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HomeMy WebLinkAbout04-0957Estate of Maxine C. Keinert Register of Wills of CUMBERLAND County, Pennsylvania PETITION FOR GRANT OF LE'rrERS ,D~e~ed Social Security No. 172-24-8694 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) ] A. Probate and Grant of Letters Testamentary and aver that Petition-er(s} is/are the execut, ors the Decedent, dated09/26/] 99] and codicil(s) dated . State relevant circumstances, e.g., renunciation, death of executor~ etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the docun~nts offered for probate; was not the victim of a killing and was never adjudicated incompetent: ] B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; dumnte minoritate) Petitionet(s) affer a proper search has/have ascertained that Decedent left no Will and was survived by the following spou~'e (if any) and hoirs: [ Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in North Middleton Township, Camber]and County, Pennsylvania with his/her last famih/ or principal resdence a 86.6 Carlwynne Manor, Apt. C 304, Car s e, North Middleton Township, Cumberland County, PA (list street, number, and municipality} Decedent, then 72 years of age, died 09/27/2004 at 866 Carlwynne Manor, Apt. C 304, Carlisle, PA /Location) Decedent at death owned property with estimated values as follows; (If domiciled in PA) All personal property (If not domiciled [n PA) Personal property in Pennsylvania (If not domiciled in PA) persona[ property in County Value of real estate in Pennsylvania situated as follows: none VVhereforo, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: T~'ped or printed name and residence Morris G. StriC~land, 690 Creek Road, Carlisle? PA 17013 Mary Arm Strickland, 690 Creek Road, Carlisle, PA 17013 Oath of Personal Representative Commonwealth of Pennsylvania County of 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 berief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will weft and truly administer the estate according to law. Sworn to or affirmed and subscribed Morris G. Strickland and Mary Ann Strickland before me this 2_5 .day of ~( TO; I~ct~ , >04 For-me Re~is--~er 1%, ~ 4 No, 72 · 690 Creek Road Estate of Maxine C. Keinert Deceased Social Security No: 172-24-8694 Date of 0oath: 09/'27/'2004 AND NOW, this '~ ~ day of ~ ~ i (2 ~,~ ['~-x , 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proot having been presented before me, IT iS DECREED that Letters [] Testamentary [] Of Administration (c,t.a.; d.b.n.c.t.a,; pendente lite; durante absentia; durante mlnoritate) are hereby granted to Morris G. Strickland and Mary Aim Strickland in the above estate and that the instrument(s) dated 09/26/'1991 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... She. Ce~iticate<~) ..... Renunciation ........ Affidavits ( ) .... Codici[ ..... I.D. No: 78014 Address: 4833 Spring Road Shermans Dalc~ PA 17090 Telephone: (717) 582 4006 inventory ......... $ Other ....... $ TOTA~ ......... S t q¢ ~/) LAST WILL AND TESTAMENT OF MAXINE C. KEINERT I, MAXINE C. KEINERT, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my Husband's nephew and his wife, MORRIS G. STRICKLAND and MARY ANN STRICKLAND, or the survivor of them. Should both MORRIS G. STRICKLAND and MARY ANN STRICKLAND, predecease me, I give, devise and bequeath the residue of my estate, of every nature and wherever situate, equally, to the then-living children (not to include grandchildren) of MORRIS G. STRICKLAND and MARY ANN STRICKLAND. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my Husband's nephew and his wife, MORRIS G. STRICKLGi{D and I.L~-RY ANN STRICKLAND, or the survivor of them, Executors of this my Last Will and Testament. Should both MORRIS G. STRICKLAND and MARY ANN STRICKLAND, fail to qualify or cease to act as Executors, I nominate, constitute and appoint MICHAEL J. STRICKLAND, Executor of this my Last Will and Testament. FIFTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. - Page 2 of 2 Pages - IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typew~ten pages, each ~dent~fied by my signature, this ?," ; ~', ~ i '"~ ' ' (SEAL) Makine C. Keinert Signed, sealed, published and declared by the above-named Testatrix, Y~%XI:,'.~- C. KEINERT, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, h~.e eunto subT~ur names as witnesses. COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) I, MAXINE C. KEINERT, 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged befoue me by MAXINE C. 1991. Max~ne C. Kein~t, Testatrix Notary Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA) : COUNTY OF CUMBERLAND ) SS. We, RONALD E. JOHNSON and /~z Bm~lda L. B~ehm, Notary Pul~c Ca~!b[~ 8oro, 'Cumbe~a~l County My Comm~skm Exp~re.~ Jan. 8, 1992 the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that MAXINE C. KEINERT signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by RONALD E. JOHNSON and 7)i~/j.~i~ ~/~,/~,~.,c1991' ,, ~i~es, this ' /~ l~,x~.~ J~6n~-Witnes~S~L) ? ~' (SEAL) / , Witness Notary Public Nof~i~ ~ ~ L. ~ehm, Not~ Pu~ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Maxine C. Keinert Date of Death: September 27, 2004 Will No. 21-04-0957 Admin. No. 2004-00957 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 October 26, 2004. Name Morris G. Strickland Mary Ann Strickland Address 690 Creek Road, 690 Creek Road, Carlisle, Carlisle, PA 17013 PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: Capacity: Mar/ W. Allshouse, ~S'quir~ 4833 Spring Road Shermans Dale, PA ~7090 (717) 582-4006 Personal Representatig~ ' X Counsel for Pergonal Representativ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOWiDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004711 ALLSHOUSE MARK W 4833 SPRING ROAD SHERMANS DALE, PA 17090 ..... fold ESTATE INFORMATION: SSN: 172-24-8694 FILE NUMBER: 2104-0957 )ECEDENT NAME: KEINERT MAXINE C }ATE OF PAYMENT: 12/08/2004 POSTMARK DATE: 1 2/08/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/27/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 87,524.00 TOTAL AMOUNT PAID: $7,524.00 REMARKS: SEAL CHECK# 104 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN HARRISBURG, PA 17128-0601 RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEC, TH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) [~1. Original Return [~4. Limited Estate [~6. Decedent Died Testate (A~ch copy of w~rl) [~9 Litigation Proceeds Received NAME FIRM NAME ~]2. Supplemental Return []4a, Future Interest Compromise (date of death after 12-12-82) [~7. Decedent Maintained a Living Trust (Attach copy of Trust) [~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) TELEPHONEN Mpv / 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 Prope~ (5) (Schedule E) OFFICIAL USE ONLY COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBEp 172 Y' THIS RETURN MUST BE FILED IN BUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~J3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required __ 8 Total Number of Safe Beposit Boxes []11. Election to tax under Sec. 9113(A) (Atiach Sch O) COMPLETE MAILING ADDRESS - ' 6. JoinUy Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) /'~D,4,' ~ (11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) ¢4) OFFICIAL USE ONLY 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 .0__ (15) 16. Amount of Line 14 taxable at lineal rate x 0__ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Decedent's Complete Address: STREET ADDRESS CITY I STATE I ZIP Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) "~'~ Total Credits ( A + B + C ) (2) Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 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. (SB) 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. 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 panaltJes 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, c~rrect and complete. Declaration of preparer other than the personal representative is based on all inf~rmatbn of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS /' ,,,,~ . '~-GN,~TJJRE(,/.~~OF PREPARER OTHER THAN.~::~?¢~.~..REPRESENTATI~f ~:~ J'~ ~ ~"~ ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 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 exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decodent's siblings is 12% [72 ES, §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. REV-f502. EX+ (6-9.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ES ~AI ~' OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or selt, both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right of survlvomhip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) RE~150~ EX+ (6-9S)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH J TOTAL (Aisc enter on line 2, Recapitulation) (If more space is needed, insed additional sheets of the same size) RE~-150~4 EX+ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 3, Recapituration) $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT 1. Name of Corporation Address / ¥/ ,J' I City / State __ Zip Code 2. Federal Employer LD. Number 3. Type of Business Product/Service FILE NUMBER State of In.rporation Date of Incorporation Total Number of Shareholders Business Repoding Year TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all fights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? If yes, Position 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ 7. 10. 11. 12. [] Yes [] No Annual Salary $ [] Yes [] No Time Devoted to Business Wastherelifeinsurancepayabletotheocrporationuponthedeathofthedecedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82? [] Yes [] No Ifyes, [] Transfer [] Sale NumberofShares Transferee or Purchaser Consideration $ Date Atlach a separate sheet for additional fransfels and/or sales. Was there a written shareholder's agreement in effect at the time of the decedenl's death? [] Yes [] No If yes, provide a copy of the agreement. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. Was the corporation 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. Didthecorporationhaveaninterestinothercorporationsorpa~nerships? [] Yes [] No If yes, repo~ 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 stock. B. Complete copies of financial statements or Federal Corporate Income Tax ratums (Form 1120) for the year of death and 4 preceding years. C. If the corporation 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. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their sataries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the docedent's stock. REV-'i 506 .EX+ (9-00~ -~- · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT FILE NUMBER 1. Name of Partnership Address City 2. Federal Employer LD. Number 3. Type of Business /7/ 7 Preduc se ,ce Date Business Commenced Business Reporting Year State__ Zip Code 4. Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $ A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. [] 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 12-31-82? [] Yes [] No If yes, [] Transfer [] Sale Pementage 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 [] 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? .................................... [] Yes [] No if yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. [] Yes [] 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 cepies of financial statements or Federal Parthership income Tax retums (Form 1065) for the year of death and 4 preceding years. C. ~fthepartnership~wnedrea~estate~submitalistsh~wingthec~m~~eteaddress/esandestimatedfairmarketva~ue/s.~freaiestateappraisaishave been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-'1507. EX+ (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) · COMMONWEALTH OF PENNSYLVAXlA INHERITANOE TAX RETURN RES)DENT DECEDENT ESTATE OF SCHEDULE E r CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All pmpsrby jointly-owned ~ the right of sundvorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER 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, JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of t'nancial institution and bank account number or similar identifying number Attach DATE OF DEATH DECD'S VALUE OF NUMSER TENANT JOINT ~ deed fgr jointly-beld rea/estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES TOTAL (Also enter on line 6, Recapitulation)$ (If more space is needed, insert additional sheets of the same size) C. OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM ~NCLUOE THE NAUE OF THE I~ANSFEREE' THEIR RELATIONSHIP TO DECEDEN~ AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALU[: NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE* VALUE OF ASSET INTEREST IIF APPtJCABLE) TOTAL (Also enteron line 7, Recapitulation) $ ._.~.,~,~:::9 . "-'- (If more space is needed, insert additional sheets of the same size) · COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. 5. 6. FUNERALEXPENSES: ADMINISTRATIVE COSTS: Personat Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State ___ Zip Year(s) Commission Paid: Attorney Fees Famity Exemption: (If decedent's address is not the same as claimant's, attach explanation} Claimant Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size} REV-iS12 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA rNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER 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 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER ESTATE OF RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE II 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and translers under Sec. 9116 {a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 19, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 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) FIE¥-,1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on REV-1500 Cover Sheet) ESTATE OF FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [] Will [] Intervivos Deed of Trust [] Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH UFE ESTATE IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Lite or [] Term of Years 1. Value of fund from which life estate is payable .......................................... $ 2. Actuarial factor per appropriate table ................................................. Interest table rate- [] 3 1/2% [] 6% [] 10% [] Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) ...................................... $ NAME(~)OF LIFE ANNUITAN~) [:)AT~ OF DE~T, [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years 1. Value of fund from which annuity is payable ............................................ $ 2. Check appropriate block below and enter correspoading (number) .......................... Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Monthly (12) [] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other ( ) 3. Amount of payout per period ........................................................ $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate- [] 3 112% [] 6% [] 10% [] Variable Rate _% 6. Adjustment Factor (see instructions) .................................................. 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 8 .......................... $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line $) + Line 3 .................................................. $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) LAST WILL ~ TESTAMENT OF MAXINE C. KEINERT I, M~XINE C. KEINERT, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my Husband's nephew and his wife, MORRIS G. STRICKLAND and MARY ANN STRICKLAND, or the survivor of them. Should both MORRIS G. STRICKLAND and MARY ANN STRICKLAND, predecease me, I give, devise and bequeath the residue of my estate, of every nature and wherever situate, equally, to the then-living children (not to include grandchildren) of MORRIS G. STRICKLAND and MARY ANN STRICKLAND. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my Husband's nephew and his wife, MORRIS G. STRICKL~I-:D and ~.~RY ~ STRICKL~ND, or the survivor of them, Executors of this my Last Will and Testament. Should both MORRIS G. STRICKL~ND and MARY ~ STRICKL~ND, fail to qualify or cease to act as Executors, I nominate, constitute and appoint MICHAEL J. STRICKLAND, Executor of this my Last Will and Testament. FIFTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. - Page 2 of 2 Pages - IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typewr~ten pages, each ~dent~fied by my signature, this / -- il Ma~ine C. ' F~iner% (SEAL) Signed, sealed, published and declared by the above-named Testatrix, M~XI~L~- C. KEINERT, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have ~eunto subscr~ur names as witnesses. COMMONWEALTH OF PENNSYLVANIA) : COUNTY OF CUMBERLAND ) SS. I, MAXINE C. KEINERT, 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged befor~ me by F~%XINE C. KEINERT, the Testatrix, this ~S~- day of %~.%w.~<f , 1991. 'Ma~i~e C. Kein~%, Testatrix Notary Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) C4~, Bom. Ournbefland C4~nty My Cornrr~io~ ~xpir~ Ja~. 6, 1~ ~e, RONALD E. JOHNSON and /~. Y ~/~,'', ~-- , the witnesses whose names are signed %o the at%-~ched or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that MAXINE C. KEINERT signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and s~bscribed to before me by RONALD 7~F.~ /~. ~'~c , wltne~es, this E. JOHNSON and . ' ' ~m day of ~,~/w~ , 1991. , S~AL) -~?ess , Witness Notary Public ( ~ '*~ ~.~m,N~p~ L My ~m~ Extrude. 170 York Rd. Carlisle, PA 17013 Carlisle (717) 249-2215 Harrisburg (717) 234-0662 | -800-745-481 I Fax (717) 249- ! 437 Family Ford Mercury I~0. 170 York Road Carlisle, PA ~ 7013 Ph: 249~2215 Manufacturers and Traders Trust Company, 1958 Spring Road, Carlisle, PA 17013 717 240 4521 r,~×717 241 7754 Morris G Strickland 690 Creek Rd. Carlisle, Pa 17013 Dear Moms G Strickland, This letter is to certify that on September 27, 2004, the date of death for Maxine Keinert, the balance on her personal checking account #521752 was $5,474.85 at the start of the day. Due to several checks cleating, the end of the day balance was $5,330.54. Sincerely, Rebecca A. Dorwart M&T Bank 1958 Spring Rd. Carlisle, Pa 17013 (717) 240-4521 Page: l'Document Name: Sessiona __ STFD 1 THF TRANSACTION STMT FORMAT 04/10/22 10.27.20 STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE ACTION COID PROD CODE DDA ACCT 521752 SHORT NAME KEINERT MAXINE CURR CODE PAGE 3 SEARCH FROM 104/08/24 THRU 104/10/08 ACTN POST EFFECTIVE CHECK NUMBER TRANAMOUNT D/C BALANCE 09/27 09/27 o9/27 09/29 PF: TRACE ID DESCRIPTION __ * 09/21 29.50 D 091000010040526 DELUXE CHECK CHECK/ACC. __ * 09/23 5343 50.00 D 5517165110 CHECK NUMBER 5343 __ * 09/23 1.00 D I-GEN104092300000457 FEE FOR CHECK RETURN OPTION 09/24 5348 515.00 D 5134925111 CHECK NUMBER 5348 5349 99.55 D 5135468876 CHECK NUMBER 5349 5347 28.76 D 5135486674 CHECK NUMBER 5347 5346 16.00 D 5135470330 CHECK NUMBER 5346 5350 50.00 D 5518512555 CHECK NUMBER 5350 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ll-CUTO -STSM 6,040.85 5,990.85 5,989.85 5,474-85 5,375.30 5,346.54 5,330.54 5,280.54 Date: 10/22/ 4 Time: 10:27:25 AM CORNERSTONE F e d e r a t ( ~ e d i t U n i c~ n P.O. Box I 181,5 East Gate Drive. Carlisle, PA i 7013 Telephone (717) 249-1661 FAX (717) 249-8208 Member Jbunded Service based www. cornerstonefcu.org October 14, 2004 Moms Strickland 690 Creek Road Carlisle, PA 17013 RE: Maxine C. Keinert SS//: 172-24-8694 Dear Sir: Per your request I am providing the following account information on the above referenced member. The account was opened 11/06/1974 and had a regular savings account with an interest rate of 1.00%. The balance on the date of her death was 7070.11. Please see attached documentation of her account. If you require any further information, please contact our office at the above number. Sincerely, Metinda Pannebaker Member Service ~ORNERS~ONE FEDERAL C.U. ?.O BOX 1181 ~ARLI'SLE PA 17013 (717) 249-1661 £Z-Member Inquiry 4ember: 25 - MAXINE C KEINERT SSN: 172-24-8694 Date Range: 01/01/2004 - 10/15/2004 ~hare Record: 01 - REGULAR SHARE ACCOUNT Frx Post Transaction Chk Post ~o. Date Description No. Srce 1 04/01/2004 DIVIDEND 30 2 05/27/2004 DEPOSIT 1 3 05/28/2004 WITHDRAWAL 1 4 06/04/2004 DEPOSIT 1 5 06/16/2004 WITHDRAWAL 1 6 07/01/2004 DIVIDEND 30 7 07/09/2004 WITHDRAWAL 1 8 09/09/2004 WITHDRAWAL 1 9 10/01/2004 DIVIDEND 30 10 10/04/2004 DEPOSIT 1 DIVS TO CLOSE AC 11 10/04/2004 WITHDRAWAL 22766 1 12 10/04/2004 CLOSE ACCOUNT 22767 1 End Amount 6.47 5000.00 -300.00 557.68 -300.00 11.29 -200.00 -300.00 18.44 .78 -7064.33 -25.00 Date Printed: 10/15/2004 Transaction History Ending Fee Balance 2601.14 7601.14 7301.14 7858.82 7558.82 7570.11 7370.11 7070.11 7088.55 25.00 .00 )RNERSTONE FEDERAL CREDIT UNION ............ Rec .......... T R A N S A C T I 0 N ......... New ...... Avail-- Effec Date Code Description Amount Fee Balance Balance 10/04/2004 O1-Reg WITHDRAWAL -7064.33 25.00 .00 lember No,: ;eller No,: Use Only: MAXINE C KEINERT Cash: 866 CARLWYNNE MANOR - AP7 C304 Check: CARLISLE PA 17013-1533 JV: Total: -Paid In- -Paid Out- .00 .00 .00 7064.33 .00 .00 7064.33 25 Check: 22766 11 Time: 11:47 (SWD.~33. b2. hll.d1278> 30th Anniversary Loan Specials now thru Oct. 23. Car rates from 3.95%-5.20% APR. Home Eouitv rates from 4~95%-6~20% APR. )RNERSTONE FEDERAL CREDIT UNION RECEIVED BY .......... Rec Effec Date Code 10/04/2004 O1-Reg ....... T R A N S A C T I 0 N ......... New .... Avail-- Descript ion Amount Fee Balance Balance CLOSE ACCOUNT -25.00 .00 .00 ~ember No.: Feller No.: ] Use Onlv: MAXINE C KEINERT Cash: 866 CARLWYNNE MANOR - APT C304 Check: CARLISLE PA 17013-1533 JV: Total: -Paid In- -Paid Out- .00 .00 .00 25.00 .00 .00 .00 25.00 25 Check: 227~7 11 Time: 11:49 <SWD.~33. b2. h12. d1283) 30th Anniversary Lean Specials now thru Oct. 23. Car rates from 3.~5%-5.20% APR. Home E~uitv rates from 4.~5%-~.20% APR. Maxiuc (7 Keincu 866 Callwynllo Manor Ap~ C Carlisle. PA Mr Jolm W Calbaugh Reg. Rep }~lYK!kwood ]I/¥eSHTIeDI Advisors, [nc 19 Brookwood Ave. Suite 103 CarlisD. ~% 17013 717-243- 8777 Holdings by Investor Date 09/27/2004 ( reateA 10/08/2(}04 Maxine C Keinert Acct Name: iRA FB© MAXINE C KEINERT PERSHING LLC AS CUSTODIAN R©LLOVER ACC©UNT 856 CAFILWYNNE MANOR APT C 304 CARLISLE PA 17013-1533 Acct No: 5CR 152348 Acct Type: Asset Name Ticker Asset Type BROKERAGE MONEY MARKET CASH OR EQUIVALENTS FEDERAL NATL MTG ASSN DEB 7.125% 01/15/30 B/E DTD 01/15/00 RYDEX SERIES-JUNO C FIXED INCOME FIXED INCOME Pershing LLC Retirement Account Mgt. Name Quantity Price(S) BROKERAGE 2,141.30 1.00 MONEY MARKET 30,000.00 1,26 value(S) 2,141.30 1.01 18.56 FIXED INCOME 30,000.00 30,36750 RYJCX FIXED INCOME RYDEX FUNDS 722.89 Account Total: 13,416.88 $45,499.39 investor Total: $91,963.07 FEDERAL HOME LN MTG CORP MEDIUM TERM NTS 5.000% 01/30/14 B/EDTD 01/30/04 CLB RYDEX SERIES-JUNO C 1856 37,687,50 RYJCX RYDEX FUNDS 357.48 6,63488 Account Total: $46,463,68 Acct Name: MAXINECKEINERT 866 CARLWYNNE MANOR APTC CARLISLEPA 17013-1533 Acct No: 5CR150482 AcctType: Individual Asset Name Ticker Asset Type Mgr. Name Quantity Price(S) Value(S) BROKERAGE MONEY MARKET CASH OR BROKERAGE 1.715.01 1 00 1 71501 EQUIVALENTS MONEY MARKET 8f~6 Carhvynne Manor Apl ( Carlisle, R& 17013 M~ John W Carbau.~h Re~. Rep~ 19 Brookwood Ave. Suite 103 Carlisle, PA 17013 717-243 8777 ttoldings I~y Investor Date 09/27/2(X)4 Created 10/08/204)4 Disclosure: For fee-based accounts only: The figures may or may not reflect the deduction of investment advisory tees If the investment is being managed through a fee-based account or agreement, the returns may be reduced by those applicable advisory fees Refer to your Advisor's Form ADV, Part I1 The Inlormation contained in these reports is collected from sou(oes believed to be reliable, However, you should always rely on your statements received directly trom product sponsors If you have any questions regarding your report, please call your representative 0 0 o°' CZ 0 0 0 m COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STRICKLAND MARY ANN 690 CREEK ROAD CARLISLE, PA 17013 nnnn IOld ESTATE INFORMATION: SSN: 172-24-8694 FILE NUMBER: 2104-0957 DECEDENT NAME: KEINERT MAXINE C DATE OF PAYMENT: 02/16/2005 POSTMARK DATE: 02/16/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/27/2004 NO. CD 004957 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,979.37 I I I I I I I I TOTAL AMOUNT PAID: $1,979.37 REMARKS: CHECK# 1376 SEAL INITIALS: CCP RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INOIVIDUAL TAX~S INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLDWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547EXAFPIl2-D4l ,",,1 -, 02-14-2005 KEINERT 09-27-2004 21 04-0957 CUMBERLAND 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN MAXINE C MARK W ALLSHOUSE 4833 SPRING RD SHERMANS DALE Allount Rellitted PA 17090 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV ::[Aii'f-Eit-AFp..C81-:6!'-t16TYci.OF-INHEi-I-TAN.ci-Y-AX.1,r"AA-isii"ENT~..ALtowANCE.oii......-........-. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KEINERT MAXINE C FILE NO. 21 04-0957 ACN 101 DATE 02-14-2005 I X) CHANGED SEE ATTACHED NOTICE TAX RETURN WAS: I ) ACCEPTED AS FILED 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 OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets .00 57.802.68 .00 .00 12.400.65 .00 5.980.00 IB) NOTE: To insure proper credit to your account} subllit the upper portion of this form with your tax payment. (1) (2) (3) (4) (5) (6) [7) 76,183.33 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 10,187.51 (9) (10) .00 Ill) (12) (13) [14) 1 n .187 ~I 65,995.82 .00 65,995.82 NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 65,995.82 X 15 = 9,899.37 (19)= 9,899.37 TAX CREDITS: <ft",,,,, ,., AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 1-) 12-08-2004 CD004711 396.00 7,524.00 PAYMENT MUST BE MADE BY 06-27-2005*. TOTAL TAX CREDIT 7,920.00 BALANCE OF TAX DUE 1,979.37 INTEREST AND PEN. .00 TOTAL DUE 1,979.37 ~. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A IICREDIP' (CR).. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED.. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. REV.'470EX(6-88) ~~ ~ INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME MAXINE C KEINERT FILE NUMBER REVIEWED BY John Kealy ACN 2104-0957 101 ITEM SCHEDULE NO. J EXPLANATION OF CHANGES Changed tax rate to 15%. The decedent's will devises the residue to "my Husband's nephew and his wife or the survivor of them" both of whom are collateral heirs. ROW Page 1 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-1607 EX AFP (03-05) MARK W ALLSHOUSE 4833 SPRING RD SHERMANS DALE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-28-2005 KEINERT 09-27-2004 21 04-0957 CUMBERLAND 101 Allount Rellitted MAXINE C PA 17090 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 ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF KEINERT MAXINE C FILE NO. 21 04-0957 ACN 101 DATE 03-28-2005 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: 02-14-2005 PRINCIPAL TAX DUE: 9,899.37 PAYMENTS (TAX CREDITS): PAYMENT DATE 12-08-2004 02-16-2005 RECEIPT NUMBER CD004711 CD004957 DISCOUNT (+) INTEREST/PEN PAID (-) 396.00 .00 AMOUNT PAID 7,524.00 1,979.37 --\) f.,I.) ~-,'"' TOTAL TAX CREDIT 9,899.37 BALANCE OF TAX DUE . IF PAID AFTER THIS DATE, SEE REVERSE 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 FORH FOR INSTRUCTIONS. ) TOTAL DUE .00 .00 .00 INTEREST AND PEN. ~s."- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: Maxine C. Keinert Date of Death: September 27,2004 Will No. 21-04-0957 Admin. No. 2004-00957 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...K.; No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes_; No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. 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: 'flIP/OS r ~"r) ture k W. Allshouse, Esq e Attorney In #78014 4833 Spring Road Shermans Dale, P A 17090 (717) 582-4006 !' 1 ( , Capacity: _ Personal Representative -L Counsel for Personal Representative erA