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Home My WebLink About01-0053 /~ ._(XO! - 1.:3, REV-1500 OFFICIAL USE ONLY REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG, PA 17126-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COONlY CODE 0053 NUMBER 01 YEAR DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 204-01-0540 THIS RETlJRN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER Enmla P. DATE OF DEATH (MM-DD-YEAR) 12 21 00 12 08 1915 (IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) DECE- DENT 3. Remainder Return 8 (date of death prior to 12-13-62) 5. Federal Estate Tax Return Required o 8. Total Number 01 Sale Depostt Boxes 011. Election to taxunderSec. 9113(A} {Attach Sch 0) ~ 2. Supplemental Return 48. Future interest Compromise (date of death after 12-12-821 7. Oee.dent MaintaIned a Living Trust Attach & copy of Trust) 10. ~pouuJ Poverty Credit {date of death between 12-31-91 and 1-1-9S~ ~ 1. OrIginal Return 4. Umned Estate 6. Decedent Oledlestat. (Attach copy of Wilij ,9. UtIgaUon Proceeds Received CHECK APPRO- PRIATE BLOCKS ',':\1,' COMPLETE MAIUNG ADDRESS One S. Balt:iJoore st. Dillsblrg, PA 17019 NAME Jan M. wil FIRM NAME (II Appl"'able) wil Ienox Col TELEPHONE NUMBER 717-432-9666 COR- RE- SPON DENT & MarZzaoco P.C. OFFICIAL USE ONLY N6ite 128, 666.!l9 None None (1) (2) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schaduie B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Raceivabla (Schadule D) (4) 5. Cash, Bank Deposno & Miscellaneous Parsonal Proparty (Schedula E) (5) 6. JolnUy Owned Proparty (Scheelula F) o Saporate Billing Raquasted e6} 13,802.08 7,797.36 RECA- PITULA- TION 7. Intar-VIvos Transfers & Miscellaneous Non-Probate Property (Schedula G or L) 86,828.28 (7) 237,094.71 (8) 27,883.25 7,120.99 (11) (12) (13) 8, Total Groos Aasela (total Unas 1-7) 9. Funaral Expanses & Administrative Costs (S'h.",. H) (9) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10) 11. Total DeducUons (10181 Unas9 & 10) 12. Net Value 01 Ealale (Una 8 minus Una 11) 13. Charitable and Govermoontal Bequests/See 9113 Trusts for which an election to taX has not baan modo (Schadule J) 14. Net Value Subectto Tax Una 12 minus Une13 35,004.24 202,090.47 None 202 090.47 (14) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14taxable atthe spousal talC rate, or transfers under Sec. 9118 (aX1.2) K .0 (15) 16. Amount of Line 14 taxable at lineal rate 202,090..47 X.O 45 (16) 17. AlnountafLine14t&'K&b'-'at$I,\)lingrate 0..00 X .12 (17) 18. AmountofUne14taxableatcollateralratll 0..00 X.15 (18) 19. Tax Due (19) 20. 0 ~QilDijJrtiOI1_iiD;llijj:IJlfilmW;Mm!ll!H~.~.f.l 9,094.07 0.00 0.00 9,094.07 TAX COMPU- TATION '~!reJ.Nrir.!~j1r.':<:)M~'.':..Y.iliMUm!ii.lf.#@J.ft.H.t$.$1tMtt~b@JtNlli o PA 15001 Copyright 2000 Greatland/Nelco LP - Forms Software Only NTF 29755 '-- . . Estate of: Emma P. Fry 21-01-0053 stHoI1\RY OF ALIDCATIONS ro BENEFICIARIES Taxable at lineal rate Robert rester Fry virginia K. Keever Robert Lee Fry 72,449.03 64,820.72 64,820.72 202,090.47 PA REV-1500 EX (6-00) Pag.2 D$C;edent's ComDlete Addr...: STREET ADDRESS 1214 Mitchell Road CllY I STATE I ZIP Mechani. PA 17055 Tax Paymants and Credits: 1. Tax Du. (Pag. 1 Un. 19) 2. Credits/Payments A. Spousal Poverty Cr.dK B. Prior Payments C. Discount (1) 9,094.07 8,272.12 435.38 Total Cr.dlts (A + B + C) (2) 8,707.50 3. IntsrestJP.naKy n appllcabl. D. Interest E. P.nsKy 0.00 0.00 Totallnt.....vP.nsKy (0 + E) 4. If Una 21s gr.at...than Un. 1 + Un. 3, .ntsr th. dIlI....nce. Tl\IS Is the OVERPAYMEMT. Check box on Page 1 Una 20 to raquaat a ralund 5. II Una 1 + Un. 3 Is gr.ater than Una 2, enter the dm....nce. ThIs Is the TAX DUE. A. Enterth.lnterest on th.tax du.. B. Enter the total of Un. 5 + SA. This Is th. BALANCE DUE. Mak. Check Payabl. to: REGISTER OF WIUS, AGEMT ff.ffjUB)I\~$rlft*l't%lifffjl~ft1[111I.ili~l*U~~1f.IM&l~f.~ll%{_1l~-l$iltl1t~j~tThI~I*1f.~HftffmIilig41f~~~fl[[j~IWi.@gl4J] PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deced.nt make a transf.r and: Ves No .. retain the use or Income ofthe propertytransfened; ....................................... ~ I :~ ~~~~=;e~~:~~=I'~::~:~ ~~~~ ~~.t~~.~r~~~.~~~~~~~~.~r.~.I~~~;. ~:::::::::::::::: d. receive the promise for IlIe of eKher payments. ben.fltsorcar.? .............................. 2. II death occurr.d .ft.r Decemb.r 12, 1962, did decedent transf.r property within on. y.ar of d.ath Without receiving adequate consideration?. . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . ... ... . . ... ., 8 ~ 3. Did decedent own an "In trust for" or payable upon death bank account or security at his or her death? ... ~ 4. Old deced.nt own an Indivtdual Retirement Account, annuKy, 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. Under p.naltl.s 01 p...Jury, I declare that I have examin.d this return including accompanying sch.dules and stst.ments, and to the b.st of my knowledge and benet, it Is true, correct and complete. Declaration at preparer other ttian the personal representative is based on Information of which Dr8Darer has any knowledae. S~SO!,~SIBLE FOR FILING RETURN DATE ~DDRESS --7"~....., 5/;JIJ oj See Schedule attached IGNATURE OF PREPARE OT ER THAN REPRESENTATIVE (3) 0.00 (4) (5) (SA) (5B) 386.57 0.00, 386.57 o Baltinore st., Dillsburg, PA 17019 ff,M~~mJ?JifAtm~mM.timamlmt*tMn:WHttfMWWtl*ttt1~Mm?_ttiWlfW.[*f.Jn~!MMWri~[M%r%;$.;$.~Mti1{M~ttW'~M~mWtYtH~:tmf&lg%9.~mr:$nMi5:J!ffi', Far dates af death an arafter July 1, 1994and befare January 1, 1995, the tax rate Impa..d an the n.t value af transfers to. arfarthe use af the surviving spouee is 3% [72 fl.S.19118(a)'(1.1)(i)J. For dates of' d....tk on Qfa.ftef January 1,'1996, tha tB.xra1elslmposetl tin Ihe net value 0.1 lranshtslo orforl'ne use of the surviving spoLlS8 Is 0% [72 P.S. 19116 (a)(1.1) (Ull. Th. statute "'n... nnt ....amnta transfer to a surviving spoulJe from tax, and the statutory requirements for disclosure of assets and filing a tax return are stlllappllcableeven if the surviving spou..is the only beneficiary. FOf dates of death on or after July 1, 2000: The tax rate imposed on the netvafue of transfers ffom a deceased child twenty-one years of age or younger at death to orforthe U811 of a natLlral parent, an adoptive parent, or a stepparent of the child Is 0% [72 P.S.19116(a)(1.2n. The tax rate imposed on the net value of transfers to or forthe use of the decedent's lineal beneficiaries I. 4.5%, except as: noted in 72.P.S.' 51116(1.2) [72 P.S.1911S(a)(1)J. The tax rat. imp and on the net value of transfers to orforthe u.. of the dec.denfs siblings I. 12% (72 P.S, '9116(a)(1.3n. A sibling I. defined, under Section 91 02. a.s an Individual w'no huat le..t one parent in common with the decedent, whether by blaod oradoption. o PA1SOO2 NTF 29758 Copyright 2000 Qr..tland/Nelco LP- Forma Software Only Estate of: Etmia P. Fry 21-01-0053 '!he followin:} person(s) are signin; the return as representative(s) of the estate: Robert Isster Fry 1214 Mitdle11 Drive Mec:hanicsb.Irg, PA 17055 IDnnllIill tttt.U Q[.eg~nt OF EII!Il\ P. FRY BE:tT REKEKBERED, that I, ZlIHA P. FRY, of ~~6 Cherry Lane, Dillsburg, York County, 'Pennsylvania, being of sound mind, memory and understanding, do make, publisn and declare this as and for my Last Will and Testament, hereby reVOking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: I give my mobile home situate at ~~6 Cherry Lane, oillsburg, Pennsylvania to my son, ROBERT LESTER FRY, providing he survives me. ITEM 3: All the rest, residue and remainder of my estate, of ~hatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my son, ROBERT LESTER FRY, my granddaughter, VIRGIlfIA II. KEEVER and my grandson, ROBERT LEE FRY, in equal shares, per stirpes. ITEM 4' I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes af whatsoever nature and kind, to which my estate or th~ transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to &..'l; fv ff' j~ 8MIIA P. FRY (SEAL) -1- charge such taxes against my residuary estate, it being my intention 'that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my son, ROBERT LESTER FRY, as Executor of this my Last will and Testament. Should my son predecease me, fail to qualify, cease to act or renounce probate, I then appoint my granddaughter, VIRGINIA X.:XEEVER and my grandson, ROBERT LEE FRY, as alternate Co-Executors of this my Last will and Testament. :ITEM 6: I direct that my Executor or his successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this~S~J day of~..Ju"''''l ' 1996. ~,., / ~~ (SEAL) EMMA P. FRY -2- COHIIOIlWEALTH OF PEIIlNSYLVlINIA I SS COUNTY OF YORK We, EKHA P. FRY, JAR H. WILEY, ESQUIRE and JlINICE E. YOCUM, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and 'Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last will and Testament as witness and' .that -tot'he best of their knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to 'and SUbscribed ~'~~; &J ~:,:: :ilL 1f 'u1~ L:b A J NOTARY PUBLIC MY COMMISSION EXPIRES: Q:_ :.'."~'i"'.'.~ - .--- -,GItJ::r"""",,~.