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Home My WebLink About02-0889 Estate of John A. Worley also known as PETITION FOR PROBATE and GRANT OF LETTERS No. J?/-O.;l-?'il'q To: Register of WtlL'intol/fAnd . Deceased. County of In the Social Security No. 164- JU-JbJ I Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix in the last will of the above decedent, dated November 18 and codicil(s) dated named 1'l'9' 2000 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland . County, Pennsylvania, with his last family or principal residence at Claremont Nurs~ng&Rehab. Ctr. 375 Claremont Dr. Carlisle, Pa 17013 Middlesex Township (list street, number and muncipality) 61 . Decendent. theIl__-..-_ years of age, died ()("t-nnpr 1, ,b9x- 7001 , at Carlisle Hospital, 'Carlisle, PA 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: 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: 1).oCo $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.La.; administration d.b.D.c.t.a.) theron. , .". u " u :g3 u " "'u " -00 C":;: tlJ";:: ~~ .".~ ~ 0 ;; " '" C;; Betty J. Swarner ~U4 tranklln St. Carlisle, Pa 17013 ~ P ~~~~/A / OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA l '8 COUNTY OF Cumberland J S The petitioner(s)'above-named swear(,) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. 2 subscribed { day of '1~xx eglster Betty J. Swarner &ryr 0.. ~./-7?'-t(>(/~~ .?' ~ - " ~ ~ Sworn to or before me this OCTOBER affirmed and 1l--C}J-/4 No. 21-02-889 Estate of John A. Worley , Deceased DECREE OF PROBATE AND GRANT OF LETTERS OCTOBER 2, 2002 AND NOW .\1l_, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 18. 2000 described therein be admitted to probate and filed of record as the last will of John A. Worley d L tt r:est:ament:ary an e ers Betty J. bwarner are hereby granted to FEES 25.00 Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ 1 8 . 00 X~~mrnn ~x~r~.p~~~?1 6.00 j"f' $ S.OO TOTAL _ $ 54.00 . 10-2-2002 FIled c'al Tea' e'xiic' .1'0....:2:...20.02...... William A. Duncan ATTORNEY (Sup. Ct. J.D. No.) 1 Irvine Row Carlisle, Fa 17013 ADDRESS 249-7780 PHONE LAST WILL & TESTAMENT OF ~/-0;2-g'~q JOHN A. WORLEY, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FffiST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot in accord with my expressed wishes. THmD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my sister, Betty J. Swarner, per stirpes. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto my sister, Betty J. Swarner, per stirpes. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto my sister, Betty J. Swarner, per stirpes. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my sister, Betty J. Swarner, as Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Betty J. Swarner, I nominate, constitute and appoint William A Duncan, Esquire as Executor of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my h.~~and seal to this, my Last Will and Testament, consisting of two typewritten pages this/%, (Jay of November, 2000. U/ {} (I), ')'1 J-- J HN A. WORLEY Signed, sealed published and declared by the above named Testator John A. Worley as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. \ \) r~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, John A. Worley, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. tft;& (2 (If ~. $' 1 A. WORL'B l . Sworn or affirmed to and acknowledged before me, 9);; John A. Worley this \1 ~y of November, 2000. NOTARIAL SEAL KATHY L MUMMERT, NOTARY PUDLlC CITY OF CARLISLE, CUMBERLAND CO., PA MY COMMISSION EXPIRES AUGUST 11, 20,'3 ~ t 1^~ c$1 Y!11 k r~ otary bhc COMMONWEALTH OF PENNSYLVANIA :SS. COUNTY OF CUMBERLAND : We, W~.A 'bM.mlcU/\ and &fr1vlc< ~~he witnesses whose names are signed to the attached or fo&going instrument, being duly qualified according to law, do depose and say that we were present and saw John A. Worley sign and execute the instrument as his Last Will; that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. \Af\~l~ ~~~ Sworn or affirmed to and subscribed before me by W.JUlU"NY\ A ~CW.\ and t3.;fYl~ .....0:\ /> "ee)witnesses, thtS I,,""day of~er, 2000. ,~ i!tJ c9 Yf)1 {fYMYlej Notary P blic NOTARIAL SEAL KATHY L. MUMMERT, NOTARY PUBLIC CITY OF CARLISLE, CUMBERLAND CO., FA MY COMMISSION EXPIRES AUGUST 11, 2003 ". , . " v CERTIFICATION OF NOTICE UNDER RULE 5.6(al Name of Decedent: John Arthur Worley, Date of Death: October 3, 2001 Will No. 2002-00889 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 10-2-02 Name Address Betty J. Swarner 504 Franklin Street, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None r---...... /;{;{!tJA{J ~-t~ Date: -J - d- -() ~ Signature Name William A. Duncan, Esquire Address 1 Irvine Row Carlisle, PA 17013 Telephone (7q 249-7780 Capacity: _ Personal Representative ~Counsel for personal representative . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUNCAN WilLIAM A ESQUIRE 1 IRVINE ROW CARLISLE, PA 17013 _____.n fold EST A TE INFORMATION: SSN: 164-30-3637 FILE NUMBER: 2102-0889 DECEDENT NAME: WORLEY JOHN A DATE OF PAYMENT: 01/24/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/03/2001 NO. CD 002085 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $150.76 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: WilLIAM A DUNCAN ESQUIRE CHECK# 4099 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS -- $150.76 DONNA M. OTTO DEPUTY REGISTER OF WillS REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W <..l W C WORLEY JOHN A. DATE OF DEATH (MM.-DO-Year) DATE OF BIRTH (MM-DD-Yeer) 10/03/2001 10/06/1939 (IF APPLICABLE) SURVNlNG SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) W I- "S.. 0"''' w~g =<",... 0..., !l: 001- Original Return D 4. limited Estate D 6. Decedent Died Testate (Attach ccpy of WI) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dale of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1~ 1-95) OFFICIAL USE ONLY ~ FILE NUMBER 21 -0 2 00889 ""'COUNTv"C06E -YEAR- - -"iiifliER-- soaAL SECURITY NUMBER 164--3-036 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAl SECURITY NUMBER D 3. Remainder Return (dale ofdBalh priarlo 12-13-82) D 5. Federal Estate Tax Return Required .Q... 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (AlIach Sch 0) I- Z W o z o .. .. w '" '" o o THIS SECTION MUST BE COMPLETED, ALL CORRESpONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS WILLIAM A. DUNCAN 1 IRVINE ROW FIRM NAME (If Apple"'o) DUNCAN & HARTMAN P.C. TELEPHONE NUMBER 717-249-7780 CARLISLE PA 17013 X _(15) 1 ,241.00 X ~(16) X .12 (17) X 15 (18) (19) 1. Real Estate (Schedule A) 2. Slocks and Bonds (Schedule B) (1) (2) (3) (4) (5) z o i= :3 :J l- ii: oct <..l W 0:: 3. Closely HeldCorporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Joinlly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (Iolal Unes 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= oct I- :J 0.. :E o <..l S 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) 16. Amount of Line 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 (8) 835.00 (11) (12) (13) (14) 20 0 CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT OFFICIAL USE ONLY 2,076.00 2,076.00 835.00 1,241.00 1,241.00 148.92 148.92 D d t' C I t Add ece en s ample e ress: STREET ADDRESS . 1 IRVINE ROW oTY I STATE I ZIP CARLISLE PA 1703 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 148.92 0.00 000 0.00 Total Credits (A+B+C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty 1.84 1.84 T otallnt...esUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, ent...the diff...ence. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is !Teater than Line 2, enler the difference. This is the TAX DUE. (5) A. Ent... the interest on the tax due. (5A) B. Ent... the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 150.76 150.76 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 00 b. retain the right to designate who shall use the property transferred or its income;............. ................. 0 00 c. retain a reversionary int...est;.or..................... ....................................... ...... 0 00 d. receive the promise for life of either payments, benefits or c<l'e?... . . ......................... ....... . 0 00 2. if death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?....... .................... ............... ....................... .............0 00 3. Did decedent own an 'in b'ust fo~ or payable upon death bank account or security at his or her death?.............. 0 00 4. Did decedent own an Imidual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation?................................................................................................. 0 00 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 penaties of perjury, I declare that I have examined this return, inciJdin~ accomplll1)ing schedules End statements, and to the best of my knowBdge and beief, it is true, correct and compete. Declaratian of prepErer o1her than the personal representative is based on allnformallO/1 of Yotlich preplWer has any knowmlge. SIGNA~,~R~O ,E~GRETURN :;{3.c:J3 ADDRESS ~ SIGNATURE DATE ADDRESS 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) (ill For dates of death on or aft... 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 disciosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased chiid twenty.one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(l)]. The tax rate imoosed on the net value of transfers to or for the use of the decedenfs siblinas is 12% f72 P_S. &9116(a)(13)1. A siblino is defined. under Section 9102. as an RE'J.1508EX +(1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST ATE OF WORLEY JOHN A. FILE NUMBER 21 02 00889 Include the proceeds of liligation and the dale 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. OESCRIPTION VALUE AT OATE OF DEATH 2,076.00 Mellon Bank Account Checking # 6100727734 TOTAL (Also enter on line 5, Recapitulation) $ 2 076.00 RE\l-1511EX+(1-97} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WORLEY JOHN A. Debts of decedent must be reported on Schedule I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 02 00889 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN ROTH FUNERAL HOME 433. DO B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City Slate Zip Yea~s) Commission Paid: 2. Attorney Fees DUNCAN & HARTMAN, P.C. 300.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 89.00 5. Accountant's Fees 6. Tax Return Prepare~s Fees 7. MOFFIT HEART & VASCULAR GROUP 11.00 8. PULMONARY 2.00 TOTAL (Also enter on line 9. Recapituiation) $ 835.00 ".<____ _____:_ ___...1_...1 :___.... _...1...1:<:___' _..__~_ _,<Uo_ _____ _'-_' RE\L1513 EX +(""97) SCHEDULE J BENEFICIARIES coMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER IMn.,. r::y JOf.lNA ?1 O? nnRRg RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. BETTY SWARNER SISTER 100 % 504 FRANKLIN STREET CARLISLE, PA 17013 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEE $ (If mnrp <m~1=! l~ n~F!Mrl ln~~rt ::vIrfttinn~1 ~hA~t~ nf th~ <::::lmp. <::17~\ LAST WILL & TESTAMENT OF JOHN A. WORLEY, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my sister, Betty 1. Swarner, per stirpes. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto my sister, Betty J. Swarner, per stirpes. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto my sister, Betty 1. Swarner, per stirpes. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my sister, Betty J. Swarner, as Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Betty 1. Swarner, I nominate, constitute and appoint William A. Duncan, Esquire as Executor of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. NINTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my ~;;n.i.and seal to this, my Last Will and Testament, consisting of two typewritten pages this/K'ilay of November, 2000. ~( 0 b'J, ,L~ ;}- J HN A WORLEY Signed, sealed published and declared by the above named Testator John A. Worley as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ('~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, John A. Worley, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it wi1Iingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ A.~O;1~ t Jt Sworn or affirmed to and acknowledged before me, 9);\ John A. Worley this \l~y of November, 2000. NOTARIAL SEAL KATHY L. llUllllERT, NOTARY PUDlIC CITY OF CARLISLE, CU1l8ERLAND CO., PA MY COMMISSION EXPIRES AUGUST 11, 20G3 ~t1.~oJ mll~ otary blic \. COMMONWEALTIl OF PENNSYLVANIA :SS. COUNTY OF. CUMBERLAND : ~ ~ '\ We, W~ A~ll~ and f!tfrl ~he witnesses whose names are signed to the attached or foltgoing instrument, being duly qualified according to law, do depose and say that we were present and saw John A. Worley sign and execute the instrument as his Last Will; that he signed wi1Iingly and that he executed as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before ~e by W~Th A. ~CM\ and AA-./1~ JJ >. ,.. ;,;, . lwitnesses, thl~~""dayof~O. \A~~ ~~b .~~~ vi Yf)Ul1Mnezt NotaryP blic NOTARIAL SEAL KATHY L. IIUIlMERT, NOTARY FUBLlC CITY OF CARLISLE. CUIlBERLAND CO., PA MY COIIIIISSION EXPIRES AUGUST 11, 2003 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUNCAN WilLIAM A 1 IRVINE ROW CARLISLE, PA 17013 --- fold ESTATE INFORMATION: SSN: 164-30-3637 FILE NUMBER: 2102-0889 DECEDENT NAME: WORLEY JOHN A DATE OF PAYMENT: 03/18/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/03/2001 NO. CD 002303 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3.07 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#108 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $3.07 DONNA M. OTTO DEPUTY REGISTER OF WillS BUREAU OF INDIVIOUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* ...--. NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15~1 EK AFP (OI-Ul WILLIAM A DUNCAN DUNCAN & HARTMAN 1 IRVINE RDW CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-17-2003 WORLEY 10-03-2001 21 02-0889 CUMBERLAND 101 JOHN A Amount Remitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... . REV=is'4TEX-AFP--foFo3Y-NO'TicniF-YNHERiTANCE-TAX-APPRAiSEf.fENT~--AL1-DwAifCE-(rR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WORLEY JOHN A FILE NO. 21 02-0889 ACN 101 DATE 03-17-2003 TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate [Schedule A) 2. Stocks and Bonds (Schedule B) 3~ Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule fJ 7. Transfers (Schedule G) 8. Total Assets III 121 131 [41 151 161 (7) .00 .00 .00 .00 2.076.00 .00 .00 181 NOTE: To insure proper credit to your account I submit the upper portion of this for.. with your tax payment. 2,076.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H] 10. Debts/Mortgage Liabilities/Liens (Schedule I] 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental 8equestsj Non-elected 9113 Trusts (Schedule J] 14. Net Value of Estate Subject to Tax 191 1101 835.00 .00 1111 U21 U31 1141 835 00 1,241. 00 .00 1,241.00 NOTE: I~ an assessment was issued previOUSly, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15] 16. Amount of Line 14 taxable at Lineal/Class A rate (16] 17. Amount of Line 14 at Sibling rate (17] 18. Amount of Line 14 taxable at Collateral/Class 8 rate (18] 19. Principal Tax Due TAX CREDITS. 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045= 1,241.00 X 12 = .00 X 15 = 1191= .00 .00 148.92 .00 148.92 . ",Tnon. 1'41 t+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID [-I 01-24-2003 CD002085 1. 84- 150.76 BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-25-2003 TOTAL TAX CREDIT 148.92 BALANCE OF TAX DUE .00 INTEREST AND PEN. 3.07 TOTAL DUE 3.07 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I /J-;?/-/j'" ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1541EXAFPUI-05J WILLIAM A DUNCAN DUNCAN & HARTMAN 1 IRVINE RDW CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-17-2003 WDRLEY 10-03-2001 21 02-0889 CUMBERLAND 101 JOHN A Allount Re..itted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=is4TEX--AFP-coFii3rNoYicE--OF-YN"HERiTANCE-YA"iniPPRAYsEifENT-,--ALD5wAifcnfli--------m------ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WORLEY JOHN A FILE NO. 21 02-0889 ACN 101 DATE 03-17-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property {Schedule fJ 7. Transfers (Schedule GJ 8. Total Assets [1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 2.076.00 .00 .00 (8) NOTE: To insure proper credit to your account, subllit the upper portion of this for.. with your tax payment. 2,076.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax [9) llO) 835.00 .00 (11) ll2) [13) ll4) 83~ nn 1,241.00 .00 1,241.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. AMount of Line 14 taxable at Collateral/Class B rate (18] 19. Principal Tax Due .00 X 00 = .00 .00 X 045 = .00 1,241.00 X 12 = 148.92 .00 X 15 = .00 ll9)= 148.92 TAX CREDITS: rAmon, '" AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-24-2003 CD002085 1.84 150.76 BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-25-2003 TOTAL TAX CREDIT 148.92 BALANCE OF TAX DUE .00 INTEREST AND PEN. 3.07 TOTAL DUE 3.07 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) /")-9/-/';/ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-IU7EX AFP {DI-D!l WILLIAM A DUNCAN DUNCAN & HARTMAN 1 IRVINE ROW CARLISLE .OJ !\PH 28 DATE ESTATE OF DATE OF DEATH FILE NUMBER P 3 :01 COUNTY ACN 04-14-2003 WORLEY 10-03-2001 21 02-0889 CUMBERLAND 101 JOHN A H8,~'< rlC:, .<. Allount Remitted (;11';1.' PA 170CilmOBnCl.;. __~:U{l '.,).. PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i60-j-Eif-jiFP-fiiFoiy------...--iNifERITANCriAiniTAfEHi-Ni-cfF'-Acciiiii.ff--.-...--------------------- ESTATE OF WORLEY JOHN A FILE NO.21 02-0889 ACN 101 DATE 04-14-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-17-2003 PRINCIPAL TAX DUE:.. 148.92 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-24-2003 CD002085 1. 84- 150.76 03-18-2003 CD002303 3.07- 3.07 TOTAL TAX CREDIT 148.92 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I . C; ~K STATUS REPORT UNDER RULE 6.12 Name ofDecedent: ::1r> h '" 4. {J 0 /2...Ie i Date of Death: 10" ~ -0 I Will No.: ZOO d _o6?f <J Admin. No.: Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State whether administration of the estate is complete: Yes J;i! No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No gj b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. I~. , Date:~~3. j!)~Ctk~ Si ature -, 10, ,11 tti-M ,A" J:jL.tI1( iAfJ ,1~tjv-uU. Name D I 7 f2" \ 11 of' f7 ()L0 (i tw 1-1 S) e -Pc..- no 13 I ~ Address I 7/7 - 2t/f- ?7P{) Telephone No. Capacity: 0 Personal Representative :S:Counsel for personal representative