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HomeMy WebLinkAbout04-0711I-- Z I.U iii LU COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG. PA 17128~601 0ECEDENT% NAME (LAST, FIRSTr AND MIDDLE INITIAL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT BAIR~ GEORGE W. JR. OFFICIAL USE ONLY FILE NUMBER SOCIAL SECURITY NUMBER 171-30-6193 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 05/08/2004 08/12/1937 REGISTER OF WILLS {IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE JNITIAL) SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (dateoldeath prio, to 12-13 82) [] 4. Limited Estate [] 4a Future Interest Compromise (dateofde~ arte~2 12-82) [] 5. Federal Estate Tax Return Required --]6. Decedent Died Testate (Att~h ;opy olw'll) [] 7 Decedent Maintained a Living Trust (At,be :om'ofTrust) -- 8 Total Number of Safe Deposit Boxes [] 9. Litigation Proceeds Received [] 10 Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 11 Election to tax under Sec. 9113(A) IA.ach Sch O) THIS SECTION MUST BE COMPLi: ~ f::U. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS DAVID W. REAGER 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER 717-763-1383 CAMP HILL PA 17011 1. Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6 Jointly Owned Propedy (Schedule F) (g) ] Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines %7) 9. Funeral Expenses & Administrative Coats (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL use ONLY 23~925.69 (8) %.) 8~825.84 (11) 8~825.84 (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16 Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18 Amount of Line 14 taxable at collateral rate 19. Tax Due X X __ (16) X .12 (17) x .15 (18) (19) > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS - ~' Hillside Dd'.'c ~" t,' ,: CITY Camp Hill I STATE PA Tax Payments and Credits: i Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Povedy Credit B. Prior Payments C. Discount (f) Total Credits ( A + B + C ) (2) 3 Interest/Penarty 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 17011 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make atransfer and: Yes No a. retain the use or income of the propedy transferred; ........................................................................... [] [] b. retain the right to designate who shall use the propedy transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the pest of my knowledge and belief, it is true. correct and complete Declaration of preparer other than the persona[ representatwe is based on all information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FTLING RETURN DATE ADDRESS ¢~'5-4~. Hillside [~¢e C¢,~ ¢_[ ~. - ~ C~mp Hill Pa 17011 SIGNATURE OF P~EP,~RF~ ,OTHER THAN REPRESENTATIVE L / ~ ~1.~_ DATE 0.00 0.00 0.00 0.00 0.00 0.00 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 PS. §9116 (a) (1.1) (ii)l. 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% I72 P.S. §9116(a)(1 ~2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4~5%, except as noted in 72 P.S. §9116(1.2) F2 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 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF BAIR, GEORGE W. JR. FILE NUMBER 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 1, 2003 Toyota - Camry XLE - 5,000 miles M&T Bank - checking account Acct# 015004406206846 M&T Bank ~ checking account Acct# 950866300 17,450.00 6,368.88 106.81 TOTAL (Also enter on line 5, Recapitulation) $ 23,925.69 (If more space is needed, insert additional sheets of the same size) REV 1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER BAIR. GEORGE W. JR. 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. CAROLYN K. BAIR WIFE 95 HILLSIDE CAMP HILL, PA 17011 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENT'S INTERE, 1. A. unknow MBNAAmerica Bank, N.A. 2,529.62 f ~u~/,~, Certificate of Deposit 2. A. unknow VanKampen Investments 8,860.01 Mutual Fund 3. A unknow Columbia Funds 11,37809 Mutual Fund 4. A. unknow Columbia Funds 16,666.71 Mutual Funds 5. A. unknow AIM Investments 109,124.12 Brokerage Account TOTAL (Aisc enter on line 6, Recapitulation) $ (If more space is needed, insed addi~onal 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 BAIR. GEORGE W. JR. FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: PARTHEMORE FUNERAL HOME ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attomey Fees Family Exemption: (if decedeni~s address is not the same as claimant's, attach explanation) Claimant Z~p Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees 8,825.84 TOTAL (Also enter on line 9, Recapitulation) $ 8~825.84 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BAIR, G[ NUMBER )RGE W. JR. FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec 9116 (a)(1.2)] Carolyn Bair 95 Hillside E~.4we~-i¢~ *~- Camp Hill, PA 17011 Collateral AMOUNT OR SHARE OFESTATE 100% of estate TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REVq 500 COVER SHEET $ (If more space is needed, insed additional sheets of the same size) B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT BEING MADE ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Kelley Blue Book - Private Party Pricing Report - Toyota, Camry Page 1 of 2 Kelley Blue Book THE TRUSTED RESOURCE BtUE 800K PRIVATE PARTY REPORT Pennsylvania · July 15, 2004 2003 Toyota Camry XLE Sedan 4D Engine: 4-Cyl. 2.4 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 5,000 Search Listings for This Car List Your Car For Sale Online Buy a New Car Free Lemon Check Auto Loans from 3.85% APR [nsurance Quo~ Print "For Sale" Sign Payment Calculator Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AH/FM Stereo Cassette Hulti Compact Disc Premium Sound Dual Front Air Bags ABS (4-Wheel) Dual Power Seats Consumer Rated Condition: Excellent "Excellent" condition means that the vehicle looks great, is in excellent mechanical condition and needs no reconditioning. Tt should pass a smog inspection. The engine compartment should be clean, with no fluid leaks. The paint is glossy and the body and interior are free of any wear or visible defects. There is no rust. The tires are the proper size and match and are new or nearly new. A clean title history is assumed. This is an exceptional vehicle. Private Party Value Search Local Listings for This Car $17,450 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value Get Invoice ~ MSRP on New Cars http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb. PA;650202;PA041 & 17011 ;+p&722;Toyota;2... 7/15/2004 Cumberland County, Pennsylvania Estate of BAIR, GEORGE W. JR. also known as INVENTORY , Deceased Date of Death 5/8/2004 Social Security No. 171306193 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct, lANe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: hD. No.: 20868 Address: 2331 MARKET STREET Dated CAMP HILL PA 17011 Telephone: 717-763-1383 2003 Toyota Camry XLE M&T Bank - checking account M&T Bank - checking account (Attach Additional Sheets if necessary) Description Total Value 17,450.00 106.81 231925.69 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY IN RE: ESTATE OF GEORGE W. BAIR, JR. ORPHANS COURT DIVISION DECEASED NO. 21-04-0711 PETITION FOR SETTLEMENT OF SMALL ESTATE To the Honorable, the Judges of said Court: 1. Your Petitioner is Carolyn K. Bair, who is the widow of George W. Bair, Jr., deceased, and has the following interest in the assets that would comprise the Estate of George W. Bair, Jr. 100% of the real and personal property of George W. Bair, Jr. 2. George W. Bair, Jr. died testate on May 8, 2004, at Holy Spirit Hospital and at the time of death the decedent's last principal residence was 95 Hdlside Circ~,(~amp~ill, Cumberland, County, Pennsylvania 17011 ~ ~ 3. The above named decedent died testate however, no letters testamentary~ave been issued as the Petitioner has elected to proceed under Section 3102 of the l~xmsylva~a Estate' and Fiduciary Code. 4. Decedent's Last Will and Testament left all tangible personal property and the residue of his estate to his wife and Petitioner herein, Carolyn K. Bair. A copy of the decedent's Last Will and Testament is attached hereto as Exhibit "A". 5. The names, addresses, and relationships of all persons having an interest in the estate of the decedent as heirs or next of kin are as follows: Name Address Relationship Carolyn K. Bair 95 Hillside Circle Wife Camp Hill, PA 17011 -1- 6. The total value of the decedent's personal estate is less then $25,000.00 and consists of the following assets which have the following values: Asset 2003 Toyota Camry XLE M&T Bank - checking account Acct# 015004406206846 M&T Bank - checking account Acct~ 950866300 Value $17,450.00 $6,368.88 + accrued interest, if any $106.81 + accrued interest, if any 7. There are no unpaid creditors. 8. A Pennsylvania inheritance tax return has been filed indicating no tax is due since the estate is being taxed at the spousal rate of Zero Pement (0%). A copy of the inheritance tax official receipt and a copy of the statement of the Department of Revenue showing no tax due is attached hereto and made a part hereof. Said Statement is attached hereto as Exhibit "B". 9. It is proposed that the following distribution of the decedent's estate be made to the following next of kin: Name Carolyn K. Bair Distribution 2003 Toyota Camry M&T Bank - checking account Acct# 015004406206846 M&T Bank - checking account Acct# 950866300 WHEREFORE, your Petitioner respectfully requests your Honorable Court to decree the distribution of the decedent's personal estate to the person entitled thereto as set forth in Paragraph 9 above and direct M&T Bank to close the aforementioned bank accounts and distribute the proceeds to Carolyn K. Bair. Carolyn K. B$~','l%tition~,,~ David W. Reagerd~ttomey for Petitioner Sup. Ct. I.D. # 2~868 Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 mdz/document/B air. SmEstate Pet -3- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX BIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX F" APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX DAVID W REAGER 2551 MARKET ST CAMP HILL PA I70II DATE 09-27-Z00G ESTATE OF BAIR JR DATE OF DEATH 05-08-200q ..... FILE NUMBER 21 0~-0711 COUNTY CUMBERLAND ACN 101 Amoun~ Remitted GEORGE W MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-[St7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BAIR JR GEORGE W FILE NO. 21 0G-0711 ACN 1Gl DATE 09-27-200q TAX RETURN WAS: (X) ACCEPTED AS FILED [ ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN G. Jointly Owned Property {ScheduIe F) 7. Transfers (Schedule G) APPROVED DEDUCTIONS AND EXEMPTIONS: (1) .00 NOTE: To insure proper (2) .00 credit ~o your account, (S] · O0 subml{ {he upper por~ion (q) .00 of ibis form with your (S) 23~925.69 tax paymen~. (el 7~289.27 (7} .00 [8) 98,21q.96 NOTE.' 8~825.8q (9) (lO) .OO (ii) ~ (12) 89,589.12 Charitable/Governmen{ai Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 Net Value of Estat~ Subject to Tax (lq) 89~589.1Z I~ an assessment ~as issued p~viously, linss Il, lS and/op 16, 17, 18 and 19 ~ill ~eflect figu~as that include the total of ALL petupns assessed to gate. ASSESSMENT OF TAX: l~. Amount of Line lfi at SpousaI rate 16. Amount of Line lq taxable a~ Lineal/C~ass A rate TAX CREDITS: 89,389.%12 x O0 .00 IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) (16) (17) .00 X 0qS: .00 .00 X 1Z = .00 .00 X 15 .00 (19)= .0 0 AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 { IF TOTAL DUE IS LESS THAN $1~ NO PAYMENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT"" {CR)~ YOU MAY DE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) OF GEORGE W. BAIR I, GEORGE W. BAIR, declare this to be my Last Will and Testament and hereby revoke all prior wills and codicils made by me. FIRST: My Executor shall pay from the residue of my estate all my debts, funeral expenses, administration expenses, and all estate, inheritance, succession, and transfer taxes imposed by the United States or any state, territory, or possession which shall become payable by reason of my death. It shall not be necessary to file any claims therefor, nor to have them allowed by any court. SECO~D: I give all of my tangible personal property to my wife, CAROLYN BAIR, if she survives me by sixty (60) days. If my wife is not living on the sixty-first (61st) day after my death, then I give such of my tangible persona], property as is set forth in a separate, dated and unsigned letter of instruction, which I shall place with my Will, to the persons therein designated. If I have not left a letter of instruction or for those articles not distributed under this letter of instruction, I direct that such items be distributed among my children living at the time of my death as Lhey may select in a~ nearly equal shares as is practical.. I direct my Co-Executors to sell, or otherwise LAST WILL AND TESTAMENT OF GEORGE W. BAIR dispose of in their discretion, any such property not specifically distributed by my letter of instruction or selected by my beneficiaries and to add the net proceeds from their sale to the residue of my estate. My children now living are KELLY A. BAIR and KATHRYN L. BAIR. THIRD: I give and devise the residue of my estate, real, personal and mixed, of whatever kind and nature, and wherever situate at thc time of my death, including shy property over which I now have or hereafter acquire a power of appointment, to my wife, CAROLYN BAIR, provided, that she survives me by sixty (60) days. If my wife, CAROLYN BAIR, predeceases me or is not living on the sixty-first (61st) day after my death, I give and devise the residue of my estate, in equal shares, to my children, provided, that the share of any child who predeceases me or is not living on the sixty-first (61st) day after my death shall be distributed to her issue per stirpes lJ. ving on the sixty-first (61st) day after my death and, in default of any such then-living issue, such share shall be added cqua/]y to the share of my other child. If I have no such children or then-living issue of deceased children, I devise and bequeath the residue of my estate to the G~CE LUTHEP3.N CHU~CII, Camp HJ]], Pennsylvania, for any purposes as determined by the Church Council. -2- LAST WILL AND TESTAMENT OF GEORGE W. BAIR FOURTH: I nominate, constitute snd appoint my wife, CAROLYN BAIR, Executor of this my Last Will and Testament, to serve without bond or security, and to make distribution of my estate in cash or in kind, or partly in cash and partly in kind, and in such manner as she may determine. I authorize, empower and direct her to sell and convey, by good and sufficient deed, in fee simple estate, any and all of my real estate, at public or private sale, for such price or prices, upon such terms and conditions, as in her judgment is best for my estate, and to that end to sign, seal, e×ecute, acknowledge and dellvcr all deeds or otber instruments necessary therefor, as effectively as I could do if I were personally present. In thc event such person does not survive me, or refuses to act as Executor or does not complete the duties of Executor, then I nominate, constitute and appoint my daughter, KELLY A. BAIR, and my daughter, KATHRYN L. BAIR, as alternate Co-E~ecutors to serve without bond or security. My alternate Co-Executors shall have all of the powers, privileges, duties and i~mmunities as provided herein. In the event one of my Co-Executors is unable to fulfill her duties, the surviving Co-Executor shall become vested with this responsibility. -3- LAST WILL AND TESTA~IENT 0F GEORGE W. BAIR IN ~ITNESS WHEREOF, I, GEORGE W. BAIR, the Testator, have to this my Last Will and Testament, set my hand and seal this ;~q day of/~~/ , 1989. ~ GEORGE W/'BAIR Signed, sealed, published and declared by the above named Testator, as and for his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and of each other. The preceding document consists of this and three (3) other consecutively numbered typewritten pages. -4- ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH QF PENNSYLVANIA ) , I ss.: COUNTY OF k~f'~=~- ) The Testator and the witnesses whose names are subscribed to the foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge and declare to the undersigned authority that the Testator signed and executed the instrument as his last Will in the presence of the witnesses, that he signed willingly or willingly directed another to sign for him, that he executed it as his free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses, and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witnes~ ~/ Sworn to, subscribed and acknowledged:before me by the above named Testator and witnesses· this t~,day of ~_~ , 198~. l.~ ( SEAL ) Notary Public ~ or ~ttorney-at-Baw 1N RE: ESTATE OF GEORGE W. BAIR, JR. DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS COURT DIVISION NO. 21-04-0711 DECREE NOW October, b/ ~' , 2004, t within Petition having been presented, read, and considered, it is hereby decreed that the following personal property of the Estate of George W. Bair, Jr., deceased, shall be distributed to Carolyn K. Bair as set forth in the within Petition: Property 2003 Toyota Camry M&T Bank - checking account Acct# 015004406206846 M&T Bank - checking account Acct# 950866300 Value $17,450.00 $6,368.88 + accrued interest, if any $106.81 + accrued interest, if any BY THE COURT BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DAVIO W RE~ER 2$$,I-HARKE~ST CANP HILL 17011 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-IE~7 EX AFP (01-05) DATE 09-27-200q ESTATE OF BAIR JR DATE OF DEATH 05-08-200q FILE NUHBER 21 0~-0711 COUNTY CUHBERLAND ACN 101 Amount Rem].'l'~:ed GEORGE W HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~.- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOgANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BAIR JR GEORGE W F'rLE NO. 21 0~-0711 ACN 101 DATE 09-27-200~ TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE XNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. S~ocks and Bonds (Schedule B} $. Closely Held S~ock/Pertnership Interest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 25t925.69 7R/289.27 .00 .00 NOTE: To insure proper .00 cradi* to your account, .00 submit ~he upper portion .00 of this form w/th your tax payment. 8,825.8q 15. NOTE: .O0 (e) 98,Z1~"96 8.82~.8q 89,389.12 .00 89,389.12 (11) (12) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Est:ate Sub.~ect 1:o Tax (lq) If an assessment was Assued prevAously, lanes 14, 15 and/or 16, 17, reflect fAgures that Anclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. A~ount of Line lq at Spousal rate 16. A~oun~ of Line lq taxable at Lineal/Class A ra~e 17. Amount of Line 1~ at S~bling rata 18. Amount of L~ne lq ~axable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 18 and 19 wall (16) 89,389.12 x O0 = .00 (16) .00 x Oq5= .00 (17) .00 x 12 ; .00 (18), . O0 x 15 = .00 (19)= . O0 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE~UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred [n possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class D (collateral) rate on any such future interest. To ~ulfill the requirements of Section 210,0 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S. Section 910,0). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, eh[ch was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available et the Office of the Register of Rills, any of the 13 Revenue District Offices, or by calling the special Z0,-hour anseering service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-0,0,7-5020 (TT on[y). Any party in interest not satisfied with the appraisement, alXaaance, or d[salloaance of deductions, er assessment of tax (including discount or interest) as shown on this Not[ce must object within sixty (60) days of receipt of this Notice by: --written pretest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court, Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOI) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (51) discount of the tax paid is alZowed. The 151 tax amnesty non-participation penalty is computed on the totml of tho tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time per[od as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at e daiXy rate of .000160,. Al1 taxes which became delinquent on and after January 1, 1982 will bear interest at a rata 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 Z000, are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rate Factor ~ ZOZ .00050,8 ~)'~'8 - 1991 llZ .000301 ~ 9Z .0001o,7 1983 162 .0000,,58 1992 92 .00020,7 ZOOZ 62 .00016o, 1980, 112 .000301 1995-1990, 77. .00019Z Z005 57. .000157 1985 13Z .000356 1995-1998 97. .OOOZ0,7 2000, 0,2 .000110 1986 IOZ .000270, 1999 77. .000192 1987 107. .000270, ZOO0 7Z .000192 --Interest is calculatmd as fallows: INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent aill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calcuZated.