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HomeMy WebLinkAbout04-1018~state of also kHOWH as DORIS A. FOWLER PETITION FOR PROBATE and GRANT OF LETTERS No. To: Register of Wills for the Deceased, Connty of Cumberland in the Commonwealth of Pennsylvania Social Security No. 190-26-6811 _ The petition of the undersigned respectfnlly represents that: Your petitioner is 18 years of age or older and the Executor named iu the last will of the aboxe decedent, dated February 6, 1996, and codicil(s) dated [none]. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 103 Ridge Road, Boiling Spriugs, South Middleton Township. Decedent, then 70 years of age, died October 18, 2004, at 103 Ridge Road, Boiling Springs, PA 17007. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompeteut: Decedent at death owned property ~vith estimated values as follows: (If domiciled in Pa.) All personal property $ unestimated (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Valne of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioncr respectfully requests the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. Donald Dean Fowler I03 Ridge Road Boiling Springs, PA 17007 (717) 258-3425 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUM BERLAN D ) Tile petitioner above-named swears or affirms that the statements itl tbe lbrcgoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affim~ed and subscribed before me this _ q day .o,f Regisler Donald Dean Fowler No. ~-I-()q-{0i~ Estate of Doris A. Fowler, Deceased DECREE OF PROBATE AND GRANT OF LETTERS ANDNOW, ~0i/ 10, ~0(74 , in consideration ofthe petition on the re,,ersc side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 6, 1996, described therein be admitted to probate and filed of record as the last will of Doris A. Fowler and Letters Teslamcntary are hereby granted to Donald Dean Foxvler. Will Book # Page FEES Probate, Letters, Etc. Short Certificates( ) TOTAL Reg stet ofW,11s [?~ Ivo V. Otto Ill, Es ui,:e (27763) q ATTORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 Filed CERTIFICATE OF DEATH , /~ ~" ~ F-d~z' -3 McConnellsburg ~'~] ,,..Housewife Domestic ,~ ~o,a/~ 103 South Ridge Road Boiling Springs, PA 17007 Clair Decker D. Dean Fowler Inc., Harrisburg, PA and17109 Cremation LAST WILL AND TESTAMENI' I, DORIS A. FOWLER, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. ITEM ONE I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes shall be paid to the extent possible from the assets held or passing under ITEM FIVE hereof as soon as practicable after my decease and as part of thc administration of my estate. ITEM TWO In the event my husband shall predecease or fail to survive me by thirty (30) days, then I give such items of personalty as are itemized in a certain list attached hereto to the persons named thereon, which list is signed and dated by me at the end thereof. ITEM THREE If my husband is living thirty (30) days after my death, then I givc, devise and bequeath all of my estate, both real and personal property, unto my said husband, DONALD DEAN FOWLER. absolutely. If my said husband, DONALD DEAN FOWLER, does not so survive me, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, unto my Trustee to be held or distributed by such Trustee under ITEM FIVE. C., hereof iTEM FOUR In the event my said husband, DONALD DEAN FOWLER, shall disclaim all or any portion of any devise or bequest made to him under the foregoing ITEM THREE, then the mount othem,ise payable shall be held by my Trustee under iTEM FIVE hereof. For purposes of the Trust established under ITEM FIVE hereof, my said husband shall not be deemed to have predeceased me by virtue of his exercise of the right to disclaim set tbrth herein. ITEM FIVE RESIDUARY AND DISCLAIMER TRUST My Trustee shall hold the assets received under ITEMS THREE and FOUR hereof, if any, Page 1 of 8 Pages D.A.F. for the following purposes: A. My Trustee shall pay the net income, at least quarter-annually, to my husband. DONALD DEAN FOWLER, for life. In addition, my Trustee in its sole discretion, may invade the principal of the Trust for the proper and adequate support of my husband, DONALD DEAN FOWLER. B. My Trustee shall further pay to my husband, DONALD DEAN FOWLER, annually. such sum from the principal of the Trust as he may request in writing, provided, however, that said sum may not exceed the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of thc aggregate value, at the time of said request, of the principal of the Trust hereunder. C. Upon the death of my husband, DONALD DEAN FOWLER, my Trustee shall divide the principal of the Trust into three (3) equal shares to be distributed as follows: 1. One share unto my daughter, ELIZABETH K. MILLER; 2. One share unto my son, BRIAN D. FOWLER; 3. In the event that either or both said ELIZABETH K. MILLER and/or BRIAN D. FOWLER shall fail to survive both my husband. DONALD DEAN FOWLER, and me. but shall leave issue surviving, such deceased child's share shall be held by the surviving parent thereof as trustee, with the net income therefrom, and so much of the principal as trustee may, in such trustee's sole discretion, think appropriate, to be used for the support. maintenance and education of such issue. The trustee shall distribute the principal of such share of such deceased child to such issue in equal shares as each shall attain the age of twenty-five (25) years. In the event that either or both ELIZABETH K. MILLER and/or BRIAN D. FOWLER shall fail to survive my husband, DONALD DEAN FOWLER, and me and shall not leave issue surviving, such deceased child's share shall be distributed to, or for the benefit of my surviving children in accordance with the terms of this ITEM FIVE. C. provided that the share of my son, ERIC C. FOWLER. if any, shall be held under the terms and conditions of the trust created under this ITEM FIVE. C, 4. 4. One share shall be held by my Trustee(s), in trust, for the following purposes: Page 2 of 8 Pages D.A.F. a. The Trustee shall use and apply as much of the income and principal as may be necessary in the sole discretion of my Trustee(s) tbr the support, well being and education of my son, ERIC C. FOWLER. These sums may be paid directly by the Trustee(s) for the benefit of Eric. Neither distribution of income nor principal shall be required to be made to Eric personally. b. The interest, ~vhether principal or income, shall not be subject to voluntary anticipation, encumbrance, alienation or assignment, either in whole or in part, nor shall any such interest while in the hands of the Executor or Trustee(s) be subject to any judicial process to levy upon or attach the same for or on behalf of Eric's creditors or claimants. c. Upon the death of Eric, this trust shall terminate and any balance remaining, whether principal or income, shall be distributed in equal shares to ELIZABETH K. MILLER and BRIAN D. FOWLER, absolutely. No distribution is required to be made on behalf of Eric or his creditors. ITEM SIX POWERS OF EXECUTORfS) AND TRUSTEE(S) In addition to the powers conferred by case law, by statute, and by other provisions hereo£ my Executor(s) and Trustee(s) and their successors, shall have the following discretionary powers applicable to all property held by them which powers shall be effective without order of any court and shall exist until final distribution: A. To retain any property of any nature received by them for whatever period they shall deem advisable; B. To invest and reinvest all or any part of said property in such stocks, bonds, securities or other property, real or personal, as in their discretion they shall deem proper, without regard to statntes limiting the property which a fiduciary may purchase; C. To sell, transfer, exchange or otherwise dispose of, any part of said property, for cash or on terms, publicly or privately, or to lease, even lbr a term exceeding five (5) years or the duration Page 3 of 8 Pages of any trust herein, xvithout liability on the purchasers or lessees to see to thc application of the proceeds, and to give options for these purchases without the obligation to repudiate them in favor ora higher offer: D. To execute and deliver any deeds, leases, assignments or other instruments as may be necessary to carry out the provisions of any trust hereunder; E. To borrow money, including the right to borrow- money from any bank and to mortgage or pledge any asset of the estate as security; F. To assume continuance of the status of any bcneficia0' xvith regard to death, marriage, divorce, illness, incapacity and the like in the absence of infbrmation deemed reliable without liability for disbursements made on such assumption; G. To pay from the trust, or the income therefrom, all debts or claims against my estate, or any taxes or similar charges on my estate; H. To make any distribution hereunder either in kind or in money, or partially in kind and partially in money. Distribution in kind shall be made at the market value of the property distributed, and my Trustee(s), in its absolute discretion, may cause the share distributed to any distributee to be composed of property similar to or different from that distributed to any other distributee; 1. To exercise any subscription right in connection with any security held hereunder, to consent to or participate in any recapitalization, reorganization, consolidation or merger of any corporation, company or association, the securities of which may be held hereunder, to delegate authority with respect thereto, to deposit investments under agreements, to pay assessments, and generally to exercise all rights of investors; J. To invest in endo~vment, insurance or annuity policies on the lives of beneficiaries of any trust hereunder; K. To continue in any partnership, joint venture, joint ownership or other business enterprise of which I am a part at the time of my death; L. To compromise claims; Page 4 of 8 Pages M. To continue for whatever period of time as they shall deem necessary any ownership as a tenant in common or as a partner, in real estate or other property and to act as I could have done had I been living; N. To lend money to my estate or to any trust created hereunder or to purchase from the estatc or from any trust created hereunder, at the market value thereof at the time of purchase, any securities or other property tendered to them by my estate or any trust created hereunder at any time and from time to time within a period of nine (9) months after my death; O. in the event that any amounts are payable hereunder or under any trust crcated hereunder to a minor, or to a person otherwise under legal disability, or to a person not adjudicated to be an incapacitated person, but who, by reason of illness or mental or physical disability is, in the opinion of fiduciary(ies) hereunder, unable to properly administer such amounts, such amounts may be paid by the fiduciary(ies) hereunder in his, her or their sole discretion in any of the following ways as he, she or they may deem best: Directly to such beneficiary; To a legally appointed guardian of such beneficiary for thc benefit of such 2. beneficiary; 3. beneficiary; 4. To a person having custody of such beneficiary for thc benefit of such By the fiduciary(ies) hereunder using such amounts directly to the benefit of such beneficiary. Evidence of the application or payment of an amount in such a manner shall be a full and complete discharge of the fiduciary(ies) hereunder to the extent of such payment or application. This paragraph shall be applicable to payments of income as well as principal. P. To employ agents, attorneys and proxics and to delegate to them such power as my personal representatives and Trustees consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; Q. To do all other acts in their judgment necessary or desirable for the proper Page 5 of 8 Pages D.A.F. management, investment and distribution of my Estate. ITEM SEVEN PROTECTIVE PROVISIONS All income or principal held for the use and benefit of any trust hereunder shall not be in any way or manner subject to anticipation, assignment, pledge, sale or transfer, nor shall any such interest, while in the possession of my Trustee(s), be liable for or subject to the debts, contracts, obligations, liabilities or torts of any beneficiary, or to attachments, executions or sequestrations under process of law. ITEM EIGHT APPOINTMENT OF EXECUTOR(S) AND TRUSTEE(S) I nominate, constitute and appoint my husband, DONALD DEAN FOWLER, as Executor of my estate. In the event that my said husband shall predecease me or fail to act as Executor. then i appoint my daughter, ELIZABETH K. MILLER~ and my son, BRIAN D. FOWLER~ or thc survivor of them, as Executors of my estate. I hereby appoint my husband, DONALD DEAN FOWLER, as Trustee of any trust created hereunder. In the event that my said husband shall fail or be unwilling toact or continue to act as Trustee, then I appoint my daughter, ELIZABETH K. MILLER, and my son, BRIAN D. FOWLER, or the surivor ofthem~ as Trustees of any trust created hereunder. In the event my husband, daughter and son, Brian, shall be unable or unxvilling to act or continue to act as Trustees, then I appoint FINANCIAL TRUST SERVICES COMPANY of Carlisle, Pennsylvania, to act as Trustee. In the event I shall not be survived by my husband, DONALD DEAN FOWLER, I nominate, constitute and appoint my daughter, ELIZABETH K. MILLER, and my son, BRIAN D. FOWLF~R~ or the survivor of them, as Guardian of the person of my son, ERIC C. FOWLER. Il'EM NINE WAIVER OF BOND l direct that neither my Executor(s) nor my Trustee(s) nor my Guardians shall be required to file any bond in any jurisdiction to secure the faithful performance of their duties, nor shall they be Page 6 of 8 Pages required to obtain any order or approval of any court for the exercise of any power or discretion set forth in this Will. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~ ~ day of ',~~'~, 1996. /' , , ., ~ [ , : '~: ~. (SEAL) Doris A. Fowler k~- SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 7 of 8 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l, Doris A. Fowler, Testatrix, whose name is s~ having been duly qualified according to law, do hereb SS. ned to the attached or foregoing instrument, acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntar, act for the purposes therein expressed. Doris A. Fowler ~4,4x Sworn or affirmed to and acknowledged before me bv Doris A. Fowler. the Testatrix, this d ay_ ~.~&~. ,~j~9 9 6. Notarial Seal ,' / ', Corrine L. Myers, Notary Pu'~lic Cari s~e Boro, Cumberland County Commission Expires May 27, 1999 ~-~a~ry Public COMMONWEALTH OF PENNSYLVANIA ) :SS. COUNTY OF CUMBERLAND ) the witnesses whose names are signed to the attached or lbregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Doris A. Fowler, the Testatrix. sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her tree and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as xvitnesses; 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. .X~ ~,~~ Address 70 ~.~'~ '~/~ Address ' ~,'- ' ' /7 ~ Sworn or affirmed to and subscribed before me this ~< day of '~-Awt&,B¢' , Carlisle Born. Cumberland County I .T:' . ' ' ~ My Commission Expires May 27, 1999 ] t~ot~y Puohc ~ 1996. Page 8 of 8 Pages F:\FI LES\DATA FILE/ES TATES/g459.2.notic~,¢er Name of Decedent: Date of Death: File No. To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Doris A. Fowler October 18, 2004 21-04-1018 I certify that notice of 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 or about December 6, 2004. Mr. Donald D. Fowler 103 South Ridge Road Boiling Springs, PA 17007 Ms. Elizabeth K. Fowler 3372 Overview Drive York, PA 17402 Mr. Brian D. Fowler 100 Mynderse Lane Altamont, NY 12009 Mr. Eric C. Fowler 434 Nevin Street Lancaster, PA 17603 Notice has now been given to all persons ~ntitled thereto under Rule 5.6(a) except: N/A Date: December 6, 2004 Signature Name Ivo V. Otto III, Esquire MARTSON DEARDORFF WiLLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative · REV. 1500 EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COUNTY CODE 04 01018 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOGIAL SECURITY NUMBER FOWLER, DORIS A. 190- 26- 6811 ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE uJ ,?, 10/18/2004 08/05/1934 REGISTER OF WILLS LU ~oo z z (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) FOWLER, DONALD DEAN [] 1. Original Return [] 2. Supplemental Return SOCIAL SECURITY NUMBER ] 3. Remainder Return (date of death pdor to 12-13-82) ] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal EstateTax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes Of Will) copy of Trust) -- [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ',lAME Ivo V. Otto III, Esquire :IRM NAME (If applicable) Martson DeardorffWilliams & Otto FELEPHONENUMBER 717/243-3341 COMPLETE MAILING ADDRESS Ten East High Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly 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 1-7) 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 ) None 391,996.07 None None None 3,807.28 62,679.12 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) ©FF CiAI... USE ONL..F I (8) 458,482.47 458,482.47 458,482.47 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 454,160.79 or transfers under Sec. 9116(a)(1.2) x .00 (15) 0.00 194.48 194.48 16.Amount of Line 14 taxable at lineal rate 4,321.68 x .045 (16) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .12 (17) x .15 (18) (19) >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: ISTREET ADDRESS CITY Boiling Springs 103 South Ridge Road STATE PA ZiP 17007 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 9.72 (1) Total Credits (A + B + C) (2) 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 I Line 20 to request a refund If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 194.48 9.72 0.00 184.76 184.76 (4) (5) (5A) (58) 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. preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Donald Dean Fowler .............<-/ 103 South Ridge Road i,:...:,".:?j,~Z ~.~¢ C'~?,;~'~: ,J: ~;.~:"/'" ~':~-'-.~;~ B oiling Springs, PA 17007 SIGNATURE PERSO ESP SIBLE FOR FILING RETURN ADDRESS DATE DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE Ivo V. Otto III, Esquire Ten East High Street Carlisle, PA/ 17013 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural 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 decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER FOWLER, DORIS A. 21 - 04- 01018 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE O NUMBER DESCRIPTION UNIT VALUE DEATH 1 Investments listed on the attached Estate Valuation 381,707.58 2 Treasury Direct Account 1300-081-4632 10,288.49 TOTAL (Aisc enter on line 2, Recapitulation) 391,996.07 COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER FOWLER, DORIS A. 21 - 04- 01018 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 Eric C. Fowler Son 434 Nevin Street Lancaster, PA 17603 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY ITEM FoRLETTERjoINT MADEDATE Include name of financial institution and bank account number DATE OF DEATH DECD'S% OF DATEvALuEOF DEATHoF NUMBER TENANT JOINT estate.er similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTERES' 1 A see issue Savings bonds as set forth on attached exhibit with 7,614.56 50~ 3,807.28 dates exception of last entry, $500 1 Bond I IOIAL (Also enter on line 6, Recapitulation) 3,807.28 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FOWLER, DORIS A. FILE NUMBER 21 - 04- 01018 This schedule must be completed and filed if the answer to any of questions 1 througl' 4 on page 2 is yes. DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH % OF NUMBER Attach a copy of the deed for real estate VALUE OF ASSET DECD'S0FEXCLUSIONAPPLICABLE) TAXABLE VALUE INTEREST 1 Fidelity Traditional IRA Account No. 2AA-325309, 62,164.72 100% 62,164.72 consisting of 3447.849 shares Fidelity Puritan ~ 18.03; beneficiary: Donald Dean Fowler, spouse 2 $500 Series I Savings Bond issued 10/30/03 in name of Eric 514.40 100% 514.40 C. Fowler (son) or Doris A. Fowler I I IOIAL {Also enter on line 7, Recapitulation} 62,679.12 REVo1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER FOWLER, DORIS A. 2] - 04 - 01018 NUMBER II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Eric C. Fowler 434 Nevin Street Lancaster, PA 17603 Donald Dean Fowler 103 South Ridge Road Boiling Springs, PA 17007 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) .~on Spouse ;nter dollar amounts for distributions shown above on lines 15 through 18, 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 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET AMOUNT OR SHARE OF ESTATE 4,321.68 Entire residue Date of Death: Valuation Date: Processing Date: Shares or Par 1) 2949.905 2) 1772.534 3) 1013 4) 716 5) 484 6) 281 7) 300 8} 730 4o3 10) 454 11) 25 10/18/2004 10/18/2004 12/01/2004 Security Description Estate Valuation High/Ask Low/Bid SCUDDER INCOME TR (811158401; AGNMX) GNMA FD AARP Mutual Fund (as quoted by NASDAQ) 10/18/2004 15.23000 Mkt INVESTMENT TR (460965767; ACDGX) SCUD G&IN AARP Mutual Fund (as quoted by NASDAQ) 10/18/2004 20.16000 Mkt ALLTEL CORP (020039103) COM New York Stock Exchange 10/18/2004 55.01000 54.09400 H/L BRISTOL MYERS SQUIBB CO (110122108) COM New York Stock Exchange 10/18/2004 23.52000 23.16000 H/L Div: 0.28 Ex: 09/29/2004 Rec: 10/01/2004 Pay: 11/01/2004 DARDEN RESTAURANTS INC (237194105) COM New York Stock Exchange 10/18/2004 24.45000 24.05000 H/L Div: 0.04 Ex: 10/06/2004 Rec: 10/08/2004 Pay: 11/01/2004 DELPHI CORP (247126105) COM New York Stock Exchange 10/18/2004 8.50000 8.23000 H/L Div: 0.07 Ex: 09/16/2004 Rec: 09/20/2004 Pay: 10/19/2004 DU PONT E I DE NEMOURS & CO (263534109) COM New York Stock Exchange 10/18/2004 43.38000 42.56000 H/L GENERAL MLS INC (370334104) COM New York Stock Exchange 10/18/2004 44.08000 43.67000 H/L Div: 0.31 Ex: 10/06/2004 Rec: 10/11/2004 Pay: 11/01/2004 GENERAL MTRS CORP (370442105) COM New York Stock Exchange 10/18/2004 39.19000 38.65000 H/L HERSHEY FOODS CORP (427866108) COM New York Stock Exchange 10/18/2004 46.66000 46.36000 H/L RAYTHEON CO (755111507) COM NEW New York Stock Exchange 10/18/2004 35.81000 35.38000 H/L Div: 0.2 Ex: 09/30/2004 Rec: 10/04/2004 Pay: 11/01/2004 Estate of: Doris A. Fowler Report Type: Date of Death Number of Securities: 14 File ID: 8459.2 Mean and/or Div and Int Security Adjustments Accruals Value 15.230000 44,927.05 20.160000 35,734.29 54.552000 55,261.18 23.340000 16,711.44 200.48 24.250000 11,737.00 19.36 8.365000 2,350.57 19.67 42.970000 12,891.00 43.875000 32,028.75 226.30 38.920000 15,684.76 46.510000 21,115.54 35.595000 889.88 5.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) Date of Death: 10/18/2004 Valuation Date: 10/18/2004 Processing Date: 12/01/2004 Shares Security or Par Description High/Ask 12) 4005 SPRINT CORP (852061100) COM FON New York Stock Exchange 10/18/2004 Low/Bid 13) 6583.8195 EATON VANCE SER TR II (277907101; EVIBX) COM Mutual Fund (as quoted by NASDAQ) lO/18/2oo4 14) 100 ZIMMER HLDGS INC (98956P102) COM New York Stock Exchange 10/18/2004 20.83000 20.45000 H/L 6.39000 Mkt 72.33000 71.10000 H/L Estate of: Doris A. Fowler Report Type: Date of Death Number of Securities: 14 File ID: 8459.2 Mean and/or Div and Int Security Adjustments Accruals Value 20.640000 82,663.20 6.390000 42,070.61 71.715000 7,171.50 Total Value: Total Accrual: Total: $381,707.58 $470.81 $381,236.77 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricin9 Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) S'avMgs Bond Calculator Series iE Bonds ~ # Bonds Total Price 26 $4,175.00 Serial Number Q5228219094E 03/1975 iQ6028881996E 01/1976 L2056709400E 12/1976 L2018346130E 09/~976 L2073103035E 04/1977 L309976414EE 12/1987 L245558424EE 03/1986 L222770612EE 12/1985 C75434536EE 02/1986 ICl 18814973EE 12/1986 C75434533EE R0024614521 D445034EE D42680702EE D42680703EE D42680704EE D42680705EE D42680706EE D445035EE D56306568EE D56306569EE D42680707EE D42680709EE D42680708EE c:~,. C008947332I 04/2003 -D003272545I 10/2003 [ Viewing Bonds 1-26 Note Description NI Not Issued Denomination Issue Date Series E E E E E EE EE EE EE EE 12/1985 EE 04/2003 I 11/1982 EE 11/1994 EE 11/1994 EE 11/1994 EE 11/1994 EE 11/1994 EE 11/1982 EE 07/2000 EE 07/2000 EE 11/1994 EE 11/1994 EE 11/1994 EE I I Total Interest $3,953.96 Issue Denom Price $25 $18.75 25 18.75 50 37.50 50 37.50 50 37.50 50 25.00 50 25.00 50 25.00 100 50.00 100 50.00 100 50.00 200 200.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 500 250.00 100 100.00 500 500.O0 http://w,,wvs.publicdebt.treas.gov/BC/SBCPrice Page 1 of 2 Serial Number Issue Date Total Value $8,128.96 Interest Interest Value $110.24 $128.99 108.24 126.99 212.56 250.06 214.38 251.88 212.56 250.06 35.74 60.74 48.14 73.14 48.14 73.14 96.28 146.28 76.40 126.40 96.28 146.28 10.80 210.80 751.00 1,001.00 134.40 384.40 134.40 384.40 134.40 384.40 134.40 384.40 134.40 384.40 751.00 1,001.00 43.60 293.60 43.60 293.60 134.40 384.40 134.40 384.40 134.40 384.40 5.40 105.40 14.40 514.40 Rate 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 2.79% 2.79% 2.79% 2.79% 2.79% 4.00% 2.84% 2.84% 2.79% 2.79% 2.79% 4.00% 3.49% YTD Interest $165.02 Next Final Accrual Maturity Note 03/2005 03/2005 01/2005 01/2006 12/2004 12/2006 03/2005 09/2006 04/2005 04/2007 12/2004 12/2017 03/2005 03/2016 12/2004 12/2015 02/2005 02/2016 12/2004 12/2016 12/2004 12/2015 11/2004 04/2033 P5 11/2004 11/2012 11/2004 11/2024 11/2004 11/2024 11/2004 11/2024 11/2004 11/2024 11/2004 11/2024 11/2004 11/2012 1t/2004 07/2030 P5 11/2004 07/2030 P5 11/2004 11/2024 11/2004 11/2024 11/2004 11/2024 11/2004 04/2033 P5 11/2004 10/2033 P5 11/15/2004 F ~FILES~DA TAFILE\WILLS\8459-W W1L LAST WILL AND TESTAMENT I, DORIS A. FOWLER, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. ITEM ONE I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes shall be paid to the extent possible from the assets held or passing under ITEM FIVE hereof as soon as practicable after my decease and as part of the administration of my estate. ITEM TWO In the event my husband shall predecease or fail to survive me by thirty (30) days, then I give such items of personalty as are itemized in a certain list attached hereto to the persons named thereon, which list is signed and dated by me at the end thereof. ITEM THREE If my husband is living thirty (30) days after my death, then I give, devise and bequeath all of my estate, both real and personal property, unto my said husband, DONALD DEAN FOWLER, absolutely. If my said husband, DONALD DEAN FOWLER, does not so survive me, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, unto my Trustee to be held or distributed by such Trustee under ITEM FIVE, C., hereof. ITEM FOUR In the event my said husband, DONALD DEAN FOWLER, shall disclaim all or any portion of any devise or bequest made to him under the foregoing ITEM THREE, then the amount otherwise payable shall be held by my Trustee under ITEM FIVE hereof. For purposes of the Trust established under ITEM FIVE hereof, my said husband shall not be deemed to have predeceased me by virtue of his exercise of the right to disclaim set forth herein. ITEM FIVE RESIDUARY AND DISCLAIMER TRUST My Trustee shall hold the assets received under ITEMS THREE and FOUR hereof, if any, Page 1 of 8 Pages D.A.F. for the following purposes: A. My Trustee shall pay the net income, at least quarter-annually, to my husband, DONALD DEAN FOWLER, for life. In addition, my Trustee in its sole discretion, may invade the principal of the Trust for the proper and adequate support of my husband, DONALD DEAN FOWLER. B. My Trustee shall further pay to my husband, DONALD DEAN FOWLER, annually, such sum from the principal of the Trust as he may request in writing, provided, however, that said sum may not exceed the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value, at the time of said request, of the principal of the Trust hereunder. C. Upon the death of my husband, DONALD DEAN FOWLER, my Trustee shall divide the principal of the Trust into three (3) equal shares to be distributed as follows: 1. One share unto my daughter, ELIZABETH K. MILLER; 2. One share unto my son, BRIAN D. FOWLER; 3. In the event that either or both said ELIZABETH K. MILLER and/or BRIAN D. FOWLER shall fail to survive both my husband, DONALD DEAN FOWLER, and me, but shall leave issue surviving, such deceased child's share shall be held by the surviving parent thereof as trustee, with the net income therefrom, and so much of the principal as trustee may, in such trustee's sole discretion, think appropriate, to be used for the support, maintenance and education of such issue. The trustee shall distribute the principal of such share of such deceased child to such issue in equal shares as each shall attain the age of twenty-five (25) years. In the event that either or both ELIZABETH K. MILLER and/or BRIAN D. FOWLER shall fail to survive my husband, DONALD DEAN FOWLER, and me and shall not leave issue surviving, such deceased child's share shall be distributed to, or for the benefit of my surviving children in accordance with the terms of this ITEM FIVE, C, provided that the share of my son, ERIC C. FOWLER, if any, shall be held under the terms and conditions of the trust created under this ITEM FIVE, C, 4. 4. One share shall be held by my Trustee(s), in trust, for the following purposes: Page 2 of 8 Pages D.A.F. a. The Trustee shall use and apply as much of the income and principal as may be necessary in the sole discretion of my Trustee(s) for the support, well being and education of my son, ERIC C. FOWLER. These sums may be paid directly by the Trustee(s) for the benefit of Eric. Neither distribution of income nor principal shall be required to be made to Eric personally. b. The interest, whether principal or income, shall not be subject to voluntary anticipation, encumbrance, alienation or assignment, either in whole or in part, nor shall any such interest while in the hands of the Executor or Trustee(s) be subject to any judicial process to levy upon or attach the same for or on behalf of Eric's creditors or claimants. c. Upon the death of Eric, this trust shall terminate and any balance remaining, whether principal or income, shall be distributed in equal shares to ELIZABETH K. MILLER and BRIAN D. FOWLER, absolutely. No distribution is required to be made on behalf of Eric or his creditors. ITEM SIX POWERS OF EXECUTOR(S) AND TRUSTEE(S) In addition to the powers conferred by case law, by statute, and by other provisions hereof, my Executor(s) and Trustee(s) and their successors, shall have the following discretionary powers applicable to all property held by them which powers shall be effective without order of any court and shall exist until final distribution: A. To retain any property of any nature received by them for whatever period they shall deem advisable; B. To invest and reinvest all or any part of said property in such stocks, bonds, securities or other property, real or personal, as in their discretion they shall deem proper, without regard to statutes limiting the property which a fiduciary may purchase; C. To sell, transfer, exchange or otherwise dispose of, any part of said property, for cash or on terms, publicly or privately, or to lease, even for a term exceeding five (5) years or the duration Page 3 of 8 Pages of any trust herein, without liability on the purchasers or lessees to see to the application of the proceeds, and to give options for these purchases without the obligation to repudiate them in Ihvor of a higher offer; D. To execute and deliver any deeds, leases, assignments or other instruments as may be necessary to carry out the provisions of any trust hereunder; E. To borrow money, including the right to borrow money from any bank and to mortgage or pledge any asset of the estate as security; F. To assume continuance of the status of any beneficiary with regard to death, marriage, divorce, illness, incapacity and the like in the absence of information deemed reliable without liability for disbursements made on such assumption; G. To pay from the trust, or the income therefrom, all debts or claims against my estate, or any taxes or similar charges on my estate; H. To make any distribution hereunder either in kind or in money, or partially in kind and partially in money. Distribution in kind shall be made at the market value of the property distributed, and my Trustee(s), in its absolute discretion, may cause the share distributed to any distributee to be composed of property similar to or different from that distributed to any other distributee; I. To exercise any subscription right in connection with any security held hereunder, to consent to or participate in any recapitalization, reorganization, consolidation or merger of any corporation, company or association, the securities of which may be held hereunder, to delegate authority with respect thereto, to deposit investments under agreements, to pay assessments, and generally to exercise all rights of investors; J. To invest in endowment, insurance or annuity policies on the lives of beneficiaries of any trust hereunder; K. To continue in any partnership, joint venture, joint ownership or other business enterprise of which I am a part at the time of my death; L. To compromise claims; Page 4 of 8 Pages M. To continue for whatever period of time as they shall deem necessary any ownership as a tenant in common or as a partner, in real estate or other property and to act as I could have done had I been living; N. To lend money to my estate or to any trust created hereunder or to purchase from the estate or from any trust created hereunder, at the market value thereof at the time of purchase, any securities or other property tendered to them by my estate or any trust created hereunder at any time and from time to time within a period of nine (9) months after my death; O. In the event that any amounts are payable hereunder or under any trust created hereunder to a minor, or to a person otherwise under legal disability, or to a person not adjudicated to be an incapacitated person, but who, by reason of illness or mental or physical disability is, in the opinion offiduciary(ies) hereunder, unable to properly administer such amounts, such amounts may be paid by the fiduciary(ies) hereunder in his, her or their sole discretion in any of the following ways as he, she or they may deem best: Directly to such beneficiary; To a legally appointed guardian of such beneficiary for the benefit of such 2. beneficiary; 3. beneficiary; 4. To a person having custody of such beneficiary for the benefit of such By the fiduciary(ies) hereunder using such amounts directly to the benefit of such beneficiary. Evidence of the application or payment of an amount in such a manner shall be a full and complete discharge of the fiduciary(ies) hereunder to the extent of such payment or application. This paragraph shall be applicable to payments of income as well as principal. P. To employ agents, attorneys and proxies and to delegate to them such power as my personal representatives and Trustees consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; Q. To do all other acts in their judgment necessary or desirable for the proper Page 5 of 8 Pages management, investment and distribution of my Estate. ITEM SEVEN PROTECTIVE PROVISIONS All income or principal held for the use and benefit of any trust hereunder shall not be in any way or manner subject to anticipation, assignment, pledge, sale or transfer, nor shall any such interest, while in the possession of my Trustee(s), be liable for or subject to the debts, contracts, obligations, liabilities or torts of any beneficiary, or to attachments, executions or sequestrations under process of law. ITEM EIGHT APPOINTMENT OF EXECUTOR(S) AND TRUSTEE(S) I nominate, constitute and appoint my husband, DONALD DEAN FOWLER, as Executor of my estate. In the event that my said husband shall predecease me or fail to act as Executor, then I appoint my daughter, ELIZABETH K. MILLER, and my son, BRIAN D. FOWLER, or the survivor of them, as Executors of my estate. I hereby appoint my husband, DONALD DEAN FOWLER, as Trustee of any trust created hereunder. In the event that my said husband shall fail or be unwilling toact or continue to act as Trustee, then I appoint my daughter, ELIZABETH K. MILLER, and my son, BRIAN D. FOWLER, or the surivor of them, as Trustees of any trust created hereunder. In the event my husband, daughter and son, Brian, shall be unable or unwilling to act or continue to act as Trustees, then I appoint FINANCIAL TRUST SERVICES COMPANY of Carlisle, Pennsylvania, to act as Trustee. In the event I shall not be survived by my husband, DONALD DEAN FOWLER, I nominate, constitute and appoint my daughter, ELIZABETH K. MILLER, and my son, BRIAN D. FOWLER, or the survivor of them, as Guardian of the person of my son, ERIC C. FOWLER. ITEM NINE WAIVER OF BOND I direct that neither my Executor(s) nor my Trustee(s) nor my Guardians shall be required to file any bond in any jurisdiction to secure the faithful performance of their duties, nor shall they be Page 6 of 8 Pages D.A.F. required to obtain any order or approval of any court for the exercise of any power or discretion set forth in this Will. IN WITNESS WHEREOF I have hereunto set my hand and seal this · ~~, 1996. day of /'~. ~ i i',-,-':2 t_..... ~:-' ~--L'"'~-,L:-~' Doris A. Fowler (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 7 of 8 Pages COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Doris A. Fowler, 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 willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Doris A. Fowler ,, Sworn or affirmed to and acknowledged before me by Doris A. Fowler, the Testatrix, this &q4'~.day_~_ ,,_~~_, !996. i Notarial Seal ('/ i .,~ \ i ^Corrina L. Myers, Notary PuBlic I /// - --..----. ~ '~ ..-~., ! uarlisle Boro Cumberland County ~ [ ///7 A.. ~ ~( , :~' l/ /'~ .~ ~,~.. ~_ ~., COMMONWEALTH OF PENNSYLVANIA ) 'SS. COUNTY OF CUMBERLAND ) 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 Doris A. Fowler, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Address / dP Sworn or affirmed to and subscribed before me this day of _, 1996. Corrina L. Myers, Notary Public Carlisle Boro. Cumberland County My Commission Expires May 27, 1999 Notary Public Page 8 of 8 Pages COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 004702 FOWLER DONALD DEAN 103 RIDGE ROAD BOILING SPRINGS, PA 17007 ESTATE INFORMATION: SSN: 190-26-6811 FILE NUMBER: 2104- 1018 DECEDENT NAME: FOWLER DORIS A DATE OF PAYMENT: 12/06/2004 POSTMARK DATE: 1 2/0612004 COUNTY: CUMBERLAND DATE OF DEATH: 1 O/18/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $184.76 REMARKS' D D FOWLER TOTAL AMOUNT PAID: $184.76 SEAL CHECK//301 INITIALS: VZ RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS '...A/. I., ~ I' i. REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: Doris A. Fowler Date of Death: October 18, 2004 File No. : 21-04-1018 Social Security No. : 190-26-6811 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 thefollowing: 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 No x Spouse was sole beneficiary and executor of estate; therefore, no accounting was necessary. d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the CI k of e Orphans' Court and may be attached to this report. Dat~)) March g, 2005 Signature: Name: Address: Ivo V. Otto III, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative F IFILES\DA T AFILEIES1'~ TESI8459 2 SREP vi COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 2B0601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-150 EX AFP 112-D~l IVO V OTTO MARTSON ETAL 10 EAST HIGH ST CARLISLE (''J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-01-2005 FOWLER 10-18-2004 21 04-1018 CUMBERLAND 101 Allount Rellitted DORIS A PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT. ALONG:;'THIS, tINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... il"V'=r!4"1':Ex-"Jp"!"!l'81---6!'--NoY-icf-oF-i'NHfrtifl'Nci-TAx-APPRAfsEi"iNT~-ArtoQANCE-OR------._----- - --. .. , ~-.... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE Of.' FOWL€J~.i DORIS A FILE NO. 21 04-1018 ACN 101 , t'i'....~ , -' DATE 03-01-2005 (~""',J C~"; TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (S) (6) (7) .00 3911996.07 .00 .00 .00 31807.28 62.679.12 (8) NOTE: To insure proper credit to your account 1 subllit the upper portion of this forll with your tax paYllent. 4581482.47 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Sub;ect to Tax .00 .00 (11) (12) (13) (14) 00 4581482.47 .00 4581482.47 I~ an assessmen~ was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lec~ ~igures ~ha~ include ~he total o~ ~ re~urns assessed ~o d~e. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. AIlount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due D TS: NOTE: 4541160.79 X 4.321.68 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 194.48 .00 .00 194.48 DATE 12-06-2004 NUMBER CD004702 INTEREST/PEN PAID (-) 9.72 AMOUNT PAID 184.76 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 194.48 .00 .00 .00 . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)