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Home My WebLink About02-0654 Estate of C. OPAL SIMPSON also known as CLARA OPAL SIMPSON Deceased. PETITION FOR PROBATE and GRANT OF LETTERS ..2/-C):J.- {,s'l To: Register of Wills County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 184 - 36 - 5878 The petition of the undersigned respectfully represents that: Your petitioner, who is 18 years of age or older, is the personai representative named in the last will of the above decedent, dated MARCH 28, 2000. Decedent was domiciled at death in UPPER ALLEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, with her last family or principal residence at 1057 ALLEN DALE ROAD, APARTMENT E, MECHANICSBURG, CUMBERLAND COUNTY, PENNSYLVANIA 17055. Decedent, then 84 years of age, died JULY 12, 2002, at BEVERLY HEALTH CARE OF CAMP HILL, CAMP HILL, PENNSYLVANIA. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent. Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal properly (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: TOTAL $ 30,384.00 $ $ $ $ 30,384.00 WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. ~ ~' , itCfl e., ~A -- - RRAINE A. SIMP 'it: - 6412 CARLISLE PIKE, LOT 19 MECHANICSBURG, PA 17050 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner above-named swears that the statements in the foregoing petition are true and correct to the best of the knowledge of petitioner and that as personal representative of the above decedent petitioner will well and truly administer ~cC~rding to law~ Sworn to and SUbs&,ribed ~~t.~ ~ '" 'v before me this R day of RAINE A. SIMPSON July, 2002. '-fYy,~(1.~, p'L(lU.~ Register ~~ /7- ?0'- 9 21-02-654 Estate of C. OPAL SIMPSON, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, July~. 2002, in consideration of the petition ,attached hereto, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated MARCH 28. 2000. described therein, be admitted to probate and filed of record as the last will of C. OPAL ~lMr~~ All(;/A Letters Testamentary are hereby granted to LORRAINE A. SIMPSON. C P SInPSON 71?~L" .!Iou"",, aM t.t2..:>Y'~UJ O'~ury R gister of Wills ,.. Probate, Letters, Etc. $ Short Certificates (s,) $ RanuAci:atiflftExTRA PG 2 $ JCP $ TOTAL $ Filed: JULY 22. 2002 70.00 15.00 6.00 5.00 96.00 9920) FEES 717-243-6090 CALLED ATTORNEY: JULY 22, 2002 ~.~" "'i ~r'--, "T\- f'.'.c:r, This is to certify that the information here given is corrccrly copi~d fror~l an original c~:[ific~(e of death dl1l~ filed with Local Re;gistrar. The original certificate will be forwarded to the Sent' Vital Records Othce for permanent fUmg, me as WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~'HHi;;;;; \,'III(~\l~_Q[pi,t,~~~.~_ /#/" '(.fij, /i~/ Jil1iI.a.... \~~ II.:!;'.""' .."., i~i .:;;,.. \~~ I~ wi, {/-, ."::b~ ~ \', ,'~ \h*,., ,.,~..'.'r'*~ '%. a\ . -. -- /~l ,~'" ,,' ~." ":.. :f-?''-~_ . .-~'r ..' ---'" I.1fENT ~\ ~ """ "I'-'-""H//I,,"IIIIIII 'JL4-'~1 ~1:;' ~1li Fee for this certificate, $2.00 P 8482782 9"1: /~ .J-GC! )... Date 'J H~, c.'8/ COMMONWEALTH Of PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH H'lt'I""l .. ~(W"''''ll.r 3,,",(,,,,,,, "'''M{oiDKi":DENT,r"", M"""".C"'I ~-~~~_..~.~-- - -~--~'"-..~~-'"- -~~" SE_.' S''''i''lE.~l/..aU1 SOCco,l SECURIn' NUM8iR O~(;'[ATi;;-:M;:;;;;7';;-_-;';:~._-' Clara 1 S' UNOER1YEAFl lo4onU\. 0...,. n UNOl'R1D..:r """""! M.....'iM MIN00f'8USlNESSiINOUS~ OAle-OFBIRT... -BIRTi<iv.cf'(,',.;:.;;-.~- PVoCEOf'QEATI<(CI><<"''''.,.""e__ _,n"'''''''''''''''''",r>e, '081 ,MQ<,'nr).....'..." ""d""U~'9'l~O"'""1 HOSP'T.... ---~--___~.__ 1""",_0 E"""-'....O 1 M1ddlesex, PA .. FACJlITYNAMEI~o",.,,,,'l\,t"""')""."'_,,nonum,,,,,, I. Female 3. 184 - 36 5878 '. July_ 12, 2002 AGin."'1l.1N'vl 84 .. . COlINn'OFOERH CITY.80FlQ A_nee;:] ~='"vIO - Cumberland J:ast Pennsboro ~~~';;;c...n.lII6c..-"'''e I~~J OECfDENT'SUSUAlOCCUp,Q'~ '~-:"~":;,;:~"":'::::t:di' 11. Clerical I". Retail Sales OEc..'EllENT'S....llING.-.ooRESSlSl'_,C....~.Sliooo_l"C""") DECEDENT'S ACTUAl RESIDENCE ISft..""""I",,," """'n.....,el White 1 057 Allendale Rd. Apt. E Mechanicsburg, PA 17055 MARIT"lSTATUS__""" _M&fT_.W~ o.-co<llS.-.fYI 14. Widowed ne.IKI.....,__..._Uooer SORVIV'N(lSPOlJ5E ,,,..... \1'....---..., --.~-~---_.- I J '. fATHER'SN..ME IF.... MOO<Je. La"J II. Clarence R. Sunday 'NfORlolANT'SNAMil'ypatf'r.el n._ Lorral.ne A. Simpson l.IlTHOOOf',OISPOSlTI:Q.N .. DATEOf'OI5PQSIT'~- . lIunal~l c,__O 1W<no....""'SI.'.[J (MooIt>DoY,_l l~"",LJ OO'O'-I5l-o....~--._-----____fJ11I>.July 16, 2002 SIGN"TUR ACT'NGAS SlJCH llCfNSE'NUliili'fi-' 111> c.,., Cumberla!:l.9_. __ 17_,0 :n...""::"..'::::ol_____ MOTHER.S...AME,F...._.M_S,,"'''''..) _____" ___._c",-., 11 Ada A. Hair INFORMANT'S MAlLINGAOOAESS1Slr_, C....."""".~, lipc:.:.o.) _6412 Carlisle Pike Lot 19 M;s:::tuti PVoCEOFDlSPOSlTIOH._o!eo.....~.C[.....""'I orOlflo.-PW:. 9\17050 c. ... u u :') ~ 22b. 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C~/"'r llCiN~-- OATESIQNED--;~lJa;'v.;:;o-'-- 31e, "'~?~.J,-L . Jl~,1-;_2.ILLZ-'~ '_':'- _ N..ME"ANOAOORESSOf'PE'ASONWHoci:iilfiinfo-CAUSE-df'ciEAi-H ---.- .-- (I,,,,,, 21lTl'POI",P'inl I~ """~./ 1'\. 1-"- '/ 'of ~ o /<1 '-" ,/'>~__:,- I-l--___", ,...( 3'1 .f' .......... 'f'II '/"""~_.!....2.2~L__ lMJEFllEOI"o""" 0.. Yow, 'tIlE01CAlEllA"'INERlCOROHER . On III. b..i. at...mi...llon ...d/o. invullll"liOll. i.. n'~ ap,mon, dul" occu".d., Ih-e Um.. d.l., and place. .,Kl dU.l0 ,". <.uU(.J ...d m...n..'.....lfll._. .._ _... .. . .... ....._... _....._.... .... ". ,,~':J;Z~O:~:::;""'?l<,v'L2./1~" ~,~~=,~_----liL41~ .. ~ /~~--- .-. 21-02-654 LAST WILL AND TESTAMENT I, C. OPAL SIMPSON, of 1057E Allendale Road, Mechanicsburg, Cumberland County, Pennsylvania 17055, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. Any personal property given to me by my children during my lifetime I give, devise and bequeath to the child by whom it was given, if such child survives me; and B. All the rest, residue and remainder to my surviving children, share and share alike. ~ 4. I nominate and appoint Lorraine A. Simpson to be the personal representative of my estate, to serve without bond. 5. I suggest that my personal representative retain the services of the Law Offices of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of March,2000. c,~~ (SEAL) C. OPAL SIMPSON Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 41bdL #' &~ . ~ . ACKNOWLEDGMENT AND AFFIDAVIT WE, C. OPAL SIMPSON, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. C, { C. OPAL SIMPSON " JO -did ~ &-/JZb- H THER A. BARBOUR COMMONWEALTH OF PENNSYLVANIA :55: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by C. OPAL SIMPSON the testatrix herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, witnesses, this TH day of March, 2000. I Notarial Seal I Harold S. Irwin III, Notary Public I Carlisle 8oro, Cumberland County I My Commission Expires Sept. 23,. 2002 M~.mber Pennsylvania Association ot Notaries i CERTIFICATE OF NOTICE UNDER RULE 5.6{ID Name of Decedent: C. OPAL SIMPSON Date of Death: JULY 12, 2002 Will No. 2002 - 00654 Admin. No. 21-02-0654 To the Register: I certify that notice of beneficial interest or estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 13, 2002. Name Address WILLIAM B. SIMPSON 224 S FRONT ST WORMLEYSBURG PA 17043 THOMAS J. SIMPSON 418 L1SBURN RD MECHANICSBURG PA 17055 LORRAINE A. SIMPSON 6412 CARLISLE PK LOT 19 MECHANICSBURG PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None August 13, 2002 35 East High Street, Suite 01 Carlisle, PA 17013 717.243.6090 Atty for Estate of C. Opal Simpson REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~~ .'. .. -1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 ECEDENrs NAME (!.AST, FIRST AND MIDDLE INITIAL) SIMPSON, C. OPAL AT F 81 NOVEMBER 4, 1917 (IF APPUCA L ) SURVIVING SPOUSE'S NA OFP.CIAL US. ONLY /1--76-9 'ILl NUl... CO~ CODE SOCIAL URlTY NUMBER 184 - 36 - 5878 Cj 02 YEAR 0654 NUMBER ATE OF TH JULY 12, 2002 E (LAST. FIR T AND MIDDLE INITIAL) IAl SECURITY NUMBER 3. Remainder Return - (dates of death prior to 12-13-82) _ 5. Federal Estate Tax Return Req _ 8. Total No. of Safe Deposit Boxes -1L 1. Original Return 4. Limited Estate _ 2. Supplemental Return -1L 6. Deoedent Died Testate (Attach copy of Will) EX. A _ 9. litigation Proceeds Received _ 4a. Future Interest Compromise (for dates of death after 12-12-82) _ 7. Deoedent Maintained a Living Trust (Attach copy of Trust) _ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 717.243.6090 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Dep & Mise Personal Property (Sched E) 6. Jointly Owned Property (Schedule F) 7. Transfers I Misc. Property(Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schad H) 10. Debts. Mortgage Liabilities & Liens (Schedule I) 11. Total Deducllons (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) 15. Amount of Line 14 taxable at the spousal rate 16. Amount of Line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax due COMPL E MAILING ADDRESS 35 EAST HIGH STREET, SUITES 201/202 CARLISLE, PA 17013 (1) OFFICIAL USE ONLY 0,00 (2) 0.00 (3) 0.00 (4) 0.00 (5) 30,792.10 (6) 0.00 (7) (8) 30,792.10 (9) 11,491.75 (10) 1,989,60 (11) 13,481.35 (12 17,310.75 (13) 0.00 (14) 17,310.75 x - = (15) 0.00 $17,310.75 x .045 = (16) 778.98 $ x .12 = (17) 0.00 $ X .15 = (18) 0,00 (19) 778.98 - "_ .,,,, -I ~ I . . " " Decedent's Complete Address: STREET ADDRESS 1057E ALLENDALE ROAD CITY I STATE I ZIP MECHANICS BURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits I payments A. Spousal Poverty Credit B. Prior Payments C. Discount $38,94 (1) $778,98 Tolal Credits (A+B+C) (2) $38,94 3. Interest I Penalty if applicable D. Interest E. Penally TOlallnteresUPenally (D+E) (3) 4. /f 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 (4) 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. (5A) (5) $740,04 B. Enter the tolal of line 5+5A. This is the BALANCE DUE, (5B)$740.04 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use of Income of the property transferred; ...""....."........"......."" b. retain the right to designate who shall use the property transferred or Its Income; ........ c. retain a reversJonaJy interest; or ........................................................................... d. receive the promise for life of either payments. benefits or care? ............................... 2. If death occurred on or before December 123,1982, did decedent wtthln two years preceding death transfer property without receiving adequate consideration? 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? ...... No J.. --1L --1L --1L N/A --1L -L IF THE ANSWER TO ANY OF THE ABOVE QUESTtONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Under penalties of perjury, f declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct and complete. Declaration of preparer ather than personal representative is based on all Information of which preparer has any know/edge. S G RE OF PERSO~ESPO lE FOR Flli)'lG RETURN ~4A.d~~ / . / _~W,~ J A RESS v 6412 CARLISLE PIKE, LOT 19, MECHANICSBURG PA 17050 S R OF PREPARER OTH R THAN PERSONAL REPRESENTATIVE DATE OCTOBER 2002 OAT 35 EAST HIGH STREE SLE, PA 17013 OCTOBER' 2002 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. Section 9116 (a)(1.1)(i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Is 0% 172 P.S. Section 9116 (a)(1.1)(ii)l. 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 appJicable even Jf the surviVing spouse Is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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. Section 9116 (a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P .S. Section 9116 (1.2)[72 P.S. Section 9116 (a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. Section 9116 (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-1502 EX + (12-85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER C. OPAL SIMPSON 2102 - 0654 (Property Jolntly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which Is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts, ITEM DESCRIPTION NUMBER SCHEDULE A REAL ESTATE VALUE AT DATE OF DEATH NONE TOTAL (AlSo enter on Line 1, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) .' REV-1503 EX + (4-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C. OPAL SIMPSON (All property Jolntly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER SCHEDULE B STOCKS AND BONDS FILE NUMBER 2102 - 0654 VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 2, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) . REV-1504 EX + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C. OPAL SIMPSON ITEM NUMBER NONE SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP FILE NUMBER 2102 - 0654 DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on Line 3. Recapitulation) (If more space is needed, insert additional sheets of same size.) NONE . . . REV-1507 EX + (6-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE ESTATE OF C. OPAL SIMPSON (All property jointly-owned with Right of Suovivorshlp must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2102 - 0654 VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 4, Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) " .. REV-1508 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF C. OPAL SIMPSON (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER FILE NUMBER 2102 - 0654 VALUE AT DATE OF DEATH ,. COMMONWEALTH OF PENNSYLVANIA - Rent Rebate $ 202.00 2. MISCELLANEOUS PERSONAL PROPERTY 556.00 3. PREPAID FUNERAL EXPENSES 6,193.75 4. CITIZENS BANK - Certificate of Deposit No. 6140-770505 (Value based on statement attached as Exhibit "B") 11,132.49 5. CITIZENS BANK - Certificate of Deposit No. 6140-7705131080670 (Value based on statement attached as Exhibit "B") 1 0,000.00 6. CITIZENS BANK - Checking Account No. 6100707342 (Value based on statement attached as Exhibit "B") 1,221.36 7. MEMBERS FIRST FEDERAL CREDIT UNION - Savings Account No. 205681 (Value based on statement attached as Exhibit "cn) 1 ,294.66 8. BARNESS - Refund 144.00 9. PP&L - Refund 47.84 TOTAL (Also enter on Line 5, Recapitulation) $ 30,792.10 Of I'J1019 space is needed. insert additional sheets of same size.) .; REV.1509 EX + (12-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C. OPAL SIMPSON SCHEDULE F .JOINTLy-oWNI!D PROPERTY FILE NUMBER 2102 - 0654 Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jolntly-owned property. ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECO'S DOLLAR NO. FOR MADE VALUE -J.INT. VALUE 0 JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST NONE TOTAL (Also enter on Line 6. Recapitulation) NONE (1f more space is needed, insert additional sheets of same size.) .' REV-1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER C. OPAL SIMPSON 2102 - 0654 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. SCHEDULE G INTERVIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ITEM DESCRIPTION OF PROPERTY DATE OF NUMBER Il'IClude name of the lransf&ree, lheir r&lationship to tlecedenl. dafe 01 fr9nshtr DEATH %OF EXCLUSION TAXABLE VALUE OF DECD'S (If applicable) VALUE ASSET INTEREST NONE TOTAL (Also enter on Line 7. Recapitulation) NONE (If more space is needed. insert additional sheets of same size.) / REV-1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS I!XPENSES ESTATE OF C. OPAL SIMPSON FILE NUMBER 2102 - 0654 ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1. MALPEZZI FUNERAL HOME 6,193.75 2. JAMES GINGRICH MEMORIALS 892.00 3. PASTOR KUGLE - Funeral Services 75.00 B. Administrative Costs: 1. Personal Representative Commissions: LORRAINE A. SIMPSON 2,100.00 Social Security Number of Personal Represenlatlve:: Year Commissions Paid: 2. Estimated Total Attorney Fees: HAROLD S. IRWIN, III 2,100.00 3. Family Exemption: Claimant Relationship Address of Claimant at decedenrs death: Street Address City Slate Zip Code 4. Probate Fees: REGISTER OF WILLS 96.00 C. Miscellaneous Expenses: 1. REGISTER OF WILLS - File Inventory and Appraisement 25.00 2. HAROLD S. IRWIN, III - Notary Fees 10.00 TOTAL $ 11,491.75 (If more space is needed, inserl additional sheets of same size,) .. REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C. OPAL SIMPSON ITEM NUMBER SCHEDULE I DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS FILE NUMBER 2102 - 0654 DESCRIPTION AMOUNT 1. VERIZON - Phone Bill $ 42.04 60.00 3. 4. PARMERICA - Prescription Bill BEVERLY HEALTH CARE - Nursing Home Expenses WEST SHORE EMS - Ambulance Bill 1,421.00 466.56 2. TOTAL (Also enter on Line 10, Recapitulation) $ 1,989.60 (ff more space is needed. insert addnional sheets of S8me size.) ) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C. OPAL SIMPSON SCHEDULE J BENEFICIARIES FILE NUMBER 2102 - 0654 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. WILLIAM B. SIMPSON SON 1/3 RESIDUE 224 SOUTH FRONT STREET WORMLEYSBURG PA 17043 2. THOMAS J. SIMPSON SON 1/3 RESIDUE 418 LISBURN ROAD MECHANICSBURG PA 17055 3, LORRAINE A. SIMPSON DAUGHTER 1/3 RESIDUE 6412 CARLISLE PIKE LOT 19 MECHANICSBURG PA 17050 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE 8. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE ANO GOVERNMENTAL BEQUESTS (Also enter on Line 13. Recapitulation) $ NONE (If more space is needed. insert additional sheets of same size.) .1 .' LAST WILL AND TESTAMENT I, C. OPAL SIMPSON, of 1057E Allendale Road, Mechanicsburg, Cumberland County, Pennsylvania 17055, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. Any personal property given to me by my children during my lifetime I give, devise and bequeath to the child by whom it was given, if such child survives me; and B. All the rest, residue and remainder to my surviving children, share and share alike. 0" 0 II t 4. I nominate and appoint Lorraine A. Simpson to be the personal representative of my estate, to serve without bond. 5. I suggest that my personal representative retain the services of the Law Offices of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of March, 2000. c>~~ (SEAL) C. OPAL SIMPSON Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~:idl.- <# &~ . .' . ACKNOWLEDGMENT AND AFFIDAVIT WE, C. OPAL SIMPSON, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. " c, {' C. OPAL SIMPSON JO .tId/ qt/ ?~/Ur H THER A. BARBOUR COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :ss: Subscribed, sworn to and acknowledged before me by C. OPAL SIMPSON the testatrix herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, witnesses, this TH day of March, 2000. Nolaria.1 Seal Harold S_ Irwin III, Notary Public Carlisle BOTO, Cumberland Covnty Mv Commission Expires Sept. 23, 2002 tvLmbe\ ~8nnSl/lvama AssocIation 01 NotarieS Notary Public ':,"C1TIZENS BANK;' 'i~, 1-888-1110-4100 Call ctttztns' f'honeBank anyttM for aceO\AM Womation. CUrNnt rates and answers to your qutitions. US059 BR292 4 1 C OPAL SIMPSON C/O l SIMPSON 6412 CARLISLE PIKE LOT 19 MECHANICBURG PA 17050 "1'- ',<;,# .\'~ :':;,.~ ~ 'j ',,;'~A4~ .,"', Citizens Circle Account Statement . of 3 Beginning June 21, 2002 through July 16, 2002 Contents Summ.JY Chetking CDs Page 1 Page 2 Page 3 Citizens Circle Summary AccDunt Account NUmhr ....... lIrls Stat.....nt . DEPOSIT BALANCE Chetk;ng Citizens Cirde Chetking CDs 2 year CD 3 year CD 610070-734-2 6140-770505 6140-770513 ~ ,.'-" ....... Last stat.....nt NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE 1,221.36 11,132.49 10,000.00 C OPAL SIMPSON CUbens C;rcle Chetk;ng 610070-734-2 o o Total Deposit Batance 22,353.85 Total Relattonshlp Balance 22.353.85 . .~- MemberslSI FEDERAL CREDIT UNION INSURANce DePARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 .1-800-283-2328 or (717) 697-1161 ~Fr.:1I1 AR !':AVINr.:!': A~~nIlNT' Account NumberlSuffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 205681 -00 06/01/2001 $1,294.66 $.68 $1,295.34 None ~BERS_1S:E A)~/<V Denise A nde Insurance Products Supervisor CREDIT UNION August 29,2002 Estate of: C. OPAL SIMPSON Date of Death: 07/12/2002 Social Security Number: 184-36-5878 COMMONWEALTH OF PENNSYLVANIA: :8S: COUNTY OF CUMBERLAND LORRAINE A. SIMPSON, being duly sworn according to law, deposes and says that she is the executrix of the estate of C. OPAL SIMPSON, late of Upper Allen Township, Cumberland County, Pennsylvania, deceased, and that the within inventory made by her, the said executrix, of the entire estate of said decedent, consisting of all of the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the inventory <epeese"' '" fa" "'0' a, of the date of d_e~th. . ~ S~f to and subscribed before me / iu&t-<-L ~. / day of October, 2002.-/L RRAINE A. SIMPSO Executrix ~~ X ~R-- NOTAIllAt.. SEAL . lIC :ARlISLE, CUMBERLAND COUNTY : SION EXPIRES OCTOBER t 7 2002 12 .JULY 2002 Date of Death: Day Month Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplemental inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. Inventory of the real and personal estate of Ctv' c. OPAL SIMPSON, deceased 1. COMMONWEALTH OF PENNSYLVANIA - Rent Rebate $ 202 00 2. MISCELLANEOUS PERSONAL PROPERTY 556 00 3. PREPAID FUNERAL EXPENSES 6,1~ 'l.f 4. CITIZENS BANK - Certificate of Deposit No. 6140-770505 (Value based on statement attached as Exhibit "B") 11,132 49 5. CITIZENS BANK - Certificate of Deposit No. 6140-7705131080670 (Value based on statement attached as Exhibit "B") 1 0,000 00 6. CITIZENS BANK - Checking Account No. 6100707342 (Value based on statement attached as Exhibit "B") 1,221 36 7. MEMBERS FIRST FEDERAL CREDIT UNION - Savings Account No. 205681 (Value based on statement attached as Exhibit "C") 1,294 66 , 8. BARNESS - Refund 144 00 9. PP&L - Refund 47 84 TOTAL $ 30,792 I~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 17128-0601 REV-l162 EX(1 1-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN HAROLD Sill 35 EAST HIGH STREET SUITE 201 CARLISLE, PA 17013 _nn___ fold ESTATE INFORMATION: SSN: 184-36-5878 FILE NUMBER: 2102-0654 DECEDENT NAME: SIMPSON C OPAL DATE OF PAYMENT: 10/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/12/2002 NO. CD 001726 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $740.04 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HAROLD S IRWIN III ESQUIRE CHECK# 6389 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $740.04 MARY C. LEWIS REGISTER OF WILLS /7-76-9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-02-2002 SIMPSON 07-12-2002 21 02-0654 CUMBERLAND 101 *' REV-1541EKJFP<Ol_DZl C o Amount Rellitted PA 17013 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-lj=i5'4TEX--AFP--fiiFiii!rNiiY-iCE-OF-YNHEifiTAifCE-YAic-APPRA-isEHENT:--ALioWANCE-ifri----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SIMPSON C 0 FILE NO. 21 02-0654 ACN 101 DATE 12-02-2002 TAX RETURN WAS, [X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property {Schedule FJ 7. Transfers (Schedule G) 8. Total Assets (ll (21 [31 (41 [51 (61 (71 .00 .00 .00 .00 30,792.10 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax [91 (101 11, 491. 75 1.989.60 (Ill [121 (131 (141 NOTE: I~ an assessment was issued previOUSly, lines re~lect ~igures that include the total o~ ~ ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (1&) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 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. 30,792.10 13.481 3~ 17,310.75 .00 17,310.75 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. . """<"' T+, AMOUNT PAID DATE NUMBER INTEREST/PEN PAID [-I 10-15-2002 CDOO1726 .00 740.04 PAYMENT MUST BE MADE BY 04-12-2003~. TOTAL TAX CREDIT 740.04 BALANCE OF TAX DUE 38.94 INTEREST AND PEN. .00 TOTAL DUE 38.94 .00 X 00 = 17 ,310.75 X 045- .00 X 12 = .00X15- [191= ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 778.98 .00 .00 778.98 IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I I BURE~U OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE / 1-IJ~ --9 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-02-2002 SIMPSON 07-12-2002 21 02-0654 CUMBERLAND 101 III *~ REV-1541EXAFPtOI_D2l C o Amount Remitted PA 17013 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 ~ iiifv:i54-n~30'iFP--fiiY:02.:n'ioYlci-oF-YNHiifI;:ANcrTAinipjjRAIsiifENi::--AL1-oWAifcE-oii----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SIMPSON C 0 FILE NO. 21 02-0654 ACN 101 DATE 12-02-2002 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 AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule GJ 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 30.792.10 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 11,491. 75 1.989.60 (11) (12) (13) (14) NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 30,792.10 B.481 3~ 17,310.75 .00 17,310.75 NOTE: If an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17,310.75 X 045 = 778.98 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 778.98 TAX CREDITS: rAm.n. ,+, AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10 15-2002 CDOOl726 .00 740.04 PAYMENT MUST BE MADE BY 04-12-2003*. TOTAL TAX CREDIT 740.04 BALANCE OF TAX DUE 38.94 INTEREST AND PEN. .00 TOTAL DUE 38.94 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) I 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 IRWIN HAROLD S III 35 EAST HIGH STREET SUITE 201 CARLISLE, PA 17013 __nun fold EST A TE INFORMATION: SSN, 184-36-5878 FILE NUMBER: 2102-0654 DECEDENT NAME: SIMPSON C OPAL DATE OF PAYMENT: 12/09/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/12/2002 NO. CD 001925 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $38.94 I I I I I I I , TOTAL AMOUNT PAID: REMARKS: HAROLD S IRWIN III ESQUIRE CHECK# 6695 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $38.94 DONNA M. OTTO DEPUTY REGISTER OF WILLS "-. 1?-"J6- 9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-U01 EX AFP (Ol-On HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 SIMPSON 07-12-2002 21 02-0654 CUMBERLAND 101 C o Allaunt Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account) submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6oTE'if-iiFP--fiiFo3r-----..j,--iNiiERli:ANcE--iAiniTA-fEiiENi-cf"-ACCOUNT--j,ii".--------------------- ESTATE OF SIMPSON C 0 FILE NO. 21 02-0654 ACN 101 DATE 01-21-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-25-2002 PRINCIPAL TAX DUE: ... 778.98 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-12-2002 CDOOI726 38.95 740.04 12-09-2002 CDOO1925 .00 38.94 01-21-2003 REFUND .00 38.95- TOTAL TAX CREDIT 778.98 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I - 1'}-'/6-9' 'v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28D601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY.U01 EX AFP (01-03) HAROLD S IRWIN STES 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-03-2003 SIMPSON 07-12-2002 21 02-0654 CUMBERLAND 101 C o Amount Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax pay.ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rifv=i 6'iWix--AFP--[oFo3Y------iiio..--zNifERI1:ANc'E--TAx--sTA-iE~iE-NT-O-F-AC-coUi,ri--..-......------------------ - -- ESTATE OF SIMPSON C 0 FILE NO.21 02-0654 ACN 101 DATE 02-03-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUMHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 11-25-2002 PRINCIPAL TAX DUE._ 778.98 PAYMENTS (TAX CREDITS), PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-12-2002 CDOOl726 38.95 740.04 12-09-2002 CDOO1925 .00 38.94 01-21-2003 REFUND ,/ .00 38.95- TOTAL TAX CREDIT 778.98 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, see REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDlpw feR).. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J / t ah STATUS REPORT UNDER RULE 6.12 Name of Decedent: C. OPAL SIMPSON Date of Death: JULY 12, 2002 Will No. 21- 02 - 0654 Admin No. 2102 - 0654 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above- captioned estate: 1. State whether administration of the estate is complete: Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No L- b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes L- No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be fried with the Clerk of the Orphans' Court and may be attached t9 thi~report. { d;Cu5[,~ Harold S. Irwin, III Attorney for Estate 0 April 14, 2003 35 East High Street Carlisle, PA 17013 717-243-6090 -