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HomeMy WebLinkAbout03-0360 Register of Wills of Cumberland PETITION FOR GRANT OF Estate of Winifred D. Adams also known as , Deceased Janice E. Adams County, Pennsylvania LETTERS No. Social Security No. 172 - 01- 8901 Petitioner(s), who is/are 18 years of age or older, apply(ies)for: /COMPLETE 'A' or 'B' BELOW:) [] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix named in the iast Will of the Decedent, dated 09/17/198~and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not merry, 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: B. Grant of Letters of Administration (c.ta.; d.b.n.c.ta; 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 Janice E. Adams R. Bradford Adams NY Daughter Son (COMPLy- I1: IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland 5 Center Drive, Camp Hill, PA 802 John Glenn Blvd., Webster, County, Pennsylvania with his/her last family or principal residence at 5 Center Drive, Lower Decedent, then 87 years of age, died 04/09/2003 Allen Twp. (liststreet, number, and municipalS) at Beverly Healthcare, 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) $ 30,000.00 $ $ $ 125,000.00 situated as follows: 5 Center Drive, Camp Hill, PA 17011, and vacant ground in Clinton Co. 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 undersi~lned: Signature Typed or printed name and residence Janice E. Adams ' --~~'.__%_~_~'_L~_"_,~_~_.~ 5 Center Drive, Camp Hill, PA 17011 Prepared by the Pennsylvania Bar Association Copyright (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 ~' r-n.X.,~)) %, O~/~ ~.,~'"' ~r{ice E. Adams before me this 24tl"day of APRIL 2003 .o. ,2 I- o3-3 o Estate of Winifred D. Adams Social Security No: 172- 01- 8901 AND NOW, APRIL 24, 2003 Date of Death: 04/09/2003 Deceased , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [-~ Testamentary E~] Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Janice E. Adams in the above estate and that the instrument(s) dated 09/17/1987 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ 235.0g 18.00 L Re'lister ~ ~l{Is 0 ' I (~ Renunciation ........ $ Affidavits ( ) .... $ Attorney: Michael L. Bangs I.D. No: 41263 Extra Pages ( ) .... $ 3.00 · Address:, Codicil ........... $ 302 South 18th Street Camp Hill, PA 17011 JCP Fee .......... $ lO. gO Telephone: 717/730-7310 Inventory .......... $ Other ........... $ TOTAL ......... $ 266.00 FILED 4-24-3003 PreparedbythePennsylvanlaaarAssoclation Copyright(c) 1996 form software only CPSysterns, lnc. mailed to atty 4-24-2003 FormRW-l(19cj1) Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Winifred D. Adams also known as , Deceased R. Bradford Adams Petitioner(s), who is/are 18 years of age or older, apply(les) for: Social Security No. 172 - 01 - 8901 (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 09/17/198 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: ~'~ B. Grant of Letters of Administration c. t. a. (c.t.a.; 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: I Name Relationship Residence Janice E. Adams rlsD2~$hter R. Bradford Adams (COMPLE I1: IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland 5 Center Drive, Camp Hill, PA 802 John Glenn Blvd., Webster, NY County, Pennsylvania with his/her last family or principal residence at 5 Center Drive, Lower Allen Twp. Decedent, then 87 years of age, died 04/09/2003 (list street, number, and municipality) at Beverly Healthcare, 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) 30,000.00 125,000.00 situated as follows: 5 Center Drive, Camp Hill, PA 17011 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: I Signature Typed or printed name and residence ~ ~ ~ R. Bradford Adams ~' 802 John Glenn Blvd., Webster, NY 14580 Prepared by the Pennsylvania Bar Association Copyright (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 before me this_~..~_day of ~(L(" l~f ,~- For the Regitter ~I Estate of Winifred D. Adams Deceased Social Security No: 172 -01- 8901 Date of Death: 04/09/2003 AND NOW, ~t ~ ~J~ , 200..~ , 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.t.a. (c.t.a.; d.b.n,c,ta.; pendente lite; durante absentia; durante minoritate) are hereby granted to R. Bradford Adams in the above estate and that the instrument(s) dated 09/17/1987 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ / 3' DO Renunciation ........ Affidavits ( ) .... $ Extra Pages ( ) .... Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ ~, - Register oftvVi~ls (~J I (./ Attorney: Hichael L. Ban~;s I.D. No: 41263 Address: 302 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 Prepared by the Pennsylvania Bar Association C~opyright (c) 1996 form software only CPSystems, blc. Form RW-1(1991) REGISTER OF WILLS OF ~. COUNTY OATH O UBSCRIBING ESS _ ~.,,. RIBING WXI'T'~ (each) a subscribing witness to the ~ presented herewith,'~ch) being duly qualified accbr~ing to law, depose(~a~ay(s) that %~ ~':'x present anew t~he testat , sign~,h~e~.same and that ~,~,..~ ~'~.signed as a witness at the req~of testat__ in h~,., presence and (in th~.~resence of each other~n the presence oi ~ other sut~ng witness(es)). '~,~ "'~'~'~ Sworn to or af~ed and subscribed before ~..~ .xl~this 'x~, daY%l~ '~,~, (Name) (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS ~1- 07,-,~o MICHAEL L BANGS AND JANICE E ADAMS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that THEY ARE familiar with the signature of WINIFRED D ADAMS codicil testat RIX of (one of the subscribing witnesses to) the ~presented herewith and codicil that THFY DO believe}{ the signature on the will is in the handwriting of WINIFRED D ADAMS to the best of THFTR Sworn to or affirmed and subscribed before me this 24th day of APRIL ~.~ O~~ ~Register knowledge and belief. /Q [A_ddr~ss) I~ (Name~ (Address) his is to certify that the information here given is correctly copied from an original certificate of death dui), filed with me as Local 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 No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ........... .~s,.~ I ~[~.~ EVE.,. I ' OEC~.rS ~n~ ' i ~ T~t-*~ ~ I,O. ~te his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office fbr permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9096130 No. Local Registrar Date , 144 Rev. 1/91 Janice ~±erk 5 Center Drive Ca~p Hill, Pa 17011 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) STATE FILE NUMBER SEX IAL SECURITY N O MBE---'~'~'"-'~ E Adams ~Fema~ ~ TDATE OF DEATH (Booth, Oag Year) ..................... ~= ~.194-36-4688 I,. May 3, 2003 la~k, White. elc DECEDENT'S 15. ACTUAL 1 ?a. Slate__ ~)a RESIDENCE Did ~7C.~ Ye., deoedoot".d i, Lower Allen ~, Last) Ross Bo Adar~ R. BradfozQ Adams Burial[~ Cr~tmn~ Re~valfmmStale~ physician is no~ av&iJab~e at time of death to ceftin cause of death. . date and place stated. decedent live in · ~ township? 17d.[~ No. decedent lived MOTHER'S NAME {F,sI~. Maiden Surname) Winifred 802 John Glenn Blvd Webster New York 14580 East Harrisburg Harrisburg, Pa 19( PERFORMED? O OF DEATH? Natural [] Homicide Yes ~ No [] Yes [] No [~ Acciden,[] ...... g ...... ig ..... May 4, 2'003 dying, such as cardiac :Month, Oay, Year) · CERTIFYING PHYSICIAN (Phys*man cmtiyng cause o{ death when another phyS~Cia n has pronounced dee h a ~d comp~eled lien] 23) TO the b~lt of my k~owledge, death OCCUmKI due 10 the CIUl4~I) e~d manner al stated ..................................................... (item 27) Type or Print No[] Coroner May 6, 2003 Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050 LAW OFFICES 317' THI~ ~T~EET NEW CUMBERLAND, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF WINIFRED D. ADAMS I, WINIFRED D. ADAMS, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding ldo hereby make, publish and declare this as and for my Last Will iand Testament hereby revoking and making void any and all other · ~wills by me at any time heretofore made. r~ I direct that my Executrix hereinafter named shall pay all ~my just debts and funeral expenses as soon as conveniently may be ~done after my decease. r~ II. I hereby give devise and bequeath unto my son, R. BRADFORD ~ADAMS, my lot of land containing fifty (50) acres, more or less, ~in Bald Eagle Township, Clinton County, Pennsylvania, and also my ~lot of ground in Sunset Pines, Lock Haven, Clinton County, oPennsylvan~_a. III. All the rest residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my daughter, JANICE E. ADAMS, or if she does not survive me, then unto my son, R. BRADFORD ADAMS. IV. I hereby nominate, constitute and appoint my daughter, JANICE E. ADAMS, as Executrix of this, my Last Will and Testament. Page one of two Pages If the said Janice E. Adams should predecease me, fail to qualify 'or cease to act as such, then I nominate, constitute and appoint iim R. BRADFORD ADAMS, as Executor. ~i Y son, I V. ~ No fiduciary acting under this Will shall be required to ~'post bond in this jurisdiction or in any jurisdiction in which ihe may act. IN WITNESS WHEREOF, I, WINIFRED D. ADAMS, the Testatrix, ~have unto this, my Last Will and Testament, set my hand and seal ~this ~°7 I~ day of September, A. D., 1987. Z © ~ D. AD, ~ SIGNED, SEALED, PUBLISHED and DECLARED by WINIFRED ~the above-named Testatrix, as and for her Last Will and Testame in the presence of us who have hereunto subscribed our names as ~witnesses at her request, in the presence of the said Testatrix iiand in the presence of each other. Page two o~w~ Pages 0 WINIFRED D. ADAMS LAW OFFICES 31~7 THIRD STREET NEW CUMBERLAND, PENNSYLVANIA 17070 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: To the Register: Winifred D. Adams April 9, 2003 2003-00360 Admin. No: I certify that notice of beneficial interest (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 28, 2003: NAME Janice E. Adams R. Bradford Adams ADDRESS 5 Center Drive, Camp Hill, Pennsylvania, 17011 802 John Glenn Blvd., Webster, NY 14580 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Date: April 28, 2003 Capacity: Signature~(_? Michael L. Bangs, Attorney-at-Law 302 South 18th Street Camp Hill, PA 17011 (717) 730-7310 Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE Whether you will receive any money or property will be determined wholly or p~rtl~ by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE PENNSYLVANIA In re: Estate of WINIFRED D. ADAMS, deceased, Estate No. 2003-00360 TO: JANICE E. ADAMS 5 Center Drive Camp Hill, PA 17011 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The Decedent, Winifred D. Adams, died on the 9th day of April, 2003, at Cumberland County, Pennsylvania. The Decedent died testate (with a Will); or The decedent died intestate (without a Will). The personal representative of the Decedent is (name, address and telephone number). Janice E. Adams, 5 Center Drive, Camp Hill, Pennsylvania, 17011 If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa., 17013. Phone No. 717-240-6345. If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa., 17043. Phone No. 717-249-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: April 28, 2003 Capacity: Signature~P~]~ ./~~ / Michael L. Bangs, Attorney-at-Law 302 South 18th Street Camp Hill, PA 17011 (717) 730-7310 Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE~- Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. rl_.E BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE PENNSYLVANIA In re: Estate of WINIFRED D. ADAMS, deceased, Estate No. 2003-00360 TO: R. BRADFORD ADAMS 802 John Glenn Blvd. Webster, NY 14580 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The Decedent, Winifred D. Adams, died on the 9th day of April, 2003, at Cumberland County, Pennsylvania. The Decedent died testate (with a Will); or The decedent died intestate (without a Will). The personal representative of the Decedent is (name, address and telephone number). Janice E. Adams, 5 Center Drive, Camp Hill, Pennsylvania, 17011 If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa., 17013. Phone No. 717-240-6345. If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa., 17043. Phone No. 717-249-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: April 28, 2003 S ignatu ref,,~/~,~~ .~~ ~_~ Michael L. Bangs, Attorney-at-Law 302 South 18th Street Camp Hill, PA 17011 (717) 730-7310 Capacity: 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(I 1-96) CD 003239 BANGS MICHAEL L ESQUIRE 302 S 18TH STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 172-01-8901 FILE NUMBER: 2103-0360 DECEDENT NAME: ADAMS WINIFRED D DATE OF PAYMENT: 11/1 7/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 04/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,241.55 TOTAL AMOUNT PAID: $13,241.55 REMARKS: MICHAEL L BANGS ESQUIRE NO POST-MARK DATE SEAL CHECK#518 INITIALS' VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) E D E N T CAPB HpRL EpIO CRAC TK KOEs Co" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 C 0 M T I O REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Adams Winifred D. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 04/09/2003 I 01/30/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21-03-0360 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 172-01-8901 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER  1. Original Return ~ 247! Supplemental Return 4. Limited Estate . Future lnterest Compromise (date of death after 1Z-17-82) 6. Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) [] 9. Litigation Proceeds Received I 110. Spousal Poverty Credit (date of death between 12 - 31 - 91 and 1 - 1-95) (date of death 3, Remainder Return priorto 1Z-13-8Z) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Michael L. Ban~s FI RM NAME (If Applicable) TELEPHONE NUMBER 717/730- 7310 COMPLETE MAILING ADDRESS 302 South 18th Street Camp Hill, 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) [~ 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. 127,648.30 None None None 182,830.70 None None 14,326.74 1,895.70 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 (6) 310,479.00 (11) (12) (13) (14) 16,222.44 294,256.56 294,256.56 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 19. Tax Due 294,256.56 X .0 0 X .0 45 X .12 X .15 (15) (16) (17) (18) ('19) 0.00 13,241.55 0.00 0.00 13,241.55 Copyright (c) ZO00 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 5 Center Drive CITY STATE Camp Hill PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0.00 S. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) ZIP 17011 13,241.55 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. (Si) 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. retaintheuseorincomeofthepropertytransferred; ......................... ~ ~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [~ [---'] 3, Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. ~] ~] 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property a beneficiary designation? ................................ ~ ~] which contains IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 0.00 13,241.55 0.00 13,241.55 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 afl information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN R. Bradford Adams DATE ~) /~ ! ~ , ,,'h_ 802 John Glenn Blvd / k K. -- ............................ SIGNATUREOFPREPA~ROTHERTHA~PRESENTATIVE Michael L Ban[s /~' ~ ' / '~~ 302 South 18th Street f t/./ ......................... For dates of death on or ~r July 1, 1994 and before Janua~ 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 Janua~ 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 statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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. 9~ 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 ¢) 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 Winifred D. Adams SS# 172-01-8901 SCHEDULE A REAL ESTATE 04/09/2003 FILENUMBER 21-03-0360 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 ri~]ht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Real Estate Located in Park Terrace, Lock Haven, PA - (See appraisal attached) Real Estate Located at 5 Center Drive, Lower Allen Twp. 10/2/03 (See attached settlement sheet) Sold on VALUE AT DATE Of DEATH 3,500.00 TOTAL (Also enter on line 1, Recapitulation) 124,148.30 $ 127,648.30 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc, Form REV- 1502 EX (Rev. 1-97) a. B. TYPE OF LOAN: UM~ U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT l'~r]FHA 2.1-']fmHA 3. L-~CONV. UN1NS. 4.[~VA 5.[~CONV. INS 6. FILE NUMBEH: I 7. LOAN NUMBF_.H: SETTLEMENT STATEMENT 03748 PP2307SC 8, MORTGAGE INS CASE NUMBER: C. NOTE; This form is furnished to give you a statement of actual settlement costs. Amounts paid fo and by the settlement agent are shown. Items marked '[POC]" were paid outside the c/osing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Steven Vogelsong and Es[ate of Winifred O. Adams Washington Savings Bank Mortice Voge[song 4201 Mitchellville Road G. PROPERTY LOCATION: H, SETTLEMENT AGENT: 25-1878915 Bowie, MD 20716 5 Center Drive I. SE'I-TLEMENT DATEi Camp Hill, PA 17011 Keystone Land Transfer, Ltd. Cumberland County, Pennsylvania PLACE OF SETTLEMENT October 2, 2003 3421 Mad(el Street Camp Hill, PA 17011 , . on ac aes rice ~ ~nce /us men s or ems al y e er ~n a vance ~ ~ axes T~ . ewer res o '~ . ewer res o -- 412. 120. GROSS AMOUNT DUE FROM BORROWER 143,053.06 420. GROSS AMOUNT DUE TO SELLER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER: i 137,075.93 201. Deposit or earnest money 2,000.00 ~01. Excess Deposit (See Instructions) '202, Principal Amount of New Loan(s) 134,750.00 ~02. SetUement Charges to Seller (Line 1400) 10,927.63 203. Exisling loan(s) [aken subjecl to 503. Existing loan(s) taken subject to 204. 205. 504. Payoff of first Mortgage 206. '50~. ~ayo. or second Mortgage 207. 506. 208. 507. (Deposil dish. as proceeds) 506. 209. Closing costs from seller 2,000.00 509. Closing costs from seller 2,00Q00 A(ljustments For Items Unpaid By Seller A(ljustments For Items Unpaid By Seller 210. Gib/Frown Taxes to 510. CityFrown Taxes to 211. County faxes to 5'1'~. County Taxes to 212. School Tax to 5i2. SchOol Tax 213. to 214. 513. 215. 514. 218. 517. 519, 220, TOTAL PAID BY/FOR BORROWER 138,750.00 520. TOTAL REDUCTION AMOUNT DUE SELLER ' 12,92763 300. GASH AT SE I rLEMENT FROMFrO BORROWER; 600. CA,~H AT ~E I [LEMENT [O/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) I 143,053.06 601. Gross Amount Due To Seller (Line 420) 137,075.93 302. Less Amount Paid By/For Borrower (Line 220) ( 138,750.00 602. Less Reductions Due Seller (Line 520) ( 12,927.63; 303. CASH ( X FROM) ( TO) BORROWER 4,303.06 803. CASH ( X TO) ( FROM) SELLER The undersigned hereby ackno_wledge receipt~d~'aa completed coov of n;an~ l,t';, ~f ml..~, ............. I 124,148.30 Borrower Mdr~c~Vo~elsong v~ - ~ ent & any attachments referred to herein. Estate o~fhifred D. Adams L, SETTLEMENT CHARGES 7 . ese on rice $ ~ ~ 8,034.00 iVl$1On o omml$$1on Ine as ow$: · , ~:' e ax ea sSocla es, nc. 8 . A N NN I WIT L A SELLER'S FUNDS AT SETTLEMENT ~ o oppen aver ppr. · en ers nspec~on ee o gage ns. pp. ee ~" ssump ~on ee · omml men ee o as lng on avlngs an . ma nspeclon 901. Interest From 10/02/03 to 11/01/03 @ $ 23.54000~s · 0 gage nsufance remlumor mon s 0 e Sg r ev. . azar nsurance remIum or . years o es le nsurance o. %) o gage nsurance · ggrega e lus men 11 . 1101. Settlemenl or Closing Fee srac or I e earc · Title Examination · I e nsurance In er . ocumen repara ion InC u es e ove i em r)um ers: · monts - .per mont mon s ~:)er mon m o n---'~E~'~*~ per ~ m o n---'~'l~"--'~r-~ per-.~----~*,*,*,*~ mon per ~ ~ per ~ to ~6 -[o o eye one an rahs er, . o eye on a r n r, . o y , . ey ra r, . o eye one r r, . o eysone an rahs er, . 1201. Recording Fees: ~ 38.50; Mort~ . ~y ou y ax amps: ee ~ . a e ax amps: evenue amps ~ge Releases '~' 7-' 13 . I 1301· Survey Cedified to be a true copy. Keystone Land Transfer, Lid. Settlement Agent ( 03748/03748 / 2t ) Estate of W~nifTed Adams L O C A T I O N : Park Terrace Lock Haven PA 17745 CLIENT : Mkheal Bangs 302 Sou~ 18~h Street, Camp Hill, PA 17011 AS OF DATE :A~9,2003 APPRAISER : Nancy $. Renninger RENNINGER APPRAISAL SERV1CES  r Estete of Winifred Adams A__dc?ess Park T~ Fi~ ~ 030707AD H~en ~.~c~ ~ C~n~_ C~nton S~te PA ~ C~e 177~ APP~ISAL AND REPORT IDENTIFICATION ~i~l ~f~ ~ ~e ~ ~e f~l~ng defin~: Com~ ~1 Lim~ value, performed without invoking the Departure Rule) (The act o~ process of estimabng value, or an estim~Cdon of value, performed under and resuffing frorn invoking the Departure Rule.) This Report is one of the follOV~ng types: ~Self Contained (A written report prepared under Standarde Rule 2-2(a) of a Complete or limited appraisal perforn~ under STANDARD 1 ) ~:~ Summary (A written raport prepared under Standards Rule 2-2(b) of a Complete or lim~t~)d appraisal performed under STANDARD I ) [~ Rsatncted (A written report prepared under Standards Rule 2-2(c) of a complete or limited appraisal performed under STANDARD 1 for client use only.) Comments on Standards Rule 2-3 certify that, to the best of my know~edge and belief: · The statements of fact co~3ir~d in this report are tn.m and correct. · The reported analTsa~, opinior~ and conclusions am limited only by the repoded asaump'dons and limiting cond~ons, and are my personal, imperfial and profe~l enaly~es, opinions and oonciumoos. · I here no present or prce~ interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. · I have no bias wflh respect to the property that is the subject of this report or the parties involved wfth th~s assignment · My engagement in this es--~gnrnent w'as not contingent upon developing or reporting predetermined resutts * My Comper~ation for completing this assignment is not cor~ngent upon the development or repot'ring of a predetermined value or direct)on in value that favors ~ cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurence of a sul~mquent event directly retatecl to the intended u~e of this appraisal. · My analyses, opinions end conclusions w~re developed and this report has been prepered, in conform~ wfth the Unrform Standards of Professional Appraisal Prac'dce. · I [~hava [] have not made e pemonal inepec'don of the property that is the subject of th~s reporL Comments on Appraisal and Report Identification Note any departures from Standards Rule~ 1-2, 1-3, 1-4, plu~ any USPAP-re~r~:I issues redu~dng disclosure: Expiration Date of Cerfirma'don or License: SUPERVISORY APPRAISER (only if required): Signature: Neme: Date Signed: State Ce~ficatJon #: or State Lloense #: State: [] ~ [] Did Not Ir~pect Property RENNINGER APPRAISAL SERVICES Mi(heal Bangs 302 South 18th Street, Camp Hill, PA 17011 In accordance with your request, I have personally inspected and appraised the property located at: Park Terrace Loc~ Haven PA 17745 The purpose of the appraisal was to estimate the market value of the property, as improved, in unencumbered fee simple title of ownership. It is my opinion that the estimated market value of the property as of Aaa 9. 2003 is $ 3,soo Respectfully submitted, Nancy S. Renninge, RENNINGER APPR.,MSAL SERVICES ~Actt.~lP..calF~st~T~xes$ ~ 138 ~) Loe~cha~=tobcpmdby~llcr ~~ ~ ~ ~2~ ~PA 17011 ~~70Xl~Xl~ El ~c___~ ~) I O~ ~ ~l~ ~ ~i~ ~ ~t ~ of~ ~ s~jj ~ ~ to ~_. ~__- CO~ NO, I CO~LE NO 3 ~' ~ ~ T~ L~ 1,8 ~ S 2.0 MI E~ ~ 0.60 MI NE Loc~ Haven 01-07.~2 8/20/02 114)1431-- 4 amll,Ii'lfmr~ 3 acr~nilar 001 : Sal~ ~ FmancU~ __ The ~ed for m oasita~Ftem, 220 Con'~mtsmdCor~mx~orApp~se ~ ~pmisal is "as is*. O~site~e~ers,f,ste~..mxlv~erwoLCdhaveap~e~~value F.~I P,~oaci~,,uon The final ~lue es~rn~e J:~edudes ur~r~:ffosed ~$ (-.::h as eesen,,ea~, pr~n~e ~ w~al~cls, interest or encroachments b~a¢ m~ i_~o~on_~ or t~e re~x~ts -' ~ Physically Inspo~ ~r RENNINGER APPRAISAL SERVICES ~R~new ~ (I1' D~t~ ~ Sian~a. File # 030707AD DEFI]~ITION OF MARKET VALUE: The most probable price which a property should bring m a competitive and open market under all conditions requisite to a fair sale, the buyer and sailer, each acting prudently, knowledgeably and assttming the price ~s not affected by undo stunulus. Implicit in this definition is the consumation ora sale as ofs specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his own best interest; (3) a reasonable Qme is allowed For exposure m the open market; (4) payment is made in terms of cash in U.$. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated wRh the sale. * Adjustments to the comparables must be made for special or ereal~ve financing or sales concessions. · ' ' No adjustments are necessary for those costs which are normally paid by sailors as a result of tradition or law in the market area; these costs are readily identifiable since the seller pays these cos~ in virtually all sales transactions. Special or creative £mancing adjustments can be made to the comparable property by comparisons to £mancing terms offered by a third party institutional lender that is not already involved in the propert~ or transaction. Any adjustment should not be calculated on a mechanical dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgement. STATEMENT OF LIMITING CONDITIONS AN1) APPRAISER'S CERTIFICATION CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to the following conditions: 1. The appraiser will not be responsible for mailers of legal nature that affect either the property being appraised or the title to ~t The appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title The properW is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size. 3. Tt~e appraiser has exarmned the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in the appraisal rep~ whether the subject site is located in an identified Special Hood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantee, express or implied, regarding the determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand. 5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at then- contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used. 6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of hazardoas wasles, toxic substances, ere.) observed during the inspe~on of the subject property or that he or she became aware of dunng the normal research involved in performing the appraisal. Unless othervnso stated in the appraisal report, the appraiser has no knowledge of any hidden or ~t conditions of the property or adverse environmental conditions (including the presense of hazardons waste, toxic subslances, etc.) that would make the property more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions that do exist or for any engineenng or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the · ' epprmsal report must not be considered as an environmental assessment of the property 7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to he true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnished by other parties. 8. The appraiser will not disclose the contents of the apprmsal report except as provided for in the Uniform Standards of Professional Appraisal Practice. 9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactor~ completion, repairs, or alterations on the assumption that completion of the improvements will be performed in s workmanlike 10. The appraiser must provide his or her Prior written consent before the lander/client specified in the appraisal report can distribute the appraisal report (inclx~l.ing conclusions about the property value, the appraiser's identity and professional designations, and references to any professional appraisal orga.mzations or the firm with which the appraiser is associated) to anyone other than the borrower, the mortgagee or its successors and assigns: the mortgage insurer, consultants; professional appraisal orgamzations; any state or federally approved financial institution; or any department agency, or instrumentality of the United States or any state or the District of Columbia; except that the lender/ctient may distribute the property description section of the report only to data collection or reporting set-ce(s) without having to obtain the appraiser's prior written consent The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media. RENNINGER APPRAJSAL SERVICES File #: 030707AD APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: I. I have researched the subject market area and have selected a minimum of three recent sales of properties most similar and proximate to the subject property for consideration in the sales comparison analysis and have made a dollar adjustment when appropriate to reflect the market reaction to those items of signifieant variation. Ifa sigmfieant item in a comparable property. is suPerior to, or more favorable than, the subject property, I have made a negative adjustment to reduce the adjusted sales price of the comparable and, ifa significant item in a comparable property is inferior to, or less favorable than, the subject propertT, I have made a positive adjustment to increase the adjusted sales price of the comparable. 2. I have taken into consideration the factors that have an impact on value in my development of the estimate of ma.rket value in the appraisal report. I have not knowingly witheld any sigmfieant information from the appraisal report and I believe, to the best of my knowledge, that ail statements and information in the aPprmsal report are true and correct. 3. I stated in the appraisal report only my personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the contingent and limiting conditions specified in this form. 4. I have no present or prospective interest in the property that is the subject o£ this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familiai status, or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the vicinity of the subject property~ 5. I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my' compensation for performing this appraisal is contingent on the appraised value of the property. 6. I was not required to report a predetermined value or direction in value that favors the cause of the client or any related party, the amount of the value estimate, the attainment ora specific result, or the occurence ora subsequent event in order to re,!ye my compensation and/or employment for performing the appraisal. I did not base the appraisal report on a requested rmmmum vaiuation, a specific vaiuation, or the need to approve a specific mortgage loan. 7. I performed this appraisal in confermaty with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal S~adsrds Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal, with the exception of the departure provision of those Standards, ~'tich does not apply. I acknowIedge that an esttmate ora reasonable time for exposure in the open market is a condition in the defm.ition of market vaiue and the estimate I developed is consistent with the marketing time noted in the neighborhood section of this report, unless I have otherwise stated in the reconciliation section. 8. I have personally ~ the interior and exterior areag of the rabject property and the exterior of all properties listed as comparables in the appraisal report. I further certify that I have noted any apparent or known adverse conditions in the subject improvements, on the subject site, or on any site within the immediate vicinity of the subject property of which I am aware and have made adjustments for these adverse conditions in my analysis of the property value to the extent that I had market evidence to support them. I have also commented about the effect of the adverse conditions on the nmrketability of the subject property. 9. I personally prepared aL1 conclusions and opinions about the real estate that were set forth in the appraisal report. If I relied on sigmfieant professional assistance fi'om any individual or individual(s) in the performance of the appraisal or the preparation of the appraisal report, I have named such individual(s) and disclosed the specific tasks performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is qualified to perform the tasks I have not authorized anyone to make change to any item in the report; therefore, if an unauthorized change is made to the appraisal report, I will take no responsibility for it. SUPERVISORY APPRA/SER'S CERTIFICATION: Ifa super~qsory appnaiser signed the appraisal report, he or she certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with the statements · . and conclusmns of the apl:~user, a~ee to be bound by the apprmsefs certifications numbered 4 through 7 above, and am taking full responsibility for the appraisal and the appraisal report, ADDRESS OF PROPERTY APPRAISED: Par~ T~r~c~ Loc~ Hsvan APPRAISER: Date Signed: A__ugust 26, 20~ State Certification #: GA-0~1063L PA or State License #: Expiration Date of Certification or License: PA 17745 SUPERVISORY APPRAISER (only if required): Signature: Name: Date Signed: State Certification #: or State License #: Diration Date of Certification or License: id [] Did Not inspect property [. Freddie Mac Form 439 6-93 Page 2 of 2 Fanme Mae Form 10(MB 6-93 RENNINGER APPRAISAL SERVICES REV- 1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Winifred D. Adams SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SS# 172-01-8901 04/09/2003 FILENUMBER 21-03-0360 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 DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Miscellaneous Cash on Hand Allfirst Bank - Certificate of Deposit 80000002027279 Allfirst Bank - Passbook Savings #87004913742604 Beverly Enterprises Refund of last payment Commerce Bank - Checking Account #0512035940 Commerce Bank - Savings Account 0430049590 Community Banks Certificate of Deposit 4800726130 Community Banks Certificate of Deposit 4800726131 Highmark Blue Shield - Unearned Insurance Premium PA State Bank Final interest on account PA State Bank - Certificate of Deposit AT&T Refund Verizon Refund Waypoint Bank - Passbook Savings Account #400063478 Waypoint Bank - Certificate of Deposit #8000049868 Proceeds of sale of personal property at auction TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 3,432.36 20,331.71 4,602.09 525.00 3,710.78 3,811.92 20,207.18 50,462.35 167.16 56.82 30,000.00 28.50 13.97 25,290.42 19,220.19 970.25 $ 182,830.70 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) CO~S~(;NOi~ / EST^Ti Ol~:/,,~ / AUCTION LOCATION: I'EIL$ONAL i~ltO I'I,~I~,'I'Y: ILEAL ESTATE: , !,71% 66 '-J" % AUCTION COMMISSION: SU II-TOTAL: $ ALICTION COMR-IISSIN AND EXI'ENSES DUE: TOTAL: TOTAL I)LIE CONSIGNOR / ESTATE: TOTAL: CI I ECl( It ItEM ITl'El) ~ ,?'?a, We al)l)rcciatc your confidence and your busincss, please call on us if we can be offurt service no.w or in thc future. allfirst' A Division of M&T Bank ,,\]]f'ir~t t"inanciaJ Center N.,\. iZO P)<)x cmo May 8, 2003 Michael L. Bangs Attorney At Law 302 South 18th Street Camp Hill, PA 17011 Estate of Winifred D. Adams Date of Death: April 9, 2003 Social Security Number: 172-01-8901 Dear Mr. Bangs: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Savings Account Account Number. ...................... 87004913742604 Ownership (Names o79 .............. Winifred D. Adams Opening Date ........................... 04/29/82 Year to Date Interest ................. $0.00 Balance on Date of Deatlz ......... $4,594.56 Accrued Interest $ 7.53 Total ....................................... $4,602.09 Account 72Jpe ........................... CertLficate of Deposit Account Number. ...................... 80000002027279 Ownership (Names o79 .............. Winifred D. Adams Opening Date ........................... 06/03/99 Year to Date Interest ................. $61.74 Balance on Date of Deattz ......... $20,331.71 Accrued Interest $ 23.28 Total ....................................... $20,354.99 · Page 2 May 8, 2003 Account Djpe ........................... Safe Deposit Box Account Number. ...................... 1000469100021401 Ownership (Names of) .............. Winifred D. Ada_ms Opemng Date ........................... 01 / 13 / 99 This letter does not include any accounts in which the deceased may have been listed as power of attorney, custodian of uniform transfers, representative payee, or trustee under a written trust agreement. For any additional information on these accounts, please contact our branch at: 1200 Market Street Lemoyne, PA 17043 Phone: (717) 255-2271 Sincerely, Charlene Warrington, Associate I (302) 934-2722 April29, 2003 Banks M/c_.2,u::,..e~ L. Bangs ATTORNEY AT LAW 302 So,th18~ Str~t Ca~p HR PA 17011 RE: E~tate of W~f~l D. A~S Ce~~ #4800726130 wasope~d lO/29/02 ~d ~es10/26/03. T~e c~r r e~t v ~g~e °f t~ ~rilate is $ 2 0 ,2 0 7 .18 . C er~f~te # 4 8 0 0 7 2 6131 was ope~IZ 1/15/02 ~d m~t~ 1 I/I 5/03. T~e c~re~t v~i~e of ~ cer~icate iS$50,462.35. I f you ~ave a~y ~ q ~s~ p ~ ~ fr~e to co~t~t ~e at (71 7)909- I590. Sa~a L. H~w~v~ C usto~e~ So~ce R~pre~e~t~e P.O, Box 350 Millersburg, PA 17061 Phone 1-800-331-8362 LOOK FOR US. WE'LL GET YOU THERE. 05/06/2003 MICH. MEL BANGS 302 S 18TH ST CAMP HILL PA 17011 The information which you requested on the account(s) of WINIFRED ADAMS (Social Security Number 172-01-8901 ) is/are as follows: Account Number 400063478 8000049868 Class of Account SAVINGS CERTIFICATE Date Opened 07/08/75 10/15/99 Principal Balance 25287.65 19213.70 Accrued Interest 2.77 6.49 Balance at Date of 25290.42 19220.19 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established SOLE Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested S~erely; ~ SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG, PENNSYLVANIA 1710S-1711 Toll FrEe 1-866-WAYPOINT (I-866.9139.7646) . IN YORK AREA 717/815-4500 · www. wagpointbank.com 0 C Z Z 0 Qom Z 0 Z 0 Z 0 Z 0 Z 0 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Winifred D. Adams SS# SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 172-01-8901 Debts of decedent must be reported on Schedule I. ITEM NUMBER Ao 1 2 3 04/09/2003 DESCRIPTION Zip FUNERAL EXPENSES: Cingrich Memorials Headstone lettering Lynn Wildon Services at funeral Myers Harner Funeral Home, Inc. Funeral Services 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 Year(s) Commission Paid: Attorney's Fees Michael L. Bangs Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal - Advertising Fee Cumberland Valley Land Transfer - Dumpster Rental Expense - Expense - Expense L.G. Connor Real Estate Appraisers Property Total of Continuation Schedule(s) FILE NUMBER 21-03-0360 AMOUNT 745.00 130.00 2,075.00 8,000.00 1 2 3 4 5 6 Zip 306.00 Chase Pitkin Home & Garden (kitchen paint) C. Frank & Sons (HVAC repairs at house) Repairs to real estate prior to settlement Lower Allen Township TOTAL (Also enter on line 9, Recapitulation) 75.00 262.60 23.13 98.00 2,000.00 275.00 337.01 $ 14,326.74 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-I$11 EX (Rev. 1-97) Estate of: Winifred D. Adams Soc Sec #: 172-01-8901 Date of Death: 04/09/2003 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount 7 Lugg & Lugg 8 Renninger Appraisers Lock Haven, PA, property 9 The Sentinel Legal Advertising 50.00 185.00 102.01 337.01 REV-151;) EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Winifred D. Adams SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 172-01-8901 04/09/2003 FILENUMBER 21-03-0360 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 DESCRIPTION Susquehanna Oil Expense - PA Water Co. (various dates) Expense - Citi Platinum Select Credit Card Expense - Connor Rich Associates Expense PP&L Electric (various bills) Expense Verizon (various) Expense - AT&T Consumer Lease Services Expense - Comcast Cable Expense - Jack Yinger (lawn care; various) Expense - Lower Allen Township (sewer and refuse) Expense - Merry Maids Travelers Indemnity - 1 month of homeowners insurance TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. AMOUNT 114.56 134.97 51.58 100.00 192.01 73.96 31.50 29.36 465.00 73.35 556.50 72.91 1,895.70 Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Winifred D. Adams SS~/ 172-01-8901 SCHEDULE J BENEFICIARIES 04/09/2003 NUMBER II. NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.Z)] Janice E. Adams 5 Center Drive Camp Hill, PA 17011 R. Bradford Adams 802 John Glenn Blvd. Webster, NY 14580 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter S on FILE NUMBER 21-03-0360 AMOUNT OR SHARE OF ESTATE Remainder of Estate Vacant Land in Lock Haven, PA 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 (If more space is needed, insert additional sheets of the same size) $ 0.00 Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) LA~' OFFICES 317 THIRD STREET NEW CUMBER~ND, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF WINIFRED D. ADAMS I, WINIFRED D. ADAMS, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other ~wills by me at any time heretofore made. I. I direct that my Executrix hereinafter named shall pay all amy just debts and funeral expenses as soon as conveniently may be ~done after my decease. > I hereby give devise and bequeath unto ~ADAMS, my lot of land containing fifty (50) acres more or less ~in Bald Eagle Township, Clinton County, Pennsylvania, and also my ~lot of ground in Sunset Pines, Lock Haven Clinton County gPennsylvania. III. my son, R. BRADFORD Ail the rest, residue and remainder of my estate, whether l;real, personal or mixed, and wheresoever situate, I hereby give, ~ devise and bequeath unto my daughter, JANICE E. ADAMS, or if she !!does not survive me, then unto my son, R. BRADFORD ADAMS. !! I hereby nominate, constitute and appoint my daughter, !!JANICE E. ADAMS, as Executrix of this, my Last Will and Testament. . Page one of two Pages If the said Janice E. Adams should predecease me, fail to qualify or cease to act as such, then I nominate, constitute and appoint my son, R. BRADFORD ADAMS, as Executor. No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which ~he may act. IN WITNESS WHEREOF, I, WINIFRED D. ADAMS, the Testatrix ~have unto this, my Last Will and Testament set my hand and seal ~ ' ~this 1'7 f~ day of September, A. D., 1987 =the above-named Testatrix, as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and in the presence of each other. Page two o ~wo Pages SIGNED, SEALED, PUBLISHED and DECLARED by WINIFRED D. ADAMS, Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Winifred D. Adams also known as , Deceased No. 21-03-0360 Date of Death 04/09/2003 Social Security No, 172 - O1 - 8901 R. Bradford Adams, 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/VVe verify that the statements made in this Inventory are true and correct, lAVe 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.: Michael L. Bangs 41263 Address: 302 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 Personal Representative Signature: ~R. ~B~a~s~z~' Signature: Address: 802 John Glenn Blvd Webster, NY 14580 Telephone: ~ ~/gq2-52-~'1 Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value Total: 310,479.00 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 (199Z) Estate of: Date of Death: County: INVENTORY Winifred D. Adams 04/09/2003 Cumberland CASH: Allfirst Bank - Certificate of Deposit 80000002027279 Allfirst Bank - Passbook Savings #87004913742604 Beverly Enterprises of last payment Refund Miscellaneous Cash on Hand Commerce Bank - Checking Account #0512035940 Commerce Bank - Savings Account 0430049590 Community Banks Certificate of Deposit 4800726130 Community Banks Certificate of Deposit 4800726131 Highmark Blue Shield - Unearned Insurance Premium PA State Bank - Final interest on account PA State Bank - Certificate of Deposit AT&T Refund Verizon Refund 20,331.71 4,602.09 525.00 3,432.36 3,710.78 3,811.92 20,207.18 50,462.35 167.16 56.82 30,000.00 28.50 13.97 Waypoint Bank - Passbook Savings Account #400063478 Waypoint Bank - Certificate of Deposit #8000049868 25,290.42 19,220.19 PERSONAL PROPERTY: Proceeds of sale of personal property at auction 970.25 181,860.45 REAL ESTATE/PA: Real Estate Located in Park Terrace, Lock Haven, PA - (See appraisal attached) Real Estate Located at 5 Center Drive, Lower Allen Twp. Sold on 10/2/03 (See attached settlement sheet) 3,500.00 124,148.30 970.25 TOTAL RECEIPTS OF PRINCIPAL ............... 127,648.30 310,479.00 -2- 302 SOUTH 18TM STREET CAMP HILL, PA 17011 E-mail: bangslaw~paonline.com OFFICE PHONE: 717-730-7310 FAX: 717-730-7374 MICHAEL L. BANGS, Attorney-at-Law WILLIAM E. MILLER, JR. WENDY S. CHESBRO, Paralegal January 30, 2004 Of Counsel Donna M. Otto, Deputy Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Winifred D. Adams File No. 21-03-0360 Dear Ms. Otto: Enclosed for filing please find the original Receipt and Release and a check in the amount of $7.00 to pay the filing fee. f ~ery truly yours, / Michael L. Bangs wsc Enclosures ) ) ESTATE OF ) WINIFRED D. ADAMS ) Deceased ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-0360 RECEIPT AND RELEASE I, R. BRADFORD ADAMS, the undersigned, being a beneficiary under the Estate of Winifred D. Adams, deceased, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all assets to which I am entitled as a beneficiary of the Estate of Winifred D. Adams; 4. To the extent of said distribution, release R. Bradford Adams, Administrator, of the Estate of Winifred D. Adams, and his heirs and personal representatives, from all liabilities, whether due to his negligence or otherwise, which he may have by reason of his administration of the Estate; 5. Agree to refund to the Estate and to the said R. Bradford Adams, Administrator, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify him and the Estate for claims made against him and to reimburse him and the Estate all expenses and costs incurred in connection with any such claim; and 6. Declare that this instrument shall be legally binding upon me, my personal representatives, and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~-~'~ day of ~,.,.,~ ~ ,2004. R. BRA~ ?2~'"~(SEAL) STATE OF NEW YORK ) ~..,,, ,,,~ (SS: COUNTY OF ]IL/5 ~'_.~ ) On Off this, the ~ day of 'Nff4~t~..4~4 ,2004, before me, the undersigned officer, personally app~5~d k. BRADPO~ ADAMS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instmment and acknowledged that (s)he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hav~ereunto set.my hand and official~al. Notary Public"' ~' STATUS REPORT UNDER RULE 6.12 Name of Decedent: Winifred D. Adams Date of Death: 04/09/2003 Will No. Admin No. 21-03-0360 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 [X] No [ ] If the answer is No, state when the personal representative reasonably believes that the administration will be complete: If the answer to No.1 is Yes, state the following: Did the pers rep file a final account with the Court? Yes [ ] No [X] The separate Orphan's Court No. (if any) for the personal rep's account is: Did the personal rep state an account informally to the parties in interest? Yes [X] No [ ] Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphan's Court and may be attached to this repot. Date: ~_~ MICHAEL L. BANGS, Esquire 302 South 18th Street Camp Hill,PA 17011 717/730-7310 Capacity: X Personal Representative Counsel for personal repre~%n~ative BUREAU OF INDIVIDUAL TAXES INHER/TANCE TAX DIVTSION DEPT. ZSOGOZ HARRTSBURG, PA 17128-0601 MICHAEL L BANGS $02 S 18TH ST CAMP HILL COHNONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-Z;gi7 EX AFP (01-OS) ~.~ ,!~,~:~ of DATE 01-12-2004 ~' ~ WitlS ESTATE OF ADAMS DATE OF DEATH 04-09-2003 FILE NUMBER 21 03-0360 '04 FEB 25 A8:30 COUNTY CUMBERLAND ACN 101 E.~,, AT O';]. ]. ~ .~ Court Ct;rnberiand Co., PA Amoun~ RemA~:~:ed WINIFRED D HAKE 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-15~7 EX AFP ~01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSENENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ADAMS WINIFRED D FILE NO. 21 03-0360 ACN 101 DATE 01-12-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE ~NTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par~nershAp In*eres~ (Schedule C) ($) ~. Nor~gages/No~as RecaAveble (Schedule D) (~) 5. Cash/Bank DaposA~s/HAsc. Personal Proper~y (Schedule E) (5) 6. JoAn*ly O~ned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Assa~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/MAsc. Expenses (Schedule H) (9) 10. Deb~s/Nor~gage LiebAIA~Aes/LAens (Schedule ~) (10) 11. To,al Daduc*Aons 12. Na~ Value of Tax Re*urn 127/648.30 .00 182~830.70 .00 .00 (8) 14,326.74 NOTE: To Ansura proper credA~ ~o your account, submA~ ~he upper portion of ~hAs form ~i~h your ~ax payment. 15. NOTE: 310,479.00 1~895.70 (11) 1~.222,44 (12) 294,256.56 CharA~eble/Govarneen~al Bequests; Non-elected 911:5 Trusts (Schedule J) (13) Ne~ Value of Es~:e~e Sub.~ec~ ~o Tax (1~) zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 294,256.56 18 and 19 will ASSESSHENT OF TAX: 1~. Aeoun~ of LAne lq a~ Spousal re~e 16. Amoun~ of LAne 1~ ~axable a~ LAnaal/Class A ra~e 17. Amoun~ of LAne 1 18. Amoun~ of LAne 1~ ~axabla a~: Colle~:eral/Class B ra~:e 19. PrAncApel Tax Due TAX CRED/TS: PAYH~NT REC[1PT DISCOUNT DATE NUHBER INTEREST/PEN PAID (-) 11-17-2003 CDOO3239 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TIONAL INTEREST. 1:$, Z41.55 .00 .00 .00 ( XF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE;)UZRED. XF TOTAL DUE 1S REFLECTED AS A "CREDIT*' (CR), YOU NAY BE DU~E% / A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~,~%~ V/-- TOTAL TAX CREDIT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE 13,2ql.55 AMOUNT PAID (ZS) .00 X O0 = .00 (26). 294,256.56 X 045= 13,241.55 (17) .00 x 12 = .00 (ZB) .00 x 15 = .00 (19)= 13,241.55 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decsdents dying on or before Dacaeber 12, 1982 -- if any future interest in the estate is transferred in possession er enjoyment to Class D (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaeonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collatmra1) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special 2~-hour answering service for fores ordering: 1-B00-362-Z050; services for taxpayers with special hearing and / or speaking needs: 1-B00-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance) or disalloeance 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: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZI) Harrisburg, PA 17128-1021, OR --election to have the matter detereined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assesseent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assesslent Review Unit, Dept. 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-IS01) for an explanation af adeinistratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid be~ore January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same 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 il) 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 (62) percent par annum calculated at a daily rate of .000164. All taxes ehich became delinquent on and after January 1, 1982 will bear interest at a rate ehich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The appIicable interest rates for 1982 through Z003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .0005~8 1987 9Z .0002~7 1999 7X .000192 1983 162 .000~38 1988-1991 llZ .000301 2000 82 .000219 X98~ 112 .000301 1992 92 .000247 2001 9Z .000247 1985 132 .000356 1993-199~ 72 .OOOXgZ ZOO2 62 .000164 1986 lOZ .000274 1995-1996 92 .000247 Z003 52 .000137 --Interest is calculated INTEREST = BALANCE OF as follows: TAX UNPAID 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 date shown an the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA -:DE."F>"AlRWEJ'tJT OF REVENUE B()REAU OF INDIVIDUAL TAXES DEPARTMENT 280601 2U!Jti&BR'~U~111?1d 7128-0601 Telephone 717-787-3930 09/11/2007 r'l1 r::n:t ,'\:- t-,L,.:r'ji\, I....)r ORPHA\;'(~ nt'! j.....T , J/".. '..... \ '\ I i-!. r'll'Iw~, ~-,.,;" v.h.' . "n. Ms. Gail Gephart Register of Wills Clinton County Courthouse PO Box 943 Lock Haven, Pa. 17745 Re: Estate of WINIFRED D ADAMS File Number: 2103-0360 County: Cumberland Date of Death:04/09/2003 Dear Register of Wills: The subject decedent legally resided in Cumberland County as of the date of death. Accordingly, you are authorized to cancel file number 1807-0122. All matters concerning this estate should be maintained under Cumberland County File Number 2103-0360. All original Inheritance Tax documents for the subject decedent should be forwarded to the Cumberland County Register of Wills; however, you may wish to retain a copy, including photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which have been issued by your office. Please contact me at the telephone number above if you have any questions. ~.~,,/ Sincerely, '. :-. . .",," . ();incere~. ..J. ": /.,.. ~..',' ~:.'f::~ ~fP:~ ~~J Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division LtJ