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HomeMy WebLinkAbout02-0474 PETITION FOR PROBATE and GRANT OF LETTERS , Deceased. 21- 02 - 47L/ Mary Lewis Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Estate of DOROTHY P. SCHALLES No. also known as To: Social Security No. 168-36-5594 The petition of the undersigned respectfully represents that: Your petitioners, who are 18 years of age or older and the Executors named in the last will of the above decedent, dated March 15,2002 and codicil(s) dated N/A Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 20 Buckthorn Drive, South Middleton Township, Carlisle, Cumberland County, Pennsylvania. Decedent, then 91 years of age, died May 5, 2002 at 20 Buckthorn Drive, South Middleton Township, Cumber1and County, Peimsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: None. Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: Mountain land, Cambria Countv, Pennsvlvania $150,000.00 $ $ $ $2,500.00 WHEREFORE, petitioners respectfully request the probate of the last will presented herewith and the grant of letters Testamentary thereon. ~~~~~ 20 Buckthorn Drive Carlisle, PA 17013 12~(l_( cUM-- Robert C. Cairns 20 Buckthorn Drive Carlisle, PAl 70 13 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) Sworn to or affirmed and subscribed before me this ~5~lday of MAY 2002 , . The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above decedent petitioners will well and truly administer the estate according to law. ~tj\},/1 /.I~~ Sc lles Cairns Gl:m ~ -eD+~, C~L-- Robert C. Cairns MARY j'/' (e') (-j NO. -OZ.-41 Estate of Dorothy P. Schalles, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 15. 2002 ,2002, in consideration ofthe petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated March 15,2002 described therein be admitted to probate and filed of record as the last will of Dorothy P. SchaBes; and Letters Testamentary are hereby granted to Mary SchaBes Cairns and Robert C. Cairns. FEES Probate, Letters, Etc. ........... $ 235. DO Short Certificate(s) ............. $ 15.00 ~~r.<;\.w..g:<;.9.. $ 21.00 jcp $ 5.00 TOTAL $ 276.00 Filed........ ..5"J.5"Q2.................................... call atty on 5-15-02 '1!l~!l!ItrJm(b4rj R gister Wills Y C IS ~rrJ(j Mictael J. Hanft, Esquire Attorney LD. No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, PA 17103-9142 (717) 249-5373 F:\User FolderlFirm DocsIEstates\2649-1petition,letters wpd .'~. .~ .-" ~, -' LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES 2/-02-471-/ I, DOROTHY P. SCHALLES, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. I I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If! do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. 2 I give, devise and bequeath the following specific bequests or property with all insurance proceeds thereon as follows: A. To First Presbyterian Church of Carlisle, Pennsylvania, I bequeath the sum ofTen Thousand Dollars ($10,000.00). Page I of 8 ~ \ ~ ~ \ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES B. Fund "A" of the Revocable Life Insurance Trust Agreement between Lawrence F. Schalles and Peoples First National Bank and Trust Company, dated August 4, 1958, I bequeath equally to my daughter, MARY SCHALLES CAIRNS, and my son-in- law, ROBERT C. CAIRNS. To the extent I would be allowed to determine the distribution of Fund "B" of the Revocable Life Insurance Trust Agreement between Lawrence F. Schalles and Peoples First National Bank and Trust Company, dated August 4, 1958, I would bequeath same equally and per stirpes to my daughter, MARY SCHALLES CAIRNS, and my daughter, AUDREY JOAN GRECO. C. 3 I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate to my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIRNS, equally, providing that they survive me by sixty (60) days. I am specifically excluding my daughter, AUDREY JOAN GRECO, from this bequest, as I have provided for her in other ways during my lifetime and MARY SCHALLES CAIRNS and ROBERT C. CAIRNS have provided for me in many ways during my lifetime, including allowing me to live with them for many years. 4 Should my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIRNS, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate as follows: Page 2 of 8 ~ \ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES A. Five percent (5%) to my grandson, NORBOURNE WILSON CADY, III, cnrrently residing in Maui, Hawaii. B. Twenty percent (20%) to my granddaughter, KIMBERLY A. LeROY, currently residing in Renfrew, Pennsylvania. C. Twenty-Five percent (25%) to my granddaughter, LAURA ELLEN CAIRNS, currently residing in Carlisle, Pennsylvania. D. Twenty-Five percent (25%) to my granddaughter, NANCY CAIRNS JACKSON, currently residing in Bellevue, Nebraska. E. Twenty-Five percent (25%) to my granddaughter, JENNY LOUISE CAIRNS, currently residing in Frederick, Maryland. It is further my desire that my personal representative, after consultation with any heir or heirs of mine who survive me, and in his, her or its own discretion, choose such articles from my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible evidences of intangible personal property) as he, she or it believes will be useful to such heir or heirs or desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the further exercise of his, her or its discretion, provided no other heir objects to the distribution. All tangible personal property not so distributed is to be sold, either publicly or privately, by my personal representative, adding the proceeds of such sale or sales to my residuary estate and to be disposed of in equal shares among my surviving heirs after payment of my estate debts, taking into account the tangible personal property otherwise provided to them. 5 I grant my personal representative the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: Page 3 of 8 ~ ~ LAST WILL AND TEST AMENT OF DOROTHY P. SCHALLES (t) (g) (h) (i) (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. To operate any business that I may own at my death. To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her, or its absolute discretion. To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. To distribute in cash or in kind upon any division or distribution of my estate. (b) (c) (d) (e) Page 4 of 8 ~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES G) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. (k) 6 No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. 7 I nominate, constitute and appoint my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIRNS, as Co-Executors of this my Last Will and Testament. In the event they are deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my attorney, MICHAEL J. HANFT, ESQUIRE, as personal representative ofthis my Last Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. Page 5 of 8 ~ ~ '\ \. "J ~~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES 8 I hereby declare it to be my express desire that my personal representative employ Michael J. Hanft, Esquire of the law firm of Hanft & Knight, P.c., of Cumberland County, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. Any mention of Michael J. Hanft, Esquire and/or Hanft & Knight, P.c. in this my Last Will and Testament, is my free and voluntary act and through no influence by any person. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this 1~j#dayofMarch, 2002. WITNESS: /. ..2Zf!:..;J~~ i t7~ 7 y"'" / ~ ~ Dorothy P. Schalles of~~~/~t;LLY1~ Page 6 of 8 ~ ~ . \ ~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES ACKNOWLEDGMENT COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND SS. I, Dorothy P. Schalles, the 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 and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purpose;~ /~ Dorothy P. Schalles Sworn or affirmed and acknowledged before me by Dorothy P. Schalles, the Testatrix, this 11 /6' LdayofMarch,2002. / L L V//A , {P> S /i.{/ ,,'- ,{I l/ Notarial Seal Laurie L. Wolf. Notary Public Sooth Middleton Twp., Cumbel1and Coun1y My Commission Expires Jan. 7. 2006 Member. Pennsylvania Association Of Notaries Page 7 of 8 ~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. WE, Al, U1At"Z.- X IIA->v'f'l and L.- ,the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Dorothy P. Schalles sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of om knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~'}71t! Sworn or affirmed and subscribed before me by )4 't-t-I-A-ez.. ::7. tI~rr and this /~dayofMarch, 2002.' ( . );) / I/i h / ( 7, / / ~ //(( {. lj L...// ( 1...--/ F\User FolderlFirm Docs\WiHs\264\l_ldpsw;ILwpd Notarial Seal LaU". L WoW. Notary Public South Middleton Twp., Cumberland County My Commission expires Jan. 7, 2006 Member. PsnnayIvanIo _ 01_ Page 8 of 8 \ :~ft _'" ,.'.' '"'" ""....'. _,':-.i -:,<,::,,,,._-, '" ."" c: J ;:: ^ ^ I c' - C . " ~ :- ~ T " . .J.. . .. ~ Q 0 .) ~ Z ~ Gi---- ;:L _ 'r, ~ :))0 . " ~ . . . .(l P< f 0- t f N ~ ~ . 0 r~ Z Z z ,. ~ < " / ;;' ~ ~ 8 ...... < .- i"': '0 " '" .~ "' . ? 1'~ l-K HANf'T& KNICln: I'.C AI'J( WNJY:--. ,,,"-- (~, 1\H<:,l:I i( )f("; .'\1 L:\\,\ I') I;h(l, ,I---..\V,)\ )l~ i\VI :---;\11 ,\\!llf. lOt> Ci\I~II'i1 r';\ j70U 914) 717 ~:)-F).S373 100X lI7,2,.1'),OI."i7 IV\VI\',II;\r-..;'III,\\;\TIP,I\U-(l".j ."f: .."c:., '~ ^ i{',: # ~'':;;::r;''':'''~ ,,; ....'-- :;"....~ F \User Fulder\Firm Docs\Eotale5\2649-1 certification_notice_ wpd v CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DOROTHY P. SCHALLES Date of Death: May 5,2002 File No. 21-02-0474 To the Register: I certify that notice of beneficial interest required by Rule 5.6( a) ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 28,2002: Name First Presbyterian Church Mary Schalles Cairns Robert C. Cairns Audrey Joan Greco Norbourne Wilson Cady, III Kimberly A. LeRoy Laura Ellen Cairns Nancy Cairns Jackson Address 2A North Hanover Street, Carlisle, P A 17013 20 Buckthorn Drive, Carlisle, P A 17013 20 Buckthorn Drive, Carlisle, P A 17013 800 Commons Court, Apt. #3, Saxonburg, PA 16056 4350 Waileo Loop, Maui, Hawaii 96753 119 Beacon Road, Renfrew, P A 16053 20 Buckthorn Drive, Carlisle, PA 17013 12427 South 25th Avenue, Bellevue, NE 68123-1724 Notice has not been given to all persons entitled thereto und r Rule 5.6(a) except: NI Date: May28,2002 L...i.-. ~.. i Mic ael 1. Hanft, Esq e Attorney LD. No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013-9142 Telephone (717) 249-5373 c.j Counsel for personal representatives HANFT & KNIGHT. P.C. ArTORNFYS & COUNSELLORS AT LAW ~..'."...;" ~..'~X' August 2, 2002 WilliAM A. ADDAMS MrCI-IAEI J. HANfT GfU'CORY H. KN]C;HT LINDSAY CJINGIUCII MACL.AY' '^J'(' AL),\-""'" '''' NIW )IRSl-Y Mary C. Lewis Register of Wills of Cumberland County Cumberland County Courthouse Courthouse Square Carlisle, P A 17013 RE: Estate of Dorothy P. Schalles Estate No. 21-02-0474 Date of Death: May 5, 2002 My File No. 2649.1 Dear Mrs. Lewis: Enclosed with this letter is my escrow check in the amount of $7,000.00, representing the pre-payment of inheritance tax in the above-referenced estate, as follows: Would you please issue the appropriate receipts and forward them to me at the above-listed address. I thank you in advance for your prompt attention to this matter. Very truly yours, fl~7'P!Pft Michael J. Hanft MJH/dln Enclosure cc: Mary Schalles Cairns, Co-Executor (wi enclosure) Robert C. Cairns, Co-Executor (wi enclosure) r: F:\User Folder\Firm DocsIEstates\2649-1tax-prepayJetter wpd It) I~R(,()nV()()I) AVINll1. SlJIII!O() C>\RII\[I, I'A 17013-()]42 717.2-4'J..')373 lAX 717.24<>.0457 \VVV\V.IIANlrlAWIIRM.U1M COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HANFT & KNIGHT PC 19 BROOKWOOD AVENUE SUITE 106 CARLISLE, PA 17013 unun fold ESTATE INFORMATION: SSN: 168-36-5594 FILE NUMBER: 2102-0474 DECEDENT NAME: SCHAllES DOROTHY P DATE OF PAYMENT: 08/02/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/05/2002 NO. CD 001477 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,000.00 I I I I I I I I TOTAL AMOUNT PAID: $7,000.00 REMARKS: ROBERT C CAIRNS C/O HANFT & KNIGHT PC CHECK#106 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS 1lf.\I....u.~ ~ . *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 02 COUNTY CODE YEAR SOCIAL SECURllY NUMBER 00474 NUMBER 181 o 181 6. 09. 1. Original Retum 2. Supplemental Return COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF REVENUE DEPT. 280601 HARRISBLJRG, PA 11128-06(11 ~ W Q W " l!: DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Schalles, Dorothy P. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR) 168-36-5594 THIS RETURN MUST BE FILED IN DUPlICATE WITH THE REGISTER OF WILLS SOCIAL SECURllY NUMBER w ~ ~~11 blll.8 ~~... ,,~.. ~ .~ I~ ,,2 o 4a. FutlSe Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach CCf)Y of Trust) o 10. Spousal Poverty Credit (date of death between 12-31.91 n 1-1-96 THIS SEcnoNIIIUStBE COMPUttEO.1ALl!.1l:ORi!ESI'ONOENc:i!ANOcoNFfOENnAliirAX FORlMt!ON'SHOULO Il.EOIRECTED TO: ME COMPLETE MAILING ADDRESS Michael J. Hanft, Esquire lAM NAME (If applicable) Hanft & Knight, P. C. 05/05/2002 05/04/1911 o 3. Remainder Retum (date of death prior to 1:2-13-82) o 5. Federal Estate Tax Retum Required 6. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A}(AItach5ch 0) 19 BrookwoodAvenue, Suite 106 Carlisle, PA 17013 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 4. limited Estate Decedent Died Testate (Attach copy otWlffJ Litigation Proceeds Received (1) (2) (3) (4) (5) (6) (7) OFFICIA.L USE ONLY ElEPHONE NUMBER 717/249-5373 t. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship ! ~ II! 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) None' None None None 237,298.62 None None 10. Debts of Decedent. MortQage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (8) 237,298.62 (9) (10) 8,836.43 204.14 (11) 9,040.57 228,258.05 10,000.00 218,258.05 (12) (13) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 9,821.61 9,821.61 CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT. 20. 0 ..,'ml!i1-i~;':;;Wl'7'-l:ir"'''1;;X-'iI~~~{j~i1Qli'~..~~!l~MAfi!,<<\.. . 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ! 16. Amount of Line 14 taxable at lineal rate 218,258.05 x .045 (16) (17) ~ 17. Amount of Line 14 taxable at sIbling rate x .12 ~ " ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6.00) Decedent's Complete Address: STREET ADDRESS 20 Buckthorn Drive CITY Carlisle ISTATE PA I ZIP \7013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CredltsfPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 9,821.61 7,000.00 368.42 Total Credits (A + B + C) (2) 7,368.42 3. InteresUPenally if applicable D. Interest E. Penally B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) (5) 2,453.19 (5A) (58) 2,453.19 TotallnteresUPenally (0 + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund 5. If Une 1 + Line 3 is greater 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 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? ...................................................................................................................... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.."........................................................... ................... ~ I b. retain the right to designate who shall use the property transferred or its income;.................................... c. retaln 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?..... ......... ".............................................................................. ........................ 0 o o 181 181 181 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I deClare that I have examkJed this relum. including accompanying schedules and statements, and to the best of rrrt knowledge and belief. it is true. correct and complete_ Declaralicrl of plllpalllr other than the personal representative i$ based on all Wiforrnalion of which pfepalllr has any krIov.1edge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS M SchaUes Ca s ~ 20 Buckthorn Drive Carlisle, PA \7013 DATE " / '-I/a ~ ADDRESS DATE 20 Buckthorn Drive /I L ~'l... Carlisle, P A 17013 ADDRESS DATE 19 Brookwood A venue, Suite 106 II Z Carlisle, P A 17013 Far dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements far disclosure of assets and filing a tax return are still applicable even jf 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 lYIenty-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 decedenfs siblings is 12% [72 P.S. 99116 (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. *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA. INHERITANCE TAX RU\.lRN RESIDENT DECEDENT ESTATE OF Schalles, Dorothy P. I FILE NUMBER 2] - 02 - 00474 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH ] Allfrrst Bank Checking Account No. 00757557]8 (date of death value) ]6,664.84 2 PNC Advisors, Account No. ]6-]0-00]-0220628 215,955.]4 3 Refund from Blue Cross 167.05 4 Refund from Sprint 13.07 5 Income fromPNC Ace\. ]6-]0-00]-0220628 643.]4 6 Iucome from PNC Ace\. 16-] 0-00] -0 114782 Trust Account 2,253.34 7 Income fromPNC Ace\. ]6-10-00]-0220628 ]02.04 8 Miscellaneous Persona] Property ],500.00 TOTAL (Also enter on Line 5, Recapitulation) 237,298.62 *' SCH3JULE H FlINERALEXPENSES& ADMINISTRA11VE COSTS COMMONWEALTH OF PENNSYLVANIA INHEARANCE TAX RETURN AESDENT OECEDENT ESTATE OF Schalles, Dorothy P. I FILE NUMBER 21 - 02 - 00474 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A FUNERAL EXPENSES: I Hollinger Funeral Home & Crematory, Inc. 3,358.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Represenlative(s): Street Address City Slate - Zip Year(s) Commission paid 2. Attorney's Fees Hanft & Knight, P. C. 5,000.00 3. Family Exemption: (If decedenfs address is not the same as cfaimant's, attach expJanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees Fee to Cumberland County Register of Wills to open Estate 276.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs I Fee to The Sentinel to advertise Letters Testamentary 122.99 2 Fee to Cumberland Law Journal to advertise Letters Testamentary 75.00 Total of Continuation Schedule(s) 3.94 TOTAL (Also enter on line 9, Recapitulation) 8,836.43 . SchecUe H FmeraI Expel ,r & M,. lil;bcdiw Costs COI'"61Jed COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Schalles, Dorothy P. I FILE NUMBER 21 - 02 - 00474 3 Certified Mail 3.94 Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIOEHT DECEDENT ESTATE OF Schalles, Dorothy P. I FILE NUMBER 21 - 02 - 00474 Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT 112.67 Sprint telephone bill, Account No. 717-243-8806-715 2 Carlisle Imaging Associates, Account No. CIA-5001781 51.97 3 Bank fee to PNC 31.00 4 Fee for checks 8.50 TOTAL (Also enter on Line 10, Recapitulation) 204.14 REV-1113 EX+ ~) *' SCHEDULE J BENEFICIARIES COUMON'NEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DeCEDENT ESTATE OF Schalles, Dorothy P. I FILE NUMBER 21 - 02 - 00474 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY "_ DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include oubighl spousal disbibutions) I Mary Schalles Cairns daughter 1/2 PNC Advisors 20 Buckthorn Drive I\ccount Carlisle, PA 17013 16-10-001-0220628 and 1/2 residue of estate 2 Robert C. Cairns son-in-law 1/2 PNC Advisors 20 Buckthorn Drive Account Carlisle, P A 17013 16-10-001-0220628 and 1/2 residue of estate Enter dollar amounts for distributions shown above on lines 15 through 18, 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 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I First Presbyterian Church, Carlisle, Pennsylvania 10,000.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 10,000.00 ~@~w LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES I, DOROTHY P. SCHALLES, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind:memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. I I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. 2 I give, devise and bequeath the following specific bequests or property with all insurance proceeds thereon as follows: A. To First Presbyterian Church of Carlisle, Pennsylvania, I bequeath the sum ofTen Thousand Dollars ($10,000.00). . ~~ ...J'._ ; ~~: \:T" 2 :t' :~~ ~ Page I of 8 3: "'" -< Vl -' ::-3 ~:J Ui \Q ~ ~ " """ II, LAST WILL AND TEST AMENT OF DOROTHY P. SCHALLES ~ B. Fund "A" of the Revocable Life Insurance Trust Agreement between Lawrence F. Schalles and Peoples First National Bank and Trust Company, dated August 4, 1958, I bequeath equally to my daughter, MARY SCHALLES CAIRNS, and my son-in- ~ law, ROBERT C. CAIRNS. C. To the extent I would be allowed to determine the distribution of Fund "B" of the Revocable Life Insurance Trust .Agreement between Lawrence F. Schalles and Peoples First National Bank and Trust Company, dated August 4, 1958, I would bequeath same equally and per stirpes to my daughter, MARY SCHALLES CAIRNS, and my daughter, AUDREY JOAN GRECO. 3 I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate to my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIRNS, equally, providing that they survive me by sixty (60) days. lam specifically excluding my daughter, AUDREY JOAN GRECO, from this bequest, as I have provided for her in other ways during my lifetime and MARY SCHALLES CAIRNS and ROBERT C. CAIRNS have provided for me in many ways during my lifetime, including allowing me to live with them for many years. 4 Should my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIR.J.~S, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds . thereon of whatsoever nature and wheresoever situate as follows: Page 2 of 8 \ , , \ , ( LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES ~ ~ A. Five percent (5%) to my grandson, NORBOURNE WILSON CADY, III, currently residing in Maui, Hawaii. B. Twenty percent (20%) to my granddaughter, KIMBERLY A. LeROY, currently residing in Renfrew, Pennsylvania. -. '\ C. Twenty-Five percent (25%) to my granddaughter, LAURA ELLEN CAIRNS. currently residing in Carlisle, Pe!\l1sylvania. D. Twenty-Five percent (25%) to my granddaughter, NANCY CAIRNS JACKSON, ) currently residing in Bel1evue, Nebraska. E. Twenty-Five percent (25%) to my granddaughter, JENNY LOUISE CAIRNS. currently residing in Frederick, Maryland. It is further my desire that my personal representative, after consultation with any heir or heirs of mine who survive me, and in his, her or its own discretion, choose such articles from my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible evidences ofintangible personal property) as he, she or it believes will be useful to such heir or heirs or desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the further exercise of his, her or its discretion, provided no other heir objects to the distribution. AI1 tangible personal property not so distributed is to be sold, either publicly or privately, by my personal representative, adding the proceeds of such sale or sales to my residuary estate and to be disposed of in equal shares among my surviving heirs after payment of my estate debts, taking into account the tangible personal property otherwise provided to them. 5 .I grant my personal representative the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: Page 3 of 8 ~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES (d) (e) (f) (g) (h) '. (i) (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. To operate any business that I may own at my death. To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her, or its absolute discretion. To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. To distribute in cash or in kind upon any division or distribution of my estate. '\ ( ( (b) ~ c (c) Page 4 of 8 To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. In general, to exercise all powers in the management of my estate which any '\: ~Q' individual could exercise in the management of similar property owned in his own "" right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES (j) (k) 6 No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. 7 I nominate, constitute and appoint my daughter, MARY SCHALLES CAIRNS, and my son-in-law, ROBERT C. CAIRNS, as Co-Executors of this my Last Will and Testament. In the event they are deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my attorney, MICHAEL J. HANFT, ESQUIRE, as personal representative of this my Last Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duti~s in this or any other jurisdiction. Page 5 of 8 ~ ~ '\. ~ LAST WILL AND TESTAMENT OF DOROTHY P. SCHALLES 8 I hereby declare it to be my express desire that my personal representative employ Michael J. Hanft, Esquire of the law linn of Hanft & Knight, P.C., of Cumberland County, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. Any mention of Michael 1. Hanft, Esquire and/or Hanft & Knight, P.e. in this my Last Will and Testament, is my free and voluntary act and through no influence by any person. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this l~rHday of March, 2002. WITNESS: / 77~d~ It t? ~7 y'.t. / ~ p;r- Dorothy P. SchaIles c4A~~'JJ'1;''''>>!~ '. Page 6 of 8 ~ c "-. ~ \ " ~ \ . LAST WILL AND TEST AMENT OF DOROTHY P. SCHALLES ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 55. I, Dorothy P. SchalIes, the 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 and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein e~pressed) /~ ()<f'. /". Dorothy P. SchalIes Sworn or affirmed and acknowledged before me by Dorothy P. SchalIes, the Testatrix, this ~day of March, 2002. ;. Page 7 of 8 /~. ):1- /~'r /' ~//h {r/ ''''-./;,.,', / " / l-/ ~ NofariaI Seal Laurie L Wolf. NoIaty Public SouIh MicIdIeton Ty,p" C<Jmbel1and County My Commission El<pIres Jan, 7. 2006 Member. PSMS\'fIoani8 Association Of_ ~ , '\ ~ ( . I I . . LAST WILL AND TEST AMENT OF DOROTHY P. SCHALLES AFFIDA VIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 55. WE, MltII/fn.. J: t-/.#/fl ,the and witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Dorothy P. SchalIes sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. 1~0-!fJ ,fA , c. t+Aer.. :7. YA#PI Sworn or affirmed and subscribed before me by r' this l~dayofMarch, 2002.' - / ' (j /,Ytl/ j-::-/t 1:'0 and 0- . /)// / -/ /ljl ~. / / .-. L,/ ( / -...../ . ~SeaI Laurie L Wolf. NolalY Public Soull1 MiOdIelOO Twp., CumbeIland Counly My ConvnisaiOn E><pIfuJon. 7. 2006 Meml>er. ""'.,."....".. ~OINoIIItea F\lJ$CI" Fcldcr\Firm Docs\Willsl.:649-ldps.....iILwpd Page 8 of 8 ~ \ \ , \ 'J \ ) \ l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HANFT & KNIGHT PC 19 BROOKWOOD AVENUE SUITE 106 CARLISLE, PA 17013 uu____ fold ESTATE INFORMATION: SSN: 168-36-5594 FILE NUMBER: 2102-0474 DECEDENT NAME: SCHAllES DOROTHY P DATE OF PAYMENT: 11/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/05/2002 NO. CD 001848 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,453.19 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MARY S CAIRNS & ROBERT C CAIRNS C/O HANFT & KNIGHT PC CHECK# 112 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WillS $2,453.19 MARY C. lEWIS REGISTER OF WillS ~v~.. ORPHANS' COURT DIVISION OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY P. SCHALLES Date of Death: May 5, 2002 Admin. No. 21-02-00474 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: L State whether administration of the estate is complete: Yes~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No --.K b. The separate Orphans' Court No. (if any) for the personal representative's account IS: c. Did the personal representative state an account informally to the parties in interest? Yes~No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: January 7,2003 Respectfully submitted, HANFT & KNIGHT, P.c. M~pff Attorney ID No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 (717) 249-5373 Counsel for personal representative f:'..U'crFoldcr\FirmDo<,\EsI.lc....]649-I,slalus.rpl....-p<l /;l-b;g -;(.9 "\... BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MICHAEL J HANFT ESQ HANFT & KNIGHT 19 BROOKWOOD AVE 106 CARLISLE PA 17013,1410 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-06-2003 SCHALLES 05-05-2002 21 02-0474 CUMBERLAND 101 *' REY-lS47 EX .o.rp (Ol.-O~) DOROTHY P Amount Remitted 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 ~ iiE-V"=is4TETAFP--coi-=o3j--iiiiYicE--o,,-YliHEifiTAN-cE-YA"x-APPRA-isEifE"ii'T-,--AiXowAircE-iJ-R"-----------m--- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SCHALLES DOROTHY P FILE NO. 21 02-0474 ACN 101 DATE 01-06-2003 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 Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets <I) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 237.298.62 .00 .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 8,836.43 (9) ClO) 204.14 11. 12. 13. 14. Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. (S) 237,298.62 Cl1) Cl2) Cl3) (14) Q.n4n ~7 228.258.05 10.000.00 218,258.05 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. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS' Cl5) .00 X 00 .00 (16) 218,258.05 X 045 = 9.821.61 (17) .00 X 12 .00 (18) .00 X 15 .00 (19)= 9,821.61 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-02-2002 CDOO1477 368.42 7,000.00 11-15-2002 CDOO1848 .00 2,453.19 TOTAL TAX CREDIT 9,821.61 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)