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Home My WebLink About02-0647 REV_1SOOEX 16.(lO) C- REV-1500 '*' COMMONWEALTH OF PENNSYLVANIA 'iiii DEPARTMENT OF REVENUE , DEPT. 280601 HARRISBURG, PA 17128-0601 w ,., :.:::!;(I) 0.'" w"O zOO 0"'.... .... .. .. INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 -02 647 COUNTY CODE YEAR NUMBER I- Z W C W o W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITiAl) Webster, Emelyn R. --- ----- -- DATE OF DEATH (MM.DD-YEARj 05/03/02 SOCiAl SECURiTY NUMBER I 105-32-9550 , --- -- I DATE OF BIRTH (MM.DD.YEAR) , 08/05/07 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I REGISTER OF WILLS - ___ ___ ______ _______ _______ ______ n___ _ SOCiAl SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A [i] 1. Original Return o 4. limited Estate 06.0ecedentOiedTestale{AlIachcopYciWII1 o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-82) o 7. Decedent Maintained a living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date ofdeath between 12-31-91 and 1-1-95) 03. Remainder Return (date of dealh prior 10 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AltachSchO) NAME ~ndrew H. Sl1aw, ~ui~ FIRM NAME (If Applicable) Robinson & Geraldo -TELEPHONE NUMBER (717) 232-8525 COMPLETE MAILING ADDRESS P.O. Box 5320 Harrisburg, PA 17110 z o 5 ::> l- ii: ~ o w ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 5. Cash, Bank Deposits & Miscellaneous Personal Property IScheduk> E) (1) (2) (3) (4) (5) 0.00 0.00 0.00 0,00 4,954,67 (6) 0.00 6. Jointly Owned Property (Schedule F) o Separate Bilting Requested 7. Inter-Vivos Transfers & Miscenaneous Non.Probate Property (Schedule Gorl) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Ex.penses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage LiabiJilies, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line a minus line 11) 13. Charitable an<! Governmental Beql.les\slSec 9113 Trusts for which an election to tax has not been made (Schedule J) (7) 0.00 4,954.67 (9) (10) (B) 605.00 7,649,57 (11) (12) (13) 8,254.57 -3,274,90 0,00 14. Net Value Subject to Tax (Une 12 minus Une 13) (14) -3,274.67 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPUCABLE RATES z o ~ I-' ::J Q. :!! o o g 15. Amount of line 14 taxable atlhe spousal tax rate. or transfers under Sec. 9116 (a)(1.2) , ,0 (15) (16) 0.00 0.00 0,00 16. Amount of Line 14 taxable at lineal rate ,.0 )( .12 (17) 17. Amount of line 14 taxabte atslbling rate x.15 (18) (19) 000 0.00 18. Amount ofUne 14 taxable at collateral rate 19. Tax Due 200 CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREETADORESS CITY Bethany Village Retirement Center 325 Mechanicsburn Wesley Drive HCC I STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousol Poverty Credit 0 B. Prior Payments 0 C. Discount 0 (1) 0 3. InteresuPenalty if applicable D.lnteresl E. Penalty Total Credits ( A + B + C ) (2) n o o TotallnteresUPenalty ( 0 + E ) (3) 0 4. If Une 2 is greater than Une 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 316 B I ZIP 17055 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) () A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5A) 0 (5B) 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS %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. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.... p' b. retain the right to designate who shall use the property transferred or its income;.. h c. r~tain a reversionary interest or... . d. receive Ihe promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . Yes .........0 .........0 .........0 .........0 %0 %0 No ~ [XI [X] g [X] g [X] Under penalties of peljury. I declare thai I have examined !his return, inc/tJdilg accompanying schedules and statements, and \t). the best of my knowledge and beTlet, it is true, correct and complete. Dedaration of preparer other Ihan Ihe personal represenlative is based on all information of which preparerhasaflyknow!edge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AD~~W. ~~.~ 405 E. Strawberry SIGNATURE~RyEP ADORESS P.O. Box 5320 Harrisburg, PA 17110 DATE / - ;ro - O:s treet Lancaster PA 17602 NTATIVE 1- DATE sO - (),> 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 tor the use of Ihe surviving spouse is 3% 172 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of lransfers to or for the use of the surviving spouse is 0% In P.S. g9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a lax retum 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 I/alue of transfers worn a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent oJ the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 PS. S9116( 1.2) (72 P.S. s9116(a)(1)J. The tax rate imposed on the netl/alue of transfers to or for the use of the decedent's siblings is 12% [72 P.S. g9116{a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-150a EX+ (6-9a) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF Webster Emelyn R. 71_(]7 r,47 Include the proceeds of litigation and the date the proceeds were received by the eslate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PNC Bank (Checking Account) $3459.76 $1385.26 $9.65 $100.00 2 . Prudential Stock 3 . 4. Conseco Direct Life Premium Refund Personal Effects TOTAL (Also enter on line 5, Recapitulation) $ 4 , 954 . 67 (If more space is needed, insert additional sheets of the same size) Mail to Field Office Instructions W SH 068 Delivery of the attached check and statement is: UNCONO IT I DNAL Address BATCH NO. SN43 ~ Prudential ~ Financial FOR INSURANCE SERVICE, GET IN TOUCH WITH YOUR REPRESENTATIVE OR THIS OFFICE CHECK STATEMENT The Prudential Insur8nce Company of America Central Atlantic Operating Center P.O. Box 631 Fort Washington, PA 19034 LIFE CLAIM OIVISION PO BOX 7390 PHILAOELPHIA PA 19101 TEL 800-778-2255 OEATH CLAIM Contract Number Insured/Annuitant Check Number 07 143 683 EMELYN R WEBSTER 0272 0447810 <lUN 12, 2002 WE HOPE WE HAVE BEEN DF HELP TO YOU OURING THIS OIFFICULT TIME, THIS CHECK FOR $3,493.35 REPRESENTS THE PROCEEOS FROM THE OEATH CLAIM ON CONTRACT 07 143 683. SOURCE OF FUNOS $1,000.00 $2,469,61 $10,60 ~ 'J l $3,493.35 '" '" '" '" '" '" '" '" '" '" '" '" '" ",fI). '" ~* * '" * * '" '" >I< '" '" '* '" '* "" '" '" '" >I< '" '" '" '" '" * '" '" '" '" '" '" '" '" '" '" IV IF THE OECEASEO WAS NAMEO AS A BENE1IbIARY ON ANY OTHER INSURANCE CONTRACTS, WE SUGGEST THAT A NEW BENEFICIARY BE NAMED AS SOON AS POSSIBLE. FACE AMOUNT OF INSURANCE ACCUMULATEO OIVIOENOS ANO INTEREST POSTMORTEM OIVIOENO INTEREST FROM OATE OF OEATH "-0", 2.0 ') L/ 7 s. S~ ~ 5' 0 , 3.5,,'" AMOUNT OF CHECK SOCIAL SECURITY BENEFITS MAY ALSO BE AVAILABLE. FOR MORE INFORMATION, GET IN TOUCH WITH THE APPROPRIATE GOVERNMENT OFFICE IN YOUR AREA. IF WE CAN BE OF ANY AODITIONAL SERVICE, PLEASE LET US KNOW, <lUST GET IN TOUCH WITH YOUR PRUOENTIAL REPRESENTATIVE OR THE OFFICE SHOWN ABOVE. OEPARTMENT OF THE TREASURY. INTERNAL REVENUE SERVICE . OMS No. 1545.0715 1aDalee/sale 1b CUSIP No. 2 Stock, bonds, etc. Reported to IRS J ~ Gros~ proceeds Proceeds From 2002 09/04/02 744320 10 2 $ 1 3 8 5 2 Gross proceeds !ess commissions Broker and ' . and option premiums Barter Exchange Form 1099-B Transactions 4 Federellncome laxwllhheld Account number 5 Description Copy B $ SALE OF STOCK For Recipient 0.00 K2300 121-3366 PRUDENTIAL COMMON This is important tax. RE(;IPIENT'S name, street address, city, slate and ZIP code PAYER'S name. address, city, state, ZIP code and telephone no. information and is being fumished to the IntemalRevenue EMELYN R \~EBSTER EQUISERVE, INC. Service. If you are required to file a 325 WESLEY DR # 225 PRUDENTIAL FINANCIAL, INC. retum, a negligence MECHANICSBURG PA 17055-3574 P.O. BOX 43033 penattyorother sanction maybe PROVIDENCE, RIo 02940-3033 imposed on you n this 1-800-305-9404 income is taxable and the IRS determines that it has not been reported. RECIPIENT'S ideJ'ltmcation number PAYER'S Federal identification number Form 1099--8 105-32-9550 43-1912740 INSTRUCTIONS FOR RECIPIENT ON REVERSE SIDE DETACH BEFORE CASHING CHECK INSURANCE COMPANY 399 MARKET 'ST. , PHilADELPHIA, UNDERWRITTEN BY COLONIAL PENN PAYEE: EST OF l M WEBSTER ==> P151469822EO PREMI UM REFUND I PATE II ~oo I 06/17/2002 0000~2q7q'2 PA 19181 FRANKLIN INSURANCE CDMPANY CORP 03200 1 TOTAL 9.65 CPF /lCPP1/ lCPP/ REV-1511 EX+ (12-99) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Webster, Emelyn R. FILE NUMBER 21-02-647 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: $25.00 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions N.... of Personal Represenla1ivels) Social Security Number(s)/EIN Number of Personal Representative(s) SlnoelAddress City State _Zip Year(s) Commission Paid: 2. Anomey Fees $550.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State_Zip Relationship of Claimant to Decedent 4. Probate Fees $30.00 5. Accountant's Fees 5. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) $ 605.00 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+(&-9B) .. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Webster, Emelyn R. FILE NUMBER 21-02-647 Include unreimburstd medical expen.... ITEM NUMBER 1 DESCRIPTION Alert Physicians at Bethany Village VALUE AT DATE OF DEATH 2. Crumay Parnes Associates, Inc. $493.79 $32.79 7. pennsylvania Department of Welfare $129.20 $82.76 $60.00 $26.77 $6,824.26 3. Bethany Village 4. 5. The Foot Care Center Woods & Myers Mobile Xray Imaging Inc. 6. TOTAL (Also enter on line 10, Recap~ulation) S (If more space is needed, insert additional sheets of the same size) 7,649.57 ALERT PHY.AT BETHANY VIL. 325 WESLEY DRIVE MECHNICSBURG, PA. 17055 PHONE: 717-796-0442 A FINANCE CHARGE OF 1.50 % PER MONTH (AN ANNUAL PERCENTAGE RATE OF 18.0%) WILL BE CHARGED ON ALL AMODNTS 30 DAYS OR MORE PAST DUE STATEMENT OF ACCOUNT I I STATEMENT DATE 06/21/20021 WEBSTER, EMELYN . 30 DAYS.. . 7.08 C/O ELIZABETH ISEMINGER 60 DAYS.. . 272.22 405 E STRAWBERRY STREET 90 DAYS.. . 200.00 LANCASTER PA 17602-0000 PLEASE DETACH HERE AND RETURN TOP PORTION WITH YOUR PAYMENT . M"<:!lW"'''''''''' ff~ 17n" I I 416611 YTD FIN II WEBSE GRP-BR PAGE 1 , ~ 1 ;.t r""a""".""".''''"1 ..,,''''.....'''...,'''.'''''1 ~-r..""..~".'''.,~1 rlOIO"'.''''''''''.''''.''''''.i 486.49 +1 .00 + 7.30 - 493.79 - .00 .u____ .___ _... -.-....._.... . ~lDmlm 03/08/01 1 1 04/05101 10/26/01 03/08/01 1 1 04/05101 10/26/01 03/16/01 1 2 04/05101 04/05/01 10/26/01 03/16/01 1 2 04/05101 10/26/01 u...L.V.. Service Description Cpt Ox Char e SHAVE SKIN LESION 1.1-2CM 11302 216.5 82.71 Medicare Payment BS PENNSYLVA Payment OFFICE VISIT NEW LEVEL 1 99201 702.11 33.93 Medicare Payment BS PENNSYLVA Payment 88305 216.5 43.30 Medicare Payment AcceEt Assixn Adj. BS P NNSYLV Payment SURGICAL PATHOLOGY TECH C 88305 216.5 4.50 Medicare Payment BS PENNSYLVA Payment ~ 66.17 0.00 27.14 0.00 34.23 0.00 3.60 0.00 16.54* 6.79* -0.51 8.56* 0.90* rl<;J~ lTE lAST PAID AJ.fOlllIT. 00/00/00 0.00 '9l........rr... CRUMAY PARNES ASSOCIATES, ;cK. 104 ERFORD ROAD rABLET. CAMP HILL, PA 17011 INC PATU I-EMLYN R WEBSTER DRU I-PARNES, HERBERT M., M.D. DRU 2-0RMAN, STEVEN K., M.D. Ph: (717)-763-7685 Acdll: 39017 Date: 10/30/01 Pase 1 of 1 STATEMENT E<F'THi'iI'W I.) I LLJiUE P U :00;< (,;':'~::.:.i CYiI"!IC' HILL Pr:-, 1. )'(;Wn ....W:..!:.':'.'. PHrn~F' NO., (717) 909-7118 FED. I" D" 1I E~3P933\J;:5 ACCOUNT NO. F'I'IE}..YI',1 1:(" I,JEI{STEF~ 3i.:!~'j WESLEY Df( HCC F.:I'I 31.e NECHA~/1 CC)f)UF:G pn :I. -/f:)~'.~.'. 8T A TEMENT DATE (.;:l ~:.:.i / (~) ':) / i?)E~ MAKE CHECKS PAYABLE TO'. HERITAGE MEDICAL GROUP ETACH AND RETURN TOP PORTION WITH YOUR PAYMENT :n'.IB, 11EllICfmE DlAG. CODe SEftVlCli OATE 1:1.1'.:";) (i)'7 /PO/(;) 1. :I. :I. /F~e./(/):I. :l.1./;:YV0:1. W:)/ID/01 lr.?/Pl/(Jl :I. {.:.~./ ;::~ 1 / (f.ll THE fWIOI..n. 1'(1::1'/1 T TO 1,'.1'::)/:1.'7/0:1. :I. F~/r.:.~ 1./0:1. 'I_P/~:?1./v.}l ,11 ~:) ,119 CURRE 't PLEASE NOTE This account is PAST DUE. Your prompt attention Is courteously requested. ;::.~:I. (~) AMOUNT ENCLOSED $ ~AOCIiOlJRIi llEFERENOE PATIENT NAME 'Y931.P I'II.,I'.IIJ!':SIW) I-IOI'IE CAPE 1033.3':: '::lAC PliYl'IEHT l'IEllICI:)I'(E 1. (.B3.3~'.' ',v,e iillJ'lJST 1"IEll I CnF~E '')'')31. E~ HI.. NI.JF(!:n Hi:) HDI'IE c('iF~E 1.03AO~51.3 PAYNEHT MEllICnm~ 1.0340~51.3 ADJ'~;T PEDICAI'(E 'j" ._,..., t")II'"'''''/"'I-''''''''''' ,).,. ynIJ'''' ("(" '1'11'" 1"'1 1\I"C"I'" "'1 '"'1''''\''' t{ ::, ... . I .... ::." ., ::.,:;. ::.... '.: on . .~. .., J...... ... .::) ..'h .... '1 d. ::... . no ::. '"\..:~ ::. tIC>.. 9')3:1:1 1',11" ~IUPS:rI.,lC' HCll'IE V:n:nT/~:>UI<c>FOUF.l"IT :l.0340~5:1.3 PAYPII::I~T MEDICAPE 1. i(13 I,(ir" ,,'j :1. 3 liD.}UBT PIE])} CliF:E . PU,A~:;E 05/09/02 u00 f?:l.W 3TATEMENT DATE PATIENT PAY Y.T.D. ACCOUNT NUMBER 6!5" ({)(~) ~"41" ,(t~:.:j "-:1.,:1.. :1.9 (-.:/~S" (.~)(~) .h..(1 1." 4~.) -,,:13.. :I. ') ".,0.. (.3(;) ....~.:!.~.:.:j" '(:1. ....:1. '7.. 1:$', STATEMENT HETHm-IY $IL.L.nm': r,l n BOX f}:::'~~S enl'l/' HIL.L. /'fCl 1 ?(i)Ql:l ....(LIC.i:!~'.. 1::'He)!'I!:': HO.:: ell)) ')Y.)<,)....l:l.:I.a FED. I.D.N 2329330'1'5 FI'1FI...YI'1 1":" t,JF:t<~:,.n::i? 3E".'.'; kiE~';L.EY DF: HCC 1(1'1 316 l'II:THm.' I C"'BUI'W pn 1 .l(;)~';~.'; ACCOUNT NO. f:~tm STATEMENT DATE .)~;/~l9/el;:! MAKE CHECKS PAYABLE TO: HERITAGE MEDICAL GROUP TACH AND RETURN TOP PORTION WITH YOUR PAYMENT I1~G:: I~EDIem(E AMOUNT ENCLOSED $ I'(E~lIT TO US" H 1 HI/i:!9/(i"Il 993:1.:;! HI' ~'UI';:SII~G HD!'JE (:;(II'(E :lP/:;~l/\>)l :1.C-13/,(;);..,';1.3 :)('WI"IEI~T l'lEDIC(',I?E :1.2/2:1./0:1. :1.0340:5:1.3 ~DJUrrr PiEDICARE THE AI'lm.II'.T BEL.O /?E/'I":FUEJ'.T~: YOl.m CO"'II~n Bm.('i1'ICE" PL.EAbE F(I:':I'IIT TO t.m. .'731. (;l:I./li"?/@,> 993H! i'1I..HI..lI',SIHG HDi'lE CA!'<E (H/p(:,/(m,'. 1\>)37/,,'.3",7 P('WI'JEHT i'lEDIcnF<E W+lP6/(-1E' 1.k)Tl/,E3~,l7 i1])JUBT !'IEDICRm:: \-3',/:;>'h/{i.l~:'>' 1~l3'l/,;::3',)"/ (')PPLIFD DEDUCTIBLE YOUF( It.IB Hf:lB BEFH m:l..I..ED 8< :;H(.mm:s iWPL.IEl) TO ymm u.'!.~m ""4:1." 4~:) .,:1.3. :1.9 OJ. Wi) ....t ~)" f~f:~ ,,-:1. E.. " ~59 "iil0 A.TEMENT DATE PATIENT PAY Y.TD. ACCOUNT NUMBER STATEMENT DFTI..lnl'H ,):t I...I...AGE P D :BOX 6P~:5 UWII::' HILI... Ptl 1 /(.')(.')I...06i:?~'j PHm~F ~m., (/17) 909~7118 FED. I.D.N 232933075 F1'IEI...YH r~. kIE:!.)""TER 325 WE""I...EY DR HCC RM 316 l'IECHm-lICSI<l..lRG P(.< :I.7€)~6 ACCOUNT NO. c.~:I. (~) STATEMENT DATE n~'j/W:j/€)2 MAKE CHECKS PAYABLE TO: HERITAGE MEDICAL GROUP :TACH AND RETURN TOP PORTION WITH YOUR PAYMENT I~,ln:: IF YC U I..IAVE 1'<1 Y ClUES. IONBF(EGAI:, I -IG TI.HS STATEI~ENT ..L,c,m: CClHTACT OUR BI1...I...H-ICmEVr .n /:1.7..-"Jv.J9..-7:J.l.B .rlJkj DETHI<HY 'v'II...I...f'lGE -ATEMENT DATE PATIENT PAY YTD. ACCOUNT NUMBEA DIAG. CODE. SERVICE DATI" . rR~VRl' RE~ERl:NCE PAl1~Nr .. . .. ~E .. l .0 :e. '-.-11"1'..11 ,Il:;:~::~ ThlFi Hn!rlj::' I..} TnT T E'FHTI r P(WI"IFHT I'IF'!) T r~(\Fil:' ,::m.TII"';T I'IFDTI"::')F;.'F' T~: ynlll:;: c~n.... T H"~ r:'(1I m.I(~F.. IN \l&>!lC!i' . ~~:)p,n i-=~::~./ 'I 'I ./('t:::) r:.j':.) :-'~r.'l ~:) t:~l:::t . r'1(.:'1 .nn f,'I!'':, /F}t, /Fl;':;' :~,Cl,('::l::~ :l rn7/:~R/R;'J 1~~gA~Af~~ ~7/:~~/R? :lR:1gA~A~~ THF (Wlnlll', T nF:' nt,. F;:FI::":;:F !:~F!', E'FI'ITT Tn un.. Fll,\ /:-::":::I/n:-:) (:)9::;;"' " ,.,.11. 1',I(_II:;:f-~T hlFi Hell'-II:" t)T ~:~ T T /qlll-'~r:;!::'(.)',JF'~'.'T f;')(,/;:=-(,/FI;:;) f;~FHTI I F(? /::~r'i /171P :1 (il::V:~P,F ':V:,::~ r1nVIYIFi-1T l"IFD T rYiJ:;.'F n7 / ::~!"l /1;\:" 1 pt,<.).'\F .'\(:,::~ nD.TlnT '<IF!) Ti'~(\PF THF' nl'j("1I11 T HFI CII.. I'?FPF'FnFI', '1'(;' ynllP CO"- T "',~ n:">1 ()HCF'.. I';:FI'ITT Tn 'I!:~. llll1tl ....(,;:::'" ~::;'? .m"1 "I " ')'1.'.) PI F(::.:~I;:' ~::; (;1 ,. f;:j f'i .. [Y\(.'1 ....r"::;;.. :::'1', ....;.:)fi"l (:.:1[;.) PI 1::'n~::;F' STATEMENT DATE '?A.. 2.~ 21f~ PATIENT PAY Y.T.D. ACCOUNT NUMBER STATEMENT FlFTH()HY '.)'1'1 I nm' p n Hnx (=,;.:~;.:; C:('~I\'IP IHl1'1 1 PA 01, '?r1f~J 0' ....f?l(:,~.:?~:S PHD"'F 1..10_, ('/':17) ':.)1'19.....7.11 f1 ~'FT)~ TpDw" ?~?g~~~.7~; 8~~ YH I'?.. WFBnTFR 3;:>!.'.'; I"JFSI FY DI'? HC:C 1','1<1 :~'I F,. IYIFoC~.I{')"'ITr~~~HI.n;~'r'l Pf.) 01 "lf71~-:i~:;; ACCOUNT NO. :::) 'I n (~~ P. /'l ::i;./ n r> MAKE CHECKS PAYABLE TO: HERITAGE MEDICAL GROUP STATEMENT DATE Tf-..IS~ DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT I~FI') Tr.nl';,F r-;TF~JFhl ~IFCI<Fhll ur"::R 1'1'0 AMOUNT ENCLOSED $ ~(I /~ .~. 7t:3..2.~ P1A STATEMENT DATE PATIENT PAY Y.T.D. ACCOUNT NUMBER STATEMENT BETH(.\I"Y VII.J..J4GE P () l"DX f,i?~.) Cm1P HILI... PI1 1713(31--136,:>'5 PHONE NO.: (717) 9139-7118 FED. 1.1). It 23,:>'933075 E~1EI...YN I~" WEBSTER ::lP~) WESLEY DR HCC r~M ~l16 MECHHNICS,BUF~G PA :1. 7!?I~i5 ,:>'1m fel STATEMENT DATE S/,f'-~ 0.ft/U./!?'i:>' (tJ MAKE CHECKS PAYABLE TO, HERITAGE MEDICAL GROU () ~ '5/\ ~( ACCOUNT NO. 'TACH AND RETURN TOP PORTION WITH YOUR PAYMENT INS: MEDICAI~E REMIT TO US. ~)lJ. 1(1/29/131. 993H.~ 1'lflNl.mSII"G HDrtE CARE 12/i'!l.101 1031.0, 51:3 PAYI1EI,rr i"IEDICAI~E 12/21./01 10:3.1',13 53.3 ADJUST l'IElJICARE THE HMDUI T BEU) I~EPRESE I'L YDUI~ CO--Jl"8 BALm,ICE. PL.EASE f~EMn TO US. ,~'7::11. mj./0~'/02 '::l9::11.2 NII"IURml'IG HOME CARE f,~'j"em ....41..45 -:1.;3. j.9 f:..!;;..(!)(a IF Y( U I.HWE 11 Y QUEG IONS'~EGAI D: NG THIG STlrn=]1EI"T BETHI\NY VIL.L.nGE ATEMENT DATE PATIENT PAY Y.T.D. ACCOUNT NUMBER :!/!g : V:-'/ ion ,21 j. - ".',-, . , i ('i," ';~i ~) i'~,: I :~:.: t i ,/' .... :'?~ .,."...., ,..Il. ,..", '-_, ;_~ f .',' .+. -..,','" ;:.'.i. ;_':'_;1. . JC, _.(~\ :1 C:'. 1/ :~. .;_': 121 :--:. (/":?I;-' ~ -?, ' ,- ,/: €~T'lt c, ", , j . ~:~ ;'r'l J:' .Il :f--)i'. :. f C'~',:::i;\;.C,:( l;"'''- ,'7'-/ 'U.i \_';LC ; \\:",.1"',:;;::,"; ,".,'...' -,r ,-' ,,..; f'j T ;',,-1 'D, 'r~r.!f-' /'1:'" . ':;:F'i-;' ,'j ,L--\(::iY!r ;\i"l T l\ll~'::\ [- 1;\~:I,(~t~:~1;. ""'1' ",--. .J; "'~';I\~CC: 'Zl;::,~ 3(!\ r'. .t.,; ~:\ V ~:. -'rr- iC', el" :Zl:;:1 : ,....:., 'j" '::''':' -->"\-: ;'--.; r ,~:::: ,".::.: '::; :r ~:~: j\' ;--. , .,;.;., . .q. .:,..l .\: l. :;~'; ( ""'ID'_\'..\~3'T;;'; r.::<{:'j"-l;''o'\E:NT ... T ';:J:< .:: )\! r '--"r I r:~;~". [---iL JU:3T:.1C:---.; t",'" .. 'i''''', ~,;1[!',!-;" rm,c'" \...,;" .1 Ci! )-:::' 'j .~: ;~:! ~'~Cl j I. : ',:'.{ \'11;: r~"..1 i. '." ';:;ii? Da.''!<::' , 12'! ~ if: i;:~ l :11 " ,"" '; ~. ;/, ., " ':::~"'; ',;, .'r' '--I ':-:;"~ /1'" DC: :~. 1/: . " E',I/i 112i" t r:;D ~,\,b OJ :;:\ 1. ;:-':'Ef, 13 (~~ ~~:';/\ :'1 I, .'~ ::-" ." . '.-' l ',""!~::\ I"'i f.\;?[;:)~!'.'i,' r:!, DC;;::-:?;:!.::' ":!", ~; ::~: ~~: :~~: ~. ~: :~;:: ~-,\ ~::'C'. :7' l...~,C. B;,.;;:',~?,! :\. ',,"-' ''''". Cr t:.:~.) [ .._ )c,t ,',\:L i. r\-: ~:~ J( " L".i.e :ctd.~ -, L, D, 3. i,,!, ,'", C E' '.',' .. ,,-'. !2';; ..,', '. ,C;, -" ,. ,n,",", '.:'Lc.: (.,c j :,:: 'L'"-: ,,-,,,It 5: ~-~ ,: ';. :?l/Iu ~?!!?I 30,CJD 'i. ':) ~~. ...., . ;~~,. e;:.:'u it:, ii,. ',';:'0 (:'!,'I::~. 7'-" n~'~E ,)~~i'.'-; l ..,. '?;::" ) 7,2"5" :/;'.. :.-: ::~i ;'::'(/' r::; i/', '<l,lZ, ,/1(1' 13 . 3 :;; ~_, r:; ~;lo~ :B:'J.~"Je". ----.,-...-.\- I.)U€~ g;~~" H;:-'r P,'_::(,1 dr', P: ,...0;..- ...... v,..,....,., , _.., $'};)~:I' It; 'F' , lilT fMME PROCEDURE DESCRIPTION ' p ~, , . ~ ~ . H::'I::::;IU/= 103/29/2002 EMELYN EMELYN R WEBSTER ORAL EVALUATION - LIMITED WOOD 60.00 , 1 i 1 i 1 1 1 1 1 1 1 1 1 MI "'I >9-1 "" gr Ei 51 "-I 0.00 I '(d ~/< /1 - -- ~l!%~ " so. 60 OAYS PLEASE REMIT BALANCE DUE, THANK YOU I .----..~--~"-'-~.--..---.------.---.-,~""'"---~--~-~~--'---'--'-~'-'--'~'------"-'-'----~~"",,,---,~,~~,-,------,,,:,,,,----,,,,,----,..'--'-.-...:....'-------.,-"--""'--"-'--."'-,,c.:...~_."___ ..__L_~.. 0.00, 0.00 j .-~~-~~~-;.L-~-~-~-~'-'-.....__'_....L":L__.__::::L~ 60-90 DAYS go DAYS & OVER PREVo BALANCE 60.00 A SERVICE CHARGE '---"'-~-'--~",-.,,----._.__._,-. % PER MONTH ( % PER YEAR) IS APPLIED TO THE ADJUSTED BALANCE OR c"","__,~"-,-"",__,--_,,_,~,,,,,:, .. . ..-....-..-.,...... "-'~''', '--' "",v.......".. ...........'.'r"'~IL.I'"' ....... mDlmmmem--'l...:r,,:,et _,.,..;j'.'"_..'tllll....:..IL"I:II~...:r.'..I:::I..,.:.r,lit. L,ti.l(11, "" .. :. . 05/02/02 71010 Chest Xray Single View TEGX 1.00 . Patient: Emelyn Webster - 19293 06/25/2002 Hgs Administrators Insurance has been billed. They will forward check Q0092 Set Up Fee TEGX 1.00 Patient: Eme1yn Webster - 19293 06/25/2002 Hgs Administrators Jnsurance has been billed. They will forward check R0070 Transportation 1 Patient TEGX 1.00 Patient: Emelyn Webster - 19293 06/25/2002 Hgs Administrators Insurance has been billed. They will forward check 63.00 12.55 47.31 '>',; \';':,t;,' . '".\.:M4 .,\'i\\\:~<:;,;"~' 26.00 ;~, f....";.. ,', ;,,'.:\',\ ':~:~~li7 05/02/02 8.30 15.63 ,... ~ 127.00 .~ '; . ;~ f <':;> :,~1.~6 i:::."" ,. 05/02/02 86.25 19.19 ';<"',', c"",.,.>, ,':>c. 'i',' 9',. ~ 'i. .~:~ .~< >r;,i J " ,;\,:\':;":::'\~:;i;' ~, ~:():~) ::;~":. Mobile X Ray Imaging Inc PAST DUE FINANCE CHARGE .~tj~'>, MESSAGE: SEE REVERSE SIDE IF AN INSURANCE MESSAGE APPEARS .. PLEASE PAY. Elizabeth Iseminger ACCOUNT NUMBER NEW CHARGES SINCE LAST BILL NEW PAYMENTS SINCE LAST BilL CURRENT DUE ',k' . COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERAilONS TPl SECTION ~ CASUAl. TY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 October 8, 2002 STATEMENT OF CLAIM SUMMARY Estate of WEBSTER, EMEL YN 940 156188 INPATIENT OUTPA TlENT LONG TERM CARE DRUG .00 .00 .00 .00 .00 .00 6,376.62 .00 6,376.62 447.64 .00 447.64 6,824.26 .00 6,824.26 REV-1513 EX+(9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF Webster, Emelyn R. FILE NUMBER 21-02-647 NUMBER NAME AND ADDRESS OF PERSON(S) RECENlNG PROPERTY I TAXABLE DISTRIBUTIONS pndude oubight spousal distributions. and transfers under Sec. 9116 (a) (1.2)] Elizabeth W. Iseminger 405 E. Strawberry Street Lancaster, PA 17602 RELATIONSHIP TO DECEDENT Do Not L1.t Tru....(.) AMOUNT OR SHARE OF ESTATE Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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-l500 COVER SHEET $ (If moI'e space is needed, insert additional sheets of the same size) Estate of(,mo\'(n RO\J)d\ \Ah bc,h r also known as PETITION FOR PROBATE and GRANT OF LETTERS ~-o;}.-f.'/7 Register of Wills for the Deceased. County ofCj),'l1\u,~ P<:IhJct in the Social Security No. It) c;- );l <I S-")11 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who islare 18 years of age or older an the execut <' '><: in the last will of the above decedent, dated ,r,J\1-l> /11 and codicil(s) dated CD ,~~Q( c1'C', [.() f Ii t':....Y) R. I{)qb~t~r f~"q(J ;1"1,)(>;~ <:l.eor\ , No. To: named , 194- (state relevant circumstances, e.g. renunciation, death of execOtor, etc.) Decendent was domiciled at death in h.,) (' last family or principal residence at .j. ^ ,( " rfr,ti,~n., '^ 1'[ .:.:.. '\n' }i-'~, 1"4 1'?lJ ~- -~ , (ltst street, number and munclpahty) Decendent, then at .. Except as foil ws, dece ent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: f-./ A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: N (!. years of age, died rI/~l ., ,190;( $ ~ -Y-\oo(:, $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters' ( theron. '2top . " l ~ ,(Qv~\-3..IS\" \~J ' ~mvv\~ ",g -g.g i~ ~~~M~:~:~WI\~1[D'tti .0 ;; o .. on OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF Curl'berland J The petitioner(s) 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 petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. A affirmed and subscribed 1 th day of en i' '" ;: ~ ~ ~ Mary . , /7-7~';' Lewis Register No. 21-::>002-647 Estate of Emelyn Rowell Webster , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 18th xx 2002. 'd' f h . . 19'=---. In conSl eratlOn 0 t e petIUon on the reverse side hereof, satisfactory proof having been presented before me. IT IS DECREED that the instrument(s) dated .lllnp 11 th, 1 Q7Q described therein be admitted to probate and filed of record as the last will of Elnelyn Rowell Webster and Letters TestaJ1"lPntnt:Y are hereby granted to Elizabeth W. Iseminger z(); Lewis 7 FEES $ 25.00 $ 9.00 $ $ -0- :'.00 TOTAL _ $ 3Q 00 Filed ..Jl,lly. .letj1.,.~QO? . . . . . . . . . . . . . . . . . Probate. Letters, Etc. ......... Short Certificates(3 ) . . . . . . . . . . Renunciation ................ x-Pages JCP ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ,.,' MAILED Lt:n= AND ORDER 'ID EXEOJ'l'RIX 00 7/18/02 REGISTER OF WILLS OF COUNTY OA TH OF SUBSCRIBING WITNESS , . codicil (each) a subscribing witness'l~the will presented herewith, (each) being d)lly ~'", /"'" law, depose(s) and say(s) that ".. / '. ..' ualified according to present and saw the testat , sign the same and that signed as a witness at the .. presence and (in tlie presence of each other) (in the presence of the "'--...." ,.,~ '''eNamel "" (AddreSS)~ '" '. request of testat_ in h other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ Register (Name) (Address) 21-2002-647 REGISTER OF WILLS OF Cumberland COUNTY OATH OF NON-SUBSCRIBING WITNESS WILLIAM R.ISEMINGER (MatI!) a subscriber hereto, cellCh) being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of EMEL YN ROWELL WEBSTEI' ~ifil will testatx..i.L- of (..nex Xlk xtha J<SlIlilsrllibilQl< lMIi1X1J:SI!06x tQj the that he presented herewith and codicil believes the signature on the will is in the handwriting of the testatrix to the best of his knowledge and belie~ Sworn to or affirmed and subscribed before (,\)~..;:..(~ (:~ ---- me this 1 Ii. h day of (Name) .Jll1 ~~. or ~L~ 7007 o For the Register J--^<. J 2070 Rivpr Rr)::ln, R,qinhrirl~PJ PA 17502 (Address) (Name) (Address) " ~ REGIS~OF WIL~ COUNTY OATI! OF SUBSCRijING WITNESS ~ ' \ ~~ " "-, .~.~ ',,- ~,. ^. "'-, ""-" codicil "'- (each) ubscribing witness to'Th~ will presented)~ith, (each) bein law, depose and say(s) that . ", uly qualified accordl to present and sa: 'lb.e testat , si the same and that req~t of testat_ in other subscribing witness(es))~"- . '- , Sworn to or affirmed and subscrib~IL"efore me this ' " d~of '--, 19~ ',,- ~egister signed~ a witness at the in the presence o~ch other) (in the 'N..esence of the "'" '-, ''-,- \,\ ''''-, " '\, "'" ~ " '" ""'. , (Name)'-, (Address) 0fame) " (Address) 21-2002-641 REGISTER OF WILLS OF cumberland COUNTY OATH OF NON-SUBSCRIBING WITNESS F l \ 2- ~ k-i''^ \A) ;:.. y" '/Y) ~ V\ f4 .l(.J~- \ ~ a subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that shp i", familiar with the signature of Hnelyn Rowell Webster codicil (I>:ill) that She presented herewith and codicil believes the signature on the (will) is in the handwriting of testatJ:i.lL of (~~~.~"Q"- ~ .J;Re Elnelvn Roswell Webster Sworn to or affirmed and subscribed before me this 11 th July /l ~.I "~.J C. Lewis knowledge and belief. U~~~ W. ~A~~,^~ , \f~ame)c:::: L '(jJ I t.\- 0 <; 'c ')-1 '(tv...) WJ\J\-'-j \J t ' W\'\ (' Ct<') ~ \,j A il W ~ (Addre1s) Register to the best of her (Name) (Address) flil';..~." RI'\ "','" This is 10 cerrif}' that the information here given is COITL'Ctly copied froln all origirul ccnific;Jtt' of death duly filed with me as Local Registrar. The original certitlcate will be fnrward\?d to the SL\tL' ViLlI Records Of-lice for permanent Filing. WARNING; It is illegal to duplicate this copy by photostat or photograph. ;\0. /.';.-j/t,-,;;;i;,;;; \/(~\l~._OEfi,i~~--~_ ",'.,.~/ '~n" II ~~ ~.A~ !iM ""~~' '~~..' "- \?'S. ~ -=:' :a .:Z~ ~t~!"~..~I/.'.., ." .~t "i.a~" /~~' ~~"', .~~l ~~-9'--'~'rI\' ~~!MEN1 \\\ ~I!!V'\" ~/ -(-~ q,()..J "YU.".,u:.n l"-. ~y.c'-bv fee tell' this ccrriflcHc, S2.()() \ m:al Registrar P 829395L MAY Date ')M" r.J)',:/. )R"...VIl7 COMMONWEALTH OF PENNSYLVANIA.. DEPARTMENT OF HEAL.TH . VITAL. RE.CORDS CERTIFICATE OF DEATH NAME OF OECEDENTIF"SI. M'~Oie, ,OSI' '" Sl~TE F'l~ .~u..aER SOCIAl SI:CURrfY "Ul,lBEIl OA11: OF OEATI1 ,Me""'. OaI.A"'" 1. EMELYN ROWELL WEBSTER N3.E\l""'~ IJtIO€A''1EAA ~R'DAY Mend.. OooVO' tio<.n l, .,.....1eI S. 94 '1.. COUNTY 01' OERI'I . ....Cumberland OECEOl:NT'SUSUA~OCCUPliJIOI\I (G'.al<>rodf!l!.__k""""dv<"'9~ cf~li";,*,nol_'_"'l nJ'eacner 1110. Education OECEDENT'SMAllIHGADOFIESS(So,...,Co/y{li:Mo>',s...~",Cod4tl OI:CEOENT'S ACTUAl. IlESIOEJoICE (s...""""""",,,," ""oon",_l ~_ Lower Allen Twp. 2'Female 1. 0 liHRTl1f'lACE,'C.Iyar.o f'LAC1:~OEATHIC""""cn'1"".--"",'o""uc,.,.,.."""t>e._1 SIal<IOI,er..."C"'-"'UYI I-lOSPITAL - h. 1 I~''''''IO EfIIOurp.o"a" C 7C ~cago. L ... FAClllTY~EII'"",'n"',"""",~,vesl'''''nonum_, ~IO K1HOOf'B-USINI:SSlINOUSTRY WllSDECI:OENTEVEAIN u.S.~MEOFOIlCES? .....0 No~ w.FlITAl.STATUS.-..... N_IUn_.W_. OMl<ced[Spec""J White SURVIVINGSPOUSf l~""'.g...m--.........) 11..Sloo. FA ~ - _... ,~? IT.,K].,_li...;i" N A 1 nwp.r All pn ... ... 325 Wesley Dr. ,..Mechaniesburg,PA 17055 fiIlOiER'SNAt,lE IF.... MoJOie,l'''1 ..Ylilliam Edward Rowell INI'ORMANT'S NAME (l )'!>OII!".-ul lTb.C<>un Cumberland '?d.o :n="=at - ".OTHER'SNAME\F.SI.M_,M..oe"S",nomel 1~ Grace Baker INFORMAtH'S MAI~AOORESS(SIr....CiI'\'lltw.", $We.lipCo<;leI t.lE'n-IO(IOFOlSPOSlT1ON _0 c,..........j(l ~DQofI..-IS>>ec,ry. ". _~omS1"'.O PLACEOFOlSPOSl1lON-N_oIee.n.t-'Y.C....""'" rI'j COoi OIou..r~ Evans Eagle Burial :lly'ault. Inc. 21.l-eola.Lanc.Co.PA 17540 W.IolfANOIoDORESSOFl'AClllT'f Fred F. Groff, Ine. 22<:. 234 St. Lan as e P OAfESlGNEtI (MonIh,Oay."""'1 _/J g.2a:J2 "'~. ~D """'& fUIjIE ~a".","23a-Conly_ ~..._....~..'''''''c1_''' r>eml'y<:aUHoI<Ioroln n.....24-26m....t>ecom"'.I'"try -"""'-_. lIIIII~TECAlJU(F""" -"'''''''''''''''' '--.0"'-)- Ct.l"-),,.c "'//1)1 "II. .""~ .. c.,o..e "".~"'''I)' '''''', "'oci< or ....<1 lail",. : ,,;>p,o.jm.'. \"".......t>e_A :_aA<l_ ! ~"'<:ondd""" ~_~1I>_ _,~UHOEIIU'1NQ CAu$E(O"'-"<i.....~ --- '--.g",........)L.AST \: OUElOIOfl,o,SAC~IUE~EOFr If, ~10 '" f., (I....... au ~~S~ONSEQ\JENCEOfl N ,/V Ot.ll:TO(OA,o,SACONSEOOENCEOfl Wi'.SANAUTOf'SY PEAf'0fl1olE0? Wl;'R"'AUl'OPSYFINOINGS -.L.A8l.I:PR.lOl'l.lO courlETlON OF CAuSE: ~~, ..........Nt:ROF DUJI1 OATEOFIN.JUflY (M"""'.~,_I TI&.lEOF."",UflY IKIURY loX W(lRl(:1 ~SCF\\eE HOW INJUl'lY OCC\lN\EO '" 0 ~B- ~.. = Ace.>>'" 0 ~ 0 n. Hom'ci<lo o o o PlACEOFII<UURV-AlhOrn..,.,rn.':;...,.I&CI<>t't."lfiea U. t""lding.a"'.'~M ... _ 0 NeD f'eo><lIngIA_lgalior'> Co~_boodel.",,",ad lOC/ll'ION(SJr_.C""fIi>oo<I.S"'OI ,~. ~ SlGN,qURE:?yTlEOFCERHftE:A lb. /~/~;-7-1t.. UCENSE R o ,leAlJ:) --., J:f'-> - L 1'4. '/7- v3 NAMEANO.o.oOAESSOI'PERSONWI10Co.uPLE1EOCAU Of' 11 (It~m27ITypeOl'Prinl J""'7JV"Cf p. hlli-;/Y, d,b7 ftou,-t lIe<- /'0.;). calTlP'IaI,C"""""""",-,,\ 'CUI1"II'YINGFHYSlCJAN IPhy,,","~C"'~ cause 00 oea'" w""n.""'~.. pII....,.,,".. p.-OI1,,,,,.eeol t1eal"anoeomo'''''''I'''''' 23) To__ol"" "'-1ed90,<Io...."""_d...Io......uo-e(.I...... m."_.....,ed. . .I"M~ANO(;Eln\fY\KGI"t\YSI(;I""'ITh,.so::..noo'~"'ooounc'n~o....n.ndce<l"v''''',cc.u..01 "ealr> To__olmy.".,..'-<ll!.. <Io.II>"""....,..,.t__, a'.. '''''p,"ca, .oddu.,"....c.u...(.).""m.nn.'...,.led 'M.EOlC41 EXAM1NER/CORONEA On~.lMai.ol.."""n.liOtl ancllor jnvestigal;cn, in my opinien, dutll cccurre<l.1 Ule lima, dala, and placa, anddu.tc tha C.UM(S) .nd mel\na'Ullal".. 3'.. RI:<O'STRAR'$S>GNATUREANO"UIo<BEA I-'>-c. o n ~'-<..'Vv'-t..Cl.' {2....i..u- 13,6,),1101 Q,qEFILEt>\"'''''"' n 0'- Co )..c."O :L- ?'.~ ')1J(1?-6~. 7 LAST HILL A1JD TESTAMENT OF El.ffiL Yll ROVELL llEBSTER -,., -:'"",,,,;';', '::::'..-..------."--=0=:=:==-=':=:-=.-___._______.____ I, EMI~LYll ROWELL HEBSTER, of the Township of Lm"er Allen, County of Cumberland and State of Pennsylvania, being of sound and disposing mino, memory ana understanding, do make, publish and declare this to be my Last will and Testa- ment, hereby revokinq anr1 making void all former Hills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon as conveniently may be after my decease. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever anel wheresoever situate, I give, devise and bequeath to my dauahter, Llizabeth H. Isem.inger, and my son, William R. Hebster, in equal shares. 3. LASTLY, I nominate, constitute and appoint my daugh- ter, r;lizabeth H. Isel'1inger, and my son, :Iilliam R. 1'7ebster, to be the Executors of this, my Last Hill and Testament. Fur- thermore, I direct that neither one of them shall be required to file bond or other security in the office of the Register of liills for the purpose of ac1ministering l~y rstate. In ,n'!':'-JESS HTIEPEOF, I have hereunto set my hand and seal this 11th day of June, A. D. 1979. /I /. . . ... .- 1-.- .' I, .----,,---- ~C<~- /tut.;~--:_~L~;LC":(J;J':':-LW~=~ ( SEAL) 1/ Signer1, sealed, publishe,] anr1 declarer1 hy the above-narn.er:1 Ei',1FLYrT PDFI:;JJL PFSSTT:P, in the presnecc of us I w!1o, at her request ancl in her presence, ancl in the pre- sence of each. other, 'lave hereunto subscribed our nam.es as witnesses thereto. C/) '. ')..1 -- ~ :o~::.~:.~~~r~"f~s:..t-_kk_~-L-C]i~=~i":::~-- \ I ) ~ " '7 ____ _ _L/./dP/r...I._df;;:r=,,>U2_______~_ _. / '- JRD/June 30, 1992117858 Estate No,: 21-02-647 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of EMEL YN ROWELL WEBSTER Late of LOWER ALLEN TOWNSHIP NO, 21-2002-647 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: ELIZABETH ISEMINGER Counsel for Personal Representative: Date of Grant of Original Letters: 07-18-2002 Date of Delinquency Notice: 10-28-2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on OCTOBER 28,2002, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 11-19-2002 ~\I~'~~~ . . ,Register 0 ill ~ Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for I-ft) - 0 -~ at ~)~. .:l<lAI<lIn Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. George E v CERTIFICATION OF NOTICE UNDER RULE 5.7 Name of Decedent: Emelyn Rowell Webster Date of Death: May 3, 2002 Will No.: 647-2002 To the Register: I certify that notice of estate administration required by Rule 5.6(a) ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 18, 2002: Elizabeth W. Iseminger 405 E. Strawberry Street, Lancaster, P A 17602 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: December 3, 2002 ~Yl UO. ~A/1A~ Eliz eth W. Iseminger 405 E. Strawberry Street Lancaster, P A 17602 (717) 393-6111 Executrix MEMO Robinson & Geraldo 4407 N. Front St. Harrisburg, P A 1711 0 (717) 232-8525 Re: Estate ofEmelyn Rowell Webster Date: February 10, 2003 Enclosed please find the Entry of Appearance to be filed in the above-referenced matter. Kindlv time stamp the enclosed copv and return it to our office in the enclosed self-addressed stamped envelope. I thank vou in advance for vour attention to this matter. Cumberland County Register of Wills One Courthouse Square Carlisle, P A 17013 Attention: Cheryl ESTATE OFEMELYNR. WEBSTER : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA ORPHAN'S COURT DIVISION NO. 647-2002 PRAECIPE TO ENTER APPEARANCE To the Register of Wills: Kindly enter the appearance of Andrew H. Shaw, Esquire, on behalf of the Executrix in the above-captioned matter. Respectfully submitted, ROBINSON & GERALDO Date: February 10. 2003 By: /!/~~.t<r Andrew H. Shaw, Esquire Attorney 1.0. No. 87371 4407 North Front Street P.O. Box 5320 Harrisburg, P A 17110 (717) 232-8525 /-')- /1- "~ BUREAU OF INDIVIDUAL TAXES INHERITANCE lAX 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 R~_1547 O:Io.FP <n.6!) ANDREW H SHAW ESQ ROBINSON & GERALDO PO BOX 5320 HBG PA 11110 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-24-2003 WEBSTER 05-03-2002 21 02-0647 CUMBERLAND 101 EMELYN R Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-,,=i54TEx--AFP--C"oi---o3Y-iiiiiYcE--oF-INiiEifITA'ircFYix-APPRAISEM-ENT-,--;:L"i.-owA'ifcFil-R"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WEBSTER EMELYN R FILE NO. 21 02-0647 ACN 101 DATE 03-24-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON, ORIGINAL RETURN 1. Real Estate (Schedule A) (I) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule DJ (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (1) 8. Total Assets .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your 4,954.67 tax payment. .00 .00 'BJ 4,954.67 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) '9J (10) 605.00 7.649.57 (11) (12) (13) (14) R .7<<;4 ti7 3,299.90- .00 3,299.90- 11. 12. 13. 14. Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax If an assessment was issued previOUSlY, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ 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 (18) HOTE, (15) (16) (11) .00 X 00 .00 .00 X 045 = .00 .00 X 12 .00 .00 X 15 .00 (19)= .00 19. Principal Tax Due TAX CREDITS: PAYMENT RECt:.IPT DISCOUNT (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ,-, TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAH $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION I Estates of decedents dying on or before DeceNber 12. 1982 -- if any future interest in the estate is transfe~~ed in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for Years. the Commonwealth hereby expressly rese~ves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and sub~it with your payment to the Register of Wills printed on the reverse side. --Make check or ~oney o~der payable to, REGISTER OF MILLS... AGENT REFUND (CR): A refund of a tax credit, which was not requested on thQ Tax Return. may be requested by completing an "Application for Refund of PennsYlvania Inheritance and Estate Tax" (REV-LH5). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-ti"i7-3020 crT only). OBJECTIONS: Any partv in interest not satisfied with the appraisement, allowance. or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) davs of receipt of this Notice bYI --written protest to the PA Department of Revenue, Board of Appeals. Dept. 281021. Harrisburg. PA 17128-1021. OR --election to have the ~atter determined at audit of the account of the personal representative. OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS I Factual errors discovered on this assessment should be addressed in writing to: PA Depart~ent of Revenue, Bureau of Individual Taxes. ATTN: Post Assessment Review Unit, Dept. 280601. Harrisburg, PA 17128.0601 Phone (71TJ 787-6505. See page 5 of th~ booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months afte~ the deced~nt's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non~participation penalty is computQd on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as vou would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar vear to calendar vear with that rate announced by the PA DepartMent of Revenue. The applicable interest rates for 1982 through 2003 are: Intere.st Dajly Interest Daily Interest ~ ~ Year Rate ~ Year Rate Daily factor Year 1982 20X .aa05ti8 1987 OX .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000:301 2000 "" .000219 198ti 11% .000:301 1992 ,% .000247 2001 ,% .0002ti7 1985 13% .000356 1993.1994 '" .OOO19Z zaoz '" .00016ti 1986 lOr. .000274 1995-1998 ,% .0002ti7 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) bevond the date of the assessment. If payment is made after the interest computation date shown on the Notice. additional interest must be calculated. davs )11 ' Gl> PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: EMEL YN R. WEBSTER Date of Death: May 3, 2002 Estate No.: 647-2002 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: I. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (dale) 3. If the answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? Yes No x B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes X 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. dL/~ Jl~r Signature ' Date: J - ;2~-O 7, Andrew H. Shaw, Esquire Name (Please type or print) P.O. Box 5320, Harrisburg, PA 17110 Address (MAH:nnUAM3) 717-232-8525 Telephone No. Capacity: Personal Representative x Counsel for Personal Representative R.W.-M '" '1\l\l\l c I.'il'\. c"\'il " '" . s ';i) ~' ~ ~ -i~ ~l '0 ~6-:;:"-~"\?; '!'- "&(t .?-a:. '" ~- ~%, o c~l ~,~ ~~ ~-e ,,?€, ~~ ~ IL~ , 0 < " '" ill ~ ~ 9-' " ~ '::' n " '., m . .. " = ~ ~ 3 ci '0 ~ m ~ :;. = ~ ~ :;. ~ ~. '" ,'" ;<;.: ? ,c' " j ~:! o " CO; m ~ m , , ?"J ~'-'- 50 m _, ~::; " ;0 G ~u 0.tJi~ ~. '. ..._'-,,~--..- ~ ~ \"5 ~ ;:; J iFI 1 () " ~') ct :~ j <il ~ " " s g -0 '" 0- :::::~ ~ ~ "'" 6 . ~I>- 'fJ,<;tJ % ..", o~cf)~ ,;.._0.. tf>${J)'it. t&:JO- \ c<'\ - \-i; 0 ~ r- ~ - :::::: ~ ~ ~ ~ '" <f) -i Ii> o 0. <f> "' 'd. In ;;, 'i ? 'a; -0 'a; <f) . 11 (f) ~ ~ ~ 3 $ ~ tv ~ Z ~ g ~ --... ::J i ~ ,')" " ~il f\) ~ o "''' :1 )> C <0 co !il ,; ~ ~ ~ :\l <: 6 ~ w ~ ....J o Q N rtfl ?' !' .. :IJ ffi s, n " C- O .. I '0 Q1 ii ! w ~~~~ ~ ~. a. g" ~*i~ ~ i\.;:: 1l = &- 000 () b '" :x<m . x -" co ~ ~ . , & ~s: ~ f!l. "E.- Q o it' " s: . <1 ~ ID , C- o . ..J f: o ~ fR . . . Q~~~~b> g~:T3.33 ....... ::r~,< ';:''Q. ~s::;:g~!!l. _Cii"(l)..... JJ<Il ggg3~!!3~ .........,.:1 ::!, ,;:;;Q.-o;<DC)(Jl UloS-mm....... -0 c::J Q.- ~:.;3O"o.!'l m~:;~~~ -g$l.l(t\Q-~o.. 3Q..gm-<!"N &fQ.a~ (ij'~ . go::l g.~ (l) '< g:.~. () 30 <D@:o Q.l != Ci1 0. 3 -g: ctj"j- fI.: iri cD !' '" o '" >< :IJ . o . '" 1l. !l ::0; W rni. ~ $ !i ll.l '8: ~ <Ii <" m ~ C- ar @ " & ~ &' n 4' 5' ~ if 3 ~ p o ~ DO O~ ?i.~ "- ~ !2. 01 ..... :;::- g: ~ $ ::; ~~ o " REV.T500 EX 1;..,0) I- Z W C W (.) W C w "' ::s::~(I) " '"'' W"" ",00 ,,0:-' .... .. '" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) N\G. C ",rt> ~ <':-\\ ex- \'- DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (M -DO-YEAR) OL\-.)O-~cx::0- \.;)-J\- \C;~:,;- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [\ \ G.- rz11. Original Return o 4. limite<! Estate o 6. Decedent Died Testate (Attach copyalWIII) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale at death afler 12-12.82) o 7. Decedent Maintained a living Trust (AttachcopyofTrust) o 10. Spousal Poverty Credit (datil aldeath between 12-31.91 and 1-1.95) OF;:IClAL U~E Oi'II_V C- 17 - -Lh ~L FILE NUMBER :1,,1 -CJ~ COUNTYtIDE YEAR g __~<f_ NUMBER SOCIAL SECURITY NUMBER 0<0\ \'8 d.~~1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date af dealh prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Tolal Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) :,THIS SECT.iONMUS, BE COMPLETED.I\.LL CORRESPONDENCE AND, CONFIDENTIAL TAXINFORMATION SHOULD BE DIRECTED TO: NAME , l COMPLETE MAILING ADDRESS III\\G~lL cLX\d\S FIRM NAME (If Awl""') ~ ();;,. M.- G:)i "-AD Il\'^-.. IJ E'0o\c....., ?'i\ "' z w " z o .. 0) w 0: 0: o " TELEPHONE NUMBER W Sl~-L\l~ l \\ t5.:). - S-S-~ \Z-o<c-d no~- I "\ I&.--- (1) OFFICIAL USE ONLY 1 r\o'N.....- i (2) \'\'O~ I (3) i(\ \0 '<\.L I (4) \\I:.)~ I (5) l"\o'l'\...L.- (6) C, 0 '1'i /. 0 d.- , (7) "''' '-"-- (8) '-10, "\ST o~ (9) S-SClS-, 00 (10) 1'5,-\,_":>- (11) 5-] 8'1. C;~ (12) g~, Lee 1. I 0 (13) D, DO (14) <eS- , Ito'l. 10 x,o_ (15) 0 x .otf5:- (16) ], '6 ~;~ 5d.- x .12 (17) 0 x .15 (18) 0 (19) 3, eD. J.y 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has nol been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) z o < I-' ::::l Q. ~ o (.) X ~ 20,0 ,> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 16. Amount of Une 14 taxable at lineal rate J'-, k0--., \ () 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT z o ~ ...J ::::l !::: Q. <I: (.) w a:: 1. Real Estate (Schedule A) 2. StocKs and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable {Schedule D} 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. tnter-Vil/os Transfers & Miscellaneous Nor.-probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Fut\ern\ Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate Decedent's Complete Address: STREET ADDRESS \ \:L 6---\t> R-b"-.d CITY E ~o \ C>-.- Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount ZIP lIoM-l'll (1) ~8~~. J:i- '..jd-I. 'Ill &d.. 'd--. Total Credits (A + 8 + C) (2) '-IS'D.,]<=;' (3) D (4) ') (5) 3, Y 0\ 1) (5A) 0 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund 5. If 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. 1 yo\ 'l~ (58) Make Check Payable to: REGISTER OF WILLS, AGENT :?:~~~;"f~~~~~~~~~;<~~~~.ii~~~~~.q~~~~,~-.. '1I\l!.ll"'~!::iIJ PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes o ....0 .........0 ....0 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;...... . .................... ................. b. retain the right to designate who shall use the property transferred or 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? ................... .................. .................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............... .................................. ................ ................... ~ ~ ~ ~ cvl ..0 o ......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 penalUes of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to lhe besl of my knowledge and belief, il is true, correct and complete. DeclaraUon 01 preparer olher than the personal representaUve is based 0 nallinlormalionolwhic reparer has any knowledge. '?~ \l~-I<;\~ DATE 01 0\ ~cc6 ADDRESS DATE ~~ .~~., Y~~'., .~. 'f;,~~2:'i'JQ:;.T~~:;;~~~~~~=~-~~.'>>!!'!I~=,..u~~di~~~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenl's lineal beneficiaries IS 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1509 EX+ (12.88) -t~ SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Joint tenant(s}: FILE NUMBER A. NAME ~\c\\e..~ c.. \.A.0',6\S ADDRESS (QO;}.. I\l--. ~3 6.-<0 [Z..o&.c1 E""'\G- ,\?VX: nodS"- \'\l~ B. C. RELATIONSHIP TO DECEDENT d "-";j '" 'Ie- ,- Jointly-owned property: LETTER DATE ITEM FOR TOTAL VALUE DECO'S DOLLAR VALUE OF NUMBE~ JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST TEN ANT JOINT 1- (l, c,,~ o~ L"''-''-'-'j l'>,. "'='" + dO, I ).1..\, ow. n90 II) t>("~, Dd- , \c.Sc- tlr \:~J\V\T\\") . . ~ \'i'i4 . 1\ ,,0 So 0(0 8", C:;,', 00 A. ..)0",L J.o, .~ 'J.-O-.L. IL..l ~7o. , 1'11'1 - I TOTAL (Also enter on line 6, Recapitulation) S So ,t;'C;l, Od- (If more space is needed insert additional sheets of same size) ,qey.1511E;('11.97j '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~\Jex- \"( I\J\ \\\."(56..-ID Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 1. 2. 3. 4. 5. 6. 7. DE5CRIPTION AMOUNT FUNERAL EXPEN5E5: .s \.>...\\,,,"-'''' \="",,,,,,<>..A \'\O~ .toe \=-'0"'~"\ c.....\. 4..-~ \) \,J,to....-\ \~~\u--~~ ~(>)'"' ~-<-$,..,"" 5..L.<;->J \ <.A....-'> -e.-.-<'~\'('f\'-'<'<. '<\ \.-'('(,..,'<'~'fO...-\t....-\.-\"'~'\., (<1,~\<:..R.,(\-J \-\"",,-,n' Ic~~-' \or ~r5~I' ;",,<..<-~\ >,0...... .u-,U\~ ')~ c l", ~ 0'>,. \".,..,r ~ YLc.<<"'-''' (",-c, \ ~ ~cd. Sv<-'hu..-S ?\'O~\.~ ~\'\o~\..~ -\"'f\~~6...- \ ~ $...k.. c~ (_X~n:_-," ADMINI5TRA TIVE C05T5: Personal Representative's Commissions 5", I O~. 00 ~ bO" 00 Name of Personal Representative (s) Social Security Numbe~s) J EIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: Attorney Fees Family Exemption: (If decedenrs address is not the same as claimanfs, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent Probate Fees Accountanfs Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) _ 00 $ S ,soC REV.I.512 EX+ fl.9J) ... SCHEDULE I - DEBTS OF DECEDENT, COMMONWEAlTH OF PENN.5YlVANIA INHERITANCf TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIOENTDfCWENT Please Print or Type ESTATE OF FILE NUMBER \<:~\)L" \.J l'I\. 1Ik,,~, 6..,0 , \1 ITEM DESCRIPTION AMOUNT NUMBER 1. ~ \ ICL \' <L\"1O\ - \\0->-'5 <.. '-\0 Io"-\c...",,-- O~ 0'" .s.--!I\oSL..n~\-o~'lV,\ ;,<.. (\<;,'Sct_-<..4-. ~d C 6.-" ~"\O\Cr.~ ~ ar. 00 \''',\''0'<>'''''- \,,\\ ,,"\ c...2, ~ \nS'-.l\6....'I"\Q.- l<o-.:~ <)J. r,-;.-. ? .-- V'~ . L (~Lj,,'c\l- CO. \-''<'i..L-\ ~,\\ - TOTAL (Also enter on line 10, Recapitulation) $ 'b'-\ C; .J- . (If more space is needed, insert additional sheets of same size.) R!v.l'.IJ EX+ (2.87) .. COMMONWEAlTH OF peNNSYlVANIA INHERITANCE TAX RETURN IlESIDENTDECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FilE NUMBER ~'(,(c ~(V ITEM NUMBER BENEFICIARY RElATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxoble Bequesls: 1. ~GW-~ L l"--'I'6\S ~o~ \\}..G/i. 6--(1) €'^,,\'-<. U q'f'r I '. ~ C'-;-j~' ..-- f if.. 0 H?> n~-\')\~ . ....,. "'TEM .... NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Beguests: 1. . TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI,o enle, on Hne 13, Rocop;lulotlon) s ~ (If more space is needed, insert additional sheets of sarne size) Date. Procedure Descrlpllon Diagnosis Charge Credit Balance Code PREVIOUS BALANCE--> 25.00 / "\ Total Currenl 31-60 Days 61-90 Days 91-120 Days Over 120 Days I Amount Due: I l $ 25.00 ) Insurance Balance $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ~ ./ Pallent Balance ASSOCIATED CARDIOLv",,,, S $ 25.00 $ 25.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 856 CENTURY DRIVE MECHANICSBURG. PA 17055 AccDunl Balance $ 25.00 All bill!n uesllons can be made between L. Bruce Althouse, M.D., FACe (1a.11.1998) Donald C, Durbeok, M,D" FACC Jeffrey S. Fugate. D.O.. FACC Stuart B. Pink, M.D.. FACC. FSCAI Kenneth J. May, Jr, M.D.. FACe Robert A. Skolnlcld, D.O., FACe David L. Scher. M.O,. FACF, FACe J~ c. L, Cotton, M,D" FACe Irs Sackman, M.D" FACe Robert O. Aronoff, M.D., FACe David C, Man, M,D" FACC Edward C. Brennan, D.O., FACe Andrea8 U. Wall. M.D., FACe Michael D. Bosak. M.D., FACe Lenke Erki. M.D. Stephen B. Sloan, M.D. Tracey Wuestkamp Sloan, MSN/CRNP Raleah M. Dave, M.D. gq the hOUfS or 8:30 AM and 4:00 PM. For aming Questions Call: (717) 591.7122 For Toll Free Call: 1-800-845-1742 Patient Name: Beverly Magaro 1112 STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION -------___._________0________________________ T Retain this portion for your records. T 2P QO,q 4.;;:'20647 07 / 16/0~!. 06/2~{/0~~ l-,}O-~ Account Number Bill Date Expiration Dale Dale Paid trbe patriot-News Thank you for subscribing BUREAU OF INDIVIDUAL TAXES INHERITANCE TAK DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOHANCE OR OISALLOHANCE OF OEOUCTION~, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 EllAFP (II-aU MICHELE C LANDIS 602 MAGARO RD ENOLA PA 17025-1912 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 11-19-2002 MARGARO 04-20-2002 21 02-0648 CUMBERLAND 201-18-2257 02128622 Amount Re..itted BEVERLY M 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=is4-i-iif-AFii-foii=ozl------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-19-2002 ESTATE OF MARGARO BEVERLY M DATE OF DEATH 04-20-2002 COUNTY CUMBERLAND FILE NO. 21 02-0648 TAX RETURN WAS: S.S/D.C. NO. 201-18-2257 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 02128622 FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0057215049 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS (JO CHECKING ( ) TRUST ( ) TIME CERTIFICATE 08-28-1964 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x 20,124.04 NOTE: 0.500 10,062.02 (53.52)-\'VILL 10,008.50 ~\"<L\ .45 \,,',\~ 450.38 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-17-2002 CDOO1424 22.52 427.87 TOTAL TAX CREDIT 450.39 BALANCE OF TAX DUE .01CR INTEREST AND PEN. .00 TOTAL DUE .G1CR . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYRENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREOn" ( CR), YOU RAY BE DUE A REFUND. SFE RFVERSE S rnE OF THTS FORH fOR TNSTRlJr~TJONS. ) (bq7;-~ -~"~o-'l - 1""- - /'~ 0 D -~ . '-' DEED THIS DEED, made the ID n1 MAY, day of hptil 1995 BETWEEN ANDREW E. MAGARO and BEVERLY M. MAGARO, his wife, as tenants by the entireties as to an undivided one-hal f interest and MICHELE C. HAGARO, now married and known as MICHELE C. LANDIS, their daughter, as to an undivided one-half interest, the respective holders of the undivided one-half interests shall be joint tenants with a right of survi vorship and not tenants in common, all of East Pennsboro Township, Cumberland County, Pennsylvania, GRANTOR, AND ANDREW E. MAGARO and BEVERLY M. MAGARO, his wife, as tenants by the entireties as to an undivided one-half interest and MICHELE C. HAGARO, now married and known as MICHELE C. LANDIS, their daughter, as to an undivided one-half interest, the respective holders of the undivided one-half interests shall be joint tenants with a right of survivorship and not tenants in common, all of East Pennsboro Township, Cumberl and County, Pennsyl vania, GRANTEE, WITNESSETH, that the Grantor, for and in consideralion of ONE DOLLAR ($1) lawful money of the United States of America, to the Grantor in hand well and truly paid by the Grantee, at or before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged and the Grantor being therewith fully satisfied, does by these presents grant, bargain, sell and convey unto the Grantee forever, ALL that certain piece or parcel of land, situate in Pennsboro Township, Cumberland County, Pennsylvania, particularly bounded and described as follows: East more BEGINNING at a point on the southern right of way line of Hagaro Road, which point represents the intersection of the northeastern corner of Lot #5 and the northwestern corner of Lot #6 of the plan of lots hereinafter described; proceeding from such point North eighty-seven degrees twenty minutes zero seconds East (N 870 20' 00" E) two hundred one and twenty-six hundredths feet . jfrlOj( 125 PACE 680 - I' (201.26') along the right of way line of Magaro Road to a. point on the dividing line between Lot #6 and lands now or formedy of Ronald Magaro to a point; thence along s?id dividing line soutl5 seven degrees fifty-four minutes lwenty"elght seco~lds West (S 07 54' 28" W) five hundred seventy-three a:,d sIxty-eIght hlln(lr~,dths feet (573.68') to a point; thence; NOeth elghty-sevcn dcgle'7:c Llfty'- three minutes thirty-two seconds West (N 870 ')3' 32" W) UIl<' hum]J cd seventy-seven and forty-one bunch e(]lh~; fet.! (177.41') ,II UO') Lbe dividing line between Lot #6 and Lot IS on said plan uf luts Lu a point; thence North twenty-one degrees forty- four rninutr,~; ei ght seconds East (N 210 44' OS" E) one hundred sixty-four and spv~nty- two hundredths feet (164.72') along the dividing lin>' ),"\\"'\'i\ lo,d #6 and Lot #5 on said plan of lot8 to a point; tlll"ncc N",lh f,";t degrees twenty-four minutes [i fty.- two "ecunds ,'Jest (N 04: 24' ')2" W) two hundred ninety-five and sixty-eight bundeedlhs ft",t (295.68') along said dividing I ine La a poinl; Ih"n,,", NoIll, t",enty degrees thirty-seven minutes thirty-eight seconds Easl (N 20' 37' 38" E) forty-four and ninety-fout. hundtedths feet (44.94') I" d point; thence North one degree zero minutes eighteen secunds EasL 'OlQ 00' 18" E) sixty-two and forty-seven hundredths feeL ~').along said dividing line to the place of BEGINNING. ...~ BEING Lot #6 on the final subdivision plan of lots for Andre", Magaro prepared by Michael C. D'Angelo, Registered Surveyor, daLed September 22, 1978 and recorded in the Office of the Recorder of Deeds in and for Cumberland County in Plan Dook 34 at Page 96. CONTAINING 2.21 acres. HAVING thereon erected a brick and alumlnum hi-'level dwelling house with detached block garage known and lIumLered as 602 Bayaru Road, Enola, Pennsylvania. SUBJECT to rights of way in the line of title. BEING THE SAME PREMISES which Andrew E. Magaro and Beverly M. Magaro, husband and wife, by their Deed acknowledged June 20, 19~9 and record.ed June 21, 1979, in the Office of the Record,,) ,,[ ""..,.,] for Dauph~n County, Pennsylvania, in Deed Book M-28 P.,) '17.1, gra',lted. an undivided ?n:-half interest in thelll"<.']~" 1./ t j".. ent1re~~es and an und~v~ded one-half interest in th,[.;, I L, 1.1 unlDarr~eddaughterMichele C. Magaro as joint tenants "il.t. 'Ji"l,!. ~~K8urvivorship and not tenants in common, the GranLrn 'Ill." ( c"~" . 1':''t}~~'' THE PURPOSE of this Deed is to evidence on the I '.r"", ,) I'" r"", ,',,'1: "t..aid Michele C. Magaro is now married and her rn11 I ,,1 ,'."" ,.. , h~1e C. Landis. 71f(~ ~D,J If:. tJDr Tftl<lt&E, TOGETHER with all and singular the buildings, improvements, ways, woods, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances to the same belonging or in anywise appertaining; and the reversion and reversions, remainder and remainders, rents, issues and profits thereof, and of every part and parcel thereof; AND ALSO all the estate, right, title, interest, use, possession, property, claim and demand whatsoever of the Grantor both in I aw and in equi ty, of, in, and to the premises herein- described and every part and parcel thereof with the appurtenances. TO HAVE AND TO HOLD all and singular the premises herein- described together with the hereditaments and appurtenances unto the Grantee and to Grantee's proper use and benefit forever. AND the Grantor covenants that, except as may be herein set forth, they do and will warrant and forever defend the lands and premises, hereditaments and appurtenances hereby conveyed, against the Grantor and all other persons lawfully claiming the same or to claim the same. In all references herein to any parties, persons, entities, corporations, the use of any particular gender or the plural or singular number is intended to include the appropriate gender or number as the text of the within instrument may require. wherever in this instrument any party shall be designated or referred to by name or' gener'al reference, such designat.ion is intended to and shall have the same effect as if the words "beirs, executor's, administl'iJ.tol'~-:i, pet"suudl or legal Lt'l?tesent.aLives, s.uc~esso~.s and assigns" had been inserted after each and evet-y suc.0,., ;~; \)\;~'~i':r':.l des1gna 11 on '[.$~~5~~i1iJ,J.. ~';!!t :0.,,,,' ,. ',;. ~~:' '~:: ,_.:0.1~ ..Ji.::.i IN WITNESS WHEREOF, the Grantors have hereunto set t.heir h ,.'.t!fAti\~~~ and seals, the day and year above-wri tt.en. "'~"i<~~I~~,if4S' ~/,:~;;;\~~"~:~;:<"; . -,." Notarial Seal Ze!Qa F. Souder. Notary Public Lower Allen Twp., Cumberfand County "1y Commission Expires April 20. 1998 Me: '1OOr, PennsytvaniaAssocfatfon of Notaries GV~c.-~ Ih yn ~lf' ,V Lc) BEVERLY M. MAGAR V[11)"l6U]!:: )(~r ~l-c- ANDREW E. MAGARo/ Notarial Seal Zel(la F. Bauder, Notary Public '.ower Allen Twp., Cumberland County . ......"mmissio'. '":''''Iiras April 2Q, 199P Notarial Seal Zelda F, Bauder, Notary Pub"c Lower Allen Twp., Cumber1and County 1v r.nmmi!=;!;jon F)t'nirP.~ April ~, 1 qqA liiin~ -f ",. f'''' ('11'" COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND .-111 . On this /0 day of MIt'l , 1995, before me, the subscribed official, personally appeared Andrew E. Magaro and Beverly M. Magaro, husband and wife, and Michele C. Landis, thpir daughter, known as Michele C. Magaro her single name prior to her marriage, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. WITNESS my hand and official seal the day and year aforesaid. /~ 17J ;/ i? ' ?5//t:(J:-~'!. "'-<- . .~.-<;~Ju {~ ,}} ~. /tJ .- q~) <t 0- r- tf) , ..... , -:r: C) r u.J LU I- _J LLJ C? C? 0 :=J '" 0 e:: l~ c:> u D- .o. 0: C1 - I '" , tn (~: L:> I N " , -: :~ I:: , , c") t,] :5 U CI ,., ~ I J ..., 1;.: ... L'" -, en bO'ot< 125 rm 683 COMMONWEALTH OF PENNSYLVANIA 55 COUNTY OF CUMBERLAND Recorded on this ere; day of --Su 11 ,199~in the Office of the Recorder of Deeds of the said Cou ty in Record Book I as- Given Unde~~Y ha~~0and offi~ial seal of the said Office on the date above wrltten. ~.~--Oq '> ;r 7;r-k.?<-- 6~ Recorder The undersigned Grantee is: certifies that the precise '1 {(:kiCLC' (!. i-1+f.JDt5 , . J. CoO)..,2. FIAtf-ftpJ) KD. E~JDI--A j fIT 170,:k\ address of the t)'I!Aii.l riFE (-~/ "'~ ....%;.1 '.. ...".(".",~.,.i' """."'. ,~1-" '~,"" ~- ',,"~+ ,"i:'-'~ ~. .... ~ ~.. ,j,l,.,t' ,.,,"'" "-" .'Jr;': -,' ,-,"~. ,~ .t:, . _ ,,' _'.." , ": ,v~ \. '~. " '_,'~ ,1- ~~l~~lf1fg~I:~tt~.".. .. ".w, ...',' ':,..." .1 :'.~~ :"-:'.&l..,l, . ""'^".,. "~:f>.",..,t -':!.I" ~'-', "'",~ ..''''~' ,~C;),..;.-.t'/ ,';:l.?H",':.;t.' t~~~,""<i'" ... ..'--: " ,fi'.,C""; ,",-,:rl"t~.'t:,~:;~;!N' iH~"J~. "'i..;."t't_ . ",'1:r_'f:'1~tfH'~,l-:G.\;\'''''''~i~::~;'U''(\'",: ;"": . ./fi..p ",-., '.' ,...~...~,.-....'.\..~ ;. .." ''''~:'I , ~. -'-' ,'t ..........;i:'~~:!ii':~r'.'..f,:.,Jj,..,_~}ju>{" . ;,.t'.,J.~ ,01' If ~ <\,\,.}-~~td~~:v~" .1::..;.~ 'fi;~''"'.' "~'-'.ll!'lO~..~.t""".,,-:...;,;;i(.,:r,f"'I.- , \'1!" . ~ ., .... ~ '~";'. (","'..."":". ""';'-." :~'-J','\.. . , ,." . ..,', .,...,......l';.... -.'" ..r..~'~ ....i-...,~ ;~{. ;..~r7~"c"\';t.-'"(,,, ..... ....., J ,'_ '''''') , Mo' ~.-.4t:'''';{ 4~Y,F'4f~C&l':':'~- --- . ~f,j',," _':' . ,I ~.~~' !'\if' ~,,~'" \-\;. -... ~ 0-. . 600K 125 f,lcr 6tH I I , i \ ( ", j d,11 ~ ~.' ". -; ~ .!. ; i \ it '. e .~ ;, \ j " I, ~ , , \ , /- \}.i \/~: ',.>........-:'". [;~~. ,." ,. ':, ". "i..'j \ ';\ . or. .~"'ON -c>~O " ,.... "'O~ ,..l.... 0) 1;'0< dl "''''- ..c::~ of .~~o ~o" '0", .1 C/J .-:::;. . ~ ~ J -t \... ':) o (:...J s o L..--(" U o /'J c 53 \... V) ~ ~ ../ u=:> ; c:,) .J c::L-() \... .:J -- - .. - .. - .. - .. -: .- - /V\ ., - 0 r .- .- a: (':t (t.J D-- ':1) , fl) ..... Y. f') -1'-1 ~ () 1"'.. \.... or" d U 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 LANDIS MICHELE C 602 1/2 MAGARO RD ENOLA, PA 17025 unnn fold ESTATE INFORMATION: SSN: 201-18-2257 FILE NUMBER: 2102-0648 DECEDENT NAME: MAGARO BEVERLY M DATE OF PAYMENT: 07/18/2002 POSTMARK DATE: 07/17/2002 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2002 NO. CD 001424 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02128622 I $427.87 I I I I I I I I TOTAL AMOUNT PAID: $427.87 REMARKS: MICHELE C LANDIS CHECK# 5485 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' I r -" '~,- l~()- INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-0~- 6<,ti? 02128622 06-21-2002 REV-1SUEXAFP(Q9-DOl EST. OF BEVERLY M MAGARO S.S. NO. 201-18-2257 DATE OF DEATH 04-20-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IXJ CHECKING o TRUST o CERHF. MICHELE CLANDIS 602 MAGARORD ENOLA PA 17025-1912 REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICES has provided the Department with the information listed below which has been used in calculating the potential:taX due. 11'181.... records indicate that at the death of the above decedent, you were a joint owner/blilneficiary of this account. If you feel ~is infgr~~on is incorrect, please obtain written correction from the financial institution, attach a COpy to this form and return it to the abo~e~ address. This account is taxable in accordance with the Inheritance Tax Laws of tha Co~monwealth of Pennsylvania. Questions .av ba answared by calling r7171 787-~327. COMPLETE PART 1 BELOW Account No. 0057215049 II II II SEE Date Established REVERSE SIDE FOR 08-28-1964 FILING AND PAYMENT INSTRUCTIONS Account Balance 20} 124.04 Percent Taxable X 50.000 Allount Subject to Tax 10}062.02 Tax Rate X .15 Potential Tax Due 1}509.30 PART TAXPAYER RESPONSE [!]lijijii~~~~I!~iiji~ijjj..I!i[j~~~~jiiii~~II~ijjii~~j!ji~~liii~Ij~~~~~i!ii[~l!iiiii~gIlU~iiiil~~giiii~i!i!~~~~i!j!~.~~~ii!ii!1 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are .ade within three (3) .onths of the decedent's date of death, you .ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. c=J The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Department of Revenue. B. c=J The abova asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return --- ~e filed by the decedent's representative. C. ~he above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART If you indicate a different tax .rate} ~leas, state your @] relationship to decedent: ct.!; \\~{I.. ~JL TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Estab11shed ~ 2. Account Balance 2 3. Percent Taxable 3 X 4. Allount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due L\d.l ,~, 8 doO \ ~L\, ()L\ rT) ,oon $') ()~~, O~ , r-l, &~ In 09($ ,!;() , ,nL\S- L\SD, ,'6 !';"Io PAYEE DESCRIPTION AMOUNT PAID l.\- '\ \;>--0 ~ QQ\.. 'L- "' \ $\-,\, \,." "----'"L\ <-'-u.-~, \< ,\\ ~, &J- TOTAL (Enter on Line 5 of Tax Computation) $ c( that the facts I lef. have reported above are true} correct HOME nil) IJ')"~~ WORK (,\,) wl;SC; TELEPHONE NUMBER and 1-\(,-0),- DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interast based on information sub~itt8d by the financial institution. Z. Inheritance tax bBCO.8S delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even thou9h the decedent's na.e was added as a matter of convenience. 4. Accounts <including those haId between husband and wife) which the decedent put in joint naMes within one year prior to death are fully taxable as transfers. 5. Accounts established jointly batween husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust farn another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and computation in the notice are correct and deductions are not being claimed~ place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the allount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return froll the Register of Wills. z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg~ PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION lINE 1. Enter NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/8Z: Accounts which the decedent put in joint nalles within one (1) year of death are taxable fully as transfers. However~ there is an exclusion not to exceed $3~000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (KK) appears before your first na.e in the address portion of this notice~ the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established 1I0re than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 in tha naMe of the decedent and two other persons and established within one year of death by X 100 50Z (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deterllined by .ultiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by SUbtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. KThe tax rate 1mposed on the net value of transfers from a deceased chIld twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is oz. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others~ adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents~ whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in cOllman with the decedent~ whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Oat. of Death Spouse lineal Sibling Collateral 07/01/9~ to 12/31/9~ 37- 67- 157- 157- 01/01/95 to 06/30/00 0% 6% 15% 157- 07/01/00 to present 0% 4,5%- 12% 157- CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being clailled llIust be itemized fully in Part 3. If additional space is needed~ use plain paper 8 112" x 11". Proof of pay.ent may be requested by the PA Department of Revenue. /?- ? 6 ...p ~ BUREAU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE DR DISALLONANCE OF DEDUCTION~, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548EXAFPC01-D21 MICHELE C LANDIS 602 MAGARO RD ENOLA PA 170Z~-1912 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 11-19-2002 MARGARO 04-20-2002 21 02-0648 CUMBERLAND 201-18-2257 02128622 Amount Rellitted BEVERLY M 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=is4-i-Eif-AFii-foi-=ozl------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-19-2002 ESTATE OF MARGARO BEVERLY M DATE OF DEATH 04-20-2002 COUNTY CUMBERLAND FILE NO. 21 02-0648 TAX RETURN WAS, S.S/D.C. NO. 201-18-2257 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 02128622 FINANCIAL INSTITUTION, ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0057215049 TYPE OF ACCDUNT: DATE ESTABLISHED ( ) SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE 08-28-1964 x 20,124.04 0.500 10,062.02 53.52 10,008.50 .45 450.38 NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO, "REGISTER OF WILLS, AGENT." Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-17-2002 CDOO1424 22.52 427.87 TOTAL TAX CREDIT 450.39 BALANCE OF TAX DUE .01CR INTEREST AND PEN. .00 TOTAL DUE .01CR . IF PAID AFTER THIS DATE, 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 "CREDlr-" ( CRl J YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ] PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the require~ents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the tap portion reverse side. -- Make check or money of this Notice and submit with your pay~ent to the Register of Wills printed on the order payable to: REGISTER OF WILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services far taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shawn on this Notice ~ay object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return far a Resident Decedent" (REV-lS01) far an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent.s death, a five percent (5%) discount of the tax paid is allowed. The 15% tax amnesty nan-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This nan-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated an this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of pay~ent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent an or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates far 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9. .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated s. follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assess~ent. If payment is made after the interest computation date shawn on the Notice, additional interest must be calculated. j/}-/b- / '\, 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 NO. COUNTY ACN 03-03-2003 MARGARO 04-20-2002 21 02-0648 Cumberland 101 MICHELE LANDIS 602 MAGARO RD ENOLA PA 17025 REV.11l47EX{12..97IPC BEVERLY M Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE q RETAIN LOWER PORTION FOR YOUR RECORDS ? .. REV:1547 EiC."(Oil:97yPC""."""".".""" "Notic'E"(lF "INHERIT ANCE"'j'"AX AiiPRAis"EMEN'j'": ,,;CL.OWANCE OR"""""."""""""""""".". -"""""""""" DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MARGARO BEVERLY M FILE NO. 2102-0648 ACN 101 DATE 03"03-2003 TAX RETURN WAS: (1:8:1) ACCEPTED AS FILED ( 0 ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/ Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funerel Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 5,305.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 84.92 11. Total Deductions (11) 5,389.92 12. Net Value ofTax Return (12) 85,607.10 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00 14. Net Value of Estate Subject to Tax (14) 85,607.10 NOTE: If an assessment was Issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures that include the total of ALL returns assessed to date. (1) (2) (3) (4) (5) (6) (7) 0.00 0.00 0.00 0.00 0.00 90,997.02 0.00 (8) 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 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 90,997.02 (15) 0.00 XOO 000 (16) 85,607.10 X.045 3,852.32 (17) 0.00 X12 000 (18) 0.00 X .15 0.00 (19) 3,852.32 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-I 07-17.2002 CD001424 22.52 427.87 01-11.2003 CD002036 0.00 3,401.93 TOTAL TAX CREDIT 3,852.32 BALANCE OF TAX DUE 0.00 INTEREST 0.00 TOTAL DUE 0.00 . IF PAJ:D AFTBR DATE INDICATED, SBE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS llEQUUtED. IF TOTAL DUE IS REPLECTED AS A CREDIT (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVA TIQN: Estates of decedents dying on or before December 12, 1982 -" if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 21 of 1995. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax (REV-1313). Applications are available at the Office of the Register of Wills or any of the 23 Revenue District Offices, or by calling the special 24-hour answering service numbers for forms ordering: In Pennsylvania 1 ~800-362-2050, outside Pennsylvania and within local Harrisburg area (717) 787-8094, TDD# (717) 772-2252 (Hearing Impaired Only). OBJECTIONS: Any party in interest not satisfied with the appraisement. allowance or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue Board of Appeals, Dept. 281021, Harrisburg, PA 17128~1 021, OR --election to have the matter determined at audit of the account of the personal representative OR --appeal to the Orphans' Court. ADMINISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601 Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 3 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedenf' (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18,1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are: Interest Daily Interest Daily Interest Daily Year ~ Factor Year ~ Factor Year ~ Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF OAYS DELINQUENT X DAILY INTEREST FACTOR -~Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. )~ !'J-'76- / BUREAU OF INDIVIDUAL TAXES INI~RITANCE TAX DIVISION DEPI. 280601 HARRISBURG, PA 17128-0601 MICHELE C LANDIS 602 MAGARO RD ENOLA PA 17025-1912 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN '* REV-UO~ EX AFP (Ol-On 03-12-2003 MARGARO 04-20-2002 21 02-0648 CUMBERLAND 201-18-2257 02128622 Allount Remitted BEVERLY M 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-1604 EX AFP (01-03) -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 03-12-2003 ESTATE OF MARGARO BEVERLY M DATE OF DEATH 04-20-2002 COUNTY CUMBERLAND FILE NO. 21 02-0648 ADJUSTMENT BASED ON: S.S/D.C. NO. 201-18-2257 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 02128622 FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0057215049 TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 08-28-1964 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 53.52 .00 .45 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE nn . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) PAVMENT: Detach the top portion of this Notice and submit with your pay~ent .ade payable to the na~e and address printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS" AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313l. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or fro~ the Department"s 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLV TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (7l7) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTV: The 15% tax a~nesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (I) day from the date of death to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which beca~e delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Depart.ent of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Vear Rate Factor ~ Rate ~ Vear ~ Factor 1982 20;: .000548 1987 9X .000247 1999 7% .000192 1983 16;: .000438 1988-1991 11;: .000301 2000 ax .000219 1984 11;: .000301 1992 9. .000247 2001 9;: .000247 1985 13% .000356 1993-1994 ]X .000192 2002 6;: .000164 1986 10% .000274 1995-1998 9;: .000247 2003 5. .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUftBER OF OAVS DELINQUENT X OAILV INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assess.ent. If payment is made after the interest computation date shown on the Notice, additional interest .ust be calculated. F,V-1470 EX (6-88) . ~ '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME REVIEWED BY ITEM SCHEDULE NO. BEVERLY M MARGARO Phyllis Hoch INHERITANCE TAX EXPLANATION OF CHANGES EXPLANATION OF CHANGES FILE NUMBER ACN ADJUSTED ABOVE ACN TO ZERO. REPORTED ON PROBATE RETURN. ROW 2102-0648 02128622 PaQe 1 - , , n '-\ -- -: --' -- ~ ~ - 1 ~\~\ ~ '1 ;! :. i. ~2 - c~ -!t i~ o ~ t/ . v y ,.- ~ ; 1 :t ~ . r:5 ) t ,., ~c3 . . ~ , . ~ - - -.....--- 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 LANDIS MICHELE C 602 1/2 MAGARO RD ENOLA, PA 17025 -------- fold ESTATE INFORMATION: SSN: 201-18-2257 FILE NUMBER: 2102-0648 DECEDENT NAME: MAGARO BEVERLY M DATE OF PAYMENT: 01/13/2003 POSTMARK DATE: 01/11/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2002 NO. CD 002036 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,401.93 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2481 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $3,401.93 DONNA M. OTTO DEPUTY REGISTER OF WILLS