. Lawrence J, 21 07 73 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compeiled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. 5 Park Circle, Newville, PA OF DEATH 80,009.22 This was decedent's residence which was sold on 3/14/03. The contract sales price was $90,000. After deductions for realtor's commission, transfer taxes, seller's assistance and other transaction fees the estate received $80,009.02 in net proceeds. Copy of Settlement Sheet is attached hereto. 2. 612 B Street, Enola, PA 17025 59,407.56 This was decedent's residence prior to purchasing the Newville property and which sold on 4/15/03. The contract sales price was $65,000. After deductions for realtor's commission, transfer taxes and other transaction fees the estate received $59,407.56 in net proceeds. Copy of Settlement Sheet is attached hereto. TOTAL (Also enter on line 1, Recapitulation) $ 139,416.7,~ REV 1503 EX +Il 97) r~'~ SCHEDULE B COMMO.W~AUH'~'""~"--~OF PE.NSYLVA~IA STOCKS & BONDS INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Moore. Lawrence J 21 03 73 Aim properly jointly-owned with right of su~ivorship musl be disclosed on Schedule F. iTEM NUMBER DESCRIPTION VALUE AT DATE 1. 8 Series E $25 Face Value Bonds OF DEATH 188 Series EE $100 Face Value Bonds 79,387.58 161 Series EE $500 Face Value Bonds (Attached is a printout of each bond mD number, issue date, issue price and face value. All of the bonds were cashed in on 2/21/03 for ~ total redemption of $79,387.58) Photocopies of the bonds are available, if requested. TOTAL (Also enter on mine 2, Recapitulation) $ 79,387.58 (If more space is needed, insed additional sheets of the same size) REV 1508 E× * {1.97) r.~'~ SCHEDULE E COMMONWEALTH"'"w"~'"~g~"'OFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERrTANCE TAX RETURN RESIDENT DECEDENT PERSONALPROPERTY ESTATE OF FILE NUMBER Moore. Lawrence J, 21 03 7~ Include the proceeds of litigation and the date the proceeds were received by the estate, All property joinUy-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER ; DESCRIPTION OF DEATH 1. Furnishings, tools and appliances (See Appraisal) 1,235.00 2. 1999 Saturn (Blue Book Value) 7,845.00 3. Social Security Underpayment 1,162.00 4. RECTV Refund 14.70 5. CenDyne 6.40 6. Sprint Refund 12.08 7. Allstate Insurance (Homeowners) 137.00 8. Allstate Insurance (Auto) 186.67 9. PP&L Refund 120.00 TOTAL (Also enter on line 5, Recapitulation) $ 10,718.85 (If more space is needed, insert additional sheets of the same size) ..v ,,,,, SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moore. Lawrence J. 21 03 79 ' If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Sharon A. Rinesmith (nee Moore) 16 Maple Lane Daughter Newville, PA 17241 C JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT ~ MADE Include name of financial inslilution and bank accounl number or similar identifying number~ Altach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real eslate. VALUE OF ASSET INTEREST DECEDENT'S INTERE~ 1. A. 9/15/99 PSECU Account including savings, checking and five 62,560.11 50. 31,280.0( (5) certificates of deposit 2. A New Cumberland F.C.U. account including savings and 81,208.97 50. 40,604.4c. four (4) certificates of deposit TOTAL (Also enter on line 6, Recapitulation) $ 71,884.5~, ~ ..... .pace is needed, insert additional sheets of the same size) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA I INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN ' / MISC. NON-PROBATE PROPERTY RESIDENT DECE DE N T__~._~__.~_~__J. ESTATE OF FILE NUMBER Moore. Lawrence J 21 03 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET ,. DESCRIPTION OF PROPERTY % OF ITEM fNCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP ID DECEDENI AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUF NUMBER ATTACH A COPY OF THE DEED FOR REAl. ESTAIE VALUE OF ASSET INTEREST {IF APPLICABLE 1. State Employee Retirement 364,424.16 There is no tax due since deceased was a State employee 2. :IRA at New Cumberland F.C.U. 67,055.57 100. 67,055.57 TOTAL (Also enter on line 7, Recapitulation) $ 67,055.5 flf mom ~n2c¢ i~ n,~,~do~ i,,.,~,-, ~,4.;~.., sheets of the same size) "EV'S,,E×,I,-9,, 'l SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Moore. Lawrence J, 21 03 73 Debts of decedent must be reported on Schedule I. iTEM NUMBER DESCRIPTION AMOUNT A. FUNERAL. EXPENSES: 1. Myers Funeral Home, 37 E. Main St., Mechanicsburg, PA 17055 7,760.00 2. Funeral dinner, Carlisle Catering, 19 W. South St., Carlisle, PA 17013 513.57 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / FIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees R. Mark Thomas, Esq, 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County - Register of Wills 336.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Patriot News - Publication of Estate Notice 99.79 8. Cumberland Law Journal - Publication of Estate Notice 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 16,284.36 (If more space is needed, insert additional sheets of the same size) SCHEDULE I CO~MONWE^LT. O~ PEN~S~LV^~,^ DEBTS OF DECEDENT, RES~DE,T DECE~ MORTGAGE LIABILITIES.~_& LIENS ESTATE OF FILE NUMBER Moore. Lawrence J 21 03 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Sadler Oil Company (Enola property) 186.98 2. Sprint Telephone (Newville property) 27.92 3. East Pennsboro Township (Sewer/refuse Enola property) 96.00 4. PP&L Electric (Newville property) 62.68 5. PP&L Electric (Enola property) 72.99 6. Sadler Oil Company (Enola property) 166.62 7. Agway Heating Oil (Newville property) 255.00 8. PP&L Electric (Newville property) 45.47 9. PP&L Electric (Enola property) 49.45 10. CV EMS 104.20 11. CV EMS 81.60 TOTAL (Also enter on line 10, Recapitulalion) $ 1,148.91 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moore. ~wrence J, 21 03 73 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do No[ List Trustee(s) OF ESTATE ]. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. Sharon A. Rinesmith Daughter 100 % 16 Maple Lane Newville, PA 17241 i ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 1|. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insed additional sheets of the same size) ~3/r'12/2g~13 16:51 7172d95755 L3BS LAW OFFICE PAGE ~2 A. Se~lem.nt B Typ~ o~ ko~fl OMB No 2502-0265 1 ~ FHA 2. ~ FmHA 3 ~ Cony. Unina File Number Loan Number Modgege Insurance Case Number' C, NOTE ~ This fo~ ia furnilhed to gNe you a l~men/of eMual sefflement coats. Amoun~ paid to and by the 9e~lemen[ agent are shewn I[ema D. NAME AND A~e ~ ~A;w .... ~,~J2~:: ~. ~;:~' Cathy S, R~d f~ C~e Read, N~I~, PA fTJal f~ Cente~ifle Roed, Neville, PA 17241 E NAME AND ADDRESS OF SELLER: F NAME AND AD~ ' * ~'~ ~, ~U~ ~f~ M~h~elebu~, PA f7055 LOCATION: P~CE OF 8E~l~: TIN; RESCISSION DATE ADJUSTMENTS t;OR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE 106. Cl~/flawR ~Kell ; ~ ~. C~ T.X~ tO ~07 Cou~ly Tm~ 03/~2003 I. 0~/0~/200~ $Z76. ~O ~07. Coun~ Ta~ea 03/14/2003 t= OZ/OZ/ZF~ 108 A.~.~.m.n~ 03/24/~003 ~ 07/0 /200~ S29D. 41 408. ~.elemen~ 03/14/2003 to 07/0~/2003 410. 1~2 ~ 41t 412, ~20 GROSSAM( IT DUE FROM BORR~R ~,7~.~3 420. GROSS AMOUNT DUE TO SELLER. ~0, ELLER ~ ~ $7, 7~7, 206 Seller ~ ~ $2,700. O0 ~. Sellmr ~le~ $2~ 700. O0 AOJUSTMENTS FOR IT~M~ UNPAID BY SELLER* ADJUSTMENTS FOR ITEMS UNPAID BY SELLER 220 TOTAL PAID BY/FOR BORROWER: 520. TOTAL REDUCTIONS : , L ENT TO. RD L R 303 ~ ( ~ HUD-q (3-a~) - RESPA, HB 4305,2 PAGE 1 $90 O0 100~ ~unl~ ~ope~v t.~ 3. O0 m~nt.e ~ $~8,3~ per month tO0? ~chool ~ l I. O0 mg~ SgO, 30 ~er month $88~, 30 10~. ~MZ/MZP 1. O0 ~ont~l ~ $ 6~, 20 p~ m~.th ~ 66. (,~c'ude~e~ve~emeNu~llOl-~O~ 2107-ZI~I $948. 75 ~ $35. O0 $900. O0 ~0~. oaxlmnm_~n '03 o 130~ Bowera Pem~ ~n~o/ I~ ~ ~ $3~. O0 ~ ~:zs.oo 1400 TOTAL SE~LEMENT CHARGE8 -- $4,2~. 11 $7~ 757.58 ~haron A. Rinesmith Eslate of Lewrenc David A. Berlc U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.[~FHA 2.[~]FmHA 3. [~CONV. UNINS. 4.[~VA 5. [-"]CONV. INS. t 6. FILE NUMBER: I 7. LOAN NUMBER: SETTLEMENT STATEMENT 200303267I 169628 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not ~ncluded in the totals. 1 0 ~ C'2~- ¥r~2~? PFEii'200303267r2) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Eric R. Lehman Sharon A. Rinesmith Members First Federal Credit U 3504 Stockwood Street TIN: 209-48-1654 5000 Louise Drive Mechanicsburg, PA 17055 Mechanicsburg, PA 17055 SSN: 195-60-3529 G. PROPERTY LOCATION: H. SETFLEMENTAGENT: 25-1843560 I SETTLEMENT DATE: 612 B Street Enola, PA 17025 Community Settlement Services, Inc. April 15, 2003 Cumberland County, Pennsylvania PLACE OF SE'I-rLEMENT 1271 Eisenhower Blvd. Suite A Harrisburg, PA 17111 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sale-., Price i 65,000.00 401. Contract Sales Price 65,000.00 102. Personal Property i 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 3,118.86 403 104. 404 105. , 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. Count/Frown Tax 04/16/03 to 01/01/04 I 152.75 406. Count/Frown Tax ,04/16/03 to 01/01/04 j 152.75 07. School Tax 04/16/03 to 07/01/03 t 170.25 407. School Tax 04/16/03 to 07/01/03 ! 170.25 108. Assessments to 408. Assessments to 109. 409. 110. I 410. 111. ! 411, 112. I ,, 412. 120. GROSSAMOUNTDUEFROMBORROWER ~ 68,441.86 420. GROSSAMOUNTDUETOSELLER ! 65,323.00 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest mone~/ . 1,000.00 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s/ 52,000.00 502. Settlement Charges to Seller ILine 1400) 5,915 44 203. Existing loan(s) taken subject to I 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. i 505. Payoff of second Mort~lage 2O6. ! 506. 207. 507. (Deposit disb. as proceeds) 208. ; 508. 209. i 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. County/Town Tax to I 510. Count/Frown Tax to 21 I. School Tax to 511. School Tax to 212. Assessments to t 512. Assessments to 213. I 513. 214.1 514. 215. 515. 216. 516. m 217. ! 517. 218. 219. r 518. : 519. 220. TOTAL PAID BY/FOR BORROWER 53,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 5.91544 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SE:f[LEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) I 68,441.86 601. Gross Amount Due To Seller (Line 420) I 65,323.00 302. Less Amount Paid By/For Borrower (Line 220) ]( 53,000.00) 602. Less Reductions Due Seller (Line 520) I( 5,915.44; 303. CASH ( X FROM) (TO) BORROWERil 15,441.86 603. CASH ( X TO) (FROM) SELLER I 59,407.56 The undersigned hereby acknowledge receipt, of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower (_/ /.?/1/.~ y~%/~,L~,,,,,-1F/?~//q/ Seller Sharon A. Rinesmith. Executrix of the Estate of Larry J Eric R. Lehman Moore OTA'L COMMISSION Based on Price $ (,~ -/o ,,+,~ou.uu ~ - 9ivision of Comnfission (line 700) as Foflows: ] BORROWER'S SELLER'S 2,625.00 to ERA NRT, Inc I FUNDS AT FUNDS AT 1,92500 . '."3 J.H. Troup SETTLEMENT SETTLEMENT ommission Paid at Settlement 4,550.00 'ransaction Fee to ERA NRT, Inc. 100.00 'EMS PAYABLE IN CONNECTION VVITH LOAN oan Origination Fee % to oan Discount % to ~ppraisal Fee to ;redit Report to .ender's Inspection Fee to /Iortgage Ins. App. Fee to ~ssumption Fee to ~pplication Fee to Members First Federal Credit Union 325.00 )ocument Preparation to Members First Federal Credit Union 275.00 Jnderwritin~] Fee to Members First Federal Credit Union 75.00 I'EMS REQUIRED BY LENDER TO BE PAID IN ADVANCE '~terest From 04/15/03 to 05/01/03 @ $ 7.123300/day ( 16 days 5.0000%) 113.97 vlort~]a~le Insurance Premium for months to tazard Insurance Premium for 1.0 years to RESERVES DEPOSITED WITH LENDER Hazard lnsurance 3.000 months (~ $ 19.50 per month 58.50 Mortgage Insurance mor, ths (~ $ per month Count¥/TownTax 3.000 months (~ $ 17.87 per month 53.61 SchoolTax 11.000 months ~ $ 68.14 per month 749.54 Assessments months I~ $ per month monks {~ $ pp, r monUm months ~ ~; per month A~,(]re,(]ate Escrow Adjustment months ~ $ per month -149.51 TITLE CHARGES Settlement or Closin~ Fee to Abstract or Title Search to Title Examination to Title Insurance Binder to Document Preparation to Notary Fees to Community Settlement Services, Inc. 10.0 Attorney's Fees to (includes above item numbers: · Title Insurance to Community Settlement Services 648.75 (includes above item numbers: , · Lender's Coverage $ 52,000.00 · Owner's Coverage $ 65,000.00 · Endorsements to Community Settlement Services, Inc. 100,300,900 150.00 Courier Fee to Community Settlement Services, Inc. 50.00 Tax Certification to Beth Williamson 2.00 :. GOVERNMENT RECORDING AND TRANSFER CHARGES · Recording Fees: Deed $ 38.50; Mortgage $ 70.50; Releases $ 109.00 :. Cibj/County Tax/Stamps: Deed 650.00; Mortgage 650.00 ,. State Tax/Stamps: Revenue Stamps 650.00; Mortgage 650.00 ;. L ADDITIONAL SETTLEMENT CHARGES . Survey to18.86 !. Pest Inspection to L 2003 County/Township Tax to Alicia D. Stine, East Pennsboro Tax Collector 214.44 L Home Warranty to Aon Home Warranty Services 399.00 3,1 ). TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section KI/~ 5,915.44 igning page I of this statement, the signalodes acknowledge receipt of a completed copy of page 2 of this tw,~ge st~t~er~~.. ( Cop:~f"nunit~ Settlement Services, Inc. ~,....~Mtlement Agent rtified to be a true copy. 1 Q2311530516E 12/1967 $12.50 $25.00 2 Q2328218348E 5/1968 $12.50 $25.00 3 Q2347821991 E 7/1968 $12.50 $25.00 4 Q2360336225E 8/1968 $12.50 $25. O0 5 Q2361710187E 9/1968 $12.50 $25.00 6 Q2539499774E 12/1970 $12.50 $25,00 7 Q2515930626E 1/1971 $12.50 $25.00 8 Q2515953402E 2/1971 $12.50 $25.00 9 C82656044EE 5/1985 $50.00 $100.00 10 C91239665EE 6/1985 $50. O0 $100.00 11 C912365586EE 6/1985 $50.00 $100.00 12 C91243155EE 7/1985 $50.00 $100.00 13 C91246036EE 7/1985 $50.00 $100.00 14 C94793046EE 8/1985 $50.00 $100.00 15 C9125834EE 8/1985 $50.00 $100.00 16 C94796261EE 9/1985 $50.00 $100.00 17 C94799555EE 9/1985 $50.00 $100.00 18 C95962845EE 10/1985 $50.00 $100.00 19 C95966115EE 10/1985 $50.00 $100.00 20 C95969454EE 10/1985 $50.00 $100.00 21 C95972454EE 11/1985 $50.00 $100.00 22 C95731258EE 11/1985 $50.00 $100.00 23 C95733640EE 12/1985 $50.00 $100.00 24 C95736924EE 12/1985 $50.00 $100.00 25 C95740263EE 1/1986 $50.00 $100.00 26 C95743479EE 1/1986 $50.00 $100.00 27 C114004003EE 2/1986 $50.00 $100.00 28 C95746715EE 2/1986 $50.00 $100.00 29 C114007374EE 3/1986 $50,00 $100.00 30 C114010612EE 3/1986 $50.00 $100.00 31 C114013889EE 4/1986 $50.00 $100.00 32 C 114017196EE 4/1986 $50.00 $100.00 33 C114020479EE 4/1986 $50.00 $100.00 34 C114023477EE 5/1986 $50.00 $100.00 35 Cl14026787EE 5/1986 $50.00 $100.00 36 C114029906EE 6/1986 $50.00 $100.00 37 0115699307EE 6/1986 $50.00 $100.00 38 0115703771EE 7/1986 $50.00 '~1~0 ........ 39 0120934517EE 7/1986 $50.00 $100.00 40 0120937885EE 8/1986 $50.00 $100.00 41 0120941507EE 8/1986 $50.00 $100.00 42 C120945583EE 9/1986 $50.00 $100.00 43 0120949324EE 9/1986 $50.00 $100.00 44 0120957604EE 10/1986 $50.00 $100.00 45 0120961577EE 10/1986 $50.00 $100.00 46 0120954834EE 10/1986 $50.00 $100.00 47 0124829013EE 11/1986 $50.00 $100.00 48 C 124833606EE 11/1986 $50.00 $100.00 49 0124837735EE 12/1986 $50.00 $100.00 50 0124841767EE 12/1986 $50.00 $100.00 51 0128383752EE 1/1987 $50.00 $100.00 52 0128387594EE 1/1987 $50.00 $100.00 53 0128391398EE 2/1987 $50.00 $100.00 54 0128395363EE 2/1987 $50.00 $100.00 55 0128399343EE 3/1987 $50.00 $100.00 56 0128403165EE 3/1987 $50.00 $100.00 57 0128407349EE 4/1987 $50.00 $100.00 58 0128410725EE 4/1987 $50.00 $100.00 59 0145056712EE 4/1987 $50.00 $100.00 60 0145060624EE 5/1987 $50.00 $100.00 61 0145064463EE 5/1987 $50.00 $100.00 62 0145068071EE 6/1987 $50.00 $100.00 63 0145071801EE 6/1987 $50.00 $100.00 64 0145075794EE 7/1987 $50.00 $100.00 65 0145079408EE 7/1987 $50.00 $100.00 66 0145084136EE 8/1987 $50.00 $100,00 67 0145087240EE 8/1987 $50.00 $100.00 68 0145091752EE 9/1987 $50.00 $100.00 69 0145095766EE 9/1987 $50.00 $100.00 70 C154099082EE 9/1987 $50.00 $100.00 71 C154103769EE 10/1987 $50.00 $100.00 72 C154108305EE 10/1987 $50.00 $100.00 73 C154112915EE 11/1987 $50.00 $100.00 74 C154117564EE 11/1987 $50.00 $100.00 75 C154122383EE 12/1987 $50.00 $100.00 76 C154126853EE 12/1987 $50.00 $100.00 77 C154131689EE 1/1988 $50.00 $100.00 78 C161402224EE 1/1988 $50.00 $100.00 79 C161406911EE 2/1988 $50.00 $100.00 80 C161411502EE 2/1988 $50.00 $100.00 81 C161416049EE 3/1988 $50.00 $100.00 82 C161420592EE 3/1988 $50.00 $100.00 83 C164745150EE 3/1988 $50.00 $100.00 84 C164749852EE 4/1988 $50.00 $100.00 85 C164754480EE 4/1988 $50.00 $100.00 86 C164758951EE 5/1988 $50.00 $100.00 87 C164763629EE 5/1988 $50.00 $100.00 88 C164768277EE 6/1988 $50.00 $100.00 89 C164772917EE 6/1988 $50.00 $100.00 90 C179526163EE 7/1988 $50.00 $100.00 91 C179526790EE 7/1988 $50.00 $100.00 92 C179531883EE 8/1988 $50.00 $100.00 93 C179537782EE 8/1988 $50.00 $100.00 94 C179543839EE 8/1988 $50.00 $100.00 95 C179550251EE 9/1988 $50.00 $100.00 96 C179556819EE 9/1988 $50.00 $100.00 97 C179563422EE 10/1988 $50.00 $100.00 98 C179570105EE 10/1988 $50.00 $100.00 99 C179576766EE 11/1988 $50.00 $100.00 100 C179583510EE 11/1988 $50.00 $100.00 101 C179590116EE 12/1988 $50.00 $100.00 102 C179596665EE 12/1988 $50.00 $100.00 103 C196107146EE 1/1989 $50.00 $100.00 104 C196113519EE 1/1989 $50.00 $100.00 105 C196120647EE 2/1989 $50.00 $100.00 106 C196127667EE 2/1989 $50.00 $100.00 107 C196132772EE 3/1989 $50.00 $100.00 108 C196138974EE 3/1989 $50.00 $100.00 109 C196145578EE 3/1989 $50.00 $100.00 110 C196151948EE 4/1989 $50.00 $100.00 111 C196158309EE 4/1989 $50.00 $100.00 112 C196164500EE 5/1989 $50.00 $100.00 113 C196170801EE 5/1989 $50.00 $100.00 114 C196177389EE 6/1989 $50.00 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8/1993 $250.00 $500.00 223 D29862289EE 8/1993 $250.00 $500.00 224 D39638242EE 9/1993 $250.00 $500.00 225 D29862904EE 9/1993 $250.00 $500.00 226 D39650632EE 10/1993 $250.00 $500.00 227 D40488367EE 10/1993 $250.00 $500.00 228 D39651856EE 11/1993 $250.00 $500.00 229 D40488995EE 11/1993 $250.00 $500.00 230 D40489624EE 12/1993 $250.00 $500.00 231 D34970062EE 12/1993 $250,00 $500.00 232 D34971161EE 1/1994 $250.00 $500.00 233 D40490251EE 1/1994 $250.00 $500.00 234 D34972358EE 2/1994 $250.00 $500.00 235 D40490888EE 2/1994 $250.00 $500.00 236 D34973455EE 3/1994 $250.00 $500.00 237 D40491506EE 3/1994 $250.00 $500.00 238 D42320345EE 4/1994 $250.00 $500.00 239 D40492126EE 4/1994 $250.00 $500.00 240 D42321418EE 5/1994 $250.00 $500.00 241 D40492733EE 5/1994 $250.00 $500.00 242 D42322606EE 6/1994 $250.00 $500.00 243 D40493346EE 6/1994 $250.00 $500.00 244 D42323909EE 7/1994 $250.00 $500.00 315 D49605104EE 3/1997 $250.00 $500.00 316 D43917458EE 4/1997 $250.00 $500.00 317 D49612585EE 4/1997 $250.00 $500.00 318 D43918050EE 5/1997 $250.00 $500.00 319 D43918624EE 5/1997 $250.00 $500.00 320 D38602373EE 5/1997 $250.00 $500.00 321 D43919197EE 6/1997 $250.00 $500.00 322 D48083013EE 6/1997 $250.00 $500.00 323 D43919759EE 7/1997 $250.00 $500.00 324 D48091783EE 7/1997 $250.00 $500.00 325 D48472326EE 8/1997 $250.00 $500.00 326 D49972372EE 8/1997 $250.00 $500.00 327 D49509110EE 8/1997 $250.00 $500.00 328 D48472924EE 9/1997 $250.00 $500.00 329 D49517771EE 9/1997 $250.00 $500.00 330 D48473519EE 10/1997 $250.00 $500.00 331 D49526434EE 10/1997 $250.00 $500.00 332 D48474117EE 11/1997 $250.00 $500.00 333 D50919316EE 11/1997 $250.00 $500.00 334 D48474739EE 12/1997 $250.00 $500.00 335 D48475319EE 1/1998 $250.00 $500.00 336 D48475908EE 2/1998 $250.00 $500.00 337 D48476455EE 3/1998 $250.00 $500.00 338 D48476985EE 4/1998 $250.00 $500.00 339 D48477547EE 5/1998 $250.00 $500.00 340 D48478078EE 5/1998 $250.00 $500.00 341 D48478609EE 6/1998 $250.00 $500.00 342 D48479095EE 7/1998 $250.00 $500.00 343 D48479614EE 8/1998 $250.00 $500.00 344 D50544141EE 9/1998 $250.00 $500.00 345 D50544670EE 10/1998 $250.00 $500.00 346 D50545240EE 11/1998 $250.00 $500.00 347 D50545770EE 12/1998 $250.00 $500.00 348 D50546310EE 1/1999 $250.00 $500.00 349 D50546841 EE 2/1999 $250.00 $500.00 350 D50547353EE 3/1999 $250.00 $500.00 351 D50547862EE 4/1999 $250.00 $500.00 352 D50548375EE 4/1999 $250.00 $500.00 353 D50548883EE 5/1999 $250.00 $500.00 354 D50549408EE 6/1999 $250.00 $500.00 355 D50549896EE 7/1999 $250.00 $500.00 356 D50550359EE 8/1999 $250.00 $500.00 357 D50550804EE 9/1999 $250.00 $500.00 1549,750.00 1599,500.00 APPRAISAL Personal Property of Z~;/~x~c~/~:, :/~f' /~ ~/--~/f~ ~/E ~/c c ~ /J~ ~ / 7~/ Appraised by Chuck E., Bricker AU094-L Date ~-~ - 0 ~ ITEM VALUE ITEM VALUE Kelley Blue Book Used Car Values Page I of 1 KELLEY BLUE BOOK Blue Book Retail Report / Pennsylvania / March 14, 2003 1999 Saturn SW1 Wagon 4D 4-Cyl. 1.9 Liter Automatic Front VVheel Drive 59,000 Miles Equipment Air Conditioning Cruise Control Dual Front Air Bags Power Steering AM/FM Stereo ABS (4-Wheel) Tilt Wheel Cassette Alloy Wheels Blue Book Suggested Retail $7,845 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. Copyright © 2003 by Kelley Blue Book Co., All Rights Reserved. Mar-Apr 2003 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. Kelley Blue Book assumes no responsibility for errors or omissions.(v.03030) http://www.kbb.corn/kb/ki.dli/kw.kc.ur?aweb;686191 ;&;r&40;Saturn; 1999%20SWI &5;S... 3/14/2003 ' COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIRD STREET- P.O. BOX 1147 HARRISBURG, PENNSYLVANIA 17108-1'147 TOLLFREE: 1-800-633-5461 www.sers.stale.pa.us June 19, 2003 SHARON A RINESMITH 16 MAPLE LN NEWVILLE PA 17241 Re: LAWRENCE J MOORE SSN: 187-32-2521 Dear Beneficiary: We are writing to you regarding the above named account. The enclosed forms must be completed by you, according to the printed instructions, before we can proceed with the processing of this account for payment. Please note: The Retirement Code does not provide for the payment of interest on the principal sum of a death benefit. If you are a spouse, please read the enclosed in[ormation pertaining to the recent change in the Federal tax law. Also, please complete the Election form and the Trustee to Trustee Transfer (if applicable) and return to the system as soon as possible. If you are not a spouse, please complete the Withholding Election form along with the required forms and return to this system as soon as possible. To aid you in making an option selection, the following information is provided. Death Benefit Payable to you: $364,424.16 Taxable Portion: Non Taxable Portion: $364,424.16 $o.oo If you have any questions or need assistance, please contact the field office nearest you at 1-800-633-5461. Sincerely, Linda M. Miller, Director Benefits Determination Division Enclosures I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII CUNA MUTUAL GROUP January 27, 2003 CUID #: 27773 SHARON A RINESMITH 16 MAPLE LANE NEWVILLE, PA 17241 RE: INDIVIDUAL RETIREMENT ACCOUNT OF LAWRENCE MOORI" Dear SHARON RINESMITH: As a beneficiary of the IRA of LAWRENCE MOORE at NEW CUMBERLAND FCU you are entitled to 100% of the funds in this account. The value of your share of this IRA as of the owner's date of death was $67,055.57. To receive the funds: 1. Complete the enclosed Benefit Selection Form Select a payment option Select a payment method Complete the witholding election(s) Provide your Social Security number, date of birth, and your daytime telephone number Sign and date the form 2. Return the form in the envelope provided. If you fail to return the form and receive your minimum distribution by the deadline for receiving payments, you may be subject to an IRS penalty. If you have questions, contact a tax advisor. 3. Keep this letter and the withholding notice pages for your records Shortly after we receive your Benefit Selection Form, NEW CUMBERLAND FCU will be authorized to disburse the IRA funds to you in the manner you elect. Please contact the IRA representative at NEW CUMBERLAND FCU if you have any questions regarding this matter. Sincerely, CUNA Mutual Group IRA Services Enclosures: Benefit Selection form Witholding Notice cc: NEW CUMBERLAND FCU A standard of excellence itt Central Pennsylvania since 1910 · BOYD L. MYERS, JR., Supervisor uneral Home, Inc. MEc. tcsBuRo, 7> 760-3 , STATEMENT OF FUNERAL GOODS!'AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below. If you selected a fune,ral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approv~if you se)¢cted arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of ~--or c.a (f t-.~ ~ ,- ~ . tl'~ .... > r ~ Date of Death Charge to: .~ 'j-¥./ o, \ /Z .,~ . ,,, , & / ~ / 7 ~ ,.,...,.'.. ~: .... ~ ~..;.: t o,.: [/.. ,~.7..! Name Address City State A. CHARGE FOR SERVICES SELECTED: Other clothing 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff .... $ 7'[~ ,,~! $ Embalming ...................... $ -,r ,., ~ Cremation urn ................... $__ Other preparation of body (Description) OTHER $ ............................... s'/,- r I $ SUB-TOTAL OF PROFESSIONAL SERVICES ......... Al $ ~ ~-~ / $__ TOTAL MERCHANDISE SELECTED .................. B $ 2. FACILITIES AND SERVICES Use of facilities and services for C. SPECIAL CHARGES: viewing (Visitation/Wake) ......... $-?-;.~. ! Forwarding of remains to $ Use of facilities and services (Funeral Home) $~ t:--~ for funeral ceremony ............ $ -[ ..... ! Receiving of remains from Use of facilities and services for Memorial Service ............... $ (Funeral Home) Use of equipment and services .. Immediate Burial ................. for graveside service ............. $') - ,. } Direct Cremation ................. Other use of facilities $ SUB-TOTAL OF SPECIAL CHARGES ................ C D. CASH ADVANCED ............................... $ 3',.,. [ Opening Grave .................. $ tTt-Z~,.. SUB-TOTAL OF FACILITIESlEQUIPMENT ........... A2 $ '7[',~-.~ I Cemetery Equipment .............. $ [ Lot and Deed .................... $__ 3. AUTOMOTIVE EQUIPMENT Newspaper Notices--Local ......... $ ?t Vehicle to transfer remains to Funeral Home· Newspaper Notices--Out-of-town .... $ Local ........................... $ ~'7-~- ¢. { Telephone & Telegrams ........... $ Hearse (Casket Coach) Airfare ......................... $ . Local ........................... $ 7-~-: ~) Clergy/Mass Offering .............. $ 7.,% Limousine ~' Pallbearers $ Local .......................... : $ --r' [ ~x~. ...................... .... Certified Copies of the Deat~ Family car (~ Certificate /..~ . f.....2_. '~ ......... $ ~.-.~ o Local ........................... $ '" ~ Police Escort .................... $ Flowers ........................ Flower car or floral disposition f.~ ~ Local ........................... $ -r~_ .. [ Vault Service Charge .............. Lead car/clergy car rq~%¢ t~2,--4 .... .. '~ ~ o,~ ,~. $ /.~'~-O" Local ........................... $ iT.'-- c ~ {'4k Car for pallbearers ~ $ ~ Local ........................... $ ........ Out of town transportation ......... $ .... $ $ ..... $ $ ..... SUB-TOTAL OF ADVANCES ....................... D $"~.5'~ ' SUB-TOTAL OF AUTOMOTIVE EQUIPMENT ........ A3 ~'['i.,, i We charge you for our services in obtaining: TOTAL OF PROFESSIONAL SERVICES, (specify cash advances that are marked, up) FACILITIES AND AUTOMOTIVE EQUIPMENT ................................... A %. SUMMARY OF CHARGES B. CHARGE FOR MERCHANDISE SELECTED: ~ A. Professional Services, Facilities and Casket .......................... $ 2. ~ ~:' Equipment, and Automotive (Description) [ ~ ? t<} (L lc.. ~.$~. x~ Equipment ...................... $ ~c~.~(-') '" ~h ,'~,---'t. r- ('~-:,~ B. Merchandise ..................... $ ~;t_c,'5 Other Receptacle ................. $__ C. Special Charges .................. $ (Description) D. Cash Advances ................... $ ::5 TOTAL OF ALL SECTIONS ........................ Outer burial container ............. $ ci~',-.) O,X x,/, PAID AT TIME OF OR PRIOR TO .,.~ ~..., ~x BALANCE DUE .................................. f7 7~o o (Description) .c .. 't .~o.,.-a..{ ARRANGEMENTS ................................ $ Acknowledgement cards ........... $-~"~ c ! REASON FOR EMBALMING Register book(s) .................. $ ~ ~ ~-~',,-', /',,./' LJ , t- ~ Memory folders .................. $ "7;, c [ If any law, cemetery, or crematory requirements have required the purchase Prayer cards ..................... $ of any ,of the items listed above the law or requirement is explained below. Temporary grave ~narker ........... $__ ( ',~ t: ~ /, ,, . / ' ( ~?r;-' '-"~' ::~o lt ...... Burial clothing ................... $__ /?,.~,, ~. / ! (- ~ .~.,',F;~.,,- . I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected, l also agree to ma~kepayment of $ 'er;- t:~ t/ within .'v: d2, days. I agree to be jointly and severally liable with anyone else who signs below. A late charge of /. 5 '?,, per month amountinR to /.~' %'" per year will be applied to the unpaid balance beginning ; /' days from the date of this agreement. I will,lsD pay to the Funeral DirectSr ali reasonable-~-cost--s paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs· Any additional services or merchandisgordered or requested after the date of this agreement will be considered, part,. . of this agreement.., and tl~e ,cost thereof will be reflected on the final bill or statement:~ (Pnrch~er) /"' ?' " ' "-~lJate) (Purchaser) (' . ....... (Licensed Funeral Ditl:~t9~ WHITE - Funeral Director YELLOW - Customer ............ Lm/OICE CARLISLE CATER1N~i 1 9 WEST SOUTtt STREET CARLISLE, PA 17013 (717)9.58-5937/F~X 9.58-49o9 E-MAIL: CARLISLECATERINf@PA.NET BILL TO: INVOICE DATE: 1 l JAN 03 INVOICE NO: 9-0037 DELIVERY TIME: 19.30 LOCATION: SHIREMANSTOWN BOROUfH HALL TERMS: CREDIT CARD/PAID IN FULL QTY' ORDERED/DELIV'ERED FOOD/SERVICES UNIT PRICE TOTAL 45 buffet # 1 10.50 $472.50 add coffe/soda/dessert 6 table cloths-guest tables 2.00 12.00 tax: 29.07 total: $513.57 PLEASE MAKE CHECKS PAYABLE TO: EWING/SHELLY, INC. Payment is due on receipt of invoice unless otherwise stated in term above. We accept MC/VISA/AMEX Overdue account are subject to a 1.5% interest 18% per annum) which accrues from the date stated in terms. A 25.00 returned check fee applies. If legal action is required to settle and account, fees are payable by client EIN25-1817230 CONHONNEALTH OF PENNSYLVANIA BUREAU OF ZNDZVZDUAL TAXES DEPARTNENT OF REVENUE g& .~.._~ INHERITANCE TAX DIVISION DEPT. 18060! HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-l~47 EX AFP C01-05) DATE 11-24-2005 ESTATE OF NOORE LAWRENCE J DATE OF DEATH 01-08-2005 FILE NUNBER 21 03-0075 R HARK THONAS 'i , -*i * L COUNTY CUHBERLAND 101 S NARKET ST ACH 101 HECHANTCSBURG PA 17055 Amount Remitted HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WTLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-Z547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AN]) ASSESSHENT OF TAX ESTATE OF NOORE LAWRENCE J FILE NO. 21 03-0073 ACN 101 DATE 11-14-2003 TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) (1) 139~416.78 NOTE: To /nsura proper 2. Stocks and Bonds (Schedule B) (2} 79z387.58 credit ~o your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) . O0 suba/t the upper portion 4. Nortgages/Notes Receivable (Schedule D) (4) . O0 of this fore with your $. Cash/Bank Depos/ts/Nisc. Personal Property (Schedule E) (E) 10;718.85 tax payment. 6. Jo/ntly Owned Property (ScheduZe F) (6) 71;884.55 7. Transfers (Schedule G) (7) 67~ 055.57 $. Total Assets (B) 368,463.33 APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Costs/N/sc. Expanses (Schedule H) (9) 16,284.36 10. Debts/Hortgage Liabil/t/es/L/ans (Schedule 1) (10) I, 148.91 11. Total Deductions (11) ]7. 433. ~7 12. Net Value of Tax Return (12) 351,030.06 13. Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J} (13) . O0 14. Nat Value of Estate Sub~ect to Tax (14) 351,030.06 NOTE: If an assess;ant ~as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of L/ns 14 at Spousal re*e (15) . O0 X 00 = . O0 16. Amount of L/ns 14 taxable at L/heal/Class A rats (16) 351,030.06 X 045 = 15,796.35 17. Amount of L/ne 14 at SibZ/ng rats (17) .00 X 12 = .00 18. Aeount of L~ne 14 taxable st Collateral/Class B rats (18). . O0 X 15 = . O0 19. Principal Tax Due TAX CREDITS: (19)= 15,796.35 PAYHENT / RECP. zp[ DT$COUNT DATE/ NUNBER INTEREST/PEN PAID (-) AHOUNT PAID 04-03-2003 CD002390 789.82 23,500.00 TOTAL TAX CREDIT I 24,Z89.82 BALANCE OF TAX DUEI 8,493.47CR INTEREST AND PEN. / .00 TOTAL DUE / 8,493.47CR ~ IF PAZD AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1~ NO PAYNENT ZS REQUZRED. FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR)., YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. RESERVATION: Estates of decedents dying on or before December 1Z, 19AZ -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2l~0 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91~0). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT REFUND (CR): A refund of a tax credit~ which was not requested on the Tax Returnj may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special 2~-hour answering service for forms ordering: 1-BOO-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-~?-$OZO (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty [60) days of receipt of this Notice by: --written protest to the PA Department of Revenua~ Board of Appeals~ Dept. ZB1021, Harrisburg, PA 17128-1021j OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB060I, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inharltance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: 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 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 tho tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January l, lgBZ 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 198Z through 2003 ara: Interest Daily Interest Daily Interest Daily Year Rate Facter Yaa__r Rata Factor Yea__r Rate Factor 1982 ZOZ .0005q8 1987 92 .O00Z~7 1999 7Z .O0019Z 1983 162 .000~58 1988-1991 XXZ .000301 ZOO0 8Z .O00Z19 X98~ llZ .O0030X 1992 92 .O00Z~? ZOOl 92 .O00Z~7 1985 132 .000356 1993-199~ 7Z .O00lgZ ZOOZ 62 .00016~ 19B6 lOZ .000~7~ 199S-199B 92 .O00Z~7 2003 SZ --Interest is calculated as faI1ows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAllY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of tho 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 NameofDecedent: Lawrence J. Moore Dateo£Death: January 8, 2003 Will No.: Admin. No.: 2003-73 Pursuant to Rule 6.12 of the Supreme Court Orphans' Com-t Rules, ! re?orr the following with respect to completion 0fthe adm/nistration of the above-captioned estate: 1. State whether administration o£the estate is complete: Yes 2. If the answer is No, state when the personal representative reasonably bel/eves 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 [] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~-~ No [-']. c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphm~s' Court and may be attached to this report. Date: 1 2/6/04 Signature R. Mark Thomas, Esq. Name ~ Mechanicsburg, PA 17055 Address ~'~ 717 796-2100 ,.? Telephone No. " C%~acity: [--] Personal Representative ~-~ Counsel forCersonal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 THOMAS R MARK 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055 RE: Estate of MOORE LAWRENCE J File Number: 2003-00073 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/08/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISTON DEPT. 280601 HARRISBURG, PA 171Z8-0601 R HARK THOMAS 101S HARKET ST NECHANICSBURG PA 17055 COMNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT DATE 1Z-II-ZOOS ESTATE OF HOORE DATE OF DEATH 01-08-2005 FILE NUMBER Z1 05-0075 COUNTY CUMBERLAND ACN 101 F Amount Remitted REV-Z6D? EX AFP (~tl-O$) LANRENCE J MAKE CHECK PAYABLE AND REHZT PAYMENT 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 fore with your tax payment. CUT ALONG THIS LINE ~ RETA'rN LONER PORTION FOR YOUR RECORDS *-~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF H00RE LANRENCE J FZLE NO. 21 05-0075 ACN 101 DATE 12-22-200:5 THIS STATEHENT ZS PROVIDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SNO#N BELON ZSA SUNHARY OF THE PRINCIPAL TAX DUE, APPLZCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED ZNTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 11-17-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID 04-05-2005 CDO02590 '~ 789.82 12-04-2005 REFUND ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), 15,796.55 .00 25,500.00 8,495.47- TOTAL TAX CREDIT 15,796.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR INSTRUCTIONS.