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Home My WebLink About03-0269 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate oS A. No. q also known as To: Register of~ills for the Deceased. County of ~~ la~ c[ in the Social Security No. ,~ ~- ~ ~ - ~ ~ ~ ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl I~d 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~unty, Penns~vania, wi~ h ~ last family or principal residence at ~M ~-~'~'c~'~lve~ ~ G (list street, number and municipality) Decendent, then ~ years or a~e, died ~ ~ ~r ~ ~ ~ , ~ ~ GG~ Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ I ~ t ~0 ~ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in~Pennsylv~ia,,l~~ ~~"~ $ ~ [~ ' ~ ~ situated as follows: ~ ~v~ ~w~ ~ ~'~ 0 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. 75 N ~d z cJ ,-, : ~ © t-r/ ,,.., OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF C~nberland 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 law. ~tto, lst' Donna M. No. 21-2003-269 Estate of Marie A. Houck , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW March 27th ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Susan H. PoDe is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Susai-i H. Pope in the estate of Marie A. Houck Register of Wills Donna M. Otto, 1st Deputy FEES Letters of Administration ..... $. 235.00 Short Certificates(6 ) .......... $. 18.00 ATTORNEY (Sup. Ct. I.D. No.) Renunciation ................ $. Bond $ 1~ JCP TOTAL __ $ 10. O0 ADDRESS Filed M .aVC~ .27th,.2003... Toea] $ 278.00 PHONE Letters will be picked up by Administratrix 3/27/03 This is to certify that the infbrmation here given is correctly copied fi'om ;in original certificate of: death duly filed with me as Local Registrar. 3'he original certificate will be forwarded to the State \/ital P, ccords ()filcc Ibr permanent filing WARNING: It is illegal to duplicate this copy by photostat or photograph. COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH STATE F~LE NUMI~ER flAME OF DECEDENT (F ,'s~. M ~]le. LaSl) SEX SOCIAL SECURITY' NUMI~EFI DATE OF OEATH ~Mc.n~. Day. 'teat) Marie A. Hquck "t-,,:~=l,a ,.204 -- 01- 9090 82 v=. : : Aug 16,20 ,. ~t~na,Pa ~,~ffi E~O~U.,~ ~ ~ ~. ; ,. DECEDE~'S USU~ ~U~ KiND ~ ~SINES~IN~STRY ~S ~CE~.~ ~VE" ~. I OECEOEN*'S ~e~*O. i '"' '"- 1,,. I,,. I 2 ,. Wi~ ,,. ,, ~ Hzll, Pa 17011 ~om..~.~ ~.~,~ ~ ~,~ ~,,. ~ms Ayle ],,. ~rtha ~nton ~. ~ la~. 1789 ~matk ~v ~,a~ flhin ~gq6 ~ ~,,~U ~ OI / ~ lie~s 2~ mua ~ c~,~ ~ ITIME ~ DE~H ]D~E P~ON~NCEO ~ (M~lh. Day, ~ar) ~S CA~ REFERRED ~ MEDIAL E~MINE~ER? ........................ 3,. ~.-g~ ~,// 21-2003-269 21-2003-269 PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY Harrisburg, Pennsylvania In the Matter of the Estate of: Marie A. Houck KNOW ALL MEN BY THESE PRESENTS, that Susan Pope , we, as Administratrix of the Estate of Marie A. Houck , and Pennsylvania National Mutual Casualty Insurance Company, a Pennsylvania Corporation, of Harrisburg, Pennsylvania, as Surety, are held and firmly bound unto Orphans Court of Cumberland County, Pennsy!vania , the in the full and just sum of Fifty Thousand and No/100 ........................................................ DOLLARS, ($ 50~000. ) for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors,, administrators, successors and assigns, jointly and severally, firmly by these presents. Sealed with our seals, and dated this 27th day of March, 2003. WHEREAS, Susan Pope , has been, or is about to be, appointed Administratrix of the estate of Marie A. Houck , by the ORPHANS Court of Cumberland County. NOW, THEREFORE, the condition of this obligation is such, that if the Susan Pope said Administratrix shall well and truly discharge the duties of said trust according to law, then this obligation is void, otherwise to remain in full force and effect. PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY ttorney-~n-F~t Form 78-168 PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY - Harrisburg, Pennsylvania POWER OF ATTORNEY Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint PATRICIA K. ARBEGAST, DAVID W. HOPCRAFT AND JEFFREY L. SCOTT, ALL OF CARLISLE, PENNSYLVANIA (EACH) its true and lawful Attorney(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed: ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING EXCEEDS THE SUM OF SEVEN HUNDRED FIFTY THOUSAND DOLLARS ($750,000.00) ........................................ ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT AT MlDNIGHT OF THE 30TM DAY OF SEPTEMBER 2005, AS RESPECTS EXECUTION SUBSEQUENT THERETO. And the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its office in Harrisburg Pennsylvania, in their own proper persons. This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and effe in Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these presents to be signed and its corporate seal to be affixed on SEPTEMBER 18, 2002 PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE C¢ Kenneth R. Shutts, Executive Vice-President, Secretary & General Coun Commonwealth of Pennsylvania, County of Dauphin - ss: On SEPTEMBER 18, 2002, before me appeared Kenneth R. Shut-ts to me personally known, who being by me duly sworn, did say that he resides in the Commonwealth of Pennsylvania, that he is Executive Vice-President, Secretary & General Counsel of PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, That he is the individual described in and executed the preceding instrument, and that the seal affixed on said instrument is the corporate seal of said Company, and that said instrument was signed and sealed on behalf of said Company by authority and direction of said Company, and the said office acknowledged said instrument to be the free act and deed of said Company. Notary Public Notarial $¢ai Commonwealth of Pennsylvania, County of Dauphin - ss: Jacqu¢iin¢ A. Ellis, Nota~/Public City Of Harrisburg, Dauphin County My Commission Expires D¢¢. ]9, 2005 Member, Pennsylvania Association of Notaries 1, Michael F. Greet, Vice President, Surety & Fidelity &the PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCI COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certify that the above and foregoing is a true copy of a Power of Attorney, executed by the said Company, which is still in full force and e~ect. V~ffP~r/ffs ~'d~nt: 'Surety~ Fi~i~ IMPORTANT NOTICE: This borcl~r must b~ ~I:D in color. If it is not FI~[~, this ¥ not a ~rtifi~d c:opy. T~h.~6~ us atAr~ Cocl~ 7~7-255-6870. ~ 78-190 (Rev 05/02) / RL6I '~'g -roqoaao uo £uedmoo oaueansuI .(aiunseD [rn~nIAI [uuo!3shI e.me,xI-(SUUOd NIOI&FI~IOS~IIt CERTIFICATION OF NOTICE UNDER RULE 5.6(a) c r;c A. Ho. ot,4 Date of Death: 0(~'~ Will No. Admin. No. ~CJ ~ 0 0 ~ ~ C~ To the Register: c-~]- 0 ~ ~ ~/o? I certify that notice of (beneficial interest) estate _administration required by Rule 5.6(a) of the Orphan~' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~f,~ '~/O.....~ : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except f~ O ~'"3 ~-- Date: -~/'' /0~ ~ ,/~---~>~~ Signature Name ~'~Ca,~' O._ t~ /~/r, ~.~ ~ Address 1~ ~ ~ ::'C .. 9-) .. ,~ ,'i~ m Capacity: Personal Representative Counsel for personal representative COHHONHEALTH OF PENNSYLVANTA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 28060I HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAXSEHENT, ALLONANCE OR DXSALLONANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-IS48 EX &FP R~:~:;: -."! ' ~*~i DATE 08-16-Z00~ ESTATE OF HOUCK HARIE A ;~ ~':~:~' - ~:!:~ DATE OF DEATH 01-29-2005 FILE NUMBER 21 03-0269 COUNTY CUHBERLAND SUSAN e POPE'04 A~ 17 P1:0~ SSN/DC 20~-01-9090 1789 HAY HARKET HAY ACN 05152859 Amoun~ ReE/'U:md HUDSON C:! ~ ~Z$6 .- HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS M REV-154~ EX AFP [01-03) NOT~CE OF INHERZTANCE TAX APPRAZSENENT~ ALLOHANCE OR DZSALLOHANCE OF DEDUCTIONS~ AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-16-200~ ESTATE OF HOUCK HARIE A DATE OF DEATH 01-29-Z00~ COUNTY CUHBERLAND FILE NO. Z1 03-0Z69 S.S/D.C. NO. Z0~-01-9090 ACN 05152859 TAX RETURN WAS: iX) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 187856-00 TYPE OF ACCOUNT: [ ~ SAVINGS ( ) CHECKING [ ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 10-16-1999 Account Balance 12,096.10 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBHIT THE Amount Subject to Tax 6,0~8.05 UPPER PORTION OF THIS NOTICE Debts and Deduct/ohs - .00 HTTH YOUR TAX PAYMENT TO THE Taxable Amount 6,0~8.05 REGISTER OF HILLS AT THE Tax Rate ~ .~5 ABOVE ADDRESS. HAKE CHECK Tax Due 272.16 OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AEENT." TAX CREDTTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID INTEREST IS CHARGED THROUGH 08-2~-200~ TOTAL TAX CREDIT .00 [ AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEI 272.16 REVERSE SIDE OF THIS FORH ZNTEREST AND PEN. 9.~ TOTAL DUE 281.60 .~/ ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 21fi0 of the Inheritance and Estate Tax Act, Act Z$ of 2000. (72 P.S. Section 910`0). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): A refund of a tax credit, mhich mas not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special 20`-hour answering service for fores ordering: 1-800-561-Z050; services for taxpayers aith special hearing and or speaking needs: 1-800-0`0`7-5010 (TT only). OBJECTIONS: Any party in interest not satisfied mith the appraisement, allowance) or disalloaance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals) Dept. 281021, Harrisburg, PA 17118-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court AONIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17118-060! Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (RE¥-1501) for an explanation of administratively correctable errors. DISCOUNT: [f any tax due is paid within three (3) calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: lnterest is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000160`. Al! taxes which became delinquent on or after January l, 1981 wil! bear interest at a rate which wil! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z000` are: Interest Daily Tnterost Dally Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .00050`8 1988-1991 111 .000501 ZOOZ 91 .00020`7 1983 167. .0000`38 1992 97. . O0010`7 2002 67. .000219 1980` 112 .000301 1995-199o, 72 .000191 2003 57. .000157 1985 131 .000556 1995-1998 91 .00020`7 2000` 0`Z .000110 1986 101 .000270` 1999 71 .OOOlgZ 1987 9Z .00020`7 2000 67. .000219 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPATD X NUMBER OF DAYS DELTNQUENT 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 date shown on the Notice, additional interest must be calculated. CONNONgEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-iS~$ESAFP($1-0$) DATE 11-01-2004 ESTATE OF HOUCK HARIE A DATE OF DEATH 01-29-2005 FILE NUHBER 21 05-0269 COUNTY CUHBERLAND -1 SSN/DC 204-01-9090 SUSAN H POPE 'Od ~:~ ~* ACN 05146097 1789 HAYMARKET gAY I Amoun{ R®m/~{ed HUDSON OH HAKE CHECK PAYABLE AND REHXT PAYNENT TO: REGISTER OF gILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOgANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-01-2004 ESTATE OF HOUCK HARIE A DATE OF DEATH 01-29-2005 COUNTY CUHBERLAND FILE NO. 21 05-0269 S.S/D.C. NO. 204-01-9090 ACH 05146097 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO. 5140050554 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 08-51-1999 Account Balance 14,427.97 NOTE: TO INSURE PROPER CREDIT TO Percent Taxab[e )~ 0.500 YOUR ACCOUNT, SUBHIT THE Amount Subject to Tax 7,Z15.99 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 HITH YOUR TAX PAYHENT TO THE TaxabZe Amount 7,215.99 REGISTER OF gILLS AT THE Tax Rate X .45 ABOVE ADDRESS. HAKE CHECK Tax Due 524.65 OR HONEY ORDER PAYABLE TO: "REGISTER OF gILLS, AGENT." TAX CREDZTS: PAYHENT RECEIPT DISCOUNT C+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 11-09-2004 TOTAL TAX CREDIT I .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl 524.65 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 14.0! TOTAL DUE 338.64 '~ a ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements cf Section Z10`0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (7Z P.S. Section 910`0). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed an the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by cowpleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-1315). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices or by calling the special Z0`-hour ansaering service for fores ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-0`0`?-3020 (TT only). OBJECTTONS: Any party in interest not satisfied with the appraisement, allowance, or disaZloaance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADHIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of /ndividual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Res[dent Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daiZy rate of .000164. Ail taxes ahich became delinquent on or after January 1, 1982 ail1 bear interest at a rate ahich ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2000` are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1984 ZOX .00050`8 1988-1991 XlX .000501 Z001 92 .00020`7 1983 162 .0000,58 1992 9Z .00020,7 2002 62 .000219 1980` 112 .00030l 1995-1990` 72 . O00192 2003 52 . O00137 1985 13Z .000356 1995-1998 92 .00020`7 200~, 0`Z .000110 1986 102 .000270` 1999 72 .000192 1987 92 .00020`7 ZOO0 8Z .000219 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUtIBER OF DAYS DELI'NI~UENT X DAXLY TNTEREST 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. COHHONHEALTH OF PENNSYLVANIA ~. BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERXTANCE TAX DZYXSZON DEPT. ZB060I HARRISDURG, PA 1712D-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLO#ANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-XS48EXAFP¢01-0S) DATE 11-01-2004 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-Z9-Z005 FILE NUMBER Z1 05-0Z69 COUNTY CUHBERLAND SUSAN H POPE ~/~ :'*"~ ~':'~:*t& SSN/DC 204-01-9090 ACH 05146098 1789 HAYHARKET HAY Amoun~ Remi~ed I HUDSON OH 4~Z~6 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS ~ ~-:~-~--~P~--~5~-5~- ................................................................................... NOTICE OF INHERITANCE TAX APPRAXSENENT, ALLOHANCE OR DXSALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS DATE 11-01-Z004 ESTATE OF HOUCK HARIE A DATE OF DEATH 01-Zg-ZO0~ COUNTY CUHBERLAND FILE NO. 21 05-0269 S.S/D.C. NO. 204-01-9090 ACN 05146098 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET /NFORNATZON FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO. 5150094669 TYPE OF ACCOUNT: (~ SAVINGS ¢ ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-$1-1999 Accoun~ Balance ~,094.61 NOTE: TO INSURE PROPER CREDIT TO PePcen'c Taxab/e X 0.500 YOUR ACCOUNT, SUBHTT THE Amoun~ Sub~ec'c 'co Tax 1,547.$1 UPPER PORTION OF THIS NOTICE Deb'cs and Deduc'cions - .00 HTTH YOUR TAX PAYHENT TO THE Taxable Amoun'c 1,547.$1 REGISTER OF HILLS AT THE Tax Ra'ce ~ .45 ABOVE ADDRESS. HAKE CHECK Tax Due 69.65 OR MONEY ORDER PAYABLE TO= **REGISTER OF HILLS, AGENT." TAX CRED'rTs: PAYMENT RECEIPT DISCOUNT C+) DATE NUHBER TNTEREST/PEN PAID (-) AHOUNT PAID INTEREST IS CHARGED THROUGH 11-09-2004 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEI 69.6~ REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.01 TOTAL DUE 7Z.Gq .~p ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ { IF TOTAL DUE IS LESS THAN $1, NO PAYHENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" { CR), YOU HAY BE DUE A REFUND. SEE REVERSE SXDE OF THIS FORH FOR INSTRUCTIONS. } PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the /nheritance and Estate Tax Act) Act Z3 of ZOO0. (7Z P.S. Section 9140). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. 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-IS15}. Applications are available at the Office of the Register of Hills, any of the Z5 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: /-800-56Z-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-447-50Z0 (TT only). OBJECTTONS: Any party in interest not satisfied with the appraisement, allowance) or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice cay object within sixty (60) days of receipt of this Notice by: --eritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-IOZ1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADH/N- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601) Harrisburg, PA 171Z6-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of admlnistratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the dacedent's death, a five percent (5X) discount of the tax paid is allowed. PENALTY: The 157. tax aenesty non-participation penalty is coeputed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you could appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payeent. Taxes ahich became delinquent before January 1, 19aZ bear interest at the rate of six (67.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 198Z ali1 bear interest at a rate which will vary from calendar year to caIendar year eith that rate announced by the PA Department of Revenue. The appIicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 207. .000548 X98'--8-1991 117. .000501 200'--~ 9X .000247 1985 167. .000458 1992 97. .000247 ZOOZ 67. .000219 1984 llZ .000301 1995-1994 72 .00019Z 2005 52 .000157 1985 122 .000256 1995-1998 97. .000Z47 ZOO4 4Z .000110 1986 lOZ .000Z74 1999 72 .000192 1987 9Z .000Z47 ZOO0 82 .O00Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELI'NqUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 POPE SUSAN H 1789 HAYMARKET WAY HUDSON, OH 44236 RE: Estate of HOUCK MARIE A File Number: 2003-00269 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/29/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Estate of HOUCK MARIE A Late of LOWER ALLEN TOWNSHIP ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-03-00269 Date: 2/11/2005 NO.: 21-03-00269 POPE SUSAN H 1789 HAYMARKET WAY HUDSON OH 44236 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS I COURT RULE Personal Representative: POPE SUSAN H Personal Representative Counsel: ** NO INFORMATION FOUND ** Date of Decedent's Death: 1/07/2003 Date of Delinquency Notice: 1/29/2005 The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans' Court, in accordance with rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor their counsel, have filed with the Register of wills or Clerk of Orphans' Court, his/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk of Orphans' Court on 2/10/2005 and that the ten (10) day notice to file the status report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or their counsel. ~~~ cc: File Personal Representative Counsel Glenda Farner Strasbaugh Clerk of Orhans' Court A hearing is scheduled for April 01, 2005 at 9:30 AM in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. GEO }vi REY'5GLlEil(IIf..J) ~' , COMMONWEALTH OF '* PENNSYLVANIA , illl/.... DEPARTMENT OF REVENUE DEPl 280601 ~ HARRISBURG, PA 17128.