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HomeMy WebLinkAbout02-0415 Register of Wills of Cumberland County, Pennsylvania Estate of JANE R. GORDNER PETITION FOR GRANT OF LETTERS ;21,~~ -1/15 No. Also known as . Deceased Social Security No. MARY LOUISE. RUFF 107-26-7147 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioners are the executors named in the Last Will of '" the Decedent, dated May 1 O. 1994 and codicil(s) dated State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent o B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 45 Old Stonehouse Road. Carlisle. Silver Sprina Township. Pennsvlvania (List street. number and municipality) Decedent, then 83 years of age, died April 20, 2002, at 45 Old Stonehouse Road. Carlisle. Pennsvlvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property.....................................................................$ (If not domiciled in PA) Personal property in Pennsylvania.....................................$ (If not domiciled in PA) Personal property in County....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ T otal......................................................................................................... $ 10.000.00 75.000.00 85.000.00 Real Estate situated as follows: Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: ll( .., ~/56 ~ T ed or rinted name and residence MARY L#o, RUFF 45 Old Stone House Road Carlisle, PA 17013 /Yl /7-59~9 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law, Sworn to and affirmed and subscribed /Yl a1Af 0( ~ R4- MARY LOUISE RUFF Before me this 2~th day of April , 2002 ~~~~~1<)AI;~ N 21-2002-415 o. Estate of JANE R. GORDNER , Deceased Social Security No: 107-26-7147 Date of Death: Aoril20. 2002 AND NOW, April 25th , 2002 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters,( Testamentary 0 of Administration d.b.n.c.l.a.; pendente lite; durante absentia; durante minoritate are hereby granted to MARY LOUISE RUFF in the above estate and that the instrument(s) dated Mav 10, 1994 described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES !I/&tt Attorney: C. ROY WEIDNER I.D. No: 19530 Address: Johnson, Duffie. Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemovne, PA 17043- Telephone: 717-761-4540 Letters........................... $ 200.00 Short Certificate(s) 3 $ 9.00 Renunciation.............. $ Affidavit ().................. $ Extra Pages (3)....... $ 9 .00 Codicil............................ $ JCP Fee....................... $ 5.00 Inventory...................... $ Other.............................. $ TOTAL....... $ 223.00 CALL Attorney 761-4540 004571-00002/May 5, 1994/CRW/SLP/35001 East 3JIlIill aub ille!.ltattttut :2/ -otZ - VIS OF JANE R. GORDNER I, JANE R. GORDNER, of the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of 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 heretofore made by me. ARTICLE I I direct the payment of my legal debts and the expenses of my last illness and disposition of my remains from my estate as soon after my death as conveniently may be done. All of the foregoing shall be considered expenses of the administration of my estate. ARTICLE II I bequeath all of my tangible personal property (excluding cash or securities), together with any existing insurance thereon, to my daughter, MARY LOUISE RUFF, if she survives me for a period of thirty (30) days. If she does not so survive me, I bequeath said tangible personal property to my son-in-law, JAMES E. RUFF, JR. ARTICLE III I devise and bequeath all of the residue of my estate to my daughter, MARY LOUISE RUFF, if she survives me for a period of thirty (30) days. If she does not so survive me, I devise and bequeath all of the residue of my estate to my son-in-law, JAMES E. RUFF, JR. 004571-00002/May 5, 1994/CRW/SLP/35001 ARTICLE IV I appoint my daughter, MARY LOUISE RUFF, Executrix of this my last Will. In the event of her inability or unwillingness to act or continue to act as Executrix, I appoint my son-in-law, JAMES E. RUFF,JR., Executor. ARTICLE V I direct that my Executrix, or her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I hereunto set my hand and seal this 10i l day of May, 1994. I'~ . /., /) /. )/ // .{// d \ . ....../ / ..' /(/ /' ku- r,;,r-;lZ-c .. ~./t>C.-t'L7ci",-:n72t::?,1\~t:AL) ~ane R. Gordner Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us, who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. '",- '5IlfIL {it ~". Y]1lJJI.f - 004571-00002/May 5, 1994/CRW/SlP/35001 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA 55: COUNTY OF CUMBERLAND I, Jane R. Gordner, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed .\, , '\~.?/ / /;:::e/~~G~d~~y#-/I--/,t, :It::A' 7 c- Sworn or affirmed to and acknowledged before me, by Jane R. Gordner, the Testatrix, this I ~ '\)('\day of May, 1994. -S::l ~ ' , M,./\'~ ,', Notary Public ~~ ..... NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21. 1997 004571-00002/May 5, 1994/CRW/SLP/3500 1 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND We, C. <<~\N~/Y-\..'-' /~~. and ~~ ~. 0!'.JJ..~k.L the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at least 18 years of age, of sound mind and under no constraint or undue influence. tl, ..... . .l~'- i / / i r //1{Zt{il-:L1----.-~ /" / /,/ / '~'<i7{UJ/'1 'Ii .,efU..bri Sworn to or affirmed to and subscribed to before me by G, -Q~ ~ .~...~.... .'~ . and ~...,.... ..._~. Q ~.1.,.... ,witnesses, this I~W day of May, 1994. ~ ~, . . l.)'-fY..............~"V~.......~ Notary Publi.) " NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21.1997 g CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JANE R. GORDNER Date of Death: April 20. 2002 Will No. 21-02-0415 Admin. No. To the Register: I certify that notice of estate administration as required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following testate and intestate beneficiaries of the above-captioned estate on May 6, 2002. Name Address MARY LOUISE RUFF 45 Old Stonehouse Road Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE Date: May 6, 2002 Signature Name Address Telephone Capacity: ~/ Johnson. Duffie. Stewart & Weidner 301 Market Street P.O. Box 109 Lemovne. PA 17043-0109 (717) 761-4540 Personal Representative ~ Counsel for personal representative ..--- .,',.. ~ J' - .. c:5 h.: I Co j"',,) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RUFF MARY LOUISE 45 OLD STONEHOUSE ROAD CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 107-26-7147 FILE NUMBER: 2102-0415 DECEDENT NAME: GORDNER JANE R DATE OF PAYMENT: 07/19/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2002 NO. CD 001430 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,792.89 I I I I I I I I TOTAL AMOUNT PAID: $5,792.89 REMARKS: MARY LOUISE RUFF CHECK# 0093 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS , /" Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of JANE R. GORDNER No. 21-02-0415 also known as Date of Death 04/20/2002 ,Deceased Social Security No. 107-26-7147 MARY LOUISE RUFF, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I N/e verify that the statements made in this Inventory are true and correct. IN/e understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: C. Roy Weidner Personal Representative Signature: /Yl ~ d~ R#i MARY LOUISE RUFF J.D. No.: 19530 Signature: Address: P. O. Box 109 Address: 45 Old Stonehouse Road Lemoyne, PA 17043-0109 Carlisle, PA 17013 Telephone: 717/761-4540 Telephone: 717/697 - 0564 Dated: 1'1/ J ~ I OJ. Description Value >.' (See continuation page(s) attached) F (it 7Ct (Attach additional sheets if necessary) Total: 76,976.45 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form tlRW-7 (1992) Estate of: Date of Death: County: ......- INVENTORY JANE R. GORDNER 04/20/2002 Cumberland CASH: Reimbursement of Taxes paid prior to death at sale of Real Estate. See attached Settlement Sheet. County Taxes 154.32 School Taxes 115.30 Sewer/Refuse 41.04 310.66 State Farm Insurance - Reimbursement 36.82 347.48 BONDS: United States Savings Bonds Series E with a denomination of $25.00 and issued in 1961. Valued as per attached Savings Bond Calculator. 1,628.97 1,628.97 REAL ESTATE/PA: -1- Proceeds from sale of Real Estate located at 402 South Broad Street, Mechanicsburg Borough, Cumberland County, PA. Tax Parcel No. 20-24-0785-130. As per value of real estate listed on attached Settlement Sheet. 75,000.00 TOTAL RECEIPTS OF PRINCIPAL............... -2- 75,000.00 76,976.45 OFFICIAL USE ONLY REV-1500 EX s (6.00) REV-1500 ~ 'l INHERITANCE TAX RETURN FILE NUMBER CO MMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE IDENT DECEDENT 21- 02 - 0415 OEPT 280601 RES . HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL. SECURITY NUMBER E GORDNER JANE R. 107-26-7147 C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 7HIS RETURN MUST BE FILED IN DUPLICATE WITH THE E D 04 20 2002 04 21/1918 REGISTER OF WILLS E N IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL SOCIAL. SECURITY NUMBER T y pp X 1. Ori final Return 2. Su lemental Return 3. Remainder Return date of death prlorto 12-13-82) • A P B 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 5. federal Estate Tax Return Required P Rj p X 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 - 8. Total Number of Safe Deposit Boxes C O T K (Attach copy of WIII) (Attach copy of Trust) E S ~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit C~ 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch O) ,... 7'HiS 5EC'TION fN{JaT 13E CCifJfPLETED. ALi;CORRESFQNDENCE 8, Cl!lI~IFIDENTIAL 7~t}f INF<1~iM~1`TICiN ~f'~i"~~L[Y$E~?1RECTED TaO:. _ P NAME COMPLETE MAILING ADDRESS O O C. Ro Weidner P. 0. Box 109 R p FIRMNAME(IfApplicable) 301 Market Street E N Johnson, Duffie, Stewart & Weidner Lemoyne, PA 17043-0109 S T TELEPHONE NUMBER -4 40 1. Real Estate (Schedule A) (1) 75 , OO(~:-QO OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 1 , 6281 97 ~~ 3. Closely Held Corporation, Partnership or (3) None Sole-Proprietorship ,-- 4. Mortgages & Notes Receivable (Schedule D) (4) ,None _ R 5. Cash, Bank Deposits 8, Miscellaneous Personal Property (5) 347.48 E C (Schedule E) - A 6. Jointly Owned Property (Schedule F) (6) 26 , 534.28 P T ~ Separate Billing Requested U 7. Inter-Vivos Transfers 8. Miscellaneous Non-Probate Property (7) 54 , 001.85 L (Schedule G or L) A T 8. Total Gross Assets (total Lines 1-7) (8) 157 , 512.58 I O 9. Funeral Expenses 8, Administrative Costs (Schedule H) (9) 15 , 678.00 N 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) 6 , 328.31 11. Total Deductions (total Lines 9 8. 10) (11) 22 .006.31 12. Net Value of Estate (Line 8 minus Line 11) (12) 135 , 506.27 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 135 , 506.27 p SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M P 15. Amount of Line 14 taxable at the spousal tax A T rate, or transfers under Sec. 9116(aX1.2) X .0 0 (15) 0.00 X A T 16. Amount of Line 14 taxable at lineal rate 135 , 506.27 X .0 45 (16) 6 , 097.78 - I O 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 N 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 6 , 097.78 20. ., .. ~.. ,, :.....fM: E`. €41i' .AAIr'~: ~£1.IWE`[~1(ai4H)~t111O1~l1~'ft~t~~A~fkl~fir7 :; ~ Rp`'fitlAF TD dfJSVUER 7t[L::t`~UE571~N5 bN-AEVf=RS`E 5`f©f?'ANf3 TO'RECHE`CK MATH ~ ~ Copyright (c) 2000 form software only The Lackner Group, Inc. Farm REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 45 Old Stonehouse Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit (t) 6 , 097.78 B. Prior Payments C. Discount 304.89 Total Credits (A + B + C) (2) 3. Interest/Penalty 'rf applicable D. Interest E. Penalty Total Interest/Penalty (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 Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 304.89 0.00 0.00 5,792.89 0.00 5,792.89 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; X b. retain the right to designate who shall use the property transferred or its income; . X c. retain a reversionary interest; or . X d. receive the promise for life of either payments, benefits or care? X 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 "in trust for" or payable upon death bank account or security at his or her death? ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ^X ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, ft is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN jyl~y LOUISE RUFF DATE 45 Old Stonehouse Road Carlisle, PA 17013 '7 1~ ~e2. SIGNATURE REPAREROTHERTHANREPR ATIVE Johnson, Duffie, Stewart & Weidner D TE /', P.O. Box 109 Lemoyne. PA 17043-0109 (~f0oi. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one years of age or younc3er at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aX1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.:S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1502 EX +(1-97) SCHEC~ULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FILE NUMBER JANE R. GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable (If more space is needed, insert additional sheets of the same size) Copyright (c) 7996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 7-97) REV-1503 EX+(1-97) SCHEb~1LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS ESTATE OF FILE NUMBER JANE R. GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 United States Savings Bonds Series E with a 1,628.97 denomination of $25.00 and issued in 1961, Valued as per attached Savings Bond Calculator. TOTAL (Also enter on line 2, Recapitulation) 1 , 628.97 (If more space is needed, insert additional sheets of the same s'+ze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) REV-1508 EX + (1-97) SCHEDULE E p COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8e MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NuMeeR JANE R. GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshla must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 7-97) REV-1509 EX+(1-97) SCH~bULE F COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JANE R. GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. MARY LOUISE RUFF 45 Old Stonehouse Road Daughter Carlisle, PA 17013 B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial Institution and bank account number or similar identifying number. Attach deed forJolntly-heldrealestate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF ECEDENT'S INTEREST 1 A 09/14/87 llfirst Bank Certificate 10,245.96 50.OOY 5,122.98 of Deposit Accnt. No. 8-700-800-0405997 A Accrued income on item 1 54.30 50.OOy 27.15 through date of death 2 A 06/28/70 Allfirst Bank Checking 27,945.85 50.OOY 13,972.93 ccount No. 0037917447 3 A United States Savings Bonds 9,533.20 50.OOY 4,766.60 Series E with a denomination of $100 of higher were joint with Mary Ruff, daughter. A valuation using the Savings Bond Calculator is attached hereto. 4 A United States Savings Bonds 5,289.24 50.OOy 2,644.62 - Series EE TOTAL (Also enter on line 6, Recapitulation) I S 26 , 534.28 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1~t0EX+(1-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA iuucaireurGreYaFruaN MISC.. NON-PROBATE PROPERTY ESTATE OF rn.e numar,n JANE R. GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY INCLUDETH NAMEOFTHETRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND THE DATE O~ TRANSFER. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE NUMBER 1 ATTACH ACOPYOF THE DEED FOR REAL ESTATE. Hartford Life Annuity 25,293.24 0.00 25,293.24 Account No. 711137118 Beneficiary: Mary Louise Ruff, Daughter 2 Morgan Stanley IRA Standard 16,708.61 16,708.61 Account No. 410041073 Beneficiary: Mary Louise Ruff, Daughter 3 Allfirst Money Fund 15,000.00 3,000.00 12,000.00 Alternative Account No.00981-1678-9 This was a Joint Account with Daughter Mary Louise Ruff. Decedent opened account in 1970 with daughters name on the account. On March 8, 2002, Decedent removed her name from the account making this a gift prior to death. TOTAL (Also enter on line 7, Recapitulation) I S 54 , 001.85 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) REV-151J EX ~ (1-97) COMMONWEALTH OF SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NuMrjtrt JANE R GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers Funeral Home 8,240.00 B. 1. 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Johnson, Duffie, Stewart & Weidner 3,500.00 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3 , 500.00 Claimant Mary Ruf f Street Address 45 Old Stonehouse Road City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent Daughter Probate Fees Register of Wills 223.00 5. I Accountant's Fees 6. 7. 1 2 3 Tax Return Preparer's Fees Other Administrative Costs Cumberland County Reporter - Estate Advertising Costs 75.00 Cumberland County Register of Wills - Addition Filing Fees for 25.00 Inheritance Tax and Inventory The Patriot News - Estate Advertising 115.00 TOTAL (Also enter on line 9, (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. ~S 15,678.00 Form REV-1511 EX (Rev. t-97) REV-15x2 IX + (1-97) SCHEDULE I IA DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS ESTATE OF r~~e numoen JANE R GORDNER SS~~ 107-26-7147 04/20/2002 21-02-0415 Include unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV -15,13 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JANE R. GORDNER SS~~ 107-26-7147 04 20/2002 21-02-0415 RELATIONSHIP TO DECE ENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousaldistributlons,and transfers under Sec. 9116(aX1.2)] 1 MARY LOUISE RUFF Daughter Entire Estate 45 Old Stonehouse Road Carlisle, PA 17013 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET ~$ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) TABLE OF EXHIBITS EXHIBIT A Last Will and Testament dated May 10, 1994 EXHIBIT B Settlement Sheet for sale of Residence EXHIBIT C Savings Bond Calculator valuing Series E Bonds, held both jointly with Mary Ruff and individually EXHIBIT D Savings Bond Calculator valuing Series EE Bonds, held jointly with Mary Ruff ~~st mill ~tn~ (7~ Qst~cxnPrct OF JANE R. GORDNER I, JANE R. GORDNER, of the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of 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 heretofore made by me. ARTICLE I I direct the payment of my legal debts and the expenses of my last illness and disposition of my remains from my estate as soon after my death as conveniently may be done. All of the foregoing shall be considered expenses of the administration of my estate. ARTICLE II I bequeath all of my tangible personal property (excluding cash or securities), together with any existing insurance thereon, to my daughter, MARY LOUISE RUFF, if she survives me for a period of thirty (30) days. If she does not so survive me, I bequeath said tangible personal property to my son-in-law, JAMES E. RUFF, JR. ARTICLE III I devise and bequeath all of the residue of my estate to my daughter, MARY LOUISE RUFF, if she survives me for a period of thirty (30) days. If she does not so survive me, I devise and bequeath all of the residue of my estate to my son-in-law, JAMES E. RUFF, JR. ARTICLE IV I appoint my daughter, MARY LOUISE RUFF, Executrix of this my last Will. In the event of her inability or unwillingness to act or continue to act as Executrix, I appoint my son-in-law, JAMES E. RUFF,JR., Executor. ARTICLE V I direct that my Executrix, or her successcrs, shall not be required to give bond for the faithful performance of their duties in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I hereunto set my hand and seal this ~(,?