HomeMy WebLinkAbout02-1047PETITION FOR PROBATE and GRANT OF LETTERS
may
Estate of i'iAR~;ARET ~. BROWN t{aaK'N5 No. 21-02-1047
also known as To:
C. Register of Wills for the
_`1 Deceased. County of Cumberlalld in the
Social Security No. 00 -16 -'3 2 ~ S Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut orG named
in the last will of the above decedent, dated FE$RUARY 17 , 19~_
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in CUPiBERLAND County, Pennsylvania, with
h er last family or principal residence at 1 700 A4ARKFT ~~~RFFm .
_ CAPSP f;TT.T.. ~FNNevT varlTA 1 701 1
(list street, number and muncipality)
Decendent, then 7 fi years of age, died ATARC_tt 8 ,~di~La 00 ~ ,
at
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If 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
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~etamar~t~r .
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
Piarlene Brown Yakowicz
,-. --
~ ;, i ~ / Ltax KIlO I i xoaa
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Pamela Browl~
1 "35 Frankl i nh~wli Read
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF ~a~r~FUI~.I~Atr,
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed - ~ ~~~-'~''~- ~u`~""'' `""`"`~"' "~
before me this 22nd day of
OVEMBER ~ %`
,/7 „ ~~.PJ.~~!y~,,,r, register
$175,000.00
NO. 21-02-1047
Estate of PiARGARET C . BROWN ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 22 ___~~2002 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated Febr~~r~-17, ~ sl-s~~~ --
described therein be admitted to probate and filed of record as the last will of _ _
T~ARCARF.'j' (• . $Rn4dN ~~ ,
and Letters Testamentary a
are hereby granted to ~,ar1 A„o Rrntrn ~~1r~T~~.v~_~,~c, -~~n~e~_
~~l12c2~/~~7 (fI.l~
Register of Wills
FEES
Probate, Letters, Etc. ......... S 235.00
Xho a eestificates( ) .......... ~ 1-~~~
Renunciation ................ ~
JCP ~ 10.00
TOTAL ~ 281.00
Filed ..N4Y.~M$~R .22, . 2.O.Q2 ............ .
ATTORNEY (Sup. Ct. LD. No.)
.ADDRESS
PHONE
21-02-1047
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribin mess to the will presented herewith, (each) being duly
law, depose(s) and say(s) tha~~ _ ,~
the testat ,sign the same and that ~~
request of testat in l~ presence and (in
other subscribing witness(es)).
~'
Sworn to or affirmed and
me this
~'berore
_ day of
19
Register
fied according to
.present and saw
signed as a witness at the
of each other) (in the presence of the
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
gene ~~o~
(each) a subscriber hereto, (each)
ko w. ~ i. a ~ ~me l~ ~~~ ~~ o w -~
eing duly qualified according to law, depose(s) and say(s) that
familiar with the signature of ,
codicil
testat of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of ___ knowledge and belief
Sworn to or affirmed and subscribed before
me this o2o2r~~_ day of
'~I 0.~~
~GCcJ,~.~ ~s~~ Register
'- 7
~~~-
!Name)
'e'
21-02-1047
MARGARET C. HOPKINS, IN THE COURT OF COMMON PLEAS
Plaintiff YORK COUNTY, PENNSYLVANIA
NO. 95SU 03246-02D
v.
CIVIL ACTION -- LAW
JAMES C. HOPKINS,
Defendant IN DIVORCE
ELECTION 'TO RESUMr^~ PRIOR i1AME
I, Margaret C. Hopkins, do hereby elect to resume my prior
name, to wit: Margaret C. Brown. I have been divorced from my
former husband by Decree in the Court of Common Pleas of York
County, Pennsylvania, entered to the above number and term on
July 29, 1996, and give this written notice avowing my intention
in accordance with the provisions of the DIVORCE CODE, Act No.
1980-26 Section 702.
Marga et C. Hopki to be known as
- ~ Marget C . - Brown• - ._
Sworn to and subscribed
bef re me this ~ ~/~ day
of ~/ 1996.
- .._-,
~,~ '
Notary Public
(SEAL) NOTARIAI_SfAL "~~~,°:!~,"1~'' ; •'~'
PATRICIA A. BOYER, Notary Public / i'' ~~ ' '
Hershey, Dauphin County
My Commission Expires July 7, y997
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his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
L l Registrar
P 813275
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21-02-1047
H105 .17 Rav ?187
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
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REGISTRAR'S SIGNATURE AND NUMBER
-' T'"`_ -._- _-_
''(/]~J`~./~('
DATE FILEDIMO~nn Oar. read
21-02-1047
LAST WILL AND TESTAMENT
OF
MARGARET BROWN HOPRINS
I, Margaret Brown Hopkins, of Dauphin County,
Pennsylvania, being of sound and disposing mind, memory, and
understanding, do hereby make, publish, and declare this as
and for my Last Will and Testament, hereby revoking all
other wills and codicils previously made by me.
FIRST
I direct the payment of my debts and expenses of my
last illness and funeral from my estate as soon after my
death as conveniently may be done.
SECOND
I direct that any and all Inheritance, Estate,
Transfer, Succession, and other taxes imposed upon my estate
passing under this Will or any codicil hereto, and interest
and penalties thereon, if any, shall be paid out of the
principal of my residuary estate as if such taxes were
administrative expenses. I authorize my Personal
Representative to pay all such taxes at such time or times
as my Personal Representative deems advisable.
THIRD
I give and bequeath all of my :jewelry to my Personal
Representatives to distribute to my daughters, grandchildren
and great-grandchildren in remembrance of me.
FOURTH
I give, devise and bequeath one-fourth of the rest,
a
residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the following terms
and conditions:
(a) Hold the entire trust fund for my granddaughter,
Michelle Lynn Brown Yakowicz who I have always felt is more
like a daughter to me because I raised her and even though I
deeply love all of my grandchildren, Michelle was a part of
my household.
(b) In the event of Michelle's death, hold the entire
trust fund for my great-granddaughter Celia Marlene Hartz.
(b) Pay so much of the income and so much of the
principal as may be deemed advisable by my Trustees for the
support, maintenance, and medical expenses of the
beneficiary or for whatever expenditure whatsoever on behalf
of my beneficiary. In making such payments, the amounts to
be paid by my Trustees from time to time shall be
established and determined by my Trustees, in their
discretion, upon the basis of the needs of the beneficiary.
(c) I authorize my Trustees to make the aforesaid
payments to my beneficiary if, in the opinion of my
Trustees, my beneficiary is of such ability to properly
apply the funds so received. The amount of payments and the
time the payments are made shall be determined by my
Trustees.
(d) If the beneficiary shall, in the opinion of my
Trustees, become mentally or physically incapacitated, the
fund shall remain in trust and my Trustees may apply the
S
fund, either principal or income, for the support and
welfare of the beneficiary, directly, without the
intervention of any guardian.
(e) If my great-granddaughter, Celia Marlene Hartz, in
her lifetime, does not receive all of the assets of the
trust fund, then I request that all remaining assets become
a part of the rest, residue and remainder of my estate and
be distributed in the manner provided in this instrument.
FIFTH
Since my son Earl Howard Brown, Jr., M.D., has always
been given my love and affection and since he has received
his college education and medical doctorate degree and has
ample means to provide for himself and his family, I give,
devise, and bequeath to each of my daughters, Marlene Brown
Yakowicz, Pamela Jean Brown and Melanie Brown Hauck,
one-fourth of my estate: provided that each daughter
receives her share only if she survives me by thirty (30)
days.
SIXTH
(a) In the event that my daughter, Pamela Jean Brown,
fails to survive me, or fails to survive me by thirty days,
then I request that her one-fourth share of my estate become
part of my residuary estate.
(b) In the event that my daughter Marlene Brown
Yakowicz, fails to survive me, or fails to survive me by
thirty days, I give, devise and bequeath her one-fourth
share of the rest, residue and remainder of my estate, to my
4
Trustees, IN TRUST, however, to act as Trustees upon the
following terms and conditions:
(1) Hold the entire trust fund for my
granddaughter, Megan Yakowicz, to be held IN TRUST according
to the same provisions enunciated in the Third Paragraph,
Items (b), (c) and (d) of this my Last Will and Testament.
(2) If my granddaughter, Megan Yakowicz, in her
lifetime, does not receive all of the assets of the trust
fund, then I request that all remaining assets become a part
of the rest, residue and remainder of my estate and be
distributed in the manner provided in this instrument.
(c) In the event that my daughter Melanie Brown Hauck,
fails to survive me, or fails to survive me by thirty days,
I give, devise and bequeath her one-fourth share of the
rest, residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the following terms
and conditions:
(1) Hold the entire trust fund, in equal shares,
for my granddaughters, Gwendolyn Brown Hauck and Elizabeth
Brown Hauck, to be held IN TRUST according to the same
provisions enunciated in the Third Paragraph, Items (b), (c)
and (d) of this my Last Will and Testament.
(2) If my granddaughters, Gwendolyn Brown Hauck
or Elizabeth Brown Hauck, in their respective lifetimes, do
not receive all of the assets of the trust funds, then I
request that all remaining assets become a part of the
surviver's trust fund.
e
5
(i) If my granddaughters, Gwendolyn Brown
Hauck or Elizabeth Brown Hauck, do not receive all of the
assets of their trust funds, then I request that all
remaining assets become a part of the rest, residue and
remainder of my estate and be distributed in the manner
provided in this instrument.
SEVENTH
I give, devise and bequeath the remainder of my estate,
if any, to my surviving grandchildren and great
grandchildren in equal shares.
EIGHTH
Any and all payment or payments of any sum or sums,
whether in cash or kind and whether for principal or income,
payable to any beneficiary, shall be free of the debts,
contracts, alienations, and anticipations of any
beneficiary, and the same shall not be liable to any levy,
execution, sequestration, or attachment while in the
possession of the Trustees or Personal Representatives.
NINTH
In addition to the powers conferred by law, I authorize
my Trustees to exercise the following in their discretion:
(a) To exercise all powers and discretion, guided by
the prudent man rule.
(b) To exercise all power, authority, and discretion
given by this Will after the termination of the trusts
created herein until the same are fully distributed.
TENTH
s
h
In addition to the powers conferred by law, I authorize
my Personal Representatives to exercise the following in
their discretion:
(a) To retain any real or personal property which may
at any time form a part of my estate as long as deemed
advisable.
(b) To exercise any option or rights arising from
ownership of investments.
(c) To repair, alter, improve, or lease for any period
of time any real or personal property and to give options
for leases.
(d) To sell at public or private sale, for cash or
credit, with or without security, to exchange or to
partition real or personal property and give options for
sales or exchanges.
(e) To compromise claims without court approval, and
without the consent of any beneficiary.
(f) To make distribution in kind.
ELEVENTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown, Trustees of the Trusts
created herein in this my Last Will and Testament.
TWELFTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown as my Personal
Representatives and Co-Executors of this my Last Will and
Testament.
THIRTEENTH
I direct that no Guardian, Trustee, E~~ecutor, Personal
Representative, or other fiduciary named, nominated, or
appointed in this, my Last Will and Testament, shall be
required to post any bond or give any security of any type
for any purpose whatsoever, any law or rule of court of the
Commonwealth of Pennsylvania or any other .jurisdiction to
the contrary notwithstanding.
IN WITNESS WHEREOF, I, Margaret Brown Hopkins, have
hereunto set my hand and seal to this, my Last Will and
T
estament, consisting of seven (7) typewritten pages, this
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l/ ..~,. -~ - .~,~_ d a y o f ~ .,G' ;~-~~*.~ ~,- / ~ 19 9 6 .
~y~f ~,!,~ . ,;.
/ n ~ (SEAL)
Margaret Brown Hopkins
Signed, sealed, published, and declared by the above
named, Margaret Brown Hopkins, as and for her Last Will and
Testament, in the presence of us, who, at her request, have
hereunto subscribed our names as witnesses thereto in the
presence of the said testatrix. f,
W i t n e s s e s. ~>~i.r'".l'r'?L~l"l,C' C/ f r'~c,~~~~ ( SEAL )
Address:
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(SEAL)
Address:
is C~~ ~~~J C~~ ~7'
Commonwealth of Pennsylvania
County of
We, Margaret Bro~rn Hopkins, and 1/t,-~=~-~/~°~z.G~~ ~~"~-`-v~`"~
the testatrix and the witnesses respectively, whose names
are signed'to the attached instrument, being first duly
sworn and qualified according to law, do hereby declare to
the undersigned authority that we were present and saw the
testatrix sign and execute the instrument as her Will, and
that she signed willingly, and that she executed it as her
free and voluntary act for the purpose therein expressed,
and that each of the witnesses, in the presence and hearing
of the testatrix signed the Will as witness and that to the
best of our knowledge the testatrix was at the time eighteen
years of age or older, of sound mind and under no constraint
or undue influence, and I, the said testatrix do hereby
acknowledge that I signed and executed the instrument as my
Last Will, that I signed it willingly, and that I signed it
as my free and voluntary act for the purpose therein
expressed.
Mar aret Brown Hopkins
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,(Witness)
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(Witness)
Sworn and subscribed to
before me this day
of 199Fi .
Notary Public
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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. CD 001918
SALOMON SMITH BARNEY INC
11 N THIRD STREET
HARRISBURG, PA 17101
-------- fold
ESTATE INFORMATION: ssly: Zoo-is-a2sa
FILE NUMBER: 2102-1047
DECEDENT NAME: HOPKINS MARGARET BROWN
DATE OF PAYMENT: 1 2/06/2002
POSTMARK DATE: 1 2/05/2002
couNTY: CUMBERLAND
DATE OF DEATH: 03/08/2002
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ S 12,000.00
TOTAL AMOUNT PAID:
REMARKS: SALOMON SMITH BARNEY INC
CHECK# 72497506
SEAL
INITIALS: AC
RECEIVED BY: MARY C. LEWIS
REV-1162 EX111-96)
S 12, 000.00
REGISTER OF WILLS
REGISTER OF WILLS
/~ l002- ~~
December 4, 2002
Ms Marlene Brown Yakowicz
227 Oak Knoll Rd.
New Cumberland, Pa.17070
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
(717) 787-3930
FAX (717) 772-0412
Re: Estate of Margaret Brown Hopkins
File Number 2102-1047
Dear Ms Yakowicz:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before June 08,2003. Because Section
2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s)
will be granted that would exceed the maximum time permitted.
Sincerely,
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~l1 ~effrey Hollenbush, Supervisor
Document Processing Unit
Inheritance Tax Division
_ _
Inventory of the real and personal estate of /
MARGARET BROWN HOPKINS
deceased
Individual Retirement Account 159073 17
Solomon Smith Barney 724-60955
Financial Management Account 3443 10
Solomon Smith Barney 724-07602
PNC Bank Checking 50-0557-3185 24090 34
PNC Bank Savings 50-0132-9636 2835 19
PNC Certificate 31300105577
11979 31
Northwest Savings Bank 804070852 4771 22
Northwest Savings Bank 800101233 i
970 33
Northwest Savings Bank 800100645
.
~~ 8118 69
--.
300 shares common Northwest Savings}Bank C $11.88/share as of dod 3564 00
80 shares common Allegheny Energy, Inc. C $37.80/share as of dod 3024 00
Mellon Investor Services account BROWN----MARGC0000 001 750 ~
01736110 ~
21869 135
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
Marlene Brown Yakowicz and Pamela Jean Brown
-------
being duly _sworn _ _____ according to law, deposes and says that they are ___
Co-Executors of the Estate of _MARGARET BROWN HOPKINS
late of ___- __ _-..Camp Hi_l_l ___ ____-._____, Cumberland County, Pa., deceased and that the
within is an inventory made by _ the_ Co-Exec-~_t9_r~_ above__na_med _ ,the said co-executors
of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of,#he Inventory repfesent, it's fair value
as of the date of decedent's death. ='~:~==~= ""-= 5.1~~'~`~ ~~~-~-U--~`-~
__ and subscribed before me, I •' /? ;~~,~'__ L 1.., '~ ~
i _- --. - ----------- ---
E cad u-or -Administrator
~ _ z ~---~ L.°`~~ ~ 227 Oak Knoll Road
_ _ ~ Ne_w_ Cumberland, Pa. 17070_ and _
~~"`"~''~'~~''~`~~" _ ~ 135 Franklintown Road
Nouu;al Seal Dillsburg r Pa . 17019
Public i --------- ------- ---
Patricia A. Gordon, Notary i
Fairview 'NJ .York Couary JI
My Commission Expires July 31, 2Q05
Memper, Pennsylvania Associat~nof~ Marc h
Date of Death
Day
Month
Address
2002
Yeer
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. $ee Article IV, Fiduciaries Act of 1949.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(al
Name of Decedent: MARGARET BROWN HOPKINS
Date of Death:
March 8, 2002
Will No. 21-02-1047
Admin. No. PA No. 21-02-1047
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 2/19/02
Name
Melanie Brown
Address
224 East Canal Street, Hummelstown, Pa 17036
Michelle Yakowicz Hartz 2580 Lewisberry Road, No. 9, York Haven, Pa.
17370
Earl H. Brown 1018 Center Schoolway, West Chester, Pa.
19382
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: February 19, 2002
r
Signature ~~~
Marlene Brown Yakowicz and
Name Pamela Jean Brown
227 Oak Knoll Road
Address New Cumberland, Pa. 17070 and
135 Franklintown Road
Dillsburg, Pa. 17019
717-774-7409
Telephone ( ) 717-432-2640
X s
Capacity: Personal Representative
Counsel for personal representative
~/
COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
Claimant B99503
Representative and/or his/her counsel
In Re: The Estate of: Court File No: 21-o2-1oa7
MARGARET BROWN
Deceased
T0: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: BANK ONE
c/o NCO Financial Systems, Inc
2) Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
4,972.73
4) The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
5) Decedent's address: 227 OAK KNOLL RD. ,NEW CUMBERLAND, PA 17070
6) Date of Death: o3-os-o2
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare nd aff under he penalties of
perJury that they Information and representatio mad rein re a and correct
to the best of my knowledge, information and lief. ,
Dated: Apri128, 2003
Written notice of claim was given to Persoirn
as stated below:
MARLENE YAKOWICZ
Name
227 OAK KNOLL RD.
Address
NEW CUMBERLAND, PA 17070
City/State/Zip
Apri128, 2003
Date notice mailed
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
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ENT
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COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of: Court File No: 21-02-1047
MARGARET BROWN
Deceased
T0: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: BANK ONE
c/o NCO Financial Systems, Inc
2) Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
9,148.94
4) The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
5) Decedent's address: 227 OAK KNOLL RD. ,NEW CUMBERLAND, PA 17070
6) Date of Death: o3-os-o2
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by.
On behalf of the claimant, I do solemnly declare d affir under tf1'e p nalties of
per ury that they Information and representatio made ein ar tr and correct
to t~e best of my knowledge, information and lief.
Dated:Apri128, 2003 ` /
Claimant B99503
Written notice of claim was given to Personal Representative a d/or his/her counsel
as stated below:
MARLENE YAKOWICZ - - '='~Elf1}~
Name ""=','?
.~. .
227 OAK KNOLL RD.
Address L ~= ltd LZ ,ttJW ~Q,
NEW CUMBERLAND, PA 17070
City/State/Zip
Apri128, 2003
Date notice mailed ,, :''~. "'~~l
.,:=sa2~
ENT
REV.1500'.:.x(6.oo)
" r' , no, _ \ '
,\t-'.-c:>C ~
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
'lllll. DEPARTMENT OF REVENUE
DEPl 280601
HARRISBURG, PA 17128.0601
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OFhCIi',L USE. QNLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FilE NUMBER
21 02
COUNTY CODE
SOCIAL SECURITY NUMBER
YEAR
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DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL)
HOPKINS, MARGARET B.
DATE OF DEATH (MM-DD.YEARI
03/08/02
DATE OF BIRTH (MM-DD-YEAR)
08/06/25
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1047
-----
NUMBER
~ 1. Original Return
o 4. limited Estate
o O. Decerlent Died Testate (Mach copy olWiIl)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (data oldealh after 12-12-82)
o 7. Decedent Maintained a Uving Trust (Altach copy of Trust)
o 10. Spousal Poverty Credit {date 0/ death between 12.31-91 alld 1.1.951
o 3. Remainder Return (date of deall1 prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113{A) IMtactlScl\O}
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hmrl!'~gCTIj;iiliMl(s:t,[BE[e()M: .__
NAME
Marlene Brown Yakowicz
FIRM NAME (ll Applicable)
TELEPHONE NUMBER
(717) 720-3294
227 Oak Knoll Road
New Cumberland, PA 17070
(1)
(2)
(3)
(4)
(5)
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0.00
215,066.50
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule Dl
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule GorL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
17,728.83
4,910.22
(11)
(12)
(13)
(6)
0.00
(7)
45,000.00
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
_ ,_0__ (15)
239,130.83 , .0 i5... (16)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
,.12 (17)
18. Amount of Une 14 taxable at collateral rate
, .15 (18)
19. Tax Due
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20 [EJ
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266,680.10
27,549.27
239,130.83
0.00
239,130.83
0.00
10,760.89
0.00
0.00
10,760.89
. Decedent's Complete Address:
STREET ADDRESS
1700 Market Street
CITY Camp Hill I STATEpA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. CreditS/Paymenls
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
10,760.89
0.00
12,000.00
600.00
Tolal Credits ( A + B + C ) (2)
12,600.00
3. InteresUPenalty if epplicable
D.lnleresl
E. Penalty
0.00
1,839.11
TotallnleresUPenalty ( D + E ) (3)
4. If Une 2 is grealer than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
B. Enler Ihe lolal of Une 5 + SA. This is Ihe BALANCE DUE.
(5)
(SA)
(5B)
5. If Une 1 + Une 3 is grealer Ihan Une 2, enler Ihe difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
H Til[UlI!lV -- . !. 1l1liil', -", ~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and: Yes
a. relain 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; aT............................................."............ ................................ .. 0
d. receive the promise for life of either payments, benefits or care?.. .................... ....................... .. D
2. If death occurred after December 12, 1982, did decedent transfer property wilhin 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?..
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . ......,....................... ................... ................,............
.. Ii]
o
Ur'lder penalties of pe~ury, I declare thai I have examined this return, including acoompanylng schedules and statements, and 10 the best of my knowledge and belief, it is true, correct
and complete.
Declaralion of pre parer other than the personal represenlative is based on all infOfmalion of which preparer has ant owledge,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
,. ~ .I-",-<.",-n U 06/04/03
ADDRESS
227 Oak Knoll Road, New Cumberland, PA 17070; 135 Franklintown Road, Dillsb
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rale imposed on the net value of transfers to or for Ihe use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rale 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) (ji)l.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
Ine surviv'lng spouse is Ihe only beneficiary.
For dales 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 slepparent of Ihe chiid is 0% [72 P.S. 99116(a)(1.2)].
The lax rale imposed on Ihe nel value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, excepl as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)}.
The lax rale imposed on the net value of lransfers to or for the use of Ihe decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A siblin9 is defined. under Seclion 9102, as an
individual who has at least one parent in common with the decedent. whether by blood or adoption.
REV.' 503 EX. (6.98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Margaret Brown Hopkins
FILE NUMBER
21-02-1047
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
,.
DESCRIPTION
300 Shares Common Northwest Savings Bank @ $11.88/share as of DOD
2. BO Shares Common Allegheny Energy, Inc. as of DOD
VALUE AT DATE
OF DEATH
3564.00
Closing Price 37.8
Day's High 38.44
Day's Low 37.B
Mean Price 38.12
3049.60
TOTAL (Also enter on line 2. Recapitulation) $
(If more space is needed. insert additional sheets of Ihe same size)
6,613.60
REV.150B EX. (6-98)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MARGARET BROWN HOPKINS
FILE NUMBER
21-02-1047
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTlDN
1. Solomon Smith Barney - Individual Retirement Account 724-60955
P.O. Box 12057, 11 North Third Street, Harrisburg, PA 17101,717-780-1700
VALUE AT DATE
OF DEATH
159073.17
2. Solomon Smith Barney - Financial Management Account 724-07602
P.O. Box 12057,11 North Third Street, Harrisburg, PA 17101,717-780-1700
3. PNC Bank Checking 50-0557-3185
P.O. Box 609, Pittsburgh, PA 15230, 1-888-762-1099
4. PNC Bank Savings 50-0132-9636
P.O. Box 609, Pittsburgh, PA 15230,1-888-762-1099
5. PNC Bank Certificate 31300105577
P.O. Box 609, Pittsburgh, PA 15230,1-888-762-1099
3443.10
24090.34
2835.19
11979.31
6. Northwest Savings Bank - Checking 804070852
Second and Liberty Streets, Warren, PA 16365, 717-533-9980 (Hershey branch)
7. Northwest Savings Bank - Savings 800101233
Second and Liberty Streets, Warren, PA 16365, 717-533-9980 (Hershey branch)
8. Northwest Savings Bank - Savings 800100645
Second and Liberty Streets, Warren, PA 16365, 717-533-9980 (Hershey branch)
4771.22
947.39
7926.78
TOTAL (Also enter on line 5. Recapitulation) $
215,066.50
(If more space is needed, insert additional sheets of the same size)
..,L()(.. ',(,;,... ..:;.....('7.{)
Security Account
Lirrjted Discretionary Authorization
7 ;), '-J b 0 q b) /;; ..:, I / -.L ~ ~
SMITH BARNEY
AMelllberofTravelersGroupj
This authorization is a limited discretionary authorization. It does not empower the agent named herein to withdraw any money.
securities or other property either in the name 01 the principal(s) or otherwise.
Please read carefully, sign and return to
Smith Barney Inc.
New Accounts Department
388 Greenwich Street
New York, NY 10013-2396
ACt\)ull\ ... _IT IC~ IfC _
b9~~j
Check 0 Fe CODE 64 rd THIRD PARTY
One: AGENT L1>l.AGENT
7~
CODE74
WARNING
This is an important legal document. It creates a durable power of at/orney. Before executing this document, you should know
these important facts:
a) This document may provide the person you designale as your at/orney-in-fact with broad powers to dispose, sell, convey and
encumber your (!roperty.
b) These powers will exist for an indefinite period of time and will continue to exist notwithstanding your subsequent disabitity,
incompetency or incapacity.
c) You have the right to revoke or terminate this durable power of at/orney by. giving us writ/en notice addressed to the branch
office servicing your account. Such revocation shall not affect your liabitlty for any transaction initiated prior to our receipt
of said revocalion.
1. The undersigned Client hereby authorizes (agent's name)
-nt~ g:~ ~~
/ .)
(whose signature appears on the reverse) as the undersigned's agent and
attorney-in-fact to buy. sell (including short sales) and trade in stocks,
bonds, options (including uncovered short positions in option contracts
or in the uncovering of any existing short position in option contracts) and
any other securities and/or contracts relating to the same on margin or
otherwise in accordance with your terms and conditions tor the
undersigned's account and risk in the undersigned's name, or number on
your books, it being turther understood that any such transaction may be
effected with you as principal or dealer or through you as agent or broker,
and that any such purchase may involve securities in the distribution of
which you may have an interest as underwriter, member of selling group,
or otherwise. The undersigned hereby agrees to indemnify and hold you
harmless from and to pay you promptly on demand any and all losses
arising therefrom or debit balance due thereon.
2. In all such purchases, sales or trades you are authorized to follow the
instructions of the above-named person in every respect concerning the
undersigned's account with you, and he or she is authorized to act for the
undersigned and in the undersigned's behalf in the same manner and with
the same force and effect as the undersigned might orcould do with respect
to such purchases, sales or trades.
3. The undersigned hereby ratifies and confirms any and all transactions
with you heretofore or hereafter made by the aforesaid agent or for the
undersigned's account.
4. This authorization and indemnity is in addition to (and in no way limits
or restricts) any rights which you may have under any other agreement or
agreements between the undersigned and your corporation.
5. To revoke this authorization, the undersigned hereby agrees to submit
a written notice addressed to you and delivered to the branch office serving
the account, but such revocation shall not affect any liability in any way
resulting from transactions initiated prior to such revocation.
6. This agreement shall inure to the benefit of your present corporation
and of any successor corporation(s) or assigns.
7. ARBITRATION.
. Arbitration is linal and binding on the parties.
. The parties are waiving their right to seek remedies in court,
including the right to jury trial.
. Pre-arbitration discovery is generally more limited than and
dillerent from court proceedings.
. The arbitrators' award is not required to include factual
lindings or legal reasoning and any party's right to appeal or
to seek modification 01 rulings by the arbitrators is strictly
limited.
. The panel 01 arbitrators will typically include a minority of
arbitrators who were or are alliliated with the securities
industry .
I agree that all claims or controversies, whether such claims or
controversies arose prior, on or subsequent to the date hereof,
between Smith Barney Inc. and me and/or any 01 your present
or lormer ollicers, directors, or employees concerning or
arising Irom (i) any account maintained by me with Smith
Barney Inc. individually or jointly with others in any capacity;
(ii) any transaction involving Smith Barney Inc. or any
predecessor lirms by merger, acquisition or other business
combination and me, whether or not such transaction occurred
in such account or accounts; or(iii)the construction, perlormance
or breach olthis or any other agreement between us, any duty
arising Irom the business of Smith Barney Inc. or otherwise,
shall be determined by arbitration belore, and only belore, any
sell-regulatory organization or exchange olwhich Smith Barney
Inc. is a member. I may elect which of these arbitration lorums
shall hear the matter by sending a registered leller or telegram
addressed to: Smith Barney Inc., Law Department, 388
Greenwich Street, New York, NY 10013-2396. II I lail to make
such election belore the expiration of live (5) days aller receipt
of a wrillen request Irom Smith Barney Inc. to make such
election, Smith Barney Inc. shall have the right to choose the
lorum.
No person shall bring a putative or certified class action to
arbitration, nor seek to enforce any pre-dispute arbitration
CLIENT'S COPY - KEEP FOR YOUR RECORDS Continued on reverse side
CPI5121
CLIENT'S COPY. KEEP FOR YOUR RECORDS
.
. agreement against any person who has initiated in court a
putative class action; or who is a member 01 a putative class
who has not opted out 01 the class with respect to any claims
encompassed by the putative class action until: (i) the class
certilication is denied; (ii) the class is decertified; or (Iii) the
customer is excluded Irom the class by the court.
Such lorbearance to enlorce an agreemenllo arbitrate shall not
conslilute a waiver 01 any rights under this agreement except to
the extent stated herein.
8. This authorization shall remain in full force and effect unless revoked
by the undersigned in accordance with the procedures stated above or until
you receive actual notice of my death or other legally mandated causes for
revocation.
~&
Complete name ~
a/account
9. If any provision of this agreement is or becomes inconsistent with any
applicable present or future law, rule or regulation, that provision will be
deemed rescinded or modified in order to comply with the relevant law, rule
or regulation. All other provisions of this agreement will continue and
remain in full force and effect
10. This authorization shall not be allected by the subsequent
disability, incapacity or incompetency olthe undersigned nor
by a lapse 01 time between its execution and exercise.
11. I (We) acknowledge receiving a copy of this agreement
12. This agreement shall be governed and construed in accordance with
the laws of the State of New York without giving effect to principles of
conflict of laws, except that the statute of limitations applicable to claims
shall be that which would be applied by the Federal District Court where the
Client resides.
~" _ _ :_ o-#-,~ a, -" ",-Y
This authorization contains a pre-dispute arbitration agreement which begins on the Iront olthis lorm at paragraph 7.
A. Clienl's ")...y,. .. 7' Oale
CLIENT'S Signalure / II ~ / /..
SIGNArURE(S) Clienl's -/...3'/ /1'f
THIS AGREEMENT Signalure
MUST BE SIGNED
BEFORE A NOTARY
PUBLIC
and
to me known and known to me to be the individual(s) described in and whO executed the above
instrument, and acknowledged to me that he/she/they executed the same.
(!,~~~~~;,u
SIGNATURE OF NOTARY PUBLIC
B. By signing below, I the agent for the prlncipal(s) named herein, accept this appointment and agree to be bound by the terms of this authorization including the
AGENT'S provisions for arbitration of disputes. Being first duly sworn, I do hereby state that this authorization was executed by the principal(s) at a time when he or she
ACKNOWLEDGMENT was legally competent to perform such act and that it has not been terminated by any means including voluntary revocation or death of the principal(s).
AND AFFIDAVIT SIGNATURE OF AGENT (individual 10 IJ Dale
THIS whomaulhorlzationisgranted) 'J1J..J<--< t).,- L \ ""7/'~....t /6 /99Y
ACKNOWLEDGMENT Yl
AND AFFIDAVIT
MUST BE SIGNED Slate of .
BEFORE A NOTARY 11... ~ tl
PUBLIC County of ~.p-<i...~
,
State of ~.
County of ",lYtu /J ~
. /
}ss
(SEAL)
Nolzr;:;,1 S9al
C. Louis8 Kra:.!tl1eiif'" i\lo~3r"/ Public
H::misburg. Dauphin COWlty
fl.iy Commission Expires Jan. 25, 1999
}ss
OnlhisJ/d
Public forlhe Counlyol
19 '71' belor,meaNolary
dayofr-.v.
perSOnaIlYappear~~ ~</7'---'
Subscribed and sworn to before me this
/ t, 7'1.-.
dayof'7?1.<./LL 19 <If
(SEAL)
Notarial Seal
C. Louise Krauthelm, Notary Public
Harrisburg, Dauphin County
My Commission Expires Jan. 25, 1999
~ . ~ I
(I. <<<.6L U,Url.u?:J
, SIGNATURE 0 NOTARY PUBLIC
Approved by Branch Mgr.
Regional Director Approval
'11{ j/2fi!
, Security Account
Limited Discretionary Authorization
7v'-"(
o 7 h 0 J.. i 0 ,C; / /
SMITH BARNEY
A Member ofTravelersGroupj
This authorization is a limited discretionary authorization. It does not empower the agent named herein to withdraw any money,
securities or other property either in the name of the principal(s) or otherwise.
Please read carefully, sign and return to
Smith Barney Inc.
New Accounts Department
388 Greenwich Street
New York, NY 10013-2396
Account Number
BT3nch Account I TIC I F~
7 ~ ]f C. 7 Io.p ~W l.Ql5_,l.L'
Check 0 Fe CODE 64 N'1 THIRD PARTY
One: AGENT ~GENT
CODE 74
l
WARNING
This is an important legal document. II creates a durable power of allorney. Before executing this document, you should know
these important facts:
a) This document may provide the person you designate as your allorney-in-fact with broad powers to dispose, sell, convey and
encumber your fJfoperty.
b) These powers will exist for an indefinite period of time and will continue to exist notwithstanding your subsequent disability,
incompetency or incapacity.
cJ You have the right to revoke or terminate this durable power of allorney by. giving us wrillen notice addressed to the branch
office servicing your account. Such revocation shall not affect your liability for any transaction initiated prior to our receipt
of said revocal/on.
~A;" ~,_..~ <J.. L . . ~
(7
(whose signature appears on the reverse) as the undersigned's agent and
attorney-in-fact to buy, sell (including short sales) and trade in stocks,
bonds, options (including uncovered short positions in option contracts
or in the uncovering of any existing short position in option contracts) and
any other securities and/or contracts relating to the same on margin or
otherwise in accordance with your terms and conditions for the
undersigned's account and risk in the undersigned's name, or number on
your books, it being further understood that any such transaction may be
effected with you as principal or dealer or through you as agent or broker,
and that any such purchase may involve securities in the distribution of
which you may have an interest as underwriter, member at selling group,
or otherwise The undersigned hereby agrees to indemnify and hold you
harmless from and to pay you promptly on demand any and all losses
arising therefrom or debit balance due thereon.
2. In all such purchases, sales or trades you are authorized to follow the
instructions of the above-named person in every respect concerning the
undersigned's account with you, and he or she is authorized to act for the
undersigned and in the undersigned's behalf in the same manner and with
the same force and effect as the undersigned might or could do with respect
to such purchases, sales or trades.
3. The undersigned hereby ratifies and confirms any and all transactions
with you heretofore or hereafter made by the aforesaid agent or for the
undersigned's account.
4. This authorization and indemnity is in addition to (and in no way limits
or restricts) any rights which you may have under any other agreement or
agreements between the undersigned and your corporation.
5. To revoke this authorization, the undersigned hereby agrees to submit
a wrillen notice addressed to you and delivered to the branch oltice serving
the account, but such revocation shall not affect any liability in any way
resulting from transactions 'lnitiated prior to such revocation.
6. This agreement shall inure to the benefit of your present corporation
and of any successor corporation(s) or assigns.
7. ARBITRATION.
. Arbitration is final and binding on the parties.
. The parties are waiving their right to seek remedies in court,
including the right to jury trial.
. Pre-arbitration discovery is generally more limifed than and
dillerent from court proceedings.
. The arbitrators' award is not required to include factual
findings or legal reasoning and any party's rightlo appeal or
to seek modification of rulings by the arbitrators is strictly
limited.
. The panel of arbitrators will typically include a minority of
arbitrators who were or are alliliated with the securities
industry.
I agree that all claims or controversies, whether such claims or
controversies arose prior, on or subsequenffo the date hereof,
befween Smith Barney Inc. and me and/or any of your present
or former ollicers, directors, or employees concerning or
arising from (i) any account maintained by me with Smith
Barney Inc. individually or jointly with others in any capacity;
(ii) any transaction involving Smith Barney Inc. or any
predecessor firms by merger, acquisition or other business
combination and me, whether or not such transaction occurred
in such account or accounts; or(iii)fhe consfruction, performance
or breach of this or any other agreement between us, any duty
ariSing from fhe business of Smith Barney Inc. or otherwise,
shall be determined by arbitration before, and only before, any
sell-regulatory organization or exchange of which Smith Barney
Inc. is a member. I may elect which of these arbitration forums
shall hear the matter by sending a registered leller or telegram
addressed to: Smith Barney Inc., Law Department, 388
Greenwich Street, New York, NY 10013-2396. III fail to make
such elecfion before the expiration of five (5) days after receipt
of a written request from Smith Barney Inc. to make such
election, Smith Barney Inc. shall have the right to choose the
forum.
No person shall bring a putative or certified class action to
arbitration, nor seek to enforce any pre-dispute arbitration
CLIENT'S COPY. KEEP FOR YOUR RECORDS Continued on reverse side
1. The undersigned Client hereby authorizes (agent's name)
CPI5121
CLIENT'S COPY - KEEP FOR YOUR RECORDS
agreentent against any person who has initiated in court a
II"Jtative class action; or who is a member of a putative class
who has not opted out of the class with respect to any claims
encompassed by the putative class action until: (i) the class
certification is denied; (ii) the class is decertified; or (Iii) the
customer is excluded from the class by the court.
Such forbearance to enforce an agreement to arbitrate shall not
conslilute a waiver of any rights under this agreement except to
the extent stated herein.
8. This authorization shall remain in full force and effect unless revoked
by the undersigned in accordance with the procedures stated above or unti I
you receive actual notice of my death or other legally mandated causes for
revocation.
~g
Complelename ~
alaccount
9. If any provision of this agreement is or becomes inconsistent with any
applicable present or future law, rule or regulation, that provision will be
deemed rescinded or modified in order to comply with the relevant law, rule
or regulation. All other provisions of this agreement will continue and
remain in full force and effect.
10. This authorization shall not be affected by the subsequent
disability, incapacity or incompetency of the undersigned nor
by a lapse of time between its execution and exercise.
11. I (We) aCknowledge receiving a copy of this agreement.
12. This agreement shall be governed and construed in accordance with
the laws of the State of New York without giving effect to principles of
conflict of laws, except that the statute of limitations applicable to claims
shall be that which wou Id be applied by the Federal District Court where the
Client resides.
;L.;,., ___:...o?W-,~~
This authorization contains a pre-dispute arbitration agreement which begins on the front of this form at paragraph 7.
A. Client's .~. .. 7 Dale
CLIENT'S Signalure / I J ~ / /..
SIGNATURE(S) Clienl's !/S/ /f"f
THIS AGREEMENT Signalure
MUST BE SIGNED
BEFORE A NOTARY
PUBLIC
and
to me known and known 10 me to be the individual(s) described in and who executed the above
inslrument, and acknowledged to me Ihal he/she/they execuled I he same.
e.,~ LI..,/Au;U
SIGNATU~PUBLlC
B. By signing below, I the agent for the principal(s} named herein, accept this appointment and agree to be bound by the terms of this authorization including the
AGENT'S provisions for arbitration of disputes. Being first duly sworn, I do hereby state that this authorization was executed by the princlpal(s) at a time when he or she
ACKNOWLEDGMENT was legally competent to perform such act and that it has not been terminated by any means including voluntary revocation or death of the principal(s).
AND AFFIDAVIT SIGNATURE OF AGENT (indlvldualto '-vi'1 /J J' Dale
THIS whom authorization is granted) //~......., th- .A.-.. ~A'.. fL. /99Y
ACKNOWLEDGMENT yl
AND AFFIDAVIT
MUST BE SIGNED State of .
BEFORE A NOTARY n... All
PUBLIC County 01 ~ <p-fi...~
,
Stateol~'
Countyof ",!Y2v A~
/
}ss
(SEAL)
Not-sri:;.1 Seal
C. Louise Krautlleirr., No:.3r," Public
H3.rrisburg. Dauphin County
My Commission Expires Jan. 25, 1999
}ss
OnthisJ/d
Public lor the County 01
19 '1' f' belore mea Notary
dayoljk..v.
perSOnaIlYappear~~~'~
Subscribed and sworn to belore melhis
/t,-/0
daYOI'/?1.t:u..J....., 19';6
(SEAL)
Notarial Seal
C.louise Krautheim, Notary Public
Harrisburg, Dauphin County
My Commission Expires Jan. 25, 1999
~ - ~ . I
(} . <U4.<!._ ,~.J.-<.d'iu?:J
, SIGNATUREO NOTARYPUBUC
Approved by Branch Mgr.
Regional Director Approval
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rotal Banking Statement
i'\C l\lllk
0. PNCBAN<
Primary account number: 50-0557-3185
P.?ge 1 of 2
For the period 02/08/2002 to 03/11/2002
Number of enclosures: 0
MARGARET C BROWN
135 FRANKLINTOWN RD
DILLSBURG PA 17019-9764
1! For 24-hour customer service or
CltHent rates: Call 1-888-PNC-BANK
(:;J Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
lQ! Visit LIS at www.pncbank.com
L.::l
8 TOO termi.nar: ,'-800-531-1648
\"'1' h":,rJl1~ 1I11lnll ('r1 clwnt>; onh
lelationship Overview
:ank Deposit Accounts
'st:rip\\on
llt.-Tesl Clll'cking
lvil',e;.~
otal DC'pusits
Account Number
[lO-O:157-3185
5()-OJ :12-9(,:16
Deposit BalanCE
'2'\,OI)().::',l
2,83:1.1 ~~
211.925.53
'remiun, Plan
nterest Checking Account Summary
';Collnt number: 50-0557-3185 Account Link@ number: 0200163298
Margaret C Brown
8..1:\
Checks and other
deductions
.on
Ending
billance
'2.1,090.~H
Please see the Activity Detail section for
addition~\ in1onnMion.
,aiance Summary
Beginning
balance
~'i/JS191
Deposits and
other additions
Average monthly
balance
Charges
and fees
~4.r)S~.17
.00
Al'rlual Percentage
Yield Earned (APYE)
Number 01 days
in interest periOd
Average collected
balance for APYE
Inlerest Earned
lhis p~riod
As of 03/11, a total of $23.98 in interest was
e~rned this year.
.terest Summary
0.'10%
"9
J_
:2.1,08~.] 7
K..I:~
lctivity Detail
'eposits and Other Additions
,/ II
Amount Description
8.,13 Inlnest P"yment
Tbere w~s 1 Deposit or Other Addition
totaling $8.43.
,Ie
laily Balance Detail
l!e Billance
2/08 2.1,0." UH
Date
03111
Balance
24,090.3.'
.ooking for a neW house or a new neighborhood?
:lkc PNC n:lllk wjlh you. 'Yhrthrr yuu're IlH:n-illg out of iila!C' orjust aern:;., lown, )'uu can kcep YOIII kmk ;1('(01111105 al PNC.
\.1111 over 700 hr;m('he:;. ill NcwJcrse)', Delaware, Pellllsylrallia, Ohio, K(,lIll1(ky and Indi;m,l, Illore th~ilI ,'.~,2()O l'NC Ballk .\T!\h
;lrjollwide, and 2.1-holll' tt'lcph(ll1t~ and web hanking, we're !lever far from your lie\\' home. Fur infurmation on the nean.'s\ PNC
';lllk office or ATi\'I, callus anytime al 1-888-PNC-BANK or risil us onlillc tll pll(h;tllk.C'um.
FORM953R
Total Banking Statement
n
FQf 24-'TlOllf cllstomer service
Call: '.888.PNC.SANK
For tho poriod 02108/2002 to 03/11/2002
MARGARET C BROWN
PrimClry account number: 50-0557-3185
PClge 2 of 2
Accounll1U1nbcr: 50.0557.3185 ~ continued
Premium Plan
Savings Account Summary
Account number: 50-0132-9636 Account Link@ number: 0200163298
Margaret C Brown
Beginning
balance
2,834.07
Deposits and
other additions
1.12
Checks and other
deductions
Ending
balance
Please see the Activity Detail section for
additional information.
Balance Summary
.00
2,835. J 9
Average monthly
balance
2,83-l.10
Cnarg8S
and fees
.00
Annual Percentage
Yield Earned (APYE)
Number of days
in interest period
Average collected
balance for APYE
Interest Earned
this period
As of 03/11, a total of $3.21 in interest was
earned this year.
Interest Summary
0.45%
32
2,834.10
Ll2
Activity Detail
Deposits and Other Additions
Date
0.3/11
Amount Description
1.12 Interest Payment
There was 1 Deposit or Other Addition
totaling $1.12.
Daily Balance Detail
Date Balance
02/08 2,834.07
Date
03/11
Balance
2,8~15.19
';-12-2003
16:25:17
MARGARET C BROWN
SECURITY DEPOSIT ACCOUNT
135 FRANKLINTOWN RD
DILLSBURG PA 17019
Savings Account Inquiry Next display:
Passbook Transactions for: 800101233
Bal as of 11-13-98
+Dep/CR:
-Chks/DR:
,0,5,
20-0700-4
QPADEV005N
863.55
Current balance: 975.09
Pst Dt Serial Number TC Description Amount Balance
X Eff Dt Str/Run/Bat/Seq#
123000 097 INTEREST 6.89 920.28
033001 097 INTEREST 6.81 927.09
063001 097 INTEREST 6.93 934.02
092801 097 INTEREST 7.06 941. 08
123101 097 INTEREST 6.31 947.39
032902 097 INTEREST 5.79 953.18
062902 097 INTEREST 5.89 959.07
093002 097 INTEREST 6.00 965.07
More.. .
F3=Exit F8=Recent trans
F13=Inquiry window
5-12-2003
16:24:47
MARGARET C BROWN
135 FRANKLINTOWN RD
DILLSBURG PA 17019
Pst Dt Serial Number
X Eff Dt
063001
092801
123101
032902.
062902
093002
123102
, , 033103
"'N~ i t
DA~ I
v',,"-
F3=Exit
F13=Inquiry window
F16=Print research stmt
F15=Restart
F1l=Fo1d/unfo1d
F24=More keys
Savings Account Inquiry
Passbook Open Items for:
Bal as of
+Dep/CR:
-Chks/DR:
Next display:
800100645
9-16-92
,1,1,
20-0700-10
QPADEV005N
33,305.53
Current balance: 8,158.53
TC Description Amount Balance
Str/Run/Bat/Seq#
097 INTEREST 58.02 7814.88
097 INTEREST 59.09 7873.97
097 INTEREST 52.81 7926.78-
097 INTEREST 48.47 7975.25
097 INTEREST 49.31 8024.56
097 INTEREST 50.16 8074.72
997 INTEREST 43.97 8118.69
997 INTEREST 39.84 8158.53
Bottom
F16=print research stmt
F15=Restart
Fll=Fo1d/unfo1d
REV-151Q 8<+ (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISe. NON-PROBATE PROPERTY
ESTATE OF
Margaret Brown Hopkins
FILE NUMBER
21-02-1047
This schedule must be completed and filed if the answer to any of questions 1lhrough 4 on the reverse side Df the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBEF THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (1FAPPL1CABLE) VALUE
1. Marlene Brown Yakowicz, daughter 18000.00 100% 3000.00 15000
2. Michelle Yakowicz Hartz, granddaughter 18000,00 100% 3000.00 15000
3. Bradley Hartz, grandson-in-Iaw 3000.00 100% 3000.00 0
4. Celia Hartz, great-granddaughter 3000.00 100% 3000.00 0
5. Megan Yakowicz, granddaughter 18000.00 100% 3000.00 15000
6. Madison Boyer, great-granddaughter 3000.00 100% 3000.00 0
7. Branden Boyer, step great-grandson 3000.00 100% 3000.00 0
8. Megan Boyer, step great-granddaughter 3000.00 100% 3000.00 0
9. R. Todd Boyer, grandson-in-Iaw 3000.00 100% 3000.00 0
Transfers were made between 3/9/01 and 3/8/02 - within
one year of decedent's death.
TOTAL (Also enter on line 7 Recapitulation) $ 45,000.0
o
(If more space is needed, insert additional sheets or the same size)
REV,15" EX' (1Z.ggl.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Margaret Brown Hopkins
FILE NUMBER
21-02-1047
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,. Trefz and Bowerser Funeral Home, Inc. 7057.15
2. Rolling Green Cemetery - family burial crypts 8778.00
3. Culhane's Steak House. funeral luncheon 1015.70
4. Lord & Taylor - burial clothes 146.98
5. Jeff Compton - officiating clergy 200.00
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Represenlative{s)
Social Security Number(s)/EIN Number or Personal Representative(s)
Street Address
City Stale _Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
StreelAddress
City Stale~Zip
Relationship of Claimant 10 Decedent
4. Probate Fees 531.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 17,728.83
(If more space is needed, insert additional sheets of the same size)
,
,
-'" ....-...~-~.-...~......__....-...-.,.~..""...._....~,__'.',"'........"'~t_,.f.;:m;I<t~;
3737
/
"
MARGARET C. BROWN
PAMELA BROWN, POA
135 FRANKLlNTQWN RD
DILLSBURG, PA 17019
'Stephel1 R. Hall, Supervisor
DA nApril 17, 2002
PAY TO TlH
ORDEROF Trefz and Bowser Funeral Home, Inc.
Seven thousand fifty-seven and 15/100 -----
PNCJBANK
PNC B;mk, N.A. 040 @ Premium
Ccntnl PA Plan
uretz & (
II4 1
RlR
60-12:73/3131
$ 7057.15
IiI s.,",;., t~.,"".
DOLLARS UJ o"::~;1:~" .oc<
-~---~----~ -----~
1:0:11.:11. 27 :la,: :I 7:17 II' 500 5 5 7 :ll.a 511'
CHAflL'.ND1g'8
Statement of Services and Merchandise
April 9, 2002
Ms. Melanie E. Brown
224 A East Canal Street
Hershey, PA 17033
Services for: Margaret C. Brown
Date of Death: March 8,2002
Services of Funeral Director and Staff for a Standard Service
Embalming, Other care of Deceased, Use of Facilities for Visitation,
Use of Facilities for Service or Use of Equipment for a Church
Service, General Use of Facilities, Transfer of Deceased to Funeral
Home, Hearse, Family Car, Flower Car, Acknowledgment Cards,
Register Book, Memorial Folders or Prayer Cards, and Casket
(18 ga. Orchid/Silver Steel Ext. Orchid Crepe Int.)
Subtotal Services and Merchandise........................................
Cash Advances
Cemetery Charges......... ................................................
Flowers.................................................................... ...
Clergy Honorarium .........................................................
Certified Copies (25 @ $2 ea.) .............................. ......... .....
Organist ........................... .. . . . . . . . . . . .. . . . . . . . .. . .. .. . .. . . . . . . . . . . .
Harpist.................... ............................ ..... ..................
Violinist.................................................................... .
Subtotal Cash Advances
Total Due
.
Please remit by April 25, 2002
$5391.00
$5391.00
$ 670.00
$ 446.\5
$ 200.00
$ 50.00
$ \ 00.00
$ \ 00.00
$ 100.00
$\666.\5
$7057.15
CULHANE'S STEAK HOUSE
CULHANE'S STEAK HOUSE
Check no Tab Cov Ser Time Date
82055/1 1 30 16 14:4803/12/02
Check no Tab Cov Ser Time Date
82056/1 20 25 8 14:47 03/12/02
26
26
4
18
21
5
5
3
Vegetab 1e
Gri 11ed Chicken
Ice Cream
Peanut Butter Pie
La rge
Coffee (No Prep)
Iced Tea
Hot Tea (No Prep)/
Food Sub-Total
2
1
1
2
1
1
Mi ller Lite
GL - Cabernet IMondavi)
Manhattan
Manhatten * VO
Dry
8aileys & Coffee
Bar Sub- Tota 1
SUB TOTAL
Pa State Sales Tax
HI; AL
THi\NK YOU
Diane
Thank You!!
Easter Sunday Hours
l1am - 3pm
938-0930
32.50
259.74
7.16
62.82
26.25
5.00
1.50
3.00
'c
403.97
4.00
3.15
3.50
8.00
0.25
4.15
24.25
428.22
24.24
452.46
23
23
1
3
2
18
5
11
8
1
5
1
Vegetable
Gri lled Chicken
Childs Chicken Fingers
Ice Cream
Sma 11 Sundae
Peanut Butter Pie
Cherry Pepsi
Large
Iced Tea
LG. Choc Milk/Hot Choc
Coffee (No Prep)
Hot Tea (No Prep)
Food Sub-Total
Michelob
Miller Lite
2
1
8ar Sub-Total
SUB TOTAL
Pa State Sales Tax
TOTAL
THANK YOU
Denise
Thank You!!
Easter Sunday Hours
l1am - 3pm
938-0930
28.75
229 . 77
5.99
5.31
4.50
62.82
1.25
21. 25
12.00
1.30
5.00
1.00
379.00
4.50
2.00
6.50
385.50
22.74
408.24
?~f: ~ /f.:Jd"
J)~t)-L
.I/O/D. 70
./
LbMKl.t..J.<.l AGH.1'..!:.L\rlbl'l J.' f/NoJ.;../v.f.e..- -f /Y"~8 .flt>>-"'-""S""
ROLLING GREEN CEMETERY t/-,r'r
11I11 Carli,le Road, Camp Hill, Pellllsylvania 17011 . (717) 761.4055
GIBRALTAR MAUSOLEUM CORPORATION, an Indiana corporation, doing ",siness as ROlling. Green Cemetery. (hereafter "SELLER"), and
/>?AIl6AR.<' C ~Plb-v.s '7- ?"""1t:<A..J /'?,eOv''II
Il'k,,,,' 1'''''' ~"""'l') ..~,-'Iy ., ,,-,II "I'I~'"'' "" 1l..".1 ~,~h" (.,.,1010"."'1
whuse rc.~idcncc i.~ althe <ludrcs> shown beluw (hcrc,lIlcr "I'URCIIASEW'), du herehy II1P'cC as follows:
For and in consideration of tile mutual covenants herein contained, the PURCHASER agrees to buy ;ltld tbe SELLE~ agrcc~ to scllthe merchandise amJ!u.r services
hereinafter enumerated and described andlor the exclusive rigllls of burial in the spaces hereinafter cnl.llllerated and dc.~lgnated In the cemetery known as Roiling Gree.n
Cemetery, upon the terms and conditions and for the al11ount~ :IS ~et forth in this Agreement. This Agre.ement is subject ~o acceptance b~ SELLER. No part o.f thiS
Agreement shall be deemed accepted by SELLER until SELLER has received 7% of the Total Ca~h Pr~ce. and a~ authon~cd representall~e of SELLER .has SIgned
the Agreement. When accepted, this Agreement shall be bindmg upon the successors, assigns, benefiCiaries, heirs and legal representallves of the partIes herelo.
1. DESCRIPTION OF BURIAL RIGHTS. The Burial Rights covered by this Agreement arc shown by the map of such gardcn/bui]ding on file in the ornee. of
SELLER, and are marc particularly described below. The purchase price of Burial Rights ducs not illdude Intermellt/ElltombmelltfInurnmcnt Fees (opemng
and dosing costs). Opellillg and dosing must be purchased separately. (See 3(0) below,)
_ Grave Space: ---L . Mausoleum: Jilnterior _Exterior _Deluxe ..bamily ~inglc
Lawn Crypt: _Double Depth _Side by Side ~ingle _ Niche: ~ntcrior -Exterior _Single _Companion
1~~ 2I1dC~~ ~Q~ ~d~~
"':~Ok;';/'" ~, .r71AcL ,"",OkC.m,"'"''
~ B"ildi", ~__ _
Section C.8
No.(s) 2'7:zJ
Level 5
~MaxilllUIll cas~et dimcnsions arc: length 90", width 31", height 26".
3. ITEMIZATION OF CHARGES
(A) Burial Rights (as described in Pam. I above)
(B) Less Preeonstruclion Di~eoLlnt r===J
(C) Le~s Certificate Di~count
Garden
Section
Lo<
Spaee(s)
2. DESCRIPTION OF MERCHANDISE
o Check: here if merchandise being purchasl:d for u>e at another eel11l:t ery.
Cel11l:tery'sname:
A. VAULT(S): #1. D~scription
iJ2.l)~"".,illl;""_______
Itl. DcsCripliull
#2. Descriptllln
C. MEf\.IORIALlMONUf\.IENT:
lI.lJRN{S):
Memorial No.
D~sign
Granite Sizl:
Embkl11
x_
X
Bronl:e Size
TugelherForev Yes_No_
Monument Description (See auacbed Monument Order Form)
D, CASKET(S):
#1 Description
Mode] Name
K2 Description
Model Name
/
/
/
/
INSCRIPTION
Mood No.
Mood No.
I"1AI!.6,A.tt:r 13R.OWN /lcpK.' '0/..:5
H2S -
-ft.:f!,fhJ
~M€l.A- ..:r '8~ot.JN
I'ISJ
l'un'hasl'r'sAI'JlI'"UVlll: X.
ISI~".''',"1
(IlJ S~...H,d l~jr.!lI "I' :utO:""CI!1
n,) Vauh(_l
tl') C;lskcl PI
(G) Caskel #2
(ll)lIrn(._1
(I) Mal.lsulcul1l Lellcring/Crypt Plale
(J) MClIlurialO MunulllentD
(K) Installation Charge and Early Care Fee
fur MCll\oriallMol1Ulllent
,
(L) Oth~r $
(M)Sales Tax $
(N) Care of Turf .'\round MClllorialfMonumellt $
(0) InlerlI1e~tomblI1~:IlUrnme.ll (Circle One) Fcc> $
for Normal Busines~ Hours Monday tlJru Saturday
No. Purcha.,ed 2
(1') Prllcc>singFee
(Q) '. (HAL CASH I'I{JCI~ (..\ tllru 1')
ITEMIZATION ')F fHE A;.!OLJtH fINANCED
(I) Tot;ll C;"h Priee
(2) A. Cash Down Paymeol
13. Tr"de In:
Old Agrcement No.
TI1wl Down Payment (lA+2B)
Unp"id Balance of Cash Price (l-2C)
Crcdill.irc lllsurallce
Tot,1I Unpaid 13:llance (3+4)
c.
(3)
(4)
(5)
4. PAYMENT The PURCHASER shall pay Ihe SELLER for such ri :,ts in accordance with 'hc ~ollowing disclosul'C stalement.
$ 7'990. oa
$
$
,
-7qS_~
.,
$
$
$
$
$
.598 ""
9.y'O.=
$ 45.00
$ 8778 -=
, (}778 CO
$ ~~.r uo
,
$ h.1-< CO
$ BU...5 ac
$
$ R/(.".3 dC)
0 AMOUNT FINA~ TOTAL OF PAYMENTS
(1+4+FC)
ANNUAL PERCENTAGE FINANCE CHARGE (FC) TOTAL SALE PRICE
R~T" Thc amuunt urcred,t pro- Ttle:ll110unt you will ha'c The total ,",ust 01 your
ri'< "lliedl111aramountlllecrelJit
The cost ofYOl.lr credit will cost you. vidcd 10 you ur on Yllur paid after you have madl: purchascollcrcdil,in-
3~ a yearly ratc. hehalr. all paYlllel1tsasschedulcd. c1Udil1gyollrd(lw~ay.
l11emor$ t:./. ."'0
- - $ - $~/r.3. c.o $ 8778.0<>
% $
YOUR PAYMENT SCHEDULE WILL BE:
Number 01 Paymellts Amount 01 Payments First Payment Due Date Thereafter, Payments Are Due -d
/2- $ ,:,80...5" I'" ,::TvN 9S ~Mtll1thly 011 the /0
[J Quarterly
$
INSURANCE: CrerJit lik illsur:1l1CC j.~ 11<11 requircd 10 ohlain nedit "lid will nOl be providcd link,., you sign :111<1 :'grce 1<1 pay the additional CIlSt.
Credit Lire rJ Individual
PremIum Cost D Joint Insured's Signature Age Date 01 Birth
/ /
Late CIlarge: If a paymenl is laIC, )'01.1 will be {'harged $5.00/5% of the payment.
Prepayment: If you pay offcilrly. you will 110t have tn pay a pcnaltyand may beel1lillcd 10:' refund of part nfthe rUlam:c<:hargc.
~~~e~e:~::~s :r~~~\:::~~t:o:~ru~I~~h:;~:~~~I~III\I~~t. Illr any audition,1I informalion "buut !llln-payment. dcl:llfll, ;lIlU reyuircd I'cpaymelll in lull bcfure the schedukd
NOTICE TO THE PURCHASER
(I) DO NOT SIGN THIS AGREEMENT llEFORE YOU READ IT OR IF IT CONTAINS ANY llLANK SPACE.
(2) YOU ARE ENTITLED TO A COMPLETELY FILLED-IN COpy OF THIS AGREEMENT.
(3) UNDER THE LAW, YOU HAVE TIlE RIGHT TO PAY OFF IN ADVANCE TIlE FULL AMOUNT DUE AND UNDER CERTAIN
CONDlTlONS TO OllTAIN A PARTIAL REFUND m. THE FINANCE CHARGE.
PURCHASER'S RIGHT TO CANCEL
(APPLIES ONLY IF SALE SOLICITED IN PURCHASER'S HOME)
YOU MAY CANCEL THIS AGREEMENT BY PROVIDING A WRlTIEN NOTICE TO THE SELLER, OR BY SENDING A TELEGRAM,
OR BV MAIL. THIS NOTICE MUST INDICATE THAT YOU DO NOT WANT THE GOODS OR SERVICES AND MUST BE DELI.
VERED OR POSTMARKED llEFORE MIDNIGHT OF THE TIIlRD BUSINESS DAY AfTER YOU SIGN TillS AGREEMENT, TIlE
NOTICE MUST BEMAILEDTOROLLINGGREENCEMETERY.ISIl CARLISLE ROAD, CAMP HILL, PENNSYLVANIA 170IJ.
IF YOU CANCEL THIS AGREEMENT, THE SELLER MAY NOT KEEP ALL OR PART OF ANY CASH DOWN PAYMENT. FOR
AN EXPLANATiON OF THIS KIGHT, SEE NOTICE OF CANCELLATION FORM WHICH YOU WILL RECEIVE ALONG WITH A
COPY OF THIS AGREEMENT.
PURCHASER'S ACKNOWLEDGEMENT
BY SIGNING BELOW, PURCHASER REPRESENTS AND ACKNOWLEDGES THAT PURCHASER HAS READ AND UNDERSTANDS
TIlE TERMS OF THIS AGREEMENT, THAT ALL RELEVANT BLANK SPACES HAVE BEEN COMPLETED, AND THAT PURCHASER
HAS RECEIVED A COPY OF THIS AGREEMENT AND PRIOR TO DISCUSSING PRICES, SERVICES OR MERCHANDISE, A COpy
OF THE APPLICABLE PRICE LIST AS REQUIRED BY THE FEDERAL TRADE COMMISSION, ~.UNERAL PRACTICES TRADE
REGULATION RULE.
~J~
SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS.
IN WITNESS WHEREOF, SELLER ~nd PURCHASER have cxecuted this Agreemc11lthi> 3 day of /11.4'1
RETAIL INSTALLMENT AGREEMENT
>99.5'.
ut7-Ji ,j)Jg-
.qI)~
l ....
~lichacl Wilson.
Sales :\Iallllgcr
Sr,
{ THAN
C;~)
Rolling Green CCllwtL'ry
loS11 Carlisle Hd.
Camp WH, 1',\ 170Il
717 -7(d --1221
Fax 717-7(,I-.H';2()
Inpul DoCUlHenl
,
2. PURCHASE
l. PURCHASER
8
/-k.es'{N
1
Address
/JA-
Sl"l~
7/7- S?3 -71,,[1
;(f"f'~L.{!) Phone
City
Phonl: No.:
I. ElllploYl'r:
'<.J\?~ 7"'':< //Y;
/70:s:5
Zip
I'holle
Gulden Cllpy~PURCHASElfS Copy
(Leave in Huuse)
2. Empluyer:
l'il1~ Copy-PURrl-lASER'S Copy
tFllrwm<.l wilh P:lymentlllMlkJ
,)(~'T'E 1,1/2')/':';)1':;
c; () i"~'r f;~(iC: '"f' D (:>1'1' E
, ,1,)\Ji'l:3EL,\Jr~
Rollll'lg Cir~eet'l (['1al"I' lsor'g ~~.:~
'il II::;;~~ 1(:~1i W",I! ::::::i; 11~::!h 1[:::"11" :11: (JI i1"',li II "II JI. ::::::i: 'II' I[JI U::;;l~ .t'II'"
11::':\1 JI. ''':!IIJI,':'..? ......iI'...,;
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i';I\)Uh~F: ::'):::<
[J'y /"iiJ(9iJ,i"'eC (: f"loni'':'ln::~~ Hrld/C)( FJiJ.iTleJEJ ,I(::~a.rl i;jl"'(:!(,'..Ii'
8 (~OldE011 C()JJi't ~i(01'sl'JE~V PA 17lj2_ 11!15!3--714~3
':\I:>t:3 C :.;J F\: r c: [:
r (,l"i'C:'h~i:: :'~)'I
.::(il. L~:) I(~>"
I. ,h' I': 1.11 I 11"1:',
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i' L: F~ f'-i ~:)
d7, . (Hi
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I,I.I..)C)
1.1,1.011,1
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(1,'::0,,1,)(,1
6~:lO.~:~ :~TARl'lN(; ~06!1.'j/95
1)[,F :::i(j 'y Ph~ J: I, ':1:;:
[.IDV-Ji"'.Ij:i('I\,'i"iE: t,.,!,'\
l'f:<'(.:-d,..j~',~F';:::I:',: fV. I., (JI;,) ';
O,l:,:;C:C.Ii.)!"11
nr-/il' ~ I::' r ["'1(->:('!C I::::D
L. ('1'/ [: C: i,n: I;~'l h~ li I:: .:;)
i3(~I..f:>tr,~c.i:: Dl...iC"
.( ," j::J {r''ii''.,! 'I :':~ 1,',1
["[..I"'-i:3 :::JLlh:C:Hr:~j3[D
",)h'C)PEi'?'f\(
i,Jj"',JIJ J (j(;j (~C::C()I)j--.j 'f
I nt:.;:; I lot. C:: I"VOt:::::,
1.:.:H('1()[L Ui:: 1:)[(':1[:[
L Cr Ltt"jPlt/SCI'
iiltel-lOI" l~t"ypt Lett8j'll"lq
(J/L. p('(~:""'r"-'~E~:e,:J
Ci"'iTI,Ji"'ti31"'iE:(1T C:HrIPi :L. :3;;: h~\/ICF:
t:id.(',j/i:: 1..11 J.()
C n,,:J.t'J(:: I 0'1" p(~;JC (.~.
I.. i"la,De I. ()t F'(~i:1C;(~
1,:;(:1 / E\ 1.
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F.nC,I(',ll
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Sect.
C::E\
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L:()F'
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(,.1:'<
,:,~,
P{~UE t
(:,CT IV;:
dlld '. 00
(",01.:::0 (,Vi
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U~Ou
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? J. 9~'::, " 0 ()
59n elf)
')(.jO, 00
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27[)
27[.1
PI :h~CE:..r,jTnG[
(-in Fun'::l::~:' (/',leeE:: F
()R[(~[NAl AMC)IJNl AMOlJNT REMAINiNG
t,J.bl :J.::~,hed F--or Tl'li :~', C:ont:r-act
REV-1512 EX+ (6-98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MARGARET BROWN HOPKINS
FILE NUMBER
:;/- 0,,- 10'17
Include unrelmbursed medIcal expenses.
ITEM
NUMBER DESCRIPTION
1. Manor Care Nursing Home
VALUE AT DATE
OF DEATH
1429.00
2. Neighbor Care
1253.92
3. Quantum Imaging
8.74
4. Internal Revenue Service - 2002 Federal Income Tax
1414.00
5. Dennis Baum - 2002 federal and state income tax return preparation
200.00
6. Dennis Baum - 2001 federal and state income tax return preparation
200.00
7. Solomon Smith Barney - commissions and transaction fees
404.56
TOTAL (Also enter on line 10, Recapitulation) $
4,910.22
(If more space is needed, insert additional sneets of the same size)
/
liCll.ManorCare
MANORCARE CAMP HILL 583
1700 MARK8T STREET
CAMP HILL, PA 17011
(717) -737-8551
PAM BROWN
FOR MARGARET BROWN
135 FRANKLINTOWN ROAD
DILLSBURG, PA 17019
PRIVATE
ROOM 112 -8
BROWN, MARGARET C
11180
10/14/98 03/08/02 03/15/02
03/01/02
03/07/02 99650
03/01/02
03/01-03/07/02
-03.'~1/~2
BALANCE FORWARD
TOTAL INCONT-DLY FEE
REV LAST MO RC
ROOM CHARGE
Ullf'lUD- 1.S0'l, ON G12S:;>. 00
QTY
7 )
5,266.00
21. 00
5,146.0(
1,162.00
19. :B
MARGARET C BROWN
MARLENE B. YAKOWICZ,
MELANIE B. HAUCK AND
PAMELA J. BROWN, PO A'S
~ 5Mm{(wJ~ty
PREFERRED 1858
eLI.NT"
62-15/311
Date March 19, 2002
j>ay to the
o..dcrof Manor Care Camp Hill
one thousand three hundred and three
I $ 1303.00
001100 ----- '
Dob
3DO SMITHBARNEY
to FIN~CIAL MANAGEMENT ACCOUNT"
() PNCNal'OfIa1Ba.nk
E WIJ"uAglon,DE
r'O>' 112-3
.:0 :I ~ WO ~ 5 71:
Ily\~~\_~.--srr<J:<() "'" --Pc'1G_
~20~B9~:l00. ~BSB
.-
1,322.2:
/ 9 .~.3
1/ '30,3 tXJ
"lit {'.f'/xf;Zt<.
{" "1 /'1
i i! r (. F {.. -,'
t<.tuI:^t>7d-C..I/1t
I /./
( ~ "' .
,)kf ...<---.. t." d
,~~ } &'0.</
~/n. ,-'- p
j (V ;/1
f
f?:
7(..0
r __ ,,/ /'1,/
1" "J
/ 'f
i .f}... '6
" ,
d,,,,,,tj
fC4A
. .
/r-.0 r{ i.
'~;,-:i.~
J
J'
.
I'
t.;I......
:/,1'" -
1
HCR.ManorCare
i
MANORCARE CAMP HILL 583
1700 MARKET STREET
CAMP HILL, PA 17011
(717) -737-8551
PRIVATE
PAM BROWN
FOR MARGARET BROWN
135 FRANKLINTOWN ROAD
DILLSBURG, PA 17019
ROOM 112 -B
BROWN, MARGARET C
11180
10/14/98 03/08/02 03/31/02
'..._, ,;.'.1"1"..':
03/01/02
03/21/02
03/21/02
03/07/02 99610
03/07/02 99650
03/01/02
03/01-03/07/02
BALANCE: FORWARD .
PAYMENT
PAYMENT
OXYGEN CONCENT RENTAL
TOTAL INCONT-DLY FEE
REV LAST MO RC
ROOM CHARGE
5,266.00
1,183.00
120.00
QTY
QTY
1
7
126.00
21.00
5,146.00
1,162.00
PAYMENT DUE UPON RECEIPT
126.00
MARGARET C BROWN
~~~~~:B~B'HR~OtW~N9l1~~
. ,POA'S
fhy to tile
Onl.rof Manor Care Camp Hill
one hundred t
Wenty six and 0011
r 300 SMITHfuRNEy 00 ----___
00 FINANCIAL MAN ::JTo1I.r.;
~ PNC N,"i""",l Bank AGEMENT ACCOUNT"
WllmJMIIOIl,DE
PlElEfmED
<;l.'"NT'.
1861
D.~ April 4, 2002
62-15/311
J $X26.00
For Room 1128
':OH WO ~ 571: ~ 201,B~1, :JOO -=:Yv\pO.A^^,,;) '~.i'!7j.LC\ \DcJ('.
:J II' ~B b ~ . ~
P,WMENT . rn~f;.r:!Kya~
. ,
CURRENT
:.~
OVER 30 DAYS OVER 60 DAYS OVER 90 DAYS OVER 120 DAYS
AGED BALANCE
8. 74
*PRlMARY lNSURANCE**
"DleARE PART B
[HF: 200163298A
',P:
*SECONDARY lNSURANCE*
BS OF PENNSYLVANIA
I D#: GGS200 163298 111I1111I11I1I1111I1I~11I11\lllill
GRP: 067000000 10187
d / 7/1
1111111111I1111111111111111111
8,74
QUANTUM IMAGING & THER
BILLING OFFICE I A93
2527 CRANBERRY HIGHWAY
WAREHAM, MA 02571-5000
BROWN
111""11.1111101",1,1111,1,1011".11".11",,,1,11,,11,.,111
lJamrlll 3J. illrnum
1I~, 717-432-2540
135 .J'rankIintown ~alI
ilUlllbutg, '" 17019-9164
5031
ARS
(il ~::,"::~.
I 0''''''0'
..
, PENNSYLVANIA STA
EMPl,.O'yI;E$CREDIT UNION
'. H~rriilbu(g. PAI7110-2990
" " (-'_-'~1f");r' l~'"" '_~.,"
~2R (tfi1~~K;r~:\\.!~&~I~?,~
'.\ i~-', ..~~
/
,
.>
3738
MARG~ET c. BROWN
PAMEL BROWN, POA
135 FRA UN10WN RO
DILLSBU~ G, PA 17019
60_1273/3131
PNClBAN
PNC Bank. N.A. 040
Central PA
. 10189 A93
roR
.:0 1 ~ 1 ~ 2 '11B'. 1 '13.B
.....
PAY TO THE
ORDER OF
...~",itj t..,u,..
- DOLLARS m D':~~~:"';n ba<k
,~/ .L4---4'~~~C)t~!/j
It'SOOSS'I3. ~BSII' r/
C><M'J..MUl,996
1040
DECEASED MARGARET C BRDWN D3/D8/2DD2
Department of the Treasury - Internal Revenue Service
2002
Form . n IV! ua ncome ax e urn 199\ IRS use only - Do not write or staple in this space.
For the year Jan 1 - Dee 31, 2002, or other tax year beoinnina ,2002, ending ,20 OMS No. 1545-0074
Label Your first name MI laslname Your sodll security number
(See instructions.) MARGARET C BROWN 200-16-3298
If a joint return, spouse's first name MI last name Spouse's social security number
Use the
IRS label.
Otherwise, Home address (number and street). If you have a P,O.box, see instructions. Apartment no. .. Important! ..
please print
or type. 135 FRANKLINTOWN RD You must enter your social
City, town or post office. If you have a foreign address. see instructions. Slale ZIP code security number(s) above.
Presidential DILLSBURG PA 17019-9764
(( "tI,-;ere
d Total number of tions cla)Ilfu' . .
7 Wages, salaries, tips, etc. t ch Fornifs)Nt:~'( .~~ -;?'.
8 a Taxable interest. Attach Schedule . required 11....
b Tax~exempt interest. 00 not include on Iln . . . .1 8 bl
9 Ordinary dividends. Attach Schedule B if require . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ....
11 Alimony received......................................
12 Business income or (loss). Attach Schedule C or C-EZ . ..... .
13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here . . . . . . . . . . . . . . . . . . .~. ti . . .
14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . .. . .. . .......
15a IRA distributions. ........ .l1?al b Taxable amount (see instrs)
16a Pensions and annuities....[J!!] b Taxable amount (see instrs)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
18 Farm income or (loss). Attach Schedule F ............ ............
19 Unemployment compensation. . . . . . . . . . . . . . . . . . .. .,..................................
20a Social security benefl~...... I 20al 2,742.1 b Taxable amount (see instrs) ..
21 Other income _ _ __ _ _ __ _ _____ _ __ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total income. ...
23 Educator expenses (see instructions) . . . . . . . . . . . . . . . . . . . 23
24 IRA deduction (see instructions) .................. 24
25 Student loan interest deduction (see instructions) . 25
26 Tuition and fees deduction (see instructions) . . . . . . . . . . . . .... 26
27 Archer MSA deduction. Attach Form 8853 ... ............... 27
28 Moving expenses. Attach Form 3903 ................... 28
29 One.half of self-employment tax. Attach Schedule SE... . 29
30 Self-employed health insurance deduction (see instructions) . 30
31 Self.employed SEP, SIMPLE, and qualified plans.... 31
32 Penalty on early withdrawal of savings ,. . . . , . . . .. 32
33 a Alimony paid b Recipient's SSN . . .. ... 33 a
34 Add hnes 23 through 33a ............. .........................
35 Subtract line 34 from line 22. This is our ad'usted ross income
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Election
Campaign
(See instructions.)
Filing Status
Check only
one box.
Exemptions
If more than
five dependents,
see instructions.
Income
Attach Forms
W-2 and W-2G
here. Also attach
Form(s) 1 099-R if
tax was withheld.
If you did not
get a W.2, see
Instructions.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
Adjusted
Gross
Income
BAA
US I d' 'd
II
T
R t
~ Note: Checkmg 'Yes' will not Change your tax or reduce your refund. You Spouse
Do ou, or your spouse If filing a oint return, want $3 to 0 to thIS fund? ... Yes X No Yes
1 X Single Head of household (with qualifying person). (See
2 Married filing jointly (even if only one had income) instructions.) If the qualifying person is a child
but not your dependent, enter this child's
3 Married filing separately. Enter spouse's SSN above & full name here. ...
name here. . ... 5 0 Qualifying widow(er) with dependent child (year
spouse died ... ... ). (See instructions.)
6a [g] Yourself. If your parent (or someone else) can claim you as a dependent on his or I No. of boxes
her tax return, do not check box 6a ...... . . . . . . . . . . . . . .. .. .. .. .. .. .. . .. . .. .. .. .. ... r ~~~~~e~bo~ .
b Souse. .. . , .. .. .. . . ".. . . .. .. . .. .. .. - ~hiid:en
(3) Dependent's (4)" on 6c who,
relationship ChW~r~~~i~~ild . lived
to you tax credit with you .....
(see instrs) . did not
live with you
due to divorce
orseperetion
(see Instrs) ..
c Dependents:
(2) DeFenden!'s
socta security
number
1 First name
Dependents
on6cnot
enteredebov. .
138.
9
10
11
12
13
14
1Sb
16b
17
18
19
20b
21
22
No
1
114.
-1,294.
27,000.
o.
1,371.
27.826.
FDIAOl12 12126/02
27 826.
Form 1040 (2002)
Form 1040 2002
Tax and
C red its
Standard
Deduction
for-
. People who
checked any box
on line 37a or
37b or who can
be claimed as a
dependent, see
instructions.
. All others:
Single,
$4,700
Head of
household,
$6,900
Married filing
jointlx or
Qualifying
widow(er),
$7,850
Married filing
separately,
3925
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC,
Refund
Direct deposit?
See instructions
and fill in 71 b,
7lc, and 71d.
Amount
You Owe
Third Party
Designee
Sign
Here
Joint return?
See instructions.
Keep a copy
for your records.
Paid
Preparer's
Use Only
MARGARET C BROWN 200-16-3298
36 Amount from line 35 (adjusted gross income) ..................,.......................
37a Check if: [g] You were 65/older, 0 Blind; 0 Spouse was 65/0Ider, 0 Blind.
L Add the number of boxes checked above and enter the total here . . . , , . . . . . . . . ~ 37 a 1
b If you are married filing separately and your spouse itemizes deductions,
or you were a dual.status alien, see instructions and check here. . . . . . . . . . . . .. ~
38 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . .
39 Subtract line 38 from line 36 ... .. .. .. .. .. .. .. .. .. .. .. . . . . . . . . .. .. .. . .. .. .. .. .
40 If line 36 is $103,000 or less multiply $3,000 by the total number of exemptions claimed
on line 6d, If line 36 is over $103,000, see the worksheet in the instructions, . . . . . . . . . . , '
41 Taxable income, Subtract line 40 from line 39.
If line 40 is more than line 39, enter .0- ...."", .. . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . . .
42 Tax (see instrs), Check if any tax is from a 0 Forrr(s) 8814 b 0 Form 4972 ,...... .
43 Alternative minimum tax (see instructions). Attach Form 6251 .......".............,....
44 Add lines 42 and 43 .............. . .......... .............. . . . . .. . . . . .. ... ~
45 Foreign tax credit. Attach Form 1116 if required 45
46 Credit for child and dependent care expenses. Attach Form 2441 46
47 Credit for the elderly or the disabled. Attach Schedule R ..... 47
48 Education credits. Attach Form 8863 ....................... 48
49 Retirement savings contributions credit. Attach Form 8880 ... 49
50 Child tax credit (see instructions) .......................... 50
51 Adoption credit. Attach Form 8839 ....................,.... 51
52 Credits from: a 0 Form 8396 b 0 Form 8859 .. .. .. .. .. .. .. ... 52
53 Other credits. Check applicable box(es): a 0 Form 3800
b 0 ~r c DSpecify 53
54 Add lines 45 through 53. These are your tot.1 credits ... . . . . .. . . .. .. .. .. .. .. .. . .... 54
55 Subtract line 54 from line 44. If line 54 is more than line 44, enter -0- . . . . . . . . , . . .... 55
56 Self.employment t.x. Attach Schedule SE ........... . . . . . . . . .. 56
57 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 57
58 Tax on qualified plans, including IRAs, and other tax-favored accounts, Attach Form 5329 if required, . . . . . . . . .. 58
59 Advance earned income credit payments from Form(s) W-2 59
60 Household employment taxes. Attach Schedule H . . . . . . . . .. ......... 60
61 Add lines 55.60. This is our total tax ............. . . .. .. .. .. . . ~ 61
62 Federal income tax withheld from Forms W-2 and 1099 62
L 63 2002 estimated tax payments and amount applied from 2001 return. . 63
64 Earned income credit (EIC)......... . . . . ............. 64
r 65 Excess social security and tier 1 RRTA tax withheld (see instructions) , , , , , .. 65
66 Additional child tax credit. Attach Form 8812 ................ 66
67 Amount paid with request for extension to file (see instructions) .. 67
68 Other pmts from: a 0 Form 2439 b 0 Form 4136 c 0 Form 8885 68
69 Add lines 62 throu h 68. These are your total a ments . . . . . . . . . . . . . . . . . . . . . .. ..
70 If line 69 is more than line 61, subtract line 61 from line 69. This is the amount you overpaid...
71 a Amount of line 70 you want refunded to you . . . . . , . ......
~ b Routing number ~ c Type: 0 Checking
~ d Account number
72 Amount of line 70 you want applied to your 2003 estimated tax. "Cll..J
73 Amount you owe. Subtract line 69 from line 61. For details on how to pay, see instructions
74 Estimated tax enal (see instructions . . . . . . . . ..1 74
Do you want to allow another person to discuss this return with the IRS
(see instructions)?.........."."..... .....",.............,.. .... 0 Yes. Complete the following.
Designee's Phane Persanal identification
name ~ no.. ~ number (PIN) ~
Under penalties cf perjury, I declare that I have examined this relurn and accompanying schedules and statements, and to. the best cf my kncwledge and
belief, they are true, ccrrect, and camplete. Declaration ef preparer (elher than taxpayer) IS based an all infermatlon ef Whlch preparer has any knewledge.
Yeur signature Dale Yeur eccupatien
Pa e2
27,826.
13,386.
14,440.
40
3,000.
11 , 440 .
1,414.
O.
1,414.
1,414.
1,414.
1,500.
~
o Savings
1,500.
86.
86.
[g] No
~
Spause's signature. If a jeint return, both must sign.
~
Date
OECEASED
Speuse's occupatien
~i~rfat~~~s" LORETTA M BAUM
Fi,m',",m. DENNIS L. BAUM
(erycurs if ... .
self-empleyed),203 N Ra 11 road
t?~rg6Je and Pal m r a
Date
04/02/2003 Checkifself-employed
Street
"N
25-1294424
(717) 838-1876
Form 1040 (2002)
PA 17078-1326
Phene no..
FOlA0112 12/26102
DENNIS L. BAUM
Accounting and'Tax Professionals
203 North Railroad Street, Palmyra, PA 17078 . (717) 838-1876
E-mail: d\w.um@nbn.net
April 4, 2003
Pamela Brown
135 Franklintown Road
Dillsburg, PA 17019-9764
RE: Margaret C Brown
2002 Tax Preparation
$ 200.00
- EBtab~ished 1969 -
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SD-017224-S
Confirmation
SALOMON SMITH BARNEY
A member of cltlgrouP1'
SALOMON SMITH BARNEY INC.
P.O. BOX 12057
11 N 3RD ST-2ND Fl
HARRISBURG PA 17101
Account Number: 724-60955-1-2-550
Financial Consultant: RAYMOND MONTCHAL
717-780-1700
1",111",1111"1",111..."1.11..1...11,,11,,,,1,11,,,11",11
".MARGARET C. BROWN #5,583
SSB IRA CUSTODIAN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
You Sold 400 at a price of 10.42
XEROX CORP
Gross Amount
Commission
SEC Fee
Transaction Fee
Amount
Settlement Date
$ 4,168.00
124.19
.07
5.00
$ 4,038.74
03/14/2002
Trade Date: 03/11/2002
Malket: Over-The-Counter
CUSIP#: 984121-10-3
Security#: Y008075
Symbol: XRX
We acted as your agent in this transaction.
Solicited Order
Cash Acct.
Ref #: 597430
PREFERENTIAL RATE
HOLD PROCEEDS
As a reminder, payment for securities purchased or delivel}' of securities sold must be deposited with us by the Settlement Date.
See reverse for further details. Keep this document for your records. Thank you for doing business with us. 03/11/2002 80-017224-$
Your Broker/Dealer is
l..ionTlrmatlon
SMITHBARl~Y__
CltlgroUpJ
CITIGROUP GLOBAL MKTS INC.
P.O. BOX 12057
11 N 3FlD ST-2ND FL
HARRISBURG PA 17101
Account Number: 724-60955-1-2.550
Financial Consultant: RAYMOND MONTCHAL
717-780-1700
Page 1 of 1
'""11",11"""""1""",11"1,,,11,11,,,,,1,11,.,1'",11
wMARGARET C. BROWN #2,638
CGM IRA CUSTODIAN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
Summary For Settlemenl Date
Total Purchases
Total Sales
Net Amount
06/03/2003
$ 5,440.72
$ 7,794.63
$ 2,353.91 Credit
Iou Bought 400 at a price of 13.22
,EADERS DtGEST ASSN INC
Gross Amount
Commission
Transaction Fee
Amount
Settlement Date
$ 5,288.00
147.72
5.00
$ 5,440.72
06/03/2003
rrade Date: OS/29/2003
Aarket: New York Stock Exch.
CUSIP#: 755267-10-1
Securitr#: R133769
Symbo : RDA
Solicited Order
Cash Accl.
Ref #: 717998
PREFERENTIAL RATE
HOLD SECURiTIES
^Ie acted as your agent in this transaction.
(ou Sold 500 at a price of 15.60
'UPPERWARE CORP
Gross Amount
SEC Fee
Transaction Fee
Amount
Settlement Date
$ 7,800.00
.37
5.00
$ 7,794.63
06/0312003
-rade Date: OS/29/2003
.larket: New York Stock Exch.
CUSIP#: 899896-10-4
Securitr#: T677379
Symbo : TU P
Solicited Order
Cash Acel.
Ref #: 745441
HOLD PROCEEDS
Je acted as your agent in this transaction.
50-012223-5
Confirmation
SALOMON SMITH BARNEY
SALOMON SMITH BARNEY INC.
P.O. EfOX 12057
- 11 N 3RD ST-2ND FL
HARRISBURG PA 17101
Amemberofc't,grouPl"
Account Number:
Financial Consultant:
724-60955.1-2-550
RAYMOND MONTCHAL
717.780-1700
1",111,"111",1111111"",1,11"1",11"1\",,\,1\,,,11,,,1\
wMARGARETC. BROWN #1.947
SSB IRA CUSTODIAN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
You Sold 1.000 at a price at .224
.., RTS LM ERICSSON
EXP 8/27/2002
RPT PRICE TO NASDAQ: .25
PX INCLDS MARK-DWN: .026
SALOMON SMITH BARNEY
IS A MARKET MAKER
Gross Amounl
SEC Fee
Transaction Fee
Amount
Settlement Dale
$ 224.00
.01
5.00
$ 218.99
08/30/2002
Trade Date: 08/27/2002
Markel: Over- The-Counter
CUSIP#: 294821-12-9
Security#: L581249
Symbol: ERICR
Solicited Order
Cash Ace\.
Ret#: 69433
HOLD PROCEEDS
We acted as principal in this transaction.
As a reminder, payment for securities purchased or delivery of securities sold must be deposited with us by the Settlement Date.
See reverse for 1urther details. Keep this document tor your records. Thank you tor doing business with us. 08.'27/2002 $D-012223.$
30-022690-5
Confirmation
SALOMON SMITH BARNEY
SALDMON SMITH BARNEY INC.
P.O. BOX 12057
11 N 3RD ST-2ND FL
HARRISBURG PA 17101
A memberof c,t,groupj"
Account Number: 724-60955-1-2-550
Financial Consultant: RAYMOND MONTCHAL
717-780-1700
1".111...111...1...111"".1.11..1...11.,11....1.11...11...11
"'MARGARET C. BROWN #2,010
5SB IRA CUSTODIAN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
You Sold 200 at a price of 20.80
PROXYMEDINC
-NEW-
Gross Amount
Commission
SEC Fee
Transaction Fee
Amount
Settlement Date
$ 4,160.00
107.07
.13
5.00
$ 4,047.80
04/05/2002
Trade Date: 04/02/2002
Market: Over - The-Counler
CUSIP#: 744290-30-5
Security#: P778377
Symbol: PILL
Solicited Order
Cash Ace\.
Ref#:42490
PREFERENTIAL RATE
HOLD PROCEEDS
We acted as your agent in this transaction.
As a reminder, payment tor securities purchased or delivery of securities sold must be deposited with us by the Setllemenl Dale.
See reverse lor lurther details. Keep this document for your records. Thank you for dOing business with us. 0410212002 SO'022690.S
REV-1513 EX' (9-00) '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Margaret Brown Hopkins
FILE NUMBER
21-02-1047
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAX.A.BLE DISTRIBUTIONS Vnclude outright spousal distributions, and transfers under
Sec. 9116 ('I (1.211
Marlene Brown Yakowicz Daughter one-fourth share
227 Oak Knoll Road
New Cumberland, Pa. 17070
Pamela Jean Brown Daughter one-fourth share
135 Franklintown Road
Dillsburg, Pa. 17019
Melanie E. Brown Daughter one-fourth share
224 East Canal Street
Hummelstown, Pa. 17033
Michelle Yakowicz Hartz Granddaughter one-fourth share
2580 Lewisberry Road, No.9
York Haven, Pa. 17370
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15DO COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
t
n/s 16 Z.
;v- ,,:2 -4s~
tv; L'- .,.. l e. tr. ft.$
Repf'hU.e - ..p. /.'''J &f~..s ;,11J
f4Jment" [o:eJ......C~ ~
"" , ()b [);-.:s c. d fNA, t-
I~ ~ ell 0 . 0 b
,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
December 4, 2002
Telephone
(717) 787-3930
FAX (717) 772-0412
Ms Marlene Brown Yakowicz
227 Oak Knoll Rd.
New Cumberland, Pa.17070
Re: Estate of Margaret Brown Hopkins
File Number 2102-1047
Dear Ms Yakowicz:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before June 08,2003. Because Section
2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s}
will be granted that would exceed the maximum time permitted.
Sincerely,
//
, ., ---!/. ..~~.)..~~-''''''''''~.;
Jeffrey Hollenbush, Supervisor
Document Processing Unit
Inheritance Tax Division
SALOMON SMITH BARNEY
Amemberof ell/group!"
')/~O?- -JD '-17
P.O. BOX 12057
11 N 3RD ST-2ND FL
HARRISBURG PA 17101
DECEMBER 5, 2002
1".111",111",1",111"".1,11"1",11"11,,,,1,11,,,11.,,11
REF.#: 1521 - PAGE: 0001 - BR.OO724
"'MARGARET C. BROWN
SSB IRA CUSTODIAN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
Dear Client:
For your protection, it Is a policy of our firm to confirm the distribution of
funds from your account to a third party. Our records indicate that a
disbursement of $12,000.00 was issued from your account
number:724-60955-1-2-550 on DECEMBER 5, 2002 to:
REGISTER OF WILLS
OF CUMBERLAND COUNTY
1 COURTHOUSE SQUARE
FIRST FLOOR
CARLISLE, PA 17013
If any of the above information is not in accordance with your instructions, please
Inform the Branch Manager of your office immediately by calling 717-780-1700.
If this information is correct, you do not need to respond to this letter.
Thank you,
~~
Susan Lobosco
Vice President
Branch Administration
SALOMON SMITH BARNEY INC.
A MEMBER OF CITlGROUP
333 WEST 34'1'11 STREET
NEW YORK, NEW YORK 10001
Thts is to certlty that the lnformation here given is correctly copied from an original certificate of death duly filed with me as
L9cal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanenr filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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.~~~"""",,,,,,,"'11JI'
~rz~~A;
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fee for this certificate, $2.00
P 8132759
Date
~105.1'3R... 2/81
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
rlP€lPA-ltoT
'"
~fR.....,.EtH
SUCKINI(
S'''-i''li~V''Q(''
'11~"EOFomOfNT({,;;M~~ Har~~::;~e~~~-~~~~ Br~W;'~-------~ :~-Fem-ale~J;:2~~CUR:"16f~ - 329~-'
.o.GE Il~"II,"",~11 UNOERI VEN! UNDER 1 on IIIF>HJPl..ACE 'C'j.M Pv.cE OF Of:ATH.r:r"",. .....',,,,, ,- -. ,,,,,,"'-'......,.,.........._,
I./Onll" D... Hou.-'!, ....~,.. S..,.", ''''''9''<:''''''''" HOSPITAl. -
76 v~ Blakely I PA l~poh.~' 0 (flJQuIp.I"..... 0
! 1....
COUNl"Y OF DUlH FACIUTY NAME I" "" ,,~,...,......, ~.... ..,.... """ ,...,,,_.
~"'IJO
Cumberland
~
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-"....p? m_Q9 :::":-=:':":=01
MOTHER'S NAl.lE ,F." "',~~"'. ......"""SU'~""'..l
Thelma
D'7T'E'()F(JE.1J",~-o;::.;;,J~_.
.. Harch 8, 2002
~.
Cumberland
k.
Camp Hill
ManorCare Services of Camp Hill
WASOECEDfNTf~fflIN
USAAMEDFQflCfS?
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l.fuite
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Social Security No. 200-16-3298
22nd day of November
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WHEREAS, on
dated February
was admitted to
the
Register of wills of CUMBERLAND County, pennsylvani
Certificate of Grant of Letters
No. 2002-01047
PA No. 21-02-1047
ESTATE OF HOPKINS MARGARET BROWN
(LAO; 1, r l!{o; 1, lVllUULl::)
a/k/a BROWN MARGARET C
Late of CAMP HILL BOROUGH
CUM~~KLN~U CUUN1Y,
2002 an instrument
17th 1996
probate as the last will of HOPKINS MARGARET BROWN
(LAO; 1, r l!{o;'l, lVllUULJ:o:)
a/k/a BROWN MARGARET C
late of CAMP HILL BOROUGH
CUMBERLAND County, who died on the
8th day of March 2002 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to YAKOWICZ MARLENE BROWN and BROWN PAMELA J
who have duly qualified as Executor (rix)
and have agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 22nd day of November 2002.
flb/7ta/ ~ ~ ~~ ~ ~N 0/
eg1.S er 0 1. 1
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**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
21-02-1047
LAST WILL AND TESTAMENT
OF
MARGARET BROWN HOPKINS
I, Margaret Brown Hopkins, of Dauphin County,
Pennsylvania, being of sound and disposing mind, memory, and
understanding, do hereby make, publish, and declare this as
and for my Last Will and Testament, hereby revoking all
other wills and codicils previously made by me.
FIRST
I direct the payment of my debts and expenses of my
last illness and funeral from my estate as soon after my
death as conveniently may be done.
SECOND
I direct that any and all Inheritance, Estate,
Transfer, Succession, and other taxes imposed upon my estate
passing under this Will or any codicil hereto, and interest
and penalties thereon, if any, shall be paid out of the
principal of my residuary estate as if such taxes were
administrative expenses. I authorize my Personal
Representative to pay all such taxes at such time or times
as my Personal Representative deems advisable.
THIRD
I give and bequeath all of my jewelry to my Personal
Representatives to distribute to my daughters, grandchildren
and great-grandchildren in remembrance of me.
FOURTH
I give, devise and bequeath one-fourth of the rest,
2
residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the following terms
and conditions:
(a) Hold the entire trust fund for my granddaughter,
Michelle Lynn Brown Yakowicz who I have always felt is more
like a daughter to me because I raised her and even though I
deeply love all of my grandchildren, Michelle was a part of
my household.
(b) In the event of Michelle's death, hold the entire
trust fund for my great-granddaughter Celia Marlene Hartz.
(b) Pay so much of the income and so much of the
principal as may be deemed advisable by my Trustees for the
support, maintenance, and medical expenses of the
beneficiary or for whatever expenditure whatsoever on behalf
of my beneficiary. In making such payments, the amounts to
be paid by my Trustees from time to time shall be
established and determined by my Trustees, in their
discretion, upon the basis of the needs of the beneficiary.
(c) I authorize my Trustees to make the aforesaid
payments to my beneficiary if, in the opinion of my
Trustees, my beneficiary is of such ability to properly
apply the funds so received. The amount of payments and the
time the payments are made shall be determined by my
Trustees.
(d) If the beneficiary shall, in the opinion of my
Trustees, become mentally or physically incapacitated, the
fund shall remain in trust and my Trustees may apply the
3
fund, either principal or income, for the support and
welfare of the beneficiary, directly, without the
intervention of any guardian.
(e) If my great-granddaughter, Celia Marlene Hartz, in
her lifetime, does not receive all of the assets of the
trust fund, then I request that all remaining assets become
a part of the rest, residue and remainder of my estate and
be distributed in the manner provided in this instrument.
FIFTH
Since my son Earl Howard Brown, Jr., M.D., has always
been given my love and affection and since he has received
his college education and medical doctorate degree and has
ample means to provide for himself and his family, I give,
devise, and bequeath to each of my daughters, Marlene Brown
Yakowicz, Pamela Jean Brown and Melanie Brown Hauck,
one-fourth of my estate: provided that each daughter
receives her share only if she survives me by thirty (30)
days.
SIXTH
(a) In the event that my daughter, Pamela Jean Brown,
fails to survive me, or fails to survive me by thirty days,
then I request that her one-fourth share of my estate become
part of my residuary estate.
(b) In the event that my daughter Marlene Brown
Yakowicz, fails to survive me, or fails to survive me by
thirty days, I give, devise and bequeath her one-fourth
share of the rest, residue and remainder of my estate, to my
4
Trustees, IN TRUST, however, to act as Trustees upon the
fOllowing terms and conditions:
(1) Hold the entire trust fund for my
granddaughter, Megan Yakowicz, to be held IN TRUST according
to the same provisions enunciated in the Third Paragraph,
Items (b), (c) and (d) of this my Last Will and Testament.
(2) If my granddaughter, Megan Yakowicz, in her
lifetime, does not receive all of the assets of the trust
fund, then I request that all remaining assets become a part
of the rest, residue and remainder of my estate and be
distributed in the manner provided in this instrument.
(c) In the event that my daughter Melanie Brown Hauck,
fails to survive me, or fails to survive me by thirty days,
I give, devise and bequeath her one-fourth share of the
rest, residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the fOllowing terms
and conditions:
(1) Hold the entire trust fund, in equal shares,
for my granddaughters, Gwendolyn Brown Hauck and Elizabeth
Brown Hauck, to be held IN TRUST according to the same
provisions enunciated in the Third Paragraph, Items (b), (c)
and (d) of this my Last Will and Testament.
(2) If my granddaughters, Gwendolyn Brown Hauck
or Elizabeth Brown Hauck, in their respective lifetimes, do
not receive all of the assets of the trust funds, then I
request that all remaining assets become a part of the
surviver's trust fund.
5
(i) If my granddaughters, Gwendolyn Brown
Hauck or Elizabeth Brown Hauck, do not receive all of the
assets of their trust funds, then I request that all
remaining assets become a part of the rest, residue and
remainder of my estate and be distributed in the manner
provided in this instrument.
SEVENTH
I give, devise and bequeath the remainder of my estate,
if any, to my surviving grandchildren and great
grandchildren in equal shares.
EIGHTH
Any and all payment or payments of any sum or sums,
whether in cash or kind and whether for principal or income,
payable to any beneficiary, shall be free of the debts,
contracts, alienations, and anticipations of any
beneficiary, and the same shall not be liable to any levy,
execution, sequestration, or attachment while in the
possession of the Trustees or Personal Representatives.
NINTH
In addition to the powers conferred by law, I authorize
my Trustees to exercise the following in their discretion:
(a) To exercise all powers and discretion, guided by
the prudent man rule.
(b) To exercise all power, authority, and discretion
given by this Will after the termination of the trusts
created herein until the same are fully distributed.
TENTH
6
In addition to the powers conferred by law, I authorize
my Personal Representatives to exercise the following in
their discretion:
(a) To retain any real or personal property which may
at any time form a part of my estate as long as deemed
advisable.
(b) To exercise any option or rights arising from
ownership of investments.
(c) To repair, alter, improve, or lease for any period
of time any real or personal property and to give options
for leases.
(d) To sell at public or private sale, for cash or
credit, with or without security, to exchange or to
partition real or personal property and give options for
sales or exchanges.
(e) To compromise claims without court approval, and
without the consent of any beneficiary.
(f) To make distribution in kind.
ELEVENTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown, Trustees of the Trusts
created herein in this my Last Will and Testament.
TWELFTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown as my Personal
Representatives and Co-Executors of this my Last Will and
Testament.
7
THIRTEENTH
I direct that no Guardian, Trustee, Executor, Personal
Representative, or other fiduciary named, nominated, or
appointed in this, my Last Will and Testament, shall be
required to post any bond or give any security of any type
for any purpose whatsoever, any law or rule of court of the
Commonwealth of pennsYlvania or any other jurisdiction to
the contrary notwithstanding.
IN WITNESS WHEREOF, I, Margaret Brown Hopkins, have
hereunto set my hand and seal to this, my Last will and
Testament, consisting of seven (7) typewritten pages, this
~'f}/1
/
day of N~A.-</01 /7
, 1996.
Jr1-dhJ~/~ -<./~ lyM'Vl (SEAL)
Margaret Brown Hopkins
Signed. sealed, published, and declared by the above
named, Margaret Brown Hopkins, as and for her Last Will and
Testament, in the presence of us, who, at her request, have
hereunto subscribed our names as witnesses thereto in the
presence of the said
testatrix., / /u {. 1
-- ':h1~>"~~
C-=--'.~:.....~.. iv. . (, '^. /. U:.v~
(SEAL)
Witnesses:
Address:
/, 1:: el.
//a; ~ -pj /7c:3 3
J//.e1P1(/k Ok ~ '''ALl
Address:
Id, {J,OL-tJEA) flL;uRl
;+EI!...JlfE\/ {J4 176T=3
I \
Commonwealth of Pennsylvania
County of
We, Margaret Brown Hopkins, and
;t~---A"--u/ A Jiuk-v./
-
a~ " M V
the testatr'x the witnesses respectively, whose names
are signed to the attached instrument, being first duly
sworn and qualified according to law, do hereby declare to
the undersigned authority that we were present and saw the
testatrix sign and execute the instrument as her Will, and
that she signed willingly, and that she executed it as her
free and voluntary act for the purpose therein expressed,
and that each of the witnesses, in the presence and hearing
of the testatrix signed the Will as witness and that to the
best of our knowledge the testatrix was at the time eighteen
years of age or older, of sound mind and under no constraint
or undue influence, and I, the said testatrix do hereby
acknowledge that I signed and executed the instrument as my
Last Will, that I signed it willingly, and that I signed it
as my free and voluntary act for the purpose therein
expressed.
m a?t'/dJ-L: ~~ ;j~
. Mar aret Brown Hopkins
/~~
-""'. -' ~
C___,~c.__,/, ~
jj AA ()21 ( tJ:J::::
~ (Witness)
Sworn and
before me
of
subscribed to
this day
1996.
Notary Public
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION '
DEPT. 280601 INHERITANCE TAX
HARRISBURG, PA 17128-0601
STATEMENT OF ACCOUNT
REV-107 E% IFV (01-03~
DATE 08-25-2003
ESTATE OF HOPKINS MARGARET C
DATE OF DEATH 03-08-2002
FILE NUMBER 21 02-1047
COUNTY CUMBERLAND
MARLENE BROWN YAKOWICZ ACN 101
227 OAK KNOLL RD Amount Remitted
NEW CUMBERLAND PA 17070
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment.
CiiT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (OI-03) *** INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF HOPKINS MARGARET C FILE N0. 21 02-1047 ACN 101 DATE 08-25-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-28-2003
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
10,981.85
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
12-05-2002 CD001918 .00 12,000.00
08-07-2003 REFUND .00 1,018.15-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST. l
( IF TOTAL DUE IS LESS THAN Sl,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
10,981.85
.00
.00
.00
-BUt4~AU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
MARLENE BROWN YAKOWICZ
227 OAK KNOLL RD
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
NEW CUMBERLAND PA 1707.0'
~; -
REV-1547 EX RFP (O1-OS)
DATE 07-28-2003
ESTATE OF HOPKINS MARGARET C
DATE OF DEATH 03-08-2002
FILE NUMBER 21 02-1047
~:'iCOUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --__--- RETAIN LOWER PORTION FOR YOUR
-------------- ----- RECORDS ~
-----------------------------------------------------
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE ---------------------
OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOPKINS MARGARET C FILE N0. 21 02-1047 ACN 101 DATE 07-28-2003
TAX RETURN WAS: ( l ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 6,6 13.60 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 215.066.50 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 45,000.00
8. Total Assets (g) 266,680.10
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl (9) 17'728'83
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 4.91 0.22
11. Total Deductions (11) - 22 .6~9 _ 0~
12. Net Value of Tax Return (1P) 244, 041.05
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 244, 041.05
NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .00 X 00 _ .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 244,041.05 X 045. 10,981.85
17. Amount of Line 14 at Sibling rate (17) .00 X 12 - .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 - .00
19. Principal Tax Due (19)= 10,981.85
T6Y PDCTTTG~.
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
12-05-2002 CD001918 .00 12,000.00
TOTAL TAX CREDIT 12,000.00
BALANCE OF TAX DUE 1,018.15CR
INTEREST AND PEN. .00
TOTAL DUE 1,018.15CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATIDN: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjcyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Canmonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 91407.
PAYMENT: Detach the tap portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax^ (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident
Decedent^ (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of
the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same Wanner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%l percent Per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 era:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .OOD247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest oust be calculated.
.•
REV-14,10 EX (8-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Margaret B. Hopkins 2102-1047
REVIEWED BY ACN
John Kuchinski 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
Row Page 1
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0501
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
MARLENE BROWN YAKOWICZ ~ __
227 OAK KNOLL RD
NEW CUMBERLAND PA 17070
REV-1607 E% ~FP (O1-OS)
DATE 08-25-2003
ESTATE OF HOPKINS MARGARET C
DATE OF DEATH 03-OS-2002
FILE NUMBER 21 02-1047
COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-03] ~~(~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF HOPKINS MARGARET C FILE N0. 21 02-1047 ACN 101 DATE 08-25-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PRDJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-28-2003
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
10,981.85
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
12-05-2002 CD001918 .00 12,000.00
08-07-2003 REFUND .00 1,018.15-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
10,981.85
.00
.00
.00
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check ar money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money ardor payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, may be requested by completing an
°Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-3b2-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TD: Questions regarding errors contained on this notice should 6e addressed ta: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280b01, Harrisburg, PA 17128-0601, phone
(7177 787-6505.
DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%l discount
of the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
e •
227 Oak Knoll Road
New Cumberland, PA 17
717-720-3294
717-774-7409
March 1, 2004
-[-#~Cf"- ..
~, ..::.
To: Donna Otto
Cumberland County Orphans' Court
Re: Status Report -Estate of Margaret Brown Hopkins
2002-1047 21-02-1047 -Date of Death: March 8, 2002
From: Marlene Brown Yakowicz and
Pamela J. Brown
Personal Representatives
Attached hereto is the referenced report.
~''' \
_~% -G?.~ iLy~
Attachment
STATUS REPORT UNDER RULE. 6.12
Name of Decedent• Margaret Brown Hopkins
Date of Death: March 8, 2002
Will No. 2002-01047
Admin. No. 21-02-1047
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: Income Tax Return for Estate
r
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached'to this re_o~t.
,,~~
Date 2/28/04 ~ ' '~~~~--~
Signature
Marlene Brown Yakowicz and
Pamela .T_ Rrnwn
Name (Please type or print)
227 Oak Knoll Road
New Cumberland, PA 17070
Address
S71 7 ) 72~-'1294
Tel. No.
Capacity: X Personal Representatives
Counsel for personal
representative
(MAH:rmf/AM3)
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I,
MARY C. LEWIS
SHORT CERTIFICATE
Register for the Probate of Wills and Granting
Letters of Administration &c. in and for said
County of CUMBERLAND do hereby certify that on
the 22nd day of November A.D.,
Two Thousand and Two,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
t t of HOPKINS MARGARET BROWN late of CAMP HILL BOROUGH
es a e
a/k/a BROWN MARGARET C
in said county, deceased, to
BROWN PAMELA J
YAKOWICZ MARLENE BROWN and
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of said office at CARLISLE, PENNSYLVANIA, this 22nd day of November
A.D., Two Thousand and Two.
File No. 2002-01047
PA File No. 21-02-1047
Date of Death 3/08/2002 Q~~~~~~~~/Y) .r~~ ~~ ~S~v.,~ Register
S. S. # 2 0 0 -16 - 3 2 9 8 /`z~ `~ ~~ kl~~~``~
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION '
DEPT. 2B0601
HARRISBURG, PA 17128-0601
MARLENE BROWN YAKOWICZ
227 OAK KNOLL RD
NEW CUMBERLAND PA 17070
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1107 ER iFV (01-03)
DATE 08-25-2003
ESTATE OF HOPKINS MARGARET C
DATE OF DEATH 03-08-2002
FILE NUMBER 21 02-1047
COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form reith your tax payment.
CiiT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS 1
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-031 ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF HOPKINS MARGARET C FILE N0. 21 02-1047 ACN 101 DATE 08-25-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-28-2003
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
10,981.85
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
12-05-2002 CD001918 .00 12,000.00
08-07-2003 REFUND .00 1,018.15-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED A5 A "CREDIT" (CRI,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
10,981.85
.00
.00
.00
/.
.
~
' /
NCO Financial Systems, Inc.
Attorney Network Services
Department 500
1804 Washington, Boulevard
Baltimore, MD 21230 //
(800) 974-9728, Ext. ~~s~
~P ;vt ,(j"'~2owtii
2~7 0~~ ~''~o~~ ~~
,~~ r~~~~~c•~Na ~ ~ ~ ~~
RE:
Creditor:
Our File Number:
Account Number:
Original Amount:
Dear E~'• ~~~N
s
iqv l~/~ ~•~sT l/,S~
~ ~9~a3
s~Yr7~ z Ss-~ir3?3 ~ Z ~ s~S~i7i 2 ~7 ~~~/~3SS~
The purpose of this letter is to confirm the recent settlement we have agreed to in the above
referenced matter.
It has been agreed you will pay the sum of ~ l ~d ~ on or before ~-~ `~ 3
Once payment is received, the account of the creditor will be deemed fully satisfied. The
payment should be made payable to ~ti.~ o~/E ,and returned to the address below.
Please reference our file number, shown above, on each payment. We greatly appreciate your
cooperation in working with us to settle this matter.
Sincerely,
~~ -
NCO Financial Systems, Inc.
NCO Attorney Network Service
THE FAIR DEBT COLLECTION PRACTICES ACT REQUIRES US TO INFORM YOU THAT
THIS COMMUNICATION IS FROM A DEBT COLLECTOR.
--------------------------------------------------------------------------------------------------
Mailing Address: NCO FINANCIAL SYSTEMS, INC.
507 PRUDENTIAL ROAD
HORSHAM PA. 19044
r
BAAIK ONE DELAWARE, NA
FUSA CARD MEMBER. SERVICES
5202 PRESIDENTS COURT DE1-0811
FREDERICK, MD 21701
Important Tax Return Document Enclosed
EST OF MARGARET BROWN
227 OAK KNOLL RD
NEW CUMBERLAND PA 17070-2836
-.:::~ 'r ~~i~i•_.+r••i~~;"~~ :~ "'~=~"'~.:1 itttiiittriiirt,itttiilttrrtitiittltt,iitriittttiriltrriirt,ii
1099 - B - OMBM 1545-0715 Instructiorre for Redpbrn Box 5. Shows a brief description of the item or service for which the proceeds or bartering income
Brokers and barter exchanges must report proceeds from transactions to you and to the Internal is being reported. For regulated futures contrails and forward comracts, "RFC" or gher
Revenue Service. This form re used to report those proceeds. appropriate description may be shown.
Box 1 a. Shows the trade date d the transaction. For aggregate reporting, no entry will be present. Regulated Futures Contracts:
Box 1 b. For broker transactbna, may show the CUSIP (Committee on Un'dorm Securhy Box Ba. Shows the profit or (bss) realized on regulated futures or foreign curcency contracts closed
Identification Procedures) number of the item reported. during 2003.
Box 2. Shows the proceeds from transactions involving stocks, bonds, other debt obligations, Box 8b. Shows the portion of the amount shown in Box 6a cosed after May 5, 2CV3. Include this
commodhies, or forward contracts. Losses on forward contracts are shown in parernheses. This box amount on your 2003 Form 6791, Gains and Losses From Sedan 1256 Contracts and Straddles,
does nq include proceeds from regulated futures cantrects. The broker must indicate whether gross Part I ,column (c).
proceeds or gross procesda lees commiasbns and option premkrms were reported to the IRS. Box 7. Shows any year-end adjustment to the profit or (loss) shown in box 6a due to open
Report this amount on Schedub D (Form 1040), Capital Gains and Losses. contracts on December 31,2002.
Box 3. Shows the cash you rocsivsd, the tar market value d any property or services you received, Box 8. Shows the unrealized proft or (bss) on open contracts held in your account on December 31
and/or the fair market value d any trade credits or scrip credited to your account by a boner 2003. These are considered sold as d that date. This wiq become an adjustment reposed
exchange. See Pub. 525, Taxabb and Nontaxable Income fw information on how to report this in box 7 in 2004.
income. Box 9a. Boxes 6a, 7, and 8 are aq.used to figure the aggregate profit or (bss) on regulated futures
Box 4. Shows badkup whhholding. Generally a payer must backup withhold at a 2897;, rate if you or foreign currency contracts for Nw~year. Indude this amoum on your 2003 Form 6761, Pan I,
did not furnish your taxpayer idemification rarmber to the payer. coumn (b).
Sea Form W-9, Request for Taxpayer Identification Number and Certrfication, for information Box 9b. Shows the portion of the amount shown in Box 9a after May 5, 2003. Indude this amount or
on backup withholding. Include this amount on your Income tax return as tax withheld, your 2003 Form 6781, Part I, column (c).
1099 - C - OMBN 1545-1424 Instructions for Debtor
q a Federal Government agency, certain agency connected wrth the Federal Government, financial
institution, credit union, or an organization having a significant trade w business of lending
money (such as a finance w credq card company) cancels or forgives a debt you awe of $600 or
more, this form must be provk o you. uenereiiy, ii you are an individual, rou musk include
the canceled amount on the "l Income line of Form 1040. H you are a ~.orporation, partnership,
or other entity, report the cancer. ,debt on your tax return. See the instructions for your tax return.
However, some canceled debts, such aH certain student loans (see Pub. 525), certain debts
reduced by the seller after purchase (see Pub. 334), qualified farm debt (see Pub. 225), quagfied
real property business debt (see Pub 334-, w debts canceled in bankruptcy (see Pub. 906), are not
includible in your income. Do not report a canceled debt as incomed you did not deduct it but
would have been able to do so on your taz return iF you had paid 8. Also do not include canrabd
debts in your income to the extent you were insolvent. If you exclude a canceled debt from your
income because it was cancebd in a bankruptcy case or during inadveency, or because the debt is
qualified farm debt or qualified real property business debt, fib Form 992, Reductbn d Tax
Attributes Due to Discharge d Indef»e~tess (and Segion 1082 Basis Adjustment).
Box 1. Shows the data the debt was canceled.
Box 2. Shows the amoum of debt canceed.
Box 3. Shows interestd included in the canceled debt in box 2. Sea Pub 625, Tauable and
iVomaxaole income.
Box 5. Shows t description of the debt. ft box 7 is completed, box 5 also shows a description
d the property.
Box 6. N the box is marked, the creditor has indicated the debt was canceled in a bankruptcy
proceeding.
Box 7. If, in the same calendar year, a foreclosure or abandonment of property occurred in
connectan with the cancellation of the debt, the fair market value d the property wiq be shown,
or you will receive a separate Form 1099-A, Acquisitan or Abendoment of Secured Prapeny.
You may have income w loss because of the acquisgion or abandoment.
See Pub. 544, Sales and Other Disposition d Assets, fw information about toreclosuures and
abandonments.
1099 - S - OMBaK 1545-0997 Irtstructbns for Transferor
For sales or exchanges of certain real estate, the person responsible for dosing a real estate
transaction must report the real estate proceeds to the Internal Revenue Service and must furnish
this statement to you. To determine H you have to report the sale or exchange d your main home
on your tax return, see the Sdtedub D (Form 1040) instructions. If the real estate was not your
main home, report the transacton ort Form 4797, Sobs d Business Property, Form 8252
Installment Sales Income, andlor Schedub D (Form 1040), Capial Gains and Losses.
Federal mortgage subsidy. You may have to ret~pture (pay back) all or part d a Federal
mortgage subsidy if all the fogowng apply:
' You received a ban provided from the proceeds q a qualgied mortgage bond or you received
a mortgage credit certificate.
' Your wginal mortgage loan was provided after 1990, and
' You sold w disposed of your home at a gas during the first 9 years char you received the
Federal mortgage subsidy.
This will increase your tax, Sse Form 8929, Recapture of Federal Mortgage subsidy, and
Pub. 523, Selling Your Home.
Box 1. Shows the date d cbsing.
Box 2. Shows the gross proceeds from a real estate transaction, generagy the cabs price.
Gross proceeds include cash and nges payafxe to you, notes assumed by the transferee
(buyer), aril any saes paid off at sentiment. Box 2 does not include the value of other
property or services you received or are to receive. gee Box 4,
Box 3. Shows the address or legal desaiptan d the properly trarmferred.
Box 4. M marked, shows that you received w wiq receive services w property (other than cash
or notes) as part of the consideration for the property transferred. The value of any services
or property (other than cash or notes) o rest included in box 2.
Box 5. Shows certain real estate tax on a residence charged to the buyer at senlemern. If you
have already paid the real estate tax fw the period that includes the sob date, subtract the
amourn in box 5 from the amount already paid to determine your deductible real estate tax. But
if you have already deducted the real estate tax in a prbr year, generegy report this amount as
income on the 'Other Income qne of Form 1040. For mess infwntation, see Pub. 523, Pub. 525
and Pub. 530.
~ -+ or'
Combined Tax Statement For Tax Year 2003 Form ,099-A CopyB-ForBorrowerOMB1545-08
Form 1099-B Copy B-For Recipient OMB 1545-07
Form 109&C Copy B-For Debtor OMB , 545-, 4:
NAME, ADDRESS, ZIP CODE & FEDERAL I.D. NO. CUSTOMER NAME, ADDRESS $ TAX I.D. NO. Form toss-MISC Copy B-For Recipient OMB ,545-Ot
Form 1099•S Copy B-For TransfarorOMB ,545-09
BANK ONE DELAWARE, NA
FUSA CARD MEMBER SERVLCES
5202 PRESIDENTS COURT DE1-0811
FREDERICK, MD 21701
Federal I.D. No. 51-0269396
EST OF MARGARET BROWN
227 OAK KNOLL RD
NEW CUMBERLAND PA 17070-2836
Taxpayer I.D. No. 200-16-329$
Customer Service Phone #: boo-238-3267 If your Taxpayer I.D. Number is incorrect, a Form W-9 must be completed in order for us to
update our records. Please call the customer service number listed to request this form to
be mailed to you or visit a bank One banking center to complete one. Please note that IRS
penalties may be imposed for an incorrect Taxpayer I.D. Number.
2003 - 1099-C, CANCELLATION OF DEBT
ACCOUNT NUMBER
CANCELED DEBT 417129511137362
BOX 1 DATE CANCELED 09/26/03
BOX 2 AMOUNT CF DEBT CANCELER 6I:.C5
BOX 5 DEBT DESCRIPTION
VISA
CANCELED DEBT 417129775113554
BOX 1 DATE CANCELED 09/26/03
BOX 2 AMOUNT OF DEBT CANCELED 1,247.19
BOX 5 DEBT DESCRIPTION
VISA
TOTAL AMOUNT OF DEBT CANCELED 1,864.24
For Form ,099-A 8 109&C :This is important tax information and is being lumished to the Imetnal Revenue Service. H you are requ'ued to f ib a retum, a negligence penahy or other sanction
may be imposed on you k taxabb inwme results from this transaction and the IRS determines that n has not been reported.
For Form ,099-B 8 1099-MISC :This is imponam tax information and is being fumi~ted to the Internal Revenue Service. N you are required to file a return, a negligence penaly or other sanction
may be imposed on you 1 income b taxable and the IRS determines that h has not been roponed.
For Form ,0995 : This is important tax inlormarion and is being furnished to the Imsmal Revenue Service. H you are required to file a return, a negligence penalty or other sanction may bs
imposed on you H this item b requited to be reported and the IRS determines that n has not been reported.
1099 - A - OM6111545-0877 Instructions for Borrower INSTRUCTIONS
Certain lenders who acquire an interest in property that was security for a loan or who have is generally the earfier d the date fhb was transferred to the tinder or the date possession
reason to know that such property has been abandoned must provide you with this statement. You and the burdens and benefits el ownersh~ were transferred to the tinder. This may be the sat
may have reportable income or loss because of such acquisitbn or abandonment. Gain or loss from d a foreclosure or execution sale or the date your right of redemption or abjection expired.
an acquisition generaAy is measured by the difference between your adjusted basis in the property For an abandonment, the date shown is the date on which the tinder first knew or had reason
and the amount o1 your debt canceled in exchange for the property, or,H greater, the cab know that the property was abandoned or the date d a toredosure, executon, or similar sob.
proceeds. H you abandoned the property, you may have income from the discharge d indebtedness Boz 2. Shows the debt (principal only) owed to the lender on the loan when interest in the pro
in the amount of the unpaid balance of your carrcebd debt. You may also have a lose from was acquired by the lender or on the date the larder first knew or had reason to know that
abandonment up to the adjusted basis d the property at the time d abanonment Losses on the property was abandoned.
acquisitions or abardonmems of proprty held for personal use are not deucti>le See Pub. 544, Box 4. Straws the fair market value of the property. H the amoum in Box 4 is less than the
Sales and Other Disposrtiors of Assets, for information about torecbsesures and abandonmems. amoum in box 2, and your debt is canceled, you may have cancelarion d debt income.
Property means any real property (such as personal residence); any intang~rb proerty; Box 5. Shows whether you were personally liable for repayment d the loan when debt was
and tangible personal property that is held for investment or used in a trade or business. created or, if muddied, when d was last mod'rtied.
H you borrowed money on this property with somoone else, each of you should receive Box 6. Shows the desaiptbn d the property acquired by iha lender a abandoned by you.
this statement. H'CCC' is shown, the forth indicates the amount of any Commodity Credit Corporation loan
Box 1. For a lenders acquisition of property that was security for a k>an, the date shown outstanding when you forfeRed your commodAy.
1099 - MISC - OMBr 1645-0115 instructions tort recpient
Amounts shown may be to tteN~mployrneM (SE) tax. H your net income from SeH-
ernploymant is $400 or more, you must file a return and compute your SE tax on Schedule SE
(form 1040). See Pub. 533, Self Employment Tax, for moro information. H no income or soda!
security and Medicare taxes were withheld and you are still receiving these paymerus see Font
1040-ES, Estimated Tax for Individuals. Individuals must report as explained babes.
Corporations, fiduciaries, or partnership, report the amounts on the proper line on your tax return.
Boxes 1 and 2. Report rents from real estate on Schedub E (Earn 1040). If you provided
significant services to the tenant, sold real estate as a business, or rooted personal property as a
business, report on Schedub C or C-EZ (Form 1040). For royalties on timber, coal, and 'aon ore,
see Pub. 544, Sales and other Disposaions d Assets.
Box 2. Generally, report this amount on line 21 d Form 1040 and identify the payment. The
amoum shown may be paymams received as beneficiary d a deceased empbyee, prizes
awards, taxable damages, Indian gaming profits, a other taxabb income. H a is trade or
business income, report this amoum on Schedule C, C-EZ or F (Form 1040).
Box 4. Shows badtup withhddirrg or withholding on Indian gaming prdita. Generally, a payer
must backup withheld at a 289: rata H you did not furnish your taxpayer identHication number.
See Form W-9, Request tort Taxpayer Identification Number and Cert1ication, for
more information. Report this smouM on your income lax return as tax withheld.
Box 5. An amount in this box means the fishing boat operator considers you ssH-ampbyed.
Report this amount on Schedule C or C-EZ (Form ,040). See Pub. 595, Tax Nighlighro for
Commerical Fisherman.
Box 8. Report on Schedule C or C-EZ (Form 1040).
Box 7. Shows nonemployee compensatan. H you are in the trade or business of catching fist
box 7 may show cash you received for the sale of fish. H payments in this box are
SE income, report this amoum on Schedule C, C-F1 or F (Form 1040-, and compbte
Sdtedub SE (Form 1040). You received this form instead of Form W-2 because the payer did
na consider you an empbyee and did not withhold income taz a soda) security and Medicare
taxes. Comas the payer H you believe this form is ircorect or has been issued in error.
H you believe you are an empbyee, report this amoum on line 7 d Form 1040 and call the IR;
for information on how to report any soda) security and Medicare taxes.
Box 8. Shows substHute paymerxs in lieu of dividends or tax-exempt interest received by you
broker on your behalf after the transfer d your securities for use in a short sale. Report on line
21 el Form 1040.
Box g. N shacked, $5,000 or more d sales el consumer products was paid to you on a buys
deposh-commission, or other basis. A dollar amoum does nu have to be shown. Generally rq
any ncome from your sob of these tMse products on Schedub C a C~Z
Box 10. Report this amoum on line 8 of Schedub F (Form 1040).
Box 13. Shows your trial compansatbn of excess golden parachute payments subject to a 2(
tax. See the Form ,040 Irrstructions for Rne 61.
Brut 14. Shows gross proceeds paid to an attorney in connectgn wRh legal services. Report
the taxabb part as income on your return.
Box /b. Other informaan may be provided to you in box 15.
Box 18-18. Shows state a bcal income tax withheld from the payments.
.4 . .
P.O. BOX 12057
11 N 3RD ST-2ND FL
HARRISBURG PA 17101
Itttllltttllltttltitllltttttltllttltttllttllttitltlltttllittll
REF.: 1275 -PAGE: 0001 • BR-00724
MARGARET C. BROWN
227 OAK KNOLL ROAD
NEW CUMBERLAND PA 17070-2836
Dear Client:
SMITHBARL~EY,,,,
cltlgroup ~
SEPTEMBER 19, 2003
For your protection, it is a policy of our firm to confirm the distribution of
funds from your account to a third party. Our records indicate that a
disbursement of $12,000.00 was issued from your account
number:724-07602-1-0-550 on SEPTEMBER 19, 2003 to:
BANK ONE
FILE NUMBER 899503
If any of the above information is not in accordance with your instructions, please
inform the Branch Manager of your office immediately by calling 717-780-1700.
If this information is correct, you do not need to respond to this letter.
Thank you,
Susan Lobosco
Vice President
Branch Administration
Smith Barney is a division and service
mark of Citigroup Global Markets Inc. Member SIPC.
/l
COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of: Court File No: 21-o2-1oa7
MARGARET BROWN
Deceased
T0: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: BANK ONE
c/o NCO Financial Systems, Inc
2) Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
4,972.73
4) The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account numberwhich is evidenced by
the attached affidavit of account stated.
5) Decedent's address: 227 OAK KNOLL RD. ,NEW CUMBERLAND, PA 17070
6) Date of Death: 03-o8-oz
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by.
On behalf of the claimant, I do solemnly decl
perJury that they Information and representa
to the best of my knowledge, information anc
Dated: April 28, 2003
Written notice of claim was given to Persdn~
as stated below:
MARLENE YAKOWICZ
Name
227 OAK KNOLL RD.
Address
NEW CUMBERLAND, PA 17070
City/State/Zip
April 28, 2003
Date notice mailed
ief.
under tfa(e denalties of
~ein ar a and correct
Claimant 6~ 899503
Representative and/or his/her counsel
ENT
.-~
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of: Court File No: zl-o2-1047
MARGARET BROWN
Deceased
T0: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. §3532(b)(2).
1) Claimant's name: BANK ONE
c/o NCO Financial Systems, Inc
2) Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230.
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
9,148.94
4) The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
5) Decedent's address: 227 OAK KNOLL RD. ,NEW CUMBERLAND, PA 17070
6) Date of Death: o3-os-o2
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare d affir nder the nalties of
pe ury that they Information and representation made ein ar t e and correct
to the best of my knowledge, information and i f.
Dated:Apri128, 2003 ~ ~ {
Claimant B99503
Written notice of claim was given to Perso al Representative and/or his/her counsel
as stated below:
MARLENE YAKOWICZ
Name
227 OAK KNOLL RD.
Address
NEW CUMBERLAND, PA 17070
City/State/Zip
April 28, 2003
Date notice mailed
JRD/June30, 1992/1 7858
Date: February 03, 2005
ORPHANS' COURT DIVISION
Marlene Yakowicz
227 Oak Knoll Road
New Cumberland, P A 17070
RE: Estate of Margaret Brown Yakowicz
File Number: 21-02-1047
Dear Sir/Madam:
It has come to my attention that you have not filed the Status Report by Personal
Representative (Rule 6.12) in the above captioned estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT
RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on
or after July 1, 1992, the personal representative or his counsel, within two (2) years of
the decedent's death, shall file with the Register of Wills a Status Report of completed or
uncompleted administration.
This filing will become delinquent on: 03/08/2005
Your prompt attention to this matter will be appreciated.
Thank you.
s~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Judge
vA
Register of Wills of Cumberland County
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
t ~O U-J~
J-{O.?7 k,' tV-S
f
Date of Death:
MeA... '""\ 0-- t" ~. 4-
3 /'i / LOO <-
10 V 7
Estate No.:
-2...l - 02--
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
. Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Y es ~ No 0
D~e:
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the 9~of the Orp~Court and may be
attached to this report. -?'f'~ ~-c.. --<....- ~/~ y ~
:2../-zs) 0 '5" ~ J.t;..-wI,v<~ // ,t/:4~
~ - / Signature / - 1.1 .1 . <-""L
t'\\L~~ \~ n'C!.. \3~. ....... " i'~J( 0 .........-
'S? Itm € I... '.1 . 0""" -....... t'\
Name 2.
2. oz...""? () 4 J< Kl'Vc "- c- I P-
IV~~ G.........~ e.--. / "NO. fit /7o~
Address
,--....-..,i:
7/7- 7~D -' 3 ~1' Y
Telephone No.
Capacity: gPersonal Representative 5
o Counsel for personal representative
vd
J REV-1500 EX(w-n)(FI) 1505610105
ennsylvanta OFFICIAL USE ONLY
PA Department of Revenue P County Code Year File Number
Bureau of Individual Taxes " "'"`"'�MFN
PO BOX28o6ot INHERITANCE TAX RETURN "h o �, (�
Harrisburg PA i7.8-o6oi RESIDENT DECEDENT `(
ENTER DECEDENT INFORMATION BELOW
OSlom I Zt=Z 09 IOC,I192.S
Decedent's Last Name Suffix Decedent's First Name MI
�RowtJ �'gu'c- G
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return M 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
REGISTER O"ILLS USE ONLY
Ca
t"A
First Line of Address =0 frt C>
- V
X C1.5 10
ZZLA cw.3.6\
Second Line of Add, s P
j r\) t5
t7O -a O O
City or Post Office State ZIP Code O IWE FIL&
INK F + w n
CIO O
'TI
Correspondent's e-mail address: MA\k►�17Rv.1r �1 7.d�1 r N�
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 RESPONSI E FOR FILING RETURN DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX(Fl) Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1.
2. Stocks and Bonds(Schedule B) ................... .................... 2. 1-A ._0 _
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivable(Schedule D).......................... . 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ...... . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8, Total Gross Assets total Lines 1 through 7 8.
( s )............................. 3 � 39°1 LAI%
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9.
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. ............. 10.
11, Total Deductions(total Lines 9 and 10)................................ . 11.
12. Net Value of Estate(Line 8 minus Line 11)............................. 12. 3 3q
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........... ............. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ........... ............. 14.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0- 15.
16. Amount of Line 14 taxable 2 p
at lineal rate X.0 Y$ 16. 1 LA9)
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE................ .. ................................. ...... 19.'' �SZ •��
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
STREETADDRESS
Ma,►acc C'�.rP { ��'d.. �eN�c PS .............
-
-tc>•o
CITY `\ STATEIIIN ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1)
2, Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,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)
aka Make check payable to: REGISTER OF WILLS,AGENT.
orao-�3Pz
��y
a^: ."MWAN ;v. {l4iriy x +'i aw9 . Miw`,``e(rrru*.ae^� ;mama
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑
b. retain the right to designate who shall use the property transferred or its income............................................ ❑
c. retain a reversionary interest.............................................................................................................................. 1:1 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 5a
2. If death occurred after Dec. 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?.............. ❑
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.
C tip ��v"�LIt�d r" 5r�svl, i Prti si�a`isII .IY
n.a(.,, Fxo_ � r R�tIRI s i.,
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent(72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 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 21 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 percent[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 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[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 adopfion.
L.ommomicami of rennsymanta 1 of 1
Remillance Advice 000128 85 67396322
Pennsylvania Treasury _ Bureau of Unclaimed Property Payment
CLAIM # 77674637
--------------------------------------------------------------------------------
Property ID Holder Name Description Amount
8994645 NORTHWEST BANCORP INC Misc. Stock 1,858.05
8994646 NORTHWEST BANCORP INC DIV REINVESTMENT 1,541.43
Total: 3,399.48
PAYEE INFORMATION: NOTE: Direct
payment inquiries to:
BROWN MELANIE E PA Unclaimed Property 1.800.222.2046
224 CANAL ST P.O. Box 1837
HUMMELSTOWN PA 17036 Harrisburg, PA 17105 1837
FOLD ON PERFORATION,THEN DETACH CAREFULLY
An
•• • •• _ •• • • - • • . c _• •
00000 003 040513 02397866 157482 000128 60-274; 67�3—a—
313 85 CDC FUND DEPT PREP DATE VOUCHER WARRANT ID
FULTON BANK
CHECK NO.
LANCASTER,PA
VERIFICATION AVAILABLE--POSITIVE PAY"PROTECTED 04/10/2013
CO��wSun�iNy�pr r!U f�a. .�
DATE
SPAY 4 C1
�
__O THE ORDER OF VOID AFTER 1810 DAY:
�
BROWN MELANIE E $**********31399.48
224 CANAL ST
HUMMELSTOWN PA 17036 co
/lt d
TREASURER OF PENNSYLVANIA
II.673963220 1:03L3027481: 121,9 538470
_
STATE OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
I, DONNA M. OTTO
Register for the Probate of Wills and Granting
Letters of Administration &c . in and for said
County of CUMBERLAND do hereby certify that on
the 22nd day of November A.D. ,
Two Thousand and Two,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of HOPKINS MARGARET BROWN late of CAMP HILL BOROUGH
(LASi ,
a/k/a BROWN MARGARET C
in said county, deceased, to YAKOWICZ MARLENE BROWN and
FIRS1 , MIDDLE)
BROWN PAMELA J
(LAST, tIX61 , MIDDLE)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of said office at CARLISLE, PENNSYLVANIA, this 15th day of September
A.D. , Two Thousand and Three.
File No. 2002-01047
PA File No. 21-02-1047
Date of Death 3/08/2002 l Register
S . S. # 200-16-3298
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
n by Cyi7 W ..
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i
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2002-01047 PA No. 21-02-1047
. ESTATE OF HOPKINS MARGARET BROWN
' FIRSI , MIDDLE)
a/k/a BROWN MARGARET C
Late of CAMP HILL BOROUGH
UUMBERLAND ,
Deceased
Social Security No. 200-16-3298
WHEREAS, on the 22nd day of November 2002 an instrument
dated February 17th 1996
was admitted to probate as the last will of HOPKINS MARGARET BROWN
( , PiR6-1 , MIDDLE)
a/k/a BROWN MARGARET C
late of CAMP HILL BOROUGH CUMBERLAND County, who died on the
8th day of March 2002 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to YAKOWICZ MARLENE BROWN and BROWN PAMELA J
who have duly qualified as Executor (rix)
and have agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 22nd day of November 2002 .
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
21-02-1047
LAST WILL AND TESTAMENT
OF
MARGARET BROWN HOPKINS
I , Margaret Brown Hopkins, of Dauphin County,
Pennsylvania, being of sound and disposing mind, memory, and
understanding, do hereby make, publish, and declare this as
and for my Last Will and Testament, hereby revoking all
other wills and codicils previously made by me.
FIRST
I direct the payment of my debts and expenses of my
last illness and funeral from my estate as soon after my
death as conveniently may be done.
SECOND
I direct that any and all Inheritance, Estate,
Transfer, Succession, and other taxes imposed upon my estate
passing under this Will or any codicil hereto, and interest
and penalties thereon, if any, shall be paid out of the
principal of my residuary estate as if such taxes were
administrative expenses. I authorize my Personal
Representative to pay all such taxes at such time or times
as my Personal Representative deems advisable.
THIRD
I give and bequeath all of my jewelry to my Personal
Representatives to distribute to my daughters, grandchildren
and great-grandchildren in remembrance of me.
FOURTH
I give, devise and bequeath one-fourth of the rest,
residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the following terms
and conditions:
(a) Hold the entire trust fund for my granddaughter,
Michelle Lynn Brown Yakowicz who I have always felt is more
like a daughter to me because I raised her and even though I
deeply love all of my grandchildren, Michelle was a part of
my household .
(b) In the event of Michelle ' s death, hold the entire
trust fund for my great-granddaughter Celia Marlene Hartz.
(b) Pay so much of the income and so much of the
principal as may be deemed advisable by my Trustees for the
support, maintenance, and medical expenses of the
beneficiary or for whatever expenditure whatsoever on behalf
of my beneficiary. In making such payments, the amounts to
be paid by my Trustees from time to time shall be
established and determined by my Trustees, in their
discretion, upon the basis of the needs of the beneficiary.
(c) I authorize my Trustees to make the aforesaid
payments to my beneficiary if, in the opinion of my
Trustees, my beneficiary is of such ability to properly
apply the funds so received. The amount of payments and the
time the payments are made shall be determined by my
Trustees.
(d) If the beneficiary shall, in the opinion of my
Trustees, become mentally or physically incapacitated, the
fund shall remain in trust and my Trustees may apply the
fund, either principal or income, for the support and
welfare of the beneficiary, directly, without the
intervention of any guardian.
(e) If my great-granddaughter, Celia Marlene Hartz, in
her lifetime, does not receive all of the assets of the
trust fund, then I request that all remaining assets become
a part of the rest, residue and remainder of my estate and
be distributed in the manner provided in this instrument.
FIFTH
Since my son Earl Howard Brown, Jr. , M.D. , has always
been given my love and affection and since he has received
his college education and medical doctorate degree and has
ample means to provide for himself and his family, I give,
devise, and bequeath to each of my daughters, Marlene Brown
Yakowicz, Pamela Jean Brown and Melanie Brown Hauck,
one-fourth of my estate: provided that each daughter
receives her share only if she survives me by thirty (30)
days.
SIXTH
(a) In the event that my daughter, Pamela Jean Brown,
fails to survive me, or fails to survive me by thirty days,
then I request that her one-fourth share of my estate become
part of my residuary estate.
(b) In the event that my daughter Marlene Brown
Yakowicz, fails to survive me, or fails to survive me by
thirty days, I give, devise and bequeath her one-fourth
share of the rest, residue and remainder of my estate, to my
Trustees, IN TRUST, however, to act as Trustees upon the
following terms and conditions:
( 1 ) Hold the entire trust fund for my
granddaughter, Megan Yakowicz, to be held IN TRUST according
to the same provisions enunciated in the Third Paragraph,
Items (b) , (c) and (d) of this my Last Will and Testament.
( 2) If my granddaughter , Megan Yakowicz, in her
lifetime, does not receive all of the assets of the trust
fund, then I request that all remaining assets become a part
of the rest, residue and remainder of my estate and be
distributed in the manner provided in this instrument.
(c) In the event that my daughter Melanie Brown Hauck,
fails to survive me, or fails to survive me by thirty days,
I give, devise and bequeath her one-fourth share of the
rest, residue and remainder of my estate, to my Trustees, IN
TRUST, however, to act as Trustees upon the following terms
and conditions:
( 1 ) Hold the entire trust fund, in equal shares,
for my granddaughters, Gwendolyn Brown Hauck and Elizabeth
Brown Hauck, to be held IN TRUST according to the same
provisions enunciated in the Third Paragraph, Items (b) , (c)
and (d) of this my Last Will and Testament.
(2) If my granddaughters, Gwendolyn Brown Hauck
or Elizabeth Brown Hauck, in their respective lifetimes, do
not receive all of the assets of the trust funds, then I
request that all remaining assets become a part of the
surviver' s trust fund.
(i ) If my granddaughters, Gwendolyn Brown
Hauck or Elizabeth Brown Hauck, do not receive all of the
assets of their trust funds, then I request that all
remaining assets become a part of the rest, residue and
remainder of my estate and be distributed in the manner
provided in this instrument.
SEVENTH
I give, devise and bequeath the remainder of my estate,
if any, to my surviving grandchildren and great
grandchildren in equal shares.
EIGHTH
Any and all payment or payments of any sum or sums,
whether in cash or kind and whether for principal or * income,
payable to any beneficiary, shall be free of the debts,
contracts, alienations, and anticipations of any
beneficiary, and the same shall not be liable to any levy,
execution, sequestration, or attachment while in the
possession of the Trustees or Personal Representatives.
NINTH
In addition to the powers conferred by law, I authorize
my Trustees to exercise the following in their discretion:
(a) To exercise all powers and discretion, guided by
the prudent man rule.
(b) To exercise all power, authority, and discretion
given by this Will after the termination of the trusts
created herein until the same are fully distributed.
TENTH
In addition to the powers conferred by law, I authorize
my Personal Representatives to exercise the following in
their discretion:
(a) To retain any real or personal property which may
at any time form a part of my estate as long as deemed
advisable.
(b) To exercise any option or rights arising from
ownership of investments.
(c) To repair, alter, improve, or lease for any period
of time any real or personal property and to give options
for leases .
(d ) To sell at public or private sale, for cash or
credit , with or without security, to exchange or to
partition real or personal property and give options for
sales or exchanges.
(e) To compromise claims without court approval, and
without the consent of any beneficiary.
(f) To make distribution in kind.
ELEVENTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown, Trustees of the Trusts
created herein in this my Last Will and Testament.
TWELFTH
I nominate, constitute, and appoint Marlene Brown
Yakowicz and Pamela Jean Brown as my Personal
Representatives and Co-Executors of this my Last Will and
Testament.
m.,.
Representative, or other fiduciary named, nominated, or
appointed in this, my Last Will and Testament, shall be
required to post any bond or give any security of any type
for any purpose whatsoever, any law or rule of court of the
Commonwealth of Pennsylvania or any other ,jurisdiction to
the contrary notwithstanding.
IN WITNESS WHEREOF, I , Margaret Brown Hopkins, have
hereunto set my hand and seal to this, my Last Will and
Testament, consisting of seven (7) typewritten pages, this
day of / 7 1996.
(SEAL)
rgaret Brown Hopkins
Signed, sealed, published, and declared by the above
named, Margaret Brown Hopkins, as and for her Last Will and
Testament, in the presence of us, who, at her request, have
hereunto subscribed our names as witnesses thereto in the
presence of the said testatrix.
Witnesses: ' �� Lt// . (SEAL)
Address:
/o G C
S 17e)3.3
(SEAL)
Address: j
1.-2, 60L-6E.11
Commonwealth of Pennsylvania
County of
We, Margaret Brown Hopkins, and
J t
the .testatr x and the witnesses respectively, whose names
are signed to the attached instrument, being first duly
sworn and qualified according to law, do hereby declare to
the undersigned authority that we were present and saw the
testatrix sign and execute the instrument as her Will, and
that she signed willingly, and that she executed it as her
free and voluntary act for the purpose therein expressed,
and that each of the witnesses, in the presence and hearing
of the testatrix signed the Will as witness and that to the
best of our knowledge the testatrix was at the time eighteen
years of age or older, of sound mind and under no constraint
or undue influence, and I, the said testatrix do hereby
acknowledge that I signed and executed the instrument as my
Last Will, that I signed it willingly, and that I signed it
as my free and voluntary act for the purpose therein
expressed.
Mar1areg t Brora HopkinsD A }
J (Witness)
(Witness)
Sworn and subscribed to
before me this day
of 1996.
Notary Public
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House of Represe ive�sW
From the Desk of
Melanie Brown
Executive Director
Human Services Committee
235 Ryan Offjce Building
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Ui Fax(17)$772-2003
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(l 1-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280801
HARRISBURG,PA 17128.0601 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 017463
BROWN MELANIE
224 CANAL STREET
HUMMELSTOWN, PA 17036
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold --------- ------
101 $152.98
ESTATE INFORMATION:
FILE NUMBER: 2102-1047
DECEDENT NAME: HOPKINS MARGARET BROWN
DATE OF PAYMENT: 04/18/2013
POSTMARK DATE: 04/17/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 03/08/2002
TOTAL AMOUNT PAID: $152.98
REMARKS: MELANIE BROWN
CHECK# 309
INITIALS: WZ
SEAL RECEIVED BY: 'GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES t � Fii i � 6{�'TANCE TAX
REV-1607 EX AFP (12-121
INHERITANCE TAX DIVISION yy� eyTATf�M,E,INT OF ACCOUNT
PO BOX 280601 R I C!�,, l�....!% V f' �'E_i,
HARRISBURG PA 17126-0601 �r U '
".'i3 I Iril 3 (-' L DATE 04-29-2013
ESTATE OF HOPKINS MARGARET C
GiLE DATE OF DEATH 03-08-2002
, FILE NUMBER 21 02-1047
V C '., -; ! COUNTY CUMBERLAND
MARLENE BROWN Y"M82RLA'_„°; ' ;;; P,1, ACN 101
227 OAK KNOLL RD
Amount Remitted
NEW CUMBERLAND PA 17070 F -
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE _ _�_ _ _ _
RETAIN LOWER PORTION FOR YOUR RECORDS 4
REV-1607 EX AFP (12-12) *** INHERITANCE TAX_STAT CC
EMENT OF ACCOUNT - *** _ _
ESTATE OF:HOPKINS MARGARET C FILE NO. : 21 02-1047 ACN: 101 DATE: 04-29-2013
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-21-2003
PRINCIPAL TAX DUE: 10,981 .85
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-05-2002 CDO01918 .00 12,000.00
08-07-2003 REFUND . 00 1 ,018. 15-
04-17-2013 CDO17463 . 00 152.98
TOTAL TAX PAYMENT 11 , 134.83
BALANCE OF TAX DUE 152.98CR
INTEREST AND PEN. .00
TOTAL DUE
152.98CR
+ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL. INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT” (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS. CO?