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Home My WebLink About03-0178HEATH 1. ALLEN KeeFER WOOD ALLEN & RAHAL, LLP ESTABL,SHED ,N ,sTe N. DAVID RAHAL 415 FALIOWFIELD ROAD, SUITE 30I CHARLES W. RUBENDALllT OF COUNSEL: ROBERT L. WELDON CAMP HILL, PA 17011-4906 SAMUEL C. HARRY EUGENE E. PEPINSKY. UR. JOHN H. ENOS'ITt PHONE 717-612-5800 GARY E. FRENCH FAX 717- 61:~-5805 HARRISBURG OFFICE: DONNA S. WELDON :~10 WALNUT STREET BRADFORD DORRANCE EIN NO. :~3-0716135 HARRISBURG, PA 17101 JEFFREY S. STOKES www. keeferwood.com ROBERT R. CHURCH PHONE ?IT-:~BB-8000 STEPHEN L. GROSE R. SCOTT SHEARER WAYNE N. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR February 26, 2003 DONALD M. LEWlSTn' 717-612-5802 JOHN A. FEICHTEL -- r ANN McGEE CARSON wpecnt(~k¢¢Icnvood.com ELIZABETH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER " VIA CERTIFIED MAIL Register of Wills of Cumberland County One Courthouse Square Carlisle, PA 17013 Re: Estate of Dorothy M. Wrightstone, deceased Date of Death: November 26, 2002 Social Security No: 182-16-1004 Dear Madam: We represent Harriet Bricker, daughter of the above-referenced decedent. Enclosed is a check in the amount of $3,847.50 which represents a prepayment of Pennsylvania Inheritance Tax for the above-referenced estate calculated as follows: Taxable Estate $90,000.00 Tax Rate .045 $ 4,050.00 Less 5% Discount (202.50) PA Inheritance Payment $ 3,847.50 Please date-stamp and return the enclosed copy of this letter acknowledging receipt of this payment. A return envelope is enclosed for your use. If you have any questions, please call me. Very truly yours, KEEFER WOO~, ALLEN & RAHAL, LLP a~~eM.~Pech// BY t WMP:cjr Enclosure cc: Harriet Bricker Register of V,"ills oft ',~'..'. 'ounty One Courthot~se Sqm!r~ Carlisle, PA !7013 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 002233 PECHT WAYNE M ESQUIRE C/O KEEFER WOOD ALLEN RAHAL 415 FALLOWFIELD RD CAMP HILL, PA 17011-4906 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $3,847,50 ESTATE INFORMATION: SSN: 182-16-1004 FILE NUMBER: 2103-01 78 DECEDENT NAME: WRIGHTSTONE DOROTHY M DATE OF PAYMENT: 02/27/2003 POSTMARK DATE: 02~26~2003 COUNTY: CUM BERLAN D DATE OF DEATH: 11/26/2002 TOTAL AMOUNT PAID' $3,847.50 REMARKS: WAYNE M PECHTESQUIRE CHECK# 1124 INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CONNONNEALTH OF PENNSYLVANIA ~ ZNFORMATTON NOTICE 03-/ DEPARTNENT OF REVENUE BUREAU OF TNDTVTDUAL TAXES FZLE NO. 21- DEPT. Z80601 AND HARRTSBURG, PA 171Z5-0601 TAXPAYER RESPONSE ACN 051062~8 ,EV-~.s EX AF, c.,-oo~ DATE OS-Off-ZOO3 TYPE OF ACCOUNT ~.~.:~:, ~ ,- EST. OF DOROTHY N NRIGHTSTONE E~SAVINGS ,,,; _~ . ':l"g S.S. NO. 18Z-16-1OOq [] CHECKING DATE OF DEATH 11-26-2002 [] TRUST COUNTY CUMBERLAND [] CERTIF. '03 JUN 17 ~30:48 REHIT PAYHENT AND FORES TO: HARRIET W ]IRICKER REGISTER OF WILLS 26 CENTRAL ]~LVD CUM]IERLAND CO COURT HOUSE CAHP HILL PA 17~1~/i!: ~.,L CARLISLE, PA 17015 PNC BANK has provided the Department wi~ ~e info,arian listed below which has been used in calculating ~e potential bx due. T~ir records indicate ~at at ~e death of the above decedent~ you were a joint owner/beneficiary this account, if you feel ~is information is incorrect, please ob~in written correction from the financial institution~ at,ch a copy tn this ~re and return it to ~e above address. This account is ~xebZe in accordance with the Znheritonce Tax Laws of the Coemoneealth of Pennsylven/a. Questions may be answered by calling (717) 787-8527. COMPLETE PART ! ~ELON # ~ ~ SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Accoun* No. 31100195385 Da~e 0q-20-2001 To insure proper credlt to your account, two Es*ebZ~shed (Z) copies o; this notice must accom~ny your Accoun~ BaZance ~,592 ~0 payeent to the Register of Hills. H~e check · payable to: "Register of NilZs, Agent". Patten{ Taxable X 50.000 NOTE: ~ ~x payments era made ei~in three Aaoun* SubSec~ ~o Tax Z,796.10 (~)monthsofthe decedent'sdateofdeath, Tax Re~e X .0~5 you aaydeductaSZdiscountofthe taxdue. Any inheritance tax due Nil1 become delinquent Po{en~Aal Tax Due [ZS.B~ nina[9) eonthsafterthedateofdeath. PART TAXPAYER RESPONSE A. 'The ebove infareetlon and rex due is corract. .! 1. You eey choose to reelt payeent to ~e Re~ister of Nills wi~ twa capias of this nntice ta obtain CHEC~ e discount ar avoid intarest, or you mey check box "A" end return this notice to the Re91stor cf ~ ONE ~ ~ NiI's end an of'icial asses,ant wJZl be issued by ~e pA Department of Revenue. ~LOCK B. The above asset has been or will be reported and ~x paid with ~e Pennsylvania Inheritance Tax return ONLY ?-~to be filed by ~a decadant's reprasantative. C. r--lThe above information is incorrect and/or dobts end deductions were paid by you. You must compZeta PART r~and/or PART I-~lbeloe. PART Zf you /ndica*e a differen* ~ax re~e, please s*a*e your reZa~onship ~o decedent: TAX RETURN - COHPUTAT~ON OF TAX ON JOZNT/TRUST ACCOUNTS LINE [. Da*e Es~abiAshed 2. Accoun~ BaZmnce ~. Percen~ Taxable 5 ~. A~oun~ SubSec~ ~o Tax S. Deb*s and Deductions 6. Amoun( Taxmblm 7. Tmx Ra(m 7 8. Tax Dum 8 PART DE)TS AN~ ~UCTIONS DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (En*er on L/ne 5 of Tax Compu*a*ion) Under penalties of perjury, Z declare ~ha* *he fac~s Z have reported above are *rue, correc~ and co.p1e~e ~o ~he bes~ of ~y knowledge and belief TAXPAYER S~GNATURE TELEPHONE NUN~ER DATE Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Dorothy M. Wri,qhtstone No. ~ '' "' ' also known as , Deceased Social Security No. 182-16-1004 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE "A" OR "B" BELOW:) C~ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executor named in the Last Will of the Decedent, dated March 18, 2002 and codicil(s) dated State relevant circumstances, e.~., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; durante absentle; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if and heirs: Name Relationship Residence I (COMP. LETE 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 418 West Keller Street, Borough of Mechanicsburq, PA 17055 (liSt street, number and municipality) Decedent, then 86 years of age, died November 26, 2002, at Chapel Pointe, 770 South Hanover Street, Borough of Carlisle, PA 17013 (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ............................................... $ 3,000.00 (If not domiciled in PA) Personal property in Pennsylvania ............................. $ (If not domiciled in PA) Personal property in County .................................. $ Value of real estate in Pennsylvania ............................................................. $ Total ........................................................................... $ 3~000.00 Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I Si~lnature Typed or printed name and residence I //'v//~ ,~ Harriet,.' Bricker, 26 Central Boulevard, Camp Hill, PA 17011 21-03-178 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and afffirm(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 %/~Z/zx.~'''~ before me this // day of ~ 2003 DECREE OF REGISTER Estate of Dorothy M. Wri.qhtstone Deceased No. 21-03-178 also known as Social Security No: 182-16-1004 Date of Death: November 26, 2002 AND NOW, JULY 11, ,2003, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] of Administration (c,t,a.; d.b.n.c.t; pendente lite: durante absentia; durante minodtate) are hereby granted to Harriet Bricker in the above estate and that the instrument(s), if any, dated March 18, 2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $. 25.00 ~'~)*v~,z)._/')Z (.~"" ~.';;'z~-~_~,.' ~z~r_ ~ . (2/~. ,,2/~z~~ ~?/-~ Register of Wills Short Certificate(s) .......... $. 9.00 Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages ( 2 ) ............ $ 6.00 Codicil ..........................$ JCP Fee ........................ $ 10o00 Attorney: Wayne M. Pecht Inventory & Tax Forms... $. I.D. No: 38904 Other ............................$ Address: 415 Fallowfield Rd. Suite 301 Camp Hill, PA 17011 TOTAL ................ $ _50.00 Telephone: 717-612-5802 DATE FILED: JULY 11, 2003 MAILED LETTERS TO ATTORNEY JULY 11, 2003 148899 1 Register of Wills of Cumberland County, Pennsylvania OATH OF NON-SUBSCRIBING WITNESS Estate of Dorothy M. Wriqhtstone No. 21-03-178 also known as , Deceased Lee M. Bricker a subscriber hereto, being duly qualified according to law, deposes and says that he was familiar with the signature of Dorothy M. Wri.qhtstone , testatrix of the will presented herewith, and that such subscriber believes the signature on the will is in the handwriting of Dorothy M. Wri.qhtstone to the best of such subscriber's knowledge and be~l[ef. (Signature)~~ 26 Central Boulevard Camp Hill, PA 17011 (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of ~~ , 2003. For the Register Register of Wills of Cumberland County, Pennsylvania OATH OF NON-SUBSCRIBING WITNESS Estate of Dorothy M. Wri.qhtstone No. 21-03-178 also known as , Deceased ReA s J. Egan a subscriber hereto, being duly qualified according to law, deposes and says that he was familiar with the signature of Dorothy M. Wrightstone , testatrix of the will presented herewith, and that such subscriber believes the signature on the will is in the handwriting of Dorothy M. Wrightstone to the best of such subscriber's knowledge and belief. ~ign reT- 113 Litchfie~ld F//ad a~ Harrisburg, PA '17112 (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of ,2003. For the Register This is to ceftin' that thc inforn~ation here given is correctly copied fi'om an origiffal certificate of' death duly filed with me as Local Registrar. The original certificate will be f~wal'ded to the State Vital Records Office fbr permanent filing. WAFllXlING: It is illegal to duplicate this copy by photostat or photograph. ;,3Re~ ~a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH NAME O~ DECEDENT (F .3o~. La~, ..... ~X I~,AL SECURITY NUMBER '~ATEOF H c,n~, Dorothy M. Wrightstone .female ,.182 _16 _ 1004 86 ~ ~ ~" ~: J~'~' 6york Co. : ~, I ~,~: - Cumberlan~ Carlisle ~2~apo~ Pounce ~0 ~.~. ~ ~0 E~~I ~ -xdowe~ ..... 'Navy ,s.~o;~s, [ ~.~~=~ . ,.,~.~. ,,..File Clerk i,,,. ,,. I,,- i,,.o ,*m [ 770 S. Hanover St. ~,u~ ,,..~,. Pa. ~ ,,..O~.. · · Carlisle, Pa. ,~ . ' ~ Carlisle ,,. '~' ,,.~ Cumberland ~ ,~ ~ ~ .,,~ Harry A. Fink El~zaDeEn ~nuosen ~.Harriet Bricker '~a~ff* ~11, co. ~ ~ ~ v.'~0, 2002 ng Green Mem. Park owerAllen Twp. Cumb , Pa, ~ L ~u$fi~n ~%era~ Home Inc. 324Hummel ~. .. . ~ . i~. nv~. I,emovne. Fa. Lira ~ ~ Ca~l~~ w~h ~ t~ Math ' · ~o~.. : ~~~th.~ ~ 0 ~1 ,~ 0 ~ 0 I~ ~ 0 ~,,~.__~ nS~' ~- ~- I~. _ I~. [lem 27) T~ ~ pi~ ~ ~~, 21-03-178 21-03-178 O~ DOROTHY M. WRIGHTSTONE I, DOROTHY M. WRIGHTSTONE, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior wills by me at any time heretofore made.. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such -1- governments, whether the property passes under this will or otherwise. I give and bequeath five (5%) percent of my net estate to my daughter-in-law, BETTY JANE WERTZ, if she survives me. If she does not survive me the gift shall lapse and fall into the residue. My net estate is intended to be the amount remaining in my estate after payment of all debts, costs, and all inheritance taxes. e I give, devise and bequeath the rest, residue and remainder of my estate to my daughter, HARRIET BRICKER, absolutely and in fee simple. Lastly, I nominate, constitute and appoint my daughter, HARRIET BRICKER, to be Executrix of this my Last Will and Testament, and in the event she should predecease me, or should she be unable or unwilling to serve in this capacity for any reason, then I nominate, constitute and appoint my granddaughter, PAMELA J. THIEL, Executrix of this, my Last Will and Testament, in her place and stead. I further direct that no bond or other security be required of my personal representative -2- to guarantee faithful performance of her duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of~, 2002. ~orothy M. Wrigl~st°ne Signed, sealed, published and declared by the above named DOROTHY M. WRIGHTSTONE, as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as wimesses, at her request, in her presence and the presence of each other. /~~! ~t.~ ~,' -3- LAST WILL AND TESTAMENT OF DOROTHY M. WRIGHTSTONE ,JOHN M. EAKIN A3~ORNEY AT LAW MEE:HANIE:SBUR~, PA. ] ?n55 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dorothy M. Wrightstone Date of Death: November 26, 2003 Will No.: 2003-00178 To the Register: I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 18, 2003: Harriet W. Bricker 26 Central Boulevard, Camp Hill, PA 17011 Betty Jane Wertz 9250-B Sable Ridge Circle, Boca Raton, FL 33428 Notice has now been given to all persons entitled thereto under Rule 5.6 (~a). Date: July 18, 2003 ~m .~Pech ~ Wayn . Pecht, Esquire Keefer Wood Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Capacity: Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of Dorothy M. Wrighstone, deceased, Estate No: 2003-00178 TO: Betty Jane Wertz 9250-B Sable Ridge Circle Boca Raton, FL 33428 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The Decedent, Dorothy M. Wrightstone, died on the 26th day of November 2002, at Carlisle, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Harriet W. Bricker 26 Central Boulevard Camp Hill, PA 17011 The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, 17013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: July18, 2003 ~/4~.~ Wayne~/l. Pecht, Esquire Keefer Wood Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Telephone 717-612~5802 Capacity: Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of Dorothy M. Wrightstone, deceased, Estate No: 2003-00178 TO: Harriet W. Bricker 26 Central Boulevard Camp Hill, PA 17011 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The Decedent, Dorothy M. Wrighstone, died on the 26th day of November 2002, at Carlisle, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Harriet W. Bricker 26 Central Boulevard Camp Hill, PA 17011 The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, 17013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: July 18, 2003 Wayne~quire~ Keefer Wood Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Telephone 717-612-5802 Capacity: Counsel for Personal Representative HEATH L. ALLEN KEEFER WOOD ALLEN & RAHAL, llP ESTABLISHED IN ~BTS N. DAVID RAHAL 415 FALLOWFIELD ROAD, SUITE 301 CHARLES W, RUBENDALL ~r OF COUNSEL: ROBERT L. WELDON CAMP HILL, PA 17011-4906 SAMUEL C. HARRY EUGENE E. PEPINSKY, JR, JOHN H. ENOSI~r PHONE 717-61a-5800 HARRISBURG OFFICE: GARY E. FRENCH FAX 717-612-5805 a~O WALNUT STREET DONNA S. WELDON HARRISBURG. PA 17101 BRADFORD DORRANCE EIN No. 23~0716135 JEFFREY S. STOKES www. keefe~vood.com PHONE 717-255-8000 ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS August 26, 2003 CRAIG A. LONGYEAR DONALD M. LEWIS3'1'1' 717-612-5802 BRIDGET M. WHITLEY wpecht~keeferwood.com JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH U. GOLDSTEIN VIA CERTIFIED MAIL BARBARA A. GALL STEPHANIE KLEINFELTER Register of Wills of Cumberland County One Courthouse Square Carlisle, PA 17013 Re: Estate of Dorothy M. Wrightstone, deceased File No: 2003-0178 Date of Death: November 26, 2002 Social Security No: 182-16-1004 '% ~''' Dear Madam: ::. Enclosed are the following items for filing with your office: 1. Original and one copy of the Pennsylvania Inheritance Tax Return; 2. Check in the amount of $324.64 representing the balance due on the Pennsyl¢~hia Inheritance Tax; 3. Original and two copies of the Inventory; 4. Check in the amount of $25 representing filing fees. I also enclose two copies of the front page of the of the Inheritance Tax Return which I ask that you time-stamp and return together with the two copies of the Inventory. A self-addressed, postage paid return envelope is enclosed for your use. If you have any questions, please call me. Very truly yours, ~VOO/D/ALLEN & RAHAL, LLP KEEFER Wayne ]Yd. Pecht WMP:cjr Enclosures cc: Harriet W. Bricker, Executrix 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 002945 PECHT WAYNE M ESQUIRE C/O KEEFER WOOD ALLEN RAHAL 415 FALLOWFIELD RD CAMP HILL, PA 17011-4906 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $324.64 ESTATE INFORMATION: SSN: 182-16-1004 FILE NUMBER: 2103-01 78 DECEDENT NAME: WRIGHTSTONE DOROTHY M DATE OF PAYMENT: 08/27/2003 POSTMARK DATE: 08/26/2003 COUNTY: CUMBERLAND DATE OF DEATH: 11/26/2002 TOTAL AMOUNT PAID: $324.64 REMARKS: HARRIET W BRICKER C/O WAYNE M PECHT CHECK# 1127 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS OFFICIAL USE ONLY COMMONWEALTH OF 'REV-1500 DEPARTMENT OF RE NUE DEPT. 28060 INHERITANCE TAX RETURN F,'ENUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 03 0178 I COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Wrightstone, Dorothy M Z 182161004 LLJ DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE "' 11/26/02 / 06/28/1916 ~ REGISTER OF WILLS Ltl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER i--w b~ 1. Odginal Return I I 2. Supplemental Return ~ 3. Remainder Return (date of death pdor to 12-13-82) ,T,~ 0-(3 ~:~'' ~ 4. Limited Estate ~-~ 4a. Future Interest Compromise (date of death after 12-12-82) r'---] 5. Federal Estate Tax Return Required 500 {'3fY'Jo.03 E~ 6. Deosdent Died Testate (Attach copy of Will) ~ 7. Decedent MaintaJnedaLivingTrust (AttachcopyofTrust) __0 8. Total NumberofSafeDepositBoxes 0. ~: r-~ 9. Litigation Proceeds ReCeived E~] 10. Spousal Poverty Credit (date of death b ...... 12-31-91afx:ll-l-95) ~'~ 11. Eleotion to tax under Sec. 9113(a)(AttachSchO) ~-- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z NAME ,,, COMPLETE MAILING ADDRESS o Wayne M. Pecht z ~O FIRM NAME(IfApplicable) 415 Fallowfield Road, Suite 301 '" Camp Hill, PA 17011 = Keefer Wood Allen & Rahal, LLP n, O TELEPHONE NUMBER 717-612-8502 1. Real Estate (Schedule A) (1) . 0.0 0~ [--~.. OFFICIAL USE ONt.Y 2. Stocks and Bonds (Schedule B) (2) i, 155. 3. Closely Held Corporation, Pa,'tnership or Sole-Proprietorship (3) 0. 00! ~:.:~. 4. Mortgages & Notes ReC~vable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 1,9'72.53 Z 6. Jointly Owned Property (Schedute F) 13,'777 60 O (6) · ~--- E~ Separate Billing Requested ,c~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 83,053.27 :::3 (Schedule G or L) ,el 8. Total Gross Assets (total Lines 1-7) (8) 99,958.79 LLI 9. Funeral Expenses& Administrative Costs (Schedule H) (9) 2,351.95 10. Debts of Decedent, Mortgage Liabilities, & Liens (Sctledule I) (10) 392 · 52 11. Total Deductions (total Lines 9 & 10) (11) 2,744. 12. Net Value of Estate (Line 8 minus Line 11) (12) 9'7,23.4.32 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 0 . 00 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 9'7,214 . 32 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) 0.00 x .00__ (15) 0.00 16. Amount of Line 14 taxable at lineal rate 97,214.32 x.o4~ (16) 4,374.64 17. Amount of Line 14 taxable at sibling rate 0. 00 x.12 (17) 0. 00 18. Amount of Line 14 taxable at collateral rate_ 0.00 x .15 (18) 0. 00 19. Tax Due (19) 4, 3"/4.64 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2w46451.000 D6cedent's Complete Address: S']3~EET ADDRESS 770 South Hanover Street CITY Carlisle I STAT PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 4~374.64 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 3,847.50 C. Discount 202.50 Total Credits(A+B+C) (2) 4,050.00 3. Interest/Penalty if applicable D. interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I 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) 324.64 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 324.64 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; ......... r-~ c. retain a reversionary interest; or ................................ ~ d. receive the promise for life of either payments, benefits or care? ................. r---] F'~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ J~ [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ E~ [] 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 exam ned this return1 including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ~lb- ~ I [ow~lel-~ R~-(/, SQlte 3U1 / / SlGNATUR~/~IP~~sENTATIVE DATE ADDRESS- ~ " 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 su~ving spouse is 3% [72 P.S. § 9916 (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 orfor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. §9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. A/4646 1.000 Estat~ of: Dorothy M Wrightstone 182161004 Harriet W Bricker 26 Central Boulevard Camp Hill, PA 17011 RE'v'-1503 EX + (1-97) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 All prope~ jointly-owned with right of su~ivomhip must be disclosed on Schedule F. I~M NUMBER ~SCRI~ON VALUE AT DA~ 1. 39 shs Prudential Financial, OFD~TH Inc. 1,155.38 TOTAL (Also enter on line 2, Recapitulation) $ 1,155. 38 2w4696 3.000 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 include the proceeds of litigation and the date the proceeds were received bythe estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. BonTon -- refund 7.94 2 Prudential Financial, Inc. -- dividend 15.60 payable 12/18/02; record dated 11/25/02 3 Chapel Point -- refund 1,095.81 4 Blue Cross/Blue Shield -- reimbursement 316.27 for prescriptions 5 Blue Cross -- refund of premium 167.05 6 Sprint -- refund 0.09 7 IRS -- refund 343.00 8 Mobile X-ray Imaging -- refund 26.77 TOTAL (Also enter on line 5, Recapitulation) i $ 1, 9 7 2.5 3 2W46AD 2.000 (If more space is needed, insert additional sheets of the same size) REV-150'9 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 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 ACORESS RELATIONSHIP TO DECEDENT A. Bricker, Harriet W 26 Central Boulevard Daughter Camp Hill, PA 17011 JOINTLY-OWNED PROPERTY: c:, ,~ DATE DESCRII:rr'ION OF PROPER iY % OF DATE OF DEATH ITEM FO~ JOiN MADE Include naree of financial insthtution and bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real -~- VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A 07/15/1974 Citizens Bank Checking 21,963.01 50.00 10,981.50 Account #610070-181-6 plus interest accrued to date of death 9. A 04/20/2001 PNC Bank Certificate of 5,592.20 50.00 2,796.10 Deposit No. 31100193383 TOTAL (Also enter on line 6, Recapitulation) $ 13,7 7 7.6 0 2W46AE 2.000 (If more space is needed, inser~ additional sheets of same size) REV-1510 EX + (1-97) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Wrightstone f Dorothy M 21-03-0178 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 yes. Dt;::$L;~IPT]ON OF PROPERTY % OF ITEM iNCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DATE OF DEATH DECD'S EXCLUSION NUMBER, DECEDENT AND THE DATE O F TRANSFER. ATTACH A COPY OF THE TAXABLE VALUE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF,N3PLICABLEI 1. Citizens Bank Mone~; Market 85,753.27 100.00 3,000.00 82,753.27 Account %620026-271-7 plus interest accrued to date of death (account made joint on 10/28/02) 2 Citizens Bank Checking 300.00 100.00 0.00 300.00 Account #620026-429-9 (account made joint on 9/05/02) TOTAL (Also enter on line 7, Recapitulation) $ 83,053.27 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 REV-1511 EX + (1~97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN AD M I N ISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 Debt of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AM O UNT A. FUNERAL EXPENSES: 1. Rolling Green Memorial -- grave opening 995.00 2 Musselman Funeral Home -- balance due 143.50 3 Hechts -- clothing for funeral 67.97 4 Hardings -- funeral luncheon 747.85 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.0 0 Name of Personal Representative(s) Social Security Number(s) /EIN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: 2. Attorney Fees 0.0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.0 0 Claimant Street Address City State __ Zip Relationship of Claimant to Decedent 4. Probate Fees 0.0 0 5. Accountant's Fees 0.0 0 6. Tax Return Preparer's Fees 0.0 0 7. Register of Wills of Cumberland County -- probate 50.00 fees 8 Chnmberland Law Journal -- legal advertising 75.00 9 The Sentinel -- legal advertising 122.63 10 Keefer Wood Allen & Rahal, LLP -- reimbursement for 150.00 miscellaneous expenses TOTAL (Also enter on line 9, Recapitulation) $ :2,3 5 1.9 5 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-151~ EX + (1-97) SCHEDULEI COMMONVVEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN~RIT~CE ~X RE~RN RESlDENT~CE~ MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 Include unreimbumed medical expenses. I~M NUMBE~ DESCRIPTION AMOUNT Pam and Travey Thiel -- reimbursement 150.00 for purchase of refrigerator 2 United Water -- final bill 10.28 3 Cumberland Apothecar~ -- balance due 18.32 4 Sprint -- final bill 34.22 50mniCare Pha~-macies -- balance due 55.92 6 Checks cleared after death on 11.64 Citizens Bank Checking Account #610070-181-6 -- #1107 -- Belvedere Medical 7 Citizens Banks-- service charge 15.00 8 Yellow Breeches EMS -- balance due 79.14 for ambulance service 9 PA Dept. of Revenue -- balance due on 18.00 2002 income tax TOTAL (Also enter on line 10, Recapitulation) i 3 9 2.5 2 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) RE'~'-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wrightstone, Dorothy M 21-03-0178 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tr._~!ee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfer: under Sec. 9116 (a) (1.2)] 1. Bricker, Harriet W Daughter 97,195.15 26 Central Boulevard Camp Hill, PA 17011 2 Wertz, Betty Jane Daugther-in-law 19.17 9250-B Sable Ridge Circle Boca Raton, FL 33428 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DIS¥1~IBUTIONS: 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0. O0 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2003-00178 PA No. 21-03-0178 ESTATE OF WRIGHTSTONE DOROTHY M (L~'I', FI~'I', Late of CARLISLE BOROUGH Deceased Social Security No. 182-16-1004 WHEREAS, on the llth day of July 2003 an instrument dated March 18th 2002 was admitted to probate as the last will of WRIGHTSTONE DOROTHY M (LAS'±', k'±m~'±', late of CARLISLE BOROUGH , CUMBERLAND County, who died on the 26th day of November 2002 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to BRICKER HARRIET W who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, iARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal Df my Office the llth day of July 2003. **NOTE** ALL NAMES ABOVEAPPEAR (LAST, FIRST, MIDDLE) 2!-03-178 DOROTHY M. WRIGHTSTONE I, DOROTHY M. WRIGHTSTONE, of the Borough of Mechanicsburg, Count)' of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior wills by me at any tLme heretofore made, 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such -1 - governmems, whether the property passes under this will or otherwise. I give and bequeath five (5%) percent of my net estate to my daughter-in-law, BETTY JANE WERTZ, if she survives me. If she does not survive me the gift shall lapse and fall into the residue. My net estate is intended to be the amount remaining in my estate after payment of all debts, costs, and all inheritance taxes. 4e I give, devise and bequeath the rest, residue and remainder of my estate to my daughter, HARRIET BRICKER, absolutely and in fee simple. Se Lastly, I nominate, constitute and appoint my daughter, HARRIET BRICKER, to be Executrix of this my Last Will and Testament, and in the event she should predecease me, or should she be unable or unwilling to serve in this capacity for any reason, then I nominate, constitute and appoint my granddaughter, PAMELA J. THIEL, Executrix of this, my Last Will and Testament, in her place and stead. I further direct that no bond or other security be required of my personal representative -2- to guarantee faithful performance of her duties. IN WITNESS WI-IEREOF, I have hereunto set my hand and seal this day of~, 2002. ,~orothy M. Wrigti_~stone Signed, sealed, published and declared by the above named DOROTHY M. WRIGHTSTONE, as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as wimesses, at her request, in her presence and the presence of each other. -3- Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Dorothy M. Wri.qhtstone No. 2003-0178 also known as Date of Death November 26, 2002 , Deceased Social Security No. 182-16-1004 Harriet W. Bricker 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Wayne M. Pecht I.D. No.: 38904 Address: Keefer Wood Allen & Bahai, LLP Dated <~'/~j~.~,-- 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Telephone: 717-612-5802 Description Value 39 shs Prudential Financial, Inc. $1,155.38 BenTon - refund 7.94 Prudential Financial, Inc. - dividend payable 12/18/02; record date 11/25/02 15.60 Chapel Point - refund 1,095.81 Blue Cross/Blue Shield - reimbursement for prescriptions 316.27 Blue Cross - refund of premium 167.05 Sprint - refund 0.09 IRS - refund 343.00 Mobile X-ray Imaging - refund 26.77 (Attach Additional Sheets if necessary) Total $3,127.91 COMMON#EALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTMENT OF REVENUE ZNHERZTANCE TAX DZV~SZON DEPT. 280601 HARR/SBURG, PA 17118-0601 NOTZCE OF /NHER/TANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX REV-2;~? EX AFP DATE 10-15-2005 ESTATE OF WRIGHTSTONE DOROTHY M DATE OF DEATH 11-26-2002 FZLE NUHBER 21 05-0178 '~ .~: !.:~:i' ~i~i! ~ ~ ' '?COUNTY CUMBERLAND WAYNE M PECHT ACN 101 KEEFER ETAL Amount Remi**ed ~15 FALLOWFIELD RD $0 CAMP H~LL PA 170I~ . HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WZLLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF WRIGHTSTONE DOROTHY MFZLE NO. 21 05-0178 ACM 101 DATE 10-15-2005 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGZNAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 1~155.38 credit to your account, $. Closely Held Stock/Partnership Znterest (Schedule C) ($) .00 submit the upper portion 4. Hortgages/Notas Receivable (Schedule D) (4) . O0 of this form with your 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 1;972.53 tax payment. 6. Jointly O~ned Property (Schedule F) (6) 13;777.60 7. Transfers (Schedule G) (7) 83 / 053.27 8. TotaZ Assets (8) 99,958.79 APPROVED DEDUCTZONS AND EXEHPTXONS: 2,351.95 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions (11) 2.7~.~7 12. Net Value of Tax Return (12) 97,21~.32 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 14. Nat Value of Estate Subject to Tax (14) 97,21~.32 NOTE: Zf an assessment was issued previously, lines 14, 15 and/er 16, 17, 18 and 19 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line 14 at Spouse1 rata (15) .00 X O0 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 97,21~.32 X 0~5 = ~,37~.6~ 17. Amount of Line 14 at Sibling rate (17) .00 x 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= q,37q.6q rAX CREDZTS: PAYHENT REC[ZPT DISCOUNT AHOUNT PAZD DATE NUMBER ZNTEREST/PEN PAZD (-) 02-26-2005 CD002233 202.50 3,8q7.50 08-26-2003 CD0029~5 .00 TOTAL TAX CREDZT q,374.6fi BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .00 TOTAL DUE . O0 ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE ( ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REQUTRED. FOR CALCULAT/ON OF ADDZTZONAL /NTEREST. TF TOTAL DUE TS REFLECTED AS A 'CREDZT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTZONS.) RESERVATION: Estates of decadents dying on or be~ora Dace.bar 11, 198Z -- if any futura interest in the estate is transferred in possession or anjoyaent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coa. onmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lamful Class B (collateral) rata on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Z14g of the Inheritance and Estate Tax Act, Act 13 af Z000. (72 P.S. Section 9140). PAYHENT: Detach the top portion of this Notice and sub.it .ith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGXSTER OF NXLLS, AGENT REFUND (CR): A refund of a tax credit, ahich ems not requested on the Tax Return, may bm requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special 24-hour ensnaring service for forms ordering: 1-800-36Z-Z050; services for taxpayers eith special hearing and / or speaking needs: 1-800-447-3010 (TT only). OBJECTIONS: Any party in interest not satisfied aith tho appraisement, allowance, or diselloeanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, Harrisburg, PA 171lB-lOll, OR --election to have the .attar determined at audit oft ha account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Depart"ant of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Raviee Unit, Dept. 180601, Harrisburg, PA 1711B-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (BX) discount of the tax paid is .1lamed. PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax end 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 tho the same time 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 frae the date of death, to the date of payment. Taxes ehich became delinquent before January l, 1982 bear interest at the rate of six (61) percent par annum calculated at a daily rata of .000164. All taxes ~hich became delinquent on and after January 1, 1982 will bear inter.st at a rata which mill vary fro. calendar year to calendar year mith that rate announced by tho PA Department of Revenue. Tho applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 201 .000548 1987 91 .000247 1999 71 .000192 1983 16Z .000438 1988-1991 llZ .000501 ZOOO BZ .O00ZX9 1984 llX .000301 1992 91 .000247 ZOO1 9X .000247 1985 131 .000356 1995-1994 71 .000192 ZOOZ 61 .000164 1986 IOZ .000274 1995-1998 91 .000247 2003 51 .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY 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 tho Notice, additional interest must ba calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy M. Wrightstone Date of Death: 11/26/02 No. 2003-00178 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: X Yes __ 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 X 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? X Yes __ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Date: 9/03/04 Elyse E./Rogers, Esu~_~ Keefer Wood Allen & Rahal, LLP r,-- 415 Fallowfield Road, Suite 301 · ~. ~: Camp Hill, PA 17011-4906 717-612-5801 I ,,, Capacity: Personal Representative ; . ./~i x Counsel for Personal Representative