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Home My WebLink About03-0850BEINHAU -C CiLLO ATTORNEYS AND C(DUNSELOI~ AT LAW September 23, 2003 Register of Wills Cumberland County Courthouse High and Hanover Streets Carlisle, PA 17013 The Estate of Philip E. Garretson Dear Register: Enclosed please find all the necessary paperwork to file the above Estate along with a check for $113.00 for filing fees and six (6) Short Certificates. The Administratrix,, Janet E. Garretson, has already been sworn in at Montgomery County Courthouse. Please file this information and remm a time stamped copy in the enclosed self-addressed stamped envelope. The original documents should be sent to the Harrisburg address. If you should have any questions, or require any further documentation, please feel free to contact my office. Thank you. Enclosures JAC/nmf Sincerely yours, BEINHAUR & CURCILLO Jos hA'~Cur" o III JOSEPH A. CURCILLO, III. ESQUIRE · JOHN R. BEINHAUR, ESQUIRE ANNE E. HOUSER, PAP. ALEGAL · COURTNEY A. WALTZ, PAI>.ALEGAL 3964 LEXINGTON STREET HARRISBURG, PA 17109 Ph: 717.651.9100 Fax: 717.651.9200 WWW.BEINHAURCUI~CILLO.COM PHILADELPHIA AREA OFFICE: 9518 HUNTINGDON PIKE SUITE E HUNTINGDON VALLEY PA 19oo6 PETITION FOR GRANT LETTERS OF ADMINISTRATION ~tare of'_Phil~? R c~r~toen alto known as ~ociai ~ No. 197-40-6278 To: Re~r of Wf, lls for the CO~y 0fCumberland ,. i~ the Commonwealth of Pesmylvania The petition of' thc undc,ei~n~ respe~ully rmrcsenU the~: Yourpetitioner(s). whois/~re 1~ yesrs of~ or older, apl~ ~-,-<~ _ forlem:rsof ~~on on thc c~tc of (d.b.n4 pmdmte Ifte; ~ ~ dur~te ndno~uue) t~e sl)ove decedem. Decendetn at dglath owned property with estimated values as follksws: (~g domiciled m Pa.) All ~ propa~ (If no~ domkilat k Pa.) Personal. property in P~,~lv'anis (If not'di~nidled in Pa.) ~ pzopert7 in Coun~ Velu~ of re~ e~tate in Pennsyh~ 247 S. Front S_tr~. .a~A]en~,. PA . River Alley, Steelt6n, PA $.3:00D._ $ $ ~o n99 1704_~ P~fioner ~ef~owin~spouse(ffany) s. ndheirs: Lo~sia F. ~e~on Barbara Kintzer after a proper scm'eh hn.a_ ~ flint d~cedimt left no w/Il ~d was survived by Janet E. Garretson ~a~ph S. Garretson Rg~omMp Mother Sister Sister Brother 523 Bosler Avenue, Lamoyne, PA 5_41 ~n_~k~ ~,,~; ~o!legeville, :523 Rns] ~r_ lUOnll~_ Lcmoyne, PA 3~ ~9-~te Read, O~sining, NY ~RR, peti~oner(s) re~pec'tftflly ~tuest(s) the Brant of letters of adminLm'ation in the appropriate form to the undersigned, ~Janet E. ~rretson OATH OF PEI~ONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ SS COUNTY OF MONTGOMERY The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are tree and correct to the best of my knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. befofff_~ne thi~ .... ~.~._~ ...... day of / Janet E Garretson .................................................................. .......... ............... ...... i PHILIP E. C~RI~ixSON Estate of ................................................................................................................ , Deceased GRANT OF LETTERS OF ADMINISTRATION ANDNOW,. ........... ...O~....T?..B..E...R....1..7...T~.. ................................ 20 ..0...3. .... , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that a/gqET E. C_~RES~ is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ................. J.AN~T..E,..~oARt~T.~ON ............................................................................................. in the estate of ...................... .P..H.X.L..I..P.....E..'...~..~...~ ................................................................................................. FEES Letters of Administration .......$ ~l.0O ................. Short Certificates (6 ) ....... $ .].~I^Q0 ................. Renunciation ...(.1}. ................. $....5.....0..0. ................. CP e 10.00 1Jn(v./~ax Forms ................... $ ............................ Commission ........................... $: ........................... TOTAL ............... $ .t-3.-3-,OO .............. lq ~ ,3. ~tt.. ke...t..t..e...r..s. 2..t.9...b.t...t.9...r~...e.y...?..n. ....................... 10/17/2003 Donna M. Ot to, ls~e~e~ O~y,b / /~/~e~ Joseph A. Curcillo, III, Esquire ........ #.....4.4.0.6. a ....................................................................... ATTORNEY (Sup. Ct I.D. No.) 3964 Lexington Street ../{ar-ri~hur. g.,....~A ...... 1.2.1.0.9. ................................. ADDRESS ........ L7..1.1.).....6.5.1.- B.I.00 .................................................. PHONE RENUNCIATION In Re Estate of 21-2003-850 Philip E. Garretson deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Louisa F. Garretson of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Janet E. Garretson WITNESS ~LTH OF pEN, NSYLVANIA_ I ~t~~~ I (Signature) (AddLess.) (Signature) (Address) (Signature) (Address) 21-2003-850 REGISTF~ OF WILL CIJMBF~I.,AND COUNTY COURTHOUSE mo~ mu~ tmqo~ STR?TS_. CARLISLE PA 17013 - UPS NEXT DAY AIR TRACKING #: 1Z FF2 010 01 9091 2904 Reference# 1: G~reuon CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Philip E. Garretson Date of Death: 08/11/03 Will No. Admin. No. 2003-0850 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: Name Address Louisa F. Garretson 523 Bosler Avenue, Lemoyne, PA 17043 Notice has now been given to all persons entitled thereto underRule 5.6(a) except Date /f)/~.-/~~/~ Signature' Name Jo _s~/~A. ~cillo, ~, Esquire Address 3964 Lexingto. a~Street Harrisburg/,~PA 17109 Telephone (717) 651-9100 Capacity: __ Personal Representative X Counsel for personal representative FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF PHILIP GARRETSON (Deceased) CLAIM No. 2003-00850 of 2003 : :~ .7 To the Clerk of Orphans court Division: Index and make proper entry in your official records of the claim of OMN~UM FINANCIAL RECEIVABLE SERVICES for HOUSEHOLD FINANCE CORPORATION (Claimant), account # 71330417119299, in the amount of $8,614.84 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 521 BOSLER AVE, LEMOYNE, PA 17043, died on August 11, 2003. Written notice of this claim was given to JOSEPH CURCILLO, 3964 LEXINGTON STREET, HARRISBURG, PA 17109 (Personal representative, if any, or counsel). October 24 , 2003 OMNIUM FINANCIAL RECEIVABLE SERVICES 7171 MERCY RD, SUITE 400 PO BOX 6618 OMAHA, NE 68106 800-999-3778 (Claimant's Address) IN RE: ESTATE OF PHILIP GARRETSON (Deceased) No. 2003-00850 of 2003 OMN1UM FINANCIAL RECEIVABLE SERVICES for HOUSEHOLD FINANCE CORPORATION (Claimant) Fee $ Filed Attorney Form 93 CLIENT: HOUSEHOLD FINANCE LOAN - ONGOING ACCOUNT: 87800081 STATUS: ACTIVE STATUS PACKET: More... E ADDRESS INFORMATION I CONTACT TYPE: PRMCON PREFIX: FIRST NAME: PHILIP MIDDLE NAME: LAST NAME: GARRETSON EXTENDED: SUFFIX: IL CODE: MAIL CONTACT INFORMATION I PHO INFO mTIONI LANGUAGE: ENGLSH PHONE TYPE: HOMPHN RESP: PRMRSP AREA CODE: 717 PREFIX: 939 NUMBER: 3254 EXTENSION: ANSWER CODE: SSN: 197406278 CALL CODE: CALL CLI REF#: 71330417119299 REASON: 42-CLAIM FILED ADDRESS TYPE: PRMHOM STREET: 521 BOSLER AV CITY: LEMOYNE STATE: PA ZIP CODE: 17043 COUNTRY: US 000 000 I EVENTS I [ BALANCES ] I ADJUSTMENTS I I-- PAYMENTS I I ACCOUNT STATISTICS I CURRENT BALANCE: 8614.84000 ADJUSTED BALANCE: 0.00 LISTING BALANCE: 8614.84000 PROMISED PAYMENTS: 0.00000 PRINCIPAL PAYMENTS: 0.00 LOCAL LISTING BAL: 0.00000 ACTIVITY: More... COMMONWEALTH OF PENNSYLVANIA NOTICE OF CLAIM COURT OF COMMON PLEAS OF CVM~EP,~.,~,~) COUNTY ORPHANS' COURT DIVISION In Re: The Estate of: PHILIP GARRETSON Deceased Court File No: 2003-00850 TO: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). Claimant's name: Claimant's address: 1) 2) 3) 4) BANK ONE cio NCO Financial Systems, Inc Probate Department,#450 1804 Washington Boulevard Baltimore, MD 21230 (443)263-3300, ext 3304 Creditor listed below is the owner and holder of a claim in the amount of $.10,523.36 The facts upon which this claim is based is a credit agreement between Creditor and Decedent, identified as account number which is evidenced by the attached affidavit of account stated. 5) 6) 7) Decedent's address: 521 BOSLER AVE. LEMOYNE, PA 17043 Date of Death: uNI~OW~ That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant I do solemnly declare/~nd afl rm under t/he ~nalti · . _ es of perjury that they Information and representatio[)~ madCl)erein ar.~"~-and correct to the best of my knowledge, information an~e;ief. Dated:.October 27, 2003 ___ /~/'~ ~k_! ~ ¥~ ,AGENT / C a mant 7- J6296~ Written notice of claim was given to Personal Representative and/or his/her 80unsel as stated below: JOSEPH CURCILLO ' ' Name 3964 LEXINGTON STREET Address HARRISBURG, PA 17109 City/State/Zip October 27, 2003 Date notice mailed In the Estate of: PHILIP E. GARRETSON D~e: NOVEMBER 6,2003 Est~e No.: 2003-00850 D~e of Decrth: AUGUST 11,2003 CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by the PHILIP E. GARRETSON deceased. ~ accordcmcewith the attachedstatementofaccount, the sumof $ 1,295.41 togetheiwith interest ~ ther~e of 0% from NOVEMBER 6,2003 un~p~d. GOODS & SERVICES FOR: VISA: 4418-5391-3516-1441 On behalf of the claimant, I do solemnly declare and cfffirm under the penalties .of perjury that the Information and representations made herein txre true and correct of the best of my knowledge, information crud belief. ROSEMARY MOORE/SENIOR ADJUSTER (Name of Claimant) BOX 3773 (Address of Claimant) OMAHA, NE 68103 (Signcffure of Clc~ant or person authorized to make verification on behalf of creditor) P 0 BOX 3773 (Address) OMAHA, NE 68108 1-800-688-7070 (Phone Number) FI! .ET): 1-800-688-7070 (Phone Number) ~'~ First National Bank Omaha B 107154 PHILIP E GARRETSON 521 BOSLER AVE LEMOYNE PA 17043-1815 4418539135161441 PREMIER EDITION VISA Payment Due Statement Closing Date Days in Billing Cycle Payment Due Date Amount Past Due $ Minimum Payment Due $ First National Bank Omaha P.O. Box 2951 Omaha, NE 68103-2951 0000000000000 Account Number: 4418 5391 3516 1441 Page 1 of 1 Payment Due Date: September 15, 2003 New Balance: $1,295.41 Minimum Payment Due: $0.00 First National Bank · Omaha A~nount Enclosed Change of Address? []Please check box and complete reverse side. 0000000129541 PLEASE DETACH HERE AND RETURN TOP PORTION WITH YOUR PAYMENT t Account Summary 08-19-03 Previous Balance $ 1,345.41 32 Payments and Credits - $ 50.00 New Transactions + $ 0.00 Total Billed FINANCE CHARGES + $ 0.00 New Balance $ 1,295.41 Account Number: 4418 5391 3516 1441 Credit Line Total Credit Limit $ Cash Limit t $ Available Credit $ Ava ab e Cash $ 2,000.00 1,000.00 0.00 0.00 Purchase Post Date Date Transaction Summar~ Payments and Credits New Transactions Visit us online! Please see our address below. Charge Summary Average Daily Balance Current Old Daily Periodic Rate 0.00 $ 1,309.93 0.0000% 0.00$ 0.00 0.0000% Corresponding APR 0.000% 0.000% Billed Pedodic Rate FINANCE CHARGE $0.00 Need Help? Online Access www.firstnational.com Issued by First National Bank of Omaha Customer Service Toll Free 1-888-530-3626 Balance Transfer Hotline TDD Telecommunications Device for the Deal Toll Free Toll Free 1-800-340-2273 X 1307 1-800-925-2833 See reverse for additional information. Thank You For Your Business ~"~ First National Bank Omaho PHILIP E GARRETSON 521 BOSLER AVE LEMOYNE PA 17043-1815 44185391351614&1 PREMIER EDITION VISA First National Bank Omaha P.O. Box 2951 Omaha, NE 68103-2951 0000000002600 Account Number: 4418 5391 3516 1441 Page 1 of 1 Payment Due Date: August 12, 2003 New Balance: $1,345.41 Minimum Payment Due: $26.00 Make checks payable to (~ First National Bank 00000001345~1 Amount Enclosed Change of Address? [Please check box and complete reverse side. PLEASE DETACH HERE AND RETURN TOP PORTION WITH YOUR PAYMENT Payment Due 07-18-03 Account Summary Statement Closing Date Previous Balance $ 674.82 08-12-03 Payments and Credits - $ 150.00 PaymentDays in BillingDue DateCyCle 30 New Transactions + $ 803.80 Amount Past Due $ 0.00 I Total Billed I FINANCE CHARGES + $ 16.79 Minimum Payment Due $ 26.00 New Ba ance $ 1,345.41 Account Number: F 4418 5391 3516 1441 Credit Line Total Credit Limit $ Cash Limit t $ Available Credit $ Ava ab e Cash $ 2,000.00 1,000.00 654.00 654.00 Purchase Post Transaction Payments New Date Date Summary and Credits Transactions 6-23 6-23 PAYMENT- THANK YOU $ 50.00- 7441800317402300005996:1 7-03 7-03 LUCIANO'S ROMA CAFE STEELTON PA $ 20.00 5812 2415838~187628395205092 7-05 7-07 THE PAR~ SOURCE BELLEVUE KY $ 175.97 592! 24445003 ! 88629525 !60781 YOU CAN PAY YOUR CREDIT CARD BILL ONLINE ANYTIME DAY OR NIGHT AT WW1N.FIRSTNATIONALCOM. IT'S FAST, SAFE AND COMPLETELY SECURE. Visit us online! Please see our address below. Charge Summary ~;~hases Average Daily Balance Daily Periodic Rate Corresponding APR Current Old 536.86 $$ 625.42 0.0657%l 23.990% 0.00 0.00 0.0657% 23.990% ANNUAL PERCENTAGE RATE 23.99 Billed Periodic Rate FINANCE CHARGE $16.79 Need Help? Online Access www.firstnational.com Issued by First National Bank of Omaha Customer Service Toll Free 1-888-530o3626 Balance Transfer Hotiine TDD Telecommunications Device lot the Deal Toll Free Toll Free 1-800-340-2273 X1307 1-8000925-2833 See reverse for additional information. SAVE 10% m~oreOt often that you'll fi,no/d the already low Super 8 prices reduced even t~"~ First National Bank Omaha 01-107358 PHILIP E GARRETSON 521 BOSLER AVE LEMOYNE PA 17043-1815 A418539135161AA1 PREMIER EDITION VISA Payment Due Statement Closing Date Days in Billing Cycle Payment Due Date Amount Past Due $ Minimum Payment Due $ First National Bank Omaha P.O. Box 2951 Omaha, NE 68103-2951 0000000002300 Account Number: 4418 5391 3516 1441 Page 1 of 1 Payment Due Date: July 14, 2003 New Balance: $674.82 Minimum Payment Due: $23,00 Make checks payable to (~ First National Bank Omaha Amount Enclosed Change of Address? []Please check box and complete reverse side. 0000000067&82 PLEASE DETACH HERE AND RETURN TOP PORTION WITH YOUR PAYMENT Account Number: F 4418 5391 3516 1441 06-18-03 Account Summary 199.80 Credit Line Previous Balance $ Total Credit Limit $ 2,000.00 4-2-9-03 Payments and Credits - $ 0.00 I Cash Limit f $ 1,000.00 07-1 New Transactions + $ 459.42 I Available Credit $ 1,325.00 10.001 Total Billed I FINANCE CHARGES + $ 15.60 Available Cash $ 1,000.00 23.00 New Baance $ 674.82 Purchase Post Transaction Payments New Date Date and Credits Transactions 5-30 5-30 EXXONMOBIL75 04208310 HARRISBU PA $ 6.51 5542 24164053151378000061893 6-03 6-04 EXX~NMOB L75 0420048i HARh SBU PA $ 7.'12' · 5542 24!64053155378000055388 2~2~8~i ~6~~i ! 6-15 6-15 COMPUSA #797 GLEN'ALLEN vA ........... $ 135.84 ~734. 2444500;~1676 !9127 !62322 ~ATE ~H~RGE ~E~ BY YOUR CLOSING DATE, WE HAD NOT RECEIYED THE REQUIRED PAYMENT. PLEASE FORWARD THE PROPER MINIMUM AMOUNT DUE TO BRING YOUR ACCOUNT CURRENT. 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THE ATTACHED CHECK CAN ONLY BE USED UP TO YOUR AVAILABLE CREDIT LIMIT. AT FIRSTNATIONAL.COM OUR HIGHEST PRIORITY IS KEEPING YOUR ASSETS AND INFORMATION SAFE ONLINE. Visit us online! Please see our address below. Charge Summary ~;~hases Average Daily Balance Current Old 550.02 $ 761.52 0.00$ 0.00 Daily Periodic Rate Corresponding APF 0.0657%I 23.990o/, 0.0657% 23.990% ANNUAL PERCENTAGE RATE 23.99 Billed Periodic Rate FINANCE CHARGE $16.01 Need Help? Online Access Customer ServiCeTo,, www.firstnational.com 1-888-530-3626 Issued by First National Bank of Omaha Balance Transfer Hotline TDD Telecommunicalior~ Device for the Deaf Toll Free Toll Free 1-800-340-2273 X 1307 1-800-925-2833 See reverse for additi(mal information. PAYABLE THRU FREMONT NATIOf~IAL BANKe FREMONT, NEBRASKA MEMO A104914018A 047802 24O5 76-1~1/1~9 DATE $ DOLLARS 539135161441 OMNIUM WORLDWIDE* 7171 Mercy Road Omaha, Nebraska 68106-2628 ~, J~HE-HP Name of Decedent: STATUS REPORT UNDER RULE 6.12 E ~;<I!~j-50N ph ;; P I Date of Death: '6/ II I ( 3 ~ \e.. . "';;5 ~- Q :iAlHrNo.: .;!OO 3-(jC' , .::, j\ dmin No ~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Comi Rules, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No J>d" 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: C) - 30 ,'b S- 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ..~ '-7 '/ / .~ / ~"",u,,"U' u ' ' .." -;;/ ,~./' ~ Signature~.,;" / ~ / ?-:,-- ---,- //1 -bS('''' 1111 If, v Name / Date: ~~)o S- .".-- ~' Lu I!(!; //0 ~~ 5g. u C::'>,-.' tJj . c,~j L.l_-: =- '-.1.. I ('; ( E~1 C', n' (") c~~~:> ~:-;,~ C-.,j 39t.o'-l Letl:/n9for\ S). 1/0 ~)a Address II ,It 171O'j " ,..c_, "-_.J ><..." (', ' o C'"J --..! ;~) =~i .,~- (~i-~'- c' c5' .,) u 117 - G, 5/- ci , ro Telephone No. l.~J ";-:,.;.} c_:} "'-' Capacity: n Personal Reuresentative lfl' Counsel for "personal representative r ~j l;V, Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/13/2005 GARRETSON JANET E 541 MUSKET COURT COLLEGEVILLE, PA 19428 RE: Estate of GARRETSON PHILIP E File Number: 2003-00850 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge ~ REV-15OG EX (6-00) REV-1500 OFFICIAL USE ONLY COMMONWEALTH OF -, PENNSYLVANIA . . DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 RESIDENT DECEDENT c9--L 0 3 Q 8' S"C) _ - HARRISBURG, PA 17128-0601 -- COlMY CODE YEAR I'UlBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER t- Z Garretson, Philip E. 197-40-6278 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RElURN MUST BE FILED IN DUPUCATE WITH THE C W 08/11/2003 11/25/1948 REGISTER OF ~LLS () W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C I LU ~ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of de'lth prior to 12-13-82) I- :.::S;(I) o 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required uC:::':: LUO-u I J:oo 0 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 8. Total Number of Safe Depodit Boxes uC::-' o-al - I 0- 0 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 11. Election to tax under Sec. 91113(A)(Attach Sch 0) <l: I i I- THIS SECTlON.MUST BE COMPLETEDLAL.l. CORRESPONDENCE AND CONFIDENTW..TAX INFORMATION SHOULD BEOIRECTEDTO: z NAME COMPLETE MAILING ADDRESS i LU Cl John R. Sroqoncik 222 S. Market Street z 0 FIRM NAME (If Applicab~) 0- Suite 202 (I) Devaney & Co. , P.C. LU c:: Elizabethtown, PA 17022 c:: TELEPHONE NUMBER 0 u (717) 367-3225 1. Real Estate (Schedule A) (1) 129,994.00 OFFICIAL U~-oNLY 0.00 . f:. ~) ;:-n 2. Stocks and Bonds (Schedule B) (2) - I -, CO) ,-", I C") 0.00 , 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ) ::.0 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 \ Iii -.J - j ....-- 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2,020.00 -'0 '; Z (Schedule E) 0 0.00 J i'll 6, Jointly ONned Property (Schedule F) (6) ., , - ~ ; o Separate Billing Requested ,-~'" -- c~...", :::> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 t- (Schedule G or L) c:: 8. Total Gross Assets (total Lines 1 - 7) (8) 1312 , 014 . 00 <C () 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 20,068.00 W 0:: 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 80,891.00 11. Total Deductions (total Lines 9 & 10) (11) 100,959.00 12, Net Value of Estate (Line 8 minus Line 11) (12) 311,055.00 13, Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 31,055.00 SEE INSTRUCTIONS FOR APPUCABLE RATES Z 0 15, Amount of Line 14 taxable at the spousal tax 0.00 ~ rate, or transfers under Sec. 9116 (a)(1.2) X,O_ (15) 31,055.00 X.O 45 '1,397.48 ~ 16, Amount of Line 14 taxable at lineal rate (16) :::> D.. 17. Amount of Line 14 taxable at sibling rate X ,12 (17) 0.00 :E 0 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 () I ~ 19, TaxDue (19) i1,397.48 20. 0 I CHECK HERE. IF YOU ARE REQUESTlNGAREFUNDOF AN OVERPAYMENTj > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < STF PA42021 F 1 FROM GIRL SCOUTS FREEDOM UALLEY PHONE NO. V\.il.U~-c.UUO litlJ Ie: i 11 t'1'l VULUNl HL LHNlJ . 610 933 8373 Oct. 05 2005 01:21PM P2 rAX NO, 71765114S9 p, 02 . . Decedent's Com lete Address: ~~52' -,:, J 7\ _ gos.er ......V$. em' Lemo ne S'l'ATE P A ZJP 17043 Tax Payments and Credits: 1. ~ Oue (Page 1 Line 19) ,. CredilstPlIym..,1$ Ao Spo~liIl?Mlly Clll~it Bo Prior Payments C. D1acount 1'otlllnterellllPen81ty (0 .jo E) (3) 4. IflJne2is greatl!ll'M Une 1 .;- Line 3. enterlhe dl~ll"ge. Th& islhB OVERPAVUENT. Check box OIl Pi&c , une ZO to nIqUIlSt 8 refu rtd 5. If Une1 .;. Una 3 ill greater IhGn UI'1B 2, tnlei' 1M dlll'er!!l'lCa ThIs is IIIl TAX DUE. (4) (6) 1,3r,.4.! I I I 0.00 I I I 0.00 0.00 1, 97..Q6 (1/ Total CrellllS (A -+- B + C) (2) ~o Interest/Penalty if applicable D. InreliSt Eo Penally A. Enter t'le inle:'eSt 0I'I1he lax due. (5A) 84.31 c.'; .~.., 8. Enter tM total of !.lilt 5 ..;.. SA. TIlls Ii the BALAllce DUE. (Sa) 1 4 a l . -, 9 Make Check Payable to: REGlSTiR OF ~LLS, AGENT . , .. i,:, ;:::i.~ ~:: :':r..~'~.:: :J',:',\l;p:. ~ . i,I,'; i.~~,~ :.:~.~.,I,:~: ,:,.' ,: J,,!,I:'II;'i :":;.i~ ~.;:;: ::'.::, ~~':: :\,:.; :~' i '~i;:: ,::~;' ::::.';0:: ,::~,~,'..': ,,~,I, I,';:,!";;}:; ';n';';,';IJUii,\~~;,;i~';~~.~.i::l"; ': ;,::,:(, :,~,t.': ,':~, ::: r l,: i[j~r~:.~(~.t.I~'::l,:: :,:,:: :',,::;1: '~~: i:~.;i.!,; ,:;.'::; '.; i~ .:~ :.~, ?~:~:~J2.;;..t ;~: ';'.; :'::i~::,~ PLEASE ~ l1iE FOLLONNG QUESnONS BY PLACING AN IIX" IN THE APPROPRlA'IE DLOCKS I 1. Dicl d.;edent make 8 trm1Rr and: Y= Ng .. rWitlll'l8 USll Dr Inclrne of lI1e prollfll1,y Ilah&ferred; ................,........ 0 . 0 0 . .. . . 0 .. ... 0 rm b. retlin the right to de$lgnsle who Ih-'I use the praperty llWl!:ferrlld gr Its Income: 0 . . . . . . . . . . . . , . . . .. 0 iii c. retain I~ intel8llt; or ...... .... ..... ..... .. ...... .. . . . . . . .. ................ 0 [i] d. ~ec:eiV8 tfJe plYlrnise for lire oflltlW paymanl$, bene~ts or en? ......................."..... 0 I:il 2. If dea1h OCCLImld . Dee8mber 12, 1_ ctid dac8d.nt ttatl8fer ~ II/ithl" one year af death ,.,ithoul receilling Idequate con&ider1tlon? . . .. . . , .. .. . .. .. . .. . o. ., . 0 . , . . . . . .. . . , , . .. . .. ,.. 0 [iI 3. Did clec:odent awn an 'ir. Nt ftll" or payable upon deat~ l:1ank IICM.lJ1t Cf &ecurity II hla or her deltb? . , , .. 0 Iil 4. Did decedent tNin lIIllntlillidual Retfrement Acaut, anm.ily. or other non..prob.la property whiell canlains a benelciary deaignltian? . , 0 . . . . . . . . . . . . . . , . . . 0 0 . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. 0 [iJ If TtE ANSweR TO AH'f OF THE ABOVE QlESTIONS IS YES YOU MUST COMPLEl'E SCI'EDUl.e G AND FILE IT M PART OF'" URK. U~1lI' pnIlin " ~~ I declere Iha! I IIlVe .."I~ this rel1Jm,lnClLdn3 1ICtQl11PS1VI~ sclllld~M 1IIlCI1'IIIItrr.trE. rd to h be8I III my _11II1II1IIId bllW, II is nil. ClIITIClIM 1Ilefe. DccIarslGn of !JIln' CllI1e'lhan :r. sonaI r 8I't.lUu1l is aased OJ\ 1I11nb'malilJl d Whlcll D ... 5IG~TURE OF ON RESPONSI FOR FIll R5TURN DATE 09/30/2005 ADDRESS 517 Cour~e Road Oreland PA 19015 SIGNA~ PREPARER OTHER THAN REPRESENTATIVE ~ ~ ~tA.. ~SS 222 South Ma~ket St.reet Suite 202, Eli:;;:abethtown, PA 17022 DATE 09/30/2005 I I ~;, :.'::i;',~~~:::i..:,':'~:ii,;:i.:'~ ::;;,::~;' 'i,:~. ,~;:;~,~::,:,:::':~.::~:}; ';: ;~ i: ;'~i~,;~.;~:.r,:~ ~::~~i'~:':;.: :!;:!:,j' i ~::i:., t~~r]::~~!.>.~'f~ ::' ::~li~~t;l;::.~r i~i:::::,,:~~~;:,~.:,;:11;r,/,'~ ~::~~'::~"f;..'::,,,;~:,,i:,;,~;;"i, .~:::: ::::~::~':',~:;,:.:.:~i~}t ~~':':~"::I' ~~r::;: .;'~U~~. ;,,':"::::':',';~'~L: f,;, ~ !:';~;'!"': ;::'L. Ford_Dr C1ealh on or at\erJlJIy 1, 1994 a:'1d tefole Janl,j!llrY 1. 1ll95,lhe t!Xl'lll8lmpoMd on thll net villue Oflrsnl1llrs Ie arklrtheuae oftnellnMng [72 P.S. ~9116 (a) (1.1} ~)J. l=ord311r1$ ltd. on CUller JI.'1l.lily 1, 1995. the taxrar.elmposed on the ~t v81ue aftrtr_tGorforthe uu of:lIl.uNilllng spouse Is 0% (72 1'.&.19116'1 ) (1.1) (UlJ. '1118 :lBIule doe$ n!lt elIenIJ! a tnnrer 10 II aUNiving splluse rrom tlllC, and lhe statlJtOly requilllTlents for dldelOllJre llf il$S'et5 ancIlIllns I tax retUrn are sail appli I, Mn ifttMi 'lINilJlng spaur" th! o"l~ Il&nsftdary. I FOl dates elf death on or allQl' JUly 1 I 3000: : The tllll rale lrnpDged ~ !he net \/alue ;f transferS ~O.'llll d.cea$lld Chile twen~-one YIlI1 of age Qr younger at death to or for the U&8 of II natLlI'I1 paPllrt. an ...w.Ii1l9 pareo . ..... n . ___.u - - --18(a)(1.2)]. T' The l lrforlne use 01 pt a not&d In '72 P.S. ~9116(1.2) [72 Fl's'IS11S1SX111. Thet ~ )r.C~ (........ -'~ (\ )rfOrtheusllO' i..--..... ',e_ _"l.:.( c;: - 1)(1,3)].Asiblil'lQisdeiinMl,ltIderSedion 102,san In.-h.i ~~ r'\ -.r:> ~",-'J.-... .h:hecle.:edent ~ ~ 0< ~~ .C.-Y.~ I 51"," <- D'-' , t- l5. Gl\2J }t-t GO c.>0 i 7~A- GL.eA~ .0)0)_ l'\ P.D ~ 5 S dO i -~- /0 -l-u~ -J. Av.sT REV-1502 EX + (~-97) (I) CdMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Garretson, Philip E. 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 knC7Nledge of the relevant facts, Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F ITEM VAll E AT DATE NUMBER DESCRIPTION o DEATH 1. Residential real estate - 521 Bosler Avenue, Lemoyne, PA 17043 (see attached settlement sheet) 60,102 2 . Investment real estate and LeB License No. R -4446 47-249 South Front Street, River Alley, Harrisburg, PA 17113 (see attached 69,892 settlement sheet) , , , , I I TOTAL (Also enter on line 1, Recapitulation) $ I 129,994.00 " (If more space IS needed, Insert additional sheets of the same size) STFPA42021F.3 REV-1503 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Garretson, Philip E. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALL E AT DATE NUMBER DESCRIPTION 0 DEATH 1. None I I I I I TOTAL (Also enter on line 2, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) STFPA42021F.4 RE\I-1504 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Garretson, Philip E. SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (Including all supporting infonnalion) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting infonnalion to be submitted for sole-proprietorships. ITEM VALL E AT DATE NUMBER DESCRIPTION o DEATH 1. None TOTAL (Also enter on line 3, Recapitulation) $ 0.00 STF PA42021 F.5 (If more space IS needed, insert additional sheets of the same size) REII-1505 EX + (1-97) (I) C6MMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Garretson, Philip E. FILE NUMBER Product/Service Bee r State of Incorporation P A Date of Incorporation 0 9/ 11 / 1 f 93 Total Number of Shareholders ~ Business Reporting Year Decem er and Liquor I 1 1. Name of Corporation M c Rat, In c . Address 3964 Lexington St. City Harrisburg State PA Federal Employer I.D. Number 2 5 - 1 7 14 18 2 Type of Business Bar Zip Code 1 7 1 0 9 2. 3. 31 STOCK TYPE Voting / Non-Voting TOTAL NUMBER OF SHARES OUTSTANDING PAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DE CEDE 1'S STOCK 4. Common 1 1 o 1 $ $ None Preferred Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? If yes, Position Bar tender Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ [Kl Yes DNo i I Non e Time Devoted to Business M i n i+a 1 6. [Kl Yes Annual Salary $ DNo 9,070 7. Was there life insurance payable to the corporation upon the death of the decedent? DYes [Kl No a. If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-ah DYes [KlNo If yes, DTransfer DSale Number of Shares I I Transferee or Purchaser Consideration $ Date i I Attach a separate sheet for additional transfers and/or sales. I 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. DYes [Kl No 10. Was the decedent's stock sold? DYes [Xl No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? [KlYes DNo If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? DYes [KlNo If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. I B. Complete copies of financial statements or Federal Corporate Income Tax retums (Form 1120) for the year of death and 4 preceding years. I C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured, attach copies. I D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. STF PA42021F.6 II REV-1506 EX + (1-97) (I) SCHEDULE C-2 COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Garretson, Philip E. , 1. Name of Partnership None Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service I 4. Decedent was a D General D Limited partner. If decedent was a limited partner, provide initial investment $ I I 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ I I Was the Partnership indebted to the decedent? DYes DNo I 7. If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? DYes DNo I If yes, Cash Surrender Value $ Net proceeds payable $ I Owner of the policy ~ 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 1 -31-82? DYes D No If yes, D Transfer D Sale Percentage transferred/sold I Transferee or Purchaser Consideration $ Date~ Attach a separate sheet for additional transfers and/or sales. I 10. Was there a written partnership agreement in effect at the time of the decedent's death? DYes DNo I If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? DYes DNo If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? DYes DNo If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? DYes DNo If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? DYes DNo If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. . . . . I . . THE FOl.LOWlNG INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. I B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding years~ C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisal have been secured, attach copies. I D. Any other information relating to the valuation of the decedent's partnership interest. STfPA42021F.7 RE'V-1507 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Garretson, Philip E. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALL E AT DATE NUMBER DESCRIPTION o DEATH 1. None I I I I I I , TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) STF PA42021 F.8 \ I REV-1508 EX + (1-97) (I) Co'MMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Garretson, Philip E. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VAL~E AT DATE NUMBER DESCRIPTION o DEATH 1. Pennsylvania State Employees Credit Union, AIC No. t 197-40-6278, One Credit Union Place, Harrisburg, PA 17110-2990 - Checking and Savings 329 2 . Cash 1,691 I I I I I TOTAL (Also enter on line 5, Recapitulation) $ \ 2,020.00 (If more space IS needed, Insert additional sheets of the same size) STfPA42021F9 REV-1509 EX +'(1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Garretson, Philip E. If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G, FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELAT10NS~IP TO DECEDENT A. B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Irclude name of finarclal institution arC bark accoll1l runber or similar identifying runber. DATE OF DEATH DEWS VALUE OF NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DE EDENTSINTEREST 1. A. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 , 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) STFPA42021F.10 REV-1510 EX +'(1-97) (I) CDMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Garretson, Philip E. SCHEDULE G INlER-VIVOS TRANSFERS & MISC. NON-PROBAlE PROPERTY FILE NUMBER This schedule must be completed CIld filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY 'Io0F I ITEM II'-CLLDE Tl-E N<\ME OF TrE TRANSFEREE, Tl-EIR RELAllONSHP TO DECEDENT ANJ Tl-E DAllE DATE OF DEATH DECD'S EXCLUSION i TAXABLE VALUE NUMBER OF TRANSFER. ATTACH A COPY OF Tl-E DEED FOR REAL ESTAllE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1, 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ! 0.00 ! TOTAL (Also enter on line 7, Recapitulation) $ 0.00 STF PA42021 F 11 (If more space IS needed, insert additional sheets of the same size) REV-1511 EX + '(1-97) (I: COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Garretson, Philip E. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION /J MOUNT A. FUNERAL EXPENSES: 1. Musselman Funeral Home, H umme 1 Avenue, Lemoyne, PA 1,100 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative( s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees 6,000 3. Family Exemption: (~decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 1,810 6. Tax Return Preparer's Fees 1,140 7. Register of Wills 131 8 . Advertising 500 9. LeB License Renewal 640 10. Final Tax Liabilities 3,153 11. Unpaid Real Estate Taxes 5,110 12. Filing Fees 484 ! I TOTAL (Also enter on line 9, Recapitulation) $ I 210, 068 . 00 (If more space is needed, insert additional sheets of the same size) STF PA42021 F.12 RE'lI-1512 EX +'(1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Garretson, Philip E. FILE NUMBER Include unreimbursed medical expenses, ITEM NUMBER 1. 2 . 3. 4 . 5. 6. 7 . 8. STF PA42021 F.13 DESCRIPTION Waypoint Bank Mortgage No. 5429000931, mortgage on residence. Liability owed on liquor license - Henry F. Coyne Esquire Louisa Garretson - Promissory Note, due on demand with interest at 5% per annum, dated May 1, 2003. Accrued interest on 5% promissory note from May 1, 2003 through August 11, 2003. Louisa Garretson - Non-interest bearing demand loan payable. 1st USA Bank One - Account Number 4417127124272337, NCO Financial Systems, Inc. 507 Prudential Rd. Omnium Financial - Account Number 71330417119299, 7171 Mercy Road, Ste. 400, Omaha, NE 68106 1st National Bank of Omaha - Account Number 4418539135161441, P.O. Box 3773, Omaha, NE 68108 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) I J MOUNT 49,650 5,000 8,000 112 2,785 8,419 5,630 1,295 i I 8!0, 891.00 RE'!I-1513 EX +'(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Garretson, Philip E. NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Louisa F. Garretson 1. 523 Bosler Ave. Lemoyne, PA FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Mother AMOUNT OR SHARE OF ESTATE i 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1SCb COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE STFPA42021F.14 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space IS needed, Insert additional sheets of the same size) , , 0.00 II REV-1514 EX + (1-97) (I) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Garretson, Philip E. This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dat~s of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Special y Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or a er 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. i DWiIl D Intervivos Deed ofTrust D Other N / A i UFEESTATE .INTERESrCALlCULATION I NAME(S) OF NEAREST AGE AT TERM OF YEARS L1F ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE o Life or OTerm of) ~ars o Life or o Term of) ~rs o Life or o Term of) ~ars o Life or OTerm of) ~ars 1. Value of fund from which life estate is payable $ I 2. Actuarial factor per appropriate table I I Interest table rate - 031/2% 06% 010% o Variable Rate % I i 3. Value of life estate (Line 1 multiplied by Line 2) $ i ANHUl'T'YlNTERESTCAlCULlATION I' .. NAME(S) OF NEAREST AGE AT TERM OF YE /\RS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PA wABLE o Life or OTerm of) ~ars o Life or OTerm of) ~ars o Life or OTerm of) ~ars o Life or OTerm of' ~ars 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout- o Weekly (52) OBi-weekly (26) o Monthly (12) o Quarterly (4) 0 Semi-annual~ (2) o Annually (1) o Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 0.00 5. Annuity Factor (see instructions) Interest table rate 031/2% 06% 010% o Variable Rate % 6. Adjustment Factor (see instructions) 7. Value ofannuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 $ I If using variable rate and period payout is at beginning of period, calculation is: I (Line 4 x Line 5 x Line 6) + Line 3 $ I I NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on i I Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate ~n Lines 13, 15,16 and 17. i (If more space is needed, insert additional sheets of the same size) STF PA42021 F.15 REV-1647 EX +'(9-00) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Garretson, Philip E. I This schedule is appropriate only for estates of decedents dying after December 12,1982. I This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession lnd enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. I o Will o Trust OOther N /A I. Beneficiaries A l:iETO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEARE~ T BIRTHDAY 1. 2. 3. 4. 5. n. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of wtthdrawal within 9 m nths of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises s ch withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdra ~I Ill. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 06%, 03%, 00010 .......................... $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 06%, 04.5% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 STF PA42021 F.16 (If more space is needed, insert additional sheets of the same size) II RE~-1649 EX +-(1-97) (I) CbMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Garretson, Philip E. Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Aet. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the N / A Trust (marital, residual A, B, By-pass, Unified ICredit, etc.). If a trust or similar arrangement meets the requirements of Section 9113 (A), and: I a. The trust or similar arrangement is listed on Schedule 0, and I b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, ! then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to Ihave such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer~ n Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator 0 this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the t st or similar arrangement. I PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the d1cedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. I DESCRIPTION VAlLE Part A Total $ 0.00 PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VAlLE Part B Total $ (If more space is needed, insert additional sheets of the same size) 0.00 SIT PA42021 F.17 'COMMONWEALTH LAND TITLE INSURANCE COI'/PANY A. Settlem.nt Statemane II O.S. Department of Housing and OrblUl Development ~ N6. ~~O'-b26S Title Insurance No.D421138CP ll. TYPe of Loan 1. [ J FHA 2. [ ] FmHA 3 . (Xl COIIV. tlnins. I 6. File Number 17. Loan Number 18. Mortgage Insurance Case No. 4. []VA 5. [ ICoDv. Ins. I I 54-aDDU I. i C.Noee: This form is furnished to give you a atatement of actual settlement costs. Amounts pa~d to and by the settlem,nt agent are shown. Itel1lS marked "(p.o.c}" were paid outside the closing; they are I!Ihown here tor informational purposes and are n~t included in the totals. D.Name and Address of Borrower TObey H. Forsman IE.Name and Address of Seller I Janet B. Garretson, Administratrix I of the Bstate of Philip E. Garretson I I I I IF.Name and Address of \ Waypoint Bank. I 101 S. George Street I York, PA I I I I LendeX" I \ I I \ I G.Property Location 521 Bosler Avenue Lemoyne. PA 17043 Cumberland J. StJMIIARY OF BORROWER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWBR: 101.Contract sales price 102.Personal property 103.Settlement charges to Count Lemo borrower (line 1400) Ad ustments for items seller in advance lo6.City/town taxes to 12/31/03 lo7.County taxes to 108. SCHOOL TAX 12/29/03 to 06/30/04 109. Refuse l2/29/03 to 12/31/03 120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 201.Deposit of earnel!lt money 202.Principal amount of new loan(s) 203.Existing loan(s) 204. 206.Lender Credit 209.Closing Cost Assistance Ad ustments for 21o.City/town taxes 211. County taxes l!Ieller to to 220. TOTAL PAID BY/FOR BORROWER 300. TOTAL AT SETTLEMENT PROM TO BORROWER 301.Gross amount due from borrower (line 120) 302.Lsl!ls amounts aid for borrower (line 220 303. CASH ([ ] FROM) ([XX] TOI BORROWER 'aRM 911 (4-88) PA 71000.00 2784.80 177.50 3080.06 75257.56 74142.56 75257.56 1,1.1.5.00 H.Settlement Agent COMMONWEALTH IJ\ND TITLE INSURANCE COMPANY place of Settlement 17 S MARKET SQUARE HARRISBURG, PA l710l Linda K. Trivel LX! K. SUMMARY OF SELLER'S TRANSACTION 400. GROSS AMOllJlT DUB TO SBLLER 401.Contract sales price 402.Personal property 403. I I. Sett I I Dee ement Date er 29, 2003 Ie I i I 71000.00 Ad ustments for items aid seller in adv e 406.City/town taxes 12/29/03 to l2/31/03 1. 36- 407. County taxes to 4. 08 . SCHOOL TAX 12/29/03 to 06/30/04 356.02 409.Refuss 12/29/03 to 12/31/03 .38 , 420. GROSS AMOtJltT DUB TO SBLLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 501..Excess Deposit (see instructions I 502-.Settlement charges to seller (line 1400) 503.~sting loan(s) 504. WAYPOINT BANK Payoff first mortgage 5429000931 506. 509.Closing Cost Assistance 71357.76 8175.4.3 F 49650.30 3080.o6j- Ad ustments for items 510.City/town taxes 511.County taxes seller to to 520. TOTAL RBIIOCTION AMOllm' DUB SELLER 600. CASH AT SB'l'TLEMENT TO FROM SELLER. 601.Gross amount due to seller (line 420) 602. Less reductiODl!l in amount due seller (line 52 603. CASH ([XXJ TO) ([ 60905.79 71357.76 60905.79 FROM) SELLBlt I I I I I I HBP05-2 I I lO,451.97 HOD-l (3-86) RBSPA. (/) 7 ( , OCo N...-I of ;f~ < la, .gg8 > j\J d JcJ..J L.- l:.D. ! c "Z.. --- D427738CP L. SETTLEMENT CHARGES II Paqe 2 of Form Approved OMS No. PAID PROM I BORROWER'S I FUNDS AT I SETTLEMENT . I I I i I [ 700. TOTAL SALES/BROKER'S COMMISSION based on price $ Division of commis.ionlline 700) as follows: 701.$ 2155.00 to Century 21 Piscioneri Realty, Inc. 702.$ 2105.00 to ReMax Realty Professionals Inc. 703.Commission Paid at Settlement 71000.00 II 6.00% - 704.$ to 800. ITEMS PAYNlLE IN CONNECTION WITH L01lN 80l.Loan Origination Fee t to 802.Loan Discount t to B03.Appraisal Fee to 804.Credit Report to Waypoint Bank. 805.Lender's Inspection Fee BOB.Underwriting Fee 809.Document Prep. 8l0.Tax Service Fee 811.Application Fee 8i2.Flood Certification Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Banlt Naypoint Bank. 4260.00 [POC $3So.0o} I I I 50.00 I I I I I "" Ii 36.24 I i I 'II II II I 65.01 I I 227.59 II i I 420.35 1'1 -256.U i I I i II II I It I 'I I 10.00 II 5.00 '*...**.....*...~I.**...****...* :****.**.:::~::.j\.**...*....*** r.....***....... t..**.......... 1****..****....* 1....**......*- I 50.00 II I 50.00 \'1 I 50.00 I I 35.00 II I 30.00 Ii I II 900. ITEMS RE IRED BY LENDER TO BE PAID IN ADVANCE 901.Interest from 12/29/03 to 01/01/04 .$ 12.08 /day 901.1 Interest from to .$ /day 902.Mortgage Insurance Premium for mo. to 903.Hazard Insurance Premium for yrs.to [POC $260.00] 1000. RESERVES DEPOSITED WITH LENDER 1001.Hazard insurance 3 mo.~$ 1002.Mortgage insurance mo.~$ 1003.C1ty property taxes 11 me.a$ 1004.County property taxes me.a$ 100S.SCHooL TAXES 7 mo.~$ 1008.Aggregate Accounting Adjustment 21.67 per mo. per !DO. 20.69 per mo. per me. 60.05 per 110. 1100. TITLE CHARGES 1101.Settlement or closing fee to l102.Abstract or title search to 1103.Title examination to 1104.Title insurance hinder to 1106.Notary Fee to Linda K. Trively (includes above items No.: ) 1108.Title Insurance to COmmonwealth Land Title Ins. Co. (inclUdes above items No.: 1101 - 1104) 1109.Lender's coverage $ 71000.00 1110.Owner's coverage $ 71000.00 1112. e:NDORSEMENT PA 300 to . COI'IMONWEALTH LAND TITLE 1113 . ENDORSEMENT PA 900 (ALTA 8.1) to CQM\l[ONWEALTH LAND TITLE 1114.e:NDORSEMENT PA 100 - CO. to COMMONWEALTH LAND TITLE 1115. CLOSING SERVICE LETTER ICSL) to COMMONWBALTH LAND TITLE 1116.EXPRESS MAIL Packet/Payoff to COMMONWEALTH LAND TITLE 1200. OOVERNMENT RECORDING AND TRANSFER CHARGBS 1201.Recording fees: Deed $ 41.50 Mortgage $ L202.City/county tax/stamps: Deed $ 710.00 Mortgage $ L203.State tax/stamps Deed $ 710.00 Mortgage $ 70.50 Releases $ 1300. ADDITIONAL SETTLEMENT CHARGES l303.Service Fee l304.2003 County/Township Taxes .305.2003 SChool Taxes .306. Final Refuse .307.Final Sewer .308.Prep. of Deed .309.2002 Unpaid Taxes to CENTURY 21 PISCIONERI to Paith A. Nicola. T~ Collector to Faith A. Nicola, Tax Collector to Lemoyne Borough to Lemoyne Ilorough to Be1nhaur i Curcillo, Atty.. at Law to Cumberland Ccnmty Tax Claim Bureau 115.00 290.00 91.00 112.00 710.00 2502-0265 PAID FROM SELLER'S FUNDS AT SE'l'TLEMENT 4260.00 710.00 195.00 273.05 792.70 146.75 128.80 100.00 11.65.13 ~ 1310.Home Warranty 1400. TOTAL SETTLEMENT CHARGES FORM 912 (4-88) to AON Home Warranty 399.00 entered on lines 103 SECTION J AND 502 Section K See page 3 for certification and signatures 2 784.80 8 175.43 A Settlement Statement u.s. Department Of~~~~pment S. Tvoe of Loan OMS No. 2502-0265 . HOO-:'1 Y86) 1. OFHA 2 OFmHA 3. OConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. OVA 5. OConv. Ins. CLT-04-203AH ..-------,-rus form 15 lumlSl1ecllo give yo.u a 5 a emen 0 a.ClUa seUlemanl coslS. Amounts paiiJ108rlcJOV me selllemenl agent are s':lawn. I TitleExpress Settlement Sy;tem C. Note: lIems marked "(p.Q,c,)" were paid outside the closing; they are shcmn here for Information purposes and are not included in the lolals WARN~NG: II is a crime to knov.ingly make false slalements 10 the United Slates on this ~r any other similar fOfm. Penalties upon Printed 04/01/2005 at 11 :29 .IC conlliclion can InClude a flne and Imnrisonment For details see: Title 18 U. S. Code Sactlon 1001 and Section 1010 D. NAME OF BORRO\^IER: JJK Ventures, Inc. ADDRESS: E. NAME OF SELLER: Estate of Philip E. Garretson ADDRESS: F. NAME OF LENDER: Cash ADDRESS: , G. PROPERTY ADDRESS: 247-249 South Front Street, River Alley, Harrisburg, PA 17113 .-._-~. .-..---4 - H. SETTLEMENT AGENT: Colonial Land Transfer, Ltd., 717.651.1488 fax:717.651.1489 PLACE OF SETTLEMENT: 3964 Lexington Street, Suite A, Harrisburg, PA 17109 .~- I. SETTLEMENT DATE: 03/31/2005 -j- J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: --_.~ --.. ...1- jQ~GRO~~AMOUNTDUEFROMBORRO~R 400. GROSS AMOUNT DUE TO SELLER .. 101 Contract sales orice 31 000.00 401. Contract sales mice -1ZL1JllQQ.90 102. Personal Property 402. Personal Prooertv 103. Settlement charaes to borrower Iline 1400) 3 873.95 403. -l-- 104. 404. (lJ 44,OOQ.~i 105. LCB License No. R.4446 44 000.00 405. LCB License No. R-4446 "_.-----,,--- Adjustments for items paid bv seller in advance Adiustments for items paid by seller in advance 1 084J6 107. County taxes 03/31/05 to 12/31/05 1 084.56 407. County taxes 03/31/05 to 12/31/05 ;4 108 School Taxes 03/31105 to 06/30/05 317.75 408. School Taxes 03/31/05 to 06/30/05 ..4 31Lfi 109. 409. -.-1- 110 410. I -j- e-111 411. I 112. 412. 76~~ 120. GROSS AMOUNT DUE FROM BORROWER 80 276.26 420. GROSS AMOUNT DUE TO SELLER 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER I 201. Deoosit or eamest money 1 000.00 501. Excess Deposit (see instructions) A'."" ..lOZc..!!incipal amount of new loans 502. Settlement charaes to seller (line 1400) . .?03. Existina loan(s) taken subject to 503. Existino loanls) taken sub'ect to 204. 504. Payoff of First Mortaaoe Loan _205,__ 505. I 206. 506. ----r 207. Water Bill Credit 1 024.54 507. ----I- J08. 508. ! i-- 209. 509. Adiustments for items unDaid bv seller Adiustments for items unoaid b~ seller --:... 213. 513. I 214. 514. 215. 515. 216 516. n_ 217. 517. _ ?JJL. 518. -j- 219. 519. MOiV _ 22Q. TOTAL PAID BY/FOR BORROWER 2 024.54 520. TOTAL REDUCTION AMOUNT DUE SELLER _~QQ._CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 76.402~i1 __101. Gross amount due from borrower (line 120) 80 276.26 601. Gross amount due to seller (line 420) 302. Less amounts paid bvlfor borrower (line 220) 2 024.54 602. Less reduction amount due seller (line 520) 6 509.A7 I 303. CASH FROM BORROWER 78 251. 72 603. CASH TO SELLER 69892.44 SUBSTITUTE FORM 1099 SELLER STATEMENT: The informaLion conlained herein is Important lax I~formalion and is being furnished 10 the Internal Revenue Service. If you are required 10 file a relum, a negligonce penallynr other sanction 'Nill be imposed on you if this item is required 10 be reported end the IRS determines thai II has not been reported. The Contract Sales PrIce described on !ine 40 I above conslllules the Gross Proceeds of thIs transaction. SEllER INSTRUCTIONS: If this real estate was \'Our principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions, complete the applicable parts 0' Form 4797, Form 6252 and/or Schedule 0 (Form 1040) You are required by law to provl,!e the s~ltlement agent (Fe!1. Tax to NO:..:? " Z I 7~ y,,111J..yg'~~ number, you may be ~ubject to avil or cnminal panallias imposad by law. ef pens les 0 pe,.,." I cerli;y'lbar(h' . TIN ~ SELLER(S) SIGNATURE(S): " h SELLER(S) NEW MAILING ADDRESS i. ax 7/jOOO , N... f 0 -r II ;. <... 6 I \::oS > , (, 9. 8'72 II U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT 5T A TEMENT File Number: CL T -04-203 PAGE 2 REV. HUD-1 (3/86) TitleExpress Settlement System Printed 04/01/2005 at11 :29 JC L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $31 000.00 (/j) 0.000 = BORROWER'S SELLER'S Division of commission (line 70m as follows: FUNDS AT FUNDS AT 701 $ to SETTLEMENT SETTLEMENT 702. $ to --B!1. Commission paid at Settlement .- 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioinalion Fee % 802. Loan Discount % 803. Annraisal Fee 804. Credil Reoort 4_ , 805. Lender's Insoeclion Fee 806. Mortoaoe Annlicaoon Fee 807. Assumntion Fee ---1-- 808. --+-- 809. -t-- 810. e-._811. ~ 900, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE I ..9Q1. Interest .From to IW$ Idav -~ ---------------j_._- 902. Mortoaoe Insurance Premium for to ...Jl.9.J Hazard Insurance Premium for to ....J!Q4 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo.lnl$ lmo .-+- - 1002. Mortn;one Insurance mo. IW $ /mo 1003. Citv Prooertv Tax mo.lnl$ lmo ----L 1004. Countv Prooertv Tax mo. IW $ lmo ; 1005 School Taxes mo. IW $ lmo 1009. Aooreoale Analvsis Adiustment 1100. TITLE CHARGES 1101. SetUement orclosino fee 1102. Abstract or title search 110J Title examination 1104. Title insurance binder e-.J 105. Document Prenaration , 1106. Notarv Fees to Anne E. Houser 10.00 1107. Attomev's fees to Beinhaur & Curcillo 2 400.00 ------- (includes above items No: ) 1108. Tille Insurance to Colonial Land Transfer 427.25 Ji!1<:liJcje![.i't:>9~.ilems No: \ J1Q.9 . b!lnde!.'0'olicy 1110. Owner's Policv 31 000.00 .427.25 1111. jJ1? 1113. - 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees Deed $41.50 . Martaaae $ . Release $ 41.50 --+-- 1202. Cilv/County tax/stamps Deed $310.00 ; Marlqaqe $ 310.00 31'0]0 1203. State Tax/stamps Deed $310.00 . Morlaaae $ 1204. Brinodo\\1l Fee to Colonial Land Transfer 7,50 1205 River Allev Deed to Recorder of Deeds 41.50 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2004/2005 SchoolT ax to Tax Claim Bureau 1.319. 9 1302. 2004 Prooertv Taxes to Tax Claim Bureau 2 775. 0 1303. 2005 Cntv/Two RE Taxes to Marianne F. Reider 1 468, 8 1304. Escrow for Balance of TransTax to Beinhaur & Curcillo 636.20 636, 0 1305. , 1306. 1307 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Seclion J and 502 Section K\ 3 873.95 6 509.si7 HUD CERTIFICATION OF BUYER AND SELLER Estate of hilip-.f..~__ 0 C~~::-:.:;;_. IJy:,_"J18 ~f}so . "v &c..' ( WARNING-IT IS A CRIME TO KNOWNGl Y FALSE STATE ENTS TO THE UNITED STATES ON THIS OR ANY SIMIlAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: u_s. CODE SECTION 1001 AND SECTION 1010. Attachment to REV - 1505 Philip E. Garretson 197 -40-6278 CLOSEL Y HELD CORPORATE STOCK INFORMATION REPORT 1. Stock valued at no value since, except for a liquor license that was sold in conjunction with the sale of real estate and reported on Schedule A, there were minimal assets, (glass and flat wear, stools, and some tables, all of which had been fully expensed), and at liquidation, the only asset was a negative cash balance. The corporation has losses from inception which were funded by Mr. Garretson, (note the liability owed to shareholder on the final balance sheet that is attached hereto). 2. Copy of final federal tax return is attached. 3. No real estate was owned by the corporation. 4. Mr. Garretson was the only shareholder of record. No shares were located. 5. Mr. Garretson was the sole shareholder and officer of the corporation. He was uncompensated. 6. There were dividends declared and or paid by the corporation. 7. Upon Mr. Garretson's death, the bar ceased to function. 'I For~ 11205 U.S. Income Tax Return for an S Corporation OMB .'10. 1;<15.Jh 30 ~ Do not file this form unless the corporation has timely filed 1r1ment of ~he -:-reasury Form 2553 to elect to be an S corporation. lal Revenue Service ~ See separate instructions. For calendar year 2003. or tax year beginning .2003. and ending 2003 A Effective date at election as an S corporatIOn C Employer identification numbe 11/24/1994 Use the IRS label. Other- wise, pri nt or type. MCRAT, INC. CIO BEINHAUR & CURCILLO, 3964 LEXINGTON STREET HARRISBURG, PA 17109 ATTORNEYS 25-1714182 o Date Incorporated B Business code number (see Instructions) 9/11/1993 E Total assets (see 'nstructlons) $ F Check applicable boxes: (1) U Initial return (2) Final return (3) Name change (4) U Address change (5) Amended return G Enter number of shareholders in the corporation at end of the tax year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ 1 Caution: Include only trade or business income and expenses on lines 7a through 27. See the instructions for more information. 5800 -2,393. 1 a Gross receipts or sales. . I 54, 923.1 b Less returns and allowances.. I Ic Bal ~ 1 cl 54, 923. I 2 Cost of goods sold (Schedule A, line 3)......................................... . . . . . . . . . . . . . . . . . . . . . 2 I 59, 049. N 3 Gross profit. Subtract line 2 from line 1 c. .. . .. . . . . .. .. .. .. .. .. 3 I -4, 126. C . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 0 4 Net gain (loss) from Form 4797, Part II, line 13 (attach Form 4797). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 I ! M 5 Other (loss) (attach schedule) . ... .. . . . . . . .. . . . . 5 . E Income .. ... '... ........ .. ... .... . . . . . . . . . . . . . . . . . . . I 6 Total income (loss). Add lines 3 through 5. . . . . . . . . . . . . . . . . . . ~! 6 ! -4, 126. ....... . . . ........ - .. . .. . .... . I 0 7 Compensation of officers. . . . . . . . . . . . . . . . . . . . . . . .. ..-......... . . . . . . . . . . . . . . . . . . . . . . . ....... . ... . ... 7 i ! E 8 Salaries and wages (less employment credits) . . . . . . . . . . . ...... ............ .......... . . . . . . . . . . . . . . . . 8 i 4,446. 0 9 Repairs and maintenance. . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . ... ............ ............ . -. ........ ... 9 i U 10 Bad debts. 10 ! C -.' . .... .. . . . . . . . . . .... . . . . . . . -.... ... .. ........., . ............ .... ......... T 11 Rents. . . .. .. .... . . ..... ... . .. . ,.. . .... . ... . ..,......... . , . . . . . . . . . . . . . 11 : I 12 Taxes and licenses. .. . ... . . ..- .-.. ............ ...... . 12 I 690. 0 .. -.. . .... .... .. .. .. ........ . -. -.. .... . N 13 Interest. _ .. . .... . .. . ..... .. . . . . . . . . . . . . . . . . - ..... "-' ...... . . ... ... . .......... .. .... ... 13 I S 14a Depreciation (Attach Form 4562) . . . . . . . . . . . . . . . . . ..... .... '" .. .. . .. .. .. I 14al ~X ! - b Depreciation claImed on Schedule A and elsewhere on return.. .. .... .. .. . . I 14bl .~ I Subtract line 14b from line 14a. . . . .. . .......... . ....... . . .. .. . . ..... .. . . . . .. . . 14C: ! c ... . . . . . . . . . . . . . . . . . . . I I 15 Depletion (Do not deduct oil and gas depletion.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . 15 ! N s 16 Advertising. ................. ........ ...... ...... ......... ............................ .... .... 16 I r I R 17 Pension. profit-sharing, etc. plans.................................................................. . 17 I u 18 Employee ! c benefit programs. . . . . . ..... ....... .... .... 18 I .. .... .... .............. -.. ... ... ..... ..... .-.. T schedule).. ...... ....... ... . . . . .. ..... .... .. . .SEE. .STATEMENT. .1. . . ... ! I 56. I 19 Other deductions (a ttach 19 o N 20 Total deductions. Add the amounts shown in the far right column for lines 7 through 19. . . . . . . . . . . . .. ~'2O i s 21 Ordinary Income (loss) from trade or business activities. Subtract line 20 from line 6 . . . . . . . . . . . . . . . . . .. 21 T 22 Tax: aE.~cess net passive Income tax (attach schedule). .. ...... ................ . . .. 22a A X b Tax from Schedule D (Form 1120S)................... ... .... .......... .. 22b c Add lines 22a and 22b (Sel! Instructions for additional taxes) . . . ... . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 22cl ~ 23 Payments: a2003 estimated tax payments and amount applied from 2002 return. . .. . . . . . . .. 23a r=: o b Tax deposited With Form 7004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 23b P c Credit for Feaeral tax paid on fuels (attach Form 4136). . . . . . . . . . . . . . . . . . ., 23c I A d Add lines 23a through 23c . . . . . . .. .. .... .. .. .. .. .... . . .. .. . . . .. .. .. .. . . .. .. . . .. . .. . . . . . .. .. . .. . . ... . I 23d ~ 24 Estimated tax penalty (See instructions). Check if Form 2220 is attached. . . . . . . . . . . . . . . . . . . . .. ~ 0 24 E 25 Tax due. If line 23d IS smaller than the total of lines 22c and 24, enter amount owed. . .. . . ............. 25 : ~ 26 Overpayment. If line 23d is larger than the total of lines 22c and 24, enter amount overpaid........ .... 26 S i 27 Enter amount of line 26 you want: Credited to 2004 estimated tax. · Refunded Z7 51192 . -9 318_ o. Sign Here Under penalties of pe'!ury. I declare thaI I have exannned thiS return. including aCCOlTlllany'ng schedules and statements. and to the best of my knowledge and beller. .lls true. correct. and comglele. DeclaratJOn of pregarer (othet than taxgayer) IS based on alllntormal1on of wOlcn pregarer has any knowleoge. I .. Signature Of omcer Date .. Title Mav the IRS dlSCUSS lhlS r~lurn wJlh the oreoarer snown bF'oW (see InstructionS)? i-" fXiYes I nNo ! Pre Darer' S sl(~na(ure ~ Dale I 3/18/04 ! ~';,'i~~elf- n 189-38-8628 IEIN 23-2922842 j I """"e 'no. 717 - 367 - 3225 SPSA010Sl JSI,Q:03 ;= arm 11 2DS ',2C03) Preoater S SSN or PTlN J r . ..:parer's ; Firm's name Use Only : (or '/ours It I selt.emOloyedl. I aaaress. Jna 1 Z!P ":'cde DEVANEY & CO., P.C. .. 222 S MARKET 5T - STE 202 ELIZABETHTOWN, PA 17022 BAA For Paperwork Reduction Act Notice. see separate instructions. II Form 11205 (2003) MCR....:;'T, INC. 2..1-1714182 Schedule A Cost of Goods Sold (see Instructions) 1 Inventory at beginning of year. . . . . . . . . . Purchases. Cost of labor. . . . . . . . . . 4 Additional section 263A costs (attach schedule). . 5 Other costs (attach schedule). . . . . . . . . . . . . 6 Total. Add lines 1 through 5. . . . . . . . . . . . . 7 Inventory at end of year. . . . . . . . . . . . . . . . . 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2. . . . . . . . . . . . . . . . . 9a Check all methods used for valuing closing inventory: (i) p Cost as descnbed in Regulations section 1.471-3 (ii) W Lower of cost or market as described In Regulations section 1.471-4 (iii) U Other (specify method used and attach explanation) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ j.. _---=-,. b Check If there was a wntedown of subnormal goods as described in Regulations section 1.471-2(c} . .. . . . . . . . . . . . . . . ....... . I". I c Check If the LIFO Inventory method was adopted this tax year for any goods (if checked. attach Form 970)............... I.. ;\ 1 - 1 :>"Q'? 2 1 2 3 4 5 6 7 8 8,000. 51,049. 59,049. 59, 49. d If the LIFO Inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ............................. I 9dl e If property is produced or acqUired for resale, do the rules of Section 263A apply to the corporation? . . . . . ... 0 Yes ::~~ '---' i i n Yes Ii ~'o I Yes No U Other (specify) .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _I f Was there any change In determining quantities. cost. or valuations between opening and clOSing Inventory? If 'Yes.' attach explanation SchedUleS Other Information (see instructions) 1 Check method of Jccountlng: (a) X Cash (b) Accrual (c) 2 See the instructions and enter the: (a) BUSiness Jctivlry .. RESTAURANT & BAR (b) Product or service. .. FOOD & DRINK I~". 3 At the end of the t~ ~;a; did t~e-c~r;o~atio~ ~~n~ dir;c~; or Indirectly, 50% or m~r; ~f ~h; :o~n~ ~t~c; cl ~ do~;stic--I corporation? (For rules of attribution, see section 267(c).) If 'Yes.' attacn a schedule Showing: (a) name. address. i and employer Identification number and (b) percentage owned. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . ! 4 Was the corporation a member of a controlled group subject to the prOVIsions of sectIon 1561? . . . . . . . . . . . . . . . . . . ... Ix Check thiS box If the corporation has filed or is required to file Form 8264. Application for Registration of a Tax Shelter.. . .......................................................................................... .. 6 Check thiS box If the corporation Issued publicly offered debt Instruments With onglnallssue discount. . . . . . . . . . . . . . If checked. the coroorahon may have to file Fonn 8281, Information Return for Publicly Offered Original Issue Discount Instruments. i I X 7 If the corporation: (a) was a C corporation before It elected to be an S corporation or the corporation acqUired an asset With a baSIS determined by reference to ItS baSIS (or the baSIS of any other property) In the hands of a C corporation and (b) has net unrealized bUilt-In gain (defined In section 1374(d)(1)) In excess of the net recognized built-In gain from pnor years. enter the net unrealized bUilt-In gain reduced by net recognized built-In gain from prior years. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . .. .. $ _ _ _ _ _ _ _ __ 8 Check thiS box If the corporation had accumulated earnings and profits at the close of the tax year. . . . . . . . . . . . . . . .. .. 9 Are the corporation's total receipts (see instructions) for the tax year and its total assets at the end of the tax year less than $250.000? If 'Yes.' the corporation is not required to complete Schedules Land M-l. . . . .. ... .... . . . . .. .. ... ........ Note: If the corporation had assets or operated a business in a foreign country or U.S. possession. it may be required to attach Schttdultt N (Fomr 7720), Foreign Operations of U.S. Corporations. to thiS return. See Schedule N for details_ SiliecfureK;.,;;;:,' Shareholders' Shares of Income, Credits. Deductions, etc (a) Pro rata share Items 1 Ordinary Income (loss) from trade or busmess actiVities (page 1, line 21). . . . . . . . . . . . . . . . . .. . . . . . . . 2 Net Income (loss) from rental real estate actiVities (attach Form 8825). . . 3a Gross Income from other rental actiVities. . . . . . . . . . . . . . . . . . . .. . . . . . .. . . 3al b Expenses from olher remal activities (attach schedule). . . . . . . . . . . . . . . 3bi c Net Income (loss) from other rental actiVities. Subtract line 3b from line 3a . 4 Portfolio income (loss): a Interest Income. b DIVidends: (1) Qualified dividends. c Royalty Income. d Net short-term capital gain (loss): (1) Post-May 5. 2003. ~ _ _ _ _ _ _ _ _ _ _ _ (2) Entire year. "I e Net long-term capital gain (loss): (1) Post-May 5. 2003. .. _ _ _ _ _ _ _ _ _ _ _ (2) Entire year. "I f Other portfOliO Income (loss) (attach schedule). ...... .... i 5 Net section; 2:;1 'Jain (loss) (attach Form ;'797): (a) Post-May 5. :003 .. _ _ _ _ _ _ _ _ _ _ _ (b) 81tJre year. ..i 6 Other Income :loss) (attach schedule) I x I n c o m e (L o s s) .. (2) Total arOlnary dIvIdends. . .. 4a 4b (2) 4c I 4d (2) I 4e (2) I 4f I 5(b) I 6 I 5PS;.oT' a :3IZ:l'03 Form 11 ZOS :(03) Form 11205 (2003) MCRAT, INC. .(;;)-1714182 Page 3 I Schedule K I Shareholders' Shares of Income, Credits, Deductions, etc (continued) (a) Pro rata share Items (b) Total amount -:luc- 7 Charitable contrlbuttons (attach schedule) . . .. . . . . . . . . . . . . .................... ... ........ '0' 7 (IS 8 Section 179 expense deduction (attach Form 4562) . . . . . . . 8 I .... .. ............ ............ .... 9 Deductions related to portfolio income (Joss) (itemize). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 I 10 Other deducl10ns (attach schedule). . . . . . . ..... .. ........... . . . . . . . . . . . . . . .......... . ...... . 10 I Invest- 11 a Interest expense on Investment debts.......... . .. .... . . . . . . ............... ...... ..... . . ... 113 I , ment b (1) Investment Income included on lines 4a. 4b(2), 4c. and 4f on page 2.............. . ... 11 b (1) Interest ... (Z) Investment expenses included on line 9 above....... . .. .. . ............. ... . . . . . . . . . .. .. 11 b (2) Credits lZa Credit for alcohol used as a fuel (attach Form 6478). . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . 123 I I b LOW-Income housing credit: i),/;;? . I (1) From partnerships to which section 42(j)(5) applies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lZb (1) I (Z) Other than on line 12b(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lZb (2)1 i c Qualified rehabilitation expenditures related to rental real estate activities (attach Form 3468). . . . . . . . . . . . . . . . . . . . . lZc I d Credits (other than credits shown on lines 12b and 12c) related to rental real I , estate activities. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . . . . . . . . . . . . lZd , e Credits related to other rental activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lZe I i 13 Other credits. . .. . . -...... ... ....... ......... ... ............ ............... ..... -........ 13 I I Adjust- 14a Depreciation adjustment on property placed In service after 1986.......................... . 14a I ments b Adjusted gain or loss. " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b I and Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prefer- c Depletion (other than 0,1 and gas). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ... 14c I ence d (1) Gross Income from 011, gas. or geothermal properties. " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d (1)1 Items (2) Deductions allocable to oil. gas, or geothermal properties. . ........... ... ... ... ...... .... 14d (Z)I e Other Jdlustments and tax oreference Items (attach schedule) . . . . .... . ........ ...... ...... . ..... . 14e I Foreign 1Sa Name of foreign country or U.S. possession. . ~ I;'t'c I Taxes ----------------------- b Gross Income from all sources. . . . . . . .... ..... ... ............ ....... ... ..... ..... .......... 15b c Gross Income sourced at shareholder level. . . . . . . ............ ...................... ... ..... 15c I d Foreign gross Income sourced at corporate level: ."",,,-,... ";! a,E,".;-" , ... ..t '"....lii..;:.;:..-;: (1) PassIve. " ..... . ........... ....... ........... ............. ........... .............. .... 1Sd (1)1 (Z) Listed categones (attach schedule). . . . .... .... ............. ... ............. ......... ... 1Sd (2)1 (3) General limitation. . . . . . . . . .. .. . .. . . . . . . . . . . . . . . . . . . . . . . . ... . . .. . .. . . . . .. . . . . . . . . . . . .. . 1Sd (3)1 e Deductions allocated and apportioned at shareholder level: ~.3.:: I (1) Interest expense. . . . . . . . . . .. . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . .. ... .. . .. . . . . . . .. . . . . . . . .. . 1Se (1) (2) Other. "...., . '.,. , .. .. '. .... ............ ..... .,..,.... .............. ...... ....... ... 15e (2)1 f Deductions allocated and apportioned at corporate level to foreign source income: ~~ ! (1) PassIve. . . . . . . . 1Sf (1) ! ,.... .... ............. ..... ............. ............................ ... (2) listed categories (attach schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Sf (2)1 (3) General limitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 (3)1 g Total foreign taxes (check one): · 0 Paid o Accnued. .. .................. .... ... .. . .... 159 h Reduction In taxes available for credit I (attach schedule) . ". .. , . , . . . . . . . . . . . .. ....... .............. ...... ........,........ ,... ... 1Sh Other 16 Section 59(e)(2) expenditures: a Type ~ b Amount ~ 16b I ! ------------------- I 17 Tax-exempt interest income. . . . . .. . . . . . . . . . . . . . . . . .... . . . . . . .. ... .. .. .. .. . . . . . . . . . . . . . ., . . 17 18 Other tax.exempt income. . .. . ............ ... ................ ...................... . . ..... . 18 I 19 Nondeductible expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 ZO Total property distributions (including cash) other than dividends reported on line 22 below. .. . ZO I I 21 Other Items and amounts required to be reported separately to shareholders .i2~~F':' (attach schedule) . ..... . ,... , ... .., . . . . . . . . . . . . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . ..,. . ..., . ';::,<c' . c' 22 Total diVidend distributions paid from accumulated earnings and profits. . . . . . . . . . . . . .... ,.., 22 23 I:;,:.,...; I Income (loss). (ReqUired only If Schedule M-l must be completed.) Combine lines 1 through ! 6 In column (b). i=rom the result. suotract the sum of lines 7 through 11a. 15g, and 16b...... I 23 i - ,318. BAA Form 112 5 (2003) SPSAOl ~41 ; V1 5103 For~ 11205 (2003) MCRAT, INC. ~...I-1714:!.82 Nc.~e: 'rohe iorooratlon IS not required to complete Scheduies L. an~ M'I If queslion 9 of Schedule 8 IS ars'Nered 'Yes' Schedule L Balance Sheets per Books I 8e~lnnlng of tax year End of tax year ~~ W 00 ~ I Cash. . . . . . . . . . . . . . . . . . -1, 075 . 6,925. er Books with Income Loss er Return - 9 , 318. 5 Income recor.dea on books this ,eJr ~Ol :ncludea I on Schedule K, lines 1 through Ii (Itemize): a T ax.exempt Interest. $ , -----------1 6 ~u~~ ~n~u~~ o~ ~h:a:e-K~I~-l ~h~u;n I 11a, 15g, and 1Gb. not chargee against book Income, this YeaT (iterntze): I a ~~~e:a~~~ ~ ~ = = = = = = = = = = -I 7 Add lines 5 and 6.. --------------------- 4 Add lines 1 through 3. . . - 9 , 318 . ! 8 Income (loss) (Schedule K. :n 231. Ln 4 less in 7 Si:fiecfW'er&-Z Analysis of Accumulated Adjustments Account, Other Adjustments Account. and Shareholders' Undistributed Taxable Income Previously Taxed (see instructions) ( ) A d (b) Oth 'I (c) Sharel101, s' 'jndis- .a ccumulate . er 1 tnbuled taxa Ie Income adlustments account adlustments Clccount I prevlousl tJXed 2a Trade notes and accounts receivable... b Less allowance for bad debts ..... 3 Inventories. 4 U.S. government obligations................ 5 Tax.exempt securities. . .. . . . . . . . .... .. . . .. . 6 Other current assets (attach schedule} . . . . . . . . . . . . . . 7 Loans to shareholders. . . . . . . . . . . . . . . . 8 Mortgage and real estate loans. . . . . . . . . . . . . 9 Other investments (attach schedule). . . . . . . . . . 10 a Buildings and other depreciable assets. . . . . b Less accumulated depreciation. . . . . . . . . . . . . 11 a Depletable assets.......... .......... b Less accumulated depletion . . . . . . . . . 12 Land (net of any amortization). . . . . . . 13a Intangible assets (amortizable only). b Less accumulated amortization. . . . . . . . . 14 Other assets (attach schedule). . . . . . . . . 15 Total assets. . . . . . . . . . . . . . . Liabilities and Shareholders' Equity 16 Accounts payable. ........................ 17 Mortgages. notes. bonds payable in less than 1 year. . 18 Other current liabilities (attach sch) . . . . . . . . . . . . . . . 19 Loans from shareholders. . . . . . . . . . "1) Mortgages, ~otes. bonds payable In 1 year or more. . . . . Other liabilities (attach scheaule) . . . . . . . . . . . . . . . . . . 22 Capital stock. 23 Additional paid-In capital. . 24 Retained earnings. . . . . . . . 25 Adlustments to shareholders' eqUity (att sch~ . . . . . . . . . 26 Less cost of treasury stock. . . . . . . . . . . . . . . . . 27 Total liabilities and shareholders' eQuit)( . . . . . iSdledafe:fil..1t Reconciliation of Income 1 Net income (loss) per books. . . . . . . . . . . . . . . . 2 Income Included on Schedule K, lines 1 through 6, not recorded on books thiS year (itemIze): 3 Expenses recorded on books thIS year not Induded on Schedule K, lines 1 through 11a, 15g, and 1Gb (itemize): a Depreciation. . . . . .. $ _ _ _ _ _ _ _ _ _ _ b Travel and entertainment. $_ _ _ _ _ _ _ _ _ _ 1 Balance at beginning of tax year. 2 Ordinary income from page 1, line 21. . 3 Other additions. '\ Loss from page 1, Ime 21. . :i Other reductlons 6 Combine lines 1 through 5. 7 Dlstnoutlons other ~han diVidend dIstributions. 8 3alance '1t ~nd !Jf :ax '1ear. Subtrac, line -: from ,:r.~ .; ::::~:'':':;~ 02n5..03 Page 4 (d) i -2,393. 8,000. - ,393. O. 9,318. -2,145. I I i I i. 9,318.) I -11,463. -11. 463. Form l1tos .::003) I' 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. CO 005874 CURCILLO JOSEPH A ESQUIRE 3964 LEXINGTON STREET HARRISBURG, PA 17109 ACN AMOUNJT ASSESSMENT CONTROL NUMBER __nun fold ---------- I -------- , 101 I $1 ,481.~9 ESTATE INFORMATION: SSN: 197-40-6278 I i FILE NUMBER: 2103-0850 I I DECEDENT NAME: GARRETSON PHILIP E I DA TE OF PAYMENT: 10/07/2005 I . POSTMARK DATE: 10/06/2005 I ! COUNTY: CUMBERLAND I I I DATE OF DEATH: 08/11/2003 I I i TOTAL AMOUNT PAID: $1,481.179 REMARKS: CHECK# 4331 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAljJ~H REGISTER OF WILLS REGISTER OF WILLS R:CCtL)cD ;--'r..,r-,j,'.--:-:-r) , ;.L, 1 D ,", i V ',..1., -, J '" ~' I './.' I ! ~- ;:. 0 u: f. )> , 0 ::iL ,.W , IIi ;,( I' U1 <0 ITl CJ ["- .::r- 0 - U1 - .J] lJ) - ["- Do CJ - CJ 0 - - CJ I - CJ - - rf) - r-'l - U1 ~, ru V - - I - .::r- - CJ l!J - CJ --- I"'- - - - - -- 0> = .0 - . .,... - 11'-- - -~ ,or- 0 :;0 )) , D ,) ..~ r...... ,- 1 ['- ~_r:- -~ ::r: ~nl ..- -..,. J OF c:; r)/\ j .' .~\ It 6 ~ CI) ~ o l'- ::c ~ g ~ ~O'~ OCl)O u~!:: ~:g< <O~ 22;~ ~"- lXl~~ ~52 ~u< u-u PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Phillip E. Garretson Date of Death: August II, 2003 Estate No.: 2003-00850 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to complection 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 reasonable believes that the administration will be complete: 3. If the answer to No. I 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: N/A 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 report. Settlement Agreement is attached. Date: /Dl!o!OE: I f //-~/ .- ,. Lt__ C': lL.J c,::: p::. :. c.:) :;;' a Lu Ci C'"": cj <, Lei, Cc: N N Q.. 3964 Lexinlrton Street ~ ~"'J Harrisburg. P A 17109 f-- LJ a c:)c ,~ c-_-3 c..--:, '" (, ' 0" e Capacity: Personal Representative X Counsel for Personal Representative \I:f/I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ,. . ~'AI'PRAISEttENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-13-2006 GARRETSON 08-11-2003 21 03-0850 CUMBERLAND 101 APPEAL DATE: 04-14-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 9Yr_~~9~~_r~~~_~~~~______~___~~!~!~_~~~~~_~~~!!~~_E~~_y~~~_~~~~~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PHILIP E FILE NO. 21 03-0850 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 :: :-~') 1-; .,., C3 JOHN R SROGONCIK DEVANEY 8 CO 222 S MARKET ST ELIZABETHTOWN 202 PA 17022 ESTATE OF GARRETSON TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ) CHANGED ll) (2) (3) (4) (5) (6) (7) 129,994.00 .00 .00 .00 2.020.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) 20,068.00 80.891. 00 ll1) ll2) ll3) ll4) REV-1547 EX AFP (06-05) PHILIP E DATE 02-13-2006 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 132,014.00 100.91i9 00 31,055.00 .00 31,055.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS. .00 X 00 = .00 31,055.00 X 045 = 1,397.48 .00 X 12 = .00 .00 X 15 = .00 ll9)= 1,397.48 . J ............- {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-06-2005 'If CD005874 84.31- 1,481.79 BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-07-2005 TOTAL TAX CREDIT 1,397.48 BALANCE OF TAX DUE .00 INTEREST AND PEN. 5.08 TOTAL DUE 5.08 · IF PAID AFTER DATE INDICATED, SEE REVERSE 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), YOU HAY BE DU A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) !~-~-~------- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CURCILLO JOSEPH A ESQUIRE 3964 LEXINGTON STREET HARRISBURG, PA 17109 u_u_u fold ESTATE INFORMATION: SSN: 197-40-6278 FILE NUMBER: 2103-0850 DECEDENT NAME: GARRETSON PHILIP E DATE OF PAYMENT: 03/28/2006 POSTMARK DATE: 03/22/2006 COUNTY: CUMBERLAND DATE OF DEATH: 08/11/2003 NO. CD 006490 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5.08 I I I I I I I I TOTAL AMOUNT PAID: $5.08 REMARKS: BEINHAUR & CURCILLO CHECK# 4434 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS '! ~, ~ '$'-' II If f Ii, l J ~.~ ii' i f ~ ~. .;,:; t \, '\.: ,'~:\~'ll'J J1. 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I I ,. 11.1 Ie I i 11111' ZIC Hllo. ...II ~ft I C v, I IJ Hie ::E:I 1-1> e>>:1l zlr Ol~ ...II U' CIP I- I I ::) I :::: UIU I~ 1-1'1) (/')~~ .....01' ~UP""'I 30 LLU<C O~D.. % .. ~<CUJ UJ.......... I-~(/') (/,)UJI-t 1-t!:Q..... c!)X~ UJ::)<C ~UU N N o I' P""'I r. '"'[':""1' (',cr"r\f:E OF BUREAU OF INDIVIDUA~tOO~iCU VI v INHERITANCE TAX DIVISION ,',:,", ('!:2':;:P r,r. \/'J\\. LS PO BOX 280601 t\t:.0\J i '....1 \.,\ , HARRISBURG PA 17128-0601 2nUo APR 2.4 PM 4~ 23 CLERK OF ORPHAN'S caUR1 A JOHN R SR~ij{LpND CO. P DEVANEY & CO 222 S MARKET ST 202 ELIZABETHTOWN PA 17022 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-17-2006 GARRETSON 08-11-2003 21 03-0850 CUMBERLAND 101 Allount Relli Hed PHILIP E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS ... --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF GARRETSON PHILIP E FILE NO. 21 03-0850 ACN 101 DATE 04-17-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYMENTS I THE CURRENT BALANCEI ANDI IF APPLICABLE I A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-13-2006 PRINCIPAL TAX DUE: 11397.48 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-06-2005 CD005874 84.31- 1 1481. 79 03-22-2006 CD006490 5.08- 5.08 TOTAL TAX CREDIT L397.48 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) c