Loading...
HomeMy WebLinkAbout04-0912Estate of Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Fred M. Matter No. /-I - - Deceased Social Security No. 204-03-4624 KAREN L. STORM Petitioner(s), who is/are 18 years of age or older, apply(les} for: (COMPLETE "A" OR "B" BELOW:) ] A. Probate and Grant of Letters of Administration C.T.A.. Petitioner, dauqhter of the Decedent, avers that Community Banks, N.A., the Executor named in the Last Will and Testament of the Decedent, dated June $¢h, 1992, renounced its riqht to administer the Estate, and that Kurt M. Matter, Son of the Decedent has also renounced his riqht to administer the Estate. Both have nominated Petitioner, Karen L. Storm, Administratrix, C.T.A. 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 to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (d,b,n,c.t.a.: pendente lite; durante absentia; durante mlnoritate) 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 I I COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 141 Simmons Road1 Mechanicsburq, Monroe Township1 Pennsylvania (List street, number and municipality) Decedent, then 86' years of age, died Auqust 28, 2004 at Manor Care Nursinq Home (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ..................................................................... $ : ' 35,000.00 (If not domiciled in PA) Personal property in Pennsylvania ..................................... $ ~ (If not domiciled in PA) Personal property in County .................................................... $ Value of real estate in Pennsylvania ...................................................................................................................... $ ~ Total ......................................................................................................... $ -35,000.00 Real Estate situated as follows: Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the gra-~t of letters in the appropriate form to the undersigned: ,Signature /' , / ?~-/ Typed or printed name and residence Iz,3~REN L. STORM Simmons Road Mechanicsburg, PA 17055 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF : , .' The Petitioner above-named swears and affirms that the statements in the foreg~ng Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal rel~resentative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and subscribed ~£'¢% )4% KAREN L. STORM Before me this ~. Fi.I- day of 2004. NO. Estate of FRED M. MATTER , Deceased. Social Security No: 204-03-4624 Date of Death: Auqust 28, 2004 AND NOW, hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration C.T.A. are hereby granted to in the above estate and that the instrument dated June 8, 1992 admitted to probate and filed of record as the last Will of the Decedent. 2004, in consideration of the Petition on the reverse side KAREN L. STORM described in the Petition be FEES Letters ........................... Short Certificate(s) $ Renunciation .............. $ Affidavit ( ) .................. $ Extra Pages ( ) ....... $ Codicil ............................ $ JCP Fee ....................... $ Inventory ...................... $_ Other .............................. $_ TOTAL .........$ ! ~ ~ . (? (~' ' Register of Wills Attorney: EDMUND G. MYERS I.D. No: 20558 Address: Johnson, Duffle, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- Telephone: 717-761-4540 Estate of Register of Wills of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS FRED M. MATTER No. ZI'O'I-~cllz- Deceased TAMIE LAUDENSLAGER and SUSAN NOVINGER Each a subscribing witness to the Will presented herewith, being duly qualified according to law, depose and say that we were present and saw the above Testator sign the same and that we signed as witnesses at the request of Testator in his presence and in the presence of each other as subscribing witnesses. TAMIE LAUDENSLAGER ,o · L./ ': (Address) / SUSAN NOVINGER (Address) COMMONWE,~LTH OF PA ' COUNTY OF ~,,'} (.~/3~¢ *- Sworn to or affirmed and subscribed bgfore me thls.~ ~[day of ~M~9~ ~ ~ ,2004. Notaw Public My Commission Expires: ~C/~ ~ (Signature and seal of Notaw or other official qualified to administer oaths. Show date of expiration of Notaw's commission.) COMMONWEALTH OF PENNSYLVANIA Nota~al Seal Rebe~:~ Radle, Notary Public My Commission Expire~ May 10, 2008 Member, Pennsylvania Association Of Notaries NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of Instrument(s) at time of notarization. Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estateof FREDM. MATTER , No. 2_', ~!'~-L}cit ?- Also known as , Deceased The undersigned, KIMBERLY ARTHUR-TRESSLER, Vice President and Trust Officer, (Relationship) of Community Banks, N.A. named Executor for the Will of the above-named decedent, hereby (Capacity) renounces the right to administer the estate and respectfully requests that Letters of Administration C.T.A. be issued to KAREN L. STORM WITNESS my hand this COMMUNITY BANKS, N.A. Kli~IBEI~Y ARTHLA~-TRESSLER SWORN to and subscribed before me this -;~(-~ day of Notary Public My Commission Expires: -~/,' ~' /~/ 2~/)~'~--<- ,2004 NotadaJ Sea Paulette M. Rovlto, Nota~ Public Lower Paxton Twp. Dauphin County My CommIss on Expires Apr. 18, 20~5 Estate of Deceased Register of Wills of Cumberland County, Pennsylvania RENUNCIATION FRED M. MATTER , No. Zt- ~- (~l 2_ The undersigned, KURT M. MATTER, Son of Decedent, Beneficiary of the above- (Relationship) (Capacity) named decedent, hereby renounces the right to administer the estate and respectfully requests that Letters of Administration C.T.A. be issued to KAREN L. STORM WITNESS my hand this day of ,2004. KURT M. MATTER 150 West Union Street Apartment C Millersburg, PA 17061 SWORN to and subscribed before, me this "TM :- · . ,¢L~/. day of · . - ¢ .~ , - ,2004· /. ~/. '-,? (' Notary Public My Commission Expires: ¢/ ,. COMMONWEALTH OF PENNSYLVANIA Notadal Seal Rebecca Radle, Notan/Public Millefsburg Bom, Dauphin County My CommiSS~Cr~ Expires May 10, 2008 Member. pennsylvania Association Of Notaries ERTIFICATE OF DEATH I,~a a ,/.¢_J AST WILL AND TESTAMENT OF FRED M. MATTER t, FRED M. MATTER, of 269 Market Street, Mlllersburg, Dauphin County, Pennsylvania, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking all Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all inheritance taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executor(rix) out of the property passing under ITEM III of this Will, as an expense and cost of administration of my estate. The Executor(rix) shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor(rix) to pay any Executor(rix) fees and all expenses of my last illness and my funeral expenses from the property passing under ITEM III of this Will as an expense and cost of administration of my estate. iTEM Iii: I give, devise and bequeath all the rest, and remainder of my estate not disposed of in the preceding portions of this Will to those listed below in equal shares/ amounts. 1. My daughter, KAREN n. STORM, of /~J ~/~r /~. 2. My son, KURT M. MATTER, OF 763 Church Street, Millersburg, Pennsylvania. ITEM IV: In the settlement of my estate, the Executor(rix) shall possess the same powers and rights regarding the assets included in my estate as I would possess should I be living. ITEM V: I hereby nominate, constitute and appoint COMMUNITY BANKS, N.A. of Millersburg, Pennsylvania, to be the Executor(rix) of my estate, and the Executor(rix) is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seal to this my LAST WILL AND TESTAMENT, consisting of this and the preceding one page(s) at the end of each page(s) of which I have also set my initials or signature for greater security and better identification this day of -j~-- , 1992. WE, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator(rix) as and for his/her Last Will and Testament, in the presence of us, who, at his/her request and in his/her presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, that at the time of the execution thereof, the was of sound and disposing mind and memory. and we certify said Testator(rix) Witnesses: Residing at CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: FRED M. MATTER August28,2004 2004-00912 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 15, 2004 Name KAREN L. STORM KURT M. MATTER Address 141 Simmons Road Mechanicsburg, PA 17055 150 West Union Street Apartment C Millersburg, PA 17061 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: None. October 15, 2004 Name: EDMUND G. MYERS Johnson, Duffle, Stewart & Weidner Address: 301 Market St P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 Capacity: Counsel for personal representative 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 REV 1162 EX(11 