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Home My WebLink About01-20-12~~i a In the Court of Common Pleas of Cumberland County, Pennsylvania Orphan's Court Division IN RE: Estate of Charles W. Naftzinger, Late of New Cumberland , Cumberland County, Pennsylvania NO. 2010-01259 Deceased PETITION FOR SETTLEMENT OF SMALL ESTATE Pursuant to Section 3102 of the Probate, Estates and Fiduciaries Code, the undersigned Petitioner respectfully represents that: 1. The Name and Address'of the Petitioner is: David J. Naftzinger 274 Jaycox Road Avon Lake, Ohio 44012 2. The relationship of the Petitioner to the Decedent is: Son 3. The Decedent died on:.October 5, 2010 4. The Decedent was domiciled at time of death in Cumberland County, Pennsylvania, with a last family or principal residence at: 223 Haldeman Avenue New Cumberland, PA 17070 5. The Decedent's Social Security Number is: 184-12-3210 6. The Death Certificate is attached hereto as Exhibit "A". 7. The Decedent died: l?( testate ~ A copy of the Will is attached as Exhibit " ~w B". ,IO ~ c H z ~ ' c.~r~N ~-, ' a w' p O 8. s wife, Elizabeth A. Naftzinger predeceased the decedent The decedent ~ ~ o ~ ~ ~o N x O ~~ 2 .'~ ~ , 9. The name(s), relationship(s), and interest(s) of all parties beneficially interested in the estate are: UI JURI NAME RELATIONSHIP INTEREST a /no David J. Naftzinger ~ Son One Fourth Yes Susan A. Naftzinger Daughter One Fourth Yes Sally L. Naftzinger Daughter One Fourth Yes Charles S. Naftzinger Son One Fourth Yes 10. If the Decedent died testate, the Decedent: 0 (a). was not married or divorced after the execution of the Will 11. The Decedent died owning only a Fulton Bank checking account with a date of death balance of $11,317.76. A copy is attached as Exhibit "C". 12. An itemized statement of all claims against the Estate is set forth below: (a) The following persons claim reimbursement for debts, expenses, and other claims (including inheritance tax, if applicable) they have paid with their own funds: Person Claiming Date of Debt of Nature of Reimbursement Payment Payee Expense Amount David J. Naftzinger Parthemore Funeral 11,395.99 Funeral Home David J. Naftzinger Johnson Duffle Stewart & Weidner Administration Expenses 300.00 Total: 11.695.99 A copy of the paid receipt for the funeral expenses is attached as Exhibit "D". The aforesaid claims are entitled to priority payment under Probates 8~ Estates Code § 3392 (1) and (3) (b) The following claims have not been paid and there are insufficient funds in the estate to pay any of them: 3 ~+r ~ ~ Creditor Name and Address Account No. Statement Date Balance Capital One Services, Inc. 5178-0525-7294-9721 11/21/2010 $3,212.44 c% Weltman Weinburg & Reis Co., LPA 323 West Lakeside Avenue Suite 200 Cleveland, Ohio 44113-1009 U.S. Bank 4897-0600-2007-4607 11/10/2010 $6,278.74 Cardmember Services PO Box 6352 Fargo, ND 58125-6352 Sears MasterCard 5121-0719-2724-2663 11/16/2010 $3,964.16 PO Box 6282 Sioux Falls, SD 57117-6282 Sears Card 5049-9481-3409-7312 12/09/2010 $3,359.30 PO Box 6283 Sioux Falls, SD 57117-6283 HFC 713304-10-315159-7 11/10/2010 $8,497.33 PO Box 3425 Buffalo, NY14240-9733 Bank of America 4313-5120-9065-7782 11/15/2010 $1,279.49 PO Box 15026 Wilmin ton, DE 19850-5026 13. There will be no Pennsylvania inheritance tax due. A copy of the filed Inheritance tax return is attached as Exhibit "E". 14. The consents of Susan A. Naftzinger and Sally L. Naftzinger and Charles S. Naftzinger are attached hereto after Petitioner's Verification. 15. Notice of intention to present the petition was given to all unpaid claimants on January 17, 2012. Copies of the aforesaid notices and receipts for mailing are attached hereto as Exhibit "F". 4 ,~r ~ , WHEREFORE, your Petitioner prays that an Order be entered authorizing distribution of the Fulton Bank Checking Account No. 1018-39231 to your Petitioner Respectfully Submitted, Johnson, Duffle, Stewart & Weidner By:~~ Richard W. Stewart Supreme Court ID 18039 Office Address: Johnson, Duffle PO Box 109, 301 Market Street Lemoyne, Pa 17043 Telephone No. 717-761-4540 5 , r ~ , VERIFICATION The undersigned petitioner hereby verifies, subject to the penalties of 18 Pa. C.S.A. §4904 (relating to unsworn falsification to authorities), that the facts set forth in the foregoing petition which are within her knowledge are true, and, as to the facts based on information received, after diligent inquiry, she believes them to be true. Date: ature o e ~ goner ,•~ . , JOINDER We, SUSAN A. NAFTZINGER and SALLY L. NAFTZINGER, daughters of Charles W. Naftzinger, have read the Petition of our brother, David J. Naftzinger, for settlement of a small estate, consent thereto and join in the prayer thereof. ,~~ . , JOINDER I, CHARLES S. NAFTZINGER, son of Charles W. Naftzinger, have read the Petition of my brother, David J. Naftzinger, for settlement of a small estate, consent thereto and join in the prayer thereof. arle . Naftzinger EXHIBIT A 105.805 REV (01/07) ~ ~ - '. - ,. ~ - f y - - ~. - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph.. 'ee for this certificate; $b.00 This is to certify that, the information here. given is correctly copied from an original Certificate of Death duly. filed with the as Local.Registrar.. The original - - certificate will be .forwarded- to the State Vital Records Office for permanent filing. P 16805056 ~ ~.'' - p 1 Certification Number. Local Registrar . - Date Issued ~~++~ COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ' (Sea Instructbns and exampba on revarael -.-_.. ....-•_-- t. War dDearad(Fiel nddde, br, rAlQ ~ 2 Sr 8 Sodr S.a,Ry gnba - _ - ...- {. Dtl, d DWi 1~+4 btu Y+rl - Charles W. Naftzin er Male 184 - 13 - 3210 October 5 2010 - ~ & AY• Rrl BAidy) UMa1 UMa 1 S DW d BM 7. etd rre a 4Pb d D•M one Ilodr ~ More rlrM Haeplat Olrr . 91 va ~ OctobeY 10, 1918 Harrisburg, PA ^ ~~ ^ BI I Oupnlyd ^ DDA ^ Nuretp Home ®Neebrbe ^ Olrr- SprJy: ~ Coudy d Ooe/i 8a Clq, Bam,.TrRll Oeelr 9d Fa3yNarronal bYlWrlda,bwadaaEM /. Wr DeadaddHYpetdc odlht ®No ^Yr IaP~Aaetkrtbdrl lledlWbl,.eb Cumberland ' New Cumberland 223 Haldeman Avenue Pne.wai~a` I~» Mrdrrl Purb ncrl r~l whit e 11. Deo,Mh Uaai daakdtr mold /a Do Mrr, 16tldVd t 12 Yya, D,aedrl era b Ir to B,eads[e EAptla ICY sly lidrl Irad, arpel,q it. A4AIr 81rc 1Mnb4 Nara 1Mtrbd 16. SwMbp Spare (11 rNe, /M maba nrr) U 9 Amrd Fawrti -Wbow d Dh d - a DnddBuobralbduby . . , . e aee yl _ (~ EM~dary r 5eoorrmry ro'+~ CoMle Q-% a 5r) t l (~ Yr ^ No Widowed' l/.neoeaar•wrro~dderl6astdb/b•awr.~pooa.l 223 Haldeman Avenue oeo,enr, aeoaea,d rwtwhrdetrene.sbb Pennsylvania lhab. - t7o.^YetiDeadetdlMdin - _ r w. New Cumberland PA 17070 Taa,~pt D ~ +>b.ca•ro Cumberland +Td ® ldr,aan~b New Cumberland ~ d dy/eao la FArlt Neme~Ftlr, ndddb, Wl Charles Wilson Naftzin er la MdtlWeNarlRrr, nldd,,nrba renar) ~ . g Edna Rline 9be. bbmrr'e Nter (TYW r ~ ~ tab. bbmrrY ~q Ntlea (tbnl. at,Ylbal'err, tip title) :David. J. Naftzia er 274 Jaycox Road, Avon Lake, OH 44012 21t YMrddpepoeWott ~. ^Qeadott-.^DOtrlon ft0. OredDYpoeYa (Matl4 dt•Y••A 21t PYadDYpalien Mrmedanrrty, aamnbryadaPYr) Old laala KTA'rball role, rp oode) ® errs D PantawlldmSM, r WrdewrbnaOaMlntAUltMSr1 October 11, 2010 ^ Olrr • ~ by MMor ErairrrCaartt - ^ Yr^ No Rolling Green Cemetery Lotaer Allen 1~Tp. PA 17011 ~. 28t ~ ~rpremaolN/ r etrh) 2ffi.llorw Numbs 29a Nenr end Addw d Fetiy ~ Parthemore FH & CS'Inc: P.O. Box 431 New Cumberland PA 17070 tbtprbl,as mlrliorlyYp . L10.TolrbWdny amrNdtl lYrr,dr,rd .~pruerdd) 290.UareNumha 29t:DYe 81Pr0IMm~ll dry,ywJ ebb /reddeAtb aAyawddu/i N St 430 ~.: Ib -_05 ~- , Mar PI.2/rrl M mnpYbd bypnr - Yr. Tbr d Ddi 25. DW liettaro,d De,tl (-bnd4 deg, Y•N ?$ Yhr Ceti IbMed b N~dcelElritrw I Coro kr a NMeon OIMr Its tlettrla a DaMbn9 •Ir ptonouew doh. ~ .. nn ,' I '..co. Al - .. ~~~ :. ^Yee. ~NO.. _ . . C'AUBE OF DEATH (8s. 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'"° nn 7 ~Ci ~ ,~i/ is i ~ I i ~ a%o a / 10 . Ht rrs,.u ~ P,r l~ 2... orpa.nbn ee~mrla. 05 ~f 2130 ' ~ .. EXHIBIT B ~; ti J ,, ^~ ~,' LAST tiIILL AND TESTA~rIENT of ` CHARLES ~YILSOPI NAFTZINGER - ~, CHARLES PfIZ,SOii. PIAFTZ~IGER, residing at ' yEw C'uyBE~2zi9.v0 223 Haldeman. Avenue in-the City oP , County CvMBE,eLANO oP and State oP Pennsylvania, being of sound . and disposing mind and memory, do hereby declare this to be my Last ~itill and Testament, hereby revoking any and all wills and testaments, or vrritings in the nature ' thereof., by me at any time heretofore made, thus dis- posing oP all my estate: ITEM I: I-give, devise and bequeath .all mg estate, wheresoever and whatsoever,. both real and per- _ sonal, to which I may be entitled or which I may have power to dispose oP at my death, unto my wife,.Eliza- beth Ann Naftzinger, absolutely, iP she shall be living at my death. - . ITEM II: In the event that my wife., Eliza= beth Ann Naftzinger does not survive'me, then I give, devise and bequeath all oP my estate, both real and personal, to my children in equal shares; but in the event that. any of them shall have died in my lifetime '~ leaving issue at my death,-such issue shall stand in ~~• their place and take the share such deceased child -would have taken. if such child had survived me. -1- EXHIBIT C ' ~ ~ ~ ~~`'~~~~~ ° • ` 1057 0010 336.1 Y ^...- LISTENING 15 JUST THE BEGINNING.'" STATEMENT OF ACCOUNTS 1018-39231 X STATEMENT PERIOD FROM ~ THROUGH 9--17-»10 10-17-10 0 PAGE 1 OF' 2 CHARLES W NAFTZINGER ELIZABETH A NAFTZINGER 223 HALDEMAN AVE 1 ENCLOSURES NEW CUMBERLND PA 17070-1138 0 ~~ ~~ ~ FUL' TON Cl.ASSI["~~ECKTNG' • ~ ~~~" -"' "' "' ~ ~.'~ "' •~ "'ACCOUNT:" 1018=39231 ~•~ ' `~ ~ PREVIOUS DEPOSITS/ CHECKS/ SERVICE ENDING STATEMENT BALANCE CREDITS 2 DEBITS 7 FEES BALANCE 11,300.30 945.48 1,057.54 .00 11,188.24 ACCOUNT/INTEREST INFORMATION INTEREST PAID THIS YEAR 4.3$ DEPOSITS/ CHECKS/ DATE ACTIVITY DESCRIPTION REFERENCE CREDITS DEBITS BALANCE 09-17 BEGINNING BALANCE ~ 11,300.30 09-17 CHK CARD PUR 901393 37.60 NICK'5114 NICK'S114C NEW CUMBERLANPA 11,262.70 09-23 VERIZON ARC 00077900000 338.03 gi6E~IX PYMT 100922 10,924.67 10-01 US TREASURY 303 00077900000 945.00 soc SEC 100110 )OOOOC3210A SSA 11,869.67 IO-04 SEARS PAYMENT 00077900000 130.00. CHECK PYMT 101001 5961 10-04 SEARS PAYMENT 00077900000 150.00 CHECK PYMT 101001 10-04 5963 CHECK 5962 00302002380 171.91 11,417.76 10-05 CAPITAL oNE ARC 00077900000 100.00 CHECK PYMT 101004 5966 11,317.76 10-06 59~ K CR CD PMT 00077900000 130.00 76 °11 187 10-X5 INTEREST CREDIT .48 , . 11,188.24 24 11 188 10-17 ENDING BALANCE , . CHECK SUMMARY * INDICATES SKIP IN CHECK NUMBERS CHECK Np 5960 AMOUNT 338.03 CHECK NO 5963 AMOUNT 150.00 5961 ~ ~ 130.00 5964 130.00 5962 171.91 5966* 100.00 TOTAL NUMBER OF CHECKS 6 TOTAL AMOUNT OF CHECKS 1,019.94 DIRECT FULTON BANK, N.A. INQUIRIES T0: PO BoX 504 EAST PETERSBURG, PA 17520-0504 ~°01~'T~' h(amLar P.D1.C TELEPHONE: 717-581-3000 OR 1-800-FULTON4 p+•~+ Page 1 EXHIBIT D EXHIBIT E ~.. NOTICE OF INHERITANCE TAX Pennsylvania ~ DEPARTMENT OF REVENUE REV-1547 EX AFP C12-10) BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DI~(IS,IOM OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 + l ' HARRISBURG PA 17128-0601 RICHARD W STEWART 301 MARKET ST PO BOX 109 LEMOYNE PA 17043 DATE 03-28-2011 ESTATE OF NAFTZINGER CHARLES W DATE OF DEATH 10-05-2010 FILE NUMBER 21 10-1259 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 05-27-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO:~ REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ------------------------------------------ ~ -------------------------------- REV-1547 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE ----------------- OR _ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: NAFTZINGER CHARLES WFILE N0.:21 10-1259 ACN: 101 DATE: 03-28-2011 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CScheduie A) C1) •0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .0 0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) 1 1,31 7.76 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .0 0 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers CScheduls 6) (7) .00 8. Totai Assets (8) 11, 317.76 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (g) 11,4 6 9.49 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 27,72 7.88 11. Total Deductions C11) 39, 197.37 12. Net Value of Tax Return C12) 27,879.61- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00 14. Net Yaiue of Estate Subject to Tax C14) 27,879.61- NOTE: If an assessment was issued previously, reflect figures that include the total ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate lines 14, 15 and/or 16, 17, 18 and 19 will of ALL returns assessed to data. (ls) .00 x 00 .00 cls) _ on x 045 = . 00 c17) - no x 12 ~ . 00 cls) .00 x 15 .00 n9)= .00 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITSs DATE ~ NUMBER ~ INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A °CREDIT" CCR), YOU MAY BE DUE - -- - FOR CALCULATION--OF ADDITIONAL-INTEREST.- -- - - - - A-REFUND.-SEE-REVERSE-SIDE OF-T-HI-S FORM-FOR-INSTRUCT-IONS.- - - - `~' ~ ~ 150561014.3 . PR Departn'lent of Revenue - OFFICIAL USE ONLY Pennsylvania county code rear File Number Bureau of Individual Taxes au"aT~r~~~~ Po Boxztosol INHERITANCE TAX RETURN 21 10 ~~ Harfisburg,PA 17128-0601 1 q RESIQ~ENT DECEDENT EN-TER DE<tEDENTINFORMATION~BELOW SociaFSecurity Number Date of Death Date of Birth -184 12" X210 10 05 2010 10 10-' 1918 Decedent's Last Name Suffix Decedent's First Name MI NAFT Z I NGER ~ '"T"ABLE S W- (!f Applicable) EFlter Surviving Spouse'y Info::- t?;; a t ~; „~ Spouse's.Last Name` Suffix Spouse's First Name MI Spouse's Social Security Nurnber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE .REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ 1. OriginaLRetum ^ (date of death 2. Supplemental. Return ^ 3' p 1 ` nor to 2 13 2) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (date of death after 2-12-82) g; Decedern oleo Testate ^ (Attach Copy Of Wilp T (D~eca~er~t AAaird~ined a Living Tnst - 8. Total Number of Safe De sit Boxes opy o rust) Po . 9. Litigation Proceeds Received ^ ^ 1 p, s sal Poverty grer't (dare r death 11, Election to tax under Sec: 9113(A) b~ en 12-31 ~J1 ar~ t-t-95~ ^ (Attach SCh. O) CORRESPONDENT -.THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD W STEWART (717) 7 454 0 ~ rn REGISTER OF~~ SE O~jY ~ ~ ~ ~r-~ ~ ~? First line of address ~~~ ,,,~ 301 MARKET ST ~O ~ ~;~ ~..~ Second line of address ~rt PO BOX 10 9 ~ ca City or Post Office DATE FILED ~ State ZtP Code LEMOYNE PA , Correspondent's a-`nail address: RWS@JDSW.COM ~ - Under penalties of pei)ury, I declare that I have examined thisretum, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, lt is true, correct and complete; Declaration of prepare` other than the personal representative is based on all information of which prepare` has any knowledge. SIGNATURE OF PERSON RE LE FOR FILING RETURN DATE David J Naftzinger ~~ ,~ 2--O[ U ADDRESS 274 Jaycox Road, Avon Lake, OH 44012 .._ . * ... ,. SIGNATURE OF PREPARE O THER THAN REPRESENTATNE R DATE ~ ,, / ____~ ~~ RICHARD W. STEWART i ~ ~ Zz - /Lj ADDRES 301 Market St., Lemoyne,; PA Side.1 - 15[]561!1143 - 15l]561p143 ~~,~~ 1505610.243 - REV-1500 EX Decedent's Social Security Number " - - oenrs"Nemar NAFTZIfVGER, Charles W 184 12 3210 RECAPITULATION 1. Reai Estate (Schedule A)::.:.:.. .......::. .............:....... ............:...............:... L - . 2. Stocks and Bonds (Schedule B) ............:.:.......... .....:... :....:..........:..:.....:..... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. ' Mortgages & Notes Receivable (Schedule D) ................... ..:...... ..:......,........ 4. 5. Cash, Bank Deposits. 8 Miscellaneous Personal Property (Schedule E): ..............' S. 11 , 317.7 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested.....:...... 6. 7. Inter-Vrvos Transfers 8~ Miscellaneous lyon; Probate Property (Schedule G) Se arate Billi R t d:: : p LJ ng eques .:.. e ..... 7, 8 Total Gross Assets (total Lines 1-7)...:........:..... .: ..:...........:...... .....:.......:... g, 11 , 317 : 7 6 9. Funeral Expenses & Administrative Costs (Schedule H).... ............................... 9. 11 , 4 6 9.4 9 10. Debts of Decedent, Mortgage Liabilities, & Lieris (Schedule I) ...................:......... 10. 2 7 ~ 7 2 7 ' 8 8 _ 11. Total Deductions{total Lines 9 & 10) ............................... .. ......... ............. 11 3 9 197 : 37 - r 12: Net Value of Estate (Line 8 minus Line 11) ...............................:......................:.. 12. - 2 7 , 8 7 9:61 , 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, -2 7 , 87 9 . ~1 , TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable " at the spousal tax rate, o? transfers under Sec. 9116 (a)~1.2) X :00 15. ~ 0.0 0 16. Amount of Line 14 taxable 0 . 0 0 at lineal rate X .045 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. ax Due..:,..... ..... ............. T :........ ........................ ...................::..............:....... 1 s. 0. 0 0 20. ., FILL IN THE OVAL IF YOU ARE. REQUESTING A REFUND OF AN OVERPAYM _. {, ENT. : Side 2 150561D243 1505610243 J 1 REV-1500 EX Page 3 Deceder>;t's Complete Address: File Number 21-10 DECEDENT'S NAME NAFT2INGER, Charles W STREET ADDRESS 223 Haldeman Avenue ` CITY- ~ New Cumberland STATE PA ZIP 17070 Tax Payments and Credits: L Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. _Prior Payments B. Discount 0.00. Total Credits (A + Bj (2) D.00 3. Interest... (3) 4, If Line. 2 is greater than Line 1 + Line 3, enter the difference.. This is the OVERPAYMENT. (g) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q.00 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 :......................:..:.............:....... .......:. ...:........ ~ 0 b. retain the right to designate who shall use the property transferred or its income :............................:..... x a retain a reversionary interest; or ..............::..........:......:...........:.................. .......:.:.............. ...:::....... x d. - receive: the promise for life of either payments, benefits or care?: ........................................: .....:......: x 2.. If death occurred after December 12, 1982,-did decedent transfer property wdhm one year of death without O a receiving adequate wnsideration?..:.........:.w .....:....... .....:.......:.:....... ......... .:...............:...... .~........ 3. Did decedent own an "in trust for" or payable upon. death bank account or security at his or her death?..:.:.. ^ Qx 4. Did decedent own an Individual Retirement Account annuity, or other non probate property which contains a beneficiary designation? ........:...:. :..:...:.:.........,... .:....... .......:. .....:... :....::.. ...:....:.. IF THEANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PARTOF THE RETURN. For dates of death on or after July ?, 1994. and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after ;laruaiy f; '995, the-tax rate~imposed on the net value of transfers to or for the use of the suniiving sprsuse is O percenf [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 stiltapplicable 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 21 ears of age of youngefat death to or for the use of a natural parent, an adoptive parent, or a stepparent`of the child is 0 percent [72 P.S. §9116 (a) (1:2)J. - . -The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §911.6 L2) [72 P:S. §91,16 (a) (1)1• .-The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §91"16 (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-f soa ex+ is-gat comimwNwtEn~TH of rENNSnvaNw fNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E Cr4SH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER NAFTZINGER, Charles W 21-10 InGude the s of Iltigation and the date the proceeds were received by the estate. All property ntlyowned with the right of survivorship must be disclosed on schedule F. (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-1167•EXt (10+061 SCHEDULE H co N, nNw FUNERAL EXPENSES`& M~~'~-D~~o~~ ADMINiSTRATfVE COSTS ESTATE OF FILE NUMBER . - ~ NAFTZINGER, Charles W 21-10 Debts of decedent must be reported on Schedule I. ITEM _ DESCRIPTION AMOUNT. NU B A. FUNERAL EXPENSES: See continuation schedule(s) attached 11,395.99 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions - Name of Personal Representative(s) Street Address City. State Zip Year(s) Commission paid 2. Attorney's Fees 3, family Exemption:. (If decedent's address is not thesame as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees ti: Tax Return Preparer's Fees- - ~ - 7. Other Administrative Gosts 73.50 See continuation schedule(s) attached . TOTAL (Also enter on line 9, Recapitulation) 11,469.49 Copyright (c) 2009 form software only The Lackner Group, Inc.. Form PA-1500. Schedule H (Rev. 10-06) ,: SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ~ _ ESTATE OF FILE NUMBER _ NAFTZINGER, Charles W 21-10 ITEM.. NUMBER DESCRIPTION AMOUNT. Funeral Ex enses 1 Funeral Expenses 11,395.99 ~. H-A 11.395.99 Other Administrative Costs 2 Cumberland County Register of Wills Office -Filing fees for Inheritance Tax Return (15.00),. 73.50 Inventory (15.00) ,Petition for Small Estate (15.00) and Cumberland County JCP Fees (28.50) - H-B7 73.50 ReY-t st ~ r~c+ hz-oet. ~~ ' ~ -SCHEDULE 1 • -bEBTS OF DECEDENT, - MORTGAGE LIABILITIES, & LIENS -COMMONWEALTH OF PENNSYLVANIA - - - - .. 'INHERITANCE TAX RETURN . RE3IDENT DECEDENT E$TATE OF _ FILE NUMBER NAFTZFNGER, Charles W 21-10 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bankol`America. 1,279.49 2 capital .One Services, Inc.. - c/o Weltman, We"inberg 8~ Reis Co: LPA 3,212.44 3 HFC 8,497.33 4 Sears Card 3,359.30 5 Sears MasterCard 3,964.16 6 US Bank Card Member Services 6,278.74 7 US Bank Card Member Services -Card Payment 130.00 8 - West Shore EMS^-ALS 1,006.42 - TOTAL (Also enter on Line 10, Ret:apitulation) 27,727.88 (If more space is needed, additional pages of the same size) ` ' Copyright'(c) 2009 form software only Tht: Lackner Group, Inc. Form PA-7500 Schedule I (Rev. 12-08) EXIBIT F COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION N0.2010-01259 IN THE ESTATE OF CHARLES W. NAFTZINGER LATE OF BOROUGH OF NEW CUMBERLAND, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED NOTICE NOTICE is hereby given that ~ Petition for Settlement of Small Estate will be filed by David J. Naftzinger, for the Estate of Charles W. Naftzinger, in the Office of the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. A copy of the Petition for Settlement of Small Estate is enclosed herewith. Unless written objections are filed with the Clerk of the Orphan's Court on or before March 6, 2012, the prayer for relief contained in the attached Petition will be granted Richard W. Stewart Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 To: Capital One Services, Inc. c/o Weltman Weinburg & Reis Co., LPA 323 West Lakeside Avenue Suite 200 Cleveland, Ohio 44113-1009 U.S. Bank Cardmember Services PO Box 6352 Fargo, ND 58125-6352 Sears MasterCard PO Box 6282 Sioux Falls, SD 57117=6282 Sears Card PO Box 6283 Sioux Falls, SD 57117-6283 HFC PO Box 3425 Buffalo, NY14240-9733 Bank of America PO Box 1.5026 Wilmin ton, DE 19850-5026 9171 9690 0935 0013 0644 92 9171 9690 0935 0013 0645 08 9171 9690 0935 0013 0645 15 91?~ 9690 0935 0013 0645 22 9171 9690 0935 0013 0645 39 9171 9690 0935 0013 0645 46