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Home My WebLink About04-0736 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of EVELYN K. SCHROTH also known as , Deceased Social Security No. 168-24-2958 (COMPLETE "a" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or Decedent, dated November 25, 1975 and codicil(s) dated The odainal Executor named in said Will, Paul P. Schroth, passed away on July 14, 1994. named in the Last Will of the 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 adjudicatsd incompetent: No Exceptions B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE iN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland 3524 September Drive, Apartment 3, Camp Hill, Pennsylvania 17011 Decedent, then 96 years of age, died July 6th ,20 0._~_4, at County, Pennsylvania, with his/her last fa r pdn I residence at Decedent at death owned property with estimated values as follows: (If dornictied in PA) All personal property (If not domiciled irt PA) Personal property in Pennsylvania (If not domidled in PA) Personal property in County Value of real eststs in Pennsylvania Total Rea[ Estate situated as follows: Holy Sairit Hospital, Camp Hill, Pennsylvania 200,000 SI SI Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codidl(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signatura Typed or pdnted name and residence Thomas K. Schroth, 3524 September Dr., Apt. 3, Camp Hill, PA 17011 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative,(.s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. ~' ~¢zfz,, ~(-~ Sworn to and affir,r~_d,_and subscribed before me this L_t ~-,~- day gf ~x_~>-~ ~ -- .., 20 O.._~ DECREE OF REGISTER Estate of EVELYN K. SCHROTH also known as , Deceased No. ~(~ Social Security No: 168-24-2958 Date of Death: July 6, 2004 AND NOW, ,20 , 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 are hereby granted to THOMAS K. SCHROTH in the above estate and that the instrument(s), if any, dated November 25, 1975 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $ Short Certificate(s) .......... $ Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages ( ) ............ $. Codicil .......................... $ JCP Fee ........................ $ Inventory & Tax Forms... $. Other ............................ $. TOTAL ................ $ Register of Wills Attorney: I.D. No: David H. Martineau, Esquire 84127 Address: 3211 North Front Street PO Box 5300; Harfisburq, PA 17110-0300 Telephone: (717) 238-8187 DATE FILED: Register of Wills of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of also known as Fvel.vn K Rchroth Deceased (each) a subscribing witness to the [] codicil(s) mwdl(s) presented herewith, (each) beidg duly quaqifled according to law depose(s) and say(s) that she/heAhey wes~vere present and saw the above Testator(dx) sign the same and that she/he/they signed as a witness at the request of Testator(dx) in his/her/their presence and [] in the presence of each other [] in the presence of the other subscribing witness(es), ~/~-~ ~ _ ~-~/~'"~-~---------~ (SignatureC)aro, A. ,..vter 3211 North Front .~tr~.P.t P O Rnx 5300 H~rri.~hur? PA 1711 (Address) (Signature) Sworn to or affirmed and, subscribed be~ore me this--~)f'3~ day of My Comrm.~ion Expires: NOTE; (Address) An~ Ewing, Notary Pubiic ~ Of Har~sburg, Dauphin County MY Cemn~sion Expires May 11, 2006 Member, Pennsvtvanie ~,.~oci~on Of No~a~s To be taken by officer authorized ~3 administer oaths. Please have present the original or copy of Instrument(s) at time of notarization. OATH OF NON-SUBSCRIBING WITNESS Estate of ~:~/~ ~-~2~ Also known as ,Deceased (each) a subscriber hereto, (each) being duly qualified~according to law, depose(s) and say(s) that , ~t, .4,0-- familiar w/th the signature of ~-tJt./,n ~"C~.-~j~ ., testat/9'/~', of (one of the subscribing wimesses to) the codicil/will presented herewith and that.~a- believes the signature on~,~efodicil/will is in the handwriting of ~l~/~sn ~'c~s-u~ to the best of ~ knowledge and belief. (Name) (Address) /7o / I Sworn to or affirme~d subscribed Before me this '~""" day. 9f (Name) (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as kocal Registrar. The original certificate will be lbrwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. l-Oq-n3 Local Registrar Evelyn K. Schroth 96 w, 3/27/1908 Cumberland East Pennsboro Clerical ttb. State of PA 3524 September Dr. Apt. 3 ^CTU~ ,PA 17011 ~ 0,~' ,~,1 COMMONWEALTH OF PENNSYLVANIA · DEPAR~ENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Female 168 -- 24 -- 2958 Butler, PA ~'~' D ~o~D ~,~ v~ ~ ~l~ ~" '+~ Widowed t,. Florence A. Wick Thomas K. Schroth 2m. 3524 September Dr. Apt. 3 CaMP Bill, PA ~Cr~~,D ~.~.,,-~ ~, Rolling Green Cemetery z~a Lower Allen Twp. PA ~) ~ July 12, 2004 . . 17011 FD012774-L I~*.Richardson F.H. 29 g. Rnmla Br. Rnola.PAI7025 K~ I TiME OFINJURY INJURY AT WORK? DESCRIBE HOWINJURY OCCURRED August 16, 2004 (dictated but not read) Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 '04 /~UEi 17 P3:23 SINCE 1888 3211 North Front Street EO. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Other Offices Colonial Park Lancaster 717-652-7020 717-431-0131 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Re: Estate of Evelyn K. Schroth No. 2004-00736 Dear Ms. Strausbaugh: Enclosed for filing is Certification of Notice Under Rule 5.6(a). So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy of the Notice with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.C. David H. Martineau DHM/amm Enclosures cc: Thomas K. Schroth (w/enc.) 310513-1 James E Carl Edward E. Knauss, IV* Jered L. Hock Steven E Miner Clark DeVere Francis J. Lafferty, IV David Iq. Martineau Andrew W. Norfleet Andrew C. Spears Young-Suh Koo * Board Certified in civil trial law and advocacy by the National Board of Trial Advocacy CERTIFICATION OF NOTICE UNDER RULE 5.6(a) '04 /~lJ~ ]7 [~3:24 Name of Decedent · Evelyn K. Schroth Date of Death ' July 6, 2004 Will No. · 2004-00736 Admin. No.: 21-04-0736 To the Register: I hereby 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 August 12, 2004. Sallie Thomas K. Schroth Address 3524 September Drive, Apt 3, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Thomas K. Schroth is only outfight beneficiary by virtue of his survival, therefore, no notice is sent to unrelated contingent beneficiaries named in decedent's Will Date: August 12, 2004 Signature Name David H. Martineau, Esquire Address 3211 North Front Street Telephone Capacity: P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 __ Personal Representative X Counsel for Personal Representative 310310-1 LAST WILL AND TESTAMENT OF EVELYN K. SCHROTH I, EVELYN K. SCHROTH, of the Borough of Camp Hill, Cumberland County, Pennsylvania, make, publish, and declare this to be my Last Will and hereby revoke all Wills and Codicils previously made by me. ITEM I. I direct my Executor hereinafter named to pay all my legal debts and funeral expenses, including the cost of my gravemarker, as soon as practicable after my death. ITEM II. If my beloved husband, PAUL P. SCHROTH, sur- vives me, I give and bequeath to him all my automobiles, jewelery, wearing apparel, books, pictures, household fur- niture and furnishings, and all other articles of household and personal use or adornment, together with any insurance existing thereon; but if he predeceases me, then to my beloved son, THOMAS K. SCHROTH .... ITEM III. All the rest, residue and remaind~i~of ~ property and estate of every kind and nature and wheres~eve~?~ situate, including all lapsed legacies and bequests, in cluding any property over which I may have a power of ~- pointment at the time of my death, I give, devise, and bequeath as follows: A. If my beloved husband, PAUL P. SCHROTH, survives me,i to him absolutely and forever; B. If my beloved husband, PAUL P. SCHROTH, predeceases me, to my beloved son, THOMAS K. SCHROTH, or if he is not then living, to his issue per stirpes. C. If my beloved husband, PAUL P. SCHROTH, predeceases me, and my beloved son, THOMAS K. SCHROTH, predeceases me and dies without issue, as follows: 1. Fifteen (15%) Percent thereof to the UNIVERSITY OF PITTSBURGH to establish a scholarship fund in memory of Paul P. Schroth. 2. Fifteen (15%) Percent thereof to PENN STATE UNIVERSITY to establish a scholarship fund in memory of Thomas K. Schroth. 3. Twenty-five (25%) Percent thereof to MEMORIAL UNITED METHODIST CHURCH, Enola, Pennsylvania, for the general religious, educational, and charitable purposes thereof, in memory of Paul P. and Evelyn K. Schroth. 4. Twenty (20%) Percent thereof to the WEST SHORE BRANCH of the YMCA, Camp Hill, Pennsylvania, to be used for the educational and charitable purposes thereof, in memory of the Paul P. Schroth Family. 5. Five (5%) Percent thereof to ENGLISH LUTHERAN CHURCH, corner of Main and Brady Streets, Butler, Penn- sylvania, to be used for the general charitable, educa- tional, and religious purposes thereof, in memory of Gilbert and Anna Schroth. 6. Five (5%) Percent thereof to FIRST METHODIST CHURCH, corner of McKean and North Streets, Butler, Penn- sylvania, to be used for the general religious, educational, and charitable purposes thereof in memory of Henry and Florence Keefer. 7. Five (5%) Percent thereof to my niece, MRS. KAY~ HOUCK, of Orchard Avenue, Ellwood City, Pennsylvania. 8. Five (5%) Percent thereof to my cousin, MRS. NELL BITNER, Wyoming Avenue, Enola, Pennsylvania. 9. Five (5%) Percent thereof to my cousin, MISS PATRICIA MURTLAND, Wyoming Avenue, Enola, Pennsylvania. - 2 - In the event that any of the aforesaid persons shall predecease me, the remaining shares of all main benefici- aries shall be proportionately increased. ITEM IV. In the event that my husband and I die simul- taneously or under circumstances as to render it difficult or impossible to determine who predeceases the other, it shall be conclusively presumed for all purposes of my Will and all of its provisions that my husband predeceased me. ITEM V. All estate, inheritance, legacy, succession, transfer taxes, including any interest and penalties there- on, imposed by any domestic or foreign law with respect to all property taxable under such laws by reason of my death, whether or not such property passes under this Will, by operation of law, by contract, or otherwise, shall be paid without any right of reimbursement from any recipient of any such property, without any right of apportionment, and without postponement. ~ ITEM VI. Should any person entitled to a share of my estate be a minor, at time of distribution to him or her, and should the value of such property be more than the amount which may be paid and delivered to him or her or in his or her behalf without the appointment of a guardian or other fiduciary or the delivery of security, such shares shall be paid and distributed to my Trustee hereinafter named, to be held IN TRUST, and managed, invested, and reinvested, together with the accumulation of income there- on, if any. The Trustee shall use and apply from time to · ~ime such portion of the income and principal thereof as it deems necessary or desirable for the minor's reasonable maintenance, support, and complete education, including preparatory, college, post-graduate, professional training, or to make payments for such purposes to the guardian or person with whom such minor resides and directed to or for the benefit of such minor without further responsibility to such minor, or any person taking care of such minor, and when such minor attains the age of eighteen (18) years, any principal or income not so paid or applied shall be dis- tributed to such minor, or if he or she dies prior thereto, to his or her personal representative. ITEM VII. In addition to powers granted by law, my personal representative shall have the following powers: A. To sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, or convert or otherwise dispose of, or grant options with respect to any and all property, real or personal, at any time fo£~ming a part of my probate or trust estate, in such manner, at such time or times, for such purposes, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances. B. To compromise any claim or controversy. C. To invest in all forms of property, without being limited to legal investments. ITEM. VIII. I nominate and appoint my beloved husband, PAUL P. SCHROTH, as the sole Executor of this my last Will, but if he predeceases me, fails to qualify, or ceases to act, I nominate and appoint as Executor my beloved son, THOMAS K. SCHROTH, but if both of them predecease me, fail to qualify, or cease to act, I nominate and appoint DAUPHIN DEPOSIT TRUST COMPANy, of Harrisburg, Pennsylvania, Executor. - 4 - ITEM IX. I nominate and appoint said DAUPHIN DEPOSIT TRUST COMPANY, of Harrisburg, Pennsylvania, as the sole Trustee of all trusts created by this my last Will. IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of ~3F , 1975. Evel~h K. Schroth The preceding instrument, consisting of this and four (4) other typewritten pages, was on the date thereof signed, published, and declared by EVELYN K. SCHROTH, the Testatrix named herein, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the pres- ence of each other, have subscribed our names as witnesses hereto. Witnesses J Naive Name David H. Martinea,-, Esquire 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 SINCE 1888 7003 3110 0002 9922 5545 Return Receipt Requested Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 September 29, 2004 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Certified Mail, Return Receipt Requested Ms. Glenda F. Strausbaugh Regismr of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re-' Estate of Evelyn K. Schroth No. 2004-00736 Dear Ms. Strausbaugh: Other Office~ Colonial Park Lancaster 717-652-7020 717-431-0131 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Enclosed is a check in the amount of $13,500 for early payment on inheritance tax in the above- referenced estate. Please send receipt of the same to me, using the envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.C. David H. Martineau DHM/amm Enclosures cc: Thomas K. Schroth 312722-1 James E Carl Edward E. Knauss, IV* Jered L. Hock Steven P. Miner Clark DeVem Francis J. Lafferty, IV David H. Martineau Andrew W. Norfleet Andrew C. Spears Young-Suh Koo * Board Certified in civil trial law and advocacy by the National Board of Trial Advocacy COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF fNDIVlDUAL TAXES DEPT. 280601 HARRfSBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004445 MARTINEAU DAVID H 3211 NORTH FRONT STREET HARRISBURG, PA 17110-0300 ........ fotd ESTATE INFORMATION: SSN: 168-24-2958 FILE NUMBER: 2104-0736 DECEDENT NAME: SCHROTH EVELYN K DATE OF PAYMENT: 09/30/2004 POSTMARK DATE: 09/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,500.00 REMARKS: SCHROTH ESTATE TOTAL AMOUNT PAID' 3,500.00 SEAL CHECK//102 INITIALS: CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS November 30, 2004 Certified Mail, Return Receipt Requested Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Other Offices Colonial Park Lancaster 717-652-7020 717431-0131 Mechatxicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-7515 717-843-0502 Re: Estate of Evelyn K. Schroth No. 2004-00736 Dear Ms. Strausbaugh: Enclosed for filing are original and one copy of Inheritance Tax Return and Probate Inventory. Also enclosed are check in the amount of $2002.94 for inheritance tax due, check in the amount of $25 for filing of the Return, and check in the amount of $10 for filing of the Inventory. So that I may be sure this mailing has been received and the filings completed, please stamp the extra copy of the Summary Sheet and Inventory with your clock-in stamp and return thorn to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WlCKERSHAM, KNAUSS & ERB, P.C. David H. Martineau DHM/amm Enclosures cc: Thomas K. Schroth 315621-1 James F. Carl Edward E. Knauss, IV~ Jered L. Hock Steven P. Miner Clark DeVere Francis J. Lafferty, IV David H. Mar tineau Andrew W. Norfleet Andrew C. Spears Young-Suh Koo "Board Certified in civil trial law and advocacy by the National Board of Trial A&~cacy REGISTER OF WILLS CUMBERLAND COUNTY INVENTORY Estate of Evelyn K. Schroth also known as ., Deceased No 21 04 0736 Date of Death07/06/2004 Social Security No. 168-24-2958 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and ali 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 vedfy that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswern falsification to authorities. Name of Attorney: David H. Martineau~ Esquire I.D. No.: 84127 Address: 3211 N. Front St.~ PO Box 5300 Harrisburg PA 171100300 Personal Representative: Thomas K. Schroth; 3524 September Dr.~ Apt. 3; Camp Hill~ PA 17011 eted /I Telephone: (717) 238-8187 Description M&T Bank - Checking Account #76205797 M&T Bank - Savings Account #21000001198549 Waypoint Bank - Savings Account #101713425 Accrued Interest: $0.02 Waypoint Bank - Certificate of Deposit #1062249974 Accrued Interest: $248.75 Waypoint Bank - Certificate of Deposit #1062249975 Accrued Interest: $3.59 Waypoint Bank - Certificate of Deposit #1062249976 Accrued interest: $13.97 (Attach Additional Sheets if necessary) Total Value 40,651.38 211.29 868.00 79,312.83 16,003.59 60,361.43 382,646.77 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 Continuation of Inventory Evelyn K. Schroth Description of Inventory Page 1 21 04 0736 Description Waypoint Bank - Certificate of Deposit #3000009883 Accrued Interest: $39.69 Waypoint Bank - Certificate of Deposit #3056295101 Accrued Interest: $15.04 Social Security Check dated 07/02/2004 Cash held at Decedent's home Miscellaneous personal property Value 80,763.65 92,328.19 963.00 1,228.41 9,955.00 Subtotal $ 185,238.25 Grand Total $ 382,646.77 COMMONWEALTH OF PENNSYLVANIA DEPAEq'MENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY N~aER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER SCHROTH, EVELYN K. 168-24-2958 DATE 0F DEATH (Mk~DD-YEAR) DATE 0F BIRTH (MM-DD-YEAR) THIS RETURN MUST RE FILED IN DUPLICATE ~ THE REGISTER OF WILLS 07-06-2004 03-27-1908 IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE IN[TIN.) SOCIAL SECUR~'Y NUMBER 3:OO uJ [] 1. Original Return [] 4. Umited Estate [] 6. DesedentDiedTnstete(attachcopyofW~l) [] 9. Litigation Pronesds Received [] 2. Supplemental Relum [] ha. Future Interest Compromise (da~e of d~h alter ~z12-a2) [] 7. DesedontMaintainedaLivingTrust(A~a~co~yofTmst) [] 10. Spousal PovertyCPedit(daIeddeethbet~ee~12-31-91 md 1-1-95) [] 5. Federal Estate Ta~( Return Required 8. Total Number o~ Safe Deposit Boxes [] 11, ElesliontetaxunderSec, 9113(A)(^~t=:~SchO) NAME DAVID H. MARTINEAU, ESQUIRE FIRM NAME(If~Im~) METZAGER, WICKERSHAM TE~PHONE NUMBER (717) 238-8187 1. Real Estata (Schedule A) (1) 2, Stecks and Baxls (Schedule B) (2) 3. Closely Held Cotpotation, Par~ership ot Sole-Proprietorship (3) 4. Mortgages & Nates Receivable (Schedule D) (4) 5. Cash, Bank Depoelta & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) [] Separate Billing Requested 7, Inter-Vi'~ Transfers & Miscellaneous Non-Probate Property (7) (Schedule Got L) 8. Total Gross Ass~ (total Lines I - 7) 9. Funeral Expenses & Administrative Costa (Schedule H) (9) 10. Debts of Decedent, Matgnge Liabilities, & Uens (Schedule I) (10) 11. 12. 13. 14. ~MP~TE RAILING ABDRESE 3211 NOR?A YEON~ PO BOX 5300 HARRISBURG, PA 17110-0300 382,646.77 (9) 10,541 . 99 12,595.00 To{al Deductions (tofal Lines 9 & 10) N~ Value of Estate (Une 8 minus Line 11 ) Charitable and Governmental Beqnests~Sec 9113 Trusts for which an elestion to tax has nof been made (Schedule J) Ne~ Value SubJeof to Tax (Line 12 minus Line 13) (11) (12) (13) ~ OFFICIAt~: USE ONLY 382,646.77 23,136.99 359,509.78 (14) 359,509.78 SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amonnt of Line 14 taxable at the spousal tax rate, ot b'ansfers under Sec. 9116 (a)(1.2} 16. Amount of Erie 14 taxable atlineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. Tax Due 0.00 x .0 (~8) 359,509.78 x.o45 (16) 16,177.94 x .12 (17) x .15 (18) (19) 16, 177.94 , Decedent's Complete Address: ..~ETADDRESS 3524 SEPTEMBER DRIVE, APT. IC~ CAMP HILL 3 I STATEpA I ZlP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 13,500.00 675.00 (1) 16,177.94 Total Credits (A + B + C) (2) 14,175.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Une 1 + Line 3 is greater than Line 2, enter the dilference. This is the TAX DUE. (5) 0.00 2,002.94 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BAI. N~CE DUE, (SB~ 2,0 0 2.9 4 Make Check Payable to: REGISTER OF 14/ILLS, AGENT PLEASE ANSWER THE FOLLO~MNG 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 fight to designate who shall use the propaty transferred or its income; ................... [] [] c. retain a reversionau 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 decedest own an "in trust for" or payable upon death bank account or security at his or her death? ..... [] [] 4. Did decedent own an Individual Ratirement Aouount, annuity, er other nen-pmbate property which contains a ber~ciary designation? ....................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEBULE G AND FILE IT AS PART OF THE RETURN, Under penalties of penury, I dedare that I have examined thb return, including accompanying schedules ~ statements, and to the best of my knowledge and belief, it is hue, coo'sci and complete. Dedaraitoo of preparer ofhar than the perscoal representative is based oo all i nformatioa of which prepare' las any knowlepge. SIG NATU RE O F~R~P ~l L, NG RETURN DATE ADDRESS Thomas K. Schroth, Executor 3524 September Dr. Apt 3, SIGNATURE.~ER OT,~T~ ADDRESS Camp Hill, PA 17011 DATE David H. Martineau, Esq. 3211 N. Front St., PO Box 5300, Harrisburg, PA 17110 For dates of death on or after July 1.1994 and before Janua~ 1. 1995. the tax rate imposed on the net value of transfes to or for the use of the sun~ving spouse is 3% [72 P.S. §9116 (a)(1.1} (i)]. For dates of death on or after January 1, 1995, t~? tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 0% [72 RS. ~9116 a) (1.1) (ii)]. The statute does not exempt a transfer to a su~v]ng spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stH 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 transfem from a deceased child twenty.one yearn of age or younger at death to or for the use of a netuml parent, an adoptive parent, er a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. Tho tax rate im posed on the nat value of transfem to or for the use of the decedent's linesl beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 P.S. §9116(a)(1 )]. The tax rate imposed on tho net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(aXI.3)]. A sibling is defined, under Section 9102, as an individual who has et least one parent in common with the decedent, whether by blood or adoption. S~PA42021F.2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIV)DUAL TAXES DEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004445 MARTINEAU DAVID H 3211 NORTH FRONT STREET HARRISBURG, PA 17110-0300 fold ESTATE INFORMATION: SSN: 168-24-2958 FILE NUMBER: 2104-0736 DECEDENT NAME: SCHROTH EVELYN K DATE OF PAYMENT: 09/30/2004 POSTMARK DATE: 09/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,500.00 TOTAL AMOUNT PAID: 3,500.00 REMARKS: SCHROTH ESTATE CHECK# 102 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAN RETURN RESIDENT DECEDENT E~I'ATE OF SCI-~ROTH, EVELYN K. SCHEDULE A REAL ESTATE FILE NUMBER NI real prope~y owned solely or as a tenant In common must be reported at fair maW, et value. Fair market vatue is defined as the price at which pr~e~ty would be exchanged between a willing buyer and a willing seller, neiiha' being compelled to buy a' sell, both having reasonable knowledge of the relevant facts. Real propa'ly whl~ Is jointly-owned with right of suwlvomhlp must be disdo~d on Schedule K ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STF PA42021F.3 REV-I~03 EX + (1-97) (I) COMMONV~LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE B [ STOCKS&BONDS FILE NUMBER All ixopeAy jointly-owned with the right of survlvmshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STF PA42021F.4 REV-1504 EX + (1-97) (I} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE C CLOSELY.HELD CORPORA'nON, PARTNERSHIP or SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 ~ C-2 (Including all supporting infixmatJon) must be altached f~- each clonely-held co~peratioWpa'tner ship interest of the decedent, other then a sole-proprietaship. See ins~u~ons for the supp(xfing information to be submilted fa' s~le-pr oprieterships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional shee~s of the same size) S33:PA42021F.5 REV-1505 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA~ RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER 1. Name of Corporation Address City State 2. Federal Employer I.D. Number 3. Type of Business Zip Code Produof/Service State of Incorporation Date of Incorporation Total Number of Shamholdem Business Reporting Year TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK vndng / Non-Vndn§ SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK Common $ Preferred $ Provide all rights and restrictions pa~ining to each class of stock. 5. Was lhe decedent employed by the Co~omtion? If yes, Position 6. Was the Corperaf~on indebted to the decedent? If yes, provide amount of indebtedness $ [~Yes [~No Annual Salary $ E~Yes E~No Time Devoted to Business 7. Was there life insumnce payable to the corporation upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the dacedeat sell or transfer stock of this cempany within one yea' pdor to death or within two yearn if the data of death was pdor to 12-31-82? [~]Yea []No Ifyea, [~Transfer [~Sale NumberofSharea Transferee or Pumhaser Consideration $ Date Attach a separate sheet fa' add~ b'ansfa's and/or sales. 9. Was there a written shareholder's agreamont in effect at the time of the denedenrs death? []Yea []No If yes, provide a copy of the agreement. 10. Was the decedenrs stonk sold? [] Yea [] No If yes, pro, de a copy of the agreement of sale, etc. 11. Was the corporation dissolved er liquidated alter the denedenrs death? []Yes []No If yes, provide a breakdown of distributions received by the estate, including dates and amounts recalved. 12. Did the corporation have an i ntereat in other corporations or pa~emhips? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedenrs stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market velue/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits mcalved from the corporation. F. Statement of dividends paid each year. List these declared and unpaid. G. Any other information relating to the valuation of the decedenrs stock. STF PA42021F.6 REV-1506 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT FILE NUMBER 1. Name of Partearship Address City 2. Federal Employer I.D. Number State Zip Code Date Business Commenced Business Reporting Year 3. Type of Business Product./Se~ce 4. Decedent wes a [] General [] Limited pertner. If decedent was a limited partner, provide initial investment $ PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnamhip indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Wes there life insurance payable to the perlnemhip upon the death of the decedent? [] Yes If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy [] No 9. Did the decedent sail or transfer an interest in this perthemhip within one year prior to death or within two years if the date of death was prior to 12-31-827 []Yea [] No If yes, []Transfer [] Sale Percentage transferrad/sold Transferee or Purchaser Consideration $ Date Ntach a separate sheet for addilJe~al ffansfers and/or sales. 10. Was there a writtea parlnership agreament in effect at the time of the decedeat's death? ~--] Yes []No If yes, provide a copy of the agreement. 11. Was the deaedent's partnership interest sold? []Yes [] No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain 14, Did the partnership have an interest in other coq)orations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule CH or C-2 for each interest. A. Detailed calculations used in the valuation of the denedent's partnemhip interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list shewing the complete eddress/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. 0. Any other information relating to the valuation of the denedent's partnership interest. S1~: PA42021F 7 COMMON16~cALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE 0 F SCHROTH, EVELYN K. SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All pmfleK'y jointly-owned with the dght of suwivomhip must be disclosed on Schedule K iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, inset: additional sheets of the same size) S11: PA42021F 8 REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE T~X RETURN RESIDENT DECEDENT ESTATE OF SCHROTHt EVELYN K. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date (he proceeds were r~ceived by the estate. All ~ Jolntly-<)vmed with the ~tght of suwivomhlp must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking Account M&T Bank, 499 Mitchell St, Account No. 76205797 Millsboro DE 19966 Savings Account M&T Bank, 499 Mitchell St, Account No. 21000001198549 Millsboro DE 19966 Savings Account Waypoint Bank, PO Box 1711, Harrisburg, Account No. 101713425 Accrued Interest PA 17105-171: Certificate of Deposit Waypoint Bank, PO Box 1711, Harrisburg, Account No. 1062249974 Accrued Interest PA 17105-171] Certificate of Deposit Waypoint Bank, PO Box 1711, Harrisburg, PA 17105-171] Account No. 1062249975 Accrued Interest Certificate of Deposit Waypoint Bank, PO Box 1711, Harrisburg, Account No. 1062249976 Accrued Interest PA 17105-171 Certificate of Deposit Waypoint Bank, PO BOX 1711, Account No. 3000009883 Accrued Interest Harrisburg, PA 17105-171 Certificate of Deposit Waypoint Bank, PO BOX 1711, Harrisburg, Account No. 3056295101 Accrued Interest Social Security Check dated 7/2/04 Cash held at Decedent's Home PA 17105-171~ 40,651.38 211.29 867.98 0.02 79,064.08 248.75 16,000.00 3.59 60,347.46 13.97 80,723.96 39.69 92 313.15 15.04 963.00 1 228.41 10. Miscellanious Personal Property 9 955.00 TOTN. (Alee enter on lirm 5, R~capitulation) $ 382,646.77 (If more space is needed, insert additional sheets of the same size) S~F PA42021F 9 AUG 3 0 200 Augu~ 26,2004 Me~gerWickersham 3211NorthFrontSHe~ P.O. Box 5300 Harrisburg, PA 17110-0300 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Evelyn K. Schroth Date of Death: July 6, 2004 Social Security Number: 168-24-2958 Dear Mr. Martineau: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account 7~jpe ........................... Checking Account Account Nuraber. ...................... 76205797 Oumer$~Jp {Names of) .............. Evelyn K. Schroth Opening Date ........................... 08/28/64 (account closed 08/18/04) Year to Date Interest ................. $0.00 Balance on Date of Deatlz ......... $40,651.38 Accrued Interest $ 0.00 Total. ...................................... $40,651.38 2 Account T!~pe ........................... Savings Account Account Number. ...................... 21000001198549 Ownership (Names of). ............. Evelyn K. Schroth Opening Date ........................... 11/06/89 Year to Date Interest. ................ $0.00 Balance on Date of Deattt ......... $211.29 Accrued Interest $ 0.00 Total. ...................................... $211.29 · Page 2 August 26, 2004 For any additional information on the above accounts please contact our West Shore Plaza branch at 717-255-2271. Sincerely, Charlene Warrington, Records Management 1-888-502-4349 Wagp2 n t 8/11/2004 METZGER WICKERSHAM 3211 N FRONT ST PO BOX 5300 HARRISBURG PA 17110-0300 The information which you requested on the account(s) of EVELYN K SCHROTH (Social Security Number 168-24-2958) is/are as follows: Account Number 101713425 Class of Account SAVINGS Date Opened 011775 Principal Balance 867.98 Accrued Interest .02 Balance at Date of 868.00 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership 011775 Was Established Account Number Class of Accoum Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, ffany Date Ownership Was Established 1062249974 1062249975 1062249976 3000009883 3056295101 CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE 040893 070793 072993 012599 070896 79064.08 16000.00 60347.46 80723.96 92313.15 248.75 3.59 13.97 39.69 15.04 79312.83 16003.59 60361.43 80763.65 92328.19 SOLE SOLE SOLE SOLE SOLE 040893 070793 072993 012599 070896 Additional Information Requested ERIN E WATTS SENIOR SERVICES REP. RO. Box 171 I. HARRISBURG. P~NN~;YI.VANIA I?lOS-1711 REVo1509 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an as~ was made joint within one year of the decedent's date of death, it must be mpo~ted on Schedule G. SURVIVING JOINT TENANT(E) NAME ADDRESS RELATIONEHIP TO DECEDENT A. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE O~ DEATH ITEM FOR JOINT MADE Include tame of financial i~on ard bank accou~ number or similar ide~i~ numbe~ DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT A~ch deed for joirf~'tq~ld real estate VALUE OFASaET INTEREST DECEDENT'S INTEREET TOTAL (Also enter on line 6, Recapitulation)$ (If more space is needed, insert additional sheets of the same size) STF PA42021 F 10 COMMONWEALTH OF PENNSYLVANIA INHERIT,~NCE TAX RETURN RESIDENT DECEDENT ESTA'n~ OF SCHROTH, EVELYN K. SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF FrEM INCLL,DE 3~-E N%ME OF ~TJ~ 3~N4,*%'=EI:?-~-.E, ~}EIR P. ELATION~I-IP TO esCEDENT AND 1¥1E DA~ DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF ~R. ATTACH A COPY OF 1¥E DEED FOR RF. AL ESTA3E~ VALUE OF ASSET INTEREST (IF .~,PPLIC,~BLE) 1. TOTAL (Also enter on line 7. Recapitulation) (if more space is needed, insert additional sheets of the same size) CO{vlMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS I FILE NUMBER Debts of deeedeet must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 9 o FUNERAL EXPENSES: Richardson Funeral Home, Inc. ADMINISTRATIVE COSTS: Persona~ Representa~ve's Commissions Name d Personal Representative(s) Social Securibj Number(s) / EIN Number of Personal Representaifve(s) Street Address City State Year(s) Commission Paid: Attanley Fees Family Exemptiee: (If deeederit's address is roi the same as claimant's, attach explanation) Claimant Zip Sb'eet Address City State Zip Ralatiomhip of Claimant to Decedent Pr~ate Fees Accountant's Fees Tax Return Preperer's Fees Filing Fee for PA Inheritance Tax Return Publication of Estate Notices Cumberland Law Journal The Sentinel Administrative Expenses (postage, fax, copies, ect. ) 4,986.00 5,000.00 281.00 25.00 75.00 149.99 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 10,541.99 (If mom space is needed, insert sdditional sheets of the same size) S31= PA42021F.~2 (717) 732-0587 MICHAEL G. MURRAY STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED SUPRRVISOR Charges are only for those items that you ~elected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below If you selected a funeral that may require embalm(hi, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will ex lain ~by below. Name Address , City Slate ~/~Vl A. CIL&RGB FOR SERVICES SBLBCTED~ 1. PROFESSIONAL SERVICES Embalming ............ O her preparation of body Local .................. Lead car/clergy car Car for pallbearers Other clothing Cremation urn .................. (Description) OTHER Receiving of remains from (Funeral Home) Direct Cremation ............... SUB-TOTAL OF SPECIAL CHARG£S D. CASH ADVANCED Opening Grave .............. Cemetery Equipment ........... Lot and Deed .................. Newspaper Notices--Out-of-town Telephone & Telegrams Airfare .................. Police Escort ................ Vault Service Charge .............. SUB-TOTAL OF AUTOMOTIVE EQUIPMENT ........ A3 S (f?' '¢~ We charge you for our services in obtaining: TOTAL OF PROFBSSIONAL SBRVICBS, (specify cash advances that are marked-up) FACILITIES AND AUTOMOTIVE EQUIPMENT A $ 5C)0~'e'} SUMMARY OF CHARGES B. CHARGE FOR MERCHANDISE SELECTED: (Description) A. Professional Services, Facilities and Equipment, and Automotive Equ[pment .................. $ 3 6 0 5'* ~-' ~'~ C. Special Charges ............. ~. Cash Advances .............. $ TOTAL OP ALL SECTIONS .................. PAID AT TIME OB OR PRIOR TO ARRANGEMENTS ............................ BALANCE DUE ............................... RBASOI~[ FOR EMBALM NG Iagreetha~~haveexam~nedthei~emS~fg~~dsandserviceSselectedab~veandf~undthemt~bec~rrectandacc~rdng o hearrangements have eqne ed acknowedge and services selecled [ also agree to make payment of S ,"-' within ' day ag ee to be jointly and ~everally liable with anyone~clse who signs below. A late charge of _ ,-~ per month amounting o ,¢¢ per year wdl be applied o he unpa dba ance beg no ng / da s from the date of this agreement I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreemelnYt Those co may include attorneys' fees, court costs and other COSTS Any additional services or merchandise ordered or requested after the date. of this agreement will (Purchaser) '~' ' ~ (Date) (Seal) (Purchaser) (Licensbd Funeral Director) form - 600 Revised 4/94 RECEIPT FOR PAYMENT Cumberland County - Re~ister Of Wills Hanover and High Stree5 Carlisle, PA I7013 Receipt Date: 8/09/2004 Receipt Time: 12:36:44 Receipt No.: 1037466 SCHROTB EVELYN K Estate File No.: 2004-00736 Paid By Remarks: THOMAS SCHROTH JA ........................ Receipt Fee/Tax Description PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE Check# 3680 Total Received ......... Distribution Payment Amount ~35.00' '12.00 24.0D ~ 10.00~ $281.00 $281.00 Payee Name CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENER3kL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 SEPTEMBER 10, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: David Martineau, ESQUIRE Evelyn K. Schroth, ESTATE Legal advertisemems must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: AUGUST 27, SEPTEMBER 3, 10, 2004 Payment received by Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 0.00 $ 75.O0 RETAIN THIS PORTION FOR YOUR RECORDS REMITTANCE ADDRESS I BILL TO !'riiE S~-'NTINEL - LEGAL P.O. BOX 130, CARLISLE, PA 17013I KNAUSS & ERB METZGER,WICKERSH~ AD NUMBER I CLASS SALESPERSON B~LLING DATE LINES 271594 10 PUBLIC NOTICES 28 09/15/04 42 * 2 AD DESCRIPTION START DATE STOP DATE NOTICE LETTERS TESTAMENTARY IN THE 08/26/04 09/09/04 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 143.64 TOTAL AD CHARGE 143.64 3 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT 3.49.99 179.99' everlyn schroth MESSAGE: AFTER 1 O/15/O4 Thank you for advertising with The Sentinel. Deadlines for in-column leqal ~dvertisements: Monday is Friday at 11 a.m.; Tuesday is Friday'at ~ p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 243-2611, ext 203. Fax your legals to 243-3754, attention Tammy Shoemaker You can also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and address as an attachment REV-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unr~mbursed medlcaJ ~ses. iTEM NUMBER DESCRIPTION AMOUNT Thomas K. Schroth - Nursing Home bill paid 6/30/04 Messiah Village - Nursing Home Bill 5,890.00 6,705.00 TOTAL (Also enter on line 10, Recapitulation) $ 12,5 9 5.0 0 (If more space is needed, inset additional sheets of the same size) STF PA42021F,13 100 MOUNTALLEN DRIVE, MECHANICSBURG, PA 17055 THOMAS SCHROTH 3524 SEPTEMBER DR. CAMP HILL, PA 17011 QUESTIONS? CALL: RESIDENT NUMBER 59911 (717) 697-4666 DATE 05/31/2004 RESIDENT(S) Mrs. EVELYN K. SCHROTH TOTAL AMOUNT DUE $5,890.00 DATE DUE 06/30/2004 $ I DATE DESCRiPTiON I UNiT I CHARGES CREDITS I BALANCE Balance Forward 5,700.00 05/30/2004 PAYMENT RECEIVED - THANK YOU!!] 5,700.00 0.00 *** Nursing Care *** 05/31/2004 RM/BRD - NURSING - SEMI-PVT 05/01-05/31 31 5,890.00 5,890.00 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 59911 5,890.00 0.00 0.00 0.00 0.00 55,890.00 RESIDENT NAME Mrs. EVELYN K. SCHROTH A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 THOMAS SCHROTH 3524 SEPTEMBER DR. CAMP HILL, PA 17011 QUESTIONS? CALL: (717) 697-4666 RESIDENT NUMBER DATE 59911 06/30/2004 RESIDENT(S) Mrs. EVELYN K. SCHROTH TOTAL AMOUNT DUE $5,700.00 DATE DUE 07/31/2004 $ DATE DESCRIPTION UNIT CHARGES CREDITS BALANCE Balance Forward 5,890.00 06/30/2004 PAYMENT RECEIVED - THANK YOU!!! 5,890.00 0.00 *** NursinR Care *** 06/19/2004 RM/BRD - NURSING - SEMI-PVT 06/01-06/49 19 3,610.00 3,610.00 06/30/2004 RM/BRD - NURSING - SEMI-PVT 06/20-06/30 111 2,090.00 5,700.00 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 59911 5,700.00 0.00 0.00 0.00 0.00 $5,700.00 RESIDENT NAME Mrs. EVELYN K. SCHROTH A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! 100 MOUNT ALLEN DR VE, MECHANICSBURG PA 17055 THOMAS SCHROTH 3524 SEPTEMBER DR. CAMP HILL, PA 17011 QUEST ONS? CALL: (717) 697-4666 RESIDENT NUMBER DATE 59911 07/31/2004 RESIDENT(S) Mrs. EVELYN K. SCHROTH TOTAL AMOUNT DUE DATE DUE $1,005.00 08/31/2004 DATE DESCRIPTION UNIT CHARGES CREDITS BALANCE Balance Forward 5,700.00 07/31/2004 PAYMENT RECEIVED - THANK YOU!!! 5,700.00 0.00 *** Nursin~ Care *** 07/05/2004 RM/BRD - NURSING - SEMI-PVT 07/01-07/05 5 1,005.00 1,005.00 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 59911 1,005.00 0.00 0.00 0.00 0.00 $1,005.00 RESIDENT NAME Mrs. EVELYN K. SCHROTH A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! REV-1513 EX <- (gq)O) COMMONWEALTH O~c PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE 0 F SCHROTH, EVELYN K. SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustsa(s) OF ESTATE TAXABLEDISTRIBUTIONS[includeoutdg~s~u~ldis~bua~s, and~nsf~ underS~.9116¢)(1.2~ Thomas K. Schroth 3524 September Drive, Apt. 3 Camp Hill, PA 17011 Son 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AB APPROPRIATE, ON REV-1500 COVER SHEET NON-,TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTN. OF P/%RT Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If mom space is needed, insert additional sheets of the same size) STF PA42021F.14 REV-1514 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. E~]Will [--Ilntervivos Deed of Trust r-]other NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE [~Life or [~Ten'n of Years __ [] Life of [~Term of Years __ [] Lifeor []Term dYe, am __ [] Life or [] Term of Years 1. Value of fund from which life estate is payable $ 2. Actuarisl factor per appropriate table Interest table rate - []3 1/2% []6% []10% []Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) $ NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years __ []Life or []Term of Yeas __ []Life or [~]Tam of Years [] Life or ~']Ter~ of Years __ 1. Value of fund from which annuity is payable 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Bi-weekly (26) [] Monthly (12) [] Quarterly (4) [] Semi-annually (2) []Annually (1) [] Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if vadable rate and period payout is at end of period, calculation is: Line 4 x Line 5 × Line 6 $ If using variable rate and pedod payout is at beginning of pedod, calculation is: (Line4 x Line5 x Line 6) + Line3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) S~ PA42021F.15 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) FILE NUMBER This schedule is appropriate only for estates of decedents dying after December 12, 1982, This schedule is to be used for all future intemsta where the rate of tax which will be applicable when the futura interest vesta in possession and enjoyment cannot be established with certainly. Indicate below the ~ of instrument which created the futura interest and attach a copy to the tax return. [] Will [] Trust [] Other [. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. ]]. For decedents dying on or after July 1, 1994, if a so.lying spouse exemised or intends to exercise a right of withdrawal within 9 months of the decedents death, check the appropriate block and attach a copy of the document in which the surviving spouse exerdses such withdrawal dght. [] Unlimited fight of withdrawal [] Limited right of withdrawal fit Explanation of Compromise Offer: Summery of Compromise Offer: 1. Arncont of Future Interest .................................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appmpriata tax rate CheckOne []6%, D3%, []0% .......................... $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One []6%, [~4.5% ................................. (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................................ $ (If more space is needed, insert additional sheets of the same size) STF PA42021 F.I 6 REV-1649 EX + (1-97) (I) COMMONWEALTH OF PENNS'fl.VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHROTH, EVELYN K. SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act. If the election applies to mom than one trust or similar arrangement, a separate form must be filed for each treat. This election applies to the Trust (marital, residual A, B, By-bess, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113 (A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is enterad in whole or in bert as an asset on Schedule O, then the transferors personal representative may specifically identify the trust (all or a fractional portion or percentage} to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable trans'~r on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar amangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar an'angement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. Part A Total PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. Part B Total $ (If more space is needed, insert additional sheets of the ssme s~ze) S'P~ PA42021F 17 LAST WILL AND TESTAMENT OF EVELYN K. SCHROTH I, EVELYN K. SCHROTH, of the Borough of Camp Hill, Cumberland County, Pennsylvania, make, publish, and declare this to be my Last Will and hereby revoke all Wills and Codicils previously made by me. ITEM I. I direct my Executor hereinafter named to pay all my legal debts and funeral expenses, including the cost of my gravemarker, as soon as practicable after my death. ITEM II. If my beloved husband, PAUL P. SCHROTH, sur- vives me, I give and bequeath to him all my automobiles, jewelery, wearing apparel, books, pictures, household fur- niture and furnishings, and all other articles of household and personal use or adornment, together with any insurance existing thereon; but if he predeceases me, then to my beloved son, THOMAS K. SCHROTH. ITEM III. All the rest, residue, and remainder of my property and estate of every kind and nature and wheresoever situate, including all lapsed legacies and bequests, in- cluding any property over which I may have a power of ap- pointment at the time of my death, I give, devise, and bequeath as follows: A. If my beloved husband, PAUL P. SCHROTH, survives me, to him absolutely and forever; B. If my beloved husband, PAUL P. SCHROTH, predeceases me, to my beloved son, THOMAS K. SCHROTH, or if he is not then living, to his issue per stirpes. C. If my beloved husband, PAUL P. SCHROTH, predeceases me, and my beloved sgn, THOMAS K. SCHROTH, predeceases me and dies without issue, as follows: 1. Fifteen (15%) Percent thereof to the UNIVERSITY OF PITTSBURGH to establish a scholarship fund in memory of Paul P. Schroth. 2. Fifteen (15%) Percent thereof to PENN STATE UNIVERSITY to establish a scholarship fund in memory of Thomas K. Schroth. 3. Twenty-five (25%) Percent thereof to MEMORIAL UNITED METHODIST CHURCH, Enola, Pennsylvania, for the general religious, educational, and charitable purposes thereof, in memory of Paul P. and Evelyn K. Schroth. 4. Twenty (20%) Percent thereof to the WEST SHORE BRANCH of the YMCA, Camp Hill, Pennsylvania, to be used for the educational and charitable purposes thereof, in memory of the Paul P. Schroth Family. 5. Five (5%) Percent thereof to ENGLISH LUTHERAN CHURCH, corner of Main and Brady Streets, Butler, Penn- sylvania, to be used for the general charitable, educa- tional, and religious purposes thereof, in memory of Gilbert and Anna Schroth. 6. Five (5%) Percent thereof to FIRST METHODIST CHURCH, corner of McKean and North Streets, Butler, Penn- sylvania, to be used for the general religious, educational, and charitable purposes thereof in memory of Henry and Florence Keefer. 7. Five (5%) Percent thereof to my niece, MRS. KAYE HOUCK, of Orchard Avenue, Ellwood City, Pennsylvania. 8. Five (5%) Percent thereof to my cousin, MRS. NELL BITNER, Wyoming Avenue, Enola, Pennsylvania. 9. Five (5%) Percent thereof to my cousin, MISS PATRICIA MURTLAND, Wyoming Avenue, Enola, Pennsylvania. - 2 - In the event that any of the aforesaid persons shall predecease me, the remaining shares of all main benefici- aries shall be proportionately increased. ITEM IV. In the event that my husband and I die simul- taneously or under circumstances as to render it difficult or impossible to determine who predeceases the other, it shall be conclusively presumed for all purposes of my Will and all of its provisions that my husband predeceased me. ITEM V. All estate, inheritance, legacy, succession, transfer taxes, including any interest and penalties there- on, imposed by any domestic or foreign law with respect to all property taxable under such laws by reason of my death, whether or not such property passes under this Will, by operation of law, by contract, or otherwise, shall be paid without any right of reimbursement from any recipient of any such property, without any right of apportionment, and without postponement. ITEM VI. Should any person entitled to a share of my estate be a minor, at time of distribution to him or her, and should the value of such property be more than the amount which may be paid and delivered to him or her or in his or her behalf without the appointment of a guardian or other fiduciary or the delivery of security, such shares shall be paid and distributed to my Trustee hereinafter named, to be held IN TRUST, and managed, invested, and reinvested, together with the accumulation of income there- on, if any. The Trustee shall use and apply from time to time such portion of the income and principal thereof as it deems necessary or desirable for the minor's reasonable - 3 - maintenance, support, and complete education, including preparatory, college, post-graduate, professional training, or to make payments for such purposes to the guardian or person with whom such minor resides and directed to or for the benefit of such minor without further responsibility to such minor, or any person taking care of such minor, and when such minor attains the age of eighteen (18) years, any principal or income not so paid or applied shall be dis- tributed to such minor, or if he or she dies prior thereto, to his or her personal representative. ITEM VII. In addition to powers granted by law, my personal representative shall have the following powers: A. TO sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, or convert or otherwise dispose of, or grant options with respect to any and all property, real or personal, at any time forming a part of my probate or trust estate, in such manner, at such time or times, for such purposes, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances. .B. TO compromise any claim or controversy. C. TO invest in all forms of property, without being limited to legal investments. ITEM VIII. I nominate and appoint my beloved husband, PAUL P. SCHROTH, as the sole Executor of this my last Will, but if he predeceases me, fails to qualify, or ceases to act, I nominate and appoint as Executor my beloved son, THOMAS K. SCHROTH, but if both of them predecease me, fail to qualify, or cease to act, I nominate and appoint DAUPHIN DEPOSIT TRUST COMPANY, of Harrisburg, Pennsylvania, Executor. - 4 - ITEM IX. I nominate and appoint said DAUPHIN DEPOSIT TRUST COMPANY, of Harrisburg, Pennsylvania, as the sole Trustee of all trusts created by this my last Will. IN WITNESS WHEREOF, I have hereunto set my hand this ~'~ day of ~ , 1975. Evel~ K. ScHroth The preceding instrument, consisting of this and four (4) other typewritten pages, was on the date thereof signed, published, and declared by EVELYN K. SCHROTH, the Testatrix named herein, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the pres- ence of each other, have subscribed our names as witnesses hereto. Witnesses: Name - 5 - COMMONWEALTH OF PENNSYLVANLA DEPARTMENTOFREVENUE BUREAU OFINDIVlDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV- 1162 EX(11-96) NO. CD 004687 MARTINEAU DAVID H 3211 NORTH FRONT STREET HARRISBURG, PA 17110-0300 ..... fold ESTATE INFORMATION: SSN: 168-24-2958 FILE NUMBER: 2104-0736 DECEDENT NAME: SCHROTH EVELYN K DATE OF PAYMENT: 12/02/2004 POSTMARK DATE: 1 2/02/2004 COUNTY: CUMBERLAND i DATE OF DEATH: 07/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,002.94 TOTAL AMOUNT PAID: $2,002.94 REMARKS: SEAL CHECK# 103 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF IN~RITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DAVID H MARTINEAU ESQ METZAGER WICKERSHAM PO BOX 5300 HBG PA 17110 1lA1Fj ESTATE OF DATE OF DEATH . FILE NUMBER COUNTY ACN 02-07-2005 SCHROTH 07-06-2004 21 04-0736 CUMBERLAND 101 '* lEV~1541 EX 'F' U2-04l EVELYN K Amount R8IJ! tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER DF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... RW:m,"'.Eic-.AF).-r~1":6'!')".NiiWCE.'b1!-i:NHlrti'i'ANCE-i"AX.'1il5'pRA.fnM.ENT~-.A[t'biUNcf.D'If--....._--_...... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SCHROTH EVELYN K FILE NO. 21 04-0736 ACN 101 DATE 02-07-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line l~ at Spousal rat. (15) 16. Amount of Line 14 taxable at Lineal/Class A rat. (16) 17. Amount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due .00 X 00 = .00 359,509.78 X 045 = 16,177.94 .00 X 12 = .00 .00 X 15 = .00 [19)= 16,177.94 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule Cl 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets 1I) (2) (3) (~) (5) (6) (7) .00 .00 .00 .00 382.646.77 .00 .00 [B) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnenta1 Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) 1I0) 10,541.99 12.595.00 1I1) 1I2) 1I3) 1I~) NOTE: To insure proper credit to your account, submit the upper portion of this forft with your tax payment. 382,646.77 '3.136 99 359,509.78 .00 359,509.78 TAX CR S: ~AYr ,., AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-29-2004 CD004445 710.53 13,500.00 12-02-2004 CDOO4687 .00 2,002.94 TOTAL TAX CREDIT 16,213.47 BALANCE OF TAX DUE 35.53CR INTEREST AND PEN. .00 TOTAL DUE 35.53CR i . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. D\> IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .)1\ BUREAU OF INOIVIIlUAi. TAXES INHERITANCE TAX DIYISI~~~ PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1607 EX AFP (03-05) '. .,-/ : ,) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-31-2005 SCHROTH 07-06-2004 21 04-0736 CUMBERLAND 101 EVELYN K DAVID HMARTINEAU ESQ- METZAGER WICKERSHAM PO BOX 5300 HBG PA 17110 Amount R_itt.d MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, s~it the upper portion of this forn with your tax pay..nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SCHROTH EVELYN K FILE NO.21 04-0736 ACN 101 DATE 05-31-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE MANED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-07-2005 PRINCIPAL TAX DUE: 16,177.94 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-29-2004 CD004445 71 0.53 13,500.00 12-02-2004 CD004687 .00 2,002.94 05-16-2005 REFUND .00 35.53- TOTAL TAX CREDIT 16,177.94 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J August 24, 2005 SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg. PA 17110-0300 717-238-8187 Fax: 717-234-9478 -'.r, Other Offices Colonial Park Lancaster 717-652-7020 717-431-0138 Mechanicsburg Millersburg 717-691-5577 717-692-5810 Shippensburg York 717-530-~ 717-81;3-0502 c:;::l ..>..) CJ' iT. o ~::;J .....J c-:) r"-h CJ r:) ~Tl ~- -'. ":c') -~ rn "'" c::: GJ N Con Ms. Glenda F. Strausbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Evelyn K. Schroth No. 2004-00736 C) :-.0 ~~~0 =::: I'll ~-:: -:-D '.:,--::, :;..~ -'1, -0 ~~ ~.~ Dear Ms. Strausbaugh: W -.l ,-) ~c ,001 Enclosed for filing is Status Report Under Rule 6.12. So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy of the Report with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.e. ~/;/~ David H. Martineau DHM/amm Enclosures cc: Thomas K. Schroth 334530-1 James F. Carl Edward E. Knauss, W>I- JeredL Hock Steven P. Miner Clark DeVere Francis J. Lafferty, IV David H. Martineau Andrew W. Norfleet Andrew C. Spears " Board Certijied in civil triallaro and advocacy by the National Board of Trial Advocacu lJ.._ o LL' U"',: LC::: LL_ C> o U-l C:\ = o U U.J n:: STATUS REPORT UNDER RULE 6.12 Name of Decedent: Evelvn K Schroth Date of Death: 07/06/2004 Will No. 2004-00736 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 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. I is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No x b . The separate Orphans' Court No. (if any) for the personal representative's account is : c . Did the personal representative state an account informally to the parties in interest ? Yes X No d . 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. ~//~ Date: ~~~k Signature ro ('j David H. Martineau. Esauire Name (Please type or print) 3211 N. Front St., PO Box 5300 Harrisbura PA 17110-0300 Address ~ "- m N ~ :::> """ ( 717 ) 238- 8187 Tel. No. ~ CL. LL cS Capacity : Personal Representative L..:"";) = c::.') <"-4 L' x Counsel for personal representative