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Home My WebLink About04-0751PETITION FOR PROBATE and GRANT OF LETTERS Estate of' /9~ ~ /</~,.gC:t~,~t.~l No. also known as Die ry /q[. t~-C~f /~t ~ ~q To: Deceased. Social Security No. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/~ 18 years of age/pr older an the execute' in the last will of the above decedent, dated ,'~r-lO~7~ ~6,/ /7 ? 7 and codicil(s) dated Register of Wills for the - County of ~?',~aeo'~[,~vt/ in the Commonwealth of Pennsylvania named , 19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~t,~ e r,~c_t ~,,~ _ County, Pg~nsy, lvania, with last family or principal residence at ~7'/0~ ///z//~,'4~.e~ fJf/Z/xo , ~'~/~' '~ , ' - -- -/ (list street, number and muncipality) Decendent, then~, ~ years ofa~,e died /q'~c~t~T~ ~ ,~lltP,-O0~/, Except as follows, decedent did not marry, was not divdced and did not h{ve a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: AJc:~/t] ~ WHEREFORE, petitioner(s) respectfully request(s) the pro~b~ate of the last will and codicil(s) presented herewith and the grant of letters :-/--e ~ 5%~t ~,¢/~? ~'p' theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -I COUNTY OF C, n~ ~r,l~-y' Y~ 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirn~c[~and subscribed beforg me thJ~ _ /j'-r'n . . da~ . ~ ~,f" ~ i~ ~o~ Estate Of -oy- 0?57 , Deceased DECREE OF PROBATE AND GRANT OF LETTERS described therein be admitted to probate and f31ed off,cord and Letters AND NOW ~/~ ,.,-O d ,5~-_ /' ~"~ JJ?'~, in consideration of the petition on the reverse side hereof, ]atisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated as the last will of are hereby granted to /' FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... $. Renunciation ................ $ $ TOTAL ~ $. Filed ................................... Register of Wills G~TTORNEY (Sup. Ct. / ADD.SS ~ PHONE OATH OF NON-SUBSCRIBING WITNESS ,Deceased (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that '~-~xo--q familiar with the signature of fI~.~'~v,,~, ~l~[q //~r,~es~tl,',~. of (one of the subscribing w/messes to) the codicil/w/Il presented herewith and that ~ believes the signature on~tthe codicil/will is in the handwriting of ~'¢ [. ~x~-~ c!~rto~ )/J/~ to the best of ~[,.q¥ t. knowledge and belief. Sworn to or affirmed arid subscribed Before me this ] .~-J~ day 9f F~t~e Rdg~ster ~ (Address) ~,",s ~'~ l'hi~ is [o certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.oc:_d Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 Local Registrar P 10585 88 AUG 92004 No. ~ ._'~ C:: Date :;:~ H10~.144 Rev. 1/91 IANENT #29-330 Mary E AGE (Lal~ B4~y) UNDER 1 YEAR Cumberland COM~ ONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) STATE FILE NUMBER Kauffman . Female a. 188-32-1_t27 NO J~ Yet [] Ifyal .p~cilyCul~an Carlis Le Carlisle Regional Medical Center M.x~,. P~,oR~ ~¢ ' · eacher P~bl ~c Schooi 9A Alliance Drive RESIDENCE Carlisle PA 17013 '~'~ James C. ~o.. Ethel Ta~lor Suflll J-"~ Cremation [] RJmo~alfmmState[] I~! Don.tm[Z] ot~,~yt ~C~ $)G NAT~I~F~. FUNERAL S~VI~. L[CEN S~ 01:~ E ~Oi~TING'~ ~c~ ~ ~ ~ath. / ' ,~,~>~ , Multiple Tr tNAS DECEDENT EVER INOECEDENT'S EDUCATION U.S. ARMED FORCES? J (Soecilv omv h,~heSt oracle com~el~d; J MARITAL ST~US · Marr~ j,,. ~*,2~ I o-~+) 4 ,,. Divorc~ C~rland ~¢ ~ ~.~",'~ White Carlisle ~AME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF ~-ATH [Itsm27)TypeorPrint Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 ,,. Mechanicsburg, Pa. 17050 MOTHER'S NAME (Fir sL Middle. Ma~den Surname) ~. Cora E. Dile iNFORMANT'S MAtUNG ADDRES~ (S~eet. City/Town. Slala. Zip Code) ~, 228 Birch Lane, Carlisle/ PA 17013 DATE OF D~SPOSITION PLACE OF DISPOSCrlON - Name of Cemetery Crematory LOCAT ON - C y,'Town. S ate. Zl~ Code E:]2~. AUq. 9, 2004 E,c. Letort Cemetery z'.~. Carlimle, Pa 17013 ~, Hof n o h ne 1 ,)o~ . La~. 51z[q~] r. 2,*. 219 North Hanover ~ ~lS~, ~ 1~ :10 A.M as August 6, 2004 ~ ~"~ ~[] ~umatic Inluries ; (Mo~h. Oay, Yea0 Aprx. J Belted passenger, 3 ,o.~. ~l ~,,~ I 9nns, I I,- [] ,o'S J crossover crash, #2 ~ Pendingmveat~at~n [] J3o.. J3~,. : 35 ? u. J3oc. 3~ vehicle J:m.. g y J~.jl~.34 South,Mt.Holly Springs, ............................................................ U ,, ~,. ~_/__~;aa~'~//~.....----...~- ~oroner LAST WILL AND TESTAMENT OF MARY M. KAUFFMAN KNOW ALL MEN BY THESE PRESENTS, That I, MARY M. KAUFFMAN, of the Borough of Carlisle, County of Cumberland and State of Pennsylvania, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executrix hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executrix hereof to pay al'l inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give and bequeath the sum of One Thousand and 00/100 ($1,000.00) to CHILD EVANGELISM FELLOWSHIP OF CUMBERLAND COUNTY, PENNSYLVANIA. THIRD - I give, devise and bequeath all the rest, residue and remainder of my estate, botl, real and personal, as foii~s: (a) One-third(i/3) thereof to CHAPEL POINT, Carlisle, Pennsylvania; (b) One-third (1/3) thereof to THE FRIENDS OF ISRAEL GOSPEL MINISTRY, INC., Bellmawr, New Jersey; and (c One-third (1/3) thereof to BACK TO THE BIBLE, INC., Lincoln, Nebraska. FOURTH - I appoint my friend, ETHYL TAYLOR, to be the Executrix of this, my Last Will and Testament. I do hereby give to the Executrix hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property co~orising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) pages on the margin of which (except this page) I have affixed my initials this ~ ~'~ day of ~ , A.D. 1997. Ma~y M~ K~ufi~anF/ (SEAL) Signed, sealed, published and declared by Mary M. Kauffman, the above named Testatrix, as and for her Last Will and Testament, in the presence of us and each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. STATE OF PENNSYLVANIA COUNTY OF DAUPHIN ACKNOWLEDGMENT :ss I, MARY M. KAUFFMAN, the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according 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 MARY M. KAUFFMAN, the testatrix, this J~ day of ~cW~ , 1997. Notary P~-- NOTARIAL SEAL i GREGORY R. REED, Notary Publio Hanisburg, Dauphin C~unty _ My Commissl?n Expires Mar. !9, 20gl. , AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :ss COUNTY OF DAUPHIN witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly 2and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn tQ or affirmed and subscribed t,o before me by witnesses, this o?~day of ~7~ , 1997. Notary Public NOTARIAL SEAL I GREGORY R. REED, Notary Public Harrisburg, Dauphin County My Commission Expire~ Mar. 19, 2001 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Maw M. Kauffman a/k/a Mary E. Kauffman Date of Death: August 6, 2004 Admin. No. 2004-00751 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed the following beneficiaries of the above-captioned estate: Name Address Date Back to the Bible 6400 Cornhusker Highway, Lincoln, NE 68507 08/23/04 Chapel Pointe of Carlisle 770 South Hanover St., Carlisle, PA 17013 08/23/04 The Evangelization Society 14400 Bustleton Avenue, P.O. Box 11527 of Philadelphia, PA Philadelphia, PA 19116 08/23/04 Child Evangelism Fellowship of Cumberland County Pennsylvania 150 Fairview Drive, Carlisle, PA 17013 08/23/04 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: August 23, 2004 :' i: s- ~, :7' Signature Name Gregory R. Reed Address 3120 Parkview Lane Harrisburg, PA 17111 Telephone (717) 238-0434 X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004562 DELORES M LIGHTNER-SMITHERS 21 HELEN AVE MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 188-32-1322 FILE NUMBER: 2104-0751 DECEDENT NAME: KAUFFMAN MARY M DATE OF PAYMENT: 10/29/2004 POSTMARK DATE: 10/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142158 $ 1,896.55 REMARKS: TOTAL AMOUNT PAID: $1,896.55 SEAL CHECK//118 INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVAN/A DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 180601 HARRISBURG, PA 17118-0601 REV-15q5 EX AFP (09-00) ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 11 0q-0751 ACN 0q1~2158 DATE 10-21-200~ DELORES N LIGHTNER-SMITHE 21 HELEN AVE HECHANICSBURG PA 17055 '04 ~l 29 EST. OF MARY M KAUFFNAN S.:S. NO. 188-$2-1322 DATE OF DEATH 08-06-200~ [~C~O.U,~Y CUMBERLAND TYPE OF ACCOUNT [] SAVINDS [] CHECKTND [] TRUST [] CERTZF. REN/T PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 THE BANK OF LANDTSBURD has provided the Department with the information listed below which has been used ]n calculating the potential tax due. Their records indicate that at the death of the above decedent, you ware a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance eith the Inheritance Tax Lams of the Commonwealth of Pennsylvania. Questions may be answered by calling (7173 787-8327. COMPLETE PART ! BELOW x x ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS PART Account No. 071-716-9 Data 11-05-2001 Established Account Balance 26,618. ZO Percent Taxable X 50.000 Amount Subject to Tax 13,309.10 Tax Rata X .15 Potantia! Tax Due I, 996.37 -- ~ TAXPAYER RESPONSE To insure proper credit to your account~ two (Z) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the decadent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAX LINE A. ~The above information and tax due is correct. ~l. You amy choose to remit payment to the Register of Hills with tee copies of this notice to obtain CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of ONE Hills and an official assessment will bm issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts end deductions mere paid by you. You must complete PART [] and/or PART ~ below. If you indicate a different tax rata, please state your relationship to decadent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established I 2. Account Balance 2 $. Percent Taxable $ ~ q. Amount Subject to Tax q S. Debts and Deductions 5 - 6. Amount Taxablm 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PATD DEBTS AND DEDUCTIONS CLAZMEt) PAYEE DESCRTPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under penalties of perjury, T declare that the facts T have reported above ara true, correct and ,/c,omplat. to t~m/,~ast of my knolladga and belief. HOME ( ~ I~ ) ?L?~ ~ ~ .:L~,~ ~, ~~ ' ~ ' ' - ' TAXPAYER SIGNATURE ' TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. 3. A joint account is taxable even though the deoedent's name was added as a matter of convenience. 4. Aocounts (including those held between husband and wife) which the decadent put in joint names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign tad copies and submit them with your check for the amount of tax to the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1SqB EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the daoedent"s representative, place an "X' in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue~ Bureau of Individual Taxes, Bept lB0601, Harrisburg, PA 171Z8-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or dmductions are being claimed, check block "C" and complete Parts Z and acoording to the instructions below. Sign two copies and submit thee with your ohack for the amount of tax payable to the Register of Mills of the county indicated. The PA Department of Revenue mill issue an official assessment (Form REV-15q8 EX) upon receipt of the return from the Register of gills. TAX RETURN PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after II/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued ta the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable far joint assets established more than one year prior to the decedent's death: 1 DIVIDED DY TOTAL NUMBER OF DIVIDED BY TOTAL NUHBER OF X lO0 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listmd in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. J Dag:e of Deag:h Spouse Lineal Sibling Collag:eral 07/01/9q 9:0 12/$1/9q SZ 6Z 01/01/95 9:0 06/$0/00 OX 6X lex 15Z 07/01/00 9:0 preseng: OX q.SZ~ ..... ~ .._~ .... · *.o,~g~ ~nm a ~.~sed child t~enty-one years of age or ' eThe tax rate imposed on the nat value ~ younger at death to or far the use of a natural parent, an adoptive parent, or a stepparant of the child is 0~. The lineal class of heirs includes grandparents~ parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, ahether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent~ whether by blood or adoption. The "Collateral" class of hairs includes all other beneficiaries. CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. D. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may bm requested by the PA Department of Revenue. ~ ............ ~",'""~'~',' ....... .'~'~"~ ......... ~':~:~:i~i~ii~:~:~i~Si !~! iii , ..~ .... : ..... ~:~:~:~l Ms. Delores Lightner-Smithers 21 He en Avenue Mechanicsburg, PA 17055 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17126-0601 CONNONHEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSENENT. ALLO#ANCE OR DXSALLONANCE OF DEDUCTXON~, AND ASSESSNENT OF TAX ON 30ZNTLY HELD OR TRUST ASSETS REV-X$¢8 EX AFP C09-O~i) DELORES M L IGHTNER-'~IT~ 21 HELEN AVE MECHANICSBURG PA ~ 17055 DATE 11-29-2004 ESTATE OF KAUFFNAN HARY DATE OF DEATH 08-06-2004 FILE NUNBER 21 04-0751 COUNTY CUNBERLAND SSN/DC 188-52-1322 ACN 04142158 Amoun~ Rmm/~ed HAKE CHECK PAYABLE AND RENXT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~* RETA'rN LOHER PORT'rON FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAXSENENT, ALLOHANCE OR DXSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON ,JOINTLY HELD OR TRUST ASSETS DATE 11-29-2004 ESTATE OF KAUFFHAN HARY H DATE OF DEATH 08-06-Z004 COUNTY CUHBERLAND FILE NO. 21 04-0751 S.S/D.C. NO. 188-32-1322 ACN 04142158 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET XNFORHATXON FINANCIAL INSTITUTION: THE BANK OF LANDISBURG ACCOUNT NO. 071-716-9 TYPE OF ACCOUNT: ( ) SAVINGS C~ CHECKING C ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 11-05-2001 Accoun~ Balance 26,618.20 Percen~ Taxable X 0.500 Amoun~ Sub~ec~ ~o Tax 1~,309.10 Debts and Deduc~/ons - .00 Taxable Amoun* 13,309.10 Tax Ra~e X .15 Tax Due 1,996.37 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: **REGISTER OF HILLS, AGENT.** PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID PAYHENT NUST BE HADE BY 05-07-2005~. TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 1,996.37 .00 1,996.37 PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" [REV-131S). Applications are available online at maw.revenue.state.Da. US, any Register of Wills or Revenue District Office, or from the Department's Z4-hour ansaaring 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 appraiseent, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Oapartment of Revenue, Board of Appeals. You may object by filing a protest online at aww.boardofappeals.state.pa.us on or 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 websita. You may also send e arittan protest to PA Department of Revenue, Board of Appeals P.O. Box ZBIOZ1, Harrisburg, PA 17128-1021. Petitions may not ba faxad. 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 assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 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 administratively correctable errors. If any tax due is paid aithin three [3) calendar months after the decedent's death, a five percent CSX) discount of the tax paid ts allowed. The 152 tax amnesty non-participation penalty is computed on the toter of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in 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 aith first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6g) percent par annum calculated at a daily rate of .D00164. AIl taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily lntarast Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'~ 202 .000548 198'----8-1991 112 ~O00~O1 2009 92 .000247 1983 Z6Z .000436 I992 92 .000247 2002 6Z .000164 1984 11Z .000301 1993-1994 72 .000192 2003 SZ .000137 1985 132 .000356 1995-1996 92 .O00Zq7 2004 42 .O00ZlO 1986 IOZ .000274 1999 72 .ODO19Z 1987 92 .000247 ZOO0 8Z .000219 --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELZNI;~UENT X DAZEY XNTEREST 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 bm calculated. BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVTSTOH PO BOX Z80601 HARRZSBURg, PA 17128-0601 COMMONNEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP DATE 12-06-200q ESTATE OF KAUFFMAN MARY M DATE OF DEATH 08-06-200q FZLE NUMBER 21 0~-0751 COUNTY CUMBERLAND DELORES M LIGHTNER-SMITHE ACN 0~1~Z158 21 HELEN AVE [ Amoun'l: Remi'H:ed MEC~d~NICSBURG PA 17055 I 0 ~ ~ ~: MAKE CHECK PAYABLE AND REHZT PAYMENT TO: ~O LL ~-L~ ~ ~ REGZSTER 0F H[LLS O ~ CUMBERLAND CO COURT HOUSE ~~--~ -- ~ CARL[SLE, PA 1701~ ~*~ ~ o~ . . . ~E: ~[nsure~r credi~ ~o your accoun~ sube[~ ~he upper pot*ion of ~hls fore wl~h your ~ax payeen~. C~ONG~HZS L~ ~ RETAZN LONER PORTZON FOR YOUR RECORDS ..~ ...................... ESTATE OF KAUFFMAN MARY M FZLE NO. 21 0q-0751 ACN 0qlq2158 DATE 1Z-06-Z00q TH]:S STATEMENT TS PROVTDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELON TS A SUMMARY OF THE PRTNCTpAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APpLTCABLE, A PROJECTED /NTEREST FTGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-29-200~ PRINCIPAL TAX DUE: ................................................................................. PAYMENTS (TAX CREDITS): 1,996.37 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PA[D DATE NUMBER INTEREST/PEN PAID (-) lO-ZS-ZOOq CDOOq56Z 99.82 1,896.5S ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), TOTAL TAX CREDZT 1,996.37 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTIONS. Gregory R. Reed Attorney At Law 3120 Parkview Lane Harrisburg, Pennsylvania 17111 Phone: (717) 238-0434 * Fax: (717) 238-8469 e-maih lawoffice(~t~epix.net January6,2005 Glenda F. Strausbaug Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Mary E. Kauffman; No. 21-04-0751 Dear Ms. Strausbaug: Enclosed find an original and two copies of an Inheritance Tax Return and check no. 3823 in the amount of $15.00 for the filing fee. Please return a "stamped" copy of the Inheritance Tax Return to my office in the enclosed self-addressed, stamped envelope. ~~R~~YR~Very truly yours, Gregory . e'ed GRR/na Enclosure pc: Ethel Taylor, Executrix -'., COMMONWEALTH OF PENNSYLVANIA ?'' ' DEPARTMENT OF REVENUE DEPT. 280601 · ~~.,~&,~' HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ 04 0751 COUNTY CODE YEAR NUMBER I- Z IJJ C~ Z UJ r~ Z DECEDENTS NAblE (LAST FIRST, AND MIDDLE INITIAL) Kauffman Mary E. DATE OF DEATH (¥1'vI-DD-YEAR) DATE OF BIRTH (MM-DB-YEAR) 08~06~2004 06/19/1905 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 188-32-1322 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER Orig~nai Return Llrniteo Esta[e Decedent Died Testate [~]2. Supplemental Return 4a. Future Interest Compromise (daie of dealn after 12-!2-82) ~ 7 Decedent Maintained a Living Trust (Al~ach,oot olTrust/ 10 Spousal Poverty Credit idate of dealh between 12.31.91 and 1-1-9.~ ] 3. Remainder Return (date of death prior to 12-13-82) E~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes r~11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME I COMPLETE MAILING ADDRESS Greoory R. Reed, Esquire I 3120 Parkview Lane FIRM NAME dfAF. picable) Harrisburg, PA 17111 TELEPHONE NUMBER (717) 238-0434 1 Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation Partnership or Sole-Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) 157,201.64 (Schedule E) 6 Jointly Owned Property (Schedule F) (6) 13,309.10 ]Separate Billing Requested ? mter-V~c~ Transfers & Miscellaneous Non-Probate Property (7) iSchedule G or L/ 8 Total Gross Assets (total Lines 1-7) (8) ,9 Funeral Expur ses& Aumin;$trative Costs (Schedule H) (9) 15,941.04 10 Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10) 11 Total Deductions (total Lines 9 & 10) (11) 12 Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 15,941.04 154,569.00 154,569.00 13,309.10 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16, Amount of Line 14 taxable at lineal rate 17 Amount of Line 14 taxable at sibling rate 18 Amount of Line 14 taxable at collateral rate ~9 Tax Due x .0 (15) x .0 (16) 13,309.10 x .12 (17) x .15 (18) (19) 1,996.37 1,996.37 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 9 Alliance Drive, Apt. 106 CITY Carlisle STATE PA ziP17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B Prior Payments C. Discount 99.82 Total Credits ( A + B + C ) 3 Interest/Penalty if applicable D. Interest E Penalty Total Interest/Penalty ( D + E ) 4 If Line 2 is greater than Line I *- Line 3. enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request d 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. (1) (2) (3) (4) (5) (5A) (5B) B Enter the total of Line 5 + 5A This is the BALANCE DUE. Make Check Payable to: REGIST£R OF WILLS, AGENT 1,996.37 1,9963,7 0.00 0.00 0.00 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 .......................................................................................................................... [] [] a 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? ....................................................................................................................... [] [] TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. IF THE ANSWER 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 ADDRESS 228 Birch Lane, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S §9116 (a) (1.1) (i)] For dates of death on or after January 1. !995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. Tile sta[ute 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 surwving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the nel value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS, §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ESTATE OF: ITEM NUMBER 1. 2. 5. 6. 7. 8. 