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HomeMy WebLinkAbout01-0679 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' .A:tv~'a.~ ff. c!L/&-P~ No. ~\- D\ - (., 1c=:t also known as To: Register of Wills for the , Deceased. County of in the Social Security No. 077- 'fL.?-3S-2-,:!::> Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executo-z...- in the last will of the above decedent, dated and codicil(s) dated named , 19_ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~/Z ~-..1l1 County h ~ last family or principal residence at .P~;) /rct:w-~ ~ , ..--1 ~.w ~ . (list street, number and muncipality) Penw;ylva.nia, with /J *""&'->~4 k~. J1'!I- I' - Dec~9dent, then ~;? at ..,,/i:orn..c:- Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: years of age, died ;C~'Z.o$- U /7 2. <!?cf) I ;~ , Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: /bL/,80D , $ $ $ $ WHEREFORE, petitioner(s) respectfully re uest{s) the probate of the last will and codicil(s) presented herewith and the grant of letters . .'6?4~a-??"IL'_hz (testamentary; a inistration c.La.; administration d.b.n.c.La.) theron. ~ '" ~ Q) u I: Q) -o~ .- '" "'~ Q) "' er::Q) I: -00 1:';:: cd ".;:: 3~ Q),- 50 t;j I: 00 <Ii / AC/7"M.':;' T C!h.<'~.o Ie- g~<) ~-&~ ~~. /?1.e", '- .........?u.--. r /J/f I 7'-> ~-S 01~" t/ 0;1 . .k&c>-6=- rC', a-.)C /..f;7 c;,~uFI/u,no// /J;.. /7027 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND 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 administ Sworn to or affirmed and subscribed ~/"""""''''''.' before me thiSJ y :9TH da! '1/1 ~ ~~C~"~flLt-~. · ..... I~' _ MAR C LEWIS Register e&tate according to law. ~1/-:'7 ~o-k en ~. ;:s l:l .... l:: ~ ~ No. 21 - 01 - 679 Estate of KATHARINE B. CHILCOTE , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUL Y ~, x~ 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 11. 1989 described therein be admitted to probate and filed of record as the last will of KATHARINE B CHILCOTE TESTAMENTARY THOMAS J CHILCOTE and Letters are hereby granted to ~ @~~pufJm~. MARY CLEWIS FEES Probate, Letters, Etc. ......... Short Certificates( 3) . . . . . . . . . . Renunciation ................ X-Pages JCP $ 200.00 $ 9.00 $ $ 24.00 5.00 TOTAL _ $ ?38.00 .. . . . . .. .J.~~ Y. .2.Q ~ . ?9.Q1.. . . . . . . . . . AITORNEY (Sup. Ct. J.D. No.) ADDRESS Filed PHONE Mailed letters to Executor on 7-20-01 H105.805 REV 9/86 This is to certifY that the information here given is correctly copied from an original certificate of death duly filed withme as Local ~egistrar. The original certificate will be forwarded to the State ViTal' Records Office for permanent"filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. \\II,''(~(1H'orpl.i---__~ IB~ f;j ',' '. ~1. ~ .. --'-.- - ~ ~~ 4::E1gc "'. ~~ l~c:I -- dO' -~ ~ '-'~ -..';j"i' J:::i,. ~ ~*~. .' ,....... '*~ 1. .A". . .... ..... ~ .,~ . "" "'....." ":" ~ ' .;:;>l -. -Ii?,,. <.\\.'r "' "'"'.. 'MENT \\\ ",.", '--:"""'#"##111"'" JiPfMd. h'~+1f Local Registrar P 7121570 ;f~A.LttJ I~~I Date Hl05_144 Rev 1191 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPE/PRINT 'N PERMANENT BLACK INK fij '" :J '" " ::; " STAlE File NUMBER A Chilcote SEX ..Female SOClo9'7CURlTY N""a'8' .. 8523 DIITE OF DEATH (M""'" Da" ...", .. February 17, 2001 DECEDENT'S USUAL OCCUPATION (Give kiOO 01 :#wok done duri'29., most 01 wa"''1'I'OrlYl!ffl1l:1/eef' ) 1~ 11~ DECEDENT'S MAlLtNG AOOAfSS (Slree!, CilyfTown, Slate, lip Code) 880 Hawthorn Ave Mechanicsburg. Pa. 17055 CITY. BOR BIRTHPLACE (Cily and PLACE OF DEATH ICheck only ooe see inS!rucllons on oIhef SIde} State ac for6lgf; Countly) HOSPITAl: Sidney, New York Inp."'''' 0 7. ... FACILITY NAME (II not institution. give S1reel and number) ~~,ty)D UNDER 1 DAY How. Minut.. RACE. Amefican k\dian. &lack. White. elc (SpeedV) While 10. SURVIVING SPOUSE (n wf<<l. gIve fl"lalden name) Thomas Chilcote DECEDENT'S ACTUAL RESIDENCE (See InSlruclions OOOlhtHsidej Cumberland Old ....- IWe in a toWnship? 17d.O ~thtn~~::nv;: of MOTHER'S NAME (first. Middle. Maiden Sulr.ame) Virginia Dunn 'wp 17b. Count CltylOO4'Q Rev. Roger Beach Thomas Chilcote 10. INFOAMANT'''lm'ti'fl~h"dpjlj'M~lTrvre'eftl:il'lf~urg, Pa. 17055 PlJ\CE Of OtSPOSllIQN. twneot Cemetery. Cremaloty o,OIh., PI". Conolite Crematory lOCAl1ON - CitylTown, SCate, Zip Code SChaefferstown, Pa. 17088 21d. NAMEANDAft~:~ru~:~lHome, Inc. 37 East Main Street Mechanicsburg, Pa 17055 22.. lICENSE NUMBER DATE StGNEO l~cwM" De)'. Yeafl DATE PRONOUNCED DEAD ~Monltl, Day, Year) ... 7: 35 P. M >s. February 17, 2001 27. PART I: Ene., the dIaeAes, injuries Of c:ornpicalions which caused the death, 00 not 4lRt8l' the mod&01 dying. sue;h as cardiac or respiratory arr951. shock Of heart faiture list only one CfIUd on aach line 23b. 23c:. w.\S CASE REFERRED TO MEOfCAL EXAMIHERlCOAONER? YosO{ NoD Pend in Investi ation DUE TO (OR AS A CONSEQUENCE 0Fl: ... :Approximale ,Inl:etval between : onaet and death ! PART N: Othet significant COI'lddions contributiog 10 Math. bul nol r....1ng in the undeftytng cause given In PART I DUE TO (OR AS A CONSEQUENCE 0f1: DUE 10 (OA AS A CONSEQUENCE OF): d. WERE AUlOPSY ANOINGS .ru\IlA8lE PRIOR 10 COMPLETION OF CAUSE OF DEATH? MANNER OF DeATH DAlE OF INJURY IMonlh, Day. Year) TIME OF INJURY Coroner INJURY AT WORK? NaluraJ o o o Homicide o Vas .... g4 NoD Ha. Jib, CERTIFJEII (O\edl; only one) aCERTWYIHQ PHYSIClAH (PhySICian certifying cause 01 dealh when another pllySlCian has pronouncau death and complete<.! Hem 23) To the beat 01 my kno...., duch OCCURN dUe to 1M c.UM(.. and manlHH''' ...t.cl. . . Yoso No r;.. Accident Pending Invesligation Dii1 :lOa. 3Ob. Jot. O PlACE OF INJURY - AI home, farm, ,treel, "Clory, office bUIldIng, ale. (S,)t,':lfy! .... Suictde ... Could nol be determined o ... Z w o w <> l'j ~ w ~ '" Z ~) /I,~ h:2l. , DATE SIGNED (Moolh, Day. 'tbarJ o ... "d.February 19, 2001 NAME AND ADDRESS OF PERSON WHO COMPlETED CAUSE Of DEATH (lIem 271 Type 0< Print Michael L. Norris, Coroner M 6375 Basehore Road, Suite #1 '1'4 32. Mechanicsburg, Pa, 17050 DATE FILED (Month, Oa~. Year) apROHOUNaHG AND CERTtFYlHG PHYSICIAN (PhYSICian both pronouncing death and cerlllyirlg 10 cause 01 uealllJ To the beet of "" knowledge, ciNCh occurred" ttM time, date. end pIKe, end due to the cauMts) and mann.r.. .Wl~.. , , . ,.. '001 LAST WILL AND TESTAMENT OF KATHARINE B. CHILCOTE KNOW ALL MEN BY THESE PRESENTS, That I, KATHARINE B. CHILCOTE, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, knowing that life is but a vapor which appears for a short while and passes away, do hereby put forth at the beginning of my Last Will and Testament the things I hold most dear. FirstlYr God is sovereign in the affairs of men and it is His elect and His elect alone for whom Christ shed His blood. Secondly, God has put His blessing upon the Authorized Version of the Scriptures as is evidenced by the fruitful use of this translation for almost 400 years. Lastly and of greatest importance is the message of the Gospel of the Grace of God which the Apostle Paul preached (Acts 20:24). Paul gave us a summary in I Corinthians 15:1-4 stating that it is the death, burial, and resurrection of Christ that saves a person. To expand on this, Paul says in Romans 6 that we must be totally identified in that death, burial and resurrection such that it actually happened to us. Let it no longer be important that I am physically dead, but . . rather, have you while living become dead in Christ that He may live out His life in you? May our Lord Jesus Christ enable you to say with Paul, "I am crucified with Christ: nevertheless I live: yet not I, but Christ liveth in me: and the life which I K6c now live in the flesh I live by the faith of the Son of God, who loved me, and gave Himself for me" (Galatians 2:20). I hereby revoke and make void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executor hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executor hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, to my husband, THOMAS J. CHILCOTE. THIRD - If my said husband fails to survive me and if all of my children shall be at least thirty-two (32) years of age at the time of my death, then I give, devise and bequeath all the rest, reside and remainder of my estate, both real and personal, to all my said children, share and share alike, to be divided equally among them. FOURTH - If my said husband fails to survive me and if any of my children shall be less than thirty-two (32) years of age 2 KBL at the time of my death, then I give, devise and bequeath all the rest, residue and remainder of my estatey both real and personal, to my friend, GREGORY R. REED, ESQUIRE, IN TRUST, for the care, maintenance and education (including college education, both undergraduate and graduate) of my said children. Said Trustee shall have the right to use both principal and income to accomplish the purposes of this trust and shall not be under any obligation to disburse, payout or award either principal or income in equal manner for my said children. When said children shall reach the age of thirty-two (32) years my Trustee shall distribute principal and undistributed income to said children equally, share and share alike. Compensation for said Trustee shall be consistent with the standard charges of the Trust Department of a reputable bank in the Harrisburg, Pennsylvania area. FIFTH - In the event my said husband fails to survive me and in the event I leave no surviving children or grandchildren, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, as follows: (a) Forty (40%) percent thereof to the Trinitarian Bible Society of 1710 Richmond Street, N.W., Grand Rapids, Michigan 49504, to be used for the distribution of the Authorized Version of the Bible (commonly referred to as the King James Version); 3 KbL (b) Ten (10%) percent thereof to THINGS TO COME MISSION, INC. of P.O. Box 96, Cope, Colorado 90812-0096, for the spread of the Gospel of the Grace of God; (c) Five (5%) percent thereof to The Maranatha Bible Society, P.O. Box 466, Litchfield, Michigan 49252, for the spread of the Gospel of the Grace of God; (d) Thirty (30%) percent thereof to all of my sister's children born or adopted prior to January 1, 2000, if said children are at least thirty-two (32) years of age at the time of my death. In the event said children are less than thirty-two (32) years of age at the time of my death, then I give said thirty (30%) percent share of my estate to my friend, GREGORY R. REED, ESQUIRE, IN TRUST, for the care, maintenance and education (including college education, both undergraduate and graduate) of said children. Said Trustee shall have the right to use both principal and income to accomplish the purpose of this trust and shall not be under any obligation to disburse, payout or award either principal or income in egual manner for said children. When said children shall be thirty-two (32) years of age or older, my Trustee shall distribute principal and undistributed income, to said children egually, share and share alike; and (e) Fifteen (15%) percent thereof to the children born or adopted prior to January 1, 2000 of my brother-in-law, DAVID B. CHILCOTE, if said children are at least thirty-two (32) years of age at the time of my death. In the event said children are less than thirty-two (32) years of age at the time of my death, then I give said fifteen (15%) percent share of my estate to my brother-in-law, DAVID B. CHILCOTE, IN TRUST, for the care, maintenance and education (including college education, both undergraduate and graduate) of said children. Said Trustee shall have the right to use both principal and income to accomplish the purpose of this trust and shall 4 K~, not be under any obligation to disburse, payout or award either principal or income in equal manner for said children. When said children shall be thirty-two (32) years of age or older, my Trustee shall distribute principal and undistributed income to said children equally, share and share alike. SIXTH - I direct the Trustee (except the Trustee named in Item 5 (e) hereof of any trust established by this, my Last will and Testament, to invest and reinvest all monies held by Trustee in accordance with the guidelines published and established for the Mutual Fund Composite Plan by Telephone Switch Newsletter, Post Office Box 2538, Huntington Beach, California 92647, whether or not said institute is in business at and after the time of my death. SEVENTH - If my said husband fails to survive me as aforesaid, then I appoint my sister, MARTHA B. MC INNIS, to be the Guardian of the persons of my minor children. In the event of the death or inability of my said sister, MARTHA B. MC INNIS, to serve as Guardian, then I appoint my sister, SUSAN B. CAMERON, to be the Guardian of the persons of my minor children. EIGHTH - I direct the Guardian of the persons of my minor children to raise them in a Christian atmosphere where the Scriptures are the sole authority for faith and everyday life. In addition, I desire that my children be raised in a country- type environment away from the physical and spiritual pollutions 5 J/ r,--., . of the city and its environment. Finally, if possible, I desire that my minor children be taught at home and not in a formal school setting. If it is not possible for the Guardian to provide a "home school" education for my children then I direct that they be enrolled in a private Christian school with high spiritual and academic standards. NINTH - I direct the Guardian of my minor children to limit the use of medicines and prescriptive drugs to those absolutely necessary and that any vaccinations and surgical procedures be avoided to the extent possible. It is my conviction that the body, under most circumstances, except for emergencies, was created by God to take care of itself. For advice in this area, please contact Dr. Guy R. Schenker, HCR 63, Box 48, Mifflintown, Pennsylvania 17059, (717) 436-8251. TENTH - I appoint my said husband, THOMAS J. CHILCOTE, to be the Executor of this, my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act of my said husband, then I appoint my said friend, GREGORY R. REED, ESQUIRE, to be the Executor hereof. I do hereby give to the Executor hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the 6 KBC property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of seven (7) typewritten pages on the margin of which (except this page) I have affixed my initials this llfu day of October, A. D., 1989. ~ruhnnl~J- l) (Iu' ~ trf-~( SEAL) Signed, sealed, published and declared by KATHARINE B. CHILCOTE, the above named Testatrix, as and for her Last Will and Testament, in the presence of each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 7 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :ss We, (&~ f? ~2fd ~~(I itfn,'''1Q .Jr ~< ~. . '.J.0/iA'- t" . I. , the COUNTY OF CUMBERLAND and witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses: and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or under influence. Sworn or affirmed to and subscribed to before me by and ,,~~,Jq7~~lnt ()crd!4:/U , 19 D9 <.e~0{Y~ 1\' /y uI . 'II\. wi tnesses, thlS II day of .Y4 a.;L ;(~ ~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :ss COUNTY OF CUMBERLAND I, KATHARINE B. CHILCOTE, testatrix whose name is signed to the attached or foregoing instrument, having been duly gualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last will and Testament; that I signed it willingly; and that I signed it as my free and vOluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by KATHARINE B. CHILCOTE, the testatrix, this /I~ day of (!)CMWL , 19 tv . ,/ (~ yj~fU-, l..-4( SEAL) 07/23/01 08:06 REGISTER OF WILLS ~ 01 NO. 544 ~02 Sworn to or affi~d and subscribed before me this 2S day of .--~ 2.00 j ~~. ~ .. Register ! 21-01179 REGISTER OF WILLS OF Cumbe('l4V\J cou '1 y OATH OF SUBSCRmlNG WITNESS I, G-retjor'j t< . Reed : II . _JUI I :1 (each) a subscribing witness to the will presented herewith. ~)! being duly quaJifidd according to law. ~ose(s) and say(s) that he. was Jesent and saw ~a(,I\Ne- B J Ch, l cere.- i !/ the testat r.')( . sign the same and that _h e. ; signed as , witness at th; request of testae..., " in h t S presence and (in the presence of leach other) (in the hresence of the other subscribing witness{es)). : 'I .~;~ /:kdJ ',G-I'~I.J R. ,e\?e-4 ,(Name) il ;?'f/2. 3 AJa",.rf/.... "t'f,II'v-4 Sdovee7' : (Ad;jress) -11 I:k "../s bu ~ j/ A-. I") II ~ I (Name) :1 NOTARIAL SEAL CARA J. WENGER, Notary Publlc Harrisburg, Dauphin County CommIseion Expires Feb. 24, 2003 (Address) REGISTER OF WILLS OF ~ CO TY I OATH OF NON-SUBSCRIBING WITNESS . 1 S U~A-N F. e.. I (~ a subscriber hereto. ~) being duly qualified according to law I d~ose(s and s 5 ~ ~ l's familiar with the signature o( \ . :~ SUbscribing witnesses 10} the: will testat ta' J'... of (one of the ~~~ present herewith and I , codicil I believes the signatur~ Oll the will is in t e handwriting of C '/U)"f~ that 8. to the best of knowledge and belie..f. Sworn to or aff~ed and subscribed before me this 2.3 day of ~ rot. ~.~ 3.ttz.3 ~rY' : ..rime) lA). ,4 (Address) RegiW!l t.JOTARIAL SEAL CARA J. WENGER, Notary Public Harrisburg, Dauphin County My Commission Expires Feb. 24, 2003 (Name) (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Katharine B. Chilcote Date of Death: February 17, 2001 No. 21-01-0679 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 27, 2001: Name Address Thomas J. Chilcote 880 Hawthorne Avenue Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except no exceptions Date: August 27, 2001 Si D. Cameron Address 1325 N. Front st. Harrisburg. PA 17102 Telephone (717) 236-3755 Capacity: Personal Representative x Counsel for personal representative INVENTORY Estate of Katharine B. Chilcote No. 21-01-0679 also known as Date of Death February 17, 2001 , Deceased Social Security No. 097-48-8523 I, Thomas J. Chilcote, Personal Raprosenlaliv~l ollhe above Eslate, deceased, verily Ihat the items appearing in the lollowing invenlory include all 01 Iho porsonal 8ssets wherovor siluate and all 01 the real estale in the Commonwealth 01 Pennsy\venia 01 said Decedenl, that Iho vlllunlion placed opposile each ilem 01 said Inventory represenls its fair value as 01 the date 01 the Decedent's dealh, and Ihal Dacodenl ownod no real estate oulside of the Commonwealth of Pennsylvania except that which appears in a memorandum III Iho end 01 this jnventOlY. 1{lt!H verify that the statements made in this Inventory aTe true and correcl. ''* undersland that IlIlse statomenls horein are mada subject to the penalties of 18 Pa. e.s. Section 4904 relating 10 unsworn lalsilicalion 10 lIulhorilios. Narne 01 AItOllley: James D. Cameron, Esq. Personal Rep' eser~: 'y ,(."...ao-, ~ C U &-, E;eec.c<M Thomas . Chilcote, Executor 58998 1325 North Front street 1.0. No,: Address: Daled Oel IS::- -Zoo J I T olophone: Harrisburg, PA 171 02 (717) 236-3755 Description Value Morgan Stanley account number 507016655265 11,444.40 Nationwide annuity contract number 01-0494408 100,247.85 Prudential (refund on long-tenn care, policy) 619.76 AICPA Insurance Trust (return of contributions) 40.00 ".',! Total: $112,352.01 IAttach Additional Sheets if necessary) NOTE: The Memorandum 01 real estate outside the Commonwealth of Pennsvlvanla mav. at the election 01 the personal representative. include Ihe velue 01 each item, but such ligures sho,uld not be extended into the total of the Inventorv, RW-8 REV.I500EX (e-OOI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 /6-/69- / REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER ~L-~--L ~~_J--2.__ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 097 - 48 - 8523 I- Z W C W (J W C DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) CHlLOJI'E, KATHARINE B. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 02/17/2001 12/29/1954 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CHlLOJI'E, THCWIS J. ~ "~l:! u..u ~og u8:co ~ ~ 1. Original Return o 4. limited Estate ~ 6. Decedent D'led Testate (Attach copy of Will) o 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 2. Supplemental Return o 48. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a Living Trust (AlIachcopyofTrusl) o 10. Spousal Poverty Credit (date of death between tz.31-!H and 1+913) 03. Remainder Return (dale of death prior to 12-1J..82} D 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A.} {A\\at:h Sth 0) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Safe-Proprietorship 4. MortIJ"Il" & NoI.. Receivable (Schedule 0) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) B. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. IntM~VIvos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Groll AJletl(lotal Unes 1-7) g. Funetlll Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortg,ge li,bililies, & liens (Schedule I) 11. Total Oeductlonl (Iotallines B & 10) 12. Not Vllue of Ellate (Une 8 minus line 11) NAME JAMES D. CAMERON ESQ. FIRM NAME 1'_'" TELEPHONE NUMBER (717) 236-3755 COMPLETE MAILING ADDRESS 1 325 NORTH FRONT STREEI' HARRISBURG, PA 17102 (1) (2) (3) (4) (5) -0- 11,444.40 -0- -0- 100,907.61 OFFICIAL USE ONLY ... z w " z ~ .. w '" '" " u z o ~ ::;) t: Q. < (J w 0::: z o ~ I-' ::;) Q. ::IE o (J ~ (6) -0- (7) -0- (8) 112,352.01 (9) (10) 3,585.00 -0- 108,767.01 -0- -0- (11) 3,585.00 (12) 108,767.01 (13) 0 (14) 108,767.01 -0- x.O_ (15) x.O_ (16) -O- x .12 (17) -O- x .15 (1B) -0- (19) -0- 13. Charitable and GovemmentalBequestslSec 9113 Trusts for which an election to tax has not been m,de (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES -0- 19. Tn Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15. Amount of Line 14 taxable at the spousal lax rale, or \!alIote" un<ter Sec. 9116 (al(U) 16. Amount of Line 14 taxable 'I lineal rala 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 20.0 Decedent's Complete Address: STREET ADDRESS - 880 HAWI'HORNE AVENUE CITY MECHANICSBURG I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CredilslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) -0- Total Credits (A + B + C) (2) -0- 3. InteresUPenally if applicable D.lnterest E. Penally Total interesVPenaily ( 0 + E ) (3) 4. If Une 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 Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) -0- A. Enter the Interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT -0- PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a. retain the use or income olthe property transferred;.......................................................................................... 0 b. retain the right to designate who shail use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 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? ...................................."........................................................................ D 3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? .............. 0 . 4. Did decedent own an Individual Relirement Account, annuily, or other non-probate property which contains a beneficiary designalion? ........................................................................................................................ 0 No [:zJ [X] [X] [X] Q9 [:zJ Q9 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 thai I have examined this return, including accompanying schedules and statements, and to the besl of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all inlonnation or which preparer has any knowledge. SIGNATUR(,OF PFRSON RESP SIBL ;"/CPnaA JP? ADDRESS DATE r:r:::c;; /:;:-~/ PA 17055 MECHANICSBURG ESENTATlVE ADDRESS 13 5 NORTH FRONT STREET, HARRISBURG, PA 17102 For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [12 P.S. ~9116 (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. ~9116 (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 detes 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 slepparent of the child is 0% [12 P.S. ~9116(a)(1.2)J. The tax rete 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. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an Individual wf10 has at least one parent in common with the decedent, whether by blood or adoption. , ~ .,'/t.JI'l""~ \> ., ",' :,~.,:"""~,.,~";;...,., ',' "', ' . , "~~ ,~r' "." , ') "l I' ~r'"'' '" ,,' , :' :~,~\ l~~~~+:~~,' . . .'.o:-",(:;~>,,,. . '.~j.t;,O/I'".,:":,,,":, : .,<~.tS!~7:~ ,.:." LAST WILL AND TESTAMENT OF KATHARINE B. CHILCOTE KNOW ALL MEN BY THESE PRESENTS, That I, KATHARINE B. CHILCOTE, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, knowing that life is but a vapor which appears for a short while and passes away, do hereby put forth at the beginning of my Last Will and Testament the things I hold most dear. Firstly, God is sovereign in the affairs of men and it is His elect and His elect alone for whom Christ shed His blood. Secondly, God has put His blessing upon the Authorized version of the Scriptures as is evidenced by the fruitful use of this translation for almost 400 years. Lastly and of greatest importance is the message of the Gospel of the Grace of God which the Apostle Paul preached (Acts 20:24). Paul gave us a summary in I corinthians 15:1-4 stating that it is the death, burial, and resurrection of Christ that saves a person. To expand on this, Paul says in Romans 6 that we must be totally identified in that death, burial and resurrection such that it actually happened to us. Let it no longer be important that I am physically dead, but . . rather, have you while living become dead in Christ that He may live out His life in you? May our Lord Jesus Christ enable you to say with Paul, "I am crucified with Christ: nevertheless I live; yet not I, but Christ liveth in me: and the life which I i<ec. now live in the flesh I live by the faith of the Son of God, who loved me, and gave Himself for me" (Galatians 2:20). I hereby revoke and make void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executor hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executor hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, to my husband, THOMAS J. CHILCOTE. THIRD - If my said husband fails to survive me and if all of my children shall be at least thirty-two (32) years of age at the time o~'mydeabhl'then I give, devise and bequeath all the rest, reside and remainder of.my estate, both real and personal, to all my said children, share and share alike, to be divided equally among' them. FOURTH -Ifmy said husband fails to survive me and if any of my children shall be less than thirty-two (32) years of age 2 ~c at the time of my death, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, to my friend, GREGORY R. REED, ESQUIRE, IN TRUST, for the care, maintenance and education (including college education, both undergraduate and graduate) of my said children. Said Trustee shall have the right to use both principal and income to accomplish the purposes of this trust and shall not be under any obligation to disburse, payout or award either principal or income in equal manner for my said children. When said children shall reach the age of thirty-two (32) years my Trustee shall distribute principal and undistributed income to said children equally, share and share alike. Compensation for said Trustee shall be consistent with the standard charges of the Trust Department of a reputable bank in the Harrisburg, Pennsylvania area. FIFTH - In the event my said husband fails to survive me and in the event I leave no surviving children or grandchildren, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, as follows; (a) Forty (40%) percent thereof to the Trinitarian Bible Society of 1710 Richmond Street, N.W., Grand Rapids, Michigan 49504, to be used for the distribution of the Authorized Version of the Bible (commonly referred to as the King James Version); 3 ~BL (b) Ten (10%) percent thereof to THINGS TO COME MISSION, INC. of P.O. Box 96, Cope, Colorado 90812-0096, for the spread of the Gospel of the Grace of God; (c) Five (5%) percent thereof to The Maranatha Bible Society, P.O. Box 466, Litchfield, Michigan 49252, for the spread of the Gospel of the Grace of God; (d) Thirty (30%) percent thereof to all of my sister's children born or adopted prior to January 1, 2000, if said children are at least thirty-two (32) years of age at the time of my death. In the event said children are less than thirty-two (32) years of age at the time of my death, then I give said thirty (30%) percent share of my estate to my friend, GREGORY R. REED, ESQUIRE, IN TRUST, for the care, maintenance and education (including college education, both undergraduate and graduate) of said children. Said Trustee shall have the right to use both principal and income to accomplish the purpose of this trust and shall not be under any obligation to disburse, payout or award either principal or income in equal manner for said children. When said children shall be thirty-two (32) years of age or older, my Trustee shall distribute principal and undistributed income, to said children equally, share and share alike; and (e) Fifteen (15%) percent thereof to the children born or adopted prior to January 1, 2000 of my brother-in-law, DAVID B. CHILCOTE; if "said children are at least thirty-two (32) years of age at the time of . my death. In the event said children are less than thirty-two (32) years of age at the time of'my death, then I give said fifteen (15%) percent share of my estate to my brother-in-law, DAVID B. CHILCOTE, IN TRUST, for the care, maintenanca and education (including college education, both undergraduate and' graduate) of said children. Said Trustee shall have the right to use both principal and income to accomplish the purpose of this trust and shall 4 k'P.r not be under any obligation to disburse, payout or award either principal or income in equal manner for said children. When said children shall be thirty-two (32) years of age or older, my Trustee shall distribute principal and undistributed income to said children equally, share and share alike. SIXTH - I direct the Trustee (except the Trustee named in Item 5 (e) hereof of any trust established by this, my Last Will and Testament, to invest and reinvest all monies held by Trustee in accordance with the guidelines published and established for the Mutual Fund Composite Plan by Telephone Switch Newsletter, Post Office Box 2538, Huntington Beach, California 92647, whether or not said institute is in business at and after the time of my death. SEVENTH - If my said husband fails to survive me as aforesaid, then I appoint my sister, MARTHA B. MC INNIS, to be the Guardian of the persons of my minor children. In the event of the death or inability of my said sister, MARTHA B. MC INNIS, to serve as Guardian, then I appoint my sister, SUSAN B. CAMERON, to be the Guardian of the persons of my minor children. EIGHTH - I direct the Guardian of the persons of my minor children to raise them in a Christian atmosphere where the c Scriptures are the sole authority for faith and everyday life. In addition, I desire that my children be raised in a country- type environment away from the physical and spiritual pollutions 5 K..'BC- of the city and its environment. Finally, if possible, I desire that my minor children be taught at home and not in a formal school setting. If it is not possible for the Guardian to provide a "home school" education for my children then I direct that they be enrolled in a private Christian school with high spiritual and academic standards. NINTH - I direct the Guardian of my minor children to limit the use of medicines and prescriptive drugs to those absolutely necessary and that any vaccinations and surgical procedures be avoided to the extent possible. It is my conviction that the body, under most circumstances, except for emergencies, was created by God to take care of itself. For advice in this area, please contact Dr. Guy R. Schenker, HeR 63, Box 48, Mifflintown, Pennsylvania 17059, (717) 436-8251. TENTH - I appoint my said husband, THOMAS J. CHILCOTE, to be the Executor of this, my Last will and Testament. In the event of the death, resignation, renunciation or inability to act of my said husband, then I appoint my said friend, GREGORY R. REED, ESQUIRE, to be the Ex~cutor hereof. I do hereby give to the Executor hereof full power, discretion and authority at any time or times to sell, at private or pUblic sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the 6 K& property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is reguired by any law, statute or rule of court, no Surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of seven (7) typewritten pages on the margin of which (except this page) I have affixed my initials this Il-th day of October, A. D., 1989. Xrdhno';"'L- ~ ('hi iF t.f......( SEAt) Signed, sealed, pUblished and declared by KATHARINE B. CHILCOTE, the above named Testatrix, as and for her tast Will and Testament, in the presence of each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 7 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :ss COUNTY OF CUMBERLAND I, KATHARINE B. CHILCOTE, testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by KATHARINE B. CHILCOTE, the testatrix, this / / r;/... day of ~ , 19 f)q . ~~~SEAL) 'ljJ:;;'[". ,,:. ' J BETTY fl'/!'" ~111~' ~1".U.,~,V,'PU~i..~C . ',Ie :I,.~, ._d' ~ . . ~ITY OF W.p'," .\ ,'" ...',r.! MY CONrnS:;L:: c:' , .,' ,i:." ", , ......,_..-'...1..........'.;' "-, AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :ss We, ~ R. ~nd <:;:4'/ 1.((",'",<( .-J,,"'1-r-. '1, f?pd , the COUNTY OF CUMBERLAND and witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or under influence. Sworn or affirmed to and ~ !?'/{wl witnesses, this 11'(1... day of subscribed to before me by and . Jf:;;~ .iQ'1'.N?fmi f)~ , 19 '69 , .yJ~;(~. ~~ REV-1-503 EX + (4-86) '* SCHEDULE B STOCKS AND BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Katharine B. Chil=te, deceased FILE NUMBER 21-01-0679 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRIPTION 1. I'brgan Stanley ac=unt munber 507016655265 (440 shares Sherwin Williams @$26.01 per share) VALUE AT DATE OF DEATH 11,444.40 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of same size.) S 11,444.40 Michael J. Bock Senior Viet' Pmident Financial Advisor 490 East Palmetto Park Road Boca Raton, FL 33432 "l MorganStanley toll free 800 681 9854 to! 561 3948558 fax 561 3948660 August 29, 2001 Mr. James Cameron Altn: Shana Geyer 1325 North Front Street Harrisburg, P A 17102 RE: Estate of Katharine Chilcote Dear Shana: On 2/17/01 Mrs. Chilcote had in her account 440 shares Sherwin Williams that would be valued at on that date at approximately $26.0 I. If you have any questions, please don't hesitate to call me at 800-681-9854. Thank you. Sincerely, y~~ ~ Katlil~en Burke Sales Assistant to: Michael J. Bock Senior Vice President Cc: Thomas Chilcote ~[[@f[f1MJ[fj) , SfP 0 4 2001 .' .REV"5OO8<":"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEN1 DECEDEN1 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Katharine B. Chilcote, deceased 21-01-0679 Include the proceeds of lltigation 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 Nationwide annuity contract number 01-0494408 (Estate is beneficiary) VALUE AT DATE OF DEATH 100,247.85 2 Prudential (refund on long-term care policy) 619.76 3 AICPA Insurance Trust (return of contributions) 40.00 TOTAL (Also enteron line 5, Recapitulation) $100,907.61 (It more space is needed, insert additional sheets of the same size) Nationwide Financial Individual Annuity Service Center P.O. Box 16609 Columbus, OH 43216 www.bestofamerica.eom August 29, 2001 J ames Cameron 1325 North Front St Harrisburg, PA 17102 RE: Nationwide Annuity Contract 01-0494408 Dear Mr. Cameron: On behalf of Nationwide, thank you for the opportunity to service your request. Via telephone, you requested that we send you a letter containing the value of the above-referenced annuity contract as of February 17,2001. . As of2/17/01 the value of the above-referenced contract was $100,247.85. I would like to thank you for allowing us the opportunity to be of service to you. If you have any questions or need further assistance, please contact our Customer Service Department at 1-800-848-6331, Monday through Friday, from 8:30 a.m. to 9:00 p.m. Eastern Time. Anyone of our Annuity Specialists will be happy to assist you. Sincerely, q; ,"~wr -ft---- Financial Services Analyst Individual Annuity Service Center ~15"EX."~1i. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Katharine B. Chilcote, deceased 21-01-0679 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Sodal Secunty Numbe~s) I EIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees 3. Family Exemplion: (If decedents address ~ llO\ \he same as clalmallfs, attach exptanalion) 3,500.00 Claimant Thomas J. Chilcote Street Address 880 Hawthorne Avenue City Mechanicsburg State PA lip 17055 Relationship of Claimant to Decedent spouse 4. Probate Fees 5. Accountants Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal (legal advertising) 60.00 8 Register of Wills of Cumberland County (filing fees) 25.00 TOTAL (Also enter on line 9, Recapitulation) $ ~ 000 ^^ (If more space is needed, insert additional sheets of the same size) 'REV'''''''''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FilE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trusteets) OFEST ATE L TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Thomas J. Chilcote spouse 100% 880 Hawthorne Avenue Mechanicsburg, PA 17055 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 n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ Katharine B. Chil=te, deceased 21-01-0679 (If more space ',s needed, insert additional sheets of the same size) 'fr " \ /c STATUS REPORT UNDER RULE 6.12 Name of Decedent: Katharine B. Chilcote Date of Death: February 17, 2001 will No. 21-01-0679 Admin No. Pursuant to Rule 6.12 of the Supreme Court orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: n/a 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes ____ No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: n/a c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: \)U, I/-, 'lOcI <I 0'\ <( a <:;::! n.: :L! c- tt'l - (, ."'" I...... ""..,., c..,;) n~ (j) C) ..-, 0 (j; 0 ~.. '" (D .~ 't1J 0 " .0 oa> - i:e <J)a:. p ID- a: 6u Ja s D. Cameron Name 1325 North Front Street Harrisburg. PA 17102 Address (717) 236-3755 Telephone Capacity: Personal Representative __X__ Counsel for Personal Representative '\. /6 -dZ-</t6~ / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU 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 Recoraeri Recd<'ti~r '1;)'''''~' of VVHls DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '01 Ole 27 AlO :12 JAMES D CAMERON ESQ 1325 N FRONT ST HBG ~€f~i~2 'CumberlarlC: , FA 12-17-2001 CHILCOTE 02-17-2001 21 01-0679 CUMBERLAND 101 '* REV-1547 EX AFP liZ-DOl KATHERINE Allount Rellitted 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=i54-j-Ex-AFP--fi'2=ooY-NoricE-oF-YNHEifiTAircE-rAx-A"PPRA"isEi"ENT~--Ar.l-oWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHILCOTE KATHERINE FILE NO. 21 01-0679 ACN 101 DATE 12-17-2001 TAX RETURN WAS: (X) 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. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets CHANGED (1) (2) (3) (4) (S) (6) (7) .00 11.444.40 .00 .00 100.907.61 .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 Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (lS) 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 3.585.00 .00 (11) (12) (13) (14) (9) (10) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 112.352.01 3.li81; 00 108.767.01 .00 108.767.01 14. 15 and/or 16. 17, 18 and 19 will returns assessed to date. 108.767.01 X 00 = .00 X 045 = .00 X 12 = .00x 15 = (19)= .00 .00 .00 .00 .00 TAX CREDITS: --"A YMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \ /6-c:2~C-/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 JAMES D CAMERON ESQ 1325 N FRONT ST HBG PA 17102 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' REV-413 EX AFP 101-03) 03-17-2003 CHILCOTE 02-17-2001 21 01-0679 CUMBERLAND 201 KATHERINE Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ....... Rifv:48]i-EX--AFP--[oi~iiji-----j(.-NCificE--OF--jETifiMiN-AfiCiN-Aiij-AS-SESSiiENlr---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF CHILCOTE KATHERINE FILE NO.21 01-0679 ACN 201 DATE 03-17-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \, /6-d)-Y6-- / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 JAMES D CAMERON ESQ 1325 N FRONT ST HBG PA 1710.2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN * REV-73' EX AFP (01-02) 03-24-2003 CHILCOTE 02-17-2001 21 01-0679 CUMBERLAND 202 KATHERINE Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ RE-i=736--EX--AFP--coi:-02j-----;-;-NOiricE--OF--DETE-iMiN~Tio-H-AN-D-AS-SESsiiENT----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ** ESTATE OF CHILCOTE KATHERINE FILE NO.21 01-0679 ACN 202 DATE 03-24-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 *IF PAID AFTER THIS DATE. SEE REVERSE SIDE {IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" {CRl. YOU MAY BE --- --..-........- ......."",.. n.r- 'T"UT~ r""no.. enD T...~TDllrTTnN~ "