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Home My WebLink About04-1100 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' Eve./y4.1 /11 . dA-~ T2.FL.L No. R \ - ol\ - \\00 , also known as To': Register of Wills for the cL , Deceased. County of e?L/fti~JA l$uJ in the Social Security No. /J?.3- /;l. - 19c; G, Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executr,'l( (s) named in the last will of the above decedent, dated Fe ~ '" "-A-.oL V 7 ,19~ , and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C-- U M h f'" r /.-+--u cL County, Pennsylvania, with h~r- last family or principal residence at .3 /9 _5" fO C' {),vd ., I- J ) 1{.'14 FJ-t e Ir- d <t Ie. } JJA EAS f- ;Oe'lJ1U5 /:"..... <J ~ U-)"usJ...,- p , (list street, number and muncipality) Decenden~en f3 _ ye~s of age, died /l).:> 0 c( u., .6 e r- (p ~ 02 0 o<-{ , , at 0 / .; S jJ J r / I- .AI c> " ,a ; I A / e .-4 H-f " /..;:. " / /. / A . " , / , , Except as foilows, decedent did not marry. was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If dOnUciled 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 $. I Df, 000, <9 0 situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters re:s f 4 4'7 "'...... ~ 14-<.. Y , theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~ '" ~ '" u c:: S'.41L> cI r 14 .J. t< j, 0 a...1 .. :5 ju:uYJ~ /-J, 7r u f' 1'=' '" ~3 "''-' < 1/ 4/- 77'1 .s r- - ,16' C-> /3 a X ~ I ( W rL[J/1€f' ~I f^, ,. 0:::'" c:: Su #1.1 ,n &/" d C4! 1+" ~A/709~ 1-1 tu-q ~ e/~fv UI/'1 IY- I 1'0 3 b -00 C::';:: " cu -.;:: 3~ ~~f)~~1 -;zh' / ~ '" '- 50 tU .' ~.~ 7.J. c.....- ...:::--' <:: ---- bl) Ci3 OATH OF' PERSONAL REPRESENTATIVE '. COMMONWEALTH OF P1NNS1LVANIA } ss . COUNTY OF CII('I\ ky 4-1'"\ . 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 represen- tative{s) of the above decedent petitioner(s) will well and truly administer the estate according to law. { ..L.. ~J -ft:., -.#-1 C/) ciq' ::l l::l ::t ~ egister \.. ;/U~?A X/ ~ ~ / No. ~J -6~-I/OO IE 'ft ZvJ yn ('{J /J,.vd-u-I/ ,Dece!!!led st:de ~li DECREE OF PROEATE AND GRANT OF LETTERS AND NO~! ~ \.~~ 0\= V ~ tll\ ~ .w~. in consideration of the petition on the reverse side hereof, satisfactory proof havmg been pr sent"'d Defore me, , )bLJ~ L~~ . Rog;"" of WU. f; C ~ b't- FEES ~ Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ ATTORNEY (Sup. Ct. LD. No.) Renunciation ................ $ $ ADDRESS TOTAL _ $ Filed ................................... PHONE -...........-- -.-, II' I:. :0 ccnify that lhe information here given is correctly copied from an original certificate of death duly filed with me as 1)(11 Registrar. Thc original certificate will be forwarded 10 the State Vital Rccords Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fcc for this certificate. $2.00 ~fij7ii'i;"" t2nm-1? 1:w~~ ....""~~\.\\\ OF pi:?:----__ l~~~ '~~~' Local Registrar' ~I! L \-Pl ~Qi .. <:a . \~~ ~'-' __tr;.6!.- I);:::: ~ ~"1.. ! ~ ':.. * . . _ ~_ . "J/ * ~ P 10687470 \~ -- .c-- '._ c /~l' NOV 0 9 2004 ~~ /'~ll\ "'>--!Il!/#f ---"{ 't,\: ",." No. -----. EN1 \\ 11"" JI"/"#",,,/llll " ;:.3 Date -J.--'" I --' ... ._~ IiJ~ 143 Rev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS I CERTIFICATE OF DEATH STATE FILE NUMBER "I NAME OF DECEDENT (First, Middle, Last) SEX SOCIAL SECURITY NUMBER " 1. Evelyn M. Hartzell 2. Female 3. 183 12 1906 AGE (Last Birthday) BIRTHPLACE (City and PA F AT heck In truction S u~~~o~ ~,;r ~OUnllY) HOSPtTPJ.... . 83 Yrs. lopalieot~ ERlOutpalientD DOAD Re5idenceD ~~:~,fyl 0 5. 7. PA B.. COUNTY OF DEATH FACILITY NAME (If not Inshtulion, give street and number) RACE. ArnenCiin Indian. Blac.k. IJ\tllle, <:1 . (Speofy) Bb. Cumberland East Pennsboro White Be. 10. DECEDENT'S USUAL OCCUPA nON KIND OF BUSINESS I INDUSTRY MARITAL STATUS. Married, SURVIVING SPOUSE (~7:~~~~t~:o d~~eu:r~ir~lll NeIlD~v~r~J?S=~ed, (I(wde. Qive lTliuden nilme) . Houseduties 14. Widowed 11a. 11b. DECEDENT'S MAILING ADDRESS (Streel, CityfTown, Stale, Zip Code) DECEDENT'S East Pennsboro . 319 2nd St. ACTUAL Iwp RESIDENCE Summerdale, PA 17093 (See instructions Cumberland 17d. 0 ~~h~~~~7~i~lf~ of 16. on other side) 17b. Count'i City/bora MOTHER'S NAME (First, Middle, Maiden Surname) 19. Edna Lickel \ ~:OR~rTis "l;'~~G ~gR.ES~~nuh~'~'lfa1 ~"VK c'N 093 PLACE OF DISPOSITlON- Name of Cemetery, Crematory LOCATION. CilyfTown, Slate, Zip Code or Other Place D 9, 2004 21c. Stone Church Cemetery 21d. Silver Spring Twp. PA . LICENSE NUMBER NAME AND ADDRESS OF FACILITY .-- 22b. FD 012774 L 22c. Richardson F.H.29S.Enola Dr. Enola, PA 17025 To the best of my knowledge, death occurred at the lime, date and place staled LICENSE NUMBER DATE SIGNED (Signature and Title) (Month, Day, Year) 23.. 23b. 23c. TIME OF DEATH WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER? 24. C83 2B. Yes D No Ga:.--- 27. PART I: Ent., III. diuue.. injUReI Of complk:ation. which caus.ed the death, : Approximate PART II: Olher significant conditions conlnbuhng 10 dealh but lis.1 only one cau.. on each line. . interval belwee not resulting in the underlYing cause given in PAR r I : onset and death a SequentmUy list conditions [ : if any, leading 10 immediate cause Enter UNDERLYING CAUSE (Disease Of Injury DUE TO (OR AS A CONSEQUENCE OF): that initialed events resuttlng on death) LAST 'MORE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED AVAILABLE PRIOR TO ~ (MIlOIh, Diay,Year) COMPLE110N OF CAUSE Natural Homicide D OF DEATH? D D YesO NoD Accident Pending Jnv~sllgatlon Yes [] No vesO NoD SUIcide 0 Could not be detem linea o 30.. 30b. M 30c. PLACE OF INJURY - At home. farm. street, factory. office 28011. buildiflg. elt:. (Specify> 2Bb. 2B. 30e. CERTIFIER (Check only one) .l~~,~~FbY~~tGOr::~\,~~~~~t~r,sd~:rh cg~gti:"'ia~~S: t~f ~ea~a~~:~(:r~~3~~x~~~a~sh:tir:~~~~1~~.~. ~~~.I~~ ~~~ .~~~~~~.t~.~ .i.I~~ .~~) . ' . .PROrmUNCING AND CERTIfYING PHYSICIAN (PhYSICian both pronouncing death and certifying 10 cause of death) To the beat of my knowledge, death occurred at the time, dale, and plOllce, and due to the cauaea,(a) OIInd manner 1& slated. 'MEDICAL EXAMINER/CORDNER On ttle baals of examination and/or Investigation, In my opinion, d80llth occurred at the time, date, and place, and due to the causesls) and mannerllst.ted.... .... ........................... .0 31i1. REGIS ~V.p<I/{ I 34. I ! 010178-OOOOlIFebruary 1, 1995/EGM/NLB/50231 " .. .. 11Ingl Dill nub WtglnttWul. :-~ 0 f~__ .....-~ \ OF -' EVELYN M. HARTZELL .' ..-> I, EVELYN M. HARTZELL, of Summerdale, East Pennsboro Township, Cumberland County, Pennsylvania. being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed as a consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE II I give and bequeath my automobile(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon 010178-OOOO1/February 1, 1995IEGMINLB/S0232 unto my daughters, SANDRA J. RHOADS and SHARON H. TRUE, or the survivor of them, to be divided equally between them in as nearly equal shares as practicable. ARTICLE ill I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, in equal shares unto my daughters, SANDRA J. RHOADS and SHARON H. TRUE, provided that should eithar predecease me, I give, devise and bequeath such deceased daughter's share unto her then-living issue, per stirpes by representation. ARTICLE IV In the event that any beneficiary of my Will shall not have reached the age of twenty-one (21) years at the time for distribution of his or her share, distribution of such share may be made in the discretion of my Co-Executrices or Successor, either directly or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A. Section 5301 et seq. My Co-Executrices or Successor may, in their or her sole discretion, designate as such Custodian any person, including either Co- Executrix or Successor, or an institution qualified to so act as a Custodian for such beneficiary under the Pennsylvania Uniform Transfers to Minors Act in effect at the time of such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my Co-Executrices, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. - 2 - ! I 01017S-OOOO1/February 1, 1995/EGMINLB/50232 ARTICLE V I name, constitute and appoint my daughters, SANDRA J. RHOADS and SHARON H. TRUE, Co-Executrices of this my Last Will and Testament. Should either fail to qualify or cease to so act, I direct that the surviving daughter shall complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and . t" Testament, this 7- day of ~ ,1996. t:vdiJ: Yn, J1~ (SEAL) EVEL M. HART LL Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament. in the presence of us. who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. fJ,~~ fJ1- '-11 ~ ,j.15~~ - 3 - , 010178-OOOOlIFebruary 1, 1995/EGM/NLB/5023:! . ,. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND We,EVELYNM.HARTZELL, ~ J::::i'<"'1!i.dci\~ ~ ~e 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 and that she had signed willingly and 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 hislher knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~m.~ EVEL M. HART LL ~J~{ }tIt-- Witness iI ~1~1It~.fR~ W ness Subscribed, sworn to and acknowledged before me by EVELYN M. HARTZELL, Testatrix, and ~& J~. ~~ and -.....,,~ ~ -t:l~ , l~ -~ ~ ~ witnesses, this' day of \- " 1996. ~r~ .~~, Notary Public - 4 - NOTARIAL SEAL DIANNE LENIG. Nolary Public lemoyne Borough Cumberland Co. My Commission Expires Dec. 21.1997 :::::JMIv',O~NJEALTH OF f'ENNS\'CVANiA REV-1162 EX(11-96i m:PARTi\'B~T OF FiEVEI\JU" BLJREAl: OF INO:VIDUAl TAXES DE:PT,28C6Q' HAHi1:S3URG, ?A . 71 28 C601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004857 TRUE SHARON H 11 WAGNER CIRCLE HUMMELSTOWN, PA 17036-9112 ACN ASSESSMENT AMOUNT CONTROL NUMBER . -- --- h"" ..-_.-.__. 101 I $11,000.00 EST ATE INFORMATION: SSN: 183.12.1906 I FILE NUMBER: 2104-1100 I DECEDENT NAME: HARTZELL EVELYN M I DATE OF PAYMENT: 01/19/2005 I POSTMARK DATE: 01/19/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 11/06/2004 I I TOTAL AMOUNT PAID: $11,000.00 REMARKS: S H TRUE CHECK# 4418 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/28/2005 RHOADS SANDRA J 311 4TH ST PO BOX 8 SUMMERDALE, PA 17093 RE: Estate of HARTZELL EVELYN M File Number: 2004-01100 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.6 (a) in the above captioned estate. 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing is due by: 03/11/2005 Your prompt attention to this matter will be appreciated. Thank You. ~~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/28/2005 TRUE SHARON H 11 WAGNER CIRCLE HUMMELSTOWN, PA 17036-9112 RE: Estate of HARTZELL EVELYN M File Number: 2004-01100 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.6 (a) in the above captioned estate. 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing is due by: 03/11/2005 Your prompt attention to this matter will be appreciated. Thank You. &:lr~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ~J~'l '717. \-; LC-VJl./J2J~ b I ~ U () '-I ,/-j{Lk1;J!~L J Date of Death: Will No. .A {J {j <( - C' /1 C Ci Admin. No. d' / - () C/ - // C 0 To the Register: 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 Name Address :d~,- !, 7<2h<"-/i-v ..3// -Jcl2.-G~ x1t flo &I'X' g ~..r'?,-<~-<. /?4 /7013 J/UU<...i/l-'1 11 ~ IIIVt2j/u,-, Ur.,.i lJup,-,~'--C/'--1 /:4- /7(130 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except /l1.....6~ Date: - J~q---()j Signature 0) I.i) Name 4!UUvrVl xl ~U- Address / I 7v {l./flce.V &~p ti.u"'L<~...JLa;,~/)/j fJA 17 G 36 9 lid, "',I Telephone VI7) s-( (, . [, 3: / / Capacity: L Personal Representative _Counsel for personal representative -J' CERTIFICATION OF NOTICE UNDER RULE 5.6Ia) Name of Decedent: E /JELl{\) /l1. f/Ater?.CLL Date of Death: 11-()0-U<-1 Will No. .;{ LJ 0 t/ - 0 /1 0 0 Admin. No. ;1.,1'04-/100 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of tbe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ./.;l. - 0 / - 6 r Name Address S Ii,..., I) ,,1+ J. IC/~r,A 0,\ 1/1 ,-/1'1(.5,';. /'U d.,x i S~, "Utlc r cia /p. r~t- 17073 SN~tf!-oAJ 1-1. TI'i':! t.( r II L<JA(~'ci,,4 e..iCe.,= l<Ju/"'/k."ls low.v /';9- /703 G Notice has now been given to all persons entitled thereto under Rule 5.6(a) except A! O/JE Date: _J-.J-o'!,- / , ~)/ 4,<,/. ,LLtZ', i\/Lr''''' , / <;(~' Signature .-L-itcc( '(..L / OJ ,\ /;{.c c<c-LJ Name /l (' y l Address .3 I ( tf r(( ,..it -.,.{,L 11'- / /~ C A,..f!{tf, (} (' / / J I' I " 1,1. C W4-YO / ) 1 1/;-1 /7 U'?1 Telephone (It?) 73..2, t:' 3 I 7 Capacity: v/ Personal Representative ! '.-' <' _Counsel for personal representative if - Yc" C) (",-.-\ U_), - (_..... t'I:: 1- o o L.~1 _ LJ". cr: ' , C") (.... 6L~J LL) :-X. p:. \ \ \ '" U") S::! :r.: 0.. -' -' --. -.... --. ....... ~~.. '~ ~ i ~,..J '. ~ "'- ~ 't'- " If') ...J :::;J ...., ...". c::> c::::> c-..a ". c.: tt. =")~"'.: u-8"~ o " :<- (f) ';;;;. a:: - ~" I.JJ z .:. .-l i rc ,. "'\ ... ~.l~ '-"" J""'\ a:: ~; 05 o ~ ~ ~ ~ ~ ~.~~ \ '-J ~~ ~ '.J ,\ ~ <~ ~rJ '~ J ~'~ \ \ "'-l. ~ ~~ .~~ ~ ~ i ... .- l- 4- w - uJ......~ ~~~ Ifl'->- l-)(Ifl IflOZ ::>coz <.:> . w oqa. jgl"'g .- ::) co (/) a: a: 4- :I: LAW OFFICES ~5~tt0eM 109 LOCUST STREET P.O. BOX 1121 HARRISBURG, PENNSYLVANIA 17108-1121 DAVID A. WI ON FRANCIS A. ZULLI JEAN D. SEIBERT (717) 236-9301 (717) 232-1488 FAX (717) 236-6100 Email: wzs@mindspring.com VICTOR A. BIHL OF COUNSEL July 14, 2005 113 EAST MAIN STREET HUMMELSTOWN, PA 17036 (717) 566-2501 Register of Wills Office Cumberland County Courthouse Carlisle, P A 17013 RE: Estate of Evelyn M. Hartzell No. 2004-1100 Dear Register of Wills: On behalf of Sandra J, Rhoads and Sharon H. True, Co-Executrixes of the above-referenced estate, I am enclosing for your filing two originals and one copy of the Inventory and P A Inheritance Tax Return, along with a check in the amount of$386.66. Kindly date stamp the copy and return same to me in the envelope I have provided, ~e trU.I. y yours, ~AY J D. Seibert (") Co ~:o en ""U rn (") .'f;J;;J;;., r'-'- Z rTl i">> ...::0 ;"C(f);>;.: ,._~Joo C)O-n ()C: ; ::D -; ji! "" => <= Con <- c:: . If you have any questions concerning this matter, please contact me. -0 :Jt r:? -:rJ -,--, (-1"-1 CY:10 {;;~~~ 1--;"1 '-'-1 '.-nc) ("-, .....-) "-j':, ::::T1 -n c5 .... rn "')'.J ':1~l Ul JDS/kd Enclosures (J'\ \D COMMONWEALTH OF PENNSYLVANIA DEPART MENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DFPT.280601 HARRISBURG, PA 17128-0601 REV-1162 EX111-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005577 RHOADS SANDRA J 311 4TH ST PO BOX 8 SUMMERDALE, PA 17093 ACN ASSESSMENT CONTROL NUMBER AMOUNT _nn___ told 101 $386.66 ESTATE INFORMATION: SSN: 183-12-1906 FILE NUMBER: 2104-1100 DECEDENT NAME: HARTZELL EVELYN M DATE OF PAYMENT: 07/15/2005 POSTMARK DATE: 07/14/2005 COUNTY: CUMBERLAND DATE OF DEATH; 11/06/2004 TOTAL AMOUNT PAID: $386.66 REMARKS: CHECK# 2001 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV.1500 EX (6-00) Rev-1500 OFFICIAl. USE ONLY , . COMMONWEALTH OF ................................................................................... PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN 21 04 1100 HARRIS8URG, PA 17128.0601 - RESIDENT DECEDENT County Code Year Number DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER r- z HARTZELL Evelyn M, 183-12-1906 w 0 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD.YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH W <.) November 6,2004 January 9,1921 REGISTER OF WILLS w 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A ID x 1 Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12- ~~fJ) - - - 0--'" 4. Limited Estate 4a. Future Interest Comprise (date of death after 12.12.82) 5. Federal Estate Tax Return Required ID 0." - - - .c.~.Q ()o.m x 6 Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a living Trust (Attach a copy of Trust) 0 8. Total Number of Safe Deposit Boxes 0. - - <i _ 10. Spousal Poverty Credit (date of death b,!we," 12.31.91 aod 1.1.95) 011. Election to tax under Sec. 9113(A) 9. Litigation Proceeds Received - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: <= NAME COMPLETE MAILING ADDRESS = -= Sandra J. Rhoads 311 Fourth Street = C> FIRM NAME (If Applicable) P.O. Box 8 C>- U) ~ Summerdale, PA 17093 :s U TELEPHONE NUMBER 717-732.0317 1. Real Estate (Schedule A) (1) $140,OOO.~ OF~L USE ONLY L~..'\ :;,0 c,n 2. Stocks and Bonds (Schedule B) (2) $0.00, '\J C- ", '!:':'"'-' c:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $OOO~,--j: f:2 I..... ; ,., ];1 - ,~: Z 4 Mortgages & Notes Receivable (Schedule D) (4) $0.00: ::') l.O '--'.' :,..:, 0 C") .:-) I- 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) $2,80582 i, 'T1 ?::-= t '''11 ~ -.... ,:,'] $2,67583ci C) ---l 6. Jointly Owned Property (Schedule F) (6) \-;? n"' :J D Separate Billing Requested ::;. c::> l- . , ~ l.O 0.... 7. Inter.Vivos Transfers & Misc. Non-Probate Property (7) $125,936.39 ~ ~ ........................................................ 0 (Schedule G or L) LU 8. Total Gross Assets (total Lines 1-7) (8) $271,418.04 0::: g. Funeral Expenses & Administrative Costs (Schedule H) (9) $4,700.57 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $815.51 11. Total Deductions (total Lines 9 & 10) (11) $551608 12. Net Value of Estate (Line 8 minus Line 11) (12) $265,901.96 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000 made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) $265,901.96 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax Z rate, or transfers under Sec. 9116 (a)(1.2) x (15) $0.00 - 0 1= 16. Amount of line 14 taxable at lineal rate $265,901.96 x .045 (16) $11,965.59 x<i - <il- 17. Amount of line 14 taxable at sibling rate x .12 (17) $0.00 I-=> a. ~ 18. Amount of line 14 taxable at collateral rate x .15 (18) $000 0 () 19. Tax Due (19) $11,965.59 20. D > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 319 Second Street P.O. Box 116 CITY Summerdale STATE PA ZIP 17093 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $11 ,965.59 $11 000 nn $'i7R q'l Total Credits (A + 8 + C) (2) $1157893 3. InteresUPenally if applicable D. Interest E. Penalty 4. TotallnteresUPenally (0 + E) (3) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $0.00 5. $386.66 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SA) (58) $386.66 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: 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 revisionary interest; or d. receive the promise for life of either payments, benefits or care? If death occurred after December 12, 1982, did decedent transfer property within on year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her Did decedent own an Individual Retirement Account, annuity, or other non-probate property which Yes No 2. ~ E3 ~ B 3. 4. contains a beneficiary designation? CD CJ 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 complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. 311 Fourth Street. PO Box 8,Summerdale, PA 17093 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE 11 Wagner Circle, Hummelstown. PA 17036 ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposec 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a SUI tax return are still applicable even if the surviving spouse is the only f\'f\? D ~ use of the surviving spouse is 0% [72 P.S. , requirements for disclosure of assets and filing a For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a 1..~51 r at death to or for the use of a natural parent. an The tax rate imposed on the net value of transfers to or for the use c P.S. 99116(a) (1)]. 5%, except as noted in 72 P.S. 99116(1.2) [72 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)J. 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.1502EX -= (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly..owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Real estate situate at 319 Second Street, City of Summerdale, Cumberland County, PA. For title into decedent, see Cumberland County Recorder of Deeds in Deed Book "V", Volume 21, Page 67. For date of death value, see attached settlement sheet. VALUE AT DATE OF DEATH $140,000.00 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $140,000.00 REV-15GB EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 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 1. Refund of real property taxes at settlement on real property $408.06 2. Highmark Health Insurance refund $99.60 3. Com cast refund $32.69 4. State Farm - car insurance refund $205.83 5. State Farm - homeowners insurance refund $59.64 6. 1994 Buick Century - 4 door sedan $1,000.00 7. Household goods and furnishings $1,000.00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $2,805.82 REV.1509 EX.;. (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Sandra J. Rhoads 311 North Fourth Street, P.O. Box 8 Summerdale, PA 17093 Daughter B. c. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH % OF DATE OF DEATH FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly~held real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 01-96 Checking account No. 514011269 at PNC Bank $5,351.67 50.0% $2,675.83 TOTAL (Also enter on line 6, Recapitulation) $2,675.83 .. (If more space IS needed. Insert additional sheets of the same size) REV-1510 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn M. Hartzell SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-04-1100 ThiS schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF DECD'S TAXABLE ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH INTEREST EXCLUSION VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET (IF APPLICABLE) 1. Glenbrook Life & Annuity Co. Account No. GA0681522 $5,692.98 100.0% $5,692.98 Two daughters, Sandra J. Rhoads and Sharon H. True, receive proceeds 2. Merrill Lynch Account No. 87250876 Transfer on death to the twD daughters, Sandra J. Rhoads and Sharon H. True - cDmprised of: 348 shares of Dupont common stock @ $44.12 per share $15,353.76 100.0% $15,353.76 1,407 shares Df American Funds IncDme Fund of America @ $17.95 per $25,255.65 100.0% $25,255.65 share 3,600 shares Df ML Senior Floating Rate Fund @ $8.96 per share $32,256.00 100.0% $32,256.00 200 shares of General MotDrs 7.5% Preferred stDck @ $25.68 per share $5,136.00 100.0% $5,136.00 300 shares of Wells Fargo Capital 5.625% Preferred stock @ $24.44 per $7,332.00 100.0% $7,332.00 share $5,000.00 Caterpillar 6.0% Corporate Bond $5,065.00 100.0% $5,065.00 $15,000.00 NM Bank America 6.5% Corporate BDnd $15,082.00 100.0% $15,082.00 $5,000.00 FNMA BDnd $4,975.00 100.0% $4,975.00 $9,000.00 Household Finance 6.4% Bond 9.788.00 100.0% $9,788.00 TOTAL (Also enter Dn line 7, Recapitulation) $125,936.39 (If mDre space IS needed, insert additional sheets of the same size) REV-1511 EX + (Va7)(f) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn M. Hartzell Debts of decedent must be reported on Schedule I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-04-1100 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Summerdale Church - luncheon $200.00 2. Pamela's - flowers for family $162.13 3. Summerdale Church - memorial flowrs $25.00 4. James R. Gingrich Memorial - tombstone inscription $100.00 5. Funeral attire $100.00 6. Music for funeral $50.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees - Wion, Zulli & Seibert $1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees $262.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Advertising - The Paxton Herald $35.50 8. 1-3-05 PA Water Co. $12.17 9. 1-8-05 East Pennsboro Township - sewage $68.50 10. 1-25-05 PP&L $82.70 11. 1-25-05 PA Water Co. $11.64 12. 2-22-05 PP&L $103.05 TOTAL (Also enter on line 9. Recapitulation) $4,700.57 (If more space IS needed, Insert additional sheets of the same size) FILE NUMBER 21-04-1100 VALUE AT DATE OF DEATH $12.22 $108.00 $2.00 $11.64 $78.41 $20.00 $68.50 $2.00 $35.00 $19.27 $19.20 $10.00 $2.00 $1,400.00 $2.00 $3.00 $100.00 $17.83 $29.81 $41.00 TOTAL COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CONTINUATION PAGE SCHEDULE _H_ ESTATE OF Evelyn M. Hartzell ITEM NUMBER DESCRIPTION 13. 2-22-05 PA Water Co. 14. 2-22-05 Susquehanna Valley FCU 15. 3-15-05 Statement charge for checks at PNC 16. 3-31-05 PA Water Co. 17. 3-31-05 PP&L 18. 4-6-05 Paxton Herald ad - garage sale 19. 4-8-05 East Pennsboro Twp. - sewage 20. 4-15-05 Charge by Bank for copies of checks 21. 4-30-05 PP&L 22. 4-30-05 PA Water Co. 23. 4-30-05 Susquehanna Valley FeU 24. 5-16-05 Charge for two copies of statement 25. 5-16-05 Charge for copy of checks 26. 5-16-05 Realty transfer tax on sale of real property 27. 5-16-05 Lakeside Abstract and Settlements - tax cert. Fee 28. 5-16-05 Alicia D. Stine - additional tax cert. Fee 29. 5-24-05 James Rhoads - four grass mowings 30. 5-31-05 PP&L 31. 5-31-05 PA Water Co. 32. 6-1-05 Sandra Rhoads - ad in Patriot News CONTINUATION PAGE SCHEDULE _H_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 ITEM NUMBER 33. 6-7-05 DESCRIPTION The PatriDt News ad - sewing machine VALUE AT DATE OF DEATH $6.00 TOTAL REV-1512 EX + (1-97){1) " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT $42.23 1. 11-8-04 Com cast 2. 11-9-04 PA Water Co. 3. 11-10-04 State Farm - car insurance 4. 12-1-04 PA Water Co. 5. 12-1-04 Verizon 6. 12-17-04 John Belsak - fix car door 7. 12-22-04 PP&L - November through January 8. 3-30-05 Alicia Stine - real estate taxes $16.81 $255.36 $11.59 $11.15 $43.78 $101.20 $333.39 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $815.51 REV-1513 EX + (9-00)) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BENEFICIARIES ESTATE OF Evelyn M. Hartzell FILE NUMBER 21-04-1100 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Sandra J. Rhoads Daughter 50% share of residue 311 Fourth Street P.O. Box 8 Summerdale, PA 17093 2. Sharon H. True Daughter 50% share of residue 11 Wagner Circle Hummelstown, PA 17036 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 .. (If more space IS needed, Insert additional sheets of the same size) ~ , REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of: Evelyn M. Hartzell, Deceased No.: 21-04-1100 Date of Death: November 6, 2004 Social Security No.: 183-12-1906 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 in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as ofthe date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of the Inventory, I verify that the statements made in this Inventory are true and correct. I 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 Representatives: ~~ ,f~-.j Sandra J. Rhoa s, Co-Executnx Dated: 91f /3,d-c~.~ Description d1Arv;d~^ /'Sharon H. True, Co-Executrix - Value Real estate situate at 319 Second Street, City of Summerdale, Cumberland County, Pennsylvania. For title into decedent, see Cumberland County Recorder of Deeds in Deed Book "V", Volume 21, Page 67. For date of death value, see attached settlement sheet. $140,000.00 Refund of real property taxes at settlement of real property c-,u : -:.0 L '''"{J = -l" () .- '-f- r- Q' C") ;.:.~ \.0 ::408..Qf} jJ :=;'" Comcast - refund 99.'60 C) U::J 32.69 Highmark Health Insurance - refund State Farm - car insurance refund 205.83 State Farm - homeowners insurance refund 59.64 1994 Buick Century - four door sedan 1,000.00 , Household goods and furnishings 1,000.00 Total $142,805.82 . ,r A. . , . B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT l.oFHA 2.DFmHA 3. [!ICONV. UN INS. 4.DVA 5.DCONV. INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 2005030102.PFD 66834 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form Is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC)" were paid outside the closing; they are shown here for Informational purposes and are not Included In the totals. 1.0 3198 (2005030102.PFOI2005030102.PFDI33) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Kathlaen A. White Estate of Evelyn M. Hartzell nBank, NA 93 R. Autmn Drive 319 Second Street 55 Merchant Street Suite 300 Enola, PA 17025 Summerdale, PA 17093 Cincinnati, OH 45246 SSN: 381-44-1740 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 20-1747090 I. SETTLEMENT DATE: 319 Second Street Lakeside Abstract & Settlements, LLC Summerdale, PA 17093 May 16, 2005 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 09-12-2995-019 101 Front Street, PO Box 426 Boiling Springs, PA 17007 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 140,000.00 401. Contract Sales Price 140,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 4,505.14 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance Adlustments For Items Paid Bv Seller in advance 106. CitvfTown Taxes to 406. CitvfTown Taxes to 107. County Taxes 05116105 to 01101106 210.08 407. County Taxes 05/16105 to 01101106 210.08 108. School Taxes 05116/05 to 07/01/05 164.11 408. School Taxes 05116105 to 07101/05 164.11 109. Credit for Sewer Paid 33.87 409. Credit for Sewer Paid 33.87 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 144,913.20 420. GROSS AMOUNT DUE TO SELLER 140,408.06 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deooslt or earnest money 500.00 501. Excess Deoosit (See Instructions) 202. Princioal Amount of New Loan(s) 112,000.00 502. Settlement Charoes to Seller (Line 1400) 1,405.00 203. Existlnoloan(s) taken sublect to 503. Existinoloan(s) taken subject to 204. 2nd Mortoaoe 20,656.90 504. Payoff of first Mort9age .,,,. 505. Payoff of second M~rtgllge OMB NO 2502 0265 A'oo. rC:l\:ltll.&. L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ la) % PAID FROM PAID FROM Division of Commission (line 700) as Follows: BORROWER'S SELLER'S 701.$ 10 FUNDS AT FUNDS AT 702.$ 10 SETTLEMENT SETTLEMENT 703. Commission Paid al Settlemenl 704. to aDo. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioinalion Fee % 10 802. Loan Discount % to 803. Appraisal Fee 10 Cody Financial Mortgage Services, Inc 275.00 804. Processing Fee 10 Cody Financial Mortgage Services, Inc 350.00 805. Flood Cert Fee 10 First American 14.50 606. UnderwrillnaFee 10 nBank, NA 295.00 607. Tax Service Fee to TRANSAMERICA 69.00 608. Escrow Waiver to Cody Financial Mortgage Services, Inc 280.00 809. Document Prep Fee 10 nBank, NA 125.00 810. YSP Pd by Lender to Cody Financial Mortgage Services, Inc POC:B2380.00 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Inleresl From 05/16/05 to 06/01/05 @ $ 19.055600/day ( 16 days %) 304.89 902. Mortaaae insurance Premium for months to 903. Hazard Insurance Premium for 1.0 vears to Prudential Financial POC $359.00 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months (1i) $ per month 1002. Mortoaoe Insurance months @ $ per month 1003. City/Town Taxes months @ $ per month 1004. County Taxes months la) $ per month 1005. School Taxes monlhs @ $ per monlh 1006. months (1i) $ per monlh 1007. months @ $ per month 1008. AooreQale Adiustmenl months la) $ oer month 1100. TITLE CHARGES 1101. SeltlemenlorClosino Fee to 1102. Abstracl or Tille Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Notarv Fees to NO CHARGE 1107. Attorney's Fees to (Includes above item numbers: I 1108. Tille Insurance to Lakeside Abstracl & Settlements LLC 1 058.75 (includes above item numbers: ) 1109. Lender's Coverage $ 112,000.00 1110. Owner's Coverage $ 140,000.00 1,058.75 . . ...^^ ....^^ ,..... ....e:.noo " ... ".......",.~.....,__"'- 'IT ~.,;.;:~~.;.;.~._^c, -",,--;;-...~""--- 10-03-2005 HARTZEL L 11-06-2004 21 04-1100 CUMBERLAND 101 APPEAL DATE: 12-02-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 f~!_~~9~~_!~!~_~!~~______~___~~!~!~_~~~~~_~~~!!~~_~~~_Y~~~_~~f~~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX EVELYN M FILE NO. 21 04-1100 ACN 101 BUREAU OF INDIVIDUAliYTAii~~~' ~~, INHERITANCE TAX DIVISIDN . PD BDX 2B0601 HARRISBURG PA 1712B-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '>), 26 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN r SANDRA J'RHOADS 311 4TH ST PO BOX 8 SUMMERDALE PA 17093 ESTATE OF HARTZELL REV-1547 EX AFP (06-051 EVEL YN M TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED DATE 10-03-2005 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 Raceivable (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) 140,000.00 .00 .00 .00 2.805.82 2,675.83 125,936.39 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 4,700.57 815 51 (11) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 271,418.04 5.516 OR 265,901.96 .00 265,901.96 NOTE: 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. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 265,901. 96 X 045 = 11 ,965.59 .00 X 12 = .00 .00 X 15 = .00 (19)= 11,965.59 TAX CR!;:DITS: "AT""'" ""l,;"~", " I+r AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-19 2005 ... CD004857 578.95 11,000.00 07-14-2005 "- CD005577 .00 386.66 TOTAL TAX CREDIT 11,965.61 BALANCE OF TAX DUE .02CR INTEREST AND PEN. .00 TOTAL DUE .02CR · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. pt. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.) Cumberland County - Register Of WiLls One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/30/2006 RHOADS SANDRA J 311 4TH ST PO BOX 8 SUMMERDALE, PA 17093 RE: Estate of HARTZELL EVELYN M File Number: 2004-01100 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: 11/06/2006 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, ~'/L~PJ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/30/2006 TRUE SHARON H 11 WAGNER CIRCLE HUMMELSTOWN, PA 17036-9112 RE: Estate of HARTZELL EVELYN M File Number: 2004-01100 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 complet~d or uncompleted administration. This filing lS due by: 11/06/2006 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. sinc.17 . rely, ~~~a~0#dv/~ /1 .// Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel \ ex Register of Wills of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 ;;t,' e../ y ~J In. I-/ell'/ z e 1/ Date of Death: ;Va u e 1'1-1 h e-f-o t:, doo Y , (/J Il- :11:;< / - 0 V- /1 tJ cJ) Estate No.: cXOOc(- 0 1100 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes g) 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 ~ No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: CD () 0 .'iS7 7 pel. 7/;S-~cC).> f(n- $386.6 b COOOi.{g-S-7 ~tL. / -19 -~007- f<-n-- <# If, C-1()O. cJ () c. Did the personal representative state an account informally to the parties in interest? Yes El No 0 - c. Copies of receipts, releases, joinders and approval of fomlal or infomlal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~JI~rn '1-1 ~jfiu-~ .---0- 1/- ;;; - c){, Date: .. Signature , I -" U'fV1~vj 12~UU-:L~L(j' ,511-:1 rO/7 /-/. 7;-1'-/ € Name \:d "":':;\"\"':-;!'; ''''~'~jl!i'r' " " ,,~.j...if .JlI'I 1\ /r'r\r"') r... NIl" V OJ i\jc} ,),1 17H&10 :10 W::IJ18 '7.0 I ;] / / . . / I vU{{j/~ ep C::/r; /V/J/?1Nfr/sT-oc<,,'J-1 Address r?l / 76.5b 7 I 7 - S- (; & -6 ~/ ) Telephone No. I 2 :21 ~1d 8 - liON gOaZ Capacity: ~ Personal Representative o Counsel for personal representative ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: E (; r:=. L 'v' /J 111 f H A /C T Z ELL , Date of Death: //- fo-oLj Estate No.: ~:.( 0 () i/- - 0 / I 0 0 fJA lUo 2/- 0</ -/1 0 0 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 ~;ther administration of the estate is complete: Yes 1.!1 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 t~yersonal representative file a final account with the Court? Yes W No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: CD D 0 S-~7 7 - p.-e tP3fi&. (p (P - ~- f::'--O.::.- CDoO t./ fS' 7 - ~J#I I Cl Cle.). () 0 - I' - /Cj -o~ c. Did the person~epresentative state an account informally to the parties in interest? Yes &1 No 0 c. Copies of receipts, releases, joinders and approval of fomlaJ or infomlal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. L~~ I~ Signature Date: II - ;!.. - 0 C" SAI0 () ~A ..J J? /-foA OS Name ~:; /f Address ~ . d 1/ Sf - 6 ~:;x S;(J(l1~-evJQ {01P;~ 17()y~ Vd' ItJn08 S.N'\J'H&10 :it] W:J31J '7/7- 73 '2--03/7 Telephone No. Capacity: ~ersonal Representative o Counsel for personal representative I 2 :21 ~~d E - AON 90aZ C'~ COMMONWEALTH OF PENNSYLVANIA f)=PARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-ll o:i eXlll-:;bJ RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RHOADS SANDRA J 311 4TH ST PO BOX 8 SUMMERDALE, PA 17093 ~..__n~_ fc,ld ESTATE INFORMATION: SSN: 183-12-1906 FILE NUMBER: 2104-1100 DECEDENT NAME: HARTZELL EVELYN M DATE OF PAYMENT: 07/15/2005 POSTMARK DATE: 07/1 A /')nnr:;. 'I I~/~VV....J COUNTY: CUMBERLAND DATE OF DEATH: 11/06/2004 NO. CD 005577 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $386.66 I I I I I I I I I ~ TOTAL AMOUNT PAID: REMARKS: CHECK# 2001 SEAL INITIALS: JA RECEIVED BY: TAXPAYFR $386.66 {v \(J 11). ,I-"" V l) \ ~"I ~- ~' V X' '1,'" ,1. f 'iJ- C'/ ;,}t iJ - Jt )' 1,..1t , r,~ iv " Ii I' '1(0'\ " t, ,,\jJ' \ \j V GLENDA FARNER STRASBAUGH REGISTER OF WILLS PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COMMONWEALTH OF PENNSYLVANIA DE~ARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: TRUE SHARON H 11 WAGNER CIRCLE HUMMELSTOWN, PA 17036-9112 ~------- fold ESTATE INFORMATION: SSN: 183-12-1906 FILE NUMBER: 2104-1100 DECEDENT NAME: HARTZELL EVELYN M DATE OF PAYMENT: 01/19/2005 POSTMARK DATE: 01/19/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/06/2004 REV-1162 EX(11-96) NO. CD 004857 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $11,000.00 I I I I I I I I TOTAL AMOUNT PAID: $11,000.00 REMARKS: S H TRUE CHECK# 4418 SEAL INITIALS: VZ RECEIVED BY: TAXPAYER GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-03-2005 HARTZELL 11-06-2004 21 04-1100 CUMBERLAND 101 APPEAL DATE: 12-02-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- REV:is47-EX-AFP-coi:osj-NOTicE-OF-iNHERiTANCE-TAX-APPRAisEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX EVELYN M FILE NO. 21 04-1100 ACN 101 SANDRA J RHOADS 311 4TH ST PO BOX 8 SUMMERDALE PA 17093 ESTATE OF HARTZEL L REV-1547 EX AFP C06-05) EVELYN M TAX RETURN WAS: (X) ACCEPTED AS FILED DATE 10- 03-2005 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) 140,000.00 .00 .00 .00 2.805.82 2,675.83 125,936.39 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 4,700.57 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 271,418.04 5.516 08 265,901.96 .00 265,901. 96 NOTE: 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. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 265,901.96 X 045 = 11,965.59 .00 X 12 = .00 .00 X 15 = .00 (19)= 11,965.59 815.51 (11) (12) (13) (14) .u......... l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-19-2005 CD004857 578.95 11,000.00 07-14-2005 CD005577 .00 386.66 TOTAL TAX CREDIT 11,965.61 BALANCE OF TAX DUE .02CR INTEREST AND PEN. .00 TOTAL DUE .02CR * 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 .to IlFFIINn ~FF IlFUFIl<:.F <:.TnF nF T"'T<:. FnDM ~nD T..<:.TDIlr-TTn.." 1 iESERV A TION: >URPOSE OF ~OTICE : PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENAL TV: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available online at www.revenue.state.oa.us. any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (rT only). Any party in interest not satisfied with the appraisement, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice bY filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofaooeals.state.oa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PI. Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 3 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. The 15% tax amnesty non-participation penalty is computed on the total of th~ ta~ and interest assessed, and net paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interest Daily Interest Daily Interest Rate Factor Year Rate Factor Year Rate -m- ~ m8-199l ~ .000301 2oOi. ~ 16% .000438 1992 9% .000247 2002 6% 11% .000301 1993-1994 7% .000192 2003 5% 13% .000356 1995-1998 9% .000247 2004 4% 10% .000274 1999 7% .000192 2005 5% 9% .000247 2000 8% .000219 Year mz 1983 1984 1985 1986 1987 Daily Factor .000247 .000164 .000137 .ooono .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTO --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the __._.,:..L~___'I ::_.&.____.a. _......4- 1-0... _~1_..1""+""rI