The URL can be used to link to this page

Home My WebLink About02-0496 ._~--_.,--,,--_.- Register of Wills of York County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of ETHEL M. BARROUK No. Jll-oa. C/,~ also known as ,Deceased Social Security No. 193-14-6796 DONNA M. CROMER Petitioner(J:) who is/8{I( 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW) I]) A. Probate and Grant of Letters Testamentary and aver that Petitione$!. is/ane the executeix named in the last Will of the decedent, dated December 21, 2001 and codicil(s) dated NIL ( State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: o 8. Grant of Letters of Administration (d.b.n.c.t.a.; pendente lite; durante absentia; durante mmoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach addItional sheets if necessary Decedent was domiciled at death in or principal residence at 824 Lisburn (Lower Allen Township) Decedent, then 79 years of age, died May 10 Road, Camp Hill, PA 17011. Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of Real Estate in Pennsylvania Cumberland County, Pennsylvania, with his/her last family Road, Apartment #307, Camp Hill, Pennsylvania 17011 (list street, number, and municipality) ,20 ~,at "The Woods", 824 Lisburn (Location) 41.000.00 $ $ $ $ situated as follows: Wiherefore, Petitione$) respectfully request(s) the probate of the last Will ~!lil(w presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Donna M. Cromer 116 Pebble Brook Circle Madison, AL 35758 snacelWillsPetGrantLtI2001 11-{,S-7 ;,,'-_..:.~~-~._<';;'._:....:...-"':":'~~ ~::.....~:; Oath of Personal Representative. Commonwealth of Pennsylvania County of York The Petitione~ above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitione~ and that, as personal representativ~ of the Decedent, PetitionW will well and truly admi~er the estate accordin; to law. Sworn to or affirmed and subscribed ~jn I/J U!I. '--JJ!. ~1U!/'J 21st DONNA M. CROMER ff;I( No. 0;2./- 602- - "S/9~ Estate of ETHEL M. RARROUK Deceased Social Security No.: 193 14 AND NOW, MAY 21st 6796 Date of Death: May 10, 2002 ,20 02 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary 0 Of Administration are hereby granted to DONNA M. CROMER d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate in the above estate and that the instrumentE!;l dated December 21 , 2001 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . . . . . . $ 80.00 Short Certificate(~.$ 12.00 Renunciation. . . . . . . $ r /JSZ73iSU;:::' Wills MARY C. WM~~ESOUIRE 2PV~~ LEWIS Attorney: Affidavits ( )....... $ Extra Pages ( ~.....$ 6.00 I.D. No: 15893 124 West Harrisburg Street Pest Gffiee BSJ[ 318 Address: Codicil. . . . . . . .. . $ Di11sburg, PA 17019-0310 JCP Fee. . . . . . . .$ 5.00 Telephone: 717-432-9733 .'!)", .., \ inventory. . . . . .. ...$ ,.. if'- J. ;.u. Automation Fee. . . . . $ Other............. .$ TOTAL. .. . ... . $ 103.00 snaceMli IIsPetGrantLV200 1 MAILED LETTERS TO A'T'IDRNEY ON MAY 22ND, 2002 C:\MyDocIWiII. 2001 Barrouk Ethel iUCl~t 1mrill ClUe QItgtctttt~ut 21-2002-t96 OF ETHEL M. BARROUK BE IT REMEMBERED, that I, ETHEL M. BARRa UK, unremarried widow, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM I: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regard to any limit that may be prescribed by a court oflaw. ITEM 2: I direct my Executrix to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate. It is my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my children, namely, DONNA M. CROMER and PETER C. BARRa UK, in equal shares, per stirpes. I have full confidence in my son and daughter, and I know that they will make a wise distribution between themselves as to my ~ ~ "\ "" "" f\ ~ '" ~ \(' ~ personal property, and that they will honor my desire that neither the cut glass which I own, nor my jewelry, ever be sold, but that these items be retained in their respective families. ITEM 4: I nominate, constitute and appoint, my daughter, DONNA M. CROMER, as Executrix of this my Last Will and Testament, providing that she not be required to furnish bond or oth~ety for the faithful performance of her duties as such Executrix. " IN WIT~ESS ~HEREOF, I have hereunto set my hand and seal this Z/.<tr day of -4 u..vm.I-eA-/ , 200 L :E~' A c. "-"/ /;:;. a/l/V~L ETHEL M. BARROUK The preceding instrument, consisting of this and one (I) other typewritten page, was on the day and date thereof signed, sealed, published, and declared by the Testatrix herein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. (~p-x_ OF 0Jz4~P& , / -( :-il / /}J A// . 1~7---/A4;lj '. . /'7/J/9 OF Page -2- COMMONWEALTH OF PENNSYLVANIA SS. f COUNTY OF YORK and the e atrix and the witnesses, respectively, oing instrument, being first duly sworn, do hereby declare to the undersigned au hority that the Testatrix signed and executed the instrument as her Last Will and Testament, 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 witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. c ~ '-hI. ga.{4.oA<A~ EZ~UK , L~ (2 . "I ~ /,." 1/ / ,:/ I /'111'4,{'d .. SWORN TO AND SUBSCRIBED BEFO --.......-.. I [ .i',""'.-"',..,," ~,-""".",, , "'.' ,,,. "'.' ...- .....'..', . - . i),1'o,:'_"_"<' I:.::_~.,::.. ~:':"\,_. "l"':.:,~ My C"'-"'~"-' ('" :,_,.- "'" -,.... .,'v - ~ II ....~:.: ~~.:.._ v~;_~.-:-:':;::-,'~:~.;-:-::~;;:',:'"'I Memner,p",r;;:.sf\iaC';:...P",$I;.-:;l...:,...'IUl' ,,,-,- ,j'.Jf. ~ CERTIFICATION OF NOTICE UNDER RULE S.6Cal Name of Decedent: Date of Death: Estate No. ETHEL M. BARROUK MAY 10, 2002 21-02-0496 To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Mav 24. 2002. Name Donna M. Cromer Address 116 pebblebrook Circle Madison AL 35758 Peter C. Barrouk 50 Leah Drive Dillsburg, PA 17019 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none. Date: ~~~~ . SCHRACK, III, ESQUIRE 124 West Harrisburg Street P.O. Box 310 Dillsburg, PA 17019 (717) 432-9733 Counsel for Personal Representative . 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 by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA In re: THE ESTATE OF: ETHEL M. BARROUK ESTATE NO. 21-02-0496 To: Donna M. Cromer 116 Pebb1ebrook Circle Madison AL 35758 Peter C. Barrouk 50 Leah Drive Di11sburg PA 17019 Please take note of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent, Ethel M. Barrouk, died on the loth day of May, 2002, at the Woods, Lower Allen Township, Cumberland County, Pennsylvania. The personal representative of the Decedent is: Donna M. Cromer 116 Pebblebrook Circle Madison, NJ 35738 (256) 721-3916 The Decedent died Testate, and the will has been filed with the office of the Register of wills of Cumberland County. Register of wills of Cumberland County 1 Courthouse square Carlisle, Pennsylvania 17013 (717) 697-0371 A copy of the will is enclosed. An additional copy of the will may be obtained by contacting the Register of wills and paying the charges for duplication. Date: ~--.4t" r~(),2; / DP /7 ~____ k~, III, ESQUIRE 124 West Harrisburg Street P.O. Box 310 Dillsburg, PA 17019 (717) 432-9733 Counsel for Personal Representative ',--.J ENCLOSURE FOR YOUR INFORMATION Re: Estate of Ethel M. Barrouk Date: 8-6-2002 Our File No,: 21-2002-0496 Your File No,: ~", (-i'l, ') - V5~'; We enclose the following to keep you informed of the progress of this matter: Enclosed find executrix's check No. 106, for'1he sum of $2,000, remitted as a pre-pavment of inheritance tax liability. Please contact us if you have any questions. " I REGISTER OF WILLS CUmberland County Court CARLISLE, PA 17013 House WM. D. SCHRACK, III ATTORNEY A T LAW TO L 124 W. HARRISBURCSTRHT P. O. BodlO DILLSBURG. PA 17019-0310 (717)432-97]] , ... WM. D. SCHRACK III , ATTORNEY AT LAW !24 \V. HAKRI.'illl:R(;STRFF.1 P,O. Box :'110 DII.LSBIIRt:, PA 17019-W-;10 J-\-,6J.-()t.\~(P i 7(;i~:#.:::~:'E2. - li.:"'"''''' " .,' -..-'-....-..- iUS. POSTAGE 1."lJl.nlll"IIPlIlIIII,,,IIIl,'LI.JIIIII.I,,LJI,,11f1l1l1 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT 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 SCHRACK WM D III ESQ 124 W HARRISBURG ST POBOX310 DILLSBURG, PA 17019 nn__n fold ESTATE INFORMATION: SSN: 193-14-6796 FILE NUMBER: 2102-0496 DECEDENT NAME: BARROUK ETHEL M DATE OF PAYMENT: 08/07/2002 POSTMARK DATE: 08/06/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/10/2002 NO. CD 001490 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DONNA M CROMER C/O WILLIAM D SCHRACK III ESQ CHECK#106 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $2,000.00 MARY C. LEWIS REGISTER OF WILLS f/v' STATUS REPORT UNDER RULE 6.12 Date of Death: ETHEL M. BARROUK 05/10/02 Name of Decedent: Will No. 2102-0496 Admin. No. 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 xx 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 xx 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 xx No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 11/1R/O? fl1?I/JM ///. ~.I1~ Signat.ure 37 I/JJ/J4/-/J Address Capacity: XX Personal Representative Counsel for personal representative (MAH:rmfJAM3) 0>.. IN RE: THE ESTATE OF ETHEL M. BARROUK LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2102-0496 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that we, as beneficiaries and heirs of the Last will and Testament of ETHEL M. BARROUK, late of Lower Allen Township, Cumberland County, Pennsylvania, deceased, do hereby acknowledge that we are about to receive from the Executrix of the Last will and Testament of the decedent, a distribution, representing the current balance of our share of distribution in said Will, in full, as total satisfaction and payment of such sum of the Estate of ETHEL M. BARROUK. We desire that the shares of the Estate be distributed without the formality of a court adjudication and final accounting, in order to save expense, publicity, and delays incident to such court proceeding, and authorize the said Executrix to make such distribution upon return of the Receipt and Release. AND, THEREFORE, we, by these presents, remise, release, quitclaim, and absolutely discharge, indemnify and hold harmless the Executors, their 8xecutors, heirs, and administrators, of, and from said legacy, and of and from all action, whatsoever, for or by reason thereof or relating in any way to there administration of the Estate or of any other act, matter, cause, or thing whatsoever from the beginning of the world to the date of these presents. INTENDING to be ~4grj~ bound h~rf'by, We have hereunto set our hands and seals thisc:z::L day of A/~fI.'YL,f~~~' 2 OO~. " ./) '1//" 1./,/ M /,o,~~ " ~ONN~(;:.i~R!~,q~~~~ 'PE~~;UK~/ r I ~ ........-- ,- OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV. 1500 EX.. {6-00) CAPB HpRL EplO CRAC KOTK ES FILE NUMBER D E C E D E N T COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVEN UE OEPT.28Q601 HARRISBURG, fA 17128-0601 DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) Barrouk Ethel M. DATE OF DEATH (MM-DO-YEAR) SOCIAL SECURITY NUMBER 193-14-6796 THIS RETURN MUST BE ALED IN DUPlICATE'MfHTHE REGISTER OF WILLS DelAL SECURIT NUMBE 21-02-0496 YEAR NUUBER COUNTY CODE DATE OF BIRTH <MM-OD-YE.-.R) us 11 29 1922 NAME \. T, lAST, AMO lIA DOLE IN 1A. 3 date of death . Remainder Retum Pflor to 12-13.82) 5. Federal Estate Tax Return Required 8. Tolal Number of Safe DeposIt Boxes 2. Supplemental Return 4a. Futwe Interest Compromise (date of death aftef 1Z-12.-Bl) 7. Decedent Maintained a living Trust (Attach copy of Trust) Spousal Poverty Credit (date of death between 12-31-91.nd 1-1-95) .POIoll)lt 1. Original Return 4. Limited Estate X 6. Decedent Died Testate (....ttach copyofWl11) o 9. Litlg.t1on Proceeds ReceIved 0'0. o 11. E&octlon to tax under Sec. 9113(A) (Attach Sc:h 0) lINF(lI'lt;4A'l',(l~1Iu~ . COMPLETE MAILING ADDRESS C P 0 0 11m. D. Schrack III Es R N FIRM NAME (If Applicable) R D E E \1m. D. Schrack, III Es uire S N T TELEPHONE NUMBER C o M T P A U X I T I o N 124 \I. Harrisburg Street Post Office Box 310 Dillsburg, PA 17019-0310 None None None OFFICIAL USE ONLY (1) (2) (3) R E C A P I T U L A T I o N 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership Of Sole-Proprielorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separale Billing Requested 7. Inter-Vivos Transfecs & M.iscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilnies. & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Velue 01 Estate (Line 8 minus Line 11) 13. Chacitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Velue Sub eel to Tex (Line 12 minus Line 13) (8) 60,845.09 (11) 3.164.07 (12) 57,681. 02 (13) (14) 57,681.02 (4) (5) None 36,151. 24 (6) 24,693.85 None 3 ,094. 77 69.30 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling r:lte 18. Amount of Line 14 taxable at collateral rate 19. Tex Due 20. 57,681.02 x X X X .0 0 .0 45 .12 .15 (15) (16) (17) (18) (19) 0.00 2,595.65 0.00 0.00 2,595.65 Copyrl;ht (c) 2000 form softwue only The Lackner Croup, Inc:. Fo,,"REV-I500 EX <Rov. 6-001 r , Decedent's Complete Address: STREET ADDRESS The lIoods at Cedar Run 824 Lisburn Rd. - Ant. 307 CITY I STATE I ZIP Carnn Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Lina 19) 2. CredilslPayments A. Spousal Poverty Cred~ B. Prior Payments C. Discount (t) 2,595.65 2,000.00 105.26 Total Cred~s ( A + B + C) (2) 2,105.26 3. InteresllPenally ~ applicable D. Interest E. Penally TotallnteresllPenally ( D + E) (3) 0 .00 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is lhe OVERPAYMENT. Check box on Page 1 Line 20 to request a mund (4) 0 . 00 5. If Line 1 + Line 3 is greater lhan Line 2. enter the difference. This is the TAX DUE. (5) 490.39 A. Enter the inlerest on the lax due. (SA) 0 . 00 B. Enter the tolal of Line 5 + SA. This is the BALANCE DUE. (5B) 490.39 """""",,,"'m""I"',,,,'~~mm,,~~;t,~;~~~:'m:~m;;;,,m!""":m~w:~~:~~~~i::~~;:~,~~~~,~,,~g~,~,l:::,,:::,,,,:'i""":;":;;""I',,,'HHI:::i:":::,,,l::l',m::l:m:m:::llm!!lI pLEASE ANSWER THE FoLLoWING QUESTiONS BY pLACING AN i,X" IN THEAPPROPRIA TEBLOCKS 1. Did decedent make a transfer and: Yes No .. retain the use or income of the property transferred; . . ~ ~ b. retain the right to designate who shaU use the property transferred or its income; . c. retain a reversionary interest; or . . . . . , . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 0 0 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death? . . . . . . . . . . . . . . D 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? D 0 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. 1 declare that I have examined this return, Incluc:lfng accompanying schedules and statements, and to the best of my knowledge and belief ,It Is true, correct and complete. Declaration of preparer other than the personal representatl..,.ls basedcn all information oi which preparer has any knowledge. Sl NATURE OF PERSON RESPONSIBLE FOR FILING RETURN Donna M. Cromer 116 Pebb1ebrook Circle --i1~di-;on~--AJL---j57.S8---------------------------- 11m. D. Schrack, III Esquire _ _ _~~,,_ _~: _ ?_~,,;: J-_s.l~lJ.!'_& _ ~!"_r.~~!"_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Di11sbur , PA 17019-0310 DATE II ;; J;/tJ cZ DAT~ ' 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 3010 [72 P.S. 9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or for lhe use of the surviving spouse is 0% [12 P.S. 9116 (a) (1.1) (in}. The statute does not exemot a transfer to a surviving spouse from laX, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the lJse of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) ('.2)]. The lax 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(aXl)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% {72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (cl 2000 form $Oftwareonfy The Lackner Group,lnc. Form REY-l500 EX (RElv. 6-00) . - , . .' REV -1508 E)( ... (1-97} COMMONWEALTH OF PENNSYlVANIA INHERITANCE 11(;( RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ethel M. Barrouk ssg 193-14-6796 05/10/2002 21-02-0496 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM NUMBER 1 Comcast - refund DESCRIPTION VALUE AT DATE OF DEATH 43.10 2 Forethought - refund from prepaid funeral 74.76 3 IRS - tax refund 648.00 4 The Woods - refund 3,729.92 5 First Colony Life annuity contract #2654263 31,655.46 TOTAL (...Iso enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 36,151. 24 JIL-_7.02; 6:16PM;GEFA BLD. TWO ;~3~622297e /I 21 2 " ., . First Colon, UfB A 6E flTlBnci31 Assvr.JIICQ CDmp:my I'Im Colony Ufo !n$IJ"_ Cmr>p.nt 7fXJ Main Slreet P.O. Box 6158 Lynchbutp. VA 245lJ5.G/58 Tall F"", 1881I322-46Z!J AIliUSt 7. 2002 AlIn: William D. Schr.ck, ill F"" No.: 717-432-1053 Re: Decedent; Ethel B=ouk - COnlrQCI No.2654263 Dc... Mr. Schrack: 1bc owner of lbe listed policy was recciviJli an annuity income. As per your request. this Jelle. provides you with annuity inforroation for estale lax purposes. The calculation has been prepared Using the following infonnaUon Ii'om our file for the deceased: Annuilanl/ Sex f Date of Birth T"" Qulllified Plan Issue Stl!.te Iaco= Oplion Payment Start Dale Payment Amount I FJ'eqlMncy Date of Death Ethel BalTOulclFemaJe 111/29/22 No FL Certain life 10 years 08101197 $S81.03/montbly May 10,2002 Th. pre....t volue ofth. annuity income QS of May 10,2002 is 531,655.46. The pre$cnl vQjuc is the value ofthoso payments not yet paid und... the original contract "" of May 10. 2002 and has been prepared in occordance with Internal ReVenUe Code Section 7520 regarding lbe valuation of annuities. The presenl value may nol represent fair market value. The prcscnt value shOWD mlgbt DOl be appropriate for use by aD taxpayers for aD iDcome. gilt aDd estate but repor1:ina purposes. GE Capital Assurance Company makes DO rep.......ntation that the present value ealC!Ulated by GE Capital Assur8Dce CompaDY is appropriate for any plU1icnl8r tlIXpayer. Ynu are adyised to consult a competenl t:lX :ldYlsor re:ardlng your p:ar1:iCtll:lr valuadon needs and obllpJions. ThIs value Is not a eommnlation value, as lbe conlr8et does not contaln 8DY provisions lbal aUow lbe rlgbllO advance. commute. or othenvlse receive unscheduled payments. If I .....y be of furtbc:r ........bulce, pic""" cOnbu:t me ~I 1.888.322-4629 """"'-";011 4242. S;~ly. c-- ~~t DebOt'llh L. l'oIIIner CuStamCl Service Representative o jf ~ I: ~ ,. REV-1509 EX + (1-97) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ethel M. Barrouk SCHEDULE F JOINTLY-OWNED PROPERTY SSfl 193-14-6796 05/10/2002 FilE NUMBER 21-02-0496 " .. asset was made joint withl" one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Donna M. Cromer ADDRESS 116 Pebb1ebrook Circle Madison, AL 35758 RELATIONSHIP TO DECEDENT Daughter B. Kirby William Cromer 50 Glenview Drive Di11sburg, PA 17019 Grandson c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM ~OR JOINT MADE Include name of tlnanclallnstltutlon and bank DATE OF DEATH DECO'S VAlUE OF account number or slmllar identifying number. NUMBER TENANT JOINT Attach deed for Jointly-held re.al estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 05/04/01 j1erri11 Lynch CMA account 47,353.05 50.00% 23,676.53 ~292-14684/Corporate High Yield Fund 2 A B 05/14/01 PNC Bank checking account 3,051. 95 33.33% 1,017.32 ~5003636613 TOTAL (Also enter on line 6, Recapitulation) $ 24,693.85 (It more space ;s needed insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) 11-- MERRILL LYNCH .. ETHEL BARROUK DCSD AND DONNA CROMER JTWROS TOD BENEFICIARIES ON FILE 824 L1SBURN RD # 307 CAMP HILL PA 17011-7101 Monthly Portfolio Summary Asset Cesh/Money Accounts CD's/Equivalents Government Securities Corporate Bonds Municipal Bonds Equities Mutual Funds Options Other Long Market Value Short Market Value Estimated Accrued Interest Debit Balance 04/26/02 Value % 41,139 85 7,O(;r, 15 48..2 06 Net Portfolio Value 48.206 NEWS - Safe, simple sind automatic. The Direct Deposit Service provides transfers of your payroll. Social Security or pension payments directly into your CMA(R) account or CMA SubAccount(SM). Please call 1-80O-MERRILL(R) (637-7455) for more informalion. + ETHEL BARROUK DCSD AND Page 1 of 6 Statement Period 04/27/02 TO 05/31/02 CMA" ACCOUNT Total Account Value As Of 05/31/2002 YOUR FINANCIAL ADVISOR: SDL (863) 382-3000 FOR CUSTOMER SERVICE QUESTIONS: 05/31/02 Value % 47,353 100 47,353 47.353 Account No. 292-14684 Income Summary Tax-Exempt Funds Tax-Exempt Interest Reportable Interest Reportable Dividends Income Not Reported Total Items for Attention Security Purchasing Power 47. 353 Financial Market Indicators Dow Jones Industrial Average Three-Month Treasury Bills Long-Term Treasury Bonds 021004 3039 $47,353.05 Your Merrill Lynch Office: 2623 US 27 SOUTH SEBRING FL 33870 1-800-MERRILL (1-800-637-7455) This Statement 19.55 129.18 148.73 Message No Items For Attention Year-te-Date 92.71 276.00 368.71 Date Investor Credit Line 6.667 This Statement Last Statement 9923.87 1. 72 \ 5.62\ 9946.22 1. 75\ 5.60\ Previous Year-End 10021. 64 1.71\ 5.47\ ;~:jn-;",;:~~~"""=< ......, ....,-::.-. - -.'.~ - .' . - ,'., .... ---"-'~-"----.._---- .-- . -... _._~.~-------- .. . '. -- .' Jl.N--21-~ 09:00 PtCBFN< 412 768 3458 P.0t/01 ~PNCBAN< Junc 20, 2002 Wm, D. Schrack, ill 124 W. Harrisburg Street P.O. Box 310 Dillsburg, PA 17019-0310 RE: Estate of Ethel M. Barrouk, deceased SSN: 193-14-6796 000: 5/1012002 Dear Mr. Schrack: In response 10 your request for Date ofDcath balances for the customer noted above, our records show the following: Checking Acconnt i\ccount#5003636613 Established 05/14/200 1 ETHEL M Bi\RROUK DONNi\ M CROMER WILLIAM KIRBY CROMER DOD balance: $3,051.95 (non-interest bea.ring) Please note that this office only provides date of death balances for deposit accounts (IRi\s, CDs, Checking and Savings accounts). We do not prnccslllDY financial transactions or provide statements. If you need assistance with any of these items, pleasc call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~ u.JUIh.. Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 fim Ave. PlllSburgh PA 15219 Member FDIC TOTAL P. 01 REV-1511 EX t (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COM MONWEAL TH OF PEN NSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ethel M. Barrouk SSII 193-14-6796 05/10/2002 FILE NUMBER 21-02-0496 Debts of d-.lenl must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, B. ADMINISTRATIVE COSTS, t. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney's Fees Wm. D. Schrack, III Esquire 1,750.00 3. Family Exemption: (1f decedent's address is not the same as claimant's, auach explanation) Claimant Street Address City State Zip - Relationship of Claimant 10 Decedent 4. Probate Fees Register of Wills 103.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Airline transportation expenses for Executrix to travel from 1,061. 77 Madison, AL to Dillsburg, PA to arrange for funeral, establish administration, etc. 2 Miscellaneous expense (photocopies, postage) Notary fees, etc. ) 30.00 3 Reserve for future administrative expense 150.00 TOTAL (Also enter on line 9, Recapitulation) S 3,094.77 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems,lnc. Form REV..1511 EX (Rev_ 1-91) REV-151Z EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETA)( RETURN RESIDENT DECEDENT ESTATE OF Ethel M. Barrouk SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSII 193-14-6796 05/10/2002 FILE NUMBER 21-02-0496 Include unr.lmbursed medical .xpen.... ITEM NUMBER 1 DESCRIPTION Comcast - final cable television bill AMOUNT 36.93 2 Sprint . final bill 10.27 3 Verizon - final bill 22.10 TOTAL (Also ontor on lino 10, R.C.D~ul.lion) $ {If mnrA c:oar:A is heftded. insert additional sheets of thA ~alTlA ll:::i"A \ 69.30 REV.1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Ethel M. Barrouk SSII 193-14-6796 05/10/2002 FILE NUMBER 21-02-0496 RELATIONSHIP TO DECEDENT AMOUNT Do Not List T,ustoe(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousaldistrfbutlons, and transfers under Sec.9116(aX1.2)J 1 Peter C. Barrouk 50 Leah Drive Di11sburg, PA 17019 Son 1/2 of residuary estate 2 Donna M. Cromer 116 Pebb1ebrook Circle Madison, AL 35758 Daughter 1/2 of residuary estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) 0.00 .... . , . l~n~t )Jill ano Q[~gtam~ttt OF ETHEL M. BARROUK BE IT REMEMBERED, that I, ETHEL M. BARROUK. unremarried widow, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regard to any limit that may be prescribed by a court oflaw. ITEM 2: I direct my Executrix to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate. It is my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my children, namely, DONNA M. CROMER and PETER C. BARROUK, in equal shares, per stirpes. I have full confidence in my son and daughter, and I know that they will make a wise distribution between themselves as to my ~ '0 .J ..,;,\ -::. ~ ~\~ '" (' ~x~ - ... \, . J , personal property, and that they will honor my desire that neither the cut glass which I own, nor my jewelry, ever be sold, but that these items be retained in their respective families. ITEM 4: I nominate, constitute and appoint, my daughter, DONNA M. CROMER, as Executrix of this my Last Will and Testament, providing that she not be required to furnish bond or oth~etY for the faithful performance of her duties as such Executrix. j IN W~SS ~HEREOF, I have hereunto set my hand and seal this .z./4r day of -#f- tU/>17..H.A-/ , 200 L (!? -htJ/ /:(1. A ~~.A_ ETHEL M. BARROUK The preceding instrument, consisting of this and one (1) other typewritten page, was on the day and date thereof signed, sealed, published, and declared by the Testatrix herein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. (~f/~_ ~ " ~ .,' . :11,>(./ (.-," . .x;f, ~:; .A -"'././ OF /J ./ , OF (),k4~P# r / ,( Jl:' )J/ f7A"f/j);Q; /717;'1 Page -2- - " , " . , , . COMMONWEALTH OF PENNSYLVANIA 55. ~ COUNTY OF YORK and whose names' e signed t ,th attached or oing instrument, being first duly sworn, do hereby declare to the undersigned au hority that the Testatrix signed and executed the instrument as her Last Will and Testament, 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 witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence, SWORN TO AND SUBSCRIBED BEFO Not,3i:il Se.'!l . Janet S. GC!'e. Nct;:Cj' P"Lib1!e Di115bo.!:!"g Be.rol, .Y~,r~ C.m~J 2002 My Commi~ioil f.;.~:.!~ ..Jet. :1_'. Membet.Poi1I'.sf.V8l'Ja~oiNGl::l'.I1I 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 SCHRACK WM Dill ESQ 124 W HARRISBURG ST POBOX310 DILLSBURG, PA 17019 n_nn_ fold ESTATE INFORMATION: SSN: 193- 1 4-6796 FILE NUMBER: 2102-0496 DECEDENT NAME: BARROUK ETHEL M DATE OF PAYMENT: 11/26/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/10/2002 NO. CD 001887 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $490.39 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: WILLIAM D SCHRACK III ESQUIRE CHECK#108 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $490.39 MARY C. LEWIS REGISTER OF WILLS /7-66-- 7 ~ 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 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN WM D SCHRACK III 124 W HARRISBURG PO BOX 310 DILLSBURG ESQ ST PA 17019 01-20-2003 BARROUK 05-10-2002 21 02-0496 CUMBERLAND 101 '* REV-1547 EX'FP UI-05> ETHEL M Allount Relllitted I CHANGED III (21 (31 (41 (51 (61 (71 .00 .00 .00 .00 36.151. 24 24.693.85 .00 (81 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=ls4'-EiCAFP-filFii3rNoYicniF-YN"HEifiTANcrYA"iril-PPRAisEifENT:--ALUiwANCro-i----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BARROUK ETHEL M FILE NO. 21 02-0496 ACN 101 DATE 01-20-2003 TAX RETURN WAS: (X I 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/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule fJ 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule HJ 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 (91 llOI 3,094.77 NOTE: To insure proper credit to your account) submit the upper portion of this form with your tax payment. 60,845.09 3.164 07 57,681.02 .00 57,681.02 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ 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' 69.30 ll1l ll21 ll31 ll41 ll51 .00 X 00 = .00 (161 57,681.02 X 045 = 2,595.65 ll71 .00 X 12 = .00 ll81 .00 X 15 = .00 ll9)= 2,595.65 . "ATn.N '+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-I 08-07-2002 CDOO1490 105.26 2,000.00 PAYMENT MUST BE MADE BY 02-10-2003~. TOTAL TAX CREDIT 2,105.26 BALANCE OF TAX DUE 490.39 INTEREST AND PEN. .00 TOTAL DUE 490.39 A 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" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I \./j-t:~ ? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-UD7 EX AFP (01-05) WM D SCHRACK II I 124 W HARRISBURG PO BOX 310 DIL LSBURG ESQ ST DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 BARROUK 05-10-2002 21 02-0496 CUMBERLAND 101 ETHEL M Amount Remitted PA 17019 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 form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiEV=i6oTEx-AF:i.-coFii3Y------iiii.--INifERI"TANcrTAX--sTA-iEHEN'r-iIF-Ac-co[iifi--..ii--------------------- ESTATE OF BARROUK ETHEL M FILE NO. 21 02-0496 ACN 101 DATE 01-21-2003 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: 01-20-2003 PRINCIPAL TAX DUE:.. 2,595.65 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-07-2002 CDOO1490 105.26 2,000.00 11-26-2002 CDOO1887 .00 490.39 TOTAL TAX CREDIT 2,595.65 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 $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I 11-".:;- 7 '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2B0601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT . DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-04-2003 BARROUK 05-10-2002 21 02-0496 CUMBERLAND 101 WM D SCHRACK III 124 W HARRISBURG PO BOX 310 DILLSBURG ESQ ST PA 170,19 Allount Rellitted *' REV~1593 H AFP (ol-as) ETHEL M 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, subllit the upper portion of this form with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rifv=iS9:3-Elf-AFi>-fol-=03)------.ii-iN-HERi-iANc-i-TA-i-RE-CORIi-ADj-USTM-iNT--..----------------------------- ESTATE OF BARROUK ETHEL M FILE NO. 21 02-0496 ACN 101 1. Real Estate {Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule OJ 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property {Schedule FJ 7. Transfers (Schedule G) 8. Total Assets DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adllinistrative Costs/ Miscellaneous 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 ADJUSTHENT BASED ON: VALUE OF ESTATE: ADMINISTRATIVE CORRECTION 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. III (2J (31 (41 (51 (61 (71 .00 .00 .00 .00 36,151. 24 24,693.85 .00 (BI DATE 02-04-2003 191 llOI 3,094.77 69.30 60,845.09 3,164.07 57,681.02 .00 57.681.02 .00 2.595.65 .00 .00 2,595.65 . .<~<.. ,~, AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 08-07-2002 CDOO1490 105.26 2,000.00 11-26-2002 CDOO1887 .00 490.39 TOTAL TAX CREDIT 2,595.65 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FDR CALCULATION OF ADDITIONAL INTEREST. (111 1121 1131 1141 ll51 ll61 ll71 ll81 .00 X 00 57,681.02X 045= .00X12 = .00X15 = ll91 IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CHI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I REV-1470 EX (5-88) ,*, INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER BARROUK, ETHEL M. 21 02-0496 REVIEWED BY ACN MARTHA J. MILLER 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES THIS NOTICE HAS BEEN ISSUED TO REFLECT ALL PAYMENTS. PaQe 1