Loading...
HomeMy WebLinkAbout03-0209PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Deceased. Social Security No. I G ~ ~ cn~. - ~-~ 3 (~) Register of Wills for the County of C0~c~btv ~(~,~c~ in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl '~ e ~ for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in C.. urC~3~ I~ County, Pennsylvania, with h i~ lastfamilyorprincipalresidenceat qc4o~ ~a~c, ~x/rx,t .gaea¼a~ic'~U~ .~ (list street, nun~be'r and municipality) d , Decendent, then '-[ { years of age, died [x,/o',/t~vx~ [~ ~ I al , l~f ~OO ~,, at ~Ao~,,~ ~?~r'~A" .Mn~O'~-I-C,\ Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ iHO..OF-~3, o© Petitioner after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs Name Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF ('t ~]~-~l,~/ ss The petitioner(s) above-named swear(s) or affirm(s)that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to taw. Sworn to or affirrpe,~ and subscribed before rrte this /~J 7-'~t day of ffrO. tx~ ,~C~~ Register L Estate of , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW r~lc.~_._.k C 18f;-~3C~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that L! .r~ [h_ {s~7_JhT~ is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ltr~a ~ t~Dorcr~- in the estate of Ix3, I I, ar~ ? .LOe_~-rL FEES Letters of ~tministration ..... Short Certificates( ) .......... $ j~enunciatiori ............. "... $- . Filed ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE .BOND. REGIS~ oF WILLS OF ' C, ombe¢l'aoc~ 'COUNTY BOND ANDSURET~ FOR.PERSONAL REPRESENTATIVE Bond #104037194 KNOW ALL BY THESE PRESENTS, That and Surety Company of America Linda DiAna Weptz as p~cip~($)and TraVelers Casualty as surety (sureties) are.held and f'umly bound unto the Commonwealth of Pennsylvania in the sum of Ninety Thousand ...... 00/100 dollars ($ 90,000. ) to be paid to the Commonwealth, for which payment we do bind'ourselves, jointly and severally, our heirs, executors, administrators and successors, the condition of this obligation being that if Linda Diana Wentz as (state fiduciary capaci~) Administrator of the estate of William POrr Wentz , deceased, or any of them, shall well and truly administer thc estate according to law, then this obligation.shall be void as to the personal representative or representatives who shall so administer the estate and his or their surety or sureties; but otherwise it shall remain in full force. Signed and sealed this 28th intending to be legally bound hereby. dayof February ?1~) 2003 , each Linda Diana Wentz (S~I) (S~al) Travelers Casualty and Surety Company of America (S~I) LYdia A. Mantle, Attorney-in-Fact (Stol) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY Hartford, Connecticut 06183-9062 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, corporations duly organized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford, County of Hartford, State of Connecticut, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make, constitute and appoint: James C. Byerly, Mary Anne Brennan, Lydia A. Mantle, of Lemoyne, Pennsylvania, their tree and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within the United States, the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now in full fbrce and effect: VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her. VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary. VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile (mechanical or printed) under and by authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, which Resolution is now in full force and effect: VOTED: That the signature of each of the tbllowing officers: President, any Executive Vicc Pres/dent, an), Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. (11-00 Standard) IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY have caused this instrument to be signed by their Senior Vice President and their corporate seals to be hereto affixed this 14th day of January, 2003. STATE OF CONNECTICUT } SS. Hartford COUNTY OF HARTFORD TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY George W. Thompson Senior Vice President On this 14th day of January, 2003 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, the corporations described in and which executed the above instrument; that he/she knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; and that he/she executed the said instrument on behalf of the corporations by authority of his/her office under the Standing Resolutions thereof. My commission expires June 30, 2006 Notary Public Marie C. Tetreault CERTIFICATE I, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, stock corporations of the State of Connecticut, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority remains in full force and has not been revoked; and furthermore, that the Standing Resolntions of the Boards of Directors, as set forth in the Certfficate of Authority, are now in force. Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut. Dated this 28th day of February ,20 03 By Kori M. Johanson Assistant Secretary, Bond Travelers IMPORTANT DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE On November 26, 2002, President Bush signed into law the Terrorism Risk Insurance Act of 2002 (the "Act"). The Act establishes a short-term program under which the Federal Government will share in the payment of covered losses caused by certain acts of international terrorism. We are providing you with this notice to inform you of the key features of the Act, and to let you know what effect, if any, the Act will have on your premium. Under the Act, insurers are required to provide coverage for certain losses caused by international acts of terrorism as defined in the Act. The Act further provides that the Federal Government will pay a share of such losses. Specifically, the Federal Government will pay 90% of the amount of covered losses caused by certain acts of terrorism which is in excess of Travelers' statutorily established deductible for that year. The Act also caps the amount of terrorism-related losses for which the Federal Government or an insurer can be responsible at $100,000,000,000.00, provided that the insurer has met its deductible. Please note that passage of the Act does not result in any change in coverage under the attached policy or bond (or the policy or bond being quoted). Please also note that no separate additional premium charge has been made for the terrorism coverage required by the Act. The premium charge that is allocable to such coverage is inseparable from and imbedded in your overall premium, and .is no more than one percent of your premium. .BOND REGISTER OF..WILLSOF ' ~0~oe¢~c~ COUNTY · BOND AND $~ FOR. PERSONAL R~PRESENTATIVE Bond #104037194 I~qOW ALL BY THESE P~, That and Surety Company of America Linda Dimna Wentz as prin~pal(s) and Travelers Casualty as surety (sureties) are.held and fmnly bound unto the CommonWealth of Pennsylvania in the sum of Ninety Thousand 00/100 dollars($ 90,000. ) to be paid to the Commonwemlth, for which paym~nt we do bind'ourselves, jointly and severally, our heirs, executors, administrators and successors, the condition .of this obligation being that if Linda Diana Wentz as (state fiduciary capacity) Administrator of the estate of William POrt Wentz or any of them, shall well and truly adminis~ thc estate according to law, then this obligation.shall be void as to the personal representative or representatives who shall so att~ miniver the estate and his or their surety or sureties; but otherwise it shall remain in full force. Signed and sealed this 28th day O~ February ?1~) 2003 , each intending to be legally bound hereby. Linda Diana Wentz (S~al) (S~) Travelers Casualty and Surety Company of America (Seal) (S~l) LYdia A. Mantle, Attorney-in-Fact TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY Hartford, Connecticut 06183-9062 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, corporations duly organized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford, County of Hartford, State of Connecticut, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make, constitute and appoint: James C. Byerly, Mary Anne Brennan, Lydia A. Mantle, of Lemoyne, Pennsylvania, their true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within the United States, the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of thc following Standing Resolutions of said Companies, which Resolutions are now in full force and effect: VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secreta~ may appoint Attorneys-in-Fact and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or thc Board of Directors at any time may remove any such appointee and revoke the power given him or her. VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary. VOTED: That any bond, recogrdzance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretmy or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or mom Company officers pursuant to a written delegation of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile (mechanical or printed) under and by authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, which Resolution is now in full force and effect: VOTED: That the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secreta~, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. (11-00 Standard) IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY have caused this instnnnent to be signed by their Senior Vice President and their corporate seals to be hereto affixed this 14th day of January, 2003. STATE OF CONNECTICUT } SS. Hartford COUNTY OF HARTFORD TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY George W. Thompson Senior Vice President On this 14th day of January, 2003 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, the corporations described in and which executed the above instrument; that he/she knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; and that he/she executed the said instnnnent on behalf of the corporations by authority of his/her office under the Standing Resolutions thereof. My commission expires June 30, 2006 Notary Public Marie C. Tetreault CERTIFICATE I, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, stock corporations of the State of Connecticut, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority remains in full force and has not been revoked; and furthermore, that the Standing Resolutions of the Boards of Directors, as set forth in the Certificate of Authority, are now in force. Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut. Dated this 28 Ch day of February ,20 03 By Kori M. Johanson Assistant Secretary, Bond Travelers IMPORTANT DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE On November 26, 2002, President Bush signed into law the Terrorism Risk Insurance Act of 2002 (the "Act"). The Act establishes a short-term program under which the Federal Government will share in the payment of covered losses caused by certain acts of international terrorism. We are providing you with this notice to inform you of the key features of the Act, and to let you know what effect, if any, the Act will have on your premium. Under the Act, insurers are required to provide coverage for certain losses caused by international acts of terrorism as defined in the Act. The Act further provides that the Federal Government will pay a share of such losses. Specifically, the Federal Government will pay 90% of the amount of covered losses caused by certain acts of terrorism which is in excess of Travelers' statutorily established deductible for that year. The Act also caps the amount of terrorism,related losses for which the Federal Government or an insurer can be responsible at $100,000,000,000.00, provided that the insurer has met its deductible. Please note that passage of the Act does not result in any change in coverage under the attached policy or bond (or the policy or bond being quoted). Please also note that no separate additional premium charge has been made for the terrorism coverage required by the Act. The premium charge that is allocable to such coverage is inseparable from and imbedded in your overall premium, and .is no more than one percent of your premium. CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: William P. Wentz Date of Death: November 19, 2002 Will No. 21-03-0209 Admin. No. To the Register: I certify that notice of beneficial interest 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 March 26, 2003: Name Linda D. Wentz Address 5120 Donovan Drive #301 Alexandria, VA 22304 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Susa(n I;I Confmr, Esquire Reager & Adler, PC 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative REV-1500 EX + (6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I" Z LU LU LU I-- Z W r-,, Z o r~ UJ 0 r~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL' WENTZ, WILLIAM P. DATE OF DEATH (MM-DD-Year) 11/19/2002 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT IDATE OF BIRTH (MM-DD-Year) 11/01/1931 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A OFFICIAL USE ONlY FILE NUMBER 2 1 -0 3 COUNTY CODE YE/~R 0 2 0 9 NUMBER SOCIAL SECURITY NUMBER 1 6 8-2 4-3 3 3 0 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1. Original Retum r-'] 4. Limited Estate "-]6. Decedent Died Testate (Attach copy of Will) E~] 9. Litigation Proceeds Received [~2. Supplemental Return ~---~ 4a. Futura Interest Compromise (date of death after 12-12-82) [---~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) '--]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-t-95) NAME SUSAN H. CONFAIR FIRM NAME (if Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER (717) 763-1383 [~3. Remainder Retum (date of death pdor to 12-13-82) r"-~ 5. Federal Estate Tax Return Required __ 8, Total Number of Safe Deposit Boxes r"-~ 11. Election to tax under Sec. 9113(A) (At~ach Sch O) COMPLETE MAILING ADDRESS 2331 MARKET STREET CAMP HILL PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate 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, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental 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) 9,000.00 62,821.17 (8) 4,237.44 1,022.23 (11) (12) OFFICIAL USE ONLY 208,282.17 5,259.67 203,022.50 (13) (14) 203,022.50 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 20. x (15) 203,022.50 x .045 (16) x .12 (17) x .15 (18) (19) 9,136.01 9,136.01 Dece, dent's~Complete Address: STREET ADDRESS 4906 SHASTA WAY MECHANICSBURG Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE PA ziP 17050 (1) 9,136.01 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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) 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 9,136.01 9,136.01 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 December 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 G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompany ng 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 knowredge. SIGNATURE OF~'ER, SON RESPONSIBLE FOR FILING_RE,~URN DATE ADDRE~' /LINDA WENTZ 5120 DONOVAN DRIVE, APT 301, ALEXANDRIA, VA 22304 SIGNATURE OF PR~~RESENTATIVE 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 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 I'neal benefic aries 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 indMdual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DE,linEalT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER WENTZ. WILLIAM P. 21 03 0209 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce 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. 4906 SHASTA WAY MECHANICSBURG, PA 17050 $135,110 (assessed value) x 1.01 (common level ratio) = $136,461.00 (fair mkt value) TOTAL (Also enter on line 1, Recapitulation (If more space is needed, insert additional sheets of the same size) 136,461.00 $ 136,461.00 REV-1508 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA iNHERiTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF FILE NUMBER WENTZ. WILLIAM p, 21 03 020~) Include the proceeds of litk:jation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. VALUE AT DATE DESCRIPTION OF DEATH 2001 BUICK - TRADE IN VALUE 9,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 9,000.00 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (1-97J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER WENTZ. WILLIAM p, 21 03 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 0209 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. LINDA A. WENTZ 5120 DONOVAN DRIVE -APT 301 DAUGHTER ALEXANDRIA, VA 22304 C 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 identifying number, Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'8 INTERES 1. A. 4/1998 VANGUARD HEALTH CARE FUND 24,525.11 50. 12,262.5~ 2. A 8/2002 CERTIFICATE OF DEPOSIT 29,181.85 100. 29,181 VARTAN NATIONAL BANK 3. A. 5/2000 PSECU - 48 MONTH CERTIFICATE OF DEPOSIT 7,384.54 50. 3,692.27 4. A. 5/2002 PSECU - 24 MONTH CERTIFICATE OF DEPOSIT 3,266.37 100. 3,266.37 5. A. 9/02 PSECU - 60 MONTH CERTIFICATE OF DEPOSIT 10,841.81 100 10,841.81 6. A. 1989 PSECU - CHECKING ACCOUNT 6,791.07' 50. 3,395.54 7. A. 1989 PSECU - SAVINGS ACCOUNT 361.54 50. 180.77 TOTAL (Also enter on line 6, Recapitulation) $ 62,821.17 (If more space is needed, insert additional sheets of the same size) REV-1511EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WENTZ. WILLIAM P. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 03 0209 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NEILL FUNERAL HOME - balance of prepaid funeral 203.60 8. 9. 10. 11. 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: Attorney Fees REAGER & ADLER, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS Zip Accountant's Fees Tax Retum Preparer's Fees GETS - Final 2002 personal income tax return CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING THE SENTINEL - LEGAL ADVERTISING RECORDER OF DEEDS - RECORDING FEE FIDUCIARY BOND 2003 REAL ESTATE TAXES 1,500.00 272.00 125.00 75.00 74.75 39.50 420.00 1,527.59 TOTAL (Also enter on line 9, Recapitulation) $ 4,237.~. (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER WENTZ. WILLIAM p. 21 03 0209 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. LINKS TO CARE - PHYSICIANS INVOICE 221.29 PENNSYLVANIA AMERICAN WATER COMPANY PP&L VERIZON HAMPDEN TOWNSHIP SEWER AND TRASH 132.59 412.09 58.26 198.00 TOTAL (Aisc enter on line 10, Recapitulation) $ 1,022.23 (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 WENTZ. ~VILLIAM P. NUMBER 1. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] LINDA D. WENTZ 5120 DONOVAN DRIVE APT #301 ALEXANDRIA, VA 22304 FILE NUMBER 21 03 0209 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE DAUGHTER 100% OF ESTATE NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET INVENTORY Estate of WENTZ, WILLIAM P. also known as ., Deceased No. 21 03 0209 Date of Death 11/19/02 Social Security No. 168243330 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. I/We verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: SUSAN H. CONFAIR I.D. No.: ¢~ 2~/ / Address: 2331 MARKET STREET CAMP HILL PA 17011 Personal Representative: Dated (~. /K~. ~),~ Telephone: (717) 763-1383 Stocks & Bonds Description Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property 2001 BUICK - TRADE IN VALUE Real Estate (Attach Additional Sheets if necessary) Total Value 9,000.00 145,461.00 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 WENTZ, WILLIAM P. Description of Inventory Continuation of Inventory Page 1 21 03 0209 4906 SHASTA WAY MECHANICSBURG, PA 17050 Description Value 136,461.00 Subtotal $ 136,461.00 Grand Total $ 145,461.00 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 002918 CONFAIR SUSAN H ESQUIRE 2331 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 168-24-3330 FILE NUMBER: 2103-0209 DECEDENT NAME: WENTZ WILLIAM P DATE OF PAYMENT: 08/1 9/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 11/1 9/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $9,136.01 TOTAL AMOUNT PAID: $9,136.01 REMARKS: LINDA D WENTZ C/O SUSAN H CONFAIR ESQUIRE SEAL CHECK#0641 INITIALS' JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS DEPT. 2806nl HARRTSBURG, PA 1712D-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-16,Ii7 EX AFP COl-OS) SUSAN H CONFAIR REAGER& ADLER 2551 MARKET ST ~, CAMP HILL PA 17011~'!~., DATE 09-29-2005 ESTATE OF WENTZ DATE OF DEATH 11-19-Z002 FZLE NUMBER 21 05-0209 ~COUNTY CUMBERLAND A~N 101 Amount Remitted WILLIAM P HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -.~ REV-1547 EX AFP (01-03) NOTZCE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF BEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF WENTZ WILLIAM P FILE NO. 21 05-0209 ACN 101 DATE 09-29-2003 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) 3. Closely Hold Stock/Partnership Xntorest (Schedule C) ($) q. Hortgegos/Notos RocoLveblo (Schedule D) (q) $, Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED BEDUCTZONS AND EXEMPTZONS: 9. Funeral Exponsos/Ade, Costs/MAsc. Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Lions (Schedule 1) (10) 11. Tote1 Deduct/ohs 12. N®t Value of Tax Return 156~61.00 .00 .00 .00 9~000.00 62~821.17 .00 (8) 2,709.85 1,022.25 (11) (12) NOTE: To /nsuro proper credLt to your account, submit tho upper portion of this form with your tax payment. 208,282.17 3.732.08 20q,550.09 15. NOTE: Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Not Velum of Estate Subject to Tax (lq) Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line lq et Spouse1 rata 16. Amount of Line lq taxable at Lineal/Class A rata 17. Aeount of Line lq at Sibling rata 18. Amount of Line lq taxable at Collateral/Class B rata 19. Principal Tax Duo TAX CREDZTS: PAYMENT RECEIPT DISCOUNT DATE NUHBER INTEREST/PEN PAZD (-) 08-19-2005 CD00Z918 .00 .00 20q,550.09 18 and 19 will (xs) .00 x O0 = .00 (16) 20q,550.09 x Oq5= 9,20q.75 (17) .00 x 1Z = .00 (18) .00 x 15 : .00 (19)= 9,206.75 AMOUNT PAXD INTEREST IS CHARGED THROUGH 10-1q-2005 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM 9,156.01 TOTAL TAX CREDZT BALANCE OF TAX DUEI XNTEREST AND PEN. TOTAL DUE 9,156.01 68.7q .55 69.27 XF PAID AFTER DATE IND/CATED, SEE REVERSE ( IF TOTAL DUE 1S LESS THAN $1, NO PAYMENT ZS REQUIRED. FOR CALCULATION OF ADDIT/ONAL INTEREST. /F TOTAL DUE KS REFLECTED AS A 'CRED/T' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORM FOR ZNSTRUCTXONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December ZZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coelonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lamful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the [nheritanca and Estate Tax Act, Act Z$ of ZOO0. (TZ P.S. Section 9140), Detach the top portion of thls Notice and submit mith your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGZSTER OF NZLLS, AgBNT A refund of a tax credit, mhich aaa not requested on the Tax Return, say be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Ni115, any of the Z5 Revenue District Offices, or by calling the special Z4-hour answering service for fares ordering: 1-800-$6Z-ZO50; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied aith the appraismeent, allowance, or disalloaanca 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: --mritten protest to the PA Department of Revenue, Board af Appeals, Dept. ZelOZ1, Harrisburg, PA 171Z8-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax duo is paid elthin three (3) calendar months after the decedant's death, a five percent (SZ) dlscount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the tatml of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner end in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes mhich became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year mith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO3 era: lntarest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .0005~8 1987 91 .000147 1999 71 .000191 1983 161 .000438 1988-1991 111 .000301 ZOO0 8Z .000119 1984 I1Z .000301 1991 91 .000247 2001 91 .00D147 1985 131 .000356 1993-1994 7Z .000192 Z002 6Z .000164 1986 lOZ .000274 1995-1998 91 .000247 2003 51 .000137 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNI;IUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data sheen on the Notice, additional interest must ba calculated. REV-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDEN'FS NAME FILE NUMBER William P Wentz 2103-0209 REVIEWED BY ACN Deborah Washington 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H B-11 Reduced to $-0-. Real estate taxes are not allowable deductions for the years after decedent's date of death. ROW page 1 THEODORE a. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR Writer's E-Mail Address: reagerpc@epix.net REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com October 17, 2003 THOMAS O. WILLIAMS SUSAN H CONFAIR JOANNE HARRISON CLOUGH SUSAN J. SMITH + Certified Civil Trial Specialist Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Estate of William P. Wentz Our file number: 97-241.001 To Whom It May Concern: Enclosed please find a check in the amount of $69.27 payable to the Register of Wills for the additional Inheritance Tax due on the Estate of William P. Wentz. Please feel free to contact me in the event you have any questions. MDZ/bab Enclosure Ver[~ yours, Morea D[~. Zerche(r~4/~) Legal Assistant BUREAU OF INOIVIOUAL TAXES INHER'~ANCE TAX DTVISION DEPT. Z80601 HARRISBURG,, PA 171Z8-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX R£V-I~i7 EX AFP SUSAN H CONFAIR REAGER & ADLER 233I MARKET ST CAMP HILL PA 17011 DATE 09-29-2005 ESTATE OF WENTZ WILLIAM DATE OF DEATH 11-19-2002 FILE NUM]IER 21 0:5-0209 COUNTY CUMBERLAND ACN 101 Amoun~ Remi~c~ed I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA I7015 CUT ALONG THIS LINE ~'* RETAIN LONER PORTION FOR YOUR RECORDS REAGER & ADLER, PC 2331 MARKET STREET CAMP HILL, PA 17011 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE, PA 17013 I,,,111,,,111,,,,,,11,,11,1,,I,I i -7.0 1 3+3323 I,,,lll,,,lll,,,,,,ll,,ll,,,ll,,,Ih,,I,l,,il,l,i,,l,l,,I, 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 003143 REAGER & ADLER PC 2331 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 168-24-3330 FILE NUMBER: 2103-0209 DECEDENT NAME: WENTZ WILLIAM P DATE OF PAYMENT: 10/20/2003 POSTMARK DATE: 10/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 11/19/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $69.27 TOTAL AMOUNT PAID: $69.27 REMARKS: LINDA DWENTZ C/O REAGER & ADLER PC SEAL CHECK# 652 INITIALS' DO RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZV'rDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG:, PA 17128-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-IG07 EX AFP (01-03) DATE 11-10-2005 ESTATE OF WENTZ WILLIAM P DATE OF DEATH 11-19-2002 F, ZLE NUMBER 21 05-0209 'i.: . ~. ~/! ' COUNTY CUMBERLAND SUSAN H CONFAIR ACN 101 REAGER & ADLER , I Amoun~ Remi~ed I 2551 MARKET ST ~.,, CAMP HILL PA 17011' *' ' MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~o your account, submi'~ ~:he upper portion of ~his form wi~h your ~ax payment:. CUT ALONG TH'rS LXNE ~.~ RETAZN LOWER PORTXON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~ XNHERXTANCE TAX STATEMENT OF ACCOUNT ESTATE OF WENTZ WILLIAM P FZLE NO. 21 05-0209 ACN 101 DATE 11-10-2005 THIS STATEMENT TS PROV/DED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHOWN BELOW ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED KNTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 09-29-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 9,204.75 PAYMENTS (TAX CREDITS): PAYHENT DATE 08-19-2005 lO-17-ZO0~ RECEIPT NUMBER CDOOZ918 CD005145 DISCOUNT (+) INTEREST/PEN PAID (-) .O0 .55- AMOUNT PAID 9,156.01 69.27 TOTAL TAX CREDIT 9,204.75 BALANCE OF TAX DUE .00 INTEREST AND PEN. TOTAL DUE .05 ZF PAKD AFTER THKS DATE, SEE REVERSE SKDE FOR CALCULATKON OF ADDKTIONAL KNTEREST. ( KF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REQUIRED. KF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THKS FORM FOR KNSTRUCTIONS. ) PAYNENT: Detach the top portion of this Notice and submit with your Payment made payable to the name and address printed on the reverse side. -- Tf RESIDENT DECEDENT make check or money order payable to: REGTSTER OF NZLLS, AGENT. -- Tf NON-RESZDENT DECEDENT make check or money order payable to: COHNONNEALTH OF PENNSYLVANZA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: Z-BOO-447-$OZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Zndividual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg) PA 171Z8-0601, phone (717) 787-6505. DZSCOUNT: If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid ]s allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and net paid before January 18, 1996, the first day after the end of the tax amnesty period. ZNTEREST: Interest is charged beginning with first day of delinquency) ar nine (9) months and one (1) day from the date of death) to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annul calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO3 are: Interest Daily Interest Daily Znterest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 1987 9Z .000Z47 1999 7Z .O00Z9Z 1983 Z6Z .000438 1988-1991 Ill .000301 2aoo BZ .OOOZZ9 1984 Ill .O0030Z 1992 9Z .O00Z~7 ZOOX 9Z .OOOZ47 1985 Z3Z .000356 1995-1994 7Z .O0019Z ZOOZ 6Z .000164 1986 IOZ .000274 1995-1998 9Z .000247 2003 5Z .g00137 --Interest is calculated as follows: ZNTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELZNQUENT X DA'rLy ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: William P. Wentz Date of Death: 11/19/2002 Will No.: 21-03-0209 Admin. No.: 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: Yes X No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 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 Bo The separate Orphans' Court No. (if any) for the personal representative's account is: Co Did the personal representative state an account informally to the parties in interest? Yes No X * · Personal Representative was sole beneficiary* Date: Do November 18, 2003 Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Susan H. Confair, Esquire Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative