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HomeMy WebLinkAbout02-0340Register of Wills of Estate of Patricia K. also known as Michael E. Alleman Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Alleman No. ~,1 "0~1~." ~l~qO , Deceased Social Security No. 186 - 34- 2508 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) ~'~ A. Probate and Grant Testamentary aver execut or of Letters and that Petitioner(s) is/are the the Decedent, dated 08/15/1989 and codicil(s) dated None None named in the last Will of State relevant circumstances, e.g., 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: None B. Grant of Letters of Administration (c.ta.;' d.b.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 (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 409 Mt. Allen Drive, Upper Allen Township (list street, number, and municipality) Decedent, then 61 years of age, died 03/24/2002 at Mechanicsbur~;, PA 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 (Location) 76,400.00 123,600.00 situated as follows: 409 Mt. Allen Drive, Upper Allen Township, Mechanicsbur~, Cumberland 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 undersi~lned: I Si~lnature Typed or printed name and residence Michael E. Alleman ~_f~ ~L~. ~'..~.~.~,-~,_~t 1152 Rossmoyne Road, Mechanicsbur~, Pa 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc, Form RW-1 (1991) 21-02-340 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 the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~ day of For the Register r, Ju~'~ Mich'~el E. Alleman - ~ No. 21-02-340 Estate of Patricia K. Alleman Deceased Social Security No: 186- 34- 2508 Date of Death: 03/24/2002 AND NOW, APRTT, 3, 2DO? __, in consideration 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.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Michael E. Alleman in the above estate and that the instrument(s) dated 08/15/1989 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Register of Wills 9.00 Attorney: Donna M. Mullin, Esquire I.D. No: 30392 JAMES, SMITH, DURKIN & CONNELLY 6.00 Address: 134 Sipe Avenue Hummelst own, PA 17036 5.00 Telephone: 717/533-3280 Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( Codicil ........... $ JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association FILED APRIL 3, 2002 MAILED LETTERS TO ATTORNEY APRIL 3, Copyright (c) 1996 form software only CPSystems, Inc. 2002 Form RW-1 (1991) 21-02-340 LAST WILL AND TESTAI~EN~T OF PATRICIAK. ALLE~fAN I, PATRICIAK. AIJ.ENAN, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 0 I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my three (3) sons, to wit, MICHAEL E. ALLEMAN, BRADFORD J. ALLE~iAN and TIMOTHY L. ALLErgeN, share and share alike, per stirpes. For the purpose of facilitating the settlement and distribution of my estate, I authorize and empower my Executor, hereinafter named, to sell any and all real estate which I may own at the time of my decease, as well as my personal property, at either public or private sale or sales. -1- COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) SS. I, PATRICIAK. ALLEF~A_N , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. day of Sworn and affirmed to and acknowledged before me by PATRICIAK, ALLE~LAN , the testa~ix , this l~th August , A. D. 1989. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) SS. NOTARIAL SEAL MARY $. I~B~NSON, I~TARY PUbLiC HECHAN~CSBURG B~RO. CUI4BERLAND CO. Cemmtsston Exptres Sept. 21, 19~1 We, the undersigned, J. ROBERT STAUFFER and JOHl~H. EAKIN , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat rix , PATRICIAK. ALLEM. AN , sign and exe- cute the instrument as h~her Last Will and Testament; that the said testat rix , PATP, ICIAK. AIJ.EF~AIq , executed it as h~her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix , signed the Will as witnesses; and that to the best of our knowledge, the testat rix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribed to befor/~/ '~ ~~~ me this 15thday of August , 1989. NOTARIAL SEAL MARY S. II#INSM, NtTARY PIJ~I. IC MECHANXCSBURG ~RO. CUMBERLAND CO. C....tssten Expires Sept. 21, 19i)1 -3- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. To the Register: PATRICIA K. ALLEMAN March 24, 2002 Adm. No. 2002-0034{) I certify that notice of estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 8, 2002. NalTle Timothy L. Alleman Address 409 Mt. Allen Drive Mechanicsburg, PA 17055 Bradford J. Alleman 300 Manchester Road Camp Hill, PA 17011 Michael E. Alleman 1152 Rossmoyne Road Mechanicsburg, PA 17055 Notice has now been given to all personal entitled thereto under Rule 5.6(a) except Date: (//'- "~'- O ~ Signature ~ ~q. ~ Name Donna M. Mullin Address 134 Sipe Avenue Humanelstown, PA 17036 Telephone ( 717 ) 533-3280 Capacity: Personal Representative X Counsel for Personal Representative REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-1500 INHERITANCE TAX RETURI RESIDENT DECEDENT OFFICIAL USE ONLY Iq- 5" FILE NUMBER 21-02-0340 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Alleman Patricia K. 186-34-2508 E C E D E N T DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-OD-YEAR) 03/24/2002 03/17/1941 (IF APPLICABLE) SURV VING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CAPB HpRL EpIO cRAC ~oTK " ES cg THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 4. Limited Estate · Future lnterest Compromise (date of death after lZ-1Z-8Z) 6. Decedent Died Testate Decedent Maintained a Living Trust 0 (Attach copy of Will) (Attach copy of Trust) ~ 9. Litigation Proceeds Received ~ 10. SpousaIPoverty Credit [----] (date of death between 12-31-91 and 1-1-95) NAME Donna M. Mullin Esq. FIRM NAME (If Applicable) JAMES, SMITH, DURKIN TELEPHONE NUMBER 717/533 -3280 & CONNELLY, LLP 2. 3. 4. R 5. E C A 6. P T U 7. L A T 8. I O 9. N 10. 11. 13. 14. C O M T I O N Real Estate (Schedule A) (1) Stocks and Bonds (Schedule B) (g) Closely Held Corporation, Partnership or (3) Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11 ) (date.of death 3. Remainder Return prior to 1Z-13-8Z) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 134 Sipe Avenue Hummelstown, PA 17036 123,610~.~'0 OFFICIAL USE ONLY 6,334 ;/25 None None 22,947.66 None 138,829.04 16,506.93 14,760.27 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate (8) 291,720.95 (11) 31,267.20 (12) 260,453.75 (13) (14) 260,453.75 X .0 0 (15) 260,453.75 X .0 45 (16) 11,720.42 X .12 (17) X .15 (18) 19. Tax Due (19) 11,720.42 Copyright (c) P000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 409 Mt. Allen Drive CITY Mechanic sbur~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) ;). Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty STATE ?A ZIP 17055 (1) 11,720.42 586.02 Total Credits ( A + B + C ) (2) 586.02 11,134.40 11,134.40 Total Interest/Penalty ( O + 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) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 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. retaintheuseorincomeofthepropertytransferred; ......................... ~ ~ 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? ;). If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ ~ ~] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r~ ~ 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. SIGNATURE OF PERSON RESPONSIBLE FOR F~LING RETURN Michael E. Alleman __ _5_2_ _u_ _o _d_ .......................... Mechanicsbur~, PA 17055 JAMES, SMITH, DURKIN & CONNELLY, LLP SIGNATURE OF PREPA'i~F'ER OTHER THAN REPRESENTATIT~[' DATE DATE ' Hummelstown, PA 17036 .................... 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. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [7;) P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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. 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 7;) P.S. 9116(1.2) [7;) 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. Copyright (c) Z000 form software only The Lackner Group, inc. Form REV-1500 EX (Rev. 6-00) REV- 150Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Patricia K. Alleman SS~ SCHEDULE A REAL ESTATE 186-34-2508 03/24/2002 FILENUMBER 21-02-0340 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Real Estate situate at 409 Mount Allen Drive, Upper Allen Township, Mechanicsburg, Cumberland County, Pennsylvania - County Assessed value VALUE AT DATE OF DEATH 123,610.00 TOTAL (Also enter on line 1, Recapitulation) 123,610.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX {Rev. 1-97) REV- 1503 EX + (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Patricia K. Alleman SS# 186-34-2508 03/24/2002 21-02-0340 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNITVALUE OF DEATH 1 481.148 shares American Express Account #01315111506 8.01 3,854.00 3 002; Mutual fund in decedents name individually; Opened 6/1998; beneficiaries are three children in equal shares 2 281.207 shares American Express - Account #01435111506 8.82 2,480.25 9 002; Mutual fund in decedents name individually; Opened 6/1998; beneficiaries are three children in equal shares TOTAL(Alsoenteronline2, Recapitulation) 6,334.25 (If more space m needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-I$03 EX (Rev. 1-97) REV- 1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Patricia K. Alleman SS# 186-34-2508 03/24/2002 21-02-0340 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F, ITEM NUMBER 1 2 3 4 5 6 7 DESCRIPTION 2001 PA Department of Revenue - income tax refund Bookspan - disablity pay deposited after death Bookspan - Medical insurance premium refund Hartford - Disability check received after death IDS Life Insurance Company - home care premium refund Ohio Casualty Group - auto insurance premium refund PNC Bank - Certificate of Deposit #21001029662; Opened 4/15/1995 held in decedent's name individually Accrued interest on item 7 to date of death 1999 Pontiac Grand Am - Kelly Blue Book Trade In Value VALUE AT DATE OF DEATH 109.00 107.50 108.72 615.30 1,302.12 80.43 15,000.00 24.59 5,600.00 TOTAL (Also enter on line 5, Recapitulation) $ 22,947.66 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Patricia K. Alleman SS# 186-34-2508 03/24/2002 21-02-0340 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFERE~THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 American Express - Account 55,181.44 55,181.44 #93003115768 6 004; Annuity decedent's name individually; Opened 6/1998; Primary beneficiaries are three children in equal shares 2 American Express Account 29,245.86 29,245.86 #93004079545 6 004; Annuity decedent's name individually; Opened 6/1998; Primary beneficiaries are three children in equal shares 3 American Express Account 2,854.14 , 2,854.14 #93106564253 6 004; Annuity decedent's name individually; Opened 6/1998; Primary beneficiaries are three children in equal shares 4 Bookspan - 401(k) Savings 47,292.01 47,292.01 Plan death benefit to non-spousal beneficiaries, all sons to share equally 5 PNC Bank - Checking Account 2,164.64 100.00~ 3,000.0£ #5001870799; Ownership established 3/20/2002; held jointly with son, Michael Alleman but created within 1 year of death from an account held in decedent's name individually 6 PNC Bank Savings Account 4,255.59 4,255.59 #5030076906; Ownership established 3/20/2002; held TOTAL(AIsoenteronline7, Recapitulation) $ 138,829.04 (If more space ms needed, insert additional sheets of the same s~ze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) Estate of: Patricia K. Alleman Soc Sec #: 186-34-2508 Date of Death: 03/24/2002 Continuation of Schedule G (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property Date of Death % Decd Exclusion Taxable Value # Value of Asset Intrst jointly with son, Michael Alleman but created within 1 year of death from an account held in decedent's name individually REV- 1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Patricia K. Alleman SS~/ 186~34-2508 03/24/2002 21-02-0340 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 2 3 4 5 FUNERALEXPENSES: Cumberland Valley Memorial Garden ~ Memorial First Christian Church - funeral service JoAnn Haubert, Caterer - funeral service Myers Funeral Home, Inc. funeral home bill ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Attorney's Fees JAMES, SMITH, DURKIN & CONNELLY, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Timothy L. Alleman Street Address 409 Mt. Allen Drive City Mechanicsbur~ State PA Zip 17055 Relationship of Claimant to Decedent S on Register of Wills Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal - estate notice Recorder of Deeds Filing fee for Disclaimer Recorder of Deeds Filing fee for Deed Reserve for additional administration expenses The Patriot News - estate notice 2,444.00 150.00 130.00 7,304.00 2,000.00 3,500.00 255.00 75.00 14.00 26.50 500.00 108.43 TOTAL (Also enter on line 9, Recapitulation) $ 16,506.93 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1511 EX (Rev. 1-97) Estate of: Patricia K. Alleman Soc Sec #: 186-34-2508 Date of Death: 03/24/2002 Continuation of Schedule H-B2 (Attorney's Fees) Item Description Amount James, Smith, Durkin & Connelly, LLP - Attorney fees 2,000.00 2,000.00 Estate of: Patricia K. Alleman Soc Sec #: 186-34-2508 Date of Death: 03/24/2002 Continuation of Schedule H-B4 (Probate Fees) Item Description Amount 1 Register of Wills probate fee 255.00 255.00 REV-151Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES[DENT DECEDENT ESTATE OF Patricia K. Alleman SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 186-34-2508 03/24/2002 FILE NUMBER 21-02-0340 Include unreimbursed medical expenses. ITEM NUMBER 3 4 5 6 7 8 9 10 Copyright (c) 1996 form software only CPSystems, Inc. DESCRIPTION AMOUNT Bookspan - Medical insurance premium payment (check written prior 108.72 to death but not paid until after death) Greensward Turf Care Lawn care (check written prior to death 41.21 but not paid until after death) Jose E. Misas, M.D. - medical bill 15.00 Jose E. Misas, MD - bill 44.65 Marlin A. Yohn, Sr. Treasurer - 2002 County Real Estate Taxes 300.42 Marlin A. Yohn, Sr. Treasurer - 2002 Per Capital Taxes (check 9.80 written prior to death but not paid until after death) Pinnacle Health Hospitals medical bill 25.00 Pinnacle Health Hospice - final payment 300.00 PNC Bank Bank Mortgage #40 01 0008108759080; held in decedent's 13,813.69 name individually U.S. Bank Credit card payoff check (check written prior to 101.78 death but not paid until after death) TOTAL (Also enter on line 10, Recapitulation) $ 14,760.27 (If more space is needed, inse~ add~ional sheets of the same size) Form REV-1512 EX (Rev. 1-9~ REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIAR lES {NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Patricia K. Alleman SS~/ 186-34-2508 03/24/2002 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116~1.Z)] Bradford J. Alleman 300 Manchester Road Camp Hill, PA 17011 NUMBER II. Michael E. Alleman 1152 Rossmoyne Road Mechanicsburg, PA 17055 Timothy L. Alleman 409 Mt. Allen Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son S on Son FILE NUMBER 21-02-0340 AMOUNT OR SHARE OF ESTATE 1/3 of residue 1/3 of residue 100% of real estate and 1/3 of the residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 (If more space is needed, insert additional sheets of the same size) Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) T.AMT T~FrT.I'. ~ TESTA~ OF PATI~ICIA K. AT.T.'ISfA'~ I, PATILICIAK. ATJ.EMAN, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my three (3) sons, to wit, 14IC~A~. E. B]IAI)FOPd) J. AT.T.~4AN and TI~OTMY L. AT.T.I~MA~, share and share alike, per stirpes. For the purpose of facilitating the settlement and distribution of my estate, I authorize and empower my Executor, hereinafter named, to sell any and all real estate which I may own at the time of my decease, as well as my personal property, at either public or private sale or sales. -1- T.ARTLY, I nominate, constitute and appoint my son, ~IUMA~. E. AIJ.~AN, Executor of this,, my Last Will and Testament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, BP, ADFORD J. AIJ.~N~, Executor of this, my Last Will and Testament, in his place and stead. this IN WITNESS, W~R~.OF, I have hereunto set my hand and seal ./,~--~ day of August, A. D. 1989. Patricia K. Alleman Signed, sealed, published and declared by the above-named PATRICIA K. AIJ.~AN, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence~of each other, have hereunto subscribed our names as wit- nesses. -2- COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBEP~AND ) SS. I, PATILICIAK. ALLEMAN , the testat rix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. day of Sworn and affirmed to and acknowledged before me by PA~I~C~AK, ATJ.RMAN , the testa~ix , this 15th Ausust , A. D. 1989. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) 'SS. NOTARIAL SEAL NARY S. It#INSOtl, NeTARY PUBLIC M£CNANICSBURG B~RO. *CLMBERLAND CO. Cemnlsston Exptr~s Sept. 21, 19~1 We, the undersigned, J. ROBEI~T STAUFFER and JO~N ~. EA~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat rix , PATILICIAK. ALL~ , sign and exe- cute the instrument as b~her Last Will and Testament; that the said testat rix , PA_TRICIAK. AT~.~A~ , executed it as h~her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix , signed the Will as witnesses; and that to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribed to befor .... me this ~ day of [f I ~ August , 1989. NOTARIAL SEAL MARY $. RIIIN~I#. NeTARY PUBLIC MECNANICSBURG #R0. CiJI4DEIU.AND CO. Cmmntsstmn Exptt-es Sept. 21, 1~J1 -3- 05/13/2882 1~:32 7174329214 AMERICAH EXPRESS PAGE AMERICAN EXPRESS FINANCIAL ADVISORS INC SUITE 101 11 TRIPLETT COURT DILLSBURG PA 17019-9490 717/432-7722 To: From: Date: Page(s) including cover sheet: NOTES: Fax fl 717/432-9214 05/13/2~2 10:32 717~32921~ AMERICAN EXPRESS PAGE May 7, 2002 IDS LiFE IN$1JI~NCE COMPANY AMERICAN F. XPRESS FUNDS AMERICAN EXPRESS CERTPFICATI~ COMPANY AMERICAN EXPRESS BROKE~GE 7Olag ~p Financial Center DORIS E BKYTZ 1 t TKIPLI2TT COUKT SUITE DTLLSBUKG, PA 1701%9490 Dour DORIS i BKYTZ: Thatk you fur your recent inquiry ~gardinl~ PATRICIA K ALI,,EMAN's accounl~. These the valuus o1' The accounl, ~ of 03/24/2002. Mutual Funds ~c.._collllt Ntu:~l~,_r ~otal Valu~ # of ill,rea Ass, t Value Per Share 01315111506 3 002 $~4.~ 481.1 g,O]O 01435111 ~06 9 002 $2480.25 281.207 8.820 Annuiti~ - Post 1985 ~q~n~Number Total Valu~ 93003115768 6 004 $$5151.44 930.1~4079545 0 004 $29245.8 93106564253 6004 $2854.14 Life InSurance Account Ngmber Total Value 90906201917 1, 004 $186210.00 Please aotc that the values indicated £or any Life l~tlrance product(s) ~flect ~c gross death benefit at ~tc or dcatlh not ~c cash val~. Thc da~ of~a~ valu,~ pwvi~d ar~ for csmm tax pu~oses a~d a~ not n valuu to be pMd. Accouats may bC subject m market fluc~ation al govemed by each product, Wc apprecla~, the ~l~portuaity to btl ofselwiee to you. l~teas, contact us if you have any questions, Sincerely. Kflatal Miller 70'f 10 AXP Finaa¢tal Center Minn~apulia, MN ~7474 }asued by iDS I.Jf~ tneure~lce ~ro~rage is pr~i~o~ ~y Anle~an Express ~nnncl~l Advlsor~ ~m. a broke~alcr. 05/13/2002 10:32 717432921~ ~M£RIC~N EXPRZSS P~E 02 Beneficiary Information Account Number: o,37s.~o~ ~ oo~ Designation: PR1MA~Y BENEFICIARY LIVINg, LAWFUl, CHILDREN IN E~UAL ~HARES 100,~% LIVING, LAW~L ~LDREN IN E~UAL SMA~Es Account Number; o~ DeslgUatlon: PRIMARY BEN£F1CIARY LW1NG, LAW,WI. ~ILDR~N IN E~UAL $~ARES 100.00~ LIVING, LAWFU~ CH1LDREN IN E~UA1. A~.cotmt Number: Designation: PRIMARY' BENEF/CIARY T~MO'D,I¥ ALL£MAN qON M1 ~"HAEL ALLI?MAN SON BRADFORD ALL£MAN SON £O. UALI.¥, nE SURVrVOR$ I~'O. UALLY~ OR T~q£ SURVIVOR Acoount ~umber; 9,~004~79545 0 004 Desl~nation: L1VIN~, kAbUL ~/LDREN IN B~UA~ 5~ARES MICNAEk E ALLEMAN ~ILD B~DFORD J ALLEMAN ~/LD ~MO~Y L ALL~N CHILD Accost Number: Desi~atiom PR/MARY B~NEFICIARY ~MO~Y ALL,MAN SON M~AEL ALLE~N SON BRADFORD ALLE~N SON ~UA~LY~ ~E SURVIVORS E~UALLY, 100.00% PNCBAN April 17, 2002 /SCP James, Smith, Durkin & Connelly LLP Law Offices PO BOX 650 Hershey PA 17033 Estate of Patricia K Allernan, deceased SSN: 186-34-2508 DOD: 03/24/2002 Dear: Ms. Galley: In response to your request for Date of Death balances for the customer noted above, our records show the following. CERTIFICATE OF DEPOSIT #21001029662 PATRICIA K ALLEMAN DOD Balance: $I 5,000.00 + $24.59 accrued interest Interest Paid 01/01/02-03/24/02.$245.96 Established 04/I 5/1995 CHECKING ACCOUNT 05001870799 PATRICIA K ALLEMAN MICHEAL ALLEMAN DOD Balance: $2,164.60 + $0.04 accrued interest Interest Paid 0 l/01/02-03/24/02-$0,00 Established 03/20/2002 SAVINGS ACCOUNT #5030076906 PATRICIA ALLEMAN MICHEAL ALLEMAN DOD Balance: $4,254,91 + $0.68 accrued interest Interest Paid 01/01/02-03/24/02-$4.36 Page 1 of 2 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenuc Pittsburgh P{mnsyivania 15222 2707 .Established 03/20/2002 16:36 PNCBANK CI¥ DEPMRIMENI 412 705 085? P.02×02 PNCBAN Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not .process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888.PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Marian Donnelly 1-800-762-1775 P7-PFSC-04-F 500 First Avenue Pittsburgh, PA 15219 Page 2 of 2 A member of The PNC Financial Serviee~ Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pennsylvania 15222 2707 TOTAL P.02 bo n 1225 South Market Street Mechanicsburg PA 17055 (717) 697-0311 April 25, 2002 Ms. Stephanie L. Gaffey James Smith Durkin & Connelly LLP P. O. Box 650 Hershey, PA 17033 RE: PATRICIA K. ALLEMAN Dear Ms. Oaffey: Attached is a copy of Ms. Alleman's 401(k) Statement as of March 24, 2002. I have requested a pension value as of the same date for the AOL Time Warner Pension Plan. If you have any questions, please contact me at (717) 795-1408. Sincerely, Maria G. Huelin Assistant Director, Human Resources attachment · ,Fidelity Investments Page 1 of 4 Bookspan 401(k) Savings Plan PATRICIA K ALLEMAN 409 MT. ALLEN DRIVE MECHANICSBURG, PA 17055-8618 Retirement Savings Statement ~ Customer Service: (800) 835-5095 Fidelity Investments Institutional Services Co. 82 Devonshire Street Boston, MA 02109 Your Account Summary Beginning Balance Ending Balance Additional Information Vested Balance Statement Period: 3/24/2002 to 3/24/2002 $47,292.01 $47,292.01 $47,292.01 Your This Period 0.0% Your Personal Rate of Return is calculated with a formula widely used by financial analysts to calculate the investment eamings of a portfolio. It reflects the results of your investment selections as well as any activity in the account. There are other Personal Rates of Return formulas used that may yield different results. Remember that past performance is no guarantee of future results. Your Asset Allocation Statement Period: 3/24/2002 to 3/24/2002 · Stock Investments *$38,552.81 (81.52%) · Bond Investments - $4,715.69 (9.97%) · Blended Fund Investments o $4,005.44 (8.47%) · Short Term Investments o$18.07 (0.04%) ~~~/s~d-detai~~htm?s~dReq~ndicat~r=HACK&m~nth-req=~&quarter-req=~&peri~d=D&day-req-4/25/~2 Fidelity Investments Page 2 of 4 Your account is allocated among the asset classes specified above as of 3/24/2002. Percentages and totals may not be exact due to rounding. The Additional Fund Information section lists the underlying allocation of your blended funds. Market Value of Your Account Statement Pedod: 3/24/2002 to 3/24/2002 Displayed in this section is the value of your account for the statement period, in both shares/units and dollars. Shares/Units Shares/Units Price Price Market Value Investment as of as of as of as of as of 3/23/2002 3/24/2002 3/23/2002 3/24/2002 3/23/2002 Market Value as of 3/24/200'~ Stock Investments $38,552.81 $38,552.81 COMPANY STOCK AOL Time Wamer STK 1,108.206 1,108.206 $30.65 $30.65 $33,966.52 $33,966.52 LARGE CAP Fidelity Equity INC 91.415 91.415 $50.17 $50.17 $4,586.29 $4,586.29 Blended Fund Investments Fidelity Balanced 265.261 $4,005.44 $4,005.44 265.261 $15.10 $15.10 $4,005.44 $4,005.44 Bond Investments $4,715.69 $4,715.69 STABLE VALUE FID MGD INC Port 4,715.690 4,715.690 $1.00 $1.00 $4,715.69 $4,715.69 Short Term Investments Fidelity RET Govt MM $18.07 $18.07 18.070 18.070 $1.00 $1.00 $18.07 $18.07 Account Total $47,292.01 $47,292.01 Remember that a dividend payment to fund shareholders reduces the share price of the fund, so a decrease in the share price for the statement period does not necessarily reflect lower fund performance. You have invested a portion of your account in Blended Funds. Blended Funds generally invest in a mixture Of stocks, bonds. and short-term investments, blending long-term growth from stocks with income from dividends and interest. Please refer to the Additional Fund Information section to see how your blended funds are allocated across the three asset classes. Your Contribution Elections This section displays the funds in which your future contributions will be invested. As of 4/25/2002 A..!.!....E.!.igible Sources Investment Option s. .... Stock Investments Large Cap FIDELITY EQUITY INC Blended Fund Investments FIDELITY BALANCED Short Term Investments FIDELITY RET GOVT MM Percent 30% 3O% 4O% ~~~/s~d-detai~~htm?s~dReqIndicat~r=HACK&m~nth-req=~&quarter-req=~&peri~d=D&day-req 4/25/02 , ,Fi6elity Investments Page 3 of 4 100% Total Your Contribution Summary Contributions Statement Period: 3/24/2002 to 3/24/2002 Before Tax Company TESOP Paysop/wci Contributions Matching Contrib ESOP Period to date Total Account Balance Total Vested Balance $0.00 $0.00 $0.00 $0.00 $16,912.14 $11,425.72 $14,224.85 $4,729.30 $16,912.14 $11,425.72 $14,224.85 $4,729.30 Your Account Activity Statement Period: 3/24/2002 to 3/24/2002 Use this section as a summary of transactions that occurred in your account during the statement period. i~lDetailed Transaction History Activity AOL Time Fidelity Equity Fidelity Balanced Fidelity RET Govt Warner STK INC MM Beginning Balance $33,966.52 $4,586.29 $4,005.44 $18.07 Ending Balance $33,966.52 $4,586.29 $4,005.44 $18.07 FID MGD INC Total Port Beginning Balance Ending Balance $4,715.69 $47,292.01 $4,715.69 $47,292.01 Your Account Information As of 04/24/2002 GENERAL INFORMATION Participant Status Participation Date Deceased Termination Date 01/05/2001 01/01/1988 Additional Fund Information Use this section to determine the asset allocation of your blended investments. Blended Investment Stocks Bonds As of 4/25/2002 Short Term FIDELITY BALANCED 60.00 % 40.00 % 0.00 % Blended investments generally invest in more than one asset class. The blended investment asset allocation above reflects the stated neutral mix or, if not available, the asset mix reported by Momingstar, Inc. for mutual funds or by investment managers for non-mutual funds. ~~~/s~d-detai~~htm?s~dReq~ndicat~r=HACK&m~nth-req=~&quarter-req=~&peri~d=D&day-req 4/25/02 , ,Fielelity Investments Page 4 of 4 **IMPORTANT P'Ri'I~Ti-N'~; INsTRLi'~:-~:'i'~NS** ........................... In order to print this statement, click anywhere on this statement screen and then press the print button in your browser. ~~~/s~d-detai~~htm ?s~dReq~ndicat~r=HACK&m~nth-req=~&quarter-req=~&peri~d=D&day-req 4/25/02 ,-\OI, Ti2.EE WA P,_NER PENSION SERVICE CENTER P.O. Box 55'i549 .jncksom'itlc, Fi. 32255-1549 AOL Time Warner To: Michael Alleman - From: Leanna Hicks Fax: 717-533-27@5 Pages: 1 Phone: 717-533-3280 [~te: June 10, 2002 Re: Alleman CC: Michael Alleman [] Urgent [] For Review L_~ Please Comment [] Please Reply [] Please Recycle · Comments: Mr. Alleman: As you requested, below is the value of the benefit bat would have been payable to Patricia Alleman at her date of death. Also included is the value of Patricia Alleman's benefit that would have been payable if she had elected a 50% Joint and Survivor option. Please note the only benefit payable from the plan is the 50% Joint and Survivor option. Participant's immediate monthly Single Life Annuity: $403,53 The present value of $403.53 is $61,068.33 based on a plan rate of 5.12% Participant's immediate monthly benefit based on the 50% Joint '~, Survivor Option: $301.44 Benefic~ary's immediate monthly benefit: $150.72 The present value of $301.44 is $45,618,51 based on a plan rate of 5.12%. The present value of $150.72 is $32,472.11 based on a plan rate of 5.12%. Should you have any questions you may reach me at: 1-877-553-1241. Leanna Hicks ESTATE OF PATRICIA K. ALLEMAN, deceased COPY : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : : ESTATE NO.: 2002-00340 DISCLAIMER and RENUNCIATION WHEREAS, Patdcia K. Alleman died on March 24, 2002, a resident of Upper Allen Township, Cumberland County, Pennsylvania. WHEREAS, Patricia K. Alleman died testate and her Last Will and Testament dated August 15, 1989, was accepted for probate and Letters Testamentary were granted to Michael E. Alleman on April 3, 2002. WHEREAS, Patricia K. Alleman died seised of a parcel of land and premises, situate at 409 Mt. Allen Drive in the Township of Upper Allen in the County of Cumberland and the Commonwealth of Pennsylvarfia, being the same premises which Robert A. Munson, widower, by his deed dated June 12, 1990 and recorded July 19, 1990 in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Deed Book R, Volur~e 34, Page 4~.~, granted and conveyed to Patdcia K. Alleman. WHEREAS, the above described real estate, being the decedent's residence, is not specifically bequeathed in the decedent's Last Will and Testament. WHEREAS, pursuant to Article Two of decedent's Last Will and Testament, the above described real estate, but for this disclaimer, would pass in equal shares as part of the residue of the decedent's estate to the residuary beneficiaries, decedent's three children, Michael E. Alleman, Bradford J. Alleman, and Timothy L. Alleman, per stirpes. WHEREAS, all of the residuary beneficiaries are adult individuals and have survived the decedent. WHEREAS, less than nine (9) months have elapsed since the date of death of Patricia K. Alleman and the undersigned disclaimants have not exercised any control as beneficial owner over the above described real property or any interest therein. WHEREAS, the 'Disclaimants acknowledge that the effect of the execution of this Disclaimer and Renunciation is that the said real property that otherwise would have passed in equal shares to all three residuary beneficiaries will now pass solely to TIMOTHY L. ALLEMAN and any other property comprising the residue of the estate of Patricia K. Alleman, if any, is not the subject of this disclaimer and will pass equally to the three residuary beneficiaries NOW, THEREFORE, we, MICHAEL E. ALLEMAN, an adult beneficiary residing at 1152 Rossmoyne Road, Mechardcsburg, PA 17055 and BRADFORD J. ALLEMAN, an adult beneficiary residing at 300 Manchester Road, Camp Hill, PA 17011, do hereby exercise the 'rights granted to us in the Pennsylvania Probate, Estates and Fiduciaries Code, 20 Pa. C.S.A. §6201 et seq., to DISCLAIM AND RENOUNCE our respective one-third interests in the above described real estate under the Last Will and Testament of Patricia K. Alleman, and we do hereby disclaim and renounce all right, title and interest to the real estate situate at 409 Mt. Allen Drive, Upper Allen Township, Cumberland County, Pennsylvania. Said one-third interests each had a value of $41,203.33 as of the date of death of Patricia K. Alleman. As a consequence of 2 this instrument, said one-third interests shall now pass to Timothy L. Alleman in accordance with the Last Will of Patricia K. Alleman. IN I~?ITNE$S I~IEREOF, intending to be legally bound hereby, we have hereunto set our hands this ...~0"J~day of May, 2002. WITNESS: MICHAEL E. ALLEMAN 3 COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF DAUPHIN ) SSi this, the ~lj' day of //(~f , 2002, before me, a Notary Public in and for the Commonwealth of Pennsylvania, the undersigned officer, personally appeared MICHAEL E. ALLEMAN and BRADFORD J. ALLEMAN, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. Pfiblic - -- My Commission Expires: 4 Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Patricia K. Alleman also known as , Deceased No. 2002-00340 Date of Death 03/24/2002 Social Security No. 186- 34- 2508 Michael E. Alleman, 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 of the 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 this Inventory. I ANe verify that the statements made in this Inventory are true and correct. I/VVe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Donna M. Mullin Esq. I.D. No.: 30392 Address: 134 Sipe Avenue Hummelstown, PA 17036 Telephone: 717/533- 3280 Personal Representative Signature: ~ Mic] Alleman Signature: Address: 1152 Rossmoyne Road Mechanicsbur~, PA 17055 Telephone: 717/795-8928 Dated: Description (See continuation page(s) attached) (Attach additional sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the electior include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Value Total: 152,891.91 of the personal representative, Form #RW-7 (199z) Estate of: Date of Death: County: INVENTORY Patricia K. Alleman 03/24/2002 Cumberland CASH: 2001 PA Department of Revenue income tax refund Bookspan - disablity pay deposited after death Bookspan - Medical insurance premium refund Hartford - Disability check received after death IDS Life Insurance Company home care premium refund Ohio Casualty Group - auto insurance premium refund PNC Bank - Certificate of Deposit #21001029662; Opened 4/15/1995; held in decedent's name individually Accrued interest through date of death 109.00 107.50 108.72 615.30 1,302.12 80.43 15,000.00 24.59 17,347.66 -1- PERSONAL PROPERTY: 1999 Pontiac Grand Am - Kelly Blue Book Trade In Value 5,600.00 STOCKS/LISTED: 481.15 shares American Express Account #01315111506 3 002; Mutual fund in decedents name individually; Opened 6/1998; beneficiaries are three children in equal shares 281.21 shares American Express Account #01435111506 9 002; Mutual fund in decedents name individually; Opened 6/1998; beneficiaries are three children in equal shares 3,854.00 2,480.25 5,600.00 REAL ESTATE/PA: Real Estate situate at 409 Mount Allen Drive, Upper Allen Township, Mechanicsburg, Cumberland County, Pennsylvania - County Assessed value 123,610.00 6,334.25 123,610.00 TOTAL RECEIPTS OF PRINCIPAL ............... 152,891.91 -2- 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 NO. REV-1162 EX(11-96) CD 001323 DONNA M MULLIN ESQUIRE 134 SIPE AVENUE HUMMELSTOWN, PA 17036 fold ESTATE INFORMATION: SSN: 186-34-2508 FILE NUMBER: 2102- 0340 DECEDENT NAME: ALLEMAN PATRICIA K DATE OF PAYMENT: 06/21/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/24/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $11,134.40 TOTAL AMOUNT PAID: $11,134.40 REMARKS: MICHAELEALLEMAN C/O DONNA M MULLIN ESQUIRE SEAL CHECK# 97 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERXTANCE TAX DTVXSXON DEPT. 180601 HARRTSBURG, PA 1711B-060! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15¢? EX AFP (01-02) DONNA H MULLIN ESQ JAMES ETAL 154 SIPE AVE HUMMELSTOWN PA DATE 08-05-2002 ESTATE OF ALLEMAN DATE OF DEATH 05-24-2002 FILE NUMBER 21 02-0540 COUNTY CUMBERLAND ACN 101 Amount RemJ. tted PATRICIA K MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ALLEMAN PATRICIA K FILE NO. 21 02-0540 ACN 101 DATE 08-05-1002 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATTON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schadula B) (2) 3. Closely Held Stock/Partnarship Interest (Schedule C) (3) q. Hortgagas/Notas Racaivabla (Schedule D) (4) E. Cash/Bank Daposits/Hisc. Personal Property (Schedule E] ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilltles/Liens (Schedule I} (10) 11. Total Deductions 12. Net Value of Tax Return 125z610.00 6/$$4.25 O0 O0 22/947.66 O0 158/829.04 (8) 291,710.95 16,506.95 NOTE: To insure proper credit to your account, submit the upper port/on of this form with your tax payment. 15. 14. NOTE: 14,760.Z7 (11) 3] .267.20 (12) 260,455.75 Charitable/Govarnmental Bequasts; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Sub~ect to Tax (14) Zf an assessment Nas issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 260,455.75 ASSESSMENT OF TAX: 15. Amount of L~ne 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 16. Amount of Line 14 taxable at Collateral/Class B rate 19. Princi)al Tax Due TAX CREDITS PAYHENT RECEIPT DZSCOUNT DATE NUMBER /NTEREST/PEN PAID (-) 06-21-2002 CD001525 586.02 18 and 19 will [F PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (16) .00 x O0 = .00 (16). 260,455.75 x 045= 11,720.4Z (17), .00 x 12 = . O0 (~8), .00 x 15 = .00 (19)= 11,720.42 ANOUNT PAZD 11,134.40 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 11,720.42 .00 .00 .00 ( IF TOTAL DUE ZS LESS THAN $1) NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: PATRICIA K. ALLEMAN March 24, 2002 Will No. Admin. No. 2002-00340 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: State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: o 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 X b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: Capacity: Signature Donna M. Mullin. Esquire JAMES. SMITH, DURKIN & CONNELLY 134 Sipe Avenue Hummelstown, PA 17036 (717) 533-3280 X __ Personal representative Counsel for personal representative