{)601 N,A,P.D REV-1500 FILE NUMBER 21 03 0269 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W Cl W U W Cl DECEDENTS NAME (lAST, FIRST, AND MIDDLE INITIAL) Houck, Marie A ;~;~g;2~~~~ iMMDDYS~R) ,._ J;~~~~;;~(MI~~D:Y=)=-___ {IF APPLICABLE} SURvlVlNG SPOUSE'S NAME {LAST; FIRST, A.~O MIDDLE INlTIAL.i lD.ftTY!Xl[E YEAR NIJllBER w ,., ::,:::S;OO u""" wll.U ",00 U"'~ ll.1ll ll. " [iJ 1. Original Return [J 4. Limtted Estate 05. Decedent Died Testate (AtIochtop'JofWli) C 9. Litigaoon Proceeds Received D 2. Supplemental Return o 4a. Future Imems! Compromise (dale (I( dwthalillt 12.12-52) o 7. Decedent Maintained a Living Trust (A:I2ft, (:l\1l' orTr~l) D 10. Spousai Po"'rtyCredtt\d;;ffior~bet\Wffil'2..J:.!f! al:!1.1-9S) SOCIAL SECURITY NUMBER 204-01-9090 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAl SECURITY NUMBER o 3. Remainder Return (cl?tP. of deoth pliJf 'D 12.13.32) [] 5, Faderal Estate Tax Return ReqUired 8. Total Number of Safe Depos!t Boxes o 11. Bection to tax under Sec. 9113(A)iAl'-..dlSr.hCl ,., z w c z o ll. "' W '" '" o u Til!$$!ii~!I!!$rl.!itll~l$!~,4P,;<<1I!l!~Plffl$i_~1'~~tII>!iI$lKl!l4P!llitll~~Pfijf NAMe COMPLETE MAILING AOORESS Susan H, Pope_~_ 195 Stratford Road FIRM NAME i' """-I Hudson, OH 44236 116,500,00 12,001.43 0,00 000 10,837,72 TELEPHONE NUM~~' (330) 656-2644 1. Real Estate (Schedule A) (1) i." C.:J 14,808.94 (.}''': 2. Stocks and Bonds (Schedule B) (2) (3) 59,246,62 213,394.71 (S) 9,20R 74 2,758.94 (11) .~~_~__.~~~~~~~~'!:I ,9!i.z~!~__ (12) 201,427,03 (13) 0,00 (14) 201,427.03 17. Amount of Line 14 taxable at sibling rate x .12 _:201,427,03 ,,0 ~ (16) ____~_____~~ (17) 9, 064, 2?~~_~_ (18) (19) 9,064.22 3. Ciosely Held Corporation, Part.nersh!p or Sole-Proprietorship 4. Mortgages 8, Notes Receivahle (Schedule 0) (4) 20,0 CHECK HERE IF YOU ARE REOUESm,G A REFUND OF AN OVERPAYMENT .......i";f~~rpjMi'~~~~~J!r ...~~~!!l,j;t.;t~J.*fi!"*j(... z o !;( ...J ::l !:: a.. <C u w 0:: 5. Castl, Bank Deposits & Miscellalleo:.:s Personal Property (Schedule E) (5) 6. Jointly Owned Property lSchedule FJ o Separate Bilfing Requested 7. Inter-VIVOS Transiers 8, Miscellaneo!.!s NOl1~Proba:!e Property (SCt1edu!eG orL) (6) (7) B. Total Gross Assets (total Lines 1-7} 9. Funeral Expenses & l',dministrative Costs (Scheduie H) (9) (10) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductiolls (mtal Lines 9 & 10} 12. Net Value of Estate (Line 8 minus Line 11) -13. Charitable and Governmental Bequest<;/Sec 9113 Tmst" for whici! an election to tax has not been made (Schedule Jj 14. Net Value Subject to Tax (Line 12 min:.:s line 13) z o :;;: I-' ::l a.. ::t o u ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable attt1e spousBI tax rate. or transfers :.:nder Sec. 9116 (ai(1.2) _~m________,,_~_~..~~~ X .0 (15) 16. Amount of Line 14 taxable at ij"eal rate 18 Amourrt of Li~e 14 taxable at collateral rate 1..15 19. Tax Due 1 - Dece(lent's Complete Address: STREET ADDRESS 3414 HawthornE! Drive f-==c CI1Y Camp Hill - -- I STATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. SpoLlsal Poverty credit B. Prior Payments C. Discount (1) 9,064.22 Tolal Gredils (A + 8 + G ) (2) 0.00 3. InterestfPena!ty if applicable D. Interest E. Penaio; 506.62 4. Totai Interesl'Penaity ( 0 + E. ) If Line 2 IS greater loon Line 1 + line 3, enler lhe difference. This is lhe OVERPAYMENT. Check box on Page 1 Line 20 10 request a refund (31 506.62 (4) B. Enler lhe lotal of L,ne 5 + 5A. Th,sls the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 9,064.22 506.62 9,570.84 5. If Line 1 + Line 3 is greater than line 2, enter the dffference. This is me TAX DUE. (5) A. Enter the "Inlerest on the lax due. (SA) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS .....~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........ ............................,.................... .......... D b. retain the right to des~nate who shall use the property transferred or its illCome: ..............."....,..... . . ......,.., D c. retain a reversionary interest: or................................................................................ ,.......,., 0 d. receive t'le promise for life of eit'ler payments, benefits Of care? ............................................. ........................ D 2. II dealh occurred after December 12, 1002, did <lecedenl Iransfer pmpertywithin "",,year of dealh without receiving adequate consideration? ..'" ...............,.".... .,..,...................................................................... 0 3. Old decedent own an ~in lrLlsl for'" or payable upon death bank acoount or security at hiS or her death? ..... 0 4. Did decedent own an individual Retirement Account, aO::"luity, or other non-probate property v-.'hidl contains a beneflCiarj destgnation? ...........,.................................................................. No ~ ~ ~ ~ ~ ~ Under penalties of pe~ury, I decl..-e thai I have exarrined tis rell.m, inducing aa:ompanying sdledJles ..,d sIatements, and to tie best at my knowledge Md bBlief, it is true, correct and complete. D9dara1im of pffipaffir o'tler 1han '!he personal re~ntative is based on all informa'Don ofwtich prepare!' has any knoWledge. SIGNATURE OF PERSON SPONSIBLE FOR zt"W~ AD)Rq~ S-froJ ~urcl~l-Juciso;;~ 01-/ SIGNATURE OF PREPARER OrnER THAN REPRESENTATIVE ~~. DATE d.. / ~~~ Lf y~ (, DATE ---_..._.._-_..~.-.._....__..__._-_.-.._-----_..__...~...---- ADDRESS For dates of death on or after Ju:y 1, 1994 and before January 1 J 1995, the lax rate imposed on the net value of trarlSfers 10 or for the LiSe of the surviving SpOlJS8 is 3% [72 PS S9116 (ai (1.1) (ili For dales 01 death on or aller January 1, 1995. llIe lax ...Ie 'mposed on lhe nel \I3'Je of Iransfers 10 or for llIe use of the SUrVril"9 spouse is 0% {72 P.S. s9116 1'1 (1.1) Iii)]. The statule does nol exemot a trar:sfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse 15 the only beneficiary. For dates of death on or af1er July 1, 2000: The lax rate \mposetS 00 tht': !l~t value of trar.siers from a deceased child t\\lenly-one years of age or younger at death 10 or for the use of a natural parent, an adoptive parent, or a stepparent of 1I1e cI1lid is 0% {72 P.s. S9116(a)(1.2)]. The lax: rate imposed on the ne1 value of transfers to Of for the use of the decedenfs linea! beneficiaries is 4.6%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)]. The tax rate imposed ""the net value 01 lrarslers to or for the use of the decedenfs sibliags is 12% {72 P.S. ~9116Ia)11.311. A sibling is d9flned, under Sechon 9102, as an individual who has at least one parent in common with the decedent. whether by blood or adoption. OMB NO 2502'()265 .... , " A. ~ B. TYPE OF LOAN, U.S. DEPARTMENT OF HOUSING & URBA.N DEVElOPMEN'T '.oFHA 2.oFmHA 3. ~CONV. UN1NS. 4.oVA 5.0CONV.INS. r<r ' 17 SETTLEMENT STATEMENT MILlERHAWTHORNE B. MORTGAGE INS CASE NUMBER: c. NUle, This form is furnished to give you 8 statement of tJctual settlement costs. Amounts paid to and by the settlement agent are shown. lIems markttd ~fPOCr were paid oulside the closing; they are shown here for inforrnational purposes and are not included in the totals. 1.0 "" (MlLLE'RHAWTHClRNE.PFDIMILlERHAWTHORNEl21) TI E. eo,""' , WALTER C. MilLER ESTATE OF MARIE A. HOUCK ERA MORTGAGE 1498 LETCHWORTH ROAD 1789 HAYMARKET WAY CAMP Hill, PA 17011 HUDSON, OH 44236 G. PROPERTY LOCATION: H. SeTTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE: 3414 HAWTHORNE DRIVE Mldstate Abstract Company CAMP Hill, PA 17011 AuguS118,2003 PLACE OF SETTLEMENT 2331 Markel Street Camp HUl, PA 17011 ,. UN ~on ac aes nee , 4lJ<I. , n ao aes "'" . Persona rope 40l. persona rope ~ emen arges 0 orrower ,"e 404. TO!>. ~us men s r ems a, y e erme ance ~us men s or ems al ~ en", ~ewer 0 ewer 44.3 . coontyTax9s 0 . l.;oun axes ~oo axes 000 axes to 109. W. 11. IT 120. GROSS AMOUNT DUE FROM BORROWER 122,249.51 420. GROSS AMOUNT DUE TO SELLER 117,785.93 E<> , , 201. Deposl or eames money xeess Deposl ee ns ons nnapa moun 0 ew oan s e emen arges 0 e er ne 1203. Exls ng oan s ensu jectto istingloan s ensu jec -,gS7lJ ::,1..14. I-'ayon or. Irs age (205. ay 0 a 207. eposl isb. asprocee s zu.. ~us men s r ems n".' y e er ~us men s r ems n".' y e r 210. Sewer 0 ewer 0 QUn a'" oun axes 0 000 axes 0 a';65 0 '4. = 116. 18. ,,,. 