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HomeMy WebLinkAbout02-0429 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS .2/.,p~ - fA,! Estate of c~/ t./c" ROBERTA KIEBLER ADAMS ~Roberta K. Adams Deceased Social Security No. 161-32-6557 RICHARD DAVID ADAMS, JR. (COMPLETE "A" OR "B" BELOW:) ~ A. Probate and Grant of Letters and aver that Petitioner is the Executor named in the Last Will of the Decedent, dated March 21, 1988. Slate relevant circumstances, c_g.. renullciatioll. deatb of executor. etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: NONE o I B. Grant of Letters of Administration (d,h.n.c.La.: pendente lite; durante absentia; durante minoritatel 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 Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 221 South Market Street, Mechanicsburg Borough, Cumberland County, Pennsylvania. (list slfecI, lIumber and municipality) Decedent, then sixty two (62) years of age, died April 2, 2002, in Harrisburg, Dauphin County, Pennsylvania. (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property....................................................................................................................... $ 1,500.00 (If not domiciled in PAl Personal property in Pennsylvania.................................................................................................. $ (If not domiciled in PAl Personal property in County............................................................................................................ $ Value of real estate in Pennsylvania..... ................................................. ... ... ..... ... ... ... .............................. ...................... .... ... .................. ............ ....... $ Total........... .... ..................... ....... ... ....................................... ... ... ..... ... ... .............................. ... ....... ............... ... .... ........................... ... ...... $ 1,500.00 Real Estate situated as follows: NONE (personal residence held jointly with surviving spouse) Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: C Signature J;;.1J2-:J)~ A~ ).. Typed or printed name and residence Richard David Adams, Jr. 221 South Market Street Mechanicsburg, P A 17055 Fonn RW-l Page I of2 (Cumberland County). Rev 9/92 /7- (,o~ 9 89018.1 4/26/02 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. j;?j<J])4IJd I4cP~ J. Sworn to and affirmed and subscribed before me this ~ day of April ,2002. CJJ:.7 C. ~L;;UU ~ Ma C. Lewis ~ No. 21-2002-4?g Roberta K Adams A/KIA Estate of ROBERTA KIEBLERADAMS, deceased Social Security No: 161-32-6557 Date of Death: April 2, 2002 AND NOW, April 30th 2002, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Richard David Adams, Jr. in the above estate and that the instrument dated March 21, 1988 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters........................... $ 25.00 Short Certificates..(~).<. $6..00 Renunciation................ $ Affidavit ( )................. $ Extra Pages ( 3 )............ $ 9.00 CodiciL....................... $ JCP Fee........................ $ t) _ 00 Inventory....................... $ Other............................ $ Attorney: I.D. No: Address: Dorm L. Snyder 06858 Perm National Insurance Tower Two North Second Street, Seventh Floor Harrisburg, PAl 71 0 1 (717) 257-7552 TOTAL................ $ 45.00 Telephone: MAILED LEITBRS TO ATTORNEY 89018.1 4(26(02 lIInst ~ill nub mesmmeut of .:"} , /) '1 d-JO ,j&/-VoL- 70( I ROBERTA KIEBLER ADAMS I, Roberta Kiebler Adams , of the Borough of Indiana County of Indiana and Commonwealth of Pennsylvania being of sound mind, memory and understanding, do make and publish this my last will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. FIRST I direct my Executrix or Executor, hereinafter named, to payout of my estate, all my just debts and obligations, including the expenses of administering my estate, as soon after my decease as is practicable. SECOND I bequeath to my husband, Richard David Adams, Jr., all my tangible personal property, exclusive of any such property used in trade or business. In the event that my husband, Richard David Adams, Jr., shall not survive me for thirty (30) days, or we should meet in death in a common calamity, then it is my will that said property shall be divided as follows: The first item for selection shall be given to my son, ANDREW DUNCAN ADAMS. The second item for selection shall be given to my daughter, AMIE ELIZABETH ADAMS. The third item for selection shall be given to my daughter, ABIGAIL RAE ADAMS. This order of selection shall continue until all of said property has been distributed. My Executor shall represent minors in this division. Any such property to which a minor would otherwise become entitled but which the Executor thinks unsuitable for such minor shall be sold and the proceeds thereof shall be distributed to the Guardian of the estate of such minor hereunder named, without bond, and the receipt of such Guardian shall be a complete release of the Executor. Any such property to which a minor thus THIRD FOURTH FIFTH In case of disagreement among my children, the Executor is authorized to make the division, having due regard for the personal preference of my children, but making such division in as nearly equal shares as the Executor deems practicable. I give, devise, and bequeath all the rest, residue, and remainder of my estate, real, personal, and mixed, of whatever situate at the time of my decease to my husband, Richard David Adams, Jr., should he survive me. In the event that my husband, Richard David Adams, Jr., shall not survive me for thirty ( 30 ) days, or we should meet in death in a common calamity, then it is my will that all my property and estate, as aforesaid devised and bequeathed to my husband, shall be equally devised and bequeathed to my children, Andrew Duncan Adams, Arnie Eli zabeth Adams, and Abigail Rae Adams, share and share alike. I hereby appoint my husband, Richard David Adams, Jr., as Guardian of my child, Abigail Rae Adams. If Richard David Adams, Jr. should not survive me, or if he should fail or be incapable to act as such Guardian or should die after my death, I appoint my son, Andrew Duncan Adams, as Guardian of the child. If any beneficiary of my estate is under the age of 18 years at the time at which distribution of any property devised and bequeathed by this Will would otherwise be made to such beneficiary, the Executor shall distribute all such property to the Guardian of the estate of such beneficiary hereinafter named. The Guardian shall hold, manage, invest, and reinvest any property received by the Guardian (whether under this will or otherwise), shall collect +h~ ; n~nmt:l i-h,:.r13nr _ .:::Inn C!'h~ l' ;:!inn 1 'U 01""\ m11,...h ^-F ~'h.o ,....o~ .; Y'lo __"""_ '!'to_,=( ';.t= ~h_ SIXTH SEVENTH the same to the principal of the property held for such beneficiary. When such beneficiary attains the age of 18 years, the Guardian shall distribute to such beneficiary all property held by the Guardian for such beneficiary. If such beneficiary dies before attaining the age of 18 years, the Guardian shall distribute to the personal representative of such beneficiary's estate all property held by the Guardian for such beneficiary. I authorize and empower my Executrix or Executor, hereinafter named, to manage the property, both real and personal, and it is my intention that such Executrix or Executor shall have the power without limitation to rent, retain, invest, reinvest, mortgage, lease, exchange, convey, sell at public or private sale, for cash or credit, or otherwise deal and dispose of any and all property that may come into their hands as such Executrix or Executor, all without Order of Court, when in the discretion of said Executrix or Executor. I hereby authorize my Executrix or Executor the power to borrow from and 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, or to di stribute in cash or in kind. These authorities shall be in addition to those granted by law and shall be exercisable without leave of Court. I appoint as the Executor of my Will, my husband, Richard David Adams, Jr. In the event that my husband, Richard David Adams, Jr., is unwilling or unable to act as Executor of my Will, then I appoint Laura Ruth Kieb1er Martin, Executrix hereof. No bond shall be required of my Executrix or Executor. /7 J ~' f~4J ~ t2d~ Signed, 'sealed, published and declared by the above-named, Roberta Kiebler Adams as and for her last Will, in the presence of us and each of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as wit- nesses thereto the day and year last above vITitten. \ \ I ( /,i t1;;;1 ,- \\~ ",I, '; / / if ;, "':/?; ,-1. _~ '~/'-II.",\,..," .f ",.. V) ../!V e I ' /1 (JUm!~ W4#M- ACKNOWLEDGMENT COf~ONWEALTH OF PENNSYLVANIA: COUNTY OF INDIANA ss I, Roberta Kiebler Adams , testatrix, whose name is signed to the attached or foregoing instrunlent, having been duly qualified according to law, do hereby ack- nowledge that I signed and exel~uted the instrument as my Last Will; that I signed it willing- ly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by c:; . 0 the testatrix, this 21......t- day of rnflh.A.~ Roberta Kiebler Adams 1989. COMNONWEAL'l'H OF PENNSYLVANIA: COUNTY OF INDIANA ss ~f\ C};M, D}, UmJ !T2rJfll1'rj 'ill) Ml;! Ie' TITLE OF OFFI CER " KAREN J. RUSHTGN. NOTARY PUBliC :2',' INDIANABO-ROUG_H, INDIANA COUNTY .' . MY COMMISSION EXPIRES JAN. 9. 1989 Member. Penrsylv3nia Association of Nola;i~s We Roberta Kiebler Adams, Carol A. Hanna, and ~JI\ rJ.. l'1tll.:'(\jYJ).. the Testa +rix and witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and !~xecuted the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hear- ing of the testatrix signed the Will as witness and that to the best of the witnesses' knowledge, the testatxix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ~.lIan<<--__ 11 /1 i . I ., . ~~r }/.. ~ 'i... \ t ,-,,;( ,../ ii/A. ,i LJ (\ UJ ~i -L It . # REV-1500 EX + (6-00) OFFICIAL USE ONLY l!....- COMMONWEAlTH OF PENNSYLVANIA REV-1500 I 1 q DEPARTMENT OF REVENUE - LPo - DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21-02-0429 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ADAMS ROBERTA K 161-32-6557 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 04/02/2002 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Richard David Adams, Jr. 3. Remainder Return CHECK r-'- ~' Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. limited Estate 4a. Fulure Interesl Compromise 5. Federal Estate Tax Return Required (dale 01 death aher12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy 01 Trust) BLOCKS 9. Litigation Proceeds Recei'lied 10. spousal Poverty Coot (date 01 death bet'lleel'. 0 11. Election to tax uncel Sec_ 9113(A) 12-31-91 and 1-1-95) (AnachSch0) u\j$'~Ub!\!MQ$tlllfQ~lili~tj;p':j\"QQ!ljj.ji~~~~Ct>>iJ!ijjl!iPlfIAtit~jNffii!jMAtjQNjljflQMltl~b!i'!mttilptQ: NAME COMPLETE MAILING ADDRESS COR- Donn L. Snyder, Esquire 2 North 2nd St. , 7th Fl RE- FIRM NAME (If Applicable) Harrisburg, PA 17101 SPON DENT Saul Ewing LLP TELEPHONE NUMBER 717-257-7552 ~ OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) ;c{j D 2. Stocks and Bonds (Schedule B) (2) 0 >.....' 3. Closely Held COf?Of'atlon, Partnership or Sole-PrQpl'i9torship (3) 0 .- 4. Mortgages & Notes Receivable (Schedule D) (4) 0 ~ _n 5. Cash, Bank Deposits & Miscellaneous Personal ~ Property (Schedule E) (5) 1,250 ,~'C: 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) 0 ". , RECA- 1 I..;'i PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 0 8. Total Gross Assets (total Lines 1-7) (8) 1,250 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 2,690 11. Total Deductions (total Unes 9 & 10) (11) 2,690 12. Net Value of Estate (Une 8 minus Une 11) (12) (1,441) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0 has nol been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (1,441) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec_ 9116 (a)(1.2) 0 X.O 00 (15) 0 TAX 16. Amount 01 Line 14 taxable at lineal rate 0 x.O 0.045 (16) 0 - COMPU- 17. Amount 01 Line 14 taxable at sibling rate 0 X .12 (17) 0 TATION 18. Atntl\lfl\ 01 Une 14 taxable at collateral rate 0 x.15 (18) 0 19. Tax Due (19) 0 20. 0 I~BeR$HfitOUw~j$tlilQHtI~i\JPOl!AlI4@RPl\YM~'WI ...................................................!}jfal;$\.!!'!!'W(Q~WalAUiQ!:I~OOll.(lNeA~gA!'IPI'!!;QH!iQKMArH""...' o PA 15001 Copyrighl2000 Greatlan<llNelco LP . Fonns Software Only NTF 29755 . -j PA REV-1500 EX (6-00) D d l'C It Add Page 2 ece en s omDle e ress: STREET ADDRESS 221 SOUTH MARKET STREET CUMBERLAND CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CredtlslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Totai Credits (A + B + C) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o o TotallnterasVPenalty (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. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS. AGENT o o o o o ."..'...-.-.-...-.....,."."......,.....-.-..-...........-,'.------..-,...-.....-------,-,."."..,..------,----....."......_--------.'.,-..,..,..,......_,-."."."."..-......-,-.". ..'...,.--.,.,....,....,..,',..',..'.....,.....,.,....,.,.,""',...,.,...,..,',..,',."....,.".,...,'.."".".."..,.,...,.,...,.."..,"".',.'....,..".,.,',..,...,..".".,...."..,..,..."."."."..."..".'. ...,......,...,--.,--..--.,..,',...,',...".,....,....,.,......,..'..,'.'..,'..,'.'. '..... ,......,.,',' ',....',.,.. 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PLEASE ANSWER THE FOllOwiNG QUEsrioNs BY-PLACING AN 1. IIX" ....."'.,.,.,'...','...'.....'."...'...,..."....',.','..,',.....'..,'...,..,....',....','....,'.,."..'".'."'."""""'" """.. .... .....,..,.... .. ..........,.. .. .. .. ...... .".".,.........'....'--'--,..,."..........--..,...,..,.,.,"',.......'.--'.----'--.--.,..,'...'.. .,....".,.,.....,........'.--'...'...,......,....,.......'....'...'.'.'...,.,....,..,.,.,......'....'....'...,........ .',., .. ............,.., .' ... .......,., ... ........., ..,'...'............'..,...--,.".,'...........'--,--.--..,,.,.....'.....'--.'--',..,..".,'...'.. .'.....,.,.,.,.............""'...,.,..,.....,...........'.....'.'.',...,"..".,.".,......,.'..,.'..,.'.''.""..,. ,,' .....".. ... ......."", ...........,..... .".".."......'...,..,--""."....'....'....'--,--.--."..,.......'.'--,..,...,..".". ',..."...,...,.........'...."",....,....,...............'.""""'..,...,.,......,......'...,.."...,.". .,.,.. . .. ............",.., .... .....,.""" . .. ............,.., IN THE APPROPRIATE BLOCKS 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. retainareversionaryinterest;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 "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. Under penalties of periury, 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 0 preparer other than the personal representative is based on information of which preparer has any knowledge. SiGNATU!J.E.,OF .rERSON RESPONSiBLE FOR 'JLiNG RETURN DATE I t-<.c.lt..~7::U~W~ 4.'" b/l-{ 02- ADDRESS 22 SIGNATURE Yes No ~ ; B ~ o ~ eet, Mechanicsburg AN R~RESENTATIVE PA 17055 ADDRESS P.O. Box 1291, Harrisburg, PA 17108-1291 [72P.S, . 9116 (a) (1.1)(i)]. For dates of death on or after January 1, 1995, 1he tax rate is imposed on the net value 01 transfers to orforthe use of the surviving spouse is 0% [72 P.S. Ii 9116 (a) (1. 1) (ii)]. The statute dOA!; not AliAmnt a 1ransfer to a surviving spouse from tax, and the statutory requirements for disclosure 01 assets and filing a tax retum are still applicable even if the surviving spouse is 1he only bene1iciary. For dates 01 death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent. or a stepparent of the child is 0% [72 P.S. 19116(a)(1.2)J. Thetsx rate imposed on the net value of transfers 10 or forthe use 01 the decedent's lineal beneliciaries is 4.5%, except as noted in 72.P.S. Ii 91 16(1.2) [72 P.S, %91 16(a)(1)]. The tax rate imposed on the net value 01 transfers 10 or for the use 01 the decedenl's siblings is 12% [72 P.S. 191 16(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. o PA 15002 NTF 29756 Copyright 2000 GreatlandlNelco LP . Fonns Software Only ~ '. REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERTA K _ ADAMS SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Include procEleds 01 litigation & dale proceeds were received by the estate FILE NUMBER 21-02-0429 All prop. jointly-owned with right of survivorship must be disclosed on Sch. F. VALUE AT DATE OF DEATH ITEM NO. 11. DESCRIPTION Pinnacle Health 365 2 The Bon Ton 149 3 Waypoint Bank 735 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,250 9 PA15081 NTF10S75 Copylight 1999 GreallandlNelco LP . FOmls Software Onl~ .. -. REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERTA K. ADAMS Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-02-0429 DESCRIPTION AMOUNT 1. 1 Andrews and Patel Associates last illness expense 306 2 Oak Wood Center Radiation Oncology Last Illness Expense 1,615 3 Shepherds town Family Last Illness Expense 27 4 Tristan Associates last illness expense 742 9 PA15121 NTF '0074 TOTAL (Also enter on line 10, Recapitulation) $ (Ii more space \s needed, insert additional sheets of the same size) 2,690 Copyright 1999 GreatlandINelco lP - FOlTT1s Software Only .. -. REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ROBERTA K. ADAMS 21-02-0429 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not Ust Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 1. ichard D. Adams 21 SOUTH MARKET STREET ECHANICSBURG, PA 17055 Surviving Spouse o ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV.1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) o o PA15131 NTF33293 Copyright 2000 GreatlandINelco LP . Forms Software Only 1 , I Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of. Roberta K. Adams No. 21-02-0429 also known as Date of Death April 2, 2002 . Deceased Social Security No. 161-32-6557 Personal Representativels) of the above Estate, deceased, verify that the items appearing in the following inventory include ail of the personal assets wherever situate and all of the real estate in thll 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/We verify that the statements made in this Inventory are true and correct. I/We 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: Donn L. Snyder Personal Representative: p vl.rMd.1) AI~ /. . 1.0. No.: 06858 Address: / 2 North Second Street, 7th Floor Dated June I~ 2002 Telephone: Harrisburg. FA 17101 (717) 257-7524 Description Value Personal Estate See Schedule "E" attached $1,250.00 1'" -.J ,"" L. ~:;: ' lH ZOo Total:$l, 250.00 (Attach Additional Sheets if neces$ary) 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. RW-8 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERTA K. ADAMS SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-02-0429 Include proceeds of litigation & date proceeds were received by the estate. DESCRIPTION All prop. jointly-owned with right of survivorship must be disclosed on Sch. F. VALUE AT DATE OF DEATH ITEM NO. 11. Pinnacle Health 2 The Bon Ton 3 Waypoint Bank 365 149 735 9 PA15081 NTF 10875 Copyright 1999 GreatlandlNelco LP - Fonns Software Only TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,250 J..--- INRE: ESTATEOF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ROBERTAK. ADAMS No. 21-2002-00429 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ROBERTA K. ADAMS Date of Death: APRIL 2, 2002 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the sole beneficiary of the above-captioned estate on August 6 2002: Name Address Richard D. Adams, Jr. 221 South Market Street, Mechanicsburg, P A 17055 Notice has been given to all persons known to the undersigned to be entitled thereto under Rule 5.6(a) August 6 , 2002 ~ ONN L. SNYDE Saul Ewing LLP Two North Second Street, 7th Floor Harrisburg, PAl 71 0 1 (717) 257-7552 Attorney for Estate r-- i p 62176.1 8/6/02 v V,. ../ STATUS REPORT UNDER RULE 6.12 ~" .,,,,,,.. ,---' r'," Name of Decedent: ROBERTA K. ADAMS Date of Death: April 2, 2002 j -..J Register File No. 21-02-00429 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 X No 2. Ifthe answer to #1 is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to #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. Did the personal representative state an account informally to the parties in interest? Yes No X* d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repo Do L. SNYDER 2 NORTH SECOND STREET, 7TH FLOOR HARRISBURG, PA, 17101 717-257-7552 Attorney for the Estate Date: August 6, 2002 *INSOLVENT ESTATE 54463. 1 8/6/02 /?-6o -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 'OJ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-29-2002 ADAMS 04-02-2002 21 02-0429 CUMBERLAND 101 -2 , ' . U DONN L SNYDER ESQ SAUL EWING 2 N 2ND ST 7TH FLR HBG PA Iv401 '* REV-1547 EX AFP IOI-D2I ROBERTA K Allount Rellitted 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'4-j-i3f-AFP-foY=02Y-NOYici-OF-YNHiiiiTAifcE-TAX-"A-PPR"A-isii.fENT~--Ar.LOWANCE-OR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ADAMS ROBERTA K FILE NO. 21 02-0429 ACN 101 DATE 07-29-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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 .00 .00 1.250.00 .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 .00 (9) llO) 2.690.00 (11) ll2) ll3) ll4) NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL 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: NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 1,250.00 2.690 00 1,441.00- .00 1,441.00- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 .00 X 15 = .00 ll9)= .00 ~ .. .~... ,,~v~~. . l+J 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.)