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Home My WebLink About02-1029PETITION FOR PROBATE and GRANT OF LETTERS ~c~RorµN L~ PL,~rr No. a~-oa - 109 Estate of To: also known as Register of ills for the Deceased. County of '~ ~ ,~ in the Social Security No. " G'' -' t ~ ' S~ t 4 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or o~l'der an tl~ {xecut^~ ' 19n~~ed in the last will of the above decedent, d ~ d0 O and codicil(s) dated ~ ~ 3 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C-U ~ ~~~'~~ N, County, Pennsylvania, with € t h ~ ~ last family or principal residence at ~ ~ j ~ B _ _ .~..~~ an ,+:~,,r~r,r 2b. ~-/1•N~ ~IGL I~i~' 1'?Oif 6T (list street, number and muncipality) Decendent, then _~`~ -- Years of age, died i9 Zvi ~; at l-f n r u ~ to - e_, - r `'_ - Except as follows, decedent did not marry, was not divorced and did not have a child born or adopte 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: $ Z~ ~Ov (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ;~~ U ~~~ N c7"~- ~ ~ ~-RE ~ 'N = l3 a ~ 1 ~~ ~ ~ is o G r4 . I'1 ~~ ~° .y ~a ~w ao in OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF C'UMBFRLAND 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 and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly dministelr`tQhe es~ a^ i cording to law. ibed ~ ~tC.tTK-~ v, Sworn to or affirmed and subscr o0 18th day of ~ before me this " NO ~~- egister ~ car I ~ - in 1- ~ No. ai-Oa- loa9 Estate of DOROTHY L PLATT ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER 19, 2002 ~x in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated_ WILL: 12-21-1981, CODICIL: 3-3-2000 described therein be admitted to probate and filed of record as the last will of DOROTHY L PLATT and Letters are hereby granted to MRS . KAREN D PATTON extra pages 12.00 r_odir.il FEES 10.50 Probate, Letters, Etc. ......... ~ 6 0 . 0 0 Short Certificates( ) .......... S 3 ' 0 0 Renunciation 5 . 0 0 ~cp ~ 10.00 TOTAL X100.50 Filed , ..11-19-200.2 ................. . ADDRESS PHONE mailed to eit~c~ 11-19-2002 ATTORNEY (Sup. Ct. LD. No.) `7!. ~, ~. ... -. .. I ,' cam- ,_. j - . _ ,. - 1 .,.-~ c", r_ C;SItC::iil~ C0~7iL~ .rt)17. ii Oi .-. C.tr,.,r _.. ._ _. - -.. 'i!Ci,l. 4} )r: itUC\ ~1t~~C. CO T~le ~Ca1T'(' ~.'!~<l~ ~~r°Ce~.t~~ ~.~ ~„-~. :-Ui .-. -_. ~~ ":H~.a~,,;~: ~~ ?~ i1ie~~a1 to 4~Li~.lliGc7te this eery ~ ~i~Otcs~z~t O~ ~ai~eser~rs.f~'.w. <,: (, , ~ , , ;__' ;isle P~T4' ~~~,¢ ~ .,-~ ~~ '~° > %i P 8643855 __ ---- ---- ~'-=~~r~~~~ ~~ ~'`~. w OV 0 8 2002 __ Rey. ve7 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT (f~r51. Middle. Ld51) SE% SGCIAL SECURITY NUMCiER DATE OF DEATH ,MCnm. Day, rear) ,. ~o~. L. ~ ~,E~ =Ten,~a-te 7.`83 - t2 - 87lg .. <,r~ ~Y,2- AGE (last 0mndayl UNDER l YEAR UNDER t DAY DA7E OF BIRTH BIRTHPLACE tCdy and PLACE OF DEATH rCnecs onry nne -- see ~nsm,plur~s on dmei noel $tdle Or FCreu)nCwnay) MomM . Days Hours . Minute ,rlonm. Day, vearl OTHER: HOSPITA4 f^ upJQMI0e7- fE FOl/oS{ ~••fyI r Y ~j- ~t ~1 Inpatwnt161 ER/Oulpausnt ^ DOA^ Homap ^ RndexeU S t ~J 7 rs. s. 8 ! e. S 7. S w ~ yl pen ,w. • COUNTY OF DEATH CttY, SORO. TWP OF DEATH FACILITY NAME (u not ~nv~luum, qwe saeet and number WAS DECEDENT OF HISPANIC ORIGIN? RACE -Amswan IMian, &ack. Wnae. etc. 4 ~ Np ® vee ^ lr yea. apenry Cuban (SpecM) /r 1 t C • r n sbe ~o 3 E ' ~ /'(yt ' ~~j ~ , s saran. Puerto Rican. ac. 1 '~ w W. Vrrvv /!cn ~ Tw fk. L, Bd. ~II ~ I ' ~ e1. t8. e DECEDENT'S USUAL QCCUPATION KIND OF BUSINESS/INDUSTRY WAS CEDE TEVERIN ECEDENT'S EDUCATION MARITAL STATUS-Married SURVIVING SPOUSE (Give kuWdrrork tlone during rtiofl U.S.ARMED FORCES7 S ~ oM hi hest ratle cwn leled Never M•RiW, Widowed, Ill cads. give maben namal of working life; do rid use reluld) Of- 'Ti'a„5 J o.f< F e "E ^ ® Elsmenlary/Secondary Cottage Divorced ISpeuty) ` . ,eL<, !1 • vas No (on zl 11 a a 5+l OECEDE 'S MAILING AD ESS (Street. Ciryrtown, Scare. ZED Cadet DECEDENT'S G ~S -t nn S ~AO/O 17 ® V i 1 V $ ~Q ' ~ ~ / ~Orr~ ~2 i/Ve. py ee. Oecedera W W n e. h A 4 w • ACTUAL t7e. Stara •-r RESIDENCE decedent ~ ISee instrucl~ans aw In a . ~ on drier vase lownsnip? No, deceder<Iivsd ^ ~ ~ ~ ~ G rte, / 7'<' ~ ~ 7 18. ~ S t 7d. V Nn Q l G vL wanin actual amna of cdylppo. 17b. County FATHER'S NAME (Full. M~ddl . La sq MOTHER'S NAME IFnsl. Mitldle. Haden Surn amej e ts. G...^P ~ So•/ S l te. n ~iefZ INFORMANT'S ME (Ty Prinq INFORMANT'S MAILING ADDRESS (Sneel,Gryrtown, Seale. ZipCWe) K ff ' !~ •'7 ° i~ ' ~ 3 ' ~ ' c.v 2a. ~ ~ e~ s 7/r ! /L xob./ / G~ r. r METHOD OF DISPOSITION DATE OF DISPOSITION PUCE OFDISPOSITION -Name or Cemetery, Crematory LOCATI N - CM/TOwn, Slate, Zip Coal nal ^ Cremation ® Removal Irom State ^ S • (Month. Day, Year) or GIMr Place u Donnion^ aver lSpecMl ^ u !- C ~ G - -! 9 ~ 2t.. 2m. ove•wber 2ooz re..,~ r 2,<. H r~,... /e i 2td. t.~. 07 SIGNATURE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH LICENS E NU BER NAME AND ADDRESS FACILITY L,/.Or-.i. A r • <a+•a. t/ <.n 0/ / a..C ~/aC,. 22e. ~ • ~7 T 22b./ ~~J~~ ~ ~' 22<.2.C~~ 1 ~+/' Cp f 1~. /a/~.rr. S r ~i9 /7/O.3 alb ms 23a~c IywMncertilying TOIM bade of my knowlstlge, death occurred al the rime. date ano Olace stated. LICENSE NUMBER DATE EO .: pnysican a rid available al lima o, aeatn to (Sgnalure and Tale) (Mmth. Day, Pearl cenlry cruse of dsatn. x7e. 2]b. 23c. _~ Items 2<-28 must M compbled by TIME OF DEATH DATE PRONOUNCED DEAD (MOnm. Day. Pearl IC L EXAMI WAS CASE REFERRED TO MED A NERICORONER? ~i person who pronounces death. / ll// 11 ~ ,•~ TT C 7 ~ vas LZMO~r ~ V N~ ~ 21. M. 2S. 'V 28. _ x7. PART I: Emer IM diseasxs, injuries or complicaluans which caused tM death !b not enter IM mode of dying, such as cardiac or respiratory arrest, shock or neap facture. t Appronmate PART II: OIMr signi0cam Wrtdiliora conk~buting to death. but . list only one cause on seen Nne. ~ interval between not resulting in IM undsrrying pose given n PART I. IMMEDIATE CAUSE (Final ~ i i onsN dial OeeM d~saase of condnan ~~- 1iaL..~ _ /- , /~ C.~ rewnin m asaml -• z ~/~ g DUE TOI SACONSEOUENCE OF): . ~c~yyV/(~~ lest cgndirans D mi ll r ~~S . eque Y a '~ it any, leading b immediate DUE TO (OR AS A CONSEQUENCE OF): I l cruse. Enter UNDERLYING c r CAUSE D isease a <,Wry . ( Mat uutated events DUE TO (OR AS A CONSEQUENCE OFD: I resualrlg n death) LAST d. WAS AN AUTOPSY _ WERE AUTOPSY FINDINGS MANNER OF DEATH GATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERFORMED? AWIWBLE PRIOR TO (Mmm. Day. Pearl COMPLETION OF CAUSE ' i ~ H i ^ =~ vLTH7 OF OE om W Natural c ye9 ^ No^ =~~ Accitlenl ^ Pendrg Invesrgation ^ 70e M. 70b 70<. 700. _` Yes ^ No IIyP'} Yos ^ No ^ SuKide ^ Could na De tletermmed ^ . . PUCE OFINJURY - At Mme, farm, street lactory. o8ice LOCATION (Sneer. C~ry/T cart. Slate) bpdang,•a.ISpecny) xa.. xeb. xe. 7oe. Tor. CERTIFIER ICneck only met SIGNATURE T LE CERTIFI q 'CERTIFYING PHYSICIAN (Pnys~can candying cause of Ceam caner a+omer pnvsw~an nas prpruxrnced tleam ano canpleled Vern 231 r;~ l~y / ~il J ~~~"' L• ~ To the best of my knowledge, death occurred dud to the cauaelal and manner as slued ............................. ............... ......... I!7 (.~ 710. ---fffjjj((( LL 'PRONOUNCING ANDCERTIFYING PRYSICIAN IPnys¢ian nom prdnouru:~ng Death andcerulymg to cause of dealM j aM due to Ua uuae(a) and manner act stated .......................... .~ death occurred st tM time date arM Place th r or m knowla~d s T D LICENy'S//E UM/~v) r~ f-^ DATE//(g1/gNEDI y. rnarl 71o/_a v L~, ~[-, 7ta-/ %`7 ~7 Z~fd ~_ ~ - , , , y g , e e ee NAMEANDADDRESSOFPERSONWHOC MPLETED CAUSE OF DEATH P • - 'MEDICAL EXAMINER/(:ORONER and due to IDs cause(s) and data and place in m inion death occurred al the time minatlon andlor invesU auan o f O th D i (Item 27 pct nnl / T ~~~`(~(,~ s!' /~p~-i.~ -/ /! , , , , g , y p n e u a o e•a manner as stated ................................................................................ ............ ...... ^ ~~V ~ ~/~ J ~~ ~~(/ ) ? / 71a. 72. Q(A1 •-a/I / J l REGISTR IGNATURE AN NUMBER/ ~~ '~y '~ " ' / ` DATE FILED(MOnM. Day. Year1 % ~ '/ .-~` LAST WILL AND TESTAMENT ~.~- o~_ /0~,9 I, DOROTHY L. PLATT, of R. D. #l, Duncannon, Perry County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this writing as and for my Last Wi11 and Testament, hereby expressl revoking all writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my just debts, to which there are no defenses it law or equity, and the expenses of my last illness and funeral be paid out of my estate as soon after my death as is convenient and expeditious in the judg- ment of my Co-Executors, hereinafter named. SECOND: I give and bequeath all of my household furniture and furnishing automobiles, books, pictures, jewelry, china, linen, silverware, wearing appare and all other like articles of household or personal use and adornment to my daughter, Phyllis I. Taylor, if she survives me. If she does not survive me, ~. I give and bequeath said items to my surviving children in equal shares, to be divided among them as they shall agree. III THIRD: I give and bequeath the sum of TWO THOUSAND ($2,000.00) DOLLARS to my son, Ronald D. Gutshall, if he is living at the time of my death: )_~ Provided that any indebtedness owed to me at the time of my death be deducted from said bequest. If he is not living at the time of my death, said bequest shall be paid to his then living issue, per stirpes. FOURTH: I give and bequeath the sum of TWO THOUSAND ($2,000.00) DOLLARS to my daughter, Mrs. Karen D. Patton, if she is living at the time of my death Provided that any indebtedness owed to me at the time of my death be deducted R. SCOTTCRAMER ~ from said bequest. If she is not living at the time of my death, said bequest ATTORNEY AT LAW CENTER SgIJARE shall be paid to her then living issue, per stirpes. DLINCANND N, PA. § i7DaD (777) 834-57D^ 'b R. SCOTT CRAMEf2 ATTORNEY AT LA W CENTER 5l'a LJARE DIJNCANNON. P.4. i7DaD (717) 834-570D FIFTH: I give and bequeath the sum of TWO THOUSAND 02,000.00) DOLLARS, to my son, Marion L. Gutshall, if he is living at the time of my death: ProvidE that any indebtedness owed to me at the time of my death be deducted from said bequest. If he is not living at the time of my death, said bequest shall be paid to his then living issue, per stirpes. SIXTH: I give and bequeath the sum of TWO THOUSAND 02,000.00) DOLLARS to my daughter, Mrs. Carol E. McMillian, if she is living at the time of my death: Provided that any indebtedness owed to me at the time of my death be I deducted from said bequest. If she is not living at the time of my death, said. bequest shall be paid to her then living issue, per stirpes. ~' SEVENTH: I give, devise and bequeath all the rest, residue and remainder of my property, be it real, personal or mixed, of whatsoever nature and wheres ever situate, to my daughter, Phyllis I, Taylor, If she is not living at the time of my death, said bequest shall be paid to her then-living issue, per stirpes. EIGHTH: If at any time any minor child shall be entitled to receive any assets hereunder, DAUPHIN DEPOSIT TRUST COMPANY, Harrisburg, Pennsylvania, shall act as Guardian of the assets payable to such child. Said Guardian may receive and administer all assets authorized by law and shall have full authori to use such assets, both principal and income, in any manner said Guardian shal deem advisable for the best interests of such child, including college, univer- sity, post-graduate or other education, without securing a court order. NINTH: I direct that all taxes that may be assessed in consequence of my death, or whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. gd TENTH: I hereby nominate, constitute and appoint Phyllis I. Taylor and Mrs. Karen D. Patton, or the survivor of the two, as Co-Executors of this my Last Will and Testament. I further direct that my personal representatives shall not be required to post any bond to secure the faithful performance of their duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, which consists of three (3) sheets of paper, dated this ~ ~.,T day of December, 1981. ~' ~"~~ (SEAL) Dorothy Platt The writing contained on this and the two preceding pages was signed and sealed by Dorothy L. Platt, and by her published and declared as her Last Will and Testament, in the presence of us, who have hereunto subscribed our names a witnesses at her request, in her presence, and in the presence of each other. 1 / ~,- ~ R. SCOTT CRAMER ATTC R N EY AT LA W CENTER SgUARE DUNCANNON~ PA. 77020 (717) 034-57C^ COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF PERRY )SS I, Dorothy L. Platt, testatrix, whose name is signed to the attache foregoing instrument, havin acknowledge that I signed agdbexecudted ghelinstrdument as m d or signed it willin 1 g to law, do hereby g y; and that I signed it as m Y Last Will; that I purposes therein expressed. Y free and voluntar y act for the SWORN or affirmed to and acknowledged before me by Dorothy L. Platt, testatrix, this ~/s t day of December, 1981. -, _ ~_~-~."' ~1~~ ,gam T _/ RUTH E~EANC?R GUNTfUM -4--z_ f ~~~ Duncannon, perr • Notary pubtiC y Co., Pa. My Commission Expires May 18, 1985 OTT C RAM ER RNEY qT LAW ER 551UgRE ~ANNON, Pq. 17020 834.5700 COMMONWEALTH OF PENNSYLVANIA ) )SS COUNTY OF PERRY ) We, R. Scott Cramer and R. Eleanor, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will; that Dorothy L. Platt signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of ;us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge the testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. %.~ C' SWORN or affirmed to and subscribed to before me by R. Scott Cramer and R. Eleanor Guntrum, witnesses, this ~/, f day of December, 1981. ~JZ2-vv LYE ~ . ~ cay Joan A. Lightner, NOT Y PUBIi' My Commission Expires October 22, 1984 Duncannon, PA Percy County :. SCOTT CRAMER ATTC R N EY AT LA W CENTER SQUARE DLJNCANNON, PA. 77020 (717) 834-5700 CODICIL TO THE LAST WILL OF DOROTHY L. PLATT 2~-oa.- ra~9 I, DOROTHY L. PLATT, of Penn Township, Perry County, Pennsylvania, declare this to be the sole codicil to my Last Will dated December 21, 1981. R. SCOTT CRAMER Attorney at Law 5 S. Market St. P. O. Drawer 159 Duncannon, PA 17020 ITEM I: I hereby delete paragraph THIRD of my Last Will and ire lieu thereof provide as follows: THIRD: I give and bequeath the sum of TWO THOUSAND ($2,000.00) DOLLARS to my grandsons, Ronald D. Gutshall, Jr., Michael Gutshall and William Gutshall in equal shares, share and share alike. ITEM II: In all other respects I hereby ratify, confirm and republish my Last Will dated December 21, 1981 and this sole codicil as and for my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal this J /' c(~ day of /Yl ~ ~ ~ f, 2000. .~ % i.-' '~ ~ ~~ Doro y L. Platt Signed, published and declared on the date thereof by the above named Dorothy L. Platt as and for the sole codicil to her Last Will dated December 21, 1981, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. .~ -'''`~~ n ~. iti RENUNCIATION In Re Estate of deceased. To the Register of Wills of ~ (o, W~ ~P Y 1~ ~ C, County, Pennsylvania. The undersigned Yl 11~s~~ ~_ ' of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be: issued to WITNESS hand this ~~day of 1~~r-JJ~. ~~Q ~~ (Signature) i ~ t.tr) , V-1C.14 ~ ~ ~ ~~ (Address) (Signature) (Address) (Signature) (Address) l~ CERTIFICATION OF NOTICE UNDER RULE 5.6 a Name of Decedent: _ ~ p r p-~~U ~ _ ~ ` 0.~- ~- Date of Death: N O ~/Qw~~j.e ~" g ~ ~ ~ ~, Will No. Admin. No. "ol G G ~ - Q ~ p ~ C~ To the Register: I certify that notice of (beneficial interest) estate administration required by Rule .5.6(a) of the Orph ns' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on _ r ~ 13 ~ 0 3 Narne Address C~4Qc1. ,G{cM,llrgv 45~G ~~~ Co~R't r1oPTHPecr, F~. 3~ZS') /hIlQR10-J GuTSHNLL Cu • l Ir pM ~k t~..e q i ~ z-3~S -1 QED Q,vE~ S'-. r t MFsQv~Ta', ri 7'^X . 7Sr3o ~~ic*F~l~ L lam,,! ~ r..,p /-If7.z~C N ,ft t t Q '~o! nt. UJ ~uuT' SAII!' q OR'. 7 5S ~~~4 ~t T Rr. ~ 3 ox ~ ~ ~-~ S ~- I I 1 s ~ w , a !C . ? ~! 9 s.S~ ,cs q4 Lo~2 t'> to Mai ;u ~F4 ~. J F~-ra n` ~ > ...., Notice has now been given to all persons entitled thereto under Rule 5.6(a) except_ (,/~~ Date: --'-E 13 ~ b3 ~ . ..~_~` Signature Name Kai re >~ ~ Q_'~-~7~ Address ~ 3 ~ I t--~ rd ~ ~~ ~ ~ P 1' ~ t~ar~r~ 5 bu r ~--r r f~ ~ 1 t O ~f Telephone ('~ 1']) ~ ~ 5 _ -~ S 3 0 Capacity: ~ Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED 1=ROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002071 PATTON KAREN D MRS 1391 FORD AVENUE HARRISBURG, PA 17109 fold ESTATE INFORMATION: ssN: 4sa-t2-B~ts FILE NUMBER: 2102-1029 DECEDENT NAME: PLATT DOROTHY L DATE OF PAYMENT: 01 /22/2003 POSTMAFIK DATE: O 1 /21 /2003 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /08/2002 REMARKS: KAREN D PATTON CHECK# 97 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 51,258.66 TOTAL AMOUNT PAID: INITIALS: CW RECEIVED BY: DONNA M. OTTO REV-1162 EX~11-96) 51,258.66 DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 N0. CD 002370 PATTON KAREN D MRS 1391 FORD AVENUE HARRISBURG, PA 17109 fold ESTATE (INFORMATION: sSN: 4s3-12-8719 FILE NUMBER: 2102-1029 DECEDENT NAME: PLATT DOROTHY L DATE OF PAYMENT: 04/01 /2003 POSTMAFIK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /08/2002 REMARKS: KAREN D PATTON CHECK#301 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 563.09 TOTAL AMOUNT PAID: INITIALS: AC RECEIVED BY: DONNA M. OTTO REV-1162 EX(11-96) 563.09 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMM~NYVEALTH OF PENNSVL~JANIA ~F' t ss: COUNTY"~F CUMBERLANQ D.rQ~n ~ . ~ c~~ ~c~ 11 being duly 5 WO Y'Y1 according to law, deposes and says that She ~ S ~ ~C ~ x_~s-u-~~ -- of the Estate of ~c~YO~~~ ~•.. ~ ~ q'j"~' late of - ~~Y`~~ ~i ~~ _____ _____________ ~ `,~ Cumberland County, Pa., deceased and fihat the within is an inventory made by Q 1_~ ~ _ ,the said ~h~ea'L~-t~1^ of the entiire estate of said decedent, consisting of all the persona( proparty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death . ~ ..aC]V' ~ and subscribed before me, 19>~03 i Executor -Administrator are:f ;Date of [)eath V Y Month INSTRUCTIONS Year f. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additiional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of i 949. p ~I I ~ '~ ~ O ? ` ~ O Z ~ o Z ~~jj~ TII w Q F- ~ ,~ ~ c, U I O ~ ~ m ~ ~ w ~ ~ , rn ~ - ~ •- d J LL i l j J Q O w a ~ ~ o_ ~ Z ~ Q +~- O o S~ "' Z 4 ° ~ w Q = U ~ .u- o. ~ -o i c .... ~ ~ ~ ~ o a, , ~ f ' ~ m - • ~ o ° - + U LL m T m C `o Q Inventory of the real and personal estate of OY'O~'`'~-~ {-~ , ~ 1 Q~ ~ deceased Vv q y ~ o ~ Y,fi ~3an 1~ - C1~ ecac: ~ ~ ~ c cf , Iv ~, , o ~ 0 0 4 ~ o o ~" ~jeverl~ ~h~""er~r;SeSt 1-v~C. - Nurs ~ hc~ ~ovne 'r'~~t~Y1ci ~ever~y ~a.\; -~or h ~ c.~ Co ~~ , - re-~~~c~ o-~ ~~e~rsov~c~~ ac..c..~u~t ~`~ v~u,r s ~ ~9 1n n w- e Cc~~Seco Sehio~ 1'~'e0.~~~ T ~5v.v`~v~.C~ Cd. - p~ewt ~ uwi ~~e~ ~ncl ~s~~~iyg S3 X91 yS ioa gS i 00 Total II3o^r(~~ Is 8 EV-15JOEX:6-00: I/o /, y' /- C / - c REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W U W C w ... :lII:::!cn uO::': w,,-u ,,00 uO:-' ,,-", "- '" ~ 1. Original Return o 4. Limited Estate D 6. Decedent Died Testate (Allach copy of Will) o 9. Litigation Proceeds Received INHERITANCE TAX RETURN RESIDENT DECEDENT L. DATE OF BIRTH (MM.DD.YEARI \qlS' o 2. Supplemental Return D 4a. Future Interest Compromise {date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) OFFICIAL OND' FILE NUMBER ~-L- 0:2. COUNTY CODE, Y~AR o-Lo~3 NUMBER SOCIAL SECURITY NUMBER 'L}'t3 - 1:1 '51/Q THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER D 3. Remainder Return (date 01 death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ... Z W Q Z o "- '" W 0: 0: o U FIRM NAME (II Applicable) TELEPHONE NUMBER '111) 5 3d 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule Dj 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested COMPLET~ MAILING ADDRESS r-:PtRl?/J D. 1.3 q I l<' R P 4V2. f-htR'R.15 Bu RG (1) (2) (3) (4) (5) 0- - 0 -0 - 0- 30""'1.~g PITr-t/)~ P",. i 7/t>q 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) z o ~ ::J l- ii: <C U w D:: 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (6) 0- (7) -0 - (9) (10) (8) Qo4,'ii' I 4 <3l-t.'3 g '--OF FlCIAL 3o'1~1 'i?5.? (11) (12) (13) \~"a<1.c.,q aq3"1~ 19 - 0- 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (ScheduleJ) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' ::J a.. ::iE o u g 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 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .;;tq3i~.J'1 x.O_ (15) x .0':i5" (16) x .12 (17) x 15 (18) (14) ,?Cl .~'1~.19 -0 - \~;l\'''5 (19) - \'3;l.\.1~ Decedent's Complete Address: STREET ADDRESS \? 0 CITY Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) \ ~ ")"iL (" l-, Total Credits (A + B + C ) (2) \"J.. S~.lo h 3. InteresUPenally if appiicabie D. Interest E. Penalty -0 - TotallnteresUPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) \ \ '3::;1..\.1 S- 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE, (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (,. '3.09 -0- ("3.oq PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;" b. retain the right to designate who shal! use the property transferred or its income;". c. retain a reversionary interest; or..... ........ ......... .............................. 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 whjch contains a beneficiary designation? . Yes .......0 ...........................0 o ....0 ....0 ..........0 .......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, No ~ 124 IXI DZI ~ ~ SIGNATURE OF PERSON RESPONSIBLE FOR FiliNG RETURN Under penalties 01 perjury, I declare thatl have examined this return, including accompanying schedules and statements, and to the /Jest of my knowledge and b8!ie!, it is true, correct and complete. Declaralion of preparer other than lhepersonal representative is based on all information of which preparer has any knowledge DATE ADDRESS \3~ I For-A A"~V\'^-e, \-+o.V'v."''o....r@ PA SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE \,'09 ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. &9116 (a) (1.1) (i)]. 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. &9116 (a) (1.1) (ii) The statute does not exempt a transfer to a sUlvjyjng 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 chiid is 0% [72 P.,S. 99116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneftciaries is 4.5%, except as noted in 72 P.S. &9116(1.2) [72 P.S. &9116(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. &9116(a)(1.3)]. A sibling is deftned, under Section 9102, as a, individual who has at Jeast one parent jn common with the decedent, whether by blood or adoption. REV."''''''''.97I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 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 Wo..'t Pd\Vl.-t- '6a.l-\1< - C,^e.J~,\GV1j f\-c.c:.+.~ 010004,005 VALUE AT DATE OF DEATH ;)..S:l4'7,l.{r;? 1... 'B~ve.r1~ l'C\-"\hv-plI';ses, r~C, -nuv-s;Vl9 hDW\~ v-etuVld 5'31c'7,'-/Y L-t. t3evev-l'j ~di -t--oYV\lC( c.ov-p. - retI..L~d D-P ?-e..YSo",o..\ 0~e..DUYl+- oj-.. hI..LV''S''~) h 6vYt ~ tOVlSec.O Se..lI'\io...- \"-\-~l\..\-\-h :r:..V\-Su.\ro..Y\~E' CD.- ?reW1 \ I..L "'" re +u. \rl d \ 0.:;2., '15 3. 4;).,(')0 TOTAL (Also enter on line 5, Recapitulation) $ 30 7 fa } , 8 2? (If more space is needed, insert additional sheets of the same size) R"'~"""''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF \)OVD~~ l.? \ ",-'1--t- Debts of decedent must be reported on Schedule I. FILE NUMBER .loo;;1-o\o~q ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: \ 1. \IV tJ o.i '<0. t).J y\ '(Y\ e.\rr\CV-" 0- G-a.... <\"1. V\ S - ~ \rOo \J ~ <!) r e. Y'- i V\<j 5 ~o, 00 ~. R~ veve.,^d Go rd(H"1 lew i S - r'-'.M V" "..I S'o(v-v,'c..~ \ 00.00 B. ADMINISTRATIVE COSTS 1. Personal Representative's CommIssions Name of Personal Representative (5) 0 - - Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City Slale Zip Year(s) Commission Paid: -0 - 2 Attorney Fees 3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation) Claimant -0 - Street Address City State Zip Relationship of Claiman110 Decedent 4. Probate Fees \(Q.5 i~\-e" 0+ UJ; \ \5 \OO.5'"D 5. Accountanfs Fees - 0 - - 0 - 6. Tax Return Preparer's Fees 7. Re"s-\-ey o-P W:\1s - :!:'V\ Ve..,^'\-Ov ~ "L\\V)~ fe~ \0.00 '6, C.t,.l""b~...\",-'^J lO-v.J J()~V-\-\c...\ - 'P lA.b \,' c ...:h' 0 ~ of- lWoi, Ce to C:..e..d.t -1-0V'S 15.00 q. \\"l!... \l&.'t-n'ot 'Ne..ws - I{>v..b\; <!.-~'C \1 oi2 q Q.31 Nc)'T\c.~ -\-0 (YQd.~toV"S TOTAL (Also enter on line 9, Recapitulation) $ 9oLf.'i5t (If more space IS needed, Insert addlllonal sheets of the same size) ,,,"""'1'''' . SCHEDULE I COMMo\j';:lTHOFPE~~SYLVANI^ DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF 'DOV"O-\-k,\ L'Y \cf1 + FILE NUMBER ).oo;;t - C)\{-,~q Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. \I'J<2S-1- S"'OV-~ ~W\S -I\M'o",-\,G<.\-\c.e... 'SeV'viC~ L\,;l..OO ).. 0..,,; \, ~ \<'iVVl I')r>~ \ r \.l.V\.~v-c....\ 'l-J.o VI-'l '€. d~~ C-e.1-+;'(;'c~+es \0.00 3. \Ne.st- S'nove. 't+oe.o....'t-\, ()..~d ~e..hQ6 c.e...-d-e., ~. ~g TOTAL (Also enter on line 10, Recapitulation) $ W <;; '-f. '8 '8 (If more space IS needed, msert addItIonal sheets of the same size) '"."",,.("". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEJ BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. ~~\J ~ehe'l", ~'L4\ ~o~ Iq'i!'O ~"G..(,,1 ",II; Savl, 0'1( i'-\ '\5::5' ~v"'"dsoV\ ~. 'iYI.cJ,.",4.\ ,",~\.....Q.V" \ 'i/o/ N.W...I"Ll.t-S-+ . 'j ro."d S l:> V) (.,(.,(.,.,"1 So..\I.S"'w, OK "l'tqsS 3. w; ''''AWl H~h.e.V", ~~'l\l ~d R,ve.rS+ '3 V'<U'\ c:l S 0'(\ fat" (",1.1:. M<t'S,\lI.' -t~ \ r)( 151 So 4. \<Qr~1'I {)"-~OY\, 13" \ FOY'd A v~ . d.<l..~ h:te r :;"ooo.OD H....V'\~b"'v-~, '{lit- 11 I () '" 5. (Y)"'......oV'\ G\',-~~dtl) &,5'1(" KifQ.C't. ~CY'l d.. 0 00. 00 !\JOt+-\-, floy-;- \ r l- 3 L/ ;l..g'l 4.. C-G.V"o\ m~m\\I\o.Y\ ~ool \-hl.lthmiYl~birdl),... dA.IA~""~Y' ;2.000.00 lY\ ) . ~clNJ.."'\cs'oo..Y~1 r?A \70 5~ "1. Q't\'1\\i:s \a.i\oY', \~W.\'Y\e..:"."lvtl~ Rd. cLo...u ~ k t€- y ;11,37.:2. / '9 De...\h, fA I, '31 '+ ENTER DOUlARAMOUNTS 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. -0 - B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. - 0 - TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ -6 - (If more space Is needed, Insert addltionalsheels of the same size) BUREAU OF INDIVIDUAL TAXES ?_/~ / ~ ~ COMMONWEALTH OF PENNSYLVANIA v INHERITANCE Tax DIVISION DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 IX AFP (01 -03) ~~;- f: DATE 05-12-2003 ~2~; _ ESTATE OF PLATT DOROTHY L DATE OF DEATH 11-08-2002 FILE NUMBER 21 02-1029 KAREN D PATTON ~03 (iAY 16 ~~~ a~7 COUNTY CUMBERLAND 1391 FORD AVE ACN 101 HBG PA •1,7.109.. Amount Remitted ~.:~_~. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - -------------- RETA_IN LOWER PORTION FOR YOUR RECORDS -~ REV-1547 EX AFP {01-03) NOTICE OF INHERITANCE TAX --------------- ------------ ----- APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PLATT --------------- DOROTHY L FILE N0. 21 02-1029 ACN 101 DATE 05-12-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. :Stocks and Bonds (Schedule B) C1) .00 NOTE: To insure proper 3. I:losely Held Stock/Partnership Interest (Schedule C) (2) •00 credit to your account, 4. Mortgages/Notes Receivable (Schedule D) (3) .00 submit the u peer portion 5• (:ash/Bank Deposits/Misc. Personal Property (Schedule E) (4) •00 of thi s form with your 6. ,lointly Owned Property (Schedule F) C5) 30,761 8 $ tax pa yment. 7. Transfers (Schedule G) C6) .0 0 8. Total Assets C7) .00 APPROVEI) DEDUCTIONS AND EXEMPTIONS: cs) 30,761.88 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 904.81 C9) 10. Debts/Mortgage Liabilities/Liens [Schedule I) 11. Total Deductions C10) 484.8$ 12. Net Value of Tax Return C11) - 7 ~R 9 c o 13. Charitable/Governmental Bequests; Non-elected 9113 Trust C12) 29,3 72.19 s (Schedule ~) 14. Net Value of Estate Subject to Tax (13) .00 c14) 29, 372.19 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16 reflect figures th , 17, at include the total of ALL returns assessed to date.a ASSESSMENT OF TAX: nd 19 will 15. Amount of Line 14 at Spousal rate 16. Amiount of Line 14 taxable at Lineal/Class A rate C15) .00 X 00 = C16) 29 372 19 .00 , . X 045 = 17. Amount of Line 14 at Sibling rate 1 321.75 ' X 12 18. Amount of Line 14 taxable at Collateral/Class B .00 rate (18) •0 O 19. Principal Tax Due X 15 = .00 n9)= 1,321.75 DATE ... .aa,uun i i+~ NUMBER INTEREST/PEN PAID (-) 01-21-2003 CD002071 04-01-20103 CD002370 66.09 .00 ^ IF PAID RIFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 1,258.66 63.09 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,387.84 6 0906 C9p R 00 6 9006 9CO. R IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE nc Turc ~,..,.. ~.._ _..__. L STATUS REPORT UNDER RULE 6.12 Name of Decedent:_ ~JOI~'O~I1~ '^• ~)(~-fi--~' i ~ t)ate of Death: Pill No. C~ Admin. No. o2QQa, -~ ~ ~~, Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes_~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal re resentative file a final account with the Court? Yes No~, b. The separate Orphans' Court No. (if any) for the personal representative's account is: account informally tDodtheepartiesainrepterestatiYeSState an d. Copies of receipts, releases approvals of formal or informal accounts may be~fileddwithathe Ce~rk of the Orphans' Court and may be attached to this report. Date: ~" 3i 03 Signature ctr ~ ~0.~--~-pv~ Name (Please type or print) 13 9 I r av-c~ ~4- ve ~i L,,,rc 1~1~q ,, Address 1"ll'7~ 5~S ~ ~SZ 3 0 sh Tel No. t `~ Capacity: personal Representative '. o ~C- Counsel for personal (MA,H:rmf/AM3) representative J ~ J'! `~„ BUREAU! of INDIVIDUAL TaxES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT INHERITANCE TAX DIVISION OF REVENUE DEPT. 2B0601 HARRISBURG, PA 17128-0601 INHERITANCE TAX STATEMENT OF ACCOUNT REV-16RI E% ~FP (R1-03) ~` ' ` DATE 06-09-2003 ESTATE OF PLATT DOROTHY L DATE OF DEATH 11-08-2002 •03 FILE NUMBER 21 02-1029 ..- ~~ i ~ ~ ~~ ~~ KAREN D PATTON . _ , COUNTY CUMBERLAND ~ 1391 FORD AVE ACN 101 HBG '~> F'A 17109 Amount Remitted i't4,. _ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS __~ REV-1607 EX AFP (01-03) ~(~~(---------------------'---------- INHERITANCE TAX STATEMENT OF ACCOUNT ~(~~ ----------------' ESTATE OF PLATT DOROTHY L FILE N0. 21 02-1029 ACN 101 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATETESHOWN BELOW 03 IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-05-2003 PRINCIPAL TAX DUE :........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-21-2003 CD002071 04-01-2003 CD002370 05-27-2003 REFUND ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. [ IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. 66.09 1,258.66 .00 63.09 .00 66.09- 1,321.75 TOTAL TAX CREDIT 1,321.75 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )