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HomeMy WebLinkAbout04-0932 STATE OF MISSISSIPPI IN THE CHANCERY COURT OF HARRISON COUNTY l, John McAdams, Clerk ofthe ChunceryCourtofHarrison County, Mississippi, doherebycertifythat the abeveendforegoingconsfitotesa~'ueandonrrectcopyendliteraltranseriptof ORDER ADMITTING LAST WILL AND TESTAMENT AND CODICIL TO PROBATE AND APPOINTING EXECUTRIX RENDERED MARCH 16, 2004 AND LETTERS TESTAMENTARY FILED MARCH 16, 2004 FILED IN THAT CERTAIN CHANCERY CAUSE STYLED, IN THE MATTER OF THE ESTATE OF GEORGE P. KELLY, DECEASED, GEORGE P. KELLY, JR., EXECUTOR AND NUMBERED C2402 04-191 (3) OF RECORD OF SAID COURT. as the same now appears, of record end on permanent file in my office, Second Judicial District. AND I FURTHER CERTIFY that said Chancery Court is a Court of Record with en official seal, end that I, as Clerk of said Chencery, am the custodian of the records end of the seal of said Court. (SEAL) IN TESTIMONY WHEREOF, I have hereunto set my hand end affixed the seal of this court, at the CITYO~ BILO~Y~I on this 6TH day - - ~-~---~f~'//'~'~"~ of the Chencery Court of Harrison County, Mississippi THE STATE OF MISSISSIPI I, JIM PERSONS , a presiding Chencellor of the Eight Chancery Court District of the State of Mississippi (said District including the County of Harrison) do hereby ~ that Jo.hn McAdams whose genuine signature appears to the mmexed end foregoing attestafi~S ~ow, a~ was at~C the date thereof, the Clerk of the Chencery Court of Harrlson County, in said State ~eiected end qualified, and that his attestation is in due form. Witness my signature, this the .200 -~ THE, STATE OF MISSISSIPPI HARRISON COUNTY 6TH_ day of//~CTOBER · CHANCelLOR [, the undersigned Clerk of thc Chancery Court of the County of Harrison, in said State (said Court being a court of record, end having en official seal), do hereby certify that JIM PERSONS , whose gonuine sigonture appears to the annexed end forgoing attestation, is now, end was at the d~e thereof, a presiding Chancellor of the Eight Chancery Court District of said State, which said District includes the said county of Harrison, and that said JOHN MCADAMS, CHANCERY CLERK as aforesaid, is now en was at the date of said attestation, duly commissioned end qualified. Given under my and seal of office, at Biloxi, Misslj~, this~ ~ 6TH dayof OCTOBER/ /,200~. // ( SEAL ) (~4~--~-- ,CLERK ~., ¢~sCssxp~ ' . ~6 P~b~su~ ' ~e¢ ~s k~ oece6e¢,s ~ast ~x AeC's sk~at~re ~a 1998 ~ ~imesseS to saX6 6ece~ -l- ' STATE OF MISSISSIPPI IN THE CHANCERY COURT OF HARRISON COUNTY I, {ohn McAdams, Clerk of ~¢ Chancery Court of Harrison Count, Miss~sipp~ do hereby certi~ ~ the aboveandforegolngconstimtesam:eandenrrectcopyandliteraltrenseriptof ORDER ADMITTING LAST WILL AND TESTAMENT AND CODICIL TO PROBATE AND APPOINTING EXECUTRIX RENDERED MARCH 16, 2004 AND LETTERS TESTAMENTARY FILED MARCH 16, 2004 FILED IN THAT CERTAIN CHANCERY CAUSE STYLED, IN THE MATTER OF THE ESTATE OF GEORGE P. KELLY, DECEASED, GEORGE P. KELLY, JR., EXECUTOR AND NUMBERED C2402 04-191 (3) OF RECORD OF SAID COURT. as the same now appears, of record and on permanent file in my office, Second Judicial District. AND I FURTHER CERTIFY that said Chancery Court is a Court of Record with an official seal, and that 1, as Clerk of said Chancery, am the custodian of the records end of the seal of said Court (SEAL) IN TESTIMONY WHEREOF, I have hereunto set my hand end affixed the seal of this court, at the CITY O.1; BIL0~X/ on this 6TH day ~--/'f"~r~.~'~-------rC-',~k of the Chancery Court of Harrison County, Mississippi THE STATE OF bIISSISSIPI I, JIM PERSONS , a presiding Chancellor of the Eight Chancery Court Dislrict of the State of Mississippi (said District including the County of Harrison) do hereby ~c~. 'Py. that Jo~n. McAdams whose genuine signatme appears to the annexed end foregoing att~4afi~s~ow, a~was at7£~ ~' the date thereof, the Clerk of the Chencery Court of Harrison County, in said State ~ elected end qualified, and that his attestation is in due form. Witness my signature, this the .200 "~ THE STATE OF MISSISSIPPI HARRISON COUNTY 6TH_ day of/~CTOBER · CHaNCelLOR I, the undersigned Clerk of the Chancery Court of the County of Harrison, in said State (said Court being a court of record, and having an official seal), do hereby certify that JIM PERSONS , whose genuine signature appears to the annexed and forgoing attestation, is now, and was at the darn thereof, a presiding Chancellor of the Eight Chancery Court Disttict of said State, which said District includes the said county of Harrison, and that said JOHN MCADAMS. CHANCERY CLERK as aforesaid, is now an was at the date of said attestation, duly commissioned and qualified. Given under my end seal of office, at Biloxl, Missif~, this~ 6TH dayof OCTOBER/ .,00K IN THE CHANCERY COURT OF I-I~R/SON COUNTY, ~ SECOND JUDICIAL DISTRICT /~ IN THE MATTER OF THE ESTATE OF ( ~4~4 GEORGE P. KELLY, DECEASED ~, BY: GEORGE P. KELLY, JR. ! CAUSE NO. C2402-04-191(3) PETITIONER ORDER ADMITTING LAST WILL AND TESTAMENT AND CODICIL TO PROBATE AND APPOINTING EXECUTRIX This cause came on this day to be heard on Petition of George P. Kelly, Jr., praying that a certain instrument of writing be admitted to probate as the Last Will and Testament and Codicil to Last Will and Testament of George P. Kelly, Deceased and for Letters Testamentary. The Court, having fully heard and considered the same on oral and documentary evidence, and being fully advised in the premises, finds as fact the following: 1. Petitioner, George P. Kelly, Jr., is an adult, fully competent in all regards, who resides and is domiciled in Biloxi, Harrison County, Mississippi; and is the son of the decedent. 2. George P. Kelly departed this life on the 5th day of February, 2004. At the time of his death, his domicile and fixed place of residence was in the Second Judicial District of Harrison County, Mississippi. Said decedent at the time of his death left a Last Will and Testament which Petitioner believes was duly signed, published, attested and proper in form under the statutes and laws of the State of Mississippi. Said Last Will and Testament is dated the 4th day of February, 1998. Decedent's Last Will and Testament is subscribed to by George P. Kelly, Jr. and Charles Jones, as witnesses to said decedent's signature and the publication thereof. Petitioner filed his -1- DDK 4 OPIGE 075 Petition to Admit Last Will and Testament to Probate and to Appoint Executor with this Court on the 2~d day of March, 2004 (the "Original Petition"). Subsequent to filing the Original Petition, Petitioner discovered that the decedent had executed a Codicil to his Last Will and Testament, which Petitioner believes was duly signed and proper in form under the statutes and laws of the State of Mississippi. Said Codicil to Last Will and Testament is a one page document dated the 13~h day of August, 2003, which is entirely in the decedent's own handwriting, and is signed at the end of the text by George P. Kelly. 3. At the time the decedent, George P. Kelly, executed his Last Will and Testament on the 4th day of February, 1998, and his Codicil to Last Will and Testament on the 13th day of Augnst, 2003, he was over eighteen (18) years of age and of sound and disposing m/nd, memory and understanding. 4. The original executed Last Will and Testament of George P. Kelly, Deceased, was filed simultaneously with the Original Petition and also filed simultaneously therewith is the executed Affidavits of George P. Kelly, Jr. and Charles Jones, subscribing witnesses to said Last Will and Testament, setting out that said decedent signed, published and described said insmunent as the Last Will and Testament in their presence and in the presence of George P. Kelly. Full photocopies of said Last Will and Testament and of said Affidavits are attached to the Original Petition and by reference are made a part thereof as if copied herein in full. Except for said Codicil dated the 13th day of August, 2003, said Last Will and Testament was never revoked or further modified by said decedent so far as Petitioner knows and believes and Petitioner avers that it was and is the Last Will and Testament of said decedent, George P. Kelly. The original executed Codicil to the Last Will and Testament of George P. Kelly, Deceased, was filed simultaneously with the -2- Petition to ?robat¢ Codicil to Last Will and Testament and to A~¢nd Original Petition to Ad~Jt Last Will and Testament to Probate and to Appo~t Executor (~e ".Amended Petition"), along with the executed Affidavits of Perry Douglas and Caroline Tucker, setting out that said Codicil is au~entic and wholly written in the handwriting of George P. Kelly; that the signature thereto is the genuine signature of the said George P. Kelly; and that said handwriting and signature were made and done by the said George P. Kelly. Full photocopies of said Codicil and of said Affidavits are attached to the Amended Petition and by reference are made a part hereof as if copied herein in full. Said Codicil was never revoked or further modified by said decedent so far as Petitioner knows and believes and Petitioner avers that, in conjunction with the decedent's Last Will and Testament, these two documents comprise the complete Last Will and Testament of George P. Kelly, Deceased. 5. Said decedent and testator, George P. Kelly, in his Last Will and Testament, nominated and appointed his wife, Gloria K. Kelly, as the Executor of his estate, and his son, George P. Kelly, Jr. as the First Alternate Executor. Gloria K. Kelly predeceased the decedent on November 24, 1999. Petitioner is over eighteen (18) years of age, of sound mind, and is under no disability. Petitioner, being moved by the desire to meet and fulfill the wishes of the decedent, George P. Kelly, and desiring that his Last Will and Testament may and all things be accomplished according to the true intent and meaning thereof, is willing to accept and undertake the office of trust confided in him. 6. Said decedent and testator, George P. Kelly, specifically directed that Petitioner not be required to file any bond or other security as Executor of his estate, and Petitioner avers that no reason exists for requihng any bond or other security. 7. Petitioner avers that the decedent waived the filing of any inventories, appraisals, accountings and periodic reports. The said decedent left an estate consisting of real and personal -3- property and Petitioner would show unto the Cotut that no useful purpose will be served by requiring a formal appraisement of the personal property as Petitioner is aware of all said property. IT IS, THEREFORE, ORDERED, ADJUDGED AND DECREED that said Last Will and Testament of George P. Kelly, Deceased, dated the 4th day of February, 1998, and attested to by George P. Kelly, Jr. and Charles Jones, as subscribing witnesses; and that said Codicil to Last Will and Testament of George P. Kelly, Deceased, dated the 13th day of August, 2003, and authenticated by Perry Douglas and Caroline Tucker, be admitted to probate and filed and recorded. That Letters Testamentary be granted and issued to George P. Kelly, Jr. as Executor upon his taking the oath prescribed by law, that no bond shall be required of the Executor and that formal appraisement of the estate be and the same is hereby dispensed with. SO ORDERED, ADJUDGED AND DECREED on this the //~ day of /~t~Wl d.q., 2004. C H AN C E(,~I~ O R (Ms. Bar No. 10113) Page, Mannino, Peresich & McDermott, P.L.L.C. 759 Vieux Marche Mall P. O. Drawer 289 Biloxi, MS 39533 Telephone: (228) 374-2100 Facsimile: (228) 432-5539 L:\CASESk30000-35000k30920\Order Admi~ng Will.wpd -4- LETTERS TESTAMENTARY IN THE CHANCERY COURT OF HARRISON COUNTY, SECOND JUDICIAL DISTRICT 16 day of March, A.D. 2004 Case Number: C2402-04-191 WltEREAS GEORGE P KELLY deceased, late of said County, made in his lifetime his last Will and Testament, which on the 16th day of March, 2004 was proved, approved and admitted to record in said Court, and probate thereof granted to GEORGE P. KELLY, JR. the Executor thereof and therein appointed GEORGE P. KELLY, JR. and the said GEORGE P. KELLY, JR. having complied with the provisions of the statute in such cases made and provided. THEREFORE, to the intent that the said Will may be well and truly performed, we do give, grant and commit unto the said GEORGE P. KELLY, JR. the administration of all and singular the goods and chattels, rights and credits, of and belonging to the estate of said testator, with full power to take the same unto his hands and possession, and to ask, levy, recover and receive the same, wherever they may be in this State; hereby requiring and enjoining upon the said GEORGE P. KELLY, JR. to make a true and perfect inventory of all and singular the goods and chattels, rights and credits which have or shall come to his hands, possession or knowledge, or unto the hands or possession of any other person or persons, for him to exhibit the said inventory to our Court within the time limited by law to well and truly administer the said goods and chattels, rights and credits, according to law; to make a just and true account of his actings and doings therein, when thereto required by our said Court; and to well and truly pay and deliver all the legacies contained and specified in the said Will, so far as the said goods and chattels, rights and credits, will extend and the law charge GEORGE P. KELLY, JR. hereby confirming the said Executor with full and ample authority to dispose of all and singular the said goods and chattels, rights and credits, according to the tenor of the said last Will and Testament, and the true intent and meaning of the said testator, by virtue of these presents. WITNESS the Honorable JIM PERSONS Chancellor of the 8t~ Chancery Court District, this 16th day of March, A.D. 2004, and the seal of Court hereunto affixed. JOHN MCADAMS, CHANCERY CLERK STATE OF MISSISSIPPI IN THE CHANCERY COURT OF HARRISON COUNTY I, John McAdams, Clerk ofthe Chancery CourtofHarrisonCounty, Misshsipp~doherebycertifythat the aboveandforegoingconsfitutesatrueandcorrectcopyandlitereltranscriptof POUR OVER WILL (LAST WILL AND TESTAMENT) OF GEORGE P. KELLY FILED MARCH 2, 2004 AND CODICIL OF GEORGE P. KELLY FILED MARCH 16, 2004 IN THAT CERTAIN CHANCERY CAUSE STYLED, IN THE MATTER OF THE ESTATE OF GEORGE P. KELLY, DECEASED, GEORGE P. KELLY, JR., EXECUTOR AND NUMBERED C2402 04-191 OF RECORD OF SAID COURT. as the same now appears, of record and on permanent file in my office, Second Judicial District. AND I FURTHER CERTIFY that said Chancery Court is a Court of Record with an official seal, and that I, as Clerk of said Chancery, am the custodian of the records and of the seal of said Court. (SEAL) IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of this~ at the CITY OF BILOXI on this 8 TH day ~ ff'tn,~,,f,.~' ", Clerk of the Chancery Court / of Harrison Cou~!3flississippi THE STATE OF MISSISSIPI ~ I, JIM PERSONS , a presiding Chancellor of the Eight Chancery Court Di~rict of the State of Mississippi (said District including the County of Harrison) do hereby certify that Jo~ McAdams whose genuine signature appears to the annexed and foregoing attestation, is now, and~vas at the date thereof, the Clerk of the Chancery Court of Harrison County, in said State duly elected ~.~ qualified, and that his attestation is in due form. Wimess my signature, this the 8 TH ' THE STATE OF MISSISSIPPI HARRISON COUNTY .2oo , CHANCELLOR I, the undersigned Clerk of the Chancery Court of the County of Harrison, in said State (said Court being a court of reonrd, and having an official seal), do hereby certify that JIM PERSONS , whose genuine signature appears to the annexed and forgoing attestation, is now, and was at the date thereof, a presiding Chancellor of the Eight Chancery Court District of said State, which said District includes the said county of Harrison, and that said .]'OLIN MCADAMS. CHANCERY CLERK, as aforesaid, is now an was at the date of said attastation, duly commissioned and qualified. Given under my and seal of office, at Biloxi, M~, this~ 8TH day of OCT0~ ,CLERK (SEAL) ?OU~ OVE~ WIL~ I, GEORGE P. KELLY, resident of the City of Biloxi, State of Mississippi, do hereby declare this to be my Last Will and Testament, and I expressly revoke all Wills, including codicils, which I have made previously. Family Declarations: Spouse: GLORIA K. KELLY Children Living: GEORGE P. KELLY, JR., SUZANNE K. MICHAEL, and DANIEL F. KELLY. Predeceased Children: None Former Marriages: None ARTICLE I I give the entire residue of my estate to the trustee then in o~fice under that trust designated as "The KELLY Family Trust," established Fe of which I am a settlor, and trustee. I direct that the residue of my estate shall be added to, administered, and distributed as part of that trust, according to the terms of the trust and any amendment made to it before my death. To the extent permitted by law, it is not my intent to create a separate trust by this will or subjeCt the trust or the pi'operty added to it by this will to the jurisdiction of the probate court. If I decide to bequeath specific gifts, I will attach a handwritten, signed and dated list of any such gifts to this Will. If no such list is found on the date of my death, all my property is to be distributed in accordance with my trust and Will provisions. ARTICLE II If the disposition in Article I, above, is inoperative or is invalid for any reason, or if the trust referred to in Article I, above, fails or is revoked, I incorporate herein by reference the terms of that trust, as executed on this date, without giving effect to any amendments made subsequently, and I bequeath and devise the residue of my estate to the trustee named in the trust as trustee, to be held, administered, and distributed as provided in this instrument. ARTICLE III No Contest, Disinheritance, Definitions If any beneficiary under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate given to that contesting beneficiary under this Will is revoked and shall be disposed of in the same manner 121897 provided herein as if that contesting beneficiary had predeceased me. Except as otherwise provided in this Will, I have intentionally omitted to provide herein for any of my heirs, or persons claiming to be my heirs, living at the date of my death, whether or not known to me. ARTICLE IV I hereby nominate GLORIA K. KELLY to be the Executor of this Will. In the event GLORIA K. KELLY may be unable to serve or declines to serve as the Executor of this Will, I hereby nominate as the alternate Executor of this Will, in the order and priority indicated, the following: First Alternate Executor - GEORGE P. KELLY, JR. Second Alternate Executor - SUZANNE K. MICHAEL Thurd Alternate Executor - DANIEL F. KELLY Signed on j~tq2,j~, ¢ Mississippi. The Executor shall have full power and authority to carry out the provisions of this will, including the power to manage and operate during the probate of my estate any property and any business belonging to my estate. The Executor shall serve without bond. ,/-~ ,199~ ,at ~)/t2~ / , ' (~'EORC~P. KELLY ' 121897 2 DECLARATION OF WITNESSES On the date written below, GEORGE P. KELLY declared to us, the undersigned, that this instrument, consisting of four pages, including the page signed by us as wimesses, was the Will of GEORGE P. KELLY (hereafter "Testator") who requested us to act as witnesses to it. Testator thereupon signed this Will in our presence, all of us being present at the same time. We now, at Testator's request, in Testator's presence and in the presence of each other, subscribe our names as witnesses. We declare under penaltyc.of perjury that the foregoing is true and correct and that this declaration was executed on .! ~'/3,~t~.'r ~ , 199r~ , at ~-Tc c)¢~ , Mississippi. Witness Signature Witness Name (Printed) Witness Address Witness Signature ~ Wimess Name (Printed) Witness Address 121897 3 STATE OF MISSISSIPPI OU T OF AFFIDAVIT OF PROOF OF WILL Personally came and appeared before me, the undersigned authority in and for the jurisdiction aforesaid, ~O'f~. C ~/<~.~ ~}~. and ~/,~cc.5 ~]cy~d~-Y who being by me first placed on oath depose and say: - ' ~ Affiants have this l~ay examin~l}an instrument of writing dated the ]-f ~/J3 day ~> Jq ) ]~ 0~ ~t/ 199 u ' , of , ....... ~ r,~ , p rport]ng to be the last Will and testament of GEORGE P. KELLY, and attested by Affiants as subscribing witnesses, which instrument of writing has this clay been exhibited to Affiants; On the date of said instrument of writing, al the request of the said GEORGE P. KELLY, who. in the presence of the Aff~ants signed published and declared said instrument of writing as his true last Will and testament, Affiants at the request of the said GEORGE P. KELLY and in his presence and in the presence of each other, affixed their signatures to said instrument of writing as subscribing witnesses: On the date of said instrument of writing the said GEORGE P. KELLY was above the age of eighteen (18) years and possessed of sound and disposing mind, memory and understanding. SWORN TO AND SUBSCRIBED before me by ~Cof~6'~ 1O. ;~fi-¢,. ~ t)/2, C~ ,JoM~s ,on this ~e ~ay of ~ ~ t/~ ~ ~ 199~. ' ' ' 121897 and My commission expires: Slits* o! illssisslPl)l ~t__. ~00~ A OlS~E ' DATE: SUBJECT: TO: FROM: 2-/-0Lf-q3~ COMMONWEALTH OF PENNSYLVANIA DOCKETING NONRESIDENT DECEDENT FILE INFORMA nON ~\s., C.,\~.\J.r, c-~'-""\. <e:....-' r. '" ,\ FO"vv....Y'_V"' COUNTY REGISTER OF WILLS John Riedman Specialty TaxINonresident Unit Inheritance Tax Division Bureau of Individual Taxes Department of Revenue Attached is nonresident decedent file information concerning taxable property located in your county. Please docket and file the attached information so it may be available for future reference. Thank you. Attachment JACQUELINE M VERNEY ESQ 44 S HANOVER ST CARLISLE PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ESTATE INFORMATION FILE NUMBER 99 04-0806 NAME OF DECEDENT (LAST) KELLY DATE OF PAYMENT POSTMARK DATE COUNTY Non-Resident DATE OF DEATH REMARKS MS SEAL - .,~ -- r'..~. PENI\nSVLVAN~.' INHERITANCE AND EsTATE TAX OF-Z.fSiI~~;:~'9.tpT No. NR006513 -' C'Ol,jf=lT ACN ASSESSMENT CONTROL NUMBER .~. "t-\ 101 (FIRST) GEORGE (MI) P 11/5/2004 11/4/2004 21512004 TOTAL AMOUNT PAID RECEIVED BY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Register AMOUNT 3,375.00 $3.375.00 John M. Riedman COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION PO 80)( Z8D60l HARRISBURG PA 17128-0601 NlI'l'~llf;DF NON~I!i~NT INHERITANCE TAX APPRAISE_Tr~ALLOMANCE OR DISALLORAHCEQF:DEOUCTIONS, AND ASSESSKENT OF TAX * REY-551 EX AfP (12-04) r::."~1 _ '~.l ')'1 I" ;__j (.. I Ii ^ QI\TE c':!StATE OF DATE OF DEATH FILE NUMBER COUNTY . fll"CN 01-31-2005 KELLY 02-05-2004 99 04-0806 NON-RESIDENT MS 101 JACQUELINE M 44 S HANOVER CARLISLE VERNEY ESQ ST Allaunt Rellitted PA 17013 GEORGE P MAKE CHECK PAYABLE AND REMIT PAYMENT TO: PA DEPARTMENT OF REVENUE P.O. Box 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE ___ RETAIN LOWER PORTION FOR YOUR RECORDS ... R'EV=S3"'--Ex-XFiiTiii:'-lii,)--riiiTi:-crci'-NoriRE'ifiiiEiff-iifHERYfANc-i-yiii-AP-PRAi:"SEM'E-ri;::-XCLCiwANC:"i-iiR - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KELLY GEORGE P FILE NO. 99 04-0806 ACN 101 TAX COMPUTATION METHOD ELECTED: IX I FLAT RATE I I PROPORTIONATE TAX RETURN WAS: [ XI ACCEPTED AS FILED [I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property [Schedule F) 7. Transfers (Schedule GJ 8. Total Assets III [21 [31 [41 [51 161 (7) 75,000.00 .00 .00 .00 .00 .00 .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 DATE 01-31-2005 NOTE: To insure proper credit to your account} submit the upper portion of this form with your tax payment. (BI 75,000.00 Illl 1121 1131 1141 .00 75,000.00 .00 75.000.00 NOTE: 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~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of line 14 at Spousal rat. 16. Amount of line 14 taxable at lineal/Class A rate 17. Amount of line 14 at Sibling rate 18. Amount of line 14 taxable at Collateral/Class Brat. 19. Principal Tax Due 1151 .00 X 00 = .00 1161 75,000.00 X 045 = 3,375.00 1171 .00 X 12 = .00 1181 .00 X 15 = .00 1191 3,375.00 TAX CREDITS: I+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-I 11- 04-2004 NR006513 .00 3,375.00 TOTAL TAX CREDIT 3,375.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED} SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST. ( IF TOTAL DUE IS lESS THAN $l} NO PAYHENT IS REQUIRED. IF TOTAL OUE IS REFLECT EO AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I \r <:... REV-17a7-2 EX. 19-OO,*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULEjl,PAR,.-y-.C~ REAL E~1AT~.. IN PENNSYLVANIA ESTATE OF <',J 1- ;~j -;:: i-n ;:: t} Lr:ILE NUMBER Kelly, George P. 99-04-00932 Part 1 must include all real property owned by the decedent indiVicjij;aJIlI-~i~~i'P'.jn common with another party(ies), having its situs in Pennsylvania. Property which is jointly-owned with right dVSUtvlvU'i'Ship,A.Hblifd be disclosed on Schedule F. All real estate must be reported at fair market value which is defined as the pri~.\'lMYh,Cl) properjr",o>AA be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell;1)dfh 'having reasonable knowledge of the relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 5 Clearview Ave, Carlisle, PA 17013 $75,000.00 C,1. ..",\,.,. \em'\" (",,-,'1' PART I TOTAL $ 75 000.00 PART 2 TOTAL Proportionate Method Only from reverse side $ TOTAL (Also enter on line 1, Recapitulation) $ 75,000.00 (If more space is needed, insert additional sheets of the same size)