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HomeMy WebLinkAbout05-20-11°y.~ 15056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0928 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207-32-6869 07/28/2010 04/21/1941 Decedent's Last Name Suffix Decedent's First Name MI Nott Ronald p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Neitz Carol A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW •' 1. Original Return 2. Supplemental Return °: 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ' ;; 5. Federal Estate Tax Return Required death after 12-12-82) • 6. Decedent Died Testate (Attach Copy of Will) _.. 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received :: 10. Spousal Poverty Credit (date of death =,,-,;::.' 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) Vu1tKtSF'UNDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Lisa Marie Coyne, Esq. (717) 737-0464 Firm Name (If Applicable) ' ~ ,:;~-~ ;,.:. Coyne & Coyne, P.C. REGISTER O F ~a. " SE ONL~~ '~ , ~"~ ~~~ First line of address ~ .-~ ~~ L..,:~~~ -~--- ~~ 3901 Market Street ~ ~ ~ ~ ; ; Second line of address r `~ ~,,.~ CJ -~ `~ ~ ,J - c..3 "pi"t { a i.,.j ..~ -p " ~.r ~ ~ ~- : . I'i'i City or Post Office State DATI~FILED ZIP Code -- -- _ ~ ~, '~ C~ Camp Hill PA 17011 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ATE ADDRESS ~ - ~ -- -- - Carol A. Neitz 105 Mountain Street, Summerdale, PA 17093 ___ --- ---- ---- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE - - - - -- ---- -- DATE - - - - - --- - --_ - _ -- ESS ---- PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 - - -- - J 15056052059 REV-1500 EX Decedent's Social Security Number decedent's rvame; Ronald P Nott .. 207-32-6869 RE _ _ ......... ....... _..... CA PITULATION ~.... _. ....... _ _ .... _.... _. _ . _ 1. Real estate (Schedule A) . ....................................... ..... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................. ..... 2. 652.12 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ........................ ..... 4. 18,752.46 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ... ..... 5. 10,214.44 6. Jointly Owned Property (Schedule F) ~~:~~ Separate Billing Requested ... .... 6. 3,404.28 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ':::::..°4.`~ Separate Billing Requested.... .... 7. 0.00 Total Gross Assets total Lines 1 7...,. (... ). ... .. ................... .... s. ,,.... ,.....,.. 33,023.30 9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. 24,800.13 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 3,382.53 11. Total Deductions (total Lines 9 & 10) ............................... .... 11. 28,182.66 12. Net Value of Estate (Line 8 minus Line 11) .............. 12 13. ............ Charitable and Governmental Bequests/Sec 9113 Trusts for which .... . 4,840.64 an election to tax has not been made (Schedule J) .................... .... 13. Tax (Line 12 minus Line 13) .............. Net Value Sub'ect to........, ._...... .....W_.~__~...W_.__.. - .... 14. 4,840.64 . ...~ _....,.....W.~ .. __ _....... ~. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ....._. ....`.W. ..~.....4 ...~~.. ..._....... ~~ "" 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 4,840.64 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .U - 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ..................................................... ....19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Ronald P Nott - -- __-- __ STREET ADDRESS _ --_ _ - _ -_-- P.O. Box 281 105 Mountain Street CITY _- _ _ - Summerdale F(le Number 21 10 0928 DECEDENTS SOCIAL SECURITY NUMBER ____-_-_ _-- _ 207-32-6869 --- -----~ STATE - PA Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit - B. Prior Payments C. Discount --- - - ------- 3. Interest/Penalty if applicable Total Credits (A + B + C ) D. Interest _---_- _ .Penalty - ---- -- 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E ) Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. --_ - _ ZIP - -- - 17093 (1) 0.00 (2) 0.00 (3) 0.00 (4) (5) 0.00 0.00 (5A) 0.00 (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.............................................. .................................... b. retain the right to designate who shall use the property transferred or its income : ..................... c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ (~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surv~ is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. Iving spouse For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Ronald P. Nott All property jointly-owned with right of survivorship must be disclosed ~~ t~hpollie ~ FILE NUMBER 21-10-0928 ~~~ nw~c o'/al.C W IICCUeU, mser[ aaaiuonai sneers of the same size) SHW Historical Prices ~ Sherwin-Williams Company (The) Stock -Yahoo! Finance Page 1 of 2 New User? Register Sign in Help Make Y! Your Yahool Mail Homepage : ~•~~•.wVl!r ~ ~ (O' ~ ~ ~ ~ 4IGC~ r~a~ t x~zc a!zar::: c x...a~zr-rr:.. rcnF ~,:.. a .zz r ~ ._... ...:::... ..:.::. ~.,.;.cry,:q:» )...:Fi: kk!A'N.:.r. biSd:.~m~,r^',rc5ra.:).rar....r.N.o,nP.r:..:.:war..:...:..e..va?dM..R.wB:,.~: ' Web Searc Dow 0.85°/n Nasdaq ~ 0.14% H®ME INVE;TING NEWS & OPiNlON PERSC3NAL. FINANGE MY PoR~rlwoi_ioS GET QUOTES "ir~<~r~E,~ ~~z~r~c.~~ ~~.r~~ Nr,.~v '?~, 2t~~ ~, ~:C~'~Pt~l ~1`" ... t).~ f~~~k~ t~ c.it~s~ ~n ~ l~~r ~~~3 ~~i~s Sherwin-Williams Co. (SHW) At 1:47PM EST: 74.2Q ~'` 0.82 (1,12%) ___ ~ • ~ a~~'y ff .. i ~• ~~~~~ : [?ktR1,S£G~tIT#~S LLG Historical Prices --- Get Historical Prices for: ~ GO Set Date Range C: Daily Start Date: Jul ~ 28 2010 Eg. Jan 1, 2010 ~'"` Weekly End Date:: Jul ~ 28 :2010 ~"` Monthly ~'"' Dividends Only Get Prices Prices Date Jul 28, 2010 _._ _ first ~ F'e-~vio~~s ~ Nest ~ Last Open High Low Close Volume Adj Close* 69.51 69.80 69.24 69.39 1,418,200 68.69 * Close price adjusted for dividends and splits. i`=i~~st ~ I~'revit~€~s ~ Ne~et ~ L.ast ~` Download to Spreadsheet Currency in USD. AdChoic;es http://finance.yahoo.com/q/hp?s=SHW&a=06&b=28&c=2010&d=06&e=28&f=2010&g=d 11/22/2010 RAD Historical Prices ~ Rite Aid Corporation Common Sto Stock -Yahoo! Finance Page 1 of l Rite Aid Corp. (RAD) At 10:03AM EDT: ~ .18 ~" 0.01 (0.85%) RAD IS ~ "" ~ f~~o~ ~~~~ .~ Historical Prices Get Historical Prices for: I GO Set Date Range __ ~- Daily Start Date: Jul ~ 28 2010 Eg. Jan 1, 2010 ,' Weekly End Date: Jul ~ 28 2010 '':; Monthly ` Dividends Only Get Prices. _. Prices Date Open High Low Close Jul 28, 2010 0.97 0.99 0.96 0.97 " Close price adjusted for dividends and splits. ,3i. !`"`'"Download to Spreadsheet Currency in USD. First ~ Previous ~ Next ~ Last Volume Adj Close" 1,823,800 0.97 First ~ Previous ~ Next ~ Last http://finance.yahoo.com/q/hp?s=R.AD&a=06&b=28&c=2010&d=06&e=28&f=2010&g=d 5/17/2011 REV-1505 EX+ (6-98) ~ SCNEDI~ILE C-1 ` CLOSELY HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Ronald P. Nott 21-10-0928 1 Name of Corporation Can, InC. State of Incorporation PA Address P.O. Box 281 Date of Incorporation 10/24/89 City Summerdale State PA Zip Code 17093 Total Number of Shareholders 2 2. Federal Employer I.D. Number 25-1614020 Business Reporting Year 3. Type of Business Speciality Goods Product/Service Knife engraving 4. STOCK TYPE VotinglNon-Voting TOTAL NUMBER OF SHARES OUTSTANDING pAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK Common voting 100 .01 51 $ 0.51 Preferred $ Provide all rights and restrictions pretaining to each Gass of stock. 5. Was the decedent employed by the Corporation? ................................ 9 Yes ^ No If yes, Position engraver/ manager Annual Salar~r $ 11,000.00 Time Devoted to Business 10hrs./wk 6. Was the Corporation indebted to the decedent? ................................. ^Yes 0 No If yes, provide amount of indebtedness $ 7. Was there life insurance 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 decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ~ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ®No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .................................................. ^Yes p No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation 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. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^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 decedent's 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 addresses and estimated fair market value/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 received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) Y. SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DFCFf~FNT -- '" " - -' FILE NUMBER Ronald P. Nott 21-10-0928 All property jointly-owned with right of survivorshiu must be disc~nsRd ~~ Rchorluln G t~~ ~~~~~~ aNa~c W IICCUCU~ ni~eri aaainonai sneers or the same size) ' ~~ ~ O '~ _ CAROL A. NEITZ, : IN THE COURT OF COMMON PLEAS OF Individually and as the Executrix :CUMBERLAND CO'iJNTY, PENNSYLVANIA of The Estate of Ronald P. Nott, Deceased, Plaintiffs . vs. NO. /1-" `~ 3 4 ~' CIVIL TERM GREGORY N. APGAR ~ ' . ~ ~,,*, ~ ° AND "' ~ ~ ~ LORI A. ORRIS f/k/a ~ ~ -~ ~ ~ -- ~'` ~~ LORI A. APG - ~ ~~ Defendants ~ ~ ~`~ CONFESSION OF JUDGMENT .~ c -~ ~~ . ~. ~ . Pursuant to the authority contained in the warrant of attorney, the original or copy`f which is attached to the complaint filed in this action, I appear for the.Defendants, Gregory N. Apgar and Lori A. Orris, f/k/a Lori A. Apgar, and confess judgment in favor of the Plaintiffs, Carol A. Netz, Individually and a.s the Executrix of the Estate of Ronald P. Nott, and against the Defendants, Gregory N. Apgar and Lori A. Orris, f/k/a Lori A. Apgar, as follows: Principal Sum: $37,504.92 Interest from May 1, 2011 $251.28 Costs of Suit $377.:50 , Attorney's Commission (at 5%) $ l , 875.25 BALANCE C~JRRENT'LY DBE $40,fl08.95 Respectfully submitted, COYNE & COYNE, P.C. r Dated: ~ ~ By~ L sa Marie Coyne, Esq. re P . Suprerrie Ct. No. 53788 901 Market Street Camp Hill, PA 17011=4227 W (717) 737-0464 Attof-rcey foY Plaintiffs { REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECFnFNT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Ronald P. Nott FILE NUMBER 21-10-0928 - -- ~- ~~----- , ,,,..,,, u,.,.~~~~~:a~ ~~~CC:~ ~~ use same size) Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of s::rvivnrcl~:...,,~~Q. ~., a:_..:___~ __ ~_~_,_ . _ Ma r,~9. 2011 ~.54AM PNC BANK 41~-705-2?41 ~~~ LEADW87HE WAY March 29, 2011 Coyne ~ Coyne P.C, 3901 Market ~t Camp Hill, pA 17011-4227 . RE: Knives by Nott & Custom Engraving SSN: 232324837 DOD: 07-25-2010 (Rauald P Natt Deceased) Dcar : SirlMadam: No, 2511 P, 2 ~n response to year request for Date of Death (DOD) balawces far the customer Hated above, our records sb-ow tie falXawix.~; . . Checl~m~ Account Account # SOQ376158$ Established:ll-Q7-20d 1 KNIVES BY NOTT & CU'S~'OIVi ENGRAVIN~'r I?OI~ balance: $ 6,896,79 + O.QQarccrued interest Please note that this off ce pravidcs date of death balances for deposit accounts (~.As, CDs, Chxking aad Savings}. RTe dQ not pros any ~aecial transoctiona or providt st~temeots. If you new ssSistanct with any afthese items, please X111-SSS-PNC-BANK (1-88g-762 22b3) ar stop by your local PNC Bank branch office. sincerely, Nationat Financial Services Centex PNC Bank, N.A. Member FDIC This message is intended for the use of the individual ar entity to which it is adc~essed and may contain information that is privileged, can, f dential and exempt from disclosure under applicable law. If the reader of this message is nvt the ir#errded reef, Arent or' the employee ar agent responsible for delivering this message to the intended recipient, you are hereby noted that any dissemination distributfan or copying o, f'this comrnunicdtions is strictly prohibited. If you have received thr's cprnmurrrcation in error, please notify me immediately by reply ar by telephone at 840-76Z-1775 and immediately destroy this fazed document. Page 1 of 1 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ~~iHic ur - FILE NUMBER Ronald P. Nott 21-10-0928 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Carol Neitz 105 Mountain Street wife Summerdale, PA 17093 B C JOINTLY-OWNED PROPERTY: . -~- -r-_- •- ~~~~~+...., m~cii auunwnai Slltl<;IS 0i In2 S8n1@ SIZe) ___ _ _ ~~ ~J~~~ ~~, 4. 