220. TOTAL PAID BY/FOR BORROWER 58,798.70 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,665.15 , , ross cun e wm OTTower ,"e ro" moun ue 0 e er ne [302, Less oun a' y or Borrower (Line 220) e" eu ons ue e er (line 520) 303. CASH ( X FROM J ( TO) BORROWER , 63,450.81 603. CASH(XTO)( FROM) SELLER 107,120.78 The ",de::":~~~~m"eted 00" of ,ag" '&2 offuls S~'::::,' & :~:::o~~nm ::~:O:::':. BY: I--V- usan ope, mlnlstra ~ . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR OISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX - . ) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX ZBD60l HARRISBURG PA 17128-0601 (, U r', <J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN I Ii SUSAN H POPE 195 STRATFORD RD HUDSON 05-23-2005 HOUCK 01-29-2003 21 03-0269 CUMBERLAND 101 '* REV-1547 EX AFP (03-05) MARIE A OH 44236 Allount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1l1V'-W~""fi.'X\wm~'II'S,.w'tm.W.!Fl'\.MA'l"f'~M.Y."'''t.71WIl7l'Y!IJIW1'~.'lI'CtbV~M.Y.IlTi'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARIE A FILE NO. 21 03-0269 ACN 101 ESTATE OF HOUCK TAX RETURN WAS: 1 ACCEPTED AS FILED I Xl CHANGED SEE DATE 05-23-2005 ATTACHED NOTICE 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/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) 121 131 141 ISl 161 (7) [91 1101 116,500.00 12.001. 43 .00 .00 10.837.72 14,808.94 62,246.62 181 9,208.74 2.758.94 NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 204,427.03 X 045 = 9,199.22 .00 X 12 = .00 .00 X 15 = .00 1191= 9,199.22 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 216,394.71 Illl 1121 1131 (14) 11.96768 204,427.03 .00 204,427.03 TAX C DITS: Cft, "<~<.ro ,+, AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 1-1 02-25-2005 CD004994 371 .62- 9,570.84 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-26-2005 TOTAL TAX CREDIT 9,199.22 BALANCE OF TAX DUE .00 INTEREST AND PEN. 148.72 TOTAL DUE 148.72 ~ . IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR1, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.l RESERVATION: PURPOSE OF NOTICE: PAVMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENAL TV: INTEREST: Estates of decedents dying on or before Dece~ber 12, 1982 -- if any future interest in the estate is transferred in possession or enjoy.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for Years~ the Co~monwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the require.ents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOOO. (72 P.S. Section 9]40). Detach the top portion of this Notice and sub.it with your pay~ent to the Register of wills printed on the reverse side. --Make check or money order payable to: REGISTEROFWLLLS,AGENT. Failure to pay the tax, interest~ and penalty dUB may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. A refund of a tax credit, which was not requested on the Tax Return, may be requested by co.pleting an nApplication for Refund of Pennsylvania Inheritance and Estate Taxn (REV-13l3). Applications are available online at www.revenue.state.Pa.us. any Register of Wills or Revenue District Dffice, or fram the Depart.ant's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assess.ent of tax (including discount or interest) as shown on this Notice .ay object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Depart~ent of Revenue, Board of Appeals. You may object by filing a protest online at www boardofaDDeals.state.oa.us on Dr before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, YOU must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Depart~ent of Revenue, Board of Appeals P.O. Box Z8l021, HarriSburg, PA 17128-1021. Petitions .ay not be faxed. B) Election to have the matter deterMined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assess.ent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17ll8-060l Phone (7I7J 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ISO!) for an explanation of adllinistratively correctable errors. If any tax due is paid within three (3) calendar ~onths after the decedent.s death, a five percant (57.) discount of the tax paid is allowed. The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid be~ore January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same /IIanner and in the the same time 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 from the date of death, to the date of pay.ent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (67.) percent per annum calculated at a daily rate of .000164. All taxes Which became delinquent on and a~ter January 1, 1982 will bear interest at a rate which will vary froll calendar year to calendar Year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOS are: Interest Daily Interest Daily Interest Rate Factor Year Rate Factor Vear Rate ~:0m48 Tml-,.., ~ -=or :!On -or- 167. .000438 1992 97. .00D2lf.7 ZOOZ 67. 117. .000301 1993-1994 n .00019Z 2003 5;: 137. .000356 1995-1998 97. .000Z47 2004 4;: 10i: .000Z74 1999 n .00019Z ZOOS 5i:' 10;: .000Z74 ZOOD 7i: .000192 VeiiJ,r mz 1983 1984 1985 1986 1987 Daily Factor .~ .000164 .000137 .000110 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to ~ifteen (IS) days beyond the date of the assessment. If paYllent is .ade after the interest co.putation date shown on the Notice, additional interest must be calculated. . REV-1470 EX (6-88)' " W INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Marie A Houck 2103-0269 REVIEWED BY ACN Sandra J Eslinger 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G 1 Annuities are 100% taxable with no exclusion. ROW Page 1 RfV-1503 EX. i6-98* C'A)MMON'Iv'EALTH OF PENNSYLVANiA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Marie A. Houck FILE NUMBER 21-03-0269 All property joindy-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH Van Kampen Inves\menls EmergingGrowIh fund 161660324125 4,541.18 7,460.25 Pace fund - Class A 14I660315489 TOTAL {Also enter on line 2, Recapitulation) $ {If more space is needed, insert additional sheets of the same size} 12.00143 V A' N K AMP E N INVESTMENTS 1-000020627 04fOl/03-Z3.34,25 Generations of Experience'" Investment Report January 1. 2003 - March 31,2003 JOHN N HOUCK & MARIE A HOUCK JT TEN 3414 HAWTHORNE DRIVE CAMP HILL PA 17011-2718 004659 1",111."111"""11."11,,1.11,,,1,,,111,,1,,.,11,1.,11",11 Total Portfolio Value as of March 31, ZOO3 $12.001.43 PortfolioVallJeSumlllarv . Quarterlv Activity' YlIsr.to-Date Activity Beginning Value I nvestme nts/Contri b utions With d rawa Is/Redem ptio ns Investment Earnings Change in Market Value Total Portfolio Value $12,051.30 $0.00 $0.00 $0.00 ($49.87) $12,001.43 $12,051.30 $0.00 $0.00 $0.00 ($49. 87) $12,001.43 Asset Allocation as of March 31, 2003 Page 1 of 3 a Financial Advisor Dare Trevor 565612 Salomon Smith Barney Inc 1001 Page Mill Ro Bldg 4 Ste 101 Palo Alto CA 94304-1020 ~ 6 Access Your Account On the Web 1800) 847-2424 vankampen.com News As of March I, 2003 general correspondence to Van Kampen Investor Services should be mailed to: Van Kampen Investor Services, Inc. P.O. Box 947,Jersey City, N] 07303-0947. Please continue to send purchases and new account applications to the addresses on their respective forms. Looking for an investment for all seasons? Consider Van Kampen Equity and Income Fund, which invests in both stocks and bonds. To learn more visit vankampen. com, or call your financial advisor. Percent Asse. Category Total Value 100.00% Growth $12,001.43 Looking to diversify your portfolio? ~ Check out our taxable and tax-free ~ N fixed-income investments. To learn ~ 0.00% Growth & Income $0.00 0.00% Glo b ai/I nte mation a I $0.00 more, visit www.vankampen.com. 0.00% Income $0.00 0.00% Senior Loan $0.00 0.00% Tax Free $0.00 0.00% Capital Preservation $0.00 100.00% Total $12,001.43 C......$"OO.,027lH90Z0.13t75.1H75,CNSAC50'.INV.......G........ACS......,000020527 1-000020627 04/01/03-23.34.25 VA'N KAMPEN INVESTMENTS Generations of Experience~ Investment Report January 1.2003 - March 31. 2003 Page 2013 Account Summary Fund Name/Symbol Opening Value + Investments/ Withdrawals/ + Investment + Change = Closing Value Fund/Account Number 85011/01/2003 CGntriblftions Redemptions Earnings inValu8 asol3f.J112003 Non-Retirement Pace Fund Class A (ACPAXI 141660315489 $4,633.05 $0.00 $0.00 $0.00 ($91.87) $4,541.18 Emerging Growth Fund Class A IACEGXI 16/660324125 $7,418.25 $0.00 $0.00 $0.00 $42.00 $7 ,460.25 Total All Accounts 512,051.30 SO.OO SO.OO SO.OO 1$49.87) 512,001.43 Account Transactions Pace Fund Class A (ACPAX) Fund/Account Number 14/660315489 Year-ta-Oete ~ividends $0.00 Account Owner John N Houck & Year-to-Oete Capitel Gains $0,00 Dividends are Reinvested Marie A HouckJt Ten Capital Gains ere Reinvested Trade Transaction Dollar Share Shares This Total Date Oescription Amount Price = Transaction Shares Beginning Velue as of 1101/2003 $4,633.05 $7.06 656.240 No Transactions This Period Ending Value as of 3/31/2003 $4,541.18 $6,92 656.240 Emerging Growth Fund Class A (ACEGX) Fund/Account Number 16/660324125 Year-ta.Oate ~ividends $0,00 Account Owner John N Houck & Year-to-Oata Capital Gains $0,00 Dividends are Reinvested Marie A HouckJt Ten Capital Gains ora Reinvested Trade Transaction Oollar Share Shares This Total Date Oescription Amount Price = Transaction Shares Beginning Value as of 1101/2003 $7,418.25 $28 . 26 262.500 ~ ~ No Transactions This Period ~ Ending Value as of 3/31/2003 $7,460.25 $28.42 262.500 ~ CMn.59Zlll)><.027HU020.13971.13971.CNS...CS01.INIIM...li...........CS...m.OOO020&21 l-OOOOl~21 c""mIC3"13.3~.15 VANKAMPEN INVESTMENTS Investment Report Generations of Experience" January 1,2003 - March 31. 2003 Page 3 of 3 * ~ N ~ Add to Your Investment John N Houck & Marie A Houck JtTen 3414 Hawthorne Drive Camp Hill PA 17011-2718 To make investments by mail. please complete, detach and mail this stub with your check. For address changes. visit vankampen.com or complete the reverse side of this form and rerurn itto Van Kampen. Fund N...../Symb.l Fund/Account Number Pace Fund Class A IACPAX) 14/660315489 Emerging Growth Fund Class A (ACEGXI 161880314125 Investment Amount Total Amount $ $ $ $ $ VAN KAMPEN INVESTMENTS P.O. BOX 219319 KANSAS CITY, MO 64121-9319 1.11...1..1...11..1.1...111.1....11....111.1,,1 Please remember to include the account number on your check and specify the amount being invested above. c...._"'nIQ._Q2.1'_2<l_I'.H_\')')H_~MS"'~!l;I:I'_lIW,....o.G.._,...."'cs_.__...llQOI)2a&V REV-15GB EX' (6-901,* COMMONWEALTH OF PENNSYLVANIA lNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Marie A. Houck FILE NUMBER 21-03-0269 Indude the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with right 01 survivorship must be disclosed on Schedule F. ITEM NU MBER DESCRIPTION VALUE AT DATE OF DEATH 1 Savings Bonds 6,292.72 2 1997 Buick LeSabre 3 Misc. Household Items 4,245.00 300.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets c:i the same size) 10,837.72 Kelley Blue Book Used Car Values Kelley Blue Book Hn lRUSnO RESOURCE ......................"........".............klIb,c<llll New ear prk:lll!J llulld a Ca,' 1l1Oi!ntiVllS Q<.aIRyRati"l,l$ o..:".,.."hip C<t$t My o.r'$ V..lue \l$!ecl Car Reboil ft~ I",JQl QUP\li! Bl'Y " U~ <at $(Ill Y(lllt Car M~q<klS Rnandng IMuranc~ lemon Ch&k Warranties Ca.. Rtlylews Car 1"""'",.... ~il.Gllides Advice f....~N~~er AOOlltkbb Home Shop over 50 models from 7 great brands I Body Style z:.l lZipGode ~ ~~ ~tw: Ywr~lt~ ~.Jt'#l~ ~@:lW~l},.~:..~W.~.;:>;,.y~.:':;_ .*::;;0.W.,:...:g$;,.w.~&%:.W-<<*<<.~ Page I of2 8IlltBook MA8m "liCIt IEnter email address Blue Book Trade-In Report Pennsylvania. October 28,2003 1997 Buick LeSabre Custom Sedan 40 .. ..... . .... .... d;;jftii'j: f$.i"'#:.., '" m,...'.C<<<<.'..._...u....-'..:.:.;._,:,y.b..,~ ."...:":'""',.,,......-.........,. v-:-..,..<...._..-......-...:""'.,........_:...,..:~ ." . . .' h Buy a New Car Buy a Used Car List Your Car For Sale Online Free Lemon Check Auto Loans from 3.59% APR Insurance Ouote Warrantv Quote Payment Calculator Current Model Features Sell vour car on eBay Motors ~ http://www.kbb.comlkb/ki.dll/kw.kc.ur?kbb.PA;577915;PA041& 170 11;sed+t;&278;Buic... 10/28/2003 "'.,. ~ * ; Engine: V6 3.8 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 17,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Cassette Dual Front Air Bags ABS (4-Wheel) Power Seat Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior haye only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Trade-In Value $4,245 Trade-in yalue represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Get the latest Btu~ e~k j}?~>.,,-~~.~.,~; ~W.M:::::}~ Get a Private PartY Value Get Invoice & MSRP on New Cars t:: o C. 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'C.,.. &.'6 Q)"C ~Q) ~ ~- S ~ i:. .;:; Q)~ ~ - '" '0 '" ., ~ 0- "d, ~ """ " \\\'0 .a.o~ :X:1>>~ \1) ":I:?"'.,...c"'(Q c:.oan.g-o ~z (I)~~ o ~.- '" '" G,.c~~a ~-o ~ c:-~ ~g ~~ ~ c,o ~ c:..... tG '.-, ao .c o::;~ Q)'O 0_='(1)0) ~.~~-i " -;;; g,'& ~ i...~ "o~Q..g~ eE. ~s ~ ~ (f)"" '<O'&.~"'.o 2. ,o....~ a CP_ ~'"O...$ .- Q) c: ~ (I) "Oj5'"f ~"Cl C '~-6 )5 tn 2._".,,, . ...%~o ~~J,.,"d, .ow.o.g 2O,&~o. "O.Ul"'O'E.2 c-o%~'G) 0"""", '" 0._ '" -:r:...o-oo ._ '!:''i0l~ cu.! ~D tOZ-1'(;; ~-o ..... . (1) to C .e -~B \~~~~ ~B~~~ -u:r.<o1G.... )(,-.........0 ..1,.1.. 00_ Wo" C. c:."O ~"'.S.- ~ 3 :g~, ~ " <>> '" '" s=, %-,; <11''''3 .0 to. tP 7"- .~'&~~ "':"-;;.0 uJ.~uiuJ.s -\'<~~~ "G) 00 J: c"'O_-(1 7,20 $~~ Q) -0'0::. 'il "i~3)(f) O-otGa) <>>",!/! ~~.~.~ ~":i 2..l 5.!! \ ..0 -0 It) , .,,0. uB- . ~ REV-1509 EX+ (6-9S* COMMONVVEAI.TH OF PENNSYLVANiA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLy-oWNED PROPERlY ESTATE OF Marie A. Houck FILE NUMBER 21-03-0269 tf an asset was m1de joint within one yell' of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT{S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Susan H. Pope 195 Stratford Road Hudson, OH 44236 Daughter B. c JOINTLY-OWNED PROPERTY: LETITR DATE DESCRIPTiON OF PROPERTY .Of DATE Of DEATH ITfM FOR JOINT M,1,DE iNCLUDE NAME OF f1NANCIAlINST:TUTION Arm BANK .a,CCOUNT NUMBEr.' OR SiMILAR DATE Of DEATH DECO'S VAI.UE\JF NUMBER TENANT JOINT IDENTlFVlNGNUN8ER. ATIACH DEED ~OR JOINTI.Y-HElO HEAl ESTATE 'JAUiEOF>\ssn INTEREST DECEDENTS iNTEREST 1. A. 11101/1999 PNC Bank - Checking 51-4003~54 14,426.29 50 7.21315 2 A 11101/1999 PNC Bank - Savings 51-3009-4669 3,093.99 50 1,547.00 3 A 1110111999 Memben; 1st - Savings -187856 12,097.58 50 6,048.79 TOTAL (Also enter on line 6, Recapitulation) $ 14,808.94 (If more space is needed, insert additional sheets d the same size) Send \Mulfes to: 5000 Louise Drive ~'m' b' ersr :::bU'll,PA17055 www.membel'$lst.org RAL CREDIT UNION t.:,n Swttchboard: (717) 697,1161 Qf (800) 283-2328 Call~24: (717) 697-4372 Qf (800) 283-4372 TOO: (717) 697-5312 Of (800) 283.2328 ext. 5312 Tel.Branch: (717) 795-6049 or (800) 237-7288 Member's Statement of Account 1...111...111......11...11..1.11...1...111,.1.",11.1.,11,..11 7'87 /'IARIE A HOUCK 3414 HAWTHORNE DR CA/'IP HILL PA 17011-2718 Aocount Number From TO 1'89'- 187856 01-01-03 03-31-03 1 of 1 WE HAVE PARTNERED WITH CARLISLE EVENTS TO PROVIDE YOU WITH THE OPPORTUNITY TO ATTEND ONE OF THEIR 10 EVENTS FREE OF CHARGE! SEE THE ENCLOSED INSERT FOR /'lORE INFORMATION. TRANS EFF. TRANSACTION. DESCRIPTION ... .. AMOUNT BALAN OATE OATE .. SUFFIX:OO SAVINGS 1/'12082 13103 DIVIDEND 15.29 22803 DIVIDEND 13.83 12111 31803 VISA CR 9.04 12120 33103 DIVIDEND 15.33 12135 JOINT OWNERS: SUSAN H POPE Y-T-D DIVIDENDS: 44.45 TRUTH IN SAVINGS INFORMATION ANNUAL PERCENTAGE YIELD ~ 1.50% ANNUAL PERCENTAGE YIELD EARNED 1.50% __n 1------ 1------------------------------------------------------- ------------ --- FOR 2003 * IRA YTD t, OTHER YTD * TOTAL YTD * TOT L YTD * TOT L YTD DIVIDENDS DIVIDENDS DIVIDENDS WITH OLDING FOR E I TURr .00 44.45 44.45 .00 I NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION. ,~H'i\) 1:t:;;C01}~,JT - ~~ ------- TH ;-, FORM is pr: ':i\1 r.'- P.:\) i',i'-.JCi\:(:: \" >UF{ v ;EJ.:~<if\]C /~,( ',-,'" , \/C:UR i\DD!TiONS ANf) '/0\ :F; CHr;Cl<jNC:: 'iv1 ,)H; i,2\ $ {i)J S (e) ;:; {c{) ~, ~;,/P"T(}i. ~~,!1 oLUS :t:~ $ S:jBTF:/\CT TOTAL CHECKS OUTSTANDING ^ $--- TOT).',;, THiS AMOlJf'-.iT SHOULD EQUAL YOUR CHEO{ P~:;G-t~-;:TER B(~Lf\NCE $ BJLL j',jG, r.t G,HT~: U(vlN;/ h- ErrorE cr Quostions About Your Bill lour (,ill l'i or Ii iV!en,t'er;::, Feoeca! end:r'u Dcp2rjrne!~t ') C;OY, ,1C sh;:jf,icsburq P/\ i 7C:,t;. (1{'o:;d more Jr,i(l!f'nati;:;:-) Ur,<on ,-, ,)' :"(!~8 u:i 9: t','~, bdd'c:'~: 2~', '300'" po,~"ibie lIT\ \,'0U nolatOi ihan GO davs after "<l" vc'u t'F ',,_'I,"h ~ 'y', (0' r:n::,b!:n-I ""F ':;:'C, 're:; ,c< \ teJc' ),i)1,0' US m, duing SO wir! tlot teserve yOtlr lights us the fOnlJ',N!nq in1(YiTi2,l!c" ',,'2 t~nc; <,C, Dun, ,'" :n--\!~P 'I' amount ut tile :'",Uspc C',,,,!"} (.!fur 'iiS eiTOt Dnd (' .:p!n!l'1 if VOW c::m IA'ill! !.<:Iicvc; lh~;re :< y;::;; .,(~",d tiley" >",;n<:!tion '-k';scr:\::'t' ;>'ii:: ik,n, 'IOU .cHiC unsure ~lr)C;ut the ! C\"2 not in qusst;oll Vi/hi::: ""'2 in'if'-S~!g8tf-" nn'/ ,m,oum ,,' \'Je ;,,~'tc it :ecc.(1 \ie'L ;i" (;, k.c,uent (1' ~,:: kf:' ::;n',/ CH!>,HGE !~: C!\ ,CL)\AITD FiNANCE CH!-,l;:;:~E th2; r,j;>,: (,:,e]its) IS :mll:ip1:ed (IY th'20 08!:"! periOdic '1uuujd hy dci{hng the F!NANCE 1n\':e -:1: H'w 1~:(!"','O co'ireh ~ 'L";:n'"c;<, Cli';'! co: the; ::.'iec;::d:r" ,.,o.','Tn0d -'W12 r~;ce>'" r::RnOR-j';J:SOLUT10N !\J(;'ncr:: s AhOlA YOUt El0r:tr(\nic Tnn:s%n, 1"0'(1<;1..1"1:)1'1 2231321) ",,',r (' ~:~j - /\1)\1 (One: '2: ~2328 (");\ co" - Ot',e" ,\2<3;:'\5 ex; ~ He;-,:-" :CPCT" , your 8181<: ,l",n; if7,sT :st;~kr:len; "'. wh;d' numt+'" u arE: (inY,'J,", 'o'h'Li' <,,"" h.;pL"in Jsnec~fd (J(v' ,,,ore 2IYJUt", " "'sfe! ';:en S'p,e'1'lert or i'f;CC~T' \NfO rnust fk,-a( from yeu ;:mneZil'''-; C!E:C',CI\, ,'15':, '/Oi' Cd) \'p i-c'Ve 'S an (liLY ," '1 \iUU ne;~c! iTiO'-' nb:T':atio;-' '1 I.~':~ 'Je' if",; ..,oJ", n iO'(-, '1~';"'~; "r-' your ciJrY1p!ai!'1 and wd: CCi!Tf:C~j ~~nv error vC), Wi': nave t'le USE' of the nmney during tl-,8 time ~ ~0L;' 1 U bus;""'?:,"> cis';!:" ~;v' ~ M1:':,;\/BERS -j s'r IS AN EC!Ul~L HOUSING LENDEI~ .tJ.NO l',!,hJ<E:.3 ALL LO/\NS V;JiTHOUT REGARD TO RACE, C()LOR, rU::UGtC)r-}, SEX OR NATlONAL ORIGIN, He': Oa,p )/)"'~ ...1 Banking Statement ; Bank 0. PNCBAN< Primary account number: 51-4003-0554 Page 1 of3 For _ p.rlod 01'0812003 to 0210812003 Number of enclosures: 5 x v MARIE A HOUCK SUSAN H POPE 3414 HAWTHORNE DR CAMP HIll PA 17011-2718 'It For 24-hour customer service or current rates: Call1-888-PNC-BANK Movinll? Please contact us at 1-888-PNC-BANK r2!SI Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 8 Visit us at www.pncbank.com II TOO terminal: 1-800-531-1648 For hearing impaired clients only Relalionship Overvie. lank Dep_it Accounts )escrlp1lon [nterest Checking Savings Iotal Deposits Account Number 51-4003-0554 51-'009-4669 Deposit BIllance 14,528.92 ',298.86 17,827.78 Get a '5". Diacount oft the TurboTax. for the WeblsMI Regular Pricea Save time and money on your taxes! Do your taxes online with the TurboTax for the Web service. Visit pncbank.com to find out how you can save 15% off the regular price when you prepare and file your federal and state taxes with the TurboTax for the Web service. Priority 50 Plus Intenst Checking Account S......ary Account number: 51-4003-0554 Account Link ill number: 2040190902 Marie A Houck Susan H Pope Please see the Activity Detail section for additional information. Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 14,843.49 1,826.'5 2,140.92 14,528.92 Average monthly Charges balllnce Ilnd fees 14,44'.14 .00 Transaction Summary Checks paid! Bank cardlPOS Account Information Teller withdrawals transactions ..slstance calls transactions 5 0 0 0 Total ATM PNC Bank MAC other MAC A TM other ATM transactions ATM transactions transactions transactions 0 0 0 0 Intereat Summary Annual Percentage Number of days Average collected Interest Earned Yield Earned (APYE) In Interest period balance for APYE this period 0.20r. 29 14,44'.14 2.28 As of 02/06, a total of $4.8. In interest was earned this year. FORM953A Total Banking Statement It For 24-hour customer service: Call: 1-888-PNC.BANK For the period 01/09/2003 to 02106/2003 MARIE A HOUCK Primary aCCOllnt number: 51-4003-0554 Page 2 of 3 Account number: 51-4003-0554 - continued Ilctivity Detail Deposits and Other Additions )ate Amount Description ~2/03 1,824.07 Direct Deposit - Civil Serv US Treasury 312 F 2539742 W CSF 02/06 2.28 Interest Payment There were 2 Deposits and Other Additions totaling $1.826.35. Checks Check Date Reference number Amount paid number 3383 1,578.00 01/30 022806010 3384 125.63 01/27 022106527 3387 * 143.72 02/05 024094752 Check number Amount 3388 3389 66.72 94.89 Date paid 01/24 01/24 Reference number 028402049 029396082 * Gap in check sequence There were 5 checks listed totaling $2.008.96. There were 6 Online or Electronic Banking Deductions totaling $131.96. Online and Electronic Banking Deductions Date Amount Description 0l/14 13.80 Direct Payment. Payment PA WC 0649877 0l/16 46.00 Direct Payment. UGI UGI Utilities 217.560-4956-00 0l/21 21.81 Direct Payment. Payments Verizon Phone Bi 717761513571092 OV21 17.12 Direct Payment - At&T Servs Au 800.222.0300 0913007013101 OV27 31.23 Direct Payment - Payments Verizon Phone Bi 717737283218411 04'05 2.00 Direct Payment - Feb Dues Priority 50 Plus 019072100000 Daily Balance Detail Date 01/09 01/14 01/16 Balance 14,843.49 14,829.69 14,783.69 Date Balance 01/21. 14,744.76 r 01/2-L/~\ \yI/27 14.42Q,~9/ ----------...---- Date 01/30 02/03 02105 Balance 12,848.29 14,672.36 14,526.64 Date 02/06 Balance 14,528.92 Important benefit information for all PNC Bank VISA Gold Check Cardholders A VISA Gold Check Card provides you with even more great benefits. For example, when you use your PNC Bank VISA Gold Check Card 10 make non-PIN purchases you have the added benefits of: Purchase Secnrity* - 90 day theft or damage protection on most card purchases. Warranty Manager* - Doubles the manufacturer's written U.S. warranty up to one year on warranties of three years or less. Register your purchases by phone or online. *Certain restrictions and conditions apply. For complete benefit information, go to www.visa.com/benefits or call 1-800-595-9928. If you don't already have a PNC Bank VISA Gold Check Card, ask us how you can get one today! Simply SlOp by your nearest PNC Bank branch, call 1-888-PNC-BANK or visit pncbank.com for details. rotal'Barildng Statement It 0. PNCBAN< For 24-hour customer service: Call: 1-888-PNC-BANK For the period 0"0912003 to 0210812003 MARIE A HOUCK Primary account number: 51-4003-0554 Page 3 of 3 Account number: 51-4003-0554 - continued Savinga Account Summary "",",unt number: 51-3009-4669 Account link" number: 2040190902 Marie A Houck Susan H Pope ....nc. Summary 3,093.99 204.87 Checks and other deductIons .00 Ending balance Please see the Activity Detail section for additional information. Beginning balance Deposits and oth.r additions 3,298.86 Average monthly balance 3,122.15 Charges and fees .00 As of 02/06, a total of ., .80 in interest was earned this year. Int.r.st Summary Annual Percentage Yield Eamed (APYE) Number of days In Interest period Average eollected balance for APYE Interest Earned this period 0.351. 29 3,122.15 .87 Activity Detail Dep... and Other Addition. Date Amount Description 02/03 204.00 Direct Deposit - Soc Sec US Treasury 303 204019090A 02/06 .87 Interest Payment There were 2 Deposits and Other Additions totaling $2M.87. Oat. 02/03 Balance 3,297.99 Date 02/06 Balance 3,298.86 FQRM953R Reviewing Your Statement Please review this statement carefully and reconcile it with your records. Call the telephone number on the upper right side of the first page of this ~ statement if: you have any questions regarding your account(~); your name or address is incorrect; you have a business account and your tax identification number is missing or incorrect; you have any questions regarding interest paid to an interest-bearing account. Balancing Your Account Update Your Account Register Compare: Check Off: The activity detail section of your statement to your account register. All items in your account register that also 3ppear on your statement. Remember to begin with the ending date of your last statement. (An asterisk [*] will appear in the Checks section if there is a gap in the listing of consecutive check numbers.) Any deposits or additions including interest payments and ATM or electronic deposits listed on the statement that are not already entered. Any account deductions including fees and ATJ\rI or electronic deductions that are not already entered. Add to Your Account Registor Balance: Subtract From Your Account Register Belance: Update Your Statement Information Step 1: Add together deposits and other additions listed in your account register but not on your statement. Date of Deposit Amount Step 2: Add together checks and other deductions listed in your account register but not on your statement. Check Number or Deduction Description Amount Total A Step 3: Enter the ending balance recorded on your statement $ Add deposits and other additions not recorded Total A + $ Subtotal= $ Subtract checks and other deductions not recorded Total B - $ The result should equal your account register balance $ Total B Verification of Direct Deposits To verify whether a direct deposit or other transfer to your account has occurred, call us at the 24-hour customer senrice telephone number listed on the upper right side of the first page of this statement. Electronic Funds Transfers In case of errors or questions about your electronic transfers or if you need more information about a transfer, call us at the 24-hour customer selVice telephone number listed on the upper right side of the first page of this statement. Or, if you prefer, please ""Tite us at: Customer Service, P.O. Box 609, Pittsburgh, PA 15230-0609, If there is a problem, you must contact us no later than 60 days after the ending date of the first statement on which the error or problem appeared. You will need to provide the following information: Your name and accollnt number(s); A description of the error or the transfer you are questioning. Please e>''Plain as dearly as )'ou can why you need more information or why you believe an error was made; The dollar amount of the suspected error. We will investigate your complaint and will correct any error promptly. If the investigation takes longer than 10 business days, we will credit your account for the amount you think is in error, so that you will have use of the funds during the time it takes us to complete our investigation. Member FDIC A Equal Housing Lender REV-151D EX, i6-98* COMMON\NEALTH OF PENNSYL'v)\N!A iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-YIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Marie A. Houck FILE NUMBER 21-03-0269 This schedule must be completed and filed if the answer to any of questions 1 throUSh 4 on the reverse side of the REV-1500 COVER SHEET is yss. ITEM DESCRIPTION Of PROPERTY INCLIJJETl-E NAME OF TfoETRANSFEREE, Mil: REl.AT1CNlH1PTOOE~ /1KJ DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER Aro.cHAca>YOFM l&D FOR REALESTATE VALUE OF ASSET INTEREST IFAPPlIC'.ARlR VALUE ,. Glenbrook Lrte and Annuity 1IGA0688295 62,246.62 100 3,000.00 59,246.62 Transferee: Susan H. Pope Relationship to decendent: daughter Date of transfer. Beneficiary upon death TOTAL (Also enter on line 7 Recapitulation) $ 59,24662 (If more space is needed, insert additional sheets of the same size) ~ Allstate. Glenbrook Life and Annuity Company PO Box 94042 Palatine IL 60094-4042 Telephone: 1-800-755-5275 Fox: 1-847-402-5313 1.,.111..,111...",11,.,11,.1,11.,.1.,.111,.1.,,1,11 MARIE A. HOURK 3414 HAWTHRONE DR. CAMP HILL PA 17011-2718 January 23, 2003 I:.;;;oc.;_~g;l)li"~i;.IIII ........ :?-::::~ ...................................................................................'.'...........-.'-.-....................................-......................w....... MARCIE LINGLE PNC INSURANCE SERVICES, INC 5288 SIMPSON FERRY ROAD MECHANICSBURG PA 17050-3514 (717)000-0000 Allstate. Advantage Plus Annuity Statement # GA0688295 ::':';::':':':::':'::;::::':';:::''::;:::.::::.::::::,:::.:::::.;.:.:"." ...N....,.._.........,....,.....,.,.......,........................................................,..................,_....,_.........'............,.. ......,..............,."...,......---,.--......-...."....-..,.........,........... .............,.-.....,-...-,-.-...-..,-......,....-....................................-.-...-..,..................'.-....--,...-....,-.-,-.......... : AmlYlJ'tt'mHllie_PPt -...-..-,..,-...-.-........-...-..-..... ..................... ......'.'.......-.'...'................... ................ ............................ ....-.....,..-....,.....,... .................-............ ,......................... ;:::::;;:'::::::::::':::.;:::::::':::::::::;:::'::::"::: ........................... ..'...............','.....,.....................'... ......................,.....,..'.......'..-........-.-.-.....,....-..-.-.-....-.....-.....- ......,-.,................................... :;,:::::::::,:::::,::;::,;:;::;;,::;::;;:;,::;:;,;:,:::::;;:,;:::::;::::::::::::::~:::,;::; ................ ................................ ..:,...... ................................... .................. ".:.,.:.:.:.:.,.:-,.:.::::.,:.......:,.:.... :,::,;::':::,::;::;:::,:::;::::::::0:'.......... ...................,........... .......,...........-...................................,...... .................w... ,............'........_..............w....... ....................... ....................... .,........:.......,.........-.......,...........:.:.....;..;.;,:::,::;,::;::.:.:::::.:.,.:.:,;::,:::::,,:,,:,,::',';::':;':"::'::'::,':':::'::'::',:,::,,:::,,:;,,;::,:::,:.,,;.,........-.-- Beginning Account Balance 10/23/02 $ 61,485.81 Interest Earned 10/23/02 thru 01/23/03 _ _ . . _ . . . . . . . . . . . . . . . . . . _ . . . . . _ . _ _ . . _ . . . . _ . . . . . . . _ _ $ 760.81 .....,... ':;;::.:'r\/ItE:::::::: -,.:.,.:.:.,.:.:.,.:.:.:.,.,.:.,.:-,.:.: .....:.,.;-:.,.:.:.:.:.:.:,'.:.:.,-:.:,'.:.;. I~9IQPH~YA~Y@Qiil~giifIql_i .........,.,......... :,:::,::,::,:::::::,:,;::,,:,:::,:,::,,:.;. ............,........ -.-..-.'..................,......w.... ..........~:'.........................'....:<.,.:.,.,.:<. ::::;:::"'::;;'::;:::':::':;:':::::':::::":::::""~,,:~ Ending Account Balance 01/23/03 . _ . . . . . . . . . . . . _ . . . _ . . _ . . . . . . . . . . . . . . . . . . . . _ . . . _ . . _ .. $ 62,246.62 ..........,...... .....-......-..... ................ ..................-:.:.,: ::,::{::::~:::::;::,:::::::,:.:.:.:.,':......:.. <.:.:.,.,.:.:.,.:.:.:.:.,.,.:.,.,.:.;.:.:.:.:.,.:.:.,.;-:.,.".:.:.:-,.:.; ......................,. ..................... .................:<_.......... Current Rate Fund Value 5.00% $ 62,246.62 New effective annual rates for each fund will be determined when the current guarantee expires. If you have any questions concerning your annuity please contact your representative at your financial institution. Glenbrook LKe and Annuity Company issues fixed and SEC-registered insurance products. SEC-registered insurance products are underwritten by ALFS, Inc. Both Glenbrook LKe and ALFS are wholly owned subsidiaries of Allstate LKe Insurance Company_ ~ MB B14H69HG.NOl aHlXX2l141fill-lGB141-GlHQXlJX1 00"" ....;;;;...;.... .;.;-;:;.;.;.:.:.:.: '::;:::::P~h:~:;:~: '.:.:.:.:.;.:.;.;.:.;.;.:.;-;.; ;;;:~:;;:;;;:::;::;::}:::~ .:.;.;.;;; ... ........-.w. ..............,;.,:. ....:.;~. ...........................-.....-.............................;.;.;.;.;-;...;.;.:.;.;.;.;...;.;.:.;.;.~;.;.,.;...... ...... .................................-.-.........-........................;.;.;-;.;.;.;.._..;.;-;.;.;.;...;.;_..;.:.;.,.;.:.;.;.;-;.;-;.;.:.;.;.;....-;.,-;.;.,.;.;.,.;.;.,.;';":V' .........-........................... .................. :.:.:.;.:.:.:.:.;.:.;.;.:.,.:..;.;.;.; ................. Annuitant: Owner: Issue Date: Type of Plan: Prlmarv Beneflclarv(les): Susan H. Pope Contlnaent Beneflclarv(les): Melanie Pope Lindsey Pope Emily Pope Marie A. Hourk Marie A. Hourk 04/23/02 Non-Qualified Percentaae 100% Percentaae Equally Equally Equally 2 .~. . ,.;. .,.:<.;.;<.;.,;. . 'u \~~~~:;;~~~~~d:t;'" ;.:.; .....:<.;<. ................. ......................................... ..................... ...................-..................... ................... .,.;.;.;.;.;.;.:..., ;-:<.;.;.;.:.;.,. .........._....................................w .......................... 814H69HG.N01 ~l.Hll--lGBlo1H!D-1a:JX1X) REV.1511 EX. (12-991. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Marie A. Houck FILE NUMBER 21-03-0269 Debts of decedent must be reported on Schedute L ITEM NUMBER A. DESCRIPTION AMOUNT 2 FUNERAL EXPENSES: Catholic Cemetanes Food and refreshments aller funeral Myers-Hamer Funeral Home 775.00 533.65 7,289.00 1. 3 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Numbe~s)/EIN Number of Personal Representative{s) Street Address City State lip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees 538.00 5. Accountant's fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal Patriol News 75.00 70.09 TOTAL (Also enter on line 9, Recap~ulation) $ (" more space is needed, insert additional sheets of the same size) 9,28074 -REV-151Z'"EX+(12-03) .. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marie A Houck FILE NUMBER 21-03-0269 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION I. BCC Development & Management Company (OuUook Pointe Assisted living) VALUE AT DATE OF DEATH 1,578.00 2. Sweet 'N Gro lwon Care 143.72 3. Brockie Pharmatech 123.44 4. Personal Taxes - Camp Hill BolO 5.00 5. Real Estate Taxes 471.06 6. Balanced Care Corp. 319.50 7. AT&T Phone lease 14.55 8. UGI- Gas 46.00 9. PAWC-WaterBill 11.16 10. Verizon 29.29 11. Comeast 17.22 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 2,758.94 . REV-1513 EX+(!UIO} '* SCHEDULE J BENEFICIARIES COMMONWFALTH Of PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marie A. Houck FILE NUMBER 21-03-D269 RElATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Truslee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 91161') 11,211 1. Susan H. Pope daughter 201,427.03 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II 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 ruTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11"96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT POPE SUSAN H 1789 HAYMARKET WAY HUDSON, OH 44236 _~auu fold ESTATE INFORMATION: SSN: 204-01-9090 FILE NUMBER: 2103-0269 DECEDENT NAME: HOUCK MARIE A DATE OF PAYMENT: 02/28/2005 POSTMARK DATE: 02/25/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/29/2003 NO. CD 004994 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $9,570.84 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2839 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $9,570.84 GLENDA FARNER STRASBAUGH REGISTER OF WillS ~ \lib a: OJ, r- :r: . to ~OC:~u1N~ 0-';i5~N~g .a..(/l'<;J"ffio-' u:. g u...Q => :l: ~ r- . 5_ ~~ -= -: ~ 1 ~~! = =; IH~~ "" - ""~ :- !i .; ..... 4. ',1S1 l;>- ,JIf. ~c\ \,;.'1,.. 6;:,<. ;. 0.;\ \~ '60<;>., ... ~""; \. 1:i -L- cf)1i;:. ;,? ~'" "" (:~ Y t ~ "".') . d;l... '3.:.~J ~./-.,- ".t'4 Dp..,Q. '@\0t \,,~ ~b ~};% \"f. '6, , '.' "'1.:', 1,.\.".. ; \.\" , \.:, '. .j ~ J - \ .1 ~y \ 0.. \ t c \ ~ ~l I'.......'. '..". " .~ - -S ~~ ~ ~ en ~ .- ~ <) :) \' ~-- ~ (^ -- V I ~ '3 ~ ~ P- \J\ ? 1 ~ \,.. ~I.. -rVJ \) 'J J ~ U-~ cI,IU c...J.- o . ~ .-.~~.~ '.--...~.._-- ~ ..~.J." lnventory of the real and personal estate of NCLrie A HoucJ.! ~\ ~~:"+cde S+ocks <;l eo,d.s C'qslJ, b<2j=~I-tS I N,sc ::To I..i I)' - o LU,-, ed' ~Or(er4l AV1n~,+y 10+6- I G rass A~s,,--G Less~ h".",e-ll::)Cpee,-sE>..s ~ De 6-b 0 r- 1)E'c~c1e.....-f Ne+- Va... 1\.Je. d ~ 1:~~-\de N<6+ Vo.-Iue.- 01=" ~s+de ~ ~ 0 l ) Lj ~( . deceased -) IH.;>'::>OO 09 I~oal Lf~ - 10837 7;).. ~ 1'-/;;'06 ~L{ 59d'-ltO <<9 I I I d\339,/ 1..1 , 1 11%1 foX 1,'1)7 6.d- , ,:) ';';:' JI I.' ('<.J c, ~ DI" Ot-h'b e8U~]eU:"r;AlTH OF rENU&YLl:fttJlA COUNTY OF CIIIAII:RI.AND ..s-u IV< M ; J ~ c{ ~P,N t-+ ~f" '[ J 55: being duly $wo r n according to law, deposes and says that she ~!)/VI '1Id'k"-. -r~.e of the Estate of M~-e A. H-ov< <:. k late of ~'lc!.~HA1A:l:rd::o@.{\)E ~_,_~f---.1J,'Lt , Cumberland County, Pa., deceased and that the within is an inventory made by ~.l:<'U'1 11. P"'f'E ., the said,qD,,^;""I";~~ of the entire estate of said decedent, consisting of all the personal proporty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. SWo~ and subscribed f"t.Jo cl. S' ~~~~ Notary Pu 0, Stat. of Ohio My Commission Expires June 1 e, 2006 Date of Death d.Cl Day before me, I 'y -t'r iJ.,oo S' /xE~:;;, .~2~ / q~ S1ra-i /';;rc/ Hudson. O/-J , P-I y <-J .;:2.3 ('" Addr.ss =r ~~t~ j- ~I v J o IT <(1 ~ 01 CJ -I 1: 0 I " I -:;; I -' ~oo::5 Y.ar INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheels may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. ,; GO ~ .. " u " C GO '" .. a.. >- GO C ~ o :s: -< ,; Z [ 'I II I I I ~ o I- Z W > Z >- I- W '" I- W <( a.. I- o V> W '" W I a.. I- -' u.. u.. -' -< 0 o <( ~ Z o c V> z ffi <( a.. .. a.. >- - c ~ o U -c c .. -;: " .D E ~ U ... -c ..! u: -" o o '" . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Marie A. Houck Date of Death: 01/29/2003 Estate No.: 21-03-0269 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 [8J No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a' Did the perso~presentative file a final account with the Court? Yes. N~ ~O,W-f b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the pers~presentative state an account informally to the parties in interest? Ye~ No .. Yes ~ c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be "'l . attached to 'his "port. ~ . ~ /~/OS- :~<)-~~ Nv~~ SIgnature Date: c.) Susan H. Pope Name 195 Stratford Road, Hudson, OH 44236 r:-~ '''; Address . , '..""..1 330-656-2644 Telephone No. Capacity: I8l Personal Representative o Counsel for personal representative cr\ COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERI'fANCE TAX INHERITANCE TAX DIVISION RECORD ADJUSTMENT PO BOX 280601 JOINTLY HELD OR TRUST ASSETS HARRISBURG PA 17128-0601 REV-1604 EX AFP (03 DATE 05-20-2005 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 FILE NUMBER 21 03-0269 COUNTY CUMBERLAND SUSAN H POPE SSN'DC 204-01-9090 ACN 03146098 1789 HAYMARKET WAY I A.ount RBlli tted I HUDSON OH 4236 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 ~~!. .~';2!4!.!~.I.~.~.I!!.......!: RETAIN LOWER PORTION FOR YOUR RECORDS ... ............................................................................... REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 05-20-2005 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 COUNTY CUMBERLAND FILE NO. 21 03-0269 S.S/D.C. NO. 204-01-9090 ACN 03146098 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION PNC BANK ACCOUNT NO. 5130094669 TYPE OF ACCOUNT: (X) SAV NGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-31-19 9 Account Balance .00 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable v 0.500 ACCOUNT. SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate y .45 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due .00 TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 I TOTAL DUE nn . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREOITn ICR), YOU HAY BE DIIE A REFUND. sei REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) -05) -=.:,\.L Q.- COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION RECORD ADJUSTMENT PO BOX 280601 JOINTLY HELD OR TRUST ASSETS HARRISBURG PA 17128-0601 REV-1604 EX AFP (03- DATE 05-20-2005 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 FILE NUMBER 21 03-0269 COUNTY CUMBERLAND SUSAN H POPE SSN/DC 204-01-9090 ACN 03146097 1789 HAYMARKET WAY I Allount R_itt.d I HUDSON OH ~4236 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 ~~!..":.~2~!.!~.I.~.~.I.~!.......! RETAIN LOWER PORTION FOR YOUR RECORDS ....... ............................................................................... REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 05-20-2005 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 COUNTY CUMBERLAND FILE NO. 21 03-0269 S.S/D.C. NO. 204-01-9090 ACN 03146097 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION PNC BANK ACCOUNT NO. 5140030554 TYPE OF ACCOUNT: ( ) SAV NGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-31-19 9 Account Balance .00 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable y 0.500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate y .45 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due .00 TO: nREGISTER OF WILLS, AGENT.n TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE nn 05) . IF PAID AFTER THIS DATE, SEr REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FD~ FOR INSTRUCTIONS. I ?~ Q-" COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF IHDIVIDU~(iiliflt$T 'iT tE I'HHERU'ANCE TAX INHERITANCE TAX DIvrSIbIr:: '. -. .. " -.--~ RECORD ADJUSTMENT PO BOX 280601 " "e JOINTLY HELD OR TRUST ASSETS HARRISBURG PA 17128-0601 REV-160~ EX AFP (03- ?r:n5~;rv", ClL '1'/' 40 DATE 05-20-2005 ....Vc; \,1 I c.. I Ii i .i... ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 CLER'a~~ FILE NUMBER 21 03-0269 ,-,.,- '" ,-.--. COUNTY CUMBERLAND Oi.+"" ::! SSN/DC 204-01-9090 '-. ,..\".-" SUSAN .~t I'HPOPE- ACN 03132859 \.,,-,'i. 1789 HAY MARKET WAY I A.ount Roi tted I HUDSON OH 4236 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 ~~!..~~2~!.!~..I.~.~.1:.~!.......!:. RETAIN LOWER PORTION FOR YOUR RECORDS ....... ............................................................................... REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 05-20-2005 ESTATE OF HOUCK MARIE A DATE OF DEATH 01-29-2003 COUNTY CUMBERLAND FILE NO. 21 03-0269 S.S/D.C. NO. 204-01-9090 ACN 03132859 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION MEMBERS 1ST FCU ACCOUNT NO. 187856-00 TYPE OF ACCOUNT: ( X) SAV NGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-16-19 9 Account Balance .00 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable y- 0.500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate y .45 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due .00 TO: nREGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (- ) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE I nn . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN '~I NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SE REVERSE SIDE OF THIS FOHN FOR INSTRUCTIONS.1 05' ~'(,.. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17t28-0601 REV-1162 EX(1 1-96) RECEIVED "ROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT POPE SUSAN H 1789 HAYMARKET WAY HUDSON, OH 44236 , n_Uu_ fold ESTATE INFORMATION: SSN: 204-01-9090 FILE NUMBER: 2103-0269 DECEDENT NAME: HOUCK MARIE A DATE OF PAYMENT: 06/13/2005 POSTMARK DATE: 06/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/29/2003 NO. CD 005427 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $148.72 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2920 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $148.72 GLENDA FARNER STRASBAUGH REGISTER OF WILLS \s , ',. 'r- \0 .3: IGI \~ '" \ III . .r- '" '3: hll . , . . . . I. I' . . . ::11 '111 """ ',. ~.. ~3: 'r- \0 .e \~ . .... Ii 1-4 ... '0 13: , ..,. '0 \:11 , ..( '0 'c \:11 , \Wt ,('I '0 ':II '" III ,,:....<11 c-DC 0\71<11 \/> ,. 0\/>:3' :3'.... ",,,: 1> ....." ...0 0'" ",rn o '" d o ,,: S" S" N '" '" ~ III 00'" ~ ,.crn ",~G) ... .... ~ ....rn\/> <II"'.... ,.0: ......1"1 -0 rn1>'" , :3' ~ dO ." ... ; - ,.gs: r- .... III ....0... ~ ...0'" ...c\/> ....,. '" "'.... :II ,,: ~ 0 c .. \/> -4 1"1 -0 ~ S ~ -4 -4 0 .. 1 S8104,! 1\:llI'i~ 'Ch~S 1 ...~- 'Oili ~l/.~ .." .........~ !:i ~a ... ".... N .. c: .. ~.... , "'g " .. .. .. ~ i~ ... \ !O ~." ('I ~ 0 ...... 1 ; \ ~ ~i H~~ ~III i- rn =." ..~~ ~~ iij ~~ ~~rn 0"'" W. rnS -n-o ~i~ :II~ .-'.!i 1ft ~3: dllf. JII~ ..:1..... 3:- 7'"''"' C' ,,.,,,,.. "'c ,:!It ,. r'-' 3: .~' ~ rn (") C:o ~-::;:\ t_ J;'g~~ ~~ 3:i~T; ~ 2~t: ~ ~c)\; l; -; -4 ": ('-.,. .r:- to-A(")NO::CO oc:~..-QU1 .... :C 1 c:: ' ......NO~ rn",-D"~ ~ t I ' r-cN N .".NO Q ~a-~ Q d-D'" \71 ~ , s ~ ~ .... ~ rn !1. .. ~ " ... , ,. " ~ ,~ all. ... '" ... ,- '" ' . I \ I \ \ \ 1\\ i\ I 1~ J~ ~~~ , ~ j ~ ~\.J 'S- \~ - ~ ..." -:: -::: -: .-:: - - - - - ~ ::; - ~ - -; - I,..J 1)\ {';l 1'.\ ..... (~I .,.. o \'~.. ; 1-',,"'- .r) [", ,,' j l..'. , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA l11Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-16D7 EX AFP (03-05) 11" ",",".-0+ I ,; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-05-2005 HOUCK 01-29-2003 21 03-0269 CUMBERLAND 101 AiIount R..Uted MARIE A OF,- SUSAN H P6P~ 195 STRATFORD RD HUDSON OH 44236 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, sub.it the upper portion of this for. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF HOUCK MARIE A FILE NO.21 03-0269 ACN 101 DATE 07-05-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACH IH THE HAMED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION DF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 05-23-2005 PRINCIPAL TAX DUE: 9,199.22 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-25-2005 CD004994 371. 62- 9,570.84 06-11-2005 CD005427 148.72- 148.72 TOTAL TAX CREDIT 9,199.22 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. ( IF TOTAL DUE IS LESS THAN $1, ND PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. J