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HomeMy WebLinkAbout02-1025PETITION F tO-R PROBATE and GRAN~IT OAF ~L~ET~TERS Estate of To: also known as Register of Wills f r the ~f County of C t l~~ in the D egs~ Social Security No. ~ - G ~~' ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: ~ n d Your petitioner(s), who is/are 18 years of age o of er an~t'h~ xecu~ ~ ~ , 19~ in the last will of the above decedent, dated ~'~ `~ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) .y,~[~ Cotknty, Pe~~}sYlva ia, with Decendent was domiciled at death in ~ ~ ~'r'~ last famil~or principal residence at (list street, number and muncipality) a©~ ~ .J ears f age, died ~- ,~C9 ' De~ndent, then Y ~ ~ at was not divorced and did not have a child born or adopted Except as fo ws, decedent did not ma y, after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: $ ~ ~ ~~ (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: ~~ U~ WHEREFORE, petitioner(s) respectfully reque,~t~~ t e prrov~ t of the last will and codicil(s) presented herewith and the grant of letters '77 (testamentary; administratio .t.a.; administration d.b.n.c.t.a.) theron. V S-h~.(~, b N ~/~ y- et.~ V'11(1 ~'' / l iv J i?A ~/_ LJ--- Ci / . C ~~ i .-. y v 0. ¢~ w 7 ~ C 00 ~~~~ OATH OF PERSONAL REPRESENTATIVE COMMONWEA TH OF PENNS ~VtANIA ~ COUNTY OF ~ "''~~/r''N~ ~ ~ ss The petitioner(s) above-named swear(s) or affirm s) that the statements in the foregoing petition are true and correct to the best of the knowledge 11 welllafd trulyladrier(ister he estatepaccording po law. tative(s) of the above decedent petitioner(s) ~" />~ Sworn to or affirllr~edh and subscribed before me this day of _ . ~, onn~ ~ ~ oo' 0 ."~~ Donna M. Otto,lst Deputy NO. 21-2002-1025 Estate of John A, stints Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW November 18th x;2002 the reverse side hereof, satisfactory proof having been presented beforeomederation of the petition on IT IS DECREED that the instrument(s) date~_ Sent~r„t-,A,- ~ntr, i ~~a described therein be admitted to probate and filed of record as the last will of John A. Stults -- and Letters Test n are hereby granted to Karen Ann Stults FEES Probate, Letters, Etc.......... ~ 18.00 Short Certificates( 4) • . • ....... S 1212 Q0 ~~f#~n X-~ages , (3 )... $ 9.00 JCP ~lO.Op TOTAL $49.Op _ Filed NQvembex'.18.th.~0~2 ............. /;~ _.~/Ii Donna M. Ott~;~~~ °J~tp X~~'vDtG.rlU ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE MAILED LL"I"IERS TO THE ~,~~PIX ON 11-18-02 ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. - Ca7MtN0l~1NIEALTH CP~ PENt*z"SYI.VANlA GFP!~RTPJIEtiT OF HEA? TH VI7AL REC~C7RDS L~t;AL RIwGI sTRA'S CR711=IOATIC3IV O~ OEAT 4 ~ ;gar' ~ ~~ ~, ~~ - ~~r ~. s =_~. ~ ~' ~;, c~ " ~ i .~ - ~C~- ~ 2.~~ Z r~~~-: .. ~t . -~ 517426 e~ '~ ~a~1~ ~~ ~,~s„ _ ,f„~ wa ~ ~,t °-- Q~ ~.J ---- - _ y,~ ~,, p ~`': " _ __ ~% _.~c, ~ ~:v i`~o. ~~ ~-_ ~~0 0_.3 ~P~ -_ Date t ~ ~.~iGt,ti~l '~-0m2./ Data o` ~ ~' ~ Tu!_• ~.Z f ~~_~~ - D±rthpiace ~~Uiyyl --- _ _. _ ., ~,;, ~ ~-, .. ~ , . a a`~~ - -- ----_ --- ---- - ------- --- ----- - --- _ _ _ ~, ~Pc,E'GBr . -' ,r z ., {~.,~~z ai ~3 ~~'a~=~ --- - -- - _ 'l~la~l~ng Ad t~~~ ---- --- ^-~+'ti . -- _ ~ ! ~ J7 ©/;~ _ ---- -- -- ----- ; v ,,,, i~;t r ~~ ;r~ ~wQ~l.~~__~ ~u~~raf D~r~, o; - _- ~~ "val ~3 "~ .WSJ., -~ ~~__1_' ~~~~~- - - ~- -- - --_ ~~.~J °Z'/ J / V ~ry / ~ ;f; J- ~J~ ~ ~/ (~,: ~~GrlhP hOW in)l~?`~y QCC~ ~'"~"a: ,l~ -_ _ -~ -. ~"~~ s~~' ~ nrz - ~~ ' ~J ,_ -,, _; ( ~~='~' ~ 3~i4y!",."ll~~~:IQ~1 i1=..i~' y;''=la(? .~ t.v''C'E,'Ct ~ CO'f?iai tYO.'T' u:" _ '~%,. .. , ^,f ~ ~ s E,, ,- ,Tl~ aS ~~Cai i-sEi~c•TraY. Till' o't~lf?ni CP;"tffiCat~ ~ti „_ 2? _; ._ :. ,.. ... ~~~ ~7~ ~ ~ ___ • _. OF ?-'--2007.-1025 JOHN A. STULTS I, JOHN A. STULTS, of Washington County, Maryland, hereby declare this to be my Last Will and Testament, hereby revoking any and all other wills and codicils that I previously may have executed. SECTION 1. Designation of Fiduciary. 1.01. Any reference to my "Personal Representative," whether in the singular or plural, is intended to refer to such person or persons to whom letters of administration are granted after my death. For convenience, I shall refer to such fiduciary or fiduciaries as my "Personal Representative," with the intention that any and all powers granted to such fiduciary shall be appurtenant to the fiduciary office. 1.02. I constitute and appoint KAREN ANN STULTS to serve as my Personal Representative. 1.03. I have made no provision in this Will for my beloved wife, Elizabeth M. Stults. The omission of any provision for my wife shall not be construed in any manner to indicate a lack of love and affection for her. SECTION 2. Funeral Expenses. 2.01. I direct my Personal Representative to make appropriate arrangements for my funeral and to pay the expenses of my last illness and of my funeral without the necessity of obtaining the approval of any court having jurisdiction over the administration of my estate and without regard to any appli- cable statutory limitation. +,~ ,~ JAS SECTION 3. Residuary Estate. 3.01. My residuary estate shall consist of (a) all property or interests therein of whatever type and wherever located not otherwise effectively disposed of in this Will, including any property over which I may have a power of appoint- ment and any insurance proceeds which may be payable to my estate, less (b) all valid claims asserted against my estate, charitable pledges, and all expenses incurred in administering my estate, including expenses of administering non-probate assets. SECTION 4. Payment of Taxes. 4.01. All inheritance, estate, succession, and other transfer taxes occasioned by my death, together with the reason- able expenses of determining the same and any interest or penal- ties thereon not caused by negligent delay, paid with respect to all probate and non-probate property includable in my gross estate or taxable by reason of my death (whether payable by my estate or by the recipient of any such property) shall be paid, without any apportionment, by my Personal Representative out of my residuary estate. SECTION 5. Specific Bequests. 5.01. I give to my daughter, SUZANNE HOLLENSHEAD, of Washington County, Maryland, the sum of One Thousand Dollars ($1,000.00), if she survives me by at least thirty (30) days. 5.02. I give to my grandson, GARY LEE HOLLENSHEAD, of Washington County, Maryland, the sum of One Thousand Dollars ($1,000.00), if he survives me by at least thirty (30) days. 5.03. I give to my son-in-law, CLIFTON G. HOLLENSHEAD, of Washington County, Maryland, the sum of One Thousand Dollars ~,~ .~.. JAS ($1,000.00), if he survives me by at least thirty (30) days. SECTION 6. Disposition of Balance of Residuary Estate. 6.01. I give, devise, and bequeath all the rest, residue, and remainder of my estate to my granddaughter and daughter by adoption, KAREN ANN STULTS, of Washington County, Maryland, if she survives me by at least thirty (30) days and to her issue if she does not so survive me. 6.02. If any person entitled to distribution under Section 6.01 is then under the age of twenty-one (21) years, such person's share shall be distributed to a custodian selected by my Personal Representative. Such share shall be administered under the Maryland Uniform Transfers to Minors Act until such person attains the age of twenty-one (21) years or dies prior thereto. SECTION 7. Powers of Personal Representative and Z1r7minici-rati~~r~ PYn~7iGinnG_ 7.01. My Personal Representative shall serve without bond. 7.02. My Personal Representative shall have all powers conferred by Maryland law. 7.03. My Personal Representative, in addition to any other powers, shall have the specific powers to invest, reinvest, sell, mortgage, or otherwise dispose of any part or all of my estate, without the necessity of obtaining prior or subsequent court approval. 7.04. Distributions may be made in cash or in kind (and if in kind, may be made non-pro rata) in the discretion of my Personal Representative. IN WITNESS WHEREOF, I have signed my name to this Last Will ~,~ -3- JAS and Testament this 'Y'~ ~-----day of . ~~~~s-~--r.~~.,....._._,,._~. 1994. ohn A. Stults The within instrument, consisting of 4 pages, of which page 4 was signed by JOHN A. STULTS, was signed, published, and declared by him in the presence of both of us to be his Last Will and Testament; in addition, all pages except the page signed by the testator were initialed by him in our presence; at the same time we, in his presence, at his request, and in the presence of each other, do hereby sign our names as attesting witnesses. t . ~ h } ~F/ .yy.~.. /i ~ ' ~ f~~ n r ~~ ~.-m.-~~..-- ,~._......_,_._.. Address : ~~ ~ J . ~~"~ ~'~`-~~`~.~-,..-. ~~ ~~ ~ ..... ,... t Y A / ~ ~ __ '~~ ,.-- ~.,-~,( ~ ~:~~^ /' ~ . ~-`~. Address . ~~ ~' `'(,~.~;,~~ ;4,,~`,., -4- REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to the law, depose(s) and say(s) that the testat ,sign the same and that present and saw signed as a witness at the request of testat in ~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19 Register 21-2002-1025 (Name) (Address) (Name) (Address) REGISTER OF WILLS OF Cunberlana COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto,~each) being duly qualified according ^to~-law, depose s(fand say(s) that (~;1e 'G~-~~ familiar with the signature of J ~J~ ~'1~~ ~~ Iodic testat ©~ of (one of the subscribing witnesses to) the will presented herewith and codicil that ~ ~~ believe,~the signature on th wil 's in the handwriting of 1 o~,v~ ~ ~ ~~-~-~ 1~-~ to the best of ®~ if knowledge and belief. Sworn to or affirmed and subscribed before me this 18th day of November ~ 2002 Donna M. Otto, lst Deputy Register codicil will presented herewith, (each) being duly qualified according to ,~, ~ ~, ~- ~ (Nam/~e) / ,, ~., ~~ , 9.~~ Cf' ~~I l ~L~ -~YJ ~' ~ L~r~l ~''/~~-~ r , , (Address) (,, CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: .~ ~ Y ~ ~ ~ ' ~ '~.(t '~-~ Date of Death: Will No. ~ 1 " ~ ~ '' ` (~ ~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the rphan 'Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~ a ~ ~~~ Name Address ~~* 2«-~i~-.s_ ~, ~(~ ~cc~e-t.- ~vl v-t' rw ~~ c~ 17yc Notice has now been given to all persons entitled thereto under Rule 5.6(a) except L~1~ ~ l/1d~''~ 15 ~, ~~ Date: ~ ~ ~ ~ ~ C7 3 i~~~~.~~ ~ si ~~_` Signature Name _ ~ ~/ ! ~ /` r~~-"'! ~L~7~ Address !~~ ~,-- Gjj ~ I ~Y 1 ~ 2~i1a.tiic t.c ~. ~ ! 0 ~3~' Telephone ~ ~~~ (~ -- ~~ Capacity: D~ Personal Representative Counsel for personal representative EV1S~OEXI6-00\ "lO .- < COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 (iFFi(;1AL USE Ol\iCY \"J j OL INHERITANCE TAX RETURN FILE NUMBER ~I -0;),. RESIDENT DECEDENT COUNTY CODE YEAR- -,---,--,~,--,,- 10 ~S- I~- NUMBER w ... :::.:::!tn u""" w"-u ,,00 UO:--' "-,,, "- " I- Z W C W o W C ... Z W o Z o "- '" w 0: 0: o U z o !;j: ..J :J l- ii: c( o w e::: z o !;;: I- :J Q. :!i o o g DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) S \ A, SOCIAL SECURITY NUMBER JI--f7 - I b gsC:,7 ) DATE OF BIRTH (MM-DD-YEAR) (Q -;;; \ - Od- d- - I d 13 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) (VA- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~OriginalReturn o 4. Limited Estate o 6. Decedent Died Testate (Mach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) D 10. Spousal Poverty Credit (dale 01 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 D 11. Election to tax under Sec. 9113(A) (Macll Scll 0) FIRM NAME {II Applicable) COMPLETE MAILING ADDRESS ('\ . q3:l e...,.,,''"} ~,v-e fYl e-J.,oMi'c ~ b (,.< Va- ) fA norr.~ TELEPHONE NUMBER 'I 1/- ~qlo - I~Gf 1, Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) /'lC(g, (pg ... '7, Cf% 00- q'1 ~'--f" f.:,g 3 Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) o Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G orL) (6) (7) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) Cf,"lS-Lf,6g' (9) (10) q/~/4 ,'-/D (8) 11. Total Deductions (total Lines 9 & 10) (11) (12) (13) $;)ifO')~ 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 (ScheduleJ) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 4/ dl!O. ;;> go 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) $;;;LfO, :JR '.0_ (15) '.0 'is: (16) $' /0. '61 , 12 (17) ,15 (18) (19) .$ /0 I ~J 16. Amount of Line 14laxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page Hine 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) S/ /oI2( Totai Credits (A+ B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 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) ZIP r'toss 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. $' /O,gr A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B) .s1l') 0 , Q} Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ........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. Ves ......0 o ....0 ...0 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.. b. retain the right to designate who shall use the property transferred or its income; ..... c. retain a reversionary interest; cr... d. receive the promise for life of either payments, benefits or care?.. ................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . .0 o No ~ c;y W Q/ 8' W SIGNATURE OF PERS Under penalties of perjury, I declare that 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 pre parer olherthan the personalrepresenlative is based on all information of which preparer has any knowledge ADDRESS , /~ fY7 eJ..at1"cS~ 93:;2., E'-"1;( SIGNATURE OF PREPARER OTHER THAN REPRE , 7oS-S- ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 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 the surviving spouse is the only beneficiary. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren 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. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a' individual who has at least one parent in common with the decedent, whether by blood or adoption. REVI508".II097I. COMMONWEALTH OF PENNSYLVANIA lNHERlTANCE TAX RETURN RE 'DENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF C ";tu \ts John J 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. A. FILE NUMBER ;), DESCRIPTION SCLAJI"'~S Aec_OUVlt- (h~6N"'5 p-,~+ ~~cJ. c.re&lt U"\o,,,", ) Acct# 1937).0 (J("e.- - p'^-' 6 16"1 vicJ ACL +. - '-vOpo/;J ~ /feet #- 0'). J.-( 0';) G '-ILJ O'd-G VALUE AT DATE OF DEATH ITEM NUMBER 1. 1/ /79<l, ft, rg f/l r-;t 1.)'6, DO TOTAL (Also enter on line 5, Recapitulation) $ q 17 )"L-j . 10<;> (if more space is needed, insert additional sheets of the same size) "'.""'".,,.,,'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS S-h< \ ts I A, FILE NUMBER }O [" r\ Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. ;}, B. 1. 2. 3 4. 5. 6 7. DESCRIPTION AMOUNT FUNERAL EXPENSES: Pn:.po-;d, Q,,-<y~cJ t::-i'~In~ -'V~O,~t (B,~ A-u- T ~ ();j. '1 ~0'-1JjO:;l6 I!. U/I~f~~ yY/{UncNlcJS - 0~ (1I~bv- 41 If, 1!;'&, c)t) 4/ / SSR ' tto J ADMINISTRATIVE COSTS: Personal Representative's CommiSSions () Name 01 Personal Representative (5) _~ ,<;' ~l is l'=- \'ch<A.J J~ SOCial Security Numbe~s) I EIN Number of Personal Rep(esentatlV~s) Street Address =:i.Z:2 fu ~ Or t v.I? City VYl.~(d""uv~{J: State PI4- Zip J7c'!SS- Year(s) CommiSSion Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant tJ Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountant's Fees Tax Retum Preparer's Fees TOTAL (Also enter on line 9, Recapifulation) $ CJ, ~I !-f . YD (If more space is needed, Insert additional sheets of the same slle) ~,.~ BUREAU OF INDIVIDUAL TAXES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX -FP (O1-OS) DATE 03-03-2003 ESTATE OF STULTS JOHN A DATE OF DEATH 06-21-2002 FILE NUMBER 21 02-1025 COUNTY CUMBERLAND KAREN STULTS RICHWINE ACN 101 932 EMILY DR Amount Remitted MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-031 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STULTS JOHN A FILE N0. 21 02-1025 ACN 101 DATE 03-03-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 9,754.68 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 s. Total Assets (g) 9,754.68 APPROVED DEDUCTIONS AND EXEMPTIONS: 9,514.40 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 9. 514.40 12. Net Value of Tax Return (12) 240.28 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 24 0.28 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16l 240.28 X 045 = 10.81 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (191= 10.81 Tev roentTC. -- -_---- - - - DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 01-07-2003 CD002020 .00 10.81 TOTAL TAX CREDIT 10.81 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RICHWINE KAREN STULTS 932 EMILY DRIVE MECHANICSBURG, PA 17055 -- fold ESTATE INFORMATION: ssN: i4~-is-8367 FILE NUMBER: 2102-1025 DECEDENT NAME: STULTS .10HN A DATE OF PAYMENT: 01 /07/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/ 21 / 2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 510.81 TOTAL AMOUNT PAID: REMARKS: KAREN STULTS RICHWINE NO POSTMARK DATE CHECK# 4014 SEAL INITIALS: JA RECEIVED BY: DONNA M. OTTO 510.81 DEPUTY REGISTER OF WILLS REV-1162 EX(11-961 NO. CD 002020 REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~~'~ ~ ~ ' `~~~ ~~ ~ Date of Death: c~U ~ °~ ~ a 4 0 Will No.: o~ /~~ ~ 'I~o~ ~ 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: 1. State wh er administration of the estate is complete: Yes ~ No ^ If the arse: er is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal repr entative file a final account with the Court? Yes _ No [~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal repr sentative state an account informally to the parties in interest? Yes ~ No ^ ~~ c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~ ~~ d 3 ~ /'~~T~/l'<-' I~Q -~-.-1 Signature Name ~ ~ ~~~~ ~ r ~'~~ Ayd~dress I_ (~~Q i -7 Q 5--~° ~ l ~1~'~'1}~.S dJ L~ 1 F , , Teleph~one~No. ' ~ (i 1 Capacity: (Personal Representative ^ Counsel for personal representative