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Home My WebLink About01-0309 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS ;)..1 -D/- 3D q Estate of Naomi c. Morgret also known as No. , Deceased Social Security No. 180-05-3529 Carroll A. Mor~ret, Jr. Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [R] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 11/27/91 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executQr, 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: o B. Grant of Letters of Administration (c.I.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 res.idence at-.JI0 South Rupp Ave., Shiremanstown Borough (list street, number, and municipality) Decedent,then~yearsofage,died 03/13~01.at Holy Spirit Hospital, Camp Hill, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 3,000.00 $ $ $ $ 120,000.00 situated as follows: 10 S. Rupp Ave., Shiremanstown Borough, Cumberland County, PA 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: Si nature Carroll A. 2165 Count T ed or rinted name and residence Morgret, Jr. Line Road, York S rin s, PA 17372 ~~r~!t:;~nia Bar Association CoPyri9ht (c) 1996 form software only CPSystems, Inc. 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. C~ d mJ1<-./ i? Carroll A. Morgret, . I' ,_ Sworn to or affirmed and subscribed before me this 21S11ayof MARCH 21-2001-309 Estate of Naomi C. Morgret Deceased Social Security No: 180 - 05 - 3529 Date of Death: 03/13/01 AND NOW, MARCH 21st 2001 ,X~in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary D Of Administration (c.I.a.; d.b.n.c.l.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Carroll A. Morgret, Jr. in the above estate and that the instrument{s) dated 11/27/91 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . $ 235.00 Short Certificate{s).( 5 ) $ 15.00 Renunciation. $ Affidavits ( $ 1.0. No: 29078 The Wiley Group Extra Pages ( 5 ) . $ 'is .00 Address: One S. Baltimore St. Codicil. $ Dillsburg, PA 1019 JCP Fee. . . . . . . . . $ 5.00 Telephone: 717/432-9666 Inventory. $ Other $ TOTAL. $ 261.00 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) ';~0:;('is to certifY that the information here given is correctly copied from an original certificate of death dul~ filed with I I R . t r The original certificate will be forwarded .to the State Vital..Records Office for permanent fi1lllg. "9ca .egls ra . . , WARNING: It is illegal to duplicate this copy by photostat or photograph. L~'f'.O:;5n<; Fee for rhis certificare, $2.00 p 7234238 No. 21-2001-309 H\05..l4JAIN,2117 me as ~M~-" f~4 &ff1 Local Regisrrar 1J{~/~ ~LlY/ are COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPliPAINT IN PERMANENT BLACK INK HAWE OF DECEDENT (F"Sf. Middle, Las) .. AGE (tail BIf1r\Gay) UNDER 1 YEAR MoNhI Oars SEX Female .. STAtE ~u NUMBER SOCIAL SECURITY NUMOSR .. 180 _ _ DAll1am"fT.'2bb'f" .. 83 v<s. BIRTHPlACE {Coty.,-.o PLACE OF DERH fCt>edo Of\ly t)l"e.- .... 'J'laltUCloOfOS Qf'llJlhel soo.l 3IaIoOlfCl8lQflCOlJI"JUYJ HOSPITAL' Enola, Pennsylvania ,__ ~ ,. FACIlJTY NAME (II noIlflS1<fUllon. w.... SI'_ ~nurntlerl Holy Spirit Hospital =",,0 COUNT"/' OF OERH Cumberland Ie. DECEDENT'S USUAl UMlON (Giwo Iund alwork done dur~ R10lIf oI~1t6memal(e1) It 11.. DECEDENT'S MMJNG AOORESS (SIr_. CIfyIlOwwn. SIMe. Zlpcoo., 10 South Rupp Ave Shiremanstown, Pa. 17011 RACE . ""'-"can kIdiiIrt. SIiIdr., WtwI.. Me 1_' White 10. MARITAL STATuS. Manwd Ne~"""_~, ~ SURVIVING SPOUSE \.......gn.oemaGen~ '0. FRHER'S NAME lFif.. MoCkIe. L.iSl) , - 1Nf00000000'S NAME (T_inoI Ralph Sadler Carroll A. Morgret Jr. "" - ......... ~1 17..~ :;"-:::-:::01 ""'"E".SN.......,............_....__. Mabel Foltz '00 1Nf00000ANT'S:rnm' emrffY"'I:ri1'i:,'1<<:ia"Cl'V8~prings. Pa. 17372 _. PlACE OF OISPOSrrMlH........ ClfCemet..-y, e,emaIDfy lOCAl'ION _ CiIy/1:Iwn. Stau.. Zip CodIi ..""*..... SI. John's Cemetery Camp Hill, Pennsylvania 17011 o "' '" " ., ~ . 21C. AertIOQIlfom Stal. 0 UCENSE NUMBER FD-012662-L 1"1.d _. lME OF DEATH DATE PAONQVNCED DEAD (Month. Day, Yearl ... 1~:3> ..... 3/,3!2.PI>/ n. PART f: Ellter lhe di....... injuries or comphcahona which caused the o.alh. 00 not ant_1M modIo 01 dying, SOCII &s cardiac 01 f.spjr~IOt)' afuil~. snoctl D( heart faiklre llSl onIy~ caUM on eawliM " /h'1p<:~/"do.1 ,.t'rl""~r.(?,, Iv:,}::. OUElDfORASACONSEOUENCEOf): . . ~'1I!7C''''-''t',.. ( '" ("~"t: .yUI-- DUE 1O(OR AS A CONSeOUENCE Of) c",. ,...,..,-~ "n.",,"P$C' L'q,.",,..:., 00___ DUE 10<<00 AS A CONSEOUENCE Of): -\ I . . WERE AU1OP'SY FINDINGS A\WlA8le PRIOR 10 COMPlETION OF CAUSE OFDERH7 Hom-'CidtI MANNER OF OEATH DATE OF INJURY (Marm, Day. 'Mar) D< o o .... Shiremanstown - 216:1. .... PART II: 0IheI1igniIII:...condMioMconuIbl.Aing1Oduth.W nDI"suIlingiftlhe~~peninPNnI. :,..."".-11' , :~/4'-J> ! TIME OF INJURY INJURY R WORK' DESCRIBE HON INJURY OCCURAE:O. Aco:odont Pendrng In,,.sligatiOn o o o PlACE Of INJURY. At hom.. tarm, saJ",Iac:tory. offic. Y. budding. etC. ISpecoty) :too. lOCATtQH (Ser_. CCyITowwn, SIal., ........ NoD< Vn 0 NoD< SWcidll Could nol be determmed 2". 21b. CERTWtEA ICheck Olll., orwl .CERTlFYtNG PHYSICIAN !PhY5lCoatl cefllfylOQ cause d de;Mh 'MIen .1flottle, phVSIC<<U1 hdS pl'OI1Oltnced dtldlfl dnu comPl~>/ed "em 2J) To"'''''o'",,, knowleclg..U.lhOC::cUfI'lIdduetolhec:.usel.l.ndmanne'......led. .............,.. zo. ~ :il :rl o l'; ~ . Z 'PROf<<)UHCIHG AND CERTlfYWG PHY$lCIAN iPhysoan boltl ;.uOllOUf\Cll1Qlle-oilh ,Iud t.:e.I,IYIf1g IOCdUSO\! 01 ded."l Ta "'0..1 01 my knawtedg., dealh occurred 11 11M lime, O&le, ilnd piKe, .ndduelO ahe c:au..,s) and menne,.. ,.allld "MEDICAL EXAMINER/COAONER On It\e bai,l. 01.:II8",ln.llon Indlo, invesligalion. in my opinion. dllath OCcurred al the lima, date, and place, and dUll 10 Ihe cause(s) and m&nne, II '.Ited.. ,... ..... ..."..,...., )1.. AEGIST . /' J.:.&2. 44---- bi'~!.lJ ..... 0 NoD "A R s::...h-... / ~ J.. 0 C) / . , LAST WILL AND TESTAMENT OF NAOMI C. MORGRET I, NAOMI C. MORGRET, of the Borough of Shiremanstown, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the paYment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my three (3) children, to wit, JUDY A. SHAFER, MARSHA B. FETTEROLF and CARROLL A. MORGRET, JR., ahare and share alike, per stirpes. LASTLY, I nominate, constitute and appoint my son, CARROLL A. MORGRET, JR., Executor of this my Last Will and Testament, and direct that he be excused from posting bond or other security for the faithful performance of his duties. -1- #I' , , IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 7 day of November, A. D., 1991. J1~:/}.'>n~ Naomi C. Mo ret (SEAL) Signed, sealed, published and deolared by the above named, NAOMI C. MORGRET, as and for her Last Will and Testament, in the presenoe of us, who have subsoribed our names hereto as witnesses, at the request of said testatrix, in her presenoe and in the presence of each other. ~ ~ .~ 'd~ ' L.U ~ ~ .'7{... -r.LL/2/.. t.. ... -2- ,. " COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, NAOMI C. MORGRET , the testatrix 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 volun- tary act and deed, for the purposes therein contained. Sworn and affirmed ~o and acknowledged before mJ.~ ~71~ NAOMI C. MORGRET , the testat rix , this _ l day of November , A. D. , 1991. ;1/ Q'[A~l/~ I !I J jav I [;~~ SS. _ __.--.---:-----t ~... : "'1". _ " COMMONWEALTH OF PENNSYLVANIA 1 , 1 _.J : ::~S ,..,'" L" COUNTY OF CUMBERLAND ) MC\i\tcr, We, the undersigned, J. ROBERT STAUFFER and RUTH ANN FULWIDER , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified accordin~ to law, depose and say that we were present and saw the testat r X , NAOMI C. MORGRET , sign and exe- cute the instrument aslbtl/her Last Will and Testament; that the said test at rix, NAOMI C. MORGRET , executed it as lDtI/her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testat rix , signed the Will as witnesses; and that to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. / Sworn and sU~~r~ed to befor me this .1 / day of November 1991. ,f /r!c~~l~i~. (j A~ ~i / Mecl;~;~<:~ .~: r.;.y CC,T'~,,': ~;'cx. McmtGf, Pc:.: "1 '\ " I ~y " _.:....~- ___.J (.'.;' ;'~(:;:.:.;t:s . REV-15eO EX. (6-00) COMMONWEA~TH OF PENNSY~VANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17126-0601 DECE- DENT CHECK APPRO- PRIATe B~OCKS COR- RE- SPON DENT RECA- PITULA- TION TAX COMPU- TATION It> ~ J.i1-1 s'l: c- OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMaEA 21 COUNTY CODE 01 0309 NUMBER YEAR DECEDENrs NAME (~ST, FIRST, AND MIDD~E INIT1A~) SOCIA~ SECURITY NUMBER Nacmi C. DATE OF DEATH (MM-DD-YEAR) 03 21 01 10 20 1917 (IF APPUCAB~E) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDD~E INITIA~) 180-05-3529 THIS RETURN MUST BE FI~D IN DUPLICATE WITH THE REGISTER OF WIUS SOCIA~ SECURITY NUMBER ~ 1. Original Return 4. Umlted Estate 6. Olllctldent Died Ttlsta.te (Attach copy of WIll) 9. L1tigatlon Proceeds Received ~ 2. SUpplemenlal Return 48. Future Interest Compromise (dat. of death aft.r 12-12-82) 7. Deeedent Maintained a living Trust Attach' copy of Trust "10. ~pousal Poverty Cr.di~ (dat. of death between 12-31-81 and 1-1-$15) 3. Remainder Return 8 (date 01 death prior 1012-13-62) 5. Federal Estale Tax Return Required o 8. Tolal Number 01 Safe Deposn Boxes 011. ElectlontotaxundllrSec,9113(Aj (Attach Son. 0) lIM. . NAME David J. I.enox FIRM NAME (If Applicable) wil I.enox eol TE~EPHONE NUMBER 717-432-9666 & Marzzaoco P.C. 1. Real Estate (Schedule A) (1) 2. Slocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, PartnerShip or SOle-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cesh, Bank Depon & Miscellaneous Personal Property (Schedule E) (5) 6. Jolntiv Owned Property (Schedule F) o Separate Billing Requested (8) 130,394-.51 None None None OFFICIA~ USE ON~Y 75,993.04 156,260.09 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or ~) (7) None (8) 52,581.59 338.84 (11) (12) (13) 362,647.64 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administrative Cests (5cho"'o H) (9) 10. Oebta of Decedent, Mortgage Liabilities, &Liens{Schedulel){10) 11. Total Deductions (Iolal Unes 9 & 10) 12. Net Value 01 Estate (Une 8 minus Une 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to taX has not been made (Schedule J) 14. Net Value Sub actio Tax (Une 12 minus Une 13 52,920.43 309,727.21 None (14) 309 727.21 SEE INSTRUCTIONS ON PAGE 2 FOR APP~ICABl.E RATeS 15. Amount of Une14taxable atthe spousal tax rate, or transfers under See. 9116 (a)(1.2) )l, .0 (15) 18. Amount of Line 14taxablut lineal ratll 309,727.21 X.O 45 (16) 17. AmountofU"e 14taxablutsibllng rate 0.00 X .12 (17) 18. Amount of Line 14taxableat collateraJratll 0.00 X .15 (18) 19. Tax Due (1e) 20. 0 11:$~{IllW$)!tj)~;Q<<'i'i*mjj,~i\~ijl!itlt'iIJ~ll'll<<H1H 13,937.72 0.00 0.00 13,937.72 WHt1mMwt.\~&tNMtMEfhWf{@MMjitii~llta(~\iU!J~illij(..fii.~_=e.f~m:t~ie.P.~i\_~iM~@n~~~?:~~Ml@mMiMg1RMM%&iMd o PA 15001 NTF 29755 Copyright 2000 Grllatland/NeJco LP- F=orms Software Only ~ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Naomi C. Morgret Date of Death: March 13, 2001 Estate Number: 21-01-0309 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 April 12, 2001: ~ Marsha B. Fetterolf Judy A. Shafer Carroll A. Morgret, Jr. Address 6931 Chambers Hill Rd., Harrisburg, P A 17111 10 S. Rupp Ave., Shiremanstown, PA 17011 2165 County Line Rd., York Springs, P A 17372 Notice has now been given to all persons entitled th Date: April 12, 2001 fA. Name: David J. Lenox, Esquire Address: One S. Baltimore St. Dillsburg, P A 17019 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. c/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Naorn'( ~~. Mor~ Date of Death: 3J.a '10 1 Will No. ~J"'DI-03Dq 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 ')( 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 representative's 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. Date: ~\O I Signature -.J)av i d :r, Lenox &54 . Name (Please type ori print).... One. 5. Ba.l-h mere Sf ' Address j)i n~blAKq, At no19 ( 1L1) Lf~:l...ql,l.l(,s Tel. No. Capacity: x Personal Representative Counsel for personal representative I May 31,2001 THE WILEY GROUP Attorneys at La~ Wiley · Lenox · Colgan · Marzzacco · P.c. Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 In Re: Estate of Naomi C. Morgret, deceased File Number 21-01-0309 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 $13,240.83 representing 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, ~ Dawn Gladfelter/ Assis ant /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 es- \::) ~ .-L ~ \ .~ ':a r <0 q> x w '" '" > w a: LO a> <.0 W ()') ~ <( <X; 0 z >< <( l- I- W c.. I- - <(<( W -I- 0 zen <(w W 1 >0 a: ..Jz I ><( ....I en zW <C 1 zO - wZ 0 0..<( - I ~ u. a:: U. ] w 0 J: Z ] ~ :'!; Z <l: ~ en >- w en >< zw.q: Z::)I- WZ..J c..W.q: u.>::I oWe 0::_ Iu.2: <l: ':Joe c.. <l: I- ~ - wz ~CJ 3:wl5g~ z:2::1om oti:.q:~~ ~<l:W'-:O:: o<::c..a:c..o:: OW::IW<l: UOlllOI o CD o cO N r:: I-- dJ-Ia: a z:2a:W o(l)l--l1l <l::(I)z:2 Wa:J ~oz <l:: :i!i o a:: II.. c W > jjj o w a:: L I-- Z :J a :2 <l:: --,."-' l~ I I Pl CD . o .::t Ql 11') ~~ t!l o ..... ~~ =ti 1)' g~ ,--l O~ 0 ui ['- ..... r-l ~E-t ~~ <I i~ G.. " ~i: i!) cr: ~~ :J en Ln' f&l .J ~~ ..J r-lZ r-< *0 Q w a: w :r: g ~ ) I J ~ ~\, : ~ ~..\,~,. : ~ '~... I ) I I I I I 1 1 I 1 1 I 1 ~1 -11 $1 ~1 eel ~j WI fBl eel 1 1 I I I I I I I I I I ] I I t I I f (T) (D ;" (J) ~. \./ ",-\~' ,I , j ....., Nl', 1 " -1.,..., "'~'\. r=)f- c.l). 'H . ;.Ii ", " '.-1'1 o <( a.. I-- z :J o :2 <l:: -I <l:: I-- a I-- fD <tw rrh: cr 2': W o W a: ~ 0- ru \('j (TJ I J Ii1 0 ~ i t=' 0 en 5 m 0:: .... ~ ~ Z ..I (;1 (.,') ~ u ~ ~ .--- G- ~L 7 z () 1-0 ~ 0 :'rJ ~<I ...~-( ..... ,~ "....1 - d-Z c~ 0 -> C r-' i= 1.-' '"- : -, 0 ,::r 0 ~ <( '-' :::2: .... 1-1- cu ru -' ru a: 0 ZlJJ I- -'. , rr ", ~ 0 0 ~o:: tij..o Will w If1) LL o::ru W(!) :20 !;;:o m 1-'-' ~ Z [clo:: >-, 0, 1.: LIj', w' ~-JJ w m.... 00 12--fJ :) 0('1') I- ~ru ~I: u. <l: >-U u. <( 0 :2 I- 0 I- Z W W I- Z W W :2 I- en ::) I- (j) ..J <l: <l: 0 0 <l: W u:: Z 0 c.. U 0 (I) ~ a: <l:: :2 W a: i.n ...J ..J l!l n; ..{) .::t # i:: U ,;J .,. -'- U -I <l:: W (I) Estate of: Naani c. ~g:t:et 21-01-0309 SUMMARY OF ALIDCATIONS TO BENEFICIARIES Taxable at lineal rate Marsha B. Fetterolf Judy A. Shafer Can'Oll A. Morgret, Jr. 103,242.41 103,242.40 103,242.40 309,727.21 PA REV-1500 EX (6-00) Co Page 2 Decedent's mDlete A reo: STREET ADDRESS 10 south RuDD Ave. CITY I STATE I ZIP Shiremanstown PA 17011 dd Tax Payments and Credits: 1. Tax Due (Page 1 Una 19) 2. Credlts/Pavments A. Spousal Poverty Credn B. Prior Payments C. Discount (1) 13,937.72 696.89 Total Credits (A + B + C) (2) 696.89 3. Interast/Pen&ny n applicable D. Interest E. Pen&ny Total InterastiPenany (0 + E) 4. If Une 21s greater than Una 1 + Una 3, enter too difference. ThIs Is too OVERPAYMENT. Check box on Page 1 Una 20 to request a refund 5. It Une 1 + Une 3 Is greater than Une 2, enter the difference. This Is the TAX DUE. A. Enter the Interest on the tax due. B. Enter the total of Une 5 + SA. This is the BALANCE DUE. Make Check Pavable to: REGISTER OF WILLS, AGENT ]Hr*l~lr.ffifffWJ.)~r.~~~i'!$fI#~~rlit$f.flffMlillirfrffl~J~I$iWmr'&1Ml*.j~m~jj~nEf}}lirt~~PJ~fH~W;1i.~Wlgil1mfr4ft~]I!Jm~ . "pLEAsE ANSWER THEFOLLOWING'QUEstioNSBYPLACiNGAN'nX" iN THE APPROPRIATE BLOCKS ' ., 1. Did decedent make a transfer and: Yes No a. retain the use orineorne ofthe property transferred; ..... ,..,.............................. ~ I :: :~~:;;~::~:::~=~:~ ~~~~ ~~.~~.~r~~~~.~~~~~~~~.~r.~.I~~~;.::::::::::::::::: d. receive the pro miss for IlIe of enher payments, benefits or care? .... . . . .. . . . . . . . . . . . . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 3. ::~:::;I:~:~~~::,:;:~:~a:~;:~~. ~~~~ ~~~;~ ~'a~~' ~'~~t 'o~'~~ ~; ~I~'~; ~:,; ~~~t~~' ::: 8 ~ 4. Old decedent own an Individual Re1Irernent Account, annuny, or other non-probato proporty which contains a beneficiary designation?- . ... . ,-. -, . . .'. . . . .. . . . . .. ., . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . ., 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under ponalties of perju(V, I declare that I have examinod this relUm, including accompanvlng schedulos and statements, and to tho best of my knowiedge and beno!, tt Is true, correcl and complete. Declaration 0 preparer other t~an lhe personal ropressntative Is based on Information of which creaarer has any knowledae. SI(OtIATURE F. PE ON ONSIBLE F FI RETURN ATE (3) 0.00 (4) (5) (SA) (5B) 13,240.83 0.00 13,240.83 ~ .s: Baltimore st., DillsJ:w:g, PA 17019 *B.M?jf*~w:titMltrti*%Ww_t4HMfi.!~@ffiiratli~&MgJWmt}t:W%HtT~']WBmt@f:MWMifM#J~mt.~W*MBtm!&WMmNt!1~Hl@m1~t~f:f:tgmf:g@mmf&1:fm~%ttu For datil$: of death on or aftllr JUly 1, 19114 and before January 1,1995, the taxratlllmposed on the net value of transfers to or forthe us. of the surviving spouse Is 3% [72 P.S. '9116(a)(1.1)(i)]. For da'\lls of de.1h on or.fter January " '99-5, tft. 1&lCratll-15 imposed on the nlltvalue of transfers to or for the use of the surviving spouse1s 0% [72 P.S. . 9116 (a) (1.1) (ii)). Th.statute of..... n...t ......m...ta transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and 1IIIng a tax return are still applicablel!lven If the sUrvlving spou..ls the only beneflelary. For dates of death on or after July 1, 2000: The tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age or youn;erat death to or forth. use of a natural parent, an adoptive parent, tl-r Ilstepp.ll.rtlnttl-i the child \s 0010 (72 P.S.19116(a)(1.2)1. Thetaxrate Imposed on the net value of transfers to orfor the use of the decedent's lineal beneficiaries Is 4.5%, except as noted in 72.P.S.19118(1.2) [72 P.S.'9116(aX1)). Thetax rate Imposed on the net value of transfers to orforthe use of the decedenfss(blingsls 12"k [72 1'".5. 1911e(1l.)(1.3n. Aslb"ng is defined, under SectIon 9102, uan individual who has at 'east one parent in common with the decedent, whether by blood IIrlldoptlon. o PA16002 NTF 29758 Copyright 2000 Greatland/Nelco LP - Forms Software Only Fstate of: Naani c. Mv...':jLet 21-01-0309 'Ihe followin;J person(s) are signin;J the return as representative(s) of the estate: Carroll A. M:u.':lL"et, Jr. 2165 Co.mty Line Road York Sprin;Js, PA 17372 ~,- 21-2001-309 LAST WILL AND TESTAMENT OF NAOMI C. MORGRET I, NAOMI C. MORGRET, of the Borough of Shiremans town, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understandin,g, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prfor Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as Boon after my decease as the same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my three (3) children, to wit, JUDY A. SHAFER, MARSHA B. FETTEROLF and CARROLL A. MORGRET, JR., ahare and share alike, Iper stirpes. LASTLY, I nominate, constitute and appoint my son, CARROLL A. MORGRET, JR., Executor of this my Last Will and Testament, and direot that he be exoused from posting bond or other security for the faithful performance of his duties. -1- IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 7 day of November, A. D., 1991. ~ '~\'A~ ~_ . ffl . Naomi C. Mo ret ( SEAL) Signed, sealed, published and declared by the above named, NAOMI C. MORGRET, as and for her Last Will and Testament, in the presenoe of us, who have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and in the presence of each other. C;;;jz,/ dc."v :;t~.~1j -2... ." ,', COMMONWEALTH,9F PENNSYLVANIA COUNTY OF CUMBERLAND 55. ) I, NAOMI C. I'IORGRET , the testat r1x whose name is signed to the attached or foregoing instrument, hsving been duly qualified according to..law, do hereby acknowledge that 1 signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that 1 signed it as my free and volun- tary set and deed, for the purposes therein contained. NAOMI day of Sworn and affirmed vo tno acknowledged C. MORGRET .. the testat rix November . A. D. . 1991. before me b.J0 ,this :J.'I ( v~ I!lQ~ '7 FJc j\ld'{'(''1:S?-'3.\ r~..',"":~ ..~~~~~:~(~~i;;.t{S'~~:~~~~8: f~~;;1 !~;:{;cmr~~;C11 ,:.",1"..,:...-.,_.~...~-;,.'cs IY'] t.......kY:~ Gi t-iot21.;h... ifternber. p6\l.i;sylVal1iaAr,;:,oC\;.o COUNTY OF CUMBERLAND ) ) 55. COMMONWEALTH OF PENNSYLVANIA We. the undersigned, J. ROBERT STAUFFER and RUTH ANN FULWIDER , the witnesses whoss names are signed to the attached or foregoing instrument, being duly qualified according to law, depOSe and say that we wers present and saw the testst rix , NAOMI C. MORGRET , sign and eXe- cute the instrument aslbtE/her Lest Will and Testament; that the said testat rix. NAOMI C. MORGRET ' , executed it as ~/per free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testat rix , signed the Will as witnesses; and that to the best of our knowledge, the testat rix was, at the time. eighteen (18) or more years of age, of sound mind, and under nO coclstraint. duress or undue influence. -' . ..' ,f Sworn and su~~~ed to befor me this .2 I day of November 1991. ;1,,+ if U Nd~;d:)18~!Jl Uarir;.'t1_~'"Y8:::<i~, \'~'\:-'~?i.b;:!} ~s:bLm:! ~l)., '::"~~j";);;.:::Y..;~'~C01~ MyComml$bon 2~I:\r38 Nil/. ('i, i9B3 ~.J1e'mber, Penn5ylva"la/~1 of No1aries REV-1S02 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Naani C. Morgret SCHEDULE A REAL ESTATE FILE NUMBER 21-01-0309 All real property owned solely or as a tenant in common must ba reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a w1U1ng buyer and a w1U1ng sailer, nenher being compelled to buy or sell, both having ..asonBible knowledge 01 the relevant Iecl$. Real property _Is 1oInIIY-owned with right of aurvlvorahlp must ba cIlsclosed on Schedule F. ITEM VALUE AT DATE NO. DESCRIPTION OF DEATH 1 sale of property situate at 10 S. RI.1R? Ave., Shiremanstown Borough, CUllIberland eounty, PA (See Line 420 on attached settlement sheet) : 130,394.51 TOTAL (Also enter on line 1. Rscllllltulation) $ (If more space Is needed, Insert additional sheets of the same size) 130.394.51 7 CPA21 NTF 10904 CopyrIght Forms Software Only, 1897 Nelca, Inc. A- U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT SffiLEMENT STATEMENT mLEPWJ WM. D. SCHRACK, III LIIDlprinl ATTORNEY AT LAW B. TYPE OF LOAN 124 West Harrisburg Street 1.[ It=HA 2.( If'MHA 3. ( I CONV. UNINS. P.O. Box 310 4.l}VA 5. { lOONY . INS. Dlllsburg, PA 17019 6. FILE NUMBER: I 7. LOAN NUMBER: 1209 AMR 0014633010 Phone (717) 432-9733 Fax (717) 432-1053 8. Mom. INS. CASE NO.: C. NOTE: This 10rm Is turnished to give you 8 statement of actual selllemenl coals. Amounts paid 10 and by Ihe selllemenlagenl are shown. I!ems marked '(p.o.c.)' were paid oulside the closing; they are &hown here for informallonal purposes and are nollncluded In the lolats. D. NAME AND ADDRESS OF BORROWER: E. NAME AND AODAESSOF SEllER: F. NAME AND ADDRESS OF LENDER: Matthew A. Derliunas Est. of Naomi C. Morgret Members 1st FCU Kathy S. Derliunas P.O. Box 40 Mechanicsbrg PA 17055 G. PROPERTY LOCATION: H. SETll.EMENT AGENT: I. semEMENT DATB Shiremanstown, PA 17011 10 S. Rupp Avenue Wm. D. Schrack. III 05{16{01 Shiremanstown BOROUGH PLACE OF SETILEMENT: CUMBERLAND County 124 W. Hbg street, Dillsburg PA 17019 J. SUMMARY OF BORROWER'S TRANSACTION; K. BUMMARY OF SELLER'S TRANSACTION; 100. OROSS AMOUNT DUE PROM BORROWER 4OO.GR08S ...IIOUI4T DUE TO SE\.\.EA 101. Contract sales price .00 401.Contrac! sales price ~~uvuu.OO 102. Personal property "02.Personal' property 103. $ell/ement charges to borrower (lill6 1400) ].Ubl2 .7lf .". I'". 404. ,os. 406. Adjuslments lor Items paId by seller In advance Adjustments lor Items paid by seller In advance 106. ClIyliown laX to 406.CltyfTownl8x to 101. County lax O~/l 264~ 401.Counlylax o Lll ;j~1 Vi; "64.4~ 1Q8.. M"HmIm~ 10 4OlI.AsHIt",enll to t". 0 0 J.30.06 .". I: J.30.06 110. to 410. lo Ill. 411. ,,. 412, 120. GROSS AMOUNT DUE FROM BORROWER 141067.21 420. OROSS AMOUNT DUE TO SELLER 130394.51 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 600. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposll or eames! money 500.00 6OI.Excess deposit (see inslrucUons) ~. Principal amount 01 new kJan(s) .lTI'f S02.$el!lement charges 10 seller (line 14(0) UOO.OO 203. existIng kJan(s) taken subject to S03.ExlsUng loan(s) taken subjecllo 204. Construction Mtg 604.Peyolf of First Mortgage loan Construbtion Mtg 20'. sor..Paycllof Sscor.d Mortgage Loan 206. "'. 20'. 601. .... "'. .... .... . AdJuslments for Items unpaid by seller Adjustments lor Uems unpaId by seller tIQ.Cllyft'ownlax lo 610.Cll:ylTowntax lo 211.CountylaX to 6ll.Countyl8X to 212.AIlKlllllnentl lo &U.A$ftnm1mla 10 ". to 613. 10 214. 6\4. ,.. SUi. ". 616. 211. 611. . 218. 618. 219. 619. 22Q. TOTAL PAID BY1FOR BORROWE.R 115500.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 1300.00 300. CASH AT SETTLEMENT FROM OR TO BORROWER 6OO.CASH AT SETlLEMENTTO OR FROM SELLER 301, Gross amount due from borrower (line 120) J.4~06', . GO,.GroS& s.moont due \0 &eIIaf (line 420) .,,~ 302. Less amounl paid by/for borrower (line 220) 115510.00 sol.Less reduellon amount due sellar (line 520) DOO.OO ". CASH (IlQ FROM) \{ ] TO) BORROWER 25567.21 ..,.CASH 1\llI 10) U ] FROM) SEllER 129094.51 Selllill's Slgna.lure Buyflr or Bon0W8r'l Slgnalure HUo.1 Rev. fiI86 L. SETTLEMENT CHARGES 1209 AMR ~ TOTAL SALES/BROKER'S COMMISSION It.lld on prlcl $ 130000.00 3.0 I BORROWER'S SELLER'S 700. FUNDS AT FUNDS AT Division of CommIssion (11n6 700) as lallows: Total: 53,900.00 SETlLEMENT SETTLEMENT 701. $ 3900.00 10 C-21 at tne Helm 702. $ 10 703. Commission paid at SelUement 3900.00 704. Trans Fee C-21 at the Helm I 125.00 BOO. ITEMS PAYABLE IN CONN.eOTlON WITH LOAN 801. Loan Origination Fee 1.000 .. Members, 1st FCU 1150.00 802. Loan Di&COUnt 1.125 .. Me:mbers 1st FCU 1293.75 803. Appraisal Fee 10 804. CredR Report 10 806. lenders Inspection Fee 808. Mortgage Insurance 1i07. Assumption Fee 808. Appllcallon fee Members 1st 300.00 P.O.C. eog. Document preparation Members 1st FCU 195.00 810. Underwriting Fee Members 1st FCU 75.00 811. 900. ITEMS REQUIRED BY LENDER TO IE PAID IN ADVANCE 901. tnterest (rom 05/16/01 1005/31/01 0$ 21.271day 340.27 902, Mortgage Insurance Premium for rno.lo 903. Hazard Insurance Premium for yrs,lo \lO4. yrs.lo 1lO6. OOO,-RESERVES DEPOSITED WITH LENDER FOR 001. Hazard Insurance 3 mo,C$ 26.75 lmo. 80.25 002. Mortgage lnsurance mo,O$ lmo. 003. CilylTown tax mo.OS lmo. 004. County tax 4 mo.OS 35.13 lmo. 140.52 005. Assessments mo.O$ Imo. 008. Schoo 1 12 mo.GS 87.91 lmo. 1054.92 007, mo,OS Imo, 1008. Aqq Es Ad mo,O$ (mo. -220.76 100. TITLE CHARGES 1101, Settlement or Closing fee to Wm D SchraCk III 1102, Abslract or tllIe saBIch 10 103. Title exsminaljon to \04. Tille insurance binder to 105, Document preparation to \ tOEi. Notal)' tees to Janet S Gore 6.00 107, Attorney's fees to Dav10 Lenox (includes above Ilems No.:) loa. Tille Insurance 10 WMD SCHRACK, TITLE ~ (includes above items No.:) 109. lender's coverage $ 115,000 110. Owner's coverage $ 130,000 ",. Exp Ma11 A1rborne 15.00 112. I r \113. I I 200. GOVERNMENT RECORDING AND TRANSFER CHARGES 201. Recording fees: Deed S 25. 50 Mortgage $ 49.50 Misc.S 75.00 202. Cily/county lax/stamps: Deed $ 1300.00Mortgage$ 1300.00 203. State tax/slamps: Deed $ 1300.00Mortgage$ :1.300.00 1204. Ass~qnment Recorder of Deeds 14.00 ~205. ~300. ADDITIONAL SETTLEMENT CHARGES 1301. 8Ulvey to 302. Pemlnspectlon 10 PUl 303. Home Inspection PUl 304. . 1306. ~400. TOTAl,. SETTLEMENT CHARG1!S (1lntGr 0I'I1inG* 103 Bnd 602, Section, J tlTld K) 10672.70 1300.00 U.S. OEP~RTMENT OF HOUSING ~ND URB~N DEVELOPMENT SElTLEMENT STATEMENT Page 2 Pilr1Id.-.grelllh.1 110 lIllblllly III Ull\Imlld by Selllemeql Agenllorlhe eaeu.ecy 01 Informelloll lumlllhed byolh_u-,-" Oil lh, HlJO.l Sllll......IIIII stet_Ill. Sltlllemelll ,11",11' heabyllXpreia/y '_fVHfherighllodepolln e"ylSlTfOunlacollllclttdlordlllburaemllllllnlln iIlle.e.. bHrl"geCOOllllllne F.,fe'"lIylnaurtldln..aullone"dloctldnlnytnlelfllllO..!Mdt~I\._~n1"'Ddll~1 compenallon lllI' III 1IaT'I'rt:Il,.... lhls I.._cllo". HUD CERTIFICATION OF BUYERS AND SELLERS tlave carefully revlewed the HUD-1 SelUsment Statemenl8nd 10 Ih6' best of my knoWledge and boller, Ills a lrue and accurate slalementof a(t r.ece!pt"al'ld dlBburIBtmmtt Ol\ my ~\by me \rl b'8hMcUOn, 1 furtl1er carllfy thai I have received a copy or Ihe HUD-l SelUemenlSlatamenl. C~.Lf O. 1>>~Jj ~~ Sellllr'eSlgnel_ SelI&<'. New Addren &. Phone: I{('H1 ) {)b7.!t~/./~Ll BuyerorBorrowe: SlgrJelurtl Buye...AddnI.. Phonll: ,.",lIceounl or Ihlt """Mellon.l he", ceUHd orwln ceuMlhe lundlllo be dIW~reed In eoco.o.nce willi Ihle elelDlnenl 8el!I9n1""IA",nl ...A..."........... ~ ~__.~ ~~_........... _~.._ ...... _-'___......~ ..~...4>__,-~ u _'. .___ 001. ._~~h'._ ___.~,_.. _ n .__....,.. _'_ '_.L.~_ ..,__ _~~..._.....___.., ..." .,.. 4 . REV-l508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Naani C. Morqret SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-01-0309 IncludeprocuJ;l, of Iltiaatlon 3. dateproo..ds were received by the ..tat.. All DI'OD.lolnUv-owned with rlaht ofsurvlvorahlD m.,-st be dlaclosed on Sch. F. ITEM NO. DESCRIPTION VAlUE AT DATE OF DEATH 1 waypoint Bank Account NUmber: 1900012430: 75,134.42 2 Value of Personal PJ.~ Ly: 3 Misc. Refunds (AARP, Lawn Doctor, Guideposts & Hc:xnecMners . insurance) : 551. 00 307.62 TOTAL (Also enter on Kne S, Rsc""llUlation\ $ (If more space Is needed, Insert addftlonal sheets of thB same size) 75.993.04 7 CPA81 NTF 10908 CopyrIght Forms Software OnlY, 1i97 NetcD, Inc. ~IWaYRqi!'Kt LOOK FOR US. WE'LL GET YOU THERE. THE WILEY GROUP I SOUTH BALTIMORE ST DILLSBURG PA 17019 The information which you requested on the NAOMI MORGRET ESTATE (Social Security Number 180-05-3529) is as follows. Account Number(s) 1900012430 Class of Account CERTIFICATE Date Opened 030199 Principal Balance 75010.13 Accrued Interest 124.29 Balance at Date of Death 75134.42 Account Ownership Name of Joint Owner, if any Date Ownership Was Established 030199 SOLE Additional Information Requested Sincerely, ~~~ Senior Services Rep. P.O. Box 1711. HARRISBURG. PeNNSYLVANIA 17105-1711 Toll Free I-B66-WAYPOINT (1-866-929-7646) . www.waypolntbank.com REV-15D9 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Naomi C. !LLq:t.et II an a_.... _ jolnt wlIhln on. yea, oIth. decedent's dale oI_th, It must be ~rted on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMllER 21-01-0309 SURVIVlNG JOINT TENANTISl NAME A carroll A. Morg..:et, Jr. ADDRESS 2165 County Line Road York springs, PA 17372 RELATIONSHIP TO DECEDENT son JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name 01 financlallnstftutlon and bank DATE OF DEATH DECO'S VALUE OF JOINT acoount number or similar Identifying number. NO. TENANT JOINT Attach deed lor jalnny-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1 A 01-01-62 Mellon Bank Acoount Number: 13,232.87 50% 6,616.43 162652059500: 2 A 07/04/91 Mellon Bank Account Number: 46,099.43 50% 23,049.71 16A61163C: 3 A 01/15/00 Mellon Bank Account Number: 80,264.89 50% 40,132.44 998868: 4 A 05/18/95 Mellon Bank Acoount Number: 44,501.15 50% 22,250.57 8850005342: 5 A 11-21-96 Mellon Bank Acoount Number: 25,066.92 50% 12,533.46 411016: 6 A 05/18/99 Mellon Bank Acoount Number: 61,263.68 50% 30,631.84 882056: 7 A 01/15/00 Mellon Bank Acoount Number: 25,091.29 50% 12,545.64 998858: 8 A 01/05/96 Mellon Acoount Number: 17,000.00 50% 8,500.00 00261316: TOTAL (Also enter on line 6, Recapitulation) $ 156.260.09 7 CPA91 NTF 10909 (If more space is needed, Insert additional sheets of the same size) Copyright Forms Softwar. OnlY, 1997 NelcD, Inc. @ Mellon Bank Wednesday, May 3D, 2001 Account '" '., Number Account Title 00261316 Naomi Morgret Or Oate Opened: 01/0511996 Account Type: TO Carroll A Morgret. Jr. Principal Sal Int fmm 1..11St Account B," YTD Int to IS of DOD Po5ting to 000 lIS of 000 000 $17,000.00 $0.00 $17,000.00 $0:00 162-652-0595 Naomi Morgrel Or Date Opened: 01/01/1962 Account 7}'pe: DO Carroll A Morgret, Jr. Principal Bal 1m from Last Account Bel YTD Int to ~ of DOD Posting to ODD lIS of ODD 000 $13,228.12 $4.75 $13,232.87 $11.26 885-001l-5342 Naomi Morgret Or Oate Opened: 05/18/1995 Account Type: DO Carroll A Morgret, Jr. Prlnc1pel Sal Int from LIIBt Account Sal YTD Intto as of DOD PostIng to 000 lIS of 000 000 $44,432.80 $68.35 $44,501.15 $276.02 00882055 Naomi Morgret Or OllIe Opened: 05/18/1999 Account 7)Ipe: TO Carroll A Morgret, Jr. PrIncipal Sal Int from Last Accountsai YTD Intto as of DOD Poftfng to DOD _ of DOD DOD $61,000.00 $263.68 $61,263.68 $917.94 00996855 Naomi Morgret Or Date Opened: 01/15/2000 Account Type: TO Carroll A Morgret, Jr. Princlpel Sal 1m from Last Account Bal YiD Int to lIS of 000 Po$thIg to 000 IU of 000 000 $25,000.00 $91.29 $25,091.29 $309.05 00998868 Naomi Morgret Or Date Opened: 01/15/2000 Account 1}pe: TO Carroll A Morgret, Jr. PrinclpelSaI 1m from LIlSt Account Sal YTD Int to as of 000 Pot:lting to 000 as of DOD ODD $80,000.00 '$264.89 $80,264.89 $1,025.88 16.A61163-C Naomi Morgret Or Date openmi: 07/04/1991 Account Type: TO Carroll A Morgret, Jr. Prine/pal Balint from Last Account Sal Y1D Int to as of 000 Pot:lting to 000 as of DOD 000 $46,000.00 $99.43 $46,099.43 $551.32 00411016 Naomi Morgret Or Date Opened: 11/21/1996 Account Type: TO Carroll A Morgret, Jr. Principal Bal Intfrom Last Account Sal YTD Intto as of 000 Posting to DOD as of ODD DOD $25,000.00 $66.92 $25,066.92 $274.54 Page 2 of 2 . REV-1&11EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Naani C. Morgret SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-01-0309 Debts of _dent must I reoorted on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Cemetery Flowers & Vase: 55.00 2 Myers F\1neral Halle: 9,389.00 3 Gi.ngrich MenDrials: 75.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's COmmissions 20,567.23 Name of Pe"",nal Representative(s) Carroll A. Mcn"l.Let, Jr. Social Security Number(s)/EIN No. of Pe"",nal Representative(s) S1reetAddress 2165 COunty Line Rd. city York Spri.nqs State PA Zip 17372 Year(s) Commission Paid: 2001 2. Attorney Fees Nane: Wiley Lenox Colgan & Marzzacco 20,567.23 3. Family Exemption: (" decedenra address Is not the same as clalmanrs, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 See Schedule attached Total from continuation page(s) 1,928.13 TOTAL (Also enter on line 9. Recaottulation\ $ 52.581. 59 be (11 more space is needed, Insert additional sheets of the same size) 7 CPA11 NTF 10911 Copyright Forms Software Only, 1997 Nelcn, Ino. Estate of: Naani c. ~ Page 2 21-01-0309 saiEDULE H, PARI' B - Administrative COsts Item No. Description Anx:mrt 7 1% transfer tax on real estate: 1,300.00 8 Patriot News (sale ad): 96.60 9 Waypoint Bank (service charge): 3.00 10 Register of Wills (probate): 264.00 11 CUmberlarxi Law Journal: 75.00 12 'Ihe sentinel: 97.07 13 Fil~ Fee: 25.00 14 Notary Fee: 10.00 15 Postmaster (stamps): 13.60 16 2 24 hem' tiJners for house: 16.94 17 2 Kwikset I.ocks for house: 22.54 18 2 "House For Sale" signs: 1.40 19 1 Drain Cover: 2.98 'roI'AL. (carry forward to main schedule) . . . . . . 1,928.13 *'SO IQ Myers Funeral Home, Inc. "if iGjo"J 37 East Main Street Mecllanicsburg, Pa. 17055 Boyd L. Mnrs Jr.. Supervisor (71 766-3421 . STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charlfos are only for those items that you selected or that are required. If we are re~uired by law or by a cemetery or crematory to use any items, we wi! explam in writing below. I~U seiected a funeral that may require embalming, sue as a funeral witJi viewing, you may have to ~r, for embalming. Yo do not have to pay for emb in\you did not approve if you selected arrangements such as direct cremation or inunediate burial. I we charge you for a embalming, we will explain why elow. For Services of Naomi C. Morgret Date Of Death March 13,2001 Date of Contract March 14, 2001 Charge to Carroll A. Morgret Jr. 2165 County Line Road Yor\{ Springs, Po. 17372 Name AddreSS cny .:state Zip A. CHARGE FOR SERVICES SELECTED: C. SPECIAL CHARGES 1. PROFESSIONAL SERVICES Forwarding Remains to other Funeral Ho~ $ Services of Funeral Director and Staff $ 1695.00 Receiving Remains form other Funeral Hom-,-- $ Embalming $ 895.00 Immediate Burial $ Caskeling, dressing, cosmetology $ 195.00 Direct Cremation $ Other Preparation of body $ 95.00 $ Hairdresser / Barber $ SUB-TOTAL OF SPECIAL CHARGES C$ Autopsy Remains $ D. CASH ADVANCED $-- Opening Grave/Crypt $ 500.00 SUB-TOTAL PROFESSIONAL SERVICES AU 2,880.00 Newapaper Local $ Incl 2. USE OF FACILITIES AND SERVICES Newapaper $ For visitation / wake service $ Clergy / Mass Offering $ 150.00 For funeral ceremony $ Certified Copies of Death Certificate 10 $ 20.00 For memorial service $ Family Flowers $ 159.00 Equipment & services for graveside serv~ $ 295.00 Cemetery Equiptment $ 90.00 $ $ SUB-TOTAL FACILITIES AND EQUIPMENT AZ$ 295.00 $ 3. AUTOMOTIVE EQUIPMENT $ Vehicle to transfer remains to Funeral Hom~ $ 350.00 SUB-TOTAL OF CASH AnV ANCED 0$ 919.00 Hearse (Casket Coach) $ 295.00 We charge you for our services in obtaining the following: Flower Car / Floral Distribution $ Incl None Family Car $ Incl Lead Car / Clergy Car $ 195.00 SUMMARY OF CHARGES Utility Car $ TOTAL ABOVE ITEMS (A,B.C.D) $ 10,479.00 Out of town transportation $ Salos Tax (if App) @ % $ 0.00 $ SUB-TOTAL AUTOMOTIVE EQUIPMENT A3 $ 840.00 TOTAL OF ALL SECTIONS $ 10,479.00 TOTAL SERVICES, FACILITIES, AUTOMOBILE A$ 4,015.00 LESS: Payment Made $ B. CHARGES FOR MERCHANDISE SELECTED LESS: Credits Pending $ Casket York Solid Copper $ 3550.00 LESS: Credits granted Package Price Discount $ 1,090.00 Other Receptacle $ BALANCE DUE by Apr 13, 2001 $ 9,389.00 Outer Burial Container 7ga. Steel $ 1995.00 A late charge of 1.5% per month on the outstanding balance (annual rate of18%) Acknowledgment Cards $ Incl will be added to the balance.' . Register Book $ Incl REASON FOR REQUIRED SERVICES OR MERCHANDISE Memorial Folders $ Incl Prayer Cards $ Reason for embalming family viewing Temporary Grave Markers $ Cemetery requires outer burial container Burial Clothing $ DISCLAIMER OF WARRANTIES Other Clothing $ Our funeral home makes no representations or warrantIes re~arclin9 caskets Cremation urn . $ or outer burial containers. The only warranties, expressed or lmplie . grant~ $ in connection with goods sold with the funeral service are the express writte $ warranties, if any, extended by the manufacturer thereof. No other warrantie including the implied warranties of merchantability or fitness for partlcula TOTAL MERCHANDISE SELECTED B$ 5,545.00 purpose are extended by the seller. I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I hay requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available f ~a6ment of the cash price for the ~ods and sel"lices selectEld. I also agree to make payment of $ 9389.00 within 30 days. I a~ree to be Jointly and several ia Ie with anyone else who Sipns low. A LATE CHARGE of 1.5% per month (18% cferannum) Will be applIed to the unpaid baance beglnnin~ 30 days afte the date of ffiis contract. I wil also pay the Funeral Director all reasonable costs ~ai bt the Funeral Director to collect amounts I owe under t is agreeme~. Those costs mah Include attorney tees and court costs. Any items requested after he da e of this agreement will be considered part of this agreement and I be reflected on t e final bill. (Seal) March 14, 2001 Purchaser Contract Date (Seal) Purchaser Boyd L. Myers Jr. Licensed FUllcral DJrector _ REV-1~12 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN . RESIDENT DECEDENT ESTATE OF Naani. C. Mo1.4Let SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-01-0309 Include unrelmbursed medical """enses. ITEM NO. DESCRIPTION AMOUNT 1 l"nrnr"o;oAt Cable: 5.94 2 ra.rer Allen Township (sewer) : 24.00 3 Waste Management: 31. 71 4 Holy Spirit Hospital (last illness): 9.54 5 PF&L: 112.61 6 Verizon: 101.06 7 PA Am;!rican Water CO.: 53.98 TOTAL (Also enter on line 10. Reclll>ltulstion) $ 338.84 7 CPA12 NTF 10912 Capyrlght Form. Software Only. 1997 NelcD, Inc. (If more space Is needed, Insert additional sheets of the same size) . REV-1 ~13 EX" (1-97) COMMONWEAI..TH OF PENNSYI..VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Naani C. t No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABI..E DISTRIBUTIONS Qnclude outright spousal distributions) 1 Marsha B. Fetterolf 6931 Chambers Hill Rd. HaIrisbJrg, PA 17111 2 Judy A. Shafer 10 S. R1lj;:p Ave. ShiremanstcMn, PA 17011 3 carroll A. Morgret, Jr. 2165 County Line Road York Sprin:r.>, PA 17372 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee(a) daughter daughter son 21-01-0309 AMOUNT OR SHARE OF ESTATE 51,155.71 51,155.71 207,415.79 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON liNES 15 THROU"'H 17 AS APPROPRIATE 0'" REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAl.. DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART" -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $ 0.00 Copyright Forms Software Only, 1997 Nelco, Ine. (If more space Is needed, Insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CKNlIIWIHO YORK } 55: Carroll A. MOrqret, Jr. being duly according to law, deposes and says that he is the executor of the Estate of T\laom; ("' ~t"'IrlJr""t- late of Shiremanstown Borough , Cumberland County, Pa" deceased and that the within is an inventory made by Carroll A. Morgret . Jr. 'I the said executor of the entire estate of said decedent, consisting of all the personal property 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. m;orn It ;J.. 0 ("l I CJJa~l) ~ , Ex.cut . Ad istrator Sworn to and subscribed before me, Notarial Seal , S Dawn Gladfelter, Notary PubliC Oillsbur$l Bora. ,York County My CommiSSion EXPires May 17, 2005 Member, PennsylVania AssOCiation of 2165 County Line Rd. York Springs, PA 17372 Address Date of Death 21 03 2001 Day Month ...Y~er INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be aHached as to personalty or realty 4. See Article IV. Fiduciaries Act of 1949. ..c: t)) ::l 0 l-l +J 0 .; >- Q) /Xl CD I- W l-l ... ~ ~ l- t)) t:: III W ~ l-l ~ Ql e.. u 0 0 VI 0 0 Ql W w :E: +J Q J: ~ Ul l- e.. Z I- ..... LL . t:: III LL ...J < 0 t) ctj c.. W 0 < w I E: >. > z ~ -.-I Q) ... Z 0 E: l-l a:: Q ::I VI Z 0 -.-I 0 0 ~ < ctj ..c: u .,. z w Z U) e.. ." a:: III - -.: 0 Gl ..a -0 CD E ... ..! III ::I ..... U u: ~nventory of the real and personal estate of Naomi C. Morgret deceased 1. Sale of property situate at 10 S. Rup~ Ave., Shiremanstown, PA: 2. Waypoint Bank Account #1900012430: 3. Personal Property: 4. Misc. Refunds (AARP, Lawn Doctor, Guideposts & Homeowners Insurance): 130,394.51 75,134.42 55.1 .00 30 .62 TOTAL: 206,38 .55 . /6-02--/9-0/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE " BUREAU OF INDIVIDUAL TAXES INHERITANC~ TAX DIVISION DEPT. Z8060l HA~RISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN DAVID J LENOX ESQ WILEY ETAL 1 S BALTIMORE ST DILLSBURG PA 17019 07-16-2001 MORGRET 03-13-2001 21 01-0309 CUMBERLAND 101 *' REV-1547 EX AFP l12-00) NAOMI C Allount Rellitted 130,394.51 .00 .00 .00 75,993.04 156,260.09 .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (1) (2) (3) (4) (5) (6) (7) (9) (10) 42,514.36 338.84 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax payment. (8) 362,647.64 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 ~ REV=is4j-EX-AFP-ri2"=ooY-NOiicE--OF-YtiHEiiiTANCE-YAX-APPRAisEMENT-,--Ai'COWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MORGRET NAOMI C FILE NO. 21 01-0309 ACN 101 DATE 07-16-2001 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) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. JointlY Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (11) (12) (13) (14) 4?R53 ?O 319,794.44 .00 319,794.44 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ Abh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. (15) .00 X 00 = .00 (16) 319,794.44 X 045 = 14,390.75 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 14,390.75 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-05-2001 AA496685 696.89 13,240.83 PAYMENT MUST BE MADE BY 12-13-2001~. TOTAL TAX CREDIT 13,937.72 BALANCE OF TAX DUE 453.03 INTEREST AND PEN. .00 TOTAL DUE 453.03 . 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.) - REV-1470 EX (6-88) . INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Morgret, Naomi C. ACN 2101-0309 101 REVIEWED BY Daniel Heck EXPLANATION OF CHANGES Reduced to $10,500.00. Personal representative fees can only be claimed against probate assets. SCHEDULE ITEM NO. H B-1 Page 1 ROW - < H Z <III ~:;) >Z (1)111 Z> ZIII 111111: G.II. 11.0 01- :CZ 1-111 ..JlE <I- 111111: 3< Za. 0111 lEA lE o U lU Ux ~< 31:1- gLL. X..JC <<I- I-l!tz lUQlU UlII:~ ZCIIl < lU I-lUlIl ~UIIl ffiz< ::C<Q Z3l:Z ~g< LL...J1Il C<Z lU "C U!Z~ ~lUt bE::) ZlUQ IIllU ~Q <LL. fc II. < III lU X < I- ... ~~ ~ 51i1 'i' ~... :s >~ 1"'4 ~ Cl ~ ~x c ~~...c. ~-t:~ti c~~ :: ! ::)f-NlQ <\jl .f!! lU 1IJ f- Cl: !ii~~ IQ ... Cl-:z: U D D , .. ll: .. H .. X ... .. 0 ~ <[ Z II: r-i r-i0\1:I Cl ClClZ Cl Clli)< NI-NCl~ I W I I W \09::~~l:Q r-i... Xr-i I Cl: I ::l Cl ......Oli)r-iNUr-i ClXCl :c 1-111: ~III II.AllQ 01l.!5 IIIOZ> I- I- ~~5a~5 ~IIIAII.U< I- Z III lE > < G. I- H lE " III GI rf) III: :' .... ~ A = - ~ lII: 1:~~ ~ \.lj llQ Ii )!: < < a. a C/) W I- C/) x W o Cl: Z 0 W-IXC!) -I~~Cl: .W-I::l <l:Q 1:I>l:QC/) HW -I >-IC/)-I <[H H 1:13:r-i1:l 0\ r-i Cl ...... r-i .~ .. o I- W C/) ::l o ~ Ii) , Cl:r-i c/)::lCl -10...... -IUr-i H 3:0< LL.Ua,. 01:1 Z .. Cl:<w W-I-I :w: I- Cl: C/) U C/)WH Hl:Q-I III C!) :E Cl: :c W ::l < U Cl:UU III :w: < lE ~ ' (I)' A g ~ is, >' a. Q L&J .""~"""'''''''' ,-- ,'- ~'~~ " ~~- ':; ~\\ ,. ... C/ .; - - ,.) ...~:), .\. f " , <'!.~~..:-:;/ 4,) {/} 25 -E 25 u - - €M~ ~......= s5g~ ~U......: ~] ~ ~ - ~- UU~: ~ .os .~ -= ...... ~- OO::SCU-:: ~UU-= ('.J t!~ z o H I- III: o G. .111: III 3 o ..J Z H < I- III III: ! (o,j (f' 1"1) 1'1:1 +- ..-) Or' I~:."l r... 'l-oJ III Z H -I (I) ~ H ~ .:c U l- t> ~ 0..: Q)o-, CJ. .l=~ Z V'Jo 0 ~! x 0 Q)t-.... o U ..J C U .....~ < 0 ... Q) <'J Eg: ~:'l ....J N I- rt; N ~M :;) ~t' ~~ U <'J ..... ~E J!:!~ CCl ::l ..r:..Q ~~ ~ "'-' <J1 C ::l= <'J 0'- be V'JO ~ 0 ~ u r-. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 RECEIVED FROM: DAVID J LENOX ESQUIRE 1 S BALTIMORE STREET DILLSBURG, PA 17019 _n_____ fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 180-05-3529 FILE NUMBER: 21-2001- 0309 DECEDENT NAME: MORGRET NAOMI C DATE OF PAYMENT: 08/08/2001 POSTMARK DATE: 08/07/2001 COUNTY: CUMBERLAND DATE OF DEATH: 03/13/2001 REMARKS: DAVID J LENOX ESQUIRE CHECK# 4777 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: AC RECEIVED BY: REGISTER OF WILLS REV-1162 EX( 11-96) NO. CD 000126 MARY C. LEWIS REGISTER OF WILLS AMOUNT $453.03 $453.03 /0-2/9-1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT / ')c/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REV-l'07 EX AFP <12-00) DAVID J LENOX ESQ WILEY ETAL 1 S BALTIMORE ST DILLSBURG PA 17019 DATE ESTATE OF DATE OF DEATH FIL,E NUMBER COUNTY ACN 09-04-2001 MORGRET 03-13-2001 21 01-0309 CUMBERLAND 101 NAOMI C Amount Remitted 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, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ___ RETAIN LOWER PORTION FOR YOUR RECORDS ___ REV=i6rfj-'Ex--AFP--[i"2-:ooY------...--xNi.f€RITANcE--fAY-STA-fEME-rif-o-F-ACCouiff--.-i.--------------------- ESTATE OF MORGRET NAOMI C FILE NO. 21 01-0309 ACN 101 DATE 09-04-2001 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, ~ PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-16-2001 P R I NCI PAL TAX DUE: ....___...._...._.....__....._..._......_............_..._..._......._..._................__........... 14,390.75 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-05-2001 AA496685 696.89 13,240.83 08-07-2001 CDOOO126 .00 453.03 TOTAL TAX CREDIT 14,390.75 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE 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. )