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Home My WebLink About02-0292OFFICIAL USE ONLY~ COMMOt~M/EAL1H OF PENNSYLVANIA DEPARTMENT OF REVENUE DEFT. 2~01 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2] COUNTY CODE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAL) SOCIAL SECURITY NUMBER Sauer, Harmon Philip 067-10-8950 lU DATE OF DEATH 0MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE O o 05/16/2000 08/12/1916 "' REGISTER OF WILLS ° ,F ^~.,c~) SURWV,.~ s.ous~s NAME C~r. FIRST~.) M,DD.E,.m~) SO~A. SECORr~ NUMB~ (none), [] [] 2. Supplemen~lRe{um after 12-12-82) copy ~ Tm~) O 10. S~l P~ Cr~ (d~ M d~ ~ 12~1-91 a~ 1-1-~ 1. Original Ratum 4. Limited Estate 6. Decedent Died Testate (A~h copy of ~ilO 9. Litigation Proceeds Received ~AME James M Robinson :IRM NAME (If applicable) Turo Law Offices 'ELEPHONE NUMBER 717/245-9688 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & No~es Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (S~ule F) [] Separate Billing Requested 7. Inter-V'wos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (to[al Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) z ] 3. Remainder Return (date of deatfl pdofto 12-13.-82) [] 5. Federal Estate Tax Ratum Required 8. Total Number of Safe Deposit Boxes [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 12. Net Value of Estate (Line 8 minus Line 11 ) (1) (2) (3) (4) (5) (6) (7) (9) (10) 28 South Pitt Street Carlisle, PA 17013 None None None 12,054.16 None None 154.00 405.84 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has nof been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Une 14 taxable atthe spousal tax rate, or transfers under See. 9116(a)(1.2) 16, Amount of Line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. Tax Due 0.00 x 11,494.32 x 0.00 x .12 0.00 x .15 Copyright 2000 form software only The Lackner Group, Inc. ~C}C)FFICIAL USE ~NLY (8) 12,054.16 559.84 11,494.32 11,494.32 (11) (12) (13) (14) (15) (16) 689.66 (17) (18) (19) 689.66 Form REV-1600 EX (Rev. 64)0) Decedent's Complete Address: STREET ADDRESS CITY Camp Hill STATE PA ZIP 17011 1700 Market Street 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 63.33 E. Penalty 172.42 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line l + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Une 20 to request a refund 5. If Line 1 + Line 3 is greater then Line 2, enter the difference. This is the TAX DUE. 689.66 0.00 235.75 925.41 925.41 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (4) (5) (5A) (5B) PLEASE ANSWER THE FOLLOWING QUESTIOHS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ..................................................................................... N b. retain the right to designate who shall use the properly transferred or its income; ......................................... [] [] c. retain a reversionay 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 properbj 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? ............... r"l [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ r'~ [] 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 perjunj, I declare that I have examined this return, including accompanying schedules and statements, and to ~ best of my knowledge and beliofI it is true, correct and complete. Declaration of preparer other then the personal repmsentaltve is based en all infommtion of which preflamr has eny knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 28 S. Pitt St. Carlisle, PA 17013 ~3 & ' Do~ dates of dea~ 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 e,,e~ml~ 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 benef'mia~j. 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-(x~ 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 o~ 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 decedenrs 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. SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sauer, Harmon Philip 21 - - Inclu.de th~. Droct~s of '..~afion and the date theproct~ls were r~:ehtod by the ~tate. All propert~ joint~-owned wRh the fight of surv~vomnlp must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2 PNC Checking Account ManorCare refund Bank Interest - 5/18/00 TOTAL (Also enter on Line 5, Recapitulation) 11,504.17 545.10 4.89 12,054.16 ESTATE OF Sauer, Harmon Philip FILE NUMBER 21-- Deb~ of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 4o FUNERAL EXPENSES: Food - Shammos ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Securit~ Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Turo Law Offices - James M. Robinson, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant (none) Stres~ Address 1700 Market Street City Camp Hill State PA Relationship of Claimant to Decedent Daughter Probate Fees Filing Fee - Inheritance Tax Return Filing Fee - Petition for Distribution ora Small Estate Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Death Certificates - paid to Cremation Society of PA Zip 17011 80.00 15.00 39.00 20.00 TOTAL (Also enter on line 9, Recapitulation) 154.00 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Sauer, Harmon Philip 21 - - Include unmimbumed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 8 Neighborcare - for drugs - Invoice dated 5/18/00 West Shore EMS - 5/18/00 The Patriot-News - 5/16/00 Kohl's - 6/18/00 Neighborcare - for drugs - Invoice dated 6/18/00 The Patriot-News - 7/13/00 Beacon Medical - Doctor - 7/31/00 Bank charges - 5/00 to 1/02 TOTAL (Also enter on Line 10, Recapitulation) 108.58 77.20 6.20 63.96 11.03 9.70 57.17 72.00 405.84 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE'IIJRN RESIDENT DECEDENT ESTATE OF Sauer, Harmon Philip SCHEDULE J BENEFICIARIES FILE NUMBER 21-- NUMBER IL NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Jacqueline S. Sheaffer 6200 Locust Lane Mechanicsburg, PA 17020 Janine McFate R.D. #2, Box 146 Pittsfield, PA 16340 RELATIONSHIP TO DECEDENT Daughter Daughter Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET AMOUNT OR SHARE OF ESTATE one-half 5,748.66 ~ne-half 5,748.66 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ~ND~VIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 00O987 ROBINSON JAMES M TURO LAW OFFICES 28 SOUTH PITT STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 067-10-8950 FILE NUMBER: 2102-0292 DECEDENT NAME: SAUER HARMON PHILIP DATE OF PAYMENT: 03/22/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2000 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $925.41 TOTAL AMOUNT PAID: $925.41 REMARKS: JACQUELINE SSHEAFFER C/O JAMES M ROBINSON SEAL CHECK# 3692 INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS IN RE: ESTATE OF HARMON PHILIP SAUER · IN THE COURT OF COMMON PLEAS OF · CUMBERLAND COUNTY, PENNSYLVANIA · ORPHAN'S COURT DIVISION PETITION FOR DISTRIBUTION OF A SMALL ESTATF Before the Register of Wills of Cumberland County, In the matter of the Estate of Harmon Philip Sauer, Deceased To the Honorable Mary C. Lewis, Register of Wills of Cumberland County: The petition of Jacqueline S· Sheaffer respectfully represents: 1. The Petitioner is Jacqueline S. Sheaffer, 6200 Locust Lane, Mechanicsburg, Cumberland County, Pennsylvania, daughter of the decedent. 2. That Harmon Philip Sauer, a resident of Camp Hill, Cumberland County, Pennsylvania died on May 16, 2000. 3. Decedent died testate, leaving an estate valued at $12,054.16 and a will that has not been probated, which names Jacqueline S. Sheaffer Executrix and requires her to post no bond. 4. Said decedent named Janine Sauer McFate and Jacqueline S. Sheaffer, his daughters and only children, both of whom are of full age and suijuris, as sole beneficiaries of his estate. 5. Both Beneficiaries have received equal shares of the Estate, leaving only the asset listed below. None of the distributed assets were for payment of wages. 6. No family exemption is being claimed in this matter. 7. The sole remaining undistributed asset o1[~ the~ decedent is a deposit account maintained at PNC Bank bearing account number 50~'~011-5674 and containing a balance of $611.21 on September 30, 2001. 8. There are no unpaid claimants against the estate. WHEREFORE, your petitioner prays for distribution of the personal property to the Executrix for distribution to decedent's beneficiaries. Date: ,~cq~eline S. Sl~ea~er !/~ VERIFICATION I verify that the statements made in the foregoing Petition for Distribution of a Small Estate 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. Date ~co~eline S. St~ea'ffe~, Peti~e~er LAST WILL AND TES?A~ENT OF HAI~qON PHILIP SAUER I, HARMON PHILIP SAUER of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expen- ses out of my estate as soon as may be practical after my death. II - I direct that all tangible personal property, including automobiles and insurance thereon, be divided by my executrix between my daughters, Janine H. Sauer and Jacqueline S. Sheaffer, in as nearly equal shares as possible. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto Jacqueline S. Sheaffer, IN TRUST, nevertheless, for the benefit of my wife, Jean Hill Sauer. My trustee shall invest and reinvest the principal and out of the income derived by the trustee shall pay all the necessary costs and expenses of the trust, including the reasonable compensation of the trustee. The trustee, in her sole and absolute discretion, may make expenditure~ Crom the income a..nd principal of the trust as she may deem ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 Page 1 necessary for the support and maintenance of my wife. In making expen- ditures of income and principal my trustee is directed to take into account all other available sources for the support of my beneficiary, including entitlement to federal and state public assistance payments. In the event that my trustee determines that it is not advisable to pay all of the income for the support and maintenance of my wife, my trustee shall pay the balance of the income in equal shares to herself and her sister, Janine H. Sauer. Upon the death of my wife, the trust shall terminate and the balance then remaining, including principal and undis- tributed income, shall be divided between my two daughters, Janine H. Sauer, and Jacqueline S. Sheaffer, in equal shares, or if either of them is deceased, to her issue per stirpes. IV - No interest in income or principal shall be assignable by or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. V - I appoint my daughter, Jacqueline S. Sheaffer, guardian of the person of my wife, Jean Hill Sauer. VI - I appoint my daughter, Jacqueline S. Sheaffer, guardian of any property which passes under this will or otherwise to a minor or an incompetent and with respect to which I am authorized to appoint a ~~~-~'~_._i~ /~J_/ Page 2 ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as income from time to time for the minor's education and support or to make payment for those purposes without further responsibility to the minor or to any person taking care of the minor. The said guardianship shall terminate as to each beneficiary when he or she reaches the age of 21 years, if a minor, or when declared competent, if an incompetent. VII - I appoint my daughter, Jacqueline S. Sheaffer, Executrix of this, my Last Will and Testament. Should my said daughter fail to qualify or cease to act as such, then I appoint my daughter, Janine H. Sauer, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this the ~! 44 day of /~a~_ 1990 Harm6~ Philip S~uer -- (SEAL) Page 3 ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 Signed, sealed, published and declared by HARMON PHILIP SAUER, Testator therein named, on this and three (3) other sheets of paper as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. · Name g - ~..~,, Name ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 Page 4 COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) : SS. WE, the undersigned, the testator and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing 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. Witness Subscribed, sworn to and acknowledged before me by the testator, and subs,~bed a~n~d sworn to before me by both witnesses, this ~/~ day of~~ , 1990. Notary Public NOTARIAL SEAL THELMA S. McCAUSLIN, Notary Public Camp Hill, PA Cumberland County My Commission Expires July 3, 1992 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ~NLY FIlE Nm 't~=AR NUMBER ~c~a~,s m~E ~. ~s~. ~ ~mu; ~m~ soc~~~ Sa~, H~on P~p 067-10-8950 ~ ~ ~ ~ ~~ ~ ~ ~ ~~ T~ R~U~ M~ ~ ~ ~ ~TE ~. THE ~ 05116~2000 08/I 211916 RE~R OF ~L~ Turo Law OI~ices 717/245-9688 [] 3. Remaine~Ra~um('~'''=~p~orto12'13'82) [] 5. Federalr'd-~T=~Re~umRequimd 8. Tobd Number of Sa~e ~ Boxes [] 11.Eleelk~ to tax under Sec. 9113(A) (Auach Sch O) 28 South Pitt Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. C~ay Had CorporaUm. Pa,r,~p or Sde-Pmpri~p (3) 4. Mortgages & No~ Rece~ab~ (Sche~u~ D) (4) 5. ~, ~ ~& ~~ P~ P~ (5) (~ E) 6. J~~ ~(~~ (6) 0 ~ ~ R~_~ 7. I~-~T~& ~ ~ ~ (~e~L) 8. T~I O~~ ~ ~ 1-~ 9. F~ ~ & ~ ~ (~ H) (9) ~0.~~~~,&~(~0 ~I.T~~~e& ~0) None None None None 12,054.16 None None 154.00 405.84 OFFICIAL USE ONLY 12,054.16 559.84 11,494.32 11,494.32 (11) 12. Ne~ Value of Estate (Une 8 minus Une 11) (12) 13. Charilable and Governmental ~ 9113 Trusts for which an eleclion to tax has no~ been made (Sch~u~ ,~ 14. Ne~ Value Subject to Tax (Line 12 minus Line 13) (13) (14) SEE BIS~ ON REVERSE SIDE FOR APPLICABLE RATES 15. Amour~ofUne14taxableallhe~,o~altaxrale, 0.00 x .O0 or Iransfem under Sec. 9116(a)(1.2) 16. Amount of Une14 taxable al ineal rale ]],494.32 x ,~6 (15) (16) 689.66 689.66 17. Amount of I_lne 14 taxable al a~:~ing tale 0.00 x .12 (1~ 18. Amount of Line 14 taxable al ¢ellateral rale 0.00 x .15 (1~ 19. Tax Due 20. I-! (19) Form REV-lr40 EX (law. 6-00) Decedent's Complete Address: ' 17OO Mnrket Slreet Camp Hill Tax Payments and Credits: 1. Tax Due (Page I Une 19) 2. Credits/Payments A. Spou~ Pa,ety credit a. Pdor Payments C. Discount mtermUPer~y if appa:ab~ D. Interest 63.33 E. Penalty 172.42 STATE PA ZIP 17011 (1) 689.66 Total Credits (A + B + C) (2) Tolal Interest/Penalty (D * E) (3) ffLine2 is gmeterthan Une 1 + Une 3, entre'the difference. This is the OVERPAYMENT. (4) C;-,ec~ box on Page I Une 20 to request a refund ffUnel + Line3 is gmderlhan Une2, enterlhed'dfermce. This is IheTAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enterlhetolal~fUneS+SA. This is Ihe BALANCE DUE. (58) 0.00 235.75 925.41 925.41 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deuedent make a transfer and: Ye~ No a. re~ain the use or inceme of the property transfened; ..................................................................................... I._[ b. rdain Ihe dght to designa~ who shall use the pmpedy ~ er its income; ......................................... c. rein a reersionary interest; or ..................................................................................................................... d. rece~m the pramise for life of eilher i~ymen~, benefils or c~re? .................................................................. 3. Dkl decedent ~wn ~n 'in trust for' or payable upon deelh benk L~,~-nt ar security ~ his or he~ deeth? ............... ]'-] 4. Did ~ ow~ ~n Individual Rdkement A_,~,__,~ ~nnuity, or el~er nm-prab~ prape~y which IF THE ~ TO ANY OF THE ABOVE QUESTIONS 18 YE~, YOU MUST COMPt.ETE SCHEDULE G AND FILE IT A~ PART OF THE RETURN. Mechanicsburg, PA 17050 28 S. Pitt St. PA 17013 ~ I surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of deelh ~xt or alter January 1, 1995, the tax ra~e impoued on the ne~ value of transfers to or fer the use of the sunY~g spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The stakde does n~ ~ a transfer to a surviving speuse from tax, and the statutory requirements for disclosure of assels ancl filing a tax relum are stiff apl:~mble even if Ihe suwMng spouse is Ihe only bene~da[y. Fo~ dates of dealh on ~x alter July 1, 2000: parent, an ad;~l~ perent, ~r a $1et~;~ent of lhe child is O~ ~ P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to o~ for the use oflhe d,,_v~denf$ lineal ber~clariss is 4.5%, except as n(~:l in 72 P.S. §9116 12) [72 P.S. ~1~6 (a) (1)]. The tax rale imposed o~ the net value oflransfers toot torlhe useoflhe____,'J",__~mt'_ s sblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined, ESTATE OF Sauer, Harmon Philip SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FLE NUMBER 21- - Inclu.de the. procee~.s of ..r~l .a~ion and the .date. ~e_proceeds were received by the estate. All property jointiy-owned with the right of survwomnip must be dl~c,o~ea on $cneame r. ITEM NUMBER DESCRIPTION PNC Checking Account ManorCam refund Bank Interest - 5/18/00 TOTAL (Also enter on Line 6, Recapitulation) VALUE AT DATE OF DEATH 11,504.17 545.10 4.89 12,054.16 ESTATE OF FILE NUMBER Saucr, Harmon Philip 21 - - Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER Ao Bo 5o FUNERAL EXPENSES: Food - Shammos ADMINISTRATIVE COSTS: Pemonal Represental~'s Commissions Social Securiiy Number(s) I EIN Number of Perf~oal Representative(s): Stras~ Address C~y Sta~ 7Jp Year(s) Commission paid Attome/s Fees Turo Law ~ - James ]VI. Robinson, Esquire Family F_~: (If de._ _-~_~.ent'$ address is rt~ the same as clabnant's, attach explana6on) C~mmt (~one) Stre~ Address 1700 Market Street C~y Camp Hill Stale PA Zip Relationship of Clabnant to De._- :~_.ent Daughter Probate Fees Filing Fee - Inhef;ia~-~ce Tax Return Filing Fee - P~-fifion for Distn~oufion of a Small Estate 17011 Accountant's Fees Tax Return PrepareCs Fees Death Certificates - paid to Cremation Society of PA TOTAL (Also enter on line 9, Recapitulation) 80.00 15.00 39.00 20.00 l~l.O0 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Sauer, Harmon Philip 21 - - Include unreimbumed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 2 3 4 5 6 7 8 Neighborcare - for drugs - Invoice dated 5/I 8/00 West Shore EMS - 5/18/00 The Pntriot-News - 5/16/00 Kohl's - 6/18/00 Neighborcare - for drugs - Invoice d____n~l_ 6/18/00 The Patriot-News - 7/13/00 Beacon Medical - Doctor - 7/31/00 Bank charges - 5/00 to 1/02 TOTAL (Also enter on Line 10, Recapitulation) 108.58 77.20 6.20 63.96 11.03 9.70 57.17 72.00 405.84 SCHEDULE J BENEFICIARIES RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY DECEDENT OF ESTATE Io TAXABLE DISTRIBUTIONS (h~clude oubight spousal 1 Jacqucline S. Sheaffer Daughter sm-half 5,748.66 6200 Locust Lane M~clumicsburg, PA 17020 2 $~nine McFate Dau~ter oaf-half 5,745.66 R.D. #2, Box 146 Pittsfield, PA 16340 Enter ddlar amounts for distraxdJons shown abo~e on lines 15 through 17, as approwia~ on Rev 1500 cover shee~ II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ESTATE OF FLE NUMBER Sauer, Harmon Philip 21 - - IN RE: ESTATE OF HARMON PHILIP SAUER · IN THE COURT OF COMMON PLEAS OF · CUMBERLAND COUNTY, PENNSYLVANIA · ORPHAN'S COURT DIVISION ORDER OF COURT AND NOW, this~_)_~ day of ~ ,2002, upon consideration of the Petition for Distribution of a Small Estate from Petitioner, Jacqueline S. Sheaffer, this Court hereby ORDERS that PNC Bank distribute all funds remaining in the account of Harmon Philip Sauer bearing account number 50-7011-5674 to the Executrix for distribution to Decedent's beneficiaries. BY THE COURT, ,,,,,. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DZVTSZON DEPT. 180601 HARR/SBURG, PA 17128-0601 JAHES H ROBINSON 18 S PITT ST CARLISLEL-:::. PA 1701:3 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-l;47 El( &FP (01-0~) DATE 05-06-2002 ESTATE OF SAUER DATE OF DEATH 05-16-2000 FILE NUNBER 21 02-0292 COUNTY CUMBERLAND ACN 101 Aeoun* Remi**ed HARMON P HAKE CHECK PAYABLE AND REHIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I?0I$ CUT ALONG THIS LXNE ~ RETAIN LOWER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SAUER HARHON P FILE NO. 21 02-0292 ACN 101 DATE 05-06-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNXNG FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~e~a (Schedule A) (1) 2. S~ocks and Bonds {Schedule B) 3. Closely Held S~ock/Par~nership In~eres~ {Schedule C) {3) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) (5) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9) 10. Deb~s/Hor~gege Liabilities/Liens (Schedule 1) (10) 11. To~el Deductions 12. Ne~ Value of Tax Re~urn .00 O0 O0 O0 12~05q.16 O0 O0 (8) 15q. O0 qO5.Bq NOTE: To lnsure proper credi~ ~o your account, submi~ ~he upper por~lon of this fore wJ~h your ~ex payment. 13. 14. NOTE: 12,05~.16 (11) ~5~. 8t (12) 11,~9q.32 Chari~abXe/Governeen~al Bequests; Non-elected 9113 Trusts (Schedule J) (13) Ne~ Value of Es~:a~:e Sub~ect ~o Tax (14) ]:f an assessment teas issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 14 a~ SpousaX ra~e 16. Amoun~ of Line 14 ~axabXe a~ LineaZ/Class A ra~e 17. Amoun~ of Line 14 a~ SibXing ra~e 18. Amoun~ of Line 14 ~axabXe a~ Co112~eraX/CXass B ra~e 19. PrincipeX Tax Due TAX CREDXTS: PAYNENI R~C~/PT DISCOUNT (+) DATE NUNBER XNTEREST/PEN PAXD (-) 03-22-2002 CD000987 63.33- .00 ll,qgq.32 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 tail1 (1;). .00 x O0 = .00 (16). ll,q9q.32 x 06 = 689.66 (17), .00 x O0 = .00 (18) . O0 x 15 = . O0 (19)= 689.66 AHOUNT PAID 925.ql TOTAL TAX CREDIT 862.08 BALANCE OF TAX DUEI XTZ.qZCR INTEREST AND PEN. .00 TOTAL DUE 172.q2CR IF TOTAL DUE ZS LESS THAN $1, NO PAYNENT IS RE~UIRED. 1F TOTAL DUE 1S REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE REFUND. SEE REVERSE S~DE OF THIS FORN FOR INSTRUCTIONS.)