~~ My~.1"'!'Y";;~"'" -'~';m;nf',;;,:p;1:l.;;May1'11 , Iq-~~~~ REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA . INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Elmia P. Fry SCHEDULE B STOCKS & BONDS FILE NUMBER 21-01-0053 All property Jolntly-owneel With rtght of survivorship must be dlsclossd on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 series EE u.s. Savin;Js Bon:i ~ion: 2 First Union Securities stock: 8,936.80 11,484.00 3 Enron eo:r:poration stock: 4 PPL Col.pCU.Cltion stock: 5 me Bank eorp.:u.ation stock: 6 Met Life, Inc. O.,.,."lr\ stock: 66,800.00 9,162.50 31,944.94 338.75 TOTAL (Also en\<lr on line 2, Racanllulatlon\ $ (II more spsce is needed, Insert additional sheelS 01 the same size) 128.666.99 7 CPA31 NTF 10905 Copyright Forms Software Only, 19517 Nelco, Inc. U.S. SAVINGS BOND TRANSACTION Customer Copy Redemption Date: 1/11/01 Issue Redemption Series Denomination Date Value Interest 1 EE $1,000 01/91 $903.20 $403.20 * 2 EE $1,000 01/91 $903.20 $403.20 * 3 EE $1,000 01/91 $903.20 $403.20 * 4 EE $1,000 01/91 $903.20 $403.20 * 5 EE $1,000 07/92 $826.80 $326.80 * 6 EE $1,000 09/92 $802.40 $302.40 * 7 EE $1,000 10/93 $707.60 $207.60 * 8 EE $1,000 10/93 $707.60 $207.60 * 9 EE $1,000 07/92 $826.80 $326.80 * 10 EE $1,000 07/93 $726.40 $226.40 * 11 EE $1,000 07/93 $726.40 $226.40 * SUBTOTALS: Pre-January 1990 Issue Dates ( 0): January 1990 and Later Issue Dates ( 11): $0.00 $8,936.80 $0.00 $3,436.80 * --------------- --------------- --------------- --------------- TOTAL: 11 Bonds $8,936.80 $3,436.80 * The interest earned on Series EE bonds issued on or after January 1990 may be wholly or partially exempt from Federal income tax under the provisions of the U.S. Savings Bond Education Benefit Program. For further information concern- ing the benefits and restrictions that apply, please contact the Internal Revenue Service. Customer Copy - 1 F~~N~ "cur/t/.. First Union Securities WF3240 3401 North Front Street, Suite 110 Harrisburg, PAl 711 0 Tel 717 238-9636 Fax 717 238-9789 January 18,2001 Jan M. Wiley, Esq. The Wiley Group 1 South Baltimore Street Dillsburg, PA 17019 RE: Estate of Emma P. Fry Dear Mr. Wiley: Per your request dated January 10, 2001, I have provided for you the date of death values as of December 26, 2000 for the following securities: P~~\;.dp.t.iQn Hi h L.ow !:;l9S~ ..,!g- 3Ql, First Union Securities $29.125 $28.75 $29.00 11,1./'34.00 Boo Enron Corporation $84.75 $81.375 $83.50 /"4,'iV O. ClJ ~6b PPL Corporation $45.875 $44.4375 $45.8125 qjl/.J~. 56 '-la1 PNC Bank Corporation $74.9375 $72.75 $74.8125 31/ QL/4.qtj Should you require additional information please do not hesitate to give me a call at (717) 231-7205. "While the information herein has been obtained from sources we believe to be reliable, its accuracy and completeness is not guaranteed. " Rrst Ul\\on Securities, Inc. Member NYSE/SIPC @ Mellon Mellon Investor Services January 29,2001 The Wiley Group Attn: Jan M. Wiley 1 South Baltimore Street DiIlsburg,PA 17019 RE: MetLife, Inc. AlC: Emma P Fry Investor ID #:806207272017 Control #: 200101198198 Dear J an Wiley: We are writing in response to your inquiry asking how to transfer shares in MetLife's Policyholder Trust due to the death of the registered shareholder. As your stated, there are currently 10 shares of Met Life, Inc. common stock (MET) being held in the above referenced account. These shares were allocated to Ms. Fry as a result of the demutualization of MetLife and were credited to heraccotint on 'April 7, 2000. Shares of MET closed on December 26, 2001 at $33.875 per share. MetLife, Inc. declared a dividend of$0.20 per share in the year 2000. A dividend check in the amount of $2.00 was sent to Ms. Fry. Our records indicate that this check was negotiated on December 20, 2000. The executor of the estate may either (A) continue participation in the Trust by re-registering the shares, or (B) sell all shares in the Trust and receive a check for the proceeds. The requirements for transfer, depending on whether the estate was Probated or Non-Probated, are as follows: If the Estate was Probated 1) A letter of instruction indicating whether you wish to re-register the shares or, re- register the shares and then sell. *Note: If this change also applies to the re-issuance of a check. please indicate this information as well. 2) The Name, Address and Taxpayer Identification Number (Social Security Number) of the person or persons to whom the , shares will be transferred. 3)' A certified copy of the court appou;,tment of the estate representative, , , .' dated within 60 days (6moiiths for aNew York decedent): " ." , Overpeck Centre' 65 Challenger Road. Ridgefield Park. NJ 07660 www.melJon-investor.com A Mellon Financia.l Company'!.M REV-150S EX + (1-97) COMMONWEA~TH OF PENNSY~VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Emma P. Fry 21-01-0053 Include proceeds of Rtigation & data proce.ds were receIved by the estate, All DroD. Jolntlv-owned with rlaht of survlvorshla must be disclosed on Soh. F. SCHEDULE E CASH, BANK DEPOSITS, " MISC. PERSONALPROPERTV ITEM NO. DESCRIPTION VA~UE AT DATE OF DEATH 1 Allfirst Financial Money F\In:i #0098259199: 2 2000 Incane Tax Refund: 13,550.08 252.00 . TOT~ (Also enter on Une 5, RecaDltulallon\ $ (tf more space Is needed. Insert addhlonaf sheets of the same size) 13,802.08 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco, Inc. 01/26/01 10:33 fJ1 302 934 2955 <;I~ IaJ 001/002 II allfnt Fax Transmittal To; Jan M. Wiley, Esquire From: Sue Kimble Company: Law Office Date: January 26, 2001 Fax Number: 717-432-0426 No. of pages: 2 Sender's tel no. 302-934-2909 Sender's fax no.: 302-934-2955 Comments: Attached, please find the information you requested for the Estate of Emma P. Fry as of December 26,2000. If I can be of further assistance, please do not hesitate to call me at 302-934- 2909. Thank you and have a great dayl Sue Kimble @ Allfirst Bank 01126/01 10:33 'a1 302 934 2955 CIS ,I AlltInt FInancial Cc:ntcrN.A. PO Box 900 Mlllboro, DE 19966 January 26, 2001 The Wiley Group Attorneys At Law 1 South Baltimore Street DilIsburg, P A 17019 Re: Estate of Emma P. FrY Social Securitv: 204-01-0540 Date of Death: December 26. 2000 Dear Sir or Madam: ~ 002/002 allflrst Per your inquiry dated January 10, 200 I please be advised that at the time of death, 1he above-named decedent had 00 deposit with this bank 1he following: l. Type of AccD1Ult Money Fund Alternattve Account Nwnber 0098259/99 Ownership (Names oj) EmmaP.Fry Robert L. Fly, PO..! Opening Dais 03//8199 Balance on Dale of Death $13.472.10 Accrued [merest $ 77.98 Total --m.S50.oa----- 'Ihi8leJter doe~ 1UJt in&tude on;y accounts in whiclr the d,cea.red mt1)f haw been lJst~d as Power qf AttOl"MJl. C;atodian of Uniform TraJq[ers, Repnwntative Payee. or TnuMe undzr a Written Agreement. For further account itfformQfion, dCMUI'eS and/or reJmbur8emen1 of lunch refer to below brancJr.: WEST SHORE PLAZA OFFICE 1200 MARKET STREET LEMOYNE, PA 17043 717-255-%%71 REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ema P. Fry SCHEDULE F JOINTLY-OWNED PROPERTY ALE NUMBER 21-01-0053 II.n ._ was made Joint within one year 01 the _. date 01 death. It muat be _rted on Schedule G. SURVIVING JOINT TENANTfSI NAME A Robert rester Fry ADDRESS 1214 Mitchell Drive MechanicsbJrg, PA 17055 REUlTlONSHIP TO DECEDENT son JOINTlY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Includa nama 01 Unanclal Ins1Itu1Ion and bank DATE OF DEATH DECO'S VALUE OF JOINT account numbsr or slml1sr Identifying number. NO. TENANT JOINT Attach daed for joinUy-hald raal astata. VALUE OF ASSET INTEREST DECEDENrSINTEREST 1 A 12/22/95 Fulton Bank Chec:kin;J 10,465.20 50% 5,232.60 #3629-34659: 2 A 12/22/95 Fulton Bank >>:mey Market 5,129.52 50% 2,564.76 savings #9955-76240: TOTAL fAlso antar on lina 6. R8C80ttulation\ $ 7 797.36 7 CPA91. NTF 10909 (If mora space Is needad, Insert addltlonal shaets of tha sama slza) Copyright Forms Software Only, 1997 Nelco,lnc. Fulton Bank P.O. BOX 4887 . LANCASTER. PA 17604 People dedicated to your success. ~ (717)291-2589 Vv'INW. FU LTON BAN K.COM 1-800-FULTON-4 January 19, 2001 Jan M. Wiley 1 South Baltimore St. Dillsburg,PA 17019 Dear Jan Wiley: RE: EmmaP. Fry, deceased December 26, 2000 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Checking #3629-34659, open 3/11/91, balance $10,465.20, joint with Robert Lester Fry. (added 12/22/95) Money Market Savings #9955-76240, open 3/11/91, balance $5,129.52 and accrued interest $6.44; paying 1.5%, joint with Robert Lester Fry. (added 12/22/95) If you have any further questions, please do not hesitate to contact me. c:;:'~ Christine Putt Smith Credit Confirmation Processor " , /'.' '- . ~ -:-i '" 1~ O(.)jjliiill Here, . H 1;:i~.' ;.". "_L',;" REV-1510 EX + (HI7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Emma P. Fry SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed fi the answer 10 any of queslions 11hrough 4 on Ihe reverse side of Ihe REV-1500 COVER SHEET Is yes. 21-01-0053 DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECO'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE\ 1 Integrity Life Insurance Co. 86,490.18 Annuity: 2 MetLife Annuity #OOO063800AB: 338.10 , TOTAL (Also enter on Une 7, RscAoltulation\ $ 86.828.28 7 CPA01 NTF 10910 Copyright Forma Software Only, 1997 Nalco,lne. (If more space Is needed, Insert additional sheetS of lhe same size) ,""':_">}:;;.::-rn,l_ FACSIMILE TUNSMf' TO, nOM, Jan M. Wiley, EsquiTe Troy H. Landis COM ANY: I The W~ley Group F...,( TJMIIER: 0 ~u... 432-~' PHO E NTJMBsa, DATE. 2-2-01 TOTAL NO. OP PAGES INCLCD1NG COYER< 2 SIlNDllR'S RllFllRlll"Cl! NCMIIIlIl' YOUR RllFllJl.ENCll NUMll"R< [J PLEASE COMMENT [J PLEASE REPLY CJ PI.EASE RHCYCI.H response to your letter dated to uS on 1-10-01. (copy included this fax.) Current date of Death Value. $ 86,490.18 Current surrender value. $ 82,291.30 Current beneficiary staus, none, Robert Fry co-owner. Cummulative.stage. y further questions, please call 245-9522. Thank-YOUt,..:.~ ~ :.-~ CONFIDENTIALITY NOTICE This facsimile contains confidendal information which may be legally 'ileged and which Is intended only for the use of the Addressee(s) named above. n ou are not the intended recipient, or the employee or agent responsible for de verlng it to the intended recipient, you are hereby notified that any d' mlnatiOD or copying of this facsimile, or the taking of any action in reliance on th contents of this teleeopied information may be strictly probibited.lfyou bave ived this faClimBe in error, please notify us immediately by telephone and re rn the entire facsimile to us via the U.s. Postal Service. Thank You. THE WILEY GROUP ATI'ORNEYSATLAW ONESOUI1IBALnM DILlSBURG,PAl7U19 I,' 44 SOUTH HANOVER STREET, CARLISLE, PA 17013 (717) 245-9522 FAX 249-02.96 I;:,:" ~, ".-"-~'_...,----"-~, ,.-"._,~ " . Metropolitan ute Insurance Company Annuity Administration Operations 12902 East 51st Street. PO Box 22053 Tulsa, OK 74121.2053 r- MetLife January 18, 2001 77u- dL~ r;:::t'e).ud ~~ ~ ~cJ3 ~. lttt1al..; -iI JIs//).70Y3- ~3?/6 ROBERT FRY 1214 MITCHELL DR MECHANICSBURG PA 17050-3132 - RE: 000063800AB EMMA P FRY Dear Mr. Fry: Thank you for notifying us of the death of our payee. Please accept our condolences. The above listed contract was issued on February 28, 1991 as a Certain 10 Year with the first payment being issued on March 28, 1991. The terms of the contract state the beneficiary must continue to receive the income payments to complete the contract term. You as beneficiary will continue to receive m payments in the amount of $11 he final payment will be issued on February ,2901. In order for us to continue payments, please send us the following: 1. A certified death certificate. 2. Completion of the enclosed forms by you as beneficiary a. Claimant Statement. b. W-4P withholding form. c. Beneficiary designation form. 3. Return of the annuity Contract or note if lost. 4. Return of the 12/28/00 payment in the amount of $112.70 5. A copy of the death certificate for Robert Lilltl Fry (spouse) as he was named primary beneficiary. Upon receipt of the above information, we will process the claim as soon as possible. If you have any questions regarding this matter, you may call our Customer Service Call Center at 1-800-635-7775. Sincerely ~~ Stephanie Hurt Annuity Benefits REV-1511EX + (1-97) .. . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fma P. Fry FILE NUMBER 21-01-0053 Debts of _I must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT See Schedule attac:hErl Total fran continuation page(s} 3,780.91. B. 1. ADMINISTRATIVE COSTS: Personal Representative's COmmissions Name of PenlOnal Representative(s) Robert rester Fry Social Sscurlty Number(s)/EIN No. of PenlOnal Representative(s) Street Address 1214 Mitchell Drive City Mec:hanisb.1rq State 11,800.00 PA Zip 17055 Yeer(s) Commission Paid: 2001 2. 3. Attorney Fees Name: Jan M. Wiley, Esquire Family Exemption: (If decedenfs address is not the same as clafmant's, attach explanation) Clalmsnt Street Address City State Zip Ralationshlp of Claimant to Decadent 11,800.00 0.00 4. Probate Fees 144.00 5. Accountanfs Fees 0.00 6. Tax Return Proper....s Fees 0.00 7 Olmberlan:i law JCRlrl1al: 75.00 B 'lhe Patriot News Co. (advertise) : 233.34 9 Register of wills (add'l short certificates): 15.00 10 Notary Fee: 10.00 11 Filing Fee: 25.00 TOTAL (Also enter on Una 9, Recapi1ulation) $ (If more space Is needed, Insert additional sheets of the same size) 27 BB3.25 7 CPA11 NTF10911 Copyright Forms Software Only, 1997 Nelco, Inc. , EState of: Ema P. Fry samxJLE H, PARI' A - F\meral Expenses Item No. Description 1 cremation Society of Harrisb.lrg: 2 Kathryn Fry (reiInOOrsement for flowers): 3 Shepardstown United Meth<:xiist Church (funeral expense) : 4 VISA (Men'orial for n..,...,n~nt): 5 Giant Food stare (funeral meal): 6 Tan Willard (preacher): 'IOI'AL. (Carry fOl:Ward to main schedule) . . . . . . Page 2 21-01-0053 Amc:unt 150.50 200.00 1,588.24 1,665.04 127.13 50.00 3,780.91 REV-1512 EX + (1-97) ., - SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTAlC OF Emma P. Fry Include unrelmbu"",d ~a1..._. ITEM NO. FILE NUMBER 21-01-0053 DESCRIPTION AMOUNT 1 Verizon ({ilone): 2 Pinnacle Health (last illness): 16.26 6,915.73 3 PA Dept. of Revenue (2000 tax): 4 MorroW' Tax Service (tax prep): 109.00 80.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space Is needed, Insert additional aheets of the same sl2e) 7,120.99 Copyright Forma Software Only. 1997 Nelco, Inc. REV-1513 EX + (1-97) . CGMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER EmIa P. Frv 21-01-0053 RELATIONSHIP TO DECEDENT AMOUNT OR No. NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not Us! Trustee(s) SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS Qnclude outright spoussldistrlbutlons) 1 Robert Lester Fry son 72,449.03 1214 Mitchell Drive Mechani.csI::AJrg, PA 17055 2 virginia K. Keever gran::ldaughter 64,820.72 311 W. T.i"'"1rIl Road Mechani.csI::AJrg, PA 17055 3 Robert lee Fry granjson 64,820.72 1709 Branchwood Court ~ gprirgs, GA 30127 ENT"R DOLLAR AMT". FOR DISTRIBS. SHOWN ABOVE ON ' 'NES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 CouER 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 , TOTAL-OF PART 11-- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $ 0.00 7 CPA13 NTF 10"13 (" more spsce is needed, Insert addltlonsl sheets of the same size) Copyright Forms Software Only, 1997 NaleD,lnc, Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Emma P. Fry also known as No. 21-01....53 , Deceased Social Security No. 204 - 01- 0540 Robert Lester Fry 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 or the Decedent, dated 01/23/96 and codicil(s) dated None named in the last Will of 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 1214 Mi tchell Drive, Mechanicsburg Borough (Jist street, number, and municipality) Decedent, then ~years of age, died 12/26 ~e.QQ., at Harrisburg Hospital, Harrisburg, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Penn::ylv(lnia 75,000.00 $ $ $ $ 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: Robert Lester Fry 1214 Mitchell Drive, Mechanicsbur , PA 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems,lnc. /~_.~o/- 1...3 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. 0- Sworn to or affirmed and subscribed J? ~ ~ ~ '" Robert Lester Fry . before me this ~ day of JANUARY tJlx2001 .<)4vM~~* For the Register No. 21-01-53 Estate of Emma P. Fry Deceased Social Security No: 204- 01- 0540 Date of Death: 12/26/00 AND NOW, JANUARY 11 2001. in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters IT] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Robert Lester Fry in the above estate and that the instrument(s) dated 01/23/96 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Short Certificate(s). $ 18.00 Regist r of Wills Wile;" ~sqsd J; 115.00 Letters. . . . . . . $ Renunciation. $ Attorney: Affidavits ( $ 1.0. No: 06298 The Wiley Group One S. Baltimore St. Extra Pages ( ) . $ 6.00 Address: Dillsburg, PA 17019 Codicil. $ JCP Fee. $ 5.00 Telephone: 717/432-9666 Inventory. $ Other . . $ TOTAl. $ 144.00 Form RW-1 (1991) Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Th is is to certify that the inforn1ation here given is correctly copied from an original c~rtificate of death du!~ filed with me as I,Dcal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent hltng. WARNING: It is illegal to duplicate this copy by photostat or photograph" No. IIIIII/'/;;;;;~ Iltl'{~\.\" OF it;;",-__ \II__~~'~/f4' ~ ,II ~"' " 'J'L~~ ,'~ ..... \.....-::: ':. $~ ... \~~ !~~I . ..~. . \?~ ~ c:::ll ... Ja... ..~~ ~ e,..) I .{{. / .:t:. ~ \*~~*j ~~~ ..0 /./~l ~~" .. /~~\\I -=:'-"--!lMENt -~{ ~'IIII\\\ ,. "''''''/ //,~, 111111 J ,J' ~ T-? ~~Pr--- () Fee for this certificate, $2.00 Local Registrar P 7022609 Ole 27 2000 Date 21-01-53 ; 43 Rell 2187 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME Of DECEDENT (flrsr MldClIe. La5Il ,. SEX 2. UNDER 1 D/f:I Hours BIRTHPLACI: (C,ty anel Slale 01 Fcretgn Country) S. COUNTY OF OERH 85 VIS. EA/Outpatlent 0 =dy}D RAce. Amencan Indian. Black. Wl'Iile. lite. (SpeclIy) .... Vau h..i.n DECEDENT'S USUAL OCCUPATION (GIve Iuod r::J work clone dutlllQ mosl of working life; do not U$8 re/Jfed I Be.auuc...i.an 8c:. HO-6 ..i.taf. DECEDENT'S EDUCATION S I onl hI esI ade com feci Elemeniary/Sec.ondary College (().I2) 12 (14015+) '0. Wh..i.te. SURVIVING SPOUSE III NIle. go". maoaen namel MARITAL STATUS - Married Never Manied. Widow<<!. Oivot'ced (Specify) 14.W..i.dowe.d 1214 M..i.tc.he.ll V~..i.Ve. 1.. Me.c.han..i.c.-6bwz.g, PA 17050 FATHER'S NAME (First MlCldle. Last) lac.ob S. Umholtz 17.. Slate PA 17c:.0 ....., decedent IiIIlId in 1Wp. 17b. Coun Did decedenI IMlln a Cumbe.~land township? 17d.D ::.:.nt'=:Of MOTHER'S NAME iF_st. M,elelle. Ma.elen Surname} C~1boro Donation 0 . 2'" SIGNATURE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH _ ~ F J Itt ''f'L.L1.11 / 12L --.LL ~CompleIe if y :.:= pfIyIcaan is not a"ailabte alllme of deal .... car1lfy C&UM of death. 't. I va. P. We.~tz INFORMANT'S MAILING ADDRESS tStreet, CltyfTown. Slale, Zip Codel 12-28-2000 LICENSE NUMBER 2'c:. 22b. 10 ttle best 0' my knowledge. dealh occurred allhe lIme. date and place slaled (Signature ana T die) (/(}P 23b. 23c. WAS CASE REFERRED TO MEDICAl. EXAMINERlCORONER? Yea 00 FV NoD Sequentially .. condiliona illlnW', '-ding to IIIV'Mdiale _. Ent.. UNDERLYING CAUSE (o.sea. 01 "'fUlY - " 1hal nliated events r-*'g '" oeaIh) LAST C4"vUO ~ a.~ t~L~ DUE 10 (OR A CONSEOUENCE.9f>: Go'pf) - ~ ~ DUE 10 (OR AS A CONSEQUENCE Of): ..Pr-~ .f- a. I Approximale : Intef\lal tMHween I onset and death I ~ PART II: Other signillc:ant conditions contributing 10 death. buc I10l resulting in lhII undertying caUM gillen in PART I. DUE 10 (OR AS A CONSEQUENCE OF): d WERE AUlOPSY FINDINGS AVAILABlE PRIOR 10 COMPLETION OF CAUSE OF DEATH? MANNER OF DEATH DATE OF INJURY (Monltl. Day. Year) TIME OF INJURY INJURV AT WORK? DESCRIBE HOW INJURY OCCURRED. Nalural ~ o o HomICide Accident PendIng In_ligation o o o ~CE OF INJURV . Al home, ta,:':;e.,. factory. olfice budding, 1Itc:. .Spec.tvl 3Oe. Vee 0 NoD .....0 NoKJ Vea 0 No 00 M. 3Oc:. St.oic:ide Could I10l be dete,mlned 211I. 21b. CERTIFIER ICh8Clt only onel "CERTIFYING PHYSICIAN (phYSICoan c;efldYIllQ cause ~ eleal/'l ""'en dnOlhe< phVSIC.an has pi Of\Olmced clealh ana completed Item 231 To the bee. of my knowledge, death occun'H due to the cauae(s) and manner a. a'ated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. "MEDICAL EXAMINER/CORONER On the b..i. of examin.lIon andJOI' investigation. in my opinion, death occurred at the time, dale. and place, and due to the cause(.) and mannet' a. atated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3'01. -In o 301. SIGNATURE AND TITLE OF C IFIE' J _ . '" 3'b. "!.tl"uJL ~ LICENSE NUMBER o 31c:. U/J -061 - I r -I, 31d.. J- ~ NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE ~ DEAT~ (Item 27lTypeor Prinl T~/l,I/jf- JL,(;)i..ef/ M. P ,U'tr AI 3m' ~ffesz4- L.1.3>O Uf'TC1/1f/n PlZ-OrAU'"J It?/V./-t- !;O,'LLJ/, 1/ / 32. DATE FILED (Monlh. Day. Yeal) { ,--r,. ~~ ~ ~ OIdtJO 34. 4. f,( (; / fX) f t "PRONOUNCING AND CERTIFYING PHYSICIAN (Phvslcliln bolh OJfonounc,ng lJealh ancl cerlllyong 10 c;ause 01 elealn\ To the ~t of my knowledgfl, death occurred a' the time. date, and piece, and due 10 Ihe CauH(a) and manner.a .'.'ed.. . A~NA~D~~ U/~I/{ I \"/6-~O/- A:3 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 JAN M WILEY ESQ WILEY ETAL 1 S BALTIMORE ST DILLSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN sl C .' 1/ 07-02-2001 FRY 12-26-2000 21 01-0053 CUMBERLAND 101 REY-1547 EX AFP (12-00> EMMA P Amount Remitted PA l'lO:19 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 ~ RE-Y=is4-j-E'X--AFP--ri'2:ooj--NCffici:--OF-.rNHEifiTANCE-T-AX-A-PPRAisEifENT~-Ail-oWAifcE-oR------------- ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FRY EMMA P FILE NO. 21 01-0053 ACN 101 DATE 07-02-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 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 (1) (2) (3) (4) (5) (6) (7) 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) (10) .00 128,666.99 .00 .00 13,802.08 7,797.36 86,828.28 (8) 27,883.25 7,120.99 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 = .00 202,090.47 X 045 = 9,094.07 .00 X 12 = .00 .00 X 15 = .00 (19)= 9,094.07 (11) (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYllent. 237,094.71 35.004.24 202,090.47 .00 202,090.47 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-22-2001 AA478194 435.37 8,272.12 05-22-2001 AA496628 .00 386.57 TOTAL TAX CREDIT 9,094.06 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.) ~ ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: from fA- (J. Fr'J Date of Death: 12-~/-OD Will No. a , - t; 1- 6 C 53 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 V" 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 v 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. Date: 5'J.;2.'J 0 I ~ -/ ame (Please type or int) O~L S. 8tLL6fl1()rt!:.. S-/-. Ad ress J:> j fl.s b tlrq . P II- /7 () 19 (//1) L/3;J -4&q(, Tel. No. Capacity: _ Personal Representative ~ Counsel for personal representative f ~ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Emma P. Fry Date of Death: Decelnber 26,2000 Estate Number: dOll/ - OO{)53 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 1- /.;2 -t) / N alne Robert Lester Fry Virginia K. Keever Robert Lee Fry Address 1214 Mitchell Drive, Mechani csburg, PAl 7055 311 W. Lisburn Rd., Mechanicsburg, P A 17055 1709 Branchwood Court, Powder Springs, GA 30127 Notice has now been given to all persons entitled the under Rule 5.6 (a) except N/A. Date: 1-{;1-0 I Name: Jan M. Wiley, Esquire Address: One S. Baltimore St. Dillsburg, P A 17019 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. ~ iII / L// THE~ILEY GROUP Attorneys at La~ Wiley · Lenox · Colgan · Marzzacco · P.C. March 22, 2001 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 In Re: Estate of Emma P. Fry, Deceased File Number: 21-01-0053 Dear Register: Enclosed please find a check from the executor of the above captioned estate in the amount of $8,272.12. This check represents prepayment of inheritance tax, calculated as follows: Approxinlate estate - $193,500.00 x 4.5% = $8,707.50 less the 5% discount of $435.38 for a total paYlnent of $8,272. ] 2. Please send a receipt for this payment to my office. I have enclosed a self-addressed, stamped envelope for your use. Thank you for your cooperation. Sincerely, //\ Ue0L~\ · G~h~l/ 5d~ 0AN M. WILEY, ESQUIRE 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 I May 22, 2001 THE '-VI LEY GROUP Attorneys at La"W" Wiley · Lenox · Colgan · Marzzacco · P.C. Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of Emma P. Fry, deceased File Number 2101-0053 Dear Register: Enclosed for filing please find 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 $386.57 representing the balance of the tax due, and a check in the amount of$25.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, ()au/1) .- I ' to? Dawn Gladfelter/ Assl tant /dg encl. 1 South Baltimore Street · Oillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale COMMONWEALTH OF PENNSYLVANIA COUNTY OF OUMIEIXANIX YORK } 55: Robert Lester Fry according to law. deposes and says that he is the executor of the Estate of Emma P. Fry late of ----11e.f:p.anic_~buffi__!!Q!:ouglL. , Cumberland County, Pa., deceased and that the within is an inventory made by Robert Lester Fry ., the said executor of the entire estate of said decedent, consisting of all the personal prop~rty 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. being duly a\\7orn Sworn to and subscribed before me, ~~O~~~ . Executor. Administrator c~ " )()~ 2001 1214 Mitchell Drive Date of Death Notarial Seal S. D~wn Gladfelter, Notary P blic D,"sburg Boro, York Coun My Commission Expires May 1 I 2005 Member, pennsylvanip ~iation of Notaries Mechanicsburg, PA 17055 Address 21 2000 Day Month Year INSTRUCTIONS , . 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 G) M I- W tilt c:: I- lU L{') ~ w -< CD 0 r:L. I- f...4 u iJ 0 V') ::s CD 0 0 w C >- c:: w ~ ..0 CI) t- J: r:L. """ [/) c t- ..J u- lU ... 0 Z -< 0 ~ U a.. 0 u- ...J == W 0 -< W -r-i ..;.. -< ~ > 0:: c: N Z t:li ctS ..... Z 0 c C ;:: ::s <> en Z ctS U 0 c:: U Z w -< E Q) ... r:L. E ~ -0 ~ c ,., ~ a:: 0 Q) ..c -0 CD E ..... ..! lU ::s ...J U u: ~nventory of the real and personal estate of Emma P. Fry deceased 1. Series EE US Savings Bond Redemption: 2. First Union Securities Stock: 3. Enron Corporation Stock: 4. PP&L Corporation Stock: 5. PNC Bank Corporation Stock: 6. Met Life, INc. Common Stock: 7. Allfirst Financial Money Fund #0098259199: 8. 2000 Income Tax Refund: 8,936 80 11,484.00 66,800.00 9,162.50 31,944.94 338.75 13,550.08 252.00 TOTAL: 142,469.07 :r.oC)e>~ yoI1iC%-S ~~~YO-S __i'V'J:"~O V1>cPC-SZ c~OOI1':Z :0 -T'ZI1i Q~Z:;..l,:P' -~ 0 0 ~ yo ':2,1"\:r. ~ -:00 -1 ~11i1"\ ~ ~-<O ~ ~~11i b ....\CZ ~ ~11i%> ~ t1\ :.< fJ) ~ ~ :p _.--'------ - --' ---- ~ \ \ --,,- ,- - 1: "",\ \~ o t:!l ;c:. ~ "1'\ ~ ~ t-4. "f''' J/ Z , \ , , 16\ ~ ~ ~ !a ~~ ~ e 'U> ~ ~()(j) corn ~~(j)b 03:P~-Z ~orn r-~ -\ ~ ~ ~ ~ ~ "'0 ~ o ~ () tn ~ ~ \ ~ ~ ~ \ ("-0# ~::) \r-~ --n o S ~ ~ ..If, Z o-s. -n~ -n~ ..,..,. ",,-0 (') Z~ ..,..,. (') ~ l=' tt\ ~ r- ~~ -;o6~ rn ~~ (') ~..... t1\~~ ..,..,.~ -Of" ...-\-' ~ ~ o c ~ ~ --- a ~ ~ p. <..0 Oi (1') ~ ~ 'f. % ~ o ..... &:> ~ ---- CJ) m ~ n ~ 11'1 n ^ . z:. (to .... ~ :D ffi ~ m :D o ""T1 :E r= r (J) ::0 0 m ~ ~ m ):10 0 ~ ......" 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