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Home My WebLink About03-0341Register of Wills of Cumberland PETITION FOR GRANT OF Estate of Lillian M. Tepe also known as James D. Bogar, Esquire County, Pennsylvania LETTERS No. , Deceased Social Security No. 107 - 12 - 1360 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 04/08/2002 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A B. Grant of Letters of Administration (c.ta.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 30 Scarsdale Drive, Lower Allen Township, Camp Hill, PA 17011 (list street, number, and municipality) Decedent, then 90 years of age, died 04/01/2003 at Bethany Village, Lower Allen Twp. , PA Decedent 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 (Location) $ 289,000.00 $ $ $ 110,000.00 situated as follows: 30 Scarsdale Drive, Camp Hill, Lower Allen Township, Cumberland Co., PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: ~ Si~lnature Typedorprintednameandresidence James D. Bogar, Esquire One West Main Street, Shiremanstown, PA 17011 Prepared by the Pennsylvania Bar Assoclatfon Copyrig ht (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 Decedent, Petitioner(s) will well and truly administer the estate according to. law. Sworn to or affirmed and subscribed 6 ~-JZ4~/J-f~ Z/~ J~a~e~- D. 'Boga ,~Esquire before me this /'2 day of No. Estate of Lillian M. Tepe Social Security No: 107-12-1360 AND NOW, i~,?/~l.. ! /-7 Date of Death: 04/01/2003 Deceased , ~,~-~' ~ , in consideration / of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~'~ Testamentary [~ Of Administration (c.ta.; d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate) are hereby granted to James D. Bo~ar, Esquire in the above estate and that the instrument(s) dated 04/08/2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... I.D. No: 19475 Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717/737-8761 Extra Pages ( ) .... $ Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Register of Wills of OATH Cumberland County, Pennsylvania OF SUBSCRIBING WITNESS Estate of Lillian M. Tepe also known as , Deceased No. Bonnie L. Williams (each) a subscribing witness to the ~] codicil(s) ~ will(s) presented herewith, (each) being duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as in the presence of each other [] in the presence of the a witness at the request of Testator(rix) in his/her/their presence and r'~ other subscribing witness(es). (Signature) Bonnie L. Williams One West Main Street Shiremanstown, PA 17011 (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this / ~_~ ~h day ! N~)tary Publ~/ ' My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Notar~l ~ Laurie L Wolf. Notay Public Sotilh Mid,eton Twp., Cumberland County My Commission Expires Jan. 7, 2006 Member, Pennsylvania Assodation Of Notaries NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-2 (1991) Register of Wills of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of also known as Lillian M. Tepe No. , Deceased James D. Bo~ar (each) a subscribing witness to the ~ codicil(s) ~ will(s) presented herewith, (each) being duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of Testator(rix) in his/her/their presence and ~--~ in the presence of each other [~] in the presence of the other subscribing witness(es). (Signature) ~'~Ce;e~; ~O~s1;reet Shiremanstown, ;PA _'L701'I (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this I I~0'Jr'~ day of ~q~,~ ) , Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) i NOTARIAL SEAL BONNIE L WILLIAMS, NOTAIW'PUBUC SHIREMANSTOWN BORO., CUMBEIIZ~ND · MY COMMISSION EXPIRES APRIL 18. 2005 NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-2 (1991) LAST WILL AND TESTAMENT OF I, LILLIAN M. TEPE, of Lower Allen Township, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars to JOAN SKINNER, of 218 Waverly Way, Clarksburg, West Virginia, provided, however, that should she predecease me, I direct that this bequest be and become a part of my residuary estate to be distributed as set forth hereinbelow. SECOND: I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars to PATRICIA A. TEPE, of 772 E. Joan D-Arc Phoenix Arizona, provided however that should she predecease me I direct that this bequest be and become a part of , my residuary estate to be distributed as set forth hereinbelow. THIRD: I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars to my granddaughter, DEBORAH BERRY, provided, however, that should she predecease me, i direct this bequest be and become a part of my residuary estate to be distributed as set forth hereinbelow. FOURTH: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together wlth any insurance policies thereon, as follows: (A) Twenty-five (25%) percent/thereof to my son, KURT L. TEPE, provided, however, that should KURT L. TEPE predecease me, then to his issue per stirpes by representation, or should there be a failure of same, then to my surviving children, in equal shares. (B) Twenty-five (25%) percent thereof to my daughter, JEANNE M. GARSKE, provided, however, that should JEANNE M. GARSKE predecease me, then to her issue per stirpes by representation, or should there be a failure of same, then to my surviving children, in equal shares. (C) Twenty-five (25%) percent thereof to my daughter, FLORENCE E. DOTSON, provided, however, that should FLORENCE E. DOTSON predecease me, then to her issue per stirpes by represen- tation, or should there be a failure of same, then to my surviv- ing children, in equal shares. (D) Fifteen percent (15%) percent thereof to my granddaughter, KAREN A. SNIDER, provided, however, that should she predecease me, then to her issue per stirpes by representa- tion, or should there be a failure of same, then to the surviving children of my deceased son, KARL A. TEPE, in equal shares. (E) Ten percent (10%) percent thereof to my grandson, ERIC R. TEPE, provided, however, that should he predecease me, then to his issue per stirpes by representation, or should there be a failure of same, then to the surviving children of my deceased son, KARL A. TEPE, in equal shares. I wish to note that both my late husband, PAUL L. TEPE, and I have provided financial assistance to ERIC R. TEPE. FIFTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. SIXTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SEVENTH: Ail interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. EIGHTH: I nominate and appoint JAMES D. BOGAR, of Shiremanstown, Pennsylvania, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said JAMES D. BOGAR, I nominate and appoint my son, KURT L. TEPE, Executor of this, my Last Will and Testament. I direct that my Executor, and its successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ day of , 2002. LILLIAN M. TEPE (SEAL) Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address 5 OF LILLIAN M. TEPE JAMES D. BOGAR ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN, PENNSYLVANIA 17011 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Lillian M. Tepe Date of Death: April 1, 2003 Will No. 21-03-0341 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 17, 2003: Name Kurt L. Tepe Jeanne M. Garske Joan Skinner Patricia A. Tepe Florence E. Dotson Karen Ann Snider Eric P. Tepe Deborah L. Berry Address 17200 W. Bell Rd. #2423 Surprise, AZ 85374 30 Scarsdale Drive Camp Hill, PA 17011 218 Waverly Way Clarksburg, WV 26301 23609 N. 38th Drive Glendale, ZA 85310 1101 Lindham Court #702 Mechanicsburg, PA 17055 127 Ridenour St. Clarksburg, WV 26301 45 Moran Farm Lane Troutville, VA 24175 317 Roberta Drive Hendersonville, TN 37075 Notice has now been given to all persons entitled thereto under Rule 5.6(a)~ except: NONE Date: 4/18/03 Capacity: Jam~s D~ B , Esquire One Wos~ ~a'~t~eet Shiremanstown, PA 17011 (717) 737-8761 Personal Representative X Counsel for Personal Representative JAMES D. BOGAR JENNIFER B. HIPP* *;dso admitted to New Jersey Bar JA~Es D. B OGAa ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN, PENNSYLVANIA 17011 e-mall mall@bogarlaw.com June 24, 2003 TELEPHONE (717) 737-8761 FACSIMILE (717) 737-2086 Direct e-mail Jbogar@bogarlaw.com VIA HAND DELIVERY Donna Otto Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: The Estate of Lillian M. Tepe No. 21-03-0341 Date of Death: April 1, 2003 Dear Ms. Otto: I represent the Estate of Lilian M. Tepe. Enclosed is a check made payable to the Register of Wills in the amount of $15,646.50, same constituting a prepayment at discount on account of Pennsylvania inheritance taxes in the above-captioned estate. The prepayment is determined as follows: $366,000.00 multiplied by 4.5% or $16,470.00, less discount in the amount of 5% or $823.50, resulting in payment of $15,646.50. Please provide me with the appropriate receipt in this matter. Your time and consideration in this matter are greatly appreciated. _V_ery truly yours, JDB / 1 eb Enclosure ~.~ C. cc: Kurt L. Tepe ?~.. ~'~, 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 002727 BOGAR JAMES D ESQUIRE ONE WEST MAIN STREET SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 107-12-1360 FILE NUMBER: 2103-0341 DECEDENT NAME: TEPE LILLIAN M DATE OF PAYMENT: 06/24/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/01/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,646.50 TOTAL AMOUNT PAID: $15,646.50 REMARKS: JAMES D BOGARESQUIRE SEAL CHECK//105 INITIALS: DO RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 003058 BOGAR JAMES D 1 W MAIN STREET SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 107-12-1360 FILE NUMBER: 2103-0341 DECEDENT NAME: TEPE LILLIAN M DATE OF PAYMENT: 09/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/01/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $348.39 REMARKS: TOTAL AMOUNT PAID: 9348.39 SEAL CHECK# 117 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-03-0341 COUNTY CODE YEAR NUMBER DI E C E D E N T cAPBI HpRL EplO cDAC ~TK "-ES C O R R E S R E C A P I T U L A T I O N C O M ×I T O DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INiTiAL) Tepe Lillian M. DATE OF BIRTH (MM-DD-YEAR) I 04/01/2003 DATE Of DEATH (MM-DD-YEAR) 02/14/1913 (iF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) E~]9. Litigation Proceeds Received SOCIAL SECURITY NUMBER 107-12-1360 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER :~4i Supplemental Return · Future Interest Compromise (date of death after 12-1;>-87) Decedent Maintained a Living Trust (Attach copy of Trust) ~]10. SpousaIPoverty Credit (date of death between 12-31-91 and (date of death 3. Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME James D. Bo~ar FIRM NAM E (if Applicable) Esquire TELEPHONE NUMBER 717./737-8761 COMPLETE MAILING ADDRESS One West Main Street Shiremanstown, PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) F~] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. 115,50~_.; O0 188,176.54 None None 97,370.96 None None 31,972.19 None Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) '~--~ OFFICIAL USE ONLY (8) 401,047.50 (11) 31,972.19 (12) 369,075.31 (13~ (14) 369,075.31 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 X .o 0 (15) 0.00 367,075.31 X .0 45 (16) 16,518.39 X .12 (17) 0.00 2,000.00 X .15 (18) 300.00 19. Tax Due (19) 16,818.39 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 30 Scarsdale Drive CITY Camp Hill STATE ?A Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) Z. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 15,646.50 823.50 (1) Total Credits ( A + B + C ) (Z) ZIP 17011 16,818.39 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 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; ........... ¢. 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? ................................ r'-] ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 16,470.00 0.00 0.00 348.39 0.00 348.39 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. SIBLE FOR FILING RETURN James D. Bogar DATE One W. Main Street ;- .................... SlGN~T~JRE OF PRE,RE, OTHER THAN REPRESENTATIVE 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, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-150Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lillian M. Tope SSf/ 107-12-1360 SCHEDULE A REAL ESTATE 04/01/2003 FILENUMBER 21-03-0341 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Ail that certain piece or parcel of real estate having erected 115,500.00 thereon a dwelling house being known and numbered as 30 ScarsdalE Drive, Camp Hill, Pennsylvania. The property was acquired by Paul L. Tepe and Lillian M. Tepe, husband and wife, by Deed dated October 3, 1967 and recorded October 3, 1967 in the Cumberland County Recorder of Deeds Office, a copy of said Deed being attached hereto and incorporated herein. The said Paul L. Tepe died August 18, 1999, whereupon full and complete title became vested solely in Lillian M. Tepe, the Decedent herein. The above-described real estate was sold pursuant to an Agreement of Sale for Real Estate dated April 28, 2003, a copy of which is attached hereto and incorporated herein. Final settlement took place on May 30, 2003. A copy of the Deed conveying said real estate, along with a copy of the Settlement Sheet, are attached hereto and incorporated herein. The sale price of the real estate was $115,500.00. TOTAL (Also enter on line 1, Recapitulation) $ 115,500.00 (If more space is needed, insert additional sheets of the same size) Copyr ght {c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) MADE THE 3rd day 0f October of our Lord one thousand nine hundred sixty-seven (1967) in the year BETWEEN HUGO J. MAJOR Pennsylvania, and M~RY F. MAJOR, his wife, of Camp Hill, parties of the first part, Grantors , PAUL L. TEPE and LILLIAN M. TEPE, his wife, of Camp Hill, Pennsylvania, parties of the second part, Grantee s: WITNE$$ETH, that in consideration of Seventeen Thousand Nine Hundred & 00/100 - .............. ($17,g00,00) ............. Dollars, in hand paid, the receipt whereof is hereby acknowledged, the eaid grantors do hereby g.ra~t and convey to the eaid grantees , their heirs and assigns, ALL that certain lot or tract of land situate in Lower Allen Township, Cumberland County, Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at a point on the southerly line of Scarsdale Drive and which point is 92.26 feet east of ~he southeasterly corner of Scar,dale Drive and Neponsit Lane extended, and the dividing line between Lots Nos. 26 and 27, Block 'G', on the hereinafter mentioned Plan of Lots; thence along said dividing line South 34 degrees 40 minutes Bast 11g.12 feet to a point at dividing line between Lots Nos. 2S and 26, Block 'G', on said plan; thence along said dividing line South 47 degrees 40 minutes West 75.55 feet to a point at the easterly line of Neponsit Lane aforesaid; thence along same North 42 degrees 20 minutes West 107.5 feet to a point; thence in an arc having a radius of 20 feet in a northeasterly direction 34.09 feet to a point on the southerly line of Scarsdale Drive aforesaid; thence along same North 55 degrees 20 minutes East 69.39 feet to a point, the place of BEGINNING. BEING Lot No. 26, Block 'G', as on Plan of Lots known as Country and Town Homes, Inc., which plan was recorded in the Cumberland County Recorder*s Office on lay 14~ 1956, in Plan Book 7, Page 41. HAVING thereon erected a split level frame dwelling known as No. 30 Scarsdale Drive. Cumb. Co., Pa. Real E~tete Transfer Tax BEING the same premises which Country and Town Homes, Inc. by its deed dated June 12, 1957 and recorded in the Cumberland County Recorder*s Office in Deed Book 17-W, Page 144, granted and conveyed unto the Grantors herein. School Dist. Cumb. Co., Pa ~t~ Real Estate Transfer Tax Cumb. Co. Dilt~ol. Agt. AND the said grantors hereby covenant and agree that they and each of them will warrant General. ly the property hereby conveyed. IN WITNESS WHEREOF, said grantors have hereunto set their hands a~(t s,~al s the day and year first above written. ......... ......... .................... -" ....... '"*- ' State of P~NNSYLVAN IA ~ County of ¥[JR~ I ss. On this, the 3rd day of October the undersigned officer, personally appeared HUGO J. MAJOR and MARY F. MAJOR~ his wife known to me (or satisfactorily proven) to be the person s whose name s udthin instrument, and acknowledged that the]/ , 1967 , before ~ con.ned :,' ,' IN'WITNESS WHEREOF, are subscribed to the executed same for the In~rposes therein I hereu~__dset my hand and official seal. Notarv Public Title of O/ricer. My Commission Expirss - October 17, 1968 I of the within named grantee is do hereby certify that the precise residence and complete post o.~c_e address Attorney for ........ Z < < COMMONWfl~'A'~TH OF PENNSYLVANIA [' SS. RECORDED on th~ ............... A. D. 19~ in the Recorders o~ee o[ the said Co~ozty, in Deed Boo~2 ~o~ .... 2_2 ........... .~~ ........ M~Y-04-~00~ 18:89 M C WALKE~ E~EALTY 717 69? 9488 8~k~kNOT~~o~'~ ~R~ ~ ~4~~ " OR · , ..... . ~ ~ · '~ ~ ~y~ ~ ~ ~ ~UI ~ ~d ~ly ~ Ru~ and ~ ~ v~w~ sm~ ~; ~4 ~5 :It: I1 4~ d4 47' I1 $. 4, zmcZ'UllZ~ & t, ZB~ONA~ PRO~L'rY (A) ~t~l~ ~ t~ ~ and ~ M~ ~v ~fl ~g l~ ~n~ntty ~ In ~ ~, ~ ~ Ib~ ~u~ pl~b~l ~y mt d~c ~ ~s~dc~ ~mll ~ w~ ~t~; ~ cOv~fl8 ~. ~s ~ ~:~n .+~n~iti~n~ / 5'/ P.02/10 MAY-A4-2003 18:~ M C ~RLKER REALTY ?iV 69? 9450 N ~ ~ ~t~ ~ ~:~ u ~M ~ G (~ ~)~1~ ~ ~'~nt~O~~ ~~ 07 ~ ou ~u~ ~.~ ~il ~ ~ · B~. ~u~ w~l~ ~Y~ AgJ~dc~ ~, ~ w~ ~ ~ ~ ~- ~ ~11~ ~n~ RU~ ~ (~ d~ ~ m s, ~0~~0~ ~C~(l~ , x~ ~ ~'~. Bu~ ,~ mM H~ ~ thc ~ ~ ~ ~d~ ~ ~ ~z (~ P~ ~ N~ and isa (A) W~ t)~ < X~ nn~ ~ ~ ~) (,f I~ ~ ~ ~ ~b ~t,ym, ~ ~u~ '~ ~, ~v ~ ~ ~ ~ 141 ~ ~ O~ ~ WS~. I'1RY-04-200~3 I?g 171 ~ z~ 2ff ~o MRY-04-2003 3. zM ~4 11, ~T4 18:11 M C WRLk~ RERLTY 717 69'7 9450 .... ~' --' ~ y ~ t ~ ~ .... ~ ~ DAYa, w~ ~, ~~~dn~ ~wh~~~ P ~ t~ ~ 1, ~n-~w~~~m~'by~('g''~~~'~'L~w~ (1) ~ ~ DAYS ~ ~ Thc ~ ~zo~, ~ ~: ~7 (1) ~o[~~~~~m~hl)~)t~b ~~ ~) ~ d~ A~ ~ ~ch m~ mit R~t~ mv,d~ ~d ~ ~unt ~ ~m ~ will ~ * ~ N~ st4 P.05/10 If th~ ;,.~,~ x~v~gs d~ ~ wa~r sqvke 8~4 not m~t It~ minimum ~ndnxds °1' aay ap~blc ~ ~y nnd/~ ~ ~~ . 4. ~$~~~,~~~e~,BW~wdl ~n_~ DA~; 8~ ~ymB~AS~~' b T~ ~6 ~ ~ ~h ~ nil ~ ~ ~ ~ ~ ~ I~ P6~ w~ ~ ~t~ ~y m B~I~ 18:12 M C WALKER REALTY 717 69? 9480 dlG , . P.0?/10 M~Y-04-~00~ Mid ~11 MAY-04-2003 2.4 M C bJALKER REALTY 72.? 69? :3480 rCl'l tim ri4 P. 09/10 Tax Parcel No. 13-25-0022-135 THIS INDENTURE, MADE THE ~C~%~ day of ~2~i_ , two thousand three (2003) BETWEEN JAMES D. BOGAR, Executor of the Last Will and Testament of LILLIAN M. TEPE, late of Cumberland County, Pennsylvania, party of the first part, and CASEY MARGARET STONE, married woman, of Mechanicsburg, Cumberland County, Pennsylvania, party of the second part: W~ER~AS, the said LILLIAN M. TEPE by her Last Will and Testament, duly proved and recorded in the Cumberland County Register of Wills Office, Pennsylvania, in Docket Book 21-03-0301, Letters Testamentary being issued on April 17, 2003, provided, in pertinent part, as follows: FIF?~: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it... EIG~T~: I nominate and appoint JAM_ES D. BOGAR, Executor of this, my Last Will and Testament .... NOW T~IS INDEN~UR~ WIT~-~SSET~, that the said party of the first part, by virtue of the power and authority aforesaid, in said Will contained, and in consideration of the sum of One Hundred Fifteen Thousand Five Hundred Dollars ($115,500.00) to him paid by the said party of the second part, at and before the ensealing and delivery of these presents, the receipt whereof is hereby acknowledged, has granted, bargained, sold and conveyed, and does hereby grant, bargain, sell and convey to the said party of the second part, her heirs and assigns forever: ALL THAT CERTAIN piece or parcel of land situate in Lower Allen Township, Cumberland County, Pennsylvania, bounded and described as follows, to wit: BEGINNING at a point on the southerly line of Scarsdale Drive and which point is 92.26 feet east of the southeasterly corner of Scarsdale Drive and Neponsit Lane extended, and the dividing line between Lot Nos. 26 and 27, Block "G", on the hereinafter mentioned Plan of Lots; thence along said dividing line South 34 degrees 40 minutes East 119.12 feet to a point at dividing line between Lot Nos. 25 and 26, Block "G", on said plan; thence along said dividing line South 47 degrees 40 minutes West 75.55 feet to a point at the easterly line of Neponsit Lane aforesaid; thence along same North 42 degrees 20 minutes West 107.5 feet to a point; thence in an arc having a radius of 20 feet in a northeasterly direction 34.09 feet to a point on the southerly line of Scarsdale Drive aforesaid; thence along same North 55 degrees 20 minutes East 69.39 feet to a point, the place of BEGINNING. BEING Lot No. 26, Block "G", as on Plan of Lots known as Country and Town Homes, Inc., which plan was recorded in the Cumberland County Recorder's Office on May 14, 1956, in Plan Book 7, Page 41. HAVING ERECTED THEREON a split level frame dwelling known as No. 30 Scarsdale Drive. BEING the same premises which Hugo J. Major and Mary F. Major, his wife, by deed dated October 3, 1967 and recorded October 3, 1967 in the Cumberland County Recorder of Deeds Office in Deed Book "N", Volume 22, Page 380, granted and conveyed unto Paul L. Tepe and Lillian M. Tepe. The said Paul L. Tepe died August 18, 1999, whereupon full and complete title of the within described property became vested solely in Lillian M. Tepe. The said Lillian M. Tepe died April 1, 2003. with all and singular the rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of the said Lillian M. Tepe at and immediately before the time of her decease, in law or equity or otherwise howsoever, of, in, to or out of the same: TO HAVE AND TO HOLD the said granted premises to the said party of the second part, her heirs and assigns forever. AND the said party of the first part, does covenant, promise, grant and agree, to and with the said party of the second part, her heirs and assigns, by these presents, that the said party of the first part, has not done, committed, or knowingly or willingly suffered to be done, any act, matter or thing what- soever, whereby the premises aforesaid, or any part thereof, is, are, shall or may be charged or encumbered, in title, charge or estate, or otherwise howsoever. IN WITNESS WHEREOF, the said party of the first part has hereunto set his hand and seal the day and year above written. Signed, Sealed and Delivered the ~resence of , ..~' ~a ~ (SEAL) JAME~ D. BO~R, Executor of the Estate of hillian M. Tepe · I COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS. On this, the ~.< t.~. day of /i.,''.,~ , 2003, before me, the undersigned officer, personally appeared JAMES D. BOGAR, Executor of the Estate of Lillian M. Tepe, known to me (or satisfactorily proven) to be the person described in the foregoing instrument, and acknowledged that he executed the same in the capacity therein stated and for the purposes therein contained. seal. IN WITNESS WHEREOF, I hereunto set my hand and official ( SEAL ) Notary Public My Commission Expires~ NOTARIAL SEAL I I BONNIE L. WILLIAMS, NOTARY PtlBLIC I ISHIREMANSTOWN BORO., CUMBERLAND CO.I I MY COMMISSION EXPIRES APRIL 18, 2005 1 CERTIFICATE OF RESIDENCE I do hereby certify that the precise residence and complete post office address of the within named grantee is 2003 Attorney/Agent for Grantees COFIMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS. RECORDED on this day of , 200 , in the Recorder's Office of the said County, in Deed Book , Page Given under my hand and the seal of the said office, the date above written. , Recorder. .......... Form App~ovl~l OMB No. 2502-0265 A. US D~PARTMENT OF HOUSING AND URI~M~I OEVELOPMENT I B. TYPE oF LOAN SETTLEMENT STATEMENT ~ 1. ! } FHA 2. ,--1 FMHA 3. i×lCONV. UNINS. Affiliated Settlement Services Group, LLP ,4., VA 5. ~ ~ CONY. ~NS. 3912 Market Street !6. ESCROW I=ILE NUMBER: 7. LOAN NUMBER: 00002427-001 NJT 03-512133 (717)CamP975-7839Hill' PA 17011 ~i ~0RTGA~N~RANC~ CASE NuMBeR: FINAL _ i .... C. NOTE: ?.his form I$ fur,?.l,~s~d t,o, give yo~ a statement of ace. ual settlement costs. Amouqts paid Jo and by the settlement agent are shown. items marked (~' u C ) we m paid outside the ck~lag; they am shown here for alformatio~3al purposes and are not included in the totals D. NAME OF BORROWERi Casey Margaretsione ADDRESS OF BORROWER: 302 West Lisbum Road Mechanicsburg, PA 17055 E. NAME OF SELLER: James Di BOg~r EXeCUtor otih~ Tep~ E-state ' ADDRESS OF SELLER: F. NAME OF LENDER: N°vastar M0rgag~; inc; ADDRESS OF LENDER: 6150 Oak Tree Blvd. Cleveland, OH 44131 G. PROPERTY LOCATION: 30 scarsd~le DYive Camp Hill, PA 17011 Cumberland County 13-25-0022-135 Lot(s) 26, Block "C", of Country and Town Homes, Inc., Map Book 7, Map Page 41 H. SETTLEMENT AGENT: Affiliated Settlement Services Group, LLP PLACE OF SETTLEMENT: 3912 Market Street, Camp Hill, PA 17011 I. SETTLEMENT DATE: 5/30/2003 PRORATION DATE: 5/30/2003 DISBURSEMENT DATE: 5/30/2003 J- suMMARy OF BoRRowER'S 'I'R~N~A~Ti(~N [ K. -- ~LII~IMA~-b~:LLER;~ TRANSACT (~N 101. Cou~ract Sales Price 115,500.00 401. Coatract Sales Price 115,500.00 102. Personal Propelly ' 402. Fersona(~r°Perty 103. Settlement charges to Borrower (line 1400) ; 3,94!!031I 403; 104. ~ ~ 404. 105. 405. ADJUSTMENTS FOR ITEMS PAID BY sELLER IN'ADVANcE: ADjUsTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 106. City/Town Taxes 107. County Taxes 05/36/03 108. Assessments 109. School Tax 05i30/03 110. Trash 05/30/03 111. Sewer 05/30~03 112. 113. 114. 115. 120. GROSS AMOUNT DUE FROM BORROWER: 406. City/Town Taxes to 12/31/03 255.27 407. County Taxes 05/30/03 408. Assessments to 06/36/03 93.~' 1-409. Sci~0ol Tax 05/30/03 to 06/30103 !- 16.4~-.~410. Trash 05/30/03 to 06/30/03 ' - 8.00 ~411. Sewer ~ ~5/30/03 to 412, 413. 415. 119,814.08 420. GROSS AMOUNT DUE TO SELLER: 201. Deposil or earnest money 202. Principal amount of new loan(s) 203. Existing loan(s) taken subject to 204. Proceeds From 2nd Mtg. 205. 206. Seller Paid Closing Costs to 12/31/03 255.27 to 06/30103 to 06/30103 06/30103 93.33 16.45 8.00 2O7 208. 209. . i 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: AI~,~USTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/Town Taxes 510, Cily/'rcwn Taxes 211. County Taxes ~ ~ 511. Counly Taxes 212. Assessments , 213. 513. 214. 514. 215. 2,6. i - 516. 217. t "- 517. 218. 219. 519. 220. TOTAL i 118,:~86.06 [ 520. ¥~)TAL REDUCTIONS'J~ AMOUNT DUE SELLER PAID BY/FOR BORROWER 301. Gross amount due from Borrower ( line 120) 119,814.08 601. Gross amount due 1o Seller (line 420) 302. Less amount paid by/for Borrower ( line 220) I- 11 ~:,~6.0~-~T-60~: Less~e~u~i0fl in a-n~nt due ~alter (line 520) 303. CASH(XIFROM) ( TO)BORROWER: 1,428.02 603. CASH(UFROM) ( ~X~ TO)SELLER 115.873.05 501. Excess deposit (see instructions) 92:000.00' 502 SeUlemenl charges ~o Seller (line 1400) 9.260.00 503 Existing loan(s) taken subject to 22,386.06504, Payoff et first mortgage loan 505. Payoff of se~,~nd mortgage loan ' 3,000.00~ ~ 506. S~ller Paid Closing Costs 3,000.00 507. 12,260.00 115,873.05 12,260.00 103,613.05 L~ SI~TTLI~M~_N,~HARGES E~¢ROW[t~7~F,I, LE NUMBER: 000024.~ BASED ON PRICES 115,500.00 O 7.000%= $0,005.00 I PAID FRC~4 PAID FROM DIVISION OF COMMISSION (LINE 700)AS FOLLOWS: I BORROVVER'S SELLER'S FUNDS AT FUNDS AT 701,$ 8,085.00 tO M, C. Wail(er Realty (Less $200) .... 1 SETTLEMENT SETTLEMENT 702 $ to M C. Walker Real~/ 703. Commission paid at settlement -- [ ~ 8,085.00 704. 801. Loan Origination Fee 802. Loan Discount Fee 803. Appraisal Fee to D~,na~ic APpraisals. InC~ ............. (300.00) 804. Credil Report to Creative Financing Solutions. Inc.. ' 805. Lenders inspecti°n Fe~_ 806. Mortgage Insurance Application Fee 807, Assumption Fee 808. Processing Fee to C~'6~fi~e Fi~a~ct-r~g~luti~,i~CT .... i 495.00 ' 809. Courier Fee to Creative Financing SolUtlonsl inc. i 50.00 811. A'see attached for kdown 901. Interest From 05/30103 to 06/01/03 ~} $15.10001day % (2 days) 30.20 902. Mortgage Insurance Premium for Month(s) to 903. Hazard Insurance Premium for I Years(s)to Ntb{ate Insuranc~ Co. 904. Spread-Y[e'ld Pram~d by Novast--~) (~rea~ve-F~andng ~ol~o~s~nc~ ....... (~84di~0)~'~ -' 1001. Hazard Insurance months {~ $ 24.33 per month 1002. Mortgage Insurance month~ ~ $ ' ~er--n~o~th ......... 1003. City Property Taxes months ~ $ per month 1004. County Property Taxes '- ~o nth~s ~ $ '- ' per monf~ 1005. Annual Assessments mo nths ~"~ - ' ~er mont~ 1006. months _~ $ per month 1007. months ~ $ per month ' ' 1008. m nths ~ { ' permo~ltJ~ ' ' 1101. Settlement or dosing fee 1102. Abstract or tlUe search 1103. Title examination 1104 Title insurance binder 1105 Document preparation 1108. Notary fees to Settlement Officer - 25.00 1107. Attorney's Fees (includes above items numbers: ) 1108 Title Insurance to AffilialecfSett~ement Services Group, LLP 844.88 (includes above items numbers: ) 1109. Lenders cover~_ga $ _. 92.400.00 ....... 1110. Owner's coverage S 115.500.00 L 1111 Endorsements100-300-8.1-71 to Affili~dSettlan~nTSe cervtEe~-G~'oup~L~P' 200.oo 1112 Overnight Delivery Fee to Affiliated Settlement Services-Group LLP 1113, ............ '2 ........... 30.00 1201. Recording Fees: Deed $ 38.50 Mortgage $ 82.50 Release $ 121.00 1202_ City/County tax/stamps Deed $ 1,155.~ortg~g~'$ 1.155.00 1203 State tax/stamps Deed $ 1',155.00 Mortgage $ 1.155.00 1204 1205 1301. Survey 1302. Pest Inspection to Bi~-ch~r& TJllery. In~.' ....... 50.00 1303. Insured Closing Protection Ur to Southe~ Titlelns'uranceC~:- 35.00 1304 Close Out Accoumt Feet Io LowerAIlen Twp. SewerAi~tl~ty 20.00 1305 1306 1307. "See attached for breakdown 1400. TOTAL SETTLEMENT CHARGES (Entar on line 103.Section J -and - line 502. S~ctlon'K) 3.941.03 ' 9.260.00 1 have carefully reviewed the HUD-1 Settlement Statornent and to the best of my knowtedge and belief, it is a true and accurate statement of all receipts and disbursements mede on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Casey Margaret~ Stone ,.,/ b~'O.q3o~'/ ar ~ of the Tepe Estate T~3e HI,,IE~/1 Settlement State~'nen[,~h I have prepared Borrowers Sellers ~,~sb~,j~,l~c~orda/~n~wi~th~.ta. rn~. n,..., is a true and accurate account of thle , ..... ~"/~;, ../~'~ ~'t°n' Ibave .... ed or will cause the fundstobe Affiliated Settlem,~eflt Se~ices Gr-ou'p, LLP ~ Da~e WARNING: It is a crime to knOWingly make false statements to the Un~tad States on this or any similar form. Penalties upon conviction can include a line and Impnsonment. For details see: Title 18 U.S, Code Section 1001 and Section 1010. Escrow Number: 00002427-001 NJT HUD 811 DETAILED BREAKDOWN OF ITEMS PAYABLE IN CONNECTION WITH LOAN Description 812. Underwriting Fee to Novastar Morgage, Inc. 813. Tax Service Fee to Novastar Morgage, Inc. 814. Flood Certification Fee to Novastar Morgage, Inc. 816. MERS Fee to Novastar Morgage, Inc. Total as shown on HUD page 2 Line #811 Buyer Amount 795.00 65.00 16.00 3.95 879.95 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer Amount 1202. City & County Tax/Stamps City Tax/Stamps: Deed $1,155.00 Total as shown on HUD page 2 Line #1202 Seller Amount 1,155.00 1203. State Tax/Stamps State Tax/Stamps: Deed $1,155.00 Total as shown on HUD page 2 Line #1203 Buyer Amount 1,155.00 Seller Amount llUD-I ADDENDUM LOAN# 03-512133 I have reviewed the HUD Settlement Statement and to the besl of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transact/on. ! further certify that I have received a copy of thc HUD Setllcm/~nt Statement. ,0 /} The HUD- 1 Settlement Statement which I have prepared is a true and accurat~ account of this transaction. ! have caused or will cause the funds to be disbursed in accordance with this statement. S ~:T~'~EMEN/T A{/I~NT - ' DATE WARNING: It is a crime to knowiugly make a fals~ statement to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Sectiou 1001 and Sectiou 1010. 05-29-2003 12: 53 OHOl 40~ REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Lillian M. Tepe SSf/ 107-12-1360 04/01/2003 21-03-0341 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 1,118.35 shares Fidelity Investments Fidelity 77.67 86,862.24 Magellan, Account No. 2AS-253685 2 9,151.108 shares Fidelity Investments Spartan PA 11.07 101,302.77 Municipal Income, CUSIP 316344209 3 Fidelity Investments Spartan PA Municipal 11.53 Income-Unpaid dividends as of date of death TOTAL (Also enter on line 2, Recapitulation) 188,176.54 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) April 24, 2003 JAMES D BOGAR ATTORNEY AT LAw ONE WEST MAIN ST SHIREMANSTOWN PA 17011 Dear Mr. Bogar: We are responding to your request for information about Lillian M. Tepe's account with Fidelity. The table below list the account holdings and values as of 04/01/2003. Fidelity account 2AS-253685: LILLIAN M TEPE-INDIVDUAL Security Description CUSIP Quantity Unit Value Market Value Fidelity Magellan 316184100 1118.350 $77.67 $86,862.24 Spartan PA Muni Income 316344209 9151.108 $11.07 $101,302.77 Total Value $188,165.01 The table below shows the accrued unpaid dividends from 4/1/2003 through 4/1/2003 Security Description Spartan PA Muni Income Dividends $11.53 We hope this information is helpful. For questions concerning account holdings or instructions on how to transfer the ownership of the accounts, please call our Inheritor Services Group at 800-544-0003 between 9:00 A.M. and 7:00 P.M. Eastern time Monday through Friday or visit our website at www.fidelitv, com. Sincerely, Fidelity Investments Our file: W015217-24APR03 ¢ 's;<e-:,ge Services provideC 5,/. Fidelity 8rokerac~e. 5er'.iices LLC, ,~em~er[~ , ,,~,~,vc,--.~_ 5IFC 2: ~_~ c,~, "~st:d'~ a~ settlement sac'/~ces by Nationai Frn~ci~i Services LLC, Me-re:e, ",1'~5~ 5:F' ~zcount ReRegistraticn Ser,/ic~s, ~C, ~7 5E'7', Ti :.s Te~s 7525~.,~T';- REV- 1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lillian M. Tepe SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SS# 107-12-1360 04/01/2003 FILE NUMBER 21-03-0341 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 4 5 6 7 8 9 10 11 DESCRIPTION Country Meadows - Refund-S500.00, accrued interest $97.50 John Hancock Life Insurance Company - Signature Access Account No. 160492907, date of death balance $33,838.33, accrued interes $53.86 Mass Mutual Financial Group - Benefit Management Account No. 820077533, date of death balance $22,652.30, accrued interest $4.34 PNC Bank, N.A. Checking Account No. 5140063815, date of death balance $1,524.18, accrued interest $0.00 United States Treasury - 2002 Federal Income Tax Refund USAA - Automobile insurance refund USAA - Homeowner's insurance refund Waypoint Bank - Checking Account No. 100290758, date of death balance $433.56, accrued interest $.31 Waypoint Bank - Savings Account No. 500063615, date of death balance $31,919.56, accrued interest $0.00 Chevrolet, 1982, VIN 2G1AN69H4C1250540 Sold at private sale Contents of home and personal property sold at public sale TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE Of DEATH 597.50 33,892.19 22,656.64 1,524.18 3,060.81 61.48 87.73 433.87 31,919.56 300.00 2,837.00 $ 97,370.96 (If more space is needed, insert additional sheets of the same size) Copyr{ght (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) John Hancock Life Insurance Company Signature Access Account, X-5 John Hancock Place Post Office Box 790 Boston. Massachusetts 02117-0790 (617) 886-3150 Fax: (617) 886~3118 Maureen Sheehan Specialist April 29, 2003 James D. Bogar Attorney at Law One West Main Street Shiremanstown, PA 17011 Re: Account Number 160492907 Account Holder Lillian M. Tepe This is in response to your letter dated April 17, 2003. As Lillian M. Tepe did not name a beneficiary, the balance in this account x~411 be due her Estate. Please have the Administrator complete the enclosed claim form and return it to me x~4th a certified copy of the Death Certificate, along x~4th a certified copy of the Court Appointment of the Administrator or Executor of the Estate. The balance in this account as of today is $33,902.17. The principal balance on the date of death (4/1/03) was $33,838.33. The amount of interest accrued on the account since the last posting that the decedent could have claimed on that date and not including the principal balance was $53.86. Please contact me directly with any questions you may have. A self-addressed envelope is enclosed for your convenience. Sincerely, / Specialist Encs T~E BLUE CHIP COMPANI£~'~ ~AM~S D BOGAR ATTORNFY AT tAW ONE WEST MAI'N STREET SHLR.EMANSTOWN PA ! ?0 May 15, 2003 Dear Mr Bogar: RE' Benefit Management Account #$20077533 Thank ~you t'or your recent inqui~ regarding the status of the Benefit Manag, ement Account. Mrs Tepe aecoum was established on September 3, 1.999 with proceeds fi.om life insurance insuring Paul L Tepe Her account balance on the account as of May 16, 2003 is $22,657.! 1 The amount as old, ate of death was $22,652 30 and the interes~ she received was $4,34. 1 hope this information ~s helpful If'you have any f~her questions, please call me at ~he number below Sincerely, L~ce Vau~han Operations Support Representative (800)-548-0705 PNCBAI K April 28, 2003 Sames D. Bogar One West M~in Street Shiremanstown, PA 17011 Estate of Lillian M. T~e, deceased SSN: 10%12-1360 DOD: 4/1/2003 Dear Mr. Bo~r: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5140063815 LILLIAN M TEPE DOD balance: $1,524.18 (non-interest bearing) Established 10/01/1960 Please note that this office only provides date of death balances for deposit acco~_,uts (ItL~, CDs, Checkin$ m~d 5avin~ accounts). We do eot process any fmsneisl transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, 1-800-762-177~ PT-PFSC-Oa-F 500 first Ave. Pimburgh PA 15219 Member FDIC TOTRL P.03 hOOK FOR US. ~VE'hh GET YOU TH~R~. 04/24/2003 JAMES BOGAR ONE WEST MAIN ST SHIRESMANTOWN PA 17011 The information which you requested on the account(s) of LILLIAN TEPE (Social Security Number 107-12-1360) is/are as follows: Account Number 100290758 500063615 Class of Account CHECKING SAVINGS Date Opened 08/20/01 06/04/75 Principal Balance 433.56 31919.56 Accrued Interest .31 Balance at Date of 433.87 31919.56 Death Account Ownership SOLE SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Or, ruer, if troy Date Ownership Was Established Additional Information Requested SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FVEE 1-866-WAYPOINT (I-866-9;=9-7646) · IN YORK AREA 717/815-4500 · vvvvw, wagpointbank, com REV-1511 EX *(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lillian M. Tepe SS# 107-12-1360 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 04/01/2003 FILENUMBER 21-03-0341 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: Iron Kettle Funeral Luncheon ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees James D. Bogar Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zip Closing Costs (per settlement City Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees H ~. P~ Block Other Administrative Costs Casey Margaret Stone - Seller Paid statement ) Cumberland Law Journal - Legal advertisement Griswold Special Care - Special Care Joseph Tamanini Lawn Care Lower Allen Twp. Sewer Authority - Lower Allen Twp. Sewer Authority - Total of Continuation Schedule(s) Sewer/Trash Final Bill Close Out of Account (per 431.73 14,875.00 345.00 139.00 3,000.00 75.00 10.00 175.00 73.35 20.00 12,828.11 TOTAL (Also enter on line 9, Recapitulation) $ 31,972.19 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Lillian M. Tepe Soc Sec #: 107-12-1360 Date of Death: 04/01/2003 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Settlement Statement) M. C. Walker Realty - Commission Pa. American Water Co. - Water Bill-final Patriot News Co. Legal Advertisement PP&L - Electric Bill-final Recorder of Deeds Realty Transfer Tax RESERVES: Costs to conclude administration of Estate including filing fee for PA Inheritance Tax Return, Inventory and First & Final Account; preparation of Personal and Fiduciary Income Tax Returns Rowe's Auction Service - Commission for auction sale Rowe's Auction Service - Hauling auction items Rowe's Auction Service - Trash removal Sprint Long Distance Telephone Bill-final Suzanne Keever Special personal care U.S. Postal Service - Certified Mailing of 2002 Personal Income Tax Return U.S. Postal Service - Certified Mail to Fidelity (2) U.S. Postal Service - Certified Mail to Internal Revenue Service UGI Gas Bill-final Verizon - Telephone Bill-final 8,085.00 56.64 81.97 121.64 1,155.00 2,000.00 709.00 180.00 145.00 31.78 39.00 4.65 9.07 4.65 178.79 25.92 12,828.11 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lillian M. Tope SS~/ 107-12-1360 SCHEDULE J BENEFICIARIES 04/01/2003 FILENUMBER 21-03-0341 NUMBER 4 II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116~(1.Z)] Deborah L. Berry 317 Roberta Drive Hendersonville, TN 37075 Florence E. Dotson c/o Debbie Devorss 100 Brandywine Lane Great Falls, MT 59404 Jeanne M. Garski 17023 S.W. E1 Dorado Tigard, OR 97224 Joan Skinner 218 Waverly Way RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Granddaughter Daughter Daughter Daughter-in-Law AMOUNT OR SHARE OF ESTATE Two Thousand ($2,000.00) Dollars Twenty-five (25%) percent of the rest, residue and remainder Twenty-five (25%) percent of the rest, residue and remainder Two Thousand ($2,000.00) ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) Z000 form software only The Lackner Group, Inc. Form R£V-1513 EX (Rev. 9-00) Estate of: Lillian M. Tepe Soc Sec #: 107-12-1360 Date of Death: 04/01/2003 Continuation of Schedule J, Part I (Taxable Bequests) Item Name and Address of Beneficiary Relationship Amount or Share of Estate Clarksburg, WV 26301 Karen A. Snider 127 Ridenour Street Clarksburg, WV 26301 Eric R. Tepe 215 Blue Ridge Avenue Front Royal, VA 22630 Kurt L. Tepe 17200 W. Bell Road #2423 Surprise, AZ 85374 Patricia A. Tepe 23609 N. 38th Drive Glendale, AZ 85310 Granddaughter Grandson Son Other Dollars Fifteen (15%) percent of the rest, residue and remainder Ten (10%) percent of the rest, residue and remainder Twenty-five (25%) percent of the rest, residue and remainder Two Thousand ($2,OOO.OO) Dollars LAST WILL AND TESTAMENT OF I, LILLIAN M. TEPE, of Lower Allen Township, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars to JOAN SKINNER, of 218 Waverly Way, Clarksburg, West Virginia, provided, however, that should she predecease me, I direct that this bequest be and become a part of my residuary estate to be distributed as set forth hereinbelow. SECOND: I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars to PATRICIA A. TEPE, of 772 E. Joan D-Arc, Phoenix, Arizona, provided, however, that should she predecease me, I direct that this bequest be and become a part of my residuary estate to be distributed as set forth hereinbelow. THIRD: I give and bequeath the sum of Two Thousand and No/100 ($2 000 00) Dollars to my granddaughter, DEBORAH BERRY provided, however, that should she predecease me, i direct that this bequest be and become a part of my residuary estate to be distributed as set forth hereinbelow. FOURTH: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any p~operty over which I hold power of appointment and together with any insurance policies thereon, as follows: (A) Twenty-five (25%) percentlithereof to my son, KURT L. TEPE, provided, however, that should KURT L. TEPE predecease me, then to his issue per stirpes by representation, or should there be a failure of same, then to my surviving children, in equal shares. (B) Twenty-five 25%) percent thereof to my daughter, JEANNE M. GARSKE, provided, however, that should JEANNE M. GARSKE predecease me, then to her issue per stirpes by representation, or should there be a failure of same, then to my surviving children, in equal shares. (C) Twenty-five (25%) percent thereof to my daughter, FLORENCE E. DOTSON, provided, however, that should FLORENCE E. DOTSON predecease me, then to her issue per stirpes by represen- tation, or should there be a failure of same, then to my surviv- ing children, in equal shares. (D) Fifteen percent (15%) percent thereof to my granddaughter, KAREN A. SNIDER, provided, however, that should she predecease me, then to her issue per stirpes by representa- tion, or should there be a failure of same, then to the surviving children of my deceased son, KARL A. TEPE, in equal shares. (E) Ten percent (10%) percent thereof to my grandson, ERIC R. TEPE, provided, however, that should he predecease me, then to his issue per stirpes by representation, or should there be a failure of same, then to the surviving children of my deceased son, KARL A. TEPE, in equal shares. I wish to note that both my late husband, PAUL L. TEPE, and I have provided financial assistance to ERIC R. TEPE. FIFTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. SIXTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SEVENTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. EIGHTH: I nominate and appoint JAMES D. BOGAR, of Shiremanstown, Pennsylvania, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said JAMES D. BOGAR, I nominate and appoint my son, KURT L. TEPE, Executor of this, my Last Will and Testament. I direct that my Executor, and its successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~{~ day of , LILLIAN M. TEPE / (SEAL) 4 Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Lillian M. Tepe also known as , Deceased No. 21-03-0341 Date of Death 04/01/2003 Social Security No. _-LO7-12-1360 James D. Bo~ar, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: James D. Bo~ar Esquire 19475 Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717/737- 8761 Personal Representative JUames D. Bo~ar Signature: Address: Telephone: Dated: One W. Main Street Shiremanstown, PA 17011 717/737-8761 Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value Total: 401,047.50 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) Estate of: Date of Death: County: Lillian M. Tepe 04/01/2003 Cumberland INVENTORY CASH: Country Meadows - Refund-S500.00, accrued interest $97.50 John Hancock Life Insurance Company - Signature Access Account No. 160492907, date of death balance $33,838.33, accrued interest $53.86 Mass Mutual Financial Group Benefit Management Account No. 820077533, date of death balance $22,652.30, accrued interest $4.34 PNC Bank, N.A. Checking Account No. 5140063815, date of death balance $1,524.18, accrued interest $0.00 United States Treasury - 2002 Federal Income Tax Refund USAA - Automobile insurance refund USAA Homeowner's insurance refund Waypoint Bank - Checking Account No. 100290758, date of death balance $433.56, accrued interest $.31 597.50 33,892.19 22,656.64 1,524.18 3,060.81 61.48 87.73 433.87 -1- Waypoint Bank Savings Account No. 500063615, date of death balance $31,919.56, accrued interest $0.00 PERSONAL PROPERTY: Chevrolet, 1982, VIN 2G1AN69H4C1250540 - Sold at private sale Contents of home and personal property sold at public sale STOCKS/LISTED: 1,118.35 shares Fidelity Investments Fidelity Magellan, Account No. 2AS-253685 9,151.108 shares Fidelity Investments Spartan PA Municipal Income, CUSIP 316344209 Fidelity Investments Spartan PA Municipal Income-Unpaid dividends as of date of death 31,919.56 300.00 2,837.00 86,862.24 101,302.77 11.53 94,233.96 3,137.00 REAL ESTATE/PA: Ail that certain piece or parcel of real estate having - erected thereon a dwelling house being known and numbered as 30 Scarsdale Drive, Camp Mill, Pennsylvania. The property was acquired by Paul L. Tepe and Lillian M. Tepe, husband and wife, by Deed dated 115,500.00 188,176.54 -2- October 3, 1967 and recorded October 3, 1967 in the Cumberland County Recorder of Deeds Office, a copy of said Deed being attached hereto and incorporated herein. The said Paul L. Tepe died August 18, 1999, whereupon full and complete title became vested solely in Lillian M. Tepe, the Decedent herein. The above-described real estate was sold pursuant to an Agreement of Sale for Real Estate dated April 28, 2003, a copy of which is attached hereto and incorporated herein. Final settlement took place on May 30, 2003. A copy of the Deed conveying said real estate, along with a copy of the Settlement Sheet, are attached hereto and incorporated herein. The sale price of the real estate was $115,500.00. TOTAL RECEIPTS OF PRINCIPAL ............... 115,500.00 401,047.50 -3- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17116-0601 JAMES D BOGAR ESQ I W MAIN ST SHIREHANSTOWN PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-'~$~i7 EX AFP DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUN'rY ACN 11-10-2005 TEPE Oq-01-ZO03 21 03-03ql CUMBERLAND 101 Amount RemLtted LILLIAN M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP [01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF TEPE LILLIAN MFZLE NO. 21 03-03~1 ACN 101 DATE 11-10-2003 TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORTGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds {Schedule B) (2) :5. Closely Held Stock/Partnership Interest (Schedule C) C3) q. Nortgegas/Notes Receivable (Schedule D) (q) 5. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) ($} 6. JolntZy Owned Property (Schedule F) (6) 7. Transfers (SchaduZe G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Nortgage L1eb/1/ties/Liens (Schedule Z) (10) 11. Tote1 Deduct ions 12. Nat Value of Tax Return 15. 1~. Charitable/Governmental Bequests; Non-elected 911:5 Trus*s (Schedule J) Net Value of Estate Sub~ect to Tax 115/500.00 188/176.5~ .00 .O0 97/370.96 .00 .00 (8) 31,972.19 .00 NOTE: To insure proper cred/t to your account, submit the upper port/on of th~s fore w~th your tax payment. NOTE: ~01,0~7.50 ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 X O0 = .00 (16) $67,075.31 X Oq5: 16,518.39 (].7), .00 x 12 : .00 (~B) Z,O00.O0 x 15 = 300.00 (19)= 16,818.39 ANOUNT PAID 15,6~6.50 $~8.39 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ASSESSMENT OF TAX: 16. Amount of L/ne lfi at Spousal rate 16. Amount of L/ne lq taxable at Lineal~Class A rate 17. Amount of L/ne lfi st Sibl/ng rate 18. Amount of L/ne lq taxable et Collateral/Class B rate 19. Prlnci ~al Tax Due TAX CREDITS PAYMENT RECETpT UT$COUNT DATE NUNBER /NTEREST/PEN PAID (-) 06-2q-2003 CD002727 823.50 09-26-2003 CD003058 .00 16,818.39 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REI~UZRED. ZF TOTAL DUE 1'S REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR TNSTRUCTZONS.) If an assessment Nas issued prev/ously, lines 14, 15 and/or 16, 17, 18 and 19 Nlll reflect figures that include the total of ALL returns assessed to date. (11) :31 .q72.19 (12) 369,075.31 (15) . O0 (~) 369,075.31 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Crass B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). 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 #ILLS, AGENT A refund of a tax credit, which was nat 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 #ills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). 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 must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlOZ1, Harrisburg, PA I71ZB-IOZI, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. lB0601, Harrisburg, PA 17128-0601 Phone (?17) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decadant's death, a five percent (SZ) discount of the tax paid is allowed. The 15Z 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 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 with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rata of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interest Daily Interest Daily Interest Daily Year Rata Factor Rate Factor Year Rate Factor 1982 ZOZ .000548 1983 16Z .000438 1984 I1Z .000301 1985 Z3Z .000356 1986 IOZ .000Z74 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID 1987 9Z .000247 1999 7Z .000192 1988-1991 11Z .000501 2000 8Z .000219 1995-1994 7Z .000192 2002 6Z .000164 1995-1998 9Z .000247 2003 5Z .000157 X NUNBER OF DAYS DELINQUENT 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 data shown on tho Notice, additional interest must bm calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Lillian M. Tepe Date of Death: April 1, 2003 Will No. 21-03-0341 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes xx No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No XX b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes XX No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court Date: 2/20/04 and may b~ttached to this report. Si~natur~ James D.~ar, Esquire (MAH:rmf/AM3) Name (Please type or print) One West Main St. Shiremanstown, PA 17011 Address (717) 737-8761 Tel. No. Capacity: X __Personal Representative __Counsel for personal representative