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Home My WebLink About09-26-11JAN L. BROWN c~L ASSOCIAT:ES ATTORNEYS AND COUNSELORS AT L.AW ,TAN L. BROWN, ESQUIRE JACQUELINE A. KELLY, ESQUIRE CHRISTA M. APLIIV, ESQLpRE BRENDA F. KEPHART, LEGAL ASSISTANT JUDITH ~~, EBERSOLE, ADMINISTRATIVE ASSISTANT September 23, 2011 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of John G. Peterson Estate No. 2011-00084 PA No. 21-11-0084 Executrix: Nancy F. Peterson To Whom It May Concern: c7 ,- ~ ~' ~--~ __. ~, - , ..,~ _ _ . ,,--, , ~- ~'~ ~~ --~, Enclosed for filing are an original and two copies of the Inheritance Tax Return and an original and one copy of the Inventory for the Estate of John G. Peterson. Also enclosed is check in the amount of $30.00 for the filing fees. a Please return atime-stamped copy of each document in the envelope provided. If you have any questions, please feel free to contact me. Sincerely, hrista M. Aplin ~~ Enclosures cc: Nancy F, Peterson Olde English Gap 845 Sir Thomas Court Suite 12 Harrisburg, PA 17109 Telephone (717) 541-5550 Fax (717) 541-9223 Email: jlbassoc@verizon.net www.janbrownlaw.com 1505610140 REV-1500 EX (I„_,o, PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY PO BOX 280601 INHERITANCE TAX RETURN County Code Year Harrisbur , PA 17128-0601 File Number ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 2 ], 1 1 Social Security Number 0 0 8 4 Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 2 2 6 5 1 4 8 1 2 2 3 2 0 1 0 0 8 3 0 1 9 Decedent's Last Name 2 4 P E T E R S O N Suffix Decedent's First Name J 0 H N MI (If Applicable) Enter Surviving Spouse's Information Below G Spouse's Last Name P E T E R S O N Suffix Spouse's First Name N ,Q MI Spouse's Social Security Number N C Y 1 6 8 9 7 F 2 4 3 8 THIS RETURN MUST BE FILED INS FILL IN APPROPRIATE OVALS BELOW DUPLICATE WITH THE REGISTER OF WILLS 0 1. Original Return ^ 2. Supplemental Return ^ ^ 4. Limited Estate 3. Remainder Return (date of death ^ 4a. Future Interest Compromise (date of Prior to 12-13-82) ^X 6. Decedent Died Testate death after 12-12-82) ^ 5. Federal Estate lax Return Required (Attach Copy of Will) ^ 7~ Decedent Maintained a Living Trust 0 ^ 9. Litigation Proceeds Received (Attach Copy of Trust) --- 8. Total Number of Safe Deposit Boxes ^ 10. Spousal Poverty Credit (date of death CORRESPONDENT -THIS SECTION MUST BE COMPLETEDtALL CORRESPONDENCE AND C ^ I 1 ~ Election to tax under Sec. 9113(A) Name (Attach Sch. O) ONFIDENTIAL T,4X INFORMATION SHOULD BE DIRECTED T0: C H R I S T A M A P L I N Daytime Telephone Number 7 1 7 5 4 1 5 5 5 0 First line of address J A N L- W N B R O & A S S O C. Second line of address 8 4 5 S I R T H O M A S C T City or Post Office H A R R I S B U R G S T E 1 2 State ZIP Code P A 1 7 1 0 9 REGISTER OF WILLS USEdNLY -~ u '_ ~ r-- ~.-~7 -~ :, ; --~ DAILED Correspondent's a-mail address: CHRISTAJLB under VERIZON.NET penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of m kn it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which re SIGNATURE OF PERSON RESPONSI E FOR FILING RETURN Y owledge and belief, P parer has any knowledge. 4DD ESS ~ ~~ DATE 333 HILLSIDE DRIVE ~~~ ~~ ~~l!4TURE O7`p '9Pnaco l.r~ ,~.. _.. _ _ r e M P KEPRESENTATIVE 845 SIR THOMAS CT STE 1 L 1505610140 PLEASE USE ORIGINAL FORM ONL B U R G HILL Side 1 PA 17011 PA 17109 150!i610140 /. ~4~ ':^~ --, ; - t- - - ; -,= ~•~=co t; REV-1500 EX 1505610240 Decedents Name: ~ 0 H N G . PETERSON Decedent's Social Security Number RECAPITULATION 1 6 2 2 6 5 1 4 8 1. Real Estate (Schedule A) ....... . ... ............. ................... 1. 2. Stocks and Bonds (Schedule B) .. , , . • 3. Closely Held Corporation, Partnership or Sole-Proprietorshi 2 1 8 1 • 5 tg p (Schedule C . , 3. 4. Mortgages and Notes R i • ece vable (Schedule D) . , , .. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E • ).... , . _ 5. 6. Jointly Owned Property (Schedule F) 7. Inter-Vi R ~ l 3 8 5 2 Q 6. 4 1 equested ...... vos Transfers & Miscellaneous N (Schedule G) ~ 6. n-P obate Prop erty 3 5 0 4 6 5. 4 1 Separate Billing Requested ...... 7 . . 8. Total Gross Assets (total Lines 1 through 7) . , _ .. • ................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .. 8 4 8 8 9 3 • 4 0 .. 9. 10. Debts of Decedent, Mortgage Liabilities and Li 2 6 1 8 1 • 8 0 , ens (Schedule I) ..... .....10. 11. Total Deductions (total Li 2 5 7 6. 4 7 nes 9 and 10) ...... . , ......... .... 11. ..... 12. Net Value of Estate (Line 8 minus Line 11) 2 8 7 5 8. 2 7 ....... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Sch d 8 2 0 1 3 5. 1 3 e ule J) ... . ........... 13 .... . 14. Net Value Subject to Tax (Line 12 minus Line 13) • TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 15. Amount of Line 14 taxabl 8 2 0 1 3 5 • 1 3 e at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.o 8 2 0 1 3 16. Amount of Line 14 taxabl 5 1 3 15 . e at lineal rate X .0 0 . Q 0 _ 17. Amount of Line 14 taxable 0 0 Q 16. at sibling rate X .12 0 • 0 0 18. Amount of Line 14 taxable 0 0 0 17 at collateral rate X .15 0 • 0 0 0 . 0 0 1a 19. TAX DUE ..... 0 . O 0 ..... ....... ....... .....19. ..... . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFU ND OF AN OVERPAYMENT L 1505610240 Side 2 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: Fire Nurnber DECEDENT'S NAME 21 1 1 0084 uurtN G. PETERSON STREET ADDRESS 833 HILLSIDE DRIVE cirv CAMP HILL Tax Payments and Credits: ~ Tax Due (Page 2, Line 19) 2• Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ,~ Total Credits (A + B ) ZIP 17011 (1) 0.00 (2) 0.00 (3) (4) 0.00 (5) 0.00 Make check payable to: REGISTER OF WILLS, .AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN T'HE A 1. Did decedent make a transfer and: PPROPRIATE BLOCKS a. retain the use or income of the property transferred; Yes No ...................................................................... ^ X b. retain the right to designate who shall use the ro ert transferred or its income; c. retain a reversionary interest; or ............. p p y ............................... d. receive the promise for life of either payments, benefits or care? ~ • ~ ~ ~ ~ • ~ ~ ~ ~ """"" "~ ~ ~ ~ • ...............................ath .............. X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of de without receiving adequate consideration? 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her deatfr? ^ X ......... ~ 0 4. Did decedent own an individual retirement account, annuity or other non-probate propert ,which ^ contains a beneficiary designation?............ y IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G O 0 For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate im AND FILE IT AS PART OF THE RETURN. 3 percent [72 P.S. §9116 (a) (1.1) (i}]. posed on the net value of transfers to or for the use of the surviving spouse For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use o [72 P.S. §9116 (a) (1.1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the sta filing a tax return are still applicable even if the surviving spouse is the only beneficiary. f the surviving spouse is 0 percent tutory requirements for disclosure of assets and For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death 10 adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefi ~ or for the use of a natural parent, an 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. craries is 4.5 I>ercent, except as noted in • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 72 F'. Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or ad [ S. §9116(a)(1.3)), Asibling is defined, unde option. STATE: r, „ REV-1503 EX + (g_g81 COMMONWEALTH OF PENNSYLVANIA SCHEDULE B INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF JOHN G. PETERSON FILE NUMBER ITEM All property jointly-owned with right of survivorship must be disclosed on chedu a F. 0084 NUMBER ~' Axa (AXA); 10.89241 shs DESCRIPTION VALUE AT DATE @ $16.67/sh OF DEATH 181.58 (If more space is needed, insert additional sh0eets of thle s me si e) line 2, Recapitulation) $ 181.58 REV-1508 EX + ~g_981 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN G. PETERSON SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate.l 0084 ITEM Alt Property jointly-owned with right of survivorship must be disclosed on Schedule F. NUMBER _ 1. DESCRIPTION VALUE AT DATE 1971 VW Super Beetle; salvage value only, not in working condition ~-- OF DEATH 0.00 2• Metro Bank Certificate of Deposit Acct # 100909 143,362.01 3. Metro Bank checking Acct # 512101684 64,408.13 4. Metro Bank checking Acct # 536616501 90, 070.00 5. PNC Bank, N.A. Certificate of Deposit Acct # 31200270378 87, 366.27 (If more space is needed, insert additional sh0eets of the samets Zed line 5, Recapitulation) $ 206.4 REV-1509 EX+ /0.10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FSTerG nr. SCHEDULE F JOINTLY-OWNED PROPERTY JOHN G. PETERSON ~ FILE NUMBER. If an asset was made jointly owned within one year of the decedent's date of death, it mw t be reported on Schedul SURVIVING JOINT TENANT(S) NAME(S) a G' A. Nancy F. Peterson ADDRESS - RELATIONSHIP TO DECEDENT 833 Hillside Drive Camp Hill, PA 17011 Spouse 13 C. JOINTLY-OWNED PROPERTY: LETTER DATE ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL IDNSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. ~~ A• 1959 Real Property located at 833 Hillside Drive, Camp Hill, PA 17011. $166,900 x 1.25 CLR 2 A See attached valuation sheet 8/1964 M&T Bank Checking Acct # 68507887 3. A 12/1982 M&T Bank Savings Acct# 15004206010685 4. A 6/1999 M&T Bank Certificate of Deposit Acct# 31003913820550 5. A 8/1996 M&T Bank Certificate of Deposit Acct# 31003914530794 6. A Sovereign (Banco Santander) Certificate of Deposit Acct # 1055175572 7~ A 83/84 12 U.S. Savings Bonds Series EE DAl'E OF DEATH VALJE OF ASSET . % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF ._ DECEDENT'S INTEREST 208, 625.00 50. 104, 312.50 7, 580.29 50. 3, 790.15 43,386.60 50. 21,693.30 164,803.89 50. 82,401.95 1'J2,890.22 50. 56,445.11 143,916.80 50. 71,958.40 24;5,808.00 50. 122,904.00 TOTAL (Also enter on Line 6. Reranln d~+~,,.,, I .. ~~ ...ore space is needed, use additional sheets of paper of the same size. ( ~ 463 505 4 REV-1511 EX+ ~10_09~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FCTeTr nr JOHN G. PETERSON FILE NUMBER Decedent's debts must be reported on Schedule t. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION ~~ Parthemore Funeral Home & Cremation Services, Inc. B 2. 3. 4. 5. 6. 7. 8. 9. 10. Ll ~ ADMINISTRATIVE COSTS: ~ ~ Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ~_ City ~_ State ZIP Year(s) Commission Paid: "'-~------ Attorney Fees: JAN L. BROWN & ASSOCIATES Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address ~_ City -~~ Relationship of Claimant to Decedent State ___ ZIP --~ Probate Fees: Register of Wills; Cumberland County Accountant Fees: Tax Return Preparer Fees: The Sentinel; legal advertising Cumberland Law Journal; legal advertising Register of Wills; Cumberland County; filing of Inheritance Tax Return and Jnvento Computershare; Transaction fee for AXA stock ry TOTAL (Also enter nn I Imo o R ~r more space is needed, use additional sheets of paper of the same size. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ecapltulatlon) $ AMOUNT 11, 594.41 14,000.00 273.50 187.54 75.00 30.00 21.35 181. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JO SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS HN G. PETERSON FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, ir~cludin 11 0084 ITEM g unreimbursed medical expenses. NUMBER DESCRIPTION VALUE AT DATE ~ PharMerica; outstanding medical bill OF DEATH 2. 76.00 Golden Living; nursing home bill check cleared after death 3. East Pennsboro Ambulance Service, Inc.; medical bill check cleared after death 4. Lisa Saksek; caregiver check cleared after death 5. Griswold Special Care; oustandin g medical bill 6. JoAnne Taylor; outstandin caregiver g medical bill TOTAL (Also anto~ „~ i ;.... ,,, ,. Ir more space is needed, insert additional sheets of the same size. V ~ c ~ ~~ Recapitulation) I $ 2 1, 086.87 48.00 70.50 1,177.60 117.50 7 REV-1513 EX+lC1~_1 n~ II 1 ESTATE OF: JOHN G. I NUMBER I. 1 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J NANCY F. PETERSON 833 HILLSIDE DRIVE CAMP HILL, PA 17011 FILE NUMBER: ~_ 21 11 008 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) --_.__ Spousal 100% AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 I NON-TAXABLE DISTRIBUTIONS: OVER SHEET, AS APPROPRIATE. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 nF RI=~i_~ ann ~"„~., ,. u more space is needed, use additional sheets of paper of the same size. `nCC I n c7 - --, -, -, , _-, "- LAST WILL AND TESTAMENT' - ' ` ' - - ~. -~ ~_:: OF _ . . - :~~; -_ JOHN G. PETERSON - ~~~ _~ ' - ~'~ - ,.,~-, _T~ I, JOHN G. PETERSON, now domiciled in Cumberland Cou to be my Last Will and Testament. I revoke all of ntY, Pennsylvania, declare this her wills and codicils that I may have previously made. Art-- icle I My just debts and expenses of my last illness, funeral, and adn-~inistration of m be paid by my Executor from the principal of my residuary estate as ~• Y estate shall .goon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest aild penalties thereo includin an n, but not g y generation skipping tax) payable by reason of my death on. any property or interest in property, including taxes assessed on jointly held assets and nonprobate assets, shall be a' and be charged generally against the principal of my residua est p id out of ry ate without reimbursement from any person. The tax shall be paid and allocated from my residuary estate t~efore my residu is divided into shares for my residuary beneficiaries. This provision is .not ~ estate a waiver of any right which my Executor has to claim reimbursement for any such taxes which become result of an p y p payable as the Y pro ert over which I have the ower of appointment. Article III I give, devise and bequeath in accordance with any memorandum which handwritten or signed, located with my will or with m valuab I have either Y le papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to or at my death, and if there is a conflict, the memorandum havi ganlZations which exist ng the latest date shall govern. Arta- c1e IV All the rest, residue and remainder of my estate, of whatsoever nature and w situate, I give, devise and bequeath to my wife, NANCY F. p heresoever ETERSON, of Cumberland County, Pennsylvania. In the event that NANCY F. PETERSON predeceases me or fa' thirty (30) days, I give, devise and bequeath the remai ils to survive me by nder of my estate, of whatsoever nature and wheresoever situate IN EQUAL SHARES, to my sister, KEROUGHI AGHA County, Pennsylvania, and to my sister, ELIZABET BEKIAN, of York H SALIB, of York County, Pennsylvania, or the survivor. Article V I understand and direct that my life insurance, annuities, individual retireme (IRAs), m trust for bank accounts and any other assets on which I m nt accounts ay de;>>gnate a beneficiary will pass to the beneficiaries that I have named and will not be controlled by the distribution r this Will. I also understand and direct that any assets I own 'ointl p ovisions of J y with another with rights of survivorship or a presumed rights of survivorship (whether the joint owners]!~i was cre after this Will) will pass to the survivin p ated before or g joint owner and distribution of such assets will not be controlled by the provisions of this Will. -2- Arti- cle VI I nominate, constitute, and appoint my wife, NANCY F. PE'T'ERSON, as Exec Last Will and Testament. In the event of the renunciation, death, or ;in utnx of my ability to act, for any reason whatsoever~f-m Y--Executrix,--I-nominate, -constitute--and appoint-my -sister, -KERQUGHI-_------___ AGHABEKIAN, as successor Executrix of my Last Will and Te;~tament. I n the event of the renunciation, death, or inability to act, for any reason whatsoever ofKEROUGHI AG I nominate, constitute and appoint my sister, ELIZABET HABEKIAN, H SALIB, as successor Executrix of my Last Will and Testament. I direct that my Executrix or successor Executrices be without bond and in addition to those powers granted by law I ra permitted to serve g nt them power to distribute m cash or in kind in like or in unlike shares and to file any qualified disclaimer I could hav e filed ~f living. My Executrix or successor Executrices shall receive reasonable compen,;ation for services rendered to my estate. Art~~1e VII In addition to the powers conferred by law, I authorize my Executrix and s Executrices, in her absolute discretion: uccessor (a) to retain in the form received and to sell either at public or private sale, an real e personal property except that which I specifically bequeath herein y state or (b) to manage real estate, (c) to invest and reinvest in all forms of property without tieing confined to investments, and without regard to the principal of diversification legal (d) to exercise any option or right arising from the ownership of investments, -3- (e) to compromise claims without court approval and without con . sent of any beneficiary, (~ to file any federal income tax return for any year for which I ha ve not filed such return prior to my death, such property ue of any =-- (h) to employ any attorney, investment advisor, or other a f;nt de Executor g erred necessary by my ,and to pay from my estate reasonable compensation for all their servic es, (i) to conduct alone or with others, any business in which I am e interest m at time of m ngaged in, or have an y death, (j) to file any qualified disclaimer I could have if living, and (k) to receive reasonable compensation in accordance with their stand effect while their services are performed, and schedule offees in IN WITNESS WHER-EOF, I, JOHN G. PETERSON, hereb set m Will and Testament, on y Y hand to this my Last °~ 2010. --- J~~N G. PETER ON~--- In our presence, the above-named JOHN G. PETERSON signed this his Last Will and Testament and now at his request, in his resenc other, we sign as witnesses. and declared this to be P e, and in the presence of each ~- ~~~ ,~ dJ Address ,~, , -4- I, JONN G. PETERSON, Testator, who signed the foregoing instrument, Navin qualified according to law, acknowledge that I signed and executed this instrumen g been duly that I signed it willin 1 as m free and volunta act for the u o;- g Y y t as my Will, and ry p rp yes therein expressed. Sworn to or affirmed and - ----~ ....~~u uc~ore me b - -- - ---.JOHN G. PETERSON, th' Testator on, ~ ~. ~_, 2010. Publi NOTARIAL SEAL RONETTE LHARRIS-SPRIGGS Notary Public SWATARA TWP, DAUPHIN COUNTY My Commis3lon Expires May 13, 2012 y. J~NN G. PETERSON We, the undersigned witnesses who signed the foregoing instrument, being dui u according to ]aw, depose and say that we were present and saw the Te~;tator sign and exe q allfied instrument as his Will; that he signed and executed ii willingly as his free and volu ute this Purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesseor the that to the best of our knowledge, that he was at that time eighteen (1.8) ears or sound mind, and under no constraint or undue influence. s, and Y more of age, of o ~~ , L ~~~~ ._ , ~~~` Its 2010. tine s -^---- NOTARIAL SEAL RONETTE LHARRIS-SPRIGGS Notary Public SWATARA TWP, DAUPHIN COUNTY MV Commission Expires May 13 2012 -5- Sworn to or affirmed and subscribed to before me TaxDB Result I~eta~ls Page 1 of 1 Detailed Results fir Parce147-18-1302-140. in the 2010 Tax As DistrictNo sessment Databa 47 Se Parcel_ID 47-18-1302-140. MapSuffix HouseNo 833 Direction Street HILLSIDE DRIVE Owned PETERSON, JOHN G & NANCY C/O F PropType R PropDesc LivArea 1447 CurLand Val 55000 CurImpVal 1 11900 ' CurTotVal 166900 CurPrefVal Acreage .66 CIGrnStat TaxEx 1 SaleAmt SaleMo SaleDa SaleCe SaleYr DeedBkPage 0019A-00420 YearBlt 1959 HF File Date 12/02/2004 HF Approval_Status A http://taxdb.ccpa.net/details.asp?id=47-18-1302-140.&dbselect= l 1/17/2011 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA ~ SS COUNTY of CUMBERLAND File Number 2011 00084 Personal Representative(s) of the Estate of John G. Peterson deceased, depose(s) and say(s) 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 verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Na cy F. P erson, Executrix Attorney -- (Name) Christy M. Aplin _ (Supreme Court 1. D. No.) 207949 (Address) 845 Sir Thomas Court, Suite 12 Harrisburg PA 17109 (Telephone) (717) 541-5550 DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. ND. 833 HILLSIDE DRIVE 12/23/2010 CAMP HILL PA 17011 162-26-5148 FIGURES MUST BE TOTALED Axa (AXA); 10.89241 shs @ $16.67/sh 181.58 1971 VW Super Beetle; salvage value only, not in working condition 0.00 Metro Bank Certificate of Deposit 143 362.01 Acct # 100909 , Metro Bank checking 64 408.13 Acct # 512101684 , Metro Bank checking 90 070.00 Acct # 536616501 , c7 PNC Bank, N.A. Certificate of Deposit ~ ' =87,366 27 Acct # 31200270378 ~ ~~7' . „ rt, ~,-, ;,., _j :.. ,__.. . J ~ __.._ ~ _`. i U _ ~.~ } ~, (Attach additional sheets as needed) ~ 385,387.99 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. (See 20 Pa. C.S. ¢ 3301(b)~ Form RW-09 rev. 10.13.06 v_ ° N 48a °' 2 $ . US POSTAGE . ~ $ FIRST-CLASS FROM 17109 ° --A SER 23 2011 Q, ~m Jan L. Brown & Associates ATTORNEYS AND COUNSELORS AT LAW 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PENNSYLVANIA 17109 ,~: Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 ~1 -: Z~}- C"7 N ~ Y" , ~,j ~_ ~ ._ v r- ., ~