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HomeMy WebLinkAbout02-1103PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Robert L. Anderson also known as Social Security No. 16 8- 3 6- 7 0 7 3 No. 21-02-1103 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The_ petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl ie_s for letters of administration on the estate of (d.b.n.; pendente liter durante absentia; durante minoritatej ~ ~ ~ ~ o ~~ .~ the above decedent. ~ ~~ -~ ~~-~'. Decendent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 8 4 5 W . Louther St . ~ Car 1 i s le PA , (list street, number and municipality) Decendent, then 5 5 years of age, died November 14 , 2 0 0 2 X~#jXX , at 845 W. Louther Street, Cumberland County . Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: _ Petitioner after a proper search ha ~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Mar E. Anderson Relationship Mother Kesidence 45 W L rlis le THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. a ~~~-~d~ ~° N 845 W Louther St a~ Carli le PA 17013 ~s -- ~: ti a, ~w ~° Deceased. g Unestimated OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) ,that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 4th day of December, 2002 X~ ,~„ /~ J Register ~ l No. ss H in 21-02 Estate of ROBERT L . ANDERSON ~ Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW DECEMBER 5 X~g~2 0 0 2, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Mary E. Anderson is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Mary E . Anderson in the estate of Robert L. Anderson Register of Wills/~°`'""`~ /`~~ FEES Letters of Administration ..... $ 60.00 Short Certificates( ) .......... $ 9.00 Renunciation ................ $ JCP $ 10.00 TOTAL _ $ 79.00 Filed ....DEC:.S,,,,,.,.,. A.D.~~ 2002 Robert M. ;trey #06274 _ ATTORNEY (Sup. Ct. I.D. No.) 5 S.Hanover St.,Carlisle PA 17013 ADDRESS (717)243-5838 PHONE T'his is ee~ ce) ~t~ 'that me i,c~csrrnarion here biven is correctly copied ~;o)z~ an original certificate of c~~~a~h di Iv ~izec ,with me as Locrl Re>;istr(r, the ori~inai ~ertttceare will he. forwarded to the `~tarz Vital Kecords Office for perm._tn<")t ti:(i.~~> WARNING: It is illegal to duplicate this copy ~y photostat or photograph. <. tfr chi; cerriiicare, `s'.Oi) P __8703873 ~~)~ ~ ~~ 5~~~ rte'. ~; ~~~~fi~~wQ , 11-119 -0~'1 ~L~~. H105.144 Rev. 1/91 JPRINT IN tANENT CK INK ~~ ~~~ ' JJ Loc.,l K~~i~~rrar _ _-_N o v _ i s_ zoo2 . r:)t,_ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Coroner) NAME OF DECEDENT (First, Mgtlle, Last) SEX STATE fILE NUMBER SOCIAL SECURITY NUMBER , ROBERT L ANDERSON M l DATE OF DEATH (MOnm, pay veer) . a e z. 7. 168-36-7073 November 14 4 2002 AGE (Last B~rthMy) UNDEq,VEAR UNDERIDAV DATE OF BIRTH BIRTHPLACE (City antl (MOnm Dey Y r) State or Forei n C M t th D H PLACE OF DEATH (Che ck Dray one-see instructrons on other wipe) . , 55 vn. s on ayn ours Minutes , . July 12, 1947 a. g oun ry) Carlisle, PA T. HOSPITAL: Inpatient ^ ER)omp.uent ^ DGA ^ 9.. OTHER: Mom: ^ Reswsnce~Q assay) ^ ' COUNTY OF DEATH CI O POF DEATH FACILITY NAME QI not instHUf ,give street antl numpr) WAS DECEDENT OF HISPANIC ORIGINT RACE-ArMripnlneisn Black Whke etc , , , . ' Cumberland Carlisle 845 W. Louther Street "°~c Y••^It yea. apscly cMM^• f •,I,. Mexlcen, PwnO Rkan, Np. IYy `1 to N. 9a 9d. 9 . 10. DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS-Marrie0 SURVIVING SPOUSE (Give kind d work tlone durirrpq ost - U.S. ARMED FOgCEST ml h nest r e tom N ever Married, WlMwetl. (II wile, grva maiden name) of wprkirq Mr,MrlIX Use rNaetll Elementary/Saco College Divorced (Specify) vea^ No~] ~~ l i 17 • (g-t2) . ,foo & D e Maker ,Tectonic CO. 12 (1-4or5+) ,ever Married s. DECEDENT'S MAILING ADDRESS (Street CMrtown, State, 2lp COtle) DECEDENT'S N. Middleton ,7s. State P~ DItl 17e 1-1 yea daoadant Mvetl lrt 845 W. Louther St RESID 7F' . ENCE aecetlam twn Carlisle, PA 17013 (~'"~`~"°"` '"°l^• h i on ot er S pe) IOwnnnipT No, Moetlent Mad 1~• 170. COUn ~'-17Tf]PY'~ap'I(j 17tl.^ Rata amual limas of FATHER'S NAME (Fag, Mitltlle, Lang Albert C Anderson pY/DOrp. MOTHER'S NAME (First, MkOb, Meipan Surname) - - - . ,•. - ' _ - _,_. ,9. Ma =E: Brewbaker - - INFORMANT S NAME (TypalPrim) Mar E A d INFORMANT'S MAILING ADDRESS (Street, CMROwn. State, Zip Coda) y . n erson 20D 845 W. Louther St., Carlisle, PA 17013 METHOD OF DISPOSITIOIyN DATE OF DISPOSITION PLACE OF DISPOSTION•Neme of CemNery, Crematory LOCATION-City?own, State, Zip Cosa / Burial L? CremaWn ^ gsmoval from SINe ^ (Mpnln, Day, year or gnat Plop ^ N 19 200 Dpn.tkn ah«(soep ^ ov. , 2 Cumberland Valley M~tnodrial Carlisle, PA .:,.. 2, D . 2,°. r ens :,tl. SIGNATUR OFF NE RVICE LICENSE ORP ONA I CM LICENSE NUMBER NAME AND ADDRESS OF FACILITY H fma -R th a ' 22a. zxe. 220 . CompMsinrrro ony nprtilying a of my nowletlge,M tarred al the time, date and place stated. LICENSE NUMBER DATE SIGNED pnyskian k not ava9aDN st Hrns OI path to '9 antl The) (Monty. Day. year) ': preHY cauN of Math. 23a. 27D, 2k. Rama 24.25 m~atMCOmplatsd OY TIME OF DEATH prx. DATE PRONOUNCED DEAD (Month,Day,Veer) WAS CASE REFERREDTO MEDICAL EXAMINER/CORONER? - person Mro pr0nounpa Mam. November 14, 2002 ve. ~ „p^ ,4 9:00 A. • M. „. 29. 27. PART I: Enter ale dbeaaee, inrynea a Complkatkns wnkh pusep Ina Mem. Dp not enter the mode of dying, Such ae cerpiac or respiratory arrant, shock or Man lailun. ,Approximate PART 11: Other ggnlf rat pndabns pntrlDutag to deem LM OMy one pUN Orl each line Dtn , . i mterval Mlw9en apt reauHlnq In tM wprlyirq pwa gMn In MRT I. ~ onpt sad pam IMMEDIATE CAUSE (Flnal °"°"e"Cantli""' Cardiom o ath reaWerq in deem)--. .. IDDM, HTN, Morbid Obesity DUE 70 (OR AS A CONSEQUENCE OFj: i SsQUamla9y Ng mndkbrtn D. ~• I H aM• Ie~Frq to NnrMdlats DUE TO (pR AS A CONSEQUENCE OFD: ptas. Emer UNDERLYING I CAUSE (piaeesa or injury c. mst iMated evan0 DUE TO (OR AS A CONSEQUENCE l')F): ~ raaAaq in deem) LAST e. NF,S AN AUTOPSY PERFORMEDT WERE AUTOPSY FINDtNOS AWMBIE PRIOR 70 MANNER OF DEATH DATE OF INJURY (Monet, DaY• Year) TIME OFINJURV INJURY AT WORK( DESCRIBE HON'INJURV OCCURRED. C ~P~ ON OF CAUSE Natural ~ MomkWe ^ y~ ^ ~ ^ Y ^ N ^ ^ Aaltlsm ^ Penping Invsglgatbn ^ 3p 30D. M. 30c. 70tl. ss o~ Yaa No SukWa ^ DouW not M Mterminee ^ PUCE OFINJURV-AIMme, farm, great, factory, oHke MiWinq, etc. (Specay) LIJCATION(Street.CMR .State) 2N. 290. 29. 7w. 701 DERTIf1ER (Check array op) CERTIFYING PHYSICIAN (Physician certaying pax d Hem when andher physician has pronounced deem antl complatetl Hem 23) . SIGNATURE AND TIT To Uls Mat M my knowNtlys, tlssM xeumtl dos to tM catns(s) antl msnmr ea ststN ..................................................... ^ COLOner 31 b. - 'PRONOUNCI910 AND CERTIFYING PHYSICIAN ~~~^ IXXn pronounang Ham antl Cenaying b puce of Hem) LICENSE NUMBER DRESIGNED (Moran, pay, ,par) T° HN Oast M k ., my rwwla9.,tlssthoeeumatlsttMthw,Mts,sndplsea,srMtlwtotl,aesuea(s)erMmmwromOW .......................... ^ 3,0. 770. November 15, 2002 • NAME ANDADORESS OF PERSON WHO COMPLETED CAUSE OF DEATH • 'MEDICALE%AMINERlCORONER - (Item27)TypeorPnnt Michael L. Norris Coroner on tM Dash of e:amtttnron anNOr Invastlpatron, In mY oplnron, tloth occurred a, the time, date, antl place, antl due to tM eauaa(a) antl , 63 7 5 Ba s ehor a Road 5u i t e ~ 1 m.anal.a.t.c.a .................................................................................................. ~ 3, a. 3z. Mechanicsburga Pa. ~ 17050 REGISIMR'S SIGNATURE AN R A. Ft,.,,~c~ L l l al + l of ,, DATE FILED(MOnm. Day, year•~ tv o o . a ,,. o , tcD ao CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: ROBERT L. ANDERSON Date of Death: November 14, 2002 Will No. Admin.No. 21-02-1103 To the Register: I certify that notice of (beneficial Interest) 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: March 12, 2003 Name Address Mary E. Anderson 845 West Lowther Street, Carlisle PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: March 12, 2003 ~~,..4,t ~~ - '~ Signature Name: Robert M. Frey Address: 5 South Hanover Street Carlisle. Pennsylvania 17013 Capacity: Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: ssN: iss-as-7o73 FILE NUMBER: 2102- 1 1 03 DECEDENT NAME: ANDERSON ROBERT L DATE OF PAYMENT: 02/13/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 4/2002 AMOUNT 101 ~ 55,814.00 TOTAL AMOUNT PAID: REMARKS: MARY E ANDERSON SEAL CHECK# 0096 INITIALS: SK RECEIVED BY: DONNA M. OTTO 55,814.00 DEPUTY REGISTER OF WILLS REV-1162 EX111-96) N0. CD 002166 REGISTER OF WILLS 217 REv- oo OOMMONWEA,T. OF REV'1500 O F,C,^L USE ON, PENNSYLVANIA INHERITANCE TAX RETURN 2 -02-110a HARRISBURG, PA17128-0601 RESIDENT DECEDENT :ou.. CODE .UMSER iDECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~- Robed L Anderson ~ ~ ~8-3~-7073 LU THIS RETURN MUST BE FILED IN DUPLICATE WITH THE o 11/14/2002 7/12/1947 REGISTER OF WILLS Ill ~ IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~'~ 1. Odginal Return ~ 2. Supplemental Ret~m [~ 3. Remainder Return (date of death pdor ,o 12.13.82) ~i~3 ~--~ 4. Limited Eslale ~-'--~ 4a- Fulure 'nleresl Compromise (date of death after '12.12.82) [~ 5. Federal i:state Tax Return Required ~ ~ [~ 6. Decedenl Died Testate (Altach copy of Will, ~ ?. Decedent Malntainod a Living Trust (Altach copy of Trust) __ 8. Total Number of Safe Deposit Boxes '{ k--~ 9. Liti§alion Proceeds Received [~ 10. Spousal Poverty Credit (dale of deaal ,:.,- 12.31.,1 and .i..i.,5) .... ~-~1 1. Eleclion to tax under Sec. 0113(A) (Altach Sch O) I~J NAME ............................ · ....- ........................................ :....~:...: ~..,.. .......... ...: ::::: O COMPLETE MAILING ADDRESS z Robert M. Frey o 5 South Hanover Street ~ FIRM NAME (if Applicable) ,,, Carlisle PA 17013 '" Fre¥ & Tiley 0 TELEPHONE NUMBER (717)243-5838 1. Real Estate (Schedule A) (1) NONE OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 4,279__ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 12,063 4. Mortgages & Notes Receivable (Schedule D) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5)_ 27,010 6. Jointly Owned Property (Schedule F) Z {~]Separate Billing Requested (6) NONE O '~. 