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HomeMy WebLinkAbout04-1102Estate of Ruth S. Graffius and Frederic G. Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Doris Q. Stevenson No. ~i~O'~ -Iii.')''~-~ . Deceased Social Security No 164-16-0543 Stevenson Petitioner(s). who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut the Decedent. dated and codicil(s) dated named in the last Wilt of State relevant circumstances, eg. renunciation, death of executor, etc. Except as follows. Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: ] B of Letters of Administration c t a Grant (c t a.; d.b n.c.t.a; pertdente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent en no will aha was su viveo u¥ he ollowing spouse if any and heirs: Name Relationship Residence James P. Stevenson Son 11 Luzerne St., West Pittston, PA Frederic G. Stevenson Son 4 Colony Court, Hanover, PA 17331 Ruth S. Graffius Daughter 944 Indiana Ave., Lemoyne, PA 17043 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County. Pennsytvania with his/her last family or principal residence at 944 Indiana Avenue, Lemoyne, PA 17043 Oecedent. then 89 years of age. died 03/22/2004 (list street, number, and municipality) at Holy Spirit Hospital, East Pennsboro, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) Ali personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) $ 40,000.00 situated as follows: Wherefore. Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: /.~' . Si~/qatu r~? /? Typed or printed name and residence Ruth S. Graffius 944 Indiana Avenue, Lemoyne, PA 17043 Frederic G. Stevenson 4 Colony Court, Hanover, PA 17331 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (199 Estate of also known as Register of Wills of Cumberland County, Pennsylvania AMENDED PETITION FOR GRANT OF LETTERS Doris Q. Stevenson No ~- , Deceased Social Security No t64-16-0543 Ruth S. Oraffius and Frederic G. Stevenson Petitioner(s). who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) ] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut __ the Decedent. dated and codicil(s) dated Dean T. Stevenson, named Executor, died November 6, 1994 named in the last Will of Reverend Canon Kermit L. Lloyd, named alternate Executor, died Jan. 28, 2000 State relevant circumstances, eg. renunciation, death of executor, etc. Except as follows. Decedent did not marry was not divorced, and dia not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: ] B. Grant of Letters of Administration C. t. a. (cra; db n c t a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence James P. Stevenson Son 11 Luzerne St., West Pittston, PA Frederic G. Stevenson Son 4 Colony Court, Hanover, PA 17331 Ruth S. Graffius Daughter 944 Ind'iana Ave., Lemoyne, PA 17043 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 944 Indiana Avenue, Lemoyne, PA 17043 (list street, number, and municipality) Decedent. then 89 yearsofage died 03/22/2004 at Holy Spirit Hospital, East Pennsboro, (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania PA 40,000.00 situated as follows: Wherefore. Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Sit, nature Typed or printed name and residence Ruth S. Oraffius 944 Indiana Avenue, Lemoyne, PA 17043 Frederic G. Stevenson 4 Colony Court, Hanover, PA 17331 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner/s) and that as personal representative(s) of Petitioner(s) will well and truly administer the estate~l)ording to law. ~f / the Decedent. Sworn to or affirmed and subscribed"~ L;I >~P~ ~. Craffius /, /////g before me this /-_/ day of t', ~' ~ Frederic G. Stevenson FoL~he Registei~ , / ; Estate of Doris Q. STevenson Deceased Social Security No: 164-16-0543 Date of Death: 03/22/2004 AND NOW, ~ l b E C-L~~Y~, IB~ ~- . 2004~ , in consideratio? of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] Of Administration c. t. &. (cra; dbn cta.; pendente lite; durante absentia; durante minoritate) are hereby granted to Ruth S. Graffius and Frederic G. Stevenson in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ..... $ Short Certificate(s) . $ Renunciation .... $ 70.00 9.00 5.00 21.00 10.50 10.00 Attorney: Register of Witls ': James O. Morgan, Jr. Affidavits ( ) . $ Extra Pages ( ) · · $ Codicil ..... $ ID. No: Address: 06897 Tucker Arensberg, P.C. 111 N. Front Street P.O. Box 889 Harrisburg, PA 17108-0889 JCP Fee $ Telephone: 717/234-4121 Inventory ..... $ Other .... $ TOTAL $ 125.50 Prepared by t he Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Doris Q. Stevenson, Deceased The undersigned, Son of the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Ruth S. Graffius and Frederic G. Stevenson. WITNESS his hand this ~-~' day of ~'~ jo%..... , 2004 ,lames P. Stevenson 11 Luzeme St. West Pittston, PA 18643 Sworn to or affirmed and subscribed before me this O~ day -[q]-O~ u blic - - ---- Notarial SeaJ My Commission Expires: JP~.a. ullnePa~Thornas, NotaryPub~c /Ciiy Of Ha~sburg, Dauphin County L_My Commission Expires Mar. 24, 2007 ARNING: It is il!egai to duoi c~t~ ~r~s 5,i¢:,':/ c,~ photostat or photograph, ,,-,, 4 4 200_4 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Doris Stevenson z. Fe~le], ]64 - ]6 - 89 Y~' ~. 3-21-15 ~. Bethlehem,PA ~,. DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY ~WAS DECEDENT EVER [N OEC[D~NT S EDUCATION MARITAL STATUS Marded SURVIVING SPOUSE J~es A. Quiet m- Violet Va~ Ruth S. Graffius [~. 944 Indiana Avenue, Lemo~e, PA 17043 O~er(S~°~) ~ 2~ ~"'~'~ ~ PA Cremato~ :~.Harrisburg, PA 17109 WAS AN AUTOPSY ~RE AUTOPSY FINDINGS IMANNER OF DEATH I CERTIFIER (Check only one) ~o he bes of my kno~dedge, death occurred due to the ca ..... ,nd ma.her as sated L.~ NUMBER J DATE SIONE,~ )ohm Oa~ Year) NAME AND ADDRESS OF PER ON OCOM ETED CAUSE OF DEATH stev.will. D/ppt/June 7, 1994 WILL I, DORIS Q. STEVENSON of Lemoyne, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. · give all my automobiles, and all other articles of personal and household use, together with all insurance relating thereto, to my below~d husband, DEAN T. STEVENSON, if he survives me by thirty days. if he does not so survive me, I give all such property and insurance to my children who so survive me, to be divided among them as they may agree or, in the absence of agreement as my executor may think appropriate. ITEM II. I give my engagement ring and wedding ring ~o my daughter, RUTH M. GRAFFIUS. ITEM III. I give all the residue of my estate, real and personal, to my husband, DEAN T. STEVENSON provided that he murvives me by thirty (30/ days; if he does not so survive me, I give the resid%]e of my estate, real and personal, in equal shares to my beloved children, JAMES P. STEVENSON, EREDERIC G. STEVENSON and RUTH M. GRAFFIUS, provided that the share of any child who predeceases me or d~es on or before the thirtieth day following my death shall be distributed to his e~ her issue per stirpes living on the thirty-first day following my death and in default of any Page 1 of 5 pages. stev.will.D/ppt/June 7, 1994 such then-living issue such shares shall be added to the share or shares for my other children. ITEM 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. ITEM V. Ail federal, state, and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. ITEM VI. I authorize my ex'ecutor: A. to retain and to invest in all [orms of real and personal property, regardless of ~i) any limitations imposed by law on investments by executors or trustees, (ii) any principle of law concerning delegation of investment responsibility by executors or trustees, or (iii) any principle of law concerning investment diversification: B. to compromise claims and to abandon any property which, in my executor's oDinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; Page 2 of 5 pages. stev.will.D/ppt/J~me 7, 1994 or to lease and to give C. to sell at public or private sale, to exchange for any period of time any real or personal property, options for sales or leases; D. to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; E. to use administrative er other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect en income er estate taxes; and F. to distribute IN KIN[} and to allocate specific assets among the beneficiaries in such proportions as my executor may think best, so long as the total market value of any heneficiary's share is not affected by such allocation. These authorities shall extend to all Foal and personal property at any time held Oy my executor and shall continue in full force until the actual distribution of all such property. Page 3 of 5 pages. stev.will. D/ppt/June 7, 1994 All powers, au{horities, and discretion granted by this will shall be in addition to those granted by ].aw and shall be exercisable without leave of court. ITEM VII. I appoint my husband, DEAN T. STEVENSON, executor under this will. Shhuld he fail to qualify or cease to act as executor, I appoint THE REVEREND CANON KERMIT L. LLOYD executor under this will. No personal representative appointed hereunder shall be required to give bond or furnish sureties in any jurisdiction. ITEM VIII. The term "executor" and "tuustee" or any pronoun used to indicate the executor, trustee, any other fiduciary or any beneficiary shall be deemed to apply to one or more than one person or corporation and to~ the masculine, feminine or neuter gender as the case may be. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will, this /~ day of June, 1994. Stevenson Page 4 of 5 pages. stev.will. D/ppt/June 7, 1994 SIGNED, SEALED, testatrix, as and for her thereupon at her request, each other, have hereunto PUBLISHED, and DECLARED by the above last will, in the presence of us, who in her presence and in the presence of subscribed our names as zitnesses. Page 5 of 5 pages. stev.will. D/ppt/,lune 7, 1.994 STATE OF PENNSYLVANIA COUNTY OF DAUPHIN We, DORIS O~. STEVENSDN, ,.j~ _ q · , and the testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn de hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will a~ that she executed it as her fr~ therein expressed, and that ea and hearing of the testatrix, to the best of ouu knowledg eighteen years of age or o constraint or undue influence ~d that she had signed willingly and ~e and voluntary act for the purposes ch of the witnesses, in the presence signed the will as witness and that , the testatrix was at that time der, of sound mind and under no /Dorls O. Ste,~ens~ %,-{ tress R SUBSCRIBED, swo~n t®or aff~rmep, and Rckn2,,.ledged before me by the above-~med testatNix and b} the ~,.itness whose names appear abeve 01, ~ ~], ~994. Rret a r y Pul~i~ IODICIL I, DORIS Q. STEVENSON Pennsylvania, declare this to dated June 14, 1994. ITEM I. I have by sepa and myself, the property located Cumberland County, Pennsylvania right of survivorship. of Lemoyne, Cumberland County, be the sole codicil to my last will ~ate document deeded to my daughter at 944 Indiana Avenue, Lemoyne, 17043, as joint tenants with the ITEM II. I hereby decl~ house are to go to my daugh~ WILLIAM GRAFFIUS, as follows: The office furnit~ matching oak swivel Bedroom furniture Bedroom furniture bedroom. ~re that the following items in the er, RUTH GRAFFIUS and her husband, re - one oak chair; partner's desk and One oak sectional f~le cabinet; One oak sectional b~okcase with drop desk integral; One oak three shelf book case; my daughter, RUTH GRAFFIUS' bedroom; my granddaughter, ALLISON GRAFFIUS' ITEM III. Ail other television in the family rc dryer, piano, items marked ar items in those two bedrooms, the om, kitchen appliances, washer and initialed by RUTH GRAFFIUS. ITEM IV. children. Those items they d disposed of in a manner to max~ to be divided as follows: the in cash to my son, JAMES ST~ daughter, RUTH GRAFFIUS and divided equally between my STEVENSON. Ail personal p~operty shall be divided between my not wish to take IN KIND shall be ~ize the proceeds. The proceeds are first $10,000.00 in monies shall go VENSON, the second $5,000.00 to my .he remainder of the money shall be sons JAMES STEVENSON and FREDERIC ITEM V. In all other re republish my last will dated J codicil, as and for my last w IN WITNESS WHEREOF, I hz day of /~~ , 1995. SIGNED, SEALED, PUBLIS ~pects, lne 14, Lll. I hereby ratify, confirm and 1994, together with this sole ve thereunto set my hand this DORIS Q. STEVENSON HED, and DECLARED by the above individual, as and for her Codicil, in the presence of us, who thereupon at her request, in each other, have hereunto sub her presence and in the presence of scribed our names as witnesses. STATE OF PENNSYLVANIA ) ( ss COUNTY OF DAUPHIN ) We, DORIS Q. STEVEN~ ~/ C~t~) ~J ~/~'i the tesl whose names are signed to th being first duly sworn do authority that the testatrix .atrix and witnesses, respectively, attached or foregoing instrument, ereby declare to the undersigned igned and executed the instrument as expressed, and that each hearing of the testatrix, si~ the best of our knowledge, th years of age or older, of so undue influence. her last will and that she/had signed willingly and that she executed it as her free and vqluntary act for the purposes therein of the witnesses, in the presence and ~ed the will as witness and that to testatrix was at that time eighteen SUBSCRIBED, sworn to or me by the above-named testat~ appear above on ~-~ ~>>~/~Jt [nd mind and under no constraint or Witness affirmed, and acknowledged before ix and by the witnesses whose names ':'7, 1995. NOtary Public Notarial Seal Jacquetyn A Zettlemoyer, 'gotary Publc Harrisburg Dauphin County My Commission Expires Jan. 29, 1,399 In the Court of Common Pleas of IN RE: Estate of Doris Q. Stevenson Cumberland County, Pennsylvania ORPHANS' COURT DIVISION NO. 21-04-1102 Certification of Notice Under Rule 5.6(a) Name of Decedent: Doris Q. Stevenson Date of Death: 03~22~2004 To the Register: I certify that notice of beneficial interest 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 12/0912004 Name Ruth S. Graffius Frederic G. Stevenson James P. Stevenson Address 944 Indiana Avenue, Lemoyne, PA 17043 4 Colony Court, Hanover, PA 17331 11 Luzerne Street, Pittston, PA 18643 N Notice has now been given to all persons entitled thereto under R~5.6(a) except. / ~ Signature ~ ' Name: //' James G. M~rgant Jr. Address// 111 N. Front Street // Harrisbur~l, PA 17108-0889 Telephone: (717) 234~121 Capacity: Personal Representative X Counsel for Personal Representative aEV-~SO0 EX + (~-00) OF-'FICJAL USE ONLY oF REV- 1500  PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN F.E NuMaE. DEPT. 280601 21 04 HARRISBURG. Pa '7128-0601 RESIDENT DECEDENT COUN~CODE ~EAR 1102 NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Stevenson, Doris Q. 164-16-0543 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 03-22-2004 03-21-1915 (iF APPLICABLE] SURVIVING SPOUSE'S NAME ( LAST FIRST AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ REGISTER OF WILLS _ SOCIAL SECURITY NUMBER x 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) '~ ~ 5 Federal Estate Tax Return Required  ,, 4. Limited Estate 4a. Future Interest Compromise (date of death after a. o 12-12-82) O= O~ VX~I 6. Decedent Died Testate (Attach 7. Decedent Maintained a Living Trust (Attach 1 8 Total Number of Safe Deposit Boxes o ~ ,n copy of Will) copy of Trust) < 9. Litigation Proceeds Received 10. Spousal Poverty Credit (aate of death between [~ 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) ]THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS James G. Morgan, Jr. 0 _ (7!_7) 234-4_121 .... 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation. Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable ISchedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) z 6. Jointly Owned Pro0erty (Schedule F) -- Separate Billing Requested <~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property -~ (Schedule G or L) Separate Billing Requested n 8. Total Gross Assets (total Lines 1-7) o 9. Funeral Expenses & Administrative Costs (Schedule H) LU 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (1) None (2) 17,000.00 (3) None (4) ._N.0.ne (5) 60,684.88 (6) None (7) None ~=IRM NAME (If applicable) Tucker Arensberg, P.C. TELEPHONE NUMBER 111 N. Front Street POB 889 Harrisburg, PA 17108-0889 (9) 5,553.16 (10) 26.94 (8) 77,684.88 (11) 5,580.10 72,104.78 0.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ; 14. Net Value Subject to Tax (Line 12 minus Line 13) z SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 0,00 or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 72,10 4.78 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 0.00 0.00 (13) (14) x .00 (15) x .045 (16) x .12 (17) x .15 (18) 19. Tax Due (19) 72,104.78 0.00 3,244.72 0.00 0.00 3,244.72 20. r--I : ~> BE SURE TO ANSWER ALL QUEST ONS ON REVERSE SIDE ~D RECHECK MATH << Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00', Decedent's Complete Address: ISTREET ADDRESS 944 Indiana Avenue ~iT~'~ '-~.e m oy n e ....... STATE PA IZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) (1) 3,244.72 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (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 theTAX DUE. (5) 3,244.72 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (5B) 3,244.72 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ............................................................................. b. retain the right to designate who shall use the property transferred or its income; ................................ c. retain a reversionary interest; or ............................................................................................................ d. receive the promise for life of either payments, benefits or care? ........................................................... ; ~x; 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. i :X 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ! ' : X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUF~ ! OF PERSON RESPO leric G. ADDRESS ADDRESS OTHER ~ENTATIVE ADDRESS DATE 944 Indiana Avenue , c.../ Lemoyne, PA 17043 ~ 4 Colony Court Hanover, PA 17331 j ~.. 111 N. Front Street Harrisburg, PA 17108-0889 For ;ath on or after J~ 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving is 3% [72 116 (a) (1.1) (i)]. For 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 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value Df transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2)[72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) COMMONV~.ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stevenson, Doris Q. SCHEDULE B STOCKS & BONDS FILE NUMBER 21-04-1102 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 U.S. Savings Bond - $50.00 Series EE; Issued on 50.00 03/89; Serial No. L387526327EE 2 U.S. Savings Bond - $50.00 Series EE; Issued on 50.00 03/89; Serial No. L387526328EE 3 U.S. Savings Bond - $200 Series EE; Issued 02/1989; 200.00 Serial No. R52501689EE 4 U.S. Savings Bond - $200 Series EE; Issued 02/1989; 200.00 Serial No. R52501690EE 5 U.S. Savings Bond - $500 Series EE; Issued 08/1989; 500.00 Serial No. D24080314EE 6 U.S. Savings Bond -$500 Series EE; Issued 11/1987; 500.00 Serial No. DI7370421EE 7 U.S. Savings Bond -$500 Series EE; Issued 10/1987; 500.00 Serial No. D17792696EE 8 U.S. Savings Bond - $500 Series EE; Issued 09/1990; 500.00 Serial No. D26983781EE 9 U.S. Savings Bond -$500 Series EE; Issued 02/1990; 500.00 Serial No. D24231240EE 10 U.S. Savings Bond -$500 Series EE; Issued 08/1988; 500.00 Serial No, DI7314179EE 11 U.S. Savings Bond -$500 Series EE; Issued 0111989; 500.00 Serial No. D19539717EE 12 U.S. Savings Bond -$500 Series EE; Issued 12/1988; 500.00 Serial No. D17625657EE Total of Continuation Schedule( ;) See attached page TOTAL (Also enter on Line 2, Recapitulation) 17,000.00 (if more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-tS03 EX+ (6-98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA ~NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 ITEM NUMBER 13 14 15 16 17 18 19 2O 21 CUSIP NUMBER DESCRIPTION U.S. Savings Bond -$500 Series EE; Issued 0111989; Serial No. DI9539716EE U.S. Savings Bond - $1,000 Series EE; Issued 0811989; Serial No. M25792076EE U.S. Savings Bond -$1,000 Series EE; Issued 08/1989; Serial No. M25792084EE U.S. Savings Bond -$1,000 Series EE; Issued 07/1992; Serial No. M45694174EE U.S. Savings Bond -$1,000 Series EE; Issued 08/1989; Serial No. M25792078EE U.S. Savings Bond - $1,000 Series EE; Issued 08/1989; Serial No. M25792077EE U.S. Savings Bond -$1,000 Series EE; Issued 01/1989; Serial No. M32335400EE U.S. Savings Bond -$1,000 Series EE; Issued 0911988; Serial No. M26057809EE U.S. Savings Bond -$5,000 Series EE; Issued 11/1990 Serial No. V2107390EE TOTAL (Also enter on Line 2, Recapitulation) VALUE AT DATE UNIT VALUE , OF DEATH 500.00 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 1,000.00 5,000.00 17,000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-l$08 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONV~ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 4 5 6 Fulton Bank - Certficate of Deposit #220-00976182 Fulton Bank - Certificate of Deposit #220-0096160 Accrued income on Item 2 through date of death Accrued income on Item 2 through date of death Fulton Bank - Certificate of Deposit #221-0022807 Accrued income on Item 3 through date of death Fulton Bank - Certificate of Deposit #221-0022963 Accrued income on Item 4 through date of death Fulton Bank - Checking Account No. 1218-15261 Fulton Bank - Money Market Acct. No. 9900-65086 16,000.00 13,185.70 287.66 40.55 18,958.67 54.68 7,934.32 213.69 1,589.33 2,420.28 TOTAL (Also enter on Line 5, Recapitulation) 60,684.88 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWIEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 ITEM NUMBER DESCRIPTION AMOUNT 1 Cremation Society of PA - funeral expenses 1,354.00 Subtotal 1,354.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) REV-Il51 EX+ (12-99) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Family Exemption: Claimant Tucker Arensberg, P.C. If decedent's address is not the same as claimant's, attach explanation) Street Add ress City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 1,354.00 3,500.00 125.50 573.66 5,553.16 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 7 Cumberland Law Journal - proof of publication Griswold Special Care - Private nursing care final bill Hershey Kidney Specialists - physicians bill Holy Spirit Hospital - hospital care Internists of Central PA - Final medical bill Life Line - emergency transportation Quantum Imaging - MRI 75.00 296.00 113.11 5.84 19.85 35.00 28.86 Subtotal 573.66 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONV~=ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Fulton Bank Visa - Acct. No. 4756211000016940 26.94 TOTAL (Also enter on Line 10, Recapitulation) 26.94 (if more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Stevenson, Doris Q. 21-04-1102 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Trustee(s) (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Ruth S. Graffius 944 Indiana Avenue Lemoyne, PA 17043 Frederic G. Stevenson 4 Colony Court Hanover, PA 1733'1 James P. Stevenson '11 Luzerne Street Pittston, PA 18643 Daughter Son Son one-third residue one-third residue 1/3 residue of estate Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE'I' Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Doris Q. Stevenson also known as ~ Deceased Ruth S. Graffius Frederic G. Stevenson No. Date of Death Social Security No. 2004-01102 03~22~2O04 164-16-0543 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 the 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. I/We verify that the statements made in this Inventory are true and correct. I/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. Personal Representative J / /~ (~ ~, Attorney: ~u ~ James G Morgan, Jr Signature' ' ' I.D. No.: 06~97 ...... Signature: s . // Firm: Address: Telephone: Tu~cker Arensbe_rg, P,C._ 111 N. Front Street POB 889 Harrisburg, PA 17108-0889 (717) 234-4121 Address: 944 Indiana Avenue Lemoyne, PA 17043 ..... Telephone: (717) 761-2572 Dated: Personal Property Cash ............................................................................................... Miscellaneous Property ................................................................ Stocks/Listed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... Total Personal Property ......................................... Total Real Property ................................................ Total Personal and Real Property ......................... Total Out-of-State Real Property .......................... 60,684.88 17,000.00 77,684.88 77,684.88I TUCKER ARENSBERG Attorneys Januaw 5,2005 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Doris Q. Stevenson File No. 21-04-1102 Dear Sir or Madam: Enclosed please find a check payable to "Register of Wills, Agent" in the amount of $3,244.72 which represents the inheritance tax due on the above-referenced file. The return was filed on December 22, 2004. Should you questions please do not hesitate to contact me. Thank you for your cooperation in this matter. Very truly yours, Tucker Arensberg, P.C. Theresa A. Wheeler Legal Assistant to James G. Morgan, Jr. :taw Enclosure Tucker Arensberg, P.C. 111 North Front Street P.O. Box 889 Harrisburg, PA 17108 www. tuckerlaw.corn p. 800.257.4121 p. 717.234.4121 f. 717.232.6802 TUCKER ARENSBERG Attorneys 111 North Front Street RO. Box 889 Harrisburg, PA 17108 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 i ? 0 i .5'.~.?..5:0 i I,,,11i,,,1ii,,,,,,i1,,11,,,i1,,,11,11,,,,,,111,1,, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004803 MORGAN JAMES G JR 111 N FRONT ST P O BOX 889 HARRISBURG, PA 17108-0889 ........ fold ESTATE INFORMATION: SSN: 164-16-0543 FILE NUMBER: 2104- 1102 DECEDENT NAME: STEVENSON DORIS Q DATE OF PAYMENT: 01/06/2005 POSTMARK DATE: 01/05/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2004 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $3,244.72 TOTAL AMOUNT PAID: $3,244.72 REMARKS' TUCKER ARENSBERG SEAL CHECK//1 INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX ZB0601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP 112-D4) JAMES G MORGAN JR TUCKER ARENSBERG PO B:D~ 889 HBG PA 17108 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-07-2005 STEVENSON 03-22-2004 21 04-1102 CUMBERLAND 101 DORIS Q Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT-ALONG ~"BIS L_ ... RETAIN LOWER PORTION FOR YOUR RECORDS ...... REv:r!l;'f-QrAFir-m;!6!'r-NoT'ICE-OF-iNHErtI-TlNCi-TAX-l-PPRl-fsE'iEN'~--A[towlNCE-oR-----_._._-----_. c--! ,,-) DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STEVENSON DORIS Q FILE NO. 21 04-1102 ACN 101 DATE 03-07-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 17.000.00 .00 .00 60.684.88 .00 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 77.684.88 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 5.553.16 26.94 (11) (12) (13) (14) 5.580 10 72.104.78 .00 72.104.78 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due AX C ITS: NOTE: .00 X 72.104.78 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 3.244.72 .00 .00 3.244.72 DATE 01-05-2005 NUMBER CD004803 + INTEREST/PEN PAID (-) .00 AMOUNT PAID 3.244.72 BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-06-2005 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 3.244.72 .00 5.43 5.43 ~ . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MORGAN JAMES G JR 111 N FRONT ST POBOX 889 HARRISBURG, PA 17108-0889 n______ fold ESTATE INFORMATION: SSN: 164-16-0543 FILE NUMBER: 2104-1102 DECEDENT NAME: STEVENSON DORIS Q DATE OF PAYMENT: 04/04/2005 POSTMARK DATE: 04/01/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2004 NO. CD 005155 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $247.56 I I I I I I , , TOTAL AMOUNT PAID: REMARKS: RUTH GRAFFIUS CHECK#13 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $247.56 GLENDA FARNER STRASBAUGH REGISTER OF WILLS TUCKERIARE~~~~,I~R April 1, 2005 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Doris a. Stevenson Dear Sir or Madam: Enclosed please find an original and two (2) copies of a supplemental PA Inheritance Tax return for filing. Please time-stamp and return the file copy in the enclosed self-addressed stamped envelope. Also enclosed is a check payable to "Register of Wills, Agent" in the amount of $247.56 which represents the tax due. The check for the filing fee in the amount of $15.00 is also included. Should you have any questions, please do not hesitate to contact me. Thank you for your cooperation in this matter. Very truly yours, Tucker Arensberg, P.C. ;1~tly~ Theresa A. Wheeler Paralegal to Attorney James G. Morgan, Jr. :taw Enclosures , ,". '-' ; Tucker Arensberg, PC. 111 North Front Street PO. Box 889 Harrisburg, PA 17108 www.tuckerlaw.com p.800.257.4121 p,717.234.4121 f,717.232.6802 ~ i..% ~~., ~~ t \~~ REV-1500 EX + (6-00) *' ~,~.Q.\) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I OFFICIAL USE ONLY IFllE NUM~'~n_.. ; II 04 ~_________j___ _GPJJt!IY GQQ~_~~6f(_____~___NUMB~~___ ___ - ----~---- SOCIAL SECURITY NUMBER 4a. Future Interest Compromise (date of death after 12-12-82) X i 6. Decedent Died Testate (Attach 7. Decedent Maintained a Living Trust (Attach copy of Will) copy of Trusl) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (data of death between 11. Election to tax under Sec. 9113(A) (Attach Sch 0) , 12-31-91 and 1-1-95) . [THiS;SEC~''''~TBE-CO~PLETe~iAill]~gRREsPO~OENCeP:NDCONFI~'!iI~~I~FBRtAAl-!ONSHOUl,Qi~E'DiRE'cT~bTO:' i NAME COMPLETE MAILING ADDRESS L-"-am e s G. M 0 r 9 al!.o........~___ _ ._.. i 1 FIRM NAME (If applicable) ! Tucker Arensberg, P .C. .-- -~--_.__._---~-_.._~~_._---,..- J TELEPHONE NUMBER 1 (?'--~_?) .~~4-~121~-==-=--=~~=c==-= DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) I- Z W C W () W C Stevenson, Doris Q. DATE OF DEATH (MM-DD-YEAR)- DATE OF BIRTH (MM.DD-YEAR) i 03-22-2004 03-21-1915 i (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) I w .... ~.o:rn ()ii!~ wo..() %og ()!l:1II 0.. .0: x 2. Supplemental Return 1. Original Return : 4. limited Estate .... z w c z o 0.. rn w DC: DC: o () 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o i= :5 :J l- ii: <( () w 0::: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 1102 164-16-0543 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (date of death prior 1012-13.82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 111 N. Front Street I POB 889 -i Harrisburg, PA 17108-0889 ._..~_.__.._-_.. .---.-.-..-- (1 ) None -_._-------~~----_.- (2) None -----------~-~-- (3) None ------~---_.--~---- (4) None (5) 5,671.38 (6) None (7) None OFFIClJi,b USE ONLY f::~:::::,)- " (':',) '~..n -"--"'i .<~.- (.II (8) 5,671.38 (9) 170.07 (11 ) 170.07 (12) 5,501.31 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) (13) 0.00 (14) 5,501.31 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 120. D 0.00 247.56 0.00 0.00 247.56 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWER All QUESTIONS ON REVERSE SIDE AND RECHECK MATH << ._~~~.--------'-'---~~- 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0 .045 (16) i= 16.Amount of Line 14 taxable at lineal rate 5,501.31 x <( I- :J ll.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :!!: 0 () 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) )( <( I- 19. Tax Due (19) Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS 944 Indiana Avenue CITY Lemoyne -'-''--'"1:--- .-. ------T-.-- -"---. iSTATE PA jZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 247.56 0.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT. 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 theTAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is theBAlANCE DUE. (3) (4) (5) (SA) (5B) 247.56 247.56 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................. x; b. retain the right to designate who shall use the property transferred or its income;................................ t!J c, retain a reversionary interest; or....................,.........__............................................................................ ['Xl d. receive the promise for life of either payments, benefits or care?........................................................... ix~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................ .............. .............................................. ........................ L!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?........................... ..................................-........................ .......................... ~..J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and C<)ffiple.t.":.Declaralion of prepsrer other Ih.an the personal.rePresen~~is..b....~...9."."11. informatiorl_of which preparer~ any knowledg.~._._ ___ SIGNATURE OF PERSON RESPONSIBL FO ILlNG RETURN ADDRESS Ruth ra us l_~J . ADDRESS'- DATE ~:~,'~~~;:V:~;3 ___ ~ 3# ~ ~;~~~~. ~~";'133-'- ____ . . 3 / ~r;h y -A'DORESS- 111 N. Front Street Harrisburg, PA 17108-0889 For dates of death 0 fter July 1, 1 a bef January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 [7 .S. 99116 (a) (1.1) . . For dates of death on or e January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. he statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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. 99116 1.2) [72 P.S. 99116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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. REV.1513 EX+ (9.00) *' SCHEDULE ,J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Stevenson, Doris Q. 21-04-1102 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS [include outright sr,ousal aistributions, and ransfers under Sec. 9116(a)(1.2)] PA Ruth S. Graffius Daughter one-third 944 Indiana Avenue residue Lemoyne, PA 17043 Frederic G. Stevenson Son one-third 4 Colony Court residue Hanover, PA 17331 James P. Stevenson Son 1/3 residue of 11 Luzerne Street estate Pittston, PA 18643 Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet 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 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stevenson, Doris Q. FILE NUMBER 21-04-1102 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Register of Wills - short certificate 4.00 2 The Sentinel - proof of publication 166.07 Subtotal 170.07 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stevenson, Doris Q. FILE NUMBER 21-04-1102 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 DESCRIPTION 1 M&T Bank Checking Acct. No. 81910819 VALUE AT DATE OF DEATH 5.671.16 Accrued income on Item 1 through date of death 0.22 TOTAL (Also enter on Line 5, Recapitulation) 5.671.38 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 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':1 :;\' tt' -:?> COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MORGAN JAMES G JR 111 N FRONT ST POBOX 889 HARRISBURG, PA 17108-0889 .------- fold ESTATE INFORMATION: SSN: 164-1 6-0543 FILE NUMBER: 2104-1102 DECEDENT NAME: STEVENSON DORIS Q DATE OF PAYMENT: 04/04/2005 POSTMARK DATE: 04/01/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/22/2004 NO. CD 005154 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5.43 I I I I I I I I TOTAL AMOUNT PAID: $5.43 REMARKS: RUTH GRAFFIUS CHECK#14 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS CJ ... t/'I 'li ~ ~ ~ ~ p ~ ., o ~ 'i \ ~ \ ~ \ 0. u1 \ t/'I \ ';. ~ \ t ~ ,\ Cl' ~~ \ ~ t/'I-:;) Q \ '2 ~ <B ~ f/)\ 111 ~ ~\ ~ .,. <B '" 0\ CA \J- 0.. 9..' 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BUREAU OF INDIVIDUAL TAxES INHERITANCE TAX DIYISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT 't, ,... ,_ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN Of:,:-' JAMES G MDR&AN JR TUCKER ARENS BERG PO BOX 889 HBG PA 17108 *' REV-1607 EX AFP (03-05) 07-05-2005 STEVENSON 03-22-2004 21 04-11 02 CUMBERLAND 101 Amount R_i tted DORIS q 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~ sub.it the upper portion of this form with your tax p.y..nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ...............................................................................................................1 REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~.. ESTATE OF STEVENSON DORIS q FILE NO.21 04-1102 ACN 101 DATE 07-05-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANEO ESTATE. SHOWN BELOW IS A SUNKARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-07-2005 PAYMENTS (TAX CREDITS): PRINCIPAL TAX DUE: 3,492.28 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-05-2005 CD004803 .00 3,244.72 04-01-2005 CD005155 .00 247.56 04-01-2005 CD005154 5.43- 5.43 06-13-2005 CD005431 3.34- 3.34 TOTAL TAX CREDIT 3,492.28 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . ~ SIDE 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. I TUCKERIARE~~~~~~ February 22, 2006 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Doris a. Stevenson Dear Sir or Madam: Enclosed please find an original and one copy of the Status Report Under Rule 6.12 for filing. Please time stamp and return the file copy to me in the enclosed self-addressed stamped envelope. Should you have any questions, please do not hesitate to contact me. Thank you for your cooperation in this matter. Very truly yours, Tucker Arensberg, P.C. ;1~/L2(td~~ f',) r-' -'0 Paralegal to Attorney James G. Morgan, Jr. j \ I -- .. ~."'1 _,-..l :taw Enclosures Tucker Arensberg, PC. 1500 One PPG Place Pittsburgh, PA 15222 p. 412.566.1212 f.412.594.5619 www.tuckerlaw.com 111 N.FrontStreet P.O. Box 889 Harrisburg,PA17108 p.717.234.4121 f.717.232.6802 Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Doris O. Stevenson Date of Death: 3/22/2004 Estate No.: 2004-01102 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: Y es ~ No 0 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? Yes 0 NoN b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes W No 0 " c. Copies of receipts, releas,.es,.j,o, i n.,d,e ,rs. and .a p~, v~~.form" " al otinJ~rm,a 1 ",:} accounts may. be filed ~lth.the Clerk of the ~,~~ ~ourt and mayl:!e ,..) ~attaChed to thIs report. """'" ", ". N~~'\ (\ \:\ \:<\. ~ .~o Date: ' :',l .~. " ",."\\~J \. . , Signa re'. '\ _ -:. \ ~, Jame G~ Morgan, Jr. Tucke A ensberg, P.C. .-) c;", ," r"\ _...l Name III N. Front St. Harrisburg, PA 17101 Address ~3 L( Y p_( Telephone No. Capacity: 0 Personal Representative \\.!Il Counsel for personal representative -f!1 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/17/2006 MORGAN JAMES G JR 111 N FRONT ST POBOX 889 HARRISBURG, PA 17108-0889 RE: Estate of STEVENSON DORIS Q File Number: 2004-01102 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July 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: 3/22/2006 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, ~F::::~7t Clerk of the Orphans' Court cc: File Personal Representative(s) f~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 STEVENSON FREDERIC G 4 COLONY COURT HANOVER, PA 17331 RE: Estate of STEVENSON DORIS Q File Number: 2004-01102 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: 3/22/2006 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, ~~J~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel v~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 GRAFFIUS RUTH S 944 INDIANA AVENUE LEMOYNE, PA 17043 RE: Estate of STEVENSON DORIS Q File Number: 2004-01102 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 3/22/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~r ~ -~ .,y://J /// p" ~" In Re: Estate of STEVENSON DORIS Q ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-01102 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: GRAFFIUS RUTH S Counsel for Personal Representative: MORGAN JAMES G JR Date of Decedent's Death: 3/22/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 4/3/2006 ~.~.~~ J. Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File ,r/ ~ .~ In Re: Estate of STEVENSON DORIS Q ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-01102 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: GRAFFIUS RUTH S Counsel for Personal Representative: MORGAN JAMES G JR Date of Decedent's Death: 3/22/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~~-U~ Date: 4/3/2006 .. Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: --D V \" S ~+t' i) ~O h Date ofDeath: 31.22.-) 0 \{ Estate No.: Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: L ~~:e Dethe~:r."io" of the estate is corr-plcte: 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ____l__vYl 0 h t-1-- 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be ~'" ' attached to this reporL ~ Date: Signatu 'IZ~{ 1-11 Name {(YLI //7- G F't? Iff LI (' J--n C;/ /"0 PI v;J-u ~ L ~~O V ncp; P+ I /O~ 7(, I, :;Z.S?;;r Address Telephone No. Capacity: JLrpersonal Representative o Counsel for personal representative ~~;