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Home My WebLink About04-0914COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OE REVENUE BJREAU OF INDIVIDUAL TAXES DEPT. 28O601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004482 JONES JAMES 7' IRVINE ROW CARLISLE, PA 17013 ESTATE INFORMATION: SSN: 554-82-7093 FILE NUMBER: 2104-0914 DECFDENT NAME: URSULA H MANTONE DATF OF PAYMENT: 1 O/12/2004 POSTMARK DATE: 10/08/2004 COUNTY: CUMBERLAND DATE! OF DEATH: 1 1/14/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~3,717.17 REMARKS: PARR TOTAL AMOUNT PAID: $3,717.17 SEAL CHECK#1583 INITIALS: CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS FILE NUMBER 21 - COUNTY CODE ......... REV-1500 CoM.o~L~. O..E..~¥,,,~,A IN H ERITANCE TAX RETURN DEPARTMENT OF REVENUE oEPT. 2.0601 RESIDENT DECEDENT HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) oq- oq q YEAR NUMBER SOCIAL SECURITY NUMBER MANTONE, Ursula H. ~z 554-82-7093 ,,, DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE o 11/14/2003 04/24/1928 o'" REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER uJ [] 1. Original Return [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Teslate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] ....... 12-31-91 and 1-1-95) ',lAME Jmes K. Jones ] 3. Remainder Return (date of death prior to12-13.82) [] 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes :IRM NAME (if applicable) Law Office of James K. Jones -ELEPHONE NUMBER 7 ] 7/240-0296 10. Spousal Poverly Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 7 Irvine Row Carlisle, PA 17013-3019 o o 9. 11. 12. 13. 14. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) None None None None 4,090.00 82,635.15 4,610.00 3,550.00 5,181.34 Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) 91,335.15 8,731.34 82,603.81 82,603.81 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x ,00 (15) 16. Amount of Line 14 taxable at lineal rate 82,603.81 x ,045 (16) 3,717.17 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .12 (17) x .15 (18) (19) 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-I$00 EX (Rev. 6-00) Decedent's Complete Address: rSTREET ADDRESS 10 Windcrofl Ct. CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) 3,717.17 Total Credits (A + B + C) (2) 0.00 0.00 3,717.17 $,717.17 Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ..................................................................................... B ~ b. retain the right to designate who shall use the property transferred or its income; ......................................... c. retain a reversionary interest; or... . ................... [] [] d. receive the promise for life of either payments, benefits or care? ...... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................................... ~;~ [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF: THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Christine/l~l. Parr /3 DATE N~TURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 1013 Forbes Ave. Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRE.~ENTATIVE ADDRESS DATE James K. Jones , . ,~. , ,...,~ . --' ,-" -' ,:...-" 7 Irvme Row r .'~/~ ~.~ Carlisle, PA 17013-3019 For {~ates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (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 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 parant, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. Th{; tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §91 ~ (a) (t)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COM MONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MANTONE, Ursula H. SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER 21-- Include the proceeds of litigation and the date theproceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Misc. Personal Property (S¢c attached) Misc. Personal Property sold at yard sale. TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 3,910.00 180.00 4,090.00 PAGE 2 Curio Cabinet (19) Llardo Figurines 4 Pcs. Belleck 8 Demitasse Cups/Saucers Ivory & Ivory type Carvings 14 Hummel Figurines Royal doulton Character Mug Oriental Chest Reclining Chair Crystal Table Lights Tea Cart 2 Cushion sofa Jewlery Decorators Chest on Chest Double Pedestal Desk (2) 3 Drawer Lamp stands Single Head Board Sewing stand Retro Cupboard 2 Alabaster Lights Lamp stand Decorators & Collectables 7 Pcs Dinette set Small electrical appliances Pots, Pans, Baking Small Kitchen & Household accessories Glass/China Wall Hangings 2 Portable TV's $ 135.00- 1330.00 120.00 100.00 225.00 700.00 65.00 210.00 35.00 40.00 45.00 60.00 225.00 35.00 65.00 70.00 20.00 15.00 45.00 20.00 30.00 10.00 65.00 45.00 20.00 35.00 45.00 30.00 10.00 60.00 TOTAL $391 0 . 00 Benny E. Rowe COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF MANTONE, Ursula H. FILE NUMBER 21-- If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Christine M. Parr Daughter 1013 Forbes Rd. Carlisle, PA 17013 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY ITEM LETTER DATE % OF DATE OF DEATH FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES' 1 A 07/19/1999 Savings Account - Members 1st FCU 137,563.22 50% 68,781.61 2 A 05/14/2001 Certificate of Deposit - Members 1st FCU 15,011.38 50°~ 7,505.6c~ 3 A 10/30/1996 Checking Account - M & T Bank 12,695.70 50°A 6,347.85 4 A TOTAL (Also enter on line 6, Recapitulation) 82,635.15 st MEMBERS Ist FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 185906 -00 07/19/1999 $137,514.24 $48.98 $137,563.22 Christine M. Parr 07/19/1999 CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 185906 -44 05/14/2003* $15,OOO.OO $11.38 $15,011.38 Christine M. Parr *Certificate purchased with funds from redeemed certificate #185906-42 purchased 5/14/01 · A. Wolfe / -- Insurance Supervisor February 25, 2004 Estate of: URSULA H. MANTONE Date of Death: 11114/2004 Social Security Number: 554-82-7093 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 ° www. memberslst.org 13214471 CLASSIC CHECKING O0 6 04345N M 021 URSULA H HANTONE CHRISTINE H PARR 1013 FORBES RD CARLISLE PA 17013 STONEHEDGE ACCOUNT SUMMARY BEGINNING: :DEPOSITS&: :1': ':: :::: :: i:i O~E~i: :::: J iiC[IRI~E~[:i: : : E~D~NG.: : :BAlANcE O~HER::ADD[T:]ONs: ~ :: CHE~KS ~PA~D : ::: ~1~ ;: :: S~Ub~t;~A~C~;~ ~: ~: I~:~m~ :: ~:: ~LAN~:: .o. ~.ou.T m NO. A.OU.T I"°' I A.OUNT I I 10,821.29 4 2,0~O.&B I 6 4,977.S0m~ m 86.79 j 0.00 J 7,817.68 ACCOUNT ACTIVITY POSTING DA T E TEANSAC'T iON DESC RI:PT I 10-22-03 BEGINNING BALANCE ~10,821.29 10-22-03 USAA P&C PRENIUMPAY 28.~ 10,792.65 10-27-03 CHECK NUMBER 1922 52.00 10-27-03 CHECK NUMBER 1924 16.76 10,74~.89 10-28-05 CHECK NUMBER 1923 29.25 10,714.64 10-31-03 SAFE BOX DEBITS SAFE BOX 13.00 10,701;64 1]-03-O&DFAS-CLEVELAND AR ANN PAY ],011.57 1]-03-03 US TREASURY 503 SOC SEC ~7.00 11-03-0~ US TREASURY 312 CIVIL SERV 452.00 12,712.2] 11-06-03,PP ELEC BILL 2972068001WS 16.51 12,695.70 "~1-17-03!DEPOSIT 50.11 11-17-05 CHECK NUMBER 1926 ~00.00 11-17-03 CHECK NUHBER 1925 12B.OO 12~&20.81 11-18-05 USAA P&C PRENIUMPAY 28.6~ 12,292.17 11-20-03 CHECK NUMBER 1927 ~474.49 7,917.68 ENDING BALANCE I ~7~817.68 1922 10-27-03 32.00 1925 10-28-05 29.25 1924 10-27-03 16.76 1925 11-17-03 125.00 1926 11-17-05 ~O0.OO 1927 11-20-0~ 4,474.49 REFER A FRIEND TO M&T BANK AND GET A FREE GIFT! NOW, WHEN YOU ASK A FRIEND TO OPEN A CHECKING ACCOUNT WITH M&T, NOT ONLY WILL YOU GET A FREE GIFT - SO WILL YOUR FRIEND. STOP BY ANY M&T BRANCH OR CALL M&T'S TELEPHONE BANKING CENTER AT 1-900-724-2440 TO GET A REFER-A-FRIEND COUPON. HURRY, GIFT QUANTITIES ARE LIMITED. FREE GIFT PROVIDED AT TIME OF ACCOUNT OPENING. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF MANTONE, Ursula H. FILE NUMBER 21-- This schedule must be completed and filed if the answer to any of questions 1 throuc I'rEM DESCRIPTION OF PROPERTY Include the name of the transferee their relationship to decedent and the date of transfer. DATE OF DEATI- % OF NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE (IF APPLICABLE) INTEREST 1 1995 Buick Regal to 4,910.00 100% 300.00 4,610.00 Robert M. Parr & Christine M. Parr (son-in-law & daughter) transferred June, 2003 (. enter on line 7, Recapitulation) 4,610.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REI1JRN RESIDENT DECEDENT ~CHEI~LE H FUNEI~N_ EXPENSE~ & ADMINISTRATIVE COSTS ESTATE OF MANTONE, UrsulaH. FILE NUMBER 21-- Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 FUNERAL EXPENSES: Ewing Brothers - Funeral Expenses St. Patrick Church Organist Cantor ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees James K. Jones, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees State ~ Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) 2,675.00 200.00 125.00 50.00 500.00 3,sso.oo COMMONgVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF MANTONE, UrsulaH. FILE NUMBER 21-- Include unreimbursed medical expenses. ITEM NUMBER l 2 3 4 5 DESCRIPTION AMOUNT Don Hall Sarah Todd - Nursing Home Pharmerica - Medications UGI - Natural Gas Service Galbaith's Accountant - Tax Service TOTAL (Also enter on Line 10, Recapitulation) 125.00 4,474.49 381.44 30.41 170.00 5,181.34 REV-I 5! 3 EX+ (9~)0) ~ SCHEDULE J COMMO,,WEA,TH OF PENNSYLVAN,^ BEN EFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MANTONE, Ursula H. FILE NUMBER I RELATIONSHIP TO AMOUNT or SHARE NtJMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT Da Nnt Lint Tru~t.~l~l OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) ' ' 1 Christine M. Parr Daughter 100% 1013 Forbes Rd. Carlisle, PA 17013 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet ti,, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET LAST WILL AND TESTAMENT OF URSULA H. MANTONE I, URSULA H. MANTONE, Social Security Number 554-82-7093, of the State of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT and I revoke all other wills and codicils previously made by me. FIRST: I appoint my daughter, CHRISTINE M. PARR as my Personal Representative concerning this Will. If my daughter, CHRISTINE M. PARR is unable or fails to serve, I then appoint my son-in-law, ROBERT M. PARR to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. b. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker for my grave), and written charitable pledges which I have made. I grant my Personal Representative the power to extend or renew ~ny debt for such time as my Personal Representative shall deem appropriate. I wish to be cremated and buried with my husband in the National Cemetary at Buschnell, Florida. c. Ail estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. d. My Personal Representative is requested to settle my estate as soon after my death as may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. PAGE 1 0F 4 PAGES e. I may leave a letter of intent with the executed copy of this Will for the purpose of giving guidance to my Personal Representative concerning the distribution or sale of certain items of my property. I request, but do not require, that my Personal Representative honor my wishes therein expressed. SECOND: I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my daughter, CHRISTINE M. PARR and to any child or children that have been or may be born to or adopted by me, in shares of substantially equal value to be divided as they may agree. a. If any of my children shall not survive me, then the share of that deceased child shall go to the descendants of that child, who are to take per stirpes and not per capita. If any of my children shall not survive me and shall not be survived by any descendants, then the share of that deceased child shall be distributed to my surviving children and the descendants of any of my other children who fail to survive me, in the manner set forth above. b. If they are unable to agree, the division among my children and the descendants of any of my children who fail to survive me shall be made by my Personal Representative, in that person's sole and absolute discretion. I empower my Personal Representative to sell any or all of such property, if such property is not distributed in kind hereunder, and to distribute the proceeds among my said children in substantially equal shares. Any determination of my Personal Representative as to what should pass or be sold under this paragraph and to whom it should pass or be delivered or at what price it should be sold shall be conclusive. THIRD: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. FOURTH: Any beneficiary who fails to survive until one hundred twenty (120) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. OF 4 PAGES FIFTH: Definitions: a. The term "children" as used in this Will includes adopted and afterborn persons. The term "children" as used in this Will shall not include step-children, the natural born or adopted children of a person's spouse who are not the natural born or adopted children of the person. A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will. b. The term "descendants" as used in this Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. c. The term "Personal Representative,, as used in this Will means Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. d. The term "per stirpes" as used in this Will means that whenever a distribution is to be made to the descendants of any person, the property to be distributed shall be divided into as many shares as there are (1) living children of the person, and (2) deceased children, who left descendants who are then living, of the person. Each living child (if any) shall take one share and the share of each deceased child shall be divided among his then living descendants in the same manner. SIXTH: In addition to any powers gmanted by the laws of the state in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may deem necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services, such compensation will be that allowed by law. SEVENTH: If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. l_.__._.PAGE 3 OF 4 PAGES IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this /~ day of /~~ , 19 q~, set m hand and s Y eal to this my LAST WILL AND TESTAMENT, consisting of 4 typewritten pages, each page bearing my handwritten signature. This document was prepared under the authority of 10 U.S.C. section 1044, and implementing military regulations and instructions, StatebY Captain John T.of Arkansas. Rothwell, wh~±~ litsed practice lawin the U~SULA H. ~LANTO~E (SEAL) The foregoing instrument was, at Carlisle Barracks, Pennsylvania, this . /~ day of '~~¢-~ , 19 .~, signed, sealed, published and declared by URSULA H. MANTONE, the testatrix, to be her LAST WILL AND TESTAMENT in the presence of all of us at one time, and at the same time we, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testatrix is of sound and disposing mind and memory at the date hereof. PAGE 4 OF 4 PAGES COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY ACKNOWLEDGMENT I, URSULA H. MANTONE, .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 i~willingly; and that I signed it free and voluntary act for the~poses~there~ expressed, as my II1 11. fRSU~A H/ MAN, NE ~ AFFIDAVIT We, S~~ ~.%~t~. ~, \~=Z~ ~rg~ ~/~K~, and ~/T~ /~. %~~ , the witnesses, sign our names to this instrumen[, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in'the hearing and sight of the testatrix signed the will as a witness; 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. Witness ..... ~ Wit~ess ' 0 Subscribed, sworn to and acknowledged before me by URSULA H. MANTONE., the testatrix, and subscribed and sworn to before me by ~_~-~1.~. ~.~ ~. . %~t~.~ , ~/~/DD~3 ~~ \~//~, and ~,~ ~. ~~ , the ~itne~'~, ~Ls /~ day of ' ~NO~A~Y P ~B-L I6~ My ~ Notarial Seal I Betty R. Standridge, Notary Public J . .Carlisle Boro, Cumberland County I My Commission Expires May 14, 2001 Member, Pennsylvania Association of Notaries BUREAU OF INDIVIDUAL TAXES TNHER/TANCE TAX DTVZSTON PO BOX 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX RE¥-1547 EX AFP (Qg-D4) JAHES K JONES LAN OFFICE J K JONES 7 IRVINE ROW CARLISLE PA DATE ESTATE OF DATE OF DEATH FILE NUHRER COUNTY ACN 12-1$-ZOOq MANTONE 11-1q-2005 210q-O91q CUMBERLAND 101 Amount RemAtted URSULA HAKE CHECK PAYADLE AND REHZT PAYNENT TO: REGTSTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HANTONE URSULA FILE NO. 21 0~-0914 ACN 101 DATE 12-15-200R TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN RASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($). rt. Hortgages/Notes Receivable (Schedule D) (rt) 5. Cash/Bank Deposits/MAsc. Personal Property (Schedule E) (5) 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule g) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/HAsc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total DeductAons 12. Net Value of Tax Return ~1090 821655 ~610 O0 NOTE: To insure proper O0 credlt to your account, O0 submAt the upper portAon 00 of this form with your O0 tax payment. .15 .00 (8) 91,335.15 :5,550. O0 5,181 (11) (12) 8.731.34 82,605.81 15. NOTE: ASSESSNENT OF TAX: 15. Amount of Line lrt at Spousal rate 16. Amount of Llne 1~ taxable at Lineal/Class A rate 17. Amount of LAne lrt at SAbling rata 18. Amount of Line irt taxable at Collateral~Class B rate ~al Tax Due 19. Princl TAX CREDITS PAYH~NT DATE 10-08-2004 Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Nat Value of Estate Subject to Tax If an assessment was issued previously, lines 14, 15 and/or reflect figures that include the total of ALL returns assessed to date. (15) .00 (irt) 82,605.81 16, 17, 18 and 19 will (15) .00 x O0 = .00 (16) 82,605.81 x 045: 5,717.17 (17) . O0 x 12 : . O0 (lB) .00 x 15 = .00 (19)= 5,717.17 RECEIPT NUHBiR CD004482 DISCOUNT (+) INTEREST/PEN PAID (-) .00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-09-2004 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AHOUNT PAID 5,717.17 TOTAL TAX CREDIT I 5,717.17 RALANCE OF TAX DuEl .00 INTEREST AND PEN. 22.49 TOTAL DUE 22.49 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE ES REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) __~ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): DEJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section 210,0 of the Inheritance and Estate Tax Act) Act 23 of 2000. (7Z P.S. Section 910,0). Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, ehich was not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available online at Nam.revenue.state.pm.us, any Register of Nills or Revenue Oistrict Office, or free the Department's 20,-hour answering service for forms orders: 1-800-362-2050; services for taxpayers aith special hearing and/or speaking needs: 1-800-0,0,7-3020 (TT only). Any party in interest not satisfied with the appraismant, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Pretest to the PA Department of Revenue) Board of Appeals. You may object by filing a protest online at www.boardofappeals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue) Board of Appeals P.O. Box 281021, Harrisburg, PA 171Z8-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (67.) percent per annum calculated et a daily rate of .000160,. All taxes which became delinquent on and after January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2000, are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~'~ ZOZ .00050,8 ~'~-1991 I1Z .000501 ~-~ 9Z .00020,7 1983 16Z .0000,38 199Z 9Z . O00Z0,7 ZOOZ 6Z .000160, 1980, llZ .000301 1993-1990, 77. . OOOl9Z ZOOS 52 .000137 1985 13Z .000356 1995-1998 9Z .00020,7 ZOO0, 4Z .000110 1986 lOZ .000270, 1999 72 .000192 1987 IOZ .000Z74 ZOO0 72 . O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shomn on the Notice, additiona! interest must be calculated. < ... Z < >111 ...::> ti'ffi i~ ilia: Oo ... ...0 o I- :I:'ffi !:is :i~ :.< ZOo 0'" SA ~ U i ~ $ 4 -' .. ~ ~ <Jl a: S ~ .. 0 I- ... Z ~ ~ Oo w I- <Jl ~ ... 0 ~ ~ :so .. a: '; III .. "" ... ~ = <Jl~ <> IS' -,0 ,... .. ;:}- -,U "" .. ... .... i~ ~ :.8< u. <>- ~ 00 :z: - Oo ",4W w...-' , >-",<Jl <Jlw.... ...."'... ClS'" w~4 ",uU III "" ~ ~ IIl~ 0 c:> c:>"" :z: c:> c:>'" < NWNO ... I :. \ I 0' 1If')o..::r'4'W .....1-'~os:A I % I S "" N4.....,-4::::>: c:> ,....~.....NU "" '" h ",... o ..... ~aO ....a~ "'..'" ~..~ ..0" I:;",\l\ ffi~~ ",.. ~~~ ..... l(,~~!e ~....,a t~l~:-\004 ~!i (:--_th l.Lt ~."'\Ml-C ,~'" 'L._o...O ( ',Q. -,':_4 1.--'__ e:) CJ 1.'-\ LL :z ~ ... ~! ~ a'tri '7' .... ~ .. ~~ ~ i~ :: .....\-'",-'lCL .. u,.Wo,O " o'i~li! ':l ~Nii <;~~ \Il~"~ i~&~ :I: I- :5= \!;A~ ...::> ...OZ>" ...!C......'i I-ti!C~a~ ~IIIQ"'U< N (" I ...."..~ c'- cO III "" c:> '..r-:< ,... c:::, "" CJ c-l <Jl W 4 :z: 0- 0 .., "" <Jl W .., :. :z: 0 0 uJ '" .., u ....ww ""u.:Z: ... U. .... <Jl <Jl 0 > .... w '" -' ~~ ...... < .., ... ,... u , . . , . . . . . , . , , . , , . 'a: 10 . 'III .'U ,'%>' ~<c: ':'~ '0 cn~""'U R.....' a:'< 0' ~ u' .:a IIlb-u a:tZ' ..... et\S.' ::t1U1\l. 0'(1')(; >-.....Cl '<. a:h~ Olo..~ ~'a... ~<. Zh<et ate. t-\....t a:\u.I~ olue 0.,_- .-. ~I<f. ......v ::ik....., O'a: !tall' ...I.:c.c z'Z ........... 4(\ l ....IA-.. uJlO. -' , -\idt 'U. ..... 1..... lofo 'Z' , . ..... :I'l '0 " III'... z:\o ...'''' .... :... "'.... ...,< :1:' 1-'" :... ~\r- 0'''' ...\11\ <,... " 1-'> ::>.... (.)~ct h \ >:. % ....,~ :-ot :0 0 ~ o ~!A , . 0 .~ -to< o .... 'i' : ~ n $ 0 !,. ~ ~ . \II ~~ ~ \-l' \II H~. 9\i " G~ i ~~ ~~'i ~.~ 'i~~ H~ '"\ '- ~ ~~~ t:.\'i' ~ ... , '& \ ~.,,: 1'0)_ ~ ~~ <;1l. 'ilo~ ,~ .... ~~ ll!r 'i ~ ~ , "'to oo~ \\~ ~ "1 ';'O!..~ . ~... \" .H \" ~ .'O~ III ~. 0;- ~ . ~~~ ~~ f'I' ~ ~~ ....Ill~ ~a~ ~. ~ 1- ~~ II . ~~ 11' ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128.0601 REV-1162 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JONES JAMES K 7 IRVINE ROW CARLISLE, PA 17013 nnnn fold EST A TE INFORMATION: SSN: 554-82-7093 FILE NUMBER: 2104-0914 DECEDENT NAME: URSULA H MANTONE DATE OF PAYMENT: 01/18/2005 POSTMARK DATE: 01/18/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/14/2003 NO. CD 004850 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $22.49 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1453 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $22.49 GLENDA FARNER STRASBAUGH REGISTER OF WillS 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 '* REY-1601 EX AFP 112-041 JAMES K JONES LAW OFFICE J K 7 IRVINE ROW CARLISLE C""J -~:-,.) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-22-2005 MANTONE 11-14-2003 21 04-0914 CUMBERLAND 101 URSULA JONES Allount RelliUed PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: Tci':insur~proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUI ALONGIHIS:.t:.UE. ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IlYN&TJ".~.Al!rrtJ~.d'!1........;.."'fAft'W!n'Ner'llr.in"t!Flm.b"'.ll:1!'6DR'f....................... ... "~ ( ESTATE OF MANTONE URSULA FILE NO.21 04-0914 ACN 101 DATE 02-22-2005 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: 12-13-2004 PRINCIPAL TAX DUE:. _"UIOIIIUIIIIIIIIIIIIIIIIIII_lIIlnl"OIllIO,,""IIOOII_ 3,717.17 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-08-2004 CD004482 .00 3,717.17 01-18-2005 CD004850 22.49- 22.49 TOTAL TAX CREDIT 3,717.17 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )