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HomeMy WebLinkAbout04-0968 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of/l~ills ~for the . / · Deceased. County off i~xlIDfI~I.~4LA~ in the Social Security No. _..9.F2~, -/_..2 --(~O~ ~ Commonwealth of Pet~hsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or pJder an~the execut named in the last wilt of the above de.ccdent, dated .d4~o~l ~". ~.tDF)} , 19___ and codicil(s) dated ~ ~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) t Decendent was domiciled at death in (~/~ ~ ~:c~tP [~[t.}0~ County, Pennsylvania, with h.~_~t~last family or p. rincip~l resi~ten~,a}'~ ,M~t~2Ot°~ I (list street, number and muncipality) Decendent, then 7 7 years of age, died ~-/q , Except as follows, d<edent did not marry, was not divorced and did not have a child born or adopted after execution of the ,wi~)gf2~red for probate; was not the victim of a killing and was never adjudicated incompetent: /~//r'! .~. Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ /~7,, tO00, ~ (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: WHEREFORE, petitioner(s) respectfully re_fluent(s) the ,p.ro_bate of the last will and codicil(s) presented herewith and the grant of letters '-~m"PA-AqF, L/y-A4~_? (testamentary administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL PRESENTATIVE CO~ONWEALTH OF PENNSYLVANIA } COUNTY OF C~~ _ ss 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 ~ personal represen- tative(s) of the a~ve decedent peti~oner(s) will well ~gd truly administer the estate according to law. Sworn to or affirm[~and subscribed ~ ~' ~~ ~ before me this ~ day of ~ : - ~' ~ q-~ _ ~egRe,~er L ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~/O)tC'/Or ~ilk -~--' Pursuant to Rule 6.12 of the Supreme Coum OChans' Cou~ Rules, ! repom ~e following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No ~ 2. If the answer is No, state when the personal representative reasonably believes that the adminis~ation will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did fl~e personal representative file a final accost with the CouP? Yes No ~ b.The separate OChans' Co~ No. (if any) for the personal representative's account is: ~ c.Did the personal representative state ~ account info,ally to the pa~ies in interest? Yes ~ No ~ c. Copies of receipts, releases, joinders and approval of focal or infomal accounts may be filed with ~e Clerk of the O~hans' Cou~ and may be attached to this re~. ~a Date: lt /qm / [ ,.. ,:~ Nam~ : ..... , Telephone No. Capaci~: ~Personal Representative ~Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 REV-1162 EX(11-96) HARRISBURG, PA 1 7128-060] RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT E~ NO. CD 004655 COULSTON SHIELA DUPLICAT 103 WILLOW MILL PARK RD MECHANICSBURG, PA 17050 ACN ASSESSMENT ........ ,o,,:, CONTROL AMOUNT NUMBER lOl I 81,3oo.oo ESTATE INFORMATION: ~ SSN: 209-12-6093 FILE NUMBER: 2104-0968 DECEDENT NAME: SUNDAY ANNA M : DATE OF PAYMENT: 11/22/2004 \ POSTMARK DATE: 11/19/2004 ~ COUNTY: CUMBERLAND DATE OF DEATH: 08/19/2004 TOTAL AMOUNT PAID' 81,300.00 REMARKS: CHECK# 1380 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER S____TRASBAUGH REGISTER OF WILLS REGISTER OF WILLS No. Estate Of ~x~c~c~o~z~ ~~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 0~Og~_o~ ~ ~ ~00~ ~___~, in consideration of the petition on the reverse side hereof, satisfacto~ proof having been presented before me, IT iS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of~_~~ and Letters -Fee %3ct~r~ ~'be, ~ ~ _ are hereby granted to ~.-~ ~o~~ FEES Probate, Letters, Etc .......... ~ Short Certi~cates(X ) .......... $ ~ ,C~,_~ ATTORNEY (Sup. Ct. I.D. No.) $ I0 . OO ADD.SS TOTAL $ O~. ~ Filed .... ).Q. :. ~.~.z. ~ ............... PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ' L Local Registrar P 10529839 2,82004 No. ~ Date CERTIFICATE OF DEATH ~. An~ ~e Sunday ~.Femle ~ 209 -- 12 -- 6093 ,Au~st 19, 2004 77 Y~ t3-1-1927 ~ec~nlcsburg, ~ ~-~D ~0 ffi ~D ~ D C~erland C~p Hill .. ~nor Care - C~p Hill ~S ARMEOFORCES? [ ~o~aeem~) MARIT~STATUS*M~ Shiela Coulston ~.103 Will~ Will Park Ne~h~icsburE,PA 17050 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of)/~ills ~for thg / , Deceased. County of( ~/~tOfA/~ in the Social Security No. _~,~"9~, -/__2 --{_,~0~ ~ Commonwealth of Pe~hsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or pJder an~the execut named in the last will of the above de?~e~den~ d_ate/zd.~.~~ .Ad~ off ~ .~?.t'9~' I ,19___ and codicil(s) dated a~z~z~_~?_ _ Descendent was domiciled at death in fll ,~ ~:~/~/tn~'~c)4~ County, Pennsylvania, with ~ last family or p. rincip.~l resik]en~at~ / (list strew, number ~d muncipality) Decendent, then ? 7 years of age, died ~-/~ , ~, at ' Except as follows, decedent did not marry, was not ~vorced and did not have a child born or adopted after execution of the ],i~f~red fo~ probate; was not the victim of a killing and was never adjudicated incompetent: /~ / r/,... Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) ~1 personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Person~ property in County $ V~ue of re~ estate in PennsylvaMa $ situated as follows: WHEREFORE, petitioner(s) respectfully re_g.que§t(s) the ,p.ro_bate of the last will and codicil(s) presented herewith and the grant of letters (testamentg. ry; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE ~'. CO~ONWEALTH OF PENNSYLVANIA ~ COUNTY OF C~ ~~ The petitioner(s) above-named swc~(s) or affirm(s) that thc statements in the foregmng petition truc and correct to the best of the knowledge and belief of peti~oner(s) ~d that as personal represen- tative(s) of the a~vc decedent petitioner(s) will well and truly ad~nister thc estate according to law. before me this ~ day of ] ~ - No. Estate Of ~c~,~o~"T~__ Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 0~CO~ Ib,~ 9~ Lv _,'9,©O~/ ~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated .~- ~ - (")\ described therein be admitted to probate and filed of record as the last will of(Xx-x'x,n~- m.,-~ o ~a-~. jl~ are hereby granted to ',~.~ ~,-~.~ Qc:~xok,sk~v._. Probate, Letters, Ere .......... ~ Short CertificatesO ) .......... $ _~ .C2k.~ ATTORNEY (Sup. Ct. I.D. No.) l~t~p~O~.(~c~x~o $ ~-~ $ I~ , O~ ADD.SS TOTAL $ ~. ~ Hled .... I.~. 7. ~.~.z. ~: .............. PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ocalReg, P 10529839 No. ~ Date CERTIFICATE DEATH ~. An~ Hae Sunday Fe~le 209 12 6093 19, 2004 77 3-1-1927 I C~p ~ill ~nor Care C~p Clerk ~a. Dtvorced 103 ~t11~ ~tll Park Road B~er ~. Clouser ~ellte Jane ~yera Shtela Coulston ~.103 ~t11~ ~tll Park Road 17050 ~m~c~m~.~s~ u~o,.v,,~ ~rmtton Society of ~ ~ 23 ~ 2004 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, ANNA MAE SUNDAY, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married, and that I have two children, JON J. SUNDAY, bom May 23, 1945, and SHIELA A. COULSTON bom August 4, 1947. II I direct that ail my just debts and funeral expenses shail be paid from my residuary estate as soon as practicable after my decease. III I direct that ail taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shail be paid from my residuary estate as a part of the expense of the administration of my estate. IV I hereby give, devise and bequeath the following specific requests: To my daughter Shiela A. Coulston, I hereby give my red wooden chair that belonged to my mother and which is currently located in my bedroom. To my granddaughter Amy Marie Coniston I hereby give, devise and bequeath ail my reai estate, including the buildings located thereon, said real estate being approximately 40 acres of land and located at an address known as 131 State Road, Mechanicsburg, Cumberland County, Pennsylvania. In addition, the mantle clock which is located in the house is to remain with the house and the "little chair" made of red maple is also to be given to my granddaughter Amy. V All the rest, residue and remainder of my estate, whether reai or persoh~wher~er situat~I hereby give, devise and bequeath to my children, Jon J. Sunday and Shiela Al Coul~[gn, in e~l~ shares, per capita, provided that each survive me by thirty (30) days. ~ VI I nominate, constitute and appoint my daughter, SHIELA A. COULSTON as Executrix of this LAST WILL to serve without bond. If my daughter is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my granddaughter, AMY MARIE COULSTON as Executrix of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, ANNA MAE SUNDAY, have set my hand to this LAST WILL this~'~"~day o f ~*,r't~ ,2001. ANNA MAE ~UNDAY ~ Signed, sealed, published and declared by the above-named ANNA MAE SUNDAY, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. 2 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : I, ANNA MAE SUNDAY, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. ANN~. MAE~SUNDAY' U Sworn or affirmed to and acknowledged before me by ANNA MAE SUNDAY, Testatrix, thi~'-'6(-4tay of -)3"'~c/,~_ , 2001. No~y-Public IMechNotarial Seal '1 Anne Carmody, Notary Pub~i_o [ AFFIDAVIT ~y Commission Expires Mar. 11, 2002 ] COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : the wimesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL; that ANNA MAE SUNDAY signed willingly and that she executed it as her free and voluntary act for the purposes 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 the time 18 years of age or more, of sound mind and under no constraint or undue influence. Sworn or.affirmed to and acknowJedged before me th s¢ day 4_; , 2001. ?tary Public Notana~ Se~ Anne C~, Notaqt Public ~bu~ B~ Cum~ Cou~ My ~miss~ ~1~ ~. 11, ~02 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/01/2005 COULSTON SHIELA 103 WILLOW MILL PARK RD MECHANICSBURG, PA 17050 RE: Estate of SUNDAY ANNA MAE File Number: 2004-00968 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 02/05/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~F=:~ Clerk of the Orphans' Court cc: File Counsel Judge L- CERTIFICATION OF NonCE UNDER RULE 5.6Ia) Name of Decedent: I l .,~ L r4 , li ~' ):;,),~'I Date of Death: /'1-;') , Will No, I "1 ':; / "If ' .-- I (,',1 Admin, No, ,')-I! I{,I 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 ' . , ii' I i/ : N= Address / - ': I '-j i,j ! / \ 'I, - '''",.:,', I 'I J. j " -' I' ' , I ,1'1 i 1/." /, _ ' 0.,1/ ,.. [,.! (" . " .1 I~"I J -I"^/ / 'f" \ ',// / ('1" I , I' ' _' , "/ ..1'''1 I / , . /i..- J L Notice has now been given to all persons entitled thereto under Rule 5,6(a) except Date: Signature Name / . ! / .. J./ . / 'f..... / . (. I ... ......__ j' Address // , IL , .! t. 1//,.// i!\ / 1 f I ,,( j / II!,: I I!. I j '.- \. ,,1,(, .;..;, ./ (L. ~(: ;1 / I Telephone ( ) ! "i ' II! -/(/.1' / Capacity: i..- Personal Representative _Counsel for personal representative -:r ,EV.l500 EX 16-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ~Du{' LoD.c.D ti5o,dR. E V -1 500 f\?D \O-tfj -tt $" INHERITANCE tAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21--Q~ COUNTY CODE YEAR Q9-~:L_ NUMBER SOCIAL SECURITY NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) / DATE OF DEATH (MM- 0- EAR) DATE OF BIRTH (MM.DD-YEAR) I- Z W C W (,) W C w ... ::&:::s~ (.)8:0 woo "'",-, 0.... .. < ... z w c z o .. w w '" '" o o z o ~ ,:J '1- ii: <( (,) w a:: z o !;t I- :J c.. == o (,) X ~ ,- _._~ ..), THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Allach copy 01 Will} o 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death alter 12-12-82) o 7. Decedent Maintained a Living Trust {AtlBch COllY of Trust} D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prXlr \0 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Election to tax under Sec. 9113(A) (Attach Sch 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. lJebts of Decedent, Mortgage liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmenta! BequestslSec 9113 Trusts for which an election to tax has not been mede (Schedule J) 1, Reel Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 14. Nel Value Subject 10 Tax (Line 12 minus Line 13) (1) (2) (3) (4) (5) ( D 3 LtHI!otL) .t1d ( PARK Rd.. !v1;.J f4--,V , 'c.$ h Ll R P,4- I 70 !:; lJ o OFFICIAL USE ONLY () o o 2J.~7'X o (6) (7) o , (S) ,;,;< 10 79' (9) L/xr;,:J.. o (10) (11) (12) (13) Lj ,'i( (", ;;t 17 'JCr; to (!.; SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) i 78'(P b 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.~ x ,0 (15) ~ x ,0'i!:2. (16) o >fOY D (] ',JOy- x ,12 (17) x .15 (16) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . '.> BE'SU C'TO~j,NSWERAl.lQUEStIONS'()H~~~~l.' N!'f~!'C~'~ i$.'W~"t{;",,;;~;-;,,-'~ ,::~,~;:;'-'C. Decedent's Complete Address: STREET ADDRESS CITY M' Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) I~&{') 40 Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( 0 + E) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) ZIP -0 >Joy /3LfO o ~~0 () o t7 Make Check Payable to: REGISTER OF WILLS, AGENT ~. __..D. _ ~.. .. J '_._ __ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;........................... ................... ................. D b. retain the right to designate who shall use the property transferred or its income; ........ ..................... D c. retain a reversionary interest; or........ ................ ........................ ................... .......... ..... D d. receive the promise for life of either payments, benefits or care? ............................. .............................. D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........ .................................... ......... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................. ................................................. ...................... ..... D No IX1 5(j ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, 1.&1 Under penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the flersonal reprt:sentative is bi:lseG on ali information of wh!c~, preparer has any kncwledge. ADDRESS f. .~':? -t ~ DATE 1Illlllm I mrfliUiIUlLJ'IUllnrilin:n",'iU_llIlUIIt''llllilIUl mfJ..:.lJl\i!l11ll~Wr 1lI!fl~~t1lellgli!lmllliJilll n 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. 99116 (aJ (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. 99116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Juiy 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)J. 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'''''''.''.''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST Alf OF HtJlJA )vi f'rL SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS C:;''1IJd-A.Y FILE NUMBER ,J.tY'4 -"i(! 9 L,.,'?' Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. (,uf.S+X IN I shIL C&-tc:kiG'I .25C) 3 Hw{K.... !vl€::<<o~i/y{ ;..Je"-/& /4 S-u FeaL e/;- FL6LLJ(j0...S 450 dc+t-e-5 100 ,t1IAJ ts-tLR... (5 M.Qov .#ith~u4-kf ) 15D B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s} ( EIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's addreS5 is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 1. I Probate Fef;:s I.cW Accountant's Fees l 5. 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapilulation) . '-( ~/~ . (If more space is needed, insert additional sheets of the same size) REV"''''"'"* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA~ OF i ,}vA ,J,1I4-C FILE NUMBER . :;( ;0()4 -{J()9 to ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AArt-ta !/ 14-1 [J8;~ Pol t'ct M;;z1 ,X .t1 Cl- ., 'J J4c.c0(t ,0 +- l,}LJfo 13,1-:;.- f<. 3, 5A-h- +'1 'bfPo5ir 13CJ)<.. 5'43 TOTAL (Also enter on line 5, Recapitulation) $ ;;',;2 to 7 If (If more space IS needed, Insel1 additional sneets oftne same Size) ~m.,,-p ~~~ " ,'" L .~ c} f}. '--_,~1-'. <' --- '. .' f. (::-;,_.~. ~ _._ t..'..... ,''v' ACCOUNT NO. ACCOUNT TYPE STATENENT PERIOD PAGE 832499 N&T DIRECT CHECKING AUG.IO-SEP.09~2004 1 OF 1 00 5 04342N N 021 676 ANNA MAE SUNDAY SHIELA COULSTON 103 WILLOW MILL PARK RD MECHANICSBURG PA 17055 CARLISLE PIKE BEGINNING DEPOSITS & OTHER ... CURRENT ENPING BALANCE OTHER ADDITIONS CHECKS' PAID SUBTRACTIONS INTEREST PO BALANCE NO. ANOUNT NO. I ANOUNT NO. ANOUNT 870.18 3 1..726.97 51 1,740.00 1 1. 00 0.00 856.15 ACCOUNT SUMMARY POSTING . DEPOSITS,INTEREST CHECKS &. OTHER llAny DATE TRANSACTIoN DESCRIPTION .. & OTHER ADDITIONS SUBTRACTIONS BALANCE 08-10-04 BEGINNING BALANCE $870.18 08-10-04 JEFFERSON-PILOT EFT PVNNT 226.97 1,,097.15 08-16-04 DEPOSIT 1,400.00 08-16-04 CHECK NUNBER 1372 35.00 2,462.15 08-27-04 CNECK NUNBER 1374 933.00 08-27-04 CHECK NUNDER 1373 610.00 919.15 08-30-04 DEPOSIT 100.00 1,019.15 08-31-04 CHECK NUNBER 1375 150.00 869.15 09-01-04 CHECK NUNBER 1377 12.00 857.15 09-09-04 FEE FOR CHECK RETURN OPTION 1.00 856.15 ENDING BALANCE $856 .15 - ACCOUNT ACTIVITY CHECKS PAID SUNNARV 1372 08-16-04 1375 08-31-04 35.00 150.00 1373 08-27-04 1377* 09- 01- 04 610.00 12.00 1374 08-27-04 933.00 WHEN IT CONES TO INVESTNENTS, HOW DO YOU KNOW WHAT'S RIGHT FOR YOU? LET THE N&T INVESTNENT GROUP HELP YOU BUILD AN INVESTNENT PORTFOLIO THAT FITS YOUR INDIVIDUAL NEEDS. TO NAKE AN APPOINTNENT WITH AN N&T SECURITIES FINANCIAL CONSULTANT, STOP BV YOUR NEAREST N&T BANK BRANCH TODAV. INVESTNENT AND INSURANCE PRODUCTS: * ARE NOT DEPOSITS. ARE NOT FDIC-INSURED . ARE NOT INSURED BV ANV FEPERAL GOVERNMENT AGENCV * HAVE NO BANK GUARANTEE * NAV GO POWN IN VALUE. "DC i'j/O::: --@NATIONAL WESTERN - LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE' AUSTIN, TEXAS 78752-1602 STATEMENT OF ACCOUNT (512-836-1010) ANNUITY CONTRACT NUMBER CURRENT (USE THIS NUMBER WHEN YOU NEED SERVICE OR MAKING ADDITIONAL PAYMENTS) 0100860]23 DATE 08/31/04 ANNA M SUNOAY 103 WILLOW MILL PARK RD MECHANICSBURG PA 1]050-1]61 ANNOUNCEMENT Our Automated Voice Response System is available aJ!,ain b.Y calling 1-888-695-5001, You mav also olltain financial information or request a statement by using our website at www.nationalwesfernlife.com. The Client Services uept. may also De contacteo at 1-800-922-9422. Your balance at the start of the vear MAYbe slightlv different from the previous year balance due to'an interest adjustment. PLEASE NOTIFY US IMMEDIATELY OF ANY ADDRESS CHANGE DEPOSITS NOTE: I DATE RECEIVED DEPOSIT I mE STATEMENT MAY NOT DATE RECEIVED DEPOSIT DATE RECEIVED DEPOSIT REFLECT TIlE MOST RECENT PAYMENT DUE TO RECEWT ****** NO ACTIVITY ****** AFTER STATEMENT DATE. TOTAL DEPOSITS .00 TOTAL WITHDRAWALS 11,200.00 ACTIVITY DETAIL FOR THE YEAR NOTE: INTEREST IS EARNED DAILY A!'II) IS COMPOUI'.'DED ANNUALLY ON THE POLICY NET SURRENDER VALUE AT STATEMENT DATE 20.562.46 ANNIVERSARY. IF THE VALUE SHOWN IS WITHDRAWN AS A LUMP SUM. IT MAY BE BALANCE AT START OF YEAR FROM PRIOR YEAR END STATEMENT. . . . . . . .. . . . 31,622.63 SUBJECT TO AN EARLY WITHDRAWAL PENALTY. PLUS DEPOSITS RECEIVED DURING PLEASE REFER TO YOUR STATEMENTPREIOD (SEE DETAIL ABOVE) ............................. .00 CONTRACT FOR EXACT CHARGES. ANY PLUS INTEREST EARNED (INTEREST IS COMPOUNDED WITHDRAWALS SHOWN HERE ANNUALLY ON POLICY ANNIVERSARy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506.08 WILL INCLUDE APPLICABLE SURRENDER CHARGES. LESS ADMINISTRATION CHARGES AND PREMIUM TAXES. . . .. . . . . . . . . . . . .. . .00 LOAN BALANCE........ . . ... . .......... .......... ............. .00 LESS WITIIDRA W ALS ............................................ 11,200.00 BALANCE AT STATEMENT DATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 20.928.]1 I ACCOUNT SUMMARY YIELD FROM INCEPTION 4.61% FQA60B ~Mf'UMM~S E.CJE.tr.~ .JtO>t;E:. 34 WEST MAIN STREET MECHANICSBURG, PA 17055 APPRAISAL Phone: 766-9422 ~-I~'C)S~ APPRAISAL Appraisal For: ~sfJ~ ot ,Aft/vA ^1AE S~N Jo( (I) !.-l-Icl:O-!;. clio-MeN) EA-Jqr-~.t 1(>.'''-7 -rh~ 'R;i\i ~{,4 J'--J Ki rl/ (fUI 9 <1101 M 17 u.1. f~ ft J:Qwt~ ,,{ APfI0;C'<'YI~7t/i 8r-Cl,\\h" 1M- ci:aY'-trJr--J ,'. A 'l(o""Ji ~A, I I 'Ii,} (},u1 u1 N.'7.. ~u" L,fy VA Iv-t 'FI 35, qO ( ~) MAN~ 14 IJ c>>t {~ J',U ~f 'D. lAA,..tA I 12.' n. '1 - lk.a. '1(': '\ f to tV s; sf.:, ~S-?c)',,,15 :;e+ ;N q /<-Ilq (;-Jk.1-l ,'''(v1fl, /' -A- 12Jvn { A,(1, II. kA J ftJJ Cl ~ ; c. ..... {/vI 1 ,-A;tiOC"f.C,. fd y 1 --r1A.~ Sfu('i ~ J=A.(( (j)~'o.(.'fr' VolUt 300' CC This appraisal, constitutes our carefully studied 0 inion f ~ :~: ~~:~~~~sPalalecsemet nt cost through our fa~i1ities 0 . no ure value of the ortlcle(s) described above insof . observation. 'We assume no liobil"t .~~ os the mountlng(s} have permitted taken on the b . of this apprOis~r. WI respect to any action that may be ,J l.lJII^.-VvL,------ Appraiser 1t/!;V-.485 Vf.,. ~.B!;ll '* SAFE DEPOSIT BOX INVENTORY COMMONWEAlTH 0' 'fNN5YlVANIA DEPARTMENT OF REVENUE I"HEIIIANa TAX DIVISION POST OffiCE lOX 8U7 HARRISBURG, fA 17105.8327 Plea.e Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE fiLE NUMBER SOCIAL SECURITY OR DEATH CERTI.ICATE NUMBER DATE OF DEATH (CITY) (STATEI (ZIP CODE) (CITY) (STATE) {lIPCODEI NAME. ADDRESS AND REL.ATlONSHIP (IF ANY) TO DECEDENT. OF PERSON!S) PRESENT AT THE BOX ENING .. INAMEI (RELATIONSHIP' (STREET ADDRESS) (CITY) (STATE) (1IfCODEI b. (NAMEI lRELATIONSHIP) (STREET ADDRESS) (CllYl (STATEI (liP CODE) c. (NAMEI (RELATIONSHIP) ISTREET ADDRESS) ICITYI (STATEl (liP CODE) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED INAME} ICITY) ISTATEI (liP CODE) .. b. (NAMEI (STREET ADDRESSI (STREET ADDRESSI (CITY! ISTATE) (ZIP CODEI ICllYl (STATEI (liP CODE) NAME AND TITlE Of EMPLOYE TAKING THE INVENTORY If v.., a. Oat. of will: b. Nam. f:lnd addr..s of p.rlanal ,epr.hntatlve, If named In the will (NAME} (STREET ADDRESS) (CllY} (STATE, (ZIP CODEI c. Name and add,e.1 af attorney, If any (NAME, (STREET ADDRESS) (CllYl 'STATE) IIIP CODE) Page of SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stock.: List in detail every common or preferred certiFicate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U. s. Government: Number of items, dote of issue.. face value" names in which registered . and type of ownership, i.e., jointly held, payable on death, elc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bonk and Saving. and Loan POllbook" Stote name of depositor, number of book, last date appearing in book, nome of bonk and branch, and balance. (6) Jewelry, Coins, Slamps, Manuscripts, elc: List and describe as fully as possible. (7) Deecl., Mortgage., Curren' .nsurance PoJities or other evidences of indebtedne.s: list and describe as fully as possible. (B) All olher conlenls. ITEM NO. ITEM DESCRIPTION I certjfy under penalty of periury that the above record i. correct and complete to the be.t of my knowledge and bellef.1f)~L ,,O<(fQJ((Io.(I) 1\r1\m Slgnatur. Dl.t. \0(~II', If fl OOOll -!:?i'M.ct bd{\ t tr Print No and Tltl. Non: Attach additional BY," xII" ,heet(,) If necenory or u.e duplicate. of thl. page of form. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 338 5/2/2005 ANNAMAE SUNDAY 21-04-0968 SHIELA COULSTON 103 WILLOW MILL PARK RD JA MEGIANICSBURG, PA 17050 Qty 1 Fee Description Additional Probate Fee 10.00 Total $10.00 Total: $10.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please rerum one copy of this invoice with your payment. Thank you. BUREAU OF INDIVIDUAL TAU,s,rc,y INHERITANCE TAX DIVISION - PO BOX 2B060I HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) '. DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-29-2005 SUNDAY 08-19-2004 21 04-0968 CUMBERLAND 101 Amount Remitted ANNA M . r t, SHIELA COULSTON 103 WILLOW MILL MECHANICSBURG PK RD PA 17050 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF SUNDAY ANNA M FILE NO.21 04-0968 ACN 101 DATE 08-29-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-11-2005 PRINCIPAL TAX DUE: 804.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-19-2004 ~ CD004655 40.20 1,300.00 08-12-2005 REFUND .00 536.20- TOTAL TAX CREDIT 804.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) RA Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 COULSTON SHIELA 103 WILLOW MILL PARK RD MECHANICSBURG, PA 17050 RE: Estate of SUNDAY ANNA MAE File Number: 2004-00968 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS I 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 decedent1s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/19/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, A' . ~p c /:l;:; ~ . V' J~'VJiJ!:&r.tfr~. V ,/' I Gle~da Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: fJ~1G14 /II4L 51./.../df47 Date of Death: 9~ /C( - C [/ ( Estate No.: ;;!./ - c Lj.- r>l0[? Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of me acL.Tililistration oft.~e above-captioned estate: 1. State whether administration of the estate is complete: Yes l2?1 No 0 2. Ift.~e answer is No, state 'when t~e 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 fmal account with. the Court? Yes 0 No rgJ 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 2J No 0 c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 7 p s/C{. I Ad&ess nt t: ~ (;?'i-c2Lir?? Telephone No. ,. ....'.,.. '..~ t.. Capacity: ~ Personal Representative o Counsel for personal representative j ~ J -.,;\... .......,) ~ ./