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HomeMy WebLinkAbout03-0851 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Register of Wills for the~ z Deceased. County of _(~_~-~n~'~-gin the Social Security No. ~Z./ (.fl - ~ ~/ ~ 5--~.~ ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in C~'_~ CQunty, Pennsylv ia, width h -~- last family or principal residence at ~ _3._ ~ /~/~-~/ P_~~ '~ - (list street, number and municipality) Decen~nt. then "~ t~ years of age, died 0 ~ - ~ ~ - C.) _~ ,,~.t,-~ 0 _~ , at ! Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ .~-'-~. ~ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner.__ after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the gr~t of letters of administration in the appropriate form to the undersigned. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Cleon P. Aitkins DateofDeath: September 30, 2003 Will No.: 21-03-0851 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [-/] 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 b. The separate Orphans' Court No. (if any) for the personal representative's accoUnt is: c. Did the personal representative state an account informally to the parties in interest? Yes [~ No [-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this re.p~_rt. A ..,.. _ ..' Date: December 3, 2004 Signature I(eith O. Brenneman ~ ' Name 4/4 }/. l'iain Street ',.c l~lechanicsburg, PA 17055 t i': "~. Address (717) 697-8528 :-:~:i Telephone No. Capacity: [--] Personal Representative Iici Counsel for personal representative OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 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 above decedent petitioner(s) will well and ,c truly administer the estate according to law. Sworn to or affirmed and subscribed bel~ore me this _ }~'~ day of -~ -- ~egis~r L so. l-03- Estate of ( ,~cm (D ~'~,,~ , Deceased GRANT OF LETTERS OF ADMINISTRATION ANDNOW 0qY~L~)'~ 17 /°)003 ~ , in consideration of the petition on the reverse side hereof, sigisfactory proof h~vin .~~d before me, IT IS DEC~ED that ~ ~ is/are entitled to Letters of Administration, ~nd in accord with such finding, Letters of A~inistration are hereby granted to ~o ~ ( ~ ~ ~ ~ in the estate of Q ~ ~ ~~'~ FEES Letters of Administration ..... $2~ ~. ~ - Short Ce~ificates( ) .......... $~ ATTORNEY (Sup. Ct. LD. No.) Renunciation ......... ~" $ $_ j O. o O ADDRESS TOTAL ~ S- Filed }.~.-.t~r. ~.~ ..... A.D. 19 - PHONE This 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 fbrwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar P 9 6 4 7 9 1 2 ocr 0 1 200:] No. ~ Date Rev. 2/a7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH - VITAL RECORDS CERTIFICATE OF DEATH Cleon P. Aitkins ,.male ,. 210 __ 24 -- 5958 . g- fi-i] 70 v~. ; I I/05/1933 ,~ ~. ; ~. ~Lew i s t own PA m Dauphin~o~m.~u,u~t~ot,~ ~.Harrisburg ~. Harrisburg Hospital i~.~.~,~,.~.. ~m. ~ite ,,.. Laborer ,bHarrisburg Steel ' ' ~'~- I,~. ~,~Married ,~Delores J. Moore 228 N. 2nd St. ~c~u~ ,~,.m~ PA Wormleysburg, PA 17043 t~ ,m.~ Cumberland ~' ,~.~~.~~'~ Wormleysburg ~HER'S ~ME (F~, ~. Lam) ,~. Clark A~tk~ns ~, Ida Lindsay ~. Delores J. Aitkins ],~,,u Tory Circle Enola, ~PAc~17025 ~ ~'~ O[.,..Oetober I, 2003 J~,~ Hollinger Crematory I~,. Hr. Holy Srlngs PA 17065 --'. ~- .~~7 12~ FD 012774-L 122cRichardson F H 29S.EnolaDr. Enola PA 17025 I. d -- L~ca~ ---' ~'~ ~ ~OUE~E ~: i ~ -- ' ~a~'~' ~m~le~Emm(~ym~ ~y J c. DuEDUE m (~ AS A C~SEOUE~E ~:m (~ ~ A C~SEQUE NCE ~: Y~m~)~T I ~ ~ 2~TM ~ ~ ~ ~ ~ ~ ~ ~le~ "P~CE ~ I~URY - Al ~**/arm, ~reet. la~, o~e TO ~ ~, Of my k~.,~.. ~.th ~c.r~., t~ lime..,...~ p~c...~ dui ~ I~ clue(l) ..n..,.,,.,~ ........................................................................................... ~ ~2 ~f /~ f~ ~-~ -- /i CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Cleon P. Aitkins Date of Death: September 30, 2003 No. 21-03-0851 1'o the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned Estate on November 3, 2003. ~4ame Address Linda L. Murdorf 319 Mount Allen Drive Mechanicsburg, PA 17055 Cleon J. Aitkins 75 Southmont Drive Enola, PA 17025 Valerie D. Wolfe 4057 Amity Road Duncannon, PA 17020 )elores Aitkins 148 Tory Circle Enola, PA 17025 qotice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. )ate: November 3, 2003 Keith O. Brenneman, Esquire :-.-, Snelbaker, Brenneman & Spare, P. C. 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 ~ Counsel for Personal Representative LAW OFFICES SNELBAKER, BRENNEMAN" & SPare JAMES A:BALOGH - MN GA,VW."ECKER- DC. r','L, MN, W" BALOGH DECKER, LTD. ARIZONA OFFICE: *CREDITOR'S RIGHTS SPECIALIST 7702 EAST DOUBLETREE AMERICAN BOARD OF CERTIFICATION ATTORNEYSATLAW RANCH ROAD ............ SUITE 300 CHELSEA A. JAGUSCH - MN, WI SCOTTSDALE, AZ 85258 ANGELA M. HORN - MN SEND ALL WRITTEN REPLIES TO: MICHAEL D. JOHNSON - MN MARY ELLEN WEEMAN - KS, MN, MO 41 50 OLSON MEMORIAL HIGHWAY, SUITE 200 THERSIA O. LEE- MN MINNEAPOLIS, MINNESOTA 55422-4804 OF COUNSEL: CHAD J. BOLINSKE - MN LITOW LAW OFFICES, P.O. DIANA THEOS - AZ, CO (IOWA) STEVEN M. TOMS- MN TELEPHONE 763-852-8440 HEATHER L. KIGHT- MN, NY FAX 763-852-8499 LUSTIG, GLASER & WILSON, P.C. MICHAEL L. MCCAIN - MN (MASSACHUSETTS) WILLIAM B. HOPKINS - MN, WI TOLL-FREE 888-762-9997 KIMBERLY L DUNCAN - MN JOHN E. OLCHEFSKE - MN ] 2/0 JON M. SUSTARICH - MN REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 Re: In the Estate of CLEON P AITKINS Probate Case No. 21-2003-00851 Social Security No: 210245958 Last known residence: 228 N 2ND ST WORMLEYSBURG, PA 17043 Our Client: DISCOVER FINANCIAL SERVICES, INC. Account Number: 6011002520308412 Amount of Debt: $ 676.37 Dear Sir or Madam: Enclosed please find a Creditor=s claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or concerns, please call our firm toll free at 1- 888-762-9997. Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. 3686 11/28/2003 1033128 COMMONWEALTH OF PENNSYLVANTA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DTVTSTON NO TICE OF CLAII~I Tn Re: The Estate of: Cour~ File No: 21-2003-00851 CLEON P AITKINS Deceased TO: THE CLERK OF THE ORPHANS' COURT DTVTSTON: Notice of claim by creditor, Pursuant to Section 3532(b)(?) of the Probate, Estates, and Fiduciaries Code, :~0 PA.C.S.A. §3532(b)(2). DISCOVER FINANCIAL SERVICES, INC. 1) Claimant's name: C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 8887629997 3) Creditor listed below is the owner and holder of a claim in the amount of $. 676.37 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 228 N 2ND ST WORMLEYSBURG, PA 17043 6) Date of Death: 09/30/03 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by. On behalf of the claimant, ! do solemnly declare and affirm under the penalties of perjury that they !nformation and representations made herein are true and correct to the best of my knowledge, information and belief. Dated: Ohelsea A. dagusch/~la M. Horn, Attorne~'"-- Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: DELORES d AITKINS Name 148 TORY CIROLE Address ENOLA, PA 17025 City/State/Zip Date notic~ mL~iled IN RE ESTATE OF: CLEON P AITKINS AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. 3. The Decedent purchased merchandise in the amount of $ 676.37 evidenced by account number 6011002520308412 4. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not BALOGH BECKER, LTD. By: ~ One of its attorneys: Chelsea A. Jagusch__ Angela M. Horn Michael D. Johnson __ Mary Ellen Weeman__ Thersia O. Lee __ Chad J. Bolinske 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4804 Subscribed and sworn before me :' This ~ day of ._'~C-.~ ,2003. P.O. Box :!.5:!.37 ~*~ ~* ~ i ~-~ Wilmington, DE 19850-5137 877-767-9383 12/22/03 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 Re: In the Estate of CLEON P AITKINS AKA CLEON AITKINS Probate Case No. 21-2003-00851 Social Security No: 210245958 Last known residence: 228 N 2ND ST WORMLEYSBURG, PA 17043 Our Client: MBNA AMERICA Account Number: 4264291826175430 Amount of Debt: $ 2207.52 Dear Sir or Madam Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or concerns, please call our finn toll free at 1-877-767-9383. Cordially, MBNA America Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt 'collector. 3858 I2/18/2003 1033128 COMMONWEALTH OF PENNSYLVANZA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT D:i:VZSZON NO TICE OF CLAIh'I :In Re: The Estate of: Cour~ File No: 21-2003-00851 CLEON P AITKINS Deceased AKA CLEON AITKINS TO: THE CLERK OF THE ORPHANS' COURT D:[VZS~ON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). MBNA AMERICA 1) Claimant's name: P.O. BOX 15137 2) Claimant's address: WILMINGTON, DE 19850--5137 8777679383 3) Creditor listed below is the owner and holder of a claim in the amount of $. 2207.52 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 228 N 2ND ST WORMLEYSBURG, PA 17043 6) Date of Death: 09/30/03 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, ! do solemnly declare and affirm under the penalties of perjury that they !nformation and representations~ tODated:the best [~(/2~//~z''''~°f my knowledge,Kyle Frenzel/Lucilleinformation a ~ be~?~i?~ '.~'~__ r~.~~Lerb-s - Authorized R~ntative For MBNA America Written notice of claim was given to PertsonavKepresentative~"--~'-- and/or his/her counsel as stated below: DELORES J AITKINS Name 148 TORY CIRCLE Address ENOLA, PA 17025 City/State/Zip Date no't~ce tnailed IN RE ESTATE OF: CLEON P AITKINS AKA CLEON AITKINS AFFIDAVIT OF ACCOUNT The undersigned, being first duly swom deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Authorized Representative- In-Fact to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. 3. The Decedent purchased merchandise in the amount of $ 2207.52 evidenced by account number 4264291826175430 4. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not ~~ / On'/of its A~~tatives: / Ky/Ye Frenzel __ [ L~dcille Roberts I /Jessica Lerbs ~ I J MBNA America ~/ P.O. Box 15137 Wilmington, DE 19850-5137 Subscribed and sworn before me This ~4~_ day o~ ,2003. · r ,_v ouu .-,.-,,.- ,-,,,,  PENNSYLVANIA COMMONWEALTH OF DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN 2 1 _0 3 0 0 8 5 l HARRISBURG, PA17128-0601 RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z Aitkins, Cleon P. _910 -- LU DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) t'1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU 09-30-2003 01-05-1933 REGISTER OF WILLS LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ¢3 Aitkins, Delores J. 201 -- 24 - 0687 ,- [~ 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date or death priarto 12-13`82) .~. a~ '-' [] 4. Limited Estate [] 4a. Future Interest Compromise (date ordeath after 12-12-82) [] 5. Federal Estate Tax Return Required o ~ ,.,-,[] 6. Decedent Died Testate (Attach copy of Will) [] 7. Decedent Maintained a Living Trust (Atlach copy of Tmst) I 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date ordea~ ~wea~ 12-3~-9~ a,d ~4-9~) [] 11. Election to tax under Sec. 9113(A)(Attach Sch O) ~_ THIS SE~[~ ~!OM,~; ~N~NCE A ,,Z, NAME COMPLETE MAILING ADDRESS z Keith O. Brenneman ~ FIRM NAME (If Applicable) ~"' Snelbaker, Brenneman & Spare· P.C. 44 W. Main Street '"' TELEPHONE NUMBER oo Mechanicsburg, PA 17055 71 7) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 9 · 607.66 (Schedule E) ~ 6. Jointly Owned Property (Schedule F) (6) 1 O, 323.40 .-~ -' [Z] Separate Billing Requested ~ 7. later-Vivos Transfers & Miscellaneous Non-Probate Property (7) I'-' (Schedule G or L) ~ 19,931.06 ,g~ 8. Total Gross Assets (total Lines 1-7) (8) LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 5,089.51 tV' 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 6,059.67 11. Total Deductions (total Lines 9 & 10) (11) l I, 149.18 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 8,781.88 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 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) 8,781.88 x .0 0 (15) ~ 16. Amount of Line 14 taxable at lineal rate x .0 (16) ~' 17. Amount of Line 14 taxable at sibling rate x .12 (17) O f.,3 18. Amount of Line 