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Home My WebLink About01-0131 N1114NiNr: (~ tS iLLPGmL TC' A(_lri_R TF'(S CRY ~~ rllos,i~~~c~i a a 'iG DUPLICATI= BY taHC~TOS"iA1' ~'J~R PNI:1TOGRt~PFi. (FEE FOR THIS CERTIFICATE 5200 (pti,l,ryi)N1N R i Or '.h dil~: ,i1Vi.: JEEA~'NENT )`hEAL.IiV-;1LE _CO'i')i ..)(;:~i. "=t I!i ~I1~~'i,f.' ~~~ C;~E'.1-"I ~' C t 'I`!C~I~ )"IF : I; r .1 is CERT. NCB. ~T ~- 6 9 ~ ~` ~ ~ Name of Decedent _ Evelyn ----------------- F,,. Sex Female ______Social Security No. -_ ~ ' G . ~_~ ~~- ;t,~;: ,T i ~.,~fENT '~` , i _,,~, n >~ ~~/~ ~p~~ November 16, 2000 Dale of Issue of This Cenitication E. Keener Mu:JI,.~ Cast 201 - 18 - 1490 November 15, 2000 --___-----------..____-- Date o~ Death - _ Date of Birth April 13, 1911 _-_ Birthplace Hanover, York County, Pennsylvania Place of Death __ Manor Care Health Services Cumberland County N, Middleton Twp. Pennsylvan Focility Nnme County Clry. Bora-~gh o~ Townsnlq Race_ White ___-Occupation Laborer ___ Armed Forces? (Yes or No) _ No Decedent's Marital Status __ Widowed Mailing Address 1023 York Road Dillsburg _ PA Numt:e Street Citc or Town State' Informant Mrs_ Arlene Mixell Funeral Director Scott D. Brenneman, FD _- Name and Address of Funeral Establishment Cocklin Funeral Home,Inc., 30 N. Chestnut Street, Dillsburg, PA 17019-0424 Part I: Immediate Cause (a) Cardiac Arrest (b}____Gastric Cancer (d) -- -- Part II: Other Significant Conditions Manner o f Death Natural ~X Homicide ^ Accident ^ Pending Investigation ^ Suicide ^ Could not be Determined ^ Describe how injury occurred: ~~ Interval Between Onset and Death >- _ _ r -- L -- - Name and Title of Certfier _ Hal S. Fineburg, MD Address 4819 E. Trindle Road, Mechanicsburg, PA 17055 (M.D., D.O., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death c;uly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. 67608 ~~LOCaI Registrar of Vital Record Distract No. November 16, 2000 153 Logan Road, Dillsburg, PA 17019 o ~- >:,i a~o~~i;~, - street Aen~esa cuy. Ecrcugn. Tnwnsnlli 1 i X W 1 W 1 ti '~" ~ Q z X Q W a a~ W V >p W J NQ J f W Z (~ a~ . I u- ~ ~ ,~ z ~ _¢ Z Y W Zw~ o Z~F o LL ~ 7 N w o~c xLL> ¢ moo a ¢~z 3Woo¢ 'm OQaNfA ~a¢a¢ Ow~w¢ U~mOS .~ _, ,< _ .. W 0 0 ~, ~. ~ a • a ~' r~ o - ~ a ° 11F ~ J J 3 ~, w o a ~ ~a~ ~ U ~ m ~ ~ ¢ Z ~ ~Z ~ ¢ a Q O .W H } w ~ £ Q: W U W ~"' ~ o ,ry ~ +~ a ,.. A LtI W iJ ~. ti W ' O F- J LL W W +-+ > p ~ ~ V "'! J'1 Q W it, [11 CJ °C L W 0 LL a C} ., m~ ~, E o F LL W Z .-~ ,~-. ~o ~ gw w o a o ~ .r o f- Wa ZN o ~ (~ a ~ ~N ~~ ~4 w a0 ~ d! ~~ Z W ~ wW Q` ~ W~ W Q m.-~ ~ o W O~ a (~ 2 Q ~ ~ ~V o«~ ~« CA z J w ~ O w ~ F- (n z ~ w H W LL Z O a U ~ ti ~~ w 1 J W Qr t~ 4 J~C1 ~hY " t~ t3 ~ W Q ~ JJ x _J O H W. ~, !'6 _~p ~„ ,t./ COMMONWEALTH OF PENNSYLVANIA 7 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION NOTICE OF INHERITANCE TAX DEPT. 280601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1567 EX AFP C12-00) DATE 03-26-2001 ESTATE OF KEENER EVELYN E DATE OF DEATH 11-15-2000 FILE NUMBER 21 01-0131 .~, COUNTY CUMBERLAND '-~' 101 JAMES D FLOWER ~ ACN SAIDIS ETAL Amount Reeitted 26 W HIGH ST CARLISLE PA;17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------------------------- -------------------------- ---------------------------------- REV-1547 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE 0 DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KEENER EVELYN E FILE NO. 21 01-0131 ACN 101 DATE 03-26-2001 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 Al (1) 133,700.00 NOTE: To insure proper (2) ,00 credit to your account, 2. Stocks and Bonds (Schedule B) ,00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) 500.00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 25,510.07 7. Transfers (Schedule G) (7) 165,920.32 (8) 325,630.39 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 11,814.75 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl (9l 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 4 48.31 (11l 72.263.06 11. Total Deductions 313,367.33 12. Net Value of Tax Return (12) .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 313,367.33 14. Net Value of Estate Subject to Tax (14] NOTE: if an assessment was issued previously, lines 14, 15 andior 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 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due BER 795 PAYMENT MUST BE MADE BY 08-15-2001*. 1, .00 X 00 = .00 (15) 75,436.33 X 045. 3,394.63 (16) 237,931.00 X 12 28,551.72 t17) .OD X 15 .00 (18) 31,946.35 (19)= AMOUNT PAID 30.265.01 TOTAL TAX CREDIT 31,857.91 BALANCE OF TAX DUE 88.44 INTEREST AND PEN. .00 TOTAL DUE 88.44 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUZRED. FOR CALCULATION OF ADDITIONAL INTEREST. pFREFUND.DSEEZREVERSECSIDEpOFATHISEFORM FOR)INSTRUCTIONS,DUE ,. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FLOWER JAMES D JR 26 W HIGH STREET CARLISLE, PA 17013-2922 fold ESTATE INFORMATION: ssN: 2oi-is-iaso FILE NUMBER: 2101 -0131 DECEDENT NAME: KEENER EVELYN E DATE OF PAYMENT: 04/16/2007 POSTMARK DATE: 04/16/2007 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 5/2000 REMARKS: SEAL CHECK#1003 REV-1162 EX(11-96) N0. CD 008027 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $88.44 TOTAL AMOUNT PAID: INITIALS: JA RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS 588.44 GLENDA EARNER STRASBAUGH °~~~" 1 e ouuxe ..w. •^ ~ O o W r ~ W .d o 1'1_1 ~ r ~ ~ >v r ~_ w' .. °Y co W r ~ O W W r O O W d ~ 'jtl O O~ I m N W D=a j D~$ N=m m~N D ~ O jv ;Am w `~' ~ N N N 1 d r~ ~ N o ~ ~. r r' ~'' i>' r ~ ~ ' ~` Fa O ~ . ~, s; O ~~~ ~ ° W !~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT f.. ~_.' ~ .. ... (,, , - ,, JAMES D FLOWER ~-, SAIDIS ETAL 26 W HIGH ST CARLISLE PA 17013 REV-1607 EX AFP C03-05) DATE 05-21-2007 ESTATE OF KEENER EVELYN E DATE OF DEATH 11-15-2000 FILE NUMBER 21 01-0131 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE '~ RETAIN LOWER PORTION FOR YOUR RECORDS - _ ~" _ _ _ _ ----------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF KEENER EVELYN E FILE N0. 21 01-0131 ACN 101 DATE 05-21-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE. AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 02-01-2001 AA477955 1,592.90 30,265.01 04-16-2007 CD008027 .00 88.44 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-17-2007 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ~ IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 61. NO PAYMENT IS REQUIRED. TOTAL DUE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 31,946.35 31,946.35 .00 28.96 28.96 C6 RE415'A EF {50]1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 „~ HARRISBURG. PA 17128-0fi01 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W Keener Evel n E, 0 DATE DF DEATH (MM-00-YEAR) DATE OF H1RTH (MM-DD-YEAR) U 11/15/2000 04/13/1911 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILL NUM73ESlihG L C~TY CCOE_ YEAry SOCIAL SECURITY NUMBER 201 - 18 - 1490 THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER F ^X 1.OdginalReturn ~2.SupplementalRehm ~3.RemainderRealm(ammnamomrm+z.+sazt x rc z ~ 4. Limited Estate ~ 4a. FuNre Interest Compromise (amma„u, aaer+z+2a21 ~ 5. Federal Estate Tax Return Requiretl a m ®6. Decedent Died Testate (A~u, cow of wJ~l ~ ). Decedent Maintained a Living Trusi (ease, moy mYn,.M1 0 6. Total Number of Safe Deposit Baxes a 9. Utigafion Proceeds Received ~ 10. Spousal Poverty Credit (mm d adm n +za+-s+ ew +-+-etil ~ 11. Election to tax under Sec. 9113(A) Inbe, sm d) F ouw _ w w NAME COMPLETEMAILING ADDRESS 0 3ames D. Flower Jr. Es uire y FIRM NAME (saopiaeMl ~ F w & Lindsa p TELEPNONE NUMBER 2 O a J H a Q U W Z Q H a O U X FQ- 1. Real Estate (Schedule A) (t) 13 3 . 7 0 0. 0 0 "' ' """` " 2. SlocKS and Bonds (Schedule 8) C2) - 3. Closely Held CorporaFon, Partnership orSole-Pmpdetorship (3) - 4. Mortgages 8 Notes Receivable (Schedule D) (a) - 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) $ 0 0 . 0 0 (Schedule E) -- 6. Jointly Owned Property (Schedule F) (6) 2 5 , 510 . 0 ~ Separate Hiiling Requested 7. InterVivos Transfers 8 Miscellaneous Non-Probate Property (T) 16 5 , 9 2 0 . 3 2 ~ ~~ (Schedule G or L) 8. Total Grass Aasets (total tines 1-7) (e) 3 2 5, 6 3 0. 3 9 9. Funeral Expenses 8 Administratlve Casts (Schedule H} {9) 11, 814.7 5 10. Debts of Decedent, Mortgage Uabilities, 8 Liens (Schedule I) (10) 4 4 8 . 31 71. Total Deductions (total Lines 9 & 10) (11) 12 . 2 6 3. 0 6 t2. Net Value of Estate (Line S minus Une 11) (12) 313. 3 6 7 . 3 3 53. Chartable antl Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) fl made (Schedule J) 14. Nat value Subjeet to Tax (Line 12 minus Line 13) (14) 313 , 3 6 7 , 3 3 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line to taxable at Ne spousal tax 0 0 x .0 rata, or bansfers under Sec. 9116 (a)(1.2) (16) 4 5 7 5, 4 3 6. 3 3 18 3, 3 9 4. 6 3 x .u 1 fi. Amount of Line 14 taxable at lineal rate ( ) 17. Amount of Line 14 taxable at sibling rate 7 3 7 r 9 31 - 0 0 x .12 (17) 2 3 F„5.51 . 7 2 1S. Amount of Line 14 taxable at collateral rote x .15 (16) t9. Taz Due (19) 31,946.35 z6. ^ e . • e NUMBER / ~ / Decedent's Complete Address: STREET ADDRESS 1023 York Road ~ITM Dillsburg STATE pA 7JP 17019 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) $ 31 , 9 4 6 . 3 5 2. CrediLslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount $ 1 , 6 81.3 4 TotalCradits(A+B+C) (2) 1,681.34 3. InteresUPenalty ifapplipble D. Interest - E. Penalty ~ - Total InterestlPenalty (D + E) (3) 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 0 Cheek box on Page 1 Une 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3 0 . 2 6 5 . O 1 A. Eller the interest on the tax due. ~ (5A) 0 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 3 0 , 2 6 5 . O 1 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ® ^ b. retain the dght 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 pre? ................................................................ ...... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideredon? ........................................................................................................ ...... ^ 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. sdtedules ida 3 it is We, DATE 1638 Fourth PREPARER OTHER s, nos 0 li say 13 For dates of death on or after July t, 1994 and before January 1, 1995, the tax rete imposed on the net value of transfers to or for the use of the surviving spouse is 3% (12 P.S. §9116 (a) (i.i) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed an the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applipble 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 twentyone years of age or younger at death to or far the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(12)]. The fax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiades is 4.5%, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or far the use of the decedents siblings is 12% [72 P.S. §9t16(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV4502 EXr (72-85~ SCHEDULE A COMMON u rA .TM OF PE ~NSsEVANIA REAL ESTATE Keener, Evelyn L. (Property jointly-owned with Right of Survivorship must bs disclosed on Sckedule FJ All real estate should be reported m fair market value which is defined as the price at which property would be exchanged between g willing buyer and g willing seller, neither being compelled (If more space is needed, insert additional sheep of same size.) NEV.1308 E%. IZ-Bn SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Keener, Evelyn L. (All property loinfly-owned wish the Right of Survivenhip must he discloaad en Schedule F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. Personal Property $ 500.00 TOTAL (Also enter on line 5 Recapitulation) I$ 500.00 IAlmch oddisional 8'k° x 11° sheen if more spoce is needed.) RlK1500 EXa 112-Rrl SCHEDULE F COMMONWEAUN Of PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Keener, Evelyn L. Joint tenant(:): NAME ADDRESS RELATIONSXIP T9 UECEUENT A. Ruthanna Rosenberger 15 Golf Course Road Sister Dillsburg, PA 17019 B. Arlene Mixell 1686 Fourth Avenue Sister Vero Beach, Florida 32960 ~• Ethel Myers 39 Carlisle Road Daughter ' Dillsburg, PA 17019 Jointly-owned property: ITEM NUMBE LppRR 101NT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~• A 3/17/8 Checking Account No. 222-109-6635, Mellon Bank, N.A. 5,850.03 0~ 2,925.02 2. A 1/30/9 Money Market Account No. 885-005-7426, Mellon Bank, N.A. 2,096.67 Og 1,048.34 3. B 5/27/9 Certificate of Deposit No. 00527574, Mellon Bank, N.A. 28,073.41 0% 14,036,71 4. C 4/24/8 Certificate of Deposit No. 220-63752-C, Mellon Bank, N.A. 15,000.00 0$ 7,500.00 TOTAL (Also emer on line 6, Recapitulation) 15 Z S , bl u , u / (If more space is needed insert addilianel sheets of same size) REV.1570 EX+ (2-E7J ~,~ SCHEDULE G COMMONWEALTH OF PENNSYLVANIA TRANSFERS IN NE0.1TANCE TA% RETURN PLEASE Keener Evelyn L THIS SCHEDULE MUST BE COMPLETED AND FILED 1F TfiE ANSWER TO ANY OFTHE OUEST10N5 ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRIPTION OF PROPERTY NUMBER Include name of Iha transferee, their re7atianship b decedent, dak of transkr. EXCLUSION TOTAL YAIUE OF ASSET DECD. % INT DOLLAR VALUE OF DECEDENT'S INTEREST 1. Certificate of Deposit No. 064- 0132547, Fulton Bank, In Trust for Larry Myers, Barry Myers & Randy Myers; opened 08/08/00 0 30,341.3 100 $ 30,341.32 Interest accrued 0 39.4 100 39.42 2. Certificate of Deposit No. 064- 0132551, Fulton Bank, In Trust for Rodney Myers; opened 08/08/00 0 20,227.5 100 20,227.54 Interest accrued 0 26.2 100 26.28 i 3. Certificate of Deposit No. 064- 0132555, Fulton Bank, In Trust for Jennifer Myers and Sabrina Myers; opened O8/O8/00 0 10,113.7 100 10,113.77 Interest accrued 0 13.1 100 13.14 4. Certificate of Deposit No. 064- 0132559, Fulton Bank, In Trust for Suzanne Coulson; opened 08/08/00 0 10,113.7 100 10,113.77 Interest accrued 0 13.1 100 13.14 5. Certificate of Deposit No. 064- 0132563, Fulton Bank, In Trust for Arlene L. Mixe11, POA for Ruth anna Rosenberger; opened 08/08/97 0 10,000.0 100 10,000.00 Interest accrued 0 12.0 100 12.99 6. Certificate of Deposit No. 643- 017229, Fulton Bank, In Trust for Arlene L. Mixell, POA for Ruthanna Rosenberger; opened 08/08/97 0 84,908.6 100 84,908.65 Interest accrued 0 110.3 100 110.30 TOTAL (AI t n 1'n 7 Recop'tulai onJ I S 16 5 9 2 0 32- (If more space is needed, insert additional sheets of same size.J ae/dSMIX•p9ry COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Keener, Evelyn L. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Cocklin Funeral Homc, Inc., funeral $ 8,784.86 2. Range End Golf Club, memorial luncheon 414.89 g, ADMINISTRATIVE COSTS: }. Personal Represer~dve's Commissbns Name of Personal Representatlve (s) Sodal Seadry Number(s) / EIN Number of Personal ReprasentalNe(s) Street Address City State Zw Yeac(s) Commission Paid: p AttomeyFees Saidis, Shuff, Flower & Lindsay 2,500.00 3, Fatuity Exemption: Qf decedent's address b not the same as daimanCs, attach explanatlon) Claimant Street Address Cdy State Zip RelaUOnship of ClaimanC to OecedeM 4 Probate Fees 5 AaaunlaM's Fees 6 Tax Rehm Prepa2rs Fees 7 Register of Wills, file Inheritance Tax Return 15,00 8. Allowance for closing costs 100.00 TOTAL (Also enter on line 9, Recapitulation) 15 11, 814.7 5 more space is needed, same size) gEK1513 f%i (1~93~ COMMONWEAUN OF RENNSYLVANIA INNFRIfANCE iAX gETURN gESIDENi OKEOENi SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Prini or Keener, Evelyn L. (If more space is needed, insert additional sheeh of some size.) REK IS^ E%. ~2~e1~ ESTATE OF :AIM OF PENNSYivAN4 fGNCE Tq% RETURN OENt OECleFNT Keener, Evelyn L. ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: I, Ruthanna Rosenberger Sister real estate < 15 Golf Course Road 1023 York Ra Dillsburg, PA 17019 Dillsburg, P. (Joint Owner of real estate} 1/4 of contel of home 2. Reba Gettys Sister 1/4 of contel 34 East York Street of home Dillsburg, PA 17019 3. Arlene Mixe11 Sister 1/4 of conte~ 1686 Fourth Avenue of home Vero Beach, Florida 32960 4. Ethel Myers Daughter Certificate ~ 39 Carlisle Road Deposit for Dillsburg, PA 17019 $20,000.00 (In Trust for Account) ~y ::) e. n•.J~«.l~t }~_i *r<: 5. Randy Myers Grandson $10,000.00 39 Carlisle Road Dillsburg, PA 17019 (In Trust For Account) CONTINUED ON ATTACHED SHEET ITEM NAME ANO ADDRESS OF BENEFICIARY AMOUNT OR NUMBER SHARE OF ESTATE B, Charitable and Governmental Bequests: I None 0 TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) SCHEDULE J BENEFICIARIES 0 tt Ld, ~ and its its its ~f l (If more space is naed~d, inearf additional sbaets of same size) SCHEDULE J -CONTINUED BENEFICIARIES ESTATE OF FILE NUMBER Ke n v 1 L ITEM NAME AND ADDRESS AMOUNT OR NUMBER OF BENEFICIARY RELATIONSHIP SHARE OF ESTATE 6. Barry Myers Grandson $10,000.00 39 Carlisle Road Dillsburg, PA 17019 (In Trust for Account) 7. Larry Myers Grandson $10,000,00 39 Carlisle Road Dillsburg, PA 17019 (In Trust For Account) 8. Rodney Myers Grandson $20,000.00 3686 York Road Helena, Montana 59601-8815 (In Trust For Account) 9. Jennifer Myers Great Grand- $5,000.00 3686 York Road Daughter Helena, Montana 59601-8815 (In Trust For Account) 10. Sabrina Myers Great Grand- $5,000,00 3686 York Road Daughter Helena, Montana 59601-8815 (In Trust For Account) L NAILING DATE: July 1, x000 District: as - NANROB TONN88IP School..: CDNBSRLAND VALLBY 9D Location:. loan mRx RoAn LOT 8 TABABLB DNIT/LOT ID..: L-0008 Lead 91ze....: .65 acres Property Typs: R Residential Kith Buildiaga THIS IS NOT A TAX BILL Parcel Identifier: 22-12-0350-019. 2000. ~ Assessed Value Old Aaaaaaed Value Market. Valua (2000 Market x 100'6) (1974 Markst x 25'h) Land as,ooo a5,ooo halo Buildings 108,700 ~ 108,700 8,750 TOTAL 133,700 133,700 10,160 -. 2000 Clean and Green Values Land - NOT NOT NOT Bulltlings `:APPLICAHLB APPLICASLS APPLICASLB TOTAL Clean and Green values apply to some farm and forest land. Such values become effective onry upon application and approval. All applications must be received by the Assessment Office by 4:30 p.m. on October 15, 2000. Those previously approved Ior Clean and Green do not need ro re-apply. Control No: 22001206 CWQAICP JRN 3l'7 '(~1 1` :II,, I ~.. ,. ,ni ~~.,, D Mellon laellon Bank, N.A. CnmmonwealLh Rc+gic~~ U.Ilsbu rq Rranch 4 s H>~lt imore Sl. Ul~lsburq PA 17019 JANOARX 30, 2007 JAMES FLOWER - ATTOKNEY RH= EVELYN I. KEF.NF.R TO NHOM TT MAY OONCERN- THE FOLLOiiING ARE. DAI.ANCES A~ OF '~ ! -15 (f0 FOR i'HF. AAOVE MKN'1~7ONE~ CT.IENT= DD 222-109 6E>35 $ 5850-OJ UFF:NED 4- :7-86 F.VELYN L KEENER VR RUTHANNA 1f ROSk:NRF:KCER DD 885-005-7426 209E .67 OPENED 1 >O-yR };VE7.YN I. KEF•Nk;R OR KUTHANNA tl ROSENHF:RGER TD 0052757Q 2A07 } _ A ! OP};NED i - 7 /-97 F:VELYN L KEENER ~lR ARi.ENE M IXF.I.L TD 220-63752-c tsono. on OPF;NF:U 4 -24--84 EVF:LYN L XF:F:NER UR RTHF.T. L MYERS ANX QUESTIONB YLF.ASE FEEL F'REF 1'O CALA Mh AT 71/-43.1-9639- SINCERELY, /~ ~ .. .7IJDITH N. CORNMAN MANAGER ~Wii DQllls People dedicated to your success.- (717)291-2589 December 8, 2000 James D. Flower, Jr. Saidis, Shuff, Flower & Lindsay 26 West High St. Carlisle, PA 17013 Dear Mr. Flower: RE: Evelyn L. Keener, deceased November 15, 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: ACC CD# BALANCE INT RATE OPEN ROLL OVER MATURITY 064-0132547 30,341.32 39.42 6.77 8/8/00 n/a 2/8/02 *In Trust For Latry Myers, Barry Myets & Randy Myers 064-0132551 20,227.>4 26.28 6.77 8/8/00 n/a 2/8/02 *In Tmst For Rodney Myers 064-0132555 10,113.77 13.14 6.77 .8/8/00 n/a 2/8/02 *In Trust For 7ennifer Myers & Sabrina Myers 064-0132559 10,113.77 13:14 6.77 8/8/00 n/a 2/8/02 *In Trust For Suzanne Coulson 064-0132563 10,000 12.99 6.77 8/8/00 ** 2!8(02 *In Trust For Arlene L. Mizell, Power of Attorney Ruthanna Rosenberger **opened with fund from a previously held CD (titled same) which opened 8!8!97 643-017229 84,908.65 110.30 6.77 8/8/97 8/8/00 2/8/02 P.O. BOX 4887 • LANCASTER, PA 17604 WWW.FULTONBANK.COM 1-800-fULTON-4 *In Trust For Arlene L. Mizell, Power of Attorney Ru[harma Rosenberger l~s r„~- aAS+•~ _ i0 r f y,,, . ,. If you have any further questions, please do not hesitate to contact me. ~:; ~.;. ti Very truly yours, ~~u5n~ ~~ 4~1~ Christine Putt Smith Credit Confirmation Processor ~1MONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0 60 1 RECEIVED FROM: FLOWER JAMES D JR 26 W HIGH STREET CARLISLE, PA 17013-2922 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 008027 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: 2oi-~s-i4so FILE NUMBER: 2101 -01 31 DECEDENT NAME: KEENER EVELYN E DATE OF PAYMENT: 04/16/2007 POSTMARK DATE: 04/16/2007 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 5/2000 REMARKS: CHECK#1003 SEAL 101 ~ 588.44 TOTAL AMOUNT PAID: INITIALS: JA 588.44 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAxes INHERITANCE TAX 1NHERIUNCE TAx o1v1SION STATEMENT O F AC CO U N T PO BOX 280601 HARRISBURG PA 17128-0601 ~__i:r;r, i~ Cac ~. ~~ c JAMES D FLOWER ^•~ ~r~ ~ ~ '~ ~'- SAIDIS ETAL U.,. 26 W HIGH ST CARLISLE PA 17013 REV-1607 EX AFP C03-05) DATE 05-21-2007 ESTATE OF KEENER EVELYN E DATE OF DEATH 11-15-2000 FILE NUMBER 21 01-0131 COUNTY CUMBERLANID ACN 101 Amount Remit ad MAKE CHECK PAYABLE AND ItENIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~'- RETAIN LOWER PORTION FOR YOUR RECORDS !~'~ --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *~** ESTATE OF KEENER EVELYN E FILE N0. 21 01-0131 ACN 101 DATE 05-21-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMEII ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE. AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 02-O1-2001 AA477955 1,592.90 30,265.01 04-16-2007 CD008027 .00 88.44 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-17-2007 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE. SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 11, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR3. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 31,946.35 31,946.35 .00 28.96 28.96 COMMONWEALTH OF PENNSYLVANIA DEPRATMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: FLOWER JAlVIES D JR 26 W HIGH STREET CARLISLE, PA 17013-2922 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) No. cD o~293~ ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- foM ESTATE INFORMATION: ssN: 201-18-1490 FILE NUMBER: 2101-0131 DECEDENT NAME: KEENER EVELYN E DATE OF PAYMENT: 06/ 17/ 2010 POSTMARK DATE: 06/ 17/2010 COUNTY: CUMBERLAND DATE OF DEATH: 11 / 15/2000 101 ~ 514.48 I TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 5821 514.48 INITIALS: CJ RECEIVED BY: GLEND•A EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA OOH DEI~ARTMENT OF REVENUE ~. ~'~r~~~?~, ~' ~~C~:I~HERITANCE TAX BUREAU OF INDIVIDUAL TAXES -~ ~' =''°~" INHERITANCE TAX DIVISION ~~+~,ut ~ ~ CEMENT OF ACCOUNT Po BOX z~®~ol ~ ( ~ ~" ,. HAIdtISBURC PA 17125-0601 REV-1607 EX AFP (03-05) IUN t ? PM ~" 4" X10 D 2007 . STATE OF E EVELYN E KEENER C dF DATE OF DEATH 11-15-2000 JAMES D FLOWER ~~ ~~~~~,~ ~~~~ ® ~~ ~~ ~~-~~~ F I L E MUMB ER COUNTY ACN 21 01- 0131 CUMBERLAND 101 SAIDIS ETAL Asount Rfwitt~d 26 W HIGH ST CARLISLE PA 17013 MAKE CHECK. PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subait the upper portion of this fors with your tax payn~ont. CUT ALONG THIS LINE ~"- RETAIN LOWER PORTION FOR YOUR RECORDS f- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF KEENER EVELYN E FILE N0. 21 01-0131 ACN 101 DATE 05-21-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PR~OJE`~TRD INTEREST FIIfURE DATE OF LAST ASSESSMENT OR REGORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 31,946.35 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 02-01-2001 AA477955 1,592.90 .30,265.01 04-16-2007 CD008027 .00 88.44 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-17-2007 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID #FTER THIS DATE, SEE REVERSE ~ TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN il. NO PAYMENT IS REQUIRED. 31,946.35 .00 28.96 28.96 IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) pennsylvan~a ~ ~ s BUREAU OF INDIVIDUAL TAXES '~'`~ ;'~~~t`, '~1~:i7ANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION _ REV-1607 EX AFP C12-09) Po Box zao6ol ~, - ..S7d~'~~~NT OF ACCUUNT HARRISBURG PA 17128-0601 ~='_ ,, ~ P ~~~ ~~ DATE 07-06-2010 ~ ~~~~ ~U~- ~ ESTATE OF KEENER EVELYN E DATE OF DEATH 11-15-2000 ~~~~~ +~''i FILE NUMBER 21 O1 -0131 ~,1 sfi~' ~ {`'(~~l~ii COUNTY CUMBERLAND JAMES D FLOWER ~ ar~-~. `. '-`, ~~~` , ~~, ~`~ 1 ACN 101 SAIDIS ETAL ` Amount Remitted 26 W HIGH ST CARLISLE PA 17013 MAKE CHECK PA YABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE_ ~__ RETAIN LOWER PORTION FOR YOUR RECORDS _ -~ _ _ _ _ __ ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~ ~ * * * I NHER I TANCE TAX STATEMENT OF ACCOUNT ~* * * ~~ ~~~~~ ~~~ ~~ ~~ REV-1607 EX AFP C12-09) ESTATE OF:KEENER EVELYN E FILE N0.:21 01-0131 ACN: 101 DATE: 07-06-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: 31,946.35 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+~ AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 02-01.-2001 AA477955 1,592.90 30,265.01 04-16-2007 CD008027 .00 88.44 04-1b-2008 WRITEOFF .00 28.96 06-17-2010 CD012937 .00 14.48 i TOTAL TAX PAYMENT ~ 31,960.83 BALANCE OF TAX DUE 14.48CR INTEREST AND PEN. .00 TOTAL DUE I 14.48CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS.