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Home My WebLink About01-0438 Estate of Samuel M. Maurer also known as Mason S. Maurer PETITION FOR PROBATE and GRANT OF LETTERS 02 I - c>, - y 3~ No. To: Register of Wills for the Deceased. County of Cumber land in the Social Security No. 210 - 26- 5944 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of a~ or olde~ an the executrix in the last will of the above decederu" dated 30 Oct9-ber and codicil(s) dated 10 May 1~~0 named , 19...8A- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber land County, Pennsylvania, with h is last family or principal residence at 201 North 33rd Strp.p.t, Rnrn n+ Camp Hlll, Pennsylvania (list street, number and muncipality) Decendent, then ~~_ years of age, died 26 April Xl<'X 2001 , at Except as follows, deccJent 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: N/ A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 300 ~ 000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled inPa.) 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 testam~ntary (testamentary; administration c.La.; administration d.b.n.c.t.a.) theron. r;, 1:1 u c: 'U ~~ r;,~ <lJ .... c::'U c: -00 c:'= "".= ,-,'U ~o.. 'U '- ~ 0 o;j c: 00 Vi \'{\~~ Q, \\\~~ Marcia A. V.aurer, Executrix 201 North 33rd Street ramp Hill 7 VA l7()11 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ..~ r S~ COUNTY OF C~berland J Sworn to or affirm~d~' subscribed { before me this.;;L day of 'ffJ{br 1OD.L- '-t/jQA"(J' ~. ~vu, fU II e, a . ~-'LD/ ['~ ~/ Reg;;!;, <f - oJ> )S;" - I The petitioner(s) "b()ve..m~med swear(s) or affirm(s) that the statements in the foregoing petition are true ana correct to the best Df the knowledge and beli~f 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. ~ Qj.. \.. V-.C~ C"j}.. :'\0.O-~-UU:-l en c)Q' ;:=s ~ - lo::: ~ ~ I G,. ~o. 21-01-438 Estate of Samuel H. "Maurer a/k/a Mason S. M~urer , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 3, 2001 H, 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 30 October 1984 and 10 Hay 1990 described therein be admitted to probate and filed of record as the last will of SAl'1UEL H MAURER A/K/ A MASON S. MAURER , and First Codicil . , and Letters Testamentary are hereby granted to Marcia A. Maurer Inl1,~ {? ~~'} "M t?: tl. .X:::JuJj OJ!.p,e.ibF" Register of Wills FEES Probate! Letters, Etc. ......... $ 270.00 CaDle L 6 ls'.a8 Short Certificates( ).......... $ ~a EXlAA. PAGES... $ 24.00 JCP $ 5.00 TOTAL _ $ 327.50 Filed . MAY. 3". .2001. . . . . . . . . . . . . . . . . . . . . William E. ~.til1er ~ Jr., ID# 7220 ATTORNEY (Sup. Ct. I.D. No.) 1822 Market Street, Camp Hill, PA 17011 ADDRESS 717/737-9210 PHONE MAILED TO ATTORNEY MAY 4, 2001 11 (1'iSil'i I\E\' 9. S(, This is to cenib; [hat the informJtioll here given is correctly copied from an original cerrificate of death duly filed with me as Local Registrar.' 'J~he origin,ll cerriflcHt' will be forwarded to the State VifJI Records Oflice For permanent flling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this cerriflCltc', $2.00 /" ;i'-jiii7iff;-;;:,~;..,~ I."",;i~~~\\i]u:tl:-:~. ,~\,\~~/ ~:rJ'L-~; 1,' ~/ '. "'/ _\ '~' i;1 '*' \~L.-o,~ (/~ '"'"",' ..: "'17 ~ ~ '::::' , ~ \~~ ~B; :.~ i~~ .... \- . . -- .!" \\ ~;tL" " '; l \~ <2" .' ~ l' \~ :1/1)"--- .,' ~k~ "" ~---~~ 'IMEN"j' ~\~ 11,1,' .....'........, 11:" "'//"~~ i P 7297262 No. /) ~~" ,/n f7~ Loc~ RegISfr"~ APR 2 8 2001 Date COMMONWEALTH Of PENNSYLVANIA · OEPARTM~NT OF HEALTH · VITAL RECORDS CERTIFICATE OF EATH 4J Rev. 2187 NAME Of DECEDENT (f,tS!. Mlddle.l"" I. Samuel M. UNDER I ow ........ Minut.. BIRTHPLACE (Co/y~.cl Slale Of F CtelQil COUt\ItYI Hbg., PA UNDER I YEAR MonIhI Days ... Cumberland DECEDENT'S USUAl OCCUMION (Give knl d work oane ducong """" ~e~ life; do not use ,....ed) E. Pennsboro Twp. ec. Cafe . 11.. 1111. DECEDENT'S MAIliNG AODReSS (SItee\, CCy/Town, SIaIB, ZIpCodel 201 N. 33rd Street Camp Hill, PA 17011 1a. FRliEA'S NAME (Fits!, Mllldle, Lastl DECEDENT'S ACTUAL RESIDENCE (See I/\SIIUCllOna on 0Iher SIde) 17.. SIa.e Q;d decedM M..8 lOWnIhip? 17b. eo.. Cumber land STAlE filE NUMBER SOCIAL SECURITY NUMBER -26 - 5944 g:oIyjO MARITAL STATUS. Manied N...... Married. Widowed. o.-c:ed (Specoly) 1J.1arried 17C.O _,~livedin RACE. Amenc:an Indi.on.llleck. While, etc, (~) to. White SUAVIVING SPOIJSE In _. ~..-name) IWp Marcia D. Maurer No. ~ lived 17~ willlin.."...._.ol MOT I ER'S NAME iF.st, follllOle. Malden Sufname) 11. INFO city.".,.., Louise K. Shutterly T'S MAVP ADOAESJ ~88I. Cotx..lTown, Slete~~~, . 2U1 ~. JJra ~t., ~IV Hl11, PA 17011 I'. _ClAMANT'S NAME (T ypelP"nll CarlA. Maurer Camp Hill 21c. Of DISPOSITION. Heme d Cemet.ry. C,emato<y Place Rolling Green Mem Pk 21d. LICENSE NUMBER 012755-L UII. the bn1 01 my knowledge. dealll oc:cur,ed al IhI I'me. dal. and place "'aled (SillnalUte and Tolle) 2.. 6 '.11 OfY) N, .' I ~(, ~OO V. PART I: Enlet the cltseases, .n,Uties Of complocaloons which c.aUH<! lhe ""alh. Do noJ enle' the mode 01 ing. such as catd<ac Ot 'asp"alo')' a' e... shock Ot heart laolule U.. OIV>I one ca.... on each line _OCATE CAUSE (Fonal _ or COIlOllton 'esAlnglOdeafl)_ r~NCE~ SequenIIaIy Ii8l COOdiliona ,,,,,,Ieeding 10 ~le _, e- UNOERLYING CAUSE (Doseue or ~y ". ......., 8VW1IS t-.....g to .,...,) LAST DUE 10 (OR AS A CONSEQUENCE OF}: DUE 10 (OR AS A CONSEOUENCE Of')' d MS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER Of DEATH PERFORMED? AIotIUU8LE PRIOR 10 ~ COMPLETION OF CAUSE 0 Of DEATH? Nalur81 Homicide Acc:ldenl 0 Pending Inveal...alion 0 ... 0 No Yes 0 No 0 Suoclde 0 Could not be dete,m,ned 0 DATE Of INJURY (Monlh. Day. 'teatl LOCRION . CilylTown- S1a1e. Zip Code Camp Hill, PA 17011 NAME AND ADDRESS Of FACIlITY ut1Yers-Harner FH, 1903 Mkt St, Oi, PA 17011 lICENSE NUMBER DATE SIGNED (MonIh, [)av. -, 23b. De. WAS CASE REFERRED TO MEDICAL EXAMINERlCORONER? Ve.O Noes I Ai>Proxl/YIale :~.= I I I PART II: Olhe, .ign~ condIliona OOnltibuIing 10 dealh. bUl not twauIling in the ~ _ \Iiv8II in PIl.RT I, \t''- rV TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED, _ 0 NoD M, 3OC. 29. PLACE OF INJURY AI home, la,m, IIt88l, lactClfy. office bulldinQ. .,C. ISpec~ I 308. 218. 280. CERJIPIER ICheck 00Iy onel 'CEIlTlfYlNO PHYSICIAN (PhySlCoan c"''''Y'''9 cause ~ death ",hen .molt,... phvsoc,an has pronouncad death ana complele<lllem 23) To'" bea. 01 my knowledQe. deeth occurred _ "'Itte cau."., 'nd manne' .. .I.ted. . . . . . . . . , . . ' . . . . . . . .. .... 'PflONOUNCING AND CERTIFYING PHYSICIAN IPhVSOC18n llOIn ,,'onounc1rlg Oealh and CI!fl"Y""llo cause 01 <leath\ To lhe beel 01 my knowledgfl, death o<:cu"ed allhelllne, d.le. and place. and due to lhe ca....(.).nd m.nn.t a. "aled. 'MEDICAL EXAMINER/CORONER On Ihe ba.i. of ...min.lion .nd/or investigation, in my opinion, de.th occurred at Ihellme, dale. and place. and due 10 the c.use(.) .nd menne' .. ".Ied,. . , , , . . . . . . . . . . . , . , . . . . . . . . . . . . . . , . . . . . 3". REGISTRA ' 33 I~/~/II 301. SlGNAT~E AND TITLE Of CERTifiER o 3'b. lJ~ (\--. ~ LICENse NUM8ER c: - DATE ~ (Moo... ,. Yeatl 31C.(\-,() 0\ ""\ L'i ) ~ 3'd. '1/' 1- b (;) NAME AND ADDAESS Of PERSON WHO COMPLETED CAUSE OF DEATH (Item 27) Type.5J'.intpE '} t?fL /#Jl::ll. M, D. o lOt. l.._o~tvTJ"'6,L 5\' 32. -""'OV)oJI!, ~A . )7,'13 DATE FilED (Month. Day. Year) 34 ~ e:l., I e:J. () 0 ,/ 21-01-438 FIRST COrICIL I I, MASON S. MAURER, al~o known as SAMUEL M. MAURER, declare this to be the First COdiC~l to my Last Will and Testament dated October 30, 1984. ITEM I. I hereby revo*e Item VIII. of my Last will and Testament of October 30, 1984, land substitute the following: i I I appoint ~y wife, Marcia A. Maurer, ITEM VIII. I Executrix under this Wtll. Should my wife, Marcia A. Maurer, fail to qualif~ or cease to act as Executrix, I appoint my son, Maso~ S. Maurer, II, also known as I Samuel M. Maurer, Jr., land my daughter, Susan M. Artevich, as alternate leo-executors under this will. I In all their respects, I ratify and reaffirm my aforesaid Last will and Testament. IN WITNESS WHEREOF, I qave hereunto set my hand and seal to this my First Codicil, thisl IOi.h day of /r\(} tt". , 1990. If U ('\ . i CCi~rro'~/..,L . ( (~(00,(l--.i(:"\/--- ason S. Maurer, also known as Samuel M. Maurer 21-01-438 . ~ 1Easlllill aub Qreslmueul I, MASON S. MAURER, also known as SAMUEL M. MAURER, of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will previously made by me. I TEM I . I direct that all my just debts and funeral expenses, including the cost of a sui table gravemarker and per- petual care for my burial plot, shall be paid from the assets of my estate as soon as practical after my death. ITEM II. I give all my automobiles, and all other articles of personal or household use, together with all insurance relating thereto, to my wife, Marcia A. Maurer, provided that she survives me by thirty (30) days. If she does not so survive me, I give all such property and insurance to my children, who do survive me by thirty (30) days, to be divided among them as they may agree, or in the absence of an agreement, as my Executrix shall deem appropriate. ITEM III. I give, devise and bequeath all the residue of my estate, real and personal to my wife, Marcia A. Maurer, provided she survives me by thirty (30) days; if my wife does not so survive me, I give the residue of my estate, real and personal, in equal Page 1 of Seven Pages I~' - I /J /J / -, .. //1 / /..1 ////4?1!Jf / /;/l /Jlltt~ (SEAL) 'Mason S. Maurer, also known as Samuel M. Maurer T 1\ . ' . . . , shares to my children, per stirpes, provided the share of any child who pre-deceases me or dies on or before the thirtieth (30th) day following my death, shall be distributed to his or her issue per stirpes, living on the thirty-first (31st) day following my death and in default of any such then li~ing issue, such share or shares shall be added to the share or shares of my children who so survive me. ITEM IV . All federal, state, and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passes under this Will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary, or any outside fund. Any death taxes on future interests shall be paid out of the principal of any residuary estate, whenever, at the discretion of my Executrix or Trustee, they deem it advisable. I TEM V. I authorize my Executrix to use administrative or other expenses of my estate as income tax or estate tax deduc- tions, or both, and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without regard to whether taxes were paid from principal or income, without requiring adjustments between income and principal for any resulting effect on income or estate taxes. Page 2 of Seven Pages ( SEAL) ason S. Maure , Samuel M. Maurer ITEM VI. No interest in income or principal shall be assignable by, or available to, anyone having a claim against a beneficiary before actual payment to the beneficiary. ITEM VII. I authorize my Executrix: (a) to compromise claims and to abandon any property which, in my executor I s opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; (b) to sell at public or private sale, to exchange or to lease for any period of time any real or personal property, and to give options for sales or leases; (c) to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; (d) to use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; Page 3 of Seven Pages (SEAL) as /ason S. Maurer, Samuel M. Maurer 1 (e) to distribute IN KIND and to allocate specific assets among the beneficiaries in such proportions as my executor may think best, so long as the total market value of any benefic- iary's share is not affected by such allocation; These authorities shall extend to all real and personal property at any time held by my executor and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM VIII. I appoint my wife, Marcia A. Maurer, Execu- trix under this Will. Should my wife, Marcia A. Maurer, fail to qualify or cease to act as Executor, I appoint my son, Mason S. Maurer, II, also known as Samuel M. Maurer, Jr., as alternate Executor under this Will. ITEM IX. I appoint Cumberland County National Bank guardians of the Estate over any property that will be passed to minor children with respect to which property I am author- ized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the same management powers as those granted to my Executrix. Page 4 of Seven Pages (( ~j (J 11/ /Y~ t"<6~1:,-r/j-1f)./ .. . /!;~ I tLt~1 (SEAL) ~Mason S. Maurer, also known as Samuel M. Maurer .1 I I j ITEM X. I direct that any fiduciary acting hereunder shall not be required to enter bond or other security in any court or jurisdiction in which the fiduciary may be called upon to act. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will, this 3ort\.day of C)c;\C}~[)~_r , 1984. /, /"~ /;'/]1 /} . J /' /. l;;''FllL/LJ~/ /) /ll>rLebJY:/l,r--- /Mason S. Maurer, also known Samuel M. Maurer ( SEAL) as SIGNED, SEALED, PUBLISHED and DECLARED by the above Testate, as and for his last Will, in the presence of us, who thereupon at his request, each other, have hereunto in his presence and in the presence I~ J subJcribed ouriin~es as wi tresses. I " I: "I / \ ",i (. \1 I "_. j , I" \ \ lit ~ ,-,-1/_1-."'>-" C/ ~"__l "~ I f of fi' (__;;_7zA' i') ----7~-.':.:_<9;1, ' /? ~ v,:"."; , . , LcIA-i-./Z(/J(.{ . u./ZuJ (/y'-' Page 5 of Seven Pages ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF DAUPHIN I, Mason S. Maurer, also known as Samuel M. Maurer, Testator, whose name is signed to the attached or foregoing instru- ment, having been duly qualified according to law, do hereby acknowledgment that I signed and executed the instrument as my last Willi that I signed it willinglYi and that I signed it as my free and voluntary act for the purposes therein expressed. (' P/~N1DLtmf71~;- ~~Mason S. Maurer, also known Samuel M. Maurer (SEAL) as SWORN or affirmed to and acknowledged before me, by Mason S. Maurer, also known as Samuel M. Maurer, the Testator, this .-5/; . ~ /(1 i!-:l) /6 ~'b ' _ - da y 0 f .> '------ , / ZC-;r , 19 8 4 . #~"~,,,--, \. PATRICIA M. OOMlESKV, Notary Public Harrisburg, Dauphin County, PC!. ..L My Commission Expires September 5. 19ei-- Page 6 of Seven Pages 1 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF DAUPHIN We, \\ , 'i\i~ /'\ed:. Sc1\1\1:J h ::rr \ and Ccz'ib ; Rli ~ (( \ \ \ n , the wi tnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testator, Mason S. Maurer, also known as Samuel M. Maurer, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator, signed the will as witnesses; and that to the best of our knowledge the testator was at that time eightef~/ (18) or more years of age, of i: ( I sound mind, and under no constra~n~, or~,undurin,fluence:/. l \ I \ t) \ i," \, ' l;. ( \ I '-- I ' ;(I,' !, / \ '" , ' ! ~ ' ,-.-./~'L" \ 0~t, {, } . / "', ) \, , Wi tnestJ, r; '" ~) k I ~ v...J4 \, Rtf, " 1-/ l:. Re siding at: ....Y--... fk I ,7/0 { &tit/ Witness '-~ Residing at: this day ,';6f irmed~rZd ~SUbS"C}, ribed to. before me by / /\.' 0 _a~d L~ ,1ft;t.vIZI-tv'tJL/, witnesse,s, ' ! d ' / Y-iJ/ " ",--'---- A ,,/~; / [/1() ',J. 9"84.) _', ,,' I ,(, i/'"' / ( ;ftkL<-PW~ ~:;t, "My C~~ission Expi~es: PATRICIA M. DOMLESKY, Notary Public Harrisburg, Dauphin County, Pa. My Commi&$ion Expires September 5, 1988 Page 7 of Seven Pages ( CERTIFICA TION OF NOTICE UNDER RULE 5.6(aJ Name of Decedent: Samuel M. Maurer Date of Death: 26 April 2001 Will No. 2001-00438 PA Admin. No. 21-01-0438 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned Estate on 20 July 2001. Name Address Mrs. Marcia A. Maurer 201 North 33rd Street Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: 20 July 2001 William E. Miller, Jr., Miller & Associate I 1822 Market Street Camp Hill, PA 17011 717/737 -9210 C / COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: SAMUEL M MAURER Deceased Court File No: 212001438 TO: 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. 93532(b)(2). 1) Claimant's name: 2) Claimant's address: BANK ONE clo NCO Financial Systems, Inc Probate Department,#450 1804 Washington Boulevard Baltimore, MD 21230 (443)263-3300, ext 3304 Creditor listed below is the owner and holder of a claim in the amount of $14,781.56 3) 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. Decedent's address: 201 N 33RD STREET, CAMP HILL, PA 17011 5) 6) 7) Date of Death: 04/28/01 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 and affirm under the penalties of perjury that they Information and representation~,. ade h..erein a..retrue aprrect to the best of my knowledge, information and beli , . i . d /j I Dated: (/ ))~/.t ,i. . /,II! /) lty--t( ,AGENT I ",--elalmant "150139 Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: MARSHA A MILLER Name 201 N 33RD STREET, Address CAMP HILL, P A 17011 City/State/Zip September 12,2003 Date notice mailed =:6 IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Register's # 21-2001-438 SAMUEL M MAURER Deceased CLAIM To the Clerk of the Orphans' Court Division: Index and make proper entry in your official records of the claim of Citibank(South Dakota)N.A. in the amount of $16,753.76 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2). The said decedent, whose last known residence was at 33RD CAMP HILL PA 170110000 N 201 written notice of this claim was given to MARCIA MAURER, Executor, N 201 33RD, CAMP HILL, PA 170110000 on July 6,2001. I RJ~d~ (Claimant) I Shawn Harmer, anager of Citicorp Credit Services, Inc. under limited power of attorney for Citibank (South Dakota) N.A. 7930 NW 110 Street, Kansas City, MO 64153 (Claimant's Address) 07/03/200 j-19B Acct. #5424180123783216, 4428135240884130 " 18'7q3~1~ 06/07/01 ~ $569.00 ~~~~@lj~i~~~i~mjI~~ ~NfflI~M~W~~~m~: j~J~I~~~~i~WmW~~~~ \ ~ 11015'3. ~ J~ SITE:KC TM:6300 ACID: 06/08/01 KCB3020 23:09:41: SAMUEL M MAURER N 201 33RD CAMP HILL 17011-2602000 CITI CARDS P.O. BOX 8109 S HACKENSACK. NJ 07606-8109 PA m~ ,~1q3.7~ V 3qf&,o.o'-l $-t&,16 3./~ citr' Platinum Select~ Card For Customer Service, call or write 1-800-950-5114 Account Number 5424 1801 2378 3216 Payment must be received by 1:00 pm local time on 06/07/2001 To report b1ll1nq errors, wrIte to this address; calling wIll not preserve y~ rights. BOX 6500 SIOUX FALLS, SD 57117 statement/Closing Date 05/14/2001 Total Credit Line $14500 Available Credit line Cash Advance Limit $731 $14500 ~~~~~Wn~er Past Due $0.00 + $283.00 + ......~U\dty$h'l~..~f$t~t~~n!I} CREDIT PROTECTOR fEE 74 0000 LATE FEE - APR PAYMENT PAST DUE 66 0000 ADVANCES*FINANCE CHARGE*PERIODIC RATE 84 0000 PURCHASES*FINANCE CHARGE*PERIODIC RATE 84 0000 PURCHASES*rINANCE CHARGE*PERIODIC RATE CHARGE TO BALANCE 1 84 0000 Available Cash limit $731 Purch! Adv Minimum Due $286.00 = New Balance $13768.32 Sa~l)ite,P~t Date R.l!!1~fijll'Allet? 5/14 5/14 5/14 5/14 5/14 Minimum Amount Due $569.00 Afuouiit' .. 24.50 0000000 0 29.00 0000000 0 22.00 0000000 0 7.50 0000000 0 68.60 0000000 0 The Annual Percentage Rate on your account may increase due to one of the fo1 owing reasons stated in your Card Agreement with us: if you fail to make a payment to us or any other creditor when due, you exceed your credit line or you make a payment to us that is not honored by your bank. Notice anything different about your statement? It has a new look. We've moved information around to make it easier to find what's most important to y,ou. Go to www.accounton1ine.com. login and click on 'New statement highlights" and see for yourself. Now you have the power to send and receive money by emai1! Introducing c2it(SM) service by Citibank. with c2it you can repay a friend for dinner, or pay for an on11ne auction purchase, all through y'our email. To learn more, sign onto www.c2it.comlsend28 Attention Cardmembers! Stay in touch with new features and benefits of your card the easy way. Register your email address at www.email .citibankcards.com. and we'll update you with relevant email messages. PLEASE REFER TO THE REVERSE SIDE OF THE ORIGINAL STATEMENT FOR PAYMENT INFORMATION. Make check or money order payable In U.S. dollars on a u.s. bank to Citi Cards. Include account number on check or money order. No cash please. rfj :51fo() . Dc/. OS/28/01 :.~~. $176.35 @~!j~m!.~~j~ii~jt~ ~~~~~~~~~~MM~~~~~~~: ~jJ~m~j~~iW~i~i~~~j~ SITE:KC TM:6300 ACID: 06/09/01 KCB3020 00:55:28: SAMUEL M MAURER MARCIA A MAURER 201 N 33RD ST CAMPHILL 17011-2602000 CHOICE VISA P.O. BOX 8101 S HACKENSACK. NJ 07606-8101 PA CHOICE~ For Customer Service, call or write 1-800-934-2788 Account Number 4428 1352 4088 4130 CHOICE VISA Payment must be received by 1:00 pm local time on OS/28/2001 To report billing errors. write to this address; calling will not preserve y..... rlqhts. BOX 6248 SIOUX fALLS, SD 57117 Statement/Closing Date 05/02/2001 Total Credit Line $6000 Avallable Credit Line Cash Advance limit $1678 $6000 ~~~dW~?n~er Past Due $0.00 + $20.00 + .....\\ActWlty.ii'~~~fnii!!timtnt.':n ....... CREDIT PROTECTOR FEE 74 0000 LATE FEE - APR PAYMENT PAST DUE 66 0000 CHECK n 0101 Of ACCOUNT 7004535809037 60 NOOOO 0 ADVANCES*fINANCE CHARGE*fOR TRANSACTIONS 86 0000 ADVANCES*fINANCE CHARGE*PERIODIC RATE 84 0000 PURCHASES*fINANCE CHARGE*PERIODIC RATE 84 0000 Available Cash Llmlt $1678 Purch{Adv Minimum Due $156.35 = New Balance $4321. 74 $a~U.UePOsrDite B!'~ti~~~#ij'\~!( 5/02 5/02 4/09 5/02 5/02 5/02 4/09 10003508 Minimum Amount Due $176.35 '~ffl9fJ~~t.... 22.67 o 70000000 0 29.00 o 70000000 0 4,000.00 o 00000000 0 120.00 o 70000000 0 35.03 o 70000000 0 1.32 o 70000000 0 Each Cash Advance is SUbject to a one-time transaction fee. This fee will cause your Annual Percentage Rate to exceed the nominal Annual Percentage Rate listed on this statement. The Annual Percentage Rate on your account may increase due to one of the following reasons stated in your Card Agreement with us: if you fail to make a payment to us or any other creditor when due, you exceed your credit line or you make a payment to us that is not honored by your bank. Please see the enclosed privacy notice for important information. Notice anything different about your statement? It has a new look. We've moved information around to make it easier to find what's most important to y.ou. Go to www.accountonline.com. login and click on 'New statement highlights" and see for yourself. Now you have the power to send and receive money by email! Introducing c2it(SM) service by Citibank. with c2it you can repay a friend for dinner, or pay for an onllne auction purchase, all through y'our email. To learn more, sign onto www.c2it.comlsend28 PLEASE REFER TO THE REVERSE SIDE OF THE ORIGINAL STATEMENT FOR PAYMENT INfORMATION. Make check or money order payable in U.S. dollars on a U.S. bank to Citl Cards. Include account number on check or money order. No cash please. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: Marcia D. ~aurer being duly sworn _ ___ ______ according to law, deposes and says that she is the Executrix of the Estate of Samuel M. Maurer late of _ CaTl)j)ll:Lll -_________, Cumberland County, Pa., deceased and that the within is an inventory made by ___~:ilJiam JL.__ MJller . Jr. _ ______________/ the said attorney 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 the Inventory represent it's fair value as of the date of decedent's death. Sworn to and subscribed before me, -"f\\~~ ~ G ,~~" I L~Q'-.U.-t~~ Executor - Aaministrotor I 201 North 33rd Street Camp Hill, PA 17011 J Address April Month 2001 Date of Death 26 D/lY y"or 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. See Article IV, Fiduciaries Act of 1949. \ , \ -ti '-<J >- ~I Q) I- ill lit H >- a:: I- It! ~ W -< i Q) ~ a... I- u 1 0 Vl l-l ' Q) 41 l-l "- 0 W w (1)i 0 O'l (1) 7'- :r: a:::: l-l' 10 Q) \J ~ 0... ::Ji Q.. rl c Z r- -1 u. It! rl .... ~ 0 C1j rl a... .,.-j 0 ~I LL -J :L: rl ~ :l: UJ -< w > 0 a:: .,.-j >. ~ ~j Z .1 ::ti ..... Z 0 :L:f c ~ 0 ::J V) p., 0 0 a:: Z rl' S 0 S Z w -< (1)1 C1j Vt- C1j a... ::JI U " -,.-j S! c r-I C1j' It! rl ..... CJ:l1 0 L- ',.-j Q) :3 <) ...0 " .J,I. Q) E ..... 41 0 IC ::J 0 .-J 0 u: a:l /6- c;) J p~ -<-/ \~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX WILLIAM E MILLER JR MILLER & ASSOCS 1822 MARKET ST CAMP HILL '02 !\PR -1 DATE ESTATE OF DATE OF DEATH FILE NUMBER :/13COUNTY ACN 03-25-2002 MAURER 04-26-2001 21 01-0438 CUMBERLAND 101 * REY-1547 EX UP [01-02) SAMUEL M Allount Rellitted PA 170\\'"1\\_ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV :is'4j-ix--AFP--coi-:02-f-No'fici--oF-'rtiHiifiTANcE-''-''x-A-ppRAisiMENT-,--ALi-owANci-oi------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MAURER SAMUEL M FILE NO. 21 01-0438 ACN 101 DATE 03-25-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 120.000.00 .00 .00 169.540.00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 13,248.00 113.485.00 (1ll (12) (13) (14) NOTE: 162,807.00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 289,540.00 126.733 nn 162,807.00 .00 162,807.00 (19)= .00 .00 .00 .00 .00 TAX CREDITS: ...........'1. 1(I:~t:~r I II (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) -:. ...-:. -:. ...-:. -:. ~ ~ -- -:. ~ ...-:. ~ J ~ ~ ~ ~ ~ Q a ... ::;:;: cJ Q -:. ~ V ... ffi ::;::::. -0 --- -:. ~ .,;; '7:j- ( Q ~ t ............. -- ~ ~ ~ \ s2 --- ~ (i' ~ C ~ t\ r ~ ....- ~1 -- ~ tP. r1 ......... -> . .- .t .--- r1 cJ --c) '-:- .. 6 0 r- ~ -eJ .. -- . d oS _ en en , c.- ! i:. "'0>' 0 cn~ ~ 'ffi~ en -t. c. ,... "ii Q. 2 C'-1 ._ ~ 0) a ~ & .5~ ~'Zo~ai .1: ~ \0 (\1 .... ,,'t. Q) .q ~ %. c., Co ..;.q'- o a.. 0 :!: ~, = Q) co ~ Z. C. a ,... ..... - - 7;00 O~~fi)mm :: m03-'-i;o =:::J..O '< C-i =- (ii' c 0- () ;0 " - -;::l.~, z- =51> ::r Q) r m = -oO~CD:::OO ~ )> ~ a. ~. m $: = ~ CD 0 _00 0 )> = -.leno m_ ::- o..a c :::0 ""0 r --lo.C~CD-i1 =- W m -< <9, =- co O~::O oCDm c;O ::1--hC ::r<m o<en c=:--i OOfijm CD 0 n[~ ~~. i" 11 - :a en -I o r- )> en~ en 3:~ )a - '-o-El=) · ~0'"1 00- Ui c::l UlIo-oA I N N ~ $; ~ ~ cr:~ ;_1 b. OJ "(.~ g ~~ !~IJ ~~: ~ ;;;;;;;;; - - ~~ c 35 :1: ' ~~z _ -o-o~ C2N~;S~-o ~~~ -p:J~ --1.- -i R3 :g ~ - m REV-15OOEX+ (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECE- DENT CHECK APPRO- PRIATE BLOCKS COR- RE- SPON DENT RECA- PITULA- TlON TAX COMPU- TATION REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ,/ /0 FILE NUMBEA 21-01-0438 COUNTY CODE OFFICIAL USE ONLY :2 d. y-- Y DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER YEAR M Maurer Samuel DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 04/26/2001 12/30/1899 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Marcia D. Maurer ~ 1. Original Return 4. um~ed Estate 6. Decedent Died Testate (Attach copy of Will) 9. Utigation Proceeds Receiyed ~ 2. Supplemental Return 4a. Future Interest Compromise (dale 01 death after 12-12-62) 7. beeedent Maintained a LI....ing Trust Attach a copy of Trust) 10. ~pousal Poverty Credlt (dale 01 death between 12-31-91and 1-1-95) ;:.t!-.." _ I"j"\ - .:<> g -0 (, 120;iJOO . 0 169 ;,540 (8) 13,248 113,48S (11) (12) (13) (14) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate,ortran$fersunderSec.9116(a)(1.2) 162,807 X.a 00 (15) 16. Amount of Line 14 taxablealllnealrale 0 X.O 0.045 (16) 17, Amount of Line 14 taxable at sibling rate 0 X .12 (17) 18. Amount 01 Line 14 taxable at collateral rate 0 X .15 (18) 19. Tax Due (19) 20. 0 IctlElbkHiilllitjliiY,ooAilElilElQljj$tiNQAlmi=tlND'PJj.'l\NpvEllllilliVMiWtl G NUMBER iffiI$l$-ectIbNMtiStl!!!~t$tetj;ilUibQRReSPQ!ii!PeNPE~cONFjQeNtiAtjAXj!'j~^tjdiit$HOijtti!lE!j1fi~11!P1lm1: NAME COMPLETE MAILING ADDRESS William E. Miller, Jr. 1822 Market Street FIRM NAME (If Applicable) Camp Hill, PA 17011 Miller & Associates, PC TELEPHONE NUMBER 717-737-9210 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) 3. Closely Held Corporation, Partnership Of Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested (6) 7. Inter-Vivos Transfers & Miscellaneous Non - Probate Property (Schedule G or L) (7) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administrative Costs (Schedule HI (9) 10. Debts of Decedent, Mortgage L1ablllties, & Liens (Schedule II (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sublect to Tax (Line 12 minus Line 13) KiOFFICI~iJIIE ONLY (D S L"~ "" Z N CO o 31 !-.....J r'.i .", o ..........................................,.,...,................................".........."....;&IlI\M>:VRiXQ.1\N$WItRI\WqQ~!mQl>l$QNgl\q~;l:I\Ntilll!GH""GKMlireM??........ o PA 15001 NTF 2B755 Copyright 2000 GreatlandfNelco LP - Forms Software Only 289,540 126,733 162,807 o 162,807 o o o o o PA REV-1500 EX (6-00) Page 2 Decedent's Comolete Address: STREET ADDRESS 201 N 33rd Street Cumberland CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Total Credits (A + 8 + C) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o o TotallnteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Une 5 + SA. This is the 8ALANCE DUE. (58) Make Check AGENT o o o o o PLEASE ANSWER THE 1. QUESTIONS BY AN "X" IN THE APPROPRIATE Yes No ~ ~ 8 ~ Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or. . . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an Min trust forM 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. 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 behef, it IS true, correct and complete. Declaration o~ preparer other than the personal representative is based on information of which preparer has anv knowledqe. SIG~ATURE OF PERS>1N R~~<?NSI8LE FOR. FILING RETURN DATE , \'\'\G..",W,- \...~, \\\C:.Ulv\t~ \~:.)<,~D~ ADDRESS 201 N 33RD STREET, CAMP HILL, PA SIGNATURE OF PREPA OTHER THAN REPRESENTATIVE .0 ~ DATE ADDRESS 1822 MARKET 00 "" [72P.S.19116(aH1.1)(i)]. For dates of death on or after January 1, 1995, the tale rate Is Imposed on the net value of transfers to or for the use of the sup/ivlng spouse is 0':11. [72 P.S. Ii 9116 (a) (1. 1)(11)]. The statute tin..", nnt "wpmnt a transfer to a surviving spouse from tale, and the statutory requirements for disclosure 01 assets and filing a tax return are stili applicable even if the surviving spouse Is the only beneficiary. For dates of death on or after July 1, 2000: The tale rate imposed on the net value 01 transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% 172 P.S.19116(a)(1.2)]. The ta)( rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, e)(cept as noted in 72.P.S. II 9116{1.2) [72 P.S. 119116(a)(1)J. The tax rate Imposed on the net value of transfers to or for the use of the decedent's siblings Is 12% 172 P.S. 19116(a)(1.3)]. A sibling Is deflned, under Section 9102, asan Individual who has at least one parent in common with the decedent, whether by blood or adopllon. o PAl5002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only REV' 1504 EX + (1-97) COMMONWEALTH OF PENNSVL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Samuel M. Maurer SCHEDULE C CLOSELY-HELD CORPORATION PARTNERSHIP or SOLE-PROPRIETORSHIP FILE NUMBER 21-01-0438 Schedule C.1 or C-2 (Including all supporting information) must be attachect for each closely-held corporation/partnership interest of the decedent, other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NO. 11. DESCRIPTION VALUE AT DATE OF DEATH Whitehill, Inc. - Business owned by Decedent, as the sole shareholder, which was sold by Agreement of Sale dated 31 August 2001 (see attached). 120,000 9 PA15041 NTF 10873 CopyrIght 1999 GreatlandlNelco LP - Forms Sollware Only TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 120,000 REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Samuel M. Maurer SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-D1-D438 If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Marcia D. Maurer 201 PA ADDRESS N 33rd Street, Camp Hill, 17011 RELATIONSHIP TO DECEDENT Surviving spouse B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF JOINT account number or similar identifying number. NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 11. A A. 01/01/1990 1712 Hummell Avenue, Camp Hill, PA - Real property own d jointly with surviving spellS Value per Agreement of Sale dated 31 August 2001 (Attach d herewith to Schedule C. ) 80,000 50.000 40,000 2 A 01/01/1990 200 North 33rd street, Camp Hill, PA - Real property own d jointly with surviving spellS (Tax assessment value used) 103,570 50.000 51,785 3 A 01/01/1990 2D1 North 33rd Street - Marital residence owned jointly with surviving spells (Tax assessment value used) 153,520 50.0DO 76,76D 4 A 01/01/1990 Waypoint Bank Checking Acct Account held jointly with surviving spouse 1,881 50.000 941 5 A Waypoint Bank Saving Account - Savings account held jointly with surviving spouse 108 50.000 54 TOTAL (Also enter on line 6, Recapitulation) $ 169,540 9 PA 15091 NTF 10876 (If more space is needed, insert additional sheets of the same size) Copyright 1999 Greatland/Nelco LP - Forms Software Only REV-1511EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Samuel M. Maurer SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-01-0438 Debts of decedent must be reoorted on Schedule I. ITEM NO. A. 1. 1 DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers Harner Funeral Home - Funeral expenses 3,895 2 stephensons Flowers 206 Total from continuation pages 274 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s)/E1N No. of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Marcia D. Maurer Street Address 201 N 33rd street CityCamp Hill State PA Zip 17011 Relationship of Claimant to Decedent SURVIVING SPOUSE 5,000 3,500 4. Probate Fees 328 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Miller & Associates, PC 45 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13,248 9 PA15111 NTF 10878 Copyrlghl1999 GreaflandlNelco LP - Forms Software Only Item No. 3 Estate of: Samuel M. Maurer Description Trinity Luthern Church - Funeral luncheon Schedule H part 1 (Page 2) Amount Total (Carry forward to main schedule) 274 274 REV-1512 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF samuel M. Maurer Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-01-0438 DESCRIPTION AMOUNT 1. 1 Boscov I s Credit card held in decedent's name alone 448 2 Ci t ibank Credit card held in decedent's name alone 13,617 3 First Union Bank 1/2 of mortgage balance on 200 N 32nd street property 23,500 4 IMPAC Funding Co. 1/2 of mortgage balance on 201 N 33rd Street property (principal residence) 75,249 5 Sears Credit card held in decedent's name alone 476 6 Wiedeman & Douty, P.C. Fees for preparation of 2000 individual tax returns 195 9 PA15121 NTF 10874 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 113,485 Copyright 1999 Greatland/Nelco LP ~ Forms Software Only REV-1513EX+ (1-97) COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Samuel M. Maurer No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outri9ht spousal distributions) 1 1. Marcia D. Maurer 2D1 N 33rd Street Camp Hill, PA 17011 FI LE NUMBER 21-01-0438 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Surviving Spouse AMOUNT OR SHARE OF ESTATE o ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 9 PA15131 NTF 10880 TOTAL OF PART II n ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ o (If more space is needed, insert additional sheets of the same size) Copyright 1999 Greatland/Nelco LP - Forms Software Only Cumberland County - Register of Wills One Courthouse Square Carlisle, P A 17013 Phone (717) 240-6345 Date: March 15,2005 William E. Miller, Jr. 1822 Market Street Camp Hill, P A 17011 RE: Estate of MAURER SAMUEL M File Number: 21-01-0438 Dear SirlMadam: ....... 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 is due by: 04/2612005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~A~,*~dH REGISTER OF WILLS cc: File Judge uF Re~srerofVVillsofCumberlandCoun~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: SarIDle1 S . Maurer Date of Death: 26 April 2001 Estate No.: 2001-00438 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. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personaIrepresentative's account is: c. Did the personal representative state an account informally to the parties in interest? Y es ~ No 0 Date: c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. 3/%1 J()~ . , o ------ ~ / Signature William E. Miller. Jr. Name (-:~) 1822 Market Street, Camp Hill, PA 17011 Address 717/737-9210 Telephone No. Capacity: 0 Personal Representative IDi Counsel for personal representative 'L,::- :;: ~