2^ 1" 3:1' F~~I FP1C B~~1K 412-1~~-747 e 1 1.~:11t1f1N~T~tEirl~-1C- i1To~ember 4, 2010 Coyne 8~ Coyne Attorneys at Law 39412 Market St Camp Hill, PA 17011-4227 RE: Rot~lcl P NQtt ssN: aa7-~z-~8~9 MoD: o7-z s-zo l Q Deer Sir/t1r,[a~dam: ~Jo, Z',' ~ 1 ". 1/1 I In response to your request for. Date of Death ~DDD) balances for the customer noted above, our records show the following; Checl~ng Acavnnt Account # 5003762222 Established: 02-26-2442 I~0~1ALD P NOTT I70D balance: $ 3,317, 65 nan interest bearing Account # 5140347998 Estgblished: 05-29-1987 RflN NUTT CARQL NEITZ DQD ~ba_ lance: $ x,.808.52 + 0.04 accrued interest Interest paid 41 Cpl -2410 thru 07-28-2010 $ 2.12 YTD Investment Account The decedent maintained Investment Account 63346448. For further iafarmation, you quay call the DrolCerage I~partment at 1-800-762-6111. Los-n Account The decedent maintained Loam Account 40010U8109621279. Fox fwrthex information and assistance, please contact 1~-88$-7622245. Select option 1, then optioa 3 and.then o (zero}. After pressing zero, please remain an the line to speak with a ~,oan Financial Service Consultant. Page 1 of 2 REV-1511 EX+ (12-99) ~' COMMONWEALTH OF (PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS w iNi c ~r FILE NUMBER Ronald P. Nott 21-10-0928 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: t ~ Richardson Funeral Home 2~ Reception 3. Romberger Memorials -- headstone 4. Marysville Cemetery 5. Honorarium B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Car01 Neltz street Address 105 Mountain Street city Summerdale State PA Zip 17093 Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Patriot News -legal advertisement $~ Cumberland Law Journal -legal advertisement 9. Inheritance Tax filing fee ~ o. Reserves ~ 1 ~ Postage 12~ Total for Schedule H, Page 2 TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Zip AMOUNT 6,100.00 700.00 1,229.00 350.00 100.00 10,000.00 3,500.00 79.50 500.00 123.38 75.00 15.00 1,000.00 88.00 940.25 24, 800.13 ESTATE OF RONALD P. NOTT SCHEDULE H: FUNERAL AND ADMINISTRATIVE COSTS PAGE 2 Item No. Description 13 Pinnacle Health 14 Quest Diagnostic 15 Moffitt Heart & Vascular Group 16 Pulmonary & Critical Care Medical Assoc., PC Amount $812.04 $39.62 $12.21 $76.38 TOTAL: $940.25 REV-1512 EX+ (12-08) ~ Pennsylvania DEPARTMENT OFf2EVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Ronald P. Nott 21-10-0928 Report debts incurred by the decedent prior to death that remained ~~~a~~ a* ttie a~~a „~ as.,... :_..~..~:__ .._____~__ - ~-•- -r-~~ ~~ .~....w..u~ uioci~ auuiuunal Dlltlel5 Oi Lflf? S8fT12 SIZ2. REV-1513 EX+ (11-08) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ] BENEFICIARIES ESTATE OF Ronald P. Nott NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ~ Carol A. Neitz FILE NUMBER 21-10-0928 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE wife 100% of residual ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size. ~ rv ~ __ - -- - CQ o ; : : _~ ._ "~ tT~ ~ . t!] ~ lD ..~.._ ,~ LAST WILL AND TESTAMENT OF RONALD P. NOTT r r nvr,a,,la r . tvv t c, prC.~C11 CZ Y` 1 ~oidirig ~n Summerdale, Pennsylvania, being of sound and disposing mind and memos do Y• make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils previously made by me. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable~by my estate~or by any recipient of any property, shall be paid by my Executrix out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my estate.. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executrix even though on proceeds of insurance or other property not passing ,under this Will. If the assets not specifically devised or bequeathed are not adequate for the pay- ment of all such taxes, then the recipients of the property specifically devised and bequeathed shall each pay a pro rata portion of any such taxes based upon the valuation of. the property_ received by each such recipient as finally determined for Federal Estate Tax purposes, or if no such determination is made, then for appiicabie State Inheritance Tax purposes. ITEM II: I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executrix and PAGE 1 OF 3 PAGES ^~ .. all property subject to all such powers of appointment shall i be included in my estate. ~, , ITEM III: I hereby give, devise and bequeath my entire interest in the business known as Enola Auto Parts, Inc., located at 25 Narth Enola Road, Enola, Pennsylvania, to my sons, Ste he P n, David and Michael, in the following proportions: to my son, Stephen, I hereby give, devise- and bequeath seventy (700) percent of my share of the business; to my son, David, I hereb iv Y g e. devise and bequeath fifteen (15~).percent of my share of the business; and to my son, Michael, I have give, devis j e and bequeath fifteen (150) percent of my share of the business. 'i ~~1 ,+ ii ITEM IV: After. the bequests in Item III have been distributed, I hereby give,'devise and bequeath the rest and residue of my entire estate, whether real, personal or mixed, of whatsoever nature or kind and wherever located, to my wife, Carol A.~Neitz, provided that she survives me by thirty (30) days. IT_ ~~`? V: In the event that my wife, Carol, does not survive me by thirty (30) days, then I give, devise and bequeath the rest and residue of my entire estate, whether real, personal or mixed, of whatsoever nature or kind and wherever located, to my sons, Stephen, David and Michael, to be divided equally amon them. g In the event that any o.f my sons predecease me, then the share which he would ..have received I give, devise and bequeath unto the surviving issue of said deceased child, per stirpes. ITEM VI: Any person who shall have died at the same time 1 i ~ as Testator, or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, or who shall have died less than thirty (30) da s Y after the death .of Testator, shall be deemed to Piave predeceased ;~ . him. ITEM VII: I nominate, constitute and appoint my wife, ,, Carol A. Neitz, to be Executrix of this my Last Will and Testa- ment. In the event of-her death, resignation, refusal or inability to serve, I nominate, constitute and appoint my son, Stephen, to be Executor of this my Last Will and Testament. My Executrix or Executor is specifically relieved from the duty or obligation of _ the filing of any bond or bonds in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of this and the preceding two (2) pages this f$ day of 1988. Ronald .~ Nott We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and,deelared by the above-named Testator as and for his Last Will and. Testament, in the presence of us, who, at his ,request and in his presence and in the presence of each other, have hereunto set our--hands and seals the day and year above written, and we certify that at the time of_th.e execu- tion thereof, the said Testator was of sound and disposing mind and memory. n ~ ~ ~~J .~ ( SEAL ) Residing at ~ ~ ~~~~~,~~ ~R,n„< <~- J v r ~ ~~ (SEAL) Residing at /aiS ~~~~-g Q~~ f ---, ___ a (SEAL)~Residing at PAGE 3 OF 3 PAGES ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF DAUPHIN ) , I, Ronald P. Nott, the Testator whose name is signed to the attached or foregoing instrument, having been duly. qualified accord- ing to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to~or affirmed and acknowledged before me by Ronald P. Nott, the Testator, this I~ d.ay of , 1988, Ronald P. Nott --. - - - ~ Testator -' ._ ( SEAL) ~~' • ~ s s.,: Notary Public My Commission Expires: ' ~'gfrieia A. Peiffer Na~ar~..Ru'~lic AF F I DAV I T F1~rrristn-r~, Goa u~~lZin County ~St['r~rnissior~ ~x}~ires: .iuaie 29, 19$:9 COMMONWEALLTH OF PENNSYLVANIA _) SS COUNTY OF DAUPHIN ) We, and ~ the witnesses whose names are signed to the attached or foregoing. instrument, being duly quali- fied according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each sub- scribing witness, in the hearing and sight of the Testator, signed the Will as a witness; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of pound mind and-under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ___ 1988. witnesses, this / 8~' day of and Witness Wit ess Witnes.