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Home My WebLink About04-0855 PETITION FOR PROBATE and GRANT OF LE' TE Estateof GEORGE K. MUNDORF No. ~_~~~'~ also known as To: · Deceased. SocialSecurityNo. 7t 6-09-38'11 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated September ~6. 2003 and codicil(s) dated NONE Register of Wills for the County of CUMBERLAND Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in CUMEEHLANO County, Pennsylvania, with h is last family or principal residence at ? POCONO DRIVE1 MECHANICSBURGI UPPER ALLEN TOWNSHIPi PENNSYLVANIA 17055 (list street, number and municipality) Decedent, then SS: years of age, died St2SI04 at HOLY SPIRIT HOSPITAL. CAMP HILLI PENNSYLVANIA Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after exeantion of the will offered for probate; was not the victim of a killing and was never ajudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in P'a.) Personal property in County Value of real estate in Pennsylvania Iq O Iq E situated as follows: $ 8~500.00 $ $ $ 0.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTMANETARY thereon.~ ____(testamentarY; administration c.t.a.; admini~::~ d.b.n.~.) ] 7 POCONO DRIVE ~ MECHANICSBURG ~: PA ': DANIEL I. MUNDORF OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUM"ERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above,decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or aft'm-ned and subscribed ~- "~ ' / "~ _..,// / / ~fore me this ~ day of ~-~'.~-NK- Q.~ · a~%-x Register Estate of GEORGE K. MUNDORF , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~.'x~ ,O~..A"~C~L2N~ ~ ~ ~.C~ Oq , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated g116/o3 described therein be admitted to probate and filed of record as the last will of GEORGE K. MORDORF and Letters TESTAMENTARY are hereby granted to DANIEL L MUNDORF Probate, Letters, Lefc ......... $ ~D .hB ShortCe~ficates ( ) ...... $ ~. ~ Ren~cia~on ............ $ ~. ~ ~ $ J ~ ,~ TOT~__$ ~.~ Filed. ~- ~-aOo~ ATTORNEY (Sup. Ct. I.D. No.) 54 EAST MAIN STREET MECHANICSBURG PA 17055 ADDRESS 7'17-697-4650 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 10530158 AUG 3 0 ?004 K. Hundor f 86 w Cumberland ~..Signalman 7 Pocono Dr. No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL REC~D~ CERTIFICATE OF DEATH ......... male 716 -- 09 --3811 ~9antel L. Hundorg 7 Pocono Dr., ~echanlcsburg, PA 17055 ~{s~ ~ ~-30-200~ Green Hem. Park . 012 L WAS CASE REFERREO TO A MEDICAL EXAMINER K~ORONER? N JURY AT VI~)RK? OESCRIBE hOW INJURY CCCURREO h YI RENUNCIATION -¥ In Re Estate of George K. Mundorf, deceased. To the Register of Wills of Cumberland County, Pennsylvania renounces her right to administer the estate Testamentary be issued to Daniel I. Mundorf. The undersigned, Diane E. Calhoon, daughter of the a~V~ dec'lent, t/e~eby and respectfully ~asks th~ Letters of WITNESS my hand this Iq4~ day of ~r~'~ 2004. Diane E. Calhoon ~ (Address) COMMONWEALTH OF PENNSYLVANIA : ss: COUNTY OF CUMBERLAND : AND NOW, this 17th day of September, 2004, before me, the undersigned officer, personally appeared Diane E. Calhoon, known to me (or satisfactorily proven) to be the person whose name is subscribed to the instrument, and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public NOTARIAL SEAL I DEBOP, AH L. RYAN, NOTARY PUBLIC CITY OF MECHANICSBURG, CUMBERLAND COUNTY MYCOMM SS ON EXP RES JUNE ,2006 OF GEORGE K. MUNDORF I, George K. Mundorf, of the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania, declare this to be my last Will and revoke any Will previously made by me. ITEM I. I devise and bequeath all of the my estate of every nature and wherever situate as follows: (A) 32 1/2% thereof to my son, Daniel K. Mundorf, if he survives me. Should my son, Daniel K. Mundorf, fail to survive me, I devise and bequeath his share to his issue, per stirpes, who survive me and in default of such issue, his shares shall be added to the other shares created under this ITEM I in the same proportion that those shares now bear to each other. 03) 32 I/2% thereof to my daughter, Diane E. Calhoon, if she sUrmves me. Should my daughter, Diane E. Calhoon, fail to survive me, I devise and bequeath her share to her issue, per stirpes, who survive me and in default of such issue, her shares shall be added to the other shares created under this fi'EM I in the same proportion that those shares now bear to each other. (C) 17 1/2% to my son, Kenneth B. Mundorf, if he survives me. Should my son, Kenneth B. Mundorf, fail to survive me, I devise and bequeath lus share to his issue, per stirpes, who survive me and in default of such issue, his shares shall be added to the other shares created under this fl'ic, M I in the same proportion that those shares now bear to each other. (D) I7 1/2% to my daughter, Nancy E. Shumberger, if she survives me. Should my daughter, Nancy E. Shumberger, fall to survive me, I devise and bequeath her share to her issue, per st/rpes, who survive me and in default of such issue, her shares shall be added to the other shares created under this ITEM I in the same proportion that those shares now bear to each other. ITEM II. I appoint M&T Bank of Harrisburg, Pennsylvama, guardian of any property which passes, either under this Will or otherwise, to a minor and with respect to which I am author/zed to appoint a guardian and have not otherwise specifically done so, provided that this appoiturnent of a guardian shall not apply to property distributable to a minor for whom I have otherwise made special promsion and provided further that this appoinUnent of a guardian shall not supersede the fight of any iiduciary in its discretion to dislzibute a share where possible to the m/nor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support or education (including college education, both graduate and undergraduate) without regard for his or her parent's ability to provide for such support and education, and to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM ~1I. I direct that all taxes that may be assessed as a consequence of death, of whatever nature and by whatever jufisdichon imposed, shall be paid from my residuary estate as a part of the expense of the admimstration of my estate. ITEM IV. I appoint my son, Daniel L. Mundorf, and my daughter, Diane E. Calhoon, Executors of this, my last Will. ITEM V. I direct that my Executors and Guardian shall not be required to give bond for the faittfful performance of its duties in any jurisdiction. IN WITNESS WHEREOF, I, George IC Mundorf, have hereunto set my hand and seal this day of September, 2003. SIGNED, SEALED, PUBLISHED AND DECLARED, by George E. Mundorf, the Testator above named, as and for his Last Will and Testament and in the presence of us, who, at his request, in lus presence and in the presence of each other, have subscribed our names as witnesses. Witnes~ Address COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : We. and , the wimesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the foregning instrument as his Last 'Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time at least 18 years of age, of sotmd mind and under no constraint or undue influence. S3vom to or affirmed and subscribed to before me by ~O),q~tfd Od · ~4~aaSt/~_ · IOn ~ ~blag~t'x , the witnesses, this 1 ~ day of September, 2003. Notary Public and :218406 4 CERTIFIC..ATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. 21-04-0855 To the Register: GEORGE K. MUNDOILF AUGUST 26, 2004 Admin. No. 2004-00855 I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on September 21, 2004. Name Ad&ess Daniel K. Mundorf 7 Pocono Drive, Mechanicsburg, PA 17055 Diane E. Calhoon 1424 College Avenue, Dunmore, PA 18509 Kenneth B. Mundorf 615 Huntingdon Street, Elon, NC 27244 Nancy E. Shumberger 1202 Apple Drive, Mechanicsburg, PA/I~055 i a°iiiehltSeiilriT,i 0giTin to all pets on se nfifle d~~fcep t: NONE Murrel R. Walters, III, Esquire 54 East Main Street Mechanicsbutg, PA 17055 (717) 697-4650 Capacity: __ Personal Representative X Counsel for personal representative Z I.U ~o~ Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) MUNDORF, GEORGE K. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (Mt~DD-Year) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIOOLE INITIAL) OFFICIAL USE ONLY 2 I -0 4 0 8 5 SOCIAL SECURITY NUMBER 7 I 6-0 9-3 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WELLS SOCIAL SECURITY NUMBER [~]1. Odgleal Retom r']4. Limited Estate r~"] 6. Decedent Died Testate (AItach copy ol Will) r--~ 9. Litigation Proceeds Received [] 2. Supplemental Return E~4a. Future Infemst Compromise Idate of dea~ after 12-12-82) E~7. Decedent Maintained a Living Trust (Attach copy of Trust) ] 10. Spousal Pove~ Credit (d~ of death between 12-31-91 and 1-1-95) E~3. Remainder Retum (dateofdeahpdc,'to12.13.82) E~]5. Federel Estate Tax Retum Required __ 8, Total Number of Safe Depesit 8oxes ]11. Electio~ ~ tax under Sec, 9113(A) (~h NAME MURREL R. WALTERS III ESQ F~RM NAME (IfApplicablel TELEPHONE NUMBER 717/697-4650 1. Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Par~ership or Sole-Prepdethrship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal Property (5) (Schedule E) 6. Jointly Owned Pmperb/(Schedule F) (6) ] Separate Billing Requestad 7. Inter-Vivos Transfers & Miscellaneous Non-Propata Properly {7) (Schedule G or L) '" 8. Total Gmea Assets (total Lines 1-7) 9. Funeral Expenses & Administra~ve Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Uedili~ies, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 54 EAST MAIN STREET MECHANIC$_~URG 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES PA 17055 497.O2! 8~317.~0; (8) (11) (12) (13) 1,565.00 3,426.40 81814-~ 4~991 .An 3,822.82 (14) 37'~ "'1' 15. Amount of Line 14 taxable at the spousat tax rate, or transfers under Sec. 9116 (a)(1.2) X (15) 16. AmountofLine14taxableatlinealrete 3,822.82 X .045 (16) 17, Amount of Liea 14 taxable at sibling rate X .12 (17) 18, Amount of Line 14 taxable at collaterel rate X ,15 (18) 19. Tax Due (19) 172.03 t 72.03 Decedent's Complete Address: STREET ADDRESS I 7 POCONO DRIVE CITY I STATE PA I DP 17055 MECHANICSBURG Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Pnor Payments C. Discount 8.60 (1) t 72.03 8,60 t 63.43 63.43 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4.If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Checl~ box on Page I Line 20 to request a refund (4) 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ~ (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the prope~y transferred; ........................................................................... [] [] b. retain the dght to designate who shall use the property transferred or its income; ........................................ [] [] c, retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............... . ...... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Ratirement Acoount, annuity, or other non_probers proberty which contains a beneficiary designation? .............................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN. Underpenattia~ofper]u~y, ldeclarethatlhaveexeminedths eturn, includin~laccompanyingschedulesandstatement~,andtothebestofm knowl eandbelief iris Beclara~on of preparer other than the personal representative is based on all Information of which preparer has any knowledge, y edg , true, correct and complete. SIGNA~SON RESP0?SIBLE FOR FILIN~ RETUP~/ '[~""~ DANIEL I. MI~NDOI~F ~ / ~' ' SIGNATURE 0F PREPATJTE~TSE~ATIME ~ E~T MAIN STREET, ~HANICSBO~G PA t7055 ,/ PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% F2 P.S. §9116 (a)(1.I) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on he ne va ue of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and he statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or youn0er at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decefient's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUNDORF. GEORGE K. ITEM NUMBER 1. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY I FILE HUMBER ~1 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0855 DESCRIPTION PARTHEMORE FUNERAL HOME REFUND OF OVERPAID FUNERAL VALUEAT DATE OF DEATH 497.02 TOTAL (Also enter on line 5, Recapitulation) $ 497.0~ (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EBTATE OF MUNDORF. GEORGE K, SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 04 o85~ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G, SURVIVING JOINT TENANT(S) NAME A. GWENDOLYNS. MUNDORF C ADDRESS 9 POCONO DRIVE MECHANICSBURG. PA 1'7055 RELATIONSHIP TO DECEDENT DAUGHTER IN LAW JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBEF TENANT JOINT iDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTERE ~ 11 A. 6/16/04 M & T BANK 4,850.08 t 00. 4,850.01 CHECKING ACCOUNT COURTESy ACCOUNT 2 A 6/t6/04 M & T BANK 3,467.12 100. 3,467.1: SAVINGS ACCOUNT COURTESY ACCOUNT TOTAL (AJso enter on line 6, Recapitulation) $ 8,3'17.20 p t, insert additional sheets of me same size) EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUNDORF. GEORq;I~ K. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule FILE NUI~IBER gl (~4 ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: PARTHEMORE FUNERAL HOME NEW CUMBERLAND, PA PREPAID ADMINISTRATIVE COSTS: Personal Representative's Commissions NameofPersonaIRepmsentative(s) DANIEL I. MUNDORF Social Security Number(s)/EIN Number of Pemonal Representative(s) StreetAddrees ? POCONO DRIVE 182-46-4710 City MECHANIr-~BURG State PA Yea~(s) Commission Paid: 2004 Altomey Fees MURREL R. WALTERS III ESQ Family Exemp~on: (if deesdent~s address is not the same as claimant's, attach explanation) Claimant Zip 17055 Street Address city Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS CUMBERLAND COUNTY Accountant's Fees State Zip Tax Retum Preparers Fees AMOUNT 500.00 % 980.00 TOTAL (Also enter on line 9, Recapitulation) $ '1,565,_~.. (If mere space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUNDORF. GEORGE K, ITEM · NUMBER 2 3 4 E 6 7 8 9 t0 12 METRO MEDICAL AMBULANCE EKG ASSOCIATES MEDICAL 5EORGE SHAHINIAN, MD MEDICAL ~ERITAGE MEDICAL GROUP MEDICAL HOLY SPIRIT HOSPITAL MEDICAL MOFFIT HEART AND VASCULAR MEDICAL PENNSYLVANIA NEUROLOGICAL MEDICAL QUANTUM IMAGING MEDICAL I~,AI LROAD RETIREMENT OVERPAYMENT REFUND EAST PENNSBORO AMBULANCE MEDICAl. VERIZON SUPPLEMENTAL MEDICAL INSURANCE BLUE RIDGE RESIDENTIAL CARE SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILENUMBER 51 04 Include unreimbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation 0855 VALUE AT DATE OF DEATH 4t .25 17.40 218.25 102.52 29.20 55.28 4g,82 26.26 t,867.86 447.00 666.16 105.60 $ (If mom space is r~ee~ed, insa~t additional sheets of t~e same size) 3~42~-~a'-" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUNDOI{F. GEORGE K. NUMBER I. 1. 2 3 4 1, 1. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions and ransfers under Sec, 9116 (a) (1.2 DANIEL I. MUNDORF (GWENDOLYN 5. MUNDORF~ WIFE) 7 POCONO DRIVE MECHANICSBURG, PA t 7055 DIANE E. CALHOUN 1424 COLLEGE AVENUE DUNMORE, PA 18509 KENNETH B. MUNDORF 615 HUNTINGDON STREET ELON, NC 27244 NANCY E. SHUMBERGER t 202 APPLE DRIVE MECHANICSBURG, PA 17055 FILE NUMBER 21 04 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SON DAUGHTER SON DAUGHTER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 1] - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET {If more space is needed, insed additional sheets of the same size) 0852 AMOUNT OR SHARE OF ESTATE 32.5% 32.5% 17.5% 17.5% ON REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEIST 280601 FIARR~SBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004674 WALTERS MURREL R III 54 E MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 716-09-3811 FILE NUMBER: 2104-0855 DECEDENT NAME: MUNDORF GEORGE K DATE OF PAYMENT: 11/30/2004 POSTMARK DATE: 11/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/26/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $163.43 REMARKS: TOTAL AMOUNT PAID: $163.43 SEAL CHECK# 3627 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z8D60l HARRISBURG PA 17128-0601 NOTIC~~F-INlI!'RITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS ~cASSESSMENT OF TAX DATE I~TATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-14-2005 MUNDORF 08-26-2004 21 04-0855 CUMBERLAND 101 MURREL R WALTERS 54 E MAIN ST MECHANICSBURG PA 17055 Amount Re.ti tied *' ItEV-15~7 Ell iF' (11-04) GEORGE K I CHANGED III (21 (31 (41 (51 (61 (71 .00 .00 .00 .00 497.02 8,317.20 .00 (81 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE"Y :r~4"f"EX""A~~""rll1":6'!riUi'ITc~""d'j!'"l"NIUR"fi'ANcE"i'Ax"APPRA"fni<<'N'l':""AtroilANC~"O'lf""""-""""""""" """ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MUNDORF GEORGE K FILE NO. 21 '04-0855 ACN 101 DATE 02-14-2005 TAX RETURN WAS: (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Est.t. (Schedule A) 2. Stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule FJ 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ Akk ASSESSMENT OF TAX: 15. Amount of Line 14 at Spous.l rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due IT : + INTEREST/PEN PAID (-I .00 DATE 11-30-2004 NUMBER CDo04674 PAYMENT MUST BE MADE BY 05-26-2005_. . IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (91 1101 1,565.00 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 8,814.22 4.991 40 3,822.82 .00 3,822.82 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 172.03 .00 .00 172.03 163.43 8.60 .00 8.60 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIDNS.I 3.426.40 (111 1121 1131 (141 .00 X DO = 3,822.82 X 045= .00 X 12 = .00 X 15 = 1191= AHOUNT PAID 163.43 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 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 WALTERS MURREl Rill 54 E MAIN STREET MECHANICSBURG, PA 17055 unnn told ESTATE INFORMATION: SSN: 71 6~09~38' , FILE NUMBER: 2104-0855 DECEDENT NAME: MUNDORF GEORGE K DATE OF PAYMENT: 03/02/2005 POSTMARK DATE: 03/02/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/26/2004 NO. CD 005008 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8.60 I I I I I I I I TOTAL AMOUNT PAID: $8.60 REMARKS: CHECK# 10819 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE BUREAU OF INPtVtDOALTAXES INHERITANCE TAXDIVlSION PO BOX 280601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLDWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ,--..,-..,. ,(.) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-14-2005 MUNDORF 08-26-2004 21 04-0855 CUMBERLAND 101 MURREL R WALTERS 54 E MAIN ST MECHANICSBURG '* REW-15~7 EX AFP 112-Ul GEORGE K PA 17055 Allount Re..itted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-" :rA~".iic..AFp..ril1":6'!'..NiiT.i'ci-'i:ij!-'I:'NlUR.I.i'AN.CE-TA~-APjlRA.i'siH.€N't~-.A[l'i:iWANCE-oii-........._-- - --. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MUNDORF GEORGE K FILE NO. 21 04-0855 ACN 101 DATE 02-14-2005 TAX RETURN WAS: [X I ACCEPTED AS FILED I CHANGED NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. Amount of line 14 taxable at Lineal/Class A rate (16) 17. Amount of line 14 at Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 3,822.82 X 045 = 172.03 .00 X 12 = .00 .00 X 15 = .00 1191= 172.03 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. Hortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets III 121 (3) (41 151 161 171 .00 .00 .00 .00 497.02 8,317.20 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax 191 IlOI 1.565.00 3.426.40 1111 1121 1131 1141 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 8,814.22 4.99) 40 3,822.82 .00 3,822.82 TAX CI>..nITS: rAmon. '+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID I-I 11-30-2004 CD004674 .00 163.43 PAYMENT MUST BE MADE BY 05-26-2005*. TOTAL TAX CREDIT 163.43 BALANCE OF TAX DUE 8.60 INTEREST AND PEN. .00 TOTAL DUE 8.60 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I BUREAU OF INDIVIDUAL T~)(ES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05) .,J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 MUNDORF 08-26-2004 21 04-0855 CUMBERLAND 101 Allount R_itted GEORGE K ~~.... MURREL R wALTERS 54 E MAIN ST MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, 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 ... ESTATE OF MUNDORF GEORGE K FILE NO.21 04-0855 ACN 101 DATE 04-04-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-14-2005 PRINCIPAL TAX DUE: 172.03 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-30-2004 CD004674 .00 163.43 03-02-2005 CD005008 .00 8.60 TOTAL TAX CREDIT 172.03 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ............'1- REV - 1500 EX + f6-OO) W I- :.:~Ul o~:': Wa..O ",00 O~...J a.. III a.. <( . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT :FILENUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG. PA 17126-0601 ---- - - 21 04 0885 ___ COUNTYCODL ~__ __t-JUM~B_ - - ------------------ - - ---------------- SOCIAL SECURITY NUMBER 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. I- Z w Q w o w Q DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) Mabius, Charles L 171-28-4267 . - >>BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Form REV-1500 EX (Rev. 6-00) Copyright 2000 form software only The Lackner Group, Inc. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE SOCIAL SECURITY NUMBER 09/16/2004 09/13/1936 I --I D D REGISTER OF WILLS --------------------- o 1. Original Return - -~. - Supplemental Return D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) D 6. Decedent Died Testate (Attach copy D 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between D 11. Election to tax under See 9113(A) (Attach Sch 0) ---- .., .>. ................ '0' . -__c. >F. 12-31-91.and 1-1-95) . .><-...-c.... ......>>._. __ ______m___ I THI$SE~mONMuSTBECOMPL.El'EO. ALL COR1R1E$PO!\lPeNCE~PCQNf'IOEN'f!AL'1'~!NI"O~A'f!QNSHOULOBEI::!IR1EC'feO'fO: NAME I COMPLETE MAILING ADDRESS Susan E. Lederer I --- 3. Remainder Return (date of death prior to 12-13~2) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes (11 ) 931.92 (1 ) None ------ (2) None .~-;--~ (3) None . . (4) None ------------ (5) 1,412.00 ' '. 'm,-.I -------- r"'-~) (6) None ------- (7) None (8) 1,412.00 (9) 500.67 - ------------ (10) 431.25 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) '1- Ulz Ww ~Q ~z 00 o a.. + --- ---- FIRM NAME (If applicable) Law Offices of Susan E. Lederer i 4811 Jonestown Rd. Suite 226 -I Harrisburg, PA 17109 I (12) 480.08 TELEPHONE NUMBER 717/652-7323 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o >= :3 ::> l- ii: <( o w ~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (13) (14) 480.08 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x >= <( I- ::> a.. 17. Amount of Line 14 taxable at sibling rate x .12 (17) :l! 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) I- 19. Tax Due (19) Decedent's Complete Address: STREET ADDRESS 70 Cherry Lane i STATE PA IZIP 17013 CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPeralty (D + E) 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is thEOVERPA YMENT Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (3) (4) 0.00 (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................. ~ ~ :: ~:~::~ :h;e~;~~i:~~~s:~~~~s~:~. .s~~ ~I. .u.~~. t.h~. :.r.o:.~.~y. .t.~~.~.sf.~~.r~.d. .~.r .it~. i.~.C.O~~;..............................~~::::::::::: ::..... ~ d. receive the promise for life of either payments, benefits or care?........................................................... LC:li 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................. ............................................................. --..................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?........... ......... ........ ."............................h.... ....... ......... .............................. 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, inciuding accompanYing schedules and statements. and to the best of my knowledge and belief, It Is true. correct and complete. Declaration .e.reparer other than the personal representative is based on all information of which preparer has any knowledge. ING RETURN ADDRESS DATE R.D. 1, Box 253 Shermansdale, PA 17090 1.1\ 1'31.).005 s -----..-.. ADDRES~-~-----------~-_._-.-..----~DAfE-- I C}--}l ~ ) ~ 00 ') ADDRESS 4811 Jonestown Rd. Suite 226 Harrisburg, P A 17109 DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 39116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 39116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 39116 1.2) [72 PS. 39116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ESTATE OF . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 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. ITEM NUMBER 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - ----- Mabius, Charles L FILE NUMBER 21 - 04 - 0885 DESCRIPTION Litigation proceeds, Thomas Mabius, Personal Representative of the Estate of Larry C. Mabius v. Celotex Corporation (asbestos claim), check received August, 24, 2005 TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH ------- ----- 1,412.00 1,412.00 ESTATE OF *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT Mabius, Charles L SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 - 04 - 0885 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. 1. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions DESCRIPTION AMOUNT Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 2 Other Administrative Costs Law Offices of Peter G. Angelos (Attorney's fees for asbestos litigation) Filing Fee for Supplemental Inheritance Tax Return Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 470.67 15.00 15.00 500.67 *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mabius, Charles L 3 Additional Probate Fees Schedule H Funeral Expenses & Acministrative Costs continued ----- -- --- r FILE NUMBER I 21 - 04 - 0885 I-~ 15.00 Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -- -. ---.-.-- ESTATE OF Mabius, Charles L Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION I FILE NUMBER 21 - 04 - 0885 -.....-. ~.._-----_.- Balogh Becker, Ltd. (New Century Financial Services, Inc.) (debt is unpaid and in dispute) TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 431.25 431.25 REV-1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mabius, Charles L FILE NUMBER 21 - 04 - 0885 ________________ _ ___u_____________ I RELATIONSHIP TO i' AMOUNT OR SHARE DECEDENT OF ESTATE ----L-___ __Do Not list Tl'Ilstee(sL_____ ___________ ________ . Sister I 1/4 of estate NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Amy A. LeBard Box 138 Mt. Holly Springs, PA 17065 2 Wilhelm Mabius 107 Valley Street Summerdale, P A 17093 Brother 1/4 of estate 3 Margaret M. Wilbert 1730 Palmer Avenue Wyomissing, PA 19610 Sister 1/4 of estate 4 Thomas Mabius 738 Pisgah Road Shermansdale, P A 17090 Brother 1/4 of estate Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT . BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COpy LAW OFFICES OF PETER G. ANGELOS SETTLEMENT AND DISTRIBUTION SHEET 171-28-4267 PA54679 1 00% E Check No. 667940 THOMAS MABIUS . Personal Representative of The Estate of LARRY C. MABIUS v. Celotex Corporation 2nd Payment SETTLEMENT $ $ $ $ $ $ 1,412.00 Celotex Corporation 2nd Payment TOTAL 1,412c~Q $.______....1412.00. ATTORNEY'S FEE: (33.33% of Settlement) $ 470.67 MEDIC.AL B!LLS $ $ 0.00 TOTAL: $ 0.00 $ 000 CASE EXPENSES $ $ $ $ 0.00 TOTAL: 0.00 $_____~OjJ_ TOTAL DEDUCTIONS: $ __ 47Q.67 BALANCE TO: THOMAS MABIUS , Personal Representative of The Estate of LARRY C. MABIUS $______9.1_L~~ I understand and acknowledge that the funds being paid to me in regard to this settlement have been maintained in a trust account in a financial institution located outside of the Commonwealth of Pennsylvania, and that settlement monies payable to me from a settling party in any future settlement, and I or monies payable to me as a result of any verdict or judgement in my case, upon receipt by the LAW OFFICES OF PETER G. ANGELOS, P.C., will be placed into such a trust account and, less attorneys' fees and expenses, will be paid thereafter to me as expeditiously as circumstances allow. I hereby give my consent to this in regard to this present settlement and in regard to all monies payabie to me as a result of any future settlements, verdicts, or judgements. 667940 FILENO: .CELOTEX-PAYMENT~2 :\i Nine Hundred Forty One and 33/l00 Dollars r~.!2412005 " "", THOMAS MABIUS, Personal Representative of The Estate oHARRYC. MABIUS! \ RD 1 Box 253 ...._...;5 f .. ..; : " , ~<~~,:',.. ,,,,,,,,,,,,"0$1 738 PisgahHoad Shermansdale, PA17090 9401.33 ~\lAPD ~ _~~t v' \ \ \ J Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 phone: (71 7) 240 - 6345 Date: 7/05/2006 MUNDORF DANIEL I 7 POCONO DRIVE MECHANICSBURG, PA 17055 RE: Estate of MUNDORF GEORGE K File Number: 2004-00855 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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: 8/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~.671! //.. / Glenda Far~er Strasbaugh Clerk of the Orphans' Court cc: File Counsel \(:' Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 WALTERS III MURREL R 54 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of MUNDORF GEORGE K File Number: 2004-00855 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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: 8/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, cA'. n .r ;"",~...J/ . ''''''7''. V ,/,<t'" / Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ~ 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 ST ATUS REPORT UNDER RULE 6.12 Name of Decedent: GEORGE K. MUNDORF Date of Death: August 26,2004 Estate No.: 2004-00855 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes_X_ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete (date) 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 _X_ B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties n interest: Yes _X No D. Copies of receipts, releases, joinders and approvals of fo~r,m or informal accounts may be filed with the Clerk of the Orphans' Cou and may be attached to this report. I l / . 'I vl01 1/1/ / Date: July 7, 2006 MURREL R. WALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 Capacity: Personal Representative -' ('"" , ; L ';..1 l, i j ,;!, -' l _X_ Counsel for Personal Representative c-