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HomeMy WebLinkAbout03-0911Estate of Zoula M. Corn PETITION FOR GRANT OF LETTERS Estate of Zoula M. Corn No. ~q'J © ~"'~ ;' ~// also known as , Deceased Social Security No. 174-05-1464 Joseph E. Corn Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) [ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or named in the Last Will of the Decedent, dated 7/7/00 and codicil(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 233 Allen Road, Carlisle, Cumberland County~ PA 17013 (list street, number and municipality) Decedent, then 95 years of age, died October 24 ,2003 , at Carlisle Hospital, Carlisle, Cumberland County, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ 50~000.00 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ 100,000.00 Total ..................................................................................................................... $ 150,000.00 Real Estate situated as follows: 233 Allen Road, Carlisle, Cumberland County, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence I I J ~-~¢~ Z ///~'~'/ Joseph E. Corn 124 Horners Road, Carlisle, PA 17013 RW-, /'7--/' 7'-/--/'/ STATUS REPORT UNDER RULE 6.12 Name of Decedent · Zoula M. Corn Date of Death' 10/24/2003 Will No. Admin. No. 21-03-00911 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 X No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court ? Yes X 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 X No ~ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this~~o~~ Date · 10/25/2004 Signature // Stephen d. Hooc~. Esquire Name (Please type or print ) 19 S. Hanover Street. SIc. 101 Carlisle PA 17013 Address (717) 2452698 ',~:,-,, 'o Tel No. Capacity' Personal Representative 8 [1 o~,z X Counsel for personal representative Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this ~ l .~ 1. day of Donna ~I. Otto,lst Deputy' DECREE OF REGISTER Estate of Zoula M. Corn .Deceased No. 21-2003-911 also known as Social Security No: 174-05-1464 Date of Death: 10/24/03 AND NOW, October 3 ] s t-. 2 0 r) ~ , , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary I~ of Administration ((c.t.a., d.b.n,c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to Joseph E. Corn in the above estate and that the instrument(s), if any, dated July 7, 2000 described in the Petition be admitted to probate and filed of record as the Last Will of Decodent. FEES ,' Letters ........................... j-,-'~, ..... $ 235 · 00 . Short Certificates(s) .... 2::::" .....$ 6.00 Donna M. Depu Renunciation ........ '-~ $ Extra Pages( 3 ) ............... $ 9·00 I.T.R ....................................... $ Signature JCP Fee ................................. $ 10.00 Attorney: Stephen J. Hog,g, Esquire Inventory ................................$ I.D. No: 36812 Other ...................................... $ Address: 19 S. Hanover Street, Ste. 101 Carlilse PA 17013 TOTAL ............................. $ ~¢;n 00 Telephone: 7172452698 DATE FILED: 10/31/2003 Call Attorney then put in ~ file- Prothonotary office on 10/31/2003 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 forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 9 6 4 9 4 8 9 uCf No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,. Zoula M. Corn . Female . 174-- 05 -- 1464 ,. October 24, 2003 : -30-1908 Ge~t~sb~o. PA ,~,~ ~o.~ ..... ~ ~0 . ~ . ~ 1~° . Cumb~land [~ C~lisle . Cl~mon~ N~s~n Hom~ ~ ...."'"~ ...... ,~. ,. Wido~d ,,. C~lisle, PA 17013 ~ ,,. John a. Eltz uo~,.~,.,,,~,,. ............. ~ .... ' Eama C. Ross m. ~. Joseph Corn I~ 124 Hornea's Road, C~tisle, PA 17013 ~.,~ ~ =~,~s~.~ ~ 10 - 30- 2003 I,,..4100 Jone~t0~n Road. H~risb~o. PA I~. 21-2003-911 ZOUL M, COP I, Zoula M. Corn, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM TWO: I give, devise and bequeath my entire estate to my two sons, Joseph E. Corn and Clyde H. Com, share and share alike, per stirpes ITEM THREE: I appoint my son Joseph E. Corn, Executor of this my last will. ITEM FOUR: All estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportioment or fight of reimbursement. ITEM FIVE: I direct that my person representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SEVEN: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property, and to give options for leases. Zola M. Com PAGE ONE OF FOUR PAGES D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN~.4~fSS WHEREOF, I have hereunto set my hand this ~ day of ,2000. t SIONED O_. Zo~h~ M. Corn The preceding instrument, consisting of this and three other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names. PAGE TWO OF FOUR PAGES COMMONWEALTH OF PENNSYLVANIA: : SS COUNTY OF CUMBERLAND : witnesses whose names are ~i the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn and subscribed to No-~ry Public Notarial Seal Bridget Ann Corcoran Notary Public Carlisle Bore, Cumberland County My Commission Exp res June 10, 2002 PAGE THREE OF FOUR PAGES COMMONWEALTH OF PENNSYLVANIA: · SS COUNTY OF CUMBERLAND · I, Zoula M. Corn, whose name is signed to the attached insmmaent, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed· Zoulat~J. Corn Sworn .~.~ a/fi'tuned to and acknowledged before me this ~ day of c,J6 ,2000. I Notary Publid Notarial Seal Bridget Ann Corcoran, Notary Pub c Carlisle Boro Cumber and County My Corem ss on Expires June 10, 2002 PAGE FOUR OF FOUR PAGES ZOULA M. CORN BROUJOS g GILROY, P.C. A'I-FORNEYS AT L3kW zl NORTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 Estate of Zoula M. Corn CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Zoula M. Corn Date of Death: 10/24/03 Will No. 51-O~- 911 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 11/5/03 · Name Address Joseph E. Corn 124 Horners Road Carlisle PA 17013 Clyde H. Corn 880Yadkin College Road Lexinqton PA 27295 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:. Name: Stephen J. Hoqq, Esquire Address: 19 S. Hanover Street, Ste. 101 Carlisle PA 17013 Telephone(717) 2452698 Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003452 HOGG STEPHEN J 19 S HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $5,500,00 ESTATE INFORMATION: SSN: 174-05-1464 FILE NUMBER: 2103-091 1 DECEDENT NAME: CORN ZOULA M DATE OF PAYMENT: 01 / 16/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 10/24/2003 TOTAL AMOUNT PAID: $5,500.00 REMARKS: STEPHEN J HOGG, ESQ CHECK//101 5 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + OOMMONWEALT. REV'1500 O F C,ALUSEO LY DEPARTMENTOEREVE.UE INHERITANCE RETURN DEPT. 280601 ,,,,,s,,,~.,,~0~ RESIDENT DECEDENT 2 1 -0 3 0 0 9 1 1 COU~ CODE y~ NUMBER DECEDENTS ~ME (~ST, FIRST, AND MIDDLE INITIAL S~IAL SECURI~ NUMBER Z Corn Zoula M. 1 7 4- 0 5- 1 4 6 4 ~ DATE OF O~TH (MM-D~Year) DAT~ OF BIRTH (M~D~Year) THIS R~U~ MUST BE FILED IN DUPLICATE ~H THE 0 10/24/2003 03/30/1908 REGISTER OF WILLS ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURIW NUMBER .~. [] 1. O~inal Ret~m [] 2. SupplementaIRetum [] 3. Remainder Return ~a.~~: ~ ~: [] 4, Limited Estate [] 4a. Futura Interest Compromise (d~ oldeah a~er 1~-1~-82) [] 5. Federal Estate Tax Return Required ~ m !._J 6. Decedent Died Testate (~ch cop~ of Will) ~ I 7, Decedent Maintained a LNing Trust lA.ch *opy of Trust) -- 8. Total Number of Safe Deposit Boxes < [] 9. LitigalJonProceedsRecehred [] 10. SpoueslPover~Cmditl~ore~athbe~,~2.31-91a,d~-~-o~) [] 11.ElectiontotexunderSec. 9113(A)lAtac, SchO) ;_ THiS SECTION MUST BE ~OM~ ~ CORREsPONdENCE mz NAME COMPLETE MAILING ADDRESS z Stephen J. Ho,q,q, Esquire '19 S. Hanover Street, Ste. '101 a. FIRM NAME (If App~ic~)le) o TELEPHONE NUMBER ~ (717) 245-2698 Carlisle PA 17013 1. Real Estete (Schedute A) (1) 88,703.~.2 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) ~ ~i~ 3. Closely Held Corporation, Partnership or Sole-Propdetorship {3) ~'~ 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) 54~ 160151 (Schedule E) 6. Join~ Owned Propod7 (Schedule F) (6) ....... "~ 7. Inter-Vives Transfers & Miscellaneous Non-Probate Properly (7) I.- (Schedule G or L) ,-, ~ 8. Total (3roes Assets (total Lines 1-7) (8) 142,864.43 ILl 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 18~889.79 10. Debts of Decedent, Mor~age Liabili~es, & Liens (Schedule i) (10) 2,780.78 11. Total Deductions (total Lines 9 & 10) (11) 21,670.57 12. Net Value of Estate (Line 8 minus Line 11) (12) 121 ~ 193.86 13. Charffable and Govemmental Bequests/Sec 9113 Trosle for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 121 ~ 193.86 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES -- rote, or transters under Sec. 9116 (a)(1.2) X __ (15) ~ 16. AmountofLine14taxableatlinealrate 121,193.86 x 4.5 (16) 5,453.72 (J X .15 (18) X 19. Tax Due ~ (19) 5,453.72 Decedent's Complete Address: STREETADDRESS 233 Allen Road C~TY Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) (1) 5,453.72 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ~.500.00 C, Discount Total Credits ( A + B + C ) (2) 5,500.00 3. Interest/Penalty if applicable D. interest E, Penalty Total Interest/Penalty ( 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) 46.28 5. If Line 1 + Line 3 is greater than Line 2, enter lhe 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. (5B) 0.00 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; ........................................................................... [] [] b. retain the right 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 cocurred 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 secudty 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 SCHEBULE G AND FILE IT AS PART OF THE RETURN. Unde pe~a ass of pedury I declare that I have examined thL~ return, includi~ accom0anying schedules and statements, and to the best of my knowledge and belief, it is true, correct and ~,,,pl,~[~. ADDII[E,~ 12~'[:~rners Roa~ PA 17013 D,~TE / 19 S. Ste. 101 Carlisle PA 17013 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% F2 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 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 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 4.5%, except as noted in 72 P,S. §91 f 6(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 12% [72 P,S. §9116(a)(1,3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Corn Zoula M, ;~1 03 00911 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 pmpmly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, beth having reasonable knowledge of the relevant fads. Real prol~ert~ which ia jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Single family home located at 233 Allen Road, Carlisle, Cumberland County, 88,703.92 Pennsylvania, Deed Book O, Page 139 ;ettlement on May 18, 2004 to Coy R. Wire, 6 Park Circle, Camp Hill 17011 TOTAL (Also enter on line 1, Recapitulation) $ 88,703.92 more space L~ needed, inse~t additional sheets of the same size) 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 Corn Zoula M, 21 03 00911 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sprint Refund 1.17 2. Interest - December 19, 2003 28.37 3. Interest - January 21,2004 26.03 4. Interest - February 20, 2004 20.55 5. Interest- March 19, 2004 19.06 6. Interest - April 21,2004 26.81 7. M&T Checking Account~538582 40,167.16 8. Refund House Insurance 116.00 9. Interest - June 21, 2004 85.72 10. Proceeds from Auction 3,514.00 11. Deposit for sale of real estate 10,000.00 12. Interest - July 21,2004 70.14 13. Interest - August 20, 2004 55.39 14. Interset - May 21,2004 30.11 TOTAL (Also enter on line 5, Recapitulation) $ 54,160.51 (If mom space is eesded, inse~ additional sheets of the same size) REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Corn Zoula M. 21 03 00911 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cremation Society 11,10 2. Pastor Charles Brophy 100.00 B. ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions NameofPemeealRepmsanteUve(s) Joseph E. Corn 6,349.63 Social Secudty Number(s)/EIN Number of Pemonal Representative(s) StmetAddrsss 124 Horners Road city Carlisle State PA Zip 17013 Year(s) Commission Paid: 2. AttomeyFees Stephen J. Hogg, Esquire, 19 S. Hanover St., Ste.101, Carlisle,PA 17013 6,349.63 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant S~et Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 260.00 5. Accountant's Fees 6. Tax Return Preparers Fees 7. Advertising: Cumberland Law Journal 75.00 Sentinel 88.43 8, Inheritance Tax Paid 5,500.00 9. Short Certificate 6.00 10. Accounting (Est.) 125.00 11. Tax Return and Inventory Filing Fee 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 18~889.79 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Corn Zoula M. 21 03 00911 Include unrelrnbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Claremont Nursing Home 608.28 2. Agway Energy Products January 5, 2004 115.48 3. Agway Energy Products March 1,2004 (Final Payment) 192.17 4. Sprint October 24, 2003 54.69 5. Sprint December 8, 2003 46.55 6. Spint December 30, 2003 46.77 7. Spint February 2, 2004 47.10 8. Sprint March 1, 2004 43.39 9. April 5, 2004 (Final Payment) 47.46 10. PP&L November 3, 2003 36.53 11. PP&L December 8, 2003 29.58 12. PP&L January 5, 2004 28.91 13. PP&L February 2, 2004 28.21 14. PP&L March 1, 2004 25.06 15. PP&L April 6, 2004 24.98 TOTAL (Also enter on line 10, Recapitulation) $ 2~780.7R (If more space is needed, inserl additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Corn Zoula M. 21 03 00911 Decedent's Name Page 1 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. PP&L May 3, 2004 19.13 17. PP&L May 29, 2004 (Final Payment) 7.40 18. Borough of Carlisle Water/Sewer December 8, 2003 15.08 19. Borough of Carlisle Water/Sewer January 5, 2004 15.08 20. Borough of Carlisle Water/Sewer February 2, 2004 15.08 21. Borough of Carlisle Water/Sewer March 1, 2004 15.08 22. Borough of Carlisle Water/Sewer April 6, 2004 15.08 23. Borough of Carlisle Water/Sewer May 3, 2004 (Final Payment) 15.08 24. Farmers Mutual Insurance Company 118.00 25. Mary Haring (Trash Hauling) December 27, 2004 60.00 26. Mary Haring (Trash Hauling) January 3, 2004 60.00 27. Mary Haring (Trash Hauling) February 28, 2004 60.00 28. Walmart - clearing supplies 104.26 29. Miscellaneous -Carlisle trash bags, stamps 103.47 30. West Shore EMS 89.81 SUBTOTAL SCHEDULE I 712.55 Continuation of REV-1500 Inheritance Tax Return Resident Decedent Corn Zoula M. 21 03 00911 Decedent's Name Page 2 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 31. Reimbursement to U.S. Treasury 693.07 SUBTOTAL SCHEDULE I 693.07 GRAND TOTAL SCHEDULE I $ 2,780.78 INVENTORY Estate of Zoula M. Corn No. 21 03 00911 also known as Date of Death 10/24/2003 ., Deceased Social Security No. 174-05-1464 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennaylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory, i/We vedfy that the statements made in this inventory are true and correct. I/We undemtand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. personal Representative: Name of Attomey: Stephen J. Ho.cj.cj, Esquire Joseph E. Corn I.D. No.: PA36812 Address: 19 S. Hanover Street, Ste. 101 Dated 09/10/04 Cadisle PA 17013 Telephone: 7172452698 Deschption Value Sprint Refund 1.17 Interest - December 19, 2003 :: ,, ~ ~28.37 Interest- January 21,2004 ; '~ : 26.03 Interest - February 20, 2004 ~ ~:,20.55 Interest - March 19, 2004 19.06 Interest - April 21, 2004 26.81 Total 54,160.51 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania ma'/, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of th,e inventory. RW-4 Continuation of Inventory ~oula M. Corn 21 03 00911 Pa,qe 1 3escription of Inventory Description Value vl&T Checking Account~538582 4(~,167.16 Refund House Insurance 116.00 'nterest - May 21,2004 30.11 Oroceeds from Auction 3,514.00 3eposit from sale of real estate 10,000.00 nterest - June 21,2004 85.72 ,nterest - July 21, 2004 70.14 interest - August 20, 2004 55.39 Subtotal 54,038.52 Grand Total $ 54,160.51 IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ZOULA M. CORN : ORPHAN'S COURT DIVISION : NO. 21 03-00911 FIRST AND FINAL ACCOUNTING Of the estate of Zoula M. Corn, Deceased, Late of Cumberland County, Pennsylvania. Filed on behalf of JOSEPH E. CORN, Executor Date of Death: October 24, 2003 Letters Testamentary Granted: October 31, 2003 Letters Advertised: The Sentinel: 11/20/03, 11/27/03, 12/04/03 Cumberland County Wall Journal: 11/1403, 11/21/03, 11/28/03 Accounting Filed: ACCOUNT FINAL AS OF: OCTOBER 15, 2004 LAW OFFICES1. OF STEPHEN j. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ZOULA M. CORN : ORPHAN'S COURT DIVISION : NO. 21 03-00911 Purpose of the Account: Joseph E. Corn, Executor of this Estate files this Accounting to acquaint interested parties with the transactions that have occurred during his execution. The Account also indicates the proposed distribution of the estate. It is important for the Account to be carefully examined. Requests for additional information or questions or objection can be discussed with the undersigned Attorney for the Estate. Stephen J. Hogg, Esquire 19 S. Hanover Street, Suite 101 Carlisle, PA 17013 (717) 245-2698 Attorney for Estate LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 RECEIPTS OF PRINCIPAL REAL ESTATE Proceeds from Sale of Real Estate at 233 Allen Road, Carlisle, PA sold to Coy R. Wire. $ 88,703.92 Deposit for Sale of Real Estate $ 10,000.00 CASH M&T Bank Checking Account #538582 $ 40,167.16 Interest to September 21,2004 $ 413.45 Direct Deposit from Social Security $ 693.07 Proceeds from Auction $ 3,514.00 Harleysville Insurance $ 28.00 STOCKS 5 Shares of Pennsylvania Railroad $ 0.00 (Affidavit of Non-Value Attached as Exhibit A) ~ REFUNDS Sprint Refund $ 1.17 Farmer's Mutual Insurance- Home Insurance Refund $ 116.00 Inheritance Tax Overpayment $ 46.28 TOTAL GROSS ASSETS $143,683.05 LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE I01 CARLISLE, PA 17013 DISBURSEMENTS OF PRINCIPAL EXPENSES AND DISBURSEMENTS Claremont Nursing Home $ 608.28 West Shore EMS $ 89.81 Farmers Mutual Insurance Company $ 118.00 Reimbursement to U.S. Treasury $ 693.07 Agway Energy Products-January 2004 $ 115.48 Agway Energy Products-March 2004 $ 192.17 Sprint- October 2003 $ 54.69 Sprint- December 2003 $ 46.55 Sprint- December 2003 $ 46.77 Sprint- February 2004 $ 47.10 Sprint- March 2004 $ 43.39 Sprint-April 2004 $ 47.46 PP&L-November 2003 $ 36.53 PP&L-December 2003 $ 29.58 PP&L-January 2004 $ 28.91 PP&L- February2004 $ 28.21 PP&L-March 2004 $ 25.06 PP&L-April 2004 $ 24.98 PP&L- May 2004 $ 19.13 PP&L~May 2004 $ 7.40 L^woF~CESOF Borough of Carlisle Water/Sewer- November 2003 $ 15.08 STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 Borough of Cadisle Water/Sewer- December 2003 $ 15.08 Borough of Carlisle Water/Sewer- January 2004 $ 15.08 Borough of Cadisle Water/Sewer- February 2004 $ 15.08 Borough of Carlisle WatedSewer- March 2004 $ 15.08 Borough of Cadisle Water/Sewer- April 2004 $ 15.08 Borough of Carlisle Water/Sewer- May 2004 $ 15.08 Mary Haring (Trash Hauling)-December 2003 $ 60.00 Mary Haring (Trash Hauling)-January 2004 $ 60.00 Mary Haring (Trash Hauling)-February 2004 $ 60.00 Wal-Mart (Cleaning Supplies) $ 104.26 Miscellaneous (Trash bags, stamps) $ 103.47 Subtotal $ 2,795.86 ADMINISTRATIVE EXPENSES Cremation Society of Pennsylvania $ 11.10 Pastor Charles Brophy $ 100.00 Personal Representative's Commission $ 6,349.63 Attorney Fees $ 6,349.63 Probate Fees $ 260.00 Advertisement: Cumberland Law Journal $ 75.00 Carlisle Sentinel $ 88.43 Accounting $ 125.00 Short Certificate $ 6.00 Tax Return and Filing Fee $ 28.00 LAW OFFICES OF STEPltEN J. ItOGG Inheritance Tax Paid $ 5,500.00 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 Subtotal $ 18,892.79 TOTAL EXPENSES AND DISBURSEMENTS $ 21,688.65 TOTAL GROSS ASSETS $143,683.05 LESS EXPENSES AND DISBURSEMENTS $ 21,688.65 NET ESTATE AMOUNT FOR DISBURSEMENT $121,994.40 LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 VERIFICATION I, Joseph E. Corn, do hereby verify that I am the Petitioner herein, and that the facts set forth in the aforegoing Petition to Settle an Estate are true to the best of my knowledge, information and belief, upon the information supplied. I understand that false statements herein are subject to the penalties of 18 Pa. C.S.A. {}4904, relating to unsworn falsifications to authorities. Jo/s~ph E.'Corn Sw~or0 to or affirmed ~ s~l~scribed to before me by witnesses, this ~ S~PHEN J. ~G, ~AflY PUBL~ ~ ~ ~ota~ Publi~ My Commission Expires: LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 CONSENT TO DISTRIBUTION I, the undersigned party in interest in the Estate of Zoula M. Corn, aver I have received and read a copy of the attached First and Final Accounting with a proposed final distribution schedule. I understand the proposed distribution and have no objection thereto. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STP~EET SUITE 101 CARLISLE, PA 17013 CONSENT TO DISTRIBUTION I, the undersigned party in interest in the Estate of Zoula M. Corn, aver I have received and read a copy of the attached First and Final Accounting with a proposed final distribution schedule. I understand the proposed distribution and have no objection thereto. C.~de H. Corn LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ZOULA M. CORN : ORPHAN'S COURT DIVISION : NO. 21 03-00911 PROPOSED DISTRIBUTION Paragraph Two of Will: Total Net Estate Value: $121,994.40 Joseph E. Corn $ 60,997.20 Clyde H. Corn $ 60,997.20 LAW OFFICES OF STEPHEN J. HOGG ~9 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 Edward Jones Art Amundsen 21 West High S~'eet Investment Representative Carlisle, PA 17013 , (717) 258--4688 ' ' EdwardJone$ MAY 21, 2004 STEPHEN HOGG 19 S HANOVER ST. CARLISLE, PA. 17013 RE: 5 SHARES OF PENNSYLVANIA RAILROAD TO WHOM IT MAY CONCERN: PENNSYLVANIA RAILROAD (5 SHARE CERTIFICATE) HAS ~ SEVERAL CHANGES~OR EXCHANGES AND NOW TRADES UNDER AMERICAN FINANCIAL GROUP. IT IS THE OPINION OF OUR COMPANY THAT DUE TO THESE CHANGES OVER SEVEP. AL YEARS THAT FUNDS MAy HAVE BEEN ESCHEATED TO THE STATE. ENCLOSED ARE ADD- RESSES AND.PHONE NUMBERS T~IAT MAy BE CONTACTED TO CHECK ON THIS. THERE MAy BE A CHARGE FOR RESEARCH. SINCERELY, ART AMUNDSEN ~RA/ama I hereby cedify th~ wdlteA notice of the liiing o~ Statement of Proposed ~, at~ cf th8 time mid I:~lilCe ~dlefl the ~4~e ~ be Pre'e~nled to the Court f~ c(x~mlalte~t ~ ~the Isst day to wrlffefl ol:Y~;:tim~ to ~ ~ of Propose,: and to =.~ ~ ~ ~ ~ ~ a~ounta~t have~ ~ ~ ~ ~, A ~py ~ ~ ~ ~ i~ ~th lhe · alq jo lxeu '/ue!oll. eueq '~ol.!peJo me elslse eql u!. laeJelu! ua uJ!elO ~o aAeq o~ ~m~.moc~e eql. ol u~ou4 uosJad Jeq, lo/ueAe ol pl. Je ~ I:~ ol ue^!§ ueeq s~4 'luno~ plae ol euof. loe{qo uetl!J~ alii ol ~ep la~l eup, ~o pu~ uolTeu~oo I~noo eql. ol pelue~eJd eq II1~ eu~ee eu~ ueq~ eoeld pue e~ull 'elep et8 lo pug '~unooov COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE BUREAU OF IHDIVIDUAL TAXES NOT/CE OF /NHERITANCE TAX ~HERITANCE TAX DIVISION po BOX ZSOGOt APPRAISEHENT, ALLONANCE OR DXSALLONANCE HARRISBURG, PA 171Z8-0601 OF DEDUCTIONS AND ASSESSHENT OF TAX REV-I$4?EXAFP¢Bg-04) DATE 11-29-Z00~ ESTATE OF CORN ZOULA M DATE OF DEATH FILE NUMBER 21 05-0911 ~ ~ ~ *~ COUNTY CUMBERLAND STEPHEN J HOGG ESQ ACN 101 STE 101 I Amount Remitted 19 S HANOVER ST CARLISLE PA 170i*$~: MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CORN ZOULA M FILE NO. 21 05-0911 ACN 101 DATE 11-29-200~ TAX RETURN WAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es{a~e (Schedule A) (1) 88z705.92 NOTE: To insure proper 2. S~ocks and Bonds (Schedule B) (2) .00 credi~ ~o your account, $. Closely Held S~ock/Per~nership In~eres~ (Schedule C) ($) .00 submi~ ~he upper portion ~. Hot,gages/No*es Rmcelveble (Schedule D) (~) .00 of ~hls form wi~h your 5. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (S) 5~1160.51 ~ex payment. 6. Jointly O~ned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. To~el Asse~s (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 15,589.79 9. Funeral Expmnses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Debts/Hot,gage Liabilities/Liens (Schedule I) (10) 2 ;780.78 11. To~el Deductions (11) 12. Ne~ Value of Tax Re~urn (12) 126,695.86 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 1~. Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq) 126,69~.86 NOTE= Z~ an assessment Nas issued previously, lines 14, 15 and/or 16, 17, 18 and 19 Nlll reflect flgures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX= .00 x O0 .00 15. Amoun~ of L/ne lq e~ Spousal ra~m (15) = 16. Amoun~ of Line 1~ ~exablm e~ Lineal/Class A re~m (16) 126,695.86 X 0~5 = 5,701.22 17. Amoun~ of Line lq e~ Sibling re~m (17) .00 X 12 = .00 18. Amoun~ of L/ne lq ~axeble e~ Collateral/Class B re~m (18) .00 X 15 = .00 19. Principal Tax Due (19)= 5,701.22 TAX CREDITS: PAYMENT RECEIP1 DXSCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 01-16-200~ CD005~52 285.06 5,500.00 11-22-200~ REFUND .00 85.8~- TOTAL TAX CREDIT 5,701.22 BALANCE OF TAX DUEI .00 INTEREST AND PEN. ] .00 TOTAL DUE I .00 ZF pAID AFTER DATE /ND/CATED, SEE REVERSE ( ZF TOTAL DUE KS LESS THAN $1, NO PAYMENT TS REQUIRED. ~ FOR CALCULATION OF ADD/TIONAL INTEREST. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR}, YOU HAY BE DUE RESERVATION: Estates of decedents dying on or before December 1Z, 19aZ -- 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 Coaaoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laeful Class S (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To fulfill the requirements of Section zlqo of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available on[ina at aaa.revenue.state.Da.us, any Register of Nills or Revenue District Office, or from the Department's Z4-hour answering service for fores orders: l-DOO-36Z-ZOSO) services for taxpayers with special hearing and/or speaking needs: 1-800-447-$0Z0 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisaent, alloaanca or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within 60 days of the date of receipt of this notice by filing one of the fallowing: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a pretest online at #ww.bcardofappaels.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals websita. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box Z810Z1, Harrisburg, PA 171ZD-lOZ1. Petitions may not be foxed. D)Election to have the matter determined at the audit of the account of the personal representative. ADMXN- 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.D. Box Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) far an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is alloaed. PENALTY: The 15Z tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and nat paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .00016¢. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate ehich will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200¢ are: Interest Daily Interest Dally Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .0005¢8 1988-1991 iXZ .000301 goox 9Z .OOOZ¢7 198S 162 .0004~8 199Z 9X .000247 ZOOZ 62 .000164 1964 11Z .000S01 1995-1994 7Z .OO019Z ZOOS 5Z .000137 1985 13Z .000S56 1995-1998 9Z .000Z¢7 200¢ ¢Z .000110 1986 lex .00027¢ 1999 72 .00019Z 1987 lOX .000Z7¢ ZOO0 7Z .O00X9Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 FILE NUMBER DECEDENTS NAME ZOULA M CORN 2103-0911 ACN REVIEVVED BY John Kealy 101 ITEM EXPLANATION OF CHANGES SCHEDULE NO. H B-8 Inheritance tax is not an allowable deduction against the taxable estate. ROW Page 1 IN RE: ESTATE OF ZOULA M. CORN IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION 21-2003-09l 1 ORDER OF COURT AND NOW, this clay of December, 2004, the within account is confirmed and distribution directed in accordancc with t ~e schedule. By the Court, COMMONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA~fi~F~i';Cn Oi'TICE OF 'rNHER'rTANCE TAX 'rNHERTTANCE TAX DTVTSTON DEF';e-'~'rr' ~'?: ~,'I l e STATEMENT OF ACCOUNT po sox zso6oz HARRISBURG, PA 17128-0601 REV-16D7 EX AFP (0g-Od) DEC 29 AH 9:12 CLERK OF ORPHAN'S COURT STEPHEN J STE [9 S HANOVER ST CARLZSLE PA 17015 DATE 12-06-200q ESTATE OF CORN DATE OF DEATH 10-24-2005 FILE NUMBER 21 05-0911 COUNTY CUMBERLAND ACN 101 Amount Remi'l:~ed ZOULA M MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LO#ER PORTTON FOR YOUR RECORDS ~ ESTATE OF CORN ZOULA M FILE NO. 21 05-0911 ACN 101 DATE 12-06-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM IN THE NAHED ESTATE. SHO#N BELON IS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, [F APPL/CABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-22-2004 PR[NC[PAL TAX DUE: ........................................................................................... PAYMENTS (TAX CREDITS): 5,701.22 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 285.06 01-16-2004 11-22-2004 CD005452 REFUND .00 5,500.00 85.84- ZF PA/D AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 5,701.22 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )