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Home My WebLink About02-0814 Estate of 73tn-1I1IQ also known as PETITION FOR PROBATE and GRANT OF LETTERS V iJp6Yl15 No. 2."02.Rll.I To: Register of Wills for the ~ ' 12.eceased. County of in the Social Security No. /7 J - S'{ - :J3 ils- Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: , Your petitioner(s), who is/are 18 years of ag~ older an the exe~ut ~~ in the last will of the above decedent, dated ~rct.. '1 I q and codicil(s) dated 11./ tA / , named , 19_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (IV",," J,~/~ COUlllY, Pennwlvania, wit~/ st family or princ~al reside,nce at I trll tJ#!';;~""'J err /if'<tR .' M(>rYf--1. (list s eet, number and muncipality) De/ident, '~b 1/1..6 ~. ye'!rs of ge, died at 4sr ( Except as follows, eced"!;t d 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: ::1 ~ f-.fi.,H" )poP"'-' 4 :iPJ20 ...l. Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real (:state ill P n s Ivania ) situated as olio s: "l )~O J WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters $ $ $ $ "t5 {)ot> robate of the last will and codicil(s) theron. strati on c.I.a.; administration d.h.n.c.La.) 'S o " :gZ 0" .o:::~ -:IS \::"= "'";: ~~ o ~ ~ ;;, :.n ].(.*#,,-,,1'1 Oolorl(s UemlC tXmj~ /J~IL ~cL- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA '1 " ;.- $:; COUNTY OF CUMBERLAND J The petitioncr( 5, above. named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best 0f :he knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the "bove decedent netitioner(s) will well a~d truly administer the estate:yording to law. Sworn t.". Gr affirmed and SUbscr.ibed { K/YTilJfAy 1)~ ~':r before me Ihis 10th day of +- ~'H ~ ~ ~~~~. ~ ~ R i~ ~ 1l--B1--lj No. ?l_n?_Rld Estate of -/5tJ.H1;l2.. /I. tJiJ/n H S , Deceased t DECREE OF PROBATE AND GRANT OF LETTERS AND NOW SEPTEMBER 11, 2002 19_, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) dated J11 drr-t.. '1J I ~ tt tI described therein,be admitted to probate and filed of record as the last will of < ~ ' and Letters - are hereby granted to ~ ,..J t.iM-tes C" F" tPWf-,-f' Jr. ATTORNEY (Sup. Ct. J.D. No,) ~,...., 1./ .^ J" w. I#tf; d/, ~ tlJ &... ~ IlItJ AD ESS 171>IJ '111-- ~ rt "1-6 ~~ PHONE FEES Probate, Letters, Etc. ..",..,. $ 200.00 Short Certificates( ),.....".. $ v2vllax lR~RUR<SiQ~J:<. .J:<:t.J;"?" .P.qg!~S$ ~ 2.' 00 jcp $ 5.00 TOTAL _ $ 226.00 Filed . l'r . 'd' 9. -:- ,1,1 :-'92 0.012" ~"O" . " .. . ca e atty - 1-~0 2 , (:: \wp51 \wills\dobyns. wil 1EClslllli11 Clnb WtglClttttttl OF BONNIE V. DOBYNS .2/- OJ- -g;1 I, BONNIE V. DOBYNS, of 1811 Waggoners Gap Road, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I hereby give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal or mixed, of whatsoever kind and wheresoever situate, to my children, LUCAS DOBYNS, LISA DOBYNS, BETH DOBYNS SHUMAKER, GLENN DOBYNS, JR. and KIMBERLY DOBYNS HERROLD, in equal shares, per stirpes. THIRD: In the event that my son, LUCAS DOBYNS, shall not have attained the age of 18 years at the time of my death, I hereby nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, of Silverdale, Washington, as Guardian of his person until he shall have attained the age of 18 years. In the event that c:\wp51 \wills\dobyns.wil KIMBERLY DOBYNS HERROLD shall be unable to act as Guardian or her personal circumstances shall be such that she deems it unadvisable to act as Guardian, I hereby nominate, constitute and appoint my son, GLENN DOBYNS, JR., to act as Guardian in her place and stead. In the event that GLENN DOBYNS, JR. shall be unable to act as Guardian or his personal circumstances shall be such that he deems it unadvisable to act as Guardian, he shall assist a court of appropriate jurisdiction in appointing a Guardian taking into account the wishes that I have expressed to him during my lifetime. FOURTH: In the event that my son, LUCAS DOBYNS, shall not have attained the age of 18 years at the time of my death, I hereby nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, of Silverdale, Washington, as Guardian of his Estate until he shall have attained the age of 18 years. In the event that KIMBERLY DOBYNS HERROLD shall be unable to serve as Guardian hereunder, I hereby nominate, constitute and appoint my son, GLENN DOBYNS, JR., as Guardian in her place and stead. LASTLY: I nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, to be the Executrix of this my Last Will and Testament. Should my daughter be unable to act for any reason, then I appoint my daughter, LISA DOBYNS, of Carlisle, Pennsylvania to act as Executrix in her place and stead. No executor shall be required to file bond in this or any other jurisdiction. 2 c:\wp51 \wills\dobyns.wil IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~ e:l. , 1994. k1-1~~ U ~~ Bonnie V. Doby s SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: 3 c:\wp51 \wills\dobyns.wil COMMONWEALTH OF PENNSYLVANIA 55 COUNTY OF CUMBERLAND I, BONNIE V. DOBYNS, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by BONNIE V. DOBYNS, the Testatrix, this qil.... day of '-/YltVl!l.A , 1994. ~~u~. Bonnie V. Dobyns, Testatrix d1~~-~~~tAv-{~~ [-JOTARIAL SEAL TERESA J. BURKHOLDER, Notal)' Public Garisle.. Cumberland County, Pa. M,' Gfi:',miBsion Expires Feb. 12 1996 ,_,,_,___ I 4 c:\wp51 \wills\dobyns. wi] COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, KATHLEEN FLANIGAN and JAMES D. FLOWER. JR. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that BONNIE V. DOBYNS 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by KATHLEEN FLANIGAN and JAMES D. FLOWER, JR. this CJfL day of '-t'y 701 (I Ie ,1994. 9(~w~~4~ 4 ~.~ \. .~ ~'L.~ / .. J itnes \ \bz;9" !],,;j., IdH dL~ UN tary ublic NOTARIAL SEAL TERESA J, BURKHOLDER, Notary Public Cartis/e, Cumbertand County, Pa My Commission EX~ires Feb, 12, 1996 5 SAlOIS SHUFF, FLOWER & LINDSAY ATIORNEYS-AT-LAW 26 W. High Street Carlisle, P A S :..-- INRE: ESTATE OF BONNIE V. DOBYNS. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 21-02-0814 CONSENT TO WITHDRAWAL OF APPEARANCE The undersigned, KIMBERLY S. HERROLD, Executor of the Estate of Bonnie V. Dobyns, hereby consent to the withdrawal of SAlOIS, SHUFF, FLOWER & LINDSAY, as attorneys for the Estate of Bonnie V. Dobyns. ESTATE OF BONNIE V. DOBYNS By October r ,2002 SAlOIS SHUFF, FLOWER & LINDSAY ATI'ORNEVS-AT-UW 26 W. High Street Carlisle. P A IN RE: Dobyns. ESTATE OF BONNIE V. DOBYNS. ~ : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 21-02-0814 PRAECIPE Please withdraw our appearance on behalf of the Estate of Bonnie V. SAIDIS, SHUFF, FLOWER & LINDSAY Attorneys for the Plaintiff (j ;1 James D. Flower, Jr I.D. #27742 26 West High Street Carlisle, PA 17013 (717) 243-6222 October I. ~...- , 2002 Kimberly Dobyns Herrold 11 E. Stoever Avenue Myerstown, PA 17067 October 10, 2002 Re: File # 2002-00814 Register of Wills 1 Courthouse Square Carlisle, P A 17013 Dear Register of Wills, On September 10, 2002, I appeared in your office to probate the will of my deceased Mother, Bonnie V. Dobyns. On that day I was accompanied by Attorney James Flowers, Jr. This attorney was listed on the PA Department of Revenue Estate Information Sheet under the Attorney/Correspondent Information Section on that day. Circumstances have changed since that day. On October 4,2002, I signed a Withdrawal of Appearance of Saidis, Shuff, Flower & Lindsay as attorneys for the Estate of Bonnie V. Dobyns. I believe that this form has been presented to the court by this time. Until another attorney be named, all correspondences should be directed to: Kimberly Dobyns Herrold II E. Stoever Avenue Myerstown, PA 17067 Ifthere be any forms to fill out in regards to this change, kindly forward them to me for completion. Thank you for your time and efforts. Sincerely, rI../ ~"Ue~%JJtur Y*:ndU__ -~~erlY Dobyns Herrold i CERTIFICATION OF NOTICE UNDER RVLE 5.6(a) Name ofDecedent: 1:301'\(11 e... V. lJo b~ nS ~pkmber tfl ;lOOd.... Date of Death: WilINo. Admin. No. ai-oJ. -()~n L\- To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of th'i o~ Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on C)C.:to 51 ;).[)O:::L , Name -k! n'\ be:r~ I-lex-r()~d /--1:<fi. 'J~ppl~RY- Gknn f,l)O~Y/1S) JC ~ '\h~ -1-UG!~ Dob~Yl5 Address Il e; ~toe.>J'€Y"" Ave.,} m~s-f,x.)f'11 f'A-t fO(P 7 :;l. VUno.. 5tr.e.eJ tJwvdle fp,. j7J.'-f1 I j d.(P13l0s.erV1 Ile. R~ Ca..rk~,1e .fA- 17013 ) . &03 AL (lIltddle fiord JVl("M-II~PM7~Yl J I \ ~II W~~Gztp f<d.) (}a1isJejP417()(:3 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except_n on e D., ockkr 157 dllO d-. J<'miW+ f/ffllJJfd- 7:l:ure Name J:, m h~ \{ J-krr 0 Jd / Address ~, s-l-veve.r Ave , , . wn PA- J7D~ 7' TelephoneC]) R~&- g8'7i Capacity: /personal Representative _Counsel for personal representative ,/ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J 55: Kimberlv D. Herrold being duly Execuror according to law, deposes and says that 9>e is the ~__ of the Estate of Bonnie V. Dobyns NortlLMiddl..t:on TownshiIL-_~_. Cumberland County, Pa., deceased and that the her . Execurrix ~-.- --_, the said personal property and real estote, except real estate outside opposite each item of the Inventory represent it's fair value ~nrn late of _____ within is an inventory made by of the entire estate of said decedent, consisting of all the the Commonwealth of Pennsylvania, and that the figures as of the date of decedent's death. Sworn and subscribed before me, ~~j) ~AtL~~ . er y . x;cutor. Administrator errold 1 t R~u~t" ~f"npvPT Avenue Myersrown. PA 17067 Notarial Seal Addr." ]..queline L. Drawbaugh. NOIaIy Public Cl'lrli~!e Bora, Cumberland Co' :.,ty My ''.1mmission Expires Aug. I 1{)3 Date of Death Mernbp ,PennsytVarlilAssociallono",v,aries Day Seprember Month 2002 Year INSTRUCTIONS I. 2. 3. 4. An inventory must be filed within three months after appointment of personal representotive. A supplement inventory must be filed within thirty days of discovery of additional assets. Additional sheets may be altached as to personalty or realty See Article IV, Fiduciaries Act of 1949. 5:>0 == Ct ::i,~ 0' (I) ",,\ [i c.. 8 ::0 ::OeD roo ....0 0. W'., , ..." en ''') :1'~ 'C' $ -< - N -0 N o (Xl 1) J;.' () ~ ... >- ." .... .. 00 .... w i ~ 0 >- ex: .... ~ I w <( CIlI " e::: Q.. .... u N 0 V') i " .. 0 0 w w C '" ... I J: ex: ~ .. .... I- Q.. C>- o: .... ...J LL ~ ~ N Z <( 0 ~I 0 LL ...J Q.. ~ W 0 <( w ~I >. 'i > z ex: ~ Z 0 " I: c ~ ,; V') Z 0 g ex: gl U Z I w <( ... g Q. o' ." 0Cl1 0: ~ I I - -.: 0 " ...c ." -" ~ E ~ ..! 0 I ~ ~ u: 0 ...J U co Inventory of the real and personal estate of BONNIE V. DOBYNS deceased 1811 Waggoners Gap Road, North Middleton Township, Carlisle Allfirst Financial Center, checking account Susquehanna Valley Federal Credit Union, share account Susquehanna Valley Federal Credit Union, Christmas club account 2000 Chevrolet Prism Personal property sold $88000 00 252 48 55 00 463 03 6500 00 1944 00 TOTAL: $97214 51 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV.1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HERROLD KIMBERLY DOBYNS 11 E STOEVER AVE MYERSTOWN, PA 17067 u__n_~ fold ESTATE INFORMATION: SSN: 192-34-7325 FILE NUMBER: 2102-0814 DECEDENT NAME: DOBYNS BONNIE V DATE OF PAYMENT: 05/12/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/04/2002 NO. CD 002555 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,211.90 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1014 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $2,211.90 DONNA M. OTTO DEPUTY REGISTER OF WILLS 1/ ('/)- /j ,/--(~ / REV-1500 EX + (6.00) OFFICIAL USE ONLY CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 171.28-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Dab s Bonnie V. DATE OF DEATH (MM-DD-YEAR) 21-02-0814 DATEOF BIRTH (MM-DQ-YEARl COUNTY CODE YEAR SOCIAL SECURITY NUMBEA 192-34-7325 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE NUMBER 09/04/2002 05/03/1943 IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, IRST, AND MlDDlE INITIAL REGISTER OF WILLS SOCIAL SECURIT NUM ER X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate o 3. date of death . Remamder Return prior to 12.13-82) 5. Federal Estate Tax Relurn Required 8. Total Number of Safe Deposit Boxes 2. 40. 7. (Attach copy of Will) o 9. Litigation Proceeds Received Supplemental Return Future Interest CompromisE! (date of death after 12.-12.-82) Decedent Maintained a Living Trust (Attach copy 01 Tlust) 010. Spousal Poverty Credit D 11. Election to tax under5ec. 9113(A) (date of death between 12-31-91.md 1-1-95) (Attach Sch 0) '. .nus SECTION t,JUSl;' BE ~OMPtIlTEI). AU eo~iiSPONDENCIi;.COItFlDiiNTIA(, TAX ItIFoAM" TION SHOULD BE QIJ:lIi'CTEl) 'TO, NAME COMPLETE MAILING ADDRESS Kimberl Herrold FIRM NAME (If Appllcable) 11 East Stoever Avenue Myerstown, PA 17067 TELEPHONE NUMBER 1. Real Estate (Schedule A) (1) 88,000.~ QFFICIAL useIOlL Y 2. Stocks and Bonds (Schedule B) (2) ~~~ t} S ::0<1:) (1J r.. 3. Closely Held Corporation, Partnership or (3) ."r' 0 :3: Sole-Proprietorship "."1 ==< t:\: 4. Mortgages & Notes Receivable (Schedule 0) (4) Non!'.. - R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 9,214.n N E (Schedule E) () C -0 A 6. Jointly Owned Property (Schedule F) (6) None N p 0 (:; I Separate Billing Requested 00 T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L (Schedule G or L) A Total Gross Assets (total Lines 1-7) (8) 97,214.51 T 8. I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,912.30 0 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 33,148.79 11. Total Deductions (total Lines 9 & 10) (11) 48.061. 09 12. Net Value of Estate (Line 8 minus Une 11) (12) 49,153.42 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) (14) 49,153.42 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transiers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. (15) (16) (17) (18) (19) 0.00 2,211. 90 0.00 0.00 2,211. 90 49,153.42 x X X X .0 0 .0 45 .12 .15 Copyright (c) 2000 form software only The Lackner GrOl)p, Inc. FormREV-1500 EX (Rev. 6-00) Decedent's Complete Address' STREET ADDRESS 1811 V/a""oners Gao Road CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,211.90 Total Credits ( A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 .... Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 10 request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, entEH the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make Check Payable 10: REGISTER OF. WILLS, AGENT 0.00 0.00 2,211.90 0.00 2,211. 90 "::~'L'~~'g':~~~~~'~Ag':~~tt~wi~~"~G~'~~i6~~:'~i'~[~~,'~~:~~"U~:!J"i~'f~'~':~~~'~'6~~'I~~':~[66~~::" ,. 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 irs income; . C. retain a reversionary interest; or, d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "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. ,.",...,. Yes No ~~ o o o IT] IT] IT] Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of whieh preparer has any knowledge. Kimberly D. Herrold 11 East Stoever Avenue ~ - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - - - - - - - - - - - - - - - - - -- M erstown, PA 17067 Kimberly Herrold 11 East Stoever Avenue - ~ - - - - ~ - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - -- DATE y C;-o 3 DATE 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) (ill 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) O;)J. 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 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. 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(a)(1)]. 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(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. Copyright (c) 2000 fOrm software emly The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV~ 1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bonnie V. Dobyns SS# 192-34-7325 09/04/2002 21-02-0814 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 knowledge of the relevant facts, Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 1811 Waggoners Gap Road, North Middleton Township - Carlisle, 88,000.00 Cumbo Co. (settlement sheet attached) SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 88,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. form REV-1502 EX (Rev. 1-97) REV-1508 EX + (1-97) COMMONWl:Al TH OF Pl:NNSYlVAN1A INHERITANCE T/JIX RETURN RESIDENT DECEDENT ESTATE OF Bonnie V. Dobyns SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSlt 192-34-7325 09/04/2002 FILE NUMBER 21-02-0814 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 Allfirst Financial Center NA - golden age checking account #0028710134 VALUE AT DATE OF DEATH 252.48 2 Susquehanna Valley FCU - share account #5135-00 55.00 3 Susquehanna Valley Federal Credit Union - Christmas club account #5135-06 463.03 4 2000 Chevrolet Prism, 31,000 miles - sold 12/09/02 6,500.00 5 Personal property sold at auction 1,944.00 TOTAL (Also enter on line 5, Recapitulation) $ 9,214.51 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSys1ems, Inc. Form REV-1508 EX (Rev. '-97) REV-1511 ~X + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCET/IX RETURN R~S\OEHT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Bonnie V. Dobyns Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSII 192-34-7325 09/04/2002 FILE NUMBER 21-02-0814 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES Country Butcher Shop - food for meal 91. 25 2 Landisburg Fire Co. Ladies Auxilary - meal 166.08 3 Landisburg Fireha11, meal 50.00 4 Nickel Funeral Home 6,089.55 Total of Continuation Schedu1e(s) 636.37 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. 175.00 3,500.00 Attorney's Fees James Family Exemption; (If dece Claimant Street ddress City Relationship of Claimant to Oecedent Zip 17t)/~ 4. Register of Wills 226.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - estate notice publication 75.00 2 53.00 D&D Septic - auction expense 3 Kevin M. Wickard Auctioneer - fees 1,519.78 4 Kimberly Herrold, postage/mileage/copies/phone charges 572.67 5 Register of Wills short certificates 15.00 6 Register of Wills 25.00 filing fees Total of Continua"ion Schedule(s) 1 , 717 . 60 TOTAL (Also enter on line 9, Recapitulation) S 14,912.30 (If more space is needed, insert additional sheets of the same size) Copyrfght(c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev, 1-97) Estate of: Bonnie V. Dobyns Soc Sec #: 192-34-7325 Date of Death: 09/04/2002 Continuation of Schedule H-A (Funeral Expenses) Item 1f Description Amount 5 Pastor Dale Barrick 6 Rice Memorial Works engraving 7 The Patriot News Co. - ob i tuary 8 Will iam Smith, grave opening 9 Word & Song - bulletins 100.00 95.00 122.40 300.00 18.97 636.37 Estate of: Bonnie V. Dobyns Soc Sec #: 192-34-7325 Date of Death: 09/04/2002 Continuation of Schedule H-B7 (Other Administrative Costs) Item # Description Amount 7 Settlement charges on sale of real estate 1,639.97 8 The Sentinel - Legal - estate notice publication 77 .63 1,717.60 AEV-1512 EX + (1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHEAITANCE TAX AETURN RESIDENT DECEDENT ESTATE OF Bonnie V. Dobyns FILE NUMBER 21-02-0814 SS!! 192-34-7325 09/04/2002 Include unreimbursed medical expenses. ITEM NUMBER 1 10 11 12 13 14 15 16 17 DESCRIPTION Boscovs, credit card balance AMOUNT 1,005.59 2 Carlisle Imaging Associates 13.00 3 Carlisle Regional Medical Center 50.00 4 504.00 Central Penn Medical Group 5 Comcast Cable 37.55 6 392.16 Daupin Oil Co. 7 25.00 Masland Associates 8 Moffitt Pease & Lim Assoc. 62.00 9 Nationwide Insurance, premium 47.50 Penn Power & Light Co. 378.01 Sears, credit card 28.99 Sprint Telephone 47.57 Susquehanna Valley Federal Credit Union VISA 746.63 Susquehanna Valley Federal Credit Union 115135 -49 home equity loan 24,566.24 Susquehanna Valley Federal Credit Union - signature loan 115135-02 4,620.98 The Bon-Ton, credit card balance 592.67 York Waste Disposal 30.90 TOTAL (Also enter on line 10, Recapitulation) $ 33,148.79 (If more space is needed, insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1St) EX + (9-00) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Bonnie V. Dobvns NUMBER I. SSjf 192-34-7325 09/04/2002 FILE NUMBER 21-02-0814 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY T AXASLE DISTRIBUTIONS [include cutright spousal distributions, and transfers under Sec. 9116(a)(1.Z)j Lisa M. Clippinger 2 Verna Street Newville, PA 17241 Daughter 1/5 remainder 2 Glenn E. Dobyns, Jr. 26 Bloserville Road Newville, PA 17241 1/5 remainder Son 3 Lucas N. Dobyns 2631 Spring Road Carlisle, PA 17013 Son 1/5 remainder 4 Kimberly S. Herrold 11 East Stoever Avenue Myerstown, PA 17067 1/5 remainder Daughter 5 Beth A. Shumaker 663 North Middle Road Newville, PA 17241 1/5 remainder Daughter ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (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) . . -- 1llast liill aub Qr~slam~nt OF BONNIE V. DOBYNS I, BONNIE V. DOBYNS, of 1811 Waggoners Gap Road, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I hereby give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal or mixed, of whatsoever kind and wheresoever situate, to my children, LUCAS DOBYNS, LISA DOBYNS, BETH DOBYNS SHUMAKER, GLENN DOBYNS, JR. and KIMBERLY DOBYNS HERROLD, in equal shares, per stirpes. THIRD: In the event that my son, LUCAS DOBYNS, shall not have attained the age of 18 years at the time of my death, I hereby nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, of Silverdale, Washington, as Guardian of his person until he shall have attained the age of 18 years. In the event that ".,".----_.._--_.-._--"_._._._~---~---_.__..._.~._.__... KIMBERLY DOBYNS HERROLD shall be unable to act as Guardian cr her personal circumstances shall be such that she deems it unadvisable to act as Guardian, I hereby nominate, constitute and appoint my son, GLENN DOBYNS, JR., to act as Guardian in her place and stead. In the event that GLENN DOBYNS, JR. shall be unable to act as Guardian or his personal circumstances shall be such that he deems it unadvisable to act as Guardian, he shall assist a court of appropriate jurisdiction in appointing a Guardian taking into account the wishes that I have expressed to him during my lifetime. FOURTH: In the event that my son, LUCAS DOBYNS, shall not have attained the age of 18 years at the time of my death, I hereby nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, of Silverdale, Washington, as Guardian of. his Estate until he shall have attained the age of 18 years. In the event that KIMBERLY DOBYNS HERROLD shall be unable to serve as Guardian hereunder, I hereby nominate, constitute and appoint my son, GLENN DOBYNS, JR., as Guardian in her place and stead. LASTLY: I nominate, constitute and appoint my daughter, KIMBERLY DOBYNS HERROLD, to be the Executrix of this my Last Will and Testament. Should my daughter be unable to act for any reason, then i appoint my daughter, LISA DOBYNS, of Carlisle, Pennsylvania to act as Executrix in her place and stead. No executor shall be required to file bond in this or any other jurisdiction. 2 IN WITNESS WHEREOF, I have hereunto set my hand and seal this 44-daYOf ~~el ,1994. SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: \'{Ituu (f) 0 i ~~~ \. I .... v........." I I . ! \.1 . ~~~ ~ltH'da~ /1 _ f;e.;'V7~U- U W Bonnie V. DObyr 3 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, BONNIE V. DOBYNS, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by BONNIE V. DOBYNS, the Testatrix, this Q1"- day of ,../Y}tLi7(1!1 , 1994. /J .. ~./T'~ tj fJ....e4l/J.... . Bonnie V. Dobyns, Testatrix ~Liy.-c'c,. j---, ~'I~iAv-(C1...Ltj Nvary Publici i l-jO I ARIAL SEAL T~RESA J. BURKHOLDER, Notary Public ;::8Jr;.~tJ, GumbtJi1and Q;unty, Fa. My ',}~;'~...nis'::.ion E~p}ies Feb. 12. 1996 4 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, KATHLEEN FLANIGAN and JAMES D. "'LOWER. JR. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw. Testatrix sign and execute the instrument as her Last Will; that BONNIE V. DOBYNS 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 that time 18 or more years. of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by KATHLEEN FLANIGAN and JN~S D. FLOWER, JR. this qfL day of '-1'// O_AJ1IL ,1994. Cf(~~d ~41-- "-- Witness" .. , ./1 AAL0 IV..... - I , n~L,~ ' . '\ \ jtnes~ , \~ ~- NOTARIAL SEAL TERESA J. BURKHOLDER, Notary Public Canisle. Cumberland CQunty. 1"3. My Commission 8:pires Feb. 12, 1996 5 A. Settlement Statement FINAL LAWOFRCES U,S. Department of Housing and Urban Development IRWIN, McKNIGlIT' & HUGHES mAR .'n ?n?n?. I R TYPF' ()F I ()AN \<\€ST POMFRET PROFESSIONAL BUILDING l. OFHA 2. g~~~A 3. DConv. Unins. 60 \<\€ST POMFRET STREET . nVA , 1.0 CARLISLE, PENNSYL VANIA 17013-3222 6. FILE NUMBER 17. l.OAN NUMBER (;OROO1\T1.01DGU 6<4~<na 8. MORTGAGE INSURANCE CASE NUMBER C. Note: This fonn Is furnished to 9Ne. you..~ of KtUa\ aetttement coste. Amount. paid to Ind by the ..Warn,pt agent.... shown. Items marked -(p.D.C.r we,.. paid outtlde the dosing; thersare .hown he,. for Information purpo'" WId are not ncluded In Ihelotll.. WARNING: It is.' crlm.to knowi~g.y make fal.. stat.men to t!', Unllld Stat.. on thl, or '~i:othtr similar form. Penaltl.. upon D. NAME OF BORROWER: BARRY GORDON and DIANE L. GROUP 41 GORDON DRIVE. CARLlSLR PA 17013 E. NAME OF SEl.LER: ESTATE OF BONNIE V. DOBYNS ADORE<<' 1811 WAGGONERS GAP ROAD ~ART.lSLE PA 17011 F. NAME OF LENDER: M&TMORTGAGECORPORATION '. 2270 ERIN, T .,,,r A ~TER. P A. 1760 I G. PROPERTY ADDRESS: 1811 W AGGONERS GAP ROAD, Carlisle, P A 17013 NMth U;rldl.tnn H. SETTLEMENT AGENT: IMH REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717.249.6354 PI ArF ' C"''''T. W.st t Prn~ . t "'rlrt hO W.O. ..0... . PA '7013 lon'" ATE: 04/04n003 J. SUMMARY OF BORROWER'S TRANSACTION: K. SIIMMARY nF SEI LER'S TRANSACTION' ,on 'nl .on IIF TO .0'" , ce. 101. 88 000.00 An< 88,000.00 '0' An '0' .. 3.228.14 ... 11'" AnA 105. An< ""'"' dn, . ,..11., . 'O? 04/04/03'rt~2/3~/03 246.63 ..7 04/04/03 ."~2/3~/03 246.63 ,no '_hM'Tn 04/04/03..06/30/03 276.86 ... .... _, T.. 04/04/03...06/30/03 276.86 <no "".. 110. .,n 111. A" "' A<? 170 '''''''.'T nllF FROM I 9~,751.63 .on r.:R()o' ...~...," .00" o~. 88 523.49 ?nn AM()IlNTo' . ()R ().. "cu.." "" .nn ~"~" ...~".'7' ""', "~ '01. noon.1t 0' 8,800.00 '"" on, .., 79,000.00 .n ~,639.97 '03. "h' ." "'" .nA "... .. "". .n, .0. '00. ",. 'OT ".7 .no ... 209. ... ,fori sell", . i..m. ".n.'" hu ..IL ,r ". .<? ".. "A ".. ." ". "0 .<7 <17 210. ",. ". <1. 220 T()TA' PA,n, 87,800.00 .,n T()TA' eO~"~70~" '''''''''-'T t'..c 00" ce 1.639.97 ~oo ~.", 07' FP"''''''PT'' I onn ~.ou." "' .n< ,"". 91 751. 63 "",. I'lM.. ...01 88.523.49 '02 ,. "'. 87 800.00 on. 1 639.97 ~n~ RnwFR 3.951.63 ~o~ 'ce 86 883.52 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: GORDONJ-OJ ~ETTLEMENT STATEMENT PAr.C? FINAl L S!'TTL!'M!'NT CHARGES PAID FROM PAID FROM 700 T"n. "n, I ,n,;o. 088,000.00 = BORROWER'S SELLER'S nM.'nn nf, FUNDS AT FUNDS AT Tn< . to SETTLEMENT SETTLEMENT TnT . to Tn, ,no,.... 800. 'T""" ..v.c, ~ '''' "." R01. . ... " Rn2. % Rn, I... toM&T MORTGAGE CORPORATI~.O.C.) 250.00 Buver LR RnA r~... g..... RO'. ' ... to M&T MORTGAGE CORPORATION LR 300.00 RnR , ... to M&T MORTGAGE CORPORATI~.O.C.) 100.00 Buyer LR R07. ., EE to M&T MORTGAGE CORPORATION LR 16.00 RnR gAT.' nr~.IN ..E to M&T MORTGAGE CORPORATION LR 440.00- .n. .M R1f. gOO I lBfD BY LENDER TO BE PAID IN ADVANCE 0" Int.~.t .~.o4/04/2003 tn 05/01/2003 ... 13.5274 Id.v 27 Days LR 365.24 .n. tn' ,n an, u....... ..... ,- an. 905 ..M ) 'WIT"" '''rtR .no. u....... 4 _.... 23.42 .-- LR 93.68 1002. mn'" Imn 1nn' mn ... 'm_ 1nnn , T.... 3 __.... 27.58 .-- LR 82.74 ,no. 11 mo.... 95.70 Imn LR 1 052.70 ,nno ... IV.ls AdJustment to N&T MORTGAGB CORPORATION LR 227.47- 0.00 1100 TITLF r" ,^."~r <<.. .... <<nT 'h.,.., ...... .h 1fn3. Till. lllL- <<nn .IlInlIJr <<n. 00" tlon 1fnR Nnt.~ .... to NOTARY PUBLIC 10.00 4.00 <<nT Attn~.v'. f... to :IRWIN MCKNIGHT & HUGHES 425.00 .h. e Items No' I 1fnR. 10 STGC/IMBLAW 786.75 ,Nn' I <<no' .J. n.". 79 000.00 - <<,n n. .J. D.", 88,000.00 - 786.75 11f1. End ,no C_J 'llll...End onn tn STGC/IMBLAW 150.00 1f17 <<n ,_ STGC/IMBLAW 35.00 ..M .AN RGES 1201. 38.50 ,.64.50 103.00 12n2. """..880.00 880.00 17n' n....880.00 880.00 17nA nn. pnn l>fIILEMENT CHARm's ".. '..~.v ''''2. , 1303 2003 COUNTY 'fAXES to ROBIN K. SOLLENBERGER, TAX COLLECTOR 330.97 nn. 'u,,, 101MB REAL ESTATE SERVICES, LLC 20.50 '''',. 13n. 13nT ''''R SUSQUEHANNA -~'-- ALLEY FEDERAL CRED1T UNION November 13, 2002 Kimberly S. Herrold 11 E. Stoever Avenue Myerstown, PA 17067 Dear Ms. Herrold: Enclosed is a check for $379.14 that closes your mother's account Following is the date of death account information you requested. There were no joint owners on any of the accounts. 1. A share account #5135.00 opened 08/12/1987 with a balance of $55.00 and no accrued interest. 2. A Christmas club #5135.06 opened 11/01/1989 with a balance of $462.06 plus accrued interest of $.97 for a total value of $463.03. 3. There were no accounts closed in the 12.month's preceding your mother's death. 4. A signature loan #5135.02 with a principal balance of $4601.40 plus $19.58 accrued interest. This has been paid in full by credit life insurance. 5. A home equity loan #5135-49 with a principal balance of $24494.45 plus $71.79 accrued interest. This has been paid in full by credit life insurance. 6. There was a VISA, which has been paid in full. Monthly account statements are mailf>d to the address of record. If there any questions, or you need any additional information, feel free to contact us. Sincerely, ~ /,"/ .') /":,,<~'cl;5''-{'- - r.~' '----<..~ Larry L. Stoner President/CEO 1.'9:~~..\ I z:--- \, ---.-- 3850 HARTZDALE DRIVE. CAMP HILL, PA I70Il.7S0ll LOCAL: (717) 737-4152 TOLL FREE: (SOD) 918-1154 FAX: (717) 737-05S9 . \j \ iC))~ , .1Z--. "-""~ !l allnrst \lUjrs[ Final1(jJl Ceiltt:r ~..\. P>:; i)'i." l",,: November 18, 2002 \fili"b('Ji'fi, ['L 1c)')(')0 Phone (302) 934.2916 Fax (302) 934-2955 Estate of Bonnie V. Dobyns Kimberly S, Herrold, Executrix 11 E. Stoever Avenue Myerstown, PA 17067 Re: Estate of Bonnie V. Dobvns Social Securitv No.: 192-34-7325 Date of Death: Seotember 4, 2002 Dear Ms. Herrold: In response to your request, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following accounts. I. Type of Account Golden Age Checking Account Number 0028710134 Ownership (Names of) Bonnie w: Dobyns Opening Date 08/28/64 Balance on Date of Death $252.48 Accrued Interest $ 0.00 Total $252.48 This teller does not include any accounts in which the deceased may have been listed as Power of Attorney, CustDdian of Uniform Transfers. Representative Payee. or Trostee under a Written Agreement. For further account information, closures and/or reimbursement of funds refer to listed branch: Carlisle West Branch at812 Y, West High Street, CarlMe. PA 17/03, TelephQne, 717-240-6717, Sincerely, ~~ Natasha ""'aters, Associate I (302) 934-2916 /' ,X_il,.. ~)~ \..)v<.u;u -tf / 951. DO I FINAL SETTLEMENT SELLER NAME Est at e. c f Ben n ; e \J, D (. b j n 5 ADDRESS 1'811 \;\!c~.9cne(5 Gap ~J, tC\,(;sle PA , LOCATION OF SALE 5 a J'Y\ E. a 5 a b DV e. AUCTIONEER K elf I n M l0 I' ck a rei- DATE OF SALE MarLh /) d,DO.3 PHONE ZIP '>~SElLER'S EXPENSES ,,) PHONE ? J 7 ~ ~ Jj 3 - 10 I g (7'~~'\i'RECEIPTS,\"" '.<.') PROFESSIONAL FEES jCfS.IO AUCTIONEER $ CLERK 1090 $ CASHIER $ OTHER EXPENSES Arlverb's: ~ $ 445.3 g SeLIe of PropertJ $ $ sso.OO $<6<Z,ODO.DO @ I fc, $ $ $ $ $ $ $ CASH $ 55Lf.OO CHECKS $ 1,390,OD OTHER RECEIPTS $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS $ I. 9'fL/. 00 , LESS TOTAL EXPENSES d 5/9. 7f , I (or we). the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my good, and property sold on the above date, I accept all responsibility for providing merchantable title to all good" and properly sold, and for delivery of title to the purchaser, k~i ~u- 'h~_-1-....J Auctioneer or Cashier's Signature Date 3-/-0J 7-) -(}:7 Date pel .;trV F"II 11ot~~ K )'" v, ;f 1t(' Date (Seller's Signature) " //)_ J7,/_ "-/ '..- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISDURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX h","'; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-16-2003 DOBYNS 09-04-2002 21 02-0814 CUMBERLAND 101 :; '03 JUN 20 ,Ql1 :40 KIMBERLY HERROLD 11 E STOEVER AVENUE MYERSTOWN PAlJiH67 Climb""" * REV-lS~7 0: AFP (Ol-(ln BONNIE V Amount Remitted F"'J-\ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rirv:is4-j-EiC.\Fi'--(,iiY:03Y-NoYfcE--oi'-iiiHEiifTAirCE-TAX-A"ppRA"fsEiiE'NT-.--"Li-oWAircE-i:iR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF OOBYNS BONNIE V FILE NO. 21 02-0814 ACN 101 DATE 06-16-2003 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 DJ 5. Cash/Bank Deposits/Misc. Personal P~operty {Schedule E) 6. Jointly Owned Property {Schedule F) 7. Transfers (Schedule G) (l) (2) (3) (4) (5) (6) (7) 88.000.00 .00 .00 .00 9.214.51 .00 .00 (B) B. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. EXPenses {Schedule H) 10. Debts/Mortgage Liabilities/Liens {Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts {Schedule J) 14. Het Value of Estate Subject to Tax (.) 14.912.30 (10) 33.148.79 (11) (12) (3) (4) HOTE: To insure proper credit to your account, submit the UpPer portion of this form with your tax payment. 97.214.51 G1Ln~1 nQ 49.153.42 .00 49.153.42 NOTE: If an assessment was issued preViously, lines 14, 15 and/or 16. 17. 18 end 19 01111 reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX, 15. Amount of Line I. at Spousal rate 05) .00 X 00 .00 16. Amount of Line I. taxable at Lineal/Class A rate (6) 49.153.42 X 045 = 2.211.90 i7. Amount cf Line i. at SibUng rate (7) .00 X 12 = .00 iB. Amount of Line I. taxable at Collateral/Class B rate (8) .00 X 15 = .00 i'. Principal Tax Due (19):::: 2.211.90 TAY TS - PJI, YHENT DISCOt]N, (+) AMOUNT PAID DATE HUMBER INTEREST/PEN PAID (-) 05-12-2003 CD002555 .00 2.211.90 TOTAL TAX CREDIT 2.211.90 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 tl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 (}~ JV Name of Decedent: BONNIE V. DOBYNS Date of Death: SEPTEMBER 4. 2002 No. 21-02-0814 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: -X.... 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 X 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? X Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. .- 'P ~"" ...,~ ~(ti; I}.~c<< ~re KImberly D. Herrold 11 East Stoever Avenue Myerstown, P A 17067 (717) 866-8874 Date: cf-Y';:{J 3 ....,./ I c:> ~# '" :=> Capacity: ....K......- Personal Representative _ Counsel for Personal Representative