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Home My WebLink About04-0819Register of Wills of Cumberland County, Pennsylvania Estate of PETITION FOR GRANT OF LETTERS ROBERT T. McCLELLAN No. O~ ! --0C/ --0~1 (~ Deceased Social Security No. 195-22-3373 MICHAEL SCOTT McCLELLAN Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of r~ the Decedent, dated August 4th, 1984 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 to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration '~-~ '::: ~ ~''' (d.b.n.c.t.a.: pendento I te; durante absent,a; dumnto mmo. r~ate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and Was survi~ by the:fOllowing,, spouse (if any) and heirs: Name Relationship ReSidencox~ COMPLETE IN ALL CASES: Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 6280 Carlisle Pike Lot 401 Salem Church Mobile Home Park, Hampden Township, Mechanicsburq, Pennsylvania (List street, number and municipality) Decedent, then 75 years of age, died August 29, 2004 at Harrisburq Hospital, Hardsburq, PA (Location) 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 ...................................................................................................................... $ Total ......................................................................................................... $ Real Estate situated as follows: 50,000.00 50,000.00 Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Signature IMICHAEL SCO ~ ~ McCLELLAN 339 Stallion Court Tarpon Springs, Florida 34688 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal.~resentative of the Decedent, Petitioner will well and truly administer the estate according to law. :::~'. ,~. .~ Sworn to and affirmed and subscribed Before me this day of ,2004. MICHAEL SCOTT McCLELLAN:. Estate of ROBERT T. McCLELLAN , Deceased. Social Security No: 195-22-3373 Date of Death: Au.qust 29, 2004 AND NOW, hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted t° in the above estate and that the instrument dated August 4, 1984 probate and filed of record as the last Will of the Decedent· ,2004, in consideration of the Petition on the reverse side MICHAEL SCOTT McCLELLAN described in the Petition be admitted to FEES Letters ........................... Short Certificate(s) Renunciation ............ ;. Affidavit ( ) .................. Extra Pages ~. ...... Codicil ............................ JCP Fee ....................... Inventory ...................... Other .............................. TOTAL ......... $ o.oo $. c5.00 $ $ $ $ 0-OO $ Ragister-of Wills Attorney: JERRY R. DUFFLE I.D. No: 09601 Address: Johnson, Duffle, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- Telephone: 717-761-4540 his is It) certify that the information here given is correctly copied from an original certificate of death duly filed with me as l:~cal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ ,,,,, ~ Local Registrar ¢ AUG 312004 No. ~ Date H1~.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH AOE(L~tBktladay) I UNDERIYEAR al.~CEOFDEAm¢C~eO;;~h,~.le.seek,~au~m~del 6280 ~rlisle Pike, ~t 104~ ~h q ~,wo~_an_cs~_.~,. PA 17055 /~ ,~.~ ~rle~ ~,~ ~. ~' ' Me~I Weller Hichael S, ~Clellen ~ 339 Stallion Ct,, To~n Spr[n~s. ~ ~688 -- ~s~) D ~ August 31, 2~ f~,~m~ ] ~TO(~~ ...... l~ ~"~ ~-D ~D s~ D ~.~-~ D ~m. ~. 'M~L ~W~NER (It~ 2~ T~ ~ ~ Register of Wills of Cumberland County, Pennsylvania OATH OF NON-SUBSCRIBING WITNESS Estate of ROBERT T. McCLELLAN No. al -OL~ - O ~ 1 9 , Deceased LUTHER EDWARD McCLELLAN a subscriber hereto, being duly qualified according to law, deposes and says that he was familiar with the signature of ROBERT T. McCLELLAN , Testator of the Will presented herewith, and that such subscriber believes the signature on the Will is in the handwriting of ROBERT T. McCLELLAN to the best of such subscriber's knowledge and belief. ~-~UTHER ~-DWARD I~I-cCLELLAN - - ADDRESS -' ' d '~' Sworn to or affirme~and subscribed __before me this g~( day(~ F°r~i~ie'l~egister ~ ~ (~ Register of Wills of Cumberland County, Pennsylvania Estate of OATH OF SUBSCRIBING WITNESS ROBERT t. McCLELLAN, No. ,~ - (2q -' 0~1C~ Deceased RICHARD M. MOHLER a subscribing witness to the Will presented herewith, being duly qualified according to law, deposes and says that he was present and saw the above Testator sign the same and that he signed as a witness at the request of Testator in his presence and in the presence of the other subscribing witness. Richard M. Mohler (Address) Sworn to or affirmed and subscribed before me this I day of ~_ ,,~,'~l~,._ .20o~L. (Signature and seal of Nota~ or other officia,I · qualified to administer oaths. Show date of ' ' ' expiration of Nota~'s commission.) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of Instrument(s) at time of notarization. LAST WILL AND TESTAMENT OF ROBERT T. McCLELLAN KNOW ALL MEN BY THESE PRESENTS, That I, ROBERT T. McCLELLAN, unmarried, of the County of Cumberland and State of Pennsylvania, being of lawful age and of sound mind, memory and understanding, do make, publish and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executor hereinafter named to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executor hereinafter named to pay without right of reimbursement and as part of the expense of administering my estate all federal, state and local inheritance, estate, transfer and succession taxes, together with all penalties and interest thereon, which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax an..~hich.passe~ by reason hereof or by any act, law, statute, rule of court o~ court decree or by operation of law or by any other' mean~whats~ever. SECOND - I give, devise and bequeath all the reside of my estate, real and personal, as follows: ~ (a) One-quarter (~) thereof to my son, MICHAEL SCOTT McCLELLAN, or, if he fails to survive me, then to his issue per stirpes; (b) One-quarter (¼) thereof to my daughter, MARSHA ANITA McCLELLAN, or, if she fails to survive me, then to her issue per stirpes; (c) One-quarter (%) thereof to my daughter, MONA LEE McCLELLAN, or, if she fails to survive me, then to her issue per stirpes; and LAW OFFICE~ RICHARD M. MOHLER LEWI~TOWNo P£NNA. 17044 (d) One-quarter (¼) thereof to my son, MARTIN STEPHEN McCLELLAN, or, if he fails to survive me, then to his issue per stirpes. THIRD - I appoint the said MICHAEL SCOTT McCLELLAN to be the Executor of this, my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act of the said MICHAEL SCOTT McCLELLAN, then I appoint the said MARTIN STEPHEN~McCLELLAN to be the Executor hereof. I do hereby give to the Executor hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. 1AW OFFICES RICHARD M, MOHLER LEWISTOWN, PENNA. 17044 IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages ,on the margin of which (except this page) I have affixed my initials this ~':~W '~-day of ~~¢'7- , A. D., 1984. ~ -"~.~.~J~--~ (SEAL) / ROBERT T. McCLELLAN Signed, sealed, published and declared by ROBERT T. McCLELLAN, the above named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. I-AW OFFIC~E9 RIC:HARD M. MOHLER LEWISTOWN, P£NNA. 17044 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: ROBERT ~McCLELLAN August29,2004 2004-00819 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the aboVe-captioned estate on September 15, 2004 Name Address Michael S. McClellan 339 Stallion Court Tarpon Springs, FLA 34688 Marsha Anita McClellan 629 N. Lombard Avenue Oak Park, IL 60302 Mona Lee McClellan P.O. Box 81103 Boca Raton, FLA 33481 Martin Stephen McClellan 3536 Stackinghay Drive Naperville, IL 60564 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: September 15, 2004 None. /~'gnature ~ //Name: JERRY_R. DUFFLE L/Johnson, Duffle, Stewart & Weidner Address: 301 Market St P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 Capacity: Counsel for personal representative 8V: LL~/ g[ d3S I;'0. z m~ m~m m ~f LAW OFFICES JOHNSON DUFFIE OF COUNSEL HORACE A JOIINSON F. LEE SHIPMAN BI/UCE I GEOSSMAN: November 23, 2004 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Robert T. McClellan SSN: 195-22-337~: Your File No. 200~0819 Our File No. 13782~1 Dear Register of Wills Office: Enclosed please find Check No. 1005 in the amount of $4,000.00. This payment rep/esents the three- month prepayment in order to qualify for the discount. The decedent died on August 29, 200.4:.~ Please time stamp the enclosed copy of this correspondence, and retum to me in the enclosed self- addressed stamped envelope. Thank you for your assistance in this matter. Should you have any questions, or require any additional information, please feel free to contact me. Very truly yours, JOHNSON, DUFFLE, STEWART & WEIDNER 'Dana L. Wieseman Legal Assistant c: Michael S. McClellan, Executor :239884 3(}1 MARl(ET STREET tZO. BOX 10g LEMOYNE, PENNSYLVANIA 17043-0109 WWWJDSW. COM 717.761.4540 FAX: 717.761.5015 MAIL@IDSW,COM JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFIND~VIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 0O4667 DUFFLE JERRY R 301 MARKET ST P O BOX 109 LEMOYNE, PA 17043-0109 ....... folC~ ESTATE INFORMATION: SSN: 195-22-3373 FILE NUMBER: 2104-081 9 DECEDENT NAME: MCCLELLAN ROBERT T DATE OF PAYMENT: 11/24/2004 POSTMARK DATE: 11/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,000.00 REMARKS: TOTAL AMOUNT PAID: $4,000.00 SEAL CHECK# 1005 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 1711&-0601 COMNONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-/54? EX AFP (Bl-oS) S BERNE SMITH ESQ 107 N ZqTH ST CAMP HILL PA 17011 DATE 09-20-200q ESTATE OF PAINTER DATE OF DEATH 07-27-2005 FILE NUMBER 21 05-0819 COUNTY CUMBERLAND ACN 101 Aaoun* Raai~ad RAYMOND R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA C__UT_ A_kO_._G- _P_O_._T_2_O_.- ...................... ,=~;..,;.1 .......... REV-15~7 EX AFP (01-03) NOTXCE OF XNHERZTANCE TAX APPRAZSENENT~ AL=LOgANCE OR DTSALLOgANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PAINTER RAYMOND R FILE NO. 21 05-0819 ACM~ 101 -~DATE 09-20-200q TAX RETURN NAS: (X) ACCEPTED AS F/LED ( RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Partnership Interest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) E. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule g) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTTONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) (9) lO. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return CHANGED lq / 500.00 15/000.98 .00 .00 .00 .00 .00 (8) .00 .00 TE: To insure proper cradlt to your account, subaJt the upper portion of this fora with your tax payaent. 29,500.98 (11) . O0 (12) 29,500.98 13. lq. NOTE: ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lq taxebXa at Lineal/Class A rata 17. Amount of Line lq at Sibling rata 18. Aaoun~ of Line lq taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECExPI D/SCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) Charitabla/Governaantal Bequests; Non-eXacted 9113 Trusts (Schedule J) Nat Value of Estate Subject ~o Tax Tf an assessment Nas issued previously, lines lq, 15 and/or (13) .00 ([~) 29,500.98 16, 17, 18 and 19 Nil1 reflect figures that include the total of ALL returns assessed to date. (15) 29,500.98 X O0 = .00 (16) .00 X Oq5 = .00 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= . O0 AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 .00 .00 .00 ( XF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. XF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF N/ELS) 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-1315). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices, or by calling the special [q-hour ansamring service for farms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-SgO-4qT-30ZO ITT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone [717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SX) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the 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 (1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1~ 1982 bear interest at the rate of six (61) percent par annum calculated at e daily rate of .00016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Year Rate Factor Year Rata Factor ~ [OX .000548 ~'8-1991 IiZ .00OSOX 1983 162 .000q38 1992 92 .O00Zq7 19Bq 117. .000301 1993-1994 77. .000192 1985 132 .000356 1995-1998 92 .O00Z~7 1986 iOZ .O00ZTq 1999 7Z .O0019Z 1987 ZOZ .000274 ZOO0 7Z . O0019Z --Interest is calculated as follows: ZNTEREST = BALANCE OF TAX UNPA/D Interest Daily Year Rate Factor ~'~ 9X .O00Z~? 200Z 62 .00016q 2003 5Z .000137 ZOOq qT. .000110 X NUNBER OF DAYS DELTN~UENT X DA'rLy INTEREST FACTOR --Any Notice issued after the tax becomes daIinquent wJXX refIsct an interest caXculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be caIcuZated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG. PA 17128-0601 AEV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUFFIE JERRY R 301 MARKET ST PO BOX 109 LEMOYNE, PA 17043-0109 nnnn lold EST A TE INFORMATION: SSN: 195-22-3373 FILE NUMBER: 2104-0819 DECEDENT NAME: MCCLELLAN ROBERT T DATE OF PAYMENT: 03/16/2005 POSTMARK DATE: 03/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/29/2004 NO. CD 005070 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $873.75 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1008 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $873.75 GLENDA FARNER STRASBAUGH REGISTER OF WILLS ., ~ ~.,.,..,... ". ~. ~ '" ::".\f_ ' ~"IfS~~ I (l'-:' ~l!" =--- ~ ~ ----- sm.I("~~5 n 1A $ 01.750 OC04seSO~6 VAR15 ZOG5 MAltED FROM ZlPCOl:ll1 7043 , ,r-o.;: '" J First Class Mail LAW 0 F Fie E S JOHNSON DUFFIE 301 MARKET STREET P,O, BOX 109 LEMOYNE, P A 17043,0109 REGISTER OF WILLS OFFICE CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 To: 1ItL.,........~ . .. ... .. .. -..----................... ...........".........."....._-,-_........-...,............. .,................,..',.,....:..\,.......,..-.... '-' """''''''';''''''''''~'>''';: ''''~''''-""',,~,:,,,,''''",-''.'.-:'- jll;:;) I: 1111TI) I: Ii i: \ !:I ~ \ \ ,c..;)1 \,\ \ 1\1 l II'!\ \\I:! i\I"!; il; I.i"'.i!. \1 ( [ \1)1T:', 1)\li:,I\ I.I!II(I I' \i \ \ "! \11 i :; liil I I;", I \: '11'\1\ \ !(\I I!I \\:[(,Iilll; \1 !..!' \ j)j !I<' OF COU~SEL I.i'\!! .:i ,.<..\ 1\ \\ () 1 I. I ( I' :..; JOHNSON DUFFIE \VlnTJJ{;< J';\l. .1\;\ 11.! F,';\l\JL iHw"f'id"i\\' ( 1m \;1 ! i ',111\ 1.,I,li\ I" H;j I \1 \\ \: 1\11; \\'\j)] I} \1\\11\ March 15, 2005 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Robert T. McClellan SSN: 195-22-3373 Our File No. 13782-1 Your File No. 21-04-0819 Dear Register: Enclosed for filing please find the Inheritance Tax Return and Inventory for the Estate of Robert T. McClellan who died on August 29, 2004, as follows: 1. 2 Original PA Inheritance Tax Returns. There is tax due in the amount of $873.75. Check No.. 1008 has been attached to this correspondence. 2. 2 copies of Pages 1&2 of the Pa Inheritance tax return, which we ask that you time-stamp and return to us in the enclosed envelope. 3, Inventory 4, Inventory (2 copies) which we ask that you time stamp and return to us in the enclosed envelope, 5. Check No. 1009 in the amount of $25.00 representing payment of the filing fee for the Inheritance Tax Return and Inventory has been attached to this correspondence. matter. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this Very truly yours, ~SON;,DUF7'f,t0~& WEIDNER ~t~~ ~, Estate Administration Paralegal c: Michael S. McClellan, Executor :246769 ,01 \Lli:KllSIIU.EI 1'.0 Bo\ Ifill IIIIIJ\\I, 1'1.\\\11\\\1\ l;lil,lilli'! 11"\\"IVIIJSI\"lOM ;1; 7IJLch4ii 1'I\;lI ;,,11111, ILIIL@llh\\lInl JOHNSON, DUFFIE, STEWART & WEIDNER, PC Register of Wills of Cumberland County, Pennsylvania INVENTORY ,Deceased No. 21-04-0819 Date of Death 08/29/2004 Social Security No. 195-22-3373 Estate of ROBERT T McCLELLAN also known as Michael S. McCLELLAN The Personal Representatlve(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 located 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 the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. I.D. No.: Jerry R. Duffie 09601 Personal Representative Signature: ~ S Jr--'RY--- Michael S. McCLELLAN Attorney: Signature: Firm: Signature: Johnson, Duffie, Stewart & Weidner C) Address: P.O, Box 109 Lemoyne, PA 717-761-4540 17043 ",0 Address: 339 Stallion Court' ;2 Tarpon Springs, FL 346~t': Telephone: 727-943-9132 ," :"~~: <f~ C"'I Telephone: Dated: c:1/ J~ ( 05 -'-J 5:5 --',J ----.~:'~ Personal ProDertv Cash............................................................................................... Miscellaneous Property................................................................ Stocks/Listed........ ............... ................ ........ ........ ........ ........ .......... Stocks/Closely Held...................................................................... Bonds............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... C') 0) 35,910.84 6,100.00 Total Personal Property...................,..................... 42,010.84 Total Real Property................................................ Total Personal and Real Property......................... F'! ,.,.,] )j, :;:i;:im?~~:,,:;~'w-+1Ji Total Out-of-State Real Property.......................... tJ.llPb . REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV.1500 EX + (6..QO) *' W ~ ~~~ w"g %~...J u.... .. <( ... Z W Q W o W Q COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ---- -,-- -------- I DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INmAL) , McCLELLAN, ROBERT T ! DATE OF DEATH (MM-OO.YEAR"f ------ --I 5ATE-OF-BfRiH(MM=-ob~Y-EARf- I 08.29-2004 ... ..... ..! ll.5-04:1929 ... .. j (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I OFFICIAL USE ONLY I FILE NUMBER 21 04 0819 I COUN~ODE ~~~~_ NUMBER SOCIAL SECURITY NUMBER 195.22.3373 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I I I 3. Remainder Return (dale of death prior to 12-13-82) Original Return Limited Estate 1-: I J I I 48. Future Interest Compromise (date of death after 12-12.82) 7. Decedent Maintained a Living Trust (Attach copyofTNst) 10 Spousal Poverty Credit (date of death between . 12-31-91 and 1-1-95) ! 10W ~". III 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes I I 11.Election to tax under Sec. 9113(A) (Attach Sch 0) l' ';'1'" Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received NAME Jerry ~Duffie FIRM NAME (If applicable) Johnson, Duffie, Stewart & Weidner TELEPHONE NUMBER 717.761.4540 ~ z W Q Z ~ o w z z o u 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o >= j :::> ... a: <( o w '" 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) I Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) I I Separate Billing Requested 8. Total Gross Assels(total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) 2. Supplemental Return P.O. Box 109 Lemoyne, PA 17043 (1) None (2) None (3) None (4) None (5) 42,010.84 (6) 1,650.05 (7) 78,971.61 OFFICIAL USE ONLY (8) (9) (10) 7,723.36 1,925.21 10.Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line B minus Line 11) (11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax(Line 12 minus Line 13) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 (16) >= 16. Amount of Line 14 taxable at lineal rate 112,983.93 x .045 <( ... :::> l1. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :E 0 0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) >< x <( ... 19. Tax Due (19) 200 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. i2',2,632.50 9,648.57 112,983.93 0.00 112,983.93 0.00 5,084.28 0.00 0.00 5,084.28 Copyright 2002 form software only The Lackner Group. Inc. ,",,+ i!!",+h';LHi):; ">, ,!:'djpilfj;Jf}, .~i!mlbJ1i N Form REV.1500 EX (Rev, 6.00: Decedent's Complete Address: STREET ADDRESS 6280 Carlisle Pike Lot 401 Salem Church Mobile Home Park CITY Mechanicsburg ISTATE PA IZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 4,0-00.00 210.53 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the dIfference. This is theOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE Make Check Payable 10: REGISTER OF WILLS, AGENT (1) 5,084.28 4,210.53 (3) (4) (5) 873.75 (5A) (5B) 873.75 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or Income of the property transferred;............................................................................. x I b. retain the right to designate who shall use the property transferred or its income;.....................,.......... x', c. retain a reversionary Interest; 0[..................................................,........................................................ x I d. receive the promise for life of either payments, benefits or care?........................................................... x I 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................,.......................,..................n................................................... I I I x i 3. Did decedent own an "In trust for" or payable upon death bank account or security at his or her death:?....... I x I 4. Old decedent own an Individual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation?............................................................................................................... I x I I I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, 1 dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and bellef, it is true. correct and complete. Declaration of pr~parer other th~n_the persC?l!l!L~pr~entalivl!!_ls ba~_ed on all informal!9_rl_~Lwhich preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Michael S. McCLELLAN 339 Stallion Court SIGN!~J.ONRtt.:O~S~~RETURN ADDRESS Tarpon Springs, FL 34688 ADDRESS P.O. Box 109 Lemoyne, PA 17043 l./td"J- DATE <-3j/5jO!J DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a)(1.1)(1)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (II)). The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even If the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child Is 0% [72 P.S. ~9116 (.)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to orfor 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. Rev-15GB EX+ (6-9B) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the rlght of survlvorlhlp mUlt be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Decedent's Cash VALUE AT DATE OF DEATH 258.02 2 Comcast Refund - Account Refund 32.39 3 M&T Premium Interest Account No. 950993026 - Account No. 950993026 35.270.43 4 Travelers Insurance Company - Refund on Policy 350.00 5 Automobile - 1997 Buick Rivera - Cash received for the Sale of this Asset 4.500.00 6 Mobile Home -1982 Mobile Home Unit - Cash recived for the Sale of this Asset 1.600.00 TOTAL (Also enter on Line 5, Recapitulation) 42,010.84 (If more space IS needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6.98) *' SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEA.l TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 If an ..set was made Joint within one year of tile decedent'. date of death, It must be reported on schedule G. SURVIVING JOINT TENANT{S) NAME A. Michael S. McClellan ADDRESS RELATIONSHIP TO DECEDENT Son 339 Stallion Court Tarpon Springs, FL 34688 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT SfTE OF DEATJi DECD'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMilAR IDENTIFYING NUMBER. ATIACH nEED FOR ALUE OF ASSE INTEREST DECEDENT'S INTEREST JOINTl V-HELD R.EAL ESrA rEo 1 A 5/28/1976 M&T Bank - Joint Checking Account No. 3.300.10 50.000% 1.650.05 58618511 TOTAL (Also enter on Line 6, Recapitulation) 1,650.05 (If more space is needed, additional pages of the sarne size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+ (6-98) *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH 01'" PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 This schedule musl be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Citizens Account No. L7K0464851 - Citizens 78,971.61 78,971.61 Investment Services Corp. Traditional IRA Account No. L7K0464851 Estate is the named Beneficiary TOTAL (Also enter on Line 7, Recapitulation) 78,971.61 (If more space IS needed, additional pages of the same size) Copyright {c} 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV.1151 EX+ (12.99) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT McCLELLAN, ROBERT T Debts of decedent must be reported on Schedule I. FILE NUMBER 21-04-0819 ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 3,407.36 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I E1N Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Johnson, Duffie, Stewart & Weidner 3,700.00 3. Family Exemption: (If decedent's address Is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Deced'ent 4. Probate Fees Cumberland County 111.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 505.00 TOTAL (Also enter on line 9, Recapitulation) 7,723.36 Copyright (c) 2002 form software only The Lackner Group, Inc. FC!rm PA-1500 Schedule H (Rev. 6-98) Rev.1502 EX+ (6-98) *' SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF l>ENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 ITEM NUMBER DESCRIPTION AMOUNT 1 Hoenstine Funeral Homes, Inc. - Funeral Bill 3.407.36 Subtotal 3.407.36 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev.15D2 EX+ (6.98) *' SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 B&T Hauling - Costs to remove items from Residence 150.00 2 Cumberland County - Register of Wills Filing Fees for Inventory and Inheritance Tax Return 25.00 3 Cumberland Law - The Cumberland Law Journal Notice of Estate Administration 75.00 4 D. Gallagher - Payment for services of Opening and Showing Decedent's Mobile Home 25.00 5 M. Dannia - Household Cleaning 100.00 6 Patriot - The Patriot News Co. Notice of Estate Administration 130.00 Subtotal 505.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAl.TH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT McCLELLAN, ROBERT T FILE NUMBER 21-04-0819 ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Ambulance Services - West Shore Emergency Medical Services VALUE AT DATE OF DEATH 529.07 2 Carlisle Pike Association - Lot Rent for Mobile Home for September & October 790.00 3 Comcast Cable Television 84.48 4 Health South - Medical Bills 16.96 5 M&T Bank Fees - Deluxe Checks Fees 11.75 6 PP&L Electric. Electric Bill 124.13 7 Tredegar Master Trust - Repayment of money received 308.02 8 Verizon . Telephone Account 717-766-2650-758 53Y 60.80 TOTAL (Also enter on Line 10, Recapitulation) 1,925.21 (If more space IS needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1513 EX+ (9 00) '* SCHEDULE .. COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McCLELLAN, ROBERT T 21-04-0819 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT NUMBER PERSON(S) RECEIVING PROPERTY Do Not LIlt Trulltee'll IWords) (SSS) I. TAXABLE DISTRIBUTIONS [Include outright s~usal Cfistributions and nsfers under Sec. 9116(a)(1.2)J Marsha Anita McClellan Daughter 1/4th of Estate 26,567.48 629 N. Lombard Avenue Oak Park, IL 60302 Martin S. McClellan Son 1/4th of Estate 26,567.48 3536 Stacking hay Drive Naperville, IL 60564 Michael S. McClellan Son 1/4th of Estate 26,567.48 339 Stallion Court Tarpon Springs, FL 34688 Mona Lee McClellan Daughter 1/4th of Estate 26,567.48 P.O. Box 81103 Boca Raton, FL 33481 Total 106,269.92 Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate. on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 COPYright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LISTING OF EXHIBITS FOR ESTATE OF ROBERT T. McCLELLAN EXHIBIT A Last Will and Testament of Robert T. McClellan dated August 4, 1984 :14677{) /1 LAST WILL AND TESTAMENT OF ROBERT T. McCLELLAN KNOW ALL MEN BY THESE PRESENTS, That I, ROBERT T. McCLELLAN, unmarried, of the County of Cumberland and State of Pennsylvania, being of lawful age and of sound mind, memory and understanding, do make, publish and declare this instrument to be my Last Will FIRST - I direct the Executor hereinafter named to pay all and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executor hereinafter named to pay without right of reimbursement and as part of the expense of administering my estate all federal, state and local inheritance, estate, transfer and succession taxes, together with all penalties and interest thereon, which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax and which passes by reason hereof or by any act, law, statute, rule of court or court decree or by operation of law or by any other means whatsoever. SECOND - I give, devise and bequeath all the residue of my estate, real and personal, as follows: (a) One-quarter (\) thereof to my son, MICHAEL SCOTT McCLELLAN, or, if he fails to survive me, then to his issue per stirpes; (b) One-quarter (\) thereof to my daughter, MARSHA ANITA McCLELLAN, or, if she fails to survive me, then to her issue per stirpes; (c) One-quarter (\) thereof to my daughter, MONA LEE McCLELLAN, or, if she fails to survive me, then to her issue per stirpes; and . .., "rIsC.- 1<, ~-,.J - LAW OFP'ICES RICHARD M. MOHLER LEWISTOWN. PENNA. 17044 ,,:.1 I ---"-- . ,--'-'~--.-~~_.~- I ,. .~ .. ., "",,"" '," ~.., (d) One-quarter (\) thereof to my son, MARTIN STEPHEN McCLELLAN, or, if he fails to survive me, then to his issue per stirpes. THIRD - I appoint the said MICHAEL SCOTT McCLELLAN to be the Executor of this, my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act of the said MICHAEL SCOTT McCLELLAN, then I appoint the said MARTIN STEPHEN McCLELLAN to be the Executor hereof. I do hereby give to the Executor hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate upon such terms as deemed best, to settle and compound any and all olaims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of oourt, no Surety shall be required thereon. A ", -'I.r~~- /1< ,... LAW OFFICES RICHARD M, MOHl.ER LEWISTOWN. PI::NNA, 17044 IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages ,on the margin of which , .' 711 my initials this 7 -- day of (except this page) I have affixed ?,I Ji~ J <'<---:- I; 1,..,\..~It.,J. A. D., 1984. :</ 7 _.{ -7M"'.., A /"'j ";::;j~'1 ,rr . (,'.'1 -1"'. J . -':"--':.k:ItL~~~---. ,H>.I.t.-v-.-............. ..-- , ROBERT T. McCLELLAN ( SEAL) Signed, sealed, pUblished and declared by ROBERT T. McCLELLAN, the above named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. .'_'" ! I" J Ij \A4t1&L'\it r Y\ Ii\/{' , J\II, \ r ~ L.l f.)..}J 1.__..... 42 i ! \"} I "/v)'1,~ !h , ) \.-./1 ,/ -f (J; .f 4'./ , 1'10f -' L.AW OFFICES RICHARD M. MOHLER LEWISTOWN, PENNA. 17044 BUREAU OF INDIVIOUAL TAXES INHERITANCE TAX DIYISION PO BOX 2150601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX Jt~:! -.7 n: ~15 06-07-2005 MCCLELLAN 08-29-2004 21 04-0819 CUMBERLAND 101 1,'\ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN r"\' t; \.-'u JERRY R DUFFIE JOHNSON ETAL PO BOX 109 LEMOYNE *' REV-1547 EX AFP (03-05) ROBERT T AlIOunt R_i ti.d PA 17043 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ J1~V-"MI:,.yt.m.m~'tI!1.'lMtm.!/I!'.!wtJ1'rt'IM!!'.'I'W.lWAlTftMMr~.YC[!lVIM!!'.1ITt'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MCCLELLAN ROBERT T FILE NO. 21 04-0819 ACN 101 DATE 06-07-2005 TAX RETURN HAS: I X) ACCEPTED AS FILED ) CHANGED I~ an assess.ent was issued previously, lines 14, IS and~or 16, 17, 18 and 19 will re~lect ~igures that include the total gf 6bb returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rat. (IS) 16. A~nt of Line 14 taxable at Lineal/Class A rat. (16) 17. AlIOunt of Line 14 .t Sibling rat. (17) 18. ~unt of Line 14 taxable at Collataral/Class Brat. (18) 19. Principal Tax Due C DIT. RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Re.l Est.t. (Schedule A) 2. Stock. _ Bond. ISch.....l. B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. ~rtpges/Not.s Receivable (Schedul. DJ 5. C.shIB~ Deposits/Hisc. Parsonal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule 8) 8. Total Assets (1) (2) (3) (4) IS) (6) (7) .00 .00 .00 .00 42.010.84 1.650.05 78.971.61 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funerel Expenses/Ad.. Costs,"isc. Expenses (Schedule H) 10. Dobts/Hortgsg. Liobiliti../Lion. l$chsdul. I) 11. Total Deductions 12. Net Value of Tax Retum 13. Charlt8ble/Governnentel Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 7,723.36 1.925.21 Ill) (12) (13) (14) NOTE: .00 112,983.93 .00 .00 X DO = X 045 = X 12 = X 15 = + INTEREST/PEN PAID 1-) 210.53 .00 AMOUNT PAID 4,000.00 873.75 DATE 11-23-2004 03-15-2005 NUHBER CD0046~ "4 CD005070"-.. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE (19)= NOTE: To insure proper credit to your account, subait the upper portion of this form "ith your tit)( pey...,t. 122,632.50 Q.~4R 117 112,983.93 .00 112,983.93 .00 5,084.28 .00 .00 5,084.28 5,084.28 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL OUE IS LESS THAN $1, NO PAYHENT IS RElIUIRED. IF TOTAL DUE IS REFLECTED AS 'A "CREDIT" ICR), YOU HAY BE DUE ' A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.) <0-" C.' L.-' c:) . L~_ - " , STATUS REPORT UNDER RULE 6.12 Name of Decedent: ROBERT T. MCCLELLAN Date of Death: AUGUST 28.2004 Will No. 2004-00819 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the Estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: August 29, 2005 N J Y R. DUFFIE OHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 Lemoyne, P A 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative e..: L......- C.:'l c-:' r ,...., ... ' tI~' c~.:.; ,,--/ ~