HomeMy WebLinkAbout01-0019
REV.1500EX(S-OOl
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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IX:
FiLE NUNisER-----------.-
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CQUNTYCQDE YEAR
2 1 - 0 1
o 0 1 9
- NUMBER- - -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GILL, Esther M.
DATE OF DEATH (MM-DD-YEAR)
11-10-2000
SOCIAL SECURITY NUMBER
209
12
6960
DATE OF BIRTH (MM.DD-YEAR)
12-11-1908
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
NA
NA
.KJ 1. Original Return
o 4. Limited Estate
\KJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12.82)
o 7. Decedent Maintained a living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (clllteof de;1\h OeW/ee\\ 12<'..141 arnl 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82]
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attadl Soh oJ
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N~~~ve C. Nicholas, Esquire
Fm~''t'IFOREMAN, PC
TELEPHONE NUMBER
(717) 236-9391
COMPLETE MAILING ADDRESS
4409 North Front street
Harrisburg, FA 17110-1709
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes ReWvable {Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Sche<Jule E)
6. joIntly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
16.612.00
86,415.91
(6)
(7)
- (6)
103,027.91
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
13,679.22
5,172.35
10. Debls of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11) 18,851.57
(12) 84,176.34
(13) 12,023.15
(14) 72,153.19
x.o_ (15) -0-
x.O_ (16) -O-
x .12 (17) -O-
x .15 (18) 10,822.97
/19) 10,822.97
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 (Schedule J)
14. Net Value Subject to Tax (Line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14laxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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16. Amount of line 14 taxable at lineal rate
-0-
-0-
12,153.19
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. rn
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>>BE 5IJRE"rO~I.dUI!:;l:;~i>t_",~:MATH''''':<f wi :S'~',:~'~l';~,:\,'~:
Decedent's Complete Address:
STREET ADDRESS
1700 Market Street
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
.
(1)
10,822.97
12,500.00
625.00
3. 'nteres~Penalty if applicable
D. Interest
E. Penalty
Total Credits (A+ 8 + C)
(2)
13,125.00
Totallnteres~Penalty ( 0 + E ) (3)
4. If Line 21s 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)
-0-
2,302.03
-0-
-0-
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. (SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
-0-
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 []I
b. retain the right to designate who shail use the property transferred or its income; ............................................ 0 []I
6. retain a reversionary interest; or.......................................................................................................................... 0 50
d. receive the promise for life of either payments, benefits or care? ....................................................,................. 0 50
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 50
3. Did decedent own an "in trust for" or payable upon death bank acoount or security at his or her death? .............. 0 rn
4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which
centains a beneficiary designation? ........................................................................................................................ 0 50
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare thai J have examined this return, including accompanying schedules and statements, and to the best 01 my knowJadge and belief, il is true, correct
and complete.
Declaration of preparer other than the personal representative is based 011 all information of which preparer has allY knowledge.
SiGNATURE SON ESPO I ING RETURN
Ie
ADDRESS
SIGNATURE OF P.
DATE
(g -IT-v I
ADDRESS
4409 North Front Street, Harrisburq, FA 17110-1709
.11' _.JilI~~~r.l1C,i' "'"'11.-_..._ .. lIP"
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 (aJ (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 survivin9 spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a sUlYiving 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 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 PS. 99116(a)(1.2)).
The tax rate imposed on the net vaiue 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 vaiue of transfers to or for the use of the decedent's siblin9s is 12% [72 P.S. 99116(a)(1.3)]. 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.
LAST \V1LL AND TESTAMENT
OF
ESTHER M. GILL
I, ESTHER M. GILL, of the City of Harrisburg, County of Dauphin, Commonwealth of
Pennsylvania, declare this to be my Last Will and revoke any Will or Codicil previously made by
me.
ITEM I: I direct that all expenses of my last illness and funeral shall be paid from my
residuary estate as soon as practicable after my decease as a part of the expense of the
administration of my estate.
ITEM II: I direct that my funeral and burial arrangements shall be in charge of the W.
Orville Kimmel Funeral Home, 2001 Market Street, Harrisburg, Pennsylvania, and that my place
of burial shall be in the Rolling Green Cemetery in the Charles and Hazel Hiller lot, Section 25,
Block "C", Grave Number 3. I further direct that religious services shall be conducted by the
minister of the Fourth United Church of Christ, 16th and Market Streets, Harrisburg,
Pennsylvania.
ITEM III: I direct my Co-Executors, to pay the reasonable travel and lodging expenses
which may be incurred by my sister in law, MARY O. GILL and by my niece, CHRISTINE
GILL LOTTS, and my nephew, WILLIAM H. GILL, and their immediate families, to attend
my funeral services. Payment of such expenses shall have precedence over any specific cash
bequests or residue requests which I make in this, my Last Will and Testament.
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ITEM IV: I bequeath the sum of Fifty Thousand and no/I 00 ($50,000,00) Dollars to my
sister-in-law, MARY O. GILL, now of 39-457 Desert Greens Drive E, Palm Desert, California,
92260 providing that she survives me by thirty (30) days.
ITEM V: I bequeath the sum ofTen Thousand and no/I 00 ($10,000.00) Dollars to my
step-nephew and his wife, WILLIAM COULTER and ELLEN COULTER, now of 1533
Englewood Street, Bethlehem, Pennsylvania providing that one of them survive me by thirty (30)
days,
ITEM VI: I bequeath the sum of Fifty Thousand and no/lOO ($50,000.00) Dollars to my
dear friend and Guardian, ZORA L. CAPELLO, now of25 Conway Drive, Middletown,
Pennsylvania 17057 providing that she survives me by thirty (30) days.
ITEM VII: I bequeath the sum of Twenty Five Thousand and no/I 00 ($25,000.00)
Dollars to my friend and fmancial advisor, CHARLES A. KOCH, JR., now of25 Orion Road,
Boiling Springs, Pennsylvania 17007 providing that he survives me by thirty (30) days.
ITEM VIII: I bequeath the sum ofTen Thousand and no/IOO ($10,000.00) Dollars to
my dear friends, BETTY BOWERS and GLENN BOWERS, now of221 Mountain Road,
Dillsburg, Pennsylvania 17019-1514 providing that one of them survive me by thirty (30) days.
ITEM IX: I bequeath the sum of Five Thousand and no/I 00 ($5,000.00) to my dear
neighbor and friend, VIRGINIA GEE, now of2015 Market Street, Harrisburg, Pennsylvania
17103 providing that she survives me by thirty (30) days.
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ITEM X: I bequeath the sum of Twenty Five Thousand and no/IOO ($25,000.00) to my
church, FOURTH UNITED CHURCH OF CHRIST, now located at 16th and Market Streets,
Harrisburg, Pennsylvania 17103.
ITEM XI: I devise and bequeath the residue of my estate, of every nature and wherever
situate, in equal shares to my niece, CHRISTINE GILL LOTTS, now of 10444 Camarillo
Avenue, Toluca Lake, California, and my nephew, WILLIAM H. GILL, now of75-375 Painted
Desert Drive, Indian Wells, California 92210, providing they survive me by thirty (30) days.
Should either of my said niece or my said nephew predecease me or die on or before the
thirtieth (30th) day following my death, I devise and bequeath their share to such of her or his
issue, per stiJ:Pes, as are living on the thirty-first (31st) day following my death.
ITEM XII: I appoint CORESTATES HAMILTON BANK, of Harrisburg, Dauphin
County, Pennsylvania, Guardian of any property which passes either under this Will or otherwise
to a minor and with respect to which I am authorized to appoint a Guardian and have not
otherwise specifically done so, provided that this appointment of a Guardian shall not supersede
the right of any fiduciary in its discretion to distribute a share where possible to the minor or to
another for the minor's benefit. Such Guardian shall have the power to use principal as well as
income from time to time for the minor's support and education (including college education,
both graduate and undergraduate) without regard to his or her parent's ability to provide for such
support and education, or to make payments for these purposes, without further responsibility, to
the minor or to the minor's parent or to any person taking care of the minor.
ITEM XIII: I direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as
a part of the expense of the administration afmy estate.
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ITEM XIV My corporate fiduciary shall be entitled to compensation based on its regular
schedule of fees for such services in effect at the time of the service rendered.
ITEM XV: Should the principal of any trust herein provided for be or become too small
in the Guardian's discretion so as to make establishment or continuance of the trust inadvisable,
my Guardian or my personal representative may make immediate distribution of the then-
remaining principal and any accumulated or undistributed income outright to the person or
persons and in the proportion they are then entitled to income. If any such person is then a
minor, distribution may be made to the guardian of the person of such minor. Upon such
termination, the rights of all persons who might otherwise have an interest as succeeding income
beneficiaries or in remainder shall cease.
ITEM XVI: I appoint GLENN BOWERS, now of 22 I Mountain Road, Dillsburg,
Pennsylvania 17019 and CHARLES A. KOCH, JR., now of25 Orion Road, Boiling Springs,
Pennsylvania 17007, as Co-Executors of this, my Last Will.
ITEM XVII: [direct that my Co-Executors, or their successors, shall not be required to
give bond for the faithful performance of their duties in any jurisdiction.
ITEM XVIII: I direct that my Co-Executors shall retain the law firm of NICHOLAS &
FOREMAN now of Harrisburg, Pennsylvania, to aid them in the administration of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of April, 1994.
[<J/tKc~J!} . .lJ~ IZL
ESTHER M. GILL
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The preceding instrument, consisting of this and other typewritten pages, identified by the
signature of the Testatrix, ESTHER M. GILL, was on the day and date thereof signed,
published and declared by ESTHER M. GILL, the Testatrix therein named, as and for her Last
Will, in the presence of us, who, at her request and in her presence and in the presence of each
other, have subscribed our names as witnesses hereto.
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ACKc'\TOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
I, ESTHER M. GILL, the Testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that r signed
and executed the instrument as my Last Will; and that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
Sworn to or aff=ed and acknowledged before me by ESTHER M. GILL, Testatrix,
this 21st day of April, 1994.
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ESTHER M. GILL
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Notary Public
NOTARIAL SEAL !
STEVE C. NICHOLAS, Notary Pub~i, ;
Horrts~u~g. Dauphin Count)/ POl. f
MyCorryml~:on E::pires S~pt. 25,19'9.'3 l
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COMMONWEALTH OF PENNSYL VANIA
SS.
COUNTY OF DAUPillN
WE, the undersigned, 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 the Testatrix, sign and execute the instrument as her free and voluntary act for the purposes
therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed
the Will as a witness; and that to the best of our knowledge, the Testatrix was at that time 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed before me by the undersigned witnesses, this 21 st
day of April, 1994.
Cf(()fO~iJ O(JrrOIJ '
Witness .
(V~LOJ Q L1.Z c llUtvl
Witness
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Notary Public
NOT,~RIAL SEAL
STEVE C NICHOLAS, NMary Public
Harrisburg, Dauphin County, Po..
M! Commission E.'\pjres Sept. 25, 19'95
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REV.I503EX.(1.97)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES!DENT DECEDENT
ESTATE OF
Esther M. Gill
FILE NUMBER
21-01-0019
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
2.
3.
4.
5.
u.s. Bond #M205882246E ($1,000) January, 1978
U.S. Bond #M205882276E ($1,000) March, 1978
U.S. Bond #M205882286E ($1,000) April, 1978
U.S. Bond #M205882287E ($1,000) April, 1978
U.S. Bond #M205669101E ($1,000) September, 1978
3,635.60
3,302.40
3,302.40
3,302.40
3,069.20
TOTAL (Also enter on fine 2, Recapitulation) $ 16,612.00
(If more space IS needed, insert addItIonal sheets of the same sIze)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Esther M. Gill
FILE NUMBER
21-01-0019
~nclude 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
First Union Bank #1000613468562
VALUE AT DATE
OF DEATH
17,705.83
2.
HCR Manorcare - Personal Account
34.90
3.
Prudential Secutities
68,675.18
TOTAL (Also enter on line 5, Recapitulation) $ 86,415.91
(If more space is needed, Insert additional sheels of the same size)
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Reference m: 124887
First Union National Bank
Attn: Account Ver1fications
POBox 40028
Roanoke V A 24022-7313
December 19, 2000
NICHOLAS & FOREMAN
4409 NORTH FRONT ST
HARRISBURG, PA 17110-1709
SUBJECT: Verification / Confirmation of Account and Balance Information provided for:
ESTHER M GILL (SSN# 209-12-6960)
Date of Death: November 10, 2000
Denosii Account Information
Account
Type
Account
Number
Date of Death
Balance
Average
Balance'"
Date
Opened
1/2/1950
Matuiity
Date
Interest Accrued YTD Date
Rate Interest Interest Paid Closed
CHECKING 1000613468562
LEGAL TITLE, ESTHER M. GILL
CHARLES A. KOCH, JR - POA
20RA L. CAPELLO. POA
NON-INTEREST BEARING ACCOUNT
$17 ,705.B3
'" Due to system 1imitations, we can only provide a twelve month average balance on depository accounts.
Other Account Information
Account
Type
Account
Number
Date of Death
Balance
Date
Opened
Date
Closed
Title(s)
SAFE DEPOSIT BOX
075B5348oo604
7/23/1996
ESTHER M. GILL
CHARLES A. KOCH. JR. . POA
20RA L. CAPELLO - POA
WCA TJON,
J 200 CAMP HILL MALL
CAMP HILL. PA 1701 J
PHONE, 717-737-8697
lJc)k. ZoNO.,
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}(,)/l.tJv1~j
S<-""-
001032
F~f;N
Reference 10: 124887
'" Date of death balance does not include accrued interest.
'" If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during that time period.
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sentative
December \ 9, 2000
Date
Drema Rubinoff
Depository Representative
Servicenter Associate
Title
(540)563-7323
Phone Number
sss; ag
001032
~ Prudential
January 3, 2001
Prudenliel Securili.. Incorpor.led
3 Lemoyne Drive. Lemoyne. PA 17043
P.O. Box 7. Camp Hill. PA 17001-9852
Tel 717 761-7344 800468-8685
fax 717 975-8426
Nicholas & Foreman
Attn: Steve Nicholas, Esq.
4409 North Front Street
Harrisburg, PA 17110
RE: Estate of Esther M. Gill
Dear Mr. Nicholas:
Enclosed please find the Date of Death values on the above referenced account. These
values are based on the Date of Death of November 10, 2000.
Quantity Security Price Per Market Value
Share
Command Money Market 1.00 1,824.00
113.449 Davis Financial Fund 36.08 4,093.24
127.842 Davis Convertible Sec Fund 24.12 3,083.55
176.890 Gabelli Growth Fund 42.73 7,558.51
1914.414 Pm Hi Yield Fund 6.43 12,309.68
405.745 Janus Fund 40.99 16,631.49
1331.752 Pm Muni Bond Fund Hi Income 10.11 13,464.01
283.310 Pm Value Fund 18.06 5,116.58
53.871 Putnam Health Science Fund 85.28 4,594.12
Total $68,675.18
Should you require any additional information, please do not hesitate to contact our office.
~iWp-
Charles A. Koch
Vice President - Investments
RE\'-1511EX+(1-97)"
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
!NHER!TANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Esther M. Gill
FilE NUMBER
21-01-0019
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPT[ON AMOUNT
A. FUNERAL EXPENSES:
1.
Glenn Bowers 2,500.00
B. ADMINISTRATIVE COSTS: SSN 200-24-9744
1. Personal Representative's Commissions 221 Mo1ilntain Road, Dillsburg, FA 17020
Name of Personal Representative (5) Charles A. Koch, Jr. 2,500.00
Sodal Security Numbe<<s) I EIN Number of Personal Representative(s)
Street Address 25 Orion Road
City Ba>ilinq Sprinqs. State FA Zip 1 7007
Year(s) Commission Paid:
2. Attorney Fees Nicholas & F0reman, PC 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant NA
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills 229.00
4.
5. Accountant's Fees Martin M. Sacks & Associates 300.00
6. Tax Return Preparer's Fees
7. Travel costs William Gill 1,791.41
8. Travel costs Christine Gill Lotts 1,158.92
9. Advertising CUmberland Law Journal 75.00
10. Advertising The Sentinel 90.59
11. Miscellaneous Postage, copies, Notary 35.00
TOTAL (Also enter on line 9, Recapitulation) . 13,679.22
.
([f more space IS needed, insert additionai sheets at the same size)
REIi.1512EX.il.~7) ~
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COMMONWEALTH OF PENNSnVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Esther M. Gill
FILE NUMBER
21-01-0019
include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
4,268.07
1.
HCR Manor Care #W819
2.
Neighbor Care #3082
Verizon #717-761-1563-257 15Y
54.83
3.
12.80
4.
First Union #1-8562 - ACH Return
768.00
5.
West Shore EMS #9052764A
68.65
TOTAL (Also enter on line 10, Recapitulation) $ 5,172.35
{If more space is needed, insert additional sneets of the same size)
Oil! Schedule J scn/est
SCHEDULE J
BENEFICIARIES
ESTATE OF File Number
GILL, Esther M. 21-01-0019
Taxable Distributions Amount or
No. Name / Address of Beneficiary Relationship Share of Estate
1. Mary O. Gill Sister-in-Law $50,000.00
4416 Placidia A venue
Toluca Lake, CA 91602
2. William and Ellen Coulter Step-Nephew and $10,000.00
1533 Englewood Street Spouse
Bethlehem, PA 18017-6173
3. Zora 1. Capello Friend $50,000.00
999 West Harrisburg Pike
Apt. 308
Middletown, PA 17057
4. Charles A. Koch, Jr. Friend $25,000.00
25 Orion Road
Boiling Springs, P A 17007
5. Glenn Bowers Friend $10,000.00
221 Mountain Road
Dillsburg, P A 17020
6. Virginia Gee Friend $5,000.00
2015 Market Street
Harrisburg, P A 17103
7. Faith United Methodist Church Charity $25,000.00
of Christ
16th and Market Streets
Harrisburg, P A 17103
8. William Gill Nephew 50% residue
5502 LeatherleafDrive
North Myrtle Beach, SC 29582-9303
9. Christine Lotts Niece 50% residue
4416 Placidia Avenue
Toluca Lake, CA 91602
Register of Wills of Oumberla~unty, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Esthpr M
C::i 11
No.
21-01-19
also known as
, Deceased
Social Security No. 209-12-6960
Petitioner(sj, who is/are 18 yeafll ot age or older, apply(iesl tOl:
(COMPLETE "A" OR "B" BELOW:)
~
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut..or..s. named in the Last Will of the
Decedent, dated April 21, 1 gg4 and codicil(s) dated None
!\To 1<;xceptionliO
State relevant circumstances, e.g., renunciation, death of executor, ete
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
Q
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.8.: pendente lite; dtlfonte absentia; dUJante minorilole)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
Decedent was domiciled at death in
residence at
~l1mhpr1ond
County, Pennsylvania, with his/her last family or principal
Pl\ 17011
1700 Market Stroot, C~mD Hill,
(list streel, nwilber and muni~8hty)
Decedent, then g 1
years of age, died November 1 0
, 20QJL at Camp Hill r PA
(Location)
Decedent at death owned property with estimated values as follows: ~~, ~ I!!'
(If domiciled in PAl All personal property .............................. $ ~,,1: VVV
(If not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . $
(If not domiciled in PAl Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . $
Value of real estate in Pennsylvania ............................................... $ -4!:1
Real Estate situatedT:;a:OI;~~~:' . .. .. ... .. . . .. . . . .. . . ... . . 'iJiJNt.. . . . ... . .. . . . . . . . . . . . . . $ ~i at)()
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:
Typed or printed name and residence
Charles A. Koch Jr
RW-7
/6 --/91'- q
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 true and
correct to the best of the knowledge and belief of Petitioner(s) and t , as pers nal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate ace In aw.
Sworn to and affirmed and subscribed
Glenn Bowers
b::::th;S 5th ::'00: ~~~~4j)-
~ ? ~1 Charles A. K ch,
//;PLL/(!- / //L/~?L~)J;()e._J~-u-z;r
Jr.
DECREE OF REGISTER
Estate of
ESTHER M GILL
Deceased
No.
21-01-19
also known as
Social Security No: 209-12-6960
Date of Death:
11-10-2000
AND NOW, JANUARY 5 , 20~, in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters !XI Testamentary 0 of Administration
le.Lll.; d.lULC.t.; pendente lite; dUlante absentia; dUfante minoritall~J
are hereby granted to
Glenn Bowers and Charles A Koch Jr
in the above estate and that the instrument(s), if any, dated 04-21-1994
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters................. .......... $
200.00
'>>)0/,(1 '::t:.a~~Lj AI"'} ~di
Reg; er of "Vilis . .
Short Certificate(s).......... $
Renunciation.................. $
Affidavit ( )................. $
Extra Pages ( )............ $
CodiciL......................... $
JCP Fee........................ $
Inventory & Tax Forms... $
Other............................ $
6.00
18.00
5.00
Attorney: steve Co Nichol.,~!';, F,!';ql1irp
1.0. No: 06845
TOTAL................ $
229.00
Address: 4409 North Front strppt
Harrisburq, PA 17110-1709
Telephone: (717) 7.1fi-Q391
DATE FILED: January 5, 2001
RW-7a
'7?j~~ ~~
['hI' is to certify that the infornation here given is correctly copied fran: an original certificate of death dul~ flied with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
/J. ~"7 /';j~
c.C-?1,/;l/ /" (. '/'~~4/zA-('~.~<<'_-
Local Registrar/,
(,
Fee for this certificate, $2.00
p
6919575
NOV ~~}OOO
21-01-19
3 R..... 2187
COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
,.
ft1.
2.
F
sr-.I€ flLf NUMeEA
SOCIAl. SECURIT'I' NUMBER
3. ,;(09 - 101. -Is, 9/,0
DAlE OF OEATH lMcNh. Oa~. '..."
.. IV (J/)E/llI3ER. I~ .toOCJ
NAME OF DECEDENT (fIts. Middle. last'
ESTHEf(
SEX
9/y"
UNDER' YEAA
........ Day>
UNDER ~
Hours; Minu1..
9lRTHPL...Aa ie.I.., ar.d PlACE OF DEATH (Ct'l('di Of\ly 1)(l8 -- 'i8I 'nSlrUCllOl'l'9 on ~ SKJet
SUl1801FCletgI'lCOlJ(II'V) HOSPItAl; -
lI/Jee/s/jui'G.. ,_,_ 0 E"""-",'" 0 DClo'\ 0
1. ? ...
FACtUT"t' NAME (If nolln!;l"IIJIIOl'l. gIVe s1,eel and numDerI
~=..,)O
AGE (laSl BlfthClaY)
et..l/i7AER-LI1ND
Ill.
sa/)/cES
RACE. Arnenan Indian. aa.ck. wt\".. eu:
(S,*""I
COUNT'I'OF llERH
e./Jrnp H IL.L
Ie. 141.
DECEDENT'S USUAL OCCUMION KlNOOF BUSINESS/lNOUSTRY
I~":"~:""":;::'::;~:'f Common WS1'H.;.T1/ of Pfl.
. ... SGCerrAteY .... {tAme CorrJ/n;ssloN
DECEDENT'S .....lING ADDRESS (Sk.... C....Ibon. SloOo. ZopCOdeI DECEDENT'S
I 70 0 In A ~K.I?T Sr.eEcT ~~~~NCE
C,q ff'l ,0 ).j ILL. (See "".""""""
,.. PC7vNS~/..(JAN'lIl /7rJll on 0".' "".l
:::-R'S"l!t;JlEI!FO~D JI. C /LL
1Nf00MANT'S NAME (T "","P,,,,,)
C/l-IM!.J..ES Kore.,./I
METHOD OF DISPOSITION
Burial ~ Cr.n\IIllQn 0 RemodIlrorn Slat. 0
OIIloIISpec",,'
'D.
4/NITc
17.. Stale
MARITAl. STRUS-_
N.......Manilld.~.
o.w.c.cI (SpocOy) .
\4. NI!l/E~ mAtI-IE/)
"c.O ......_liYodin
SURVIVING SPOuSE
\".... 1JI"" tnalOIn name)
..."
17b.Cou
cnm,IJ JI/4L.
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Pf:J 1'/067
...~
21.
I ApproXUTI".
::-.:::
PART If: Od\e1~CONflIiona<::anUibutinO\Oo.ath.bu&
...resuling in 1M undeftytng c-.. given in PART I.
c V Pr--
DUE lO (00 AS A CONSEQUENCE Of)'.
I :
OlJElO(OR AS ACONSEQUENCE Of),
DUE lOtOR AS ACONSEOUENCE Of}
WERE AUTOPSY FINDINGS
-'LA8lE PRIOR lO
COMPl.ETION Of CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
(Monll Day. Vear)
TlWE OF INJ AY
INJURY ,lQ' WORK1 DESCRIBE HOW INJURY OCCUflREO
........01
IS
o
~
Ham.....
pending lnYnliQation
o
o
o PlACE OF INJURV - "" hOme. '..m. SUeel,ladort. otfece ...
building, ttC.1Spec'lv)
3...
..... 0 NoD
-.....
b<vI q>( //1' I
lOC,lQ'\ON (Sk.... C4y/T0wn. SIoItI)
Y.. 0
NoD
SuicicH
Could noI be de'.rmaned
aIL 211:1.
ClJlTIFlU tCr.eck only Of'le')
-CERTIFYING PHYSJCIAN (PhySIC..n Cefllfylng cau5e ~ death when a(\otl1., ph"SIC,.an has pi'onouncea dealh ana completed Item 231
To Ute bear o. my knowledge, death occuned'" Ie ..... c.u..(S) _nd menner.. at.ttd. . . . . . . . . . . . . . . . .
21.
.PRONOUNCINQ AND CERTlfYlHQ PHYSICIAN (PhVSolCliln boCh ;.llonOUflClng oealfl aooceI1llyll'tq 10 cause 01 deatfl\
To'" blnt o. my knowledge, d.a'" Of;cu,,1ICI at U\e ume, d.te..nd plac.. and due 10 Ihe cau"(I).nd mann., a. "aled.. ...
o
o
,,1> '1...:1
...
CJ
,-
J;/
INRE:
ESTATE OF:
EVE DASHER
ESTATE NO. 2100-19
DECEASED.
SATISFACTION AND RELEASE OF CLAIM
The undersigned, Marti Harris-German, Agent for BANK OF AMERICA, has received a
payment of $8981.98 which satisfies the claim as filed for the date of death liability. This
Satisfaction and Release of Claim is executed to acknowledge discharge of the claim and to
release the estate and personal representative from all further liability with respect to the date of
death liability on account number 4262085000033726.
Executed this November 20, 2000.
BANK OF AMERICA
Claimant
By:j)t\ flA.j:l-~\A-,O - () l~/yyt{t;VL
MARTI HARRIS-GERMAN, Age~j
Estate Recoveries, Inc.
P.O. Box 24566
Baltimore, MD 21214
410-444-8022 Ext. 765
~
Gill Settle Agr/scn/est
RECEIPT AND RELEASE AGREEMENT
This Agreement is made by and between Glenn Bowers and Charles A. Koch, Jr., as
Executors of the Estate of Esther M. Gill, deceased ("Executor") and Mary O. Gill, William and
Ellen Coulter, Zorra L. Capello, Charles A. Koch, Jr., Glenn Bowers, Virginia Gee and Faith
United Church of Christ, specific beneficiaries of the said estate ("Specific Beneficiaries"), and
Christine Gill Lotts and William H. Gill, residuary beneficiaries of the said estate ("Residuary
Beneficiaries").
In accordance with their desire that the administration of the Estate of Esther M. Gill be
terminated without the expense and further delay of a court accounting, the parties hereto, in
consideration of the mutual covenants herein expressed, and intending to be legally bound
hereby, agree that:
1. Esther M. Gill died on November 10, 2000, and her estate is now in the process of
administration. The Register of Wills of Cumberland County, Pennsylvania duly granted Letters
Testamentary to Glenn Bowers and Charles A. Koch, Jr., on January 5, 2001 at No. 2001-0019.
2. Under provisions of the Decedent's Last Will dated April 21, 1994, the Decedent
made the following cash bequests:
1. Mary O. Gill - $50,000
2. William and Ellen Coulter - $10,000
3. Zorra L. Capello - $50,000
4. Charles A. Koch, Jr., - $25,000
5. Glenn Bowers - $10,000
6. Virginia Gee - $5,000
7. Faith United Church of Christ - $25,000
3. The combined balance of principal and income of the estate for distribution
pursuant to the First and Final Account of the Executor totals $67,506.97. A copy of the First and
Final Account is attached hereto as Exhibit "A".
4. The Executor shall reserve the sum of $1 ,000.00 to pay any additional expenses,
including filing fees, fiduciary taxes and attorney fees that may be incurred to finalize and close
the estate. There shall be no funds available for distribution to the Residuary Beneficiaries and
therefore any unused reserve shall be distributed to the specific beneficiaries pro-rated.
5. The balance remaining for distribution to the specific beneficiaries stated as of
December 27, 2001, less the $1,000.00 reserve fund totals $66,506.97. The Executor proposes to
distribute the said $66,506.97 upon the execution and tiling of this Agreement with the Court as
follows:
1. Mary O. Gill - $19,001.99
2. William & Ellen Coulter - $3,800.40
3. Zorra L. Capello - $19,001.99
4. Charles A. Koch, Jr. - $9,501.00
5. Glenn Bowers - $3,800.40
6. Virginia Gee - $1,900.19
7. Faith United Church of Christ - $9,501.00
Total Distribution
$66,506.97
6. Each Beneficiary acknowledges that the Executor has received the assets and has
made the payments set forth in the First and Final Account. The Beneficiaries approve the said
First and Final Account of the Executor as stated, in its entirety.
7. The Beneficiaries consent, approve and agree that the remaining balance of the
estate assets shall be distributed as set forth in paragraph 5 hereinabove.
8. Without intending to limit the rights or remedies of Executor or his attorneys, the
Beneficiaries further agree to indemnify the Executor or his attorneys, and save them harmless
against all liability, loss, and expense (including, but not limited to, costs and counsel fees)
which they, may incur, whether due to their, negligence or otherwise, as a result of making the
above-described distributions without a court audit. The Beneficiaries hereby forever fully
release, compromise, settle and discharge any and all claims, demands, actions or causes of
action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which they may
have against any other party hereto or against the Estate of Esther M. Gill or the Executor or his
attorneys thereof, by reason of any matter, cause or thing growing out of or relating to any
property or assets of the said estate, or growing out of or relating to any act of the Executor or his
attorneys, in the administration of said estate, even if attributable to negligence, and agree that in
no event shall the said period for collection of any erroneous distribution or distributions be less
than two years after the actual discovery thereof by the Executor or his attorneys.
9. The Beneficiaries agree to execute such additional releases as the Executor or his
attorneys, may submit to them in order to confirm their discharge from any further liability to the
parties in connection with the said estate.
10. This Agreement may be executed in multiple counterparts and, when so executed
by all parties hereto, shall be binding upon all the parties, and their respective heirs, next-of-kin,
personal representatives and assigns.
IN WITNESS WHEREOF, the parties have hereunto set their hands and seat the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Executor
Dated
:J 9 /)1 r' 2002
ary O. Gill, Beneficiar pO'W<A. 5 ~
. '
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Mary O. Gill, Beneficiary of the Estate of Esther M. Gill who being duly sworn
according to law, deposes and says that the facts contained in the foregoing First and Final
Account are true and correct to the best of her knowledge, information and belief.
i4:LA.t~
Mary O. Gill
SWORN to and subscribed
before me this ;;) q ~ day
of rvw l.-r 2002..
~Q If 1.. u- V CJ.. Qpnt.l ,,--
Notary Public
THERESA VALENCIA
a Commission # 1335036 z
~. Notary Public - California ~
J Los Angeles County
MyCorrrn. Expires Dee 15, 2005
,.. -- ,...- II~
My Commission Expires: {d.-I S ~D ..,:;
IN WITNESS WHEREOF, the parties have hereunto set their hands and sear the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Executor
"-j
D t d l_1f{.A-l-/. / g
a e . I
(/
,2002
>~ J:./~ ~~r-
/, i~{.,...I .
./ I~
iU;rra L. Capello, BeneKciary
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Zorra L. Capello, Beneficiary of the Estate of Esther M. Gill who being duly sworn
according to law, deposes and says that the facts contained in the foregoing First and Final
Account are true and correct to the best of her knowledge, information and belief.
~G(/ 0( ~r-
(}6rra L. Capello
SWORN to and subscribed
before me this / ff -ct day
Of~;ffU&f/'i 2002.
! ,- .
~u~9' titff~/
/Notary Public .
My Commission Expires:
NOTARiAL SEA!.
.~ GlORIAJ.ALTIMORE. ~ld,;aryPubl!c
, lcNJGi Swamra T'l!p., Dauphin Coon!;! a
My ~sOOn expires ~!!, 2004 J
IN WITNESS WHEREOF, the parties have hereunto set their hands and seat the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
I /; 7 It> 2.- , 2002
I '
~r
Dated
I /17 ~ #
( ,
,2002
Charles A. Koch, Jr., Exec or
Charles A. Koch, Jr., l3enefi~ '
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Charles A. Koch, Jr., Executor and Beneficiary of the Estate of Esther M. Gill who
being duly sworn according to law, deposes and says that the facts contained in the foregoing
First and Final Account are true and correct to the best of his knowledge, information and belief.
r~.~
Charles A. Koch, Jr. 7
SWORN to and subPlibed
before me this '7 day
of 2002.
My Commission Expires: / t.jl1J.d'","
Notarial Seal
Mary Gregory Soule, Notary Public
lemoyne Boro. Cumberland County
My Commission Expires Dec. 18,2005
Member, Pennsyivan;a Association Of Notaries
IN WITNESS WHEREOF, the parties have hereunto set their hands and seal'the day and
year hereafter set forth.
Dated ~.
{I
~}
,2002
Dated
,2002
Dated ~. .z.3
,2002
CharleSA~:
, '
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OFfl"rn'IIIt,' ~O(j{
: ss.
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Glenn Bowers, Executor of the Estate of Esther M. Gill and Beneficiary of the Estate of
Esther M. Gill, who being duly sworn according to law, deposes and says that the facts contained
in the foregoing First and Final Account are true and correct to the best of his knowledge,
information and belief.
SWORN to and subscribed
before me this 2~ day
of7T(t1tI{(J,ry 2002.
=:4::t j-<f~1id
Notar Public
My Commission Expires:
Notarial Seal
S. Dawn Gladfelter, Notary Public
DII/sbur~ Bora, York COunty
My Commission Expires May 17, 2005
Member, Pennsylvania Association of Notaries
IN WITNESS WHEREOF, the parties have hereunto set their hands ahd seal 'the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Executor
Dated I-.J L/_ 0,;1
,2002
/--1
7A c....~../ /. ~ (
~/ / /r->.
.~)2/~-J '( . \i' eft, v".rz1
f j) /, l/
v./u.If.;
COMMONWEAL TH OF PENNSYL VANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Virginia Gee, Beneficiary of the Estate of Esther M. Gill who being duly sworn
according to law, deposes and says that the facts contained in the foregoing First and Final
Account are true and correct to the best of her knowledge, information and belief.
SWORN to and subscribed
before me this dif1 !.l day
of ~t\N\l M I.(' 2002.
Cl-\A,ot{A~ J Vu.Ct~A;{ ?-0
Notary Public
~ .0
-,1\
/<--t.--u':" ,..' , '..e.-{"
{.; Vir nia Gee '.
1/ '--..././
~.. _ /j/ 7-'
~.')/ec{'J{ .t::n,J
/l7..(j . /9
My Commission Expires:
NOTARIAL SEAL
CHRISTINA L. NICHOLAS, Notary PUOI(
Susquehanna Twp: Dauphin County h
My Commission Expires Jun~32.3gQ::__
IN WITNESS WHEREOF, the parties have hereunto set their hands ahd seal 'the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Execut
Dated \:-- ~ \r 'LX Q
,2002
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Reverend Mary Medkeff-Rose, Authorized Representative of Fourth United Church of
Christ, Beneficiary of the Estate of Esther M. Gill who being duly sworn according to law,
deposes and says that the facts contained in the foregoing First and Final Account are true and
correct to the best of her knowledge, information and belief.
SWORN to and subscjbed
before me this /R 1;j (1 day
of :::f~ . 2002.
~!)~,_#~
Notary Public
My Commission Expires:
~:~',~,~ f'E;,~L
, ;:);lry Public
Ji:,;;i",in County
:ji'~~~:<\DriI17, 2003
IN WITNESS WHEREOF, the parties have hereunto set their hands and seal 'the day and
year hereafter set forth,
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Executor
Dated
,a 9 7J1 d-- ,2002
~ij ~;Ict4-
Christine Gill Lotts, Beneficimy
. '
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, Christine Gill Lotts, Beneficiary of the Estate of Esther M. Gill who being duly sworn
according to law, deposes and says that the facts contained in the foregoing First and Final
Account are true and correct to the best of her knowledge, information and belief.
flA~LA~~
Christine Gill Lotts /
SWORN to and subscribed
before me this ~ ib- day
of (VI aL) 2002.
~/\..Q;LUB.- \! fA t (; IYl,C{A/
Notary Public
J----~_.............._.....--
~ THERESA VALENCIA
_ Commission fI. 1335036 ~
~. Notary Public. California ~
j los A!'l9p.les County f
My Cornm. Expires r:A3c 15, 2005
___ __ -....r- -":.~. _ ____ __ __ __ __ __ __
My Commission Expires: 1 d - 15--05
IN WITNESS WHEREOF, the parties have hereunto set their hands a1\d seal the day and
year hereafter set forth.
Dated
,2002
Glenn Bowers, Executor
Dated
,2002
Charles A. Koch, Jr., Executor
1/ "7 /'
Dated /7.,., 0 ,J;. V
/f
,2002
) /~/. / f /..V/
/'/;'t> A.~~ ...y. ~.:.../~.
William H. Gil( Beneficiary
COMMONWEAL TH OF PENNSYLVANIA
: ss.
COUNTY OF DAUPHIN
Personally appeared before me, a Notary Public, in and for said Commonwealth and
County, William H. Gill, Beneficiary of the Estate of Esther M. Gill who being duly sworn
according to law, deposes and says that the facts contained in the foregoing First and Final
Account are true and correct to the best of his knowledge, information and belief.
~A/~
William H. Gill
SWORN to and subscribed
before me this ,,? I' day
of ~ 2002.
/. ';1r~~~
Notary Puo IC
My Commission Expires:
~~ "'....""..,.:;.:~. J;
. ~~~. ~:27
..... ",'
ilJ!,.i"'.; .~ . .).. (1;..,.. '. ..
~Ii \i,i..........~.,..:':-;..~..:~../:.:~:~I~~,-;-j-_\:;,?':'!"~.., ~
~ (...,~:,: :..':.J(
Gill f&f scn/est revised 01/1812002
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
9TH JUDICIAL DISTRICT
PA File No: 21-01-0019
No: 2001-0019
ESTATE OF ESTHER M. GILL, DECEASED
LATE OF CAMP HILL BOROUGH
EIN 25-6756875
FIRST AND FINAL ACCOUNT
OF
GLENN BOWERS and
CHARLES A. KOCH, JR., EXECUTORS
Date of Death:
Letters Granted:
First Complete Advertisement of Letters:
Account Stated To:
November 10,2000
January 5, 2001
February 1,2001
December 27,2001
NICHOLAS & FOREMAN
by~(I7J~
,
STEVE C. NICHOLAS, Esquire
4409 North Front Street
Harrisburg, P A 17110-1709
Supreme Court J.D. 06845
(717) 236-9391
E ^ J-tb.' 1- A
SUMMARY OF ACCOUNT
PRINCIP AL RECEIPTS
Principal per Inventory filed
Adjustments to Principal
Prudential Financial
Acct. #044-098300-28 (less)
U.S. Bonds (add)
IRS Refund (add)
Miscellaneous Income (add)
PA Tax Refund (add)
Total Adjustments
(less)
Adjusted Principal Receipts
Principal Disbursements
(less)
Net Principal Remaining
INCOME RECEIPTS
First Union Estate Account
Total Income Receipts
Remaining Balance of Principal & Income
Reserve
(less)
Total Balance For Distribution
PRINCIP AL
$103,027.91
($6,658.36)
$ 109.20
$ 300.00
$ 793.38
$ 236.00
$ (5,219.78}
$ 97,808.13
$ (30,439.67)
$ 67,368.46
INCOME
$ 138.51
$ 138.51
$ 67,506.97
$ 1,000.00
$ 66,506.97
2
Date
01-05-01
01-05-01
01-12-01
02-02-01
02-05-01
02-05-01
02-05-01
02-05-01
02-05-01
02-05-01
02-09-01
02-09-01
06- 20-01
06-29-01
07-03-01
PRINCIP AL DISBURSEMENTS
Payee - Purpose
Register of Wills-Letters -Testamentary
U.S. Treasury - Social Security Refund
Cumberland Law Journal-Advertising
Register of Wills, Agent -Inheritance Tax
Christine G. Lotts - Reimbursement
William H. Gill - Reimbursement
West Shore EMS
HCR Manor Care
Neighbor Care
Verizon
The Sentinel - Advertising
Cumberland Law Journal-Advertising
Martin M. Sacks Associates
Register of Wills - Filing Fee
Register of Wills - Supplemental -Filing Fee
Glenn Bowers - Commission
Charles A. Koch, Jr. - Commission
Nicholas & Foreman-Fees
Nicholas & Foreman - copies and postage
TOT AL PRINCIPAL DISBURSEMENTS
RESERVE
Amount
$ 229.00
$ 768.00
$ 60.00
$ 12,500.00
$ 1,158.92
$ 1,791.41
$ 68.65
$ 4,268.07
$ 54.83
$ 12.80
$ 90.59
$ 15.00
$ 300.00
$ 15.00
$ 35.00
$ 2,500.00
$ 2,500.00
$ 4,000.00
$ 72.40
$ 30,439.67
Your Accountants shall reserve the sum of $1,000.00 for payment of final fiduciary
income taxes, filing fees, and any additional estate expenses. Any remaining balance shall be
distributed in equal shares to the estate beneficiaries.
TOTAL RESERVE
3
$ 1,000.00
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
9TH JUDICIAL DISTRICT
PA File No.: 21-01-0019
No.: 2001-0019
ESTATE OF ESTHER M. GILL, DECEASED
LATE OF CAMP HILL, BOROUGH
PROPOSED DISTRIBUTION
SUGGESTED BY
GLENN BOWERS AND
CHARLES A. KOCH, JR., EXECUTORS
NICHOLAS & FOREMAN
by ~(tV <-./'---
STEVE c. NICHOLAS, Esquire
4409 North Front Street
Harrisburg, PAl 711 0-1 709
Supreme Court J.D. 06845
(717) 236-9391
5
f't,..{cl}(T ()
PROPOSED DISTRIBUTION
All inheritance taxes, administration expenses, claims and debts of the Estate have been
or sufficient funds have been reserved to pay them in full.
The remaining balance of principal and interest income for distribution totals $67,506.97
that consists solely of cash. Your Accountants have elected to reserve the sum of $1,000.00 for
the purpose of paying any additional filing fees, taxes and claims that may be determined to be
due and payable.
Under the terms of the Last Will and Testament at ITEM III, the Executors were directed
to pay reasonable travel and lodging expenses incurred by Mary O. Gill, Christine Gill Lotts and
William H. Gill and their immediately families for the purpose of attending the Decedent's
funeral services.
After presentation of bills with supporting documents, the Executors paid Christine G.
Lotts the sum of$1,158.92, and further paid William H. Gill the sum of$1,791.41.
Under the terms of the Last Will and Testament at ITEM IV through ITEM X, the
Decedent made the following specific cash bequests, including:
1. ITEM IV, to Mary O. Gill the sum of$50,000.
2. ITEM V, to William and Ellen Coulter the sum of$10,000.
3. ITEM VI, to Zora L. Capello the sum of $50,000.
4. ITEM VII, to Charles A. Koch, Jr., the sum of $25,000.
5. ITEM VIII, to Betty and Glenn Bowers the sum of$10,000.
6. ITEM IX, to Virginia Gee the sum of $5,000.
7. ITEM X, to Fourth United Church of Christ the sum of$25,000.
The Decedent at ITEM XI, bequeathed the residue of her Estate in equal shares to
Christine Gill Lotts and William H. Gill.
All of the individual beneficiaries have survived the Decedent except Betty Bowers who
predeceased the Decedent. However, the bequest to Betty Bowers was a joint bequest to Betty
Bowers and Glenn Bowers and therefore Glenn Bowers is entitled to the entire cash bequest per
ITEM VIII.
The specific bequests made by the Decedent total $175,000.
6
There are not sufficient funds available to pay all the cash bequests in full and therefore
the cash bequests will be pro-rated for payment as follows:
1. Mary O. Gill - $19,001.99
2. William and Ellen Coulter - $3,800.40
3. Zora L. Capello - $19,001.99
4. Charles A. Koch, Jr. - $9,501.00
5. Glenn Bowers - $3,800.40
6. Virginia Gee - $1,900.19
7. Fourth United Church of Christ - $9,501.00
Total proposed distribution: $66,506.97
The reserve fund of $1,000 shall be used for the purpose of paying any additional filing
fees, taxes and claims that may be presented for payment. Any balance remaining from the
$1,000 reserve after payment of all final filing fees, taxes and claims shall be distributed
proportionately to the above specific cash beneficiaries.
No funds are available for distribution to the residuary beneficiaries.
7
PROOF OF PUBLICATION
State of Pennsylvania,
County of Cumberland.
Sherry Clifford, Classified Ad Manager of THE SENTINEL,
of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of
general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th,
1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice
or publication attached hereto is exactly the same as was printed and published in the regular editions and
issues of THE SENTINEL on the following dates, viz
Copy of Notice of Publication
EXECUTOR NOTICE
LETTERS TESTAMeNTA-
RY on the Edt. of
Ee.tharM. Gill, late of
the BotjUgh of Camp
Hill, Cumberland
County, PA, having
been granted to the
undersigned, all persons
indebted to the said
Estate are required to
make immediate
payment and those hav-
ing claims will present
them for settlement to:
Glenn Bowers, Executor
221 Mountain Road
Dillsburg, PA17109
Charles A. Koch, ,Jr.
25 Orion Road
Boiling Springs, PA17007
Steve C. Nicholas, Esquire
Nicholas & Foreman P.C.
4409 North Front Street
Harrisburg, PA 17110-1709
January 18, 25 and February 1, 2001
Affiant further deposes that he is not interested in
the subject matter of the aforesaid notice or
advertisement, and that all allegations in the
foregoing statement as to time, place and character
of publication are true.
14~.~~
February 8, 2001
Sworn to and subscribed before me this 8th
day of February , 2001.
~AAhJA- C.~~
~ - - - - --r Notary Public
My commission expires:
NOTARIAL SEAL
Sttm.EY O. DURNIN, Notary Public
Carlisle Bore., Cumberland County
Commission Ex 'res Au . 9, 2003
E..{:I,;f <--
,
CUMBERLAND LAW JOURNAL
2 LIBERTY AVENUE
CARLISLE, P A 17013
FEBRUARY 9, 2001
Cumberland Law Journal is published every Friday by the Cumband County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Steve C, Nicholas, ESQUIRE
RE:
Esther M. Gill, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------------------------------------------------------
---------------------------------------------------------------------
Advertisement inserted on following dates:
January 26, February 2,9,2001
Second Proof Request
$ 75.00
$ 0.00
$ 0,00
$ 60.00
-------------
Advertising Cost
Proof of Publication
Payment received
Total Amount Due
$ 15.00
Payment received JANUARY 23,2001
by Becky H. Morgenthal/Executive Director
f ~ 4 ,1,,'''' ()
"".
. '
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), p, L.1784
STATEOFPENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND :
Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County
and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland
Law Journal, a legal periodical published in the Borough of Carlisle in the County and State
aforesaid, was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
VIZ:
JANUARY 26, FEBRUARY 2,9,2001
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Gill, Esther M., dec'd.
Late of the Borough of Camp Hill.
Executor: Glenn Bowers, 221
Mountain Road, Dlllsburg, PA
17109 and Charles A. Koch, Jr.,
25 Orion Road, Boiling Springs,
PA 17007.
/~---
Roge/M. Morgenthal, Editor
SWORN TO AND SUBSCRIBED before me this
9 day of FEBRUARY, 2001
Attorneys: Steve C. Nicholas,
Esquire, Nicholas & Foreman
P.C., 4409 North Front Street,
Harrisburg, PA 17110-1709.
NOT ARt l SEAL
LOIS e. SNYDER, Notary Pvblk
CarMI. 8oro, C,,",b.rkmd County, PA
My Commlllion Expires March 5,2001
STATUS REPORT UNDER RULE 6.12
/, ("..."
r. r /
,.-0
,..."
$)J~'/
./' Q/ aJL-
I
612 Status Report scnlest
Name of Decedent:
Esther M. Gill
Date of Death:
November 10,2002
Will No:
2001-00019
Estate No:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration ofthe above-captioned estate:
1. State whether administration of the estate is complete:
Yes XX No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
NA
Tfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes
No
XX
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: NA
c. Did the personal representative state an account informally to the parties in
interest?
Yes XX
_.___.._..........._._......M____..._
No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
z:---
Date: October 15, 2002
Steve C. Nicholas, Esquire
Nicholas & Foreman PC
4409 N. Front Street
Harrisburg, P A ] 7110- ] 709
(7] 7) 236-939]
Supreme Court ID No. 06845
Capacity: Attorney for Estate
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 10/08/2002
GLENN BOWERS
221 MOUNTAIN ROAD
DILLSBURG, PA 17019
RE: Estate of GILL ESTHER M
File Number: 2001-00019
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 11/10/2002
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~ m. f)J;I? W:!?t?t
MARY C. LEWIS ~~
REGISTER OF WILLS
cc:
JFile
Counsel
Judge
--
~
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
REVISED
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
In re: Estate of Esther M. Gill, Deceased
No. 2001-00019
PA No. 21-01-0019
To the Register:
I certifY that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
January 12,2001 as follows:
N ames and Addresses
Mary O. Gill, 39-457 Desert Greens Drive E, Palm Desert, California 92260
William Coulter and Ellen Coulter, 1533 Englewood Street, Bethlehem, Pennsylvania 18015
Zora Capello, 25 Conway Drive, Middletown, P A 17057
Charles A. Koch, Jr., 25 Orion Road, Boiling Springs, Pennsylvania, 17007
Betty Bowers and Glenn Bowers, 221 Mountain Road, Dillsburg, P A 17019-1514
Virginia Gee, 2015 Market Street, Harrisburg, Pennsylvania, 17103
Fourth United Church of Christ, 16th and Market Streets, Harrisburg, Pennsylvania, 17103
Christine Gill Lotts, 10444 Camarillo Avenue, Toluca Lake, California 91602
William H. Gill, 75-375 Painted Desert Drive, Indian Wells, California, 92210
Subsequently the notice mailed to Zora L. Capello was returned as undeliverable and on
February 2, 2001 notice mailed to Zora Capello at 999 West Harrisburg Pike, Apt 308,
Middletown, P A 17057
Notice has now been given to all persons entitled thereto under Rule 5.6 except: No exceptions.
Additional information may be obtained from the undersigned
Signature ~ ~
.r
Steve C. Nicholas, Esq.
4409 North Front Street
Harrisburg, P A 17110-1709
(717) 236-9391
Counsel for Personal Representative
Dated: February 2,2001
-
()
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
In re: Estate of Esther M. Gill, Deceased
No. 2001-00019
PA No. 21-01-0019
To the Register:
I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
January 12,2001 as follows:
Names and Addresses
Mary O. Gill, 39-457 Desert Greens Drive E, Palm Desert, California 92260
William Coulter and Ellen Coulter, 1533 Englewood Street, Bethlehem, Pennsylvania 18015
Zora L. Capello, 25 Conway Drive, Middletown, Pennsylvania, 17057
Charles A. Koch, Jr., 25 Orion Road, Boiling Springs, Pennsylvania, 17007
Betty Bowers and Glenn Bowers, 221 Mountain Road, Dillsburg, P A 17019-1514
Virginia Gee, 2015 Market Street, Harrisburg, Pennsylvania, 17103
Fourth United Church of Christ, 16th and Market Streets, Harrisburg, Pennsylvania, 17103
Christine Gill Lotts, 10444 Camarillo Avenue, Toluca Lake, California 91602
William H. Gill, 75-375 Painted Desert Drive, Indian Wells, California, 92210
Notice has now been given to all persons entitled thereto under Rule 5.6 except: No exception.
Additional information may be obtained from the undersigned
Dated: January 12,2001
//"} ----- C---.
Signatur~~~
Steve C. Nicholas, Esq.
4409 North Front Street
Harrisburg, PA 17110-1709
(717) 236-9391
Counsel for Personal Representative
...."...
\. /6-199- 9
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
'02 flr+; 1 2
STEVE C NICHOLAS ESQ
NICHOLAS 8 FOREMAN
4409 N FRONT ST ~~. ,.'.,..
HBG "pA" 1711 0
;) 1 :53
04-01-2002
GILL
11-10-2000
21 01-0019
CUMBERLAND
101
Allount Rellitted
'*
REV-1547 EX AFP (01-021
ESTHER
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i5'4-j-Ex-iFP--('OY=02Y-NOTicE--OF-YNHEiiiTANCE-TAx-jrPPRAisEMENT-:--iLIoWANCE-o"R-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GILL ESTHER M FILE NO. 21 01-0019 ACN 101 DATE 04-01-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
16,612.00
.00
.00
86,415.91
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H)
10. Debts/"ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
DATE
02-07-2001
.n......... .
NU"BER
AA477985
(+)
INTEREST/PEN PAID (-)
561.65
(9)
(10)
10,728.89
5 .172 . 35
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
103,027.91
15.901 24
87,126.67
12,240.33
74,886.34
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.OOXOO=
.00 X 045 =
.00 X 12 =
74,886.34 X 15 =
(19)=
A"OUNT PAID
12,500.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
11,232.95
11,232.95
13,061.65
1,828.70CR
.00
1,828.70CR
( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
ESTHER M. GILL
FILE NUMBER
21 01-0019
REVIEWED BY
CHARLOTTE R. LAMKE
ACN
SCHEDULE
ITEM
NO.
H
7,8
EXPLANATION OF CHANGES
The deduction for travel expenses has been disallowed. The executor or administrator of
the estate is the only person entitled to claim these expenses in conjunction with the
administration of the estate. These travel expenses are not considered a deduction but
rather a taxable bequest under the will.
ROW
Page 1
/6 -/9?- 9
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-UD1 EX AFP IDl-DU
'02
1 7 !J?:/ U
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-22-2002
GILL
11-10-2000
21 01-0019
CUMBERLAND
101
ESTHER
M
STEVE C NICHOLAS ESQ
NICHOLAS 8 FOREMAN L,
4409 N FRONT ST Cl n:
HBG PA 1111~
Anount Renitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: i6o-j-E3f-AFP-('oy=02y------...--iNHERiYANc'E-TAx--sTA-fEME-tiT-oF'-Ac-couiif--.-..--------------- - -----
ESTATE OF GILL ESTHER M FILE NO.21 01-0019 ACN 101 DATE 04-22-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-01-2002
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
11,232 . 95
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-07-2001 AA477985 561.65 12,500.00
04-02-2002 REFUND .00 1,828.70-
TOTAL TAX CREDIT 11,232.95
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
r'
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<h
E!