HomeMy WebLinkAbout02-0397
21-02-0397
Law Offices of
FARRELL & SMALL
MICHAEL H. SMALL
JOSEPH MICHAEL FARRELL
201/203 South Roilrood Street
PO. Box 113
Palmyra, Pennsylvania 17078-0113
717-838-1385
717-534-294B
FAX 717-838-7215
April 16, 2002
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Cumberland County Register of wills
Attn: Cheryl
Cumberland County Court House
One Court House Square
Carlisle, PA 17013
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In reo
Evelyn Ruth Fortney, deceased
Inheritance tax deposit
Dear Cheryl:
In regard to the above-captioned Decedent, you will find
enclosed herewith my Escrow Check No. 11467 payable to the
"Register of wills, Agent" in the amount of $30,000.00. This is
submitted as a deposit payment on the anticipated inheritance tax
liability. To record this payment within the discount period, I
am requesting that the postmark date of April 16, 2002 be noted
as part of the procedure for your receipt and processing of this
payment. Also, I have enclosed a copy of the check which I am
requesting that you please clock-stamp and return to me in the
enclosed self-addressed, stamped envelope.
For your records, I have also prepared, signed and enclosed
an Estate Information Sheet. To supplement the information on
that sheet, please note that the Decedent, at the time of death,
was a resident of 124 Clark Street, in the Borough of Lemoyne,
Cumberland County.
Thank you for your assistance in this matter!
Very truly
Michael H. Small, Esquire
MHS/pab
Enclosures
cc: G. Phyllis Stoner
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1 162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SMALL MICHAEL H ESQ
POBOX 113
201/203 SOUTH RAILROAD STREET
PALMYRA, PA 17078
______n fold
ESTATE INFORMATION: SSN: 205-09-9134
FILE NUMBER: 2102-0397
DECEDENT NAME: FORTNEY EVELYN RUTH
DATE OF PAYMENT: 04/17/2002
POSTMARK DATE: 04/16/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2002
NO. CD 001081
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $30,000.00
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TOTAL AMOUNT PAID:
$30,000.00
REMARKS: MICHAEL H SMALL ESQUIRE
CHECK# 11467
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
17-S-lS-'<I
'-
REV-1500 EX +(6-00) REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1 - 0 2 0 3 9 7
CO'i:iNTY"'CQij'f-YEAR---N"GM'BEFl--
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- FORTNEY, EVELYN RUTH 2 0 5 - 0 9 - 9 1 3 4
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W OATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Yearl THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
0
W 01/16/2002 08/11/1920 REGISTER OF WILLS
U
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME \LAS1, FIRS1, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
0
N/A - -
w ~ ,. Or~inal Return o 2. Supplemenlel Return o 3. Remainder Retum (date afdeatJ'IMiQI m 12-1:)-B2}
...
~.:!(/.l o 4, Limited Estate o 4a. Future Interest Compromise (dateofdeat.ll'-1Z-12-8Z} o 5. Federal Estate Tax Return Required
0"'''
w&g o 6_ Decedent Died Testate (Attach co~y ofWdl) o 7. Decedent Maintained a Living Trust (AthlCh copyofTrust) 1
""'''' 8. Total Number of Safe Deposit Boxes
00.10
0. o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit(daleOfdealhbeWteel\12-3H1llfld1.1-\l5) o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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... THIS SECTION MUS" aE COMPLETE!). ALL CORRESPONDENCE AND CONFIOENTIAl.TAl< IHFORMA,.1ON SHOULD BE DIRECTED TO:
z NAME COMPLETE MAILING ADDRESS
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Q MICHAEL H. SMALL, ESQUIRE 201 South Railroad Street
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Q FIRM NAME (It Applicable)
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w FARRELL & SMALL P.O. Box 113
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'" TELEPHONE NUMBER
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0 717/838-1385 Palmvra - ",- d -:Iii 17078
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t~?,' \ OFFl~QJSE ONLY
1. Real Eslate (Schedule A) (1) f,' C--_ ,
2. Slacks and Bonds (Schedule B) (2) 0.001 ~ , r ,.,. I ~
I I
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) N
..... i ,'.,
4. Mortgages & Notes Receivable (Schedule Dj (4) . --0
I eN ,:,::r
5. Cash, Bank. Deposits & Miscellaneous Personal Property (5) Ui ._~
(Schedule E) -' I 0\
z 239,745.241
0 6. Jointly Owned Property (Schedule F) (6)
5 o Separate Billing Requested I
~ 7. )nter~Vivos Transfers & Miscellaneous Non-Probate Property (7)
I- (Schedule G or L)
a:: 239,745.24
< 8. Total Gross Assets (\olel Lines 1-7) (8)
U 13,960.00
w 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
0:: 1,451.00
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10)
11. Total Deductions (\olel Lines 9 & 10) (11) 15,411.00
12. Net Value of Estate (Line 8 minus Line 11) (12) 224,334.24
13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value SUbject to Tax (Line 12 minus Une 13) (14) 224.334.24
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
/
15. Amount of Line 14 taJl.able at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X (15)
X (16)
X .12 (17)
224,334.24 X .15 (18) 33.650.14
(19) 33,650.14
16. Amount of Line 14 taxable at lineal rate
>. Amount of Une 14 taxable at sibling rate
!\.mount of Line 14 tax.able at collateral rate
lX Due
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CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
> > BE! SURe TO ANSWER Al..L QUe$TtONS ON REVERSE SIDE AND RECHECK MATH < <
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ece en s omDle e ress:
STREET ADDRESS
124 Clark Street
CITY I STATE PA I ZIP
Lemoyne 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discount
(1)
33,650.14
30,000.00
1.578.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
31,578.00
T otallnteresUPenalty ( 0 + E ) (3)
4. If Line 21s 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
2,072.14
65.57
2,137.71
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ,........................................................................., 0 ~
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 ~
c. retain a reversionary interest; or ...................................................................................................... 0 (29
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 ~
2. if death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?............,..,."....,.....,..........". ........."..........".... ,....,.....,........,... 0 ~
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. 0 ~
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .......,.....,...............,...................,...,...........,........,.,.....,.....,.............. 0 ~
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 examlfled 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 koowledge.
SIGNATURE OF ERSO~SPONSIBLE FDR FILING URN DATE
. V -"'\., '" O'~
ADDRESS G. Phyllis Stone
124 Clark Street, Lemo ne, PA 170 3
SIGNATURE OF PARER OTHER THAN RE ATIVE
ADDRESS
~
DATE
(p It- 03
PA 17078
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 orforthe use of the surviving spouse is 3%
[72 PS ~9116 (a) (1.1) (i)]
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (Ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the staMory 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 Juiy 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 oftransters to or tor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in?2 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)J.
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 ieast one parent in common with the deceden1, whether by biood or adoption.
.
COMMoNwEALYH Of PI:N!IlSVI.VANIA.
DE~ARTMEN't Of ~eVetWe
IHMEltI1A.Ha: TAX DWI$\QN
DEPT. 2&0601
H,UR1SIURG, PA, 1"'211.0601 please PI'in', or Typ@
MUST BE COMPLETED BY REPRESENTATIYE OF FiNANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS ,O';ATED AND RETUR~ED TO ABOVE ADDRESS
cOUNTY cQUE fiLE tlUM&Ea SOCIAL SECURITY OR IlEATH CERTIFICATI NUMBER
21 21-02-0397 205-09-9134
DEe 'S NAME ltA;T. 'l~ST, MIDDll1 I!lA 0 D T
FORTNEY, EVELYN RUTH 01/16/2002
ADDRESS Of DECEDENT IETO"'I ICITY) IETAHI
124 Clark Street Lema ne PA
NAME AND ADDRESS Of PERSON REQUESTING THE OPENING Of THE SAFE DEPOSIT BOX
(NAME)
G. Phyllis Stoner
SAFE DEPOSIT BOX
INVENTORY
IEV.AU EX... P-92'1
IlIPCODE)
17043
(StRBBT ADDRESSl ICITY} lET A",) (llHODE)
124 Clark Street Lema ne PA 17043
NAME, ADDRESS AND RBlATlONSHIP (IF ANYI TO DBCEDENT, OF PERSON IS) PRESENT AT THE BOX OPENING
a. (NAME) ~BlATlONS"'1'l
Michael H. Small. Esquire Attorney for Decedent/Estate (non robate
(STREET A.DDRESS) (CITY) {STATEl (X1P CODE'
201 South Railroad Street Palmvra- PA 17078
b. {KAME) I~ELATIOKS"IPI
G. Phyllis Stoner Joint.Ownpr
15TR~ET ADDRESS) (CITY) ($TATEl (ZIP COPE)
124 Clark Street Lemovne' PA 17043
c. INAME) fReLAf10NSM1Pl
ISTREET ADDResSI
(CITY'
!STATE)
(ZIP CODE)
NAME AND ADDRESS OF fiNANCIAL INSTITUTION WHERE THE SAfE DEPOSIT BOX .S LOCATED
INAM')
PNC Bank
tSTUBT ADDRESS] ICITY) (STUB) IZIP CODe)
1104 Carlisle Road PA 17011
NAM' OF P.RSON MAKING lAST ENTRY
Evelyn Ruth ForDne 1 11 lq9q
OAT! Of CONTRACT fO RENT BOX NUMSER OF IlOX finE UNDER WHICH BOX IS REGISTEREb
03/31/1995 107 Evel Ruth Fa
NAME AND ADDRESS Of PERSONlS) HAVlNG ACCESS TO lOX
a. IN~"') . IN'""'I
Evelyn Ruth Fortney G. Phyllis Stoner
(STREFf ADDRESS) ISTREET ADO~ES5)
124 Clark Street 124 Clark Street
ICITY) !STAT'I flIP CODE) ICITy! ISTATE) (ZIPCODE)
Lemoyne PA 17@4B Lemo ne
NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
Michael H. Small, Esquire - Attorney for Decedent/Estate (non-probate)
WAS A WILL IN THE BOX? DYES JOtlo II V.,, a. Oat..1 will,
b. Name alld a~clrlll& 4If ptlftonal f!R9rfiQl\tGn..,t, tf' ftCHn41d in "he wi"
INAME)
(S'fRr:~ ADOItESS}
(CITVI
fSTATEI
IZIPCODOI
C. N4i'fII" and Clddress of ."'meY1 If ony
fNAM"
Isrom ADORnSl
IClTY)
ISTATE)
{ZIP CODE}
Pege of
. SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stacks: List in detail every common or preferred (ertifi(:tlt9~ warrant _ or oth~!r rights found in box_ Stocks are
to be designtlted by name of company. c:ertifkota numbe.r, dote of certificQte, nome in which !.to~k is registeredl
ond !'lumber of shores ond class of stock.
(31 Obllgatio",s of U. S. Govetnme-nh Number of itam~... date of issue, face value, nome, in ~,1hich registered
Clnd type of ownership, i.e., jointly held, payable on death, etc. .
(4) Bonds: Designate by nome, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: Slate nome of depositor, numb.r of book, la,t dole appearing in
book, nome of bonk and branch, and balance.
(6) Jewelry,Coi"" Stamp., Manus.ripts, etc: Li,t ond describe os fully os po;sible,
(7) DllIllId., Mortgag"s, Current Insurance Polleles or other IlIvidenc..s of indebtedness: Li,t" nel describe as
fully as possible.
[8} All other contenlo.
ITEM
1>10.
, ITEM DESCRIPTION
8 On 3/15/2002, the Decedent's jointly-rented Safe Deposi~ Box as
described on nane 1 was inventorierl "'100 "'~V "l"" r"nT"" ~n"
registered by the Decedent and G. Phyllis Stoner, who was the
ioint tenant sole benefici"rv and do .~ ~ ...Ex"""Tri x ,,~~ +-10=
Decedent. However, no probate proceeding was required. Attached
hereto as Exhibit "A" is a copy of the "File Memo" dated 111/'~/?1111?
which details each. and evervj T.em ~om~uorl "~~m .1il:li -Ill 117 l-,u +-100
undersigned.
.
.
.
.
..
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1 CEWTIFY UNDEW PENAlT'/ OF JURY THAl THE A80VI RECORD IS PER$Q.,!. RE~!,YING COF.Y OF
CORR CT AND COMPLETE TO am'OF MY K E AND WHI.F. SAFE DEPOSIT 1I0X INVENTORY,
Y JJl- liE // r SlG~TU'E (' - }",' <;, ..' c,"~
/;', ..J...._ n "-?> ~\,~ ^ T:'i'T
, ( I E PRINT NA.ME ANO CHECK j~,:I'PR6J~" BflOV.t
H. Small Esnuire G. Phvllis Stoner
CHECI", ,t,PI'ROI"i\IAH: BOX:
DI!.IC9CUlor(lrixl 0 Adlflinittrl;ltQr'trlx)
Df&tgfo R:Qprl;sQntotive ~ Joint owner of 5of(J depQsit bQ:II;
I,,,,,,,, '"
A ./.
~INT NAME
Michael
liNT. TITLE
Attorney for Decedent/
Estate (non-probate)
',,~
.
NOTE' A"ach addifional 8~" x 11" sheet (s) if nec..ssary or us.. duplicates of this poge of for,n.
FILE MEMO
Estate of Evelyn R. Fortney
March 15, 2002
Contents of Safety Deposit Box
Inventory of Box #107 on 3/15/02:
1. Social Security card for G. Phyllis Stoner.
2. Social Security Number stub for G. Phyllis
Stoner.
3. Original and 2 copies of Certification of
Birth for Grace Phyllis Stoner.
4. Certificate of Stillbirth for Jo Ann
McKissack (Mother - Grace Phyllis Stoner).
5. Original and 1 copy of Marriage Certificate
for William M. McKissack and Grace P.
Stoner.
6. Certification of Birth for William Thomas
McKissack.
7. Transcripts of G. Phyllis Stoner re: The
Pennsylvania State College, State Teachers
College, Shippensburg, Pa., and Lemoyne Jr-
Sr High School.
Exhibit I'AI'
8. Summary of family names and addresses of G.
Phyllis Stoner family.
9. Lemoyne High School Diploma for Grace
Phyllis Stoner.
10. Copy of Power of Attorney for Evelyn Ruth
Fortney with notation on front of copy, i.e.
"This is a copy - Original is at home in
Folder marked "Wills" in File Cabinet".
11. Copy of Power of Attorney for Grace Phyllis
Stoner with notation on front of copy, i.e.
"This is a copy - Original is at home in
Folder in File Cabinet (Folder marked is
"Wills")".
12. Original Divorce Decree dated 1/31/51
between Grace P. McKissack and William T.
McKissack.
13. Original Honorable Discharge Certificate
from the United States Navy for Grace
Phyllis McKissack, SR, USNR-R.
14. Certified copy and one regular copy of
Election To Resume Maiden Name of Grace
Phyllis Stoner.
15. Original letter from Richard W. Stewart of
Johnson, Duffie, Stewart & Weidner addressed
to G. Phyllis Stoner and Evelyn R. Fortney
enclosing Deed for 124 Clark Street.
16. Original Deed for 124 Clark Street, Lemoyne,
Pennsylvania as in Cumberland County Deed
Book K, Vol. 33, Page 237.
17. Original Cemetery Deed for Memorial U.B.
Church of Lebanon, Pa. to Mrs. Cathrine
Fortney for Lot No. 49, Section 7.
18. Original Cemetery Deed for Mountain View
Cemetery Association of San Bernardino for
Grave Numbered 3 in Lot Numbered 481 in Lawn
J. (For stillbirth)
19. Original Group Policy Certificate re:
Federal Employees' Group Life Insurance for
G. Phyllis Stoner.
20. Original PNC Bank Receipt dated 1-17-02 re:
Military Discharge paper received by G.
Phyllis Stoner.
REV-1509EX+11-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
FORTNEY EVELYN RUTH
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
21 02
0397
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. G. Phyllis Stoner
124 Clark Street
Lemoyne, PA 17043
None
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution ami bank ~cun\ number or sim~ar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for join~y-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 6/17166 Real estate situate at and known as 124 Clark Street, 115,000.00 50. 57,500.00
Lemoyne, Cumbo Cty., PA, as in Cumbo Cty. DB K, Vol.
33, P.237 - See copies of Deed & Appraisal attached
2. A 10/5/01 Citizen's Bank/Mellon Bank 46,516.07 50. 24,256.04
Tiered Rate Savings Account #00355-075964
- See verification attached
3. A 2/6/01 Fulton Bank CD. #049-0147710 19,426.03 50. 9,713.02
- See verification attached
4. A 11119194 Fulton Bank CD. #522-0065937 3,617.61 50. 1,606.91
- See verification attached
5. A 5/2/01 L P L Financial Services - Investment Account 122,407.36 50. 61,203.69
#65356743
- See verification attached
6. A 10/2101 PNC Bank C.D. #21001029574 5,095.59 50. 2,547.60
- See verification attached
7. A 10/2/01 PNC Bank CD. #31600132619 40,453.26 50. 20,226.64
- See verification attached
6. A 10/2/01 PNC Bank C.D. #31200214769 44,694.61 50. 22,347.31
- See verification attached
9. A 1012101 PNC Bank Checking Account #5140017317 4,435.90 50. 2,217 .95
- See vermcation attached
10. A 11/1/72 PNC Bank Checking Account #5140062417 23,459.66 50. 11,729.94
- See verification attached
TOTAL (Also enter on line 6. Recapitulation) $ 239,745.24
(If more space is needed, insert additional sheets of the same size)
Continuation of REV.1500 Inheritance Tax Return Resident Decedent
FORTNEY, EVELYN RUTH
21
02
0397
Pai:je 1
Schedule f-2 - Jointly-Owned Property
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Ir'lclude name of finar'lcial institution ar'ld bank account number or similar identifying number. Attach OA1E OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
11. A 11/15/89 PNC Bank Sailings Account #5130107255 30,919.67 50. 15,459.94
- See lIerification attached
12. A 1992 Series HH U.S. Savings Bonds (5 @$1,OOO.00 each) 5,000.00 50. 2,500.00
- See Verification attached
13. A 1992 Series HH U.S. Sailings Bonds (1 @$500.00 each) 500.00 50. 250.00
- See Verification attached
14. A 2123101 2001 Pontiac Aztek automobile - See copy of 13,500.00 50. 6,750.00
Appraisal and Certificate of Title attached
15. A 1968 Misc. household furniture and furnishings - See copy 2,464.00 50. 1,232.00
of Appraisal attached
SUBTOTAL SCHEDULE F-2 26,191.94
GRAND TOTAL SCHEDULE F.2 $ 239,745.24
.
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No. 536
P'EE-8IHPLE DEED-T:rpewri~
~
.'~btS' 3Jubruturr.
ilabr Wlrr
I ,,-t-L,
day 0'
June
.. 1M !leer 01 QUf" Lor4 0..
/'l0..... ....., H__.... Eighty-eight (1988)
irlwrtl1 FLORENCE L. BEAVER, a sine1e woman, of the County of
Cumberland, and Commonwealth of Pennsylvania, Grantor and Party
of the First Part;
- AND -
G. Phyllis Stoner and Evelyn R. Fortne~ of Harrisburg, Dauphin
County, Pennsylvania, as Joint tenants with the right of survivor-
ship, Grantees, and Parties
-/ ,,.. HOOlIWI pori, Bitllr5srtl1 ~ Me __"..,-r Y ot ,It,. ,.... parr. tor _d 1ft ooflMflflnllH...
".u...m 0' Eighty-two Thousand and .00/1.00 ---- ($82,000.00) ______
Dollor.. kiwi'" money 01 th.e Uttited Slat.. 01 America, teell.Ad I",I~ JlfJk'l by th.e ..Id pGrties 01 ,At
.ecoM pGrl to tM aoid pGrl Y of the fir" pari. at GAd before tlH~ M'Gltn, and ddit'ery of t~
".e.".. ,Ile receipt tcJkreof $I 1t.ereby dckno1oledged,
"...tdd. bGrgained. .old. GUen.ed, aftofjed, re'..ed. con"eweG ..d oon.l4rMed aAd by 'u.. prHenb J"
gron'. bar/1Gift. .,.11. .,"'-. _feo". l"ekcwl!l, DOtWey. GIld mnftrm ""0 Uti' ..u pan ies .,
1/a.8 HOOrwI JtlU"f their Win IJtN/ ....~
All
THOSE TWO CERTAIN lots or tracts of land situate
in the Borough of Lemoyne, County of Cumberland and
Commonwealth of Pennsylvania, more particularly bounded and
described as follows, to wit:
TRACT NO.1:
BEGINNING at a point on the southern side of Clark
Street by a curve to the right having a radius of. ~6? ~ef;;!_t,
100.97 feet East of the eastern line of Warren Street, said
point also being the eastern line of Lot No. 392 on the Plan
of Lots hereinafter referred to: thence continuing by a
curve to the right having a radius of 365 feet along the
southern side of Clark Street 108.63 feet to a point on the
western line of Lot No. 394 on the Plan of Lots hereinafter
referred to; thence along the western line of Lot No. 394
aforesaid South 3 degrees 1 minute West 114.55 feet to a
point at the northern line of Lot No. 390 on the Plan of
Lots hereinafter referred to; thence along the northern line
of Lot No. 390 aforesaid South 60 degrees West 36.47 feet to
a point; thence along the eastern line of Lots Nos. 390, 391
and 392 on the Plan of Lots hereinafter referred to North 30
degrees West 141.05 feet to a point, the place of BEGINNING.
BEING Lot No. 393 on Plan for Re-Subdivision of the
Lower Walton Tract as laid out by the Trustee of the James
McCormick Estate, dated July 7, 1941, and recorded in Plan
Book 3, Page 55.
BOOK k 33 PAGE W
HAVING THEREON erected a single dwelling known and
numbered as 124 Clark Street, Lemoyne, Pennsylvania.
TRACT NO.2:
BEGINNING at a point on the line of the southern edge
of Clark Street, said point being a distance of 221.30 feet
from the eastern line of Warren Street by said line of Clark
Street, having a curve to the right with a radius of 365
feet; thence South 4 degrees 57 minutes West by other lands
now or late of Mark D. King and Kathryn E. King, his wife,
and J. Barry Miner and Phyllis Miner, his wife, for a
distance of 109.77 feet to an iron pin; thence South 60
degrees West 8.53...f."'...t_t_o.!,.cpoint a~.~..lands now or late
.-of~-MarK- O. King, et al; thence along the eastern line of
Tract No.1, North 3 degrees 1 minute East for a distance of
114.55 feet to a point at the said line of Clark Street;
thence in an easterly direction by said line of Clark St~eet
for a distance of 11 feet 37 inches to the point and place
of BEGINNING.
BEING a part of Lot No. 394 on the Plan for
Re-Subdivision of the Lower Walton Tract as laid out by the
Trustee of James McCormick dated July 7, 1941 and recorded
in the Cumberland County Recorder of Deeds Office in Plan
Book 3, page 55.
SAID TWO TRACTS of land are conveyed under and subject
to the restrictions contained in prior deeds and in the said
Plan of Lots.
BEING the same premises which James J. Beaver and
Florence L. Beaver by deed dated April 12, 1988 and recorded
April 14, 1988 in Cumberland County Deed Book G-33, Page
989, granted and conveyed unto Florence L. Beaver, Grantor
herein .~_
,_. ..
~ECORDED'Of\"ICE OF TilE
RECOROER OF OEEDS
i)r~ts.:"" :."~ 1'011~n"'''PJt
o :::'ir::~1
'88 JUN 17 PM 3 ~Z
BOOK)<-33 PACE 238
~ ~;".
)
RElllSltllED BY 1IlE
BOROUGH Of E PA
l.ol n
G:J\6
arngl"t~l'r to"'" oU ond linflUw, tM tMememt., lMreditsmeftu a.M a.pptWtMMlCe. 101M .0,""
klonging or in. anywbe appertaining, and Ue rwe",ion and revtr,ioru, remeindtr Gtld remaindf!r"
,..,.t.. '"ue.) and profit. thereof i .AM a150 all 1M e.tote, riqM. litle, mtft'ed, property, clai,.
M4 demand whatsoever, both in law and equity, of the .oid pari y 01 tM firll J)Orl. of. ... t.
.... out of the .laid flNlmUe., Q.nd Mler1/ pari Gftd par"' 11lereof
<<fa ~nul' utili tn I1n III 'M ../4 1'""'4.... .,j'h 0" 0"" '"'lI"kw .., .ppu,,"""...., u.,-
tM Hid part ies of the .eOOM part, their Mfr. and IUhPM. to arul for the only prop",
.,e lInd beltofJ oj the ,aid pari ies of tlte UOOfl,d perl. their heW, orad tunfl'U
,.........
Aull
7'8B SAID
Grantor, her successors.
~r', eeecutor. and odminhtrator.. do ~ tI.~." praen.,.. ~"L (/t"G", find flgrt:e 10 dIM!
eDilA. tAe Mid pGr1 iea of tM ,~ruI pori. their MW. aft411
Mrit/M.IMt she the Hid Grantor J her successors
t.lrin aU and lingulor the hereditamtmt. Gfl.d premiaea ^ere1n.a.bove de.cribed ond f/t"MJted or mentioned
ad intended.o to be, with appurtenance,. unto the .aid port ies 01 the ,econd port, their
Wir, and 018i9"', again'" the .aid part y 01 tAt. fir" pa" and her heir. on.d again.t all
M4 eoery other lIer.on or peraotU whom.toet7f'T". lawfully claiming or to olaim tM so.me or any parr
tAereof, .koll mul unll. by th".e pNl8eflt8. WA.RRANT A.ND FOR
liVER DEFENl)
In IHhtl'51l 1I11l'rl'llf
llil"rf!'Mnto 'f" her ltaffd
t1Jea,JicSpM'Y
01 the lir,; pan
...
...d .eQl t/t.e day arid )/'f'Br 1ird abot~ W"ttM.
~~......(SEAl"
(SBA.Ll
\RIlAl~'
(SEAL I
(SEAL,
(SEAL I
(SEAL,
{SEAL'
(SEAL.
(REA.LI
(SEAL I
IBEALI
BOOK )<- 33 rAGE 239
I
;
i
I
;
'. . }
OOJiJiONWBAI4B 0' I'nNtrrLJ'AIlU .
. . ..' . ..
eoUN'I'Y 0-, .......<;;lM.!lJ;:.~1tMlJL...............__
. . .. /.r7I . June . 88
0.. tM., 'M ._..(~:::... doJ ./ __..................................._.._..................; .........., Hfore -
.............-'-'........;.;g,...IlR.t.\I);'.)l'...ll.lllilt.l<.................................._.:....................................., tho .M"'~
.t1*", per;cinally appeared .....Il~.'F.!.n.s~...1.~...~~.~!~.~.t...!...~!.~.sJ.~m!.9.~!E!................................
...................................................................................................-:.-.............__........................................................
. ,- -
......................................................................................~.................................-...................................................
_OtDft to me (or loti,lacforilll proven.) to be tILe p.,,.,on ................ .eM" fWlme ................ IUblcribed ff
rA., tDithin .inltrumeftt, (lAd ecknowIedge4 tJwJt ..........>> le ............ Neculed 1M ._.._ lor '1&6 purpo"
~_ . ~ .-: ~...".-'t: ~l
t"'_ ooft.t(1..n~u.. ?,_"~.',,' ::.
',.,' .-"{ ',,,
IN WITNE8S WHERBOP'. 1 A.......t. lOt ~~.d d .ffi~"'l.. , '"..~.:...:...:' ,,-
,'J I"",
..,. ..... .. ..:' -.,
" '.' "-IE m.."
1D1I oom"'-qI1On. eiZpi"u: .............tM'.!luu 'JIt'-I1.'- ':. I
. IYC._ ',111 - ' ,
I Aereby certIfy fluJf the PrecUe Benden.ce of the Grantee, tn tlt-.,.CfIIIM ' ,... " ',' .......'r.t:.:~:' l'
_.............I;.!f........5:k,.!i......~!!.~~.t................~~~...S:~..~k.:~.~.:!.,..........f.h............l2~.~"...,h.""~.;::i:. -r'
..........................'...........................................................::::::::~;:f.::2Z..~::~:~:.~
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COMMONWEALTH 01' PENNSYLVANIA }'
.___~.@^:,?t..COUNTY, SS:
Brrllrllrll In the Office for Recording of Deeds, M?~gages, etc., in and
for the County ;f:..~/:J............. in Deed BookK.,..... Vol.,,.3..3........
P ........'7 -, '. ..' .
age =..>../............... . .. " , if,. .'
.1IntB.6 My Hand and Sea.l of Office, this ........j'2:.".1;;:~:>.:~:rTN.~
/l~ ., 0V ,i':;~-c. ','_.. '
.................................................':::::1.......................... Anno DOmInl III 30 . . . . \ \ ..
OOOKIL~ PACE 240 9~~~~~
~CCA~ . -
IFIIe No. 21 PMe .11
nla
fm2 s 124 Claril: Street
CilY-Lamo.;;;-a
ltlIliBr Michael H. Small e-"uire
2
Coo"'" Cumberland
S1ataPA
'"' e.... 11043
APPRAISAL AND REPORT IDENTIFICATION
This appraisal conloRns to !1M of the following definitions:
o Complete Appraisal (The act or process of esUmaUng value, or an opinion of value, performed without Involdng the Departurv Rule,)
I:;gJ Limited Appraisal (The act or process of estimating value, or an opimoo of vaJue, pedormed under and resumng from Invoking the
Departure Rukl.)
This report Is !1M 01 the lollowlng types:
[J Self Contained (A written report prepared under Standards Rule 2-2(a) of a Complete or limited Appraisal performed under STANDARD f.)
o Summary (A written report prepared under Standards Rule 2-2(b) of a Complete or limited Appraisal performed und6l' STANDARD 1.)
o Resbicted (A written report prepared under Standards Rule 2-2(C) of a Complete or limited Appraisal performed under STANDARD 1
forcUentuseonly.)
Comments on Standards Rule 2-3
I certify that, to the best 01 my knowlsdge and belief:
o The statements of lact contained In this report are tnJe and COfl'ecl
o The leport&d analyses, opinions, and conclusions are limited only by the reported assumptions and IImlling condllions, and are my personal, impartial, and unbiased
Professional analyses, opinions and conclusions.
o I have no (orIMspecllled) present or lKospactNtlnter!stklth6 \lI'O\l6l't'/ttm Is the subjec\ 01 1his report, and no lorltle speclflad) personal Interestwilh respect to tile
partleslnvotved.
Dlhavenobiaswlthrespecttolhepropef1ythatlsthesubjectofthisreportorthepartlesinvolvedwlthtt\lsasslgnmenl
o My engaoement In this aSSignment was not contingent upon developing or reportlng predetermined results.
o My compensation for completing this assiOfTment Is no! contingent upon the development or reporting of a predetermil'l8d value or direction In vahle that favors tile cause
oC\tIe cllent,tneasnoontotthevalue op\n\on,1he attainment 01 a sliplJlated result, or the occurrence of a Sllbsequent event dlrectly related to the inlelKleduSloCthiS8jlpralsal.
o My analyses, opinions and concluslons were developed and tIlis report lias be8Jl prepared, in con1ormlly with the Unllorm Standards of Professional Appraisal ~tice.
Of have (or have not) madll a personal Inspection of the property ttm is \tie subjecta1ttm>ftIlGrt.
o No one provided significant real property appraisal assistance to the person sIgning this certificatIOn. 01 fuere are exceptions, the name 01 each Indivldllal jllovlding slgnlflcanl
real property 8jlpraisal assislaoce must be slated.)
Comments on Appraisal and Report Identification
Note any dapartures from Standard. Rule. 1-3, 1-4, plus any USPAP.related Issues requiring disclosure:
APPRAISER: /'~ ~ .-.-_--..---
S~nahJre: /' /">2-;;/-<
Nama: RO~ O. ~ox
Date Signed.' Mav 24. 2002
StateCertification#:
or State license #: AB05Q159l
SlaIe: Pennsvlvania
Expiration Date of Certification or LIcense: Mav 31 , 2000/
SUPERVISORY APPRAISER (only II requlfed\:
Signature:
Name:
Date Signed:
SlateCartfllcatloo#:
orSlalel/Cense#:
Slate:
ExplrationOat1lo1Certi!ica1lollorUcense:
C8JDid o Did Nat Inspect Property
Robert Fox
Form 103 - 'TOTAL lor Windows' appraisal software by a la mode, inc. - 1.800-ALAMODE
IAleNo 21 PallEl#31
SUMMARY DF SALIENT FEATURES
SubjeclAddress 124 Clark Street
Legal Description 33K Page 237 (6117/88)
City lemoyne
Cc\l!lt'j Cumberland
State PA
Zip Code 17043
Census Tract 106
Map Relerence
SalePI\Ce $ n/a
Date 01 Sale nla
Borrower/Client Michelel H. Small, Esquire
Lender Michael H. Small Esquire
Size \S~UaTeFeet) 1,400
Price per Square Foot
Location suburban
Age 50
Condition average
Total Rooms 6
BedlOmns 3
Baths 1.5
Appraiser Robert D. Fox
Date of Appraised Value June 30, 2002
FinalEstimateotValue
S 115,000
Form SSD - "TOTAl for Windows' appraisal software by a la mode, Inc, - 1.801J..A1..AMOOE
Borrower Client Michael H. Small Esnuire
Prooertv Address 124 Clark Street
Cltv Lemovne Countv Cumberland
Lender Michael H. Small Esauire
FileNo. 2
Slate PA
ZinCode 17043
TABLE OF CONTENTS
USPAPldentification.
Serviceslnvoice.
SummaryofSalientFeatures..
URAR..
Statement of Limiting Conditions ..
Supplemental Mklendum .
SubjectPholos..
Comparable Photos 1.3..
SubjectPhOlos..
ComparablePholos 1.3..
1
....2
3
.....4
...6
8
.....g
10
....11
12
Form TOC? - 'TOTAL for Windows' appraisal software by a Ill. mode, inc. - 1-800-ALAMOOE
R TI L APPR ISAL REPORT FileNo, 2
Pr~-Address 124 Clark Street City Lemovne StatePA ZiDCode 17043
L.....alDescrintion 33K Parre 237 16117/88' COlll'oru Cumberland
Assesso~sParcelNo. 12-22-0820-038 Tax Year 2002 R.E. Taxes S 1 578.34 <::n.ocial ~ss8S<"'en'" t 0.00
Borrower Michael H. Small Estluire r.urrent Owner G. PhvUis Stoner & Evelvn Fornev OccuDant fX1 Owner .'1 Tenant --1 Vacant
PronerlVrtnh~nn';-ised r'X"!Fee~e i leasehold Pro'eclTvDe i PUD I I ondomlnlum IHUONA onl HDA o.
NeMlbortlood or Pro'ect Name lower Walton Tract Man Reference Census Tract 106
SalePricef: nla DateofSalen/a n,_strlnliM and to amrnmt 01 loan cn.me~lenn~e.slons to h.o nald seltr nla
lendMJrlfent Michael H. Small ES;:;ulre Address 201-203 South Railroad Street Palmvra PA 17078
~raiser Robert D. Fox Address 976 Pinetown Road Lewisberrv PA 17339
L~,~ Ii Urnan ~ ~uburnan lru"' Predominant 3!!~llamuy no~,,~ Pteaent land II" % land UH change
PRI AG . ::8J Not likely '1 Ukely
Buitt up iXJ Over 75% 25.75% Under 25% occllpancy S(OOO) (yrs) Onefamlly~
Growth rate [~l Rapid Stable Slow ~ Owner 95% 80 000 lO~ ~ 2.4 family _ [J In process
PropertyvaJues [g) Increasing Stable Declining ~I Tenant 150000 Hill.h 60 Multl-family_ To:
Deman~supply f;)!, S,~~~'9' ,~:n b.anee ,; ~V" supply G;J Vaeant(O-S%l _Predomlnant-'Commelcial
Marlc:etlnn time Un er 3 mos. 3-6 mos. Over 6 mos r:"'-lVa~{0'I~r5%1 110-120 40 I
Nole: Racl and the racial composition 01 thll neighborhood arl not appraisal factOfS.
Nelgltbomoodw.mdafies and charat-rerlr.fu:r.'. To the North. Walton Street To the East - Susquehanna River. To the South _ Bailev Street and to
the West - Brid"e Street. This is a sinnle familv detached neiahborhood
Factors that affect the marketability 01 the propertles in the neighbomood (proximity to employmw\ al\d amenities, tl1TIPloyment stabmty, appeal 10 market, elc.):
PronF!r1v is situate iust north of the boro of New Cumberland and iust west of the western boundrv of the Susquehanna river.
Proneriv is located within 5 minutes driv!nn time of downtown Harrisbu'"" local reoional malls and many emololle~' both small ......ivate
com"'~mies as well as lame comorate and "ovemment fadllities. This area was one of the earlv orowth areas after the end of World War II.
Markelcondilions in the subject neighbortlood (Including support for tI1e a boveconclusionsrelatedlothetrendofpropertyvalues,demand/suppIY,andmarketingtime
--such as data on compelitive properties for sale in the neighborhood. descriptio n 01 the prevalence of sales and fill'allCln\} concessions, etc.):
There are no foreseeable economic factors that mav adverselv influence the marketabUitv or market value of the subiectr nomertv. The averane
marketinn time would be between 60- 90 davs. At the time of this insnection there were no prooerties for sale in the neirrhborhood.
Project InformatIOn for PUOI (n applk:able) . - Is the developer/builder in control of the Home Owners' Association (HOAl? c.j Yes cg:: No
Approximate total number of units Ifl the SUbject project Approximate total number of unlts lor sa16ln the sublect project
Desclibe common elements and recreational faelHties:
Dimensions two tracts. irreaular shaDe Topography flaV entleslo
Site area .24 acres Comer Lot DYes iZI No Size aver-;;-e
Specific zoning c!assification and description Suburban Residential Shape irre!:lular
Zoningcompiiance [XJLegal~JLegalnonconlorming(GrandlathereduselUUlegal o NozonlWil Drainage a.nnears adenuate
HI hB~ R. be~ "5. as I...nroved: . Present use i-~' (;',her use lemlainl View averane
UtiIIl1es Public Other on-.11e Improvement. Type Public Private Landscaping averane
E,.,1I\city l' Street macadam iZI [j Drlveway Surface macadam
Gas ,- Curb/gutter concrete iZI -, Apparent easements none a""arent
W"r )<1 Slde.walk none '] r; FEMA Special Aood Hazard Area i.-J Yes k?JNo
Sanilarysewer ~ Streetlights ves iZI :-1 FEMAZone c Map Date
Storm sewer Allev none n ,- fEMAM"N<l.
Comments {apparenl adverse easements. encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use. etc.}: none noted
GENERALDESCRIPTJON EXTERIOR DESCRIPTION FOUNDATiON BASEMENT INSULATiON
No. of Units 1 Foundation block Slab nia AreaSQ.Ft, 1400 Rool unk -
No. 01 Stories 1 EXlerlorWaUs Stone/vin I CrawlSpace % Finished 70% Ceiling yes ~
lYP'ID"IAn.) detached RoolSurface comoosition Basement full Ceiling dron Walls wlsiding X
Des~n IS~') ranch Gutters & DWTlspts. aluminum Sump Pump no Walls kn~ioe Roar ~r8l
Exlsting/Proposed existinn Window Type double huon Dampness no Fioor cpt None
Ag.(Yrs.) 40 Storm/Screens ".. Settlement no OUlsideEntryno Unknown [J
Effective A eNrs,\ 15 ManulacturedHouse Infestation non
ROOMS ~r Llvin,; inIn Kitchen Den Famil Rm. Ree.Rm. Bedrooms # Baths Laund nlli& Alsa--s.\Ft
Basement , , 1400
Levell , , , , , 1.5 1400
Level 2
Fjnishedareaabo~adeConlains: 6 Rooms' 3 Bedmomls , 1.5 Bath s. 1 400 S uare Feet 01 Gross LivTr; Area
INTERIOR Materials/Condition HEATING KITCHEN ECUIP. ATIlC AMENITIES CAR STORAGE:
Floors .....ntfvjn lype BB Refrigerator !2J None n Fireplace(s)#~kSJ None rJ
~
Walls d""""all Fuel oil Range/Oven Zi Stairs -, Patio 18x20 2':1 Garage #ofcars
-
TrilTl/Finish wood Condition ave Disposal !2J Drop Stair '] Deck C Attached 1 car
Bath Floor vin I COOLING .Iee Ols~'Nasher Zi Scuttle '" Porch 14x24 :.J Detached --
Bath Wainscot ceramic Central , Fan/Hood 'I Roar r, Fence wood iZI Built-In
~ =1
Doors wood Other Microwave i2SJ Heated Pool '] C""'"
Condition averane Washer/DNer ,', Finished I' Drivewall macadam
Addilionalfealures(specialenergyefficientitems,etc.): enclosed screened in orch in rear measurina 14 x 24.
Condition of the improvements, depreciation (physieal,functional,and extemal).repairsneeded,quaIityofconstruclion,remodeUng/addmons,etc.: Pro"""rt" isin
avera"e condHon. ImnrOvmenls are tvnical for a"e of "'rooertv and neiahborhood.
Adv8l"se envirlmmtl\ta\ comlltions (sllch as, but nollimrted 10, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the
immediareviclnityolthesuble<:tproperty.: none observed
UNIFO M RESIDEN A
Freddie Mac Form 70 6/93
Robert Fox
PAGE10f2
IAleNo.21 Palle#41
A
T
Form UA2 - 'TOTAL lor Windows" appraisal software by a la mode. Inc. - 1-800-ALAMOOE
Fannie Mae Form 1004 t3/9a
lFiIe No 2\ PaGe #51
ESTlMA1Bl SITE VAlUE
ESnMA1Bl REPRDDUCnDN CDST-NEW.DF IMPROVEMENTS:
Dw<lNng S~Ft.@$ =$
DSq.Ft.@$
UNIFORM RESIDENTIAL APPRAISAL REPORT A"N~ 2
"" $ Comments on Cost Approach (such as, source of cost estimate, site value,
square loot calculation and for HUO, VA and FmHA, the estimated remaining
economlc lite oI1he propeIty): The c:;ost a ch thou h considered
is not a liable Indication of value do to the a of the
1m menta and the difficu in aasessin all fonns
of de reciation. Therefore I did not use that a roach in this
'" rt.
=$
E""""
Funell"'"
-$
-$
=$
COMPARABLE NO. 1
344 1.owther Steet
Lern ne
314 mile
COMPARABLE NO. 2
4 Haldennan Court
New Cumbertand
1J4mUe
COMPARABLE NO.3
925 16th Street
New Cumberland
3J4mile
118000
115000
112000
97.04 rp
MLS & County Web Site
74.05 rp
MlS & County WebSite
72.12 rp
MlS & County Web Site
DESCRIPTION + -$Ad sf. DESCIlIPTJQH + -I ". OESCRIPTJQN + -$Ad' sl
none known none known none known
8/31101 6121102 7(2.4101
similar similar similar
same same same
.50 acres -2000 .29 acres .28 aeres
similar similar similar
same same same
similar similar similar
42 61 47
..... . avel1l e avel1l e avera e
Total: Bdrms: Baths Total :Sdmls: Baths' Total: drms: Baths' Total :Bdrms: Bath.
6 3 1.5 6 3 2.0 -2,000 6 3 2 -2,000 6 3 2 .2,000
1400S .R. 1216 S .Ft. +2 000 1553 S .Ft.: +3 000 1553 .Ft. -2000
1,400 finished finished finl_
70%
avera e similar similar similar
OilBBlCfA same OIIlCIA OilFHNCA
1 ear 2 ear -3000 ,= 1 ear
Screend porch 12 x 24 breezway +1,500 none +1,500
2 0 +1000 1
Net Ad. "" 2 500
Ad/Usled Sallis Prlcll
of ble 114000
Comments on Sakls Comparison (locIuding the subject property's compatibility to the nelghbomood, etc.):
and lie within similar nei hbomOQds. Com arable #2 is closest in roximal to the su 'ed. I have we hted aU of the com arables in amvI
the finalvslue of the ro rt. All of the rtie&in thes 'ectare resentatlveoftheirres ctivene' hbomoods.
ITEM SUBJECT COMPARABLE NO, 1 COMPARABLE NO.2 COMPARABLE NO.3
Oate,PtlctandOata
Source, lorprlor sales
within of ralsal
AnalyslsofanycurmttagreememolsaJe,option,orllstlngolsubjeclpropertyandanafysisofanyprlorsales 01 subjecl and comparables wIthln one year of the date of appraisal:
INIlICATBlVAUJE BY BAL!SCOIlPAIlISON APPROACH $ 115000
INDlCATEDVAWEBYINCOMEAPPROACH edM Rent o. x G sRentMullf lIer
This appraisal is made 'as Is' ._ subject to th, repairs, alterations, Inspections or condltlons listed below subject to completion per plans & specttlcations.
eon., of AppraIsal: This s raisal is inoom lete without the attached comment addel'\dum eertificationltimlt conditions and 8U lernenlal
ce;tl~Ii::::. s~ attached'.
Anal R8COIICUIaIion: I have we' hted m final 0 inion of market value In favor of the Sales Com arison a roach whIch i. usuaU the beSt indicator
of the market value. Both the CO$\ and income a roaches were considered but were not deemed to be reliable.
The purpose of this appraisal is to estimalll the markslvalue aftl:lereal proptlrtytl\at\sltles*o11his Ieport, based onltle above conditlons an dlhecertlllcation,cOOUngent
and Ilmltlng condlllons, and market value defInition that are staled In the attached freddie Mac Form 4391FNMA form 10048 (Revised 6193 ).
I (WE) EBnMATE THE MARKET V UE, AS DEFINED. OF THE REAl. PROPERTY THAT IS THE SUBJECT OF THIS REPOflT. AS OF June 30 2002
(WMICtIlSlHEDATE~", " AND EfFECTlVeDATEOFTHlSREP'QIllU'.O.B:E $ 115.000
APPRAISER: R ". F ,B ~MI'-----:7 /......-- _>'SUPERVlSORYAPPRAlSER(ONLYIFRECXJIRED):
S n re ,/j-" "/~--../' /./ .- / ,,- - Slanature
Name Robtfrt D. x Name
Date ReoorrSlanlld' August 6, 2002 Date Re S ned
State CeItlficatlon # State SIateCerli11c tlan#
Or State license # AB050159L StatePA OrS llcllTlSe#
Fr8ddie Mac Form 70 6193 PAGE20F2
Form UA2 - "TOTAL lor Windows' appraisal software by a fa mode. Inc. -1.800-ALAMOOE
[8JOld COldN01
Inspe<:tProperty
late
let.
Fannie Mae Form 1004 6-93
.: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
December 16, 2002
Michael H Small
Farrell & Small
POBox 113
Palmyra,PA 17078-0113
Estate of Evelyn R Fortney
Date of Death: Jan 16,2002
SSN: 205-09-9134
Dear Sir:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of her date of death. This account was established as a joint account on its opening date.
For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries, please
call 412.867.3877.
Sincerely,
\~
John Mason
Operations Services
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. MAY. 212003(WED) 14,18 FULTON COMM CREDIT
1 717 291 2839
PACE. 2/2
Fulton Bank
CAPITAL DIVISION . LANCASTER/CHESTER DIVISION
DROVERS BANK DIVISION . GREAT VALLEY DIVISION
(717)291-2437
May 21, 2003
Farrell & Small
201/203 South Rai Iroad Street
P.O. Box 113
Palmyra, Pennsylvania 17078
Dear Mr. Small:
RE: Evelyn Ruth Fortney, deceased January 16,2002
In response to your recent inquiry conceming the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
CD # 049-0147710, open 2/6/2001, matures 3/3/2002, balance
$18,496.14 and accrued interest $929.89; paying 5.16%. Joint
with G. Phyllis Stoner. (Evelyn added 10/3/2001 ) * opened with
funds from a previously held joint account titled Jeanne S. Dunfee
or G. Phyllis Stoner whieh opened 2/03/1997.
CD # 522-0065937, open 11/19/1994, roll over 11119/2000, matures
5/19/2002, balance $3,586.62 and accrued interest $31.19; paying
5.45%. Joint with G. Phyllis Stoner.
If you should have any fLlrther qtlestions, please do not hesitate to cOlltact me.
, "l"'~ ~~}.,j rOo':' fl rij ~;.; !r\{, . ~ .. ~ l:\ L
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Very truly YOlII'S,
~~.~a.o.>
Karen D. Hillegas
Credit Inquiry Processor
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POBox 4887 . lancosler PA 17604
,
www.fullonbank.com
1-800-FULTO~J-4
Dated:
-r~<
5. Jffi7
,
TO: Michael H. Small, Esquire
201/203 S. Railroad Street
P.O. Box 113
Palmyra, Pa. 17078-0113
RE:
Evelyn Ruth Fortney, deceased
The in'formation which you requested on the account(s) of
Evelyn Ruth Fortney, deceased
(Social Security No. 205-09-9134
is as follows:
Account Numbed s) 65358743
Type of Account Investment Account
Da te Opened ~ ;2 , 2. t10 I
Principal Balance
Accrued Interest
Acct. Ownership
~N/ !1tIit[1
.:J ()VJ.,:(
Balance at Date
of Death: 1/16/2002
Name of Joint
Owner, if any
r;..PII~/2L15 $7CJIM(
Date Ownership
was Established
!f)/N .2..;)00 J
Additional Infor-
mation Requested
By:
;;:
L P L Financial Services
:LPL
[Juane E. Herman, CPA
Financial Consultant
1)~'H-. '",Tr 1111 . :>'lnh.1l1l,-,h'11t:. 1'.\ 1-11-:;; . -:-_-.\-_~I(1I1 . S(J!I,'-I'j.SII'!(J . l'.u "'I"'--.~-_~()O~
'f'
~ r'~ -~,':'
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'1.:1
June 5. 2002
Michael II. Small. Esq,
Fiirrdl & Smiill
PO Box 113
Palmyra, P A 17078-0113
Rc; Estate of Evelyn R Fortney
Dear Mike:
Pursuant to your request, the following is the intormation relating to the value of the joint
account that fvelyn R, Forney and G. Phyllis Stoner held at LPL Financial Services as of
January 16, 2002,
Money Market Funds
PIMeO Rcal Return Fund Class C
Federal Home Loan Mortgage Corp,
5.25% Notes due 1115/06
Federal National Mortgage Association
5.75'Yo Notcs due 6/\ 5/05
Fcderal National MOJ1gagc Association
4.75% Notes due 3115/04
MBNA America Bank-CD 3.7% due 12/26/03
Total Janumy 16,2002 value
1116/02
Value
$ 4,755.54
21,456.79
14,851.50
15,848.55
15,495.00
50.000.00
$122,407.38
I f you required any additional intormation, please contact me.
Yours vcry truly,
(~
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/
/
,/../
!/ ( "
[)uane E. Herman, CPA
,/
,-,/'
',/
Limeo/Private l.edger .i\1emhcl" ;--..rASD/SJPC
MAY-31-2002 12:37
- -
PNCBANK
41<' '(btJ ~4"tl
,......1::11
o PNCBAN<
May 30, 2002
Michael H. Small, Esquire
201-203 South Railroad Street
P.O, Box 113
Palmyra, PA 17078-0113
RE: Estate of Evelyn Ruth Fortney, deceased
SSN: 205-09-9134
000: 1116/2002
Dear Mr. Small:
In response to your request for Date of Death balances for the customer noted above, our
records show the followin8:
Certificates of Deposit
Account # 21001029574
Established 10/0212001
G PHYLLIS STONER
EVELYN R FORTNEY
DOD balance: $5,090.35 + $5.24 accrued intcrest
Account #31600132819
Established 10/02/200 I
G PHYLLIS STONER
EVELYN R FORTNEY
DOD balance: $40,449.19 + $4.09 accrued interest
Account #31200214789
Established 10/021200 I
G PHYLLIS STONER
EVELYN R FORTNEY
DOD balance: $43,854.53 + $840.08 accrued interest
Checking Accounts
Account #5140017317
Established 10/02/200 I
G PHYLLIS STONER
EVELYNR FORTNEY
DOD balance: $4,435,66 + $0.24 accrued interest
Page I of2
. ~1-2002 12:37
PNCBANK
412 768 3458
P.02
Account #5140062417
Established 11/01/1972
G PHYLLIS STONER
EVELYN R FORTNEY
DOD balance: $23,457.92 + $1.96 accrued interest
Savings Aeeount
Account #5130107255
Established 11115/1989
G PHYLLIS STONER
EVELYNR FORTNEY
000 balance: $30,912.26 + $7.61 accrued interest
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 st.tements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
(3?{)~M1LuJdh-
Rachelle Wells
1-800-762-1775
P7-PFSC-04-F
500 fi"" Ave.
Pittshurgh P A 15219
Page 2 of2
Memher FDIC
TOmL P.02
EVELYN R. FORTNEY, DECEASED
SERIES HH SAVINGS BONDS IN THE NAMES OF
G. Phyllis Stoner (SS#: 179-12-5549)
OR
Evelyn R. Fortney, deceased (SS#205-09-9134; DOD: 01/16/2002)
ISSUE DATE SERIAL NUMBER FACE AMOUNT VALUE ON 01/16/2002
Feb. 1992 M 420 458 5 HH $ 1,000.00 $ I. (;0:. DO
I
Feb. 1992 M 420 458 6 HH $ 1,000.00 $ J.O((J.(D
.
Feb. 1992 M 420 458 7 HH $ 1,000.00 $ I (C' "('
! i.C' .( "
Feb. 1992 M 420 458 8 HH $ 1,000.00 $ J [ -, (Y'
J ( ( . . . "
Feb. 1992 M 420 458 9 HH $ 1,000.00 $ ~ Gre .((\
Feb. 1992 D 303 689 5 HH $ 500.00 $ r: (., (i
,j!;' (
LEBANON VALLEY FARMERS BANK
.;; /
By: /)((II?t.//n!U/,j/2!l /J/i3/(\f-,
Phyllis Stoner
124 Clark St
Lemoyne, Pa 17043
b!J.lIJ~~
FREY SINGER PONTIAC, GMC, BUICK, MAZDA, HYUNDAI, INC.
6251 CARLISLE PIKE I MECHANICSBURG. PA 17055 . TEL. 717-766-8422
March 19,2002
M
The value of your 2001 Aztek on Jan 16, 2002 was $13500.
Freysinger Pontiac
Te~:;;r~lesman
(TYPE OR PRINT) Certificate 01 {- .ust be submitted within 20 days. ;;~iess tre iJurchaser IS '3. ( ,ered dealer holding thei8h,cte for resale.
WARNING _ ~50EBC~tl!"\PE~~~~5'v'fO~NRJ~~I!t~~Hti..Jr8E~VU)J~~~1G~~~2E"me~Of,~g~'?,,~p~:~8r~:':~~;fA'iSFER OF OWNERSHIP. FAILURE
A ASSIGNMENT OF TiTlE R~IsIer1lCl <leal",s f'huSl complete forms MV2iA or I.I'/e,e i cAST FIRS:> AU.
- as .1Ill.....a<l "y ISN l1 p(JfC~O~.. is NQT a '''glslel'fl,j ;J~~ ," I
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ROY D SHIRK, APPRAISER
LICENSE # AU-003248-L
988 HORSESHOE PIKE
LEBANON,PA 17042
PHONE (717) 867-1119 FAX (717) 867-5606
Personal Property Appraisal
Evelyn R. Fortney Estate
Round End Table
2 End Tables @ 15.00 ea.
Matching Sofa & Love Seat
2 Matching Lamps@5.00 ea.
Card Table
Desk Chair
Misc. Throw Pillows
Rust Chair
Small Hutch
Base Portable Radio
Zenith Television
Magnavox VCR
Dining Table w/4 Chairs
Magazine Rack (Flakeboard)
Small Cabinet (Flakeboard)
Magazine Rack
Tappan Microwave (Old)
Microwave Cart (Flakeboard)
Upright Cabinet (Flake board)
Step Stool
Misc. Kitchen Utensils
Coffee Maker
Plastic Trash Can
Book Shelf (Flakeboard)
Computer Mand (Flakeboard)
Printer Stand (Flakeboard)
Desk Cba,r
Metal Stoeage Cabinet
4-Drawer File Cabinet
Wooden Desk w/Chair
Table Light
Misc. Wall Hangings
Misc. Books
Trash Can
5-Pc Bedroom Suite
2 Table Lamps @ 4.00 ea.
Small Bench
Plastic Step Stool
Clothes Tree
Wall Shelf
Misc. Knick Knacks
6-Piece Blonde Bedroom Suite
Blue Recliner
Wicker Shelf
2 Table Lamps@3.00 ea.
Table Lamp
RCA Television
RCA VCR
Misc. Tapes
VCR Shelf (Flakeboard)
$
10.00
30.00
75.00
1000
2.00
5.00
2.00
5.00
50.00
50.00
45.00
10.00
50.00
2.00
5.00
20.00
10.00
15.00
20.00
3.00
25.00
2.00
1.00
20.00
1000
3.00
15.00
5.00
22.00
15.00
1.00
20.00
15.00
2.00
200.00
8.00
5.00
1.00
10.00
15.00
20.00
250.00
20.00
15.00
6.00
2.00
45.00
20.00
5.00
5.00
Page 2
Personal Property Appraisal / Fortney Estate
2 Telephones @ 2.00 ea.
Waste Can
Misc. Wall Pictures
Crock
2 Green Metal Cabinets @ 5.00 ea.
Kenmore Upright Freezer (Old)
Hoover Vacuum Cleaner (Not Working)
GE Washing Machine
Frigidaire Dryer
Iron
Ironing Board
Misc. Brooms & Mops
GE Dehumidifier
Laundry Cart
Old Single Bed
Oval Pedestal Table
Towel Rack
Upright Bureau
Secretary Desk w/Top
End Table w/Lamp
Bar Stool
Bureau (Painted & Broken)
Small Chest of Drawers
Maple Table
Whirlpool Dehumidifier
Blue Recliner (Worn)
Book Shelf
Misc. Luggage
Bar Stool
Pole Light
2 Wooden Chairs @ 5.00 ea.
Exercise Bicycle
End Table
Rust Sofa & Loveseat (Worn)
Misc. Toys (Hess Trucks)
Folding Table
Small Wooden Wheel Barrow
Wall Clock w/Chimes
2 Table Lights @ 1.00 ea.
Plastic Shelf
Hoover Vacuum Cleaner
Misc. Puzzles
Misc. Bedding
Small Radio Cabinet w/o Radio
Console Stereo
Zenith Television
RCA VCR
Pole Light
Television Cart (Flakeboard)
Entertainment Cabinet (Flakeboard)
Small Book Shelf
Ceramic Dogs
Misc. Books
Misc. Knick Knacks
Christmas Decorations
Misc. Hand Tools
Patio Table w/4 Chairs
4.00
1.00
15.00
20.00
10.00
20.00
- No Value-
30.00
20.00
3.00
2.00
4.00
20.00
1.00
5.00
55.00
5.00
50.00
250.00
15.00
3.00
5.00
20.00
25.00
20.00
10.00
3.00
10.00
3.00
2.00
10.00
25.00
10.00
15.00
100.00
5.00
20.00
50.00
2.00
1.00
10.00
2.00
15.00
5.00
1.00
30.00
20.00
2.00
3.00
15.00
7.00
]5.00
10.00
15.00
5.00
25.00
20.00
Page 3
Personal Property Appraisal I Fortney Estate
Older Glider
4 Pieces of Patio Furniture
2 Metal Cabinets @ 2.00 ea.
3 Garbage Cans @ I. 00 ea.
Gas Grill
Charcoal Grill
2 Wooden Benches @ 4.00 ea.
Misc. Garden Tools
Snowblower (Doesn't Work)
Red Wagon
Electric Leaf Blower
Metal Cart
Electric Weed Eater
Electrical Cords
2 Metal Cabinets @2.00 ea.
Step Ladder
Step Stool Ladder
Misc. Odds & Ends
Electric Hedge Trimmer
TOTAL INDICATED VALUE:
$
5.00
15.00
4.00
3.00
20.00
1.00
8.00
40.00
10.00
15.00
10.00
5.00
5.00
3.00
4.00
10.00
5.00
20.00
10.00
2464.00
REV-1511EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FORTNEY EVELYN RUTH
FILE NUMBER
21 02
0397
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home and Cremation Services, Inc.-See copy-Funeral bill attached 6,022.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street A<ldress
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Farrell & Small 7,500.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6 Tax Return Preparers Fees
7. Robert D. Fox - Real Estate Appraisal re: 124 Clark Street, Lemoyne, Pa. 250.00
8. Bureau of Vital Records - Additional Death Certificates 48.00
9. Roy D. Shirk - Appraisal of personal property 125.00
10. Cumberland County Register of Wills - Filing fee for PA Inheritance Tax Return 15.00
TOTAL (Also enter on line 9, Recapitulation) $ 13,960.00
(If more space IS needed, insert additional sheets of the same size)
G PHYLLIS STONER I J
EVELYN R. FORTNEY
124 CLARK ST I 22. 0'2. 60-12131313
LEMOYNE, PA 17043 Date.. 101
~;'t:;:~. ~ tM "n~C>/<~ L~ Cf--b $ 6022.0n
~;r{ ~~,~ o...~ ~ 't;/"C l'"l~~06Dona" In =":"
~ PNCBAN< (S
Premium
Plan A .G.CJw ~~ '1~
1:0:i B ~ 2 ?:I81: 5 ~ ..om, 2.. ~ ?II' 1;8 5 :i~~C;;0 1;02 200,"
6853
PNC Banlc, N.^- 040
Cenlral PA
For Ii: (l.r ~ mWX'DJ
P.O. Box 137
324 Hummel Avenue SUB-TOTAL
lemoyne, PA 17043-0137
(717) 763-7440
Fax: 717-730-9798
WNW. musselmanfuneral.colll
OC'lw...__
J.
, "-.' .,.
-.....~...~:.~
Mllllssehuan
Funcral Home
& Crematioll
Senices, Inc.
Established 1895
Brian C, Musselman. EO.
Supervisor
William G, Pegan, ED,
....
~....- ... ..- . .....- - ......... '
To Fnneral Expenses of EVELYN R. FDRTNEY (date of death, Jan.16,2002)
Statement prepared Feb.7,2002
G. Phyllis Stoner
124 Clark St.
Lemoyne, PA 17043
2002
January 18
PROF. SERVICES, FACILITIES & AUTO EQUIP.
Praying Hands Stainless Steel Casket
$4,300.00
2,650.00
$5,950.00
Cash Advance Itell'3:
Flowers
Copies of certiflcate
Minister's gratuity
106.00
16.00
50.00
172100
TOTAL
(Cumberland Co. veteran allowance)
$6,122.00
100.00
~6'022~
jJJ
P! Jj I {)().J.. - ,
l( I !J3( {)d-
/ ~ r "--".JA- {
'(\ I JR'. U /7"
" /,
REV.1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES1DENl DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
FORTNEY, EVELYN RUTH
FilE NUMBER
21 02
0397
Include unreimbursed medical e.pen....
ITEM
NUMBER
OESCRIPTION
AMOUNT
1,000.00
1.
Yena Williams - In-home nurselcare giver expense - Final bill
2.
Kenyata Allison - In-home nurse/care giver expense - Final bill
275.00
3.
Global Health Care - Medical bill
176.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,451.00
REV-1513 EX + (9-001
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
F "\1'" VI\! QIIT\-! ?1 n? n~Q7
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS {Include outright spousal dlstnbulions, and transfers under
Sec. 9116 (e) (1.2)]
1. G. Phyllis Stoner Friend 100% of Residuary
124 Clark Street Estate
Lemoyne, PA 17043
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 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)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2..'0601
.
. -,-\ARR\SBURG, PA '7' 28-060,
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SMALL MICHAEL H ESQ
POBOX 113
201/203 SOUTH RAILROAD STREET
PALMYRA, PA 17078
___n___ fold
ESTATE INFORMATION: SSN: 205-09-9134
FILE NUMBER: 2102-0397
DECEDENT NAME: FORTNEY EVELYN RUTH
DATE OF PAYMENT: 06/02/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2002
NO. CD 002635
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,137.71
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,137.71
REMARKS: MICHAEL H SMALL ESQUIRE
CHECK# 12027
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IND1VlQUAL TAXES
DEPT,280601
.. 'dARRISt'URG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002631
SMALL MICHAEL H ESQ
POBOX 113
201/203 SOUTH RAILROAD STREET
PALMYRA, PA 17078
REMARKS: MICHAEL H SM
AC
ASSES
CO
NU
AMOUNT
--------fold
101
$2,137.11
ESTATE INFORMATION: SSN: 205-09-9134
FILE NUMBER: 2102-0397
DECEDENT NAME: FORTNEY EVELYN RUTH
DATE OF PAYMENT: 06/02/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2002
TOTAL AMOUNT PAID:
$2,137.11
CHECK# 12027
SEAL
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
"- Fl-&.R-~
BUREAU OF INDIVIDUAL TAXES
IMHERITAHCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NDTICE DF INHERITANCE TAX
APPRAISEKENT, ALLDMANCE OR DISALLDUNCE
OF DEDUCTION~, AND ASSESSKENT DF TAX ON
JOINTLY HELD DR TRUST ASSETS
REV-1SU EX UP [Ol~OS)
\;
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
02-17-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
205-09-9134
02111348
Allount Re.1l tt.d
EVELYN
R
G
124 CLARK
LEMOYNE
P STONER
ST
PA 17043
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 .....
Rifv=i54-i-Ex--AFP--foi-=o3i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-17-2003
ESTATE OF FORTNEY
EVELYN
R DATE OF DEATH 01-16-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0397
TAX RETURN WAS:
S.S/D.C. NO. 205-09-9134
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02111348
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
522-0065937
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE
DATE ESTABLISHED 11-19-1994
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3,617.81
0.500
1,808.91
.00
1,808.91
.15
271 . 34
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 02-25-2003 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 271 . 34
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.46
TOTAL DUE 276.80
. IF PAlO AFTER THIS OATE, SEE REVERSE FOR CALCULATION OF ADOITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYKENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU KAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. I
17.....5"'8' - ~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DI~ISIOH
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
NOTICE OF INHERITANCE TAX
APPRAISEKENT, ALLOMANCE OR DISALLOMANCE
OF DEDUCTION~<_ANO ASSESSKENT OF TAX ON
JOINTLY KELD OR TRUST ASSETS
REV~IS48 EX iF' (Dl~05l
G
124 CLARK
LEMOYNE
P STONER
ST
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
02-17-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
205-09-9134
02111347
EVELYN
R
Allaunt Remitted
PA 17043
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 ---
Rifv=is4-i-Ex--AFP--foi-:031------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-17-2003
ESTATE OF FDRTNEY
EVELYN
R DATE OF DEATH 01-16-2002
CDUNTY
CUMBERLAND
FILE NO. 21 02-0397
TAX RETURN WAS:
S.S/D.C. NO. 205-09-9134
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02111347
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT ND.
049-0147710
TYPE OF ACCOUNT:
DATE ESTABLISHED
( ) SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
10-03-2001
x
16,426.03
1. 000
16,426.03
.00
16,426.03
.15
2,463.90
NOTE: TD INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTIDN OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 02-25-2003 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 2,463.90
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 49.61
TOTAL DUE 2,513.51
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I
//-6"E-~
~ BUREAU OF INDIVIDUAL
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
TAXES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
P STONER
ST
NOTICE OF INHERITANCE TAX
APPRAISEKENT, ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~. AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
Recore's,! CJf:.';- OIDATE
Rec' "J ESTATE OF
DATE OF DEATH
FILE NUMBER
'03 ~lAY 16 '10 'Ali;OUNTY
(l!' '~'s'SN/DC
ACN
REV-.54B EX "FP (Ol-D~)
G
124 CLARK
LEMOYNE
05-19-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
205 - 09 - 9134
02127965
EVEL YN R
PA 1704VS .
(":11i~C'
Amount Remitted
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 ......
RE-Y=is4-i-E;C-AFP--'oi-:03j------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-19-2003
ESTATE OF FORTNEY
EVELYN
R DATE OF DEATH 01-16-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0397
TAX RETURN WAS:
S.S/D.C. NO. 205-09-9134
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02127965
FINANCIAL INSTITUTION: CITIZENS BANK
ACCOUNT NO.
00355-075984
TYPE OF ACCOUNT:
DATE ESTABLISHED
(JO SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
10-05-2001
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
45,463.72
1.000
45,463.72
.00
45,463.72
.15
6,819.56
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEl PT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 05-27-2003 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 6,819.56
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 222.34
TOTAL DUE 7,041.90
* IF PAID AFTER THIS DATE, 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 "CREOn" ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
//j
F-/) //
\...-J" -
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
>
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
fi.::;:.:: 1:
H" ,
(,;DATE
( ESTATE OF
DATE OF DEATH
.flLE NUMBER
f\ "1 :':tl!IUNTY
ACN
06-30-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
101
MICHAEL H SMALL ESQ
201 S RAILROAD STREET
POBOX 113
PALMYRA
"03 JUN 30
*'
REV-1S47 EX AFP (Ol-03J
EVEL YN
R
Cob!>
PA 1707sCUmb",,",,
Allount Rellitt.d
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=m-j-ix-AFii-liiFo3riiiiirici--OF-i-NHiifiTANCE-TAx-jippRAisiiiEiiiT~--ALi-oWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FORTNEY EVELYN R FILE NO. 21 02-0397 ACN 101 DATE 06-30-2003
TAX RETURN WAS: I X I ACCEPTED AS FILED
I CHANGED
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~ Abb returns assessed to date.
ASSESSMENT OF TAX:
15. Allount 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 rat. (17)
18. Amount of Line 14 taxable .t Collateral/Class Brat. (18)
19. Principal Tax Due
TAX CREDITS,
eM"<n. .<~<u ,., AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID I-I
04-16-2002 CD001081 1,578.95 30,000.00
06-02-2003 COOO2635 66.52- 2,137.71
BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-03-2003 TOTAL TAX CREDIT 33,650.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.71
TOTAL DUE 2.71
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Estate (Schedule A)
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
III
121
131
141
151
161
(7)
.00
.00
.00
.00
.00
239.745.24
.00
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Tot.l 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
191
1101
13,960.00
1.451.00
1111
1121
1131
1141
NOTE:
.00
.00
.00
224,334.24
X 00 =
X 045 =
X 12 =
X 15 =
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account~
submit the upper portion
of this form with your
tax PRyment.
239,745.24
11; .411 nn
224,334.24
.00
224,334.24
1191=
.00
.00
.00
33,650.14
33,650.14
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
Law Offices of
c--
FARRELL & SMALL
MICHAEL H. SMALL
JOSEPH MICHAEL FARRELL
201/203 South Roilrood Street
P.O. Box 113
Palmyro, Pennsylvanio 1707B-0113
717-B38-1385
717-534-2948
FAX 717-B38-7215
July 3, 2003
Cumberland County Register of wills
Attn: Cheryl
Cumberland County Court House
One Court House Square
Carlisle, PA 17013
In reo
Estate of Evelyn Ruth Fortney
File No_ 21-02-0397
Dear Cheryl:
In regard to the above-captioned matter, you will find
enclosed herewith the Remittance portion of the Notice of
Inheritance Tax Appraisement dated June 30, 2003, along with my
Escrow check No. 12078 in the amount of $2.71 made payable to the
Register of Wills. Also, I have enclosed a copy of the
Remittance slip and Escrow check, which I am requesting that you
clock-stamp and return in the enclosed self-addressed, stamped
envelope. Thank you for your assistance!
1/
Michael H. Small, Esquire
MHS/pab
Enclosures
~r
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f""'"
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8
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c:::
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I
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;g
~
"- --."
'--'"
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
DF DEDUCTIONS AND ASSESSHENT OF TAX
I-i c'_'
f~Uf.j;
,.j
.,;,.
-.,\1 ' ";,':;
!;":':;;i,i'~~:,)!" ;';'
'03 JUL -7 1\11 :44
MICHAEL H SMALL ESQ
201 S RAILROAD STREET
POBOX 113 G..1 "
PALMYRA PA !M7Ci, ", ' ' ,: '"
DATE
ESTATE OF
DI\1E OF DEATH
FiLE NUMBER
COUNTY
ACN
REY~15U ElliFP (O1-O5l
06-30-2003
,FORTNEY,
01-16-20'02
,21 Ot",'0397
CUMBERLAND
101
EVELYN
R
Amount Rellitt.d
$2.71
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 ~
;'-:"-:':'-.;';-.;'-=";;--;;;'-:'--;'A-;'--;;::;''';.--.-::::'::''-:'':::'--'':'':-'';.-'''';''~:''''-:=.';::-.:.;::::-':..-..-:--.-:.:;::.'7.-.:.::=,':::'.:.,::,.---~:"''':'-.:.-:-;'::-==-':..-.:---
--------------
law Offices of
*
!'ARRELL & SMALL
201/203 South Railroad Street
P. O. Box 113
'olmyro, Pennsylvania 1707B-0113
;.J
05'
(D~
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-0
\.'..
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CUM1>,F.RLAND COUNTY REGISTER OF WILLS
ATI'N CHERYL
CUMBERLAND COUNTY COURT HOUSE
ONE COURT HOUSE SQUARE
CARLISLE PA 17013
-
-'-
-
"
i70i3#11'32.
,.. .... .....~.
l_I.JIJ;:'
1",1/1",11/,,,,,,1/,,1/,,,11,,,11,1,1,,,,1,11,1,,1,/,,,,/1,'
COMMONWEALTH OF PENN5YL VANIA
DEPARTMENT OF REVENUE
BUREAU OF INOlVIDUAl TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SMALL MICHAEL H ESQ
POBOX 113
201/203 SOUTH RAILROAD STREET
PALMYRA, PA 17078
-n-----Iold
ESTATE INFORMATION: SSN: 205-09-9134
FILE NUMBER: 2102-0397
DECEDENT NAME: FORTNEY EVELYN RUTH
DATE OF PAYMENT: 07/07/2003
POSTMARK DATE: 07/03/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 01/16/2002
NO. CD 002771
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2.71
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 12078
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$2.71
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
'HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
'*'
REY-I6D4 ElrAFP (Ol-Ul
G
124 CLARK
LEMOYNE
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)
DATE
,ESTATE OF
DATE OF DEATH
FILE NUMBER
P ~~~~
ACN
06-25-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
205-09-9134
02111348
A.ouni: Reltitt.d
EVELYN
R
Rw\'
Hc'
P STONER
ST
JUL -7
PA 17043 l."
Ct'!r:~(
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-1604 EX AFP (01-03)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 06-25-2003
ESTATE OF FORTNEY
EVELYN
R DATE OF DEATH 01-16-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0397
ADJUSTMENT BASED ON:
S.S/D.C. NO. 205-09-9134
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
02111348
FINANCIAL INSTITUTION, FULTON BANK
ACCOUNT NO. 522-0065937
TYPE OF ACCOUNT, () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTA8LISHED 11-19-1994
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE nn
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.J
G
124 CLARK
LEMOYNE
P STONER
ST
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
~~~NT~Y HELD ORU;;:ST ASSETS
F,.. , ''EST ATE OF
DATE OF DEATH
FILE NUMBER
"03 JUL - 7
P 4 ~~~~
ACN
*'
BUREAU OF INOIVIDUAL TAXES
INHERITANCE TAX DIVISION
nEPT. 280601
HARRISBU~G, PA 17128-0601
REV-IU4EXAFP 101.031
u~;
PA 17043 Cl:lnt;
06-25-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
205-09-9134
02127965
"..ount R.llltt.d
EVEL YN R
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-1604 EX AFP (01-03)
.. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ..
DATE 06-25-2003
ESTATE OF FORTNEY
EVELYN
R DATE OF DEATH 01-16-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0397
ADJUSTMENT BASED ON:
S.S/D.C. NO. 205-09-9134
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
02127965
FINANCIAL INSTITUTION: CITIZENS BANK
ACCOUNT NO. 00355-075984
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 10-05-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
1.000
.00
.00
.00
.15
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $I, NO PAYMENT IS REllUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV'1470EX(&'88)
'*'
INHERITANCE TAX
EXPLANATION
OF CIif1J~~ES
\,.~ '.>
',j
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
FILE NUMBER
REVIEWED BY
Phyllis Hoch
'OJ JUL -( 104.\ LI
ACN
2102.0397
02111347,48,02127965
EVELYN R FORTNEY
ITEM
SCHEDULE NO. ElIPLANATION OF CHANGES
ADJUSTED ABOVE ACN'S TO ZERC): REPORTED ON PROBATE RETURN.
ROW
Paq8 1
\ /7~S-~-i
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128~0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REW~lU1 EX AFP (Gl-Ul
~--=l
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
i~ 9 :;!O COUNTY
ACN
07-21-2003
FORTNEY
01-16-2002
21 02-0397
CUMBERLAND
101
EVELYN
R
MICHAEL H SMALL
FARRELL & SMALL
PD BOX 113
PALMYRA
ESQ
'OJ
JUL 28
Allount Relllfted
L' .c.
PA 17d'}ur-:-:b
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insur. proper cr.dit to your account) subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6ifj-Eif-AFP-foFo3Y------.ioii"iNiiE"RiTANCE--TAX-STATEMENT-iiF"-AC-couiif--iE..--------------- - -- ---
ESTATE OF FORTNEY EVELYN R FILE NO. 21 02-0397 ACN 101 DATE 07-21-2003
THIS STATEHENT IS PROVIDED TO AOVISE OF THE CURRENT STATUS OF THE STATEO ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SU""ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, TNE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTEO INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 06-30-2003
PRINCIPAL TAX DUE: ...
33,650.14
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-16-2002 CDOOI081 1,578.95 30,000.00
06-02-2003 CD002635 66.52- 2,137.71
07-03-2003 CD002771 2.71- 2.71
TOTAL TAX CREDIT 33,650.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SlOE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL OUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE OUE A REFUNO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )