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HomeMy WebLinkAbout02-0930 Register of Wills of Cumberland County, Pennsylvania : Estate of Robert L. Summers No.~I-I"l~.O-:l.1"'\ : also known as , , , Deceased Social Security No. 165-16-044~ I Petitioner{s), who is/are 18 years of age or older, apply(ies) for. named in the Last Will J (COMPLETE "A" OR "B" BELOW:) GJ A. Probate and Grant of Lelters and aver that Petitioner(s) islare the execut fix he Decedent, dated 8/2/96 and codicil(s) dated none State relevant circumstances, e.g., renunciation, death of executor, ate I Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: 0 B. Grant of Lelters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minori1a1e) Petitioner(s) after a proper search haslhave ascertained the Decedent left no Will and was survived by the following spou (if any) and heirs: I I Name Relationship Residence I , (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with hislher last family or princi I residence at 72 Greenwood Circle Borounh of Wormlevsburn (list street, number and municipality) Decedent, then 85 years of age, died October 7 ,2002 ,at Holv Soirit Hosoital East Pennsboro Townshi (Location) Decedent at death owned property with estimated values as follows: 4250 b.oO (if domiciled in PAl All personal property ......................................... $ (if not domiciled in PAl Personal property in Pennsylvania .......... ......... $ (If not domiciled in PAl Personal property in County .............................. $ Value of real estate in Pennsylvania ... $ I ......................................................... Total......... ........................................... .......................................................... $ 4250 0.00 .... Real Estate situated as follows: Wherefore, Petitioner(s) respectfUlly request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: r /"'\ _ Sign~ure Typed or printed name and residence I I: "' Ie / .,. " / Jean R. Bilunas 7 1808 Chatham Drive CamoHill PA 17011 Ii PETITION FOR GRANT OF LETTERS RW-7 \""1--CH.J-\~ Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are e and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the De ent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 16th OCTOBER 2002 day of /r!~ L, ~~~:PJ~~ Estate of Robert L Summers DECREE OF REGISTER No. also known as Deceased Social Security No: 165-16-0443 OCTOBER 16, 2002 Date of Death: 10/7/02 AND NOW, on the reverse side hereon, satisfactory proof having been presented before me, , in consideration of the Petition IT IS DECREED that Letters llil Testamentary Q of Administration (c.t.a., d.b.n.c.t, pendente lite; durante absentia; durante minori1a are hereby granted to Jean R Bilunas in the above estate and thatthe instrument(s), if any, dated 8 - 2 - 1 996 described in the Petition be admitted to probate and filed of record as the last Will of Dece.~nt ".~ :"- Short Certificate(s) ............... $ $ $ $ $ $ Inventory & Tax Forms............. $ $ Renunciation .......................... Affidavit ( ) .---.................. ).............. Extra Pages ( Codicil ........... JCP Fee ................................. Other ...................................... TOTAL ..__.........................$ RW-7A , L.) g 00 I 5.00 Attorney: Charles J. DeHart III Esouire 1.0. No: 15617 Address: 3631 North Front Street Harrisburn 369.00 Telephone: 1717\232-7661 DATE FILED: 10-16-2002 mailed to atty 10-16-2002 PA 17110', ,) HI058()~ REV y/RI; This is to certify that the information here given is correctly copied from an original certificate of death duly filed v,.. Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent tiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 III,'III"UU~~~~~~~~~ ","!..~\.1" OF PE;f-----_ "':..,~..--...'1'O" /~~. ...... "v~, f::E e- 0".._ ~% ~~ ~:' !.i:~ , *. , >j~. . ,'* l \ .. -.' ',- ~ ";;.~ :--:':.\"':. ~", ~-?t,. -~""" ""~.... '"ENT \h IJlllf "''''''''''~''J"III ~7/(~ Local Regisaar (/ OCT 1 0 200t P 8629582 No. DJte ,JRol'V.2187 COMMONWEALTH OF PENNSYLVANlA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH $To\TI;FtU;_R SEX fsoclAl.. SfCUflI1l' NUMBER RobVt:t L. SwnmVt~ ~ Ma.te \.. 165 16 0443 AGE {l.asl8irlho81'l UHDER1YtNl UHOERIOlfJl OMEOFBlRTH /, 8lFl1'HPl.ACCJCdv_ PLACEOFOEMHlO>eo:l<or"'I."....-__.....''''''''''...".__1 ~ :!, o.y. Hounf !:........ l'-\oolrl.08y,'_1 SlalolarfaregnCOuNly) HOSPflA1.; f:r.HE.A: 85 ". 3-Z9-1911 ,Millo", VA :--I!\- ,,,,,,-0 "",,0 ,:::::.:"0 : ~NC=~f<md ... E:;;:::O [M,'Z~;:~,:.j,i;;:',-~1I I:;=€~~~~= PECEDENI"'SUSUAt.OCClJAQ'lOH 1UHD00IIUSlNESSlfNDUSTRY g:~EVERIN CCOENT'SEDUC.liTIOH MAflITALSWUS.".."...>> ",. lInlat kdDnedoM moll I.' I,U.S.AAMEOI'OFlCES7 ~""ried.WIclrMN. "ilfWOl'IIk1g.::'<IotoClt...=} r.7l ~ ~ OMlrc.d{Sj:.CllyI u--- -- :t S:t 0 __14.l NoD (0.12) 12 CUOIs+l4 H-"J[,ied . 11.. Mu.nQ,aeme.n 11111. e.e..t.. 12. 13. 1.. MWt. DECEDENrSIMlLINGADOFES8d(Slr_~.SIIla.ZopCodel ~~rs Ih.w. Pe.nMulvan..ia Did 17c.D'tM......lMd... 72 GJte.e.nwoo C<<c..(.e. ~~ =- 1.. WOJr.mle.Y.-6bUltg, PA 17043 ""_sidltl 171t. CumbPJttand --'7 17,,-0:::"-=-=01' ," FATHER'S NAME IFiIsI. Mooc:h. Laslj MOTHeR'S NAMe lFu$I, Mta<Ie. MtIden s...-....... NAME OF DECEDENT (F".9I. Midde. LasQ 1~~ZHtcM .. _0 , t me as ! ! , I , , JI1O-:l.. , F-.,o 1:fW::E.AmInc;an . SI.d<.WNl..MC. ,""'" Wh'le> .. I" I ,,=,,~ I. Audltey 10 16bawn . ^ ... C.faJ<e"ee V 0 SwmnVt~ 1Nf'0000000000SMANE\T~ "'. AudJtey 10 KoWty -"''''''''''''''" JI:OArEOFDlSPOSITlOM ....0 ~OO ~IrooIISUHO (Munlh.~...) 2~O cw.r~ D211t..Oc:t.obVt 10 2002 ~rY1~~r::':""( .) oj~~ N ~ --0:.......... ~==-~=.7~~ :::::~i~._oc:a.a<<I.Ihe'm.,dMfI_pUASWMt ~....dy_aldNIIl. "'" =.~=--=by nr.te~~ I lo.vE~~OEAD(MonIl.Ou_1 ... :r:.J~ .. I... ( 0 '7;ldd;z. 27.MRTI: ~:.:;-o:.~=~~i0n5..nk:h~IIloI"""h.Don(ll_lhemodeofdpJg,auc:hU~ar..arorv...r....&I>OCkQrl\ftfll"'" .. VOJlo:thu lo BaJ<tholomew IHFOfIt.fANT'SIl&AlUNGAOORESS(;5lr...~.:st.M.ZipCodltl _ 12 Glteemuood C.iJte.fe, WOJlm.feu~bw[Q. VA /104 Pl..ACE.QFOISPOSl11ON-Nemeat~er.m-y LOCRION.~__.ZIpc- ."""'... CJtemauo" Soeiety 06 ".. Ve"Mulvania CJtema:tOltu ,.. HaJ<Jti~bWln. VA 1:::'470';;-s;:e-:;;.,,,c~ ~~"-Z~ h ~1~t~~ 0 JtPe LUKSEtMti!IEJl I~~ 1~'08v.'IltaI) "" WJoS CASE REFEJ'lfIfO 10 MEDICAl. EXAWlNERICOAONEA1 ...I<l ]l "'IEOIATI!CAU$I!lFinaI ~OI~ '8IIUIingindulhj_ ... .- '-....~ :__dNIIl . i MRT.: O\tlM.......~_ilI\lllng llIlII.-....gln.,.~_ 'o'MSANAI.1n:lPSY PEAFOAMEO? . ,lUuvn""~ 6t#6~ ::rh~~ ~ro(ORASACONSEOOENCE Of}: <:~/<;" -:ue 10 lOR AS A CONSEOUENCE Of): ,~ Wf<k/r DUE TOlOAASACON$EOUENCE 0Fl: ,/ ~..i:! ....-rc. &"'~~~b WEAEAU'rof'SYFINOINGS MAHNEI'IOfDEMH .......LA8LEF'fIIORlO CCltlIPl.ETIOHOfCAUSE "'......'" v.. 0 NclO s.q..,.iaIr"~ iI~ 1Mdln01O--"'" _.~1JNQfRlXlNQ CAUHlOil.MOf....y '~liootialtd__ '-..lIingin~Lo\ST I: i TfME OF fMJUR'l' DESCRIBE tIOW IMJURY OCCURRED. OME OF f/'UURV lMonlh. Oily. Vearl lNJUfl'l'ftl'o\ORl(? ..... ~ o o CouI4__"-I_ o Ol_ D Pl..ACEOFfNJUflY-AlIlcmot.Iarm.~.IKUIIy,omc. U. building, Mt. (Spec~yl .... -- ....... P_"ll"-1fiQ8lIOn 1_. Il.OCRlON~.~s-. hat. ... P~LE~ATlFlE.A ~ // ~ -,.-'" ....... 17 ....D'~ 0.,.. '"' ' o fe. 1:114.1'''''......-0:;; NAME IoHD AOOAESS OF PERSON WHO COMPLETED CAUSE Of' OUrH (llem21lT~Cl'lPrinl ( j2dCtfyJO ([!X( , m I) o D5,1:s..("(,j~-!f2; f.r::~~ ;~rl>- :~'"Z/;; ;"" J.. "... 0 Noyd. .. 0 N<> [j :u.. 2110. CUlTIl'IUlrChoockcny~ 'CEllTurnMQ.PHVUClI.N~~_"OMlh_~~lIIClMltasP<OI'O.II'lC6CIdeilW1"""~flern2Jf To"'bNlot",,~,"'lhoccumd"'lO""AUU(~_...._...mtH.. ............... ...... ....... ... .PAONOUNCIHlIANDc:aflTlFYlHQl'HYSlClAN(Pt\"'-b<llhPl~lI'lQ~"'llIce<1typ}IO~aI<Ifilh1 To"'lIeMaf,,~,""\OCC__&l_"""""_fUc'.._~Io_ceUH(.laIMl"_".IaI"".. "MEDICAL EXAIIIHERICOROH On...~ot.llMllnMlon alldIorlllvea1lgallon,lnmyOptnIoft.dnlhoccurred allM 1m... dIIl_, at1d pIK., ~du.IOUI. CAlM(_I.1ld __...IId..........."............ ......... ...... ................ ...... .................. ...... ..... ....... ". " REGISTRAR'S5pNRUAEANDm" '-" // -n ~J 4____ 0t-4</ . . c.. 'T&-0~~..,;/J!'-~," (I ic:>'\ '1-1-',11 - 0109 ~a.n.{.a ",0 .... , ! [' LAST WILL AND TESTAMENT ill: ROBERT L. SUMMERS 21-02-930 I, ROBERT L. SUMMERS, of 72 Greenwood Circle, Wormleys yrg, Cumberland County, Pennsylvania, being of sound mind, memor' and I understanding, do make and publish this my Last Will and Testa nt, hereby revoking and making void all former wills by me at anyime heretofore made. ITEM I. I direct that all my just bts and funeral expenses be fully paid and satisfied as soo as conveniently may be after my decease. ITEM II. For purposes of informati I acknowledge the existence of numerous assets owned jointl as tenants by entireties with my wife, Audrey Summers. As a resul of the benefit she will receive as joint owner upon my death, I ch se to redirect the residual portion of my estate for the benefit 0 my children as hereinbelow set forth. " I' !! ITEM III. I give all of the rest, re idue and remainder of my estate unto my three (3) children, Jea j R. , , Bilunas, Susan K. Summers and Mary R. Dechant, in equal sh rs, , share and share alike, or to their living issue per stirpes. ITEM IV. In addition to the P9,ers conferred by law, I authorize my Executrix or Trustee, in abs ~te I I I discretion: A. To retain in the form received, and to sell eith at pUblic or private sale any real or personal property. B. To manage real estate. C. To invest and reinvest only in forms of property de ned as legal investments according to the laws of the Commonweal of Pennsylvania. D. To exercise any optional rights arising from ownersh'p of investments. II E. To compromise claims without court approval, and wi ~out , I I I i ! the consent of any beneficiary. 2 II II [' ITEM V. It is hereby directed tha my Executrix, hereinafter named, shall pay all inheritance, st te, succession and legacy taxes to which my estate or the transfe of any property hereunder may be subject and to charge such ta as part of the administration, payable out of my residuary estat~. ITEM VI. I nominate, constitute appoint my daughter, Jean R. Bilunas, to be and act as my Executrix of this my Last will and Testament. In the even renunciation, death, resignation or inability to act for any r whatsoever of my daughter, Jean R. Bilunas, I nominate, const' and appoint my daughter, Susan K. Summers, as Executrix of th' ind fle ~:: rte I my Last Will and Testament. No personal representative or fidu ary appointed herein shall be required to post bond or give any I !i II ! security. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal ",0- L day of ff~J '-'8 J 1996. , The preceding instrument, consisting of this, and three typewritten pages, was on the date thereof signed, publishe declared by ROBERT L. SUMMERS, the Testator therein named, a for his Last Will, in the presence of us, who at his reques his presence and in the presence of each other, have subscribe names as witnesses hereto. ~)C~ / - Residing at CherI. J. DeHart. 11 3631 Nonh Front Street Harrisbur Pe ia 17110 ~f~' 2/f ~ ~; Residing at fA I7dtfO 75366-1 4 I' II 'I I , I I ~iS I, , I: I II II 1:1 ! i II It- !I ! I I !I It II 11 ! i {""'" ,_Oi", .."", '" ~"a ""io'{" '" .""" "~"''''' """"'". (,,"', dot"",""", oc","'i", '" II' law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and II that she/he/they signed as a witness at the request of the Testator(rix) in her/his/their presence an<€! in the I presence of each other !ill in the presence of the other subscribing witness(es). II /?.;' . II L.-^-J i I REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA OATH OF SUBSCRIBING WITNESS Estate of Robert L. Summers No. ~I-O~' Q30 also known as , Deceased Charles J. DeHart, III, and Nancy L. Breski (Signature) 3631 North Front Street Harrisbur PA 17110 (Address) ./,~ (Signature) 217 Zion Road Newbur PA 17240 (Address) Sworn to or affirmed and subscribed before me this /511V day of ;?oo :::z-, Not Public M CommismrAEltlllre&AL FAY L POTIEIGER, Notary Public Susquehanna Township, Dauphin County My Commie,.;on Expires July 1, 2003 J _,._._"~"~H___ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. RW-2 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA J CERTIFICATION OF NOTICE UNDER RULE 5.6(al Will No. nJ..Q3D Admin. No. Name of Decedent: m rs Date of Death: 10/7/02 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Cou served on or mailed to the following beneficiaries of the above-captioned estate on 10 16102 I ! . " i ;: , ~ules was Name Address Jean R. Bilunas 1808 Chatham Drive Cam Hill PA 1 11 Susan K. Summers 6525 Baywood Drive arrisb r PA 1 ~1 Mary R. Dechant Perivolakron Terma I Kalamata Gr ece Audrey Koury-Summers 72 Greenwood Circle Wor Ie sbur Date: 1 0/16/02 Notice has now been given to all persons entitled thereto under Ruie 5.6(a) except: Signature Address: 36 1 N rth Fr nt Stree H rri b r Telephone(232) - 7661 Capacity: x Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17126-0601 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: DEHART CHARLES Jill ESQ 3631 NORTHFRONTST HARRISBURG, PA 17110 n-.---.lold ESTATE INFORMATION: SSN: 165-16-0443 FILE NUMBER: 2102-0930 DECEDENT NAME: SUMMERS ROBERT l DATE OF PAYMENT: 12/26/2002 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 10/07/2002 TOTAL AMOUNT P REMARKS: CHECK# 104 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS I REV-1162 EX\1 181 ETAX NO. CD 0019~ ACN SSESSMENT AMOUNT CONTROL NUMBER -- 101 I $42,750.00 I I I I I I I I AID: $42,750.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS A WAIVER OF RIGHT OF ELECTION TO TAKE ( ESTATE OF ROBERT L. SUMMERS, : IN THE COURT OF COMMON PLEAS DECEASED : CUMBERLAND COUNTY, PENNSYLV ~ No. ~\l-O^- oqJO THE STATUTORY SHARE OF A SURVIVING SPOUSE I, Audrey I Koury, hereby waive the right of election under 20 Pa.C.S.g2201 et sea. Date: a..../ \ ;;( I D "3 "' c:~,q\-~ Audrey I. Koury ~ ESTATE OF ROBERT L. SUMMERS, : IN THE COURT OF COMMON PLEAS DECEASED : CUMBERLAND COUNTY, PENNSYL V ; No. J-.I- oJ- -C-7JO RECEIPT OF FAMILY EXEMPTION I, Audrey I Koury, acknowledge I have received the following items from the Estate of Robert L. Summers in full satisfaction of the tamily exemptIon: the oriental rugs located in my residence. Date: 11?..) 63 I -, ~QA- CYK Audrey 1. KOUry) ( REV-1500EX+(&OOI .' . COMMONWEALTH OF PENNSYL VANIA , DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG, PA 17128-0601 /7-9~eJJ_1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY ~ FILE NUMBER 2 1 -0 2 0 9 3 0 COUNTY"'C05E ----yE.I\R- - - 'NUMBER-- I- Z W o W o W o DECEDENrs NAME (LAST. FIRST. AND MIDDLE INITIAL) Robert L Summers DATE OF OEA1H \MM-OO-Year) DATE OF BIR1H (MM-DD- Year) 10/07/2002 03/29/1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) w .... :x::::!;cn 0"'''' w"o ",00 0"'.... .... .. " 129 1.0riginalRetum o 4. limited Estate [R] 6_ Decedent Died Testate {Attach copy of Will} o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. future Interest Compromise (date of dealh after 12-12-82) o 7. Decedent Maintained a Living Trust (Attacll OOIlY ofTfllst) o 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1-95) SOCIAL SECIJRITY NIJMBER 165-16-0443 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 03. Remainder Return (dateofdealhpriortoI2-1J.82) [Xl 5, Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (ArtachSch01 COMPLETE MAILING ADDRESS 3631 North Front Street .... z w o z o .. Ul W '" '" o o NAME Charles J. DeHart, III, Es uire FIRM NAME (If App'cable) CALDWELL & KEARNS TELEPHONE NUMBER 717 232-7661 Harrisbur z o i= :5 ::> l- ii: <l: o w a:: 1. Real Esfate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Noles Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (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. T ota) Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus line 11} 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjec1to Tax (Une 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ ::> c.. :!: o o X <l: I- 15, Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec, 9116 (a)(1.2) 29,993.00 X _(15) 1,031,596.13 X .045 (16) X .12 (17) X 15 (18) (19) 16. Amount of line 14 ta.xable at lineal rate 17. Amount of line 14 taxable at sibling rate 18, Amount of line 14 taxable at collateral rale 19. Tax Due 20 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 0.00 , 432,9~i*l - ~_., ' ~.~ n~ g :". 91 'l 17 ,9:!i\ .00 c (''''I 5,8t3.00 .: , -0 c. 629,78'1:00 I (8) 20,239.87 153.00 (11) (12) (13) (14) PA 17110 OFFICIAL USE ONLY @ :lJ :::Om ~,p c {~J~,' E:'!~ '1~ {'D n "" "" -< I co :I=> co N 0'1._ ~~~ n 1,086,492.00 20,392.87 1,066,099,13 4,510.00 1,061,589.13 46,421 .83 46,421.83 Decedent's omplete Ad ress: STREET ADDRESS 17 G d C. I reenwoo Ire e CITY I STATE I ZIP Wormleysburg PA 17043 C d Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 46,421 .83 42,750.00 2,250.00 Total Credits (A + B + C) (2) 45,000.00 3. InteresUPenalty if applicable D. Interest E. Penalty T otallnteresUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greaterthan Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILL$, AGENT 0.00 1,421.83 1,421.83 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 IZl b. retain the right to designate who shall use the property transferred or its income; ........................................ D IZl c. retain a reversionary interest; or ...................................................................................................... 0 ~ d. receive the promise for life of either payments, benefits or care? ............................................................. D IZl 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 [ZJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D IZl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................... ............................................................................ ~ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepare!" other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE 0 SON RESPON~ ~OR FI G RETURN DA T ADDRESS 0 Chatham Drive Camp Hill SIGNATURE OF PREPARER OTHER THAN REP ESENTATlVE ~ ADDRESS Charles J. DeHart. ill 3631 North Front Street PA 17011 ~~J For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 3% 172 PS ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rale imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (al (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a lax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The lax 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 slepparent of the child is 0% [72 P.S. ~9116(a)(1.211. The lax rate imposed on the net value of transfers to or tor the use of the decedent's lineal beneficiaries is 45%, excepl as noled in 72 P.S. ~9116(1.2) [72 PS. ~9116(a)(111. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J, A sibling is defined, under Section 9102, as an ndividual who has at least one parent in common with the decedent, whether by blood or adoption. "","W".""'.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R I ED SCHEDULE A REAL ESTATE ESTATE OF FILE IlUMBER Robert L Summers All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 1, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 0.00 """~"'."''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE I NT DECEDENT SCHEDULE B STOCKS & BONDS Robert L Summers All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 02 0930 ESTATE OF ITEM NUMBER 1 DESCRIPTION Merrill Lynch Securities Account #872-28643, consisting of the following securities: (See attached statement) VALUE AT DATE OF DEATH 25,000 Washington CO PA Hospital debenture, maturity 12/15/09, Unit price $102.827 - Fair market value 25,707.00 20,000 Philadelphia PA Gas debenture, due 7/1/03, Unit price $102.911 - Fair market value 20,582.00 40,000 Penn Deleo PA Scbool debenture, due 2/15/13, Unit price $103.994 - Current value 41,598.00 20,000 Philadelphia PAdebenture, due 3/15/08, Unit price $111.346- Fair market value 22,269.00 10,000 Philadelphia PA Gas Works debenture, due 7/01/03, Unit price $102.934 - Fair market value 10,293.00 1,500 Brandywine Realth Trust, Unit price $20.66 - Fair market value 30,990.00 343 shares Conoeo Phillips, price per share - $47, Fair market value 16,121.00 800 shares common stock Duke Energy Corp., price per share $16.05- Fair market value 12,840.00 400 sbares common stock Electronic Data, price per share $16.62 - Fair market value 6,648.00 400 shares common stock Heritage Property Investment Trust, price per share - $24.02 - Fair market value 9,608.00 500 shares Health Care Property Inv - price per share $41.78 - Fair market value 20,890.00 600 shares Keyspan Corp. - price per share $33.88 - Fair market value 16,940.00 3,355 shares common stock Mellon Financial - price per share $21.64 - Fair market value 72,602.00 1,000 shares PPL Capital Funding pfd - price per share $17.91 - Fair market value 17 ,910.00 600 shares SBC Communications - price per share $21.35 - Fair market value 12,810.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 432,948.00 . Continuation of REV-1500 Inheritance Tax Return Resident Decedent Robert L. Summers 21 02 0930 PaQe 1 Schedule B . Stocks & Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 500 shares Simon Property Group - price per share $32.95 - Fair market 16,475.00 value 200 shares Select Medical Corp. - price per share $13.90 - Fair market 2,780.00 value 400 shares Sempra Energy - price per share $20.86 - Fair market value 8,344.00 800 shares common stock Sysco Corporation - price per share $29.39 - 23,512.00 Fair market value 37,479 units CMA PA Municipal Money Market Fund - price per unit 37,479.00 $1.00 - Fair market value 2 2 shares Beaver Run Hunting and Fishing Club - $500.00 per share (see attached 1,000.00 statement) 3. 212 shares Metlife common stock at $26.1799 per share 5,550.00 SUBTOTAL SCHEDULE B 95,140.00 GRANO TOTAL SCHEDULE B $ 432,948.00 REV-15G8 E?\ + (6-98) . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Robert L Summers FILE NUMBER 21 02 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0930 ITEM NUMBER 1. DESCRIPTION 1997 Ford Sport Utility Explorer - Sale proceeds VALUE AT DATE OF DEATH 9,000.00 2. Miscellaneous items of household furniture individually owned 630.00 3. 2 used oriental rugs (estimated value) 3,500.00 4. 1954 Classic 16-foot Runabout with 2 outooard engines - Appraised value 2,475.00 5. 2002 Federal Income Tax Refund 2,329.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 17,934.00 ''''~m,''''',. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Robert L Summers If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jean R. Bilunas 1808 Chatham Drive Camp Hill, PA 17011 Daughter B c JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name 01 financial institution and barlk account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed forjointly.held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A 4/16/02 Commerce Bank Checking Accl. #0513182972 - see 5,823.00 100, 5,823.00 attached statement TOTAL (Also enter on line 6, Recapitulation) $ 5,823,00 (If more space is needed, insert additional sheets of the same size) ,,,,;om.,,",,,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Robert L. Summers FilE NUMBER This schedule must be completed and flied if the answer to any of Questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE H!E NAME Of HIE TRANSFEREE. THEIR RELATIONSHIP TO DECEOENl ANDT HE DATE OF TRANSfER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACI-lACOPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IFAPPlICA8LEI 1. MetLife Annuity Contract #073424542AB - Payable to Jean 119.971.00 100. 119,971.00 Bilunas, Susan Summers, Mary Dechant, Audrey Summers 2. Merrill lynch Account #872-45002, Ruth E. Summers Exemption Trust created by Last Will and Testament of Ruth E. Summers under date of May 6,1983 (see attached) and funded by Ruth E. Summers upon her death on July 3, 1992, payable to Jean Bilunas, Susan Summers and Mary Dechant upon the death of the surviving spouse, Robert L. Summers (see attached statement from Merrill Lynch) a. CMA PA Municipal Money Market Fund, unit price $1.00- 11,217.00 100. 11,217.00 Fair market value b. $5,000 Dallastown, PA Borough Sewer Debenture, due 5,558.00 100. 5,558.00 8/1/2013, unit price $111.161 - Fair market value c. $10,000 Delaware River Port Authority Debenture, due 11,39300 100. 11,393.00 1/15/2010, unit price $113.927 - Fair market value d. $25,000 Philadelphia PA Hospital Authority Debenture, 28,511.00 100. 28,511.00 due 7/01/2008, unit price $114.045 - Fair market value e. $15,000 Washington County PA Hospital Debenture, due 15,424.00 100. 15,424.00 12/15/2009, unit price $102.827 - Fair market value f. $50,000 Valley View PA School District Debenture, due 55,622.00 100. 55,622.00 11/15/2008, unit price $111.243 - Fair market value g. $50,000 Pittsburgh PA Water & Sewer Authority 52,248.00 100. 52,248.00 Debenture, due 9/01/2005, unit price $104.496 - Fair market value h. $25,000 Philadelphia PA Gas Works Debenture, due 27,288.00 100. 27,288.00 7/01/2007, unit price $109.153 - Fair market value i. $15,000 Wyoming Valley PA Sanitary Debenture, due 16,158.00 100. 16,158.00 7/01/2007, unit price $107.719 - Fair market value j. 2,000 shares Brandywine Realty Trust, unit price $20.66 - 41,320.00 100. 41,320.00 Fair market value k. 462 shares common stock Chevron Texaco, unit price 33,084.00 100. 33,084.00 $71.61 - Fair market value I. 800 shares First Industrial Realty Trust, unit price $24.70 - 19,760.00 100. 19,760.00 Fair market value TOTAL (Also enter on line 7, Recapitulation) $ 629,78700 (If more space is needed, insert additional sheets of the same size) . Continuation of REV-1500 Inheritance Tax Return Resident Decedent Robert L. Summers PaQe 2 Schedule G - Inter-Vivos Transfers & Misc. Non-Probate Property DESCRIPTION OF PROPERTY %OF ITEM INCLUDf THE NAMEOFTHETRIINSFEREE,THEIRRELATlONSHIPTO DECEDENT A NO THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALuE NUMBER ATTACH A COPY OFTHE DEED FOR REAL ESTATE VALuE OF ASSET INTEREST {IF APPLlCABLEI m. 200 shares Health Care Property Investment. unit price 8.35600 100. 8,356.00 $41.78 - Fair market value n. 1,000 shares Mills Corporation, unit price $27.89 - Fair 2,789.00 100. 2,789.00 market value o. 660 shares common stock Mellon Financial Corp., unit 14,282.00 100. 14,282.00 price $21.64 - Fair market value p. 400 shares PPL Capital Funding preferred, unit price 7,164.00 100. 7,164.00 $17.91 - Fair market value q. 584 shares SBC Communications, unit price $21.35- 12,468.00 100. 12,468.00 Fair market value r. 600 shares Simon Property Group, unit price $32.95 - 19,770.00 100. 19,770.00 Fair market value s. 8,815.945 shares Eaton Vance Tax Managed Growth 122,894.00 100. 122,894.00 Fund, unit price $13.94 - Fair market value 3. Bucknell University Charitable Annuity with income payable to 4,510.00 100. 4,510.00 Robert L. Summers for life and remainder to Bucknell University upon death - Date-of-death value (see attached statement) SUBTOTAL SCHEDULE G 192,233.00 GRAND TOTAL SCHEDULE G $ 629,787.00 REV-1511 EX + (12-99). '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Robert L Summers 21 02 0930 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cremation Society - Funeral expenses 1,78600 2. Flowers 143.00 3. Church and clergy 350.00 4. Funeral reception 500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Jean R. Bilunas - Waived 0.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1808 Chatham Drive City Camp Hili State P A Zip 17011 Year(s) Commission Paid: 2003 2. Attorney Fees Caldweli & Kearns 12,950.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Audrey Koury-Summers Street Address 72 Greenwood Circle City Wormleysburg State P A Zip 17043 Relationship of Claimant to Decedent Surviving Spouse 4. Probate Fees Register of Wi lis 800.00 5. Accountant's Fees 6. Tax Return Pre parers Fees 7. Cumberland Law Journal - Legal advertising 75.00 8. The Sentinel - Legal advertising 80.87 9. Postage 55.00 TOTAL (Also enter on line 9, Recapitulation) $ 20,239.87 (If more space is needed, insert additional sheets of the same size) "",,;,m'''''i. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Robert L. Summers FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 153.00 1. Commerce Bank - outstanding check on joint checking account which cleared following the date of death TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 153.00 REV~1513EX.j9_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Rnhort I ""mmors RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONIS) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTR!BUTIONS (include outright spousal distributions, and transfers under Sec. 9116 lal 11.2)] 1. Jean R. Bilunas Daughter 2. Susan Summers Daughter 3. Mary Dechant Daughter 4~ Audrey Koury-Summers Surviving Spouse a. 25% share of Met Life Annuity on Schedule G 29,993.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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. Bucknell University - Charitable Annuity as identified on Schedule G 4,510.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV~ 1500 COVER SHEET $ 4,510.00 (If more space is needed, insert additional sheets of the same size) Beaver Run Hunting & Fishing Club Founded 1895 December 3, 2002 Jean Bilunas 1808 Chatham Drive Camp Hill, PA 17011 Dear Jean, On behalf of the Beaver Run Hunting & Fishing Club, I would like to thank you and your sisters for your generous gift of your father's two shares that was used to renovate our stewards' quarters. These shares have a value oftive hundred dollars each, or $1000 in total. This gift from you in memory of your father will be acknowledged in our December newsletter that will be received by all of Bob's fellow members later this week. As I tried to express to you previously, Bob was a genuine friend to all of us at the Club and he will be sadly ruissed. He will remain in our hearts as a first class outdoorsman and an exemplary gentleman. Additionally, the club has begun a fund to create some tangible reruinder, (possibly an oft- postponed renovation or hoped for convenience) somewhere at the Club in his memory. I will keep you informed as this effort develops further. I spoke to Buff Hawley on Saturday while I was at the club, and he has agreed to bring home all of Bob's belongings from the club when he returns this weekend. Sincerely, ,/;:_.;111",/ ~.{' J;/)~'.("/~ "" John R. Much, President Beaver Run Hunting & Fishing Club 101m R. Much, President 24 HilIendale Road Perkasie, PA 1&944 (2]5) 257-9694 NUV,l~.2~U2 4:07PM OFC OF POLICY & TECHNOLOGY NO. 396 P.2 MBtropolitan Lit, Insuranc, Company MetLife Cuslom,r S'rvICB C,nter' Tulsa 12902 EZSl51 II Street, PO Box 22069 Tulsa, OK 74121-2069 MetLife JEAN R BILUNAS 1808 CHATHAM DR CAMP HILL PA 17011 RE: Contract # 073 424 542 AS gec~ased;~OB_ERT 1 SUJ\ltM.;I1~_ . -. ... .~-- - -~- ,---..-"" - -,-~ Dear Ms. Bilunas, This is a follow up of our telephone conversation of this date regarding the death claim proceeds on your father's contract. Contract 073 424 542 AS is non-qualified and all monies over the cost basis are considered taxable in the year received. The cost basis is $109,604.62. The date of death value as of October 7, 2002 is $119,970.63. Where there qre multiple beneficiaries, we will only value the death benefit as of the time the first beneficiary submits the necessary documentation in good order. Any death benefit amounts attributable to any beneficiary, which remain in the investment divisions. are subject to investment risk. and are not guaranteed. Your claim was received on November 4, 2002 and the contract was valued as of that date for $135,732.55. Your share of this death benefit was $33,933.14, which was paid on November 5, 2002. Audrey, Susan and 'Mary's share'of the-proceeds is still outstan'ding.- ' , -, - ,-, Thank you for allowing me to be of assistance to you. If you have any questions, you may contact our Customer Service Representatives at 1-800- 638-7732 or you may reach me at 918-252-8768. Connie S Brown, ALHC Payout Specialist 1\ Annuity Administrative Operations November 13, 2002 Commerce flBank.. January 8, 2003 Caldwell & Kearns Attorneys At Law 3631 N Front St Harrisburg, PA 17110-1533 RE: Estate of: Robert L Summers Social Security #: 165-16-0443 Date of Death: October 7, 2002 Dear Sir/Madam: In reference to the letter regarding the above mentioned Estate, we would like to inform you of the information that we have researched and found. Type: Checking Account #: 513182972 Date Opened: 7/10/01 Date Closed: 10/16/02 Primary Owner: Robert L Summers Secondary Owner: Jean Bilunias Date of Death Balance: $5,822.97 Jean Bilunias was added as an owner April 16, 2002 If there are any questions or additional information that is needed, please feel free to contact me at (717) 795-7118 ext. 3151. Sincerely, ~~aD;~~s~ ~f)M~ CIF Associate Commerce Bank j Harrisburg, N.A. P.O. Box 8599 100 Senate Avenue Camp Hill, Pennsylvania 17001-8599 ...",l<[', ..<';~~Mlkkt:::.:. ;>;~.~.; f~II~~ --' ~ Office of Planned Giving Bucknell University Lewisburg, Pennsylvania 17837 Phone: 570-577-3200 Fax: 570-577~36lO Bucknell January 9, 2003 Mr. Charles J. DeHart III Caldwell and Kearns, Attorneys at Law 3631 North Front Street Harrisburg, PA 17110-1533 SUBJECT: Robert L. Summers Charitable Gift Annuity Dear Mr. DeHart: A copy of the original contract governing Robert L. Summers' charitable gift annuity with Bucknell University is enclosed for your file. You may see from reading that he was the sole income beneficiary of this contract. Under the terms of the contract, Bucknell University's obligation to pay Mr. Summers ended with the quarterly installment next preceding his death, which payment was made on September 30, 2002. We believe that no part of Mr. Summers' annuity is includable in his gross estate for federal tax purposes. Section 2039(a) of the Internal Revenue Code (IRC) of 1986 provides that "The gross estate shall include the value of an annuity or other payment receivable by any beneficiary by reason of surviving the decedent under any form of contract or agreement entered into after March 3,1931...." However, we believe that no part of the IRC mandates or provides for inclusion in the estate of a donor who also was the sole life income beneficiary of any part of the value of a one-life charitable gift annlJity. Although I am far less certain of Pennsylvania Inheritance Tax law, I believe that inheritance tax is imposed only upon estates passing to non-charitable beneficiaries. Since no part of the value of Mr. Summers' charitable gift annuity accrues at this death to any individual or entity other than Bucknell University, we believe that no part is included in his gross estate. All that said, an actuarial calculation titled "Death Date Values" is enclosed showing that the value of Mr. Summers' annuity interest in his plan on his date of death was $4,509.60. This value appears on line 9 ("Investment in Contract") of the calculation sheet. Note that the calculation is made assuming the applicable federal rate elected under IRC g7520(a) for August 2002. Mr'. Charles J. DeHart III Page 2 A photocopy of an actuarial calculation prepared when Mr. Summers funded his annuity also is enclosed; this form is headed "Taxation of Gift Annuity Payments." The table appearing at the bottom of that page, titled "Breakdown of Annuity," shows that a portion of the income Mr. Summers was paid in each year of his life after establishing the annuity was treated as capital gain, another portion as ordinary income, and the balance as tax-exempt income. The tax-exempt portion represents his initial investment in the contract, distributable under tax rules ratably over his life expectancy. IRC ~72(b)(3)(A) provides that any unrecovered investment in the initial contract upon the decedent's death may be claimed as an income tax deduction on the decedent's final federal income tax return. Mr. Summers was due tax-exempt income representing the ratably payable investment in the contract, $67.61 per quarter through December 31, 2006. Further, another $45.84 was due for the first quarter of 2007. Thus, $1,195.21 of ratably payable investment in the contract was unrecovered at his death on October 7. These values are shown on the table "Breakdown of Annuity" and a separate spreadsheet summary also enclosed. The final 1099 Form due Mr. Summers will be mailed to you as counsel for his estate, before the end of January. This 1099 Form will show that Bucknell paid Mr. Summers $720 during 2002, including $236.37 in ratably reportable long-term capital gain, $202.83 in tax-exempt income, and $280.80 in ordinary income, Note that neither I nor anyone at Bucknell can serve as legal or financial advisor to Mr. Summers, his estate, or his heirs. However, we hope that the information suggested above is helpful; you must of course judge its value on your own. Naturally, I will be pleased to help if you have further questions. Thank you for your service to Mr. Summers' estate and to Bucknell. Sincerely, . ~~ Mark Elliott Director of Planned Giving ME/gl Enclosures BUCKNELL UNIVERSITY Prepared for: Robert Summers January 7, 2003 Deduction Calculations Actuarial Calculations Death date Values 9.6% Charitable Gift Annuity ASSUMPTIONS: [I] Annuitant Date of Gift [3/29/1917] 86 1017/2002 Principal Donated Cost Basis $10,000.00 $4,618.27 [2] [3] [4] [5] Annuity Rate 9.6% Payment Schedule quarterly at end [6] Discount Rate under IRC Section 7520(a) for 8/2002 5.2% CALCULATIONS: [7] Annuity ([2] x [4]) $960.00 [8] [a] Value of $1 for age on [1], rate on [6] (Table S in IRS Publication 1457 (1999)) [b] Adjustment for schedule on [5], rate on [6] (Table K in IRS Publication 1457 (1999)) [c] Adj. Value of $1 ([8a] x [8b]) [9] Investment in Contract ([7] x [8c]) [10] CHARITABLE DEDUCTION ([2] - [9]) 4.6086 1.0193 4.6975 $4,509.60 $5,490.40 [II] [a] Expected Return for age on [I] (Table V in Reg. 1.72-9) [b] Adjustment for payment schedule on [5] (Reg. 1.72-5(a)(2)(i)) [c] Expected Return per $1 ([Ila] + [lIb]) [l2] Expected Return ([7] x [I Ie]) [13] Exclusion Ratio ([9] / [12]) (Regs. 1.72-4, 1.l011-2(c) Example (8)) 6.5 -0.1 6.4 $6,144.00 0.734 [14] Bargain Sale Ratio ([9] / [2]) (Regs. 1.170A-l(d), 1.l01l-2(b)) [15] Total Reportable Gain ([14] x ([2] - [3])) [16] Life Expectancy of Donor Age 86 (Reg. 1.l01l-2(a)(4)(ii)) 0.45096 $2,426.94 6.4 Prepared by: Mark Elliott We believe tbis report is accurate. However, this report in no way authorizes or confirms your right to any tax deductions or other results. Consult your personal advisors. Private Client Group .- '1_ 2]4 Senate Avenue Posl Of lice Box 0810 Camp Hill, Pennsylvania 17001-0810 717 975 4600 Olflce 800937 0735 Toll Free FAX 717 975 4663 "" <11'.." -!ll,ll: November 26, 2002 Charles J. DeHart, III Caldwell & Kearns 3631 North Front Street Harrisburg PA 17110-1533 RE: Robert L. Summers Date of Death: October Merrill Lynch Accounts: 7, 2002 872-28643, 872-45002 Dear Mr. DeHart: Referencing your letter I am providing below date of death values for the above captioned client. Account #872-28643 name of Robert L. Summers, established 03/03/1981: 25,000 Washington Co PA Hospital Auth Revenue 5.88% due 12/15/2009 20,000 Philadelphia PA Gas Works Revenue 5.50% due 07/01/2003 Cusip 938592EK4 Price 102.8270 Cusip 7l7823B56 Price 102.9110 10,000 Philadelphia PA Gas Works Revenue 5.50% due 07/01/2003 Cusip 707332FJ6 Price 103.9940 Cusip 71 7813BMO Price 111. 3460 Cusip 7l7823B49 Price 102.9340 40,000 Penn Deleo PA School District 4.60% due 02/15/2013 20,000 Philadelphia PA 5.00% due 03/15/2008 1,500 Brandywine Realth Trust (BDN) Cusip 105368203 21.120 high 20.200 low 20.280 close 343 Conoco Phillips (COP) Cusip 20825C104 48.050 high 45.940 low 45.950 close ''':'''[1',,'' 11,'" I'll,."", "\1,,,;,,\, "'L'" '1.-',""'" ,.",,,, '''I'' ""1" ;"':'"":;(C' .... -- '- ~"'';i4': " . ~.,. Charles J. DeHart III November 26, 2002 Page Two Merrill Lynch Account #872-28643 continued 800 Duke Energy Corp (DKE) 400 Electronic Data Systems 7.625% prides (EDSprI) 400 Heritage Property Investment Trust Inc. (HTG) 500 Health Care Property Invs Inc (HCP) 600 Keyspan Corp (KSE) 3,355 Mellon Financial Corp (KEL) 1,000 PPL Capital Funding 7.75% conv pfd (PPLprE) 600 SBC Communications Inc (SBC) Private Client Group 214 Senate Avenue Post Office Box OSlO Camp Hill, Pennsylvania 17001-{JSIO 717 975 4600 Office SOO 937 0735 Toll Free FAX 7179754663 Cusip 264399585 16.290 high 15.810 low 16.250 close Cusip 285661203 16.880 high 16.360 low 16.580 close Cusip 42725MI07 24.530 high 23.500 low 23.700 close Cusip 421915109 42.210 high 41.350 low 41.430 close Cusip 49337WlOO 34.400 high 33.360 low 33.790 close Cusip 58551A108 22.400 high 20.870 low 21.020 close Cusip 69352F204 18.160 high 17.660 low 17 .850 close Cusip 78387GI03 21. 700 high 20.990 low 21.030 close Private Client Group 214 Senate Avenue Post Office Box 0810 Camp Hill, Pennsylvania 17001-0810 717 975 4600 Office 800 937 0735 Toll Free FAX 717 975 4663 "" -J :_.' Charles J. DeHart November 26,2002 Page Three III Merrill Lynch Account #872-28643 (continued) 500 Simon Property Group (SPG) Cusip 828806109 33.790 high 32.110 low 32.330 close 200 Select Medical Corp (SEM) Cusip 816196109 14.100 high 13.700 low 13.950 close 400 Sempra Energy Cusip 816851208 21.140 high 20.580 low 20.600 close 800 Sysco Corporation (SYY) Cusip 871829107 29.750 high 29.030 low 29.360 close $37,479 CMA PA Municipal Money Market Fund Cusip 12599D913 Price 1.00 Merrill Lynch Account #872-45002 name of Jearn R. Bilunas. Trustee, Mary Dechant. Trustee, Susan K. Summers, Trustee. Robert L. Summers, Trustee Under Will of Ruth E. Summers - established 01/31/1994 $1l,217 CMA PA Municipal Money Market Fund Cusip 12599D913 Price 1.00 5,000 Dallastown PA Boro Sewer Auth Revenue Cusip 235460AQ5 6.00% due 08/01/2013 Price 111.1610 10,000 Delaware River Port Authority PA & NJ Cusip 246361AX7 6.00% due 01/15/2010 Price 113.9270 25,000 Philadelphia PA Hospital Authority Revenue Cusip 717826CVl 7.00% due 07/01/2008 Price 114.0450 '1,_""" "".'-"1' , " I."",,', ,~t('2: ... ~...... "~->"~$.., ":"'. iJ '!l"",,! 'J"J'. Charles J. DeHart III November 26, 2002 Page Four Merrill Lynch Account #872-45002 (continued) 15,000 Washington Co PA Hospital Authority Revenue 5.88% due 12/15/2009 50,000 Valley View PA School District 5.25% due 11/15/2008 50,000 Pittsburgh PA Water & Sewer Auth Sys 4.75% due 09/01/2005 25,000 Philadelphia PA Gas Works Revenue 4.50% due 07/01/2007 15,000 Wyoming Valley PA Sanitary Authority Rev 5.13% due 07/01/2007 2,000 Brandywine Realty Trust (BDN) 462 Chevron Texaco Corp (CVX) 800 First Industrial Realty Trust (FRprD) 200 Health Care Property Inv. (HCP) 1,000 Mills Corporation (MLS) Private Client Group 214 Senate Avenue Post Office Box 0810 Camp Hill, Pennsylvania 17001-0810 7179754600 Office 800 937 0735 Toll Free FAX 717 975 4663 Cusip 938592EK4 Price 102.8270 Cusip 920213ET8 Price 111.2430 Cusip 725304CW7 Price 104.4960 Cusip 717823VPO Price 109.1530 Cusip 983510AU2 Price 107.7190 Cusip 105368203 21.120 high 20.200 low 20.280 close Cusip 166764100 72.710 high 70.500 low 70.500 close Cusip 32054K806 24.710 high 24.680 low 24.680 close Cusip 421915109 42.210 high 41.350 low 41.430 close Cusip 601148109 28.350 high 27.430 low 27.470 close Private Client Group 214 Senate Avenue Posl Office Box 0810 Camp Hill, Pennsylvania 17001-0810 717 975 4600 Office 800 937 0735 Toll Free FAX 717 975 4663 ,-'" . ..1,',;. Charles J. DeHart III November 26, 2002 Page Five Merrill Lynch Account 1872-45002 (continued) ..wo ~<" Mellon Financial Corp (HEL) Cusip 58551Al08 22.400 high 20.870 low 21.020 close 400 PPL Capital Funding 7.75% conv pfd (PPLpreE) Cusip 69352F204 18.160 high 17.660 low 17 . 850 close 584 SBC Communications (SBC) Cusip 78387G103 21.700 high 20.990 low 21.030 close 600 Simon Property Group (SPG) Cusip 828806109 33.790 high 32.110 low 32.330 close 8,815. 945 Eaton Vance Tax Managed Growth Fund (ECTGX) Cusip 277911822 13.940 bid 13.940 offer Please feel free to contact us should you require any additional information. S~. llY, JY:l1f;;u-7~ ~ ~bert F. Brenner, CFP Vice President and Wealth Management Advisor RFB: eDDD cc: Jean R. Bilunas Susan K. SUDDDers Mary Dechant .,1.,,.,,,,,,,, "'I,, .j,;, LAST WILL AND TESTAMENT OF ROBERT L. SUMMERS I, ROBERT L. SUMMERS, of 72 Greenwood Circle, Wormleysburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this my Last will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses be fully paid and satisfied as soon as conveniently may be after my decease. ITEM II. For purposes of information, I acknowledge the existence of numerous assets owned jointly as tenants by entireties with my wife, Audrey Summers. As a result of the benefit she will :cecei":.re as joint owner upon my death, I choose to redirect the residual portion of my estate for the benefit of my children as hereinbelow set forth. " ITEM III. I give all of the rest, residue and remainder of my estate unt6 my three (3) children, Jean R. Bilunas, Susan K. Summers and Mary R. Dechant, in equal shares, share and share alike, or to their living issue per stirpes. ITEM IV. In addition to the powers conferred by law, I authorize my Executrix or Trustee, in absolute discretion: A. To retain in the form received, and to sell either at public or private sale any real or personal property. B. To manage real estate. C. To invest and reinvest only in forms of property defined as legal investments according to the laws of the Commonwealth of Pennsylvania. D. To exercise any optional rights arising from ownership of investments. E. To compromise claims without court approval, and without the consent of any beneficiary. 2 . ITEM V. It is hereby directed that my Executrix, hereinafter named, shall pay all inheritance, state, succession and legacy taxes to which my estate or the transfer of any property hereunder may be subject and to charge such tax as part of the administration, payable out of my residuary estate. ITEM VI. I nominate, constitute and appoint my daughter, Jean R. Bilunas, to be and act as my sole Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of my daughter, Jean R. Bilunas, I nominate, constitute and appoint my daughter, Susan K. Summers, as Executrix of this my Last will and Testament. No personal representative or fiduciary appointed herein shall be required to post bond or give any security. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this ;vi 2 ~ day of flLLj "'57- ,1996. /'1 / ,/ .1 " ;....;--. ',,:'1 . ' /'!t--I.u d ~ l5)./~.\.~ ~{~~ ROBERT L. SuMMERS The preceding instrument, consisting of this, and three other typewritten pages, was on the date thereof signed, published and declared by ROBERT L. SUMMERS, the Testator therein named, as and for his Last Will, in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. (. LL,-:> ) // Cc "'-/.., .j"~~ - Residing at Charles J, DeHart. II 3631 North Front Street Harrisburg, Pemsylvania 17110 !(fM;,eC1- ...'1' /~,t4,k{ u Residing at ,2 1"7 'Jtv1'1 u , .1 ! ~'; h-l!.t..<:~(-(,t,4( 0' fA ilJ'f(i 75366-1 4 I REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Robert L. Summers No. also known as Date of Death 1Onl02 , Deceased Social Security No. 165-16-0443 Personal Representative{s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedenfs death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IfINe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Charles J. DeHart, III, Esquire Jean R. Bilunas " . 1.0. No.: 15617 l J. k. ",(-2 .I . 1.4 3631 North Front Street (/ 'Jd f)1" .~ Address: Dated ( J Harrisburg PA 17110 Telephone; (717) 232-7661 Description Value 1. 1997 Ford Sport Utility Explorer - Sale proceeds 9,000.0 2. Miscellaneous items of household furniture individually owned 630.0 (All other household furniture owned jointly with surviving spouse) 3. 2 used oriental rugs (estimated value) 3,500.0 4. Merrill Lynch Securities Account #872-28643, consisting of the following securities: 25,000 Washington CO PA Hospital debenture, maturity 12/15/09, Unit 25,707.0 price $102.827 - Fair market value 20,000 Philadelphia PA Gas debenture, due 7/1/03, Unit price $102.911 - 20,582.0 Fair market value Total 450,882.0 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. ! RW.4 I Continuation of Inventory Robert L. Summers Paoe 1 Description of Inventory Description 40,000 Penn Delco PA School debenture, due 2/15/13, Unit price $103.994 - Current value Value 41,598.00 20,000 Philadelphia PA debenture, due 3/15/08, Unit price $111.346 - Fair market value 22,269.00 10,000 Philadelphia PA Gas Works debenture, due 7/01/03, Unit price $102.934 - Fair market value 10,293.00 1,500 Brandywine Realth Trust, Unit price $20.66 - Fair market value 30,990.00 343 shares Conoco Phillips, price per share - $47, Fair market value 16,121.00 800 shares common stock Duke Energy Corp., price per share $16.05 - Fair market value 12,840.00 400 shares common stock Electronic Data, price per share $16.62 - Fair market value 6,648.00 400 shares common stock Heritage Property Investment Trust, price per share - $24.02 - Fair market value 9,608.00 500 shares Health Care Property Inv - price per share $41.78 - Fair market value 20,890.00 600 shares Keyspan Corp. - price per share $33.88 - Fair market value 16,940.00 3,355 shares common stock Mellon Financial - price per share $21.64 - Fair market value 72,602.00 1,000 shares PPL Capital Funding pld - price per share $17.91 - Fair market value 17,910.00 600 shares SBC Communications - price per share $21.35 - Fair market value 12,810.00 500 shares Simon Property Group - price per share $32.95 - Fair market value 16,475.00 Subtotal $ 307,994.00 Continuation of Inventory Robert l. Summers Paae 2 Description of Inventory Description 200 shares Select Medical Corp. - price per share $13.90 - Fair market value Value 2,780.00 400 shares Sempra Energy - price per share $20.86 - Fair market value 8,344.00 800 shares common stock Sysco Corporation - price per share $29.39 - Fair market value 23,512.00 37.479 units CMA PA Municipal Money Market Fund - price per unit $1.00 - Fair market value 37,479.00 5. 1954 Classic 16-fool Runabout with 2 outboard engines - Appraised value 2,475.00 6. 2 shares Beaver Run Hunting and Fishing Club - $500.00 per share 1,000.00 7. 212 shares MelLife common stock at $26.1799 per share 5,550.00 8. 2002 Federal Income Tax Refund 2,329.00 Subtotal $ 83,469.00 Grand T mal $ 450,882.00 11\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT DEHART CHARLES J III ESQUIRE CALDWELL & KEARNS 3631 NORTH FRONT STREET HARRISBURG, PA 17110 ___nn_ fold ESTATE INFORMATION: SSN: 165-16-0443 FILE NUMBER: 2102-0930 DECEDENT NAME: SUMMERS ROBERT L DATE OF PAYMENT: 05/08/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/07/2002 TOTAL AMOUNT REMARKS: JEAN R BILUNAS C/O CHARLES J DEHART III ESQ CHECK# 108 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS " REV-1162 EX(11- ) E TAX NO. CD 00254 ACN SSESSMENT AMOUNT CONTROL NUMBER + --- 101 I $1,421.83 I I I I I I I I PAID: $1,421.83 DONNA M. OTTO DEPUTY REGISTER OF WILLS I A /1- f7"- /3 ~ BUREAU OF INDIVIDUAL TAXES IHHERlTAHCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 11128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ti.-.::: ':~ DATE 'eSTATE OF DATE OF DEATH "lILE NUMBER d '-C~TV ACN .03 JUN 30 CHARLES J DEHART III ESQ CALDWELL & KEARNS 3631 N FRONT ST HBG PA 17110 C.::rl - GUrnb6ddrf_- i'/.. REY-1S<i7EXA (1-O.$) 06-23-2003 SUMMERS 10-07-2002 21 02-0930 CUMBERLAND 101 ROBER L Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT 0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-,,=is4j-EX-AFP--ciii---ii3")--iiiiYicE--OF-YtiiiERTrAt.'-cTYA"lTAPPRAisE'j.i'EiiT",--ALi-oWANCE-'Q-i---------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SUMMERS ROBERT L FILE NO. 21 02-0930 ACN 101 DATE 06-2 2003 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. 3. 4. 5. 6. 1. 8. (1) (2) (3) (4) E) (5) (6) (7) Stocks and Bonds (Schedule B) Closely Held Stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule OJ Cash/Bank Deposits/Misc. Personal Property (Schedule Jointly Dwnad Property (Schedule F) Transfers (Schedule G) Total Assets CHANGED .00 NOTE: To insu proper 432.948.00 credi t to you ccount, .00 submit the up portion .00 of this form h your 17.934.00 tax payment. 5,823.00 629,787.00 (8) 1,086,49 00 20,239.87 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax If an assess.ent was issued prevlously~ lines 14~ 15 and/or 16~ 17~ 18 and 1 reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX R DIT : PAYM DATE 12-26-2002 05-08-2003 NOTE: 153.00 (11) (12) (13) (14) 13 00 13 1,066,09 4~51 1~061,58 ill 00 045 = 12 15 (6) 29,993.00 X 1,031,596.13 X .00 X .00 X .00 .83 .00 .00 .83 (IS) (7) (18) REC IPT NUMBER COOO 1992 CD002541 DISCOUNT (+) INTEREST/PEN PAID (-) 2,250.00 .00 46,42 (19)= 46,42 AMOUNT PAID 42,750.00 1,421.83 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 46,421. . 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 MA~ liE DUE A REFUND. SEE REVERSF" Sfn!: n!: TUT~ J:"nD" J:"nD T"'~Tn""'T..ir<lL'~ l/j- q~- /-8 '\.. BUREAU OF INDIVIDUAL lH"ERITAHCE TAX DIVISION VEPT. 280601 HARRISBURG. PA 17128-0601 TAXES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~- ;\:JJ DATE ESTATE OF DATE OF DEATH FILE NUMBER : llCOUNTY ACN 08-18-2003 SUMMERS 10-07-2002 21 02-0930 CUMllERLAND 201 ROBER L CHARLES J DEHART III ESQ CALDWELL & KEARNS 3631 N FRONT ST \ HBG PA 1711n ~o.~ 1 S} Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT 0: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insu~e p~oper credit to your account, submit the upper portion of this form with your tax pant. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES .... iiE-V"::483-EitAFP-('oFo35------.-;-N'itfic'E--OF--OEi:E-R"iiiNATi'Q-.nND-;.S-SESSMENy--------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF SUMMERS ROBERT L FILE NO.21 02-0930 ACN 201 DATE 08-18 003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 44 . 171 . 83 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 44 1 .83 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMllER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .0 .0 .0 .0 *IF PAID AFTER THIS DATE. SEE REVERSE SIDE {IF TOTAL DUE IS LESS THAN tl. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" {CR>. YOU HAY BE , , DUE A REFUND. SEE REVERSE SIDE OF THIS J;'nRM I:nR T"'<'TDII"'TTnLJ~ :", ~ i' CALDWELL & KEARNS A PROFESSIONAL CORPORATION JAMES R. CLlPPINGE.R CHARU:S J. DEHART. III ,JAMES D. CAMPBELL. JR. JAMEs L. GOLDSMITH JEFFREY T. McGUIRE" STANLEY ..J. A. LASKOWSKI DOUGLAS K. MARSICO BRETT M. WOODBURN RAY .J. MICH,<I.LOWSKI ATTORNEYS AT LAW OF COUNSEL j RICHARD L. KEA +~ CARL G. WAS I: II Ii THOMAS O. CALDWE h JR. (1928-20011 i' 3631 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17110-1533 -ALSO A MEMBER OF NJ BAR October 29, 2003 i: 717-232-7661[. FA<,717-232-,).l.. thefirm@Caldwelrkea~.DOm Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Dear Sir/Madam: Re: Estate of Robert L. Summers No. 2002-00930 I am enclosing herewith the following: 1. Copy of the Estate Tax Closing Document for docketing. 2. The Status Report Under Rule 6.12, indicating that the estate administration is closed. 3. A copy of each document and a self-addressed, stamped envelope for your convenience in returning clocked-in copies. Thank you for your cooperation. Sincerely, ~ ';VV..u- Charles J. DeHart, III CALDWELL & KEARNS CJD/nb /Enclosures 02-737/52800-1 r-' t::, ~.-.., .- "c I,..' STATUS REPORT UNDER RULE 6.12 t/ of.-.. Name of Decedent: RODert L. Summers Date of Death: 10/7/02 Will No. ;2h1d-t?.Jo Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I . State whether administration of the estate is complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X 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 X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 10/29/03 (' ~~J Signature -;'-j Charles J. DeHart III Es uire Name (Please type or print) 3631 North Front Street HarrisDur PA 17110 Address Capacity : Personal Representative X Counsel for personal representative CHARLES J DEHART III ESQ CALDWELL & KEARNS 3631 N FRONT ST HBG PA 17110 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~A!~ of { ()fll1A1~ OF DATE OF DEATH FILE NUMBER "04 FEB 2t~rf~02 i.JOUJ Ctnnb", and Co.. piJ MAKE CHECK PAYABLE AND REMIT PAYMENT / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION IEPT. 280601 HARRISBURG~ PA 17128-0601 IEY.7S'EIlM -R. 03-01-2004 SUMMERS 10-07-2002 21 02-0930 CUMBERLAND 202 ROBER L Amount R...1 Heel C:S'rJ\U 0: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account" sub.it the upper portion of this font with your tax pa "t. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES .... iiEV=i3'6-EXAIWTlii:.-ozr----..-iloficrliF--IiEi'rriiiiNATiorn.iiinsSESSMEii'f--------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF SUMMERS ROBERT L FILE NO.21 02-0930 ACN 202 DATE 03-01 004 ESTATE TAX DETERMINATION 1. Credit FDr State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding DiscDunt and/Dr Interest) 44,171.83 3. Inheritance Tax Assessed by Other States Dr TerritDries Df the United States (Excluding DiscDunt and/Dr Interest) .00 4. TDtal Inheritance Tax Assessed 44 1 .83 5. Pennsylvania Estate Tax Due .00 6. Amount Df Pennsylvania Estate Tax PreviDusly Assessed Based Dn Federal Estate Tax Return .00 7. AdditiDnal Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT 0 BALANCE OF TAX DUE 0 INTEREST AND PEN. 0 TOTAL DUE 0 aIf PAID AFTER THIS DATE, SEE REVERSE SIDE lIF TOTAL DUE IS LESS THAN $1, 110 PAYIIENT IS RElIUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUlID. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.