Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
01-0706
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Nuh~ri A. (};r6e. Sr, also known as No. To: ~\-D\-(Dlo Register of Wills for the County of C~ll:1bPr/anql in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/aM 18 years of age or older, applies for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in C lJ OJ be,- / Il ~uJ County, Pennsylvania, with hi ~ last family or principal residence at Churd, "I (;"e/ No~ J1;;/ I/gd~'er ~/ar.ts/t;., /!A J (list street, number and municipality) INC. tn/eIt://e/;'" 7Wp. .:Th!y ~S , ~':<fX)1 78 years of age, died Decendent, then at Decendent at death owned property with estimated values as folllows: (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: AliA $ IeS5 Man ~/()t:J. t:)t:JO. Db ~ $ AI/A- $ ,IV/A- $ Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name f . C!br<< Jr. RD/urC r! (bl"ht! G-,.ac H. S~"er Relationship SD., Cion fer THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. t IfJ!1t-OI rut.. ]~ lIuhol A. &1'6,- fro I ~ g II/) $oHM t';'J.I~j, HeI. ;:g AJ'{I.h~~1J'cc/u~~~ #/1 /705"0 3~ ~ 711- 7~~ ~~D <1J c....-- , 50 ~ C bIl Ci'i lto- ;;>~"'- \q OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. /tL;--o .aL J. / / -- <IJ -- o \-, = .... ~ s:: Of) V3 No. 21 - 01 - 706 Estate of HUBERT A CORBE SR , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW JUL Y 30, XV9 2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that HUBERT A CORBE JR is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby:granted to HUBERT A CORBE JR in the estate of HUBERT A CORBE SR ~@. ~~:f::) #A- t),&tk. MARY CLEWIS . 0 ~ .~it~ES Letters of Administration Short Certificates( 5) . . . . . . . . . . Renunciation . (2.)............ JCP $ 200.00 $ 1Fi.OO $ 10 00 $ Ii 00 TOTAL _ $ ?:iO 00 . . . .JULY. .31 ,.2001. A.D. b9c ?001 f!/~ /?4e/~7i: ATTORNEY (Sup. Ct. LD. No.) 38'S-IS 6 ehk.5pr Rd, /J!fl7j/l/J,(-s6Itd, AI /7/)SS-- ADDRESS "7/7 - 76(P -o2LJ 9 PHONE Filed Mailed letters to attorney on 7-31-01 o .11S 1S to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. 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. No. ?~ ~-~ Local Registrar Fee for this certificate, $2.00 p 7555438 9'1 :z l ;tool . Date H 105.143 Rev 2187 COMMONWEALTH OF PENNSVLVANIA . DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ....PEJPRINl IN PERMANENT BLACK INK NAME Of' DECEDENT cf'$1 ""_. last .. AG( (la$l BonnoaVl UNDER. VEAR -.. oa,. 81RTHP1.Aci (CoIy and Slate 01 f Oleoyn C""""YI Chicago. Illinois ~IO 98 '1',. S. COUNTY OF llERH Cumberland RACE. __.... 8IaclI. _.. ... t~, lit. "'. White DECEDENT'S USUAl OCCUAVION lGiv<>""" "'.-" done dulong.... oI-ong"';.sao nal._ ,"elI I . "a. engineer 1111. OECEOENT'SIoIAllIHG AOOAESS (SIr.... CIy/Town. SlaIa.l'opCodeI 801 Hanover Street Carlisle, Pennsylvania 17013 II. ... FATHER'S NAME tfoll.~. la..) ITll. Did cIacadonl .... .. a Cumberland -.NpT 17...0 ~-==:::'" MOTHER'S NAME ,F... _. "'_Surname) It. Caroline C. Cramer INFOIUIANT'S MAIlIHG AllOftfSSISlr".CCyfboA.~. ~coo.l 2Gb. 6 Dewalt Drive Mechanicsburg, Pa. 17050 PlACE OF 0ISP0SlT1ON. _oIc-a.y. Cr..-y lOCRlOtt. CilyfboA. SIale. Z-., Code 01""""_ Rolling Green Memorial Park a.e. MAAITAl STAruS . Iol4Imacl _.......... Widowed. ow-.d~l Widowed II. North Middleton SUfMVlHG SPOUSE In _. gowomaooonnamool '"'" ~ II. lNfORMAHT'S NAME (Typ8IPr""l Zenan M. Carbe Grace Stoner ~ o w :rl o o ~ 0( z ald. Camp Hill, Pennsylvania 17011 (~e4..r~ev>~ t;;u'l.dl~ DUE rof{lAAS A CONSEOUENCE (1): at. .~ '-- :--- I I d-r ~' PART II: DII1er Ilgf1iIIc:anl c:ondiliona lXll1II1IluIinQ to _. .... "'" --.g iII_~...... giloan.. PlUlT I ~ ~ ..J ~ ~ ~ [ : DUE 1O(OflASACONSEOUENCE (1): DUE rotOR AS A CONSEOUENCE Of) WERE AUlCPSY FINDINGS l.tANNEROf'DEATH -.-eLt: ....-10 COMPlETION OF CAUSE Hal..... lEf 0 OF IlEAlH? Homooda Ace_ D P....mg """''lIa'ion 0 No~ _0 No 0 S<Jicidoo 0 Could noI M delermtned 0 DATE Of' INJURY 1_. Oa.,. \liar) TINE OF IKJlJAV IHJURY A7WOflK? OESCRIIIE IfON IHJUAV occu_o. ..... 0 HD~ AI. ~ lu2.t I ~ ( ll-I o 2... allt. CEIlTII'ISIIOI_ oR, anal -CERTIfYING ....ySICIAN:(Physc'ilf\~en.ty.ngColUM ~ aealtl wfle" anO&h8r lJhVSICIoiU\ has pOflOW'lC.ed oe41t"l diOOC()fl)p1eled Ilem 23) 10 ... _ of Ill" _....... de.... occ:......s _10 \he eauH(.) and manna, .. ........ . . . .. . . . . . . . . . . . . . . . . . . . . . . H. PlACE OF INJURY. At _.!ann. ...... tactoty._ -.g. ... ,SpacM 3Oa. .PftC)HOUHC;lNG ANO CERTifYING PHYSICIAN ,J't>,soc"", boon ;><ooouncong ueolth aodc..'dy"'9lO .""SIt 01 """.,) To.... DNa of MY know..... cIeath oc.cunM .Ilt\e II",., de.e, .nd ... and due to lM cauM(.t and m.nnc'-.. a..led ".OICAL EXAMINER/CORONER On _ _ ot aumln.Uon ancIIor in"Ullgation. in my optnion, deall1 occ:..".d alll1. II...... dal.. and plac.. and d...lo Ih. c.....,.} and m.nner.. ...ted.. . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . 31. 34. Ju I y 02Z ;10Q ~1 - 01 - 706 RENUNCIATION To the Register of Wills of M-ub2-c\::.. Pt~ Co\~ ,,~r. ~U \'Y\ 'ca-~~ deceased. In Re Estate of County, Pennsylvania. The undersigned _ ~Rob~b ~ &rk ~bY"'\ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters a1= ~L\ VV\; n \ ~\-<'ttt:i 0 n be issued to H\.) ~ A.. C,prb12..) J"" r- hand this 3e>~ day of H · ,Yf2<<LL. WITNESS ~ ~E~p ~ x f2u u::: d (Signature) 7'-Lf.5l; 4o,;,t~?' L.u,~ ;b{Y/Nrl'/s, Gf. ~Z (Address (Signature) (Address) (Signature) (Address) #1~~ (1 - 01 - 706 RENUNCIATION To the Register of Wills of tt,,'o1rl-- A ~\~) "S" (' l ) u'Y""\ 'Qer ~nc\ deceased. In Re Estate of County, Pennsylvania. The undersigned ~,<J..C..Q... t+. 0-\-0~ } rL~~ of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters at Ad.N\\,<,\~'\~6Y\ be issued to \-\-v ~\"'-\::.. A. Qp\~) 3'"~ WITNESS ~ hand this 30/4 day of M ,~ ::loOt ~ Z ~:iii> ~ r/ /: ~~A'// r;X(~- (Signature) X 6 altJ4lf /Jr., IlItdll/J;cSbJt J" #1 tI/1 17f)SZ) (Address) (/ (Signature) (Address) (Signature) (Address) "-'"'i , \ ~ --- CERTIFICA TION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Hubert A. Corbe Date of Death: July 25,2001 Will No. Admin. No. 21-01-0706 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 3,2001: Name Address Grace Stoner 110 Salem Church Road, Mechanicsburg, P A 17050 450 Lapidary Lane, Young Harris, GA 30582 6 Dewalt Drive, Mechanicsburg, PA 17050 Hubert A. Corre Robert Corb6 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: August 5, 2001 ~ N 0: '."3 tE :) ~~~c-? HARLES E. SHIEL , III _ 6 Clouser Road Mechanicsburg, P A 17055 Telephone: (717) 766-0209 Counsel for Personal Representative o - \n:.;:~ o or5; u ('I) a> a: CC C".) c::J ;:\3 p .,~:'2 '::J:: \1)= Gu 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 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 -.------ fold ESTATE INFORMATION: SSN: 172-01-9149 FILE NUMBER: 2101-0706 DECEDENT NAME: CORBE HUBERT A SR DA TE OF PAYMENT: 04/23/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2001 NO. CD 001101 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4( 1 00.00 I I I I I I I I TOTAL AMOUNT PAID: $4,100.00 REMARKS: HUBERT A CORBE JR C/O CHARLES E SHIELDS III ESQ CHECK#103 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS \, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 i,HARRISBURG, PA 17128-0601 April 29, 2002 .02 (iny -3 i '1 q i .,-- Telephone (717) 787-3930 FAX (717) 772-0412 Charles E. Shields, III, Esq. t.:' " 6 Clouser Road eln Corner of Trindle & Clouser Rd. Mechanicsburg, Pa.17055 Re: Estate of Hubert A. Corbe Sr. File Number 2101-0706 Dear Mr Shields: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before October 25,2002. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, -~'''',-,- /:'::"/, ,'" -- ~.,--...~,,~:.~-... 7 ~', ' i ~ ;,1 /t Il / f'f /'/ i:~ (t 'f: (I It / ij!!~,? I I (,/ //1 " / J/'l //"'/;,> /l'~~/Ii!ffr~'cQ~' enbush, Supervisor 1/ ~,~ 'Document Processing Unit Inheritance Tax Division' Ib -,;LY'6' /y ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-19-2002 CORBE 07-25-2001 21 01-0706 CUMBERLAND 101 Allount Rellitted CHARLES E SHIELDS III 'O~ 6 CLOUSER RD MECHANICSBURG PA ~!055 (", .. 't ,I \. ,\ . 23 * REY-l547 EX AFP COl-a2) HUBERT A ) CHANGED ll) (2) (3) (4) (S) (6) (7) .00 91.300.82 .00 .00 784.13 7.691.31 .00 (8) 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 ~ REY=is4-j-E"X-AFP-ccfi=02j--NOT-fcE--OF-"fNHEiifTANCi-TAX-A-PPRAfsEi'-ENT~--Ai:.i-owAiicE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CORBE HUBERT A FILE NO. 21 01-0706 ACN 101 DATE 08-19-2002 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. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage 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 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ abb returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 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: NOTE: (9) llO) 7,255.38 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 99,776.26 11.847 34 87,928.92 .00 87,928.92 (19)= .00 31956.80 .00 .00 3,956.80 4.591.96 ll1) ll2) ll3) (14) .00 X 00 = 871928.92 X 045 = .00 X 12 = .00 X 15 = "A'"Cnl KC~C.L"I T+T AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-23-2002 CDOOIIOl .00 4,100.00 TOTAL TAX CREDIT 4..100.00 BALANCE OF TAX DUE 143.20CR INTEREST AND PEN. .00 TOTAL DUE 143.20CR . 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).. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) "v /6--02Y6 -/y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV-l'07 EX AFP (01-02> CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG PA.17055 ~ . \ '1 C DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-16-2002 CORBE 07-25-2001 21 01-0706 CUMBERLAND 101 HUBERT A :-: ') 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 RECORDS ~ iiey=i6'ifj-ix--AFP-col-:02i-------...-iNHEii'fANcE--YAX--ii"A'TEMENY-ifF'-AccoiJiff--i.-.---------------- -- --- ESTATE OF CORBE HUBERT A FILE NO. 21 01-0706 ACN 101 DATE 09-16-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYHENTS~ THE CURRENT BALANCE~ AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 PR I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 3~956.80 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-23-2002 CDOOII01 .00 4,100.00 08-28-2002 REFUND .00 143.20- TOTAL TAX CREDIT 3,956.80 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 $l~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAY BE DUE A REFUND SEE REVE ~ RSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) .. .. , . ~:K STATUS REPORT UNDER RULE 6.12 ~f Name of Decedent: ("oe13c; l-/u,ber-c A 7 -;;J S-- 0/ Date of Death: Will No.: Admin. No.: d j 0/070& 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 r&J 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 the personal representative file a final account with the Court? Yes No @ b. The separate Orphans' Court No. (if any) for the personal representative's account is: Date: c. Did the personal representative state an account informally to the parties in interest? Yes J\l 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. U~ f Hdtr/s ~ Signature Ch~ES CC Shleltls. 1lL Name 0\ ~ #; C/-fJtI.f~ ~IJO Address /Me07tll1llSburz;. #J /' 7o~ 717-'l&tb-O/07 Telephone No. E: \.0 z ;::::l J ""'1 it CV\ P _0 .:;:: "p :-c::: (:;(5 Capacity: 0 Personal Representative ~ Counsel for personal representative . Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 ~ Date: 6/10/2003 CORBE HUBERT A JR 110 SALEM CHURCH RD MECHANICSBURG, PA 17050 RE: Estate of CORBE HUBERT A SR File Number: 2001-00706 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: 7/25/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: )File Counsel Judge . ."", COMMONWEALTH OF ~. tt,. PENNSYLVANIA , . ~ DEPARTMENT OF REVENUE DEPl 280601 HARRISBURG, PA 17128.Q601 REV.1500EX(6.oo) I- Z W C W U W C w ..., :.::~(J) 0"'''' w"-o ",00 0"''' ,,-lZI "- .. z o ~ ::::l l- ii: <( u w a:: z o !<e I- ::::l ll. :ii o u X ~ -', ;':-:'/,/.), REV-1500' OFFICIAL USE ONLY 6 /fo~ ~c./0~ /~ FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT ::1.L-.2.1- COUNTY CODE YEAR OO...7QirL NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C-O~f5E, HUBER! ,40., SR. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 07- ::!5- ,).001 O.f'-/)fs, -/902- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) AI/A SOCIAL SECURITY NUMBER /7.2 - 0/ 9JL1-9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return 04. Limited Estate ~] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale ofdealh aller 12-12-82) D 7. Decedent Maintained a Living Trust (AtlachoopyofTrusl) o 10. Spousal Poverty Credit (dateofdealh tletween 12.1'-~1 and 1-1-95) o 3. Remainder Return (date of death priOf to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to lax under Sec. 9113(A) (AlIachSch0) ..., z w o z o "- '" w '" '" o o NAME (!J-I /lte L ES E: $/I/EL-D-S FIRM NAME (If Applicable) N IA llL COMPLETE MAILING ADDRESS c;,. C LOuSE/i' ~O/9.D /J1EC:hI-9/11/CftSlIRG, P/I /7t:JS.r TELEPHONE NUMBER 7/7- 7~' - 0:1..09 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inler-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 minus Une 11) OFFICIAL USE ONLY -::::" 1- '1'1 77(,.;?fs, , (11) (12) (13) ; /I, fS'I7. 3'1 , ~7, 9~5", '1d o 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Une 13) (14) f g~ '125',';2 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amounlof Line 14 taxable at the spousal lax rate, or transfers under Sec. 9116 (a)(1.2) o tj 8"7, 9" ,u. 't2. o (} x .0 12- (15) xO~ (16) 0 ~ 3. q 5 {,. 6'0 (? 0 '3 'i Sb, 8'0 J 16. Amount of Line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate x 12 (17) x 15 (IB) 18. Amount of Une 14 taxable at collateral rate 19. Tax Due (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS CHUIUfI 01= G-oj) HI/mE /, " - . !to/ N. fllf.#PY~ .s TA!/fET CITY C/fllLISLG' I STATE flA I liP 17l>/~ " (3) 0 If (4) I '13. ;;LO (5) 0 (5A) 0 0 (58) Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Pnor Payments C. Discount (1) o IbP I #0 () 'fl.{., Total Credits (A+ 8 + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty () o TotallnteresUPenaity ( D + E ) 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 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. ! 3, qSr...1l0 . l.{., IDO. DO A. Enter the interest on the tax due. 8. Enter the totai of Line 5 + 5A. This is the 8ALANCE DUE. 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 a. retain the use or income of the property Iransferred;.......................................................................................... 0 b. retain the nght to designate who shail use the property transferred or its income; ............................................ 0 6. 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 deeth without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust fo~ or payable upon death benk account or secunty at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non. probate property which contains a beneficiary designation? ........................................................................................................................ 0 No ~ ~ ~ ~ IRI I8l ~ 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~UlY, 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. Dedaration of parer other than the personal representative is based on all information of which preparer has any knowledge. SIGN E F PE L jl'0 FILING RETURN Xl AD RESS HUe. H. ".e8 ,.T.e. //0 S/JU!h1 t!1-/,u(~H ,eD., meC,IJ/J/p/C.f8ttlf6;,P/J /70S'0 SIGNATURE OF PREPARER OTHER THAN EPRESENTATIVE cAft.< . II ADDRESS C.#/9A!LeJ E: SH//i!Z.OS 1/f ~ CL..Ott,si:Je Rj)., met!IT/J/VICSditRG, "'/1 170SS' DATE (; ..;It''' z DATE ~ ' .? ~ 'Q z.. ~~~~~~n~r:?~1i1~~I~~~~r 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. 29116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net vaiue of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. 29116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutoI)' 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 0% [72 P.S. 29116(a)(1.2)). The tax rate imposed on the net value oftrensfers to or for the use of the decedent's lineal beneficianes is 4.5%, except as noted in 72 P.S. 29116(1.2) [72 P.S. 29116(a)(1)J. 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. 29116(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. , , COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE 8:';~~AI; OF INDIVIDUAL TAXES OEPT_ 28060'1 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) ~ R~CEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ---n-nlold ESTATE INFORMATION: SSN: 172-01-9149 FILE NUMBER: 2101-0706 DECEDENT NAME: CORBE HUBERT A SR DATE OF PAYMENT: 04/23/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2001 NO. CD 001101 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,100.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HUBERT A CORBE JR C/O CHARLES E SHIELDS III ESQ CHECK# 103 SEAL INITIALS: SK RECEIVED BY: TAXPAYER $4,100.00 MARY C. LEWIS REGISTER OF WILLS 'REV_1503~':'(1'97l. I I I I j. . ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF _ &R.8~, /ltt.l5eA!.T A., SA': SCHEDULE B STOCKS & BONDS FILE NUMBER ;;:2 /-ol-7t?(D All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F. ITEM NUMBER 1. :I. 3. 1. s. VALUE AT DATE OF DEATH DESCRIPTION ~ s t.J .s~qre.r q! e,;11f/11M C-u5if'~ O::J !i81"f/D 9~ h: 3l?lo 10 37.'1' sf"d< of /f.1J1t:r/call /::.></) rt:ss :;r. ave. 37.7f xc,s4 = ~ :J'f, 70 f. 12. ~. uf. ~ T~k(r {f' {".f' ~yUJo' ,200 shtlr'es 01 c:,/JIdI'~ s!z,d< "f ""m~r/cA.ll (J.. . /. . 1& f ~ U(51f7. 0.30{77 10 r m ;(0. ZZ 0 {'f.sl <t-t.!!. ~ 3,973.00 ~ S's. 97 Jhlll"eJ u/ &/JI/I1M (!.asip 077f'0/0;' ft.' Y/,bS s!-bck..f /3el/ sou~, I" If 3'1.70 a.e. "1/tlJ7S '" 'Iss. 9'J ~ "Ill'. f{:>~.20 , /DI. 3:3 'f sl"U"I!S' uP I!oI/lIl1P/! s/77?-/< tf .&hIl1M I3rolt'e.H &s/I .5'.:t'l9~1l'O~1' At' "7:1.00 !o -7.DO ave, ~7.7.00 x. 101.33'1= ~ ~ .:l7,.0:> Ii( 7. '1.5''17 shares Cusip L,t '" 2.S f{ 1/)-0 01 ~1I1111()1I mcJ1 0/ JP /)7br1lJ,n Chase.f~. A; 1 '13./$ " "-iV.70 a.e. ~'f~.I{S J<. I ;J,i. 'is'/7 =: ~ 5, 'fJf.I, 7 b. 10,2 slutT'es "I &111A11>>1 ~I< or (tsip 5''f9 (,,3167 000 i; "7.00 I,. ~~93.6b Lucent ted.n%f"u ~,."o aye. flh.'tJ x. 10;1 - 7. fJr.. d'e"f;af SOl!u,,;f,~s, ,4ut H~h1- L,ttJ3Z$" Pr..,4"h'al UHf. hind cl /I- / ,:)'17. 1)~9 shaleS @ ~/. 31 " 2, Iil/f. 12. 8: ~r shltl'eS ,1 e-,IIf"'" s-hd<.r &,5;/1 713 ~GI/).3I)OO A; .'13. '19 , n 3/7. Sf., sse. c.,""I\1Ll.Y1iC4.l-; 0"" I> ~ k 'If I. 1'0 a~, ff2. f(S" X. '(oK =: 'I. 100 shlJ~ of {!Pili",,,, sbd of J!/!"izon Cu~ip 9J.3'1:JV /b'l-tlo It; ~5"'.P(1 /0 "'5'1.30 ~ '5; SIS,DO (1 Vi!. 5.5'.15 X. 100 ., Ip. .(5~ SlrIJhS t.! {bAfmP/'1 -:skd: "f VodohAe 6roqp f7L~ dts,jo 9'?S'S7W/(MOOO /,; ~b.o.s- " " JtS; 0'15. So /0 I? '15' a.ve. 19.15' " :l S II ~ TOTAL (Also enter on line 2, Recapitulation) $ q /, 3 D/). Z;;l (If more space IS needed, ,nsert additional sheets of the same s,ze) """"""'1'''1 *' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. 'NH~~~i~~Zi ;~E~~~~RN PERSONAL PROPERTY ESTATE OF C~A!,t5E; I-Itr~c72T /1-., SA:". ~ FILE NUMBER 2/-01- 7 ~tD 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. .2. g. 4. 5. r:.. 7. 1'. 7. /0. It. DESCRIPTION E sch eat fJrt'l'er~ fb.YH":Af -;;."... (l,J1fHl"hw~a/H, .i7$"'/~1 Escheat Pr..pa'/j IkYIJ(~HI ,t;...At &IfIIHOHW~6 Iff, ~-/Z.2/"" Esc/reed p""/Urtr IkY/J?Mf !n>n, (J,,Mf/Ho/lwetlJ'i ~//S'I../ jJrk'/~/Ih'al ckt:lln'lf Znc.c~ A)dllotf 7/Z./D' YerizoA - A"e h.n,f 8a/eOlu 1t/2-8/o/ VALUE AT DATE OF DEATH ,r 1"1. ~o }l 13;z...59 , '73.00 ,c /03. 9 I /'lifT - r;/,q/ /fUbtlHt C!ncl,'f B..! ,f'e,.{."d 8/30/01 " 5.35 Y It). S.:z t?../u!<d - S",{';s~,.iph'ol1 ~ r;...;del''''s~ 1/31/6'2. {!rul,'I /Jak1na! left"",! ehedt 1;0'11 U.J.ISeut,k ID/.-/O/ Belco Coml11utlllf eredd Ltn; 6.. ,hd- -it> 04~'2./O r"f; /icer. +0 d.o.d. 0.. I+em -/I q. (6ee feller alfae/wl herelr>) Cred,f 1;]411l"u - PIf?Pj//~I/I/J "I.U, II S.I>O ~ 175.7'1 . 'fS ~H.91 t- I;!h:, 1'I/J1e: ~e(JetltHl MtS elderly, I;ver! in ntbtlesf fu,me hI" elderly awl ktl //t't:n lilUay all f;,'ff/:bk p-rsont1/1;- d~' JtAY ralue ~ /tQ"~ tljo. TOTAL (Also enter on line 5, Recapitulation) $ 716 if. 13 (If more space is needed, insert additional sheets of the same size) """""'"'l- 001 ~ ' '~DC FUND '=== ,'~,~ ,,~ , -= THE YORK BANK AND TRUST"CO:'" ,= YORK, PA ,~ VERIFICATION AVAILABLE- "POSITIVE PAY'" = ,- - ,- ,- '~ - .......... ._-~". " ~' , , =, 00184848 VOUCHER \lVV,lQ' 60-153 313 ~1 09373509 . n, CHECK NUMBER r~:~~::.!iIltQ TO THE ORDER OF HUBERT A CORBE 99272242 1100 GRANDON WAY MECHANICSBURG PA 17055 ( .;"j. -1P....., C ",0 ' '-', "r,'q ,(I..... SI~,.:J..,,,.'Y 2.,.~.I......1 "1~q. PROTECTEO 05/30/2001 DATE VOID AFTER 180 DAYS $ ************101.40 &~ TREASURER OF PENNS 11'0'1:17:150'111' I:O:llo301o5:121: 10228 81:... 1:.11' TO THE ORDER OF HUBERT A CORBE 99272240 1100 GRANDON WAY MECHANICSBURG PA 17050 .1..;n.l"'l"'''::I=--.T!T~'':I.I''.:[.I..lh.~I._1...fC1:I_I....I:::l:II;;:1o..'I.'I...::I:I,'J'.':l~~ ( ", '"1).-,---,~ ,. ,.,.,. _'-"'-". ,"_' ,.., "'.,.,, ,>.., ",. ""'-'. ,',' .', . " iHOLDOOCUME""TQ.LiCiHTTOI(ERIFY\iI(,,,TE"MA"~S ...,' " .. , " '.. .. , -. , ,''''.- ,',' -~ -.; .- .. ."...." 0000.72; 60-153 313. CDC 001 FUND 051501 PREP DATE 00184824 VOUCHER €.2 ? 09366986 51 003 OEPT CHECK NUMBER '. THE YORK BANK AND TRUSt~O." YORK, PA VERIFICATION AVAILABLE- "-PQ,S.ITIVE'; PAY'.' = - = - = - = - - - """"""" = - .......... - .- ~ ........ .;'':'/th.l P ~."I.- e"~"'''Si..I:. .)-,"., ':/).,-1?0o..., Q."q. P-ROTECTED OS/22/2001 DATE VOID AFTER 180 DAYS $ ************132.89 lI'O'l:l1:.1:.'181:.II' 1:0:110:10105:121: 1022881:... 1:.11' DO NOT ACCEPT WITHOUT HOLDING TO LIGHT TO VERIFY WATERMARKS. -.,:7;:::-----",.-,----,--,-,-:-;- ----,--,- ," "',. ~ ""~~.'":':.~--.--,-., ." ,,\,ATERMARKS 000057 E3-- 28 03778842 CHECK NUMBER , . :: HOLDodCuMEiIITTQLICi!it I(ERlFY' , 001 003 060701 00184918 315764 172019149 I. CDC FUND DEPT PREP DATE VOUCHER WARRANT ID , ~ = = = = ,- - = ,- = = = - = ~ '- '~ ,~ = '- ~ 56-389 412 ~ATIONAL CITY BANK PITTSBURGH, PA VERIFICATION AVAILABLE- "POSI:TIVE PAY" PAY,...l".,~n ONL~mm TO THE ORDER OF HUBERT A CORBE SR 99004506 1100 GRANDON WAY MECHANICSBURG PA 17050 ,."""hl. ,,/P""'ISf/t. C.Q...."'oSI~.,._']._,~., 2"...."....., t...."',;,. PROTECTED 06/15/2001 DATE VOID AFTER 180 DAYS $ *************93.00 TREASURER OF PENNS 11'0:177881. 211' 1:01.1020:18'151: 0 lo 1051:.1.1011' Pock Slip Station P.O. Box 2052 N"'tf York, NY 10272 ~ Prudenti~ Securities 2, ZOOI "_'SYRA:~USE. NEW YORK j ~tf;~ '" .:._;0 HCM-403255 JULY "",'''''';' ,NO. 011805407 $1l1l1l1l1l1l1l1l***'lO8-.91 ~ 213 Account Numb., OlE One Hundrell Eia~~ 9-V1~O _Q9LLARS, "'''-",~",2+':..;. ",- ~, "",,,,,,,;,;".,,,, ''i'':'::'':':''':'':';:':'1 r . """""c",",'..' ;"':','i -,':.,'::,:,":'.:','::..;': ""',"C PlIJTo Th.Onl.rOf HUBERT A CORaE 1100 GRANDO'N WA MECHANICSBURG P VOID AFTER 180 DAYS (jJ~ ~ Prudential S.cvrltt..lncorponrted ./ ".,."";""".,'.'.\.",-....."...:.-::,.,,,, "., ,.. ....c,. """..,,,;,,..,,'ir,, ",,,"",,,,,11"',",": ",""""C~:I,'L ,.""'~.\~,:..W!~'..."""",:,,....,,"""', \""',- """"""'''''''''''"'"..,','.'::'''M'''''''''''.,.''''.r "'",',;~"",\"i"",',"~';," /;""-,;,;aW"".""",;,;,,,,,,,,,,,,"'~.',':,,;;iIil.'~,\'_""""",,,,,,.,:,,_ 11"0 ~ ~ao 51.0 711" 1:0 2 ~ ,109 :1791: 1;0 ~'" 2.11 257:1 :III" a ~ O.Krlptlon _... s 4DlV ~ Prudential'" Securities Account Numb.r HeM 403255 JULY 02, 2001 I , yf/ ,;."< .::,- DATE 08/28/01 CREDIT 8ALANCE REFUND TELEPHONE NUMBER 717 761-4921 TOTAL REFUND $5.35 PA '" ., ~. verizR!t 51-44 119 NO. 5555763 AUG 28, 2001 COMMISSIOU/REFUND FIVE AND 35/100 TO THE ORDER OF ACCOUNT **********************************DOLLARS PAY $*******5.35** CB VERIZON PA HUBERT A CORBE 110 SALEM CHURCH RD MCHNCSBRG PA 17050 Authorized Signature YNFC - YERIZOM PENNSYLYANIA PAYABLE THROUGH FLEET BANK HARTFORD. CONN II" 5 5 5 5 'i'b 311" eo 1.1..,001.1. 5';' b'i'l.l.bll" -.-.-.- - - - - - - _.,----- ----.- -.-,- .........-.- -.- -.-,-.-....... ~...:....____,_,-..___.___~___4_...._._._._'_ - ---,.-- - - -.......- --~ . . -- .....--..... . .._n.__.. ___. _no_.. ... ...._ _ BOOOOO 0913128964201 HUBERT A CORBE , . HECK DESCRI PHON - 963 FINAL LED ACCOUNT CREDIT BALANCE REFUND RINCIPLE AIIOUNT REFUNDED 00000001052 CHECK NO. 4-0166008 8AT1.T DATE 08/30/01 RAPSB CHECK AIIT. $*********10.52 FOR INQUIRIES CALL 800-222-0300 SYSTEII RESIDENCE SERVICE REFUND SYSTEII CODE ,~ 11ach ire - - ._,.__._ - o..u .. _ __. _ 0 _____ o__._.__~_______. _._...... ___ ._.....~_~__ ....._.__._ _.__ DBtaollj Here .=0=-'-. 62-28/311 8AT1.T The First National Bank of Chicago - 0710, Chic:aqo, Ulinoi. Payable tb:touqh FCC .ational Bank, Wilainqton,Dela_re ~count MWDber 0911'782 Check No. 40166008 Payable Mo. Day Yr. 08130101 RESIDENCE SERVICE REFUND TEN DOLLARS AND FIFTY TWO CENTS IN US DOLLARS PAY TO rHE ~DER OF HUBERT A CORBE 110 SALEM CHURCH RD MECHANICSBURG PA 17050 $*********10.52 I PLEASE CASH PROMPTLY. VOID AFTER 110 DA.YS OFFICE BOOOOO ACCOUNT NO. 0913128964201 RAPSB ~~~::1~eL)wr- 11"1.01.1;,1;00811" ':0 :11.1.0028 :II: O'i 71.78211" ''-....., . .....-~,._. . I " " . f-' .... <.r1 :'0:; en 'I ~ <.0 ...~ W '0 '" DATE: October 29, 200l TO: Hubert Corbe, Jr. FROM: Charles E. Shields, III RE: Check from US Bank Charles E. Shields, III Attorney-at-Law 6 Clouser Road Mechanicsburg, PA 17055 717/766-0209. FAX: 717/795-7473 Enclosed is a check from US Bank for deposit. fkdPJ.~E. S'/" ~ ll.S. (Ja4~aA I- I' ,I I Reissues ACCOUNT NO 4190080857500130 -':-(U)"'-' OPERATIONS CENTER . . 1010 S. 7TH STREET FBTT0416 MINNEAPOLIS, MN 55415 PAY *** FIVE AND 00/100 DOLLARS *** TO THE ORDER OF ESTATE OF HUBERT A CORBE CIO CHARLES E SHIELDS III 6 CLOUSER ROAD I MECHANICSBURG PA 17055 l!Elbank. ~ll.MN 17.2.910 DATE 1 0109/2001 g~ 963101 AMOUNT $5.00 NOT VALID FOR OVER $50,000.00 ~") pL ;?J-P? I I I I I i il I'tP "%'i ~I II""!:, 3 ~O ~ II" 1:0., ~OOOO 2 21: ~ 7 3 ~OOO 7 7 3 ~ 711" CHARLES E. SHIELDS, m ATTORNEY-AT-LA W 6 CLOUSER ROAD Comer ofTrindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795-7473 October 29, 2001 Ms. Linda Luthi Customer Service Supervisor US Bank National Association, ND clo U.S. Bankcorp Service Center, Inc. r 0 Box 6345 Fargo, North Dakota 58215-6345 Re: Estate of Hubert A. Corbe, Sf. 4190080857500130 Dear Ms. Luthi: Enclosed is a death certificate for Hubert A. Corbe, Sf. as requested in your letter of October 5,2001 (copy attached). Thank you for your assistance with this. Very truly yours. tM,f~ Charles E. Shields, III CESdab Encs.2 . [:!I1bank.. October 5,2001 Charles E. Shields, III 6 Clouser Road Mechanicsburg, P A 17055 RE: 4190080857500130 - Hubert A. Corbe, Sr. Dear Charles E. Shields, III: Thank you for contacting U.S. Bancorp Service Center regarding Credit Balance Refund Check # 930322 issued to Herbert Corbe, for $5.00. We have requested that the above-referenced check is reissued to the Estate of Hubert A. Corbe, Sf. Please accept our apology for any confusion that this may have created for you. For security purposes we have closed the above-referenced account. However, please send a copy of the death certificate so that we can complete our records. If you have any further questions, please contact any of our service representatives in our 24-hour Customer Service Department at I (800) 285-8585. We are here to provide solutions to your banking needs and look forward to continuing to serve you. Sincerely, Linda Luthi Customer Service Supervisor Creditor is U. S. BanI< National Association, NO, do U. S. Bancorp Service Center, Inc., P.O. Box 6345, Fargo, ND 58125-6345 Local .. . ____.,._________ _____ 0-' _H ._ _~.~__U) --t'~-- U_~....U ........b~u.... _...~<u'-'........... v. ........a.>! u,,,uI .lu.......... Registrar.' The original certificate will be Forwarded to the State Viral Records Office for permanent fikng. YV!Ul UH, a.::. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~~ 11,'Ft'~\.