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Home My WebLink About01-0428 PETITION FOR PROBATE and GRANT OF LETTERS Estate of. t\,Q\l7\^ \~ \ \l\\O'-i\--\t\\ \~ci'\()V\ No. ~-Ol-If ~ r also known as" \ To: Register o~ills fer th County OI\.::.." \i t c in the Commonwealth of Pennsylvan'a , Deceased. Social Security No. '?{Y::J ' \ ~A \ I{? J. Cy The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or\oldcl an the execut .~ K in the last will of the above decedent, dated t 0 ~ 3 _ C6iQ I and codicil(s) dated named ,19__ (state relevant circumstances, e.g. renunciation, de th of executor, etc,) \ he$" Decend nt, t en ~~. at - i Except as folIo s, dece ent did not m rry, was ot divorced and did not ha a child born or adopted after execution of he will offered for probate; was not the victim of a killing and was never adjudicated incompetent: \ 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 Pennsylvania situated as follows: $ \Sn CCC:; cO $ \ $ $ ,_~ ~~l? r r r' n () , ~S"1 - ~3\ . WHEREFORE, petitioner(s) respectfully r presented herewith and the grant of letters a.; administration d.b.n.c.t.a.) theron. '" v u C v ~3 v.... et::V c -00 C:;'O roo::: "",v ~o... v,- :; 0 ~ c 00 Ci3 D :D'\ 1 \ ~ - Lee SV~D~~\?V\ Il') - OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH O~ PEN.NSY~AN.IA ~ ss COUNTY OF ~t~$J\ \~ \[ \0.. VI-... J 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 represen- tative(s) of the above decedent petitioner(s) will well and truly ad inister the estate according to law. Sworn to or aff~~ and subscribed '. " ,Sv.." L-~{e-J~ ore ple this day"..pJ \...,~ r; (? Ii ~ II 1~ "LuGl ~ s::: ~ ~ No. 21-2001-428 Estate of Helen L. Worthingrnn , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW April 30th ~ 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 October 3rd, 1986 described therein be admitted to probate and filed of record as the last will of Helen L.Worthington Testamentary Dixie Lee Snowden and Letters are hereby granted to $ 235.00 $ 36.00 $ $ 3 .00 TOTAL _ $ 5.00 Filed .l~P:J:-.i); .~9:t.l1,.?99.1......s. .~7~...QQ. . FEES Probate, Letters, Etc. ......... Shon Cenificates(14 . . . . . . . . . . Renunciation ................ x-Pages (1) JCP .c.~ A TIORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE Executrix will pick up letters and Order :hl' is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as (h.~,:l Registrar." The original certificate will be torwarded to the State Vital Records Office for permanent Rling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. t-1,AAA-Q/UP f!.dL'A~ Local Registrar \ Fee for this certifIcate, $2.00 p 7386245 (f ~ ~t: ;Joo I Date 21-2001-428 H105 144 Rev 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPE/PRINT IN P~IlMANENT BLACK INK ~ 5'J ~ o o w :;;; <( z STATE FilE NUMBER SEX SOCIAL SECURITV NUMBER 2 Female 3. 305 - 12 DATE OF DEATH (MonUl, Oa~,'. Ye,J/~ April 24, 2001 BIRTHPLACE (CIty allu PLACE OF DEATH (Check only one see Instrucltons on olh81 side) SIdle or fme'Q{1 Country) HOSPITAL Del aware CO. I~pa"en'~ 7. I n d i a n a aa FACILITY NAME (II nolrnsllluhon gIVe sIr eel and numl)er) g~,r/)O Holy Spirit Hospital RACE. American Indian. Black. White, ate ISpeo'YI 10. Hhite WAS DECEDENT EVER IN U S ARMED FORCES? Yes 0 NoJ[] MARITAL STATUS. Married Never Marrle'd. Widowed, Divorced (SpecIfy) Wi dO\>/ed 17er} Yes. decedent loved In Ham 0 den SURVIVING SPOUSE (II WIle iJIV~ mdloen namt-:j 12. 17b. County Cumberland Did decedent live in a township? _~~_____IWp CIty/bora 21e. Sunland Memorial NAME AND ADDRESS Of FACILlTV 22l'1yers Funeral LICENSE NUMBER 21d. Sun C i t y, A r i Z 0 n a Home 37 E. Main St MBG, Pa T':'lhc bSit of m,' :"i.o....,ledg8, di;att-I occulI~t..l dllhlil lima, t..ldltl dlllJ J.lldl.;tf ~1i1h:lu ISIU! kllul e drld Tille) IJAl t SIGNED (Monlll,{)(ly', '({;r.1q 23. TIME OF DEATH DATE PRONOUNCED DEAD !Monlh, Ddl YUdl) 23b. 23c. WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? Yes ~ NoLI 24 5:55 A'M 25 April 24, 2001 27. PART I: Enlerlhe diseases. inJuries or complications which caused lhe death. 00 no' ente, the mode 01 dYing, such as caldiac or respiratory arresl, shock or heart failure List only one cause on each line a _ SeQ~1~ _____ DUE TO lOR AS A CONSEOUENCE OF) Poor AntiboQy~~on~~ DUE TO (OR AS A CONSEOUE NCE OF)' (___AU~a:g!~_Re~~t!Q!L ~l1!~I!lCl !:~h~g DUE TO lOR AS A CONSEUUENCE OF, !!!QQg _'!'!'~!l~i !!~:!Q!! 26 IApprOXlmale : inl8rIJal between ! ol1se' and dealh I I I -r- I \- PART II: Other signlhcanl candUions. contributing 10 death, bu1 nol resulting in rhe underlYing cause Ql'yen In PART I d WERE AUTOPSV FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? Suicide 29. [] [J [J ~ ~A~,~t?0~~,J~~r~ TIME OF INJURY Camp Hill, PA MANNER OF DEATH Homicide [J Apr. 13,2001 o 30a. 30b 11: 40 P M. o PLACE OF INJ,UAY - Al home. farm, slroet, faclor)', olfice - ~~~'ng, elc. (SP"""" Hospital Ves 0 NO~ 280. 2ab CERTIFIER (Check only one) .CERTIFYING PHYSICIAN IPl1ys,cldrl certllYlng cause 01 dt:dth when afloltlel jJ11','SICldll hd:; pronounceu tWdll1 ,1I1(j ClJlllllleled Ilt~111 23) To the be.t of my knowledge, death occurred due to the cauI..a) and manner.. Itated. . Yes 0 No 0 Pending In'f'estigallOfl Could nOll.J1j dtllermioed Coroner . PRONOUNCING AND CERTlFYING PHYSICIAN (PtlYSlCllill wlh ~ronOllllC1tI9 death 0110 cellllyulU IOCdUse 01 I..h:iilli) To the belt of my knowledge, death occurred at the tlm., date, and place, and due to the cau"(I) and manner I' stated.. . o 31c. 31d. A ril 27, 2001 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (lIefJl 2l) TyP6 or Prinl Michael L. Norris, Coroner ~ 6375 Basehore Road, Suite #1 ~ Mechanicsburg, Pa. 17050 34. .MEDICAl EXAMINER/CORONER On Ih. b.ata of ..amlnallon and/or tnv.atlllatlon, In my opinion, dealh occurred allhe lime, date, and place, and due 10 Ihe cause(a) and mann.r aa atated" , . . . , , , . . , . . . . , . . . . , . . , , , . , , , . , . , , , , . , , , . . . , , . , . , . . . , . . . . . . . . . . , , . . . . . . . . . . . . . . . , , . , , . , . , , , , . . , . 31a. REGISTRAR' 11JLLilM REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) 21-2001-428 REGISTER OF WILLS OF Cumberland COUNTY OATH OF NON-SUBSCRIBING WITNESS jol" Lv. ~ lA () <-u de- '" (each) a subscriber hereto, (each) being duly qualified according to w, .depose(s) and say(s) that r Q ~ familiar with the signature of Ie 1. J 1 r f-{;~ ' p ~ ~J \/ cod!9L_____ testat~ of (one of the subscribing witnesses to) the ~presented herewith and L / ri .~icil that -nG Lu. v~ 't believes the signature on the tYs in the handwriting of Sworn to or affirmed and subscribed before me this day of ~~ 2001 ~ ~ o l), ~{'~ J 0 ~II\ kJ, Sk. 0 (.ude VL f (Na'fle) SZ 6 8 ~r r 0 fu l,.t,~, Y' e. 0 Y' ' h-1 Pc lc< L.j~d~ti'"J ~, /70-;-0 (Name) to the best of -b " s knowledge and belief. (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS _ codicil (each) a subscribing witn~s's..-t~..,the will presented herewith, (each) eing duly qualified according to law, depose(s) and say(s) that"-,,- present and saw the testat , sign the same and that''''-'. signed as a witness at the request of testat_ in h presence a~(t(in the resence of each other) (in the presence of the '. other subscribing witness(es)). '" Sworn to or affirmed and subscribed before me this "-....... "', , '", " --"-__ (Name) """, ~dress) " " '....". (Namei' (Address) / 21-2001-428 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS -\\~ t\~ (each) \ a ~ubscriber hereto, (each) being duly qualified according t'\ la'f, depose(s) and say(s) tl)at \ ~ ::=r= \N~ Q~ \M... familiar with the signature of ~ g1 Q 11\ k" \1. ;0 If \: \ n '^-, \ a VI... testa~ (one of the subscribing witnesses to) the CO@)presented herewith and T' ~dicil that - \ believ~ the signature on the~is in the handwriting of ~ Q \ (L '^ \-.. ~ I C)~=\ \JL \, \i~C1-\-C> V\ to the best of ' knowled~e and belief. \ 0 ~ Sworn to or affirmed a d subscribed before ~~~();{o<:::::: ~bL~ ~\"'-"---' me this 30TH day of ~.. . (~ame)~. \ ) APRIL Ip ~ n-2fJfll '-LJ", '\.. l ~ \. p E~, L;I ')~lG\;\ / _~ L · _" 'U<- ress) MARY C. IS Register --. . ',- ~ \J\.,I... 0 e D \f ~, \. 'L ~ ~~DuJd.Q.v\ \705 0 (Address) ~ Name of Decedent: CERTIFCATION OF NOTICE UNDER RULE 5.6(A) , '\.. " r~~. \\ . Date of Death: F \ \..e rv.J../\M... '"'' ~A_, , Will No.: ~". ce., - <~O Lt~cr5 Admin No.: ~ (\. \ "~\ ~~~. r......~ ) ~ \J' X'(.'c...!L- '~.'-./. . :\ ,-, \ \ To the Register: ~ '-'. v L ~K ~ Q... ~ -" ." f I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the 0 hans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on . Name Address .';'. \ Q "~~\. \ ~ \,. \~ l' "...- \ ' '\ \\ ~\C< -. t) +\ . II C 1-.;> () ('\ ( \, \ ' l._i v\. Y '- \/~.- \\ '\ \ ." \ <.'~'-' _,\~__)" I G...- ~., > ,__,)\1\ /_ "" f~'\..,. ..{... ' \.. { c.) --"'-~ \, . \.\ ' v t, '\:~\\.(j'~'~(.2. ~~~>.,~ ':"'\ ... "- \", ) '. \~ ...- Notice has now bee given to all persons entitled thereto under Rule 5.6(a) except " '\ I ). ~) L., . ! Signature ~)'-\IC1 / Name . t,. ~ '\.,' (' , i\ " '. '.,,)\ t\. '\ ~.,-- . \J '-A \ ""'.\......J t. ' 'I DateS \ 1 \ 0 \ C'. \~ '-_' \'-- <,,;,\\ \) vJ <\ (? \:\. \", \)~\ ',tp'> '," r . 'J '--- .,.,,~;.) \ ,"";-'",\ ," \2-i-\ II ['is [) '1' .'\ L \ <'>' "'- ~~ \!:;~). I ",,;, . , , \~ \ ct.' c \" \~~\ \,,\ \ l c,'') ':~~\.i\ '\ C \ Address ~ \1 - Ilp~3 ~ ().3.l.,J.., Telephone . , . Capacity: 0" Personal Representative (VI\ C:::.:' C 0\\-" \. r--, )" U Counsel for personal representative ~a!if ~ill anb QIe!lht1n~nt ll'f HELEN L. WORTHINGTON I, HELEN L. WORTHINGTON, a resident of Maricopa County, Arizona, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all wills and Codicils hereto- fore made by me. FIRST: I declare that I am a widow and that I am the mother of DIXIE LEE SNOWDEN. SECOND: I direct my Personal Repre- sentative, hereinafter named, to pay all of my legal debts, expenses of last illness and funeral expenses, as soon as can be lawfully and conveniently done after my demise. THIRD: I direct that all inheritance and estate taxes which may be assessed against my estate, any beneficiary thereof, and any recipient of non-probate assets, shall be paid out of my estate without apportionment or contribution from any beneficiary or recipient. FOURTH: I may choose to leave written instructions concerning the disposition of my remains and concerning services which are to be held, if any, and it is my hope and desire that my Personal Representative will see that such instructions are carried out. FIFTH: I may choose to leave a written memorandum concerning the disposition of certain items of tangible personal property, and my Personal Representative is directed to follow my instructions contained therein just as though such instructions were set forth herein verbatim. Any such personal property items which are disposed of pursuant to such instructions shall not be considered a part of the residue and remainder of my estate. SIXTH: All the rest, residue and remainder of my estate I devise to my daughter, DIXIE LEE SNOWDEN, if surviving. If my daughter does not survive me, all of the rest, residue and remainder of my estate shall be distributed in equal shares to her then living children and the then living children of her husband, JOHN W. SNOWDEN. - I , /. /. / lejA:.. Lc . J.( j '-/.. . / . -'-7-. .}\ L- C A-c.tltl..- H! l r'" i../ will - Page One SEVENTH: In addition to such power and authority conferred upon my Personal Representative by law, my Personal Representative, and any successor, shall have all such rights, powers and discretions as may be necessary or appropriate for the effective administration of my estate, and it is my desire that my estate be distributed at the earliest feasible date. EIGHTH: I hereby nominate and appoint my daughter, DIXIE LEE SNOWDEN, as Personal Representative of this my Last will and Testament. If for any reason my daughter shall be unwilling or unable to so act, I hereby nominate and appoint JOHN W. SNOWDEN, as Alternate Personal Representative. My Personal Representative or my Alternate Personal Representative shall be permitted to qualify and act as such without bond or other security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this day of [t1t , 1986, at Sun City, Arizona. The foregoing instrument, consisting of two (2) pages, including this page, was on the above date signed, published and declared by HELEN L. WORTHINGTON, the Testatrix, to be her Last Will and Testament, in the presence of us, the undersigned, who thereupon, at her request, and in her presence, and in the presence of each other, have subscribed our names as attesting witnesses the day and year last above written. /.>>' ...----'~ / . J' , ./ ' /~':/~~ t'tt~~ ,',i ~~ t ~;.&,~ /, '/I/C:., residing at /~ /~/r /t/~ .~~~. I I.; '. . /f(l'~ !J1c~i~-" .. () g~ ,-'1L<JL.g (I - residing at ~-.) , ;"";+-~~ -~- f /~;': ;/~ d~ )' Lk-" I .?' d2.....~~ L./Cf ,i' _ / J I -- f} . 190 tL '7 Ii). A PX<1.+rJ ri?4- ~ {l:t(f/ I!c- f()39J Will - Page Two COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 162 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DIXIE LEE SNOWDEN 3526 HARRISBURG EAST MALL HARRISBURG, PA 17111-1209 -------- fold ESTATE INFORMATION: SSN: 305-12-1620 FILE NUMBER: 21-2001- 0428 DECEDENT NAME: WORTHINGTON HELEN L DATE OF PAYMENT: 11/21/2001 POSTMARK DATE: 11/20/2001 COUNTY: CUMBERLAND DATE OF DEATH: 04/24/2001 NO. CD 000546 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $115.53 I I I I I I I I TOTAL AMOUNT PAID: $115.53 REMARKS: DIXIE LEE SNOWDEN CHECK#1019 SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DIXIE LEE SNOWDEN 5268 STRATHMORE DRIVE MECHANICSBURG, PA 17050 ____uu fold ESTATE INFORMATION: SSN: 305-12-1620 FILE NUMBER: 21-2001- 0428 DECEDENT NAME: WORTHINGTON HELEN L DA TE OF PAYMENT: 07/12/2001 POSTMARK DATE: 00/00/0000 f\Uf GIVEN COUNTY: CUMBERLAND DATE OF DEATH: 04/24/2001 NO. CD 000045 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $10,762.00 I I I I I I I I TOTAL AMOUNT PAID: $10,762.00 REMARKS: DIXIE L SNOWDON CHECK#1014 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT / h/~cJ-7- {, * -' Ii, )1- C/ REY-1607 EX AFP (12-00) ReCOfijc; R' A"";', 4,' ~t~):<;ft [if DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-31-2001 WORTHINGTON 04-24-2001 21 01-0428 CUMBERLAND 101 HELEN L .02 JAN 11 P 3 ~2 1 DIXIE L SNOWDEN 5268 STRATHMORE DR ., MECHANICSBURG PA~7.~~tL" Allount Rellitted J F:.'/~.',- MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 NOTE: To insure proper credit to your account1 subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifE-V =i6"ifj-Ex--AFP--ri"2-:oo1-------...--iNHERI'T-ANcE"-YAX--STA-fEME-tiY-oF"-Ac-couiff--.-..--------------- - - - --- ESTATE OF WORTHINGTON HELEN L FILE NO.21 01-0428 ACN 101 DATE 12-31-2001 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 DUEl APPLICATION OF ALL PAYMENTS 1 THE CURRENT BALANCE1 AND1 IF APPLICABLE 1 A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-29-2001 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 111443.95 PAYMENTS (TAX CREDITS): ...... PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-12-2001 CDOOO045 566.42 101762.00 11-20-2001 CDOO0546 .00 115.53 TOTAL TAX CREDIT 111443.95 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE1 SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR11 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1 /t -c:2:27-b ~ BU~U OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION of DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LEONARDO HERRADA 630 LOWTHER RD LEWISBERRY DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-29-2001 WORTHINGTON 04-24-2001 21 01-0428 CUMBERLAND 101 * REY-1547 EX AFP [12-00) HELEN L Allount Remitted PA 17339 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-\j=is4j-E"X-AFP--fi'2-:o0j--NOYicE--OF--fNHEifiTAifcE-T-AX-A-PPRjrisEHENT~--AL1-owAifcE-oR-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WORTHINGTON HELEN L FILE NO. 21 01-0428 ACN 101 DATE 10-29-2001 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 254,310.00 X 045 = 11,443.95 .00 X 12 = .00 .00 X 15 = .00 (9)= 11~443.95 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 n) (2) (3) (4) (5) (6) (7) .00 .00 .00 61.464.00 204.611.00 .00 .00 (8) 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 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) nO) 11.203.00 562.00 NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax payment. 266~075.00 nl) (2) (3) (4) 11.761; 00 254~310.00 .00 254~310.00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-12-2001 CDOOO045 566.42 10~762.00 PAYMENT MUST BE MADE BY 01-24-2002*. TOTAL TAX CREDIT 11~328.42 BALANCE OF TAX DUE 115.53 INTEREST AND PEN. .00 TOTAL DUE 115.53 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $l~ 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 DECEDENT'S NAME FILE NUMBER HELEN L WORTHINGTON REVIEWED BY ACN 2101-0428 101 John Kealy ITEM SCHEDULE NO. H D EXPLANATION OF CHANGES The deduction for travel expenses has been lowered to $1644. The executor or administrator of the estate is the only person entitled to claim these expenses in conjunction with the administration of the estate. ROW Page 1 f, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BURE4U OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recorded -' DATE ESTATE OF DA TE OF DEATH FILE NUMBER COUNTY ACN 10-29-2001 WORTHINGTON 04-24-2001 21 01-0428 CUMBERLAND 101 .01 NOV 21 All :40 LEONARDO HERRADA 630 LOWTHER RD LEWISBERRY Cien;,. P A G,l~;, ,'. '>' \ ~M 11...f\; i } ;....-',:.' - REY-ISH EX AFP (12-001 HELEN L Allount Rellitted ( x) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 61,464.00 204,611.00 .00 .00 (8) TAX RETURN WAS: ) ACCEPTED AS FILED SEE ATTACHED NOTICE \ \Sa S3 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=is4-j-E:f-AFP--fl"2':oo'Y-NC);--ICE--oF--fNHERITAifcE-TAX-j(ppRA-isEMENT-,--AL.I-OWAifcE-cfi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WORTHINGTON HELEN L FILE NO. 21 01-0428 ACN 101 DATE 10-29-2001 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 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 (9) (10) 11,203.00 562.00 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 266,075.00 (11) (12) (13) (14) 11.761:) nn 254,310.00 .00 254,310.00 NOTE: IT an assessment was issued previously, lines 14, lS and/or 16, 17, 18 and 19 will reTlect Tigures that include the total oT ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 254,310.00 X 045 = 11,443.95 .00 X 12 = .00 .00 X 15 = .00 (19)= 11,443.95 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-12-2001 CDOOO045 566.42 10,762.00 PAYMENT MUST BE MADE BY 01-24-2002*. TOTAL TAX CREDIT 11,328.42 BALANCE OF TAX DUE 115.53 INTEREST AND PEN. .00 TOTAL DUE 115.53 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A ~1:1:1I...n <:1:1: ~1:\lI:D~e ~Tne nl:: TUY~. enDM enD ~"'~TDII"'T"~ L RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Com.onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate an any such future interest. PURPOSE OF NOTICE: To fulfill the require.ents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAVMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS I AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, HarriSburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administrativelY correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. PENAL TV: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as yOU would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (67.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates far 1982 through 2001 are: Year Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 20Z .000548 1992 97. .000247 1983 167. .000438 1993-1994 7Z .000192 1984 117. .000301 1995-1998 97. .000247 1985 13Z .000356 1999 7Z .000192 1986 107. .000274 2000 87- .000219 1987 97. .000247 2001 97. .000247 1988-1991 117. .000301 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the aS58ss..nt. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. '<E'/-1470::X '0-381 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT 280601 HARRISBURG. PA 17128-0601 DECEDENTS NAME INHERITANCE TAX EXPLANA TION OF CHANGES HELEN L WORTHINGTON FILE NUMBER John Kealy ACN 2101-0428 101 REVIEWED BY ITEM SCHEDULE NO. H D EXPLANATION OF CHANGES The deduction for travel expenses has been lowered to $1644. The executor or administrator of the estate is the only person entitled to claim these expenses in conjunction with the administration of the estate. ORIGINAL Page 1 ,. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Date: 3/10/2003 DIXIE LEE SNOWDEN 5268 STRATHMORE DRIVE MECHANICSBURG, PA 17050 RE: Estate of WORTHINGTON HELEN L File Number: 2001-00428 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 4/24/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~:?J1~~~ Pft'~ DONNA M. OTTO ~ DEPUTY REGISTER OF WILLS d cc: . File Counsel Judge Name of Decedent: STATUS REPORT UNDER RULE 6.12 ~ ""1 \("\ 't -\- \i\ \ V\ ,--\ 0 If\ ( (/ O~ Date of Death: \\~\ \zv\ \-. , 4- \ ':AA- \ 0\ M~o~, Admin. No.: ~ \ - 0\ - DJr a ~ Will No.: ~pO \ - Dr)4--~ ~ 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. Stat~hether administration of the estate is complete: xyfD No 0 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 thJ personal representative file a final account with the Court? Yes:] No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal ~resentative state an account informally to the parties in interest? Yes~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: *1 \C3 ~~&~~~~ Signature 1:J~i.l' ~ \-. .Sv\'t)W~~,-,\ Name ~~\orc ~"~~~e\f~ ~f · ~~C~~i""L~~\1...\C\ ~ \1 DS 1:) Address \ ~ Capacity: Personal Representative o Counsel for personal representative 11EV-1,OOEXI6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 w ..., ",:$", <->"'''' w"<-> ,,00 <->"''''' ..Ill .. " INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z w Q w U W Q DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) WOfHt+1Nl,.!ON liL-6./V L, DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 041 A I 0 I 16 0'1 I 9 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I ~ 1. Original Return D 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise ldate of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Altacn copy olTn.lst) D 10. Spousal Poverty Credit (date ol death ootween 12-31.91 and i-1-95) ..., Z W o Z o .. '" w '" '" o <-> ll~ll!tI fit :CO "~I~lofA.l;10N:SJ:lOtll'J:lBI!.DIRECTED TO,! COMPLETE MAILING ADDRESS 6.5 0 [o,.."r I...fl- f2.0l>a L€-LvlJ tJUZ_,e 7, f' fl 1'1] J 'I MI:ISIl\ e: H Eo (/."fLfl OIl TELEPHONE NUMBER 'I I')) g 38 - I B 6 2, 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule 8) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o !;( ..J :::l l- ii: <C u w 0:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/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 APPLICABLE RATES z o ~ I-' :::l c.. :iE o u X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aJ{1.2) x.O_ (15) x .0 4-5 (16) x .12 (17) x .15 (18) (19) 16. Amount of Une 14 taxable at lineal rate '2JI ')4-1. , 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,:........ ,.... ,:"'." ~' , "., '''.,{-- ',,> > BESURE. ro,ANaWERALLQ /6 -.::J:> 7-6 ,/ '::;:;;;iC).L USr:.:'::NL'/ FILE NUMBER :l.. \ --.0-.1 COUNTY CODE YEAR QQ4-.l....a NUMBER SOCIAL SECURITY NUMBER .3 OS - / 2 - / b 1 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (datil of death pnor to 12-13-82) D 5. Federal Estate Tax Return Required ...a. 8. Total Number of Safe Deposit Boxes o 11. Election to lax under Sec. 9113(A) {Attach Scn 0) (11) (12) (13) 14,33 ~ (14) .2SI ')4-2 . ) I ~ 2'6 ) I ~ 29s 'RB:HEcK'MATH-<'<' ",''''': " " J'1 CITY f11~C.HAu <..L/!.&- STATE p!+ ZIP i '1 6S(J Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 11,31f, S("b Total Credits (A + B + C) (2) S66 3. InteresUPenaity if applicable D. Interest E. Penalty TotallnteresUPenalty ( 0 + E ) 4. If Une 2 is greater than Une 1 + Une 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If 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 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT n ;.;......,.. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS .........0 J):Q IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or ............. .................................................. ....n............. ........ ................................ D d. receive the 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? .................................. ........................................................................... 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? ..............................,................. ........................... ........................ No r;gd ~ I8J IZJ [2J C8J Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer oll1er than the personal representative is based on all information of which preparer has any knowledge. SIG ADDRESS TJ'J.nli. ,~AJ'wltJfi-v. S 1.. 623 .{7fL1+TiltkOf1.Il f)fW'JE SIGN-iTURE OF PREPARER OTHER THAN REPRESENTATIVE ----P. 1 ..I - 14 ADDRESS . LF..orvAf2..tJu H€-~Ofl. PI!- /,,1, 0 LO'"->TH-f.tt !2c,AO , (h (L('I~AN 1.e.. ( /2 uJl G- fJA / ~ oS 0 DAT~ 07{ (f)/ Mol LfEw lJlJli./1./l" P If J') J 7 q i .__' For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)], For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July I, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's 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 oommon with the decedent, whether by blood or adoption. 'EV.,om",...". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX R8URN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF HE-LEN L. lJ 011...7 ,,1.N(,.'o,IV FILE NUMBER ;l..' - 0' - ()O4- :2. $\ All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION .s",o~o&"'J ~""'_"I"I' .s>>.... ':1vc /VOT€. ftk-6- V~......../i: ~ IDB,QIS.'l1 UNPA~D !3A...ANc../i. .jl bl, 4-~3, 9 I OAT'" Of .NoH.: J""N"A/l~ 01,1'192 OMfi OF f"',MtA.n.J-.h: {Jfi..<.{i."'4t1.1l DI, lOOt eATS Dr- ~,-JTG.t!fwr! 10'7" ('l.~Tlt'-'t P'f~""~T ft"'o'~r: "1,43'1,33 CO(....."l-T~'- ~ AJoNIi VALUE AT DATE OF DEATH {,1,4t,'t- TOTAL (Also enler on line 4, Re<:apilulation) $ is I , 4- t, 4- (ff more space is needed, Insert add~lonal sheels of Ihe same size) REV,'''''','',,". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HE.'-E.ov L WOIl..Tt+l.N&TO"v FILE NUMBER :2.1 - 6/ -064-2. I;" Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 'l,4-44 1. 5, ,,\-, s' {, - /6 A L.l...F~ICJT B4"'~; P. 6. 11 u!< '100, 1"1 1. t..dl3oJ2.o . tJ Ii.. }9'7;("6 A<<Uu~T I'rP/i.: CHJi:c.../L-l..,& 4i'ou~T /lJu.,,",~E"- '. 004-2 '16 ~8U. !SAt..ANd 0"", 04r(i. DF Oi..MH: $')4-4-4-,2.2. 4l-'-F-I.I1.Jr [31\"'1<-' P.o, ;30)1 '16(), fl-IULJ(l./tu. rJli. 1~'76(, At<oL.",' "',0"-' UlLnF-U4'f!i. Of O..,oo.l.J.-f 4<<ou~r AJu.t>\M./2 '. e,'lOO ~D60 22 ") 8Lf. ~ fJALAMli. (l,.., Olhli OF (kM~ :t2,4-,ILf.4-.il I 34, 14-4- Fr.fWr UVl.u,,", 1\JF\71.6~/.l~ &A^-'i<-' fJ.6. Cule 4-00<.&, ~A-uo/C.c-, IIA 2.4-0LL-~JIJ AC<Ot.J"'7 T'tfJIi' (HilL~k&- At!""u,,,' Nu."'~p-f<..: IC\4-ISb93'b4-3S BA'-AM.f 0..... rJ",,!i.. Of {JUITI<: ill,468.6S \ ,4(, C} h.. ILl T lAlV~()<V N'n1-6,v'k ISA"'~' Pu, (1u" 4oo.i..B. QOA""VI<-i., IJA )40H-')~n A'<OIJ~' 1't1"1E: C~(l.n.FU.4'TJi: Of- O~Pu;'l.T AUDU_, /IJ",fk.fJo.fI..'. :l.4-'l()LL()~{48J&~1 I2AL-Arvc../i. ON OJQrE 6~ OIi-4Ti+ ~ ,'I;SS, ~3'1. 64- '?'s,34Q WA'7,oo:1v1' f~II.vI(.H: PA !'JIM.!')II f 0 (!,o x ('\ I I, ittI..Jt.l.j(?v..fl.(.., ^ T....,./i.' CE.fl..n.r~L/-lTfi. () f- K)lil'.Jl..,. HCCt.!UNt , . Au Uu_T Nuf'--eA.A" t 600 16 '060'1 _ !3R<-AN<"[' 6..... OAHi. Of ()~II'fU: "'46,'1'l LSo +b,II) S6../i. AfJr.nT'L6/'-'At.. !.Hf/i..r- 1'\44-1 TOTAL(Alsoenteronline5,Recapitulation) $ ~64 b I \ (If more space ,s needed, Insert additional sheets of the same size) <EV"""',,",",*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF H/i.L.fW L, !JOII-7"II~G-ra", FILE NUMBER ). J - 0 I - do4- 2 B Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F, ITEM NUMBER 6, DESCRIPTION VALUE AT DATE OF DEATH /, 8, a., 16 W 1t'T P<>lN T ~AN 1"-.'. P6.l.3u)C 1'\11, J.l.Afl.IUJ041L(.,flA /"liaS,I')II fh/(Jv~r !YI'Ii-: Ul-Tl/-U,q.r6. ()f- ,Of.jJOJt.7' iho"""I\Jc.c"'I1lL't: l'COOO045'13 I3A<-ANc./i:. ON &:itli OF DIi,4rH: (i\OJ.I,'1'J '/021 , WA'lI'Ol.NT JJI/N"-: ,'J.6. [Ju?c /')1), ).I!'tfVLLJtJ"ur..(..I'A I')IOS- /'1/1 f)<q"N"t T'tPf_: {.1i.I-'r~F-lu't7"fi Or- YJ'-PoH 7" Jiu DUN'" ;1.;"''''Ilil.''-: I ~OOO()"I-9S , ..$I &A~A"'c.t 6,... 04'1rL Or- ()f,47'i1: I,6/'1,4-S 'I all , WA'7"'owr !JAN/<-' IJ IJ I" I-IAll.fI-lJOL<"-(' f'fJ I'll Ill", /') ( I I'. O. po/( ,II r ' A((o"~r T'1J"Ii' CIi-/L'rtf-U<4r(i ().. O/LI'OJLr Auo...",!" !\Jv."'fJ'-/l.: liQS<f Z L 2.33 ') 13r:l...ANG./i i!,.... .oA'ri\. OF Oli-Art-l: J 10, l.J4-. 39 I (), J.. 14- (l')lJc..~t...f.-ANaD""'.1 P/i..f'-l'h4~ Pfl..I'/Lrt.n 3,060 TI!.AIVJAr-f./l.lLll . "T1i-.fLPHolV( ;t;c.~"E-A' 1- ~ou -1, Se, - 42.60 " 1'1"'~' fllVlVv-LT'1 - "I,vT'-Il~.'" f.)lJfua".", nlCQlIiUr rlL . Rc"ou~'f ;t.rv~~,(.I1.~ TAIS J26S~IU2 ):)"'~f't"'<-li (\.... OAT. Or- fJfA71i: ts L, '8.), '10 A,cov~< To (..'0" J~ fJfi-Ui.M4U,2-DOI fl10^,TIJ.-l.-Y Sl 18!' , TOTAL (Also enter on line 5, Recapitulation) $ ') '1, 4- 4- I (If more space IS needed, 'nsert additronal sheets of the same size) ,/ !l allflrst May 24,2001 Allfirst Att: Margie Fealtman Financial Sales Rep. Il HAMPDEN Allfirst Financial Center N.A. p.o. Box 900 Millsboro, DE 19966 RE: Estate of Helen L. Worthington Date of Death: April 24, 2001 Social Security Number: 305-12-1620 Dear Ms. Fealtman: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type........................... Relationship w /Int. Checking Account Account Number....................... 0042703816 Ownership (Names of)............... Helen L. Worthington Opening Date........................... 10/28/86 Balance on Date ofDeath.........$ 7,440.90 -, Accrued Interest $ 3.32 Total. ...... ... ................ ..... .... ....$ 7,444.22 2. Account Type........................... Certificate of Deposit 13 MOS Account Number....................... 87008000227843 Ownership (Names of)............... Helen L. Worthington Opening Date........................... 09/ lRj91 Balance on Date ofDeath.........$ 34,023.22 Accrued Interest $ 120.79 Total.. ... ..... ....... .................. ....$ 34,144.01 /<".r . Page 2 May 24, 2001 Please feel free to contact us again with any further questions. Sincerely, '2'~ 4'. .2?~~~' Mary Anne Macielag Associate I I CIS (302) 934-2240 F_N. Reference 10: 168468 First Union National Bank Attn: Account Verifications POBox 40028 Roanoke VA 24022-7313 May 30, 2001 J;>IXIE LEE SNOWDEN 5268 S1RATHMORE DRIVE MECHANICSBURG, PA 17055 SUBJECT: Verification I Comrrmation of Account and Balance InIormation provided for: HELEN WORTHINGTON (SSN# 305-12-1620) Date of Death: April 24, 2001 DeDosit Account Information Account Type Account Number Date of Death Balance Average Balance'" Date Opened Maturity Interest Accrued YTD Date Date Rate Interest Interest Paid Closed CERTIFICATE OF DEPOSIT 247022031485681 LEGAL TITLE: HELEN L. WORTHINGTON COUNTRY MEADOWS $35,287.17 3/14/2001 $52.47 $147.43 5/24/2001 CHECKING 1014156938435 LEGAL TITLE: HELEN L. WORTHINGTON NON-INTEREST BEARING ACCOUNT $1,468.65 211 011997 5/24/2001 ... Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Type Account Number Date of Death Balance Date Opened 12111/2000 Date Closed Title(s) ANNUITY TAFSI26861862 HELEN WORTHINGTON PLEASE CONTACT TRANSAMERlCA @ 1-800-258-4260 1("\ ... Date of death balance does not include accrued interest. ... If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. May 30, 2001 Date Drema Rubinoff Depository Representative Servicenter Associate Title (540)563-7323 Phone Number sss; at 001 032 ~ .., Way~qi!lt LOOK FOR US. WE'LL GET YOU THERE. DIXIE SNOWDEN 5268 STRATHMORE DR MECHANICSBURG P A 17050 The information which you requested on the HELEN WORTHINGTON ESTATE (Social Security Nwnber 305-12-1620) is as follows. Account Nwnber(s) 1000168009 1800004893 1800004951 Class of Account CERTIFICATE CERTIFICATE CERTIFICATE Date Opened 041289 022398 051498 Principal Balance 46584.34 7000.00 7000.00 Accrued Interest 188.16 21.79 19.45 Balance at Date of Death 46772.50 7021.79 7019.45 Account Ownership SOLE SOLE SOLE Name of Joint Owner, if any Date Ownership Was Established 041289 022398 051498 Additional Information Requested P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com ~/Way~qi!lt LOOK FOR US. WELL GET YOU THERE. Account Number(s) 1854222337 Class of Account CERTIFICATE Date Opened 123192 Principal Balance 10176.94 Accrued Interest 37.45 Balance at Date of Death 10214.39 Account Ownership Name of Joint Owner, if any SOLE Date Ownership Was Established 123192 Additional Information Requested s,Jcerel y" 'f/t1;t1 -? 71JfM~ Kath'{ L. 'y;~g rJ Senior Services Rep. P.O. BOX 1711. HARRISBURG. PeNNSYlVANIA 17105-1711 Toll Free 1-866-WAYF'OINT (1-866-929-7646) . www.waypointbank.com REV-1511 EX+ (12-99) . ~ COMMONWEALrH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF l.kL.EN L I,J" rLT~).vCr TO ^" FILE NUMBER )..., - 61 - 604- 2 2, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. "I. fl'1'tlZ:/lJ p.,~....,..- I-tOl"<E, 3'\ E. (/1111.. ST/<i.LT, f'1UJ1A,...,lc..JI3..."", PA- l') 4J"J 6,0 <is - f"\OIL'!"'X..L1.AoV s'''-f'-olLli.j F-'"'~A"'..""'& CNI'''-f', E.r'- . , ' IL I'Ii'JI<-A. r;..~...tUlL Her-Ii. I 2..~6 . c. lc..........L.A.....a es..""..ri./?.'7 SSe rJ. T M"~L. f/<I'fi-JliJ 4, 2.1'2.. fl, FDa", OVIL'l-v& f"~iJulL S:SS F. (.... 0 ,H1.ou & Fut>- tJf..GLo...., B. AOMINISTRATIVE COSTS: BO 1. Personal Representative's Commissions Name of Personal Representative(sl Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees ~2.S 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship at Claimant to Decedent 4. Probale Fees ).')'1 5. Accountant's Fees 6. Tax Return Preparer's Fees 4'1S 7. TOTAL (Also enter on line g, Recapitulation) $ /3, 'I'll Debts of decedent must be reported on Schedule I. (If more space IS needed, insert additional sheets of the same size) ""'''''''''''''"1'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE.SIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF _HF-L.tAl L. WOILW:W("TO~ Include unreimbursed medical expenses. ITEM NUMBER I, fl'\ L",:j.LA,- L.;cP€-v.6.,J FILE NUMBER .:2.1- 01- 004-2 E, DESCRIPTION AMOUNT Sbl TOTAL (!'Jso enteron line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same siZe) SC2.. "".,""'.".,,'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER I. SCHEDULE J BENEFICIARIES ).iii-LEN L, IJOrLTI+'W&'O,v 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) GU.lli L. ~",,,~.oc,v S2.<:~ .hll.tlTIi!>\otUi f.)(Ll...,(i Y'1 fc..H II'" t.c.lI.lWlCr fit n oS () , FILE NUMBER .2. I - () I - (J 04- 2. )?, RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE l)flc.o.&if rE.fL J..S 2., 3004- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON liNE 13 OF RE'11500 COVER SHEET S (If more space is needed. insert additional sheets of the same size) ~__':;I_""'_"" _...- _f"'" -...~:1 ......... ....y...~u............... One Copy to file of Mull, Hayt and Mason 10421 west coggins Drive Sun city, Arizona 85351 ~asf 28ill amh <IT.eshun~nt oJ 'R1iI:r.1I!1I T. 'Vf\'DfMT...YfIl'lttR........ I, HELEN L. WORTHINGTON, a resident of Maricopa County, Ari2ona, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils hereto- fore made by me. : FIRST: I declare that I am a widow and that I am the mother of DIXIE LEE SNOWDEN. SECONDI I direct my Personal Repre- sentative, hereinafter named, to ~ay all of my legal debts, expenses of last illness and funeral expenses, as soon as can be lawfully and conveniently done after my demise. THIRD, I direct that all inheritance and estate taxes whiqh may be assessed against my estate, any benefiCiary thereof, and any recipient of non-prObate assets, shall be paid out of my e.tate without apportionment or contribution from any beneficiary or recipient. l'OlJRTH: I may choose to leave written instructions oonoerning the disposition of my remains and concerning services whioh are to be held, if any, and it is my hope and desire that my Personal Representative will see that suoh inetructions are oarried out. FTFTH\ I may choose to leave a written memorandum concerning the dispOSition of oertain items of tangible personal property, and my Personal Representative is direoted to follow my instructions contained therein just as though suoh instructions were Bet forth herein verbatim. Any such personal property items which are disposed of pursuant to such instructions Ihall not be considered a part of the residue and remainder of my estate. STXTH: All the rest, residue and remainder of my estate I devise to my daughter, DIXI! LEE SNOWDEN, if surviving. If my daughter does not survive me, all of the rest, residue and remainder of my estate shall be distributed in equal aha res to her then living children and the then living children of her husband, JOHN W. SNOWDBN. ~;. ~~~~ Will - Page One SEVENTY, In addition to suoh power and authority conferred upon my Persenal Representative by law, my Personal Representative, and any successor, shall heve all suoh rights, powers and diacretiona as may be necessary or appropriate for the effective administration of my estate, and it is my desire that my estate be distributed at the earliest feasible date. EI~RTYI I hereby nominate and appoint my daughter, DIXIS LS! SNOWDBN, as Personal Representative of this my Last will and Testament. If fer any reason my daughter ahall be unwilling or unable to so act, X hereby nominate and appoint JOHN W. SNOWDEN, as Al tQr:nate Pe !:,sonal Representative.:.., My' Personal Representative or my Alternate Personal Representative shall be permitted, to qualify and act as such without bond or other security 'in any jurisdiction. IN WITNESS WHEREOF, 1 haVe bereunto set my hand this day of (/.'('1" , 1986, at Sun City, Arhena. ,) The foregoing instrument, consisting of two (2) pages, including this page, was on the above date signed, published ana declared by HELEN L. WORTHINGTON, the Testatri~, to be her Last Will and Testament, in the presence ef us, the undersigned, who thereupon, at her request, and in her presence, and in the presence of each other, have subscribed our names as attesting witnesses the day and year last above written. 4/lr ~ c..' ,-') ~ ,7' -r. ( . " A ~ C ,. X'~,( ( I.ldy;-"l ~ ~':..f!.~/ residing 111 tr...'-<. ;."..;., , (J ,() g;~A1,m~ , reSiding at (I<<t/f' // 7<1 ~ ..~::~~r:::;ik ~ 9" IJbff"39J -....--...-. ~ ~- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DIXIE LEE SNOWDEN 5268 STRATHMORE DRIVE MECHANICSBURG, PA 17050 ____un fold ESTATE INFORMATION: SSN: 305-12-1620 FILE NUMBER: 2101-0428 DECEDENT NAME: WORTHINGTON HELEN L DA TE OF PAYMENT: 05/04/2006 POSTMARK DATE: 05/04/2006 COUNTY: CUMBERLAND DATE OF DEATH: 04/24/2001 NO. CD 006659 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,902.50 I I I I I I I I TOTAL AMOUNT PAID: $2,902.50 REMARKS: CHECK# 4907 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS " -..J 15056051058 . \ REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128.00>1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 01 0428 Date of Birth 305-12-1620 04/24/2001 10/07/1917 Decedent's Last Name Suffix Decedent's First Name MI WORTHINGTON Helen L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ".-:1 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate (,~ 4a. Future Interest Compromise (date of death after 12-12-82) '.-J 7. Decedent Maintained a Living Trust (Attach Copy of Trust) CJ 10. Spousal Poverty Credit (date of death CJ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes (.a:::. Leonardo Herrada, PA (717) 938-1868 "'-' ~:~ .~',~_:;l "--REGiSTEROF-'~lsusE'o~- . , I,] Firm Name (If Applicable) ~; First line of address City or Post Office Lewisberry State ZIP Code ..;.- 630 Lowther Road -t) Second line of address G) DATE FILED N PA 17339 Correspondent's e-mail address: Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS Leonardo Herrada, P.A., 630 Lowther Road, Lewisberry, PA 17339 717.938.1868 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 / 15056051058 .-J ---I 15056052059 \ , REV-1500 EX Decedent's Name: Helen L WORTHINGTON 305-12-1620 Decedent's Social Security Number RECAPITULATION 1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) C~-:::; Separate Billing Requested . . . . . " 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C"-=:;\ Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) " . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X .045 64,500.05 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 64,500.05 ""'\.., 64,500.05 64,500.05 64,500.05 2,902.50 2,902.50 "'''N''''''':; ---I REV-1500 EX Page 3 File Number , Decedent's Complete Address: i 21 I 01 1'0428 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Helen L WORTHINGTON 305-12-1620 STREET ADDRESS c/o Dixie L. Snowden 11 Carousel Circle CITY I STATE I ZIP Hershey I PA i 17033 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,902.50 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 2,902.50 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. 2,902.50 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D iii d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D iii 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) {ill. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (OJ percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to oTfor the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116{a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has atreast one parent in common with the decedent, whether by blood or adoption. I REV-150B EX+ (6-9B) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen L. WORTHINGTON FILE NUMBER 21-01-0428 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Net proceeds received by the estate as the result of litigation initiated by the Administratrix/Executrix of VALUE AT DATE OF DEATH 64,500.05 the estate on behalf of the decedent. (Settlement is confidential and copy of such settlement will be provided only upon request). TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 64,500.05 ~ ,.. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX! 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DIXIE lEE SNOWDEN 5268 STRATHMORE DRIVE MECHANICSBURG, PA 17050 ____un fold ESTATE INFORMATION: SSN: 305-12-1620 FILE NUMBER: 2101-0428 DECEDENT NAME: WORTHINGTON HELEN l DATE OF PAYMENT: 05/04/2006 POSTMARK DATE: 05/04/2006 COUNTY: CUMBERLAND DATE OF DEATH: 04/24/2001 NO. CD 006659 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,902.50 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 4907 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS $2,902.50 GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CD 007200 NO. HERRADDA LEONARDO PA 630 LOWTHER ROAD LEWISBERRY, PA 17339 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 501 I $201.12 ESTATE INFORMATION: SSN: 305-12-1620 I FILE NUMBER: 2101-0428 I DECEDENT NAME: WORTHINGTON HELEN L I DA TE OF PAYMENT: 09/13/2006 I POSTMARK DATE: 09/12/2006 I COUNTY: CUMBERLAND I DA TE OF DEATH: 04/24/2001 I I TOT AL AMOUNT PAID: $201.12 REMARKS: CHECK# 4944 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS c( H Z c(1II >::;) ..IZ >111 tn> ZIII i5111: a.1L ILO 01- :z:Z 1-111 ..I :E" :it ~c( Za. 0111 :E~ :E o U III ~~ :at- o ..II&. X..lO CC t-~!i IIIQIII W~~ I~Of3 IIICII -~C~; 3::1 M.. ~!;.. L ~ ,Z', 0111- .. j:r- I ~. '.! 5- 'Ell ~A) f:i.-<< ' " t~, - 0 C .... III ..J I .0 o .... a.. LL. C X 1&1 .... ~ 111 ... I :> 1&1 ae Z UJ ..J UJ ::c \D __ ClGol ClI: N.C) l:a "".lll Z .....s- \DO....llOQ IQ ClI-ClNZ CI d (!)c:~ .. c( .... ti NZ.NCI ..J ~ I'.... I I ar: I: "'.::C ~ .... 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C2 u.l rt 1./1 ~ ~ 'J ( I-CL a: ~ =,0 l'_OO :..:00 i-c (07: u.c ~ --' C'C';. 6~ 1 ~ ) ~. \.T, ! C.:.., c:' c' tL ~ 1 (=~_-~ 1 C:.: C') {- c. C") ~-' '.1- u.J en ~ c::=> c::=> C""-I ~ ~~ (,)0 .~ r- U- -< 5~~ "0 to ~ ~u-! c:-~ rn-~ - .. - -= ... :: -:: = -:: .. ~ :: .. - -: .. -= .. - .. .. - - == E - - ": .. - ,'t.' In it) N .... ('~ ..... o rp ..... 08-14-2006 WORTHINGTON 04-24-2001 21 01-0428 CUMBERLAND 501 APPEAL DATE: 10-13-2006 ( See reverse side under Objections) Amount R_ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HELEN L FILE NO. 21 01-0428 ACN 501 DATE 08-14-2006 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE I~ an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total ~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. AIIount of Une 14 at Spousal rate (1S) 16. A.ount of Line 14 taxable at Lineal/Class A rate (16) 17. AlIOunt of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collaterel/Class B rate (18) 19. Principal Tax Due ( BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX ZlS0601 HARRISBURG PA 171ZlS-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX C-~~"~f")~~.9"ANCE OR DISALLOWANCE '~'::'O~L~ A,HD ASSESSI1ENT OF TAX irl! I';" ," 'jOri6 ~ r !.", I S' I.. J d ' f; U \..1 fili II: 4 I DATE ESTATE OF DA TE OF DEATH FILE NUMBER COUNTY ACN LEONARDO HERRADA PA 630 LOWTHER ROAD LEWISBERRY C-,,'" " ': r'"\l It 'vi,,' PA 17339 ESTATE OF WORTHINGTON RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN 1. R..l Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closel~ Held stock/Partnership Interest (Schedule C) (3) 4 . I1ort5llB5lIBs/Notes Receivable (Schedule D) (4) S. Cash/Benk Deposits/l1isc. Personel Propert~ (Schedule E) (S) 6. Jointl~ OWned Propert~ (Schedule F) (6) 7. Trensfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 64.500.05 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/l1isc. Expenses (Schedule H) (9) 10. Debts/l1ortp5lI8 Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnantal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estete Subject to Tax .00 .00 (11) (12) (13) (14) NOTE: .00 X 641500.05 X .00 X .00 X 00 = 045 = 12 = 15 = DATE 05-04-2006 AI10UNT PAID 21902.50 NUltBER CD006659 INTEREST/PEN PAID (-) .00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-05-2006 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (19)= '* REV-1547 EX AFP (06-05) HELEN L NOTE: To insure proper credit to ~our account I subIIi t the upper portion of this for. with ~our tax pa~t. 641500.05 00 641500.05 .00 641500.05 .00 21902.50 .00 .00 21902.50 21902.50 .00 201.12 201.12 ( IF TOTAL DUE IS LESS THAN $11 NO PAYI1ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIr" (CR)I YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) , ~ REV!'l470 EX (6-88) , '* . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDMDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER HELEN L WORTHINGTON 2101-0428 REVIEWED BY ACN John Kealy 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Interest is effective 2/3/05. ROW Page 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171ZB-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE O~COR8f.~~~~rANCE TAX '1~,~(,:~!1rt~~~",t OF ACCOUNT (;I_\]L~; j [:~~; j" :"i/:~.L '~. *' REV-1607 EX AFP (03-05) LEONARDO HERRADA PA 630 LOWTHER ROAD LEWISBERRY CLERK OF OR.C::;'..;'.M\!'("\ r'(lURT ! : I.' ; 'f ..) (,_, ,.1' i 1 CU!",; ~,'" ,."("\, PA DATE AM /0: 22 ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-02-2006 WORTHINGTON 04-24-2001 21 01-0428 CUMBERLAND 501 AIIount R_ittad HELEN L 2U06 OCT 3 I PA 17339 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your eccount. s~it the upper portion of this for. with your tax p.~nt. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF WORTHINGTON HELEN L FILE NO. 21 01-0428 ACN 501 DATE 10-02-2006 THIS STATEI1ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE fWtED ESTATE. SHOWN BELOW IS A SUII1ARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-14-2006 PRINCIPAL TAX DUE: 2.902.50 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-04-2006 CD006659 .00 2.902.50 09-12-2006 CD007200 201.12- 201.12 TOTAL TAX CREDIT 2.902.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 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" (CRl. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~