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Home My WebLink About02-0830 Will PETITION FOR PROBATE and GRANT OF LETTERS Will I Eslale .. P.QJ:.qtl\Y. .)3.,. ;ElJ;;i.g.<;Hl. ......."........... also known as. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . . , . , , 1.<3: ~~.. 9.f, . .., " ..... .... ". . -..... . , ., ....., . . . Cumberland. County",. PA,..,."..,."., . Deceased. Socia! SecurllY No, .." ~tl(l:-..l,O;-.O.B2_2" , ,., "., , ". No,. .~\...~-,S3o...,.". To: Reg-isler of Will. to, the Counlyof Cumberland of the Commonwealth of Pennsylvania The petition of the under.igned reapectlully represent. that: Your petitionens) Ware 18 yeau olage and the execut qr,$ , , , . . . , , . , . . . . .' named in the last will of the above decedent, dllted, , . .:1.1.....2.4-::9.7 . ,,', , ,and codicil(.) dated, . . Pet i t iO!1.er.s . a.~~, .1;.h,e-. s.~'rY:~YJ.l).g, ,9P,~ldren 'named 'as'c-d-personal fY .rep.resentati,v. e.s. ,i"I)...?'aJ:",qg.r.aPA ,~, .9f. .1?P,~, .1,,!~,t, ,w, ,q.;I., ,?!J:o, !:-.est a~nent. .,?f. de,ce~ent. . "1"A.. e..- So ov _ 'f- J. (Stat. rfl.vep!.fltoWJ1ft.nc... '.Q. Renu.n~tion, dNth oj uecutor, .fe.) :7 J ~e '" ecede-.T cl-,.;;J tfr)-0ul'f ~/;;ZOOOjhe .vOt~ 1/14-1'Vle/ ~-v-~ e.-;.-~, . Decedent was domiciled al de 11th in Cumberland County, Pennsylvania. with her. . last family or prmclpal,e.idence at ,QUt.1.QO,~. gqintl". .ath~hiPP,~~,~b1J,r:9,,.J?9. WalJ11,lt. .B~o.ttcm Road ,Shipp,ensbur,g ,..PA .l7.4~? . .. .. (5, . . ,,',f I"~"",A>~!). Jqwr-~.h..,"f'.).' '. , . . . . . (Jilt .u..t, number and m\.Onidpalily) Decedent, then, .e.s, , years of aile, died. , .1\1,lSl,~st. . 21 ~ . .2.002, , . . , . " """"""" atShi~~~gSbU~Sl Health Care CentE)r, 12.1 ~alnut BottO.~. Roa.d ~ . .Shippe~sb.urg, , ~cePt as 7011ows, decedent did not marry, was not divorced and did not have a child born or "dopled aft", executlon 01 the will offered for probate, was not the victim of a lcJlIing and was neVer adjudicated incom. petent . . Non.e , , , , . , . , . . . , , , . , , , , , . . . . , , . , . , , , , . , , . . . , . , , . , . . . , . . , . , . . , . . . . , . . , . , . . , , . , . Decedent at death owned property with estimated value. aa tollowa: (If domiciled in Pa.) (I1 not domiciled in Pa,) (If not domiciled in Pa,) Value of real estate in Pennsylvania sltuated as follows: All personal property Personal property in Pennsylvania Personal propetty in County $329,151,78 $. $. $. WHEREFORE, petitioner!s) re.pectfully request the probate of the last will and codicil(s) presented here. wdh the grant oflotlers.......,...." t.es~,a~e.nt.a.rJ'..,... . """" ,'..,..... .", . '.. theleen. (T..tamentaty. adrnini.tretion c,l,a.. adminatt4tion d,b n.C;,ld ) _fJ ~ SiQlil.atur.(l) and Ro.id.nc..,{s) ~0~ ~ ff- ~r: oIP.litionel(.l ~ Lawren<;~.~ . ,r-.;ggS ,. .20,168. ,Path. .Va.lIe.y.. Road, . Dry. .Run, .PA. .17220.. ,~ "'-"'" /I5:t;,~ Dc ores ."'tl<..Mu len 10995 Woodr' L W .. . . . ~ $~~~:~l~: . . .1~9 . . aIle, . : p.Yn~SbOJ;O, . fA :17268. . ft) Sherrie. ~ : ~e~~Oj;:t;,: :52.18:Le~arRoad~: :M~rce.rsbUrg, .P.A. .17236.-.9656. . \+--88-,S " OATH OF PERSONAL REPRESENTATIVE ~6~~~~~~L:')~~.:~:~Y~~ANlA ~ SS Th. petttion.r(.) above named, or aHirm(,) that the .tat.menl. in the for.going p.tltlOl\ are trUI and correct to the b..l of the Iasowledg. ud b.li.f of ....titioner!.) end that .. .... 1 f' ~ .....rlOna npr...ntettve(s) 0' tbe above petition.lf.) will wen and truly adm/nitter the ..tat. according to lew, , l~hJ,J....__~/. Sworn to or alllrlllec1 ane sub- "'~"l'l:'~ncg ,r~rQ.Pih},'i,ggS""'~' scribed before m. thl. ' ) ?~y of ., ~ ttX, ?!~" , , , , ~SEPTEM,BE~, ',""'" ,.R~:~ .. ,D?l.ore~ ~.,MUl1e~' '~~" , . ~o..~,t~;::r.:1J " ,"sm1AM..,~~ '" , ~ '\"OK5!l(j~" ..1?heg~~..~1'!.1,1.9,t;t..,e. No, 2\-;Q2..-B30, -,,- !It.t. of. , .. . . , ,DOROTHY. B BRIGGS "......".,..,.... Cee..nd ~_.~- DECREE OF PROBATE AND GRANT OF LElTERS , SEPTEMBER 16, 2002 ANDNO'l,(j .,.., .,',"",.,..".,.,..,',... 2002.. ,U1CQnaldtratlonofthepell!iononthueveueside hereof, satidactory proaf havlnq been preunled before Ille, rr IS DECREED that the llulrument(.) elated ,Nov:~qt)W., .Z~". 3.99,7. , .. , . . .. . . . . , .. . ' ' . . .. . ' . . . ... . . , .. . , .. , , , . . , , . described ther.ln b. admitted 10 probet. and filed of record as thela.t will 01 , P9rotl1Y.. B... ,B.r.iggs, ' . . '" "...............".....,... ,. .,.,...... ,'" ". ...........,., ,.... ..,.......' "" ,." and lefters ' , . , .li"..i('III.'(l.t..~y , . '. . . .. " ...,..",..,.."......."...,.,...,.......,.,',.",. are hereby Ilranled 10,., .Lewrence JgQ,.. Brigg$',' .tJoiores'~~'MU'lien;' 'and . .~... ,........'. ".." "c... ,sherr.ie"~e'Hot-t,...,.".."""...".".,...,.,.~.,. . ..~~~.AU~~~ .......... .......~~, ....... ....... 'f1'A... Dz.th 01 Subscribinq WIlZleo(a) 0 Oath of Non..ublCdbtnll Wiln...(.l 0 Oath 01 Wlln...(.) 10 ",..lie 0 Renunciation(s) 0 LETTERS 305.00 EXTRA PAGES 6.00 SHORT CERT. 12.00 JCP FEE 5.00 TOTAL 328.00 mailed to atty on 9-16~02 filed 9-16-2002 '. ,(7.l7). .53.h4832,., PHONE This .i~ to cert;Cy t!--,Jt J:~lL information here given is correcdy copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Viral Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. lr!i/il""''''''''''',,~ ","< \>.\.,~ OF PEP'" "'.~'""'M" \t~ ,,' "~~ liif_ ...... -r-..-<- '" foe,;i ' ',lr - \,...\ ~~I- - I~" ,Q) ,.r" '-~ ~t....'~ il'''T !:l:..~ \*~. ~'''''.:J>'*I - ~. -~, \~ ,-~- - ~"""'./ ""- ---: ~\\\ '--;;'?l~. -'<, 't.",Y-", --"'~.../l'1fNl ~\,j!lllll '"",,,,,,,,/,11 t#h;,4Y. Local Registrar . hI.' fOi. this certifIcate. $2.00 P 8474307 ~~te ~(/ -i--. . .' , " ,'. .w COMMONWEALTH OF PEHHSVLVANtA . DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH H_OfCl!CEOEf'IT!....,IMl~_._'-_._.._------------~ 5f.J< 1_......._111 SOCtA,L3l!CIJ~r'tOill""'E" DA'iEO..iiw..,~,o;;;,;;;,---- ,. Dorath Belle Bd . AGE(l"'--" ".,.,,, I,JIlDER1DIfT ~~ , - .... ......... po;;;- '"""",,,,0..,'_1 8S ~ ! ~ug. 23,191 .. COUHTYOI'DEArH ".... O'~~ "" I. female 3. 188 -10 822 8IR\'~1t:...._ Pl..ACtOl'DEAnlo "-""'I''''...._,">I".,t.'''.''''__' ~"'."'_C""""v1 HO~rr...1. . ..-- _0 .Doylesburg, PA " (It""',""""""",OI>4.........,.,.-, .. u u .Shi ens bur IONOOf8IJ!ll+4t Tw Shl ens bur ~'~~~'1:r .....0,..,1iJ Health Care llllE HT'SI! _0 ~)o Cumberland Cf )j'f' tJ4-=,~:""=:::::&:'l' II Laborer ,~lothin DECEOf:J(f'S.....IHGAOOAf:UjS\<M,,~,...h>CodoI f..__._._..., ,-, .. white ,... ~ - --. Cumberland --" 17<t.CJ ::w..-=-=... UOTHE"'SHoUlll!(",,',~._Surn_ " (0.'1) B Pennsylvania "l::..~U~ -- 14. .idowed '7c.m......___.. SVflVtyrHQSPOulll' l~"","""'",",,*,_ 121 Walnut Bottom 1~Shippen8burgf PA. F.>nIEIrSNMll!(f'HI.....,...,tAIll It. William Seibert , 'SIWllf(t~ Lawrence L. Dr! ~~ Road 17257 Hanufactu OEC!OINT'S ~,~ -... -- -- f7a.S1_ ShiDDensbur2 .. - "_:M.H_~,", _...~-, , fr*"0RMAHr1 We 20168 P Sl ,~~,2ipCoa.l th Val e ._oIC-.y,er-..y . ... _0 " ,~ I ~_n........., ~.."""-..-""~.. __OldMHt . """" ....- tug. 24) 2002 lICE"'-HUUIIE:P. FD-013083-L -"'''''I~.__..r'''t.....<lIl..~r;...to<l 159*';A1I'oC11"1 -.C'/!-1,'-- 1'1 . Ii It I ~,_I :;.. o-C.:::L- l RlON.C~._.ZIl>C<><IOI . ..,<IIa<:..,..p.,.l<><'/.,,_.._."'......~ ,- '-- l___ , i 01Iloo MI_~toojQth."'" ....--.q.._""'""-__"'''''''''I ~ICAUelI''''' .-..- ''''''''''"11'''__ .. cu~~~~ .:na-~' Dl.IElOP'lASAC NCEon: , " --- d.....-......a..-...... -,~.....fINQ CAUM to.-........., --- '''''-''O'''~LAI, F . DUE lOll ~CON5(OU Of)' 'oWoSN4.1ol,11OHV ~"-m Wf:REAIJ'IOHV'fMlINGS -'-"''EPI'lICII'110 ETIOf,IOFCAUSI ~,....." ~ 0..0' ~O =~~~ _ 0 o OATEOf"I...,U~V !Iol.......~_l Tlr.lEOI'tNJUAV INJURVf(JWOI'\kt ~$CI'IItl!HClWIH./UAVOCCUl'lRED ..0 .... - "'-""'Iol_""""", C<>olO..............._ o o o I'L/oCE rJ<l,/UAV-AlhO_...""._.I__'" ~...~ - ... 0 _0 fQ'\0f4~.~,s..., ... _. ~~...,.... .C8lTII"'flItIO,.,.,-.aN4\Pl'l_...lIIVtng_d__~_llI'....._....P1"'__Oh_"..,."''''''''......i'31 lio'..._<Jf....,~.____...""'~.~.._(.I__'.._. n. Slll"'''-f,I/IIE .. fOf"CER1IFIVI .. I~ I...U,JI ,,?!..I HU R 0IIf'E PEtI_u..._, 0'. "'() oj91c9-L- Ii' '-'0 !U,MElllU)l\DtlIll!U(JFP!;:IISONWHOCOIIIPLEU:OC\USli:O"Of-'TH Q'eml1lfl'lOollrPtl/ll'la<;,,voIt4 S. ~t-h4-6L4, "+ f _ h'~J..I '~eN lJfz~ a ~ :-""'~-HJf/ d-f ? ./J(J k- o - a ~o,tfOt:llJIT""'_~lIICIAIfIPhyoc"'_"'onaunc:'r'll""""""~1CI0_"'dn"" llo..._oI""_........_...ClC<:.......at__.<l81.._~..__"""'"'._.l_rn.~...'...._. .1lIfDICALVlA.MfNlllIC~Efl OrI...~.....II'II..-.ndI,.I......III.tlo>o....""OI>I..lon.dfMII...ctI~..II..II"'..oI.I., _..IItaI..,...............................,........................ .... 11.. REG>S1"/IIAA'SSIONMtJ/lEA,HOhfUlll8(1I ~:'Wr_~ rA_._""'to_o....../.),,'III . 21~02-830 1fIagt ~iU aub ~tgtamtnt I, DOROTHY B. BRIGGS, of 20475 Path Valley Road, Dry Run, Franklin County, Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and declaring null and void any and all wills and codicils by me at any time heretofore made. FIRST: I direct my Executors to pay my just debts, the expenses of my last illness and my funeral expenses. SECOND: I give, devise and bequeath all of my estate, of whatsoever nature and wheresoever situate, to my husband, Luther J. Briggs, if he survives me. Should my husband fail to survive me, I give, devise and bequeath all of my aforesaid estate, in equal shares, to my children, Dolores Jean Mullen, Lawrence Lee Briggs, and Sherrie Dawn Mellott, if they survive me. Should any of my children fail to survive me, his or her share shall be distributed to his or her issue, per stirpes, surviving me. THIRD: I direct my Executors to payout of the principal of my estate, all federal estate, state inheritance, estate and succession taxes imposed upon or with respect to my estate or any property in which I may have an interest, including any property not forming a part of my testamentary estate, but included in my gross estate for tax purposes, in such manner as my Executors, in their sole discretion, shall deem advisable; and no such taxes or any portion thereof Page 1 of a Three-Page Will so paid shall be collected from or paid by any other person, persons, or corporations by way of reimbursement, proration, apportionment or otherwise. FOURTH: I name and appoint my husband, Luther J. Briggs, Executor of this, my Last Will and Testament. Should my husband, Luther J. Briggs, fail to qualify or cease to act as Executor, I name and appoint my children, Dolores Jean Mullen, Lawrence Lee Briggs, and Sherrie Dawn Mellott, Co-Executors of this, my Last Will and Testament. I direct that my personal representatives shall not be required to post bond for the faithful performance of their duties in this or in any other jurisdiction. IN WITNESS WH~OF, I have hereunto set my hand and seal this J-~ day of 7ur JlfA'A ~~. aWITuNESS' ~' . ,,,/" . , . (2 / f.. "," ..&I( ~l-,.)r~tBt /5. ,hi Y '~.. _ (SEAL) 4~ 1/. ~~ Dorothy Briggs i Page 2 of a Three-Page Will COMMONWEALTH OF PENNSYLVANIA :SS. COUNTY OF FRANKLIN We, Dorothy B. Briggs, Richard K. Hoskinson, and Linda N. Dickinson, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she 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 hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. " 1;~r~t~~jB1 {ri:~~i~J~ix 6~~~n Richard K. Hoskinson, Witness ~~ 11. J:s.~~~ Linda N. Dickinson, Witness Subscribed, affirmed, and acknowledged before me by Dorothy B. Briggs, Testatrix, and subscribed and affirmed ~fore me by Richard ~~ Hoskinson and Linda N. Dickinson, witnesses, this.2i.:i.:'day of J1/0).ct:. nd>e,"-./ , 1997. ",I... J~C\ ,;t )It ) i () ) ./) t ))j'JZA:L.L . NOTAII4l RAl GI4Il L DA'lWAlT, Nooowy PIIIIIc ? .,...-......""",...c.......y~" Mr c." . 1 ..... Ill"l' sc, If" Page 3 of a Three-Page Will CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Estate of Dorothy B. Briggs Estate No. 21-02-0830 PA No. 2002-00830 Date of death: August 21, 2002 TO: THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules and copies of the will was served on or mailed to the following beneficiaries of the above-captioned estate on November 12, 2002: Name Address Lawrence L Briggs 20168 Path Valley Road, Dry Run, PA 17220 Dolores B. Mullen 10995 Woodring Lane, Waynesboro, PA 17268 Sherrie D. Mellot 5218 Lemar Road, Mercersburg. PA 17236-9656 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Dated: November 12, 2002 " to RULE 5.7 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA Estate of Dorothy B. Briggs Estate No. 21-02-0830; PA No. 2002-00830 TO: Lawrence L. Briggs 20168 Path Valley Road Dry Run, PA 17220 Dolores B. Mullen 10995 Woodring Lane Waynesboro, PA 17268 Sherrie D. Mellot 5218 Lemar Road Mercersburg, PA 17236 PLEASE TAKE NOTICE of the death of the decedent and the grant of letters to the personal representatives named below. The decedent, Dorothy B. Briggs, died on August 21, 2002, at her place of domicile located at Shippensburg Health Care Center, 121 Walnut Bottom Road, Shippensburg, PA 17257 The decedent died testate (with a will). The co-personal representatives of the decedent are: Lawrence L. Briggs 20168 Path Valley Road Dry Run, PA 17220 Dolores B. Mullen 10995 Woodring Lane Waynesboro, PA 17268 Sherrie D. Mellot 5218 Lemar Road Mercersburg, PA 17236 Dated: November 12, 2002 _......MI,.IH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOlVlDUAl TAXES DEPT. 280601 HARR!SBURG, PA 17128-0601 REV-1162 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MACALUSO JOSEPH A 9614 ROWE RUN lOOP SHIPPENSBURG, PA 17257 _n~__n f<lld ESTATE INFORMATION: SSN: 188-10-0822 FILE NUMBER: 2102-0830 DECEDENT NAME: BRIGGS DOROTHY B DATE OF PAYMENT: 11/20/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/21/2002 NO. CD 001868 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $13,299.66 I I I I I I I I TOTAL AMOUNT PAID: $13,299.66 REMARKS: CHECK# 99 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS 3D"V1SOd SO ~'m'.tI "'-~. ; ,,",U(( N o '" '" o \2 '" -, '" ... o Z N NO O~O ONM N ~ -- E ':;'.:' '" 0 0 N ~O _ ,,0 - . -~ 1'1 t: g U '", a .<:: frv o~ ,-0 0'<:: ~t: ,.. '" v 0 OU cl<l .c '" 003- ::='00 .- U t-- ~-t;j:( 15at:4 l--o "i: "' v v v t;,.o~ '5b S ~ l1) ==' &1 p::uu ~ ~ \ ~ ,/1 c"~ ~.:'" ~-:~.".,~-~- -'-, "" <:> !~ ~8)~ 11 R:;~ - - : - ..;;: -:: - - ~ - - "l ~ - -::.;E - - -- ..-j'. In the E.... of: OoV'othd b ~rl;f5 5 Estate No. ,:}/ ()/) - :i3() Date II 11.k lJd-. , , CLAIM AGAINST DECEDENT'S ESTATE The claimant certifies that there is due and owing by the decedent in accordance with the attached statement of account or other basis for the claim the sum of $. 10/, ,{] I solemnly affirm under the penalties of perjury that the contents of the foregoing claim are true to the best of my knowledge, information, and belief. Pharmacare N_..ICla_1 f)nll1-'~. At )-<.JlJ~_ 518l1"..... 01 _nt........_ __10_. wrtl...._on.......lol_nl Jeanne Zaladoni8. Billing ~..... TIlle of P.....n Signing Claim Olle Jallle8 Day Drive AddrHa Cumberland, MD 21502 (301) 777-1773 Ext.117 T..."...... N_ FILED: RECORDED: Claims Docket L1ber Folio Instructions: 1. This lonn may be tiled with the Register of Wills upon payment of the tiling lee provided by law. A copy must aleo be sent to the personal representative by the claimant. 2. It a claim Is nol. yel due, inditate the dale when it will become due. It a claim is contingent, indicate the nature of the contingency. It a claim is secured, describe Ihe security. RW28 ps.: PHARMACARE ONE JAMES DAY DR. CUMBERLAND, MD 21502 PHONE: 301-777-1773 A LATE CHARGE OF 1.5% PER MONTH (18.0% ANNUALLY) WILL BE ADDED TO AMOUNTS 31 DAYS PAST DUE 10/31/2002 BRIGGS, LAWRENCE FOR DOROTHY BRIGGS 23168 PATH VALLEY ROAD DRY RUN PA 17220 BRIGGLAWR GRP-GS PAGE 1 AMT DUE. 101.47 PHARMACARE ONE JAMES DAY DR. CUMBERLAND, MD 21502 ** ACTIVITY FOR BRIGGS, DOROTHY B -BRIGDORO 08/16/02 7210458 7 LEVAQUIN 500MG TA 01 * 73.99 .00 73. ! 00045-1525-50 08/20/02 4105644 10 PROPOXY-N/APAP 10 01 . 12.99 .00 12.! 00376-0155-01 08/20/02 7209428 4 DAILY MULTIVITAMI 01 . . 3.00 .00 3.1 63739-0068-01 08/20/02 7209434 4 SYNTHROID 0.025MG 01 . 8.49 .00 8.- 00048-1020-03 08/20/02 7209430 7 DSS/CASANTHRANOL 01 * * 3.00 .00 3.1 51079-0039-20 PAY 101.47***IF PAID BY 11/30/2002 .00 LO 1.47 101.47 95.47 6.00 ) DED YTD MED LEGEND NON-LEGEND MONTH DEDUCTION FOR MONTH FOR MONTH .00 101.47 .00 101.47 .00 101.4 PHARMACARE OF CUMBERLAND RECISTER OF WILLS CORPORATE ACCOUNT [)~ltc II/OJ/'2()(C 1:&\'1 Type Bill Reference OOROTHY BRICGS -RID :iJ)J~ ~ Ori~inu[ Arn.L 5.00 5902 11/27!2I)02 B~\lancc Duc Discotmt 5.(1) Check Amount P;JYlllCtlt 5.1)0 5.00 5.(1) C1J/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Estate of Dorothy B. Briggs Date of death: August 21, 2002 File No. 21-02-0830 PA No. 2002-00830 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. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N/A 3. If the answer to No. I 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: N/A c. Did the personal representative state an account informally to the parties in interest? Yes X No_ d. A Copy of the executed Agreement for Approval of Account, Release, and Indemnification is attached hereto for filing with the Clerk of the Orphans' Court. Date: November 7, 2003 THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA Name of Decedent: Estate of Dorothy B. Briggs Estate No. 21-02-0830 PA No. 2002-00830 Date of death: August 21,2002 AGREEMENT FOR APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION The undersigned, are all the beneficiaries named in the will of the decedent in connection with the above-referenced estate, and desire that the administration of the estate be concluded without the formality of a court accounting. The undersigned, are also all the co-personal representatives of the Estate of Dorothy B. Briggs, and are willing to consent that the administration of the estate be concluded without the formality of a court accounting upon receipt of a proper release and indemnification, which it is the purpose of this Agreement to provide. In consideration of the willingness of the co-personal representatives to terminate the estate in accordance with the terms of the will without the protection afforded them by a formal adjudication of their account, the undersigned beneficiaries, their heirs, administrators, and/or personal representatives do hereby: 1. Acknowledge that the undersigned are authorized to execute this Agreement, and has read this Agreement and represent that the facts set forth herein are true and correct to the best of their knowledge, information and belief. The undersigned further acknowledge that they are familiar with the provisions of the will of the decedent; 2. Waive the filing of a formal account of the administration of this estate, in any court which has jurisdiction, in particular, the Office of the Cumberland County Register of Wills; 3. Understand that the distribution still may be subject to the payment of certain administration expenses; and accept and approve it with the same force and effect as if it had been prepared and duly filed with, audited, adjudicated and confirmed absolutely by such court which has jurisdiction over this estate, and, as if the distribution had been awarded by said court in accordance with this Agreement; 4. Warrant that they know of no outstanding and unsatisfied claims against the estate and approve final distribution; 5. Absolutely and irrevocably release and discharge the co-personal representatives, their personal representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and demands, including specifically but not limited to liability arising in connection with any mistake of fact or law, or negligent or careless act or omission by the co-personal representatives, in connection with the administration and distribution of assets, without a formal court accounting and adjudication; 6. Agree to refund to the co-personal representatives such part or all of the amount being distributed which may at any time be determined to have been an erroneous distribution regardless of the cause of such error, even if attributable to negligence; 7. Agree that any period of limitation of actions for the collection for any erroneous distribution to them shall commence only at such time as the co-personal representatives have obtained actual knowledge of such erroneous distribution and that in no event shall the obligation to collect any erroneous distribution start earlier than the actual discovery thereof by the co-personal representatives; 8. With respect to any distribution which the beneficiary has received, or will receive upon execution of this Agreement, agree to indemnify and hold harmless the co-personal representatives, their personal representatives, heirs, successors and assigns, from any liability, loss or expense (including but not limited to costs and counsel fees), arising from any cause whatsoever, which may be incurred by the co-personal representatives as a result of the administration of this estate or distribution in accordance with this Agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania inheritance tax or any other death taxes and federal and state income taxes, together with any interest and costs incidental thereto, relating in any way to the estate and also including, but not limited to, any assets received or payments or distributions made by reason of any negligence or mistake of fact or law; 9. Agree that this Agreement shall be governed by the laws of the Commonwealth of Pennsylvania; 10. Agree that this Agreement is the entire and only agreement between the beneficiaries and co-personal representatives, and any changes or additions to this Agreement must be made in writing and executed by the parties hereto; 11. Agree that this Agreement is binding on the parties hereto, their heirs, personal representatives, successors and assigns, as the case may be; 12. Agree that in the event any part of this Agreement is construed as unenforceable, the remaining provisions of this Agreement shall be in full force and effect, and enforceable as though the unenforceable part or parts were not included; 13. Acknowledge that the beneficiaries have received their entire share from the estate and have been informed by the co-personal representatives of all expenses and debts of the estate. IN WITNESS WHEREOF, the undersigned agree tobe bound hereby and have caused this Agreement to be signed this L day of ~J..wv , 2003. Witness ,1,/ I' j . ,.,. .) . . I (-,' (. I ~/'~' r"/I / I ' . //) - /~I/~..flj i/ .; ~ /? . o j~.I - ,;(vf!:5u'<ljf4/ Lawrence L. Briggs [/ Ct2/z-t fJ-. ~ W db J( Ch:l- M M 0 AJ r3, Jilu.1/RAA./ Dolores B. Mullen SA LV / it - ~ YLfe-tifi(j Sherrie D. Mellot (' ......; , - , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0601 . INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 02-0630 02150667 12-02-2002 RE~-15~5 EX AFP 109-00> EST. OF DOROTHY B BRIGGS 5.5. NO. 166-10-0622 DATE OF DEATH 06-21-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [Xl CERTIF . ** SHERRIE D MELLOTT 20166 PATH VALLEY RD DRY RUN PA 17220 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN 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 fro. 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. Questions may be answered by calling (717) 787-8327. Dat. Established REVERSE SIDE FOR 10-24-2001 FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW Account No. 5050067343 " " " SEE Account Balance 97 } 316.05 Percent Taxable X 100 . 00 Allount Subject to Tax 97 }316. 05 Tax Rate X .15 Potential Tax Due 14} 597.41 PART TAXPAYER RESPONSE [I] I'".,:,P. :f!)~~.',~~~:!!:~.!P..':,.!!!,.~~~~~!il!j~,:..,i~~1~i:il!~Di:~!~~~ii:::lilii!!~~![!!:.i!!!~~~~~i,::~i!!iif~I:I!!!!~~~.~!:::::,T~!i:i!~~!:!:~g]!l:i~~!i!:~..:~.~~~.!!:,:~.,,~.~.~~i::'mTl. 11:.! :. ..........,."........ ...,..........;~.............. .....:.. ........t!..iL.....". ,~.~ .......== ,.,,,..;...........~.........!....!....U~'.....~m......~......::1,......... ..~............lm~. .......,......, -:liiliillI To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Hake check payable to: "Register of Wills, Agent", NOTE: If tax pay.ants are _ade within three {3l months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. [] The above information and tax due is correct. 1. You may choose to re.it pay.ant to the Register of Wills with two copies of this notice to obtain a discount Dr avoid interest} or you may check box "A" end return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue, B. ~ The above asset has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by tha decedent's rapresentative. C. c=J Tha above information is incorrect and/or debts and deductions were paid by you. You must complate PART 0 and/or PART ~ balow. PART @] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rat.} please state your relationship to decedent: OF 1 2 3 4 5 6 7 8 x x PART o DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line S of Tax Computation) Under penalties of perjury} I declare that the facts I COMplete to the best of my knowledge and belief. ~j)~ TAXPAYER SIGNATURE have reported above are true} correct HOME (717) 3;\&'-Sfr3 WORK (717) ~(p<l-go1-<f TELEPHONE NUMBER and 3-5-()3 DATE Joseph A. Macaluso Attorney at Law 9614 Rowe Run Loop' Shippensburg. Pennsylvania 17257 Admitted to Practice in Pennsylvania, New Jersey, and New York (717) 532-4832 March 8, 2003 PA Department of Revenue Bureau of Individual Taxes Inheritance Tax Division Dept. 280601 Harrisburg, PA 17128-0601 Re: Estate of Dorothy B. Briggs File No. 2102-0830 Dear SirfMadam: I represent Lawrence L. Briggs, Dolores B. Mullen, and Sherrie D. Mellot, the personal representatives of the Estate of Dorothy B. Briggs. I have enclosed herewith in triplicate the two separate Information Notice and Taxpayer Responses each dated December 2, 2002, one of which pertains to Certificate of Deposit Account No. 5050067320 for Lawrence L. Briggs, and the other which pertains to Certificate of Deposit Account No. 5050067343 for Sherrie D. Mellot, both maintained at Orrstown Bank, which have been signed and dated by my clients. Block B. of Part 1 has been checked in each form to indicate that the asset will be reported and the Inheritance Tax will be paid with the Pennsylvania Inheritance Tax Return. Please return the extra copies of this form marked "filed", in the enclosed self-addressed stamped envelope. Also, I note for informational purposes that the tax rate indicated in each form for the asset is set forth as 15%; however, since my clients, the surviving joint owners, are the the son and daughter of the decedent, respectively, the applicable tax rate will be 4.5%. The Information Notice permits only one box to be checked in Part 1, and so we could not check the box stating that the information is not correct. In any event, the Inheritance Tax Return will show the correct tax rate when filed. Joseph A. Macaluso March 8, 2003 Page 2 Lastly, the address for Sherrie D. Mellot is incorrectly stated as being 20168 Path Valley Road, Dry Run, PA 17220. Her correct address is 5218 Lemar Road, Mercersburg, PA 17236-9656, if you desire to note this for your records. Thank you for your indulgence in this matter. incerely, /]1'/ 'V/rht! / ty:v.~/ J seph A. Macaluso cc: Lawrence L. Briggs Sherrie D. Mellot Dolores B. Mullen (w/o encl.) Cumberland County Register of Wills G COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 02-0830 02150665 12-02-2002 REY-1543 E~ AFP tD9-aD) EST. OF DOROTHY B BRIGGS 5.5. NO. 188-10-0822 DATE OF DEATH 08-21-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. ** LAWRENCe L BRIGGS 20168 PATH VALLEY RD DRY RUN PA 17220 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 QRRSTOWN BANK has provided the Depart.snt with the infer.atian listed below which has been used in calculating the potential tax due. Their ,ecords indicate that at the death of the ebovB decedent, yau wera a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, pleBse obtain written correction frolll the financial ino:;titution. 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 P.m"",,,l,,,,,,,i... Qu..,.tio"", la8\1 b.. answQrlld by call:ln~ (717) 7d7..83Z7. COMPLETE PART 1 BELOW Account No. 5050067320 Date Established REVERSE SIDE FOR 09-25-2001 FILING AND PAYMENT INSTRUCTIONS II II II SEE Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 97,299.59 100.00 97,299.59 .15 14,594.94 To insure proper credit to your account, two (Z) copies of this notice must accompany YOUr payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE [!J1ji,,~~~~~~~,ii"'~~i,ii~I~.!i,i~i~~~!ii!!~g.~!!!!!~li!i!~I!I!i~!I~I~~!!li!ril!!!I!!~QIII~!I!!I~~gl!i!i!li!lli~~~~'lil'~~,~~~!!'!1 [CHECK ] ONE BLOCK ONLY A. c=J The above information and tax due is correct. 1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of wills and an official assessment will be issued by the PA Department of Revenue. LINE RETURN - COMPUTATION OF 1- Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 x x PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax Computation) I $ Under penalties of perjury~ I declare that the facts I complete to the best of ny knowledge and belief. .,1 /) . {a~~1trstGN1r'u~~;Y;" have reported above are true, correct and HOME (717) 3''/976;2 7 W~:~EP~ONE N~~BER /S7::a5 () 3 DATE AUTHORITY TO PAY COURT APPOINTED COUNSEL 1. COURT o District Justice 0 Common Pleas 3. FOR (D.J.. C.P., APPELLATE) ~ .- 6.INTHE-'---r '(",y>','<'SNtK'!f 0t<SC(n v. /fl, ~4_ 9. PROCEEDINGS (Describe briefly) (j o Appellate 0 Other 4. AT (CITY/STATE) 7. CHARGE/OFFENSE (PURDON CITATION) 11. PERSON REPRESENTED 1 .l( Delendsnt - Adult 2 0 Defendant. Juvenile 3 0 Appellant 4 0 Appellee 5 0 Habeas Petitioner 6 0 Material Witness 7 0 Parolee Charged With ViolaliOfl 8 0 Probationer Charged With Violation 9 0 Other: ~4.loIlCl./1)g/i,/.J 10. PERSON REPRESENTED (Full Name) ~-tlan /11, /7la1a.IO ApplO... I 3~' 03 16. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS n. ~l1lJ'Li NAME OF COMMON pl'LEAgJUDG#ASSlimED TO CASE ~ MAR 0 4 2003 ~ 2 VOUC~~ 6892 5. ~~DG ET CODE . ~. (}(-.:J~~ .LIII -()~(J 8. 0 PETTY OFFENSE o FELONY 0 MISDEMEANOR 12. CIVIL DOCKET "'0. . ~,_.c"... 02/- OS'C)fy 13. CRIMINAL DOCKET NO 14. APPEALS DOCKET NO. Lindsay Dare B~ird 37 ~~outh Hanover Street C '>:". P...f\ T?P13.3307 17. TELEPHO~~NO. __ ~ ~-57 r..i- CLAIM FOR SERVICES OR EXPENSES 19. SERVICE DATES HOURS ... a: ::> e u ;!: a. Arraignment and/or Plea b. Preliminary Heartng c. Motions and Aequests d. Bail Hearings e. Sentence Hearings I. Trial g. Revocation He.rings h. Juvenile Hearings i. Appeals Court j. Other (Specify on additional sheets) / .;) / , -;u , d)Q / ,;I. ~ tJ3/ a '.)./'C3 ./"" ~RHOUR TOTAL HOURS'" 20. a. Interviews and conferenc.s IL..... b. Obtaining and reviewing records a a:: c. Legal research and brief writing ...::> 5 8 d. Investigative and other w()(k (Specify on additional sheets) TOTAL HOURS = x $<0 PER HOUR 21. ITEMIZATION OF REIMBURSABLE EXPENSES Mite-;;a $.25 Mr m~e x AMI. PER ITEM a: w ::t .... e 22. CERTIFICATION OF ATTORNEY/PAYEE V Has compensation and/or reimbu"ment for work In this CUe previously been spplled for? 0 YES ~ NO Uyes.wereyoupaid? 0 YES Jl. NO If yes, by whom were you peld? How much? Has the person represented paid any money to you. or to your knOWlp~eLB.n~~:;':lse..in co".n. ection with the matter tor which you were apPOinted to provide representation? 0,;1S pI-NO "~LW~.detll!IS on sdditional...lheets I swear or affirm the truth or correctness tacT' j. s. ~ of Ihe above statements ~Iure of Altomey1Payee Date 26 ftPpnOVl;"\ I. FOI~ Signature of ""'V,,"E.NT Judge "". '. U.. ' A .L1r"-"r, A........' to Dale: tl 10 I D I Copy 1 - Mail to Court Administrator at completion 01 service 18. SOCIAL SECURITY NO OR EIN NO /4J>' ,,& 'J-M; AMOUNTS CLAIMED Multiply rate per hour limes total hours to obtain Hln CourtH com. pensation. Enter total below. '9A TOTAL IN COURT COMP, =$ /I.).jd Multipty rate per hour limes total hours. Enter total "Out of Court~ compensation below. 20A TOTAL OUT OF COURT COMP. =$ 21A TOTAL ITEMIZED EXP. -$ 23. GRAND TOTAL CLAIMED - $ //,;? )-;) 24. DEDUCT. PRIOR PVMTS. -$ 25. NET AMOUNT CLAIMED =$ //.;{..:;O 27. AMT. APPROVED_ = $ I p.... "J "'? \./' INVENTORY Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 NUMBER ITEM AMOUNT Bank Accounts 1. Hometown Investment account #105210116 $ 25,458.44 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 2. Checking account #319805 3,693.34 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 3. Certificate of deposit #5050067320 $100,000.00 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 4. Certificate of deposit #5050067342 $100,000.00 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 5. Certificate of deposit #5050067343 $100.000.00 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 TOTAL $329,151.78 ?> ;l < :3l :n b ! t;I t;;. ~ ::II 8: .~ - "l1 .s <tl ~ '0' 0 :tl ~ cD 0 :ro - .0 '"Tj .. .>; '01 P- .,. '0 & ! '1lI '00 'cT E ~ :;ll:I Z (j) :p :::r :::r -< ? .0. ...... "< ffl 5' 'tl ~ 'n !O :i:D 0 :0 "l1 - .~~ Q. - .ro .' sa, ::II Q P .~ .p tTl ~ s:. -< ~ 'p '00 :i:D ~ III "0 CD :cT :0' .01 ...... .~~ 8- Q l:' "0 '< .~ ...... tTl :tJ .q 0' :>0 - '01 ;g t;l ::II ~~ ro .. 10 ::;! "'. '< . . Z Q. .1Il . . 0 .00 8' ~ '>'3 ~ ) " .Q (\ '0 , cD ~ :a: 1 :~ ) .w ... (j) .::3 . <Xl ro '00 :N N fl- '::r 0'> ...... N \ 'tl INVENTORY IN RE Eslale of .. Dp.rothX . B.,. . B~.i.Q'<;l!3. . . . . . '. late of mberland County. Pennsylvania. Shippensburg Township .. ...... ... ... .... ,. ........ '... .,.., STATE OF PENNSYLVANIA. COUNTY OF CUMJ;lEIH"AND 55.: We verify that the statements made in this Inventory are true and correct. we understand thJ( false statements herein are made subject to the penalties of IX P. A. C. S. Section 4904 relating ~tl? Date Co-Personal Representatives: to authorities. 3h IJ1.JU'!l .")), ~fj;J Signature ce L, Briggs Dolores B. Mullen Sherrie D, Mellott NO ITEM A. MOUNT See reverse side \1" ~'?"' S' Of REV -1 5 0 O-J , "5:":I'-r~ ".' COMMONWEALTH OF , PENNSYLVANIA , DEPARTMENT OF REVENUE DEPT 280601 ., HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W Cl W U W Cl DECEDENTS NAME (LAST, fiRST, AND MIDDLE INITIAL) Bri s Doroth B. DATE Of DEATH (MM-DD-YEAR) DATE Of BIRTH (MM-DD-YEAR) 8-21-02 8-23-16 :If APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, fiRST, AND MIDDLE INITIAL) N/A w :; ~-'" u"'~ W~U IOO u"'~ ~"' ~ " fXl1 Original Return []4,LimltedEstate r.c- ~' 6 Decedent Died Testate (Attach copy of Willj o 9.LitigalionProceedsReceived D 2. Supplemental Return o 4a. Future Interest Compromise (dateofdeatha~er 12.12-82) D 7, Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1.951 OFFICIAL USE ONLY FILE NUMBER ..1. l - ..Q 2... COUNTY CODE YEAR JLfL8_3..Jl_ NUMBER SOCIAL SECURITY NUMBER 188 10 0822 THIS RETURN MUST BE fiLED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3,RemainderRelurn(dateDfoealhpriorto12_13_82, o 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (AtlacnSc~O: >-- z w c z o ~ '" w '" '" o u THlsslli NAME COMPLETE MAILING ADDRESS -; ;'1'1';~::::J:::Li ,~): '~",~;:l"," l ,\:: ' "J: J ~ :,. ";;..;!:. ~~:iJ~o. . FIRM NAME (If Applicable) 9614 Rowe Run Shippensburg, Loop PA 17257 (1) 0 jOFFICIAL USE"ONLY (2) 0 I (3) 0 (4) 0 I (5) 329,151.78 (6) 0 (7) 0 ~._------_.. ----.-- (8) 329,151.78 (9) 16,920.78 (10) 1.619.49 (11) 18,540.27 (12) 310.011.51 (13) 0 (14) 310.011.51 x.o_ (15) 0 x .0"i5.. (16) 13.977.52 x 12 (17) 0 x .15 (18) n (19) 13,977.52 Real Estate (Schedule A) z o ~ ...J ::::l t:: c. <l: u w a:: Stocks and Bonds (Schedule B) Closely Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) o Separate Billing Requested 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) 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) 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax 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 ~ I- ::::l C. ~ o u >< i:!: 15. Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec. 9116 (a)(1.2) 16 Amount of Line 14 taxable at lineal rate 310,611.51 17 Amount of Line 14 taxable at sibling rate 0 18 Amount of Line 14 taxable at collateral rate 0 19 Tax Due 20~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS Outlooke Pointe at Shi "i'"'- 129 Walnut Bottom Roa CITY STATE PA ZIP 17257 Shi en Tax Payments and Credits: 1 Tax Due (Page I Line 19) 2. Credlls/Payments A Spousal Poverty Credit 8. Prior Payments C, Discount (1) 13,977.52 o 13,299.66 699.98 Tolal Credits (A + B + C ) (2) 13,999.64 3 InleresUPenalty If applicable D. Interest E. Penally o o BEnter Ihe tolal of Line 5 + 5A. This is the BALANCE DUE. (3) 0 (4) 77 17 (5) NIl>. (5A) N/A (5B) N/A TotallnteresVPenalty ( D + E ) 4. If Line 2 IS greater than line 1 + Line 3, enler the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund 5. If Line 1 + Line 3 is grealer than Line 2, enter the difference. This is the TAX DUE. A. Enter the Interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT i;i;t:f~~ lilili.4!I!JIIlIJ -II If ._JIId . 11I1 i1.[!Jlf_l!i'1i'''''''.''''.,\l< PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property Iransferred:... .. . 0 ~ b. retain the right to deSignate who shall use the property transferred or Its income:.. .. ......... 0 ~ c. retain a reversionary interest; or.... .. ..... 0 ~ d. receive Ihe promise for life of either payments, benefits or care?. ...... 0 ~ 2 If dealh occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. ,..... . D ~ 3 Old decedent own an "in trusl 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 conlalns a benefiCiary designation? .. .... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FfLE IT AS PART OF THE RETURN. Under peilalties of perjury I declare that I have examined this return, including accompanying schedules and statements, and to tile best of my knowledge ana oolief, it is tW8, correct and complete Declaration of preparer olher than the personal representative is based on all informalion of which preparer has any knowledge DATE Lf. C. SIGNATUR ADORE )?~ >7 ~ 0 'f --"-,, 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 PS 39f16 (.) (11) (i)}. For dates of death on or after January 1, 1995, the tax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 0% [72 PS. 99116 (a) (1.1) (Ii) The statute does not exemot a transfer to a surviving spouse from tax, and the slatulory 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 ora stepparent of Ihe child is 0% [72 PS. 99116(a)(I.2)I. The tax rate Imposed on the net value of transfers to Dr for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. Tha tax rate Imposed on the nel value of Iransfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a indiVidual who has at least one parent in common with the decedenl, whelher by blood or adoption. RfIJ.t~O,"(1.97) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH Of PENNS~LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy B. Briqqs 21-02-00830 Indude the proceeds of litigation and the date the proceeds were received by the estate, All property jointly..owned wtth th9 right of survNol'$hlp must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION See attached Continuation Schedule VALUE AT DATE OF DEATH TOTAL (Also enter on line 5, Recapitulation) $ 329, 151 .78 (If more space IS needed, insert eddltional sheets of the same size) PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 SCHEDULE E CONTINUATION SCHEDULE - PAGE 1 CASH, BANK DEPOSITS, AND MISCELLANEOUS PERSONAL PROPERTY ITEM VALUE AT DATE NUMBER DE$CRIPTION OF DEATH Personal Property Bank Accounts 1. Hometown Investment account #105210116 $ 25,458.44 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 (see attached letter from Orrstown Bank verifying date of death balance) 2. Checking account #319805 3,693.34 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 (see attached letter from Orrstown Bank verifying date of death balance) 3. Certificate of deposit #5050067320 $100,000.00 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 (see attached letter from Orrstown Bank verifying date of death balance) 4. Certificate of deposit #5050067342 $100,000.00 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 (see attached letter from Orrstown Bank verifying date of death balance) PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 SCHEDULE E CONTINUATION SCHEDULE - PAGE 2 CASH. BANK DEPOSITS, AND MISCELLANEOUS PERSONAL PROPERTY ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Personal Prooertv Bank Accounts 5. Certificate of deposit #5050067343 Orrstown Bank 16400 Path Valley Road Spring Run, PA 17262 (see attached letter from Orrstown Bank verifying date of death balance) $100,000.00 TOTAL $329,151.78 npr Uj Uj Uj:jlp Urrst.oll.ln B.enk "1/J4th:':-.:Jtt.l. 1'" l ~ BANK "rri) J, 2J03 AT.: en: Joseph Tids letll::[ is in regards to the acccunts th.8t Dorothy H. Briggs had wit~1. Orrstown Bank <.:.t th~ time of li<:>T death. ,\c,''CU:1t ;Iumj~r3 3.nd balances are dH of August 21) 2.002. l.('rti~lcate of Dep0sit 505-0067320 100,000.00 ':::1-' J-t: i:;: iL;Jte of lkp0Sit 505-0067342 100,000.00 Ccr:..ificate of )eposit 505-0067343 100,000.00 Hccetown Inve.stmen:. 105-2IOlJ 6 25,4SH.44 Ch~ckiH':; Ac-count 000-319805 .J, 693.34 Sincerely) B!iliK H..J1- PO 80x 250' Shippen.burg. PA 17257. (717) 5'>2-6114' (717) 532.4143 Fax' www.orrstown.com RE\ )11 Ex+F12-99) . , , ,.l,~h:",~~' 't ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dorothy B. Briggs 21-02-00830 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION AMOUNT FUNERAL EXPENSES: See attached Continuation Schedule B ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Aepresentative(sj Social Security Number(s)/E1N Number of Personal Representative(sl Street Address City Sial. _ Zip Year(s) Commission Paid 2 Attorney Fees 3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant SlreetAddress City State ~ Zip Relationship of Claimant to Decedent 4 Probate Fees 5 Accountant's Fees 6 Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) $ 1 6 , 920 . 38 (If more space is needed, insert additional sheets of the same size) PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 ITEM NUMBER A. B. SCHEDULE H CONTINUATION SCHEDULE - PAGE 1 FUNERAL EXPENSES AND ADMINISTRATIVE COSTS DESCRIPTION FUNERAL EXPENSES John Aggett Funeral Home Foster's Memorial (marker) Rev. William Bair (pastor) Bill O'Donnell (grave) Repast $4,724.00 60.00 50.00 175.00 270.00 ADMINISTRATIVE COSTS 1. Personal Representative's Commission Names of Co-Personal Representatives: Lawrence L. Briggs, Dolores B. Mullen, and Sherrie D. Mellot Lawrence L. Briggs Social Security Number: 186-36-3114 Street Address: 20168 Path Valley Road City: Dry Run State: PA Zip: 17220 Year Commission Paid: N/A Dolores B. Mullen Social Security Number: 161-32-9045 Street Address: 10995 Woodring Lane City: Waynesboro State: PA Zip: 17268 Year Commission Paid: N/A AMOUNT $5,279.00 NONE I," ., ., . PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 SCHEDULE H CONTINUATION SCHEDULE - PAGE 2 FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Sherrie D. Mellot Social Security Number: 178-48-2367 Street Address: 5218 Lemar Road City: Mercersburg State: PA Zip: 17236-9656 Year Commission Paid: N/A 2. Attorney fees Joseph A. Macaluso, Esq. 3. Family Exemption 4. Probate fees (Cumberland County Register of Wills) petition for probatelletters $305.00 extra pages 6.00 JCP fee 5.00 short certificates 12.00 return 15.00 inventory 10.00 5. Accountant's fees 6. Tax Return Preparer's fees S&S Tax Service $10,874.55 -0- $ 353.00 -0- $ 80.00 7. Postage, telephone, transportation expenses $ 127.40 7. Legal Advertising - estate notice Cumberland County Law Journal $ 75.00 News Chronicle 131.43 TOTAL $ 206.43 $16,920.38 R"Vt5I2U-I,97; .' ~-t. ~ . ". CO~~MON'NEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Dorothy B. Briggs 21-02-00830 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT See attached Continuation Schedule TOTAL (Also enter on line 10, Recapitulation) $ 1 , 6 19 . 49 (If more space is needed, Insert additional sheets of the same size) PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 SCHEDULE I CONTINUATION SCHEDULE - PAGE 1 DEBTS OF DECEDENT. MORTGAGE LIABILITIES. AND LIENS ITEM NUMBER DESCRIPTION AMOUNT 1. Pharmacare - pharmacy bill $ 101.47 2. Cumberland Valley Orthopedic - medical bill 200.44 Shippensburg Health CareCenter 945.00 (5 days of care) 3. 5. 6. State Retirement System - payment 52.72 State income tax payment 310.00 4. Shippensburg Family Practice - medical bill 9.86 TOTAL $1,619.49 ,o""'''''''~ .,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETuRN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER 2 0 00830 Dorn+hv B. Briaas 1- 2- RELATIONSHIP TO OECEDENT AMOUNT OR SHARE lUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outnght spousal distnbutions) 1, See attached Continuation Schedule ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRiBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 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) PENNSYLVANIA INHERITANCE TAX RETURN Re: Estate of Dorothy B. Briggs No. 2002-00830 PA No. 21-02-0830 SCHEDULE J CONTINUATION SCHEDULE BENEFICIARIES AMOUNT OR NAME AND ADDRESS OF RELATIONSHIP SHARE OF NUMBER RECEIVING PROPERTY TO DECEDENT ESTATE I. TAXABLE DISTRIBUTIONS 1. Lawrence L. Briggs son 1/3 of residue 20168 Path Valley Road and beneficiary Dry Run, PA 17220 of Certificate of Deposit Account #5050067320 2. Dolores B. Mullen daughter 1/3 of residue 10995 Woodring Lane and beneficiary Waynesboro, PA 17268 of Certificate of Deposit Account ##5050067342 3. Sherrie D. Mellot daughter 1/3 of residue 5218 Lemar Road and beneficiary Mercersburg, PA 17236-9656 of Certificate of Deposit Account #5050067343 II. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 -0- FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS -0- TOTAL OF PART II. -0- " " 21-02-830 WTnst ~iU nnh 'Q}tstamtnt I, DOROTHY B. BRIGGS, of 20475 Path Valley Road, Dry Run, Franklin County, Pennsylvania, being of sound mind and memory, do make, publish and declare tliis my Last Will and Testament, hereby revoking and declaring null and void any and all wills and codicils by me at any time heretofore made. FIRST: I direct my Executors to pay my just debts, the expenses of my last illness and my funeral expenses. SECOND: I give, devise and bequeath all of my estate, of whatsoever nature and wheresoever situate, to my husband, Luther J. Briggs, if he survives me. Should my husband fail to survive me, I give, devise and bequeath all of my aforesaid estate, in equal shares, to my children, Dolores Jean Mullen, Lawrence Lee Briggs, and Sherrie Dawn Mellott, if they survive me. Should any of my children fail to survive me, his or her share shall be distributed to his or her issue, per stirpes, surviving me. THIRD: I direct my Executors to payout of the principal of my estate, all federal estate, state inheritance, estate and succession taxes imposed upon or with respect to my estate or any properly in which I may have an Interest, including any properly not forming a pari of my testamentary estate, but included in my gross estate for tax purposes, in such manner as my Executors, in their sole discretion, shall deem advisable; and no such taxes or any portion thereof Page 1 of a Three-Page Will so paid shall be collected from or paid by any other person, persons, or corporations by way of reimbursement, proration, apportionment or otherwise. FOURTH: I name and appoint my husband, Luther J. Briggs, Executor of this, my Last Will and Testament. Should my husband, Luther J. Briggs, fail to qualify or cease to act as Executor, I name and appoint my children, Dolores Jean Mullen, Lawrence Lee Briggs, and Sherrie Dawn Mellott, Co-Executors of this, my Last Will and Testament. I direct that my personal representatives shall not be required to post bond for the faithful performance of their duties in this or in any other jurisdiction. IN..'ijITNESS WHERj;OF, I have hereunto set my hand and seal this J--'f-tl day of JL.\..A" -' ..Ii' A.~{'LV~. WITNESS: ~ l1. .L-.~ J. 1 ' ,J ~ (SEAL) Page 2 of a Three-Page Will COMMONWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN :SS. We, Dorothy B. Briggs, Richard K. Hoskinson, and Linda N. Dickinson, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she 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 hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. '. _ _) i /'~~r~th~18i B~i:~~~~~S\;;~iX 7 ~L' ") . c. (/({(j{ceues;/'.''tl..?C??'~::Zf\ Richard K. Hoskinson, Witness . j . ~> ! ~J"~ 1'1. ~.l(:t'-L tV)("1 Linda N. Dickinson, Witness Subscribed, affirmed, and acknowledged before me by Dorothy B. Briggs, Testatrix, and subscribed and affirmed.before me by Richard K. Hoskinson and \ j. ' . LindaN,Dickinson,witnesses,this./';/j"dayof /1/,"" .... i ,.", . 1997. , /11 . I I, i I: (I )' it} J /(' ( I ( '. ..'~ / I NOT AllAl seAL .,. L PAYW~T. -,. ~ ,,-~...t...<\, ....., "",..... """"'" M ..,e.....1 .flIplr.~K 1m Page 3 of a Three-Page Will \.. P)-%Jl--5~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX Raco'oe:.! Rt}fJ;L~t~-: r; of DATE ESTATE OF DATE OF DEATH FILE NUMBER Al0 :2StOUNTY ACN 05-19-2003 BRIGGS 08-21-2002 21 02-0830 CUMBERLAND 101 JOSEPH A MACALUSO 9614 ROWE RUN LOOP SHIPPENSBURG PA '03 MAY 23 * REV-lS47UiFPU1-OS> DOROTHY B 172Usn~ Gumbe, ,. Amount 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 -41 RW=iSirj-Eif-AFP--fiiFo3Y-NCificniF-i-NHERTi'ilNCE-YAinfppRAisEifENT~--ALrOwili.rCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DOROTHY B FILE NO. 21 02-0830 ACN 101 ESTATE OF BRIGGS TAX RETURN WAS: ( ( X) CHANGED SEE DATE 05-19-2003 ATTACHED NOTICE NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of line l~ at Spousal rate (15) 16. Allount of Line l~ taxable at Lineal/Class A rate (16) 17. Allount of line 14 .t Sibling rat. (17) 18. Allount of line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 310,611.51 X 045 = 13,977.52 .00 X 12 = .00 .00 X 15 = .00 (19)= 13,977 .52 ) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnershlp 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 ll) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 29.151. 78 .00 300.000.00 (8) 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. Net Value of Estate Subject to Tax (9) 1l0) 16,920.78 1.619.49 (11) (12) (13) (14) NOTE: To insure proper credit to your account I submit the upper portion of this form with your tax paYllent. 329,151. 78 18.~4n "l7 310,611.51 .00 310,611.51 TAXp~: ,., AHOUNT PAID DATE NlJHBER INTEREST/PEN PAID (-) 11-20-2002 CDOO1868 698.88 13,299.66 05-12-2003 REFUND .,00 21.02- TOTAL TAX CREDIT 13,977.52 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) REV_1470 EX (6-88) '* INHERITANCE TAX EXPLANATION OF CHANGES .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME Dorothy B. Briggs FILE NUMBER REVIEWED BY John Kuchinski ACN 2102-0830 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES E 3-5 These accounts have been moved and correctly reported as non-probate assets on Schedule G with the children as beneficiaries. ROW Page 1 /'/) .,---")' '---' \ BUREAU OF INDIVIDUAL TAXES ~ INHERITANCE TAX DIVISION DEPT. Z8D60l HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT .. REV-ln7 EX AFP IDI-Ul RC:lt'"' h,.... DAn_" ESTAn OF DAn OF DEATH FILE NUMBER JUN 2cFOImT~ 0 ACN 05-27-2003 BRIGGS 08-21-2002 21 02-0830 CUMBERLAND 101 DDRDTHY B JOSEPH A MACALUSD 9614 RDWE RUN LOOP SHIPPENSBURG PA 003 A.aunt Remitted 17257 C,", Ct;lnL. MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax pay.ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i60-;-Eif-"F"--foFo:3Y------..ii-iNHEiiiTANC'E--TAif-sTilYEM'E-NT-OF-ACciiuiff--.-..------------------ --- ESTAn OF BRIGGS DOROTHY B FILE NO.21 02-0830 ACN 101 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: 05-12-2003 PRINCIPAL TAX DUE:, 13,977.52 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2002 CDOO1868 698.88 13,299.66 05-12-2003 REFUND .00 21.02- TOTAL TAX CREDIT 13,977.52 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (eft), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )