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Home My WebLink About02-0865 PETITION FOR PROBATE and GRANT OF L TTERS Estate of Dorothy D. Belden No. 1- also known as To: Register of Wills for the Deceased. County of CUMB RLAND in the Social Security No. 183-12-2937 Commonwealth of ennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execulors in the last will of the above decedent, dated March j and codicil(s) dated Ncmp named ,19~ (state relevant circumstances. e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland. . CPJln y',.Pennsylyania with h er last familv OJ: orincinal residence at Green Rldge Vll1age :llU ]llg Sprlng Ave., West ~ennsboro lOwnStllp (list street, number and muncipality) Decendent, then R 1 at Cr9~f' 'R;r1g'" 'U;1 Except as follows, decedent did not marry, was not <:Jivorced 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 as never adjudicated incompetent: N/ A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real ~state in Pennsylvania situated as follows: years of age, died Se tember 17 2002 ,19 00,000.00 None $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the la t will and codicil(s) presented herewith and the grant of letters Testamentary llestamenlary; adminislration c.La.; dministration d.h.n.c.La.) theron. ~ ~en~ 11 Scott Cove F~~t Rp~ PA 17116 Zci. ~~ , "' ;:: ~2 O.J '- x~ -::IE 1::';:; C':;l'':: ~ 7. OA TH OF PERSONAL REPRESENT A TI E COMMONWEALTH OF PENNSYLVANIA l.- ss COUNTY OF _CUMBERLAND ) The petitioner( ,) above-named ,wear(s) or affirm(s) that the statements in the oregoing petition are true and correct to the best of the knowledge and belieflof itioner(s) apd tha as personal represen- tative(s) of the above decedent petitioner(s) will well and mi r the es ate according to law. Sworn (0 or affirmed and before me this 24th SEPTEMBER 2 02 subscribed { day of JI:!Xxxxx '" 00' " '" " ~ :s: \ -:l. _o,r, _ ,,.. egisler No. 2.1-02.- 8a..~ Estate of DOROTHY D. BELDEN , Deceased DECREE OF PROBATE AND GRANT OF LE TERS AND NOW SEPTEMBER 25, 200 2 ~ljxxxx, in considerat n of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) date" March 3, 1995 described therein be admitted to probate and filed of record as the last will of Dorothy D. Belden and Letters Testamentary are hereby granted to Robert L. Belden and Edward D. Belden FEES Probate, Letters, Etc. ......... $ 200.00 Short Certificates( ).......... $ 6. 00 x:Jl.<!~ ~.xt:r:i!-. .page.s $ 12.00 jcp $ 5.00 TOTAL _ $ 223.00 Filed.. .9;-.25.-: 2.Q 0.2. ................... put in atty proth box 9-25-2002 Jacqueline M. Ver y, Esq. ATTORNEY (Su . Cl. J.D. No.) 11231b7 44 S. Hanover St. CarlisI e ADDR SS (717) 243-9190 PA 17013 PHO . '\ ~- , \ I . 1 Z "/....1'. c: ~ ,: II" " / ER OF WI S OF ATH OF S SCRIBING (Name) (Address) REGISTER OF WILLS OF CUMBERLAND C UNTY OATH OF NON-SUBSCRIBING WITNE 21-02-865 (each) a subscriber hereto, (each) being duly qualified according to law, dep they are familiar with the signature of Doroth codicil will that they pres nted herewith and codi I believes the signature on the will is n the handwriting of e(s) and say(s) that . Belden testat rix of (cme---of--ttre-"nb"dbilll\ -witnesses-lOt the Dorothy D. Belden to the best of their knowledge and belief. Sworn to or affirmed and subscribed before me this ?H"h day of ~~~;:,: Beth B. Belden~.4~ (Name) 13 Scott Coye, East Be lin, PA 17316 (Address Patricia A. Belden. (Name) 941 Green Spring Road, Newville, PA 17241 (Address) 1I10'j,305 REV')i3ii This is to certify that the information here given is correctly copied from an original eertifiear of dearh duly filed with me as Local Regisrrar. The original eerrificate will be forwarded to rhe State Vital Records Office fa permanent filing. WARNING: It is illegal to duplicate this copy by photostat or ph tograph. No. ....~,'S\1irOF"7;t;;;___." ,\~"c____',' , "J'. I~~\ g~t,:, 4/0_, ',:!:~ i. t-'L /tfr, . l:b~ \~ ':">'<'-,:, ~~/ "i:.::'<>: '- " ~l '." "'A'{Mm '/,\ ~~"'" """,,,,,##111' llu- . ~bJ,..~ fee for this certificate, $2.00 oeal Registrar P 8608189 SEP 1 8 2092 Date H1OS.1<03R<1v.2m COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. YITAL RECORDS CERTIFICATE OF DEATH "'" AVlCEUCE AeSUCH ,TIOft: ~I\.I sa: SOCIAl SECWlrN liUM8t:1l female ,183 _12 2937 "" - N.r./II€OFOECltCENT1F....,_.l_ DORorH'! JANE BELDEN .. AOEIld8ofl'l<lrn VfoIOf:Il1Y€AA - - Ul'IDE"IOolO' OREOFllIRTH 1_.0.,._1 """"""''''''- SII..CII~"'eognCol.nlr'll . CClUNT'l'OF-DERH Sly... -lM- E~_O -41 Cunt>erland ~ 1WoS00Cl!DE EVEAIN U.'&.UVft.tlFClfllCUl Distribut r _ 0 ND ~ White DE: DENT'S USVH. lGMO_fil"""'_=_ ~....NIt..... lilt) Beverage .. 19 operator 1110. DECEDEHT-SIlAJl..lNG~E_CS-!'f.~s-.Z;PCode\ _ Green Ridge Vluage 210 8ig spring Ave. ,. Newville, PA 17241 ~SNANfi{F"....M"""'.t.aIl) ."""'... ..'. .... 1'''0I~.1 ........."""'" 11I-.~__ ". 1111. a- PA - .. - "'in. Ctmberland ......, lNiJ :;.,-=-= MOTHER-Sru.MEIFQI._.~s..._1 ry Leone Goodhart ~"&ve~rer 'frj'. Arthur Deckman SfrW.W.~ Robert Selden . INWCl ~O ~__.O - E lIP08ITlClH P\.ACEOF-llISf'OSn'1C)H."..".Of~c.-.w, o.,.~ .0Ilwt~ Sep". 20. 2002 Westminster Mem:>rial Gar 21e. laNSE~0343-L - / DUE (OAI4ACONSEOUE. Of); .." OO€fI.... ,- '-- l--- , i 11: ~1igniIIl:IIlll""""'-"""'IO""""bIot ....-...,iII........,...._.....iIIf'1\l11Tl. n.MIlTI, E_..__......"'~...... lill.....,__""__. dnlh.Do............_oI _._OI.....alOIY..'..........,.,..__. \' o . DUE'fOIOA-"ACONSEOUEHCEOF}: CUElDlOA,,:r.ACONSfOUENCECIf): MM.o.u1Ol'SY~~S 1UoHNER000DERH --..""""'" ~ """"........ - - "'''''"'' - 0 -- ~e' ",0 ~O ....... 0 eo...w____ ......"''''"''' .....,~ DlSCIllIlEHOWINJt,lft'(CICCIJMEl). _ 0 _0 ~,I,;::"I,d - ,,1/ - CUT_~....,~ '~~H\F'I'_,*""",,,,_d___~""pr___call""_7.l) "__M",,~.___1D"".-('J""'_"__......'..'.""'....'" ... 'lIIIOtCALIXAMlNlRICOl'tONEA Oll....~..p......lIlIonwod1OfIlw."~.ln"'1'opInloll.d..th""""""1tMII_.n'...nclprlC.."dU<ltt:ltI'lIe....-(.Jand _.....stat<td...............................,..........................._........................................ ,.. AEOlSTIW\.S SIGNAnIAE AH .,~c ~ INCINQAHOevnl".lNOl'H'I'SICLUI""-'_~_"ClII'ltro"Ilw:._al_) 1b.._IJf...,.~,..___.__......ndpIH.._.....1D_ceuM(oll_m._.._.... , , " ~. ~tu-~ '" IJ<IIlERl..EO~. A. Townsend High St. ~" <j;$.,O~ F:\WP51\WILLS\BELDEND.WLL 12/1/94 3:30pm Thu LAST WILL AND TESTAMENT 21-02-865 I, DOROTHY D. BELDEN, of the Borough of Carli Ie, Cumberland County, Pennsylvania, declare this to be my Last wi I and Testament and revoke any will or Codicil previously made bye. ITEM I: I direct that all my just debts (ex ept as may be barred by a Statute of Limitations) and my feral expenses (including my gravemarker and expenses of my last i lness) shall be paid from my residuary estate as soon as practi able after my decease as a part of the administration of my esta e. ITEM II: My husband, MURRAY G. BELDEN, and I have two sons, ROBERT L. BELDEN (who is married to Beth) and EDWAR D. BELDEN (who is married to Pat). Rob and Beth do not have any hildren nor is it likely that they ever will have any. Ed an Pat have two children (Lauren and Emily) and it is not likely that they will have any more. We have a very good relationship ith and strong feelings for our daughters-in-law. We, therefore, ant to have our irectly or as daughters-in-law receive certain gifts, either substitute beneficiaries in the event their resp ctive husbands should predecease the survivor of Murray or me. is our hope and request that the gifts given to our daughters-in-Ia hereunder will be utilized and enjoyed by them and then at their eaths whatever is remaining of those gifts will be passed on to our grandchildren, Lauren and Emily. It is within the above context, hat Murray and I are making the gifts specified in our wills. ITEM III: I devise and bequeath all of my e tate of every P- ~J;' nature and wherever situate to my husband, MU BELDEN, providing he shall survive me by thirty (30) days. ITEM IV: Should my husband, MURRAY G. BELDEN, me or die on or before the thirtieth (30th) day follow ng my death, I bequeath those articles of my household furniture nd furnishings and those articles of my personal effects and ta gible personal property as set forth in a separate memorandum (wh"ch is signed by me and my husband, MURRAY, dated and makes specif c reference to this will and which I shall place with my will or eposit with my attorney), to the persons therein designated. ITEM V: Should my husband, MURRAY G. BELDEN, P edecease me or die on or before the thirtieth (30th) day follow"ng my death, I devise and bequeath all of the residue of my estate of every nature and wherever situate in equal shares to such of my c ildren, ROBERT L. BELDEN and EDWARD D. BELDEN, as are living on t e thirty-first (31st) day following my death. Should either ROBE T L. BELDEN or EDWARD D. BELDEN (or both of them) fail to survive he survivor of me and Murray, then his share shall pass to his espective wife (Beth or Pat, as the case may be), providing she sh II so survive. Should either son and his respective wife fail 0 survive the survivor of me and Murray, then their share shall pass, in equal shares, to my grandchildren, Lauren and Emily. ITEM VI: If any portion of my estate shall become distributable to a beneficiary who has not attai ed the age of twenty-one (21) years, the Executor may in its so e and absolute 2 ;cJ. discretion either pay over such Principal and ny accrued or undistributed income therefrom at any time to the guardian(s) of the property of such beneficiary, or to a cust dian for such beneficiary under the Pa. Uniform Transfers for Mi ors Act, which custodian may be my Executor or be selected by my E ecutor, retain the same for such beneficiary, IN SEPARATE TRUST, ntil he or she attains the age of twenty-one (21) years. In case of such retention, the Trustee may use or apply so much of the net income and Principal as it deems necessary or advisable f om time to time for support, heal th and medical care, (including college education, both undergraduate and of such beneficiary, or may make payment for without further obligation or responsibility to see the proper expenditure thereof, directly to such beneficia or to such beneficiary's parent or to any person taking care of such beneficiary. Any Principal or income not so ap lied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-one (21) years. If he or s e dies before attaining age twenty-one (21), such share shall be distributed to his or her personal representative, discharged of rust. ITEM VII: I direct that all taxes that may be assessed in consequence of my death, of whatever nature a d by whatever juriSdiction imposed, shall be paid from my resi uary estate as part of the expenses of the administration of my e tate. ITEM VIII: I appoint my sons, ROBERT L. BELDE and EDWARD D. 3 ~c). BELDEN, Executors of this my Last will. Should eit er of my sons, ROBERT L. BELDEN and EDWARD D. BELDEN, fail to qual"fy or cease to act as Executors, I appoint my attorney, HAMI TON C. DAVIS, substitute Co-Executor of this my Last Will. ITEM IX: I direct that my Executors or their s ccessors shall not be required to give bond for the faithful perfo ance of their duties in any jurisdiction. ITEM X: My individual fiduciary shall be entitle to reasonable compensation for his or her services rendered fro time to time and/or to reimbursement of out of pocket expenses. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on five (5) sheets f paper, dated this ...3 day of ~ , 1995. (SEAL) DO The preceding instrument, consisting of thi other typewritten pages, each identified by th initials of the Testatrix, was on the day and date published and declared by the Testatrix therein na her Last Will, in the presence of us, who, at her presence, and in the presence of each other have names as witnesses hereto. and four (4) signature or hereof signed, ed, as and for equest, in her subscribed our residing at residing at 4 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, DOROTHY D. BELDEN, the Testatrix whose na e is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I sig ed and executed the instrument as my Last will; and that I signed "t willingly and as my free and voluntary act for the purposes the in expressed. Sworn to or affirmed before me by Testatrix, this and acknowledged , the day of , 1995. Notary Public COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : ~, ~ , the witnesses whose names are signed to the attac d or foregoing instrument, being duly qualified according to law do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix s"gned willingly and executed it as her free and voluntary act f r the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the will as a witne s; and that to the best of our knowledge the Testatrix was at th time eighteen (18) or more years of age and of sound mind and und r no constraint or undue influence. Sworn to or affirmed before me by day of and subscribed to and , witnesses, this , 1995. Notary Public 5 .::r CERTIFICATION OF NOTICE UNDER RULE S.6(a) Name of Decedent: Dorothy D. Belden Date of Death: September 17, 2002 Will No. 21-02-0865 Admin. No. To the Register: I certify that notice of (beneficial interest) estate ..dminl......\ion required by Rule 5.~ of Orphans' S'b'5~lules was served on or mailed to the following beneficiaries of tbe above-captioned estate on ov mber 27, : ~ Address Robert L. Belden 13 Scott Cove, East Berlin, A 17316 Edward D. Belden 941 Green Spring Road, Newvi ie, PA 17241 Notice bas now been given to all persons entitled thereto under Rule 5.6(a) except No e Date: /1- .27-07--- /Lt. Name Jac ueiine M. Ve ney, Esquire Address 44 South Hanove Street Carlisle, PA 17 13 Telepbone (717) 243-9190 Capacity: _ Personal Representative ~Counsel for personal repres tative Inventory of the real and personal estate of Dorothy D. Belden dece ed 1. Orrstown Bank Trust Dept. Acct. #0529 113,538 26 2. Members 1st. Savings Acct. #42759 126 98 I Ii I tal 113,665 24 v.. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J 55: Robert L. Belden according to law, deposes and says that he is th co-executor of the Estate of late of _y,,_s~R"nnsJ>()'Co _T",p .____ _____ , Cumberland County, a., deceased and that the within is an inventory made by Robert L. Belden ., the id co executor of the entire estate of said decedent, consisting of all the personal prop.rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Invento y represent it's fair value es of the date of decedent's death. being duly sworn co-Exeeutor . A inish.tor ~ ~~ 1$ ~ 2002 tad~ NOTARIAL SEAL KATHlEEN l<. SHAULIS, Notary Public Carlisle BolO. Cumberland County My Commission Expires Dee 22. 2003 17 and subscribed before me, Robert L. Belden 13 Scott Cove East Berlin, PA 1731 Addr u September 2002 Date of Death Day Month Y..r INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal represen tive. 2. A supplement inventory must be filed within thirty days of discovery of additional asset. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. '" U) . "- " :> '" H 'tl ..; >- M 0 .. ..... w '" " ~ or) ~ '" ..... '" 0 .. '" w -< .0 .. <Xl ... ..... . U) u .. 0 .. 0 0 II> P " C ... >- I w '" w " .. .. N l- I ... :>-. '" ... c 0 ..... ....I u.. .c "" .. ~ Z -< 0 ... 0 u.. ....I '-' * W 0 -< w 0 '-' > '" " U) ,;. -< Ii z 0 '" - Z 0 c C p ;3 " .; II> Z 0 '" -< () ... z I w ... " c .. I - -.: I 0 .. .J:l -" .. E .. 0 - .. " 0 I ....I () ... REV-1500EX(5-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY L '\~__iCL___ FILE NUMBER I- Z W C W o W C '" '" ::.::~fI) ,,"'''' ","" ",00 "",~ ..Ill .. .. INHERITANCE TAX RETURN RESIDENT DECEDENT ...2-L-..D.-2- ---D----D---R~J COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Belden Dorothy D. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 09/17/02 01/22/21 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER 183 12 2937 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER GJ 1. Original Return o 4. Limited Estate o 6, Decedent Died Testate (Attach 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 Ma'mtained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required -...0.. 8. Total Number of Safe Deposit Boxes D 11, Election to tax under Sec. 91 i 3{A) {Jl.t\acl\ Sch 0\ .... % '" " ~ <Il '" '" '" o " NAME COMPLETE MAILING ADDRESS Jacqueline M. Verney, Esquire 44 South Hanover Street Carlisle, PA 17013 Jac ueline M. Verne FIRM NAME (If Applicable) Es uire TELEPHONE NUMBER (717) 243-9190 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 113,665.24 z o g ::l l- ii: <( o W 0:: 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly 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) 111 ,hhS 1/, (6) (I) (8) (9) (10) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11, Total Deduetions (tota\ Lines 9 & 1Q) 12. Net Value of Estate (Line 8 minus Line 11) 11,><91 59 1,129.13 (11) (12) (13) 14.020.')7 99,644.52 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 99,644.52 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !cC I-' ::l ll. ::E o o g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) x.o_ (15) x .0 iLS.. (16) 4 ~!..R/I on x .12 (17) x .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 99,644.'52 17. Amount of Line 14 taxable al sibling rate 18. Amount of Line 14laxable at collateral rate 19. Tax Cue 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS "~~~n '" rl~~ n 1 o~p 210 Big Spring Avenue CITY Newville I STATE PA I ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,484.00 224.20 Total Credits (A + B + C) (2) 224.20 3. InteresVPenally if applicable D. Interest E. Penally TotallnteresVPenally ( D + E) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) 4,259.80 B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) 4,259.80 Make Check Payable to: REGISTER OF WILLS, AGENT _'1_~r m mll'%'''m'''f~m~ L:l:~i1lI!'''\_1Il1 'llllllllll1lill__'llI1IJ! PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .................... ....... .................. ....... D ~ b. retain the right to designate who shall use the property transferred or its income; .... D ~ c. retain a reversionary interest; or. .......................... ........................ ........ ........ mu 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 Q 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0 GJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..... .............................................................. . D GI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Urrder penalties of perjury, f deciare that I have examirred this retum, irtdudirtg accompanying schedules and statements, am:! /0 the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other tharl the personal representalive is based on all information of which preparer has any knowledge / ADDRESS ~ "'-- SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN " Cove East Berlin PA 17316 SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE H. Verne Es uire ADDRESS 44 South Hanover Street Carlisle, P 2..--- lll\'i~-____IIJ!JlJ'\t('f.ll.",~,_...__-lmIll"L.ll..n;. -rllll~.I.!~ II.mllL...J;!~"_\MIIllIJnlilnrnl For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)J. 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 D% [72 P.S. ~9116 (a) (1.1) (iill. The statute does not exemDt 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. ~9118(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)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. ~9116(a)(1.3)]. A sibling Is defined, under Section 9102, as an individual who has at Jeast one parent in common with the decedent, whether by blood or adoption. F:\w~'YIWJLL5\i:iHiJI:JW.Wl..l lillJ'Il.t .;):.)Upn IflU . LAST WILL AND TESTAMENT I, DOROTHY D. BELDEN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last will and Testament and revoke any Will or codicil previously made by me. ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations) and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from my residuary estate as soon as praeticable after my decease as a part of the administration of my estate. ITEM II: My husband, MURRAY G. BELDEN, and I have two sons, ROBERT L. BELDEN (who is married to Beth) and EDWARD D. BELDEN (who is married to Pat). Rob and Beth do not have any children nor is it likely that they ever will have any. Ed and Pat have two children (Lauren and Emily) and it is not likely that they will have any more. We have a very good relationship with and stronq feelings for our daughters-in-law. We, therefore, want to have our daughters-in-law receive certain gifts, either directly or as substitute beneficiaries in the event their respective husbands should predecease the survivor of Murray or me. It is our hope and request that the gifts given to our daughters-in-law hereunder will be utilized and enjoyed by them and then at their deaths whatever is remaining of those gifts will be passed on to our grandchildren, Lauren and Emily. It is within the above context, that Murray and I are making the gifts specified in our Wills. ITEM III: I devise and bequeath all of my estate of every . jJ' )5\ nature and wherever situate to my husband, MURRAY G. BELDEN, providing he shall survive me by thirty (30) days. ITEM IV: Should my husband, MURRAY G. BELDEN, predecease me or die on or before the thirtieth (30th) day following my death, ! bequeath those articles of my household furniture and furnishinqs and those articles of my personal effects and tangible personal property as set forth in a separate memorandum (which is siqned by me and my husband, MURRAY, dated and makes specific reference to this will and which I shall place with my Will or deposit with my attorney), to the persons therein designated. ITEM V: Should my husband, MURRAY G. BELDEN, predecease me or die on or before the thirtieth (30th) day following my death, ! devise and bequeath all of the residue of my estate of every nature and wherever situate in equal shares to such of my children, ROBERT' L. BELDEN and EDWARD D. BELDEN, as are living on the thirty-first (31st) day following my death. Should either ROBERT L. SELDEN or EDWARD D. BELDEN (or both of them) fail to survive the survivor of me and Murray, then his share shall pass to his respective wife (Beth or Pat, as the case may be), providinq she shall so survive. Should either son and his respective wife fail to survive the survivor of me and Murray, then their share shall pass, in equal shares, to my grandchildren, Lauren and Emily. ITEM VI: If any portion of my estate shall become distributable to a beneficiary who has not attained the aqe of twenty-one (21) years, the Executor may in its sole and absolute 2 ~q}' BELDEN, Executors of this my Last Will. Should either of my sons, ROBERT L. BELDEN and EDWARD D. BELDEN, fail to qualify or cease to act as Executors, I appoint my attorney, HAMILTON C. DAVIS, sUbstitute Co-Executor of this my Last will. ITEM IX: I direct that my Executors or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM X: My individual fiduciary shall be entitled to reasonable compensation for his or her services rendered from time to time and/or to reimbursement of out of pocket expenses. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on five (5) sheets of paper, dated this J day of ~ , 1995. --L-' _1.~:d-du.~J (SEAL) DO HY D. 'BELD The preceding instrument, consisting of this and four (4) other typewritten pages, each identified by the signature or initials 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 subscribed our names as witnesses hereto. residing at residing at 4 RE\I_1508 EX + (1-97) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Belden Dorothy D. 21 ~ -0865 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 Orrstown Bank Trust Dept. Acct. #0529 P.O. Box 250 Shippensburg, PA 17257 VALUE AT DATE OF DEATH $113,538.26 2. Members 1st Savings Acct. #42759 P.O. Box 40 Mechanicsburg, PA 17055 126.98 TOTAL (Also enter on line 5, Recapitulation) $ 113,665.24 (If more space is needed, insert additional sheets of the same size) SENT BY: ORRSTOWN BAN~; 71753~934~; OCT-30-0~ 3:45PM; PAGE ~!~ ...... ORRSTOWNlw4K TRUSTnEPARTMENr OODVALUES@9117/2002 . DORarIfYD. BELDBN/ACCT # 0529 ~ SCcIlritv Name Ptke .AI VlIlue 025076100 AmeriCllll Cent. Equity lne. #38 6.43 2084.402 $13.402:70 02S07M6500 American Cent. Equity Gwth #982 15.ZZ 650.351 S 9,898.34. 471023101 JanUs Fwd /I 42 18.29 434.232 S 7,942.10 .4710Z3309 JlIIIUS Worldwide Fund 33.49 262.249 $ 8,782.71 471023408 JlIIIUS Twenty Fund 29.61 285.702 $ 8,459.64 471 023606 JIIIlUS Flexible Ine Pund 9.57 1019.367 $ 9,755.34 575736103 MFS Malis In". Trust A 12.96 732.258 $ 9,490.06 821431101 INO Pilgrim Financial Cl A 18.48 686.202 $12,681.01 60934N625 Federated Furnt 851 .1.00 33104.48 $33,104.48 (Accrued interest III DOD) $ 21.88 By: ~ PO .Box250 . 5hippensburg. PA 17257 . (717) 532.&114' (717) 532'4143 Fax. www.orntown.com Send Inquires 10. Member's Statement of Account Account Number From TO Page 42759 04-01-02 06-30-02 1 of 1 . 5000 Louise Drive M b 1ST POBox40 em ers Mechanicsburg, PA 17055 www.memberslst.org FEDERAL CREDIT UNION Main Switchboard: (717) 697-1161 or (800) 283-2328 Call-24: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237.7288 JOIN US SUNDAY JULY 28TH AT RIVERSIDE STADIUM. SEE THE ENCLOSED INSERT FOR MORE DETAILS! I",III",I"I,J,I,J,I",III""II"I"I,II."I"I,II.".II"I DOROTHY D BELDEN P .0. BOX 680 SHIPPENSBURG PA 17257-0680 21114 .18 .19 .18 BALANCE 125.77 125.95 126.14 126.32 + .M. /~6.q. ~ 43002 53102 63002 TRANSACTION. DESCRIPTION SUFFIX:OO SAVINGS DIVIDEND DIVIDEND DIVIDEND AMOUNT TRANS EFF. DATE DATE Y-T-D DIVIDENDS: l. 10 ANNUAL ANNUAL TRUTH IN SAVINGS INFORMATION PERCENTAGE YIELD PERCENTAGE YIELD EARNED ~ 1.75% 1.76% ---------- ------------------------------------------------------ ------------ FOR 2002 * IRA YTD * OTHER YTD * TOTAL YTD * TOT L YTD * TOT L YTD * DIVIDENDS DIVIDENDS DIVIDENDS WITH OLDING FOR EITURES .00 l. 10 l. 10 .00 .00 cO c~uS ))e(fCJS f-riD IN !}eT. E3~ 1%-1/6 ...--- =tI j;)-t. P NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION. .".,~ ,);' >'n! LP~;:Ok-;::l::SUl.;.' no f<EV-1511EX+(HI7) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Belden, Dorothy D. FILE NUMBER 21 -02-0865 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 219 N. Hanover Street Carlisle, PA 17013 7,203.00 2. Westminister Cemetery 1159 Newville Road Carlisle, PA 17013 900.00 3. Luncheon at church 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) N/A Social Secunty Numbe~s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees J.M. Verney, Esq, 44 South Hanover St. , Carlisle, PA 4,000.00 3. Family Exemption: (If decedenfs address is not the same as claimant's. attach explanation) N/A Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 223.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 2002 income tax preparation (estimated) 200.00 7. Advertise Letters A. Sentinel 90.59 B. Cumb Bar Journal 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 12,891.59 (If more space is needed, insert additional sheets of the same size) !..r-- 'c... -07' (. "3IIIJ ~~H fILAMI.j IPD1I -....11 '~~~'B:IlN"IllllIlJPlMUdOI"'HM _ ~._~)Ja$~~dP~n~__.____ (s~dlO..n~ ---. 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"""""ffiEBffi Ch"",; , - AUDiT A~l:J Kt~l'1N'c. ari:ti.l""~\;lhIJlill(ol",,[>..1t:d) 1N'l'UMtm"0l'leU.0i2CkS[) I h'I1"MN&.'TOCIWCOIWrt.4'{UJPllf</VtJ,I.4t; ___ M^!!I'ftl'o.-=...~~ru.~ ~I.AT8OQKI'o.Nr>t...O~t.l...."".;.1O...'rBP )' lIl1Jl1J,l.~ll:E~.t.NDF!l.EO ""'" """'-~Il!l'l~ W~:.... AdrIt....v_". /;:..$nv...._...d_~_ 1&: E;l7 ~ECE[VED FROM:717 249 9365 P.l;)! 01 ,/J7J ~ ~P-Pl- ~ CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, P A 17013 NOVEMBER 1,2002 Cumberland Law Journal is published every Friday by the Cumband County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication oflegal notices. TO: Jacqueline M. Verney, ESQUIRE RE: DorothyD. Belden, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. -------------------------------------------------------- ------------------------------------------------------- Advertisement inserted on following dates: OCTOBER 18, 25, NOVEMBER 1,2002 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 Total Amount Due $ 0.00 ------- -~----- Payment received OCTOBER 14. 2002 by Beckv H. MorgenthallExecutive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 ST ATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: OCTOBER 18, 25, NOVEMBER 1,2002 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~ Belden, Dorothy D.. dec'd. Late of West Pennsboro Town- ship. Executors: Robert L. Belden and Edward D. Belden, c/o Jacque- line M. Verney. Esquire. 44 South Hanover Street. Carlisle, PA 17013. Attorney: Jacqueline M. Verney. Esquire, 44 South Hanover Street, Carlisle. PA 17013. SWORN TO AND SUBSCRIBED before me this 1 day of NOVEMBER. 2002 LOIS E. SNYDER, NotafY PubIlc CarlIsle Bolo, Cumb8l1and CountY My (:ommis8Ion ExpiI8S March 5. 2005 REMITTA~CE ADDRESS T BILL TO THE ENTINEL - LEGAL JACQUELINE M. VERNEY P.O. BOX 130. CARLISLE PA 17013 AD NUMBER I CLASS SALESPERSON BILLING DATE LINES 232953 10 PUBLIC NOTICES c31 10/31/02 26 AD DESCRIPTION START DATE STOP DATE EXECUTOR'S NOTICE LETTERS TESTAMENT 10/15/02 10/29/02 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 84.24 TOTAL AD CHARGE 84.24 3 2002 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT 90.59 108.71* Dorothy Belden RETAIN THIS PORTION FOR YOUR RECORDS . AFTER 11/30/02 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Lori Saylor 243-2611 ext. 201 Fax your legals to 243-3754, attention Lori Saylor You can also EMAIL yourlega1toC1assifiedads:ads@cumberlink.com. Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL ~ LEGAL h POBOX 130 CARLISLE PA 17013 Dorot y Belden . . AD NUMBER CLASSO START DATE STOP DATE 232953 PUBLIC NOTICES 10/15/02 10/29/02 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER EXECUTOR'S NOTICE LETTERS TESTAMENT 10/31/02 717-243-9190 GROSS AMOUNT OF 108.71 DUE AFTER 11 P0/02 TOTAL AMOUNT DUE 90.59 ENTER AMOUNT ENCLOSED JACQUELINE M. VERNEY 44 SOUTH HANOVER STREET CARLISLE, PA 1",111,,,111,,,,,,11,,11,1,,1,1 17013 20200000002329530000000000000001087100000090595 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. Lori Saylor, Classified Advertising Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication ~ EXECUTOR'S NOTICE Letters Testamentary on 'he "'stat~ 01 DORoTHY D,. .I!I.OEN I,,~ of lhe Township otWest' Pennsbor:o. Cumbertencf ,County,PeonsylvanJa, I '(:Iech8ed. have been gra~led to the under- stgned. AUpersons kl1ow1nQ. them- setYeSto be lndSbtlrd 10 sElkfEJt4te wlUm.~!1l payment Imme$tety, and those having claims will present them fQr ' settletrurot. RobertL ~'Id~n and Estw~rdO, B..tct80,. " " ,Exeeutm 0/0 44 S. tianOV$r Stl'EJiet C " Ca,uste,PA'17013 Jac:qu8\ll\OM.V_, Attqmey ; 44 S. HenoverStreet Catllale,PA 11013 October 15, 22 and 29, 2002 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~~~~ October 31,2002 Sworn to and subscribed before me this 31 rst day of October, 2002. ~ 0, d)WV)UA1 Notary Public My commission expires: NOTARIAL SEAL SHiRlEY o~ DURNIN, Notary Public CarllsIe Bora., Cumoorland County Commission Expires AU8~9."?Q9" REV.IS12 EX. (T.9/i ESTATE OF .> 0' ~ . ~~~ J'. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-02-0865 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Belden, Dorothv D. Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. 2. 3. 4. AMOUNT Keller Financial Group 17 E. High Street Carlisle, PA 17013 2001 Tax preparation $ 200.00 Presbyterian Homes, INC. Swaim Health Center 210 Big Spring Road Newville, PA 17241 Final Balance 852.54 MGM Pharmacy - Newville 39 Carlisle,Road Newville, PA 17241 56.59 Paul J. Creeden, D.P.M. 625 W. South St. Carlisle, PA 17013 20.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,129.13 Statement KELLER FINANCIAL GROUP , TO: BELDEN,DOROTHY clo Robert Belden Shippensburg Beverage Center I West Orange Street Shippen,burg, P A 17257 I---------;;~~ 10/01/2002 ----r TRANSACTION 1 Balance forward i ----cuRRENT-~-30 DAYS PAST I_~_~-+~U~ , 0.00 , 0.00 I -.~._--~---~._--- \ 31-60 DAYS AST , DUE 0.00 \' ~& 200.00 -.. UAIt: I" 17\EHlGM SINI:.l:.I--.--stJITE 103 11lll>l~l~LE. Pf: 17013 L_. (7 P) 2 3-8553 FAX (7171243-0577 I ~M~~o:::UE 1 AMOUNT E~C___== '.._ -_---ir-------------J : AMOUNT I BALANCE ! IT 200.001 \\ {V ~\~ bVER 90 DA S PAST DUE AMOUNT DUE , ~_._-~--- ----I , , _.__._-~-_. 0.00 $200.00 __....J SECURITIES OFFERED THROUGH FINANCIAL NETWORK INVESTMENT CORPORATION, MEMBER srpc. REGISTERED BROKER/DEALER KELLER FINANCIAL GROUP AND FINANCIAL NETWORK ARE NOT AFFILIATED. SWAIM HEALTH CENTER 210 BIG SPRING ROAD NEWVILLE PA 17241.9486 (717) 776-8256 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 09/30/2002 .& ~ .:mF.l.IIl::iJ[.IU"'I'I'JI.';TIl::]f~ -llI 'Pres6yterian J{omes, Inc. Balance Due: 852.54 DOROTHY BELDEN c/o ROBERT BELDEN 13 SCOTT COVE EAST BERLIN PA 17316 Account Number: 183122937PC Balance Forward: 2,415.70 0813112002 - 0813112002 Days Away Credit 2.00 (30.00) 2.385.70 0911212002 - 0911212002 Telephone 1.00 14.84 2.400.54 09112/2002 - 09112/2002 Days Away Credit 12.00 (180.00) 2.220.54 0911312002 - 0913012002 Room/Board-Self Pay (18.00) (1.368.00) 852.54 TOTAL: (1.563.16) 0.00 852.54 \O~ 0\0'" ~~\v =<ETURN one copy with your remittance RETAIN one copy for your records THIS IS THE ONLY COPY YOU WILL RECEIVE SWAIM HEALTH CENTER: DOROTHY BELDEN 183122937PC MGM Pharmacy-Newville 39 Carlisle Road PAGE 1 Newville PA 17241 (717) 776-3182 ~ ~ Dorothy Belden C/O Robert Belden 1 W Orange St Shippensburg PA 17257 Amount Due 56.59 PLEASE DETACH HERE AT PERFORATION AND RETURN THE TOP PORTION WITH YOUR REMITTANCE. -------------------------------~---------------------------------------------------------------------------------------- 09/01/02 Previous Balance Due 09/30/02 Finance Charge 55.59 1.00 \\~ \~\ ~l PAST DUE Notice: Please pay all balance due amounts promptly. ~ ~ MGM Pha~acy-Newville 55.59 + 1 00 - 00 ~~. 39 Carl~sle Road . . ~;}?~~t-3182 _ _ _ _ - · 56. ~+~+~+~+~ SERVICE CHARGES are calculated at a MONTHLY PERIODIC RATE OF 1 50% (ANNUAL RATE OF 18 oo~ based upon an unpaid balance of 55.59 outstanding 0000 days or m6re as of this billing date . TlO.,-:;:I:H~C'N~," ~4g. 3s:,~7 PAUL J CREEDEN,DPM. 625 Vi. sown, ST. CARl-ISLE. F'Er-jNA, 1 lor 3 8~ 2~-1=__ _~ ;:tJ~~__ __~_&1I~ _ / tI/ I _Sf ___ 4. ,/~ /7~S1 FOP. PROFES$!CNAL SERVICES ~~-~ _~ tl}- ,0<.0 R!;CEIVED PAY'v1E,"JT ,',~n~ _~~<l'ca, Arl. I>.~%'" '.8:Jt'.22~-2 '9 \UV \~\Q\ ~6V ~\ REV_1513 EX+ 12_87) .. COMMONWEAlTH OF P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Belden, Dorothy D. 21-02-0865 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: Robert L. Belden son 1/2 I. 13 Scott Cove East Berlin, PA 17316 2. Edward D. Belden son 1/2 941 Green Spring Road Newville, PA 17241 i . ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: I. I TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on Hne 13, Recapitulation) S (If more space is needed, insert additional sheets of same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: VERNEY JACQUELINE M 44 S HANOVER STREET CARLISLE, PA 17013 ____un fold ESTATE INFORMATION: SSN: 183-12-2937 FILE NUMBER: 2102-0865 DECEDENT NAME: BELDEN DOROTHY D DATE OF PAYMENT: 12/13/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/17/2002 TOTAL AMOUNT P REMARKS: JACQUELINE M VERNEY ESQUIRE CHECK# 110 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WillS REV-1162 EX(11-96) E TAX N( . CD 001947 ACN SSESSMENT AMOUNT CONTROL NUMBER n_n_n 101 $4,259.80 I I I I AID: $4,259.80 DONNA M. OT 0 DEPUTY REGIS cER OF WILLS A \. I? - 90-/0 COMMONWEALTH OF PENNSYLVANIA * BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG~ PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX IlEY-1547 EX iFP (D1~Ul DATE 02-10 -2003 ESTATE OF BE LDE DDROTHY D DATE OF DEATH 09-17 -2002 FILE NUMBER 21 0, -0865 . COUNTY CUMBE RLAND I JACQUELINE M VERNEY ESQ ACN 101 44 S HANDVER ST A.o.....t e..itt.d CARLISLE PA 17013 " MAKE CHECK PAYABLE ND REMIT PAYMENT TO: REGISTER OF WIl LS CUMBERLAND CO ( OURT HOUSE CARLISLE, PA ] 7013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... REy:is4j-EiCAf'p-foFii3Y-NlfficniF-YNHEii'iTANcrTAin'PPRAiSEiiENT:--ALi -WANCE-iii----------------- DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BELDEN DOROTHY D FILE NO. 21 02-0865 ACN 101 DATE 02-10-2003 TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule Al (1) .00 NOTE: To insure prope 2. Stocks and Bonds (Schedule Bl (2) .00 credi t to your accoun 3. Closely Held stock/Partnership Interest (Schedule C) (3) .00 sub.it the upper port 4. Hortpges/Notes Receivable (Schedule Dl (4) .00 of this form with you S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 113 66 .24 tax P8YlIIIIlt. 6. ~ointly Owned Property (Schedule Fl (6) .00 7. Transfers (Schedule Gl (71 .00 8. Total Assets (8) 113,665.24 APPROVED DEDUCTIONS AND EXEMPTIONS: 12,89 .59 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Il (10) , ,,,b ,'< 11. Total Deductions Ill) 14.0:>0 r;:> 12. Net Value of Tax Return (12) 99,644.52 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~l (13) .00 14. Net Value of Estate Subject to Tax (14) 99,644.52 NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect ~igures that include the tatal af abb returns asses ed to date. ASSESSMENT OF TAX: .0 00 15. ~ount of Line 14 at Spousal rate (15) X = .00 16. A.uunt of Line 14 taxable at Lineal/Class A rate (16) 99,644.5 X 045 = 4,484.00 17. '-ount of Line 14 .t Sibling rat. 1171 .0 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 X 15 = .00 19. Principal Tax Due (19)= 4,484.00 ~: "J AHOUNT PAID DATE NUH8ER INTEREST/PEN PAID (-) 12-13-2002 CDOO1947 224.20 4,25 .80 TOTAL TAX CRE. IT 4,484.00 BALANCE OF TAX DUE .00 INTEREST AND P N. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, 10 PAYHENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU HAY BE DU A REFUND. SEE REVERSE SIDE OF HIS FORH FOR INSTRUCTIONS.) r t, ion r E STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy D. Belden Date of Death: 9/17/2002 will No. 21-02-00865 Admin. No. v C 01- 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 e tate is complete: Yes x No 2. If the answer is No, state when the p rsonal representative reasonably believes that the adminis ration will be complete: Nt A 3. If the answer to No. I is Yes, state he following: a. Did the personal representative ile a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative account informally to the parties in interest? Yes tate an X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be fil d with the Cerk of the Orphans' Court and may be attached to t is report. Date: 3-3/-0<' Jacqueline M. Name (Please typ Address No. .~ , Esquire PA 17013 Capacity: Person I Representative X Counse for personal repres ntative (MAH: rmfl AM3) Estate of Dorothy D. Belden also known as PETITION FOR PROBATE and GRANT OF \- No. To: the RL D in the ennsylvania Register of Wills f Deceased. County of CUMB Social Security No. 183-12-2937 Commonwealth of The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execulors in the last will of the above decedent, dated March j and codicil(s) dated Nom, named 1995 ,- (slate relevant circumstances. e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland. . CPJ.l.ll y,.Pennsylvania with h er last familv or orincinal residence at Green Rldge Vlllage L1U ]l1g Spring Ave., West pennsborO Townsnlp (list slreel, number and muncipality) Decendent, then R] years of age, died Se tember 17 2002 , 19 at Gr~E'n lH<lg'=' Vi1 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 as never adjudicated incompetent: N/ A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None $ 00,000.00 $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the la presented herewith and the grant of letters Testamentary (lestamentary; administralion c.t.a.; will and codicil(s) ministration d.b.n,c.t.a.) theron. \' //1dt?~ ~~e~en 1'0 Scott Cove ~L-Be~ PA 17316 ~= ;j, 7; oa ~ " " ;; ~2 o " ~~ ~.g :oj"= OATH OF PERSONAL REPRESENTATI E COMMONWEALTH OF PENNSYLVANIA ~ 88 COUNTY OF _CUMBERLAND ) The petitioner(s) above-named swear(s) or affirm(s) that the statements in the f regoing petttlon are true and correct to the best of the knowledge and belief'of ilioner(s) apd that s personal represen- tative(s) of the above decedcnt petirioner(s) will well and mi r the est te according to law. Sworn to or affirmed and before me this 24th ~ 02 subscribed {~ day of JJ:9CXXXX '" ,.' " Q s:: " ~ \ --. -.... e?,ister No. 2.I-OZ.- At..~ Estate of DOROTHY D, BELDEN Deceased DECREE OF PROBATE AND GRANT OF LE+TERS AND NOW SEPTEMBER 25, 2002 ~~xxxx, in consideratipn of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) date" March 3, 1995 described therein be admitted to probate and filed of record as the last will of Dorothy D. Belden and Letters Testamentarv are hereby granted to Robert L. Belden and Edward D. Belden FEES Probate, Letters, Etc. ......... $ 200.00 Short Certificates( ).......... $ 6. 00 x:fl.~~ \".~t:r:~. .p'a.ge.s $ 12.00 jCJ;> $ 5.00 TOTAL _ $ 223.00 Filed.. .9:-.25.-:2.QO.2.................... put in atty proth box 9-25-2002 Jacqueline M. vernFY' Esq. ATTORNEY (Su . Ct. I.D. No.) 11231b7 44 S. Hanover St. Carlisle ADDR SS (717) 243-9190 PA 17013 PHO . , I,! Le. ':. ,i 17Z ZOo ER OF WI S OF ATH OF S sign the same req st of testa in h scribing witne es)). (Address) REGISTER OF WILLS OF CUMBERLAND C UNTY OATH OF NON-SUBSCRIBING WITNE S 21-02-865 (each) a subscriber hereto, (each) being duly qualified according to law, de they are familiar with the signature of Doroth codicil will se(s) and say(s) that . Belden testat r ix of (mre--of--tlre-'Snb,...,ibi"l; -witnesses--mt the that they pre ented herewith and codi il believes the signature on the will is in the handwriting of Dorothy D. Belden to the best of their knowledge and belief. Beth B. Belden ~ ~~ Sworn to or affirmed and subscribed before me this ?<Ith day of ~^'~ r' ~ .~Register (Name) 13 Scott Cove, East B (Address Patricia A. Belden lin, PA 17316 (Name) 941 Green Spring Road, Newville, PA 17241 (Address) Ili()i.SO) I{EV9/llli This is to certify that the information here given is correctly copied from an original certifica e of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office f, r petmanent fihng. WARNING: It is illegal to duplicate this copy by photostat or p otograph. No. ,,'llf"/#";"~""", "'~""~~\.1N OFPEl!;j',- l~\\; ''-;--_- .-= _ _f',~\. f~ -~ ___.._ '~l ~:Ji_'" -.', ~'i ~C::t--- -:. --~ ~c..,) c ~- ,,:bo~ ~ * .', "." " -~ *;: \* __--~;f_'--_-c ~l '\.~ - ,'- ~\\\ '-. I?rMEN1 '1.'< ~"""", """""",,#1111111"'" ~ LocaJ Registrar Fee for this cenificate, $2.00 P 8608189 SEP 1 8 2002 Date H1Q6.1431Wr.2II1 COMMONWEALTH OF PENNSYLVANIA" DEPARTMENT OF HEALTH.. VITAL RECORDS CERTIFICATE OF DEATH ,~ ~"' - .......:OI'OECEOENTlFotSI.Mocf(lle.[,.., DORorH'L JANE BELDEN .. '" female !WI"-l!. SOCI.ot.SECUArTY MJ~ ,).83 _12 2937 ~l ,o,QE(IMr~ VNOEA1Y(Nl - "'" IJHDERIOIIIt -l- SlflTHPl...c.ElC"'I<_ Sl-....F~c:eurwr'" SlY"" c::clUPff'l'Of'DERH CUmberland White """-"'"' ....IlECEDEI'fTEVER... \l.$.AAMl:DI'OACES7 t Beverage Distribut r _0 ....t:J . It or 11~ I c:ECEDUff'SUAlUHGAOOfIIE.(Slr~~s...Zillc-I MMT'S . Green Ri9g'e Vl.uage ACTUAL 11..SUH 210 Big ~ing Ave. :.~ ,.. Newville I PA 17241 --. fmER'SN.wE(f"..... "-'.1MIl Arthur Deckman 'L ...........,.. l!~ , """"""'''''''''' (1'-......-- PA .. - h.' - .... .~. CUmberland "- Robert Belden ..".", _0 , "-""'"l"'-Sbl,D -..- carlisle, PA 17013 I DUE IOIIAS/IlCONSEOUf. OF): oJ. .- !:::-.::: , O()l,fl : ""'. I: DUl!1OIOIIASACONSEOUENc:EOF), DlJElOICAASACONSEOUENCf:OF): WEAE MI10PSY FINDIl'<<]S IUHNEIlOFDERH -...........'" ru/ ~'E'nONr:1Ic.wst 0 "'''"''''' - - - 0 -- 0 ..II!I' _0 ..0 ...... 0 ~_...- 0 OREOI'INJUAY ....- T1MEOF-INJUA'l' ....... """" HOWINAJflYOCI:;URIII!O. ... ..0 Y. - - ... ~ce:r.:.."""'onel j .CDn'Ft1MQPMYSICIAM(Pn,-c<<1IIyonoj...~....._Ml(IIlW~....llI_dMII'l_~_Zll ,...........""-.......-_.........~......:.I....._..-.................. .................... Pl..ACEOFIfoUUfIY..u_.-,_.I8ClOIy,_ -.......j~ - -"""-- --- '" -.otCAL O,.,lllMR/COftOIfE,. On _.... fII..amlMtlorl and/or 11IY"1f9a1\oft.11l my oplnlon. dellth 0CC\IIftd lit the II",., cr.,.. ."" phi"". -..d du.1O the eauM(., and -............................................................................................................ ~.. AEGJ$TAAR'S SlQNRUFlE AN .fftJ ~ MClMIQ.o.MOakI'trf_~MI~_~_..._~IO_ol<lQfl1 ....._..""...........,...---"'..._,-;""".....--......~I-"'"........._........... , , .. ""- 0' o a . ~. ~b>-~ ~,I ,;:l., 1,01 ~tl~. ... i of carliFle, Cumberland Last Wi~l and Testament i F:\~51\WILLS\BELDEND.WLL 12/1/94 3:3Dpm Thu LAST WILL AND TESTAMENT 21-02-865 I, DOROTHY D. BELDEN, of the Borough County, Pennsylvania, declare this to be my and revoke any will or Codicil previously made by ITEM I: I direct that all my just debts barred by a Statute of Limitations) and my f (including my gravemarker and expenses of my last i paid from my residuary estate as soon as decease as a part of the administration of my esta e. as may be expenses shall be after my ITEM II: My husband, MURRAY G. BELDEN, and I have two sons, ROBERT L. BELDEN (who is married to Beth) and EDWARcl D. BELDEN (who is married to Pat). Rob and Beth do not have any ~hildren nor is , I it likely that they ever will have any. Ed an Pat have two children (Lauren and Emily) and it is not likely that they will have any more. We have a very good relationship ith and strong feelings for our daughters-in-law. We, therefore, 4ant to have our daughters-in-law receive certain gifts, either irectly or as substitute beneficiaries in the event their resp ctive husbands should predecease the survivor of Murray or me. It is our hope and request that the gifts given to our daUghters-in-Ia~ hereunder will , be utilized and enjoyed by them and then at their ~eaths whatever I is remaining of those gifts will be passed on to our! grandchildren, I Lauren and Emily. It is within the above context, that Murray and I are making the gifts specified in our wills. , , , I , ertate I I ITEM III: I devise and bequeath all of my of every >~jJ. nature and wherever situate to my husband, ~y G. BELDEN, , providing he shall survive me by thirty (30) days.! i ITEM IV: Should my husband, MURRAY G. BELDEN, ~redecease me or I die on or before the thirtieth (30th) day fOllowtng my death, I bequeath those articles of my household furniture ~nd furnishings and those articles of my personal effects and ta~gible personal I property as set forth in a separate memorandum (Wh~Ch is signed by me and my husband, MURRAY, dated and makes specif~c reference to this will and which I shall place with my will or ~eposit with my I I attorney), to the persons therein designated. I ITEM V: Should my husband, MURRAY G. BELDEN, Pfedecease me or die on or before the thirtieth (30th) day follOW~ng my death, I I devise and bequeath all of the residue of my estate iof every nature I and wherever situate in equal shares to such of my children, ROBERT I L. BELDEN and EDWARD D. BELDEN, as are living on tre thirty-first (31st) day following my death. Should either ROBEfT L. BELDEN or EDWARD D. BELDEN (or both of them) fail to survive the survivor of i me and Murray, then his share shall pass to his tespective wife , (Beth or Pat, as the case may be), providing she sh~ll so survive. I Should either son and his respective wife fail ~o survive the survivor of me and Murray, then their share shall [pass, in equal shares, to my grandchildren, Lauren and Emily. ITEM VI: If any portion of my estate I shall become 2 i not attaired the age of in its so~e and absolute I i I I distributable to a beneficiary who has twenty-one (21) years, the Executor may ~;. I discretion either pay over such Principal and rny accrued or undistributed income therefrom at any time to thel guardian(s) of the property of such beneficiary, or to a Cus~odian for such beneficiary under the Pa. Uniform Transfers for M4nors Act, which custodian may be my Executor or be selected by my ~xecutor, retain the same for such beneficiary, IN SEPARATE TRUST, ~ntil he or she I attains the age of twenty-one (21) years. 19 case of such retention, the Trustee may use or apply so much Of! the net income I and Principal as it deems necessary or advisable f~om time to time I for support, health and medical care, and education (including college education, both undergraduate and gra4uate) of such beneficiary, or may make payment for these pu~poses, without further obligation or responsibility to see ~o the proper , expenditure thereof, directly to such beneficia~y or to such beneficiary's parent or to any person taking I care of such beneficiary. Any Principal or income not so aJplied shall be distributed to such beneficiary absolutely when he\or she attains I the age of twenty-one (21) years. If he or s~e dies before attaining age twenty-one (21), such share shall be! distributed to I his or her personal representative, discharged of trust. I ITEM VII: I direct that all taxes that maYlbe assessed in consequence of my death, of whatever nature a1d by whatever jurisdiction imposed, shall be paid from my resi~uary estate as part of the expenses of the administration of my ettate. ITEM VIII: I appoint my sons, ROBERT L. BELDE~ and EDWARD D. 3 ~qfi. BELDEN, Executors of this my Last will. Should ei~er of my sons, ROBERT L. BELDEN and EDWARD D. BELDEN, fail to quallifY or cease to I act as Executors, I appoint my attorney, HAMIfTON C. DAVIS, substitute Co-Executor of this my Last will. i , ITEM IX: I direct that my Executors or their s~ccessors not be required to give bond for the faithful perfo~ance of i shall their duties in any jurisdiction. this , I , I ITEM X: My individual fiduciary shall be entitler to reasonable compensation for his or her services rendered frdm time to time I . i and/or to relmbursement of out of pocket expenses.i i . IN WITNESS WHEREOF, I hereunto set my hand and iseal to thlS my I Last will and Testament, written on five (5) sheets ~f paper, dated I i I I ~. . d .y~d~J..l~l.L(SEAL) DO HY D. ~ELD i ...3 day of ~ , 1995. , I The preceding instrument, consisting of thi other typewritten pages, each identified by th initials of the Testatrix, was on the day and date published and declared by the Testatrix therein na her Last Will, in the presence of us, who, at her presence, and in the presence of each other have names as witnesses hereto. and four (4) signature or hereof signed, ed, as and for equest, in her subscribed our residing at residing at 4 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND : I, DOROTHY D. BELDEN, the Testatrix whose na e is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I sig ed and executed the instrument as my Last will; and that I signed 't willingly and as my free and voluntary act for the purposes the in expressed. DO Sworn to or affirmed before me by Testatrix, this and acknowledged , the day of , 1995. Notary Public COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND ~, ~ , the witnesses whose names are signed to the attach d or foregoing instrument, being duly qualified according to law do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix s gned willingly and executed it as her free and voluntary act f r the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the will as a witne s; and that to the best of our knowledge the Testatrix was at th time eighteen (18) or more years of age and of sound mind and unde no constraint or undue influence. Sworn to or affirmed before me by day of and subscribed to and , witnesses, this , 1995. Notary Public 5 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 11128-0501 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: VERNEY JACQUELINE M 44 S HANOVER STREET CARLISLE, PA 17013 _nn___ fold ESTATE INFORMATION: SSN: 183-12-2937 FILE NUMBER: 2102-0865 DECEDENT NAME: BELDEN DOROTHY D DATE OF PAYMENT: 12/13/2002 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 09/17/2002 TOTAL AMOUNT REMARKS: JACQUELINE M VERNEY ESQUIRE CHECK# 110 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS REV-1 162 EX111-961 E TAX N J. CD 001947 ACN SSESSMENT AMOUNT CONTROL NUMBER ___un_ 101 I $4,259.80 I I I I PAID: $4,259.80 DONNA M. or 0 DEPUTY REGIS ER OF WILLS A \, I'? - 90 - /0 COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE '*' INHERITANCE lAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE DR DISALLDWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX lEV-1SU ElllfP (111.15) DATE 02-1 -2003 ESTATE OF BELD N DOROTHY D DATE OF DEATH 09-1 -2002 FILE NUMBER 21 0 -0865 . ;: COUNTY CUMB RLAND JACQUELINE M VERNEY ESQ , ACN 101 44 S HANOVER ST A.oU"tt Re..ltted CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WI LS CUMBERLAND CD OURT HOUSE CARLISLE, PA 7013 P.!-!.!_~~~_t!I!_.!_I!!~__I:.!~~_______~____~_~!~!!'!._~!'_'!.~~_!..l.!~!_I_l.!~_f..l.!~_.!l.!~~__I!~P~I!~~ .... REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, A~F iWAiicE-iDii----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT 0 TAX ESTATE OF BELDEN DOROTHY D FILE NO. 21 02-0665 ACN 101 DATE 02-10-2003 TAX RETURN WAS: ( X I ACCEPTED AS FILED ( I CIlANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Estate (Schedule AJ (11 .00 NOTE: To insure pr 2. stocks and Bonds (ScMidul. B) (21 .00 credit to your accoun 3. Closely Held Stock/Partnership Interest (Schedule CI (31 .00 wboIlt the upper port 4. Mortgages/Notes Receivable (Schedule DJ ('II .00 of this for. with you 5. Cash/Bank Deposi tslHlsc. Personal Property (Schedule E) (51 113 66 .24 tax paylllNlt. 6. Jointly Ownad Property (Schedule F) (61 .00 7. Transfers (Schedule G) (71 .00 8. Total A.ssets (81 113,665.24 APPROVED DEDUCTIONS AND EXEMPTIONS: 12,891 .59 9. Funeral Expenses/AcIII. Cosi:s/"isc. ExPenses (Schedule H) (91 10. Debts/Hort~g. Liabilities/Liens (Schedule Xl 1101 1 12' _1~ 11. Total Deductions (Ill 14.020 5? 12. Net Value of Tax Return (12) 99,644.52 13. Charitable/Govern..ntal Bequestsi Non-elected 9113 Trusts (Schedule ~) 1131 .00 14. Net Value of Estate Subject to Tax (14) 99,644.52 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of abb returns asses ed to date. ASSESSMENT OF TAX: .00 15. Aaount of Line 14 at Spouse1 rate 1151 X 00 = .00 16. A.ount of Line 14 taxable at Lineal/Class A rat. 1161 99,644.52 X 045 = 4,484.00 17. Anount of Line 14 at Sibling rete (171 .00 X 12 = .00 18. ~ount of Line 14 taxable at Collateral/Class B rate (181 .00 X 15 = .00 19. Principal Tax Du. (191= 4,484.00 TAX CR S: ., II (+, AIlDUNT PAID DATE NUHBER INTEREST/PEN PAID (-I 12-13-2002 CDOO1947 224.20 4,25 .80 TOTAL TAX CRED T 4,484.00 BALANCE OF TAX .UE .00 INTEREST AND PE ~. .00 TOTAL DUE .00 - t, Ion r . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NIl PAYHENT IS REIlUIRED. IF TOTAL DUE IS REFLECTED AS A ~CREDITn (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDF OF Tlh~ ~nDM I:'nD ......c.!"I"IIoI_"I"T.......... ... STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy D. Belden Date of Death: 9/17/2002 Will No. 21-02-00865 Admin. No. v c 01- 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 e tate is complete: Yes X No 2. If the answer is No, state when the rsonal representative reasonably believes that the adminis ration will be complete: N/ A 3. If the answer to No.1 is Yes, state he following: a. Did the personal representative account with the Court? Yes No X b. The separate Orphans' Court No. the personal representative's account is: c. Did the personal representative account informally to the parties in interest? Yes d. Copies of receipts, releases, jo approvals of formal or informal accounts may be fil Cerk of the Orphans' Court and may be attached to t Date: 3 - 3/-0 <; ile a final if any) for tate an X No nders and d with the is report. ~.V; Jacqueline M. Verney Esquire Name (Please type or print) Address No. Capacity: isTh PA 1700 Persona Representative X Counsel for personal represe tative (MAH:rmf/AM3)