-~ ~ day of May, 1994: L ~_. Jane R. Gordner Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us, who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND I, Jane R. Gordner, Testatrix, whose name is signed to the foregoing instrument, having i, been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ';~ ~, , one R. Gordner Sworn or affirmed to and acknowledged before me, by Jane R. Gordner, the Testatrix, this j i ~y~`~'day of May, 1994. ~_ . Notary Public ~• NOTARIAL SERI DIANNE LENIG, Notary Public Lemoyne Borough Gumberland Co. My Commission Expires Dec. 21,1997 a AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: We, C . K2-~~ ~ ~. ,'~ , and -!`~Cw,~.,-. ;~~~_ the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; ghat each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed to and subscribed to before me by L , -~C2-~.~~-°~~•~ ,'~ . and -~hv.r~,.-. ~~ . ~ n.~.11~l1.ti ,witnesses, this 1 ~~ day of May, 1994. ~,, ~.. , -~ ~ ~ Notary Publi N01'AAIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec. 21,1997 A. U.S. DEPAATMEN7 OF HOUSING and URBAN DEVELOPMENT SETTLEMENT STATEMENT OMB tVo. 2502.0265 TITLEPRO ' . HERITAGE SETTLEMENT L.aserprint SERVICES, LLC B. TYPE OF LOAN 4705 East Trindle Road Mechanicsburg, PA 17050 1. [ ]FHA 2. [ ] FMHA 3. [ j CONV. UNINS. a. [ j vA 5. [)CONY. INS. Phone: (717) 975-2117 Fax: (717) 730-9665 6. FILE NUMBER: 992506 7. LOAN NUMBER: 8. MORT. INS. CASE NO.: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown, Items marked '(p.o.c.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWERp Timothy J. Sowers '~' Melody S. SowezS ~~ E. NAME AND ADDRESS OF SELLER: Estate of Jane R. Gordner, Mary Lousie Ruff F NAME AND ADDRESS OF LENDER: NO LENDER G. PROPERTY LOCATION: Mechanicsburg 402 S. Broad Street H. SETTLEMEN7 AGENT: Herita e Settlement Services, LLC I. SETTLEMENT DATE: 04:/30/02 Mechanicsburg Borough Cumberland County PLACE OF SETTLEMENT: 4705 E. Trindle Rd., Mechanicsburg, PA J, SUMMARY OF BORROWER'S TRANSACTION: K. SUMMAAY OF SELLER'S TRANSACTION: too. GROSS AMOUNT DUE FROM BORROWER 4oo.GgOSS AMOUNT DUE TO SELLER 1o1.Contractsalesprice 75000.00 4ot.Contractsalesprice "15000.00 tae. Personal propert 4oz.Personal propert 103. Settlement char es to borrower (line 1400) 15 8 8 .2 5 493. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad~ustments for items aid b seller in advance t06. City/Town tax to 4o6.C1 /Town tax to to7.Coun tax 04 30 02to 12 31 02 154 , 32 4o7.Counrytax 04 30 02to 12/31 02 154.32 tos. Assessments to 4oe.Assessments to 109. SCHOOL 04 30 02to 06 30 02 115.30 409. SCHOOL 04 30 02to 06/30 02 115.30 t to. to 410. to ,,,.Swr Ref:$60,40 end 7/1 41.04 41t.Swr Ref:$60.40 end 7 1 41.04 112. 412. t20. GROSS AMOUNT DUE FROM BORROWER 7 6 8 9 8.91 420. GROSS AMOUNT DUE TO SELLER '7 5 310.6 6 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 5o0.REDUC170N5 IN AMOUNT DUE TO SELLER 201. Deposit or earnest mono 2 0 0 0 . 0 0 Sot.Excess de osit see instructions) 2oz. Principal amount of new loan(s) Soz.Settlement char es to seller (line 1400) 6 3 2 8.31 2oa. Existing loan(s) taken subject to So3.Existin loan(s) taken subject to 204. so4.Payoff of First Mortgage Loan zos. 5o5.Payoff of Second Mortgage Loan 206. 506. 207. 5117. 208. SOB. 209. 509. Ad'ustments for items unpaid b seller Ad'ustments for items unpaid b seller 2to. Ci /town tax to 5to.Cily/Town tax to 2t t. Courtly tax to St t.County lax to 2t2.AsseSSments to 512.ASSessments t0 213. SCFiWL l0 Sta. Sr;H(bI, [o 214. 514. ...___ 215. 515. 21fi. 516. 217. 517. 218. 51 B. 219. 519. 220. TOTAL PAID BY/FOR 80RROWER 2 D D O . O O 52o.TOTAL REDUCTION AMOUNT DUE SELLER 6 3 2 8.31 300. CASH AT SETTLEMENT FROM OR TO 80RROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120 768 98.91 sot.Gross amount due to seller Tine 420 75310.6 6 302. Less amount paid b/for borrower (line 220) 2 0 00.0 0 s ss reduction amount due seller (line 520) 63 2 8.31 303, CASH ([$ FROM) ([ ] TO) BORROWER 7 4 8 9 8.91 603 ([ $TO) ([ ]FROM) SELLER 6 8 9 8 2 . 3 5 Buyer or Borrower's Sign re Seller's Signature HUD-t Rev. 5/86 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT UMLi NO. YSUZ-UZbb SFTTI FMFNT STATEMENT Page 2 L SETTLEMENT CHARGES 9 9 2 5 0 6 PAID FROM WER'S P/tID FROM SF_LLER'S 70TAL SALHS/BROKER'S COMMISSION based on pdce E 7 5 0 0 0. 0 0 7. 0 700. BORRO FUNDS AT Fl1NDS AT DlVision of Commission (line 700) as follows: Total.: fJ 25 D . D D SETTLEMENT SETTLEMENT lot. S 5250.00 to ERA NRT, Inc. 7oz. $ to `` `:` :~ ~: 703. Commission paid at Settlement 5250.00 7oa.Transact. ERA-NRT Inc. 100.00 100.00 500. HEMS PAYABLE IN CONNECTfON WRH LOAN cot. Login Ori ination Fee % eoz. Loan Discount % 503. Appraisal Fee to 804. Credit Report to 805. Lenders Inspection Fee 806. Monga a Insurance Application Fee to eo7. Assumption Fee eoe. sos. Sto. 811. g00, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE sot.lnteresttrom 04 30 02 to04 30 02 ~$ !da 902. Mort a e Insurance Premium for mo. to 903. Hazard Insurance Premium for yrs. to gOq, yrs. to 905. 000, RESERVES DEPOSRED WITH LENDER FOR ~~ 001. Hazard Insurance mo. ®$ /mo. 002. Monga a Insurance mo. ®$ lmo. " k 003. City/fOWn lax mo. ~ $ /m0. 3 ooa. Count tax mo. Q $ 19.16 /mo. 005. Assessments mo. ®$ /mo. 006, mo. ®$ 5 7 .4 9 /mo. 007. mo. ®$ /mo. '' ooe. mo. ~ $ /mo. ) 100. TRLE CHARGES 101. Settlement or closing fee to toe. Abstractor title search to 103. Title examination to toe. Title insurance binder to tos. Document preparation to Ro Weidner Es POC tos. Notary fees to Notar PtibliC 4 .00 to7. Attorne 's fees to (includes above items No.:) { ' toe. Title Insurance to Herita a Settlement Srvs 708.75 (includes above items No.:) 1102 1103 1104 109. Lender's covers e $ Ito. Owner's coverage$ 75 000 tti. 112. 113. 2pp, GOVERNMENT RECORDING AND TRANSFER CHARGES tot. Recording fees: Deed $ 2 5 . 5 0 Mort age $ Misc. $ 2 5 . 5 0 202. Cit /countytax/stamps: Deed$ 750.OOMortga e$ 750.00 203. State tax/stamps: Deed $ 7 5 0. 0 0 Mort age $ 7 5 0. 0 0 204. 205. 300. ADDITIONAL SETTLEMENT CHARGES 301. SUNe IO 302. Pest Inspection to 303.02 Co T Barr Heckard ._ 225.31 3oa.Tax Cert Barr Heckard 3.00 3os. 400. TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502, Sections J and K) 15 8 8 .2 5 E.3 2 8.31 Partin agree Thal no Ilabikty b acsumed by Sellkment Agent for the accuracy of inlortnalion tarnished by others as shown on Iha HUD•1 Satlbmanl Statement. Selllemenl Agonl hereby expressly raearvas the dghl to deposit any amounts collected for disbursement in an interest bearing account in a Federalty insured institution end to credit any interest so earned to Its own account as additional compancalbn for ila services in thh lransaclian. HUD CERTIFICATION OF BUYERS AN FILERS I have carefully reviewed the HUD•t Settlement Statement and to the best of my knowle ge an elief, it is a true and accurate..,slt~at/e/%m~ent of all receipts and disbursements made on my account by me in this transaction. I lurther certiry that I have received a co of •1 SettleryertC~ ant. CV F~ ~ ~~F~~ Buyer or 9orrower's Sgnatura Seller's Signature Buyer's Address 8 Phone: Seler's New Address a Phone: e HUD- Se lament Slalemenl ev pr ra is rue end accurate account 01 I 's transaction. I hav caused or will cause the lands to be disbursed in accordance with this statement. ~,t--,3o -O~'-- Ibment 1 Dal ARNIN a cane to knowingty mak else statements to the Uniletl States an this ar any aknilar loan. Ponallies upon convlclion can inclutle a line antl impriaonmenl. For details sea 1a: U.S. Code Section 10 and Section 1010. HUCI.1 Rev. SlS6 T n• Q+ rT ry 0 C~D Czi b n~ N N N O O N A ~ . ~ '; r~-~ ~ ~ 00 00 00 00 00 00 C7 * O O DO ~ J 00 00 ~ \O l ~D eo p ~ W -- vi O r !i vi . N N ~ t0 r-+ 00 J l!~ s C J o v J W N ~ W ti ~ ~ . 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N N N N N N r w N ' O N ~--~ N ~ N ~-+ 3 --+ N O O t N t3 e o ~+ 0 o 0 0 0 0 0 0 o 0 a 0 c K ~ a ,.,, o0 0 ~ .~ ~ ~ ~T °° ~ y R ~ 2 'rs: ~A ,s C O ~ O d ~rV ~ . ~p Q i j C gtr' A -i d rt _ fD a ;~:: ~~ C!] ~-1 Cf~ 7C1 , !n + ~"~, ~t"~00 :u0~ U N N N N N N N N ~Li7 ~~• ~ Z ~ F~rJ' . z ~ ~ ~ ~L3 O ~~OLn h]~OU] + + + N ~ NW O a O g O O O O -.~ lJ'1 l31 -~ ~• .'J• -P -P r + v+ w ~~~O~~E ~~ o. w w ~-~.o .~.o w-~ ~+.~_ ~ ~ • • F,~" ~ rd ~ H ~ O H U N w w Ja 1~ W •P w --~ -~ ~O ~• ~' ~~ L+d W ~O ~. 00 l~7 H • • • • • .~ CO `7 LTI LT7 Lit O~ O+ Vl ~l 00 Z rt.i ~ ~ O+ . N N OD CO ~ W .P ~ ~~ 3 `r a"-. QQ y 0 a n F-+ 0 "'~ z C ~~ a. ~o a~ ao 0 ~, c~ o~ b ., ~~ N N N O O N m N ~~~ a a a. y CrJ z '1 W ~ ~ o x ~ ~ ~ ~ ... ~ a' ~ ~ o a' o ~ ~' ~ ~ x ~ x '~ ~ x .~ ~z zz 0 0 r~ w' ~ CD a c~ 0 ~, }d n ~~ a~ o~ 0 a. 0 ~, b QQ CD N O M N ~L'~51 AiE'LECAL 800-221-0510 E~11 REGVCLE[~ ~~ 'L7 a' N n a a' n cu 00 C y ~~'t C f b c~u N N N O 0 N ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ r r r r r r ,~ .p ~ .p w w w w w w w w .? -P .A .P .P ~ A w w w w w w w w w w w w o0 00 00 00 00 00 ., v, v, v~ v, v~ o, o~ o~ rn o~ c, rn ~ ~o ~o ~o ~c ~c ~. l!i 111 tJt Clt ~•-` ~ -r r-~+ ~ ~ ~ ~-` ~A ~ -P -P •P ~ Z O~ Q~ G~ 01 ~D ~D ~O ~D ~O ~O ~G ~O ~] J J J J J ~ r-~ r-+ ~-+ r.+ ~ O\ O~ O~ O1 O~ Q1 O~ ~-+ ~ ~ ~ rr r~ N N N N ~ W ~ W W W W W ~~~~~~ a O~ J ~O 0o r-+ \O O 00 J C!i O~ •P O~ J In w ~? 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O CL C~ b n~ cn y ?. P~ f~D Z ~ ~ [77 ~ C~ (~D ~ w ~ ~ n .-r ~ ~ W ~ r. ~ O rr ~ ~ ~. o ~ `'' O .~-~ ~-' v' a z ~ f7 ~. ~ 'b ~ ~ ~ ' ` ~ l r ~ ~' ~ ~. N N N N N N W J ~1 ~7 N N ~-' Qt O~ Q'~ N N ~? ~ f--. F"' ~ ~ ~ oo Oo 0o O O O ~ N W VWi ~ Ov Ctrs tm ~ m ~ ~ ~ ~ ~ ~ rn < ~ Un ~ O ~ A. --~ o N O ~ ry ~ x ~ rt ~ ~ ~-. '"~ tri to t~s to t~ t~ ~ ~ ~ ~ ~ ~ x O O O O O O O O O O O O r,, rr r.+ ~-+ ~ r--~ p O O O O O 0 0 0 0 0 0 p O O O O O WP -P ~ N N O N N N N N O ,..., ~.+ i--~ ~ rr F-+ Wp ~ ~ N N O W W W W W 00 N N N N N O W W W W W W OO 00 00 ~O ~ OQ o ~ o O O O ~ '-' ~"'' ~p ~ ~ O O O N N N N N N O O p O O O O O O O O O N N N N N N O O O O O O ~ ~ ~ ~ ~ ~ N N N N N N O O O O O O VNi VNi VNi CNIi VNi ~ ~~ ~ tD tD t!i N N N O O N b Sv dG C9 W O W STATUS REPORT UNDER RULE 6.12 Name of Decedent: JANE R. GORDNER Date of Death: April 20. 2002 Will No. 2002-0415 Admin No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the Estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 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 X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: November 11,2002 t/7cAAk? C. ROY WEIDNER, ESQ. JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 Lemoyne, P A 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative - -'. ....1 Gv O~ \; /"}-6--'9- 9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN C ROY WEIDNER JOHNSON ETAL PO BOX 109 LEMOYNE '(). P~17043 09-02-2002 GORDNER 04-20-2002 21 02-0415 CUMBERLAND 101 ". REV-1S.7 EX AFP !Ol-On JANE R Allount Rellitted (9) (10) (1) (2) (3) (4) (5) (6) (7) ) CHANGED 75.000.00 1,628.97 .00 .00 347.48 26.534.28 54.001.85 (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 15.678.00 6.328.31 (11) (12) (13) (14) .00 X 135,506.27 X .00 X .00 X 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 =is4j-Ex-AFP--foY=o2Y-NoYicE--oF-YtiHEifiTAifcE-YAx-APPRAisEMENT-,--AL1-owANCE-oi------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GORDNER JANE R FILE NO. 21 02-0415 ACN 101 DATE 09-02-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 157,512.58 22.006 :31 135,506.27 .00 135,506.27 00 = 045 = 12 = 15 = .00 6,097.78 .00 .00 6,097.78 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 TAX CREDITS: 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) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets NOTE: (19)= . ". "..... K~l;U.1" I l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-19-2002 CDOO1430 304.89 5,792.89 TOTAL TAX CREDIT 6,097.78 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.)