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property I----' (Schedule G or L) (7) O 8. TOTAL GROSS ASSETS (total Lines 1-7) ,,, (8) 43,352 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,353 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) :10) 24 11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 1 _~__?,2,77 12. NET VALUE OF ESTATE (Line 8 minus Line 11) (12) ~U~5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . .(13), 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) "~ --~":JCl'cl7~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax z rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) I- <I: 16. Amount of Line 14 taxable at lineal rate ~- 30,975 x .045 (t~) -, 1,394 ~ '~7. Amount of Line 14 taxable at sibling rate O x .12 (17) ~ 18. Amount of Line 14 taxable at collateral rate ~- x .15 (18) 19. Tax Due 20.J~ I~.','" :'iF" '~! .,~~l~~.._j~,..~~j~j~~~1~ 'r..: .'-....:. .. ............... (19) 1,394 717 ~ Robert L. Anderson 168-36-7073 Decedent's Complete Address: I STREET ADDRESS 845 W. Louther Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 1,394 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 5~814 C. Discount 306 Total Credits ( A + B + C ) (2) 6,120 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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 I Line 20 to request a refund (4) 4,726 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. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check !~)~able to: REGISTER OF WILLS, AGENT PLEASE ANSWER THI~ 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. retain the dght 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? ................... r--] 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 SCHEBULE G AND FILE IT AS PART OF THE RETURN. Under penallies of perjury, I declare that I have examined Ihis return, including acco.~nying schedules and statements, and to the best of my knowledge and belief, it is true, and complete. Declaration of preparer olher Ihan the personal representative is ha~ed on all i~'u,~,u~ion of which preparer has an), knowledge. SIGNA..TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 845 W. Louther Street, Carlisle, Pennsylvania 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~_.~,,,,t,j~:~r DATE ADDRESS 1 0/20/2004 5 South Hanover Street, Carlisle, Pennsylvania 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on Ihe net value of Iransfers to or for Ihe use of the surviving spouse is 3% [72 P.S. Sectio~ 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 Ihe surviving spouse is 0% [72 P.S. Seclion 9116 (a)(1.1)(ii)]. The statule does not exempt a transfer Io a surviving spouse from tax, and the statutory requirements for disclosure of assels and filing a lax return are still applicable even if Ihe 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 Iransfers from a deceased child twenty-one years of age or younger at death Io or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%[72 P.S. Section 9116{a)(1.2)]. The lax rale imposed on Ihe net value of Iransfers to or for Ihe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Seclion 9116(a)(1)]. The tax rale imposed on Ihe net value of transfers Io or for the use of the decedent's siblings is 12% [72 P.S. Seclion 9116(a)(1.3)] .A sibling is defined, under Section 9102, as an individual who has al least one parent in common with Ihe decedent, whelher by blood or adoption. 217 .~v-~x+(~ SCHEDULE B ~o~,.~.w~. o~ ~..~v^..^ STOCKS & BON DS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert L Anderson 21-02-1103' All Ixoperty jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MetLife Trusts Interests, ID~8064 1549 3377(88 shares ~26.92) 2,369 2. Tyco International Ltd.(124 shares @15.40 1,910 TOTAL (Also enter on line 2, Recapitulation) 4,279 (If more space is needed, insert additional sheets of the same size) WS.I. com Stock ~Charting for MET 10/20/04 2:59 PM (NYSE) U.S. Dollar Date Price High Low Volume 2 bbnth (Daily) ®BigChart~.com 11/14/02 26.92 27.2 26.4 2,471,700 ~' No Splits 24 Get another quote any day after 1/2/1970 Nov Dec 1/211970 1mo 2mo 3mo 6mo lyr 3yr 5yr Symbol: I_ Date: 111/14/2002J ~ Copyright © 1998-2004 BiqCharts,com Inc. Historical and current end-of-day data provided by FT Interactive Data. Copyright © 2004 Dow Jones & Company, Inc. All Rights Reserved http://www~bi~charts~c~m/cust~m/wsjie/wsjbb~hist~rica~~asp?symb=Met&c~~se-date=~ 1%2F14%2F2002&x=0&y=0 Page 1 of l WS$.¢om Stock Charting for TYC 10/20/04 2:51 PM (NYSE) U.S. Dollar Date Price High Low Volume ~i~ 2 Month (Daily) (~BigCharts.com 15 No Splits Get another quote any day after 1/2/1970 + Nov Dec 112/1970 1mo 2mo 3mo 6mo lyr 3yr 5yr Symbol: Date: 111/14/20021 Copyright © 1998-2004 B ,qCharts.com Inc. Historical and current end-of-day data provided by FT Interactive Data. Copyright © 2004 Dow Jones & Company, Inc. All Rights Reserved http//www b,gcharts com/custom/ws ]e/ws bb h~stoncal as ?s mb TYC I e o : ' ' ' J' J - ' ' · P y = &c ose_date=ll~2Fl4~2F2002&x=0&y=O Page I of l 2,17 ,' REV-1506 EX+ (9-00) SCHEDULE C-2 COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP INHERITANCE TAX RETURN RES,DE.T [~ECEOE.T INFORMATION REPORT ESTATE OF FILE NUMBER Robert L. Anderson 21-02-1103 1. Name of Partnership Hatch Huntinq Club Date Business Commenced 6/12/1905 Address 1205 Trindle Road Business Reporting Year City Carlisle State PA Zip Code 17013 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a E~]General [~]Limited partner. If decedent was a limited partner, provide initial investment $ A. Paul J. Creeden 20% 20% B. Ray C. Heckendorn 20% 20.00% C. James E. Heckendorn 20.00% 20.00% D. Gerald Lehman 20.00% 20.00% 6. Value of the decedent's interest $ 12,063 7. Was the Partnership indebted to the decedent? .................. r'---]Yes [~-]No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? . . ["--]Yes [-~No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-827 [---~Yes E~]No If yes,[---']Transfer E~Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? . . ~'~Yes [--']No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .................. ['~Yes E~No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ........ [-~Yes ~-]No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ................. E~Yes E~]No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? ....... ~-'--~Yes E~No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1508 EX ~ (1-97) (I) SCHEDULE E coMMo.w~.~.O~PE..S~.V^.,^ CASH, BANK DEPOSITS. & MISC. .Es,DE.~ D~CEDE.~ PERSONAL PROPERTY ESTATE OF FILE NUMBER RobeA L. Anderson I~e ~e ~b~s of Iltig~ ~ Ihe d~e t~ p~s ~m ~v~ ~ Ihe ~t~e. ALL PROPER~ JOI~LY-OWNED WITH THE RIGHT OF SU~ORSHIP MUST BE DISCLOSED ON SCHEDULE F. I'~EM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank, Checking Acct ~742252 2. M&T Bank, Savings Acct ~15004200125563 9,793 3. Refund, Peerless Insurance Co., Auto Insurance 12,472 4. Refund, U.S. Treasu~ 2002 Taxes 349 5. Refund, Capital Blue Cross Premium 2,141 6. Microsoft, Paid Invoice 173 7. Refund, Publish Se~ices, Inc. 100 50 8. Refund, Down East Ente~Hses, Inc., Speedway Illustrated 41 9. Refund, AHP Se~lement Trust "Drug Refund" 182 10. CNA Group Life Assurance Co., Policy ~9456197, Long Te~ Disabili~ Insurance 1,425 11. 1983 Chevrolet Caprice, NO Value 12. MetLife, Dividend 13. Tyco Dividend 18 2 14. Refund, Unum Provident, Long Term Care Insurance 264 TOTAL (Also enter on line 5, Recapitulation) 27,010 (If more space is needed, insert additional sheets of the same size) Manufacturers and Traders Trust Company, 1100 Wehrle Drive, RO. Box 767, Buffalo, NY 14240-0767 January 29, 2003 RE: Estate Search The Estate of: ROBERT L ANDERSON Date of Death (D.O.D.) 11/14/2002 To Whom It May cOncern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Account Number Account Title Opening Branch D.O.D. Accrued Interest Type Balances (Includes Accr. Int.) CHK 742252 ROBERT L ANDERSON 4319 $9792.66 $.00 OPENED 9/67 SAV 15004200125563 ROBERT L ANDERSON 4319 $12,471.55 $.95 OPENED 11/77 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description NO Safe Deposit Box titled in the Decedent's name existed at our office. If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION Authorized Signature - 217 .~v-,~,o ~x+ (~) SCHEDULE O co.~,~LT, o~ ~..~v..,^ INTER-VIVOS T~NSFERS & ,..~ T~ Rm.. MISC. NON-PROBATE PROPER~ RE~ E~TA~ ~ FI~ ~M~R Robe~ L Andemon 21~-1103 ~ ~u~ m~ ~ ~ a~ fi~ E ~ a~r to a~ ~ q~ns 1 ~h 4 ~ ~ ~ s~ ~ t~ ~-1~ ~R SHE~ i~ ~. DESCRIPTION OF PROPER~ ITEM ~~~REE,~IRR~p~~~ DATE OF D~TP % OF DECD'S ~CLUSION T~BLE NUMBER ~- VALUE OF ASSET INTEREST (~'~) VALUE 1. Waddell & R~, I~ A~5115386 108,~3 0.00% 0 Date of BiRh July 12, 1~7 0 2. Prudential Bank & Trust Co, I~ A~280730790 8,035 0.00% 0 (Pru~iI~FD:C1BF~02-1,2~.740 shares ~6.67) 0 Date of Bi~h July 12, 1~7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOT~ (Nso enter on line 7 R~p~ulation) $ 0 (If more spa~ is n~, inseA additional shes of the same s~e) TO: ROBERT M FREY · · · · · Company: FREY & TILEY #35115386 · · · · · Fax Numbe~ 1-717-243-6441 · · · · · Phone Numbe~ ..... FROM: CSR/CORRESPONDENCE · · ·., Fax Numbe~ 1-800-532-2749 · · · · Ph~e Numbe~ 1-800-888-WADDELL · ···· RE: 351153861RA ROLL ROBERT L ANDERSON · · · · · THE DATE OF DEATH VALUES FOR THE ABOVE LISTED ACCOUNT ARE: · · · · · 602- $8.23 PER S/H 4841.039 SHARES $39,841.75 VALUE · · · · · 608- $14.33 PER S/H 1943.150 SHARES $27,845.34 VALUE · · · · · 677- $7.46 PER S/H 3038.948 SHARES $22,670.55 VALUE · · · · · 688- $6.79 PER S/H 2725.391 SHARES $18,505.40 VALUE · · a · · THE BENEFICIARY OF THIS ACCOUNT WAS MARY E ANDERSON. · · · · · THANKS REGINA PFEIFER, CSR CORRESPONDENCE olios ·eeoc · · · · · Date and time of tmnsmissiofl: Friday, February 14, 2003 11:24:40 AM · · · · · Number of pages Including this cover sheet: 05 This document was faxed using a RIghtFAX v7.0 electronic document delivery solution. RightRRX l (~ Prudential Investments Prudentia Financial Prudential Mutual Fund Services LLC P O Box 8098 Philadelphia, PA 19101 (800) 225-1852 www.prudential,com Frey & Tiley Shareholder: Robert L Anderson Attorneys at Law IRA A1 IN: Robert M Frey 5 South Hanover Street Carisle PA 17013 Account Number: 2807830790 February 18, 2003 Dear Robert M Frey: I am writing to you in reference to recent correspondence received in our office regarding the Prudential mutual fund account listed above for Robert L Anderson. On November 14, 2002, the value in the account is as follows: Fund Name Shares Share Price Value Utility: Class B 1,204.704 $6.67 $8,035.38 The account balance is determined by multiplying the total number of shares in the account by the Net/lsset Value (price per share of the fund). Please keep in mind that the Net Asset Value of the fund fluctuates on a daily basis and therefore, the account value will aiso fluctuate. I trust that this information has been helpful. In the event that you have questions or need further assistance, please do not hesitate to contact our Prudential Mutual Fund Service Center at 1-800-225-1852, Monday through Friday, 8:00am to 8:00pm, eastern time. For account information that is available 24 hours a day, 7 days a week, you may access your account online at www.prudential.com. ,, Sincerely, , / esde Kaufman ~ Project Manager 217 " REV-1511 EX + (12-99) SCHEDULE H c~,~, o~ ~,~.v^,,^ FUNERAL EXPENSES & INHER[TANCE TAX RETURN .Es~o~r~-c~rr ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Robert L Anderson 21-02-1103 Debts of decedent nmst be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 5,233 B. ~.DMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Persmml Represarttalive (s) Social Security Number(s) / EIN Number of Personal Repr"-~,mflative(s) City Slate Zip Year(s) Commission Paid: 2. AUomw Fees 3,337 3. Family Exemption: (#r decedent's address is not ~ same as claimant's, attach explanation) Ciaiment Mary E. Anderson stre~ Address 845 W. Louther Street c~ Carlisle State PA ap 17013 Relationship of Claimenl to Decedent Mother 3,500 4. Probate Fees 79 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 3ank Charge, Estate Checks 10 8. Register of Wills, (4) Short Certificates ~3.00 12 9. Checks clear after Date of Death 167 10. Filing Fee for PA Inheritance Tax Return 15 TOTAL (Also enter on line 9r Recapitulation) $ 12~353 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) 217 SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Robert L. Anderson 21-02-1103 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bank Fees 24 TOTAL (Also enter on line 10. Recapitulation) $ 24 (If more space is needed, insert additional sheets of the same size) 217 REV-1513 EX + (9-00) SCHEDULE J COMMONWE^,T. OF PE..SV,V^.~^ BENEFICIARIES ,..ER,T^.CE T*X RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert L. Anderson 21-02-1103 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. Mary E. Anderson 845 S. Louther Street Carlisle, Pennsylvania Mother 100% residue of estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18~ AS APPROPRIATE ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Robert L. Anderson Date of Death: November 14, 2002 Will No. Admin. No. 21-02-01103 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 ( ) No ( X ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 2005 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes ( ) No (). (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes (X) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: December 8, 2004 Signature Robert M. Frey Name (Please type or print) 5 South Hanover Street Carlisle, Pa 17013 Address '~ (717) 243-5838 ~'~ ~ Telephone No. Capacity: ( ) Personal Representative ( X ) Counsel for personal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 ANDERSON MARY E 845 W LOUTHER ST CARLISLE, PA 17013 RE: Estate of ANDERSON ROBERT L File Number: 2002-01103 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 11/14/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge BUREAU OF INDIVIDUAL TAXEjicrv\;;,,':tj ,'" INHERITANCE TAX DIVISION rL\.A:, \t.',"L~ " PO BOX 28D601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE n"-'F ne: r;~~,_ Vi NOTICE OF INHERITANCE TAX "liPP~ISE"ENT, ALLOWANCE OR DISALLOWANCE , 'OF DEDUCTIONS AND ASSESS"ENT OF TAX I 0 ",',t, '3: 4 5 2055 Ji\i'l K' CLER;\ OF ORPrW~':) COI!n" ROBERT M FREY CUMr:;:: 'i: iL,;', cr" ,,\ FREY & TI LEY 5 S HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-03-2005 ANDERSON 11-14-2002 21 02-1103 CUMBERLAND 101 *' REY-1547EXiFPID9-D4l ROBERT L Allount Re.1i tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=i5i,-j-Ex--AFi'--coFliiY-NoTlcniF-YNHERYi'ilifCE-YAx-jrp'PRA"IsEHENT~--AL1-owilNcE-irR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ANDERSON ROBERT L FILE NO. 21 02-1103 ACN 101 DATE 01-03-2005 TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule 5) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule Gl 8. Total Assets III 121 131 [41 [51 161 [71 .00 4.279.00 12,063.00 .00 27.010.00 .00 .00 IBI APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax [91 1101 12,353.00 24.00 1111 1121 1131 1141 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 43,352.00 17.377 no 30,975.00 .00 30,975.00 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 rate 16. Amount of Line 14 taxable at Lineal/Class A rat. 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collat.ral/Class B rate 19. Principal Tax Due TAX CREDITS. 1151 .00 X 00 = .00 1161 30,975.00 X 045 = 1,394.00 1171 .00 X 12 = .00 I1BI .00 X 15 = .00 1191= 1,394.00 . l+T ".~u, A"OUNT PAID DATE NUHBER INTEREST/PEN PAID I-I 02-13-2003 CD002166 69.70 5,814.00 TOTAL TAX CREDIT 5,883.70 BALANCE OF TAX DUE 4,489.70CR INTEREST AND PEN. .00 TOTAL DUE 4,489.70CR ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. oK. I IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. ,_~, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE Yr' A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. I STATUS REPORT UNDER RULE 6.12 Name of Decedent: ROBERT L. ANDERSON Date of Death: November 14, 2002 Will No. Admin. No. 21-02-1103 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (x ) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes () No ( ). (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes (x) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: March 3, 2005 ~-~-~~ Signature - I . .:1 C~_.: Robert M. Frey Name (Please type or print) 5 South Hanover Street Carlisle. Pa 17013 Address (717) 243-5838 Telephone No. (Capacity: ( ) Personal Representative ( X ) Counsel for personal representative vA BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-ln7 EX AFP 112-00 ~ <~ i tj DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-22-2005 ANDERSON 11-14-2002 21 02-1103 CUMBERLAND 101 ROBERT L ROBERT M.. FREY FREY & TILEY 5 S HANOVER ST CARLISLE Allount Rellitted PA 17013 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. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Iw:r&tI.,.!y.A:I!"..rnr-if!,...........'YAflWf'n'Ner'"fly.!n'WAm.o".ltl:l50FH....................... ... ESTATE OF ANDERSON ROBERT L FILE NO.21 02-1103 ACN 101 DATE 02-22-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-27-2004 PRINCIPAL TAX DUE:. 1.394.00 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-13-2003 CD002166 69.70 5.814.00 01-31-2005 REFUND .00 4.489.70- TOTAL TAX CREDIT 1.394.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )