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Home My WebLink About02-0945 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Madelyn P. Kilmoyer No. ~\ - C.::l.- q\.lS also known as , Deceased Social Security No. 175-05-68' Petitioner(s), who isfare 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) GJ A. Probate and Grant of Letters and aver that Petitioner(s) is/.... the execut rix named in the Last Will the Decedent, dated 7/26/89 and codicil{s) dated State relevant circumstances, e.g., renunciation. death of executor, ate Except as follows, Decedent did not many, 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 Letters of Administration (c.t.e., d.b.n.C.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spou (if any) and heirs: I Name Relationship Residence 1 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland ~ounty, Pennsylvania, lith his/her last family or p"n al residence at 153 W. Vine Street, Shiremanstown, PA 17011 I.Y V. , :hd (list street. 'mlmber and municipality) ./ Decedent, then 84 years of age, died OCT. 8 ,:Z..Q.QL ,at M Q (', (Location) Decedent at death owned property with estimated values as follows: , nnn nn (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 ....................................................................................... $ Total............................... ..................................................................................... $ 5 000.00 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: I ~nature Typed or printed name and residence I :=f~,~tJ 'P" '^ L, ~ / Hazel K. Duncan 1 1 ~. M<"'" ~. ~ n. ,) 1705 RW-7 _C Fl- I , I 8S- I--:z. O. A ('c<;: _ K\lfYl04E~ Ie~ Ele 1* 78 L/ 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 tru and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Dece nt, Petitioner(s) will well and truly administer the estate ac ord' g to law r Sworn to and affirmed and subscribed before me this 1 7 t h OCTOBRER 2002 day of ~~1'Ld~ '~l-U / ~~ . DECREE OF REGISTER Estate of Madelvn P Kilmover also known as Social Security No: 175-05-6830 OCOTBER 23, Deceased No, Date of Death: OCTOBER 8 2002 2002 AND NOW, on the reverse side hereon, satisfactory proof having been presented before me, , in consideration of the Petition IT IS DECREED that Letters (8J Testamentary 0 of Administration C (c.I.a., d.D.n.c.t.; pendente lite; durante absentia; durante minoritate are hereby granted to HAZEL K DUNCAN < in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. 7-26-1989 FEES Letters ............,..............,......., $ 25.00 Short Certificate(s) ...J~QL $ 30.00 Renunciation ........................., $ Affidavit ( ) ....................... $ Extra Pages ( )............., $ , 00 Codicil................................. $ JCP Fee ................................. $ 5.00 Inventory & Tax Forms............. $ Other ...................................... $ TOTAL .............................$ h' nn mailed to RW-7A f'C!';'_ KILtrn\lfill""l\er.> ,H nr:;ftS Attorney: James I.D. No: 09667 Address: 4000 Vine Street Middletown PA 17057 Telephone: 717-944-1333 DATE FILED: lt9btm2 1 0-23-2002 atty 10-23-2 BI()'UW'; ItEV9i8(, This is to certify that the information here given is correctly copied from an original certificate of death duly filed wit me as Local Registrar. The original certificate will be forwarded to the Stare Viral Records Office for permanem filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ",~,"'r~\1.'".'O.tp.~.:t.;.~ l#_:. ,...''' ~'\ f~~. : <::<\ ~~ ,;i "~.. ~i i ~f ' -f$i~: i~~ \ *' ". ........'" ;/*1 . ~ . ,- /.~' ~,...,~--= '{:~~;~l "_~~1"'EN1 ~\ ~ ,." ~"'''''I'''NNN1JJJllllf! ~k~ Fee for this certifica(e, $2.00 Local Registrar P 8629701 OCT 1 4 2002 Date :4JAiW 2187 COMMONWEALTH OF PENHSVLVAN)A . DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH AGE\laslBorFoaI'l UNDf:f'lIYV.Fl ........ '''' Madel IJNOEf'lIDMt ......! ..ino.oIa .. ctr't'. 9OAO. TWf" OF OEATH '" F<1.Il1<1le 5T.....I ~'I.E...lItollll!R $OC1AoL SECURITY NUMBER ,. 175 05 6830 CWEOFOEATH,1oI(:1lIh ,Oc.tobu 8 , .., NMIEOF OECEOEHTlf_sr 1.1_.._ .. , 84 COUNTY OF OEAI"H ,. PA PLM:€OFOEATH(~"-;A"""""""., _.......'''''''''''...''''<JII'eI>><.lel HOSPrtt.&.. -- lnp.ol"""~ Ef\ICluIpM.....O ~D 2002 Oau hin DECEDENT'S USUAL OCCUl'RlON ial_"=:'~~~:r 11.. PVt-60nne..f Mana VI. 1 DECEDENT'S MM.JNG AODAES$ (SIr... c.erno-.. ~ Z'f) COdal 153 Wut Vine S:Vteet Oerry Twp. KIHO Of' BUSlNESSIINOUSTAY M. S. Hershey Medical Cenler ~DECeDf:NTEVERIH us. ARW:OF0flGES1 ...0 NaKl :=-"YlO AACE.~ .&l.d<.WtQ._ ,_. .. Sh.iJtellUUl4.1:own. PA 17011 FAllfEIrSNAMEtFrst~.L"'J .. Whi rnc. '". .. '- 10-121 12 w.Alw..STAfIJS.~ _......-d.~ -- ...Ne V!Ut IMvur..ied (11-,,,.. -. ''". Did 17c.i' "._~in - _.. CumbeJtia.nd --";'1 17..0 :...a:-.:::ol MOTHER'SN/IME,h.. M.daIe.IoIaodenSu~ ... 11-. Stale Sh.iJtemaru..town - ". INFQRWANl'S!WE rt'fP'/Pl..... LiD d E. Kilmo !Ut Mk~. Hazel Vuncan "--"-sa...O . COLoN C,nv{~' NtE:rrr-J.T/fT:J:.<-. DlIElOlOAAS",C(WSEOUENCECF1; / Hait!t.u.bWl . oc..te. 0 !ti~ P OArE EO lMclPIl.OoIy....... .... w.,SC...sEAlFERAEOTO~'M1R1COFlOHERl '\Wid' j NoD " !=...-=-. I'ARtIt: '::'.=~~_ 1--- , i 17109 !tem 21.. on 17109 "'- TIME OF DEATH ORE PRONOuNCED DEAD (Monf>. 0.,-. YeiYI 24. .~ >v e,1 M. 21. OC.-ro,1~ 1;; ;2..00.;?.. 27.P/lIfTI: E-""'__........or~IOftidl~I".OII.Ih,Du_._u..muclfoldymg._n<.....ailCor'_aIOrya<'."'._kor""."la.Iut. LiIlonlV_~CII'I_... -... inPIIRTI L DUElOlCflloSA CONSEOUENCE Ofl DUE TO(OR/IS"CONS{:OUENCE Of); I'lEAU'JOf'SYFINDINGS UANHEA OF DEATH .-aILA8I.e:PRIOfIlO COUPl.E11ONOFCAUSE cs 0 "..,........ -- t-\QmJcao - 0 "-'9-0gMi0r0 0 ... 0 ...... ...0 ...I!ll. ....... 0 Co<6O........"-.."""_ 0 DATE 0#' IHJURY tMunnOay._' T...-e OF IN,JUAY kJURV IIJ V\oORI(? DESCAI8E HOW INJURY 0CCIJFlRE . .... 0 NoD a.. 2811. corr.....tC,,_ onr,Of'Wl 'carrlFYlNG,,"YSlClAM\Pt\fOIIC-~~d__"""""'PII"""_llasprOtlClUr1(;e<l<loo_"""'CCllTlpoOleOJlem2J! T....IIIII..ot...._............__............UtlH(.'_m_n...'-Ct. . >s. PlACE OF INJUflV......_-.;.... $I'M. 1_. oMI:. ~_,ISpolC>lvl _. .. lOCAJlOHfSlr_.CoIy{bwn, S-l .... SKOWIruAE AND nTlE OF CERTIFIER ;?<!:c:.e. k....,;.. 1~/,:;2.-/,7I- o . lICEMSEN\JUBf.A tlRESlGHEDI""'-.Oa-,. lYJ1. . ,-1.)'-)O~ j_~~il-f.- _ 31". ~_it?.:'.i~e.. HAw: At<<) ..ooRIESS OF PE.ASOrol WHO COMPlETED CAUSE OF DE""'H (lle<t>l1\ry~cxp.lCll fJ rlc-tc.V R.. ~i~ 32. r-.t S. Hersl~\' Medical Center Hcrsl~\'. P :H~E:~!~~ ..:.b.,:.L- .Pl'lONOtJtrtClNGAN[ICERTIFYINOI'HYSlCIAN(~_...."''''''''''1f\Qoe-A>''''''c_~IO~oIdl'61~. 1.....~.....'k....___.lIN...0C<:..,...,&I..._.....Ie._plac:......._"'_<:a....I..I."""'a"".....""I_.. "yEOtCAllXAllIHfRlCOAOHEf'l On...NJi.oIu~1l0nandlOO'iIl....liotP~.lnrn'opillion.de.lhOCC'W..d dlhel......d.t.. ARdp..u. 'nddw.to lheUUH,"'J."" _...1................................................................................................... ,... AEGlSTR.Ul'S SIGNATURE A,.,ONUMaEA aC4C/ .??z ~~r - .~--,~ ,. ---- ntH) JON F. LAFAVER 41 3]7 THIRD STREET 0 >JEW CUMBERLAND, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF MADELYN P. KILMOYER Ii 21-02-945 I, MADELYN P. KILMOYER, of Shiremanstown, Cumberland County, of sound mind, memory and understanding, do hereby mak 'publish and declare this as and for my Last Will and Testament hereby revo ng and all other wills by me at any time heretofore made. 1. I direct that my Executrix hereinafter named shall pay all my ju '[debts and funeral expenses as soon as conveniently may be done after my de ase , i II. :1 :! All the rest, residue and remainder of my estate, whether real, il II . :'personal or mixed, and wheresoever s~tuate, I hereby give, devise and bequ th il :'unto my sister, HAZEL K. DUNCAN, or if she does not survive me, then unto r 1! ! !issue, in equal shares per stirpes. :i !i " III. " ~ \ I I hereby nominate, constitute and appoint my sister, HAZEL K. D AN, .,as Executrix of this, my Last Will and Testament. If the said Hazel K. Dun an is~ould predecease me, fail to qualify or cease to act as such, then I nomin te " I Iconstitute and appoint my nephew, DAVID V. DUNCAN, as Executor. I IV. No fiduciary acting under this Will shall be required to post bon in this jurisdiction or in any jurisdiction in which he may act. LAW Qll<flC~.s JON F, lAIP~~e:R: 317 THIRtl. 'S'lt:Et:r NEW CUMBER u.r.tD. E"A IN WITNESS WHEREOF, I, MADELYN P. KILMOYER, the Testatrix, have u :2.." rf;, da ,this, my Last Will and Testament, set my hand and seal this u_ y of o :j.0'O , A. D., 1989. I .~' r~li-ti .(lvtT1 iJ (. , !(,;J LNd--'0 t/'v' ( J AL) Page one of two Pages LAW OFFICES JON F. LAFAVER 317 THIRD STREET NEW CUMBERLAND, PA SIGNED. by MADELYN P. KILMOYER, e Testatrix, as and for her Last W:LU and Testament, in the pre nee of us who have hereunto subscribed our names .a$ witnesses at her request, n the presence of the said Testatrix and in the ~resence of each other. / Page two of t~o Wages Sworn to or affirmed me this ;--. (Address) REGISTER OF WILLS OF cmIBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-02-945 ,- ;]/1U;d V JJ J)/Jc'A/J o'Jd ,Sf./Jl-l2N) 8. 'u U A-J:. JI1 //.J (each) a subscriber hereto, (each) being duly qualified according to law. depose(s) and ~ay(s) that We CLtC~ familiar with the signature ofJ.f1r!Y<!ln V .c: JffJOLJq<..., codicil IJ testat~ of (one of the subscribing witnesses to) the @ presented herewith and codicil that II X:" //..12. f'~ believes the signature on th@is in the handwriting of ) to the best of OL(' knowledge and belief. Sworn to or affirmed and subscribed before me this 22nd day of OCTOBER 2002 ~ ~~a:.f;.~.'t' V. UV1V~.J . fNamt;.) ))-5 < <?1-<?.,3,z",uK. '''~' ""'.<7IJ/&>_~,'V ( ) 11 5) (Address) 5JL.i!I'/}t/ A .~UAJeiJIl" , / (Nam~ 'vi rf tI. ;,. fl4{ I{ .iT!1 n (i// /IJ. .! ''Zis ~ rfiddress) Yi(.....;:.u:L.u W1tv-rL- :~ ./70 (J-7 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA J CERTIFICATION OF NOTICE UNDER RULE 5.6Ia) Name of Decedent: MADEL YN P. KILMOYER Date of Death: 10/8/02 Will No. Admin. No. 2002-00945 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court uJes was served on or mailed to the following beneficiaries of the above-captioned estate on 10/31/02 Name Address HazelK. Duncan 11 Beechwood Drive Middletown PA 1 57 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NO EXCEPTIONS Date: /Oh/~ / Signatur Name: Pannebaker & Jones P.C. Address: 4000 Vine Street Middletown PA 17 7 Telephone(717) - 944-133 -'I 1.- Capacity: X Personal Representative Counsel for Personal Representative Rt"I-1500 EX + (5-00) * I- Z W C W U W C w !;;: ",-<n 0"'''' w"-o ",00 0"'.... "-m "- .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) 1 0/08/2002 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT c..- OFFICIAL USE ONLY u- 9'6-- II.! FILE NUMBER -4TYcbr - 0 YEA;- J!... J!... N~8ER-i. 2- SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 75--0-5680 THIS RETURN MUST BE FILED IN DUPLICATE wrrH THE REGISTER OF WILLS 11/16/1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER lKl1. Original Return D 4. Limited Estate lKl 6. Decedent Died Testate (Atlach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dateofdeath after 12-12-82) D 7. Decedent Maintained a Living Trust (AltachcoPyofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1.95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o ~ :J l- ii: <C u W lII:: z o ~ :J II. ::!: o U S .;",,"..; 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owne<l Property (Sche<lule 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 olDecedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total 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) .... z w o z o "- <n w '" '" o o I NAME James B. Pannebaker, Es uire FIRM NAME (If Applicable) PANNEBAKER AND JONES, P.C. TELEPHONE NUMBER 717944-1333 Middletown PA 17057 75,000.00 ! OFFICIAL USE 01 2,975.00 173,748.04 J (8) 251,723,04 10,258.79 594.06 (11) (12) (13) 10,852.85 240,870.19 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 (14) 240,870.19 X 0_(15) X 0_(16) 240,870.19 X .12 (17) 28,904.42 X .15 (18) (19) 28,904.42 ;,,;;;;;;;::;: ;;;+\\"'"'//''''' 'ifidiiiJi! 1m fUrL!!;, CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT 20. 0 Decedent's ComDlete Address: S1REE1 ADDRESS 1 W t V' 5t t . , .. 53 es me ree CITY . I STA1E PA I ZIP 17011 5hlremanstown Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 28,904.42 1 .445.22 Total Crecits (A + B +C) (2) 1,445.22 3. InleresVPenalty If applicable D. Interest E. Penally TotallnteresUPenalty (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 greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILLS, AGENT 27,459.20 27,459.20 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; ........................................................................,.. 0 [2SJ b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [2SJ c. retain a reversionary interest; or ...................................................................................................... 0 [Z] d. receive the promise for life of either payments, benefits or care? ........................,.................................... 0 [2SJ 2. II death occurred after December 12, 1982, did dececent Iransfer property wllhln one year of death without receiving adequate consideralion?....................... ..................... .................................................. 0 [2SJ 3. Did dececent own an 'in trust for" or payable upon death bank account or security al his or her death? ................. 0 [2SJ 4. Did decedent own an Individual Relirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 [2SJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nel value of transfers 10 or for the use of Ihe surviving spouse is 3% [72 P.S. 1}9116 (a) (1 .1) (il]. For dates of death on or after January 1, 1995, the tax rate imposec on Ihe net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 1}9116 (a) (1.1) (il)]. The statute does not exemot a transfer to a surviving spouse from tax. and the statutory requirements for disclosure 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 child twenty-one years 01 age or younger at death to or for the use of a nalural parenl, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1 .2)]. The lax rale imposed on Ihe net value of Iransfers 10 or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. 1}9116(1.2) [72 P.S. 1}9116(a)(1)). The tax rate imposed on the net value ottransters to or for the use of the decedenrs siblings is 12% [72 P.S. 99116(a)(I.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~'~~.I1C:". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Kilmover Madelvn P 02 00945 All real property owned solely or as a tenant in common must be reported at fair market value. Fair marKet value is defule<:l as the price at which property would be exchanged between a wjJljng 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 75,000.00 Real Estate Property Situate at: 153 W. Vine Street Shiremanstown, PA 17011 (Estimated Sale, Net of Expenses/Costs) TOTAL (Also enter on line 1, Recapitulation) $ 75,000.00 '~'~EX'I'''! '* COMMONWEALTH OF PENNSYLVANIA INHERIT ANeE TAX RETURN RESIDENT DECEDEN1 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY KilmOVAr Madelvn P FILE NUMBER 02 00945 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 1992, Ford Sedan, Serial #1FACP52UINA109189 VALUE AT DATE OF DEATH 2,725.00 2. Misc. Furniture, Artifacts & Jewelry 250.00 TOTAL (Also enter on line 5, Recapitulation) $ (It more space is needed, insert additionai sheets of the same size) 2,975.00 e"','~9EX'I,I,",,~_ "~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY -OWNED PROPERTY ESTATE OF Kilmover Madelvn P If an as.set was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 02 00945 SURVIVING JOINT TENANT(S} NAME ADDRESS RELA TIQNSHIP TO DECEDENT A. Hazel K. Duncan 11 Beechwood Drive Middletown, PA 17057 Sister B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include !\<llT\e of financial (nstitutiorl and bank account \'lumber or similar identifying number, Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1- A, PNC Bank-CD#31900213292, Held as in Trust for 90,026.48 100, 90,026.48 Hazel K. Duncan, Purchased for 7/6/01 2. A. PNC Bank-CD#31700215485, Held as In Trustfor Hazel 20,011.56 100. 20,011.56 K. Duncan, Purchased 8/3/01 3. A. Agway, Inc. Has filed for Chapter 11 Bankruptcy 0.00 CD#ZG120, Face Value $10,OOO.00-repayment is uncertain 4. A. Agway, Inc. Has filed for Chapter 11 Bankruptcy 0.00 CD#LD164, Face Value $20,OOO.00-repayment is uncertain 5. A. Agway, Inc.Has filed for Chapter 11 Bankruptcy 0.00 CD#ZM799, Face Value $10,OOO.00-Repayment is uncertain 6. A. Agway, Inc. has filed for Chapter 11 Bankruptcy 0.00 CD#OG41, Face Value $1 O,OOO.OO-repayment is uncertain 7. A. Agway, Inc. Has filed for Chapter 11 Bankruptcy 0.00 CD#OK111, Face Value $20,000.00-repayment is uncertain 8. A. 2/15/02 Commerce Bank-Savings Acct #616306925 40,650.61 100. 40,650.61 Date Opened 2/7/02 9. A. PNC Bank-Checking Acct #51-4003-4264 23,059.39 100. 23,059.39 10/4/02 Bank Statement Balance TOTAL (Also enter on line 6. Recapitulation) $ 173,748.04 (II more space Is needed, insert additional sheets of the same size) REGISTER OF WILLS DAUPHIN COUNTY, PENNSYLVANIA INVENTORY Estate of Madelyn P. Kilmoyer No. 02 00945 also known as Date of Death 1 0/08/2002 , Deceased Social Security No. 175-05-68 Personal Representative(s) of the above Estate, deceased. verify that the items appearing in the following inventory indude 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. I/We 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 EXEr.UTRTX Attorney: James B. Pannebaker, Esquire HAZEL K. DUNCAN I.D. No.: 09667 Address: 4000 Vine Street Dated 12/27/02 Middletown PA 17057 Telephone: (717)944-1333 Description Value 1992, Ford Sedan, Serial #1FACP52UINA109189 2,725.0 Misc. Furniture, Artifacts & Jewelry 250.0 Real Estate Property Situate at: 75,000.0 153 W. Vine Street . . Shiremanstown, PA 17011 (Estimated Sale, Net of Expenses/Costs) ~ .- '. , I,,' '.' , . - , , Total 77,975.0 (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 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA '7128-0601 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: PANNEBAKER JAMES B ESQUIRE 4000 VINE STREET MIDDLETOWN, PA 17057 _n__h~ fold ESTATE INFORMATION: SSN: 175-05-6830 FILE NUMBER: 2102-0945 DECEDENT NAME: KllMOYER MADEL YN P DATE OF PAYMENT: 12/31/2002 POSTMARK DATE: 12/30/2002 COUNTY: CUMBERLAND DATE OF DEATH: 10/08/2002 TOTAL AMOUNT P REMARKS: HAZEL K DUNCAN C/O JAMES B PANNEBAKER ESQUIRE CHECK# 113 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS REV-1162 EX(1 1-9 E TAX NO. CD 0020H ACN SSESSMENT AMOUNT CONTROL NUMBER --- -- 101 I $27,459.20 I I I I I I I I AID: $27,459.20 DONNA M. OTTO DEPUTY REGISTER OF WillS A ::!' .~ ,'" d r .., .... Q a: -: "'0 J: .... g ~ o '" C' .c ~ ~ M ~ ":C VI .... ~ .... .... ...,j n >.f\ -.1 ~ (U .... -.1 o (U .c u.I -.1 .Jl IS' , 't'> - , \ \ \ \ \ , ... Q ~ '" ", -0 '"' . * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 S fJPPLEMfNTAI- REV-1500i7 'r~-ft/ INHERITANCE TAX RETURN RESIDENT DECEDENT w >- ::.:::$(1) 0"'>: w..o ,,00 0"'... .." .. " z o i= <( ...I ::::J l- ii: <( () W It: z o ~ I- ::::J Il. ::!: o () ~ I- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W () W C KILMOYER MADELYN P. DATE OF BIRTH (MM-DD-Year) DATE OF DEATH (MM-OO-Year) 10/08/2002 11/06/1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) D 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (AltachcopyofWiII) o g, litigation Proceeds Received [Rl 2. Supplemental Return o 4a. Future Interest Compromise (dateofdeathafler 12.12.82) D 7. Decedent Maintained a living Trust (Attach copy alTrust) o 10. Spousal Poverty Credit (dale of death between 12.31-91 and 1-1-95) >- Z W C Z o .. V> W '" '" o o THISissi!fjo~1IIIl:II11i!1l i!illllM~LI!iItliiDi!( 'iIii!IlDM . l!!eI!iNIlE,i1\1I NAME James B. Pannebaker, Es uire FIRM NAME (If Applicable) Pannebaker & Jones, P.C. TELEPHONE NUMBER 717-944-1333 Nlli1\!!i:r:!:iI' 'llitlll!llllDlli'.u' COMPLETE MAiliNG ADDRESS Pannebaker & Jones, P.C. 4000 Vine Street Middletown 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o 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. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (8) 13. Charitable and Governmental BequestsfSec 9113 Trusts for which an election 10 tax has not been made (Schedule J) 14, Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X_(15) X _(16) 1,530.82 X 12 (17) X .15 (18) (19) 16. Amount of line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT E SIDE~IiII:l< ECH r:11€. # 17585- OFFICIAL USE ONLY <!- FILE NUMBER .:21 -02 00945 """Cci"U"NTY""Cci5E ----vE~ - - 'NUMiiER-- SOCIAL SECURITY NUMBER 175-05-6830 THIS RETURN MUST BE FILEO IN OUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-S2) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11, Election to tax under Sec. 9113(A} (AltachSchO) PA 17057 11 ,500.00 I~ I OFFICIAL USE ONLY 466.82 u_~_~1 11,966.82 10,436.00 (11) (12) (13) 10,436.00 1,530.82 (14) 1,530.82 183.70 183.70 " .:.~..., . .~~ .... .,. . ." /',." lit .. \'~ "'. '.... ...; ....."...1 \;; :/..... <(',. Decepent's Complete Address: STREET ADDRESS 153 West Vine Street CITY I STATE PA I ZIP 17011 Shiremanstown Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 183.70 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D.lnterest E. Penalty TotallnteresUPenalty ( D + E) (3) 4. it Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILLS, AGENT 183.70 183.70 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; ..................................... ......,............... .............. 0 D b. retain the right to designate who shall use the property transferred or its income; ......................... .............. 0 0 c. retain a reversionary interest; or ...................................................................................................... D 0 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. ..................................... .......................,.............................,.. D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................ ............................................................... D 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 perjury, I declare that I have examined this return, includinq accompanying schedules and statements, afld to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the persoflal representative is based on all mformation of which preparer has afly knowledge. SIGNATURE OF. PERS N RESPONSIBLE F R FIL RETURN DATE ADDRESS aze. Duncan, Executrix 11 Beechwood Drive, Middletown SIGNATURE OF PREPA ER ATIVE ADDRESS Jam . Pannebaker, Equire Pa nebaker & Jones, P.C., 4000 Vine Street, Middletown PA 17057 ""1','" , """r 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. 99116 (a) (1.1) (ill. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% (72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed onthe net value of transfers from a deceased child twenty."ne 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. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !i9116(1.2) [72 P.S. !i9116(a)(I)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102 as an individual who has af leasl one parenl in common with the decedent, whelher by blood or adoption. ' .'''''"''':I'~''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN I ESTATE OF FILE NUMBER KILMOYER MADEL YN P 02 00945 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 SCHEDULE A REAL ESTATE survivorshiD must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate situate at 153 W. Vine Street Shiremanstown PA 17011 To Restate Value of Property Sold-1 /31 /03 to Lisa A. Kemas for $86,500.00 Previously reported as Estimate Sale, net of expenses/costs $75000.00 11,500.00 Net Increase $11 500.00 TOTAL (Also enter on line 1, Recapitulation) $ 11,500.00 /""'J"Cf/7P1)l pzv, /7'1''''2::> AS ( i<"-~l- v '"'.--- '\ "IJI oax~ 'Nv::lNnci'~ l3Z'tH Jallas S3V>13>1' _d1'1urC~ I) ~ ,CYy r V' ",7/ / JaMOJJog l8'Of:S'9l IB173S ( WOlid )(01 X ) HS'rf::! '009 60TSC'l 1i3MOliClOS ( 01 ) (WOCld X ) HS'rf::! 'ODE 009CV'O, ) (Olr; sun) Jauas ana suO(pnpaCl 5881 'lOg 98'8lC'68 } (Oll gUn) .laMo.uoa ..lO::l!^8 Pled 1unow\i ssal 'laC 08'996'98 I (02:17 aUlll J8W3S 0.1 ana lunow'<:j SSOJE) . ~O9 %,89"6 <aU aUil) J8MOJJ08 WOJ.::! ana junowv SSOJ8 . ~O€ :1l3113S WOll~/OJ. 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IES!ElddV "t:OB 01 % luno:JS!O ueol 'GaS 01 % aa::! UOljEUIDPO ueol . we NV01 H.LIM NOI.L:J3NN08 NI 31811Alid SW3.L1 'OOB '8NI 'A.L lli3lJ IlJ3NOl8SId Ic AlJn.LN38 0) 33. NOI.L8liSNIi>ll 'POL , 1uawamag lE PIEd UO!SSIWWO:) TOL i '8NI 'A.L 11l3lJ 1~3N018Sld '~c AlJn.LN38 0) OS'ZOO'( $ 'ZOL I '8NI '.LlJN-lilJ3 OJ 09'c90'f: $ 'IOL :sMollod se (OOL au!!) UO!SS!WWO;))O UO!S!/110 I 00"9S0'9 % GOOO'L '@ 00'009'99 $ 8:JPd 1.10 pasea NOISSIWWO:) 1'0'101. 'OOL S3~~VH::J IN311\131.ll3S '1 Wa5V \uawamas AN dW08 .L::>1i~ I ~81i A.LllJnd >~ / '-.:....;7 :JOd 00'998 00'S98 00'68 $ saseala~ 0S'9 ~ 00' OS! ( 9L'08L 1S0-f:O'd ( 00'9 OO'G! 80dl0330 00'~90'9 lN3lf\l31.1l3S 1 V' SGNf'd S;~::I3113S V>lO~.=I Ql'ltd OP'ZO(:- LllUOW '..nuow 41UDW cS'f:eL 4lUDW 41uDW 16'06(: 4lUOW 41UOW 9c'99 41UOW Sc'89n DIP! 00'9Sc OS'ZZ OO'SL OOOP 00'96 ~ lN31N31l1-3S .I.'lJSONf\::l s.~3Mmftl08 V'lO'!:!:!Ol'fd ::lOd ~9Z$ 80d OSf:$ 'Moo anlf e aq 01 pa!J11188 OREV""""W''',* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF KILMOYER MADEL YN p FILE NUMBER 02 00945 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION School Tax - (01/31/03 - 7/01/02) (Real Estate Settlement) VALUE AT DATE OF DEATH 449.02 2. 1st Quarter Sewer (01/31/03-4/01/03) 16.00 3. January Assn. Fee (01/31/03 to 2/01/03) 1.80 TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same Size) 466.82 ..~- ."""m;ii"'~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KILMOYER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS MADEL YN FILE NUMBER 02 00945 P Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. DESCRIPTION AMOUNT 6,055.00 Century 21/Piscioneri Realty Inc. - Sales Commission, 1/31/03 Notary - Notary Fee 1/31/03 6.00 State Transfer Charges - Mortgage, 1/31/03 865.00 AON - Home Warranty Services, 1/31/03 399.00 ERA-NRT, INC. - Transaction Fee, 1/31103 100.00 Home Spec - Pest Control Treatment 1/31/03 302.10 Property Management Inc. - Resale Certificate Fee, 1/31/03 37.50 Closing Cost Credit, 1/31/03 2,500.00 County/Borough taxes - adjustment of unpaid taxes 1/31/03 28.86 Paul's Maintenance-Repairs 1/31/03 100.00 David V. Duncan - Home Repair Services 1/31/03 42.54 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 10,436.00 COMMQNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARI!ISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 02-0945 ACN 02152727 DATE 12-19-2002 REV~15U EM ArP {09.00l EST. OF MADELVN P KILMOVER 5.5. NO. 175-05-6830 DATE OF DEATH 10-08-2002 COUNTY CUMBERLAND TVPE OF ACCOUNT o SAVINGS o CHECKING IX] TRUST o CERTIF. HAZEL K DUNCAN 11 BEECHWOOD DR MIDDLETOWN PA 17057 REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PHC BANK has provided the Dapart_ant with tha information listlild balow which has bean used in calculating the potential tax due. Thair records indicata that at tha dasth of tha above decadent, you were a ioint owner/beneficiary of this account. If yoU feal this information'is incorrect, please obtain written correction from the financial institution, attach a COPY to this form and rBturn it to tha above address. This account is taxable in accordsnca with the Inheritance Tax Laws of tha Com.onwBalth of Pennsylvania. Questinn~ III..W hA i'lnswl;>,.ed boY r-!l!!i!"!!: (717J 7!1-e3:!7. oat. Established REVERSE SIDE FOR 06-05-2000 FILING AND PAVMENT INSTRUCTIONS COMPLETE PART 1 BELOW . Account No. 31900213292 . . SEE Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 90,026.48 100.00 90,026.48 .15 13,503.97 To insura proper credit to your account, two (2) copies of this notice nust acco.pany your paYlIKlnt to the Ragister of Wills. Make check payable to: "Ragister of Wills, Agent". x NOTE: If tax payments are made within thrae (3) months of the dacedent's date of death, YOU .ay daduct a 5% discount of the taK dug. Any inheritance taK dUB will bacoma delinquent nine (9) months aftar the date of death. PART TAXPAYER RESPONSE m 1F"A:XIllI1~::~~Q:::''i!:''DH'j;:X':''R~:':::II::'::>:....iiI:::II!\X:::',I!\S!l:1K\!:::::.~:::fxs~HmJlU -...... ,,_ ,_,__._ ~~-.-.-. "u,,;,\,~;f!i!L"'9"_,,-,_u'_"""F"""__ _ _ ,,_~"""._,_._. _.u."...,.,.,.,_~.~,....u,.,.",,,,~~~,,,~J.l\_._i',,u.'u,.;.,"-""-"""";'"H" ,_,_.,.,.,...,,',...,_,_._._u,.'u.,., ...._._..u,...,.;_,"',""-,,,,,,,,,-,,,-,,,-,,,-,""',,,-",-,"""',.,...""'-"'-"'''''''''-'-'''''''';''''''-'-'''''''') :;,;,'",'""",,,,),:,:;:;:;,,.,;'.,,,,,,,:,:;:;r,~',,,,,.,""""<':"""""""':""""",(""""':','j',,;':;: .'...,;,.",;,:",,,,,.,,,.,.,., "''''''''''''''''''''''''''';'''''''''''''''''''''''''''''''''''''''' ''''"""""""""""''''''''''-''''''''''''''''.'.'''",'''''''''''.''""""""'''''''''''''''''''''''''''''''''''''''''''''''.'.''':l:l;'''''jj'''''''''''''''''''''''''''''''''''''''':' [CHECK ] ONE BLOCK ONLY A. 0 The above information and taK due is correct. 1. YOU.ay choose to ramit pay.ant to the RegIster of Wills with two copies of this notice to obtain 8 discount or avoid intarest, or you .ay check box "An and return this notice to the Ragister of Wills and an offi~ial assess_ent will be issued by the PA Dapartment of Revanua. B. 0 The above assat has been or will be reported and tax paid with tha Pennsylvania InharitancB Tax return to ba filad by the decadent's l"epl"esentative. C. 0 Tha above information is incorrlilct and/or debts and deductions were paid by yOU. 'fou must cQllplete PART ~ and/or PART 0 below. PART [!] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent laxab1e 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAVEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Co.putation) Under penalties of perjury, I declare that the facts I have reported above .ra true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,.. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 02-0945 ACN 02152726 DATE 12-19-2002 REV-150 EX iF" (n~OOJ EST. OF MADElYN P KllMOYER 5.5. NO. 175-05-6830 DATE OF DEATH 10-08-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING iii TRUST o CERTIF. HAZEL K DUNCAN 11 BEECHWOOD DR MIDDLETOWN PA 17057 REMIT PAYMENT AND FORMS TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided ths Department with the inforllation listed below which has been ussd in calculating the potential tax due. Their records indicate that at the death of the above decedsnt, you were a joint owner/beneficiary of this account. If you feel this infor_ation is incorrect, please obtain written correction froll ths financial institution, attach a COpy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Psnnsylvanfa. QU8~tions may ba answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . Account No. 31700215485 . . SEE Date Established REVERSE SIDE FOR 08-03-2001 FILING AND PAYMENT INSTRUCTIONS Account Balance 20 1 0 11 . 56 Percent Taxable X 100.00 Allount Subject to Tax 20/011.56 Tax Rate X .15 Potential Tax Due 3/001.73 PART TAXPAYER RESPONSE mli!i~i~I~~~liii!~li!!!.II"i!!iil~~~iliii~I!.~ii!i!~'iiii~li!!!~~lh~~i~~ii!!i~~~!i!il~~.,!liii!i.~g!!ii,.!ii!.~~m!.~~~J To insurs proper credit to your account, two (2) copies of this notice .ust accompany your payment to the Registsr of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax p8Yllents are lIade within three (3) Ilonths of the decedsnt.s date of death, you may deduct a 5% discount of the tax due. Any inhsritance tax due will become delinquent nins (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. 0 The above infor.atian and tax due is correct. 1. You may choose to re.it paYllent to the Register of Wills with two copies of this notice to obtain B discount or avoid intersst, or you may check box "An and rsturn this no tics to the Register of Wills and an official assesSllent will bs issued by the PA Department of Revenus. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s rspr",sentative. C. 0 The above information is incorrect and/or dsbts and deductions were paid by you. You .ust co.pletB PART 0 and/or PART 0 below. If you indicate a different tax rate 1 please state your relationship to decedent: PART [!j DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART .~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax COllputation] I $ Under penalties of perjury 1 I declare that the facts I have reported above Bre truel correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE CO~HONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEP~. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 02-0945 02152728 12-19-2002 REV-lS4!EXAFPla9-DOl TYPE OF ACCOUNT o SAVINGS IXJ CHECKING o TRUST o CERTIF. TO: EST. OF MADELYN P KILMOYER 5.5. NO. 175-05-6830 DATE OF DEATH 10-08-2002 COUNTY CUMBERLAND HAZEL K DUNCAN 11 BEECHWOOD DR MIDDLETOWN PA 17057 REMIT PAYMENT AND FORMS REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Depart.ent with- the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of this account. If yOU feel this infor.ation is incorrect, please obtain written correction frail the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COMllonwealth of PBnn~ylvania. QU8~tior.~ ~ay b6 ar.S~Br.d b~ c~~lin9 (717) 7&7-6327. COMPLETE PART 1 BELOW Account No. 514003'4264 JI JI JI SEE Date Established REVERSE SIDE FOR 05-10-1995 FILING AND PAYMENT INSTRUCTIONS Account Balance 23,264.11 Percent Taxable X 50 . 000 Allount Subject to Tax 11,632.06 Tax Rat. X .15 Potential Tax Due 1,744.81 PART TAXPAYER RESPONSE [!]ll!I!!!~fij~~~~~I!!M!!!!'~.!I!i'~~~!!i!!~I~~!I!I!~I!~[~~I!!I.~!~~~II!!!~~~I!!!~~..~~I!!i!'~~D1!i[!.I!!~I~~!!!!l.~.!~ To insure proper credit to your account, two (2) copies of this notice IIUst accollpany your paYllent to the Register of Wills. Make check payable to: ftRegister of Wills, Agentft. NOTE: If tax paYllents are lIade within three (3) .onths of the decedent.s date of death, yoU lIay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. [CHECK ] ONE BLOCK ONLY A. c=J The above infor_ation and tax due is correct. 1. You may choose to rellit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box ftAft and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. c. c=J The above information is incorrect and/or debts and deductions were paid by you. You must cOllplete PART 0 and/or PART @] below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART 13.] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Allount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate a. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 X X PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax COMPutation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and COMplete to the best of IIY knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE Commerce "Banko. November 6, 2002 pannebaker and Jones, PC 4000 Vine St Middletown, PA 17057-3596 RE: Estate of: Madelyn P Kilmoyer Social Security #: 175-05-6830 Date of Death: October 8, 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: Savings Account #: 616306925 Date Opened: 2/7/02 Date Closed: 11/4/02 Primary Owner: Madelyn P Kilmoyer Secondary Owner: Hazel K Duncan Date of Death Balance: $40,650.61 Accrued Interest: $17.63 Hazel K Duncan was added as joint owner on 2/15/02. ,f the!:'e are any questions or additional information that is needed, please feel free to contact me at (717) 795-7118 ext. 3151. Sincerely, L0(l'Y)ch !~ ~L1."L'LLO Wanda J. Morris ClF Associate Commerce Bank I Harrisburg, N.A. P.O. Box 8599 100 Senate Avenue Camp Hill, Pennsylvania 17001-8599 .""""""'071* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS EST ATE OF Kilmover Madelvn P. Debts of decedent must be reported on Schedule I. FILE NUMBER 02 00945 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) SoCial Security Numbef(s) I EIN Number of Personal Representati'Je(s} Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees Pannebaker and Jones, P.C. 10,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees & Short Cerificates: Register of Wills 63.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Misc. Fax Charges-1 0/24/02 -Fax to Jack Gaugen 2.50 8. Misc. Fax Charge-11/25/02 -Fax to Agway Inc. 2.50 9. Estate Advertisements, 11/8, 15,22,2002-Cumberland Law Journal 75.00 10.0 Estate Advertisements, 11/5,12,19,2002- The Sentinal 115.79 TOTAL (Also enler on lin09, RecapitUlation) $ 10,258.79 (It more space is needed, insert additional sheets of the same size) '~""'2E"":"* COMMONWEALTH OF PENNSYLVANIA INHERITANCE r AX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Kilmover. Madelvn P FILE NUMBER 02 00945 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PA American Water Co.-10/9/02 Utility Services 25.52 2. Property Management, Inc.-Nov. Condo Fees 52.50 3. Bank Card Services-AccL Balance, 10/3/02 159.37 4. Comcast-TV Cable Service 36.93 5. UGI, 10/22/02 Utility Gas Service 36.64 6. PP&L Electric, 10/28/02 Utility Service 46.13 7. Property Management, Inc. - December Condo Fees 52.50 8. PA American Water Co, 11/12/02-Utility Services 11.14 9. Verizon.Phone Service, 11/14/02 6.88 10. PP&L Electric-11/28/02 Utility Service 26.48 11. UGI Utility Inc.-11/20/02 Utility Gas Service 84.22 12. Property Management Inc.-Jan. 2003 Condo Services 55.75 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same Size) 594.06 .'~'''m'J19''* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ,p n? M~'~ 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. Hazel K. Duncan. 88#184-12-2056 8ister 100% Remainder 11 Beechwood Drive Middletown, PA 17057 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 SHEET $ (If more space is needed, insert additional sheefs of the same size) , WHEREAS, dated July on the 23rd 26th 1989 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2002-00945 PA No. 21-02-0945 ESTATE OF KILMOYER MADELYN P ILAbl, rlKbl, M1UUL~) Late of SHIREMANSTOWN BOROUGH CUMH~KLM~U CUUN1Y, Deceased Social Security No. 175-05-6830 day of October 2002 an instrument was admitted to probate as the last. will of KILMOYER MADELYN P (LAbl, rlKbl, M1UUL~) late of SHIREMANSTOWN BOROUGH CUMBERLAND County, who died on the 8th day of October 2002 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to DUNCAN HAZEL K who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 23rd day of October 2002. ,Q ,,'," I iWJJ'~J~(.\!lltf i' , ..J {'-"'\.oJor- K'l'''~j **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAW OFflCE5 JON F. LAFAVJEllR tar 3\7 TH1RD STREET b )J EW CUMBERLAND. PENNSYLVANIA 17070 'I i i il I, il LAST WILL AND TESTAMENT OF MADELYN P. KILMOYER 21-02-945 I ! Pennsylvania , being I publish and declare I, MADELYN P. KILMOYER, of Shiremanstown, Cumberland County, of sound mind, memory and understanding, do hereby make, this as and for my Last Will and Testament hereby revoking "and making void any and all other wills by me at any time heretofore made. " " I I 'I I 'Idebts , I. I direct that my Executrix hereinafter named shall pay all my just and funeral expenses as soon as conveniently may be done after my decease II. All the rest, residue and remainder of my estate, whether real, 'personal or mixed, and wheresoever situate, 1 hereby give, devise and bequeath 'unto my sister, HAZEL K. DUNCAN, or if she does not survive me, then unto her issue, in equal shares per stirpes. ,I III. I hereby nominate, constitute and appoint my sister, HAZEL K. DUNCAN, '!as Executrix of this, my Last Will and Testament. If the said Hazel K. Duncan I: .1 "should predecease me, fail to qualify or cease to act as such, then I nominate I constitute and appoint my nephew, DAVID V. DUNCAN, as Executor. IV. No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. l..Il<W OFFICES JON F. LAFAVER IN WITNESS WHEREOF, I, MADELYN P. KILMOYER, the Testatrix, have unto this, my Last Will and Testament, set my hand and seal this :2..6 r{, day of 317 THlRO STREET ;EW CUMBERLAND. PA , ~A~J'i 'I (J U , A. D., 1989. III OjZ/;Ll " , ( , !f>J l,,,,,-H,'lt>1/ () (SEAL) Page one of two Pages ~ LAW OFFICES JON F. LAFAVER 317 THIRD STREET NEW CUMBERL.AND, PA " SIGNED, SEALED, PUBLISHED and DECLARED by MADELYN P. KILMOYER, the above-named Testatrix, as and for her Last Will and Testament, in the presence ,of us who have hereunto subscribed our names as witnesses at her request, in [the presence of the said Testatrix and in the presence of each other. ,I i / '! Page two of two Pages ~~~ PANNEBAKER AND JONES. P. C. FOUR THOUSAND VINE STREET MIDDLETOWN, PENNSYLVANIA 17057-3596 TELEPHONE E-MAIL ADDRESS TElECOPIER 717-944-1333 pjpc.pannebaker~jones.com 717-944-4004 PETIR R. HENNINGER, JR- DONALD L JONES JAMB B. PANNEBAKER December 30, 2002 Mary C. Lewis Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 RE: Estate or Madelyn P. Kilmoyer Estate No.: 2002-00945 ',A. Dear Ms. Lewis: Enclosed please find an original and three (3) copies of Inheritance tax return and inventory to be filed in the above Estate, along with a check in the amount of $27,459.20 representing the total amount of tax due and a check in the amount of $25.00 representing the fee due for the filing of the taxes. Please retain 2 copies for your files and return to copies to me in the enclosed self-addressed stamped envelope. If you have any questions please do not hesitate to give me a call. Sincerely, ~~~~ Legal Assistant CIVil LITIGATION PERSONAL INJURY WRONGFUL DEAlll AUTOMOBILE ACCIDENTS ESTATE PLANNING ESTATE SETTLEMENT llUSINESS LAW CORPORATE LAW FAMILYt.AW REAL ESTATE MUNICIPAL LAW LAND USE INSURANCE LAW ENVIRONMENTAL LAW :sls KILMOYERESTATE LT123002 #17585 VISIT OUR WEB SITE AT, www.pannebaker-jones.com k~-/ PANNEBAKER AND .JONEIIi. P. C. FOUR THOUSAND VINE STREET MIDDLETOWN, PENNSYLVANIA 17057-3596 TELEPHONE E-MAIL ADDRESS TELECOPIER 717-944-1333 pjpc.pannebaker~jone&.com 717-944-4004 PETER R. HENNINC DONAlD L JONES IAMB 8. PANNE February 21, 2003 Mary C. Lewis Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 RE: Estate of Madelyn P. Kilmoyer County Code No. 2002-00945 Our File No. 17585 Dear Ms. Lewis: Please find enClose} three (3) sets of a supplemental tax return for the above-named estate and a check for $183.70 for payment of additional tax due. Upon receipt please time-stamp our file copy and return it with a paid receipt. - Sincerely, ?-=y~ Ed :. LO unga ~ Legal Assistant EAC/rcs Enclosure -=-1:: If 2. ;),./""(' "if 6--'00 r-':/-:..y r~ VISIT OUR WEB SITE AT: www_pannebaker-jon...com !NTS Res: Kilmoyer17585-RegisterLtr022103 '" 8 ~ a ~ ~ -- ~ ~~~ C'>~ ~~"" ~'6"''''C'> rC\~\A' ';J,~';';<l~ t>~'e~~ ";"'C'>~<I> '?t'lo.... ~<I>~~ O%?-<I> ~~'6 ~ ~ ~ ~ ~ ~ ." ~ ~ & W>> ~ -e r- . . /~ . ~ (' 0;;; " l) T~ -t Y e, ,,,OJ, i.~(.. d> .;;.,.,\..:...~~ ~ % ~ \~ :;;1i;~"~ --l;l'l 11_ ?~"';"~ III ~ ..,,~- "" '<.1" % N . ~., COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: PANNEBAKER JAMES B ESQUIRE 4000 VINE STREET MIDDLETOWN, PA 17057 __uuB fold ESTATE INFORMATION: SSN: 175~O5~6830 FILE NUMBER: 2102-0945 DECEDENT NAME: KllMOYER MADEL YN P DATE OF PAYMENT: 02/24/2003 POSTMARK DATE: 02/21/2003 COUNTY: CUMBERLAND DATE OF DEATH: 10/08/2002 TOTAL AMOUNT REMARKS: HAZEL K DUNCAN C/O JAMES B PENNEBAKER ESQUIRE CHECK# 127 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS REV~1162 EX(11'-9 ) E TAX NO. CD 00220~ ACN SSESSMENT AMOUNT CONTROL NUMBER -- ~ 101 I $183.70 I I I I I I I I PAID: $183.70 DONNA M. OTTO DEPUTY REGISTER OF WillS A \, 17-~/~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-06Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR OISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN D2-25-2003 KILMOYER 10-08-2002 21 02-0945 CUMBERLAND 101 JAMES B PANNEBAKER ESQ PANNEBAKER & JONES 4000 VINE ST MIDDLETOWN PA 17057 Allount R..itt.d .EV-1541 Ell AFP ~ U) MADELY P MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... REY:is4'-EX-AFP-fiiFii3Y-NOTicniF-YriiiEii'iiAi"-CE-TAX-jiPPRAiSEMENT~--AiXciwANCE-iiR----------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KILMOYER MADELYN P FILE NO. 21 02-0945 ACN 101 DATE 02-25 003 TAX RETURN WAS: I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Kisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Totel Assets I CHANGED III 121 131 141 151 161 171 75.000.00 .00 .00 .00 2.975.00 173.748.04 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ad.. Costs/Hisc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitabl./Gover~ntal Bequestsi Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: I~ an assess.ent was issued previously, lines reflect ~igures that include the total af abb ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate liS) 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 17. A.uunt of Line 14 at Sibling rate (17) 18. A.ount of Line 14 taxable .t Collateral/Class B rate (18) 19. Principal Tax Due AX TS: IU1BER CD002010 INTEREST/PEN PAID I-I 1,445.22 DATE 12-30-2002 10,258.79 594.06 1111 1121 1131 1141 191 1101 NOTE: To insu credit to you sub.it the u of this for.. tax pay_nt. proper count, portion h your 251,72 .04 240,87 19 00 240,87 19 14, 15 and/or 16, 17, 18 and 1 returns assessed to date. ill .00 X 00 = .00 X 045 = 240,870.19 X 12 = .00 X 15 = 1191= 28,90 AMOUNT PAID 27,459.20 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 00 42 00 42 28,90 28,904 o o o . IF PAlO AFTER OATE INDICATED, SEE REVERSE FOR CALCULATION OF AOOITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A "CREOIT" (CRI, YOU MA E DUE A REFUNO. SEE REVERSE SlOE OF THIS FORM FOR INSTRUCT S.I F)-f!6--// ~ 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 OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1S41EXAFP OS) JAMES B PANNEBAKER ESQ- PANNEBAKER & JONES 4000 VINE ST MIDDLETOWN PA 17057 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-24-2003 KILMOYER 10-08-2002 21 02-0945 CUMBERLAND 101 MADELY P Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiirv=is4--n:X-AFP--C:oY=oiY-iiiiflcE--oi'-YNiiEifITAircE:-TJUTAppRAIsEiriii=j::--A'Li-owAN-cE:-il-i---------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KILMOYER MADELYN P FILE NO. 21 02-0945 ACN 101 DATE 03-24 003 TAX RETURN WAS: (X) ACCEPTED AS FILED 1. Real Estate (Schedule Al 2. 3. 4. 5. Closely Held stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule OJ Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule FJ (4) (5) (6) (7) CHANGED NO. 01 1l.500.00 NOTE: To insu proper .00 credit to you ccount. .00 submit the up por-tion .00 af this for-m h your- 466.82 tax payment. .00 .00 (8) 1l.96 82 .00 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL Stocks and Bonds (Schedule B) RETURN (1) (2) (3) 7. Tr-ansfer-s (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funer-al Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mor-tgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Retur-n 13. Char-itable/Gover-nmental Bequests; Non-elected 9113 Tr-usts (Schedule J) (9) (10) 10.436.00 (11) (12) (13) (14) 1,5 82 00 242.40 01 14. Net Value of Estate Subject to Tax NOTE: If an assess..nt was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 1 will reflect figures that include the total of !bh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal r-ate 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 Collater-al/Class B r-ate 19. Principal Tax Due T CRE TS: PENT ECEIPT DISC UNT (+) DATE NUMBER INTEREST/PEN PAID (-) 12-30-2002 CD002010 1,445.22 02-21-2003 CD002209 .00 (15) .00 X 00 00 (16) .00 X 045 = 00 (17) 242,401.01 X 12 29,0 12 (18) .00 X 15 = 00 (19)= 29.0 12 AMOUNT PAID 27.459.20 183.70 , TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 29,088. 2 o o o * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU M A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUC BE DUE NS.) IN RE: ESTATE OF MADELYN P. KILMOYER, OF THE BOROUGH OF SHIREMANSTOWN, PENNSYLVANIA, Deceased, October 8, 2002 IN THE COURT OF COMMON PLE CUMBERLAND COUNTY, PENNSYLV IA NO. 2002-00945 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, Hazel K. Duncan, of Beechwood Drive, Middletown, Pennsylvania, and Hazel K. Duncan, Executrix, of Middletown, pennsylvania, do hereby acknowledge receipt from Hazel K. Duncan, Executrix, of the Estate of Madelyn P. Kilmoyer, of the following: CASH - 100% RESIDUE Auto - 1992 Ford, In-Kind Furniture, In-Kind TOTAL $35,999.99 2,725.00 250.00 $38,974.99 ---------- ---------- In full satisfaction of the residuary. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the Estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Executrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Executrix may suffer, incur, be put to, payor layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Executrix upon receipt of such a request from the Executrix. AND the undersigned does hereby release all real estate of the decedent and of the said Executrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on the '~~ay of April 2003. WITNESS: .0~ (Seal) COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN On this, the 75~ day of arP 2003, before me, a Notary Public in and for the said State and County, personally appeared Hazel K. Duncan, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Receipt and Release and acknowledged that she executed the same for the purposes therein contained and desires that the same be recorded as such. WITNESS my hand and Notarial Seal. IlOlAAI~L ",I"I"RIOII ~. COLUNGA. NotarY I'll IMIIQnd"q Twll.. Oauphln County, PA Mv MllIll\laalon bpl"s May 7. 2006 My Commission Expires Res: KilmoyerEstate~Receipt&Release FIRST AND FINAL ACCOUNT OF HAZEL K. DUNCAN, EXECUTRIX FOR THE ESTATE OF MADELYN P. KILMOYER, DECEASED OF CUMBERLAND COUNTY - CODE NO. 0945-2002 Date of Death: 10/08/02 Date of Executrix's Appointment: 10/23/02 The Estate advertisements were in the following publications on the following dates: A. Cumberland Law Journal: 11/08/02 11/15/02 11/22/02 B. The Sentinal: 11/05/02 11/12/02 11/19/02 Accounting for the period: From October 9, 2002 to April 4, 2003. Purpose of Account: Hazel K. Duncan offers this account to acquaint interested parties with the transactions that have occurred during h administration. The Accountant also indicates the proposed distribution. It is important that the account be carefully examined. Requests fo additional information or questions or objections can be discussed with: James B. Pannebaker, Counsel pannebaker and Jones, P.C. 4000 Vine Street Middletown, PA 17057 (717) 944-1333 1 SUMMARY OF ACCOUNT Principal Receipts Receipts/Assets Add: Income/Interest & Dividends Total Assets Less Disbursements: Debts of the Decedent Real Estate Settlement Expenses Administration Expenses Federal and State Taxes Funeral Expenses Fees $ 981.51 9,969.18 524.67 27,642.90 0.00 3,500.00 Total Disbursements Balance Before Distributions/Transfers Reserved cash for filing fees, Reimbursement To Executrix, Fiduciary Income Tax Return, and Attorney Fees. Balance Before Distributions Distribution to Beneficiary Balance After Distribution 2 $134,275.24 + 240.08 $134,515.32 - 42,618.26 $ 91,897.06 -52,922.07 $38,974.99 -38,974.99 $ 0.00 ---------- ---------- SUMMARY OF ACCOUNT Principal Receipts Receipts/Assets Add: Income/Interest & Dividends Total Assets Less Disbursements: Debts of the Decedent Real Estate Settlement Expenses Administration Expenses Federal and State Taxes Funeral Expenses Fees Total Disbursements $ 981.51 9,969.18 524.67 27,642.90 0.00 3,500.00 Balance Before Distributions/Transfers Reserved cash for filing fees, Reimbursement To Executrix, Fiduciary Income Tax Return, and Attorney Fees. Balance Before Distributions Distribution to Beneficiary Balance After Distribution 2 $134,275.24 + 240.08 $134,515.32 - 42,618.26 $ 91,897.06 -52,922.07 $38,974.99 -38,974.99 $ 0.00 ---------- ---------- RECEIPT OF PRINCIPAL ASSETS LISTED IN INVENTORY: (VALUED AS OF DATE OF DEATH) 1992, Ford Sedan, Serial #IFACP52UINAI09189 Misc. Furniture, Artifacts & Jewelry Real Estate Property Situate at: 153 W. Vine Street Shiremanstown, PA 17011 (Estimated Sale, Net of Expenses/Costs) Total Inventory $ 2,725.00 250.00 75,000.00 ADJUSTMENT TO INVENTORY 1/31/03 Real Estate Property - Actual Sale Inventory Estimated Value Net Increase Net Total Adjusted Inventory 3 $86,500.00 -75,000.00 $77,975.00 11,500.00 $89,475.00 RECEIPTS SUBSEQUENT TO INVENTORY AGWAY - Employees Retirement Inc. 11/11/02 Retirement Benefit $1,456.42 Keystone Health Plan - Medical Insurance Claim, 12/9/02 108.00 Countryway Insurance Company - Refund of Insurance Premium 12/9/03 24.00 Hazel Duncan - Loan to the Estate in order For it to pay its expenses, 10/25/02 $23,178.04 Hazel Duncan - Loan to the Estate in order for it to pay inheritance taxes and balance of expenses, 12/27/02 $20,000.00 Total Loans To The Estate From Hazel Duncan 43,178.04 MBNA - Refund Credit Acct. Balance, 1/8/03 15.78 Countryway Insurance Co. - Refund of Home Insurance Premium, 3/21/03 18.00 TOTAL SUBSEQUENT RECEIPTS TOTAL INVENTORY & SUBSEQUENT RECEIPT 4 44,800. $134,275. 4 INTEREST INCOME Citizens Bank-Estate Checking Account to 3/18/03 $ 17 . 24 Citizens Bank-Estate Money Market Account to 2/17/03 222.84 Total Interest Earned $ 240.08 -------- -------- 5 DEBTS PA American Water Co. Service-Utility to 10/9/02 Property Management, Inc. Condo Fees for 11/1/02 Bank Card Services - Credit Card Acct. Balance 10/3/02 Comcast - TV Cable Service UGI Gas Service, PiE 10/22/02 PP&L Electric Utilities - PIE 10/28/02 Property Management Inc., Shireman Gardens, Acct. Due 12/1/02 PA American Water Utility 12/12/02 Verizon - Phone Service PIE 11/14/02 PP&L Electric Utilities PIE 11/28/02 UGI Utilities Inc., PIE 11/20/02 Property Management Inc., Condo Fees, Jan. PA American Water Co. Services to 12/12/02 UGI Gas Service Utilities PiE 12/23/02 6 $ 25.52 52.50 159.37 36.93 36.64 46.13 52.50 11.14 6.88 26.48 84.22 55.75 10.61 89.75 PP&L Electric Utilities PIE 12/31/02 Lower Allen Township Sewer Service 1/1/03 to 3/31/03 PA American Water Co. PIE 1/10/03 PP&L Electric Utilities - January Utilities to 1/29/03 UGI Utilities, Inc. - Final Gas Bill to 1/31/03 PA American Water - Final Water Bill to 1/30/03 PP&L Electric Utilities - Final 3/13/03 TOTAL EXPENSES 44.15 24.00 11.16 38.60 160.71 7.62 7 .85 $981. 51 ------- ------- REAL ESTATE SETTLEMENT EXPENSES January 31, 2003 ERA-NRI Inc. - Sale Commission $3,052.50 Century 21 Piscionary Realty Inc. - Sale Commission 3,002.50 Miscellaneous - Notary Fee 6.00 Government Recording & Transfer Charges State Tax/Mortgage 865.00 AON Home Warranty Svcs - Warranty 399.00 ERA-NRI, Inc. - Transaction Fee 100.00 Home Specialist - Pest Treatment 302.10 Property Management Inc. - Resale Certificate Fee 37.50 Other - Settlement Closing Costs 2,500.00 County/Bora Taxes - Adjustment to Taxes 28.86 Paul's Maintenance - Home Repairs 100.00 David V. Duncan - Home Repairs 42.54 School Tax: Adjusted 1/31/03 - 7/01/03, paid by Estate <449.02> Sewer - Adjusted, 1/31/03 - 4/1/03, paid by Estate < 16.00> Property Management Adjustment to Assn. Fee 1/31/03 to 2/01/03 < 1.08> Total Net Settlement Expenses $9,969.18 8 TAXES Register of Wills-PA Inheritance Tax Return 12/27/02 $ 27,459.20 Register of Wills - Supplemental Tax Return, 2/19/03 183.70 TOTAL TAXES $27,642.90 ----------- ----------- 10 RESERVED FOR ADMINISTRATION EXPENSES, FEES AND CONTINGENT PENNSYLVANIA FIDUCIARY INCOME TAX RETURNS PA Dept. of Revenue- Fiduciary Income Tax, (11/1/02-3/3/03) $ 7.00 u.s. Estate Income Tax Return For Estates For 11/1/02 to 3/31/03) 0.00 Register of Wills Filing fees for First and Final Account & Releases 25.00 Hazel K. Duncan - reimbursement Of loans made to the Estate On 10/25/02 and 12/27/02 43,178.04 pannebaker & Jones, P.C.- Balance due for Attorney's fee 9,684.49 Pannebaker and Jones, P.C.- Reimbursement for cost paid in behalf of the Estate for: copying of First and Final Acct., Release, Copies of the u.s. Federal Fiduciary Tax Returns and the PA Fiduciary Income Tax Returns 27.54 $52,922.07 ----------- ----------- 11 ESTATE OF MADELYN P. KILMOYER PROPOSED DISTRIBUTION TO RESIDUARY HEIRS Name & Address Of Beneficiary Relationship Amount of Share Of The Estate Distribution Cash Hazel K. Duncan Sister 11 Beachwood Dr. Middletown, FA 17057 100% Cash Remainder $35,999.99 1992 Ford Sedan In-Kind $ 2,725.00 Misc.: Furniture Artifacts & Jewelry, In-Kind 250.00 TOTAL DISTRIBUTION $38,974.99 ---------- ---------- Respectfully Submitted: ~;://;/ Date y Hazel K. Duncan, 12 IN THE ORPHANS' COURT IN AND FOR THE COUNTY OF DAUPHIN AND STATE OF PENNSYLVANIA ESTATE OF MADELYN P. KILMOYER, DECEASED NO. 0945, YEAR OF 2002 AND NOW, TO WIT, this CERTIFICATE OF MEMBER c7t1- day of April, OF BAR 2003, this is to certify that the undersigned, James B. Pannebaker, a practicing attorney and member of the Bar of Orphans' Court of Cumberland County, pennsylvani being familiar with the administration of the above-captioned Estate d having examined the items of credit and debit set forth and contained n the foregoing First and Final Account of Hazel K. Duncan, Executrix 0 the Estate of Madelyn P. Kilmoyer, Deceased, certifies that according 0 his knowledge, information and belief, all such items are true and correct without any exceptions whatsoever. James B. aker, Esquire Panneba er and Jones, P.C. I. D. #09667 4000 Vine Street Middletown, PA 17057 (717)944-1333 13 , I DECLARATION OF EXECUTRIX Hazel K. Duncan, Executrix of the Estate of Madelyn P. Kilmoyer, Deceased, hereby declares under oath [penalties of perjury] that she s fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accountin period; that all known claims against the Estate have been paid in fu ; that to her knowledge, there are no claims now outstanding against th Estate; and that all taxes the Estate have been pa OAf Haze K. Du can, Executr%x 0 The Estate of Madelyn P. Kilmoyer SWORN and ?~bscribed to This 1J~. day of ~ ' 2003. ~~ ~~ tary Publlc Res: KilrnoyerEstate-FIRST&FINAL NOTARIAL SEAL ESPlRIRRION A. COWNGA, NoIaIy Public Londonderry Twp.. Dlupllln County, fA My Commlu'on expire. May 7, 2006 14 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH RJ.:.t....~_ THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YE UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 ~I( Name of Decedent: MA DET ,YN P. KTT ,MOYER Date of Death: OCTOBER 8, 2002 Estate No.: OQ4 <;-7002 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with re ct 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: (date) 3. If the answer to No. lis yes, state the following: A. Did the personal representative file a final account with the court? Yes No x B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) 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 infonnal accounts may be filed with the Clerk of the Orphans' Court and may be atta d to this report. Date: #1 JAMES B PANNEBABAKER Name (Please type or print) PANNEBAKER AND JONES PC 4000 VINE STREET Address 717-944-1333 (MAH:rmtlAM3) Telephone No. Capacity: Personal Representative x Counsel for Personal Representati R.W.-56