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Home My WebLink About02-0800PETITION FOR PROBATE and GRANT OF LETTEryRS Estate of _ ~ i 'Fce M E a h c No. ~'- Qa ' a Q~ also known as To: Social Security No. Deceased. S-o The petition of the undersigned respectfully represents that: the Your petitioner(,vJ; who is~ere~18 years of age or older an the executrix named in the last will of the above decedent, dated D a 6 ~ .P , 1934_ and -codici}(s}-dated- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C4 ^'bp.~ertc( County, Pennsylvania, with her last family or principal residence at ~F 4o S ~~t -rte: „a I~ P_., a (list street, number and muncipaliry) Decendent, then /~ years pf age, died Qe~ c1 Z3 ~ }}aoo at N~ Iv Sa r 't 1-!~, ~ ta.1t ---~-~ 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: ner Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property g (If not domiciled in Pa.) Personal property in Pennsylvania $ _~p pp o,o (If not domiciled in Pa.) Personal property in County $ ~ - Value of real estate in Pennsylvania $ - situated as follows: - WHEREFORE, petitionerspf respectfully request(s) the probate of the last will ~~ presented herewith aed the grant of letters [heron. (testamentary; a inislra[ion c.[.a.; administration d. b. n.c.t.a.) ~n p ~„ v ~ d/ ~_ ~ N. sr ao A~a r krr~ cl. ,~,a" _ E_nola PA t~oas" ~ o c m in COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF _ C~tmb2rl nd Register of Wills for the County of C~,r6er lanof; in Commonwealth of Pennsylvania S3 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer th estate according to law. Sworn to or affirmed and subscribed ~~~~tc.~r/~ (~.~ before me this _. 4th _ day of 4 f~~~ ~ 2002 ~ A ~/ >; Donna M. Otto, lst DeputyR inter i OATH OF PERSONAL REPRESENTATIVE No. zl-zooz-aoo Estate Of xita M. i;~rans ~ Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW September 5th tI$ 2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT [S DECREED that the instrument(s) date' Decanber 8th 1999 described therein be admitted to probate and filed of record as the last will of and Letters Testamentary are hereby granted to xebecca M. Stains FEES Probate, Letters, Etc.......... $ 25.00 Short Certificates((d .......... $ 18.00 Renunciation ................ $ x-Pages (~) $ 6.00 JCP TOTAL $_.~~- Filed . September. 5th,2002............ Register of Wills Ibntla ~ tt0, 1St Depll~y J n Brou'os, >;s` 1106268 ATTORNEY (Sup. . I.D. No.) 4 N Hanover St Carlisle,PA 17013 ADDRESS 717-243-4574 PHONE CALL ATTORNEY JOHN H. BROUJOS ON 9/5/02 ,, .,; ~' I IT'orm.uion here ~vrn is correctly copied tmnl an original certificate otdcarh duh/ tiled with me as 111 II Z~z;i:l ] !u~ o ,,nnl rcr.Iticalre will he h>rL~~arded to [he Sratc Vila) Rrcords Office for pernuu~enl tiling. ~1/ARIVING: It is illegal to duplicate this copy by photostat or photograph. I r_ fI' :'Titi Crlftlicdtc, F2.00 P 8607869 ~~„_ --- nl DS.:q Rn. ve] vT RT r R 78 Yd Cumberland L]0.~wEa A• ~eaa.c~~ax~~e,- qf2~.. L~u:al Kcgicn~ar _ auc z s zoo2 u l(~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • YITAL RECORDS CERTIFICATE OF DEATH STne[aENUxeer 9E% $CCI,vL SELVRNY NVMRER VNOERIpp p4E0[elgin ] ]' Iwv[ NMNw mm, De[. EMI SLNUFV LE F/I[M PUCECf CERMRISYCNYm•-w•mnrvtlummgM. Dec.20$1923 Smithfield]RI ~ ky E > ,. T RrowlYm G pp,^ CITY,aL11p.1%F OFpEATX F%Ctt!]Y NRMEIIIIp,mcUM1M [' ~V~Y »eNamnunpvi Va CEDEMOF . Pennsboro 24p. « NOL~ St"IR IZ' µpSPl7~L M~[m.0.[ ^ p..YNw. ^ iSpemM1 ^ m• O W.V EMm[ Nlnl•RVa«o^ouY ~dYp ~~!~ . WNa.N. VIV ' L. ter „B. C stal Co. rsP.Lm "`"''~' OECEOENT'aNµlrp .00RE%Iynw, Ciry?wn. yaN, 24CW1 afCEDENi'B ]]~ 1]. I1~•n5.1 Countyy Meadows .cruu " I[. 4905 E. TL'indle Rd. gssrDENCE n.. s.l. PA DN n[.C3ve[,YMe•m w.e ___ ~,..i IE. Me IS[ei pvnaw e.oe.N S I /~~ `~1~'-~ MM• F%INEp']NpME1FVV MmY 1 Im. tcu yINIyJCylamrR YNmNIp] Ila.^.ylyn[nuYMM[pl N Peter Orgef~e Rainville MOTNfn'sx%Mf lFVp.Mny. MewmsnrmmN ~--- INFORM.VIf'aN.MElfrye'Prvy I.. Mary Ann Oearosiers ]B,, Rebecca M. Stains INF09M.Ni'$MMLVp.ppgE$$IEp[N Ce./p y.y $p LMe) METIgppF NSpEISrtwN :d. 45 WetherbU d OAEOFdaPOSIiION PIACECigapyllDN-pnydCFmYI• EDm.ewn^ am. sis®,,,rY~ "n^ R«~N.Nlmnsw.^ ^IMeIdI. m..wNl daM, n].. mc,.m.m,r Lae,vwn.env/r .sMl..npew. 5iO ^'"E R n Eqi PEq nND Ra sucN }1°' AUg. 28/ 2002 ]IeSt• PatC1Ck'9 Cemete LICEx%NUMaER E]a. Cdr1191e. PA N%ME%xD%OpRE%o[FpDwrY Hoffman-Roth N,.m~mm _ m. 014351 L a.. Funeral H MgM[W Ym%mNMYfm•d Ce[IM"nw IST.nuea~5 ~) I•M.o••InatwmoallMOm[. yN [M Wn WIp, omlYnu•do••m. LICENSENVMBER ORESgHFO MMb3EmblbxnDMM OY ~° IMtM. 4N Y•nl pvrnn,vlnpiomuMY[y[In TIME CSOEMX pgEPgONWNCED DFAO(Nmm, py Myl p%, °' r1 `r ~] BC44EREFERgEOTOMEOIC.LLE%gMINENCgipNEp] ]]. MR[I: Em•rm•d«•.wy,~urN•Fymp4•Ime.nsnte ~ I M. ]a. I~ ~ndl ~J~~~~ ~ .pe^ VYaMigy[ xN ri[, uuo1M 0.[In.Nml•m[r ln[mW[ol e[uNi[Cwn[pr. • „' W lory yr [I.NxYmM•n l•tlur[, '.vpR YyeYI• P.R]II; pnn[iyiilkglmr 3EenmM~Wl IWfd.Tf CMM! IF.w puw•vocwarm (~ dw INa~ •wupmXUlmErMNUU• nv+Ngm«dnl-~ [ tJ SIS O V E !O ICR /S R CLdSE W ENCE OF1: 4•ou•ml•F/4mWbm ~ a I ^~: yVNDf11LYllq DUE IDICq AS.CCN$EOUENLE CFl: I C1Nl IWr[[nrgvy M~'"]`•nb OUE ro1CR 0.5.v CONSEOVENCE OR. eJN-M~d.nlwT I Ma1N/.11]OPaY WERE %UICPEY FIHOIN03 I 'ERFORMEV] Ay1lABLE PRgq ]p MµNEq OFOEncM Xomi[ie• pRE CF INJURY iIMEOFINJVgY IWURYR NppNi L($LRIBE NCW IWURYIX.CUgp Ci CFANi CFC%U% NxurY W IMmm~p[M NwI 'MeM'A ^ P[MlrglnNUgLlbn ^ vY ^ W ^ vx ^ W p 1YV ^ No ^ Sw'M• ^ Coupm GMNrmmM ^ M. B.. Y .__ PULf aFlulllov.•..__..._ _ ar. __.__ ..................................................... ^ ]10. 'FROMOVNtIIq%MOCfRtI[Y11q IMYSICINMIFI~v'srn Rm pd«ns~ LIC SE NUMB R mm.e.ddmr Yeo.l.ef., a•.m«.~...eMme Bme, e.N.•M e0O°im ineCM1Y"a w~mm.de.elm 7 4 6 E oaE NE M OI pl«•.•wouvrom[e•e••1.1[M m•.mr.. n.ln...... °rY' .................. I. u u,Sfi'.~_3'~oo°,Z 'MEOIO.LL EXAMINER/COpOHEp ~ N%M RryORppgF%Cf PERSON WIp CO LETEOC..USE ERM OnIM BUN aI•a[minNlOn[nElerlnvaellg[IIen, In my Oplnian. C[NR «tun[d Nl]la llm•.EN[, [ne IRe[, ]nG UU[IOIM awpa(Q [M Igem $]IT pp m m•nnYru N[]Yp .............. r. ~2. K~c. Qho 2 ................... gEO15 TR/.q'S SIGNRIIRE INO ^]]. 11I~ LouJ+l+f-L St, zmDL ~te~j~.17~D a3 q• ~~ ~L I.v , _ .. ORE EILEOIMmm p[Y W[r~ ~i[C zi-zooz-aoo ~1 RITA M. EVANS, of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ~ftem ®tte: I direct that all my debts and funeral expenses including my gravemarker shall be paid from my residuary estate as soon as practicable afrer my decease as a part of the expense of the administration of my estate. 3ftem too: I give and bequeath the sum of Two Thousand Dollars ($2,000.00) to my beloved church, St. Patrick Catholic Church, 140 East Pomfret Street, Cumberland County, Pennsylvania. 3ftem ~ryree: I give, devise, and bequeath all the rest, residue and remainder of my estate, of whatever nature and wherever situate, to my four children, Rebecca M. Stains, Ronald P. Evans, Kathleen Calaman, and Maureen Brady, equally, share and share alike, per capita. ~ftem Jfour: I appoint my daughter Rebecca M. Stains Executrix of this my last will. Should she fail to qualify or cease to act as Executrix, I appoint my daughter Kathleen Calaman as an alternate Executrix with the same rights, powers, and duties. p ~ _, 3ftem~fibe: All estate, inheritance, succession, and other taxes, imposed or payable by reason of N~} my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. item mix: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Item ~iebett: In addition to the rights and powers given to the fiduciaries by law or elsewhere in ~ this will, I give to my Executrix during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his or her sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition, to mortgage or pledge real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of December, 1999. Signed ,~ I_~,~3 ~ • ~7r`~~,c-//' The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subsc " ' COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND . We John H. Broujos and (~-~~~,A ~, . ~`,,? ~F-~~P ,witnesses whose names are signed to the attached or toregomg instrument, being $u y qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ,. r~ w.. Swom and subscribed to before this 8th day of D cember, 1999. N ARY PUBLIC Notarial Ssal Bridget Ann Corcoren, Notary Public Carlisle Boro, Cumbedand County My Commission Expires June 10, 2002 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I Rita M. Evans, whose name is signed to the attached document, having been duly qualified according to taw, do hereby acknowledge Goat I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. -1 LI,EiI J ~ ~ ~°i~-C~ ~?~ Rtta M. Evans Sworn and affirmed to and acknowledged before me this 8th day of December, 1999. ~cQ~~.J NOT RY P LIC Notarial Seal Bridget Ann Corcoran, Notary Public Carlisle Boro, CumbedarM County My Commission Expires June 10, 2002 CERTIFICATION OF NOTICE UNDER RULE 5 6 (al Name of Decedent: Date of Death: Will No.: To the Register: Rita M. Evans August 23, 2002 Admin. No.: 21-02-0800 I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphan's Courl: Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 9-~~- ~~- Name St. Patrick's Church Rebecca M. Stains Ronald P. Evans Kathleen C. Calaman Maureen A. Brady Address 140 E. Pomfret Street, Cazlisle, PA 17013 45 Wetherburn Road, Enola, PA 17025 7201 Windwillow Drive, Corpus Christi, TX 78414 18 Tunbridge Lane, Carlisle, PA 17013 209 Hemlock Road, New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none Date: Q D~ c Signature Rebecca M. Stains 45 Wetherburn Road Enola, PA 17025 717-732-5319 Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EIXI11-9fi1 BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1)128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 001$77 BROUJOS JOHN ESQUIRE 4 N HANOVER STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL _-_-__ as NUMBER ESTATE INFORMATION: ssN: oaa-12-2s5o FILE NUMBER: 2102-0800 DECEDENT NAME: EVANS RITA M DATE OF PAYMENT: 11/22/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/23/2002 TOTAL AMOUNT PAID: 101 ~ 52,400.00 REMARKS: RITA M EVANS C/O JOHN BROUJOS ESQUIRE CHECK#102 INITIALS: CW SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS 52,400.00 REGISTER OF WILLS INVENTORY OF THE REAL AND PERSONAL ESTATE OF Rita M. Evans, deceased File No.: 21-02-0800 Date of Death: August 23, 2002 M&T Bank checking acct # 761982 2. Country Meadows refund on monthly apartment rental 3. Cash on hand 4. United America -supplemental insurance monthly premium refund 5. Franklin Templeton Investments Franklin Money Fund acct # 1 1 1-1 1 1 04566871 TOTAL $ 1,652.37 761.53 53.29 103.59 65,856.26 $ 68,427.04 Rebecca M. Stains deposes and says that she is the Executrix of the Estate of Rita M. Evans, late of Mechanicsburg, Cumberland County, Pennsylvania, and has made the above inventory of the entire estate of decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent its fair value as of the date of decedent's death. Ce' ~ :~~ Rebecca M. Stains, Exec trix Date: May /5', 2003 .~. ..,.~ C" r; .~ 'O ~; . n~ Cr rn RE"'-1500EX~6-00} '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 1I-'i(,-.8 Of- REV-1500 V INHERITANCE TAX RETURN RESIDENT DECEDENT v OFFICIAL USE ONLY FILE NUMBER 21-0200800 ""'COON"ry"'C5i5r --vi:~ - - N'ITMBER-- I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) EVANS RITA M. DATE OF DEATH (MM-DD- Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 038-12-2850 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 08/23/2002 12/20/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER w !;( ,,-Ul u"''' w@)O :t:D::9 Otm < [Kl1. Original Return o 4. limited Estate 00 6, Decedent Died Testate (Atlach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.'-95} 03. Remainder Retum {dateofdeathpriorto12-1J-82) o 5. Federal Estate Tax Return Required Q... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under See, 9113(A} (Attach Sth 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN H. BROUJOS ESQUIRE 4 NORTH HANOVER STREET FIRM NAME IIf Ap~"abIe) BROUJOS & GILROY PC. TELEPHONE NUMBER 717-243-4574 OR 717-766-1690 CARLISLE PA 17013 ... z w o z o .. Ul w 0: 0: o U z o i= Cl: ...J ::J I- 0:: Cl: o W II:: z o i= Cl: I- ::J D.. :!; o o >< Cl: I- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Reoeivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Join!y Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 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. fatal Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) _ (n 3 :;- u ('1) '8 OFFmlWSE ONLY m-, (1) (2) (3) (4) (5) (6) 17) (8) (9) 110) {J:::::"::~ ::.: "" -< , ." ~ Ul (", 6&:42i04 I ~ =-R':' I UJ - ,.. I--.J 000 0.00 68,427.04 11,967.40 206.36 (11) (12) (13) 12,173.76 56,253.28 2,000.00 14. Net Value Subject to Tax {Une 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 16. Amount of Une 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18, Amount of Line 14 taxable at collateral rate 19. Tax Due (14) 54,253.28 X _(15) 54,253.28 X .045 (16) X .12 117) X .15 (18) (19) 2,441.40 2,441.40 20. [8] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aXl2) ~ Decedent's Complete Address: STREE1 ADDRESS Country Meadows 4905 Easl Trindle Road CITY I STATE I ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,441.40 2400.00 12207 Total Credits (A + B + C) (2) 2,522.07 3. InteresUPenalty if applicable D. Interest E. Penalty T otallnterestlPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the d',fference. This Is the OVERPAYMENT. Check box on Page 1 Line 20 to requesl 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) B. Enter the total oj Line 5 + 5A. This Is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 80.67 0.00 000 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves No a retain the use or income of the property transferred; .............. .............................. . ................ 0 IKI b. retain the right to designate who shall use the property transferred or Its Income; ........ ........... 0 IKI c. retain a reversionary interest; or . .............................. .......... 0 00 d. receive the promise for life of either payments, benefits or care? . .... 0 IKI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.......... ....... ............................. .... 0 IKI 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ..... ........... 0 IKI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............. ................................. ................... ............ 0 IKI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties. of perjul)', l declare that I ha'Je examined this. retl.Jrn, incluOi~ accompanying scheaules and statements, and 10 the besl of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURJilOF "pERSON RESPONSIBLE F FILING ~ETURN DATE.-/ ~~ 5 ADDRESS 45 Wetherburn oad nola PA 17025 PREPARER DATE \-l S ~ (\ AD 4 North Hanover Stre I Carlisle PA 17013 For dates of death on or after July I, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and tHing 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 fransfers 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% 172 P.S. ~9116(a)11.2)). 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) 172 P.S. ~9116(a)(1)] The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the deceden\, whether by blood or adoption. e"'~8EX.;;:""" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF EVANS RITA M. FILE NUMBER 21 02 00800 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1,652.37 M&T Bank checking acct# 761982 2. Country Meadows refund on monthly apartment rental 761.53 3. Cash on hand 53.29 4. United American - supplemental insurance monthly premium refund 103.59 5. Franklin Templeton Investments: Franklin Money Fund Acct # 111-11104566871 65,856.26 TOTAL (Also enter on line 5, Recapitulation) $ (tf more space is needed, insert additional sheets of the same size) 68427.04 "''''''''''"'''* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlDEN1 DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF EVANS. RITA M. FILE NUMBER 21 02 00800 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 7,579.50 2. Carlisle Memorial Services - gravestone 1,356.00 3. Rebecca Stains - reimbursement for caterer and rental of hall for meal 393.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) 0.00 Social Security Number(s) I EIN Numberof Personal Representative(s) Street Address City State Zip Year{s) Commission Paid: 2. Attorney Fees Broujos & Gilroy, P.C.; EIN 23-2267691 2,200.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 144.00 5. Accountant's Fees 6. Tax Return Preparer's Fees - Carey Associates 45.00 7. Register of Wills - Inventory filing fee 10.00 8. Register of Wills - Inheritance Tax Return filing fee 15.00 9. Register of Wills - Family Settlement Agreement 17.00 10. Kathleen Calaman - reimbursement for cerlified letter to Templeton Investments 7.90 11. Ivo Otto, Esq. - opinion letter on tax consequences, reimbursed to Broujos&Gilroy,PC 200.00 TOTAL (Also enter on line 9, Recapitulation) $ 11 967.40 (If more space is needed, insert additional sheets of the same size) C"''''''':~'''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF EVANS RITA M. FILE NUMBER 21 02 00800 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 206.36 1 Country Meadows - medicine TOTAL (Alsoen!er on line 10, Recapitulation) $ (If more space IS needed, Insert additIOnal sheets of the same size) 206.36 ",',"m',~"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER I=VAI\lC:: ~ITA ~'. ?1 n2 nnRM RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Rebecca M. Stains daughter 1/4 of residue 45 Wetherburn Road, Enola, PA 17025 2. Ronald P. Evans son 1/4 of residue 7201 Windwillow Drive, Corpus Christi, TX 78414 3. Kathleen C. Calaman daughter 1/4 of residue 18 Tunbridge Lane, Carlisle, PA 17013 4. Maureen A. Brady daughter 1/4 of residue 209 Hemlock Road, New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. St. Patrick's Church 2,000.00 140 E. Pomfret Street, Carlisle, PA 17013 TOTAL OF PART Il- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 2 000.00 (If more space is needed, insert additional sheets of the same size) ~ ~ ~--~' '" COMMONWEALTH OF PENNSYLVANIA t„ BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 1]128-0601 APPRAISEME NT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX vtvascv a +vv ~o~-oD BATE 06-16-2003 ~~ ~ :-„' ESTATE OF EVANS RITA M ~; DATE OF DEATH 08-23-2002 FILE NUMBER 21 02-0800 •U3 ~~~-~ 20 'y j :fA9~INTY CUMBERLAND JOHN H BROUJOS pCN 101 4 N HANOVER ST Amount Remitted CARLISLE PA 170131.-.~:' 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 EVANS RITA M FILE N0. 21 02-0800 ACN 101 DATE 06-16-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( 7 CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B7 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mork9ages/Notes Receivable CSChetlule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (17 (2) (37 (4) (5) .00 .00 .00 .00 68,427.04 NOTE: To Snsure proper credit to your account, submit the upper portion of this form with your tax payment. 6. JoinYlY Ownetl Property (Schedule F) (67 .00 l G7 (7) .00 e 7. Transfers (Schedu e. Total Assets (g7 68x427.04 APPROVED DEDUCTIONS AND EXEMPTIONS: 11,967.40 9. Funeral Expenses/Atlm. Costs/Misc. Expenses (Schedule H7 C97 10. Debts/Mortgage LSabSlities/Liens (Schedule I) C10) 206.36 11. Total Detluctions (117 12.17.76 12. Net Value of Tax Return (12) 56,253.28 2,000.00 13. Charitable/GOV¢rnmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 14. Net Value of Estate Subject to Tax (147 54,253.28 NOTE: If an assesseent was issued previously. lines 14, 15 and/or 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 = 54,253.28 X 045 = 2,441.40 16. Amount of Line 14 taxable at LSneal/Class A rate (16) 17. Amounk of Line 14 at Sibling rate (17) •00 X 12 .00 •00 X 15 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) (19). 2,441.40 19. Principal Tax Due NE 6R Lllp' AYMENT DATE RECEIPT NUMBER SCOUNT (+7 INTEREST/PEN PAID (-) AMOUNT PAID 11-22-2002 (0001877 122.07 2,400.00 06-09-2003 REFUND .00 80.67- TOTAL TAX CREDIT 2,441.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 x IF PAID AFTER DATE INOICAT ED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REpU1RED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YO(I MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ice- ~~y - ~- BUREAU OF INDIVIDUAL TAXES INHERITANCE TA% DIVISION DEPT. 280601 HARR ISBURG~ PA 17128-0601 JOHN H BROUJOS 4 N HANOVER ST CARLISLE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REY-16w E% \FY 101-OA DATE 06-23-2003 ESTATE OF EVANS RITA M DATE OF DEATH 08-23-2002 FILE NUMBER 21 02-0800 ~~~ JUI- ~,.~_, ~ 1 ~ COUNTY CUMBERLAND ACN 101 ~" P X7013 Amount Ranitted p, l,l, 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, subni4 tha upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t REV-1607 EX AFP (01-03) *x~ INHERITANCE TAX STATEMENT OF ACCOUNT *x* ESTATE OF EVANS RITA M FILE N0. 21 02-0800 ACN 101 DATE 06-23-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHONN BELOW IS A SUMMARY DF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECDRD ADJUSTMENT: 06-16-2003 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 2,441.40 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 11-22-2002 CD001877 122.07 2,400.00 06-09-2003 REFUND .00 80.67- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU MAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS. ) 2,441.40 .OD .00 .DO Family Settlement Agreement ~ File No. 21-02-0800 THIS is an Agreement entered into this o?d "°e day of u ~7" , 2003, by and between Rebecca M. Stains, Executrix and Beneficiary under the estate of Rita M. Evans, of 45 Wetherburn Road, Enola, PA 17025 (Executrix), Ronald P. Evans, 7201 Windwillow Drive Corpus Christi, TX 78414, Kathleen C. Calaman, 18 Tunbridge Lane, Carlisle, PA 17013, and Maureen A. Brady, 209 Hemlock Road, New Cumberland, PA 17070, Beneficiaries, whose names are set forth as signatories at the end of this Agreement. WHEREAS A. Rita M. Evans, of Country Meadows, 4905 East Trindle Road, Mechanicsburg, PA 17050, died on August 23, 2002. B. On September 5, 2002, Letters Testamentary were granted to Rebecca M. Stains at File No. 21-02-0800 in the Register of Wills Office for Cumberland County, Pennsylvania. C. Executrix has administered the Estate of Rita M. Evans, up until the present time and has paid all debts of the estate, including Inheritance Tax owed. D. Rita M. Evans died testate, thereby vesting all rights and interest in her personal and real property to her four children listed above. E. Estate of Rita M. Evans has received assets set forth in Exhibit A attached hereto and made a part hereof. F. Estate of Rita M. Evans has paid debts and expenses as set forth in Exhibit B attached hereto and made a part hereof; and has made distributions as set forth in Exhibit C. G. There remains to be distributed to the beneficiaries the assets set forth in the Schedule of Distribution in Exhibit C attached hereto and made a part hereof. H. Executrix and Beneficiaries desire to forego a formal accounting and schedule of distribution and desire to conclude the estate by virtue of the filing of this document. NOW, THEREFORE, Executrix and Beneficiaries intending to be legally bound, state as follows: 1. The Executrix and Beneficiaries agree that the Executrix of the Estate of Rita M. Evans need not file a formal accounting or schedule of distribution. 2. Executrix states that all costs of the estate are paid. 3. The parties agree to distribution of the assets in accordance with Schedule C. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Rita M. Evans, subject to the provisions hereof. IN WITNESS WHEREOF, Rebecca M. Stains, Executrix, and Beneficiaries, intending to be legally bound hereby set their hands and seals the day and year first above written. WITNF,SS: ,(~r~ Rebecca M. St ms, Executrix and Bene iciary Ronald P. Evans, Beneficiary Kathleen C. Calaman, Beneficiary Maureen A. Brady, Beneficiary The parties agree to distribution of the assets in accordance with Schedule C. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Rita M. Evans, subject to the provisions hereof. IN WITNESS WHEREOF, Rebecca M. Stains, Executrix, and Beneficiaries, intending to be legally bound hereby set their hands and seals the day and year first above written. WITNESS: ~~ ~ /,, G~ Rebecca M. Suns, Executrix and Bene ~ciary Ronald P. Evans, Beneficiary Kathleen C. Calaman, Beneficiary Maureen A. Brady, Beneficiary The parties agree to distribution of the assets in accordance with Schedule C. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorise and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Rita M. Evans, subject to the provisions hereof. [N WITNESS WHEREOF, Rebecca M. Stains, Executrix, and Beneficiaries, intending to be legally bound hereby set their hands and seals the day and year first above written. WITNESS: ~, T~~ Rebecc~ns, Executrix and Bene it ary Ronald P. Evans, Beneficiary at teen C. Calaman, Beneficiary Maureen A. Brady, Beneficiary The parties agree to distribution of the assets in accordance with Schedule C. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Rita M. Evans, subject to the provisions hereof. CN WITNESS WHEREOF, Rebecca M. Stains, Executrix, and Beneficiaries, intending to be legally bound hereby set their hands and seals the day and year first above written. WITNESS: .~ -~~~ ,~ Rebecca M. Suns, Executrix and Bene iciary Ronald P. Evans, Beneficiary Kathleen C. Calaman, Beneficiary ~~ tom..-- f~,,e ,~t,y Maurgen A. Brady, et eficia ~` EXHIBIT A -ASSETS AND INCOME ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. M&T Bank checking acct # 761982 $ 1,635.94 2. Country Meadows refund on monthly apartment rental 716.53 3. Cash on hand 53.29 4. United America -supplemental insurance monthly premium refund 103.59 5. Verizon -refund 4.04 6. Franklin Templeton Investments 65 856.26 Franklin Money Fund acct # 111-11104566871 TOTAL ASSETS $ 68,369.65 INCOME 1. Dividends earned in Franklin Templeton investments since DOD 161.73 TOTAL ASSETS AND INCOME $ 88,531.38 EXHIBIT B -DEBTS AND DEDUCTIONS ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1. Hoffman-Roth Funeral Home $ 7,579.50 2. Carlisle Memorial Services -gravestone 1,356.00 3. Rebecca Stains -reimbursement for caterer and rental of hall for meal 393.00 B. ADMINISTRATIVE COSTS 1. Attorney Fees -Broujos & Gilroy, P.C.; EIN 23-2267691 2,200.00 2. Register of Wills -Probate Fees 144.00 3. Register of Wills -Inventory 10.00 4. Register of Wills -Inheritance Tax Return 15.00 5. Register of Wills -Final Settlement Statement 17.00 6. Carey Associates -Income tax return preparer 45.OD 7. Kathleen Calaman -reimbursement for certified letter to Templeton 7.90 8. No Otto, Esquire -opinion letter on tax consequences, 200.00 reimbursement to Broujos & Gilroy, P.C. C. MIS CELLANEOUS DEBTS 1. Country Meadows -medicine 206.36 SUBTOTAL 12,173.76 Inheritance Tax ($2,441.40 less $122.07 discount) 2.319.33 TOTAL DEBTS AND DEDUCTIONS $14,493.09 EXHIBIT C -DISTRIBUTION Assets and Income Debts and Deductions Balance Advance Distribution: Rebecca M. Stains Ronald P. Evans Kathleen C. Calaman Maureen A. Brady St. Patrick's Church Balance $12, 500 12,500 12,500 12,500 2.000 Checkbook Balance Final Bills Register of Wills -Family Settlement Agreement filing fee Broujos & Gilroy, P.C. -final legal fees Balance for Distribution Rebecca M. Stains $ 509.58 Ronald P. Evans 509.57 Kathleen C. Calaman 509.57 Maureen A. Brady 509.57 17.00 240.00 $ 68,531.38 - 14.493.09 54,038.29 - 52 000.00 2,038.29 2,295.29 - 257.00 $ 2,038.29 Balance - 0 - ~ti V ~~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Rita M. Evans - Date of Death: 8.23.02 Will Admin. No. 21-02-0800 _ 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: State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: if the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account/statement with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of Orphans' Court and may be attached to this report. ~ p Date: ~: z. 0 3 ~-G~'~ >~'~v~'i.2' - Signature Rebecca M. Stains 45 Wetherburn Road Enola, PA 17025 717-732-5319 Capacity: X Personal Representative