9. SCHEDULE "E" CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY MARY E. KAUFFMAN FILE NO. DESCRIPTION PNC Bank Checking Acct #5140426348 PNC Bank Savings Acct #5003852009 See copy of PNC letter dated August 30, 2004 attached hereto, marked Exhibit "1" and incorporated herein by reference. M&T Bank Checking Acct. #2671002588 See copy of M&T letter dated August 26, 2004 attached hereto, marked Exhibit "2" and incorporated herein by reference. Inter County Hospital Plan (Refund) Life Insurance Co., Dallas, Texas (Refund) Hartford Insurance Co. (Property Loss) Cash found in decedent's apartment Back to the Bible (annuity dividend) Survival action that has not been initiated (traffic accident that resulted in her death. Accident occurred on August 1, 2004 and she died on August 6, 2004. 21-04-0751 VALUE AT DATE OF DEATH $ 68,868.57 30,331.76 52,003.96 264.80 50.08 2,426.68 3,136.00 119.79 TOTAL SCHEDULE"E" $ 157,201.64 SCHEDULE "F" JOINTLY-OWNED PROPERTY ESTATE OF: FILE NO. 21-04-0751 MARY M. KAUFFMAN 1. Delores M. Lightner Smithers JOINTLY-OWNED PROPERTY: Item Date made Description Number Joint Date of Death % of Date of Death Value Asset Decd's Value of Interest Interest 1. 11/05/01 SUPER NOW savings account #071-716-9 See copy of bank letter attached hereto, marked Exhibit "3" and incorporated herein by reference. $ 26,618.20 50% $13,309.10 TOTAL SCHEDULE"F" $ 13,309.10 SCHEDULE "H" FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF: MARY E. KAUFFMAN FILE NO. 21-04-0751 ITEM NUMBER 3. 2 4. 5. 6. 7. 8. 9. 10. DESCRIPTION Funeral Expenses: 1. Hoffman Roth Funeral Home Hoffman Roth (advertise obituary in Lancaster) Administrative Costs: Executrix Fee - Ethel Taylor 228 Birch Lane Carlisle, PA 17013 SS# Attorney Fees - Gregory R. Reed, Esquire Probate Fees The Sentinel (Advertise Letters) Rev. Sidney Harris (soloist at funeral) Rev. Thomas Rowett - (Led singing at funeral) Sue Shearer (soloist at funeral) Chapel Pointe (last rental) Borough of Carlisle (July/August water/sewer bills) Sprint (July/August telephone bills) VALUE AT DATE OF DEATH $ 5,570.75 63.00 6,288.07 6,288.07 276.50 95.27 25.00 50.00 25.00 32.36 33.25 SCHEDULE "H" FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF: MARY E. KAUFFMAN FILE NO. 21-04-0751 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 11. 12. 13. PP&L (July/August electric bill) Carlisle Hospital (copy or records) News Chronicle 41.77 109.50 42.50 TOTAL SCHEDULE "H" $15,941.04 SCHEDULE "J" BENEFICIARIES ESTATE OF: MARY E. KAUFFMAN FILE NO. 21-04-0751 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: RELATIONSHIP AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: Child Evangelism Fellowship Of Cumberland County Carlisle, PA 17013 Back to the Bible 6400 Cornhusker Highway Lincoln, NE 68507 Evangelization Society of Philadelphia 14400 Bustleton Avenue Philadelphia, PA 19116 Chapel Pointe of Carlisle 770 South Hanover Street Carlisle, PA 17013 $ 1,000.00 One-Third Residue One-Third Residue One-Third Residue PNCBAI K August 30, 2004 Gregory R Reed Attorney at Law 3120 Pnrkview Ln Harrisburg, Pa 17111 scp Estate of Mary M'Kauffman (Decc~sed) SSN: 188-32-1322 DOD; 08-06-2004 In resporme to your request for Date of Death balances for the customer noted above, our reoorfl0 ohm. tho follox-inll~ Checking Account Account #5140426348 Established 04-03-1984 MARY M KAUFFMAN DOD balance: $68,865.54 + $3.03 accrued interest Savings Account Account #5003852009 Established 11-30-2001 MARy M KAUFFMAN DOD balance: $30,324.54 + $7.22 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRA.% CDs, Checking and Savings accounts). We do not process any financial transactions or provide ~tatements. If you need ass/stance w/th any of these items, please call I-S88-PNC-BANK (I-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Eriea L $chlegel 1-800-762-1775 P7-PFSC-04-F 500 F{r~t Arc. Pitt, bm'~h PA 15219 Meml~r FDIC Exhibit "1" TOTRL P.O1 MaT Bank August 26, 2004 Gregory R. Reed Attorney At Law 3120 Parkview Lane Harrisburg, PA 17111 499 Mitchell Street, Mfllsboro, DE 19966 Estate of Mary M. Kauffman Date of Death: August 6, 2004 Social Security Number: 188-32-1322 Dear Mr. Reed: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Check/ng Account Account Number. ...................... 2671002588 Ownership {Names of). ............. Mary M. Kauffman Opening Date ........................... 06/06/94 (account closed 08/24/04) Balance on Date of Death_ ......... $51,994.72 Accrued Interest $ 9.24 Total ....................................... $52,003.96 For any additional information on the above accounts please contact our High Street Carlisle branch at 717-240-4536. Sincerely, Charlene Warrington, Record~ Management 1-888-509.-4349 Exhibit "2" L Thel an ol: Landisbu ESTABLISHED 1903 P.O. BOX 179 * LANDISBUI'~G, PA 17040 Bank records indicate the following account balances on 8/6/04 for Mary M. Kauffman 21 Helen Avenue SS = ~echanicsburg PA 17055 188-32-1322 Sole Jt. Acct Acct# Ownership With ~)71-716-9 Delores M. Lightnet Smithers S~w~ Balance Pr~o~'T~ Interest $ 26,613.61 Iht Bearing Yes Accrued Interest $ 4.59 Exhibit "3" LAST WILL AND TESTA/~NT OF MARY M. ~AUFFMAN KNOW ALL MEN BY THESE PRESENTS, That I, MARY M. KAUFFMAN, of the Borough of Carlisle, County of Cumberland and State of Pennsylvania, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST - I direct~, the Executrix hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executrix hereof to pay al~ inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give and bequeath the sum of One Thousand Dollars and 00/100 ($1,000.00) to CHILD EVANGELISM FELLOWSHIP OF CUMBERLAND COUNTY, PENNSYLVANIA. THIRD - I give, devise and bequeath all the rest, residue and remainder of my estate, both'real and personal, as follows: (a) One-third(I/3) thereof to CHAPEL POINT, Carlisle, Pennsylvania; (b) One-third (1/3) thereof to THE FRIENDS OF ISRAEL GOSPEL MINISTRY, INC., Bellmawr, New Jersey; and (c) One-third (1/3) thereof to BACK TO THE BIBLE, INC., Lincoln, Nebraska. FOURTH - I appoint my friend, ETHYL TAYLOR, to be the Executrix of this, my Last Will and Testament. I do hereby give to the Executrix hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) pages on the margin of which (except this page) I have affixed my initials this ~ ~ day of ~ , A.D. 1997. (SEAL) Signed, sealed, published and declared by Mary M. Kauffman, the above named Testatrix, as and for her Last Will and Testament, in the presence of us and each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. STATE OF PENNSYLVANIA COUNTY OF DAUPHIN _ACKNOWLEDGMENT :ss I, MARY M. KAUFFMAN, the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according 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 MARY M. KAUFFMAN, the testatrix, this _J~ day of ~~ , 1997. Notar ~ P~lic NOTARIAl. SEAL GREGORY R. REED, Notan] _ Harrisburg, Dauphin County ! My Commission Expires Mar. 19, ~200l AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :SS COUNTY OF DAUPHIN witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the-testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly 2and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn t~ or affirmed and subscribed to before me by witnesses, this ~=~day of .. _/~qj/- , 1997. Notary Public ~ NOTARIAL SEAL ' ~,~EGORY R. REED, I'Jotary Public Harrisburg, Dauphin Courr{y My Corn_mi_ss!on Expires Mar. 1S, 2001 Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: GREGORY R. REED 3120 PARKVIEW LANE HARRISBURG, PA 17111 Invoic eNo: Invoice Date: Estate off Estate No: 164 01-12-2005 MARYE. KAUFFMAN 04-751 R KELLY Fee Description Fee Total Additional Probate 25.00 $25.00 Total: $25.00 Checks should be made payable to the Register of W'tlls. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '* REV-1547 EX AFP (03-05) GREGORY R REED ESQ 3120 PARKVIEW LN HBG PA 17111 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 KAUFFMAN 08-06-2004 21 04-0751 CUMBERLAND 101 MARY M Allount Re..itted 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 ~ It~Yl4"YI.m.ml!1t!'.wtJtm.W.IMMA!'J'4M."t.tx't.lWltlTftPlWf~.'X'CtbV,tM!!'.fJTt'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KAUFFMAN MARY M FILE NO. 21 04-0751 ACN 101 DATE 04-04-2005 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) un (6) (7) .00 .00 .00 .00 157.201.64 .00 .00 NOTE: To insure proper credit to your account, sub..it the upper portion of this forll with your tax pay..ent. (8) 157,201.64 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 (9) UO) 15,941.04 .00 UlJ (2) (3) (4) 15.941 04 141,260.60 141,260.60 .00 19 will NOTE: I~ an assessment was issued previOUSly, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. AMount of Line 14 at Spousal rate (lS) 16. AlIOunt of Line 14 taxable at Lineal/Class A rate (16) 17. AlIOunt of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CDS: 14, 15 and/or 16, 17, 18 ~abd returns assessed; 'to. date.'....~ . ';::~2 :..~,,". .00 X Ol}"'f-.; . . . 00 X 04!i:;t,~ .00 X 12::;";:-:1 .00 X 15(:..::;--, , I (],9l= .UrQ -~ D..~ .00 .00, -.01} . i I --r-; ...,..,;:.,.. 1) DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID (~"i 0-" TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~~ Q. REV-1470!!X (6-88) '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Mary E. Kauffman REVIEWED BY ACN 2104-0751 101 Destiny S.R.Brown ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the jointly held assets is being stricken from the assessment of this return since they were previously assessed on 11-29-2004 under ACN 04142158. 00000000 ROW Page 1 --) :~" ~ C".3 , .l '. ., IN THE OFFICE OF THE REGISTER OF WILLS OF CUMBERLAND COUNTY. PENNSYLVANIA IN THE MATTER OF THE ESTATE OF MARY M. KAUFFMAN, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, deceased c:-' NO. 2004-00751 ('0 , -- RECEIPT. FINAL AND COMPLETE RELEASE AND INDEMNIFICAflON AGREE1VII.?fr KNOW ALL MEN BY THESE PRESENTS, that I, f(e iI:, - //10/'1 A:S, 1-1 v c ~t!- , of the THE EVANGELIZATION SOCIETY OF PHILADELPHIA, INC., a non-profit corporation, hereby declare that I am authorized to sign this Receipt on behalf of said Church, I do hereby acknowledge receipt from ETHEL T AYLOR (hereinafter referred to as "Fiduciary"), Executrix of the Estate of MARY M. KAUFFMAN, deceased, the sum total sum of Fifty-Seven Thousand Six Hundred Ninety-Four and 42/100 ($57,694.42) Dollars in satisfaction of all claims, distribution, shares and property, (real and/or personal, tangible and/or intangible) due the undersigned from the estate. The undersigned acknowledges receipt of Notice of Beneficial Interest in Estate from the FIDLJCIAR Y and timely infonnatlOn from FIDUCIARY when requested by the undersigned. IN CONSIDERATION WHEREOF, the undersigned does hereby remise, release, quitclaim and forever discharge the FIDUCIARY and the respective heirs, personal representatives, successors and/or assigns thereof as well as said decedent's estate, of and from all manner of actions, cause or causes of action, debts, dues, claims and demands whatsoever, both in law and in equity, against the FIDUCIARY, individually, corporately and/or in a fiduciary capacity, and against said decedent's estate, whether as legatee under the Last Will and pt. Testament and/or as heir-at-Iaw of said decedent and/or as claimant/creditor and/or in any other capacity which the undersigned has had or now has or ought to have had for or by reason of any act, matter, cause or thing from the beginning of the world to the day of the date of these presents. AND IN FURTHER CONSIDERATION WHEREOF, the undersigned does hereby expressly stipulate, covenant and agree, in consideration of the aforesaid distribution and payment, to indemnify and hold harmless said FIDUCIARY and the respective heirs, personal representatives, successors and assigns thereof against loss from any and all further claims, demands and actions, in law or in equity or otherwise, that may hereafter at any time be made or brought by the Commonwealth of Pennsylvania, or anyone in its behalf, for any unpaid Pennsylvania Death Transfer Inheritance Taxes or by the Internal Revenue Service, or anyone in its behalf, for any unpaid Federal Gift or Estate Taxes on the gross taxable estate of said decedent and the undersigned hereby waives any and all rights of exemption, both as to real and personal property, to which the und~signed may be entitled under the laws of this or any other state as against such claim for reimbursement or indemnity. The undersigned does hereby consent to the discharge of the FIDUCIARY without notice to, or necessity of joinder of, the undersigned. IN WITNESS WHEREOF, the undersigned has duly executed this Receipt, Final and Complete Release and Indemnification Agreement the day, month and year set opposite the signature of the undersigned. / (._._._...._--~ " J; (J\ /) . ... ..,," \ // . '! : ' / '. I. ' " ~lhl..aw,,"~::, \ li,,,-,< %f'1:5'~zev ~ /{.L..~ Witness (/ .' Date ACKNOWLEDGMENT STATE OF :ss COUNTY OF ,,/zi I On this, the d day of ~ ~~ r , 2005, before me, the undersigned, p~rson~ppeared rh ~ i'l1l/ ) ://..t,J.rho acknowledged himself or herself to be J);r "-1' . r , of THE EY ANGELIZA nON SOCIETY OF PHILADELPHIA, INC., a non-profit corporation, and that he/she as such 1J I 'R.e c~ Te , being authorized to do so, executed the foregoing release for the purposes herein contained by signing the name of the Corporation by himself/herself as BO~A D M ~ t5~ . g; J ICe c..,c, "Z IN WITNESS WHEREOF, I have hereunto set my hand and official 1. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Cheryl Y. Rich, Notary Public ower Southampton Twp., Bucks County My Commission Expires Dec. 9, 2008 Member. Pennsylvania Association of Notaries IN THE OFFICE OF THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA r~.~ IN THE MATTER OF THE ESTATE OF MARY M. KAUFFMAN, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, deceased NO. 2004-00751 -I r'-,.,) "'d__J RECEIPT , FINAL AND COMPLETE RELEASE AND INDEMNIFICATION AGREEMENT KNOW ALL MEN BY THESE PRESENTS, that I, De'n,t"Clh ~. "Sprr.1~~, E:-uLvfl.i'.- \Ji.~ctvr , of the CHAPEL POINTE OF CARLISLE, a non-profit corporation, hereby declare that I am authorized to sign this Receipt on behalf of said Church, I do hereby acknowledge receipt from ETHEL T AYLOR (hereinafter referred to as "Fiduciary"), Executrix of the Estate of MARY M. KAUFFMAN, deceased, the sum total sum of Fifty-Seven Thousand Six Hundred Ninety-Four and 421100 ($57,694.42) Dollars in satisfaction of all claims, distribution, shares and property, (real and/or personal, tangible and/or intangible) due the undersigned from the estate. The undersigned acknowledges receipt of Notice of Beneficial Interest in Estate from the FIDUCIARY and timely information from FIDUCIARY when requested by the undersigned. IN CONSIDERA nON WHEREOF, the undersigned does hereby remise, release, quitclaim and forever discharge the FIDUCIARY and the respective heirs, personal representatives, successors and/or assigns thereof as well as said decedent's estate, of and from all manner of actions, cause or causes of action, debts, dues, claims and demands whatsoever, both in law and in equity, against the FIDUCIARY, individually, corporately and/or in a fiduciary capacity, and against said decedent's estate, whether as legatee under the Last Will and RA Testament and/or as heir-at-Iaw of said decedent and/or as claimant/creditor and/or in any other capacity which the undersigned has had or now has or ought to have had for or by reason of any act, matter, cause or thing from the beginning of the world to the day of the date of these presents. AND IN FURTHER CONSIDERATION WHEREOF, the undersigned does hereby expressly stipulate, covenant and agree, in consideration of the aforesaid distribution and payment, to indemnify and hold harmless said FIDUCIARY and the respective heirs, personal representatives, successors and assigns thereof against loss from any and all further claims, demands and actions, in law or in equity or otherwise, that may hereafter at any time be made or brought by the Commonwealth of Pennsylvania, or anyone in its behalf, for any unpaid Pennsylvania Death Transfer Inheritance Taxes or by the Internal Revenue Service, or anyone in its behalf, for any unpaid Federal Gift or Estate Taxes on the gross taxable estate of said decedent and the undersigned hereby waives any and all rights of exemption, both as to real and personal property, to which the undersigned may be entitled under the laws of this or any other state as against such claim for reimbursement or indemnity. The undersigned does hereby consent to the discharge of the FIDUCIARY without notice to, or necessity of joinder of, the undersigned. IN WITNESS WHEREOF, the undersigned has duly executed this Receipt, Final and Complete Release and Indemnification Agreement the day, month and year set opposite the signature of the undersigned. ~~ Witness 10 I ;;. ~ I 0 ~ Date ~&U 'it/I 4;.~ ACKNOWLEDGMENT COMMONWEALTH OF :ss COUNTY OF On this, the ~'"'dt-day of ~ ,2005, before me, the undersigned, ersonally appearyd~ J 'f)') ~~f)a..~ who acknowledged himself or herself to be . , of CHAPEL PO TE OF CARLISLE, a non-profit corporation, and that he/she a suc ., being authorized to do so, executed the f~regoing release for the kes he~ ein contained by signing the name of the Corporation by hImself/herself as ~ r;k./l/~' IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~~ YY? Notary Public j)J ...d'~ '--- COMMONWEAL TH OF PENNSYLVANIA Notarial Seal ~ren M. Tumer, Notary Public CarlISIe~, Cumberland County My Commission Expires July 21, 2008 Member. Pennsylvania Association Of Notaries ! . ~-'" ,"'l IN THE OFFICE OF THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA IN THE MATTER OF THE EST A TE OF MARY M. KAUFFMAN, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, deceased NO. 2004-00751 f"...) , -'-'''; RECEIPT, FINAL AND COMPLETE RELEASE AND INDEMNIFICATION AGREEMENT KNOW ALL MEN BY THESE PRESENTS, that I, Bryon L. Swanson Assistant Secretary , of the BACK TO THE BIBLE, a non-profit corporation, hereby declare that I am authorized to sign this Receipt on behalf of said Church, I do hereby acknowledge receipt from ETHEL TAYLOR (hereinafter referred to as "Fiduciary"), Executrix of the Estate of MARY M. KAUFFMAN, deceased, the sum total sum of Fifty-Seven Thousand Six Hundred Ninety-Four and 42/100 ($57,694.42) Dollars in satisfaction of all claims, distribution, shares and property, (real and/or personal, tangible and/or intangible) due the undersigned from the estate. The undersigned acknowledges receipt of Notice of Beneficial Interest in Estate from the FIDUCIARY and timely information from FIDUCIARY when requested by the undersigned. IN CONSIDERATION WHEREOF, the undersigned does hereby remise, release, quitclaim and forever discharge the FIDUCIARY and the respective heirs, personal representatives, successors and/or assigns thereof as well as said decedent's estate, of and from all manner of actions, cause or causes of action, debts, dues, claims and demands whatsoever, both in law and in equity, against the FIDUCIARY, individually, corporately and/or in a tiduciary capacity, and against said decedent's estate, whether as legatee under the Last Will and pt Testament and/or as heir-at-law of said decedent and/or as claimant/creditor and/or in any other capacity which the undersigned has had or now has or ought to have had for or by reason of any act, matter, cause or thing from the beginning of the world to the day of the date of these presents. AND IN FURTHER CONSIDERATION WHEREOF, the undersigned does hereby expressly stipulate, covenant and agree, in consideration of the aforesaid distribution and payment, to indemnify and hold harmless said FIDUCIARY and the respective heirs, personal representatives, successors and assigns thereof against loss from any and all further claims, demands and actions, in law or in equity or otherwise, that may hereafter at any time be made or brought by the Commonwealth of Pennsylvania, or anyone in its behalf, for any unpaid Pennsylvania Death Transfer Inheritance Taxes or by the Internal Revenue Service, or anyone in its behalf, for any unpaid Federal Gift or Estate Taxes on the gross taxable estate of said decedent and the undersigned hereby waives any and all rights of exemption, both as to real and personal property, to which the undersigned may be entitled under the laws of this or any other state as against such claim for reimbursement or indemnity. The undersigned does hereby consent to the discharge of the FIDUCIARY without notice to, or necessity of joinder of, the undersigned. IN WITNESS WHEREOF, the undersigned has duly executed this Receipt, Final and Complete Release and Indemnification Agreement the day, month and year set opposite the signature of the undersigned. ~J.~ Witness 1/ :!J r 2[()S Date .) n n.... { Y ; J ~dj~ ?' ..L.vvJ~ J' .. ACKNOWLEDGMENT STATE OF NEBRASKA COUNTY OF LANCASTER :ss IV 0 1/ (un bq. ,r On this, the 3 day of &t00Cl;' , 2005, before me, the undersigned, personally appeared Bryon L. Swanson , who acknowledged himself or herself to be Assistant Secretary , of BACK TO THE BIBLE, a non-profit corporation, and that he/she as such Assistant Secretary , being authorized to do so, executed the foregoing release for the purposes herein contained by signing the name of the Corporation by himself/herself as Assistant Secretary IN WITNESS WHEREOF, I have hereunto set my hand and official seal. I.A..-:~~ ~~ \). CJta~A Notary Public t> Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 REED GREGORY R ESQUIRE LAW OFFICES OF REED, GREGORY 3120 PARKVIEW LANE HARRISBURG, PA 17111 RE: Estate of KAUFFMAN MARY M File Number: 2004-00751 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent1s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: S/06/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, /r ,f /) .~~~ftLV"~ /! Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 TAYLOR ETHEL 228 BIRCH LANE CARLISLE, PA 17013 RE: Estate of KAUFFMAN MARY M File Number: 2004-00751 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 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 lS due by: 8/06/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, U ~I:J! ~ /;/ , ~ , ...~:'"",.,,,. ' ~ '".,'''!'L'-".If. ~, -; ,- ',...,' &if,,, "A/...I' j,./"A/:.i,<" /'1"' ( Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~