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HomeMy WebLinkAbout04-1026PETITION FOR PROBATE and GRANT OF LETTERS Estate of Wayne E. Ki_~ner No. also known as To: Deceased. Social Security No. 185- 03 - 051'5 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor ~ ~=~rocu~trix in the last will of the above decedent, dated March 1, 2004 , and codicil(s) dated in the _ __ named (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber 1 and County, Pennsylvania, with his last famil;~ or nrincipal residence at dlq39 East Trind!e ~=~ Apt 322 ff~ 'P~;/;A Mechanicsburg, PA ¥5~g0 (list street, number and muncipality) Decendertt, then 85 y..ears of age, died October 8 2004 at Hershey Medical center ' ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $. situated as follows: 509 Drexel Road, Harrisburq, PA 169,083.00 12~:000:00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ffe~rrey' ~. ~xsner zo2 West Green Street Shiremanstown, PA 17011 Q~Janet G. Harmafi ~5803 Stephens Crossinq Rd Mechanicsburg, PA 17050 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA q '-~ COUNTY OF CUMBERLAND ) ss : The petitioner(s) above-named swear(s) or affirm(s) that the statements in the f°regoi~petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before .me this //.) P/C, day o[ ~ ~gtster Estate Of Wayne E. Kisner , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW /d//~ ~/t~)'7~-- 2004, 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 March 1, 2004 described therein be admitted to probate and filed of record as the last will of Wayne E. Ki sner and Letters Testamentary are hereby granted to Jeffrey W. Kisner and Janet G. Harman FEES Probate, Letters, Etc .......... Short Certificates(,5') .......... Jq9 TOTAL Filed ~.'ln~.. ~..I.0./.%.. Register of ' ~ Thomas D. Gould 36508 .. ATTORNEY (Sup. Ct. I.D. No.) 2 East Main Street Shiremanstown, PA 17011 ADDRESS (717) 731-1461 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, $2.00' ~ '04 ',,{J/ l No. 5; Local Registrar OCT 1 1 2004 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) Wayne Kisner UNDER 1 YEAR Dauphin ~. ~, ~'$ MAILI~ ADORE~ ~. Cffy/Town. S~te. ~ Code) 4839 E. Trind£e Rd. APT 322 ,~¢chanicsburg, PA 17050 Peter Kisner ~/. Kisner MOTHER'S NME, 1~, M~Y. Ma~te~ ~mme) [,,. J~__ w. u~een S~. Sh&em~o~n, PA 17011 j~&~,.,o.- ~ o,~,~, c.~ ],~.~.~.~ [E. H~rZsb~g C~y [ H~r~b~g, PA lai*. - · lale .... in, lO0 Jone~mn Ro~ E~q~b~, PA 17109 . ~y, ~) "'"~°? I h~.~'~?.";I,''~°~'"~u"~ I'"~',wo.~? ~ ~ __ -- -- *, J.. ' ' Pa~iXg L. ~ J.. 4837 Cie Rd'. M~ni~burg, PA ................................ ,.. ~ =~ ~ ~.~ , Chief Deputy ............... ~'~a~'~'~'~'~')'M~"m~ ......................... ~ · ~ J,~o. ~to~r 8, 2004 · ~~ fllem27)T~Prlfll PaRy J. ~er .............................................................. ~ 1271 South 28th Street ~__~~~ "- Harrisbur~A 17111 ." ~/~,/,~1 ~~/~ ~o~ Diabetes Hypothyroidism Aortic Valve Replacement 3:45 AM October 8, 2004 Closed Head Injury Fall DUE TO (OR AS A CON~OUENCE IF): LAST WILL AND TESTAMENT OF WAYNE E. KISNER I, WAYNE E. KISNER, now of 4905 East Trindle Road, Apartment 50, Mechanicsburg, Cumberland County, Pennsylvania 17050, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Executor. (A) Family and Background Information. I am a widower, my wife, EDITH V. KISNER, having passed away on October 12, 2003. Our children are JANET G. HARMAN and JEFFREY W. KISNER. Throughout this Will, EDITH V. KISNER will be referred to as "my wife" or "my spouse", and JANET G. HARMAN and JEFFREY W. KISNER will be referred to as "my issue" or "my children." The word "issue" will include our children as well as our other descendants. (B) Appointment of Executor. I appoint as my Executors and/or Co-Executors (all hereinafter referred to as Executor or Executors under this Will), the following named persons or corporations to serve without bond and without being required to account to any Court: Executors: My children, JANET G. HARMAN and JEFFREY W. KISNER, to act jointly only, or thc survivor of them. SECOND: Funeral and Last Illness Expensesl Taxes. (A) Expenses of Funeral and Last Illness. Notwithstanding that my spouse survives me, I direct my Executors to pay my funeral expenses and the expenses of my last illness from my estate. (B) Taxes. I direct my Executors to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all LAST WILL AND TESTAMENT OF WAYNE E. KISNER Page 2 interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death, upon or with respect to any and all property included in my gross estate for the purpose of such taxes, whether such property passes under or outside of this Will, out of my residuary estate, without being prorated or apportioned among or charged against the respective devises, legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them. The Executors shall not be entitled to reimbursement for any portion of any such taxes from any such person. THIRD: Tangible Personal Property_. Except for those items excluded below and those items enumerated in the Letter of Instruction, I bequeath to my children living at the time of my death, all tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, to be divided among them as they may select in as nearly equal shares as is practical. Tangible personal property shall not include: (1) any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and (5) any life, health or accident insurance policies. If I have no living children at the time of my death, I leave such tangible personal property to my closest living relative, per stirpes. If there is any disagreement as to distribution, I direct my Executors to make such distribution. The decision of my Executors shall be final and binding. Any items not selected or any items which my Executors consider unsuitable for my children may be distributed or sold in the sole discretion of my Executors and, if sold, the net proceeds therefrom shall be added to the residue of my estate. Any such article allocated to a minor may, as my Executors deem advisable, either be delivered to the minor or to any person to safeguard on behalf of the minor. Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article THIRD, and such Letter of Instruction shall determine the distribution of such items. FOURTH: Residuary Gifts. (A) If my spouse, EDITH V. KISNER, does not survive me, I give, devise and bequeath the sum of ONE THOUSAND AND 00/100 ($1,000.00) DOLLARS to the LAST WILL AND TESTAMENT' OF WAYNE E. KISNER Page 3 CHINESE OVERSEAS CHRISTIAN MISSION, INC., now or formerly of P.O. Box 310, Fairfax, Virginia 22030-0310, to be used in the discretion of its governing board for the support of Rev. Charles Shearer. (B) If my spouse, EDITH V. KISNER, does not survive me, I give, devise and bequeath all the rest, residue and remainder of my estate, of every kind and character, mai, personal and mixed, tangible and intangible, and wherever situated, including any lapsed or renounced legacies or devises (and including any property over which I may have a Power of Appointment), as follows: 1. I give, devise and bequeath TWENTY (20%) PERCENT of the residue of my estate to my son, JEFFREY W. KISNER, or if he predeceases me then to his surviving issue, per stirpes. 2. I give, devise and bequeath TWENTY (20%) PERCENT of the residue of my estate to my daughter, JANET G. HARMAN, or if she predeceases me then to my son, per stirpes. 3. I give, devise and bequeath TWENTY (20%) PERCENT of the residue of my estate to my daughter-in-law, SUSAN E. KISNER, or if she predeceases me then to her surviving issue, per stirpes. 4. I give, devise and bequeath TWENTY (20%) PERCENT of the residue of my estate to my granddaughter, CHELSEA S. KISNER, per stirpes. 5. I give, devise and bequeath TWENTY (20%) PERCENT of the residue of my estate to my grandson, BRYAN J. KISNER, per stirpes. (C) If my children predecease me without leaving issue, then I give, devise and bequeath all the rest, residue and remainder of my estate, of every kind and character, real, personal, and mixed, tangible and intangible, and wherever situated, including any lapsed or renounced legacies or devises (and including any property over which I may have a power of appointment), to my closest living relatives, per stirpes. LAST WILL AND TESTAMENT OF WAYNE E. KISNER Pa~e 4 (D) Distributions During Administration, Prior to final distribution of my estate, the Executors, in their discretion, may make partial distributions to one or more beneficiaries or Trusts. As a consequence, the Executorship and any Trusts created under this Will may exist contemporaneously. A distribution may be made subject to any indebtedness or liability of my estate. FIFTH: Spendthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate or any trust estate in any manner other than by the valid exercise of a power of appointment. No part of the estate or any trust estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. SIXTH: Powers of Executors. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executors shall have and exercise exclusive management and control of the Estate and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon him by law: (A) In the management, care and disposition of the Estate, the Executors shall have the power to do all things and to execute such deeds and instruments as may be deemed necessary or proper, including the following powers, all of which may be exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property, real, personal or mixed, at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Estate, and to grant options, including any option for a period beyond the duration of the Estate. (2) To invest all monies in such stocks, bonds, securities, mortgages, notes, choses in action, real estate or improvements thereon, and any other property as the Executors may deem best, without regard to any law now or hereafter enforced limiting investments of fiduciaries. LAST WILL AND TESTAMENT OF WAYNE E. KISNER Page 5 (3) To retain for investment any property deposited with the Executors hereunder. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Estate and to agree to any rescission or modification of any contract or agreement affecting the Estate. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Estate, including the power to borrow at a reasonable rate of interest. (8) To retain and carry on any business in which the Estate may acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Estate may have an interest. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that such security is a Estate asset and the Executors shall be responsible for the acts of such nominee. 01) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executors need not require the appointment of a guardian, but shall be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a LAST WILL AND TESTAMENT OF WAYNE E. KISNER Page 6 legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (C) In the disbursement of the Estate and any division into separate trusts or shares, the Executors shall be authorized to make the distribution and division in money or in kind, or both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executors shall be binding and conclusive on all persons taking hereunder. The Executors may in making such distribution or division allot undivided interests in the same property to several trusts or shares. (1)) The Executors shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as the Executors may deem equitable and fair under all circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executors may reasonably deem equitable and just under all the circumstances. SEVENTH: Ri~_.hts and Liabilities of Executors. (A) No bond or other security shall be required of any Executor. (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment of the estate, the overall performance of the entire estate shall be taken into account. LAST WILL AND TESTAMENT OF WAYNE E. KISNER Page 7 (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he/she performs the services. EIGHTH: Tax Elections. In determining the estate, inheritance and income tax liability relating to my Estate, the Executors' decision as to all available tax elections shall be conclusive on all concerned. In accordance with IRC Section 2632(a) and without regard to whether a Federal estate tax return is actually filed, my Executors shall allocate so much of the Federal Generation Skipping Transfer (GST) exemption amount as will fully exempt any generation skipping transfer which may occur under this Will. NINTH: Def'mitions and General Provisions. (A) Survival. Any beneficiary who dies within sixty (60) days after my death shall be considered not to have survived me. (B) Trust Estate. "Trust Estate" means all assets, however and wherever acquired, including income, which may belong to a Trust at any given time. (C) Children. Except for discretionary distributions which may be made unequally among a group of persons and distributions pursuant to a valid exercise of a Power of Appointment, in making a distribution to the children of any person, the property to be distributed shall be divided into as many shares as there are living children of the person and deceased children of the person who left children who are then-living. Each living child shall take one share and the share of each deceased child shall be divided among his then-living descendants in the same manner. A posthumous child shall be considered as living at the death of his parent. (D) Code. Unless otherwise stated, all references in my Will to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate. (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. LAST WILL AND TESTAMENT OF WAYNE E. KISNER Page 8 (F) Captions. The captions set forth in this Will at the beginning of the various divisions hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. (G) Powers of Appointment are Exercised. By this Will I exercise any Power of Appointment which I may possess at my death. IN WITNESS WHEREOF, I, WAYNE E. KISNER, the Testator, have to this my Last Will and Testament, typewritten on nine (9) pages, including the Acknowledgment and Affidavit, set my hand and seal this ! day of l~ ~-~ ,2004. (SEAL) WAYNE E. KISNER Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and in the presence of each other. Each of us further declares that he or she believes the Testator to be of sound mind and memory. The preceding in~q3~nent consists of this and eight (8) other consecutively numbered typewritten p~~jclmowledgment and Affidavit., / ~47W~('W'~(print hame) ~~'~, x~f~4~[~~r, esidingat ¢tzi' ct¢, PA (print name) ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF~ SS: The Testator and the wimesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge, depose and say to the undersigned authority, that the Testator signed and executed the instrument as his Last Will in the presence of the wimesses; that he signed it willingly or willingly directed another to sign it for him; that he executed it as his free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testator sign and execute the instrument as his Last Will; that each subscribing witness in the hearing and sight of the Testator signed the will as witnesses; and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. /~estator Witness COMMONWEALTH OF PENNSYLVANIA · COUNTY OF ~-/.,r~'~7.4~ .' SS: On this, the /,d..~day o~~_, 2004, before me, a Notary Public, the undersigned officer, personally appeared LOWELL R. GATES, ESQUIRE, Pennsylvania Supreme Court Identification Number 46779, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgment and affidavit were signed by the Testator and witnesses. Notarial Seal Ted L. Walker, Notary Public rvlL~e~7,~mYr~r e Boro, Cumberland County y mission Expires Jan. 20, 2007 Member. Pennsylvania A.~soc. iatJon Of Notaries IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission Expires: CERTIFICATE OF NOTICE UNDER RLrLE 5.6(a) Name of Decedent: Date of Death: Will No. 21-04-1026 TO THE REGISTER: Wayne E. Kisner October 8, 2004 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was serviced on or mailed to the following beneficiaries of the above-captioned estate on Nover~ber 29, 2004. Name Address JEFFREY W. KISNER Ji~NET G. H. ARMAN CHINESE OVERSEAS CHRISTIA~N MISSION, SUSAN E. KISNER CHELSEA S. KISNER BRYAN J. KISNER 202 WEST GREEN STREET SHIREMANSTOWN, PA 17011 5803 STEPHENS CROSSING MECHANICSBURG, PA 17050 INC. P.O. BOX 310 FAIRFAX, VA 22030 202 WEST GREEN STREET SHIREMA-NSTOWN, PA 17011 202 WEST GREEN STREET SHIREMANSTOWN, PA 17011 202 WEST GREEN STREET SHIREMANSTOWN, PA 17011 Notice has now been given Rule 5.6(a) . Date: , to all persons entitled thereto under Thomas D. Gould, Esquire I.D. # 36508 Attorney For The Estate 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 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 KISNER JEFFREY W 202 WEST GREEN STREET SHIREMANSTOWN, PA 17011 ~__~_n_ fold ESTATE INFORMATION: SSN: 185-03-0515 FILE NUMBER: 2104-1026 DECEDENT NAME: KISNER WAYNE E DATE OF PAYMENT: 03/15/2006 POSTMARK DATE: 03/15/2006 COUNTY: CUMBERLAND DATE OF DEATH: 10/08/2004 NO. CD 006437 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $12,679.29 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: J HARMAN CHECK#109 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $12,679.29 GLENDA FARNER STRASBAUGH REGISTER OF WillS :EV.1500EX (6-0CJ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPl 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- :.::~Ul uO:::':: wo..u IOO uO::...J 0.. III 0.. <( I- Z W o W U W o I- Z W o z o 0.. Ul l!J 0:: 0:: o U z o ~ ...J :J !:: 0.. <( U w 0::: FILE NUMBER 2 1 - 0 4 INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER o 1 o 2 6 COUNTY CODE YEAR DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) KISNER WAYNE E. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 10/08/2004 . 04/08/1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 185 -03 0515 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1 Onginal Return o 4. limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date or death after 12.'2-82) o 7 Decedent Maintained a living Trust (Altach copy of Trustj D 10. Spousal Poverty Credit (dateofdealh belween 12-31-91 and '.'.95) D 3. Remainder Return (dale of deal" pnor to 12.13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Mach Soh 0) 1'1iISSECT.loN..MUSTBE.p:o.MPLE.TED'ALL:CO~IlESPONOENCE'ANDCONFIDEN1J,AI.JTAX..INFORMATION.Sf\OULD,BE DIRECTED .TO: ~IAME COMPLETE MAILING ADDRESS THOMAS D. GOULD, ESQUIRE FIRM NAME (If App!icable) 2 EAST MAIN STREET SHIREMANSTOWN, PA 17011 TELEPHONE NUMBER (717) 731-1461 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) 125,900.00 14,388.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mongages & Notes Receivabie (Schedule Dj (4) \..-' ) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (5) 137,269.00 (6) L,. I (7) 24,000.00 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (8) 10,760.00 20,665.00 301,557.00 (9) (10) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) (11) (12) (13) 31,425.00 270.132.00 1,000.00 12. Net Value of Estate (Line 8 minus line 11) 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) (14) 269,132.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I- :J 0.. :2 o u >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) xO 45 (16) x .12 (17) x .15 (18) (19) 12,111.00 16. Amount of Line 14 taxable at lineal rate 269,132.00 12,111.00 17. Amount of Line 14 taxabte at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT "c",-_-,;:<;-"_/;(_, ,. > >8E SU~ETQANgWERALLQUES1l0NSONREvERSESIDEAND ilECHECKMATH <II! {: -~'-:c./_;<i:'__>:;,,_::_\-:;: Decedent's Complete Address: STREET ADDRESS 4839 EAST TRINDLE ROAD CITY APARTMENT 322 ~-_. MECHANICSBURG PA STATE Tax Payments and Credits: 1. Tex Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 12,111.00 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 568.29 4. Total Interest/Penalty ( D + E ) 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 (3) (4) (5) (SA) 5. If Line 1 + 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 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 568.29 12,111.00 568.29 12,679.29 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;................. ................ ...................... ...................... . ..... [] b. retain the right to designate who shall use the property transferred or its income; .. D c. retain a reversionary interest; or.................. .............................................. ........ U 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? ........................... ................. .... ................... [lg 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? ....................... ................... .......................... .........~ No sa Q9 lxJ [i] D [Xl D 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 penalties of perjury, I declare that I have examined thiS return, including accompanying schedules and statements, and to the best of my knowledge and betlef, it is true, correct and complete Declaration of prepar a he personal representative is based on all information of which preparer has any knowledge. DATE .3 - lS - CS"l..Q ~ 5803 STEPHENS CROSSING ROAD MEcHANICSBURG, PA 17050 DATE 3-fS-". 2(Jt:J~ ADDRESS 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. S9116 (a) (1.1) (i)J. 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. S9116 (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 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 paren or a stepparent of the child is 0% [72 P.S. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-i502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WAYNE E. KISNER FILE NUMBER 21-04-01026 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 sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 509 DEXEL ROAD, HARRISBURG, PA 17109 125,900.00 TOTAL (Also enter on line 1, Recapitulation) $ 125,900.00 (If more space is needed, insert additional sheets of the same size) REV-1503 Ex -+ (1-97) ESTATE OF SCHEDULE 8 STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT WAYNE E. KISNER FILE NUMBER 21-04-01026 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. VALUE AT DATE OF DEATH 14,388.00 DESCRIPTION PPL 600 shares @ $23.98 14,388.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) RE\i-150B EX... (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAYNE E. KISNER 21-04-01026 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2 3 4 5 6 7 8 9 10 11 12 13 DESCRIPTION M&T BANK CHECKING ACCT # 515456837810 JACKSON NATIONAL CHECKING ACCT # 9350313499 JACKSON NATIONAL BANK IRA # 1000125888 ALLIANTE CHECKING ACCT # 00006725672 WAYPOINT BANK SAVINGS ACCT # 0203023820 1990 CHEVROLET TRUCK 1999 CHEVROLET VAN MISC HOUSEHOLD GOODS TAX PRORATION FROM SALE OF HOUSE KEYSTONE HEALTHCARE REFUND METLIFE INSURANCE -# 404-9019184 TRAVELERS HOME INSURANCE REFUND JACKSON NATIONAL LIFE # 1000116994 VALUE AT DATE OF DEATH 33,055.63 7,081.29 23,431.74 23,797.89 33,055.63 2,000.00 6,000.00 1,715.00 593.76 91.00 3,897.63 449.00 2,100.00 137,269.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV 1510 EX' (197) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAYNE E. KISNER 21-04-01026 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 INCLUDE THE NAME OF THE TRANSFEREE:, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COpy OF THE: DEED FOR REAL ESTATE VALUE OF ASSET IF APPliCABLE) NUMBER INTEREST 1. CASH TO JEFFREY, SUSAN, BRYAN AND 24,000.00 100 24,000.0 CHELSEA KISNER SON, DAUGHTER-IN-LAW & GRANDCHILDRE IJ TOTAL (Also enter on line 7, Recapitulation) $ 24,000 .0 o (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~, _~'J~:\~_ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WAYNE E. KISNER FILE NUMBER 21-04-01026 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: ZIMMERMAN FUNERAL HOME SNYDERS FLOWERS POT-a-LOVE 7,518.00 415.42 125.00 B. ADMINISTRATIVE COSTS: 1. Personal 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: 2. Attorney Fees 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Add ress City _______ State __ __ Zip Relationship of Claimant to Decedent 4. Probate Fees 348.00 5. Accountant's Fees 150.00 6. Tax Return Preparer's Fees 7. PUBLICATION FEES 204.77 TOTAL (Also enter on line 9, Recapitulation) $ 10,760.00 (If more space is needed, insert additional sheets of the same size) A. Settlement Statement U.S. Department of Housing and Urban Development ~ ,r OMB No. 2502-0265 B. Type of Loan 1.0 FHi\ 2.0 FmHA 3. 0 Com Untnsl6 Fde Number 17. Loan Number 18. Mortgage Insurance Case ]\;umber 4.0 VA 50 Com Ins I 34153 ROSS : i C. NOTE: This fOlm is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. '\TAME OF BORROWER: William J. Ross, Jr. ADDRESS OF BORROWER: 1004 Topview Dr.. Harrisburg, PA 17112 E. NAME OF SELLER: Wayne E. Kisner Estate ADDRESS OF SELLER: F. NAME OF LENDER: FUL TON BANK ADDRESS OF LENDER: G. PROPERTY LOCATION: PO BOX 5762, CINCINNATI, OH 45201-5762 509 Drexel Rd Harrisburg, PA 17109 H. SETTLEME:\T AGENT: SHUMAKER WILLIAMS, P.C. 3425 SIMPSON FERRY ROAD, CAMP HILL, P A 170 II 3425 SIMPSON FERRY ROAD, CAMP HILL, PA 17011 PLACE OF SETTLEMENT: I. SETTLEMEl'IT DATE: J. SUMMARY OF BORROWER'S TR<\NSACTION 1 OO.CiROSS AMOUNT DUE FROM BORROWER LQI.ContUlc.uilk"-R[i~_ _ . ____ JJ)].J'o;l:s.onaLp.IQjJerty -- -- --- 10J,S~ttlemenu:ImW.l9_bp)1Q.wer (line] 400) 104. 105. ________ __Mill:>tments fQr items paid by seJI!'Liu_aJivaJ]I& ______ 1 06.CitY/lQwn taxes _._______J9_ ._ II)7.CountYJa~~s_ 12/20/2004 to 12/3112004 1 08_.~\sses,,-rmm~_~_Jo ._ i O.9.Sch.ool Taxes 12120/20041Q .. 6/30/2005 : 10 ___m_ _ to .. _.-r----- I.LL_ _ __._ _ n ___. ____to i12. K. SUMMARY OF SELLER'S TRANSACTION 400.GROSS AMOUNT DUE TO SELLER __ __1 2 5,2JlQ..QQ_40U:QntracLs al e~pric:!'__ 402.Personal property 4811.04 403. 404. 405. -.--- ---...AJ:1.llisJll1ents_JQL~ms]Jaid_12y seller in advance ______ 406.Citv/town taxes _. ______.1.0 ___________ 19.99 407.Countv taxes 12/20/20Q1!O ]2/31/2004J..9.99 408.Assessments to_I---_______. 573.77 409. School Taxes i 2/20/2004 to 6/3Q(2QQj ________J-L1..27 4]0. t9___ ___.._ 411. to ______ ____.__ 412. to ll.5.,90000 -- ..--------.- -~--I------ .- ._~--~ -.----- to 120 GROSS AMOUNT DUE FRO:V! BORROWER ~ 131,304.80 420.GROSS AMOUKT DUE TO SELLER ~ 126,493.76 200.AMOUNTS PAID BY OR IN BEHALF OF BORROWliR 500.REDUCTIONS IN AMOUNT DUE TO SELLER 2Q1.])~Rosit or eameSJ.1]1Ql1_ey . __________ __ _....5.JlOJlJ2D jD1J:;,xcess deposit (see instructionsL______ ~________ 202.Pling]J~lnD1ounJ.QLnm.JQ<!Il(s) _ ______ ___~OD.n_QJill. 2Q2~S.~t1s:ment chames to seIlerllind.1QQ) _....1.112.6.6.l2_ 20TExlstingJQ.4n\.8 taken subiect to 503.Existilw loanls) taken subiect to .-------r---- n____ 204.__ 504.Pavoff of firs; mortgnge..lOJlD r----.... 205__ .------t------. 505.Pavoff of second mortgage loan ._- n_ ______..__ ---- W.!j.Princip'iljlmountof s~ller financing 2_0.L. 208.SeIleLR_a.)'Jng Buyer Costs 209_ 209Jl___.__ 2090 ._. . ~\9I~-stm::~~5_~~_r~1!~:!~~__unpaidT;y seller 210.C1ty/tO\Y1Lt4xes to 211.CounlYJ':l.\.eL________ to 212cE.ssessments to 2 U ___n..__ to _ _ 214. .________ _______ to 2l5._~_______ ____ to 218 ____n._ 219 no TOTAL AMOUNTS PAID BY OR IN BEHALF OF BORROWER 300 CASH AT SETTLEMENT FRO:vI/TO BORROWER 30 I.Gross amount due from borrower !line 1201 302.Less amounts naid by/for borrower !line 220) 506.Principal amount of.sru~r fi!lIW..dtJg ---.--- -- .... '__ 5!2lc....____ .---___ _~__.3,E2Slli. jD~SelkL.Pi!Yi.Dg Buyer Costs ___~_.___ 5~___ 509a 509b Adjustments for ite;:;';': unpaid by seller 51 0.Citv/to\\11 taxes __ to 5] 1. County taxes to 512.Assessments _ to 51.3~.___ ____ _ . ____nO to 514. to 515. to 516. to 517. ..__ to 518. to 519. to 520.TOTAL REDUCTIONS IN 109,497.00 AMOGNT DUE SELLER 600. CASH AT SETTLEMENT TO/FROM SELLER 131304.80 601. Gr055 amount due to seller !line 420) 109497.00 602.Less reductions in amount due seller !line 520 --- _ __.3 77Ulli_ ----- -- ----- --- ------ 216 _21 7 ~ to to to to - ~.._----- ---~ -----~-- ~ ~ 14,043.32 303.CASH !Xl From 0 To BORROWER ~ 21,807.80 603.CASH !Xl To 0 From SELLER ~ 126.493.76 14043.32 112,450.44 PAGE 1 ~2004 Display Systems. Inc. (863) 76:J-SSSS _ Laser Generated flUD-i (3-86) RESPA, HB 4305.2 U.S. DEPARTMENT OF HOUSfNG AND URBAN DEVELOP1vIENT SETTLEMENT STATEMENT PAGE 2 L. Settlement Chames 700. TOJAk SALES1!iROKER'S COM. bas_~.'Lol:umCC .__~U;IOn ofCommissionj.line 7.0.0) as follows: .1Q~_3,8122.J2!L. _~. J02__.1)52.aO 7Q} CorD.rnission R"id at Settlcment 704. 8.0.0. Items Payable In Connection With Loan .80 LLomlili]g11] ati on FJ'_c__ % ._to .__ _.. _ 802. Loan Dlscount .~_%__ to FUUQN BANK __._-12'i.9a-..---____==~ 803._AlwraisaL&.L_______... to VincgntMinnici..S.2l.~a.O P.O C. BY LENDE.R. ~_ ~__ _____ 804. Credit R~porL_ to cBLlli.aa P.OJ::cJ'.A!D BY LENDER ___ _ ._____ __~____ i-lill~'._Tax.Rclaled.s.ervice FeeJ'Qr CitimQl1g~----1Q_FUL_TON BANK 7,.nn__ J;1}_QJillc.essing l'e.e_____~__ to FULTON BANK 19.0..0.0 ___ JIO]_QvemightDelivery_f~__ to FUl.TON BANK ._ _ 15..0.0____. ~08 AppJ.ication ree __ _____ .__~__ to FULTONJ3.ANK __._. 3.0.0..0.0 ___ .__ J;,Q2._Docunl,-ut PreparationE~_.___tQ_EUL TON BANK ---.- ----.J~4i.Jo)Da- __.___ .___._ -,s'.L.o"jn",e.stor fee-psLknder forCitimor!gage. to FULTON BANK " .1llJ.. F10pd D~ter/IYIonitor to J'irsLAmencan Flood ____ l--. ___ 1'LJlO.. _ .__.____ 8J_2.J\utOl]}[\te.d UndeJ:\.vriting Fe_U'.d....hUender to FUL To1'\ BANK (Fannie Mau29..(0) p.n.c. B.LL ____ ___ _____no to_._ __._ e-8J4.____ --~- 815. to 9.00. Items Reollired B, Lender To Be Paid [n Advance 911.1. IuterestfroUL12i20i2aa4 to lilI2aa5 (c[; 14.79153. Idav c'-,lQ2 __"1QJ:!gllg,,JmurangoYremium fOL _----1I!Q.11Jhs to 9a3...o.lIazal<;LIDlimance Plcmlum for 1 vears to The Cincinnati Insurance Co. S4n.D~ 9.04 ___. .___._ ._.J'C_ars to 905. years to 1000. Reserves Denosited With Lender Jj2Q.L.miaUU]1SUrancc ... ..._~___.._____._______3 months@ LQQ2.)JQI\gl)gc_]]1.sY~ _ _ ___ month>@: __. 1.003. Cl1:LJ2LOpcl1YJ.a;'.~-,----_______._ months@i I QOA._CountY-P'[QpeI1y taxg.s_~.__----L2._J!lJm1h.S@--,- Jaili.,-.l.,mllli!La2SCSSm~_._... __ months@__ 1 QQ2dch.QoLI~______~___ 8 months.@._ JJ)j)L____~__ _ __ months@ 1..o.Q8,Aggregate_.Adiustme.rlt __ _ mo.nJ~(cU. 1.0.09. 11.00. Title Char!!es .11010 Settlement orcJ.2sing fe<:___ ___------1Q ._____ 1.10";:' AlJstJ:a~J or title sellrch .__ to lJJi.:LTltlc_c2'amina1t9_n__. __. to L1Q:;Jit]c inSLJn!llCe bin~~r to_. 11D.LOQsument RU~p'ar.a\iQlJ to 1106. Notar' fe.el__.._~____.. .___._ to Shumaker Williams P.c.. LIQL .Altomev's fees to... .. _uncludes abovCJtcms.Jlumbers: _... 11D.8. Title inSJJLall_cc. to Shumaker Williams~E.C,___ _---1llli:!JJ_'ks..aJ2QYe items numbers: U 02l) .03 11 .04 _______________~. HQ9~.L91cicr's Co-"-~rage:-___ __._____ ___INS AMT: 1.0.0 71.0..0.0 111.o.0'l'ner's C_overage: .___ INS AMT: 12:i,9_0_QjLO_____~__~. 11103 Endors_emelmJaa 3.0.0 8.1 .._______~__ .._ ______----15.0lJ.Q. _~_____ Ul I. Closing Service Letter to First American Title IrlS.tjLaJl~.eJ::..QmRa.uy-_____ ~.___)5.aa .1112. Prepare Deed & Certification .___n to Thomas Gould, Esquire ..._____ ~.__ 1.0.0..0.0 1113. to 12.00. Government Recordino and Transfer Char!!es nO!. RecQrding Fe5's;_O.e."tl44."a. L::1YlQl1gll,gl;(S) $67.5.0' S-Mortga.lr-e.(.s)_;.Re]eo,e, 12m, City/eWDIY taxist;j,ll1)2.s: Qeed 51.259..0.0: L,MQrtgage(s) S-Mortgage(s).___. _____~_ . 1,2JU--SJa te taxi stanJP.s:_D~..59~Oa..;_L- Mort ga gel s) ~_S. M oJ:1gage.(s} 1."-04__~ __.__. 1259.0.0.00 @! 6. .00_',;,.=-----'1,5,5 '1.,0.0_ Paid From Borro\ver's Funds At SettlemeDL......... Paid From Seller's Funds At .__.S.cttlellJ.'-.nt 125'lQQ.. -------- to HOWARD HANNA DETWEILER REALTY to BROKERS REALTY.COM to .--- 1 n.5St _.__ 'P.O.C.* --.--- 39.33 per month __..lll.22 _____.___ per m0111h_ ___ _ ____.. ___ _______ ner month 54.59 !lermQ.DJh___ _.__ __6.&.0.8_ __~__ ner month RQ.32 ner month ner month ner month .. (493.74)~---- 714.56 _.~---I----._.- - ---- -------. ---------~-_.- .-~~~=--:-----==~~: :=_:~-.6!JO -~6:O0 .... Q8R 7<> 1205. 112.00 ..LZ.~Qo. _______ _._.L2.5.9W ---- ~- 130.0. Additional Settlement Charges 1.30.]. Tran.s.<lcJjon Fee ___ _.__ . __.. to Howard IhU11.alktweiler 1302~!'~stJnspectiQ1L. to ,lilll.Trama.ction Fee__ to Bx-okers Realty.com_.___. 0.3.04. Tax CQ.lj_Reimbursem~lt to KJ2 Snyder Ua5.CotlJ:ier Fec__ to Shumak,x..Rilliams P.c. UlliU;e\I'!~LlDLLtoJ2/2a/0..4._ _____._ __.___-------.tlLLsl\ver Paxton TWlLAthv 1.30.7 2QaASchool Ta"e, _______...~___ to Patsy DQ11mQyer Tax Collector U08. to -----------_._--~-- 1309. to 1400. Total Settlement Charges (enter on lines 103, Section J and 5.02, ScctionK) ~___l.25aa 125..0.0 __J ..0.0. _______.--.lj.aa_ ____ _~__7232.. 1 148.43 ._---~--~-- ~ 4,811.0.4 10.,266.32 CERTlFICA TlO:" . . DATE 12120!?aa4 I have carefullv reviewed the HUD. 1 Settlement Statement and to the best of my knowledge and belief, It IS a true and accurate statement of all receipts and dl5bursemcntsmade on my account or by me in thIS transaction. j further certify that I have received a copy of the HUD . ] Settlement Statement. Wayne E. Kisner Estate 1/;~-;;;I~ /-__~ William J. ROSS,~..f_. BotTower B SelicI' Borrower 13 1- Seller The HUD.I Settlement Statement which I have pre red is a true and accurate accou of this transaction. I have caused the funds to be dIsbursed In accord. ance With this statement SHUMAKER WILLIAMS, P.C _____.~_ Settlement Agent WARNING: It IS a crime to knowingly m e false statements to the United States on this or any other similar form. fine and impnsonment. For details see: Tltle I S U.S. Code SectIOn 100.1 and SectIon 10.1 a. 12/20./20.0.4 Date Penalties upon conviction can include a 34153 ROSS REV 1512 EX. (1.9'i ~ ~.t~/O": -'I~ n ~1 i~.>;. i;;~"'~~.. ~:C>i>-~~~ .-'.~.-=-.~~... .....- COMMONWEALTH OF PENNSYLVANii, INHERITANCE TAX RETURfJ f<ESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER WAYNE E. KISNER 21-04-01026 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 2 3 4 5 FEES RELATED TO SALE OF HOUSE UTILITIES TO MAINTAIN HOME MAINTENANCE ON HOUSE REPAIRS AND SERVICE TO HOUSE MEDICAL EXPENSES 14,043-32 442 . 19 420.00 2,995.20 2,764.08 TOTAL (Also enter on line 10, Recapitulation) $ 20 , 665 . 00 (If more space is needed, Insert additional sheets of the same size) REV-1513 EX+ (9-00) \': .~;I~.-~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF WAYNE E. KISNER FILE NUMBER 21-04-01026 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE r TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. JEFFREY KISNER SON 20% 2 SUSAN KISNER DAUGHTER-in-L, w 20% 3 JANET HARMAN DAUGHTER 20% 4 BRYAN KISNER GRANDSON 20% 5 CHELSEA KISNER GRANDDAUGHTER 20% I I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. CHINESE OVERSEAS CHRISTIAN MISSION, INC, 1,000.00 TOTAL OF PART II - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 1,000.00 (If more space is needed, insert additional sheets of the same size) Cumberland -County - RegiEfter at WiITS One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 GOULD THOMAS D 2 E MAIN STREET SHIREMANSTOWN, PA 17011-6309 RE: Estate of KISNER WAYNE E File Number: 2004-01026 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' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 10/08/2006 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, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ~ Cumberland C6i.i:hEy--=--~e~f~L:er or WLLlS---- One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 KISNER JEFFREY W 202 WEST GREEN STREET SHIREMANSTOWN, PA 17011 RE: Estate of KISNER WAYNE E File Number: 2004-01026 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' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 10/08/2006 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, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ CUmberland CountY--=.R~glgL~r-.or .Wll..IS. One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/14/2006 HARMAN JANET G 5803 STEPHENS CROSSING ROAD MECHANICSBURG, PA 17050 RE: Estate of KISNER WAYNE E File Number: 2004-01026 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' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July-I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 10/08/2006 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, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ IN THE MATTER OF THE ESTATE OF WAYNE E. KISNER, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-1026 STATUS REPORT UNDER 6. 12 Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No x 2. If the answer is no, state when the personal representative reasonably believes that the administration will be complete: 60 Days 3. If the answer to No. 1 is yes, state the following: a. Did the personal representative file a final account with the court? Yes No b. The separate Orphan's 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and the Estate Settlement Agreement is attached to this report. 'Vd "OJ ON't'iti.38~n8 ltlnOJ SNvHdtlO Date: ()d-o~,,. ~ 216'0 >18318 is :ZI Wd Z IIJO 9002 1~44 0. -'~ Thomas D. Gould Attorney for Co-Executors I.D. # 36508 2 East Main Street Shiremanstown, Pa 17011 (717) 731-1461 cd C'!.~l'l.' ,LI"'\ I !~ 101(\" , v l i NI JV dj10i::,,'jd jO 3JI:HO 03080838 ""1'~~'''''' o'''~~~)?''!lIr~'''''''j]$f:='.".',~,' . _~...,.. '. i:~'_e"':"',"l' +. -"- ',..,,,~ Z1IJ!'.' ",~~~..m~,;,:;:t.,.%, ~~,,,..tC.,,:.~. ~." "~'".",.._" "M"" ...."" v ~,~.~ -. '. %omas f)). (jou{d 2 EAST MAIN STREET SHIREMANSTOWN,PA 17011 ATTORNEY AT LAW (717) 731-1461 FAX 761-1974 October 9, 2006 REGISTER OF WILLS CUMBERLAND COUNTY COURT HOUSE HIGH AND HANOVER STREET CARLISLE, PA 17013 Re: Estate of Wayne E. Kisner No. 21-04-1026 Dear Register Lewis: Enclosed please find the original and one copy of the Status Report under 6.12 for the above reference matter. Please file the original and time stamp the copy and return it to me in the enclosed stamped, self-addressed envelope. Thank you for your anticipated cooperation. Respectfully, ~." D.~ Thomas D. Gould enclosure cc. Jeffrey W. Kisner (") ~O -"'-:0 CJ:J:o ~H:r (') ~~Fn t,,,, _ ~.:o ~<- C/) ^ CJ(') 000 oc" ~ :0 :0-1 )3: r-..;, c:::, c::" ~ o ('"") --f ::o;U n-"lfIj 00 c':) ::0 --.-; 0 ~i-] 23 C) -l/~ :~fg r'-' rT'1 c:"') i-:-) ~1 N -0 :x ~ c.n -.I IN RE: ESTATE OF WAYNE E. KISNER, ~ = () ~ ,-.() , IN THE COURT OF CO~ PLE~ " CUMBERLAND COUNTY, J?~~ij'LV~IA ~=-~ ".<-::..0 0 .' --~ I~J-:; ~5.::::' NO. 2004-01026 "'"\j ____:'l'.. ->... - ; ;~3 ~~~ :'0 ~-i f;-? W C> ORPHANS COURT PETITION FOR APPROVAL OF THE FINAL ACCOUNT AND PROPOSED DISTRIBUTION NOW COMES the Co-Executors of the Estate of Wayne E. Kisner and files this Petition for approval of the Estate's final account and to authorize the distribution of the Estate's assets. 1. The decedent, Wayne E. Kisner, widowed, late of Hampden Township., Pennsylvania died on October 8, 2004 having a Will, duly probated on November 10, 2004 and recorded at with Cumberland County Register of Wills, docketed at 2004-01026, naming Jeffrey W. Kisner and Janet G. Harman, who were granted Letters on November 10, 2004 to administer the Estate. 2. In a Decree dated December 27, 2004 Jeffrey and Susan Kisner were appointed guardians of the estates of their son Bryan Kisner and daughter, Chelsea Kisner. 3. Bryan Kisner, date of birth November 23, 1987, has attained the age of 18 and an Order dated August 31, 2006, vacated the appointment of his mother and father as his guardians. 4. At the time of death decedent had assets as set forth in the attached Account. 5. In administering the Estate the Personal Representatives paid expenses and debts as set forth in the attached Account. /'", v 6. After death the Estate received dividend checks from PPL totaling $1,341.00. 7 . The Estate has made a distribution to Janet Harman of $6,000.00 which equals the amount each of the other heirs received from the decedent within one year of his death. 8. The Personal Representatives request the approval of the Account and permission to make distribution of the remaining assets as provided in the attached Proposed Distribution. Respectfully submitted, ...... " , >'\U ~/, ,,~..:-r.../- () ..... ",.....Q "\...'\. JaJet G. Harman ~~ c~.... ,., ~ Susan E. Kisner ~c~ Susan E. Kisner Kisner ~~f). Au Thomas D. Gould, Esquire 1.0. # 36508 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 ACCOUNT ESTATE OF WAYNE E. KISNER ITEM VALUE AT DEATH ASSETS: Total $ 125,900.00 $ 14,388.00 $ 78,681.63 $ 24,000.00 $ 1,341.00 $ 244,310.63 Real Estate PPL stock Financial deposits & personal property Distributions within one year of death PPL dividends DEBITS: Funeral & Administration Expenses Fees related to sale of home Maintenance on home Repairs & service to home Utilities related to home Medical expenses PA Inheritance Tax & interest $ 10,760.00 $ 14,043.32 $ 420.00 $ 2,995.20 $ 442.19 $ 2,764.08 $ 11,030.52 Total $ 42,455.32 Net Value of Estate for distribution $ 201,855.32 PROPOSED DISTRIBUTION OF ASSETS BENEFICIARY SHARE CHINESE OVERSEAS CHRISTIAN MISSION, INC. $ 1,000.00 JEFFREY W. KISNER $ 40,571.06* SUSAN E. KISNER $ 40,571.06* JANET G. HARMAN $ 40,571.06* BRYAN J. KISNER $ 40,571.06* CHELSEA S. KISNER $ 40,571.06* Total $ 201,855.32 * each heir will be credited with having received a $6,000.00 distribution .... t' IN RE: ESTATE OF WAYNE E. KISNER, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION NO. 04-1026 ORPHANS' COURT ORDER OF COURT (' AND NOW, this 13th day of November, 2006, upon consideration of the Petition ..,. for Approval of the Final Account and Proposed Distribution, to the extent that the petition seeks to bypass the normal procedure for confirmation of accounts, including advertising requirements, it is denied. BY THE COURT, Thomas D. Gould, Esq. 2 East Main Street Shiremanstown, P A 17011 :rc (") ~o <' :0 ~~~p - L? rn ..:...,. -.lJ <i5~ o C.) (JO.l (>-jC ;- :0 -u --I ):'.> ......, c::;:l c:::;) 0"" :z c::> -< .:::- -0 :J: i::R :. ) ( ) ~l~ C7 - ~~~j C) (T1 U1 (X) ~ In Re: ESTATE OF WAYNE E. KISNER ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA t NO. 21-2004-1026 , CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 11/14/06 JUDGE'S INITIALS: JWO TIME STAMP DATE: 11/14/2006 IN RE: ORDER OF COURT SERVICE TO: THOMAS D. GOULD. ESQ. METHOD OF MAILING: ENVELOPES PROVIDED BY: [g1 USPS DRRR D HAND DELIVERED D OTHER_ [g1 PETITIONER D mDGE D CLERK OF ORPHANS COURT MAILED: 11-14-2006 SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: D USPS DRRR D HAND DELIVERED D OTHER_ D PETITIONER D mDGE D CLERK OF ORPHANS COURT MAILED: .-.... ". .. , IN RE: ESTATE OF WAYNE E. KISNER, ~ c:::> ~ 2. a"' IN THE COURT OF CO~ p~ CUMBERLAND COUNTY, _Q.rl~ . 4~"" 0 Cf) 7' C)() ,-)0-" "o',C :-j 'I) , :..~ -n p NO. 2004-01026 ORPHANS COURT PETITION FOR APPROVAL OF THE FINAL ACCOUNT AND PROPOSED DISTRIBUTION NOW COMES the Co-Executors of the Estate of Wayne E. Kisner and files this Petition for approval of the Estate's final account and to authorize the distribution of the Estate's assets. 1. The decedent, Wayne E. Kisner, widowed, late of Hampden Township~ Pennsylvania died on October 8, 2004 having a Will, duly probated on November 10, 2004 and recorded at with Cumberland County Register of Wills, docketed at 2004-01026, naming Jeffrey W. Kisner and Janet G. Harman, who were granted Letters on November 10, 2004 to administer the Estate. 2. In a Decree dated December 27, 2004 Jeffrey and Susan Kisner were appointed guardians of the estates of their son Bryan Kisner and daughter, Chelsea Kisner. 3. Bryan Kisner, date of birth November 23, 1987, has attained the age of 18 and an Order dated August 31, 2006, vacated the appointment of his mother and father as his guardians. 4. At the time of death decedent had assets as set forth in the attached Account. 5. In administering the Estate the Personal Representatives paid expenses and debts as set forth in the attached Account. -0 :.'C r:-? (..) Q --q n"'1 C) C) --0 ;:~~} i-n C.:::J C) ---" -" .5 (T'l '.~?\ G ... '" 6. After death the Estate received dividend checks from PPL totaling $1,341.00. 7 . The Estate has made a distribution to Janet Harman of $6,000.00 which equals the amount each of the other heirs received from the- decedent within one year of his death. 8. The Personal Representatives request the approval of the Account and permission to make distribution of the remaining assets as provided in the attached Proposed Distribution. Respectfully submitted, 9!1w~i~ ,~C~ Susan E. Kisner ~~ Kisner Kisner ~."f)~ Au Thomas o. Gould, Esquire 1.0. # 36508 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 --, . ' ~ ACCOUNT ESTATE OF WAYNE E. KISNER ITEM VALUE AT DEATH ASSETS: Total $ 125,900.00 $ 14 , 38 8. 0 0 $ 78,681.63 $ 24,000.00 $ 1,341.00 $ 244,310.63 Real Estate PPL stock Financial deposits & personal property Distributions within one year of death PPL dividends DEBITS: Funeral & Administration Expenses Fees related to sale of home Maintenance on home Repairs & service to home Utilities related to home Medical expenses PA Inheritance Tax & interest $ 10,760.00 $ 14,043.32 $ 420.00 $ 2,995.20 $ 442.19 $ 2,764.08 $ 11,030.52 Total $ 42,455.32 Net Value of Estate for distribution $ 201,855.32 PROPOSED DISTRIBUTION OF ASSETS BENEFICIARY SHARE CHINESE OVERSEAS CHRISTIAN MISSION, INC. $ 1,000.00 JEFFREY w. KISNER $ 40,571.06* SUSAN E. KISNER $ 40,571.06* JANET G. HARMAN $ 40,571.06* BRYAN J. KISNER $ 40,571.06* CHELSEA S. KISNER $ 40,571.06* Total $ 201,855.32 * each heir will be credited with having received a $6,000.00 distribution .. . . '.. y OCT a 1 20061"'1 IN RE: ESTATE OF WAYNE E. KISNER, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2004-01026 ORPHANS COURT ORDER AND NOW, , 2006, after review of the Petition For Approval of the Final Account and Proposed Distribution filed by the Co-Executors and signed by heirs of the Estate of Wayne E. Kisner, the petition is granted and the Final Account and Proposed Distribution is approved and the co-executives are directed to make distribution of the assets as set forth in the Final Distribution and are authorized to close the Estate. BY THE COURT, IN RE: ESTATE OF WAYNE E. KISNER, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2004-01026 ORPHANS COURT FIRST AND FINAL ACCOUNT AND PROPOSED DISTRIBUTION JANET G. HARMAN JEFFREY W. KISNER PERSONAL REPRESENTATIVES Decedent died on October 8, 2004 Letters advertised In the Cumberland Law Journal on December 10,17,24, 2004 Letters advertised in the Sentinel on December 1,8,15, 2004 The Account and Proposed Distribution of assets is attached. I verify that the statements made In this First and Final i~ccount . and Proposed Distribution are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. , ' . '~'\J ',',"f\ "._1'\ \-,.J ,: ,.:,',-; \'..10 >'I~< \' ,-",8'....1 JD ').!:j3l'J ~4?~.~ Thomas D. Gould, Esquire Attorney for the Representatives 1.0. #36508 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 lid 0(' ~U~\'d cn'v 8 \ :2 ~r v l\ i'\.J .. ACCOUNT ESTATE OF WAYNE E. KISNER ITEM VALUE AT DEATH ASSETS: Total $ 125,900.00 $ 14,388.00 $ 78,681.63 $ 24,000.00 $ 1,341.00 $ 244,310.63 Real Estate PPL stock Financial deposits & personal property Distributions within one year of death PPL dividends DEBITS: Funeral & Administration Expenses Fees related to sale of home Maintenance on home Repairs & service to home Utilities related to home Medical expenses FA Inheritance Tax & interest $ 10,760.00 $ 14,043.32 $ 420.00 $ 2,995.20 $ 442.19 $ 2,764.08 $ 11,030.52 Total $ 42,455.32 Net Value of Estate for distribution $ 201,855.32 PROPOSED DISTRIBUTION OF ASSETS BENEFICIARY SHARE CHINESE OVERSEAS CHRISTIAN MISSION, INC. $ 1,000.00 JEFFREY W. KISNER $ 40,571.06* SUSAN E. KISNER $ 40,571. 06* JANET G. HARMAN $ 40,571.06* BRYAN J. KISNER $ 40,571.06* CHELSEA S. KISNER $ 40,571.06* Total $ 201,855.32 * each heir will be credited with having received a $6,000.00 distribution PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, V1Z: DECEMBER 10, 17 ,24, 2004 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ' Kisner, Wayne E.. dec'd. Latc of Mechanicsburg. Personal Representative: Jeffrey W. Kisner, 202 West Green Street, Shiremanstown. PA 17011 and Janet G. Harman, 5803 Stephens Crossing, Mechanicsburg, PA 17050. Attomey: Thomas D. Gould, Es- quire, 2 East Main Street, Shire- rnanstown, FA 17011. SWORN TO AND SUBSCRIBED before me this 24 day of DECEMBER 2004 ~,l.~ ....c.. '-='''"-'><c:'Nl1t~IT~:r==-- .,"C'= ~ PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tammy Shoemaker, Classified Sales Mana~, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following date(s December 01, 08, 15, 2004 COPY OF NOTICE OF PUBLICATION NOTICE NOTICE IS HEREBY GIVEN that letters of testamentary have been granted to Jeffrey W. Kisner and Janet G Harman In the estate of WAYNE E. KISNER late Of' Mechanicsburg, Cumberland County, Pennsylvania, who d,ed on October 8, 2004. All persons indebted to the said estate are required to make payment, and those haVing claims or demands to present the same without delay to Jeffrey W. Kisner and Janet G. Harman Personal Representatives, c/o Thomas D. Gould EsqUire, 2 East Main Street, Shiremanstown ' Pennsylvania 17011. ' Thomas D. Gould, Esquire 2 East Main Street Shiremanstown, PA 17011 Affiant further deposes that he/ she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of pub ication are true. . {)vYV\ Sworn to and subscribed before me this 15th day of December, 2004 0- l /UtJ-b/,'"T 'y: I . 1 /'~t j ,/J L-l/( -IX. j Notary tublic My commission expires: (! /(/15';- COMMONWEALTH OF PENNSYLVANIA I Notarial Seal ! Chnstina L. Wolfe, Notary Public i Cariisle BOfO, Cumberland County My Commission Expires Sept 1, 2008 Member. Penos,!lvani3 Association Of Notaries BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 'I:NHERITANCE TAX STATEMENT OF ACCOUNT " . . ,,(1 ~ L! ~ REV-1607 EX AFP (03-05) ""'i:! Lic DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-18-2006 KISNER 10-08-2004 21 04-1026 CUMBERLAND 101 WAYNE E THOMAS D GOULD ESlf' 2 E MAIN ST SHIREMANSTOWN PA 17011 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- --+ RETAIN LOWER PORTION FOR YOUR RECORDS +- ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF KISNER WAYNE E FILE NO. 21 04-1026 ACN 101 DATE 09-18-2006 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: 08-23-2006 PRINCIPAL TAX DUE: 10,623.43 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-15-2006 CD006437 407.09- 12,679.29 08-29-2006 REFUND .00 1,648.77- TOTAL TAX CREDIT 10,623.43 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REflECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J ~ ~ ~~~ I hereby cef1Ify that written notice of the fiUng of this Statement of Proposed DI8tJ1butIon. and of the date. time and place when the 88Rl8 wi! be preeented to the Court fa' Wllh_.!!.1o. J and d I1e IMt ~ to file written objectIonI to Itid fAllla....' d Proposed Di8lrIbution. has been gillen to fINefY unpMI claimant and to evety other person IInown to the accountant to have or cteim an Intere8lIn the 8III8Ie _ oredIklr. beneflclary. heir 01' next of kin. A copy of said Statement was Included with the notice. f II" 01- -8e: o.....i~ .. t'< D ~~. IF t1l :I . co.,; g!.o..~ ; ;~'. ,fa ~I D.-"- ~:~o ~ ...=- i:if j' ill IN THE MATTER OF THE ESTATE OF WAYNE E. KISNER, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-1026 STATUS REPORT UNDER 6.12 Pursuant to Rule 6.12 of the Supreme Court Orphan's 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. I f the answer lS no, state when the personal representative reasonably believes that the administration will be complete: N/A 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 x No b. The separate Orphan's Court No. (If any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes No x d. Copies of receipts, releases, joinders and approvals of formal or informal accounts were filed with the Clerk of the Orphans' Court. ., ,"' . Ct.::: : J i J c_; , : c:. ~44~. ~ Thomas D. Gould Attorney for Co-Executors LD. # 36508 2 East Main Street Shiremanstown, Pa 17011 (717) 731-1461 Da t e: . &i S, 241.,' , __ ~,:--3,1 '\ ,~,_v