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Thi~ is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
I .. I R . t The original certificate will be forwarded to the State VItal Records Office for permanent filmg.
JOL.1 egIS rar.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~,~ 7? ~~,,~~/!-~
rJ
Fee for this certificate, $2.00
Local Registrar
p
7176806
rEB 1 5 2001
Date
... 2187
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME Of' DECEDENT If"... MlddIe. l""
t. Loti J. K-ing
UNCER t YEAR
MonIlIa Oaya
SEX
I. Female
STATE FIlE NUM8ER
SOCiAl SECURITY NUMllER
3.040 - 38 0884
DAlE Of' DEATH ,Mcn1Il. Oa~. ._,
..2-13-01
UNDER I 01111
Hauos ~ Iotinul_
8lATHPI..AC!: (CoIy _ ~E Of' DEAI'H lCtoecJo ClJ'ly flI'e.- _ ffll'ucloOOS on 0IMt ...,.\
Slate Of Fcre.gt1 CounlfyJ HOSPiTAl; OTHER:
t H CT ......- 0 ERIOwtpat'.... 0 004 0 ~ rIP
7. We~ aven, .-... ~
FACILITY NAME (II noc......lUllOO. glllll SIt"' ano 1'lUmbIIt.
12.
~
13.
:=trlO
....
Camp Hill BoJto
ICIND Of' BUSlHESSIINDUSTRY
ManoJt CaJte NuJt~-ing Home
wu DECEDENT EVER IN
U.S. ARMED FORCES?
~O No~
RACE. Amenc:M 1ndiM. 8IKk. While. eIC.
ISpeo:Iy)
white
OECEDENT'S
ACTUAl.
RESIDENCE
See .....tuC\lOI'la
gn.,."., SIde)
17.. Slate
PA
Cumbe.Jtland
MARITAl. STAI'US . Marriad
.... .....iecI. WicDwed.
0MIrcecI ($peetr)
14. S-ingle
17C.O ,*-.dIcedanlw.dw.
SURVIVING SPOUSE
I" _. gove..- namel
IlicI
dIcedanl
....111.
-.ship?
hip.
Ilb.
Camp H-ill
dy/boIo.
PA 17036
......1IGm Sial. 0
171 09.
......TlE CAUSa! (FonaI
_Of condlloon
'-*'11"'_)-
rluJc:.- ~c~ h:.
DUE 10 tOR AS A CONSEQUENCE Of):
~llIIcandilionI
. eny.1eMing to immecIiaI.
_. E_ UNDEIILYING
CAUIe(o.-OI.....y
....~-
'-*'11"'_1 LAST
I:
DUE 10 (OR AS A CONSEOUf NCE Of):
OUE1O(OR AS A CONSEOUENCf Of);
v.MS AN AUlOPSY WERE AU1tlPSY FINDINGS MANNER OF DEATH
PERFORMED? -.a..A8lE PRIOR 10
COMPLETION 01' CAUSE ~ 0
Of' OEArH? -..r.. HomICide
AccIcIenl 0 Pending In_illation 0
~ 0 No IE V.. 0 No Of Suicide 0 Could ROC be determIned 0
DATE Of' INJURY
(Uonlh. Day. \\tall
liMEOf' INJ RY
INJURY AI' WORK? DESCRIBE HOW INJURY OCCURRED.
'*- 0 NoD
33.
R'SSIGN~~
I ~I 1.2., 1'( I
aIL 21b.
CElfTIl'lI!R .Check only one)
.CElfTIFYING PHYIIICIAH (PhylOClall cefltr"'9 cause d dealh wheo aoolh... pIlySoC"",, haS pronoun<:e<l death ana cornpleleQ nem 23)
ToN bMIol..."Iulowledge...maccu....._Io_c.uM(.)andm......' ..ate_...............................................
a.
. 3OIl.
PlACE Of' INJURY. AI homlI. larm. ..,_. 'act...,. olfice
building. ale. ISpec~vl
3Oe.
.PRONOUNCING AND CERTIFYING PHYSICIAN IPhVSCliOn bolIl ;>ronouoc""} oealh and cenllytog 10 cause of deallll
To Iha ..... 01 ...y k.....ledg.. de..,. occur"" .t .... ....... <100", _ place. and d... 10 1M c:auM(.) and man...' aa alated. .
.MEDICAL EXAMINEAlCORONER
On ....lNIaia of ...min.llon anOlOl invesligalion. in my opinion. d..lh occurred 811hellme, d.le, and plac.. and due 10 Ihe eluse(sland
"'-R" .. slalacl.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31..
fIE
/~.J dJ(!'Jt:J I
~____~--r
----------
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT .280601
HARRISBURG. PA 17128-0601
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
'*
No.AA 496645 REV01162 EX (11096)
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
RICHARD HUBBEl.l. KING
101
..7.. SO
lS74 MACINTOSH WAY
...........L..TOWN, PA 170a.
FOLD HERE 0
'-- : Fa.D HERE
ESTATE INFORMATION:
RLE NUMBER
el-2001-0SOS
SSN 040-38-0884
NAME OF DECEDENT (LAST) (FIRST)
KINCJ LOIS JEANETTE
DATE OF PAYMENT
5/l!f5/2001
POSTMARK DATE
0/00/0000
(MI)
,vto.
I".,., " ..,.
_ ,.. '\ 40"
\. .II
". .. "" #l"fa
":'0 ,'/. 'It
. . O"~. , ..,~
~'...~.:~ \
: ~,'..:. ..1,','. t
-; "..419; =
. .~. : e... :
COUNTY
CUPtBERL.AND
DATE OF DEATH
2/13/2001
REMARKS
TOTAL AMOUNT PAID
,"'" 1<"'....) . ~
j:}:: "
i ....... ,.
.. ......
t
RECEIVED BY
MARY C.
RESISTE
I I
CHECK. 1513
SEAL
REGISTER OF WIL.LS
__._.-- ____---------.----.-- _________._.---'- _ ---'" ---'" __ _~--'- _ __,,______ __ ___'0
REV-1500.EX{6-001
W
I-
:ll:~CI)
00:'"
W"O
,,00
00:....
.."
..
<(
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
)(, -~3&- 1\3
REV-1500
OFFICIAL USE ONLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~I -01
-- --
COUNTY CODE YEAR
- &a t-
NUMBER
I-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
KING, LOIS J.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
FEBRUARY 13, 2001 JUNE 30, 2001
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
040 - 38 - 0884
!XJ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dalll of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (daleofdealll prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
I-
Z
W
C
Z
o
..
"'
w
0:
0:
o
o
NAME
RICHARD H. KING
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
1574 MACINTOSH WAY
HUMMELSTOWN, PENNA. 17036
TELEPHONE NUMBER
(717) 566 - 6114
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) NONE
(2) NONE
(3) NONE
(4) N€lNE
(5) 9,112.32
(6) NONE
(7) NONE
(B)
(9) 3,534.23
(10) 1,055.08
OFFICIAL USE ONLY
z
o
~
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l-
ii:
00(
u
w
0::
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Prohate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9,112.32
/
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11) 4,589.31
(12) 4,530.01
(13) NONE
(14) 4,530.01
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
!c(
I-
::::l
a.
:::E
o
U
g
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18) 679.50
(19) 679.50
16. Amount of Line 14 taxable at lineal rate
17. Amoun! of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable al collateral rate
4,530.01
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADO{r'OO MARKET STREET
MANORCARE HEALTH SERVICES, ROOMI130 2
CITY CAMP HILL 1 STATEpENNA. TZIP17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
679.50
Total Credits (A + 8 + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
679.50
A. Enter the interest on the tax due.
(5)
(5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
679.50
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income o!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.......................... ............................... ................................... 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? ..................... ......................... ..................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?"
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................... ................................... .................................
o
uD
uD
No
~
KJ
IU
[]
IU
lD
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 penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of pre parer other than the personal representative is based on alllnformalion of which preparer has any knowledge.
17036
HUMMELSTOWN, PENNA.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
MAY 25, 2001
ADDRESS
DATE
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%
172 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 dales 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 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 lineai beneficiaries is 4.5%, 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 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 common with the decedent, whether by blood or adoption.
REV.j506 EX + (1.971
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
LOIS J. KING
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
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
CHECKING ACCOUNT #0400015588
WAYPOINT BANK HARRISBURG, PENNA.
9,112.32
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is neeced, insert additional sheets of the same size)
9,112.32
REY-151,1 EX+ (12-?9) i
S>jJ~'~
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
LOIS J. KING
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. SEE OTHER SIDE FOR DETAILS 3,534.23
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City_.. State __ Zip
Year(s) Commission Paid:
2 Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City - State __Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 3,534.23
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
FUNERAL EXPENSES: LOIS J. KING
JSEE OTHER SIDE}
1] CREMATION
2] FUNERAL URN
3] PAID OBIT. NEWSPAPER NOTICE {NEW HA VEN,CT}
4] PRINTING/STAMPS {MEMORIAL SERVICE NOTICE}
5] MILEAGE: HERSHEY-W. HAVEN, CT. & RETURN
671 @.31PERMlLE
895.00
203.00
98.82
76.23
6] TOLLS
7]MOTEL ACCOMIDATIONS
8] FUNERAL FLOWERS
9]FUNERAL DINNER (PER REQUEST OF DECEASED]
10] OPENING OF GRAVE
11] DIRECT CHURCH COSTS
12) HEADSTONE (INCL. INSTALLATION]
13] ACKNOWLEDGEMENT CARDS (RE DONATIONS]--
208.01
3.50
343.15
343.80
356.02
300.00
375.00
418.70
.-.......16;00
TOTAL
$3,534.23
REV-1S12EX~(1.g7) ~
.."
, ~
~V .
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LOIS J. KING
SCHEDULE)
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
1. MEDICAL
2. JANUARY TELEPHONE
3. MASTERCARD [JAN FLOWERS SENT]
4. MISC. [STAMPS ACKNOW MEMORIAL SERVICE[
5. SPECIAL NURSING SERVICES [2/1-2/9/01]
AMOUNT
779.01
49.98
34.00
20.40
171.69
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ 1,055.08
~ '~~WaYRqi!lJ
LOOK FOR US. we'LL GeT yoLl THeRe.
P.O. Box 1711. Harrlsbur~, Pennsylvania 17105-1711
Member FDIC
LOIS J KING
RICHARD H KING
1574 MACINTOSH WAY
HUMMELSTOWN PA 17036-8729
STATEMENT DATE FOCUS
2/26/01
1515
PAGE 1
1(.."
ACCOUNT NUMat~:I.!:tfpt OF'AtCOUkt:'" <.'tmmr PAID
.. YEAR TO OATE
04000iS588'FOCUnO FREt INtERESt. 22.11
.
ANNuAL PERCENTAGE YIELD
EARNED {APVEl
1.24 I
DAYS IN CYCLE
32
AVERAGE 8ALANCE
10.775.11
____________~~~~~~~~~~~~~~~~~~~~~_~~~l____~.~~~_~__~_______________~____~____________________________
rh.4Ib.34
)Q:I43.00
25.00
10.04
10.00
438.98
70.51
5.00
15.00
5.417 .51
32. 91
81.15
ENDING BALANCE
9.009.80
8ALANCE
8.605.93
8.580.93
8.570.93
13.981.27
15.114.17
15.099.17
15.089.23
15.079.13
14.640.15
14.569.73
14.564.73
14.539.73
9.111.11
. 9.079.30
8.998.15
9.009.80
PREVIOUS BAlANCE, DEPoSlTS
~.65S.93 6.~53.31 ,.,
DATE !)tTIVIYY bESCRlptlON
:;~~;~l i~~~~~ ~l~i~
- --1119101 --:;-c"ECkm59--:----.--~---
1/30/01 : stAtE OF CONNIREtIRE pAy' . . .
2/01/01 US TREASURY 3031S0C SEC
2/01/01 CHECk '1485
2/01101 'CHECk'1489
2102/01 'XHECk '1448
1/05/01 'CHECk'1487
2/05/01 CHECk '1490
Imm---m~iili!I-~-------..f-~!~-.-c5:L?~~-~~ 1-113 {c I
2126101 ,CHECk 11493 ~
2/16/01 INTEREST EARNED ~
CHECk SUMMARY
* Indicates skIp In check numbers
DATE CHECk NO. AMOUNT
2108101 1486 25.00
2/05/01 1181 438.98
1/05/01 1488 5.00
ilol/Ol 1489 10.04
WITHDRAWALS
6.211.12
CHARGES
.00
INTEREST
11.65
WlTHORAWALS
50.00
25.00
- 10.00
DEPosits
DATE
1/19/01
2101101
1129/01
1/29/01
2101101
CHECK NO.
1443
1448'
1458*
1459
1485'
. AMOUNT
25.00
10.00
50.00
10.00
25.00
DATE
2105/01
2109/01
2121/01
1/16/01
CHECK NO.
1490
1491
1492
1493
AMOUNT
70.51
5.417 .51
31.92
81.15
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POD-502 (10100)
LAST WILL ANI> TESTAMENT
OF
LOIS ,I. KING
I, LOIS J. KING, now domiciled in Cumberland County, Pennsylvania, declare this to be my
.
Last Will and Testament I revoke all other wills and codicils that ( may have previously made
ArJicj~_!
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principAl of my residUAry estate AS soon as practicAble afler my
death
Article 1\
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including Rny generation skipping tRX) payahle hy reRRon or my dealh 8hall he paid oul of and be
chArged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment
ALlicj~ill
All the rest, residue and remainder of my estate, whether real, personAl or mixed, wherever
situate or which I may die seil,ed or possessed, or 10 which (may be entitled allhe lime of my
decease, including therein all of the property over which (mAY have the power of appointment or
disposal, I give, bequeath and devise as follows
(a) One-hatf(tI2) thereof to my nephew, RICIIARD II. KING, presently of Orange,
Connecticut, if living. and in the event he predeceases me. or fails to survive me by
.8.... t. thirty (30) days, then in equal shares to his present wife, Joan W King, a.m-ma-
ute 0"'; Tf~_
j- . if ~ ehild,vl. 1;.i"8 at Ill.. I;~. 9fr,,) ,k~th, and in the further event that Joan W. King shall
')'J-'r At>' v. 1/
(/ predecease me, or fail to survive me by thirjy (30) days, then in equal shares to his
children living at the time of my death
(b) One-half (112) thereof to my niece. LOIS K. HORNE, presently of Hiawassee,
Georgia, if living, and in the event she predeceases me, or fails to survive me by thirty
(30) days. then in equal shares to her children living at the time of my death.
~l\icl~.n'
nominate, constitute, and appoint my nephew, RICHARD II. KING Executor of my Last
Will and Testament. In the event of the renunciation, death, or inability to act, for any reason
whatsoever of my Executor, I nominate, constitute and appoint LOIS K. HORNE, successor
Executrix of my Last Wilt and Testament 'direct that my Executor or successor Executrix be
permitted to serve without bond and in addition to those powers granted by law, I grant them power
to sell both real and personal property, at private or public sale, to invest cash without being limited
to statutory investments, to distribute in cash or ;n kind in like or in unlike hares and to file any
qualified disclaimer I could have filed if living My Executor shall receive reasonable compensation
for services rendered to my estate.
2
8rtic~ v
In addition to the powers conferred by law, I authorb:e my Executor, in his/her absolute
discretion:
(a) to retain in the form received Rnd to sell either Rt public or privRte sRle, Rny reRI estRte or
personal property except that which I specifically bequeath he/she herein,
(b) to manage real estate,
.
(c) to invest and reinvest in all forms of property without being confined to legal investments,
and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise c1Rims without court approvRI and without consent of any beneficiary,
(I) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any such
propel1y,
(h) to employ any aHorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services, and
(I) to conduct alone or with others, any business in which 1 am engaged in, or have an interest
in at time of my death.
3
IN WITNESS WHEREOF, I, LOIS ,J. KING, hereby set my hand to this my Last Will and
Testament, on this /3 yI'day of -A:k.1''t41'~~, 19 '1 Z.
,"~'0,.Y ,
/,-,
;fe-H._?!
LOIS ./. KING
In our presence, the above-named LOIS .1. KING ~igned this and declared this to be her Last
Will and Testament and now at her request. in her presence, and in the presence of each other. we
sign as witnesses.
Name
PA2=- y./: ~~
(Ylud, AtfJ?
Address
_LZC'o jJ~.~-/- &-1./ C'-"''f'!-rJJ1(J, PA-
, .. .I!:I c/, /.L. '~
LZc~..J.h~i-.~'_'-Jl_QvJ'I2flJ I j c,
I, LOIS J. KING, Testatrix, who signed the foregoing instrument, having been duly qualified
according to law, acknowledge that I signed and executed this instrument as my Will, and that I
signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
LOIS J. KING, the Testatrix,
this ~ day or dL7V~...d'-4 ,19 2..z_
,"/C:9[> I, /C~
Ail'1tC-< r) ~1;....... fie,
Nota~ Ibl~
LOIS ./. KING
Nolml"' SeAl
Nancy J !luoko, NOI",y Public
. Harrisburg. Plluphill C')l Illly
My Comml:.slon F.v.plr~~ S~pI1:~. 19q9
ember, ennsylvanla Association of olarles
4
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and Saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue innuence. .
Sworn to or affirmed and
subscribed to before me
by
and
witness~ ~
day of ~, 19!iL.
a,,-,~ ~<-j~/-tz:~<L-
(y~ss
/, ;j - ffi
__{;JI1P:~~{02~_a~_
Witness (./
_~~ ti du~o-
Notary P ic,f'
Notarial Seal
Nancy J. Bur.ho, Nolary Public:
Harrisburg. Dauphin Gaunly
My Commls!'lion r:xpircs Sepl. 13, 1999
em er, ennsylvan a ssoclatlon of olarles
!3
/i,-oJ.!J~-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601 .
HARRISBURG, PA 17128-0601
.' "
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RICHARD H KING
1574 MACINTOSH WAY
HUMMELSTOWN PA 11036-2002
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
(l COUNTY
ACN
07-09-2001
KING
02-13-2001
21 01-0508
CUMBERLAND
101
*'
REV-l!;47 EX AFP <12-88>
LOIS
J
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: iS4-j-Ex--AFP--fi'2-:o0.r-NOY-icE--OF-.rNHEififAi'-ci-YAX-A-PPRjrisEi'-ENT~--Ar.i-oWANCi-OR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KING LOIS J FILE NO. 21 01-0508 ACN 101 DATE 07-09-2001
TAX RETURN WAS:
( X) CHANGED
SEE ATTACHED NOTICE
) ACCEPTED AS FILED
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
9.112.32
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
3,534.23
1.055.08
(11)
(12)
(13)
(14)
If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. AlIOunt of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
NOTE:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
9,112.32
4.589 3]
4,523.01
.00
4,523.01
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 x 00 =
.00 X 045=
.00 X 12 =
4,523.01 x 15 =
(19)=
(15)
(16)
(17)
(18)
.00
.00
.00
678.46
678.46
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
05-25-2001 AA496645 .00 679.50
TOTAL TAX CREDIT 679.50
BALANCE OF TAX DUE 1.04CR
INTEREST AND PEN. .00
TOTAL DUE 1.04CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR) J YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
. INHERITANCE TAX
- EXPLANA TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
King, Lois J. 2101-0508
REVIEWED BY ACN
Daniel Heck 101
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1