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Home My WebLink About04-0921 Register of Wills Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Dorothy S. McCormick No. (A 1- 0 ~ - 0 CI'~ I also known as Dorothy E. McCormick , Deceased Social Security No. 723-05-4111 Jill A. McCormick and Mark L. McCormick. P~';tio<leF(.L who;.!." lA Y.... 01 &(Ie DIOkle., applyli..-Ilor; (COMPLETE "A" OR nB" BELOW:) ~ A. Probate and Grant of Letters and aver that Petitioner(sl is/are the execut_ named in the Last Will of the Decedent, dated and codicil(sl dated Bt.... ,elIUI'l' ci''''''''''t''''cn. e.~.. ,,,,,,,,,ci...ion. death 01 exeCUtor. "Ie Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted aft-er' eXecution~ot the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: !'Xl. B. Grant of letters of Administration. c.t.a. ~ (c."S.. a,b.n.c."e pend"",. Ii',,; """"". .bun".; d",,,,,'~ mi"""'oI"l 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: I Name Relationship Rasidence_ I Jill A. McCormick Dauahter 1808 Pine Street Camo Hill PA 17011 Mark L. McCormick San 1126 Thaver Street, Sa/etv Harbor, FL 34695 I.... IN ALL L;A::'C::::.:J Attach additional sheets IT necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 1808 Pine Street. Camo Hill. Lower Allen Townshio. Cumberland Countv. Pennsvlvania 17011 llrs'.""', "umb<>fandmu",~,p"'itv) Decedent, then ~ years of age, died September 25 , 20Q!L, at Holy Spirit Hospital, East Pennsboro Twsp., Cumberland'C~unty, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property $ 1 ,000.00 (If not domiciled in PAl Personal property in Pennsylvania. . . . . . $ 0.00 (If not domiciled in PAl Personal property in County. . . . , . . . $ n nn Value of real estate in Pennsylvania ...... . . . . . . . . . . . $ 1278500.00 Total . . . . . . . . . . . . . . . . . . . $ 1 ~ ,bOO.UU Real Estate situated as follows: 1808 Pine Street. Garno Hill Lower Allen Township Cumherlann ~olmty PA Wherefore, Petitioner(sl respectfully request(sJ the probate of the last Will and Codici1(sl presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence ormi k P Mark L. McCormick 1126 Tha er Street Safet Harbor FL 34 RW-7 ;-OI\'1'1,10'\J\.','EA'_Tr" OF PE:NN;;y'_'v'AN,A REV 1162 EX( 11 96) DEPA'1TME\;T OF RE'v''ONUE 3'..)8EA',) C" INDIVI;:;UAL ";'AXES ;:;Ft-'T 280601 HARRISBJi'1G PA, 17< 2S0f.01 PENNSYLVANIA RECEIVED FROM: INHERIT ANCE AND EST A TE TAX OFFICIAL RECEIPT NO, CD 004751 MCCORMICK Jill A 1808 PINE STREET CAMP Hill, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER '"" 101 I $8,700.00 ESTATE INFORMATION: SSN: 723-05-4111 I FILE NUMBER: 2104-0921 I DECEDENT NAME: MCCORMICK DOROTHY S I DATE OF PAYMENT: 12/20/2004 I POSTMARK DATE: 12/20/2004 I COUNTY: CUMBERLAND I \ DATE OF DEATH: 09/25/2004 I I TOTAL AMOUNT PAID: $8,700.00 REMARKS: J A MCCORMICK CHECK# 117 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland - --- The Petitionerlsl above-named swearls) and affirmlsl that the statements in the foregolAg Petition are true and correct to the best of the knowledge and belief of Petitionerlsl and that, as personal representative(s) of the Decedent, i Petitioner(s) will well and truly administer the estate according to law. -- Sworn to and affirmed and subscribed _._~ before me this 13 day of . CS C T C 13[-1'<\ 2004 L l( l I L(c ;. K-- ~' HD- '\ 41,- yL "'i!;Jr" IU\ctc l"-f~t'Q. LUILUU. - 1;rI~ ~ .,- ~ \ t / /.;. /('{~ ~u V I ) ) / Ul -1) It---- Mar L. McCormd DECREE OF REGISTER Estate of Dorothv S. McCormick Deceased No. ?t!-04-0Cnl also known as Dorothy E. McCormick Social Security No: 723-05-4111 Date of Death: September 25, 2004 AND NOW, 20 _ in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that letters 0 Testamentary I2'J of Administration, c.I.a. (c.'_~.; d.b.n.c..l: pend..,,,..,!,.., ow.",,, .bIl<'tlO~; du.....'" mmOn'.'CI are hereby granted to Jill A. McCormick and Mark l. McCormick in the above estate and that the instrument(s), if any, dated Mav 2,1983 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES tiLl { [Lltcfiu.AL MUll JhLU! letters......................... .. $ ~)5.00 '/1 , ; Register of Wills Short Certificateisl.......... $ Go DC tsJr Renunciation................. . $ 50e \ Affidavit ( I................ . $ , Extra Pages i I........... . $ (o,DO Codicil.......................... $ JCP Fee........................ $_10 00 Attorney: Cory J. Snook. Esquire Inventory & Tax Forms... $ I.D. No: 85734 Other............................ $ Address: Gates. Halbruner & Hatch, P.C. a~lo.CO 1013 Mumma Rd" Suite 100, lemoyne, PA 17043 TOTAL..........:... $ Telephone: (717) 731-9600 DATE FilED: IlW-7a Register of Wills Cumberland County, Pennsylvania RENUNCIA TION Estate of Dorothv S. McCormick No. ~ I~ [) 1- C 9 1>/ also known as Dorothy E. McCormick , Deceased The undersigned, Marian s. Clark. sister 01 (RelatIOnship I (Capacity I the above Decedent, ~ereby renounce/51 the right to administer the estate and respectfully request Is) that Letters of AClmini Rt-r;!t"i on. rt-::l be issued to Ii 11 A McCormick Ann MRrK T Mrr.nrmirk Witness mv hand this 5th day of October . ~;Ij-1Q04. -~l7 &c',' ~ S {! L.z.L.{~ (Signaturel )lL1t!./Y:zi~n/~ . /2;: 71'-7 A /J~/ 2/ (Address) / ; /7,)5-'7 --- (Signature) -~--------_._-~._--- (Address) (Signature I -----------.-------- - (Addressl Sworn to or affirmed and subscribed before me this 5th day of n.....t-r'hor r ?nn/. I Notarial Seal J iff?J t i Teri L. Walker, Notary Public . .' . I.j (/j'j ( L I Lemoyne Bore. Cumberland County ~otary Public L My Commission Expires Jan. 20, 2007 \ My Commission Expires; Mo-:mhpr P~n'l"vh!:1rJh Associau()n Of Notaries (Hog,....".~ """ ...... ,,1 N"....~ ". m',., fOlhG'''' NOTE, Renunciations executed outsldn the Office 01 Regl:il~r ul .'''''''1<0<<1,..._...".[.......... Shrno,od"'~.,[ Wills are reqUired in some countle::; to bf1 nOlanzad. ".J....U...''''N[''......,,,........,., , RW-13 (Rvsd 9/92) WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. " ~\---o~,Oq^l 5281748 ~"P .... Cct. 8, 2CXl2 RidBrd J. M::D:>rmick M3.le 187-44-77(X) Cctcter 4, 2CXl2 Cct. 3, 1952 Chaffi,NE '!he Rffdirg fbcpital & Ma:J CEnter EerksCb. West Rffdirg \\hite I'Erd1an:Jise DirEctor No l'l3rried 14 Dietrich VallEY Pd., Kutzta.,n, PA 1953J IBssa M::Cbrmick Ctmiel B. l.lt:c>M1 BnJ..in Furt2ral fbTEs loc., leD Brid:Je st., MifflintCM'l1, PA 17059 Int:ra[ertaal HErrorrffi:Je 6 hrs. I'b:1::nrin3l Paraca1tesis 7 hrs. A9cites 2 yrs. Cirrh::sis due to Alplliantit:ry[:sin Ceficiercy 2 yrs. FIilnrnary El1p-1yseTB due to Alf:h3.lantit:ry[:sin Ceficiercy x =tal Snith, M.D. 3Jl S. ::'eventh St., West Rffdirg, PA 19611 n ~}J 9<- 1J :~1.-A 3'J.-3J7 Cct. 7, 2CXl2 lCB Path St. Mittlin PCJro. 09-13-Z005 MCCORMICK 09-Z5-Z004 Zl 04-09Z1 CUMBERLAND 101 APPEAL DATE: ll-lZ-Z005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS +- REy:is47-Ei-AFP-'(03:0si-NOTicE-OF-iNHERiTANCE-TAX-APPRAiSEMENT:-AL.L.ONANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DOROTHY S FILE NO. Zl 04-0921 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEMUE NOTICE OF INHERITANCE TAX APPR~~~~,,' ,_ C~ DISALLOWANCE OF D , , " MID ASSESSIIENT OF TAX I;'[',_::J~ j ....1,..' -~,.' , MARK E HAL BRUNER ESQ GATES ETAL 1013 MUMMA LEMoYNE n,.. " . DATE 2Du5 S~p 13 i';, ItSlll.TE OF DATE OF DEATH ClEP:< ',: FILE NUMBER ope.. "-ilQUNTY ('I .' . ACN ;"""- RD STE 100 PA 17043 ESTATE OF MCCORMICK *' REV-1547 EX AFP (06-05) DOROTHY S TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED DATE 09-13-Z005 I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will re~lB~t ~igures that in~lude the total o~ Abb returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable .t Lineal/Class A rat. (16) 17. A~unt of Line 14 at Sibling rete (11) 18. Amount of line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due X RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estat. (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Clo~ly Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hi.c. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule Gl 8. Total Assets III 121 (3) I'll ISI 161 171 127.67Z.Z0 .00 .00 .00 Z5.131.06 .00 58,891.39 tBI APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Xl 11. Total Deductions 12. Net Value of Tax Return 13. Cherltable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax 191 1101 Z7,733.Z0 990.38 1111 1121 1131 1141 NOTE: .00 X 18Z,971.07 X .00 X .00 X + AIIOUNT PAID 8,700.00 DATE 12-20-2004 NUIIBER CD004751 INTEREST/PEN PAID I-I 411 .69 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 = 045 = 1Z = 15 = 1191= NOTE: To insure proper credit to your account, sut.i t the upper portion of this form with your tax pay...,t. Zl1,694.65 28.723 ';8 182,971.07 .00 18Z,971.07 .00 8,233.70 .00 .00 8,Z33.70 9,111.69 877.99CR .00 877.99CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYIIENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE \ (L ' A REFUND. SEE REVERSE SIDE OF THI~ FnlPM I='nD Tt.fC:TD..,..T....-........ \J..('" ./ ~ [-D4 -04.1t I ~rJ1~4 '/1- ~ C i:) SEP 28 2004 Hl115.'....R<tv,HlIl COMMONWEALTH OF PENNSYU(AN1A. DEPARTMENT OF HEALTH. VITAL RECORDS m.,."'" CERTIFICATE OF DEATH . ;f29-359 (Coroner) ........'" Jl1lllf1<."E~Ur.lllll'll """'- NAM[OFOI;CI!DOIT(f,st.,........Uosl', M. SOCIAt.SECVR'lV~lJ/tol@IEFI Q,O;fEOI'Ol!:oQ"HIIo4oMt"n...-'-i E McCormick .. Female . 723-05-4111 . September 25. 2004 1"IN0000!\ll)fl11 - -. ~~, i ~D 1\00__0 ~,O I ro'. lUCE-""'.tiCan Indi.". 8"", W""., elc Cumberland East Pennsboro Holy Spirit Hospital ,- I K. .. White ~ m ~ .~ ..... ~" Mil#lllJ\lST,tIFUS-IoI_ SUAVIVlHGSPOO$E I I~'::.~~~~u':.:(:'~ _\1.,_,_, I""'" Il"'."'....,"" """..-, Wi~(Spoc""1 " , 17<:.~.ll.11.:.n - I 1808 Pine St. Camp Hill, PA 1701 1 17b.eou.. Cumber lanl 11..0 ~=-=<lI i SWitzer MO~(F.~s.".n...ne) I ". INFORMANT'S MAlUNG {Str....,c..,~n,Sl8..Z,pCOdll) 1808 Pine Street, ~ Hill, PA 17011 I Olc.m.t..-y,C'"'''''''Y , i'TI>oIn.s....llp -- MI.fflirto.n, ~ 29, 2004 ---~ m 17(8.j , , ~ llCl:OIlSE mJM8eA NAMlEANOAOOAESSOFFitCllITV , .FD-012925-L F\raal /tIrEs Irr I LIceNSE IlUMQEA ~. T""EOFD Pl'lC>>4O\1NCEDDEAO{M""'" 1._' 'oIIIoSCMEAEFEMmTOME ~m 5:00 A. " September 25, 2004 . ~O . . 2f.l'llflTl; E.....ltle_...,.....Df(:<loolllliC.._wI1od\""_....._.OO_."""lI'w_oIdy1nQ,""""..~""_,-.-,........,_or__ ,~.. Cllh.<l9'dlc0n4CCl'1\di1lano~"'_,lIUl lioI~""'CIUM""""""'" :inl__ __iflVftl1NI.......~CO'-~InPNlTI i"""'"-- e 0 e ic Ca diovascular Disease I OlJElO'QFI~~CONSi:OUENC~OF. , , I OU~TO(ORA5ACONSEOOENCEon I , OUE1OIOR"SA.CQNSEClVENCEOFl --. . I weAEAt!l'OPSYFINtllNOS MANNEAO/'OE,(I"H OAfEOI'INJUAY ~ot'lNJ\)RY IN.I\)RY,o;rWOA1<? DESCRI8E HON INJURV OCCURAEO ~EPAIOfllO (l,l",,"'Do"._l COI.II'lETIONOF CA.USE -. ~ _<10 0 Y9tU ~CJ OFDEATH1 I ~~ ,-, ~ ~ "_ng'n_ogao_ 0 " _0 ~ '_J 0 [1 PLACEOFltLjI)flY_A.l""""'_I...m",....,loctO;.<>Il\c1o r:''i,T""". ~,.'&I .... Ccuf<I""'bo,loO...m,,>ed '~elC;.Spoc.ly' ... u. "'. I II'IUI(CtOlC"<>r<y"""l .lZIlTlFv_I'tI1"IlClAN(~,...,." c"""y"","c.auseul '''"~or'' "".,...;on<><'" ph~"",.." ,'&> ,"cn"""~,,,',_ "'''' ,,,_,,"""'.... ".'" n, 0 Coroner I ""-~at""'''''''''''>____'''''''''''''''l_____. . o.o.fESlGNEO''''''''''hlMy,Vewl ~ "~...oANOcsn-Il"IING"""'lIClANiPMy"""'c-o!h""''''''''''\(J''!<l"",'M"",!<1y;''Il'''L'''''''~~eil&<l > Se t. 27, 2004 u Tl>....beMol....,-...,_~..__,_,_pIIaI,.ndd_"'lho"""'"'"4.~____.. N.-.lolEANOIWORESSOFPEASOIolWl-fOC0t.4PlETEOc.o.USEOf'OEAl"H ~ 1~~27iTypeOlI>f",! Michael L. Norris, Coroner ~ "IIIEDIt.u.EXA_RICOAOHEII OnIhe....of__lUIdIorl......uplIon,lnmylljMftlon,dNl:hOCCUfftd._I.....,_.,_~,__IOlhe~.._ 6375 Basehore Road. Suite #1 ~ -..-.. Mechanicsburg. Pa. 17050 1 fl. ~ L"'r'f,~,()171 [JO",,""') SEP 2 8 2004 ~ &~\-oi- ClA\ lJIST WILL OF DOROTHY S. McCORMICK I, DOROTHY S. McCORMICK, of the Township of Lower Allen, County of Cumberland, State of Pennsylvania, being in good bodily health and of sound and disposing mind and memory and not acting under duress, menace, fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing of my worldly goods while I have the strength and capacity so to do, I do make, publish and declare this my Last Will and Testament. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my Last Will and Testament. As to such estate as it has pleased God to entrust me with, I dispose of the same as follows, viz: ITEM l. I direct that my executors hereinafter named pay and discharge all of my just debts and funeral and testamentary expenses. ITEM 2. I order and direct that I be buried in a lot which I own situate at the Presbyterian Cemetery in Mifflintown, Juniata County, Pennsylvania. ITEM '3. All the rest, residue and remainder of my entire estate, whereso- ever situate and whatsoever it may consist of, I give, devise and bequeath, absolutely, and in fee, to my dearly beloved children, in the following shares: l. 50% of my estate to my dearly beloved daughter JILL McCORMICK. 2. 25% of my estate to my dearly beloved son R. JAMES McCORMICK. 3. 25% of my estate to my dearly beloved son MARK L McCORMICK. ITEM 4. I nominate and appoint MARIAN S. CLARK as Executrix of this my Last Will. Should the Executrix named fail to qualify or cease to act as Executrix, then I appoint R. JAMES McCORMICK as Executor in her stead. ITEM 5. I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance ,LutES M. BACH ATTORNEY AND of their duties in any jurisdiction. COUNSELOR Al LAW I, \07 ST JOHN'S -, ,/ _'" ('- I)" .- CHURCH RD : A'-' .' d. .) .! ' . c'1 (' ~, SUITE # 2. ,~_ _.'.-- ~q'" ,-"t;--, 4' '} _' '. _ _ f ~ I. ~. J { ('- ,- C"MP HILL. PA_ 17011 DOROTJG:'" S. McC ORMICK " TEL 1717) 737_2033 COJVJlllONWEALTH OF PENNSYLVANIA~ s COUNTY OF CUMBERLANIi I, DOROTHY S. McCORMICK, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary aot for the purpose therein expressed. Sworn or affimed to and acknowledged before me, by DOROTHY S. McCORMICK, L( -/) )"J u the Testatrix, this .;: "~v- day of , 1983. / 1 .-; . '4/ I, of '1.- )~( '~2 // l'>~' 1';" .j ~ -- , Notar,y; Publio My Commission Expires: i'; . _Yj'{ (om; -fl, ~ "; J ',.'~:J.' tv The preceding instrument consisting of this and (1) one other typewritten page, each identified by the signature of the Testatrix was on the date there- of signed, published and declared by DOROTHY S. McCORMICK, the Testatrix therein named hereunto subscribed our names as witness. /:""'tL Residing at 107 St. John's Church Road Sui te #2 J Camp Hill, Penna. 17011 flU'Lt J j .. -1- (_~ \..,c, \...J) 1_;;'1 \ ,.-' , Residing at 107 St. John's Church Road Suite #2 Camp Hill, Penna. 17011 ,L\~rES ::\1. BACH - 2 - ATTORNEY AND COUNSELOR AT LAW 1075T JOHN'S CHURCH RD SUITE # 2 CAMP HIl..L. PA 17011 -- TEL. (717) 737.2033 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA~ ss COUNTY OF CUMBERLAND We, James M. Bach, Esquire and Albert Dt Agostino , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified acoording to law, do depose and say that we were present and saw Testatrix sign and exeoute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by _ . '1 .. ." ;.... r / ,~ ,~ and tdl" t -t!);-l: L ('I" , ~ ;; Wit.~ ses, this .':/1'L( day of .;/)/,,,'1 ' 1983. f/ . " , cr j A / / ' . '; , -~ ! " / :.1 Ie (~:_ - _ ~ ") l' /-~ (J 'l Not PUblic . ;, My Commission Expires: J{ " ,L\\fES ~I. BACH .... 3 - ATTORNEY AND COUNSELOR AT LAW 107ST JOHN"S CHURCH RO SUITE #"2 CAMP HILL. PA. 1701 \ TEL {71n 737-2033 CERTZFZCATZON OF NOTZCE UNDER RULE 5.6(&) Name of Decedent: Doeo'f-klj S. ~O~\.cJ<-. ~I *M &:ec'My e- Date of Death: Sc-plem Ia0.e.- <:10; ~4 File No.: )(xJ4--cxPt~( / PA 1Jo. ;U -04- 09J./ To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December -L, 2004. ~ Address /!1.dft L Wk~""fc%.. Jrw !?(tJC S,. ~A.17d(( kA. ", ~l~ I"W~ -p.~E- S-t-" (l~ j...kU! PFt I7d I ( Notice has now been given to all persons entitled thereto under Rule 5.6(a), Dated: December ~ , 2004 I co '0 cc 9- LAW OFFICES OF GATES, HALBRUNER &-HATCH, P.C. 1013 MUMMA ROAD. SUITE 100' LEMOYNE, PENNSYLVANIA 17043 (717) 731-9600' FAX: (717) 731-9627 LOWELL R. GATES, LL. M. BRANCH OFFICE: LL M. in Taxation 3 WEST MONUMENT SQUARE, SUITE 304 Also Admitted to Massachusetts Bar LEWlSTOWN, PA 17044 MARK E. HALBRUNER (717) 248-6909 Also Admitted to New Jersey Bar WEB SITE: CRAIG A. HATCH, CELA www.GatesLawFirm.com Certijied as an Elder Law Attorney by the National Elder Law Foundation CORRESPONDENCE ADDRESS: ALBERT N. PETERLlN Lemoyne Office Also Admitted to Maryland Bar STACEY L. NACE CLIFTON R, GUISE ParalegaVOffice Manager Also Admitted to practice before the U.S. Patent & Trademark Office TRACI L SEPKOVIC BYRON L. McMASTERS, LL.M. Paralegal LL M. in Taxation VALERIE LONG Paralegal June 23, 2005 Cumberland County Courthouse Office of the Register of Wills One Courthouse Square Carlisle, P A 17013 RE: Estate of Dorothy S. McCormick Estate No. 21-04-00921 Dear Sir or Madam: Enclosed for filing are the Pennsylvania inheritance tax return (in duplicate), Inventory and Status Report for the Estate of Dorothy S. McCormick. A check in the amount of$30.00 is enclosed as the filing fee for the inheritance tax return and Inventory. Please time-stamp the additional photocopy of each document and return them to our office in the enclosed envelope. Thank you for your assistance in this matter. Sincerely, UtZ-tA A. ~~{~ Traci L. Sepkovic Paralegal Enclosures cc: Jill A. McCormick, Co-Administrator Mark L. McCormick, Co-Administrator ,._~__ ,., '."~.~~'" .,__-..................;d___.~.~____.".A '^..-.' I Register of Wills Cumberland County, Pennsylvania ,. INVENTORY Estate of Dorothy S. McCormick No. 21-04-00921 also known as Date of Death 09/25/2004 , Deceased Social Security No. 723-05-4111 Jill A. McCormick, Personal Representative(s) of the ebove Estate, deceased, verity that the items appearing in the fOllowing inventory include ail of the personal assets wherever situate and all of the reel estate in the Commonweelth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair valua as of the datB of the Decadent's death, and that Decedent owned no real estata outside of the Commonwsalth of Pennsylvania except that which appears in e memorandum at the end of this inventory. IflNe verify that the stetements made in this Inventory are true and correot, I/We understand that false statements herein are mede subject to the penalties of 18 Ps, C.S, Seotion 4904 relating to unsworn falsification to authorities. Name of Mark E. Halbruner, Esquire per~onaZ;CseViv.e/4A~(!tlc~ Attorney: I.D. No.: 66737 ~ ~7?,~LQS Address: Gates, Halbruner & Hatch, P.C. - I ' 1013 Mumma Rd., Suite 100, Lemoyne, PA 17043 Telephone: 717-731-9600 Description Value Real estate located at 1808 Pine Street, Camp Hill, PA 17011 $127,672.20 1986 Cadillac DeVille $750.00 2004 personal income tax refund $596.00 Waypoint Bank checking account no, 0090373697 $23,785.06 (.,,, T Olal: $152,803.26 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsvlvanla may, at the election of the persona' representative. include the value of sach Item, but such figures should not be extended into the total of the Inventory. RW-B REV-15roEX (~) . OFFICIAL USE ONLY COMMONWEALTH OF REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~L - -9L 00921_ __ COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER .... McCormick Dorothy S 723-05-4111 Z w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETUfIol MUST BE FILED IN DUPLICATE WITH THE C W 9/25/2004 2/5/1924 REGISTER OF WILLS 0 w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w [i] 1. Original Return D 2. Supplemental Retum D 3. Remainder Return (date of death prior to 12-13-82) I- :ll:: :!cn D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required Oa::ll:: wll.O :t:~ [i] 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes Oll.lD ll. D 9. Litigation Proceeds Received D 10, Spousal Poverty Credit (date ot death between t2-31-91 aI'<l1-t-95) D 11. Election to tax under Sec. 9113(A) (Attach SchO) CC THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD$E DIRECTED to: I- NAME COMPLETE MAILING ADDRESS z w Q Mark E. Halbruner, Esquire 1013 Mumma Road, Suite 100 z 0 FIRM NAME (If Applicable) ll.. l/) w Gates, Halbruner & Hatch, P.C. Lemoyne, PA 17043 a: a: 0 TELEPHONE NUMBER u 717-731-9600 1. Real Estate (Schedule A) (1) $127,672 .20 OFFICIAl USE ONLY 2. Stocks and Bonds (Schedule B) (2) $0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) $25,131.06 (Schedule E) Z 6. JO Owned Property (Schedule F) (6) $0.00 0 i= Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) $58,891.39 ;:) (Schedule G or L) .... 0: 8. Total Gross Assets (total Lines 1-7) (8) $211,694.65 <C 0 $27,733.20 w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) a: 10. Debts of Decedent, Mortgage Liabil~ies. & Liens (Schedule I) (10) $990.38 11. Total Deductions (total Lines 9 & 10) (11) $28,723.58 12. Net Value of Estate (Line 8 minus Line 11) (12) $182,971.07 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) $0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $182,971.07 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax $0.00 x.O ~(15) $0.00 z rate, or transfers under Sec. 9116 (a)(1.2) 0 ~ 16. Amount of Line 14 taxable at lineal rate $182,971. 07 X.O ~(16) $8,233.70 CC I- :J $0.00 $0.00 ll. 17. Amount of Line 14 taxable at sibling rate x.12 (17) :E 0 $0.00 $0.00 0 18. Amount of Line 14 taxable at collateral rate x.15 (18) >< CC 19. Tax Due $8,233.70 I- (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Com lete Address: ET ADDRESS 1808 Pine Street CWllberland CITY STA1E ZIP C Hill PA 17011- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) $8.233.70 2, Credits/Payments A. Spousal Poverty Credit $0.00 B. Prior Payments $8.700.00 C. Discount $411.69 Total Credits (A + B + C) (2) $9.111.69 3. Interest/Penalty if applicable D. Interest $0.00 E. Penalty $0.00 Total Interest/Penalty (D + E) (3) $0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) $877.99 S, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (S) $0.00 A. Enter the interest on the tax due, (SA) $0.00 B. Enter the total of Line S + SA. (SB) $0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yf?f3 No a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . . . D [j b. retain the right to designate who shall use the property transferred or its income;. . D [j c. retain a reversionary interf?f3t; or . . .. .. .. .. .. . .. .. . . . .. .. .. .. . .. .. .. .. .. . . . D ua d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . D [j 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. D og 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary df?f3ignation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !iJ D 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 refum, including accompanying schedules and statements. and to the best of my knowledge and belief, it is tNe, correct and complete. Declaration of preparer other than the personal representative is based on all infonnalion of which preparer has any knowledge. SIGNA RE OF ~,E~SON PONSI LE FOR FILING RETU DA~E " tv Camp Hill. PA 17011 <S For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to Of for the use of the surviving spouse is 3% [72 P.S.!! 9916 (a) (1.1) (i)]. For dates ot death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the su rviving spouse is the only beneficiary. For dates of death on or after July 1 , 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent ofthe child is 0% [72 P.S. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12% (72 P.S. 9 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. 3W4646 1.000 . . REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL EST ATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothv S. McCormick 21 04 00921 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is JOintly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. 1808 Pine Street $127,672.20 One-story, single-story dwelling; located at 1808 Pine Street, Camp Hill, Cumberland County, Pennsylvania; Tax Parcel No. 24-0805-036; transferred to decedent by deed dated September 23, 1959, and recorded on September 28, 1959, in the Office of the Recorder of Deeds of Cumberland County, at Deed Book R, Volwne 19, Page 450. Value is county assessed value multiplied by common level ratio applicable at date of death. TOTAL (Also enter on line 1, Recapitulation) $ $127,672.20 3W4695 1.000 (If more space is needed, insert additional sheets of the same size) . . REV-1508 EX + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Dorothy S. McCormick 21 04 00921 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the rlaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1986 Cadillac DeVille value is private-party value $750.00 2 United States Treasury $596.00 2004 personal income tax refund 3 Waypoint Bank $23,785.06 Checking Acct. No. 0090373697 TOTAL (Also enter on line 5 Recaoitulation) $ $25,131.06 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) . . REV-1510 EX + (6-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy S. McCormick 21 04 00921 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERlY ITEM IIOillE TIE NA/JE OF TIE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT MIl DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TIE DATE OF T1WSfER. ATTACH A COPY OF TIE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST {If APPUCABLEl VALUE 1. AIG Annuity Insurance Co. $4,181.20 100.0000 $0.00 $4,181.20 Annuity No. FJ206374 Owner: Dorothy S. McCormick Annuitant: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 2 American Express $9,884.58 100.0000 $0.00 $9,884.58 Annuity No. 9920-3448862 Owner: Dorothy S. McCormick Annuitant: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 3 John Hancock Life Insurance Co. $7,433.35 100.0000 $0.00 $7,433.35 Annuity No. GP07287286 Owner: Dorothy S. McCormick Annuitant: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 4 Lincoln Benefit Life $5,717.38 100.0000 $0.00 $5,717.38 Owner: Dorothy S. McCormick Annuitant: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 5 MBNA America $3,230.18 100.0000 $0.00 $3,230.18 Certificate of Deposit No. 405901095 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 6 MBNA America $6,357.98 100.0000 $0.00 $6,357.98 Total from continuation sched les . . . . . . . . . $22,086.72 TOTAL (Also enter on line 7, Recapitulation) $ ~58-891.39 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 . . Estate of: Dorothy S. McCormick 723-05-4111 Schedule G (Page 2) Item DOD Value Taxable No. Description of Asset % Interest Exclusion Value Certificate of Deposit No. 409280710 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 7 MBNA America $3,285.16 100.0000 $0.00 $3,285.16 Certificate of Deposit No. 408472391 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 8 MBNA America $3,553.21 100.0000 $0.00 $3,553.21 Certificate of Deposit No. 409507120 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 9 Susquehanna Valley Federal Credit Union $6.48 100.0000 $0.00 $6.48 Share Savings Account Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 10 Susquehanna Valley Federal Credit Union $6,247.62 100.0000 $0.00 $6,247.62 Certificate of Deposit Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 11 Waypoint Bank $3,019.66 100.0000 $0.00 $3,019.66 Certificate of Deposit No. 7000010198 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 12 Waypoint Bank $2,922.01 100.0000 $0.00 $2,922.01 Total (Carry forward to main schedule) $19,034.14 . . Estate of: Dorothy S. McCormick 723-05-4111 Schedule G (Page 3) Item DOD Value Taxable No. Description of Asset % Interest Exclusion Value Certificate of Deposit No. 8000016491 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares 13 Waypoint Bank $3,052.58 100.0000 $0.00 $3,052.58 Certificate of Deposit No. 8000053821 Owner: Dorothy S. McCormick Beneficiaries: children, Jill A. McCormick and Mark L. McCormick, in equal shares Total (Carry forward to main schedule) $3,052.58 REV-1511 EX + (12-99) SCHEDULE H . COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothv S. McCormick 21 04 00921 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. Brown Funeral Home Funeral Goods & Services $9.234.06 Total from continuation schedules . . . . . . . . . $4.630.81 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees $7.000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) $3.500.00 Claimant Jill A. McCormick Street Address City State Zip Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees $316.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7, 1 AT&T phone service $186.63 Total from continuation schedules . . . . . . . . . $2.865.70 TOTAL (Also enter on line 9, Recapitulation) $ $27.733.20 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) . . Estate of: Dorothy S. MCCormick 723-05-4111 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Gingrich Memorials Gravesite Marker $3,590.00 3 The Garden Bouquet Flowers for Funeral Home $217.72 4 Treasters Flowers Flowers for Funeral Home $823.09 Total (Carry forward to main schedule) $4,630.81 . . Estate of: Dorothy S. McCormick 723-05-4111 Schedule H Part 7 (Page 2) 2 Cumberland Law Journal fee for publication of estate notice $75.00 3 Harleysville insurance auto insurance $114.14 4 Lower Allen Township trash removal $73.35 5 PA American Water water service $160.40 6 PA Department of Revenue 2004 fiduciary income tax liability $94.00 7 Patriot-News fee for publication of estate notice $260.53 8 PPL Electric Utilities electric service $256.03 9 Public School Employee's Retirement System returned portion of benefit payment directly deposited to decedent's checking account prior to date of death $1,057.00 10 Stiteler & Associates accountant's fee for preparation of 2004 income tax returns $200.00 11 UGi gas utility service $292.72 12 United States Treasury 2004 fiduciary income tax liability $219.00 13 Verizon phone service $63.53 Total (Carry forward to main schedule) $2,865.70 . . AEV-1512 EX + (12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothv S. McCormick 21 04 00921 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AM Security home security $59.88 2 Associated Cardiologists medical bill $1. 74 3 AT&T phone service $64.60 4 AT&T Wireless cellular phone service $223.28 5 JC Penney credit card debt $100.93 6 Kilmore Eye Associates medical bill $20.00 7 Lower Allen Township trash removal $73.35 8 PA American Water water service $48.04 9 Pep Boys repair to decedent's vehicle contracted for prior to death $120.68 10 PPL Electric Utilities electric service $71.72 11 Quantum Therapeutic medical bill $2.70 12 UGI gas utility service $127.00 13 Verizon phone service $27.04 14 West Shore Anesthesia medical bill $49.42 TOTAL (Also enter on line 10. Recaoitulationl $ S990.38 3W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-10613 EX+ (9JQO) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothv S. McCormick 21 04 00921 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Jill A. MCCormdck 1808 Pine Street Camp Hill, PA 17011 Daughter $106,995.49 2 Mark A. McCormick 1126 Thayer Street Safety Harbor, FL 34695 Son $75,975.58 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 TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOT AL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ SO.OO 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) . "- DEATH CERTIFICATE ~ \ 1. I: 1\1 Cl'rui'y thai the information here given is correctly copied from an original certificate of death duly filed with me as Lx:d'Rq,isu-1lr. The original cenificate will be forwarded to the State Vital Records Office for permanent filing, \;V,!;,RNiNG: !t is illegal to duplicate this copy by photostat or photograph. thi' cenihcdtc. S;::'.OO ~ .-;il-il1.!.~:IF,:i:?~.,-;;;.~_ /"p' , \ H U~ D ,.'->. If .,,1 \.. t>..\..', "Ii" --:, l~> / ':-<'~~:r~\ ..~~ ....~~) h:~!- -'.--: -, - \7~ "~I. .~fII"<Jt.-__.,_.-. . ";;iJ!::.,... It ~;\,-~",__/};j, ,.,.:r ,/,;'.h~' I" *{"';'''''''~ ,,-' ,*) p 11'7(j,)h:RO c. ~__'...; .....,~. ,,' . ~\!5~,,;',~:~~~~i /./ h,,"M. .. /./ ..- SEP-2''S''2004 J......1, J,,-lJ~!..J . -..-------.--.- "'<'':c:.fi1Hi \ \\1 ~,,!~ '~.!~!1!!!~ Dale l "- H10&.144 fWv. 1"1 COMMONWEALTH OF I"ENNSYLVANIA . DEPARTMENT OF HEALTH. VITAL RECORDS TY~ CERTIFICATE OF DEATH II ({'.('ron"r) NMAIlINT BWE All NUMBEA IILACIC _ "". SOCIAL SECURITY NUMlEA ME OF DEATH (troton/tl. Day. '/MI'j E a. Female September 25, 2004 UNDER 1 OM -- - ~)O CITY. Pennsboro DENT' KINO OF IlU8lN SURYMNG SPOUSE (~~~::~~ 1Ilwh.glVtlmQidetlnarnel DId ..... 1808 Pine St. - ",In. Camp Hill, PA 17011 Cumberlaro -ill? 17d.O ::..ae:.m=oI 1~ .. A'S NAME (riflt. Midde. Latd) MOTHER~"'k-Su<'- James E SWitzer 1 . B nest MAN 'SNAMEfT_oInl) tNPORUANT'S UAIU4G ADDRE88 ($I..... QlyfbWn, SWIe. ZipCodet Jill A. McCormick 1808 Pine Street, Camp Hill, PA 17011 I --.. ,- LOCRlON- ItylTown,S1etI,lIp ~ s.....:lCC c-..tionO "'__$1...0 2004 Mi.ffI.irtx:W1, m 1 'Jffi9 O_~l " E OR PERSON ACTING AS SUCH UCEHSE NUMBeR AND AOOfIE8S OF FO.CIlJlV ~ FD-012925-L ~ F\rB:al Itnas In:: UCEtrfSE NUMBER no. 'ME DATE PRONOUNCED (Monltt.OlI~. .......) WUl CASE REFERRED 'TO ME A' 5:00 A'M September' 25. 2004 ... ...0 .. %I. MAT I: Enter ttle......, injutIM 01 compllcMktnlI..t\IchcaUNld tM dQth. Do not ..-rtt.1"rIOde Of Gylng. auctl.. c-...c or r..prlltoly."... thack Ol' "-1 ~ IAwoxtlNil. OIhef.tgnlfttantcondltlonleontributtng IGdNlft. but UeI onty one cauM on ..eh lint. ,1n1erWl MtwMn noc ,nutting," tM U1Wttvtnv c-....ljliven In....m I ~CAU8I!(Final !ontlIt PddNttl _OfOOndltion A -*'oln~)--.. .. , b. ! DUE 10 (OR AS A CONSEauENCE OF): ! c. DUE TO (OR "'9 '" CONSEOUENCE OF): , .. WEAE AU'fOPS-V FINOI'NGS MANNER OF DE.IJ'M o.cre OF INJURV TIME OF INJURY INJURY 1J WORK? oeSCRfBE HOw JNJUAV OCCURRED ~ PAIORTO (Month. Day. ..,) COMPLETION OF= CAlISE ~ 0 OF 0EAl'H? ........ ~.. .... ...0 NoD - 0 P_- 0 0 o PlACE OF INJUR~. AI home. '-"n. tltre<<,lIClDry, otfIca .CityITown.Stalel ....... Could not be dMltf1'IIMC buIIdinO. .rc. (SpecllyJ ... .... ... .... CIIITI..... (Check only 008) -currlftytNQpHYSfCtAN (Phy&lCl8r~ cer1tfylng cawe 01 de.31'l when anotheJ ptlylliciar' lIas pTO~ deafl and compIHted nem 231 c Coroner TO.......ot...,.~......ooc.........ClWtohCllUltllf~..~.._.......,.."...,..."...,..,..., ,........ ..,... ........,. 1< DATE SIGNED (Monltl, Day, ~i") ~ ePAOtfOUNcaNQ AND C&RT1flY1NG PHYSICIAN {Phy!UCian both pronouncing r1Clath And ('.erlltylng locauS8 ot dMth) o 1., 1. Se t. 27, 2004 TO......oI"'Y............dHthlMlOutNd..lblt..........IindP**.........~................................... ........, NAIE AND ADDRESS OF PERSON WHO COMPLETED CAu&E OF DENH ollEDlCAl.ItU,_ERlCOIIONEA Ihem 27) Typo Of P'lnl Michael L. Norris, Coroner l!; On......OI ~ lIftdIor m\lWdptlOn.1n lIlY optnIOn, death GCCUn"td.. tM....., ..... IncI pMct, .... dve to the .......:.) InCf 6375 Basehore Road, Suite tI1 I ..........r.........................,......... .........,.............. ....,..,........... ........ ,... ...,.... ....... II. Mechanicsburg, Pa. 17050 11.. AIt IJ\ /1\3 If) I 71 DATE FILED {Month Day. ~rJ SEP 2 8 2004 ... . . " " LAST WILL AND TESTAMENT OF DOROTHY S. MCCORMICK LAST WILL OF DOROTHY S. McCORMICK . . I, DOROTHY S. McCORMICK, of the Township of Lower Allen, County of Cumberland, State of Pennsylvania, being in good bodily health and of sound ; and disposing mind and memory and not acting under duress, menace, fraud, or undue influence of any person whomsoever, merely calling to mind the frail ty of human life, and being desirous of disposing of my worldly goods : while I have the strength and capacity so to do, I do make, publish and declare this my Last Will and Testament. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at a:n;r time made, and declare this alone to be my Last Will and Testament. As to such estate as it has pleased God to entrust me with, I dispose of the same as follows, viz: ITEM 1- I direct that my executors hereinafter named pay and discharge all of my just debts and funeral and testamentary expenses. ITEM 2. I order and direct that I be buried in a lot which I own situate at the Presbyterian Cemetery in Mifflintown, Juniata County, Pennsylvania. ITEM '3. All the rest, residue and remainder of my entire estate, whereso-: ever situate and whatsoever it may consist of, I give, devise and bequeath, absolutely, and in fee, to my dearly beloved children, in the following shares: ; 1. 50% of my estate to my dearly beloved daughter JILL. McCORMICK. 2. 25% of my estate to my dearly beloved son R. JAMES. McCORMICK. 3. 25% of my estate to my dearly beloved son MARK L McCORMICK. ITEM 4. I nominate and appoint MARIAN S. CLARK as Executrix of this my Las tWill. Should the Executrix named fail to qualify or cease to act as Executrix, then I appoint R. JAMES McCORMICK as Executor in her stead. ITEM 5. I direct that my personal representatives, as well a~ their " successors, shall not be required to give bond for the faithful performance JA'lES M. BACH ATTORNEY AND of their duties ina:n;r jurisdiction. COUNSELOR AT LAW 107 ST. JOHN'S CHURCH RO SUITE. #:2 CAMP HILL. PA. 17011 - TEL. (717) 737-2033 . COMMONWEALTH OF PENNSYLV.AN.IA~ s COUNTY OF CUMBERL.AND I, DOROTHY S. McCORMICK, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. " Sworn or affirmed to and acknowledged before me, by DOROTHY S. McCOBJ.IIICK, I' I the Testatrix, this ~ /l',j;f: day of /} 7t'~r-. ' 1983. 4 ~ i8 J ! ~... /1-11:}1' ;j, A.>l//r>,'~</]) Nota PulSlic I' My Commission Expires: NAl.T'_'\'. J: t~U'.._R, .l.L<~try _ m?oih~ My Com:m~.sl.,n Expires O~f..>bor 27 19 J CQmp WII, fA CUl1l~ I d' (:.~ :)Jr all County I I The preceding instrument consisting of this and (1) one other typewritten I ., page, each identified by.the signature of the Testatrix was on the date there- of signed, published and declared by DOROTHY S. McCORMICK, the Testatrix i therein named hereunto subscribed our names as witness. I cr~ .ttM::-L Residing at 107 St. John's Church Road Suite #2 Camp Hill. Penna. 17011 tltk~e ~& ~ t; uYL~1- L) (' Residing at 107 st. John's Church Road Suite #2 Camp Hill, Penna. 17011 ~ JAl\IES 1\:1. BACH - 2 - ATTORNEY AND COUNSELOR AT LAW 107 ST. JO....N.S CHURCH RD. SUITE # 2 CAMP HILL. PA. 17011 . AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA~ ss COUNTY OF CUMBERLAND We, James M. Bach, Esquire and Albert DI~ostino , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. 'ifl t: , crorr .01, '0 , '7?1 tlf ff. ' 1983. a' / /} 7f~ I _ll 1.<.-<1 ~ Pti' . '}>,1>' / "AY (( 1. I Not. blic . . ' MY Commission EXpires: !VA,'./C;_ Aty Co J. J:?"ENr, Cqtr; :l,lmit~iolJ E.,.. .' 1J-lvG.;.:;p, P Nt/I, r A 'PII";;:'$ 0,", I ., .J.VOtar . '0,,, <? Y P~bli CI;'':.::';:;;'QlJd ',..,'9 p~~- c ~OUiUy . '\ JAMES M. BACH - 3 - ATTORNEY AND COUNSELOR AT LAW 107 ST. JOHN'S CHURCH RD. SUITE # Z CAMP HILL. PI.. 17011 - . "- PA REV-1500 SCHEDULE A REAL ESTATE BOOK ^" ltJ PAGE45U . FEE-SIMPLE DEED- Typewrlte~ w4ia1fubrnture. :!lUll!' <Irqt -23~ da,ol ~ in the year of our Lord One Thou,and :Nine Hundred and Fifty-nine (1959). 1!1tfttttttt JOHN M. KNAUB and JANET A. KNAUB, his wife, by her ATTORNEY- IN-FACT JOID'T H. KNAUB, which power lias conferred bJr docwnent filed in the Cumberland County Recorder's Office in Miscl. Book 129, Page 4Sl, and !1ELVIN C. CHRONIS1~R and ETHEL L. CHRONISTER, his wife, by her ATTORNEY-IN-FACT HELVIN C. CHRONISTER, which power was conferred by virtue of document filed in the Cumberland County Recorder's Office in Miscl. Book 114, Page 75, all of the Borough of 11arysville, Perry County, Pennsylvania, Grantors, parties of the first part A N D ) DOROTHY S. J.\CCORHICK, single woman, of the Borough of Co.m~) Hill, Cm'lborland COlmty, Louer Allen \'o\Tl1ship, Pennn;"'_ vcnia, party of the ucond port, ~itttt!l!i!~ Tha~th. '~d ~art iesof /th. fir" port, for and in con,ideralion of thHum 01 NTIlETEElI I'lIOUSAlfD;;, HUlIDlillD F lF1Y (.l':), 050 .00) _ _ _ _ _ _ _ _ _ _ _ Dolla". lawful money of the United State, of America, well and truly paid by the ,aid party' oPf the ucond port to the laid port iat! the fir" port, at and before the ualing and delivery of thue preunh, the receipl whereof il hereby acknowledged, have granted, bargained, ,old, aliened, enfeoffed, releaud, con'Oey,d, and confirmed and by the,e preunh do grant, bargain, ull, aU.n, enfeoff, releau, convey, and confirm unto the laid party of the ucond port her heir. and 481ign'J .2\11 that certain lot or tract of land situate in lower Allen TownShip, Cumberland County, Pennsylvania,_ more particularly bounded and described as follows, to wit; BEGINNING at the point of intersection of the line of adjoiner between lots No.1 and 2, Block liD" and the Southern line of Pine Street; thence South 11 degrees 6 minutes East by said line of adjoiner for a distance of 211.41 feet to a point; thence North 77 degrees 11 minutes 40 seconds West for a distance of 87~51 feet to a point at the Southeastern corner of lot No.3; thence North 11 degrees 6 minutes West by the eastern line of lot No.3 for a distance of 176.21 feet to a point on the Southern line of Pine Street; thenCe North 78 degrees 54 minutes East for a distance of 80 feet to the point and place of BEGINNING. I BEING lot No.2, Block liD" on the Plan of lots of Cedar Village as I recorded in the Recorder of Deeds Office in and for Cumberland County, Pennsyl~ vania on April 23, 1959, in Plan Book 10, Page 25. HAVING THEREON ERECTED a brick ranch d1lelUng Hi th attached car~JOrt known and numbered as 1808 Pine Street, Cedar Village. BEING PART of the seme premises which John A. Knaub, et aI, by deed - - ... - - -... . - . - . QUOK A!. 19 rAGE ~51 UNDER JU1ll sUBJECT. newr"'e1eee, to thO re,triction' end convenant. reCOrded by tbe Or"'''''' he,."in Jnne 9, 1955 '" tbe Recorder" orfice .rare..i. in Miscl. Book 111... Page 69. tU~I\.~ ~tt~ \~'imS~W ~t~n~t ~IS\;."\ \';[AI. ES1 ATE. 1f'~NSflR.1 A'f.. , ,'_' Date'? )'J-. 'i /:;;1 1\>>,;)...II'1t i ~. _..s...'''''''''' . I . , I p./,- - . I,';'; ii _ . ..,..' ,'. .\rl..,...."""'" ,,,,,,,---,,"_J.'!'/'f,',j"'SECRE-ff~ ' ~GE.N'T . '," . ....-...-- . . ". "'" ., - . . ~1 ~~......~, \ 1,.' IDogetl1rr 'With all and sin(Jular~ the tenements, herediiamerLtI and appll.rtcnancel to the same belong- iny or in anywise appedaining, and the rClJcrsion and Tt-'versions. remainder and remainders, rents, issue. and profits thereof; l\nll al!1o all the estate, right, title, interrat, property, claim and demand whatsoever, both in law and equit,y, of the said part ies of the first part, of, in, to or out of the said premises, and every part and parcel thereof .,. Wo i!fnur nUll to 1ijOlll the said premises, -with all and singular the appurtr1lance.,.. unto th,' said part y of the second part, her heirs and assigns, to and for the only proper use and behoof of the said partieS of the .<ccond part, her heirs and assign.'1 forever, .i\Ull THE SAID parties of the first part, for themselves, their llf~iT'; 't~ecutor8 and admin.iatrators, do by these prcs""ts, covenant, grant and agree to and with Ihe said part y of the ..cond part, her heirs and assigns, that they the .aid parties of the fifst part, their heirs all and .ingular the 'iereditaments and premi..s hereinabove dacriberl and granted or mentioned, and in- tended so to be, with appurtenances, unto the said part y of the second part, her hei.. and assigns, against the said part iea of the first part and their heir.'r and against all and every other person or person. whomsoever, lawfully claiming or to claim the somp or any part thereof, shall and will, by these preRcnts, WARRANT AND FOREVER DEFEND 3Jtt IIUUr!Hi IIl1rrrof the said part ies of the first part have :bJIl: hereunto set their hand S and seal S the day and year first above written. ~~-:?f:zl;/>;~. .. ('~A<.] ..~ A~?KNAtB;~R'ATT6"'Y::':fN~Ab1rEAL} Signed, Sealed and DeliveredJO' ?'KhA~Ji.:~,~~ (SEAL) . th P f~"~"'i.. c Ji}dccw;.td- (SEAL) III e resence 0 .ME;tv rC....C~NIS.~.... . A (h r \ [' ueZ c "cl 'J v -( .. .. THE .... ..:... .......... ... ...... __ (?~~\~w .~J,~~HERA,,"HER~~~~T ................................................................................................................... I . ..................................................... .......... .... .............. . : ::::~ I ~"..".; -,;;,;; . . ~~~A~ COMMONWEALTH OF PENNSYLVANIA l ~UMBER ...... LAND COUNII COUNTY OF ..................P..!!!!-.P..hi.n......................................-................... 58: PENNSYLVANIA ____::~~~:~~~~~~;;::::-_:'~L~-==~:~:_:;.::":::;~; officer, personall!! appeared ..~Qhn....M....."K~1JQ~.....I.@~.:!<...4.~....Kn!1,g!:?....!:?.Y.....J:l.!~;r.....A:tt;Qmay""In~.a.c.t....JP.bn.. ~.!.....!SE.~~E.....~!.1.g....t~.~1.y..i..!:l....Q..!....9.hr.Q!:l.;!,.~.~~!."....~.:t.h~.l.:....~.!"..9.h!.2n.~f:l..:t.~.r... .!?Y.:...h~.r....Mt:Q.rn~Y:::J.n::.f..!l&:!;......... ~~.l.:yi!:l....9..!.....9.h.r.2n~.~t.~r................................... .................... ....... ..........................................................................................-...."..... ...........:::........................ "".""'", "- . ,,',,~~q;{Jk..l~'.:r,e...(or .atisfactoriZ!! proven) to bc the persoll .fL....................... whose name ..s........a.r.e. .ub.cribed to the ~ V ''...1:'/'' '. -'/~'. t ,', : IJ..- ..' -Ftll ii' &.l~ellt, and acknowledged that .............. he y:............ ezecuted the .ame for the purpo.e therein contained. . ,. (:): e.... .. (~~_.. ;'. :. 0: tu...."... lNi..' "'.1fs. l'~_SS WHEREOF, I hereunto set my hand and offi~'al seal. I .;;t :.i'OF'!i;': : ~- ___".. I". "". ~ . "._ .., : -<0 ... '_n......~; t _,)J 4-" . \ .'-:1." ..,d."" . . .' .- ................... .....-.k..0l2;ll.....:t,. .-.... ......C...~r................... "''''''R "'PO' BL'" .... '- 1....'.:.:~..\W' 'I:"~ (J .) I A ." "., . 0'. ,.~"\.'. ... AI .,. ~ ..........IJ.'... . '. <.n '.Jj Y '~~3 , 1"- ". ..,;. " y COm7l1188wn expzre,:... ". ...-../....-......... ......M!I' ~UlIJ_,..udW.. ... J l J "''';''' ,,' "~,, . ., .'. / \lamsbU\1- ?a. Do...""" co,,,.1 y I ~He y certIfy that the PreClie Re..dence of tl.. Granlee, lII(~"e wtthin Deed~ is,......""..................".................."..,,. I B" ()? P' ")1- .. ..... . c;:,:-;=:t~~L-:jI-::--::=::==:~~~~~~t;:::= Attorney for Grantee., 'I-t' ! '1 ~ ~j ~ : ~ I ~ &....j fl.! ,,'il j II 2 gj Co/) ; wi Q) iU j ~ "" Ql I : g:ll'1!~! .~ <>l '" r-lo-l ~ i l. ... ,..... .--l ~ --j' r-I 0; a; oj i <>l 1 " I i r-- ~ oj <-) J ,3\..... l. ~; 0; ,m '\ t' I ~ ! '" . +' t;:! ,,,: all:> ~ h i C;;j ! j -S "CI '" 1" U) 1-11) n:: ';j! 'll'\'" ,'" \01' ~ 0 r\! +'i ~ 1 ~ \ --oi \ \ .9 -:@ '<ll"""" ,,<-) .! "filjijl Q) j ~" : ' "B I <>l"' ""l ~ ~ 0 ~ "'1 rol <-) O! fl. I <~ II ~; u\ fa E-t . Q~ ali -- E~ .. i lei" "t N ~ ,t/l ~i .f1l~i ~ d to \ g : I ~!l . '" ~ I;:, ,n. ... s' ,~, ... l;; 0 . Vt. . .... w: . ~ ! ... ~ U ::;:. . ~Lb::1o! t 11 I 'iO-S Ul 53 @ 1l fl.: t/l <\ q! ':>l 1! I ~ ~ t- ~ . 0 0 .....!! 'Il \1 ! Ill"" ~ ~ f t-;, t=lI CIS Q : : 0 Q,) I ... 0 I ~ ~ ! ! t.) i>:l i 8 u ~ I'" i -- ' i ....t::ZZZ:.:.~.~.S~~~::y, } ss: JRrt~rll 191 the J3fficeJlk Recording of Deeds, Mortgages, etc. in and for the County of~.. in Deed Book A'.' Vol. ../1"'''''''''''1#' Page.4:$P."". ' .~~~J.'~~ ";~; ~!ln~' a~~ Seal of Office,' ~~~."..."..."...::........t.?3.n~"................" 4ay of }' . -/--"t /. . ....... ~ . . Page 2 of2 REAL PROPERTY TAX ASSESSOR RECORD Tax Roll Certification Date:01-01-2004 Owr!er Info~ll,ation Current Through:N/A County Last Updated:07-29-2004 Current Date:10/06/2004 Source: TAX ASSESSOR , CUMBERLAND, PENNSYLVANIA OWNER I:NFORMATI:ON Owner(s): MCCORMI:CK DOROTHY S Property Address: 1808 PI:NE ST CAMP HI:LL PA 17011-7443 Mailing Address: 1808 PI:NE ST CAMP HI:LL PA 17011-7443 Phone:717-737-6448 "- PROPERTY I:NFORMATI:ON County: CUMBERLAND Assessor's Parcel Number:24-0805-036 Property Type:SINGLE FAMILY RESIDENCE - TOWNHOUSE Land Use:RESIDENTIAL (NEC) Lot Size (acres or square feet) :15681 Lot Acreage:0.3600 Width Footage:80 Depth Footage:194 Municipality:LOWER ALLEN TOWNSHIP Legal Description:LOT 2-D PB 10 PG 25 Lot Number:2 TAX ASSESSMENT I:NFORMATI:ON Tax Year:2004 Land Va1ue:$28,000.00 '. ~, \.. r ~ Improvement Value:$87,020.00 )( -- Valuation Method:MARKET Tax Amount:$1,662.27 lA.71/ (; 721.(/ BUI:LDI:NG/I:MPROVEMENT CHARACTERI:STI:CS Number of Buildings:1 Living Square Feet:1220 LAST SALE I:NFORMATI:ON Deed Type:GRANT DEED Recording Book/Page:Book 19K, Page 450 TO ORDER ORIGINAL FILINGS OR OTHER RELATED DOCUMENTS, CALL 1-877-DOC-RETR (1-877-362-7387) . END OF DOCUMENT https://print.westlaw .comJdelivery .html?dest=atp&dataid=A005580000004041 0005048488BBED88ACC 1... 10/6/2004 ., '- PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY Kelley Blue Book - Private Party Pricing Report - Cadillac, DeVille Page 1 of2 . . .!,8i~= o\cqs advertisement Quick Dealer Price Quote Search Used Cars Listings List Your Car for Sale USED CARS REVIEWS & RATINGS ADVICE FINANCING 8. iNSURANCE BLUE BOOKff P'RIVATE PARTY REPORT BLUE BOOK CLASSlfIEDS'" Pennsylva!"ia · June. 21, 2005 }earth Used (tlr U~tillg} 1986 Cadillac DeVille Sedan 40 Quickly browse through over Search Listings for This Car 600,000 used vehicle listings List Your Car For Sale Online to find exactly the car or truck .... . . you want. . V8 4 1 L't Quick New Car Price Quote Engme: . I er Trans: Automatic free CAR fAX Bec:orcl Check "- Drive: Front Wheel Drive Al,.!tQLo~ml:!fr()m4Ji5%_APR Mileage: 124,000 Insurance Quote "-_."~-- advertisement ----- Print "FoLSale" Sign Payment Calculator Equipment Air Conditioning Power Door Locks Power Steering Cruise Control Power Windows AM/FM Stereo Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. This vehicle has a clean title history, the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Private Party Value Search Local Listings I List This Car for Sale $750 Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Gel a J.Lsec!CarTcade"In_ \laJue Get Invoicelk MSRP on New Cars Geta_f'ers_on to PersonA_utQ_loaD _...'....'.,'......."....'. . ... . ." ." N'~ "'. ,'., , Copyright @ 2005 by Kelley Blue Book Co., All Rights Reserved. May-lun 2005 Edition. The specific Information required to determine the value for this particular vehicle was supplied by the person generating this report, Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the Individual use of the person generating this report only and shall not be sold or transmitted to another party, Kelley Blue Book assumes no responsibility for errors or omlssions.(v.05057) http://www.kbb.com/kblki.dlllkw.kc.ur?kbb.PA;103148;P A041 &17011 ;sed+p&723;Cadillac; 1986%20DeV... 6/21/2005 , . DOROTHY S MCCORMICK 1808 PINE STREET CAMP HILL, PA 17011 '>(Q) ~O 2004 U.S. INDIVIDUAL INCOME TAX RETURN SUMMARY ~jb Adjusted Gross Income $ 10,585 Taxable Income $ 1,435 Total Tax $ 0 Total Payments $ 596 Refund $ 596 Effective Tax Rate 0.00 % INSTRUCTIONS FOR FILING YOUR RETURN ELECTRONICALLY If you file electronically, make sure to follow the Electronic Filing Instructions to complete your tax return. "- Come back to TurboTax in 24 to 48 hours to check the status of your return. TurboTax will let you know if your return has been accepted or rejected by the IRS. If the IRS accepts your tax return, TurboTax will walk you through the final steps of electronic filing. It may involve printing and mailing some electronic filing forms. (DO NOT mail a printed copy of your tax return to the IRS. They already received an electronic copy of your tax return.) If your return is rejected due to an error, you have two options. You must fix the error and retransmit your return electronically, or you can mail a printed copy of your return to the IRS. To mail your printed return, follow the mailing instructions below. INSTRUCTIONS FOR FILING YOUR RETURN BY MAIL Your federal Form 1040 shows a refund of $596. Please mall your return to the following ~RS address postmarked by Friday, April 15, 2005 Internal Revenue Service Center Philadelphia, PA 19255-0002 Be sure to sign and date your return and include the proper amount of postage on the envelope. KEEP THIS PAGE FOR YOUR RECORDS -- DO NOT MAIL. . . ~l Way~qi!1J LOOK FOR US. WE'LL GET YOU THERE. October 30. 2004 Cory J. Snook 1013 Mumma Rd, Suite 100 Lemoyne. Pa. 17043 RE: Dorothy McCormick Estate Dear Attorney Snook; At the request of Mark McCormick, the following is the information on the accounts owned by Mrs. McCormick. "- Account #0090373697 , Checking account Balance as of 9/25/2004 - $23,785.06 Year to Date interest up to 9/25/2004 - $ 21.85 No Beneficiaries Account #7000010198 Certificate of Deposit Balance as of 9/25/2004 - $3,019.66 Year to Date interest up to 9/25/2004 - $36.15 Beneficiaries: Jill A and Mark L. McCormick, and James McCormick, deceased Account #8000016491 Certificate of Deposit Balance as of 9/25/2004 - $2,922.01 Year to Date interest up to 9/25/2004 - $34.76 Beneficiaries: Jill A. and Mark L. McCormick, and James McCormick, deceased Account #8000053821 Certificate of Deposit Balance as of 9/25/2004 - $3052.58 Year to Date interest up to 9/25/2004 - $47.43 Beneficiaries: Jill A. and Mark L. McCormick, and James McCormick, deceased If you need any further information, please feel free to contact me. Since ely ~ ~ De orah B. Eckerd Customer Service Representative Mechanicsburg Office 717 -697 -8279 P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FreE 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank,com "- PA REV-1500 SCHEDULE G INTER-VIVOS TRANSFERS and MISCELLANEOUS NON-PROBATE PROPERTY m AIG Annuity InslIram'c Cmnpany PO BoxK71 .:\ rnariIlo. Te\as 7q I OS-OX7 J K()(U2-+-+l)t)() November 12, 2004 Mark McCormick 1808 Pine Street Camp Hill, PA 17011 RE: AIG Annuity Insuranc'e Company Dorothy McCormick, Deceased Contract/Policy #FJ206374 Dear Mr, McCormick: We acknowledge receipt of the correspondence dated November 8, 2004 requesting the date of death value, interest amounts, and beneficiary designations. Listed below is the death benefit information for the above-referenced annuity contact. Type of Annuity Contract: Qual i fied Date of ]ssue: 08-06-1999 Contract Owner'" Nilme(s)' Dorothy McCormick Original Investment: $5,000.00 Cost Basis $5000.00 l.ilsh Villue as of Date of Death on 09/25/2004: $4, I 8l.20 Total Payment for Death Benefit on 11/12/2004: $4,200. ] 6 Intercst earned from 01/01/2004 to 09/25/2004 $ 104.28 Interest earned from 09/25/04 to ] ] / 12/2004 $18.96 Proceeds made payable to: Mark McCormick & Jill McCormick If you have any questions or require further assistance, pleasc contact our Customer Care Representatives, available Monday through Friday, 8:00 AM to 6:00 PM Central Time, at (800) 424-4990. We appreciate thIS opportunity to serve you. Silll:t:n::ly, / ;1 i ' 'I r , ,,' / . ,',,? -' / "l,f \ J~{_'lt,,j.-- I:'''; ,..}\ :__1 ~_' . " .." . t ~, Kristie Woods, Annuity Claims Clcrk A1G Annuity Insurance Company \/1'- \"1,,1:', ( \.r"ll/lt'! "/ ,ii, t'l"" I . . American Enterprise life Insurance Company n.... ::-.! ~\_',t- r .' r,~ :~,<:-1,~".'.~ Annuity Statelllent Platinum Flex Annuity Ownership Information Contract/Certificate Information Dortllhy S f\lcConnick COlllract iCert i fiC<llL' Number: 9920 34-l8X62 1808 Pinc SI TOlal pa::-l1lCllts: 56.000 00 Camp Hill. PA 17011 Issue dalC: (fit ll) 11)94 Annuitallt: Dorothy S !\1cCormid.. Payment Type Non.(.)u:i11 lied " Statement Period 07/20/2003 to 07/1912004 SummaQ' of Activity Beginning Annuity Value 07!J 9/2003: "9A89.2<J Plus additional payl11ellls: (J.( )() Plus interest earned: 332.13 Minus withdrawals: 0.00 Ending Annuity Value 07119/2004: S9.821.42 Current \\. ithdrawal Value 07/ 19!20()~t: S9.821.42 Relle, 'r\ iII/IIJl/IY l'lI/lIe /1'.\\ /IllY IlIl/u/ri/lW/ (/1/11'1':(,\_ Transactions During Statement Period Date Transact ion 11llOlIIlt .\'0 11m/Slier/OilS ill tllis <;wrelliCI/{ period Current Interest Rate Being Earned Current Payment Effective Annllal ValUl' IlIterest Rate S 9.82142 3.50 c; flhJf..f-ICiAF:-'1:. 5 - 1l'i4tt~ I..-.,/t t: 0'~--("'HC.l<" if qf:~':J cy l)ATf- l~ bEAn4- 1/ Au..t.E - .: ,; ,. _i . i. J ! lL A, ,vkw,t.M \t.-IL , \ I I . I $.1'+' IJCC;......J:..t,') IN riU:s. r {II! I1'll TlJ f/ ~i of p.. . "I M^O M CCmt..'" ! c,K (tJ W.Jl;:) t.h ) ," ! j I .., ,t.) 'f.,: ii I';; 'J''X~.f I ;--l.~,...:-:, ,"} . John Hancock Life Insurance Company Insurance products are issued by John H~ncock In<;ur~ncB Company John Hancock Variable Life Insurance Company (not licensed in New York) Life and Annuity Claim Services John Hancock Place Post Office Box 111 Boston, Massachusetts 02117 Phone: 1-800 732.5543 Fax: (617) 886-31 19 e-mail :mmazer@jhancock.com December G, 2004 Mark L McCormick 1808 Pine 8t Camp Hill, PA 17011 Re: Ann~ity # GP07287286 Annuitant: Dorothy S McCormick "- Owner: Dorothy S McCormick "- Beneficiaries: Jill McCormick, Mark McCormick, children, primary, pqually Dear Sir/Madam: We have received your inquiry regarding above annuity(ies). The following are the figures for Estate Tax Return(if any). Please consult your tax adviser: GP07287286 Date of Death Value 09/25/2004 $7,433.35 Claim paid 12/06/2004 $7,484.53 Thank you for your kind attention. Sincerely, Matthew Mazer, Claim Analyst Life & Annuity Claim Services ~ ;,JCOL,,} 8bJt:.f ,'r U ff... Co. Life and Annuity Claims :'4-1 Lakc\'lcw Parkway Vernon Hills. IL 60061 Telto'pilOl1e: (877) 49C).641 g Facsimi Ie: (866) 635-4523 November 16. 2()O-1 f\lark 1.. f\lcCon11lck 1808 Pine Strect Camp lIill. PA 17011.7-1-13 Rc: Dnr\)thy S. J\.1cCllrmid ('onl r~lCl ~ 0: U31.' I W{~9,"S "- Claim :~(): 222013959 Account Type: Fixed Annuity Tax Type: Non-Qualified I >ear [\:11'. McCoflnic\..:: Thank you I'llI' recently contacting our depanment regarding the above re1'crenced annuity. The fi.!llowing is a breakdown of the infonllalion you had requested on your annLllty claim: 11 Owner of Annuity: Dorothy S_ \1cCormick ;D Vnlue a~ of the Date of Death: (I) ..2:- ..2UO-l) S:-.;' 1 !.-'~ 11 Interest Earned f!"Om 1/1/200.,t - 9/25/2004: $717.38 :!1 Interest Enmed from 9/25/2004 - 11/16/2004: S43.78 il SIII'viving Named Rcnctlriaries: .I i II A McCormick and Mark ,," MeConlliek \Vc apprecIate the opportunll~' to assist you. Should you have any questions. or require further assistance. rlcasL' contaL'! our Custnmer Care l'nit at l.i.;77-c19(l-6..J J X. Sinccrciy, l.inc\,ln Benefit Life l'OI1lP:lIlV kmr I I It " " .'i' J~ ,...",', ~_~0.' '!I . :\o\'eml1er 10, 2004 Mark LMcCorl1lick Jill A. McCormick 1 R08 Pine St. Camp Hill. PA 170 II Suhlcet: Estate of Dorothy S. Me('ormiek Dear Mr. & Ms. McCormick, "- We recently recei vcd your reqw;st to provide the date-of-death balance for the below referenced accounts. Weare very sorry to hear of your loss. The information that you requested is as follows: -- Account Type of Account Date-of-Death Balance Accrued Interest Inc luded m Number September 25, :!OO4 l)ate-ot~Death Balance 405901095 Certificate of Deposit S3,230,18 $1.94 - 409280710 Certificate or Deposit 56,357.98 $3.68 - 408472391 eerlllicate of Deposit $3285.] 6 $7.34 409':;07]20 I Certi ticate of Deposit I $3,553.21 I $4,75 I Enclosed arc statements provldmg the addltlonalll1formatlon requested. I r you have any questions, please call 1-800-44] -7048, extension 715] 0, Monday through Fnday fi'om 8 a.1ll. to 5 p.m., (Eastern time). If you prefer, you may write to P. O. Box] 51 03, Wilmington, DE 19850- 5103. SilICl.:n::lv, /~. Kelly Totty Deposit ServICes department Enc losures ,j I ... ! . . SlPQPEH A 1'.1 T\J A. I~ ) S( . . ) . ,....1- .1 '\J 1 ; , ~_r -~-- . \1:\1 I EY l 1. ../L.t -" . F'E[,;EF~/~L CF~ED!T U r'"j I () r~J ()cloher _if} :!OO4 COf\' J Snook 10!3MumnlaRJ Stille \ 0\1 l.enw\nc P\ 170.n "- RF .\ccount of DOr0111\ ') t\1ct.'ormick Dcar \1r ~nook: Susquehanna Valle, leu account 1;9{1 was titkd In the naml: of Dorni\1\ S !vlcC'ormlck and con1<1I!1cd a Share Sa\ mgs ;\CCOUn\ and one CerUrlcak of [)eposit There \\a~, no Joint owner on 1 he accoll nl ~Jamcd BenefiClanes are Jill A. and f\1ark L McConmek Date' of Death \ aiL!<': on th\.' account \ ()9 25 04, \\US S6 ,.+8 In the Share Sa\mg\ Account ,md S6.2..P()::' m the l.\:rtii'icalc orTkpo\\l Income earned rrD1l1 n I 0 I U4 HJ 09 2\ 04 lotakd SCJ6 67- Please Icel fr I..' \..' to contact me 11' YOU have an\ questions or rt'\.]uII'c any additIOnal information Sim.'cn:h " . . I L / ) " ~ --. , '. f Cat)1\ I McLllU~.d)l/il As',! (JpCr;J!lon:; f'vlanager ... "'-,'-"" ' r /" i ! ! " j; ''r\. i ( 1_' ( I .' ..::.: . \~.~ Jt ./- '\. -"\. 1, ~'" ,...- ,- -~ - 1- "j. j i" '),-, . . VI Wayf:tqipJ LOOK FOR US. WE'LL GET YOU THERE. October 30, 2004 Cory J. Snook 1013 Mumma Rd. Suite 100 Lemoyne, Pa. 17043 RE: Dorothy McCormick Estate Dear Attorney Snook; At the request of Mark McCormick, the following is the information on the accounts owned by Mrs. McCormick. Account #0090373697 " Checking account Balance as of 9/25/2004 - $23,785.06 Year to Date interest up to 9/25/2004 - $ 21.85 No Beneficiaries Account #7000010198 Certificate of Deposit Balance as of 9/25/2004 - $3,019.66 Year to Date interest up to 9/25/2004 - $36.15 Beneficiaries: Jill A and Mark L. McCormick, and James McCormick, deceased Account #8000016491 Certificate of Deposit Balance as of 9/25/2004 - $2,922.01 Year to Date interest up to 9/25/2004 - $34.76 Beneficiaries: Jill A. and Mark L. McCormick, and James McCormick, deceased Account #8000053821 Certificate of Deposit Balance as of 9/25/2004 - $3052.58 Year to Date interest up to 9/25/2004 - $47.43 Beneficiaries: Jill A. and Mark L. McCormick, and James McCormick, deceased If you need any further information, please feel free to contact me. ~~~ :6'- De orah B. Eckerd Customer Service Representative Mechanicsburg Office 717 -697 -8279 P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free I-B66-WAYPOINT (1-866-929-7646) . www,waypointbank.com . "- PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRA TIVE COSTS . ~ROWN FUNERAL HOMES, INC. Daniel D. Drown, Supervisor K.irk D. Freed, Supervisor 100 Bridge Street 16 We.tfan Street Mifflintown. PA 17059 5 generations of service since 1845 McAli.tervIUe, PA 17049 (717) 436-6252 (717) 463-2711 September 29, 2004 6\ 1h V-\ bfP,v & ~ ~ q5' ~ To: Jill A. McCormick ~ ~/ ~tr 1808 Pine St. ~~~ Camp Hill, P A 17011 ~4y ~O. For: Funeral services conducted for the late Dorothy S. McCormick, on September 29, 2004: "- Casket & Services ..............................................$7,120.00 Outer Burial Container .........................................1,155.00 Certified Copies of Death .........................................50.00 Grave Opening ...... ............................... .......... .........3 50.00 Musician........................... ........................................ .30.00 Clergy.............................. ......... ....... ...................... ..200.00 Paid Obit-Lewistown Sentinel................................140.00 Paid Obit-Harrisburg Patriot. .............. ......... ...........274.06 Hairdressing.......... .......................... ............... ........ ...15.00 T ota! Charges ................. .......... ....... ................. ..$9,334.06 Balance Due ......................................................$9,334.06 k1 I c1 Ci1 w'ld 0 (,L 1 0 () .ce. .( iA "" 'CI'- 0 IA . ~ '.::r-- :- i/c1-0a '" v3c~,cf1 . Thank 7,J. '3 "'.0 V you, Daniel B. Brown Presid!.:":Dl Tenas: Net due 30 days. Unpaid balances after 30 days will De subject:tea aanee charge of 1.50/0 per meBtn (180/0 annual rate) .J U r"1 -.L I -...::. lQ t:.I ....... .1. t:) . .....,. Il::.J ,..., I I l...:I A. I , "-"....... ... - 1 I I I a.- I 1"-"..... .a. r.......... '-' . ... I ,--- --- -- ---..... . . . -- .... . . t '\. ' . . '.4?I. / ..".,e, R, 1119"'c" ~_ _ _ ___-~-;--~,. -(-~'_: ,.. -, -'\ '---~'--0:\E ["'1 OR l\J..,S----~~~~..u~,.,-~... !)~~t.~:'\ ~iillP.;::'..lll r:'?n~J ~\'_'()'.! r\;'\f.': li:"'lil ';_"III-':~, t:.i'- ! ()~\(I.'\ ~';! :.') ~l~f. dl(~l Attn: Ms. Jill McCormick June 16, 2005 Dorothy McCormick Memorial Proposal Mter our visit to the cemetby, and based upon our discussions, I have determined that the best approach is to install a memorial that will be a match to the existing memorial for Dorothy's husband, Richard. The memorial shall be an exact match to that existing memorial in terms of size, design, and layou t, and shall be made of your choice of either Colonial Rose or Heirloom Rose granite. The cost breakdown is as follows: The granite itself $ 2,895.00 Lettering . 290.00 Concrete foundation 355.00 Delivery & Installation : 50.00 ----------- Grand Total $ 3,590.00 (no sales tax in PAl I sincerely appreciate this opportunity to be of service, and hope that you find this proposal to be acceptable. If you have any questions, please don't hesitate to call me at 766-5622. This price qu.ote is valid for 60 days. Respectfully su bmhted, Rc~ C~/l_, Ron Colvin, Mechanicsburg Office M.fJI.t?..ger ~~J , __~rd~~>\ . ",",' ...-, :,r,~:~:. ,/ -r~ ~ Treaster's Flowers . ....~. ,;, "-~ / '-.-!",. RR 5, Box 172 · Mifflintown, PA 17059 ~~, .... DAVE & GALE TREASTER Phone: (717) 436-2968 - STATEMENT - Customer: \)~ \ \ ~:f~ "\L" c, U0)--"~~ \ (j Yu?; (J~ \ ~qlo b~j~\Jc) _1 v ~\ ~ '. ~\- ''l'Jv~-c\vV\;=-. r 'u~JJ.. c .) o.-cGJi"VVv Customer's Phone Number: Date:~ - -:z. (:,- C:'-l. CTY. DESCRIPTION AMOUNT '-\ C) a I CJ ';:) . I \ \.S" I () '0 C2:lGi~10 ~ \ C) ~ I () I-:J c:... .Q..r~"-".J ~~ d113""'" c~~ /d.-Y. I \J .~ \ 0 I : tJ \y I I I I --~-------_._--_._._----_._---_.. ! Thonk \\)U \ <--.--.- ------------.-----.- ._.,~----,--~-_._-_. .--."------- Payment by credit care' accepted on/V'll time of sale. Sub Imai 1 ~'\'-i r '-:-" AI/ invoiced sales may be paid bv cash or meck. ~ J. '.0 ~,~___ Sales Tax [;; (:. : ':::'"'~ Notes: Deiivery Charge __:j ~'__ Total ';<'-:::'''-,)' ,- '::.:-, - '~;:;.(....j '--'. . . ,-"..", ....... "..~,.<. " ~.,..._."'~~.___".~.......,,~...,". .,.",,~~_v< '. .. d.lll'll_ .,..........,'~",'<~,.., . . .. RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Re~ister Of Wills Receipt Date: 10/13/2004 Hanover and Hi1h Stree Receipt Time: 11:08:10 Carlisle, PA 7013 Receipt No. : 1038087 MCCORMICK DOROTHY S - -- - -- Estate File No. : 2004-00921 Paid By Remarks: J A MCCORMICK VZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name "- PETITION LTRS ADM 235.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 30.00 CUMBERLAND COUNTY GENERAL FUN EXTRA PAGES 6.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION EXECU 5.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D ---------------- Check# 2008 ~286.00 Total Received......... 286.00 '( (}; ~ -f ~'~ . ~ 4 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 DECEMBER 10, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. "- TO: " Cory J. Snook, ESQUIRE RE: Dorothy S. McCormick aka Dorothy E. McCormick. EST A TE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement iriserted on following dates: November 26, December 3, 10,2004 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 ------------- Total Amount Due $ 0.00 --------- --------- Payment received November 29. 2004 by Becky H. Morgenthal/Executive Director . . ([be patriot-News Order Confirmation Now you know Customer Orderer Account Number Ad Order 0001221264 GATES, HALBRUNER & HATCH, P.C 11885 Sales rholton Paver Paver Account Number Order Taker rholton 11885 Order Source Fax Special Pricinq None GATES, HALBRUNER & HATCH, P.C PO Number ESTATE OF MCCORMIC ATTN: TRACI L. SEPKOVIC,1013 MUMMA ROAD, Ordered Bv TRACI SUITE 100 LEMOYNE PA 17043 USA Customer Fax Customer EMail Customer Phone 717-731-9600 "- Paver Phone 717-731-9600 Tear Sheets Proofs Affidavits Blind Box Promo Tvpe 0 0 1 <NONE> Invoice Text Ad Order Notes Materials Total Ad Cost $260.53 Pavment Amount $0.00 Pavment Method ~.m.ount Due $260,53 Ad Number Ad Tvpe Ad Size Color 0001221264-0' Legal Liners : 1.0 X 21 Li <NONE> Production Method Production Notes Ad Booker Product Information Classification # Inserts Run Dates PNCO: :Full Run 806-Estate Notices 3 11/19/2004, 11/26/2004, 12/3/2004 Run Schedule Invoice Text LETTERS OF ADMINISTRATION, CTA., for the Estate of DOROTHY S, 12/6/20049:41:56AM 1 . ' .. Invoice Stiteler & Associates CPA's, P.c. 3920 Market Street 2nd Floor Date Invoice # Camp Hill, PA 17011 04/05/2005 2]55 Bill To Dorothy McCormick 1808 Pine St Camp Hill, PA 17011 "- Description Amount Form 1040-U.S. IndividualIncome Tax Return 50.00 . I I I I I I I i I i ! , I ! I ! I i I ! . : TIumt YOU Jor yom business. I - T.. ! E3G:OO . . '- PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS . . PAYMENTS~THESTATECHECKS DATE CHECK # AMOUNT SERVICE USING WAYPOINT TEMPORARY ESTATE CHECKS 10/13/04 93 $74.15 Harleysville (car insurance) 10/17/04 94 $64.60 AT&T I 0/22/04 95 $9234.06 Brown Funeral Home 10/22/04 96 $823.09 Treasters Flowers - Funeral 10/27/04 97 $27.04 Verizon 10/29/04 98 $71.72 PPL 10/29/04 99 $73.35 Trash/Sewer - LA Township 10/29/04 100 $127.00 UGI USING ESTATE ISSUED CHECKS FROM WAYPOINT 10/29/04 101 $20.00 Kilmore Eye Associates 10/29/04 102 $48.04 P A American Water 11/15/04 103 $39.99 Harlyesville (car insurance) 11/22/04 104 $27.14 Verizon 11/22/04 105 $43.41 P A American Water 11/22/04 106 $68.27 PPL 11/28/04 107 $1195.00 Dept of Veterans Affairs (was returned to us - we didn't need to make payment) 11/28/04 108 $1057.00 P A School Employees Retirement 12/1/04 109 $3237.37 Gates, Halbruner, Hatch-lawyer bill 12/11/04 110 $128.99 UGI 12/14/04 111 $1.74 Associated Cardiologists - dr. bill 12/14/04 112 $4'" ')'" AT&T .) ......) 12/14/04 113 $16.96 Verizon 12/14/04 114 $69.83 PPL 12/14/04 115 $50.35 P A American Water 12/20/04 116 $260.53 Patriot News (estate notice) 12/20/04 117 $8700.00 Register of Wills (prelim inheritance tax) 12/27/04 118 $49.42 West Shore Anesthesia --dr. bill 1/17/05 119 $2.70 Quantum Therapeutic - dr. bill 1/17/05 120 $67.12 AT&T 1/26/05 12] $90.73 PPL 1/26/05 122 $163.73 UGI 1/16/05 123 $41.39 AT&T 1/26/05 124 $19.43 Verizon . 1/26/05 125 $73.35 Sewer/Trash - LA To'wnship 2/7/05 126 $27,7.0 PPL 2/7/05 127 $66.64 P A American Water ~ p. "- *** END OF ATTACHMENTS *** PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE EST ATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy S. McCormick Date of Death: September 25, 2004 Will No.: 21-04-00921 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 ofthe estate is complete: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: December 2005 3. If the answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? Nt A B. The separate Orphans' Court No. (if any) for the personal representative's account is: NtA C. Did the personal representative state an account informally to the parties in interest? Nt A D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: June 23, 2005 ~4"~ Mark E. Halbruner, Esquire PA LD. # 66737 GATES, HALBRUNER & HATCH, P.C. 1013 Mumma Road, Suite 100 Lemoyne, PA 17043 (717)731-9600 Capacity: Counsel for Personal Representative cd PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy S. McCormick Date of Death: September 25, 2004 Will No.: 21-04-00921 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: I. State whether administration of the estate is complete: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: December 2005 3. If the answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? NI A 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? N/A D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: June 23, 2005 ~~,r '~? Mark E. Halbruner, Esquire PA I.D. # 66737 GATES, HALBRUNER & HATCH, P.C. 1013 Mumma Road, Suite 100 Lemoyne, P A 17043 (717)731-9600 Capacity: Counsel for Personal Representative U) LAW OFFICES RUPP AND MEIKLE HERBERT G. RUPP, JR. RICHARD C. RUPP A PROFESSIONAL CORPORATION 355 NORTH 21ST STREET, SUITE 20' (717) 761-3459 FAX: (717) 730-0214 CAMP HILL, PA 17011 E-MAIL: RUPPLAWOFFICE@AOL.COM ANN MEIKLE ERIKSSON (1954-82) ~ ~~ ~ I 2..0of{ c)~ ~ <?.tj I > ~ 1 WIIJJ CU yv. ~ I 0...... J-- C vvwa fA :-) o 'J , -,-:(j , r--- "" -::::>> c:~ c,n "<0 ~ <Po~o~ IV1c.OJrf^ ;cK " f:o;1' U) rrl -u I CJ ~ m c) C) cb c, ,on , C) -",---) Uo ?: C"'J --,1 .- --.,-, ~--; ~~ -:.,-~) .il ',,) Ul r",) ~l- Ot/- qrJ. ( r?12.~J.L- ~k- ~ elft-L-LO~ d ~S fA- C{~~W\ ~ "-:~" J, .\L C, ~ 1/)"o'Cf A1 t COV'N'''; (.. \~ 4eJ.A< k 7 l)V- ~~ rc7~ -J ;(\^- l-t< k l o~-q2-1 July 21, 2005 o ~..~ t-:J '-~.2 ~"-~ C"J ~:: ~~, "" .:-:::;t C::~ en U) ,,, -0 I 0:> Mark McCormick Jill McCormick 1808 Pine Street Camp Hill, PA 17011 /.... " ;p. Mark McCormick and Jill McCormick;: --1 Co-Executors of Dorothy McCormick u::> en N STATEMENT FOR PROFESSIONAL SERVICES-FINAL STATEMENT TIC with Dorothy McCormick set up family settlement meeting, travel and represent at family settlement meeting, drafting of letters, and proposals regarding the Pannebaker Estate and possible settlement Pannebaker Estate Drafting of family settlement agreement, preparation and revision of letter to Attorney O'Donnell Receipt and review letter from Attorney O'Donnell Receipt and review letters from Attorneys preparation of endorsement clause and all beneficiaries checks, review file and conference HGR Re: Estate of Pannebaker Draft of letter to Dorothy McCormick further drafting and revision of family settlement agreement, further preparation and finalization of revision of family settlement agreement for Pannebaker Estate, packaging and preparation for sending family settlement agreement TIC Dorothy McCormick Conference with HGR Re: Pannebaker Estate Receive and review letter from Attorney O'Donnell Review, revise family settlement from Attorney Zimmerman conference Mark McCormick 'c'J -11 '"~) -) ::::1 <J ~Tl ~':J --,,-') ~Tl 2J . ~---) r'n July 21,2005 page 2 36.5 hours @ $150.00/hr ...................................................................$5,475.00 Costs..................................................................................................... $69.75 Legal Assistant Fees ........................................................................... $50.00 TOTAL DUE STATEMENT .......................................................................$5,594.75 THANK YOU FOR THE OPPORTUNITY TO BE OF SERVICE TO YOU REV. 1500 EX (b-OO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- lC:$1Il C,)~lC wl1.C,) J:oo C,)~...J I1.lXl 11. c( FILE NUMBER 21 04 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNTY CODE YEAR NUMBER 00921 I- Z W C W (.) W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) McCormick, Dorothy S. DATE OF DEATH (MM-DD-YEAR) 09/25/2004 SOCIAL SECURITY NUMBER ! 723-05-4111 I I DATE OF BIRTH (MM-DD-YEAR) ! 02/05/1924 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) n/a o 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received ~ 2 Supplemental Return o 4a. Future Interest Compromise (date at death aher 12.12.82) o 7 Decedent Maintained a Living Trust (Attach copy ofTrus!) o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1-95) o 3. Remainder Return (date of death pflorto 12-13-82) o 5 Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z W o Z o Q.. III W ~ ~ o C,) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE blRl!qreDto~ NAME COMPLETE MAILING ADDRESS Mark E. Halbruner, Esquire 1013 Mumma Road Suite 100 FIRM NAME (If Applicable) , Gates, Halbruner & Hatch, P.C. Lemoyne, PA 17043 TELEPHONE NUMBER (717) 731-9600 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (1) (2) (3) (4) (5) 0.00 0.00 0.00 0.00 32,115.76 Ui r', , c:::.:> L_~'" '-1 _.~ ,...,-./ CJ z o 5 ;:) l- ii: c( (.) w a:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 4,805.85 0.00 32,115.76 ( .1. -) (6) 0.00 0.00 (":J c; (7) (9) (10) 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) (11) (12) (13) 4,805.85 27,309.91 0.00 13. Charitable and Governmental Bequests/See 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) (14) 27,309.91 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ;:) ll. :!E o (.) g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 27,309.91 x.O 45 (16) 1,228.95 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 1 ,228.95 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 Decedent's Complete Address: STREET ADDRESS 1808 Pine Street CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,228.95 0.00 877.99 0.00 Total Credits ( A + B + C ) (2) 877.99 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/Penally ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 0.00 350.96 0.00 5. 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. 350.96 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS !Kl D D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......... ................................ .................... D b. retain the right to designate who shall use the property transferred or its income; ...................... D c. retain a reversionary interest; or ....................... ............................. ...................... .................... ....................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D 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 t. b f" d' t'? r.;l con aJns a ene IClary eSlgna Ion. ........................................................................................................................ ~ No !Kl !Kl [iJ [iJ Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowiedge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge. SIGN JUR&XE(!N :E~;:~ ADDRES 1 8 Pin Street, Camp Hill, PA 17011 SI'1 OF PR,.W-RER ~ESENTATIVE ~~;:: _/ ADDRESS 1013 Mumma Road, Suite 100. Lemoyne, PA 17043 DAlE / _____ ~ l31CJ~ DATE \ L.. ( \") I C) ~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS 99116 (a) (1.1) (i)J. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 PS. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(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 PS. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1S08 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy S. McCormick SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-04-0921 DESCRIPTION Distribution received from the Estate of Kathryn S. Pannebaker, Juniata County Estate File No. 34-96-0106, per Release dated August 16, 2005. VALUE AT DATE OF DEATH 32,115.76 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 32,115.76 REV-1511 EX+ (12-99) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Dorothy S. McCormick FILE NUMBER 21-04-0921 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name 01 Personal Representative(s) Social Security Number(s)/EIN Number 01 Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 590.85 3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ,Zip Relationship 01 Claimant to Decedent 4. Probate Fees for supplemental asset 35.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 8. Register of Wills - filing fee for Supplemental REV-1500 Rupp & Meikle - settlement of claim against estate for legal fees 15.00 4,200.00 7. TOTAL (Also enter on line 9, Recapitulation) $ (II more space is needed, insert additional sheets of the same size) 4,840.85 REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy S. McCormick SCHEDULE J BENEFICIARIES FILE NUMBER 21-04-0921 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] 1 Jill A. McCormick, 1808 Pine Street, Camp Hill, PA 17011 Daughter 13,654.96 2 Mark A. McCormick, 1126 Thayer Street, Safety Harbor, FL 34695 Son 13,654.95 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET " NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) ~~~ l>OO-< :IJ--il> ~ ~ (/) m <3 :Xl .Z :IJ ::; 0 < f5 I (1 > n rJ'J. 5'= rn ~ ~~ g ~ r1" - -.rJ'J. -..., 0(1 ~= ~~ -...J(1 ~ .. o U1 .- .lJ o o UJ U1 UJ .. o o r- r- UJ CJ .lJ .- o [J"J ~oo ~ ~ if ~!~ ~~ i~ ' !l~ I\.... I i jifi ::s: (") ~ 8 ~ ~ H ~ .. ~ ~, ~ _= t-3 i ~; t:Ej - . I I __= I I I I _.= I I -,-~ I .::-- I - - I ,:': I I I I I I I I I I I I I I I I I I , I I I I I I I I I :?:..==:. = ':. .: :: - i€ E ; -f;fl o o r r )> :D (J) "'0 )> -< 0--1 :00 0--1 mI :Om o ..., t::I o gg t-3 ~ Cf.l "'I'" cO~ '" o ---\. ~ +::=a w CO to ~ C) cr> 01 Ul -i :I: in 8 n ~ in ~ ~ :I: - c; .. r >> 0 z ,. UJ '" -i '" .- '5 UJ ,. r '" .- >> 0 ;;1 ~ n.J ,. '" .- r- oo .lJ '" z - -i .. '" " 0 7- U1 -i :I: '" UJ '" ,. n Co .lJ -i :I: '" .- " '" 0 0 ~ 0 'ii -i .- ~ U1 8 n 1 ~ in z -i :I: ,. ~ 0' ,. :;: r- i'i '" CJ ~ '" .- Z -i IV\ ~ ~ Ci z ,. -i C ~ ~ i:: r z ~ !" c:::. r: ,,' ~ !l1 ~I~ lfl iri \) \I",~ 'ii -i ' :I: l~ ~ i)l m ;;J ! EP~' ~ ,. -i C '" 1 i)l ;u ~ '" r: if ~ z " ~ i'i ,. -i en ,. n ~ s: :;; Z C )> z 0 a?J:ii: ~?J- .Z!'- en ~8:IJ xO ~~I:D 0<0- OI""Z 'P en ~ 0 ~ Z ~ ~ CD ~ ..... ... . l .. RECEIPT AND ACCORD AND SATISFACTION Rupp and Meikle received from Jill McCormick on October 12, 2005 a check No. l?tJb in the sum of $4,200.00 as payment in full for the legal fees billed to the Estate of Dorothy McCormick, said payment of the sum of $4,200.00 is accepted by Rupp and Meikle as payment in full of all legal fees and costs to Dorothy McCormick as an accord and satisfaction between Rupp and Meikle and the Estate of Dorothy McCormick. Jill McCormick, a co-executor of the Estate of Dorothy McCormick is authorized to sign this receipt and accord and satisfaction on behalf of the Estate. Rupp and Meikle ! 0 /11'2- / b ~ ------------~ ,/..~~--- /'/' ~ I / \ // (, /'/ I l ~~~/ ~ L "L-j.. / Richard C. Rupp, Esq. -,y Estate of Dorothy McCormick '-~' .. '\ J' ... 't\1-.;;:~:> lll;~r- ~) r --- --=-~ -~ ESTATE OF DOROTHY McCORMICK 6~~~~~;~~~~3 ~ 306 ~ 1808 PINE STREET CAMP HILL, PA 17011 ,Jt,WiI11:~l)~ ~~ ~J' ~io/~rhP~=:t~~oL_~d~~~~ %.-,Sovereign Bank -//.'!\\::- ,...- sovL~eig1lbank.com $fj!,W1.iJ/J ~ ~ U 6 ;c-e...- 1:2:1.:172{;9*1: *{;8.7. " COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006112 MCCORMICK JILL A 1808 PINE STREET CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER __n__n fold ---------- -------- 101 I $350.96 ESTATE INFORMATION: SSN: 723-05-4111 I FILE NUMBER: 2104-0921 I DECEDENT NAME: MCCORMICK DOROTHY S I DATE OF PAYMENT: 12/15/2005 I POSTMARK DATE: 12/14/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 09/25/2004 I I TOTAL AMOUNT PAID: $350.96 REMARKS: CHECK# 102 I I INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS LAW OFFICES OF GATES, HALBRUNER &-HATCH, P.C. 1013 MUMMA ROAD. SUITE 100. LEMOYNE, PENNSYLVANIA 17043 (717) 731-9600 . FAX: (717) 731-9627 LOWELL R. GATES, LL. M. LL M. in Taxation Also Admitted to Massachusetts Bar MARK E. HALBRUNER Aiso Admitted to New Jersey Bar CRAIG A. HATCH, CELA Certrtied as an Eider Law Attorney by the National Elder Law Foundation ALBERT N. PETERLIN Also Admitted to Maryiand Bar CLIFTON R. GUISE Also Admitted to practice before the U.S. Patent & Trademark Ottice BYRON L. McMASTERS, LL.M. LL M. in Taxation BRANCH OFFICE: 3 WEST MONUMENT SQUARE, SUITE 304 LEWISTOWN, PA 17044 (717) 248.6909 WEB SITE: www.GatesLawFirm.com CORRESPONDENCE ADDRESS: Lemoyne Office STACEY L. NACE ParalegaVOttice Manager TRACI L SEPKOVIC Paralegal VALERIE LONG Paralegal December 14, 2005 Cumberland County Courthouse Office of the Register of Wills One Courthouse Square Carlisle, P A 17013 Q ::c;:Q ~~ .~r.1 ,'.~~2 ;O"'....:l t-'::::'::t ~.') w" c:::; :';'j C-) RE: Estate of Dorothy S. McCormick Estate No. 21-04-00921 ,,'ill >; ~l~ G~c, :r? to: Dear Sir or Madam: a a Enclosed for filing is the supplemental Pennsylvania inheritance tax return (in duplicate) for the Estate of Dorothy S. McCormick. A check in the amount of$50.00 is enclosed as the filing and additional probates fees. A second check in the amount of$350.96 is enclosed as payment of the inheritance tax. Please time-stamp the photocopy of the supplemental inheritance tax return and return it to our office in the enclosed envelope. Thank you for your assistance in this matter. Sincerely, U a c// ~/WV/.<-- Traci L. Sepkovic Paralegal Enclosures cc: Jill A. McCormick, Co-Administrator Mark L. McCormick, Co-Administrator r' ( ~~~ ~~) -.- f i -1 ,_~ t CL.. , / r' . ; ,~ '.-.... .J c:: " ;,J ..J ~-:...;; r6 {)'" , :J <J ( :a: Cl- ~ 0:. ::::J; u-C-" 0(.; !_ . L{) ~---::~ (/) r(~ . ~.L.; ..,~.< r> 7", -r=:1 'c' '-r ~~~, r " ......j Ci '.d (~ L-:'l "::-:::-J ,':=:J .. '..J - ~ - I 1 j~ I I~I, ; 00 ll; ,..., ,..., "' Qi 'M :z= 00;3 u M ;:l4-l o'<t ..8 0 I~ 00 ......1"- .j.J w:( H H Qi :I: f-_ I ;:l Qi -z o .j.J H "-~ ::::l~ UOOcOC") 0 oo.> 'M ;:l (fJ1~ O...J I >, ao O".-l ~>- .j.JQiU)O S2 ~ oOO r:: po:; Q) ~ tt Z a:::Z ;:l Z OQiOO<: o ~ ~w U"C;:lp., ::2: a. .j.J 0 ~ ~ ::2: . "C ::::lW I "1::l 4-l.j.J ~ ::2:~ r:: 0 H Q) . ..J cO ;:l ,..., 1< MO ,..., Qi 0 00 ......::2: H U U 'M :I: ~w Qi M ,..., I rI)"' ...J 1l~Q)H ;:l 4-l r:: cO ~ uoou ~ ~" I .. .....' 0 1 'I ~ l - 03-13-2006 MCCORMICK 09-25-2004 21 04-0921 CUMBERLAND 501 APPEAL DATE: 05-12-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- REY:is4'-Ex-AFP-ioi:osi-NOYiCE-OF-iNHERiYANCE-YAX-APPRAisEHENY:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DOROTHY S FILE NO. 21 04-0921 ACN 501 ....- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL T~~Y:Pi);=r\ nFr-l(~fl~AISEI1ENT 1 ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION . '-'-"" ,.,V../ ',.. "J~ ''^F DEDUCTIONS AND ASSESSI1ENT OF TAX PO BOX Z80601 (~ HARRISBURG PA 171Z8-0601 200& MAR I 0 PM 12: 18 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN Cl r-r'/ Or- Lt--l"";~\ . Il- l... Ii:\ ..it ....,ORPl-'Pl'('\ MARK E HALB'r.l''''~~.rj GATES ETAL V,m..... '. 1013 MUMMA RD STE 100 LEMOYNE PA 17043 ESTATE OF MCCORMICK '*' REV-1547 EX AFP (06-05) DOROTHY S TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED DATE 03-13-2006 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. ~ount of Line 14 at Spousal rate (15) 16. ~unt of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Lina 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due S: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. Real Estate (Schedule A) (l) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. 110rtgages/Notes Receivable (Schedule D) (4) S. Cash/Bank Deposits/l1isc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 32.115.76 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/l1isc. Expenses (Schedule H) 10. Debts/l1ortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tex Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 41805.85 .00 (1l) (12) (13) (14) NOTE: .00 271309.91 .00 .00 X 00 = X 045 = X 12 = X 15 = AMOUNT PAID 877.99 350.96 DATE 12-20-2004 12-14-2005 NUI1BER CDo04751 CD006112 INTEREST/PEN PAID (-) 46.21 .04- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your accountl suai t the upper portion of this for. with your tax paYll8l\t. 321115.76 4.805 81i 271309.91 .00 271309.91 (19)= .00 11228.95 .00 .00 L228.95 11275.12 46.17CR .00 46.17CR . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR)I YOU I1AY BE DUE C- A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) MARK E HAL BRUNER ESQ GATES ETAL 1013 MUMMA RD STE 100 LEMOYNE PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-06-2006 MCCORMICK 09-25-2004 21 04-0921 CUMBERLAND 101 DOROTHY S Amount Remi Hed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MCCORMICK DOROTHY S FILE NO.21 04-0921 ACN 101 DATE 03-06-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-06-2005 PRINCIPAL TAX DUE: 8,233.70 PAYMENTS (TAX CREDITS): I PAYMENT I RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2004 CD004751 411.68 7,822.01 ,.,.",..- TOTAL TAX CREDIT 8,233.69 BALANCE OF TAX DUE .01 INTEREST AND PEN. .00 if IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .01 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT MARK E HAL BRUNER ESQ GATES ETAL 1013 MUMMA RD STE 100 LEMOYNE PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-1607 EX AFP (03-05) 03-13-2006 MCCORMICK 09-25-2004 21 04-0921 CUMBERLAND 501 DOROTHY S Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -+ NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. +- RETAIN LOWER PORTION FOR YOUR RECORDS *** INHERITANCE TAX STATEMENT OF ACCOUNT ... REV-1607 EX AFP (03-05) ESTATE OF MCCORMICK DOROTHY S FILE NO.21 04-0921 ACN 501 DATE 03-13-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-13-2006 PRINCIPAL TAX DUE: 1,228.95 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2004 CD004751 46.21 877.99 12-14-2005 CD006112 .04- 350.96 '" , , TOTAL TAX CREDIT 1,275.12 BALANCE OF TAX DUE 46 . 17CR INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 46 . 17CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l r '0 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Dorothy S. McCormick September 25, 2004 21-04-00921 Will 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 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? No B. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A C. Did the personal representative state an account informally to the parties in interest? Yes D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. ), r.. '.~ ,.-------) ~~ . {--1, <! '. ~ ,-----~ Mark E. Halbruner, Esquire P A J.D. # 66737 GATES, HALBRUNER & HATCH, P.C. 1013 Mumma Road, Suite 100 Lemoyne, P A 17043 (717) 731-9600 Date: April 20, 2006 S i * j I! Capacity: Counsel for Personal Representative ._:'..,"I_j". ....' ~