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Home My WebLink About01-0155 PETITION FOR PROBATE and GRANT OF LETTERS Estate of f1+ lI.. / D HeR. J\J also known as No. To: 21-01-155 Register of Wills for the County of elL""'" h. Lr<...I A h d in the Commonwealth of Pennsylvania , Deceased. Social Security No. ~ ~ q ~ cJ.. g- - ~(~ '/ .~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of ~e or older an the execut R. I, in the last will of the above decedent, dated / ,( .i/l'" "- Ol.. G /9 q I and codicil(s) dated named , 19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (IU__i'Y"> b Juti t:+-nd County, P~~nsylvania, with hIS. last family or principal residence at .J. 13 '( 1? /+ h-k Ii -H '^- ~1 \..!.JtR./,.) J.~ I PI} I P, (~t:. i n ~ t ;.... --rtA-/CJ . ' , (list street, number and muncipality) D~enden!, then . . tp if , years of age, died-:r A h, .tl ~ , 19- '2 0 () l, at UR 12../ is. /,' 1-1 Co..; t? ,+fl ( Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: II/IA I Decendent 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 Pen~sy)vania situated as follows: Iv / J1. I I, 0 (') (). ("1(/ $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ---f..;...j, '-fA m IIJ_ n-r A.R. (..1 (testamentary; administration c. La.; administration d.b.n.c.La.) theron. f. ~ ;:! u ~2 u ..... 0:: v C -00 co;:: roo= u '?o... Ut.- ~ 0 51 Vi -)/'rl<t/-l.^j i}o-~ ^- '-N<..\/I.-'Y\.. d J .:s 'i J<..:-ty..~ '7:-, ~LU..: (~.1/l -;'j.~ l" ) F~, /? (I~ ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I s'" COUNTY OF CUMBERLAND f ~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the bes: of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and before me this 7 th FEBRUARY 7;VtJ///./ r;J~///",/ .-hn./ ~(' /- / / ... / / ' , / SUb. ~~~h. ~~. { '--7?7a'~r iJ {'?/\A J ~ /:IAJ1_~ . ~2001 ;l{/,J / / /:'l Register CI'} aQ' ~ t:l ..... ~ ~ ~ /t . ~(:)p- I / ~o. 21-01-155 Estate of PAUL D HORN , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW FEBRUARY 8 Xl<<) 2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated JUNE 26, 1997 described therein be admitted to probate and filed of record as the last will of PAUL D HORN TESTAMENTARY MARY JANE HORN and Letters are hereby granted to \, --, ./" \ ' - -- // /(/1//../(>' 'f(;<, / //. /j..?'Ij/ ,AA/ /' Ji)/.u'?:(',c- .' / -+/'/ I l\4ister of Wills FEES Probate, Letters, Etc. ......... Short Certificates( ).......... tteJ'J1Jtraiion ................ JCP $ $ $ $ 5.00 TOTAL _ $ 41.00 . . . f.E~RVARr . 7.,. )09.1. . . . . . . . . . . . . 18.00 3.00 15.00 ATTORNEY (Sup. Ct. l.D. No.) ADDRESS Filed PHONE 1" ;~ ro lcrrih rlUl tb: inform;Hi()!1 here given IS correctly (opic,t1 from ,in ungird Ll'nirlcl[(' 01 death du!\: fikd with me ;is " "!'11t..:' ')1.\'(1]'\1:11 i'~I.t'lfll,'r" willi1\: f~)rwarded (0 rill' \ [;ltl' ViLli Rl',ords ()tti~c fur f'un1.1I1l'1l1 rdln!:. ~), RCglStL1L '- t' ' ,,- . ,t... WARNING: It is illegal to duplicate this copy by photostat or photograph. '\( '. ilil~i~G~orp;}~~~.~ ,:~;I~~,/" . "--<!.1'J'-~~~ ;, ~/ . ',J---c.., .l <:::::i f ~." <'L, ~\ i~~~' .'~ 'p~\ i'~ ~", ~ia~ ~~\ \ ~ :\~'~r , ~. .'.- ;', ~,N ~ a..... "-....~d '-:' <';<) '.. .' ~ ,'i '- A/,- '. ... ~'r II, \~~*,.._~lMENi \\"- ~ ,,,// ....~~~:!O/~/lIJJJ;j!!.!.y ~---. 2 ~'~1)_..~~ ~ ~\ht-"'''~ "'~j It l\..ll IZl'~,isrr;lr '-'" I l'l' 1(' r [h i .' ~ c'rr i t ll,l (c' <'" () Ii p 504on5':" ! ,=,. ou \.5 IAN ~-, t "'" t:'" t) 20111 I ), Ii l' 21-01-155 ~'05 '43Ae\f 2/87 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS CERTIFICATE OF DEATH ~fNl AGE Il051 9"""'oy, UNDeR' YU-R Months Days UNOER 1 0.0.'1' Hours ~';tM 5T"1 E J'llf ~UM6ER --------..---.---------------- :~-;--~L~~;CUR:'4U~~R _ 8273 ---I~T; /;~~;M~~~O~:':'-;'I-'----- P!.XE ~ DEATH ,C~eck Of'Iy 0I'e - ..... ,n5!'U(:!oOOS on _ """'I HOSPITAL Inpatient ~ ERJQuto.atien' 0 7, ... FACILITY NAME (II nol ,nsNUltOf', gIVe srfee1 and numoen g'~'Y1 0 ENT NI( NAME OF OECEDEN,. (~lrSf Mlcdle, :..asl) Paul D. Horn 64 5, COUNTY OF DEATH KIND OF eUSINESS""'OUST RY WAS DECEDENT EVER IN U.S. ARMED FORCES? b. Yo. IZI No 0 PA RACE. .Amencan lnolan. Black. White. ~rc (Specify) 10. White SURVIVING SPOUSE (11 ""e. .~'\I'l! maeOerl name) ~ \ . lb. Cumber land DECEDENT'S USUAL OCCUPATION IGlve k~ of 'III'Ofk done CkJr"'9 most of 'fIllIOf'kH"g tit'e; de not use retired 1 . "0, ForEman ~rlisle Tire & Whe DECEO€NT'S "AII.ING ADORESS (SIree!, CilyfTown, SIOIO. Zip Code' DECEOENT'S ACTUAL RESIOENCE (See Inslrucll()n5 on olt'le, SIde) Ie, Car lisle Bora. 2134 Ritner Highway Carlisle, PA 17013 II, FATHER'S NAME (F.... M"'dlo La..) ". Jerry W. Horn INFORMANT'S NAME (T )'lleIPnnt) _. Ma Jane Horn METHOD ~ OtSPOSITION Bunol rn C,_hon 0 01_ (Specrlyl 17.. Slate 17b. Coun Cumberland Did dee_Ill liW in a township? """ '7d.o ::'..i,:-.'.::oI city",""" MOTHER'S NAME IFIrSl. Middle, Matden Surname) Martha G. Wickard PA 17013 2., M, 25. 27. PART J: Enter 1M diseases. inlurtes or compItcahons which caused the death. Do not enter the mode 01 dying. s list onfy one uuse on ..Ch tiN! 2te.Westminster Mem. Grds. 2td. Carlisle, PA 17013 NAME ANO ADORESS ~ FACILITY 22e.Ewing Brothers Funeral Hane, Carlisle, PA 17013 DATE SIGNED ,. ) r. (Momtl, Day, -, 23b. tV 3 I to 7 S'1 L 23c, I - '- ':, - u WAS CASE REFERREO TO MEDICAL EXAMINERiCORONER? Yeeo NoD-- a. A 11 ~ r IL-o r I ( L 4 T e:: (L A-L ~ ( LCfLoS " OUE TO (OR AS A CONSEOUENCE OF} I Approximate : interval befween I onMI and death I ~ PART II: Other stgniflcant eondiIions contributing to death, but flOC resulting in the unde11ying cause grv.n in PAAT I ! :: d. WERE AUTOPSY FINOlNGS AVAILABLE PRIOR TO COUPLETION OF CAUSE ~ DEATH? OUE TO (OR AS A CONSEOUENCE Of] OUE TO (OR AS A CONSEOUE NCE OF) "'ANNER OF DEATH _ Na""ol ~ OATE OF INJURY (Men"'. Day. Year) TIME OF INJURY INJURY AT WORK? OESCRIBE HOW INJURY OCCURRED Yes 0 ",,0 SutcM;e o o Pending InY8SltgatiOn o o o ~'CE OF INJURY. AI hOme, 'ar~,O:;e.t, factOf'y, orne. M. building. etc, ISpeclfvl 30., o NoD Could not be determIned 300. 3oa. LOCATION (5tr.... C'lylTown. Slalel . PRONOUNCING AND CERTIFYING PHYSICIAN CPtlYSICl3n oo,t". ;)IonovrlClng dealh and certlfVlng 10 cause 01 deal"l To Il'Ie M-at 0' my knowt.d~~. dealh occurred at 11'1. time, date, and place, and due to th. causeCs) and manner.. stated. 2", 2.b, CERTIFIER ,C'eck oniy onel .CERTIFYING PHYSICIAN (PhysICian CP.f11fytng cause 01 C:~afh wtIer anoU'ef DhVSIC.an has ptonOlJnceCl dealh anQ comOleled IIPrt'1 23) To the but 0'"'1 Icnowled94t, deltl'l oecurrecl due 10 Ihe cause(l) and manner.s s1a1ed. o 'MEDICAL EXAMINER/CORONER On the b..is ot examination andlor investigation, in my opinion, death occurred at the time. date, and place, and due to Ihe cause(s) and manne, IS s1ate<t.. . . . . . . .. .. ......,...... ...." ...........,.,....",..,......... . . . . . . . . . . . . . . . . . . . . . . . . . . . , J,.. REGISTRAR'SSIG"ATUREA"ON~~. r~~ ~ll~\IOI 32. DATE FILED (Monrfl. Day. 'f"eaf) ~. ('J~" ~I ~~tJ\ TI,..,,)4 ((.'L'-lN~ (A /'- L, <,LE: l+<.>5r I .. AL- o 21-01-155 11Iersl J!Iill ernb Q[eslermenl "~ ~> ~ ,,-' ~, .~ ~, 0- ~ ~ I, PAUL D. HORN, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish, and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my Executor hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my Executor need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. SECOND I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse, MARY JANE HORN, providing that she survives me by sixty (60) days. THIRD Should my spouse, MARY JANE HORN, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares to my children, STEPHEN P. HORN, STEPHANIE A. BLAIN, DA VID P. HORN, and MICHAEL P. HORN, who survive me by sixty (60) days, per stirpes. I direct my Executor to divide among such beneficiaries all personal property of a sentimental or family nature (excluding cash, stocks, bonds, and the like), including but not limited to jewelry, household goods, antiques, furniture and memorabilia, in accordance with a separate memorandum which I GRIFFIE Be ASSOCIATES ATTORNEYS AT LAW PAGE 1 of 4 14 NORTH MAIN STREET SU ITE 307 CHAMBERSBURG. PA 17201 200 NORTH HANOVER STREET CARLISLE. PA 17013 may place with my will or deposit with my attorney. In the absence of such disposition by memorandum, I direct that the said tangible personal property be divided between my residual beneficiaries with due regard for their personal preferences in as nearly equal shares as practical, with the value of such dispositions being credited to the share of each respective recipient. If said beneficiaries do not agrees to the division of the personal property provided for hereunder, the decision of my Executor, including the decision to sell the property at public or private sale and distribute the proceeds therefrom as provided hereinafter, shall be final and conclusive on all parties. FOURTH Any devise or distribution under this Last Will and Testament which is payable to any beneficiary who may be under twenty-one (21) years of age or, in the judgment of my Executor, mentally disabled, shall be held in a separate trust by the beneficiary's surviving parent as trustee until such beneficiary reaches twenty-one (21) years of age or during such period of disability. During the term of any trust created pursuant to this Paragraph, the Trustee is authorized to expend and apply so much of the net income and principal of each such trust as the Trustee shall consider advisable for the health, maintenance, support, and education (including college education, undergraduate and graduate) of each such beneficiary until he or she attains twenty-one (21) years of age, or until all such amounts are paid out of trust. I direct that no Guardian shall be required to give or post bond for the faithful performance of the Guardian's duties in this or any other jurisdiction. FIFTH I grant my Executor the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET SUITE 550 CHAMBERSBURG,PA 17201 200 NORTH HANOVER STREET CARLISLE, PA 17013 PAGE 2 of 4 <::::::"" ". ..," \ ~'-' R: \~ !~ ,~ '0 ~.. ~ '\:. ~ (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. ( e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her or its absolute discretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. U) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate, which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET SUITE 550 CHAMBERSBURG,PA 17201 PAGE 3 of 4 200 NORTH HANOVER STREET CARLISLE, PA 17013 I~ :0.. \\ .\~ !~ i~ ( '.J .~ i-~J ~ i~ -- I~ i~ I~ I I I I I SIXTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my Executor for the liability of such beneficiary. SEVENTH I nominate, constitute and appoint my spouse, MARY JANE HORN, as Executrix of this my Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute, and appoint my son, STEPHEN P. HORN, as Executor of this my Last Will and Testament. In the event that my son, STEPHEN P. HORN, is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my daughter, STEPHANIE A. BLAIN, as Executrix. I direct that my Executrix or Executors shall not be required to give or post bond for the faithful performance of his or her duties in this or any other jurisdiction. EIGHTH I hereby declare it to be my expressed desire that my Executor employ the law firm of GRIFFIE & ASSOCIATES, of Carlisle, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this .:( t l/t day of 9 L{fll!' _ , 1997. WITNESS: (1., . L .';' I J' l i i AJ fL. f( rit j/l..--i.... ..,t -'OJ I;u9 -IJ~j{fl,/;l( PAUL D. Hi) / --:') /J r/l.1UJ'r1' -:.l I ....~-Iz.. ..t.. If ..L'{,..~ GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET SUITE 550 CHAMBERSBURG,PA 17201 PAGE 4 of 4 200 NORTH HANOVER STREET CARLISLE, PA 17013 ACKNOWLEDGMENT COMMONWEAL TH OF PENNSYL VANIA SS COUNTY OF CUMBERLAND I, PAUL D. HORN, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. //") /)/ ~ J cut J !2 4c?'?;t-l PAUL D. HORN Sworn or affirmed and acknowledged before me, PAUL D. HORN, the Testator, this ;'! t I!J day of I/} !~/U? ~ , 1997. ;y ~ . ( : tA /l '-/!ktLeA-/ ~--_..----~---" Notarial Seal Leah A. Miller, Notary Public Carlisle Bora. Cumberland. ~?ynty My CommisSion Expires Apnl II, 2000 GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET SUITE 550 CHAMBERSBURG,PA 17201 200 NORTH HANOVER STREET CARLISLE, PA 17013 .J AFFIDA VIT COMMONWEAL TH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We, ('VI: { it~' I ! e r(l (,iA i\' '(~ (' 1, and '''''-;1 lib, r"\ J, {::e ') t, (,) r' f\--' the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and T estament~ that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed~ that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence, -. , I,. tJ (I.../,: .l.'..(.^,:, _ ,.1 f'i'I!'" {."j (t, E ..'-",-'- t. .'\ ) 4 ( , ..' /L-1 I} ~-( '1'-' , .i- ) {}Q '.AX- A ___ ,/ ... and Sworn or affirmed and subscribed before me by ) .r' .f') tJ.-1)/1 ,1. (~ \ r, '1 A f: if' Il ,YIU1L ~,.' , lr/i> i..v. lie -/;;; (!.i..lC'''!f?( , dt~ day of this , 1997, Jf1 ./. 1L' . '.-AA /I ~ /(Lt:~/~~ N" I. La~hA Mi' Carlisle Bora. My Commission 'Jublic County \1 il'!! 1 2000 GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET SUITE 550 CHAMBERSBURG,PA 17201 200 NORTH HANOVER STREET CARLISLE, PA 17013 ~ CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Paul D. Horn Date of Death: January 23, 2001 Will No. 2001-00155 TO THE REGISTER: Admin. No. 21-01-0155 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was mailed to the following beneficiaries of the above-captioned estate on May 16, 2001. NAME ADDRESS Mary Jane Horn 2134 Ritner Highway Carlisle, P A 17013 Notice has now been given to all personal entitled thereto under Rule 5.6(a) except: NONE DATE: sf; Ijb I rif; , squire ouns 0 ersonal Representative G FFIE & ASSOCIATES 200 North Hanover Street Carlisle, P A 17013 (717) 243-5551 (800) 347-5552 In Re: Estate of PAUL D. HORN Late of: DICKINSON TOWNSHIP ORPHAN'S COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA. NO. 21-01-0155 ORDER OF COURT AND NOW, this f.( ~Of ~ , 2001, upon consideration of Petitioner's Petition for Settlement of a Small Estate pursuant to 20 Pa.C.S.A. 93102, and it appearing that the estate is an insolvent estate, the distributions of the Estate of Paul D. Horn, are authorized and approved as set forth in the Petition. BY THE COURT, 1. In Re: Estate of PAUL D. HORN Late of: DICKINSON TOWNSHIP ORPHAN'S COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA. : NO. 21-01-0155 PETITION FOR SETTLEMENT OF A SMALL ESTATE PURSUANT TO 20 Pa.C.S.A. ~3102 TO THE HONORABLE JUDGES OF SAID COURT: The Petition of Mary Jane Horn, presented by and through her counsel of record, Bradley L. Griffie, Esquire, respectfully represents that: 1. Paul D. Horn, died on January 23, 2001, a resident of Dickinson Township, Cun1berland County, Pennsylvania. 2. Petitioner, whose address is 2134 Ritner Highway, Carlisle, Cumberland County, Pennsylvania, 17013, is the wife of the decedent. 3. Decedent left a Last Will and Testament dated June 26, 1997, a copy of which is Last Will and TestaInent is attached hereto and incorporated herein by reference as Exhibit "A," which was probated on February 8, 2001. 4. A Certificate of Grant of Letters was issued February 8, 2001, granting Letter Testamentary to Mary Jane Horn. No bond was required. 5. Decedent was survived by Petitioner, Decedent's wife who is entitled to receive Decedent's entire estate pursuant to his Last Will and Testament. 6. The property owned by the Decedent, individually, at the time of his death and the value thereof is as follows. PROPERTY VALUE Certificate of Deposit Account #: 31003911168176 $1,343.48 7. Decedent at the time of his death, was also entitled to receIve the following Individual Retirement Accounts (IRA): ACCOUNT VALUE IRA Account #: 35004200215299 $3,094.79 IRA Account #: 35004200307757 $2,826.40 8. No disbursements have been made from this Estate prior to the filing of this Petition. 9. The names of all claimants or creditors of whom Petitioner has knowledge and the amount admitted to be due to said creditors by Petitioner are: CREDITORS EXPENSE Ewing Brothers Funeral Home $3,613.32 Administration costs: Register of Wills Griffie & Associates 60.00 750.00 TOTAL $4,423.32 10. Petitioner has claimed a $3,500.00 family exemption to which she is entitled. 11. The Pennsylvania Inheritance Tax Return is being filed contemporaneously with this Petition, wherein it is claimed no tax is due from this insolvent estate. 12. Pursuant to 20 Pa.C.S. 93392, to date distribution has been made to pay only the administration costs hereinbefore set forth. 13. Following the payment of administration costs and fees, the balance of FIVE HUNDRED THIRTY-THREE and 45/100 ($533.45) DOLLARS will remain for distribution to creditors. 14. Petitioner will pay the outstanding debt due and owing to Ewing Brothers Funeral Home from her personal funds. 15. Pursuant to 20 Pa.C.S. 93392, Petitioner seeks authorization for the release of the remaining balance in the estate account to Ewing Brothers Funeral Home for partial payment of Decedent's funeral and burial expenses. WHEREFORE, Petitioner requests your Honorable Court to authorize and approved distribution of Descendant's Estate to the payment of costs of Administration as previously paid by Petitioner and distribution of the balance of the estate provide to Ewing Brothers Funeral Home. Iffie, squire or the Estate of Paul D. Horn IE & ASSOCIATES 200 North Hanover Street Carlisle, P A 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsifications to authorities. DATE: )l/tzL!\A ~ odt--1'VC -JJo- UV'- MARY JAN H , ExecutrIx 21-01-155 1[a5t lll1Iill ann ([t5ta~nt .~ N..~ ~) ~ r; ""~ " ~ ~ r, PA UL D. HORiV, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish, and declare this to be my Last Will and Testament, hereby revoking and making void all previous \Viils and Codicils heretofore made by me. FIRST r order and direct my Executor hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my Executor need not accelerate and pay those unmatured obligations whic~ in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. SECOND r give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse, J-L4RY JA1VE HORN, providing that she survives me by sixty (60) days. THIRD Should my spouse. il-IARY JAN"E HOR.N, predecease me or die on or before the sixtieth (60t.~) day following my death. then I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares to my children, STEPHE1V P. HORiV, STEPHA1VIE A. BL4liV, DA VID P. HORJV, and JIICHAEL P HORN, who survive me by sixty (60) days, per stIrpes. I direct my Executor to divide among such beneficiaries all personal property of a sentimental or family nature (excluding cash, stocks, bonds, and the like), including but not limited to jewelry, household goods, antiques, furniture and memorabilia, in accordance with a separate memorandum v. hich I GRIFFIE & ASSOCIATES AITORNEYS AT LAW ZOO NORTH HANOVER STREET CARLISLE. PA 17013 14 NORTH ~AIN ST.:;::::T SU ITE 307 PAGE 1 of 4 CHAM8ERSBURG, PA ~7201 Exhibit "A" may place with my will or deposit with my attorney. In the absence of such disposition by memorandum, I direct that the said tangible personal property be divided between my residual beneficiaries with due regard for their personal preferences in as nearly equal shares as practical, with the value of such dispositions being credited to the share of each respective recipient. If said beneficiaries do not agrees to the division of the personal property provided for hereunder, the decision of my Executor, including the decision to sell the property at public or private sale and distribute the proceeds therefrom as provided hereinafter, shall be final and conclusive on all parties. FOURTH Any devise or distribution under this Last Will and Testament which is payable to any beneficiary who may be under twenty-one (21) years of age or, in the judgment of my Executor, mentally disabled, shall be held in a separate trust by the beneficiary's surviving parent as truste~ until such beneficiary reaches twenty-one (21) years of age or during such period of disability. During the term of any trust created pursuant to this Paragrap~ the Trustee is authorized to expend and apply so much of the net income and principal of each such trust as the Trustee shall consider advisable for the hea1t~ maintenance, support, and education (including college education, undergraduate and graduate) of each such beneficiary until he or she attains twenty-one (21) years of age, or until all such amounts are paid out of trust. I direct that no Guardian shall be required to give or post bond for the faithful performance of the Guardian's duties in this or any other jurisdiction. FIFTH I grant my Executor the following powers in addition to and not in limitation of such powers as my personal representati'/e shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan~ to delegate authority with respect thereto~ to deposit investments under agreements and pay assessments~ and generally to exercise all rights of investors, including but not limited to, the voting of shares. GRIFFIE & ASSOCIATES ATTORNEYS AT L~W 14 NOR,H MAIN STRE:::T SUITE 550 CHAMBERSBURG. PA 1720 I 200 NORTH HANOVER STREET CARLISLE. PA 17013 PAGE 2 of 4 ~ '" , ~- r'... i'.. ~ .~ "-J I~ ," I~ "'-.:. I I (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her or its absolute discretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as secunty. (h) To compromise claims without approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. (j) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate, which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this. my Last \\fill and Testament. GRIFFIE & ASSOCIATES A.TTORNEYS AT LAW 14 NORTH "'AIN STREET SU ITE SSO CHAM8ERSBURG, PA 17201 PAGE 3 of 4 200 ,'<ORTH HANOVER STREET CARLISLE. PA 17013 ~ I\: --.} ~ I'" SIXTH No interest of any beneficiary of my estate, either in income or in principal, shaIl be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject In any manner while in the possession of my Executor for the liability of such beneficiary. SEVENTH I nominate, constitute and appoint my spouse, i\1ARY JANE HORN, as Executrix of this my Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or shall cease to serve for any r~ason whatsoever, then I nominate, constitute, and appoint my son, STEPHEiV P. HORN, as Executor of this my Last Will and Testament. In the event that my son, STEPHEN P. HORN, is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my daughter, STEPHANIE A. BL4IN, as Executrix. I direct that my Executrix or Executors shall not be required to give or post bond for the faithful performance of his or her duties in this or any other jurisdiction. EIGHTH I hereby declare it to be my expressed desire that my Executor employ the law firm of GRIFFIE & ASSOCL4 TES, of Carlisle, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this Instrument, the administration of my estate, and the execution of the powers herein mentioned. Testament this rN WITNESS \VHEREOF, I have hereunto set my hand to this my Last Will and eX & M day of. (] tuze _ ~ , 1997. WITI\fESS: t~ ') .."' . j' L I f' t . ILLf . J!. 7 y( , ~ i - /- I. .i ' r- :;t . f ..~, ../" ~ r . " / tj ".;' 4. / //X J/' )h-4?;?/ PAUL D. HO 'v /,--'j 1 '- ~ /1 1/ U}. '-t-. J / / J7~~!r~t'C "- GRIFFIE Be ASSOCIATES ATTORNEYS AT LAW I <1 NORTH MAIN STREET SUITE 550 CHAMBERSBURG, PA 17201 PAGE 4 of 4 200 NORTH HANOVER STREET CARLISLE, PA 17013 r A CKNO WLEDG1\1ENT CONfM:ONWEAL TH OF PEt-iNSYL V Al'fIA 5S COlJNIY OF CtftvfBERLAl"\TD I, PA UL D. HORlV, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last \,\,fill and T estament~ that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ()/o (~ / czuX t) W~ PAUL D. HORN ' Sworn or affirmed and acknowledged before me, PAUL D. HORN, the Testator. this eX ~ I!J day of 9 !~/2k: _ , 1997. {;{u.-A /I yYZ; /LA L = Notanal Seai LeanA. Miller. Notary Puolic Carlisle 3oro. Cumberland C'?u~ty tl/1y Comr;"SSiOr. Exo!res Apnl 1 .' . dJOO GRIFFIE & ASSOCIATES ATTORNEYS AT I..AW t 4 NORTH MAIN STREET SUITE SSO CHAMBERS8URG,PA 17201 200 NORTH HANOVER STREET CARLISLE. PA 17013 AFFIDA V1T COM1v10NV/EAL TH OF PENNSYL V Al'\fI A ss COUNTY OF CUNffiERLAi"ID We, I" 'I I Y1 : .. h,> ! .' ;.) f( (J I \'-;P r +- and ~lJ0/-(1 .II (:'CJtl.Jr'^-' the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that he signed v"ilIingiy and that he executed it as his free and voluntary act for the purposes therein expressed~ that each subscribing witness in the hearing and sight of the Testator sig~1ed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. "'" ~ [ l Ii f V II f .J J fJ ~ i' ,f , Cc._Li....~~ t- .-j f I. r" . /.0 I) ,4<-~_) ~ "~" - ,.../ and Sworn or affirmed and subscribed before me by ~ r' , M ~(llrl T. t., f"J "') A /l r It this ()IL~ - Y 1/- 'I /: I J I it ^~)IC --;:; / CL-f '- .~rc- , ~t~ day of , 1997. x~ /l '/?Zi-~~L~ / Nc Lash A. M:;' Carlisie 3ora. My CommisSIon ':IDIIC C:C''':~t'1 "J;(i! l' 2000 GRIFFIE & ASSOCIATES ATTORNEYS AT L.AW 14 NORTH MAIN STREET SUITE 550 CHAM8ERS8URG,PA 17201 200 NORTH HANOVER STREET CARLISLE, PA 17013 '<~I-\5OClEJ\';'''''lC\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W a w u w a DECEDENTS NAME I,LAST. F!RST, AND MIDDLE INITIAL) HORN, PAUL D. DATE OF OE.e..Tn IMM-DO.vEAR) /6-0.J6f?- / J REV-1500 ,/ OF=lCl-1L uS:: 0NL Y FILE NUMBER -.L ..L - _L.L COUNTY CODE yEAR o 1 5 5 -_E.~--- i SOCIAL SECURITY NUMBER 209 - 28 8273 I THIS RETURN MUST BE ClLED IN OUPUCATE WITH THE REGISTER OF WILLS SOCiAL SECURITY NUMBE.R ! DATE OF BIRT>i (MM-DD.YEAR) 01/23/01 07/12/36 (.IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE iNITIAL) w >- ::c:Scn u """ w"-u ,,00 uO:-' "-,,, "- " Horn, Mar Jane XJ 1. Ongmal Return o 4, limited Estate LJ 6.. Decedent Died Testate iAItacll CODyofWi11J c--, U 9. Litigation P~oceeds Received [J 2. Supplemental Return n 4a. F'Jture Interest Compromise ili3\e oj '1eaVt aiter j'FH2) '-' [] 7 Decedent Maintained a Uving Trust ,Attaen cony ot Trustl n 10. Spousal Poverty Credit (caleotdeatlloll'dlln !2..Jl.glvul1-1-95l 03. Remainder Rewm ',::ale::i:eattlcnor::: '2..13--'~: o 5. Federal Estate Tax Rerum ReGuirec 8.. Total Number Jr Safe Deposil Soxes o 11.. 8ection to tax. under Sec. 9113(A) ,~3c'I':;-. .-nilaSECn<iIllIlUUIIE~J\tL:CO~ROfiD~_ _ ~ NAME COMPLETE MAILING ADDRESS >- z W Q Z o Q. '" W a: 0: o u z o < -J ;:) l- ii: < u w c:: z o < I- ;:) a. ::E o u >< ~ FIRM NAME {If ApoiicaOle) GRIFFIE & ASSOCIATED TELEPHONE NUMBER (717) 243-5551 1. Real Estate (Schedule A) 2, SlocKS and Bonds (Schedule B) 3, Closely Held CO!1)OCatian, Pattnel'Ship or So\e-.Pro~jp 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, BanK Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Scheduie F) o Separate Billing Requested 7. Inter.V'lVos Transhn & Miscellaneous Non.probate Property (Scheduie G or l) 8, Total Gross AssetS (10131 Lines 1-7) 9. Funeral Expenses & Administrative Costs (SChedule H) 10. Debts of Oecedent. Mortgage Uabilmes. & Liens (Schedule I) 11. Total Oeductions (Iotal Lines 9 & 10) 12. Net Value of Estate (line 8 minus Line 11) 200 Nortb Hanover Street Carlisle, PA 17013 (1) (2) (3) (4) (5) OFFICIAL USE ONLY 0.00 0.00 0.00 0.00 1 , 141 4R (6) 0.00 (7) c; I Q? 1 1 Q (8) 7r?F.~ (,7 (9) (10) 7.923.32 0.00 (11) 7rG?i .,,? 112) ( -) A oR Ao ill) 0.00 (14) ( -) 6';8.65 13. Charitable and GQvemmental SequeslSi'Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCASLE RATES lS. Amount of Line 14 taxable at ltle spousal tax r'le, or transfe" under See, 9116 (.)(1.2) ( -) ~'i.R ~c; 16. Amount of Line 14 taxable at lineal rate 17 Amount of Line 14 taxable at Sibling rate 18. Amount of line 14 taxable at collateral rate 19, Tax Cue o no , .0 !lJl.. (15) ,0_ (16) x 12 (17) x .15 (18) (19) 0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 ~~;?~,%j,.i~~.c' - . '-?''l'~S~~~'-\L.'''QO~~. .~,~}fAnf~',!.~"J!I~;"-~ Decedent's Complete Address: STREET ADDRESS ? 1 11. 0" u, ~".'^.. CITY I STATE I Z:? Carlisle PA 17013 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. PMor Payments C. Discount (1) 0.00 0.00 n on 9.99 Total Credits (A + 8 + C) (2) 0.00 3. InteresUPenalty if applicable D.lnterest E. Penalty (3) 0.00 (4) g.Qg (5) 0.00 (SA) 0 00 (58) 0 00 o 00 n on 1 TotallnteresUPenalty ( D + E ) If Line 2 IS greater tIlan Line 1 + Line 3, enter Ihe difference. This IS the OVERPAYMENT. Check box on Page 1 Line 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 tile total of Line 5 + SA. This is the 8ALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT - ~ ~ ~,___~___ ~ ~ __"" ~-.. -. -. ~",-:-~__,---' -'_ -c---:;.. ~'-;' - -_~ .- - --~. - -- . - - - - ~. - ,-- ~~:!" PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN OX" IN THE APPROPRIATE BLOCKS, ,. Did decedent make a transfer and: Yes a. retain the use or income of tile property transferred;..................................................................................,....... 0 b. retain tile nght to designate who shall use tile property transferred or its income; ............................................ 0 C. retain a reversionary interest. or...._..................................................................................................................... IT d. receive tile promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ,... ............................................................. ...........u................................ 0 3. Did decedent own an 'in trust for' or payable upon death bank account or secunty at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a benenClary deSignation? ........................................................................................................................ 6ll No IX] IX] IX] IX] iXJ [XJ [J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. jnl18!' penalties oi PerJury. ! declare that I na...e exammed thIS return. ,nduding accomoanYlng scneaules and statementS. and to the best of my lUlowledge ~ tleIief. it is :rue. .:olTeCt arc:;omple(e. Jec:aration of oreoarer other :han the ~nal recresentan...e IS ~ased on aU information of which oreparer"as aMY knowleage. SIGNATLRE OF PERSON RESPONSI8LE FOR FiLING RETURN ~1A..if::: (J/)"'AJ'-"~ M::lrv .Tanp Horn ADDRESS (J''''--- 2134 Ritner Highway, Carlisle, PA 17013 SiGNAT REP THAN RE ESENTATiVE 8radle L. Griffie Es uire DATE I ( C. IY OJ DATE t..lr8(6l rth Hanover Street, Carlisle. PA 17013 -f~- .lJ .-- _ .-..~ i:5.--~ki. ~ '7_"" For dates of death on or ,fter July 1, 1994 ,nd before January " 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surJiving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or ,fter January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is O~, [72 P.S. 99116 (a) (1.1) (ii)). The statute does not ~xemot a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax re1J.:m are still applicable even if &Ie surviving spouse is the only benetidary. For dates of death on or ,fter Juiy 1, 2000: The tax rate imposed on the net value of transfers from a deceased cnild twenty.one years of age or younger atjeath to or for the use of a naturai parent an adoptive parent or, stepparent of the child is 0% [72 PS. 99116Ia)(1.21j. The tax rate imposed on the net value of transfers to or 'or the use of the decedents lineal beneficianes IS 4.5%, eX!:ept as nOled in 72 ?S. 99116(1.2! [72 PS. 99118(a)(1)]. r:,e tax rate imposed on the net value of transfers 10 or for the use of the decedents siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined. under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ;u:v.'9JJex.ll~ '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAliH OF P'ENNSYLVANIA INH5m"AIlCE TAX ,'lETlJRN RESlDE.'Il" DEC""<DE.'Il" eSTATE OF Paul D. Horn F1l.E HUMBER 21-01-0155 Indude !!te procoeds of rltigation and !!te date !!te procoeds weB receiYed by 1IIe estne. AU propetly joi~ willi tile ,;gilt of SlIrvivorsl1ip _be _ on ~Io F, ITEM VALUEATDA,,,, NUMBS" DESCRIPTION OF CE~ TH 1. Certificate of Deposit Account * 31003911168176 M & T Bank $1,343.48 TOTAL (Also erneron lineS, Recapitulation) $ 1,343.48 (If more SDace is needed, insert additional sheets of the same SIze) REV. ISle EX+- (2.an c>.'&.v 'fJ~j;'~ COMMONWEAlTH OF iJENNSY\."IANIA INHERrTANC! TAX A:ETURflt IitESIDENT DECEDENT SCHEDULE G TRANSFERS PLEASE PRINT OR TYPE ESTAU OF FILE NUMBER Paul D. Htlrn 21-01-0155 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OFTHE COVCR SHm 15 YES. ITEM I DESCRIPTION OF PROPERTY I TOTAL VALUE DeCO. DOlLAR VALue NUMBER Include name of ~he ~ransferH, their relationship to dK&dent, date of transfer. eXCLUSION OF ASSET l:t'r. OF ,~~~~T'S 1. IRA Account # 35004200215299 M & T Bank 3,094.79 1007. 3,094.79 2. IRA Account# 35004200307757 2,826.40 1007. 2,826.40 TOTAL tAlso ~ter en line 7, Raeopitulatian) \ S 5 , 9 21 . 19 (If more space is nHded, insert additional sn..fs of same size.) RfY.151IEX.(H7] '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOENT DECEDENT ESTATE OF Paul D. Horn FILE NUMBER 'l-Ol-0155 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home 3,613.32 8. ADMINISTRATIVE COSTS: 1- Personal Representative's CommissiOns - Name of Pe""nal Representa1iVe (s) SOdal Security Number(sj I EIN Number of Pe""naI Representa1ive(s) Street Add,",s City SIa1e Zip Year(s) CommISSion Paid: 2. Attomey Fees Griffie & Associates 750.00 3- Family Exemption: (If decedents address is not ttJe same as claimants, attach explanation) 3,500.00 C:aimant Marv lane Hor.n Street Address 2114 Ri t"ner Hi ~hw.'=ly City r.l:lrl; c: 1 P State PA Zip 1 (('\1 ~ Relationship of Claimant to Decedent !':pt'll1<:P 4. Probate Fees 60.00 5. Accountants Fees 6. Tax Retum ?reparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) S 7,923.32 (If more space is needed, insert additional sheets of the same size) . lE\I.l!13ex.{'-87} *' SCHEDULE J . BENEFICIARIES COf.tMONWEALTH OF PENNSYlVANIA INHERITANCE TJo!1. RETURN RIO IIl€NT OECEIl€NT ESTATE OF Paul D. Horn FILE NUMBER 21-01-0155 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECE[VING PROPERTY Do Not Ust Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (indude outright spousal distributions) 1. Mary Jane Horn 2134 Ritner Highway, Carlisle, PA 17013 Wife 100% ENTER DOlLAR AMOUNTS FOR DISTRIBUT[ONS SHOWN ABOVE ON UNES 15 THROUGH 17, AS APPROPRIATE. ON REV 1500 COVER SHEET U. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX [S NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS. 1. TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $ (n more space is needed, insert additional sheets of the same size) ,/ t - ,/{"~s 1/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT _~80601 HAP;c.(SBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX BRADLEY L GRIFFIE ESQ GRIFFIE & ASSOCIATES 200 N HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-23-2001 HORN 01-23-2001 21 01-0155 CUMBERLAND 101 REY-1547 EX AFP (12-00) PAUL D Amount Remitted 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-V = 1 s4-j-Ex--AFP--f 12-:0 (ir-NO,.-icE--OF--Z-NHEifiTANCE-,.-A" i-A-PPRA-isEi.fENT-,--ALi-OWAtfcE-'(fi----------- -- -- -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HORN PAUL D FILE NO. 21 01-0155 ACN 101 DATE 07-23-2001 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. 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) (S) (6) (7) .00 .00 .00 .00 1,343.48 .00 5,921.19 (8) 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) 5,766.80 .00 (11) (12) (13) (14) NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal rate (IS) 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: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 7,264.67 1).766 80 1,497.87 .00 1,497.87 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. 1,497.87 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = (19)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * 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.) 91'i ~. - STATUS REPORT UNDER RULE 6.12 /) C Name of Decedent: Paul D. Horn Date of Death: January 23, 2001 Will No. 2001-00155 Admin. No. 21-01-0155 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 X 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 X b. The separate Orphans' Court No. (if any) for the personal representatives account is: c. Did the personal representative state an account informally to the parties in interest? Yes X 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. See copy of Petition for Settlement of a Small Estate and related Order entered June 21, 2001, filed of record. Date: I i 7()f!O , e, Es e for personal- epresentative GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, P A 17013 (717) 243-5551 (800) 347-5552