Loading...
HomeMy WebLinkAbout03-0861Estate of also known as Register of Wills of County, Pennsylvania PETITION FOR GRANT OF LETTERS , Deceased Social Security No. 011- ~.~,~0 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that PetitionerC~ is/,¢~'~' the executor named in the Last Will of the Decedent, dated ~-~7 ~'~',* / ~9 ? and codicil(s) dated Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse, (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional heetsif necessary. Decedent was domiciled at death in (~IA v~,~d~)~i-~.~ residence at ~.0 ~. I~f~ S~; ~0~ Decedent, then ~ years of age, died ~~ ~ County, Pennsylvania, with his/her last family or pnnopal Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ........................... $ (tf not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County ........................ Value of real estate in Pennsylvania ............................................. Total ............................................................. $ Real Estate situated as follows: ~ R:a, q O0 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with th~s Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence /7-/7/-// Oath of Personal Representative Commonwealth of Pennsylvania County of ~ COMBV, RLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and ~h~t, ~S~ p ~e~._,~onaL representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. '- Sworn to and affirmed and subscribed before me this 21st day of 4f~October 1~ 2003 Donna Pl. Otto, 1st Deputy ~ DECREE OF REGISTER Estate of DORIS R. CASAVANT Deceased No. 21-2003-861 also known as Social Security No:011-24-3580 Date of Death: October 8, 2003 AND NOW, October 22nd ~R 2003, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary [] of Administration are hereby granted to E. THC~4AS WOJDYLAK-- in the above estate and that the instrument(s), if any, dated May 27th, 1994 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $ 60.00 Short Certificate(s)....4 ..... Renunciation .................. Affidavit ( ) ................. Extra Pages (3) ............ Codicil .......................... JCP Fee ........................ Inventory & Tax Forms... Other ............................ 12.00 9.00 $ 10.00 TOTAL ................ $91.00 RW-7a Attorney: I.D. No: Address: Telephone: DATE FILED' Mailed Letters to Executor on 10/22/03 October 22nd, 2003 his is to certify that the information here given is correctly copied from an original certificate of death dui,,, filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~al Reg~sstrar - P 9 7 0 2 9 8 8 No. ' ~ Date COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,'t~7 ~,~t,,,,~, o~. /'1/i/ £/V ZZgaSd,-L o [] 21-2003-861 LAST WILL AND TESTAMENT OF DORIS R. CASAVANT I, DORIS R. CASAVANT, having my legal residence at 245 Old York Road, New Cumberland, Fairview Township, York County, Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. I direct that there be no viewing and nor funeral service and, further, that my body be delivered to the Neil Funeral Home of Camp Hill, Pennsylvania for shipment by airplane to Polik's Funeral Home in Gardner, Massachusetts. ITEM TWO: I bequeath any automobile I own at the time of death to my brother-in-law, EDWARD T. WOJDYLAK, if he survives my death by thirty (30) calendar days. If he fails to so survive, said bequest-shall pass to my nephew, E. THOMAS WOJDYLAK. ITEM THREE: I bequeath my household belongings, furniture, clothing, and my two gold chains to my friend, JOANNE M. SEMONES. ITEM FOUR: I bequeath my mother's diamond ring to my niece, KAREN C. LUCKENBACH, if she survives my death by thirty (30) calendar days. If she fails to survive my death, said bequest shall pass to my niece, NANCY ACKERSON. ITEM FIVE: I bequeath my Honda Passport Motorcycle to my friend, JOANNE M. SEMONES. It is my desire that said motorcycle be held for the use and/or benefit of ANDREW J. HECKERT. However, I do not wish to create a guardianship or trust arrangement which would create any tax or other administrative burden for JOANNE and, therefore, I will trust her to carry out my intentions and desires without imposing the legal obligation of a trustee or guardian. ITEM SIX: I devise and bequeath all of the rest and remainder of my estate of whatsoever nature and wheresoever situate, as follows: a. Four (4%) percent to my brother, NORMAN CASAVANT, of Gardner, Massachusetts, if he survives my death by thirty (30) calendar days. If he fails to so survive, said share shall pass to his issue in equal shares, per stirpes; b. Ten (10%) percent to be divided equally in equal shares, per capita, among my grand-nieces and grand-nephews, who survive my death by thirty (30) calendar days. My grand-nieces and grand-nephews presently consist of TAVIS COMEE, MEGAN COMEE, SHAWN COMEE, NICHOLAS CASAVANT, and AMANDA ACKERSON; c. Eighty-six (86%) percent to be divided among my nieces and nephews in equal shares, per stirpes, who survive my death by thirty (30) calendar days or who leave issue who survive my death by thirty (30) calendar days. My nieces and nephews presently consist of E. THOMAS WOJDYLAK, MICHAEL WOJDYLAK, DAVID COMEE, DENNIS COMEE, NANCY ACKERSON, KAREN C. LUCKENBACH and BRADLEY CASAVANT. ITEM SEVEN: Ail estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM EIGHT: I appoint my nephew, E. THOMAS WOJDYLAK, Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such manner as he shall deem proper, limited only by his own discretion. If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint MICHAEL A. WOJDYLAK, my Executor with the same powers and privileges set forth above. IN WITNESS WHERE~F~ I have at Hershey, Pennsylvania, this ~ day of _ ~//~/ , 1994 set my hand and seal to this, my Last/~l and Tes~/~nt consisting of four (4) pages including the acknowle~, t~~ L DORY SIGNED, sealed, published and ~eclared by DORIS R. CASAVANT, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~' ~ Residence 1~~ ~ Residence ACKNOWLEDGEMENT We, DORIS R. CASAVANT, ~--~d ~0~Y and -~L-lt~--b~_bO-- ~©0~C~iC~, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind ~ under no constraint or undue influence. ~~. ~ ~/ ~ ~ / WITNESS Subscribed, sworn to and acknowledged before me by DORIS R. CASAVANT, the Testatrix, and subscribed and sworn to before me by ~ ~. V~T~ and ~-Ii~50~ ~%~L..B~CSIG-~-"I witnesses, this..~7~Aday of 1994. (SEAL) NOTARY PUBLIC DORIS R. CASAVANT 245 OLD YORK ROAD NEW CUMBERLAND, PA 17070 LAST WILL AND TESTAMENT YOST & DAVlnSO~ 320 WEST CHOCOLATE AVENUE P.O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 COMMONWEALTH OF PENNSYLVAN~ DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 /?-/7/--// REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIP, L USE ONLY Fi'L'E NUMBER 21 COUNTY CODE 03 00861 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER CASAVANT, DORIS R 011 - 24- 3580 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 10/08/2003 05/28/1927 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER UJ ~:oo NONE, [] 1. Original Return [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12.,82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95} ",lAME JON A YOST :IRM NAME (If applicable) YOST & DAVIDSON FELEPHONE NUMBER 717/533-5101 ] 3. Remainder Return (date of death prior to 12-13-82) [] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [] 11 .Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 320 WEST CHOCOLATE AVENUE P. O. BOX 437 HERSHEY, PA 17033 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) None 772.50 None None 32,483.86 None None 6,322.50 2,581.00 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) OFFICIAL USE ONLY (8) 33,256.36 8,903.50 24,352.86 24,352.86 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 x .00 0.00 x .045 918.91 x .12 23,433.95 x .15 (15) (16) (17) (18) (19) 110.27 3,515.09 3,625.36 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: ISTREETADDRESS 20 NORTH 12TH STREET CITY LEMOYNE STATE PA Zh~ 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3,443.81 181.25 (1) 3,625.~(~ Total Credits (A + B + C) (2) 3,625. ~, Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund If Line 1 + 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. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 0.3t:> PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property trensferred; .................................................................................. [~ I~ b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest; or .................................................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. 2. If death 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 Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has an)/knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE E. THOMAS WOJDYLAK., ]/O g ~E"~ bl~ ~ 101 N. 31ST STREET HARRISB~G, PA 17111 SIGNATURE OF PERSON RESPOI~SIBI~E FOR FILING RETURN ADDRESS DATE SIGNeT, LIllE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS 320 WEST CHOCOLATE AVENUE DAT~/ JOiq A Y~ST ~ For dates of death on or after July ~, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a sullying spouse from tax, and the s~tuto~ requirements for disclosure of assets and filing a tax return are still applicable even if the sullying spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child ~en~-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a steppamnt of the child is 0% [72 P.S. ~9116 {a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~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 decadent'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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CASAVANT, DORIS R SCHEDULE B STOCKS & BONDS FILE NUMBER 21 - 03 - 00861 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE OI NUMBER DESCRIPTION UNIT VALUE DEATH 25 SHARES OF MET LIFE, INC. HELD BY THE 30.90 772.50 MET LIFE POLICYHOLDER TRUST WITH DECEDENT AS TRUST BENEFICIARY(SEE ATTACHED STATEMENT) TOTAL (Also enter on line 2, Recapitulation) 772.50 COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CASAVANT, DORIS R SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 03 - 00861 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 7 8 9 DESCRIPTION JEWELRY, PER ATTAC~D APPRAISAL CHECKING ACCOUNT #200023792 WAYPOINT BANK (see attached statement) SAVINGS ACCOUNT #760003071 WAYPOINT BANK(see attached statement) MISCELLANEOUS HOUSEHOLD FURNISHINGS AND CLOTHING (DECEDENT WAS LIVING IN ONE ROOM IN A NURSING HOME AND HAD DISPOSED OF MOST OF HER BELONGINGS AT THE TIME OF ENTRY) TELEPHONE COMPANY REFUND REFUND OF SECURITY DEPOSIT FROM ESSEX HOUSE REFUND OF HOSPICE FEES PAID IN ADVANCE OF ADMISSION TO CAROLYN CROXTON SLANE HOSPICE RESIDENCE REFUND FROM FACKLER FUNERAL HOME FROM PREPAID FUNERAL SERVICES REFUND FROM MET LIFE INSURANCE COMPANY FOR CAR INSURANCE REFUND FROM ERIE FOR APARTMENT INSURANCE TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 650.00 22,843.67 51.73 750.00 7.96 747.50 6,600.00 710.00 76.00 47.00 32,483.86 11/06/03 Thomas Wojdylak 5775 Allentown Blvd. Harrisburg, PA 17112 4636 Jonestown Road Harrisburg, Pennsylvania 17109 Phone (717) 652-8477 · Fax (717) 652-9245 COPY Joseph A. Rosi, Jr., CGA President Dear Mr. Wojdylak: This appraisal is being issued by a Certified Gemologist Appraiser of the American Gem Society, an elite group of gelologically-trained professional jewelers who subscribe to a strict code of'ethics. Great care has been taken to provide you with complete descriptions of your jewelery and accurate estimated ESTATE VALUE. Unless specifically stated, mounting are assumed to be mass produced rather than handmade, and in good repair. Most mountings will not permit us to examine and measure every detail, therefore the appraisal values are based only on estimated quality, weights and measurements of the items, unless otherwise stated. It should be understood by our appraisal clientele that an appraisal is not an all inclusive document, but, rather, that there are many specific types of appraisals suited for specific needs. To avoid misunderstanding, the enclosed appraisal is report number 000852. The total ESTATE VALUE for the jewelry listed is $630.00. Sincerel~/~/ Josel~f ~% .' Rosi, Jr., CGA Certified Gemologist Appraiser, American Gem Society ESTATE OF DORIS R. CASAVANT 000852B 000852C 000852D Appraisal Number: 000852 Date: 11/06/03 Property of: Thomas Wojdylak 5775 Allentown Blvd. Harrisburg, PA 17112 Items List 18 Inch~old Chain 14K Yellow Gold Herringbone Chain measuring approximately 18 inches in length and 3.25 mm in width and weighing approximately 5.6 grams. Replacement value: 45.00 20 inch chain 14K Yellow Gold Herringbone Chian measuring approximately 20 inches in length and 3.25 mm in width, The chain weighes approximately 6.0 grams. Replacement value: 50.00 18 inch chain 14K Yellow Gold Herringbone Chain measuring approximately 18 inches in length and 1.0 aah in width and weighing approximately 1.1 grams. Replacement value: 10.00 Appraisal continued on next page. Appraisal Number: 000852 Page: 2 Property of: Thomas Wojdylak 5775 Allentown Blvd. Harrisburg, PA 17112 Items list Ladies Diamond Rimg Ladies 14K White Gold Diamond Ring containing one Single Cut Diamond set in Box Mead with one Single Cut Diamond on either side and two (2) Single Cut Diamonds on top and bottom of Center Diamond. The Ring is 14K White Gold weighing approximately 2.1 grams. GEMSTONE GRADING REPORT: Type ............. Diamonds (7) Shape ............ Single Cut Size .............. 1-2.0mm, 2-1.7mm, 4-1.3mm Weight ............. 11 carat total Color ............. Near Colorless (G) Clarity ........... VS 1 Replacement value; 525.00 This is to certify that we are engaged in the business of buying and selling items made from precious metals and precious and semi-precious stones. We certify that the item(s) on this appraisal were appraised using a 10 power gemscope and other gemological equipment in accordance with industry standard procedures. This is not an offer to buy. It represents our evaluation of the replacement value at the time of inspection. J Certified Gemologist Appraiser, American Gem Society FRO~ ': F~ NO. : Dec. 29 2003 08:36PM P4 Box 171. I-I~fl'l~l~ufl~ P~flflsLIIV~nla r710:3-r711 DORIS R CASAVANT VIP ¢~£[ COMBINED STATEMENT DATE 10-26-02 200023792 0~7-610 PAGE 2 lO/lO CHECK '600 7000.00 25840.77 10/10 CHECK 1599 3000.00 10/26 INTEREST PAYMENT 2.81 * ' ' '0'N ' .... ~A~E ..... A OUNT-M=CHECKS PAID ............... HO. DATE AMOUNT ,o-oz oD 1S97 10-02 6000.00 1600 10-10 7000,00 ACCOUNT TYPE OF ACCOUNT 760002071 SAVER'S ADVANTAGE PREVIOUS BALANCE 4.7~1.47 DEPOSITS ,00 CHARfZES INTEREST ~~~~ ENDIN~ B A L ~~/~:, INTEREST EARNED ~~~ ' ' ' DAYS ]N PERIOD INTEREST EARNED ANNUAL PERCENTAGE INTEREST PAID T~~~~' INTEREST ~II~HEk~~~~-2 0¢~0 DESCRIPTION~. 4~ BALANCEs. CONFIRHATIONd O0 10/~6 I"TEREST PAYHE"T THANK YOU FOR BANKING AT WAYPOINT BANK Customer SErvice TOII-IEl~e 1-866-~VAYPOINT www, waupolrd~anlccom FROM ~ FAX NO. : Dec. 29 2003 08:35RM P3 P.O. Box 1711, Harelsbueg, Pennsylvania 1710S-1'211 ~mb~' FDIC COMBINED STATEMENT DATE 10-26-03 DORIS R CASAVANT ~ TOM WOODYLAK 101 N 21 ST HARRISBURG PA 17111 017-610 WAYPOINT BANK HAS THE <ASH FOR THE THINGS YOU NEED - RIGHT NOW! COME TALK TO US NOW DDRING OUR FALL LOAN SALE. STOP BY YOUR LOCAL BRANCH TODAY. OR CALL US AT 1-866-WAYPOINT (1-866-929-7646). * ............. YOUR ACCOUNTS WITH US ............ * --YOUR DEPOSITS-- ACCOUNT NBR BALANCE SAVER,S ADVANT4~_.I: 003071 73 - 200 ~760 V I P,~_P_P_P_P_P_P~_~ E ~ , ':~~... 2- .,: ..... ~;;.~ ',. -n"',. -Total of..Your Depo .~ ~ .. '~ . ,31 ACCOUNT I'YPE OF ACCO~~~ ~. ~~ ~AL~ WITHDRAWALS 117 78 EREST. O0 ENDING BALANCE 2.843 58 * ........... UMMARY ....... * INTEREST EARNED FROM 10/26/02 DAYS IN PERIOD ~ INTEREST EARNED 2.81 ANNUAL PERCENTAGE YIELD EARNED .19 INTEREST PAID THIS YEAR 6.44 INTEREST WITHHELD THIS YEAR ,00 * .............. TRANSACTION SUMMARY .............. TRANSACTION DEPOSITS/ CHECKS/ DATE DESCRIPTION CREDITS 9/30 ATM/WEB CREDIT 4700.00 10/02 CHECK 1597 10/02 CHECK 1595 10/03 ELECTRONIC TRANSACTION 874.00 US TREASURY 303 SOC SEC 10/06 DISTR IRA 181521712 2544g.~g 10/86 DISTR IRA 9500004214 8219.26 10/06 DISTR 125507432 1520.10 10/06 CHECK 1596 10/07 ELECTRONIC TRANSACTION TRANS TO IRA FOR FED W/H 10/09 CHECK 1598 CONTINUED ON NEXT PAGE DEBITS BALANCE 7895.50 6000.00 1895,50 1495.00 400,50 1274.50 26724,19 34943,45 36463,55 87,55 36376.00 3517.54 32858,46 17.69 32840.77 COMMONV~=5~.TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CASAVANT, DORIS R SCI4~XJLEH RJNERN. EXPENSES & FILE NUMBER 21 - 03 - 00861 Debts of decedent must be reported on Schedule I. ITEM NUMBER 1 2 3 DESCRIPTION FUNERAL EXPENSES: POLIKS FUNERAL HOME MICHAEL WOJDYLAK-REIMBURSEMENT FOR PURCHASING FUNERAL CLOTHING FOR DECEDENT FAMILY MEMORIALS-GRAVESTONE ENGRAVING ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees ¥OST & DAVIDSON Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees R.EGIST~R OF WILLS State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs JOSEPH A. ROSI JEWELERS, INC., JEWELRY APPRAISAL TOTAL (Also enter on line 9, Recapitulation) AMOUNT 4,351.00 216.00 85.00 1,500.00 91.00 79.50 6,322.50 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVAN~ INHERFFANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CASAVANT, DORIS R 21 -03- 00861 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 U.S. TREASURY-BALANCE DUE ON DECEDENTS 2003 FEDERAL INCOME TAX MICHAEL WOJDYLAK-REIMBURSEMENT FOR MEDICAL BILLS AND PRESCRIPTIONS PURCHASED FOR DECEDENT IMMEDIATELY PRIOR TO HER DEATH TOTAL (Also enter on Line 10, Recapitulation) 2,280.00 301.00 2,581.00 · REV-1513 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES CASAVANT, DORIS R !FILE NUMBER 21 - 03 - 00861 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT ~, ~* L~. Tr~::-'==:=.', OF ESTATE lo TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 JOANNE M. SEMONES Friend 855.00 131 LOCUST STREET GOLD CHAINS SHIR. EMANSTOWN, PA 17011-6733 ($105) AND HOUSEHOLD BELONGINGS ($750) 2 KAI~N C. LUCKENBACH Niece 3,347.38 17 HUNTER RIDGE DIAMOND RING WINDSOR, CT 06095 ($525) PLUS 1/7 OF 86% OF I~MAINDER ($2822.38) 3 NORMAN CASAVANT Brother 918.91 145 PELLY STREET 4% OF REMAINDER GARDNER MASS 01440 See Continuation Schedule(s) attached 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET SCHEDULE J COM~:~VV~LTH OF PE..SVLV^.,A BENEFICIARIES continued ,..ERrr^.cE T~X RESIDENT DECEDENT ESTATE OF FILE NUMBER CASAVANT, DORIS R 21 - 03 - 00861 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE Do Not List Tmstm~.) OF ESTATE [include outright spousal distributions, and transfers under L tAXABLE DISTRIBUTIONS Sec. 9116(a)(1.2)] 4 TAVIS COMEE Grand Nephew 328.18 65 MARQUETTE STREET 1/7 OF 10% OF GARDNER, MASS 01440 REMAINDER 5 MEGAN COMEE Grand Niece 328.18 65 MARQUETTE STREET 1/7 OF 10% OF GARDNER, MASS 01440 REMAINDER 6 SHAWN COMEE Grand Nephew 328.18 92 LEO DRIVE 1/7 OF 10% OF GARDNER, MASS 01440 REMAINDER 7 NICHOLAS CASAVANT Grand Nephew 328.18 976 CLARK STREET 1/7 OF 10% OF GARDNER, MASS 01440 REMAINDER 8 AMANDA ACKERSON Grand Niece 328.18 99 LIGHTHOUSE HILL ROAD 1/7 OF 10% OF WINDSOR, CT 06095 REMAINDER 9 KATE ACKERSON Grand Niece 328.19 99 LIGHTHOUSE HILL ROAD 1/7 OF 10% OF WINDSOR, CT 06095 REMAINDER 10 CI-I/USTA CASAVANT Grand Niece 328.19 976 CLARK STREET 1/7 OF 10% OF GARDNER, MASS 01440 REMAINDER 11 E. THOMAS WOJDYLAK Nephew 2,822.38 101 N. 31ST STREET 1/7 OF 86% OF HARRISBURG, PA 17111 REMAINDER 12 MICHAEL WOIDYLAK Nephew 2,822.38 1410 HERITAGE SQUARE 1/7 OF 86% OF MIDDLETOWN, PA 17057 REMAINDER 13 DAVID COMEE Nephew 2,822.38 65 MARQUETTE STREET 1/7 OF 86% OF GARDNER, MASS 01440 REMAINDER 14 DENNIS COMEE Nephew 2,822.38 92 LEO DRIVE 1/7 OF 86% OF GARDNER, MASS 01440 REMAINDER Page 2 of Schedule J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES continued FILE NUMBER CASAVANT, DORIS R 21 - 03 - 00861 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE Be Not Ll~t Tr_,_~,~.~_~s) OF ESTATE [include outright spousal distributions, and transfers under I. rAY, ABLE DISTRIBUTIONS Sec. 9118(a)(1.2)] 15 NANCY ACKERSON Niece 2,822.38 99 LIGHTHOUSE HILL ROAD 1/7 OF 86% OF WINDSOR, CT 06095 REMAINDER 16 BRADLEY CASAVANT Nephew 2,822.38 976 CLARK STREET 1/7 OF 86% OF GARDNER, MASS 01440 REMAINDER Page 3 of Schedule J LAST WILL AND TESTAMENT OF DORIS R. CASAVANT I, DORIS R. CASAVANT, having my legal residence at 245 Old York Road, New Cumberland, Fairview Township, York County, Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. I direct that there be no viewing and nor funeral service and, further, that my body be delivered to the Neil Funeral Home of Camp Hill, Pennsylvania for shipment by airplane to Polik's Funeral Home in Gardner, Massachusetts. ITEM TWO: I bequeath any automobile I own at the time of death to my brother-in-law, EDWARD T. WOJDYLAK, if he survives my death by thirty (30) calendar days. If he fails to so survive, said bequest-shall pass to my nephew, E. THOMAS WOJDYLAK. ITEM THREE: I bequeath my household belongings, furniture, clothing, and my two gold chains to my friend, JOANNE M. SEMONES. ITEM FOUR: I bequeath my mother's diamond ring to my niece, KAREN C. LUCKENBACH, if she survives my death by thirty (30) calendar days. If she fails to survive my death, said bequest shall pass to my niece, NANCY ACKERSON. ITEM FIVE: I bequeath my Honda Passport Motorcycle to my friend, JOANNE M. SEMONES. It is my desire that said motorcycle be held for the use and/or benefit of ANDREW J. HECKERT. However, I do not wish to create a guardianship or trust arrangement which would create any tax or other administrative burden for JOANNE and, therefore, I will trust her to carry out my intentions and desires without imposing the legal obligation of a trustee or guardian. ITEM SIX: I devise and bequeath all of the rest and remainder of my estate of whatsoever nature and wheresoever situate, as follows: a. Four (4%) percent to my brother, NORMAN CASAVANT, of Gardner, Massachusetts, if he survives my death by thirty (30) calendar days. If he fails to so survive, said share shall pass to his issue in equal shares, per stirpes; b. Ten (10%) percent to be divided equally in equal shares, per capita, among my grand-nieces and grand-nephews, who survive my death by thirty (30) calendar days. My grand-nieces and grand-nephews presently consist of TAVIS COMEE, MEGAN COMEE, SHAWN COMEE, NICHOLAS CASAVANT, and AMANDA ACKERSON; c. Eighty-six (86%) percent to be divided among my nieces and nephews in equal shares, per stirpes, who survive my death by thirty (30) calendar days or who leave issue who survive my death by thirty (30) calendar days. My nieces and nephews presently consist of E. THOMAS WOJDYLAK, MICHAEL WOJDYLAK, DAVID COMEE, DENNIS COMEE, NANCY ACKERSON, KAREN C. LUCKENBACH and BRADLEY CASAVANT. ITEM SEVEN: Ail estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM EIGHT: I appoint my nephew, E. THOMAS WOJDYLAK, Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such manner as he shall deem proper, limited only by his own discretion. If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint MICHAEL A. WOJDYLAK, my Executor with the same powers and privileges set forth above. IN___,WITNESS WHERE?_F~ I have at Hershey, Pennsylvania, this ~ day of /V/~; ~/ , 1994 set my hand and seal to this, my L~st/~l and Test~nt consisting of four (4) pages including the acknowledg~me~t./~l / /F-'/ f/~ SIG~ED, sealed, published andSeclared by DORIS R. CASAVANT, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. Residence Residence ACKNOWLEDGEMENT We, DORIS R. CASAVANT, TJ ~'~Y and ~/i%%0~ ~O~C~, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind ~ under no constraint or undue influence. :~~_~~~.~~ } -~ ~ITNES WITNESS Subscribed, sworn to and acknowledged before me by DORIS R. CASAVANT, the Testatrix, and subscribed and sworn to before me by ~ ~. ~. ~-~ and ~li~ ~%~010~ witnesses, this,,~Aday of /~ , 1994. (SEAL) NOTARY PUBLIC NO..T p,,R$,e,i SEAL ~-~ SARAH A. TE~PLSN, NOTARY PUBLIC ~RRY TWP., DAUPHIN CO., PA,,. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003404 YOST JON A ESQUIRE 320 WEST CHOCOLATE AVENUE P O BOX 427 HERSHEY, PA 17033 fold ESTATE INFORMATION: SSN: 011-24-3580 FILE NUMBER: 2103-0861 DECEDENT NAME: CASAVANT DORIS R DATE OF PAYMENT: 01/02/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,443.81 TOTAL AMOUNT PAID' $3,443.81 REMARKS: E THOMAS WOJDYLAK C/O JON A YOST ESQUIRE SEAL CHECK# 98 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERTTAHCE TAX DIVISION DEPT. ZS060Z HARRISBURG,, PA Z71ZS-0601 JON A YOST YOST & DAVIDSON PO BOX 457 HERSHEY PA 17033 CONHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATENENT OF ACCOUNT ~/¥iti~STATE OF DATE OF DEATH 02-23-2004 CASAVANT 10-08-2005 21 03-0861 CUHBERLAND 101 REV-iI~O? EX AFP C01-03) DORIS R :NUHBER '04 FEB 27 P 1 ' 'rY ACN I HAKE CHECK PAYAgLE AND REH~T PAYHENT REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To &nsur,e pr,oper, cr-edi~: ~:o your` account:, submit: ~he upper` por,~:ion of ~his for,m tfi~h your` ~ex payment. CUT ALONG TH'rS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS *-~ REV-1607 EX AFP (01-03) ##~ INHERITANCE TAX STATENENT OF ACCOUNT ESTATE OF CASAVANT DORIS R F'rLE NO. 21 05-0861 ACN 101 DATE 02-23-2004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELON ZSA SUHHARY OF THE PRINCIPAL TAX DUE., APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND., ZF APPLICABLE, A PROJECTED TNTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 02-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 3,625.36 PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID 01-02-2004 CD003404 181.25 3,443.81 ZF PAID AFTER TH/S DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { ZF TOTAL DUE KS LESS THAN 91, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CRED/T' TOTAL TAX CREDIT 3,625.06 BALANCE OF TAX DUE .30 INTEREST AND PEN. .00 TOTAL DUE YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCT/ONS. ) .3O PAYMENT: Detach the top portion of this Notice and submit mlth your payment made payable to the name and address printed on the reverse side. -- Tf RESTDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- Tf NON-RESTDENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Tnheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or free tho Department's [4-hour answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with spec[a[ hearing and / or speaking needs: 1-800-447-30Z0 (TT only). REPLY TO: guastions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Tndividual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DTSCOUNT: If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount of tha tax paid is a11oaed. PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. TNTEREST: Tnterest is charged beginning with first day of delinquency, or nine [9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .gOO16q. All taxes ahich became delinquent on and after January 1, 1982 ail1 bear interest at a rate ahich aill vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate Daily Factor 1982 ZOZ .O00Sq8 1987 9Z .000247 1999 7Z .O0019Z 1983 16Z .000458 1988-1991 1XX .000301 ZOOO 8X .000219 1984 11Z .000301 199Z 9Z .000Z47 ZOO1 9X .000Z47 1985 13Z .000356 1993-1994 7X .OOO19Z 2002 62 .000164 1986 lO[ .000Z74 1995-1998 9Z .000247 2003 5Z .000137 --Tntarest is calculated as follaas: INTEREST = BALANCE OF TAX UNPAID X NU)IBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent ail1 reflect an interest calculation to fifteen (la) days beyond the date of the assessment. Tf payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. IN RE: ESTATE OF DORIS R. CASAVANT, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : DECEASED : NO. 21-03-861 CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Doris R. Casavant Date of Death: October 8, 2003 Will No. N/A Admin. No. N/A To the Register: I hereby certify that notice of the 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 ~[C~A~L ~o3-0yLAK bAvto '~AVts com~&' Date: Notice has been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions. E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : :NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF ClJI~IBERLAblD COUlqTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: 'E. Thomas Wojdylak, 101 North 31 st Street, Harrisburg, PA 17111 (717) 541-1860 Ifth6'Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : :NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUlffBERLAlqD COI. IlqTY In Re: Estate of Doris R. Casavant, Deceased TO: (Name) (Address) Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: 'E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifth~Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan'd County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy 'of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: t ti o/ o.3 E. Thomas Wojdylak Capacity:. X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : :NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEWE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CmmEP, LANI) COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: Please take notice of ~e death of ~e decedent ~d the ~t of letters to the personal representative nmed below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifth6'Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlar~l County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: ,,1~-o[o~ g ~'~~ ~/,J~ E. Thomas Wojdylak Capacity:. X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: I~Av t,r /~- 6J' P'l^g ¢J 7. Please t~'e notice of ~e dea~ of the decedent ~d ~e ~t of le~ers to ~e personal representative nmed below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31 st Street, Harrisburg, PA 17111 (717) 541-1860 If th~",Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE'OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CLIlVlBERLAIqD COLrblTY In Re: Estate of Doris R. Casavant, Deceased TO: (Name) (Address) tq66:Ad Pl. Coffee {2-g ~AP-.9~/'- 77/-- ,CZ Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: *E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifthd'Decedent died testate, the Will has been filed with the Office o£the Register of Wills of Cumberland, County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A' copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: Itl~.oJo3 E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property Will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COIINTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: b Please t~'e notice of ~e death of ~e decedent ~d ~e ~t of le2ers to ~e personal representative nmed below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: E. Thomas Wojdylak, 101 North 31 st Street, Harrisburg, PA 17111 (717) 541-1860 Ifthd"Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland, County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: ',] ~-ol 0_3 C~. ~"-~ ~~ E. Thomas Wojdylak Capacity:. X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA · ORPHANS' COURT DWISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE'OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CI.131-BERLAlxlD COIJlqTY In Re: Estate of Doffs R. Casavant, Deceased (Name) (Address) TO: J' B/~ ~//x/ Cota~ 6 ~ ~. [ko Oe,.IVA- Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doffs R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: - E. Thomas Wojdylak, 101 North 31 st Street, Harrisburg, PA 17111 (717) 541-1860 If tho'.Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan~ County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: Ill 03 °b; E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF Cmi~Ee, L~q~) COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: KAf..A-~4 I~cX£p/ I~Ac/q Please take notice of the death of' the decedent and the grant of letters to the personal representative named below. The Decedent, Doffs R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifth~Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland, County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: E. Thomas Wojdylak Capacity:. X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE'OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CmI3ERLA~D comqt~ In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: cT Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: 'E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 If thd",Decedent died testate, the Will has been filed with the Office of the Register of Wills 0f Cumberlan'd County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: Illa.~[o3 E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21.-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUM3ERLAND COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifthi',Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan~ County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. E. Thomas Wojdylak Capacity:. X Personal Representative 1N THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CU~Bv.~,LmqD COUtqTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) ~t~r~, c7 060?3' Please t~e notice of ~e dea~ of the decedent ~d ~e ~t of leRers to the personal representative nmed below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifthd"Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland~ County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : :NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property Will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COIJNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: ~6~/~i)t.~.Y' C P, ,f' t% q h ,,J 'f Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: 'E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 If thd',Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan~ County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. I£the decedent dies without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF ctr~gw&UA~O cotmT~ In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: q'/(o Cc.~g~ .f 7. G-,¢~vb~ , ~^ 6'.f otw't o Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: 'E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 If th~'Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan'~, County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUI~BERLAlqD COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) ~]ease take ~ofice o[ ~e death o[ the decedent ~d ~e ~t of ]e~e~s to the ~ep~ese~tatJ~e ~ed below. The Decedent, Doris R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 Ifthd~Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: III ~o/~3 ~' ff~~~ E. Thomas Wojdylak Capacity: X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DWISION : : NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF Ct~BEP, Lmq~) COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: NO~A~ C A.C^ u/%d ~ Please take notice of the death of the decedent ~d ~e ~mt of letters to the personal representative nmed below. The Decedent, Doffs R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 If th~Decedent died testate, the Will has been filed with the Office of the Register o£Wills of Cumberland County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: ltl ~-~,1 3 ~- ~"~ ~/~ E. Thomas Wojdylak Capacity:. X Personal Representative IN THE MATTER OF THE ESTATE OF DORIS R. CASAVANT, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : :NO. 21-03-861 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILT, RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent dies without a Will, whether you will receive anymoney or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUlVlBERLAND COUNTY In Re: Estate of Doris R. Casavant, Deceased (Name) (Address) TO: ,-)"'-o&t*~ M, J'k/t, xoN~J~ d'. t._o¢~,.r'7 ,f"Tg-P-P.'7 ff'H ~,~,-c'7o...,,,: (PR I 7o11- 6? 3_1 Please take notice of the death of the decedent and the grant of letters to the personal representative named below. The Decedent, Doffs R. Casavant, died on the 8th day of October, 2003 at Carolyn Croxton Slane Hospice, Susquehanna Township, Dauphin County, Pennsylvania. The Decedent died testate (with a Will); The personal representative of the Decedent is: -E. Thomas Wojdylak, 101 North 31st Street, Harrisburg, PA 17111 (717) 541-1860 If thd',Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberlan~l County, One Courthouse Square, Carlisle, PA 17013; phone (717) 240-6345. Date: A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. E. Thomas Wojdylak Capacity: X Personal Representative BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17118-0601 COMMONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX REV-ISiS7 EX AFP c01-03) JON A YOST YOST & DAVZDSON PO BOX 457 HERSHEY CUT ALONG THZS LZNE ~ '04 FEB 27 ..... ~ DATE 02-24-2004 ??iS ESTATE OF CASAVAHT DATE OF DEATH 10-08-2005 FZLE NUMBER 21 03-0861 P 1COUNTY CUMBERLAND -'ACN 101 PA ].7o~,~mberiar~d Co., PA Amoun~ Rami~ad DORIS MAKE CHECK PAYABLE AND RENZT PAYMENT TOt REGZSTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAZN LONER PORTZON FOR YOUR RECORDS ~ DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF CASAVANT DORIS R FZLE NO. 21 05-0861 ACM 101 DATE 02-24-2004 TAX RETURN #AS: (X) ACCEPTED AS F*rLED ( ) CHANGED RESERVAT'rON CONCERNZNG FUTURE TNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ONe 1 2 5 6 ORTGINAL RETURN Real Es~a~a (Schedule A) (1) S~ocks end Bonds (Schedule B) (2) Closely Held S~ock/Par~cnership In~aras~ (Schedule C) (5) Not,gages/No,es Receivable (Schedule D) (4) Cash/Bank Deposits/Misc. Personal Propar~y (Schedule E) (.6) Jointly Owned Propar~¥ (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expensas/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabili~ias/Liens (Schedule I) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn 772.50 52/485.86 .00 .00 NOTE: To insure proper cradi~ ~o your account, .00 submi~ ~ha upper portion .00 of ~his form wi~h your ~ax payment. .00 (8) 6,522.50 15. 14. NOTE: 2,581.00 (11) (12) Chari~ibla/Governman~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Es~e~e Sub~ac~ ~o Tax (14) Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. DISCOUNT (+) INTEREST/PEN PAZD (-) (1.6) .00 X O0 = (16) .00 X 045= (17) 918.91 X 12 = (18) 23,435.95 X 15 = (19)= AMOUNT PAZD ASSESSMENT OF TAX: 1.6. kmoun~ of Line 14 a~ Spousal ra~e 16. AIoun~ of Line 14 ~axabla a~ Lineal/Class A rI~e 17. Amoun~ of Line 14 e~ Sibllng ra~a 18. Amoun~ of Line 1~ ~axabla a~ Collateral/Class B ra~a 19. Principal Tax Due TAX CREDZTS: PAYMENT RECEIPT DATE NUHBER PAYMENT MUST BE MADE BY 07-08-200~. IF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADD/TZONAL INTEREST. 55,256.56 8.903.50 24,552.86 .o0 24,552.86 18 and 19 Nill .00 .00 110.27 5,515.09 5,625.$6 TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE .00 5,625.56 .00 5,625.56 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S RE~UZRED. ZF TOTAL DUE IS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/15/2005 YOST JON A ESQ 320 W CHOCOLATE AVE HERSHEY, PA 17033 RE: Estate of CASAVANT DORIS R File Number: 2003-00861 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 ~aptioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying o~ or after July 1, 1992, the personal representative or his counsel, w~thin two (2) years of the decedent's death, shall file with the Regi~ter of Wills a Status Report of completed or uncompleted administr~tion. This filing is due by: 10/08/2005 Thank You. Your prompt attention to this matter will be appreciatep. I Sincerely, ~~~ '-', GLENDA FARNER STRP.SBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge \..-\:1- 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 File No. 2003-00861 Admin. No.: 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: N / A 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: 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. ~^r-- Q.~ Signat Jon A. Yost, Esq. Date: September 20, 2005 CD ( (',- 1 Name (Please type or print) '--_:\ C',J 320 West Chocolate Avenue, Hershey, PA 17033 Address ---' 717-533-5101 L~ {.,~ (MAH:rmt/AM3) ('-! Telephone No. Capacity: Personal Representative X Counsel for Personal Representative ~Q RW. -27