\". OF. pl;t~~ "'-,\.~. "'1"',," \\\~/'--:~':~: ',' tF...J.:\. "~"."-""-c ~" ~~I -',!Ii"'-: 'y'" 1 ""~':.; \"'" ~= d-' -;;: ~ t,;l ...n' .. !h~ ~",'.- ".. ", '1*# \a~ ,'-"_ _" /~\\' ...~~.- ~-- - ,,~,\ ';. .:?, ~--<(\,"f"/ ',..!l,1ffNi ~~ ~ """ """"~#'#/"IJJIII'1 ~O-2J/,n~ I{~."- ~ Local Registrar \ Fee for this ceniflClte, $2.00 P 7555430 9~ ,z7 , 7<.,;1<) / , Da[e H10~_;'JA.. 2.'87 COMMOHWEA\.THOF Pf,HHSV\.VANlA . DEPAR'TMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYP~PfltHT '" PfRM"".ENT BUCI\INIt AQEll...II"",,-.J UNDER I YEAR - ,~ Hubert A. Carbe, Sr. uNQEalOlli -i-" ~'Ulltf"IN"-R -------- ~--;~~2U~~NUM~; _ ~~;_r~EJ~1;257f6tf.-;'-- _lkJ'\.AC!iIC.'~."" P\JoCEOFOE,o.:rH'C~oco"""Y"""'_'(""""""""""""'_ ...,."'fe'"".I"C........Vl HOSI'Il"'~, Chicago, Illinois """......0 ~\O tl.u.lEOfDEGEOENT(f.51._,l....1 ... ... Church of God Nursing Home RACE..........,....__._....e ,-, 98 v" . CO\.ll'iTtOFUE.oVH Cumberland White ". " Pennsylvania .. - _... Cumberland --..1 ,1111.0 :;::-:=.IlIl IoIOTHEfI.$N...IIoIE'f...._._~ II. Caroline C. Cramer ''''''OflMAHrsa.lAll.INOAllORESSlSnool.cw-. S-. ZopCcQoI _. 6 Dewalt Drive Mechanicsburg, Pa. 17050 Pl.Al;:EOFOISP08ITlON.N_"'~Ct_ Loc.vlON.Cj~s.....~Coo'- OIOl_PIKe Rolling Green Memorial Park lIe. w.AI1Al5WlJS.AIarf..... __IMl.W_ -- 14. Widowed u..~ -._-..... North Middleton SUSlVIVINQSI'OUSIi IU_.VOW"'->......., DECEOENl'SU5IJAl.OCCul'l'II'lON IG..._"'_~_do.oong.- oI~"'"'"tnginee..tl 11.. 1111.. OECEOI"'Il'S"'AIl.lNQ"'COflESIlSII",C~.S"",i''l>CO<lol lUNOOFBUSlHESS/lNOUS1~V Communications WiIlSOECEOEN1EVE~W US...._DfQlllCl;S1 _11J ,..0 '. fAtHE~'SN"'MEIFio.."'_,la"~ 801 Hanover Street Carlisle, PennsY\\lania 17013 DlOGEOENT'S ACTUAl. RESIDENCE ...-- ""-'-I u..s.w. ~ 11....C""" - " INFOR.........T'SN.....(l_"'''''1 Zenan M. Corbe Grace Stoner ,... METHOOOF OlSPOSlTION _[].CI_'_O _.."Q"'I....O CI/IiOFOOll'OSlllON J_.Oof._1 o Jut 28. 2001 311.. 11... Camp Hill, Pennsylvania 17011 " A'" 1E000PUISQKJ,CllltUl>S'S\lG)o\ LICEIiSEttuMIlf:R N.....I5At<<l'\oo~ES$lYF4ClUTV Myers Funeral Home. LICItMSEHUtoIIlI1R ..fizf) (/:>'J--e12~ ::--"'-'';- wo.S C\SE ~EFEARED 10 "OICAL EX"'IoIlJolERlCQAOHER? _0 o.;lil ~ , . . , ~''''Ya''.II._Q/''..rt'''''''. ... .olppf1Ul""'" '-- :--- : J- ~ PJUlTIl: OI_OIW'oIIc...._CGI1IIil>uln9.........,Doll "",.-..,.._~.-_..PAflTl (~e;;.rH...,~'-L;~.,/ UU.j.~tlhC- DUilOIORAS...CONstQUt:NCEOf1' '."J ~ ,- , ( OUElOlOflAS"C0N5EOUENC(O!'t : ~-'--OUE.'iiJ\OO..s:":~\lU\.t<<;Lut\ Wl!:RI!"'UJt)PSV~I~8 "'''''NE~OFDENH --..o.eu,..HltJl\lU COW\l'\.E"I~Of-C"'USE Of'~H? O"'TEOF-I~URV _.u..,._1 nM1i:0F1N.IUA'l' ItUURv,aWORK1 DESC~IBEtoOWl>lJU~Yor;;cUARf.O. , \J \..J l'-.~ N"",,, I@ o [] _.. [J [J o ~EOfINJU~Y'AI_.",,,,,"''''',lac&ory.Q_ ~. ~."e,l_wI _. _ 0 ,....lQ' "'.0- P._........~.,- Pt.f) " "~ ..,... 0 ,..,1&\ '" 0 ~[] S".._ C.,..,""'I>II...,........... ,~ i 3... nit. allTlI'IUI,C.oco....._, .C.....llf"f__..~lCl..."i\'h.""'.."".."'l""'leao'..'" d..... .........,""".. ...,....""'~.."'~OC...,I."""~,~J<..'.....,od"""'nl TO....._.''''Y.--..............IICC~..........''''".ca~.O\.I.nd'''._'.....,..... " ...IU)IC...... EU,MIIoIERlCO"ONI!~ 0" II.. b..'" 01 .......".11"" lI.I"Idior NlUollqollon, In my "p"""-,d<t.oh,,,"""." "\Mll<111o. II".. anO pIau. antill...,o Itl. ......C.l.nd m.".......,.'.o.. '" flEGIST')'A'SSfGN...rU~f:"'NONU_~,. , . ~J u .,--~.~~.,-,:{.~...~ .H:.L.vl.L..-)j~"l'~~P: \""J t ,.:>.,' "'-I ~ o ~". ~~:NlJtMJE~3f-Y? Z ,Ii- :TP~o.Tf:(}j_1 ~ WlIllEAHOAIXlI'I!SSOFPE~SONW\'IOCOt.lPt.ET.EOC"""'SEOIOi;ArH (11I....lnTyp.....pr\nI ,n..!. U/h'I//t6?./ / ht-...... ~ "d?, tV I~.(-n...--"-" _ o I~.... 'h~ J, /.}. /';;"1..1. n. o.oIE'...Eo'''''''''nO'O.,_1 'PAOM(lUNC,NQ ...NDClIlTlFYI_""'SICIANl""I""""''''''''"'",....,.'''.''l''e..'''.J''d~..,..onq'''''''''....''''_'' T..m._..l""..._leoIG..~..Ih....<...'.....,h.,I.....d..., ."".......ndd.....,........O(.I_..............,.,.... ...July..l? 10,-, -..--.--.-.. . - r BElOO COlll"llurit~ Cre,/i! U"ioll .Lw- Committed to Quality Service 1. Name(s) in which the account was held: DECEDENT ESTATE INFORMATION ]. ~()(he 2. Account number: 3. Balance as of date of death: Balance Accrued Dividends Regular Savings: $ \JS.itL $ GLIS Christmas Club: $ $ Whatver Club: $ $ Checking: $ () $ D Money Market: $ $ Certificates: Balance Accrued Dividends Certficate Number $ $ $ $ $ $ $ $ $ $ ~lo~ 4. Date the account was initiated: 5. Name(s) in which Safe Deposit Box was held: 6. Date the box was initially rented: 7. Branch address at which the box is located: 8. Loan Information: Balance Accrued Interest Per Diem Int A. Unsecured Loans: $ $ $ $ $ $ $ $ $ 8. Secured Loans: $ $ $ $ $ $ $ $ $ C. Mortgage Loans: $ $ $ $ $ $ $ ~O~- $ qr~. $ 9. Miscellaneous: ihls QC~t\h.fl+ !~ on BELCO COMMUNITY CREDIT UNION MAIN OFFICE 403 N. 2nd Street . P.O. Box 82 . Harrisburg, PA 17108 . (717) 23-BELCO Web Site: www.belco.org ',:) <:(',,1 ~; NCUA --",......".~_...'- ,R~_t~M~". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENi DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF Ct?~ 5 t; l-Iu8EtZr /1-., s /? FILE NUMBER ::1I-0J- 7~(, If an asset was made joint within one yea, of the decedent's date of death, "must be reported on Schedule G, SURVIVING JOINT TENANT!S) NAME ADDRESS RELA TrONSHIP TO DECEDENT A. H 1J.f3Ellr If. ~1l8E; JR. / / (J S/l-L-Eh! C!lt(Ai!t!/! /i'Ll. hlE(!H-1-Nlc5811Ai!(,., ,61", /7oso SoN s, c, JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH ITEM FQRJOINT MADE tnclude name Qf~nancial il'lstitutioo and haok ~nt number or similar id9rltifying number. Attach DATE OF OEATH ~CD'S VAl.UE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1- A. 'II..,./....t, Ih + 7 lJ..ufk ~et/ltl!t frt:'1! /ell.--n/ CN.{J /J. ~ " 1/-0" /S,312.&./ ~~ 7, {, '11..31 y...", ({ebud( ~~cltLd) ...,... TOTAL (Also enter on line 6, Recapitulation) $ 7, " 'lI. 31 - (If more space Is needed, insen aclclltional sheets of the same size) , clro.c1 ~ ~M&rBank October 5,2001 Charles E. Shields Attorney-At-Law 6 Clouser Road Mechanicsburg, P A 17055 Re: Hubert A. Corbe M&T Bank Account Dear Mr. Shields, I am writing in response to your request for the deceased's banking information. As of the Date of Death you indicated, Mr. Corbe had just one deposit account with M&T Bank. At that time the balance, according to our records, was $15,382.61. This is not an interest bearing account. Furthermore, the account is a joint account with right of survivorship. The second account owner is Hubert A. Corbe Jr. There is no record of a safe deposit box. If further assistance is needed, please contact me at (717) 766-1847. s1er , ~~. ~ebu Branch Manager Mechanicsburg Branch Manufacturers and Traders Trust Company. 5303 East Simpson Ferry Road, Mechanicsburg, PA 17050 (717) 766-1847 . Fax: (717) 796.1671 REV.1511E):.+{1-97:.~ -"~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CtJ~8G; fltlI5EJi?/ ~'/ .s~ FILE NUMBER ;;'/-0/- 7~r.. Debts of decedent must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. :l. oIu//a se/kd - ,t;r h.vner../ / L{ ncheb '" '" 75".<<>0 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Pe"onal Representauve (s) H....lo"rt A. Corbe, Jr. WA IVED Social Secunly Numbe~s) I EIN Number of Pel1lOnal Representauve(s) /:1.3-1<1 - 35 I~ Street Address liD SQ.!<:"., C-hu.rc.h r<J. Cily Mech!lniesb.....~ Stale M Zip 11DS'"O Year(s) Commission Paid: ~ 2, Attorney Fees C/'4,.I"s E. Sh/elds -:or 4,f13,tf3 3. Family ExempUoo: (If decedents addres5 is nol the same as claimants, atlach explanation) Claimant NONE" /!Ip/jlE Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probale Fees aAAa Dr,,!; nal i:S~\.Le of. ~h"rt ee.rti (,'CfLre.s ~';;30.oo 5. AccountanfsFees 1 Crudo" H.{[;.."., brMnaw"lh (r!.o., -J,r c.I.$I-o...t 'O'{OJ :l! hi ~P, fEst Ifeh,rns: It>VI, f'J'" ~/, t:.t<. [J-e.\u-'e.J] 'JbD.O{) 6, Tax Return Preparer's Fees 7. /!If'verf;,n'''r! ;" (!um6erla.Jl,J UtW Jt)(.( NI a.1 ,c 7S.00 '0. ,4 dye r h".s; "! ;'7 /J!eh-" - Ne.st l' 8t:>.s;? 9. ,!/'/d,';"Plfal elealt, cerf;hl:cdes -iPr flu hed tf. CDrbe, Sr: ' LfS.~ /D, (,H/ft//sSlo"s- IHttl clt4rfes: re: ('!u/daf,;'n P{ S2el.t.ti he> ~ // If<fl. '13 (See scAd. H. Ctil/h;,. flo"u ,1/ f.,8 //:-: fldAfIl1/SSI'NS) If. Ad'" I/ol/a! <1611# (!<:rf;f;caks fz,r G7-a.ce /11. GPrhe ~S,oo TOTAL (Also enter on line 9, Recapitulation) $ 7/.;).5').3&' (If more space IS needed, Insert additional sheets of Ihe same size) ."';. ~ o g lJ.J .. lJ.J o '!'1.J .0 In In - . .. IS ~!~ !? If r;z, ~ IE. '~i " ~"fll "'$!-4 ~2... ~f ~~g _>,21 "-<III Ii m '" !'1.J IT' -u o o o ~Q:I ,.. . . lJ.J \ ;: t<~ lJ.J ~ -.J ~'~ I :;~~., I .........., i ~, I ~- ,~ ~- ill ~ r~ ~ , . r , ~, 09 I '. 1:1 '" ~ (D .~ '.... , ,........~ ~-_.~ 0 ,,,- '- '\, ;\ .~ ~ c.> ~ ~~ :;;;! ~~ 'I ~ c " v 1:1 i2. "' N :2 ~\ I;; 8> !':l fif ~- ~.. .' ScN.J 1-1. Ccfl +; n ueci ~ tUf& I'f t= st. ,1f H...krt A-, Cor-be, Sr; ~h1mI5SIMfS aItC/ t?If/f/e6eS /l-5'b~/"fTef) '56 f!/(LI77tn : /!-;?/,g( ICAW SC"o,.eESS 7./-ol-7orb tv/iN tV"" 1l>~7#A/ of &1I/11/S5;M ~c. he frill/5.k r,q 4/e//.M ::z:;,j/~.s~r.r: 0/-- /;dtvttrd" 4nes j a, : ~ tDSt" (!ufJ.4.. ~s.oo yr 33~.?~ , . 72 s ::?. ?S A TIT r-/q ,e/Mfr/ .ftna i &>: sec.;'.. ?r,tAs. ke )3ELL. Sotl771 FlU /11~" :Z'/1 J/t:s!z,r,s : "Em.,4rcl .7O-'K" i-~. eAllAfl..s.s,bn JY /a>. $1'<- IC .Iz. " ~. 's- S(l..""/;;I!:.~4! ~",.Ob 7i-""'1f He ~...'"O Jl' ? 70 F . "2 % /0(."'" .II! 1":J..9S -'" /o~.= ~/o. 06 ~J?gO ~NtMI:Sti:"61H -'5z;. tc .12 l" 2. 9s- t},,,, /11 /.s5 / b'" J" ~."'O _03 fC .<. 9S"' ~N(II1"S.sI't)J1 1 ,;IS'S: 3;2 .53 ~ ~.1:i :Xry/a ;:u 7;4'-/-'1 he &/1/41/5:5/"" S",e. fee trItAS./u S.ver fJ"iI1!"t7/ 5(.1' f J ce /4,., Tr-tr'-/-"f hu LE# /J1/M/ ,BRoS. h'q f<:"Kwlrr! V;~.s f~. ~.k fraAS. k LItCIFIVT YIlT €.t'/(/lt",1 ..7'/II!'J" 1 &. ~c.;:u mAs. k 5BC ""I'tI Edw~,.eI .:Tones i Qz.. &ce.. fe.. f;'lW;. fee <' sck/ II. ~4fJ.I f'J~ 15 Est aI Jlubert A. GrJ., Sr. ~/'//)/I 55 /hVS / ~/I/d. VF~ IZM' j/,'q .:& {e~. ?;/VJS. b. EP(",,,.rd ..h~e$ J ~ ~. Vo{JIfFofll~ j/lq G"-t''"'''''''' hnes f' &. 5e1!.h. 7;4"$< ~e ~ ~1-61-70~ {l,h(d/JSS/6P/ &J'H-'1/SSJ'<M1 ,/",,,. ~o ./7 1".:{.'JS' ~ /roo.';:~ , l2. )1 a- -? r:' %, J 'ILI/. Y'.3 c:~/'hh'd ma,'tizts J ~ Ii, 7.00 .?/S,OD fa.. 13. If pa. ye d2 schul I( ~/}td. Edll-fe of Hubert k. ~r!oe/ Sr. Nd/I'Mal skrt t?erl1'hca/;..s ,4dd,'/,;'"a( SliP,.! ee,...;lhca~.s ~,inbl(r~edfMts ~ 61"rks E. ~/e/.::& iiL ~r /os!ztreJ j/kh~iJ/eS, eE. F;';J4111!e h> li"r;skr pi 4--/14 -r1>r #h. ~ #t:lum /5: 0l.1- 01-70(., ~,oo ;r fs,.Ob ''''.''''.''','''''',~ ~ SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INH~~~i~~~i6:2E~~~~RN MORTGAGE LIABILITIES & LIENS ESTATE OF /J_J fj II d c;dA!oE; n'/(~f:;Z" ".., ~"'. FILE NUMBER :21-01-7/)6, Include unreimbursed medical expenses. ITEM NUMBER 1. ;Z. 3. If. s:. b. 7. 8'. 9. II). If. 1:1.. DESCRIPTION AMOUNT ~::?S 3.00 )II -i' :r.lIf jC 33.9.z. 1'/7. 9S" .z .:::I7.l!Jfc ., f,537.IZ )II 305.21 )II .;1'1.93 $< "l.2..zz Pe-nna. Neart,. ~5SP(!.., <fd. lie-aiM; l/eal/1f S,,6.s~r;pt. l/i>lIiMI L/oes UIlt!Ph1ntpn Cures //-Ilsltlerd l'ra7er.f' (' Gu/de~ps is) /I T ~ T LM.J ,p;sf"}1ce /Brp.c.k;e fJharm...fect, Pr~n d,;:U1 t'lJA {!qrd /J1Pbtle x-I?a.y N8es /,ey IIply ImaJ;7' Iltt:-. S/,;rd flo.s,o,fa/ jJL.(!.tJ VI, LLe. ((!re~kr;e/4J/ /JakOtt,t! on /'/plHe b;/{s l>"nald C. llona.Jher, Jr. -r.6,.k~ HCAII/' {JrM'/lef$ (Re;",j",r.setnenf Jt, Chas. S/';t!/d's ;;'r adv4na ) . ~ 2, I ~ I. 2!> , 1/9. 1!> 7' "3. 99' TOTAL (Also enteron line 10, Recapitulation) $ '1,511. 9(" (If more space is needed, insert additional sheelS oi the same size) ....- + ' . ""AY;(ND!'" GRANOON. M.D. f~ RAYMOND C. GRANDON, M.D. 13' STATE STREET HARRISBURG PA 17101 TELe:PHONI!. (7n) 23.4-4187 PFolACTICE LIMITED TO INTERNAL MEDICINE FAX i (717) 23A.08g~ , - II I I r Hubert Corbe Outlook Pointe at Creekview , 1100 Grandon Way i Mechanicsburg, PA 17055 L -I Medi BS . ;'D,6,TE DESCRIPTION CHARGES CREDITS BALANCE I , 87 29 I ~.~ I AlAO. ,~(.J..^^ , 1)'1 1,J l.l.J. '.- ll\ ())( II" aq Illl qq~\1 -i ('1?fP.r.."I\LoOfJ 11.o3 - 0l2'O ad. 'E l~ S irit Hospital. -~p Hil . PA 1701 f' 9/01 ~ ,", fU"V ... .." .a.uu. '" 99233) level 3 sub visi 80. 0 ~ 7 ,~~~~ ~,71"fo' u. (99232) .3 lave 2 su vis ~s@60. Oea h. ..... ~-- . ,n 7 23/0 Discharged to Carlisle HID .0 IE : 4 6.. 414.00, 427.31, 428. ~. . I ; ~.~ ~ IlA ~ ~obo.I.3. <1f) 14a~ illi ./ltj~i ~.-vt Ml111 ~ ;JiJJ.: ~ ~ ]; I DJ )1 "M iad-^V1J.L\al ~ /.1, In: Cali I /I 'I~ '\1 Pr14~'~ T7 'A}'}~ liCl '7^-1 ~:' 2Yf'" L.Y..l ,~ :i ,:>.LI'I 'hI'v'rl --'M_ J>A :~ ,-~ld - '-/-)1 o::u. . ~ II 0 . U , . I Medl..,e h...ppUed I. ).1 trom the cbarges toward Ydur ~ i OMl'1<EH' ~l~e: HISTORY ANO PHYSICAL LABORAT "o.n..1 deductible". We must ""TED ~ R'( .-.NO PHYSICAL P'T1Mf t"erltor8. look to you for 34.42,ETC ITEftM~~ ~~ICE VISIT cec.= payment and would 3P1Jreciate PLEASE ><TEND<: ~~ E VISIT FBS.a an early remittance. pp.,y 1.A5T FIGURE DNSU;::-~ N$ SMA 12 IN THIS COLUMN RAYOi PA AND LATERAL ELECTROCARDIOGRAM-RESTING UECTION ELECTROCARDIOGRAM-MONITOREO WITH lMUNlZA N suaM,t,lUMAL STRESS TEST. MASTER TWO STEP STRESS TEST ! ALL STA.TEMENTS PAYASU! MONTHLY. THIS IS A COPY OF YOUR LEDGER CARD AT IT APPEARS ON OUR RECORDS. wE WILl.. A~ECIATE YOUR COOPERATION IN PAYING YOUR ACCOUNT PROMPTLY. i I ,I. <"I'"J ,l,f +--;;;'C;j{.~ /)(i'. /..1/ u ;:.~.., /t..) ':'Ui_' .{fJ..~-1 We"{l..ltl [.1 L' ,Jf7! t<'I'I"I.I-.1 ,C) .:' " ~ -.:" . .. .. '" 0 0 0 .. 0 0 '" ..... ..... '" 0 0 '" I .......... 0 '" ......co 0 '" ,....,....'" i<-K-l' "" co........._ iCi<i:: I ..... CO ~{:;{: ~"'O 01 .. ,.... .. .. ..... .. .. ........~.. '" .. ~'"' 01 -.+-K v'"' +.. .c v .. "'+.. "'<0 U+.. H+" 0 0 ,,",+-i: 0 0 "-+.. 0+" 0 0 +.. ...1+" ...1+" < .. U .. U"O 0 "'Xi" 0 0 en .. . < "0 '" ~O-kO '" H ...1:;j" '" H '" ., 0 H .. ... x: >-..:.. ...., ~"'.. >..'" '" en 0"'" '" ...1 H l-IU-K-4" ... ~ U ..:en.. Z :;j .a..l-ii< C"") ..... 0 0" '" '" Z> ~ ..., ..: en ..'" '" "- H ... '" '" ~ 0"'" '" = >- "'~.. <:::7' ..: Z u .. '" 0 :;jU" ~ .... ..:.. ...1 '" U :;j ..:"'.. <'"' ~<: H :0...... H" > ..., tI)(J)i( E-oCO UOl I I zXi" H g, ....g, "'... jooof i: Z "H" Z.. 0 ..:... '" "'''' .... ~~ ~<-k E-o :0 ...1 ..:..: ::J::ltl)iC ....1>- 0'>- 00 ~~-k =:Jcn "'en U 0>"" UlZ enz 0 :;j .. ZZ "'Z en (--Ii: O~ :0'" en ..a..-k U.a.. en", < ..: .",.. en .U" ...1"- ...1"- 0.... OU" <0 <0 ..:'" '" '" "'<.. .... .... ::>"'... '" . H .. Hen Hen "''':0 ..: , Z3" "'''' "'''' Z....,.... 0 J "'0" en en en ..... U u , OZ" 0 0 < .. :z: :z: H ..: < < 0"''' :;j '" '" . ...13" :z: .... '" .. > .... ..: H .. .... 0 ...1 3 '" '" :z:+.. 0 >- 0 Z '" en+.. ... '" z en ...1 >- :0 '" +.. 0 0 Z 0 :z: "'+.. :::; Zco x: I ::>+.. "" "'0 '" ..... ....:I+iC _ ..... "'..... ...1 "'+.. .. c """ .. .......... .......... " 0 .... --X{:;iCOO 00 0 < -ll:iCiC................ ............ .. ...... '" -k-k-kN...:r ...... .... 0 ~ "' .....'" .....'" "" 0 ............ ............ .... ...... w ""'co ""'co w 0 -' ".. 00 00 .... 0 wv.. "" "w> C ..",.. "v.. -- A ,C, C 0 U N T HIS TOR Y - Please keep for I/Ollr recortls, -T Customer Name: Account No: HUBERT A CORBE 00043564046 Product Ordered: HEALTH & HEAUNG THE HEAUNG POWER OF FOOD $25.41 (SHIPPED 09100) Previous Balance: Credits Through: July 18, 2001 $0.00 Total Past Due: $25.41 $25.41 <J e\L \ c )1~\ f To: HubertACorbe Unless we receive your payment within four weeks, your account will be m8l1<ed as a bad debt. This could mean: 1. exclusion from future Reader's Digest promotional offers. 2. Denial of all future orders because of a bad debt account status. 3. Further collection action by an Independent collection agency. We preferto avoid any unpleasant action so we are glvtng you this final opportunity to pay your debt. If you wish to discuss this mattar with our Customer Servlce Department, call toll.frea 24 hours a day, 7 days a week 1-800-234-9000. Acct. ':00043564046 Director. Credit Status Reader's Digest P'111RCJ01 CH" "",.....-1"1'R1r' n c: U) d 3: m ;:0 n 9 ~ >< i (if../ l //1 , /' To: Hubert A Corbe ACCOUNT 1/ 00043564046 APPROACHING BAD DEBT STATUS Your Reader's Digest account has been listed as a delinquent account. Every effort has been made by this department to collect payment for the above bill. To prevent further deterioration of your credit status with us, return payment immediately in the enclosed envelope. Your payment or explanation is required to prevent you from being listed as a bad debt on our file. ACCT.#: 00043564046 Director, Collections CUstomer Copy Em: 'i.mIr Records Amt. pd 2ft '/ / Date pd 1{,::z/:/ Check #f;, / HEALm & HEAlJNG THE HEAlJNG POWER OF FOOD $25.41 (SIDPPED 09/00) . I WHY HAVEN'T WE HEARD FROM YOU? Dear Huber~ A Corbe' Please examine ~he above bill. I ihJ Is something wrong? Has ~here been a mis~ake? Our files show that - You ordered BOTTOMLINE'S UNCOMMON CURES from us some ~ime ago. - We processed your order and shipped you your book. - You received an Invoice with your book, and ~wo addi~ional bills have been mailed ~o you reques~ing paymen~. - We still have not received payment nor any o~her word from you to da~e. Take this oppor~uni~y ~o settle your account now, before it goes into DELINQUENT s~atus and o~her measures for collecting i~ mus~ be considered. If there is a problem, tell us about it. please honor your obliga~ion to pay this bill paymen~ today for ~he balance due of $33.92. If not, then and mail your ,(/,C"- T" r1i.:."V P ') I [ K. C. O'Hare Your Customer Service Representative _ 47_2-3.80 4.0lL j;,-'!~____ _ _____________.___~~_~~ur pay~e~~i:~eady..i~_th~_~~il, please disregard this notice.) IOTTOM LINE BOOKS. PO Box 11014. Des Moines. IA50336-1014 ,.",;,'.T . L .. FOR PROPER CREDIT. DETACH AND MAIL THIS PORTION WITH YOUR PA'fMENT rlwllk hJII! .. 07/01/0 I Dear Hubert Corbe, NOTICE OF YOUR LEGAL RIGHTS I just saw a copy of the accounting department's list of customers recommended for further collection action. I am sorry to tell you that the name, Hubert Corbe, is on tbat list. Ifthere bas been some misunderstanding about your bill in the amount of$19.95 for your order for ANSWERED PRAYERS, contact Guideposts immediately so the matter can be resolved. - If there is not a problem and you rush a check or money order for the full balance of $19.95, your name will be removed from the list before it goes any further. Please write my nanle on the enclosed reply envelope and use it to send your payment-- right awayl () (I "- Y C~ (J 11' 11 ),;;1._- fiL- 1)2-1 Susan Erikson Credit Manager OSBR-9 Account number: 38 I 561596 0002669 384.{)()E39..(J07237 .J~TQT #BWNCJFM #09181289642013# P 29812AT10269E112A97474"30GT 1",111",111.",1.1,11",1,1"".111,1,..1,1,..11.1",1,,11,1 HUBERT A CORBE 1100 GRANDON WAY STE 512 MECHANICSBURG PA 17050"9195 JUL Y 03. 2001 Re: Account Number 0913128964201 Perhaps you did nol realize that your AT& T Long Distance account is past due. The tolal amount owed is $27.06 ;n.:luding do pa::.l Jue allluulIt 01 ;pLti.l3. Allhougll I am sure that tllis was an oversight, a prompt payment will return your account to good standing" To ensure proper handling please write your account number on your check Of money order and include the attached payment coupon with your payment. II is not necessary to contact us if your payment was already mailed or if you plan to mail it within the next two days" Thank you for using A T& T Sincefely. ~"/ (',,- ,_ i") '- . ; ~1 t~ AT&T Credit Management Center U Save a check. Save a stamp. Save time. U Enjoy the convenience of Automatic Bill Payment: To enroll visit our website at; www.all.comlpayall to make your payment via Credit Card and learn more about our Automatic Bill Payment feature, "or caU1-800-532-7486 and ask the AT&T Representative for AT&T's Automafic Bill Payment." XAOO1222 XA {'.. \ \ \ H ~ \\i . l/F.... -.. cS~:i~At'4t""' t:-'- ~}.. '\:; ~j -~ 4Ft ~~ -:~ \.f)~ ~4 " . '" I / (' :~ . i ,~ ~ \ " . ...- .' .... \ ". ~\~ \ j.S\ . . , ; \ . . . ~9: , , \\ \ ' \~ \ ", ~.9P , . \ '" \ : " \~ \~ 1 \ , . \ I . . I\, . , \~!lo~ /l \11 '" :to 0- 1- ",;:l 0<0 0'" u.\ w>< ",z. '" ,..:x: ",... ... \ \11\ "':x: ",1- wz. ....0 0.'"' ... uJ 0< o ,,", , .ct. pC '" </l ~>- 0'" Cl W ! 'r- G . ~~ ..0< '"' :x: 0 ",\'" ",0-'" 0"'''' u"'o. r-' Q; 2!, ~', ~\ ". ~' 0'. >"~ ~; r-' -, 3:. '%' 0' - , r- , '" ot 0. , 0. , 01 to't' i~ ~r ';at ~\ '%, 4, IIIr ,,- III' ~T ~- Q' 4t W' 0.' uJ ~; ~. Ill' ,.!' ~\ , . . . . ~ i . , , , , , , , , .... "" .... "" \ '" '" ... ,... .... 0'" ",0- :r: . '" U n'" ... =,'" ",w:r:'" u.,1cou-:J ",,,,, '" :;Jo~lf) :c.uwu ....... .t-4:~ l.Li 0::: if; oCt .,w :r: o:.~6W. o~0:4uJ w~~$ <f' wI- u...c:iZ c.ct~ ...0 w'Z"E ",w'" "'U "'''''.... :x:u.i~ 00-'" uJ....z t.,,;<LC Z=' .ctZO ZZ'" ~<L(!)uJ l.L- 0:::.::) -Z4:0 4:,<c::t: --0 . If. w '" ",,,, ",Z :x:'" 03 o "'.... u-' ZO ",u. Z ...'" u.:tO ... e> ...u. 00 :>' "':x: ... 0'" ..."" ... ... \ ... \ .. - ell r1'I I. 0 II\ ... r1'I ... ~ r1'I 0 ~ ., - - "'""~..................:.::.:..............- -...-.,......-........... ~ 8 ~ ~ 'i ~ ill ~ ~ I- uJ '" '" ... a> :!: <b M u '" uJ'" '" ...'" \ <c::>~c:::r :E:<LO\S> a:uJc:::r<P 4:"'''''''\ :!: ....... c;..-:c ~ ... "'.... ",,,,0- ",0 ~z. .u.,i !J ~~ 00'\0:.0 c::\Sl'o:C coN'o. ... '" oS> '" - '" "" - .... oS> i>> '4 0. to' Q ~ '4. 'Ui .j ~ ---- II ., -0 ~ :c ~ - i!l "" >- - ~ ~ .. ~~ . ffi " , ' u ~ '-' .0 z ~'1 ~- ~ u- 0 ~.5 ~ lh -e c ,.~ ~~ ~z ,. ~ -" z ,. if o o ..; - ~~rn- z ~ 0 ~ C N :I 0 .; ,. W N C ~ " .. 0 ::> c ~~~ ~ e N u fe co; :! ::: ~... - :; 0 Z <'t: ~ . A o o . . e i . ..... N N '" . .... '" O~~ ::- ~M ....>- ~~ i'-', =U'1 ...; Z ' ,..." a~ _UIft 0- ~'" 0 .. . . Ii ~ . . '5 ~ .. I I c a: ti <<( CIl :;; Z <<( is :;; o a: Go e o Eli . ~ 0 . 0 ~ : ",.s III f · :::! ~ . -- li: o. O- f . -::" -::0: -=~ -=:i i =SMIE :z:g~ -=S.IA -:ox '" :500 :OIlllZ; =0:0< _Q.A.:I III - - a - .lii ... "N ..~ liI 'I' l!l 3 ..... '" ..... '" , Cl 1ft Cl .... ..... ='"' """: cn>< """: <0... :W3 =M:O C) .et::zo:: """:00::1 -= U CUD : ZCII ..:4.<U = Dl:t-4 _,....oz :a::: c:z:: = woX -= _aU ::::I...-tW _::C_:E o o o o o .... nJ m o m o CJ CJ CJ Lt1 .... CJ CJ CJ .... ru nJ :r l'- o .... o m o CJ LIT a- U1 LIT :r I~ I C\l <:t ,... C') I :~ I , I III ill IDleR a:~; Ozl1. Uo6 '0"' Czj Ii:~'" 111,,11 1D8~ ::t::o :z: w :li ~~ _N :>;~ ~ ~ "" 1:'<" ~ ~) ~ Q) .- III Q ~ ! ;'~ Hi <B "' ... ..::: "0 Q , " '- - r~ r J III ,~ t-" nJ , . 'i..J ~~ ~~, ~ ',j ..." ... ~I &!h ~H m <X3 0' 0' o C'- c.D nJ .. r1"f . ~ ""' 0 j ~.. . -u ~----=-.. 'i' ,e. < ... ......z " , ... :& ... ..~ I! fA o '" '" '" , .... '" LJl , .... .... .... t""l ~ I u Z HE-< '" ""''""' Z .. '""' HE-<'""' ~UJ"" l<:..'""' H"'''; )o4g;~ ::16" ><;gJ ",:::!<!l .:l UJ HO~ <!lN~ 0'""' :O:LJl LJl LJl e .... '""' .. ,.; ~'" ooz" <!l0'" ~~~ ()~rJ E-< " H ~o~ <!leU =>'""'''' "''""':0: - ;""':c '" - ~Ij . f- Z UJ ::: >- ~ 0:: :0 !2 I f- :i: <Il :0 f- ro a. o f- Z 0:: :0 f- UJ 0:: o Z <( UJ 0:: UJ I I () ;'S UJ o UJ ~ ~ w -" a. . u < " , '" o " < , " > a ~ 8 ,jl I!'" ~ .-.- M <t ?"- M Mm ~6 lil ~\ '::K.~ t'{ ~ "0 ~ ~ .:') I', " on W on lD<>- R a: - o~< uza. go .c a: ~':l!iil a:a:(/) well.! lDSz ~-~ :a::-u UJ :li hJ t ~ ~ H~ J 11 ~'~ ~I "'I ,-\2. I '':'~,~ rn I ,~.rl~ ~"~I,, ~ " rn' - cat o 01' o C'- eEl d11 ru III ~, , ~J !i~ ~if . ~: U1 U1 cr ru o & ~Jj -- ------ -- i\ hl \ ~ ~ ~s \U ~ " ~ ~ ~ "$ <8 '.,., ~ t~\ ~ \ II< '" . '" ':) ';i ~ 'a . '. '~ 0- '8 '~ ,'- ... .~~ ..,. '2 '" ~ -.. ,.. N " <-< ~~ % "" .:a .- -'- " ~ -.:5 :i S '_, ~ C-- ,~. . ---:,,'j '" -~l; ,:c.. t: \ 0 - ~'" " ,>..... '~ ~~ ""-..1 '. ... '7, d1 .;.S: ~U 0 ,,' -< 0 '~ ~,...""' 0 ",,,,"" '.. ",'" 'A\ t'- .~ :':1>1> 'th~ .Jl' O?"E. ...... -;r.:C,.-'l '6~t ui" . a: \ 4ii . ti '"" \3 '" ., 'i) ~ \l 1\ , - .Q ~ lllS\ LI' <i e .s1 ~ ? ~ $ i~~ IT. z~ ;'I, :s call ....... - - \ 0 " ? \ ,\\ .~ '3 "...... .... ,. ... v -50 ... Ct,:'< .~ .s~ ..... 8 " 0 ~,.. 0 p..0 "" .' - , a- N ru N If" o Cl Cl o f\J en If" Cl ru '" o o o o o o o o Cl o Cl Cl Cl Cl o o Cl Cl Cl o Cl o Cl .-'\ en .-'\ Cl '" en Cl "1 - -: ~ -: 1 ~ -: ~ -: -:: -:: -:: . ~ -:: -:: -:: - .; .; ~ ..:; <t ~ .r, 6 or. "" 0' - '" '" ....z ~o ~b y.~ ",0:>' uc:=.~ 0:>0- ;J::o..3' "'~ ~ 6\ "" - " ? ~ - " " S G' c_ , ' ALCO VI, LLC (Creekview) 1100 Grandon Way Mechanicsburg PA 17055- (717) 730-4033 I Hubert A Corbe, Jr. -"1 110 Sa/en Church Rd Mechanicsburg PA 17055 STAn:~Ir:Yr OF AI '(""I 'i\T Hubert A Corbe 08/31/01 UESGIUPTJ()N f)ATE qLJA......TlTY CIIAR(:I<:S ICREIlITSi HAL\~("E Private BALANCE FORWARD Maintenance/Houskeeping8/7 Room And Board7/30-7/31 Room And Board (Aug) 11/30/98 07/29/01 06/30/01 08/09/01 08/03/01 08/01/01 1,00 1.00 (31,00) 3,836,89 280,00 (120,64) (1,835,00) r H~~~;:~;~~R~i~~R~' ;~~~~~~~;TOR ---~~11 ~:=~--=-=~~=;=-1 ',~,I,' M'~~H~~~~B~~~~~~ R,~~~O ,,::;o:~"E i:ai// I ~ "n,,,,,,, /IL1/. I' ~ T. -. ill , "1i""~.-L2..r;Jo.~_rLL LLr! ((' -r '~ . ~li. j; _' )-.--.u&.~1<, iI/;::J.{! __, --.: $"1 ///2':;:- _ L f / __... (, 'l (l I I / \ 1 ,.... - - -/ {;/ i ~.~ ~ " . '<< U,~'-' jilvI. LlbJ.IJI./..'Y/?[il \;,'1/ / j c..(.- 2.':1 ~ ~., ~ . ~- /: ~ "~_.cC'O[)OII \RS tD " ~ W~~ j~ -:/-'71; / / ,I' I L~0.::;'E~f,; :,00-":,' ~~~~DC; ~ 4~==_,,-':J ----~ $2,161,25 PLEASE DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT Please pay this amount by 9/10/2001 - Thank you! $2,161.25 Hubert A Corbe % Hubert A Corbe, Jr. CORB H Please Remit Payment To: ALCO VI, LLC (Creekview) 110 Salen Church Rd Mechanicsburg PA 17055 1100 Grandon Way 'Mechanicsburg PA 17055. DBA,CCC PO' BOX !l88 ,- HARRiSBURG, PA 17108-0988 -~ -' Hours: 800 900-1380 Mon-Fri 8am-10pm, Sat 8am-2pm (Eastern Standard Time) 2001/08/10 t.c.TOR$ .... ~o->' a ~oc, f .:1. ..,7S . ---.1. ~ t... ~~.. . i "~~!Y~' ~"'It"AT'O"" ~ 111111111111111111111111111111111111111111111 iD A880665 H A CORBE 1100 GRANDON WAY MECHANICSBURG, PA 17050-0000 ICLlENT: Time Magaz i ne !TOTAL BALANCE DUE: $49.95 -The below referenced account(s) has been assigned to this office for collection. All future payments and communications should be directed to CCC. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in wr~ing within 30 days from receiving this notice, this office will obtain verification of the debt or obtain a copy of a judgement and mail you a copy of such judgement or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original cred~or, if different from the current cred~or. SERVICE RENDERED SERVICE DATE ACCOUNT NUMBER BALANCE TIME MAGAZINE 2000/05/08 517050CRBGA100H92 $49.95 ThiS letter is from a debt collection agency. This is an attempt to collect a debt. Any information obtained will be used for that purpose. If you have an Attorney to represent you or have filed bankruptcy, please disregard this letter and furnish us with the appropriate information so we may mark our files accordingly. Detach and return with payment to exped~e cred~ to your account 2001/08/10 ~~~~''-.~. -';~'- -&[:'-~';...,JfIJ.~~~___ / . /! / I /7/ / ///(' '~, .~ / ,,( ..L<,~ Ci,:. , C /,! 2r,70008 10:1 101l":l71.,r, 'j' 1.1: l ; u' // / , /",j~, .I '~..... v- --~r. '~i~_ , --"~J!!JffA.-,..~:"_I"'_~'7:~ 3746 ~! ,~, led liO-Z9S1313 432' '~ I~ ~ ii -- ~ it i~- ~ i ,i ~. ::c " H A CORBE 1100 GRAND MECHANICS HUBERT A. CORBE 1100 GRANDON WAY MECHANlCSBURG.PA 11055 Date F( hu !o / , OMJ fJ G H.r I? .T;;. - 10 NUMBER: BALANCE OJ Pay to the fA., , C Order of /1/ I)L J) - HURry Mill;:: c/- I~ .~ 1ft M8iI'Bank I~r=~=...~ I' I, ,~ For !t~:01..:l.0 2'15 5.: I $ Y~9.t) 3%, ." Dollars IIi ,. 0000004995 . ' ACCOUNT NUMBER ,45,59-5003-0107-4221 PROVIDIAN VISA CARD Make Check!! Pavable to Providian s.oo II SEP 29, 2001 I '0 '"diut" chang~ of address on back 111,.".11.".1111."1..1,1,1,,,1.1.,1.1,.,11..1.1...11,1,.1.1 PROVIDIAN VISA CARD PO BOX 9553 MANCHESTER NH 03108-9553 1",111...111...,1.1.11"..,1,11,.1...11,.1..1..,1111...1,1..I HUBERT A CORBE SR 110 SALEM CHURCH RD MECHANICSBURG PA 17050-2834 $.00 11$ Please be sure .... this address appears in the wi ndow. Page 1 of 1 P025253 45595003010742210000000000000000000 raccoun"fis Issued by P-rovidla" National Baiiii,- Tillon;-"NtC- -- - - - - - - - - -- -- -- -- -~E~;C;-;;;R~ -... - ........PLEASE SEE ENCLOSED IMPORTANT LEGAL NOTICES CONCERNING THE ADDITION Of AN ARBITRATION PROVISION TO YOUR ACCOUNT AGREEMENT AND CHANGES TO OUR PAVSMAAT (sm) SERVICES. PLEASE READ THESE NOTICES CAREFULLY AND KEEP THEM FOA YOUR RECORDS..... ANSACTlONS te Description -17 PAYMENT RECEIVED -- THANK YDU Amount 303.21 PY .. AVAILABLE CREDIT .. Your Total Available Credit Is $770.00 ... $770.00 of your Available Credit can be accessed for Cash Advances. It. The portion of your credit line that can be used for Cash Advances i8 limited to $770.00. FOR BILLING ERRORS AND IMPORTANT INFORMATION, SEE REVERSE SIDE. :COUNT SUMMARY !vious Balance redits ayments urchases & lher Charges ash Advances 'NANCE CHARGE: On Balances ale Charge EW BALANCE 1300000 4941 3613 STATEMENT DATE Number of Days in Billing Cycle $303.21 .00 303.21 Average Daily B.lance 09I04I01 PAYMENT INFORMATION 32 $.00 Purchase Cash Advance Account Number 4559 5003 0107 4221 .00 .00 ANNUAL PERCENTAGE RATE 21.74%" .00 .00 Daily Periodic Rale .059562%1Il $.00 credit Line Jtlt" $770 $.00 Available Credit ..... $770.00 21.74% Minimum Payment Due $.00 .059562". Payment Due Date 09129101 "These rates may vary. J waKS MealIn t-'roaucts . ,3.198 Airport Loop Drive, Suite G ,- . Costa Mesa, CA 92626'-34017 INVOICE ,J..."! 0-z~ e,iJ t'- ,AJL{{~J- rG Hubert Corbe 1100 Grandon Way Mechanicsburg, PA 17050-9191 1".111."111.,,,1.1.11...1.1.,,,.111,1,.,..111.1,,1.1,.1.1..1 Dear Hubert Corbe, I was going through your account today and noticed that you have an open balance with us: Invoice Date 81812000 101912000 Invoice # 1713090 1861178 Description PotencyPlus EnergyCaps Balance Due $33.97 $29.97 Total Due $63.94 This matter may have slipped your notice at the time, but I'd appreciate you clearing it up right now. Please take a moment to write a check and mail it with the voucher below in the enclosed envelope. The amount you owe is $63.94. Please mail your check today and clear this up while it's fresh in your mind. Thank you. Sincerely, MaUTe: Tabak's Health Products 3198 Airport Loop Drive, Suite G Costa Mesa, CA 92626-3407 Hubert Corbe 727260 DETACH AND MAIL BOTTOM PORTION WITH YOUR PAYMENT 01/22/02 RT5 Method of payment. J oS 0(_] olil OEe::j Exp. Date: Invoice Date 81812000 101912000 Invoice # 1713090 1861178 o Money Order 0 Check Credit Card # Description potencyPlus EnergyCaps /,401--( Amount Enclosed: $ if ') '-1 Balance Due $33.97 $29.97 Pay This Amount Cf6~3~~4-) 11111~lllilllllll~llllllll~ I~ ~~ . ATTY. CHARLES E. SHIELDS III 6 CLOUSER ROAD MECHAN1CSI3URG, PA 17055 6O-B2114 313 1421107754~ Date ~ 7,,0~ 4375 ~~J:7~~e ..:J",~' ~ p~ ~J~~(LY ~ ",!I..! $~.3 -.:r;:;, .0. _._ r1~119rs L!.J =...... ~ ~~NA C ' Harrisburg,PA /26/f7d /1J " c. /-"/ /7/J . Memo ~,~ /7/30'1 0 c.!-/U?~~_~~ '! ':0:11. :100821.1: j,l. 2"11.1.0"'7 7 51,11' l.:17 5 j ~' . REV_1513EX.I1;97l... '...' , . . , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER I. ~.egE; IIIt~FRr '#./ S~. FILE NUMBER ::1.1-0/- 7()tJ:, AMOUNT OR SHARE OF ESTATE 7"3 Y3 Y3 ENTER DOLLAR AMOUNTS FOR D[STR[BUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPR[A TE, ON REV 1500 COVER SHEET II. NON.TAXABLE DISTR[BUT[ONS: A SPOUSAL D[STR[BUTIONS UNDERSECT[ON 9113 FOR WHICH AN ELECT[ON TO TAX [S NOT BEING MADE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE D[STR[BUT[ONS (inc[ude outright spousal distributions) RELA T[ONSHIP TO DECEDENT Do Not List Trustee(s) 1. 1-1 u but If. Ccrbe //0 S,,/t:m Ch"rCh Rei. l11echttn;csbur" ;P'" /70S0 5c:>VI ~. /(t>hut- Ccrbe 'f57J Llflp/cltt")' Y",u:J J.leu',.,' s, Llflhe G,If 3DS8Z So VI .!.. Grace ;:)-/r,ner {. D~wll.Jf Dr. /Yle.c..hlln;cshlArg, jJlf 1705'"0 011( (J h Ter 1. B. CHAR[TABLE AND GOVERNMENTAL D[STR[BUT[ONS 1. TOTAL OF PART II. ENTER TOTAL NON.TAXABLE DISTRIBUT[ONS ON LINE 13 OF REV 1500 COVER SHEET $ ([f more space is needed, insert additional sheets of the same size) 15056041046 --' REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year INHERITANCE TAX RETURN File Number Dept. 280601 Harrisburg, PA 17126-0601 RESIDENT DECEDENT oZ ~ U ~ D ~ 7 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth J~~ aI 41~q ~7~ Szoo1 a~o6 ~qoZ Decedents Last Name Suffix. Decedents First Name MI Co~'8E S~ HuQ~~T ~} (If Applicable) Enter Surviving Spouse's Information Below Sp o uses Last Name Suffix Spouses First Name h11 ` ` N / Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~ 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) Q 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CNAR~E~ ~ SN l~L~S ~ ~ ~ 7~ 7 7~la D,~09 Firm Name (IfApplicablei ~/ First line of address SeACrond line of address /v / City or Post Office State ZIP Code "(") ^7 ~~) _. 7 _._~ ,~ "r C~ m C7 _.r7 l-1 RCN ~N / t^ ~~ ~,~~ p,¢ / ~o ~Sq?3s Correspondent's a-mail address: Ce $/! / e~4~S 3 ~ C0/1iCQSt• ~I~t Under penalties of perjury, 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, correc)'any~ complete. Declaration of prepare` other than the personal representative is based on all information of which prepare` has any knowledge. ADORES H LlBERT A- CoI~BE, R, //a e/H Cf~u~ R ,, /YJec anicslur~ , ~ 170~~ SIX AT F P PARER ER T A R E _/`~' f ~ DATE` ~ ~ ` ADDR s y R4Es E. SW/i!2DS ~ C buss`' ~?dt, /'NP.C~an',cs w~. /° /7o SS o PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 J a 15056042047 REV-1500 EX Decedent's Social Security Number /+ ~~` !!-- • CO?'~7C !^~ ~• i SP ~ l1 UC ' ~ ~ 4 a ~ ~ q , ~ ~~ / ~ ' / , ~ . i Decedent s Name 1 . .: , ,,. ., _ RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. ~' D ~ / `/ ~ao~~o~3 ~ 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. .. + ~,~ ~~ a ~ , O 4. Mortgages i~ Notes Receivable (Schedule D) ........................... .. 4. ~ , ~'~ 5. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E P P Y( ) ...... 5. .. { ~? D > ~~:: 1 6. Jointly Owned Property (Schedule F) C Separate. Billing Requested ..... .. 6. O ~ D ,, ,. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property D O (Schedule G) C Separate Billing Requested...... .. 7. ~ s,. ; ~ ~ 22'O .,, y D~3 8. . Total Gross Assets (total Lines 1-7) ................................. .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. i,J S .~ ~ . f ,~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .........:.... .. 10. • ~ ~ 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ~ S 3 7 . ~ 3 -,~- . . r 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. a O . . . ~, a ~` G ~ O .~~ 7 • 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which s an election to tax has not been made (Schedule J) ... , .................. .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ l0~ g ~w ~ ~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 O O 15 D ~ (a)(1.2) X .OQ- ~ . . 16. Amount of Line 14 taxable p q at lineal rate X .0 ~ p ~ g z . ! O 16. 3 ~ 0 ~r 7 17. Amount of Line 14 taxable ~ ~ 17 « ~~ ~ at sibling rate X .12 • 18. Amount of Line 14 taxable ~ ~ ~ ~O at collateral rate X .15 • 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT / i ~ ~ r~ .J O Side 2 L 15056042047 150.56042047 J REV-1500 EX Page 3 File Number Z' ,~ p' ~ 7~(O Decedent's Complete Address: DECEDENT'S NAME ~ ~ u~ Cif pF G-oD H on-1 E - ------ ---- - -- -- STREETADDRESS 80/ N. H~NDV~? S~: CITY - -- -C~~2GlS L E' ---- --STATE Q~ l ZIP / 7 0 / .3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit ._ 8. Prior Payments C. Discount 0 D D 3. InteresUPenalty if applicable D. Interest ~ E. Penalty _- ~ (1) ~3go,'13 Total Credits (A + B + C) (2) - Total InteresUPenalty (D + E ) 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. 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. b (3) O (4) ~ (5) 390.7.3 (5A) ~ ~ :~ . ~.3 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ,~~ 3_ ~6 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 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 awn an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ^ 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. §9116 (a) (1.1) (i)j. 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 (0) percent [72 P.S. §9116 (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 stil{ 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. §9116(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. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)j. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ {6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER (~D12,C;E, ~/Gl,QFipT f~., ~S'iP. .7./-07- lob All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER -7~y Q~p(~ DESCRIPTION/ /~ OF DEATH t. f7, aO'7 ~~. ~ ~DAI. SfOGK Ot /VC/C f~j; 3~,~5 le 37.20 a~ X37.68 x 79. d~~ ~ '~3, o/D. 03 ~SeG Ylc~uR/7aN 4~~4 ~~'cG~dl ~. ~Oo sh. o~ Coryt. Sfack ~{' L-'XE'Lolj1 ~ ~if 59./0 slo ,,$' 3, OD ave. `5'b.05 X 200 = 1 i', 2 io. ao (see Valica,~ioh d~a ~~{n,chea~ ~, TOTAL (Also enter on line 2, Recapitulation) $ ' ~ a Zf7 , ~ (lt more space is needed, insert addi6onai sheets of the same size) NCR: Historical Prices for NCR CP -Yahoo! Finance {~ Daily Start Date: 'Jul ~~' 2 i 20 Eg• Jan i, 2003 ~ Weekly End Date:. )ui '~ S ; 2001 !Monthly Dividends Only -Get Prices' First {Prev {Next {Last PRICES Date 25-Jul-01 Open High Low Close Volume Adj Close* 37.30 38.15 37.20 38.10 1,385,600 9.07 `Close price adjusted for dividends and splits. ~~;r~~, First {Prev {Next {Last ~~Vlj°b~°~' Download To Spreadsheet ~`(~ j~-aj~~ia~j• A7 E~lE4tY STAGE 37, 20 ~ ~---~ QE LIFE. 7S, 3S : Z = 37. ~~ ~ 7q, b8 ~s~. 3~ of or D3 l~ Add to Portfolio 'Q' Set Alert G Email to a Friend Get Historical Prices for Another Symbol: ~~' GO- Symbol Lookup • Stock Screener • Mercers & Acq_ isiu tions • Splits Copyright ®2009 Yahool Inc. AN rights reserved. Privacy Policy -Terms of Service - Coovright/IP Policy -Send Feedback Quotes delayed, except where indicated otherwise. Delay times are 15 mins for NASDAQ, 20 mins for NYSE and Amex. See also delay times for other exchanges. Historical chart data and daily updates provided by Commodity Systems. Inc. (CSII. International historical chart data, dally updates, fund summary, fund pertormance, dividend data and Morningstar Index data provided by Morningstar. Inc.. Fundamental company data provided by Caoltal IO. Quotes and other information supplied by Independent providers Identified on the Yahoo! Finance Qartner pace. Quotes are updated automatically, but will be turned off after 25 minutes of Inactivity. Quotes are delayed at least 15 minutes. Real-Time continuous streaming quotes are available through our aremlum service. You may turn streaming quotes on or off. Ali information provided "as Is" for Informational purposes only, not Intended for trading purposes or advice. Neither Yahoo! nor any of independent providers is liable for any informational errors, Incompleteness, or delays, or for any actions taken In reliance on Information contained herein. By accessing the Yahoo! site, you agree not to redistribute the Information found therein. 12/31/09 10:40 AM http://finance.yahoo.com/q/hp?s=NCR&a=06&b=25&c=2001&d=06&e=25&f=2001&g=d Page 2 of 2 EXC: Historical Prices for EXELON CORPORATION -Yahoo! Finance {*~ Daily Start Date: ,Jul ~ :' 5 2001 ! Eg. )an 1, 2003 Weekly INTRODUCING End Date: ,Jul ? 2001 Monthly ! "'nhanced Dividends Only ' 4n~ln~ Get:Prices' ~'~~~~ First ~ Prev ~ Next ~ Last , ' ~ PRYCES `~ ! Date Open High Low Close Volume C ose• ~ `" ~~~~~ 25-Jul-01 53.70 59.10 53.00 59.10 9,384,400 22.41 '"'"""~- ' Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last JJ,,~~ f"i Download To Spreadsheet J 1 ~ ~~2.~0 - ~ - ~ D5 S b D .O ~ 5~~ , x ZDD• ~~ db.c ~ ~ ~ a ro. °° ~ ere- Tum h ~ r Imsstnq Mwo1-ea rick, Eo»gn InvaaUtwrta invgve greau,r tlaka titan U.B, yrvaehnaned Oomdar your a6jadrvst. Una horimn, and rick toM2nce eantulY. FWMq Brokvepe 3ervkxa, ~A9rtmer NYSE, 31PC fi5185e.1 k~ Add to Portfolio +~ Set Alert U Email to a Friend Get Historical Prices for Another Symbol: ~~- GO = Svmbol Lookuo • Stock Screener • Mercers & Acquisitions • flits Copyright ®2009 Yahoo! Inc. All rights reserved. Privacy Policy - lgrms of Service - CoovriahUlP Po{icv -Send Feedback Quotes delayed, except where indicated otherwise. Delay times are 15 mins for NASDAQ, 20 mins for NYSE and Amex. See also delay times for other exchanges. Historical chart data and dally updates provided by Commodity Systems. Inc. fCSI1. International historical chart data, dally updates, fund summary, fund performance, dividend data and Morningstar Index data provided by Morninastar, Inc.. Fundamental company data provided by Cao!tal IO. Quotes and other Informatlon supplied by independent providers Identified on the Yahoo! Finance partner gage. quotes are updated automatically, but will be turned off after 25 minutes of Inactivity. Quotes are delayed at least 15 minutes. Reai-Time continuous streaming quotes are available through our premium service. You may turn streaming quotes on or off. Ali information provided "as is" for Informational purposes only, not Intended for trading purposes or advice. Neither Yahoo! nor any of independent providers is liable for any Informational errors, incompleteness, or delays, or for any actions taken in reliance on Informatlon contained herein. By accessing the Yahoo! site, you agree not to redistribute the Information found therein. 12/18/09 9:19 AM http:/Jfinance.yahoo.com/q/hp?s=EXC&a=06&b=25&c=2001&d=06&e=25&f=2001&g=d Page 2 of 2 REV-1511 EX+ {10-06) SCI~IEDtiLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8t INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ,,.. FILE NUMBER ~ ` ~D 7 - 7p C o2aF; Hu,~E'i2 i ~. ~ S~Z, Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions w~4-v~ I' 1.. Name of Personal Representative(s) ~ u.~rfiL ~' • ~bt' be. r ~I^ Street Address City State Zip Year(s) Commission Paid: 2. Attorney fees Ctiwrles ~. StitGIdS~ ~ T ~/, pp 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 ~'Ct.Y1Qt,J~'f' ~ lo, ~ A' 1 MI °Lu'`4.A'l t ~*S bGl,1''~ ~6r rJ1~R'O IDy ~ ~aSO~ Ob a ¢~. 6. Tax Return Preparer's Fees ~. F,'1;,~ ~ w~~ Rca~sfer v~ Wills ~ I$; ao G'. F.ilC/P.l~'~c/1l/nisSiea DH ~Xt,~os1 Cs/yo ,S/D~k ~~ ~: ~3, t9b.79 ~. 17'~iR~C,rs Gd~tl~lliSSi oN os~ ilJc,Q (~r~ .~//in n,/~~ ~ s~ ~{ 3 ~f (Sct Coa~n%ss%on d~ af'~clr¢a/) TOTAL (Also enter on line 9, Recapitulation) $ ,>~ ',S 3 7• ,~ CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) January 8, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Hubert A. Corbe, Sr. No. 21-01-0706 Dear Register of Wills: TELEPHONE (?17) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Hubert A. Corbe, Sr. Estate as well as Check No. 392, in the amount of $S63.S6 for the Supplemental Inheritance Tax due and Check No. 393, in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures C7 c.:.a TJ G. r ,' r l ~1^-~ - ~` ' 7 ' ' ~ s E COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 012215 CORBE HUBERT A JR 1 10 SALEM CHURCH RD MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: X72-0~-9149 FILE NUMBER: 2101-0706 DECEDENT NAME: CORBE HUBERT A SR DATE OF PAYMENT: 01 / 1 1 /2010 POSTMARK DATE: 01 /08/2010 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2001 REMARKS: RECEIPT TO ATTY CHECK# 392 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $563.56 TOTAL AMOUNT PAID: INITIALS: CJ $563.56 GLENDA EARNER STRASBAUGH RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 _, ~ `:~~ ~N~ERITANCE TAX ~~'.:~ s +~ .~f A~~MENT OF ACCOUNT Pennsylvania ~ DEPARTMENT OF REVENUE REV-1607 IX AFP (12-09) DATE 02-08-2010 ESTATE OF CORBE HUBERT A DATE OF DEATH 07-25-2001 FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 Amount Remitted 2010 I: EB 16 PN i ~ 50 ~~~~'~ C?~P~-iA~f'S ~,)t1RT 4 , anal=iii ~t:~=.i() lY'~ , ~f~, CHARLES E SHIEL ~ III 6 CLOUSER RD MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (12-09) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:CORBE HUBERT A FILE NO.: 21 01-0706 ACN: 101 DATE: 02-08-2010 TAXSDUEATAPPLICATOONDOF ALLRPAYMENTS~,STHE CURRENTTBALANCEINANDE IFMAPPLICABLE,BALPROJECTED INTEREST FIGUREINCIPAL T DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 3,956.80 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) INTEREST/PEN PAID C-) DATE NUMBER 04-23-2002 CD001101 .00 08-28-2002 REFUND .00 01-08-2010 CD012215 .00 AMOUNT PAID 4,100.00 143.20- 563.56 TOTAL TAX PAYMENT 4,520.36 BALANCE OF TAX DUE 563.56CR .00 INTEREST AND PEN. TOTAL DUE ~ 563.56CR ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM i_~ FOR INSTRUCTIONS. ~ 1505610101 REV 1500 °` ~°'-'°' ~1 ~ OFFICIAL USE ONLY PA Department of Revenue perlnsylvania County Code Year File Number OFMRTNFNT OF REVENUE Bureau of Individual Taxes ~ ~ O IIIIIO 7 D PO Box z8o6oi INHERITANCE TAX RETURN Harrisburg. PA i~~z8-or~oi RESIDENT DECEDENT ENTER DECEDENT NUFFOR#RA110N BELOW S~oaal~Secxrrity Number q / Date of Deathc MMDDYYYY Decedent's Last Name Suffix oR. Date of Birth MMDDYYYY D poi ! 90 Decedent's First Name MI ~ u e T~r1TC"TTl'~ (ff Applkable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~m r~~~-r~r-rT~.~~~~_~~~~RR~T~~~R ~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL iN APPROPRIATE OVALS BELOW O 1. Original Retum ~ 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate b 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch.-0) CORRESPONDENT - TN18 $ECTIOR MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Narrre Daytime Telephone Number CHILL 5~! ! CDS ~!/ ~~7 76G~~To~ REGISTER OF WILLS USE ONLY ~,,~ r.~ c~ First line of address C ma=y ~j , ° ~ •'~ C'7 ~ '.7 Second line of address ~~ c~~ tD0 ',1 ~ ~.,~ . ,~ _) ~ r ~- FILED '~ ' City or Post Office State ZIP Code _ ;- ~ '"`. il dd ' ` C25~fC(~S 3 ®ComC a St• net' s e~rna a ress: fesponderrt Cor Under penaMies of perjury, 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 rbmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG R F P ES SIB F FILING RETURN DATE /3 / o AD Ess iHu IQT ~. CDlP . ~R., /~o Sulurl ChKr+cli Rd., /1lechan~~s iuNf, i4 70 0 SIGNARJBE OF I:REPAI3J;R OTHE)~TJ~dV.RE,6JR~SENTATIVE DATE .../ ~ C N ~R~ F. SNIFLDS ~', !o Clouser Rd., Mac-h~tn.cc L r~.~, ~ /'toss PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J REV 1500 EX oeoedent's Name: ~ ~ (RECAPITULATION 1505610105 N u.bert ~: , Sr. Decedent's Social Security Number 1. Real Estate (Schedule A) ..........................................~ ...: 1. i~ iri n `' ..' ~ O 2. Stocks and Bonds(Schedu~ B) ....................................... 2. ~ .Z 7 3.. Closely Held Corporation, Partnership or Sole-Proprietorship {Schedule C) ..... 3. d d 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ ,O 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-V'rvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 ttKOUgh 7) ............................. 8.F ~ Z. O ~{ 7 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. Q ~ 7 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~ d 11. Total Deductions (total Lines 9 and 10) .................:............... 11. y' Q ~ ~ 12. Net Valrie of Estate (Line 8 minus Line 11) .............................. 12. ~ ~ 13. Charitable and Govemmenta113equestslSec 9113 Trusts for which an electlon totax has not been made (Schedule J) ................ . ....... 13. ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~1 ~) / ~ 7 3 TAX CALCULATION -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 .Oj'Z 15. 16. Amount of line 14 taxable at lineal rate X .0 ~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14•taxable at collateral rate X .15 18. 19. TAXI)UE ..........................'..::...............•......::... 1.9. Z0. FILL.IN THE OVAL IF YOU ARE REWJESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~, ~ -~ O ~ - 7~b DECEnENrs NAME ChutrtL, o~' God Morns sTREETAI)pRESS -, SDI N. Nanode~' CITY ^ ~~ I S~ STATE Pg ZIP ' 7 O ~,3 Tax Payments and Credits: 1. Tax Due (Pegs 2, Line 19) 2. CrediL~Payrrrenls A. Prior Paymams B. Discount 0 3. Interest 4. ff Line 2 is greater than Lane 1 + Line 3, enter the difference. This is the OVERPAYMENT. FiN th oval on Page 2, Line 20 to request a refund. 5. M Line 1 + Line 3 is grater than Line 2, enter the difference. This is the TAX DUE. rt D (3) ~ _ ~ ~ Y. 3S (4) ~ (5) .3A 7 Q'S~ 7 Make check payable t+o: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer arid: Yes No a. retain the use or irx~orrre of the property transferred :.......................................................................................... ^ (~ b. retain the right to designath who shah use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefds or care? ......................................... ~........................... ^ 2. H death ooaxred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an 'in-mist for" or payable-uponjieath bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which bontains a benefiaary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY ~ THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. Fa dates of death on or after Juty 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 peroertt (72 P.S. §9116 {a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer tp a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return are still appticaae even if the surviving spouse is the only benefiaary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent (72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Coedits (A + l3) (2) ~ ~ ~~ ~ t 31 ~p,~f ~ I ~ a s?j.~ ~ ~I~sD° ~. ~©. ~ .~ fD ~oD3 " 3 b5 ,,, t 3t , 35 a. s.-- i f ~.Z0p3 ~ ~ 3~ ~ D 5 ~~# ~ s~~i~$gss5` say 3~5 #'~ --- p3 r 3~~ 00 -, to ~ ~ ~4- Bag t ~ Sit-~ ~=-~-~~ s . # !~ 5~~ 3b,S ~ a.~a - f p. 353 ~a s?~. ~ _ ~ as. s~qs '` ~~- ~ ~ -1 3 ~ ¢` ~; ~g3~--- Y --_ ! po5 2 i ,~ p , ~# ~.---- __--- 3lr,S ~ 1 j ~ poD 1!, 0.~3~ 3 ~ a ~, ~-- ,~ ,---- _--- P~ ~~~~ .-_- C,;~~~ b • ~ ¢ ~ ~ S0• bq~~- ?~ ~ 3 go.l~q _- a. yQ37 ~ % --~ ~- 3~5 ~° _ 3 °~ ~ ~ a. 3 5 a 3._--~- p00 ~ ~ 2g. SSQ.._-- ~3~,a3 v _ ~a _ ~ p ~' D~ ~~° ~ . $ ~ .lob a~ i 1 1 ~. ld5• off.------"_ ~~ ~.ss __---- ~d p~..,..._----- I p 3 5'f ~~ ~.,©o ~a~.sg ~pp~ ao 5.5 3~--~ a,oo g ~ ag ,sq ~-- ^~,.0 0 (~3~b5 ,~.-- ~-""~ ~ -...- ^i-~ REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~CNEpVLE B STOCKS & BONDS ESTATE OF CG /'bC, ~k ~tt ~,, ~r FILE NUMBER ~, / _~ / _,~ All property Jo1nNy-owned with -right of survivorship must be dfedosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ OF DEATH t ' ~~ ~~S 3~it/+C6 ~ YG'/ ZO/1 C0N/Al0/1 S/r~c~G i~~:j7i,cw /eat ~3o are, =~Sa:/S ~StL I'~l~rt~i%d S`ltaf Lr~.tc`ieq~ S~iot~r/irts ~~:S~ricetl dar4) d ~ i i i '~~ i ~62,0'f3.7S TOTAL (Also enter on line 2, Recapitulation) S 6 ~, DY 3, 73' (If more space is needed. insert ad~itiorrel sheets d Nre same sae) w. a VZ: Historical Prices for Verizon Communications Inc. Com -Yahoo! Finance New User? Register ~ Sign In ~ Help Trending: Prince Yahoo! Mail Search Web Search Dow '~' 1.96% Nasdaq 't' 2.06% HOME INVESTING NEWS 8~ OPINION PERSONAL FINANCE MY PORTFOl1OS TECH TICKER I I (SET QUOTES Finance Search 1Ner! Jul 7, 2(31, 2 1 PM EDT - U S Markets c Verizon Communications Inc. (VZ) At 1:58PM ED' i~ a i AN ,; Y, c*nMOC ua+arres uo , , Historical Prices Get Historical Prices for: ~~ r'^o ccr ns~ aeNe:F ADVERTISEMENT 7/7/10 2:14 PM lose in 1 hr ~47 m!ns 26.28 "~' 0.15 (0.57°l0} i , ~I I http://finance.yahoo.com/q/hp?s=VZba=06bb=25bc=2001bd=06be=25bf=2001bg=d ~ Page 1 of 2 .. .. , VZ: Historical Prices for Verizon Communications Inc. Com-- Yahoo! Finance t Daily Start Date:. )tri ~~$ 25 M 2001 . 2010an 1, Weekly End Date: ~ Wt ~ , 25 2001 Monthly t ~ Dividends Only Cet t~riees ` First ~ Previous ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close* Jul 25, 2001 .54.45 56.00 54.30 55.83 3,948,600 35.87 * Close price a usted for dividends and splits. ,I~ First ~ Previous ~ Next ~ Last ! Download to Spreadsheet fi 3(,. DO ~~'~f. 30 ~ /Io. 30 ~ ~ X55, is HAW ~~i ~~ ~~~ YV~Irireeli f UlIeK! f~loe~t tit 1~ fat rich ~~22. T#~e any he tmad iMt'~ MM011[ 10r hiifn il~e dtit~. He h~ tgKf fll[IG11 I1kWflBy fit? iifrtl~e~ti. But if you ir+i~l+e iiiras it~n 51 t dears. And a i~ d ~. 1~fU (l1Sy ire (~.triyli1~~ rlry~eww n i~eiiti~f8d 'i!e qet tt~h. 7/7/10 2:14 PM Copyright ®2010 Yahoo! Inc. Ail rights reserved. Privacy Policy - about Our Ads -Terms of Senrice - Coovright/IP Policy - n F Quotes delayed, except where indicated otherwise. Delay times are 15 minx for NASDAQ, NYSE and Amex. See also delay times for other exchanges. Quotes and other information supplied by independent providers identified on the Yahoos Finance partner oage.Quotes are updated autorn tically, but will be turned off after 25 minutes of inactivity. Quotes are delayed at least 15 minutes. Alf information provided "as is" for informational purposes o ly, not intended for trading purposes or advice. Neither Yahoo! nor arty of independent providers is liable for any informational ercors, incompleteness, or dela , or for any actions taken in reliance on information contained herein. By accessing the Yahoo! site, you agree not to redistribute the information found therein. Fundamental company data provided by i I I .Historical chart data and daily updates provided by Commodity Systems. Inca. (~SI). International historical chart data, daily updates, fund summary, fund performance, dividend data and Momingstar Index data provided by Momingstar. Inc. http:J/finance.yahoo.com/q/hp?s=VZ&a=066b=25&c~2001&d~066e=25&f=2001bged ', Page 2 of 2 • REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Carbe, Hu6~,~-f' A.., Sr ~1-01- 70~ Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: I B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Nam f P e o ersonal Re resentative s r Jr P A'. kilt ~-Lor.lw.r'~ C.e ~ () f 00 ~ 0. ~ ~ ~ Q Social Security Number(s)/EIN Number of Personal Representative(s) Street A ddress ~~ City State Zip Year(s) C om m fission Paid: 2. / ~ " Attorney Fees Ch~A" IGb r~ ~h~e.I~IS ~ II f°?i c~8o,p0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) I Claimant I~ Street Address ~I City State Zip I Relationship of Claimant to Decedent 4. Probate Fees I 5. Accountant's Fees ' G+~e~a~o~l~' ~ 4, . o f Il~tel~pm ~ c s 6« r,, G~ h: wl f~~a• ~ II 6. Tax Return Pre rer's Fees t r ~ T~ t ~~~ P~ 4) / ~' ~e ~f M~ ~ p ~fS~, o0 a. ,add;~~~,~~ p,~~,~ ~«, ~t S~ ~~ o~y s~-.~ ~ 5~~~.~. ! F 3S, oa fie: ~n 6~+-sc.~n f ~b' C!'t~s. ~; ~~i, e~.rs r~ ~ s~b~t crrt• ~' ~ ~ yr, 00 fie, ~~ .. ,~ ~ '~ ~ ~, ao See Cohfia, 5~lest) L, 1 TOTAL Also enter on line 9 Reca itulation ~ p 1 7 ~O. ~~ ,9 (If more space is needed, insert additional sheets of the same size) S • ~.ST. of C'pR~~ Nu.8Ei2T i4..~ SR ~/GF fit!©. 2/-~I -7ob .. .• - -r . • - n_ .. i_ c-L - ! fig c~c REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpVLE J BENEFICIARIES ESTATE OF FILE NUMBER Co r bt, I-(ubu~ /1,,, Sr. call-o! - lob RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustes(a) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1,2)] 1. j-{ utiath~ A.. Gorbc' ~ Tr ~~ Ito $alcr+~ Church Rd ~jn 3 Mec..hcut;itcsbu•~, P~ !'loso ~. f~,oloort' C~r~ son y,3 L~.ne DSO ~a~ r d 0.rJi Nara s, 6~ 3oS82 yo~ 3 ~ Grad S~bner d awJhfi~r y3 (~ '17eWali' fir, dvl~eytatl~csbult~, Ph ~7os'n ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON RE -1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I . CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I i i 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ i~ (If more space is needed, insert additional sheets of the same size) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG> PA 17055 GEORGE M. HOUCK TELEPHONE (717) 766-0209 (1912-1991) FAX (717) 795-7473 August 16, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Hubert A. Corby, Sr. No. 21-O1-00706 Dear Register of Wills: Please find enclosed for filing 2 copies of the Inheritance Tax Return for the I-~ubert A. Corby, Sr. Estate as well as Check No. 478, in the amount of $3,795.79 for the Supplemental Inheritance Tax due and Check No. 475, in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law ~ o .. ~~ ~ a- r ^:3 CES/dab ~ ~~ ~~, , ., °, Enclosures ,~: ~ ~ ~ f ~ ` :,, III, _~ c-~ c . ~.; _. ~ N ', a ~. ~.•? ... i t~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEFT. 280801 HARRISBURG, PA 17128-0601 RECEIVED FROM: REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. C[~ 013226 CORBE HUBERT A JR 110 SALEM CHURCH RD MECHANICSBURG, PA 17050 ESTATE INFORMATION: sSN: 172-0~-9149 FILE NUMBER: 2101-0706 DECEDENT NAME: CORBE HUBERT A SR DATE OF PAYMENT: 08/18/2010 POSTMARK DATE: 0$/17/2010 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2001 ACN ASSESSMENT MOUNT CONTROL NUMBER GLENDA EARNER STRA~BAUGH REGISTER OF WILLS TOTAL AMOUNT F REMARKS: SEAL CHECK# 478 INITIALS: SAP RECEIVED BY: REGISTER OF WILLS ~n v o p ~ °~ ~ a N ~-~ ~ o J ~ ~ a ~ W ° ~o ~ ~ LWL m m ~ i ~ G ~ ~ N -~ •• AA co ~ N HAM . p~.~ ~ (~ 'SV~~- a~ N U ~c ~ ~ T. _ ^ ~~= Q = Z O .7 Q ~ ~ ~ ~ ~ 4 O W ~ ~ - LL MM ,/~ ~ ~ W Ldp N ' ~„ ~ ' to m ~ J .~- ~ a W ? ~ ~ Q N w CCU.-U w a ~ o _~~ .. cnocv O ~ ~ ~ w Z ~©_ ,a r ~ U cc,~ ;~ ,., ;, BUREAU OF INDIVIDUAL T~1lXE.S_ " INHERITANCE TAX DIVISION PO BOX 280601 ~~iµ•~~~t HARRISBURG PA 17128-0601 . ';~~. ;~~ INHERITANCE TAX '''' ~5.'TATEMENT OF ACCOUNT ., ; ~ _ •~ ~~ ~ o s~P ~ o ~ ~ ~ ~ s o o~p~v~s ~~u~j C HAR L E S E Sg~~~,~~j ~~, P~, 6 CLOUSER RD MECHANICSBURG PA 17055 Pennsylvania ~ DEPARTMENT QFREVENUE ' REV-1607 EX AFP (12-09) ! DATE 09-07-2010 ESTATE OF CORBE HUBERT A DATE OF DEATH 07-25-2001 FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-09~ *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:CORBE HUBERT A FILE N0.:21 01-0706 ACN: 101 DATE: 09-07-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY 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: 08-12-2002 PRINCIPAL TAX DUE: 3,956.80 PAYMENTS (TAX CREDITS?: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+~ INTEREST/PEN PAID C-) AMOUNT PAID 04-23-2002 CD001101 .00 4,100.00 08-28-2002 REFUND .00 143.20- 01-08-2010 CD012215 .00 563.5b 08-17-2010 CD013226 .00 3,795.79 TOTAL TAX PAYMENT ~ 8,316.15 BALANCE OF TAX DUES 4,359.35CR INTEREST AND PEN. ~ .00 TOTAL DUE 4,359.35CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE 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. -a~~-^ ~`"r °~`~~'" l~l(~I ~ OF INHERITANCE TAX i ~~ i~, A,~~R~z:$E'1~~, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES ~ ,~ - ~~; ~~DU~~T~ONS AND ASSESSMENT OF TAX INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 X01 U DEC - 3 A I l~ D C1_~~K CF CHARLES E SHIELDS 6 CLOUSER RD MECHANICSBURG PA 17055-9735 aaa Pennsylvania ° T ~ T DEPARTMENT OF REVENUE ' REV-1.547 EX AFP (12-09) DATE 11-29-2010 ESTATE OF CORBE HUBERT A DATE OF DEATH 07-25-2001 FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-28-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---)-_RETAIN_LOWER_PORTION-FOR-YOUR-RECORDS^ ~-- -- ------------------------ REV-1547 EX AFP t12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: CORBE HUBERT AFILE N0.:21 01-0706 ACN: 101 -__ ____ ---------- OR DATE: 11-29-2010 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .0 0 NOTE: To ensure proper (2) 62, 043.75 credit to your account, 2. Stocks and Bonds (Schedule B) submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 tax: payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .0 0 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) (7) .0 0 (8) 62, 043.75 8. Total Assets APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 4,9 0 0,54 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 C11) 4,900.54 11. Total Deductions 57, 143.21 12. Net Value of Tax Return (12) 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0 T x t t b S (14) 145, 072.13 14. a jec o u Net Value of Estate NOTE: If an assessment was issuedpreviouslY, 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. Amount of Line 14 at Spousal rate (15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 145. 07?.13 x 045 = 6,528.24 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 .0 0 19 Principal Tax Due (19)= 6,528.24 . rex rQ~nTrc~ PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 04-23-2002 CD001101 .00 4,100.00 08-28-2002 REFUND .00 143.20- 01-08-2010 CD012215 .00 563.56 08-17-2010 CD01322b 1,209.30- 3,795.79 TOTAL TAX PAYMENT 7,106.85 BALANCE OF TAX DUE 578.61CR INTEREST AND PEN. .00 TOTAL DUE 578.b1CR * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~'~"~ ~...!..iti.% Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: HUBERT A. CORBE, SR. Date of Death: 7/25/2001 File Number: 21-01-0706 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ Yes ~ No 2. If the answer is No, state wher. the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: CO v _-' :,. ;_.; =.,~ ,_ L~ ~'~'_ C`,! :_~ ~_ a. Did the personal representative file a final account with the Court? ....... Yes 0No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... ~ Yes ~ 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. Aunust 22, 2011 l ~ wJ Signature of Person Filing this Form Capacity: Personal Representative Counsel ~_ Charles E. Shields III ~~; -, ~,,, ~; cL _ .... L~ ~- ~-- r~.:1- C~ Form RW-10 rev. 10.13.06 Name ojPerson Filing this Form 6 Clouser Road Address Mechanicsburg, PA 17055 (717)766-0209 Telephone C- f"' BUREAU OF INDIVIDUAL TAXES r INHERITANCE TAX DIVISION _ ~:~,~~ I TA N C E TAX PD Box z8o6o1 STAT~hNT OF ACCOUNT HARRISBURG PA 17128-0601 ,~ CHARLES E SHIEL~~ ~( ~ ~-~l!~;'}~T 6 CLOUSER RD ~r' MECHANICSBURG PA 17055 Pennsylvania ~_ ;~~ DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) - DATE 08-15-2011 ESTATE OF CORBE DATE OF DEATH 07-25-2001 HUBERT q FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 11002793 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE NOTE: To ensure proper credit to CARLISLE PA 17013 your account, submit the upper portion of this form with CUT ALONG THIS LINE your tax ...................................RETAIN LOWS R~ ~OR~ IONS FOR-YOUR...............~ .............avment. **~ REV-1607 EX AFP C12-10) INHERITANCE TAX STATEMENT OFRECORDS ACCOUNT *** ~••....^ ESTATE OF:CORBE THIS STATEMENT PROVIDES CURRENT SFTATBUSROF THEE TFATED ACN•IN2THEONAMEDO STATE. B ACN: 11002793 DATE: 08-15-2011 TAX DUE, gppLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, ELOW IS A SUMMARY OF THE PRINCIPAL A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-09-2011 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DATE NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) 08-17-2010 CD013226 08-09-2011 REFUND •00 .00 AMOUNT PAID 578.61 578.61- TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. .00 00 .00 .00 TOTAL DUE I ~- * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FDR CALCULATION OF ADDITIONAL INTEREST. •O 0 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~P BUREAU OF INDIVIDUAL TAXES'-' r ~~{;, INHERITANCE TAX DIVISION ~~--.!i ~ n E R I TA N C E TAX Po Box zaB6o1 _ S`,TAffEMENT OF HARRISBURG PA 17128-0601 ~ ~' ~ A C C O U N T ~, - CHARLES E SHI~E~`$, "'~' ~~~~~~ 6 CLOUSER RD ~N' MECHANICSBURG PA 17055-9735 Pennsylvania -; DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) ~- -- DATE 08-15-2011 ESTATE OF CORBE DATE OF DEATH 07-25-2001 HUBERT FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: A REGISTER OF= WILLS 1 COURTHOUSE SQUARE NOTE: To ensure Proper credit to CARLISLE PA 17013 your account, submit the u CUT ALONG THIS LINE Peer portion of this form with REV-1607 EX AFP C12-10) LOWER PORTION FOR YOUR RECORDS ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ :~~~~R STAIN ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~:~ ~~~~~~~~taX Payment. *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ............. ESTATE OF:CORBE HUBERT A FILE NO.: 21 01-0706 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE CBELOWOIS A SUMMARY TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, DATE: 08-15-2011 A PROJECTED INTEREST FIGUREINCIPAL DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-22-2010 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 6'528'24 PAYMENT RECEIPT DATE NUMBER DISCOUNT (+) INTEREST/PEN 04-23-2002 PAID (-) AMOUNT PAID CD001101 08-28-2002 REFUND •00 4,100 00 01-08-2010 CD012215 •00 . 143 20- 08-17-2010 CD013226 '00 . 563 56 1,209.30- . 3,217.18 TOTAL TAX PAYMENT 6,528.24 BALANCE OF TAX DUE .00 INTEREST AND PEN, .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. •00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS F FOR INSTRUCTIONS. ORM ~P BUREAU OF INDIVIDUAL TAXES r ,Y INHERITANCE TAX DIVISION - -~~~I~ ~ I TA N C E TAX Po Box zBO6oI STAT~h(~'NT OF HARRISBURG PA I~I26-6661 ACC 0 U N T i~ F~I,~ ~ ~<<f;r ~ ~ CHARLES E SHIEL~S ~''` ~' l ~LF''r 6 CLOUSER RD ~ ~~~ MECHANICSBURG PA 17055 Pennsylvania' DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) -------- DATE 08-15-2011 ESTATE OF CORBE DATE OF DEATH 07-25-2001 HUBERT q FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 11002793 Amount Remitted MAKE CHECK PAYI~BLE AND REMIT PAYMENT T0: REGISTER OIF WILLS 1 COURTHOU:iE SQUARE NOTE: To ensure proper credit to CARLISLE f'A 17013 your account, submit the u CUT ALONG THIS LINE PPer portion of this form with ...............................~:.....RE~A~N LOWER~POR~ION~FOR~ ~O~R........................tax payment. **~ REV-1607 EX AFP C12-10) INHERITANCE TAX STATEMENT OFREGDRDS ACCOUNT *** '~~~~~•.....^ ESTATE OF:CORBE THIS STATEMENT PROVIDES CURRENT SfTATBUSROF THEE qI ED q O • IN2THEONA E DO STATE. tax DuE, ACN,; 11002793 DATE: 08-15-2011 APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, BELOW IS A SUMMARY OF THE PRINCIPAL AND, IF APPLICABLE, ~~ PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: OS-09-2011 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): .00 PAYMENT RECEIPT DATE NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-17-2010 CD013226 08-09-2011 REFUND •00 5i'8.61 .00 578.61- TOTAL TAX PAYMIENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE I * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. •00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVER:iE SIDE OF THIS FORM FOR INSTRUCTIONS. aP BUREAU OF INDIVIDUAL TAXES' ~ "" INHERITANCE TAX DIVISION ~:.i[.i H E R I TA N C E TAX PO BOX 280601 HARRISBURG PA 171zs-o6o1 -- - - S,TAff E M E N T O F A C C O U N T u ~ ~ f r: a ' i c~~ ~~ ~r v' s ~ r °~,'~ J ~~ r ~ CHARLES E SHI~~~~$ ' ~ ~C~I 6 CLOUSER RD ~` fir, MECHANICSBURG PA 17055-9735 Pennsylvania DEPARTMENT OF REVENUE , REV-1607 EX AFP (12-10) ~~ DATE 08-15-2011 ESTATE OF CORBE DATE OF DEATH 07-25-2001 HUBERT q FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYI~BLE AND REMIT PAYMENT T0: REGISTER 01= WILLS 1 COURTHOU;;E SQUARE NOTE: To ensure proper credit to CARLISLE F'q your account, submit the u 17013 CUT ALONG THIS LINE PPer portion of this form with RETAIN LOWER ppRTION FOR YOUR pavment. R E V 160 7 SEX A FP ......^...........^..^.....^..^ ............................^.......^ ~ your tax C12-10} *** INHERITANCE T RECORDS AX STATEMENT OF ACI}OUNT **°"""~~~~^.......... ESTATE OF:CORBE 21 01-0706 ACN: 101 THIS STATEMENT PROVIDES CURRENT STIATBUSROF THE A TAI ED q O•IN THE NAMED TAX DUE, APPLICATION DF ALL PAYMENTS, THE CURRENT BALANCE, DATE: O$- ESTATE. BELOW IS A SUMMARY OF THE PR5 NC PAL AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-22-2010 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS}: 6,528.24 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+} INTEREST/PEN 04-23-2002 CD001101 PAID C-} AMOUNT P,4ID 08-28-2002 REFUND '00 ~_ O1-OS-2010 CD012215 .00 4,100.00 08-17-2010 CD013226 •00 143.20- 1,209.30- 563.56 3,21;x.18 TOTAL 7AX PAYMENT 6,528.24 BALANCE OF TAX :DUE .00 INTEREST AND PEN. .00 TOTAL DUE I * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A •OO FOR INSTRUCTIONS. ~~CREDIT" CCR), YOU MAy BE DUE A REFUND. SEE REVERSE= SIDE OF THIS FORM ~P COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CORBE HUBERT A JR 1 10 SALEM CHURCH RD MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: Ssty: 172-01-914s FILE NUMBER: 2101-0706 DECEDENT NAME: CORBE HUBERT A SR DATE OF PAYMENT: 06/15/2012 POSTMARK DATE: 06/14/2012 couNTY: CUMBERLAND DATE OF DEATH: 07/25/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 53,908.77 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY CHECK#585 SEAL INITIALS: CJ 53,908.77 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX111-96) NO. CD 016126 REGISTER OF WILLS J 1505610101 REV-1500 ex ~°,_1°~ !~' PA Department of Revenue Bureau of Individual Taxes PO BOX 28o6oi Harrisburg, PA i'ji28-o6oi Pennsylvania DERApTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth MMDDY r ` Y D ~ ° l~ 9~0. ~. Decedent's First Name MI u 4_ y ~- Spouse's First Name MI n I"-~' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~~- REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate p 4a. Future Interest Compromise (date of prior to 12-13-82) O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0 Name : Daytime Telephone Number CN GFS H i ~ /i/ i ~~ !, 6 0 09 First line of address t ~6yC~D us o ~ ~ ~. ~ _ Second line of address REGISTER OF WILLS UJ~ONLY ~ `ICJ __ ~ C ~ '~ , ~~ ~ ~ ~ ~ L 4J i V T .J-.! - ~ FILED N i-- (-1'i • CJi =. ®__ Correspondent's a-mail address: CecS{'j ~ C ~a~s 3 ~ CO~rr~llSt. //p.~' Under penalties of perjury, 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~omplete. Declaration of preparer other than the personal representative is based on all information of which preparer has anv knowledaa cinni RETURN DATE Hwb~ert A: Cor6e, J~ //o S~.lBM C/~kral, ~/,, Mcell4nicsbll~ AR I"fos~ SIiG~ z SIGNATURE ~j P~EPA ER OT ER TH~I~PPRF~ NTATIVE v //~iJ . ~i~ _ ~ /Lf ~ !/~ .cam DATE ~./ i ~yiv / ~ ADDRESS Chi-1es E: Sh;GI~s tt (e C~oc~ser QZd., lnechanicsba--9, l~f} ~7vSs PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number A~. Corbe. Sr. l 7 2 0 1, 9/~ 9 Decedent's Name: H u ~Crt RECAPITULATION _ ~ ~ 1. - - - 1. Real Estate (Schedule A) ............................................. (>,0~.3~.as~ ...................... 2. , 2. Stocks and Bonds (Schedule B) ................ . 3 •~ O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 4. • ~ O 4. Mortgages and Notes Receivable (Schedule D) ........................... ; 5. • D O 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... • • • . O O 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6• , 7. Inter-Vivos Transfers & Miscellaneous Noon-PS paraterBilling Requested........ 7. ' ~ ~ (Schedule G) .......8. (oS~(o•aS 8. Total Gross Assets (total Lines 1 through 7) ...................... S / Cl 3 ............. 9. ~ 9 9. Funeral Expenses and Administrative Costs (Schedule H)...... ~,, 10. •~ ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. . ~3 9 ~ l - X1.3 11. 11. Total Deductions (total Lines 9 and 10) ................................. / 7.. .................12. ~(p S ~ T 12. Net Value of Estate (Line 8 minus Line 11) ............. ~O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. ' an election to tax has not been made (Schedule J) ....... 14 -~ 6 ~ ~ 7 • ~- Z ............. 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or s ` transfers under Sec. 9116 ~ ~ 15. (a)(1.2) X .0_ 16. Amount of Line 14 taxable ~ ~ 5 ~ i / B Z 16. ~ S. ~ ~O ' 31 ~ 2 at lineal rate X .0 ~ `f 17. Amount of Line 14 taxable Q Q 17, ~ ~'"~ at sibling rate X .12 r .":`, k~ '~ ~~ •~ 18. Amount of Line 14 taxable • D o 18 ^ D` d at collateral rate X .15 ' 3Z .. 19 19. TAX DUE ....................................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610105 Side 2 1505610105 O File Number .Z+/ ~ ~ ~ ~ ~~~ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME STREET ADDRESS cHuRe~y Goy tlomE _-__ --_-__ --_-- o~ - __ __ ----- _ _. - ---- -- -~? STATE ~P ciTY-_-- ----- C~4R-~ ISLE P~' /7 0/3 Tax Payments and Credits: (1) a~ S-~6, 3 Z 1. Tax Due (Page 2, Line 19) 2. CreditslPayments p A. Prior Payments ------- B. Discount _-__-- ~ --- Total Credits (A + B) (2) ~ 3. Interest (3) ~ ~ 3 6 aZ. ~{S 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) ~ Fill in oval on Page 2, Line 20 to request a refund. 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Make check payable to: REGISTER OF WILLS, AGENT. ~ _ , T._ .- ,~ .~; rCi ~'s~,. its,,. r ~' y,' !" _ w~'.4k .. .. ,.... .. , ._ ,1' ~ `q~, ~- '"~wF} -;. max.. _-? -.; ..,1 -~Y' vr" .5._...'!i,.. t y PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the propefij transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "intrust 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? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN., ~ .. ,,r -~ v , ;,. For dates of death on or after July 1,19947, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. a does not exam t aetransfeeto ansuhrviv ng spouse from tax, and the statutory requ cements for disclosure of assets and [72 P.S. §9116 (a) (1.1) (u)]. The statut P 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 21 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 percent [72 P.S. §9116(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 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF / FILE NUMBER ~/ `D,_ 70~ L.DI~3F Hu/3E72T A~. , SR. eu mm~nrty fointN-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert addroonai sneers or me same ~~cC1 Did you know? Most shareholders can manage their holdings online vaith free access to Computershare's Investor Centre`"' website. Use this simple tool to quickly and easily update account information, sign up for electronic delivery of documents and more. Enroll FREE today at vrww.computershare.cam/investor. CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG PA 17055 March 14, -2012 Company: Registration: Holder Account Number: Document I.D.: Our Reference: Dear Sir/Madam: AT&T INC. HUBERT A CORBE 00002752727 12065WF00205132 AlT/0002834490/7/sd/66651 ~omputershare Computershare Investor Services 250 Royali Street Canton Massachusetts 02021 www.com putershare.com Thank you for contacting Computershare, the transfer agent for AT&T Inc. We appreciate the opportunity to be of service to you. Our records indicate we are presently maintaining a.zero share balance for this account. The account has maintained a zero balance since the shares were transferred on August 30, 2011. The shares were then sold from the Estate account, 01002460731, on September 6, 2011. The original account had a balance of 1,426.06 shares on July 25, 2001. The shares closed at $43.38 per share on that date. If you have any further questions, please visit our website at www computershare.com/att or you may contact us by phone at 800-351-7221. We offer an automated telephone service to assist you at any time, or you may reach a representative during regular business days, 8:30 a.m. to 8 p.m. Eastern Time. Please note that any available representative can assist you. Sincerely, Service Representative Enclosure: None T Historical Prices I AT&T Inc. Stock -Yahoo! Finance New User? Register Sign In fie'p 3/26/12 11:56 AM Make Y! My Homepage Ma~~ My Y' Yst*ao! Search ~~Search WebJ ~ HOME I FNVESTING I NEWS I PERSONAL FINANCE I MY PORTFOLIOS ~ EXCLUSIVES I FANTAS'l FINANCE ..-......__._____-._ f E-- - Get Quotes Mon. Maf 28, 2012. 11 56AM EDT U.S. Markets Gose ut 4 rs mins _.l__..____.__.___._.__._..__~___._________ __ __.._._____.__.---__~..___._____ Dow ?'0.96°/. Nasdaq 'l1.24% i k . 5~5 ~F12EE T ~..__..._.__---._.___.._.___., ,_..._____. i AT&T InCQ. (T) -NYSE ( Add to Portfoilo ~ Like ~ 373; 31 . ~ V ? ~.26 ~~.82%~ 71:56AM EDT -Nasdaq Real Time Price Historical Prices Get Historical Prices tor. ~~~ ^c Set Date Range Daily Start Date: tttf" 25 ~ 2001- ; Eg. Jan t, 2010 Weekly End Date: 25 I 2001 i~Monthly ~D'nridends Only Prices Date Open High Low Close Jul 25, 2001 42.00 43.49 41.40 43.38 price adjust for dividends and spl'ds.~/ EDoWnload to Spreadsheet Currency in USD. First ~ Previous ~ Next ~ Last ~~ Volume Adj Close' 10,195,000 25.57 First ~ Previous ~ Next j Last http://finance.yahoo.com/q/hp?s=T&a=06&b=25&c=2001&d=06&e=25&f=2001&g=d Page 1 of 2 T Historical Prices ~ AT&T Inc. Stock -Yahoo! Finance Copyright ®2(!12 Vahoo! Inc. All rights reserved. prh;aCy FoLry - ~C,rvvt f>ur %.ds -'erms a Sr~rviG~. - ^oGyrghc~lY Fcli;;}• - send ~ E,edtacx - Yah00! -ABC News Network 3/26/ 12 11:56 AM Quotes for NYSE, Nasdaq and MYSEAmex are Real-time and sourced from Nasdaq Lest Sale when available. If not available from NLS, quotes will appear delayed from primary listing source. See also delay times for o<ner exchanges. Quotes and other information supplied by independent providers identified on the Yahoo! Finance parirer page.Quotes are updated automatically, but will be turned off after 25 minutes of inadivity. quotes are delayed at least 15 minutes. All inforatron provided "as is" for infornafanal purposes only, not intended for trading purposes or advice. Neither Yahoo! nor any of independent providers is liable for any infommtional errors, incompleteness, or delays, or for any actions taken in reliance on information contained herein. By accessing the Yahoo! site, you agree not to redistribute the information found therein. Fundamental company data provided by Capital iQ. Historical chart data and daily updates provided by .ommedi?y Systems, Inc. (CSq. In[emational historical chart data, daffy updates, fund summary, fund performance, dividend data and Morningstar Index data provided by tAor.?ir?gsta*; 4r?; . http://finance.yahoo.corn/q/hp?s=T&a=06&b=25&c=2001&d=06&e=25&f=2001&g=d Page 2 of 2 REV-1511 EX+(10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF L'o,~BE, ~/u~F~e r ~,, S,P t~bts of decedent must be reported on Schedule L ITEM A. I FUNERAL EXPENSES: 1. FILE NUMBER al- o/- 7010 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions , t Name of Personal Representative(s) Na b~r~ // . L 'e r h e,~.J"r ~I ~, & ~~,, 09 " ~ ~ n Street Address ((O SOaP.T1~l CR'1K1^!~~ 7~o[tc~ City Me~han~t Sbtnr+q State P~ Zip h e s'a Year(s) Commission Paid: 2• AttomeyFees C~l[1'IC.S ~ oShtG/q5 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 Cron NoJTMrcn, 6reU~-4wa~f FCo,~ CPAS~ `J/]~~ttA'LiGS-- ~ Gtr, PA /~,- I o'fl, P~SFI SwpplG-,,ar-~zils ,Z,Sn•~ 6. Tax Return Preparer's Fees 7• g dd; ,y'o~a/ arc6af >~es Baer /995 app/.'eR,~/e Se~edu /~ ~35.oa ~. ~./i/t~ Fee /v Re~;sfer ~ wil/s ~l/~~ DO 9. ~t~Mbt~rsement ~ ~-ha,-Ics ~, 5~~elds ~ -fit- ~ostdge, ` C(',r~' ~ fed ma, ~ 1 ~ n~, p I,o~. Co ~; a s, ~~~. ~ ~/`/. Z S TOTAL (Also enter on line 9, Recapitulation) $ 3 q,5'~/, Lf` j (If more space is needed, insert additional sheets of the same size) REV-1513 EX.It-97) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C~•e,8~ ~{llL3F,rzT ~ ~ ~S.t? NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. N c.c bert !~. Co rbc ~~O SQ ~C/y! Ch urcLj ~~ ~'lechar~,"c sbur~, .~~1 : ~o,s-O ~. ~odcrf C'orbe S~SD L~t~oi c%r ry La he yoan_q Na rte: s, G.¢ 30 5'gZ .~ Grace ~5~nner 6 De L1J4 i t 1`7 r: Mec.hQ,~; c sbur~, pff 17050 FILE NUMBER Z/-Ol- 7010 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE So Yt ~~ ~ a u~ h t'G•.. y3 y3 y3 ~ 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 15 (tf more space Is needed, insert additional sheets of the same size) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) June 13, 2012 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Hubert A. Corbe, Sr. No. 21-01-00706 Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Hubert A. Corbe, Sr. Estate as well as Check No.583 in the amount of $15.00 for the filing fee, Check No. 584 in the amount of $35.00 for additional probate and Check No. 585 in the amount of $3,908.77 for the Supplemental Inheritance Tax due. Thank. you for your kind attention to this matter. Very truly yours, ~ ~~~~ Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures 7'' ' Yi l~ `C~ a i~ ~ r,., .i ' ~ ~~ r r r~ . ~ C7 C -~;; -f-i c_ J~ 1'~,) ~~- !'1~-1 ~~ `~ ~n v - ° ~i .- N a W . ~ oo Q N ~ a~ ~ ~ W ° o ~ ~ W ~ LL ~ m' r ~ ~ N O o Zcom- , C ~ L ~ U N = T d Q ~ ~ J } ~ N H ~ W W ti ~ ~ ~ ~ ~ ~ V M = fn Z ' - Q W ~ N Q ~ ~ 1- o U +'~ o ~ ~ J ~ ~ ~ r -~ O o W Z N N .: r U O ~* ~' cc a v ~/1 ~/ / 1~ (~ ~ ~ ~ ~ = ~ ~ ~ zN _ ~~~ ~ ~ ~ Q Z ~ ~; OQOa ~ ~ W J H J o H ~^ v + ~W~N = Q CA [p ~ J a J ~ = ~ w ~V'-V= ~ _ wo =aim .. o W cno~v O w ~ u- Wc nz J ~ Q Q. W U U co ~ ~ m u~ ~_ C o ~ ~ ~ o `- o o . ~ ~~ a ~- W U W Z w I_- 0 w_ LL H W U ~~ ~ o . o BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 CHARLES E SHIELDS 6 CLOUSER RD MECHANICSBURG ~ ,,,_ ~RJl~ TAX Pennsylvania DEPARTMENT OF REVENUE ;~ `_ ~~ ' ~1~t~C~T F~+ A !I+A C C O U N T REV-1607 EX AFP (12-11) 4 ~ 2~~1 JUL ~3 P~} «: 4 -2012 2 ESTATE OF CORBE HUBE RT A nr ~~`~ ~j Dr,Q~'3 ~V'(,~ r VtJ ~C~;rf,~;-[~ ~,0~ PA DATE OF DEATH FILE NUMBER COUNTY AcN 07-25-2001 21 01-0706 CUMBERLAND lol PA 17055-9735 Amount Remitted - ~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - - - - ~"')_ RE_TAIN LOWER PORTION FOR YOUR RECORDS _ E~ REV-1607 EX AFP C12-11) ~~* INHERITANCE TAX STATEMENT OF ACCOUNT ~** ESTATE OF:CORBE HUBERT A FILE N0.:21 01-0706 ACN: 101 DATE: 07-09-2012 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY 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: 11-22-2010 PRINCIPAL TAX DUE: 6,528.24 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) *** SUMMARY OF ALL 005 PAYMENTS *** 06-14-2012 1,209.30- 11,646.31 TOTAL TAX PAYMENT 10,437.01 BALANCE OF TAX DUE 3,908.77CR INTEREST AND PEN. .00 TOTAL DUE 3,908.77CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS. NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TaxES OF DEDUCTIONS AND ASSESSMENT OF TAX INHERITANCE TAX DIVISION - PO BOX 280601 HARRISBURG PA 17128-0601 flC~~~~~~ ~~~~~~ ~~ R~~I~T~~ ~F ~ ~~.~.5 Z0~3 Ff8 ~2 P~ ~2 ~ CHARLES E SHIELD~~~~~ ~~ b CLOUSER RD ~R~'~t~t~S' ~a(J~'~' MECHANICSBIg£~~1~5~e 97,5 ~ Pennsylvania DEPARTMENT OF REVENUE REV-1547 IX AFP C09-12) DATE 02-18-2013 ESTATE OF CORBE HUBERT A DATE OF DEATH 07-25-2001 FILE NUMBER 21 01-0706 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 04-19-2013 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE----- ~ --R_ETA_IN LOWER POR_TION_ REV-1547 EX AFP C12-11) NOTICE OF INHERITANCE TAX DISALLOWANCE OF DEDUCTIONS ESTATE OF: CORBE HUBERT AFILE N0.:21 FOR YOUR RECORDS ~- _ APPRAISEMENT, ALLOWANCE AND ASSESSMENT OF TAX 01-0706 ACN: 101 __________ OR DATE: 02-18-2013 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. 02 1. Real Estate (Schedule A) C1) •0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) C2) 60,536.25 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .0 0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) .0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E ) C5) .0 0 6. Jointly Owned Property (Schedule F) C6) .0 0 7. Transfers (Schedule G) C7) .0 0 s. Total Assets C8) b0 , 536 .25 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H ) C9) 3.9 5 1.4 3 10. Debts/Mortgage Liabilities/Liens tSchedule I) C10) .0 0 11. Total Deductions C11) 3, 951 .43 12. Net Value of Tax Return C12) 56,584.82 13. Charitable/Governmental Bequests; Non-elected 9113 Tru sts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax C14) 201 , 656.95 NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will reflect figures that include the total of all returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at lineal rate C16) 701 • 6S6 - 9S X 045 = 9, 074 . 5b 17. Amount of Line 14 at sibling rate (17) _0 0 X 12 = ~ .0 0 18. Amount of Line 14 taxable at collateral rate C18) .0 0 X 15 = .0 0 19. Principal Tax Due C19)= 9, 074.56 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID *** SUMMARY 0 ALL 05 PAYMENTS **~ 06-14-2012 2,501.49- 11,646.31 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 9,144.82 70.26CR .00 70.26CR * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.