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HomeMy WebLinkAbout02-0523 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Claire A. Bowersox No. 2, - 02-5'3_ also known as Claire Bowersox ,Deceased Social Security No. 207-05-6838 Petitioner(s),who,slare 18 yearsofageorolder,apply(ies) for (COMPLETE "A" OR "B" BELOW:) 1JI A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut~ named in the Last Will of the Decedent, dated Februarv 10. 1995 and codicil(s) dated Stale relev3nt circumslanctls, e.g., renunciation, death of execulor, 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: 1JI B. Grant of Letters of Administration (c.t.a.,d.b.ll_c_ta.:pendentelile;duranteabsentia;duranleminoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following soouse (if anv) and heirs: I Name Relationshio Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland principal residence at 1501 Dalkeith Drive, Hampden Township (I;ststreet, number and municipality) County, Pennsylvania, with his/her last family or Decedent, thenj!L years of age, died May 21, 2002, at Holy Spirit Hospital. East Pennsboro Township, Cumberland County, PA (Location) 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 . . . . . . . . . . . . . . . . Total Real Estate situated as follows: $ $ $ $ ......... $ 92.000.00 -0- 92.000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: T ed or rinted name and residence C nthia 1501 Dalkeith Drive Mechanicsbur , PA 17050 Form RW-l Page 1 012 (Dauphin County- Rev. 9/92) \>t-to1:-if Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate accord!!!g to law. n (- .', Sworn to and affirmed and subscribed l -':r~ >~--"- before me this 30th day of MAY 2002. MARY C LEWIS DECREE OF REGISTER Estate of Claire A. Bowersox Deceased No.21- 02 -5Z3 also known as Claire Bowersox Social Security No: 207-05-6838 Date of Death: Mav 21. 2002 AND NOW, MAY 30, 2002 ,2002, 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 TESTAMENTARY are hereby granted to Cvnthia. Rule Cr- " (c.t.a.; d.b.n.c.t.; penoentelite: durante absentia; durante minor itale) in the above estate and that the instrument(s), if any, dated February 10.1995 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters........................... $ 200.00 MARY CLEWIS Register of Wills ~_.",- ,-- ~~-' 8 Short Certificate(s).......... $ 9.00 Renunciation.................. $ Affidavit ()................. $ Extra Pages ( )............ $ 9.00 CodiciL......................... $ JCP Fee........................ $ 5.00 Inventory & Tax Forms... $ Other............................ $ J~Ur Attorney: Wayne M. Pecht I.D. No: 38904 Address: 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Telephone: 717-612-5802 DATE FILED: MAY 30, 2002 ~~~' c..-, '.d 'C TOTAL................ $ 223.00 mailed to ex~c on 5-30-02 LAST WILL AND TESTAMENT OF CLAIRE A. BOWERSOX .2..1-02-52..3 I, CLAIRE A. BOWERSOX, widow woman, of Harrisburg, Dauphin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils previously made by me at any time heretofore. FIRST: I hereby direct that my personal representative, hereinafter named, to pay all of my just debts, funeral and testamentary expenses, including Pennsylvania Inheritance Taxes, as soon after my demise as may be practicable. SECOND: All the rest, residue and remainder of my estate, I hereby give, devise and bequeath as follows: A. TWENTY (20%) PERCENT to my niece, SUSAN KNELLER, B. TWENTY (20%) PERCENT to my niece, LINDA KURTZ, C. THIRTY (30%) PERCENT to my niece, CYNTHIA RULE, and D. THIRTY (30%) PERCENT to my nephew, EARL SNYDER. THIRD: Should SUSAN KNELLER and/or LINDA KURTZ predecease me, their TWENTY (20%) PERCENT share shall pass, per capita, to the other heirs named herein. ~~ ?>r ,J tJj ~~ tJj. 2'5 ( x ~-s:.:. " ~d ro ~ IT " III IT \ " C'. x . (j) ~ t-< FOURTH: Should CYNTHIA RULE and/or EARL SNYDER predecease me, their respective shares shall pass, per stirpes, to their respective children; namely, ANDREA MORGAN, and KATLYN AND RYAN SNYDER, respectively. FIFTH: A. In the event that Paragraph FOURTH becomes operational and any and all of the three (3) children named therein have not attained the age of twenty-one (21), such monies available shall be held in trust until each child reaches that age. B. I hereby designate EARL SNYDER, as Trustee, for any such monies to be held for the benefit of ANDREA MORGAN. C. I hereby designate, CYNTHIA RULE, as Trustee, for any such monies to be held for the benefit of KA TL YN and/or RYAN SNYDER. <-'J (j) Ul c+ '" c+ 'i <-,. behalf of the named beneficiaries before their twenty-first (21st) birthday, if necessary. ~ D. Each Trustee shall have full discretion to expend money on However, BE IT KNOWN THAT, I strongly prefer that no distribution be made before the twenty-first (21 st) birthday; at which time, each trust shall be dissolved and the entire balance, if any, be distributed to said child(ren). SIXTH: I hereby nominate, constitute and appoint my niece, CYNTHIA RULE, of Mechanicsburg, Cumberland County, Pennsylvania, as Executrix of this my, Last Will and Testament In the event that CYNTHIA RULE should predecease me, fail to qualify, cease to act, or for some reason is incapable of performing such task, I then nominate, constitute and appoint my niece, SUSAN KNELLER, as alternate Executrix ~~ ~~ ", ~, . gs~ ;;1') ~r-'::, ~ 1 '" ",' ~ Ul '" ", t-< of this my, Last Will and Testament. SEVENTH: None of the above named persons shall be required to post bond or surety in this or any other jurisdiction for faithful compliance of the office of Executrix and/or Trustee. IN WITNESS WHEREOF, I hereby set my hand and seal and declare this to be my, LAST WILL AND TESTAMENT, consisting of this and two (2) other typewritten pages, identified by my signature, dated on this, the /0 "'Ectay of ,'1/.( t~A'-,'~1.-'I ,19 f: 1 ~ / //)~(v'- 'C. /!!Lf-~~b:U1_l CLAIRE A. BOWERSOX (Testatrix) The preceding instrument, consisting of this and two (2) other typewritten pages, identified by the signature of the Testatrix, CLAIRE A. BOWERSOX, as and for her Last Will; who at her request, in her presence and in the presence of each other have subscribed our names as WITNESSES hereto. () () r\ -) I) tb,::l--L~'Pp--1c->--ReSiding At . \:~~ ,\:,:~ Residing At r COMMONWEALTH OF PENNSYLVANIA) ) COUNTY OF CUMBERLAND ) () (;) WE, " K~c?i'- u'(" k~ , AND IJ. , the Testatrix,' nd the witnesses, respectively, whose mes are signed to the attached and foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix, CLAIRE A. BOWERSOX, signed and executed the instrument as her Last Will, and that she signed and executed it willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, that each of the Witnesses, in the presence and hearing of the Testatrix, CLAIRE A. BOWERSOX, signed the Will as witnesses, and that to the best of our knowledge and sight, was at the time eighteen (18) or more years of age, of sound and disposing mind, memory and under no constraint or undue influence. (/.&. e'~ '~.~"LL"Af-.~' CLAIRE A. BOWERSOX (Testatrix) ~'- (I " /) , i I I, . : 1/ n iJ -,,,C~~ .-r--L.a.._~ ( )... ~~ __k Jl. WitNESS . :) ~, ~ \;~ \L \ LJ( WITNESS Subscribed, sworn to and acknowledged before me by CLAIRE A. BOWERSOX, the Testatrix, who personally appeared before me, the undersigned officer, and sup-sgibed to 'j>worn to by th IT SSES,/() (I . V -Q'"" (e and P-. . v-.... " I<L-on thl~- / the (1\ day of .;: ') " 19k. c--------- , ~~zie {L.. NOTARY PUBLIC -- My Commission Expires: Notarial Seal Donald 8. Owen, Notary Public East Pennsboro Twp., Cumberland County ~,1y Commission Expires Nov. 24, 1996 M.n1b<lr, P""n.l'lv.ru"~ 01 Notane. , E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Claire A. Bowersox Date of Death: May 21,2002 Will No.: 2002-00523 To the Register: I certify that notice of estate administration required by Rule 5.6 ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries ofthe above-captioned estate on June 7, 2002: Susan Kneller Linda Kurtz Cynthia Rule Earl Snyder 908 Magnolia Road, Hellertown, P A 18055 1374 Main Street, Hellertown, P A 18055 1501 Dalkeith Drive, Mechanicsburg, PA 17050 616 14th Avenue, Bethlehem, PA 18018 Notice has now been given to all persons entitled thereto under Rule 5.6 (a). Date: l.c 1-, I cd-.. ~~ Cynt ia Rule 1501 Dalkeith Drive Mechanicsburg, P A 17050 Capacity: Personal Representative I::: 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, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of Claire A. Bowersox, deceased, Estate No: 2002-00523 TO: Susan Kneller 908 Magnolia Road Hellertown, PA 18055 Please take notice of the death of decedent and the grant of letters to the personal representative named below. The Decedent, Claire A. Bowersox, died on the 21" day of May 2002, at East Pennsboro Township, Cumberland County, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, PA 17050 The Will has been filed with the Office of the Register of Wills of Cumberland County, Hanover and High Streets, Carlisle, P A 17013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. u/,(eJ.. ~~{o Cynt a Rule 1501 Dalkeith Drive Mechanicsburg, P A 17050 Date: Capacity: Telephone 717-975-2741 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, COUNTY OF CUMBERLAND, CARLISLE, P A In re Estate of Claire A. Bowersox, deceased, Estate No: 2002-00523 TO: Linda Kurtz 1374 Main Street Hellertown, PA 18055 Please take notice of the death of decedent and the grant ofletters to the personal representative named below. The Decedent, Claire A. Bowersox, died on the 21" day of May 2002, at East Pennsboro Township, Cumberland County, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, PA 17050 The Will has been filed with the Office of the Register of Wills of Cumberland County, Hanover and High Streets, Carlisle, P A 17013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: G/{/{)~ . ~7L- Cynthi Rule 1501 Dalkeith Drive Mechanicsburg, P A 17050 Capacity: Telephone 717-975-2741 Personal Representative . IMPORTANT NOTICE NOTICE OF EST ATE 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. Ifthe 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, COUNTY OF CUMBERLAND, CARLISLE, P A In re Estate of Claire A. Bowersox, deceased, Estate No: 2002-00523 TO: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, PAl 7050 Please take notice of the death of decedent and the grant ofIetters to the personal representative named below. The Decedent, Claire A. Bowersox, died on the 21" day of May 2002, at East Pennsboro Township, Cumberland County, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, PAl 7050 The Will has been filed with the Office of the Register of Wills of Cumberland County, Hanover and High Streets, Carlisle, PAl 7013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: Loll (Od-, ~~L Cynthi Rule 1501 Dalkeith Drive Mechanicsburg, PAl 7050 Capacity: Telephone 717-975-2741 Personal Representative IMPORTANT NOTICE NOTICE OF EST ATE 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, COUNTY OF CUMBERLAND, CARLISLE, P A In re Estate of Claire A. Bowersox, deceased, Estate No: 2002-00523 TO: Earl Snyder 616 14th Avenue Bethlehem, P A 18018 Please take notice of the death of decedent and the grant ofletters to the personal representative named below. The Decedent, Claire A. Bowersox, died on the 21" day of May 2002, at East Pennsboro Township, Cumberland County, Pennsylvania. The Decedent died testate (with a Will). The personal representative of the Decedent is: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, P A 17050 The Will has been filed with the Office of the Register of Wills of Cumberland County, Hanover and High Streets, Carlisle, P A 17013. Phone number 717-240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: U; (, /0 d-, Cynthi~ ~ 1501 Dalkeith Drive Mechanicsburg, P A 17050 Capacity: Telephone 717-975-2741 Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX{11-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RULE CYNTHIA 1501 DALKEITH DR MECHANICSBURG, PA 17050 nnn__ fold ESTATE INFORMATION: SSN: 207-05-6838 FILE NUMBER: 2102-0523 DECEDENT NAME: BOWERSOX CLAIRE A DATE OF PAYMENT: 08/21/2002 POSTMARK DATE: 08/20/2002 COUNTY: CUMBERLAND DATE OF DEATH: OS/21/2002 NO. CD 001551 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $14,250.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CYNTHIA RULE CHECK# 93 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $14,250.00 MARY C. LEWIS REGISTER OF WILLS Rule ISO! Dalkeith Drive Mechanicsburg, P A 17050 flUIIIIIIIIIIIIIIW 1111 m '" '<':.',t' ,,' .. /- ~, " .. .i:~/ 7002 1000 0005 0062 3861 "-:z5 O;2-':::;>C VIA CERTIFIED MAIL Register ofWiJI< "f< 'umberland County One Courthouse c,'1uare Carlisle, PA 17(1J; ~ -: ~. :t .'".:: ~: 'j::. _.- -' .....~:~:-:..'-~~ ~...-...~-<+":- ,~- _...~:,_. .~ .~ "._''''-, -. ~-, '~.,~,.~.__.--. "-~--_.._- -- ...'''"-....- .."--,,, ..-----~,~----._.~.._-- /' II II Ii .11././""1.11.1,,1./,,,,11.1 Ill; I 11l1!1I II 111 II 1501 Dalkeith Drive Mechanicsburg, P A 17050 August 20, 2002 VIA CERTIFIED MAIL Register oC'.Vills cf CurubeJ."land County One Courthouse Square Carlisle, PA 17013 Re: Estate of Claire A. Bowersox, deceased Date of Death: May 21,2002 Countv File No: 2002-00523 Dear Madam: Enclosed is an estate check in the amount of $14,250 which represents a prepayment of Pennsylvania Inheritance Tax for the above-referenced estate calculated as follows: Taxable Estate Tax Rate $100,000.00 .15 $ 15,000.00 050.00) Less 5% Discount P A Inheritance Payment $ 14250.00 Please date-stamp and return the enclosed copy of this letter acknowledging receipt of this payment. A return envelope is enclosed for your use. If you have any questions, please call me. Very truly yours, ~L~ Enclosure / REV-1~00 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 1712B-0601 RESIDENT DECEDENT 21 2002 0523 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Bowersox, Claire A. 207-05-6838 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT OS/21/02 09/07/1918 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ 1. Original Return ~' Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-:82) PRIATE 6. Decedent Died Testate 7. Decedent Malntamed a LIving Trust 00 B. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (datE! of death between 0 11. ElectIOn to tax under Sec. 9113(A) 12-31-91 and 1-1-95j (Attach Sch OJ :wl$$~1tii9~MQjlj;Ili$pPi\ljij!$ll;;p;AJ.ikp6ijij!l$IiQt>lP~ffj@l~pQ~ijip!#iitiAtTAll)jiii@ijMl\rjQ~$IiQijL&~$QiR$pfl;@:tQi NAME COMPLETE MAILING ADDRESS COR- Wayne M. Pecht, Esquire 415 Fallowfield Road, suite 301 RE- FIRM NAME (11 Applicable) Carrp Hill, PA 17011-4906 SPON DENT Keefer Wood Allen & Rahal, LLP TELEPHONE NUMBER 717-612-5802 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnersh'lp or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule 0) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 94,379.12 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) 62.85 RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 15,175.00 8. T etal Gross Assets (total Lines 1 -7) (B) 109,616.97 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 4,995.41 10. Debts of Decedent, Mortgage Liabllities, &. Uens (Schedule \) (i0) 113.15 11. Total Deductions (total Lines 9 & 10) (11) 5,108.56 12. Net Value of Estate (Line 8 minus Line 11) (12) 104,508.41 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 104,508.41 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a}(1.2) X .0 (15) TAX 16. Amoun1 01 Une 14 taxable at lineal rate 0.00 X.O 45 (16) 0.00 0.00 - 0.00 COMPU- 17. Amountofline14til,xableil,tsiblingrate X .12 (17) TATION 1B. Amountof Lins 14 taxable at collateril,l rate 104,508.41 X .15 (1B) 15,676.26 19. Tax Doe (19) 15,676.26 20. 0 !g.W;PKll$ji!lil;'MoiiJi.iji!lRi!lQi.!!1,$tI~Al'(awNPpit)WQveFi!1AYM~f1t.1 /1-6-?- ^I <-- . .' ;".BE..SURE TO.ANSWER ALLGiI"ESTIONS'mrPA"E 2 AND' RECHECK MATH~<. o PA15001 N1F 29755 Copyr'lght 2000 Grsatlil,nd/Nelco LP- Forms Software Only Estate of: Claire A. Bowersox SUMMARY OF ALLCCATIONS TO BENEFICIARIES Taxable at collateral rate Susan Kneller Linda Kilrtz Cynthia Rule Earl Snyder 17,854.11 17,854.11 42,019.02 26,781.17 104,508.41 21~2002~0523 PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS 1501 Dalkeith Drive CITY T STATE \ ZIP Mechanicsburq PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2.. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 15,676.26 14,250.00 750.00 Total Credits (A + B + C) (2) 15,000.00 3. Interest/Penalty i1 applicable D. Interest E. Penalty (3) 0.00 (4) (5) 676.26 (5A) 0.00 (58) 676.26 Totallnterest/Penalty (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 Une 2Q to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. . Make. Check Payable to:. .REG.ISTER. OF. WILLS,. AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. 2. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the nghtto designate who shall 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? If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . Did decedent own an "in trust tor" or payable upon death bank account or security at his or her death? Did decedent own an Individua.l Retirement Account, annuity, or other non-prObate property which contains a beneficial}/ designation? . . . . . . . . . . . . . . . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~ I B ~ 3. 4. o o EPRESENTATIVE DATE J-/9-0,J ADDR SS Keefer wcxx:l. Allen & Raba1, LLP, 415 Fallawfield Road, Carq:l Hill, PA 17011-4906 :)}j;({(Ht:?/t:::::::\tj)::;:))})tj:tf:ttY}?//:tt/:tIt))})tt))j)H})j}tttt:{t:ttt}J}::::;'t})}}Y'tt:::;:'j:::tt}):/f}}t:\:};:t)}}U/J)}}))J):t:\,(:):C/?\::Y:);:)),::')))),;:)):;j'::{" For dates of deat'h on or after July 1,1994 and before January 1, 1'395, the tall fate impDsed on'\:\\e net value 01 transfers to or 10rtl1e use of the surviving spouse is 3% [72 P.S. 9 9116(a)(1.1}(i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to orforthe use of the surviving spouse is 0% [72 P.S.!j 9116 (a.) (1.1J(iiJ]. ThE statute rlOF'~ nnt p"pmot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicabie 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 netvaiue of transfers from a deceased child twenty-one years of age or younger at death to or forthe llse of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The lax rate imposed on t'ne 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.!j 9116(1.2) [72 P.S.!Jj 9116(a){1)J. The tax rate imposed on the net value of transfers to orfortne llse of the deceder'lt's siblings is 12% [72 P.S.!j 9116(a}(1.3)J. Asibling is defined, under Section 9102, as an individual who hasat least one parent in common with the decedent, whether by blood oradoption. o PMS002 N1F 29756 Copyright 2000 Greatland/Nelco lP - Forms Software Only Estate of: Claire A. Bowersox 21-2002-0523 The following person (s) are signing the return as representative (s) of the estate: Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, AP 17050 REV-15G8 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire A. Bowersox SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2002-0523 ITEM NO. DESCRIPTION Include proceeds of litigation & date proceeds were received by the estate. All Drop. Jolntlv-owned with right of survivorship must be disclosed on Sch. F. 1 Waypoint Bank Savings ACCOlillt #200053264 2 Interest accrued to date of death on Waypoint Bank savings ACCOlillt #200053264 3 waypoint Bank Certificate of Deposit #259284393 dated 2/20/96 4 Interest accrued to date of death on Waypoint Bank Certificate of Deposit #259284393 5 uncashed interest check fran Waypcint Bank dtd 4/30/02 for certificate of deposit #259284393 6 First union Bank Certificate of Deposit #247412064677226 dated 11//02/87 7 Interest accrued to date of death on First union Certificate of Deposit #247412064677226 8 First union Certificate of Deposit #247412064677218 dated 11/02/87 9 Interest accrued to date of death on First union Certificate of Deposit #247412064677218 10 First union Certificate of Deposit #2474l20577l550l dated 3/07/94 11 Interest accrued to date of death on First union Certificate of Deposit #2474l205771550l 12 First union Certificate of Deposit #247412061l03666 dated 3/20/2000 13 Interest accrued to date of death on First union Certificate of Deposit #247412061103666 14 First union Checking AcCOlillt #l000643109684 15 Interest accrued to date of death on First union Checking AccOlillt #1000643109684 16 First union Checking AcCOlillt #1010041725485 Total fran continuation naoe(s) VALUE AT DATE OF DEATH 9,991.71 6.79 11,500.00 14.68 22.02 5,045.57 7.64 5,045.57 7.64 lO,500.00 11.70 17,435.38 6.64 5,738.62 0.95 28,618.05 426.16 $ 94,379.l2 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco, Inc. Page 2 Estate of: Claire A. Bowersox 21-2002-0523 SCHEDULE E -- Cash, Bank Deposits and Miscellaneous Personal Property Item No. Description Value at Date of Death 17 Interest accrued to date of death on First Union Checking Account #1010041725485 20.35 18 National Association of Letter Carriers Health Benefit Plan -- reirrtJurserrent 73.55 19 IRS -- 2002 Incare Tax refund 300.00 20 Moffitt Heart & Vascular Group -- refund 32.26 'IOTI\L. (Carry forward to l1Bin schedule) . . . . . . 426.16 REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire A. Bowersox SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-2002-0523 If an asset was made Joint within one year of the decedent's date 01 death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A Cynthia Rule ADDRESS 1501 Dalkeith Drive Mechanicsburg, AP 17050 RELATIONSHIP TO DECEDENT Great-Niece JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name 01 financial institution and bank DATE OF DEATH DECO'S VALUE OF JOINT account number or similar identifying number. NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1 A 11/20/81 $25 U.S. Savings Bond dated 125 .71 50% 62.85 6/72 TOTAL (Also enter on line 6, Recapitulation) $ 62.85 7 CPA91 NT\' ,Og(lg (\1 more space is needed, insert additional sheets of the same size) Copyright Forms Softwa.re Only, 1997 Nelco, Inc. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire A. Bowersox SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2002-0523 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 .l\nerican General Annuity #FJ215141 15,175.00 dtd 6/12/2000; beneficiary Cynthia J. Rule TOTAL (Also enter on fine 7, Recapitulation) $ 15,175.00 7 CPA01 NT\" 1(\910 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1897 Nelca, Inc. REV-t511 EX . (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claire A. Bowersox SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2002-0523 Debts 01 decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Neill Funeral Hare - - balance due 642.97 2 Sneeringer Merrorials -- lettering on graverre.rker 170.00 3 Cynthia J. Rule - - reimburserrent for funeral luncheon 117.25 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 3,000.00 Name 01 Persol1al Representative(s) Cynthia J. Rule Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 1501 Dalkeith Drive - City Mechanicsburq, State PA Zip 17050 Year(s) Commission Paid: 2003 2. Anomey Fees Narre : Keefer Wood Allen & Rahal, LLP 500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 223.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Curriberland COilllty Bar Association n legal advertising 75.00 8 The Patriot-News n legal advertising 114.19 9 Keefer Wood Allen & Rahal, LLP - - reimburserrent for postage and 100.00 photocopies 10 Register of wills of Cumberland COilllty -- filing fees 53.00 TOTAL (Also enter on line 9, Recapitulation) $ 4,995.41 (tt more space is needed, insert additional sheets 01 the same size) 7 CPA11 NTF 10911 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TN< RETURN RESIDENT DECEDENT ESTATE OF Claire A. Bowersox Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2002-0523 DESCRIPTION AMOUNT 1 West Shore EMS balance due 39.60 2 West Shore EMS balance due 73.55 . 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (\1 more space is needed, insert additional sheets of the same size) 113.15 Copyright Forms Software Only, 1997 Nelco, Inc. REV-f513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Claire A. Bowersox No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Susan Kneller Hellertown, PA 18055 2 Linda Kurtz Hellertown, PA 18055 3 Cynthia Rule 1501 Dalkeith Drive Mechanicsburg, AP 17050 4 Earl Snyder 616 14th Avenue Bethlehem, PA 18018 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) Niece Niece Great-Niece Great-Nephew 21-2002-0523 AMOUNT OR SHARE OF ESTATE 17,854.11 17,854.11 42,019.02 26,781.17 ENTER DOLLAR AMTS. FOR DISTRIBS. 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 None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 1,09,3 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ Copyright Forms Software Only, 1997 Nelco, Inc. (\1 more space is needed, insert additional sheets of the same size) 0.00 WHEREAS, on the 30th dated February 10th 1995 was admitted to probate as the last will of BOWERSOX CLAIRE A (LAo;'1', t'lKo; 1, lVlllJlJLJ:;;) """'<1,',;,_..._ ..' "e ..... ,(I) (r. ,), .l ,. 'd'<?" ..,......",....... /ii.) ,"I " .....'4' ',J ~J',-,> ~1.~ I - "\. (If) (~~. \ ~'~~~. .1 ::rh.' I::~: \, .. "Vt' I:J ..-,<;00 . ."~. ..... ~~ 1'1' ....f..'. ,.",\ Ii , ~-...'{( a/k/a BOWERSOX CLAIRE CUMBERLAND County, who died on the late of HAMPDEN TOWNSHIP 21st day of May 2002 and, WHEREAS, a true copy of the will THEREFORE, I, MARY C. LEWIS Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2002-00523 PA No. 21-02-0523 ESTATE OF BOWERSOX CLAIRE A (LAO; 1 , tlKo;l, MllJlJLJ:;;) a/k/a BOWERSOX CLAIRE Late of HAMPDEN TOWNSHIP ~UM~bKLill~U LUUNIY, Deceased Social day Security of May 2002 an instrument No. 207-05-6838 as probated is annexed hereto. , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to RULE CYNTHIA who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, of my Office the 30th day I have hereunto set my hand and affixed the seal of May 2002. @ ~ Ii ~ UL~" or .~ **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND TESTAMENT OF CLAIRE A. BOWERSOX :;2/- 02.-523 I, CLAIRE A. BOWERSOX, widow woman, of Harrisburg, Dauphin County, Pennsylvania, being of sound and disposing mind, memory and understanding. do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils previously made by me at . any time heretofore. FIRST: I hereby direct that my personal representative, hereinafter named, to pay all of my just debts, funeral and testamentary expenses, including Pennsylvania Inheritance Taxes, as soon after my demise as may be practicable. SECOND: All the rest. residue and remainder of my estate, I hereby give. devise and bequeath as follows: A. TWENTY (20%) PERCENT to my niece, SUSAN KNELLER. B. TWENTY (20%) PERCENT to my niece, LINDA KURTZ, C. THIRTY (30%) PERCENT to my niece, CYNTHIA RULE, and D. THIRTY (30%) PERCENT to my nephew, EARL SNYDER. THIRD: Should SUSAN KNELLER and/or LINDA KURTZ predecease me, their TWENTY (20%) PERCENT share shall pass, per capita. to the other heirs named herein. ~~ ?> ~ . tp ~~ ~. ~'~. .\ '" ~~ c+ >i f-'. >< (fl ~ , FOURTH: Should CYNTHIA RULE and/or EARL SNYDER predecease me, their respective shares shall pass, per stirpes, to their respective children; namely, ANDREA MORGAN, and KATLYN AND RYAN SNYDER, respectively. FIFTH: A. In the event that Paragraph FOURTH becomes operational and any and all of the three (3) children named therein have not attained the age of twenty-one (21), such monies available shall be held in trust until each child reaches . that age. B. I hereby designate EARL SNYDER, as Trustee, for any such monies to be held for the benefit of ANDREA MORGAN. C. I hereby designate, CYNTHIA RULE, as Trustee, for any such monies to be held for the benefit of KA TL YN and/or RY AN SNYDER. >-3 ro U> ct ~ >; 1-" behalf of the named beneficiaries before their twenty-first (21st) birthday, if necessary. 2.. D. Each Trustee shall have full discretion to expend money on However, BE IT KNOWN THAT, I strongly prefer that no distribution be made before the twenty-first (21 st) birthday; at which time, each trust shall be dissolved and the entire balance, if any, be distributed to said child{ren). SIXTH: I hereby nominate, constitute and appoint my niece, CYNTHIA RULE, of Mechanicsburg, Cumberland County, Pennsylvania, as Executrix of this my, Last Will and Testament. In the event that CYNTHIA RULE should predecease me, fail to qualify, cease to act, or for some reason is incapable of performing such task, I then nominate, constitute and appoint my niece, SUSAN KNELLER, as alternate Executrix ~~ ~~ ?> %.. ~~ ~~ '" <:'. Ul t>1 ~ \ of this my, Last Will and Testament. SEVENTH: None of the above named persons shall be required to post bond or surety in this or any other jurisdiction for faithful compliance of the office of Executrix and/or Trustee. IN WITNESS WHEREOF, I hereby set my hand and seal and declare this to be , my, LAST WILL AND TESTAMENT, consisting of this and two (2) other typewritten pages, identified by my signature, dated on this, the /t'" 4cjay of tJY-~7 ,19 ~f~ ~~'v/'C.&-h-~ CLAIRE A. BOWERSOX (Testatrix) The preceding instrument, consisting of this and two (2) other typewritten pages, identified by the signature of the Testatrix, CLAIRE A. BOWERSOX, as and for her Last Will; who at her request, in her presence and in the presence of each other have subscribed our names as WITNESSES hereto. 9t~f:.{}k'~";d;'" At ~'--',,~ Residing At \ COMMONWEALTH OF PENNSYLVANIA) ) COUNTY OF CUMBERLAND ) WE, ' ~ Q~ ,AND , the Testatrix, nd the witnesses, respectively, whose mes are signed to the attached and foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix, CLAIRE A. BOWERSOX, signed and executed the instrument as her Last Will, and that she signed and executed it willingly, and that she executed it as her free and voluntary act for the p;lrposes therein expressed. that each of the Witnesses, in the presence and hearing of the Testatrix, CLAIRE A. BOWERSOX, signed the Will as witnesses, and that to the best of our knowledge and sight, was at the time eighteen (18) or more years of age, of sound and disposing mind, memory and under no constraint or undue influence. (l~~h~~ CLAIRE A. BOWERSOX (Testatrix) ~f) . . I (~...-L_ WI ESS ' \;2 ~'I:a WITNESS Subscribed, sworn to and acknowledged before me by CLAIRE A. BOWERSOX, the before me, the undersigned officer, and IT SSES.(J K" GL,on thi~........... -- , IS.1.L. , 6~. NOTARY PUBLIC My Commission Expires: Notarial Seal Donald 8. Owen. Notary Public East pannsboro Twp., Cumberland County My Commission Expires Nov. 24, 1996 M_,P~t..._IltNotarieo ...- Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Claire A. Bowersox No. 2002-00523 also known as Claire Bowersox Date of Death Mav 21, 2002 , Deceased Social Security No. 207-05-6838 Cvnthia Rule Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Wayne M. Pecht ~~rLL- 1.0. No.: 38904 Address: Keefer Wood Allen & Rahal, LLP 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 Dated -~fu~3__ Telephone: 717-612-5802 Description Value SEE ATTACHED (Attach Additional Sheets jf necessary) Total $ NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory ForrnRW-7IDauphmCountv_Rev.91911 12. 13. 14. 15. 16. 17. 18. 19. 20. TOTAL Estate of Claire A. Bowersox Date of Death: May 21, 2002 1. 2. Waypoint Bank Savings Account #200053264 Interest accrued to date of death on Waypoint Bank Savings Account #200053264 Waypoint Bank Certificate of Deposit #259284393 dated 2/20/96 Interest accrued to date of death on Waypoint Bank Certificate of Deposit #259284393 Uncashed interest check from Waypoint Bank dtd 4/30/02 for certificate of deposit #2592834393 First Union Bank Certificate of Deposit #247412064677226 dated 11/02/87 Interest accrued to date of death on First Union Bank Certificate of Deposit #247412064677226 First Union Bank Certificate of Deposit #247412064677218 dated 11/02/87 Interest accrued to date of death on First Union Bank Certificate of Deposit #247412064677218 First Union Bank Certificate of Deposit #247412057715501 dated 3/07/94 Interest accrued to date of death on First Union Bank Certificate of Deposit #2247412057715501 First Union Bank Certificate of Deposit #2437412061110366 dated 3/20/2000 Interest accrued to date of death on First Union Bank Certificate of Deposit #2437412061110366 First Union Bank Checking Account #1000643109684 Interest accrued to date of death on First Union Bank Checking Account #1000643109684 First Union Bank Checking Account #1010041725485 Interest accrued to date of death on First Union Bank Checking Account #2020041725485 National Association of Letter Carriers Health Benefit Plan - reimbursement IRS - 2002 Income Tax refund Moffitt Heart & Vascular Group - refund 3. 4. 5. 6. 7. 8. 9. 10. 11. 2002-00523 $ 9,991.71 6.79 11,500.00 14.68 22.02 5,045.57 7.64 5,045.57 7.64 10,500.00 11.70 17,435.38 6.64 5,738.62 0.95 28,618.05 20.35 73.55 300.00 32.26 $94,379.12 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 PECHT WAYNE M ESQUIRE C/O KEEFER WOOD ALLEN RAHAL 415 FALLOWFIELD RD CAMP HILL, PA 17011-4906 __nn__ fold ESTATE INFORMATION: SSN: 207-05-6838 FILE NUMBER: 2102-0523 DECEDENT NAME: BOWERSOX CLAIRE A DATE OF PAYMENT: 02/19/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: OS/21/2002 NO. CD 002188 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $676.26 I I I I I I I , TOTAL AMOUNT PAID: REMARKS: WAYNE M PECHT ESQUIRE CHECK#100 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS - $676.26 DONNA M. OTTO DEPUTY REGISTER OF WILLS ~/"7-~?-~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17126-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX WAYNE M PECHT ESQ KEEFER HAL 415 FALLOWFIELD RD 30 CAMP HILL PA 17011 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2003 BOWERSOX 05-21-2002 21 02-0523 CUMBERLAND 101 *' REV-1547EXAFPIOI_OSl CLAIRE A Allount 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 ~ Rifv=i54-j-EX--AFP--fiiFo3"'n'io;--fcE--OF-YNHEifi'i'AN-Cn'AX-jrppRXfsEHENT:--ALi-owAiicE-ifli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOWERSOX CLAIRE A FILE NO. 21 02-0523 ACN 101 DATE 03-31-2003 TAX RETURN WAS: I X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previoUSly, lines 14, IS 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 (15J 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17] 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax DUB TAX CREDITS: .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 104,508.41 X 15 = 15,676.26 (19)= 15,676.26 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 94,379.12 62.85 15,175.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax (9) (10) 4,995.41 113.15 Ill) (12) (13) (14) NOTE: To insure proper credit to your account3 submit the upper portion of this form with your tax payment. 109,616.97 ~ ]08 ~6 104,508.41 .00 104,508.41 ';ii.iiiBER "'- AMOUNT PAID DATE INTEREST/PEN PAID 1-) 08-20-2002 CDOO1551 750.00 14,250.00 02-19-2003 CD002188 .00 676.26 TOTAL TAX CREDIT 15,676.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)3 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) --- IN THE MATTER OF THE EST A TE OF CLAIRE A. BOWERSOX, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2002-0523 ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT, made this I qk day of ~ 2003, WITNESSETH: THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: 1. Claire A. Bowersox (the "Decedent"), an unmarried woman, died testate on May 21, 2002, and Cynthia 1. Rule duly qualified with the Register of Wills of Cumberland County, Pennsylvania, as Executrix (the "Executrix") of her probate Estate (the "Estate"). 2. The Will provides as follows: Article SECOND: All the rest, residue and remainder of my estate, I hereby give, devise and bequeath as follows: A. TWENTY (20%) PERCENT to my niece, SUSAN KNELLER, B. TWENTY (20%) PERCENT to my niece, LINDA KURTZ, C. THIRTY (30%) PERCENT to my niece, CYNTHIA RULE, and D. THIRTY (30%) PERCENT to my nephew, EARL SNYDER. - 3. Susan Kneller, Linda Kurtz, Cynthia Rule and Earl Snyder (the "Beneficiaries") desire the Executrix to settle the Estate informally in order to avoid the expense and delay involved with the formal adjudication of a First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "Court"). 4. The Beneficiaries desire to forever settle and compromise any and all claims and rights which they may possess, now or hereafter, in the Estate and to confirm their acceptance of the Informal Account (the "Account") and the Schedule of Distribution (the "Schedule") which are attached hereto as Exhibits "A" and "B", respectively, and incorporated herein by this reference. The Beneficiaries desire that the terms of the Schedule be in full satisfaction oftheir rights in the Estate. 5. The Beneficiaries wish to release the Executrix and to indemnify her against any and all claims that may be asserted against the Estate or the Executrix after the date hereof. 6. The Executrix is willing to settle the Estate informally in consideration of the indemnifications hereinafter provided by the Beneficiaries. NOW, THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, the Beneficiaries, for themselves, their heirs, personal representa- tives, successors and assigns: I. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information, and belief. 2. Acknowledge receipt of a copy ofthe Account and a copy of the Schedule. -2- - 3. Declare that they have had the opportunity to review the Account and based upon an examination (or on their decision not to make such an examination), they are satisfied that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. 4. Accept the Account, examined or not, as if the same had been duly filed with and audited, adjudicated, and confirmed absolutely by the Court. 5. Acknowledge that the distributive share or amount received shall be in full satisfaction of their respective entitlements under the Will, and ac- knowledge that they have each'received their respective shares. 6. Release, remise, quitclaim and forever discharge the Executrix, her heirs, personal representatives, successors and assigns, from and against all claims that they, as residuary legatees and heirs had, now have, or may in the future have, in connection with the Estate, 7, Agree to refund on demand, all or any part of any aforesaid distribution, which has been determined by the Executrix, or by the Court, or by any court of competent jurisdiction to have been improperly made. 8. Agree to indemnify and hold harmless the Executrix, her heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence -3- - of the Executrix) that may hereafter be asserted against the Estate or against the Executrix. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, and intending to be legally bound, the Beneficiaries have placed their hands and seals on the attached Consents to this Estate Settlement Agreement. -4- - CONSENT TO EST A TE SETTLEMENT AGREEMENT I, SUSAN KNELLER, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Claire A Bowersox, deceased, a copy of which Estate Settlement Agree- ment has been provided to me. .5 illA tV\ ~ SUSAN KNELLER COMMONWEALTH OF PENNSYLV ANlA COUNTY OF /V'b/CTI-IA-y-y-")/, r",,-' SS. On this, the .a. Ci day of & ~ _ 2003, before me, the undersigned officer, personally appeared SUSAN KNELLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. u~ If? ? ~,,);;. .16 Notary Public Notartal Saal Dawn C. Klrkpalrtck, Notary Public Hallartown BOlO, Northampton County My Commission Expires Sept. 16, 2006 -5- CONSENT TO ESTATE SETTLEMENT AGREEMENT I, LINDA KURTZ, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Claire A Bowersox, deceased, a copy of which Estate Settlement Agree- ment has been provided to me. ~-L, 7~ LIND UR TZ COMMONWEALTH OF PENNSYLVANIA COUNTY OF Vdll. r 1-1 A ,1. ~<./ SS. On this, the I 1 day of J t.t IV c:: 2003, before me, the undersigned officer, personally appeared LINDA KURTZ, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~J-eLVL'" 1L tfI:b" Qe-L ~PUbIiC . < Notarial Seal Jeannette D. Fields Henertown Boro, Northampton County My Commission Ex"ires Nov t6 2006 -6- CONSENT TO ESTATE SETTLEMENT AGREEMENT I, CYNTHIA RULE, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Claire A. Bowersox, deceased, a copy of which Estate Settlement Agree- ment has been provided to me. ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. On this, the 3* day of~ ~ personally appeared CYNTHIA RULE, known to me (or satisfactorily proven) to be the person 2003, before me, the undersigned officer, whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~\1 ~~ NOTARIAL SEAL PATRICIA D. OLYARNIK, Notary Public Hillllpden Twp., Cumbe!land County. . Mv Commission Expires August 27, 2005 -7- - CONSENT TO ESTATE SETTLEMENT AGREEMENT I, EARL SNYDER, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Claire A. Bowersox, deceased, a copy of which Estate Settlement Agree- ment has been provided to me. ~ ~.<;;~~ EARL SNYDER ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF A<..h ,g4 SS. On this, the d?7/1fdayof 2003, before me, the undersigned officer, personally appeared EARL S ER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~d~'-~ Notary Public r ~---_._..__._---~ Notarial Seai Cynthia S. Frisch, Notary Public Bethlehem, Lehigh County My Comm!,~~~.~~. ~~~~:_es~!. 29, 2004 I -8- Exhibit "A" Accounting for the Estate of Claire A. Bowersox, Deceased Receipts of Principal Assets Listed in Inventory (Valned as of Date of Death) Waypoint Bank Savings Account #200053264 Interest accrued to date of death on Waypoint Bank Savings Account #200053264 Waypoint Bank Certificate of Deposit #259284393 dated 2/20/96 Interest accrued to date of death on Waypoint Bank Certificate of Deposit #259284393 Uncashed interest check from Waypoint Bank dtd 4/30/02 for certificate of deposit #2592834393 First Union Bank Certificate of Deposit #247412064677226 dated 11102/87 Interest accrued to date of death on First Union Bank Certificate of Deposit #247412064677226 First Union Bank Certificate of Deposit #247412064677218 dated 11102/87 Interest accrued to date of death on First Union Bank Certificate of Deposit #247412064677218 First Union Bank Certificate of Deposit #247412057715501 dated 3/07/94 Interest accrued to date of death on First Union Bank Certificate of Deposit #2247412057715501 First Union Bank Certificate of Deposit #2437412061110366 dated 3/20/2000 Interest accrued to date of death on First Union Bank Certificate of Deposit #2437412061110366 First Union Bank Checking Account #1000643109684 Interest accrued to date of death on First Union Bank Checking Account #1000643109684 First Union Bank Checking Account #1010041725485 Interest accrued to date of death on First Union Bank Checking Account #2020041725485 -1- $ 9,991.71 6.79 11,500.00 14.68 22.02 5,045.57 7.64 5,045.57 7.64 10,500.00 11.70 17,435.38 6.64 5,738.62 0.95 28,618.05 20.35 National Association of Letter Carriers Health Benefit Plan - reimbursement IRS - 2002 Income Tax refund Moffitt Heart & Vascular Group - refund 73.55 300.00 32.26 Total Inventory Total Receipts of Principal -2- - $94.379.12 $94.379.12 Debts of Decedent Disbursements of Principal 06/05/02 11/27102 West Shore EMS - balance due West Shore EMS - balance due Funeral Expenses 06/05/02 06/05/02 06/19/02 Neill Funeral Home - balance due Smeeringer Memorials - engraving Cynthia 1. Rule - reimbursement for funeral luncheon Administration Expenses 06/05/02 06/19/02 07/15/02 0211 9/03 0511 4/03 xxxxx Cumberland Law Journal- legal advertising Cynthia J. Rule - reimbursement for probate costs The Patriot-News - legal advertising Register of Wills of Cumberland County- filing fees Keefer Wood Allen & Rahal, LLP __ miscellaneous expenses Reserve for closing costs and miscellaneous expenses Federal and State Taxes 08/20/02 02/19/03 06/05/03 Register of Wills, Agent - prepay Inheritance Tax Register of Wills, Agent - balance due on Inheritance Tax P A Dept. of Revenue - fiduciary income tax Executor's Commission 02/24/03 Cynthia J. Rule - executor's commission Total Disbursements - -3- $39.60 73.55 $642.97 170.00 117.25 $ 75.00 223.00 114.19 28.00 24.47 500.00 $14,250.00 676.26 21.00 $113.15 $930.22 $964.66 $14,947.26 $ 3,000.00 $19,955.29 Principal Distributions to Beneficiaries To: Susan Kneller 09/03/02 5>10,000.00 02/24/03 5,000.00 $15,000.00 To: Linda Kurtz 09/03/02 $10,000.00 02/28/03 5,000.00 $15,000.00 To: Earl Snyder 09/03/02 $10,000.00 02/21/03 7,500.00 $17,500.00 To: Cynthia Rule 09/03/02 $10,000.00 02/24/03 7.500.00 $17,500.00 Total Principal Distributions to Beneficiaries $65.000.00 -4- - Receipts of Income and Recognition of Losses Interest Waypoint Bank Savings Account #200053264 06/07/02 Waypoint Bank Certificate of Deposit #259284393 05/31/02 06/07/02 First Union Bank Certificate of Deposit #247412064677226 06/05/02 First Union Bank Certificate of Deposit #247412064677218 06/05/02 First Union Bank Certificate of Deposit #247412057715501 05/13/03 First Union Bank Certificate of Deposit #2437412061110366 06/05/02 First Union Bank Checking Account #1000643109684 06/06/02 First Union Bank High Performance Money Market Account #1010041725485 06/06/02 First Union Bank Checking Account #1010049472060 06/26/02 07/25/02 08/26/02 09/26/02 10/28/02 11/26/02 12/26/02 01/26/03 02/26/03 03/26/03 04/24/03 OS/27/03 -5- -- $8.07 --211 $1.25 1.10 1.02 0.99 1.02 0.87 0.77 0.79 0.54 0.22 0.12 0.12 5> 5.77 13.20 5.35 5.35 10.93 46.56 0.88 19.01 8.81 First Union Bank Checking Account #1010049472057 06/26/02 07/25/02 08/26/02 09/26/02 10/28/02 11/26/02 12/26/02 01/28/03 02/26/03 03/26/03 04/24/03 OS/27/03 Net Receipts of Income $ 98.08 133.64 135.70 68.57 49.20 41.27 34.96 38.12 32.50 2.17 1.87 2.12 638.20 Income Distributions to Beneficiaries NONE TOTAL ASSETS A V AILABLE FOR DISTRIBUTION -6- $754.06 -0- $10.177.89 . EXHlBIT "B" SCHEDULE OF DISTRIBUTION l. To: Susan Kneller Twenty (20%) Percent of Net Principal ($74,423.83) $14,884.77 Twenty (20%) Percent of Net Income Receipts ($754.06) 150.81 $15,035.58 Less: Prior Distributions (15,000.00) Amount Remaining to be distributed $35.58 2. To: Linda Kurtz Twenty (20%) Percent of Net Principal ($74,423.83) $14,884.77 Twenty (20%) Percent of Net Income Receipts ($754.06) 150.81 $15,035.58 Less: Prior Distributions (15.000.00) Amount Remaining to be distributed $35.58 3. To: Cynthia Rule Thirty (30%) Percent of Net Principal ($74,423.83) $22,327.14 Thirty (30%) Percent of Net Income Receipts ($754.06) 226.22 $22,553.36 Less: Prior Distributions (17,500.00) Amount Remaining to be distributed $5,053.36 4. To: Earl Snyder Thirty (30%) Percent of Net Principal ($74,423.83) $22,327.15 Thirty (30%) Percent of Net Income Receipts ($754.06) 226.22 $22,553.37 Less: Prior Distributions (17,500.00) Amount Remaining to be distributed $5.053.37 TOTAL ASSETS TO BE DISTRIBUTED $10,177.89 -- PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 ~o~ Name of Decedent: Claire A. Bowersox Date of Death: Mav 21. 2002 Will No. 2002-00523 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: 'ies:A. 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 J\:... 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.L 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. /l__~ Signature Date: '6/' ( O.,S C,i Cvnthia Rule Name (Please type or print) \..l" """ I Sd ? 1501 Dalkeith Drive Address '" o MechanicsburE!;. P A 17050 ".-:' - ~ 717-975-2741 Telephone Capacity: 'I-. Personal Representative _ Counsel for Personal Representative -...........