The URL can be used to link to this page

Home My WebLink About04-1079 ,Rn-_b'::i~) . *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT280601 HARRISBURO,PA 1]128.0801 i DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) , Burke, Clare E. 1- : DATE OF DEATH (MM-DD.YEAR) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY I FILE NUMBER 21 04 i .QOU"-'!!Y CQQE YE~EL SOCIAL SECURITY NUMBER 1079 NUMBER _ ~ z l!I w u w o DATE OF BIRTH (MM-DD-YEAR) I I THIS RETURN MUST BE FILED IN DUPUCATE WITH THE 201-18-4940 109/29/2004 I 10/23/1926 I(IF APPUCABLEj SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) 'jg1 :0 1 Original Return o o 2. Supplemental Return ~ :.::~12 fda8 ug:m: ~ 4. Limited Estate 48. Future Interest Compromise (date 01 death after 12-12.82) .~ ~ffi ,,0 8~ , 717-/232-8731 1. Real Estate (Schedule A) (1) (2) (3) (4) (5) (6) (7) 380,000.00 141,990.76 OFFICIAl. USE ONLY 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship None z o ~ " ~ ~ w " 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 625.00 360,510.92 9,078.30 -0- (8) 892,204.98 (9) 25,486.83 I 10. Debts 01 Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (1') 25,486.83 12. Net Value of Estate (Line 8 minus Line 11) (12) 866,718.15 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 866,718.15 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES , 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 866,718.15 .045 (16) 0 16.Amount of Line 14 taxable at Ijneal rate x ~ " .. 17.Amount of Line 14 taxable at sibling rate x .12 (17) '" 0 u S 18. Amount of Une 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 39,002.32 39,002.32 I 20. 181 ......liPii1il! llli=n:01'< CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) ST;\TT :s R FPORT I JNOFR R IiI F 6J2 Name of Decedent: Rlanche Williams Date of Death: Fehruary 17 1994 Estate No.: 1994-01 ()79 Pursuant to Rule 6.] 2 of the Supreme Court Orphans' Court Rules. I report the following with respect to completion of the administration of the above-captioned estate: ]. State whether administration of the estate is complete: Yes D No [K] i If the answer is ~o. state \,hen the personal rcpresemative reasonably believes that the administration vvill he complete: Sepkll1hJr /7 I()()() 3. If the ansvver to \:0. I is Yes. state the following: a. Did the personall~,resentative file a final account with the Court? Yes 0 .\Jo U b. The separate Orphans' Court No. (if any) for the personal representative's account IS: c. Did the personal representative state an account inf(,rmally to the parties in interest? Yes 0 NoD c. Copies of receipts. releases. joinders and approval of fOri} . . 1formal accounts may be filed with the Clerk of the Or b.ans' Court and ay be attached to this report. Signature ,,~, C~ '.,.. ,--? :" / '\~ --Y.-c) Date: Illlle 'i i()()6 c fohn H Rn)1ljos ,- c. Name 4 Norlhllano\f'T Street Carlisle P/\ 1701 ') Address c , . 717-/4")-4'i74 , r,--.' Telephone No. ("apacity: o Personal Reorcsentativc llli Counsel for 'personal representative , .\ i ... 1..~ Will PETITION FOR PROBATE anti GRANT OF LETTERS Es,ateoS ClareE. Burke No. )--~-~)'~/~lO ~7 9 also known as To: Register of Wills for the Sociai Security No. 201-18-4940 , Deceased. County of Cumberlandin the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents, that: Your petitioner is 18 years of age or older and the execut Or. named in the last will of the a[l~q~ve d~edent, dated Aoril 3. lag? ~ and. codicil(O dated ong~na~ namea executor uhder the will, William e, ~s aeceasea, lne petitioner is the name0 m~h.~tih ~tP. mm.n~tqr Decedent was domiciled at death in Cumberland County, Pennsylvania, with h er cipal residence at 618 Coolidge Street, New Cumberland, PA 17070 last family or prin- Decedent, then 77 years of age, died September 29, 2004 at 618 Coolidge Street. New Cumberland. PA 17070 Except as follows, decedent did not marry, was not divorced and did not have a chi]d born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated in- competent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 377,352 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ ' ns van' $ Value of real estate ~l~l(~o~,hge ~reet, New Cumberland, PA 17070 situated as follows: 46 Victoria Way: Camp Hill: PA 17011 WHEREFORE, petitioner(s) respectfully request(s) thc probate of thc last will and codicil(s) presented herewith and the grant 9gJe/t~rs testamentary thereon. ~ ~ : William P. Burke .~ ~. _. ,,.-; 46 Victoria Way ~ Camp Hill, PA 17011 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF Cumberland$ ss Thc petitioner(s) above-named swear(s) or affirm(s) that thc statements in thc foregoing petition arc truc and correct to the best of thc knowledge and belief of petitioner(s) and that as personal representative(s) of thc above decedent petitioner[s) will well and..t~u~administcr thc estate according to law. · 'v,/~,., . ////' // Sworn ,o or affirmed and subscribed [ /~t/~u.~'/.,YZ/~.~~C~ ~ before me this ~ ~ ~_ day of J __v ,~ , ~ ~ / _ --~,or the 6~e/gisteY ~- , /,tI t. Estate of Clare E. Burke , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, ~-~'~d,~.-,, ~/-~ottc~h4.. ;Ioo~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s), dated described therein be admitted to probate and filed of record as the last will of ; and Letters. are hereby granted to FEES Probate, Letters, Etc ..............$ Short Certificates ( ) .............. $. Renunciation .................... $. TOTAL ............. $ Filed Thomas A. Capper, ID No. 75020 ATTORNEY (Su{~ Ct ! D. No.) 2303 Market Street: Camn Hill, PA 1701 'ADDR£SS ' (717) 232-8731 PHONE i~i. ix Io ccrliFy that the informati(m here given is corrccll., copied fi'om an original certificate of death duly filed with me as I,t,cul lgcgistrar. Thc original certificate will be forwarded t}) the State Vital Records Office for permanent f~lim2. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee For this certificate, $2.00 No, Local Registrar S£P 8 0 2004 Date COMMONWEALTH OF PENNSYLVANIA - DEPARTMENI OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH L Clare E Burke [s~x ~c,^ts~cu.,r~Nu~.~. Td^,Eo~o~, ^c.[I,~e.~'.a.v} I UN~n,vm I u~ml omeo~emt .......... ~~ema~ ~01 --18 --4940 I'-Senr~mho~ 9q 9nn/, : I Y) ftO~I~L ....... OI~R' ~ , 77 ,,. : { ! ct.23,1926 Williamsto~, ,~ e~ .... ~ ~ -~ m ...... I . --' I ~ECEDE~ ~ HISPAN~ ~IGIN? {~e Am~ ~n. . Cure--nd [.Tew Cumberzand. PAI 6~8 Coolidge Street {~ --~.--~.~. I'~, 618 ~~~"~ .... P~nnsylv~ni~ ~ ,~.~ ~.~ ::~a~~nO, PA 17070 .... ~ ,~.c~ Cumberland ~ .... ~ :~ ,e~ Cumberland ,e. John Clay ton Penne 11 J~ot.en.s NAME ,F..~. m,~. Ma,~ ~m~.) ~=~'s~e~,~} -- J,,- Mary Elsie Lvnch ~. William P Bur~ I'"[°"~rs~m~m'~'c~.~.z~ ~,~ms~s,,~s ' ~'~ ,~ ........ ~. 46 Victoria Way Cam Hill P ..... ~ ~ , P , A 17011 -%,.. October 2, 2004 I ;'S;; ct,on Cemetary JWest Hanover ~' ~ 7~~'~ _ I-~. FD 013 34n~em~e FH ~~v~- mOnm~t ~b:: ~1 ~o11~ j~ ~m ,., i o n .~d/o~ i .... ,i~.lion. lo my opimo., death ...... d .! the lime. dali. and pi ...... d due ,o Ih I05.905M REV. 4/96 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Viral Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. 0288492 No. Charles Hardester State Registrar APR $ 1999 Date H106.144 ~. *m~ COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS wP~,.~ CERTIFICATE OF DEATH 0 '" (Coroner) I,. William F Burke ~XNal~ I~ 5Ec~ NUMAR DATE ~ OE~H (M~. ~y. ~) P' ~ 1"209--14--0726 I' Februar 26, 1999 I .~ I ~ ~ I ~ u~ I ~.~.~1 I ~c~ 1~ .... ~--~---~,.~h~) ~s. I I h. I I~ ~ ~u ~-~-~.s,am~,~.~.~..~ ,~,~.~ , ,, I,,. ~' I I-.~[~ ~,~. Clare Pennell ~) ~ ~erl~d ~? .,~ ~ ~w ~rl~d ~,. Patrick ~- I-OmE.'* ~(~., .~, ..~ ~ IN~S WE ~ine ~Ke ". ~erite ~ssidy m~. ' ~ b~ ' ' ~,~ ~ ~,~.~ ~.~ ~.~,.~ I~~ ,~ ...... c ...... i~..c~.~.,s,.,..~ ,.. ~ DI 3/2/99 I i~. ~ ~%~ ~~&V2~:~=/ I~-O12849-n ........... ~renS Occlusive Coronary Artery Disease / · $1b. Coroner 3,=. J,,d. Feb. 27, 1999 (,t~nZBTm.~P,m Michael L. Norris, Coroner 405 Fairway Drive ,. Mechanicsburg, Pa. 17055 -. 7*7~'~-~/. l~ ~ F OF CLARE E. BURKE PETERS & WASILEFSKI 2931 North Front Street Harrisburg, Pennsylvania 17110 LAST WILL AND TESTAMENT OF CLARE E. BURKE I, CLARE E. BURKE, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I devise and bequeath all of my estate of every na~re~nd wherever situate to my husband, William F. Burke, providing he shall survive me by thirty days. ITEM III. Should my husband, William F. Burke, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the residue of my estate of every nature and wherever situate as follows: ~ A. In recognition of monies invested in my real estate located at 46 Victoria Way, Camp Hill, Pennsylvania, and in order to equalize gifts which I have made to my daughter, Clarice Ann Glad~s, during my lifetime, I bequeath the sum of Twenty-five thousand and 00/100 ($25,000.00) Dollars to my son, William p. Burke. B. The balance to my children, Clarice Ann Glades and William p. Burke, provided that the share for either child not living on the thirty-first day following my death, shall be distributed to that child's issue per stirpes living on the thirty-first day following my death and, in default of any such then living issue, shall be distributed as a part of the share for my other child, or his or her then living issue per stirpes. ~ ITEM IV. I appoint my daughter, Clarice Ann Glad~s, guardian of any property which passes either under this will or otherwise to any minor children of my son, William p. Burke, and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for -2- the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM V. I appoint my son, William P. Burke, guardian of any property which passes either under this will or otherwise to any minor children of my daughter, Clarice Ann Glad~s, and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. -3- ITEM VI. I appoint my son, William p. Burke, guard~.of any minor children of my daughter, Clarice Ann Gladgs. ITEM VII. I appoint my daughter, Clarice Ann Glados, guardian of any minor children of my son, William F. Burke. ITEM VIII. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM IX. I appoint my husband, William F. Burke, executor of this my last will. Should my husband, William F. Burke, fail to qualify or cease to act as executor, I appoint my son, William p. Burke, executor of this my last will. ITEM X. I direct that my executor or guardians or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this _~ day of ~/~~ , 1993. Clare E. Burke -4- The preceding instrument, consisting of this and four other typewritten pages identified by the signature of the testatrix, Clare E. Burke, was on the day and date thereof signed, published and declared by Clare E. Burke, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. -5- COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS: and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will; that she had signed willingly; that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witness and that to the best of their knowledge the testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Testatrix, ~_~/~_~ ~ ~ :; ~ ~ ~.A_t~C~~.~ residing at Witness, residing at ness. · ' '~ n 'to' a~ ' : Subscrib::W0r acknowledged before me by Clare E. Burke, the testatrix, and subscribed and sworn to before :4 /~"~-" ~'-~.w~tnesse , this '~:j day of _. ~,~, , 1992. 46 Victoria Way Camp Hill, PA 17011 (717) 728-8994 December 28, 2004 Via Hand Delivery Glenda Farner-Strasbaugh Register of Wills Cumberland County One Courthouse Square Carlisle, PA 17013 RE: Estate of Clare E. Burke Date of Death: September 29, 2004 Estate No. 2004-01079 PA No. 21-04-1079 Dear Ms. Farner-Strasbaugh: Enclosed for ffing please find prepayment of inheritance tax for the estate of Clare E. Burke, Estate No. 2004-01079. Payment is made in the amount of Thirty-Eight Thousand and Thirty-Two ($38,032) Dollars which is a 5% discount from an estimated inheritance tax of Forty Thousand and Thirty-Four ($40,034) Dollars. Please time-stamp and return the enclosed copy of this letter. Very truly yours, Executor COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 0O4777 BURKE WILLIAM P 46 VICTORIA WAY CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 201-18-4940 FILE NUMBER: 2104- 1079 DECEDENT NAME: BURKE CLARE E DATE OF PAYMENT: 12/29/2OO4 POSTMARK DATE: 12/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $38,032.00 REMARKS: TOTAL AMOUNT PAID: $38,032.00 SEAL CHECK# 101 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: aare E. Burke Date of Death: September 29,2004 Will No. 2004-01079 Admin. No. 21-04-1079 To the Register: Glenda Famer-Strasbaugh Register of Wills Gunberland County I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above captioned estate on Januaty24. 2005 Name Address Ms. aarice Burke-Pack Mr. William P. Burke 739 Chalet Drive; Woodbridge, NJ 07095 46 Victoria Way, Camp Hill, PA 17011 Notice has now been given to all persons entided hereto under Rule 5.6(a) Date: January 24, 2005 Signature ~4:~ Name Thomas A Capper, Esquire Telephone: 2303 Market Street Camp Hill, PA 17011 (717) 232-8731 Address: .,i(1'J I' '-,., c' ',:,"Hd:-!O r'paCl't". Cli '\""-"" ,~,.\\',' - .J \......a "'J" - '(; \;q:O-I" :ru' )11-,_1 ,~ Personal Representative x 11 :Z fld 92 E~r SOUl Counsel for Personal Representative i ,,-,', " -- "" ,- -," IJ' ".,~ -4i,' -i- '!lj-~" I IJ-;', !!-,I J:L.J ~'V ...l'-" -'..... -"",,-, v- LAw OFFICES BALL, MURREN & CONNELL 2303 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 PHILIP J. MURREN RICHARD E. CONNELL MAURA K. QUINLAN TERESA R. MCCORMACK THOMAS A. CAPPER (717) 232.8731 FACSIMILE (717) 232-2142 WILLIAM BENTLEY BALL (1916-1999) MAILING ADDRESS: P.O. BOX 1108 HARRISBURG, PENNSYLVANIA 17108-1108 HAND DELIVERED June 28, 2005 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Clare E, Burke Date of Death: September 29, 2004 PA Estate No, 21-04-1079 County No. 2004-01079 Dear Ms. Strasbaugh: Enclosed please find, in duplicate, the Inheritance Tax Return (with copies of decedent's Will attached) for Clare E, Burke, Please date-stamp the additional copy of the Return for our records, Also enclosed, please find the Estate Inventory, Finally, enclosed is a check in the amount of$30 for the filing of the Inheritance Tax Return and the Inventory, Very truly yours, ~c~ Thomas A, Capper TAClhmp Enclosures ,MIo.__.'l!X':i\.40t . *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT280601 HARRISBURG,PA 17128.0801 DECEDENT'S NAME {LAST, FIRST, AND MIDDLE INITIAL} Burke, Clare E. ~ Z W Q W U W Q CDATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM-DD-YEAR) ,09/29/2004 10/23/1926 I(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) OFFICIAL, USE ONLY 04 Y~.AR ------- SOCIAL SECURITY NUMBER 1079 NUMBER 21 COV~TI QQQ_E 201-18-4940 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER i j ~ 1. Original Return 0 2. Supplemental Return D- 3. Remainder Retum (date of death prior to 12-13-82) w , lI: < U) II 0 4 Limited Estate 0 4a. Future Interest Compromise (date 01 death after 0 5. Federal Estate Tax Return Required o ii2l1: 12-12-82) wQ.8 IQI 0 ::c ~ ...J ICliI 6 Decedent Died Testate (Attach copy 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes o Q. m of Will) copy of Trust) ~ 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (data of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0) IlfI&illlllill.. NAME 'COMPLETE MAILING ADDRESS . ~ Thomas A. Capper, Esq. l!lz 82 ~ FIRM NAME (If applicable) 8 ~ Ball, Murren & Connell ~ELEPHONE NUMBER 717-/232-8731 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship Z Q ~ " ~ ;;: <l il! 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 2303 Market Street Camp Hill. PA 17011 (1) 380,000.00 (2) 141,990.76 (3) None (4) 625.00 (5) 360,510.92 (6) 9,078.30 (7) -0- (9) 25,486.83 (10) OFFICIAL US~ ONLY r'" (8) 892,204.98 (11) 25,486.83 (12) 866,718.15 (13) (14) 866,718.15 ---- -- 13. Charitable and Governmental Bequests/See 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x ,00 (15) or transfers under Sec. 9116(a)(1.2) Z 866,718.15 ,045 (16) 0 16.Amount of Line 14 taxable at lineal rate x S " .. 17.Amount of Line 14 taxable at sibling rate x ,12 (17) '" Q U ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) i 19. Tax Due (19) 39,002.32 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 39,002.32 ! 20. 181 ........]i~~. Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6.(0) AP~ .. $3500 .tJ ~~;g- &I.~ 9/05 I SJ{ sK ., Decedent's Complete Address: STREET ADDRESS 618 Coolidge Street CtTY 1------ !STATE PA ZIP 17070 New Cumberland Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 38,032.00 1,950.12 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 39,002.32 39,982.12 0.00 979.80 0.00 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.......... .......................................................... b. retain the right to designate who shall use the property transferred or its income;...... ................ c. retain a reversionary interest; or..........,."........................................................................".......................... d. receive the promise for life of either payments, benefits or care?............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................ ....................... ................... ................. .............. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '~ i 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation?...... ................. ............... o D jgI jgI jgI 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 schadules ancl statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre~~r ot!!~!_than the. personal representative is based on aU ill!?~~t!~__?f~i~ er~parer has_any~~~~ge _ _ ___ SIGNATURE OF PERSONnESPON elf';; F0R FILING RETURN ADDRESS w.~m m.r r,ke 46 Victoria Way . CampHill,PA 17011 S1G ATU S RES LE ADDRES-S SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Thomas Capper. Esq. ADDRESS 2303 Market Street Camp Hill, PA 17011 DATE (p- do -05m DATE DATE 61;)~ tJ5 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or atter 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even jf the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. 99116 (al (1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. " *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burke, Clare E. I FILE NUMBER 21-04-1079 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 al which property would be exchanged between a willing buyer and a wilnng seller, neither being compelled to buy or sell, both having reasonable knowledge of lhe relevant facls. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER ------- 1 DESCRIPTION VALUE AT DATE OF DEATH ----- 187,500.00 6 I 8 Coolidge Street, Borougb of New Cumberland, Cumberland County, conveyed to William F. Burke and decedent as tenants by the entireties by deed dated July 18, 1955, recorded July 20,1955, in Cumberland County Deed Book P, No. 16, Page 46. Conveyed to decedent upon rigbt of survivorship after death of William F. Burke on February 26, 1999. 2 46 Victoria Way, East Pennsboro Township, Cumberland County, conveyed to William F. Burke and decedent as tenants by the entireties by deed dated June 27, 1986, recorded July 1, 1986, in Cumberland County Deed Book No. Z, Vol. 31, Page 588. Conveyed to decedent upon right of survivorship after death of William F. Burke on February 26,1999. 192,500.00 TOTAL (Also enter on Line 1, Recapitulation) 380,000.00 ESTATE OF '* SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENTDECEDENT Burke, Clare E. ! FILE NUMBER I 21-04-1079 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER --------- I DESCRIPTION 'VALUE AT DATE OF DEATH ------- 48,140.70 UNIT VALUE Bank of America (BAC) 1,110 shares 43.37 , 2 Harsco Corp. (HSC) 1,236.5459 shares 44.33 54,816.08 3 U.S. Savings Bonds (see attached listing of Series EE valuations) 12,757.32 4 Harris Associates Large Cap Value Fund (NEFOX) 87.261 shares (New England Securities - Acc!. # 4VB-130258) 1,103.85 12.65 5 Eaton Vance Tax-Mgd Int'! Equity (EMIGX) 1,886.792 shares (New England Securities - Acc!. # 4VB-130258) 6.52 12,301.88 6 i 12.98" 5,662.50 Putnam Tax-Free High Yield (PTHAX) ! 436.248 shares ! (New England Securities - Acc!. # 4VB-130258) 7 Washington Mutual Investors Fund (A WSHX) 238.374 shares (New England Securities - Acc!. # 4VB-130258) 30.24, 7,208.43 TOTAL (Also enter on line 2, Recapitulation) J-- ! 141,990.76 ./ ." ,. ~,:Sl1Jg:s DUI1U \..,.UJ\;UJalUI '. yage j or L 109/2004 !ueI~"J [:::':'.e-"'_J Attachment to: REV - 1500 Estate of Oare E. Burke File No. 21-04-1079 Schedule B . Value A1s Of Bond Info Series I EE Bonds Denomination Serial Number ::.l $\100 3 Results # Bond. Total Price Total Intere.t Total Value YTD Inl 34 $1,700.00 $420.68 $2,120.68 $55.3 :l Sr:;:",'Y Is.ue Interest Next Final Serial Number Issue Date Series Denom Price Interest Value Rate Accrual Maturity C671218523EE 08/1999 EE $100 $50.00 $11.68 $61.68 2.84% 10/2004 08/2029 C671218522EE 08/1999 EE 100 50,00 11.68 61.68 2.84% 10/2004 08/2029 C671211000EE 08/1999 EE 100 50.00 11.68 61.68 2.84% 10/2004 08/2029 C671210999EE 08/1999 EE 100 50.00 11.68 61.68 2.84% 10/2004 08/2029 C671203415EE 07/] 999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671203414EE 07/1999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671195856EE 07/1999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671195855EE 0711 999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671188215EE 07/1999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671188214EE 07/1999 EE 100 50.00 11.80 61.80 2.84% 10/2004 07/2029 C671180208EE 06/1999 EE 100 50.00 11.96 61.96 2.84% 10/2004 06/2029 C671180207EE 06/1999 EE 100 50.00 11.96 61.96 2.84% 10/2004 06/2029 C671171999EE 06/1999 EE 100 50.00 11.96 61.96 2.84% 10/2004 06/2029 C671171998EE 0611 999 EE 100 50.00 11.96 61.96 2.84% 10/2004 06/2029 C671164143EE 05/1999 EE 100 50.00 12.12 62.12 2.84% 10/2004 OS/2029 C671 I 64 I 42EE 05/1999 EE 100 50.00 12.12 62.12 2.84% 10/2004 OS/2029 C671156109EE 05/1999 EE 100 50.00 12.12 62.12 2.84% 10/2004 OS/2029 C671156108EE 05/1999 EE 100 50.00 12.12 62.12 2.84% 10/2004 OS/2029 C654155891EE 04/1999 EE 100 50.00 12.72 62.72 2.61% 10/2004 04/2029 C654155890EE 0411 999 EE 100 50.00 12.72 62,72 2.61% 10/2004 04/2029 C65414739lEE 04/1999 EE 100 50.00 12.72 6272 2.61% 10/2004 04/2029 C654147390EE 04/1999 EE 100 50.00 12.72 62.72 2.61% 10/2004 04/2029 C654139264EE 03/1999 EE 100 50.00 12.84 6284 2.84% 10/2004 03/2029 C654139263EE 03/1999 EE 100 50.00 12.84 6284 2,84% 10/2004 03/2029 C65413 I I 42EE 03/1999 EE 100 50.00 12.84 62.84 2.84% 10/2004 03/2029 C654131141EE 03/1999 EE 100 50.00 12.84 62.84 2.84% 10/2004 03/2029 C654122725EE 02/1999 EE 100 50.00 13.00 63.00 2.84% 10/2004 02/2029 C654 I 22724EE 02/1999 EE 100 50.00 13.00 6300 2.84% 10/2004 02/2029 C654114095EE 02/1999 EE 100 50.00 1300 63.00 2.84% 10/2004 02/2029 C654114094EE 01/1999 EE 100 50.00 1312 63.12 2.84% 10/2004 01/2029 http://wwws.publicdebt.treas.gov/BC/SBCPrice 4/20/2005 ',,'1" .'>jlV1U503 .L.IVUU '-'Ul.....U1U...Vl J.aOc;k VJ. k /. C654105655EE 01/1999 EE 100 50.00 13.12 63.12 2.84% 10/2004 01/2029 C654105654EE 01/1999 EE 100 50.00 13.12 63.12 2.84% 10/2004 01/2029 C654097205EE 01/1999 EE 100 50.00 13.12 63.12 2.84% 10/2004 01/2029 C654097204EE 01/1999 EE 100 50.00 13.12 63.12 2.84% 10/2004 01/2029 [!;e,:! 10 II Viewing Bonds 1-34 Le end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty MA Matured and Not Earning Interest Please rate this service. (please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator r r r r Submit Survey Reset i http://wwws. publicdebt. treas.gov/BC/SBCPrice 4/20/2005 '1, 1(.1"1115'"' .I...JIVUU ,-,CU\,;U1a.lVl '.' , ., \ Value As Of yage 1 or L Savinc U:'!,II'__J CALca L!Jp date I !09/2004 Bond Info Series lEE Bonds Denomination Serial Number ..:J $j100 ...:J Results # BOD d. Total Price Totallntere.t Total Value 54 $2,700.00 $811.12 $3,511.12 Issue Interest Serial Number Issue Date Series Denom Price Interest Valne Rate C654088614EE 12/1998 EE $100 $50.00 $13.28 $63.28 2.84% C654088613EE 12/1998 EE 100 50.00 13.28 63.28 2.84% C654079628EE 12/1998 EE 100 50.00 13.28 63.28 2.84% C654079627EE 12/1998 EE 100 50.00 13.28 63.28 2.84% C645311046EE 12/1998 EE 100 50.00 13.28 63.28 2.84% C645311045EE 12/1998 EE 100 50.00 13.28 63.28 2.84% C645302323EE 11/1998 EE 100 50.00 13 .44 63.44 2.84% C645302322EE 11/1998 EE 100 50.00 13.44 63.44 2.84% C645293530EE 11/1998 EE 100 50.00 13 .44 63.44 2.84% C645293529EE 11/1998 EE 100 50.00 13 .44 63.44 2.84% C645284632EE 10/1998 EE 100 50.00 14.32 64.32 2.61% C645284631EE 10/1998 EE 100 50.00 14.32 64.32 2.61% 645275850EE 10/1998 EE 100 50.00 14.32 64.32 2.61% C645275849EE 10/1998 EE 100 50.00 14.32 6432 2.61% C645267146EE 09/1998 EE 100 50.00 14.48 64.48 2.84% C645267145EE 09/1998 EE 100 50.00 14.48 64.48 2.84% C645258168EE 09/1998 EE 100 50.00 14.48 64.48 2.84% C645258167EE 09/1998 EE 100 50.00 14.48 64.48 2.84% C645249131EE 08/1998 EE 100 50.00 14.64 64.64 2.84% C645249130EE 08/1998 EE 100 50.00 14.64 6464 2.84% C645240331EE 08/1998 EE 100 50.00 14.64 6464 2.84% C645240330EE 08/1998 EE 100 50.00 1464 6464 2.84% C637175722EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C637175721EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C637166991EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C637166990EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C637158221EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C63 715 8220EE 07/1998 EE 100 50.00 14.80 64.80 2.84% C637149608EE 06/1998 EE 100 50.00 14.92 64.92 2.84% C637149607EE 06/1998 EE 100 50.00 14.92 64.92 2.84% http://wwws.publicdebt.treas.govfBC/SBCPrice Issue Date In. Next Accrual YTD 1n1 $68.~&, Vi'. '1 G Final Matnrity 10/2004 12/2028 10/2004 12/2028 10/2004 12/2028 10/2004 12/2028 10/2004 12/2028 10/2004 12/2028 10/2004 11/2028 10/2004 11/2028 10/2004 11/2028 10/2004 11/2028 10/2004 10/2028 10/2004 10/2028 10/2004 10/2028 10/2004 10/2028 10/2004 09/2028 10/2004 09/2028 10/2004 09/2028 10/2004 09/2028 10/2004 08/2028 10/2004 08/2028 10/2004 08/2028 10/2004 08/2028 10/2004 0712028 10/2004 07/2028 10/2004 07/2028 10/2004 07/2028 10/2004 07/2028 10/2004 07/2028 10/2004 06/2028 10/2004 06/2028 4/20/2005 ... '\> ~'U Y 1.1.15'" .LJIVu..... ........u....,...u.UUJ. ........0..,....'-'....... \ C637140956EE 06/1998 BE 100 50.00 14.92 64.92 2.84% 10/2004 06/2028 C637140955EE 06/1998 EE 100 50.00 14.92 64.92 2.84% 10/2004 06/2028 C637132007EE 05/1998 EE 100 50.00 15.08 65.08 2.84% 10/2004 OS/2028 C637132006EE 05/1998 EE 100 50.00 15.08 65.08 2.84% 10/2004 OS/2028 C637122687EE 05/1998 EE 100 50.00 15.08 65.08 2.84% 10/2004 OS/2028 C637122686EE 05/1998 EE 100 50.00 15.08 65.08 2.84% 10/2004 OS/2028 C637113725EE 04/1998 EE 100 50.00 16.16 66.16 2.61% 10/2004 04/2028 C637113724EE 04/1998 EE 100 50.00 16.16 66.16 2.61% 10/2004 04/2028 C637104596EE 04/1998 EE 100 50.00 16.16 66.16 2.61% 10/2004 04/2028 C637104595EE 04/1998 EE 100 50.00 16.16 66.16 2.61% 10/2004 04/2028 C622511485EE 03/1998 EE 100 50.00 16.28 66.28 2.84% 10/2004 03/2028 C622511484EE 03/1998 EE 100 50.00 16.28 66.28 2.84% 10/2004 03/2028 C622502077EE 03/1998 EE 100 50.00 16.28 66.28 2.84% 10/2004 03/2028 C622502076EE 03/1998 EE 100 50.00 16.28 66.28 2.84% 10/2004 03/2028 C622492827EE 02/1998 EE 100 50.00 1644 66.44 2.84% 10/2004 02/2028 C622492826EE 02/1998 EE 100 50.00 16.44 66.44 2.84% 10/2004 02/2028 C622483525EE 02/1998 EE 100 50.00 16.44 66.44 2.84% 10/2004 02/2028 C622483524EE 02/1998 EE 100 50.00 16.44 66.44 2.84% 10/2004 02/2028 C622474336EE 01/1998 EE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 C622474335EE 01/1998 BE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 C622464624EE 01/1998 EE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 C622464623EE 01/1998 EE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 C622455160EE 01/1998 EE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 C622455159EE 01/1998 EE 100 50.00 16.60 66.60 2.84% 10/2004 01/2028 I View IOJ I Viewing Bonds] -54 le end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3 -month interest penalty MA Matured and Not Earning Interest Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator r r r r Submit Survey Reset i http://wwws. publicdebt treas.gov/BC/SBCPri ce 4/20/2005 ..:. ..;JaVU1l5;:) UUIJU \...-al\..Ult1LVJ '(- ... , Value As Of page I ot :z Savinc '-----"1 lJ1J>d3'te I [..Help J CALca 109/2004 Bond Info Series Denomination Serial Number lEE Bonds. d $1100 ..:l Results # Bonds Total Price Totallntere,t Total Value 52 $2,600.00 $926.32 $3,526.32 Issue Intere,t Serial Number Issue Date Series Denom Price Intere,t Value Rate C622445559EE 12/1997 EE $100 $50.00 $16.76 $66.76 2.84% C622445558EE 12/1997 EE 100 50.00 16.76 66.76 2.84% C611587862EE 12/1997 BE 100 5000 16.76 66.76 2.84% C911587861EE 12/1997 EE 100 50.00 16.76 66.76 2.84% C6115779IIEE 11/1997 EE 100 50.00 16.92 66.92 2.84% C611577910EE 11/1997 EE 100 50.00 16.92 66.92 2.84% C611568172EE 11/1997 EE 100 5000 16.92 66.92 2.84% C611568187EE 11/1997 EE 100 50.00 16.92 66.92 2.84% C611558524EE 10/1997 EE 100 50.00 18.08 68.08 2.61% C611558523EE 10/1997 EE 100 50.00 1808 68.08 2.61% C611548677EE 10/1997 EE 100 50.00 18.08 68.08 2.61% C611548676EE 10/1997 EE 100 50.00 18.08 68.08 2.61% C611538589EE 09/1997 EE 100 50.00 18.24 68.24 2.84% C611538588EE 09/1997 EE 100 50.00 18.24 68.24 2.84% C611528664EE 09/1997 EE 100 5000 18.24 68.24 2.84% C611528663EE 09/1997 EE 100 50.00 18.24 6824 2.84% C611519017EE 08/1997 EE 100 50.00 18.40 68.40 2.84% C611519016EE 08/1997 EE 100 50.00 18.40 68.40 2.84% C60797289IEE 08/1997 EE 100 50.00 18.40 68.40 2.84% C607972890EE 08/1997 EE 100 5000 18.40 68.40 2.84% C607962968EE 08/1997 EE 100 50.00 18.40 68.40 2.84% C607962967EE 08/1997 EE 100 50.00 18.40 68.40 2.84% C607953189EE 07/1997 EE 100 50.00 18.56 68.56 2.84% C607953188EE 07/1997 EE 100 50.00 18.56 68.56 2.84% C607943587EE 07/1997 EE 100 50.00 18.56 68.56 2.84% C607943586EE 07/1997 EE 100 50.00 18.56 68.56 284% C60793 3720EE 06/1997 EE 100 50.00 18.72 6872 2.84% C607933719EE 06/1997 EE 100 50.00 1872 68.72 2.84% C607923148EE 06/1997 EE 100 50.00 18.72 6872 2.84% C607923147EE 06/1997 EE 100 50.00 18.72 6872 2.84% http://wwws.publicdebt.treas.govIBC/SBCPrice Issue Date [ Next Accrual YTD In. $72~ 't ~)?I Final Maturit) 10/2004 12/202, 10/2004 12/202, 10/2004 12/202, 10/2004 12/2021 10/2004 11/202, 10/2004 11/202, 10/2004 11/202, 10/2004 11/2021 10/2004 10/2021 10/2004 10/202, 10/2004 10/2021 10/2004 10/202, 10/2004 09/202, 10/2004 09/202, 10/2004 09/202, 1012004 09/202, 10/2004 08/202, 10/2004 08/202, 10/2004 08/202, 10/2004 08/202, 10/2004 08/202, 1012004 08/202, 10/2004 07/202, 10/2004 07/202, 10/2004 07/2021 10/2004 07/202, 10/2004 06/202, 1012004 06/202'j 10/2004 06/202'i 10/2004 06/2021 4/20/2005 J '"' '-'UVU.lo" .l.JV.l.lU ,-,Ul\.1U.l(:tLUl J.-a~t;;;.t:.. U.l~ . " I C607913458EE 05/1997 EE 100 50.00 18.88 68.88 2.84% 10/2004 OS/202"i C607913457EE 05/1997 EE 100 50.00 18.88 68.88 2.84% 10/2004 OS/202"i C607903368EE 05/1997 EE 100 50.00 18.88 68.88 2.84% 10/2004 OS/202"i C607903367EE 05/1997 EE 100 50.00 18.88 68.88 2.84% 10/2004 OS/202"i C607893294EE 04/1997 EE 100 50.00 16.64 66.64 2.46% 10/2004 04/202"i C607893293EE 04/1997 EE 100 50.00 16.64 66.64 2.46% 10/2004 04/202"i C607882782EE 04/1997 EE 100 50.00 16.64 66.64 2.46% 10/2004 04/202"i C60788278 lEE 04/1997 EE 100 50.00 16.64 66.64 2.46% 10/2004 04/202"i C607872530EE 03/1997 EE 100 50.00 17.48 67.48 2.68% 03/2005 03/202"i C607872529EE 03/1997 EE 100 50.00 17.48 67.48 2.68% 03/2005 03/202"i C607862243EE 03/1997 EE 100 50.00 17.48 67.48 2.68% 03/2005 03/202"i C607862242EE 03/1997 EE 100 50.00 17.48 67.48 2.68% 03/2005 03/202"i C594011806EE 02/1997 EE 100 50.00 17.48 67.48 2.68% 02/2005 02/202"i C594011805EE 02/1997 EE 100 50.00 17.48 67.48 2.68% 02/2005 02/202"i C594000847EE 02/1997 EE 100 50.00 17.48 67.48 2.68% 02/2005 02/202"i C594000846EE 02/1997 EE 100 50.00 17.48 67.48 2.68% 02/2005 02/202"i C5939900343EE 01/1997 EE 100 50.00 17.48 67.48 2.68% 0112005 01/202"i C583990342EE 01/1997 EE 100 50.00 17.48 67.48 2.68% 01/2005 01/202"i C574339324EE 01/1997 EE 100 50.00 17.48 67.48 2.68% 01/2005 01/202"i C574339323EE 01/1997 EE 100 50.00 17.48 67.48 2.68% 01/2005 01/202"i C574328725EE 01/1997 EE 100 50.00 17.48 67.48 2.68% 01/2005 01l202"i C574328724EE 0111997 EE 100 50.00 17.48 67.48 2.68% 01/2005 01/202"i LView 10] I Viewing Bonds )-52 le end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-monlh interest penalty MA Matured and Not Earning Interest Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator r r r r Submit Survey Reset I http://wwws. publicdebt treas. gov/BC/SBCPrice 4/20/2005 .-- ;:,avmgs tlono calcUlator ,- '~" .......-- . Value As Of Page 1 01'2 Savinc lUJ>..l!aJ....J CHelp . i CALCU 109/2004 Bond Info Series lEE Bonds Denomination Serial Number ~ $1100 ..:J Results # Bonds Total Priee Total Interest Total Value 52 $2,600.00 $999.20 $3,599.20 Issue Interest Serial Number Issue Date Series Denom Price Interest Value Rate C574317669EE 12/1996 EE $100 $50.00 $17.48 $67.48 2.68% C574317668EE 12/1996 EE 100 50.00 17.48 67.48 2.68% C574306975EE 12/1996 EE 100 50.00 17.48 67.48 2.68% C574306974EE 12/1996 EE 100 50.00 17.48 67.48 2.68% C574295703EE 11/1996 EE 100 50.00 17.48 67.48 2.68% C574298702EE 11/1996 EE 100 50.00 17.48 67.48 2.68% C574284566EE 11/1996 EE 100 50.00 17.48 67.48 2.68% C574284565EE 11/1996 EE 100 50.00 17.48 67.48 2.68% C57427297lEE 10/1996 EE 100 50.00 18.16 68.16 2.46% C574272970EE 10/1996 EE 100 50.00 18.16 68.16 2.46% C574261871EE 10/1996 EE 100 50.00 18.16 68.16 2.46% C574261870EE 10/1996 EE 100 50.00 1816 68.16 2.46% C574250750EE 09/1996 EE 100 50.00 19.00 69.00 2.68% C574250749EE 09/1996 EE 100 50.00 19.00 69.00 2.68% C574239504EE 09/1996 EE 100 50.00 19.00 69.00 2.68% C574239503EE 09/1996 EE 100 50.00 19.00 69.00 2.68% C559761977EE 08/1996 EE 100 50.00 19.00 69.00 2.68% C559761976EE 08/1996 EE 100 50.00 19.00 6900 2.68% C559750732EE 08/1996 EE 100 50.00 1900 69.00 2.68% C559750731EE 08/1996 EE 100 50.00 19.00 69.00 2.68% C559740071EE 08/1996 EE 100 50.00 1900 69.00 2.68% C559740070EE 08/1996 EE 100 50.00 1900 69.00 2.68% C559728535EE 07/1996 EE 100 50.00 19.00 69.00 2.68% C559728534EE 07/1996 EE 100 50.00 19.00 69.00 2.68% C559717623EE 07/1996 EE 100 50.00 19.00 69.00 2.68% C5597117622EE 0711996 EE 100 50.00 1900 69.00 2.68% C559706361EE 06/1996 EE 100 50.00 1900 69.00 2.68% C559706360EE 06/1996 EE 100 50.00 19.00 6900 2.68% C559695599EE 06/1996 EE 100 50.00 19.00 69.00 2.68% C559695598EE 06/1996 EE 100 50.00 19.00 69.00 2.68% http://wwws.publicdebt.treas.gov/BC/SBCPrice Issue Date L YTD Inl $6s.lf g Next Final Accrual Maturit) 12/2004 12/202e 12/2004 12/202e 12/2004 12/202e 12/2004 12/202e 11/2004 11/202e 11/2004 11/202e 11/2004 11/202e 11/2004 11 /202e 10/2004 10/202e 10/2004 10/202e 10/2004 10/202e 10/2004 10/202e 03/2005 09/202e 03/2005 09/202e 03/2005 09/202e 03/2005 09/202e 02/2005 08/202e 02/2005 08/202e 02/2005 08/202e 02/2005 08/202e 02/2005 08/202e 02/2005 08/202e 01/2005 07/202e 01/2005 07/202e 01/2005 07/202e 01/2005 07l202e 12/2004 06/202e 12/2004 06/202e 12/2004 06/202e 12/2004 06/202e 4/20/2005 .,aVIng:) Dunu LalljUli::UUI ragt::.i.. UIL. .' , ,. ..-...... C559683858EE 05/1996 EE 100 50.00 19.00 69.00 2.68% 1112004 05!202f C559683857EE 05/1996 EE 100 50.00 19.00 69.00 2.68% 1112004 OS/202f C559672458EE 05/1996 EE 100 50.00 19.00 69.00 2.68% 1112004 OS/202f C559672457EE 05/1996 EE 100 50,00 19.00 69,00 2,68% 1112004 OS/202f C559661144EE 04/1996 EE 100 50.00 19.80 69.80 2.46% 10/2004 04/202f C559661143EE 04/1996 EE 100 50.00 19.80 69.80 2.46% 10/2004 04/202f C559649911EE 04/1996 EE 100 50.00 19.80 69.80 2.46% 10/2004 04/202f C559649910EE 04/1996 EE 100 50,00 19.80 69.80 2.46% 10/2004 04/202f C61040496lEE 03/1996 EE 100 50.00 20.68 70.68 2.68% 03/2005 03/202f C610404960EE 03/1996 EE 100 50.00 20.68 70.68 2.68% 03/2005 03/202f C539997894EE 03/1996 EE 100 50.00 20.68 70.68 268% 03/2005 03/202f C539997893EE 03/1996 EE 100 50.00 20.68 70.68 2.68% 03/2005 03!202f C539974387EE 03/1996 EE 100 50.00 20.68 70.68 268% 03/2005 03/202f C539974386EE 03/1996 EE 100 50,00 20.68 70.68 2.68% 03/2005 03/202f C539962987EE 02/1996 EE 100 50.00 20.68 70.68 2.68% 02/2005 02/202f C539962986EE 02/1996 EE 100 50.00 20.68 70.68 268% 02/2005 02/202f C539950788EE 02/1996 EE 100 50.00 20.68 70.68 268% 02/2005 02/202f C539950787EE 02/1996 EE 100 50.00 20.68 70.68 268% 02/2005 02/202f C510594086EE 0111996 EE 100 50.00 20.68 70.68 2.68% 0112005 01l202f C510594085EE 0111996 EE 100 50.00 20,68 70.68 2.68% 0112005 01l202f C51058243lEE 0111996 EE 100 50.00 20.68 70.68 2.68% 0112005 01l20Zt C510582430EE 0111996 EE 100 50.00 20.68 70.68 2.68% 0112005 01l202f [,View-IOJ I Viewing Bonds 1-52 Le end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty MA Matured and Not Earning Interest Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator r r r r Submit Survey Reset I http://wwws.publicdebttreas.gov/BC/SBCPrice 4/20/2005 ESTATE OF *' SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RElURN RESIOENTDECEDENT Burke, Clare E. I FILE NUMBER 21-04-1079 --.-----.....-----.-- All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 625.00 Promissory Note signed by Shawn Burke, the decedent's nephew, on December 13,1999. Face value of original note: $24,000. Amount of funds contributed by decedent: $15,000. Percentage of note owned by decedent: 62.5%. Total outstanding balance as of date of death of decedent : $15,150. Total outstanding balance owed to decedent as of date of death: $9,468.75. Subsequent to decedent's death, Shawn Burke paid $1,000 toward his outstanding loan. However, he has since defaulted on his loan obligation. As a result, the executor has retained legal counsel, John W. Purcell, Jr., Esq., to pursue coIlection of the defaulted loan. Formal demand for repayment has been made, however, ultimate coIlection of the outstanding loan is deemed remote due to Shawn Burke's likely refusal to pay and the speculative value of this claim against a creditor who, it is believed, lacks the resources to satisfY a judgment even if one is obtained. As such, the executor is reporting the date of death balance of the loan as $1,000 which is the amount coIlected from Mr. Burke since decedent's death. 62.5% of this amount - - - $625 - - - is the percentage attributable to the estate and, therefore, the taxable amount that is being reported. However, should any additional recovery be made, the executor will file a supplemental return to report any additional taxable assets of the estate. TOTAL (Also enter on Line 4, Recapitulation) 625.00 ESTATE OF *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENTDECEOENT Burke, Clare E. FILE NUMBER 21-04-1079 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 I 1990 Buick Skylark DESCRIPTION VALUE AT DATE OF DEATH 500.00 2 Miscellaneous clothing and personal possessions 500.00 3 Northern Trust Company Penn Mutual Beneficiary Account Account No. 9230002905 12,979.68 4 New England Securities Short Term Income Account No. 4VB-130258 1,004.25 5 MetLife Annuity Account No. 439953 RB 1,151.25 6 New England Life Insurance Co. Variable Annuity-American Growth Series Contract No; V 440717 162,860.31 7 Decedent's funds - retained by Shawn Burke in his personal insurance agent account intended for purchase ofNuveen PA - Tax Free Municipal bonds (Bonds were not purchased;account was not created) 50,000.00 Total of Continuation Schedule(s) 131,515.43 TOTAL (Also enter on Line 5, Recapitulation) 360,510,92 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. . PERSONAL PROPERTY continued ____L______ i ____I COMMONWEAL1l-I OF PENNSYLVANIA INHERITANCE TAX RElURN RESIOENT OECEOENT I FILE NUMBER 21-04-1079 _..___m____________ ESTATE OF B k CI E ur e, are . 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 , --g-tl Individ~al Retirement Account New England Securities 'I Account No: 41 H-697199 , a) Dreyfus Premier Core Bond (DRCBX) , 3,660.725 shares Unit Value: $14.65 Value: $53,629.62 b) Europacilic Growth (AEGBX) 251.605 shares Unit Value: $31.32 Value: $7,880.27 c) Investment Company of America (AICBX) 1,201.883 shares Unit Value: $28.86 Value: $34,686.34 d) Washington Mutual Investors (WSHBX) 1,198.612 shares Unit Value: $29.20 Value: $34,999.47 e) Short Term Income Value: $319.73 DESCRIPTION I VALUE AT DATE OF DEATH ------------+--- - --- 131,515.43 I Page 2 of Schedule E *' SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 04 - 1079 ESTATE OF Burke, Clare E. II an asset was made joint within one year 01 the decedent's date 01 death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A William P. Burke ADDRESS RELATIONSHIP TO DECEDENT 46 Victoria Way Camp Hill, PA 17011 Son JOINTLY OWNED PROPERTY: ITEM I LETTER DATE NUMBER I FOR JOINT MADE TENANT JOINT A I : 03/0911998 Pennsylvania State Employee's i : Credit Union (PSECU) , Account # 0201184940 --", ,n, , I - - DESCRIPTION OF PROPERTY '!. OF ----- ilncl~d~ n~me C?f ~inancial institution and bank .a~count number DATE OF DEATH DECO'S DA~;~~ED;TH or Similar Identlfymg number. Attach deed for Jomtly.held real VALUE OF ASSETINTERESTI DECEDENT'S INTEREST estate. I. - ------!- 9,612.14' +----- 50% 4,806.07 2 A 0211311985 PSECU Account # 0202465801 8,544.46 50% 4,272.23 i TOTAL (Also enter on line 6, Recapitulation) 9,078.30 '* SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burke, Clare E. FILE NUMBER 21-04-1079 ITEM NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on paJlf!2liS yes,_ DESCRIPTION OF PROPERTY , % OF Include the name of the transferee, their relationship to decedent and the date of transfer DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate VALUE OF ASSET I INTEREST (IFAPPLlCABLE)r __ ___ State Employee Retirement System retirement account 0.00 0.00 Beneficiaries: a) William P. Burke - Son b) Clarice A. Burke-Pack - Daughter 'Lump sum death benefit of $97,519 exempt from inheritance tax pursuant to SERS Code. TOTAL (Also enter on line 7, Recapitulation) ESTATE OF *' SCHEDU..E H Fl.IN:RAL. EXPENSES & ADI\IIrIIS1RA11VE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlDENTOECEDENT Burke, Clare E. FILE NUMBER 21-04-1079 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1--- -- I I FUNERAL EXPENSES: Parthemore Funeral Home & Cremation Services, Inc. 2 Diocese of Harrisburg - Office of Catholic Cemeteries (Interment Expenses) 3 Funeral LuncheonlReception - Knights of Columbus B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. 3. 4. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip Attorney's Fees (PLEASE SEE ATTACHED) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Maintenance, utilities and homeowners expenses for real estate (decedent's last residence-- 618 Coolidge Street, New Cumberland, P A - - necessary for preservation of asset: a) Trash/Sewer (Oct. 2004 through May 2005): $223.80 b) UGI (Oct. 2004 through June 2005): $465.83 c) Homeowner's Insurance (Oct. 2004 through June 2005): $546.60 TOTAL (Also enter on line 9, Recapitulation) 25,486.83 8,945.70 1,000.00 620.38 0.00 6,300.00 500.00 551.50 7,569.25 '* SchedUe H FmeraI Expel : -; & Mni1istJative Costs c:onIinued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burke, Clare E, -----1 d) Real Estate Taxes: $1,065.02 e) New rubber roof over family room due to leakage: $3,680.00 1) Repair to air conditioner unit (freon added): $156.00 g) P A Power & Light (Oct. 2004 through June 2005): $1,431.82 FILE NUMBER 21-04-1079 Page 2 of Schedule H ATTACHMENT TO: REV - 1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Estate oeClare E. Burke File No. 21-04-1079 Social Security No. 201-18-4940 SCHEDULE H (CONTINUED) FUNERAL EXPENSES & ADMINISTRATIVE COSTS B. ADMINISTRATIVE COSTS: 2. Attorney's Fees: Ball, Murren & Connell- Thomas A. Capper, Esq. (Estate Administration - estimated costs & fees) $ 6,300.00 Purcell, Krug & Haller - John W. Purcell, Jr., Esq. 1718 North Front Street Harrisburg, PA 17102 (Collection matter against Shawn D. Burke) $ 500.00 . REV.1513 Ex+ (9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 1__- SCHEDULE J BENEFICIARIES 1 __--1__ ---- - ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY FILE NUMBER 21-04-1079 RELATIONSHIP TO I AM~~NT OR SHARE DECEDENT OF ESTATE Do...NollJst TrualeeOO-n_ ,__ ______ Burke, Clare E. I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) William P. Burke '146 Victoria Way Camp Hill, PA 17011 I Son 1$25,000 and 1/2 of residue 2 I Clarice A. Burke-Pack 1739 Chalet Drive Woodbridge, NJ 07095 Daughter I 1 '1/2 of residue 'Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriale, on Rev 1500 cover sheet I II NON-TAXABLE DISTRIBUTIONS: . IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT 1 BEING MADE I lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SH==TI . . \~, ( ---~ ,.,... ~.i,~., ~,~) In t~' Q:j ~, , I' tJ:j~ ~ ' Cj' . :>;' CD -- "..: LAST WILL AND TESTAMENT OF CLARE E. BURKE I, CLARE E. BURKE, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I devise and bequeath all of my estate of every naeur~nd wherever situate to my husband, William F. Burke, providing he shall survive me by thirty days. ITEM III. Should my husband, William F. Burke, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the residue of my estate of every nature and wherever situate as follows: ~ A. In recognition of monies invested in my real estate located at 46 Victoria Way, Camp Hill, pennsylvania, and in order to equalize J71Lf UO~ ., ...,........... . . . ., -} , , \ 1 gifts ~hich I have made to my daughter, Clarice d~ Ann Glad~s, during my lifetime, I bequeath the sum of T~enty-five thousand and 00/100 ($25,000.00) Dollars to my son, William P. Burke. B. The balance to my children, U' Clarice Ann Glad~s and William P. Burke, provided that the share for either child not living on the thirty-first day follo~ing my death, shall be distributed to that child's issue per stirpes living on the thirty-first day follo~ing my death and, in default of any such then living issue, shall be distributed as a part of the share for my other child, or his or her then living issue per stirpes. r~ Glad~s, guardian of ITEM IV. I appoint my daughter, Clarice Ann any property ~hich passes either under this ~ill or other~ise to any minor children of [~ ~f g~ A ro ~ ^ , ~ }., ~ my son, William P. Burke, and ~ith respect to ~hich I am authorized to appoint a guardian and have not other~ise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share ~here possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as ~ell as income from time to time for -2- . . () ~0, ~ ~: ~\ i'j tJ:j ~. :~ ro ~ \.. " " }. \ the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM V. I appoint my son, William P. Burke, guardian of any property which passes either under this will or otherwise to any minor children of my daughter, a,)3. Clarice Ann Glad~s, and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. -3- . ITEM VI. I appoint my son, William P. Burke, guardian of any minor children of my daughter, Clarice {J.jJ . Ann Glad9's. ITEM VII. I appoint my daughter, Clarice Ann Glados, guardian of any minor children of my son, William F. Burke. ITEM VIII. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM IX. I appoint my husband, William F. Burke, executor of this my last will. Should my husband, William F. Burke, fail to qualify or cease to act as executor, I appoint my son, William P. Burke, executor of this my last will. ITEM X. I direct that my executor or guardians or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my L.a hand this _2 (i '. day of .V'&A.,~/ , 199,;l. (ii /J AT! Ii? ' " ~.."-cc.Lt..._ b .. 7.c.q.Ar Clare E. Burke -4- . . . . ' The preceding instrument, consisting of this and four other typewritten pages identified by the signature of the testatrix, Clare E. Burke, was on the day and date thereof signed, published and declared by Clare E. Burke, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. C' ---~ ---- -~- . . . COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS: We, Clare E. Burke, i;V, 1/ /. WJ J. re JdS TI,I9'V1ClS A. E--""f .j and M/tJ,..,,( J. (Vlc b."'::f'" , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will; that she had signed willingly; that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witness and that to the best of their knowledge the ~ testatrix was at that time eighteen (18) years of age or older, vJi tness, of sound mind and under no constraint or undue influence"J . . ~ / 6c9~-ec~- d'/~'- (] <:::::::g a:t fi~~. ~_1 residing at .! -7~~~/4' / /1 ..,;;;:) residing a.t l/-/i,./'//fAf f~ . ~- c...---- j acknowledged before me by Testatrix, Witness, ~ Witness, Clare E. Burke, the testatrix, and subscribed and sworn to before , / ",/ . j '.7 r 'J' ,1 me by IL--ut"<~'-1...--v,,__ / J,_U:'/r_.,Y,'_ , . ./L6'-~')/V',0\_";:-L. tn<-:,j:N.i If (1)(f&r!l/.",-Witnesses, this (j 1992. / /) c) /'f-&--',-,'--4 rl , . ~, ~,~ day of and {LY"":':;,,, '/ ,,~- .j.. c I ",/~:r~. r', . .(: S^, ///t'1 ~ ,~....-,r, c ! C:::-~!. Notary Public -l.-<.-.-:J-J..,.,K:.....j J /, Ii I NOT AP.I,t>..L S:::: '.L . / ~ Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Burke, Clare E. NO.2] - 04 - 1079 Date 01 Death 9/29/2004 also known as , Deceased Social Security No. 201-18-4940 William P. Burke - - - -- -- - ---- -- -- - -- - - _.----- --- -, - ------.-------..----- The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of fhe real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are lrue and correct. l!We understand that false statements herein are made sUbject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. I.D. No.: 75020 Personai Represe~ta~~'vle. '~<.'... Signature: \() . William . Burke - - - - - .. - - - - -- Signature: Attorney: Thomas A Capper, Esq: _ Signature: Address: 2303 Market Street Camp Hill, PA 17011 Address: 46 Victoria Way Camp Hill, PA 17011 Telephone: 717-/232-8731 Telephone: 717 n28/8994 Dated: il;i/C'5~ Personal Property Bank of America (BAC) 1,110 shares 48,140.70 Harsco Corp. (HSC) 1,236.5459 shares 54,816.08 U.S. Savings Bonds 12,757.32 Harris Associates Large Cap Value Fund (NEFOX) 87.261 shares (New England Securities - Acct. # 4VB-130258) 1,103.85 Eaton Vance Tax-Mgd Int'I Equity (EMIGX) 1,886.792 shares (New England Securities - Acct. # 4VB-130258) r ' 12,301.88 Putnam Tax-Free High Yield (PTHAX) 436.248 shares (New England Securities - Accl. # 4VB-130258) 5,662.50 (Attach additional sheets if necessary) Total Personal Property and Real Estate $883,126.68 , Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Burke, Clare E. No. 21 - 04 - 1079 Date at Death 9/29/2004 Social Security No. 201-18-4940 also known as , Deceased 7,208.43 Washington Mutual Investors Fund (A WSHX) 238.374 shares (New England Securities - Acc!. # 4VB-130258) Promissory Note signed by Shawn Burke, the decedent's nephew, on December 13,1999. Face value of original note: $24,000. Amount of funds contributed by decedent: $15,000. Percentage of note owned by decedent: 62.5%. Total outstanding balance as of date of death of decedent: $15,150. Total outstanding balance owed to decedent as of date of death: $9,468.75. Subsequent to decedent's death, Shawn Burke paid $1,000 toward his outstanding loan. However, he has since defaulted on his loan obligation. As a result, the executor has retained legal counsel, John W. Purcell, Jr., Esq., to pursue collection of the defaulted loan. Formal demand for repayment has been made, however, ultimate collection of the outstanding loan is deemed remote due to Shawn Burke's likely refusal to pay and the speculative value of this claim against a creditor who, it is believed, lacks the resources to satis/)' a judgment even if one is obtained. As such, the executor is reporting the date of death balance of the loan as $1,000 which is the amount collected from Mr. Burke since decedent's death. 62.5% of this amount __ - $625 - - - is the percentage attributable to the estate and, therefore, the taxable amount that is being reported. However, should any additional recovery be made, the executor will file a supplemental return to report any additional taxable assets of the estate. 1990 Buick Skylark Miscellaneous clothing and personal possessions Northern Trust Company Penn Mutual Beneficiary Account Account No. 9230002905 New England Securities Short Term Income Account No. 4VB-130258 MetLife Annuity Account No. 439953 RB New England Life Insurance Co. Variable Annuity-American Growth Series Contract No: V4407l7 2 625.00 500.00 500.00 12,979.68 1,004.25 1,151.25 162,860.31 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued , Deceased No. 21 - 04 -1079 Date of Death 9/29/2004 Social Security No. 201-18-4240_ Estate of Burke, Clare E. also known as Decedent's funds - retained by Shawn Burke in his personal insurance agent account intended for purchase ofNuveen PA - Tax Free Municipal bonds (Bonds were not purchased;account was not created) 50,000.00 Individual Retirement Account New England Securities Account No: 41 H-697199 a) Dreyfus Premier Core Bond (DRCBX) 3,660.725 shares Unit Value: $14.65 Value: $53,629.62 b) Europacific Growth (AEGBX) 251.605 shares Unit Value: $31.32 Value: $7,880.27 c) Investment Company of America (AICBX) 1,201.883 shares Unit Value: $28.86 Value: $34,686.34 d) Washington Mutual Investors (WSHBX) 1,198.612 shares Unit Value: $29.20 Value: $34,999.47 e) Short Term Income Value: $319.73 131,515.43 Total Personal Property $503,126.68 3 . ,- Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Burke, Clare E. No. 21 - 04 - 1079 --- ---.. ---.. --- -- ._- --- --- -- - ---._--.- also known as Date of Death 9/29/2004 , Deceased Social Security No. 201-18-4940 Real Estate 618 Coolidge Street, Borough of New Cumberland, Cumberland County, conveyed to William F. Burke and decedent as tenants by the entireties by deed dated July IS, 1955, recorded July 20,1955, in Cumberland County Deed Book P, No. \6, Page 46. Conveyed to decedent upon right of survivorship after death of William F. Burke on February 26, 1999. 187,500.00 46 Victoria Way, East Pennsboro Township, Cumberland County, conveyed to William F. Burke and decedent as tenants by the entireties by deed dated June 27,1986, recorded July I, ]986, in Cumberland County Deed Book No. Z, Vol. 3 t, Page 588. Conveyed to decedent upon right of survivorship after death of William F. Burke on February 26, 1999. 192,500.00 Total Real Estate $380,000.00 4 Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 428 6/29/2005 CLARE E BURKE 21-2004-1079 BALL MURREN & CDNNELL 2303 MARKET S1REET CAMP HILL, PA 17011 SK 35,00 Total $35,00 Qty 1 Fee Description Additional Probate Fee Total: $35,00 d1ecks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice witb your payment. Thank you, 08-29-2005 BURKE 09-29-2004 21 04-1079 CUMBERLAND 101 APPEAL DATE: 10-28-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REy:is47-Ex-AFP-coi:os3-NOTICE-OF-INHERITANCE-TAX-APPRAISEHENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX CLARE E FILE NO. 21 04-1079 ACN 101 BUREAU OF INDlvlm~G(J~ OFFICE CF INHERITANCE TAX DIVISlq.tf; i".""....-,., t.e: , - PO BOX Z80601 :-'-,~ - "!' HARRISBURG PA 17128-06111-- ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOHANCE OF DEDUCTIONS AND ASSESSNENT OF TAX 20DSAUGJO Pi; 1::22 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN f\l j (-,C:: '\..1 \ 1_'; OFF!'- ' THOMASCA CAPPER ESQ BALL ETAL 2303 MARKET ST CAMP HILL PA 17011 ESTATE OF BURKE *' REV-1547 EK ~p (06-05) CLARE E TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGED DATE 08-29-2005 If an assesSBent was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will reflect figures that include the total of ab!.. returns assessed to date. ASSESSMENT OF TAX: 15. A.o.....t of line 14 at Spousal rat. (IS) 16. A.ount of Line 14 taxable at Lineal/Class A rei. (16) 17. Amount of Line 14 .t Sibling rat. (17) 18. A.aunt of Line 14 taxable at Collateral/Class B ret. (18) 19. Principal Tax Due X C RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estat. (Sch~18 AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El 6. ~ointly Owned Property (Schedule Fl 7. Transfers (Schedule Gl 8. Total Assets III (21 (31 (41 (51 (61 (71 380,000.00 141.990.76 .00 625.00 360.510.92 9.078.30 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax R.turn l~. CharltablelGov.r~ntal Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax (91 1101 25,486.83 .00 1111 1121 1131 1141 NOTE: .00 X 866,718.15 X .00 X .00 X 00 = 045 = 12 = 15 = . INTEREST/PEN PAID (-I 1,950.12 AMOUNT PAID 38,032.00 _BER CD004777 DATE 12-29-2004 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, su~it the upper portion of this fo,.. w1 th your tax payment. 892,204.98 25.486 83 866,718.15 .00 866,718.15 (191= .00 39,002.32 .00 .00 39,002.32 39,982.12 979.80CR .00 979.80CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) BUREAU OF INDIV~~!'~ INHERITANCE TAX DIYISImli' i_ _I, PO BOX 280601 . HARRISBURG PA 17128-lffilii COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REY-1607 EX AFP (03-05) ,"'"' ~ THOMAS-A CAPPER BALL ETAL 2303 MARKET ST CAMP HILL ESQ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-03-2005 BURKE 09-29-2004 21 04-1079 CUMBERLAND 101 CLARE E ?r;ns nr'T ? n .:..,:_:.,.. "-I ".~ '.-J I t_'-J P;i 3:: 23 Amount Remitted PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~.. ESTATE OF BURKE CLARE E FILE NO.21 04-1079 ACN 101 DATE 10-03-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-22-2005 PRINCIPAL TAX DUE: 39,002.32 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-29-2004 CDo04777 1,950.12 38,032.00 09-12-2005 REFUND .00 979.80- TOTAL TAX CREDIT 39,002.32 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 PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J cf'-- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 CAPPER THOMAS A BALL MURREN & CONNELL 2303 MARKET STREET CAMP HILL, PA 17011 RE: Estate of BURKE CLARE E File Number: 2004-01079 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: 9/29/2006 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, I . c..# .. Li- /. /J ~~ u&~AjJc:Z1.a.rtJ7~ C/ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 BURKE WILLIAM P 46 VICTORIA WAY CAMP HILL, PA 17011 RE: Estate of BURKE CLARE E File Number: 2004-01079 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: 9/29/2006 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, lara~ L~~vjJ~L~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel STATUS REPORT UNDER RULE 6.12 Name of Decedent: Clare E. Burke Date of Death: 9/29/2004 Will No.: 2004 - 01079 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No x 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: March 29,2007 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 Orphans' Court No. (if any) for the personal representative's account is: C. Did the personal representative state an account informally to the parties In mterest? 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 may be attached to thIS report. ~ c:!,~ Signature Date: 9/13/06 Thomas A. Capper, Esquire Name (Please type or print) 2303 Market Street, Camp Hill, PA 17011 Address ("") UJ ~.~~ - U.: --' I' . c:_) ~ _~~ ......:- ~ (717) 232-8731 Telephone No. LJ...I co Capacity: Personal Representati ve a.... L...J V) '-.C) = C"~ ('"-...I L~I rc- c..~ :=s () x Counsel for Personal Represent.lIJ\e ~ LAw OFFICES BALL, MURREN & CONNELL 2303 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 PHIUP J. MURREN RICHARD E. CONNELL TERESAR.McCORMACK THOMAS A. CAPPER (717) 232-8731 FACSIMILE (717) 232-2142 L.J I ( '\ ( "; MAILING ADDRESS: P.O. BOX 1108 HARmSBURG, PENNSYLVANIA 17108-1108 September 15, 2006 Ms. Glenda Farner Strasbaugh Clerk of the Orphans' Court Cumberland County Register of Wills One Courthouse Square Carlisle, P A 17013 RE: Estate of Clare E. Burke File Number: 2004-01079 Our File Number 2714 Dear Ms. Farner Strasbaugh: WILLIAM BENTLEY BALL (1916-1999) Enclosed for filing is the Status Report Under Rule 6.12. Also enclosed are a copy of the Status Report for date-stamping and a postage-prepaid envelope. Kindly return the date-stamped copy to us for our records. If you have any questions, please feel free to call. ("") l.f) Very trol y yours, .:;:-< C <..:;;;( 0::> ~~I Thomas A. Capper '.' , I . '~-, fEnclo~ts' f./) c-:: - . '-,0 0=5 ~: Mr~William P. Burke Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF Cumberland COUNTY, PENNSYL VANIA Name of Decedent: Clare E. Burke Date of Death: 9/29/2004 File Number: 2004-01079 Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. IllYes 0 No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. DYes III No b. The separate Orphans' 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 II1terest? ............................... IZ]Yes DNo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be Do" ~e~k;~orPhans' Court and may be attached to this report. Capacity: IllPersonal Representative o Counsel William P. Burke L.L C) ,c~..:. . C~S 9 - .......... c::c Name of Person Filing this Form 0"1 "-J U LtJ a '-0 It=> = "-I 46 Victoria Way Address Camp Hill, PA 17011 (717) 728-8994 Telephone o Form RW-IO rev. 10.13.06 ~ ~