96) NO. CD 004662 MYERS EDMUND G 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 ESTATE INFORMATION: SSN: 204-03-4624 FILE NUMBER: 2104-091 2 )ECEDENT NAME: MATTER FRED M DATE OF PAYMENT: 11/23/2004 POSTMARK DATE: 11/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/28/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,173.78 TOTAL AMOUNT PAID: $3,173.78 REMARKS: SEAL CHECK# 101 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JERRY R. DUFFLE RICNARD W. STEWART C. ROY WEIDNER, JR EDMUND G. MYERS DAVID W. DELUCE IOIIN A STATLER ]EFFERSON ]. SHIPMAN RALPH H. WRIGHT JR MARK C. DUFFLE JOHN R. NINOSKY MICIIAEL J, CASSIDY MELISSA PEEL GREEVY ROBERT M. WALKER WADE D, MANLEY Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 LAW OFFICES JOHNSON DUFFLE November22,2004 RE: Estate of Fred M. Matter Social Secudty No. 204-03-4624 Date of Death: August 28, 2004 Your File No.. 2004-00912 Our File No. 13801-1 OF COUNSEL HORACE A. JOHNSON E LEt! SltlPMAN BRUCE I (]ROSSMAN: Dear Register of Wills Office: Enclosed for filing please find the following documents for the above referenced decedent: 3. 4. 5. 20dginal PA Inheritance Tax Returns. There is tax due in the amount of $3,173.78. This amount includes the deduction of the 3-month prepayment. 2 copies Pages 1&2 of the Pa Inheritance tax retum, which we ask that you time-stamp and return to us in the enclosed envelope. Inventory 2 copies of the inventory which we ask that you time stamp and return to us in the enclosed envelope. Estate Check in the amount of $150.00 representing the filing fee for the Inheritance Tax Return of $10.00, Inventory of $10.00 and $130.00 representing additional probate fees for the Estate. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. .Very truly yours JOHNSON, DL~FFIE, STEWART & WEIDNER x....~na L. Wi~emhn Legal Assistant c: Karen L. Storm, Administratrix :239767 301 MARKET STREET EO. BOX 109 LEMOYNE, PENNSYLVANIA 17043 0109 WWW. JDSW. COM 717.761.4540 FAX: 717.761..3015 MAIL@JDSVECOM JOHNSON, DUFFLE, STEWART & WEIDNER, P.C. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of FRED M MATTER No. 21-04-0912 also known as Date of Death 0812812004 , Deceased Social Security No. 204-03-4624 KAREN L STORM The Personal Representative(s) of the above Estate, deceased, verify that the Items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents Its fair value as of the date of the Decedent'e death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears In a memorandum at the end of this Inventory. I/We verify that the statements made In this Inventory ars true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Attorney: Edmund G. Myers Signature: I.D. No.: 20558 Signature: Signature: Firm: Johnson, Duffle, Stewart & Weidner KAREN L STORM Address: Lemoyne, PA 17043 Telephone: 717-761-4540 Personal Property Cash ............................................................................................... Miscellaneous Property ................................................................ Stocks/Listed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... Address: 141 Simmons Road Mechanicsburg, PA 17055 Telephone:717-697-0438 :e 417.00 Total Personal Property ......................................... 54,598.16 Total Real Property ................................................ Total Personal and Real Property ......................... Total Out-of-State Real Property .......................... COMMO.W A T, REV'1500 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN HARRISBURG. PA 17128-0601 RESIDENT DECEDENT MATTER, FRED M 08-28-2004 05-11-1918 IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) · 0 I 1. Original Return I 4. Limited Estate I X I 6. Decedent Died Testate (Attach co~y of Will) I I 9. Litigation pn3ceeds Received Edmund G. Myers :IRM NAME (if ~pplicable) [ 2. Supplemental Return I [4a Futurelnterest Compromise (daleof dea[hoftef · 12-12-82) I I 7. DecedentMaintainedaLivingTrust(Atiach copy of Tr~s[) I I ~0 Spousal Pover~ Credit data of death between ' * 12-31-9 and - -95 Johnson, Duffle, Stewart & Weidner FELEPHONE NUMBER 717-761-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) I [ Separate Billing Requested 7 nter-V vos Transfem & Miscellaneous Non-Probate Property (Schedule G or L) I I Separate Billing Requested 8. Total Gross Aseeta(totsl Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 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) (1) (2) (3) (4) OFFICIAL USE ONLY FILE RUMB;; ~44 -- -- 0912 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 204-03-4624 THi~ RE'rLIRN Muir ~E FILED IH OUPLiCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I 3. Remainder Return (date of death phOr to 12-13-82) I I 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes I I 11. Election to tax under Sec. 9113(A) (Attach Sch O) OMPLETE MAILING ADDRESS (5) (6) (7) P.O. Box 109 Lemoyns, PA 17043 (9) (lO) 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, or tmnsfem 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 co[lataral rate 19. Tax Due None 54,181.16~: None 417.00 460.36 29,539.3~: 9,739.01 616.22 OFFICIAL USE ONLY F'] What-If Analysis E~leer Amounta ot Supported --b,.~Y Transactions (6) 84,597.87 (11) 10,355.23 (12) 74,242.64 (13) 0.00 (14) 74,242.64 2.25 x .00 (15) 0.00 74,240.39 x .045 (16) 3,340.82 0.00 x .12 (17) 0.00 0.00 x .15 (18) 0.00 Copyright 2002 fo~n software only The Lackner Group, Inc. (19) 3,340.82 Form REV-tS00 EX (Rev. 6-00', SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER MATTER, FRED M 21.04-0912 ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH I 203628102 1,472,451 shares Community Banks Inc. -Valued 27.645 40,705.91 using EstateVal, Valuation is attached to this Return, 2 247126105 22 shares Delphi Corporation - Valued using EstatVal. 9.2325 203,12 Valuation is attached to this Return. 3 370442105 32 shares General Motors Corporation - Valued using 41.5775 1,330,48 EstateVal. Valuation is attached to this Return. 4 709051106 252 shares PP& L Corporation - valued using 47.3875 11,941.65 EstateVal. Valuation is attached to this Return. TOTAL (Also enter on Line 2, Recapitulation) 54,181.16 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, inc. Form PA-1500 Schedule B (Rev. 6-98) Rev.15~ EX+ COMMONWEALTH OF PENN$'~.VANIA INHERITANCE TAX RETURN RESIDENT DEC~DEN"r SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MATTER, FRED M 21-04-0912 Include the proceeds of litigation and the ~tale the proceeds were ~celved by the estate. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER AARP - Refund of Account Payments AARP - Final Refund on Account Keystone Health Plan - Senior Blue Premium Refund 26.00 245.00 146.00 TOTAL (Also enter on Line 5, Recapitulation) 417.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Ray-1509 EX<. (6-1~i ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER MATTER, FRED M 21-044)912 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Karen L. Storm Daughter 141 Simmons Road Mschanicsburg, PA 17055 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FORTENANTJOIN'I JOINTMADE NUMBER OR SIMILARjoiNTLY.HELDIDENTIFYINGREALNUMBER.ESTATE.ATTACH DEED FOR ,/ALUE OF ASSE~ INTEREST DECEDENT*S INTERES' 1 A :}4125/2003 Community Bank Checking Account - 920.71 50,000% 460.36 Account No. 11-61504809 TOTAL (Also enter on Line 6, Recapitulation) 460.36 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-IS00 Schedule F (Rev. 6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MA'I-FER, FRED M 21-04-0912 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DBCD'S EXCLUSION TAXABLE INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST IF APPLICABLE VALUE NUMBER THE DAT~ OF TRANSFER. ATTACH A COPY OF 'i'HE DEED FOR REAL ESTATE. I Bankers Life & Casualty Company - Single 29,539.35 29,539.35 Premium Non Qualified, Deferred Annuity Policy No. 7,735,843; Issue Date: 07101/2002 Beneficiaries: Karen L. Storm, Daughter and Kurt Matter, Son TOTAL (Also enter on Line 7, Recapitulation) 29,539.35 (If more space is needed, additional pages of the sart~ size) Copyright (c) 2002 form software only The Lackner Group, inc. Form PA-1500 Schedule G (Rev. 6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS MA'I-FER, FRED M Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER 5. 6. 7. FILE NUMBER 21-04-0912 FUNERAL EXPENSES: See continuation schedule(s) attached ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s)7 EIN Number of Personal Representative(s); Street Address City State Zip Year(s) Commission paid Attomey's Fees Johnson, Duffle, Stewart & Weidner Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Karen L. Storm street Address 141 Simmons Road City Mechanicsburg State PA Zip 17055 Relationship of Claimant to Decedent Daughter Probate Fees See continuation schedule(s) attached Accountant's Fees Tax Return Preparer's Fees Other Administrative Costa See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) AMOUNT 2,278.26 3,500.00 3,500.00 108.00 352.75 9,739,01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-IS00 Schedule H {Rev, 6-98) SCHEDULE H-A FUNERAL EXPENSES continued ESTATE OF FILE NUMBER MATTER, FRED M 21-04-0912 ITEM NUMBER DESCRIPTION AMOUNT I Funeral - Funeral coats 2,278.26 Subtotal 2,278.26 Copyright (c) 2002 form software only The Lackner Group, inc. Form PA.1600 Schedule H-A (Rev. 6-98) SCHEDULE H-B4 PROBATE FEES continued ESTATE OF FILE NUMBER MATTER, FRED M 21-04-0912 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County Register of Wills Office - Probate Fee 108.00 Subtotal 108.00 Copyright (c) 2002 form software only The Lackner Group, inc. Form PA-t 500 Schedule H~B4 (Rev. 6-98) Rev-ll~2 EX+ (~98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER MATTER, FRED M 21-04-0912 ITEM NUMBER DESCRIPTION AMOUNT 3 4 Cumberland County Register of Wills Office - Additional Probate Fees Cumberland County Register of Wills Office - Filing Fees for Inventory ($10.00) and Return ($10.00) Cumberland Law Journal - Notice of Estate Administration The Patriot News - Notice of Estate Administration 130.00 20.00 75.00 127.75 Subtotal 352.75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B? (Rev. 6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMkIONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE'~JRN ESTATE OF FILE NUMBER MA'rFER, FRED M 21-04-0912 VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER Community Life Team - EMS Services West Shore Ambulance TOTAL (Also enter on Line 10, Recapitulation) 99.50 516.72 616.22 (if more space is needed~ additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, inc. Form PA-t500 Schedule I (Rev. 6-98) REV-1513 EX+ (g-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER MATrER, FRED M 21-04-0912 NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY (Words) ($$$) RELATIONSHIP TO DECEDENT TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. ~116(a)(1.2)] KURT M. MATTER Son 1/2 of Residue 150 West Union Street, Apt. C MIIlersburg, PA 17061 KAREN L. STORM Daughter 112 of Residue 141 Simmons Road Mechanicsburg, PA 17055 Enter doiJar amounts for distributions shown above on lines 15 through 18, as appropriate, on NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE U. Total Rev 1500 coy S. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ;r sheet TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE'I Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LISTING OF EXHIBITS FOR ESTATE OF FRED M. MATTER EXHIBIT A Last Will and Testament for Fred M. Matter dated June 8th, 1992. EXHIBIT B EstateVal Valuation Page for the Stocks on Schedule A. :239800 LAST WILL AND TESTAMENT OF FRED M. MATTER I, FRED M. MATTER, of 269 Market Street, Millersburg, Dauphin County, Pennsylvania, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking all Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all inheritance taxes becoming due by reason of my death, whether such taxes may be pa~'le ~1~ my :~: estate or by any recipient of any property, shalJ~' be paid by,: '~he Executor(rix) out of the property passing under ITEM tI~ of this Will, as an expense and cost of administration of my estate. The Executor(rix) shall have no duty or obligation to:obta~ ~ : reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor(rix) to pay any Executor(rix) fees and all expenses of my last illness and my funeral expenses from the property passing under ITEM III of this Will as an expense and cost of administration of my estate. iTE~i iii: and remainder of my estate not disposed of in the preceding portions of this Will to those listed below in equal shares/ I give, devise and be~aeath all the rest, residue amounts. 1. My daughter, KAREN L. STORM, of /~/ ~/~ My son, KURT M. MATTER, OF 763 Church Street, Millersburg, Pennsylvania. ITEM IV: In the settlement of my estate, the Executor(rix) shall possess the same powers and rights regarding the assets included in my estate as I would possess should I be living. ITEM V: I hereby nominate, constitute and appoint COMMUNITY BANKS, N.A. of Millersburg, Pennsylvania, to be the Executor(rix) of my estate, and the Executor(rix) is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seal to this my LAST WILL AND TESTAMENT, consisting of this and the preceding one page(s) at the end of each page(s) of which I have also set my initials or signature for greater security and better identification this day of ~e_~ , 1992. FRED M. MATTER WE, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator(rix) as and for his/her Last Will and Testament, in the presence of us, who, at his/her request and in his/her presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator(rix) was of sound and disposing mind and memory. Witnesses: Residing at Residing at Date of Death: 08/28/2004 Valuation Date: 08/28/2004 Processing Date: 11/22/2004 Shares Security or Par Description 1) 1472.451 2) 252 3) 32 4) 22 5) 4 Estate Valuation High/Ask Low/Bid COMMUNITY BKS INC MILLERSBURG (203628102) COM NASDAQ Bank - Insurance 08/27/2004 27.95000 08/30/2004 28.49000 26.94000 H/L 27.20000 H/L PPL CORP (709051106} COM New York Stock Exchange 08/27/2004 47.48000 47.29000 H/L 08/30/2004 47.55000 47.23000 H/L GENERAL MTRS CORP (370442105) COM New York Stock Exchange 08/27/2004 42.01000 41.53000 H/L 08/30/2004 41.70000 41.07000 H/L Div: 0.5 Ex: 08/11/2004 Rec: 08/13/2004 Pay: 09/10/2004 DELPHI CORP (247126105) CON New York Stock Exchange 08/27/2004 9.31000 6.25000 H/L 08/30/2004 9.29000 9.08000 H/L GENERAL MTES CORP (370442832) CL H NEW New York Stock Exchange 12/22/2003 Last price available on I2/22/2003 16.13000 15.64000 H/L Estate of: Matter, Estate of Fred M Account: 13801-1 Report Type: Date of Death Number of Securities: 5 File ID: MATTER Mean and/or Div and Iht Security Adjustments Accruals value 27.645000 40,705.91 47.387500 11,941.65 41.577500 1,330.48 16.00 9.232500 203.12 15.885000 N/A Total Value: Total Accrual: Total: $54,181.16 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL1A)cES INHERITANCE TAX DIVISION PO SOX 280601 HARRISBURG PA 171Z8-06Dl NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX EDMUND G HYERS JOHNSON ETAL PO BOX 109 LEMOYNE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-31-2005 MATTER 08-28-2004 21 04-0912 CUMBERLAND 101 . {/ REV~1S41 EX _FP (12..1I4) FRED 1'1 AldOunt Rellitted PA 17043 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 ~ RW:I!1,"f'Ex'AFi.--cll1":6J"'NoTicE'il~'lNHEi't{i'ANCE'''AX'AP~RA'fUi<<iii':..,(CLiliUF(C'€.o'R................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MATTER FRED M FILE NO. 21 04-0912 ACN 101 DATE 01-31-2005 TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGED 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) ~. Closely Held St~k/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets III (ZI (31 (41 ISI (6) 171 .00 54,181.16 .00 .00 417.00 460.36 29.539.35 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern..ntal Bequests; Non-elected 9113 Trusts (Schedule J) l~. Net Value of Estate Subject to Tax (9) (10) 9,739.01 616.22 (111 IlZ1 1131 1141 NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ abb ASSESSMENT OF TAX: 15. AMount of Line 14 at Spousal rat. (15) 16. Aaount of Line 14 t.xabl. at Lineal/Class A rate (16) 17. Amount of Line 1~ at S1bling rat. (17) 18. AMount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due T R TS: NOTE: To insure proper credit to your account} submit the upper portion of this for. with your tax paYMent. 84,597.87 IO.~E;E; ?3 74,242.64 .00 74,242.64 14, IS and/or 16. 17. 18 and 19 will returns assessed to date. 2.25 X 00 = 74,240.39 X 045 = .00 X 12 = .00 X 15 = 1191= DATE 11-22-2004 AMOUNT PAID 3,173.78 NUI1BER CD004662 INTEREST/PEN PAID (-I 167.04 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 3,340.82 .00 .00 3,340.82 3,340.82 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAVMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I 51\ ok, STATUS REPORT UNDER RULE 6.12 Name of Decedent: FRED M. MATTER Date of Death: AUGUST 28.2004 Will No. 2004-00912 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the Estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the 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. Date: August 29, 2005 N E~&~ JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 Lemoyne, P A 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative t_', " C' L.i c_> C~ L', C". c: l: . c . , t, ' ......:- C~~: C. L) LL; L," o if'