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ESTATE OF . No. 2109 0938 ; � N � ;
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WILLIAM K. PEFFER, II, Deceased . -- <: � " T;
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RECEIPT, RELEASE, REFUNDING, AND INDEMNIFICATION AGRE�IIENT
The undersigned sole legatee and Executrix under the Last Will of WILLIAM
K. PEFFER, II, Deceased, does hereby:
1. Acknowledge that she has examined and approved the statement of
the Pennsylvania Department of Revenue accepting the Inheritance Tax Return
for referenced administration of the Estate of William K. Peffer, II, Deceased, a
copy of which is attached hereto and incorporated by reference;
2. Waive the filing of a formal Account and Schedule of Distribution;
3. Acknowledge receipt of the entire proceeds of the said Estate;
4. Release herself the appointed Personal Representative and the sole
Beneficiary of the Estate of William K. Peffer, II, and her heirs and Personal
Representatives, from all liabilities, whether due to her negligence or otherwise,
which may have arisen by reason of her administration of the Estate;
5. Agree to refund to the Estate any portion of the distribution to which
she is not properly entitled, and to the extent of said distribution, to indemnify
herself for claims made against her as Executrix, and to reimburse all expenses
and costs incurred in connection with any such claims; and
6. Declare that this instrument shall be legally binding upon herself as
Personal Representative and her heirs, successors and assigns.
IN WITNE55 WHEREOF, I have hereunto with intent to be legally bound, set my
�
hand and seal this �M1 day of��� / , 2015.
�,,.,—Q .L� G�-��`'"� (SEAL)
Carol K. Wilcox
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA )
) SS.
COUNTY OF CUMBERLAND )
On
� Z �� rl � L 2015 before a Notary Public in and
for said County and State, personally appeared CAROL K. WiLCOX personally
known to me (or proved to me on the basis of satisfactory evidence) to be the
person whose name is subscribed to the within instrument and acknowledged to
me that she executed the same in her authorized capacity, and that by her
signature on the instrument the person, or the entity on behalf of which the
person acted, executed the instrument.
WITNESS my hand and official seal.
���� �� �
�pmmonwealth of Pennsylvania
NOTARULLSEAL Notary Public in and for
Wllllam S.DriMls�Nwry��
eor�,:,. , ..r�ia a�me.nanetwny� Said County and State
yy wmmission �,.. �P• .�'°,...ee.t3.1017
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� NOTICE OP INNERITANLE TAX . : pennsylvania
pPPRAISEMENT. ALLOWANCE OR UISALLOWANCE ��� opppp.MENrovasvervue
OF OEOUCTIONS RND ASSESSMENT OF TA% Li�7
BU2EAU OF INOIVIOWL TR%ES REV-354I EX AW (11-14>
IHXERILRNLE T/.X OIVISIOH
PO BOS 38060I
XRRRISEYRG P� VII0-�601
DATE oz-ov-zois
ESTATE OF PEFFER 2N0 WILLIAM K
DI1TE OF DEATH 09-29-2009
FILE NUMBER Z1 09-0936
GOUNTY CUMHERLAND
DANIELS WILLIAM S ACN 101
RPPEAL OATE: 04-10-2015
STE 205 (SeereversesideunderObjecNonsJ
1 W HIGH ST �
GpRLISLE PA 1]013-2951 A�ount ReeltSetl�—
MAKE CNECK PAVRBLE ANO REMIT PAVMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SpUARE
CARLISLE PA 17013
LI1T ALON6 THIS LINE H kETRIN LOWER PORTION FOR YOUR RELORUS � ______________
REV-1547 EX AFP (I1-14) NOTICE OF INHERITANCE TA% APPRAISEMENT. ALLOWANCE OR
DfSALLCWRNLE OF ➢E�UCTiOtiS nND ASSEnSMENT JF 7A%
ESTATE OF: PEFFER 2N0 WILLIAM KFILE N0. :21 09-0936 ACN: 101 DATE: 02-09-2015
TPX REtOFN WRS: l $> A��EPTED RS FILED < ) �NPNGEO
APPRAISEU VALUE OF RETURN 8ASE0 ON: ORIGINAL RETURN
�y� 464,ll200 xore: ra ensure arwe�
t. aeai estaae <scneauie a� 192.936.99 reaaa m your a mune,
2. stock: ane Bones [scneeule W «� sue�3t tne uveereportion
3. CloselY Heltl Stack/Gartne�s�ip Inte�est (Sc�etlule O !3] •�� of t�is fa�m Mi[� Yow
«> .oa ��. oev�o„�.
e. nor[sayesrt+o[es ea�ei.aeie cscneaule m 45,039.16
5. Cas�/Bank �eVasi[5/Nisc. Personal P�ope�ty lSc�aEule E) (5J ,00
6. Jo3ntlY OVOed oropB�tY 6cM1e0u1B P) �6�
��� ao
�. Tt'ansfe�s (ScOeUule GJ ]Q'1.148.1$
(0)
8. Total Assets
APPROVEO DEOUCTIONS ANO EXEMPTIONS: 48.213.95
9. Fune�al Ezpenses/<tlm. [osts/Misc. E[penses [SCFeEule Hl �9� 32.60a.96
30. Oebtx/Mo�i9aga Llabllities/Liens (ScheEule I] ���� 80�614.91
13. Tefal OoEu<kiens ("�
�1z� 621,333.24
L2. Nat Value af Taz 0.eturn ,QO
13. C�arvtable/GovaTmenfal BeGuesfs{ Mon-ele<fe0 9113 TNsts (Sc�eUule D (L3]
ia. xex vai�e o. E�eaie s�eieoi co *a:
ut> 621 .333.24
NOTE: If an assessnent was 35suetl nreviouslv. Lines 14, 15. 16. 17. 18 antl/a� 19 v111
refleeY figuras that include the tolal oF all returns assessea to tlate.
ASSESSMENT OF TAX: .p9 � 70 = � ��
I5. pmount oi Lino l4 a< sp^uca] �ate :15]
ac) R91 'ais �G x 045 = 27•960.00
is. nmo�oa or �m: ia �a.�ui. ae i.�..i �,a. .no x 1z = .00
I'!. Pmount of L1ne l4 at siElin9 �ate �1��
.00 x is = �oo
la, amo�nc of Line 15 taxable at callateraa rate <18� tt9>= 27,960.00
t9. Princioal Ta[ Oue
TAX CREOITS:
PAVMENT RECfIGT �ISCOUNT (+> pn00NT PRID
pq7E NIIXBEN SNTEREST/PEN PRID <-)
12-23-2009 GU012140 1.398.00 28.000.�0
TaTAL TAX PAVMENT 29,398.U0
BALANCE OF TA% DUE 1.438.00CR
INTEREST AND PEN. •0�
TOTAL DUE 1,438.00CN
IF PAIO AFTER 0>TE INOICATEO. SEE REVERSE IF TOTAL OIIE IS NEFLECTEO AS �l CREOIT lCRI� V00 MAV BE �UE
• FOR LPLN��lTIOH OF ADOITIDNAL INTEREST. P REFUNO. SEE 2EVEkSE SIOE FOR INSTRUCTIONS.