14 taxable at collateral rate x .15 (18)  19. Tax Due (19) O Decedent's Complete Address: STREET ADDRESS I 228 N. 2nd Street CITY Normleysburg ISTATE PA I ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. InterestJPenalty if applicable D. Interest E. Penalty Total IntereslJPenalty ( 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 I 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) O Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the dght 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 which contains a beneficiary designation? ........................................................................................................................ [] 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, I declare that I have examined this return, induding accompanying schedules and stalements, and to the best of my knowledge and belief, it is true, correct and comCete. Deciaraf~on of preparer other than the personal representa~ve is based on all information of which preparer has any knov,~edge. Administratrix ~O/~f SIGNATURE QF I~REPjIJ~ER OTHER THAN REPRESENTATIVE DATE ADDRESS 44 W. Main Street, Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S §9116 (a)(1.1) (i)]. For dates of death on or mqer January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 RS. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decodent's siblings is 12% [72 RS. §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, whelher by blood or adoption. ,~ CHEDULE E COMMONWEALTH OFPENNSYLVANIA I CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN I PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Cleon P. Aitkins 21-03-00851 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of sundvorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank - Certificate of Deposit, account No. 31003913938923 $2,972.18 2. PNC Bank, N.A. - checking account No. 5140000478 4,464.32 3. Cash 143.91 4. Miscellaneous coins and bills sold at auction (gross) 927.25 5. 1992 Buick Le Sabre 1,000.00 6. 1983 Chevrolet S-10 pickup truck 100.00 TOTAL (Also enter on line 5. Recapitulation) $ 9,607.66 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98). 1~' SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNEDPROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Cleon P. Aitkins 21-03-00851 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Delores Aitkins 114 Austin Drive surviving spouse gnola, PA 17025 JOINTLY-OWNED PROPERTY: L~ ~ ~ bK DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OFASSET INTEREST DECEDENTS INTEREST 1 A. 3/86 $200.00 U.S. Savings Bond, Series Et, 9281.20 IOU~ $ 281.20 No. R22184069EE 2. A. 1/93 $10,000.00 U.S. Savings Bond, Series $9,304.00 100% 9,304.00 Et, No. X2398867EE 3. A. 2/86 $100.00 U. S. Savings Bond, Series $140.60 100% 140.60 gE, No. Cl11295835EE 4. A. 7/99 $1,000.00 U.S. Savings Bond, Series $597.60 100% 597.60 Et, No. M73168071EE TOTAL (Also enter on line 6, Recapitulation) $ 10,323.40 (If more space is needed, insert additional sheets of the same size) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Cleon P. Aitkins 21-03-00851 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Halpe~-zi Funeral ltome $1,850.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions waJ_ved Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Add ress City State __ Zip Year(s) Commission Paid: 2. Att°mey Fees to Snelbaker, Brenneman & Spare, P.C. $2,500.00 3. Family Exemption: (If decedent's address is not the same es claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees tO Register of W~_lls /47.00 5. Accountant's Fees, miscellaneous probate fees, filing fees and costs (reserve) 400.00 6. Tax Return Preparer's Fees 7. Advertise grant of letters of Administration: a. The Patriot News: $217.51 b. Cumberland Law Journal: 75.00 292.51 TOTAL (Also enter on line 9, Recapitulation) $ 5,089.51 (If more space is needed, insert additional sheets of the same size) REV-1512 EX,- {12-03) COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAXRETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Cleon P. Aitkins 21-03-00851 Re )od debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbureed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. OF DEATH Discover Financial Services, Inc. - credit debt due, account No. 6011002520308412 $ 676.37 2. MBNA America - credit debt due, account No. 4264291826175430 2,207.52 3. Dr. John D. Conroy - payment on account of medical expenses 2,890.46 4. UGI - payment on account of utility expense 120.47 5. PP&L - payment on account of utility expense 79.43 6. Comcast - payment on account of cable expense 17.89 7. Verizon - payment on account of utility expense 67.53 TOTAL (Also enter on line l0, Recapitulation) $ 6,059.67 (If more space is needed, insert additional sheets of the same size) MONWEALTH OF PENNSYLVANIA I BENEFICIARIES ~EFICIARIES I ESTATE OF Cleon P. Aitkins FILE NUMBER MI-~ RELATIONSHIP TO DECEDENt'- 21-03-00851 NU NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY AMOUNT OR SHARE D~ ~ Do Not List Trustee(s) OF ESTATE TAXABLE ISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Delores J. Aitkins surviving spouse *114 Austin Drive $30,000 plus Enola, PA 17025 1/2 of residue Cleon J- Aitkins 75 Southmont Drive son 1/4 of residue Enola, PA 17025 Linda L. Hurdorf 319 biount Allen Drive daughter 1/4 of residue Hechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Il 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 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) COMMONWEALTH OF PENNSYLVANIA ~ ss: COUNTY OF CUMBERLAND J Delores J. Aitkins being duly sworn eccordlng +o law, deposes and says the+ She is the , Admin~stratrix_ of the Estate of Cleon P. Aitkins late of the Borou_~h_ of Wormleysburg , Cumberland County, Pa., deceased and that the within is an inventory made by Delores J. Aitkins ~, the said Administratrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde the Commonwealth of Pennsylvania, and fhaf the figures opposite each item of the Inventory represent it's fair value as of the date of decedenf's death. ~-~Lc..~2~ -'~co andsubscribedbeforeme, /~~~~~ ~Execufor - Administrator Su~n L. Ma~, No~ Pu~ic Address ~ani~ ~, Cum~and ~n~ My ~~ Ex~ Nov. 24, 2~7 Member, Pennsylvania Ass~iation Of NotaHee Date of Death 30 September 2003 Day Month Yea~ INSTRUCTIONS I. An inventory must be filed within three months after appolnfmenf of personal represenfafive. 2. A supplement inventory must be filed wifhrn fhlrfy days of discovery of additional assets. 3. Additional sheets may be attached as fo personalty or realty 4. See Article IV, Fiduciaries Act of 1949. Inventory of the real and personal estate of Cleon P. Aitkins ., deceased I. REAL ESTATE. NONE NONE II. PERSONALTY. A. M&T Bank, Certificate of Deposit No. 31003913938923 $2,972.18 B. PNC Bank, N.A., Checking Account No. 514000078 4,464.32 C. Cash and Coins 1,071.16 D. 1992 Buick Le Sabre 1,000.00 E. 1983 Chevrolet S-10 pickup truck 100.00 TOTAL VALUE, PERSONALTY $9,607 36 TOTAL VALUE, ALL PROPERTY: $9,607.66 COHNONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE BUREAU OF ZNDZVZDUAL TAXES /NHERITAHCE TAX DIVISION NOTZCE OF ZNHERZTANCE TAX PO BOX 280601 APPRAZSEHENT, ALLONANCE OR DZSALLONANCE HARRISBURG, PA 17118-0601 OF DEDUCT/ONS AND ASSESSHENT OF TAX REV-t;4~ £x DATE 11-15-200~ ESTATE OF A/TKZNS CLEON P DATE OF DEATH 09-$0-2005 FZLE NUHBER 21 03-0851 COUNTY CUHBERLAND KEITH 0 BRENNEHAN ACN 101 SNEL~AKER ETAL Amoun* Remi~ed ~q W MA[N ST HECHANICSBURG PA 17055 HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REG/STER OF W/LLS CUH~ERLAND CO COURT HOUSE CARL/SLE, PA 17015 CUT ALONG THZS LZNE I~ RETAZN LONER PORTZON FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTZCE OF /NHERZTANCE TAX APPRA/SEHENT~ ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF A[TK[NS CLEON P FZLE NO. 21 03-0851 ACN 101 DATE 11-15-200~ TAX RETURN NAS: { X} ACCEPTED AS FZLED ( } CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es*a*e (Schedule A) (1) .00 NOTE: To Ansure proper 2. S~ocks and Bonds (Schedule B) (2) .00 credi~ ~o your accoun*, ~. Closely Held Stock/Partnership In~erms~ (Schedule C) ($) .00 subai~ ~he upper portion ~. Hor~geges/No~es Rece/veble (Schedule D) (q) .00 of ~his fora wi~h your 5. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) ($) 9;607.66 ~ax payment. 6. Jointly Owned Proper*y (Schedule F) 16) 7. Transfers (Schedule G) 17} .00 8. To,al Asse~s 18) 19,951.06 APPROVED DEDUCTZONS AND EXEHPTZONS: 5,089.51 9. Funeral Expanses/Ada. Cos~s/Nisc. Expanses (Schedule H) 19) 10. Deb*s/Hor~gage Liabilities/Liens (Schedule I) 110) 6;059.67 12. Ne~ Value of Tax Re~urn (12) 8,781.88 15. Chari~eble/Governaen~el Bequests; Non-elected 9115 Trusts (Schedule J) 115) .00 lq. Ne* Value of Es~e~e SubSec* ~o Tax 11~) 8,781.88 NOTE: Z~ an assess;ent ~as ~ssued previously, lines 1~, ~5 and/or 16, 17, ~8 and reflect f~gures that ~nclude the total of ALL returns assessed to date. ASSESSNENT OF TAX= 15. Amoun~ of Line 1~ a~ Spouse1 ra~e 115) 8,781.88 X O0 = .00 16. Amoun~ of Line 1~ *axable m~ Lineal/Class A ra~e 116) ~0 X 0~5 = .00 17. Amoun~ of LAne lq a~ Sibling rolo 1171 ~.00 I = ' .00 O0 x 15 = .00 18. Amoun~ of Line Ii taxable at Collateral/Class B rate (18) 19. Pr/nclpal Tax Duo ~)= .00 TAX CREDZTS: PAYHENT RECEZPT DZSCOUNT (+) AHOUNT PA/D DATE NUHBER /NTEREST/PEN PAZD (-) TOTAL TAX CREDZT I .00 BALANCE OF TAX DUEl .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ~ 1F PAZD AFTER DATE /ND/CATED~ SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQU/RED. FOR CALCULATZON OF ADDZT/ONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 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 Coeeoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 2S of ZOO0. (7Z P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HXLLS, AGENT REFUND (CR): A refund of a tax credit, mhich was not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-131S). Applications are available online at ewe.revenue.state.om.us) any Register of Hills or Revenue Oistrict Office, or free the Department's Z4-hour answering service for fores orders: 1-800-56Z-ZOSO; services for taxpayers with special hearing end/or speaking needs: 1-800-447-5020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment) allowance or disalloeance of deductions or assessment of tax (including discount or interest) as shown on this Notice say object within 60 days of the date of receipt of this notice by filing one of the folloaing: A) Protest to the PA Department of Revenue, Board of Appeals. Yau say object by filing a protest online at aww.boardofappeals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to ba valid, you must receive a confirmation number and processed date fram the Board of Appeals websita. You say also send a written protest to PA Department of Revenue) Board of Appeals P.O. Box ZBIOZ1, Harrisburg, PA lT1ZB-lOZ1. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. ADNIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: 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, P.O. Box ZB0601, Harrisburg) PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (5X) discount of the tax paid is allowed. PENALTY: The 1Si 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 mould appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death) to the date of payment. Taxes which became delinquent before January l) 19aZ bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. Ail taxes which became delinquent on and after January 1, 19Bi will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19Bi through 2004 ara: Interest Daily Interest gaily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 ~"~)"~"~-1991 llZ .000301 ~ 9Z .000247 1983 162 .000438 1992 9Z .000247 200Z 62 .000164 1984 llZ .O003Ol 1993-1994 7Z .O0019Z 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000247 2004 42 .000110 1986 IOZ .000274 1999 7Z .00019Z 1987 lOX .000274 ZOO0 72 .000192 --Interest is calculated es follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.