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Home My WebLink About01-12-121505607121 -'~' REV-1500 EX (06-05) PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 2sosol 2 1 1 0 ? 1 3 Harrisbu , PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 1 4 0 8 0 5 6 0 5 0 6 2 0 1 0 0 3 1 8 1 9 4 9 Decedent's Last Name Suffix Decedent's First Name MI O r r i s J a m e s E (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ a 1. Original Return ^ 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) i B ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ oxes t 8. Total Number of Safe Depos (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death ^ haOunder Sec. 9113(A) 11 • A h S ) between 12-31-91 and 1-1-95) c ttac ( CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BF~D.jRECTED TO: Daytime Telephege Number _r Name u i r e E 7 1 7 ~~ 3 0: ~ 2; 0 ^' W a y n e F S h a s q d e _. ,~ - Firm Name (If Applicable) -~~ REGISTER OF11VItt8 USE-ONLY = ° _ ` 7 .:} I "_;; .~ _ - ,, - First line of address _ _ ti 5 3 W e s t P o m f r e t S t r e e t ~1 ~ r~~ Second line of address City or Post Office C a r l i s l e State ZIP Code DATE FILED P A 1 7 0 1 3 correspondent's a-mail address: waynefshade(a~comcast net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA OF PERSON RE NSIB FILING RETURN DATE ADDRESS ~ P A 17 0 2 5 6958 Wertzville Road Enola SIGNA OF PREPAR H N EPRESENTATIVE D TE /! f ADDRESS 53 West Pomfret Street Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505607121 Side 1 1505607121 ,~,J 1505607221 REV-1500 EX Decedent's S ocial Security Number Decedent's Name; James E• 0 r^ r i s 1 9 1 4 0 8 0 5 6 RECAPITULATION 1. Real estate (Schedule A) ..................................... 1. ... 2 1 8 1. 0 0 2. Stocks and Bonds (Schedule B) ...... . . . . .............. 2. 3. Closely Hetd Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages & Notes Receivable (Schedule D) ..................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5. 4 5 6 4 3 . 8 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 4 7 8 2 4. 8 0 9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 1 4 2 8 1, 4 3 10. Debts of Decedent,. Mortgage Liabilities, & Liens (Schedule I) ......... ... 10. 4 9 3 1 3. 4 0 11. Total Deductions (total Lines 9 & 10) ........................ ... 11. 6 3 5 9 4 , 8 3 12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. - 1 5 7 7 0 , 0 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ .. 14. - 1 5 7 7 0 . 0 3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18 0. 0 0 19. Tax Due ....................................... .. ..... .. 19. 0 . 0 0 20. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME James E. Orris File Number 21 10 713 STREET ADDRESS _ _- -- _ _ __ _ __ 7320 Wertzville Road _ _ - _ _ _ _ __ CITY _ _ - STATE _ --ZIP - _ Carlisle PA 17015 Tax Payments and Credits: 1• Tax Due (Page 2 Line 19) (1) 0.00 2. CreditslPayments A. Spousal Poverty Credit B• Prior Payments C. Discount Total Credits (A + g + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest 0.00 E• Penalty Total InteresUPenalty (D + E) (3) 0.00 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPR IATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................... ... ^ a b. retain the right to designate who shall use the property transferred or its income; ............................ ... ^ 0 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? .............. . .......... ... ^ X 3. Did decedent own an "intrust 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 FIL E IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 zero (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 beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Orris 21 10 713 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'ointl -owned with right of survivorship must be disclosed nn s~tiod~~io r ITEM NUMBER ~. Net procee s o sa e o ouse ai 7320 Wertzville Road, Carlisle, DESCRIPTION t o groan own an num ere as nberland County, Pennsylvania VALUE AT DATE OF DEATH TOTAL (Also enter on line 1 Recapitulation) ~ $ 2,181 00 (If more space is needed, insert additional sheets of the same size) a. Settlement Statement (HUD-1) OMB Approval No. 2502-02G I . ®FHA 4 ~VA ~. U rcna s. UConv. Unins. 6. File Number: .7. Loan Number 8. Mortgage Instuance Case Number: 5. ~Conv.lns. P147-462 1012004008 446-0648115/703 C. NOTE: This form is fiunished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not inchtded .m rt,P r..r~t~ J. Summa of Borrower's Transaction D. Name & Address of Borrower(s): Ian M. Rohrer Kimberly L. Rohrer 127 Mountain Road 127 Motmtain Road Shennans Dale, PA 17090 Shetmans Dale, PA 17090 F. Name & Address of Lender: Vision Mortgage Capital, a division of Continental Bank 620 West Germantown Pike, Suite 350 Plymouth Meeting, PA 19462 Place of Settlement: Wayne F. Shade, Esquire 53 West Pomfret Street Carlisle, Pennsylvania 17013 Previous editions arc obsolete E. Natne & Address of Seller(s): James E. Orris, Jr., Executor Estate of James E. Orris, Deceased 6958 Wertzville Road Enola, PA 17025 G. Property Location: 7320 Wertzville Road Middlesex Township Carlisle, PA 17015 H. Name of Settlement Agent Wayne F. Shade, Esquire 1. Closing Date: Disbursement Date: 3-31-2011 K, Summa of Seller's Transaction The Public Reposing Burden for this collection of information is estimated at 35 minwes per response for collecting, reviewing, and repormg the data. "I~his agency may not collect Ihis information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured, this disclosure is mandatory. "this is desibmed to provide the parties to a RFSPA covered transaction with information during the settlement process. 700. Total Real Estafe E3ased on price $ Division ofcotmni. 701.$ 801. Our origination 802. Your credit or c _ 803. Your adjusted c 804. Appraisal fee tc 805. Credit report to 806. Tax service to 807. Flood certificate 808. Ellie Mae closer 809. Repair inspectic 810. 811. 812. 813. 814. _ 900. Items Required 901. Daily interest ch. _902. Morteaee insurai 903. Homeowners ins 904. Hazard insurance 905. 1000. Reserves Depose 1001. Initial deposit for 1002. Homeowners insi 1003. MorteaQe insuran 1004. Protxrtv taxes 1005. County nrnn taY r the 03/31/2011 to 04/01/2011 2 1102. Settlement or closing fee to Wayne F 1 103. Owner's title insurance 1 104. Lenders title insurance 1 105. Lenders title oolicv limit $ 139 380 O( 1106. Owners title policy limit $ 168 000 OC 1 107. AEent's portion of the total title insurat 1108. Underwriters portion of the total title i 1109. Service Closine Letter to Commonwea I 1 10. Federal Express - $50 to $ 59 Paid From Paid From Borrowers Seller's Funds at Funds at Settlement Settlement $ 750.00 (from GFE k I ) $ (from GFE k2) (from GFE A) 750.00 (from GFE k3) (from GFE N3) 14.02 (from GFE N3) (from GFE H3) 8.00 100.00 100.00 (from GFE fF10) 20.05 (from GFE N3) 1380.00 (from GFE # I l ) (from GFE f!9) 1.421.38 1 -~ -wiosa (from GFE $ 659.25 (from GFE • •~~ ~ ~~ orn~emem statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as pan ~of~thpe settlement of this transaction- ~_. ~~'~~~ /~-_~2rf~j.t March 31, X01 I Wa1'ne f=,,>~hadc, I~syuirc Date Total 2 274.00 2 188.02 Increase between GFE and HUD-1 Cha es $ -85.98 or _3.78 Loan Terms Your initial loan amount is Your loan term is Your initial interest rate is Your initial monthly amount owed for principal, interest, and any mortgage insurance is Can your interest rate rise? Even ifyou make payments on time, can your loan balance rise? Even ifyou make payments on time, can your monthly amount owed for principal, interest, and mortgage insurance rise? Does your loan have a prepayment penalty? Dces your loan have a ballon payment? Total monthly amount owed including escrow account payments $ 139,380.00 30 years 5.250 % 866.79 includes ® Principal ® Interest ® Mortgage Insurance ® No.^ Yes, it can rise to a maximum of %. The first change will be on and can change again every after . Every change date, your interest rate can increase or decease by %. Aver the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. ® No.^ Yes, in can rise to a maximum of S ® No.^ Yes, the first increase can be on and the monthly amount owed can rise to $ The maximum it can ever rise to is S ® No.^ Yes, your maximum prepayment penalty is $ ® No.^ Yes, you have a balloon payment of S due in years on ^ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ® You have an additional monthly escrow payment of $ 270.73 that results in a total initial monthly amount owed of $ 1,137.52 principal, interest, any mortgage insurance and any items checked below ® Property taxes ~ Homeowner's insurance ^ Flood instrance ^ Note: If you have any questions about the Senlement Charges and Loan Tenns listed on ibis form, please contact your lender. Previous editions are obsolete Pane l of i HUD-t 750.00 750.00 750.00 750.00 1 680.00 1 680.00 LOAN #: 1012004008 VISION MORTGAGE CAPITAL, A DIVISION OF CONTINENTAL ~RRH 31, 2011 ADDENDUM TO HUD-1 SETTLEMENT STATEMENT Property Address: 7320 Wentzville Road Carlisle, PA 17015 NOTICE TO ALL PARTIES: If information is obtained which indicates that the source of the borrower's financial contribution is other than from the borrower or other than stated by the lender in its closing instructions, the settlement agent is to obtain written instructions from the lender before proceeding with settlement. CERTIFICATION OF BUYER IN AN FHA-INSURED LOAN TRANSACTION I certify that I have no knowledge ofany loans that have been or will be made tome (us) or loans that have been or will be assumed by me (us) for purposes of financing this transaction, other than those described in the sales contract dated (including addenda). I certify that I (we) have not been paid or reimbursed for any of the cash downpayment. I certify that I (we) have notand will not receive any payment or reimbursement forany of my(our) closing costs which have not been reviously disclosed in the sales rnntract (includingaddenda)and/or myapplication for mortgage insurance submitted to my (our) ortgage ten Ian M Rohrer Date Kimberl Rohrer Date CERTIFICATION OF SELLER IN AN FHA-INSURED LOAN TRANSACTION I certify that I have no knowledge of any loans that have been or will be made to the borrower(s), or loans that have been or will be assumed by the borrower(s), for purposes of financing this transaction, other than those described in the sales contract dated (including addenda). I certify that I have not and will not pay or reimburse the borrower(s) for any part of the cash downpayment. I certify that 1 have not and will not pay or reimburse the borrower(s) for any part of the borrower's closing costs which have not been previously disclosed in the sales contract (including any addenda). ~ ~j Il J es E Orris ,. ~ ate CERTIFICATION OF SETTLEMENT AGENT IN AN FHA-INSURED LOAN TRANSACTION To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account ofthe funds which were (i) received, or (ii) paid outside closing, and the funds received have been or will be disbursed by the undersigned as part of the settlement of this transaction. 1 further certify that I have obtained the above certifications which were executed by the borrower(s) and seller(s) as indicated. Sett ment Agent Date The certifications contained herein may be obtained from the respective parties al different limes or may be obtained on separate addenda.] WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment For details, see: Title IR U.S. Code Sections 1001 and 1010. crux ~m LOAN #: 1012004008 ADDENDUM TO HUD-1 SETTLEMENT STATEMENT I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my 2ccount or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. J es E Orris Ian M Rohrer itaberl Rohrer The HUD-1 Settlement Statementwhich I have prepared is atrue and accurate account ofthis transaction. I have caused or will cause the funds to be dais-bu-rsed in accordance with this statement. Wayne F Sh~de, Esquire 717-2 Settlement Agent 43-0220 Date WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine arid imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010. Online Documents, Inc. GAHt 0907 REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Orris 21 10 713 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 1999 C evro et B azer, Agreement o Sae ^ ~ ^^ ^^ 2. Walmart, final paycheck 3. Members 1st Federal Credit Union, account # 188108-00 4. Members 1st Federal Credit Union, account # 188108-11 5. Members 1st Federal Credit Union, account # 229853-00 6. Members 1st Federal Credit Union, account # 229853-11 7. Central Pennsylvania Teamsters Pension Fund, pension payment 8. Rowe's Auction Service, proceeds of sale of miscellaneous household contents 9. Internal Revenue Service, 2010 federal income tax refund 10. Pennsylvania Department of Revenue, 2010 income tax refund 11. Internal Revenue Service, earned income credit refund 12. Pacific Life Insurance Company, final structured settlement payment 9.16 13.35 1,708.48 5.00 70.16 1,737.00 3,320.45 357.00 92.00 231.20 36,000.00 TOTAL (Also enter on line 5, Recapitulation) ~ $ 45,643.80 (If more space is needed, insert additional sheets of the same size) MEMBERS 1St. FEDERAL CREDIT UNION BUSINESS SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 229853-00* 05/08/2003 $5.00 $.00 $5.00 None *DBA: OJIMBO SALES & TRANSPORT BUSINESS CHECKING ACCOUNT: Account Number/Suffix 229853-11* Date Account Established 05/08/2003 Principal Balance at Date of Death $70.16 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $70.16 Name of Joint Owner None *DBA: OJIMBO SALES 8~ TRANSPORT E ERSt 1sT FE1DERAL C EDIT U N i e A. Kline Lending Insurance Support Specialist November 9, 2010 Estate of: JAMES ORRIS Date of Death: 05/06/2010 Social Security Number: 191-40-8056 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org MEMBERS 1s~ FEDERAL CREDITiJN-ON SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 188108-00 10/07/1999 $13.35 $.00 $13.35 None 188108-11 10/07/1999 $1, 708.48 $.00 $1,708.48 None M MB RS 1sT FEDERAL CREDIT U Danielle A. Kline Lending Insurance Support Specialist November 9, 2010 Estate of: JAMES ORRIS Date of Death: 05/06/2010 Social Security Number: 191-40-8056 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER James E. Orris 21 10 713 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Hoffman-Roth Funeral Home 2,363.27 B. 2. 3. 4 5. 6. 7. 8. 9. 10. 11. 12. City State Zip ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address Year(s) Commission Paid: Attorney Fees Wayne F. Shade, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Register of Wills of Cumberland County, PA Accountants Fees Smith Elliott Kearns & Company Tax Return Preparers Fees Cumberland Law Journal, advertise Letters Testamentary The Sentinel, advertise Letters Testamentary Peck's Septic Service, pump septic tank York Waste Disposal, trash removal Register of Wills, filing inheritance tax return Register of Wills, reserve for filing Account, etc. 75.00 198.16 175.00 97.50 15.00 450.00 TOTAL (Also enter on line 9, Recapitulation) I $ 14.281.43 10,000.00 157.50 750.00 (If more space is needed, insert additional sheets of the same size) The amount of attorney fees in this modest estate reflect the necessity of expenditure of an unusual amount of time to address issues of insolvency in the estate for a year and a half until a final personal injury structured settlement payment was received. The efforts resulted in avoiding foreclosure against the residence and in achieving the write-off of thousands of dollars of claims of creditors. REV-1512 EX + (12-03) SCHEDULE i COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER James E. Orris 21 10 713 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Chase, mortgage account # 0001847456296, mortgage payments until sale of the 15,267.34 property 2. Chase, credit card # 5418220583066955 4,667.98 3. Chase, credit card # 4185813832619279 3,506.22 4 Capital One Bank (USA), N.C.A., account # 5178057250616963 2,058.51 5. PPL, electric service -account # 86720-72014 1,517.16 6. PPL, electric service -account # 86720-72023 276.58 7. York Waste Disposal, Inc., refuse removal 148.26 8. Capital One Bank (USA), N.C.A., account # 5178057250616963 1,338.03 9. Verizon Wireless, telephone service 294.99 10. Robinson and Geraldo, account # 1500 1,151.48 11. AseraCare Harrisburg PA, unreimbursed medical expense 2,200.00 12. Pathology associates of Central PA, unreimbursed medical expense 1,446.00 13. Quantum Imaging and Therapeutic Associates, unreimbursed medical expense 1,636.00 14. Tristan Associates, unreimbursed medical expense 1,675.00 15. East Shore Oncology, unreimbursed medical expense 110.00 TOTAL (Also enter on line 10, Recapitulation) ~ $ 49,313.40 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent James E. Orris Decedent's Name Page 1 21 10 713 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. 17. Pmnac e Hea t , unreim urse me ica expense First National Bank of Marysville, fuel oil owed to now bankrupt West Shore Oil 11,585.30 434.55 SUBTOTAL SCHEDULE I 12,019.85 GRAND TOTAL SCHEDULE I $ 49,313.40 REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Orris 21 10 713 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. James E. Orris, Jr. Lineal 6958 Wertzville Road Enola, PA 17025 2. Kimberly L. Rohrer Lineal 7320 Wertzville Road Carlisle, PA 17015 3. Rebecca A. Davis Lineal 72 Hoover Road Carlisle, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART [I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space is needed, insert additional sheets of the same size) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Discount: 0.00 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 _ __ _ ___ 1982 __ _ _ _ _- _ 1983 - --- --_ ___ _ __ _ _____ 1984 _--__ __ -- ___ 1985 ---- ,_ ___ _ _--_ 1986 . _ ----__ _ __ _ 1987 1988 through 1991 ---- _ -_ _ 1992 __ __ _ _ - 1993 through 1994 --__ 1995 through 1998 __ __ __ 1999 ___ _ _ 2000 2001 __ - 2002 _ - __ -___ 2003 _ - _ ____ 2004 _ 2005 -- _ __ - _ _ 2006 2007 __. - - - _ __ _- 2008 2009 2011 _328 _ _ _ _ _ _ _ 0.00_ __-__ 2012.__ _ _6 _ - _ _ _ 0.00.. ___ __ 0.00 TOTALS ..334 0.00 Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: LAST WILL AND TESTAMENT I, JAMES E. ORRIS, of the Township of Hampden, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my personal representative or representatives, hereinafter named, as soon as conveniently may be done after my decease. I further authorize my personal representative to expend funds from my Estate in such amounts as my personal representative shall consider appropriate, for the disposition and memorial of my remains. SECOND. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto such of my issue who shall survive me in equal shares by representation and not per capita. For the purposes of this my Last Will and Testament, my issue shall include children born to my children as well as step-children and adopted children of my children. THIRD. For the purposes of this my Last Will and Testament, a person shall not WAYNE F. SHADE Attorney at Law S3 West Pomfret Street Carlisle, Pennsylvania 17013 be deemed to have survived me unless he or she shall have survived me by more than ninety (90) days. FOURTH. I order and direct that any estate, inheritance or similar tax due as a result of my death with respect to any property passing as a result of my death, shall be paid from the residue of my Estate before its division into shares and prior to distribution as an expense of administration and that no part of the taxes should be prorated or apportioned among the persons or beneficiaries receiving the taxable property. It is my express intention that all inheritance taxes imposed as a result of my death be paid from the residue of my Estate whether or not the property passes under my Last Will and Testament. My personal representative shall have full power and authority to pay, compromise or settle any such taxes at anytime whether with respect to present or future interests. FIFTH. Any and all decisions, determinations or actions made or taken by a personal representative or Trustee hereunder, if made in good faith, shall be final and conclusive on all persons who are or may become interested in my Estate. No fiduciary acting under this my Last Will and Testament shall be liable for any error in judgment or for any depreciation or reduction in value of any Estate or Trust assets at anytime, in the absence of willful default. LASTLY. I nominate, constitute and appoint my son, JAMES E. ORRIS, JR., to WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania ]7013 be the Executor of this my Last Will and Testament, but if, for any reason, he should fail to qualify as such Executor or decline or cease so to serve, I nominate, constitute and appoint my daughters, KIMBF,RLY L. ORRIS and REBECCA A. ORRIS, to be the successive alternate personal representatives hereof, all to serve without bond. -2- IN WITNESS WHEREOF, I, JAMES E. ORRIS, have hereunto set my hand and seal to this my Last Will and Testament which consists of five (5) typewritten pages to each of which I have affixed my signature, this 13th day of April , A.D. One Thousand Nine Hundred Ninety-Nine (1999). (SEAL) J es E. Orris The preceding instrument, consisting of this and four (4) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by JAMES E. ORRIS, the Testator therein named, as his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. " /YL~LL J ~,T ~ ! / WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -3- Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, JAMES E. ORRIS, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to er affirmed and acknowledged before me by JAMES E. ORRIS, this 13th day of April 1999. mes E. Orris Notary Pub 'c Notarial Seal Connie J. Tritt, Notary Public ~ Carlis{e, Cumberland County ~.~y Commission Expires Oct. 5, 2000 WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -4- Affidavit COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS: We, Wayne F Shade and the witnesses whose names are signed hereto, bein dul Karen F . B ers g y qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instru as his Last Will and Testament; that the Testator signed willingly and executed it as hment free and voluntary act for the purposes therein expressed; that each subscribin witn the hearing and sight of the Testator signed the Wi11 as a witness; and that, to the best o in our knowledge, the Testator was at that time eighteen or more years of age, of sound f mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Wayne F. Shade and Karen F. Byers this 1_ day of April , 1999. ,witnesses, ti -~ ~. - 2r-~ Notary t lic Notarial Seal Connie J. Tritt, Notary Public Carlisle, Cumberland County ~`~ Commission Expires Oct. 5, 2000 ~.. , _,,,..~.._n_.,.__.__-._.___ WAYNE F, SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -5-