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Home My WebLink About01-0049 ~\ \2 \ j"/ I r:..'~- Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS 21-01-49 Estate of Mary E. Stare also known as No. , Deceased Social Security No. 162-22-0315 Roy C. Stare and Lee Stare Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors ~larneJ in the lasl Will of the Decedent, dated 11 - :( - '~1 ~;, and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc 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: D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia: durante minoritate) 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: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with his/her last family or principal residence at 100 Mt. Allen Dr i ve, Upper Allen Twp. (list street, number, and municipality) Decedent, then ~years of age. died _J1/13 ,:JC!aJ,1t Mess iah Village, Mechanicsburg, . (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PAl Personal property in Pennsylvania (It not domiciled in PAl Personal property in County Value of real estate in Ponnsylvanla PA $ I{>{>, ()tX1.{J 0 $ $ $ situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a riate form to the undersi ned: Roy C. Stare 34 St. John's Drive, Cam Hill, PA 17011 Lee Stare ~ 16 Richard Road, Mechanicsbur , PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. 16 -- e:2 CJ I -- 9 Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland 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 representative(s) of the Decedent. Petitioner( s) will well and truly administer the estate according to law. \'-:>/ . / (J---'C1 r1 \' I;' - ) .~ ~ '---- ~-1<,.L--C~-~ Roy C .i$tare K~' ~7;'~~~""-- Lee Stare Sworn to or affirmed and subscribed before me this 2 7 thday of December $2000 I n;72ILL/ r; ~/'(<4 / -0// .~/ M/.,y'i f or the R6"gister , No. 21- 01-49 Estate of Mary E. Stare Deceased Social Security No: 162 - 22 - 0315 Date of Death: 12/13/00 AND NOW. JANUARY 10, 2001 , 19 , in consideration of the Petition on the reverse side hereon. satisfactory proof having been presented before me. IT IS DECREED that Letters ~ Testamentary D Of Administration (c.t.a.: d.b.n.c.t.a., pendente lite; durante absentia. durante minoritate) are hereby granted to Roy C. Stare and Lee Stare ( ? / !~c/ I r:2 - c;/ 7 - ~C-)C)(:> in the above estate and that the instrument(s) dated JULY 2, 1993 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters . $ Short Certificate( s) . $ Renunciation. $ Affidavits ( $ Extra Pages ( ) . $ Codicil. $ JCP Fee. $ Inventory. $ Other $ ,ilii. W TOTAL. $ Prepared by the Pennsylvania Bar Association 200.00 ':no 15.00 wl';;v,' E~r~ / In;/ L/ ..(' / /<!e'/ ( / Ai( Regi~ter of Wills L}/</ /-;/-( /' I I) 1.0. No: 06298 The Wiley Group One S. Baltimore St. 3.00 Address: Dillsburg, FA 17019 5.00 Telephone: 717/432 - 9666 //)0.,-<,",/ ie., uZZ/yc: /y~ y 223.00 Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) i'~ t' r~.: lopil'd In ,m in original clTrdlGlll' of (karh d~dy fIled with me ~b till' ~L1t\' '/iul !\l'umb (Htllc f()r pcmLllil'lH filing, '11 \\-l! t WARNING It IS illegal to duplicate this copy by photostat or photograph. p 6987498 /;;;I/II/J";~;-', ;,1'" '~~\ H OF p1;;::'::,; ,/~\ ~ ,.,,t,,/.~ ,,/ ~"'/ . <~~-~\ l;gi ~~(~~ ;~ ~.., r~ . ~%\ \% 5~ /[,g', h~) \~_ _ , 'II ", ~', ~' $1 'l*~."" >.*t ~" 4, '. "l::: ,1'1 ~ t)C ""', '. .... ~.:,/ -~!?tMENi \l~ 't-~'I/Y ".<~~~~~::~/!.!.!!!!!!.!.!!!J I!" 21-01-0049 1 . i~~-'uK.dh ;,Q1-r.ft4 I (Ical ,n () rJ h:-,<,,~..? /U.-e...~ / 3 ,)ei (:1 (I --- ----r r hlL' H IOS ~ 43 Ae-v 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH i YPE.1PRINT 'N PERMANEN T BLACK INK NAME Of DECEDENT (firS! MldOIe. LasI) AGE (L a51 8lrthday) UNDER' YEAR Monlt1. Days 8lATHPLACE rc,I..,. ,If:d 31al8 Ol f.crt''9I1 COtJnllyl Markleysburg, Pa. 92 Hour> l Min~t..' Yrs 5, COUNTY Of OEJJH Cumberland .... DECEDEN1'S USUAL OCCUPIIJIOH (~f~'~';~~~ KINO Of BUSINESS/INDUSTRY Own Home WAS DECEDENT EVER IN US ARMED FO~ES? Ye. 0 No CJ 12. . ,... "b. DECEDE10(tl'v~f~ir~EBft've C>ty1TOwn SIaM. Z'" Code) Mechanicsburg, Pa 17055 DECEDEN1'S ACTUAL RESIDENCE (See tfl~rUCIIOf\S on Q(her Slde) 11. Stale Cumberland 1.. FATHER"S NAME (fl'st. fI,4,OdHJ last) 17b. Coon Joseph ~:,tyIO RACE . Am.nc~ I~.n. 8lllCk, Whlt._ Me (Specoty) White SURVIVING SPOuSE III ...,de. ;jI.... n\Glderl nama) Dod doce<lenl Mlna IOWnSohap1 - 17d.O ::==01 c..,~ ... INFORMANl'S NAME (T ypelPnll'1 MOTHER'S NAME ,F"$1 M,ddle. Ma""",s.,,n"'~ella B. Kochenderfer II. INFORMANl'~~"'SFjoWfl"rnfl~~h1~'#M, Pa. 17011 2Ob, PlACE Of OISPOSrTMJN - Name of Cemetery. C,em.lory LOCAT'K)N . Clt';/Town, SIAl., Zip Code OIOlhefP1ace Slate Hill Cemetery Camp Hill, Pa 17011 H. I AppIOlumale : Interval ~n I onMI and death . CtL I I :=-::J~~f.~1I=:~~<<~::IQ~>a!~'~__l__n~'_ c ____, '. lL!u.LE~ b.L~J0: _. ,~! fJl--:\ _,_~__+-_, DUE (OA AS A CONSEOUE NCE OF) I d ~ WERE AUTOPSY FINOlNCS MANNER OF OEATH DATE OF INJURY TIME OE INJURY AVAILABLE PRIOA TO tMOI\1h Day. Yeat) COMPLETION Of' CAUSE OF DEATH? a er ldLi..L2LU2:J 21e. LICENSE NUMBERFD_o 14318-L 22b To the besl 01 my know . dealh occuued allhe Ume, dale and place Slated 2310 TIME Of DEAl% DATE PRON;07/D D/EA_D31t.47'~"oY Yea "I) 0 24 ? II'''''' M ~_,___ 27_ PART I: Enter the diseases. InJunes or comphCahoO$ whK:h caused the death 00 not enler the mode 01 dyirlQ. such as cardiac or respI,atory anest, shock or heattlalluf. list only OfWI causa on eacll !toe o NO~ Yea 0 NoD Natural &1 HOmlcKMI [] Acclden' [J PendIng Inv8511gallOn ['] fl Could not btI determined [J JOIo JOb. PLACE OF INJiJRv:AI~';-l!t-:-'t~fm. street. factory. attic. bUlIdlng. .Ie tSPflC,11l1 Jo. "<.- 2". 280. CERTIFIER ICt'eck Oili..,. one) .CERTIFYlfrfG PHYSICIAN iPhySIC1cUI (~fhIYIl\g CdUs.e ull.1t.>dlh '101111':/' ,)11UU1t:f lJl'y~I(.'dll h,JS ~fo(IU'-Jrl(:e<l llCdlll dl'L) ,;Ofnpll!lt:!(t 11t:!ln i!J) To the beat of my know'-dge, delth oc;curred due to the CilUse(S),Ind m.nner.. ,t.led . r.:: Z <oJ ~ '" ~ . PRONOUNCING AND CERTifYING PHYSiCIAN IPtl,.~t..l.fl tl(Jlt., O)I;)I'UUi 011() oedltl dlllJ \..erlllY"1Y 10 Cdll:.e 01 ,k'dltl\ To the Mal 01 my knowledgf'). CSe.lh occurre-d ~11he Ume. date. and place, and duelo the (;iluse(.) And mill1fl1U.. sl.led 'MEDICAL EXAMINER/CORONER On the basil of examination lindior invesligallon, In my opinion, dealh occurred ill the time, dale, and place, and due 10 the causc(a) and m.nnirr.s5\at..d....... ... _ ........ ,'. ............. ,.. ._....... . ... ,... ;0;.:..'....... 11. . , REGIST/~ S SIGNATURE AND NUMB~-~-- - ~ -- ----; --- -- --' -- tr t<' oL< .. CrH/ t' -Ail:.GH.U-,./lj.;~~--... 2td. NAMEANDA~~Eri'~~~t~ltHDme, Inc. 37 East Main Street Mechanicsburg, Pa 17055 22c. LICENSE NUMBER DIIJE SIGNED IMonltl. Day, Yeatl 2Jb 2Jc. WAS CASE REFERRED 10 MEDICAL EXAMINERiCORONERl .....0 No~ PART I': Other sic~rllrlCU\1 co~ oonlnbuhng to delllh. boC noI resullU'ltjltn Ihe undertytng uwe given in PART I INJURY AT WORK7 DESCRIBE HOW 'NJURY OCCURRED YeI 0 No 0 M. JOe. JOel, lOCAl ION (Str88l. Cltyffowo. ~lale. Jot, SIGNATURE AND TIT OF CERTIFIER [J Jtb' '( .~dLQ.Jl.e>VJ LICE. NS. E N. UMBER. ~.. DATE SIGNEDlMon"'lY' Yea') LI lIE ftl-'12{lSfi~_.4.:tJ.-.. n h~' ~/ J .3 0'(':) NAME AND ADDRESS Of' PERSON WHO COMPLETED CAUSE OF DEATH (lIem27lTypeOlPrlIll io;:.... L" '-.JfL./ J I /? It' " i:. '., ~ [J L-t #'.... ~ '../.1'-'<. 32. DATE FILED (Monlh Ody. Yeo!l J4- ,- i-J. -" (' -t'm be? /c" 1:3 ., A. () Ci c.. < .. '" 21-01-49 LAST WILL AND TESTAMENT I, MARY E. STARE, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my Last will and Testament, hereby revoking and making void all former wills, codicils and other testamentary dispositions by me at any time heretofore made. 1. I direct my Executor, hereinafter named r to pay as soon as practicable after my decease all my just debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever si tuate, unto my husband, Roy E. Stare, providing he shall survive me by sixty (60) days. 3. Should my said husband, Roy E. Stare, predecease me or die on or before the sixtieth ( 60th) day following my death, then and in that event, I dispose of my estate as follows: (A) I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto each of my grandchildren, Linda L. Ziemke, Michael L. Ziemke, Kathleen S. Wells, Nancy M. Solevo, Roy C. Stare, Jr., Deborah L. Sheaffer, Cynthia A. Stare and Robert A. Stare. (B) I give, devise and bequeath all the rest, residue and remainder of my estate, whatsoever and wheresoever situate, unto my children, Marilyn S. Robbins, Lee Stare and Roy C. Stare, equally, share and share alike. 4. I hereby nominate, constitute and appoint my said husband, Roy E. Stare, Executor of this my Last Will. Should my husband, Roy E. Stare, fail to qualify or . A .. , , .. ~ ",-, cease to act as Executor, I appoint my sons, Roy C. Stare and Lee Stare, and the survivor of them, Executors of this my Last Will and Testament. 5. I appoint The First Bank and Trust Company of Mechanicsburg, pennsylvania, guardian of any property which passes, either under this ~'Jill or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education without regard to his or her parent's ability to provide for such support and education, or to make paYment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. IN WITNESS WHEREOF, I, Mary E. STARE, the Testatrix, have hereunto set my hand and seal to this my Last Will and Testment this JL'~ day of fI f) 1-.LVC:if 1993. V)l a-"-1j.-t ACc,.A'<- ( SEAL) Signed, sealed, published and declared by the above named Mary E. STARE as and for her Last Will and Testament in the presence of us, who, at her request and her presence and in the presence of each other have hereunto subscribed our names as witnesses thereto. .01/ A . / c, // /1 / j;.. ,< "/ ;//f~ /' :/// /i-/ _~. '/~) "'/ / .' '.: /c..J .', ...-:J: 1.~ / Ii j/-''; p' , ,./d;Lil(:~ 0( - ~,.:. ~k:-:4..y / /,) (; - 2 - Register of Wills of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of Mary E. Stare No. 21-01-49 also known as , Deceased Charlyn Y. Guerriero William L. Sunday (each) a subscribing witness to the 0 codicil(s) []] will(s) presented herewith. (each) being duly qualified according to law depose(s) and say(s) that she/ he/ they was/ were present and saw the above Testator(rix) sign the same and that she/helthey signed as a witness at the request of T estator( rix) in his/her/their presence and [R] in the presence of each other D in the presence of the other subscribing witness( es). /~ i~1 . I /.,/ fl/ j \..._ ~(?{ k ~~, / L.t...- /7 . / t/ ut=~ :C(.L 1-c'''--- /? . ._&~/', / /~ /J ~ (Sjgnaturirl~? '__ ..;' // , x/t-l/) ''A.;'/\7>''?:';'..,/C)--;t''G'':.;'c_<-,(/ ~~-:f)~~/6: 2-;;,~~- ):!Jf ~ / I:.. /9 / ':/ / . . (Address) / ~~ ,(/ --L:U~gnature) 39 W. Main Street Mechanicsburg, PA 17055 (Address) Sworn to or affirmed and subscribed ". / before me this /..;;:, i z::;{ / day .,......--) .' /. ,,7 . ;;!:7ft~::~~ '2:~,-~( / Q/:,/;' , " ,'7 //" ;A'/;' -- f /'.. -1 ..... , ,/ o"/, '7', / ' , /' , .'-. _ ' ,t{.A.'..t../C~ h7' "./ .( u:: i t-u t c - ~T'ub~ r"rj;;'",:~-f;;-:---~ I ~r';1~~9:~~:~:J;'" ",' r'" ',J;( I (~'~rjilqrk an(:j'S'eat%tf~dfaryor other offilii~~ I ~",.,,( \_JGrl,ln1~> n :'.\H .~--. .'. , .:.,_') 1 Iifmd!o edn~L~~~,~ths,ShQWdatebf I ~)(l31tlltlokbf Nqt~<<im8l~j;;;;"--'---~ NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-2 (1991) - t::::: ~ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Mary E. Stare Date of Death: 12/13/00 Estate Number: 2001-00049 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 March 1, 2001: Name Lee Stare: Roy C. Stare: Linda Ziemke: Michael Ziemke: Kathleen Simmons: Nancy Salevo: Cindy A. Myers Deborah L. Hennessy: Robert A. Stare Roy C. Stare, Jf. Address 16 Richard Rd., Mechanicsburg, P A 17055 34 St. John's Drive, Camp Hill, P A 17011 55 Beaver River Rd., West Kingston, RI 02892 305 Erdman Drive, Dauphin, PA 17018 687 Ada St., blue Ridge, GA 30513 101 Flat Rock Road, Branford, CT 06405 4584 Longwater Chase, Sarasota, FL 34235 75 Junction Rd., Dillsburg, P A 17019 70 Rose of Sharon Drive, Etters, P A 17319 34 St. John's Drive, Camp Hill, P A 17011 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Date: 3/1/01 . ~:( 1. ( n \ ' l ~) ,J~"'l ( S~gnature ,--~ Name: Jan M. Wiley, Esquire Address: One S. BaltilTIOre St. Dillsburg, P A 17019 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. - C l-- CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Mary E. Stare Date of Death: 12/13/00 Estate Number: 2001-00049 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 March 1, 2001 : Name Lee Stare: Roy C. Stare: Linda Ziemke: Michael Ziemke: Kathleen Simmons: Nancy Salevo: Cindy A. Myers Deborah L. Hennessy: Robert A. Stare Roy C. Stare, Jr. Address 16 Richard Rd., Mechanicsburg, P A 17055 34 St. John's Drive, Camp Hill, PAl 7011 55 Beaver River Rd., West Kingston, RI 02892 305 Erdman Drive, Dauphin, P A 17018 687 Ada St., blue Ridge, GA 30513 101 Flat Rock Road, Branford, CT 06405 4584 Longwater Chase, Sarasota, FL 34235 75 Junction Rd., Dillsburg, P A 17019 70 Rose of Sharon Drive, Etters, PAl 7319 34 St. John's Drive, Camp Hill, P A 17011 Date: 3/1/01 eret~ ,under Rule 5. 6 (a) except NI A -vv.-.W Notice has now been given to all persons enti Name: Jan M. Wiley, Esquire Address: One S. Baltimore St. Dillsburg, PAl 70 19 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~~D YORK l j ss: T.pp ~trlrp rlnd Rny C' ~tarE' being duly s~.7orn according to law, deposes and says that th~ arQ thQ Co-Executors of the Estate of Mdry E stdrp- late of TTppez:--Allen-~-GWnsh--i-p------ , Cumberland County, Pa., deceased and that the within is an inventory made by Lee Stare n nn Roy C. _ S t d rp- '0 the said r.o- F.XP~ll tor!=; of the entire estate of said decedent, consisting of all the personal propdrty 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. Wx2001 l~~~v~ . . Executor - Administrator J~ IZi c.hrud tZ-rl, M~( hI? r11(':;ho ;-1 ~Il )7tJ$ S- f , xCRO ct .sa-~ 34 :5 f · '-:Soh 17 5 'J) n [; fll' rt(i/Vl-p 1ft I ~ fit /7 (j / ( Address Sworn to and subscribed before me, Date of Death 13 / Day December Month 2000 Year INSTRUCTIONS I. 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. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. 0'\ >- -0 :3 Q) o:;:t' t- W <It >- a: t- E-i ra 0 w -( (l) ~ Q.. t- u 0 0 V') (]) C (l) Q) 0 W w \...I (]) C 0' ~ I 0::: ctl .., Q) I- Q.. r-l Q.. C 0 Z t- -I LL ..j.J r-l ra ... ...J -( 0 CI) ~ Q.. 0 LL = 0 W 0 -( w >. -( N > Z a: \...I -+- Z 0 ~ (]) c C ~ ci V') Z 0 0::: ~ U Z w -( ~ Q.. \...I ::> -0 ctl c :8 ra ..... &: 0 (l) ..a -0 ~ (l) E -+- Q) 0 ra ~ 0 -I U u: m Inventory of the real and personal estate of MARY E. STARE deceased 1 . American Express F,inancial Advisors Discovery FD-A Account Number: 01180235631-8-002: 14,13 .83 2. American Express Financial Advisors Global Bond FD-A, Account Number 01220235631-1-002: 11,81 .89 3. American Express Financial Advisors Fed Income FD-A, Account Number 01240235631-0-002: 81 ,64 .28 4 . ?American Express Financial Advisors International FD-A, Account Number 01280235631-6-002: 8,74 .31 5. American Express Financial Advisors Blue Chip Advant FD-A, Account Nujmber 01310235631-1-002: Growth FD-A, Accoun~! 13,70 .30 6. American Express Financial ADvisors Global Number 01320235631-0-002: Value FD-A, Account II 8,94 .46 7 . American Express Financial ADvisors Equity Number 01370235631-5-002: . 'I 12,59 .96 8. American Express Financial Advisors Divsfd Eq Incm FD-A, II Account Number 01430235631-7-002: Extra Income FD-A, Account II 12,25 .81 9. American Express Financial Advisors Number 04250235631-6-002: 21,19 .94 1 0 . American Express Financial ADvisors Cash Manage FD-A, Account II Number 06130235631-8-002: 24,73 .50 TOTAL: I j I 1209,782.28 I / , REV-1500 EX + (6-00) , ,rV COMMONWEALTH OF PENNSYLVANIA t ~~ t DEPARTMENT OF REVENUE \ ~l () ( DEPT. 280601 \ HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 20 COUNTY CODE -dOl' - S'i, ~ OFFICIAL USE ONLY 01 00049 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER stare, Mary E. 162-22-0315 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 12/13/00 09/15/1908 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ 1. Original Return ~2 Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between D 11. Election to tax un der Sec. 91 13(A) 12-31-91 and 1-1-95) (Attach Sch 0) ::tijJ$X$~~tfMQ$t::ij$::P.9MeU~tjt#AijMpQin~ij$ijQN:tjj$~j@~QNf:/P'gijt~AM1MJ.nNfQijMAIJQl~($fRW!:tp)~ijji~j:$.it.~p.::f.4.m NAME COMPLETE MAILING ADDRESS COR- Jan M. Wiley, Esquire One s. Baltimore st. RE- FIRM NAME (If Applicable) Dillsburg, PA 17019 SPON DENT The Wiley Group TELEPHONE NUMBER 717-432-9666 None OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bonds (Schedule B) (2) 209,782.28 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) None 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 124,258.18 8. Total Gross Assets (total Lines 1-7) (8) 334,040.46 9. Fu neral Expenses & Administrative Costs (Schedule H)(9) 31,028.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,806.91 11. Total Deductions (total Lines 9 & 10) (11 ) 37,834.91 12. Net Value of Estate (Line 8 minus Line 11) (12) 296,205.55 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 296,205.55 - SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 (a)(1.2) X .0 (15) - TAX 16. Amount of Line 14 taxable at lineal rate 296,205.55 X .0 45 (16) 13,329.25 - COMPU- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00 TATION 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (19) 13,329.25 20. 0 1:.&ff~e.Ktia.atS:lf::YOQ::AR!::R!qV!ijj*G\'RI;f.Qijp::OfJAt(QVI;ij~jVMJi,.df:1 .... ,"... ..... .......... ..... ........... ....... . ....,...... . ........... ... ........... ':,::::::::~?':a1;Sl;JRIS<rO'::ANSWEftAt.tQ{jESTfO'N$.::Q~[PAGd~:2:'ANO<BeCHEGKMAUfif:;i:;/:::/:: ... .. o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of: Mary E. stare SUMMARY OF ALLOCATIONS ID BENEFICIARIES Taxable at lineal rate Lee Stare Roy C. Stare Linda Ziemke Michael Ziemke Kathleen sinunons Nancy Salevo Cindy A. Myers Deborah L. Hennessy Robert A. Stare Roy C. Stare, Jr. 82,664.42 90,876.69 25,666.11 25,666.11 25,666.11 25,666.11 5,000.00 5,000.00 5,000.00 5,000.00 296,205.55 20-01-00049 . . PA REV-1500 EX (6-00) C I Page 2 Add Decedent s amplete ress: STREET ADDRESS Messiah Village 100 Mt. Allen Drive CITY I STATE I ZIP Mechanicsburq PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 13,329.25 666.47 Total Credits (A + B + C) (2) 666.47 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. :-;.:-;-:.;-:.:-;-:.:-:-;.:.:-:-:-:-;.;.:-:-;-:.... . ...;;.;.:-:.;:-:-:::.:-::;:-::.::;.:.;.:;-:-:-::-.... Make:.;S:~~:~k payable::~~.:::::~;;~:I:~T~R OF Wllls,.'.:.eGENT.. :-:::;:-. .:.:-:...;:.;:::::;;~[~ASE..AN.~~;i~~:~~:~::~~CCB~I:~:d ..:Q.UE::STi~:NS:;:.B.Y::PLACING.::-~~:';~~:;:, "j'N' THE"A'Pp:ROp:R:IATE "s'LbtKS (3) 0.00 (4) (5) 12,662.78 (5A) 0.00 (58) 12,662.78 1, Did decedent make a transfer and: a. retain the use or income of the property transferred; ...............,....."................ b, retain the right to designate who shall use the property transferred or its income; ................. c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 2, Yes No ~ i B ~ o Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has any knowledqe, SIGNA RE OF PE SON RESPON BlE FOR FILING RETURN DATE S 0/ ADDRESS See Schedule attached SIG URE OF PREPARER OTHER THAN REPRESENTATIVE YY\,.. 17019 or on use spouse [72 P.S.! 9116 (a) (l.l)(i)]. For dates of death on or after January 1, 1995, th e tax rate is imposed on th e net value of transfers to or for th e use of the surviving spouse is 0% [72 P.S. S 9116 (a) (1.1) (ii)). The statute do",; nnt I'xf'mpt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiCiary. For dates of death on or after July 1,2000: The tax rate imposed 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 th e ch ild is 0% [72 P.S. s9116(a)(1.2)], The tax rate imposed on the net value of transfers to orforthe use of the decedent's lineal beneficiaries is 4.5%, exceptas noted in 72.P.S. s 9116(1.2) [72 P.S. li9116(a)(1)]. The tax rate imposed on th e net value of transfers to orfor th e use of the decedent's si blings is 12% [72 P.S. li 9116(a)(1.3)]. A si bling is defined, under Section 9102, as an individual who has at least one parent in common With the decedent, whether by blood oradoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only . . Estate of: Mary E. stare 20-01-00049 The fOllowing person(s) are signing the return as representative(s) of the estate: lee stare 16 Richard Road Mechanicsburg, PA 17055 Roy c. stare 34 st. John's Drive camp Hill, PA 17011 LAST WILL AND TESTAMENT 1. I direct my Executor, hereinafter named, to pay as soon as practicable after my decease all my just debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, unto my husband, Roy E. Stare, providing he shall survive me by sixty (60) days. :3. Should my said husband, Roy E. Stare, predecease me or die on or before the sixtieth (60th) day following my death, then and in that event, I dispose of my estate as follows: (A) I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto each of my grandchildren, Linda L. Ziemke, Michael L. Ziemke, Kathleen S. Wells, Nancy M. Solevo, Roy C. Stare, Jr., Deborah L. Sheaffer, Cynthia A. Stare and Robert A. Stare. (B) I give, devise and bequeath all the rest, residue and remainder of my estate, whatsoever and wheresoever situate, unto my children, Marilyn S. Robbins, Lee Stare and Roy C. Stare, equally, share and share alike. 4. I hereby nominate, constitute and appoint my said husband, Roy E. Stare, Executor of this my Last Will. Should my husband, Roy E. Stare, fail to qualify or cease to act as Executor, I appoint my sqna, Roy C. Stare and Lee Stare, and the survivor of them, Executors of this my Last Will and Testament. 5. I appoint The First Bank and Trust Company of Mechanicsburg, 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. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. hand and seal to this my Last Will and Testment this IN WITNESS WHEREOF, I, Mary E. STARE, the Testatrix, have hereunto set my " ~ (J-A~ r/-. day of ([ - ~ (j 1993. 'VY1 afi./{f ~ ~V\JL ( SEAL) V Signed, sealed, published and declared by the above named Mary E. STARE as and for her Last Will and Testament in the presence of us, who, at her request and her presence and in the presence of each other have hereunto subscribed our names as witnesses thereto. UA~ - 2 - f\EV-1503 'EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. stare SCHEDULE B STOCKS & BONDS FILE NUMBER 20-01-00049 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NO. DESCRIPTION OF DEATH 1 American Express Financial Advisors Discovery FD-A, Account 14,130.83 Nilltll::er : 01180235631-8 002: 2 American Express Financial Advisors Global Bond FD-A, Account 11,817.89 Nilltll::er : 01220235631- 2 002: 3 American Express Financial Advisors Fed Income FD-A, Account 81,646.28 Nilltll::er : 01240235631-0 002: 4 American Express Financial Advisors International FD-A Account 8,746.31 Nilltll::er : 01280235631-6 002: 5 American Express Financial Advisors Blue Chip Advant FD-A, 13,708.30 Account Nilltll::er: 01310235631-1 002: 6 American Express Financial Advisors Globa.l Growth FD-A, Account 8,949.46 Number: 01320235631-0 002: 7 American Express Financial Advisors Equity Value FD-A, Account 12,599.96 Nilltll::er : 01370235631-5 002: 8 American Express Financial Advisors Divsfd Eq Incm FD-A, Account 12,253.81 Nilltll::er : 01430235631-7 002: 9 American Express Financial Advisors Extra Income FD-A, Account 21,191.94 Number : 04250235631-6 002: 10 American Express Financial Advisors Cash Manage FD-A, Account 24,737.50 Nilltll::er : 06130235631-8 002: TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 209,782.28 7 CPA31 NTF 10905 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. stare SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 20-01-00049 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECO'S (IF TAXABLE VALUE RELATIONSHIP TO DECO & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 American Express Financial Advisors 47,686.24 Annuity: Mode E Settlement OR Account Nt.nnber: 93002744640 8 004: 2 American Express Financial Advisors 8,212.27 Annuity: Fixed Retirement Annuity 1- YR, Account Nt.nnber: 93004170321 4 004: 3 American Express Financial Advisors 51,148.32 Annuity: Single Prem Inunediate Annuity, Account Nt.nnber: 93005108449 7 004: 4 American Express Financial Adviors 17,211.35 Annuity: Fixed Rei trement AnTIui ty - VP, Account Nt.nnber: 93006160045 6 004: TOTAL (Also enter on line 7, Recapitulation) $ 124,258.18 7 CPA01 NTF 10910 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. Mary E. Stare Date of Death Values December 13, 2000 Mutual Funds: Fund Title: Account Number: Total Value: # of Shares: Asset Value per Share: Discovery FD- A 01180235631 8 002 $ 14,130.83 1478.120 9.560 Global Bond FD- A 01220235631 2002 $ 11,817.89 2117.224 5.5501,/ Fed Income FD- A 01240235631 0 002 $ 81,646.28 17162.213 4.740 ~, International FD- A 01280235631 6 002 $ 8,746.31 817.412 10.700 '" Blue Chip Advant FD- A 01310235631 1 002 $ 13,708.30 1219.600 11 .240 I, Global Growth FD- A 01320235631 0002 $ 8,949.46 1071.792 8.350 Equity Value FD- A 01370235631 5002 $ 12,599.96 1177.566 10.700 / Divsfd Eq Incm FD- A 01430235631 7 002 $ 12,253.81 1404.780 8.710/ Extra Income FD- A 04250235631 6 002 $ 21,191 .94 6855.807 3.070 ,- Cash Manage FD- A 06130235631 8002 $ 24,737.50 24677.860 1.000 / ,/ Annuities - Post 1985: Annuity Title: Account Number: Total Value: Status: Mode E Settlement OR 93002744640 8 004 $ 47,686.24 Payout ./ Fixed Retirement Annuity 1- YR 93004170321 4 004 $ 8,212.27 / Single Prem Immediate Annuity 93005108449 7 004 $ 51,148.32 Payout Fixed Retirement Annuity - VP 93006160045 6 004 $ 17,211.35 Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death, not the cash value. REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. stare SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 20-01-00049 Debts of decedent must be reported on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 Myers Funeral Home: 7,883.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 16,700.00 Zip City State Year(s) Commission Paid: 2. 3. Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 5,830.00 0.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Register of wills (probate): 8 cumberland Law Journal (advertise): 223.00 75.00 9 The Carlisle Sentinal (advertise): 82.00 10 Notary Fee: 10.00 11 Filing Fee: 30.00 12 Alfred Whitcomb (tax prep) : 195.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 31,028.00 7 CPA11 NTF10911 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. stare Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 20-01-00049 DESCRIPTION AMOUNT 1 Messiah Village (nursing home) : 6,263.00 2 Mobile X-Ray (last illness): 216.00 3 Pinnacle Health (last illness): 60.25 4 Pharmerica (last illness) : 238.42 5 AT&T: 13.21 6 Verizon (telephone): 16.03 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,806.91 Copyright Forms Software Only, 1997 Nelco, Inc. .. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Mary E. stare No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) See Schedule attached FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 20-01-00049 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMTS. FOR DISTRIBS. 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 None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 Copynght Forms Software Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) " Estate of: Mary E. stare SCHEDULE J, Part 1 -- Taxable Distributions Item No. Name and Address of Beneficiary 1 Lee stare 16 Richard Road Mechanicsburg, PA 17055 2 Roy C. Stare 34 st. John's Drive Camp Hill, PA 17011 3 Linda Ziemke 55 Beaver River Rd. West Kingston, RI 02892 4 Michael Ziemke 305 Erdman Drive Dauphin, PA 17018 5 Kathleen simmons 687 Ada st. Blue Ridge, GA 30513 6 Nancy Salevo 101 Flat Rock Road Branford, cr 06405 7 Cindy A. Myers 4584 Iongwater Chase Sarasota, FL 34235 8 Deborah L. Hennessy 75 Junction Rd. Dillsburg, PA 17019 9 Robert A. Stare 70 Rose of Sharon Drive Etters, PA 17319 10 Roy C. stare, Jr. 34 st. John's Drive Camp Hill, PA 17011 Relationship son son granddaughter grandson granddaughter granddaughter granddaughter granddaughter grandson grandson Page 2 20-01-00049 Amount 82,664.42 90,876.69 25,666.11 25,666.11 25,666.11 25,666.11 5,000.00 5,000.00 5,000.00 5,000.00 -.....-- - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG. PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT No.AA 4 7 815 0 REV-1162 EX(11-96) RECEIVED FROM: ACN ASSESSMENT CONTROL NUMBER AMOUNT I - FOLD HERE FOLD HERE ESTATE INFORMATION: FILE NUMBER NAME OF DECEDENT (LAST) (FIRST) (MI) DATE OF PAYMENT POSTMARK DATE COUNTY TOTAL AMOUNT PAID DATE OF DEATH REMARKS'- RECEIVED BY . ,. ,j>." ',1 / ..,,;:; "I ,l 7' !,"/f. :"--'.-.k:"/.~<~ ' . I~ ,i /~;r,' SEAL REGISTER OF WILLS ,/ - --.--........---------- 'v / /1:, -;2{J 1- 9< COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT.. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER .COUNTY ACN 04-30-2001 STARE 12-13-2000 21 01-0049 CUMBERLAND 101 JAN M WILEY ESQ THE WILEY GROUP 1 S BALTIMORE ST DILLSBURG PA 17019 REV-1547 EX AFP <12-00) MARY E Amount Remitted CHANGED U) (2) (3) (4) (5) (6) (7) .00 209,782.28 .00 .00 .00 .00 124,258.18 (8) 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 ~ R If" = ls4-j-'E:3f - AF P- -fi"2- :00 Y -NOT i c'E--oF - YNHER iT ANcE - TAX -XP PRXi S Ei.fENT-,-- Ai: i-ow AifcE-ori- - - --- - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STARE MARY E FILE NO. 21 01-0049 ACN 101 DATE 04-30-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED 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. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 31..028.00 6,806.91 NOTE: To insure proper credit to your account.. submit the upper portion of this form with your tax payment. 334..040.46 (11) (12) (3) (14) 37.834 91 296..205.55 .00 296..205.55 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 296..205.55 X 045 ::: 13..329.25 .00 X 12 = .00 .00 X 15 = .00 (9)= 13..329.25 I PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-13-2001 AA478150 666.46 12..662.78 TOTAL TAX CREDIT 13..329.24 BALANCE OF TAX DUE .01 INTEREST AND PEN. .00 TOTAL DUE .01 * IF PAID AFTER DATE INDICATED.. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1.. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR).. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) March 14, 2001 THE'WII-AEY GROUP Attorneys at La"", Wi ley · Lenox · Colgan · Marzzacco · P.C. !\ i'b /1 Register of Wills Cumberland County Courthouse Carlisle, P A 17013 In Re: Estate of Mary E. Stare, deceased File Number 2001-00049 Dear Register: Enclosed for filing please tlnd an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of 25.00 representing the filing fee. The inheritance tax check was forwarded yesterday under separate cover to ensure the 50/0 discount was received. Please return a recording receipt to my office in the envelope provided. Thank you for your cooperation. verelY, Daw~dfelter/AS . tant /dg encl. 1 South Baltimore Street. Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale r--~"""-""h I ' . It i I ; ! I \ ""..., -,- ""'-"~.-' '- THEW-II-JEY GROUP Attorneys at La~v Wiley · Lenox · Colgan · Marzzacco · P.C. March 12, 2001 Register of \\Tills Cumberland County Courthouse Carlisle, P A 17013 In Re: Estate of Mary E. Stare File Number: 2001-00049 Dear Register: Enclosed please find my firm's trust check in the amount of $12,662.78, representing prepayment of inheritance taxes with regard to the above captioned estate. Please forward a receipt to my attention. I have enclosed an envelope for your use. Thank you. Sincerely, -: '- .I e:!..'!..- -}1 i. Cc ~/(. / ' 'jan M. Wiley, Esquire G'; / 'ozlff JMW/sdg encl 1 South Baltimore Street. Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale "~ " ;', <S." ~~ ~. --'::- ti'I · .. ? l.~ ~ t' ~- 0.) rfl :J o { ? o U -: -: ~ rrj -:. c..--- rfl:JO-: aqr-:: ':z U"-- ': -.,., .-cJ <1. ': bao:...= ~ ""C e.j'::; 0.) 0.)""'" - ~ .!:J . ~ ..:;. ...... ~.-- ~fl "5 'a-: ~UU...::. ~ I'-' """ ~ "'-'m,'-~~I~vl', 1 ~ \ ~ ';, '; r,.\ " , ~U \ ,..1C \ ~3 t~ -"...---:::;.;;-- ~ ~ e Jool"\ ~ ;j 0.:. y- 0 o u ~~ -l~ . >- _ ro ~2 ~ c ro on -0 U -- C) C)U' ~O c)\'--- 0::' So- .~ - - cD ro >- cD:J .s::.~ ____ (f) :J:::= 0'- rjJO - - : - - - -: - - - -: ::: - - ~ - ('1 o ~ ~ \" r' , r' '" o t' ~ [ STATUS REPORT UNDER RULE 6.12 Name of Decedent: fl1a I [I I Date of Death: /~ //~3J{) 0 , , Will No. ..;){)- () /-()() tj 9 f- SICLr-e Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: yes-l- 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 representative file a final account with the Court? Yes NO)(. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. . Did the personal representative state an account informally to the parties in interest? Yes)( No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. --------, ..'\ Date: ...4/5/0/ '~ //" W~ ~, " ~---r'-_ . ~ ~. Si~ J~ /VI. (1 lL LE- Lj t-s ~ r Name (Please type of prin ) () Y)...~ .5. ;3a It; fYJ (If e, Sf Addres s ':];;> i //.:5 )U-r~; /}4.. 170lq ( 7/7) '/3.J -11/1/& Tel. No. Capacity: Personal Representative V'Counsel for personal representative (MAH:rmf/AM3)