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HomeMy WebLinkAbout02-0724ADMZNISTRA'3:'I~SN PETITION FOR PROBATE and GRANT OF LETTERS c•'i'•A Estate of Rana 1 c3 ~ Ebersole also known as u /a Deceased. Social Security No. 159-3 $ - ~ ~ 5 9 No. ~ / "d~ ~ /'~C 7 To: Register of wVills for the County of _Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who isiare 18 years of age or older an the execut, named in the last will of the above decedent, dated Ju v ?_$, , 19.3._ and codicil(s) dated NSA .~ under the Wi11 and he so a eneficiary ave signe a renunciation dated July 24, 2002_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland _ County, Pennsylvania, with h; ~ last family or principal residence at 2804 Warren Wad, Mechanicsburg, xamgdPn m~~,~~shir, Ciunberlandl'aunt~, Penns.~l~ani a 1 7050 (list street, number and muncipality) Decendent, then 55 years of age, died Jul 22 ~- 2002 , at__Milton S. Hershey Medical Center, aup in oun 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: N/A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ Unknown (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ None situated as follows: __ 11/A WHEREFORE, petitioner(s) respectfully request(s), the probate of the last will and codicil(s) presented herewith and the grant of letters of administration c . t . a . theron -., ~ .-. vv ~~ b.~ ~~ ~0. vw ~~ ~~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~~~~ a erso e 225 S..Hig Street Mechanicsburg, PA 17055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNS3~LVANIA ~ ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) t at the staternents in t e fgcegoing petition are true and correct to the best of the knowledge and be of o petitioner(s) and th 'as personal represen- tative(s) of the above decedent petitioner(s) will we and rely adr~tini~t~fij the st e according to law. Sworn to or affirmed and subscribed ~~, ~; v ~~ ~ `~ __ ~, before me this 9th day of Dana M Eb ~' A ust / x~ 2002 225 S . Hig Street Std Mechanicsburg, PA 17055 Regi er - NO. 21-2002-724 Estate of Ronald S . Ebersole ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS ADMINISTRATION C.'I'.A, AND NOW August 13th ~ 2nn2n consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated July 2 8 , 19 9 3 described therein be admitted to probate and filed of record as the last will of Ronald S. Ebersole and Letters of administration c . t . a ' are hereby granted to Dana M. Ebersole FEES Probate, Letters, Etc.......... ~ 18.00 Short Certificates(2) .......... $ 6.00 Renunciation . ~ 1 ~ ............ $ 5.00 x-Pages (2} ~ 6.00 JCP 5.00 TOTAL ~ Filed .~~glzst . l~.th ~ 20U.2 ... _ $40.00.. . Register of Wills X47077 ATTORNEY (Sup. Ct. LD. No.) 44 W. Main St., Mechanicsburg, PA ADDRESS 17 0 5 5 (717) 697-8528 PT-TONE CALL ATTORNEY ON 8/13/2002 itmsn, ~t.~ ~ush This is to cerrifv that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8482874 ~o. YPE PHINI IN PEf.Mf'rENT Bl AC% INN _ 1 Local Registrar rate COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH Ulu. '. a7 Hav 2:B? NAME OF DECEDENTIFmv Mldde.:eal Rona Ebersole d S t SEX SG;ML SECURII'YNUMBEA ~~ pAlEOF LEA]H,MCrw, Oa ear/ ~ 2001 Male 159 38 3359 July 22 l . , ,. - .. _ wr•L II ay Uvthaay) UNDER 1 YEAR UNDER 1 DAY DATE OF BIPTM BIRTHPLACE .C ry are _ _ ManIM I Days Hours . MinMw Munro. DaY. 'revel 'ilalea hcrngn Cnunuyi PLACE OF DEATH ICnel'.a rtny ore I..~t al uR~e ~ --- -- r>xM, Ina O HOSPITAL: TITER--... - ._ - .__.--.. ___-_-.___ York, Pennsylvania 55 Y.. I Sep 13, 1946 Inpal»nl C?~ EWQAp;lli.nl G Doll ^ ,~~"~"° ^ Rrabenu 7 a« R ^ T E y, k (:OUNTY OF DEATH CTTY. BORO. TWP OF DEATH FACILRY NAME 111 not msl NI on. give street an0 nlXnberl VN$ D ECEDEN T OF HISPANIC OgIGIN? RACE ~ Am.ncan Mtian. BNCt, Wn... xc. F g - ~ lSpeoMl No L'l Yu L J E yw NNKM CuDrn . . . Hershe Medical Center Mea%an.PwnoRlcan.we White M S Ha « er Tw Y . . . ,a. ,. ,,. _. DE f N'S USUALOCCUPATIOfI VINO BUSINESS/INDUSTRY NMS DECEDENT EVERIN OECEDENT'SEDUCATNk1 MARITAL STA]US~Marr»A SURVIVING SPOUSE - IC:,ve auNW work,]r%y Wru,g US. M EOfOiiCES] S en W Mt eat r crrn e0 Nrvw MartnM, WiOOwW, Ill aea. ),vs ma•Ien normal M- d waAnp eN; CO not usa repeal F y U.S. Goverment Yw LA No^ Elrrwnwyy5rcawery coEear IMdCW iSlaeceyl Communications IDI~ nAaD.l Di d ~ ,,, vorce ~ LLD. Ix. ,]. 1 DECEDENT'S MART a .CaylTOwn. SDIIe. Lp Dcael DECEDENT'S Pennsylvania Ham den Acru,u n. SM» l~ Yr I T P 2804 Warren Way . ... _ as c a. Rxrmn lrvre In RESIDENCE a.L.aal1 ^- --------- "'° Mechanicsburg, Pennsylvania .1705 nee tea."; Cumberland ~~] No'a.w.»~ l,` ' _- -___ _ _ _ _ __ ~ rAVmn.o ,Te. coon -- _ _ I?s.^ »Anm.naHarnera- _ _ ' FATHER S NAME IFnA. MnJr]e. Lavl Russel S. Ebersole MOTHER'S NAME IFaM. Mnlule. Mayan Swnamel Bett J Hickman „ . y , INFORMANT'S NAME (Type~PraAl Bri Ebersole n K INFORMANT'S MAEYIO ADE4iESS ISDrw. Gry/town. SWN Lp Corte 6 ,,, . a ur Pa. 17055 2804 Warren Wa Mechanlcs xm. Y 9r MET/10D OF dSPOSITpN DATE OF DISPOSITION PLACE OF DISPOSITION-Narw of CrmeHry.Gwnalory LOCA'ION~CM/T SIaN Lp COaa C»malvl yR Rarrlgy Yom SIaN ^ (Hallo. QnY 1Dar) a OIMr PIK. , . -^ ^ D«»non ^ Olive (SpecRY Jul 23 2002 Conolite Crematory Schaefferstown, Pa. 17088 ,,, , x,. x1D x e ' SIGNATU NERA ICE N 0.5Di1 ACTING AS H LICENSE NUMBER NAIAEIWD ADDRESS OF FACQITY " a.. x,D, _ FD-012662-L „a Myers Funeral Home, Inc- 37 East Main Slree[ Mechanicsburg, Pa 17055 b items Y only wf»n cenRytnq Tp q my MnowNaps, araln occwnd al IM ume. data arW Place uarea. LICENSE NUMBER pATE SIGNED piryscun a trot ayaAaDq a Tyne oe worm to rwery uuw of cream. tae era T~»I (MmM. Dav vsarl ~- x]D. xx. awns 2e-x, muR W compww Dy 7BAE OF DEATH DATE PRONOUNCED DEAD IMUnm. Day. V rl YWS CASE REFERRED TO MEDICAL E%AMINERICORONER7 pwaon rtn prapuocw awN. w.13 6 L a` .s,- F„^ ~ I >->- l D v x. ° ~6 AM M . . xs. x,. x]. PART L Enlrr IM aiwasra, inla»s a corrpNr:alUne wNrn carnet Ina darn Do rot enter IM moor el0yep, such as cardac a rasp,ralory anasl, stuck Rr Man IaJure I ApproaunMr PART N: Omw spn,f 1 cwbAa» convCUleg to Ham Dui LW OMyOM Causr On rafJ~Yr» IiMwvMDwwwn rlolrwWer,nlM UrWrT/Ir,y taut gnwnPAgTI I or»w orb orem WYEdATE CAUSE ¢•ue .alaate a ra~dlgn ~ i v Pit- F~- _ ouE ro (oR As w coNSEOUENCE oFy ~.. ------ ---------- -- - - eryr•erMU.axv xr w•raltone D I wly, M+aln9 a anm.a»le DLIE ro Ion As A coNSEOUENCE of). I _ rare. Emw IMIDERLYINO I CAUSE16snavauyaY e. r • Yw wulnr nvwas dJE roIOFI ASACONSEOUE NCE OFD. ~es~,savy n uaaml LAST 1 - a ~------------- -. ----. _.__._----------------~-----.. _ WAS wN AUTOPSY WERE AUTOPSY FINdNG$ N/WNEq OF DEATH DATE OF IKIURY TIME ()F INJURY INJURY AI YA7RK] DESCRIBE HON INJURY OCCURRED PERfOHMED] AWILABLE PRgRro (Ma~Rl. Day. Years COMPLETION OF CAUSE OF DEATH? NwaN ~ Hom b rc r VM ^ No^ J AccWN Prr,IAny lnvrsuyalnn I~ ~lpp ('l I~l f t ]Oa. ___-__- ha L I No 4Q Y'w LJ No ^ SracM. 1 r J CaWO not Dn J l 0 1 ~ ~. _ ~. M. ------~- . e a mxre . PIACE UFIWUAYAt IaJme. Hrm, Areal. factory, ORlce LOCATION IShewGN/Ww.rSWnl DuYrAnq_ rrc ISpnr:nvl ]M. x,D. 29. ]w. ]p. CERIIFIEP,I~a.~s unYrr~e) 'CERTIFYING PNY51CiANIPnysa.a.carliyuq rouse ul,Yarn .Men xulnn arvv. ar, nesW - JI T --_ -- -'~_ SIGNATURE ANM ~IT~OF GEfli~F1EA /` " ) - - , o IM Dial of my krgw4agr, seam «cnrrea Ow b mr cauaa(al arW manner er Nelea . - .... ....... I-~ H .~ Jj j~.~ L'~h 3 µ ]ID. ` 'PRONOUNCING ANDCERTIFYINOPHYSICIANIPnyswun twin ~, ~, uu w,xJOnaln a„a rcr lyy en __ _ _ LICENSE MNUMBER vRr '1ry]~1-111 nn T TE SIG NEDr Uy mTQ4-'IT'IZ~ 1 yy )~~ ~~ Toth OSel of myFMwleaye, watn occnHra aF me tlme aalr ant piece, orb aw tolM causelel orb net as states ....-.. ..... LI ]IC. __-___ _,_ __,. ] e NwME wND ADDRESS OF PERSON WMO COMPLETED CAUSE OF DEA1N - 'MEDICAL E%AMINER/CORONER on me De.a nI e..minmon.na/« l R m Item 2]7 T «Pr YP. rot MDNR»'Imn9 N+~ OfJ ASI F LJ4 ~y: '/ eN nyea 9 ton, m my opml n, ae.m o«r,rrea aI me um., aa1e, ana Plere, ana sae to IM e.we(y ana mannw .. aUlea. . .... JL _..__.........._ ........................................ HEGISI ~SSIGNATURE AND NUMBER `-"---'"---'-----'---- Tx CISII MCL~ICiII CL; nlcr H[;ISIICY. PA I TIT. H c ~~Va•~ ,a ~r `/-J ,y - l1 _ \/~} p I, ~ ~ f ~ ~ ~ / ~ ~J ~ ]] _`/ \ A.-Q1-i12L.Q~LL31- ~=~l~S~:.~ _16~_- .rC.t_ _..___ 42~J_i~lj_1~ t ~-~ _ DATE FILEDIMonm. Day. Marl ]1. .- -__ ~~a ~nCJ~- ---- v 21-2002-724 LAST WILL AND TESTAMENT OF RONALD S. EBERSOLE I, RONALD S. EBERSOLE, of the Township of Hampden, County of Cumberland, and State of Pennsylvania, being in good bodily health and of sound and disposing mind and memory, and not acting under duress, menace fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing of my worldly goods while I have the strength and capacity so to do, I do make, publish and declare this my LAST WILL AND TESTAMENT. T hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my Executors hereinafter named pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that my bodily remains be cremated. ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and in fee, to MY DEARLY BELOVED SON, BRYAN R. EBERSOLE, per stirpes. _~. , ~~,._. ,~ ~F..,f~ `L' z~,r, RO ALD S. EBERSOLE 1. .~ w w ITEM 4. I nominate and appoint LINDA JOAN BOGART as Executrix of this my Last Will. ITEM 5. I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passes under this Last Will, shall be paid by my Executor out of my residuary estate. ITEM 7. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. `~~~ >- `C~ ., ~~ ~'~CL'~'L ji~`' r RONALD S. EBERSOLE 2. ----------------------------END------------------------------- COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND ) I, RONALD S. EBERSOLE ,TESTATOR, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn or affirmed to and acknowledged before me, by RONALD S. EBERSOLE the TESTATOR, this 28th day of July 19 93 ~770RNEY '` ARY PUBLIC JAMES M. EACH. Me hanicsburg, PA "~~ CumDcrlan~ County Natery Fap1~ MY Oo«nrniasion Ezpfres Me M y C o rn m i s s i o n E x p i r e s: 0 5/ 1 3/ 9 5 ,~ 13. 199 ; The preceding instrumen consisting of this and two (2) other typewritten pages, identified by the signature of the TESTATOR, was on the date thereof signed, published and declared by RONALD S. EBERSOLE , the TESTATOR therein named as and for his LAST WILL AND TESTAMENT. uLAD S B. S RAMELLI DANA L. MIDDLEKAUFF Residing at 352 S. Sporting Hill Road Mechanicsburg, PA 17055 Residing at 352 S. Sporting Hill Road Mechanicsburg, PA 17055 A F F I D A V I T COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND ) We GLADYS B. SPRAMELLI and DANA L. MIDDLEKAUFF the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw TESTATOR sign and execute the instrument as his LAST WILL; that he signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the TESTATOR signed the WILL as witnesses; and that to tY1e best of our knowledge the TESTATOR was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by GLADYS B. SPRAMELLI and DA~ip, L. MIDDLEKAUFF witnesses, this 28 day of July ~ 1993. ~~.. NOT, '~~~RA~Eio JAM ~~IAC SEAL°_ 0 ARY PUBLIC Cumue~gM SAC M hanicsburg, PA '--~~'~~mrnissien ~'dCoun~ N`t~'yF~Wr~ My Commission Expires: 05/13/95 3 RENUNCIATION 21-2Q02-724 In Re Estate of Ronald S. Ebersole deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned ha FxPC-»trix in the last will. of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary ~ be issued to Dana PSI 1`berso~ e WITNESS hand this 2 4 t.h day of .T~~ i ~ , X~.2d~.2 ~. ignature) Linda J. art r /GL.~ (Addr ss) ~~~--~' (Signature) Bryan R. Ebersole (Address) (Signature) (Address) REV.1SOOEX (5.QO) /"}-Y/- 6~ '* COMMONWEA~HOF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 . HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '" '" ~:!;!;2 ulfu "'00 "'",... 0.... .. '" DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) I- Z W C W () W C Ie Ronald S. DATE OF DEATH (MM-DD- YEAR) 07/22/2002 -~._~-- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A DATE OF BIRTH (MM-DD-YEAR) 09/13/1946 ( FILE NUMBER 2.... -1 - JL ...2 COUNTY CODE YEAR o 072 4 - NUMBER- - - [jI1. Original Return o 4. LirnitedEstate Q!l6. Decedent Died Testate (Allach copy'ofWiIl) o 9. Litigation Proceeds Reoo\'IeO o 2. Supplemental Return o 4a. Future Interest Compromise (date ri dealh after 12_12-82) 07. Decedent Maintained a Living Trust (AtlachoopyofTrusl) o 10. Spousal Poverty Credit (~le 0( death between 12-31-91 and 1-1-95) SOCIAL SECURllY NUMBER 159 38 3359 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURllY NUMBER o '3. Remainder Return (dale 0( lklalh 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) (AtlachScf10) '" z '" c z o .. .. '" '" '" o o NAME Keith O. Brenneman FIRM NAME (lfApp~~ble) Snelbaker, Brenneman & Spare, P.C. 'TELEPHONE NUMBER COMPLETE MAILING ADDRESS 44 W. Main Street Mechanicsburg, PA 17055 (B) 19,224-:-83 (1) (2) (3) (4) (5) z o ~ :;) I- 0: <( () w a:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership Of Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) 6. Cash, Bank Deposits & Miscellaneous Personal Property (Schellul. E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 1. Inter-VlVOs Transfers & MisceDaneous Non-Probate Property (ScheduleGorL) 8. Total Gross Assets (total Lines 1-7) 9. Funeral 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 Line 11) 13. Charitable and Governmental Bequests.!Sec 9113 Trusts forwhicl1 an election to tax has not been made (Schedule J) (11) 18,901.42 (12) 323.41 (13) (14) 323.41 14.55 14.55 14,034.40 (6) (7) 5,190.43 (9) (10) '1,445.36 13,456.06 14. Net Value Subject to Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-" ::J a. :E o () g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o_ (15) 45 (16) x.O __ x .12 (17) x .15 (18) (19) 323.41 16. Amount of Une 14 taxable at lineal rate 17. AmoUl'lt of One 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 200 CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET IIODRESS 2804 Warren Way M -~ ni"<<bura Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount I STATE CITY PA (1) -- I ZIP 17050 14.55 Total Credits (A+ B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penally TotallnteresUPenalty ( D + E) (3) 4. It 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. (5) A Enter the interest on the tax due. (5A) 14.55 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 14 'i'i 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 or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or................................... ............................................................................ 0 d. receive the promise for life of either payments, benefits or care? ................. ......"........."..................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust fo~ or payable upon death bank account or secunty at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-proba1e property which contains a beneficiary designation? .................................................................................................. ......................)Q!I No ~ ~ [29 o ~ ~ o BO E QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. nof........lchpreparerhasanyknowledge. N ~ D S 5 S. High Street, Mechanicsburg, PA 17055 SIGN~TURE OF PREPARER OTHER THAN REPRESENTATIVE 44~. Street, Mechanicsburg, PA 17055 ADDRESS M~: /fj.t~ D~TE 4/22/03 DATE 4/22/03 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on ttle net lJalue 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 Jal1llary 1, 1995, the lax rate imposed on the net value of transters to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute dOA~ 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. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the deoedenrs siblings ~ 12% [72 P.S. ~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-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 21-02-00724 Ronald S. Ebersole Include the proceeds of litigation and the dale the proceeds were received by the estate. All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. DESCRIPTION Miscellaneous furniture, furnishings and household effects: Members 1st F.C.U. account no. 46042-00 (savings): Members 1st F.C.U. account no. 46042-11 (checking) 1997 Jeep Cherokee Members 1st F.C.U., credit life insurance proceeds payable on account no. 46042-22 (see Sch. 1,2.) The Brambles - security interest payment AFGE Dental Trust - premium refund PA State Collection and Disbursement Unit - support refund VALUE AT DATE OF DEATH $ 595.00 293.24 1,413.94 5,900.00 5,699.69 4.76 126.00 1.77 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14,034.40 REV-1510 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY Ronald S. Ebersole FILE NUMBER 21-02-00724 ESTATE OF This schedule must be completed and filed if the answer to any of questions 1 through 4 01'1 the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE. NMlEOF1HE TRANSFEREE, 1HEIR REl.ATlONSHIP"IO DECEDENT AND DATE OF DEA.TH % OF DECO'S THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VAlUE OF ASSET INTEREST Federal Employee's Group Life Insuran e Program. MetLife life insurance benefit. Transferee/beneficiary: Brian R. Ebersole,*July 22, 2002 $46,000 100 EXCLUSION IFAPPUCABLEl TAXABLE VALUE 46,00 -0- 2. Federal Civil Service Retirement System Benefit, death benefit payable to Brian R. Ebersole, July 22, 2002 31,937.~7 100 31,93 .27 -0 3. Thrift Savings plan Benefit (Defined contribution retirement plan), payable to Brian R. Ebersole, July 22, 2002 2,592.2~ 100 N.A. $2,592.25 4. Unpaid Compensation from Department of Navy, payable to Brian R. Ebersole July 22, 2002 2,598.18 100 N.A. 2,598.18 *son of decedent TOTAL (Also enter on line 7 Recapitulation) $ 5,190.43 (If more space is needed, insert additional sheets of tl1e same size) REV-1S11 EX. (12-991. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ronald S. Ebersole FILE NUMBER 21-02-00724 Debt. of decedent must be reported oR Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. Myers Funeral Home, Mechanicsburg $2,348.00 2. Flowers for funeral, Flowerama 68.36 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) StreelAddress City Stale ~Zip Year(s) Commiss'lon Paid: 2. Attorney Fees to Snelbaker, Brenneman & Spare, P.C. 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant SlreetAddress City State _Zip Relationship of Claimant to Decedent 4. Probate Fees to Register of wills 40.00 5. Accountant's Fees /reserve for miscellaneous filing fees and expenses 500.00 6. Tax Return Preparer's Fees 7. Auctioneer - C. Bricker appraisal/sale fees 183.00 8. Automobile insurance and advertisement for sale of decedent's vehicle 123.00 9. Advertise grant of Letters Testamentary: a. Cumberland Law Journal: $ 75.00 b. The Patriot News: 108.00 183.00 TOTAL (Also enter on line 9. Recapitulation) $ 5,445.36 (If more space is needed, insert additional sheets of the same size) REV-1512 EX.. (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ronald S. Ebersole FILE NUMBER 21-02-00724 Include unrelmbursed medical expenses ITEM NUMBER 1. DESCRIPTION Members 1st F.C.U. account no. 4121449999460426, Visa Credit Card: VALUE AT DATE OF DEATH $1,196.44 2. Members 1st F.C.U. account no. 46042-22, loan account: 5,699.69 3. UGI Utilities, Inc. account no. 218601374031, balance due on account: 69.18 4. The Brambles (Commerce Acceptance Company) balance due for apartment rent: 935.65 5. Pennsylvania-American Water Company, account no. 24-1133788-0, balance due on account: 75.64 6. Comcast (North American Collection Agency), account no. 728069-01, balance due on account: 75.17 7. PPL Electric Utilities (Powell, Rogers & Speaks, Inc.) account no. 5461083013, balance due on account: 92.49 8. Texaco/Shell, (Credit Card Center) account no. 30-869-4325-9, balance due on account: 118.55 9. J.C. Penny (Victor & Victor, Ltd.) account no. CG8890807-46 5760, balance due on account: 112.95 10. Holy Spirit Hospital, account no. 19222629, balanc~ due on account: 3.18 11. Hampden Township Ambulence, account no. 159 38 335901, balance due on account: 100.50 12. West Shore Emergency Medical Services, account no. 40390, balance due on account: 273.78 13. OSI Funding Corp., balance due on account/judgment. 4,702.84 TOTAL (Also enter on line 10, Recapitulation) $ 13,456.06 (If more space IS needed, msert additional sheets of the same size) REV-1513 EX+(9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ronald s. Ebersole FILE NUMBER 21-02-00724 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (al (1.2IJ Brian R. Ebersole 807 Bay Street Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT Do Not list Trustee(s) AMOUNT OR SHARE OF ESTATE Son 100% ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB, AS APPROPRIATE, ON REV-1500 COVER SHEET [[ 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.1500 COVER SHEET $ (If more space is needed, insert additioroal sheets of the same size) ,., ('I' .. ~ b~f ~~~: r~ i?~1 1".; LAST WILL AND TESTAMENT OF RONALD S. EBERSOLE ~-,,~ ~ :..,'" ~i( r;.; ;t f.!, I, RONALD S. EBERSOLE, of the Township of Hampden, County of Cumberland, and State of Pennsylvania, being in good bodily health and of sound and disposing mind and memory, and not acting under duress, menace fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of ~uman life, .and being desirous of disposing of my worldly goods while I have the strength and capacity so to do, I do make, publish P/ ~~. ~, c-, t t ~ ~.? ;Tf. 1;' and declare this my LAST liILL AND TESTAMEN'l'. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my LAST WILL AND TESTAMENT. h;' K AS TO SUCH ESTATE AS IT BAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOliS, VIZ: ITEM 1. I direct that my Executors hereinafter named pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that my bodily remains be cremated. ~ ,. ;. ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever situate, and whatsoever it may consist of, ;; t I give, devise, and bequeath, absolutely, and in fee, to MY DEARLY BELOVED SON, BRYAN R. EBERSOLE, per stirpes. fu};j" /"5' ;/;//_~ /-v/-z-/ff--?:7' ./ -' /~ RO ALD S. EBERSOLE 1. I'l'EM 4. I nominate and appoint LINDA JOM BOGART as Executrix of this illY Last Will.. ITEM 5. I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passes under this Last Will, shall be paid by my Executor out of my residuary estate. ITEM 7. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. ;' /'j!u/~ 1~.t--v.t.1'/ /Y'~ RONALD S. EBERSOLE 2. ----------------------------END------------------------------- . _...''-'... J..J" r~~'1..l..ti. 'I I ss COUNTY Of CUHBCRLAND I, RONALD S. EBERSOLE ,TESTATOR, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn or affirlned to and acknowledged before me, 0y IWNl\LlJ S, EIJERSOLE , the TESTATOR, this 28th day of July 19 9~ ~ ,,~.~ ~C ,1T10fiNn IWiM1JA;:-S'(A~-~-" 0 ARY PUBLIC ,;."". JAM(S M. BACH N Me hanicsburg, P,~ W "1' C . C~mberl8.n~ Co"n" - ,.tary FttlIic '" OIttiJ)/IiS~ E ~ J Ny Commission Expires; 1]5/13/9~ I n ~ir~ Mal ra. 199:) .~~ The preceding instrument consisting of this and two (2) other typewritten pages, identified by the signature of the TESTATOR. was on the date theeeof signed, published and declared by RONALD S. EBERSOLE , the TESTATOR therein named .s and for his LnST WILL AND TESTAMENT. 'Iii 'I'" f.-'. ,} ( , ')/)- 'C tf/ftu':::vJn .../~l;'} (' hl r'Gt.u GLAOdS ~. S~RAHELL[ Residing at 352 s. Sporting Hill Road Mechanicsburg, PA 17055 Residing at 352 S. Sporting Hill Road Mechanicsburg, PA 11055 A f f I D A V I T COH~IONWEALTIl OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We GLADYS B. SPRAMEllI and DANA L. MIDDLEKAUFF, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw TESTATOR sign and execute the instrument as his LAST WILL: that he signed willingly and that he executed it as his free and voluritary act foe the purpose therein expressed; that each of us in the hearing and sight of the TESTATOR signed the WILL as witnesses; and that to the best of our knowledge tile TESTATOR was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by GLADYS B. SPRAMELLI and DANA L. MIDDLEKAUFF, witnesses. this 28 day of July 1993 . ~"NO ---- .~N[y JAM~~R;7l SEAl. ,i'(Uu~i Climb . DAC/f N '".1 Cr-.....'. erlafld C . ~jllr" A.~I. ~'''''II;SJrn E~. "UfJlv ., . IolllIIC ~M!1:fr3 . ---: 19911:if ~. ,,'" ~ ~ o ARY PUBLIC M hanlcsburg, PA My Commission Explres: 05/13/95 3 ." r (,1 I: ~-i ~.~ , " , . ll.[1J.1SClClH(ti-oo~ /-;-p/- 6~ , . '* COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT 2BOW1 . HARRISBURG, PA 17128-0601 REV-1500 v INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2 1 0 2 o 0 724 COUNTY CODE YEAR - NUMBER- - - I- Z W C W (J W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) :l':b5'~~o],e-, ~on~1d E.. _ _ _ _ __ __ _ DATE OF DEATH (MM-DD-YEAR) IoATE OF BIRTH (MM-OO-YEAR) 07/22/2002_ __ j __0~/~3!~946_ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER __L.1:5.2_ =_:3.8_ _ _3~~9_ __ I THIS RETURN MUST BE FILED IN OUPLlCATE WITH THE J _ _ __~E_(;'sr~R9~ "",''-.LS_ I SOCIAL SECURITY NUMBER w '" ~:$U) u ."" w"u ,,00 u"-' ..'" .. " o 1. Original Retum o 4. Limited Estate o 6 Decedent Died Testate (Atlac.h copy of Will) o 9. Litigation Proceeds Received o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes Election to tax under Sec. 9113(A) (Atlach Sdl oJ ~. Supplemental Return o 4a. Future Interest Compromise (dale of dealh after 12-12-82) o 7. Decedent Maintained a Living Trust (Altadl copy o/Trust) o 10. Spousal Poverty Credit ,\late l)\ \lealh between 12-31.91 and ,_ t-95) '" Z W o Z o .. "' w " " o u NAME . Kelth O. Brenneman --FIRM NAME\I(~~l---------- ------ - - --- -- ----- _Snelbaker L I3rennema.n ~ JPa:r::!" L P ._ TELEPHONE NUMBER 717-697-8528 44 W. Main Street Mechanicsburg, PA 17055 Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule D) (1) (2) (3) (4) (5) 984.00 z o 5 :J l- ii: <( (J w c:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Bllling Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (ScheduleG orL) 8. T'Jtal Gross Assets (tota\ lines 1-7) 9" Funeral Expenses & Administrative Cost~ (Schedule H) 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) , 1. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 m"lnus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (ScheduleJ) (11) (12) 984.00 (13) 984.00 (14) (6) (7) , (8) 984.00 (9) (10) 14. Net Value Subject. to Tax (Une 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= i:!: :J Q. :!1 o (J g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unoor Sec. 9116 (,,)("1.2) x 0 (15) xO 45 (16) 44.28 984.00 16 Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 laxable at sibling rate x .12 (17) 18. Amount of Line 14 laxableat coIIateral rate x 15 (181 19. Tax Due (19) 44.28 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT , . Decedent's Complete Address: STREET ADDRESS 2804 Warren Way ----- --- -~-_.- -- ---.._---.- -.....-.-.. -----.- Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount CITY STATE PA (1) 44.28 Total Credits (A + B + C ) (2) ZIP 17050 3. Interest/Penalty if applicable D.lnlerest E. Penalty 1.13 TotallnteresVPenalty ( D + E ) (3) 4. If Une 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 1.13 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 45.41 A Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5A) (5B) 45.41 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS fi fi fi 0 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;...... 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 wilhout 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? . Ves ...........0 ...........0 .0 .0 ...........0 .........0 IF No U U XX XX RETURN eluding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. on allinform<llion 01 which preparerhasany knowiedge. s. High Street, Mechanicsburg, PA 17055 - -.- -- - - ..- - SIGNATU1~THAN REPRESENTATIVE ADDRESS ~44W. M~in~tr~~t,_Mechanicsburg,~1'~_17055_ DATE 10/23/03 --.. --- -- DATE 10/23/03 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 10 or for the use of the surviving spouse (s 3% [72 P.S. 39116 (al (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 sllNiving spouse is 0% [72 P.S. s9116 (a) (1.1) (i'I)). The statute does no! exemot a transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or fur the uoo of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 39116(a)(1.2)]. The lax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. s9116(1.2) {72 P.S. s9116(a)(1 )]. The lax rale imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whelher by blood or adoption. . . REV-150. EX+ (6-981 .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Ronald S. Ebersole FILE NUMBER 21-02-00724 ESTATE OF Incfude the proceeds of litigation and the aate the proceeds were received by the estate. All property Jointly-owned with right of survIvorship must be disclosed on Schedule F. 1. DESCRIPTION Decedent's 2002 Federal Income Tax Refund VALUE AT DATE OF DEATH ITEM NUMBER $984.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 984.00 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jerry A. Marsicano, Sr., a/k/a Jerome A. Marsicano Date of Death: February 13, 2001 21-01-0724 Will No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: February 2006 3. If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? N/A 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? N/ A D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. D~i~ April ~ 2005 ~Pf 4 r>. -+ c:==z Mark E. Halbruner, Esquire PAI.D.#66737 GATES, HALBRUNER & HATCH, P.e. 1013 Mumma Road, Suite 100 Lemoyne, P A 17043 (717) 731-9600 Capacity: Counsel for Personal Representative .IN CERTIFICATION OF NOTICE UNDER RULE 5.6(a) LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Name of Decedent: Ronald S. Ebersole Date of Death: July 22, 2002 Will No. 2002-00724 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiary of the above-captioned estate on December 9, 2002 Name Address Bryan R. Ebersole 607 Bay Street Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: December 9, 2002 ~~~~ Keith O. Brenneman, Esquire Snelbaker, Brenneman & Spare, P. C. 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA l ss: COUNTY OF CUMBERLAND 1 - Dana M. Ebersole being duly sworn ., according to law, deposes and says that ~e t s the Arlmi nistrat-r; Y C.T.A. - - of the Estate of Rona1_d S_ Ebersole late of ___-Hampden_Town~hi~.___ Cumberland County, Pa., deceased and that the within is an inventory made by Dana M. Ebersole _ ., the said Administratrix of the entire estate of said decedent, consisting of all the personal p arty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite eac~ item of the Inventory represent it's fair value as of the date of decedent's -death . ~~ Sworn to and subscribed .before me, this 23rd day of ..October, 20~~03 ~~~~ ~~~ a~een~h Notary Publ~ Mediedcslx~ ~o% Gtim ~~ q. Onn~+c~rhr!+n~^ Aea^^~nf~^n r1t n-0f811~A Date of Death 22 Dey Month Address 2002 Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement 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 IY, Fiduciaries Act of 1949. , N r` 0 0 I N 0 I N O L - AOmtn tiirdtOr Da ~ M. Ebersole 5 S. High Street Mec anics urg, July L`i F-- L.L.! L tom-. u.i C H a ~ ~ ,;, OC u H G J ~ LL ,~ Q O O Q C z O a c Z L' Q N 0 N a~ ,.q W (!1 b~ r~ ~r O ~ m N ~ A a~ 3 O p H O ~ b ~_ cad U C A ~ ` O d ..~.. a~ o = ~ m A ~ `o O ~~ <~ I O N .~ i .~ I Q~ ~ ~C © O C SUPPLEMENTAL Inventory of the real and personal estate of Ronald S. Ebersole deceased .: A. PERSONALTY Decedent's 2002 personal federal income tax refund: $ 984 0 TOTAL APPRAISED VALUE, PERSONALTY: ~ $ 984 0 COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND J Dana M. Ebersole being duly sworn according to law, deposes and says that ~e i G +hE+ Aram; n; ~+,-a+r; Y C.T.A. ~ of the Estate of Ronald S_ Ebersole late of ___-Hampden_Townshi.~.____ ,Cumberland County, Pa., deceased and that the within is an inventory made by Dana M. Ebersole _ ., the said Administratrix of the entire estate of said decedent, consisting of all the personal p arty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite eac item of the Inve~~y represent it's fair value as of the date of decedent's death . Sworn to and subscribed before me, this 23rd day of October, 2003 ~8 ~ ~ ~' 9ueen f~ , I~b~ta Public ro, Cumberland ~j 1ydC~ Ex~r~f~lov.24, r Onn.~cvhronh ~ocnnleNnn r,+ A1Q{8f~~f, Date of Death 22 Day CJ ~ " ~~ Execu±o Aami r~or ~Da~ M. Eberso `2~5 S. High Street Mec anics urg, July Mon+h Address 2002 Ysar INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. $ee Article IV, Fiduciaries Act of 1949. , N ~ n o o I o r-I Z }~ ~-/ Q ~ Z W i > I ~ ,I w S ,i O ~ w c ~ a ~ Z v> W a w ~ ~ w Q w C Z Q O 0 U1 ~ A W c!1 rd fd o x .~ Cr" H x 0 d 0 m R a~ u a> 0 ~o a ~: c 0 U -~ d E c+ r G", '~ C ~ `o ~ ~ N Q ~ O ~ ~ ~ +~ . ~ x m o 0 SUPPLEMENTAL Inventory of the real and personal estate of Ronald S . Ebersole deceased A. PERSONALTY Decedent's 2002 personal federal income tax refund: $ 984 0 TOTAL APPRAISED VALUE, PERSONALTY: $ 984 0 COMMONWEALTH OF PENNSYLVANIA 'l COUNTY OF CUMBERLAND J ~~ Dana M. Ebersole being duly sworn according to law, deposes and says that She ~ s the Ac3mi ni ~tratri u C.T.A. Ronald S. Ebersole of the Estate of late of --.-_.-- Hampden Townsflip________-_ Cumberland County, Pa., deceased and that the within is an inventory made by Dana M. Ebersole __ _ the said Admi ni stratri 3 of the entire estate of said decedent, consisting of all the personal pro party and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite.-etch item o$ the ~entor~;represent it's fair value as of the date of decedent's death , r Sworn to this ~ 4'~ day of _ and subscribed before me, ~P/2/ ~-- ~x 2003 i~-'f~'~ Notarlel Ss~ ~`~aan L. 4~otary Publbp -- 'i~.n F~pP~l~ ttilrJV. M~ ,.o~sw,.:, r - 22 Date of Death Day ~ ~ ~ Execut ~ Administretor an ~ M. Eberso 2.5 ;_ High StrPPt Mechanicsburg, PA 17055 Address July 200 Month Yser INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement 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 !Y, Fiduciaries Act of 1949. , d+ N 0 O I N O rI N I 0 Z 0 W Z ~-- w o! F-~ W Q a ~ W ~ w F=- ~ J ll. LL J W O Z ~ ~ D ~ Z w Q a ~ ~ 0 N A w . ~, ~ I ~ I a°' -v m d u ~o d T c 0 U ~ ~ c o d ~ E ~ U O+ T ~ '0 c ~ a ~, ~ o ~ ~ ~ , ~ ~ ° ii: m Inventory of the real and personal estate of Ronald S . Ebersole deceased A. PERSONALTY 1. Miscellaneous furniture, furnishings and household effects: $ 595.00 2. Members 1st F.C.U. account no. 46042-00 (savings): 293.24 3. Members 1st F.C.U. account no. 46042-11 (checking): 1,413.94 4. 1997 Jeep Cherokee 5,900.00 5. The Brambles - security interest payment: 4.76 6. I~FGE Dental Trust - premium refund: 126.00 7. PA State Collection and Disbursement Unit - support payment: ~ ~ .,],,..77. TOTAL APPRAISED VALUE, PERSONALTY: !I B. REAL ESTATE i _ TOTAL APPRAISED VALUE,ALL ASSETS: $8,33471 NONE $8,33471 ~ ~~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 KEITH 0 BRENNEMAN SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCUUNT RfV-1607 EX AFP (01-03) DATE 12-01-2003 ESTATE OF EBERSOLE RONALD S DATE OF DEATH 07-22-2002 FILE NUMBER 21 02-0724 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP CO1-03) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF EBERSOLE RONALD S FILE N0. 21 02-0724 ACN 101 DATE 12-01-2003 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: 11-10-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 58.83 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 04-23-2003 CD002481 .00 14.55 11-13-2003 CD003223 1.25- 45.60 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ~ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DU E SIDE FOR CALCULATION OF ADDITIONAL INTEREST. t ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.. ) 58.90 .07CR .00 .07CR PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND CCR): 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, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY T0: puestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 260601, Harrisburg. PA 17128-0601, phone C717) 787-6505. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent t5%) 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) 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 (6Y.) 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 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1482 20% .000548 1987 9% .000247 1999 7% .000192 1983 16Y. .000438 1968-1991 I1% .000301 2000 8% .000219 1984 11Y. .000301 1992 9% .000247 2001 9% .000247 1985 13Y. .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 DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 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. v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 KEITH 0 BRENNEMAN SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% AFP [O1-Di) DATE 11-10-2003 ESTATE OF EBERSOLE RONALD S DATE OF DEATH 07-22-2002 FILE NUMBER 21 02-0724 ;_: COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -+~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-031 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EBERSOLE RONALD S FILE N0. 21 02-0724 ACN 101 DATE 11-10-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) [3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 9 84.00 tax payment. 6. Jointly Owned Property (Schedule F) (6) _ .00 7. Transfers (Schedule G) (7) .00 8. s Total Asse APPROVED DEDUCTIONS AND EXEMPTIONS: .00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 11. Total Deductions (11) .OD 12. Net Value of Tax Return (1P) 984.00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) [13) .00 t t T S b E t t (l4) 1,307.41 14. ax o u jec s a e Net Value of NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 . 00 15. Amount of Line 14 at Spousal rate (15) • = X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 1,307.41 X 045. 58.83 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00 19. Principal Tax Due Twv nsrn*rc•. (lq)= (g) 984.00 t 58.83 . DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 04-23-2003 CDD02481 .00 14.55 INTEREST IS CHARGED THROUGH 11-25-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT 14.55 BALANCE OF TAX DUE 44.28 INTEREST AND PEN. 1.32 TOTAL DUE 45.60 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATIDN: 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 23 of 2000. (72 P.S. Section 91407. PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed an the reverse side. --Make check ar money order payable to: REGISTER OF WILLS, AGENT REFUND CCR): A refund of a tax credit, which was not requested an 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, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and / or speaking needs: 1-B00-447-3020 (TT amyl. OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, ar 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 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE 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 (7171 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent^ CREV-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 CS%l 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 the sane 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 C9] 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 far 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .OOD548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .OD0219 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 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 assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BRENNEMAN KEITH O ESQUIRE 44 W MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: i5s-38-3359 FILE NUMBER: 2102-0724 DECEDENT NAME: EBERSOLE RONALD S DATE OF PAYMENT: 04/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/22j2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 514.55 1 TOTAL AMOUNT PAID: REMARKS: KEITH O BRENNEMAN ESQUIRE CHECK#1924 SEAL INITIALS: AC RECEIVED BY: DONNA M. OTTO 514.55 DEPUTY REGISTER OF WILLS REV-1162 EX111-96) NO. CD 002481 REGISTER OF WILLS i~ ~~ , _ l -- ~' COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX RFV (O1-OS) Yt`~'= DATE 06-09-2003 ESTATE OF EBERSOLE RONALD S DATE OF DEATH 07-22-2002 FILE NUMBER 21 02-0724 ~0.3 t>>~~`~ ~ ~ ~ ~ ' '~ COUNTY CUMBERLAND KEITH 0 BRENNEMAN ACN 101 SNELBAKER ETAL 44 W MAIN ST ~,; ;.i', ~ Amount Remitted MECHANICSBURG PA ~~7~d'~'~ - = MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ----------------------------- - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ----- REV-1547 EX AFP (01-03) ------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EBERSOLE RONALD S FILE N0. 21 02-0724 ACN 101 DATE 06-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAI SED VALUE OF RETURN SASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds [Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this Porn with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 14,034.4 0 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 5,190.43 8. Total Assets (g) 19,224.83 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 5,445.36 (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 13,456.06 11. Total Deductions (11) 18.901 .42 12. Net Value of Tax Return (12) 323.41 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts [Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 323.41 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) . DO X 00 _ . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 323.41 X 045 . 14.55 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)= 14.55 TAY f`D C*1TTC. DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 04-23-2003 CD002481 .00 14.55 TOTAL TAX CREDIT 14.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE [ IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 2ESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transYerren 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 8 (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 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order pava6le to: REGISTER OF HILLS, AGENT REFUND CCR): A refund of a tax credit, which was not requested on the Tax Return, may he 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, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). DBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, ar 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 17128-1021, OR --election to have the natter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CDRRECTIONS: 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 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 after the decedent's death, a five percent CS%) 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 man-participation penalty is appealable in the same manner and in the the same time period as you wculd appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, ar nine C9) 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 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate 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 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 assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-96) N0. CD 003223 SNELBAKER BRENNEMAN ETAL 44 W MAIN STREET MECHANICSBURG, PA 17055 -- fold ESTATE INFORMATION: ssN: ~ 59-3a-3359 FILE NUMBER: 2102-0724 DECEDENT NAME: EBERSOLE RONALD S DATE OF PAYMENT: 1 1 / 1 3/2003 POSTMARK DATE: 00/00/0000 CouNTY: CUMBERLAND DATE OF DEATH: 07/22/2002 REMARKS: SNELBAKER ETAL CHECK# 2097 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 545.60 TOTAL AMOUNT PAID: 545.60 INITIALS: DO SEAL RECEIVED BY: DONNA M. OTTO REGISTER OF WILLS DEPUTY REGISTER OF WILLS ~ ~ ~~ 3 i.' STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ronald S FhPr~nl ~ Date of Death: July 22, 2002 Will No.: 21-02-00724 _ Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [X~ No ^ Date: ~r> M i ,,, ~ ci • :'.: o q~ °` 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 _XX No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ^ No ^ c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to this repf ort. ~f~ March 2, 2004 t /~/ Signature Keith O. Brenneman Name 44 W. Main Street Mechanicsburg, PA 17055 Address ,.. ,,; ., ~Fi-.j (717) 697-8528 Telephone No. Capacity: Q Personal Representative Counsel for personal representative