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Home My WebLink About04-0666Name of Decedent: Date of Death: Will No. 21-04-0666 To the Register: REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Holles B. Kern July 8, 2004 Admin. No. 2004-00666 I certify that notice of (beneficial interest) 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 July 2-~ , 2004. Nalne Frank D. Kern Denise M. Askins Ad&ess 2327 Ridge Club Circle, Wichita, KS 67205 1114 Carrington Court East, Mechanicsburg, pA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: Capacity: Thomas E. Flower, Esquire SAIDIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Personal Representative X Counsel for Personal Representative Estate of aiso known as Register of Wills of CU V[BERL^ND County, Pennsylvania PETITION FOR GRANT OF LETTERS HollesB. Kem No. Oq'° who is/are 18 years of age or older, apgJy(ias) for: Social Security No. 269-28-7519 (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Let~rs Tastamentar/and aver that Petitioner(s} is/am the execut, rix the Decedent, datedApril 6, 2004 and codicil(s} dated . named in the last Will of State relevant circ~i;~,ncas, e.g., renunciation, death of executor, etc. Except as follows, Oecedent did not merry, was not divorced, arid did not have a chill born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: ] B. Grant of Letters of Administration (c.ta.; d.b.n.c.ta; pendente lite; durant~-absentia; ~;'ante minoritate) Pstitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spo?e (if any) and heirs: l, Name Relationship (COMPLETE IN ALL CASES:) Attach additional sheets if necessar/. Decedent was domiciled at death in Silver Spring Township, Cumberland Residence County, Pennsylvania with his/her last family or principal residence at 7,0 Greenspring Drive, Mechanicsbur~, Cumberland County, Pennsylvania (list street, number, and municipality) Decedent, then 70 years of age, died July/8, 2004 at 70.Greenspring Drive, Silver Spring Township, Cumberland Co., PA (Location) Decedent at death owned propeFr/with estimated values as follows: (if domiciiad in PA) All personal prope~y (If not domiciled in PA) Personal property in Pennsylvania (if not domiciled in PA) Personal property in County Value of real estate in Pennsylvania S 62,000.00 $ $ $ 167,000.00 situated as follows: 70 Greenspring Drive, Silver Sprin~ Township, Mechanicsbur~, Cumberland Co.~ PA Wherefore, Per, loner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented wiih this Petition and the grant of the appropriate form to the unciars',~ncd: Si~netore · T~'ped or ptinted name and residence Denise M. Askins 1114 Carrin~ton Court East Mechanicsburg, PA 17050 Oath of Personal Representative Commonwealth of Ponneylvanla Coumy of Cumk~rland The Petifionar(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 Petitiona~(s) and thaL as personal represR'~tafive(s) of the Decedent, Petitioner(s) will well and truly adrr~nister the estate according to law. Sworn to or affirmed and subscribed Denise M. Askins ~/~ before me this_L~..~ay of ] ] 14 Can*ington CouTt East % For th, R,9 rG Estate of Holies B. Kem Social Security No: 269-28-7519 Oate of Oeath: July 8, 2004 ANO NOW, this ~ (_0~C~ day of ~-'~.x~qJ~ 2004 of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS OECREED that Letters [] Testamentary [] Of Administration (c.t.a,; d.b.n.c.t.a.; pendente lite; durante abaentia; duranto mifloritate) are hereby granted to Denise M. Askins in the above estate and that the instrument(s) dated ApT~I 6, 2004 described in the Petition be adm~ed to probate and filed of record as the last Will of Decedent. FEES Lst~rs ........... $ ,~. Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... Extra Pages ( Codicil ........... JCP Fee .......... $ Inventory. ......... Other ........... $ TOTAL ......... Attorney: Thomas E. Flower, Esquire LD. No: 83993 Address: 2109 Market Street Camp Hill~ PA 17011 Telephone: (717) 737-3405 prepare~ by the Pe~npylvanla Bar Aesoclaflon Copyright (c) 1996 farm software only CPSystems, inc. Fo~m RW-f 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 10544989 Local Registrar 4 .Ly q, aoo4 Date COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT OF HEALTH · VITAL RECORDE CERTIFICATE OF OEATH ' Holies B. Kern '. ,. 269 519 ~ntcs~, PA ~7050 ~ Samuel Rhoads D4ant~9 M. ASkt~S 2004 FD-014889 12:40 2004 SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA LAST WILL AND TESTAMENT OF HOLLES B. KERN I, Holies B. Kern, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby rev6king all Other Wills and Codicils heretofore made by me. ~ ~ FIRST I direct the payment of my just debts and expenses of my last_~Uness and funeral from my estate as soon after my death as conveniently may be done~ If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate in such amount as they shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA SECOND I give, devise and bequeath all the rest, residue and remainder of my estate in equal shares unto my children, Denise M. Askins and Frank D. Kern, per stirpes. THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in their absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments; C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in their sole SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my personal representative in their sole discretion may deem wise without the necessity of obtaining any court approval thereof; F. To make distribution hereunder either in cash or kind, as my personal representative in their discretion may deem wise. FIFTH I do hereby nominate, constitute and appoint my daughter, Denise M. Askins to act as Executrix of this my Last Will and Testament. Provided, however, that if Denise M. Askins is unwilling or unable to act as Executrix, I direct the duties of Executor to be performed by my son-in-law, Michael A. Askins. SIXTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Holies B. Kern, have hereunto set my hand and seal to this my Last Will and Testament, consisting of four typewritten pages, the first three of which bear my initials in the margin for identification, this __ ,20°4. day of Holles B. Kern 3 Signed, sealed, published and declared by the above-named Holies B. Kern, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. ADDRESS SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Slreet Carlisle, PA 4 SAIDIS SHUFF, FLOWER & LINDSAY 26W. High Street Carlisle, PA COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : We, Holies B. Kern~,dff,~ ~-../~V~,'/~_~f--~ and 3~L~l ~Cl ~ %~ ,~the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. /,Witness Subscribed, sworn to and acknowledged before me by Holies B. Kern, the Testatrix, and subscribed to and sworn or affirmed to before me by ,~ra. d-~,r~,7,~r" and ~ witnesses, this ~%day of I-IOta I ,2004. Camp Hill, Cumberland Cou My Commission EXpires March 29,~Y2008 #O?Al~r SEtll. Notary Public Sallie All,house, Notary Publlo 5 JOHN E. SLIKE ROBERT C. SAIDIS GEOFFREY S. SHUFF JAMES D. FLOWER, JR. CAROL J. LINDSAY BRIAN C. CAFFREY GEORGE F. DOUGLAS, III MATTHEW J. ESHELMAN~' THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN SMITH LAW OFFICES SAIDIS, SHUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 EMAIL: attorney@ssfl-law.com www.ssfl-law.com October 20, 2004 CARLISLE OFFICE: 26 W. HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 ~'Board Certified by the American Board of Certification in Creditors' Rights Representation REPLY TO CAMP HILL Register of Wills, Agent CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, PA 17013 Re'- Estate of Holles B. Kern No. 21-04-0666 Dear Sir/Madam: Enclosed please find the original and two copies of an Inheritance Tax Return for the above Estate, a check in the amount of $15.00 for your filing fee and a check in the amount of $3,400.91 for the tax due. Will you please file the original return, time-stamp a copy and mail the copy back to us in the envelope provided. If you have any questions, please feel free to contact this office. Very truly yours, SAIDIS, SHUFF, FLOWER & LINDSAY Thomas E. Flower TEF/sa Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004525 ASKINS DENISE M 1114 CARRINGTON COURT EAST MECHANICSBURG, PA 17050 ........ fod ESTATE INFORMATION: SSN: 269-28-7519 FILE NUMBER: 21 04-0666 DECEDENT NAME: KERN HOLLES B DATE OF PAYMENT: 10/21/2004 POSTMARK DATE: 10/21/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,400.91 TOTAL AMOUNT PAID: $3,400.91 REMARKS: KERN SEAL CHECK//1020 INITIALS: CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ O4 0666 COUNTY CODE YEAR NUMBER [~ O U DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Kern, Holies B. DATE OF DEATH (MM-DD-YEAR) 07/08/04 IDATE OF BIRTH (MM-DD-YEAR) 10/10/33 SOCIAL SECURITY NUMBER 269-28-7519 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER []1. Odginal Return [~4. Limited Estate [~6. Decedent Died Testate (Altach copy of Will) [-~9. LitigaUon Proceeds Received I--]2. Supplemental Retum ~--] 4a. Future Interest Compromise (det~ of deaLh after 12-12-82) r~7. Decedent Maintained a Living Trust (A~ch ~py e~Trus~) [~10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95) []3. Remainder Return (date o[ death pdor to 12-13-82) --15. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (A,ach Sc, O) NAME Thomas E. Flower, Esquire FiRM NAME (IfApplicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 737-3405 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. JoinUy Owned Property (Schedule F) (6) [--] Separata Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I)(10) 11. 12. 13. 14. COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 174,900.00 0.00 0.00 0.00 8,961.56 17,375.04 28,714.08 22,164.10 132,210.90 229,950.68 Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (11) 154,375.00 (12) 75,575.68 (13) 0.00 (14) 75,575.68 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at lhe spousal tax rate, or transfers under Sec. 9116 (a)(1.2) ................................................. _0._:..0.__0__ x .0 ___ (15) 0.00 16. Amount of Line 14 taxable at lineal rate 75,575.68 x .0 45_ (16) 3,400.91 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) 3,400.91 Decedent's Complete Address: STREET ADDRESS 70 Greenspring Drive Cl'Dr'. , Mecnanicsburg STATE PA IZlP 17050 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 3,400.91 0.00 0.00 0.00 3,400.91 0.00 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. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,400.91 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after Becember 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 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 true, correct and complete, Declarationjof preparer other than the personal representative is based on all information of which preparer has any knowledge. SlGNAT~IRE .OF PERSON RE,.~i~ONSIBLE FOR'.FILIN, G RETURN ADDRESS Denise M. Askins, 1114 Carrington Cou~ East, Mechanicsburg, PA 17050 DATE S~E OF PREPARER_OTHE'-'R~T,H'~N REPRESENTATIVE DATE ,..--- Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. {}9116(1.2) [72 RS. {}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 RS. {}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. REV-1502 EX+ (6-98),~,1~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 All real property owned solely or as a tenant in common must be reported at fair market value. Fair markel value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 174,900.00 Dwelling house and lot, 70 Greenspring Dr, Mechanicsburg, PA, gross sale price TOTAL (Also enter on line 1, Recapitulation) $ 174,900.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) CONIMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-O666 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on ScheduLe F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. Wachovia checking acct. no. 1000293236826, principal bal. $2,168.62 plus accrued int. $0.11 Wachovia checking acct. no. 1010092967742, principal bal. $5,234.95 plus accrued int. $0.08 Wachovia savings acct. no. 3082294497041 :Prorated property taxes returned at settlement upon 70 Greenspring Dr., Mechanicsburg 2,168.73 5,235.03 30.03 1,527.77 TOTAL (Also enter on line 5, Recapitulation) $ 8,961.56 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~ COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 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 DAUGHTER A. DENISE M. ASKINS FRANK D. KERN 1 1 14 CARRINGTON CT. EAST MECHANICSBURG, PA 17050 2327 RIDGE CLUB CIRCLE WICHITA, KS 67205 SON JOINTLY-OWNED PROPERTY: LETfER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A,B 02/17/2004 AMEX investment acct. #327386199021 52,125.13 1/3 17,375.04 i i TOTAL (Also enter on line 6, Recapitulation) $ 17,375.04 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 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 is es. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. A~i'ACH A COPY 0F THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE} VALUE 1. 1/3 of AMEX investment acct. # 327386199021 to Denise M. 17,357.04 0 3000 14,357.¢ Askins, daughter on 02/17/04 when account made joint 2. 1/3 of AMEX investment acct. # 327386199021 to Frank D 17,357.04 0 3000 14,357.£ Kern, son on 02/17/04 when account made joint TOTAL (Also enter on line 7 Recapitulation) $ 28,714.(] (If more space is needed, insed additional sheets of the same size) REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT 2. 3. 4. 5. FUNERAL EXPENSES: Malpezzi Funeral Home - cremation & memorial service 2,805.00 Urn 58.00 Obituary 81.06 Death Certificates 50.00 Flowers 159.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Estate Advertising Notices Settlement costs on sale of 70 Greenspring Drive, Mechanicsburg, PA 17050 3,153.06 3,500.00 274.00 211.31 15,025.73 TOTAL (Also enter on line 9, Recapitulation) $ 22,164.10 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (6-98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 Include unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Wachovia Mortgage Loan # 5329020147003884, paid off at settlement (see HUD1) 132,210.90 TOTAL (Also enter on line 10, Recapitulation) $ 132,210.90 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER HOLLES B. KERN 21-04-0666 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] FRANK D. KERN, 2327 Ridge Club Circle, Wichta, KS 67205 DENISE M. ASKINS, 1114 Carrington Court East, Mechanicsburg 17050 son daughter 0.50 0.50 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 ~A~I II - ENTER IOT^L NO~-T^XABLF DISIRIBUTIONS ON I. IN[ ~3 OF RE¥-lfiO0 COYER SHF[I $ 0.00 (If more space is needed, insed additional sheets of the same size) SAIDIS ;HUFF, FLOWER & LINDSAY ATrORNEYS.AToLAW 26 W. High Street Carlisle, PA LAST W~LL AND TESTAMENT OF HOLLES B. KERN I, Holles B. Kern, of Mechanicsburg, Cmnberland County, Pe~xsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I dLrect the payment of my just debts and expenses of my last flhxess and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery tot available for my interment owned by me at the t~nqe of my death, I authorize my personal representative to purchase such cemetery lot with a contTact for perpetual cra'e, using therefore funds from my estate in such amount as they shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable fo~ the pm'chase, erection and inscription of a suitable marker for nay gTave. SAIDIS ]HUFF, FLOWER & LINDSAY ATTORNEYS,AT-LAW 26 W. High Street Carlisle, PA SECOND I give, devise and bequeath all the rest, residue and remainder of my estate in equal shares unto my children~ Denise M. Askins and Frank D. Kern, per stirpes. THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in their absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments; C. To join in any pla~ of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any ~ust may hold stocks, bonds or other securities; D. To sell, ~ransfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for a~y purpose of adminis~ation or disfl'ibufion, for such prices and upon such terms as my personal representative, in their sole SAIDIS ~HUFF, FLOWER & LINDSAY ATtORNEYS.AT-LAW 26 W. High Street Carlisle, PA discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my persona] re?resentafive in their sole discretion may deem wise without the necessi]:y o~ obtaining any com't approval thereof; F. To make disa'ibution hereunder either in cash or kind, as my personal representative in their discretion may deem wise. FIFTH I do hereby nominate, constitute and appofl~t my daughter, Denise M. Askins to a'ct as Executrix of this my Last Will and Testament. Provided, however, ~hat if Denise M. Askins is unwilling or unable to act as Execu~'ix, I dffect the duties of Executor to be performed by my son-in-law, Michael A. Askins. SIXTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faitl-fful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Holies B. Kern, have hereunto set my hand and seal to this my Last Will and Testament, consisting of four typewritten pages, the first ttu'ee of which bear my initials in the margin for identification, tkis __ day o£ Holles B. Kern SAIDIS 5HUFF, FLOWER & LINDSAY AYroRN~YS *AToLAW 26 W. High Street Carlisle, PA Signed, sealed, published and declared by the above-named Holles B. Kern, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testah'ix and of each other. .? ';;'/ C; ADDRESS 4 SAIDIS SHIJFE FLOWER & LINDSAY ATFORNEYS,AT.LAW 26 W. High Street Carlisle, PA COMMON~rEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix sighted and executed the instrument as her Last Will and Testament and that she si~:ed willingly and that executed as her free and voluntary act for the purposes therein expressed, and that each of the witnTesses, in the presence and hearing of the Testatrix sigT~ed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constn'aint or undue influence. Subscribed, sworn to and acknowledged before me by Holles B. Kern, the Testatrix, and subscribed to mqd sworn or affirmed to before me by ~r~r~ d:7~3,'/-~r./,.,r' and ~ Jr~/~r; /?]. ~.~¼,"-/4'~ ,witnesses, this ~oJ'/~day of i59 D' I 2004. NOTARY SEAL Sallie AIIshouse, Notary Public Camp Hill, Cumberland County My Commission Expires March 29~ 200~ Notary Public 5 t20J , - ....... 1302..200q School J.~ ~la~¢ .DO& Fh~ Sc~v~ Dirt rt~.8/_l P/C,,~) ~. _Sflwr smmg T~p Auamr ~,'. WACI~IOVI& Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 0 200 Reference ID: 976029 Account Type August 3, 2004 SAIDIS SHUFF FLOWER & LINDSAY 2109 MARKET STREET CAMP HILL, PA 17011 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: HOLLES B KERN (SSN# 269-28-7519) Date of Death: July 8, 2004 Deposit Account Information Account Date of Death Average Date Maturity Interest Accrued Number Balance Balance* Opened Date Rate Interest YTD Interest Paid Date Closed CHECKING 1000293236826 LEGAL TITLE: HOLLES B KERN $2,168.73 5/20/1991 $0.11 $1.16 7/16/2004 CHECKING l 010092967742 LEGAL TITLE: HOLLES B KERN $5,235.03 1/26/2004 $0.08 $81.99 7/19/2004 SAVINGS 3082794497041 LEGAL TITLE: HOLLES B KERN $30.03 8/11/1992 $0.00 $0.03 7/16/2004 Account Type * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Loan Account Information Account Date of Deatb Original Date Monthly Interest Times Number Balance Amount Opened Payments Rate Late Int Paid Thru Terms Due Date CONSUM ER LOAN 320801000083482 LEGAL TITLE: HOLLES B KERN $131,300.00 1/20/2004 Revolving Credit Information Account Account Date of Death Credit Date Date Type Number Balance Limit Opened Closed Times Late Legal Title MASTERCARD 5329020147003884 MBNA - Revolving credit accounts are no longer serviced by Wachovia Bank. Please contact MBNA at 800-477-9131. VISA 4800137277466789 MBNA - Revolving credit accounts are no longer serviced by Wachovia Bank. Please contact MBNA at 800-477-9131. WACItO'~rlA Reference ID: 976029 No Safe Deposit Box ~'ound for customer. * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were ch~ing ~ Audrey Trour~ Servicenter Associate Phone: (540)563-7323 ssp; at tESS August 9, 2004 Saidis, Shuff, Flower & Lindsay Attn: Thomas E. Flower 2109 Market Street Camp Hill, PA 17011 The Estate ofHolles B. Kern Social Security No.: 269-28-7519 Advisor Group David R. Lyon Senior Financial Advisor Certified Financial PlannerTM American Express Financial Advisors Inc. IDS Life Insurance Company Suite 201 5006 East Trindle Road Mechanicsbur§, PA 17050 Bus: 717.441.4801 Bus: 877.460.8120 Fax: 717.441 A808 Dear Thomas, Please find attached the date of death information that you requested for Holles B. Kern as of July 8, 2004, which was provide by our corporate office. Please note that this account was an individual account with a transfer on death (TOD) designation. Holles' children were named as equal, joint beneficiaries. This account was established on February 27, 2004. Sin..cerTly, Senior Financial Advisor Advanced Advisor Group American Express Financial . Advisors Inc. Member NASD. An AEFA associated franchise. Insurance and annuities are issued by IDS Life Insurance Company, an American Express company. American Express Company is separate from American Express Financial Advisors Inc. and is not a hmker-dealer. David R Lyon 08/09/2004 10:53 AM To: CC: Subject: David A Berkebile/FietdNVH/AEFA@AMEX Client Holtes Kern id# 20020441 0 001 ...................... Forwarded by David R Lyon/FieldNVH/AEFA on 08~09~2004 10:53 AM ........................... Kelly Pramann 08~09~2004 10:20 AM To: CC: Subject: David R Lyon/FieldNVH/AEFA@AMEX Client Holies Kern id# 20020441 0 001 IDS LIFE INSURANCE COMPANY AMERICAN EXPRESS FUNDS AMERICAN EXPRESS CERTIFICATE COMPANY AMERICAN EXPRESS BROKERAGE 70100 AXP Financial Center Minneapolis, MN 55474 August 9, 2004 DAVID RAYMOND LYON STE 201 5006 E TRINDLE RD MECHANICSBURG. PA 17050-3651 Dear DAVID RAYMOND LYON: Thank you for your recent inquiry regarding HOLLES B KERN's accounts. These are the values of the accom~ts as of 07/08/2004. Accounl Number Total Value 00032738619 9 021 $52125.13 Client Name: Holies B Kern Account: 32738619 9 021 Date of Death: 7/8/2004 Valuation Date: 7/8/2004 Estimated Values };N6:.I:' .;:.!.;: :; '. Se~u~ityP0slti0h'::':L' I symbol I'"'::~ Cusip' ::I Shares I High I' Low I Fair Ma~'ket Value Total I AXPDIVERSIFIED BOND- A INBNX 00245B100 2460.308 $4.81 $11,834.08 3 AXP INCOME OPPS - A AIOAX 002,45G865 682.316 $10.26 $7,000.56 ~';~.::'il ~'.~I~R~FI~,=E~]N(~;-A., .~;:'': ,::-.;: -;IND~' .~:ii ~,00245Q107=; '~622.389 . -: ........ $9162 ';$5;987.38 5 AXP MID CAP VALUE- A AMVAX 00245Q883 925.926 $6.52 $6,037.04 6' AXP!I~QU",i,~'VAI.~UE~'';!A'' ' :' :?,; ';,: ' IEVAX'~ ;0024~" '1~6S.98'1 . ~. . $8,;95 $1t,366.33 Thc date of deafl~ values provided are for estate tax purposes and are not a value to be paid. Accotmts may be subjecl to ~narke! fluctuation as governed by each product. We appreciate lite opportuni5, to be of service to you. Please contact us if you have any questions. Shncerely, Kelly Pramann Dealh Settlements Processing Team 70100 AXP Financial Center Minneapolis. MN 55474 888-723-8476, option 1, 3, 1 COHHON#EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR D/SALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX AFP (09-Dq) DEC 29 9:08 CLERK OF 'OURT SA~"~SHUFF ETAL 2109 HARKET ST CAHP HILL PA 17011 CUT ALONG TH]:S LZNE ~ DATE 12-27-2004 ESTATE OF KERN DATE OF DEATH 07-08-2004 FILE NUHBER 21 04-0666 COUNTY CUHBERLAND ACN 101 Amount Remitted HOLLES HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LO#ER PORTION FOR YOUR RECORDS ~ DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF KERN HOLLES B FILE NO. 21 04-0666 ACN 101 DATE 12-27-2004 TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATTON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (ScheduZe A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Zntarast (Schedule C) ($) ~. Hortgagas/Notas Receivable (Schedule D) (~) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 10. Dabts/Hortgage Liabilities/Liens (Schedula Z) (10) 11. Total Deductions 12. Nat Value of Tax Raturn 174~900.00 .00 .00 .00 8~961.56 17~$75.04 28~714.08 (8} 22,164.10 NOTE: To insure proper credit to your account, submit the upper portion of ~his fore wi~h your tax payment. 13. NOTE: 229,950.68 152~210.90 (11) 15~.375.00 (12) 75,575.68 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Subject to Tax (lq) Zf an assessBent ~as lssued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of Line lq taxable at Linaal/Class A rm~a 17. Amount of Line lq at Sibling rata 18. Amount of Line lq taxable at Collataral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYHENT RECEZPT DZSCOUNT (+) DATE NUHBER INTEREST/PEN PA/D (-) 10-21-2004 CD004525 .00 .00 75,575.68 ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 w111 (15) .00 X O0 = .00 (16) 75,575.68 x 045 = 3,400.91 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= ~,400.91 AHOUNT PAID ~,400.91 TOTAL TAX CREDZT $,400.91 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.).~.<~-- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: HolIes B. Kern Date of Death: July 8, 2004 VVillNo.2004-00666 Admin. No. 21-04-0666 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. 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. account is: b. The separate Orphans' Court No. (if any) for the personal representative's 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 informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to this report. Date: fJ il ! tJ c;- ;'~,r .~~ " Thomas E. Flower, Esquire I.D. No. 83993 SAID IS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, P A 17011 (717) 737-3405 L1- C",,; Capacity: _ Personal Representative -L Counsel for Personal Representative voP