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Home My WebLink About02-1102PETITION FOR PROBATE and GRANT OF LETTERS Estate of C• r t)1(,~~ L. ~f V ,~, ~ - ~i '~ - ~ ~ ~~~ ~;~ also known as No. _ To: Register of Wills for the Deceased. County of ~'~hc'r-!w n Social Security No. 1 C~ {3 -- Z (o - ~~ q~, in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut r ~ x in the last will of the above decedent, dated lyl a r c h named and codicil(s) dated ~l , 19a~1 (state relevant circumstances, e.g, renunciation, death of executor, etc.) Decendent was domiciled at death in _ u+r ~''r IGt n Gl h ~L- last-family or principal residence at i I County, Pennsylvania, with Pa ~ (list street, number and muncipality) at Decendente 1 ~n i~_ years of age, died Tt~ np i , 19 d00 I , Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania $ ~ I ~ OoG (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) v V /~ v~ xv ro~ ~~ ;?'~- mGtur~ nl Q J ° ° t-larrt Sb ""~~ >°Q /7/O~ ° m ~'~~.~ . OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF ~~ ~c.,/~~ E~r~~ ~ ~% ~- ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly a~dpminister the estate according to law. Sworn to or affirm and subscribed ~ ~~.t~-e2` O(. ~ `~,(~~Q~~ before rrle this ~ ~ da of ~' kr y --~, .r_ t, ~ w Registe I C~~^ ' i ~ its, > l "?' !', ` ! No. 21-02-1102 Estate of FRY MARTHA L . ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW FEBRUARY 6th ~ 2003 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_ NOT DATED described therein be admitted to probate and filed of record as the last will of MARTHA L. FRY and Letters TESTAMENTARY are hereby granted to CAROLL L. McCLIMANS FEES Probate, Letters, Etc.......... $ 70.00 Short Certificates( 1) .......... $ 3.00 ' n . extra. F.age... $ 3.00 JCP ~ 10.00 TOTAL $ 86.00 Filed .FEBRUARY . 6,. 2003 . . . . . . ........ . Register of Wills ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE MAILED LETTERS TO EXECUTRIX FEBRUARY 6, 2003 10ti.R05 kL~' 9/HG This is to cerCifv that the information here given is correctly copied from an original certificate of c{eath duly Tiled with me as Local iZegistrar.~ The original certificate will be forwarded to the State Vital Records Office for permanent 'filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fec for this certificate, $2.00 P 7386785 No. H105.1.3 Rev 2J87 TrvfJPRINT IN PERMANENT BLACK INK u ~ _ z o - i z ~ a o ~ z D ; a e: ? Nom/ e2 d~ Local R gisrrar v ~ Uate COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STNF FILE NUMBER NAME OF DECEDENT If uv. Mbpa. Leal SE% SGGUI SECURITY NUMBER DATE OF OEATH:MaM. Day, Marl ,. Martha L. Fry ,. Female ,. 168 - 26 - 2894 .. June 1, 2001 AGE (La9 BvbdaYl UNDER 1 YEM UNDER 1 DAY DATE OF 81PTH BIRTHPLACE :Cay x4 PLACE Oi DEATH ICrti!cl; avy are-- ,ea ~nNrucl.an nn aMI s;Cal MAIM Day kMl iMlea faegnCwmrYl MpYm1 r Daya tlalba Mmu,aa '~ HOSPIUL 07NER: : 1933 Harrisburg, r Sep 26 67 v Irpatwm ^ EPlOutparwnl ^ Dw ^ N~w+w•w ^ ReeWrlu ~ ,°sw m ^ , r.. s. ~ B. ,. ~ ... • COUNTY OF DERN GIY, 8080. TWP OF OEATM FACILITY NAM III I eel aa] ntAnoeri VMS DECEDEM OF HISPANIC ORMa1N7 RACE - Amerurl Ntien, Black, NTite. eac. No tA,l yba ^ KM.NKICMCWn, ISpeceyl Cumberland Mechanicsburg 311 South High Street M.fe;an.PuMORICan.Mp White • M. Oe. b. 0. ,0. DECEDEM'S USUAL OCCUPATION KIND OF BUSINESSIINDUSTRV VMS DECEDENT EVERIN DECEDENT'S EDUCATION MARITAL STATUS. ManIeC SURVIVNaG SPOUSE S7 5 ant n r:N c b Nawr Marti W. WdowC. Itl rAe. Vlve nvadan Mnrol C E IGwe Nrd Wwp%Cale Cw onto U.S.ARMEO FOR D^'OiCiOISP.cM ~, , 1 d naNNq w;CO na user eel Own Home va^ NoW E1~Ce~y 1,~5•I William L Fry Homema~er Married . • ~~~ „• „b „ „ ,~. DECEDENT'S YNLING ADDRESS ISIIM.Gy/4wr. 50r. Zp Coeal DECEDENT'S Penns Ivania ,,. CacWem NVW in ^Yee Y 311 South High Street . . tlq. Oi0 ACTUAL 17a. Stole RESIDENCE e.c.a.N Mechanicsburg, Pennsylvania 1705 uaaner~sd.1~ Mechanicsburg Cumberland '°~^"`p7 ® ~ ~ ,. Cey, ,,.. ,, ,, '°°r° ,7b Gwe _ FATHER'S NAME (Fu9. MdOe. Lda1) Clarence T Swenson MOTHER'S NAME IFeL. MdOfa. Mabn$wna+Ml Ella R Weller 10. „ . WFORMANT'S NAME (TypePrral I NFORMANT'S MAR1fW ADDRESS ISbaM. Gy/6wr, SIW, Zip Coh) Caroll L. McClimans 139 West Vine Street Shiremanstown Pa 17011 2M. „b. . METHOD OF OISPOSITKK I GATE OF DISPOSITION PLACE OF OISPOSRION- NerM W CamNary, Cnmalay LOGQION - CAYrTwm• BM,e. Zp CaN q Bunts td Gerrutesn^ RrMVY Man Slale^ • (Maus. Day. Yaarl aOIMr Plaee Darraia,^ n ^ 2001 Jun 5 Rolling Green Memorial Park Camp Hill, Pennsylvania 17011 m. , 2m, t,e. ra. RV LICENSEE ORP TING AS SUCH SIGNATU OF LN;ENSE NVMBER NAPE AND ADDRESS OF FACB.ITV v • „~, / (/~'( 22b. FD-014318-L ,2c. tyi ers Funarat Hcme Inc. 37 E-st Main Str a tat ni r CarlpleM Aema 2]a<ally w unllyep MYfea•rI a rwl aeaiMbl. al a a aWII /c~~palBE. LICENSE NUMBER N my WaN occwr~~oowwnbrrpp t rM. Ca pla Ie ana T ) ORE SIGNED (Ma+n. Dav. rbarl ~ A, ' I ~ L fir, - L `~ - y C a J ~ 1 - ,,.. 28b. 2x. - Noma 2428 muY M catypNlaG by TIME OF DEATH DATE PRON NCED l~AOlMOnm. Oay. Year) VMS CASE REFERRED TO MEDICAL EXAMINERICORONER7 ^ N I o ba • person too walwncaa Nam. D L• - c I - 0 r. R ,.. M 2s. 2,. PART I: Enter tM Aiaeafaa, mryrMSa CdnpNCatprya wl:cn GuseC IM aeatn Do amw IM nwa of aylrp, wcn az carCiac or respnalory anent. snwk or Men lailwa. I AppofuMle PART N: ONrr siOnCkem wrlCNiorr mrw101! q b Ceem. nut c lrMnPART I mIM dM 11 W aw Q . b1Q ryp ~~~~ rtd raeU La1 OnIyOM t]Ufe OrlBxA ant ; ~ I NIYEdATE CAUSE IFvw ~ 1 un ~.a,.a~adN~n L q CoL_ c. m I ,~..qn~)-.. a ~ - DIIE AS ACONSEOUENCE Of} Sepwrtlutly en ralyeitnM b ' i 011E ro 10R As A coNBEauENCE oFl: tl Mty. Irtl4yp Io.MNaiele I auwe EMw UNDERLYtli[i ---- ~ __. _ CAUSE IIMwaea WwY • mat erlMleo events ~ c OIIE ro (OR AS A CONSEQUENCE DFl: 1 Ias11Wp n oeW11lA8T a r VMS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT V.ORK, DESCRIBE I/OWIWURY OCCURRED. PERFORMED? AWIABLE PRgflro IMralm. DaY. ylarl qN l7F CAUSE ,~a ^ ' OF ~~H Hom¢de NNwM .LT YM ^ ~ ^ AccdeM ^ PardNp mwMgatgn ^ M ,,ye ^ ~ ~ VM ^ flo ^ SwciCe ^ Count na M CerermuleC ^ PLACE OF INJURY ~ Al home, larm, avant, lapory, office LOCATION (Sbew. Caylfown. Slalel 2M. 20b. 19. buNCbq, Nc. ISOecnvl ~•' ~~ QJR VIER ICnacR avy arl •CERTIFYIND PNYSKIAN IPnYS<an ce.INyvg cause tl ceau; when .mane pnYZI[•an nas aonwrcea Oealn env canavlen nem 271 CeaN oeeumad Ow b 61e cauuUl arse manner n ebta0 ..................................................... ^ TO Ilte MN o1 mY YrowNCpe SIGNATURE AND TITLE OF CERTIFIER b. , 'ItTDNOUNCINC AND CEPTIFYIND PHYSICIAN IfTyvc.an veun ya~wrc;nq Deem ald <eneylnV to cause of oeamt ^ e r lee d ICENSE NUMBER _ E S a. -o d/6?~o _o ~,,. DI DaY, '/ all ~~__ .......................... maM r as e e To NIe Mel of mY EMwNCge, ceaN eccwrad at tlN Ilrrle, Cale, and place, ant Cw to OM ceuselet er ~ NAME ANDADORESS OF PERSON WHO COMPLE7EDCAUSE ATH ' ' 'MEDICAL E%AMINER/CORONER pl 7' T PryK 1 \~ On Ina buia of OaamiMtlon anClor Invealigatbn, M my oplNOn, de Nn occurreC al Ina time, Cate, and place, and due to the cauaelal and ...................... ° . U ~ ~A 5 '' . m.nn.r ae afalb .......................................................................... afa. o ~2. REGI R'S SIGNATURE AND NUMBER DATE ILED(MONn. Day II 1L:1-~ 21-02-1102 A235-10 LAST WILL AND TESTAMENT R235-04 BE IT KNOWN that I, ~~~ tI1C~ ~ • ~ ~y , a resident of ,County of ~~ ~Er (Ctnd , in the State of ~3i1 S Ntc~h ST, fYlechGl'it~sbury F~~.n r'15 y I ~ ~~ n i h ,being of sound mind, do make and declare this to be my Last Will and Testament expressly revoking all my prior Wills and Codicils at any time made. I. PERSONAL REPRESENTATIVE: I appoint LCir,~ (l )_. rY1 C ~' i ~ -~t G n S of 13~ U% ~ ~r ~ C1F ~-r . ~Y1i r ~ lrar~s tz>w ~, ~~. 17v ~ ~ , as Personal Representative of this my Last Will and Testament and pro- vide if this Persona] Representative is unable or unwilling to serve then I appoint fir. .S(A2 I~ nn ~ I C~P ~ (, as alternate Personal Representative. My Personal Representative shall be authorized to carry out all pro- visions of this Will and pay my just debts, obligations and funeral expenses. I further provide my Personal Representative shall not be required to post surety bond in this or any other jurisdiction, and direct that no expert appraisal be made of my estate unless required by law. II. GUARDIAN: In the event I shall die as the sole parent of minor children, then I appoint as Guardian of said minor children. If this named Guardian is unable or unwilling to serve, then I appoint as alternate Guardian. III. BEQUESTS: I direct that after payment of all my just debts, my property be bequeathed in the manner following: d ~. C c~lrt~l, ~F 1. h~ cc~ me -1-h ~ :sc I~ } L - F ~L a~ ,( a n oar~ds a n ~ bc~ n IC. ~~ Bess+~n a~= (,~, ; I l i ccrn ~, y Ci ct>v U n~ ~ . Jul inn S~deil shall c~e+ +h~ ~ha~e Ia~anSe, ~-I~~ 1cv~ s'~'a± ~,Wt Mass b~~.~l ~ -}-he gook ~aS~ rc ~ I n'l~ L' I l mans s ha i I g~ ~ `+-h ~- C' h i n~ ~) oSe~+, ~-'~ ~ bCaO1c C t~ .~ 1n.' ~l I I ~~ a rn L ~ c;y~ 1=r~ s hn I I ~ ~ f ~, ~ ~ ~ ~.. k o~F ~l-he hom ~ rn ~ ~ ~ ~`Ic.+u v-e s ~~i~d ~~~Cb~kej s ha I I c~~-i- ~ ~~ r>~ 5 ~~roorn ~w i te, Testator's Initials Page of Execute and attest before a notary. Caution: Louisiana residents should consult an attorney before preparing a will. Rev. 6/00 1992-2000 E-Z Legal Forms, Inc. Th1S ptOCIUCt d0eS not ConstttUte the tendering of legal advice or services. This product is intended for informational use only and is not a substitute for legal l~l~e. Stale laws V3Ty, SO COUSUIt 311 3tt0IDe}' O11 311 legal matters. Thls ptodAFAA snot necessarily prepared by a person licensed Ln practice law in this state- L~urc~ ~~~~tkEl ~h~(I ~t/f ~'he _S~te, ~~drvom su~fc~. IN WITNESS WHEREOF, I have hereunto set my hand this day of (year), to this my Last Will and Testament. IV. WITNESSED: es for Signature The testator has signed this will at the end and on each other separate page, and has declared or signified in our presence that it is his/her last will and testament, and in the presence of the testator and each other we have hereunto subscribed our names this day of (year). ~ - ,- _ ~~ Witness Signature Witness Signatur Address ~ ~~ ~~~ ~ ~~~ Address ~`~~~~ Witness Signature Address ACKNOWLEDGMENT State of l"1rz N ~' Sy~~~-v~ County o„f ~ QJL,'VY~(3:-Ru'~M We, V'(~72~c~u1 L. »l:T2nZ , and the testator and the witnesses, respectively, whose names are signed to the attached and foregoing instrument, were sworn and declared to the undersigned that the testator signed the instrument as his/her Last Will and tHat each of the witnesses, in the presence of the testa~or and each other, signed the will witness. - t ' -- Testator: ~'~ > i • Witness ~ '~~ '/ ~,. Witness - °~ ~' n~ Witness On ~~ (nom-cca 2tz.t before me, (yl~~tor~ c...Ky- ~/~~2~c~yi L.S~_~;z,~i;ti, /~Uti«.u,F~.1-L~``"~ appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official sea1l. Signature d Z~Q~Q V~ _ • Affiant nown :.ID-~" ND ARIA!-5 ~ Type of ID A t~t2tc,d=~~~ ~~=E4wc~, %H~`Pc ES r. 1~dARBOLD, Notary Public (Seal) ~ Camp Hiii Bora, Cutt~erlattd CLt6-~!'IY g ~ ~~ B~.~ per, ;Ig, ~ Pa a of CDMMDNNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOT I C E BUREAU OF INDIVIDUAL TAXES AND DEPT. 280601 TAXPAYER RESPONSE HARRISBURG, PA 17126-0601 REV-1543 EX AFP (09-VO) FILE N0. 21 Da.-`~doZ ACN 02149046 DATE 11-25-2002 EST. OF MARTHA FRY S.S. N0. 168-26-2894 DATE OF DEATH 06-01-2001 _, COUNTY CUMBERLAND CAROLL MCCLIMANS C/0 5026 MAURETANIA AVE HBG PA.-17109 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WAY POINT BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. 4uestions may be answered by calling (7171 787-8527. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1800035485 Date 05-24-2000 To insure proper credit to your account, two Established (2l copies of this notice must accompany your payment to the Register of Nills. Make check Account Balance 19,165.53 payable to: ''Register of Wills, Agent••. Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to TEiX 9, 582 • 77 (3) months of the decedent's date of death, TeX Rate X , 15 You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 1 , 437 .42 nine (9l months after the date of death. PART TAXPAYER RESPONSE A. ~/ The J l above information and tax due is correct. ister the Re t t of Wills with two copies of this notice to obtain p 1. g o You may choose to remit paymen a discount or avoid interest, or you may check box ^A'• and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 CK C B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. ~ The C above information is incorrect and/or debts and deductions were paid by you. . You must complete PART 2^ and/or PART 3^ below. ART _ lease sae Your f ......... ' dsfferent tax rate, p ""' ou indicate ::: ?.'=~~tii;l~~€si€ig ..::::~ € ~!€€ _ ~~?fi~?f(";:: ::::::::::::::::::::::::::::: 2 relationship to decedent: ;+;:€~_=;i!ass=~€is~!`~€~i ;€~~`•A~:`;1~~1~;~F~:;:;::;:;::~:::s: TAX RE TL'R~' - COMPUTAT.ON OF TPX OM JOINT/TP.U~T AC~OUN . ¢ ~~~:;; :::.:;::::. ~ LINE 1. Date Established 1 2. 2 ce lam t Ba un co Ac . 3 ble xa Ta ent rc Pe v . 4 o Tax t t "ec Sub t oun An 7 ~ ~~ ~ ~ ~ ~~ ~ is ~ . 5 ctions 5 ed d D an is eb D is ~s='f=s'~ - 5 ' ' €~ _'_'':' ~'_ ~ '' ~,,,, ~;, ~ ~~ ~ ~`~ ~ ~~ ~ ~' ~ ~~;''' _ ~ ~ ~~'' 6. 6 e bl axe t T un Ano 7. Tax Rate .:;::::. ~~~"` 8. .Tax Due ::~:.:: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ~~"' . . ~~ DEBTS AND DEDUCTIONS CLAIMED PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Conputatsonl ~ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. HOME C ) WORK C ) T..,~..,~o cTf±\IATIIDC TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: MCCLIMANS CAROLL 5026 MAURETANIA AVENUE HARRISBURG, PA 17109 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: SsN: 768-2s-2x94 FILE NUMBER: 2102-1 102 DECEDENT NAME: FRY MARTHA DATE OF PAYMENT: 1 2/05/2002 POSTMARK DATE: 1 2/04/2002 couNTY: CUMBERLAND DATE OF DEATH: 06/01 /2001 AMOUNT 02149046 ~ S 1,437.42 TOTAL AMOUNT PAID: REMARKS: CAROLL L MCCLIMANS SEAL CHECK# 3205 INITIALS: SK RECEIVED BY: MARY C. LEWIS S 1,437.42 REGISTER OF WILLS REV-1162EX(11-96) NO. CD 001916 REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~~ (+ ha ~-- • ~ 7~ Date of Death: ~p ' ~ ' ~ Will No.: r~~~' ~ ~ ~ ~ ~- Admin. No.: I -0~' d 2 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: State whether administration of the estate is complete: Yes ~ 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 ^ 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 ^ c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and maybe attached to this report. Date:... -~ I-c..3 ~a~s~~~c ~ ~'JCC~iIt,~: Signature (gin ro I ~ L~ ~ ~~ I i ~'`na ins Name L~C,i.~2~o m~u~'e~-ce Flo G ~d~. ~4ac('t c~~~ru ~z. ~71~.`~ Address ~ 7 i~) C~ -~1- ~ ~ ~ 5 Telephone No. ~~ G ~~ Capacity: ~ Personal Representative ^ Counsel for personal representative ~, i~-/O6 - /o COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSIiENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX RFP coy-oar DATE 01-28-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 COUNTY CUMBERLAND SSN/DC 168-26-2894 CAROLL MCCLIMANS ACN 02149046 C/0 5026 MAURETANIA AVE Amount Remitted HBG PA 17109 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION_FOR_YOUR RECORDS ___1______________________ -------------------------------------------------- REV-1548 EX AFP CO1-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 01-28-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 COUNTY CUMBERLAND FILE N0. 21 02-1102 S.S/D.C. N0. 168-26-2894 ACN 02149046 TAX RETURN WAS: CX) ACCEPTED AS FILED C ~ CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: WAY POINT BANK ACCOUNT N0. 1800035485 TYPE OF ACCOUNT: C ) SAVINGS ( ~ CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 05-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 19,165.53 NOTE: v 0.500 9,582.77 .00 9,582.77 ~ .15 1,437.42 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 12-04-2002 CD001916 .00 1,437.42 BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-05-2002 TOTAL TAX CREDIT 1,437.42 BALANCE OF TAX DUE .00 INTEREST AND PEN. 65.53 TOTAL DUE 65.53 ^ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. _ ___. _____ ... .....,~,,.r,. ~ ro, vnn Mev nF nuF A REFUND. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, oA 11125-0601 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 COUNTY CUMBERLAND CAROLL MCCLIMANS 5026 MAURETANIA AVE HBG PA 17109-0000 REV-1604 E% AFP (Y1-03) DATE 02-11-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 COUNTY CUMBERLAND SSN/DC 168-26-2894 ACN 02149046 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-03) ~~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE 02-11-2003 FILE N0. 21 02-1102 S.S/D.C. N0. 168-26-2894 ACN 02149046 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: WAY POINT BANK ACCOUNT N0. 1800035485 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 19,165.53 NOTE: X 0.500 9,582.77 _ .00 9,582.77 X .45 431.23 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN A80VE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 12-04-2002 CD001916 19.66- 1,437.42 TOTAL TAX CREDIT 1,417.76 BALANCE OF TAX DUE 986.53CR INTEREST AND PEN. .00 TOTAL DUE 6 R * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), vnu Nsv BE ouE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV•1470 EX (&88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 DECEDENT'S NAME Martha Fry FILE NUMBER 2102-1102 REVIEWED BY H~rv J. Paul Dibert 02149046 SCHEDULE I INO. I EXPLANATION OF CHANGES Tax rate adjusted to 4.5%. Available credit to be applied against probate return being filed by executrix. INHERITANCE TAX EXPLANATION OF CHANGES Row Page 1 CERTIFICATION OF NOTICE UNDER RULE 5.6(al Name of Decedent: ~~ Q r 1 ~Q ~ ~ r ~~ Date of Death: lr9 ` l - Will No. ~ d~ ~ - ~ ~ ~ ~ ~ Admin. No. •~ ~ ~ ~ ~ ~ ~ f! a Z To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 2 _ ~ `~" t) 3 Name Address ~~ See ~n~~`~c~P I(, f~3~ ~'in cS~~ ~Qr ha rn, N-~ ~~ ~58I ~2 ~- I N ~ i ~+~ a n~.i c , ~l- 3~.~~0.~ ~' ~ nr ~1.v 1 / L ~or~.K_~~e~ r~n~`Z ~3 7G 1 n~-rc~ c~Or~'f/£~~.~,Q+el~~Ci:~-; g~~~_D Vii. Iy1eC~, ~. 17(~Q Notice has now been given to all persons entitled thereto under Rule 5.6(a; except Date: ~' ~ ~~~ ,~ ~~~~ ~~ ~ ~~iGti~~ Signature Name ` ~• ~Cl ~I ~rnC1~.5 Address ~ Q 21~~ ~ u ~ ~ ~~~ ~ ~ e , rr~lshurg ~~ . ~710`~ Telephone (717 ~~(" ~ _ ~ z ~,~ Capacity: ~ Personal Representative Counsel for personal representative B~R:ai' OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION OEPT..280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS CAROLL MCCLIMANS 5026 MAURETANIA AVE HBG PA 17109-0000 REY-1604 EX AFP (Y3-03) DATE 02-11-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 COUNTY CUMBERLAND SSN/DC 168-26-2894 ACN 02149046 Aeount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~____________________ ------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-03) ~~( INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~* DATE 02-11-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 COUNTY CUMBERLAND FILE N0. 21 02-1102 S.S/D.C. N0. 168-26-2894 ACN 02149046 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: WAY POINT BANK ACCOUNT N0. 1800035485 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-24-2000 Account Balance Percent Taxable Amount Subject t~ Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 19,165.53 X 0.500 9,582.77 .00 9,582.77 X .45 431.23 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THES NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 12-04-2002 CD001916 19.66- 1,437.42 TOTAL TAX CREDIT 1,417.76 BALANCE OF TAX DUE 986.53CR INTEREST AND PEN. .00 TOTAL DUE .5 R * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), .,..~~ ..... oe nnr a wFFUUn_ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (8-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 Martha Fry INHERITANCE TAX EXPLANATION OF CHANGES KCVICVVCV o, ~. paul Dibert SCHEDULEI NO. Tax rate adjusted to 4.5%. by executrix. EXPLANATION OF CHANGES R 2102-1102 AcN 02149046 Available credit to be applied against probate return being filed ORIGINAL Page "V_1500 EX :,6_00) ~ .- . w ... ::c::!cn "",,,, w"" ,,00 ,,"'-' ..ell .. " j/"-NL -j(/ REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FR DATE OF DEATH (MM.DD.YEAR) L. OATE OF BIRTH (MM-DD.YEAR) OFFICIAL USE O' f/<:lb ~ F~ tM~Ej[ ~.U -l d COUNTY CODE. YEAR NUMBER SOCIAL SECURITY NUMBER 1(,,8-2~ -28 a-,.d)i-~OC;/ Oq-2(.,-jC(33 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Artach OOf.1yof Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12,12-62) o 7. Decedent Maintained a Living TrusIIA~achcopyofTrust) o 10. Spousal Poverty Creditldale of death oetween 12.31-91 and 1_1_95) D 3, Remainder Retum (date oldealt1 prior to 12-1J.82) o 5. Federal Estate Tax Return Required 8. Tolal Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ... Z W o Z o .. '" W '" '" o " THIS SECTJON MUST~BJ 'cOMPLETED: ALL:ClOMEsllONlUit.lCl NAME COMPLETE MAILING ADDRESS - ;'T,;'"~'I'~"-~" > ""'tr';~:'":.?)",fr~"'j'1""'"";f.'Z-",;r<"l'Jf;"r-)"';.>,'''~,'~') . ,,~~.~ .,.. \ ~t..f'...." """.... ",,"", _""',.;1.1-\;... U" ",.\~:J~,\,....,..'_..'~::"\U. L. < 002(, HA-AAi~ Bu~, MAURE.TANi~ Avc.-:. PA. i7iO<J FIRM NAME (II Applicable) TELEPHONE NUMBER 7/ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 41. '1-+1. z o !;;c ...J :J I- 0: <( u w c:: 3. Closely Held Corporation, Partnership or Sole.Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, f3ank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9 Funeral Expenses & Administrative Costs (Schedule H) (9) (10) ~533 (6) (7) 10. Deals of Decedent, Mortgage Liabilities, & Liens (Schedule !/ 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;;c I- :J lJ.. == o u X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x,O_ (IS) x .0 if:!i (16) x .12 (17) x ,15 (18) (19) 16. Amount of Line 14 taxable at lineal rate / 7. l>o1- 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20,~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTlON$ON/lI;VERlllt_ ~p ~C!lEc:K MATH" <;'"/'. . ,:",,,,g;;c,..,:l,':\i:f:',. . I OFFICIAL USE ONLY (8) o.f I, 7"1-1. (11) (12) (13) ~..533 ~~~ 208 o (14) :::ss: 208 7f2. 792. Decedent's Complete Address: STREET ADDRESS CITY " '. Tax Payments and Credits: t Tax Due (Page 1 Une 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount (1) i 417. Total Credits (A+ 8 + C) (2) 3. InteresVPenally if applicable D. Interest E. Penally , ?, 4-. (3) (4) (5) (SA) (58) TotallnteresVPenally ( D + E ) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. 792. i'1-/7, '34-. '1-9/. A. Enter the interest on the tax due. 8. Enter the total of Une 5 + SA This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;....... .... ........................................... .................... ............ 0 b. retain the right to designate who shall use the property transferred or its income; .................................. ... D c. retain a reversionary interest; or .................. ...................................... ........... ................ .... 0 d. receive the promise for life of either payments, benefits or care? ............................................. 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . .......................... ........ ................. .................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. ........... 0 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? . ............................ .......................... 0 No ~ ~ ~ ~ [1<J ~ ~ 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 tile best of my knowledge and belief. it is true, correct and ccrrplete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF ERSON RESPONSI~LE FOR FILING RET~RN , /.L C?/YJ1 ADDRESS V?'O;.l(,. rrtPrllRETfHJi A AVE. SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE ' fJA. ItB6 ) , 7/09 . DATE ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. ~9116 (a) (11) (i)]. For dates of dealh on or after January 1. 1995, the lax rale imposed on the nel value of transfers to or for Ihe use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii) The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. ~9116(a)(t2)]. The tax rate imposed on Ihe net value of Iransfers 10 or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(t2) [72 P-S. ~9116(a)(I)]. The tax rate imposed on the nel value of transfers to or for the use of the decedent's siblings is 12% [72 P.s. ~9116(a)(U)I. A sibling Is defined, under Seclion 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. RM:""I'.;', '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE T I>:X RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. rt'ler<;, FUller,,! Kol"\e - i3 v r'j G\l (", 't-'t'7 . 00 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address Ci~ Slate Zip Yea~s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 8(",00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (" Ji 33. .. (If more space IS needed, Insert additional sheets of the same Size) Rp'-l508 EX. (1-97) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 'vJ A'ffOt r.h "Bf'lt.l~ 02~) 571.0. 1-. WIltYFOH-JT '"BANK 19) 1105. TOTAL (Also enter on line 5, Recapitulation) $ + I .1 '+- I . (If more space IS needed, Insert additional sheets of the same size) EV-1500 EX 16_001 .., '. COMMONWEALTH OF PENNSYLVANIA . 'illli. DEPARTMENT OF REVENUE DEPT 280601 , HARRISBURG, PA 17128-0601 w "' :.:::::!;UJ ,,"'''' wo." ",00 "",~ 0." 0. '" I 7- / c 6 - /0 REV-1500 ONLY ~ OFFICIAL FILE NUMBER rJ-L tJrl CQUNTYCODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT OL~{L~ NUMBER I- Z W C w U w C DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) f" R L. DATE OF DEATH (MM-DD.YEARi DATE OF BIRTH {MM-DD-YEARi ()(('/-Oi -.;,(001 Oq -2("-/Cf33 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 1&8-2(:> -28(Lf THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 2. Supplemental Return D 4a. Future Interest Compromise (date 01 death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) D 10. Spousal Poverty Credit (date 01 death between 12-31.91 and 1-1-95) 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property Z (Schedule E) 0 6 Jointly Owned Property (Schedule F) !;: D Separate Billing Requested ...I ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G or L) ii: <( B Total Gross Assets (total Lines 1-7) U Funeral Expenses & Administrative Costs (Schedule H) W 9 Q: 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) fi(] 1. Original Return D 4. Limiled Estate D 6. Decedent Died Testate (Attach copy 01 Will) D 9. Litigation Proceeds Received "' Z W C Z o 0. '" W '" '" o " L..' FIRM NAME (II Applicable) L. D 3. Remainder Return (dale 01 death prior to 12-13-S2) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) COMPLETE MAILING ADDRESS M AU RE TA N U", Ave. . i 7/0'1 502" HitRR/:i Bu((.., r"\ t"A. (1) (2) (3) (4) (5) OF.r:IC!Al: lisE-ONLY~"". (6) I I . 10 II..,.) , I I>> 1-0 1:::0 IN 'CO ~ a ('\') ~,,,..... ;-J.... '7.i l. ::0 ~ 4/. '1-+1- (7) ," ,~ Itj _. _... .....,.__ co o..f I, 74-/. (8) (9) G:, 5 3 3 (IOi (11) (12) (13) <;:,..533 35 208 C> 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) J.e1t>l 1/ -j h - 03 14. Net Value Subject to Tax (Line 12 minus Line 13) ;:S~ 20 B SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) z o < I-' ~ ll. :::E o U ~ 15. Amount of Line 14 taxable al the spousal tax rate, or transfers under Sec, 9116 (a)(1.2) 16, Amount of line 141axable at lineal rate 17, Amount of line 14 taxable al sibling rate 18, Amount of Line 141axable at collateral rate 19 Tax Due 20~ / 7. ~o4 . x.O_ (15) ,0 'i:5. (16) x .12 (17) x .15 (IB) (19) 792. 792. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~.f1:EV:1508&<+(1-97)~.. . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH \;J A'ffolt.h"Bf'l~1::.. 02d..)57~. 1.... \N/lrYfOIN-r ""BANK 19) 11a5. TOTAL (Also enteron lineS, Recapitulation) $ + I '1 't I. (If more space is needed, Insert additional sheets of the same size) REV-151\'7)(:11-sn~~ "~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. rv'I'Ief'':> Funer"l /tome - 13 V f''j Gl.l (P, 'f-'t 7.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Numbe~s) I EIN Number of Personal Represen1ative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attacn explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 8~,OO 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ to !) 33. (If more space IS needed, Insert addlllonal sheets of the same size) COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT O F A C C O U N T REV-1607 EX ,iP (O1-CS) ~~;~~ ,~ ~?,_ DATE 06-02-2003 ESTATE OF FRY MARTHA L DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 ~~~~ ~ :~ ~ COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: '03 ~El~l -6 CAROLL L MCCLIMANS 5026 MAURETANIA AVE HBG PA 1~~_~9` ~1~iTtC~ ~; ,: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER- PORTION- FOR_ YOUR RECORDS -__~______________________ --------------------------------------------- REV-1607 EX AFP (01-03) *~* INHERITANCE TAX STATEMENT OF ACCOUNT ~(** ESTATE OF FRY MARTHA L FILE N0. 21 02-1102 ACN 101 DATE 06-02-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-03-2003 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID C-) 12-04-2002 CD001916 32.91- AMOUNT PAID 986.53 721.94 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. TOTAL DUE 953.62 231.68CR .00 231.68CR IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), ....(( wev nc n~~F a REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT O F ACCOUNT REY-1607 E% AFP (01-03) ~ .__ -;DATE 05-27-2003 ESTATE OF FRY MARTHA L DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 .O~ ~~~~ _~ ~;~~ .~QOUNTY CUMBERLAND CAROLL MCCLIMANS ACN 02149046 5026 MAURETANIA AVE Amount Remitted HBG PA 1710~~, :a) _~~ ~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS __-~______________________ --------------------------------- ----------------------------- REV-1607 EX AFP (01-03) ~** INHERITANCE TAX STATEMENT OF ACCOUN *** ESTATE OF FRY MARTHA L FILE N0. 21 02-1102 ACN 02149046 DATE 05-27-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-10-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 12-04-2002 CD001916 19.66- * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. 431.23 AMOUNT PAID 450.89 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 431.23 .00 .00 .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), vrn~ MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) /~-106-/b 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 ~-~' „. i CAROLL L MCCLIMANS 5026 MAURETANIA AVE HBG PA t1~109 REV-1547 E% ~FP (R1-RSl DATE 06-03-2003 ESTATE OF FRY MARTHA DATE OF DEATH 06-01-2001 FILE NUMBER 21 02-1102 COUNTY CUMBERLAND ACN 101 Amount Reeitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 L CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ------------------------------- -------------------------- ------------------------------------------------------ (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR REV-1547 EX AFP DISALLOWANCE OF DEDUCTIONS AND ASSES SMENT OF TAX MARTHA L FILE N0. 21 02-1102 ACN 101 DATE 06-03-2003 ESTATE OF FRY TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN pp NOTE: To insure proper 1. Real Estate (Schedule A) (1) , 00 credit to your account, (2) 2. Stocks and Bonds (Schedule B) , O 0 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) , 00 of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) . tax payment. 00 576 22 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) _ . , 00 6. Jointly Owned Property (Schedule F) (6) , 00 (7) 7. Transfers (Schedule G) . (8) 22, 576.00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 6,533.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) , (11) 6.533.00 11. Total Deductions (12) 16, 043.00 12. Net Value of Tax Return .00 ernmental Bequests; Non-elected 9113 Trusts (Schedule J) (14) 16 00 043 /G l ov e 13. Charitab . , Net Value of Estate Subject to Tax 14 . NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will tal of ALL returns assessed to date. t o reflect figures that include the ASSESSMENT OF TAX: (15) .00 X 00 = .00 15. Amount of Line 14 at Spousal rate 16,043.00 X 045. 721.94 Anount of Line 14 taxable at Lineal/Class A rate (16) 16 .00 00 12 - . Amount of Line 14 at Sibling rate (17) 17 . _ X _ .00 15 00 . Anount of Line 14 taxable at Collateral/Class B rate (18) 18 _ X . 7 21.94 . (19)- 19. Principal Tax Due GKGYi ~ ~- T (+) I AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 9 8 -04-2002 CD001916 ~ 32.91 TOTAL TAX CREDIT 953.62 BALANCE OF TAX DUE 231.68CR INTEREST AND PEN. .00 TOTAL DUE 231.68CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS REFLECTED AS~ANOCREDITNT(CR)REQOURMAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (8-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OP INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER MARTHA L FRY 2102-1102 REVIEWED BY ACN John Kealy 101 ITEM SCHEDULE Np, EXPLANATION OF CHANGES E 1 The value of this account is fully taxable because it was held solely in the decedent's name. E 2 The value of the jointly held asset is being stricken from the assessment of this return because it was previously assessed on 1/28/03 under ACN 02149046. Row Page 1 ~ ~~-/a6- ~d COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT O F ACCOUNT REY-1607 E% ~FP (O1-OS) „1u ... .. ~._ ~j ,~_ CAROLL L MCCLIMANS 5026 MAURETANIA AVE HBG PA 17109 ~-, C ,, , BATE 06-30-2003 'ESTATE OF FRY MARTHA L DATE OF DEATH 06-O1-2001 _ ~I,LE NUMBER 21 02-1102 ` COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ___~______________________ --------------------------------- ----------------------------- REV-1607 EX AFP (01-03) *** INHERITANCE TAX STATEMENT OF ACCOU ~*~ ESTATE OF FRY MARTHA L FILE N0. 21 02-1102 ACN 101 DATE 06-30-2003 ISIA SUMMARYNOFITHERPRINCIPAL TAXIDUE,FAPPLICATIONTOFTALLSPAYMENTSSTTHEDCURRENT BALANCEEDANDTAIF•APPLICABLE,w A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-27-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT NUMBER INTEREST/PEN PAID (-) DATE 12-04-2002 CD001916 32.91- 06-13-2003 REFUND .00 AMOUNT PAID 721.94 986.53 231.68- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. TOTAL DUE 721.94 .00 .00 .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), .,.... ..... e~ roc A RFFl1ND_ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )